Transcript Why medical malpractice? It is, of course, perfectly right and proper

The company for cooperative
insurance
((TAWUNIYA))
Name Group:
Saleh AL-Yami
Abdullah AL-Bgimi
Performance
Our Company
Tawuniya
The Company for Cooperative Insurance (Tawuniya) is a
Saudi Joint Stock Company established in Riyadh, Saudi
Arabia by Royal Decree number M/5 of 5.4.1985 G
(17.4.1405H).
.
The purpose of the Company is to transact in cooperative
insurance operations and all related activities such as
reinsurance or agency activities. Its principal lines of
business include motor, marine, fire, medical, engineering,
energy, aviation, takaful, and casualty insurance.
Historical Milestones
1986: Established as a Saudi Joint Stock
Company.
1987: The first fiscal year.
1988: Achieving the highest growth rate of
business amounting 789%
1989: Confirmed through recognized research as
the market leader in the Saudi insurance market.
1991: Launched a medical insurance program
which subsequently became known as Taj.
1992: Achieved 50% growth in retail business.
1993: Launched EDGE, Tawuniya’s integrated
bilingual back bone information system.
1995: Introduction of new retail products such as
personal Accident, Rukhsa, Taj Family/Individual,
and Medical Malpractice.
1997: Established a state-of-the-art Customers
Services Center (CSC).
1998: Achieved 50% nationalization of
Tawuniya’s workforce.
1999: Keeping the same growth rate without
being affected by low oil prices.
2000: Launching of savings plans for the first
time.
2001: Re-structuring the business into 4
segments (major, corporate, Commercial, and
Retail.)
2002: introduction of compulsory Drivers’
License (Rukhsa) and Foreign Vehicle insurance.
2003: the issuance of the law on the
supervision of cooperative insurance
Companies.
2004:
- Received the first registered license from SAMA to
transact business in accordance with the new Cooperative
insurance Law.
- Shareholders increased the paid up capital from SR 250
million to SR 500 million.
- The Tawuniya IPO started on December 21, 2004
floating 7 million shares representing 70% of the
company’s total capital.
2005:
- Conducted its first General Assembly after privatization
of the company.
- Launched two insurance plans (Shop Owners Insurance
Plan and Manasek Plan for Hajj and Umrah Performers).
2006:
- Assigned (A) rating from S&P.
- Dividing the structure to 3 strategic business units
and 2 distribution units.
2007:
- Establishing the Sharayaa Committee to revise the
insurance policies in accordance with islamic
Sharayaa.
- Launching a new identity to respond to the market
trends.
- Assigned (A) voting from S&P for the second year
respectively.
Capital & Ownership
The authorized and issued capital of Tawuniya
is SR 500 million, split into 50 million shares
of SR 10 each. Seventy percent of Tawuniya
stock is owned by Saudi nationals, and is
traded on the Saudi stock market. The
remaining 30% share is divided between the
General Organization for Social insurance and
the Public Pension Agency.
Strategy , Missio, Goals and Vision
Strategy Development
Tawuniya’s vision is distinct because it is based on a
careful assessment of external and internal factors so as to
meet the evolving insurance market conditions. Ittakes
into account the likely regulatory environment as well as
commercial risk scenarios and the means for mitigating
risk through creative developments of our business
model. Competitors will constantly improve, but we will
also drive the evolution of our business so as to
outperform our nearest rival and retain market leadership
within the Kingdoms’ rapidly expanding insurance
markets.
Strategy Achievement
To achieve our strategic goals Tawuniya invests in
developments and improvements that leverages IT
and mobilizes our human capital in a process of
continuous value creation. We do this by aligning
the Company around one strategic agenda.
Mission Statement
“To be the professional insurer of choice by
delivering world-class solutions for the protection
of economic and human interests”.
Strategic Goals
Tawuniya’s management strives towards a set
of medium-term activity objectives that are
chosen as having the greatest part to play in
propelling Tawuniya towards its vision and in
the implementation of its Strategy. When
these objectives are achieved they are
replaced by others so that the vision and
Strategy becomes progressively realized.
Our Vision
Tawuniya’s Vision addresses a long-term planning horizon
of five years. It describes a future where Tawuniya
benefits from the forecasted rapid insurance growth,
especially in service intensive lines, and where attractive
and challenging results are achieved. The vision also
includes a compelling insight about how Tawuniya’s
distribution channels, processes, organization and its
business culture will be transformed so as to bring these
desired results to fruition for the benefit of our
stakeholders. The stakeholders we have considered
include shareholders, customers, employees and partners
as well as the wider interests of the insurance industry
and society.
Environment
Structure and Organizational Chart
Desired Culture
Tawuniya aims at creating a culture built on 2 main
parts. The first is the soft side characterized by
components such as strong relationships, proactive
environment, influence, teamwork, empowerment,
and personal development, the second part is the
Hard side consisting of standards, improvement,
communication, service, decision making, and
accountability.
Organizational Structure
The structure included assigning 6 vice presidents in
addition to dividing the structure to 3 strategic business
units (motor, medical & takaful and property &
casualty) and 2 distribution units (key accounts and
marketing & sales).
Trained Staff
The quality services of Tawuniya do not solely depend
on the quality of its insurance coverages. It also
depends on the Company’s most significant asset, its
human
resources.
Tawuniya
has
designed
comprehensive development programs to retain highly
qualified staff.
Nationalization
In compliance with the national goal to achieve
Nationalization and to provide ample job opportunities for
the upcoming young Saudi generation, Tawuniya spares no
effort to attract Saudi employees to assume jobs at the
Company. Tawuniya invests heavily in training Saudi
nationals in many areas required by the business, and helps
them acquire the professional skills necessary to perform
assigned tasks.
Sharayaa Committee
The sharayaa committee of Tawuniya was formed on
25/2/2007. it is composed f their Eminence sheikh/Abdullah
Bin Sulaiman Al-Manie (Chairman), Dr. Mohammed Bin Ali
Al-Qarri Bin Eid (Member) and Sheikh Youssif Bin Abdul Al-Aziz
Al Farraj (Member).
Development
Innovative Services and Products
Market Intelligence
Based on Tawuniya strategy, which renders customer
service and customer satisfaction as a major goal, the
Company is keen to make all of its services
conveniently available to clients. Through its
competent staff, Tawuniya collects data on the Saudi
insurance market and consults customers about the
extent of Tawuniya insurance covers offered and
whether they meet their overall needs.
Innovative Products
Motor Insurance
Al-Shamel for private and commercial
vehicle insurance
Rukhsa Insurance
Sanad Vehicle Liability
Sanad Plus
Foreign Vehicle Liability Insurance
Medical Insurance
Family/Individual Insurance Plans
Group Medical Insurance
Balsam Cooperative Health Insurance Plans
Fire & Property
Property Damage Insurance
Consequential Loss
Accidental Damage
Business nterruption
Miscellaneous Accident
International Travel
Medical Malpractice
Personal Accident
Manasek Policy
General Liabilities
Home Insurance
Shopowners Insurance
Pharmacy Insurance
Many other Insurance
Engineering Insurance
Contractors All Risks
Erection All Risks
Contractor Plant & Machinery Insuracnce
Boiler & Pressure Vessel Insurance
Electronic Equipment Insurance
Machinery Breakdown Insurance
Loss of Profit following machinery breakdown
Deterioration of stock in Cold Storage
Marine Insurance
Marine Cargo
Marine-Hull
Inland Transit Insurance
Necessity for Healthy Life
Health is real wealth, if utilized properly the result will be a
very happy life. Like 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 exorbitant medical treatment expenses, Tawuniya has
prepared well-organized 4 medical insurance plans to
provide you and your family with comprehensive healthcare
at the largest medical provider(s) in the Kingdom. You can
obtain such benefits against the payment of annual premium
at your disposal.
.
Being the client of Tawuniya, you and your family will
receive a high standard of medical services.
Plans
A’shifa Plan
As a member of this plan, you will be covered for all inpatient expenses including room and board in hospital,
surgery, an aesthetics, 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.
A’Shifa Premier Plan
This plan provides all the benefits mentioned under A’Shifa
Plan, plus higher cover limits and delivery expenses.
Ri’aya Plan
This plan provides people seeking comprehensive cover
(out-patient and in-patient). It covers both A’Shifa plans as
detailed above with additional cover for out-patient
services. Such cover includes doctor fees, medications,
diagnostic procedures and treatments.
Ri’aya 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, eye and
dental treatment expenses.
Unique Features
* To provide you with comprehensive medical treatments at the
lagest medical providers in the Kingdom.
* To provide you with 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.
* Out of KSA cover with additional contribution.
* To offer worldwide healthcare assistance to clients whilst
traveling outside the Kingdom.
* To ensure customer receive excellent health care service by
applying the service quality control check.
* To provide assistance through our Toll Free No. 800 124 9990.
* To simplify the procedures of obtaining required medical service
with no unnecessary administrative obstacles.
Table of Benefits
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
involves a degree of risk to the patient, this is
not an abstract concept but a profound
responsibility to be born every moment of his
or her working life.
Who Needs this Policy?
Recognizing that the Kingdom’s medical profession
has a growing need for specialist support and
protection against alleged malpractice, Tawuniya
launched the Medical Malpractice Policy to provide
peace of mind for professionals of all categories of
medical and associated practitioners.
.
Protection against the financial consequences of
professional errors is essential for all individual
surgeons, doctors, nurses, pharmacists, dentists,
technicians etc… it is also vitally important for
hospitals.
What does the Medical Malpractice Policy Cover?
Economically priced and designed with painstaking care
to meet the needs of today's medical professional, the
policy indemnifies you against legal liability for
negligent acts committed within Saudi Arabia covering
compensation and claimant's costs as well as the cost of
defence and investigation of the alleged malpractice.
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's occupation or business or in
respect to other emergency medical treatment.
Advantages
* 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
including these compensation and claimant's costs and the cost
of defence and investigation of the alleged malpractice.
* 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's
occupation or business, conducted within Saudi Arabia, as
stated in the Proposal or Declaration including the provision of
food and drink.
Advantages
It provides protection against the legal liability of the
practitioner which arises in the course of or in connection with
the Insured's occupation or business including the liability
arising out of food and drink supplied through (kitchens in
licensed medical providers) as follows:
.
* Compensation and claimant’s costs
* The cost of defence and investigations of the alleged incident
Available Limits
You may choose the financial limit or indemnity from the
following limits:
Balsam Cooperative
Health Insurance
Policy
Limitations & Exclusions
A. This Policy does not cover claims arising from
the following:
1. Intentional self-inflicted injuy.
2. Ailments arising out of abuse certain
medicine, stimulants or depressants or by
the uses of alcohol, narcotics and the like.
3. Cosmetic surgery or treatment unless
necessitated by an accidental bodily injury
not otherwise excluded in this Section.
4. General health examinations, vaccinations,
drugs or prophylactics which are not required
for treatment of an ailment provided for
herein (excluding the preventive measures
specified by the Ministry of Health such as
vaccinations, maternity and childcare).
5. Pregnancy and maternity treatment for a
woman who is contracted on the basis of
“unmarried status”.
6. Treatment, which the Insured person receives
without charge.
7. Convalescence and general physical health
programs and treatment at social care centers.
8. Any ailment or injury arising as a direct result
of the insured person’s occupation.
9. The treatment of any venereal or sexually
transmitted disease.
10. Medical expenses for the treatment period
following the diagnosis of the HIV (Human
Immune Deficiency Virus) and/or HIV related
ailment including AIDS (Acquired Immune
Deficiency Syndrome) and or any mutant,
derivative or variation thereof.
11. All dental charges relating to prosthesis and
false teeth unless occasioned by violent
external means.
12. All tests for sight and hearing correction and
audiovisual aids, unless ordered by a licensed
physician.
13. Transportation of the insured person other by local
ambulance service licensed by or belonging to the
Saudi Red crescent Society.
14. Hair loss, alopecia or wigs.
15. Any psychiatric treatment or nervous or mental
disorder, except for severe cases.
16. Allergy testing of any nature, other than those
relating to the medicine, diagnosis or treatment.
17. Devices, medicines, procedures and/or hormone
treatment related to birth control, contraception or
conception, sterility, impotency or infertility, and invitro fertilization or any other artificial insemination
procedures.
18. Any congenital weakness or deformity existing prior
to the policy effectiveness and is not considered life
threatening.
19. Any additional costs or expenses incurred by the
companion of the insured person during his inpatient or stay at the hospital, except room and
board in a hospital for one companion, such as the
mother accompanying her child below 12 years of
age or as required by medical necessity at the sole
discretion of the treating physician.
20. Acne treatment or obesity or overweight related
treatment.
21. Any cases of organ and bone marrow transplantation
or implantation of any prosthetic devices replacing an
organ.
B. This policy does not cover the health benefits
and repatriation of mortal remains to home
country in case of claims arising directly from:
1. War, invasion, acts of foreign enemy, hostilities
(whether war be declared or not) and civil war.
2. Lonizing radiation by radioactivity from any nuclear
fuel or from any nuclear waste from the combustion
of nuclear fuel.
3. The radioactive, toxic, explosive or other hazardous
properties of any explosive nuclear assembly or
nuclear component thereof.
4. The insured person engaging in or taking part in
armed forces or police service or operation.
5. Riots, strikes, terrorism or any similar acts.