Co-operative Group Health Insurance
Eligibility:
- All employees.
- Spouses.
- Sons up-to 18 years of age.
- Unmarried / Divorced / widowed daughters.
Payment of Premium:
Employer policyholder pays the premium for the insured persons.
Reimbursable Costs & Benefits:
Upon specific recommendation by a licensed physician, who treats the Insured for illness / symptoms the following are reimbursable:
- Consultation, diagnosis, treatment, and medication costs as per policy schedule.
- Hospital expenses including surgeries, pre post-operative care / Day care.
- Medically recommended treatment of teeth and gingival diseases.
- Preventive measures specified by the Ministry of Health (e.g. vaccination, maternity and child care).
Health Service Provider Network Direct Debit basis on Insurance Company’s Account:
- Wafa to issue Health Insurance card to every Insured person.
- Health service providers network accredited by CCHI to provide health services on monthly basis.
- Wafa to notify policyholder / service providers on policy limits.
- In the case of emergencies, Insured can get admitted and seek reimbursement.
Salient Features:
| SCOPE OF COVER | BENEFITS & LIMITS |
| Maximum benefit limit (per person per year) | SR. 250,000 |
| Out Patient Clinic Treatment Charges: Cover |
As medically recommended. 20% subject to max of SR.100 |
| Pregnancy and Delivery | Maximum SR. 15,000 during Policy period |
| Premature Babies | Upto maximum policy limit |
| Repatriation of mortal remains to country of origin | SR.10,000 (Maximum) |
| Coverage Area Limit | Inside and outside Kingdom of Saudi Arabia* |
Exclusions:
Insurance is subject to standard exclusions such as self-injury, cosmetic plastic surgery, HIV treatment, teeth implantation, congenital deformities (if not life threatening), birth control, baldness, etc.
To help us process your request, kindly send the filled and signed Application to
Fax: 920005444 Ext: 444 Or scan it to Customer Care Email: customercare@wafainsurance.com