SALAMA provides health groups insurance policy that has a distinguished medical services with different classes to meet the needs of all segments.  All health insurance classes correspond with the requirements of the Council of Cooperative Health Insurance (CCHI) in the coverage and exceptions, which are as follows:

§  Main Coverage (Annual limit per person per policy year = SR 250,000):

a.     In-patient (Hospitalization)

b.     Out-patient

c.      Diagnostic Tests

d.     Consultation

e.     Chronic and pre-existing conditions

f.       Maternity (maximum up to SR 15,000)

g.     Acute Psychological Treatment  (maximum up to SR 15,000)

h.     Hospital accommodation

i.        Dialysis (covered up to SR 100,000 per person per policy period)

j.       Congenital diseases in new born, if life threatening

k.     Dental (covered up to SR 2,000)

l.        Optical (covered up to SR 200)

m.  Hearing test and hearing aid (covered up to policy max limit)

n.     Acute Psychological Treatment  (maximum up to SR 15,000)

o.     Death Repatriation  (maximum up to SR 10,000)

p.     Consultation  (GP SR 50, Consultant max up to SR 250)

q.     Physiotherapy  (if medically necessary and recommended)

r.      Hospitals and clinics network  (as per standard TPA’s network)

§  Major Exclusions:

a.     Self inflicted injuries and diseases

b.     Any type of cosmetic surgery and cosmetic treatment

c.      Any ailment or injury arising  as a direct result of insured’s occupation

d.     Ailments which arise out of drug abuse, alcohol, sedatives etc.

e.     Any diagnostic test, vaccine, drugs or preventive measures not required by medical treatment

f.       Expenses of treatment pertaining to diagnosis of HIV, AIDS and related diseases

g.     Pregnancy and maternity contracted on unmarried status

h.     Treatment received by the insured without any consultation

i.        Physiotherapy  (if medically necessary and recommended)

j.       Hospitals and clinics network  (as per standard TPA’s network)

k.     Treatment of sexual diseases or sexually transmitted diseases

l.        Any body weakness and congenital deformity

m.  Treatment of acne of obesity or over-weight treatment

n.     Organ transplant, bone marrow transplant, or the transplant of any substitute artificial limb replacing the original limb

o.     Deductibles

p.     Any claim arising out of war, invasion, civil war, radioactivity, riot, strike, civil commotion

q.     Non emergency treatment at non panel hospital is covered up to 80%

§  Geographical Scope of Coverage:

a.     Covered all over the Kingdom

b.     Covered all over the world for medical emergencies:

•      During business trips, and

•      During annual leaves maximum up to 60 days

c.      Coverage outside Kingdom should be as per TPA’s network customary charges

d.     Non emergency cases outside kingdom  are covered up to 80% subject to:

•      Pre-approval from insurance company

•      As per TPA’s network customary charges

The classes offered by SALAMA contain all the features and conditions above, the main difference is the size of the network and the maximum coverage of some conditions. Health Insurance classes are divided into five categories:

§  VIP Category

§  A Category

§  B Category

§  C Category