Qualifying department qualifies insurance companies to participate in the cooperative health insurance business, and qualifies third party administrative companies to handle cooperative health insurance claims. Moreover, oversee the performance of companies and supervise them to do their responsibilities stated by the Cooperative Health Insurance Law and its Implementing regulation and its standardize policy. Tasks and responsibilities :: First, overseeing the implementation of the system: Control over the comprehensive health insurance coverage. Rehabilitation of insurance companies to transact insurance business health. The adoption of health service providers. Osaddad Financial Regulation for the revenues and expenditures of the Council. To resolve differences for the settlement of claims payments between service providers and insurance companies. The development of standards of medical service necessary for the health insurance companies to respond quickly to service providers bear the costs of treatment. To grant exceptions to the health insurance companies to contract with non-Saudi physicians for the purpose of monitoring the compliance requirements of service providers within the treatment cost-effectiveness. Examine complaints that arise between the parties to the relationship of insurance and forwarded to the Commission violations of the system. Collect the value of financial sanctions for breaching the provisions of the health insurance system. Determine the technical provisions recognized in coordination with other regulators and insurance companies are obliged to them. Supervision of the Cooperative Health Insurance Fund based on converting part of the surplus of insurance, calculated in the light of the results of the insurance company. Review insurance premiums and permit approval for insurance companies on premium if different than the value of the premium made by the company in the Action Plan. Clarification and interpretation of the Regulations. Dissemination of public information about the activities of insurance companies are eligible. Publication of the tables and statistical data on health insurance in the UK each year. Second, supervision and control of insurance companies: Disqualification of the health insurance business in the following cases: ◦ disturb the qualification requirements of the insurance company. ◦ Do not use during rehabilitation (12) months. ◦ give the insurance company expressly for rehabilitation. ◦ the company had stopped the practice of the Company for (6) months. Protect the interests of the beneficiaries as it may deem necessary, such as the Secretariat to amend the plan of work of any health insurance company. To obtain from the other supervisory information, data, and that work on issues such as health insurance application forms used by the health insurance company in correspondence with the parties to the relationship of insurance. Review and audit of all health insurance companies under the jurisdiction of the Council and the demand from other regulatory bodies to do so. A reservation on any of the executives in any of the health insurance companies. Take action after reviewing the bringing of any malfunction of the other oversight responsibility for ensuring the solvency of the company and its capital adequacy and safety of its assets and its allocation and the technical ability to fulfill its commitment to the beneficiaries. To maintain the confidentiality of the information on the insurance companies are not used only for official purposes specified in the regulations. Third, supervision and control of service providers: Determine the fees for the adoption of health service providers. Determine the fees for exempt entities that have medical facilities of the insurance coverage or part of it. Proposal to pilot a service contract between service providers and insurance companies. Identify requirements that should be available at the health facility, to maintain quality of health services provided in cooperation with the government health institutions with the capacity. Control standards provide the requirements of quality and commitment of the service provider contract (by Secretariat), a special consultant with the Office to assess the extent of its commitment to quality requirements. Assessment of health and service contracts between insurance companies and providers of services and monitor the compliance of the contracts to maintain quality controls. Revoke the accreditation of service providers in the following cases: ◦ withdrawn the license of the facility by the Ministry of Health. ◦ lack of commitment to the service provider contracted by the Office of the Secretariat, with a specialist to assess and measure the extent of his commitment to the requirements of quality
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Contact Information
Kingdom of Saudi Arabia Cooperative Health Insurance Council General Secretariat Alsahafa District , King Fahd Road Customer Service l: 920001177 P.O. 94 764 Riyadh 11614
Phone: 966-11-4878600
Fax: 966-11-4870071
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