Four models across seven countries

The first model is the visa-linked private policy. In the United Arab Emirates, government schemes serve nationals and public staff, so an expatriate in the private sector is insured through a policy the employer buys. From 1 January 2025 that policy became a condition of issuing or renewing the residence permit in every emirate, not only Abu Dhabi and Dubai.

The second is national insurance that follows residency. Israel insures every resident under its national health insurance law. Each person registers with one of the health funds, and contributions are collected by the National Insurance Institute along with national insurance. The employer reports the worker and deducts the health contribution from pay.

The third is a social health scheme run through payroll, which covers most of the region. In Türkiye the employer registers a contracted employee with the social security institution (SGK) for general health insurance. Kenya moved from the old hospital fund to SHIF under the Social Health Insurance Act, 2023, with payroll deductions starting in October 2024. Commentary on Nigeria’s 2022 health insurance act describes cover as mandatory for citizens and legal residents. Egypt is building universal health insurance under Law No. 2 of 2018.

The fourth is voluntary private cover. South Africa has no compulsory health insurance today. Employees use public clinics and hospitals or join a medical scheme, often called medical aid, which many employers subsidise.

Schemes that are still taking shape

Several of these systems are mid-change, so the date of any guidance matters. Egypt is rolling its new system out one governorate at a time. The first phase covers Port Said, Ismailia, Suez, South Sinai, Luxor and Aswan, with national coverage targeted for 2032, and the older health insurance organisation scheme still applies where the new one has not arrived.

South Africa’s National Health Insurance Act is law but not in force. In February 2026 the President committed to not proclaiming any of its sections until the Constitutional Court rules on challenges to how it was passed. In Nigeria, commentary describes enforcement on private employers as uneven, because much of the system runs through each state’s own scheme.

For an employer, the practical step is to record exactly where each person lives: the emirate, the Egyptian governorate or the Nigerian state can change which rules apply.

Where the insurer is authorised matters

Almost every country here controls which companies may insure people who live there. Law-firm guides to the UAE’s Federal Decree-Law No. 48 of 2023 describe a requirement to insure people located in the UAE with a company authorised by the central bank. Türkiye’s Insurance Law No. 5684 requires insurable interests of residents to be insured with companies operating in Türkiye; its exceptions include health cover limited to time spent abroad.

Kenya’s Insurance Act bars placing Kenya business with an insurer not authorised under it unless the Commissioner of Insurance approves in writing beforehand, and the Act’s definition reaches people living in Kenya. Egypt’s Unified Insurance Law of 2024 gives the Financial Regulatory Authority sole power to authorise and supervise insurers. Commentary on Nigeria’s 2025 insurance reform act says Nigerian-based interests may not be insured with a foreign insurer unless exempted. In South Africa, only a registered medical scheme may carry on the business of one.

None of this decides whether a particular international plan works for a particular person. That is for the insurer to confirm, country by country.

Local plans your employees already know

Each market has a familiar private layer, and an employee will compare your offer with it. In Türkiye, complementary health insurance pays the extra fee that SGK-contracted private hospitals charge, while full private cover reaches a wider set of hospitals. Nigerian employers usually buy cover through health maintenance organisations (HMOs), which must register with the national health insurance authority. Israel’s health funds sell their own supplementary plans.

In Kenya, group medical plans with inpatient, outpatient, dental and optical benefits are the norm for professional roles, and the 2023 Act states that nothing in it stops a member from holding private insurance as well. South African medical schemes must cover a set of prescribed minimum benefits on every option, including emergencies and chronic conditions on a defined list. SARS treats employer-paid scheme contributions as a taxable fringe benefit.

Where a mandatory scheme exists, plan for an international policy to sit on top of it rather than in its place; whether any plan can meet a local mandate is for the insurer to confirm. In South Africa, with no mandate, whether a global plan can cover a resident at all is for the insurer to confirm, and the medical scheme fees tax credit applies only to registered schemes.

Families, and duties that are not health cover

Dependant rules vary as much as the schemes. Abu Dhabi puts a spouse and up to three children under 18 on the employer or sponsor, while Dubai leaves each resident dependant to their visa sponsor, usually the employee. Egypt’s new system is family-based, with a working member paying for a spouse and children who do not work. Israel’s Foreign Workers Law, as official handbooks describe it, has the employer of a foreign worker without state cover provide private medical insurance at its own expense.

Payroll here often carries obligations that sit outside health insurance. Nigeria’s Pension Reform Act 2014 requires every employer to keep a group life policy for all employees, alongside pension contributions and the employees’ compensation fund. Kenyan payroll adds the national social security fund and the affordable housing levy. South African employers pay unemployment insurance, the skills development levy and workers’ compensation. Egyptian employers register staff with the national social insurance organisation, and foreign employees were brought into it in September 2021.

Meeting those duties does not take care of health cover, and arranging health cover does not take care of them. Budget for both.

Entity, employer of record or contractor

Without a local company, US employers in this region usually hire through an employer of record. EOR providers describe the UAE arrangement this way: the EOR’s approved local company becomes the legal employer and visa sponsor, so the mandatory policy sits with it. In Türkiye, sponsoring a work permit for a foreign national needs a Turkish employer, and the EOR registers the employee with SGK. In Nigeria and Kenya, the EOR runs payroll registrations and any private medical plan.

Staffing is regulated in places. Israel requires official approval for anyone acting as a manpower contractor, and South Africa’s 2024 PAYE changes affect non-resident employers with a permanent establishment there.

A genuine independent contractor arranges their own cover; in Kenya that means registering with SHA as a non-salaried household. Because the right structure varies so much, check each country’s setup with a local adviser or tax professional before the start date.

Country guides for the Middle East and Africa

Each guide goes deeper on one country’s scheme, insurer rules and hiring routes:

United Arab Emirates: the residence-permit policy and how it differs by emirate
Israel: health funds, payroll deductions and staff who are not residents
Türkiye (Turkey): general health insurance through SGK and complementary plans
Egypt: the universal health insurance rollout and social insurance
Nigeria: state schemes, HMOs and the group life duty
Kenya: SHIF payroll deductions and the Insurance Act
South Africa: medical schemes, minimum benefits and the paused NHI

For the wider picture, including other regions, start with the international health insurance overview.

Getting an introduction to a benefits partner

Use the quote form on this page to tell us which countries your people live in, how many work in each, how each one is hired, and which family members you want covered. We pass that to a benefits partner that handles international and remote-team health coverage. From there, eligibility, plan choices and pricing rest with the partner and the insurer, not with Mithril1.

On the business side, an overseas team can change what you need from your US workers’ compensation, employment practices liability and cyber cover. We request those policies from insurers, and the insurer decides terms; see insurance changes for remote teams, or the employee benefits hub for every benefits guide.

A few useful answers

Common questions

Can one international plan cover a team spread across the Middle East and Africa?

It can sit alongside local cover in several countries, but each country sets its own base layer and its own limits on which insurers may cover residents. Whether a plan can cover someone living in a given country is for the insurer to confirm.

Where in the region does the employer buy the health policy itself?

In the UAE, the employer buys a policy before the residence permit is issued or renewed. In Israel, an employer of a foreign worker without state cover provides private medical insurance. In Türkiye, Kenya, Egypt and Nigeria, cover runs mainly through payroll schemes and registration.

Is South Africa’s National Health Insurance in force?

No. The Act is law, but in February 2026 the President committed to not proclaiming any section until the Constitutional Court rules on challenges to how it was passed. Medical scheme membership remains voluntary.

What does an employer of record usually handle for health cover here?

As the legal employer, the EOR typically registers the employee with the local scheme, runs payroll contributions and, in the UAE, sponsors the visa and arranges the mandatory policy. Your company can then decide whether to fund extra cover on top.

Is Nigeria’s group life requirement a form of health insurance?

No. The Pension Reform Act 2014 requires a group life policy for all employees, which is life cover. The health insurance mandate under the 2022 act is a separate duty.

International Health Insurance for Remote Employees in the Middle East and Africa