revealed
The Consumer Protection Association announced an integrated package of rights and procedures regulating the relationship of beneficiaries with the Health Insurance Council, especially with regard to holders of premium residency, stressing that the executive rules and regulations guarantee comprehensive health coverage according to specific standards, and oblige insurance companies to comply with them without exception.
Insurance coverage rights for premium residency holders
The association explained that one of the most prominent rights enjoyed by the holder of premium residency is the ability to request insurance coverage for those linked to his record, even if they are not family members, in accordance with what is stipulated in the executive regulations of the cooperative health insurance system
The association stressed that Insurance companies do not have the right to reject any application for insurance coverage as long as the application meets the conditions and is compatible with the system and its executive regulations, in a clear affirmation of protecting the rights of consumers and preventing any arbitrary practices that may limit their access to health services.
It stressed that the health insurance policy of the premium residency holder must be compatible – at a minimum – with the benefits of the basic health insurance document, ensuring the provision of the minimum approved health care.
On the other hand, linked insurance policies are not considered In emergency cases or documents of visitors or pilgrims, an alternative to Basic health insurance documentrequired.
Requirements for issuing and renewing the insurance policy
With regard to regulatory procedures, the association clarified that the applicant for premium residency must, after being informed of approval, submit a compatible health insurance document within a period not exceeding 30 days from the date of approval. The policy is required to be issued by insurance companies within the Kingdom, and must include an approved coverage network for health care providers.
The insurance policy is required to remain valid throughout the duration of premium residency, with the need to renew it in the event of extension of residency, in addition to ensuring that there is insurance coverage for all Those linked to the residency holder’s record.
The association indicated that the employer’s insurance may be considered sufficient if it is valid and compatible with the basic document, provided that the duration of coverage is not less than six months, especially if the applicant works within the Kingdom during the period of processing the residency application.
The scope of health benefits to the consumer
In a related context, the association reviewed the details of the health benefits that the consumer is entitled to receive within the health insurance policy, stressing that they include comprehensive coverage for the expenses of medical examination, diagnosis, treatment, and medications, according to what is specified in the unified policy schedule.
The coverage extends to include the costs of hospitalization, including surgeries and one-day surgeries, as well as pregnancy and childbirth services, within the framework of ensuring integrated health care for the insured.
The rights also include treatment of dental and gum diseases, With coverage of dental cleaning once during the policy period, in addition to preventive services such as seasonal vaccinations and maternity and child care, according to the instructions of the Ministry of Health.
Advanced and comprehensive medical coverage
The association confirmed that the coverage is not limited to basic services, but also includes treatment of psychological conditions, whether acute or non-acute, in addition to infectious diseases that require isolation, Alzheimer’s cases, and acquired heart valve diseases.
The document includes important national programs such as early screening of newborns, programs for detecting hearing impairment and congenital heart defects, in addition to autism treatment services according to specific controls.
The benefits also include coverage of organ and bone marrow transplants, prosthetic limbs, and treatment. Alternative medicine, treatment of skin diseases such as psoriasis and acne, in addition to covering disability cases
With regard to family care, the association explained that the policy covers the costs of infant formula for infants in medical need up to the age of 24 months, according to specific controls, and also includes immunization programs for children’s respiratory viruses.
The coverage provides accompanying services for the patient inside the hospital in specific cases, such as a mother accompanying her child, while bearing some of the costs associated with that, with the exception of accommodation and food for one companion.
