How to File Complaint with Saudi CHI (Council for Health Insurance)

The Council for Health Insurance (CHI) is Saudi Arabia's dedicated regulator for health insurance. If your insurer has denied a valid claim, ignored your appeal, or acted in bad faith, CHI is the official body with the power to investigate and compel resolution. This guide explains exactly how to use the CHI complaints process.

What Is CHI and What Can It Do?

Established under Royal Decree M/10 (2005), the Council for Health Insurance regulates all health insurance companies operating in Saudi Arabia. CHI's mandate includes:

• Licensing health insurers
• Setting minimum benefit standards for policies
• Enforcing insurer compliance with policy obligations
• Handling consumer complaints and disputes

When you file a complaint with CHI, the council has authority to investigate your case, compel the insurer to respond, and direct payment of valid claims. CHI can also refer systemic violations to the Saudi Central Bank (SAMA) for sanctions.

CHI is headquartered in Riyadh (Al-Olaya district) and its complaint portal is accessible online at chi.gov.sa/complaints.

Before You File: What You Need to Have Done First

CHI requires you to attempt resolution with your insurer directly before filing a complaint. This means:

1. You have submitted a formal internal complaint to your insurer's complaints department
2. The insurer has either rejected your appeal, or has not responded within 10 business days

This internal step is mandatory. If you go to CHI without having first filed an internal complaint, they will direct you back to the insurer.

Documents to Prepare Before Filing

Gather the following before you begin the CHI complaint form:

• Your insurance policy number and member ID (usually on your insurance card)
• Your Iqama number (residency permit) or Saudi national ID
• The formal denial letter from your insurer, specifying the denial reason and policy clause
• Evidence of your internal complaint to the insurer — an email, complaint reference number, or written letter with a dated submission record
• Medical documentation supporting your claim: doctor's prescriptions, referral letters, diagnostic reports, hospital discharge summaries
• Pre-authorization records if applicable — confirmation emails, reference numbers, or screenshots from the insurer's portal or app
• Receipts or invoices if you paid out of pocket and are seeking reimbursement

Having all of these ready before you start the form will prevent delays.

Step-by-Step: Filing a CHI Complaint Online

Step 1: Access the CHI Portal

Go to chi.gov.sa and navigate to the complaints section. The portal supports both Arabic and English. If you are filing as an individual policyholder, select the individual/beneficiary complaint option.

Step 2: Register or Log In

You will need to create an account or log in using your Iqama number or national ID. Saudi nationals can log in via the Nafath digital identity platform.

Step 3: Complete the Complaint Form

Fill in:

• Your personal details and contact information
• Your insurer name and policy number
• The nature of your complaint (claim denial, delayed payment, failure to respond, etc.)
• A clear description of events in chronological order: when you sought treatment, what happened with the claim, when you appealed internally, and what the insurer's response was
• The outcome you are seeking (claim payment, policy correction, etc.)

Be factual and specific. Avoid emotional language. State the denial reason exactly as the insurer cited it and address it directly.

Step 4: Upload Supporting Documents

Upload all documents in the required format (PDF or JPEG, typically under 5MB per file). Label each document clearly so the CHI investigator can quickly understand what it is.

Step 5: Submit and Retain Your Reference Number

After submission you will receive a CHI complaint reference number. Save this — you will need it for any follow-up communication.

What Happens After You File

Insurer Notification (Within Days)

CHI notifies the insurer of your complaint and requires them to provide a formal response. The insurer has a defined window — typically 7 to 10 business days — to submit their position to CHI.

CHI Investigation (Up to 30 Days)

A CHI case officer reviews your complaint alongside the insurer's response. They may request additional information from either party. In straightforward cases, this process resolves within two to three weeks. Complex disputes involving medical necessity assessments may take longer.

CHI Decision

CHI will issue a formal decision. If they find in your favor, they will direct the insurer to process your claim or reimburse your out-of-pocket costs. The insurer is legally bound to comply.

If CHI Does Not Resolve Your Issue

In cases where the insurer fails to comply with CHI's decision, or where the complaint involves conduct beyond CHI's mandate (solvency concerns, systemic violations, licensing issues), escalate to:

Saudi Central Bank (SAMA) — sama.gov.sa — SAMA has broader powers to impose fines and sanctions on non-compliant insurers.

Tips for a Successful CHI Complaint

• File within a reasonable time of the denial — do not wait months before complaining, as documentation becomes harder to gather and CHI may question the delay.
• Be precise: CHI investigators work best with specific dates, reference numbers, and clear timelines.
• If you do not speak Arabic, prepare your complaint in English — CHI handles bilingual complaints.
• If your claim involves a medical necessity dispute, having your doctor write a formal clinical justification letter significantly strengthens your case.

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Related Reading:

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Internal vs External Insurance Appeal