Member Guide

Welcome Valued Saudi Enaya Members,

Saudi Enaya is glad to serve as your health insurance partner, managing your health care benefits and providing you with services of the highest standard.

We invite you to read this guide carefully since it provides essential information regarding your health care benefits. This booklet will help you to make use of all quality services from Saudi Enaya and to understand your full range of benefits.

 This Guide Applies To The Following Saudi Enaya Products

  • Al Dana الدانة
  • Zumorod زمرد
  • Yaqout ياقوت
  • Fairouz  فيروز

These products offer different geographical coverages:
- Saudi Arabia only,
- Saudi Arabia and Home Country (as per the member’s nationality and nominated as Home Country on the Census Data provided)
- Saudi Arabia and WW2 - Worldwide 2 (excluding Europe, UK, USA & Canada)
- WW1 - Worldwide 1 (all countries)

These products are compliant with the regulations set forth by the Council of Cooperative Health Insurance (CCHI) and have been designed to provide you with:

  • Choice,
  • Security,
  • Ease of use,
  • Peace of mind

The products cover all mandatory eligible healthcare expenses for you and your dependants and as well as additional extras depending on your level of cover.

 

A Guide To Your Membership,

We have prepared this guide to help you appreciate what it means to be a member of Saudi Enaya and to understand your membership benefits as well as your responsibilities.This guide should be read in conjunction with the Table of Benefits that you are receiving together with this guide. Please check the file attached with this and take some time to read this guide carefully.

Get Familiar With Your Medical ID Card

Saudi Enaya Member Services

  • Member Assistance around the clock (24/7)
  • Online Authorization
  • SMS Services
  • Provider Network

Direct Billing & Reimbursement

  • Direct Billing
  • Reimbursement

Definitions

  • Applicable Healthcare Benefits
  • Out-patient Treatment
  • Co-Insurance
  • In-patient Treatment
  • Room Type
  • Companion Cover
  • Pre-existing & Chronic Diseases
  • Maternity
  • Optical
  • Dental
  • Emergency Treatment

Pre-Approval

  • What is Pre-Approval?
  • Prior Approval and Notification Requirements
  • 5 Steps to avail Health Services
  • Feedback or Complaints
  • Glossary of terms

Additional information