Understanding Medical Insurance Deductibles, Co-Insurance and Co-Pays

How much you choose to pay out of your own pocket will have a direct impact on your health insurance premium.

When it comes to medical insurance, one of the main factors residents in the UAE look at is how much they have to pay out of their own pocket when receiving medical treatment. Deductibles, also known as excesses, comprise a fixed amount of money that you will have to pay from your own pocket before you can take advantage of the benefits in your medical policy. The deductible amount is also referred to as a co-payment when it is calculated as a percentage of the treatment cost.

The deductible amount varies greatly based on the medical insurance policy you choose. While comparing health insurance plans in the UAE on Bayzat, you will find that deductibles can vary from zero up to 30% co-payment. If your policy comes with a deductible, you will have to pay that amount when receiving treatment at a medical facility. If you are filing a reimbursement claim, you have to pay the entire treatment cost, and the deductible will be subtracted from the claim amount while the remainder will be reimbursed to you.

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.

The type of deductible you choose has a direct impact on the premium. For example, if you take a health insurance policy with the exact same benefits except for the fact that one has an AED 30 deductible per visit, while the other has a 20% co-pay, the second option will be 21% cheaper.

Health insurance companies in the UAE such as ADNIC, Daman, Dubai National Insurance & Reinsurance (DNIRC), Orient Insurance and Bupa allow customers to choose from several different deductible options. This makes it easier to find a policy within your price range. When comparing medical insurance in the UAE, keep in mind that you can significantly lower your health insurance premium by choosing a plan with a deductible.

Related articles:

Why the Track Record of Your Insurance Company Is Important

Everything You Need to Know About Maternity Cover in the UAE