Mandatory Health Insurance Is On Its Way

Resolution No 34/2019 - For the Issue of Unified Healthcare Insurance Policy Form

Introduction

The Health insurance market embraces itself for another mandated health insurance law in the Sultanate of Oman. Residents in Oman will be required to have in place a minimum level of medical insurance coverage with minimum benefits pursuant to the prescribed provisions of Resolution No 34 of 2019 For the Issue of Unified Healthcare Insurance Policy Form , which was issued by the Capital Markets Authority (CMA) as at 24 March 2019 and is now in force ("the Law").

The application of the Law is relevant to the employer market and the beneficiaries arising from those relationships including employer, employee and dependents.

The Law applies and has adopted a "Basic Benefits" and "Optional Benefits" coverage, standard form "Policy Schedule" for parties' signature and a standard "Insurance Application" for pre contractual disclosure requirements.

Chapter One of the Law prescribes a "Unified Health Insurance Policy" ("the Policy"). Insured is defined as "natural or unnatural person responsible to pay the insurance premium" and Beneficiary has been defined as "employee or employee dependent to whom the Insurer performs the duties assigned by the provisions of this Policy". Dependents have been defined to include employee's legally wedded spouse, residing in Oman, children of the employee who 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.

Insurer has been defined as "Insurance company licensed to practice health insurance business in the Sultanate" thereby clarifying that the Policy can't be underwritten on non-admitted basis by foreign insurers, which provides welcome clarity to the market.

The Policy must be completed and submitted by the Insured as a legal obligation. The Law, as currently prescribed, addresses application, coverage, mandatory minimum benefits and claims management.

Chapter Two is of interest, as the preamble defines a wide interpretation of what shall constitute the contract of health insurance, which includes all basic information, details and common practices in healthcare insurance contracts etc. Insurers will need to take care with their pre-contractual documents, as these could for all intents and purposes unintentionally constitute the contract of insurance...

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