Products

Product and Expertise

A Range of Choices

All Saudi Enaya products are compliant with the minimum requirements mandated by the Council of Cooperative Health Insurance.

The products available vary in the levels of access to health care providers, room type and benefit limits with the options chosen to be determined by you the customer.

For businesses looking for Group Health Insurance we have flexible options available for business customers knowing that many wish to provide different levels of cover dependant on the employees rank or position within the company.

Expertise in Health Insurance

The management and operations team of Saudi Enaya consists of a number of internationally experienced health insurance specialists.

Our dedicated team uses a range of internationally proven IT systems that manages claims, pre-authorization's and other core functions to support the relevant needs of our customers and members.

Healthcare Providers

The comprehensive CCHI Accredited, Healthcare Provider network developed by Saudi Enaya consists of more than 600 providers across the Kingdom of Saudi Arabia including hospitals, Polyclinics, Diagnostic Centers, Dental Centers, Optical Centers and Pharmacies.

These Healthcare Providers have been chosen based on regulatory compliance, location, services and specialization to best service the needs of Saudi Enaya members.

The classification for each is based on the above criteria and is ranked from 1 to 4 with 1 providing high level services to 4 providing basic medical services.

Our Products

Saudi Enaya offers four different products:

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

Option for International Coverage

The Saudi Enaya product portfolio includes the options for coverage in;

- Saudi Arabia only,
- Saudi Arabia and Home Country
- Saudi Arabia and Worldwide 2 (excluding Europe, UK, USA & Canada)
- Worldwide 1 (all countries)

The international coverage is based on reimbursement of claims once received by Saudi Enaya and is subject to customary charges, preauthorization rules and standard exclusions.

Hundreds of choices

With the various In-patient benefits as well as options to increase Optical and Dental coverage there are 100's of choices.

Talk to an Enaya representative, Insurance Broker or Agent today to discuss what options best suit you and Ask for a Quotation.

Product Table

Benefits Limits of Cover
Product SE Premier (NW 1) SE Enhanced (NW 2) SE Classic (NW 3) SE Care (NW 4)
Annual Aggregate Limit SR 250,000
SR 500,000
SR 1,000,000
  SR 250,000
SR 500,000
SR 250,000 SR 250,000
In-patient Limit Up to the Annual Aggregate Limit
Out-patient Limit Up to the Annual Aggregate Limit
Network Premier (NW 1) Enhanced (NW 2) Classic (NW 3) Care (NW 4)
Room Accomodation Standard Suite Private Room Semi-Private Room Shared Room
Geographical Area KSA & Worldwide 1 (Worldwide Coverage) or
KSA & Worldwide 2 (excluding USA, Canada, Europe, UK)
KSA & Home Country only KSA only
Companion Covered for children up to the age of 12 years
Pre-existing & Chronic Conditions Covered up to the Annual Aggregate Limit
Pregnancy & Delivery (provided the beneficiary is of a married status in the contract) Covered up to the maximum of SR 15,000 during the term of the policy
Maternity Complications Covered up to the Annual Aggregate Limit
Newborn Baby Covered from Day 1
Premature Baby Covered up to the Annual Aggregate Limit if the Maternity Benefit is covered
Circumcision of newborn Boys and Ear-piercing for newborn Girls Covered up to the Annual Aggregate Limit if the Maternity Benefit is covered
Vaccination Covered for children up to the age of 6 years as per the Ministry of Health (MOH)
Life threatening Congenital cases Covered up to the Annual Aggregate Limit


Out Patient Co-Insurance
0%, 10% or 20% per visit with a maximum limit of SR 100 per visit (Co-Insurance: the percentage paid by the member when visiting an Out Patient clinic physician including all consultations, lab tests, x-rays, medicines and other medical necessities as well as follow-up visits and referral for the same illness, not every procedure separately)
Deductible Nil



Maximum Physician Fees
 
General Practitioner (GP)
Specialist
Consultant
Rare specialties such as cardiac,
neurology and blood vessel surgeries,
complicated specialties

SR 50
SR 100

SR 150
SR 250
Ambulance Covered only for Emergency cases within KSA



Overseas Coverage (outside KSA)
1. Covered 100% for Emergency cases on reimbursement basis


2. Covered 100% for Non-Emergency cases on reimbursement basis subject to reasonable and customary charges in KSA and with all admissions / surgeries subject to prior approval by Saudi Enaya
1. Covered 100% for Emergency cases on reimbursement basis, subject to reasonable and customary charges in KSA
2. Covered 80% for Non-Emergency cases on reimbursement basis, subject to reasonable and customary charges in KSA with all admissions / surgeries subject to prior approval by Saudi Enaya



not available


Coverage outside Network (in KSA)
1. Covered 100% for Emergency cases on reimbursement basis

2. Covered 80% for Non-Emergency cases on reimbursement basis, subject to reasonable and customary charges in KSA with all admissions / surgeries subject to prior approval by Saudi Enaya

Covered 100% for Emergency cases on reimbursement basis
Physiotherapy Covered when medically necessary
Dental Benefit / Annual Limit:
(consultation, x-rays, extraction of natural tooth, amalgam & composite fillings, root canal treatment, gum treatment; excluding scaling and cleaning)

SR 2,000
SR 3,500
SR 5,000


SR 2,000
SR 3,500


SR 2,000


SR 2,000
Optical Benefit / Annual Limit: (consultation, basic prescription glasses & frames ; excluding optical appliances and contact lenses)

SR 200
SR 1,000
SR 2,500


SR 200
SR 1,000


SR 200


SR 200
Renal Dialysis Covered up to the maximum of SR 100,000 during the term of the policy
Body Repatriation to Home Country Covered up to the maximum of SR 10,000 during the term of the policy
Acute Psychological Disorders / Annual Limit Covered up to 90 days up to a maximum of SR 15,000

Worldwide 1* has no limitation on region or country

Worldwide 2* excludes the United States, Canada, Europe and the United Kingdom

Worldwide benefits (to be paid on reimbursement)

  • Elective treatment for those members with access to Network 1 & 2 (Products Premier & Enhanced) to be paid 100% as per KSA reasonable and customary Healthcare Provider charges
  • Elective treatment for those members with access to Network 3 (Product Classic) to be paid 80% as per KSA reasonable and customary Healthcare Provider charges.
  • Emergency Treatment charges for those members with access to Network 1 & 2 (Products Premier & Enhanced) will be reimbursed as incurred.
  • Emergency Treatment charges for those members with access to Network 3 (Product Classic) will be reimbursed as 100% per KSA reasonable and customary Healthcare Provider charges.

Note: The recommendations in the table above are indicative only and it is at the discretion of the purchaser as to what level of cover they choose.

CO-INSURANCE

With all Enaya products there is the option to include a Co-Insurance payment to be made for each Out-Patient visit.

The Co-Insurance options available are all CCHI compliant and the maximum Co-Insurance is limited at SAR 100.

OPTIONS AVAILABLE MAXIMUM OUT OF POCKET OPTIONS
0% Nil
10% SR 50, SR 100
20% SR 50, SR 100
DENTAL & OPTICAL

All Enaya products include the CCHI minimum mandatory coverage however the option is available to increase the level of coverage for either Dental or Optical as highlighted in the table below (only for Premier & Enhanced Product).

DENTAL
limits available
OPTICAL
limits available
SR 2,000
(minimum CCHI requirement)
SR 200
(minimum CCHI requirement)
SR 2,000 SR 200
SR 3,500 SR 1,000
SR 5,000 SR 2,500
MATERNITY

Maternity cover is compliant with CCHI regulation which allows for a standard benefit of SR 15,000 for normal delivery and up to policy limit in case of complications.

Additional information