Muscat: Expats and citizens covered by the new mandatory health insurance will each be entitled to OMR3,000 of treatment per year, according to the Capital Market Authority.
The mandatory health insurance will be implemented in stages related to the size of companies required to implement the policy, until it finally covers 2.1 million private sector workers in Oman.
Sheikh Abdullah Al Salmi, Chief Executive Officer of the Capital Market Authority, issued decision No 34/2019 which revealed the prototype of the United mandatory health insurance document, and included details about the scope and coverage of the policy.
“The issuance of Unified Health Insurance Policy is a declaration of the readiness of the legislative infrastructure of the Dhamani,” said Al Salmi.
According to Al Salmi, the Unified Health Insurance Policy (UHIP) is one of the main components of compulsory health insurance, known as “Dhamani”, for the employees of the private sector, expats and visitors. The policy includes hospital visits, doctors’ fees and diagnosis, medicines, ambulance expenses as well as outpatient care. He added that the implementation phases will be determined by how prepared employers are for the change and the ability of the private health institutions to cope with the expected numbers: the scheme is expected to provide insurance cover for 2.1mn workers in the private sector, Omanis and residents in addition to visitors.
Read here: Authority reveals mandatory health insurance exceptions in Oman
According to Dr Rohil Raghavan, Regional CEO of Oman VPS, an integrated healthcare provider with a network of hospitals, told Times of Oman, “This is going to lead to more people having insurance, but I don’t think that it will be too much for most hospitals to handle.”
He added, “Of course, from a humanitarian perspective we want everyone to have access to insurance and healthcare so that they can pay for proper care. I also think that from the economic perspective, this is good for companies as business will increase.”
The health insurance basic scheme includes the wife of the worker and his dependants, including children up to the age of 21. The initial period of insurance will be for one year and that may increase as agreed by both parties (the insurance company and the employer). According to the decree, the basic health insurance scheme will include “Inpatient care up to OMR3,000 for the insured person, a maximum of 30 days stay in a shared room in hospital and transportation to the hospital for up to OMR100 for each visit.”
This care also includes diagnosis, consultancy fees (if recommended by a practitioner), prescriptions, emergency and ambulance services, and a chaperone for patients younger than 16 years old.
For outpatient care, the insurance offers consultancy, diagnosis, scans, and lab tests, as well as pharmacy fees, for up to OMR500. It also includes repatriation costs of up to OMR500 for the deceased.
PM Jaber, an insurance broker with Salam Insurance LLC, said, “This is fantastic news, as it allows people to have access to quality healthcare.
“There are also economic benefits related to an increase in the market of insurance. It is sure to benefit the insurance market as more companies sign on to insurance schemes.”
A spokesperson for the CMA said to Times of Oman, “This health insurance is not in effect yet. This can be seen as laying the legislative groundwork before the insurance is announced.”
The decision signed by the Capital Market Authority has also revealed the exceptions of the new mandatory health insurance. Excluded conditions include premeditated self-inflicted injuries, experimental treatment, pre-existing conditions and health check-ups for non-medical reasons such as travel, insurance, or gaining a permit.
Also excluded are personal injuries which occur outside the workplace, alternative medicines, and diseases that come from substance abuse such as alcoholism or overuse of prescriptions medication.
Any plastic surgery or dental work will only be covered if it is to prevent or treat a work place injury and vision-correction, baldness, weight control and infertility treatments are all excluded.
Furthermore, medical insurance does not include sexually-transmitted diseases, or the costs associated after a person is diagnosed with HIV or a similar disease.
The law also excludes cases of organ or bone marrow transplants and external prescribed equipment that is not considered medication.
Other reasons for injury which will not be covered include military operations, natural disasters, criminal activity, radiation, poisoning, rioting and terrorist attacks, as well as chemical or biological reactions.”