Compare and save big on medical insurance

Under the Essential Benefits Plan (EBP) there is a 6 month waiting period for pre-existing conditions, covered subject to policy terms and conditions. (The co-insurance is specified for Inpatient and Out-patient treatment in the SOB from Participating Insurers.)

The DMCC health insurance solution offers a nil waiting period for pre-existing conditions, subject to the continuity of coverage for the Secure Bronze plan; otherwise, a 180 day waiting period applies to pre-existing conditions. However should a member not have continuity of coverage, the SELECT plans offer a nil waiting period for pre-existing conditions. Please note pre-existing conditions are covered subject to policy terms, conditions and general exclusions.

All emergency cases will also be covered by the insurance within the territorial limit specified in the policy. In fact, any emergency procedure will not require a pre-authorisation. If a patient happens to be in an emergency situation and is taken to a hospital that is not covered by their insurance, the patient will still be taken there and emergency treatment will be carried out.

Only after that can a hospital shift the patient to a hospital that is under the insurance coverage once the patient’s condition stabilizes.

The minimum standards must meet the Essential Benefits Plan (EBP). Workers with a gross salary of 4,000 AED per month or less (LSB) may only obtain insurance products from one of the participating Insurers (PI). The annual premium per employee varies between AED 500/- to AED 700/-, however, PI may deviate from the index rate by plus or minus AED 25/-.P participating insurers (PI) may offer LSB workers enhanced benefits to the Essential Benefits Plan (EBP) at an additional cost.

Workers with a gross salary above 4,000 AED per month, HSB workers, may obtain insurance products from both Participating Insurers (PI) and non-Participating Insurers, who have a Health Insurance Permit (HIP.) The annual premium for these workers is subject to underwriting of the Insurer, which the PI or non-PI are allowed to increase the index rate offered to LSB.

Age is a major factor that determines the premium, the older you are the premium cost will be higher because you are more prone to illnesses. Previous medical history is another major factor that determines the premium. If no prior medical history exists, the premium will automatically be lower. Claim free years can also be a factor in determining the cost of the premium as it might benefit you with a certain percentage of discount. This will automatically help you reduce your premium.

What you pay towards your plan’s deductible, coinsurance and copays are all applied to your out-of-pocket max. Once you reach your out-of-pocket max, your plan pays 100 percent of the allowed amount for covered services.

If your plan covers more than one person, you may have a family out-of-pocket max and individual out-of-pocket maximums. That means:

1. When the deductible, coinsurance and copays for one person reach the individual maximum, your plan then pays 100 percent of the allowed amount for that person.
2. When what you’ve paid toward individual maximums adds up to your family out-of-pocket max, your plan will pay 100 percent of the allowed amount for health care services for everyone on the plan.

Basically Deductibles, coinsurance, and copays are all examples of cost-sharing.

1. Deductible: A deductible is the amount you pay for health care services before your health insurance begins to pay.
   How it works: If your plan’s deductible is AED 5,000, you’ll pay 100 percent of eligible health care expenses until the bills total AED 5,000. After that, you share the cost with your plan by paying coinsurance.
2. Coinsurance: Coinsurance is your share of the costs of a health care service. It’s usually figured as a percentage of the amount we allow to be charged for services. You start paying coinsurance after you’ve paid your plan’s deductible.
   How it works: You’ve paid AED 5,000 in health care expenses and met your deductible. When you go to the doctor, instead of paying all costs, you and your plan share the cost. For example, your plan pays 70 percent. The 30 percent you pay is your coinsurance.
3. Copay: A copay is a fixed amount you pay for a health care service, usually when you receive the service. The amount can vary by the type of service.
   How it works: Your plan determines what your copay is for different types of services, and when you have one. You may have a copay before you’ve finished paying toward your deductible. You may also have a copay after you pay your deductible, and when you owe coinsurance.

This depends on the type of plan you have chosen. For example, if you have selected a GCC coverage then you are also covered in all the other GCC territories. If you have selected Worldwide Cover excluding the USA/Canada then you are covered worldwide except for North America.

You need to complete a medical declaration, although sometimes you might be asked for a medical report from your doctor.

The exact amount of hospital treatment you are covered for depends on the level of hospital cover that you purchase, as well as the hospital and doctor you choose and whether they have an agreement with your health insurer and are included in their network. You can also purchase extra coverage that includes services that are generally not provided such as services for pregnancy and childbirth and/or dental treatments.

Being a private health insurance member allows you to be treated in a private or public hospital as a private patient. This means that you may be able to choose from a range of clinics and/or hospitals, the doctor that treats you, and the time for treatment that suits you.