Employees in Oman’s private sector won’t have to pay a single rial towards health insurance after the mandatory system is rolled out, the scheme administrator Capital Market Authority has said.
Insurance experts and employee welfare advisors feel that once the Dhamani (Arabic for guarantee) system is in place, it will remove the financial burden from workers, particularly in cases where the cost of healthcare is high. Abdullah Al Salmi, Executive President of the Capital Market Authority (CMA), said, “The full cost of The Dhamani Insurance Project will be taken care of by employers in order to provide health care for their employees. The first phase of the mandatory healthcare project will include international companies, followed by other smaller companies until finally, even all domestic workers will be covered.
He added, “This health insurance represents the minimum basic coverage. It will provide three main services, namely hospital admission, emergencies and the treatment of basic diseases that affect employee productivity, in addition to the provision of prescribed medication. The cost of all of this will be covered by the employer.”
According to the Capital Market Authority, the electronic platform which Dhamani uses will work to exchange medical information, settle insurance claims, transfer funds, ask for treatment approval, and audit health insurance coverage.
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“With these systems, the authority is confident that the project will provide fair insurance that does not lower quality of health care.
Hamza Al Saadi, Acting Director of Supervision over Health Insurance at the CMA added, “The electronic platform will add to the transparency between health insurance bodies, including those that finance health insurance and those who provide care, as well as the bodies that will oversee the process.
Furthermore, each health insurance claim will usually be automatically accepted. In cases where the insurance company disputes it, Rumel Tubbaje from Oman Reinsurance Company explained, “Insurance companies must clarify why they have refused claims. They must also adhere to a time limit in their response so that the patient can receive proper care.
Hamza Al Saadi, Acting Director of Health Insurance Oversight at the Capital Market Authority, also added, “If an insurance company does not refute a claim within a specified time period, the patient’s illness will automatically be approved for funding for treatment.”
One of the issues that can increase the cost of health insurance is the existence of a monopoly, but the Capital Market Authority is working to curb that danger. Ahmed Al Maamari, the Vice President of the CMA’s Insurance Sector, said having a monopoly run of and by insurance companies would be detrimental to the welfare of those who actually needed it to support their care.
“A monopoly in health insurance is a disfiguration of the market because of a lack of demand,” he explained. “Dhamani will increase demand, which will help in combating the existence of a monopoly. The authority will provide new permits for companies to provide health insurance products under regulations which guarantee high quality care.”
He added, “Many factors affect the cost of care, which is why the current efforts are focused on balancing an appropriate cost with quality insurance coverage,” he explained. “Demand will play a large role.”
Dr Matlooba Al Zadjali, Executive Director of the International Specialised Centre for Heart and Vascular Diseases, said, “The pricing of medical services depends on the price of equipment and the costs involved in constantantly developing new techniques which must be acquired.”
She added, “We hope that having this mandatory health insurance will improve the health of employees as well as their productivity.”
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