Article 7 of the Saudi Cooperative Health Insurance Law
المادة 7 من نظام الضمان الصحي التعاوني
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.
Official text (Arabic)
This article has not been amended since the law was issued.
تُغطي وثيقة الضمان الصحي التعاوني الخدمات الصحية الأساسية الآتية :
أ - الكشف الطبي والعلاج في العيادات، والأدوية.
ب - الإجراءات الوقائية مِثل: التطعيمات، ورعاية الأمومة والطفولة.
ج - الفحوصات المِخبرية والشُعاعية التي تتطلبُها الحالة.
د - الإقامة والعلاج في المُستشفيات بما في ذلك الوِلادة والعمليات.
هـ - مُعالجة أمراض الأسنان واللِّثة، ما عدا التقويم والأطقُم الصِناعية.
ولا تخِل هذه الخدمات بما تقضي بِه أحكام نِظام التأمينات الاجتِماعية، وما تُقدِّمه الشركات والمؤسسات الخاصة والأفراد لجميع منسوبيها مِن خدمات صحية أشمل مِّما نص عليه هذا النِظام.
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 7 explained in plain English
This article answers an important question: what does a cooperative health insurance policy cover? It covers the following basic health services:
- Medical examination and treatment in clinics, and medicines.
- Preventive measures, such as vaccinations and maternal and child care.
- Laboratory and radiological tests that the condition requires.
- Hospital stay and treatment, including childbirth and surgeries.
- Treatment of dental and gum diseases, except orthodontics and artificial dentures.
Two limits are noted in the text: tests are covered if they are what the condition requires, and dental treatment does not include orthodontics and artificial dentures.
The article ends with an important provision: these services do not prejudice two matters:
- What the provisions of the Social Insurance Law provide.
- The health services that private companies, establishments and individuals provide to all their personnel that are more comprehensive than what this Law provides.
This list is therefore a minimum that does not prevent broader coverage. Article 8 confirms this, as it allows the employer to expand the services through additional appendices at additional cost to include other diagnostic and treatment services.
If there is a dispute with the insurance company about the coverage of a particular service, it is advisable to refer to the text of the policy and consult a lawyer who specializes in health insurance cases.
Practical example
A resident worker in Khobar had a toothache and went to an accredited dentist. Treatment of dental and gum diseases is covered by the cooperative health insurance policy, but if he asked for orthodontics or an artificial denture, the basic coverage would not include it 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 7 of the Saudi Cooperative Health Insurance Law
What does mandatory health insurance cover?
Examinations, treatment in clinics and medicines, vaccinations and maternal and child care, laboratory and radiological tests, hospital stays including childbirth and surgeries, and treatment of dental and gum diseases.
Does health insurance cover orthodontics?
No. The article excludes orthodontics and artificial dentures from the coverage of dental and gum treatment.
Does health insurance cover childbirth?
Yes. Coverage includes hospital stay and treatment, including childbirth and surgeries.
Can insurance coverage be broader than this?
Yes. These services do not prejudice the more comprehensive health services that companies, establishments and individuals provide to their personnel.
More articles on Health Insurance Policy Coverage
- 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 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.