Following from the initial announcement of the health insurance for employees mandate in 2018, a new Resolution has been released highlighting a scheme implementing mandatory employee health coverage in the Sultanate of Oman, private sector employers will be required by law to provide medical coverage to their employees.
The Unified Health Insurance Policy (UHIP) must cover compulsory minimum benefits in accordance to the provisions outlined in Resolution No 34 of 2019 for ‘The Issue of Unified Healthcare Insurance Policy Form’; details on basic benefits and optional benefits have been detailed. This Resolution was released by the Capital Markets Authority (CMA) on 24th March 2019 with the condition of immediate implementation. Certain requirements have been determined with regards to healthcare providers and insurers, which include:
- All Health Insurance Claim Management systems of the Providers must be compatible with the electronic claims system
- Medical Consultations will be free of charge only if prior referral from a licensed physician has been arranged.
- Healthcare providers must seek prior approvals for any inpatient or outpatient treatments where the cost exceeds QR 100 (excluding emergency situations; in emergency situations treatment must begin immediately)
- Healthcare providers must complete all the information in the online application to obtain approval and the insurer must respond within 30 minutes (if the insurer doesn’t reply in this timeframe, this will be seen as an automatic approval)
- For any outside the network claims (reimbursement), the insured party must make the claim within 120 days of treatment
- In the instance when an insurer rejects a claim, the insurer must provide the insured party a written statement of rejection within 10 days.
Other important information about Unified Health Insurance Policy (UHIP) includes:
- UHIP will cover 2 million workers in the private sector in addition to visitors to Oman, including the dependants of the employee.
- UHIP will provide minimum health coverage including inpatient and out patient treatments, emergency coverage and costs of medicine.
- The employers is responsible to cover the insurance cost whereas the employee has the right to upgrade coverage on their own expense, if required.
- The expenditure limit for inpatient treatments is OMR 3,000
- The expenditure limit for outpatient treatments is OMR 500
Insurance providers in the Middle East are prepared to handle the large influx of new policies due to experiences with the UAE and Saudi Arabia when a similar mandate was instigated, therefore, it is predicted that this implementation will be streamline. It is important that you review the basic coverage inclusions highlighted in the Resolution to determine if the mandatory medical insurance has the coverage you require. To review the full Resolution No 34 of 2019 for ‘The Issue of Unified Healthcare Insurance Policy Form’, please visit https://www.cma.gov.om/
PRO Partner Group provides foreign businesses with a complete company formation solution, we cover all legalities involved in establishing and maintaining a commercial entity in Oman and the UAE. For more information on health care requirements for your business, please contact Natalia Shutilo on email@example.com.
— PRO Partner Group (@PROPartnerGroup) May 12, 2019