Basic Health Insurance Policy

The Basic Health Insurance Policy is a document issued by the Council of Health Insurance (CHI) in the Kingdom of Saudi Arabia. It ensures comprehensive coverage and protection for beneficiaries, aiming to maintain their physical and mental health by promoting disease prevention and encouraging healthy lifestyle practices.

The Basic Health Insurance Policy strengthens the efforts of the CHI in maintaining public health in the Kingdom. The direct impact of the essential benefits package included in the policy ensures the efficiency and quality of services provided to beneficiaries. The General Secretariat of the Council regularly updates the benefits package, coverage limits, and the insurance drug formulary, while also developing and updating the implementing regulations and the unified policy to enhance the level of health insurance services provided to the insured and related entities.

There is no age limit for the insured as long as they are employed in the private sector, whether they are citizens or residents. Once the contractual relationship ends, the employer's obligation to provide health insurance for the employee and their family members also ends. For citizens, all healthcare services are provided free of charge by the state. Optional insurance programs are not subject to the Cooperative Health Insurance Law. The coverage also extends to family members according to the details specified in the policy.

The coverage provided by the Basic Health Insurance Policy contributes to enhancing the quality of life by ensuring physical and mental well-being through the updated essential health benefits package. The CHI focuses on promoting healthy lifestyles, improving clinical outcomes, and providing comprehensive disease prevention. The number of beneficiaries of private health insurance has exceeded eleven million, with eighteen new benefits added and ten benefits updated.

The CHI began implementing the Basic Health Insurance Policy in 2022. The policy includes additional benefits, and under no circumstances, and it is not permitted to issue a health insurance policy with benefits less than those specified in this document. The financial coverage limit under the active health insurance policy is set at SAR1 million, covering a package of benefits that includes all expenses related to medical consultations, diagnosis, treatment, medications, and hospitalization expenses, including surgeries and day-case procedures, according to the policy schedule.

The prices and quality of healthcare services are approved and monitored by the Ministry of Health. The relationship between health insurance companies and healthcare service providers is governed by Article (117) of Chapter Eight (Relationships Between Parties to the Insurance Contract) in the Implementing Regulations of the Health Insurance Law. This article stipulates that "health insurance companies and health insurance claims management companies are not permitted to own or operate facilities for the purpose of providing healthcare to insured individuals, and private healthcare facilities are not allowed to own health insurance companies".

In 2016, the CHI began implementing the Unified Health Insurance Policy for employers in four phases. The first phase targeted institutions with more than one hundred employees. The second phase, which followed, covered institutions with fifty to ninety-nine employees. The third phase began at the start of 2017 and addressed the situation of institutions with twenty-five to forty-nine employees. The final phase focused on institutions with fewer than twenty-five employees.