Executive
Council Resolution No. (7) of 2016
Approving
Health
Insurance Fees and Fines in the Emirate of Dubai[1]
ــــــــــــــــــــــــــــــــــــــــــــــ
We, Hamdan bin Mohammed bin
Rashid Al Maktoum,
Crown Prince of Dubai, Chairman of the Executive Council,
After
perusal of:
Law
No. (3) of 2003 Establishing the Executive Council of the Emirate of Dubai;
Law
No. (13) of 2007 Establishing the Dubai Health Authority (the “DHA”) and
its amendments;
Law
No. (35) of 2009 Concerning Management of the Public Funds of the Government of
Dubai and its amendments;
Law
No. (9) of 2011 Concerning the Dubai Healthcare City (the “DHCC”);
Law
No. (11) of 2013 Concerning Health Insurance in the Emirate of Dubai (the “Law”);
and
Resolution
No. (8) of 2015 Extending the Application of the Health Insurance Law to Health
Service Providers Licensed in the Dubai Healthcare City,
Do hereby issue this Resolution.
The words and expressions mentioned in this Resolution will have the
same meaning assigned to them in the Law.
In return for issuing Authorisations and providing the services stated
in Schedule (1) attached hereto, the DHA and the DHCA will charge the fees
indicated opposite each of these Authorisations and services.
a. Without prejudice to any
stricter penalty stipulated in any other legislation, a person who commits any
of the acts stated in Schedule (2) attached hereto will be punished by the fine
indicated opposite that act.
b. Upon repetition of the same
violation within one (1) year from the date of the previous violation, the
amount of the fine referred to in paragraph (a) of this Article will be
doubled. The doubled fine must 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 and the DHCA may, each within its jurisdiction, take one
or more of the following actions and measures against a violator:
1. warning;
2. suspension of Health Insurance activities for a
period not exceeding two (2) years; and/or
3. revocation of Authorisation.
The
fees and fines collected by the DHA pursuant to this Resolution will be paid to
the Public Treasury of the Government of Dubai. However, the fees and fines
collected by the DHCA will be retained by the DHCA.
This Resolution will be published in the
Official Gazette and will come into force on the day on which it is published.
Hamdan bin Mohammed
bin Rashid Al Maktoum
Crown Prince of Dubai
Chairman of the Executive Council
Issued in Dubai on 7 March 2016
Corresponding to 27 Jumada
al-Ula 1437 A.H.
Schedule (1)
Health Insurance Fees
|
SN |
Description |
Fee (in Dirhams) |
|
1 |
Application
for Authorisation |
1,000.00 |
|
2 |
Issuing an
Authorisation for an Insurance Company to provide Health Insurance packages
to Beneficiaries whose income exceeds the limit approved by the DHA |
150,000.00 |
|
3 |
Issuing an
Authorisation for an Insurance Company to provide Health Insurance packages
for all types of Beneficiaries irrespective of their income |
350,000.00 |
|
4 |
Renewing the
Authorisation of an Insurance Company |
Half a percent (0.5%) of the amount of paid
insurance claims for the previous year, provided that the fee collected is in
no event less than the fee prescribed for issuing a new Authorisation |
|
5 |
Issuing or
renewing an Authorisation of an Insurance Broker |
20,000.00 |
|
6 |
Issuing an Insurance
Broker card |
AED 500.00 per person |
|
7 |
Issuing or
renewing an Authorisation of a Claim Management Company |
40,000.00 |
|
8 |
Issuing or
renewing an Authorisation of a Health Service Provider (hospitals) |
10,000.00 |
|
9 |
Issuing or
renewing an Authorisation of a Health Service Provider (polyclinics) |
5,000.00 |
|
10 |
Issuing or
renewing an Authorisation of a Health Service Provider (single-speciality
clinics, pharmacies, laboratories, medical test and radiology centres, and
similar facilities) |
1,500.00 |
Schedule (2)
Health Insurance Violations
and Fines
|
SN |
Violation |
Fine (in Dirhams) |
|
1 |
Conducting
a Health Insurance activity in the Emirate without, or after the expiry of,
an Authorisation |
50,000.00 |
|
2 |
Failure
by an Insurance Company to comply with the terms of its Authorisation |
50,000.00 |
|
3 |
Failure
by an Insurance Broker to comply with the terms of its Authorisation |
10,000.00 |
|
4 |
Failure
by a Claim Management Company to comply with the terms of its Authorisation |
10,000.00 |
|
5 |
Failure
by a Health Service Provider to comply with the terms of its Authorisation |
5,000.00 |
|
6 |
Failure
by an Employer or Sponsor to comply with his obligation to enrol his
employees or the persons he sponsors in a Health Insurance scheme, or his
failure to enrol them, by the relevant deadline prescribed by the Government,
in a Health Insurance scheme that provides at least the Basic Coverage |
AED 500.00 per month of delay (a part of a month
will be rounded up to a full month) |
|
7 |
Failure,
by an Employer or Sponsor, to pay the cost of health services and/or medical
intervention in Emergency Cases for his employees or the persons he sponsors
whom he has failed to enrol in a Health Insurance scheme as required |
1,000.00 |
|
8 |
Charging,
by an Employer or Sponsor, of a Beneficiary all or part of the cost of
enrolling that Beneficiary in a Health Insurance scheme |
AED 10,000.00 per Beneficiary, plus refund of the
amount paid by the Beneficiary |
|
9 |
Failure,
by an Employer or Sponsor, to provide a Beneficiary with a Health Insurance
Card or to enable the Beneficiary to obtain it |
AED 1,000.00 per incident |
|
10 |
Failure,
by an Employer or Sponsor, to provide the Health Insurance Policy of a
Beneficiary upon issuing or renewing a residence or visit permit, or failure to
enable the Beneficiary to obtain it |
AED 1,000.00 per incident |
|
11 |
Failure,
by a Beneficiary, to notify the entity responsible for enrolling him in a
Health Insurance scheme of the loss or damage of his Health Insurance Card
within thirty (30) days from such a loss or damage |
500.00 |
|
12 |
Allowing,
by a Beneficiary, any use or misuse of his Health Insurance Card by third
parties |
5,000.00 |
|
13 |
Committing
an act, by a Beneficiary, intended to illegally obtain Health Benefits or
material gains |
AED 5,000.00, plus payment of the cost of the Health
Benefits illegally obtained |
|
14 |
Providing
false information by an Insurance Company, a Claim Management Company, a
Health Service Provider, or an Insurance Broker to obtain an Authorisation |
50,000.00 |
|
15 |
Providing
false financial data by an Insurance Company, a Claim Management Company, a
Health Service Provider, or an Insurance Broker |
AED 20,000.00 per incident |
|
16 |
Failure,
by an Insurance Company or a Claim Management Company, to pay the cost of
Health Benefits provided by a Health Service Provider, or its default in the
payment of such cost beyond the deadline specified in its contract with the
Health Service Provider |
AED 20,000.00 per incident |
|
17 |
Failure,
by an Insurance Company, to announce twice the revocation of its
Authorisation by the DHA in two local newspapers, one in Arabic and the other
in English |
150,000.00 |
|
18 |
Suspension,
by an Insurance Company or a Claim Management Company, of an authorised
activity without the prior approval of the DHA |
100,000.00 |
|
19 |
Failure,
by an Insurance Company, to pay the cost of the Health Benefits provided in
an Emergency Case by a Health Service Provider that is not part of its Health
Service Provider Network within seven (7) working days from the date of
provision of such benefits |
AED 5,000.00, plus payment of the cost of treatment |
|
20 |
Failure,
by an Insurance Company, to allow a Beneficiary access to his rights under a
Health Insurance Policy |
50,000.00 |
|
21 |
Failure,
by an Insurance Company, to record the details of Health Insurance Policies
in the register maintained by the DHA for this purpose |
AED 20,000.00 per unregistered policy |
|
22 |
Failure
by an Insurance Company, a Claim Management Company, or a Health Service
Provider to comply with the procedures adopted by the DHA concerning Health
Insurance financial claims |
AED 50,000.00 per claim |
|
23 |
Failure,
by an Insurance Company, to comply with the form of the Health Insurance
Policy prescribed by the DHA |
AED 20,000.00 per policy |
|
24 |
Failure,
by an Insurance Company, to comply with the Health Insurance Policy terms and
conditions approved by the DHA |
AED 20,000.00 per policy |
|
25 |
Failure,
by an Insurance Company, to issue a Health Insurance Card without a reason
acceptable to the DHA |
AED 5,000.00 per card |
|
26 |
Delay,
without an acceptable reason, in issuing a Health Insurance Card beyond the
relevant period prescribed by the DHA |
AED 500.00 per card |
|
27 |
Refusal
by an Insurance Company to provide a Beneficiary, without a reason acceptable
to the DHA, with a list of the Health Service Providers that are part of its Health
Service Provider Network or with any updates thereto |
AED 1,000.00 per Beneficiary |
|
28 |
Delay,
without an acceptable reason, in providing a Beneficiary with a list of the
Health Service Providers that are part of its Health Service Provider Network
beyond the period prescribed by the DHA |
AED 500.00 per Beneficiary |
|
29 |
Failure,
by an Insurance Company or a Claim Management Company, to notify the DHA of
any direct or indirect conflict of interest with any Health Service Providers
|
20,000.00 |
|
30 |
Failure,
by an Insurance Company or a Claim Management Company, to notify the DHA of
any incident of unlawful exploitation, manipulation, omission, negligence, or
breach by a Health Service Provider or any party to the Health Insurance
system |
5,000.00 |
|
31 |
Failure
by an Insurance Company or a Claim Management Company to maintain, for the
period determined by the DHA, the financial and statistical records and the
reports relating to the Health Benefits provided to Beneficiaries |
20,000.00 |
|
32 |
Failure
by an Insurance Company to maintain, for the period determined by the DHA,
Health Insurance financial records, or failure to separate such records from
those related to its other activities |
30,000.00 |
|
33 |
Failure
by an Insurance Company, a Claim Management Company, or a Health Service
Provider to protect the privacy and confidentiality of Beneficiary data. This
applies to illegal disclosure of that data |
AED 10,000.00 per incident |
|
34 |
Failure
by an Insurance Company or a Claim Management Company to comply with the
rules, regulations, and procedures adopted by the DHA in considering and
determining the complaints submitted to it |
3,000.00 |
|
35 |
Failure
by an Insurance Company or a Claim Management Company to record the
complaints submitted to it, within seven (7) working days from the date of
submission in normal cases, or within twenty-four (24) hours from the date of
submission in Emergency Cases |
10,000.00 |
|
36 |
Failure
by an Insurance Company or a Claim Management Company to determine the
complaints submitted to it within thirty (30) days from the date of
submission, unless the DHA extends this period for reasons given by that
company |
20,000.00 |
|
37 |
Failure
by an Insurance Company or a Claim Management Company to hire the qualified
professional and administrative staff required for conducting its activity |
5,000.00 |
|
38 |
Failure
by an Insurance Company, a Claim Management Company, or a Health Service
Provider, to notify the DHA of any change in, or amendment to, the
information and documents based on which its Authorisation has been issued,
within seven (7) working days from the date of such change or amendment |
20,000.00 |
|
39 |
Failure
by an Insurance Company, a Claim Management Company, or a Health Service
Provider to use its trade name or service mark in all dealings with third
parties |
20,000.00 |
|
40 |
Refusal,
failure, or delay of an Insurance Company or a Claim Management Company, to
issue the required approvals for the health services provided to a
Beneficiary without a reason acceptable to the DHA |
AED 20,000.00 per incident |
|
41 |
Failure,
by an Insurance Company, to issue a Health Insurance Policy without a reason
acceptable to the DHA |
AED 50,000.00 per policy |
|
42 |
Failure
by an Insurance Company, a Claim Management Company, a Health Service
Provider, or an Insurance Broker to provide the DHA with any information,
data, statistics, or documents that the DHA requests or deems necessary to
access, within the period determined by the DHA |
AED 1,000.00 per day of delay |
|
43 |
Failure
by an Insurance Company, a Claim Management Company, a Health Service
Provider, or an Insurance Broker, to cooperate with the DHA competent
employees or give them access to its data and records |
20,000.00 |
|
44 |
Failure
by an Insurance Company or an Insurance Broker to comply with the Health
Insurance Policy rates approved by the DHA |
AED 10,000.00 per policy |
|
45 |
Failure
by a Health Service Provider to comply, in the course of providing Health
Benefits, with the prescribed professional and ethical standards, the
treatment guidelines approved by the DHA, or the Health Benefits provision
policies and procedures |
10,000.00 |
|
46 |
Failure
by a Health Service Provider to comply with the DHA prescribed rates for
Health Services provided to Beneficiaries, or its failure to comply with the percentage
of Beneficiary Co-insurance prescribed by the DHA for these services |
AED 10,000.00 per incident |
|
47 |
Failure
by a Health Service Provider to comply with the Health Insurance Policy in
the course of providing Health Services to Beneficiaries |
AED 10,000.00 per incident |
|
48 |
Failure
by a Health Service Provider, even if it is not part of the relevant Health
Service Provider Network, to provide health services to a Beneficiary in an
Emergency Case until the Beneficiary’s life is no longer threatened |
AED 10,000.00 per incident |
|
49 |
Failure
by a Health Service Provider to maintain the records and files of
Beneficiaries in accordance with the rules, and for the periods, prescribed
by the DHA |
10,000.00 |
|
50 |
Failure
by a Health Service Provider to provide a Beneficiary, upon his request, with
a copy of medical reports extracted from his medical file, or with a copy of
such file, without a reason acceptable to the DHA |
AED 5,000.00 per incident |
|
51 |
Negligence
or manipulation, by a Health Service Provider, of the medical or financial
records relating to the Health Benefits provided to Beneficiaries |
AED 20,000.00 per incident |
|
52 |
Committing
an act, by a Health Service Provider, that constitutes a breach of the
principles of fair competition, or that is aimed to manipulate the Health
Insurance system or to illegally obtain material gains |
50,000.00 |
|
53 |
Failure
by a Health Service Provider to notify the DHA of any direct or indirect
conflict of interest with a Health Service Provider, an Insurance Company, or
a Claim Management Company |
20,000.00 |
|
54 |
Failure
by a Health Service Provider to provide the DHA, Insurance Company, and Claim
Management Company with all information, data, and documents relating to the
Health Benefits it has provided to Beneficiaries, within seven (7) days from
the date of provision of such benefits |
AED 1,000.00 per day of delay |
|
55 |
Failure
by an Insurance Broker to register his employees in the Insurance Brokers
register maintained by the DHA |
5,000.00 |
|
56 |
Failure
by an Insurance Company, a Claim Management Company, an Insurance Broker, or
a Health Service Provider, to comply with the rules, conditions, and procedures
approved under the Law, or under the instructions, bylaws, and resolutions
issued by the DHA |
10,000.00 |
©2016 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.