New Health Insurance Law
  

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

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.

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

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.
 

 

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