Why We Need Medical Insurance

• High Cost of Healthcare
  • Medical treatment in the UAE is very expensive without insurance coverage.
  • Insurance helps manage and reduce out-of-pocket expenses for both routine and emergency care.
• Legal Requirement in the UAE
  • Mandatory from January 1, 2025:
    • Medical insurance is required by law in the UAE from this date.
    • This is essential for issuing or renewing residency permits.

• Penalties for Non-Compliance
• Failure to comply with the insurance requirement can lead to monthly fines for both employers and individual sponsors.
• The penalty for not having health insurance can range from AED 500 to AED 150,000 depending on the duration and severity of the violation.

Things You Need to Know Before Purchasing Medical Insurance in the UAE

• Types of Medical Insurance

1. Basic Medical Insurance
   • Coverage includes clinics only.
   • No direct access to hospitals unless it’s an emergency.
   • No direct access to specialists unless there is a referral from a General Practitioner (GP).
   • Typically has a lower premium, but:
     • The premium also depends on salary (whether it’s above or below AED 4,000).

2. Enhanced Medical Insurance
   • Covers both hospitals and clinics.
   • Allows direct access to specialists.
   • Coverage and network access depend on the specific plan selected within the enhanced policy.

• Factors That Affect Premiums

• • Age: A major factor in premium calculation — the older the person, the higher the premium.
  • Gender: Females generally have higher premiums compared to males.
  • Salary Bracket: Especially relevant for basic insurance plans.

Network Plans Under Basic and Enhanced Medical Policies

• Overview of Network Categories
  Medical insurance network plans are broadly classified into four types:

1. RN3 – Restricted Network 3
2. RN2 – Restricted Network 2
3. RN – Restricted Network
4. GN – General Network

RN3 (Restricted Network 3)

Enhanced plan:

•  RN3 provides access to clinics and specialists, but does not include hospitals.
• It allows different co-payment options, such as 20%, 10%, or 0%, depending on the sub-plan.

Basic plan:

• RN3 covers clinics only, with no direct access to specialists unless referred by a General Practitioner (GP).
• The co-payment in RN3 Basic is fixed at 20%, with no flexibility or option to reduce it.

RN2 (Restricted Network 2)

Enhanced Plan Only

• RN2 includes hospitals, clinics, and direct access to specialists.
• It also covers various treatments, including dental and optical care up to a certain limit.
• This plan offers multiple co-payment options, such as 20%, 10%, and 0%, providing better control over out-of-pocket expenses. 

RN and GN (Restricted Network and General Network)

Enhanced Plan Only

• RN and GN plans offer access to a larger network of hospitals and clinics, including some of the top medical facilities in the UAE.
• They cover a broader range of treatments and come with higher policy limits compared to RN2.
• The GN plan provides the widest coverage among all network types, with access to premium healthcare providers across the country.

Premium Consideration

• As the network coverage and benefits increase from RN3 to GN, the premium also increases.
• It is important to match your plan selection with your medical needs, lifestyle, and budget.

Co-payment in Medical Insurance

• A co-payment (or copay) is the portion of the medical bill that the patient pays out of pocket, while the rest is covered by the insurance provider.
• In Enhanced medical insurance plans, there are typically three co-payment options available: 20%, 10%, and 0%.
• The lower the co-payment, the higher the premium will be. For example, a 0% co-payment plan will cost more in premiums than a 20% co-payment plan.
• Regardless of which co-payment plan is selected, the consultation fee must always be paid at 20% by the patient. This does not change even in a 0% co-payment plan.

Important Things to Keep in Mind

1. Loading (Additional Premium Charges)

• Loading refers to an extra premium that may be added to the standard insurance premium based on certain risk factors.
• Several factors can affect whether loading is applied:
  • Age:
    As individuals get older, the risk of hospitalization and medical expenses increases, which can lead to higher premiums through loading.
  • Health Status:
    The overall health condition of the individual plays a role. Those with ongoing health issues may attract higher premiums.
  • Pre-existing Conditions or Diseases:
    If a person has existing medical conditions, they are more likely to file multiple claims, leading to higher expected costs for the insurer.
    As a result, the insurer may apply a loading on the premium due to the high-risk profile of the applicant.

2. Medical Application Form (MAF)

• The Medical Application Form (MAF) must be filled out accurately at the time of purchasing insurance.
• It is crucial to declare any pre-existing conditions in the MAF.
  Declaring these conditions ensures they are covered under the policy, and helps avoid claim rejection later.

3. Six-Month Waiting Period

• A waiting period refers to the time between purchasing the policy and when coverage begins for certain conditions.
• Treatment for chronic diseases and declared pre-existing conditions is usually covered without a waiting period.
• However, new conditions not declared at the time of purchasing the policy and non-chronic issues will typically have a waiting period of six months before coverage starts.
• This means that any undeclared or newly diagnosed conditions will not be covered immediately, and claims during the waiting period may be denied.

How Savington Insurance Brokers Help in the Medical Insurance Process

• Customers can begin by visiting the Savington Insurance Brokers website, where they can explore basic information or reach out for expert assistance. Once on the site, they have the option to connect directly with an insurance agent for a more personalized approach. The customer will be asked to share the necessary documents. After this, an assigned agent will guide them step-by-step through the selection and application process, ensuring a smooth and informed experience.

Customers will be provided with:

• A Rate Sheet – showing the premium options based on network and co-payment choices.
• A Table of Benefits (TOB) – outlining what’s covered under the plan.
• A Network List – detailing the clinics, hospitals, and specialists available in each plan.

The process is designed to be transparent, quick, and tailored to meet each customer’s medical and financial requirements. With expert guidance and access to the most up-to-date policy details, Savington ensures that every customer receives the right coverage with confidence—truly living up to the promise of being Safe, Secured, and Insured.

Savington Insurance can guide customers on choosing and renewing the right policy.
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