Statute of the National Health Insurance Center

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  • The Council of Ministers

  • Having reviewed the correspondence received from the Royal Court No. 24447 dated 3/5/1442 AH, including the telegram from the Ministry of Health No. 1247539-1439 dated 26/6/1439 AH, regarding the detailed documents necessary for the privatization of the health sector, the draft Articles of Association of the Health Holding Company, and the draft regulation of the National Health Insurance Center.

  • Having reviewed the draft Articles of Association and the regulation referred to.

  • Having reviewed Royal Order No. (52631) dated 15/11/1438 AH.

  • Having reviewed the Health Law issued by Royal Decree No. (M/11) dated 23/3/1423 AH, and its amendments.

  • Having reviewed the Companies Law issued by Royal Decree No. (M/3) dated 28/1/1437 AH, and its amendments.

  • Having reviewed the Privatization Law issued by Royal Decree No. (M/63) dated 5/8/1442 AH.

  • Having reviewed the amended rules of work for the supervisory committees of the sectors targeted for privatization and their tasks, issued by Council of Ministers Decision No. (55) dated 20/1/1442 AH.

  • Having reviewed the rules and arrangements regarding the treatment of employees and workers in the sectors targeted for transformation and privatization, issued by Council of Ministers Decision No. (616) dated 20/10/1442 AH.

  • Having reviewed Council of Ministers Decision No. (27) dated 26/1/1421 AH, amended by Council of Ministers Decision No. (66) dated 23/1/1443 AH.

  • Having reviewed the two Royal Orders No. (46708) dated 12/10/1438 AH, and No. (27997) dated 22/5/1440 AH.

  • Having reviewed the minutes No. (290) dated 15/2/1440 AH, and No. (929) dated 10/7/1441 AH, and memoranda No. (1129) dated 20/8/1439 AH, No. (712) dated 23/4/1440 AH, No. (983) dated 2/6/1440 AH, No. (747) dated 21/9/1441 AH, No. (1164) dated 20/12/1441 AH, No. (1275) dated 5/8/1442 AH, No. (1578) dated 10/9/1442 AH, No. (1326) dated 13/6/1443 AH, prepared by the Bureau of Experts at the Council of Ministers.

  • Having reviewed the recommendation prepared by the Council of Economic and Development Affairs No. (4-28/43/D) dated 24/6/1443 AH.

  • Having reviewed the recommendation of the General Committee of the Council of Ministers No. (7133) dated 12/8/1443 AH.

  • Decides the following:

    • First: 1- Approval of the license to establish the Health Holding Company, in accordance with its attached Articles of Association.
    • 2- Approval of the provisions contained in Articles: (Third), (Tenth), (Fourteenth), (Sixteenth), (Twenty-ninth), (Thirty-fourth), (Thirty-fifth), and paragraph (2) of Article (Thirty-third) of the Articles of Association of the Health Holding Company.
    • Second: The Supervisory Committee for Privatization in the Health Sector shall be the Founding Assembly of the Health Holding Company.
    • Third: The primary and additional members of the Supervisory Committee for Privatization in the Health Sector – within their competencies – or those they delegate – in matters related to the Health Holding Company – shall represent the owner’s share (the State) in this company and exercise its powers and the powers of the shareholders’ assemblies.
    • Fourth: The ordinary general assembly meeting of the Health Holding Company shall not be valid unless the Supervisory Committee for Privatization in the Health Sector attends with all its representatives from the primary and additional members – within their competencies – or those they delegate – in matters related to the Health Holding Company. The extraordinary general assembly meeting of the company shall not be valid unless the Supervisory Committee for Privatization in the Health Sector attends with all its representatives from the primary and additional members – within their competencies. In case of non-attendance as stated above, a second meeting shall be convened within thirty (30) days following the date of the previous meeting, and the committee’s decisions shall be issued unanimously.
    • Fifth: Exemption of the Minister of Health from the provision of paragraph (1) of Council of Ministers Decision No. (27) dated 26/1/1421 AH, regarding his chairmanship of the first Board of Directors of the Health Holding Company, and directing the Supervisory Committee for Privatization in the Health Sector (the Founding Assembly) to act accordingly when appointing the first Board of Directors pursuant to its powers granted under Article (Twelve) of the company’s Articles of Association.
    • Sixth: Employees and workers related to providing healthcare services at all levels – affiliated with the Ministry of Health – shall be transferred to the Health Holding Company or any of its subsidiaries, in accordance with the rules and arrangements regarding the treatment of employees and workers in the sectors targeted for transformation and privatization, issued by Council of Ministers Decision No. (616) dated 20/10/1442 AH.
    • Seventh: The Ministry of Health shall be the regulatory and supervisory authority over public and private health institutions, in accordance with the provisions of paragraph (First) of Royal Order No. (27997) dated 22/5/1440 AH, and any subsequent provisions issued in this regard. The Ministry shall continue to provide healthcare services at all levels until they are fully transferred to the Health Holding Company or any of its subsidiaries.
    • Eighth: The Ministry of Health shall continue, with respect to state real estate allocated to it, to exercise its role related to these properties in accordance with the applicable laws and regulations.
    • Ninth: The Health Holding Company and its subsidiaries shall commit to applying the modern healthcare model, according to the requirements determined by the Ministry of Health.
    • Tenth: 1- Approval of the regulation of the National Health Insurance Center, in the attached form.
    • 2- Delegation of the Supervisory Committee for Privatization in the Health Sector to exercise the powers of the Board of Directors of the National Health Insurance Center as stipulated in its regulation referred to in paragraph (1) of this clause, until the Board of Directors of the Center is formed. Decisions made accordingly shall be presented to the Board at its first meeting after formation for information.
    • Eleventh: 1- The National Health Insurance Center shall purchase health services provided by the Health Holding Company and any of its subsidiaries, in accordance with the controls and mechanisms stipulated in the Center’s regulation referred to in paragraph (1) of clause (Tenth) of this decision.
    • 2- The amounts allocated in the Ministry of Health’s budget for providing all levels of healthcare services shall be transferred to the National Health Insurance Center, according to the plan, phases, and mechanism determined by the Supervisory Committee for Privatization in the Health Sector, with its decisions in this regard issued unanimously by the primary and additional members within their competencies. The budget allocated for currently approved capital projects of the Ministry of Health shall continue to be disbursed according to current arrangements.
    • 3- The National Health Insurance Center shall submit the comprehensive health insurance concept for citizens – in accordance with the provisions of the Center’s regulation referred to in paragraph (1) of clause (Tenth) of this decision – and its implementation mechanisms to the Strategic Committee at the Council of Economic and Development Affairs for approval before commencing the implementation of health insurance for citizens, including the provisions of paragraphs (1) and (2) of this clause.
    • 4- Without prejudice to the provisions of paragraph (3) of this clause, the Supervisory Committee for Privatization in the Health Sector – after agreement with the Ministry of Finance – shall set the interim arrangements for financing the provision of healthcare services by the Health Holding Company or any of its subsidiaries until the implementation of health insurance for citizens.
    • Twelfth: 1- The Health Holding Company shall establish health clusters in the form of independent companies known as (Health Cluster Companies) to provide health services. The Health Holding Company may establish other subsidiaries in accordance with its Articles of Association.
    • 2- The Health Holding Company shall continue to perform activities related to providing healthcare services through health clusters in various regions of the Kingdom until all related activities, assets, and rights are transferred to the health cluster companies. Subsequently, the necessary procedures shall be taken to dissolve the Health Holding Company whose services, assets, and rights have been transferred to the health cluster companies.
    • Thirteenth: The foregoing provisions shall not impose any additional financial burden or obligation on the State beyond what is allocated to the Ministry of Health in the general state budget.
    • Fourteenth: The Minister of Health, Chairman of the Supervisory Committee for Privatization in the Health Sector, shall submit a detailed (semi-annual) report to the Council of Economic and Development Affairs including the progress made in implementing the provisions of this decision.
    • Fifteenth: The Ministry of Health shall review all regulatory texts related to its competencies, propose amendments consistent with the provisions of this decision, and submit the outcomes to complete the necessary regulatory procedures in this regard.

  • Prime Minister

Article 1

  • The following words and phrases wherever they appear in this Statute shall have the meanings indicated opposite each of them:

    • Center: National Health Insurance Center.
    • Statute: Statute of the Center.
    • Council: Board of Directors of the Center.
    • Minister: Minister of Health.
    • Ministry: Ministry of Health.
    • President: Chairman of the Board.
    • Chief Executive Officer: Chief Executive Officer of the Center.
    • Healthcare: Services and benefits related to health promotion, preventive, therapeutic, and rehabilitative care, concerned with the health of the individual and society at primary, secondary, and specialized levels.
    • Healthcare Coverage: Health services and benefits, usage and selection criteria related to those services and benefits and their various levels, and the rights and obligations of the beneficiary, as specified in the Healthcare Coverage Regulation.
    • Healthcare Coverage Document: A document issued by the Center - in accordance with the Healthcare Coverage Regulation - that includes a statement of the healthcare coverage for the beneficiary, and their rights and obligations.
    • Accredited Health Institutions: Institutions providing healthcare services or related products, which are accredited by the Center pursuant to a regulation issued by the Council.
    • Beneficiary or Beneficiaries: Any individual from the categories stipulated in Article (Four) of the Statute.

Article 2

  • 1- A center called the (National Health Insurance Center) shall be established under the Statute, organizationally affiliated with the Minister, and shall have legal personality, financial and administrative independence.

2- The center's headquarters shall be in Riyadh, and it may establish branches or other offices within the Kingdom as needed.

3- The center may solely establish subsidiary companies, and it may participate - in any manner - with Saudi and foreign companies, institutions, or other entities in establishing other companies, or purchasing shares or stakes in existing companies to engage in activities complementary or similar to its activities, or that may assist it in achieving its objectives and exercising its jurisdiction.

Article 3

  • 1- The center aims to purchase healthcare - and everything related to it - from accredited healthcare institutions, ensuring the following:

    • A- Providing healthcare institutions with the provision of healthcare to beneficiaries with high quality and efficiency.
    • B- Supporting the health system's response to the community's health needs.
    • C- Controlling healthcare costs, enhancing competitiveness and transparency, ensuring financial sustainability and fair distribution of resources.

  • 2- The center, in order to achieve its objectives, shall use the best foundations, standards, and financial and commercial practices, and enjoys the flexibility and powers that enable it to carry out its tasks and achieve its objectives.

Article 4

  • The following categories benefit from services related to the center's objectives:

    • 1- All citizens entitled to healthcare - in accordance with the relevant laws and decisions - if they are not covered by other healthcare systems, programs, or special services provided to them by entities other than the Ministry.
    • 2- Citizens covered by other healthcare systems, programs, or special services provided to them by entities other than the Ministry, in accordance with what is approved by the Council of Ministers based on a proposal submitted by the Ministry, the Ministry of Finance, and those entities.
    • 3- Saudis working in the public and private sectors, their family members, children of a Saudi mother and a non-Saudi father residing in the Kingdom, a non-Saudi wife married to a Saudi, and a non-Saudi husband married to a Saudi woman residing in the Kingdom; if the required healthcare is not covered by the insurance coverage in the Cooperative Health Insurance policy issued to them pursuant to the Cooperative Health Insurance Law and its executive regulations.
    • 4- Non-Saudis working in government sectors; if they are not covered by other healthcare systems, programs, or special services.
    • 5- Any category included as beneficiaries by a regulatory instrument.

Article 5

The Ministry shall prepare the (Healthcare Coverage Regulation), ensuring adequate coverage to meet the beneficiaries' needs, protection from risks, fairness in the distribution of services, and their quality, in accordance with the relevant laws, regulations, and decisions, and it shall be approved by a decision of the Council.

Article 6

  • Accredited healthcare institutions shall commit to the following:

    • 1- Considering the objectives of the center when practicing their activities, and working to achieve those objectives in relation to their dealings with the center.

2- Providing the center - with full transparency - with information and documents related to the healthcare subject to purchase; in the form and manner determined by the center.

3- Aligning all their procedures and systems with the procedures and systems of the center; enabling it to exercise its jurisdiction and achieve its objectives.

4- Fulfilling all their contractual obligations towards the center.

5- Adhering to the guidelines issued by the center related to the purchase of healthcare.

Article 7

  • 1- The Center shall have a Board of Directors chaired by the Minister, and membership shall include:

    • A- A representative from the Ministry of Finance.
    • B- A representative from the Expenditure and Projects Efficiency Authority.
    • C- A representative from the National Center for Privatization.
    • D- Five members from the public and private sectors (local and international).

  • 2- The appointment of the members referred to in paragraph (1/D) of this article shall be issued by a decision of the Council of Ministers based on a proposal from the Minister and after the approval of the Council of Economic and Development Affairs. Their membership term shall be three years, renewable once.

Article 8

  • 1- The Council meetings are convened by the invitation of the President, or if requested by no less than half of the members. In all cases, the Council meetings must not be less than two meetings per year.

2- The Council meetings shall be held at the Center's headquarters. If necessary, they may be held at any other place within the Kingdom.

3- The President - or the member he delegates - shall preside over the meeting, and the meeting shall not be valid unless at least two-thirds of the members are present.

4- The Council's decisions are issued by the majority of the votes of the members present at least, and in the event of a tie, the side that the President of the meeting voted for shall prevail.

5- A Council member may not abstain from voting or delegate another member to vote on his behalf in his absence. The objecting member may record his objection and the reasons for the objection in the minutes of the Council meeting.

6- The Council may take any of its decisions by circulating them among the members separately, provided that all members approve the decision in writing, and it is presented to the Council at the first subsequent meeting to be recorded in the minutes of the meeting.

7- The Council's deliberations and decisions shall be recorded in minutes signed by the President of the meeting and the Council members present.

8- The Council may invite specialists and consultants whom it deems necessary to assist to attend its meetings, without having the right to vote.

Article 9

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