Dr. Nasser Al-Juhani, spokesman for the Health Insurance Council, revealed to Okaz that the council added a number of benefits that focus on prevention and reducing complications of diseases, explaining that the council works to review the insurance policy every 3 years or sooner if necessary, stressing that starting from Today (Saturday), the insurance coverage will include the expansion of bariatric surgeries, kidney transplantation, and raising the cost of dialysis from 100,000 to 180,000 riyals.
Al-Juhani explained that for the first time, exploratory examinations were added, which are applied according to the eligibility criteria approved by the Public Health Authority, and include screening for colon cancer, breast cancer, cervical cancer, diabetes screening, bone density testing and comprehensive lipid testing, indicating that behavioral counseling has been added. and diet for healthy diet and physical activity to prevent cardiovascular disease for adults with cardiovascular risk factors.
A spokesman for the Health Insurance Council indicated that within the framework of the interest in promoting women’s health and meeting their needs, the insurance covers several exploratory examinations such as mammograms to detect breast cancer and Pap smears. To temporary contraceptives that include hormonal replacement and IUDs.
On the role of insurance companies in meeting all benefits, Al-Juhani explained that the health insurance premium is determined by agreement between the company and the employer, and the insurance company, when determining the value of the insurance premium, must adhere to a number of criteria, such that the value of the document is technically justified and based on objective foundations, and not less than Its value is in any way related to the real cost of the policy and the usual or potential treatment expenses that it entails, and the company may not rely solely as a basis for determining the value of the health insurance policy on the rates applied by companies, taking into account that the prices are compatible with the rates of the health insurance market rates, Stressing that when studying the addition of any of the benefits, an economic and financial analysis is done to review the coverage limits.
Al-Juhani had revealed to “Okaz” two weeks agothat the start of the application of the new standards for the expansion of coverage of obesity surgeries will take place as of October 1, 2022, and includes private health insurance beneficiaries who have new and renewed policies from this date onwards, according to what is included in the benefits package and the updated insurance coverage limits, indicating that the eligibility of insurance coverage for procedures Obesity operations if the body mass exceeds 40 and higher without complications, or the body mass is 35 and higher in the case of accompanying chronic diseases.