Essential Benefits Plan Health Insurance
The Essential Benefits Plan, commonly known as EBP, provides the minimum
level of medical coverage required for eligible residents in Dubai. It
helps insured members access essential healthcare services through an
approved medical-provider network.
The available benefits, annual limits, co-payments, medical network and
approval requirements depend on the issued policy and its schedule of
benefits.
Who May Need an Essential Benefits Plan?
EBP coverage may be arranged for eligible:
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Employees:
Employers must arrange suitable medical insurance for eligible employees
working for Dubai-registered companies.
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Spouses and Children:
Sponsors may need to arrange medical coverage for eligible dependants
who are not insured through another valid policy.
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Domestic Workers:
Sponsors are responsible for arranging suitable medical insurance for
eligible domestic helpers under their sponsorship.
-
Other Eligible Residents:
Self-sponsored residents and other applicants may request appropriate
medical coverage according to their residency category.
What May an EBP Cover?
Depending on the policy, essential benefits may include:
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Outpatient Consultations:
Eligible consultations with general practitioners and approved
specialists within the assigned network.
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Diagnostic Services:
Medically necessary laboratory tests, scans and other investigations,
subject to policy requirements.
-
Prescribed Medicines:
Approved medicines may be covered according to the applicable formulary,
benefit limits and co-payment.
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Inpatient Treatment:
Eligible hospital admissions, surgeries and related treatment, subject
to medical necessity and prior approval requirements.
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Emergency Treatment:
Emergency medical services may be covered according to the policy terms
and geographical limits.
-
Maternity Benefits:
Eligible maternity services may be included, subject to waiting periods,
limits, co-payments and other policy conditions.
How to Use an EBP Medical Policy:
Review these steps before receiving treatment:
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Check Your Assigned Network:
Use hospitals, clinics, pharmacies and other providers included in the
specific network shown on your medical insurance card.
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Visit a General Practitioner:
A GP consultation and referral may be required before visiting a
specialist or consultant.
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Present Your Documents:
Show your valid Emirates ID and medical insurance card at the healthcare
provider.
-
Obtain Approval When Required:
Certain treatments, tests, medicines and hospital admissions require
prior authorisation.
-
Pay the Applicable Share:
The insured member may need to pay a co-payment or deductible according
to the policy.
What to Check Before Selecting an EBP:
Review these important policy details:
-
Medical Network:
Confirm that suitable healthcare providers are available near your home
or workplace.
-
Coverage Limits:
Review the annual policy limit and any separate limits applying to
individual benefits.
-
Co-payments:
Check the amount payable for consultations, medicines, diagnostic tests
and other services.
-
Referral Requirements:
Confirm whether a GP referral is required before specialist treatment.
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Exclusions and Waiting Periods:
Understand which services are excluded, restricted or available only
after a waiting period.
Documents Required:
You may need the following documents:
- Emirates ID
- Passport copy
- Residence visa copy or visa application details
- Employer or sponsor information
- Employment or domestic-worker details, where applicable
- Previous medical insurance details, if available
- Medical declaration or reports, if requested
Why Choose Al Buhaira Insurance?
Eligible customers can access:
-
Essential Benefits Plan Networks:
Al Buhaira works with appointed TPA networks for eligible EBP medical
policies.
-
Appointed TPA Options:
Eligible policies may be administered through NextCare, FMC, Aafiya or
NAS, depending on the assigned plan.
-
Online Quotation:
Applicants can submit their personal and medical details through the
online medical-insurance quotation journey.
-
Medical Network Search:
Members can review healthcare providers according to their assigned
network, emirate, provider type and speciality.
Frequently Asked Questions:
Ans: An EBP is the minimum level of medical insurance established for eligible Dubai residents, providing access to essential healthcare services through an assigned network.
Ans: Not necessarily. It provides essential benefits according to the applicable minimum standard. Wider networks or additional benefits require a different or enhanced plan.
Ans: No. Members should generally use providers included in the specific medical network assigned to their policy.
Ans: A referral from a general practitioner may be required before specialist or consultant treatment, except where the policy or applicable rules provide otherwise.
Ans: A co-payment or deductible may apply to consultations, medicines, diagnostic services and other treatment. Check the schedule of benefits for details.
Ans: Eligible applicants can submit their information through Al Buhaira Insurance’s online medical-insurance quotation service.
