UAE Mandatory Health Insurance Is Flooding Insurers with Claims. Here's How to Handle the Volume.

The numbers tell a story that every insurer operating in the UAE already feels. Health insurance premiums rose 20.9 percent year-on-year to AED 31.3 billion in 2024. The number of active policies surged 59.9 percent to 2.2 million. And on January 1, 2025, mandatory health insurance expanded from Dubai and Abu Dhabi to cover private sector employees and domestic workers across all seven emirates — Sharjah, Ajman, Umm Al Quwain, Ras Al Khaimah, and Fujairah — adding millions more insured lives to a system already under strain.

For 2026, industry analysts project another 8 to 10 percent premium increase. The insured pool continues to expand. Claims volumes are rising faster than headcount. And the Central Bank of the UAE has consolidated insurance oversight under Federal Law No. 6 of 2025, tightening regulatory expectations on everything from claims processing timelines to audit trails and data governance.

This is not a temporary spike. It is a structural shift in the UAE insurance market that will permanently change how claims operations must run. Insurers and Third Party Administrators (TPAs) that continue to process claims the way they did in 2023 will find themselves drowning in backlogs, compliance gaps, and customer complaints. Those that invest in claims automation now will capture the growth without proportionally scaling headcount — and position themselves as the operationally excellent partners that employers and regulators demand.

The regulatory pressure is coming from every direction

The UAE's insurance regulatory landscape entered a pivotal new phase with Federal Law No. 6 of 2025. The Central Bank of the UAE (CBUAE) has consolidated regulatory oversight over both banking and insurance activities under a single federal framework, signaling a significantly strengthened enforcement posture.

Licensing and authorization requirements have expanded. All entities conducting insurance-related activities in non-financial free zones — including DMCC, JAFZA, SAIF Zone, RAKEZ, and Meydan — now require CBUAE authorization. Insurance-related activities explicitly include claims-related services. Entities operating without proper authorization face substantial risk of regulatory consequences.

Audit and compliance expectations are rising. The CBUAE's demonstrated commitment to enforcement against Licensed Financial Institutions means that claims operations are subject to increasing scrutiny. Insurers need to demonstrate that every claim is processed according to documented procedures, that decisions are traceable, and that data is handled in accordance with both federal regulations and emirate-specific requirements.

The mandatory insurance scheme itself creates compliance obligations. The basic health insurance package — priced at AED 320 per year — includes specific co-payment structures: 20 percent for inpatient services (capped at AED 500 per visit, AED 1,000 annually), 25 percent for outpatient care (capped at AED 100 per visit), and 30 percent for pharmaceuticals (capped at AED 1,500 annually). Every claim must be adjudicated against these rules accurately and consistently. Errors in co-payment calculations, benefit limits, or network eligibility create both financial exposure and regulatory risk.

For TPAs processing health claims on behalf of insurers, the stakes are even higher. They sit in the middle of a triangle between the insurer, the healthcare provider, and the regulator. Their claims processing accuracy, speed, and auditability directly determine the insurer's compliance posture.

Why the volume problem cannot be solved by hiring

The traditional response to rising claims volumes is to hire more claims processors. In the UAE market, this approach hits three walls simultaneously.

Talent scarcity. The UAE insurance market is growing faster than the available pool of experienced claims professionals. Every insurer and TPA is competing for the same talent, driving up labor costs and making it difficult to scale quickly.

The economics do not work. When the basic health insurance package costs AED 320 per year and the insured pool includes millions of low-cost policies, the margin available to fund claims operations is thin. Adding headcount at the same rate as claims growth makes the book of business unprofitable. Insurers need to process significantly more claims per employee to maintain viable unit economics.

Consistency degrades at scale. When you double your claims processing team in 12 months, quality control becomes extremely difficult. New hires make more errors. Training takes time. Supervisory ratios stretch thin. The result is exactly the kind of inconsistency that regulators are watching for — different adjusters applying co-payment rules differently, benefits interpreted inconsistently across providers, and decisions that cannot be adequately explained in an audit.

The only sustainable path is to process more claims with fewer manual touches. That means automating the high-volume, rules-based work so that human expertise is reserved for complex cases, exceptions, and relationships.

What claims automation looks like in the UAE context

Automated document intake and data extraction

Health claims in the UAE typically arrive as a combination of electronic submissions (for in-network providers) and paper or PDF documents (for out-of-network and complex cases). Document processing technology using AI and OCR can extract structured data from these submissions automatically — patient details, provider information, diagnosis codes, treatment codes, invoice amounts, and supporting documentation.

For the UAE specifically, this means handling both English and Arabic documents, which many Western-built platforms cannot do natively. Bilingual document processing is not a nice-to-have in this market — it is a prerequisite.

Rules-based adjudication for standard claims

The basic health insurance scheme has clearly defined benefit structures, co-payment percentages, caps, and network rules. These are exactly the kind of deterministic rules that automation handles well. A properly configured workflow engine can:

• Validate that the provider is within the approved network
• Confirm the policyholder's coverage is active and the treatment falls within covered benefits
• Calculate the correct co-payment based on service type (inpatient, outpatient, pharmaceutical) and apply annual caps
• Check for duplicate submissions
• Apply pre-authorization requirements where applicable
• Route straightforward claims for automatic approval and payment

For the millions of routine health claims that flow through the UAE system — GP visits, basic diagnostics, prescription medications — there is no reason a human should touch a claim that meets all the rules. Automation can process these in seconds rather than days.

Fraud detection and abuse prevention

The expansion of mandatory insurance creates new opportunities for fraud and overutilization. When access to healthcare feels free at the point of service, usage increases — and overuse becomes common. Insurers face what industry professionals call the "abuse cycle": they pay once through increased claims and again through the mechanisms designed to manage excessive utilization.

Automated fraud detection applies AI models to identify patterns that manual review would miss: providers billing for services not rendered, patients visiting multiple providers for the same condition, pharmacies dispensing medication in quantities that do not match the prescription, and networks of providers engaging in coordinated billing schemes.

Complete audit trails for regulatory compliance

Under the new regulatory framework, every claims decision must be traceable. Who reviewed the claim? What data was considered? Which rules were applied? When was the payment authorized? If the CBUAE or a court examines a disputed claim, the insurer needs to produce a clear, timestamped record of every step.

Manual processes make this extraordinarily difficult. Automated workflow systems log every action, every rule evaluation, every routing decision, and every approval — creating the kind of tamper-resistant audit trail that regulators expect.

The financial case for automation in the UAE market

Consider the unit economics. An insurer processing claims for employers under the basic health insurance scheme is collecting AED 320 per covered life per year. If each covered life generates an average of 4 to 6 claims per year, the insurer needs to process each claim for a few dirhams in operational cost to maintain a viable margin.

Manual claims processing in the UAE typically costs AED 15 to 40 per claim when you account for labor, supervision, quality assurance, rework, and overhead. Automated processing for standard claims can reduce this to AED 2 to 5 per claim — a reduction that means the difference between a profitable book of business and one that destroys value.

At scale, the numbers become significant quickly. An insurer or TPA processing 500,000 health claims per year at AED 30 per claim in manual costs is spending AED 15 million on claims operations. Reducing the average cost to AED 10 per claim through automation of routine cases saves AED 10 million annually — a return that justifies significant technology investment.

The calculation improves further when you factor in reduced claims leakage (overpayments, missed co-payments, duplicate payments), faster processing times (which improve provider relationships and reduce complaints to regulators), and the ability to scale volume without proportional headcount growth.

What UAE insurers should look for in a claims platform

Arabic and English bilingual processing. Both document extraction and user interfaces must handle Arabic natively, not as an afterthought. Claims documents, medical reports, and correspondence arrive in both languages, often mixed within the same document. See the bilingual motor report as an example of the dual-language documentation standards common in GCC insurance markets.

UAE-specific benefit structures. The co-payment rules, benefit caps, network definitions, and pre-authorization requirements vary by emirate, scheme type, and policy tier. The platform must support configurable benefit structures that can be updated as regulations change.

CBUAE regulatory alignment. Claims processing platforms must support the audit trail, data governance, and reporting requirements that the CBUAE is increasingly enforcing. This includes secure document management, role-based access controls, and retention policies that meet regulatory minimums.

Integration with existing ecosystems. UAE insurers typically operate with a mix of core policy administration systems, provider networks, and health information exchanges. The claims platform needs to integrate with these systems rather than requiring a wholesale replacement of existing infrastructure.

Scalability for seasonal and regulatory-driven volume spikes. The ongoing expansion of mandatory insurance coverage will continue to produce step-change increases in claims volumes. The platform must scale without degradation in processing speed, accuracy, or auditability.

The window is now

The UAE's mandatory health insurance expansion is not slowing down. Premium growth of 8 to 10 percent is expected again in 2026. The CBUAE's regulatory framework is tightening. And every month that passes with manual claims processes is a month of accumulating operational debt — higher costs per claim, growing compliance exposure, and an increasingly untenable ratio of claims volume to processing capacity.

Insurers and TPAs that automate now capture two advantages: they handle the current volume surge profitably, and they build the operational infrastructure that positions them for the next wave of growth. Those that wait will find themselves competing against automated competitors while still processing claims by hand.

The UAE insurance market is being reshaped by regulation. The question is whether your claims operation will be reshaped by design or by crisis.

Regure's claims automation platform is built for the demands of the Middle East insurance market — with bilingual Arabic/English document processing, configurable benefit structures for UAE regulatory requirements, and complete audit trails for CBUAE compliance. Request a demo to see how we help UAE insurers and TPAs scale claims operations without scaling headcount.