Essential Benefits Plan Medical Insurance

The Essential Benefits Plan, commonly known as EBP, is the minimum medical-insurance standard established for eligible residents in Dubai. It provides access to essential healthcare services through the medical network assigned to the issued policy.

EBP benefits are not unlimited. Coverage remains subject to the policy schedule, annual and benefit-specific limits, co-payments, deductibles, pre-authorisation requirements, exclusions and waiting periods.

Who May Need an Essential Benefits Plan?

Medical coverage may need to be arranged for eligible:

1. Private-Sector Employees: Employers must arrange at least the applicable minimum medical coverage for eligible employees working for Dubai-registered companies, including applicable free-zone entities.
2. Spouses and Children: Sponsors must arrange medical insurance for eligible dependants when coverage is not provided through another valid policy.
3. Domestic Workers: Sponsors are responsible for arranging suitable medical insurance for eligible domestic workers under their sponsorship.
4. Self-Sponsored Residents: Investors, freelancers and other eligible self-sponsored residents may need to purchase their own medical insurance.

What May an EBP 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 policy 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 treatment, 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 applicable limits, co-payments, waiting periods and policy conditions.

How to Use an EBP Medical Policy:

Follow these steps before receiving non-emergency treatment:

1. Check Your Assigned Network: Confirm that the hospital, clinic, pharmacy or specialist is included in the network stated on your medical insurance card.
2. Present Your Documents: Show your valid Emirates ID and medical insurance card when visiting the healthcare provider.
3. Confirm the Benefit: Ask whether the consultation, test, medicine or treatment is covered and whether a co-payment applies.
4. Follow Referral Requirements: Some specialist consultations may require a referral from a general practitioner, depending on the policy.
5. Obtain Prior Approval: Certain tests, medicines, procedures and hospital admissions may require pre-authorisation.

What to Check Before Selecting an EBP:

Review these important policy details:

1. Medical Network: Confirm that suitable hospitals, clinics and pharmacies are available near your home or workplace.
2. Annual Coverage Limit: Review the total annual limit and any separate limits applying to individual medical benefits.
3. Co-payments and Deductibles: Check how much the insured member may need to contribute when receiving treatment.
4. Pre-authorisation: Understand which medicines, investigations, treatments and admissions require approval.
5. Geographical Coverage: Confirm whether the medical network includes providers only in Dubai or also in other emirates.
6. Exclusions and Waiting Periods: Review services that are excluded, restricted or available only after a stated waiting period.

Can Additional Benefits Be Included?

An employer, sponsor or individual may select medical coverage that provides benefits beyond the minimum EBP requirements. Additional benefits may include a broader medical network, higher limits or selected dental, optical, maternity or geographical benefits.

Additional services are not automatically included and may result in a different premium. The quotation and schedule of benefits should be reviewed before purchasing the policy.

How to Request EBP Medical 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 medical conditions, previous treatment and other requested information accurately.
4. Review the Available Plan: Check the medical network, benefits, 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. Policy Support: Assistance is available for new enquiries, policy issuance, renewals and endorsements.
4. Medical-Service Support: Members can request assistance with network enquiries, pre-authorisation and reimbursement claims.

Frequently Asked Questions: