Q1: What are the communication channels available to contact Saudi Enaya?
A1:You may contact us through the following:
- Our 24/7 Customer Service toll free number: 8003010030
- Fax:012- 6613514
Q2: What are the providers I am eligible to visit?
A2:Providers you are eligible to visit are listed in the provider network booklet provided in your membership pack, or you may contact our customer service team.
Q3: How can I activate my SMS services?
A3: You may activate your SMS services by contacting our customer service team, your mobile number will be activated within 24 hours during weekdays.
Q4: How can I replace my medical insurance card?
A4: Contact your group secretary to send us a request to re-issue your membership card, the membership card will be provided within 5 working days. In case of losing your membership card, you may obtain a confirmation of membership letter by contacting our customer service team, which will enable you to access your medical services within your entitled list of providers.
Q5:How can I add my newborn baby?
A5:Addition requests are done through your Insurance coordinator of your company.The membership card will be delivered within 24 hours during weekdays upon completion of all requirements.
Q6: How can I issue an insurance certificate for visa applications?
A6:By contacting our customer service team to issue the certificate and send it to you within the day as per policy geographical coverage.
Q7: Do you have customer service representatives available in hospitals?
A7:Customer service representatives are available to assist you with various services and follow up on your pre-authorization requests in some major providers, for further details please contact our customer service team.
Q8: How can I submit suggestions or complaints to Saudi Enaya?
Q9: What is the difference between pre-authorization and re-imbursement claims?
A9:Pre-authorization is to obtain a pre-approval to any medical services within your designated providers, which applies to:
- Any services containing sub-limits“such as Maternity services, Dental services, Optical services…etc.”
- Outpatient services above 1000 SAR “may vary depending on policy agreement”.
- All inpatient services.
Re-imbursement claims, are treatments or services paid for and utilized outside your designated network providers, which can be claimed by submitting the required documents to Saudi Enaya for re-imbursement according to policy terms and conditions.
Q10: What are the required documents to submit a re-imbursement claim?
A10:We require the following documents for re-imbursement submission:
1. Copy of ID / Iqama.
2. Copy of Saudi Enaya Insurance Card.
3. Claim form filled out completely signed by member and stamped by policy holder.
4. Original Itemized payment invoices and receipts.
5. Medical prescription from the treating doctor. “Signed by doctor”.
6. Investigation results/reports. For example: laboratory and imaging.
7. Medical Report mentioning the complaint, diagnosis, and treatment.
8. For Dental Services: Please specify the tooth Number.
9. For Inpatient and Day-Case Services: Prior approval / Authorization Letter from Saudi Enaya, together with discharge Summary stamped and signed by the treating Doctor.
Q11: How is a re-imbursement claim calculated? And when can it be settled?
A11: Re-imbursement claims are calculated based on policy terms and conditions. Saudi Enaya will finalize your re-imbursement claims at the earliest time possible within a maximum of 15 working days from the date of submission of completed required documents.
Q12: When can I submit a re-imbursement claim?
A12: Re-imbursement claims must be received no longer than 30 days after the date of treatment for services done within KSA and 60 days for services done outside KSAas per policy terms and conditions.
Q13: What should I do in case I want to visit a provider that is not within my network?
A13:It’s your choice to receive treatments or services paid for and utilized outside the designated network of providers, which can be claimed by submitting the required documents to us for re-imbursement (please check your re-imbursement terms and conditions). As for the re -imbursement claims requirements, they are stated in Q10. Claims will be processed based on policy terms and conditions.
Q14: How can I follow up on my pre-authorization and claims requests?
A14: If your mobile is registered in our system you will receive SMS messages whenever we receive re-imbursement claims documents or pre-authorization requests from providers; you may also follow-up on all requests by registering on our website www.saudienaya.com or through our toll-free number, for more information please contact our customer service team.
Q15: What should I do in case I am not accepted in a provider within my network list?
A15: Call our customer service toll free for immediate assistance.
Q16: What should I do in case my prescribed medication/s isn’t available at the provider?
A16: Contact our customer service toll free in order to coordinate with another provider and direct you on where to go get your medication.
You may also obtain your medications from any branch of United Pharmacies, as Saudi Enaya has developed a verbal approval process with United Pharmacies Group to insure dispensing your medications without any delay. Please insure that you provide the pharmacist with the following:
- Medical report or UCAF clarifying the diagnosis.
- Original Prescription.
- Receipt of the deductible collection (from the provider’s reception).
Q17: What medications can be dispensed from United Pharmacies?
A17: You may dispense all covered medication through the branches of United Pharmacies in case your prescribed medications or chronic medications are not available in the provider, for further details please contact our customer service team.
Q18: What should I do if the provider I am visiting doesn’t have a service or specialty I am in need for?
A18: For Inpatient services: you may contact our customer service team through our toll free to coordinate with an alternative provider to refer the case and update you. As for outpatient services: you may visit a different provider within your network.
Q19: What do I do in case of an emergency?
A19: During a life threatening emergency situation, visit the nearest provider to get the required emergency treatment and call our customer service toll free for immediate assistance.
Q20: Does Saudi Enaya provide a global emergency service?
A20: Saudi Enaya’s global emergency service is done through “Assist America” which immediately connects you to doctors, hospitals, pharmacies and other services if you experience a medical emergency while traveling “150 kilometers or more” away from your permanent residence or traveling outside the country. For further details, please contact our customer service team.
Q21: Can I acquire medical treatment from international providers?
A21: You may obtain access to international providers as per policy geographical coverage; this service is pre-arranged for elective cases. For further details please contact our customer service team.
Q22: What are the standard exclusions under my medical insurance policy?
A22: The standard exclusions according to the regulations of CCHI (Council of Cooperative Health Insurance) are listed within your membership pack, for further details please contact our customer team.
Q23: What are the differences between In-patient and Out-Patient services?
A23: In-patient services include all admission cases or surgeries. Out-patient services include all medical services such as medical consultations, lab tests, X-Ray. Etc…
Q24: How long does it take to respond to pre -authorization requests?
A24: We reply to pre-authorization requests within sixty minutes from the time of receiving the request.