Tawuniya basic b hospital list

TAWUNIYA

Our Company

The Company for Cooperative Insurance (Tawuniya) was founded in 1986 in Riyadh as a Saudi joint stock company and the first licensed national insurance company​in Saudi Arabia offering various ​insurance products commensurate with the needs of the community of individuals and companies in accordance with the cooperative concept that is islamically accepted.

During the years Tawuniya has established work high value goals that primarily target customers, where it is based on the knowledge of customer insurance requirements and work to meet them by group competent experts in the same field.

Tawuniya continued its growth and maintained its position as the insurance company leader in Saudi Arabia, with a high level of services and advanced insurance programs to become the first choice for customers.

Our strategy

Tawuniya strategies proceed from our mission that states “To be the professional insurer of choice by delivering world-class solutions for the protection of economic and humanistic interests”. Tawuniya puts in mind the development of its overall strategy on an ongoing basis so that it is an accurate assessment of the internal and external factors to meet the emerging changes in the insurance market.

The company has taken into account the evolution of regulatory environment and risk scenarios activity and ways to reduce them. It is working on development and innovation continuously to consolidate its leadership position in the Saudi insurance market that is rapidly growing.

In order to achieve the strategic objectives, Tawuniya invests in the development and improvement of information technology and human resources to create added values. This is done by aligning all departments of the company around a clear strategic agenda, and by focusing on a specific set of initiatives and strategic priorities. State-of-art help Tawuniya’s management to navigate towards the strategic goals while reducing risks and meeting different customer needs.

ompetitive advantages

· Leading insurance company in Saudi Arabia with a professional experience that extends for thirty years.

· It has a very strong competitive position benefiting from its reputation in the market and a lot of the ingredients that are characterized by.

· Tawuniya’s diversified portfolio constitutes of medical, motor, and property & casualty insurance programs and provides about 40 insurance policies.

· Strong financial position is supported by a paid-up capital of 1,250 million riyals.

· The wide geographical presence in the Saudi insurance market and has the largest sales network of up to 115 offices.

· Tawuniya has a huge customer base that includes major Saudi companies and government bodies.

· Tawuniya provides the highest level of quality insurance services available around the clock via the customer service, e-commerce systems, and smart phones application.

· Tawuniya has achieved the compliance with regulations, implementing regulations and the sharaia review.

· Tawuniya is distinguished with its sophisticated electronic work environment and employing well trained human resources.

· It has strategic alliances with local and international partners and high class reinsurers.

· Tawuniya has the largest network of service providers in Saudi Arabia.

· The Company provides value added serves to different customer segments.

2015 Achievements

· The leading insurance company in Saudi Arabia with a market share of 21.2%.

· Having a diversified portfolio with GWP of 7.5 billion riyals.

· Achieved the largest profit in the history of the company of 642 million riyals.

· The company's total assets exceeded 11.5 billion riyals in 2015.

· Achieved the highest investment profits in the insurance market of 234 million riyals.

· Assigned (A) rating by Standard & Poor's for the tenth consecutive years.

· The highest Saudization rate achieved in 2015 of 79%.

· Awarded a most famous brand in Saudi Arabia in 2015.

· Selected in the list of the Top 100 Saudi companies in 2015.

· Tawuniya won the award for the best corporate insurance solutions provider in 2015.

Social Responsibility

Tawuniya launches innovative, social and philanthropic initiatives based on its own philosophy of supporting social responsibilities. This is focused on adapting our technical expertise, characterized by social services work through several efforts, such as funding local causes through donations. Other company activities in social responsibilities are varied to include support for specific categories of community members in assisting them in identifying and solving problems, as well as to raise awareness within the community concerning health and environment. In addition to, providing support for training community services programs, and participating in charitable social works and national campaigns to support people around the globe, in accordance with the Kingdom’s policies.

In this context, Tawuniya has introduced a number of activities within the realm of social responsibilities. For example, since 2006, Tawuniya has participated in the launch of a cooperative initiative with Prince Fahad Bin Salman Charity Association for Renal Failure Patients Care (Kelana).

Corporate Governance

Tawuniya is generally one of the first Saudi companies that issued governance guidelines, which was confirmed through the Board of Directors and Executive Management the company's commitment to develop professional and managerial standards consistent with the best practices. On the other hand, Tawuniya has achieved full compliance with all articles of the Corporate Governance Regulations issued by the Capital Market Authority (CMA).

The governance guidelines include standards covering the company's corporate governance policies, its strategic direction, the required culture, and the guidance principles followed at the core of the functional areas of the company. The governance guidelines also reflect the main guiding principles issued by the Saudi Arabian Monetary Agency (SAMA) on corporate governance in general. The list includes basic rules of corporate governance of listed companies, reporting requirements imposed, disclosure in the capital market system and relevant regulations.

Sharayaa Compliance

The Sharayaa Committee was formed by Tawuniya on 25/2/2007, to ensure the entire compliance of Tawuniya insurance policies and investment activities by the rules and principles of Islamic Law (Sharia).

The legitimacy basis mode of the policies and investment was set, by contracting with the Sariyah Review Bureau, the Corporate World’s leading Shari’a Advisor.

This is to confirm the interest of the Board of Directors and executive management to maintain Tawuniya’s compliance with the provisions of Islamic law in its insurance operations and investments.

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

Silver

Bronze

Basic

MAXIMUM COVERAGE AMOUNT PER PERSON PER YEAR (IN SAUDI RIYALS)

1,000,000

800,000

700,000

600,000

500,000

500,000

COVERAGE RATE IN EXTERNAL CLINICS PER VISIT

Not applicable

10% with a maximum of SR 100

20% with a maximum of SR 100

20% with a maximum of SR 100

20% with a maximum of SR 100

20% with a maximum of SR 100

DOCTOR CONSULTANCY FEES

Covered

Covered

Covered

Covered

Covered

Covered

APPROVAL ON EXTERNAL CLINICS' SERVICES

SR 1,000

SR 1,000

SR 1,000

SR 1,000

SR 500

SR 500

COVERAGE RATE FOR HOSPITALIZATION

Not available

Not available

Not available

Not available

Not available

Not available

ROOM TYPE

Regular Suite

Regular Suite

Private Room

Private Room

Shared Room

Shared Room

PREGNANCY & DELIVERY

30,000

25,000

20,000

15,000

15,000

15,000

COVERAGE OF NEWBORNS

The infant is added to the policy from the date of birth in order to facilitate their access to the necessary treatment. Until the procedures of adding them to the policy is done, the mother's card can be used for a maximum period of 15 days.

PRE-TERM BABY TREATMENT

Covered

Covered

Covered

Covered

Covered

Covered

PREGNANCY/DELIVERY COMPLICATIONS

Covered

Covered

Covered

Covered

Covered

Covered

DENTAL CARE COVERAGE

5,000

4,000

3,000

2,000

2,000

2,000

PRESCRIPTION GLASSES COVERAGE

2,000

1,500

1,000

800

400

400

HEARING AID COVERAGE

6,000

6,000

6,000

6,000

6,000

6,000

EMERGENCIES IN KSA

Covered

Covered

Covered

Covered

Covered

Covered

OPTIONAL TREATMENT (NOT AN EMERGENCY) OUTSIDE THE NETWORK INSIDE THE KINGDOM OR ABROAD

Covered with consideration to regular fees

Covered with consideration to regular fees

Covered with consideration to regular fees

Covered with consideration to regular fees

Covered with consideration to regular fees

Not covered

EVACUATION IN CASE OF EMERGENCIES AROUND THE WORLD THROUGH UNITED HEALTHCARE GLOBAL

Covered

Covered

Covered

Covered

Covered

Not covered

TREATMENT OF EMERGENCY CASES OUTSIDE THE KINGDOM

100,000

75,000

50,000

50,000

50,000

Not covered

REPATRIATION OF REMAINS TO HOMELAND

15,000

10,000

10,000

10,000

10,000

10,000

AUTHORIZED SERVICE PROVIDER NETWORK

Golden/+1

Golden/+1

1

+2

3

4

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 92 000 7699 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.

My Family" Medical Insurance Program

This is an insurance program that provides adequate healthcare for all family members, in compliant with the provisions of Islamic Sharia. The program consists of four categories commensurate with the various members of the community.

"My Family" program covers most of the medical services provided in the outpatient as well as inpatient services, including the expenses of medical examination, diagnosis, medical treatment, medicines, vaccination, pre existing diseases, pregnancy and maternity at the largest approved medical service providers network KSA.

Categories of "My Family" Program

"My Family" program is suitable to all members of the society with its four different categories, namely:

· My Family Silver

· My Family Golden

· My Family Platinum

· My Family Diamond

The categories of "My Family" program include many of the benefits, privileges and services that are compatible with your needs and that of your family to provide comprehensive medical cover up to a maximum limit of SR 250,000 per person per policy year.

Medical Coverage & Benefits

My Family Silver

My Family Gold

My Family Platinum

My Family Diamond

BASIC MEDICAL COVER

Maximum policy benefit limit per person every year

SR 30,000

SR 50,000

SR 100,000

SR 250,000

Room & board limit At preferred provider network At non preferred provider network (emergency only)

Shared Room SR 350

Shared Room SR 350

Private Room SR 600

Private Room SR 600

Out-patient doctors fees at preferred provider network

SR 75

SR 100

SR 150

SR 200

Maximum pre-existing benefit sub-limit per person every year (no waiting period)

SR 30,000

SR 50,000

SR 100,000

SR 250,000

Local ambulance services

Covered

Covered

Covered

Covered

Circumcision for newborn male babies

Covered

Covered

Covered

Covered

Ear piercing for newborn female babies

Covered

Covered

Covered

Covered

Vaccinations for children as per MOH specification

Covered

Covered

Covered

Covered

Physiotherapy treatment

Covered (12 Sessions)

Covered (12 Sessions)

Covered (12 Sessions)

Covered (12 Sessions)

Hearing aids / other aids / equipments

SR 1,000

SR 1,000

SR 1,000

SR 1,000

Geographical limits Within KSA Outside KSA

Covered Not Covered

Covered Not Covered

Covered Not Covered

Covered Not Covered

OPTICAL COVER BENEFITS LIMIT

Maximum optical benefit limit Per Person Per Year

SR. 200

SR. 300

SR. 500

SR. 1,000

Optical cover benefit limit to:

Optical examination

Covered

Covered

Covered

Covered

lenses once per person per year

Covered

Covered

Covered

Covered

MATERNITY/OBSTETRICAL COVER

Maximum maternity benefit limit per spouse per year (PSPY)

SR. 5,000

SR. 7,000

SR. 10,000

SR. 15,000

Normal delivery Caesarean section/complications

SR. 5,000

SR. 7,000

SR. 10,000

SR. 15,000

Legal Abortion/Miscarriage(Pre and post natal care covered under basic limit)

SR. 5,000

SR. 7,000

SR. 10,000

SR. 15,000

DENTAL COVER BENEFITS LIMIT

Maximum dental benefit limit PPPY (basic cover only)

SR. 1,000

SR. 1,500

SR. 2,000

SR. 3,000

Dental cover benefit limit to:

Dental consultation

Covered

Covered

Covered

Covered

Extraction non-surgical/surgical

Covered

Covered

Covered

Covered

Amalgam/composite (non-cosmetic) filling

Covered

Covered

Covered

Covered

Root canal treatment

Covered

Covered

Covered

Covered

Gum treatment

Covered

Covered

Covered

Covered

X-rays & prescribed medication in respect of above covers

Covered

Covered

Covered

Covered

DEDUCTIBLE/COINSURANCE

Each and every out-patient claim

20%

20%

20%

20%

Each and every in-patient claim

20%

20%

20%

20%

Program Conditions

· Insurance must include all family members, without exception or selection

· The Saudi families only can benefit from "My Family" program

· Coverage begins 30 days after the policy issuance

· Percentage of deductible is 20% per each claim in both outpatient and inpatient cases

· The insurance provided covers the male until the age of 18 years and females (unmarried / widowed / divorced) until the age of 60 years

· The program does not allow adding new beneficiaries during the currency of insurance policy with the exception of newborn or new wife

· The program covers the elderly up to 60 years

Advantages of the program

1. Medical treatment is available for the Golden Network on all approved medical service providers, which include hospitals and medical centers in all major cities, dispensaries, clinics, pharmacies and optics shops

2. The insurance premiums can be paid in monthly installments at no extra charge

3. This insurance covers chronic diseases such as hypertension, diabetes, and pregnancy and delivery expenses since the first month of the inception of cover without a waiting period

4. It covers vaccinations for children as per schedule decided by the Ministry of Health

5. Immediate response to medical approvals

6. The provision of second medical opinion in complicated disease cases

7. It provides medical assistance around the clock by the Toll Free Phone No. : 920019990