Munsha’at more then 20

Network
NW5
NW5
NW6
NW6
NW6
NW7
NW7
NW7
NW7+
NW7+
NW7+

Annual Limit
SAR 500,000
SAR 500,000
SAR 500,000
SAR 500,000
SAR 500,000
SAR 500,000
SAR 500,000
SAR 500,000
SAR 500,000
SAR 500,000
SAR 500,000

Inpatient

Room Type
Single Room
Standard Suite
Single Room
Standard Suite
Standard Suite
Single Room
Standard Suite
Standard Suite
Single Room
Standard Suite
Standard Suite

Companion Charges (When medically necessary)

Inpatient Co-pay
NIL
NIL
NIL
NIL
NIL
NIL
NIL
NIL
NIL
NIL
NIL

Outpatient

Outpatient Co-pay
20% up to: ● Hospitals: SAR 300 ● Polyclinics & MPN: SAR 75
20% up to: ● Hospitals: SAR 100 ● Polyclinics & MPN: SAR 75
20% up to: ● Hospitals: SAR 300 ● Polyclinics & MPN: SAR 75
20% up to: ● Hospitals: SAR 100 ● Polyclinics & MPN: SAR 75
NIL
20% up to: ● Hospitals: SAR 300 ● Polyclinics & MPN: SAR 75
20% up to: ● Hospitals: SAR 100 ● Polyclinics & MPN: SAR 75
NIL
20% up to: ● Hospitals: SAR 300 ● Polyclinics & MPN: SAR 75
20% up to: ● Hospitals: SAR 100 ● Polyclinics & MPN: SAR 75
NIL

Medication Co-pay
● Generic Medication or Branded Medication: 20% up to SAR 30
● Generic Medication or Branded Medication: 20% up to SAR 30
● Generic Medication or Branded Medication: 20% up to SAR 30
● Generic Medication or Branded Medication: 20% up to SAR 30
NIL
● Generic Medication or Branded Medication: 20% up to SAR 30
● Generic Medication or Branded Medication: 20% up to SAR 30
NIL
● Generic Medication or Branded Medication: 20% up to SAR 30
● Generic Medication or Branded Medication: 20% up to SAR 30
NIL

Pregnancy & Childbirth
SAR 15,000
SAR 20,000
SAR 20,000
SAR 25,000
SAR 30,000
SAR 20,000
SAR 25,000
SAR 30,000
SAR 20,000
SAR 25,000
SAR 30,000

Pregnancy & Childbirth-related Complications

Premature Children’s Treatment

Circumcision
SAR 500
SAR 500
SAR 500
SAR 500
SAR 500
SAR 500
SAR 500
SAR 500
SAR 500
SAR 500
SAR 500

Neonatal

Newborn Early Testing
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000

Dental Treatment
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,200 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 800 with 20% deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,800 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 1,200 with NIL deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,800 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 1,200 with NIL deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,800 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 1,200 with NIL deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 2,400 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 1,600 with NIL deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,800 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 1,200 with NIL deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 2,400 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 1,600 with NIL deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 3,000 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 2,000 with NIL deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,800 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 1,200 with NIL deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 2,400 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 1,600 with NIL deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 3,000 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 2,000 with NIL deductible.

Optical
SAR 600 (For all beneficiaries)
SAR 800 (For all beneficiaries)
SAR 800 (For all beneficiaries)
SAR 1,000 (For all beneficiaries)
SAR 1,000 (For all beneficiaries)
SAR 1,000 (For all beneficiaries)
SAR 1,000 (For all beneficiaries)
SAR 2,000 (For all beneficiaries)
SAR 800 (For all beneficiaries)
SAR 1,000 (For all beneficiaries)
SAR 2,000 (For all beneficiaries)

Pre-existing Conditions & Chronic Diseases

Hearing Aids
SAR 6,000
SAR 6,000
SAR 6,000
SAR 6,000
SAR 6,000
SAR 6,000
SAR 6,000
SAR 6,000
SAR 6,000
SAR 6,000
SAR 6,000

Vaccination & Inoculations

Physiotherapy (When medically necessary)

Dialysis
SAR 180,000
SAR 180,000
SAR 180,000
SAR 180,000
SAR 180,000
SAR 180,000
SAR 180,000
SAR 180,000
SAR 180,000
SAR 180,000
SAR 180,000

Psychiatric Treatment
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000

Rehabilitation (physiotherapy)

Disability
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000

Obesity Treatment
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy

Acquired Heart Valve Diseases
SAR 150,000
SAR 150,000
SAR 150,000
SAR 150,000
SAR 150,000
SAR 150,000
SAR 150,000
SAR 150,000
SAR 150,000
SAR 150,000
SAR 150,000

Alzheimer’s Treatment
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000

Autism Treatment
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000

Donor Part Collection
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000

Emergency Out-of-Network Treatment

Transportation of the Deceased Beneficiary’s Body
SAR 10,000
SAR 10,000
SAR 10,000
SAR 10,000
SAR 10,000
SAR 10,000
SAR 10,000
SAR 10,000
SAR 10,000
SAR 10,000
SAR 10,000

Consulting an In-Network Doctor

Maximum Physician's Fees within the Network
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR

Family Planning
SAR 1,500
SAR 1,500
SAR 1,500
SAR 1,500
SAR 1,500
SAR 1,500
SAR 1,500
SAR 1,500
SAR 1,500
SAR 1,500
SAR 1,500

Menopausal & Perimenopausal

Sexually Transmitted Diseases

Comprehensive Diabetic Program

Kidney Transplant
SAR 250,000
SAR 250,000
SAR 250,000
SAR 250,000
SAR 250,000
SAR 250,000
SAR 250,000
SAR 250,000
SAR 250,000
SAR 250,000
SAR 250,000

Preventive Screenings

Local Ambulance

Medical Devices

Birth Defects

Network
NWM
NWS
NWS
NWR
NWR

Annual Limit
SAR 500,000
SAR 500,000
SAR 500,000
SAR 500,000
SAR 500,000

Inpatient

Room Type
Shared Room (Paid in full)
Shared Room (Paid in full)
Shared Room (Paid in full)
Shared Room (Paid in full)
Shared Room (Paid in full)

Companion Charges (When medically necessary)

Inpatient Co-pay
NIL
NIL
NIL
NIL
NIL

Outpatient

Outpatient Co-pay
20% up to SAR 75
20% up to: ● Hospitals: SAR 300 ● Polyclinics & MPN: SAR 75
20% up to: ● Hospitals: SAR 100 ● Polyclinics & MPN: SAR 75
20% up to: ● Hospitals: SAR 300 ● Polyclinics & MPN: SAR 75
20% up to: ● Hospitals: SAR 100 ● Polyclinics & MPN: SAR 75

Medication Co-pay
● Generic Medication or Branded Medication with no Generic Alternative Available: 20% up to SAR 30 ● Branded Medication with Generic Alternative Available: 50% without CAP
● Generic Medication or Branded Medication with no Generic Alternative Available: 20% up to SAR 30 ● Branded Medication with Generic Alternative Available: 50% without CAP
● Generic Medication or Branded Medication with no Generic Alternative Available: 20% up to SAR 30 ● Branded Medication with Generic Alternative Available: 50% without CAP
● Generic Medication or Branded Medication with no Generic Alternative Available: 20% up to SAR 30 ● Branded Medication with Generic Alternative Available: 50% without CAP
● Generic Medication or Branded Medication with no Generic Alternative Available: 20% up to SAR 30 ● Branded Medication with Generic Alternative Available: 50% without CAP

Pregnancy & Childbirth
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000

Pregnancy & Childbirth-related Complications

Premature Children’s Treatment

Circumcision
SAR 500
SAR 500
SAR 500
SAR 500
SAR 500

Neonatal

Newborn Early Testing
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000

Dental Treatment
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,200 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 800 with 20% deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,200 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 800 with 20% deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,200 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 800 with 20% deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,200 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 800 with 20% deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,200 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 800 with 20% deductible.

Optical
SAR 400 (For beneficiaries up to 14 years old)
SAR 400 (For beneficiaries up to 14 years old)
SAR 400 (For beneficiaries up to 14 years old)
SAR 400 (For beneficiaries up to 14 years old)
SAR 400 (For beneficiaries up to 14 years old)

Pre-existing Conditions & Chronic Diseases

Hearing Aids
SAR 6,000
SAR 6,000
SAR 6,000
SAR 6,000
SAR 6,000

Vaccination & Inoculations

Physiotherapy (When medically necessary)

Dialysis
SAR 180,000
SAR 180,000
SAR 180,000
SAR 180,000
SAR 180,000

Psychiatric Treatment
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000

Rehabilitation (physiotherapy)

Disability
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000

Obesity Treatment
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy

Acquired Heart Valve Diseases
SAR 150,000
SAR 150,000
SAR 150,000
SAR 150,000
SAR 150,000

Alzheimer’s Treatment
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000

Autism Treatment
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000

Donor Part Collection
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000

Transportation of the Deceased Beneficiary’s Body
SAR 10,000
SAR 10,000
SAR 10,000
SAR 10,000
SAR 10,000

Emergency Out-of-Network Treatment

Consulting an In-Network Doctor

Maximum Physician's Fees within the Network
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR

Family Planning
SAR 1,500
SAR 1,500
SAR 1,500
SAR 1,500
SAR 1,500

Menopausal & Perimenopausal

Sexually Transmitted Diseases

Comprehensive Diabetic Program

Preventive Screenings

Kidney Transplant
SAR 250,000
SAR 250,000
SAR 250,000
SAR 250,000
SAR 250,000

Local Ambulance

Medical Devices

Birth Defects

Network
NW1
NW1
NW2
NW2
NW3
NW3
NW4
NW4

Annual Limit
SAR 500,000
SAR 500,000
SAR 500,000
SAR 500,000
SAR 500,000
SAR 500,000
SAR 500,000
SAR 500,000

Inpatient

Room Type
Shared Room (Paid in full)
Shared Room (Paid in full)
Shared Room (Paid in full)
Shared Room (Paid in full)
Single Room
Single Room
Single Room
Single Room

Companion Charges (When medically necessary)

Inpatient Co-pay
NIL
NIL
NIL
NIL
NIL
NIL
NIL
NIL

Outpatient

Outpatient Co-pay
20% up to: ● Hospitals: SAR 300 ● Polyclinics & MPN: SAR 75
20% up to: ● Hospitals: SAR 100 ● Polyclinics & MPN: SAR 75
20% up to: ● Hospitals: SAR 300 ● Polyclinics & MPN: SAR 75
20% up to: ● Hospitals: SAR 100 ● Polyclinics & MPN: SAR 75
20% up to: ● Hospitals: SAR 300 ● Polyclinics & MPN: SAR 75
20% up to: ● Hospitals: SAR 100 ● Polyclinics & MPN: SAR 75
20% up to: ● Hospitals: SAR 300 ● Polyclinics & MPN: SAR 75
20% up to: ● Hospitals: SAR 100 ● Polyclinics & MPN: SAR 75

Medication Co-pay
● Generic Medication or Branded Medication with no Generic Alternative Available: 20% up to SAR 30 ● Branded Medication with Generic Alternative Available: 20% without CAP
● Generic Medication or Branded Medication with no Generic Alternative Available: 20% up to SAR 30 ● Branded Medication with Generic Alternative Available: 20% without CAP
● Generic Medication or Branded Medication with no Generic Alternative Available: 20% up to SAR 30 ● Branded Medication with Generic Alternative Available: 20% without CAP
● Generic Medication or Branded Medication with no Generic Alternative Available: 20% up to SAR 30 ● Branded Medication with Generic Alternative Available: 20% without CAP
● Generic Medication or Branded Medication with no Generic Alternative Available: 20% up to SAR 30 ● Branded Medication with Generic Alternative Available: 20% without CAP
● Generic Medication or Branded Medication with no Generic Alternative Available: 20% up to SAR 30 ● Branded Medication with Generic Alternative Available: 20% without CAP
● Generic Medication or Branded Medication with no Generic Alternative Available: 20% up to SAR 30 ● Branded Medication with Generic Alternative Available: 20% without CAP
● Generic Medication or Branded Medication with no Generic Alternative Available: 20% up to SAR 30 ● Branded Medication with Generic Alternative Available: 20% without CAP

Pregnancy & Childbirth
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000

Pregnancy & Childbirth-related Complications

Premature Children’s Treatment

Circumcision
SAR 500
SAR 500
SAR 500
SAR 500
SAR 500
SAR 500
SAR 500
SAR 500

Neonatal

Newborn Early Testing
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000

Dental Treatment
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,200 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 800 with 20% deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,200 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 800 with 20% deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,200 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 800 with 20% deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,200 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 800 with 20% deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,200 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 800 with 20% deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,200 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 800 with 20% deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,200 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 800 with 20% deductible.
● Essential & Preventive dental treatment: Covered up to a maximum of SAR 1,200 without deductible. ● Treatment of root canals & Emergencies: Covered up to SAR 800 with 20% deductible.

Optical
SAR 400 (For all beneficiaries)
SAR 400 (For all beneficiaries)
SAR 400 (For all beneficiaries)
SAR 400 (For all beneficiaries)
SAR 600 (For all beneficiaries)
SAR 600 (For all beneficiaries)
SAR 600 (For all beneficiaries)
SAR 600 (For all beneficiaries)

Pre-existing Conditions & Chronic Diseases

Hearing Aids
SAR 6,000
SAR 6,000
SAR 6,000
SAR 6,000
SAR 6,000
SAR 6,000
SAR 6,000
SAR 6,000

Vaccination & Inoculations

Physiotherapy (When medically necessary)

Dialysis
SAR 180,000
SAR 180,000
SAR 180,000
SAR 180,000
SAR 180,000
SAR 180,000
SAR 180,000
SAR 180,000

Psychiatric Treatment
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000

Rehabilitation (physiotherapy)

Disability
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000
SAR 100,000

Obesity Treatment
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy
● Covered up to SR 15,000 per insurance cover period, with 20% co-pay up to SAR 1,000. (Coverage is subject to the BMI mentioned as per (Bariatric Surgery Bundle) from the unified CHI policy

Acquired Heart Valve Diseases
SAR 150,000
SAR 150,000
SAR 150,000
SAR 150,000
SAR 150,000
SAR 150,000
SAR 150,000
SAR 150,000

Alzheimer’s Treatment
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000
SAR 15,000

Autism Treatment
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000

Donor Part Collection
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000
SAR 50,000

Emergency Out-of-Network Treatment

Transportation of the Deceased Beneficiary’s Body
SAR 10,000
SAR 10,000
SAR 10,000
SAR 10,000
SAR 10,000
SAR 10,000
SAR 10,000
SAR 10,000

Consulting an In-Network Doctor

Maximum Physician's Fees within the Network
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR
● General Practitioner/ specialist (First Registrar Doctor): 100 - 150 SAR ● Specialist (Second Registrar Doctor)/ Consultant: 200 - 300 SAR ● Specializations with scarcity and the like: (Such as cardiology, neurosurgery, vascular surgery and subspecialties according to the standards of the Saudi Commission for Health Specialties) 400 SAR

Family Planning
SAR 1,500
SAR 1,500
SAR 1,500
SAR 1,500
SAR 1,500
SAR 1,500
SAR 1,500
SAR 1,500

Menopausal & Perimenopausal

Sexually Transmitted Diseases

Comprehensive Diabetic Program

Kidney Transplant
SAR 250,000
SAR 250,000
SAR 250,000
SAR 250,000
SAR 250,000
SAR 250,000
SAR 250,000
SAR 250,000

Preventive Screenings

Local Ambulance

Medical Devices

Birth Defects

Annual Limit
SAR 525,000
SAR 450,000
SAR 450,000
SAR 275,0000
SAR 275,0000
SAR 275,0000
SAR 275,0000
SAR 275,0000
SAR 275,0000
SAR 275,0000
SAR 275,0000
SAR 275,0000

Coverage
23 hospitals
44 hospitals
43 hospitals
12 hospitals
32 hospitals
11 hospitals
23 hospitals
22 hospitals
5 hospitals
3 hospitals
4 hospitals
9 hospitals

Inpatient Hospitalization
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered

Accomodation
Standard Suite
Standard Suite
Standard Suite
Standard Suite
Standard Suite
Standard Suite
Standard Suite
Standard Suite
Standard Suite
Standard Suite
Standard Suite
Standard Suite

Companion
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered

Co-Pay Hospitalization Only
-
-
-
-
-
-
-
-
-
-
-
-

Co-Pay Outpatient
Hospital 0
Hospital 0
Hospital 0
Hospital 0
Hospital 0
Hospital 0
Hospital 0
Hospital 0
Hospital 0
Hospital 0
Hospital 0
Hospital 0

Outpatient Dept Cost
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered

Inpatient deductible
-
-
-
-
-
-
-
-
-
-
-
-

Outpatient Coverage
12 sessions
12 sessions
12 sessions
12 sessions
12 sessions
12 sessions
12 sessions
12 sessions
12 sessions
12 sessions
12 sessions
12 sessions

Annual Limit
SAR 525,000
SAR 450,000
SAR 450,000
SAR 275,0000
SAR 275,0000
SAR 275,0000
SAR 275,0000
SAR 275,0000
SAR 275,0000
SAR 275,0000
SAR 275,0000
SAR 275,0000

Coverage
23 hospitals
44 hospitals
43 hospitals
12 hospitals
32 hospitals
11 hospitals
23 hospitals
22 hospitals
5 hospitals
3 hospitals
4 hospitals
9 hospitals

Inpatient Hospitalization
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered

Accomodation
Standard Suite
Standard Suite
Standard Suite
Standard Suite
Standard Suite
Standard Suite
Standard Suite
Standard Suite
Standard Suite
Standard Suite
Standard Suite
Standard Suite

Companion
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered

Co-Pay Hospitalization Only
-
-
-
-
-
-
-
-
-
-
-
-

Co-Pay Outpatient
Hospital 0
Hospital 0
Hospital 0
Hospital 0
Hospital 0
Hospital 0
Hospital 0
Hospital 0
Hospital 0
Hospital 0
Hospital 0
Hospital 0

Outpatient Dept Cost
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered

Inpatient deductible
-
-
-
-
-
-
-
-
-
-
-
-

Outpatient Coverage
12 sessions
12 sessions
12 sessions
12 sessions
12 sessions
12 sessions
12 sessions
12 sessions
12 sessions
12 sessions
12 sessions
12 sessions

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Premium 2.1

Premium 2.2

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Premium 3.1

Premium 3.2

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Premium 4.1

Premium 4.2

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Essential 2.1

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Essential 1.0

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Essential 2.1

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Essential 3.1

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Classic 1.1

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Classic 4.1

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Classic 1.1

Classic 2.0

Classic 2.1

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Classic 3.1

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Classic 4.1

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