للذهاب الى النسخة العربية

 

Article 1:
This act aims to regulate the provision of health care for non-Saudi residents in the Kingdom. It may be applied to Saudi Citizens and others by a cabinet decree.

Article 2:
The coverage of cooperative health insurance shall include all those subject to this act and their dependents as specified in Para (B) Article 5.

Article 3:
With respect to the implementation phases specified in Para (B) Article 5, Article 12 and article 13 of this act, anyone sponsoring a resident shall be obliged to participate in the cooperative health insurance for the benefit of the resident.
Residence permit shall not be issued nor renewed without prior obtaining the cooperative health insurance policy. The period covering the residence permit (Iqama) must be equivalent to the policy period.

Article 4:

A council for health insurance shall be established and to be chaired by the Minister of Health and the membership of:

a. A representative -Deputy Minister level- nominated by each of the following ministries: the Ministry of Interior, the Ministry of Health, the Ministry of Labor & Social Affairs, the Ministry of Finance & National Economy and the Ministry of Commerce.
b. A representative for the Council of Saudi Chambers of Commerce & Industry nominated by the Minister of Commerce, and a representative for the cooperative insurance companies nominated by the Minister of Finance & National Economy in consultation with the Minister of Commerce.
c. A representative for the private health sector and two representatives for other governmental health sectors shall be nominated by the Minister of Health in coordination with their respective sectors.
The Council members shall be appointed by a cabinet decree for three years (renewable).

Article 5:
The health insurance council shall regulate the implementation of this act and in particular:

I. Preparing a draft of an executive bylaw for this act.
J. Issuing necessary decisions for regulating changing matters regarding the implementation of the rules governing this act, including implementation phases, the family members of the beneficiary to be covered by this insurance, the way and percentage of contribution by the beneficiary and the employer in the cooperative health insurance and the maximum limit for this amount based on actuarial and specialist study.
K. Qualifying the cooperative insurance companies to work in the field of the cooperative health insurance.
L. Accrediting the health institutions to provide cooperative health insurance services.
M. Determining the financial compensation for qualifying the cooperative health insurance companies to work in this field, and the financial compensation for the accreditation of health institutions to provide cooperative health insurance services, after consulting the ministry of finance and national economy.
N. Issuing the financial bylaws for the revenues and expenditure of the health insurance council, including employees salaries and remuneration after consulting the ministry of finance and national economy.
O. Issuing the internal bylaws of the council.
P. Appointing secretary general for the council based on a nomination by the minister of health, and formation of secretariat general and defining its duties.

Article 6:
The necessary expenses for the performance of the health insurance council covering its activities, salaries of employees and their remuneration shall be paid from the revenues collected as specified in Para (E) article (5) and as agreed upon between the Ministry of Health and the Ministry of Finance and National Economy.

Article 7:
The cooperative health insurance policy covers the following basic health services :

a. Medical examination, treatment in clinics and medication.
b. Preventive procedures such as vaccination, motherhood and childhood care.
c. Required laboratory and radiological examinations.
d. Inpatient care (Accommodation & treatment) including delivery and operations.
e. Treatment of teeth and periodental diseases excluding orthdontics and dentures.
These services shall not prejudice the requirements of the social insurance regulations nor with health services offered by private companies, institutions and individuals to their employees in excess of those provided by this act.

Article 8:
The employer may extend the scope of the cooperative health insurance services through at additional annexes at additional cost to include more curative and diagnostic services than what was specified in the previous article.

Article 9:
The preventive health procedures for those covered by the insurance including examinations, vaccination and in the period prior to issuance of the cooperative health insurance policy shall be made by a decree issued by the Minister of Health.

Article 10:
The employer shall bear the medical treatment costs if the beneficiary needs a medical treatment before the date of participation in the cooperative health insurance.

Article 11:

a. Governmental health facilities may -when needed- provide the health services included in the cooperative health insurance policy to the policy holder for a financial compensation to be borne by the health insurance company.
The health insurance council shall determine these facilities and the financial compensation for such services.
b. The minister of health in agreement with the minister of finance and national economy shall define procedures and rules for collecting the financial compensation stipulated in the previous paragraph.

Article 12:
The medical treatment of personnel working for government institutions and who are covered by this act as well as their family members shall take place in the governmental health facilities if they are directly contracted and sponsored by these institutions and when their contracts state their right for treatment.

Article 13:
The health insurance council may issue a decree exempting institutions and companies, which own a qualified private medical facilities from participating in the cooperative health insurance for the services offered by these facilities to their members.

Article 14:

a. If an employer fails to subscribe or pay the premiums of the cooperative health insurance for his employee covered together with his dependants in the cooperative health insurance policy, the employer shall be obliged to pay all premiums due, in addition to a financial fine not exceeding the annual contribution of each individual. He may also be deprived of the right to recruit expatriate permanently or temporarily.
In such case, the executive bylaws will determine the authority to whom due premiums shall be paid.
b. In case any of the cooperative insurance companies fails to fulfill its obligations as defined in the cooperative health insurance policy, it shall be obliged to fulfill its commitment and to compensate for its violations.
In addition to a fine not exceeding SR five thousand for each individual covered in the policy being the subject of such violation.
c. One committee or more shall be formed by a decree from the chairman of the health insurance council, and to be represented of the :

1. Ministry of interior
2. Ministry of labor and social affairs
3. Ministry of justice
4. Ministry of finance and national economy
5. Ministry of health
6. Ministry of Commerce

This committee shall be entrusted with the violations of this act and proposing appropriate penalty, this penalty shall be imposed by a decree from the chairman of the cooperative health insurance council. The executive bylaws shall define this committee.
Complaint of such decree may be submitted to the bureau of grievances within 60 days from notification.

Article 15:
T he non-Saudi resident not entitled by a sponsorship, shall take the place of the employer in fulfilling all obligations stated in this act.

Article 16:
The ministry of health shall be entrusted to monitor the quality assurance of the health services provided to the beneficiaries of the cooperative health insurance.

Article 17:
The cooperative health insurance shall be implemented by qualified Saudi cooperative insurance companies applying the cooperative insurance manner, similar to that stated for the national company for cooperative insurance, and in compliance with what is stated in the decree of the senior Olama board No. (51) dated 4.4.1497H.

Article 18:
The minister of health shall issue the executive bylaws for this act within a maximum period of one year from date of its issuance.

Article 19:
This act shall be published in the official gazette and shall be effective after 90 days from issuance of the executive bylaws. The rules related to the establishment of a health insurance council and to the scope of competence shall be effective from the date of publication of the act.

 

 

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Council Cooperative Health Insurance