MUSCAT, Sept 13: Ahead of the formal launch of Mandatory Health Insurance, branded ‘Dhamani’, for private sector employees and their dependents, as well as tourists and visitors to the Sultanate, the Capital Market Authority (CMA) has issued licenses to four Health Insurance Third Party Administrators (TPAs) to support the roll-out of the insurance scheme later this year.
In a statement, the sector regulator said the new licences will enhance the delivery of health insurances services, given that TPAs are competent in claims administration and compensation evaluation and play a key role between health service providers and health insurance policyholders.
Last year, the CMA issued regulations governing the practice of TPAs, who administer medical expenses, claims management, payment and render support for health insurance policyholders.
They ensure policyholders obtain the appropriate health service by the health service providers and ensure the providers get their compensation by the insurers on time through their networks.
TPAs provide health services to health insurance policyholders through creation of networks with the hospital, clinics and pharmacies and conclude contracts with insurance companies to provide health care services to health insurance policyholders through the providers’ network and then inform the health insurance policyholder of the health care providers they can deal with to obtain treatment and acquaint them with claim settlement mechanisms.
The health care providers inform the TPAs of the claims and the cases that require prior approval by the insurance companies to render the treatment service to the health insurance policyholder or decline the claim based on the terms and conditions of the policy.
The health insurance sector grew at an average rate of 19 per cent over the past eight years.
It now accounts for a 34 per cent share of gross insurance premiums, totaling RO 466 million in 2020.