Chairman of the Executive Council Resolution No. (25) of 2006 Concerning the Issuance of the Executive Regulation of Law No. (23) Of 2005 Concerning Health Insurance in the Emirate of Abu Dhabi

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Chairman of the Executive Council Resolution No. (25)
of 2006 Concerning the Issuance of the Executive
Regulation of Law No. (23) Of 2005 Concerning
Health Insurance in the Emirate of Abu Dhabi
Having reviewed Chairman of the Executive Council Resolution No. (17) of
2017 concerning the exemption of some services from applying the Health
Insurance Scheme in the Emirate.
The Executive Council has decided the following:
Article (6) of Chairman of the Executive Council Resolution No. (25) of 2006
concerning the Executive Regulation of Law No. (23) of 2005 concerning
Health Insurance in the Emirate of Abu Dhabi shall be replaced with the
following:
1. Treatment services shall be provided by virtue of the Health Insurance
Policies, which include basic medical treatment services covered by the
Basic Health Insurance Policy, or medical treatment services covered by
the Flexible Health Insurance Policy, and any other medical treatment
services agreed to be added from among the excluded medical treatment
services.
2. Health Insurance Policies shall be divided into several types as follows:
a. Flexible Health Insurance Policy with the following categories of
beneficiaries:
Expatriates, residing in the Emirate, who work in the private sector
with a monthly income not exceeding AED 5000.
Desiring investors and holders of self-employment licences, their
families and their employees.
Families of the resident expatriates and their workers who are not
covered by health insurance by the employer (governmental or
private).

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The Flexible Health Insurance Policy shall be deemed a document
of contractual nature, and its conclusion shall not result in the
obtainment, by the accredited health insurance company that issues
this type of Policy, of any governmental support in relation to this
Policy, and its beneficiaries shall not be entitled to register for any
type of treatment program funded by the Emirate.
In the event that the annual coverage limit of this Policy is exhausted,
the subscriber to the health insurance shall agree with the accredited
health insurance company issuing the Policy to extend the treatment
coverage of the insured until the end of the period specified in the
Policy and pay the relevant insurance premium due, or provide
another Health Insurance Policy for the insured in accordance with
the provisions of this Resolution.
The insurance premium for the Flexible Health Insurance Policy shall
be an amount of AED 750 - seven hundred and fifty dirhams - annually
per person.
Schedule No. (6) attached to this Resolution specifies the medical
treatment services covered by the Flexible Health Insurance Policy.
b: Basic Health Insurance Policy with the following categories of
beneficiaries:
Low-income people, as well as their families and workers who receive
overall salaries as follows:
AED 4,000 per month with housing, or
AED 5,000 per month without housing.
The families of the resident expatriates and their workers who are
not covered by health insurance by the employer and who are not
beneficiaries of the Flexible Health Insurance Policy.
Domestic workers of nationals in accordance with the relevant
provisions governing them.
Non-citizens who are in need and critical humanitarian cases,
provided that the Department of Health prescribed the necessary
controls in this respect.

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The value of the premium for the Basic Health Insurance Policy shall
be specified by an Executive Council Resolution.
c. The Health Insurance Policy for Emergencies, with following categories
of beneficiaries:
• Those coming to the Emirate on a visit visa.
• Children who are not permanent residents in the State, provided
that a notarised document is presented stating that their residence
is covered by the father or the mother.
• This Policy shall cover the medical treatment services for emergency
cases only, and its value shall be determined according to the
duration of the visit or residence within the State, according to the
market rate.
d. The Enhanced Health insurance Policy which is available to the
remaining categories of beneficiaries.
3. Other medical treatment services may be added to the basic medical
treatment services listed in Schedule No. (1) or the medical treatment
services covered by the Flexible Health Insurance Policy listed in
Schedule No. (6), provided that these services, the premium and
the annual insurance coverage for them are agreed upon among the
accredited health insurance companies and other parties to the Policy.
4. The term of the Health Insurance Policy shall be one or more Gregorian
years, and it shall not be permissible to recover any part of the value
of the Basic Health Insurance Policy after its conclusion. As for other
health insurance policies, an agreement shall be made among the
accredited health insurance companies and the other parties to these
policies on the cases, conditions and procedures of recovery of part of
the aforesaid policies.
5. The Health Insurance Policy shall include the following data:
• The medical treatment services covered by the Basic Health Insurance
Policy as stated in Schedule No. (1) or the health insurance services
covered by the Flexible Health Insurance Policy as stated in Schedule
No. (6) attached to this Resolution.

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• Medical treatment services excluded as set out in Schedule No. (2).
• Medical treatment services that are agreed to be added from among
the excluded medical treatment services to the medical treatment
services covered by the Basic Health Insurance Policy or the Flexible
Health Insurance Policy.
• The amount or percentage of the deductible that the insured shall pay
when requesting medical examination or treatment covered by the
Health Insurance Policy, medicines or medical examinations.
• The maximum value of medical treatment services borne by the
accredited health insurance company under the Health Insurance Policy.
• List of excluded medical treatment services.
• Complaint examination and dispute resolution methods.
6. The Health Insurance Policy shall include a statement of the exemptions
granted in the field of basic medical treatment services, with a stipulation
stating that the value of the policy shall be reduced by an amount
equivalent to these prescribed exemptions.
7. The provisions of the Health Insurance Policy shall be written in Arabic
with a translation into English, and the Arabic provisions shall prevail in
case any dispute arises.
8. It shall not be permissible to treat major diseases with high costs from
which the insured coming to reside or work for the first time in the
Emirate suffers, if the insured does not hold a valid health card, under
the Flexible or Basic Health Insurance Policy, except after six months
from the date of entry into force of the Policy, and the Department of
Health shall specify the type of these diseases.
9. It shall not be permissible to obtain the Flexible Health Insurance Policy
concurrently with other health insurance policies referred to in this
resolution.
10. The approved health insurance companies shall provide the insured
persons with cards containing the details of the Health Insurance Policy.
11. The approved health insurance company shall issue a notice of renewal
of the insurance policy 30 days before its expiry date, provided that the

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notice includes the value of the premium, the annual coverage amount,
and any changes in the renewed policy.
12. Health fitness for work or residence shall be proved before subscribing
to the health insurance plan.”
• Schedule No. (6) attached to this Resolution shall be added to the
aforesaid Chairman of the Executive Council Resolution No. (25) of
2006.
• This Resolution shall be effective from 01/01/2023.
Issuance Date: 22 December 2022
Corresponding to: 28 Jumada AL Owla 1444 Hijri
Saif Saeed Ghobash
Secretary-General

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Schedule No. (6)
Flexible Health Insurance Benefits
List of Benefits
The Maximum Annual Ceiling
for the Treatment Services per
person AED 150,000
Coverage Area (elective
treatment) Within the borders of the Emirate
of Abu Dhabi
Coverage Area (emergency
cases) The State of the United Arab
Emirates
Network of Healthcare Providers Network of Healthcare Providers
(outpatient treatment shall be
limited to clinics)
Inpatient care services for major
high-cost diseases, according
to the list of the Department of
Health
The coverage shall be subject to
a waiting period of 6 months from
the beginning of the first health
insurance policy with the contracted
company, and the subscriber to the
health insurance shall be responsible,
on behalf of the insured, for the
coverage of these costs during this
period.
For medical treatment services in accredited hospitals, the coverage
reaches the maximum annual ceiling for treatment services per
individual/per policy with prior approval.
Procedures of transfer to
specialised clinics in hospitals Transfer procedures:
The insured shall not incur any
costs for advice or consultation
provided by specialists or
consultants in hospitals if the
transfer by a network GP (or
equivalent as determined by the
Department of Health) who is
licensed by the Department of
Health or any other competent
authority in the UAE, is payable by
the insurance company.
The GP shall transfer the insured,
provided that the reasons are
mentioned, via the electronic
system in order for the claim to
be considered by the insurance
company.

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Coverage approval requirements • Non-emergency medical conditions
(elective) - prior approval is
mandatory.
• Emergency medical services –
notifying the insurance company
within 24 hours of admission to
the hospital covered under the
insurance network.
The rate of deductibles by the
insured
• %20 to be paid by the insured, up
to a maximum of AED 500 to be
paid for every new service.
• An annual total ceiling for the
deductible rate equal to AED 1000.
• In case of exceeding the ceilings,
the insurance company shall cover
%100 of the treatment cost.
Type of stay • Providing in-hospital treatment
services in rooms with two or more
beds.
Hospital stay and related
services Covered
Intensive care unit and
treatment of coronary artery
disease
Covered
Fees for consultants, surgeons,
and anaesthesiologists Covered
Various treatments including
physiotherapy, chemotherapy,
radiotherapy, etc.
Covered
Use of medical devices and
equipment (eg heart-lung
support systems, etc.)
Covered
Land transportation services in
the State, provided by a licensed
entity for medical emergencies
(Ground ambulance services)
Covered

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Stay of a companion (to
accompany an insured child up
to the age of 16 years)
Covered up to a maximum of AED
100 per night
Cost of accommodation for the
companion of a patient staying
in the same room in cases of
medical necessity based on the
recommendation of the treating
physician, and following the
prior approval of the insurance
company providing coverage.
Covered up to a maximum of AED
100 per night
Outpatient Treatment
(Basic health services: At licensed out-patient clinics)
• Primary care/first line of care
within the network of health
service providers
• General Practitioner (GP) or
Network Gatekeeper only
Transfer procedures
• The Insured will not incur any
costs for advice or consultations
provided by specialists or
consultants in out-patient clinics if
the transfer is made by a network
general medical practitioner (or
equivalent as determined by the
Department of Health) who is
licensed by the Department of
Health or any other competent
authority in the UAE, payable by
the insurance company.
• The general medical practitioner
shall transfer the insured, while
stating the reasons, via the
electronic system, in order for the
insurance company to consider
the claim.
Examination, diagnosis and
treatment services by certified
practitioners, specialists and
consultants
%20 deductible rate to be paid by
the insured per visit
Not applicable in case of a follow-up
visit within seven days

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Laboratory testing and
radiological diagnostic services
%20 deductible rate to be paid by
the insured per visit.
In non-emergency medical cases,
prior approval is required for
magnetic resonance imaging (MRI),
CT scan, and endoscopy.
Medicines and drugs %30 deductible to be paid by the
insured per prescription
The value of medicines and drugs
is covered up to a maximum of
AED 1500 annually (including the
deductible percentage).
*The deductible shall only apply to
products included in medical-health
prescriptions where available.
New-born vaccinations and
immunisations
• Basic vaccinations and
immunisations for newborns
and children as stipulated in the
policies of the Ministry of Health
and their updates.
• Claims shall be covered
on reimbursement basis
(reimbursement of accrued
expenses) as per the coverage
determined in the Section of
the “Medical Claims Settlement
Requirements” in this Document.
Physiotherapy (requires prior
approval)
%20 deductible rate to be paid by
the insured per session.
Covered up to 6 sessions per
member annually.

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Other Additional Services
One-day treatment Covered
Outpatient surgery Covered
New-born coverage
• Covered for the first 30 days
after the date of birth of a new-
born baby with the mother's
annual benefits up to the
maximum limit of the mother's
policy - /AED 150,000.
• Covered for the tests of bacille
Calmette-Guerin (BCG) and
Hepatitis B, as well as new-born
check-ups up to 30 days from the
date of birth.
Diagnostic and treatment
services for the treatment of
teeth and gums
• Covered only in medical
emergencies, subject to a %20
deductible rate to be paid by the
insured.
Hearing and optical aids, and
vision correction through
surgeries and laser.
• Covered only in medical
emergencies, subject to a %20
deductible rate to be paid by the
insured.

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Pregnancy and Childbirth Services
Pregnancy
and Childbirth
Services
*Should any
situation
develop
into an
emergency,
necessary
medical
expenses will
be covered up
to the annual
total limit
Prenatal services
in outpatient
clinics
Prior approval
from the health
insurance
company is
required
• %10 deductible
to be paid by the
insured woman.
• 8 visits to
primary health
care centres,
including
check-ups,
examinations
and tests,
according to
prenatal care
protocols.
• All types of care
provided by an
obstetrician in
low-risk primary
care or an
obstetrician for
high-risk cases.
In-hospital
pregnancy
and childbirth
services
Requires prior
approval from the
health insurance
company, or
notification
within 24 hours
of emergency
treatment.
• %10 deductible
rate to be paid
by the insured
woman.
• AED 7000 for a
normal delivery,
or AED 10000
for a medically
necessary
caesarean
delivery
(C-section),
complications
and necessary
medical
termination of
pregnancy.
New-born
coverage • Covered for the
first 30 days
from birth.

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Medical Claims Settlement Requirements (amounts paid by the
insurance company)
Elective
treatment
Free or cashless
access (the
Network)
Within the
network of
healthcare
providers
%100 of actual
costs covered
Reimbursement
of expenses
owed (outside
the network
of healthcare
providers).
In the UAE
governmental
hospitals
%80 of the
actual cost
covered is
subject to
up to %100
of applicable
network rates.
In the UAE,
except for
government
hospitals
Not covered
Reimbursement
of charges
in covered
countries (for
in-hospital
services only)
%100 of the
actual cost
covered is
subject to %100
of the network
rates applied in
the State.
Emergency
treatment within
the geographic
coverage area
Free access (within the network of
healthcare providers)
%100 of actual
costs covered
Reimbursement of expenses owed
(outside the network of healthcare
providers in the UAE)
%100 of actual
costs covered

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