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KSA’s Cooperative Health Insurance Law Explained

Council of Cooperative Health Insurance Secretariat General Headquarters Building. Imagesource:cchi.gov.sa

The Council of Cooperative Health Insurance - Ang sangay ng gobyerno na nagpapatupad ng Cooperative Health Insurance Law ng KSA.

Ano ang Cooperative Health Insurance Law?

Ito ay isang batas ng Saudi Arabia na binuo noong 1999 para sa libreng pagpapagamot, operasyon ng mga residents ng kaharian, mapa-Saudi national man or foreigner.

Ang Cooperative Health Insurance Law ay may 19 Articles

http://www.cchi.gov.sa/en/Rules/Pages/default.aspx

Ano ang mga benefits na makukuha kung merong health insurance?

Article 7 of the Cooperative Health Insurance Law

The cooperative health insurance policy covers the following basic health services:
a. Medical examination, treatment in clinics and medication.
b. Preventive procedures such as vaccination, motherhood and childhood care.
c. Required laboratory- and radiological examinations.-
d. Inpatient care (Accommodation & treatment) including delivery and operations.
e. Treatment of teeth and priodental diseases excluding orthdontics and dentures.

see also Chapter 4 of the Implementing Regulations ng Cooperative Health Insurance Law

http://www.cchi.gov.sa/en/Rules/OList/Pages/Chapter4.aspx

Ang Health Insurance na ito ay para lang ba sa mga Saudis?

Hindi lang ito para sa Saudis, kundi para sa mga foreign workers din.

Article 1:

This system is designed to provide health care and organize all residents to non-Saudis in the Kingdom, and may be applied to other citizens and the decision of the Council of Ministers.

Sino ang magbabayad para sa health insurance ng mga workers?

Ang employer ang magbabayad ng health insurance para sa kanyang mga workers at ng mga dependents nito.

http://www.cchi.gov.sa/en/Employers/Duties/Pages/default.aspx

Papano masisiguro na magbayad ang mga employer para sa kanyang mga workers?

Hindi sya makakarenew ng iqama ng kanyang worker kung hindi nya ito ma-enroll ng medical insurance.

Article 3: of the Cooperative Health Insurance law

With respect to the implementation phases specified in para (B) Article 5, Article 12 and article 13 of this act, anyone sponsoring a resident shall be obliged to participate in the cooperative health insurance for the benefit of the resident.

Residence permit shall not be issued nor renewed without prior obtaining the cooperative health insurance policy. The period covering the residence permit (Iqama) must be equivalent to the policy period..

http://www.cchi.gov.sa/en/Rules/Pages/default.aspx

Note ang Iqama at work permit ng worker ay obligasyon din na employer (as per article 40.1 of the Saudi Labor Law)

Kasama ba ang mga dependents (asawa at anak) ng worker sa insurance na ito?

Kasama sa babayaran ng employer ang health insurance ng mga anak at asawa ng kanyang worker

Article 2:of the Cooperative Health Insurance Law

The cooperative health insurance coverage of all this system applies to them and their family members.

http://www.cchi.gov.sa/en/Rules/Pages/default.aspx

Please explain in details?

Chapter 2, Article (2) of the Implementing Regulations ng Cooperative Health Insurance Law

The following categories are subject to health insurance:
1. Non-Saudis working for the non-government sector.
2. Persons unemployed in the non-government sector, who are residing in the Kingdom.
3. Family dependents of persons specified in paragraphs 1 and 2 of this Article, who are holding a residence permit in the Kingdom.
4. Saudis working in the private sector and individuals with whom they have labor contracts or proof of employment, regardless of the form of remuneration1
5. Family members of Saudis referred to in paragraph 4 of this Article as determined by the Cooperative Health Insurance Council

Chapter 2, Article (3) – of the Implementing Regulations ng Cooperative Health Insurance Law

The following categories shall be excluded from the health insurance provided for in Article (2) of these Regulations:
1. Non-Saudi employees working for government bodies and those whose work contract do not provide for health care services shall be obligated to obtain insurance coverage in accordance with approved insurance policies.
2. Family dependents of employees specified in paragraph 1 of this Article. The scope of treatment specified in the above paragraph shall at least conform to the provisions of Article (7) of the Law and the quality standard provided for in Chapter 9 of these Regulations.

http://www.cchi.gov.sa/en/Rules/OList/Pages/Chapter2.aspx

Meron bang age limit para sa insurance?

Meron

Please explain in details?

Persons Eligible for Insurance: All employees on the job and whose ages are less than 65 years shall be eligible for insurance as of the effective date of policy. Employees joining policy holder later on – who are less than 65 years old – shall be eligible for insurance as from date of their joining service or date of arrival in the Kingdom.

Husband / Wife – Maximum age: Below 65 year at the effe ctive date of insurance coverage.

Children – Maximum Age = 18 years old

Magkano naman ang limit ng libreng pagpagamot ?

250 Thousand Riyals (approx 2.5 million pesos) per beneficiary (sa bawat worker at sa bawat kanyang dependent)

C) The maximum benefit limit per beneficiary of two hundred and fifty thousand Saudi Riyals only.

Ano ang kaibahan nito sa Social Insurance GOSI-OHB?

Ang GOSI-OHB ay para sa mga occupational injuries or occupational diseases o mga karamdaman sanhi ng ginampanang trabaho. Habang ang health insurance ay para sa lahat sakit na hindi work related.

Papano kung dahil sa emergency ay nagamit ang medical insurance at hindi ang GOSI?

Nakasulat din yan sa batas

Chapter 4 , Articles 28 – 32 of the Implementing Regulations ng Cooperative Health Insurance Law

Article (28): If the insurance company to provide those health services, it became clear later that the Occupational Hazards Branch in the General Organization for Social Insurance is the one who should cover these services, Pay Pal insurance proceed with a request for compensation for what has borne the expenses of the General Organization for Social Insurance.

Article (29): If the General Organization for Social Insurance to provide health services to people linked to an insurance contract with the health insurance company, although the latter is obliged to provide those services, the insurance company is committed to compensate the General Organization for Social Insurance for expenses that have arisen in this regard, within the limits of the document.

Article (30): The General Organization for Social Insurance and the insurance company a joint contract between the two states to take specific actions to meet the services contained in Article (28) and Article (29) of these Regulations.

http://www.cchi.gov.sa/en/Rules/OList/Pages/Chapter4.aspx

Sakop ba ng cooperative heath insurance law ang pagpapagamot kung magkasakit sa labas ng Saudi Arabia?

Hindi, subalit may mga insurance companies na isinama sa kanilang package na pwedeng mairefund ang nagastos sa pagpapagamot kung nagkasakit sa labas ng Saudi Arabia? May mga insurance companies din na isinama sa kanilang package ang libreng travel insurance. May mga insurance companies din na ang maximum limit ay lumagpas sa 250 Thousand Saudi Riyals.

May mga listahan po ba ng mga legal na insurance companies? 

meron at ito yong link (note: the list is in Arabic you may use google translate or any translation software)

http://www.cchi.gov.sa/en/InsuranceCompanies/Pages/Companies.aspx

Sakop ba ng Cooperative Health Insurance ang mga takas at undocumented?

Katulad ng GOSI-OHB,  hindi sakop ng health insurance ang mga takas at undocumented dahil ang maaring makapagpa-enroll lamang sa kanila ay ang kanilang tunay na sponsor.

Para sa karagdaghang impormasyon ay bumisita sa website ng Council of Cooperative Health Insurance at http://www.cchi.gov.sa

See Also

KSA’s Social Insurance Law (GOSI-OHB) Explained