ENAYA scheme in UAE

ENAYA is the Government of Dubai Employees & citizens Healthcare Benefits Scheme.

ENAYA provides a broad range of cover including treatment for almost all types of ailments (Chronic and/or acute).

ENAYA Benefits

ENAYA offers comprehensive coverage including:

• Maternity

  • Under ENAYA, expectant mothers and their babies are cared for from the start of the pregnancy to birth and afterwards. And, unlike other policies, there is no waiting period for this benefit under ENAYA.

• Pre-existing and Chronic Diseases

• Disease Prevention

  • Routine periodic check-ups and vaccinations are fully covered and may be availed at DHA facilities.

Eligibility Criteria of ENAYA scheme in UAE

Citizens of Emirate of Dubai who do not benefit from any other government insurance.

Employees of government departments in the Emirate of Dubai and their families.

Emiratis:

• Wives
• Sons up to 24 years
• Daughter until marriage or work
• Parents.

Expatriate Employees:

If expatriate Husband and wife are employees of the government of Dubai and are covered under ENAYA with different categories, then the spouse and dependents will follow spouse with the highest coverage.

1. Only three (3) children can be covered by ENAYA, under the following conditions:

2. Employee's sons will be covered only up to the age of 21 and as long as they are UAE residents and unemployed.

3. Employee’s daughters will be covered only up to the age of 21 and as long as they are UAE residents, unemployed and unmarried.

4. The ENAYA policy allows employees to exchange one child for another only once a year and it cannot be retroactive.

5. Only one wife can be covered by ENAYA Insurance.

6. Employee’s parents will not be included under ENAYA Insurance.

7. If the employee and his family (Spouse/ Children) are covered under ENAYA, they are required to provide a written commitment that they are not covered with any other health insurance provided by the Government of Dubai

8. HR needs to get written commitment from employees that they follow all the above mentioned rules.

How to enroll for ENAYA scheme in UAE?

Citizens of Emirate of Dubai who does not benefit from any other government insurance.

Enrollment can be done through:

• Online registration (please contact Neuron toll-free line for guidance 800 436292)

• Kiosk registration using Emirates ID through the following steps:

• Proceed to the nearest ENAYA Kiosk within Dubai in one of the following locations:

  • Al Barsha Health Center

  • Nad Al Hamar Health Center

  • Al Mizhar Health Center

  • Hatta Hospital

  • Dubai Festival Tower

• Press start on the digital screen

• Insert the Emirates ID card into the designated reader Complete entry of required details

• Enroll remaining family members Confirm registration

Note: you can’t be enrolled in ENAYA without a valid original Emirates ID card.

For Employees of government departments in the Emirate of Dubai and their family’s enrollment request should be received from the HR at place of work.

How to get medical care under ENAYA program?

Within the UAE/within the ENAYA Network

For Out-patient treatment, please remember to:

• Check the ENAYA Network List (Available on Neuron App) and book an appointment with the selected hospital/clinic.

• Present your Emirates ID card at the hospital/clinic, in order for your consultation and/or related tests, treatment etc. to be on direct billing (otherwise, you will be required to pay for your visit and reimbursement will not be possible as per policy terms and conditions).

• Sign on the Neuron Claim Form after completion of consultation, treatment, laboratory test(s) etc. Pay the Co-insurance and/orDeductible (whichever is applicable).

• Present a copy of the duly completed Neuron Claim Form -Direct Billing along with original prescription and the ENAYA membership card at a Network pharmacy to claim for medications.

For In-Patient Treatment:

• The Emirates ID Card should be presented at the time of your admission to the hospital.

• Network hospitals are required to seek pre-authorization before they proceed with any elective admissions or surgeries.

• Network hospitals do not need to seek pre-authorization for emergency admissions; however, they are required to inform Neuron within 24 hours from the time of admission.

Kindly Note

• Network hospitals/clinics/diagnostic centers/pharmacies are required to collect payment from any member who fails to present the ENAYA membership card at the time of visit.

• Always remember that refund and/or reimbursement is not allowed.

• Network hospitals/clinics/diagnostic centers/pharmacies are required to seek pre-authorization/approval from Neuron before proceeding with certain procedures/ investigations/treatment etc.

• Whenever prompted to pay by any service provider, contact the ENAYA Helpline for clarification and guidance.

• For inquiries regarding the status of a pre-authorization request, kindly contact ENAYA Helpline toll-free number (800 4 ENAYA or 800 4 36292.)

• Ask your doctor whether all actions required of tests/xray/check/essential drugs before proceeding.

• You are required to pay for expenses related to treatment or conditions that are excluded from cover under the ENAYA Scheme.

• All inpatient services require prior approval through system online submission.

• In the event of any complaints concerning any service provider, please contact ENAYA Helpline.

• If you observe or discover the existence of any fraud, please contact ENAYA Helpline.

Within the UAE / Outside the ENAYA Network

As an ENAYA Category A Nationals Member, you are entitled to treatment outside the ENAYA Network. However, you are required to pay for any consultation/treatment/medications and submit all pertinent documentation to your HR Department or through Neuron App to claim reimbursement for eligible amounts paid.

Reimbursement of eligible claims is based on Usual, Customary & Reasonable (UCR) rates and subject to 15% coinsurance.

Outside the UAE:

1) Emergency Treatment
Should you need emergency medical treatment, whilst traveling on business or holiday, please contact Neuron’s International Direct Number (+97143823700). Neuron will ensure that necessary arrangements are made to provide you with the assistance you require.

2) Elective Treatment
As an ENAYA Category A Nationals member, you are also eligible to seek elective treatment, whilst overseas. However, treatment will be on a cash and claim (reimbursement) basis only subject to policy terms & conditions.

3) For Home country Treatment
Reimbursement with Coinsurance 20% applied to UAE UCR Rates. Documentation to be submitted within 60 days from day of treatment or as soon as reasonably possible. Pre-approval required: cost of treatment only is covered, travel costs excluded.

Please note:

Direct billing is subject to the provider’s acceptance of a payment guarantee from Neuron and/or its partners.

Coverage for treatment overseas is based on Usual, Customary & Reasonable (UCR) rates and subject to applicable coinsurance.

Where do I submit my claim?

The complete list of documents will have to be submitted to Neuron through contacting helpline to guide you through the submission process, also through Neuron App. Your request will be assessed as per Enaya policy terms and conditions and feedback will be shared with you via email.

Please make sure that all reimbursement claims need to be submitted to Neuron within 60 days from the date of treatment.