Published on and written by Cyril Jarnias
Relocating to Saudi Arabia means confronting a healthcare system that is highly developed, heavily regulated, and profoundly different from what most newcomers are used to. The overall quality of care is generally high, the infrastructure is modern, and the state invests heavily in health as part of the Vision 2030 program. But for expatriates, access to care depends almost entirely on private insurance and a solid understanding of the local rules.
The Saudi healthcare system combines public and private hospitals. Health insurance is mandatory for expatriates. It’s crucial to research costs, practical procedures, local health risks, and specific services (mental health, maternity, pediatrics) before and after arriving in the country.
Understanding the Saudi Healthcare System
The Saudi healthcare system is mixed: on one side, a massive and generous public sector for citizens, and on the other, a very dense private network that most foreigners turn to. The country has over 500 hospitals, including 287 public facilities and about 160 to 170 private hospitals, supported by more than 2,000 primary care centers.
Riyadh, Jeddah, and Dammam are the three major Saudi metropolises offering some of the best levels of care in the Middle East.
The state spends a significant portion of its budget on health (about 9% of GDP, with nearly three-quarters of health expenditures funded by the public sector). Under Vision 2030, the priority is placed on prevention, digitalization of services, telemedicine, surgical robotics, and the creation of high-level specialized centers (oncology, transplantation, cardiology, etc.).
However, this public generosity does not automatically benefit foreigners.
What This Means for Expatriates
Saudis and, to a certain extent, nationals of the Gulf Cooperation Council (Bahrain, Kuwait, Oman, Qatar, United Arab Emirates) have free or reduced-cost access to public hospitals. Non-GCC expatriates, however, in practice do not have access to these services for routine care: they must turn to the private sector and finance their care through mandatory health insurance.
Foreigners can be treated in public hospitals, but they will have to pay, except in cases of life-threatening emergencies. They are therefore often directed to the private sector (private clinics and hospitals), where the quality is excellent but the costs are very high without good insurance.
In summary, for an expatriate, two realities structure access to care: residency status and the level of insurance coverage.
Mandatory Health Insurance: The Real Key
The cornerstone of healthcare for expatriates in Saudi Arabia is insurance. Without it, no residency permit (iqama), no standardized recourse to private hospitals, and a major financial risk in case of trouble.
The regulation is based on the Cooperative Health Insurance System (CHIS) and the mandatory employment-linked health insurance program (CEBHI). The Council of Health Insurance (CHI, or CCHI) oversees implementation and controls insurers.
Who Must Be Insured?
The obligation is broad and affects almost all profiles of foreigners:
In Saudi Arabia, health insurance is mandatory for several categories of people. This includes private sector employees and their dependents (spouse, single and unemployed sons up to age 25, single daughters with no age limit if they do not work), as well as households employing more than four domestic workers. The obligation also applies to non-GCC foreign students, holders of premium residency or investor visas and their families, as well as expatriate retirees remaining in the country. Freelancers and self-employed individuals must subscribe to local or international coverage, while job seekers and tourists subject to visas must respectively obtain visitor insurance and medical insurance linked to their visa.
Even short stays are concerned: basic “tourism health insurance” is integrated into visa fees for visitors subject to a visa, with emergency coverage of around 100,000 SAR.
The Role of Insurance in the Iqama
Having valid insurance isn’t just a formality for accessing care: it is legally linked to residency status. Without a valid policy, it becomes impossible to issue or renew the iqama. Authorities cross-check data via the CHI’s electronic systems; negligent employers face fines and blocked administrative procedures.
In practice, most large corporations automatically update their employees’ insurance contracts before they expire. Expatriates should nonetheless check the validity dates themselves, especially if they change employers.
What Basic Insurance Covers – and Does Not Cover
Regulations set a minimum basket of care that any mandatory insurance must cover, with an annual envelope per insured of up to 450,000 SAR for essential care. This basic coverage typically includes:
The main guarantees included in our health insurance contract to protect you in your daily life.
Coverage for medical consultations and visits to specialists.
Coverage for lab analyses and imaging exams (radiology, MRI, CT scan depending on the contract).
Coverage for hospitalization in a standard room, emergencies, and surgical procedures.
Reimbursement for medications prescribed by a doctor.
Protection in case of accident, including work-related accidents.
On the other hand, “basic” policies often have limits: exclusions for certain pre-existing conditions, high deductibles and co-payments, caps for maternity or psychiatry, absence or weak coverage for dental, optical, or care abroad.
Many expatriates thus discover, when facing a serious problem, that their corporate policy does not cover, or only partially covers a complex surgery, long-term rehabilitation, or care at an ultra-specialized hospital. It is therefore common to add an international “top-up” insurance with providers like Cigna, APRIL International, Allianz, AXA, or Bupa Global, which supplement the local base with better guarantees and, sometimes, coverage abroad.
Comparing Coverage Levels
Insurance costs vary significantly based on level of coverage, age, and health status. To give a rough idea:
| Type of Coverage | Indicative Annual Cost (per person) | General Characteristics |
|---|---|---|
| Basic “local” plan | 2,500 – 5,000 SAR | Minimal coverage, limited network, high co-payments |
| Extended “local” plan | From 7,500 SAR | Better hospitalization, more specialties, lower out-of-pocket costs |
| Full international plan | > 10,000 SAR | Multi-country coverage, evacuation, access to premium hospitals, high guarantees |
| Estimated average for an adult | ≈ 1,430 USD/year | Average amount across all plans |
| Average for a family of 4 | ≈ 4,970 USD/year | Depending on age, medical history, chosen options |
Prices rise with age, pre-existing conditions, geographical scope (worldwide vs. regional) and the addition of options (maternity, dental, optical, psychiatry). Some contracts cover hospitalizations very well but much less so outpatient care and primary care. For an expatriate who travels or plans to change countries, the more expensive international plans offer better portability and more comfortable coverage limits.
Public, Private, Specialized “Clusters”: Which Hospital to Go To?
For a newcomer, the diversity of players can be confusing. Three main blocks are distinguished: the public network of the Ministry of Health, the specialized public “clusters”, and the private sector, where the majority of insured expatriates go.
The Ministry of Health Public Network
The Ministry of Health (MOH) manages hundreds of hospitals and over 2,000 primary care centers. These facilities primarily serve Saudi citizens and public sector employees (of all nationalities), for whom care is largely free.
Foreigners outside the public sector can receive care there, but:
– they do not benefit from free care (except for emergencies);
– waiting times are longer;
– administrative procedures can be burdensome.
For complex cases (trauma, major surgery, burns, etc.), reference public hospitals like King Saud Medical City in Riyadh or King Fahd Medical City can admit expatriates. Access is usually conditional upon a transfer letter from a private facility and also depends on the availability of the relevant services.
The Specialized Care Clusters
Alongside the MOH network, several public or para-public entities act as centers of excellence, often reserved for certain beneficiaries (military, National Guard) but accessible, in some cases, to foreign residents via their insurance or specific agreements. Among the best known:
| Establishment | Main City(ies) | Notable Specialties | Capacity/Characteristics |
|---|---|---|---|
| King Faisal Specialist Hospital & Research Centre (KFSH&RC) | Riyadh, Jeddah | Oncology, transplantation, genetics, cardio, neuroscience | > 1,200 beds, > 9,000 transplantations performed, world-class research center |
| National Guard Health Affairs / King Abdulaziz Medical City (KAMC) | Riyadh, Jeddah, Dammam | Cardiac surgery, orthopedics, IVF, oncology | Multi-specialty reference, often the national “gold standard” |
| King Saud Medical City (KSMC) | Riyadh | Trauma, burns, complex surgery, orthopedics, bariatrics | > 1,500 beds, over 200,000 annual emergency visits |
| King Fahd Specialist Hospital – Dammam | Dammam | Oncology, cardiology, transplantation, neurology, cellular therapies | Major center for the Eastern Province |
| King Khalid University Hospital (KKUH) | Riyadh | Neurosurgery, trauma, cardio | King Saud University teaching hospital, > 1,200 beds |
Access to these institutions for an expatriate generally requires a formal referral, medical justification, and compatibility with the insurance network. Therefore, they should not be considered as facilities where one shows up spontaneously for a routine consultation.
Major Private Groups: The Daily Reality for Expatriates
For everything related to primary care, common emergencies, childbirth, or planned surgeries, the majority of expatriates use the private sector. Several groups dominate the landscape, with hospitals and clinics in several cities:
| Private Group | Main Cities | Key Points for Expatriates |
|---|---|---|
| Dr. Sulaiman Al Habib Medical Group | Riyadh, Jeddah, Al Khobar | Modern technical facilities, surgical robotics, multi-specialties, very present in expat insurance networks |
| Saudi German Health | Riyadh, Jeddah, Dammam, Madinah, Aseer, Hail | Doctors often trained in Europe, strong reputation in orthopedics, IVF, oncology, VIP suites |
| Mouwasat Hospitals | Dammam, Khobar, Qatif, Riyadh | Neuroscience, cardiology, minimally invasive surgery, very established in the Eastern Province |
| Dallah Hospitals | Riyadh | Maternity, internal medicine, orthopedics, breast oncology (reference center at Al Nakheel) |
| Almana Group of Hospitals | Al Khobar, Dammam, Al Hofuf, Jubail | Leading private group in the Eastern Province, multiple general hospitals |
| Dr. Soliman Fakeeh Hospital | Jeddah | Private pioneer, JCI accredited, highly regarded in pediatrics, orthopedics, cardiology |
These facilities often offer “Western-style” services: English-speaking reception, online appointment booking, in-house pharmacy, comfortable rooms (WiFi, satellite TV, even hotel-style catering service), and sometimes VIP suites. However, the costs match the standard: a night of hospitalization can quickly exceed the equivalent of 200 USD in a standard room and climb to several hundred dollars in a private or VIP room.
How to Actually Use the System as an Expatriate
The procedure depends on the situation (routine consultation, specialist follow-up, emergency), but a few reflexes are constant.
Understanding Your Insurance Policy
Even before leaving your home country, it is essential to read in detail:
– the included care network (list of partner hospitals, geographical areas);
– the annual limits per category (hospitalization, outpatient care, maternity, dental, psychiatry);
– deductibles and co-payments (e.g., 20 to 50% of a GP consultation);
– the procedure in case of hospitalization (pre-authorization, direct coverage or reimbursement);
– coverage abroad (weekends out of the country, travel, repatriation).
This step avoids unpleasant surprises, like discovering that the nice hospital recommended by colleagues is not in the network, or that the desired maternity ward applies a substantial non-reimbursable surcharge.
Registering at a Primary Care Center
Even though the culture of a “family doctor” is less formalized than in Europe, it is generally advisable to choose a primary healthcare center (PHC) or a private clinic of reference in your neighborhood and register there as a regular patient. This center becomes the entry point for:
– minor health problems (ENT infections, pain, prescription renewal);
– routine health check-ups;
– initial referrals to specialists (cardiologist, endocrinologist, dermatologist, etc.).
With some insurance plans, consulting a specialist without going through a GP is possible, but the PHC step often remains more effective for being referred to a suitable practitioner compatible with the insurance policy.
The Typical Process for a Consultation
The most frequent sequence in a private hospital or clinic is as follows: consultation with a doctor, medical tests, diagnosis, and finally treatment and care.
1. Registration at the reception desk with presentation of the iqama, insurance card, and sometimes a bank card for pre-authorization of uncovered costs. 2. Online verification by the hospital with the insurer (via the CHI system) of eligibility and coverage. 3. Possible payment of the co-payment (for example, 20 to 50% of the consultation cost). 4. Medical consultation followed by prescription (medications, further tests, X-ray, MRI…). 5. Instant or delayed approval by the insurer for costly procedures (imaging, hospitalization). 6. Visit to the in-house pharmacy to receive covered medications.
With some contracts, the patient must pay the full bill, then submit supporting documents (scanned invoices, medical reports) to the insurer for reimbursement. This process is common with international insurances not directly connected to the local network.
In Case of Emergency
In an emergency situation, the reflex is not to check your insurance contract, but to get to the hospital as quickly as possible. The numbers to remember are:
– 997 for ambulance (medical emergency);
– 999 for police;
– 998 for fire department;
– 112 for certain emergencies via mobile.
Ambulances are free, but their response times can vary depending on the city, time of day, and traffic. Many expatriates prefer to call a taxi or get to the nearest private hospital on their own, especially in major cities.
Once at the emergency room, care is provided according to the severity. Insurance is verified afterward. It’s important to:
– ensure you are officially “discharged” with proper discharge paperwork;
– collect all reports, prescriptions, and invoices, necessary for any subsequent reimbursement.
Leaving without a formal discharge procedure can complicate, or even invalidate, coverage by the insurer.
Typical Costs and Out-of-Pocket Expenses
Even with insurance, expatriates may bear a significant portion of healthcare expenses, especially with basic policies. As an indication:
| Type of Care | Cost Range (before reimbursement) | Particularities |
|---|---|---|
| Private GP consultation | 200 – 500 SAR | A portion often paid by the patient (co-payment) |
| Specialist consultation | 400 – 1,000 SAR | May require pre-authorization depending on the contract |
| Night of hospitalization in standard room | 450 – 900 USD | Private or VIP room more costly |
| Appendectomy / Common surgery | 4,500 – 8,500 USD | Variation depending on the hospital and follow-up |
| Childbirth | 2,000 – 15,000 SAR | Depends on the type of facility and complications |
Without adequate coverage, an accident, surgery, or prolonged hospitalization can become financially overwhelming. That is why many expatriates opt for an additional layer of international protection.
Access to Medications and Pharmacies
Pharmacies are very present, especially in large cities, with well-known chains like Al Nahdi, Al-Dawaa, Tadawi, or White Pharmacy. Many stay open late, and some operate 24/7 near major hospitals.
Many common medications are available over the counter, but antibiotics and heavy treatments require a prescription. Prices, often subsidized, make chronic treatments affordable in the local system. Importing substances subject to restrictions should be avoided.
It is essential to:
– travel with medications in their original packaging, accompanied by a prescription and a medical letter;
– check with the Saudi embassy or consulate if a particular treatment is allowed (some psychotropic drugs or substances like certain stimulants are prohibited or highly controlled);
– know the generic names of medications to find them locally.
International services specialized in shipping medications for expatriates exist, but they cannot ship controlled substances and remain subject to Saudi customs rules.
Mental Health: A Growing Issue, Especially for Expatriates
Mental health has long been taboo in the region, but the subject is increasingly emerging, driven by a youth very present on social media and by the Vision 2030 reforms. The figures remain concerning: about one-third of the population would experience a psychological disorder in their lifetime, and the majority of people suffering from severe disorders never seek consultation.
Expatriates form a particularly vulnerable group, exposed to isolation, work stress, the precariousness of migration status, and language barriers. Studies show an over-representation of foreign workers in some suicide statistics.
Nevertheless, the care offer is becoming structured:
Number of primary care centers into which mental health services have been integrated.
For an expatriate, the choice is often between: working abroad, family life, and personal adventure.
– free or low-cost public services, but with delays and some administrative rigidity (and sometimes a lack of anonymity);
– private practitioners (psychiatrists, psychologists) in-person or online, more expensive but more flexible and bilingual.
Corporate insurance policies still cover psychiatry insufficiently, even though the coverage limit has been raised in the country (for example, from around 15,000 SAR to 50,000 SAR in some regulatory frameworks). Here again, supplementary insurance can justify its cost just for this aspect.
Maternity and Pediatrics for Expatriates
The care for maternity and children is generally of a good standard, with infant mortality rates comparable to those of developed countries. Most deliveries take place in a hospital setting, under the supervision of an obstetrician, with very medicalized follow-up.
Cultural and Legal Particularities
Two major elements distinguish maternity in Saudi Arabia from many other countries:
Getting pregnant or giving birth outside of marriage is illegal and exposes one to heavy penalties; healthcare facilities require proof of marriage for pregnancy follow-up. Furthermore, the hospital environment is strictly gendered: spaces are generally separated by sex, and in many public hospitals, men are not admitted to the delivery room, unlike some more flexible private facilities where the spouse’s presence is often possible.
For a married expatriate woman with proper insurance, the journey remains relatively comfortable, especially in large private hospitals, where one can find female teams, childbirth preparation classes, various analgesic options (epidural, spinal anesthesia, nitrous oxide), and continuous pediatric follow-up for the newborn.
Cost and Maternity Coverage
The costs of childbirth vary enormously depending on: the place of delivery, the type of delivery (natural or cesarean), potential complications, patient choices (such as the presence of a doula or specific support), and the healthcare system in force in each country.
– the nature of the delivery (vaginal/cesarean, complications);
– the type of hospital (public, standard private, VIP facility);
– the room category (standard, private, suite).
The cost of a delivery ranges from 2,000 to 15,000 SAR, to which are added the costs of ultrasounds, prenatal analyses, and post-partum follow-up. Basic insurances often cover these expenses insufficiently. It is therefore crucial for prospective expatriate parents to choose insurance with comprehensive maternity coverage, possibly from a specialized international insurer.
Children’s Health and Vaccinations
Children are generally attached to their parents’ insurance and followed by pediatricians until 18 years old. The system provides for:
– free pediatric vaccinations in public centers for citizens, but also easily accessible for residents;
– a complete vaccination schedule (BCG and hepatitis B at birth, then polio, DTP, Hib, pneumococcus, rotavirus, measles, meningitis, hepatitis A, chickenpox, according to age);
– modern neonatal (NICU) services in major hospitals, although studies still mention human resource pressures.
For expatriate families, two topics often come up: the relative shortage of pediatricians (only a few hundred for the entire country), which makes community recommendations valuable, and the rise of childhood obesity, with some of the highest rates in the world among 5-14 year olds. Part of the prevention will therefore be at the lifestyle level (diet, physical activity) rather than at the care level.
Specific Health Risks and Prevention
Life in Saudi Arabia, especially in desert cities like Riyadh, exposes one to particular risks:
The main health risks in Saudi Arabia include extreme heat (heatstroke, dehydration), sandstorms (respiratory problems), and infections (foodborne, waterborne, or specific). It is crucial to choose health insurance that covers these emergencies well, to check coverage limits for pulmonary care, and to ensure mandatory vaccinations (yellow fever, meningococcus for pilgrimages) are up to date.
Before departure, it is therefore wise to:
– update your basic vaccines (measles-mumps-rubella, diphtheria-tetanus-polio, hepatitis A and B, flu);
– consult a travel medicine doctor for personalized recommendations;
– prepare a detailed medical letter outlining medical history, allergies, blood type, and treatments, ideally translated into English.
Before Arrival: Preparing Your Health File
Many problems are resolved in advance, even before boarding the plane. A well-prepared expatriate will have:
Before leaving to work in Saudi Arabia, it is crucial to: verify that your current insurance covers emergencies abroad while waiting for the local contract to activate; build up a stock of your chronic medications with detailed prescriptions and INNs; prepare a complete portable medical file including check-ups, tests, and reports; identify reference hospitals in your future city in advance via dedicated resources; and ensure the legality of all your treatments, particularly psychotropic drugs, on Saudi territory.
Upon arrival, next comes the iqama medical examination at an approved center, updating the insurance card, and then choosing a reference hospital/clinic for daily care.
After a Consultation or Hospitalization: Habits to Adopt
To avoid any dispute with an insurer and keep control of your medical history, it is advisable, after each significant care episode, to:
After medical treatment abroad, it is crucial to keep all reports, lab and radiology results, and original invoices, even for small amounts. If the file is in Arabic, request an English summary. Verify that the hospital has properly transmitted the data to your insurer, especially in case of direct coverage, and schedule a follow-up consultation, possibly via teleconsultation with a doctor from your home country for complex cases.
Upon returning to your home country or when changing countries, transmitting all of this data to your new doctor allows for coherent follow-up and avoids redundant exams.
Digitalization, Telemedicine, and Useful Tools
As part of Vision 2030, Saudi Arabia has accelerated the digitalization of its healthcare system:
Discover the main digital services implemented to improve access to care and medical follow-up for citizens.
Centralizes part of medical data, allows booking appointments, tracking prescriptions, and, in some cases, accessing teleconsultations.
Presented as one of the world’s largest virtual hospitals, it offers remote specialized consultations, particularly to regions less well-staffed with specialists.
The 937 hotline provides health information and advice accessible to all.
For expatriates comfortable with digital tools, these services usefully complement the traditional offer, especially for follow-up care, renewals of non-complex prescriptions, or second opinions.
Key Takeaways for Expatriates
Living in Saudi Arabia offers access to a high-level medical system, often very modern and equipped with the latest technologies, in fields as advanced as interventional cardiology, transplantation, oncology, or bariatric surgery. But this excellence comes at a price, one that cannot reasonably be faced without solid insurance.
For an expatriate, the winning strategy rests on a few simple pillars:
For a peaceful expatriation, consider health insurance as a contract to be read carefully, beyond the administrative obligation. Opt for broader coverage than the legal minimum if your family situation, a maternity project, or medical history justifies it. Upon arrival, build a personal healthcare network (primary doctor, private hospital, pharmacy). Also anticipate the psychological dimension of expatriation by identifying available support resources. Finally, always carry your iqama, insurance card, your insurer’s contact details, and emergency numbers with you.
With these precautions, the apparent complexity of the system transforms into a medical environment rather favorable to expatriates, provided they understand its codes and remain proactive regarding insurance and prevention.
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Cyril Jarnias is an independent expert in international wealth management with over 20 years of experience. As an expatriate himself, he is dedicated to helping individuals and business leaders build, protect, and pass on their wealth with complete peace of mind.
On his website, cyriljarnias.com, he shares his expertise on international real estate, offshore company formation, and expatriation.
Thanks to his expertise, he offers sound advice to optimize his clients' wealth management. Cyril Jarnias is also recognized for his appearances in many prestigious media outlets such as BFM Business, les Français de l’étranger, Le Figaro, Les Echos, and Mieux vivre votre argent, where he shares his knowledge and know-how in wealth management.
