|Who should be insured by the health Insurance law |
Anyone residing or working in the Emirate of Abu Dhabi and his/her visa is issued from the Emirate of Abu Dhabi
Who is responsible to provide Health insurance coverage for people residing or working in Abu Dhabi?
“According to the health insurance law, the employer shall undertake to provide health insurance coverage for all his employees/ workers and their family
members including the wife and 3 children under 18 yeas of age. Every sponsor shall undertake to provide health coverage for those sponsored by him who are covered by the employers “.
When can the employer cancel the health insurance plan for an employer
When the Visa is cancelled, transferred or the member leaves the country, the health insurance plan will be cancelled accordingly.
What action should I take if the employer/ sponsor refused to enrol me and my family in the health insurance program?
you should report your complaint to the Customer Service Centre (CSC) in HAAD with all the supporting documents and the required fees. CSC will report the complaint immediately to the responsible personnel in HAAD.
If three of my children were insured by my employer. How can I insure my 4th child and under which benefit plan?
As per the health insurance law 23/2005 and its bylaw the father should issue a health insurance for the 4th kid from any from the authorized health insurance companies.
What are the different health insurance policies?
Basic Product Policies – for individuals with monthly salaries under AED 5000 or under AED 4000 plus housing allowance.
Enhanced Policy – for all other individuals. These policies will include additional benefits over the basic product schedule of benefits and as per the agreement between the insured, and the Authorized Health Insurance Provider
Emergency Policies – for all visitors to the Emirate of Abu Dhabi and non-resident children sponsored by
their fathers or mothers, provided they show proof that they are not permanently residing in the county. The premium will be set according to the duration of the visit and in consideration of the prices in the market”
Where do I buy health insurance from?
from any of the authorized health insurance companies available on HAAD website.An updated list of authorized insurance providers will be published periodically by HAAD
Where can I use my basic product health insurance card?
• In the basic product network
•In case of emergency, people can use the card outside of Abu Dhabi within limitations
•The annual limit of Basic Product Policy is AED 250,000
What benefits does the basic product include?
Please refer to schedule No. (1) of the health insurance law 23/2005 and its by-law For how long will the Policy be valid?
The policy is valid for 1 year and shall to be renewed annually
Can the insured shift from one Policy to another within the same insurance company?
This depends on the terms and conditions of the contract between both parties.
Can an employer pass on the cost of the Health Insurance to the Employee?
“Basic Health Insurance Policy:
01. Low-income people (workers / employees)
The cost of the basic health insurance policy for this category is determined by the following:
a. Age group up to 40 years old:
• Insurance premium = the employer /sponsor will bear the cost of the health insurance policy by 100%
B. Age group above 40 years old:
• Insurance Premium = Optional participation up to a maximum of 50% (worker / employee) to be agreed upon between the employer and the worker / employee.
02. Dependents of an expatriates residents who are covered by the employer’s health insurance (family) (wife + 3 children under 18):
Insurance premium = Employee shall bear 50% of the policy cost.
0.3 Dependents of an expatriates residents who are covered by individual’s health insurance (father / mother / fourth son / …….):
Insurance premium = The sponsor pays 100% of the policy cost
However, domestic labor sponsored by national are excluded from the above. As for the enhanced document, the cost will be according to the insurance company’s underwriting”
What about the people who already have international health insurance?
The health insurance should be issued from one of the authorized health insurance companies in the Emirate of Abu Dhabi available on HAAD website.
Can the employer ask for the loss ratio?
The employer can ask for the group policy loss ratio only but not for a specific individual.
What should an individual/ employer do if he/she has fines
For fines the policy holder can settle at the health insurance company by paying the full fine (300/ per employee/per month). The policy holder can appeal at HAAD and his appeal will be transferred to AD Judicial department . For The family of the employee, the sponsor can pay an appeal fees of 100 at the insurance company in order to settle For employees who have visa from Dubai but work in bu Dhabi.
Should they buy health insurance from Abu Dhabi?
No, only people that have visa issued from the Emirate of Abu Dhabi should get a health insurance from one of the authorized health insurance companies in Abu Dhabi.
The client who has an international health insurance plan that can cover him/her worldwide should he buy health insurance from Abu Dhabi?
Yes, he/ she should buy an authorized health insurance policy from any of the authorized health insurance companies available on HAAD website Appeals against violations issued by HAAD.
The customer can file an appeal with the supporting documents at the Grievances & Appeals Department at the Health System Financing Division, pay AED of 2000. The appeal will be reviewed and an official letter will be sent to the company with the result/ decision
Is the dental treatment coverage is mandatory for all medical insurance providers?
Any health insurance product should not be less than Basic product, and should be approved by HAAD
What is the period allowed to issue health insurance for new comers without going into fines?
The obligation of an employer and Sponsor to subscribe to the Health Insurance Scheme for an employee or a sponsored person shall commence after seven working days following the arrival of date on which the medical examination card is obtained.
What are the requested documents for filling a complaint against an employer?
01. Valid passport copy
02. Valid visa (a proof of residency)
03. all correspondences with the employer (letters, emails, etc….)
04. Details about the sponsor/ employer (contact details, Name of the Manager, location of the company, etc….)
05. copy of trade license
06. copy of the health insurance card
08. copy of the Emirates ID
09. labor contract
10. complaint fees receipt.
What is the best way to file a complaint?
The dispute settlement procedures between the insured and an authorized health company under the latter’s system have been exhausted. However if the customer was not satisfied with the health insurance company’s feedback, he/ she can file an official complaint in Customer Service Centre at HAAD in Abu Dhabi or Al Ain enclosing all the supporting documents and the health insurance company’s feedback and pay their complaint fees. Taking into consideration that as complainant shall be entitled to request for a feedback within 30 days of the complainant request of details of any action or investigation taken by the complaints unit.
What are the conditions of filing a complaint?
“To file a complaint, the dispute settlement between the insured and the authorized health insurance company under the latter’s system have been exhausted and the complaint shall be as follows:
01. made in writing in the prescribed form and signed by the complainant
02. be accompanied by prescribed fees
03. enclose all relevant documentation in support of the complaint
04. include all particulars of the complainant’s claim
05. be either in English or Arabic Language