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Oman: Plans for mandatory health insurance under development

Health and Benefits
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May 20, 2019

Establishment of a standard basic healthcare plan could significantly reshape the market in Oman. Development of draft legislation is the next key step.

EMPLOYER ACTION CODE: MONITOR

The government has for some time indicated that it is planning to require that employers in the private sector provide health insurance for all employees (85% of whom are foreign workers) and their dependents. The requirement to have health insurance would apply to foreign visitors as well. While the draft legislation is still under development, Oman’s Capital Market Authority (CMA) has now issued a Unified Health Insurance Policy (UHIP) template that outlines the parameters for the insurance policies. Like the other Gulf Cooperation Council (GCC) countries, health care is largely publicly run and financed, with spending by individuals and enterprises on health insurance accounting for only 5% of all health care spending as of 2016, according to World Health Organization data.

KEY DETAILS

Draft provisions of the UHIP template include:

  • Minimum guaranteed coverage for in- and out-patient treatment, care for emergencies and chronic conditions, and medicines, with the premium costs fully covered by employers (injuries resulting from accidents outside the workplace would not be covered)
  • Optional coverage for maternity (pre- and post-natal) care as well as dental and vision care, subject to employer agreement
  • Cost coverage for in-patient treatment (i.e., hospitalization, daily charges, doctor/laboratory fees, medicines and transportation), capped at OMR 3,000 per stay
  • Coverage for out-patient treatment set at OMR 500 per consultation (including diagnostics, laboratory and drug costs)
  • Coverage for funeral transportation of the deceased to the individual’s permanent home or country of origin up to OMR 1,000
  • Coverage for dependent spouses and children (under the age of 21) under the employee policies
  • Policy terms of one year initially

The government estimates that the policies, referred to as dhamani (Arabic for “guarantee”), would be sold by private insurers and would cover the approximately two million foreign workers and residents as well as foreign visitors (excluding citizens of other GCC states). The government hopes that the development of a regulatory framework for private health insurance would spur investment by private health care providers and insurers. Currently private hospitals and beds account for about 20% of all hospitals and 10% of beds.

EMPLOYER IMPLICATIONS

Most of the employers surveyed by Willis Towers Watson (78%) provide private health insurance for employees and their dependents at an annual cost of OMR 800 per employee (approximately USD 2,100). The requirement for employers to provide health insurance for all employees and the standardization of a basic policy option should at a minimum, create more insurance options for employers and their staff; however, a good deal of details are still to be determined, such as the minimum premium and cost-sharing features, if any. The government is targeting a phased rollout of the plan in the near term beginning with the largest employers, but it should be noted that discussions on the development of the mandate and pending implementation date back to at least 2017. It is our understanding that the proposal has received some pushback on the potential cost of the mandate and its implications for onsite clinics in the workplace. Further information on matters such as a specific timetable for launch awaits the release of the draft legislation.

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