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What is included in Mandatory Health Insurance?

By PolicyBazaar

Don’t gamble with your health, get the right cover at the right price.

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The Dubai mandatory health insurance scheme is a boon for the common public who cannot afford expensive medical treatments in emergency situations.

In UAE, the employer has to cover the health needs of the employees and provide protection in the event of any medical emergency. However, the non-working people are at risk without mandatory health coverage. For this reason, the government has made it compulsory for everyone in Dubai to have health insurance and this will improve the overall standard of living by a huge margin. In this regard, the Essential Benefits Plan (EBP) is introduced that provides uniform coverage for the citizens. The EBP can be obtained by paying as less as DH650 in Dubai and other regions. Here is everything that you must know about the Essential Benefits Plan.

What is Essential Benefits Plan (EBP)?

Spearheaded by the Dubai Health Authority, Essential Benefits Plan (EBP) is a pioneering initiative that aims to provide a minimum standard of Dubai mandatory health insurance to all the residents and visa holders of Dubai. It offers exactly what its name suggests: pre-packaged, several standardized, medical insurance plans offered by few DHA-approved participating insurance companies. In that manner, EBP will offer the Dubai residents with access to good and adequate healthcare to pay for any medical emergency or curative health care requirements.

Why Do You Need Essential Benefits Plan (EBP)?

Essential Benefits Plan is a scheme that ensures that all children, non-working residents, low income employees of Dubai will have access to good quality medical care with affordable premium cost right from Dh 650 to Dh 725 per annum only.

For expatriates who cannot afford to buy medical insurance for their non-working spouse or elderly parents due to high premium rates, this is indeed the go-to option. This mandatory health insurance Dubai will drive down medical care costs associated with regular medical check-ups, illnesses, emergency medical treatments, some other routine medical requirements.

However, EBP might not be suitable for you if you want more out of your health insurance coverage in terms of medical or geographical coverage or if you want a high cap on the annual health insurance cover.

Who Must Be Insured Under Essential Benefits Plan (EBP)?

The EBP is designed for the residents of Dubai and this plan is basically ideal for those people who are earning below DH 4000 per month which also includes dependents who may not work at all. Those people who are earning more than DH 4000 are not even eligible for this plan but as a minimum their health insurance will meet the standards highlighted in the Essential Benefits Plan. 

Is EBP the Best Plan for Everyone?

This is not the best option for everyone as the coverage offered is only basic and you may need advanced coverage for your specific health requirements in the future. However, this is the most inexpensive option available and you can get it from authorized medical insurance companies in Dubai. The basic plan which begins at DH650 is suited for non-working dependents. It is also the best option when you want to provide basic coverage for your employees at nominal costs. Moreover, the lower income group can easily afford to buy health insurance and lead a secured life without any hassles. Note that this EBP comes with geographical restrictions and not suited when you are frequently traveling out of Dubai to other regions of UAE.

How Much Dubai Mandatory Health Insurance or EBP Cost?

Even though the basic cost of EBP starts at a low price of DH650, it is not priced uniformly for everyone. You need to understand that the risk of covering health expenses for women and a senior citizen are slightly higher than men. The EBP chosen for working people depends on their earnings and people earning more than DH4000 need a higher priced EBP.

The premium charged for senior citizens is higher and they need to pay around DH2500 to get coverage. This is because the risk factor increases with age as per the insurance company.

In case of married women in the age group of 18 to 45, the premium charged is slightly higher than the basic coverage and it stands at DH4600.

Will EBP be Covering Pre-Existing Conditions?

You need not to worry anymore about pre-existing health conditions as they can get coverage under EBP without any restrictions. The same benefits are extended even in case of chronic conditions and this is a huge boon for the common public. However, the only restriction is that you need to declare them accurately while buying health cover. Additionally, there is a waiting period of six months to get coverage for such conditions.

Is There any Maximum Limit for the EBP Coverage?

Under the basic mandatory health coverage offered through EBP, you can claim a maximum of DH150, 000 for the medical expenses throughout the year. Anything in excess of this should be paid by the consumers and the plan will only offer basic coverage as mentioned below:

  • Inpatient Treatment: You can avail inpatient treatment at nominal costs and you can get exemption of up to 20% for such services through the EBP option. The maximum claim you can make per year, in this case, is DH1000 and you are not supposed to pay more than DH500 per visit. This is extended to diagnosis and treatment including surgeries.
  • Outpatient Treatment: Even the outpatient treatment has a similar slab and 20% of the cost of treatment is provided under EBP and you need to pay the remaining from your pocket.

Does EBP Cover Maternity Expenses?

The women falling in the age group of 18 to 45 years and are married need to pay a higher premium than normal as maternity coverage is given under the EBP scheme. The best part about EBP is that you can use it for diagnostic tests in any stage of pregnancy. The maximum number of tests that are covered in this situation is restricted to eight before delivery and the insurance company will cover 10% of the cost of diagnosis. In the event of normal delivery, cost up to DH 7000 is given to the insured. The coverage is extended up to DH 10,000 in the event of cesarean delivery. Even the newborn child gets coverage initially for a period of one month from the date of delivery. 

Which Medical Insurance Companies in Dubai are Authorized to Provide EBP?

Even though there are numerous registered insurance companies in Dubai, the Dubai Health Authority (DHA) has given permission to provide EBP only to twelve medical insurance companies in Dubai. As an individual or as an organization, you can choose to get the basic mandatory health cover from any of these companies. The rates of the policy will usually be the same and you may only find small differences with regards to service charges and other things. The below mentioned insurance companies provide EBP for all the people in UAE.

  • Takaful Emarat Insurance Company
  • Metlife Alico Insurance Company
  • Oman Insurance Company
  • Orient Insurance Company
  • Axa Insurance Company
  • Dar Al Takaful Insurance Company
  • National Health Insurance Comp0061ny Daman
  • National Life and General Insurance Company Saoc
  • Ras Al Khaimah National Insurance Company
  • Noor Takaful
  • Union National Insurance
  • Abu Dhabi National Insurance

Summing it Up:

These are the basic coverage options available under the Dubai mandatory health insurance plans or EBP in UAE. The rules may vary slightly depending on the geographical location of the service provider and you should read them carefully while taking the policy. However, in most cases, you will not have any issues with accessing EBP throughout Dubai.