With health insurance becoming mandatory for many, understanding company health insurance offerings is critical. But with all of the details to review, it is easy to become overwhelmed when looking over the information. To help make the information more accessible, here is a beginner’s guide to company health insurance.
Get to Know Your Network
Insurance plans are associated with specific medical networks comprised of a set of hospitals and clinics. Often, in-network medical providers support direct billing for policyholders, simplifying the payment process. Additionally, using in-network facilities can help keep policyholder out-of-pocket costs low.
Commonly, the size of the medical network impacts the amount owed as a monthly premium. More comprehensive offerings cost more than those with higher levels of restrictions.
In some cases, the networks are also focused on specific locations in the UAE. Most people want to make sure their network includes medical facilities near their home or work. Otherwise, simply getting to an in-network hospital or medical clinic can be highly inconvenient.
However, the alternative of going to an out-of-network provider also comes with inconveniences related to coverage, costs, and claims filings. This makes care at in-network providers preferable, so understanding the included network is key.
Most health insurance policies include some exclusions or costs that will not be covered by the insurance provider. Some exclusions are time sensitive. Those exclusions require a specific amount of time to pass after the policy was originally selected before coverage is provided. For example, certain preexisting conditions have waiting periods before costs related to their treatment will be covered by the insurance plan.
Other exclusions are never lifted. For example, certain fees associated with a hospital stay may be excluded from coverage. Additionally, any procedure not deemed medically necessary, such as cosmetic procedures, will likely not be covered regardless of how long the policyholder has maintained the policy.
Each policy may have different exclusions, so it is important to review this information to fully understand what the company health insurance actually covers.
Typically, health insurance policies come with a variety of coverage limits. This means that the insurer will only cover costs associated with a particular health condition up to a certain point. After that threshold is reached, the policyholder is responsible for all additional costs. Most coverage limits are calculated over a certain period of time, such as a calendar year.
Understanding coverage limits is a necessity, especially for health events that can result in significant costs. For example, if a health insurance policy includes maternity coverage, the coverage limit may vary depending on the policy details. Limits may range from AED 7,000 to AED 80,000. While the lower limit may be sufficient under normal circumstances, but might not cover expenses related to complications that can arise due to a difficult pregnancy.
By knowing your coverage limits, policyholders can ensure they are financially prepared should the costs of treatment exceed the preset limit.
Riders and Top-Ups
While company health insurance policies must meet certain coverage minimums, not every potential expense has to be included. Often, this means policyholders can choose from a selection of riders and top-ups to help fill in gaps that relate specifically to their or their households unique circumstances.
For example, individuals with dependents, such as spouses or children, can add dependent coverage riders to provide their family members with health insurance coverage. Maternity coverage can also include a rider to help manage expenses beyond basic coverage.
Often, physiotherapy, dental, and optic benefits require a separate rider to provide coverage for those needs. Additionally, if coverage needs to be extended into a larger geographic area, there are riders to meet those requirements as well.
Top-ups are separate from riders. These additions to a plan help elevate coverage limit when certain coverage maximums have been reached. Often, top-up coverage is less expensive to add than riders, but riders are often more comprehensive in their specific areas.
Premiums, Deductibles, and Co-Payments
Premiums, deductibles, and co-payments (or co-insurance) as the costs for which policyholders are responsible. The premium is the monthly payment the policyholder must make to maintain their coverage. This amount is required regardless of whether services were used during that particular month.
Deductibles are fixed amounts that must be paid before coverage will be provided by the insurer. For example, an annual deductible is a specific amount that the policyholder must pay out-of-pocket before any coverage begins. A deductible of AED 1,000 means that the policyholder will need to pay AED 1,000 to qualified medical providers before the insurance company begins making any payments on the person’s behalf.
A deductible may also be required for each individual visit. For example, outpatient doctor visits may have a deductible of AED 30. That means the policyholder must pay AED 30 for every outpatient doctor’s appointment before any costs generated by that appointment will be covered by the insurer.
Co-payments are different from deductibles. These costs are a form of cost-sharing based on the total cost of certain medical treatments. A co-payment is often based on a specific percentage of the total cost. For example, a co-payment may be 10% for maternity benefits or 20% for dental benefits.
Most plans involved either a fixed deductible per visit or a percentage co-payment. However, all plans generally included an annual deductible.
Comparing Health Insurance
All of the above points are important when comparing health insurance in the UAE. By understanding how company health insurance works, both employers and employees can select options that will best suit their needs.