Big changes in health insurance across GCC with recent developments in Qatar - which follow similar mandatory requirements in the UAE. These changes will provide potential opportunities for health insurance companies in the region. With the appointment of new partner, Simon Isgar, Kennedys can assist with expert legal advice & knowledge.

In this update, Simon Isgar, Partner, Kennedys Dubai LLP (and a new addition to the Kennedys’ Corporate Insurance team), looks at the new mandatory health insurance laws in Qatar and reviews the legal obligations imposed on healthcare providers, medical insurers, employers and sponsors in Qatar.

Most, if not all the GCC operates an insurance based system for healthcare coverage unlike the UK, which is predominately based on the National Healthcare Services (NHS), funded indirectly through national insurance contributions. In light of the rising healthcare costs throughout the Middle East, many GCC now look to a cost effective healthcare system predominately based on mandatory healthcare cover. Such schemes have been implemented in Saudi Arabia, Abu Dhabi and Dubai.

The provision of healthcare in Qatar is among the best in the Middle East region, and was recently ranked at the top of healthcare expenditure in the Gulf Cooperation Council (GCC) countries by the World Health Organisation. Qatar’s National Health Strategy 2011-2016 sets-out the vision to improve the health of Qatar’s population, as well as to develop and achieve a world class healthcare system. Part of this initiative and drive is the implementation of an insurance based “Social Healthcare Scheme” for all residents and visitors to Qatar.

Law No 7 of 2013 concerning the Social Health Insurance Scheme (The Social Health Insurance Law), was issued on 3 June 2013 with the objective of providing access  to universal healthcare to all residents and visitors to Qatar in line with the Qatar’s National Vision 2030.

Prior to the introduction of Social Health Insurance Law, health and medical risks were governed by Decree No 1 of 1966 (along with all other non-life insurance classes) as well as Insurance Companies Law [RD 12/79 as amended]. Although a freezone, the provisions of Social Health Insurance Law apply to Insurers writing medical business within the Qatar Financial Centre (QFC) as well.

The Social Health Insurance Law contains 30 Articles, and is broken down into 6 Chapters, which cover amongst other things, obligations for premium payments, the incorporation of a National Health Insurance Company (NHIC), the Basic and Additional Services (Benefits), the mandatory requirements to have in place health insurance and the prescribed penalties for violations of the Social Health Insurance Law. Pursuant to Article 5 of Social Health Insurance Law, the Supreme Council of Health (SCH) have overall oversight and supervision of the Social Healthcare Scheme.

The Social Health Insurance Law and its implementing Bylaws (Resolution No. 22 of 2013 of the Minister of Public Health, which contain executive regulations) (the “Regulations”) sets up the Social Health Insurance Scheme, which is now called “SEHA” (which originates from the word “health” in Arabic). SEHA incorporated the NHIC, as a Qatari joint stock company and wholly owned by the Government of Qatar, with oversight of the Social Health Insurance Scheme including its phased implementation and ongoing management. The NHIC Mission Statement is “To run the National Health Insurance Scheme providing access to reliable and quality healthcare for all people in Qatar in a cost effective manner.”

It was anticipated that the Social Health Insurance Scheme would be introduced in five phases starting from July 2013 and being completed in 2015. However, while some of the provisions have been implemented, it is likely that the final phase will be introduced in 2017, covering all residents and visitors to Qatar. These phases are:

  • Phase 1 - coverage of benefits for gynaecology, obstetrics, maternity and related women’s health conditions for Qatari women aged 12+ years introduced in July 2013;
  • Phase 2 - all Qatari nationals with all services and benefits with selected public and private health care providers introduced in April 2014;
  • Phase 3 - full coverage to Qatari nationals, but with an expanded network of health care providers;
  • Phase 4 - all Qatari nationals, white-collar expatriates and visitors with all services at selected health care providers and was anticipated to be implemented this year;
  • Phase 5 - all residents including blue-collar expatriate workers, with a number of specially designated purpose built all male hospitals for this latter group.

Completion of phase 5 would effectively complete full implementation of the Social Health Insurance Scheme for all residents of Qatar. As stated above, it is likely that this will occur in 2017.

The Social Health Insurance Law mandates that all residents and visitors should have access to the Basic Healthcare Services over the phased time-table. Article 1 of the Social Health Insurance Law sets out the definitions and includes definitions of the Basic and Additional Healthcare Services, which include for Basic Healthcare Services as “…a range of health care services that shall be provided to the beneficiaries in accordance with the provisions of this Law and for Additional Healthcare Services “….a range of health care services that may be provided, in addition to basic health services, to the beneficiaries in accordance with the provisions of this Law.”

The definition of “visitor” under Article 1 reads, “…each natural non-citizen person who enters the State temporarily for work” but that does leaves doubt as to whether a tourist will be covered under this definition. Possibly, the intent behind this drafting was to catch short term workers on a different visa category that may not have medical or travel insurance coverage while in Qatar. Article 15 of the Social health Insurance Law specifies that visitors “…shall be responsible for payment of health insurance premiums for the period of his stay in the State. Visitor visas will not be issued unless health cover has been put in place.

Interestingly, under these Regulations, the Basic Healthcare Services can be provided only by the NHIC, whereas the Additional Healthcare Services may be provided by licenced and authorised insurers in Qatar as top up coverage. In addition, insurers, including international and foreign insurers, will need to be licensed in Qatar to offer the Additional Healthcare Services pursuant to Article 16 of the Regulations. That is to say that insurers offering the Additional Healthcare Services must have, amongst other factors, have a place of business in Qatar.

Other important points to consider from the Social Health Insurance Law are:

  • Healthcare providers will also be regulated under the Regulations, and are defined under Article 1 of the Law as “…health facilities licensed to provide health care services, according to the laws in force in the State.” They will need to register in the designated Provider Networks to offer the Basic Healthcare Services as healthcare providers.
  • Article 7 of the Social Health Insurance Law obligates the Employers and the Sponsors to provide the necessary evidence of the Basic Healthcare Services in order to procure a resident/work permit visa, which must be disclosed and filed with SEHA.
  • Article 13 of the Social Health Insurance Law obligates the Qatar Government to pay the health insurance premium for all Qatari nationals.
  • Article 18 of the Regulations prohibits the employers and sponsors from recovering the health insurance premiums from their employees and family members respectively.

Qatar, like the United Arab Emirates, is leading the way among the GCC countries to regulate healthcare in order to provide essential coverage of medical benefits to its population through mandated medical insurance. Due to the delays in the full implementation of the Social Health Insurance Scheme, the full extent of the Social Health Insurance Scheme is yet to be tested. Furthermore, due to the evolving nature of this initiative and the Qatar’s National Health Strategy of 2011-2016, it is likely that more regulations will follow.