The new health insurance law issued by the Emirate of Abu Dhabi is the first step towards maintaining a global standard in health care and medical services for the capital. The new law will provide medical coverage for all expatriates working and residing in the Emirate. The new law will also cover all visitors staying for more than 2 months.
Steps to Implementation
The new health insurance law will be implemented in two phases:
Phase 1
The first phase of the law will be effective July 1st, 2006, and will be applicable to all local, federal and quasi government organisations and all private companies with more than 1000 expatriate employees.
Phase 2
The second phase of the law will be effective January 1st, 2007, and will deem it mandatory for all expatriates residing and working in the Emirate of Abu Dhabi to have health insurance provided by their employer or sponsor.
Health Insurance Scheme
The health insurance scheme offers 3 kinds of policies for coverage.
■ Basic Health Insurance Policy – for individuals with monthly salaries less than AED 4000 or AED 3000 plus housing allowance. The premium has been set at AED 600.
■ Enhanced Health Insurance Policy – for all other individuals. These policies will include basic products plus additional coverage as per the agreement between the beneficiary and the insurance company.
■ Emergency Health Insurance Policy – for all visitors to the Emirates in the event of an emergency. The premium will be set according to the duration of the visit and in consideration of the prices in the market.
Exemptions
The following is a list of those exempted from the law:
■ UAE nationals
■ GCC nationals that are residents in the Emirate of Abu Dhabi
■ A non-national wife of a UAE national
■ The children of a national mother married to a non-national
■ UAE passport holders who are residents in the Emirate of Abu Dhabi
■ All individuals who are exempted from the insurance law after the acceptance of GAHS and the Executive Council
■ Holders of valid health cards issued by GAHS before July 1st 2006 (with regards to local and federal government, qausi-government, private companies employing over 1000 expatriates) and before January 1st 2007 (with regards to all residents of the Emirate of Abu Dhabi) throughout the validity of the health card
■ Organizations that maintain their own medical facilities in accordance with the highest standards (as set within the Code of Regulations and audited by GHAS) can be excluded and will not be required to provide health insurance to their employees under the condition that they must apply for exemption and obtain approval from GAHS.
Durations and terms of policies
The insurance policies wil be valid for 1 year after the date of issuance and should be renewed annually (the insured are not entitled to claim back the premium). Shifting from one policy to another is flexible provided the insured pays the difference. The policies contain basic health care services, excluded services, additional services, maximum coverage, procedure of complaints guidelines and a co-payment to be paid by the insured. The health insurance scheme shall not replace any existing obligation to procure insurance by way of Workers Compensation Coverage as per Law No. 8 for the year 1980. All employers and sponsors must still provide health insurance coverage as set within the Code of Regulations in excess to existing agreements with staff.
Obligations of Health Providers in Emergency Situations
An authorised health care provider shall provide health care to any injured party, whether or not their insurance covers the treatment in the case of a medical emergency. The cost can be recovered from the health insurance company if insured, or from the employer/sponsor if not insured. In the case of work related injuries, the Health Insurance Scheme will not cover any medical treatments. These will be covered by the Work Compensation Insurance.
Objectives of the Law
■ To foster an efficient and competitive health insurance industry
■ To protect the interests of all participants in the health insurance scheme
■ To ensure the optimal utilisation of health insurance premiums for the level of benefits covered
■ To promote the prudential safety of all participants in the health insurance scheme
■ To provide appropriate health care for all participants in the health insurance scheme
■ To support the private sector and encourage their active role
■ To provide free choice of access to patients
Employer Obligations
All employers and sponsors are responsible for the procurement of health insurance coverage and possession of valid health insurance at all times for their employees and their families (1 spouse and 3 children under 18), inclusive of registration fees, as well as the cost of the policy and for the cost of all health care services that are provided to persons on his sponsorship in the event that such a person is not covered by a valid health insurance policy. Obtaining or renewing sponsorship of any resident expatriate will not be permitted without submitting evidence of a valid health insurance policy for the sponsored person to the relevant governmental organisations.
The law restricts the employer or sponsor from passing on the cost of providing health insurance to their employees and dependents, and such an act will be considered a violation of the law and shall hold the employer or sponsor subject to investigation and penalties. Complaints may be filed at the Complaints Unit at GAHS, if such a case occurs.
All companies within the Emirate of Abu Dhabi are expected to adhere to the health insurance law, given that due time and notice has been provided. A fair and severe list of punitive measures has been formulated and approved within the Code of Regulations for failure to comply with the law