Overall Annual Maximum Limit per Member |
SAR 37,500,000 / USD 10,000,000 |
SAR 7,500,000 / USD 2,000,000 |
Coverage |
worldwide (USA optional) |
worldwide (USA optional) |
Network of Healthcare Providers |
Inside KSA: NW7. Outside KSA: Access to over 1.2 million medical facilities around the world. |
Inside KSA: NW7. Outside KSA: Access to over 1.2 million medical facilities around the world. |
Accommodation |
Inside KSA: Standard suite. Outside KSA: Single room with private bathroom. |
Inside KSA: Standard suite. Outside KSA: Single room with private bathroom. |
Outpatient Deductible |
NIL |
Inside KSA: 20% of net amount up to SAR 100 per visit. Outside KSA: SAR 100 per visit. |
Maternity Cover with Benefits |
SAR 61,000 / USD 16,300 |
SAR 45,000 / USD 12,000 |
Dental Coverage
|
SAR 15,000 / USD 4,000 |
SAR 11,250 / USD 3,000 |
Optical Coverage |
SAR 1,600 / USD 462 |
SAR 1,175 / USD 313 |
Preventative tests |
SAR 7,500 / USD 2,000 |
SAR 3,750 / USD 1,000 |
Inpatient Pre-authorization Approval |
As per standard protocol |
As per standard protocol |
Inpatient / day-case coverage |
Up to annual maximum limit |
- |
Companion Charges |
Up to annual maximum limit |
Up to annual maximum limit |
Outpatient coverage |
|
|
Outpatient coverage |
|
|
Outpatient Coverage |
Up to annual maximum limit |
Up to annual maximum limit |
Outpatient Pre-authorization Approval |
Inside KSA: not required except for services with sub-limits such as dental, optical, maternity services etc. Outside KSA: As per standard protocol |
Inside KSA: not required except for services with sub-limits such as dental and optical. Outside KSA: As per standard protocol. |
Advanced Imaging (MRI, CT, PET) |
Up to annual maximum limit |
Up to annual maximum limit |
Artificial limbs |
Up to annual maximum limit |
Up to annual maximum limit |
Cancer treatment |
Up to annual maximum limit |
Up to annual maximum limit |
Congenital illness |
Up to annual maximum limit |
Up to annual maximum limit |
Dialysis |
Up to annual maximum limit |
Up to annual maximum limit |
Emergency treatment at a healthcare provider outside the Bupa network |
100% of costs covered up to annual maximum limit, inside and outside KSA |
100% of costs covered up to annual maximum limit, inside and outside KSA. |
Emergency medical treatment in the US |
Up to SAR 187,500 / USD 50,000 up to a maximum of 30 days. |
Up to SAR 187,500 / USD 50,000 up to a maximum of 30 days. |
Healthline Services |
Included |
Included |
Hearing aids |
Up to SAR 10,000 / USD 2,666 |
Up to SAR 10,000 / USD 2,666 |
Local Road Ambulance for Emergency Cases Only |
Up to annual maximum limit |
Up to annual maximum limit |
Local air ambulance for emergency cases only |
Up to SAR 37,500 / USD 10,000 |
Up to SAR 37,500 / USD 10,000 |
Maternity complications (Caesarean deliveries, legal abortion, miscarriage, haemorrhages) |
Up to annual maximum limit |
Up to annual maximum limit |
Neonatal/ Newborn cover |
Inside KSA: Covered from Day 1. Outside KSA: Up to 7 days following birth for routine care. and up to SAR 560,000 / USD 150,000 for non-routine care |
Inside KSA: Covered from Day 1. Outside KSA: Up to 7 days following birth for routine care. and up to SAR 560,000 / USD 150,000 for non-routine care |
Treatment of premature babies |
Inside KSA: Up to annual maximum limit. Outside KSA: new-born care benefit, see above. |
Inside KSA: Up to annual maximum limit. Outside KSA: new-born care benefit, see above. |
Mental health acute psychiatric treatment |
Up to SAR 15,000 / USD 4,000 |
Up to SAR 15,000 / USD 4,000 (out-patient co-payment applies) |
Mental health non-acute psychiatric treatment |
Up to 30 visits |
Up to 30 visits (out-patient co-payment applies) |
Elective (non-emergency) treatment outside of network in or outside KSA |
Inside KSA: Based on 100% of customary prices of Network hospitals in Network level NW7. Outside KSA: Subject to Reasonable and Customary charges. |
Inside KSA: Based on 100% of customary prices of Network hospitals in Network level NW7. Outside KSA: Subject to Reasonable and Customary charges. |
Physiotherapy |
Physiotherapy when medically necessary: up to annual maximum limit. |
Physiotherapy when medically necessary: up to annual maximum limit (out-patient co-payment applies) |
Pre-existing Conditions and Chronic Diseases |
Covered |
Covered |
Preventive tests |
Up to SAR 7,500 / USD 2,000 |
Up to SAR 3,750 / USD 1,000 (out-patient co-payment applies) |
Physiotherapy |
Rehabilitation and physiotherapy: up to annual maximum limit. |
Rehabilitation and physiotherapy: up to annual maximum limit. |
Transportation of Mortal Remains to Home Country in Case of Death in KSA |
Up to SAR 10,000 / USD 2,666 |
Up to SAR 10,000 / USD 2,666 |
Treatment for damage to acquired heart valves |
Up to annual maximum limit |
Up to annual maximum limit |
Alzheimer’s Disease |
Up to SAR 15,000 / USD 4,000 |
Up to SAR 15,000 / USD 4,000 |
Autism |
Up to SAR 15,000 / USD 4,000 |
Up to SAR 15,000 / USD 4,000 |
Cost of early screening for new-borns (National Program for Prevention of Disability) |
Inside KSA: Up to SAR 100,000 / USD 27,000 |
Inside KSA: Up to SAR 100,000 / USD 27,000. Outside KSA: Not covered. |
Disability cases |
Up to annual maximum limit |
Up to annual maximum limit |
Circumcision of new-born boys and ear piercing of new-born girls |
Up to SAR 500 / USD 140 |
Up to SAR 500 / USD 140 |
Circumcision of new-born boys and ear piercing of new-born girls |
Up to SAR 300 / USD 80 |
Up to SAR 300 / USD 80 |
Cost of obtaining/harvesting donor organ |
Up to SAR 50,000 / USD 13,333 |
Up to SAR 50,000 / USD 13,333 |
Transplant of organ or bone marrow |
Up to annual maximum limit |
Up to annual maximum limit |
Treatment for contagious or endemic diseases |
Treated as any condition or sickness |
Treated as any other condition or sickness |
Vaccinations and inoculations (up till age 6) |
Inside KSA: Up to annual maximum limit Outside KSA: Up to SAR 6,375 / USD 1,700 |
Inside KSA: Up to annual maximum limit. Outside KSA: Up to SAR 6,375 / USD 1,700 (out-patient co-payment applies). |
Vaccinations and inoculations (after age 6) |
Up to SAR 3,750 / USD 1,000 |
Up to SAR 1,125 / USD 300 (out-patient co-payment applies) |
Emergency treatment outside the kingdom |
- |
- |
Seniors over 64-year-old annual limit |
- |
- |
Inpatient / Day-Case Coverage |
Up to annual maximum limit. |
Up to annual maximum limit |
Inpatient Deductible |
NIL |
NIL |
Circumcision of new-born boys and ear piercing of new-born girls |
Up to SAR 500/ USD 140 for circumcision and up to SAR 300/ USD 80 for ear piercing. |
Up to SAR 500/ USD 140 for circumcision and up to SAR 300/ USD 80 for ear piercing. |
Pre-existing Conditions and Chronic Diseases |
- |
- |
Vaccinations and Inoculations as per the Ministry of Health (MOH) Schedule |
- |
- |
Seasonal vaccination including mother and child care as per MOH program and schedule |
- |
- |
Treatment for damage to acquired heart valves |
- |
- |
Physiotherapy |
- |
- |
Mental health acute psychiatric treatment |
- |
- |
Life-threatening emergency treatment out of network in KSA |
- |
- |
Physician’s fees within the network |
- |
- |
Emergency Evacuations through International SOS Assistance |
- |
- |
Emergency treatment outside the kingdom through International SOS Assistance |
|
|
Emergency treatment outside the kingdom |
- |
- |
Emergency Treatment Outside of Network in KSA |
|
|
Elective (Non-Emergency) Treatment Outside of Network in KSA |
- |
- |
Physiotherapy |
- |
- |
Vaccination and inoculations as per the Ministry of Health (MOH) schedule |
- |
- |