Law
No. (11) of 2013
Concerning
Health
Insurance in the Emirate of Dubai[1]
ــــــــــــــــــــــــــــــــــــــــــــــ
We, Mohammed bin Rashid Al
Maktoum, Ruler of Dubai,
After
perusal of:
Federal
Law No. (6) of 2007 Establishing the Insurance Authority and Regulating the
Insurance Business and its amendments;
Law
No. (3) of 2003 Establishing the Executive Council of the Emirate of Dubai;
Law
No. (9) of 2004 Concerning the Dubai International Financial Centre and its
amendments;
Law
No. (13) of 2007 Establishing the Dubai Health Authority;
Decree
No. (22) of 2009 Concerning Special Development Zones in the Emirate of Dubai;
Decree
No. (9) of 2012 Approving a Pricing Method for the Dubai Health Authority
Services; and
The
legislation regulating free zones in the Emirate of Dubai,
Do hereby issue this Law.
This Law will be cited as “Law
No. (11) of 2013 Concerning Health Insurance in the Emirate of Dubai”.
The following words and
expressions, wherever mentioned in this Law, will have the meaning indicated
opposite each of them unless the context implies otherwise:
|
UAE: |
The United
Arab Emirates. |
|
Emirate: |
The Emirate
of Dubai. |
|
Government: |
The Government
of Dubai. |
|
Executive Council: |
The
Executive Council of the Emirate of Dubai. |
|
DHA: |
The Dubai
Health Authority. |
|
Concerned Entity: |
A Government
entity concerned with the implementation of this Law. |
|
Director General: |
The director
general of the DHA. |
|
Health Insurance: |
Enjoyment
by a Beneficiary of Health Benefits as stipulated in this Law and the
resolutions issued in pursuance hereof. |
|
Beneficiary: |
A
natural person who is entitled to Health Insurance in accordance with this
Law. |
|
Health Benefits: |
The
set of health services a Beneficiary obtains from a Health Service Provider
pursuant to a Health Insurance Policy. |
|
Coverage Provider: |
The entity
which bears the cost of Health Benefits that a Health Service Provider
provides to a Beneficiary, including the Government and the Insurance Company. |
|
Health Insurance Policy: |
A document
which determines the rights and obligations of a Beneficiary and a Coverage
Provider in all matters relating to Health Benefits. |
|
Basic Coverage: |
The minimum
Health Benefits prescribed for a Resident under the resolutions issued in
pursuance hereof. |
|
Supplementary Coverage: |
The Health
Benefits provided to a Beneficiary in addition to the Basic Coverage. |
|
Co-insurance: |
A lump
sum or percentage determined in the Health Insurance Policy which must be
paid by a Beneficiary when he receives Health Benefits. |
|
Health Insurance Card: |
A document
issued by a Coverage Provider to a Beneficiary to present to a Health Service
Provider, which proves his enrolment in Health Insurance for the Coverage
Period stated therein. |
|
Coverage Period: |
The period
starting from the commencement date and ending on the expiry of the Health
Insurance Policy. |
|
Health Service Provider: |
A Government
or private healthcare facility authorised to provide Health Benefits to
Beneficiaries in accordance with this Law and the resolutions issued in
pursuance hereof. |
|
Health Service Provider Network: |
The list
of names and addresses of the Health Service Providers stated in the Health
Insurance Policy. |
|
Insurance Company: |
An
insurance or Takaful insurance company licensed in the UAE to conduct
insurance business and authorised by the DHA to conduct Health Insurance
activities in the Emirate. |
|
Claim Management Company: |
An
establishment licensed in the UAE to conduct the insurance claims settlement
activity and authorised by the DHA to conduct Health Insurance activities in
the Emirate. |
|
Insurance Broker: |
An
establishment licensed in the UAE to conduct the insurance brokerage activity
and authorised by the DHA to conduct the activity of marketing or sale of
Health Insurance Policies in the Emirate. |
|
Authorisation: |
A document
issued by the DHA which authorises the conduct of any activity related to
Health Insurance in the Emirate in accordance with the terms and requirements
stipulated in this Law and the resolutions issued in pursuance hereof. |
|
UAE National: |
A
natural person holding the UAE nationality. |
|
Resident: |
A
natural person who does not hold UAE nationality but who holds a valid
residence permit issued by the competent authority in the Emirate. |
|
Employer: |
A
public or private natural or legal person who engages employees or workers
for remuneration of whatever nature. |
|
Sponsor: |
A
natural or legal person who sponsors, in accordance with the legislation in
force in the Emirate, a non-UAE National natural person for the purpose of visiting
or residing in the UAE. |
|
Visitor: |
A
natural person, including tourists, who visits the UAE through the Emirate in
accordance with applicable legislation. |
|
Emergency Case: |
A case
which requires an immediate medical intervention by a Health Service Provider
to save, or eliminate a threat to, a person’s life. |
This
Law aims to:
1. provide the Emirate with a high-quality
integrated health system which is flexible and upgradable, and which meets the
expectations of Beneficiaries;
2. establish an efficient and sustainable
health financing system;
3. create a health system which attracts
investment in, and preserves the competitiveness of, the Emirate; and
4. provide health services within a
framework in which the rights of all parties involved are protected.
This
Law will apply to all areas of the Emirate including Special Development Zones and
free zones such as the Dubai International Financial Centre. This Law will also
apply to the following persons and categories of persons:
1. UAE Nationals;
2. Residents;
3. Visitors;
4. Employers;
5. Sponsors;
6. Health Service Providers;
7. Insurance Companies;
8. Claim Management Companies;
9. Insurance Brokers; and
10. any other person or category of persons determined by the Executive Council upon recommendation of the DHA.
For the purposes of this Law, the DHA will have the duties and powers to:
1. establish policies, plans, procedures,
regulations, and standards required for the implementation of this Law;
2. pre-qualify and categorise Insurance
Companies, Claim Management Companies, and Insurance Brokers who will conduct the
Health Insurance business in the Emirate in accordance with relevant criteria approved
by the DHA;
3. issue Authorisations to Health Service
Providers, Insurance Companies, Claim Management Companies, Insurance Brokers, and
any other entity wishing to conduct any Health Insurance activity in the
Emirate, in accordance with the criteria and terms determined pursuant to
relevant resolutions issued by the DHA;
4. review and approve the method of
presenting claims, and of payment and settlement of financial dues arising from
Health Insurance in the Emirate;
5. approve charges for the health
services provided by Health Service Providers, and monitor their compliance
with approved charges;
6. approve Health Insurance packages,
their prices, Co-insurance, and Health Insurance Policy forms,
in accordance with terms and criteria determined pursuant to relevant
resolutions issued by the DHA;
7. establish principles and rules for
data processing and protection at Insurance Companies, Claim Management
Companies, Insurance Brokers, Health Service Providers, and any other entity dealing
with such data;
8. establish rules for transferring a
Beneficiary’s Health Insurance from one Coverage Provider to another;
9. coordinate all Health Insurance matters
with Concerned Entities;
10. monitor compliance by all persons with
this Law and the resolutions issued in
pursuance hereof,
and take the necessary action against violators;
11. prepare and monitor the application of
the policy and procedure for determining complaints and disputes arising out of
Health Insurance which are submitted to it;
12. approve and monitor the application of
the policy and procedure for determining complaints and disputes arising out of
Health Insurance adopted by Health Service Providers, Insurance Companies, Claim
Management Companies, Insurance Brokers, and any establishment authorised to
conduct any Health Insurance activity in the Emirate;
13. monitor the scope of Health Benefits,
and the cost of Health Insurance Policies;
14. monitor the cost of Health Benefits
included in the Health Insurance Policy;
15. publish periodicals and bulletins that
state the policies, guidelines, and procedures relating to implementation of
Health Insurance legislation;
16. conduct studies and research required for
developing Health Insurance in the Emirate, and submit recommendations in this
regard to the Executive Council; and
17. perform any other duties required for
the achievement of the objectives of this Law.
a. No natural or legal person may
conduct in the Emirate any of the Health Insurance activities determined in
this Law or the resolutions issued in
pursuance hereof unless
such person obtains the relevant Authorisation from the DHA.
b.
The resolutions issued in implementation
of this Law will determine the terms, procedure, and fees for issuing
Authorisations for Health Insurance activities.
c.
The validity of an Authorisation will be one (1) year, renewable for the
same period. The renewal application must be submitted within thirty (30) days
prior to expiry.
a. The entities determined in
Article (9) of this Law must enrol UAE Nationals, Residents and Visitors in
Health Insurance in accordance with this Law and the resolutions issued in pursuance hereof.
b.
Health Insurance implementation phases
will be determined pursuant to a resolution of the Chairman of the Executive
Council upon the recommendation of the DHA. Such resolution must state:
1.
the start date
for the implementation of each phase;
2. the categories of persons benefitting
from Health Insurance in each phase;
3. the entities responsible for enrolling
Beneficiaries in Health Insurance in each phase; and
4. implementation criteria and procedures
for each phase.
a.
Health Benefits of Beneficiaries will
be divided into the following categories:
1. Health
Benefits for UAE Nationals which include providing preventative and curative health
services as determined by the DHA in this respect;
2. Health
Benefits for Residents which include the health services that must be provided
by an Employer or Sponsor provided that these are not less than the Basic
Coverage. An Employer or Sponsor may provide Supplementary Coverage to the
Beneficiary and his family members;
and
3. Health
Benefits for Visitors, which include the provision of health services in
Emergency Cases as approved by the DHA in this respect in coordination with
Concerned Entities.
b.
The
Executive Council may add new categories to those stipulated in paragraph (a)
of this Article and determine the scope of their Health Benefit entitlements.
c.
The
resolutions issued under this Law will determine the details of Health Benefits
for each category stated in paragraph (a) of this Article.
a.
Responsibility for enrolment in Health
Insurance will be as follows:
1.
the Government will be responsible for enroling UAE Nationals in
accordance with the Health Insurance policy and the rules determined
by the DHA pursuant to the resolutions issued in this respect;
2.
an Employer will be responsible for enroling his employees in accordance
with his own Health Insurance policy, provided that the Health
Benefits of such policy are no less than the Basic Coverage;
3.
a Sponsor will be responsible for enroling the persons he sponsors who
do not have an Employer, provided that the Health Benefits he
provides to them are no less than the Basic Coverage; and
4.
the entity determined by the DHA in coordination with competent entities
will be responsible for enroling Visitors.
b.
Health Insurance will be provided to those
entitled to Health Insurance through a contract entered into between the
entities referred to in paragraph (a) of this Article and the Insurance Company
or the entity determined by the DHA, in accordance with the relevant standards
issued by the DHA.
c.
The entities referred to in paragraph
(a) of this Article will bear the cost of enroling a Beneficiary in Health
Insurance.
An
Employer must:
1. enrol his employees in Health
Insurance in
accordance with his own applicable Health Insurance policy, and in
accordance with this Law and the resolutions issued in pursuance hereof;
2. bear the cost
of enroling his
employees in Health Insurance, and not charge such cost to Beneficiaries;
3. ensure that his employees’ Health
Insurance is valid
throughout their service period;
4. bear the cost
of health services and medical intervention in Emergency Cases for any of his employees
who does not have Health Insurance as stipulated
in this Law;
5. provide his employees with a Health
Insurance Card;
6. produce a Health
Insurance Policy when issuing or renewing the residence
permits of his employees; and
7. perform any other obligations
determined pursuant to relevant resolutions issued by the DHA.
A Sponsor
must:
1. enrol the persons he sponsors where
such persons are not provided with Health Insurance by an Employer;
2. bear the cost
of Health Insurance enrolment for the persons he sponsors,
and not charge such cost to Beneficiaries;
3. ensure that the Health
Insurance of the persons
he sponsors is valid
throughout their residence or visit;
4. bear the cost
of health services and medical intervention in Emergency Cases for each person
he sponsors who does not have Health Insurance as stipulated in this Law;
5. provide the persons he sponsors with a Health
Insurance Card;
6. produce a Health
Insurance Policy when issuing or renewing the residence
or visit permits of the persons he sponsors; and
7. perform any other obligations
determined pursuant to relevant resolutions issued by the DHA.
A Beneficiary
must:
1. immediately notify the entity
responsible for enroling him in Health Insurance if his Health
Insurance Card is lost or damaged;
2. not misuse the Health
Insurance Card in any way whatsoever, including allowing others to use it;
3. pay Co-insurance as determined in the Health
Insurance Policy;
4. notify the DHA of any fraud,
misuse, omission, or negligence by any party to the Health Insurance system
which affects him;
5. refrain from any act intended to illegally
obtain Health Benefits or material gains; and
6. perform any other obligations determined
pursuant to relevant resolutions issued by the DHA.
An
Insurance Company must:
1. pay the cost of Health Benefits;
2. pay the cost of the Health
Benefits provided by a Health Service Provider that is not part of the Health
Service Provider Network in an Emergency Case until the Beneficiary’s life is
no longer threatened;
3. allow the Beneficiary to obtain,
by all means available, all his rights as determined in the Health
Insurance Policy;
4. comply with the terms of the
Authorisation issued to it and with the terms of the contracts concluded with parties
connected to Health Insurance;
5. comply with the method approved by the
DHA for Health Insurance financial claims;
6. comply with the terms and conditions
of the Health Insurance Policy, and use the forms approved by the DHA in this respect;
7. issue Health Insurance Cards;
8. provide Beneficiaries with, and regularly
update, the Health Service Provider Network;
9. notify the DHA of any conflict of interest and of
any direct or indirect interest with Health
Service Providers;
10. notify the DHA of any violation committed by Health Service Providers or any party to the
Health Insurance system;
11. in coordination with the DHA, publish and distribute to Beneficiaries instructions,
guidelines, forms, documents, publications, and booklets relating to Health
Insurance;
12. maintain, for a period determined by the DHA, financial and statistical
records and reports relating to Health
Benefits provided to Beneficiaries;
13. maintain, for a period determined by the DHA, Health Insurance financial records and separate them from those
of all other activities;
14. preserve and protect the privacy
and confidentiality of Beneficiary
data;
15. determine complaints submitted to it in
accordance with the method which it adopts after approval by the DHA;
16. have a qualified professional and
administrative staff that ensures optimal performance of its duties;
17. notify the DHA, within seven (7) working days of
its occurrence, of any change or variation in the data or the documents based
on which Authorisations are issued, provided that such change or variation does
not conflict with this Law, the resolutions issued in pursuance hereof, and the
legislation in force in the Emirate;
18. use the trade name stated in its Authorisation in all its dealings with third
parties;
19. provide the DHA with any information, data, or
statistics that the DHA requests or deems necessary to access in implementation
of this Law and the resolutions issued in pursuance hereof, and cooperate with DHA
employees and give them access to its databases and records;
20. comply with the rules, conditions,
and procedures approved pursuant to this Law and the resolutions, instructions,
and the bylaws issued in
pursuance hereof,
and with the legislation in force in the Emirate; and
21. comply with any other obligations
determined pursuant to relevant resolutions issued by the DHA.
A Claim Management Company must:
1. comply with the method approved by the
DHA for Health Insurance financial claims;
2. comply with the terms of the
Authorisation issued to it and with the terms of contracts concluded with
Health Insurance entities;
3. notify the DHA of any conflict of interest and of
any direct or indirect interest with Health
Service Providers;
4. notify the DHA of any violation committed by Health Service Providers or Insurance
Companies;
5. maintain, for the period determined by the DHA, financial and statistical
records and reports relating to the Health
Benefits provided to Beneficiaries;
6. preserve and protect the privacy
and confidentiality of Beneficiary
data;
7. determine complaints submitted to it in
accordance with the method which it adopts after approval by the DHA;
8. have a qualified professional and
administrative staff that ensures optimal performance of its duties;
9. notify the DHA, within seven (7) business days of
its occurrence, of any change or variation in the data or the documents based
on which Authorisations are issued, provided that such change or variation does
not conflict with this Law, the resolutions issued in pursuance hereof, and the
legislation in force in the Emirate;
10. use the trade name stated in its Authorisation in all its dealings with third
parties;
11. provide the DHA with any information, data, or
statistics that the DHA requests or deems necessary to access in implementation
of this Law and the resolutions issued in pursuance hereof, and cooperate with the DHA employees and
give them access to its databases and records;
12. comply with the criteria, conditions,
and procedures approved pursuant to this Law and the resolutions, instructions,
and the bylaws issued in pursuance hereof, and with the legislation in force in
the Emirate; and
13. comply with any other obligations
determined pursuant to relevant resolutions issued by the DHA.
A Health
Service Provider must:
1. provide Health Benefits in
accordance with prescribed professional and ethical standards and the medical guides
approved by the DHA;
2. comply with policies and
procedures issued by the DHA in respect of provision of
Health Benefits;
3. submit Health Insurance financial claims in accordance with the
method approved by the DHA
in this respect;
4. have its health service tariff approved
by the DHA and comply with such tariff;
5. not manipulate or neglect the medical or
financial records relating to the Health
Benefits provided to Beneficiaries;
6. provide services to Beneficiaries in accordance with the Health Insurance Policy;
7. without prejudice to his right to have
recourse against the Coverage Provider for payment of the cost of the health
services, provide
medical services to Beneficiaries in Emergency Cases until
the Beneficiary’s life is no longer threatened, even if he is not part of the Health Service Provider Network;
8. preserve and protect the privacy
and confidentiality of Beneficiary
information and data;
9. maintain Beneficiary records and files for the
period determined by the
DHA;
10. provide the Beneficiary, upon his request, with a copy of his
medical reports extracted from his medical file, or with a copy of such file;
11. comply with the principles of fair
competition, and refrain from performing any act that may involve defrauding
the prescribed Health Insurance system or illegally obtaining material gains;
12. notify the DHA of any conflict of interest and of
any direct or indirect interest with Health
Service Providers;
13. provide the DHA, Insurance Company, and Claim
Management Company
with required information, data, and documents relating to the Health Benefits it has provided to Beneficiaries;
14. notify the DHA, within seven (7) business days of
its occurrence, of any change or variation in the data or the documents based
on which Authorisations are issued, provided that such change or variation does
not conflict with this Law, the resolutions issued in pursuance hereof, and the legislation in force in the Emirate;
15. use the trade name stated in its Authorisation in all its dealings with third
parties;
16. provide the DHA with any information, data, or
statistics that the DHA requests or deems necessary to access in implementation
of this Law and the resolutions issued in pursuance hereof, and cooperate with the DHA employees and
give them access to its databases and records;
17. comply with the rules, conditions, and procedures approved pursuant to this Law
and the resolutions, instructions, and bylaws issued in pursuance hereof, and
with the legislation in
force in the Emirate; and
18. comply with any other obligations
determined pursuant to relevant resolutions issued by the DHA.
a.
A Health Insurance Policy
is issued by a Coverage Provider.
b.
A Health Insurance Policy
must include the following information:
1. scope of Health Benefits, their financial ceiling, and Coverage
Period;
2. Health Service Provider Network;
3. Co-insurance;
4. procedure for settling financial claims
relating to the Health Benefits provided to a Beneficiary;
5. methods of submitting complaints, and settling
disputes and damages arising out of breach of the Health Insurance Policy;
6. rules for preserving and protecting the
confidentiality of Beneficiary data and information;
7. rules, standards, and procedures for handling
and maintaining Health Insurance information and data; and
8. any other information the DHA deems it
important enough to include in the Health Insurance Policy.
c.
A Health Insurance Policy
issued on the form approved by the DHA is the main reference in determining the rights and obligations
of a Beneficiary, the entity responsible for enroling Beneficiaries in Health Insurance, and other concerned parties.
a.
A Health Insurance Policy
expires on expiry of
the Coverage Period stated on the document, death of the Beneficiary, or
termination of his relationship with the entity responsible for enroling him in
Health Insurance for any legally valid reason.
b.
Without prejudice to the legislation in force in the Emirate, and notwithstanding
paragraph (a) of this Article, the validity of the Health Insurance Policy of a Resident whose residence permit is
cancelled will continue thereafter for the period determined by law.
Any person
who violates the terms and conditions of the Health Insurance Policy, or provides incorrect
information to obtain Health Benefits, must pay the total cost of health
services provided to the Beneficiary as per rates approved by the DHA.
The
Coverage Provider will issue a Health
Insurance Card to a Beneficiary. The resolutions issued pursuant
to this Law will determine the conditions for issuing such card, the
information that must be stated on it, and its method of use.
Without
prejudice to his right to have recourse against the entity legally responsible
for payment of the cost of Health Benefits, the Coverage Provider will bear the
cost of the Health Benefits provided to a Beneficiary in accordance with the Health Insurance Policy.
The DHA
may establish a system for the settlement of disputes arising out of Health Insurance, and may make it mandatory
for Health Insurance parties, prior to recourse to the courts or arbitration.
In return
for issuing Authorisations and providing services, the DHA will collect fees as
prescribed in a resolution of the Chairman of the Executive Council.
a.
Without
prejudice to any stricter penalty stipulated in any other legislation, any
person who violates this Law and the resolutions issued in pursuance hereof will be punished by a fine of not less than
five hundred Dirhams (AED 500.00) and not more than one hundred and fifty
thousand Dirhams (AED 150,000.00).
Fines prescribed for the violations of this Law will be determined by a
resolution of the Chairman of the Executive Council.
b.
The amount of
the prescribed fine mentioned in paragraph (a) of this Article will be doubled
upon repetition of the same violation within one (1) year from the date of the
previous violation, provided that the amount of such fine does not exceed five
hundred thousand Dirhams (AED 500,000.00).
c.
In addition to
the penalty of a fine referred to in paragraph (a) of this Article, the DHA may
take one or more of the following measures against the violator:
1. notice;
2. suspension of Health Insurance
activities in the Emirate for no more than two (2) years; and/or
3. revocation of Authorisation.
d.
The penalties and measures referred
to in this Article will not, where appropriate, prejudice the civil or penal
liability of the violator.
e.
The DHA may, where required, notify the licensing authority and the Concerned
Entity of the violations of this Law and the resolutions issued in pursuance hereof, and of the penalties imposed on violators,
to enable them to take the appropriate action in this respect.
DHA employees
nominated pursuant to a resolution of the Director General, in coordination
with the Director General of the Government of Dubai Legal Affairs Department, will
have the capacity of law enforcement officers to record the acts committed in
breach of the provisions of this Law and the resolutions issued in pursuance hereof, and may, in such capacity, issue the required
violation reports and seek assistance from police personnel.
Any
affected party may submit a written grievance to the Director General against the
decisions, measures, and procedures taken against him by the DHA under this Law
and the resolutions issued in
pursuance hereof,
within thirty (30) days of being notified of the same. The grievance will be
determined, within thirty (30) days from the date of its submission, by a committee
formed by the Director General for this purpose . The decision issued in
respect of the grievance will be final.
Fees and
fines collected pursuant to this Law and the resolutions
issued in pursuance hereof will be paid to the Public Treasury
of the Government.
a.
Subject to paragraph (b) of Article (7) of this Law, a Health Insurance Policy issued prior to the effective date of this Law
will continue to be valid until its expiry date, or after the lapse of one year
from such effective date, whichever is earlier. This period may be extended
pursuant to a resolution of the DHA.
b.
All Employers and Sponsors must comply with this Law and the resolutions issued in pursuance hereof within one (1) year of being subject to this
Law, failing which, the DHA may take the required action against them.
The DHA
will coordinate with competent entities in charge of issuing and renewing
permits and visas for entry into the UAE via the Emirate or for residing in the
Emirate, in connection with the provision of Health Insurance Policies to those who have been issued a permit or
visa.
All
Concerned Entities in the Emirate must, each in its own jurisdiction, provide the
necessary support to the DHA to enable it to perform the duties assigned to it
under this Law and the resolutions issued in pursuance hereof, and must take all necessary measures to
implement the resolutions issued by the DHA under this Law.
The Chairman
of the Executive Council will issue the resolutions required for the
implementation of the provisions of this Law in cases where the DHA is not
mandated to act.
Any
provision in any other legislation will be repealed to the extent that it
contradicts the provisions of this Law.
This
Law will be published in the Official Gazette, and will come into force sixty
(60) days from the day on which it is published.
Mohammed bin Rashid Al Maktoum
Ruler
of Dubai
Issued in Dubai on 24 November 2013
Corresponding to 20 Muharram 1435 A.H.
©2015 The Supreme Legislation Committee in the
Emirate of Dubai
[1]Every effort has been made to produce an
accurate and complete English version of this legislation. However, for the
purpose of its interpretation and application, reference must be made to the
original Arabic text. In case of conflict the Arabic text will prevail.