With so many insurance companies in the market offering different types of health insurance plans, identifying the most suitable policy that satisfies your requirements can be a difficult task. With the introduction of the mandatory medical insurance law by the Dubai Health Authority, all residents of the Emirate will be required to purchase a policy by June 2016. As a result, health insurance has now become an integral aspect for UAE residents living in Abu Dhabi and Dubai.
When it comes to medical benefits, the biggest dilemma facing an individual is which factors to consider before choosing a policy. Aside from the budget, the next step is to compare different health insurance plans that provide the right coverage and benefits for your needs.
Below are a few essential factors that you should consider before buying a health insurance plan:
Pre-existing conditions
As the name suggests, a pre-existing condition is an ailment or illness that exists before purchasing a health insurance plan. It usually impacts the overall policy premium, which can make a prospective policyholder hesitant to declare existing conditions. While certain insurance companies provide 100% coverage for pre-existing conditions, other companies only provide coverage after a pre-defined duration; for example, coverage may begin 6 months after buying the policy. Some companies also provide coverage with a specific limit. For instance, many plans have a limit of AED 150,000 for all pre-existing conditions.
Waiting period
Waiting periods are applicable for different benefits, such as dental treatments or pre-existing conditions. This protects insurance companies from individuals purchasing a plan to specifically treat an existing condition.
Hospital network
Just because a health insurance plan covers the UAE, it does not mean that the policy covers all the hospitals in the country, which is why it is vital to check the list of hospitals and clinics under an insurance company’s medical network. A policyholder might require medical attention at any time, so it is advisable to choose an insurance policy which covers at least some of the major hospitals near your home. It should be noted that treatment within a network hospital is generally cashless (direct billing) while treatment outside the network is on a reimbursement basis. Direct billing saves you from the hassle of collating all the paperwork and then following up with the insurance company for a reimbursement. Under the cashless benefit, the insurance company has a tie up with the hospital and directly settles the charges for treatment.
Deductibles and co-payments
Deductibles are fixed charges that policyholders have to pay out of their own pockets when undergoing a treatment. Also known as co-payment or co-insurance, there are a few types of deductibles:
Fixed amount per visit:
Under this type of deductible, the policyholder has to pay a fixed amount, which ranges anywhere from AED 20 to AED 75 for every visit to the doctor. This type of deductible is usually applicable for outpatient treatments only, which is defined as any treatment that does not require the patient to be hospitalised for more than 24 hours.
Co-payments:
As mentioned above, here the policyholder has to pay a certain percentage of the overall treatment cost. In the UAE, maternity benefits usually have 10% co-payment, whereas dental treatments typically have a 20% co-insurance.
Annual deductible:
Annual deductibles are quite rare in the UAE. Under this type of cost sharing, the policyholder has to pay the annual deductible first, after which the insurance company starts paying the remaining amount. For instance, if your medical treatment charges for the first six months amount to AED 1,500 and you have an annual deductible of AED 1,000, then you have to pay AED 1,000 while the remaining AED 500 will be paid by the insurance company. Furthermore, the remaining six months charges will be entirely covered by the company.
Exclusions
Finally, once you have compared the above factors, it would be prudent to compare the exclusions that are listed in the policy. Just like there are certain benefits in a health insurance plan for which you get coverage, exclusions are specific treatments or conditions that are not included in your plan. Every health insurance plan in the UAE will come with exclusions. It is important that you thoroughly review the plans beforehand in order to find out what is covered and what is excluded under the policy. There are certain ailments that are permanently excluded. When choosing a health insurance plan, talk to an expert about specific medical conditions you want covered to make sure they are not excluded.
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How Health Insurance Companies Deal With Pre-Existing Conditions
Consider These Points When Making Health Insurance Reimbursement Claims
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