Industry experts say insurance providers are suffering from huge backlog of applications and have failed to provide cards.
Despite complying with the June 30 deadline for mandatory health insurance for workers, employers say they are yet to get insurance cards. Many insurance companies have failed to process the paperwork and are struggling to clear the backlog, industry experts said.
Gulf News received many complaints about the failure of insurance companies to provide cards.
Dubai Health Authority (DHA) implemented a phased rollout of the mandatory health insurance scheme in February last year. This is in line with the Health Insurance Law No 11 of 2013. Companies with less than 100 employees were part of Phase II of the implementation which ended on June 30 this year.
Only dependants and domestic workers got an extended insurance deadline until the end of the year.
Companies filled in and submitted paperwork to insurance companies well before the deadline. However many complain that they have yet to receive any proof that the insurance is through although payments for the coverage have been realised.
Experts say insurance coverage follows two or three meticulous steps.
Step one: Employers have to provide a complete set of documents for each employee. The papers include Emirates ID, passport copies and photographs.
Step two: Insurance broker’s representatives check the documents, submit them to the insurance company and the underwriter processes each case.
Step three: After underwriting, the employer seeking the coverage issues a debit note for payments and the insurance company issues a certificate once the money is realised.
Step four: The Third Party Administrator steps in to execute the insurance and issues insurance cards to employees.
However, brokers say lack of proper knowledge of processes, lack of availability of trained executives and a backlog of applications has slowed down the process. Insurance companies are lost in the paperwork and have not been able to complete steps two, three and four, they said.
Speaking to Gulf News on the condition of anonymity, a director of a brokerage firm that liaises for group insurances between companies and the parent insurance company, said: “It is a complete mess and the end user who has been denied a card is suffering. Most insurance companies are understaffed as they were not prepared for the increased demand. They rely on brokers to complete paperwork but to process those papers is a tedious process. Owing to the summer vacations, half-day working hours during Ramadan, followed by long Eid holidays, work has not been done at the desired pace. The companies have taken money for insurance but are struggling to issue certificates to the group or cards to the individuals. There is a long waiting list of companies. Now they have stopped picking up our phones to explain the delay and we have cases where workers in need of surgical intervention are suffering as they have to pay themselves.”
In one case, an employee whose visa was expiring was stuck as the group policy had not been processed. Ultimately, after a lot of pressure, the insurance company just issued one individual certificate for her, while others were left in the lurch.
In absence of the insurance card, workers have to pay for treatment. Two days ago R.V., an Asian employee was rushed to Rashid Hospital with acute appendicitis pain and he had to be operated. Although his company has paid for the group insurance, cards have not yet been issued. The hospital bill for the surgery was Dh15,000 which has been paid by R.V.. Whether he will get reimbursed for the surgery is a tricky question.
“In some cases where a certificate has been issued to the employer it might be possible to claim reimbursement later as the company has already paid the amount for the coverage. In other cases, where the certificate was not issued, there is no way a company can realise the hospital bill. Besides there needs to be a new Dubai Health Authority (DHA) compliant claim form for these particular groups, which is not ready as yet,” added the representative of RV’s company.
The worst affected are blue collar workers. At a clinic in Al Quoz, the receptionist said that even now nearly 30 per cent were cash patients in their clinic as their companies had failed to give them an insurance card.
Momin B., a Bangladeshi working as a cleaner for seven years in a Dubai-based company who had severe abdomen pain, shelled out Dh180 for a GP consultation followed by blood and stool investigations. “I have been pleading for an insurance card but they say they are unable to provide it because of the delay in processing. I do not know when I will get it and I earn only Dh600. Paying Dh180 is unaffordable for me but I have no choice.”
The receptionist said that in some cases generous employers were themselves offering to reimburse the amounts on actual bills for the time-being.
A Third Party Administrator who implements the insurance conditions by providing the network of hospitals and clinics told Gulf News: “Unless the authorities step in and take firm action against these tardy companies it might easily take at least a year for things to function smoothly.”
In the meanwhile employers who have paid but have been unable to get insurance cards for their employees can register their complaints with DHA on their website www.ishad.ae.
Phase I, completed on October 31, 2014, covered all companies with more than 1,000 employees.
Phase II ended on July 31, 2015 and covered companies with 100 to 999 employees.
Phase III, that ended on June 30, 2016, was to cover companies with 100 or less employees and by December 30 spouses, dependants and domestic workers will be brought under the insurance scheme.
Source: Gulf News