The amendments were designed to utilise the health insurance system in increasing overall efficiency across the sector to better meet current and future demands.
The insurance changes being announced are for both the ‘Thiqa’ plan and the Abu Dhabi Basic Plan. Changes to the ‘Thiqa’ plan stipulate that cardholders will receive 80% coverage of the fees for treatment services availed at private healthcare facilities in the Emirate. Thiqa holders will continue to receive full coverage (100%) for treatment services availed at all governmental healthcare facilities in the Emirate.
Thiqa will cover 50% of the cost if cardholders should seek to avail medical services outside the Abu Dhabi Emirate, however, in cases where specialized services and treatments are unavailable at healthcare facilities within the Abu Dhabi Emirate, Thiqa will cover 100% of the treatment cost. Changes also exclude coverage for ‘Orthodontic braces’ for those who are 18 years of age or above from the plan, unless there is a medical necessity identified. Thiqa holders will also be offered full coverage of IVF treatment if availed at a governmental healthcare facility, in addition to one attempt per year at any private medical facility in the Abu Dhabi Emirate.
Additionally, in a bid to enhance operational efficiency and streamline coordination between healthcare providers and pharmacies, the new amendments state that all prescriptions from private healthcare facilities will only be dispensed at private pharmacies.
Commenting on these changes, Adeeb Al Zaabi, Manager of Corporate Communication department at HAAD, explained: “HAAD is working towards a more sustainable healthcare sector by encouraging competition and further improving the quality and breadth of the healthcare offering. Implementing these changes is an important new step towards fulfilling our vision for a ‘healthier Abu Dhabi’. These measures will further contribute to our ongoing efforts to increase efficiency, standardize operations and increase the sector’s financial viability – for the benefit of the patient, and the healthcare system as a whole.”
Changes to the Abu Dhabi Basic Plan include the following: workers above 40 years of age will have an optional co-payment of up to 50% of their own insurance policy’s premium, the co-payment percentage is to be set in agreement between the employees and their employers.
All employees under the Abu Dhabi Basic Plan will be obligated to pay 50% of the insurance policy’s premium for their dependents (e.g. wife and three children), depending on their dependents’ age. Other dependents such as father, mother and fourth child are to be fully covered by the individual. Childbirth costs are to be charged according to a separate scheme. Domestic workers at Emirati households are exempt from these changes until the necessary framework is in place to support this category.
The amendments are to be implemented with immediate effect as of Friday July 1, 2016. For more information on amendments, please visit the following link: www.haad.ae or www.damanhealth.ae
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