JEDDAH — A large private hospital has been referred to the Bureau of Investigation and Public Prosecution on suspicion of falsifying financial claims, and six health insurance companies have been suspended from issuing health insurance for violating the health insurance system, according to a senior Saudi health official.
Secretary General of the Council for Cooperative Health Insurance Muhammad Al-Hussein said that health insurance accounts for just over 51 percent of the SR30.48 billion Saudi insurance market.
The Council received 2,380 complaints in 2015 that consisted mostly of client’s not receiving basic benefits specified in the policy.
Al-Hussein said the health insurance sector was in continuous growth, where health insurance premiums rose to SR15.7 million, an increase of SR2.7 million, or 21.6 percent growth over the same period in 2013.
The number of insured individuals till October was approximately 11 million.
Al-Hussein said the maximum financial coverage of a health insurance policy is SR500,000.
“I would like to clarify that the cooperative health insurance policy offers packages of essential and necessary services for health care benefits,” he said.
He said Article 90 of the regulations requires insurance companies to respond within 60 minutes to the requests for approval. If a response is not made within 60 minutes, the request will be considered as approved.
Al-Hussein said 1,600,000 visitors to the Kingdom who will be covered by the compulsory health insurance. This excludes Haj and Umrah pilgrims as well as visitors to diplomatic missions, international organizations and the State.
He said that the Cooperative Health Insurance Council has adopted the Medical Policy for the visitors and their dependents covering a maximum of SR100,000 in medical treatment including expenses of emergency cases, medical examination, medication, inpatient services, pregnancy/childbirth, dental/gum diseases, endodontics, nerve treatment, removal of abscess, premature childbirth cases, emergency dialysis, medical evacuation within and outside the Kingdom, injuries from traffic accidents, and expenses of deportation of the insured deceased visitor’s body to his or her country.
