The Standard Insurance Policy of the compulsory health insurance for domestic workers and their equivalent who are more

The following words and phrases, wherever they occur herein, shall have the meanings assigned thereto, unless the context requires otherwise. Policy: The Standard Insurance Policy of the compulsory health insurance for domestic workers and their equivalent who number are more than (4) The Company: The Insurance Company licensed by the Insurance Authority that conducting health insurance activities. Kingdom: Kingdom of Saudi Arabia. Authority: Insurance Authority Council: Council of Health Insurance Employer: Every natural person who recruited a domestic service worker himself, or through a licensed recruitment agency, to perform a domestic service, or to whom the services of a domestic service worker were transferred. Domestic service worker: Every natural person who performs domestic service directly for the employer or any member of his family, and during the performance of the service he is under the supervision and direction of the employer, or someone acting in his place, even if he is away from his supervision. The competent authority determines the professions of the worker. Home service. The insured: the domestic worker who benefits from insurance coverage according to the provisions stated in the policy. Policyholder: the employer in whose name the policy was issued. Policy schedule: The schedule atached to the policy. It contains the data of the employer and the domestic worker and also contains the coverage limits for the benefits included in the insurance coverage. Appendix: An agreement between the insurance company and the employer subsequent to the issuance of the policy, for the purpose of adding, amending, or canceling additional coverages. Premium: the amount paid by the Insurance Applicant on behalf of the Employer to the Insurer for its acceptance to indemnify the Insured for the damage directly caused by a risk covered under the Policy. Claim: a request submited to the insurance company or its representative from a service provider, the insured, or the policyholder, for the purpose of replacing the value of health services expenses included within the policy’s coverage, and which is accompanied by the financial and medical documents supporting it. Service Provider: The health facility (governmental and non-governmental) that is legally qualified or licensed to provide health services in the Kingdom in accordance with the relevant regulations and rules, and approved by the Health Insurance Council, and for example but not limited to: a hospital, a general medical complex, a complex Specialized medical, diagnostic center, clinic, pharmacy, laboratory, physical therapy center or radiation therapy center. Approved service provider network: A group of health service providers approved by the Council and designated by the insurance company to provide the service to the insured. These services are credited directly to the insurance company’s account, this network includes the following levels of health services: Emergency cases: emergency medical treatment required by the insured’s medical condition following the occurrence of an event, accident, or emergency health condition that requires rapid medical intervention, according to the following levels of urgent medical care triage levels (1- Resuscitation, 2- Emergency, 3 - An urgent situation that could lead to the loss of life, the loss of one or more organs, or the occurrence of a temporary or permanent disability) as stated in the private health institutions system and its executive regulations. Hospitalization: Registering the insured person as an admited patient in the hospital until at least the next morning, including a patient who is admited based on this reason and leaves the hospital for any reason without spending the night. Expenses for returning the remains of the deceased to his country of origin: All expenses for preparing and returning the body of the insured person to his country of origin. Emergency medical evacuation: Transferring the patient to the nearest medical center inside and outside the Kingdom that provides the health service the patient needs. Traffic accident: Any accident that results in serious or minor damage or partial or total material loss to property without intention, as a result of using the vehicle while it is in motion, as stipulated in the relevant and relevant regulations. Material Fact: any information requested by the Insurer from the Insurance Applicant when concluding the Policy that may affect the Insurer’s decision to accept or reject the insurance coverage request, or accept it under different conditions. Basis for compensatory compensation: The method used to compensate the policyholder for the compensable expenses incurred by the insured and for which a claim is submited, after applying the payment participation rate. Primary health care Secondary (general hospitals). Tertiaory (specialized or referral hospitals). Centers providing other complementary health services (such as: day surgery centers, pharmacies, physical therapy centers, optical stores, telemedicine, and home care). عافيتهم من عافيتنا Insurance Coverage