Thiqa Program

As the UAE continues to develop and expand its healthcare system, the importance of health insurance programmes is becoming increasingly apparent. Several types of health insurance programmes are available - both private and government-funded ones. 

Among several government-funded health insurance programmes, Thiqa is considered to be one of the most comprehensive programmes. In the following article, we will extensively cover the key details about the Thiqa programme, the coverage options, eligibility requirements, and other related aspects.

What is Thiqa?

One of the comprehensive healthcare programmes, Thiqa is offered by the Government of Abu Dhabi to UAE nationals and non-UAE national family members as per the eligibility criteria. Thiqa was established in 2008 and is managed by Daman, a top-notch health insurance provider in the UAE.

Without further ado, let's take a look at the salient features and key advantages of the Thiqa programme in Abu Dhabi – 

• The Thiqa programme provides access to the best healthcare with popular medical facilities, clinics, pharmacies, and health centres.
• It provides round-the-clock customer services through digital services channels and contact centres to its customers.
• UAE nationals and non-UAE family members can avail the benefits of the Thiqa health insurance programme in Abu Dhabi.
• The program covers a wide range of medical services such as hospitalisation, diagnostic tests, surgery, and prescription medication.
• You can access a network of highly qualified and experienced medical professionals, ensuring that you get high-quality care.
• With a wide range of options available, you can choose the coverage level that best meets your needs and budget.
• You can access the programme through its online services and mobile application. As an alternative, you can visit the nearest relevant branch to avail of the benefits.
• The organisation takes up to three working days for a successful Thiqa health insurance programme application.
• Thiqa health insurance policies come with a validity period of one year. To get continuous coverage, you should renew your policy on time.

Coverage Provided by the Thiqa Health Insurance Programme

As previously mentioned, the Thiqa health insurance programme offers a wide range of medical services so that you get access to healthcare services when you need them. Given below is the list of coverages provided by the Thiqa health insurance programmes – 

Inpatient Benefits

• Hospital accommodation and services of the private hospital room
• Day surgery
• Home nursing and long-term care
• Surgeons, consultants, and anaesthetists’ fees and other relevant charges
• Escort accommodation (parents or otherwise) as specified by the treating medical facility

Outpatient Benefits

• Physician consultations
• Dietician consultations
• Diagnostics tests, X-rays, and laboratories
• Outpatient psychiatric treatment
• MRI, CT, PET scan, and other similar tests, if prescribed
• Pharmaceuticals 
• Medical appliances and equipment
• Physiotherapy 

Maternity Benefits

• Outpatient maternity
• Inpatient maternity

Other Benefits

• The repatriation of deceased individuals and their accompanying family members to their country of origin will only be conducted through a designated emergency assistance provider.
• Treatment is provided in emergency situations.
• Fertility treatment is limited to a maximum of 3 attempts per year.
• Treatment and support are provided to assist in recovery from an injury, illness, or addiction.
• Services are offered to assist with emergencies that occur abroad.
• A medical examination is conducted to assess an individual's general health status.
• Treatment is provided for dental health issues as well.

Who is eligible Thiqa Health Insurance Programme?

In order to qualify for the Thiqa health insurance programme, you should meet the following eligibility criteria- 

• Individuals who are UAE nationals or hold similar status from Abu Dhabi are entitled to full medical coverage through the Thiqa Abu Dhabi public and private network, including coverage for emergency treatment in the UAE and worldwide. Note that there is no annual benefit limit per member.
• UAE nationals or individuals with similar status from other Emirates who reside in Abu Dhabi (whether working, studying, or owning property) are eligible for full medical coverage through the Thiqa Abu Dhabi public and private network, including coverage for emergency treatment within the UAE. There is no annual benefit limit per member.
• UAE nationals or individuals with similar status from other Emirates who do not reside in Abu Dhabi are entitled to full medical coverage through the Thiqa Abu Dhabi public network - this includes coverage for emergency treatment within the UAE. There is no annual benefit limit per member.
• Non-UAE nationals who are sponsored by a UAE national family member are eligible for full medical coverage through the Thiqa Abu Dhabi public network, including coverage for emergency treatment within the UAE. Note that there is no annual benefit limit per member in this case as well.

Points to Consider When Applying to Thiqa Insurance

A few points are to be kept in mind regarding the eligibility criteria for the Thiqa health programme. The central point to proceed with the application here is that you will be required to take up a Weqaya screening test.

1. The test is conducted in various regions of Abu Dhabi and involves a few medical tests along with a questionnaire session.
2. UAE people aged 18-75 years of age are eligible for this scheme. 
3. Following are some of the essential documents one must carry for the screening test - 

• Original Family Book
• Original Passport
• Birth certificate for a newborn baby
• Emirates ID
• Photograph

How Much Does Thiqa Membership Cost?

You can avail of Thiqa health insurance programme benefits for free if you are eligible as per the criteria discussed earlier.

How to Access the Services of the Thiqa Healthcare Programme?

You can avail of the services provided by the Thiqa healthcare programme via three channels – Thiqa.ae or Thiqa mobile application, Hayakom, and branches.

Given below are the finer details of each of the channels – 

• Online Services via Thiqa Online Website and Mobile Application

With the online services and mobile application of the Thiqa program, you can avail of a wide range of services like the easy renewal of policies, enrollment of new family members, searching for hospitals and clinics within the network, submission of reimbursement claims, and access to various other features.

• Hayakom - Thiqa Smart Branch

The smart branch of the Thiqa program offers all the services available at a traditional Thiqa branch but with an innovative approach that relies on an advanced appointment system. Through this system, members can select a suitable time to virtually meet with a Thiqa representative and access a range of services. 

The smart branch also enables the electronic sharing of documents and discussion of policies with a customer advisor, providing the same facilities as an in-person visit to a branch.

• Branches

Currently, Thiqa members can visit any of the three exclusive branches in Abu Dhabi, Al Ain, and Al Dhafra to solve their queries or address any concerns.

Note: Currently, the branches are only open to cater to emergency cases. Visitors are required to provide a negative PCR test with a validity period of 3 days as a safety precaution for members and employees.

Reimbursement Claim Procedure for Thiqa Health Insurance

The Thiqa health insurance reimbursement claim procedure is a simple process that can be initiated by members who have incurred medical expenses outside the Thiqa network. To start the reimbursement claim, members are required to keep the stack of medical documents ready and invoices of bills or other related expenses. It is to be noted that the insured individual has to submit the claim procedure within 180 days of receiving the medical treatment.

Documents Required for Thiqa Reimbursement Claim Process

• Detailed invoices or bills that break down each medical service and its unit cost, along with a confirmation of payment or a corresponding receipt.
• A complete medical report or discharge summary is also necessary, along with a precise diagnosis or a description of the symptoms by the doctor.
• Prescriptions for medications and medical appliances must be provided to support the reimbursement claim.

Keep the following points in mind while applying for a Thiqa reimbursement claim – 

• You can submit your Thiqa reimbursement claim on the official Thiqa website or use the Thiqa mobile application for the same.
• Generally, claims are settled within 7 days, provided all submitted documents are dated and accurate.
• You can review the status of your claim via Thiqa online website or mobile application.
• In case your claim is rejected, you can call on 800 480 000 for clarification.

For a few more details about the Thiqa health insurance programme, refer to the next section of the article.

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Frequently Asked Questions (FAQs)

Q1. How can I get the list of benefits of my Thiqa health insurance coverage?

Ans: You can check the coverage of your Thiqa health insurance policy via online services like Thiq.ae or Thiqa mobile application. As an alternative, you can reach out to customer care by dialling 800 480 000 to address your queries.

Q2. What documents are required at the time of enrolling in the Thiqa health insurance programme?

Ans: You may be required to present your Emirates ID, family book, and other documents as per eligibility requirements.

Q3. Does Thiqa health insurance provide worldwide coverage?

Ans: Some Thiqa health insurance policies provide medical emergency coverage worldwide. To extend the coverage, you can buy 'Musafer’.

Q4. Are Emirates ID and Thiqa health insurance linked?

Ans: No, Emirates ID and Thiqa health insurance policies are not linked. However, medical facilities may reject your application if your Emirates ID card has expired.

Q5. What is Thiqa's health insurance number?

Ans: The Thiqa health insurance program in the United Arab Emirates (UAE) issues its members a 12-digit health insurance policy number. This number serves as a unique identifier for each member and is used by them to access their Thiqa coverage, including medical services and reimbursement claims. Members can find their Thiqa policy number on their health insurance card or by logging into their Thiqa account through the program's website or mobile application.