SME Health Insurance
General Questions
What is tree SME Health Insurance?
tree SME Health Insurance is a cooperative health insurance policy that covers employees and their dependents, while helping your company comply with health insurance regulations in Saudi Arabia, with flexible plans that suit your needs and budget.
Is this insurance mandatory for my company or establishment?
Yes, it is mandatory. In accordance with the Council of Health Insurance (CHI) regulations, all private sector establishments are required to provide health insurance for all their employees and their eligible dependents.
Who is covered under the establishment’s insurance?
Coverage includes:
The employee
Spouse(s)
Sons (up to 25 years of age)
Unmarried daughters
When does coverage begin and become active for employees?
Coverage begins on the activation date specified in the policy, which takes effect once payment is completed and employee data is entered into the system
What is the policy duration for establishment insurance?
The policy duration is one full year (12 months), renewable annually upon mutual agreement.
What categories and tiers are available for companies?
We offer more than 10 different medical tiers to ensure you find the right coverage that suits your employees' needs and fits your company budget.
How do the tiers and plans differ from one another?
Each category or plan offers different options regarding: the available network of hospitals and clinics, the deductible amount (copayment paid by the employee at the clinic), and additional benefits.
Coverage Basics
What are the geographical coverage limits for the plans?
All plans cover medical treatment within Saudi Arabia. As for the higher-tier plans, they provide your employees with coverage for medical emergencies outside the Kingdom up to specific limits.
What is the annual coverage limit per individual?
The annual coverage limit is SAR 1,000,000 per insured person across all plans, in accordance with the Council of Health Insurance (CHI) regulations.
What are the basic medical services covered?
All plans cover the following essential services within specific sub-limits for each category: outpatient visits and consultations, hospital admissions and surgeries, prescribed medications, lab tests and X-rays, pregnancy and maternity, vaccinations, as well as dental and optical care.
Does SME insurance cover maternity and pregnancy expenses?
Yes, maternity is covered for female employees and spouses of employees. Financial sub limits vary based on the selected plan, and any pregnancy related complications are covered under the total annual policy limit.
Are dental and optical coverages included for employees?
Yes, they are included up to annual sub-limits that vary by plan. Please note that cosmetic procedures (such as teeth whitening or LASIK) are excluded.
Claims & Changes
Can I assign different plans and tiers to different employees within the same company?
Yes, you can customize the plans and assign specific tiers to individual employees or groups based on their job grades or your company preferences.
Can I upgrade an employee's tier or add a new employee while the policy is active?
Yes, you can add or remove employees or upgrade any member's tier via the digital "Policy Management Platform." Access details will be sent to your designated insurance administrator upon policy issuance.
Can I add new dependents for an employee (such as a new spouse or newborn) during the policy term?
Yes, easily via the Policy Management Platform. For marriage: update the details and add the spouse. For newborns: the baby is automatically covered for the first 30 days from birth, and must be officially registered on the platform within this period to maintain continuous coverage.
How is the insurance premium calculated and determined for the company?
The price depends on three main factors: the total number of employees and dependents, their ages, and the selected medical tiers for each.
What payment methods are available?
We offer multiple flexible payment options suited for businesses: SADAD, Apple Pay, and credit cards.
How can an employee use the insurance and receive medical treatment?
Once the policy is issued and linked with the Council of Health Insurance (CHI) system, the employee can visit any medical facility within their approved network and show their ID to receive immediate care.
Is treatment outside the approved medical network covered?
The policy covers treatment outside the network for emergency cases only.
Cancellation & Renewal
Can I cancel the company insurance policy?
Yes, you can cancel the policy provided you submit a written notice 30 days prior to the intended cancellation date.
Can I change employee tiers and plans upon policy renewal?
Yes, during annual renewal, you can adjust tiers, modify plans, and reconfigure your overall coverage options based on your updated requirements.
How can I contact tree team?
You can contact us anytime through our website or by calling our Customer Care team at 8001240505. You can also find all our contact channels on our Contact Us page.