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Health Insurance Agreement
"I need a Health Insurance Agreement for my tech company based in Riyadh, covering 200 employees and their dependents, with international coverage options and special provisions for remote workers, to be effective from March 1, 2025."
1. Parties: Identification of the insurance provider and the policyholder/insured party
2. Background: Context of the agreement and brief description of the parties' intentions
3. Definitions: Detailed definitions of terms used throughout the agreement, including medical and insurance-specific terminology
4. Scope of Coverage: Detailed description of health insurance coverage, including mandatory benefits as per CCHI regulations
5. Premium Payment: Terms and conditions for premium payments, including payment schedule and methods
6. Claims Procedure: Process for submitting and handling claims, including documentation requirements
7. Exclusions: Specific conditions, treatments, and circumstances not covered by the insurance
8. Obligations of the Insurer: Responsibilities and commitments of the insurance provider
9. Obligations of the Insured: Responsibilities and commitments of the policyholder/insured party
10. Duration and Renewal: Term of the agreement and conditions for renewal
11. Termination: Circumstances and procedures for termination of the agreement
12. Dispute Resolution: Procedures for handling disputes, including reference to Saudi courts and CCHI arbitration
13. Confidentiality: Provisions regarding the handling of medical and personal information
14. Governing Law: Specification of Saudi law as governing law and compliance with Shariah principles
1. International Coverage: Terms for coverage outside Saudi Arabia, used when international coverage is requested
2. Group Policy Provisions: Specific terms for group insurance policies, included when the policy covers multiple individuals
3. Pre-existing Conditions: Special terms regarding pre-existing conditions, included when relevant to the specific policy
4. Maternity Coverage: Specific terms for maternity coverage, included when this coverage is part of the policy
5. Chronic Disease Management: Special provisions for chronic disease coverage and management programs
6. Network Providers: Terms specific to using in-network healthcare providers, included when the insurer has a specific network
7. Premium Adjustment: Terms for premium adjustments based on claims history or risk factors, included for certain policy types
1. Schedule A - Benefits Table: Detailed breakdown of coverage limits, deductibles, and co-payments for different types of medical services
2. Schedule B - Network Providers: List of approved healthcare providers and facilities within the insurance network
3. Schedule C - Premium Schedule: Detailed premium calculations and payment schedule
4. Schedule D - Excluded Treatments: Comprehensive list of excluded medical treatments and procedures
5. Schedule E - Claims Documentation: List of required documents and forms for claims processing
6. Appendix 1 - Pre-approval Procedures: List of treatments requiring pre-approval and the approval process
7. Appendix 2 - Emergency Procedures: Procedures for emergency treatment and coverage
8. Appendix 3 - Complaint Procedures: Detailed procedures for filing and handling complaints as per CCHI requirements
Authors
Healthcare
Insurance
Financial Services
Corporate Services
Human Resources
Professional Services
Manufacturing
Retail
Technology
Education
Construction
Hospitality
Legal
Human Resources
Compliance
Finance
Operations
Risk Management
Employee Benefits
Corporate Affairs
Insurance Operations
Healthcare Administration
Legal Counsel
Compliance Officer
HR Manager
Benefits Administrator
Insurance Manager
Risk Manager
Contract Manager
Chief Financial Officer
Operations Manager
Employee Relations Manager
Compensation and Benefits Specialist
Healthcare Administrator
Insurance Underwriter
Claims Manager
Corporate Secretary
Chief Legal Officer
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