How does the Saudi health insurance system operate? Classify the answer into three parts: 

– Specify the inputs including, health insurance, providers, CHI, SAMA, and others. Explain each essential role in monitoring the system. 

– Identify the major process steps in micro levels including claim management, UCAF process, copayment, and others. 

– Health insurance impact on access to care, equity, quality of life, quality of care and methods to improve the Saudi health insurance. 

Note:

1. Draw a process chart to identify the vital key players in the health insurance system. 

2. Use the correct health insurance terminology.

3. Give clear examples and thoroughly criticize the steps to improve the services provided to the customers.

2nd Question: 

You are a health insurance specialist, and you have been requested to issue a unified health policy for a company with the following details:

1. The insured staff is expected to be 1500, aged between 25-55 and one third is female.

2. The scope business of the company in logistics in Saudi Arabia and the GCC.

3. There are less than1% of the insured in executive positions, but the majority is labor.

Based on the above data, can you issue a health policy insurance for NAQEL LOGISTICS COMPANY? The policy holder would like the policy to commence on 1 May 2022 with the lowest price. Bear in mind that such policy is on an alignment with the UNIFIED POLICY issued by CHI.

Make real health policy with its benefits. 

3d Question:

Suppose that under your health insurance policy, hospital expenses are subject to a $1,000 deductible and $250 per day copay. You get sick and are hospitalized for 4 days, and the bill (after insurance discounts are applied) comes to $6,000. How much of that hospital bill will you have to pay yourself?

A. $ 0

B. $ 1000

C. $ 2000

D. $ 4000

Explain in details why do you select your answer. Identify all definitions related to the term moral hazards in risk reduction in this context. Which one may suite the Saudi system? Why?