UAE's new health insurance scheme: What's covered and how to sign up

Maternity care, dental and road traffic injuries are exempt from coverage, but a Dh120 top-up adds wider benefits

Mandatory healthcare across the Northern Emirates came into effect from the beginning of this year. Silvia Razgova / The National

Healthcare centres in Ras Al Khaimah are set for significant expansion to keep up with an expected rise in demand due to mandatory health insurance that rolled out on January 1 across the Northern Emirates.

Employees registered in the private sector and domestic workers living in Sharjah, Ajman, Umm Al Quwain, Ras Al Khaimah, and Fujairah can now benefit from multiple health services thanks to the Dh320 insurance plan that employers must provide for any new workers from 2025.

A Dh120 top-up for each insurance plan covers a wider range of services and procedures, taking the total price for an enhanced scheme to Dh440.

However, the mandate does not apply to employees with valid work permits issued before January 1, 2024, and will only become mandatory when their residency permits are due for renewal.

The Arabian Healthcare Group, the regional healthcare provider of RAK Hospital, is preparing to keep pace with growing demand through significant expansion in Ras Al Khaimah.

Alongside CommonSpirit Health, one of the largest hospital systems in the US, AHG plans to launch community clinics as part of its comprehensive hub-and-spoke model.

Free-standing clinics will be developed in Al Dhait, Al Maried and Al Ghail, while the existing Al Hamra clinic will be expanded significantly.

Expansion plans

The clinics aim to deliver internationally accredited healthcare services directly to residents, ensuring care is convenient and easily accessible.

“With mandatory health insurance set to roll out across the Northern Emirates by the end of 2025, the region is expected to see a significant surge in investments in healthcare infrastructure,” said Dr Raza Siddiqui, executive director of RAK Hospital and chief executive of Arabian Healthcare Group.

“This mandate will likely encourage private providers to establish new facilities catering to the growing population of insured residents, focusing on both outpatient and inpatient care. The demand for advanced tertiary care facilities, in particular, is anticipated to rise, creating substantial market opportunities for private healthcare players.”

Clinics will serve wide-ranging healthcare demands, from routine check-ups and gynaecological services to paediatric care, dental treatments, and basic dermatology. By adopting the urgent care model successfully introduced by CommonSpirit Health in the US, AHG aims to change how minor health concerns are addressed.

“While care will be provided 24/7 for basic emergencies, this approach aims to reduce the need for hospital visits for common ailments, ensuring patients receive timely treatment at the most appropriate location,” said Dr Siddiqui. “The integration of mandatory insurance is set to significantly reshape the healthcare landscape in the Northern Emirates, offering immense opportunities for growth.”

Forward step

Analysts called the nationwide mandatory health insurance a ‘step in the right direction’.

While it allows insured people to access treatment when needed, particularly in emergencies, several important exclusions remain, such as providing care for injuries sustained in road accidents, or maternity care and mental health support, unless in an emergency.

According to the Institute for Health Metrics and Evaluation’s 2021 Global Burden of Disease report, road accidents were the third biggest killer behind Covid-19 and heart disease. The World Health Organisation’s Mental Health Atlas 2020 showed there were 49,213 treated cases of psychosis, including care for mental health, neurological conditions and substance abuse disorders.

Mansoor Ahmed, a regional expert and consultant in healthcare infrastructure said mandatory insurance would bring peace of mind to low-income workers, who may previously have been uninsured.

“The scheme is undoubtedly a positive initiative and a step in the right direction,” he said. “Its most significant aspect is that it allows insured individuals to access treatment as and when needed, particularly in emergencies.

“Workers, including domestic workers, can have peace of mind knowing they are covered in the event of an accident or unforeseen incident.

“This will positively impact the competitiveness of the country’s labour market by enhancing performance on key indicators such as quality of life, protection of rights, and social and healthcare security.”

GCC plan

Health insurance is already offered in Abu Dhabi and Dubai, while regionally, Saudi Arabia and Bahrain provide similar insurance. It is expected other GCC countries will also introduce mandatory health insurance for citizens and expatriates.

While there are co-payments and annual coverage limits, these are expected to improve over time as providers analyse the cost-benefit data and behavioural trends. The UAE's current health insurance market sees premiums valued at about $3.5 billion, according to Statista Market Insights.

This figure is expected to rise to about $4 billion by 2029. By comparison, the US is projected to generate the highest gross written premiums globally, amounting to $1,708 billion last year. Providing a space that feels like a home from home contributes to a more sustainable economy, said Mr Ahmed, who has worked in the region for 25 years.

“Currently, the network comprises seven hospitals, 46 clinics and medical centres, and 45 pharmacies,” he said. “Over time, it will be necessary to expand the network to include more providers, ensuring fast and convenient access to healthcare services.

“Regulators must play a crucial role in ensuring that services are delivered at optimal premium rates and that insured individuals are not denied access to the services they are entitled to.

“Overall, the UAE will be able to attract more skilled workers and it will reinforce the UAE as a preferred choice to work and live.”

In this guide, residents can learn how to benefit from the Workers Health Insurance (WHI) initiative.

What does a basic plan pay for?

The WHI basic plan covers existing health conditions and provides care under the policy for two years, with outpatient care capped at a limit of Dh10,000. Inpatient care will require pre-approvals and will be limited to an annual cost of Dh50,000.

A maximum of six physiotherapy sessions are offered under the plan, with 25 per cent coinsurance. Medications are covered up to a maximum of Dh1,500 with a 30 per cent co-pay by the patient.

The costs involved in overnight accommodation for someone accompanying a child up to the age of 16, or in the case of medical necessity, are also paid for up to a maximum of Dh100 per night.

The enhanced plan will increase the upper limit for all care to Dh100,000. It will cover all tests, diagnoses, treatments and surgeries in hospitals for non-urgent medical cases with prior approval from the insurer.

What does the worker pay for?

Any hospital visit carries a 20 per cent payment by the insured patient, up to a maximum of Dh500 a visit and an annual cap of Dh1,000. This includes emergency care and the cost of a semi-private room in the hospital. Any costs above this will be covered by the insurance company.

Radiology, such as an MRI or CAT scan, carries a 25 per cent co-payment from the insured, as does any laboratory tests that may be required.

Examinations by a specialist or GP require the insured to also pay 25 per cent of the fees, up to an annual maximum of Dh1,000.

Which hospitals or health centres are covered?

The plan is limited to care at seven hospitals and clinics in the Northern Emirates under the DubaiCare network, and workers must get referred by their doctors first.

The network includes RAK Hospital, the Amina Hospital Group in Ajman, Central Hospital and Aster Hospital in Sharjah, as well as Ministry of Health Hospitals in Dibba, Fujairah and Umm Al Quwain.

What isn’t covered by the WHI plan?

The plan does not cover the cost of treating injuries sustained in road traffic accidents, so any related hospital fees are not paid for under the insurance policy.

Other exceptions are the costs of maternity care, mental health care and dental treatment. Such treatments are not covered under the basic insurance plan. The cover will also not pay the costs of hearing or vision aids or any sight correction surgery.

Cosmetic procedures, smoking cessation programmes, prosthetic devices or any injuries incurred from competing in professional sports are outside of basic health coverage.

Is remote care covered if a worker can’t get to a hospital?

Yes, telehealth is an emerging area of expert care, with Novitas and Ison Healthcare partnering to provide remote care through a mobile app, offering health advice, diagnosis and instruction.

Will the workers' families be covered?

An employee’s dependents include spouse and children, while business partners and investors can also be insured for an additional Dh163 on top of the basic plan fee of Dh320. All insured must be aged between one and 64 and can benefit from the same health insurance terms.

Parents or in-laws of the insured aged over 64 can also be covered, subject to underwriters and a separate medical assessment.

What documents are required to process the plan?

Employees must provide a valid work permit, while their dependents must complete a medical application form to include any recent medical reports and prescriptions.

They must also provide a passport copy, with the visa page, and the Emirates ID of their sponsor.

For group insurance for companies, Dubai Insurance will ask for a copy of each employee’s current health insurance card.

How are the claims settled?

Inside the UAE, 100 per cent of care costs are paid for within the network of providers on direct billing, subject to applicable coinsurance. Any care received at hospitals outside of the network will not be covered, unless it is an emergency or life-threatening.