| Medical Service Provider Network | DH-M | DH-S | DH-3 |
| Benefits and Coverage Limits under the Policy | SAR 100,000 | SAR 100,000 | SAR 100,000 |
| Hospitalization | The co-payment rate for hospitalization is covered without any deductible | The co-payment rate for hospitalization is covered without any deductible | The document covers emergency cases with an unlimited number of visits, while non-emergency cases are covered for up to 4 visits only. For primary care, there is a 5% co-payment with a maximum of 25 Riyals, and in the case of a referral to specialized centers, the co-payment is 10% with a maximum of 75 Riyals. If there is no referral, the co-payment is 10% with a maximum of 500 Riyals. |
| Ambulance Transportation | Covered for emergency cases only, 1000 | Covered for emergency cases only, 1001 | Covered for emergency cases only, 1002 |
| Outpatient Treatment | The policy covers emergency cases with an unlimited number of visits, while non-emergency cases are covered for up to 4 visits only. For primary care, there is a 5% co-payment with a maximum of 25 Riyals, and in the case of a referral to specialized centers, the co-payment is 10% with a maximum of 75 Riyals. If there is no referral, the co-payment is 10% with a maximum of 500 Riyals. | The policy covers emergency cases with an unlimited number of visits, while non-emergency cases are covered for up to 4 visits only. For primary care, there is a 5% co-payment with a maximum of 25 Riyals, and in the case of a referral to specialized centers, the co-payment is 10% with a maximum of 75 Riyals. If there is no referral, the co-payment is 10% with a maximum of 500 Riyals. | The policy covers emergency cases with an unlimited number of visits, while non-emergency cases are covered for up to 4 visits only. For primary care, there is a 5% co-payment with a maximum of 25 Riyals, and in the case of a referral to specialized centers, the co-payment is 10% with a maximum of 75 Riyals. If there is no referral, the co-payment is 10% with a maximum of 500 Riyals. |
| Vaccinations and tests | covered | covered | covered |
| Consultation | Medical examination fees range from 100 to 150 riyals for a general practitioner or specialist, and from 200 to 300 riyals for a specialized doctor or consultant, while fees for rare specialties are fixed at 400 riyals. | Medical examination fees range from 100 to 150 riyals for a general practitioner or specialist, and from 200 to 300 riyals for a specialized doctor or consultant, while fees for rare specialties are fixed at 400 riyals. | Medical examination fees range from 100 to 150 riyals for a general practitioner or specialist, and from 200 to 300 riyals for a specialized doctor or consultant, while fees for rare specialties are fixed at 400 riyals. |
| Dental coverage | Not covered | Not covered | Not covered |
| Eyeglasses coverage | Not covered | Not covered | Not covered |
| Laboratory tests and X-rays | Laboratory tests are covered at 15% up to a maximum of 200 SAR, while X-rays and other services are covered at 30% with no maximum limit. | Laboratory tests are covered at 15% up to a maximum of 200 SAR, while X-rays and other services are covered at 30% with no maximum limit. | Laboratory tests are covered at 15% up to a maximum of 200 SAR, while X-rays and other services are covered at 30% with no maximum limit. |
| Medications | According to the approved drug formulary | According to the approved drug formulary | According to the approved drug formulary |
| Repatriation of the deceased to their home country | 10,000 | 10,000 | 10,000 |
| General requirements | requires adherence to submitting the medical disclosure form and obtaining the insurance company's approval. Additionally, responsibility for paying the costs in case of duplication in the insurance policies for domestic workers and those in similar positions is organized in coordination between the Insurance Authority and the Health Insurance Council. | requires adherence to submitting the medical disclosure form and obtaining the insurance company's approval. Additionally, responsibility for paying the costs in case of duplication in the insurance policies for domestic workers and those in similar positions is organized in coordination between the Insurance Authority and the Health Insurance Council. | requires adherence to submitting the medical disclosure form and obtaining the insurance company's approval. Additionally, responsibility for paying the costs in case of duplication in the insurance policies for domestic workers and those in similar positions is organized in coordination between the Insurance Authority and the Health Insurance Council. |
