How to File a CCHI Complaint in Saudi Arabia for a Denied Insurance Claim

The Council of Cooperative Health Insurance (CCHI) is Saudi Arabia's primary regulator for health insurance. Established under Royal Decree No. M/10 of 1999, the CCHI licenses insurers, sets mandatory benefit standards, and — most importantly for policyholders — operates a formal dispute resolution process for health insurance complaints.

If your insurer in Saudi Arabia has denied a claim and your internal appeal has failed, the CCHI complaint process is your most direct and effective recourse.

What the CCHI Regulates

The CCHI oversees all private health insurance activity in Saudi Arabia under the Cooperative Health Insurance Law. This covers:

• All licensed cooperative health insurers operating in Saudi Arabia (Tawuniya, Bupa Arabia, MedGulf, Malath, GIG Gulf Saudi, and 20+ others)
• Third-party administrators (TPAs) that process claims on behalf of insurers
• Employer compliance with mandatory insurance obligations for non-Saudi workers

The CCHI does not regulate motor, property, or life insurance — those fall under the Saudi Central Bank (SAMA). But for health insurance disputes, the CCHI is the first and most powerful regulatory body to approach.

Who Can File a CCHI Complaint?

Any person covered by a CCHI-regulated health insurance policy can file a complaint. This includes:

• Saudi nationals with private supplementary health insurance
• Expatriate workers whose employers are required by law to insure them
• Dependants (spouse and children) covered under a family or group plan
• An employer disputing incorrect charges levied by an insurer

Crucially, expatriates can file CCHI complaints — the process is accessible in Arabic and English and does not require a Saudi national ID number.

Step 1: Exhaust the Insurer's Internal Process

The CCHI expects policyholders to attempt direct resolution with the insurer first. File a written complaint with your insurer and keep documented records of the response (or non-response). Give the insurer at least 10 to 15 working days to respond. If they uphold the denial or fail to respond, proceed to the CCHI.

Step 2: Prepare Your Evidence

A strong CCHI complaint file contains:

• The insurer's denial letter with the reason code and specific policy clause
• Your policy certificate and schedule of benefits
• Your Iqama (residency permit) or national ID
• Your insurer's internal complaint correspondence
• The treating physician's medical report, diagnosis, and clinical notes
• All invoices, receipts, and hospitalisation summaries
• Any pre-authorisation correspondence
• Supporting clinical literature (optional but helpful for necessity disputes)

Step 3: File the CCHI Complaint Online

The easiest and fastest method is the CCHI electronic complaints portal:

1. Go to cchi.gov.sa
2. Navigate to e-Services → Complaints and Suggestions (شكاوى ومقترحات)
3. Register for a CCHI account or log in with your Absher/National Access credentials (Saudi nationals) or as a guest (expatriates)
4. Select "Health Insurance Complaint" and complete the complaint form
5. Upload all supporting documents in PDF format (Arabic preferred, English accepted)
6. Submit and note the case reference number provided

Phone: Call 920001177 — the CCHI's unified service line, available Sunday to Thursday during business hours. The agent will log your complaint and provide a reference number.

In person: CCHI has offices in Riyadh (headquarters), Jeddah, and Dammam. Bring originals and copies of all documents.

Step 4: The CCHI Review Process

After submission, the CCHI will:

1. Acknowledge receipt and assign a case officer (typically within 3 to 5 working days)
2. Formally notify the insurer and request the complete claim file
3. Review the file, which may include referral to the CCHI's Medical Review Committee for clinical necessity disputes
4. Issue a preliminary finding, giving the insurer a chance to respond
5. Issue a final determination, typically within 30 to 45 working days for standard disputes (complex clinical cases may take longer)

If the CCHI finds in your favour, it will direct the insurer to pay the claim, issue pre-authorisation, or take corrective action. Insurers that fail to comply face fines and potential licence action.

Step 5: Appeals and Further Escalation

If you disagree with the CCHI's determination, you can:

• Request a CCHI internal review: Submit additional evidence within the prescribed timeframe stated in the decision letter.
• File with SAMA: The Saudi Central Bank (SAMA) at sama.gov.sa handles broader regulatory complaints against insurers, including those involving systematic bad-faith claims handling or violations of SAMA's insurance conduct rules. Phone: 800 1256000.
• Saudi Courts: A CCHI decision in your favour is admissible in Saudi civil court proceedings and can support a damages claim.

Key CCHI Rules That Protect You

• Insurers must provide a Unified Standard Health Insurance Policy — minimum benefits are fixed by law
• Pre-existing conditions may be excluded for no more than 12 months from the policy commencement date
• Emergency medical treatment cannot be denied regardless of network or pre-authorisation status
• Insurers must respond to pre-authorisation requests within 24 hours for urgent cases
• Employers who fail to insure their non-Saudi workers face fines of up to SAR 10,000 per uninsured worker

Expat-Specific Advice

• If your employer has not insured you at all, file a CCHI complaint against the employer — this is a separate violation from an insurer denial.
• If your employer changes insurers mid-year and there is a coverage gap, document the gap and report it to the CCHI.
• The CCHI system is integrated with the Muqeem foreign worker database, so your Iqama details can be verified electronically.
• If you are outside Saudi Arabia, you can still file online via the CCHI portal or appoint a representative in Saudi Arabia.

Fight Back With ClaimBack

The CCHI complaint process is your most effective tool against unfair Saudi health insurance denials. ClaimBack helps you build a complete, well-documented CCHI complaint that addresses the insurer's specific reasoning.

Start your free appeal at ClaimBack

Related Reading

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Insurance Ombudsman Guide