Patients Frequently Asked Questions (FAQs)


1- What is health insurance?

Health insurance is a type of insurance coverage that pays for medical and surgical expenses incurred by the insured within the scope of medical necessity and coverage terms and conditions. It can be purchased by individuals, families, or provided by employers as part of a benefits package.


2- What does my health insurance cover or not cover?

Health insurance covers a wide range of medical expenses, including hospital stays, doctor visits, emergency care, prescription drugs, and more. The specific coverage and benefits vary depending on your insurance policy table of benefits (TOB). 


3- Why am I being treated under my insurance when I am eligible for free care in governmental


As per government regulations within the health sector transformation and Council of Health Insurance (CHI Article 11), all the citizens who are medically insured shall obtain the treatment as usual, but financially it shall be claimed through their health insurance company. 


4- Do I have to pay anything towards my treatment?

As of now, no payment is needed from the patient. KFSH&RC will shoulder the deductible amount on behalf of the patient. You may be expected to pay for services not covered by insurance.


5- What is meant by deduction/co-payment? 

It is part of the amount which you pay when receiving medical treatment in the outpatient clinics or ER as prescribed (if any) in the list stated in your insurance policy.


6- Who is responsible for paying the deduction/co-payment when receiving medical services, and what are the exceptions?

When receiving treatment, every beneficiary shall pay the deduction/co-payment amount (if any) as stated in their insurance policy. As of now, you will not be requested to pay towards your treatment under insurance in KFSH&RC.


7- How long will it take for my insurance company to respond to an approval request?

The insurance company must respond to the request for approval for treatment within sixty minutes; with the exception of  emergency cases, which don’t require prior approval.


8- Do I need to wait for the approval to proceed with medical care at KFSH&RC?

As of now, you will not wait for the insurance company to approve the requested services, and you can proceed directly to obtain the services.


9- Does an insurance policy cover claims related to congenital deformities?

The standard insurance policy does not cover cases of congenital deformities unless they pose a risk to the life of the insured.


10- If I consume or reach my insurance coverage limit, would I still be treated in KFSH&RC?

It will depend on your clinical condition and your medical eligibility.


11- How do I know if I am eligible to be treated under insurance in KFSH&RC?

You may contact your insurance company, or you may contact KFSH&RC at Tel: 0114647272 Ext 30864.


12- Does having health insurance give me priority for appointments or surgeries?

No, scheduling is dependent on KFSH&RC clinical parameters such as case severity and bed availability.


13- What medical services are excluded from health insurance coverage?

They are services not covered by insurance companies, listed in your insurance policy in the table of benefits. You may also check the unified CHI policy on the CHI website.


14- Is cosmetic surgery covered under health insurance?

It depends on the insurance policy, table of benefits, and the nature of the surgery.


15- Am I able to receive a medical device under health insurance?

Some medical devices are covered for chronic cases e.g.  blood pressure monitors, blood sugar monitors and nebulizing devices. All are subject to the medical necessity reviews and the payer approval.


16- What documents do I need to bring with me to be treated under insurance in KFSH&RC?

After having met the medical insurance eligibility and been accepted at KFSH&RC, you will be required to present your National ID during each visit.


17- Is it possible for me to be treated under another person's medical insurance?

Health insurance cannot be used by anyone other than the insured person.


18 - If I have medical insurance and I do not have a medical file in the hospital, can I still be treated at KFSH&RC?

As of now, you need to meet the medical acceptance criteria prior to being treated in KFSH&RC.