FAQs

1- Does the Cooperative Insurance Company have the right to select any of the health care provider centers?

Yes, The Cooperative Insurance Company has the right to select any health care provider it prefers, if such center licensed by Ministry of Health (MOH) and qualified by Council of Cooperative Health Insurance (CCHI) in Kingdom of Saudi Arabia.

2- Does the Cooperative Insurance Company have the right to reject any health insurance order?

No, the Cooperative Insurance Company has no the right to reject any health insurance order, if such order within its financial margin solvency.

3- Based on what, an insured will be reimbursed if he/she pays for a health service(s) covered by the policy?

Any insured will be reimbursed against a health service(s) "covered by the policy" based on the following conditions:

If the Insurance Company does not regulate the service for the insured in an effective timely manner.

If the Insurance Company does not have the right to reject the provision of the service for the insured.

The reimbursement will be subjected to the cooperative health insurance policy conditions.

The reimbursement will be subjected to what the company pays at the same level of health care.

4- Do the policy holders have to contribute for their employee(s) in this act, if their contracts do not guarantee health care delivery for them?

We do have here two cases:

A) All policy holders in the public sector: have to contribute for their employee(s) in this act, only, if the employee(s) contract guarantees the provision of health care for them.
If any employee contract does not contain this condition, he/she has to find his/her own health insurance coverage.

B) All policy holders in the private sector: have to contribute for their employee(s) in this act, either or nor, their employee(s) contract guarantees the provision of health care for them.

5- Does the Cooperative Health Insurance Act cover all policy holders in kingdom including the big companies such as Aramco and Sabic?

Yes, the Cooperative Health Insurance Act covers all policy holders in kingdom, except if they own health care facilities providing one or more of the health care levels (primary, secondary and tertiary) and request such exemption from the council.

6- What about the health insurance policies in the market before implementing this act?

All contracting parties are subjected to finalize their commitments within a year as of the issuance of the executive bylaws.
However, they can continue with the same commitments according to the following conditions:

The Health Insurance Company must be qualified by CCHI.

The Health Care Provider Center must be licensed by MOH and accredited by CCHI.

They must be able to continue their commitments according to the rules of the cooperative health insurance act and its executive bylaws.

This is only applicable for all companies and individual institutions having more than 500 non-Saudi residents' employees.

7- Who is responsible for issuing the cooperative health insurance policy? How?

The health insurance company is responsible for issuing the cooperative health insurance policy based on a written letter from a policy holder.

8- Do all health insurance parties have the right to cancel the cooperative health insurance policy? How?

Yes, all health insurance parties have the right to cancel the cooperative health insurance policy by sending a letter to the another party by a month of the canceling date.

9- Who is responsible for licensing the cooperative health insurance companies?

The responsibility for licensing the cooperative health insurance companies in kingdom will be appointed to a governmental agency.

10- Who is responsible for qualifying the cooperative health insurance companies?

It is the responsibility of Secretariat General of the Council of Cooperative Health Insurance to qualify the cooperative health insurance companies.

11- What is the role of the council of cooperative health insurance (CCHI) regarding any violation of this act?

There is a committee or more formed by head of CCHI entrusted with such violations and recommending the appropriate penalty which will be decreed by the head of CCHI.

12- Whenever there is a claim submitted against an insured person, how many times the health insurance company has the right to diagnose him/her? Where?

In such case, the health insurance company has the right to process diagnosis up to two times within 60 day as of the claim submission date. Such procedure must be done at accredited health care provider center within the network.

13- Does the cooperative health insurance cover work injuries?

Any work injuries must be covered by social insurance (GOSI Act) and labor acts regulations.

14- Can the insured transfer to upper health care level without a referral?

Yes, the insured can transfer to upper health care level without a referral, but he / she has to pay the difference of medical expenses.

15- Will the cooperative health insurance policy cover all health care services without any exemptions?

The cooperative health insurance policy will cover the following benefits:

1) Health benefits:

A- Diagnosis, Medications, Treatment and Medical Expenses in accordance with the policy schedule.
B- All hospitalization expenses including operations, one day surgeries and treatment, and delivery.
C- The treatment of teeth and gingival diseases.
D- Preventive measures as specified by M.O.H such as vaccinations and maternity and childhood.

2) The expenses of repatriation of the remains of the insured to his / her country of origin.

16- What are the accredited governmental and private health care facilities which will provide the cooperative health insurance services?

All private and public health care facilities have the right to apply at CCHI for accreditation for health care delivery.

17- Does the cooperative health insurance act cover Hajj and Aumrah?

No, this act does not cover such service.

18- Will the cooperative health insurance be free of charge for retired, elderly and students?

No, this act aims to regulate the basic health services for non-Saudi residents and their dependents. With regard Saudi Citizens, for the time being, they will be served by the governmental facilities.

19- Is there a system providing the health care for poor and unemployed people as per Medicaid in USA?

This act aims to regulate the basic health services for non-Saudi residents and their dependents in kingdom for work purposes. It also subscribes the policy holders to contribute for them in the cooperative health insurance.

With regard Saudi Citizens, they are still served by the governmental facilities regardless their social situation.

20- In case of issuing any violations between the insured and the health insurance company, which agency can the insured complains to?

In case of issuing such violations, it could be raised to the CCHI where the appropriate penalty will be decreed by the head of the council. Any complaint against such decree could be submitted to the bureau of grievances within 60 days from notification.

21- What are the main advantages of the cooperative health insurance act?

This act may have the following advantages:

Creating an official channels through which the health care could be regulated to non-Saudi resident and their dependents.

Financing health services through implementing the cooperative health insurance act.

Ensuring a comprehensive health care service for all community members and maintaining of the kingdom health gains.

Reducing the pressure on the public sector by encouraging the private sector to provide health care for non-Saudi under this act. As a result, Saudi Citizens will gain more benefits from public sector and maintaining the life span of medical equipments and buildings in the public sector. Thus, there will be redistribution in and between both sectors.

Maintaining the quality of health care by reducing the pressure on the public sector and encouraging the competition between the health care providers.

Reducing the health care cost in kingdom which expenses about 10% of its annual budget.

22- What are the disadvantages of the cooperative health insurance act?

For the time being, we can not predict the disadvantage of this act before the implementation output.

23- Who is supervising the quality of health care delivery?

The ministry of health is entrusted to monitor the quality of health care delivery and CCHI is working on the application of quality standards in the health insurance industry.

24- Will the health insurance companies apply Diagnostic Related Groups (DRG) as per in Canada and USA?

The health insurance market in kingdom is opened and subjects to the competition between the insurance parties.

25- Do the physicians have the right to share in a health insurance company stocks?

Yes, any Saudi Citizen has the right to share in a health insurance company stocks.

26- Is the cooperative health insurance policy international?

No, the cooperative health insurance policy coverage is only effective in kingdom only.

27- What are the exemptions standards of any policy holder contribution in the cooperative health insurance act?

Any policy holder could be exempted of contribution in the cooperative health insurance act according to the following conditions:

If the policy holder owns a health care facilities accredited from CCHI.

If the policy holder owns a health care facilities providing one or more of the health care levels (Primary, Secondary and Tertiary).

If the policy holder owns a health care facilities which having health care quality standards.

28- Does the act cover all dependents of non-Saudi residents?

Yes, it covers all dependents are defined and documented as a dependent in the policy holder records.

29- Do the policy holders have to contribute for their non-Saudi residents and their dependents?

Yes, all policy holders are subjected to contribute for their non-Saudi residents and their dependents.

30- What are the duties and responsibilities of Cooperative Health Insurance Council (CCHI)?

The Cooperative Health Insurance Council is responsible for
supervising the implementation of the cooperative health insurance act and in particular is entrusted to:

Preparing the executive bylaws of this act.

Issuing the necessary decisions for organizing any changing matter regarding the implementation of this act.

Qualifying the cooperative health insurance companies.

Accreditation of the health care providers.

Specifying the financial requirements for the qualifying and accreditation process.

Issuing the council's financial bylaws including the revenues, expenses and employee's salaries of CCHI after coordination with the ministry of finance and national economy.

Issuing the internal bylaws of CCHI for organizing the council work flow.

Appointing a general secretary of CCHI.

31- Who is paying for medical expenses before issuing the policy?

The policy holders are responsible for such expenses before issuing policy.

32- When will the cooperative health insurance act be implemented?

It will be implemented after 90 day as of issuing the executive bylaws.

33- How will the cooperative health insurance act be implemented?

It will be implemented by a cooperative health insurance companies qualified by CCHI.

34- Does the cooperative health insurance act cover all non-Saudi residents in kingdom?

Yes, it covers all legal non-Saudi residents in kingdom.

35- Does the cooperative health insurance act cover Saudi citizens in kingdom?

For the time being, it only covers all non-Saudi residents in kingdom and it may be applied to Saudi citizens and others by a cabinet decree.

36- How is the CCHI being formed?

It is headed by Minister of Health and the membership of:

A representative from each of the following ministries: ministry of interior, ministry of health, ministry of labor and social affairs, ministry of finance and national economy, ministry of commerce. Each representative shall be holding the rank of undersecretary and shall be nominated by the right authority.

A representative on behalf of the Saudi chamber of commerce and industry to be nominated by the minister of commerce and a representative on behalf of the cooperative insurance companies to be nominated by the minister of finance and national economy in consultancy with the minister of commerce.

A representative on behalf of the private health sector and two representatives on behalf of other governmental health sectors to be nominated by the minister of health in coordination with the relevant authority.

Members of the CCHI shall be appointed by a cabinet decree for three years which can be renewed.

37- Can the governmental sector provide the cooperative health insurance services?

Yes, the governmental sector can provide the cooperative health insurance services in case of there is no private health care provider in the area and / or there is a need for the health care in the public sector.

38- What does the Cooperative Health Insurance Act aim to and whom does it work for?

Cooperative Insurance Act aims to regulate the provision of health care for non-Saudi residents in Kingdom, and it may be applied to Saudi citizens and others by a cabinet decree.