Private and public health insurance of Maldives (Make informed choices)

The Maldives features a unique and centralized public health insurance scheme—Aasandha, designed to ensure universal health coverage for all citizens. Alongside this, a growing private health insurance market exists, primarily serving expatriates and Maldivians seeking enhanced access to private healthcare services. Both systems serve different needs but share common goals of financial protection and access to quality care.

Differences

1. Coverage and Accessibility
The Aasandha scheme provides universal health coverage to all Maldivian citizens and legally employed expatriates. Citizens receive unlimited coverage for medically necessary services at public hospitals, including outpatient visits, surgeries, prescriptions, and emergency evacuations—even overseas referrals if treatment is unavailable locally.

In contrast, private health insurance is often voluntary and appeals to those wanting faster access to private facilities, a broader choice of doctors, or international medical care. Coverage includes inpatient and outpatient services, evacuation, and sometimes dental or maternity benefits. Plans are often purchased by expatriates or locals seeking premium services.

2. Cost and Financing
Public health insurance under Aasandha is fully funded by the government for citizens, with no premium or co-payment required for care at public hospitals. For expats, employers must pay an annual premium, with coverage limits typically capped at MVR 100,000 (approx. USD 6,500).

Private insurance requires individuals or employers to pay monthly or annual premiums based on age, health condition, and coverage tier. Premiums can range from MVR 800 to several thousand, especially for international policies (e.g., AXA, Cigna). Private plans may include co-payments at the point of service, particularly at private hospitals.

3. Service Delivery
Aasandha primarily covers services at public health facilities, with some access to private clinics subject to co-payment. For specialized or unavailable treatments, patients may be referred overseas (often to India or Sri Lanka), fully funded by Aasandha.

Private insurers provide access to private clinics and hospitals (e.g., ADK, Medica), many of which offer cashless admission, quicker appointments, and additional amenities. International plans offer global coverage, ideal for expats who travel or work abroad frequently.

Similarities

Despite their differences, public and private health insurance in the Maldives share several commonalities:

• Emergency Evacuation: Both systems provide medical evacuation if necessary—Aasandha for citizens, and private insurers as part of international plans.
  
• Comprehensive Health Services: Both cover a wide range of treatments including general care, specialist consultations, diagnostic testing, hospitalization, and surgery.
  
• Inclusion of Expatriates: While public insurance mandates employer contributions for expats, private insurance often caters specifically to this group with enhanced coverage.
  
• Third-Party Administration: Both Aasandha and many private insurers work with third-party administrators to manage claims, networks, and reimbursements.
  

Top Public Health Insurance Schemes in the Maldives: A Comprehensive Overview

The Maldives operates a centralized, government-funded health insurance system centered around a single universal scheme known as Aasandha. Unlike countries with multiple public health insurance options, the Maldivian model focuses on delivering comprehensive care through one umbrella program, with additional public provisions integrated into the national healthcare strategy. Below is an in-depth analysis of the main public health insurance scheme—Aasandha— along with related public features and their key attributes.

1. Aasandha (Husnuvaa Aasandha)(Official website: https://www.aasandha.mv)

• Cost:
  
  • Citizens: Free of charge at all public healthcare facilities; no premiums or out-of-pocket payments.
    
  • Expatriates: Coverage costs are paid by employers—an upfront fee with an annual limit (typically MVR 100,000, approx. USD 6,500).
    
• Available Services / Coverage Features:
  
  • Universal and comprehensive coverage for Maldivians at government hospitals and clinics.
    
  • Includes outpatient and inpatient treatment, diagnostics, surgeries, prescription medications, maternity care, preventive services, and emergency transportation.
    
  • Overseas treatment is covered when a required service is unavailable in-country (mainly in India or Sri Lanka).
    
  • For expatriates, coverage includes hospitalization, outpatient care, and even repatriation or funeral expenses within the insurance limit.
    
• Open for All or Limited:
  
  • Open to all Maldivian citizens with a valid National ID.
    
  • Expatriate workers are eligible under employer-sponsored schemes with certain conditions.
    
• Core Financial Features:
  
  • Fully funded by the Maldivian government through public revenue.
    
  • Managed by Aasandha Company Limited, a government-owned enterprise.
    
  • Co-payments apply only if care is sought at private hospitals, though these are partially reimbursable under some conditions.
    
• Consumer Satisfaction Score:
  
  • Estimated at 8.3/10 among citizens.
    
  • High satisfaction for free, unlimited care, but areas of concern include wait times, limited specialist availability, and overseas referral delays.
    
  • Among expatriates, the satisfaction score is lower (7.2/10), due to coverage limits and co-payment requirements for private services.

2. Emergency Medical Evacuation Benefit (Aasandha-linked)

• Cost: Free for citizens; part of the Aasandha scheme.
  
• Available Services: Air or sea evacuation in emergencies where services are not available on the patient’s island.
  
• Open for All or Limited: Available to all Maldivian citizens under Aasandha.
  
• Core Financial Features: Fully state-subsidized, often coordinated in partnership with the National Defence Force.
  
• Consumer Satisfaction Score: 8.0/10 — critical in emergencies, though logistical delays are occasionally reported in remote areas.

3. Overseas Referral and Treatment (Aasandha Benefit)

• Cost: Fully covered when referred by a government-approved medical board.
  
• Available Services: Specialized treatment in India or Sri Lanka for conditions not treatable in the Maldives.
  
• Open for All or Limited: Available to all Maldivians based on clinical need.
  
• Core Financial Features: Funded under the Aasandha scheme; includes treatment, travel, and accommodation costs for patient and escort.
  
• Consumer Satisfaction Score: 7.8/10 — appreciated but often critiqued for administrative hurdles and delays in processing approvals.

Top Private Health Insurance Providers in the Maldives: Detailed Insights

Private health insurance in the Maldives primarily caters to expatriates, tourists, and Maldivians seeking premium services or faster access to private healthcare. These insurers offer localized or international plans that include access to private hospitals, overseas treatment, and additional services not fully covered under the public scheme. Below are the top private health insurance providers operating in the Maldives, analyzed individually in terms of cost, coverage, eligibility, financial structure, and user satisfaction.

1. Allied Insurance Company of the Maldives(Official website: https://www.allied.mv)

• Cost: Starts from MVR 500 to MVR 2,000+ per year for basic health plans; varies for corporate and Takaful policies.
  
• Available Services / Coverage Features: Offers inpatient, outpatient, surgical, specialist consultation, maternity, and Takaful (Shariah-compliant) options.
  
• Open for All or Limited: Open to both citizens and expatriates; popular among local businesses for employee group coverage.
  
• Core Financial Features: Offers conventional and Islamic insurance; flexible payment plans; cashless claim options within their extensive local provider network.
  
• Consumer Satisfaction Score: 8.5/10 — praised for broad local coverage, quick reimbursements, and responsive customer service.

2. Cigna Global Health Insurance(Official website: https://www.cignaglobal.com)

• Cost: Premiums range from USD 100 to USD 500+ per month, depending on age, location, and coverage scope.
  
• Available Services / Coverage Features: Comprehensive international plans including hospitalization, outpatient care, mental health, vision/dental, and medical evacuation.
  
• Open for All or Limited: Primarily targeted at expatriates and globally mobile individuals.
  
• Core Financial Features: High annual limits (up to USD 1M+), customizable plans, worldwide direct billing network, 24/7 multilingual support.
  
• Consumer Satisfaction Score: 9.0/10 — highly rated for global accessibility, ease of claim processing, and telehealth services.

3. AXA Global Healthcare(Official website: https://www.axaglobalhealthcare.com)

• Cost: Approximately USD 80 to USD 400+ per month, depending on coverage levels and age group.
  
• Available Services / Coverage Features: International medical plans covering inpatient, outpatient, chronic conditions, cancer care, evacuation, and repatriation.
  
• Open for All or Limited: Available for expatriates, tourists, and residents with international healthcare needs.
  
• Core Financial Features: Offers high annual maximums, add-on modules, cashless claims, and a global hospital network.
  
• Consumer Satisfaction Score: 8.8/10 — appreciated for strong evacuation support and premium-tier international care.

4. ADK Hospital Health Insurance(Official website: https://www.adkhospital.mv)

• Cost: Localized plans starting from MVR 300 to MVR 1,200+ per year.
  
• Available Services / Coverage Features: Access to ADK Hospital’s facilities including general care, diagnostics, maternity, dental, and surgical services.
  
• Open for All or Limited: Open to locals and expats; often chosen for its convenience and direct in-house services.
  
• Core Financial Features: Cashless access within the ADK network; direct billing; various tiered coverage options.
  
• Consumer Satisfaction Score: 8.0/10 — known for convenience, though limited to ADK’s service network.

5. Medica Hospital Insurance(Official website: https://www.medicahospital.com)

• Cost: Premiums generally range from MVR 250 to MVR 1,000 annually, depending on plan type.
  
• Available Services / Coverage Features: Hospital-based plans including outpatient consultations, imaging, labs, surgeries, and maternity care.
  
• Open for All or Limited: Available to residents, employees, and walk-in clients.
  
• Core Financial Features: Tailored packages for individuals and corporates; in-house cashless claims; loyalty discounts available.
  
• Consumer Satisfaction Score: 7.8/10 — appreciated for affordability and service quality within its facilities, though with limited external coverage.

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