Electronic system to link insurers, healthcare providers with CMA, MoH reviewed

December 03, 2018

To maintain fair prices and overcome the current problems of claims and reimbursements in matters related to the proposed mandatory health insurance, Capital Market Authority has reviewed an electronic system that will link insurance companies and private health institutions which will in turn link these to regulatory entities such as the Ministry of Health (MoH) and the CMA.

According to the proposal, the system will create an interactive database that will use medical coding techniques and the Diagnosis Related Group classification system. “It will contribute in maintaining fair prices and overcoming the current problems with processing claims and reimbursements,” a statement from CMA said.

During a meeting – the third to date - held to discuss updates on the national project aimed at generalising health insurance coverage for all private sector employees, Ahmed bin Ali al Mamari, vice president of Insurance Sector and head of the Health Insurance Project Team at CMA, discussed its current status and implementation phases.

He also underlined the efforts made by the project team in the classification of companies operating in Oman under various categories. The proposed date of commencement of the project and various implementation timelines and other updates were also discussed at the meeting. It was attended by the project’s team members from MoH, Ministry of Manpower, Oman Chamber of Commerce and Industry, Oman Insurance Association and Public Authority for Social Insurance.

Following an earlier announcement on the completion of the draft of the unified insurance policy, CMA reviewed with the team members the current status and comments received from different parties of the project.
The insurance policy is considered one of the main pillars of this project. It aims at providing basic medical insurance coverage for employees. It will offer necessary healthcare to workers in emergency or victims of unexpected complications as a result of their illness, which may affect their work and productivity.

Additionally, the team discussed implementation phases of the project which will be based on the categories to which companies are assigned and it will not include SMEs in its initial stages.