Sukoon (formerly Oman) features and benefits with respect to its health insurance and understand why it is one of the top choices for individuals and families in the country.
Health insurance plays an essential role in providing financial protection against the high costs of medical care, ensuring that you and your families can access essential healthcare services when needed.
Multiple top-notch insurers in UAE provide a wide variety of health insurance plans, and, thus, it is important to understand the types of diseases covered under these types of health insurance plans. This can help you make informed decisions when choosing the best plan for you and your loved ones.
The following article provides an overview of the most common diseases covered under health insurance policies and discusses key factors such as pre-existing diseases, waiting periods, and exclusions that can impact your coverage.
By understanding the various aspects of disease coverage in health insurance, you can better navigate the complex world of healthcare financing and, ultimately, make a wise decision concerning your health insurance coverage.
Most Emirates in the UAE, including Dubai and Abu Dhabi, have made it mandatory for all residents to have health insurance coverage so that the said residents (including expatriates) have access to essential healthcare services.
The UAE guidelines stipulate that health insurance policies must provide a minimum level of benefits, like coverage for a range of diseases, including inpatient care, emergency services, and maternity care. However, most of the leading insurance providers of the UAE often offer additional coverage options for a more comprehensive range of diseases and medical conditions, including chronic diseases, mental health disorders, and dental and vision care.
Generally, health insurance and disease coverage are intricately linked, as the primary goal of health insurance is to provide financial protection against the expenses incurred due to medical conditions. Comprehending the extent of disease coverage by your health insurance, thus, helps you select an appropriate plan that meets your needs and ensures adequate coverage.
Depending on your health insurance policy and insurer, your coverage may differ slightly. Generally, the following diseases are covered by health insurance policies in the UAE –
Cardiovascular diseases affect the heart and blood vessels, which include conditions like corona artery disease, heart attacks, heart failures, and strokes. In the UAE, these diseases are among the most common and potentially severe medical diseases and, thus, are covered by your health insurance policy. The extent of coverage, however, can vary as per the specific policy and insurance provider.
Most health insurance policies usually cover the costs of diagnostic tests & procedures necessary to identify and assess the severity of cardiovascular diseases like blood tests, ECGs, and angiograms, among others. In addition to this, you may also be covered for a wide range of treatments and medications required to manage the disease as well as expenses related to surgeries like artery bypass graft, heart valve repair or replacement, and more.
Cancer treatment can be quite expensive, and health insurance policies in the UAE generally cover various types of cancer, including breast, lung, colon, and prostate. Health insurance policies can cover expenses related to diagnostic tests, surgeries, chemotherapy, radiation therapy, targeted therapies, and palliative care in the advanced stages of the disease.
Given the rising prevalence of diabetes in the UAE, most health insurance policies cover the diagnosis, treatment, and management of this chronic condition. Coverage typically includes regular consultations with healthcare professionals, blood sugar monitoring, medications, and diabetes education programs to help patients manage their condition effectively.
The COVID-19 pandemic has had a profound impact on the UAE healthcare system. In response to the pandemic, the UAE government and health insurance providers have taken several measures to ensure that all UAE residents have access to COVID-19 testing, treatment, and vaccination through their health insurance policies. Many health insurance plans provide coverage for hospitalisation and other expenses related to COVID-19.
Gastrointestinal disorders, including gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD), are also commonly covered under health insurance plans in the UAE. These policies cover expenses related to diagnostic tests, medications, and treatments for managing the symptoms and complications of these conditions.
Health insurance plans in the UAE generally provide coverage for respiratory illnesses such as asthma, chronic obstructive pulmonary disease (COPD), and pneumonia. This coverage includes diagnostic tests, medications, and treatments to manage the symptoms and improve lung function.
In UAE, most health insurance policies cover cataract surgery, a common eye condition in which the lens of the eye gets covered with a cloudy area. Cataract surgery involves the removal of the clouded natural lens in the eye and its replacement with an artificial one to restore clear vision.
Keep in mind that some insurance providers may require pre-authorisation before covering cataract surgery. This process involves obtaining approval from the insurance company, confirming that the procedure is medically necessary and covered under your policy.
Note: It is essential to carefully examine your health insurance policy to comprehend the precise coverage, as it may vary depending on the specific policy and insurance company.
A pre-existing condition refers to any illness, injury, or medical condition that you were diagnosed with or received treatment for before obtaining a health insurance policy. In the UAE, the common pre-existing conditions include diabetes, hypertension, and heart diseases.
Generally, health insurance policies provide coverage for pre-existing diseases in several ways, such as covering them after a waiting period, applying specific exclusions, or charging higher premiums.
A waiting period is a specified duration in which your insurance policy does not cover specific medical expenses. In the UAE, the waiting period for pre-existing conditions typically ranges from 6 months to 2 years.
Once the waiting period has passed, the health insurance policy will start covering pre-existing conditions. This coverage may include diagnostic tests, treatments, and medication related to that condition as per the terms and conditions of the policy.
Keep in mind that it is mandatory to disclose any known pre-existing condition to your insurance provider - failing to do so can lead to the denial of claims, cancellation of the policy, or other penalties. By being transparent about your medical history, you can help your insurer determine the appropriate coverage, waiting period, and premium of your health insurance policy.
Note: Some health insurance policies may also have exclusions and limitations related to pre-existing conditions, meaning that certain treatments or expenses may not be covered even after the waiting period. Generally, these diseases or illnesses are excluded from your health insurance policy.
Congenital diseases are conditions that are present at birth, whereas hereditary diseases are genetic disorders passed down from one or both parents. Several insurance providers offer enhanced health insurance plans that provide comprehensive coverage, which may include congenital and hereditary diseases.
Some health providers may impose waiting periods for coverage of congenital or hereditary diseases, particularly if they are considered pre-existing conditions. However, the duration of the waiting period can vary depending on the policy and the insurance provider. Once the waiting period is over, the policy will start covering the specific disease, which may include tests, surgeries, medications, and so forth.
It’s worth noting that certain treatments, procedures, or medications related to congenital and hereditary diseases may not be covered by your health insurance policy, or there may be a cap on the total coverage amount for these conditions. In any case, you should review your health insurance policy documents and get a fair idea of its coverage and exclusions.
As awareness about mental health issues increases, more and more insurance providers are offering coverage for mental health disorders as part of their health insurance plans. These policies can cover diagnostic assessments, psychotherapy, counselling, medications, and other treatments related to mental health conditions.
Depending on your policy, coverage for mental health disorders may be provided for both inpatient and outpatient treatment. Inpatient coverage typically includes hospitalisation and residential care, while outpatient coverage covers consultations, therapy sessions, and medications.
Make sure you understand the extent of coverage before opting for the policy for inpatient and outpatient treatment related to mental health disorders.
As global health crises like the COVID-19 pandemic have highlighted the importance of comprehensive coverage for infectious diseases and pandemic outbreaks, numerous insurance providers have included these events in their plans.
This indicates that the UAE government may require insurance providers to offer specific coverage for infectious diseases or pandemic outbreaks in response to public health emergencies. For instance, during the COVID-19 pandemic, the government mandated that all health insurance policies, including basic and enhanced plans, cover COVID-19 testing and treatment costs.
This, however, also means that it is essential to stay informed about government regulations and updates to ensure that your policy complies with any mandated coverage requirements.
Basic health insurance plans typically provide a minimum level of benefits, which may include coverage for infectious diseases and pandemic outbreaks such as COVID-19. This coverage could encompass diagnostic testing, hospitalisation, and treatment expenses related to infectious diseases.
Some health insurance policies may also offer additional coverage for infectious diseases or pandemic outbreaks if they occur while travelling abroad. This coverage may include medical evacuation, repatriation, and treatment expenses incurred in a foreign country. It is essential to understand the extent of travel-related coverage provided by your policy and any restrictions or limitations that may apply.
Health insurance in the UAE plays a significant role in providing maternity and newborn care coverage, ensuring that expecting mothers and their newborns receive the necessary medical attention and support.
In Dubai, as per the Dubai Health Insurance Law (11) of 2013, it is necessary to have a health insurance policy with maternity coverage. The law also mandates employers to have maternity coverage for their employees. Depending on your policy and insurer, the coverage may include prenatal consultations, routine check-ups, diagnostic tests, delivery, postnatal care, and newborn care, including vaccinations and screenings.
Generally, in Dubai, a comprehensive maternity health insurance policy will cover all the costs associated with your pregnancy, from prenatal care to postnatal care, which, otherwise, can range between AED 20,000 to AED 30,000 and even more depending on the type of health insurance policy. However, before opting for the policy, it is essential to look for the moratorium, which simply means the waiting period specified by the insurance provider before you can submit a claim.
Apart from maternity coverage, many health insurance providers in the UAE have also recognised the importance of providing coverage for newborn care to ensure that infants receive the necessary medical attention and support during their crucial early days. The coverage may include the essential vaccinations and inoculations for newborns as stipulated in DHA's policies. Typically, health insurance plans in UAE start the newborn cover from 30 days from birth.
Coverage for dental, hearing, and vision services is often considered supplementary to standard medical care, and their coverage may not be included in basic health insurance plans. However, some basic policies may cover limited services or consultations related to these areas.
In some cases, insurance providers may also offer standalone policies or add-on coverage specifically for dental, hearing, and vision care. These policies can be purchased separately from your primary health insurance plan or added to your existing coverage for more comprehensive protection for these services.
Over the past decade, the UAE's Organ Transplant Law has revolutionised the availability of organ transplants within the country, including kidneys, livers, and bone marrow transplants.
Before implementing these regulations, patients had to seek transplant surgeries abroad. Since the introduction of this law, however, numerous medical professionals have been trained in organ transplant procedures and dedicated transplant units have been established within hospitals.
The UAE permits the transplantation of human organs from both living and deceased donors, in line with the provisions stipulated in a federal decree law. The extent of coverage for organ transplants under health insurance plans, however, can vary.
Comprehensive health plans in the UAE typically provide coverage for the full cost of such services, covering associated procedures before and after the actual transplant surgery. However, as there may be some differences among plans, you should review your policy to know about the coverage offered by your health plan. For instance, a health plan may cover the entire transplant procedure cost but exclude additional post-operative care expenses.
Given below is the list of some diseases that may not be covered by your health insurance in UAE –
Note: Each health insurance policy has its own exclusions or limitations. You should carefully review the policy documents and discuss any limitations or exclusions with your insurance provider.
Understanding which diseases are covered under health insurance policies in the UAE is crucial for making informed decisions when choosing the best plan for you and your loved ones.
Health insurance coverage in the UAE typically includes cardiovascular diseases, cancer, diabetes, COVID-19, gastrointestinal disorders, respiratory illnesses, cataracts, pre-existing conditions, congenital and hereditary diseases, mental health disorders, infectious diseases and pandemic outbreaks, maternity and newborn care, dental, hearing and vision care, and organ transplants.
However, some diseases or treatments, such as cosmetic or elective procedures, infertility treatments, alternative therapies, experimental treatments, or those resulting from self-inflicted injuries or substance abuse, may not be covered.
It is crucial to carefully go through your policy documents and be aware of the coverage, exclusions, and limitations of your insurance plan and provider to ensure that you have adequate protection for your healthcare needs.
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