Dubai Health Authority to introduce mandatory examination

Date published

29/08/2017

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The Dubai Health Authority (DHA) plans to introduce a mandatory health insurance examination (the Exam) for those health insurance providers marketing, selling and placing health insurance risks in the Emirate of Dubai.

Once implemented, all insurers and intermediaries who provide and place medical insurance in the Emirate of Dubai, will have to ensure that their employees and individuals that are involved with marketing, selling and placing health insurance, at any level, sit the Exam to become certified as a "Permitted Health Insurance Representative" (PHIR). The introduction of the Exam was originally scheduled for August 2017 but this has been deferred to a later date due to the changes required to be made by the DHA in respect of the PHIR process and registration.

We have been informed that the syllabus for the Exam that has been agreed by the DHA contains nine sections, which are as follows:

1. Basic principles of insurance and its regulation as applied to health insurance (5% of the syllabus)

This section requires PHIRs to apply various knowledge such as understand the principle of insurable interest and how it applies to health insurance, understand the relationship between risk management insurance and understand the basic principles of conventional insurance and Takaful and be able to explain the differences between them.

2. Private health insurance coverage (10% of the syllabus)

This section requires PHIRs to apply various knowledge such as to be able to explain the purpose and scope of coverage of a private health insurance policy, be able to explain various exclusions and the extent of coverage and be able to explain various terms and conditions in a health insurance policy.

3. The market for health insurance (25% of the syllabus)

This section requires PHIRs to apply various knowledge such as being aware of the operation of public healthcare schemes in the United Arab Emirates (UAE), the funding for those schemes, persons covered by them and the challenges faced during the operation of those schemes.

4. Health insurance regulation in the UAE (25% if the syllabus)

This section requires PHIRs to apply various knowledge such as knowing the extent and application of health coverage systems operated at Federal and Emirate levels that benefit UAE nationals.

5. Main factors affecting underwriting in health insurance (10% of the syllabus)

This section requires PHIRs to apply various knowledge such as understanding factors affecting the acceptance and rating of risks and being able to explain the meaning and significance of conditions and diseases commonly found in the questions in a proposal form.

6. Disease, healthcare management and preventative programs (5% of the syllabus)

This section requires PHIRs to apply various knowledge such as understanding the role of chronic disease management in limiting health insurance claims costs.

7. Claims processing (5% of the syllabus)

This section requires PHIRs to apply various knowledge such as knowing the factors that contribute to health insurance claims and understanding the claims processing cycle including the mechanism within an electronic claims processing system (eClaims).

8. Prevention of fraud, waste and abuse (5% of the syllabus)

This section requires PHIRs to apply various knowledge such as being aware of the risk of fraud and abuse perpetrated by various stakeholders in the health insurance systems.

9. Conduct of business and professional ethics (10% of the syllabus)

This section requires PHIRs to apply various knowledge such as knowing the distinction between professional ethics and the law in relation to health insurance and understanding the need to keep accurate and confidential records in relation to dealings with clients or prospective clients.

The cost of the Exam and associated training materials are not yet known. The intention is that they be charged together rather than separately. Once the training material is published by the DHA, any training centres who are interested in offering the course will need to apply to the DHA for approval. The Exam will be taken online at DHA-approved outsourced testing facilities. Candidates will be able to choose their test centre. The Exam content will be available in both Arabic and English and will hold similar status to the Chartered Insurance Institute (CII) qualification in the United Kingdom. We understand that there will be no exemptions from the Exam and all employees and individuals that are involved with marketing, selling and placing health insurance will be required to sit the Exam.

The DHA Code of Conduct published in 2015 will apply to all PHIRs who receive certification. Any breaches of the Code of Conduct will be recorded by the PHIR's employer and maintained in a Register of Breaches that will be available for inspection by the DHA.

The implementation of the Exam will ensure that PHIRs selling, marketing and placing health insurance in the Emirate of Dubai will have a better knowledge of the underwriting and claims processes as well as the laws and regulations surrounding health insurance in the Emirate of Dubai. This will enable the PHIRs to give their customers adequate and up to date advice in relation to all aspects of health insurance.

The Exam is a welcome development in the Dubai insurance market. It reflects the DHA's desire to embrace conduct of business rules, to regulate the conduct of those selling health insurance and provide greater consumer protection.

Both domestic and international health insurers that provide health insurance in the Emirate of Dubai should start making plans for its staff members to prepare them for the training and the Exam.