By Majorie van Leijen
Published Saturday, January 14, 2012
It has been rumoured for a while now. Although nobody knows of when and how, mandatory health insurance for all residents of Dubai is on the lure.
In a survey conducted among 5,000 residents by Dubai Health Authority (DHA) in 2010, statistics showed that 75 per cent of Asian and Arab residents had no health insurance. Among the group existing of wage-earners with an average of Dh2,273 in salary a month, less than 23 per cent was covered by a health insurance.
Laila Al Jassmi, chief executive officer of the Health Policy and Strategy Sector at the DHA commented in an interview at that time that there is “quite a large percentage of people without health insurance” and that people need “at least a minimum coverage”.
Although medical care is relatively cheap in the UAE compared to European countries and the United States, baring the costs of certain medical treatment can prove to be burdening, and for some people even impossible.
However, selecting the right health insurance package that benefits you the most is not an easy task either. With 20 health insurance companies present in the UAE all reaching out to you, the customer, the medical jargon might be dazzling as you go through the many pages stating what you are committing to.
There is no perfect package, and there is no best health insurance company,
as health insurance totally depends on the needs and the budget of the customer. In order to list some tips that might prove helpful when deciding for a health insurance company, 'Emirates24|7' spoke to Ahad Khalid, who now works as a consultant in commercial insurance but has worked in the field of health insurance for years and to health insurance guru's Vala Setareh and Sunshine Gerodias of www.InsureMe.ae, an insurance comparison website aiding customers to choose the best-suited insurance deal.
Apart from emergency cases, which are treated free of charge in public hospitals in Dubai, having a health insurance does not mean that health care will be provided for free. A customer may choose to pay a high premium, which decreases the costs paid upon receiving health care. Or, when paying a low premium, the costs for certain medical treatment may prove to be high on the side of the customer.
These costs for the customer can be expressed as deductibles, excess or co-pay/co-insurance. When the insurance company mentions deductible costs, it refers to the amount agreed on for the customer to pay per visit to a health care provider. This amount can range between Dh25 to Dh5,000. Co-pay instead focuses on a percentage of the total cost of a treatment that is for the customer to pay.
It is important to consider whether you are willing to pay the amount expressed in deductibles, express or co-pay in order to lower your premium, or whether you opt for the more fully-covered plan, having to count on somewhat higher costs for the annual premium bill.
Select your health care provider Health insurance companies do not cover for treatment in every healthcare facility, or for purchase from every pharmacy. Companies have a network of selected healthcare providers and pharmacies, which you may want to view before deciding for a certain insurer. You may have a preference for certain healthcare providers, which in turn has an effect on the premium.
“Healthcare facilities operated and managed by international companies are usually more expensive than public hospitals,” explain the team of www.InsureMe.ae.
Subjected to deductibles, co-pay and limitations on certain medical care, a health insurance company will pay the full amount when the treatment is received by the healthcare provider within its network. In some cases the payment can be done by simply presenting the health insurance card, and no money exchange between the patient and the facility will be needed. On the other hand, when health care is received by a provider outside the network, the patient might have to pay up front, receive only a percentage of the bill by the insurer or not be reimbursed at all.
Diabetes, asthma, heart disease
Agreements can be impacted quite a lot when the customer is experiencing a chronic disease, as healthcare for such diseases is usually long-lasting and expensive. However, there is a big difference between a pre-existing condition and a condition that was discovered when already insured.
There are few companies that will provide coverage for a pre-existing or a chronic disease, according to www.InsureMe.ae, and they therefore advice to remain with the same health insurance company once a chronic disease is diagnosed.
When a chronic disease is diagnosed when already a customer, an insurance company will have to reconsider your plan and probably increase your premium, restrict the cover for chronic diseases, or do both. However,
chances are fair that the condition will be partly covered and you will remain to be a customer.
“Important is to be honest about your health situation” advises Ahad Khalid,
who now works as a consultant in commercial insurance but has worked in the field of health insurance for years. “Insurance fraud is low in the UAE,
probably because it is punished for harshly. I would not advise anyone into misleading an insurance company.”
Another condition that deserves special attention is the happier conceived maternity. Although this often comes more expected and welcomed, maternity care is one of the most expensive medical financial posts, as an average delivery only can reach up to 15 to 20 dirhams in the UAE, says Ahad.
Maternity does not only require delivery care, however. Think of pre care, after care and chances of complications during pregnancy, and you will soon discover that coverage by an insurer is not a luxury.
Being able to claim for maternity costs requires a waiting period. Depending on the company you decide to go for, this waiting period can lead up to a year, which is quite usual, according to the InsureMe consultants.
This means that when planning to be pregnant in the future, it is wise to start arranging maternity coverage now, which is mostly not included in a basic package. Furthermore, when already having an insurance plan, it is similarly important to upgrade this plan when expecting to be pregnant, even when the insurance is paid by your company.
Dental care is not cheap. This is partly caused by the fact that dentists charge very high bills for their services, explains Ahad. However, there are few people that have never visited the dentist or can be sure that they never will.
Coverage for dental care is often co-paid by the customer, with the exception of visits as a result of an accident, which are often fully covered. Furthermore, most insurers are more likely to provide coverage for routine treatments, examinations, and cleaning, simple fillings than for special or major dental treatment. "The latter care is often part of a higher plan, requiring a higher premium," explains the InsureMe team.
“It is not surprising that people do not regularly visit the dentist,” says Ahad as not many people are willing to pay for such care from their own pocket.”
Local versus international
According to the InsureMe team, there are quite a lot of benefits attached to the international health care provider that are not present with local providers, the latter referring to health insurers from the region and the UAE.
One of the most important obstacles that you may face with a local provider is that at renewal of your plan, it looks at your age, medical condition and claims history, meaning that your premium may increase or even be declined due to your individual medical record.
This is different with an international insurer, as it looks at your age,
gender and the medical claims history of its entire customer pool. "The probability that the insurer declines you or increases your premium substantially at renewal date can be lower as renewability will not be viewed on the basis of your individual claims history alone, "say the InsureMe team.”
Furthermore, international insurance companies are much more lenient when it comes to reimbursements of claims of medical treatment received outside the UAE.
If you buy a global cover then you can have elective treatment worldwide. An international insurance company will provide full medical reimbursement of claims made outside the UAE. However, local insurers will consider the UAE rate that would be charged in a similar case, and reimburse a percentage of this amount, depending on the plan.
At last, it should be emphasised that it is important to know what someone is insured for, says Ahad. “People often sign without knowing what they signed for, and when they want to claim for their medical treatment they get surprised by enormous bills.”
He adds that health insurance is relatively simple in the UAE, as the whole package is mostly explained in 10 pages instead of the sometimes 50 pages that US citizens are bound to read when choosing their health insurer.
However, people do have to be accurate in their reading, as sometimes claims are not reimbursed while it seems as if they are in the contract. “This is because companies have complicated policies when it comes to the claiming process,” he says.
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