Basic Health Insurance in the UAE

Basic health insurance provides access to essential medical services through the healthcare network assigned to the policy. The exact benefits, annual limits, co-payments, exclusions and approval requirements depend on the selected plan and the rules applicable to the insured member.

Health-insurance requirements differ across the UAE. Dubai and Abu Dhabi have their own health-insurance frameworks, while the federal Basic Health Insurance Scheme applies to eligible private-sector employees and domestic workers who are not already covered under those local systems.

Who May Need Basic Health Insurance?

Medical coverage may need to be arranged for:

1. Private-Sector Employees: Employers are responsible for arranging the required medical insurance for eligible employees under the applicable framework.
2. Domestic Workers: Employers or sponsors must arrange suitable medical coverage for eligible domestic workers.
3. Family Dependants: Sponsors may need to arrange separate coverage for spouses, children and other eligible dependants who are not insured under another policy.
4. Self-Sponsored Residents: Investors, freelancers and other self-sponsored residents may need to purchase their own health insurance.

What May Basic Health Insurance Cover?

Depending on the issued policy, benefits may include:

1. Outpatient Consultations: Eligible consultations with general practitioners and approved specialists within the assigned medical network.
2. Diagnostic Services: Medically necessary laboratory tests, imaging and other investigations, subject to applicable limits and approval requirements.
3. Prescribed Medicines: Approved medicines may be covered according to the applicable formulary, benefit limit and co-payment.
4. Inpatient Treatment: Eligible hospital admissions, surgeries and related medical care, subject to medical necessity and pre-authorisation.
5. Emergency Treatment: Emergency medical services may be covered according to the policy terms and geographical limits.
6. Maternity Benefits: Eligible maternity services may be included, subject to limits, co-payments, waiting periods and policy conditions.

Health Insurance Requirements Across the UAE:

The applicable framework depends on the insured member’s circumstances:

1. Dubai: Residents must maintain valid health insurance under Dubai’s applicable health-insurance framework.
2. Abu Dhabi: Residents are covered under the applicable Abu Dhabi health-insurance framework based on their nationality, employment, sponsorship and eligibility category.
3. Sharjah and the Northern Emirates: Since 1 January 2025, employers must purchase health insurance for eligible private-sector employees and domestic workers when issuing or renewing applicable residence permits.

How to Use Basic Health Insurance:

Follow these steps before receiving non-emergency treatment:

1. Check the Assigned Network: Confirm that the hospital, clinic, pharmacy or specialist is included in the network shown on your medical card.
2. Present Your Documents: Show your valid Emirates ID and medical insurance card at the healthcare provider.
3. Confirm the Benefit: Check whether the consultation, test, medicine or treatment is covered under the policy.
4. Obtain Approval When Required: Some medicines, investigations, procedures and hospital admissions require prior authorisation.
5. Pay the Applicable Share: The insured member may need to pay a co-payment, deductible or non-covered expense.

What to Check Before Selecting a Plan:

Review these important policy details:

1. Medical Network: Confirm that suitable hospitals, clinics, pharmacies and specialists are available near your home or workplace.
2. Coverage Limits: Review the overall annual limit and any separate limits applying to medicines, maternity or other benefits.
3. Co-payments and Deductibles: Check how much you may need to contribute when receiving medical services.
4. Referral and Approval Rules: Confirm whether a general-practitioner referral or prior approval is required for certain services.
5. Geographical Coverage: Check whether the policy can be used within one emirate, across the UAE or in other countries.
6. Exclusions and Waiting Periods: Understand which treatments are excluded, restricted or available only after a stated waiting period.

How to Request Basic Health Insurance:

Follow these steps:

1. Provide the Applicant’s Details: Enter the applicant’s personal, identification, contact and residency information.
2. Provide Employer or Sponsor Details: Submit the applicable employment, family sponsorship or self-sponsorship information.
3. Complete the Medical Declaration: Disclose existing conditions, previous treatment and other requested medical information accurately.
4. Review the Available Coverage: Check the benefits, medical network, limits, co-payments and exclusions.
5. Submit the Required Documents: Provide the requested identification, residency and supporting records.
6. Review the Quotation: Confirm the premium and policy conditions before completing the application.

Documents Required:

You may need the following documents:

1. Emirates ID
2. Passport copy
3. Residence visa copy or visa application details
4. Employer or sponsor information
5. Employment or domestic-worker details, where applicable
6. Previous medical insurance details, if available
7. Medical declaration or supporting reports, if requested

Why Choose Al Buhaira Insurance?

Eligible applicants and members can access:

1. Online Medical Quotation: Applicants can submit their personal and medical information through the online medical-insurance quotation journey.
2. Medical Network Search: Members can search healthcare providers by network, emirate, provider type and speciality.
3. In-House and TPA Networks: Medical policies may use an Al Buhaira in-house network or an appointed Third Party Administrator, depending on the issued plan.
4. Medical Insurance Support: Assistance is available for policy enquiries, renewals, endorsements, network questions, approvals and reimbursement claims.

Frequently Asked Questions: