Medical Insurance Document for Private Sector Employees

Medical Insurance Document for Private Sector Employees

The Saudi regulator is keen to protect the rights of workers within the Kingdom and impose obligations and controls on employers to provide a healthy and suitable environment for work. Health care is considered one of the worker’s rights guaranteed in the Saudi system in accordance with the provisions of the Health Insurance Council system and its executive regulations.

The system specifies the limits of insurance coverage, the categories covered by medical insurance, and the obligations of the employer and employee.

What is the health insurance system in Saudi Arabia?

It is the provision and organization of necessary health care for residents and citizens in Saudi Arabia who benefit from medical insurance services in accordance with specific controls and procedures.

Insurance services are provided by accredited medical insurance companies such as the Cooperative Medical Insurance Company.

What health services are covered by a medical insurance document?

The medical insurance policy covers the following basic health services:

• Medical examination, treatment in clinics and medications.
• Preventive measures such as vaccinations and maternal and child care.
• Laboratory and radiological examinations depending on the type of condition.
• Hospital accommodation and treatment such as operations and childbirth.
• Treating dental and gum diseases.

Is health insurance mandatory in Saudi Arabia?

Is health insurance mandatory in Saudi Arabia?

Medical insurance is one of the most important obligations that an employer has in order to provide health care to his workers.

Employer obligations

Providing medical insurance for the worker, all his employees, and their family members.
Paying the installment agreed upon with the insurance company. In the event of non-payment, the employer is obligated to provide health care to his employees until an alternative is found.
Providing the insurance company with basic employee data.
Medical insurance for institutions that own medical facilities is subject to the compulsory health insurance system, as approved medical insurance companies must be contracted to provide health care to their workers.

Worker’s obligations

The worker is obligated to provide correct and non-misleading data when filling out the medical disclosure form.
Notifying the employer or insurance company of any update regarding his family members covered by insurance coverage.
The worker must inform the employer in order to add a new baby to him in an insurance document independent of the mother within a maximum period of 30 days after the date of birth of the baby.
Pay the liability percentage amount as agreed upon in the insurance policy.
Medical insurance policy for private sector workers

Is medical insurance mandatory for Saudis?

The Health Insurance Regulations specify the categories covered by medical insurance, which are:

• Non-Saudi workers in the private sector.
• Family members supported by a foreign worker and who have valid residency within the Kingdom.
• All Saudis working in the private sector.
• Family members of a Saudi worker are as follows:
• If the worker is a man, medical insurance covers his wife, unmarried daughters, and male children under the age of 25.
• If the worker is a married woman, medical insurance includes her husband if he is not an employee, a government or private employee who is not subject to compulsory health insurance, her unmarried daughters and male children who are not over 25 years old.
• Orphans held by families benefiting from institutional medical insurance.

How much are health insurance fees in Saudi Arabia?

Medical insurance prices in Saudi Arabia vary and vary due to several factors, including:

• Package type and insurance company: Package prices vary depending on the type of package offered, as the gold package is more expensive than the silver package, and medical insurance prices for cooperative individuals are also different from the prices of other insurance companies.
• Age group: As the worker’s age increases, the cost of medical insurance increases.
• Coverage level: Insurance coverage may cover all treatment costs, or it may cover half, with the worker bearing the other part.
• Medical insurance provider: Prices vary between service providers depending on the quality and variety of service.

How to inquire about medical insurance?

A worker benefiting from medical insurance services can inquire about insurance information through the Health Insurance Council website and follow the following steps:

• Log in to “Insurance Information Inquiry Service“
• Enter your national ID number or residence number.
• Enter the verification code and then click on the search icon.
• Consent to the processing and sharing of your personal data with the Saudi Council.
• The beneficiary can view his insurance details.

It is important to appoint a lawyer specialized in insurance disputes from the Binah application to review the details of insurance coverage, the type of insurance, and cases of insurance refusal to bear treatment costs.

A specialized lawyer from Abdul Majeed Al Rashid Law Firm and Legal Consultations provides a variety of legal services, including case study and analysis, reviewing medical insurance policies and providing legal advice on them, drafting legal memoranda and defenses, representing clients before insurance dispute committees and competent judicial authorities, attending court hearings on behalf of clients, and other services.

Lawyer Abdul Majeed Al Rashid’s office brings together licensed lawyers in one place…