- Overall annual maximum limit per member (in SR)
- SAR 150,000
- SAR 250,000
- SAR 500,000
- SAR 150,000
- SAR 250,000
- Hearing Aids
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Congenital Illness
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Dialysis
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Rehabilitation (physiotherapy)
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Healthline Services
- Available
- Available
- Available
- Available
- Available
- Neonatal cover
- Not covered until newborn added optionally in the policy
- Not covered until added optionally in the policy
- Not covered until added optionally in the policy
- Not covered until newborn added optionally in the policy
- Not covered until added optionally in the policy
- OP Deductible
- 25% with no limit
- 25% with no limit
- 25% with no limit
- 20% up to 100 SAR
- NIL
- VI Ministry Health
- Covered
- Covered
- Covered
- Covered
- Accommodation
- Single Room
- Single Room
- Suite
- Single Room
- Standard Suite
- International emergency treatment
- Not Covered
- Not Covered
- Not Covered
- 100% cover on the first SR 50,000 subject to scheme limits and sub-limits. Any cost over this amount will be based on the customary prices of network hospitals according to the member’s scheme level.
- Maternity cover with benefits
- SAR 10,000
- SAR 15,000
- SAR 20,000
- SAR 15,000
- SAR 25,000
- Dental coverage
- SAR 1,000
- SAR 1,500
- SAR 2,000
- SAR 2,000
- SAR 3,000
- Optical coverage
- Not Covered
- Not covered
- Not Covered
- SAR 600
- SAR 1,000
- Seniors over 64-year old annual limit
- SAR 150,000
- SAR 250,000
- SAR 500,000
- SAR 150,000
- SAR 250,000
- In-patient / day-case coverage
- Covered
- Covered
- Covered
- Covered
- Covered
- Companion charges
- Not Covered
- Not Covered
- Not Covered
- Covered up to 12 years old
- Covered until 12 years old
- In-patient deductible
- 20% no Limit
- 25% with no limit
- 25% with no limit
- Covered
- NIL
- Out-patient coverage
- 20% no Limit
- 25% with no limit
- 25% with no limit
- Covered 20% up to SR 100
- Treatment of premature babies
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Circumcision of new-born boys and ear piercing of new-born girls
- Not Covered
- Not Covered
- Not Covered
- Covered
- Covered
- Pre-existing conditions and chronic disease
- Covered, with IP/OP co-pay and Medication sub-limit
- Covered, with IP/OP co-pay and Medication sub-limit
- Covered, subject to IP/OP co-pay and Medication sub-limit
- Covered
- Covered
- Treatment for acquired heart valves diseases
- Not Covered
- Not Covered
- Covered
- Seasonal vaccination including mother and child care as per the Ministry of Health (MOH) programme and schedule
- Covered
- Physiotherapy when medically needed
- 12 Sessions for covered procedures
- 12 Sessions for covered procedures
- 12 Sessions when medically necessary and covered procedure
- 12 Sessions when medically necessary for covered procedures
- 12 Sessions when medically necessary and covered procedures
- Cost of early screening for new-borns (National Program for Prevention of Disability)
- Not Covered
- Not Covered
- Not Covered
- Alzheimer’s Disease
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Autism
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Acute psychiatric
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Disability cases
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Treatment for damage to acquired heart valves
- Not Covered
- Not Covered
- Not Covered
- Artificial limbs
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Cost of obtaining harvesting donor organs
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Local road ambulance for emergency cases only
- Not Covered
- Not Covered
- Not Covered
- SAR 1,000
- SAR 3,000
- Transportation of mortal remains to home country in case of death in KSA
- Not Covered
- Not Covered
- Not Covered
- SAR 1,000
- Not Covered
- life threating emergency treatment out of network in KSA
- Covered from the maximum annual benefit limit based on the network benchmarked prices
- Covered from the maximum annual benefit limit based on the network benchmarked prices
- Covered from the maximum annual benefit limit based on the network benchmarked prices
- 100% cover on the first SR 50,000 subject to scheme limits and sub-limits. Any cost over this amount will be based on the customary prices of network hospitals according to the member’s scheme level
- 100% cover on the first SR 50,000 subject to scheme limits and sub-limits. Any cost over this amount will be based on the customary prices of network hospitals according to the member’s scheme level
- Physicians fees within the network
- Covered
- Covered
- Covered
- Covered
- Covered
- Emergency evacuation through international SOS assistance
- Not Covered
- Not Covered
- Not Covered
- Covered
- Covered
- Elective (non-emergency) treatment out of network in or out of KSA
- Not Covered
- Covered from the maximum annual benefit limit based on the network benchmarked prices within the Kingdom
- Covered from the maximum annual benefit limit based on the network benchmarked prices within the Kingdom
- inpatient pre authorization approval
- Pre-authorization required above 1,000 SAR
- Pre-authorization required above 1,000 SAR
- Pre-authorization required above 1,000 SAR
- Pre-authorization required above 1,000 SAR
- Pre-authorization required above 1,000 SAR
- out patient pre authorization approval
- Pre-authorization required above 1,000 SAR
- Pre-authorization required above 1,000 SAR
- Pre-authorization required above 1,000 SAR
- Pre-authorization required above 1,000 SAR
- Pre-authorization required above 1,000 SAR
- Advanced Imaging (MRI, CT, PET)
- Pre-authorization Required
- Pre-authorization Required
- Pre-authorization Required
- Pre-authorization Required
- Pre-authorization Required
- Cancer treatment
- Local air ambulance for emergency cases only
- Maternity complications (Caesarean deliveries, legal abortion, miscarriage, hemorrhages …)
- SAR 10,000
- SAR 15,000
- SAR 20,000
- SAR 15,000
- SAR 25,000
- Neonatal newborn cover
- Not covered until newborn added optionally in the policy
- Not covered until newborn added optionally in the policy
- Not covered until newborn added optionally in the policy
- Not covered until newborn added optionally in the policy
- Not covered until added optionally in the policy
- Mental health conditions (acute psychiatric treatment)
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Non-emergency (elective) treatment outside the Bupa network
- Covered 100% based on the customary prices according to the member’s scheme level and network hospitals within the Kingdom
- Covered 100% based on the customary prices according to the member’s scheme level and network hospitals within the Kingdom
- Physiotherapy when medically necessary
- 12 Sessions for covered procedures
- 12 Sessions for covered procedures
- 12 Sessions when medically necessary and covered procedure
- 12 Sessions when medically necessary for covered procedures
- 12 Sessions when medically necessary and to covered procedures
- Circumcision of new born boys
- Not Covered
- Not Covered
- Not Covered
- Covered
- Covered
- Ear piercing of new born girls
- Not Covered
- Not Covered
- Not Covered
- Covered
- Covered
- transplant of organ or born marrow
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Treatment for contagious or endemic diseases
- Not Covered
- Not Covered
- Not Covered
- Vaccinations and inoculations (up till age 6)
- Covered
- Covered
- Covered
- Covered
- Covered
- Vaccinations and inoculations (after age 6)
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Covered
- MOH vaccines
- Covered
- Covered
- Not Covered
- Covered
- Covered
- Physiotherapy
- 12 Sessions when medically necessary for covered procedures
- 12 Sessions when medically necessary for covered procedures
- 12 Sessions when medically necessary and covered procedure
- 12 Sessions when medically necessary for covered procedures
- 12 Sessions when medically necessary and for covered procedures
- Emergency medical treatment in the US
- Not Covered
- Not Covered
- In patient day case treatment
- Covered
- Covered
- Covered
- Covered
- Covered
- Appropriate diagnosis and treatment in outpatient clinics including the cost of the General Physical/ Specialists, radiology, chemotherapy, laboratory exams, other diagnostic tests and medication
- Covered
- Covered
- Covered
- Covered
- Covered
- Out-patient Consultation
- Covered, 25% with no limit
- Covered, 25% with no limit
- Covered, 25% with no limit
- Covered
- Covered
- Emergency treatment outside the kingdom through International SOS Assistance
- Not Covered
- Not Covered
- Not Covered
- Covered
- Covered
- Emergency treatment outside of network in KSA
- Covered 100% of the actual cost up to the annual maximum limit
- 100% cover on the first SR 50,000 subject to scheme limits and sub-limits. Any cost over this amount will be based on the customary prices of network hospitals according to the member’s scheme level
- Artificial milk and milk products
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- New born congenital heart anomalies screening
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- New born screening hearing test
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Obesity
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Respiratory syncytial virus (RSV) prophylaxis
- Not Covered
- Not Covered
- Not Covered
- Not Covered
- Deductible Rate
- 25% with no limit
- 25% with no limit
- 25% with no limit
- 20% up to 100 SAR
- NIL
- Maximum Deductible (Hospital)
- 25% with no limit
- 25% with no limit
- Maximum Deductible (MPN)
- 25% with no limit
- 25% with no limit
- Maximum Deductible (Polyclinic)
- 25% with no limit
- 25% with no limit