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Oman – Mandatory Health Insurance is on its way

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. Chapter Two further sets out the general terms and conditions, places obligations on the insured to disclose correct and accurate information. The Code of Conduct for Insurance Business issued by the CMA requires insurers to inform insureds of their duty to disclose relevant information. Omani Law therefore applies the duty of utmost good faith (uberrimae fidei). Chapter Two also prescribes the excluded conditions from the coverage under the Policy.

The overall combined limit under the Policy is OR 4,500 in terms of financial spend so surprisingly much lower that the UAE and KSA mandated schemes. Inpatient treatment limits for the policy year is capped at OMR 3,000 and includes usual basic cover, i.e. admission in hospital or daycare, 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 under the Policy must be in a joint room and is limited to 30 days at each instance, whereas the ambulance cover is limited at OR 100 each trip. Outpatient treatment is limited to OR 500 for each policy year and the cover is limited to consultancy fees, diagnosis and tests, pharmacy fees and lab fee. Additionally, the Policy includes the cost of repatriating a deceased beneficiary to their country of origin, for which a limit of OR 1000 has been allocated.

Any departure from the basic benefits is not permitted unless agreed as a Schedule to the Policy and signed by both parties and should additional benefits be opted for by the insured, they must be set out in the Optional Benefit Schedule format provided in Appendix 3 to the Law.

The Law also sets out specific obligations on how it will be administered, some of which we set out below:

  • All Health Insurance Claim Management systems of the Providers must be compatible with the electronic claims system applicable in Oman;
  • Insurers will bear the cost of a medical Consultations only if there is prior referral from a licensed physician;
  • Providers must seek prior approval for all inpatient treatment and for all outpatient treatment where costs exceed OR 100, however in emergency cases treatment must start immediately;
  • For approvals, providers must upload all details in the online application and the insurer must respond within 30 minutes with a decision, failing which it will be deemed as approved;
  • Similarly, a Provider is also required to respond to any inquiries or observation by Insurer within 30 minutes of the inquiry/observation being made;
  • For all claims made outside the network, the Insured must make the claim within 120 days of the claim and insurer must compensate beneficiary within a period of 15 days of receiving documents in support of a claim; and
  • Whenever a claim is rejected by Insurer, the Insurer must provide to the Beneficiary, within 10 days of rejection a written statement highlighting the reasons for which the claim is rejected.

Appendix 4 to the Law sets out the mandatory basic minimum coverage under the Policy, which provides two options to the Insured based on which premium will be determined by the Insurer. While both options have the same coverage terms and limits, the first option provides for deductibles on certain categories and the second option does not require deductibles to be paid by the beneficiary. The deductibles on the first option are limited to outpatient treatment only and are set at 10% for medicine, subject to the limit of OR 5 per visit and 15% for consultancy fees, diagnosis and lab fee for providers within network (with a cap of OR 20 per visit) and at 30% for Providers outside the network (with no cap!).

While the Middle East insurance market is to a large extent geared up for the new mandated health insurance requirements in Oman based on previous experiences with the KSA and UAE markets, they should no doubt see the opportunities for top over coverage in Oman given that the minimum coverage is very basic in nature (i.e. no maternity coverage offered as a minimum benefit). Of interest, Oman has not applied licensing for third party claims administrators at present, which also presents opportunities in this market.

We anticipate many questions and clarifications around the Law both from insurers, reinsurers, intermediaries, third party administrator, clinical providers and others. BSA are well placed to provide support in this area with its expertise in health insurance laws and regulations and its Muscat law office.

If you would like to find out more information about BSA, please visit https://bsabh.com/

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UAE Legal Update: Regulatory Alert (Healthcare)

Federal Law No.2 of 2019 – Using IT and Telecommunications in the Healthcare Sector

The United Arab Emirates Government Promulgate Federal Law No.2 of 2019 – Using IT and Telecommunications in the Healthcare Sector (“the Law”), which for the first time regulates healthcare data processed, controlled, transferred and stored electronically.

The Law contains 22 Articles, which includes, but is not limited to the creation of a central data base system, obligations in respect of data privacy and use of IT and telecommunication technology when processing, transferring and storing data. In addition, obligations are placed on media licensing, training and violations for breach of the Law.

The Law is unique insofar that it is the first federal privacy law relating to healthcare data and protection of personal and sensitive data in the UAE.

Healthcare providers, insurers, insurance intermediaries, third party medical claims administrators, technology companies in the healthcare space and others dealing with healthcare will need review an audit their current practices and comply with the Law.

The Law is expected to be gazetted in the coming weeks and will be implemented three months from that date.

BSA will provide a follow up detailed analysis of the law in due course.

About BSA Ahmad Bin Hezeem & Associates LLP

BSA is a law firm originally founded in Dubai with the primary mission of delivering top-tier legal services based on our comprehensive knowledge of local, national, and international law.

Since our inception in 2001, we have rapidly expanded to a leading full-service law firm, with offices throughout the Middle East and France. Our lawyers are internationally educated, bi-lingual in languages such as English, Arabic, and French, and dual-qualified in both regional and international jurisdictions, having rights of audience in every country within which we operate.

BSA is a law firm that truly reflects the energy and ambition of the Middle East.

UAE PHOTO

Legal challenges for a growing defence market

The IDEX conference just concluded last week in Abu Dhabi demonstrated the intertwining nature of the threats that the world currently faces in dealing with malevolent actors, as well as the resilient manner in which government and industry have developed countermeasures to deal with this ever-increasing threat spectrum.

The UAE is at the forefront of adopting 4IR technology for the public benefit. Given this adoption, the UAE government has enacted a legal framework to regulate the use of cyber-technology and related forward-looking innovations. However, as is the case with almost all emerging technologies, legislation and regulatory guidance often plays catch up with the technology, and there are gaps that need to be cured as the technology advances.

There are numerous UAE laws and regulations covering various aspects of 4IR technology, including Federal Law No. 5 of 2012 covering cyber-crimes, and the newly enacted Federal Law No. 25 of 2018 dealing with futuristic projects, which seeks to regulate development of AI. However, the latter has yet to be fully implemented through its enabling regulation, leading to some marketplace uncertainty.

Likewise, the various free zone authorities, particularly the DIFC and ADGM, have separate regulatory schemes covering such technology. Thus, stakeholders need to be aware of the legal landscape in which this technology is currently being developed and deployed.

This terrain creates opportunities for both large corporations and SMEs alike to develop and deploy innovative solutions to defend against malevolent actors, including threats posed by terrorism and cyber-criminals, as well as the inevitable byproduct of non-malicious technological failures inherent in all emerging technologies.

For more information about BSA Ahmad Bin Hezeem & Associates LLP, please visit https://bsabh.com/

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Law Firm becomes Official Supporter of 2019 Special Olympics

We are proud to announce our signing of a partnership agreement that will see Hadef and Partners support the Special Olympics World Games as the official legal supporter and provide legal advisory services through the build-up to, during and after the World Games.

The Games, which will take place for the first time in the Middle East, will run across the Emirate in venues within both Abu Dhabi and Dubai from the 14-21 March 2019. The event will be under the patronage of His Highness Sheikh Mohamed bin Zayed Al Nahyan and will be the largest sports and humanitarian event this year.

Hadef & Partners will provide legal support from their offices in both Abu Dhabi and Dubai and will call upon the full service experience of almost 100 lawyers from the UAE, Middle East and the international arena.

Commenting on the signing, Dr Faraj Ahnish, Managing Partner of Hadef & Partners Abu Dhabi said:

“We are extremely proud of our history, heritage and reputation as a dedicated UAE law firm and when we saw the opportunity to become involved, we did not hesitate. These Games will be the largest of their kind to date in our region and provides a unique opportunity to create and deliver awareness and change for People of Determination in the UAE and to showcase our wonderful people, cities and culture at the same time. We are delighted to be involved in this momentous event and offer our support to ensure a memorable Games.”

Hamad Al Zaabi, Senior Director of Business Support at Special Olympics World Games Abu Dhabi 2019, said:

“We are very grateful to have Hadef & Partners on board with us as the official legal supporter of Special Olympics World Games Abu Dhabi 2019.”

“With this partnership, Hadef & Partners will provide required support and legal consultation to Special Olympics World Games Abu Dhabi 2019. The team’s expertise will help us ensure a long-lasting legacy for People of Determination.”

For more information on the Special Olympics World Games Abu Dhabi 2019, please visit https://www.abudhabi2019.org/.

ME PHOTO

Insights and reports for technology driven visionary leaders

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Our exclusive, invitation-only event concept offers our clients the opportunity to have pre-booked meetings with the most potential customers and network with the forerunners in their field. The event participants are technology-driven leaders of the largest companies in Europe and Southeast Asia.

Annually, we produce more than 150 business events bringing together 20,000 leaders and 2,000 solution providers in 15 countries generating business opportunities through 50,000 face-to-face meetings. Currently, we operate in Austria, Denmark, Germany, Finland, the Netherlands, Norway, Sweden, Switzerland, Malaysia, UAE, Turkey and Singapore.

For more information about Management Events, please visit: https://managementevents.com/