The Saudi Indian Company For Co operative The Saudi Indian Company For Co operative Insurance is a joint Saudi company established under Insurance is a joint Saudi company established under the vice minister order No,233 date 16-9-1427\9-10-the vice minister order No,233 date 16-9-1427\9-10-2006 and the Royal order No,m/60 date 18-9-1427\11-2006 and the Royal order No,m/60 date 18-9-1427\11-10-2006.The company capital is 100,ooo,ooo (1oo 10-2006.The company capital is 100,ooo,ooo (1oo million SR) divided to 10 millions stocks with 10 SR million SR) divided to 10 millions stocks with 10 SR per stock and after the end of joining and holding the per stock and after the end of joining and holding the establishing general association of the company , establishing general association of the company , claims will be sent to the Minister of Trade and claims will be sent to the Minister of Trade and Industry to declare establishing the company which Industry to declare establishing the company which will be held from the date of the ministry order to will be held from the date of the ministry order to establish it .establish it .

The coverage limits The coverage limits The minimum limt for any document by the insurance company is the co op The minimum limt for any document by the insurance company is the co op health insurance document and there are other documents by the company health insurance document and there are other documents by the company include its covers and the benefits limits are like the benefits at the include its covers and the benefits limits are like the benefits at the document of the health insurance and the more these benefits and the document of the health insurance and the more these benefits and the coverage limits are, the more price of applying to this document will be .coverage limits are, the more price of applying to this document will be .These benefits and coverage limits depend on the client needs .These benefits and coverage limits depend on the client needs .1-1-The benefits and the coverage limits for the maximum benefit to the The benefits and the coverage limits for the maximum benefit to the insured according to the unite document of the Health Insurance insured according to the unite document of the Health Insurance Council:250,000 SR and can be more up to the client request .Council:250,000 SR and can be more up to the client request .2-2-The out patient clinic treatment charges: Deductions/portability: The The out patient clinic treatment charges: Deductions/portability: The percentagepercentage paid by beneficiary whenpaid by beneficiary when consulting the physician is 20% and it consulting the physician is 20% and it differs according to the client request and they can‘t be cancelled .differs according to the client request and they can‘t be cancelled .The physician fees:100 SR according to the health insurance document and The physician fees:100 SR according to the health insurance document and can increase at the other documents which the company issues according to can increase at the other documents which the company issues according to the client request .the client request . The daily stay and board limit The daily stay and board limit : :350 SR maximum and on the client need, he 350 SR maximum and on the client need, he can ask for a single room so the price will increase .can ask for a single room so the price will increase .The hard existing diseases like diabetes, high pressure, cancer, ….etc .The hard existing diseases like diabetes, high pressure, cancer, ….etc .

The Co oprative Health Insurance DocumentThe Co oprative Health Insurance DocumentThe Document ScheduleThe Document Schedule

The Insured Name / The Insurance company:The Insured Name / The Insurance company:………………………………Code:……….Code:……….…The Document Number: ………………………The Document Holder Code:……….…The Document Number: ………………………The Document Holder Code:……….

The Document Holder Name: ………………………………………………………..The Document Holder Name: ………………………………………………………..Post Address:…………………………………………………………………………Post Address:…………………………………………………………………………Phone No:………….Fax No:…………………………………………………………Phone No:………….Fax No:…………………………………………………………

The Insurance Type : The Obligatory Co op Health InsuranceThe Insurance Type : The Obligatory Co op Health InsuranceThe document Duration / The Insurance Duration: From: D…..M…..Y………..The document Duration / The Insurance Duration: From: D…..M…..Y………..

To :D…..M…..Y………..To :D…..M…..Y………..The Date of renewal of the document : D…..M…..Y………..The Date of renewal of the document : D…..M…..Y………..

The Annual Membership:………………………………………………………SRThe Annual Membership:………………………………………………………SRThe Qualified For Insurance The Qualified For Insurance

All the existing employees already at the labor who are included and their ages under All the existing employees already at the labor who are included and their ages under 65years are applicable to insurance conditions starting of the document date, but the 65years are applicable to insurance conditions starting of the document date, but the

employees who apply for the service of the document holder and their ages under employees who apply for the service of the document holder and their ages under 65years are applicable to insurance conditions starting of the document date or their 65years are applicable to insurance conditions starting of the document date or their

arrival date to the Kingdom .arrival date to the Kingdom .Husband/Wife-Maximum :65 years Husband/Wife-Maximum :65 years

Children-Minimum :from the birth date Children-Minimum :from the birth date Sons-Maximum:18 years Sons-Maximum:18 years

( The insurance coverage at this document includes the employees' daughters who ( The insurance coverage at this document includes the employees' daughters who aren‘t married ,widows, the not working divorced female workers and those who aren‘t married ,widows, the not working divorced female workers and those who depend on the this employee and this is for the maximum limit to the age of the depend on the this employee and this is for the maximum limit to the age of the

employee .employee .

The benefits and limits of coverage for the The benefits and limits of coverage for the documentdocumentThe maximum limit of benefit per person at the document year The maximum limit of benefit per person at the document year 250,000 SR 250,000 SR

Out patient clinic treatment chargesOut patient clinic treatment charges : :Deductions/portability: The percentage paid by beneficiary when Deductions/portability: The percentage paid by beneficiary when calling on a physician including consultations, examinations and calling on a physician including consultations, examinations and medicine required ( in one divisible lot )medicine required ( in one divisible lot )

The maximum limit for the physician The maximum limit for the physician consultations fees :consultations fees :The General Physician: 50 SRThe General Physician: 50 SRThe consultant (sent from the general physician ):150 SRThe consultant (sent from the general physician ):150 SRThe consultant (not sent from the general physician ):50 SRThe consultant (not sent from the general physician ):50 SR

The accommodation expenses at the hospital:The accommodation expenses at the hospital: Deductions/portability: not foundDeductions/portability: not foundThe daily stay and board limit (double room at maximum 350 SR per The daily stay and board limit (double room at maximum 350 SR per night )night )

Maternity and pregnancy cover limit:Maternity and pregnancy cover limit:Maximum 10,000 SR during the document durationMaximum 10,000 SR during the document duration(In case that the employee has the benefit of a married (In case that the employee has the benefit of a married contract)contract)Prematurely born child: The maximum limit Prematurely born child: The maximum limit Dental Cover:2ooo SR maximum during the document Dental Cover:2ooo SR maximum during the document durationdurationOptical Cover:250 SR maximum during the document Optical Cover:250 SR maximum during the document durationdurationHearing Cover :1500 SR maximum during the document Hearing Cover :1500 SR maximum during the document durationdurationMorgue & Repatriation to native country Cover:10,000 Morgue & Repatriation to native country Cover:10,000 SR maximum during the document durationSR maximum during the document durationArea of coverage: The Kingdom of Saudi ArabiaArea of coverage: The Kingdom of Saudi ArabiaThe registration type The registration type The employee ………………….SRThe employee ………………….SRThe husband/wife …………….SRThe husband/wife …………….SRChildren…………………………..SRChildren…………………………..SRThe document holder has read the terms and conditions The document holder has read the terms and conditions of this document with its schedule and agreed on it of this document with its schedule and agreed on it Date…………The document holder signature Date…………The document holder signature ………………..The insurance company ………………..The insurance company signature………………signature………………

The Insurance expensesThe Insurance expensesand Ways of Discretionand Ways of Discretion

The health insurance expenses depend on many factors :The health insurance expenses depend on many factors :

1-The number of the employees applied for insurance :The more this 1-The number of the employees applied for insurance :The more this number is , the less expenses will be . number is , the less expenses will be .

2-The coverage limits and benefits : The more these required benefits 2-The coverage limits and benefits : The more these required benefits and the -coverage limits sums are , the more expenses will be .and the -coverage limits sums are , the more expenses will be .

3-The expenses of the service providers (hospitals and medical centers 3-The expenses of the service providers (hospitals and medical centers ):The -more services are , the more expenses will be .):The -more services are , the more expenses will be .

4-The history of the health insurance for the company applying to this 4-The history of the health insurance for the company applying to this service :If this company documents make loses at last because of the service :If this company documents make loses at last because of the more money it pays , the expenses will increase .more money it pays , the expenses will increase .

Note: There are many factors differ from company to another like the Note: There are many factors differ from company to another like the employees sex (male or female) and how cultured these employees of employees sex (male or female) and how cultured these employees of the insurance policies are .the insurance policies are .

The terms and procedures followed by the company The terms and procedures followed by the company at the- health sectorat the- health sector

1-The client asks for a health insurance application stating in it 1-The client asks for a health insurance application stating in it the numbers of the laborers and information about the the numbers of the laborers and information about the company and the details of the employees like ( age – gender – company and the details of the employees like ( age – gender – nationality – families – children ) .nationality – families – children ) .2-The application then will be studied and the prices will be 2-The application then will be studied and the prices will be shown if it is accepted .shown if it is accepted .3-After paying the money of the insurance , the healthy 3-After paying the money of the insurance , the healthy insurance document will be issued to the employees and their insurance document will be issued to the employees and their families .families .4-The employee in charge will check then the medical service 4-The employee in charge will check then the medical service centers available at the health services providers for the centers available at the health services providers for the insurance company .insurance company .5-If the service is out the coverage area , the patient will 5-If the service is out the coverage area , the patient will receive the treatment pills .receive the treatment pills .6-In case of adding or cancelling the insured employees as the 6-In case of adding or cancelling the insured employees as the manager of the company ordered , it will be considered that manager of the company ordered , it will be considered that the rest of the money will paid .the rest of the money will paid .7-If the insurance document is over , it will be renewed after 7-If the insurance document is over , it will be renewed after paying the money again and the agreement of the company .paying the money again and the agreement of the company .

The policy will not cover claims The policy will not cover claims arising out of the following:arising out of the following:

• Injury caused deliberately by the personInjury caused deliberately by the person• Treatment related to pregnancy and delivery Treatment related to pregnancy and delivery

for a women on single status contract.for a women on single status contract.• Free of charge treatment of injured person.Free of charge treatment of injured person.• Rest, general body health programmes and Rest, general body health programmes and

treatment at social welfare houses.treatment at social welfare houses.• Any illness or injury resulting directly from Any illness or injury resulting directly from

profession of the insured.profession of the insured.• Hair falling, baldness or wigs.Hair falling, baldness or wigs.

• Psychotherapy , mental or neurotic Psychotherapy , mental or neurotic disorders excluding acute cases.disorders excluding acute cases.

• Allergy tests of whatever nature Allergy tests of whatever nature excluding those related to drugs , excluding those related to drugs , diagnosis or treatment.diagnosis or treatment.

• treatment of acne or any other treatment of acne or any other treatment relating to obscenity or treatment relating to obscenity or overweight.overweight.

• Transplant of organs taken from other Transplant of organs taken from other persons bone marrow and artificial persons bone marrow and artificial limbs replacing any organ in the body.limbs replacing any organ in the body.

• Tests for correction of sight &hearing Tests for correction of sight &hearing and audio- visual aids , unless ordered and audio- visual aids , unless ordered by a licensed physician.by a licensed physician.

• Plastic surgery or treatment unless Plastic surgery or treatment unless necessitated by an accidental bodily necessitated by an accidental bodily injury not excluded in this part.injury not excluded in this part.

• Treatment of genital diseases and the Treatment of genital diseases and the medically recognized diseases usually medically recognized diseases usually communicated by sexual intercourse.communicated by sexual intercourse.

• Expenses of transportation of an Expenses of transportation of an insured by local or authorized insured by local or authorized ambulances or by ambulances ambulances or by ambulances belonging to the saudi red.belonging to the saudi red.

Area of coverageArea of coverageKingdom of saudi arabia Kingdom of saudi arabia onlyonly

Name of TPAName of TPA Globe med saudiGlobe med saudi

Maximum benefit limit for Maximum benefit limit for each person per yeareach person per year 250,000 SR250,000 SR

Coverage as fromCoverage as from DAY 1DAY 1

Maximum insurable ageMaximum insurable age 65 years inclusive65 years inclusive

In patient BenefitsIn patient BenefitsDaily room and board limit Daily room and board limit 350 SR per day350 SR per day

Emergency treatment Emergency treatment anywhere in the worldanywhere in the world not applicablenot applicable

Period of cover Period of cover not applicablenot applicable

Deductible Deductible not applicablenot applicable

Emergency treatmentEmergency treatment in in native country native country not applicablenot applicable

Morgue & repatriation to Morgue & repatriation to native country following native country following covered hospital covered hospital confinementconfinement 10,000 SR10,000 SR

Pre existing cases & chronic Pre existing cases & chronic conditionsconditions

coveredcovered

Vaccination as per MOH scheduleVaccination as per MOH schedule coveredcovered

Parent accommodationParent accommodation Covered: one parent can accompany a child Covered: one parent can accompany a child aged 12 years or below aged 12 years or below

out patient clinic treatment chargesout patient clinic treatment charges

Deductions / portabilityDeductions / portability

the percentage paid by beneficiary the percentage paid by beneficiary when calling on physician including when calling on physician including consultations , examination and consultations , examination and medicine required (in one divisible lot medicine required (in one divisible lot ))

20%of claim amount subject 20%of claim amount subject to a maximum of SR 100to a maximum of SR 100

Dental covered:Dental covered:

* Benefits* Benefits

Cover is limited to teeth and Cover is limited to teeth and gingival diseasesgingival diseases

* annual financial limitation per * annual financial limitation per insured per yearsinsured per years

2000 SR2000 SR

Optical cover:Optical cover:* annual financial limitation per * annual financial limitation per insured per yearsinsured per years

250 SR250 SR

Hearing aids annual financial Hearing aids annual financial limitation per insured per yearslimitation per insured per years 1500 SR1500 SR

Maternity cover Maternity cover not applicablenot applicable

Normal including mis-carriage Normal including mis-carriage /abortion/abortion

not applicablenot applicable

Complicated maternityComplicated maternity not applicablenot applicable

Prematurely born child Prematurely born child not applicablenot applicable

Prepar: Abdullh AL-OtibePrepar: Abdullh AL-Otibe

Talal AL-QahtaniTalal AL-Qahtani