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10/11/2020

Rules for COVID-19

 

 

For Members

 

What is COVID-19?
Corona Virus Infectious Disease, first incident happened in 2019 is called, COVID-19.

  • CO is for Corona
  • V is for Virus
  • ID is for Infectious Disease
  • 19 is for 2019.

 

What are the symptoms of COVID-19?
Most common symptoms: Fever, Dry Cough, Tiredness/Fatigue, and Loss of sense of taste & smell. However, serious symptoms include: Difficulty of breathing or severe shortness of breath, chest pain or pressure, loss of speech or movement.

 

What should I do if I have symptoms in UAE?
It’s very important to start isolating yourself and visit the nearest network healthcare provider to check if it’s necessary to do the PCR test.

 

Does my insurance cover COVID-19 test?

 

  • Dubai Policies:
    • If you are having symptoms, and you have a DHA insurance policy(Dubai policy), then your policy will cover medically required services requested by the treating physician.
    • If you are asymptomatic or came in contact with COVID-19 positive case, your policy will not cover the screening test for COVID-19.
    • For insurance policies other than DHA, your healthcare provider shall advise you if it will be covered or not according to the rules and regulations of each emirate.
  • Abu Dhabi Policies:
    • Diagnostic and Treatment Services are covered under Program No. (5) of the Activity-Based Funded Mandates which includes epidemics and pandemics for all providers located in the Emirate of Abu Dhabi only.
    • Cost of diagnosis/treatment of COVID-19 cases for DOH compliant policies (Abu Dhabi and Al Ain) incurred in facilities outside the Emirate of Abu Dhabi shall be subject to the policy terms and condition, and might be rejected unless specified by the payer/insurer as a general rule.
  • Northern Emirates (Non-DHA & Non-DOH Policies):
    • If your Policy is not regulated by DHA or DOH, please contact the payer/insurer because coverage will depend on their decision.

 

 

Am I covered for COVID-19 test and treatment outside UAE?

COVID-19 tests and treatment undergone abroad are not part of your UAE health insurance coverage.

 

 

Who do I call if I need more information?

  • Ministry of Health & Prevention – call 80011111
  • Abu Dhabi: Department of Health – Estijaba service – call 8001717
  • Dubai: Dubai Health Authority – call 800342

 

 

For Healthcare Providers

 

  • Signs and symptoms: For patients presenting with any signs/symptoms and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as:
  • Cough (786.2)
  • Shortness of breath (786.05)
  • Fever unspecified (780.6)
  • Immunoassay for infectious agent antibody/ies (86328) [qualitative or semi quantitative, single step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARSCoV-2)].
  • PCR test: Infectious agent detection by nucleic acid, DNA or RNA please use CPT 87635.
  • Please follow the local regulators coding guidelines for preapproval/claim submission of COVID-19 related claims.
  • For the purpose of mapping new mandatory COVID-19 procedure prices for the existing CPT codes, twelve new DSL codes was introduced by the DHA, these have been created to ease the operations of all providers and payers without changing already agreed and existing pricing for the services listed below to be inline with standard unified pricing stated in GC 13 of 2020
  • To report confirmed cases, assign code U07.1 “COVID-19” then followed by the specific respiratory condition (e.g. pneumonia, acute bronchitis or unspecified acute lower respiratory infection etc.). Only assign signs and symptoms codes where a definitive diagnosis has not be established.
  • To report suspected cases, assign Z20.828 “Contact with and exposure to other viral communicable diseases”.
  • To report negative cases, assign Z03.818 “Encounter for observation for suspected exposure to other biological agents ruled out”.
  • To report screening for asymptomatic cases, assign Z11.59 “Encounter for screening for other viral diseases”.
  • To report asymptomatic cases with positive test result, assign U07.1 “COVID-19”.
  • To report infection during pregnancy, childbirth or the puerperium, assign O98.5x, Other viral diseases complicating pregnancy, childbirth and the puerperium then followed by U07.1 “COVID-19”.