Everything about the Essential Benefits Plan

You already know by now that as per the Health Insurance Law of Dubai, every resident must have a level of health insurance that either meets or exceeds the minimum benefits as mentioned by DHA. These minimum benefits are known as the Essential Benefits Plan.

The Essential Benefits Plan or EBP was created to alleviate the burden off the employers as this health insurance plan has a nominal price. It also ensures that the most vulnerable workers are protected, hence the insurance providers make a small amount of profit from this plan. In accordance with these conditions, only a selected number of insurance companies can provide cover on a cost-effective basis and these companies are known as the Participating Insurers.

The companies that provide EBP are:

• Abu Dhabi National insurance Company (ADNIC)
• AXA Insurance
• Dar al Takaful
• Metlife Alico
• National General Insurance (NGI)
• National Health Insurance Company (Daman)
• Noor Takaful
• Oman Insurance Company
• Orient Insurance
• Ras Al Khaimah Insurance
• Takaful Emarat
• Union Insurance

These twelve insurance companies can provide EBP as they can handle volume business and demonstrate the operational effectiveness and high levels of customer service. The DHA invites insurance companies to bid to become a participating insurer. They have to submit an application and once they bid, they are invited by the DHA for a presentation and application review.

The EBP is only for Dubai residents who are earning less that AED 4,000 per month, including dependents. This plan’s coverage includes emergencies, surgeries, medical tests, medications, outpatient and inpatient treatments and maternity. There are also various restrictions, limitations and co-insurance requirements in place. There is an annual claim limit of AED 150,000 and the emergency medical treatment is limited to the emirates within the UAE. The treatment for chronic and pre-existing conditions are not included for the first six months.

EBP also has a 20% co-insurance payable by the policyholder with a cap of AED 500 per encounter, and a cap of AED 1000 annually for basic in-patient healthcare services. As for the cost of drugs and medicines, there is an annual limit of AED 1500 and a co-insurance of 30% for each prescription. The EBP also covers maternity and coverage for the newborn for the first 30 days, under the mothers policy.

For outpatient services, blood tests, 3 ultrasounds and 8 pre-delivery visits are covered and for inpatient services, normal delivery of upto AED 7,000 and medically necessaty C section of upto AED 10,000 is covered. There is also a 10% co-insurance that needs to be paid for inpatient and outpatient servies. There is a fixed cost for EBP ranging between AED 550 and AED 650 per year.