Introduction to

Medical
Insurance
A Complete Overview
Learn the Lingo
of Medical
Insurance
Network – Medical facilities
available to member

Inpatient (IP) – Emergency

treatment

Outpatient (OP) – Elective

treatment
Learn the Lingo
of Medical
Insurance
Annual Limit – Sum total of
benefit insured can utilize

Deductible – Maximum amount

payable for treatment undertaken

Co-payment – Percentage amount

payable for treatment undertaken
 Learn the Lingo
of Medical
Insurance
Pre-existing & chronic conditions
– Medical conditions that have no
definite cure and require long term
treatment

Waiting period – 6-9 month period

under which pre-existing & chronic
condition are not covered

Certificate of Continuity (COC) –

Certificate given to waive of waiting
period
Learn the Lingo
of Medical
Insurance
DHA – Dubai Health Authority

HAAD – Health Authority of Abu

Dhabi
Slide 2 TYPES OF
HEALTH
INSURANCE

Individual Group Health

Health
For either an individual For a company
or family
Slide 2 INDIVIDUAL
HEALTH
INSURANCE

Basic Plan Standard

Entry level plan with basic Health
Customized plan with
benefits as per DHA mandate enhanced benefits
Slide 2 BENEFIT
BENEFITS
COMPARISON
BASIC PLAN STANDARD PLAN
Annual Limit AED 150,000 AED 1,000,000 or higher
Network Clinic only network Clinics + Hospital network
Inpatient (IP) 20% co-pay max AED 500 Nil co-pay
Outpatient (OP) - Specialist via GP referral Direct access to specialist
Consultation 20% co-pay 20% / 10% / Nil co-pay
Lab test 20% co-pay 20% / 10% / Nil co-pay
Medicine 30% co-pay – limit AED 1,500 20% / 10% / Nil co-pay
Maternity 10% co-pay – AED 7,000-10,000 10% co-pay – AED 10,000-25,000
Dental Not covered 20% co-pay – AED 2,000-3,500
Optical Not covered 20% co-pay – AED 1,000-3,500
 Slide 2 PREMIUM
COMPARISON

Basic Plan Standard

CATEGORY PREMIUM Health
Starts from AED 3,500
Male/Female employee – Salary below AED 590
4k
Male/Female employee – Salary above AED 775
4k
Female dependent – Age 18-45 AED 1,773

Female dependent – Age 0-17 & 45-64 AED 697

Male dependent – Age 0-64 AED 697

Parent AED 4,240

Slide 2 DOCUMENTATION
TYPE BASIC PLAN STANDARD PLAN
Quote PP and Visa of insured PP, Visa and EID of insured
PP, Visa and EID of sponsor
Filled Medical Application Form
Lab reports (if any declared
conditions)

Issuance PP, Visa and EID of insured Signed quote

PP, Visa and EID of sponsor Payment proof – cheque/wire
transfer
Filled credit authorization form Previous insurance (if any)
Previous insurance (if any)
Slide 2 TURN AROUND
TIME -
QUOTATION

Basic Plan Standard

Self / Immediate Health
Indicative – Self / 1 working
day
Final – 4 – 7 working days
Slide 2 TURN AROUND
TIME - ISSUANCE

Basic Plan Standard

1 working day Health
5 – 10 working days
 GROUP HEALTH
Learn the Lingo of
INSURANCE
Medical Insurance

Network – Medical facilities

available to memberBasic
Insert or DragPlan
and Drop Photo
then Send to Back for overlay effect
Inpatient (IP) – Emergency
treatment Enhanced
Plan
Outpatient (OP) – Elective
treatment
SME Plan
 Slide 2 COMPARISON
BENEFITS BASIC PLAN ENHANCED PLAN SME PLAN
Annual Limit AED 150,000 AED 150,000 – 250,000 AED 500,000 or higher
Network Clinic only network Clinics + Hospital network Clinics + Hospital network
Inpatient (IP) 20% co-pay max AED 500 Nil co-pay Nil co-pay
Outpatient (OP) - Specialist via GP referral Specialist via GP referral Direct access to specialist
Consultation 20% co-pay 20% / 10% / Nil co-pay 20% / 10% / Nil co-pay
Lab test 20% co-pay 20% / 10% / Nil co-pay 20% / 10% / Nil co-pay
Medicine 30% co-pay – limit AED 20% / 10% / Nil co-pay 20% / 10% / Nil co-pay
1,500
Maternity 10% co-pay – AED 7,000- 10% co-pay – AED 7,000- 10% co-pay – AED 10,000-
10,000 10,000 25,000
Dental Not covered Not covered 20% co-pay – AED 2,000-
3,500
Optical Not covered Not covered 20% co-pay – AED 1,000-
3,500
Slide 2 PREMIUM
COMPARISON

Basic Plan Enhanced Plan SME Plan

AED 590 per person AED 650 – 1,900 per AED 2,500 – 15,000 per
person person
Slide 2 DOCUMENTATION
TYPE DOCUMENTS
QUOTE Company census & trade license
(less than 100 members) Previous insurance copy (if any)
Budget

QUOTE Company census & trade license

(more than 100 members) Previous insurance copy (if any)
Budget
Detailed claims report
Loss ratio
Slide 2 TURN AROUND TIME
- QUOTATION

Basic Plan Enhanced Plan SME Plan

1 working day 1 – 2 working days 1 – 2 working days
Slide 2 TURN AROUND TIME
- ISSUANCE

Basic Plan Enhanced Plan SME Plan

5 – 8 working days 7 – 12 working days 9 – 14 working days
 Regulatory
Framework
DHA – Mandatory insurance for
all DXB visa holders

HAAD – Mandatory insurance

for all AUH visa holders

Northern Emirates – Not

mandatory
Slide 11

THANK YOU