The Health Insurance Council is preparing to launch the benefits package, updated insurance coverage limits, and insurance drug guide, starting next October.
The benefits package includes adding 18 new benefits to the health insurance policy and making improvements to 10 other benefits, so that work will start on the renewed and issued policies from October 1, 2022.
The official spokesman for the Health Insurance Council, Nasser Al-Juhani, confirmed that a number of updated benefits have been added related to exploratory preventive examinations, vaccinations, and a focus on women’s health, obese operations and kidney transplantation, and mental health coverage was raised to 50,000 instead of 15,000 for acute and chronic cases, and the value of Hemodialysis coverage and other benefits.
The document aims at 7 main objectives, namely, the prevention of beneficiaries, health promotion, reduction of complications of disease, improvement of capacity and functions of beneficiaries, facilitating access to the service category, empowering beneficiaries, and enhancing service quality and efficiency.
He explained that the entry into force of the updates will be from October 1, to apply to private health insurance policies issued or renewed on this date and beyond.
Maximum benefit for a person
The document specified a maximum of one million riyals for the benefit of each person for the year of the policy, provided that small and medium enterprises are supported for more than 500 thousand from the guarantee fund program.
emergency treatment services
With regard to emergency treatment services, no percentage of the emergency medical treatment required by the beneficiary’s condition is deducted following the occurrence of an event, accident, or emergency health condition that requires rapid medical intervention, according to the levels of urgent medical care, which includes resuscitation, emergency and the urgent situation that may lead to To the loss of life or one or more organs in the body, or the occurrence of a permanent or permanent disability.
Outpatient clinics
Regarding the expenses of treatment in outpatient clinics, the beneficiary is obliged to pay the deductible, and it includes all the advice that the doctor does, and the required laboratory tests, x-rays and any treatment supplies, as well as a follow-up visit and referral for the same ailment and not for each procedure separately, with the exception of medicines.
The beneficiary who visits primary care clinics, which includes family and general medicine, pediatrics, general internal medicine, obstetrics and gynecology and others, pays a rate of 0-5% with a maximum of 25 riyals, provided that the primary care clinic is approved by the Council.
He bears 0-10% during a visit to specialized clinics following obtaining a referral from the primary care or emergency clinics, with a maximum of 75 riyals, while he bears 0-50% when visiting them without obtaining a referral from the primary care clinics, with a maximum of 500 riyals.
pharmaceutical
In the event that the generic drug and non-prescription drugs are available, the beneficiary shall bear 20%, provided that the maximum contribution to the payment is 30 riyals, while the beneficiary shall bear in the case of innovative treatment and the absence of a generic alternative 0-50%, provided that the maximum payment is determined by agreement between the owner Work and insurance company.
Benefits covered by the policy:
The document specifies the costs of a common room with a maximum of 500 riyals per day, while the daily accommodation and subsistence limit for utilities is 150 riyals per day in the common room.
With regard to the expenses of pregnancy and childbirth, the costs of covering them are on the mother’s document and a maximum of 30 days from the date of birth until they are added to the document with a retroactive effect from its date, and their expenses will be a maximum of 15,000 riyals during the period of the document, and pregnancy complications and births are covered with the maximum benefit of the document.
The costs of newborns are covered on the mother’s document up to a maximum of 30 days from the date of birth until they are added to the document with a retroactive effect from its date. It also includes the birth and treatment of premature babies, up to the maximum benefit of the policy.
The document covers the costs of dental treatment, at a maximum of 1200 riyals for basic and preventive dentistry, without a deductible during the policy period, while it covers emergency cases and root canal treatment up to 800 riyals, with a 20% incurred during the policy period.
As for eyeglasses, the policy includes the costs of a maximum of 400 riyals for those aged 14 and under during the policy, as well as the costs of interventions to correct functional vision, at the maximum limit of the policy.
It also includes the costs of dialysis with a maximum of 180,000 riyals, the costs of kidney transplantation with a maximum of 250 thousand riyals, the costs of treating psychological conditions with a maximum of 50,000 riyals, returning the body of the deceased to its original home with a maximum of 10,000 riyals, and the costs of hearing aids with a maximum of 6,000 riyals. And the costs of cases of damage to the heart valves, with a maximum of 150 thousand riyals, and conducting an organ donation process with a maximum of 50 thousand riyals, the costs of Alzheimer’s disease, with a maximum of 15 thousand riyals, and the costs of autism cases with a maximum of 50 thousand riyals.
The document included the costs of the national program for early examination of newborns to reduce disability to a maximum of 100 thousand riyals, the costs of disability cases to a maximum of 100 thousand riyals, the costs of covering obesity surgery operations with a maximum of 15 thousand riyals, the tolerance ratio 0-20% and the maximum payment of 1000 SR, in addition to the costs of male circumcision cases of a maximum of 500 riyals, contraceptives of a maximum of 1500 riyals, and complications resulting from the treatment of a benefit covered by the policy.
Cases not covered by the document:
And outside the framework of the benefits of the policy, complications resulting from a deliberate injury caused by a person to himself, diseases arising from the intentional misuse of certain medicines, stimulants or sedatives, non-reconstructive plastic surgery, comprehensive examinations, vaccinations or drugs that do not require medical treatment.
It also does not include the treatment that the insured person receives free of charge, recuperation and general physical health programs, all dental implant costs, or an injury that arises as a direct result of the insured’s profession, the procedure for correcting vision for eye diseases that do not lead to blindness, and the expenses of the person’s transportation within the Kingdom by means other than Licensed ground ambulance.
The policy does not cover hair loss, allergy tests, cases of congenital malformation, except for those that pose a current or future threat to the life of the insured, any costs during hospitalization and hospital stay other than accommodation and subsistence, acne treatment, human organ transplantation, joint replacement, and personal risks, Medicines and means of alternative medicine, prosthetics and assistance, diseases classified as epidemics or pandemics by the Ministry of Health, eyeglasses for those over 14 years of age, complications resulting from any disease or injury excluded under the provisions of the document, long-term care, and hypnosis for rehabilitative treatment of alcohol or drug abuse.
Cases of transferring the body to the original country that are not covered by the document:
The document states that health benefits or repatriation of the body will not be covered in cases of war, invasion, acts of foreign aggression, ionizing radiation or radioactivity contamination from any nuclear fuel or nuclear waste, radioactive, toxic or explosive properties, or the practice of the insured person Or his participation in the service of the armed forces or the police or their operations, or riots, strikes, terrorism, accidents, or chemical, biological or bacteriological interactions.
Infant formula coverage cases:
The document covers the milk of infants in cases of metabolic diseases, diseases of the National Program for Early Newborn Screening to reduce disability, milk or sugar sensitivity, absorption problems, premature or underdeveloped child or excessive weight for gestational age, and independence diseases.
