1. نايف المطيري و أيمن الشهري
بسم الله الرحمن الرحيم
إعداد الطالبين
نايف المطيري و أيمن الشهري
بأشراف د /ناصر الجارالله

2. LIMIT OF BENEFITS
(In SAR)
Class VIP
Class A
Class B
Class C
Work related
lnjury / illness
Not covered
Not covered
Not covered
Not covered
Georaphical scope
KSA ONIY
KSA ONIY
KSA ONIY
KSA ONIY
Dependents Covered
Yes
Yes
Yes
Yes
Waiting period of
newborn baby
NIL
NIL
NIL
NIL
Global Annual
Limit person SR SR SR SR
In Hospital: Allowed
room at APN
SUITE
private
Semi- private
Semi- private

3. Deductible each & every
Daily Room & Board
in KSA
SR.800
SR600
SR.400
SR350
Daily Room & Board
ABROAD
SR.1.000
SR.600
SR.400
SR.350
COST OF SURGERY &
ANESTHESIA
Full cover
Full cover
Full cover
Full cover
Radiotherapy &
chemotherapy
Full cover
Full cover
Full cover
Full cover
Daycare for surgical
procedure
Full cover
Full cover
Full cover
Full cover
Deductible each & every
claim
NIL
NIL
NIL
NIL
Co- Insurance outside
APN in KSA
(EMERGENCY)
NIL*
NIL*
NIL*
NIL*

4. Co- Insurance outside APN abroad (EMERGENCY) NIL* NIL* NIL* NIL*
OUT Patient
covered
covered
covered
covered
Deductible each &
every claim
20%with maximum
of SR.100 per
visit**.
20%with maximum
of SR.100 per
visit**.
20%with maximum
of SR.100 per
visit**.
20%with maximum
of SR.100 per
visit**.
Co- Insurance outside
APN in KSA
(EMERGENCY)
NIL*
NIL*
NIL*
NIL*
Co- Insurance outside
APN abroad
(EMERGENCY)
NIL*
NIL*
NIL*
NIL*
Cash reimbursement for Emergency CASES (In. k.S.A or 100%subject to network rating
However, no reimbursement for dental & optical claims incurred outside APN.
The visit includes doctor consultation, rlated in vestigations & prescribed medicine.

5. LIMIT OF BENEFITS (In SAR) Class VIP Class A Class B Class C
Pre – Existing &
Chronic
Covered
Covered
Covered
Covered
Maternity Coverage :
Annual limit
10.000
10.000
10.000
10.000
Waiting Period
Nil
Nil
Nil
Nil
Dental Care :Annual
Limit
2,000
2,000
2,000
2,000
Co -Insurance
20%with maximum
of SR.100 per
visit**.
20%with maximum
of SR.100 per
visit**.
20%with maximum
of SR.100 per
visit**.
20%with maximum
of SR.100 per
visit**.
Optical Coverage :
Annual limit
250
250
250
250

6. Repatriation OF mortal Remains to country of origin SR.10.000
Co -Insurance
20%with maximum
of SR.100 per
visit**.
20%with maximum
of SR.100 per
visit**.
20%with maximum
of SR.100 per
visit**.
20%with maximum
of SR.100 per
visit**.
Hearing Aids :
Annual limit
1,500
1,500
1,500
1,500
Co -Insurance
20%with maximum
of SR.100 per
visit**.
20%with maximum
of SR.100 per
visit**.
20%with maximum
of SR.100 per
visit**.
20%with maximum
of SR.100 per
visit**.
Repatriation Costs
covered
covered
covered
covered
Repatriation OF mortal
Remains to
country of origin SR SR SR SR
Worldwide Emergency
services
covered
covered
covered
covered
When traveling for more
than 150 km away
from home or abroad
Full Cover
Full Cover
Full Cover
Full Cover

7. LIMIT OF BENEFITS
(In SAR)
Class VIP
Class A
Class B
Class C
Children aged up
to 17 Years
As Agreed
As Agreed
As Agreed
As Agreed
Adult Males aged
18 to 64 Years
As Agreed
As Agreed
As Agreed
As Agreed
Adult Females aged
18 to 64 Years
As Agreed
As Agreed
As Agreed
As Agreed
Total Annual Premium
As Agreed
Mode of Payment
Due Dates
100% at inception on 21 July, 2008.
Mode of Payment

8. The visit includes doctor consultation, related investigations & Prescribed medicine.
SPECIAL CONDNITIONS:
1- Class c members will be assigned a network of clinics, such clinic (s) can only be changed subject to 30 days notice. Members will receive outpatient treatment / medical services at their assigned clinic (s) and con only call on their network hospitals in case of emergency (as defined), or (b) by referral from an assigned clinic and upon approval from Medivisa.
2- The policyholder agrees that some changes cannot be implemented during the period of insurance. E.g. upgrading the cover of a member (even if promoted), etc… such changes can only be implemented upon renewal of the policy.
3- Territorial limits are extended worldwide for emerency (and /or non emergency) treatment only whilst on business trips vacation, not exceeding 60 days per policy year.

9. COMPULSORY BASIC COVER
Section I:
*Accident
*Allergy
* Beneficiary (Insured person):
Benefit :
*Premium (contribution):
*Congenital Deformity :
*Insurance Cover
* Coinsurance/deductible (Co- payment):
*Employee :
*Dependent :
*Claim supporting Documents
*Direct billing or company billing :
*Inception Date :
*Effective Date :
*Endorsement :
*Hospital :
* Hospitalisation :
*Insurance :

10. *Licensed doctor :
*limit of cover :
*Service Provider :
*Pregnancy and Delivery :
* Daycase or Daycare :
*Treatment in outpatient clinics:
*Service providers, Network :
*Grace Period:
*Period of Insurance :
*Policyholder:
*Reasonable and customary medical expenses:
*Basis of compensation:

11. Section ii: Recoverable Expenses/Benefits
1- Health benefits:
2- The cost of repatriating the bodily remains of a beneficiary to his home country.
Section III: Limitations and Exclusions
A - THIS policy shall not cover claims arising from:
1-Intentional self – inflicted injury.
2- Sicknesses resulting form the abuse of some medicine stimulants or tranquilizers, or from the use of alcohol, drugs or similar substances
3- Cosmetic treatment or surgery unless necessitated by a bodily injury not excluded in this secion

12. 4- general checkup inoculation drug or preventive measure that are not require for medical treatment cover under this policy ( excluding preventive procedures as define by the ministry of health like vaccinations and mother care and childcare 5- pregnancy and delivery of woman contractual status in un - married 6- treatment received by beneficiary free of charge 7- rest cures general health cures and treatment in social healthcare institution 8- any disease or injuries resulting directly from the beneficiary profession 9- all costs relating to tooth implant artificial teeth and fixed 10- vision or hearing test and visual or hearing aids unless required by the license doctor 11- loss of hair baldness artificial hair 12- psychological treatment mental or nervous disorder unless of an acute nature 13- allergy testing of any nature unless relating to medicine diagnosis or treatment

13. 14- any congenital defect or deformity B- THIS POLICY SHALL NOT COVER ANY MEDICAL BENEFITS AND REPATRIATION OF THE BODY TO HOME COUNTARY IN CASE CLAIM IS DIRECTLY RESULTING FROM 1- war ,invasion act of foreign enemy , hostilities ( whether war is declared or not , civil war 2 – the beneficiary services or participation in armed forces or policy activity 3- riots , strikes , terrorism or similar events

14. section Iv: general conditions
- proof of validity Records and reports Eligibility Premium payment Effective date of cover Adding and deleting beneficiaries and relating premiums

15. -Termination of beneficiaries insurance cover.
- Subrogation of rights
- Non duplication of benefits.
- Basis of direct billing of the company by the
Assigned providers network.
- coinsurance / deductible .
- Reimbursement basis.

16. - Cancellation
- Pre-authorisation
- Gender
- Notices
- Abiding with policy conditions
- Arbitration
- Participating in the surplus of Insurance Operations (Concept of Cooperative Insurance)

17. Global emergency services - SERVICES PROVIDED: 1- medical consultation evaluation & referral hospital admission guarantee. 3- emergency medical evacuation . 4- critical care monitoring . 5- medically supervised repatriation . 6- prescription assistance. 7- emergency message transmission. 8- compassionate visit care of minor children return of mortal remains. 11- lost luggage or document assistance. Interpreter & legal referrals pre – trip information.

18. CONDITION & EXCLUSION- This extension is subject to the following exclusion : 1- travel undertaken specifically for securing medical treatment . 2- injuries resulting from participation in acts of war or insurrection. 3- attempt at suicide . 4- incidents involving the use of drugs unless prescribed by physician. 5- commission of unlawful acts. 6- transfer of participant from one medical facility to another medical facility of similar capabilities and providing a similar level of care . QENERAL EXCLUSION : 1- trips . 2- participant traveling.