Employers' Commitment to Insurance Coverage Policy

2.1 Ensuring health insurance coverage for all employees and their dependents in accordance with the applicable regulations in the Kingdom.

2.2 Protecting the rights of beneficiaries and ensuring they receive healthcare covered by insurance.

2.3 Enhancing employers' compliance with health insurance requirements.

Chapter Four: Obligations and Responsibilities

1.     Employer's Obligations

1. The Employer shall procure and maintain a valid and enforceable health insurance policy with an insurance company duly licensed to operate within the Kingdom of Saudi Arabia. Such policy shall provide comprehensive coverage for all Employees subject to the provisions of the Cooperative Health Insurance Law, as well as all eligible Dependents, in accordance with the applicable laws, regulations, and regulatory directives.
2. The Employer shall be obligated to bear all medical treatment costs incurred by the Beneficiary for the period between the date on which the Beneficiary becomes entitled to receive treatment and the date on which the health insurance coverage under the Cooperative Health Insurance Policy becomes effective.
3. Providing the minimum insurance coverage specified in the basic policy for the employee and/or dependents.
4. Paying the due insurance premiums on time.
5. Complying with the Health Insurance Beneficiaries Protection Regulations.
6. Cooperating with regulatory authorities to ensure compliance with health insurance requirements.
7. Providing the Health Insurance Council with any information and data required to apply the Law's provisions.
8. Providing the insurance company with all the necessary data to register its employees and dependents in the National Information Center, for employees who have a contractual relationship with the employer at the start of the policy's validity.
9. Bearing responsibility for any damages resulting from entering into health insurance contracts issued by unauthorized entities, with the Council having the right to take legal action if such practices are proven.
10. Explaining and clarifying the policy and coverage limits to the beneficiaries covered by it through appropriate means.

1. Beneficiaries Obligations

1. Eligibility for Insurance Coverage

The insurance coverage for the employee and/or dependent ends in the following cases:

1. When the maximum benefit limit specified in the policy is exhausted before the policy's expiration (365 days).
2. When the insurance is cancelled.
3. Upon the death of the insured, in accordance with the policies and procedures of the basic health insurance policy.
4. When the insured leaves the Kingdom permanently.
5. When the contractual relationship between the employee and the employer ends, including when the insured moves to a new employer.
6. When a dependent loses their insurance status as defined in Chapter One.

1. The insurance coverage for a non-Saudi employee who is absent from work may not be cancelled until their contractual relationship with the employer has ended.
2. The employer may change or cancel the insurance company contracted to provide the insurance coverage, provided that they send a letter to the insurance company and the Council of Health Insurance at least 30 working days prior to the desired cancellation date. The employer must also enter into a new insurance contract with a qualified insurance company, ensuring that the new coverage begins on the day following the cancellation of the previous policy.
3. The employer may remove one or more employees from the policy after providing proof to the insurance company of the insured's departure from the Kingdom or transfer to a new employer.​
   

First Case: Failure to subscribe or renew insurance coverage

1. The employer is obligated to subscribe or renew insurance coverage for the worker and their dependents.
2. The employer is obligated to pay any unpaid premiums.
3. The employer is obligated to pay a fine for each individual eligible for insurance who is not insured.

Second case: If a new insurance policy is not issued

1. The employer is obligated to issue a health insurance policy covering all employees and their dependents covered by the system.
2. The employer is obligated to pay the premiums due to the Council from the date of non-insurance for each employee and their dependents.
3. The employer is obligated to pay a fine for each individual entitled to insurance who is not insured.​
   

Paying all due installments to the council, which are the installments for the months in which employees and their dependents were not covered under the system. The value of the installments is determined based on the following:

1. First case: If the employer has an insurance policy, the penalty is calculated based on the average price of the employer's insurance policy.
2. Second case: If the employer does not have an insurance policy, the penalty is calculated based on the average price of insurance policies in the market.

*According to the procedures outlined in (Table No. 2).

A financial penalty is imposed on the employer, not exceeding the value of the annual subscription for each individual without insurance coverage. The policy price is determined based on the following criteria:

1. First case: If the employer has an insurance policy, the violation amount is calculated based on the average price of the employer's insurance policy.
2. Second case: If the employer does not have an insurance policy, the violation amount is calculated based on the average price of insurance policies in the market.

• According to the procedures outlined in (Table No. 2).

The fine is calculated taking into account the size of the entity, the type of activity, and the region.

The employer or beneficiary can contact the council for inquiries or submit complaints through the following official channels:

• Email: info@chi.gov.sa 
• Phone number: 19977
• Visit the website: CHI.gov.sa​