24/12/2019
Council of Cooperative Health Insurance Exposes Ten Statutory Violations by Six Service Providers and an Insurance Company

​​Council of Cooperative Health Insurance exposed 10 violations by (6) Health Care Providers and a Health Insurance Company, and such parties have been subject to established regulatory procedures. “Supervision Department has performed 200 inspections of a number of Health Insurance Companies and Health Care Providers approved under insurance umbrella in ten Cities and Governorates” CCHI spokesperson, Mr. Yasser Al-Ma’arak said. He also referred to that “CCHI places great importance on monitoring and supervision aiming to raising the level of compliance with Cooperative Health Insurance Law,  executive regulation, unified policy and CCHI resolutions that guarantee the provision of appropriate health care services to insured parties. In addition, safeguarding insurance parties’ rights, and sustaining market integrity against negative practices”. “CCHI relies on various mechanisms to detect violations in private health insurance market, such as automated system for issuing policies that enables extrapolation of extent of compliance with laws and regulations. In addition to, mystery shopper, unannounced and scheduled inspections of Health Insurance Companies and Health Care Providers, as well as fraud reports submitted thereto from all insurance parties.” He explained. Further, He illustrated that “one of most prominent violations monitored was: Failure to comply with conditions of approving and issuing health insurance policies, and criteria of requesting approval of medical services, as well as weakness of electronic systems, delay in payment of financial claims to service providers and submission of fake claims to insurance companies. In addition to, violations related to delay in referring financial claims and sending approval request to Insurance Company, dealing with service providers unapproved by CCHI, providing CCHI General Secretariat with false information and lack of health insurance coverage for Saudi workers and their family members”. “CCHI is very keen on controlling private health insurance procedures and protection of market against any malpractices. Thereby contributing to achievement of CCHI’s vision to be a world leading authority in enhancement of health services quality by raising private health insurance efficiency.” He asserted. Al-Ma’arak also encouraged all insured parties to keen on knowledge and awareness of their obligations and insurance rights by reviewing cooperative health insurance law, executive regulations and unified policy, as well as use of communication channels provided by CCHI to answer all questions as well as receive all comments, proposals, and complaints via following channels:​

Last Update : 12/01/2020 12:16 م