Dubai Health Authority's Smart developments to guarantee a satisfied City
In this publication, we address how Dubai is leading the way in the application of technology to its healthcare insurance system and how the health insurance law is developing around these initiatives. In addition, we provide a general update on the proposed training requirements for those involved with selling health insurance in Dubai.
Since 2013, the Dubai Health Authority ("DHA"), the healthcare regulator for the Emirate of Dubai, has regularly updated the processes involved in, and significantly developed the laws and regulations for, the provision of healthcare in Dubai. These changes are in line with "The Smart Dubai Initiative", formally undertaken in March 2014, which aims to establish Dubai as the "smartest" city by 2017. The vision of the initiative "is to make Dubai the happiest city on Earth" and its mission is "to create happiness, by embracing technology innovation".
Mandatory Health Insurance Coverage
The DHA aims to provide an accessible, effective and integrated healthcare system, to protect public health and improve the quality of life within Dubai. The DHA's mission is to ensure access to health services, maintain and improve the quality of those services, improve the health status of nationals, residents and visitors and oversee a dynamic, efficient and innovative health sector.
To further that aim, in 2013, Dubai issued Health Insurance Law (No. 11 of 2013) (the "Law") concerning health insurance in the Emirate of Dubai. The Law stipulates that it is mandatory for every person on a Dubai residence visa to be provided with a basic health insurance policy, which is compliant with the DHA rules, regulations and guidelines. The deadline for full compliance was 30 June 2016.
It also establishes various obligations on Employers, Sponsors, Beneficiaries, Medical Claims Administration Companies, Health Services Providers, Insurance Brokers and Insurance Companies. For example, Insurers must provide their members with policies containing the minimum benefits set out in the Basic Medical Insurance Package Benefits Schedule.
It was anticipated that the Law would be followed by the issue of a General Circular and Executive Regulations, which would detail any penalties and fines in respect of breaches and the enforcement of the same. General Circular No. 5 of 2014 (GC 05/2014) in respect of the DHA's approach to enforcement of fines and penalties was published on 18 November 2014.
After the publication of GC 05/2014, the DHA initially took a supportive approach to non-compliance, in order to encourage stakeholders to comply. However, on 4 April 2016, Executive Council Resolution No (7) of 2016 (the "Resolution") was published in issue 398 of the Dubai Gazette and it is clear from the Resolution, that the DHA will now look to take punitive actions against those stakeholders that violate any of the regulatory obligations associated with the Law in order to protect residents of Dubai and uphold their rights. The Resolution was effective from the date of publication. It deals with the aspects of enforcement and provides further clarity on what fines health insurers in the Dubai market might be vulnerable to and completes another stage in the implementation of the mandatory health insurance scheme for residents of Dubai.
Two tables are Annexed to the Resolution. Table No. (1) outlines relevant fees payable for the provision of health insurance services, including fees for obtaining and renewing permits for insurance firms, insurance brokers, claim management companies, hospitals, polyclinics and specialised clinics, pharmacies, laboratories, radiology and analysis centres and other related companies.
Table No. (2), lists 56 violations with a specified fine for each. The Resolution stipulates that offenders who repeat an offence within one year of the date of the first fine will be charged double the fine up to a maximum of AED 500,000. In addition to levying fines, the DHA and Dubai Healthcare City Authority ("DHCA") have the power to take other actions, including the issuance of warnings, suspension from providing health insurance related services in Dubai for up to two years, and revoking licenses. A stakeholder that has its license revoked is required to publish two notifications in a local Arabic and English language newspaper. Failure to do so can result in the company incurring a fine of up to AED 150,000. The Resolution further stipulates that an "employer or sponsor not engaging the persons they are required to engage in health insurance or engaging them below basic coverage at the time set by the government in this concern" will be fined "AED 500 per delay month, and a part of month shall be a month".
Grace Period for Violations
The DHA announced in June 2016, that the original 30 June 2016 deadline for compliance with the Law was delayed until the "end of the year" for the category of "non-employees" and those they sponsor as dependents. The category of "Non-employees" includes individual sponsors, their dependents and their employees such as maids and cooks.
The DHA have also confirmed they will be organising workshops and roadshows, where insurance companies who have been shortlisted to provide the basic insurance package will be invited to meet the public to ease the mandatory health insurance process further.
The announcement provides extra time for sponsors and employers in Dubai to comply with the Law. However, the DHA continues to urge everyone to abide by the Law as soon as possible, as it aims to protect not only the dependents, but also the sponsors, from against incurring high medical costs due to illness.
All stakeholders involved with health insurance in Dubai, including insurance companies, should make sure that they have completed a full legal and compliance audit of their legal obligations. For example, some insurers may not be providing the correct level of health insurance coverage required by the Law, which requires that all Dubai residents must have a level of health insurance that meets or exceeds minimum benefits stipulated by DHA. These benefits form what is known as the Essential Benefits Plan ("EBP").
In addition, international private medical insurers that use primary fronting insurers as a partner to write their medical products locally in Dubai should ensure that they engage with those partners in order to avoid any violations and consequent reputational risks.
Mandatory Insurance Exams
In order to ensure residents of Dubai are getting adequate and up to date advice in relation to health insurance, the DHA is introducing a new process, which is aimed solely at insurers and brokers selling health insurance. For Insurers to provide medical insurance in Dubai, all employees involved in the selling and marketing of medical insurance, at any level, will have to sit mandatory insurance examinations. The examinations will be part of the updated Permitted Health Insurance Representative's process and as this is currently being changed from its original plan, the deadline is currently uncertain, but it is believed that all employees will need to have completed and passed the examinations by August 2017.
While the content of the examinations is still in the process of being finalized, it is suggested that employees will be required to sit a one-off examination to be licensed and one for CPD each year, both of which will be multiple choice consisting of 75 questions. An online system will be created by the DHA in order for employees to register for and sit the examinations. The results will be provided to the employee on the same day.
These will be Level 4 qualifications, which is the same level as the Chartered Insurance Institute examinations in the United Kingdom. There will be two categories of examinations, entry level and advanced level.
The syllabus is yet to be finalised and approved by the DHA. It is anticipated that it will cover a variety of subjects, including:
- Basic Principles of Insurance and Regulations;
- Private Health Insurance Coverage (self-funded, exclusions, basic terms & conditions) (approximately 10% of syllabus);
- The Market for Health Insurance (approximately 25% of syllabus);
- Health Insurance Regulation in the United Arab Emirates;
- Main factors affecting Underwriting in Health Insurance (approximately 10% of syllabus);
- Claims Processing;
- Fraud, Waste and Abuse;
- Conduct of business and professional conduct.
Online Portal to purchase Health Insurance
As we state above, the mission of the Dubai Smart City Initiative is to create happiness by embracing technology innovation.
The DHA is already on board when it comes to embracing technology, as can be seen by its implementation of the online health insurance claims system - ipromes.eclaimslink.ae - in 2012.
On 13 July 2015, the DHA published General Circular 04/2015, which requested expressions of interest from licensed health insurers in "Project Full Sweep". Since the implementation of the Law, there has been extra demand for health insurance in Dubai. Project Full Sweep will help the DHA expedite the process, by providing the public access to an online portal that will allow them to purchase health insurance easily from a selection of pre-underwritten products from DHA-approved insurers. The products will cater to both individuals and groups, depending on the insurer. This model is similar to current health exchange models in the USA and Ireland.
The deadline for expressions of interest was 27 July 2015. However, insurers are still expressing interest on a regular basis. The project is still in its development stages and the DHA is working on minor issues to ensure the portal is 100% "bug" free and ready for operation once it is live. The portal will be accessible via the community marketplace at www.isahd.ae and will offer consumers the ability to purchase health insurance plans in the name of the employer sponsors (for employees) or individual sponsors (for spouses, dependents, domestic workers). Participating insurers are limited to a specific range of underwriting questions. Satisfactory answers will allow the applicant to purchase immediate cover without further underwriting. At this stage, the DHA envisages these questions being limited to age, gender, number of insured lives, occupation, height and weight and pre-existing conditions. The insurer must have certain information available on or via the portal, including: (i) a rating engine, which will allow the applicant to view the cost of the insurance plan; (ii) full product details and policy documents (which must be legally compliant); (iii) an online payment facility; and (iv) a function enabling policy schedules and wordings to be downloaded or delivered by email. The portal will automatically update the DHA Member Register, which contains insurance related details, collected from insurance companies, about the insured population in Dubai.
All polices on the portal must meet the EBP requirements and the decision to include an insurer on the portal will be taken by the DHA, and will depend upon whether or not the product offered meets the objective of allowing the target audience to access affordable online health insurance cover in a simple and efficient manner.
There have been, and will continue to be, significant developments in health insurance laws and regulations in Dubai, reflecting and embracing the use of technology. It is anticipated that this may serve as a model for other GCC countries. All stakeholders in the sector should ensure they keep themselves updated with legal and technological developments, or they may find themselves shut out of a potentially lucrative, and growing, market.
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