Article 16 of the Saudi Cooperative Health Insurance Law
المادة 16 من نظام الضمان الصحي التعاوني
The Ministry of Health monitors the quality assurance of the health services provided to cooperative health insurance beneficiaries.
Official text (Arabic)
This article has not been amended since the law was issued.
تتولى وزارة الصحة مُراقبة ضمان جودة ما يُقدم مِن خدمات صحية للمُستفيدين مِن الضمان الصحي التعاوني.
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 16 explained in plain English
This article specifies the body responsible for the quality of the health services provided to cooperative health insurance beneficiaries, which is the Ministry of Health.
The Ministry monitors the quality assurance of the health services provided to beneficiaries. This means that oversight of the level of the medical service itself, that is, how sound and good it is, falls within the competence of the Ministry of Health.
It follows that the right of a health insurance policy holder is not limited to the existence of coverage, but the quality of the services he receives is subject to the oversight of a government body. The article did not specify the method or tools of this oversight, or the procedures for submitting complaints about quality.
This article comes between:
- Article 15, which makes a resident who is not under a work sponsorship take the employer's place in the obligations imposed on the employer under the Law.
- Article 17, which provides that cooperative health insurance is applied through qualified Saudi cooperative insurance companies, operating on the cooperative insurance model like the National Company for Cooperative Insurance, and in accordance with Resolution No. (51) of the Council of Senior Scholars dated 4/4/1397 AH.
Insurance companies are therefore the ones that apply the insurance, while oversight of the quality of the health services provided to beneficiaries belongs to the Ministry of Health.
Practical example
A resident in Taif receives treatment at a private clinic under his health insurance policy and noticed a clear weakness in the level of the medical service. Monitoring the quality assurance of these services is within the competence of the Ministry of Health under this article.
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 16 of the Saudi Cooperative Health Insurance Law
Who monitors the quality of medical services for the insured?
The Ministry of Health monitors the quality assurance of the health services provided to cooperative health insurance beneficiaries.
Does the article say how to file a complaint about service quality?
No. The article only specified the body responsible for oversight, without the procedural details.
Is quality oversight the work of insurance companies?
The article made monitoring quality assurance the responsibility of the Ministry of Health.
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 11
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.
أ - يجوز عند الحاجة تقديم الخدمات الصحية المشمولة في وثيقة الضمان الصحي التعاوني لحامِلها مِن قِبل المرافِق الصحية الحُكومية، وذلك بمُقابِل مالي تتحملُه جهة الض
- 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.