Report

Saudi Arabia Health And Medical Insurance Market Analysis

The Saudi Arabia health and medical insurance market is valued at USD 10.03 billion in 2025 and is on track to reach USD 13.74 billion by 2030, advancing at a 6.52% CAGR. Rapid digitization, expansion of mandatory coverage, and Vision 2030's push to boost private-sector participation in healthcare from 40% to 65% underpin this growth. Mandatory e-claims processing through NPHIES is reducing cash-cycle times, while value-based purchasing via AR-DRG bundles is prompting richer benefit designs. New compulsory cover for dependents of private-sector Saudis immediately enlarges the insured pool by 3.2 million lives. Demand also rises as SMEs proliferate and mobile-first consumers channel 46% of claims through apps. Although GLP-1 obesity drugs and premium-ceiling regulations pressure margins, insurers are countering digital efficiencies and product innovation.

Saudi Arabia Health And Medical Insurance Market Trends and Insights



NPHIES real-time e-claims mandate transforms payment velocity

National Platform for Health and Insurance Exchange Services (NPHIES) has eliminated the previous 30-60 day reimbursement cycle, enabling providers to obtain real-time payment authorizations and significantly reducing their working capital requirements by up to 50%. This advancement streamlines financial operations for healthcare providers, allowing them to focus more on patient care rather than administrative burdens. With integration into the Saudi Billing System, NPHIES now supports 7,947 unified codes, representing a 30% increase over the older lists. This alignment enhances standardization and efficiency across the healthcare billing process. While early adopters report a 25-30% reduction in administrative costs, only 62% of providers are prepared for Diagnosis-Related Group (DRG) coding. This readiness gap has prompted insurers to invest in coding training programs, aiming to equip providers with the necessary skills and ensure the liquidity of their networks remains intact, thereby fostering a more robust and efficient healthcare ecosystem.

CHI value-based purchasing through AR-DRG bundles reshapes benefit design

In collaboration with Australia's Department of Health, the rollout of Australian Refined Diagnosis-Related Groups (AR-DRG) is transitioning reimbursements from a fee-for-service model to bundled payments. This initiative equips actuaries with detailed cost data, enabling more accurate financial planning and resource allocation. Pilot results from King Fahd Central Hospital indicate that DRG costing exceeds traditional averages by 9%, offering deeper insights into pricing strategies and operational efficiencies. Under the Essential Benefit framework of the Council of Health Insurance (CHI), insurers are rolling out tiered preventive care packages. These packages aim to enhance patient outcomes by prioritizing quality over the volume of utilization, marking a significant shift in the healthcare reimbursement landscape.

GLP-1 obesity drugs create USD800 million claims pressure

Monthly costs for Semaglutide and tripeptide treatments range from USD533 to USD1,067 per patient. These treatments, which are gaining popularity for their effectiveness in managing obesity, could lead to an annual claims surge of USD800 million starting in 2025. With adult obesity rates at 35%, the financial burden on insurers is significant. To address this, insurers are implementing measures such as prior authorization to ensure appropriate use and outcome-based reimbursement strategies to link payments to treatment effectiveness, thereby mitigating their financial exposure. Additionally, the rising demand for these drugs highlights the growing focus on addressing obesity as a critical public health issue, further emphasizing the need for sustainable reimbursement models to balance patient access and cost management.

Other drivers and restraints analyzed in the detailed report include:

Compulsory coverage extension adds 3.2 million lives / Vision 2030 SME boom drives micro-group insurance innovation / CHI premium-ceiling circular constrains pricing flexibility /

For complete list of drivers and restraints, kindly check the Table Of Contents.

Segment Analysis

Group plans lock in 74.5% of the Saudi Arabian health insurance market share due to mandatory employer coverage, yet individual policies deliver the highest 15.81% CAGR. Digital apps such as Daman speed onboarding for freelancers and self-employed customers seeking portable benefits. Recent USD203 million and USD213 million group contracts with Saudi Arabia and the Saudi Electricity Company underscore the volume still anchored in corporate accounts.

Meanwhile, the gig economy workforce amplifies individual uptake, giving carriers room to diversify beyond employer-centric models. The Saudi Arabia health insurance market size for individual plans is projected to accelerate as mobile enrollment and flexible riders capture price-sensitive consumers. Established insurers refine actuarial models to price self-funded risks, leveraging telehealth to minimize claim costs and reinforce insurer-insured engagement, while group carriers continue to differentiate via provider-network breadth and wellness-incentive programs.

Inpatient benefits represented 63.3% of premiums in 2024, but wellness and telehealth riders exhibit an 18.52% CAGR, reflecting a preventive-care pivot. The Seha Virtual Hospital and Sehhaty app normalize virtual diagnostics for 24 million registered users, driving coverage beyond classic hospital care. Outpatient, maternity, and dental optics maintain mid-single-digit growth as base demand endures.

The Saudi Arabia health insurance market size attached to wellness riders is expanding rapidly as insurers pair app-based coaching with rewards that reduce chronic disease claims. This trend lowers hospital admissions over time, whereas inpatient-centric insurers confront rising specialty-drug costs. Consequently, product design now embeds wellness modules to preserve competitiveness and shore up loss ratios.

The Saudi Arabia Health and Medical Insurance Market is Segmented by Insurance Type (Individual Health and Group Health), Coverage Type (Inpatient, Outpatient, and More), Plan Tier (Bronze, Silver, and More), Insurance Model (Co-Operative and Conventional), Distribution Channel (Insurance Brokers, Bancassurance, and More), and End-User (SMEs, and More), and Region. The Market Sizes and Forecasts are Provided in Value (USD).

List of Companies Covered in this Report:

Bupa Arabia for Cooperative Insurance / Tawuniya (The Company for Cooperative Insurance) / MedGulf (Mediterranean & Gulf Cooperative Insurance & Reinsurance) / Al Rajhi Company for Cooperative Insurance (Al Rajhi Takaful) / Saudi Arabian Cooperative Insurance Company (SAICO) / Walaa Cooperative Insurance Company / GIG Saudi Cooperative Insurance Company (formerly AXA Cooperative) / Malath Cooperative Insurance & Reinsurance Company / Arabian Shield Cooperative Insurance Company / Allianz Saudi Fransi Cooperative Insurance Company / United Cooperative Assurance Company (UCA) / Saudi National Insurance Company (SNIC) / Al Sagr Cooperative Insurance Company / Saudi Enaya Cooperative Insurance Company / Gulf General Cooperative Insurance Company / Chubb Arabia Cooperative Insurance Company / Arabia Insurance Cooperative Company / Allied Cooperative Insurance Group (ACIG) / Al Etihad Cooperative Insurance Company / Al Alamiya for Cooperative Insurance Company /

Additional Benefits:

The market estimate (ME) sheet in Excel format /
3 months of analyst support /