Healthcare Insurance (HCM 563)

Public Health Department Health Sciences College
  HCM563 Course Code: Healthcare Insurance Course Name
3 hours Contact Hours 3 credit Hours Credit Hours
  English   Arabic Teaching Language
None Prerequisite Level 2 Course Level
Course Description:

It was designed to focus on general insurance concepts and particularly health insurance in addition to health cooperative guaranty programs which are applied in the kingdom. The course will focus on how to use health insurance to reduce the adverse financial impact in case of a loss has become an important element of financial and risk management in our society

Course learning outcomes:

1. Describe the usage of diagnostic medical coding for global classification of insurance to avoid fraud and abuse in the healthcare practice.

2. Define the basic concepts of health insurance and its usage, types of coverage, and terminology of the health insurance industry in Saudi Arabia , health insurance systems globally.

3. Appraise the process of the risk selection and risk adjustment in Health Insurance practices.

4. Analyze the potential of health and preventative measures and the future of health insurance in Saudi Arabia based on the Cooperative Health Insurance System directive issued by the Council of Ministers and Saudi Vision 2030

5. Evaluate the processes of billing, claims,  reimbursement in financial impact of health insurance in the Saudi Arabia .


Major Topics :

1.      Introduction to the Emergence of Insurance
2.      Basic Concepts, Usage, Criteria, and Terminology of Insurance
3.      Providing Universal Health Coverage
4.      Contracts and Networks in Saudi Arabia
5.      Benefits of Health Insurance
6.      Processing Healthcare Claims in Saudi Arabia
7.      Reimbursement of Claims
8.      Funding Health Insurance
9.      Managed Care
10.  Underwriting, Risk Selection, and Risk Adjustment
11.  Saudi Arabia’s Legal Requirements for Employers
12.  Coding Basics
13.  Insurance Fraud and Abuse Globally and in Saudi Arabia
14.  Future of Health Insurance in Saudi Arabia
  Assignments   Quizzes   Mid-Term Exams Grading:
   Lab Work   Project   Final Exam
Valerius, J., Bayes, N., Newby, C., & Biochowiak, A. (2020). Medical insurance: A revenue cycle process approach: McGraw-Hill(8th ed.). ISBN: 9781259608551, 1259608557 Text Book:

Hachem W., Wakerley, S., & Neighbour, T. (2017). Insurance and reinsurance in Saudi Arabia: Overview.

Reference Book (s):

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