Ask questions or fill in the information for a quote, we're here to help.
How do you know your doctor is covered by your health insurance plan?
Posted on Jun 11, 2015 by Rob McBroom
UMI looks into what you need to do in order to find if your doctor is included in your health insurance network. For those living in Dubai, this may not be as straight forward as it may seem. Read on to learn more.
The ongoing reforms implemented by the Dubai Health Authority have changed the face of health insurance in Dubai for the better. Now, any expat moving to the city must have private health insurance in place before they are granted a visa. This mandatory coverage is great for individuals and families as it essentially ensures that you have a sound risk management and cost offsetting strategy. That being said there are downfalls with this plan: Just because you have insurance it doesn’t necessarily mean that the physician or medical center of your choice may be covered by your plan. To help, we have written this article which covers how you can find out whether your preferred doctor will be covered by your plan.
First: Know what network your doctor is in
Dubai has seen explosive growth in the number of health care facilities in the city, with this growth expected to continue for the foreseeable future. Like many other world-class health care cities there is a wide difference in the costs at the different hospitals. Some are akin to public hospitals in other cities - offering cheap healthcare to the masses - while others are the height of luxury, offering the best of everything to the city’s wealthy elite. Because of this, not every plan will cover treatment at every type of hospital with many insurance providers grouping types of hospitals into networks - a group of medical centers that agree to work with, and accept payments from, insurance companies.
While there are a wide number of networks, the vast majority of plans can be broken down into three main coverage groups - based on what type of hospital they provide coverage for:
Plans that cover low cost facilities
Where possible, the government is actively trying to reduce the strain on the public hospitals (in Dubai, these are referred to as government hospitals), and one of the main ways this is being accomplished is via the DHA reforms that have made it mandatory for expats to have private insurance. This private insurance essentially dictates that you will be visiting at least a low-cost private facility like the Iranian Hospital instead of a government run one. In fact, if you visit a government facility in a non-emergency situation, there is a good chance you will be instructed to visit one of these facilities.
Plans that support this group are usually designed to have lower premiums and as such have generally lower coverage limits with a longer list of exclusions or limitations. Depending on your salary, you may not even qualify for these plans as these are only available to people who have a monthly income of less than 4000 AED. One of the most common limitations found in plans that service this group network is based on what facilities they cover. Many plans explicitly list facilities that are included in the network. If you visit these facilities you will be covered to the limits of the plan. Go outside of the network however and there is a good chance you won’t be fully covered, or will find you aren’t covered at all.
If you have one of these plans, you need to be acutely aware of your coverage limits. If your doctor of choice charges more than these limits you are going to have to pay the excess.
Plans that cover mid cost facilities
Plans that support this type of network offer more breathing room when it comes to coverage limits and hospitals/facilities covered. These plans will still impose coverage limits, however which means while you have greater flexibility in terms of health care providers,
One of the main downsides to these plans however is that access to higher cost facilities and specialized clinics is still largely restricted. While these plans may cover some of the cost, the coverage limits likely won’t be high enough which means you will be paying a fair amount out of pocket if you wish to access these facilities.
Plans that cover high cost or luxury facilities
These plans are often referred to as ‘unlimited’ plans because they offer coverage for the best care in the world, usually with super high or no limits. While the premiums are higher, these plans are almost always international which means you will be able to receive care not only at the top facilities in Dubai, but anywhere in the world, which makes these plans ideal for expats who feel more comfortable receiving care in their home country.
Second: Know how to find out whether your doctor is covered by your plan of choice
If you have a physician or medical facility in Dubai you would like to continue visiting, there are three ways you can find out if your insurance will cover these visits.
1. Check the documentation that came with your card
When you sign up for a plan in Dubai you should get a package that contains plan documentation and information that explains what is covered, your plan limits, and even where you can receive treatment. Be sure to go over this information and keep it accessible in case you need to access it at a future date.
Many plans also come with a card that you show the doctor or receptionists at the facility when you arrive for treatment. These cards often have useful information including coverage limits with some even providing an abbreviated list of care facilities. At the very least, they will have a phone number you can call for more information.
2. Call or email your doctor
If you can’t find your card or the documentation, then calling your doctor could be a good idea. They will be able to tell you if they work with your plan’s network. That being said, they will ask that you present your card when you arrive so if you have lost it, you will likely need to replace it before hand.
3. Talk with UMI
Finally, talk with the health insurance experts at UMI. As brokers who are based the city we work with all of the top insurance providers and can help you find not only the best plan, but also help with the claims process and provide advice on where you can receive treatment.
If you do have a preferred doctor or clinic, we can recommend plans that not only meet your needs but are DHA compliant and also in your preferred healthcare network. Contact us today to learn more.