An employee group health insurance comprises of a medical insurance plan that provides health care coverage to all the employees of a company and their dependents.
Employees being a key component of any organization, has helped identify that group health insurance is one of the most attractive benefits to lure new talent and curtail employee attrition rate.
On top of the usual coverage of insurance, there are a number of optional benefits you can select to add to your group medical insurance plan to ensure that all your employees’ medical needs are covered.
Typical Scope of Group Health Insurance
- Consultation
- Chronic conditions
- Maternity
- Prescribed medications and diagnostics
- Prescribed physiotherapy sessions
- Surgeries
- Room board
Additional Benefits and Options You Can Offer Your Employees
Dental
- Routine Dental: Coverage for dental procedures such as scaling, root canal, filling, extraction, x-rays, and medications related to treatment sought
- Cover for orthodontic treatment
- Cover for bridges, crowns and implants
- This will usually be forming part of the overall Dental cover limit
- What is not covered:
- Prescriptions for mouthwash, toothpaste, dental cleaning agents, desensitizing agents, antiseptics
- Dentures
Optical
- Routine Optical: Coverage for eyesight testing spectacles and cost of frames
- What is not covered: Lasik surgery, some insurers may not include frames
Global Direct Billing
- Access to direct billing services in the home country or anywhere in the world. Avoiding the need to pay and reimburse.
Alternative Therapies
- Chiropractic / Osteopathy / Ayurveda / Homeopathy. The cover is usually on a reimbursement basis
- Some insurers also provide cover for alternative therapies such as Chinese herbal medicine, acupuncture and podiatry
Psychiatry
- Cover provided on a financial limit per year per member OR number of sessions. Usually on a reimbursement basis. (AED 5,000 – 20,000)
Counselling / Psychological Treatments or Sessions
- Most insurers restrict this under psychiatric cover and can be approved based on necessity confirmed by the psychiatrist. The member can then be endorsed to a psychologist for counselling or support sessions. There are some insurers that cover work-related psychological cases as part of wellness.
Home Nursing
- For patients recovering from surgery or illnesses. Home Nursing or in-home care cover provides a nurse at the patient’s home to assist with recovery, treatment or rehabilitative therapies.
- The cover is provided on a limit of time (number of days in a year) or a financial limit (E.g. up to AED 10,000)
Prosthetic/External Medical Devices
- Cover for a fixed limit per person per year
Kidney Dialysis
- Cover for a fixed limit per person per year
Organ Transplant
- Cover can be provided for a fixed limit per person but would not include Donor’s expenses
Infertility Treatment
- Considered on a case to case basis
International Assistance (Repatriation and Evacuation services)
- Cover to provide assistance for medical repatriation and evacuation in case treatment is not available in the vicinity.
Death Benefit
- A fixed benefit to the legal heir of the member in the event of members death. E.g. AED 50,000
Critical Illness Benefit
- A fixed amount paid upfront upon diagnosis of a critical illness (such as cancer, renal failure, stroke)
Palliative and Hospice Care
- Support for terminally ill patients through therapy & counselling, and pain management
Medical Aids and Monitors, Prosthetic Devices, External Medical Equipment
- Typically out of the scope of most insurance plans but cover available through certain insurance providers to include the cost of – Wheelchairs, Crutches, Braces, Spinal Supports, Orthopedic Inserts
- Blood Pressure and Blood Sugar Monitors, Nebulizers
- Cover can be for a fixed limit per person per year or cover up to the annual limit
Wellness and Preventative Medicine
- Standard Medical insurance cover would only approve tests if symptoms or a medical condition is noted by the attending physician
- Cover can be extended to include Annual Check-ups covering various tests including Blood & Urine Analysis, Major organ function tests, cancer screening
- This will be over and above essential cancer and Diabetes screening cover for high-risk individuals as stipulated by DHA
- There need not be any symptoms or illnesses to report to avail the check up if this cover is included.
- Cover can be provided for 1 annual checkup or for a fixed amount per year on reimbursement
Road Traffic Accidents Cover
- Most insurers limit or exclude this. However, life-threatening emergencies following a road accident must be covered in the emirate of Dubai as per DHA guidelines. The cover will stop once the patient is stabilized
- Enhanced cover is available with certain insurers to include full cover for all medical expenses following a road traffic accident
Work Related Injuries
- Typically excluded in policies underwritten for members in the Emirate of Dubai and the Northern Emirates
- Some insurers offer cover for work-related injuries over and above the cover provided by any Workmen Compensation or Employers Liability Insurance
Other Enhancements to Basic Benefits:
- Reduced co-insurances on pharmaceuticals or consultations
- Widening of geographic scope – UAE + Indian subcontinent, worldwide etc.
- Increase in limit on basic services such as maternity, pharmaceuticals
- A wider network of direct billing service providers
Also, recently, the DHA has provided additional information on the required coverage of new-borns under a DHA approved medical insurance.
Mandatory Newborn Cover
- Married women employees who deliver the baby within the policy year can add their newborns to the policy as per DHA
- No waiting period will be applied; membership can be backdated up to 7 days
- Newborn are covered under the mother’s policy for the first 30 days or up to the annual limit
We understand that the process of selecting the right insurance benefits that fit the needs of your employees and organization, while keeping it affordable, can be complicated. Download our free eBook – The Ultimate Guide to Group Health Insurance for HR Managers in the UAE and learn everything you need to know about Group Health Insurance in the UAE.
