Taking a next step from the preliminary announcement about the health insurance for employees’ directive in the year 2018, now a new declaration or resolution has been published emphasizing the scheme that carries out the obligatory employee health coverage in the Sultanate of Oman. According to this, all the private sector employers have to necessarily as per the law provide medical coverage to all their employees.
The Unified Health Insurance Policy (UHIP) should cover the required and obligatory minimum benefits as per the provisions mentioned in Resolution No. 34 of 2019 for ‘The Issue of Unified Healthcare Insurance Policy Form’; which describes the basic advantages and optional advantages in detail. This resolution was published on 24th March 2019 by the Capital Markets Authority (CMA) with immediate effect. There are some specific requirements that have been established with regards to all the healthcare providers and insurers, including:
- The Health Insurance Claim Management systems of the Insurance Providers should be compatible and harmonizing with the electronic claims system.
- All the medical consultations would be free of charge in case there is a prior referral that has been arranged from a licensed physician.
- The healthcare providers should necessarily pursue prior approvals if there are requirements for any inpatient or outpatient treatments involving cost over QR 100 (excluding any emergency situations. In case of emergency situations, the treatment has to be given immediately).
- The healthcare providers should first complete the online application form to get an approval; then the insurer should respond within 30 minutes. In case, the insurer doesn’t get back within this time frame, then this would be considered as an automatic approval.
- In case of any outside the network claims or reimbursements, the insured party has to make the claim within the time frame of 120 days of treatment.
- If in case, the insurer rejects a claim, they should give a written statement of rejection and its reason within 10 days to the insured party.
Other significant information about Unified Health Insurance Policy (UHIP) is as follows:
- UHIP is all set to cover almost two million employees in the private sector besides the visitors to Oman, which includes the dependants of the employee.
- UHIP will offer minimum health coverage, which includes inpatient and outpatient treatments, costs of medicine, and emergency coverage.
- The employers are accountable to cover the cost of insurance while the employee is allowed to upgrade coverage on his or her own expense, if needed.
- The expense threshold for inpatient treatments is OMR 3,000.
- The expense threshold for outpatient treatments is OMR 500.
All the insurance providers located in the Middle East are equipped to handle the huge inflow of new policies because of the experiences and events with the UAE and Saudi Arabia when a similar directive was instigated. Thus, it is foreseen that this implementation would be streamlined and very much on track. It is imperative to review the basic coverage inclusions that are highlighted in the resolution to find out if the obligatory medical insurance has the coverage you need or not. To review the full Resolution No. 34 of 2019 for ‘The Issue of Unified Healthcare Insurance Policy Form’, you could visit https://www.cma.gov.om/
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