Abu Dhabi: With health-care costs spiralling, the Abu Dhabi Government will stop providing broader geographical coverage and extra health benefits currently enjoyed by Daman’s thiqa cardholders, according to a decision by the Abu Dhabi Executive Council.
Under the decision, which takes effect from the beginning of April, the UAE national scheme, called thiqa, which provides Emiratis living in Abu Dhabi with full medical coverage, will limit medical access to only health-care providers in the UAE and revoke extra benefits such as opticals, massage and alternative medicine.
Those who wish to enjoy these extra benefits, including physiotherapy and alternative medicine, have to pay for them or get their premiums increased, said health experts.
According to documents obtained by Gulf News, the decision dated February 8 states that the health-care providers network will be limited to providers in the UAE and the home country of workers employed by government and semi-government companies.
The Abu Dhabi Government provides full medical coverage for all citizens living in Abu Dhabi. In cooperation with the National Health Insurance Company (Daman), Abu Dhabi Government introduced the UAE national scheme called thiqa.
Through thiqa, which is Arabic for ‘trust’, Daman provides all Emiratis living in Abu Dhabi with a thiqa card giving comprehensive access to a large number of private and public health-care providers registered within Daman’s network. It also includes broader geographical coverage and extra health benefits.
The present broader geographical coverage and extra benefits will continue unchanged until the end of this month, according to the decision.
According to data from the Insurance Authority — which was set up by the government of the UAE in 2007 to regulate and supervise the insurance sector in the country — the average growth rate of health insurance premiums between 2011 and 2014 in the UAE was about 20 per cent, with the annual cost of insuring an employee now ranging from Dh650 per person to Dh15,000.
The decision puts the maximum medical coverage for thiqa cardholders at Dh500,000 and the insured will pay 20 per cent of the cost of all services provided by clinics and hospitals outside Abu Dhabi.
The decision also stops the reimbursement of 80 per cent of the medical claims accrued to providers outside the UAE network and the home country of employees of government and semi-government companies.
Extra health benefits can be provided but at an extra premium. The decision provides for co-pay of 30 per cent of the cost of medicines, Dh50 for seeing a doctor, Dh30 for laboratory tests.
Written premiums throughout the UAE total around Dh33 billion annually, yet losses from medical fraud clock in at around Dh4 billion a year. This means more than 11 per cent of all claims in the region are fraudulent, with some experts suggesting the figure may be much higher.
Soft and hard fraud
There is soft and hard fraud. Soft insurance fraud is usually opportunistic, such as ‘up-coding’, where practitioners bill for a higher-priced treatment than actually provided, or ‘unbundling’, where each step of a standard procedure is billed for separately to get a higher payment from the insurer.
Hard fraud requires a great deal of planning, so is less common, but is usually more financially damaging, and can even involve claims for procedures never performed or from clinics that do not actually exist.
The decision limits childbirth services to providers inside the UAE only, with co-pay of Dh500. Dental services will be provided with 20 per cent of the cost being paid by the insured and a medical coverage ceiling of Dh2,000 annually.
Medical insurance experts said the move was prompted by the spiralling cost of health care. “The Government and insurers have been feeling the pinch from the substantial — and ever growing — cost of health care,” an expert said.
The decision, the expert added, came after insurance companies overseen by the Abu Dhabi Government incurred substantial losses due to malpractices and abuses by individual and corporate beneficiaries. “So, when the time comes for medical policy renewals, insurers have to rationalise their expenses.”
© Gulf NewsMar 2016