Dubai Health Insurance – Violations & Fines
Dubai Executive Council issued Executive Council Resolution No (7) of 2016 (Resolution) pertaining to fees and fines pursuant to Health Insurance Law (No 11 of 2013) of the Emirates of Dubai.
As many of the readers are aware, The Dubai Health Authority promulgated Health Insurance Law (No 11 of 2013) of the Emirates of Dubai, which regulates mandatory health insurance coverage for all residents in Dubai. The Resolution deals with aspects of enforcement through several listed violations.
The Resolution compliments General Circular No.5 of 2014 (GC 05/2014) in respect of the Dubai health Authority's approach to enforcement of fines and penalties. At publication of GC 05/2014, the Dubai Health Authority initially took a supportive approach to non-compliance in order to encourage stakeholders to meet it compliance obligations. The DHA now take punitive actions against those stakeholders that violate any of the regulatory obligations associated with Health Insurance Law (No 11 of 2013) of the Emirates of Dubai in order to protect residents of Dubai and uphold their legal rights.
What does this mean the stakeholders involved with health insurance in the Emirate of Dubai?
The Resolution extends the legal provisions of Health Insurance Law (No 11 of 2013) of the Emirates of Dubai in that it gives both the Dubai Health Authority (DHA) and Dubai Healthcare City Authority (DHCA), regulatory oversight to supervise the industry and the participating stakeholders. The Resolution permits both bodies to issue permits and penalties on the various stakeholders including insurance companies, third party claims administrators, medical providers, brokers and employers and sponsors that participate in the mandatory health insurance scheme in the Emirate of Dubai.
What should stakeholders that participate in Dubai mandatory health insurance be aware of?
Annexed to the Resolution is Table No. (1) (see below), which outlines the fees related to health insurance services including fees for obtaining and renewing permits for insurance firms, insurance brokers, claim management companies, hospitals, polyclinics and specialised clinics, pharmacies, laboratories, radiology and analysis centres and other related companies.
Table No. (2), list 56 violations with a specified fine for each (see below). The Resolution stipulates that offenders, who repeat an offence within a year of the date of the first fine, will be charged double the fine up to a maximum of AED 500,000. In addition to the fine, the DHA and DHCA can take further actions including the issuance of warnings to violators and suspension from providing health insurance related services in the Emirates for a period of up to 2 years, as well as revoking licenses. If a license is revoked, stakeholders are required to publish two notifications each on the cancellation of its license in a local Arabic and English language newspaper. Failure to do so can result in the company incurring a fine of up to AED 150,000.
All stakeholders involved with Dubai health insurance, including insurance companies should take care not to violate any of the regulatory provisions and make sure that they have completed a full legal and compliance audit in respect of their legal obligations under Health Insurance Law (No 11 of 2013) of the Emirates of Dubai. For example, some insurers may not have complied with the Essential Benefits Plan (EBP), in terms of the coverage that they may be offering residents of Dubai.
International private medical insurers that use primary fronting insurers to write their medical products locally in the Emirate of Dubai should make sure that they engage with their licensed partners for them to avoid any violations and reputational risks. They should also carry out proper audits. Note the regulatory risk is with those primary licensed insurers.
A translation of the law is set out below with details of the violation offences and financial penalties.
Government of Dubai
Executive Council Resolution No. (7) of 2016
Approving the Charges and Fines of Health Insurance in the Emirate of Dubai
We, Hamdan bin Mohammed bin Rashid Al Maktoum, Crown Prince of Dubai and Chairman of the Executive Council, Having perused Law No. (3) of 2003 on the Establishment of the Executive Council of the Emirate of Dubai;
Law No. (13) of 2007 on the Establishment of the Health Authority of Dubai, as amended, (hereinafter referred to as "Authority");
Law No. (35) of 2009 Regarding the Management of the Public Funds of the Government of Dubai, as amended;
Law No. (9) of 2011 Concerning Dubai Healthcare City, (hereinafter referred to as "DHCC");
Law No. (11) of 2013 Regarding Health Insurance in Dubai, (hereinafter referred to as "Law");
Resolution No. (8) of 2015 Concerning the Application of the Health Insurance Law to Health Service Providers Licensed at DHC
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