Compulsory Health Insurance in Oman From 2023

International private medical insurance and global healthcare analyst and report author, Ian Youngman, takes a look at compulsory health insurance in Oman from 2023.

The new compulsory health insurance rules-delayed from 2021- will effectively restrict PMI and IPMI to locally licensed insurers.

Healthcare

• The standard of healthcare is rising with many modern hospitals. All cities and major towns have at least one modern hospital with state-of-the-art equipment.
• Oman’s Health Vision 2050 aims to support the goal of providing an equitable and responsive healthcare system, which in turn will create a productive population.

Healthcare for expatriates

• Omani nationals receive free treatment in public hospitals, but foreigners must pay.
• Expatriates typically seek medical care in private sector clinics and hospitals.

State health insurance

• Oman has a public health service providing free or very low cost health care for its nationals. Omani nationals receive free treatment in public hospitals, but foreigners must pay. Despite the fact that Omanis can be treated without charge in government hospitals, some choose to visit private hospitals to avoid wait times.

Compulsory health insurance for locals

• National Health Insurance (Dhamani) is for employees of the private sector, residents and visitors to Oman.
• Oman's mandatory universal health insurance is for private sector employees- Omanis and expatriates.
• Phase One is now planned for 2023.
• Phase One is for employees and their dependants of large local and global companies will be in phase one, domestic and farm workers and visitors to the Sultanate.
• SMEs are exempt from the mandatory health insurance requirement in the initial phase of the scheme.
• Not everyone will be covered at launch -as various groups will be added in stages.
• Dates and groups await details of company classifications and the ability of local healthcare providers to cope.
• The government will decide classifications and dates in stages.
• Eventually it will cover all private sector workers, all expats and all visitors.
• Employer cover applies to employees, employee's spouse, residing in Oman, children of the employee who are under 21 years age and any other person who resides in Oman and is dependent on the employee. This may include the employee's parents/other relatives based in Oman, house help or maid who is sponsored by the employee.
• The system aims to provide affordable health insurance to private sector employees and domestic workers, as well as visitors to Oman.
• Dhamani mandatory health insurance has an electronic online platform that links a number of regulatory and supervisory authorities in the Sultanate, including Ministry of Health, Ministry of Labour, Ministry of Transport, Royal Oman Police, other government agencies in addition to health insurance companies and health insurance TPAs and over 100 health service providers, for them to exchange data and information related to health insurance services.
• Cover can only be written by insurance companies licenced in Oman so cannot be written on a non-admitted basis by foreign insurers.
• All health insurance claim management systems of insurer must be compatible with the electronic claims system applicable in Oman.
• Under the compulsory health insurance scheme, insurance companies are mandated to provide specific minimum health insurance cover.
• There is a basic package and an optional package.
• The overall combined limit under the Policy is OR 4,500 -much lower than the UAE and KSA mandated schemes. Inpatient treatment limits for the policy year is capped at OMR 3,000 and includes admission in hospital or day care, cost of treatment, room cost, consultant fees, diagnosis and test, medicine, ambulance cost and companion cost, also including the cost for pre-existing and chronic conditions for in-patient treatment, while the latter is excluded for out-patient treatment. Hospital admission must be in a joint room and is limited to 30 days at each instance, while the ambulance cover is limited at OR 100 each trip. Outpatient treatment is limited to OR 500 for each policy year and the cover is limited to consultancy fees, diagnosis and tests, pharmacy fees and lab fees. Additionally, the policy includes the cost of repatriating a deceased beneficiary to their country of origin, for which a limit of OR 1000 has been allocated.
• The mandatory basic minimum package provides two options that have the same cover terms and limits. The first option provides for deductibles on certain categories and the second option does not require deductibles to be paid by the beneficiary. The deductibles on the first option are limited to outpatient treatment only and are set at 10% for medicine, subject to the limit of OR 5 per visit and 15% for consultancy fees, diagnosis and lab fee for providers within network (with a cap of OR 20 per visit) and at 30% for providers outside the network (with no cap).
• On top of basic health insurance, insurance companies can compete by offering different health insurance schemes that improve on the basic mandate at different prices. So the cover of the optional package is not defined. Maternity cover is not within the basic package.
• The government hopes that the law will help encourage overseas healthcare investors and more health insurers- both local and global.
• The insurance scheme will cover workers in the private sector employees and visitors to the Sultanate, including the spouse of the workers and their children (21 years and below.)

Compulsory health insurance top up

• When the compulsory health insurance scheme for all residents, visitors and expatriates is in place everyone will have to buy insurance from a health insurer with minimum standard cover.
• Under the compulsory health insurance scheme, insurance companies are mandated to provide specific minimum health insurance cover.
• On top of basic health insurance, insurance companies will be able to compete by offering different health insurance schemes that improve on Basic Benefits with additional benefits.

International health insurers present

There are ten to a dozen leading national and international health insurers and at least one who plan or planned to open but the delay from 2021 to 2023 may have changed plans.

Can insurers offer offshore IPMI to meet the new rules?

There does not appear to be any loophole where offshore IPMI is a replacement for PMI that meets Dhamani.

Insurers must be licenced in Oman to offer it.

The situation on top up cover is not so clear but the suggestion is that offshore top ups are not allowed.

Do we know the dates?

Not yet, and past experience will suggest that not much notice will be given on categories and dates.