Inpatient care
Admission, treatment and surgical services at approved hospitals within the network, subject to the approved limits.
Our services
Health services for members and their families
Organised health services for members and their family members, according to what has been approved and its terms and limits.
Overview
The health services are a framework the Cooperative provides to its members to organise access to care through approved providers within the network.
What has been approved for each member decides which services are covered, their limits, and the conditions for using them. So start with your own services document. That is where the answer for you is written.
Areas of care
What the services may include
The health services may cover the following areas, depending on what has been approved for the member.
Doctor visits
Consultations with doctors at approved clinics and medical centres.
Outpatient services
Laboratory tests, medical imaging and diagnostic services outside hospital admission.
Prescription medicines
Medicines prescribed by a doctor, at approved pharmacies and under the approved conditions.
Physiotherapy
Physiotherapy sessions at approved centres where a medical referral exists.
Emergency services
Emergency cases handled according to the procedures set out in the services document.
Coverage features
What a member gets in the Fund
Under the terms of the services approved for the member.
Guaranteed renewal
After the first year, renewal is guaranteed.
Waiting periods waived
A member who already had health coverage attaches a copy of the previous card. Continuity is credited, and waiting periods are waived under the approved terms.
100% cover in hospital and emergency
100% coverage in hospital and in emergency, with no co-payment.
From 0 to 99 years
No age band is excluded between 0 and 99 years.
Available services vary according to what has been approved for each member.
Why the Fund
Why the Health Care Fund?
- Health takaful among the families who join the Fund
- A cooperative alternative to commercial health cover, at a cost within reach of families
- Health services inside the Kingdom and abroad, with guaranteed renewal after the first year
- Treatment costs eased for the family
- Contributions managed for the benefit of members
What is covered depends on what is approved for you
Benefits, participation percentages, limits, waiting periods and exclusions may vary according to the services approved for each member.
To know exactly what applies to you, review your services document or contact the Cooperative.
Benefit card
The member benefit card
The benefit card identifies the member at approved providers within the network. It is presented when visiting a hospital, clinic, pharmacy or laboratory.
The card by itself does not mean every service is automatically covered. Access remains subject to the services approved for you and their conditions, and some services may require prior approval.
- Present it at every visit to an approved provider
- It is used to verify eligibility
- Access remains within the approved limits
- If it is lost, notify the Cooperative
Prior approvals
Some medical services may require prior approval before they are provided, according to the approved rules and the principle of medical necessity.
Typically the provider submits the approval request to the party responsible for managing approvals, and a response is issued under the approved procedures. The member's role is to present the benefit card and confirm the service has been approved before proceeding.
In an emergency
In an emergency, the priority is always the patient's safety and receiving the necessary care immediately.
Afterwards, notify the Cooperative or the party that manages approvals as soon as you can, and send the required documents. The services document sets out what is needed and by when.
Supporting documents
The Cooperative holds its official records, including the registration certificate, the internal bylaws, and the contracting letters with its coverage and administration partners. Members can review them by contacting the Cooperative.
Ready to start a membership request?
A request is the approved form, the required documents, and a review by the Cooperative under its regulations. See what to prepare before you fill it in.