Basics of Health Insurance .pdf
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Basics of Health Insurance:
Different aspects of Health Insurance and why should you take it
The three most popular things that are insured after life are cars, homes and health. Cars
can and homes can be rebuilt and renovated but your health almost always in a state of
degeneration with age. So it is important to keep yourself insured at all times.
Dr. Haidar Al Yousuf, Director of Public Health Funding at DHA has stated that 75 per cent of
Dubai expatriates are now covered by insurance, thanks to the mandatory health insurance
“This means we have 25 per cent left to cover by June, we hope to have close to 100 per
cent of Dubai expatriates covered by the insurance by the end of next month," said Dr Al
Dubai Health Authority (DHA) will complete the implementation of Dubai’s Mandatory
Health Insurance Scheme ISAHD (Bringing Happiness), by the end of June, 2016. DHA is
currently in the third and final phase of implementing the scheme on companies with less
than 100 employees, including all spouses, dependents and domestic workers.
Typical benefits covered under a health insurance policy:
Maternity and newborn care
Mental health and substance use disorder, including behavioral health treatment
Rehabilitative and habilitative services and devices
Preventive and wellness services and chronic disease management
Types of Health Insurance Policy
Individual – covered by self or employer:
Health insurance that you purchase on your own or through your employer which
covers only the medical expenses related to your health is called an individual policy.
Such a policy covers an individual and their immediate family members including
spouse, children and/or dependent parents. The policy can have a fixed coverage for
each individual or a total coverage “floater”, which can be shared among all
Do you know what insurance premium is?
Premium is the amount the policy‐holder or their sponsor (e.g. an employer) pays to
the health insurance provider for providing coverage.
o Some of the popular health insurance providers in the UAE are:
Dubai National Insurance.. & many more
Some health insurance terminology
o Co‐payment: The policyholder has to pay a certain percentage of the overall
treatment cost. In the UAE, maternity benefits usually have 10% co‐payment,
whereas dental treatments typically have a 20% co‐insurance.
o Deductibles: Deductibles are fixed charges that policyholders have to pay out of
their own pockets when undergoing a treatment. Also known as co‐payment or
co‐insurance, there are a few types of deductibles:
Generally, there are three types of deductibles available to customers:
Annual Deductible or Excesses
With an annual deductible, the insurance company will not start paying for any
treatments until you have paid up to the deductible amount from your own
pocket. Let’s say your health insurance policy has an annual deductible of AED
1,000, and your overall medical expenses in the first six months amount to AED
1,500, then you are supposed to pay AED 1,000 while the insurance company
will cover the remaining AED 500. In addition, for the next six months, the health
insurance company will cover the cost for medical treatments while you pay
nothing. Annual deductibles are not very common in the UAE, of the
approximately 100 medical insurance plans on Bayzat.com, only a handful (such
as Bupa health insurance plans) have an annual excess.
Fixed Deductible per Visit
This type of deductible is very common in the UAE. Usually, the policyholder will
have to pay a fixed amount for each outpatient visit to the doctor. This can range
from AED 30 to AED 75 per visit. In the UAE, fixed deductibles typically only apply
to outpatient treatments, which refers to procedures or doctor visits where you
are not hospitalized overnight. With most medical insurance plans in Dubai and
Abu Dhabi, the insurer covers in‐patient costs (i.e. when you are hospitalized)
without applying a deductible.
Co‐Insurance or Co‐Payment
This is a form of cost‐sharing whereby out of the total amount paid for a medical
treatment, the policyholder pays a percentage of the cost. Of course, this can be
a risky type of medical insurance to purchase if you get very sick or require an
expensive procedure. Some health insurance plans might have a fixed deductible
per visit, combined with co‐payments for specific benefits. In Dubai, it is
common to see a 10% co‐payment for maternity benefits, and up to a 20% co‐
payment for dental benefits.
Know your exclusions
Exclusions are specific treatments or conditions that are not included in your
plan. Every health insurance plan in the UAE will come with exclusions. It is
important that you thoroughly review the plans beforehand in order to find out
what is covered and what is excluded under the policy. There are certain
ailments that are permanently excluded. When choosing a health insurance
plan, talk to an expert about specific medical conditions you want covered to
make sure they are not excluded.
o Pre existing disease :
Some of us mistake pre‐existing conditions as ‘an illness or condition that a
person might have at the time of buying a policy’.
Well, pre‐existing condition does not only refer to an illnesses that a person has
at the time of buying a policy but it also includes a thorough medical history of
any condition ranging from heart attacks, diabetes, past hospitalizations, any
surgeries, medications for any disease or illnesses like high blood pressure or
thyroid, skin disorders, major accidental injuries and any signs or symptoms such
as increase in sugar, or high blood pressure. The insurance company wants to
know about absolutely any disease, condition or injury you’ve had
Many insurance companies in the UAE now provide cover for pre‐existing
conditions, however, there are a few steps they take to mitigate their risk.
Some methods like Premium Loading , Waiting Period , Premium loading +
waiting period , Exclusion of Pre‐existing conditions ..etc will likely impact you if
you have an existing condition:
Tips to select a health insurance plan :
Choose your insurance company wisely
Plan according to your future needs
Make an informed decision about the type of health insurance
Think on amount of ‘sum assured’
Check the empanelled hospitals
Understand the premium calculation process
Read the fine print (clauses)
Check waiting Time