Health Insurance Coverage

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Overview of Health Insurance

Health insurance is a type of insurance scheme that covers the expenses of medical treatments. It offers protection to the policyholder against medical emergencies, critical illnesses, chronic diseases, and bodily injuries. Health insurance helps you pay for a variety of medical services such as hospitalisation, surgeries, doctor’s consultations, laboratory procedures, and medicines etc.

What are the Common Diseases Covered by Medical Insurance?

The diseases covered under health insurance may vary slightly across insurers and insurance plans. However, the common diseases covered by most policies in the UAE are as follows:

Cancer

The cancer treatment is expensive as it requires advanced healthcare facilities and costly drugs. A health insurance plan covers the cost of diagnostic procedures, surgeries, chemotherapy, radiation, medicines, and rehabilitation care. Health insurance policies in the UAE cover various types of cancer such as blood, lung, breast, colon, etc.

heart-attack

Heart Diseases

Cardiac ailments such as heart attack, stroke, and heart failure are quite common in the UAE and other parts of the world. Medical insurance covers the cost of diagnostic procedures such as blood tests, ECG, angiograms, and treatments such as coronary artery bypass, graft, valve replacement, and medicines.

Respiratory Diseases

Health insurance plans cover common respiratory diseases such as asthma, pneumonia, and chronic obstructive pulmonary disease (COPD). Most of these illnesses are chronic. They persist for a long time and require continuous care to protect and improve the functioning of the lungs.

Hypertension

High blood pressure often comes without a warning with no explicit symptoms. The situation can turn serious or fatal if it is not managed effectively. A person with hypertension may suffer a sudden stroke or heart attack. Several healthcare plans are available in the UAE to specifically cover the cost of treating hypertension.

Diabetes

This is another chronic condition that is often referred to as the silent killer. It is common among the adult population and requires proper care for control & management of the disease. Medical insurance coverage includes consultations with physicians, regular blood sugar monitoring, and suitable medication.

Thyroid Disorders

The thyroid hormones help to regulate our body’s metabolism. As thyroid gland problems can affect any part of the body, it requires proper medical intervention to prevent the situation from becoming life-threatening. Health insurance coverage for thyroid covers in-patient, daycare, and pre & post-hospitalization expenses.

Gastrointestinal Disorders

Several illnesses related to the stomach and intestines such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), gastroesophageal reflux disease (GERD), and celiac disease are covered by most health insurance plans in the UAE. All the expenses related to testing, treatment, and medication are reimbursed by the insurance provider.

Other Critical Illnesses

Apart from cancer and heart diseases, health insurance also covers other critical illnesses such as paralysis, liver failure, brain tumors, Parkinson’s disease, HIV, etc. The insurance companies generally provide a lump sum payout when a critical illness has been diagnosed. This helps the patient to cover the treatment costs and other living expenses.

What are the Pre-existing Conditions Covered and their Waiting Periods?

A pre existing condition refers to any health condition that has been diagnosed or treated for an individual before buying a health insurance policy. The most common pre-existing conditions in the UAE include BP, diabetes, hypertension, and certain heart diseases.

Insurance providers do not automatically cover pre-existing diseases. They may prescribe a waiting period, apply some restrictions, or charge a higher premium to cover them. If a waiting period in health insurance is specified, you need to wait for this period before you become eligible to claim health insurance benefits. In the UAE, the typical waiting period ranges between 6 to 12 months.

It is mandatory for policyholders to disclose any pre-existing condition before buying health insurance. Failure to do so may lead to rejection of claims or even cancellation of the policy.

Coverage for Infectious Diseases Under Health Insurance

The recent COVID-19 pandemic has reinforced the importance of proper health insurance coverage for infectious diseases or pandemic outbreaks. The UAE government also made it mandatory for all health insurance policies to provide coverage for COVID-19 testing and treatment.

Going forward, it may be compulsory for insurers to provide specific coverage for severe infectious diseases that can result in a public health emergency. Policyholders need to stay updated on government regulations to ensure that their policy meets all requirements.

Basic health insurance plans provide a minimum level of coverage for infectious diseases. They cover the costs related to diagnostic tests, hospitalization, and other medical expenses within the country. However, some plans do provide additional coverage for pandemics or infectious diseases contracted during foreign travel. This includes the cost of treatment in a foreign country, medical evacuation, and repatriation.

Maternity and Newborn Care Coverage

Health insurance coverage for maternity and newborn care ensures that mothers and newborn babies get high-quality medical treatment. Under Dubai health insurance laws, it is mandatory for health insurance plans to provide maternity coverage benefits. The law also makes it compulsory for employers to provide maternity benefits to their women employees.

A comprehensive maternity plan covers all the expenses related to prenatal care, routine checkups during pregnancy, diagnostic procedures, delivery, postnatal care, and newborn care. This also includes the cost of periodic vaccinations and immunizations for the baby during the early days.

Before buying a health insurance plan, it is necessary to check the waiting period stated by the insurance provider. The policy benefits can be claimed only after this period is completed.

Medical Insurance Coverage for Hereditary and Congenital Diseases

The diseases covered under health insurance include hereditary and congenital diseases. Hereditary diseases refer to genetic disorders passed from either of the two parents. Congenital diseases are those that a person is born with.

Insurance providers generally specify a waiting period for covering hereditary and congenital diseases that are listed as pre-existing conditions. The waiting period may vary across health insurance companies and their policies. The insurance providers may also impose certain restrictions on treatments and the level of coverage. It is necessary to check the policy document for specific details.

Coverage for Organ Transplants

The new organ transplant law in the UAE has been a game-changer in the healthcare sector as the residents can now avail of organ transplant facilities within the country itself. Prior to the introduction of this law, the patients had to go abroad for transplant surgeries.

The transplantation of human organs (from both living & deceased donors) is permitted under UAE laws. Health insurance plans usually cover the cost of all procedures required before and after the transplant. However, there may be some variation between the plans of two different insurance companies. It is necessary to know what they cover and do not cover before you purchase the policy.

What are the diseases not covered under Medical Insurance?

The list of diseases not covered under health insurance is as follows:

Note: There may be specific exclusions in every health insurance policy. Please check the policy document carefully. Discuss with your insurance provider/advisor regarding the suitability of the policy.

Frequently Asked Questions on Health Insurance Coverage

Definitely yes. Health insurance is not just for the old and the infirm. Even if you are young, medical emergencies can arise anytime. Bodily injuries and infectious diseases also require hospitalization and other medical treatments. Further, Dubai and Abu Dhabi have made it mandatory for all their residents to have health insurance coverage.

Yes. For instance, you may be covered under your employer’s group health insurance. You can buy another health insurance policy to enhance the coverage and get more benefits for yourself and your family.

Medical insurance generally covers all diseases except those that are listed under exclusions or subject to the waiting period clause.

Health insurance in the UAE typically covers treatments that are deemed necessary by a qualified medical professional. It does not cover optional or non-essential treatments such as beauty enhancement or weight reduction.

Insurance companies need a true and complete picture of your health to know the risks and make an informed decision regarding policy coverage and premiums. Failure to disclose pre-existing conditions may later lead to rejection of your claim or cancellation of the policy.

Disclaimer: The health insurance policy or plan may have limitations, exclusions, and other terms and conditions that may affect coverage. It is important to carefully review the policy wording before making any decision.