ByBy
Saad Ali AL-AsmreiSaad Ali AL-Asmrei
Awad Falah AL-AnzyAwad Falah AL-Anzy
Al-Ahlia for Cooperative Al-Ahlia for Cooperative Insurance CompanyInsurance Company
THE COMPANY IN BRIEFTHE COMPANY IN BRIEF
Al-AHLIAAl-AHLIA for cooperative insurance for cooperative insurance company was founded by virtue of company was founded by virtue of the executive regulations and the executive regulations and system of controlling the insurance system of controlling the insurance companies incorporated in the companies incorporated in the Kingdom of Saudi Arabia .Kingdom of Saudi Arabia .
THE COMPANY IN BRIEFTHE COMPANY IN BRIEF
In view of the company's previous experience as In view of the company's previous experience as represented in its involvement in the insurance represented in its involvement in the insurance business in the kingdom over ten years as well business in the kingdom over ten years as well as the experience gained from the mother as the experience gained from the mother company , National Insurance company of Egypt company , National Insurance company of Egypt , which has engaged in the insurance activity , which has engaged in the insurance activity since 1900 AD in addition to being the first since 1900 AD in addition to being the first insurance company in the Arab world , the insurance company in the Arab world , the attributed to credibility and professionalism in attributed to credibility and professionalism in conducting transactions conducting transactions ..
THE SHAREE’AH COMMITTEETHE SHAREE’AH COMMITTEE
As being the company keens to run all of its As being the company keens to run all of its insurance documents and products in insurance documents and products in accordance with the principles of the Sharee’ah , accordance with the principles of the Sharee’ah , the company has formed a Sharee’ah committee the company has formed a Sharee’ah committee contained a number of the senior scholars to contained a number of the senior scholars to review the products and the documents with the review the products and the documents with the rules of the tolerated Islamic Law and the rules of the tolerated Islamic Law and the principle of the coopertive insurance approved principle of the coopertive insurance approved by the Committee of Senior Scholars .by the Committee of Senior Scholars .
RE-INSURES RE-INSURES Al-AHLIA for cooperative insurance entered Al-AHLIA for cooperative insurance entered
agreements of the reinsurance as an agreements of the reinsurance as an addition cover-which enhances its financial addition cover-which enhances its financial ability as well as the global standards of ability as well as the global standards of the reinsurance companies , which deals the reinsurance companies , which deals Al-AHLIA , is a strong indication of the Al-AHLIA , is a strong indication of the confidence an authority enjoyed by the confidence an authority enjoyed by the company . company .
RE-INSURESRE-INSURES
In view of its good reputation and the distinguished relation In view of its good reputation and the distinguished relation with the major insurance companies in the world Al-ahlia with the major insurance companies in the world Al-ahlia for cooperative insurance company could manage for cooperative insurance company could manage agreements with the prestigious global reinsurance agreements with the prestigious global reinsurance companies , such as MUNCH RE , one of the largest companies , such as MUNCH RE , one of the largest reinsurance companies in the world ,which leads the reinsurance companies in the world ,which leads the agreements of Ahlia for Cooperative Insurance in this agreements of Ahlia for Cooperative Insurance in this regard , in addition to a wide variety of reinsurance which regard , in addition to a wide variety of reinsurance which have the same classification in the insurance field , for have the same classification in the insurance field , for instant : Swiss-Re company , SCOR company , in instant : Swiss-Re company , SCOR company , in addition to Group Azu-Lloyods and many other world addition to Group Azu-Lloyods and many other world reinsurance companies , which always guarantee of the reinsurance companies , which always guarantee of the policyholders’ rights and getting their claims on due policyholders’ rights and getting their claims on due course. course.
TECHNICAL BACKUPTECHNICAL BACKUP
AL-Ahlia insurance company gets direct technical support from AL-Ahlia insurance company gets direct technical support from the National insurance company of Egypt (parent company) the National insurance company of Egypt (parent company) which is rated A (excellent) by AM Best and rated BBB by which is rated A (excellent) by AM Best and rated BBB by standard and poor . Both rates reflect the strong financial standard and poor . Both rates reflect the strong financial capacity of the company .capacity of the company .
SAUDIZATION AND TRAININGSAUDIZATION AND TRAINING
Al-ahlia for cooperative insurance company is one of the Al-ahlia for cooperative insurance company is one of the insurance company which have, through its own insurance company which have, through its own insurance institute , attracted trained and provided a insurance institute , attracted trained and provided a large number of Saudi youth with the necessary skills large number of Saudi youth with the necessary skills that are bound to enable theme to successfully engage in that are bound to enable theme to successfully engage in the insurance activity .the insurance activity .
THE COMPANY DOCUMENTSTHE COMPANY DOCUMENTSAl-ahlia for cooperative insurance company offers its Al-ahlia for cooperative insurance company offers its
esteemed customers all types of insurance policies:esteemed customers all types of insurance policies: Property insurance .Property insurance . Motor insurance.Motor insurance. Vehicle insurance.Vehicle insurance. Accident insurance.Accident insurance. Transport insurance (marine , air and land ) .Transport insurance (marine , air and land ) . Engineering insurance .Engineering insurance . Health insurance.Health insurance.
And liability insurance including the liabilities against the And liability insurance including the liabilities against the medical malpractice , and the liabilities of employers … to medical malpractice , and the liabilities of employers … to other programs offered by the company for its clients other programs offered by the company for its clients when the need arises. when the need arises.
HEALTH INSURANCEHEALTH INSURANCE
By virtue of the royal directive issued by the Custodian of the Two Holy By virtue of the royal directive issued by the Custodian of the Two Holy Mosques which guarantees medical treatment to all citizens and Mosques which guarantees medical treatment to all citizens and residents according to a medical insurance document and the residents according to a medical insurance document and the creation of a health board in the Kingdom whose duty is to oversee creation of a health board in the Kingdom whose duty is to oversee that the implementation of this project , Al-AHLIA for Cooperative that the implementation of this project , Al-AHLIA for Cooperative Insurance Company has been keen to provide documents and Insurance Company has been keen to provide documents and medical insurance to all companies , institutions and installation , in medical insurance to all companies , institutions and installation , in whatever sphere of activity they are engaged in , through the high whatever sphere of activity they are engaged in , through the high technical expertise available to the to them as well as through the technical expertise available to the to them as well as through the network of medical facilities scattered in , in various parts of the network of medical facilities scattered in , in various parts of the Kingdom . It is for this reason , therefore , that Al-AHLIA for Kingdom . It is for this reason , therefore , that Al-AHLIA for Cooperative Insurance Company expresses its deep commitment to Cooperative Insurance Company expresses its deep commitment to designing the best possible health programs required by client as designing the best possible health programs required by client as well as managing any remedial programs to customer in return for well as managing any remedial programs to customer in return for nominal to be agreed upon.nominal to be agreed upon.
TARIFFSTARIFFS
For the purposes of this insurance, the For the purposes of this insurance, the words and phrases and expressions that are words and phrases and expressions that are to be interpreted wherever it appeared in the to be interpreted wherever it appeared in the document or its annexes or supplements in document or its annexes or supplements in accordance with the definitions set out accordance with the definitions set out below:below:
Incident: accidental injury or an accidental Incident: accidental injury or an accidental occurrence, however, is expected during the occurrence, however, is expected during the period of insurance.period of insurance.
Cause: illness or disease that affects the insured Cause: illness or disease that affects the insured person, and necessarily require access to person, and necessarily require access to medical treatment from a doctor licensed during medical treatment from a doctor licensed during the period of insurance.the period of insurance.
Beneficiary (insured) : a person covered by the Beneficiary (insured) : a person covered by the system (the employee or dependent) on the system (the employee or dependent) on the agenda of insured persons annex to this agenda of insured persons annex to this document. document.
Sensitivity: the individual sensors, in particular, Sensitivity: the individual sensors, in particular, for certain types of food, weather, dust or pollen for certain types of food, weather, dust or pollen Mahdthat any other plants, insects, animals, Mahdthat any other plants, insects, animals, minerals, elements or other material, where the minerals, elements or other material, where the individual physical reactions caused by direct individual physical reactions caused by direct contact or However, the direct cause of those contact or However, the direct cause of those items, such as in cases of asthma, poor items, such as in cases of asthma, poor digestion, bacterial infections, fever, straw, digestion, bacterial infections, fever, straw, eczema, headaches. eczema, headaches.
Congenital Deformity: dysfunction or chemical , Congenital Deformity: dysfunction or chemical , which is normally present before birth, either which is normally present before birth, either genetically or as a result of environmental genetically or as a result of environmental factors. factors.
Employee: any person engaged in the actual Employee: any person engaged in the actual work of the holder of the document and recorded work of the holder of the document and recorded as such in the records and has been a time of as such in the records and has been a time of joining the insurance coverage of the age of 65 joining the insurance coverage of the age of 65 years.years.
Dependent: Dependent: A - A husband / wife registered as such in the A - A husband / wife registered as such in the records of the owner and resident of order, records of the owner and resident of order, Saudi Arabia. Saudi Arabia.
B - The children of the employee or children of B - The children of the employee or children of either the husband or wife or children secured a either the husband or wife or children secured a resident of Saudi Arabia accredited to support resident of Saudi Arabia accredited to support the staff member and registered as such in the the staff member and registered as such in the records of the bearer of the document. records of the bearer of the document.
Pregnancy and Childbirth : any Pregnancy and Childbirth : any pregnant and / or arising from pregnant and / or arising from the birth of the legitimacy of a the birth of the legitimacy of a marriage relationship. marriage relationship.
Table of BenefitsTable of Benefits VIPVIP AA BB CCMax. Annual Limit Max. Annual Limit per person per person per yearper year
SR.250,00SR.250,0000
SR.250,000SR.250,000 SR.250,000SR.250,000 SR.250,000SR.250,000
Max. Annual Limit for Pre-Max. Annual Limit for Pre-Existing AilmentsExisting Ailments
SR.250,00SR.250,0000
SR.250,000SR.250,000SR.250,000SR.250,000SR.250,000SR.250,000
Emergency Treatment outside Emergency Treatment outside the Geographical limit during the Geographical limit during Business trips and annual Business trips and annual vacation up to 60 days per yearvacation up to 60 days per year
Extended to Extended to world wideworld wide
Kingdom of Saudi Kingdom of Saudi Arabia onlyArabia only
- -In - Patient Treatment includesIn - Patient Treatment includes::
Accommodation and Medical Services per person Accommodation and Medical Services per person per case, as followsper case, as follows::
> > Max. limit for accommodation provided in a Max. limit for accommodation provided in a hospital designated in the Directory of appointed hospital designated in the Directory of appointed providers, per person per caseproviders, per person per case
> > Max. limit for daily benefit received in any un Max. limit for daily benefit received in any un appointed hospital, per person per caseappointed hospital, per person per case
> > Max. limit for daily benefit for one parent Max. limit for daily benefit for one parent accompanying an insured Child under 12 years of accompanying an insured Child under 12 years of age per person per casage per person per cas..
Surgeons’ & Anesthetists’ FeesSurgeons’ & Anesthetists’ Fees
Consultants’ & Physicians’ FeesConsultants’ & Physicians’ Fees
Chemotherapy & RadiotherapyChemotherapy & Radiotherapy
Day-Care treatmentDay-Care treatment
CoveredCovered
SuiteSuite
SR.800SR.800
CoveredCovered
CoveredCovered
CoveredCovered
CoveredCovered
CoveredCovered
CoveredCovered
PrivatePrivate
SR.600SR.600
CoveredCovered
CoveredCovered
CoveredCovered
CoveredCovered
CoveredCovered
CoveredCovered
Semi PrivateSemi Private
SR.450SR.450
CoveredCovered
CoveredCovered
CoveredCovered
CoveredCovered
CoveredCovered
CoveredCovered
SharedShared
SR.350SR.350
CoveredCovered
CoveredCovered
CoveredCovered
CoveredCovered
AmbulanceAmbulance::
Max. Annual limit for emergency transportation Max. Annual limit for emergency transportation in a local licensed ambulance or in a Red in a local licensed ambulance or in a Red
Crescent ambulanceCrescent ambulance
CoveredCovered
Out-Patient TreatmentOut-Patient Treatment
Consultation, Diagnostic Procedure includingConsultation, Diagnostic Procedure including
tests & X-rays, Prescriptions & Medicinestests & X-rays, Prescriptions & Medicines
CoveredCovered
-Maximum Limit for ConsultationMaximum Limit for Consultation Per person Per person per case:per case:-General PhysicianGeneral Physician-Specialist/ Consultant (with referral from GP)Specialist/ Consultant (with referral from GP)-Specialist/ Consultant (w/out referral from GP) Specialist/ Consultant (w/out referral from GP)
SR.200 SR.150 SR.100 SR.50SR.200 SR.150 SR.100 SR.50
SR.250 SR.200 SR.150 SR.150SR.250 SR.200 SR.150 SR.150
SR.200 SR.150 SR.100 SR.50SR.200 SR.150 SR.100 SR.50
Pregnancy & Maternity: (If Applicable)Pregnancy & Maternity: (If Applicable)
Pre-natal, Normal Delivery and Post-natal Pre-natal, Normal Delivery and Post-natal care. Maximum limit per spouse per yearcare. Maximum limit per spouse per year
Pre-natal, Caesarean Delivery and Post-Pre-natal, Caesarean Delivery and Post-natal carenatal care
Pre-natal care and Miscarriage / Legal Pre-natal care and Miscarriage / Legal AbortionAbortion
SR.16.000SR.16.000
CoveredCovered
CoveredCovered
SR.14.000SR.14.000
CoveredCovered
CoveredCovered
SR.12.000SR.12.000
CoveredCovered
CoveredCovered
SR.10.000SR.10.000
CoveredCovered
CoveredCovered
Treatment of Pre-matured Treatment of Pre-matured
babies babies Max. Annual LimitMax. Annual Limit CoveredCoveredCoveredCoveredCoveredCoveredCoveredCovered
Circumcision & Vaccinations Circumcision & Vaccinations thatthat
are required by the Ministry of are required by the Ministry of Health for childrenHealth for children
CoveredCoveredCoveredCoveredCoveredCoveredCoveredCovered
Emergency Treatment outside the Emergency Treatment outside the
Appointed Medical ProvidersAppointed Medical Providers Refundable at 80% of the reasonable and customary Refundable at 80% of the reasonable and customary
expenses in the appointed providersexpenses in the appointed providers
Physiotherapy sessionsPhysiotherapy sessions: :
Max. limit P.P.P.Y (provided that Max. limit P.P.P.Y (provided that after surgical operation or covered after surgical operation or covered
accident)accident) 1414 SessionsSessions1212 SessionsSessions1010 SessionsSessions88 SessionsSessions
Repatriation of Human remains to Repatriation of Human remains to
home country, max. limit P.P.P.Yhome country, max. limit P.P.P.Y: : SR.10000SR.10000
Emergency Hearing Aids, max. Emergency Hearing Aids, max.
limit per person per policy yearlimit per person per policy year: : SR2,500SR2,500
Dental BenefitDental Benefit : :
Includes Consultation, Extraction, Includes Consultation, Extraction, Amalgam filling, Root canal, Gum Amalgam filling, Root canal, Gum treatment and Prescribed treatment and Prescribed Medicines only, max. limit P.P.P.YMedicines only, max. limit P.P.P.Y
SR.2,000SR.2,000
Optical BenefitOptical Benefit : :
Covers one refraction tests and one Covers one refraction tests and one pair of ordinary medical lenses, max. pair of ordinary medical lenses, max.
limit P.P.P.Ylimit P.P.P.Y: : SR.250SR.250
Appointed Medical ProvidersAppointed Medical Providers
))To be agreedTo be agreed(( Network Network (VIP)(VIP)
Network Network (A)(A)
Network Network (B)(B)
NetwNetwork ork (C)(C)
Deductible on Each and Every Deductible on Each and Every
Out-Patient ClaimOut-Patient Claim
20%20% up to maximum of SR.100up to maximum of SR.100
BeneficiaryBeneficiaryEmployeeEmployeeWifeWife
SonSon
oror
DaughterDaughter
ClassClass
VIPVIP
25002500
ToTo
40004000
40004000
ToTo
50005000
25002500
ToTo
40004000
ClassClass
AA
20002000
ToTo
25002500
38003800
ToTo
45004500
20002000
ToTo
25002500
ClassClass
BB
15001500
ToTo
20002000
25002500
ToTo
30003000
15001500
ToTo
20002000
ClassClass
CC
950950
ToTo
12001200
20002000
ToTo
30003000
950950
ToTo
12001200