Qatar national health insurance scheme update

Article 5 of the Health Insurance Law tasks the Supreme Council of Health (the SCH) with supervising and developing Seha. Article 19 of the Health Insurance Law tasks the National Health Insurance Company (the NHIC) with implementing and managing Seha, and the powers of the NHIC are listed in Article 20. The NHIC is a government-owned entity with a board of directors including representatives from various ministries and two members from the private business sector.

The NHIC has appointed Al Khaleej Takaful as its third party administrator and Aetna and GlobeMed as exclusive subcontractors of the third party administrator.

Implementation
Seha is to be rolled out in five phases, the first phase launched in July 2013 with 7 hospitals providing female health care services to Qatari women aged 12 and above. In April 2014 the network of service providers was expanded and all services made available to all Qataris. Currently there are 73 Seha providers including 4 public facilities and 69 private facilities. The third phase, to launch in Q3 2014, will further increase the number of service providers. The fourth and fifth phases, to launch in 2015, will extend coverage to white collar workers, visitors and blue collar workers.

The Regulations
The Regulations contain conditions which impact the operation of Seha and its participants. Article 16 provides that a health insurance provider must have its place of business inside Qatar and be licenced by the competent governmental authority in Qatar, it also prohibits health insurance providers from managing or running, solely or jointly, healthcare services rendered to beneficiaries inside Qatar.

‘Basic’ and ‘Additional’ healthcare services
Article 1 of the Health Insurance Law distinguishes between ‘Basic’ and ‘Additional’ healthcare services. Pursuant to Article 28 of the Regulations, mandatory insurance coverage for all Basic healthcare services will be provided by the NHIC alone. The extent of coverage under Basic healthcare services is determined by one’s nationality and residency status.

Accredited health insurance companies will be entitled to offer insurance cover for Additional healthcare services only. It is not clear whether the NHIC will participate in offering Additional healthcare service insurance.

Health insurance premiums
The value of health insurance premiums (Premiums) has yet to be determined. Article 14 of the Health Insurance Law provides that the SCH will set Premiums according to “generally accepted actuarial principles”. Article 2 of the Regulations provides that Premiums shall be set without discrimination between beneficiaries in respect of age, gender, previous health status or any other risk factors. Premiums shall be paid as a percentage of all costs of the healthcare activities, in addition to actuarial forecasts.

Premiums will be paid in accordance with the Regulations pursuant to Article 12 of the Health Insurance Law. Under Article 13 of the Health Insurance Law, the Government is responsible for paying Premiums for Qatari nationals. Employers and sponsors are responsible for paying Premiums for their employees (and their families) and sponsored persons, respectively. Employers and sponsors are prohibited from recovering Premiums from employees or sponsored persons.

SCH Circular No 7 of 2013 introduced a moratorium on price increases for health care services offered by private health care providers until Seha is fully implemented to avoid potential price increases during the implementation phase.

Note: all Qatari Laws quoted in this article are issued in Arabic and there are no official translations. For the purposes of drafting this article Clyde & Co has used its own translation and interpreted the same in the context of Qatari laws, regulations and current market practice.