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The headline changes to our health plans for UAE residents:
- Low average inflationary premium increases for existing customers
- New benefit for accidental death
- Improvements to the way we calculate insurance premiums
- Changes apply to health plans starting on or after 01 June 2021
Our values
We believe in people
Some insurers rely on AI and Big Data to do their work for them. We think differently. Healthcare is a highly personal experience, so it deserves a personal service. We’re a team of real people, at the end of a phone call when customers really need us.
Committed to fairness
Healthcare is expensive, and— sadly—costs are on the up. We do everything possible to spread this inflation fairly. We calculate premiums with a long- term pricing model, and we give customers tailoring tools to help reduce their premium without significantly compromising their cover.
Transparency matters to us
Insurance is about trust, so we believe in being fair and open. This belief informs our idea of healthcare as a partnership between our customers and us. That’s why we’re completely upfront with our health plans, and we want customers to understand precisely what they’re buying.
Commitment to relationships
The UAE (and especially Dubai) is a transactional marketplace. We’ve been active in Dubai since 2006, and in that time providers have come and gone. We remain committed to providing international insurance in the UAE. As usual, we prioritise a consultative approach with our brokers and customers and premiums that are sustainable for the long term.
Some housekeeping
CEGA no longer provides our 24-hour medical assistance
Members can now contact NEXtCARE at +971 4 270 8800 or nextcare@nextcarehealth.com.
Benefit changes for Flex
Ambulance benefit
The ambulance benefit now includes cover for air ambulances, in addition to road ambulances.
Kidney dialysis
We now cover kidney dialysis in full, regardless of whether the member is an in-patient, day-patient or out-patient.
Mental health treatment
We’re increasing the annual limit and reducing the co-insurance. We’ve also clarified the benefit wording for out-patient mental health treatment, which now includes consultations with a registered counsellor. We also now cover out-patient mental health drugs.
| Plans starting before 01 June 2021 | Plans starting on/after 01 June 2021 | |
|---|---|---|
| Annual limit for mental health treatment |
US$1,362 (subject to 30% co-insurance) | US$2,500 (subject to 20% co-insurance) |
Medical aids
We no longer exclude medical aids that form part of the care of a chronic condition, including insulin pumps, reservoirs, glucose sensors, lancets, and quickset infusions.
Physiotherapy
We no longer exclude physiotherapy that aims at maintaining (rather than curing) chronic conditions.
Repatriation of mortal remains
If you die as a result of a condition that is covered by your plan, we will now pay up to US$2,500 for your body or ashes to be transported to your country of residence or nationality.
COVID-related primary medical care
We now include the COVID-19 PCR test and antigen testing within the primary medical care benefit, provided the member is experiencing relevant symptoms such as cough or fever.
COVID-related preventive health & well-being
We now include COVID-19 vaccinations administered in the member’s country of residence, plus an initial COVID-19 PCR and antigen test when the member has been in close proximity with someone who has tested positive for COVID-19.
Pre-existing & chronic medical conditions
We now provide full cover for pre-existing and chronic medical conditions.
Complementary treatments
We’ve removed the restriction on receiving complementary treatments in the 90-day period following the member’s discharge from hospital. Any co-insurance is subject to the co-insurance selected by the employer.
Refiguring the maternity benefit
We now refer to the routine out-patient maternity care and newborn care benefit simply as ‘routine out- patient maternity care’. We’ve also separated the in-patient maternity care benefit from the newborn care benefit in the table of benefits.
Finally, we’ve removed two exclusions:
- We no longer exclude treatment of newborn children following assisted reproduction in the event of birth occurring within 36 weeks of conception.
- We no longer exclude treatment for complications arising from a pregnancy established through assisted reproduction until after the standard 12-week scan.
Benefit changes for Silver and Gold
Ambulance benefit
The ambulance benefit now includes cover for air ambulances, in addition to road ambulances.
Cancer benefits
We’ve added cover for mental health treatment under the counselling benefit of each plan. We’ve also made some changes to differentiate the cancer benefits under Silver and Gold.
| Plans starting before 01 June 2021 | Plans starting on/after 01 June 2021 | |
|---|---|---|
| Wig benefit (Gold) |
US$150* | US$250* |
| Counselling benefit (Gold) |
US$500* | US$750* |
| Dietitian benefit (Gold) |
US$100* | US$250* |
| Counselling benefit (Silver & Gold) |
10 consultations with a psychologist/counsellor | 10 consultations, plus drugs prescribed for mental health treatment* |
*Lifetime limit
Mental health treatment
We now cover out-patient mental health drugs.
| Plans starting before 01 June 2021 | Plans starting on/after 01 June 2021 | |
|---|---|---|
| Out-patient mental health medication |
No cover | US$500 (subject to 20% co-insurance) |
Medical aids
We no longer exclude medical aids that form part of the care of a chronic condition, including insulin pumps, reservoirs, glucose sensors, lancets, and quickset infusions.
Complementary treatments
We no longer exclude complementary treatments that aim at maintaining (rather than curing) chronic conditions.
Physiotherapy
We no longer exclude physiotherapy that aims at maintaining (rather than curing) chronic conditions.
COVID-related preventive health & well-being
We now include COVID-19 vaccinations administered in the member’s country of residence, plus an initial COVID-19 PCR and antigen test when the member has been in close proximity with someone who has tested positive for COVID-19.
Refiguring the maternity benefit
We now refer to the routine out-patient maternity care and newborn care benefit simply as ‘routine out- patient maternity care’. We’ve also separated the in-patient maternity care benefit from the newborn care benefit in the table of benefits.
Finally, we’ve removed two exclusions:
- We no longer exclude treatment of newborn children following assisted reproduction in the event of birth occurring within 36 weeks of conception.
- We no longer exclude treatment for complications arising from a pregnancy established through assisted reproduction until after the standard 12-week scan.
Accidental death benefit
We pay out US$15,000 if a member dies as a consequence of accidental bodily injury while the member’s plan is in force. The member must have a Gold plan, death must occur within 12 months of the accidental bodily injury, and the accidental bodily injury must not be caused by anything excluded in the plan agreement or by special terms on the member’s certificate of insurance.
Changes to our pricing model
Average inflationary premium increase
The average inflationary premium increase from DIC-20/21 to DIC-21/21 is 4.9%. We’re funding this increase in different ways across our portfolio. The inflationary premium increase is in addition to the normal age-related premium increases.
Does the 4.9% average inflationary premium increase vary?
Yes, sometimes by quite a margin. It depends on how you put together the plan, the excess, network, age of the member, and plan selection.
Premium swings can occur with different options. Among those who’ll experience higher-than-average premium increases are members with the General Network, US$15 excess with nil co-pay on Flex, US$15 excess on Silver/Gold, and Flex 3. We estimate that the lowest increase a member could experience is -1%, while some members may experience an increase as high as 7.5%.
What else is changing?
We’re changing all the excess discounts and the price differentials between the Flex 1, 2 and 3 options. We’re also changing how we price the optional dental. From 01 June 2021, the optional dental benefits will cost a flat premium loading, rather than a percentage.
Changes to child discounts
We’re reducing the discount we give to second and subsequent children on health plans. The discounts apply to new business and renewals.
| Discounts for plans starting before 01 June 2021 |
Discounts for plans starting on/after 01 June 2021 |
|
|---|---|---|
| First child | 0% | 0% |
| Second child | 10% | 5% |
| Third child onwards | 15% | 7.5% |
Changes to exclusions
We’re making the following changes to the exclusion section of the plan agreements for health plans starting on/after 01 June 2021.
Accidental bodily injury
| Plans starting before 01 June 2021 | Plans starting on/after 01 June 2021 |
|---|---|
You are not covered for:
We’ll only pay for patch testing if you’ve been referred by a medical doctor. |
You’re not covered for treatment related to:
|
Circumcision
| Plans starting before 01 June 2021 | Plans starting on/after 01 June 2021 |
|---|---|
| You’re not covered for treatment relating to circumcision unless it’s required for treatment of an acute medical condition covered by your plan. | You’re not covered for treatment relating to circumcision unless it’s for a newborn covered by your plan or unless it’s required for treatment of an acute medical condition covered by your plan. |
Drugs prescribed for out-patient mental health treatment
| Plans starting before 01 June 2021 | Plans starting on/after 01 June 2021 |
|---|---|
| You’re not covered for drugs prescribed for out-patient mental health treatment. | n/a |
Foetal anomalies
| Plans starting before 01 June 2021 | Plans starting on/after 01 June 2021 |
|---|---|
| n/a | Any investigations, tests or procedures carried out with the intention of ruling out any foetal anomaly. |
Foetal surgery
| Plans starting before 01 June 2021 | Plans starting on/after 01 June 2021 |
|---|---|
| You’re not covered for surgery undertaken on a child while it’s in its mother’s womb. | n/a |
The above changes apply to residents of the UAE whose health plan renews on or after 01 June 2021. Our article on the changes we’ve made to health plans for residents living anywhere other than the UAE is available on our blog.
