Network
Inside KSA: NW7 Outside KSA: Access to over 800,500 medical facilities around the world.
- Approved hospitals and clinics network
- Inpatient
Hospitalization costs and same-day cases.
- Inpatient Co-pay
- Co-pay (contribution to payment) in the case of hospitalization only.
- Outpatient
- Out-patient department costs.
- Outpatient Co-pay
- Co-pay (payment participation) for out-patient department costs. Percentage paid by the beneficiary in the event of treatment at an out-patient department. It covers everything the doctor carries out including consultations, laboratory tests, scans, medications, and other treatments as well as a follow-up visit and referral for the same condition and not for each procedure separately
- Room Type
- Level of accommodation within the network
- Companion Charges (When medically necessary)
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- Annual Limit
- Maximum level for each insured person for the term of the policy. This includes the sub-limit which appears in this document
- Pre-authorization Approval Protocol
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- Medication Co-pay
- Deductible for all Drug services and is separate from medical visits to outpatient clinics and applied according to the Insurance Drug formulary (IDF), with the adoption of generic drugs as an alternative to innovative drugs according to the unified CHI Policy
- Pregnancy & Childbirth
- (Natural childbirth, prenatal and postnatal care).
- Pregnancy & Childbirth-related Complications
- Pregnancy and childbirth-related complications including Caesarean delivery, ectopic pregnancy, bleeding associated with childbirth, pregnancy loss and legal abortion.
- Premature Children’s Treatment
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- Circumcision
Costs of circumcision (males)
- Neonatal
Neonatal covers newborn babies under the mother's policy up to 30 days from the date of birth until added in the policy retroactively form the date of birth.
- Newborn Early Testing
Costs relating to the national program for early testing of newborn children to prevent disability.
- Dental Treatment
All essential dental procedures and Root Canals and Emergencies.
- Optical
- Basic medical frame and lenses without any add-ons.
- Optical Treatment
- Including (one routine eye test each insurance period, and cost for contact lenses – basic prescription lenses without additional features such as UV protection or anti-reflection)
- Pre-existing Conditions & Chronic Diseases
- Pre-existing conditions & chronic diseases
- Hearing Aids
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- Vaccination & Inoculations
- Vaccination & inoculations as per the Ministry of Health (MOH) schedule
- Young Child Care (6+ years)
Routine preventative care and check-ups are covered
- Physiotherapy (When medically necessary)
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- Congenital Illness
- This covers treatment for a congenital condition, weakness or deformity that is life threatening, and where you require treatment in accordance with a medical report issued by the health facility approved by CHI in Saudi Arabia, or by any authorized party/ facility elsewhere in the world.
- Dialysis
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- Psychiatric Treatment
- Acute and non-acute psychiatric
- Rehabilitation (physiotherapy)
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- Disability
- Disability costs (Cases that have been diagnosed and concluded as long term or permanent disabilities i.e. post-polio syndrome, amputation, neural tube defects and consequent disability, spinal cord injury and consequent disability, traumatic brain injury and consequent disability, all form of paralysis, muscular dystrophy, cerebral palsy) and examples for services included: All forms of musculoskeletal assistance such as crutches, wheel chairs, prosthesis, other mobility aids and physiotherapy rehabilitation, Medications used to treat, Botox injections for CP, Surgical release of spastic CPs, Any corrective surgical procedure for deformities leading to physical disability.
- Obesity Treatment
The cost of covering obesity treatment based on (Bariatric Surgery Bundle) from the unified CHI policy
- Acquired Heart Valve Diseases
- Cost of acquired heart valve diseases management
- Alzheimer’s Treatment
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- Autism Treatment
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- Donor Part Collection
- Cost of donor part collection
- Transportation of the Deceased Beneficiary’s Body
- Transportation of the deceased beneficiary’s body from the Kingdom to his country of origin
- Consulting an In-Network Doctor
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- Maximum Physician's Fees within the Network
● General Practitioner
● Specialist
● Consultant
● Rare medical specialties and the like, such as cardiology, brain and neurological surgery, vascular surgery, and other subspecialties as per standards of the Saudi Commission for Health Specialties. (The beneficiary shall be examined as per sequence of service provision procedures except when the service is unavailable in the Approved Provider Network).
- Family Planning
- Cost of birth control for females (Coverage for temporary contraception that includes hormonal contraceptives therapy and intrauterine devices according to the approved guideline)
- Menopausal & Perimenopausal
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- Sexually Transmitted Diseases
- Sexually Transmitted Diseases (Insurance coverage for the treatment of sexually transmitted diseases (whatever the way the infection occurs) include cover for Nongonococcal urethritis, Trichomoniasis, HIV, Syphilis, Human Papillomavirus (genetic warts), Neisseria gonorrhoeae, Genetic herpes, Chancroid)
- Comprehensive Diabetic Program
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- Preventive Screenings
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- Organ/ Bone Marrow Transplant
- This covers cornea, small bowel, kidney, kidney/ pancreas, liver, heart, lung, or heart/lung transplant. It also covers bone marrow transplants (either using own bone marrow or that of a compatible donor) and peripheral stem cell transplants, with or without high dose chemotherapy. Costs associated with the donor or the donor organs are not covered under this benefit . Any drugs prescribed for use as an out-patient, including anti-rejection drugs are paid from the ‘Prescribed medicines’ benefit
- Vision Correction
- Covered only to prevent loss of vision
- Knee/ Hip Replacement
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- Emergency Treatment
Received at a healthcare provider that is not in the Bupa Network. Emergency means a serious medical condition or symptoms resulting from a disease, illness or injury which arises suddenly and, in the judgment of a reasonable person, requires immediate treatment, generally within 48 hours of onset, and which would otherwise put your health at risk.
- Emergency Medical Treatment (Unplanned) in the USA
- Based on the Special Provisions applying to the Table of Benefits
- Local Ambulance
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- Local Air Ambulance
- For emergency cases only
- Non-Emergency (Elective) Treatment
Treatment received at a healthcare provider that is not in the Bupa network
- Medical Devices
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- Birth Defects
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