Coverage for some Daman members

DUBAI // Insurer Daman provides coverage for bariatric surgery for Thiqa members and those on the company’s premier plan.

Daman Premier members will be covered for gastric banding if they are morbidly obese as defined by the World Health Organisation – a BMI of 40 or over – but they must first undergo a lifestyle change administered by a qualified health professional, such as a diet and exercise plan.

“Although members of other plans are not covered at the moment, we intend to review our coverage criteria for bariatric surgeries in 2017, which may result in more members being eligible,” said Dr Jad Aoun, chief medical officer at Daman.

“Our coverage criteria are in line with local and international guidelines relevant to the treatment of obese and morbidly obese patients.” Thiqa members are covered for sleeve gastrectomy, gastric bypass and gastric banding if their BMI is over 30.

Those on the lower end of the obesity scale (BMI 30 to 39.9) must meet the aforementioned conditions and also be suffering from a number of longterm conditions to be eligible for treatment. Patients with a BMI of 35 to 39.9 need to be suffering from two conditions of Type 2 diabetes, liver disease, high cholesterol levels, sleep apnoea, hypertension and asthma to fit surgery criteria.

Stephen Maclaren, a senior executive at insurer Al Futtaim Willis, said health insurance will very rarely cover obesity.

“The insurer’s view is very much that the member should diet and exercise,” he said.

“While that is true for most people, it is not for all. It all comes down to whether the employers have a claims-rated scheme. If they wanted it covered, it could be, but for a cost.”