CMA issues Mandatory Health Insurance regulations

KEY MILESTONE: Regulatory framework governs the relationship between all stakeholders participating in the Unified Health Insurance Scheme (Dhamani) due to be implemented in the Sultanate: CMA Executive President

The Executive President of the Capital Market Authority (CMA) has issued the regulations underpinning the Health Insurance Scheme (Dhamani) due to be rolled out in the Sultanate.

Decision 78/2019, enshrined the guidelines for Health Insurance in Oman, were compiled in collaboration with the concerned entities tasked with preparing the legislative and regulatory infrastructure for the Dhamani health insurance scheme for employees of the private sector, the residents and visitors to Oman, said the Authority in press statement. Abdullah Salim al Salmi, (pictured) Executive President of the Capital Market Authority, said the issuance of the decision represents an advanced step in the preparedness of the legislative infrastructure and legal framework and one of the five steps identified by CMA in the preparatory phase of implementation of Dhamani scheme.

Al Salmi explained that the health insurance rules means regulating the business of health insurance in Oman by specifying the obligations of the parties in the insurance relationship i.e. insurers, third party administrators, health services providers, the worker and employer. Al Salmi said that the health insurance rules set out the regulations and specify the legal obligations of each of the parties in the insurance process in four chapters focusing on the following: General provisions governing health insurance market; licensing requirements to carry out the business; obligations of the parties; and dispute resolution.

On the key features of the health insurance rules, Al Salmi said that insurance companies licenced to carry out the business, health service providers, third party administrators and others will be obliged to implement an electronic link, “Dhamani Platform”, incorporating the latest technology related to the scheme.

The rules restrict insurance companies from retaining more than 40 per cent of the insurance premiums in Oman. As to the licence to practice the health insurance, the rules set out a number of licensing requirements with the aim of creating efficient and highly professionally capable insurance institutions.

Al Salmi expressed his happiness with the level of preparedness of the legislative infrastructure in the preparatory phase of the health insurance scheme for the employees of the private sector led by CMA in collaboration with the relevant entities.