CMA issues Unified Health Insurance Policy

01 April 2019

News

 

  • Al Salmi:  Issuance of Unified Health Insurance Policy is declaration ofhe readiness of the legislative infrastructure of the  Dhamani

 

  • Dhamani will provide  health care for more than 2 million workers and visitors

 

  • Partnership between the parties concerned with health insurance  was fundamental methodology in drafting the policy

 

  • Striking balance between cost  and adequacy of basic insurance coverage

 

  • Employer is responsible for payment of insurance premium

 

  • The policy is the minimum limit of basic health care

 

  • Pregnancy, birth, dental and eye care and work injuries are optional features

 

 

The  Executive  President of the Capital Market Authority HE Sheikhk 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 legislations 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 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 impatient services the treatment will be provided directly without any participation by the worker. The  policy covers the benefit of repatriation of corpse to the home country of the deceases.

 

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.

 

Implementation of the scheme and issuance of the UHIP coincides with  remarkable growth in health insurance products during the past years. The share of health insurance in the total  insurance portfolio was 33% in 2018 thanks to the growing awareness of the individuals and institutions of the importance of the health insurance and its role in reducing the costs of treatment in case of illness or injury.

 

The  health insurance management team chaired by CMA and comprising members from the Ministry of Health,  Ministry of Manpower, Oman Chamber of Commerce and Industry, Public Authority for Social Insurance and Omani Insurance Association  continued holding  meetings  to execute the agreed tasks and prepared  the legislative infrastructure of the  scheme.

 

The UHIP included a number of clauses and provisions on maintaining the confidentiality of information of the insured, mechanisms for cancellation or  deletion or addition of members and complaints and grievance mechanisms as well as employer’s ability to  increase the ceiling of the benefits of UHIP and optional benefits.

 

It is noteworthy that  CMA organized a number of events to introduce   “Dhamani” with the participation of  the related parties and exchange of views on the scheme and implementation methods to ensure success of the scheme and sound implementation. CMA endeavors to reach all targeted segments and to this end  designed an awareness campaign on the health insurance and its social and economic importance. CMA will commence during the coming period  organizing introductory meetings in collaboration of Oman Chamber of Commerce and Industry targeting businesspersons  in the Wilayats and Governorates of the Sultanate focusing in April  on four governorates  namely North Al Batinah, Dakhiliyah, South Sharqiyah and Al Buraimi and later the remaining Governorates.

 


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