ABU DHABI // Emiratis and expatriates in Abu Dhabi will have to pay more for health care at private facilities after changes to insurance cover were announced by the Health Authority Abu Dhabi (Haad).
The changes in cover apply to the Thiqa plan for Emiratis, and for those expats and their families who are covered by Daman insurance’s Abu Dhabi Basic Plan, who seek treatment at private hospitals.
Procedures at government hospitals are unaffected.
Under the new rules, Thiqa cardholders will need to pay 20 per cent of the cost of treatment at private hospitals. Previously the plan fully covered the cost of all procedures at private health centres. This has now been reduced to 80 per cent.
But cardholders will continue to receive full coverage at all government hospitals in the emirate, while outside Abu Dhabi Thiqa will cover 50 per cent of the cost of treatment, down from 90 per cent.
In cases where specialised services and treatments are not available in Abu Dhabi, Thiqa will cover the cost of healthcare outside the emirate.
The changes also reduce the number of IVF (in vitro fertilisation) treatments available to Emiratis at private hospitals from three to one a year. Such procedures at government hospitals, again, are unaffected
For expats, changes to the Abu Dhabi Basic Plan mean that workers over the age of 40 may have to pay up to 50 per cent of their policy’s premium. But this co-payment percentage is flexible and can be agreed between staff and their employers.
Changes also mean that employees covered under the Abu Dhabi Basic Plan will have to pay half of the policy’s premium for dependents (wife and up to three children). Childbirth costs will be charged according to a separate scheme.
Daman’s Basic Plan offers health insurance cover of Dh250,000 per person.
“Haad is working towards a more sustainable healthcare sector by encouraging competition and further improving the quality and breadth of the healthcare offered,” said Adeeb Al Zaabi, manager of corporate communication at Haad.
“Implementing these changes is an important new step towards fulfilling our vision for a ‘healthier Abu Dhabi’.
“Earlier the employer was responsible for covering the employee with their wife and three children. What has now been introduced is a co-payment for these co-dependents. In our capacity as regulator for the emirate of Abu Dhabi we see these changes are necessary for the viability of the healthcare sector.”
Clancey Po, chief executive of the private Burjeel Hospital in Abu Dhabi, said he was unsure what impact the changes would have on healthcare providers.
“I haven’t had the chance to speak to any Haad official or to Daman insurance. Over the weekend we will study the decision,” he said.
“The decision will impact premium card holders. It will affect us negatively. We have invested in Shahama and Shamkha and we have a project coming up in Mohammed bin Zayed City. We wanted to serve the Emiratis in the area,” Mr Po said.
About 35 per cent of patients at Burjeel Hospital are Emiratis, while at healthcare centres in Shamkha and Shahama, Emiratis make up between 70 and 90 per cent of patients.
Burjeel’s IVF centre also serves many Emiratis, although Mr Po was confident the changes to cover would not affect the hospital too much.
“Abu Dhabi has been very resilient and irrespective of the decision, we have always come back,” he said.
Shahrukh, an Indian expatriate living in Abu Dhabi, said the decision would have a huge effect, especially on individuals earning a salary of less than Dh5,000 a month.
“I don’t think it stops them from coming to Abu Dhabi, but it definitely hurts their pocket,” he said.
A B, an Emirati who lives in Abu Dhabi, said in the past the average person did not understand what was and what wasn’t covered under their health insurance.
“It used to be 100 per cent covered in private healthcare facilities and now it’s only 80 per cent. That means the individual has to learn more about what goes into the kind of care the Government has been providing us.”
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Changes to Thiqa plan
• Thiqa cardholders will get 80 per cent coverage of treatment at private healthcare facilities in Abu Dhabi. Previously, they received full coverage at both private and public hospitals in Abu Dhabi.
• Outside Abu Dhabi, Thiqa will cover 50 per cent of the cost of treatment, a decrease from the 90 per cent coverage cardholders used to receive outside the emirate. Thiqa will cover treatment if service is unavailable in Abu Dhabi.
• Thiqa holders can get full coverage of IVF treatment at a governmental healthcare facility, in addition to one attempt per year at any private medical facility in Abu Dhabi. Previously, Emiratis could avail of three IVF treatments per year.
• Orthodontic braces for those above 18 years of age are no longer covered, unless they are a medical necessity.
• Medicines prescribed at a private healthcare facility can only be dispensed at a private pharmacy.
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Changes to Abu Dhabi Basic Plan
• Abu Dhabi Basic Plan holders older than 40 will have an optional co-payment of up to 50 per cent of their own insurance policy’s premium.
• All employees under the Abu Dhabi Basic Plan will have to pay half of the insurance policy’s premium for their dependents (wife and three children).
• Childbirth costs will be charged according to a separate scheme.
arivi2@theantional.ae
