360° Health Insurance Plan for SME

The success of your business requires proper planning to face potential risks. Insurance experts at Tawuniya, the leading Saudi insurance company, will help you to identify, analyze and manage such risks and suggest appropriate insurance solutions. 360° Insurance Plan for Small and Medium Enterprises (SMEs) provides you with all your insurance needs from one place. Dedicate to grow your business.. and leave us the responsibility to protect it.


The 360° Health Plan... important for beneficiaries

  • Helps improve the health of the company's employees, and reinforces their productivity while boosting your business
  • Helps avoid workflow disturbance in case of employee absence for long periods of time as a result of being ill without receiving the proper healthcare
  • Helps you have a sound financial plan for your company because the insurance predetermines the value of the healthcare packages' installments that you commit to settling, and helps you better control medical expenses
  • Eases up your company's administrative tasks because Tawuniya will take care of all beneficiaries' treatment procedures, in coordination with the authorized medical services' providers
  • Provides various categories of healthcare plans that meet the needs of your employees depending on their administrative grade with coverage ranging between SR 500,000 and SR 1 million per beneficiary per year
  • Provides your employees with the needed healthcare while they're on leave or during business trips outside the Kingdom as per the terms and conditions of the chosen plan
  • Increases the company's profitability margin by cutting down on the expenses allocated to treating employees, especially from chronic and dangerous illnesses that require considerable amounts of money for an extended period of time
  • Makes the Tawuniya services accessible around the clock while providing your employees with the necessary care at any health services' provider listed within our network which spreads across KSA and beyond
VIP A/B Platinum A/B Gold A/B/C Silver A/B Bronze A/B Basic A/B
Network
Golden/+1 Golden/+1 Golden/+1/1 1/+2 2/3 3/4
Annual maximum limit per person
1,000,000 SR 800,000 SR 700,000 SR 600,000 SR 500,000 SR 500,000 SR
Outpatient deductible for each patient visit subject to upper limit
None 10% 20%
 20%  20%  20%
Upper limit for Out-Patient Deductible/Co-insurance per visit
None
  • UMPN providers maximum limit "Hospital&Polyclinic" (75 SR)
  • Out UMPN providers maximum limit "Hospitals" (100 SR)
  • In/Out of UMPN providers maximum limit "Other provider " (100 SR)

* UMPN: Unified Minimum Provider Network.

Doctor Consultancy Fees
Covered
 Covered  Covered  Covered  Covered  Covered
Outpatient Pre-authorization
SR 1,000 SR 1,000 SR 1,000 SR 1,000 SR 500 SR 500
Inpatient Deductible
None
 None  None  None  None  None
Room
Normal Suite up to 1,500 SR
Private Room
Shared Room
Dental Benefit
5,000 4,000 3,000 2,000 2,000 2,000
Spectacles Benefit
2,000 1,500 1,000 800 400 400
Hearing Aid Benefit
6,000 6,000 6,000 6,000 6,000 6,000
Maternity Benefit
30,000 25,000 20,000 15,000 15,000 15,000
Newborn Coverage
Covered on: The mother’s policy up to a maximum of 30 days from the date of birth until they are added in the policy on retroactive basis from the date of birth.
Premature Born Babies
Covered Covered Covered Covered Covered Covered
Complications of Delivery / Pregnancy
Covered Covered Covered Covered Covered Covered
Emergency Cases in KSA
Covered Covered Covered Covered Covered Covered
Elective (non-emergency) treatment out of network in or out of KSA
Covered subject to reasonable and customary charges
Not covered
Emergency evacuation through UnitedHealthcare Global
Covered Covered Covered Covered Covered Not covered
Emergency treatment out of KSA
100,000 75,000 50,000 50,000 50,000 Not covered
Repatriation of mortal remains to home country
15,000 10,000 10,000 10,000 10,000 10,000

The Common Benefits (for all categories)

Type of Expenses

Coverage Ceiling (In Saudi Riyal)

Dialysis

100,000

Severe Psychiatric Illnesses

15,000

Acquired Damage in Heart Valves

70,000

Operation on an Organ Donor (for the donor)

50,000

Alzheimer Patients

15,000

Autism Cases

15,000

National Program for Early Diagnosis in Newborns

100,000

Disability

100,000

Newborn Circumcision (males)

500

Ears piercing (Females)

300

Infant vaccines according to the schedule of the Ministry of Health

Covered

Intensive Care Unit

Covered

Pre-existing and chronic diseases prior to the insurance policy

Covered

Natural Treatment

Covered

Caregivers of children under 12 years old

Covered

Ambulance service on local roads

Covered

Life-threatening congenital diseases

Covered

Treatment of allergy-triggered illnesses

Covered


Value-Added Services

  • The Dawai Service
  • Available online through the website and is used to renew a patient's prescription for chronic diseases' medications from certified pharmacies directly without referring back to your physician.

  • Tawuniya's Health Zone Program
  • This is a mobile platform by Tawuniya which is set up at the customer's headquarters to provide vital signs' checkups, tests, and advice about nutrition, losing weight and dealing with blood pressure and diabetes.

  • The Tabibi Service
  • This service grants beneficiaries access to general medical advice by contacting the number 920033404 which is dedicated to Tawuniya's customers service among SMEs.

  • Al Saha wal Afiyah
  • An awareness program that provides monthly tips about family and individual healthcare by email and SMS.

  • Second Medical Opinion
  • Offered to customers suffering from severe illnesses to ensure diagnosis' accuracy and sound treatment administration and management.

  • Auto-reply Service
  • Customers can follow up with their reimbursement or medical approval requests through the auto-reply system.


Unique & Exclusive Features

  • Instant Medical Approvals
  • Tawuniya offers this express service to its customers through an e-system that allows the issuance of medical approvals in a few minutes. The company issues more than 2 million medical approvals per year.

  • Worldwide Medical Assistance
  • We give our customers access to more than 4,000 medical services' providers in the world through our international insurance partner United Healthcare Global, and provide proper, round-the-clock healthcare for beneficiaries located outside the Kingdom.

  • Assistance Hotline
  • The hotline number is reachable around the clock and receives around 1.5 million calls per year with a service efficiency that reaches 100%.

  • Medical Expenses' Reimbursement
  • Tawuniya enables policy beneficiaries to apply a request to redeem medical expenses online. The request is processed within 24 hours and the amount is transferred to the customer's account within 5 working days. This service allows customers to redeem their medical expenses when consulting a medical service provider from outside the network, especially in emergency cases. We also send an SMS to the customer concerning the settlement of the medical expenses.

  • A Large Network of Service Providers
  • Around 2,000 hospitals, dispensaries, and medical centers spread across the Kingdom and offering full-fledged healthcare services available through several networks that fit with the insurance category chosen by the customer.

  • Exclusive Services
  • We have a dedicated customer-service team and exclusive facilities for VIP customers.

  • The Tawuniya Application
  • Available for all smart phones, this application grants users access to the details of their policy benefits as well as allows them to follow up on claims and medical approvals, receive approval notifications, and check the list of authorized medical services' providers.

  • Automated Self-Services
  • This automatic service enables customers to follow up on their medical approvals and medical expenses reimbursement's procedures, using a smart auto-reply system on the number 920019990.

 

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