The General Secretariat of the Cooperative Health Insurance Council organized a workshop for the Charitable Association for Patients Care (`inaya), held at the Association’s headquarters in Riyadh this morning. The workshop aimed at introducing the health insurance system, its executive bylaws, and the unified document, as well as raising awareness about the role of the Council in the industry of the insurance market and its efforts to safeguard the rights of the insured and to help in shaping a positive public opinion about the health insurance industry.  

Secretary General Muhammad ibn Sulaiman Al-Hussain said: “The General Secretariat is seeking to establish and support such activities that promote contact with various segments of society and contribute to the building of bridges of cooperation with the parties of common concern related to health insurance, patients care and preservation of their rights.” Al-Hussain noted that the cooperative health insurance system aimed at providing health care services to all employees in the private sector and their family members, both Saudis and non-Saudis, until the total number of insured reached (12,345,335), where (993,520) of them were Saudi employees and their dependents were (1,645,631). However, the number of insured non-Saudi employees reached (7,301,547) and the number of their dependents reached (2,404,637). They receive health insurance services through (27) qualified health insurance companies and (9) claims management companies in addition to more than (4467) accredited health service providers. He pointed out that the General Secretariat has taken many measures to strengthen its supervisory and regulatory means that contribute to the preservation of the rights of the insured. Cooperative health insurance companies and medical claims management companies (TPA) have been brought up to standard, health care providers have been accredited, ensuring their readiness to work under the umbrella of the Council, to contract with health insurance companies qualified by the Council. In addition, schedules have been prepared to include the application to enable everyone to easily integrate into the system without any confusion, to follow up the target segments’  benefiting from the insurance coverage, and to follow up the implementation of the national quality medical standards through the central council for the accreditation of health facilities. The General Secretariat has prepared the unified health insurance policy, followed up its implementation and compliance, and set the criteria for approving the costs of treatment and for following up the compliance and continuous improvement to serve the patient. It has also developed unified forms for claims, approvals and billing, follow-up and settling disputes among the parties of the insurance relationship. It has also worked to keep abreast with the changes and developments in the capacity and quality of medical coverage as well as developments in the health insurance market.

Al-Hussain said that these efforts come within the duties of the Council and its General Secretariat regarding the insured,  and they deepen the concept of ‘patients' rights’ through the achievement and development of specific and unified medical benefits for all the insured. Achieving this enables the Council to provide and organize health care for all private sector employees and their families, taking into account the concept of justice in terms of equality for all in the quality of specific medical coverage considered as the standard that cannot be compromised. At the same time, he pointed out to the attempt to improve the level of medical service, reduce the pressure on government health facilities, and strengthen the role of the private medical sector through competition to improve the service, since one of the most important functions of the health insurance system is to provide health care to beneficiaries of the system and their family members.

He stated that the Council's duty to prepare the executive bylaws that organize all health insurance activities and to regulate the relations of partners has also been dictated by the need to formulate a cooperative health insurance policy. This policy has reached the maximum benefit of up to five hundred thousand Saudi riyals during the year divided into various packages, where each package covers the cost of treatment and health care needed by the insured. Thus, the insured should not pay the health care provider specified by the insurance company. In addition, if the insured receives health care outside the network of accredited service providers, the insurance company must compensate him based on the allowance in accordance with the terms and conditions of the insurance policy within a period not exceeding 30 days from the date of the submission of the claim and at the prevailing prices.  
Al-Hussain referred to the advanced system of issuing the insurance policies which was adopted as one of the operational tools to activate the operation of the electronic portal as it is a guide for the use of the electronic system, which includes the instructions and procedures to be used as a guide and followed in each process of health insurance policies.