Abu Dhabi: Emiratis will have to pay 20 per cent of the fees for treatment received at private health care facilities in the emirate of Abu Dhabi with effect from July 1.
They will also have to shell out 50 per cent of the fees if they seek treatment at facilities outside the emirate for care in specialties that is already available in Abu Dhabi.
Meanwhile, expatriate workers aged 40 years and older who receive a salary of up to Dh5,000, and are covered by the Abu Dhabi Basic insurance plan, could also have to pay up to 50 per cent of the insurance premium each year. In addition, expatriate employees under this Basic plan will have to pay 50 per cent of the insurance premium for dependants — namely, spouse and three children below the age of 18 years.
The changes in the health insurance charges were announced on Thursday by the Health Authority Abu Dhabi (Haad).
“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’,” said Adeeb Al Zaabi, manager of corporate communication department at Haad.
“Overall, the main outcome that we aim for from these amendments is the sustainability of the sector. The amendments will be main drivers in standardising operations, streamlining processes and increasing efficiencies across the sector. The resulting financial viability of the sector will have a direct positive impact on the quality of healthcare services,” he told Gulf News.
Health insurance for Emiratis is covered under the Thiqa (Arabic for ‘trust’) scheme by The National Health Insurance Company (Daman), 80 per cent of which is owned by the Abu Dhabi Government and 20 per cent by the German-based reinsurer, Munich Re.
For Emiratis, care at all Abu Dhabi’s public healthcare facilities will continue to be fully covered, including fertility treatment. However, there will now be Thiqa coverage for only one attempted fertility treatment cycle per year at private facilities. Coverage for orthodontic braces for those 18 years or older is also excluded, except in cases where medical necessity is justified.
In addition, all prescriptions obtained by Emiratis from private healthcare facilities will only be dispensed at private pharmacies.
Expat workers
Daman also insures workers who earn up to Dh5,000 per month (or up to Dh4,000+accommodation) under its Basic plan. Currently, the premium for a Basic plan for an adult worker is Dh600 per year. Employers can now decide whether workers aged 40 years or older will have to pay up to 50 per cent more of their annual insurance premiums, the Haad statement said. The details on how the extra premium charge will be collected will have to be agreed between employers and employees.
With the new changes, workers under the Basic plan must also pay 50 per cent of the premiums for their dependants, including spouse and three children up to the age of 18 years. In the past, this was fully covered. The cost of insurance for other dependants, such as parents and fourth child, will also have to be fully borne by the individual.
Childbirth costs will also be charged under a separate scheme, but details on this were not announced. Previously, a Dh500 charge was set for delivery at hospitals within the Basic plan’s network, and Dh20 per outpatient consultation at these facilities.
Domestic workers at Emirati households who are covered by the Basic plan are exempt from these changes for now, the Haad has said.
The announced changes pertain only to the Thiqa and Basic plans. However, as the Basic plan is the minimum threshold for payment, there could be some changes in the near future for the enhanced insurance plans that cover most expats. However, these changes cannot immediately be determined, industry insiders told Gulf News.
At a glance
For Emiratis, the additional costs are:
20% of payment at private healthcare facilities in Abu Dhabi
50% of payment at healthcare facilities outside Abu Dhabi, except in cases where the specialised treatment is not available in the emirate
Full payment for fertility treatment at private facilities in Abu Dhabi. Only one attempt a year at private facilities will be covered by Thiqa
Full payment for orthodontic braces for those aged 18 years and older, except in cases where medical necessity is justified
Also, Emiratis obtaining prescriptions from private healthcare facilities have to approach private pharmacies
For expat workers under the Basic plan (who earn up to Dh5,000 per month or up to Dh4,000 with accommodation), the additional costs are:
Up to 50% of the annual insurance premiums if they are 40 years or older, as decided by their employers
50% of insurance premiums for spouse and three children aged up to 18 years
Expected changes in childbirth costs not yet announced
Domestic workers at Emirati household are exempt from changes for now
Source: Health Authority Abu Dhabi
