Summary of the Complaint Against Amanah Insurance Group

Subject: 3rd Formal Complaint Regarding Negligence, Miscommunication, Non-Approval, and Poor Service

Complaint Highlights:
1. Misinformation and Negligence:
• Policyholder Khalid Mehmood Khattak (Resident ID: 2389134814) reported his wife’s pregnancy during policy initiation, but Amanah failed to disclose pregnancy-related coverage exclusions.
• Critical tests and hospital services were denied, citing pregnancy exclusions, despite prior approval assurances.
2. Delayed Approvals and Cancellations:
• Hospital admissions were initially approved but later canceled mid-treatment, leading to life-threatening risks for the insured’s wife and child.
• Delayed approvals violated the 60-minute approval rule stipulated in Article 14 of the Cooperative Health Insurance Law.
3. Financial Burden:
• The policyholder paid SAR 23,000 and was billed SAR 19,119 for denied services, despite Amanah’s responsibility.
• Due to Amanah’s actions, the insured was forced to seek government hospital services and bear delivery expenses out-of-pocket.
4. Violation of Regulations:
• Breached multiple articles of the Cooperative Health Insurance Law (Articles 8, 11, 14, and 21) and Saudi Civil Transactions Law (Articles 1, 82, 84, and 206).
• Negligence and failure to provide timely and accurate information caused severe emotional, financial, and physical harm.

Demands:
1. Amanah must cover all pending claims, including the Mowasat hospital bill (SAR 19,119).
2. Compensation of SAR 1,000,000 for emotional distress, financial losses, and health risks caused by Amanah’s negligence.
3. Disciplinary action against Amanah for non-compliance and mistreatment of policyholders.
4. Accountability for delays, miscommunication, and violations of legal obligations.

The policyholder urges SAMA and CHI to ensure justice and impose penalties on Amanah for their actions.