Ahmed Al Nuaimi issues a decision regarding the health insurance system in the Ajman government
Sheikh Ahmed bin Humaid Al Nuaimi, the representative of His Highness the Ruler of Ajman for Administrative and Financial Affairs, issued Decision No. 30 of 2020 regarding the health insurance system in the government of Ajman, to be implemented as of January 1, 2021, and to be published in the Official Gazette of the Emirate.
This decision comes based on what was presented by the Director General of Ajman Government's Human Resources Department regarding the modernization of the health insurance system in the Ajman government, and the Ajman government’s keenness to preserve human cadres and provide a safe and healthy work environment and a desire to raise and improve the health insurance umbrella to include employees and their families, which provides the best care. Healthy them and protect them from any health symptoms that negatively affect their job performance.
The decision specified the scope of application of the health insurance system so that it includes all local government agencies in the Emirate of Ajman in which Emiri Decree No. 4 of 2017 applies regarding the issuance of the Ajman Government Human Resources Law and its implementing regulations and any other entity other than the parties mentioned, the legislator decides on the local legislation issued to establish them Or to reorganize it and subject its employees to the provisions of the law.
The decision permits the addition of any entity within the Emirate of Ajman to be included in the insurance system with the written approval of the Ruler's representative based on the recommendation of the Human Resources Department, and it is also permissible, with the written approval of the Ruler's representative, to add any person to be included in the insurance policy and according to the instructions and directives issued by him in this regard.
The decision specified the categories of health insurance, and the categories are classified with the contracted insurance company on the basis of which the insurance cards are issued and the medical services described in the insurance policy are provided.
He also specified the beneficiaries of the insurance system: First, the citizen employee and according to the system, the citizen employee and his family are entitled to health insurance, and the entitlement of his family members to health insurance continues until the employee’s service ends and the marital relationship ends with regard to the husband and the son’s work or reaching the age of twenty-one years of age, whichever is earlier for male children unless one of them is A person suffering from a handicap or disability that prevents him from working according to a certificate from the competent authorities in the state and the work of the daughter or her marriage unless she is widowed or divorced.
The decision stated that, in all cases, the insured must not be covered by any type of health insurance with any other party within the country, with the exception of spouses of employees working in the armed forces and holders of trust insurance of the third and second categories and happiness insurance.
Second: The non-national employee and includes employees of the first degree up to the fourth degree. He, his wife and three children are entitled to a maximum, and the employees of the fifth degree up to the seventh degree. He, his wife and children are entitled to a maximum of "two" and the employees of the eighth degree up to the tenth degree, and he and his wife only and the employees of the eleventh degree to the tenth degree are entitled to The fourteenth employee only according to a set of conditions, the most important of which is the issuance of a health insurance card for the employee and his family in accordance with the requirements for issuing residency permits issued by the competent authorities in the state and that the insured is not covered by any of the types of health insurance for any other party within the state and that the age of the children does not exceed 18 years old, whether male or female.
The insured is entitled to the health insurance prescribed for him according to the commencement of the insurance policy, and for new employees or transferred employees, they are entitled to health insurance as of the date they start work, and if a situation or event occurs that affects the insured's entitlement to health insurance, then his entitlement is modified from the date of the emergence of that situation or incident.
The decision affirmed that it is not permissible to combine the health insurance established under the provisions of this decision with any other health insurance if the employee and his wife work for the government, so the health insurance entitlement is to the holder of the highest degree, and if their entitlements are equal, then the health insurance entitlement is according to the entitlement of the husband (man) and if one is The two spouses work for the government and the other outside the government or enjoy any other health insurance inside the country, so the entitlement to health insurance is for the employee who works in the government of Ajman unless the employee or his wife waives this insurance in writing for the purposes of enjoying another health insurance.
The insured's entitlement to health insurance continues throughout the weekends and official holidays and leaves authorized for the employee in accordance with the provisions of the law and applicable legislation, and the costs of medical care for the insured while he is outside the country are covered only in emergency cases in addition to any other additional benefits that may be included in the insurance policy provided by the insurance company in accordance with For the conditions and procedures specified by the document and its annexes.
The decision also stipulated that the Human Resources Department shall supervise the implementation of the provisions of the insurance system, introduce the system and raise awareness of its provisions, conditions and appendices for the concerned parties who implement it by all available means, and provide a personal database for the insured to be used in the future in accordance with the requirements of health insurance, and to ensure that the human resources units carry out their duties. And contracting with the health insurance company through the appropriate procurement method in accordance with the provisions of the unified financial system of the Ajman government, provided that this jurisdiction shall start from the date of issuance of this decision in addition to reviewing and re-evaluating the applied health insurance system on an annual basis or whenever needed and presenting the results of these reviews and suggestions to The Ruler's representative for approval and coordination between the government agency and the Finance Department regarding the inclusion of estimates of health insurance expenditures pertaining to it in its annual budget project and the preparation of certificates of completion and payment orders for the insurance company according to the entitlement in accordance with the terms and conditions of the insurance contract and in accordance with the procedures in force in the government in addition to the payment of the insurance company's dues according to the terms And the provisions of the contract and based on the certificates of completion and the orders of the father
Actions issued by the Human Resources Department in accordance with the provisions of the unified financial system of the Ajman government and the necessary settlement procedures between the accounts of the concerned government agencies, respond to inquiries, and provide the necessary legal and technical support to human resources units in government agencies regarding the application of the system.
The decision specifies the duties of human resources units, including receiving insurance documents and requests and ensuring their completeness and correctness, including the certificates of the husband or wife's employer not to obtain health insurance for the family and birth certificates for children or any documents requested by the Human Resources Department and entering data and information of the insured on electronic systems. In force in the government, reviewing and updating them periodically and providing the Human Resources Department with the necessary reports, forms and documents about the insured and their insurance information accurately and updating them periodically and any changes in the social or employment status or personal data of the insured or any event that changes their insurance status in addition to coordination with the unit The concerned financial system in the government agency regarding reviewing and approving health insurance statements for its employees according to the dates specified by the Human Resources Department, responding to the government agency’s employees’s inquiries regarding health insurance, receiving the insured’s cards upon termination of their services, and preparing and implementing health awareness and education programs for the insured in coordination with the Resources Department Mankind and privacy protection
Data of the insured.
The decision obliges the employee during his period of service in the government to notify the Human Resources Unit whether he or any of his family members have health insurance and inform them in the event of loss or damage to his health insurance card or any of his family members, and in this case the employee is charged the value of issuing an insurance card A new health insurance amounting to one hundred dirhams for each card and providing the Human Resources Unit with any data or information related to his eligibility for health insurance in a clear and accurate manner and informing them of any developments that may affect his eligibility or the eligibility of any family member to health insurance.
The decision noted not to misuse the health insurance card in any way, not to allow others to use the card for himself or any of his family members, and to inform the Human Resources Unit of any exploitation, negligence, or default committed by the providers of treatment units, and to hand over health insurance cards in the event of expiry. The service and the Human Resources Unit must immediately inform the Human Resources Department of the end of the employee’s service to inform the insurance company to stop the cards, and in the event that the employee or his family is proven to use these cards after the end of his service, all costs are deducted from his end of service dues, with the concerned employee responsible for failure to report fully responsible if Not charging the end-of-service employee with the costs of using health insurance cards.
He also indicated that the non-citizen employee did not switch between the children benefiting from health insurance during the validity period of the coverage, and in the event that the change is desired, the application must be submitted at the end of the year and during the renewal period, and in the event that the children switch between children because one of the children reaches the legal age during the year, the added son benefits Recently from the remaining period in health insurance.
The decision punishes anyone who violates the provisions of this system, misuses health insurance, forges information and documents about his health condition or insurance status, or cooperates with any external party to achieve benefits for himself or for others by exploiting health insurance in accordance with human resources laws and regulations without prejudice to any other legislation They are valid in the emirate or the state, and any costs or financial obligations arising from the failure to perform their duties stipulated in this bylaw shall be borne by the government agency or employee or both.
The Human Resources Department has the right from time to time to issue circulars, executive decisions, annexes and forms as necessary to ensure the implementation of the provisions contained in this system, provided that they do not contradict its provisions, and the bodies involved in the application of the insurance system must implement the procedures and instructions issued to them by the Department of Human Resources.
The implementation of Resolution No. 42 of 2017 regarding the health insurance system in the Ajman government and its amendments, and any circulars or instructions issued pursuant to it, shall be canceled and replaced by the insurance system issued pursuant to this decision and any circulars or instructions issued in this regard.
Any text or provision mentioned in another decision in effect in the Emirate that contradicts what is stated in the provisions of this decision shall also be canceled without prejudice to the validity and enforceability of any decisions issued or measures taken under the provisions of the canceled decision prior to the effective date of this decision, and this decision shall be enforced as of January 1, 2021 and published The Official Gazette of the Emirate.
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