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Council of Cooperative Health Insurance
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1. What the limits of insurance coverage?
The health insurance policy covers all expenses of medical examination, diagnosis, treatment and medication, except for the exceptions referred to in the CCHI unified policy
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2. Can a policyholder upgrade insurance coverage to cover other diseases?
An employer may upgrade insurance coverage by means of additional annexes with extra cost to cover other diagnostic and treatment services.
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3. What is meant by deduction/payment sharing?
It is the part which the beneficiary pays when receiving treatment in the outpatient clinics as prescribed (if any) in the list contained in the policy,
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4. Who is responsible for paying the deduction/payment sharing when receiving healthcare services, and what are the exceptions?
When receiving a health service, every beneficiary shall pay the payment sharing amount (if any) as prescribed in the list contained in the policy
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5. What is the period necessary for insurance companies to respond to approve treatment requests?
The insurance company must respond to the request for approval to treatment within sixty minutes, with the exception of emergency cases, which do not require prior approval
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6. Does the CCHI policy cover claims arising from congenital deformities?
The CCHI policy does not cover cases of congenital deformities unless they pose a risk to the life of the insured as contemplated in clause (17)
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7. Does the policy cover psychological cases?
The CCHI policy covers treatment of acute psychological cases with a maximum amount of 15 thousand riyals.
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8. How is insurance for people with chronic diseases carried out?
The beneficiary must disclose if he/she has any illnesses before entering into insurance once given a medical questionnaire (disclosure form) by the company.
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9. What is the maximum benefit limit?
The maximum benefit limit per beneficiary is (500) thousand Saudi riyals only.
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10. Is the employment contract concluded between the employer and employee enough to determine the marital status of the latter?
The employment contract does not identify marital status, and the categories stated in Article (2) of the executive regulations
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