Saudi Gazette report

RIYADH — The Council of Health Insurance (Dhaman) announced on Tuesday that the state will no longer bear the treatment costs of COVID-19 patients in the private sector facilities. Dhaman notified this through a circular sent to all the approved healthcare service providers and the qualified health insurance companies in the Kingdom.

The Council also underlined the need to ensure completion of administering vaccination doses and as well as booster doses for all the people in the Kingdom in accordance with the directives of the Ministry of Health and the Public Health Authority (Weqaya).

The Council confirmed that the state will bear the costs to complete treatment of any of the coronavirus infected patients who were admitted before March 13 until they were transferred to hospitals under the Ministry of Health, with detailed medical reports in preparation for their transfer when beds are available there for them.

The circular also spelled out the procedures of dealing with patients who do not have eligibility for treatment or insurance coverage. Such patients shall obtain prior approval from the Health Insurance Program and obtain health services through the operating company.

The state will bear the costs of treating those patients, who have required hospitalization due to confirmed coronavirus cases with a positive result and needs oxygen due to suffering from severe pneumonia, until they are discharged from hospital.

The treatment expenses will also be met if the coronavirus inpatients need oxygen due to pneumonia until issuance of two confirmed negative results according to the approved protocol.

However the state will not bear the costs of medical tests in outpatient clinics for coronavirus symptoms except for cases that required hospitalization.

The circular also stressed that the limits for the state to meet the costs of treating inpatients will be on the basis of the daily packages in accordance with the price list approved by the Ministry of Health.

The amount that exceeds those packages is subject to individual evaluation for each case and that is with the prior approval of the Health Insurance Program and the purchase of health services from the insurance company.

Dhaman stated that the state does not bear the costs of testing or treatment of those who are previously admitted due to another illness and then infected with coronavirus, or those who reached emergency section due to other health reasons. The cases that reach emergency will be dealt with according to the rules for treating emergency cases.

The council noted that the circular was issued in light of the falling cases of coronavirus infection, as well as rates of severity and admission cases, coupled with an increase in the proportion of immunized persons, and lifting of most of the precautionary measures related to combating the virus.

The insurance companies shall have to cover all expenses resulting from suspected and confirmed cases of coronavirus infection for health insurance beneficiaries within the limits of medical insurance document.