RIYADH — The Council of Cooperative Health Insurance (CCHI) has approved a number of amendments to health insurance system that go into effect by the end of next month. Some of the major changes include a maximum ceiling of SR500,000 for a health policy coverage, permission for women employees to unconditionally include their husbands in their insurance policies and coverage of both expatriates and citizens, Al-Riyadh daily reported.
The insurance will cover all non-Saudi employees in the private sector, and expatriates who are neither public nor private sector employees. If the insured is a male employee, his wife or wives are included in the policy, as well as his under-25 male children and unmarried daughters.
Non-Saudi employees in the public sector and their families are exempted from insurance coverage except the husband of an insured woman. No insurance company can refuse an insurance policy as long it is in accordance with rules and regulations of the CCHI insurance system.
Insurance companies are required to have a contract with companies that have approved medical facilities to treat their insured employees there. Business owners are required to provide an insurance company with proof that an insured employee has left the country on an exit-only visa, has transferred sponsorship, or is dead, so the insurance company may void the policy. Insurance companies are required to issue insurance certificates, upon the request of an insured company, so it can be presented to the concerned bodies for the issuance or renewal of iqamas (residency permits). A business owner has the right to cancel an insurance policy if a letter is submitted 30 days prior to the cancellation date to the insurance company and copied to the CCHI. In such case, the company has the right to receive a partial compensation for the unused insurance period, and companies are required to return insurance cards to the insurance company, and sign a contract with another insurance company for health coverage to begin the day after the first insurance policy expires.
If an employee is transferred from one company to another, the latter company should insure the employee beginning the day of his transfer. Insurance policies will cover maternity and birth expenses, and children born from in vitro fertilization, but infertility, impotence, and in vitro fertilization expenses are exempted. Insurance coverage is limited to the network of medical services providers the insurance company has contracted with, but in emergency cases, the coverage includes medical providers that are outside the network.
A business owner is committed to providing health insurance to expatriates since the day of their arrival into the country, and should hand them their insurance cards within 10 days of their arrival.
Insurance companies should agree to insurance premiums with business owners, but should be in accordance with premiums in the insurance market. The premium should be technically justified, and should never be below the actual cost of the policy. A cooperative health insurance fund will be set up to cover expenses exceeding the insurance policy coverage.
Insurance companies may refuse insuring a certain company by submitting a letter to the CCHI explaining the reasons for such refusal. Insurance coverage will not be linked to the issuance of insurance cards, and an insurance policy will not be included in the automatic system of CCHI if the premiums are not justified. In addition, insurance companies are required to list the names of the insured, within 48 hours, in the electronic system of CCHI.
An insurance company will be disqualified if it is proven that it has issued an insurance policy without providing any true health services. The medical services providers include primary health care providers (first level), general hospitals (second level), and specialized hospitals (third level), in addition to complementary health providers such as one-day procedures, pharmacies, physical therapists and optics shops.
Service providers are to submit reports every three years explaining their commitment to quality provided, according to the CCHI requirements.
