"Article 36 :(a) The health insurance premium shall be determined by agreement between the insurance company and the employer.
(b) The insurance company, when determining insurance premiums, shall comply with the following:1. Rates must be in line with average health insurance market rates.
2. The policy rate must not cause any decrease or increase in the rates of products of the insurance company as approved by SAMA.
3. The policy value must be technically justifiable on objective bases and may not in any case be less than the actual cost of the policy and associated ordinary or possible treatment costs.4. The insurance company may not rely solely on rates applied by other companies to determine the insurance premium.
(c) The maximum benefit under the policy for each beneficiary shall be five hundred thousand Saudi riyals only."
Article 37 :An employer shall undertake to pay the insurance company he selected the premiums for his employees and their dependents. The employer shall be solely responsible for the payment of premiums at the beginning of each insurance year unless there is an agreement on scheduling the premiums. Individuals residing in the Kingdom who do not meet the definition of “employee” shall be responsible for the payment of health insurance premiums for themselves and their dependents.
Article 38 :If premiums are not paid on the dates agreed upon, the insurance company may cancel the policy and shall notify the General Secretariat, PPN Network and policyholder accordingly.
Article 39 :Charges collected by the Council for overseeing the application of the Law shall be one percent (1%) of the total subscribed health insurance premiums collected by the accredited insurance companies in accordance with the audited financial statements of the previous year, provided that such percentage be reviewed in coordination with SAMA.
Article 40 :A cooperative health insurance fund shall be established to cover expenses exceeding the insurance coverage specified under the insurance policy. Affiliation of said fund as well as its procedures and controls including its financing and determination of beneficiaries thereof shall be determined in coordination between the Council and SAMA.
"Article 41 :Expenses of the Council shall be financed by revenues generated from the application of the Law in accordance with Article 6 of the Law. Such revenues shall be as follows:
1. Charges for accreditation and annual renewal of accreditation of insurance companies.2. Charges for accreditation and annual renewal of accreditation of TPAs.
3. Charges for annual accreditation of governmental and non-governmental healthcare service providers.
4. Charges collected by the Council for overseeing the application of the Law at the rate of one percent (1%) of total premiums collected by the accredited insurance companies in accordance with the audited financial statements of the previous year.
5. Fines payable to the Council which are imposed by the Committee for Violations of the Cooperative Health Insurance Law as specified in Article 14 of the Law.
6. Donations, grants and investment revenues.
7. Revenues collected from other sources such as the issuance of magazines, booklets as well as training and consultation services provided by the Council."
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