The Council of Cooperative Health Insurance (CCHI) issued a circular on 30 January 2014 addressed to all health insurance companies providing that a new Cooperative Health Insurance Policy will come into effect in 2018. The 2018 Cooperative Health Insurance Policy will replace the Cooperative Health Insurance Policy issued in 2014. This article will outline the way this policy will be implemented.

  1. The 2018 Cooperative Health Insurance Policy shall apply to new or renewed health insurance policies starting from 01-07-2018
  2. Policies concluded before 01-07-2018 will continue under the 2014 Cooperative Health insurance Policy until their expiry date
  3. Insurance companies are not entitled to cancel health insurance policies before their expiry date and reissue the same policies before 1-7-2018, except in the situations specified by the law
  4. The 2018 Cooperative Health Insurance Policy shall apply to all health insurance policies as of 01-07-2019, the 2014 Cooperative Health insurance Policy will not be accepted.

The 2018 Cooperative Health Insurance Policy includes additional compulsory benefits. The maximum limits of the 2018 Cooperative Health Insurance Policy is SAR 500,000 (no increase from 2014) the policy covers a package of benefits including expenses of medical examination, diagnosis, treatment and medicines, and expenses of surgery and one-day surgery or treatment as detailed in the policy schedule. The new benefits introduced in the 2018 Cooperative Health Insurance Policy include:

  • Treatment of dental and gums diseases including one-time dental cleaning costs;

  • RSV vaccination for children, coverage of early hearing impairment program in early childhood;

  • New-born program for critical congenital heart disease;

  • Coverage of Sleeve gastrectomy surgeries for beneficiaries with 45 BMI up to a maximum of SAR 20,000;

  • Treatment of Serious and non-serious psychological disorders up to a maximum of SAR 15,000 for serious psychological issues including SAR 5000 for non-serious disorders for 4 sessions with medications;

  • Treatment of conditions requiring hospital isolation, and psoriasis treatment;

  • The cost of infant formula for infants in need of formula for medical reasons up to the age of 24 months;

  • The limits on autism care have increased from SAR 15,000 to SAR 50,000;

  • Impairments costs have been introduced alongside disability costs with an aggregate limit of SAR 100,000.

The Secretary-General of the CCHI Mohammed bin Suleiman al-Hussein has warned the market that under no circumstances should any health insurance companies issue policies from 1 July 2018 with benefits lower than those mandated in the 2018 Cooperative Health Insurance Policy. It is advisable for all health insurance companies to review their health insurance policies in time to ensure policies will reflect the new benefits from 1 July 2018 and to avoid any ambiguity in this regard.