Transcript Medical Insurance - KSU Faculty Member websites

Ballorat company for
cooperative insurance
agencies services
Mission Statement
“To be the professional insurer of choice by delivering
world-class solutions for the protection of economic and
human interests”.
Our vision
Ballorat vision reflects the image of what the external and
internal environment and the desired culture is going to be
at a definite point in time. The year 2007 was chosen as
the designated point in time for Ballorat vision to
materialize. The Company's vision of the external and
internal environment includes the legal environment,
society, industry, market position, financial position and
overall position.
Strategic Goals
Since its inception, Ballorat goals have exceeded purely commercial
ambitions based on profit gain as an ultimate objective. Hence, the Company
has designed its strategic goals and implemented them in a manner to realize
its future financial and non-financial ambitions.
These goals are:
1. Offer professional quality service to customers and provide first class
security.
2. Promote awareness of the benefits derived from the concept of
cooperative insurance.
3. Maximize retention of insurance funds within Saudi Arabia.
4. Maximize the number of professionally qualified Saudi nationals within the
Saudi insurance industry.
Ballorat offers its retail and corporate clients a mixture
of products that cater to their insurance needs
such as:
Products :
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Motor Insurance
Medical Insurance
Fire & Property
Miscellaneous Accident
Engineering Insurance
Marine Insurance
Takaful Insurance
Aviation Insurance
Energy Insurance
Health insurance
To avoid the high cost of medical treatment, NCCI
offers a number of well-organized medical insurance
plans. These plans provide comprehensive healthcare
at the largest medical centers in the Kingdom.
Individual insurance :
Ballorat provides individuals with a diversified set of
retail insurance programs that offer comprehensive
protection to them and their property. These
programs include the insurances of Motor, Medical,
and Casualty and Property. The Company has the
resources and means to extend its insurance covers to
meet all retail needs. The following are Ballorat retail
programs.
Taj medical insurance:
Taj Necessity for Healthy Life
Health is real wealth, if utilized properly the result will be
a very happy life. Alike the “Crown”, which according to
the Arabic proverb, sits on the head of healthy people
only seen by patients. Hence, it is essential to plan
perfectly to obtain you and your family members high
quality healthcare. To avoid the exorbitant medical
treatment expenses, NCCI has prepared a well-organized
4 medical insurance plans to provide you and your family
with a comprehensive healthcare at the largest medical
providers in the Kingdom. You can obtain such benefits
against the payment of annual premium at your disposal.
Being the client of NCCI, you and your family will
receive high standard medical services.
Taj Plans:
NCCI provides 4 quality medical insurance plans that vary as
to coverage limits to meet the healthcare demand of our
clients’ needs. All Plans provide the beneficiaries, within the
period of insurance, the maximum level of healthcare. These
plans are as follows:
1 . A’Shifa Plan
As a member of this plan, you will be covered for all Inpatient expenses including room and board in hospital,
surgery, anesthetics, investigations and medical supplies and
treatment. The cover also includes post hospital treatment
expenses, one day surgery/ treatment, ambulance services,
companion of a child less than 10 years old expenses and
repatriation of mortal remains.
2 . A’Shifa Premier Plan
This plan provides all the benefits mentioned under A’Shifa Plan, plus
higher coverage limits and delivery expenses.
3. Taj Care Plan
This Plan provides people seeking comprehensive coverage (out-patient
and in-patient). It covers both A’Shifa plans covers as detailed above
with additional coverage for out-patient services. Such cover includes
doctor fees, medications, diagnostic procedures and treatments.
4 . Taj Care Premier Plan
It is the best and most comprehensive plan you can get. It grants you
added security by knowing that you are fully insured with high benefit
limits against any medical expenses arising as a result of In-patient and
Out-patient medical treatment including maternity and delivery and
dental treatment expenses. The cover limit of taj amounted to SR 1
million per insured person per policy year.
Taj group Medical
Eligibility for Insurance:
While designing this program, we highly considered
that our largest medical care should include the
beneficiaries. The coverage is eligible for full-time
employees, their spouses, dependent children (up to
21st birthday) and unmarried daughters. Providing
more flexibility, we may expand the choice to include
dependent children (up to 25th birthday), divorced
and widowed daughters too.
Benefits Duration Period:
The duration of coverage will be for one Gregorian year, starting from the inception date.
Renewal is possible at the desire of both parties. However, each party has the right to
end, cancel or amend any of the contract conditions or cover limits prior to renewal.
Scope of Cover
• In- Patient and Out-Patient Services:
These are the main covers of all medical insurance programs launched in
the market. By the time many services are being excluded from other
medical programs, TAJ Medical Program provides a wide range coverage
to all basic healthcare expenses, presented either in patient or under
treatment as an out-patient. Out-patient services include doctors’
consultation fees, medication, x-rays, lab tests and children vaccination.
In-Patient covers includes ambulance services to or from hospital,
accommodation and board expenses, surgery, oxygen supplies,
anesthetizes, physiotherapy, wheelchair service, artificial organs, private
nursing within the insured’s home and the companion charges for
children.
• Pregnancy and Maternity:
The pregnancy and maternity is one of the additional covers provided by
this program. It includes both pre-natal and post-natal care in addition to
baby born care. Benefits payable are not limited to normal deliveries
only. It expands to also include caesarean/complicated delivery plus the
miscarriage/ legal abortion. The cover commences from the inception of
the insurance period and is payable for one pregnancy per spouse per
policy year.
• Optical Treatment:
The NCCI medical program provides an additional cover with agreed
limit to the expenses of optical examination and normal lenses per
person per policy year.
• Dental Treatment:
Up to suitable maximum sub-limit, the program covers dental expenses
per person per policy year related to teeth extractions, fillings, root
canals and gum treatment and periodontal treatment including related xrays and prescribed medications.
• Pre-existing Diseases:
It may coincide that some of your employees have certain diseases or
injury cases prior to policy. Such cases are usually excluded by some
insurers as to avoid extra expenses. Yet, TAJ program provides the
advantage of covering pre-existing cases along with all medical services
needed for treatment.
• Geographical Limits:
Basically, the program provides insurance cover for employees resident
in Saudi Arabia. Yet, we offer to extend such coverage to provide
benefits for insured employees and their eligible dependents for
emergency medical treatment while abroad on vacation or business
trips/training. Moreover, we can provide full cover over medical cases
provided that a prior approval is obtained from the company and the
medical reports stated that the treatment is unavailable in the Kingdom
of Saudi Arabia.
• Repatriation of Mortal Remains:
In addition to all previous covers, the program also provides the cost of
repatriating of remains of an insured person, following a fatal ailment, to
his country of origin or KSA.
TAJ Medical Cards
NCCI will provide each insured employee and eligible dependents Taj
Medical Cards including basic information such as policy number, expiry
date and insured ID number. By presenting this card, the insured will be
able to obtain all necessary medical services directly from the approved
medical providers by all facilitated means. NCCI will freely replace lost
or damaged cards and will issue cards for every new insured member.
Medical Care Kingdom-Wide
NCCI has highly qualified officers and coordinators who are able to
assist you all around the country. Not only through our head office that
you can reach us, but we can be as near as possible in all regions. There
are qualified doctors in our three regional offices (Riyadh, Jeddah and
Dammam) available to solve any problem related to program benefits
and, in some cases, may provide second opinion as needed.
Taj Unique Features:
- To provide out of KSA cover with additional contribution.
- To provide you with a comprehensive medical treatment at the largest
medical providers in the Kingdom.
- To provide you with the second medical opinion on critical cases to
ensure exact diagnosis.
- To provide the tele-medicine service to save our clients the trouble and
hardship sustained when traveling abroad for medical treatment.
- To offer world wide healthcare assistance to clients whilst traveling
outside the Kingdom.
- To ensure the customers receive excellent healthcare service by
applying the service quality control check.
- To simplify the procedures of obtaining required medical service with
no unnecessary administrative obstacles.
Taj Plan Rates
NCCI has prepared a schedule of Taj plan rates
through which you know the premium amount
you have to pay for obtaining the required
medical cover. You only have to select one of
Taj's 4 plans then determine age, sex and
geographical limit. The value of payable
premium is determined to you accordingly.
Reimbursement of medical expenses:
• The insured person should refer only to the approved
medical providers stated in the policy.
• In certain cases may you will not be able to find appointed
medical provider, in this case NCCI will accept your bills for
reimbursement.
• In order for the claim to be eligible for reimbursement:
a. You must fill in the reimbursement form completely.
b. Forward originals of Doctor's prescriptions, pharmacy bills
and all cash receipts.
c. Original detailed medical report.
d. A copy of the medical card.
• Emergency cases and in cities where no providers NCCI will
accept your bills subject to the stated policy conditions.
Why medical malpractice ?
It is of course perfectly right and proper that everyone
has personal liability for any harm he might cause to
another person . for the medical professional whose
work necessarily involve a degree of risk of the
patient, this is not an abstract concept but a profound
responsibility to be porn every moment of his or her
working life.
Although these rules set guideline for the profession
they in no way limit the liability of the individual
practitioner under sharia law.
What does the medical malpractice policy cover ?
Economically priced and designed with painstaking
care to meet the needs of today medical professional,
the policy indemnifies you against legal liability for
negligent acts committed within Saudi Arabia covering
compensation and claimant costs as well as the cost of
defence and investigation of the alleged malpractice.
Cover is provided for all claims made during the
currency of the policy. General public Liability cover
is also available as an optional extra. You may set the
financial limit of indemnity according to your own
requirements.
Basic Cover: Malpractice:
Any bodily or mental injuries, illness, disease or death of any
patient caused by any negligent act, error or omission
committed by the insured in or about the conduct, within
Saudi Arabia, of the insured occupation or business or in
respect of other emergency medical treatment.
Advantages:
1. It provides protection against economical and financial
consequences of professional errors in medicine which may
arise out of negligent acts. Indemnity against legal liability for
negligence in medicine are as follows:
 Compensation and claimant costs.
 The cost of defence and investigation of the alleged
malpractice.
2. Evidence of insurance cover that may be a protection against
being held or prohibited from travel by the authorities.
Optional Cover: public Liability
Any bodily or mental injuries, illness, disease or death of or to
any person (not an employee), or loss of or damage to
tangible property of any person in connection with the
insured occupation or business, conducted within Saudi
Arabia, as stated in the proposal or Declaration including
the provision of food and drink.
Advantage:
It provides protection against the legal liability of the
practitioner which arises in the course of or in connection
with the insured occupation
Or business including the liability arising out of food and drink
supplied through (kitchens in licensed medical providers) as
follows:
 compensation and claimants costs.
 the cost of defence and investigations of the alleged incident.
Medical expenses insurance quotation
Group medical insurance has become a legal and
economic necessity for any organization .the
following is a summary of its main benefits:
1.providing health care for employees and their eligible
family members that will reflect positively on their
standard of work and performance
2.controlling medical expenses as the employer pays a
fixed contribution for providing his employees and
their families with adequate medical cover.
3. relieving management of the administrative burden ,
thus allowing the employer to devote his energies to
better mange and develop his core business.
The Cooperative Insurance Concept
The cooperative insurance concept is approved by the
Saudi Council of Senior Ulema as the Islamically
accepted substitute for commercial insurance.
In simple words, the cooperative concept is based on
the cooperation of the policyholders contributing
funds towards compensating those amongst themselves
who are faced with accidental mishaps.
Surplus resulting from insurance operations is returned
back to the policyholders in the manner and time
determined by NCCI’s Board of Directors. Till this
date, NCCI returned back to policyholders in surplus
distributions more than SR 285 million for the
insurance operations from 1990 to 2004.