CONSUMER PROTECTION

CONSUMER PROTECTION PRINCIPLES

Our commitment

Cigna Healthcare KSA is committed to treating consumers fairly, transparently, respectfully, and securely throughout the insurance relationship. These principles describe the standards consumers can expect when seeking information, purchasing or using coverage, accessing services, submitting claims, or raising complaints.

1. Purpose

These Consumer Protection Principles explain how Cigna Healthcare KSA protects the interests of consumers and beneficiaries across products, services, communications, digital channels, claims, approvals, complaints, and after-sales support. They are intended for public website publication and should be read together with the applicable policy documents, Privacy Policy, Terms of Use, Service Information and Beneficiary Rights page, and Frequently Asked Questions.

2. Scope

These principles apply to consumers, beneficiaries, policyholders, authorized representatives, prospective customers, and users of Cigna Healthcare KSA services and channels. They apply across the website, mobile and digital services, contact centre, email, complaint channels, provider-related support, brokers or intermediaries where applicable, and other approved customer touchpoints.

3. Fair and Respectful Treatment

Consumers will be treated fairly, honestly, respectfully, and without unjustified discrimination. Decisions will be based on applicable policy terms, documented information, service standards, and relevant legal or regulatory requirements. Consumer circumstances and accessibility needs will be considered where appropriate.

4. Clear Information and Transparency

Information will be presented in clear and understandable language. Before a consumer commits to or starts a service, Cigna Healthcare KSA will make available the information reasonably needed to make an informed decision, including:

• The nature and purpose of the product or service.
• Eligibility requirements and the intended beneficiary.
• Key benefits, limits, conditions, exclusions, waiting periods, and network requirements.
• Prior approval, documentation, and medical necessity requirements where applicable.
• Premiums, co-payments, deductibles, contributions, fees, non-covered amounts, or other potential financial responsibility.
• The main service or claims journey and expected outcome.
• Approved response or completion timelines displayed for the relevant service.
• Cancellation, amendment, renewal, complaint, appeal, and escalation arrangements.

5. Product and Service Suitability

Product and service information should be accurate and sufficient for the intended customer group. Consumers should be given a reasonable opportunity to review relevant documents and ask questions. Recommendations, where provided, should consider the information available about the consumer’s stated needs and circumstances. Final coverage remains subject to the issued policy documents.

6. Policy Documents and Contractual Clarity

Consumers should receive or be given access to the applicable policy schedule, Table of Benefits, endorsements, exclusions, and terms. These documents govern coverage and take priority over general marketing or website content. Material rights, obligations, limitations, and renewal or cancellation conditions should be clearly identified.

7. Responsible Communication and Marketing

Customer communications and marketing materials should be clear, accurate, balanced, and not misleading. Important conditions and limitations should not be hidden or presented in a way that could create an incorrect impression. Direct marketing should be sent only where permitted, and consumers should be able to manage marketing preferences through the available channel.

8. Privacy, Confidentiality, and Information Security

Personal and health data will be handled confidentially and in accordance with the Cigna Healthcare KSA Privacy Policy and applicable Saudi requirements. Only data relevant to a lawful and stated purpose should be collected. Appropriate safeguards should be applied to protect data from unauthorized access, use, disclosure, alteration, loss, or destruction.

9. Accessible and Reliable Service Channels

Consumers should be able to access services and support through clearly published and appropriate channels. Digital content should be easy to locate and understand, and support should be available where a consumer cannot complete a journey independently. Cigna Healthcare KSA will seek to maintain reliable channels and communicate material service interruptions where appropriate.

10. Claims and Medical Approval Handling

Claims and medical approval requests will be handled objectively and consistently based on eligibility, policy terms, benefits, limits, exclusions, supporting documents, prior approval requirements, network arrangements, and medical necessity where applicable. Consumers may be asked for additional information where needed to complete the assessment.

Consumers should receive a clear outcome. Where a claim or approval is declined or partially approved, the response should identify the reason and the relevant policy basis, subject to applicable requirements. The consumer may use the published complaint or appeal route if dissatisfied.

11. Complaints, Appeals, and Escalation

Consumers may submit a complaint through the official Cigna Healthcare KSA complaint channel. Complaints should be registered, assigned a reference number, reviewed objectively, and communicated through the registered or selected channel. Consumers may be asked to provide relevant references, dates, correspondence, invoices, medical documents, screenshots, or other supporting information.

If a consumer is dissatisfied with the final response or complaint handling, the consumer may use the published appeal or escalation route. Where applicable, the consumer may escalate the matter through the Insurance Authority’s official complaint service. The Authority may request confirmation of a prior complaint to the insurance company, the company complaint reference number, and supporting documents.

12. Conflicts of Interest

Cigna Healthcare KSA will identify and manage actual or potential conflicts of interest that could affect fair customer outcomes. Employees, representatives, and service partners are expected to act professionally and avoid using their position or customer information for improper benefit.

13. Third Parties and Service Partners

Where a third party supports delivery of a service, Cigna Healthcare KSA will seek to ensure that the arrangement includes appropriate service, confidentiality, data protection, and consumer treatment expectations. The use of a third party does not remove the need for clear customer communication and an accessible complaint route.

14. Support for Vulnerable Consumers and Accessibility Needs

Consumers who may require additional assistance should be provided reasonable support through available channels. This may include clear instructions, accessible communication, assistance through an authorized representative, and appropriate consideration of disability, age-related support needs, language, digital access, or other circumstances, subject to identity, consent, and legal requirements.

15. Consumer Rights

• To be treated fairly, respectfully, and transparently.
• To receive clear information about products, services, benefits, limits, exclusions, costs, and responsibilities.
• To access applicable policy and benefit documents.
• To have personal and health information handled confidentially and securely.
• To receive clear claim, approval, or complaint outcomes, subject to applicable requirements.
• To submit a complaint, receive a reference number, track the matter, and receive a response.
• To appeal or escalate dissatisfaction through the published route and, where applicable, to the Insurance Authority.
• To receive reasonable support through accessible service channels.

16. Consumer Responsibilities

• Provide complete, accurate, and current information.
• Review policy documents, benefits, conditions, exclusions, and service instructions.
• Disclose relevant information required for underwriting, eligibility, claims, approvals, or service delivery.
• Provide supporting documents promptly and cooperate with reasonable verification requests.
• Protect account credentials, passwords, and one-time passwords.
• Use services and complaint channels lawfully and avoid false, misleading, or fraudulent submissions.
• Notify the appropriate party of relevant changes to contact, eligibility, or policy information.

17. Governance and Continuous Improvement

Cigna Healthcare KSA will monitor customer feedback, complaints, service issues, root causes, and recurring themes to support corrective action and continuous improvement. Relevant functions should review material consumer protection risks, service failures, and regulatory concerns and maintain appropriate records and evidence.

18. Publication and Accessibility

These Consumer Protection Principles should be published as a clearly labelled page on the Cigna Healthcare KSA website. A direct link should be available from the homepage or website footer and positioned alongside the Privacy Policy, Terms of Use, Service Information and Beneficiary Rights, Frequently Asked Questions, Contact Us, and Complaints and Escalations pages. The required website presentation is set out in Appendix A.

19. Contact and Complaints

20. Review and Updates

These principles shall be reviewed at least annually, or earlier to reflect changes in law, regulation, products, services, customer needs, or business practices. The latest version and effective date will be published on this page.