MUSCAT, MARCH 31 - With guarantee for minimum health coverage to workers in the private sector and visitors, the Capital Market Authority (CMA) has unveiled details of the Unified Health Insurance Policy on Sunday.
The mandatory health insurance scheme branded as ‘Dhamani’ is expected to provide coverage to an estimated two million expatriates living and working in the Sultanate in addition to visitors to the country.
According to Abdullah bin Salim al Salmi, Executive President of CMA, the implementation phases will be decided in accordance with the classification of the companies.
“Preparation for actual implementation of the policy is progressing in coordination with other authorities involved in the matter,” Al Salmi said in a statement.
“Dhamani will meet the needs of the employees in the private sector relating to coverage of basic health, so as to limit the high costs that employers of the private sector incur,” he said.
The scheme will also ensure quality services by insurance companies and healthcare units to the insured, the executive president said in the statement.
According to the regulator, the scheme is being unveiled using the same methodology of drafting the laws and regulations governing the capital market and insurance sectors.
While giving details about the policy, Al Salmi said that ‘Dhamani’ will cater to basic healthcare facilities to outpatients and inpatients, emergency and treatment of basic illnesses.
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.
The employee can withdraw from the scheme by giving a notice to the employer 30 days in advance along with a proof of an alternative insurance policy.
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.
The employer has the option of involving the worker in payment of the treatment costs for the outpatient services.
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.
At the same time, premeditated self-inflicted injuries, experimental treatments, comprehensive check-ups that do not require medical treatment, any check-ups 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.
According to Al Salmi, the implementation ‘Dhamani’ will attract international insurance companies specialised in rendering high quality health insurance services to the country.
This, the executive president said would open up employment opportunities in the insurance and health sectors and also enhance the efficiency of the medical cadres working in the private health institutions.
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