The Health Authority Abu Dhabi (HAAD) has announced a number of amendments to the Emirate’s health insurance programs
21 June 2016
The changes apply to those who seek treatment at a private hospital under the ‘Thiqa’ plan for Emiratis, or for expatriates and their families, the Daman insurance’s Abu Dhabi Basic Plan. Procedures at government hospitals are unaffected.
According to HAAD the amendments are designed to utilise the health insurance system by increasing overall efficiency across the sector to better meet current and future demands. The amendments are to be implemented with effect from Friday, 1st July 2016.
Changes to the Thiqa plan stipulate that cardholders will receive 80% coverage of the fees for treatment services charged at private healthcare facilities in the Emirate. Previously they had 100% cover. 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 medical services outside the Abu Dhabi Emirate, however, in cases where specialised 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 for IVF treatment at a governmental healthcare facility, in addition to one attempt per year at any private medical facility in the Emirate.
For expatriates 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 dependants (e.g. wife and three children), based on the age of the dependant. The premium for other dependants 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.
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.