Earlier this summer, the Health Authority – Abu Dhabi (HAAD) announced changes to two of its main health insurance programs, the 'Thiqa' plan and the Abu Dhabi Basic Plan.
Changes to 'Thiqa'
The Thiqa plan for Emiratis has seen the following changes:
- Cardholders will receive 80% coverage of fees for treatment at private hospitals; they will continue to receive 100% coverage for treatment at Government hospitals;
- Cardholders will receive 50% coverage of fees for treatment 'abroad' (the term abroad refers to treatment outside the Emirate of Abu Dhabi and this includes other Emirates) unless the treatment is unavailable in Abu Dhabi in which case they will receive 100% coverage;
- Changes have also been made to coverage for 'non-essential' treatments such as orthodontic braces for adults and IVF treatment.
- All prescriptions from private healthcare facilities will only be dispensed at private pharmacies.
Abu Dhabi Basic Plan
The changes to the Abu Dhabi Basic Plan are more significant. The Abu Dhabi Basic Plan is the plan offered to expatriate workers, with a visa issued in Abu Dhabi and who earn AED5,000/month or less.
Workers on this plan over 40 years of age could now be required to pay 50% of their own premium if required to do so by their employer and all employees will be obliged to pay 50% of the premium for their dependants' coverage (wife and up to three children). The cost of insurance for other dependants, such as parents and fourth child, will also have to be fully borne by the individual. Childbirth costs will also now be charged according to a separate scheme.
Previously, the basic coverage was at an annual premium of AED 600, this has now increased to AED 800 for expatriate employees between the ages of 18 to 59, and AED 5,500 for employees at the age of 60 and above. Additionally, there is a mandatory maternity surcharge for married females between the ages of 18 to 50 of AED 750.
HAAD have announced that the changes for both plans came into effect on 1 July 2016, however the revised regulations that will underpin the changes are not yet publicly available.
Dubai's Essential Benefits Plan
The health insurance plan for Dubai is offered to holders of residence visas issued in Dubai, including free zones. Employees with a gross salary less than or equal to AED 4,000 may only obtain insurance from one of the participating insurers (7 insurance companies have been appointed as participating insurers). Workers with a gross salary above 4,000 AED per month may obtain insurance from participating insurers and non-participating Insurers holding a health insurance permit.
The renewal of an employee’s visa will be subject to the employee having health insurance in place. Employers have to provide a basic health coverage with an annual premium between AED 500 to AED 700 and a maximum insurance cover per person per annum of AED150,000.
The minimum level of coverage stipulated by the Dubai Health Authority (DHA) under the plan will cover in-patient treatment with the territorial limit of the Emirate of Dubai only (for example consultant's, surgeon's and anaesthetist's fees, childbirth or any pregnancy related complications), and out-patient treatment (for example, drugs prescribed by physician, physiotherapy sessions) and maternity; the cover extends to the wider UAE for emergency treatment only.
Employees have to pay the deductible or co-insurance amounts, which are specified below:
- Co-insurance of 20% applicable for all inpatient and outpatient treatments ( an out of pocket limit of AED 500 per encounter and an annual aggregate limit of AED 1,000 applies for inpatient and day treatment);
- Co-insurance of 30% applicable for pharmaceuticals or medications;
- Co-insurance of 10% applicable for all inpatient and outpatient maternity treatments;
- No co-insurance is applicable in case of preventive services, vaccines and immunization, parent and companion accommodation services; or
- Co-insurance of 20% is applicable for emergency treatments.