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Jun 2019

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Oman: CMA releases details about scope of mandatory health scheme

Source: Middle East Insurance Review | May 2019

The Capital Market Authority (CMA) has issued details of the Unified Health Insurance Policy (UHIP) under the mandatory health insurance scheme to be implemented for private sector employees, including expatriates and visitors to Oman.
 
The insurance scheme will cover 2m workers in the private sector and visitors to the Sultanate, including the spouses of the workers and their children (21 years and below), reported Oman Observer.
 
The details include:
  • 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 premiums and, in agreement with the employee, he can include added benefits for pregnancy, childbirth, dental and eye care.
  • The employee can withdraw from the scheme by giving 30 days’ notice to the employer, along with a proof of an alternative insurance policy.
  • Premeditated self-inflicted injuries, experimental treatments, pre-existing 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 excluded from the mandatory insurance policy.
  • The coverage 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.
  • The expenditure limit for the treatment of an inpatient is OMR3,000 ($7,802), including hospital stay, doctors’ fees and diagnosis, medicines, ambulance expenses and patient care.
  • The expenditure limit at outpatient clinics is OMR500, the cost of consultation, diagnostics, laboratory and medication fees.
  • The policy documentation has been prepared in partnership with stakeholders, namely, Oman Chamber of Commerce and Industry (OCCI), insurers operating in the Sultanate, private health institutions and the General Federation of Trade Unions (GFTOU).
  • The insurance plan covers the cost of transporting the deceased’s body to his native or permanent home. The cost limit for repatriation of the deceased’s body is OMR1,000.
 
The CMA said the implementation of Oman’s compulsory health insurance scheme, named Dhamani (Arabic for ‘guarantee’), will contribute to attracting international private health institutions to invest in the Sultanate and spreading private health care in various governorates.
 
It will also contribute to the entry of international insurers offering products of high quality, thereby creating employment opportunities for Omanis in the sectors of insurance and health.
 
The scheme is scheduled to start operating by the end of this year.
 
Mr Abdullah bin Salim Al Salmi, CMA executive president, said the UHIP was prepared based on a number of main principles in that the clauses must be fair and equitable in regulating the relationship between the health service providers and insurers to render appropriate health coverage and the insurance premiums shall not cause excessive burden on the employers in addition to meeting the medical treatment needs of the insured smoothly. M 
 
OMR1 = $2.60
 
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