The official spokesman of the Council of Cooperative Health
Insurance (CCHI), Yaser Almaarek, confirmed that the mandatory unified health
insurance policy currently in force covers all ages of any current target group
and there is no age limit for the insured, whether Saudi or non-Saudi, as long
as he is a private sector employee. However, after the expiration of the
contractual capacity by retirement or otherwise, the employer shall not be
liable for providing health insurance services for the employees and their
family members while KSA, may Allah protect it, shall be liable for providing all
health care services free of charge to Saudi employees in accordance with the
ruling law. Optional insurance programs are not subject to the Cooperative
Health Insurance Law and no regulating entity can impose any option as long as
it is not obligated by Law.
He pointed out that the new unified policy will come into force next
month as of 01/07/2018, but the policies concluded before the date of entry
into force of the new policy will subject to the previous unified policy until
the expiry of those policies. Moreover, the insurance companies are not
entitled to cancel health insurance policies before their expiry date and
re-issue the same policies before the first of next July, except in cases
specified by the law.
Almaarek explained that the new policy includes additional
benefits, such as: treatment of dental and periodontal diseases, including
costs of one-time dental cleaning during the policy period, respiratory
syncytial virus (RSV) vaccines for children, coverage of early screening of
hearing impairment program ram, program of critical congenital heart defects
(critical CHDs) for all births, surgical treatment of super super morbid
obesity by sleeve gastrectomy only (Sleeve) for insured with a body mass
index (BMI) of 45 kg/m2, treatment of severe and non-severe psychological
disorders, treatment of pathological conditions requiring hospital isolation determined by the
Ministry of Health, treatment of psoriasis and costs of infant formula for
infants in need of formula for medical reasons up to the age of 24 months pursuant
to the regulations, including cases, such as: metabolic disorders, diseases included
in National Newborn Screening Program to reduce disability, milk and sugar
allergy, malabsorption, and premature, small for gestational age (SGA) or very
low birth weight (VLBW) infants, who need calorie or growth boosters besides
breast milk according to the regulations in order to include the benefit of
infant formula milk within the benefits set out in the policy schedule.
He indicated that the financial coverage limits of the health
insurance policy in force is (SAR 500,000) five thousand Riyals, which covers a
package of benefits including all expenses of medical examination, diagnosis,
treatment and medication, and expenses of hospitalization, including surgeries or
one-day surgery or treatment as detailed in the policy schedule, considering
that law does not, in no case, permit the issuance of a health insurance policy
with less benefits than those stated in the policy.
Almaarek said that insurance companies determine the insurance
premium based on technical grounds defined by the actuarial expert, including
several factors, such as medical history, age, risk ratio and insurance
category, through which the value of these premiums is determined, taking into
consideration the previous results, and approved by the Saudi Arabian Monetary Authority (SAMA).
Meanwhile, the prices and quality of health services are approved and monitored
by the Ministry of Health, emphasizing that CCHI stands equidistantly from
neutrality with health insurance companies and health care service providers.
He also pointed out that Article (117) of Chapter Eight (Relations among the Parties
to the Insurance Relationship) of the implementing regulations of the Health Insurance
Law provided that: “Insurance companies and health insurance claim management
companies shall not be allowed to own or operate facilities for the purpose of health
care of the insured nor shall private health facilities be allowed to own
health insurance companies.”
He added that CCHI Secretariat General has regularly developed and
updated the implementing regulations and the unified policy, at least for three
years, to raise the level of health insurance services for the insured and relevant
parties, stating that CCHI and its partners thoroughly studied all feedbacks
and suggestions received by the Secretariat General on the previous policy from
all relevant and competent parties before the inclusion of these additions and
updates.
Almaarek also called upon the insured to be aware of their insurance
rights by having cognizance of the Cooperative Health Insurance Law, the
implementing regulations and the new unified policy through visiting the
website, www.cchi.gov.sa. In addition to this, he recommended that the insured
benefits from the communication channels for responding to all inquiries and
receiving feedback, suggestions and complaints through one of the following
channels: unified # 920001177, e-mail: info@cchi.gov.sa, smart phone
applications, or CCHI official webpages cchi.ksa on social media channels
(Twitter, Facebook and LinkedIn).