In a significant regulatory step aimed at enhancing healthcare protection for private sector employees, the Council of Cooperative Health Insurance (CCHI unveiled new guidelines through its "Survey" platform. These guidelines address potential gaps that employees and their families may face in accessing medical care. This initiative is part of a comprehensive framework designed to mandate employers to provide immediate and comprehensive insurance coverage, holding them directly financially responsible for any medical expenses incurred before the issuance of the official insurance policy.
The context of health transition and rights protection
These proposed amendments come at a time when the Kingdom of Saudi Arabia is undergoing a major transformation in the healthcare sector, in line with the goals of Vision 2030, which focuses on quality of life and facilitating access to healthcare services. The Council of Cooperative Health Insurance is the legislative and regulatory body responsible for ensuring the implementation of regulations that protect the rights of all parties involved in the insurance relationship (the service provider, the insurance company, the employer, and the beneficiary). This step is of paramount importance as it addresses one of the most significant administrative issues that previously led to employees being denied treatment during transitional periods or administrative waiting periods.
Closing the "waiting period" gap
The new draft provides a radical and decisive solution to the problem of the so-called "waiting period," or the time gap between the work being due and the document being issued. The regulations clearly stipulate the following:
- The employer is obligated to bear all treatment costs (which are usually covered by the policy) if the beneficiary needs medical care during the period between the date of entitlement and the actual date of issuance of the policy.
- Protecting employees from health and financial risks resulting from any administrative delays by the establishment.
- Ensuring that there is not a single workday without financial health coverage for the employee or eligible family members.
Precise determination of coverage validity dates
To prevent ambiguity or manipulation of insurance start dates, the new regulations have set definitive time points for the commencement of coverage:
- For Saudi citizens: Coverage begins from the date of commencement of work.
- For residents: Coverage begins from the moment of entering the Kingdom of Saudi Arabia.
- For newborns: Coverage begins immediately after birth, to ensure intensive care for mother and child.
Transparency and legal accountability
The new policy did not stop at the financial aspect; it also focused on awareness and legal matters. It mandated that establishments clearly explain the details of the document and the limits of benefits to employees, and that their data be updated in the National Information Center system to ensure the automatic application of their rights. The regulations also prohibited dealing with unlicensed entities that issue fraudulent documents, holding employers fully legally and financially responsible for any damages incurred by beneficiaries as a result. Furthermore, the council was granted broad powers to intervene and address violations.
Penalties and fines
To ensure compliance, deterrent measures included imposing fines on employers who failed to pay or renew their insurance. Regulations stipulate that the fine does not exceed the annual premium for an individual and is calculated based on average market rates or the policy price for the establishment, with the employer being obligated to pay the outstanding premiums retroactively. Despite the strictness of the regulations, the system granted employers flexibility to change insurance providers, provided they gave thirty days' prior notice, and guaranteed their right to appeal penalties before the relevant committees.
