Essential Benefits Plan

What is the Essential Benefits Plan (EBP)?

The Essential Benefits Plan or EBP for short is the minimal level of health insurance cover that residents of Dubai are required to meet or exceed under Dubai law.

Who is eligible for the EBP?

The EBP is for Dubai residents who are earning less than AED 4,000 per month, which includes dependents who may not work at all. Those earning more than AED 4,000 are not eligible for the EBP, but as a minimum their medical insurance will meet the standards outlined in the EBP.

How much does the EBP cost?

The Essential Benefits Plan has a fixed cost of between AED 550 and AED 650 per year.

What level of cover does the Essential Benefits Plan provide?

The EBP coverage includes emergencies, surgeries, medical tests, medication, outpatient and inpatient treatments and maternity. However, there are restrictions, limitations and co-insurance (the amount the insured person will have to pay) stipulations in place.

These include;

• An annual claim limit of AED 150,000
• Emergency medical treatment limited to Emirates within the UAE
• Basic healthcare services within the Emirate of Dubai
• Treatment for chronic and pre-existing conditions are not included for the first 6 months, but are included after.
• For basic in-patient healthcare services there is a 20% co-insurance payable by the person insured with a cap (the most that can be paid) of AED 500 per encounter, and an annual aggregate cap of AED 1,000. Anything above these caps the insurer will pay for.
• Cost of drugs and medicines up to an annual limit of AED 1,500 – there’s a 30% co-insurance (payable by the person insured) in respect of each and every prescription.

The complete details of coverage can be found in DHA’s Employer’s Information Pack.

Does the EBP provide maternity coverage?

The EBP provides some cover for maternity, this includes;

• Out-patient antenatal services – blood tests, 3 ultrasounds, and 8 pre-delivery visits.
• In-patient services – normal birth delivery of up-to AED 7,000 and AED 10,000 for medically necessary C-section.
• Coverage for newborn – 30 days coverage for the newborn child from the date of birth under the mother’s insurance policy for tests and screenings.

For out-patient and in-patient maternity services there is a 10% co-insuance that will need to be paid by the person insured.

The complete details of coverage can be found in DHA’s Employer’s Information Pack.

What companies can provide EBP?

Only a small number of insurers called ‘Participating Insurers’ are able to provide EBPs. The DHA wanted to ensure that the most vulnerable workers are protected, and as such insurers are restricted in the amount of profit they can make. Only insurers who can handle high volumes of business, and can demonstrate operational effectiveness and high levels of customer service are able to sell the Essential Benefits Plan. These companies are their websites and listed below.