The Cabinet approved the organization of the National Health Insurance Center.
The following are the most prominent details, objectives and beneficiaries of it, according to what was published in the official newspaper “Umm Al-Qura”:
The birth of the center
According to the regulation, a center called the “National Health Insurance Center” shall be established. It is organizationally linked to the minister, and enjoys legal personality and financial and administrative independence. The center’s headquarters shall be in the city of Riyadh, and it may establish branches or other offices within the Kingdom as needed.
The Center may also establish subsidiaries on its own, and may participate with other Saudi and foreign companies, institutions or bodies in establishing other companies, or purchase shares or shares in existing companies to engage in business complementary or similar to its business or that would assist it in achieving its objectives and exercising its competence.
Objectives of the center
The center aims to purchase health care and all associated with approved health institutions, in order to ensure that health institutions provide health care to beneficiaries with high quality and efficiency, support the health system’s response to the health needs of the community, control the cost of health care, and enhance competitiveness and transparency, in order to ensure financial sustainability and distribution equitable resources.
In order to achieve its goals, the Center has the right to use the best financing and commercial principles, standards and practices, and it has the flexibility and powers that enable it to carry out its tasks and achieve its goals.
Categories benefiting from the center
The following categories of services related to the center’s objectives benefit from:
1- All citizens who are eligible for health care – in accordance with the relevant regulations and decisions – if they are not covered by other health care systems, programs or services provided to them by entities other than the Ministry.
2- Citizens covered by health care systems, programs or other special services provided to them by bodies other than the Ministry, in accordance with what is approved by the Council of Ministers based on a proposal submitted by the Ministry, the Ministry of Finance and those bodies.
3- Saudis working in the public and private sectors, their family members, children of a Saudi mother from a non-Saudi husband residing in the Kingdom, a non-Saudi wife married to a Saudi, and a non-Saudi married to a Saudi woman residing in the Kingdom; If the required health care is not covered by the insurance coverage in the cooperative health insurance policy issued to them in accordance with the cooperative health insurance system and its executive regulations.
4- Non-Saudis working in government sectors; If they are not covered by other special health care systems, programs or services.
5- Any category that issues a regular tool by including it among the beneficiaries.
Preparing a health care coverage list
The amendment stipulates that the Ministry shall prepare a regulation for health care coverage, taking into account the adequate coverage of the beneficiaries’ needs, protection from risks, fair distribution and quality of services, in accordance with relevant laws, regulations and decisions, and approved by a decision of the Council. The approved health institutions are also committed to the following:
1- Taking into account the objectives of the Center when exercising its activities, and working to achieve those objectives in relation to its dealings with the Center.
2- Providing the center – in full transparency – with information and documents related to the health care being purchased; In the form and manner specified by the Centre.
3- To reconcile all its procedures and systems with the procedures and systems of the Centre; To enable him to exercise his competence and achieve his goals.
4- Fulfilling all its contractual obligations towards the Centre.
5- Adherence to the evidence issued by the center related to the purchase of health care.
The center’s board of directors and its meetings
The center shall have a board of directors headed by the Minister of Health, and the membership of each is a representative of the Ministry of Finance, a representative of the Spending Efficiency and Governmental Projects Authority, a representative of the National Center for Privatization, and five members from the public and private sectors (local and international). These members are also appointed by a decision of the Council of Ministers Based on a proposal from the Minister and after the approval of the Council of Economic and Development Affairs, their membership term is three years, renewable once.
The center shall have a competent and experienced chief executive, appointed by the board for a period of four years, subject to renewal, and determines his wages and other benefits. The provisions of the labor system and social insurance system.
The decisions of the Board are issued by the majority of the votes of the attending members at least. In the event of a tie, the side with which the meeting chairperson voted shall prevail. The Board may invite specialists and consultants to attend its meetings, without having the right to vote.
The regulation also stipulated that a council member may not divulge any of the center’s secrets because of his membership in the council, and a council member may not have any direct or indirect personal interest in the business and contracts related to the center.
Council Powers
The council is the dominant authority to manage, supervise and manage the affairs of the center, and takes all the necessary decisions to achieve its goals within the limits of the provisions of the organization, and among the most prominent of these competencies are the approval of policies, strategies, programmes, plans and tools that achieve the goals of the center, the approval of the center’s organizational structure, in accordance with the regular procedures, and the approval of The center’s annual budget draft, its final account, the auditor’s report, and the annual report, and submitting them in accordance with the statutory procedures.
His powers also included proposing draft laws, regulations, decisions, incentives and enablers that would contribute to achieving the center’s objectives, suggesting amending the existing ones, and submitting it to the competent authorities.
Center resources and budgets
The resources of the center consist of what is allocated to it from the appropriations within the general budget of the state, the sums awarded for the interest of the center, gifts, subsidies, grants, donations, wills and endowments accepted by the council in accordance with the relevant statutory texts, and any other resource accepted or approved by the council in a way that does not conflict with the provisions of the relevant statutory texts .
The resources of the center are deposited in the current account of the Ministry of Finance in the Central Bank of Saudi Arabia. The center also has an independent annual budget, which is prepared and issued in accordance with the arrangements for issuing the state’s general budget. The center’s resources and expenditures are also subject to the oversight of the General Auditing Bureau.
The Minister of Health submits to the Council of Ministers the final account of the center for each fiscal year, in addition to the annual report on the center’s work and achievements, and provides the General Auditing Bureau with a copy of the final account.
other details
The regulation stipulates that the Board appoint one or more auditors who are licensed to work in the Kingdom, and fix their fees. The auditor submits his report to the Board, and provides the General Auditing Bureau with a copy of it after approval by the Board. The Board may appoint an internal auditor, and its administrative reference is to the Board or any of the committees emanating from it, provided that the regulation cancels any provisions that contradict it.