Updates to your local Oman plan

Your health care benefits in Oman are getting better

We’re building on the strength of our preferred partnership with global benefits leader, Allianz Partners to bring you a new, locally compliant benefits solution. The Oman Summit 1A plan is designed to deliver a simplified health care experience and broad network access to Aetna International members living in Oman.

What to expect 

• Broader access to care with an extensive direct-pay provider network of more than 300 providers across Oman — that’s a 275% increase in network size
• A MIC-Nextcare branded member ID card for a better experience
• Lumi by Nextcare mobile app for innovative, on-the-go health plan management in multiple languages
• Faster claims processing and reimbursement when needed
  
• Ability for members to request a preauthorization for direct pay with out-of-network health care providers, which helps avoid paying out of pocket up front for care
• A multilingual staff when support is needed for claims and customer service

What's staying the same

• Coverage though a fully compliant, local health and well-being solution
• A broad provider network that matches and exceeds existing access in Oman
• Outside-of-network care will still cost more even with preauthorization
• Reimbursement claims will be processed by Nextcare according to reasonable and customary (R&C) rates in Oman. R&C costs are defined as the average cost of treatment, expertise or services given by similar types of medical providers within the same country or geographical region, based on knowledge, experience and reasonable opinion
• Your non-Oman global plan, Aetna member W ID number, member tools, online portal, mobile and all related member services are not changing

What's changing with the Oman Summit 1A plan

• The plan is issued and insured through Muscat Insurance Company (MIC) and administered by Nextcare Oman. Nextcare Oman is Allianz Partners’ local Third Party Administrator (TPA).
• New MIC-Nextcare digital ID card will be issued with a new member ID number
• Searching for providers in the extended Oman network now happens on the Lumi app
• Managing Oman benefits information and submitting claims is now the Lumi app
• Oman member and customer service support after renewal/enrollment is now through Nextcare Oman
• When accessing out-of-network care, members must precertify/preauthorize certain services
  
• Preauthorization is required for select services in addition to services for out-of-network care. This ensures 100% direct payment based on plan benefits that align with reasonable and customary costs within the Oman network.
• If select services are received without obtaining preauthorization, a cost-share of 20% for inpatient services and 50% for other services will apply to the member

Answers to frequently asked questions

Here’s what to know to help make this transition as smooth as possible.

Is health insurance mandatory in Oman?

Yes. The Sultanate of Oman mandates that all residents are required to have at least a minimum level of medical insurance coverage with minimum benefits (pursuant to the prescribed provisions of Resolution No. 34 of 2019). A locally compliant plan provides benefits that are consistent with local laws and regulations and easy access to necessary documentation like ID cards.

Why is this change happening?

Regulations in Oman have changed. So through Muscat Insurance Company (MIC) and Nextcare Oman, we're offering a new, locally compliant, supplemental benefits solution for residents in Oman. Nextcare Oman, Allianz Partners’ local TPA, has an extensive network presence of over 300 providers in Oman and share our experience, longevity and commitment when it comes to our customers and members. They currently serve over 1,000 members in Oman and have a team of customer service, compliance, clinical and claims personnel based locally.

When will this change take effect?

All new and renewing groups will transition to the Oman Summit 1A plan for coverage in Oman beginning on 1/1/2024. The plan is issued and insured through MIC and administered by Nextcare Oman.

Will there be any changes to network provider access?

Yes, members will now have broader network access in Oman. The Nextcare Oman network includes existing providers able through Aetna and includes as 275% increase in direct-pay providers. Members will continue to have access to their existing Aetna network providers until their plan is renewed and they are transferred to the new plan. Full details of in-network Oman providers can be viewed at Nextcarehealth.com/healthcare-network or by using the Lumi app by Nextcare.

Will members receive a separate member ID card for use in Oman?

Yes. Members on the Oman 1A plan will receive a digital MIC-Nextcare branded ID card which can be used to access services at in-network providers in Oman. The Oman ID cards don’t have an expiration date, so new cards will not be issued every year. Members will keep and continue to use their physical/digital Aetna International member ID card when accessing care outside of Oman.

Will members need to request preauthorization for care in Oman?

Yes. a preauthorization is required for certain types of care. This often includes inpatient and high-cost treatments. Refer to the Table of Benefits for care that requires preauthorization. If you make a claim to receive reimbursement for these types of care without preauthorization, you may not get fully reimbursed. For example:

• If the treatment received is subsequently proven to be medically unnecessary, we reserve the right to decline your claim
• If the treatment is subsequently proven to be medically necessary, the plan will pay 80% of in-patient benefits and 50% of other benefits

How will claims work with the new supplemental plan?

With an extensive network of 300 providers in Oman, most members won’t need to submit claims for reimbursement. However, when a member does need to make a claim they can use the streamlined submission process on the Lumi app by Nextcare. The online process will guide members through the information needed to make the claim. Once all relevant information is provided and complete — most claims are processed within 2 working days. Claims can also be submitted by emailing membercare@nextcarehealth.com. 

How will Oman claims incurred prior to the transition be handled after 1/1/2024?

Members can continue to submit all Oman claims for services incurred prior to the transition date to Aetna International through their member website at AetnaInternational.com. Members can submit claims incurred within six months of the date of service received and invoiced. Claims that are still in processing will be completed by Aetna International. All new claims in Oman incurred on or after the plan renewal date can be submitted through the Lumi app by Nextcare.

Plans and programs are underwritten or administered by Aetna Life & Casualty (Bermuda) Ltd. or Aetna Life Insurance Company (Aetna). The insurer is Muscat Insurance Company S.A.O.G. – P.O. Box 72, Postal Code 112, Ruwi, Sultanate of Oman. Company Registration No.: 1452916.

Aetna does not provide care or guarantee access to health services. Not all health services are covered, and coverage is subject to applicable laws and regulations, including economic and trade sanctions. Information is believed to be accurate as of the production date; however, it is subject to change.

©2024 Aetna Inc. All rights reserved.

2736400-04-01 (10/23)