This slide provide basic idea regarding Do's & Dont's of Dental Services under health Insurance in Kingdom of Saudi Arabia

2. Insurance Perspective of
Dental Treatment in KSA
By: Dr Wasim Reza, BDS, MHA,
Specialized Diploma in Health Insurance
E-mail : lwreza@gmail.com

3. General Rules
• Write Detailed History and Justify the Line of treatment
• The History Should Reflect
• Chief Complaint
• Finding of Oral Examination
• Radiological finding
• History of Chronic disease if Any
• Mention Correct Tooth Number (Universal/FDI Numbering System)
• D-CAF with Detailed history is required when Dental Service is billed

4. Health Insurance – Why???
• To reduce the Morbidity & Mortality
• Standard Dental Health Insurance Policy is designed by CCHI
• Additional services above standard basic requirement is called Riders
and varies with policies
• CCHI declared some the Dental Service Under Standard exclusion
** CCHI (Council of Cooperative Health Insurance) the regulator of
Health Insurance in Kingdom

5. Standard Exclusions – Major Area
• Preventive Treatment
• Cosmetic treatment
• Developmental Disorder
• Congenital Weakness or Deformity
• Any treatment not related to Morbidity or Mortality

6. Standard Exclusion – Dental Services
• Oral Prophylaxis considered as preventive measure
• Scaling & Polishing {Some Policies Covers as Rider}
• Dental Prosthesis
• Dental Implants
• Crown & Bridges
• Orthodontic treatment
• Bleaching
• Composite filling if Cosmetic in nature
• Development Disorder unless life threatening

7. Standard Coverage – Dental Services
• Condition related to Morbidity & Mortality
• Root Canal Treatment
• Filling or Restoration
• Amalgam Filling
• Composite filling (Non- Cosmetic in nature)
• Dental Extraction
• Treatment of Gingivitis
• Abscess Treatment
• Gum Treatment (Excluding Scaling & Polishing)
• Curettage

8. Standard Rules
• Pre-Authorization is mandatory for dental treatment & medicine
• One RCT / Surgical Extraction in One Follow-up Period
• Two Fillings in One Follow-up period
• Two Simple Extraction in One Follow-up Period
• Two fillings / SE should be done in One Sitting
• Approval, Billing & Service Delivery preferably Should be on Same Day
• Same Medicine Should not be dispensed within 7 days
• Extraction within 6 month of RCT is not allowed in General