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Abu Dhabi Government Health Plans FAQ
What are the main amendments to the Abu Dhabi Basic insurance plan?
- Premiums: Minor increases to the premiums. The amount will vary based on the member’s category and age group.
- Benefits: Minor amendments to the benefits as follows:
- Inpatient and Daycare: Out-of-pocket amount of
200 per admission with an annual cap of 500. - Medicines: Covering 70% of the costs of medicines, equivalent to 1,500, with a deductible of 30%.
- Diagnostic and lab services: 20% co-pay, max 50 per visit.
- Inpatient and Daycare: Out-of-pocket amount of
Why are these changes being made?
The changes are being made in line with the ongoing efforts to ensure that all community members receive continued access to the highest quality of care. The changes will also enhance efficiency in the delivery of healthcare services within the emirate, in accordance with best practices and international standards.
What changes are being made to the coverage for inpatient and daycare treatments?
Out-of-pocket expense is now 200 per encounter with an annual aggregate Out-of-pocket limit of 500.
What changes are being made to medications and pharmaceutical product coverage?
Under the Abu Dhabi Basic Health Insurance Plan, the coverage for medicines and pharmaceutical products remains the same, equal to 70% coverage within the policy’s network providers list, a deductible value of 30%, and a total coverage value of 1,500.
What changes are being made to diagnostics and laboratory services?
Previously, there was a deductible of 10 for lab tests and 10 for diagnostics. Now, there will be a 20% co-pay with a maximum amount of 50, including radiology.
When will these changes take effect?
The changes will take effect on the 1st of July 2024.
How do these changes benefit policyholders?
These changes aim to ensure the sustainability of the programme and the continuity of the coverage for all the eligible categories and age groups, while maintaining access to quality care, which aligns with the evolving needs of individuals and families living in Abu Dhabi.
Will there be any changes to the network of healthcare providers?
There is no changes in the current Basic Network. Policyholders can continue to access services from the existing network providers which comprises over 1,250 providers offering outpatient, inpatient, and emergency services in the various regions of the emirate of Abu Dhabi.
Access to quality healthcare providers remains unchanged through this update; however, Daman and the Department of Health constantly update the network as part of their regular network review.