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Frequently Asked Questions

Why medical insurance is a necessity?

Medical insurance is becoming increasingly important for people particularly where local medical facilities may be unable to provide the treatment you need or inaccessible and/or when Private facilities are often expensive. With global medical inflation rising annually, it is a fact that a serious illness or injury could not only cause physical impairments but also severely impact a person’s financial. This is why in today’s world; quality Medical Insurance is a necessity rather than a luxury. Having a medical insurance gives you a choice of where and how quickly you can be treated.

Medical Insurance in Saudi Arabia?

Following the Royal Decree No. M/10 dated 1/5/1420 H and the rules of implementation therefore issued by Ministry Of Health Resolution No.460/23/1 Dated 27/3/1423H, medical insurance is now compulsory for all the foreign or citizens workers and their dependents living in Saudi Arabia working in the private sector. In a phased manner, over a period of time, this could be extended to include all Saudi Nationals.

What types of treatment are covered? These are some of the most common categories:

  • In-Patient: Admission to a hospital for treatment or investigations for which you stay for one or more nights.
  • Day-care: Admission to a hospital for treatment or investigations but for which you are not required to stay overnight
  • Out-Patient: Treatment or investigations at hospital or clinic by a medical practitioner but where you are not admitted either as in-patient or day care patient.

Area of Cover?

The basic cover provides for treatment in the Kingdom of Saudi Arabia.

Out of Area of Cover?

Can the policy be extended for treatment outside the area of cover? Yes, this option is available for group schemes on the basis of written request received from the proposer and appropriate terms agreed upon. Out-of-area cover gives you the reassurance that you will be covered in countries outside Saudi Arabia, whether travelling on business or for pleasure. While there are limits to the amounts you can claim, this does provide you with both in-patient and out-patient cover for emergency treatment of sudden illness.

Once you’ve chosen your medical insurance policy the most important thing you need to know is how to make a claim for treatment.

Arranging treatment & Pre authorization for treatment:

This is a process whereby the Customer Service Supervisor will review information to make sure that the insured’s medical needs are being met and the most cost effective solution is being utilized. This is done in conjunction with the insured, his attending physician, and the medical facility. For services obtained within the designated provider network in Saudi Arabia, pre-authorization should be sent to GU by the designated provider and not by the member.

Pre-authorization is required for the following:

In-hospital Admission, Extension of Hospital stay, Daycare Services, MRI/CT Scan/EMG/ECG, and Physiotherapy, all dental, maternity and optical treatment & non-emergency out-patient services exceeding the limit mentioned on insurance ID card.

Treatment within the designated provider network (Direct Billing):

Gulf Union will issue Medical I. D Card(s) to each member: Whenever a member visits a provider that is a part of the designated network, the member should present his Medical I.D. Card to the medical providers’ receptionist, who will verify membership and provide a medical expenses claim form. The member should complete this giving his details on the Claim Form and signing the members’ section prior to visiting the attending medical practitioner.

Procedure for Treatment or settlement of claims outside the Designated Network / Outside the Area of Cover (Reimbursement basis):

The member MUST obtain pre-authorization from GU.2. The member must pay 100% of all charges to the medical provider at the time of treatment.3. To obtain reimbursement the member must submit original documents (photocopies are not acceptable).

Emergency Treatment:

In case of emergency you should use the nearest medical provider. If the medical provider is non-designated, you must advise Gulf Union promptly, taking into account your physical condition. Gulf Union will then advise you on pre-authorization and will liaise with you and the medical provider regarding your treatment. In an emergency we would not expect the member to contact us beforehand. However, please ask someone to telephone us as soon as practicable so that we are made aware of your case. Why choose Gulf Union for your medical insurance? We believe that what really makes Gulf Union healthcare different from other medical insurance provider is our personal touch. We treat people the way they should be treated – as individuals, not as numbers. Not only are our employees friendly, professional and efficient, they also have it their business to help and look after you.

Medical Provider Network in Saudi Arabia

To provide you with the very best healthcare cover Gulf Union has established a wide network of hospitals and clinics (known as designated care provider network) throughout the Kingdom of Saudi Arabia. The ‘designated care provider network’ has been specifically designed bearing you in mind for the best in healthcare. However, if necessary and relevant treatment(s) are not available within our ‘designated care provider network’, appropriate arrangements are then made to ensure that the required treatment(s) can be provided.

Interested in Medical Insurance? To get a quote from Gulf Union healthcare:

  • For individual medical quote: Please complete an Individual application form and email or fax it to us. To give you a personalized quote you will need to provide us with complete information including medical history, if any.
  • For group medical quote: Please complete a group application form and email or fax it to us. Alternatively call us our customer service team will assist you to answer to your questions.

These questions and answers are designed to help clarify some of the concepts, but are not considered a legal reference to any dispute, as the first reference will be the insurance policy and its terms.