Insurance

1. What is the role of the General Department of Insurance Control at SAMA?

The Cooperative Insurance Companies Control Law issued by Royal Decree No. M/32 dated 02/06/1424H entrusted SAMA with regulating and monitoring the insurance market in Saudi Arabia and supervising companies operating in the sector. Therefore, SAMA has designated the General Department of Insurance Control to achieve this goal.

 

2. Where can information on Saudi Arabia’s insurance sector be found?

SAMA is the main source of information about the insurance market in Saudi Arabia, and it has all available information about insurance, specifically in the Publications section of its website.

 

3. What is the aim of cooperative insurance?

Cooperative insurance aims to provide the insured with protection against potential risks and bring the insured back to their position before the risk occurred through mutual cooperation among a group of insureds.

 

4. What does insurable interest mean?

It is the legal right of a natural or legal person to have insurance coverage on any of their properties (e.g. a car), provided that a legal relationship must exist between the insured and the subject matter of insurance. An example of legal relationships is “ownership”; a person has the right to have insurance on items they own, whereas they cannot have insurance on any item belonging to any other person because there is no insurable interest.

 

5. What is a deductible (copayment)?

It is an amount specified in the policy schedule and paid by the insured in case an accident or risk falls within the coverage limits of the insurance policy is incurred. For example,  if a car accident with a SAR 5,000 cost of repairs occurs and the deductible amount is SAR 1,000, the insurer bears SAR 4,000 and the insured bears SAR 1,000.

 

6. What are coverage limits?

They are the maximum limits of coverage provided by an insurer as specified in the policy schedule before applying any deductibles. For example, the maximum limit in accordance with the coverage limits of the motor insurance policy is SAR 5,000,000 (five million Saudi riyals) for material damage and SAR 5,000,000 (five million Saudi riyals) for physical damage, and any amounts exceeding these limits of coverage should be borne by the insured

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  Motor Insurance

 

7. What is a compulsory motor insurance policy?

A compulsory motor insurance policy covers the damage caused by your vehicle to a third party (both individuals and properties). It does not cover the damage inflicted on you or your vehicle. For example, if you have been in an accident, and the accident is 100% your fault, the insurer will compensate the third party in that accident against all the damage they suffered, but the insurer will not compensate you for the damage inflicted on you or your vehicle.

 

8. What is a comprehensive motor insurance policy?

A comprehensive motor insurance policy has two parts. The first part covers damage suffered by the insured, the insured vehicle (the vehicle is covered against fire, theft, and incidental accidents) and other passengers. The second part covers damage incurred by a third party (both properties and individuals). For example, in case of an accident involving two vehicles, the comprehensive motor insurance policy will cover all the damage you caused or incurred in accordance with the agreed terms and obligations in the policy. The insurer will pay all costs of repairing your vehicle, repair and compensate the third party for the damage that you caused.
The comprehensive insurance coverage can be extended for an additional premium to include the following:
a. Rental of an alternative vehicle for the insured during the period of repairing the damaged vehicle.
b. Roadside assistance.
c. Repair of the damaged vehicle in its main service center or one of the workshops.

 

9. What are the things that you should check when purchasing a comprehensive motor insurance policy?

-Coverage Limits:

The amount of coverage stated in the policy or the vehicle’s market value at the time of the accident, whichever is lower, represents the insurer’s maximum liability for compensation. It is important that you report the actual value of your vehicle to the insurer when applying for an insurance policy and at the time of renewal of the policy and to be precise about the value as the main objective of an insurance policy is compensation.

-Percentage of Depreciation:

The principle of depreciation applied to the insured item refers basically to the principle of compensation, which aims at restoring the insured to the same financial position prior to the loss. This method is used widely by insurers as a means to compensate for the actual value of the damage incurred, taking into consideration the lifespan of the depreciated spare parts. For example, if a vehicle had an accident after six months of insurance and was totally wrecked, and its value was SAR 100,000 at the time of purchasing the insurance policy, the insurer will not reimburse the insured for the whole amount but will consider the depreciation amount of the vehicle for six months and deduct that amount from the reimbursement amount.

-No Claim Discount (NCD):
Some insurers offer this discount by which insurance premiums are reduced to the insured for the next year due to having a claim-free and accident-free record over the previous insurance year. This offer encourages insureds to avoid motor vehicle accidents. On the other hand, some insurers raise the insurance premium for the new insurance year if a claim was submitted to the insurer during the previous insurance year.

10. What are the supporting documents for a claim of motor insurance?

To file a claim, the insured should have documents indicating the validity of the insurance policy and the accompanying circumstances of the accident subject of the claim. In addition, the insured should provide the accident report issued by the General Department of Traffic and any other documents the insurer may require, including:

 – Driving license.
 – Vehicle registration.
 – Insurance policy.

 

11. What are the exclusions of motor insurance?

The insured should be aware of the cases involving an accident that is excluded from the insurance coverage, and the insurer is not liable for indemnifying the insured for the damage caused to their vehicle as a result of such accident. Such cases are included in the policy under “Exclusions” or “Exclusions from the Coverage Limits” or “General Exceptions.” For example:
 – Disaster risks.
 – Risks resulting from driving a vehicle by a person under the age of 18.

 

  Property Insurance

 

12. What are the types of property that can be insured?

 

This type of insurance covers potential risks to private property, including factories, companies, goods and warehouses, as it is insured against any disaster such as fire, lightning, etc.

 

Insurable property can be divided into three categories:
a. Buildings: the structure of the building and its attachments.
b. Machinery and other contents: all the building contents except stock that might be stored in the storehouse or the building.
c. Stock: all items in the custody of the insured whether owned by the insured or not, and the items and goods kept by an entity whether it owns them or not.

 

13. What are the coverage limits of property insurance?

 1. The coverage of the insured item(s) whether it is real estate or a movable asset against risks (e.g. fire, theft, pipe cracks, natural hazards, etc.)
2. Contents of the item(s) insured.
3. Personal liability.
4. Legal liability against death cases and casualties caused by unforeseen accidents to the insured property.
5. Rent loss for the landlord owing to the real estate’s unsuitable condition arising from a defect or risk covered by insurance according to the insurance policy.
6. The cost of an alternative accommodation while the damaged real estate is being repaired.

 

14. What are the excluded risks of property insurance?

a. Damage caused by riots and civil disturbances unless it was agreed to be added in the insurance policy.
b. Damage resulting from wars, whether declared or not.
c. Damage caused by radioactive contamination, whether it is the direct cause or not.
d. Injuries or death caused by pollution.
e. All types of consequential losses.
f. Terrorism risks.
g. Damage ensuing from maritime risks if its exclusion has been clearly stated in the insurance policy.

 

Medical Insurance

 

15. What is meant by medical (health) insurance?

Medical (health) insurance  provides coverage for medical treatment costs, medications, and medical and therapeutic services and supplies as well as management of medical programs.

 

16. What is meant by the “benefit brought to the insured” in medical (health) insurance?

It refers to the costs of providing health services covered by the insurance within the limits set out in the policy.

 

17. What is meant by “base of direct entry” or “in the company’s account” in medical (health) insurance?

It refers to the facilities of no-payment appointed by the company and available for the insured. All expenses incurred at these facilities are directly debited from the company’s account.

 

18. What does a “service provider” mean in medical (health) insurance?

It is the person or health facility which is accredited and licensed according to applied regulations to provide medical services in Saudi Arabia, e.g. hospitals, diagnosis centers, clinics, pharmacies, laboratories and physiotherapy or radiotherapy centers.

 

19. What is meant by the “service providers’ network” in medical (health) insurance?

It is a group of health service providers accredited by the Council of Cooperative Health Insurance (CCHI) and specified by the insurer to provide the service for its policyholders. These service providers will directly debit expenses from the insurance company’s account when the policyholder presents a valid insurance card.

 

20. What are the supporting documents for a claim of medical (health) insurance?

The insured should have all documents proving their age, nationality and identity, validity of the policy, accompanying circumstances of the subject of the claim and incurred expenses in addition to the following documents: Invoices, receipts, prescriptions, medical reports, referrals, recommendations and any other original documents that may be required by the insurer.

 

21. What diseases and cases do insurers usually exclude from the coverage of medical (health) insurance?

1. Cosmetic surgeries except those required for correcting deformities ensuing from an accident.
2. Chronic diseases suffered prior to entering into the insurance contract, such as diabetes.
3. Routine medical check-ups for employment or travel.
4. Steroids and vitamins.

 

22. Does the insured bear a proportion of the cost of healthcare treatment or does the insurer bear the whole costs?

It depends on the type of policy; some policies do not require the insured to bear any part of the costs while others stipulate paying a specific portion of the costs based on the insurer’s agreement with the insured. In general, the value of the insurance policy providing full coverage for medical costs is higher than the one that provides partial coverage for medical costs.

 

Protection and Savings Insurance

 

23. What does protection and savings insurance mean?

It is a contract by which the insurer assumes to pay to the insured sums of money, including savings proceeds, on a future date in exchange for premiums paid by the insured.

 

24. What are the types of protection and savings insurance?

There are several types of protection and savings insurance, such as:
 Protection insurance: it covers risks related to death and permanent or temporary, total or partial, disability for individuals and groups.
 Protection and savings insurance: it involves insurance policies under which the insurer pays an amount or amounts, including savings proceeds, on a future date in return for premiums paid by the insured.

 

Regulation

 

25. What are the prevailing insurance laws and regulations in Saudi Arabia?

In Saudi Arabia, the insurance legal framework is composed of:

– The Cooperative Insurance Companies Control Law (click here)

– The Implementing Regulations (click here)

– Topic-specific regulations, e.g. Insurance Market Code of Conduct, Risk Management Regulations, Anti-Fraud Regulation, Rules Governing Anti-Money Laundering and Combating Terrorist Financing, Audit Committees Regulations for Insurance and/or Reinsurance Companies, and all other circulars and instructions issued by SAMA

 

26. Who defines the regulations about insurance and how?

SAMA sets all topic-specific regulations, circulars and instructions about insurance. This process consists of three steps:

– SAMA identifies the need to set a new regulation.

– SAMA drafts the regulations and posts them for public consultation on its website (for 20 to 60 days). During that time, professionals and the public are invited to comment on the new regulations.

– SAMA reviews the comments received and then updates and publishes the regulations on its website.

 

Licensing

 

27. What is the process to obtain an insurance and/or reinsurance license?

The insurance and/or reinsurance licensing process entails five main steps, namely application submission, file review, Royal decree issuing, IPO and license issuing. The process can take up to 16 months, depending on the content.

Step 1: Application Submission

Step 2: File Review

Step 3: Royal Decree Issuing

Step 4: Initial Public Offering (IPO)

Step 5: License Issuing

 

28. What are the required documents when applying for a license?

There are 8 supporting documents to be submitted along with the application for an insurance/reinsurance company license or an insurance/reinsurance service provider license:

1.       Completed license application form

2.      Memorandum of association

3.      Articles of association

4.      Organizational structure

5.      Feasibility study

6.      Five-year operation plan that includes the following as a minimum:

– Insurance types which the company intends to practice

– The ability to accept re-insurance agreements for the types to be reinsured

– Product marketing plan

– Expected costs of starting the business and the necessary funding sources

– Expected business growth rates taking into consideration the solvency margin requirements

– Expected number of staff and the employment/qualification plan in Saudi Arabia

– Annual expenses based on the expected business growth rates

– Estimated financial statements linked to growth expectations

– Statement of the technical basis of the insurance operations and a certificate from an actuary confirming that the basis, advantages and restrictions of insurance operations are sound and enforceable

– Branch distribution and business plan

 

7. Any agreements with other parties

8. Irrevocable bank guarantee for an amount equivalent to the required capital in favor of the agency, provided that the guarantee is issued by a local bank and renewable automatically until the capital is fully paid.

 

29. Can SAMA revoke the license of an insurance/reinsurance company or service provider?

Yes, SAMA can revoke the license of any insurance or reinsurance company or service provider. You can find details of the cases in the Implementing Regulations of the Cooperative Insurance Companies Control Law.

 

30. What is the process to obtain a license for service providers?

There are four steps to obtain a license for insurance and/or reinsurance service providers, namely application submission, file review, commercial registration issuing, and license issuing.

 

Step 1: Application Submission

Step 2: File Review

Step 3: Commercial Registration Issuing from the Ministry of Commerce

Step 4: License Issuing

 

31. Which companies are licensed to operate in Saudi Arabia?

To obtain the full list of companies licensed to operate in Saudi Arabia, click here or visit the “Licensed Companies” section.

 

Product Approval

 

32. What is the “File and Use” approval?

There are two types of insurance product approvals, namely “File and Use” and permanent approvals.

– The General Department of Insurance Control grants the “File and Use” approval, a form of temporary approval, when the complete product approval application is submitted. During the “File and Use” approval, the Department reviews the product to decide whether to permanently approve it or decline it. This approval excludes medical expenses, motor, and all protection and savings products, except for employer-sponsored group life insurance.

– When SAMA grants the insurance company a permanent approval, the insurer can permanently advertise and market the product in the Saudi market.

 

33. What is the process to obtain SAMA’s approval on a new product?

The product approval process consists of three steps, namely: product approval application submission, application review, and product approval/rejection.

 

Step 1: Product Approval Application Submission

The application must be submitted to the General Department of Insurance Control in hard and soft copies, in both Arabic and English languages, in addition to the following necessary documents for approval:

– Application form

– Insurance policy wording and annexes

– Insurance policy schedule

– Reinsurance treaties

Step 2: Application Review

SAMA will contact the insurance company to obtain other documents and information.

Step 3: Product Approval/Rejection

After the review is complete, SAMA notifies the insurance company of the permanent approval/rejection of the product.

 

34. What is the expected timeline to obtain approval of a product?

There is no specific timeline to approve a product; it depends on the type and complexity of the product.

 

35. What criteria are assessed to approve a product?

The supervisors in the General Department of Insurance Control ascertain that the products comply with the insurance law, implementing regulations and other regulations of SAMA.

 

36. Should all products be approved before marketing?

All insurance products must have a permanent or “File and Use” approval before they are marketed.

 

Supervision

 

37. What is the supervision process?

The supervision process of the General Department of Insurance Control consist of four activities, namely: continuous monitoring, compliance assessment, off-site examination, and on-site inspection.

– Continuous monitoring includes financial monitoring which measures the Saudi insurance market strength in addition to complaint analysis which assesses insurance companies’ conduct towards the insured.

– The compliance assessment measures companies’ compliance with the insurance law and SAMA regulations.

– Off-site examination helps in developing the risk profile of regulated entities.

– On-site inspection helps in completing the risk profile of regulated entities by visiting the company’s premises.

 

38. Is the activity of companies regularly reviewed? How often is an assessment carried out?

The supervisors in the General Department of Insurance Control review the activity of regulated entities regularly:

 

– Financial strength is measured throughout the year.

– Off-site examination and compliance assessment are conducted annually.

– On-site inspection is conducted periodically.

 

39- Which entity is responsible for supervising insurance and reinsurance companies?

 It is the responsibility of SAMA, represented by the General Department of Insurance Control.

 

Financial Reporting

 

40. What is financial reporting and why is it important?

Financial reporting is the provision of financial information to the General Department of Insurance Control for review and analysis. It allows the Department to measure the strength of the Saudi insurance market.

 

41. Which companies are required to submit financial statements to SAMA and how often?

 

Licensed insurance companies are required to submit the following to SAMA:

– Annual and quarterly audited financial statements for SAMA’s approval before publishing them

– Monthly, quarterly and annual supervisory data using the financial reporting forms

 

42. Where can a company find the latest version of the financial reporting form to submit it to SAMA?

To obtain the latest versions of the financial reporting forms, click here or visit the Forms page.

 

43. What accounting standards are followed in the financial reporting forms?

The forms were developed in accordance with the International Accounting Standards (IAS) and the Implementing Regulations of the Cooperative Insurance Companies Control Law.

 

              

Complaint Handling

 

44. How fast are insurance/reinsurance companies and service providers are in responding to policyholders’ complaints?

Insurance/reinsurance companies and service providers are required to respond to policyholders’ complaints within 15 days from the date of receiving the complaint pursuant to Article 45 of the Implementing Regulations of the Cooperative Insurance Companies Control Law.

 

45. What is the process to file a complaint against an insurance company or service provider?

The complainant should visit the website of the General Secretariat of the Committees for Resolution of Insurance Disputes and Violations (www.idc.gov.sa) or call the toll-free number 8001240042 during official working hours (08:00 am to 04:00 pm) from Sunday to Thursday. We are pleased to receive any suggestions or complaints about the work of the General Secretariat on the Email address (Ins.disp@idc.gov.sa). Please note that you have to attach the required documents for motor insurance complaints (click here) and non-motor insurance complaints (click here) and fill out the claim form (click here).

 

46. What information should be provided when filing a complaint against an insurance company or service provider?

The complainant should explain the circumstances that led to filing the complaint against the company and provide supporting evidence (if available) as well as details of the insurance policy number and contact information.

 

47. How can I follow up on a complaint filed with SAMA?

The complainant can follow up on their complaint by contacting the Committees for Resolution of Insurance Disputes and Violations.

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