Almost every UAE health insurance policy charges a co-pay - a share of the cost of each visit you pay out of pocket, with insurance covering the rest. The co-pay is usually quoted as a percentage. The most common is 20% on outpatient, but you'll see 10%, 25%, and 30% out there. Some plans bundle a flat fee on top (e.g., AED 50 per consultation).
The maths, in three lines
If your plan says 20% co-pay on outpatient and the clinic charges AED 250 for the visit:
- Insurance pays 80% of AED 250 = AED 200
- You pay 20% of AED 250 = AED 50
- The clinic bills your insurer for AED 200 and takes AED 50 from you at the desk.
That AED 50 is the co-pay. It's not a fee Covered or your insurer adds on - it's your agreed share under the policy.
Where it gets confusing
Tiered networks
Most plans have multiple network tiers - say, Network 1 (the premium hospitals), Network 2 (mid-tier), and Network 3 (basic). Your co-pay often changes based on the tier you use. A 20% co-pay at Network 2 might balloon to 30% if you walk into a Network 1 hospital.
Some plans charge a flat 100% (no cover at all) if you go outside their network entirely. Check this before you book - Covered surfaces the network tier and co-pay on the Coverage Summary.
Different categories, different co-pays
Outpatient (clinic visits, GPs, specialists) usually has one co-pay rate. Pharmacy can have another. Maternity, mental health, and dental - when they're covered at all - often have their own. A "20% co-pay" headline number rarely applies to everything; the policy will spell it out per category.
Deductibles, on top
A few plans add a deductible - a fixed amount you pay before insurance kicks in at all. If your plan has an AED 500 annual deductible, you pay the first AED 500 of total claims yourself, and the co-pay kicks in after that. Most consumer policies in the UAE waive the deductible (AED 0) on outpatient. Always worth checking.
Co-pay caps
Better plans put a cap on how much co-pay you can be charged on a single visit. E.g., "20% co-pay, max AED 250 per consultation." Without a cap, a 20% co-pay on a complex AED 5,000 procedure means AED 1,000 out of your pocket. With a cap, it's whatever the cap says.
How to sanity-check a bill at the desk
If you're handed an out-of-pocket charge that feels wrong:
- Ask for the full charge before insurance.
- Multiply that by your co-pay percentage for the category (outpatient, pharmacy, etc.).
- That should match the number on your bill, give or take any flat consultation fee.
If the maths is off by more than a few dirhams, ask why. Common reasons: the service is outside the standard outpatient category (e.g., a procedure billed as day-case surgery), or you've slipped into a different network tier.
What the Spending tab does with this
Covered's Spending tab inverts the calculation. When you log a visit, you tell it what you paid out of pocket and which category. Covered uses your policy's stated co-pay to work out what the full visit cost was - and therefore how much your insurance covered for you. Across the year, that number gets surprisingly large.
It's the easiest way to see - concretely - what your policy is doing for you. Especially useful at renewal, when you're trying to decide whether to upgrade, downgrade, or switch insurer.