Now in its 6th year of implementation, Dubai’s 2013 Health Insurance Law No (11) stipulates that it’s mandatory for employed residents to have medical insurance coverage. The employees’ sponsors (employers) are the ones responsible for the payment of basic health coverage.
It’s critical for residents to understand the benefits of their insurance packages, and learn reading the fine print. The mandatory medical insurance includes a Table of Benefits for the coverage, which contains a summary of what the health plan covers. It is the right of employees to fully understand the health plans the main policyholders (employers) have signed up on their behalf.
An insurance claim lawyer will be able to educate you on the full scope of your health coverage and ensure you have optimal use of your insurance. To ensure you have a clear idea of the insurance coverage, the hired professional will also inform you of the cost of personal contribution and sub-limits of cost.
Before you consult for a health insurance claim, here are some basic facts you need to be aware of regarding your health insurance:
As stipulated by law, health insurance is mandatory for all, which means every single resident has to be covered with medical insurance. Each health plan package has a specific range of coverage, referring to a list of health care services and health conditions that can be addressed.
The basic coverage is Essential Basic Package (EBP), which is the most affordable as it’s at Dh550 to Dh750 annually (minimum premium). This coverage includes maternity and dental cover, and General Physician consultation. The EBP also offers a maximum of Dh150,000 as annual insurance limit in the event of emergencies.
In addition, the package covers all pre-existing conditions 6 months after the date of purchase.
Networks are organizations that are in contract with health insurance companies to provide medical services to covered members for pre-negotiated rates. Network providers also referred to as in-network providers, organize diagnostic centers, pharmacies, and clinics where subscribed members can avail services.
As for out-of-network providers, they’re not contracted to provide services and are not covered by health insurance plans. On an insurance card, the network’s name is mentioned under ‘Insurance Provider (IP)’. A policyholder needs to check the list of available health care outlets in the annexure that’s provided by the health insurance company.
The Table of Benefits that’s provided by an insurance company will also include a list of family physicians, pharmacies, and diagnostic centers approved under EBP.
As mandated by law, an EBP network has adequate geographic coverage across Dubai and the rest of the UAE; however, you can check the list to see whether it includes clinics you prefer using for their reputation and/or location.
This is relevant to a new subscriber of an insurance package. If a plan member suffers from a medical condition e.g. hypertension, diabetes, or cancer, he/she must disclose the medical information to the insurance provider. As mentioned earlier, the ailment won’t be covered for the first 6 months after the insurance subscription.
If the plan member opts for another insurance plan or changes jobs, it won’t alter the parameters of the insurance policy in any way. All pre-existing conditions are treated under EBP.
Last Month Coverage
There are instances wherein insurance policyholders are denied coverage for the previous month e.g. medicine coverage for the month of January, even though the insurance coverage includes the specific month. Take note: this is NOT in accordance with the UAE law.
If a clinic or pharmacy denies you of a service covered by your health plan, that is illegal which means you can register a complaint. It is your right as an insurance policyholder to have health coverage until its expiry. If there’s a violation to this right, we suggest you consult with lawyers in Dubai. Reputable law firms like HHS lawyers in Dubai can provide you with an insurance claim lawyer to represent on your behalf, most especially when you can no longer fill out a form for an insurance claim and wait to be reimbursed quickly and fairly.
If you’ve filed a complaint on your own and the insurance provider denies your claim, you have the option to not accept the outcome. There are insurance companies that undervalue or wrongfully deny claims. Insurance lawyers in Dubai can represent you and file a lawsuit in order to get the benefits under your health insurance policy.