Cooperative Health Insurance Law

Article 1

  • This Law aims to provide and regulate healthcare for non-Saudi residents in the Kingdom; it may, pursuant to a resolution by the Council of Ministers, be applied to Saudi citizens and others.

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Article 2

  • Cooperative health insurance coverage shall include all persons subject to this Law and their family members in accordance with Article 5(b).

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Article 3

  • Subject to the phases of implementation provided for in Article 5(b) and the provisions of Articles 12 and 13 of this Law, the sponsor of a resident must register said resident in cooperative health insurance.

  • A residency permit shall not be granted or renewed unless a cooperative health insurance policy is obtained, provided that the policy covers the term of the permit.

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Article 4

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  • The Council of Health Insurance shall be formed; it shall be chaired by the Minister of Health and comprise the following members:

    • a) A representative at the rank of "Deputy Minister", or its equivalent, of each of the following: the Ministry of Health, the Ministry of Labor and Social Development, the Ministry of Finance, the Ministry of Commerce and Investment, and the National Information Center. Such representatives shall be nominated by their respective entities.

    • b) A representative of the Council of Saudi Chambers of Commerce and Industry to be nominated by the Minister of Commerce and Investment and a representative of cooperative insurance companies to be nominated by the Minister of Finance in coordination with the Minister of Commerce and Investment.

    • c) A representative of the private health sector, and two representatives of the other government health sectors, to be nominated by the Minister of Health in coordination with their respective sectors.

  • Appointment of council members referred to in paragraphs (b) and (c) of this Article shall be pursuant to an order by the President of the Council of Ministers. The term of membership for council members shall be for a term of three years, renewable once".

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Article 5

  • The Council of Health Insurance shall supervise the implementation of this Law and shall, in particular, be responsible for the following:

    • a) Preparing the draft implementing regulations of this Law.

    • b) Issuing the decisions necessary to regulate any changes relating to the application of this Law including determining its implementation phases; specifying the beneficiary’s family members who are covered by the insurance; determining the percentage of the cooperative health insurance subscription to be paid by the beneficiary and by the employer and specifying the manner therefor; and determining the upper limit for such subscription based on a specialized study of insurance accounts.

    • c) Qualifying cooperative insurance companies to operate in the field of cooperative health insurance.

    • d) Accrediting health facilities which provide cooperative health insurance services.

    • e) Determining the fees for qualifying cooperative insurance companies to operate in this field and the fees for accrediting health facilities which provide cooperative health insurance services, upon consultation with the Ministry of Finance and National Economy.

    • f) Issuing the financial regulations for the revenues and expenditures of the Council of Health Insurance, including the wages and remuneration of its employees, upon consultation with the Ministry of Finance and National Economy.

    • g) Issuing the internal regulations governing the work procedures of the Council.

    • h) Assigning a secretary general for the Council upon the nomination of the Minister of Health, and forming a general secretariat and determining the tasks thereof.

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Article 6

  • The expenses necessary for the Council of Health Insurance to carry out its duties and pay the wages and remuneration of its employees shall be dispensed from the revenues collected as specified in Article 5(e), in accordance with the agreement between the Ministry of Health and the Ministry of Finance and National Economy.

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Article 7

  • The cooperative health insurance policy shall cover the following basic health services:

    • a) Medical examinations, outpatient treatment, and medications.

    • b) Preventive measures, such as vaccinations and maternal and child care.

    • c) Laboratory and radiological tests, as necessary.

    • d) Hospitalization and inpatient treatment, including delivery and operations.

    • e) Treatment of dental and periodontal diseases, excluding orthodontics and dentures.

  • These services, however, shall not prejudice the provisions of the Social Insurance Law nor the health services provided by individuals and private companies and establishments for their employees if such services are more comprehensive than the services provided for in this Law.

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Article 8

  • The employer may, using an addendum and for an additional cost, expand the scope of the services of cooperative health insurance to include other diagnostic and treatment services not provided for in the previous Article.

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Article 9

  • Matters relating to preventive health measures for those covered by insurance, including examinations and vaccinations during the period which precedes the issuance of the cooperative health insurance policy, shall be arranged pursuant to a decision by the Minister of Health.

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Article 10

  • The employer shall bear the cost of treatment of the insurance beneficiary during the period between the date of the need for treatment and the date of subscribing to cooperative health insurance.

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