January 30, 2018

Pre-Packaged EBP For Small Units


As part of the mandatory health insurance for all employees in Dubai, Small and Medium Enterprises (SMEs) are required to provide medical insurance to their staff.

As part of the mandatory health insurance for all employees in Dubai, Small and Medium Enterprises (SMEs) are required to provide medical insurance to their staff. SMEs are defined as companies employing up to 100 staff, though some insurers consider higher limit of 150 employees to be included in the SME category. SME employees can be covered in group health insurance under pre-packaged pre-packaged medical insurance plans. 

This is provided as group health insurance. Most of the insurers require minimum of 11 employees to be covered. If there are fewer than 10 employees, then individual underwriting would be required for all members, though some insurance companies can do for 10 employees and fewer without underwriting.

The pre-packaged plans can be for the Essential Basic cover Package (EBP), covering all those earning under AED4,000 per month, irrespective of their age or condition. EBP includes outpatient consultation at clinics, General Practioner referrals to specialist for surgical and pathology investigations, maternity health cover, emergency visit to hospital and any surgery required as well as medications. If the members wish for a comprehensive cover with direct access to hospitals and rates would vary per network of clinics and hospitals. 

There are the limitations of EBP as far as coverage, critical illness, chronic diseases management are concerned. Limitations on coverage are they cover mostly UAE and some insurers do not cover Abu Dhabi. For critical illness, there is no exclusion as such but after the waiting period they would be covered if not excluded. As for chronic diseases, there is a waiting period of six months for pre-existing conditions and client has to show continuity of cover every year to waive off the same.

The beneficiary with basic insurance cover gets a maximum coverage of up to AED150,00 annually in cases where the insured requires prolonged hospitalisation. However, there is a special protection package under the EBP scheme. This package mandates that although a beneficiary has to pay a minimum of 20 per cent of co-insurance payment in case of a hospital stay or surgery, it is capped at AED500. This means that if the insured has a major surgery costing AED40,000, even those in the basic package would be expected to pay AED8,000 as 20 per cent. But the protection package mandates a ceiling of AED500 and a maximum payment of AED1,000 in the whole year.

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