Membership Guide

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With more than 102 million customers around the globe, AXA is one of the world’s largest insurance providers. We offer a wide range of insurance products to meet your personal and business needs.

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800 116 0020 www.axa-cooperative.com

AXA Cooperative Insurance Company A company registered with the Ministry of Commerce and Industry of the Kingdom of Saudi Arabia under Commercial Registration No.1010271203 and holding Insurance license No. TMN/25/20101 issued by the Saudi Arabian Monetary Agency Table of Contents

Section Page Description No. 1. Welcome to AXA Cooperative 1 Insurance Company Your Membership Card 2. How to contact AXA 2 3. The purpose of your coverage 3 4. Entitlement 4 Eligibility Period of Cover Effective Date Expiry Date 5. Your coverage 5 What we pay for Table of enefits Limitations and Exclusions . est use of your benefits and 8 how to claim Where to receive treatment? Designated network for In-patient and day-care treatment Outside your designated network Direct billing versus reimbursement Reimbursement claim 7. Prior approval 10 Why do we require a prior approval? Prior Approval for Treatment on a Reimbursement Basis Prior Approval for Treatment on a Direct Billing Basis What if we do not seek prior approval when required? How long does it take to obtain a prior approval? Emergency Treatment Requiring Hospitalization 8. To Summarize 12 . efinition of terms 13 10. Providers 18 11. TOB 56 12. Reimbursement Claim Form 58 membership guide

1.Welcome to AXA Cooperative Insurance Company

Please read this guide and the This Membership Guide was created to accompanying Table of enefits before provide you with an overview of your you or one of your dependents needs company’s healthcare insurance plan medical treatment. Then relax, with AXA. Please use it along with your acknowledge you have access to the personal Table of enefits and best available healthcare service Membership Card to understand through AXA Cooperative Insurance various benefits available to you.

Company. Your Membership Card Your company selected AXA Cooperative Membership Cards for you and your Insurance Company to manage your eligible insured dependents are healthcare benefits. is one of the important documents; please ensure world’s most trusted healthcare that the information on these cards is benefits companies, providing superior accurately in line with your personal details. coverage in more than 200 countries worldwide. Kindly note, prior to admission or We have incorporated the Arabic word receiving treatment you must identify yourself and your eligibility for “Seha” into the name of our healthcare treatment by showing your medical I.D. plans as a reection of our card together with a recognized official commitment to helping you stay form of identification such as ational healthy. To that end, we will do ID or Iqama) to any network provider as everything possible to give you access evidence that you are an insured to the best available care to support you member of an AXA insurance policy. and your family. As a member of an “AXA Seha” plan, you have the opportunity to benefit from our healthcare experience and our commitment to excellence.

Healthcare Membership Card

Policy Number Name: Number of your policy, used as Policy No.: re f erence by AXA and medical Network providers. Membership No.: NW: Medical provider network as DOB: ID No. agreed with your company. Membership Number Emp ID: ID No. Membership number is unique and Saudi/iqama number as provided medicalproviders use this number to Policy holder: by your company. Benefits: verify your benefits with AXA. Valid Date Benefits Valid From: To: Start and end of your policy The benefit applied with services, Area of Cover: coverage. roomlevel shows on the medical card

Area of Cover Hospital Clinic/Polyclinic Lower NW Geographical areas of coverage in accordancewith the agreement during Policy issued by AXA Cooperative Insurance Company (ACIC) the contract withmember company’s

Deductible The amount you have to p ay directly to the medical provider whenever you have a treatment

1 2. How to contact AXA

If you have any questions about your an ress healthcare coverage, please contact Healthcare Department your Human Resources Department AXA Cooperative Insurance Company first and for further clarification, please P.O. Box 21044 contact us. Our team is available to iyadh discuss your treatment options and ingdom of audi rabia answer the questions you may have about your coverage via the phone/fax este numbers and office hours shown For further information, please visit our below. website at: aaeratem

Toll free number: 800 116 0020 available 24/7

Land line number: +966 11 413 6900 Fax: +966 11 477 3097

ﬁe urs unday to Thursday from 8:00 AM to 5:00 PM

Always by your side

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For Remarks about the service CCHI Call Center Toll - Free Prided call / 920001177 contact number

For Customer Service Please call below Numbers á«dÉàdG ΩÉbQC’G »∏Y ∫É°üJ’G AÉLôdG AÓª©dG áe~ÿ »∏Y ∫É°üJ’G AÉLôdG áµ∏ªŸG πNGO øe ∫É°üJÓd Within Saudi Arabia Please Call 800 11 60020 AXA Customer Service Outside Saudi Arabia Please Call +966 11 4136900 »∏Y ∫É°üJ’G AÉLôdG áµ∏ªŸG êQÉN øe ∫É°üJÓd Toll Free contact number

This Card is the property of AXA Cooperative Insurance Company and is void if membership is terminated

www.axa-cooperative.com

AXA Cooperative Insurance Website

2 membership guide

3. The purpose of your coverage

“When my daughter broke her arm at school last winter, AXA network gave us access to a medical center close to my home and I was able to sleep at night without worrying about hospital costs.”

What your health insurance cover is designed to do

As with all insurance policies your “Seha” healthcare plan is there to cover you for costs arising from an unforeseen event. For healthcare insurance this means the cost of eligible treatment resulting from an unexpected illness or accident.

You must take care of your own health and do not only rely on healthcare professionals to do this for you. When something unfortunate does affect your health we will do our best to help you but we must always act within the limits of your policy.

At the same time, it is important that all members realize that it is in everyone’s best interest to use the group healthcare plan sensibly and responsibly to keep future premiums affordable. The level of premium your company pays for group coverage is determined by the amount of claims paid under the plan. When the plan is used irresponsibly, premiums can go up unnecessarily, taking funds away from other Company/Employee initiatives.

4. Entitlement

Eligibility are eligible and we have not received a All on-the-job employees shall be written request for your enrolment from eligible from the date of commence- your company within 30 days, we ment of the Policy. Employees who reserve the right to request from you to later join the service of the policyholder ﬁll and complete a ealth eclaration shall be eligible from the date of joining Form and charge you an additional the service or arrival to the Kingdom of premium. Saudi Arabia. pouses Expiry Date hildren inimum from date of Your coverage will cease at the earliest birth of the following dates

ons aimum years of age. piry date of the ealth lan (Insurance coverage under the policy ancellation date of the shall include the employee’s ealth lan unemployed daughters who are ate when you cease to be eligible unmarried, widowed or divorced who for inclusion in the health plan in the are dependents of the employee) event you stop being eligible during

The period of cover your company must Period of Cover send us a written request for deletion The health plan is normally valid for immediately and your membership aperiod of year unless agreed must be return cards to the company, otherwise by us in writing. Effective and including the ones of your dependents epirydates of your plan are shown on if applicable. yourmembership card and on your table ofbenefits. Please note that we will not accept a deletion date which is more than thirty Effective Date days from the date we receive the Your coverage can start if you are written request for deletion. f we find eligible and if we have received from out that you are no longer eligible and your company a written request for that your company has failed to notify enrollment in no later than ten us about your deletion, we will suspend days.Your coverage can start from the your coverage. Please note that the following date day you stop being eligible, your ffective date of the ealth lan dependents automatically will cease to ate when you first became eligible be eligible.

Your company must notify us in writing about your enrolment. In the event you

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5. Your Coverage

WHAT WE PAY FOR (RECOVERABLE f. Cases of contagious diseases EXPENSES/BENEFITS) requiring isolation in hospitals For purposes of the policy, recoverable as specified by the inistry of Health. expenses shall mean the actual costs incurred for services, supplies and g. Cases of Alzheimer within the equipment, not excluded in Section limits specified in the policy 4.3, prescribed by a licensed physician schedule. for an illness occurring to the beneficiary, provided such epenses h. Cases of acquired damage to are necessary, reasonable and the heart valves within the limits customary at the time and place of specified in the policy schedule.

their occurrence. Accordingly, i. National Program for early recoverable expenses shall include: screening for newborns to eat enefits reduce disability, and it includes a. All costs relating to medical the specified tests in appendi consultation, diagnosis, included along with this policy. treatment and medicines as shown in the policy schedule. j. Autism cases as per the provided services to Autistic b. All costs relating to patients in Appendix 4 within the hospitalization including limits specified in the policy surgeries, same-day surgeries or schedule. treatment as well as maternity and delivery. k. Coverage of the early screening

program for auditory disability c. Treatment of dental and gum and critical Congenital Heart diseases that includes dental anomalies for all newborns. cleaning for one time during the policy within the limits speciﬁed l. Costs of the organ acquiring in the policy schedule. from the donor in Transplant

surgery within the limits d. Preventive measures such as specified in the policy schedule. vaccinations including seasonal vaccinations and maternity and Cases of Disability within the child care in accordance with limits specified in the policy instructions issued by the schedule. Ministry of Health provided for in Cost of Psoriasis treatment. the Annex (1) and Annex (2) attached to this Policy. Cost of Baby milk for newborns if e. Acute psychological disorders medically required up to the age within the limits specified in the of 24 months within the limits policyschedule.

5 speciﬁed for aby mil TTT T mentioned in ppendi. T T T Cost of RSV vaccinations for T T, children as per the T, TT vaccinations schedule ..

mentioned in ppendi . . TTT T . ost of besity treatment only by astric leeve urgery, if the 6. T , T is over within the limits TTT speciﬁed in the policy schedule. TTT.

2. Costs of preparation and 7. T repatriation of the corpse of a T T . beneﬁciary to the home country speciﬁed in the labor contract. 8. TTT TABLE OF BENEFITS .

Table of beneﬁts contains the ealth 9. T TTT overage roﬁle. t shows what you are covered for, the deductible level and T T , the maimum limits that apply to your T T, TT T . coverage.

10. T T T TT LIMITATIONS AND EXCLUSIONS: T, T, The policy shall not cover claims arising TT from TTT, T

1. TT T . T T .

2. T 11. T TT . , TT T, 12. T TTT , T T T T . T T 3. . T TTT TT 13. , T T T . T. . TT T, . , T, T T , T TTT.

6 membership guide

EQUIPMENT, MEANS, DRUGS AND 22. ALTERNATIVE MEDICINES FOR PROCE- PROCEDURES, OR HORMONE DURES AND MEDICATIONS. TREATMENT AIMED AT REGULATING 23. ARTIFICIAL AND ANCILLARY LIMPS. REPRODUCTION, CONTRACEPTION, FERTILITY, INFERTILITY, IMPOTENCE, 24. NATURAL CHANGES RELATED TO SECONDARY STERILITY, IN-VITRO MENOPAUSE, INCLUDING MENSTRUAL

FERTILIZATION OR ANY OTHER DISORDERS. METHOD OF ARTIFICIAL FERTILIZATION. THIS POLICY SHALL NOT COVER MEDICAL ANY CONGENITAL WEAKNESS OR BENEFITS OR CORPSE REPATRIATION TO DEFORMITY UNLESS IT IS LIFE HOME COUNTRY IN CLAIMS RESULTING THREATENING. DIRECTLY FROM:

1. WAR, INVASION, ACTS OF FOREIGN ANY COSTS OR ADDITIONAL ENEMY, ACTS OF AGGRESSION EXPENSES INCURRED BY THE (WHETHER OR NOT WAR IS BENEFICIARY'S COMPANION DURING A DECLARED) OR CIVIL WAR. HOSPITAL STAY, EXCEPT FOR HOSPITAL ROOM AND BOARD CHARGES FOR 2. IONIZING RADIATIONS, POLLUTION ONE COMPANION SUCH AS A MOTHER FROM RADIOACTIVE ACTIVITY OF ACCOMPANYING HER CHILD AGED UP ANY NUCLEAR FUEL OR WASTE TO TWELVE YEARS OR WHENEVER RESULTING FROM THE COMBUSTION MEDICALLY NECESSARY AS ASSESSED OF NUCLEAR FUEL.

BY THE ATTENDING PHYSICIAN. 3. RADIOACTIVE, TOXIC, EXPLOSIVE OR TREATMENT OF ACNE. OTHER HAZARDOUS PROPERTIES OF ANY NUCLEAR PLANT OR ANY OF ITS ANY TREATMENT RELATING TO NUCLEAR COMPONENTS. OBESITY OR OVERWEIGHT EXCEPT GASTRIC SLEEVE SURGERY, IF THE 4. BENEFICIARY’S SERVICE OR BMI IS OVER 45 WITHIN THE LIMITS PARTICIPATION IN ARMED FORCES OR SPECIFIED IN THE POLICY SCHEDULE. POLICE ACTIVITIES.

ORGAN OR MARROW TRANSPLANT, OR 5. RIOTS, STRIKE, TERRORISM OR SIMILAR ACTS IMPLANT OF ARTIFICIAL ORGANS TO REPLACE ANY ORGAN OF THE BODY 6. ACCIDENTS OR CHEMICAL REACTIONS TOTALLY OR PARTIALLY. OR BIOLOGICAL, BACTERIOLOGICAL, PERSONAL RISKS SET FORTH IN IF THESE INTERACTIONS OR SECTION - 1 (DEFINITIONS) OF THIS ACCIDENTS DUE TO WORK INJURIES POLICY. OR OCCUPATIONAL HAZARDS.

7 . est se of eneﬁts o to im

Where to receive treatment? providingyour treatment has been pre-approved. You can receive treatment anywhere you want within your area of cover. With By AXA in writing, the level of charges AXA you are free to go anywhere. incurred will fall within the usual and However, your premium is calculated customary charges and therefore all on the basis of usual and customary eligible charges would be payable in full. charges which are applicable within the designated network shown for your Designated Network for Out- Patient plan. Treatment Whenever you receive a treatment The out-patient network mentioned in within your network and that treatment your policy defines the networ of falls within our agreement with the medical providers which is available on medical provider, we will pay you in full. a direct billing basis (if you are entitled Whenever you receive a treatment to direct billing) and is also used to outside your network, we might not pay assess the level of usual and custom- you in full. The level of our ary charges up to which we would pay reimbursement to you will dependon in full (if you require outpatient treatment) the charges made by the medical provider compared with the charges When you receive treatment within the for the same treatment within your out-patient network shown, and provid- network. ing you have identified yourself with your membership card your treatment Designated Network for In-Patient & Day Care Treatment has been pre-approved by AXA in writing whenever necessary, the level The in-patient network mentioned of charges incurred. inyour policy defines the networ ofmedical providers which is Will fall within the usual and customary availableon a direct billing basis (if you charges and therefore all eligible areentitled to direct billing) and is charges would be payable in full. alsoused to assess the level of usual and customary charges up to Outside Your Designated Network whichwe would pay in full (if you require Outside the network shown in your inpatient& day care treatment). plan, whether for in-patient or out-patient treatment, we will In case of admission to the hospital,any reimburse up to the usual and custom- member can have access to any ary level defined by the networ shown hospital of his designated Network. for your plan.

When you receive treatment within If the charges incurred at a medical thein-patient network shown, and provider outside your designated

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network are lower than the usual and general guidelines. Therefore, itmight customary cost within your designated happen that a medical providerrefuses network, we will reimburse you in full to facilitate direct billing fortreatment (subject to prior approval). generally not covered for themajority of

our plans. If such an eventoccurs, On the contrary, when charges incurred you are welcome to refer to the at medical provider outside your desig- reimbursement claim procedureand nated network are higher than to claim for this treatment on the usual and customary level within areimbursement basis. your designated network, you will have to pay the difference in addition to Outside the network shown for your any deductible applicable to your plan, you can receive treatment, pay for outpatient treatment. the cost upfront and then claim the

paid amount for reimbursement. This is If you wish to receive a treatment what we refer to as reimbursement. outside your designated network, you should contact us prior to receiving Reimbursement Claim Procedure treatment to conﬁrm your level of cover Every time you visit a doctor on a and to minimize your out-of-pocket reimbursement basis, please ensure contribution. you take the reimbursement claim form with you. Outside the network shown for your plan, you can receive treatment, pay for A completed claim form is the only way the cost upfront and then claim the to have your claim settled promptly.

paid amount for reimbursement. This is The doctor must complete the medical what we refer to as reimbursement. sections of the claim form before signing, stamping and dating it. Direct Billing Versus Reimbursement Within your designated network shown You should complete the other admin- in your plan and if allowed by your istrative sections wherever applicable. policyterms and conditions you can receivetreatment on a direct billing You need to attach the original invoice basis. supported by the original prescription. Copies will not be accepted.

Direct billing corresponds to thedirect payment by us to the medicalprovider If you have requested a prior approval, for your eligible medicalexpenses. You you should attach a copy of this will only have to pay themedical approval to facilitate the processing of provider your deductible anduncovered your claims. You must sign and date the claim form. expenses, if any. In order tomake the direct billing process simple and Your claim will be assessed and efﬁcient, we have provided allproviders processed within 15 days from the included in our network withclear receipt of the completed claim ﬁle.

9 7. Prior Approval

Why do we require prior approval? iagnostic procedures which might The reason that we require prior cost more than , in aggregate per visit. approval of planned treatment is to protect you from unexpected costs. , T can, ndoscopies, hen issuing conﬁrmation of cover in astroscopi or olonoscopies. this way, we conﬁrm the following urgical procedures received The planned treatment is eligible on an outpatient basis

under your policy. hysiotherapy treatment

The planned treatment is medically st prenatal visit in a given medical necessary. provider when pregnancy is covered. The planned treatment is within reasonable and customary costs. elivery when pregnancy is covered. The planned treatment cost falls within the remaining beneﬁt limit ental care. of your plan. ptical care

Prior Approval for Treatment On a What if you do not seek prior Reimbursement Basis approval? Our written prior approval is required f you do not as for prior approval for the following when recommended, we will not pay ll nonemergency inpatient for your treatment in full. However, treatment prior to admission requesting a prior approval does not iagnostic procedures which might guarantee that your treatment will be cost more than , in paid in full. The main purpose of prior aggregate per visit. approvals are for you to be aware in , T can, ndoscopies, advance whether the treatment and its astroscopies or olonoscopies associated costs are covered under urgicl procedures received on an your policy. outpatient basis.

Prior Approval for Treatment On a How long does it take to obtain a Direct Billing Basis prior approval? Our written prior approval is required Our medical department will respond for the following to the request as soon as possible and within 15 minutes of the receipt of the

ll nonemergency inpatient request. treatment prior to admission

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Emergency Treatment Requiring Hospitalization In case of an emergency you shoulduse the nearest medical provider.If the medical provider is inside yourdesignated network, you will be takencare of immediately and the medicalprovider will notify us as soon as possible. If the medical provider is outside yourdesignated network you, or someonearound you must advise us as soon aspossible. We will then liaise with youand the medical provider and conﬁrmto you the amount we will cover. In case of an emergency we would notexpect from you to contact us beforereceiving treatment. However, lease ask someone to contact us as soon aspossible so that we are made aware of your case.

11 8. To summarize

In case of emergency hospitalization: “Contact us or have someone contact us as soon as possible”

For out-patient treatment: “Check your designated network and preferably visit a medical provider that is included in your network”

Before going for treatment: “Take a reimbursement claim form”

Before receiving treatment on a reimbursement basis, ask yourself: “Do I need a prior approval?” If you do not know, reread this guide and/or contact us by phone on: 800 116 0020 available 24/7

After receiving treatment, ask yourself: “Do I have all the required documents and information to make a claim?” See “Section 5.6: Reimbursement claim procedure: for claim details.

12 membership guide

9. Deﬁnition of Terms

efintns nsurane erae For purposes of this insurance, the asic health benefits made available to following terms, phrases and expres- the beneficiary as specified in the sions, wherever mentioned in the insurance policy. policy or its endorsement or attachments, shall be construed as mt erae follows: The maximum limit of the Company's

nsurane liability as shown in the policy schedule proof of validity of the insurance in respect to any beneﬁciary and before coverage as witnessed by this applying the coinsurance/deductible.

policy, its schedule, endorsements or attachments. nsurane reatns artes Policy holders and medical er nsurane insurance companies and third party’s The period shown in the policy administrative and service providers. schedule during which insurance remains in force. e nsurane many

qualiﬁed insurance company rae er The number of days during which the licensed by the Council to operate in policy remains valid in case of the ingdom in the ﬁeld of cooperative non-payment of the total contribution health insurance

shown in the schedule. yer netn ate The natural or corporate person in The date shown in the policy schedule whose name the policy is issued. on which insurance coverage commences. Benefiary nsure ersn The person (employee or dependent) ete ate included under the scheme and listed The date chosen by the policyholder and approved by the Company to start in the list of beneficiaries attached to this policy. covering a beneficiary under this policy or to add a beneficiary or delete him myee from the policy. A natural person works for the interest Benefit of the employer under his supervision The cost of providing health services in return of salary.

included in the insurance coverage eenent within the limits identiﬁed in the policy Spouse, sons up to 25 years of age and schedule. unmarried daughters.

13 Service Provider: Licensed Physician: The government / non-government A medical practitioner having received medical facility approved and licensed his qualiﬁcation and ofﬁcially licensed under applicable law to provide to practice medicine and accepted by medical services in the Kingdom, such the policyholder and the Company as hospital, diagnostic center, clinic, to provide treatment for which pharmacy, laboratory, physiotherapy or compensation might be claimed under radiotherapy center. this policy.

Approved Service Providers Network: Disease: The approved service providers A sickness or illness that occurs to the network should include the following beneficiary and necessitates medical health services levels: treatment by a licensed physician during the period of insurance. The first level primary health care) Accident: evel public hospitals A sudden injury or a sudden and evel specialized hospitals or unforeseen event occurring during the period of insurance. referred hospitals) Centers provide other Road accident: complementary health services An unintended collision and eg, ambulatory surgery centers, undesirable for a vehicle, or a vehicle pharmacies, physical therapy or mechanical or electrical, whether a centers, eye glasses shops). car or a bus, private or public, with a Hospital: wagon or other vehicle, in the case of qualified medical facility approved by paring or traffic, or with a stationary the Council and acceptable to the object such as construction or barrier, policyholder and the Company and column, or the tree or the like, or with a licensed under applicable law to person of the infantry, in any of the operate as a hospital and to provide roads or streets, which may lead to treatment for which compensation may physical injuries mild intensity to be claimed under this policy. The term high-risk, and may reach physical "hospital" as used in this policy does disability or death or damage in whole not include hotels, pensions, guest or in part of the property. houses, rest houses, sanatoriums, convalescence homes, quarantine, Violent External Means: retirement or nursing homes, mental Any means resulting in accident or asylums or any place usuallyused to injury to the insured. shelter and treat drug or alcohol addicts.

14 membership guide

Personal Risks: Congenital Anomaly: Any activities known to involve high risk Dysfunctional or chemical or structural, of exposing a person to an illness or an which have existed before birth usually accident, or is expected to aggravate a either hereditary or the result of previous illness or injury. environmental factors by medical

custom. Emergency: The medical treatment required for an Pregnancy and Delivery: insured person as result of an Any pregnancy and/or delivery, accident, or a case requiring prompt including natural delivery, caesarean medical attention. and abortion.

Treatment in Outpatient Clinics: Acute Psychiatric Cases: The beneﬁciarys visits to outpatient Turmoil in thinking, mood, perception, clinics for diagnosis or treatment of a memory and mental abilities, some or disease. all of them, and this is a severe

disorder if the cause of an imbalance in Surgery or Same-Day Treatment: any two of the following functions: Surgery or treatment requiring . ound udgment. ound preparation for admission to a reasoning in terms of decision hospital or treatment center without maing necessitating an overnight stay. 2. Human behavior. Hospitalization: 3. Sense of reality. egistering a beneﬁciary as an 4. Coping with ordinary life inpatient staying overnight in a responsibilities.

hospital following a referral from a This policy covers the diagnosis and licensed physician. treatment of these cases during the policy period. Allergy: The sensitivity a particular person has Disability: to certain kinds of food, weather or Inclusive term includes the various pollen, or acquires from plants, insects, forms of the disorder organ dysfunc animals, minerals, elements or other tion, limited activity, and restrictions materials causing such person to that limit participation. develop bodily reactions from direct or indirect contact with such materials Rehabilitation (Physiotherapy): resulting in conditions like asthma, A complementary part of indigestion, itching, hay fever, eczema comprehensive health care service or headache. and its applications for rehabilitating a person. The Cooperative Healthcare

15 Insurance Policy covers diagnostic and Claim: treatment procedures and tests A document submitted by the health pertaining to rehabilitation cases care provider (and in some cases the during the validity of the policy. insured or policyholder) to the

insurance company for reimbursement Premium (contribution): for health expenses offered to the The amount due by the policyholder in insured. consideration of the insurance coverage granted under the policy during the Claim Supporting Documents: period of insurance. All documents proving and establishing

the beneficiarys age, nationality, Coinsurance / Deductible identity and the validity of the (co-payment): insurance coverage, circumstances of The part (as determined in the policy the event giving rise to claim and schedule that the beneficiary has to payment of costs as well as other pay for health care received in documents such as police report, outpatient clinics. invoices, receipts, prescriptions, Direct Billing or Company Billing: physicians report, referrals and The facility of nonpayment granted to recommendations and any other the beneficiary at one or more medical original documents that may be facilities appointed by the Company required by the Company. whereby all such costs are directly billed to the Company. Compensation expenses in road accident: Basis of compensation allowance: Claim medical arising from a car The method used to compensate the accident to cover the affected person policyholder for recoverable expenses as a result of this incident and whether incurred by the insured after the incident caused by him or not, and submitting a reimbursement claim, if the claimed expenses are covered and applying the deductible. under any plan, program or other insurance or similar therefore, the Recoverable expenses: insurance company that was first The actual costs incurred for services, informed has the responsibility to cover supplies and equipment, not excluded the injured person and the follow-up in Section 3, prescribed by a licensed medical treatment and the physician for an illness occurring to the compensation of those expenses, and beneficiary, provided such epenses replace the insured person to request are necessary, reasonable and others to pay their share relative to that customary in the time and place of claim. their occurrence.

16 membership guide

Reasonable and Customary Medical Misleading: Expenses: The occurrence of the behavior of a. The medical expenses compatible persons or entities, which do not fall with level of fees charged by the under the definition of fraud. majority of licensed physicians or hospitals in the Kingdom Appendix: provided such fees are for the A document issued by the Company on treatment of a similar condition the official form dated and signed by an by physicians and hospitals authorized officer as an evidence on of similar qualifications and the veracity of any changes in the standing to those which provided document, so that does not affect the the treatment. basic coverage, upon written request of the policyholder. b. The medical treatment that does not differ significantly from what a Policy Annex: licensed physician considers An annex is attached to this Policy acceptable as being usual and containing instructions and procedures customary for any particular relevant to the application of this disease for which compensation Policy. for the costs of its treatment is recoverable under this policy. Costs of Corpse Repatriation: All costs of preparation and repatriation of corpse to the home country set forth in the labor contract.

Fraud: Intentional misleading by a person or an entity with the intent to exploit health care and distort facts or the intentional deceit leading to obtaining beneﬁts or offering of privileges that are excluded or exceeding the allowable limits for a person or entity.

17 10. Providers

Service City Provider Name VVIP VIP A B C D E Telephone Type

Riyadh Abad Specialized Clinic OP 011-2016677

Riyadh Raseel Medical Center OP 011-2047700

Riyadh Magrabi Optical -Al-Hayaat Mall OP 011-2056895

Riyadh Kadoon Dental Center 1 OP 011-2060230

Riyadh Maha Opticals - Al-Malaz OP 011-2068986

Riyadh Dr.abdulelah Al-Obikan Medical Complex OP 011-2077177

Riyadh Aram Medical Complex OP 011-2081111

Riyadh Al-Azhar Optical OP 011-2096004

Riyadh Al Magrabi Optical - Khurais Plaza OP 011-2096485

Riyadh Al-Mohammadia Medical Center OP 011-2101414

Riyadh Basmat Alfarabi Dental Clinics (3) OP 011-2105017

Riyadh Magrabi Optical -Kingdom Tower OP 011-2112524

Riyadh Factories Medical Care Polyclinic OP 011-2122200

Riyadh Pioneers Specialist Medical Center OP 011-2130011

Riyadh Roaya Company For Medical Services OP/IP 011-2154138

Riyadh Al Magrabi Optical - Olaya Al Moosa Center OP 011-2160656

Riyadh Eye World Medical Center OP 011-2162020

Riyadh Barakat Optical -After Kingdom Tower OP 011-2167714

Riyadh Kadoon Dental Center 2 OP 011-2168888

Riyadh Mayeiz Medical Center OP 011-2169999

Riyadh Al Salman Optics - Olaya OP 011-2178888

Riyadh Dent Care Clinics OP 011-2196000

Riyadh Fal Al Afa Poly Clinic OP 011-2220222

Riyadh Alsalam Hospital OP/IP 011-2222211

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 18 Service City Provider Name VVIP VIP A B C D E Telephone Type

Riyadh Pretty Smile Dental Center -1 - OP 011-2243333

Riyadh Nebras Medical Complex OP/IP 011-2254477

Riyadh Al Maseef Medical Clinic OP 011-2255000

Riyadh Alrahmah Medical Complex Co OP/IP 011-2260600

Riyadh Al-Ebdaa Medical Clinic & Center OP 011-2263800

Riyadh Al Mawiyah Clinic 7 OP 011-2272333

Riyadh Vitamin Consultant Center -2- OP 011-2276565

Riyadh Al Rabe'a Medical Clinic OP 011-2287042

Riyadh Lamsat Al Shefaa Polyclinic Co - Riyadh OP 011-2288888

Riyadh Al Raheema Medical Center - Riyadh OP 011-2293232

Riyadh Panorama Alfarabi Dental Clinics OP 011-2300412

Riyadh Maha Opticals -Nassem OP 011-2305402

Riyadh Mirad Medical Center OP 011-2306044

Riyadh Al Mawiyah Consultive Clinic -1 - OP 011-2314444

Riyadh Consultative Medical Clinic OP 011-2320000

Riyadh Thumiri Medecal Center Br2 - OP 011-2320707

Riyadh Al Haramain Medical Clinic OP 011-2323666

Riyadh Al-Faiha Medical Center OP 011-2328888

Riyadh Ebtesamatic Dental Dispensary OP 011-2329905

Riyadh Al -Subhi Specialized Center OP 011-2335000

Riyadh Bariq Al Ebtesama Dental Clinic OP 011-2338010

Riyadh Bilad Al-Taib Clinic -2 OP 011-2338855

Riyadh Barakat Optical -Rawda 3 OP 011-2348122

Riyadh Jazeera Medical Center OP 011-2350108

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 19 Service City Provider Name VVIP VIP A B C D E Telephone Type

Riyadh How Medical Center Group – Alnaseem OP 011-2356111

Riyadh Senymar Medical Center OP 011-2356321

Riyadh Al Mawiyah Clinic 4 OP 011-2359090

Riyadh Khalid Medical Clinic OP 011-2365000

Riyadh Al Fraeidy National Clinic OP 011-2366662

Riyadh Al Azhar Hospital OP/IP 011-2366788

Riyadh Al Jazeera Hospital OP/IP 011-2388888

Riyadh Vitamin Consultant Center -3- OP 011-2404800

Riyadh Sanad Hospital OP/IP 011-2407778

Riyadh Mansour Medical Dispensary OP 011-2411888

Riyadh Fayha Health Medical Complex OP 011-2418000

Riyadh Al Hayat National Clinic OP 011-2444111

Riyadh Rokon Abas Medical Center 6 OP 011-2444714

Riyadh Dwa'ak Medical Center -1 - OP 011-2446677

Riyadh Maha Opticals Hai Al-Nazeem OP 011-2452988

Riyadh Typical Medical Clinic OP 011-2454444

Riyadh Family Care Hospital OP/IP 011-2454444

Riyadh Magrabi Optical -Salam Mall OP 011-2472340

Riyadh Basmat Al Farabi Dental Clinics (4) OP 011-2475371

Riyadh Hakeem Dental Polyclinic OP 011-2475517

Riyadh Adwa'a Dorat Al Alami Poly Clinic OP 011-2481400

Riyadh Specialized Dental Center - Riyadh (Moh) OP/IP 011-2482698

Riyadh Abas Medical Center 2 OP 011-2488000

Riyadh The Medical Alotes Company Ltd OP 011-2490667

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 20 Service City Provider Name VVIP VIP A B C D E Telephone Type

Riyadh How Medical Center - Almurooj OP 011-2493999

Riyadh Nahj Al Takwa Dental Center OP 011-2498882

Riyadh Tadawee Al-Riyadh Medical Complex OP 011-2533999

Riyadh Barakat Optical -Ghornatha Mall OP 011-2535227

Magrabi Optical -Gernata Commerical Riyadh OP 011-2535445 Center Imam Abdulrahman Al Faisal Hospital Riyadh OP/IP 011-2615555 (Moh)

Riyadh Prince Mohamed Bin Abdulaziz Hos (Moh) OP/IP 011-2616650

Riyadh Al- Fares Medical Clinic OP 011-2624678

Riyadh Al Mawiyah Clinic 9 OP 011-2637777

Riyadh Omar Al Ajaji Medical Centetr-2- OP 011-2655525

Riyadh Magrabi Optical -Sweedy Branch OP 011-2676539

Riyadh Almadina Optical - Dhahrat Al Badiah OP 011-2677454

Riyadh Saudi German Hospital OP/IP 011-2685504

Riyadh Qasr Al Raed Polyclinic OP 011-2690606

Riyadh River Of Health Medical Center OP 011-2692080

Riyadh Al Nakheel Medical Center Riyadh OP 011-2705022

Riyadh Al-Khazan Clinic-2- OP 011-2713118

Riyadh Magrabi Optical -Alfsalia Mall OP 011-2734212

Riyadh Al Hayat National Clinic 3 OP 011-2741840

Riyadh Kingdom Hospital OP/IP 011-2751111

Riyadh Smile World Dental Center OP 011-2770121

Riyadh Durrat Ghornata Medical Complex OP 011-2771162

Riyadh Bilad Altib Medical Clinic -1- OP 011-2775552

Riyadh Abas Medical Center 3 OP 011-2776277

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 21 Service City Provider Name VVIP VIP A B C D E Telephone Type

Riyadh Abiat Al Tibb Medical Center OP 011-2780211

Riyadh Al Alam Medical Company OP 011-2783330

Riyadh Al Hayat National Polyclinic-1 OP 011-2789333

Riyadh Al Magrabi Optical - Panorama Mall OP 011-2814374

Riyadh Al Garb Specialist Hospital For Med OP/IP 011-2833333

Riyadh Almadina Optical - Al Dariah OP 011-2860219

Riyadh King Fahad Medical City REFERAL 011-2889619

Riyadh Almadina Optical -Malaz OP 011-2916090

Riyadh Olaya Intirnational Clinic OP 011-2930135

Riyadh Alsalam Care Polyclinic OP/IP 011-2946167

Riyadh Maha Opticals -Shifa Branch OP 011-2982667

Riyadh Almadina Optical - Al Futah OP 011-4011708

Riyadh Al-Rayan International Polyclinic OP 011-4011833

Riyadh Dar Al- Shefa Hospital OP/IP 011-4012029

Riyadh Safa Makkah Polyclinic -3 OP 011-4012128

Riyadh Mobarak Hospital OP/IP 011-4015282

Riyadh Badruddin Polyclinic OP 011-4025501

Riyadh Safa Makkah Poly Clinic 1 OP 011-4036111

Riyadh Al Washem Medical Clinic OP 011-4036673

Riyadh Safa Makkah Poly Clinic 2 OP 011-4040188

Mutlaq Poly Clinic ( Abdulfatah Riyadh OP 011-4059787 Mohammed Al-Mutlaq )

Riyadh Elixir International Polyclinic OP 011-4067001

Riyadh Suncity's Poly Clinic OP 011-4067772

Riyadh Omar Al Ajaji Medical Complex - Batha OP 011-4082211

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 22 Service City Provider Name VVIP VIP A B C D E Telephone Type Prince Sultan Complex Health Care Riyadh OP/IP 011-4088810 Solidarity

Riyadh Abeer Medical Polyclinic-Al-Batha OP 011-4091064

Riyadh Seven Medical Rehabilitation Center OP 011-4100022

Riyadh Al-Salameh Medical Center OP 011-4113289

Riyadh Naseem Al- Azhar Clinic OP 011-4115965

Riyadh Shifa Al-Jazeera Poly Clinic OP 011-4124900

Riyadh Al Mouwasat Hospital OP/IP 011-4130000

Riyadh Qimmat Al-Nakheel Dental Polyclinic 1 OP 011-4181178

Riyadh Al Salman Optics - Al Shifa OP 011-4216440

Riyadh Awaf Poly Clinic OP 011-4216699

Riyadh Al Masudi Clinic 1 OP 011-4223063

Riyadh Al-Abraj Dental Polyclinic OP 011-4246101

Riyadh Al Hammadi Hospital - Swaidi OP/IP 011-4250000

Riyadh Almadina Optical - Dhahrat Al Badiah OP 011-4250678

Riyadh Farabi Dental Center OP 011-4255987

Riyadh Al Salman Optics - Alswaidy OP 011-4256465

Riyadh Dar Al Elaj Dispensary OP 011-4258933

Riyadh Ibn Rushed Medical Center Co- Premier OP 011-4262226

Riyadh Al-Osrah Medical Center OP 011-4262233

Riyadh Maha Opticals -Shabra OP 011-4269391

Riyadh Alfarabi Top Dental Clinics - 3 OP 011-4278555

Riyadh Al Magrabi Optical - Al Badiah OP 011-4288192

Riyadh Khaled Al Ajaji Medecal Center OP 011-4303539

Riyadh Hakeem Medicl Center OP 011-4304747

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 23 Service City Provider Name VVIP VIP A B C D E Telephone Type

Riyadh King Salman Hospital - Riyadh (Moh) OP/IP 011-4311100

Riyadh Zahrat Al Amal Clinic -2- OP 011-4313333

Riyadh Al Salman Optics - Al Majmah OP 011-4313444

Riyadh Basmat Al Farabi Medical Complex OP 011-4318484

Riyadh Zahrat Al-Amal Clinic -1 - OP 011-4319988

Riyadh Badiah Consultaive Clinic OP 011-4320666

Riyadh Andalus Dental Polyclinic OP 011-4332701

Riyadh Specialized Medical Center Hospital OP/IP 011-4343800

Riyadh Al-Khazan Clinic OP 011-4355252

Riyadh King Saud Medical City - (Moh) OP/IP 011-4355555

Riyadh Al Aried Clinic OP 011-4356042

Riyadh Metrek Medical Clinic OP 011-4367195

Riyadh Dr Musaed A. Aziz Alzalal Polyclinic-2- OP 011-4367777

Riyadh Family Healthcare Center - Riyadh OP 011-4379000

Riyadh Abeer Supreme Medical Center - Riyadh OP 011-4388012

Riyadh Heraa Medical Clinic OP 011-4390040

Riyadh Al Salman Optics - Hotat Sudair OP 011-4430352

Riyadh Hayat National Hospital OP/IP 011-4455555

Riyadh Al Magrabi Optical - Rabwa Othaim Mall OP 011-4458650

Riyadh Dar Al Hekma Clinic OP 011-4461804

Riyadh Al Salman Optics - Almansoura OP 011-4463577

Riyadh Al Falah International Hospital OP/IP 011-4463737

Riyadh Shifa Al Sultan Poly Clinic – Al Riyadh OP 011-4469440

Riyadh Aleman General Hospital - Riyadh (Moh) OP/IP 011-4471922

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 24 Service City Provider Name VVIP VIP A B C D E Telephone Type

Riyadh Khaledya Clinic OP 011-4481448

Riyadh Almadina Optical -Ghobaira OP 011-4482869

Riyadh Aviccenna Polyclinic OP 011-4486834

Riyadh Barakat Optical -Batha OP 011-4487703

Riyadh Al Kadesiah Clinic OP 011-4488809

Riyadh Future Medical Center OP 011-4506000

Riyadh Riyadh Conslutative Clinic OP 011-4507000

Riyadh Al-Badri Medical Center OP 011-4509000

Riyadh Al Bayan Polyclinic OP 011-4510944

Riyadh Belad Medical Center OP 011-4511895

Riyadh Al Magrabi Optical - Swaidy Al Qasser Mall OP 011-4515571

Riyadh Barakat Optical -King Abdullah Road OP 011-4530382

Riyadh Al Shammel Dental Center 1 OP 011-4531415

Riyadh Al Mawed Medical Center OP 011-4531714

Riyadh Dr Musaed A. Aziz Alzalal Polyclinic OP 011-4533666

Riyadh Al Salman Optics - Al Takhasusi OP 011-4536127

Consultative Mawyah Corner Riyadh OP/IP 011-4537777 Polyclinics(Mawyah Clinics 2 )

Riyadh Ajial Medical Polyclinic OP 011-4543104

Riyadh Al- Shomoly Medicl Polyclinic OP 011-4543232

Riyadh Al-Ajaji National Clinic OP 011-4545453

Riyadh Barakat Optical-Fal Center OP 011-4548186

Riyadh Al-Riyadh Care Medical Clinic OP 011-4553041

Riyadh Specialized Medical Care Center OP 011-4553925

Riyadh Al Nozha Medical Center OP 011-4554400

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 25 Service City Provider Name VVIP VIP A B C D E Telephone Type

Riyadh Abas Medical Center OP 011-4557000

Riyadh Magarbi Optical -Sahari Center OP 011-4559720

Riyadh Maha Opticals -Al-Murooj OP 011-4562286

Riyadh Shoa'a Medical Complex OP 011-4563777

Riyadh Family Smile Medical Complex OP 011-4569729

Riyadh Tiba Al-Osrah Medical Center OP 011-4572417

Riyadh Almadina Optical - Yamama OP 011-4581661

Riyadh Al Eman Medical Clinic OP 011-4582070

Riyadh Al Bustan Clinic OP 011-4582140

Riyadh Al Wattan Medical Complex 1 OP 011-4588444

Abeer International Medical Clinic - Riyadh OP 011-4596424 Manfuha

Riyadh Savvy Dental Care Center - Riyadh OP 011-4603322

Riyadh Al Salman Optics - Orouba OP 011-4605244

Riyadh Majestic Millennium Medical Complex OP 011-4607642

Alestsharyoon Company Center Polyclinic Riyadh REFERAL 011-4612266 For Radiography Diagnostic

Riyadh Society Medical Center -1 - OP 011-4612726

Riyadh Bin Rushd Medical Center OP/IP 011-4613131

Riyadh Elite Doctors Company Center OP/IP 011-4616777

Riyadh Al Hammadi Hospital OP/IP 011-4622000

Riyadh Almadina Optical - Sulaimania OP 011-4622104

Riyadh Dr.sulaiman Al Habib Medical Center OP/IP 011-4622224

Riyadh Dr.sulaiman Al-Habib-Maternity Hospital OP/IP 011-4622224

Riyadh Al Salman Optics - Sulaiman Al Habib OP 011-4622224

Riyadh Al Magrabi Optical - Olaya OP 011-4623858

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 26 Service City Provider Name VVIP VIP A B C D E Telephone Type

Riyadh Al Mawyah Clinic 6 OP 011-4631431

Riyadh Al Ewan Medical Center – Al Riyadh OP 011-4631606

Riyadh Mustawsaf Olaya Poly Clinic OP 011-4632691

Riyadh Dima Dental Complex -2- Riyadh OP 011-4633444

Riyadh Saudi British Hospital OP/IP 011-4636666

Riyadh Abas Dental Center Riyadh OP 011-4640788

Riyadh Green Crescent Hospital OP/IP 011-4644434

Riyadh Olaya Medical Center OP/IP 011-4645501

Riyadh Pearl's Smile Medical Center OP 011-4646334

Riyadh Arabian Dental Clinic OP 011-4650748

Riyadh Riyadh Medical Center OP 011-4653060

Riyadh Al Magrabi Optical - Sulaimaniya OP 011-4657074

Riyadh Dr. Abdul Rahman Al-Mishari Hospital OP/IP 011-4657700

Riyadh Consulting Clinic OP/IP 011-4659100

Riyadh Al-Zalal Medical Co. OP 011-4660222

Riyadh Dima Dental Complex - 1- Riyadh OP 011-4661200

Riyadh Maha Opticals -Al-Warood OP 011-4702859

Riyadh Al Warood Medical Center OP/IP 011-4703355

Riyadh Al Warood Center For The Optical - Riyadh OP 011-4703355

Riyadh Al Magrabi Optical -Magrabi Hospital OP 011-4705838

Riyadh Al Najmah Polyclinic OP 011-4714698

Riyadh Al Magrabi Optical - Malaz OP 011-4731027

Riyadh Medical World Polyclinic OP 011-4731313

Riyadh Omar Al Ajaji Medical Centetr-1- OP 011-4741122

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 27 Service City Provider Name VVIP VIP A B C D E Telephone Type

Riyadh Al Ridwan Dental Complex- Riyadh OP 011-4743441

Riyadh Maha Opticals-Al-Malaz , 60 St OP 011-4744846

Sulaiman Habib Hospital - Suwaidi - Riyadh OP/IP 011-4754444 Riyadh

Riyadh Riyadh National Hospital OP/IP 011-4761211

Riyadh Barakat Optical -Sitteen St OP 011-4765714

Riyadh Obeid Specialized Hospital OP/IP 011-4767222

Riyadh Al Malaz Modern Clinic OP 011-4771515

Riyadh Barakat Hearing Care Center OP 011-4777127

Riyadh Jarir Medical Center OP 011-4777471

Riyadh Noorana Medical Center OP 011-4780000

Riyadh Mumtaz Poly Clinic OP 011-4781858

Riyadh Integrated Treatment Center (Moh) OP 011-4784446

Riyadh Riyadh Medical Complex OP 011-4787070

Riyadh Almadina Hearing Aid Center OP 011-4787733

Riyadh Al Salman Optics - Al Malaz OP 011-4791488

Riyadh E.n.t Medical Center - Riyadh OP/IP 011-4802229

Riyadh Amal Complex For Mental Health (Moh) OP/IP 011-4804548

Riyadh Omm Al Hamam Polyclinic OP 011-4806348

Riyadh Ktdoqi Dialysis Center OP 011-4808922

Riyadh King Khaled Eye Specialist Hospital (Moh) OP/IP 011-4821234

Riyadh Hammadi Hospital Nozha OP/IP 011-4837777

Riyadh Weqayah Medical Center OP 011-4854460

Riyadh Alfarabi Top Dental Clinics-Al-Aqique OP 011-4854495

Riyadh Hetteen Medical Complex OP 011-4855111

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 28 Service City Provider Name VVIP VIP A B C D E Telephone Type

Riyadh Taif Medical Center OP 011-4881133

Riyadh Jwel Clinics OP 011-4883424

Dr Sulaiman Al Habib Medical Center Riyadh OP/IP 011-4909999 Arryan

Riyadh Al-Thomairy Medical Clinic (1) OP 011-4911149

Yamamah Maternity & Children Hosp- Riyadh OP/IP 011-4914444 Riyadh(Moh)

Riyadh Magrabi Optical -Al-Rawdah OP 011-4915229

Riyadh Al Salman Optics - Al Rabwa OP 011-4917977

Riyadh Modern Medical Clinic OP 011-4918003

Riyadh Al Salman Optics - Al Rawabi OP 011-4918239

Riyadh Arrayan National Clinic OP 011-4931785

Riyadh Riyadh Care Hospital OP/IP 011-4933000

Riyadh Maha Opticals -Ahmed Bin Hanbal Street OP 011-4937112

Riyadh Rawdat Al-Aqsa Medical Complex OP 011-4938919

Riyadh Allied Diagnostic Center REFERAL 011-4942990

Riyadh Adwaa Al-Alami Polyclinic OP 011-4953022

Zahrat Alfarabi Dental & Orthodontics Riyadh OP 011-4953322 Complex

Riyadh Manarat Alteb Poly Clinic OP 011-4956000

Riyadh Al Azizia Medical Center OP 011-4956127

Riyadh Basmat Al Farabi Dental Clinics 2 -Aziziah OP 011-4959485

Riyadh Al Wattan Medical Complex 2 OP 011-4964455

Riyadh King Salman Center For Nephrology OP/IP 011-4976333

Riyadh Factories Polyclinics OP 011-4985255

Riyadh Dar Al Shefa Clinic OP 011-4989220

Riyadh Rabiah Hospital OP/IP 011-4999000

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 29 Service City Provider Name VVIP VIP A B C D E Telephone Type

Riyadh Dhrma General Hospital (Moh) OP/IP 011-5220607

Riyadh National Guard Hospital (N.g.h) OP/IP 011-8011111

Riyadh Al Salman Optics - Almursalat OP 011-8100599

Riyadh Al Magrabi Optical - Ishbelia Plaza OP 011-8120427

Riyadh Al Hayat Polyclinic 2 OP 01-2460254

Riyadh Al Salman Optics - Shaqra OP 016-6229595

Riyadh Abeer Medical Polyclinic-Shumaissy OP 920000517

Riyadh Al Khaleejy Medical Clinic-Shoubr OP 920002462

Riyadh Al Khaleejy Medical Clinic - Shefa OP 920002462

Riyadh Al Khaleejy Dental Center -Shoubra OP 920002462

Riyadh Al Khaleejy Polyclinic - 2Th Indus OP 920002462

Riyadh Al Khaleejy Dental Center -Al-Sewedi OP 920002462

Riyadh Al Khaleejy Medical Clinic -Maza'ar - OP 920002462

Riyadh Dar Al Muafat Polyclinic OP 920003314

Riyadh Esteshari Dental Center OP 920008117

Riyadh Dallah Hospital OP/IP 920012222

Riyadh Al Raed Consultant Medical Center OP 920033560

Al-Dareyaa Maha Opticals -King Saud Street OP 011-4840927

Basmat Al Farabi Dental Clinics (1) - Al-Dareyaa OP 011-4862828 Daraya

Al-Dareyaa Saha Al Daraya Polyclinic OP 011-4863388

Al-Kharj Al-Taawin Medical Polyclinic -3- OP 011-5410399

Al-Kharj Al Ameed Clinic OP 011-5442777

Al-Kharj Al-Taawin Medical Polyclinic -1- OP 011-5443040

Al-Kharj King Khalid Hospital - (Moh) OP/IP 011-5444444

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 30 Service City Provider Name VVIP VIP A B C D E Telephone Type

Al-Kharj Tabib Al Hyayat Medical Complex – 2 OP 011-5444471

Al-Kharj Al-Taawin Medical Polyclinic -2- OP 011-5447072

Al-Kharj Al-Kharj National Clinic OP 011-5447332

Al-Kharj Advanced Consultant Poly Clinic OP 011-5451111

Al-Kharj Abdul Rahman Al-Ganas OP 011-5475555

Al-Kharj Al Dossary Medical Clinic OP 011-5482039

Al-Kharj Maha Opticals - King Fahad Road OP 011-5482679

Al-Kharj Dar Alshoubaa Medical Polyclinic OP 011-5488866

Al-Kharj Tabib Al Hayat Medical Complex – 1 OP 011-5511116

Al-Kharj Barakat Optical -Alhedaithy Mall OP 011-5513112

Al-Kharj Howtat Bani Tamim Hospital (Moh) OP/IP 011-5553818

Al-Kharj King Khaled Eye Specialist Hospital (Moh) OP/IP 011-5821200

Al-Majmaah Sudair Consulting Clinic OP 016-4322444

Al-Majmaah King Khalid Hospital - Almajmaa (Moh) OP/IP 016-4323389

Al-Majmaah Houta Sudair Hospital (Moh) OP/IP 016-4431311

Al-Majmaah Tumair General Hospital (Moh) OP/IP 016-4437636

Al-Muzahmia Metrek Medical Clinic OP 011-5232323

Al-Qweyaa Alqaueiah General Hospital (Moh) OP/IP 011-6521003

Al-Qweyaa Metrek Medical Clinic OP 011-6521333

Al-Qweyaa Angel Of Mercy Medical Company OP 011-6524777

Al-Qweyaa Rauedat Alard General Hospital - (Moh) OP/IP 011-6552900

Remah Remah General Hospital (Moh) OP/IP 011-5521162

Remah Farhan Al Nader Clinic OP 11-7841539

Riyadh Vitamin Consultant Center -4- OP 011-2033311

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 31 Service City Provider Name VVIP VIP A B C D E Telephone Type

Unayna Dia'a Olaya Medical Complex OP 011-5281111

Unayna Al-Enjaz Medical Center OP 011-5288000

Afeef Aff General Hospital (Moh) OP/IP 011-7223000

Afeef Zalim General Hopital (Moh) OP/IP 012-8530887

Al-Afaag Alafag General Hospital (Moh) OP/IP 011-6820002

Al-Afaag Farhan Al Nader Clinic OP 011-6822842

Al-Afaag Maha Opticals OP 011-6826670

Al-Artawyaa Al-Faiha Medical Center OP 016-4360333

Al-Bekeryaa Albekeriah General Hospital (Moh) OP/IP 016-3350059

Al-Bekeryaa Attadawe Clinic OP 016-3351122

Al-Dawadmi Naf General Hospital OP/IP 011-6346684

Al-Dawadmi Abo Zaid Medical Clinic OP 011-6423338

Al-Dawadmi Aldawadmi General Hospital (Moh) OP/IP 011-6436587

Al-Ras Al Genah Medical Clinic OP 016-3335500

Al-Ras Alras General Hospital (Moh) OP/IP 016-3339996

Al-Sulaeel Solail National Clinic OP 011-7820871

Al-Sulaeel Solail General Hospital (Moh) OP/IP 011-7821041

Al-Zelf Qima Medical Clinic OP 016-4222333

Al-Zelf Zulf General Hospital (Moh) OP/IP 016-4223458

Buryadah Maha Opticals-Prince Sultan St OP 011-2484769

Buryadah Dr Sulaiman Al Habib Medical Center OP/IP 016-3166666

Buryadah Buridah Central Hospital (Moh) OP/IP 016-3240110

Buryadah Al Mohaimid National Clinic OP 016-3244905

Buryadah Al Ferah Hospital OP/IP 016-3245501

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 32 Service City Provider Name VVIP VIP A B C D E Telephone Type King Fahad Specialist Hospital - Buridah Buryadah OP/IP 016-3252000 (Moh)

Buryadah Prince Sultan Cardiac Center (Moh) OP/IP 016-3257790

Buryadah Future Care Clinics OP 016-3259900

Buryadah Magrabi Optical -King Abdul Aziz St OP 016-3260215

Buryadah Shifa Buraidah Poly Clinic OP 016-3261492

Buryadah Al-Faiha Medical Center - 1- OP 016-3814020

Buryadah Saudi Medical Dispensary OP 016-3821999

Buryadah Magrabi Optical - Nakheel Plaza OP 016-3837071

Buryadah Mojama Eyadat Enaya Panorama OP 016-3846777

Maternity & Children Hospital - Buridah Buryadah OP/IP 016-3851258 (Moh)

Buryadah Al-Faiha Medical Center -2- OP 016-3852285

Buryadah Uyun Al-Jawa Hospital (Moh) OP/IP 016-3911320

Hwtat Bani Maha Opticals -Baliadya St OP 011-5551328 Tamim Hwtat Bani Viola Medical Complex OP 011-5554032 Tamim

Onezah Al Salam National Clinic OP 016-3610009

Onezah Al Wafa Hospital OP/IP 016-3632200

Onezah Al Magrabi Optical - Unaizah Mall OP 016-3637485

Onezah King Saud Hospital - Enizah (Moh) OP/IP 016-3645000

Onezah Al Barakah Polyclinic OP 016-3651800

Prince Salman Ibn Mohammed Al Saud Shaqraa OP/IP 011-5417018 Hospital (Moh)

Shaqraa Al-Amal & Al-Khair Medical Complex OP 011-6222555

Shaqraa Abas Corner Medical Complex OP 011-6224343

Shaqraa Thadek General Hospital (Moh) OP/IP 016-4439911

Wadi Al Wadi Aldawasir General Hospital (Moh) OP/IP 011-7843084 Dawaser

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 33 Service City Provider Name VVIP VIP A B C D E Telephone Type Wadi Al Al Khamasine Medical Clinic OP 011-7847016 Dawaser Wadi Al Nowaemah National Clinic OP 011-7861495 Dawaser

Jeddah Hussam Optical - Cu Optics OP 011-4611485

Implant Dental Cosmetic Medical Center Jeddah OP 012-2066610 - Jedd

Jeddah Magrabi Optical -Red Sea Mall OP 012-2151660

Jeddah King Abdul Aziz Medical City (N.g.h) OP/IP 012-2266666

Jeddah Hussam Opticals OP 012-2275000

Jeddah King Abdullah Medical Complex (Moh) OP/IP 012-2285000

Jeddah East Jeddah General Hospital (Moh) OP/IP 012-2327555

Jeddah Al Noor Medical Center OP 012-2606000

Jeddah Shifa Al Munthaza Polyclinic OP 012-2620501

Jeddah New Al-Hiba Polyclinic OP 012-2656005

Jeddah Magrabi Optical - Stars Avenue Optical OP 012-2754487

Jeddah Naseem Jeddah Polyclinic OP 012-2875560

Jeddah Al Rahaily Polyclinic OP 012-2894583

Jeddah Hussam Opticals OP 012-5422942

Jeddah Al-Faisal Polyclinic -2- OP 012-6120999

Jeddah Al Rdaddi Clinic OP 012-6141412

Jeddah Al Raqoun Medical Center OP 012-6143630

Jeddah Magrabi Optical-Aziz Mall OP 012-6161900

Jeddah Magarbi Optical-Salama Center OP 012-6165655

Jeddah My Care Medical Center OP 012-6190606

Jeddah Hiba Asia Polyclinic OP 012-6232020

Jeddah Al Rayan Polyclinic OP 012-6300298

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 34 Service City Provider Name VVIP VIP A B C D E Telephone Type

Jeddah Al-Majd Polyclinic OP 012-6308000

Jeddah Jeddah Clinic Hospital - Al Kandarah OP/IP 012-6313131

Al Saqqaf Complex Ophthalmology And Jeddah OP/IP 012-6314004 Day Surgery

Jeddah Al-Faisal Polyclinic -1- OP 012-6318900

Jeddah Ibn Sina National College Hospital OP/IP 012-6355566

Jeddah Taj Polyclinic OP 012-6355715

Jeddah Magrabi Optical -Magrabi Hospital OP 012-6366215

Jeddah New Al-Jeddani Hospital OP/IP 012-6368100

Jeddah Al-Hayat Hospital OP/IP 012-6370707

King Abdulaziz Hospital And Oncology Jeddah OP/IP 012-6375555 Center -(Moh)

Jeddah New Gulail Polyclinic OP 012-6378073

Jeddah Tala Medical Clinic OP 012-6391818

Jeddah Abeer Medical Polyclinic-Bawadi OP 012-6395444

Jeddah Dr Khalid Idriss Hospital OP/IP 012-6424555

Jeddah Badrudin Polyclinic-Sharafyah- OP 012-6436053

Jeddah Badr Al Tamam Polyclinic OP 012-6452884

Jeddah New Sidrah Mdical Center OP 012-6500065

Jeddah Al Hiba Polyclinic OP 012-6500089

Jeddah International Medical Center OP/IP 012-6509000

Jeddah Dr.bakhsh Hospital OP/IP 012-6510666

Jeddah United Doctors Hospital OP/IP 012-6533333

Jeddah Shifa Jeddah Polyclinic OP 012-6533636

Magrabi Optical -Heraa International Jeddah OP 012-6546872 Market

Jeddah Badrudin Polyclinic-Bawadi - OP 012-6559191

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 35 Service City Provider Name VVIP VIP A B C D E Telephone Type

Jeddah Hussam Opticals OP 012-6600148

Jeddah Dr. Hala Essa Bin Laden Hospital OP/IP 012-6603332

Jeddah King Fahad General Hospital (Moh) OP/IP 012-6606111

Jeddah General Medical Polyclinic -Sari OP 012-6626444

Jeddah Dr.hassan Ghazzawi Hospital OP/IP 012-6636333

Maternity & Children Hospital - Misaidiah Jeddah OP/IP 012-6652600 (Moh)

Jeddah Al Hamra Hospital OP/IP 012-6653777

Jeddah Dr. Suliman Fakeeh Hospital OP/IP 012-6655000

Jeddah Magrabi Optical -Madinah Road OP 012-6655463

Jeddah Hussam Opticals OP 012-6657287

Jeddah New Jeddah Clinic Hospital OP/IP 012-6675000

Jeddah Shar Medical Clinic -1 OP 012-6675729

Jeddah Bugshan Hospital OP/IP 012-6691222

Jeddah Bani Malik Polyclinic OP 012-6700116

Jeddah Aziziah Medical Clinic OP 012-6701071

Jeddah Andalusiah Dental Center 1 OP 012-6702777

Jeddah Jeddah National Hospital OP/IP 012-6710040

Jeddah Badrudin Polyclinic-Anakish- OP 012-6710216

Jeddah Saudi Hospital OP/IP 012-6711831

Jeddah Shar Medical Clinic -2 OP 012-6720679

Jeddah Dr.hala Essa Binladen Polyclinic OP/IP 012-6722315

Jeddah Mareez Dental Clinic OP 012-6726969

Jeddah Badrudin Polyclinic-Bani Malik- OP 012-6728338

Maternity & Children Hospital - Aziziah Jeddah OP/IP 012-6729092 (Moh)

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 36 Service City Provider Name VVIP VIP A B C D E Telephone Type

Jeddah Hussam Opticals OP 012-6732959

Jeddah Mushrifah Polyclinic OP 012-6736287

Jeddah Badr Al Samaa Polyclinic OP 012-6744333

Jeddah Sameera Polyclinic OP 012-6744370

Jeddah Al-Amal Polyclinic OP 012-6748484

Jeddah Al Jeddani Hospital OP/IP 012-6772221

Jeddah Hai Al Jemea Hospital OP/IP 012-6806666

Jeddah Dr. Erfan & Bagedo General Hospital OP/IP 012-6820022

Jeddah Shifa Polyclinic -1- OP 012-6822900

Jeddah Gnp (Ghassan N.pharaon Hospital) OP/IP 012-6823200

Jeddah Al Zahra Hospital OP/IP 012-6823331

Jeddah Saudi German Hospital OP/IP 012-6829000

Jeddah Islam Medical Clinic OP 012-6871077

Jeddah Al Mostaqbal Hospital OP/IP 012-6875255

Jeddah My Clinic International Medical Co. OP 012-6888222

Jeddah Badrudin Polyclinic-Al-Iskan - OP 012-6896009

Jeddah Magrabi Optical - Al Saffa Branch OP 012-6934215

Jeddah Dr.talal Qutub Medical Center OP 012-6939222

Jeddah Dr. Hani Abdullah Ragaban Polyclinic OP 012-6946207

Jeddah Quds Polyclinic OP 012-6970224

Jeddah Magrabi Optical -Sarry Branch OP 012-6971140

Jeddah Hussam Opticals OP 014-3960510

Jeddah Abeer Medical Polyclinic-Al-Sharafyah OP/IP 920000501

Jeddah Abeer Medical Polyclinic -Al-Sanyaia OP/IP 920000502

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 37 Service City Provider Name VVIP VIP A B C D E Telephone Type

Jeddah Abeer Medical Polyclinic-Al Aziziya Dist- OP/IP 920000503

Jeddah Eed Clinic OP/IP 920022211

Jeddah The First Clinic OP 920029090

Makkha Mustasharak Medical Center OP/IP 012-2220000

Makkha Asfaan Polyclinic OP 012-2652999

Makkha Ibn Sina Hospital Hadda (Moh) OP/IP 012-4320554

Makkha Hera General Hospital - (Moh) OP/IP 012-5203535

Makkha Muhammed Salih Bashrahil Hospital OP/IP 012-5204444

Makkha Makkah Medical Center OP/IP 012-5222222

Makkha Al Fares Crystal Medical Complex OP 012-5277222

Makkha Magrabi Optical -Setteen Street OP 012-5347296

Makkha Asian Polyclinic OP 012-5361280

Magrabi Optical-Makkah Commercial Makkha OP 012-5365978 Center

Makkha Modern Medical Center OP 012-5371111

Makkha Umm Al Qura Hospital OP/IP 012-5376767

Makkha Roya Optical - Hai Al Sheefa OP 012-5395213

Makkha Dr. Zahir Qadeeb Alban Medical Center-1 OP 012-5400004

Makkha Makkah Medical Polyclinic OP 012-5440707

Makkha Saedi Medical Clinic OP 012-5442261

Makkha King Abdulaziz Hospital (Moh) OP/IP 012-5442400

Makkha Rafe Hospital OP/IP 012-5454455

Makkha Makkah Polyclinic OP 012-5496542

Makkha Al Magrabi Optical - Diafa Shoping Center OP 012-5497379

Makkha Maternity Hospital - Makkah (Moh) OP/IP 012-5530400

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 38 Service City Provider Name VVIP VIP A B C D E Telephone Type

Makkha Al-Bader Polyclinic-3- OP 012-5533770

Makkha King Abdullah Medical City (Moh) OP/IP 012-5549999

Makkha Saudi National Hospital OP/IP 012-5562177

Makkha Magrabi Optical - Azizia OP 012-5565576

Makkha Alawi Tunsi & Bros Hospital OP/IP 012-5587777

Dr. Zahir Qadeeb Alban Medical Center-2 Makkha OP 012-5587799 -Azizah -

Makkha Elite Medical Clinic OP 012-5614001

Makkha Alnor Specialist Hospital (Moh) OP/IP 012-5665000

Makkha Albayt Medical Center OP 012-5718400

Makkha Alsalam Medical Hospital OP 012-5772222

Makkha Badrudin Polyclinic -Bab Makkah- OP 012-6441108

Makkha Dr Khalid Bakr Al Bakri Polyclinic Jeddah OP 012-6754555

Makkha Adhm General Hospital (Moh) OP/IP 017-7426088

Makkha Abeer Medical Polyclinic OP/IP 920000506

Al-Madinah Roya Optical -King Fahad St OP 014-4833293

Al-Madinah Andalus Dental Center OP 014-8151444

Al-Madinah Magrabi Optical -Anwar Al Madina Mall OP 014-8180377

Al-Madinah Hussam Opticals OP 014-8228726

Al-Madinah Dr Abdul Rahman Al-Ogally Clinic OP 014-8250561

Al-Madinah Al – Rahma Hospital OP/IP 014-8272777

Al-Madinah Safa Al Madina Hospital OP/IP 014-8280000

Al-Madinah Wahat Al Shifa Clinic OP 014-8288177

Al-Madinah Roya Opticals - Al Haram OP 014-8290100

Al-Madinah Ahod General Hospital - (Moh) OP/IP 014-8300016

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 39 Service City Provider Name VVIP VIP A B C D E Telephone Type

Al-Madinah Roya Optical - Qurban 2 OP 014-8303293

Al-Madinah Roya Optical - Al Hujaira OP 014-8303293

Al-Madinah Roya Optical -Univirsity Road OP 014-8303456

Al-Madinah Dr.hamid S.al-Ahmadi Hospital OP/IP 014-8363332

Al-Madinah Atebba Al Madina Polyclinic OP 014-8372313

Al-Madinah Saudi German Hospital OP/IP 014-8406000

Al-Madinah Al Mouwassat Hospital OP/IP 014-8422211

Al-Madinah Magrabi Optical -Mowasat Hospital OP 014-8422740

Al-Madinah Madina National Hospital OP/IP 014-8444444

Al-Madinah Roya Optical - Sultanah OP 014-8451771

Al-Madinah Magrabi Optical -Sultana OP 014-8454218

Al-Madinah King Fahad General Hospital - (Moh) OP/IP 014-8463080

Al-Madinah Al Zahra Hospital OP/IP 014-8488808

Al-Madinah Eye Specialist Center OP 014-8493355

Al-Madinah Magrabi Optical -Noor Mall OP 014-8494301

Al-Madinah Cardiac Disease Surgery Centre-(Moh) OP/IP 014-8550481

Al-Madinah Roya Optical - Hai Al Khalidia OP 014-8648778

Al-Madinah Maternity & Children Hospital (Moh) OP/IP 014-8649999

Al-Madinah Basmat Alfarabi Dental Clinics OP 014-8666640

Al-Madinah Al- Dar Hospital OP/IP 014-8677777

Al-Madinah Almahd General Hospital OP/IP 014-8680506

Al-Madinah Roya Optical - Khaibar Al Rawdah OP 014-8822102

Prince Abdulmahsam General Hospital Al-Madinah OP/IP 014-8840182 (Moh)

Al-Madinah Roya Optical - Al-Shada'a Road OP 014-8842255

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 40 Service City Provider Name VVIP VIP A B C D E Telephone Type Al Abeer International Medical Clinic - Al-Madinah OP 920000507 Madina

Taif Al- Nahda Hospital OP/IP 012-7250600

Taif Al Siteen Medical Clinics OP 012-7255660

Taif King Abdulaziz Specialist Hospital (Moh) OP/IP 012-7310800

Taif Bin Reshoud Genral Medical Complex OP/IP 012-7325005

Taif Magrabi Optical -Panda Al-Azizia OP 012-7333588

Taif Barakat Optical - Obaikan Mall OP 012-7334385

Taif Al-Adwani General Hospital OP/IP 012-7340000

Taif Al-Ameen Hospital OP/IP 012-7366416

Taif Children Hospital - (Moh) OP/IP 012-7447202

Taif King Faisal Complex -(Moh) OP 012-7481699

Taif Al-Wattan National Clinic OP 012-7490660

Taif Your Health Medical Center OP 012-7499099

Taif Al Hassan General Hospital OP/IP 920009551

Yanbou Al- Pretty Smile Dental Center OP 014-3220077 Bahar Yanbou Al- Magrabi Optical -Yanbu Al Bahar OP 014-3222135 Bahar Yanbou Al- Red Sea Private Clinic OP 014-3223413 Bahar Yanbou Al- Al Amal Medical Polyclinic OP 014-3225166 Bahar

Yanbou Yanbu General Hospital (Moh) OP/IP 014-3222640

Yanbou Roya Optical - Yanbu Al-Bahar OP 014-3907656

Yanbou Safa Yanbu Hospital OP/IP 014-3910000

Yanbou Sameer Ibrahim Saeedi General Hospital OP/IP 014-3915000

Yanbou Al-Ansari Specialist Hospital OP/IP 014-3926444

Yanbou Pretty Smile Dental Center OP 014-3929090

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 41 Service City Provider Name VVIP VIP A B C D E Telephone Type

Yanbou Royal Commission Medical Center OP/IP 014-3937700

Yanbou Yanbu National Hospital OP/IP 014-3962000

AL-Hunakyaa Hinakiya Private Hospital OP/IP 014-8620893

Al-lith Allith General Hospital (Moh) OP/IP 017-7421958

Al-lith Laith National Policlinic OP/IP 017-7423446

Badar Al Noor Polyclinic OP 014-3320227

Badar Badr Al Shahuda Specialist Clinic OP 014-3322900

Khulaiss Al Bishri Medical Complex OP/IP 012-2135562

Omlej Omluj General Hospital (Moh) OP/IP 014-3820092

Omlej Al-Salamah & Al Hayah Polyclinic OP 014-3820222

Rabeg Al- Nakheel National Clinic OP 012-4221200

Rabeg Al Bishri Medical Complex OP/IP 012-4221332

Rabeg Hussam Opticals OP 012-4221385

Rabeg Rabig General Hospital (Moh) OP/IP 012-4221776

Rabeg Dr.khalid Idriss Medical Center OP 012-4222229

Rabeg Al Amal Polyclinic Rabegh OP 012-4222916

Thowal Al Bishri Medical Complex OP/IP 012-2886800

Thowal Medical Clinics Complex - Thoual (Moh) OP 012-2900110

Al-Dammam Balsam Elaj Medical Complex OP 012-8323346

Al-Dammam Prince Sultan Bin Abdulaziz Hospital (Moh) OP/IP 013-3280593

Al-Dammam Al Magrabi Optical - Othaim Mall OP 013-5876620

Al-Dammam Dar Al Afa Medical Group OP/IP 013-8050101

Al-Dammam Ajyad Medical Services Co Ltd OP 013-8056444

Al-Dammam Dammam Private Medical Complex - 1 OP 013-8056888

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 42 Service City Provider Name VVIP VIP A B C D E Telephone Type

Al-Dammam Dammam Medical Dispnsary 2 OP 013-8056888

Al-Dammam Al Taqwa Medical Complex OP 013-8096464

Al-Dammam Al Kahal Medical Complex OP 013-8097777

Al-Dammam Lama Medical Complex - Dammam OP 013-8115131

Al-Dammam Mana Dispensary OP 013-8122162

Nazer For Dialysis & Advance Health Al-Dammam OP 013-8130282 Service Co. Ltd

Al-Dammam Alam Ram Medical Complex OP 013-8133000

Al-Dammam Fajar Al-Dammam Medical Complex OP 013-8152555

Al-Dammam Dammam Medical Complex (Moh) OP/IP 013-8155770

Al-Dammam Dar As Siha Medical Center OP 013-8177899

Al-Dammam Al -Rai Medical Dispensary OP 013-8182584

Al-Dammam Al Mouwassat Hospital OP/IP 013-8200000

Al-Dammam Al Ahmadi Medical Complex - Dammam OP 013-8203183

Al-Dammam Magrabi Optical - Mouwassat Hospital OP 013-8204626

Al-Dammam Al Hillal Pharmacy - Khobar OP 013-8221604

Al-Dammam Health & Life Dispensary OP 013-8222222

Al-Dammam Mana General Hospital OP/IP 013-8262111

Al-Dammam Cardio Vascular Center OP/IP 013-8273703

Al-Dammam Dammam Ray Center Polyclinic REFERAL 013-8301718

Al-Dammam Al Magrabi Optical - Faisaliyah Plaza OP 013-8318172

Al-Dammam Badr Al- Rabie Dispensary OP 013-8326000

Al-Dammam Al Wazzan Vision - 2- OP 013-8326641

Al Ryan Extra Ordinary Polyclinic - Al-Dammam OP 013-8330233 Dammam

Al-Dammam Barakat Optical -Alemarah Road OP 013-8340340

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 43 Service City Provider Name VVIP VIP A B C D E Telephone Type

Al-Dammam Safa Medical Center OP 013-8341016

Al-Dammam Arrawdha Medical Complex - Dammam OP 013-8346555

Al-Dammam Arrawdah General Hospital OP/IP 013-8346555

Al-Dammam Tadawi General Hospital OP/IP 013-8348777

Al-Dammam Ram Dental Care OP 013-8356755

Al-Dammam Clinic 9 Medical Center - Dammam OP 013-8393320

Al-Dammam Al Faraby Dispensary OP/IP 013-8420909

Al-Dammam Ram Dental Care-2- OP 013-8425701

Maternity & Children Hospital - Dammam Al-Dammam OP/IP 013-8426666 (Moh)

Al-Dammam Al-Dukair Clinic OP 013-8429461

Al-Dammam Al Wazzan Vision Optical OP 013-8432762

Al-Dammam Dammam National Dispansary OP/IP 013-8434090

Al-Dammam King Fahad Specialist Hospital - (Moh) OP/IP 013-8442222

Al-Dammam Alenaya Alsehia Alshamela Dispensary OP 013-8467777

Al-Dammam Enaya Hospital – Al Dammam OP/IP 013-8467777

Al-Dammam Al Faraby Dispensary (1St,Industrial Area ) OP/IP 013-8474070

Saud Albabtin Center Cardiac Surgery Al-Dammam OP/IP 013-8517515 (Moh)

Al-Dammam Al Wazzan Vision - 2- OP 013-8524056

Al-Dammam National Guard Hospital (N.g.h) OP/IP 013-8532555

Al-Dammam Sham Dental Clinic OP 013-8873322

Al-Khobar Al Mana Medical Center OP/IP 013-8333777

Al-Khobar Dr. Layla Dawood Al- Onaizi Polyclinic OP 013-8574040

Al-Khobar Gama Hospital OP/IP 013-8590024

Al-Khobar Khobar Cooperative Clinic OP 013-8640141

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 44 Service City Provider Name VVIP VIP A B C D E Telephone Type

Al-Khobar As-Salama Hospital OP/IP 013-8641011

Al-Khobar Al Hillal Pharmacy - Khobar OP 013-8641551

Al-Khobar Al Yousuf Hospital For Medical Services OP/IP 013-8642751

Al-Khobar Ram Dental & Orthodontic Clinic OP 013-8648181

Al-Khobar Jabal Ram Dental Care OP 013-8675566

Al-Khobar Rawnaq Dental Clinic OP 013-8820003

Al-Khobar Shorouk Al Hada Polyclinic OP 013-8820006

Al-Khobar Saad Specialist Hospital OP/IP 013-8826666

Al-Khobar Sham Dental Clinic OP 013-8878676

Al-Khobar Ozone Dental Centre OP 013-8940007

Al-Khobar Al Wazzan Vision OP 013-8940714

Al-Khobar Barakat Optical-Al-Rashed Mall OP 013-8941288

Al-Khobar Magrabi Optical -Al Rashed Mall OP 013-8942172

Al-Khobar Shifa Al Khobar Polyclinic OP 013-8944984

Al-Khobar Mohammed Dossary Hospital OP/IP 013-8945524

Al-Khobar Magrabi Optical -Cornich Road OP 013-8954791

Al-Khobar Dr. Fakhry & Al-Rajhi Hospital OP/IP 013-8954960

Al-Khobar Riaya Procare Hospital OP/IP 013-8955900

Al-Khobar Al Jazira Clinic OP 013-8982022

Al-Khobar Barakat Optical -King Khalid Road OP 013-8985743

Al-Khobar Mana General Hospital OP/IP 013-8987000

Al-Ahsaa Prince Saud Bin Jalawi Hospital - (Moh) OP/IP 013-5300011

Al-Ahsaa Obeid Hospital OP/IP 013-5303333

Al-Ahsaa Al Moosa Specialist Hospital OP/IP 013-5307000

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 45 Service City Provider Name VVIP VIP A B C D E Telephone Type

Al-Ahsaa Al-Jaber Hospital - (Moh) OP/IP 013-5311056

Al-Ahsaa Al Wazzan Vision -1- OP 013-5311552

Al-Ahsaa Magrabi Optical -Elwan Branch OP 013-5312992

Al-Ahsaa Al Maghlouth Medical Dispensary OP 013-5313333

Al-Ahsaa Ram Dental Care OP 013-5313831

Al-Ahsaa Al Mouwassat Dispensary OP/IP 013-5360000

Al-Ahsaa Al-Taraf Charitable Society Clinic OP 013-5393200

Al-Ahsaa Prince Sultan Center For Cardiac (Moh) OP/IP 013-5730000

Al-Ahsaa Care And Beauty Center OP 013-5812822

Al-Ahsaa Al Wazzan Vision -2- OP 013-5840161

Al-Ahsaa Al-Ahsa Hospital OP/IP 013-5844000

Al-Ahsaa Magrabi Optical -Ahsa Hospital OP 013-5869255

Al-Ahsaa Magrabi Optical -Otheem Mall OP 013-5876620

Al-Ahsaa Al Mardiah Al- Hawraa Clinic OP 013-5879585

Al-Ahsaa Barakat Optical -Al-Othaim Mall OP 013-5879973

Al-Ahsaa Mana General Hospital OP/IP 013-5887000

Al-Ahsaa King Abdul Aziz Hospital(N.g.h) OP/IP 013-5910000

Al-Ahsaa Maternity & Children Hospital (Moh) OP/IP 013-5924649

Al-Ahsaa Bright Smile Dental Center OP 013-5933337

Al-Ahsaa Al Rida Clinic OP 013-5966890

Al-Ahsaa Health Vision Company - Al Qara OP/IP 013-5983000

Al-Dahran Magrabi Optical -Dahran Mall OP 013-8684033

Al-Dahran Doha Medical Clinic OP 013-8913111

Al-Dahran Eye Specialist Hospital - Dhahran (Moh) OP/IP 013-8914226

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 46 Service City Provider Name VVIP VIP A B C D E Telephone Type

Al-Dahran Al Faraby Medical Center OP/IP 013-8916163

Al-Hafouf Salwa General Hospital (Moh) OP/IP 013-5470259

Al-Hafouf King Fahad Hospital -Moh OP/IP 013-5750000

Al-Hafouf Al Batha General Hospital (Moh) OP/IP 013-5755761

Al-Hafouf Hussein Al Ali Hospital OP/IP 013-5827777

Al-Hafouf Al Mashaf Complex OP 013-5865900

Al-Jubail Mana General Hospital OP/IP 013-3412000

Royal Commission Health Service Program Al-Jubail OP/IP 013-3464000 - Jubail

Al-Jubail Magrabi Optical - Jubail OP 013-3471311

Al-Jubail Magrabi Optical -Fanateer Branch OP 013-3471311

Al-Jubail Al Wazzan Vision OP 013-3477714

Al-Jubail Al- Lulu Dispensary OP 013-3486600

Al-Jubail Al Mouwassat Hospital OP/IP 013-3490000

Al-Jubail Shifa Al Jubail Medical Center OP 013-3611777

Khonaini General Dispansary For Medical Al-Jubail OP 013-3615737 Services

Al-Jubail Kims (Suncity ) Medical Center OP 013-3620039

Al-Jubail Jubail National Dispensary OP 013-3620385

Al-Jubail Dina Dispensary For Medical Services OP 013-3620636

Al-Jubail Al Jubail General Hospital-Moh OP/IP 013-3622233

Al-Jubail Gulf Asian Medical Center OP 013-3627121

Al-Jubail Arrazi Clinics OP 013-3627373

Al-Jubail Magrabi Optical -Al Balad OP 013-3631731

Al-Jubail Jubail Medical Center OP 013-3631888

Al-Jubail Arrazi Optical Lenses Est OP 013-3634484

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 47 Service City Provider Name VVIP VIP A B C D E Telephone Type

Al-Jubail Badr Al Khaleej Medical Centre OP 013-3643000

Al-Khafji Al Khafji National Hospital OP/IP 013-7661111

Al-Khafji Al Manar Medical Complex OP/IP 013-7666464

Al-Khafji Al Khafji General Hospital (Moh) OP/IP 013-7666865

Al-Khafji Khafji Specialized Medical Center OP 013-7672088

Al-Khafji Al Rahma Medical Complex OP 013-7674499

Al-Nuayraa Alnairiah General Hospital (Moh) OP/IP 013-3731000

Al-Nuayraa Al Nauriyah National Clinic OP/IP 013-3731100

Al-Nuayraa Care & Heal Medical Complex OP 013-3733351

Al-Qatif Al Mouwassat Hospital OP/IP 013-8200000

Al-Qatif Al Batti Dispensary OP 013-8232811

Al-Qatif Qatif Central Hospital (Moh) OP/IP 013-8361880

Al-Qatif Nahj-Alshifaa General Medical Complex OP 0138463999

Al-Qatif Medical Excellence Center OP 013-8523324

Al-Qatif Al Wazzan Vision -1- OP 013-8524056

Al-Qatif Noor Al Madar -3-Dental Center OP 013-8525858

Al-Qatif Zuher Al-Shuwekhat Optical Center OP 013-8548551

Al-Qatif Al Wazzan Vision -2- OP 013-8554188

Al-Qatif Al Zahra General Hospital OP/IP 013-8555000

Al-Qatif Mudar Charitable Society OP 013-8558513

Al-Qatif Basmat Ram Dental Care OP 013-8559004

Beqaiq Manar Al-Sihha Dispensary - Abqaiq OP 013-5660163

Beqaiq Baqiq General Hospital (Moh) OP/IP 013-5662222

Beqaiq Al Shefa Dispensary OP/IP 013-5663444

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 48 Service City Provider Name VVIP VIP A B C D E Telephone Type

Beqaiq Abdullah Al Dosary National Dispensary OP 013-5663747

Jubail Wadi Ram Dental Care OP 013-3472323 Industrial Jubail Al Khonaini Medical Complex – Deff- OP 013-3495910 Industrial Industrial Area

Rahemah Shifa Rahima Mediacl Center OP 013-6672525

Ras Tanwrah Dar Al Taaf Dispensary OP/IP 013-6671378

Ras Tanwrah Rastanura General Hospital OP/IP 013-6674444

Ras Tanwrah Rahima Medical Polyclinic OP/IP 013-6677700

Ras Tanwrah Zuher Al-Shuwekhat Optical Center OP 013-6681816

Safwaa Salammtek Dispensary OP 013-6630959

Safwaa Al Safa Social Service Charity Dispensary OP 013-6641645

Safwaa Specialized Polyclinic Complex OP/IP 013-6644116

Rubban Medical Center (Saihat Khalij Sihaat OP/IP 013-8387401 Dispensary )

Sihaat Al Wazzan Vision -1- OP 013-8390034

Sihaat Zuhair Alshowikhat Optical Center OP 013-8394200

Sihaat Al-Sadiq Hospital OP/IP 013-8500156

Sihaat Al Madlouh Dispensary OP 013-8500208

Sihaat Zuher Al-Shuwekhat Optical Center OP 013-8505205

Sihaat Al Wazzan Vision -2- OP 013-8564554

Tarut Al Hadi Medical Clinic OP 013-8230333

Thuqbah Al Wazzan Vision OP 013-8969494

Al-Ouiqliah Alawikqiah Hospital (Moh) OP/IP 014-6690481

Al-Quriayt Qurayat Al Ulya General Hospital OP/IP 013-3863303

Al-Quriayt Al-Hikmah Medical Clinic OP/IP 014-6332009

Al-Quriayt Qurayat General Hospital -Moh OP/IP 014-6424712

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 49 Service City Provider Name VVIP VIP A B C D E Telephone Type

Al-Quriayt Dr.bader Medical Center OP 014-6432333

Al-Quriayt Alhadithah General Hospital (Moh) OP/IP 014-6440902

Al-Quriayt Alisawiah General Hospital -(Moh) OP/IP 014-6571110

Arar Maternity & Children Hospital - (Moh) OP/IP 014-6528013

Arar Al-Khanani Poly Clinic OP/IP 014-6627770

Prince Abdulaziz Bin Musaad Hospital Arar OP/IP 014-6628936 (Moh) Prince Abdullah Bin Abdulaziz Bin Arar OP/IP 014-6629031 Mousaed Specialist Dental Center (Moh)

Arar Salamaty Polyclinic OP 014-6636222

Arar Arar Central Hospital (Moh) OP/IP 014-6643291

Prince Abdullah Bin Abdulaziz Center For Arar OP/IP 014-7000000 Cardiac Surgery (Moh)

Baqaa Allewa’a Medical Comple OP 016-5271122

Baqaa Baqaa General Hospital (Moh) OP/IP 016-5271688

Debaa Dhuba National Clinic OP/IP 014-4320000

Debaa Duba General Hospital -Moh OP/IP 014-4320900

Hafar Al- Al Rafeeah General Hospital (Moh) OP/IP 013-3880714 Baten Hafar Al- Dr. Noor M. Khan Clinic OP 013-7220701 Baten Hafar Al- Al Hujailan Medical Dispensary OP 013-7225270 Baten Hafar Al- Dr. Noor M. Khan Hospital OP/IP 013-7225550 Baten Hafar Al- King Khiled Hospital (Moh) OP/IP 013-7247777 Baten Hafar Al- Maternity & Children Hospital (Moh) OP/IP 013-7292628 Baten Hafar Al- Hafer Albatin Central Hospital (Moh) OP/IP 013-7294418 Baten

Hail Zamzam Clinic OP 016-5312121

Hail Heart Center -(Moh) OP/IP 016-5319526

Hail Khaleej Poly Clinic OP 016-5322333

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 50 Service City Provider Name VVIP VIP A B C D E Telephone Type

Hail Hail Dental Center OP 016-5326436

Hail Semah Poly Clinic OP 016-5328000

Hail King Khaled Hospital -Moh OP/IP 016-5328888

Hail Al-Rashid General Hospital OP/IP 016-5332222

Hail Al Magrabi Optical - Airport Road OP 016-5342027

Hail Noor Poly Clinic OP 016-5344440

Hail Maternity & Childern Hospital -Moh OP/IP 016-5437007

Hail Salamat Clinic OP 016-5588888

Rafha Al-Faiha Medical Center OP 014-6764000

Rafha Rafha Hospital (Moh) OP/IP 014-6764201

Rafha Shabit Nasab Hospital (Moh) OP/IP 014-6780031

Skakaa Daumat Aljandel Hospital (Moh) OP/IP 014-6224070

Skakaa Maternity & Childern Hospital - Moh REFERAL 014-6242224

Skakaa Zahraa Al-Jufe Medical Complex OP 014-6244442

Skakaa Zahraa Al-Jufe OP 014-6244442

Skakaa Prince Abdul Rahman Al Sudairy - Moh OP/IP 014-6247200

Skakaa Hamad Medical Center OP/IP 014-6248888

Kind Abdulaziz Specialist Hospital - Aljouf Skakaa OP/IP 014-6256060 (Moh)

Skakaa Specialised Dental Medical Center OP 014-6263010

Tabrjal Tabrgal General Hospital (Moh) OP/IP 014-6286227

Tabuk Health Gulf Medical OP 014-4211113

Tabuk Magrabi Optical -Sanabal OP 014-4212828

Tabuk King Khaled Hospital- Moh OP/IP 014-4220100

Tabuk Zaid Alarjan Medical Complex OP 014-4222218

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 51 Service City Provider Name VVIP VIP A B C D E Telephone Type

Tabuk Tabuk National Polyclinic OP 014-4226215

Tabuk Mabasem Medical Complex- Tabuk OP 014-4228840

Tabuk Maternity & Childern Hospital - Moh OP/IP 014-4236952

Tabuk Nabras Al Jazeera Polyclinic OP 014-4237009

Tabuk Al Dakhel Polyclinic OP 014-4242222

Tabuk King Fahad Specialist Hospital - (Moh) OP/IP 014-4259044

Tabuk Prince Fahd Bin Sultan Hospital OP/IP 014-4280555

Tabuk Alwagh General Hospital (Moh) OP/IP 014-4424070

Tabuk Taimaa General Hospital (Moh) OP/IP 014-4630031

Tabuk Ali Al Affary Polyclinic OP 920010019

Traif Turaif General Hospital -Moh OP/IP 014-6521822

Traif Al-Mona Medical Center OP/IP 014-6530091

Abha Aseer Central Hospital -(Moh) OP/IP 017-2251155

Abha Maternity & Children Hospital - (Moh) OP/IP 017-2257575

Abha Al-Nomais Polyclinic OP 017-2272192

Abha Daweni Medical Center OP/IP 017-2280505

Abha Abha Private Hospital OP/IP 017-2292222

Abha Safa Abha Medical Center OP 017-2298884

Abha Al-Themal Medical Center OP/IP 017-2316666

Abo Aresh Nasser Muraya Polyclinic OP 017-3221990

Abo Aresh Abu Arish General Hospital (Moh) OP/IP 017-3250012

Ahad Al- Emeis Modern Polyclinic OP/IP 017-2506633 Rafedah Ahad Al Haramain Medical Complex OP 017-2507777 Rafedah

Al-Baha Turbah General Hospital (Moh) OP/IP 012-8221683

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 52 Service City Provider Name VVIP VIP A B C D E Telephone Type

Al-Baha Shamekh Poly Clinic OP/IP 017-7240044

Al-Baha King Fahad Hospital - Moh OP/IP 017-7254000

Al-Baha Alaqiq General Hospital (Moh) OP/IP 017-7390382

Al-Makwah Almokhuah General Hospital (Moh) OP/IP 017-7280601

Al-Qunfuzaa Qunfudah General Hospital (Moh) OP/IP 017-7321790

Al-Qunfuzaa South Qunfudah General Hospital (Moh) OP/IP 017-7328000

Al-Qunfuzaa Alzobydi Medical Complex OP 017-7331071

Baljurshi Ghodran General Hospital OP/IP 017-7224470

Baljurshi Prince Meshari Bin Saud Hospital - (Moh) OP/IP 017-7226448

Beesh Baish General Hospital (Moh) OP/IP 017-3420944

Beesh Nakhabat Al-Ganoob Medical Polyclinic OP 017-3424077

Beshaa King Abullah Hospital(Moh) OP/IP 017-6223333

Beshaa Al Salam Medical Dispensary OP/IP 017-6223575

Beshaa Bisha Medical Dispensary OP/IP 017-6226560

Dahran Al- Badr Al - Janoub General Hospital (Moh) OP/IP 017-5454522 Janob

Jazan Farasan General Hospital (Moh) OP/IP 017-3161101

Jazan Al Magrabi Optical - Prince Sultan Street OP 017-3171339

Jazan Al Haramain Polyclinic OP 017-3172222

Jazan Al Magrabi Optical - Kadi Mall OP 017-3215259

Jazan Ali Khamaj Medical Clinic OP 017-3220990

Jazan Al Safwa Dental Complex OP 017-3222777

Jazan Al-Emeis Polyclinic OP/IP 017-3226633

Jazan Shifa Jizan Polyclinic OP 017-3232266

Prince Mohammed Bin Nasser Hospital Jazan OP/IP 017-3238007 (Moh)

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 53 Service City Provider Name VVIP VIP A B C D E Telephone Type

Jazan King Fahad Central Hospital (Moh) OP/IP 017-3250717

Jazan Hayat National Hospital OP/IP 017-3311111

Jazan Aldarb General Hospital (Moh) OP/IP 017-3461063

Jazan Shifa Al Darb Poly Clinic - Al Darb OP 017-3461177

Khamis Gnp (Ghassan N.pharaon Hospital) OP/IP 017-2200002 Mushyet Khamis Barakat Optical -Al-Sooq Al-Khairy OP 017-2206003 Mushyet Khamis Reayati Poly Clinic OP 017-2207771 Mushyet Khamis Al Magrabi Optical - Khairiyah Center OP 017-2218688 Mushyet Khamis Al-Themal Medical Center OP/IP 017-2226666 Mushyet Khamis Al-Shamil Family Polyclinic OP/IP 017-2228800 Mushyet Khamis Maternity & Children Hospital -(Moh) OP/IP 017-2231107 Mushyet Khamis Al-Hayat National Hospital OP/IP 017-2334444 Mushyet Khamis Al Hussam Medical Complex OP 017-2351154 Mushyet Khamis Saudi German Hospital OP/IP 017-2355000 Mushyet Khamis Khamis Mushait General Hospital (Moh) OP/IP 017-2371919 Mushyet Khamis Al Magrabi Optical - Magrabi Hospital OP 017-2384072 Mushyet Khamis Dhahran Al Janoub General Hospital (Moh) OP/IP 017-2550340 Mushyet Khamis Tadawi Medical Center OP 017-2680000 Mushyet Khamis Namas General Hospital (Moh) OP/IP 017-2821334 Mushyet Khamis Naser Daifallah Moraya Medical Polyclinic- OP 017-3222407 Mushyet Bani Malic

Mahayel Assir Shifa Al- Khamis Poly Clinic OP 017-2371777

Mahayel Assir Mahail General Hopsital (Moh) OP/IP 017-2851511

Mahayel Assir Muhayl National Hospital OP/IP 017-2856666

Najran King Khaled Hospital -Moh OP/IP 017-5224116

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 54 Service City Provider Name VVIP VIP A B C D E Telephone Type

Najran Magrabi Optical -Khalidya OP 017-5232708

Najran Al-Hayat Medical Center OP 017-5290888

Najran Maternity & Children Hospital - Moh OP/IP 017-5295000

Najran Najran General Hospital (Moh) OP/IP 017-5421932

Najran Al Zafer Hospital OP/IP 017-5429999

Najran Al-Atfain Polyclinic OP/IP 017-5440016

Najran Khabbash General Hospital (Moh) OP/IP 017-5449400

Najran Habuna General Hospital (Moh) OP/IP 017-5452409

Najran Al-Hayah Medical Dental OP 017-5459000

Najran International Medical Complex OP/IP 017-5468440

Najran Najran General New Hospital (Moh) OP/IP 05-45259919

Sabet Al- Sabt Alalaia Hospital (Moh) OP/IP 017-6301032 Alayaa

Sabyaa Naser Daifallah Moraya Medical Polyclinic OP 017-3222407

Sabyaa Al- Emeis Hospital OP/IP 017-3266633

Sabyaa Sabya General Hospital - Moh OP/IP 017-3270750

Samtaah Samtah General Hospital (Moh) OP/IP 017-3321216

Sharowraah Al-Jazerah Polyclinic OP/IP 017-5320234

Sharowraah Sharorah General Hospital (Moh) OP/IP 017-5321457

Surat Obedah Ministry Of Health OP/IP 017-2590159

Surat Obedah Sarat Abidah General Hospital (Moh) OP/IP 017-2590159

Tathleeth Tathlith General Hospital (Moh) OP/IP 017-2670923

Note | Dear Customer: Modifcation may occur on this list based on providers accreditation from CCHI & contract agreement. 55 ae Beneﬁts

an ntrat nrmatn Benefits Summary Annual Limit: SAR 500,000 "0%-20% Max.75 SR (Lower NW) 0%-20% Max.300 SR (Hospitals in Deductible: all Networks Excl.LNW) 0%-20% Max.100 SR (Clinics/Polyclinics in all Networks Excl. LNW)" Network of Provider: - natent ay are enefits Room & Board: - Room & Board extension for accompanying SAR 150 Deductible For In-patient: N/A utatent Benefits General doctor: SAR 50 Specialist doctor (Registrar): SAR 100 Specialist doctor (Senior Registrar): SAR 200 Consultant doctor: SAR 300 Rare specialists: SAR 500 ter Benefits Pre-existing conditions: SAR 500,000 Repatriation of mortal remains to Home SAR 10,000 Country: Pregnancy & Delivery: SAR 15,000 Dental Care: SAR 2,000 Optical Care: SAR 400 Dialysis limitation: SAR 100,000 Psychiatric treatment (Acute cases) including SAR 15,000 Non Acute Cases Covered up to SR 5,000 up to Maxium 4 Sessions including medicines during the policy period. Hearing aids: SAR 6,000 Damage costs in acquired heart valves: SAR 150.000 Organ Transplant / Donor surgery cost ONLY SAR 50,000 Alzheimer SAR 15,000 Autism SAR 50,000 The cost of the national program for newborns SAR 100,000 to reduce disability Disability costs SAR100,000 Bariatric (Obesity) surgery in case BMI is SAR 20,000 above 45, (Gastric Sleeve Surgery ONLY) Circumcision (for male) SR 500 Ear Piercing (for female) SAR 300 "Newborns are covered by the mother's membership maximum of 30 days from the date of birth until they are added to the policy retroactively from the date of birth"

56 Customer Details

Policyholder:

Policy No.:

Membership No.:

Insured Name:

Mobile No.: (mandatory to update your claim status)

Email address:

In which country was the treatment originally billed?

Details of Expenses

Consultation fee

Drugs

Lab/x-rays, etc.

Optical Frame

Optical/Contact Lenses

Others

Total

Documents Requirement Dully ﬁlled medical Reimbursement Claim Detailed medical report describes the medical form. condition. Clear medical ID card copy. Discharge summary for inpatient cases. Clear copy of Iqama or Saudi ID. Doctor`s drugs prescription. Original Itemised invoice (with cost breakdown Results of diagnostic. item-by item & payment receipt). Copy of exit/ re-entry visa (if treatment outside KSA) with AXA Insurance acceptance letter. Additional Documents required for Visitor Insurance

Passport copy. Insurance policy certificate. Visa entry number. Beneficiary name and account details. KSA entry stamp on passport. Beneficiary Iqama Number.

Note:

Settlement of the claim will be as per the policy T&C. Name (As recorded in bank): IBAN Account Number:

Bank Name: I, the undersigned declare that the information above is correct.

I hereby agree that I shall indemnify AXA Insurance Company against all or any loss arising from my misrepresentation under these declarations and AXA Insurance Company shall have the right at its own discretion to reevaluate, reject the claim and /or investigate claims with no legal liability towards them.

Name :

Signature:

Date: