Oman: the end of outbound medical travel

When the delayed compulsory health insurance launches and with the healthcare sector set to undergo a major expansion, the end of most outbound medical travel from Oman is nigh, says Ian Youngman.

When the delayed compulsory health insurance launches, it will end most outbound medical tourism.

Dhamani: Oman’s mandatory health insurance

National Health Insurance (Dhamani) is for employees of the private sector, residents and visitors to Oman.

It was due to launch in September 2021, but operational problems delayed the launch into a soon but not yet announced date in 2022.

Oman has a public health service providing free or very low-cost healthcare 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. The government typically reimburses private hospitals for their care.

Dhamani builds on the concept of private health insurance and does not include direct government support or funding. Social health insurance partially or entirely funded by the government is for those not covered by Dhamani.

Oman’s mandatory universal health insurance is for private sector employees covering both Omanis and expatriates.

Phase One was planned for September 2021 but has been delayed until 2022.

The dates in 2022 for Phase One and after are still awaited at time of publication of this article.

Phase One is for employees of large local and global companies and their dependants , 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. 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 expatriates 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, or house help who is sponsored by the employee.

Dhamani mandatory health insurance has an electronic platform that links a number of regulatory and supervisory authorities in the Sultanate, including Ministry of Health, Ministry of Labour, Ministry of Transport, and the Royal Oman Police, 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.

This automatic linking is only for use within Oman so has no provision for treatment outside of Oman.

Cover can only be written by insurance companies licensed 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.

Basic and optional package options

There is a basic package and an optional package.

Inpatient treatment limits for the policy year are capped at OMR3,000 (US$7,791) and include 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 OMR100 (US$259) each trip. Outpatient treatment is limited to OMR500 (US$1298) 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 OMR1,000 (US$2,597) has been allocated.

The mandatory basic minimum package provides two options that have the same cover terms and limits.

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 basic cover does not allow for treatment not in Oman.

Encouraging inward investment in healthcare

The government hopes that the law will help encourage overseas healthcare investors and more health insurers, both local and global.

The employer is responsible for the payment of the insurance premium and in agreement with the employee they can include added benefits for pregnancy, childbirth, dental and eye care.

Evolving healthcare in Oman

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.

There are several distinct types of Omani hospitals, including public, private and military establishments. Some hospitals in the private sector are luxuriously appointed and could easily pass for five-star hotels, though they also charge five-star prices for treatment. One new hospital is even “7-star”.

The healthcare sector in Oman is set to undergo a major expansion, with both the government and the private sector investing in new medical cities as well as developing a number of smaller hospitals.

Oman has invested heavily in the health sector and created a relatively modern health care system. The Ministry of Health has 77 hospitals as well as 266 government health centres, clinics, and pharmacies, and there are 1,105 private clinics. There are 49 government-run hospitals for the general Omani public and 15 private hospitals. The Royal Armed Forces, the Royal Oman Police, and Sultan Qaboos University operate other hospitals.

Oman’s private health sector comprises 1,800 establishments distributed across clinics, polyclinics, hospitals, company clinics, university clinics, laboratory, dental centres, dermatology clinics, optical shops, diagnostic centres and physiotherapy clinics.

Oman’s Health Vision 2050 aims to support the government’s goal of providing an equitable and responsive healthcare system, which in turn will create a productive population.

Outbound medical tourism will likely become a thing of the past.