Tim Elliott
Okay. We are live on TikTok for the first time on this podcast about medical insurance. Here’s the question: My partner is pregnant. She will deliver next month. We are not married. Will the insurance provided by her company cover her delivery?
Ludmila Yamalova
This is a great question. The short answer is that it should. I will tell you, we’ve had a number of questions like this recently with a baby coming up, but no insurance or the marriage certificate issued yet. Will the delivery be covered? Will the mother be covered? Will the baby be covered?
Remember, these are all three different stages: the mother’s own care, then pre-delivery and during delivery, and then the mother herself, if she has any complications related to birth—whether that will be covered or not. Then there is the baby, the baby’s birth, and the baby’s further medical treatment, if need be. These questions come up quite regularly. The short answer is yes. Health insurance should cover all of these parties and circumstances.
It is interesting because we have actually reached out, and I’ll tell you why first, perhaps logically, and then I will give a bit of a legal justification. Logically, when the mother gets pregnant, most insurance policies here cover maternity. Legally, I have never actually seen maternity coverage conditioned on being legally married. I have never seen that.
Now we know these questions didn’t really come up in the past as much because having a baby out of wedlock or a pregnancy without a marriage certificate was previously illegal. They are not illegal anymore. It has become a lot easier to not only have these kinds of relationships here but also to deliver children here without necessarily a marriage certificate—not just because the laws have changed, but also because society and institutions have changed, and it has become a lot more acceptable.
Yet, because of that, these discussions are coming up a lot more. I have been told by employers or companies that the health insurance does not cover this. I don’t know where that comes from, to be honest with you, because legally, I have never seen a single health insurance policy that has a specific condition stating you can only benefit from maternity coverage if you are legally married. I have never seen one.
Furthermore, on the back of the multitude of questions we have received recently, we have gone back and researched the health insurance laws themselves and also talked to various health insurance brokers and contacts that we know, and asked that very question. We have not once seen a source that even remotely suggests that being legally married is a condition for maternity coverage.
That is basically the overall premise. Therefore, if your health insurance includes maternity coverage, then by default, that will cover your pre-delivery visits to the doctor, your delivery itself, any issues related to the mother, and also, by default, all health insurance plans that cover maternity also cover the baby for the first three months.
That makes sense. The baby does not have a legal identity yet to qualify for their own visa until they have been born, discharged from the hospital, and had their birth notification, birth certificate, passport, and residence visa. You cannot apply for health insurance here for a resident that is not a resident.
For a baby to even apply for health insurance, you do need to go through that process of the birth notification, which is issued by the hospital. On the back of the birth notification, you’ll apply for the birth certificate.
Tim Elliott
And it will take some time.
Ludmila Yamalova
Well, these days it’s taking a lot less time. But in the past, yes, for sure. Even today, there could be complications where the baby or mother does not leave the hospital for a month.
The last thing on their minds in that case is applying for paperwork. Then you get the birth certificate, and you apply to your embassy for the passport. Depending on the embassy, it could take a few weeks. Once you have the baby’s passport, only then can you apply for them as a resident dependent. That’s a process, and only then can you apply for health insurance.
I have not seen anything to the contrary. There may be some exceptions, but I have not seen any maternity coverage that excludes the baby because that would be nonsensical. Therefore, all maternity coverage, usually by default, includes the baby’s treatment for at least three months. It includes any kind of emergency related to the baby and also regular treatment such as vaccines for the first three months.
That is a very long-winded answer to the question. It should not be the case that coverage is denied, but nevertheless, we are hearing that a lot of people are being told this. Legally speaking and contract-wise, we have never seen anything to substantiate that theory.
My recommendation to anyone that finds themselves in that situation is to simply get copies of all the insurance policies and read carefully to see if there is any kind of exception like that. If you don’t find an exception, that means it does not exist. I predict there won’t be such a clause in the agreement, and therefore, the mother and the baby will qualify for health insurance coverage.
Tim Elliott
Okay. Mother and child for three months. Legally married or not, it doesn’t make any difference. Hello, Ma’am. My company said they will be deducting the amount for the health insurance from my salary. Can they do that?
Ludmila Yamalova
Well, no. By default, no. That goes back to your previous question, which I have not answered yet, and that is in terms of the penalties, because there is a specific penalty for that.
Let’s say I offer employees coverage to the tune of AED 5,000 a year, and that is all I’m willing to pay or able to pay. But you, as an employee, want better coverage. You want a policy that costs AED 10,000. I am not required to provide you with health insurance of your choosing. I am only required to provide you with a basic plan.
However, if I am providing a lot more than just a basic plan and I pay AED 5,000 on your behalf, but you want an AED 10,000 policy, we can agree that I provide that to you. I can either offer it to you as additional compensation, or I can offer to pay for it and deduct the difference—the AED 5,000 gap—from your salary.
Tim Elliott
That would need to be in an employment contract in some form, wouldn’t it?
Ludmila Yamalova
Sure. It can be a separate undertaking. You and I can sit down and agree that there is an additional AED 5,000 that you have asked me to pay for you. It is ultimately like a loan that I am paying to you in advance, and therefore, I can deduct that from your salary.
By the way, under the new employment law, any kind of deductions from salaries or end-of-service benefits, for example, are very strictly regulated. Even previously, deductions were not supposed to be loosely applied, as many companies may have done. But now, as per the new law, it is even clearer—there are very few deductions that can be made, and there are specific requirements as to how they must be done.
As you rightfully said, one of the requirements is a very specific undertaking or agreement on how I am going to be deducting the amount. I also cannot deduct all of it right away. There are specific steps on how much I can deduct from your monthly salary.
Tim Elliott
Lots of questions to ask you, Ludmila. If the PRO of the company did not cancel the health insurance of a worker, is there a way to solve it? They did not issue my working visa for two years and no Emirates ID either. I am not even aware if I have any insurance, which goes back to your earlier point of it not being communicated. Now that they have canceled me, the new company applied for a visa, and it shows that I have huge insurance fines.
Ludmila Yamalova
Interesting. The insurance fines—let’s go back to your previous question about health insurance fines. There are so many different types of fines that can apply, and this is why we said earlier this topic is important because a lot of people don’t know. The law is there, but they may not be aware of the obligation and the consequences if they don’t follow the obligations.
The fines depend on which emirate you are in and where you are working, so there are a lot of nuances. But at a high level, the penalties—for example, in Dubai—for violating the Dubai health insurance laws range from AED 500 to AED 150,000, depending on the circumstances.
For example, for employers or companies who fail to provide health insurance to their employees, there is a fine of AED 1,000 per employee.
As a company, if I don’t give you the insurance, to all those who are listening, if your company is telling you that you don’t have health insurance or you think you don’t have it for some reason, then there is a fine of AED 1,000 per employee.
By the way, it is interesting—the law says a fine of AED 1,000 per person for employers or sponsors who do not provide or make accessible health insurance to their employees or dependents.
Tim Elliott
That’s interesting.
Ludmila Yamalova
Make accessible means basically that ignorance of the policy is also a breach of the law. If the company is not communicating with you, theoretically or technically speaking under the law, that is also a violation, and therefore, the company is subject to the fine.
Tim Elliott
So, if you didn’t communicate it or hand over the physical health card or tell somebody how to use the app where the health card resides—because most of it is online here now—the sponsor company is liable.
Ludmila Yamalova
Indeed. Exactly. Then, another fine, which is interesting and directly related to the listener’s question, there is a fine of AED 10,000 per person for employers who require their employees or dependents to cover the cost or part of the cost of their health insurance.
This is in addition to returning the cost to the employee or the dependent. In other words, let’s say in our listener’s case where your employer is deducting money, you may want to bring this to their attention. This is assuming you are based in Dubai, but Abu Dhabi might have a similar provision.
The Dubai Executive Council Decision 7 of 2016 sets out fines and penalties in connection with health insurance claims. This specific law states that companies requiring employees to compensate them for health insurance will be fined AED 10,000.
That is a fine on the company, and that’s in addition to reimbursing the employee for the health insurance coverage.
Let’s say, going back to you and me, if you were my employee and your health insurance cost AED 12,000 a year, and I had been deducting AED 1,000 every month, and now six months into it, you find out—you can report me.
As a company, legally speaking, I should be subject to the AED 10,000 fine for the violation, and I will have to return to you the AED 6,000 that you have reimbursed me for the health insurance. Technically speaking, the penalties are fairly serious.
Tim Elliott
I’d report you.
Ludmila Yamalova
I’m sure you would.
Tim Elliott
Let me tell you. Let me ask you two more questions. The first one is this: I was diagnosed with cancer recently, somebody writes in. You have positive thoughts from us on this. I’ve been through that, so positivity coming towards you. My insurance is expiring at the end of the month. I haven’t started my treatment yet. It looks like my employer doesn’t want to renew my insurance because they don’t want to pay a higher premium for me. Is it legal for employers not to renew employees’ insurance?
Ludmila Yamalova
To renew—as long as the employee remains employed and sponsored by the company—the obligation to have the health insurance and to continue to renew it remains.
However, the premiums—it’s an interesting question because, at this point in time, I am not sure necessarily if the premiums would go up. But let’s say if they are going up and going up substantially, there could be an agreement between the company and the employee about the additional premiums.
As I mentioned earlier, there is a requirement to provide health insurance to the employee, but there isn’t a requirement to provide certain kinds of coverage. The basic coverage must be provided, but anything above that—or whatever is contractually agreed on—is basically up to the parties to decide.
In this case, let’s say, depending on how your contract is drafted, if the contract says the company provides you with health insurance, period, and now as part of the renewal the premiums go up and the company cannot reduce those premiums, then by default, the requirement to renew, even if it is at higher premiums, may still remain.
However, if there is a limit in the agreement itself that says the company will provide you with health insurance and this is above just the basic health insurance coverage—let’s say AED 12,000 a year—but anything above that, they are not responsible for, then in this case it may be that the company can still renew the insurance and pay the AED 12,000. But the margin or the difference between that amount and the higher amount would be your responsibility if you wanted to pay that extra.
Tim Elliott
Final question. My family is with me and on my sponsorship. Does my employer have to provide medical insurance for them also?
Ludmila Yamalova
A great question. No. The answer is no. The general rule is that the requirement for health insurance is on the sponsor.
If it’s your family, your obligation as a sponsor is to provide them with health insurance. Some companies offer this as a benefit to their employees, but it’s more contractual and not mandated by law. So, in this case, it’s not the obligation of the company at all. It is your own obligation unless you have a specific provision in your agreement that provides otherwise.
Tim Elliott
Alright. Thank you for the questions. I think that pretty much wraps it up, Ludmila.
Ludmila Yamalova
No. One more point about essential benefits. This is for all of those who have just basic health insurance coverage.
A lot of people think, oh, I don’t have any insurance. As I said earlier, even if you have a health certificate, it is a form of health insurance coverage, and that health insurance coverage, by the way, under the Dubai law is called the Essential Benefits Plan.
It actually has a specific name. To be even more specific, the law has a definition of basic coverage. Basic coverage is the minimum health benefits to be provided to the resident in accordance with the resolution issued under the law, and this is called the Essential Benefits Plan.
Under the Essential Benefits Plan, it specifies the bare minimum benefits and coverage which every health insurance plan in Dubai must include. This is not subject to debate.
For example, under the Essential Benefits Plan, the annual aggregate claim limit is AED 150,000 per year. In other words, it covers claims up to AED 150,000 a year.
It covers basic tests, diagnosis, and treatment within Dubai. This is important. It covers all kinds of basic tests, diagnosis, and treatments within Dubai and possibly other emirates, depending on the insurance, as well as emergency medical treatments in all emirates.
In other words, if you are a resident in Dubai and sponsored by the company, then you will have this essential coverage, an Essential Benefits Plan. Therefore, you will have coverage, but this coverage has a more limited set of providers and limited types of coverage. You cannot go to any hospital—there are specific hospitals that are included. But there are minimal benefits, and certainly emergencies are covered under the law.
Tim Elliott
That’s another episode of Lawgical, health insurance here in the UAE—an overview, a catchup if you like. Essentially, it’s the law, and you need it. It is most likely in place, particularly if you are employed, working, and have a visa here in Dubai or in Abu Dhabi as well.
