 What is the definition of the following :

 Protocol Clients: (9.1.)
 Persons registered for care in the Medical Protocol Department as per the approved list of the Chief Executive Officer, National Guard Health Affairs.
 SANG Employee: (9.2.)
 Saudi Arabian National Guard Employee, whether Military or Civilian.
 Program: (9.3.)
 Project Direct Hire for National Guard Health Affairs.
 Program Employee: (9.4.)
 Project Direct Hire (PDH) Employee; hired to work in the organization but not an employee of Saudi National Guard.
 Protocol Outpatient: (9.5.)
 The outpatient clinic in each of the Program Sites specifically reserved/designed for Protocol Clients as defined above.
 Protocol Inpatient: (9.6.)
 The Ward(s) in each of the Program Sites specifically reserved/designed for protocol clients as defined in above.
 Eligibility A: (9.7.)
 Privileges both for Medical Protocol Inpatient and Outpatient Services.
 Duration for Eligibility is variable depending on the person’s relation with the
Family Head, to a maximum of Five (5) years.
 Eligibility B: (9.8.)
 Privileges for Medical Protocol Outpatient Services Only.
 Duration of Eligibility is Two (2) Years only, at the end of which the information has to be updated.

 What are the goals of defining Eligibility for Protocol Services policy and procedure? ( 3.1.)

 Managing all resources in alignment with the Corporate Vision of National Guard Health Affairs.
 Providing a reference for all those involved in Protocol Healthcare Management.

 What are the objectives that need to be met in order to move towards achieving the above goals? (3.2.)

 Preparation and maintenance of eligibility list for all categories and all situations encountered in practice according to organizational policies and directives.
 Ensuring that those involved in registration are fully aware of the relevant details of the various aspects of eligibility for Protocol Services.
 Provision of a support system for ongoing assessment and adjustment of management process for Eligibility through PACER (Periodic Assessment and Coverage Evaluation Reports) system.

 What are the Categories of the Employees who are Eligible for treatment in Medical Protocol Department? ( 5.3.)

 Saudi Arabian National Guard (SANG) Employees:
a) Military Personnel: Colonel and above.
b) Civilian Personnel: Grade 12 and above.
 Executive Director in Health Affairs.
 Program Employees:
a) Program Consultant.
 Special Exception or Instruction by His Excellency the Chief Executive Officer.

 What are the Employee Categories under Eligibility A ?( 5.4)

 Saudi Arabian National Guard Employees: Colonel and above; Grade 12 and above.
 Program Employees:
a) Executive Directors
b) Program Consultants: Both Saudi National and other Consultants.
 Regarding Saudi Staff Physicians, Associate Consultants, and Assistant
 Consultants, subject to the following conditions:
a) Those who have retired after at least 20 years of service.
b) Those who Currently Are, and have been, in active service for at least 20 Years, AND Were Registered in the Medical Protocol Department on or before December 31, 2007.
 Employees in the Category of Health Professions in the Saudi Bureau of Civil Services:
• Grade 7 from the following categories:
a) Pharmacists
b) Dieticians / Nutritionists
c) Social Workers
d) Laboratory Technicians
• Technicians in General Health
a) Those who have retired after at least 20 years of service.
b) Those who Currently Are, and have been, in active service for at least 20 years, AND Were Registered in the Medical Protocol Department on or before December 31, 2007.

 What are the Employee Categories under Eligibility B ?( 5.5)

 Saudi Nationals SANG Employees from National Guard Universities and
 Colleges in the Grades of Assistant Professor and above.
 Other Health Affairs Staff Categories exempted by His Excellency the Chief Executive Officer.
 Categories of staff not mentioned in 5.5.1 and 5.5.2 above may need special processing from the office of the General Director Medical Protocol Department.
 All those with Letters of Exception are assigned Eligibility B unless specifically directed otherwise by His Excellency the Chief Executive Officer:
a) Those with Letter of Exception who are assigned Eligibility B status will have full coverage Except Special Services as described in 5.1 above.
b) Provision of Special Services to Eligibility B Letters of Exception can only be overruled by Explicit Directions from His Excellency the Chief Executive Officer.

 can you describe the Letters of Identification required for Registration for:

 Students (5.6.1.)?

 Studentship identification should be produced at the beginning of the academic year.
 Academic year will be considered to continue till the beginning of the next academic year.
 Expiry of the current eligibility of a student will be considered at the end of the first week on the beginning of the next academic year.
 University Identity Cards are not considered a proof of studentship.
 Only a letter from the University or College Students Affairs is to be accepted as proof of studentship.

 Employees (5.6.2.)?
 All letters of identification must have been issued within a period not exceeding 4 weeks preceding the date of registration.
 For all Civilian Staff, letters specifying service grades will be accepted only if from Human Resources Department.
 Letters certifying Service Grade from any sources other than HR, as specified in above, will not be acceptable.
 For Civilian Staff in Health Affairs (Consultants) the monthly updated staff list provided by the Medical Services will serve as a reference.

 What is the Eligibility duration for: (5.7.4)
 Male Children of More than 13 years old? ( 5.7.4.1.)
 From 13 – 17 years of age, get eligibility up to the age of 18 years.
 Eighteen years and above, students, get eligibility till the end of academic year if they produce proof of being a student.
 Those employed are not eligible after having completed 18 years of age.

 Female Children of More than 13 years old? ( 5.7.4.2.)
 From 13 – 19 years of age, get eligibility up to the age of 20 years.
 Twenty years and above, get eligibility for 2 years on proving that she is on her father’s family card.
 If a female is 20 years of age or older and is still on her father’s family card but is married, her eligibility will not follow that of her father

 Students? (5.7.5.)
 Following age limits are accepted for different studentship categories, with the condition that the person concerned is not in active service in private or general sector AND produces undertaking to that effect from the guardian.
a) Secondary School students: up to 23 years of age.
b) Bachelor students: up to 26 years.
c) Masters students: up to 29 years.
d) PhD students: up to 30 years.
 Studentship certificates should specify the student to be a Regular, Full Time, AND Day Shift student
 Part time students are not eligible for treatment in Medical Protocol Department.
 Studentship Certificates from both the Governmental and Private Institutes need attestation from the concerned higher authority from a Government Institution.
 Studentship certificates will need renewal every year at the beginning of the academic year.

 Can you describe the Eligibility in Marital Status? ( 5.8.)

 Divorced wives of eligible persons lose their eligibility immediately on divorce.
 Divorced daughters of an eligible person will get eligibility for six months from the date of divorce decree from the court.
 After these six months, she must be on the Family Card of her father for eligibility to continue.
 Her father must produce the original Family Card for this purpose.

 Can you describe the Eligibility for Families of a Person eligible for treatment in Medical Protocol Department? (5.9.)

 Families of Female SANG employees eligible for treatment in Medical Protocol
Department:
a) In case their husbands are Saudi nationals, they will be treated in Medical Protocol Department.
b) If case their husbands are non-Saudis, they will be referred to patient services for management.
c) Their children will be given the privileges of their mothers.
 SANG Employees who are Children of clients eligible for treatment in Medical Protocol Department will be treated according to SANG Employees’ regulations and not according to the status of their parents.
 A Daughter who has separate ID card but is still single, her guardian will bring certificate from Civil Authority proving her marital status along with the family card that includes her name.

 Are the non-Saudi SANG employees eligible for treatment in medical protocol?
(5.10.)

 Non-Saudi parents of Saudi SANG Employees, they are eligible for treatment in Medical Protocol Department.
 Eligible SANG Employees with Saudi Passport but not Saudi Nationality will be treated as Saudi Nationals.

 Describe the Service Status and Eligibility Status? (5.11.)

 An Officer who is on Special Status (not in active service though not yet retired) is entitled for treatment and is not treated as retired.
 An Officer who is Relieved of Service but taking salary of a retired officer will be entitled for Medical Protocol Department services.
 In case an eligible SANG employee of Executive Status retires from service while still in executive status, his executive eligibility will continue after retirement.
 In case an eligible SANG employee is Terminated from Service, his eligibility is cancelled.
 In case an eligible employee is demoted from Service, eligibility is cancelled.
 In case a SANG employee is granted eligibility on Special Permission from HE the CEO (Eligibility B), his eligibility will be for treatment in protocol Outpatient Only for a period of Two years, at the end of which he has to get HE the CEO’s approval again.
 Non-SANG Officers working with the Custodian of the Two Holy Mosques, from Ministry of Interior or Intelligence etc., equivalent in Grade to Medical Protocol Department eligible SANG employees, will have eligibility B, that is to be seen in Medical Protocol Department Outpatient only for a period of 2 years.
 At the end of these 2 years such Non-SANG Officers will have to renew their eligibility according to regulations.

 Should letter of exception client with inactive file in medical protocol department receive treatment during emergency room visit? (5.12.)

 Such persons will receive eligibility Only for Emergency Treatment.
 For Medical Protocol Services they will have to get a new letter from HE the CEO.

 What is the procedure if the client with inactive file had an emergency room visit with their original documents presented? (5.13.1.)

 They will get emergency services and treatment extension for a period of two weeks by the Protocol Officer on duty.
 Such patient will be eligible for admission in Medical Protocol Department managed beds.
 The extension for two weeks will be given by the Protocol Officer on duty at night after ensuring that original documents are there and the patient will produce such documents to the Eligibility Review Committee within the period of two weeks.
 The Protocol Officer on duty will submit the case to the Eligibility Review Committee during the same or immediately next working shift.
 If original documents are not produced in these two weeks.
 Patient may receive another extension for two weeks during which he must produce original documents.
 In case of failure to produce original documents even the second time, eligibility for treatment in the Medical Protocol Department will be terminated.
 Any employee granting such extensions against the policy or more than twice will be held responsible and will be referred to internal audit for investigation and due action.

 What is the procedure if the client with inactive file had an emergency room visit without their original documents? ( 5.13.2.)

 Extension will be granted for two (2) days only.
 Admission will not be granted in Medical Protocol Department managed beds.
 The patient will be asked to produce original documents within these two (2) days.
 One further extension for 2 days may be granted if on a next visit to ER, original documents are not produced again.
 One further extension for two (2) days may be granted if, on a next visit to ER, original documents are not produced again.
 Any employee granting such extensions against the policy or more than twice will be held responsible and will be referred to internal audit for investigation and due action.
 If at the end of the second two (2) days’ extension the original papers are not produced, the eligibility for treatment in Medical Protocol Department will be terminated.

 What are the Special Categories for Eligibility? (5.14.)

 King Abdulaziz Library and Strategic Studies Institute’s heads only are eligible for treatment in the Medical Protocol Department as per instructions from HE the CEO.
 Assistant Professor and above from King Khaled Military Hospital and King Saud Ibn Abdulaziz University for Medical Sciences:
a) Saudi: Eligible for Two years, Eligibility B, i.e. for Medical Protocol Outpatient only.
b) Non-Saudi: Eligible for One year only, Eligibility B, i.e. for Medical Protocol Outpatient only.

 Should children of eligible medical protocol department clients who have disabilities receive treatment during the disability period? (5.15.)

 Children of eligible Medical Protocol Department clients that are 18 years of age or above, and have disabilities, such that enforce dependence for subsistence, supported by medical certificate, are entitled for treatment for the period of disability.

 How are the Letters of Exception being processed? ( 5.16.)

 Any patient whose period of eligibility by a Letter of Exception is over is not eligible for protocol services on reporting to ER or regular services except if directed by HE the CEO through the General Director Medical Protocol Department or Designee.
 Initiation of all requests for a letter of exception must be processed through the Medical Protocol Department in the concerned region.
 Protocol Services in all regions will forward all requests for letters of exception to the office of the General Director, Medical Protocol Department.
 The General Director, Medical Protocol Department will, after review, forward these requests to the office of HE the CEO.
 Office of HE the CEO will inform the office of the General Director about the decision regarding these requests.
 The General Director, Medical Protocol Department will then communicate to the concerned Protocol Offices about the decisions taken.

 What are the procedure involved in the Review and Update of Eligibility Criteria? (5.17.)

 Review and update of Eligibility Criteria will be an ongoing process.
 Such review will be done by the Supervisor of Patient Services, Medical Protocol Department, or designee, in collaboration with the Administrator, Medical Protocol Department, or designee.
 Necessary approvals will be sought from HE the CEO, through the General Director, Medical Protocol Department or designee
 Supervisor Patient services, through the Manager Medical Protocol Department or Designee, will immediately report any occurrence of variance in this respect to the General Director Medical Protocol Department.
 Eligibility Criteria and their implementation will be subject to Periodic Audits and Reviews by the Supervisor Review, Medical Protocol Department, Central Region, using Periodic Assessment and Coverage Evaluation system.
 Based on Periodic Reviews, Supervisor Review will present Yearly Evaluation Summary Reports to the General Director Medical Protocol Department.

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