Pregnancy and childbirth limit
- (Natural childbirth, prenatal and postnatal care).
SAR 15,000
- Pregnancy and childbirth-related complications including Caesarean delivery, ectopic pregnancy, bleeding associated with childbirth, pregnancy loss and legal abortion.
Covered up to the overall annual maximum limit.
- Premature children’s treatment.
Covered up to the overall annual maximum limit.
- Neonatal cover newborn babies are covered 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
Covered up to the annual maximum limit.
Costs of circumcision (males)
Covered up to a maximum of SAR 500
Costs relating to the national program for early testing of newborn children to prevent disability
Covered up to SAR 100,000 during the policy term.
Dental Treatment:
All essential dental procedures and Root Canals and Emergencies
SAR 1,200 (Essential & Preventive, no deductible)
SAR 800 (Treatment of root canals & Emergencies, with 20% deductible)
Optical: Basic medical frame and lenses without any add-ons.
(Rate limit for framework is SAR 400).
SAR 400
(For all beneficiaries)
Pre-existing conditions & chronic diseases
Covered up to the maximum annual benefit limit
Hearing aid costs
Covered up to SAR 6,000 for total claims for both ears over the policy term
Vaccination & inoculations as per the Ministry of Health (MOH) schedule
Covered based on MOH’s vaccination guidelines for children and adults
Physiotherapy when medically necessary.
Covered up to the overall annual maximum limit.
Dialysis
Covered up to SR 180,000 per insurance cover period.
Psychiatric Treatment
Covered up to SR 50,000 per insurance cover period.
Rehabilitation (physiotherapy)
Covered up to the overall annual maximum limit.
Disability costs
Covered up to a maximum of SAR 100,000 during the policy term.
Obesity treatment: The cost of covering obesity treatment based on (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
Cost of acquired heart valve
diseases management
Covered up to a maximum of SAR 150,000 during the policy term
Alzheimer’s treatment
Covered up to a maximum of SAR 15,000 during the policy term
Autism treatment
Covered up to SAR 50,000 per insurance cover period according
to the announced regulations
Cost of donor part collection
Covered up to a maximum of SAR 50,000 during the policy term
Transportation of the deceased beneficiary’s
body from the Kingdom to his country of origin
Covered up to a maximum of SAR 10,000 during the policy term
Consulting an in-network doctor
Covered
Local ambulance
Covered by ambulances of approved service providers in cases
of medical emergencies
Out-of-network treatment for life-threatening
emergency conditions inside the Kingdom:
Fully covered from the maximum annual benefit limit.
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
Covered
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:
Cost of birth control for females
(Coverage for temporary contraception that includes hormonal contraceptives therapy and intrauterine devices according to the approved guideline)
Covered up to SR 1500 per insurance cover period
Menopausal & Perimenopausal
Covered including alternative hormone therapy
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)
Covered
Comprehensive Diabetic Program
Covered
Preventive Screenings
Covered based on national guidelines for periodic health examinations
(1. Mammogram to detect breast cancer, 2. Pap smear to detect cervical cancer, 3. Fecal immunochemical test (FIT) or colonoscopy as per the medical necessity and best clinical practice to detect colon cancer. (Fecal immunochemical test) or colonoscopy according to medical need and best medical practices, 4. Behavioral or dietary consultations, or both, about healthy diet, and physical activity to prevent cardiovascular disease for adults with cardiovascular risk factors and have a Body Mass Index of more than 30 or those with two and more risk factors for heart Disease, 5. Diabetes screening by fasting blood sugar test or checking (HbA1C) test, 6. Lipid profile test, 7. Bone densitometry (DEXA) to Detect Osteoporosis)
Kidney Transplant
Covered up to SR 250,000 per insurance cover period
Medical Devices
Covered based on the Saudi clinical guide for diabetes
Birth defects
Covered up to the overall annual maximum limit
Additional Table of benefits
Emergency medical evacuation in cooperation with International SOS Assistance when the
illness occurs outside the KSA only
Not covered
Emergency life threating treatment –out KSA
The actual cost of covered medical services is limited to the amounts mentioned below.
Any cost exceeding this amount will be covered at reasonable and customary rates for the same
level of coverage in the approved network within Saudi Arabia (SR 50,000)
Elective (non-emergency) treatment out of network – IN/OUT KSA
Covered as per accepted prices and approved for the same level of coverage in the network approved within
the Kingdom of Saudi Arabia through the principle of Reimbursements only for the cases covered in this
policy, based on the conditions of Reimbursements and the prior approval of Buba Arabia