The Council of Cooperative Health Insurance has revealed that it has received 1585 complaints from the parties involved in insurance (insured, health insurance companies, health service providers), by an increase of 56% from last year's rate. The Secretary-General of the Council of Cooperative Health Insurance Mr. Mohammed Bin Salman Al-Hussein said that 96.28% of those complaints have been resolved according to official procedures, while 3.53% have been referred to other agencies for lack of jurisdiction; only 0.19% complaints have been retained for failure to complete the required paperwork.
Al Hussein further stated that the rise in complaints is due to the expansion of the health insurance market and the increase of the insured to about 9.6 million who enjoy health care services through an established network of more than 2521 service providers through 28 health insurance companies, in addition to increasing awareness of the Cooperative Health system and its implementing regulations and the expansion of diversified means of communicating with the Secretariat of the Council to receive feedback and suggestions.
Al Hussein pointed out that the majority of complaints relate to the beneficiary being unable to obtain the basic available benefits specified in the document of the Cooperative Health Insurance Council, whereas other complaints are directed against the employers who fail to provide health insurance to their employees and their family members, and some other complaints revolve around financial claims.
He further disclosed that the complaints were distributed as follows: 1329 complaints representing 83.85% against the insurance companies, 186 complaints representing 11.74% against employers, and 50 complaints representing 3.15%, against the service providers, whereas 20 other complaints have been referred to the competent authorities, such as Labor Office and Ministry of Health. Al Hussein noted that the Council is aware of the important role it has to play in the way of health insurance market and protection of the parties to the insurance industry, where the General Secretariat has provided many official channels for receiving comments, suggestions and complaints through a package of programs aimed at serving the clients' who are parties to the insurance relationship, including the unified call center number 920001177 in both Arabic and English languages, which provides the caller with information on the health insurance system and interpretation of its regulations and the names of the qualified companies in addition to the names of the accredited health service providers, registration and receipt of complaints and suggestions, and responding to all inquiries and questions; not to mention the portal www.cchi. gov.sa, which provides all information related to the health insurance system and the terms of the rehabilitation of health insurance companies, as well as the approval of health facilities. Al Hussein pointed out that besides the phone No. 011 4878600 and Fax No. 011 4870071 complaints and inquiries can be communicated via one of the following media channels:
Al Hussein confirmed that the Cooperative Health Insurance Council is moving steadily towards realizing its objectives of the provision of health care to the targeted stratum i.e. all private sector Saudi and non-Saudi employees and their families, as well as supervision, monitoring and control of all the parties to the insurance relationship so as to secure the right of everyone, including evaluation of the effects of the enforcement of the system, and the continued development of the means and tools of the Council to achieve excellent health care insurance.
On the other hand, the Director of the Contraventions and Complaints Department at the Secretariat of the Council of Cooperative Health Insurance Mr. Shaie Al Shaie said that the Department is constantly striving to improve its performance to prevent illegal practices in the field of health insurance, in addition to participating in the field tours of the control teams established by the Secretariat of the Cooperative Health Insurance Council, and paying particular attention to the complaints and solving them through direct communication with the complainants, and strengthening contact with the relevant government agencies such as the Ministry of Health and the Ministry of Labor to serve the parties to the insurance relationship and to protect them against unfair and improper practices.
