Abdullah bin Salim al Salmi, Executive President of the Capital Market Authority (CMA), said the issuance of licensing requirements for third party administrators (TPAs) will further strengthen the regulation of the health insurance sector in Oman.
TPAs play an important role in the ecosystem, by providing outsourced post-sales administrative services to insurance companies by facilitating cost-effective claims operations with high efficiency and quality while ensuring a seamless and pleasant consumer experience to the insured policyholders when seeking covered treatment from health service providers.
Decision 34 /2020 covering the licensing of TPAs will add to the readiness of the infrastructure of the insurance industry in the Omani market, improve quality of services related to health insurance and complete the legislative and regulatory framework of the health insurance scheme for the employees of the private sector, expatriates residing in Oman and the visitors.
In 2019, health insurance valued at RO 170 million topped the list of insurance products, accounting for 35 per cent of the total insurance market. “The sector witnessed considerable growth in the past five years by more than 25 per cent year-on-year growth, and we expect that health insurance products will see a higher turnout,” he said.
The regulations allow licensed TPAs to render services to more than one insurance company. It outlines the framework for contracting health service providers. Besides enabling ease of investment by nationals, the regulations also promote Omanisation, and recruitment of fresh graduates from local colleges and universities.
The CMA’s Dhamani portal, said Al Salmi, will be the centralised health insurance exchange platform that will integrate and link the regulators, insurers, TPAs, private health institutions, insured members and all other relevant stakeholders to seamlessly interact and conduct all transactions electronically, thereby improving efficiency and reducing administrative overhead costs.
TPAs are required to have a minimum capital of RO 200,000 and focus exclusively on providing TPA services with minimum overlap with the functions of brokers and agents. The TPAs are required to have a full time manager with university degree in medicine, health care or insurance with no less than 5 years of experience after completion of the degree in addition to having a full time doctor with no less than 5 years of experience.