The Dubai Health Authority has finally released the full details of the basic health insurance coverage for residents of Dubai, which they have named the Essential Benefits Plan. While the price is obviously the main selling point, it will cost between AED 500 to AED 700, the coverage is actually minimal. With this plan, members can expect to pay a significant amount out of their own pocket when seeking treatment.
The annual limit on all claims, including the coinsurance paid by the member, is AED 150,000. While most people will not claim the full amount, there is a risk of exceeding it in case of emergencies (when you actually need your health insurance the most!). If the cost of treatments over a year exceed AED 150,000, the insured will have to pay everything above the annual claims limit from their own pocket.
Another shortcoming is that basic healthcare services are only covered in Dubai, while emergency medical treatment is covered within all emirates of the UAE. This means if you are travelling abroad and have a medical emergency, you will not be covered by the health insurance plan. Moreover, no hospitals and clinics network has been defined by the DHA, meaning this will be at the discretion of the insurers. The only guidance that has been provided is that the network must provide reasonable geographic access for the insured with regards to their place of work and residence.
Preexisting and chronic conditions will be covered after 6 months, which is standard among most health insurance plans that provide this benefit. The insured must pay 20% of the cost of in-patient treatment and emergency services at authorized hospitals. However, there is a cap of AED 500 per treatment, and the total coinsurance paid will be limited to AED 1,000 per year.
The Essential Benefits Plan becomes much more costly for outpatient treatments, which are defined as regular hospital or clinic visits that do not require an overnight stay at the medical facility. For maternity related services, there is a 10% coinsurance that must be paid, and only 8 visits to a primary health care center are covered in addition to 3 ultrasound scans. The limit covered by the health insurance company for a normal delivery is AED 7,000.
One of the biggest weaknesses of this plan is that drugs and medicines are covered up to AED 1,500; this includes the 30% payable by the insured member.
The basic health insurance plan is a great option for Dubai residents who simply cannot afford to pay more. However, with the high copayment required with this policy, you should consider taking a more expensive healthcare plan; not only will you get better coverage, but you will also end up paying less out of your own pocket for treatments. Depending on how often you visit the doctor during the year, it might actually be cheaper to pay for a more expensive health insurance policy upfront.