Commentary on Law No. (22) of 2021 regulating health care services

His Highness Sheikh Tamim bin Hamad Al Thani, Emir of the State of Qatar, issued Law No. (22) of 2021 regulating health care services, as it was published in the Official Gazette on October 18, 2021, which defines the controls, procedures, systems and standards necessary to provide health care services in government and private health facilities. And it is scheduled to start implementing the law after 6 months of its issuance.

This law came within a set of other health laws that were issued before it, foremost of which is the rights affirmed by the permanent constitution of the State of Qatar for the year 2004 in Article (23) which states that “the state is concerned with public health and provides the means of prevention and treatment of diseases and epidemics in accordance with the law”.

The law in its entirety contained (48) articles that were divided into (6) chapters: it opened with definitions and general provisions, then the provision of health care services to health card holders, and the obligations of the parties to the insurance relationship, chapter five was devoted to the grievance committee, and finally the final penalties and provisions.

In its first article, the law introduced several definitions, including its clarification of what is meant by health care services: that they are a group of health care services that are provided in accordance with the provisions of this law and the regulations. And between governmental and private health facilities, and he defined an emergency situation as: a medical condition or injury that poses a threat to the life of a person or any of its organs, and requires immediate medical intervention to save the life of this person or injured organ.

The law requires the patient’s consent first in order to receive health care services. However, the patient’s consent is not considered if he has not reached the age of 18 or the patient’s will is not considered legally, and in both cases the consent of the guardian or guardian must be obtained. He postponed the discussion of the rights and duties of patients to a decision determined by the Minister.

To whom are health care services provided in government health facilities free of charge?

These services are provided to citizens, and a decision by the Council of Ministers may specify a category or categories that benefit from these services and the limits of their use.

The law confirmed the mandatory health insurance for expatriates and visitors, meaning that every person within the borders of the State of Qatar who are not citizens and those to whom a decision is issued by the Council of Ministers must obtain health insurance in accordance with the law, which guarantees them access to health care when they are exposed to any health problem.

Accordingly, this law came to regulate the relations of the insurance parties. It initially required the registration of companies wishing to carry out the activity of compulsory health insurance in the register. The executive regulations of the law will specify the conditions, procedures, and controls for registration.

Who is the employer, as one of the parties to the insurance relationship?

Ministries, other government agencies, public bodies and institutions, and every natural or legal person who employs employees, workers or employees in return for a wage of any kind.

What are the obligations of the employer?

1. Payment of health insurance premiums to provide insurance coverage for basic health care services for its employees. Payment of health insurance premiums for family members of its employees will be from the date of their entry into the country, in accordance with the limits indicated by the regulation.
2. Provide his employees with a health insurance card, after the insurance policy is issued.
3. Provide proof that his employees and other eligible persons are covered by the compulsory health insurance system when issuing or renewing their residency.
4. Paying the costs of health care services provided to the beneficiaries arising from his breach of his obligation to maintain valid insurance coverage, and he may not deduct from them the cost of these services or part of them.
5. Any other obligations specified by the regulations or decisions issued in implementation of this law.

Who is the recruiter as one of the parties to the insurance relationship?

Every natural or legal person who brings a natural person for the purposes of residence or work with him in the country, in accordance with the provisions of Law No. (21) of 2015 regulating the entry, exit and residence of expatriates.

What are the obligations of the applicant?

1. Paying health insurance premiums to provide insurance coverage for basic health care services to those who are recruited by those who are not covered by insurance coverage from the employer, from the date of their entry into the country, in accordance with the regulations.
2. Provide the beneficiary with a health insurance card after the insurance policy is issued.
3. Provide proof that the beneficiaries are covered by the health insurance system when issuing or renewing their residency.
4. Paying the costs of health care services provided to the beneficiaries arising from his breach of his obligation to maintain valid insurance coverage, and he may not deduct from them the cost of these services or part of them.
5. Any other obligations specified by the regulations or decisions issued in implementation of this law.

Who is the visitor as one of the parties to the insurance relationship?

Every non-Qatari person who enters the country temporarily for a purpose other than for the purpose of residence or work.

What are the visitor obligations?

The visitor is obligated to pay the health insurance premium, or to provide proof that he has a valid international insurance that includes the State of Qatar and covers the period of his stay in the country.

Who is the beneficiary as one of the parties to the insurance relationship?

Every non-Qatari natural person is entitled to obtain health care services under the mandatory health insurance, in accordance with the provisions of this law and regulations.

What are the obligations of the beneficiary?

1. Pay the co-payment amounts or the deductions specified in the insurance policy.
2. Not to misuse the insurance policy or health insurance card, in any way.
3. Any other obligations specified by the regulations or decisions issued in implementation of this law.

Who is the insurance company as one of the parties to the insurance relationship?

Every national insurance company that conducts health insurance business in the country in accordance with the provisions of the law and regulations.

The law defines the obligations of the insurance company, the most important of which are:

1. Applying the best systems and procedures that guarantee the provision of fast and efficient services in fulfillment of its obligations towards insurance policy holders and beneficiaries.
2. Concluding contracts with health care service providers in the country to establish a network of health care service providers in accordance with this law and regulation.
3. Paying the value of health care services to the providers of those services in accordance with the contracts concluded with them and in the manner set forth in the Regulations.
4. Paying the value of health care services provided to the beneficiary by a health care service provider who is not included in the network of such service providers, in emergency cases.
5. Enable the beneficiary to obtain his rights specified in the insurance policy by all available means, and not to place any restrictions or conditions that limit the use of health care services contracted to provide.
6. Not to refuse any request to contract with it to cover the compulsory health insurance from an employer, a recruiter, or a visitor, as long as this request complies with the controls stipulated in this law and the regulations, without the written approval of the competent department, and in accordance with what is specified by the regulations.

Who are the health care providers as one of the parties to the insurance relationship?

Governmental health facilities that provide health care services, and private health facilities licensed to provide such services, in accordance with the laws in force in the country.

What are the obligations of health care providers?

1. Providing health care services in accordance with the established professional and ethical standards and in accordance with the treatment evidence approved by the Ministry.
2. The rules and procedures determined by the Ministry regarding how to provide health services.
3. Maintain regular medical and financial records regarding health care services provided to beneficiaries.
4. Not requiring any party other than the insurance company to pay the value of the health care services provided to the beneficiary, with the exception of co-payment amounts or deductions.
5. Providing health care services to the beneficiary in emergency cases without asking him to pay any money, until the danger has passed, even if the service provider is not within the network of health care service providers for the beneficiary, provided that this does not prejudice the right of the health care service provider to refer to The insurance company, or the employer, or the recruiter, as the case may be, to pay the cost of this service.
6. Protecting the information and data of the beneficiaries and maintaining its confidentiality.
7. Providing the competent department, the insurance company and the claims management company with information, data and documents related to health care services provided by them to the beneficiaries.
8. Providing the competent department with any information, data, or statistics that it requests or considers necessary to have access to in implementation of the provisions of this law and the regulations and decisions issued in implementation of it, including the beneficiary’s medical file, and cooperate with the employees of the competent department and enable them to view their databases and records.
9. Any other obligations specified by the regulations or decisions issued in implementation of this law.

What does the insurance contract concluded between health service providers and the insurance company include?

The contract includes the details of the health care services contracted to provide, and the terms and conditions on which the contract was made, as specified by the regulation.

What does the insurance policy include?

The insurance policy includes the data specified by the regulation. The insurance policy remains valid even if the insurance company’s registration is canceled, and the company is committed to fulfilling the rights contained in the policy for its holder throughout its validity period.

Who is a health insurance broker and what are its obligations?

Every natural or legal person who markets and sells insurance policies in return for a financial consideration in accordance with the provisions of this law and regulations. Old information, advice and recommendations to beneficiaries, employers and recruits are committed to the best insurance coverage and the best prices offered by insurance companies with complete impartiality and independence. The regulation determines the other obligations of the health insurance broker.

The law referred to the establishment of the Grievances Committee, which is concerned with examining the grievances submitted by the concerned parties against the decisions issued by the competent department in accordance with this law and the regulations. Science. The Minister shall decide on the grievance within ten days from the date of its submission, and the lapse of this period without a response to the grievance is considered an implicit rejection of the grievance, and the decision on the grievance shall be final.

Penalties imposed:

The Health Care Services Law imposed several penalties, with a fine of no more than (500,000) five hundred thousand riyals, every private health facility that refrains from providing health care services in cases of emergency or accidents. Unregistered health facilities shall be punished with a fine not exceeding (500,000) five hundred thousand riyals. A fine of not more than (30,000) thirty thousand riyals shall be imposed on every employer or recruiter who refrains from providing insurance coverage, paying the health insurance premium, or collecting any part of the value of the premium from any of his employees or the persons who are obligated to pay the premiums on their behalf, with obligating him to Refund those amounts to them. The penalty shall be multiplied by the number of persons for whom the violation occurred.

The Minister or whomever the delegates may conciliate in the crimes stipulated in this law, except for those stipulated in Article (28) of this law regarding the failure of health facilities to provide health care in emergency situations. The criminal case or during its consideration and before adjudication of it by a final judgment.

In conclusion, we can only commend the importance of the Health Care Services Law, which was comprehensive to define the duties, obligations, and rights of all groups in society, both moral and natural. Health care services come into force after 6 months from the date of its publication in the Official Gazette, and primary health care institutions will continue providing their services to those who hold a health card throughout this period until then. Laws No. (7) of 1996 regarding the regulation of medical treatment and health services at home, and Law No. (7) of 2013 regarding the social health insurance system have also been repealed.