2/7/2018
Health Insurance denies determining an age limit for the insured

 

The official spokesman of the Council of Cooperative Health Insurance (CCHI), Yaser Almaarek, confirmed that the mandatory unified health insurance policy currently in force covers all ages of any current target group and there is no age limit for the insured, whether Saudi or non-Saudi, as long as he is a private sector employee. However, after the expiration of the contractual capacity by retirement or otherwise, the employer shall not be liable for providing health insurance services for the employees and their family members while KSA, may Allah protect it, shall be liable for providing all health care services free of charge to Saudi employees in accordance with the ruling law. Optional insurance programs are not subject to the Cooperative Health Insurance Law and no regulating entity can impose any option as long as it is not obligated by Law.

He pointed out that the new unified policy will come into force next month as of 01/07/2018, but the policies concluded before the date of entry into force of the new policy will subject to the previous unified policy until the expiry of those policies. Moreover, the insurance companies are not entitled to cancel health insurance policies before their expiry date and re-issue the same policies before the first of next July, except in cases specified by the law.

Almaarek explained that the new policy includes additional benefits, such as: treatment of dental and periodontal diseases, including costs of one-time dental cleaning during the policy period, respiratory syncytial virus (RSV) vaccines for children, coverage of early screening of hearing impairment program ram, program of critical congenital heart defects (critical CHDs) for all births, surgical treatment of super super morbid obesity by sleeve gastrectomy only (Sleeve) for insured with a body mass index (BMI) of 45 kg/m2, treatment of severe and non-severe psychological disorders, treatment of pathological conditions requiring hospital isolation determined by the Ministry of Health, treatment of psoriasis and costs of infant formula for infants in need of formula for medical reasons up to the age of 24 months pursuant to the regulations, including cases, such as: metabolic disorders, diseases included in National Newborn Screening Program to reduce disability, milk and sugar allergy, malabsorption, and premature, small for gestational age (SGA) or very low birth weight (VLBW) infants, who need calorie or growth boosters besides breast milk according to the regulations in order to include the benefit of infant formula milk within the benefits set out in the policy schedule.

He indicated that the financial coverage limits of the health insurance policy in force is (SAR 500,000) five thousand Riyals, which covers a package of benefits including all expenses of medical examination, diagnosis, treatment and medication, and expenses of hospitalization, including surgeries or one-day surgery or treatment as detailed in the policy schedule, considering that law does not, in no case, permit the issuance of a health insurance policy with less benefits than those stated in the policy.

Almaarek said that insurance companies determine the insurance premium based on technical grounds defined by the actuarial expert, including several factors, such as medical history, age, risk ratio and insurance category, through which the value of these premiums is determined, taking into consideration the previous results, and approved by the Saudi Arabian Monetary Authority (SAMA). Meanwhile, the prices and quality of health services are approved and monitored by the Ministry of Health, emphasizing that CCHI stands equidistantly from neutrality with health insurance companies and health care service providers. He also pointed out that Article (117) of Chapter Eight (Relations among the Parties to the Insurance Relationship) of the implementing regulations of the Health Insurance Law provided that: “Insurance companies and health insurance claim management companies shall not be allowed to own or operate facilities for the purpose of health care of the insured nor shall private health facilities be allowed to own health insurance companies.”

He added that CCHI Secretariat General has regularly developed and updated the implementing regulations and the unified policy, at least for three years, to raise the level of health insurance services for the insured and relevant parties, stating that CCHI and its partners thoroughly studied all feedbacks and suggestions received by the Secretariat General on the previous policy from all relevant and competent parties before the inclusion of these additions and updates.

Almaarek also called upon the insured to be aware of their insurance rights by having cognizance of the Cooperative Health Insurance Law, the implementing regulations and the new unified policy through visiting the website, www.cchi.gov.sa. In addition to this, he recommended that the insured benefits from the communication channels for responding to all inquiries and receiving feedback, suggestions and complaints through one of the following channels: unified # 920001177, e-mail: info@cchi.gov.sa, smart phone applications, or CCHI official webpages cchi.ksa on social media channels (Twitter, Facebook and LinkedIn).

Last Update : 8/7/2018 7:20 PM