Rules and Regulations

Royal Decree No. M/10 (1 Jumada I 1420 / 12 August 1999)​
Council of Minister’s Resolution No. 71 (27 Rabi’ II 1420 / 9 August 1999)
 
 
Article (1):
This Law aims at providing and regulating health care to non-Saudi residents of the Kingdom. It may be applied to Saudi citizens and others pursuant to a resolution by the Council of Ministers.
 
Article (2):
The cooperative health insurance coverage shall include all individuals to whom this Law applies and their family members, in accordance with the stipulation of paragraph (b) of Article (5).
 
Article (3):
With due consideration to the application phases referred to in paragraph (b) of Article (5) and the stipulations of Articles (12) and (13) of this Law, any sponsor of a resident shall be obligated to subscribe in the cooperative health insurance  in favor of the resident.
A residence permit may not be granted or renewed except after obtaining the cooperative health insurance policy, provided that said policy covers the duration of the residence permit.
 
Article (4):
The Health Insurance Council shall be constituted under the chairmanship of the Minister of Health and membership of the following:
(a)   A representative at the level of deputy minister representing the Ministry of Interior, Ministry of Health, Ministry of Labor and Social Affairs, Ministry of Finance and National Economy and Ministry of Commerce, to be nominated by their respective ministries.
(b)  A representative of the Council of Saudi Chambers of Commerce and Industry to be nominated by the Minister of Commerce and a representative of the cooperative health insurance companies to be nominated by the Minister of Finance and National Economy in consultation with the Minister of Commerce.
(c)   A representative of the private health sector and two representatives of the other government health sectors, to be nominated by the Minister of Health in coordination with their respective sectors. 
Appointment of Council members and renewal of their membership shall be pursuant to a resolution by the Council of Ministers for a renewable three-year term.
 
Article (5):
The Health Insurance Council shall oversee the application of this Law, particularly the following:
(a)   Preparing the draft implementing regulations of this Law.
(b)  Issuing decisions necessary to regulate changing matters pertaining to the application of the provisions of this Law, including determining the phases of its application, coverable family members of the beneficiary, manner and percentage of contribution to be made by both the beneficiary and the employer towards the premium of the cooperative health insurance and the ceiling of such premium, based on an actuarial study.
(c)   Qualifying cooperative insurance companies to operate in the cooperative health insurance field.
(d)  Accrediting health facilities providing cooperative health insurance services.
(e)   Determining the financial charges for qualifying cooperative insurance companies to operate in this field, and the financial charges for accrediting health facilities which provide cooperative health insurance services, after consulting the Ministry of Finance and National Economy.
(f)    Issuing the financial regulations for the Health Insurance Council’s revenues and expenditure, including wages and remunerations of its staff, after consulting the Ministry of Finance and National Economy.
(g)  Issuing the bylaws regulating the Council’s business.
(h)  Appointing the Council’s Secretary General based on a nomination by the Minister of Health, and forming a general secretariat and determining its tasks.
 
Article (6):
Expenditures necessary for the Health Insurance Council to conduct its business as well as the wages and remunerations of its staff shall be covered from revenues collected in accordance with paragraph (e) of Article (5) as agreed upon by the Ministry of Health and the Ministry of Finance and National Economy.
 
Article (7):
The cooperative health insurance policy shall cover the following basic health benefits:
(a)   Medical examination, outpatient treatment and medications.
(b)  Preventive measures such as: vaccinations, maternity and pediatric care.
(c)   Laboratory tests and radiology required for each case.
(d)  Hospitalization and treatment including delivery and operations.
(e)   Treatment of dental and gum diseases, excluding orthodontics and dentures.
 
These benefits shall be without prejudice to provisions of the Social Insurance Law or to benefits provided to employees by companies, private establishments and individuals, where such benefits are more comprehensive than those provided for in this Law.
 
Article (8):
An employer may expand the scope of the cooperative health insurance benefits by additional addendums at an additional cost to include other diagnostic and treatment services not provided for in the previous article.
 
Article (9):
Arrangement of matters relating to preventive health measures for policyholders, including examinations and vaccinations during the period preceding the issuance of the cooperative health insurance policy shall be made pursuant to a decision by the Minister of Health.
 
Article (10):
The employer shall bear the treatment expenses of the beneficiary during the period that falls between the due date of treatment and the date of subscription in the cooperative health insurance.
 
Article (11):
(a)   Health benefits included in the cooperative health insurance policy, when needed, may be provided by government health facilities against financial charges to be borne by the cooperative insurance provider. The Health Insurance Council shall identify the facilities to provide such benefits and determine the charges therefor.
(b)  The Minister of Health, in coordination with the Minister of Finance and National Economy, shall determine the procedures and controls for collecting the financial charges provided for in the previous paragraph.
 
 
Article (12):
Treatment of government employees subject to this Law and their family members shall be provided by public health facilities if they are directly employed and sponsored by said agencies and if their contracts provide for their right to receive treatment.
 
Article (13):
Pursuant to a decision by the Health Insurance Council, companies and establishments which have their own qualified medical facilities may be exempted from subscribing to cooperative health insurance for those benefits provided for their staff.
 
Article (14):
(a)   If an employer does not subscribe to the cooperative health insurance, or fails to pay premiums for a worker, subject to this Law, and his family members who are covered by the cooperative health insurance policy, the employer shall be obligated to pay all due premiums, in addition to a fine not exceeding the amount of the annual subscription for each individual and the possibility of denying him, permanently or temporarily, the right to recruit expatriate workers. 
In such case, the Implementing Regulations shall determine the agency to whom the due premiums are payable.
(b)  If any cooperative insurance company violates any of its obligations stipulated in the cooperative health insurance policy, it shall be required to meet such obligations and to pay for the damage that may have occurred as a result of such violation, in addition to a fine not exceeding five thousand riyals for each individual covered by the policy subject of the violation.
(c)   One or more committees shall be formed pursuant to a decision by the Chairman of the Health Insurance Council, comprising a representative of each of the following:
(1)   Ministry of Interior.
(2)   Ministry of Labor and Social Affairs.
(3)   Ministry of Justice.
(4)   Ministry of Finance and National Economy.
(5)   Ministry of Health.
(6)   Ministry of Commerce.
 
The Committee shall have the power to review violations of the provisions of this Law and recommend the suitable penalty. The penalty shall be imposed pursuant to a decision by the Chairman of the Health Insurance Council. The Implementing Regulations shall define said committee.
A grievance may be file against such decision before the Board of Grievances within sixty days from its notification.
 
Article (15):
A resident not covered by a work sponsorship shall assume the employer’s  obligations under this Law.
 
Article (16):
The Ministry of Health shall monitor the quality of health services provided for the beneficiaries under the cooperative health insurance.
 
Article (17):
The Cooperative Health Insurance Law shall be applied through qualified Saudi cooperative insurance companies operating in a manner similar to that of the National Company for Cooperative Insurance and in accordance with the Senior Ulema Commission Resolution No. (51) dated 04/04/1397 H.
 
Article (18):
The Minister of Health shall issue the Implementing Regulations of this Law in a period not exceeding one year from the date of its issuance.
 
Article (19):
This Law shall be published in the Official Gazette and shall enter into force ninety days following the issuance of the Implementing Regulations. Provisions related to formation and powers of the Health Insurance Council shall be deemed valid from the date of its publication.
 
 
 
 
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Last Update : 9/11/2019 4:12 PM