Council clarifies benefits and coverage limits of mandatory health insurance

The Health Insurance Council has clarified the benefits and coverage limits of the mandatory health insurance policy, noting that it includes a range of essential healthcare services.

The policy covers screening tests, maternity and childbirth care, as well as dental treatment and medications according to specified coverage regulations.

It also includes preventive services such as vaccinations and check-ups, in addition to emergency and inpatient services.

Full policy details are available on the Health Insurance Council website: chi.gov.sa/Rules/UnifiedD.

Support for maternal health

The Health Insurance Council confirmed that the mandatory health insurance policy provides comprehensive support for maternal and child health.

The council explained that "the mandatory health insurance policy offers services focused on maternal and child health, including regular pregnancy monitoring through check-ups and ongoing care."

For childbirth, the policy covers delivery services in remote areas. Newborns are covered under the mother's policy for up to 30 days, and vaccinations are provided through national immunization campaigns.

Co-payment rates in health insurance

The council specified the co-payment rate in health insurance, which is the amount the beneficiary must pay for covered healthcare services, if applicable.

The council stated that the maximum co-payment within the medical network is 75 riyals (SAR) per visit, up to 300 riyals at hospitals outside the network, and up to 100 riyals at other out-of-network providers.

The Health Insurance Council noted that co-payments do not apply in emergency or inpatient cases, ensuring beneficiaries receive necessary care in such situations without these charges.