Details of mandatory health insurance in Oman revealed

Muscat: The Capital Market Authority (CMA) has issued the Unified Health Insurance Policy (UHIP) to be implemented for private sector employees, including expatriates and visitors to the Sultanate.

  • The insurance scheme will cover two million workers in the private sector and visitors to the Sultanate, including the spouse of the workers and their children (21 years and below.)
  • The project guarantees minimum basic health coverage to both outpatients and inpatients, emergency conditions, treatment of diseases, and the cost of medicines.
  • The employer is responsible for the payment of the premium and in agreement with the employee he can include added benefits for pregnancy, childbirth, dental and eye care.
  • The employee can withdraw from a scheme by giving 30 days notice to the employer, along with a proof of an alternative insurance policy.
  • The project document has been prepared in partnership with the concerned stakeholders, Oman Chamber of Commerce and Industry (OCCI), insurance companies operating in the Sultanate, private health institutions and the General Federation of Trade Unions (GFTOU).
  • The employer is obliged to pay the cost of the premium and also the ‘inpatient treatment costs’ do not include any contribution from the worker.
  • It covers the cost of transporting the deceased’s body to his native or permanent home.
  • The health insurance project will contribute to attracting international private health institutions to invest in the Sultanate and as well as in spreading private health care in various governorates and the Sultanate.
  • It will also contribute to the entry of international insurance companies offering products of high quality, thereby creating employment opportunities for Omanis in the sectors of insurance and health.
  • It will also improve the level of efficiency of medical staff working in the private health institutions of the sultanate.
  • Premeditated self-inflicted injuries, experimental treatments, preexisting conditions, comprehensive check-ups that do not require medical treatment, any checkups or health services done for reasons such as travel, insurance or a permit are exempted from the mandatory insurance policy.
  • It also excludes injuries reported from outside the workplace, alternative medicines and diseases as a result of alcoholism or overuse of medicines, sexually-transmitted diseases, or the costs incurred by a person diagnosed with HIV.
  • The insurance term is one year initially with legal residents of Oman eligible to be included in the policy.
  • The expenditure limit for the treatment of an inpatient is RO 3,000, including hospital stay, doctors fees and diagnosis, medicines, ambulance expenses and patient care.
  • The expenditure limit at outpatient clinics is RO 500, the cost of consultation, diagnostics, laboratory and medication fees.
  • The cost limit for repatriation of the deceased’s body to his original home is RO 1, 000.
In a press statement, Abdullah Salim al Salmi said the Unified Health Insurance Policy (UHIP) is one of the main components of  compulsory health insurance for the employees of the private sector, expatriates and visitors Dhamani, which CMA is preparing for actual implementation in collaboration with the  concerned entities in implementation of the decision of the Council of Ministers NO. 26/2017  to prepare the required regulations and legislation to implement health insurance scheme in Oman.

He pointed out that the issuance of UHIP is a declaration of preparedness of the legislation infrastructure of the health insurance scheme Dhamani as a prelude for gradual implementation in phases after approval of the Council of Ministers. He added that the implementation phases will be determined as per the classification of the commercial companies and the ability of the private health institutions to accommodate the expected numbers as the scheme is expected to provide insurance coverage for 2.1 million workers in the private sector Omanis and residents in addition to the visitors.

Al Salmi said the issuance of the policy is very important at this time for insurance companies as opportunity to establish health insurance products commensurate with the expected demand in accordance with the high-quality standards.

On the methodology of preparation of the policy, Al Salmi said  the UHIP was prepared based on a number of mainstays in that the clauses must be fair and equitable in regulating the relationship between the health  service providers and insurance companies to render appropriate  health coverage and the insurance premium shall not cause additional burden or  expensive  financial cost on the employers in addition to meeting the treatment needs of the insured smoothly without any complications or unnecessary procedures.

He pointed out that UHIP  Dhamani was issued according to the same methodology of drafting  the laws and regulations governing the capital market and insurance sectors  such as community partnership among the related parties and passed through  a number of steps with the participation of the Ministry of Health, General Union of the Workers of the Sultanate of Oman, Oman Chamber of Commerce and Industry in addition to insurance companies operating in Oman and  private health institutions for exchange of views in the interest of the public.

Al Salmi explained that the policy represents the minimum limit of basic health care which would be granted to the beneficiaries of “Dhamani” and will render basic health care namely inpatient services, emergency and treatment of basic illnesses that hinder productivity in addition to prescribed medicines by MOH licensed doctor. It also includes a number of optional benefits such as pregnancy, birth, child health, dental and eye care which are additional benefits the employer may include in the basic and compulsory coverage as agreed with the worker and the ability of the establishment to provide these benefits.

Al Salmi said the provisions of the policy provide that the employer is obliged to pay the insurance premium and left to the employer the option of involving the worker in payment of the treatment costs for the outpatient services, as to inpatient services the treatment will be provided directly without any participation by the worker.

The Executive President of CMA said that implementation of health insurance scheme “Dhamani” in Oman will contribute to attracting international health institutions in the Sultanate further to the role of the scheme in spreading health care in the various Governorates and  Wilayats of the Sultanate.

Moreover,  the  increased demand for the health insurance policy will contribute to attracting  international insurance companies specialized in rendering high quality health insurance services which means new active market that would provide  employment opportunities in the insurance and health sectors and would enhance  the efficiency of the medical cadres working in the private health institutions and the quality of the rendered service.

Implementation of Dhamani is expected to spread the  health insurance for the employees of the private sector and  expatriates residing in Oman and visitors and that would contribute to increasing the GDP of the country and creation of investment entities on the level of insurance companies and private health institutions in addition to specialized health insurance third party administrators as brokers between health services providers and insurance companies.