Article 11 of the Saudi Cooperative Health Insurance Law
المادة 11 من نظام الضمان الصحي التعاوني
Government health facilities may, when needed, provide the services covered by a policy to its holder for a fee borne by the health insurance body, with the Council determining the facilities and the fee.
Official text (Arabic)
This article has not been amended since the law was issued.
أ - يجوز عند الحاجة تقديم الخدمات الصحية المشمولة في وثيقة الضمان الصحي التعاوني لحامِلها مِن قِبل المرافِق الصحية الحُكومية، وذلك بمُقابِل مالي تتحملُه جهة الضمان الصحي، ويُحدِّد مجلِس الضمان الصحي المرافِق التي تُقدِّم هذه الخِدمة، والمُقابِل المالي لها.
ب - يُحدِّد وزير الصحة بعد الاتِفاق مع وزير المالية والاقتصاد الوطني إجراءات وضوابِط كيفية تحصيل المُقابِل المالي المنصوص عليه في الفقرة السابِقة.
This is the official Arabic wording, the only legally binding version. We do not translate the law itself; the explanation below is ours. Official source: Bureau of Experts at the Council of Ministers
Article 11 explained in plain English
This article regulates the treatment of a cooperative health insurance policy holder in government health facilities, and contains two paragraphs:
Paragraph (a): when needed, government health facilities may provide the policy holder with the health services covered by his policy, and this is done:
- for a fee.
- borne by the health insurance body, not the policy holder.
- The Council of Health Insurance determines the facilities that provide this service and the fee for it.
Paragraph (b): the Minister of Health, after agreement with the Minister of Finance and National Economy, determines the procedures and controls for collecting this fee.
It is noted that the text limited this by two conditions: it must be when needed, and the service must be one of the services covered by the policy. It also does not include all government facilities, but those the Council determines.
This article differs from Article 12, which deals with another category, employees of government entities who are covered by the Law and their family members, whose treatment is in government health facilities where they are contracted directly with these entities and under their sponsorship and their contracts state their right to treatment.
The article comes after Article 10, which makes the employer bear the cost of the beneficiary's treatment in the period between entitlement to treatment and subscription.
Practical example
A resident in a remote area holds a cooperative health insurance policy and needed a surgery covered by his policy, and the nearest suitable facility was a government hospital among the facilities the Council of Health Insurance has determined. The hospital may provide him the service, and the health insurance body bears the fee.
Translated from our Arabic explanation with machine assistance. For guidance only; it does not replace advice from a lawyer on your situation.
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Frequently asked questions about Article 11 of the Saudi Cooperative Health Insurance Law
Can health insurance be used in a government hospital?
When needed, government health facilities that the Council of Health Insurance determines may provide the services covered by the policy to its holder.
Who pays the cost of treatment in a government hospital for an insurance holder?
The health insurance body bears the fee.
Who determines which government hospitals accept the insurance?
The Council of Health Insurance determines the facilities that provide this service and the fee for it.
More articles on Health Insurance Policy Coverage
- Article 7
The article lists the basic health services a cooperative health insurance policy covers, from examinations and medicines to hospital stays, childbirth, surgery and dental treatment.
تُغطي وثيقة الضمان الصحي التعاوني الخدمات الصحية الأساسية الآتية : أ - الكشف الطبي والعلاج في العيادات، والأدوية. ب - الإجراءات الوقائية مِثل: التطعيمات، ورعاية
- Article 8
The employer may expand cooperative health insurance services through additional appendices at additional cost to include diagnostic and treatment services beyond those in Article 7.
يجوز لصاحِب العمل توسيع مجال خدمات الضمان الصحي التعاوني ،بموجب ملاحِق إضافية، وبتكلِفة إضافية لتشمل خدمات تشخيصية وعلاجية أُخرى أكثر مِّما نُص عليه في المادة ا
- Article 9
The arrangement of preventive health measures, such as tests and vaccines, for those covered by the insurance in the period before the policy is issued is made by decision of the Minister of Health.
يتم ترتيب ما يتعلق بالإجراءات الوقائية الصحية التي يخضع لها المشمولون بالضمان بما في ذلك الفحوصات واللُّقاحات في المُدة التي تسبِق إصدار وثيقة الضمان الصحي التع
- Article 16
The Ministry of Health monitors the quality assurance of the health services provided to cooperative health insurance beneficiaries.
تتولى وزارة الصحة مُراقبة ضمان جودة ما يُقدم مِن خدمات صحية للمُستفيدين مِن الضمان الصحي التعاوني.
- Article 17
Cooperative health insurance is applied through qualified Saudi cooperative insurance companies operating on the cooperative insurance model, in accordance with Resolution No. (51) of the Council of Senior Scholars.
يتم تطبيق الضمان الصحي التعاوني عن طريق شركات تأمين تعاونية سعودية مؤهلة، تعمل بأسلوب التأمين التعاوني على غِرار ما تقوم بِه الشركة الوطنية للتأمين التعاوني ، و
The texts are reproduced from the official website of the Bureau of Experts at the Council of Ministers for reference; where they differ, the officially published Arabic text prevails. This content is not legal advice.