What you need to know
- The former Council of Cooperative Health Insurance (CCHI) now uses the name Council of Health Insurance (CHI); the official pages reviewed do not date the change.
- Since 4 March 2024 health insurance sector mandates sit with the Insurance Authority, while the council keeps compulsory cover enforcement, coverage decisions, provider accreditation and NPHIES.
- Private sector employers must insure Saudi and non-Saudi employees and covered family members, according to the Insurance Authority.
- Health insurance premiums were SAR 18.5 billion in Q1 2026, 62% of the market, with 14.5 million beneficiaries, the Insurance Authority said.
- From 1 November 2026 insurers must offer an outpatient product without pre-approval requests, under an IA directive of 20 August 2026.
CCHI is the abbreviation many readers still use when they look up the body that runs compulsory health insurance in Saudi Arabia, and the first thing to know in 2026 is that the job has been split. The body once called the Council of Cooperative Health Insurance (CCHI) now uses the name Council of Health Insurance (CHI), and since March 2024 most supervision of the health insurance sector has sat with the Insurance Authority (IA). For hospital finance teams, insurers, employers and health IT vendors, the practical question is which body sets which rule. This guide answers that from official documents, as of November 2026.
What CCHI is now: the Council of Health Insurance
The council’s English announcement of March 2024 uses the name Council of Health Insurance and the abbreviation CHI. So do the Insurance Authority’s published FAQs, and the IA’s standard policy for domestic workers defines “Council” as the “Council of Health Insurance”.
The former name appears in a Ministry of Health release of 27 November 2012, which described the minister of health as “Chairman of the Council of Cooperative Health Insurance (CCHI)”, and the IA’s list of health insurance documents still includes “The Benefits of Unified Policy for Council of Cooperative Health Insurance”. The official pages we could open do not record the date or the instrument of the renaming, so this guide gives neither. We could open only one page of the council’s own website, which limited what could be checked about its history and governing law.
What is clearly documented is the council’s current remit. In an announcement dated Monday 4 March 2024, the Council of Health Insurance said that “the roles and responsibilities of the health insurance sector have been transferred to the Insurance Authority (IA)”, which had begun operating the previous November. The same announcement listed what the council keeps:
- “enforcing compulsory health insurance”;
- “determining those covered by the mandatory coverage”;
- “accrediting and qualifying healthcare providers to deliver services to CHI beneficiaries”;
- continuing to operate NPHIES “for health insurance transactions (SHIB)”;
- receiving complaints and inquiries related to compulsory health insurance, and supervising healthcare providers.
The council’s official spokesman, Dr. Naser Al-Juhani, explained in the same announcement that the insurance sector’s roles and responsibilities had been fully transferred to the Insurance Authority, and that beneficiaries could contact the IA with complaints and inquiries. He also affirmed the council’s continued provision of services to health insurance beneficiaries.
The 2024 split between CCHI and the Insurance Authority
The Insurance Authority was established under Council of Ministers Resolution No. 85 dated 15 August 2023, according to its FAQ page, and became the authorised regulator of the insurance industry in Saudi Arabia from 23 November 2023. Complaints previously lodged with SAMA Cares moved to IA Care from that date.
The IA FAQ states that “effective from March 4th, 2024, all health insurance-related mandates will be transferred from the Council of Health Insurance (CHI) to the IA”, and that current laws and regulations, including those previously issued by SAMA or by the council, remain in effect “until further instructions are issued”. The table summarises the division of labour as the two bodies describe it.
| Function | Council of Health Insurance (CHI) | Insurance Authority (IA) |
|---|---|---|
| Supervision of the health insurance sector and insurers | Transferred to the IA on 4 March 2024 | Holds health insurance-related mandates from 4 March 2024 |
| Enforcing compulsory health insurance | Retained | Not listed |
| Deciding who must be covered | Retained | Not listed |
| Accrediting and qualifying healthcare providers | Retained | Not listed |
| NPHIES transaction platform | Retained | Not listed |
| Complaints | Complaints about compulsory health insurance | All health insurance complaints through IA Care from 4 March 2024 |
| Health insurance qualification requests from insurance sector participants | Not stated | Directed to the IA from 4 March 2024, according to its FAQ |
| Standard policies | Not stated | Publishes standard policies, including the compulsory domestic worker policy |
The two descriptions of complaints overlap. The IA FAQ says “all health insurance related complaints should be raised with IA Care from March 4th onwards”, while the council says it still receives complaints related to compulsory health insurance. Read together, the two texts point disputes with an insurer to the IA, and questions about whether a person must be covered, or about a provider’s accreditation, to the council; the pages reviewed contain no joint statement settling the overlap.
The IA describes itself as “the regulatory body responsible for regulating, supervising, and overseeing the insurance sector”, and says it has an independent legal personality with financial and administrative independence. The Council of Health Insurance’s retained functions sit closer to the health system: who is covered, which providers can treat insured patients, and the data exchange between them. Our Policy and payers section follows both bodies.
Who must be covered: the compulsory health insurance rules CCHI enforces
The IA’s FAQ gives the core rule. Asked whether insurance is mandatory for Saudis and their families, it answers that “private sector employers must insure all their Saudi and non-Saudi employees and their family members covered by the system”, listing “spouses, sons until age 25, unmarried non-working daughters, and orphans fostered by insured families” under mandatory health insurance. Determining who falls inside that coverage remains a Council of Health Insurance function under the March 2024 announcement, and the IA FAQ says “the Council will follow up on employer compliance in insuring the covered categories as per the Health Insurance Law executive regulations”.
The same FAQ sets out the employer’s side. The employer alone is responsible for paying the premiums for employees and their dependants. An employer that does not subscribe or pay for an employee and covered family members must pay all premiums due, plus a penalty of up to the annual subscription value per person, and may be barred from recruiting workers permanently or temporarily. Employers are not obliged to insure visitors, who fall under a separate visitor policy covering emergency cases up to SAR 100,000.
Domestic workers are covered by a separate standard policy. The IA’s standard policy for compulsory health insurance of domestic workers, dated 27 August 2024 on the IA regulations page, applies to employers with more than four domestic workers. It covers the fifth worker and those after, starts from the date of issue or renewal of that worker’s residency, and is issued as one policy covering all of an employer’s eligible workers. The document cites Cabinet Resolution No. (724) of 1444H as its legal reference and says the policy is issued by insurers licensed by the Insurance Authority.
The documents reviewed for this guide do not set out the full rules for every group, such as public sector employees, and we could not open the council’s own coverage pages. Employers with groups outside the cases above should check directly with the Council of Health Insurance, which holds the power to decide who must be covered.
What compulsory health insurance policies cover
The general benefit schedule for employees is set in the unified policy. The IA’s list of health insurance documents includes its benefits, but we could not open that document for this guide, so its limits are not quoted here. The domestic worker policy published by the IA shows how a standard compulsory policy is built, and its schedule is specific:
| Benefit | Limit in the domestic worker standard policy |
|---|---|
| Overall limit per insured person for the policy period | SAR 100,000 |
| Emergency cases | Up to the policy maximum, no copayment |
| Hospital admission, shared room | SAR 600 a day |
| Companion | SAR 150 a day |
| Ambulance transport | Up to SAR 1,000 |
| Medication | Up to SAR 10,000 |
| Return of remains | Up to SAR 10,000 |
| Outpatient care | Maximum of 4 visits, plus Ministry of Health preventive measures |
| Primary care copayment | 0% to 5%, capped at SAR 25 |
Emergency dialysis and injuries from traffic accidents are covered up to the policy maximum. Dental treatment, eyeglasses, and pregnancy and childbirth are excluded. The text reviewed does not state a deductible or any waiting periods.
Coverage of services outside hospital has been clarified this year. Gulf News reported, in an article last updated on 15 October 2026, that the Council of Health Insurance had confirmed that the mandatory health insurance policy “covers a range of home healthcare services” after discharge, naming urinary catheterisation, intravenous medication following surgery and post-operative wound care. The report did not give eligibility rules or an effective date. Our report on the home care clarification sets out what was and was not published.
CCHI provider accreditation and claims rules
For hospitals and clinics, the Council of Health Insurance’s most important retained power is “accrediting and qualifying healthcare providers to deliver services to CHI beneficiaries”, together with supervising those providers. In the domestic worker standard policy, providers must be “approved by the Health Insurance Council”, and approved facilities form the insurer’s network; claims inside the network are settled directly between provider and insurer.
The same policy sets the clocks that drive a provider’s cash flow and a patient’s experience:
- pre-approval: the insurer must reply “within a period not exceeding sixty minutes from the time of requesting approval”;
- provider claims: service providers must forward expenses “within a period not exceeding 30 days”;
- member claims: the insured must submit a claim within 30 days of incurring it;
- reimbursement: the insurer pays the insured within 15 working days of the claim being submitted.
Those timelines apply to the domestic worker product. The equivalent rules in the main employee policy are in the unified policy, which we could not review. Provider accreditation criteria, fees and renewal periods were also not available on the pages we could open, so they are not stated here.
NPHIES: the platform CCHI still runs
NPHIES is the electronic exchange the council uses for health insurance transactions. Its 4 March 2024 announcement says the Council of Health Insurance “will continue operating NPHIES for health insurance transactions (SHIB)”, which keeps the data link between providers and insurers with the council rather than the IA. The announcement does not expand the acronym, and we could not open the NPHIES website for this guide, so transaction volumes, connected-facility counts and technical standards are not given here.
The commercial effect is visible in the vendor market. Some revenue cycle software sold to Saudi hospitals is marketed on NPHIES compatibility; Waseel, for example, says its revenue cycle product supports NPHIES integration, according to its profile in our Suppliers Guide. That is the company’s claim. For buyers, the point is that NPHIES conformance is set by the council, so buyers should check a vendor’s claims against the council’s requirements.
The IA’s Q1 2026 market report does not mention NPHIES; it supplements its health analysis with the IA’s own Insurance Data Hub, as set out below.
Insured population and premiums
The most recent official figures come from the IA. On 8 September 2026 the Insurance Authority reported gross written premiums of SAR 29.8 billion for the first quarter of 2026, up 14.4%, with health insurance recording the largest share: SAR 18.5 billion, or 62% of the market. It said “the number of beneficiaries reached 14.5 million”.
The IA market report for Q1 2026 shows how that figure has moved. Its figures need a caveat: the report says selected health insights on price, volume, cover mix and risk profile are supplemented by a sample-based Insurance Data Hub analysis, “suitable for directional market insight, but it is not yet a fully validated market-wide dataset”, and that some indicators may be provisional.
| Period | Active health insurance lives |
|---|---|
| 2021 | 9.8 million |
| 2022 | 11.9 million |
| 2023 | 12.1 million |
| 2024 | 13.1 million |
| 2025 | 14.5 million |
| Q1 2026 | 14.5 million |
The same report puts health gross written premiums at SAR 15.6 billion in Q1 2025 and SAR 18.5 billion in Q1 2026, an increase of SAR 2.9 billion that its bridge chart splits into SAR 1.5 billion from volume and SAR 1.4 billion from pricing. Average premium per life was SAR 3,558 in Q1 2026, against SAR 3,528 in 2025; the report says it “has increased only modestly”. The net combined ratio for health was 93.7% in Q1 2026, down from 96.1% at the end of 2025. Rolling 12-month health premiums reached SAR 50.6 billion.
The age mix is shifting. People aged 18 to 35 made up 35% of active lives in Q1 2026, up from 27% in 2022, while those aged 36 to 65 fell from 54% to 44%. Under-18s rose from 15% to 17% and over-65s fell from 5% to 4%.
The report says health “contributed the largest share of incremental growth” in the sector, and it links falling complaint rates in health, motor and domestic worker insurance to “the cumulative effect of regulatory interventions through 2025”. Health complaints fell from 10 to 8 per 10,000 policies in the quarter, and claims procedures and rejection of medical approval “continue to account for the large majority of customer complaints”, the report says.
The ambition is larger. The IA’s National Insurance Sector Strategy lists “expanding health insurance coverage to 23 million beneficiaries” among its strategic promises, and its health insurance programme has 11 initiatives, including strengthening how compulsory health insurance is implemented and reducing fraud, waste and misuse. The Q1 2026 report’s tracker for that promise shows 12 million health beneficiaries in 2023 and 14.5 million in Q1 2026 against the 2030 target of 23 million, and rates progress as “Approaching Pace”.
The strategy page lists what the 11 health insurance initiatives aim to do:
- develop the health insurance market and expand voluntary coverage;
- strengthen how mandatory health insurance is implemented;
- encourage innovation and long-term sustainability;
- improve beneficiary satisfaction;
- promote careful use of healthcare services and reduce fraud, waste and misuse;
- help employers, especially small and medium-sized firms, absorb insurance costs;
- expand vertical integration through regulatory reform and new supervisory tools.
Several of those aims fall partly on the council, which enforces compulsory cover and supervises providers, and partly on the IA, which supervises insurers. How the two divide the work on fraud and on employer costs is not spelled out on the pages reviewed.
What changed in 2025 and 2026
- 20 August 2026: the IA directed insurers to offer “a health insurance product without pre-medical approval requests for out-patient services”, as an additional option for employers and policyholders, available “starting from 1st November, 2026”. Customers refused the option after that date were told to complain to the IA.
- 8 September 2026: the IA published Q1 2026 figures showing health premiums of SAR 18.5 billion and 14.5 million beneficiaries.
- 15 October 2026: Gulf News, in an article last updated that day, reported the council’s confirmation that mandatory cover includes a range of home healthcare services after discharge.
- 1 November 2026: the IA’s board appointed Abdulaziz Ibrahim Alnowaiser as chief executive, succeeding Eng. Naji AlFaisal AlTamimi, effective that day.
The outpatient product is the change with the most direct effect on providers. It removes pre-approval requests for outpatient services in the policies that include it, taking away one of the insurer’s controls before treatment, in a market where rejection of medical approval is one of the two largest complaint types in the IA’s Q1 2026 data. The IA said the product is an additional option; how many employers choose it will decide its effect on clinic workflows and claims patterns.
What it means for providers, insurers and employers
For hospitals and clinics that dealt with CCHI as a single regulator, there are now two counterparties. Accreditation to treat insured patients, supervision as a provider and the NPHIES connection run through the Council of Health Insurance; disputes with insurers and sector conduct run through the IA. Revenue cycle teams need contacts at both.
For insurers, the IA is the prudential and conduct regulator, while the council still defines the compulsory market by deciding who must be covered and which providers can serve them. Health accounted for 62% of premiums in Q1 2026, so changes at either body move the largest line in the sector. Related coverage: Aon’s 2027 medical cost forecast for the Gulf and Gulf Union Alahlia’s renewal of a corporate health contract.
For employers, the compulsory health insurance obligation is set out plainly in the IA FAQ: insure Saudi and non-Saudi employees and covered dependants. Households with more than four domestic workers have their own compulsory product. The new outpatient option without pre-approvals, available from 1 November 2026, is a choice employers can now ask insurers for.
For investors, the 14.5 million figure and the 23 million strategy target frame the growth case, and the flat count between 2025 and Q1 2026 shows how far the market has to move. Premium growth in Q1 2026 came roughly equally from volume and pricing, according to the IA, and the report says premium-per-life growth needs to be monitored against medical inflation and utilisation.
What to watch next
- Uptake of the outpatient product without pre-approvals from 1 November 2026, and any IA data on complaints about refusals.
- Further IA quarterly reports, which will show whether active lives move beyond the 14.5 million recorded for 2025 and Q1 2026.
- Any update to the unified compulsory policy or to the benefit schedule, including how home healthcare services are covered and who is eligible.
- Council of Health Insurance changes to provider accreditation or to NPHIES requirements, which would affect hospital systems and vendors.
- Whether the remaining overlap on complaints between the council and the IA is formally settled.
We log Saudi payer decisions on The Tracker. Corrections to this CCHI guide can be sent through our contact page.
Questions readers ask
What is CCHI called now?
The council's English announcement of 4 March 2024 uses the name Council of Health Insurance and the abbreviation CHI, as do the Insurance Authority's FAQs. A Ministry of Health release of November 2012 used the former name, Council of Cooperative Health Insurance (CCHI). The official pages reviewed for this guide do not record the date or the instrument of the renaming, so neither is given here.
Is health insurance compulsory in Saudi Arabia?
For private sector employees, yes. The Insurance Authority's FAQ says private sector employers must insure all their Saudi and non-Saudi employees and their family members covered by the system, listing spouses, sons until age 25, unmarried non-working daughters and orphans fostered by insured families. A separate compulsory standard policy applies to employers with more than four domestic workers.
Who regulates health insurance companies in Saudi Arabia?
The Insurance Authority. Its FAQ says all health insurance-related mandates transferred from the Council of Health Insurance to the IA effective 4 March 2024, and that the IA became the authorised regulator of the insurance industry from 23 November 2023. Health insurance complaints go to IA Care. Existing laws and regulations stay in effect until further instructions.
What does the Council of Health Insurance still do?
According to its announcement of 4 March 2024, the council keeps enforcing compulsory health insurance, determining who must be covered, accrediting and qualifying healthcare providers, and operating NPHIES for health insurance transactions. It also receives complaints and inquiries about compulsory health insurance and supervises healthcare providers. Other health insurance sector roles moved to the Insurance Authority.
How many people have health insurance in Saudi Arabia?
The Insurance Authority said on 8 September 2026 that health insurance beneficiaries reached 14.5 million in the first quarter of 2026. Its market report shows active lives rising from 9.8 million in 2021 to 14.5 million in 2025 and Q1 2026. The National Insurance Sector Strategy aims to expand coverage to 23 million beneficiaries.
Do employers have to insure domestic workers in Saudi Arabia?
Employers with more than four domestic workers must buy the compulsory standard policy published by the Insurance Authority. It covers the fifth worker and those after, starts from the issue or renewal of the worker's residency and has an overall limit of SAR 100,000 per insured person for the policy period. Dental care, eyeglasses and pregnancy are excluded.
What changed for outpatient pre-approvals in November 2026?
On 20 August 2026 the Insurance Authority directed insurers to offer a health insurance product without pre-medical approval requests for outpatient services, available from 1 November 2026. It is an additional option for employers and policyholders, not a replacement for existing products. The IA told customers to complain if an insurer refuses to provide the option after that date.
Sources
Announced plans, figures and dates are as stated in the sources below at the time of publication and can change. Conclusions drawn from them are our reading.
- Council of Health Insurance: announcement on transferring roles and responsibilities of the health insurance sector to the IA (4 March 2024)
- Insurance Authority: FAQs
- Insurance Authority: SAR 29.8 billion in gross written premiums in Q1 2026 (8 September 2026)
- Insurance Authority: health insurance product without pre-approvals for outpatient services (20 August 2026)
- Insurance Authority: Abdulaziz Alnowaiser appointed CEO of the Insurance Authority (1 November 2026)
- Insurance Authority: Saudi Arabia Insurance Market Pulse Q1 2026 (PDF, September 2026)
- Insurance Authority: quarterly publications
- Insurance Authority: standard policy of the compulsory health insurance for domestic workers (more than 4) (PDF, 27 August 2024)
- Insurance Authority: regulations list
- Insurance Authority: National Insurance Sector Strategy
- Insurance Authority: about the Authority
- Insurance Authority: health insurance laws, regulations and circulars (document list)
- Ministry of Health: Meeting of the Council of Cooperative Health Insurance held under Dr. Al-Rabeeah's chairmanship (27 November 2012)
- Gulf News: Saudi Arabia's mandatory health insurance covers home healthcare services for patients (Last updated 15 October 2026)
Follow The Healthcare Daily on Google News
New stories appear where you already read the news.
The Healthcare Daily. We report from primary sources and list them on every story.
