A couple of days ago I wrote an article that identified the fundamental structural differences between an individual health cover and a group policy. I explained how price is usually not the key difference – the cover is. Predominantly, you will find that group medical policies have the ability to disregard medical history and therefore cover pre-existing conditions – in addition to lots of other things like maternity without waiting periods and general check-ups.
This article serves to firstly define group medical policies, identify the different kinds of group medical policies available here in Dubai and thereafter some recommendations on what you should be doing in order to get it right. A group medical insurance policy is usually bought by a registered organisation – it could be a for-profit entity or otherwise. As a result of being on a ‘group’ basis, the individuals within the group benefit from economies of scale and scope.
Practically speaking, though it is possible to quote on a ‘group’ basis for a company having as low as two employees, the real benefits of being structured as a group come about when an organisation is able to insure at least ten employees. The main feature here is that you would usually require more than five employees to start having a ‘medical history disregarded’ policy whereby all pre-existing conditions are covered without a medical history being declared by each of the individual members within the group.
When reviewing different group medical insurance policies in Dubai, you would find prices varying significantly from product to product. Indeed you can have a policy that costs just AED 400 per member all the way up to AED 50,000 per member or even more! As a result, it’s important to understand the differences between policies when purchasing.
HMO – Health Maintenance and Organisation – plans for blue collar workers – usually priced between AED 400 and AED 900.
Family Plan – individual policies grouped by family – prices range from around AED 2000 per member to over USD 15,000 depending on various factors and product covers.
Capped Pre-existing SME – plans for usually smaller companies with a limited coverage for pre-existing conditions.
In-Patient Only Plan – a very cost effective solution that only covers the financial catastrophe that is in-patient. Usually these policies have a higher excess as well.
Full Pre-existing SME subject to individual critical illness application – usually for companies with more than five employees and less than twenty five. All members would have pre-existing conditions covered subject to a confirmation from each one that nobody has a critical illness (as defined by the insurance company).
Medical History Disregarded (MHD) – MHD plans are usually offered to companies with more than ten employees. While these plans are not cheap, they would cover all pre-existing conditions without any questions asked or declarations completed.
Large Corporate – plans that cover groups of employees starting from a census of fifty. These are usually able to cover pre-existing ailments to the policy limit however in view of the recent poor performance of most of these portfolios (i.e. a higher amount being paid in claims than insurance premium), the benefits may be restricted in order to meet certain budgetary requirements.
As there are various types of products available in the UAE insurance market, sometimes you may find a combination of the above plans. It’s best to completely understand the policy you are buying before you buy it and make sure you have a very trustworthy advisor who is not trying to simply make a sale but rather developing a long term service relationship backed by solid logical reasoning as to why a certain product would work best for you.
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[Image source: nomedicallifeinsurance.ca]