New Regulations for Healthcare Services in Qatar: What You Need to Know
Healthcare &Life Sciences Focus
The Minister of Public Health issued Resolution No. 8 of 2022, which contains the Executive Regulations of Law No. 22 of 2021, regulating healthcare services within Qatar (the “Regulations”).
Law Update: Issue 364 - Healthcare & Life Sciences Focus
Nuša Gorenjak Paralegal,Corporate Commercial
Sabeeha MoollaProfessional Support Lawyer, Corporate Structuring
The Minister of Public Health issued Resolution No. 8 of 2022, which contains the Executive Regulations of Law No. 22 of 2021, regulating healthcare services within Qatar (the “Regulations”). The Regulations have been published in the Official Gazette on 1 September 2022 and came into force from the day following its publication in the Official Gazette.
The Regulations aim to implement the provisions of Law No. 22 of 2021, which introduced a compulsory health insurance system for expatriates and visitors, as well as a health card system for certain categories of residents. They also cover various aspects of the health insurance system, such as: registration; obligations, rights, and responsibilities of stakeholders; health insurance premiums; health insurance policy; healthcare services utilisation controls; confidentiality of data and information; and the supervision and monitoring of healthcare services.
This article will attempt to summarise the key provisions of the Regulations.
The Regulations require the competent department of the Ministry of Public Health to maintain a separate register of persons who wish to practice in activities related to the compulsory health insurance, including insurers, healthcare service providers and claims management companies. Requirements are set out for registration applications as well as a grievance procedures concerning registration decisions. The registration controls and procedures aim to ensure that the parties involved in the health insurance system are licensed, qualified, and compliant with the standards and obligations set by the Ministry of Public Health.
The Regulations impose the obligation, of providing insurance coverage for the essential healthcare services and/or the extra healthcare services, on the employers, recruiters and visitors to Qatar. For employers and recruiters, inter alia, the following obligations apply:-
employers shall enter into a contractual arrangement with a registered insurer to cover all its employees and their eligible family members (a spouse and three children below eighteen years of age); and
recruiters shall enter into a contractual arrangement with a registered insurer to cover all the recruited personnel who are not covered by the employer.
Any visitor shall enter into a contractual arrangement with a registered insurer upon applying for a visit visa such that the contract is in place on arrival in Qatar, unless such individual already has a valid international healthcare insurance that covers Qatar.
The Regulations grant the insured person the right to access the essential healthcare services specified in the Regulations, provided that:
a health insurance card is presented to the service provider; and
any co-payments or deductibles are paid.
The insured also must consent to be medically re-examined by a licensed medical practitioner identified by the insurer, if the insurer deems it necessary.
There are rights contained in the Regulations to make complaints and have grievances addressed.
The Regulations impose various obligations on the insurer, including:
entry into a healthcare service providers network contract with the registered healthcare service providers, as per the standard form developed by the competent department;
to adhere to the maximum limit of each insurance policy, the co-payments, the deductibles, and the prior approvals;
to pay the healthcare service provider's dues on the dates specified in the contract;
to apply the claims management rules;
to reimburse the beneficiary for the reimbursable expenses;
to have in place a mechanism for receiving and deciding on complaints filed by any party to an insurance relationship;
to process and settle the claims filed by the healthcare service provider, the beneficiary, or the insurance policyholder, within prescribed time limits; and
to notify the competent department of any changes to its business activities or its operating procedures in relation to the health insurance.
Furthermore, insurers are not permitted to refuse to accept new applications from employers or recruiters to provide the insurance coverage throughout the registration term, without obtaining the competent department's written approval.
The Regulations define the functions and obligations of claims management companies, which include:
managing claims arising from receiving the healthcare services according to the claims management rules;
assessing the reimbursable expenses;
managing any medical programs that the insurers are obliged to provide; and
making sure that the beneficiary has paid the co-payments or deductibles.
Additionally, claims management companies must comply with internationally-recognised professional standards in the area of practicing claims management and provide the competent department with regular reports on financial claims, or any other reports required by the same.
In this regard, the health insurance broker may not collect any brokerage amounts from the insured, employers, or recruiters and must maintain confidentiality of all information concerning healthcare service providers and the insured.
The Regulations further:-
provide for the mechanisms and procedures for collecting health insurance premiums for each category of beneficiaries;
emphasise the confidentiality of the records of beneficiaries with all parties to an insurance relationship and, in particular, the records of the healthcare service providers pertaining to essential healthcare services and extra healthcare services of a patient;
empower the competent department to supervise and monitor healthcare services generally.
The Regulations provide a comprehensive and detailed legal framework for the regulation of healthcare services within Qatar, in accordance with Law No. 22 of 2021. The Regulations cover a wide variety of activities in the field, setting out obligations and rights for the various stakeholders.
The aim of the Regulations is to ensure that the expatriate employees and visitors have access to the essential healthcare services and/or the extra healthcare services, as well as to protect their rights and interests in case of any disputes or complaints with the insurers or the healthcare service providers. The Regulations also prevent visitors from taking advantage of Qatar’s exceptional healthcare standards by ensuring that proper insurance is in place during the term of any visit.
It is also expected that insurers, healthcare service providers, claims management companies, and the health insurance brokers provide their services in a professional and transparent manner and that the health insurance system is financially sustainable and fair, as well as reflecting the cost and quality of the healthcare services.
For further information,please contact Nuša Gorenjak and Sabeeha Moolla.
Published in January 2024
