Muscat: The Capital Market Authority (CMA) issued licenses for four Health Insurance Third Party Administrators (TPAs) up to the end of June this year.
This is to enhance the regulatory aspect of the health insurance market in the Sultanate for their roles in claims administration and compensation evaluation between health service providers and health insurance policyholders.
CMA issued the regulation for practising the business of TPAs last year which is a step forward in the regulatory process of the health insurance sector in Oman.
TPAs administer the medical expenses, claims management, payment and render support for health insurance policyholders. They ensure policyholders obtaining appropriate health services from the health service providers and ensure the providers get their compensation from the insurers on time through their networks.
TPAs provide health services to health insurance policyholders through the creation of networks with the hospital, clinics and pharmacies and conclude contracts with insurance companies to provide health care services to health insurance policyholders through the providers’ network and then inform the health insurance policyholder of the health care providers they can deal with to obtain treatment and acquaint them with claim settlement mechanisms.
The health care providers inform the TPA’s of the claims and the cases that require prior approval by the insurance companies to render the treatment service to the health insurance policyholder or decline the claim based on the terms and conditions of the policy.
The statistics indicate the average annual growth of the health insurance sector in the past eight years was 19 per cent leading the other insurance sector with a 34 per cent share in the gross insurance premiums in 2020 at OMR466 million.
