SAUDI ARABIAN OIL COMPANY (Saudi Aramco) G. I.

NUMBER Approved
GENERAL INSTRUCTION MANUAL 151.001

ISSUING ORG. MEDICAL SUPPORT SERVICES DEPARTMENT ISSUE DATE REPLACES

06/01/2002 1/23/2002
SUBJECT: MEDICAL REFERRAL PLAN APPROVAL PAGE NUMBER
KGB Page 1 of 23

CONTENT:

This General Instruction outlines procedures and guidelines in the handling of patients medically or self
referred to non-company owned/operated medical facilities. It also outlines procedures for referrals within the
contracted medical facilities. The text includes:
1. Objective
2. Eligibility
3. Recommendation & Approval of Medical Referrals
4. Self Referrals
5. Medical Referral Committee (MRC)
6. Responsibility for Self Referrals
7. Social Insurance & Retirement Affairs Division, Employee Relations Services Department
8. ASC/Riyadh & Jeddah Government Affairs and other Company's agent offices
9. Pay Status
10. Transportation
11. Medical Expenses
12. Living Expenses
13. Cash Advance
14. Unused Tickets
15. Medical Expenses of Escorts
16. Medical Fiscal Affairs Division
17. Medical Referral SP Procedures
18. Expenses reimbursable for Self Referrals.
19. Expenses not covered for Self Referrals.
20. Processing Self Referrals claims.
21. Medical Designated Facility Referrals.
22. CDPNE, ASDPNE, Apprentice, COOP, Summer Students & EAP.
23. Oncology Treatment Center (OTC) Referrals.

1.0 OBJECTIVE:

The Company's objective is to provide medical care to its employees and their eligible dependents in
Company operated or designated hospitals. However, industrial and non-industrial cases of serious
/acute medical conditions which Company's medical facilities are not equipped to handle, or cases of
an emergency nature, precluding handling at company operated or designated medical facilities, may
be referred to outside hospitals or specialists. Rehabilitation cases are also considered for medical
referral if Medical Referral Committee expected the patient’s quality of life to be improved. This can
be measured by the patient’s ability to be independent to carry on the activities of daily living and to
re-integrate into his/her home community of family. However, it would be unrealistic to establish a
target of full rehabilitation in all cases to the capabilities, which existed before the illness or injury,
but the goal is to restore daily life as soon as possible relative to others similarly affected. To meet this
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GENERAL INSTRUCTION MANUAL 151.001

ISSUING ORG. MEDICAL SUPPORT SERVICES DEPARTMENT ISSUE DATE REPLACES

06/01/2002 1/23/2002
SUBJECT: MEDICAL REFERRAL PLAN APPROVAL PAGE NUMBER
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objective, the management in April 1981, to become effective in June 01, 1981, approved a Medical
Referral Plan.

2.0 ELIGIBILITY:

Saudi Aramco employees of all nationalities and their resident eligible dependents as specified in G.I.
151.004 (Eligibility for Medical Care) and Saudi Arab retirees and their spouses who are registered
with the Company before retirement date are covered by the Medical Referral Plan. U.S. Company
loanees and Tapline employees are also covered by the plan except that the U.S. Company involved
will be charged for all expenses if:

a) Any of the U.S. Company employees or their eligible dependents have been cleared with a pre-
existing condition disqualifying residence in Saudi Arabia.

b) Any of the U.S. Company employees or their eligible dependents have been cleared with a pre-
existing major medical condition which requires repatriation for medical treatment within six
months of arrival in Saudi Arabia.

The evaluation that the condition was pre-existing will be made by the Medical Referral Committee
(MRC) in SAO and its decision will be accepted by all concerned.

2.1 Accompanying Family Members: On an individual case basis, MRC may also authorize that
the patient, in the event of a referral, be accompanied by a member or members of his or her
family. In authorizing family accompaniment, consideration will be given to the Saudi culture,
nature of the medical problem, the age and relationship of the patient and family member(s).
When family members are authorized to accompany, their transportation cost and reasonable
living expenses will be borne by the Company.

3.0 RECOMMENDATIONS AND APPROVAL OF MEDICAL REFERRALS:

A. MRC Recommended Referral:

Recommendations or requests for Medical Referral or Self Referral will be made in writing to the
Medical Referral Committee, Saudi Aramco Medical Services Organization, Box 76, Dhahran, by the
Saudi Aramco specialist attending the case and/or the Personnel Department, Social Insurance &
Retirement Affairs Division, the employee's supervisor, Medical Fiscal Affairs Division, Medical
Designated Facilities Division or by employees themselves.

3.1 Requests for medical referral will be reviewed and when justified, recommended by the
Medical Referral Committee for approval by the General Manager, Clinical Services on form
SA-2462, Medical Referral Notice.

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SAUDI ARABIAN OIL COMPANY (Saudi Aramco) G. I. NUMBER Approved
GENERAL INSTRUCTION MANUAL 151.001

ISSUING ORG. MEDICAL SUPPORT SERVICES DEPARTMENT ISSUE DATE REPLACES

06/01/2002 1/23/2002
SUBJECT: MEDICAL REFERRAL PLAN APPROVAL PAGE NUMBER
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3.2 The approval for medical referral is given for a specific period and unless it is extended by
MRC, all benefits under the Medical Referral Plan cease at the expiration of this period or
discharge from attending physician care, whichever occurs first.

4.0 SELF-REFERRAL:

Under unusual circumstances, employees of all nationalities and Saudi Arab Retirees and their
spouses who are registered with the company before retirement date, may refer themselves or their
eligible dependents residing in Saudi Arabia to non-Company operated or designated medical
facilities for treatment of conditions that Saudi Aramco operated or designated facilities are equipped
to handle, provided the following conditions are met:
4.1 The undertaken treatment was necessary, justified and beneficial as perceived by the Medical
Referral Committee (MRC), and

4.2 The employee or dependent first made a reasonable effort to obtain treatment in Saudi Aramco
or designated facilities. Both requirements must be met, or:

4.3 The condition was serious justifying emergency treatment. Serious medical conditions are
defined as life threatening including maternity delivery.

4.4 Cost of medical emergencies arising during vacation or personal leave abroad or In-Kingdom
are not covered under this Plan.

5.0 MEDICAL REFERRAL COMMITTEE (MRC):

5.1 Membership:
The Medical Referral Committee will be comprised of medical specialists, one of whom will
serve as the Chairman. Committee members and the Chairman will be appointed by the General
Manager, Clinical Services.
5.2 Function:
The MRC reviews and recommends medical referrals to non-Saudi Aramco medical facilities for
approval of General Manager, Clinical Services. The MRC also reviews claims for self-referral
cost reimbursements and recommends their approval to the General Manager, Clinical Services.
The MRC's decisions are made on medical merit and in a manner that will be perceived as
consistent and fair. When considering referrals, the MRC will also take into consideration the
availability of such care in the employee's home country. Emergency medical cases may be
immediately approved for referral by the Committee Chairman who then informs the Committee
of his decision in the first committee meeting following that specific referral.
5.3 Responsibilities for MRC referred cases:

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GENERAL INSTRUCTION MANUAL 151.001

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SUBJECT: MEDICAL REFERRAL PLAN APPROVAL PAGE NUMBER
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5.3.1 Assists the General Manager, Clinical Services in accomplishing Corporate medical
objectives in an efficient manner.

5.3.2 Reviews and considers whether or not to approve medical cases recommended for
referral to or considered for self-referral at non-Saudi Aramco medical facilities for
diagnostic workup, further evaluations and/or inpatient/outpatient treatment.

5.3.2.1 The condition for which the referral is approved will be stated as clearly
as possible on form SA-2462 together with anticipated diagnostic or
treatment approach.

5.3.3 Approves the medical facility and/or specialist In-Kingdom or Out-of-Kingdom.

Expatriates will usually be repatriated to their home country, although certain
circumstances/specialty availability may dictate referral to another location. The
destination is decided by the MRC.

5.3.4 Decides on the need for and recommends medical and/or family escort(s) to
accompany the patient.

5.3.5 Considers any proposals to upgrade travel arrangements. Economy travel standards
will apply when approved class of travel is fully booked. Justification to upgrade:
patient's condition, unavailability of seating in economy or approved business class
when scheduled appointments/admissions will be missed if a later flight is taken,
timely return to duty of employee/medical escort or when a patient has a medical
escort to/from Riyadh/Jeddah and equipment or specialized medical attention is
required during flight.

5.3.6 Sets the period limit for which the referral is approved. This will be specified on form
SA-2462 and will include time required for diagnostic evaluation, inpatient/outpatient
treatment, discharge by attending physician, or SAO clearance but excluding time
required for convalescence. Extends or reduces the period by issuing supplemental
SA-2462s.

5.3.7 Reviews and decides on problems related to medical referrals, including authorization
and reimbursement of cost, subject to limitations of Company policy.

5.3.8 While benefits under the Medical Referral Plan as described in this instruction may
not be exceeded, the MRC may also at its discretion, restrict or limit these benefits in
certain cases.

5.3.9 Approved medical referral cases are processed by the Chairman of the MRC with the
assistance of the MRC, Coordinator, as indicated below:

5.3.9.1 Makes the appointment with the selected facility or specialist three the
Saudi Aramco representative in the area.

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GENERAL INSTRUCTION MANUAL 151.001

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5.3.9.2 Ensures that summaries, x-rays, slides, etc. are made available to the
patient.

5.3.9.3 Arranges, when necessary for Air Travel Fitness Certificate.

5.3.9.4 Arranges, when necessary for ambulance and medical escort.

5.3.9.5 Prepares Medical Referral Notice, form SA-2462 in six copies and
distributes as follows:
Original - Social Insurance & Retirement Affairs Division.
2nd Copy - Patient file
3rd Copy - MRC file
4th Copy - Medical Fiscal Affairs Division
5th Copy - Aramco Agents/ASC/MDFD (Whichever is applicable)
6th Copy - Personnel

The form will be assigned a referral number and will be approved by the General
Manager, Clinical Services.
5.3.9.6 Receives medical information on the patient's condition from attending
physician or medical facility and provide one copy to referring physician
and one copy to patient's medical file.

5.3.9.7 Arranges follow-up care in SAO or outside as requested by the referring

physician and approved by MRC.

6.0 RESPONSIBILITIES FOR SELF-REFERRALS:

Upon receipt of Self-Referral claim will:

6.1 Review the claim in conjunction with employee's memo, medical reports and the attached
related documents/comments to determine:

6.1.1 If the employee first made efforts to obtain treatment in Saudi Aramco operated or
designated facilities.

6.1.2 The treatment received was necessary, justified and beneficial.

6.2 Examine the patient if required.

6.3 If employee has expressed dissatisfaction with treatment received in Saudi Aramco-operated or
designated facilities or has complained about difficulties in obtaining treatment at Saudi
Aramco medical facilities, the MRC may interview the employee to discuss the problems. If
there is a misunderstanding on the part of the employee, efforts will be made by the MRC to
clarify it. If a problem situation is determined, the MRC will take action to correct it.

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GENERAL INSTRUCTION MANUAL 151.001

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SUBJECT: MEDICAL REFERRAL PLAN APPROVAL PAGE NUMBER
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6.4 Whether the claim is approved or rejected, the MRC's decision will be issued in the form of a
memo addressed to the office that had originated the request for review by the MRC.

6.4.1 If the claim is rejected completely, or in part, a comprehensive explanation of the

reasons for rejection will be given in the decision.

6.4.2 If the claim is partially approved, the part approved and the part rejected will be
clearly identified.

6.4.3 Days approved for purpose of disability time if employee is the patient or, "P" time if
employee's escorting the patient is approved, will be indicated by Medical Referral
Committee.

6.4.4 Forward a copy of the MRC’s decision and all original documents submitted with the
claim, to Medical Fiscal Affairs Division if the claim is approved.

7.0 SOCIAL INSURANCE & RETIREMENT AFFAIRS DIVISION (SI&RAD),

EMPLOYEE RELATIONS SVCS DEPT:

For MRC Referred cases:

On receipt of approved Medical Referral Notice, form SA-2462, SI&RAD will initiate the following
actions on all cases irrespective of payroll or nationality:
7.1 Informs employee and employee's department of referral decision.

7.2 Initiates and approves Passport Clearance and Company Purchased Airline Ticket form (SA-
5973A) charging the assigned SP account for patient and approved family escort travel. A copy
of the form should be provided to Medical Fiscal Affairs Division.

7.3 Contacts patient and escort for completing passport, visa and travel requirements in cooperation
with the Passport & Permits Office, Personnel Department.

7.4 Issues SA-60 in the name of employee for (except that Saudi Aramco retirees and their spouses
who are registered with the company before retirement date are not eligible for cash advance
payment (See Para 13.1 below):

7.4.1 Advance payment, which should not exceed referral limitation of living per diem for
each patient/escort referred to ASC charging account 10-401-05. Similar payment, if
justified, may be made for patients/escorts referred to Riyadh/Jeddah charging the
assigned SP account. (See Section 12 for rates and details).

7.4.2 Cash advance, which should not exceed referral limitation stated on form SA-2462,
for patients/escorts referred to other locations, charging account 10-401-10.

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GENERAL INSTRUCTION MANUAL 151.001

ISSUING ORG. MEDICAL SUPPORT SERVICES DEPARTMENT ISSUE DATE REPLACES

06/01/2002 1/23/2002
SUBJECT: MEDICAL REFERRAL PLAN APPROVAL PAGE NUMBER
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7.4.3 Settlement of living per diem for patients returning from referral in Riyadh/Jeddah
charging the assigned SP account.

7.4.4 Notifying the appropriate Saudi Aramco Office by telex/fax of the amount paid in
advance and forwards a copy of all Payment Authorizations (SA-60) initiated by them
to the Medical Fiscal Affairs Division.

7.5 Advises employee and employee's department on accrued employee disability benefits,
approved "P" time, etc., for time keeping purposes. (Section 9 on "Pay Status"). Notify
employee's department of adjustments, as necessary, after the employee returns from referral.

7.6 Issues a Referral Guide (SA-9078) in the name of the employee explaining benefits available to
the employee under the Medical Referral Plan; its extent and limitations as related to pay status;
medical, living and transportation expenses; authorized escorts; cash advance; and information
on travel and assistance while at the point of referral. Acknowledgment from patients/escorts
should be obtained on the referral guide.

7.7 Explains to U.S. and Canadian employees, in writing, application of Medical Payment Plan.
Supplies them with insurance company claim forms.

7.8 Provides a memo to patient escorts describing their responsibilities towards the patient and the
type of expenses which will be absorbed by Saudi Aramco on behalf of the escort.

7.9 Coordinates with ASC/Saudi Aramco Representatives/Riyadh/Jeddah Government Affairs

Offices, or other Saudi Aramco designated offices, as appropriate, patient arrival at the point of
referral, lodging and assistance required on arrival.

7.10 Issues airline tickets, cash advance (if any) medical reports, X-rays, referral guide and any other
necessary documents to the patient and/or escort.
For Self-Referred Cases:

7.1 Records and forwards, on receipt from the employee, all claims to the MRC together with their
comments and copies of all attachments including medical reports, bills and receipts, etc.

7.2 Receives approval or rejection notice on the claim from the MRC and communicate this to the
employee.

7.2.1 If the claim is rejected, discuss the reasons for rejection with the employee and return
claim documents to the employee.

7.2.2 If the claim is approved, communicates to the employee's department the number of
days that should be converted to "M", "K", "L" or "P" time as approved by the MRC.

7.2.3 If the claim is approved, forwards original receipts to Medical Fiscal Affairs Division.

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SUBJECT: MEDICAL REFERRAL PLAN APPROVAL PAGE NUMBER
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Initiating Claim for Self-Referral Reimbursement: (Employee Responsibilities)

7.1 Initiates a memo addressed to Social Insurance & Retirement Affairs Division, Medical Fiscal
Affairs Division, explaining the circumstances under which the employee or his/her eligible
dependent was treated in outside facilities. The following information should be provided in
the memo:

7.1.1 Reasons for seeking treatment in outside facilities and a description of the nature of
health problem and symptoms noticed.

7.1.2 Efforts made to obtain treatment at Company operated or designated facilities should
be explained in detail.

7.1.3 Name and address of the hospital or physician who treated the patient.

7.1.4 State exactly the amount and currency claimed for reimbursement in total with
breakdown for medical and transportation expenses.

7.2 Attach the following documents to the memo:

7.2.1 Doctor's report, if any, describing diagnosis, symptoms, history, treatment given and
surgery performed.

7.2.2 Other medical reports, such as lab reports, X-ray reports, etc.

7.2.3 Hospital bill, detailing dates of admission/discharge and itemized expenses.

7.2.4 Bills of professional services such as physician, surgeon, anesthesiologist, radiologist,

pathologist, etc.

7.2.5 Bills of other medical hospital services, supplies and medications.

7.2.6 Original receipts of bills paid or canceled checks.

8.0 ASC/SAUDI ARAMCO REPRESENTATIVE, RIYADH/JEDDAH SAUDI

ARAMCO GOVERNMENT AFFAIRS OFFICES: (MRC referred cases only)

NOTE: At locations (OOK) where ASC services are not available, such as London and Manila, the
Medical Organization may make alternate arrangements with local agencies. The services
performed by such agencies will be governed by their contracts. Their functions will
generally be the same as listed below for ASC and Riyadh/Jeddah offices but may be
limited.
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SUBJECT: MEDICAL REFERRAL PLAN APPROVAL PAGE NUMBER
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ASC/Saudi Aramco Representative and Riyadh/Jeddah Government Affairs Offices will:

8.1 Assist MRC in setting up appointments with specialists, scheduling admissions to hospitals and
arranging for immediate lodging and transportation for patient and escort.

8.2 Assist patient and escort while on referral in every way possible including obtaining of
treatment, housing, living, and provision of cash advance or living allowance as described
under Sections 12 and 13.

8.3 Lease or rent accommodation or arrange for a direct payment to hotels for reasonable room cost
only at approved location, to accommodate patients and escorts. Account 742-512 will be
charged and adequate documentation supporting charges will be provided.

8.3.1 When direct payment to hotels is arranged, Saudi Aramco will pay room cost only.
Saudi Aramco will not pay bills for meals, personal telephone calls, or other incidental
expenses at the hotel. These should be paid by the patients and escorts from the living
per diem provided to them. If circumstances warrant payment of bills for incidental
expenses, these will be deducted from the living per diem or charged to the
employee's personal account in SAO if it exceeds the per diem entitlement.

8.4 Provide patients and escorts in Houston with living per diem at appropriate intervals and at
rates specified in Section 12, charging account specified on SA-2462. Patients and approved
medical escorts are entitled for living per diem from the date of arrival, up to the period
approved by the MRC on form SA-2462, or discharged from physician care, whichever occurs
first, plus a justifiable travel delay. Initially, they will be provided with a maximum of 14 days
each per diem allowance as a cash advance if requested in SAO prior to their departure. ASC
will provide per diem for the remaining period (if any).

8.4.1 Unused per diem paid in advance will be adjusted by ASC directly from the
employee's personal account in SAO, including per diem paid in advance by the
Social Insurance & Retirement Affairs Division.

8.5 Provides patients and escorts, who are referred to other locations in USA, Canada, Manila and
UK, a cash advance for living and lodging expenses at rates specified in Section of 12.5
charging account 10-401-10. A maximum of 14 days cash advance is given in SAO prior to
their departure. ASC/Saudi Aramco Representative will obtain authorization from the Medical
Fiscal Affairs Division for additional cash advance, up to the approved referral period by
providing the following information:

8.5.1 Employee I.D. number.

8.5.2 Names of patient and escort(s).

8.5.3 Date arrived at point of referral.

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8.5.4 Date patient admitted to hospital or is expected to be admitted to hospital.

8.5.5 Date patient discharged or expected to be discharged from hospital.

8.5.6 Date outpatient treatment is expected to be completed (if no hospitalization is

involved).

8.5.7 Date patient and escort(s) are expected to be cleared for return to Saudi Arabia.

8.5.8 Number of days for which living allowance has been paid to:
- patient
- escort(s)
8.6 Keeps Medical Referral Office informed of patient progress. If treatment is anticipated to be
extended beyond approved period, MRC should be requested to consider approving extension
of period.

8.7 Pays medical bills on behalf of SA, UK and AOA patients and the balance of bills not covered
by insurance on US/CAN patients to the assigned SP account.

8.8 Transmits, on completion of treatment, the following information to Fiscal Affairs Division by
telex/fax with a copy to SI&RAD:

8.8.1 Employee's I.D. Number

8.8.2 Patient's name and relation

8.8.3 Escort(s) name and relation

8.8.4 Date patient/escort(s) arrival (at point of referral)

8.8.5 Date patient admitted to hospital

8.8.6 Date discharged from hospital

8.8.7 Date outpatient treatment started

8.8.8 Date outpatient treatment completed

8.8.9 Date discharged from attending physician’s care

8.8.10 Date of patient departure

8.8.11 Date of escort(s) departure

8.8.12 Reason for delay

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8.8.13 Expense charged to the assigned SP account Days Amount

Living per diem - Patient:

- Escort(s):
Lodging cost:
Medical expense:
8.8.14 Cash advance charged to 10-401-10.

8.9 Saudi Aramco Office in Houston, Company representatives in other locations and Social
Insurance & Retirement Affairs Division Offices in SAO will exercise appropriate controls and
review procedures to assure conformity with policy and accuracy of payments. Adequate
records and files will be maintained to substantiate charges made to the assigned SP account on
individual patients.

8.10 In emergency situations, during weekends/holidays and after office hours, the Riyadh & Jeddah
Offices will, when necessary, issue hospital introductory letters and make payments of living
per diem through their petty cash fund on form SA-314. A copy of forms issued will be
forwarded to Social Insurance and Retirement Affairs Division for follow-up.

8.10.1 Saudi Aramco's Government Affairs office in Riyadh will receive medical bills from
KFSH/KKESH and ensure that each payment is supported by a copy of the
introductory letter issued by Social Insurance & Retirement Affairs Division and/or
Riyadh Government Affairs and forwards them to Medical Fiscal Affairs Division for
review and approval of payments.

9.0 PAY STATUS:

9.1 Employees who are on medical referral or approved for self-referral will be authorized medical
time off. The expected duration of the treatment should not exceed 365 days (it is a factor to be
considered before the referral is approved), less the number of ‘M’ days already used.
Employees are either medically terminated or declared permanently and totally disabled beyond
that point.

9.2 Employees on return from medical referral will immediately report to their clinics to obtain
Medical Aid Request, form SA-155 for release to duty or continued off-duty. The form must
be signed by a Saudi Aramco attending physician or Medical Designated Facilities Regional
Unit physician.

9.3 An employee who is approved to accompany a patient on medical referral or self-referral is

eligible for "P" time (leave with pay). The number of days will be determined on the following
basis

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9.3.1 The Medical Referral Committee may authorize up to maximum of 90 days of P time
at full pay for an authorized employee escort.

9.3.2 Following the utilization of the above P time, the authorized accompanying employee
may choose to use his available vacation credit or take X time. The total absence,
including P, L, and X time must not exceed one year.

9.3.3 "P" time cannot be granted to more than one escort at one referral per each referral.

9.3.4 Days approved for purposes of disability time off, if employee is the patient, or "P"
time if employee is escorting the patient will be indicated by the Medical Referral
Committee.

10.0 TRANSPORTATION (for MRC referred cases):

When a medical referral is approved, transportation costs to/from the point of referral will be borne by Saudi Aramco for
the patient, authorized accompanying family members and/or necessary accompanying medical staff as follows:
10.1 Travel by commercial airlines will be in accordance with the Company-paid business travel
policy contained in Chapter 16 of the Industrial Relations Manual. In cases where travel class
upgrade is required (see Section 5.3.5), the authorization for upgrading is recommended by the
Medical Referral Committee and approved by the General Manager, Clinical Services on the
Medical Referral Notice (form SA-2462). A Passport Clearance and Company Purchased
Airline Ticket form (SA-5973A) will then be initiated and approved by the Director, Employee
Relations Services Department upon receipt of approved form SA-2462. If In-Kingdom airline
travel is not available or if patient condition does not permit air travel, the patient/escort may
elect to use alternate transportation and be reimbursed based upon actual receipts or in
accordance with rates approved for use of a Saudi Aramco service vehicle. Escort(s) will
utilize the same class of travel as authorized for the patient. Escorts traveling without the
patient will travel economy class. Tickets will be purchased by Saudi Aramco and charged to
the assigned SP account. Patients who are approved for referral in conjunction with vacation or
personal leave may be allowed to buy their own tickets for domestic travel and claim
reimbursement of cost thereafter.

10.2 When medical referral travel is in conjunction with an employee's vacation or personal leave,
maximum reimbursement for such travel is limited to the added cost of travel over that incurred
for personal travel or that provided by the Personnel Department to the employee for vacation
travel.

10.3 Local transportation to Eastern Province medical facilities is via the Company's scheduled bus
service. When a taxi is authorized, reimbursement is made in accordance with rates approved
for the use of Saudi Aramco service vehicles.

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11.0 MEDICAL EXPENSES FOR MRC REFERRED CASES:

Saudi Aramco will pay medical costs as described below, associated with diagnostic work-up and treatment of the condition
for which referral has been approved. Consultation, diagnostic work-up or treatment undertaken by the patient for any
other condition or at his/her own initiative without prior approval of the Medical Referral Committee will be at the
employee's own cost and responsibility.
11.1 Payment of medical expenses for US/Canadian patients will first be made by their insurance
companies, with any excess then paid by Saudi Aramco. All medical expenses of Saudi Arab
and other expatriate patients, not covered by insurance, will be fully paid by Saudi Aramco.

11.2 ASC will make payments on medical bills after reviewing them for accuracy and
reasonableness. The SP account number, as specified on form SA-2462, will be charged; and
the patient's name, employee badge number, and referral number will be shown on all medical
bills paid.
The Riyadh Government Affairs Office will review KFSH/KKESH invoices for accuracy and
compliance with the medical referral guidelines and eligibility for medical care (G.I. 151.001
and G.I. 151.004 respectively). Invoices will then be forwarded to Medical Fiscal Affairs
Division for approval of payments.
At other locations, Saudi Aramco Offices or designated agents will review and pay medical bills, and charge Saudi
Aramco through established procedures, or forward them to Medical Fiscal Affairs Division for approval of
payments.
11.3 Financial (Receivables) Accounting will forward debit memos received from ASC to the
Medical Fiscal Affairs Division for approval. ASC debit memos must be endorsed by the
Medical Fiscal Affairs Division before charging to medical account. Medical invoices received
by Accounting from other Saudi Aramco offices, agents, or other hospitals, will also be
forwarded to the Medical Fiscal Affairs Division for approval before being charged.

11.4 U.S. and Canadian patients, who are covered by the Medical Payment Plan, will complete the
insurance forms and instruct the hospital or doctor involved to forward the medical bills first to
the employee's insurance company. Portions of medical bills, if any, not covered by insurance
will be paid by ASC and charged to the assigned SP account.

11.5 Under unusual circumstances, when the employee has paid the medical bills directly,
reimbursement may be claimed by the employee on Expense Report (SA-165). Original bills
of itemized charges and receipts of payments made, or canceled checks, should be produced.
US/Canadian employees will first claim reimbursements from their insurance company and
then from ASC for the uncovered portions.

11.6 Cost of dental treatment (except that which is referred in conjunction with the treatment of
medical referrals), dental prosthetic appliances, eye refraction, prescription glasses, hearing
aids, cosmetic procedures, chiropractic treatments, podiatry, herbal therapy, speech therapy,
infertility clinics, acupuncture, transplants (excluding cornea) and procedures performed by
non-physicians, unless prior authorization is specified by the MRC, will not be paid by Saudi
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Aramco. Also, in-hospital expenses of a personal nature, such as in-hospital guests/extra

meals/telephone calls etc., will be borne by the employee. Cost of local telephone calls made
by patients while admitted to In-Kingdom hospitals may be absorbed up to SR.200/- per month
per referral by Saudi Aramco. The MRC is authorized to recommend out-of-policy referrals for
exceptional procedures for approval by the General Manager, Clinical services when justified.

12.0 LIVING EXPENSES FOR MRC REFERRED CASES:

While patients and approved medical escort(s) are on authorized medical referral, they will either be
furnished paid accommodation or will be reimbursed for reasonable costs. They will also be provided
a daily per diem allowance to subsidize living costs. The period of coverage will be limited from the
date of arrival at the point of referral to the date of discharge from attending physician care or the
period approved by the Medical Referral Committee, whichever is less. Hospitalized patients are not
eligible for living and lodging allowances; neither are escorts living in the hospital while Saudi
Aramco is paying their room and living expenses at the hospital.

12.1 Patients and escorts referred to Riyadh, Houston or London may be provided free housing in
Saudi Aramco-leased or rented accommodation. Similar arrangements may be made at other
locations at Saudi Aramco's discretion. If free housing is provided, they are not eligible for
lodging per diem daily rates, only living per diem is payable.

12.2 Patients and escorts may be allowed to arrange their own accommodation when company-
provided accommodation is not available. In such cases, employees may claim reimbursement
of actual cost of lodging on the basis of bills paid, or accept the combined living and lodging
per diem as specified in Section 12.5. For Out-of-Kingdom referral claims, reimbursements
will be made on form SA-165 to Medical Fiscal Affairs Division.

12.3 Patients and escorts residing in their point of origin during referral will not be eligible for
lodging per diem; only hotel bills will be considered for reimbursement of lodging cost.

12.4 Living Expenses Per Diem:

Patients and escorts will be given an unaccountable per diem allowance to subsidize the cost of
meals, food, laundry, local transportation, local telephone, tips and other incidental expenses.
Payments of per diems will be made by the Saudi Aramco Office in the area of referral in
reasonable advance installments. Cash advance payments of per diems may be made in SAO
by SI&RAD for patients referred Out-of-Kingdom.

For referrals to Riyadh and Jeddah, payments of per diems will usually be made by SI&RAD
upon patient's return from referral. Riyadh & Jeddah offices will make payments of per diems
only if the conditions specified in Section 8.10 above are met.

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Payments made for the living expenses per diems to Riyadh, Jeddah or ASC referrals will be
charged to the specified SP account on form SA-2462. Payments will be unaccountable and
will not require preparation of expense report.

* The rates of a daily living expense per diem, per person, are as follows:

Saudi Arabia US/Canada U.K. Other

Locations
SR US$ £STG SR
Adult Patient/ Escort 220 70 70 220
Child Patient/ Escort 120 40 40 120
(Under 12)

12.5 Living Plus Lodging Expenses Per Diem:

When Saudi Aramco does not provide free accommodation, and patients and escorts are
substantiated by bills paid, plus living expenses per diem specified in Section 12.4 above.

Employees may elect to receive the combined per diem for daily living expenses and lodging in
lieu of submitting bills and receipts for lodging cost reimbursement. Employees, in such cases,
will be given an accountable cash advance equivalent to the living plus lodging per diem.
Upon patient's return from referral, the employee will be required to account for and clear the
cash advance by submission of an Expense Report (SA-165). Refer to Section 8 for handling
of cash advance.

* Rates of a daily living plus lodging expenses per diem, per person, are as follows:

Saudi
Arabia US/Canada U.K. Other
Locations
SR US$ £STG SR.
Adult Patient/ Escort 440 140 140 440
Child Patient/ Escort 240 80 80 240
(Under 12)

Above per diems are not applicable if the medical referral is at the patient's point of origin, in
which case only living per diem and hotel bills are considered for reimbursement (refer to
Section 12.3).

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13.0 CASH ADVANCE FOR MRC REFERRED CASES:

13.1 Patients and escorts who are not provided free accommodation at the point of referral will be
given a reasonable cash advance except that Saudi Aramco retirees and their spouses who are
registered with the company before retirement date are not eligible for cash advance payment.
Instead, they need to submit expense reports upon their return to SAO for their reasonable
incidental expenses for reimbursement, supported by proper receipts. All cash advance
payments will be charged to account 10-401-10.

13.2 Initial cash advances, except for Houston referrals, will be made by SI&RAD for a maximum
of 14 days or up to the approved referral period as mentioned on form SA-2462 and will be
calculated at the per diem rate specified in Section 12.5. Subsequent cash advances will be
made by the appropriate Saudi Aramco Office upon authorization received from the Medical
Fiscal Affairs Division.

13.3 Upon return from the referral, the employee will submit an Expense Report (SA-165) for the
patient and eligible escort to the Medical Fiscal Affairs Division to clear the cash advance.

13.4 Receivable Accounting will provide the Medical Fiscal Affairs Division with a monthly sub-
ledger of account 10-401-10 listing advances made to each employee.

13.5 In accordance with the established Company procedure on follow-up of uncleared cash
advances, employees who fail to make an Expense Report and clear cash advances within a
month after their return from referral will be sent a deduction notice. If no Expense Report is
turned in within a month from the time the notice is issued, the full amount of cash advance
will be deducted from their salary.

14.0 UNUSED TICKETS:

Patients and escorts should return used or unused portions of air tickets to Medical Fiscal Affairs
Division or Social Insurance & Retirement Affairs Division who in turn will forward them to the Rates
& Invoice Verification Unit, Materials Traffic Dept., Bldg: 3124, Room 225, Dhahran to claim, if
applicable, a refund.

15.0 MEDICAL EXPENSES OF APPROVED ESCORTS (for MRC referred cases):

Saudi Aramco will pay medical expenses of escorts for emergency medical treatment while they are
accompanying a patient. Emergency condition is defined as life threatening. Payment may be made
directly to the doctor or hospital by ASC, Saudi Aramco Representative or Riyadh Government Affairs
Office after satisfying that emergency medical attention was justified, or the employee may claim
reimbursement on an Expense Report upon return from the referral. Such claims supported by a

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doctor's report, detailed medical bills and receipts of payments made, should be forwarded to the
Medical Fiscal Affairs Division.

16.0 MEDICAL FISCAL AFFAIRS DIVISION:

Medical Fiscal Affairs Division will:

16.1 Authorize, control and clear all cash advances:

16.1.1 Approval of cash advances (other than initial cash advance made by Social Insurance
& Retirement Affairs Division) will be made via telex/fax authorization through the
Treasurer's Operation Department

Cash advances for patients in Manila, if justified and recommended by the MRC, will
be made against the revolving fund maintained by the Company agent.

16.1.2 Keep records of cash advances made, and follow up with employees to clear them.
Account 10-401-10 will be used to record cash advance payments. An Expense
Report (SA-165) will be used to settle related expenses and clear the cash advance.

16.2 Review and approve Expense Reports and other claims of medical referral related expenses
submitted by employees.

16.3 Budget and prepare accountability on referral plan activity. Account 742-512 (Medical
Referral Program) will be used to record all costs of Medical Referral Plan.

16.3.1 Examine and approve invoices and other Credit/Debit memos prior to booking.

16.3.2 Review other documents to ensure accuracy of amounts charged to A/C: 742-512.

16.3.3 Conduct, review and analyze of cost data to ensure conformity with policy.

16.4 Answer inquiries on charges and policy matters of the plan, and coordinates with other
organizations to assure smooth and efficient application of the plan.

16.5 Keep statistical and cost records on all medical referrals, and issues periodical reports.

17.0 MEDICAL REFERRAL SP PROCEDURES:

Special Project (SP) Account type code 67 was established in 1986 to provide a useful manner of
accumulating costs by individual medical referral case.

The SP account is assigned by Ledger Accounting on a yearly basis as requested by the Medical Fiscal
Affairs Division.
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17.1 OBJECTIVES:
The objectives of opening an SP account are to have the following advantages:
17.1.1 Cost of each referral will be available at all times.

17.1.2 To analyze costs, especially in reviewing for omission and duplication of charges.

17.1.3 Cost comparison and control.

17.2 HOW SP WILL OPERATE:

17.2.1 Ledger Accounting will assign to the Saudi Aramco Medical Services Organization
(SAMSO) SP account, type code 67, for each year.

17.2.2 SP system will operate by numerically. Thus, the numbers assigned by Ledger
Accounting per each SP block broken down in many stages to identify location for
information and convenience.

17.2.3 The SP sub-number will be given to each referral from the assigned block of each
location in serial number irrespective of nationality.

17.2.4 The four numerical digits in the referral invoice include a number representing the
year in which the referral was made. For example, in the number SR-LON-4841 the
'4' represents 1994.

17.2.5 Ledger Accounting will be requested on Special Project Notice SA-690 to open SP for
each referral. Without sending SA-690 or blanket letter signed by the Administrator
of the Medical Fiscal Affairs Division to Ledger Accounting, SP for referrals cannot
be opened or canceled. Several referrals at a time can be included on SA-690 or a
blanket letter to Ledger Accounting.

17.3 UNUSED NUMBERS:

Unused referral numbers will be utilized when assigned block has been totally used and more numbers are required
in the current year. In other words, some numbers are kept in reserve for emergency use.

17.4 MEDICAL REFERRAL COORDINATOR:

17.4.1 Assigns the referral number for each referral from the assigned block to the Referral
location.

17.4.2 Puts the SP number on the Medical Referral Notice (SA-2462) in the column
"Account Number" on each referral.

17.4.3 Informs the Medical Fiscal Affairs Division of the issuance/cancellation/change of

each referral to open or close SP number.

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17.4.4 Writes the SP number on patient/escort's travel order and each out-going referral telex,
fax, etc.

17.4.5 Keeps a log and control on each issued/canceled referral.

17.4.6 Issues supplemental referrals for those referrals which have SP numbers. The Medical
Fiscal Affairs Division does not need to use SA-690 for supplemental referrals.

17.5 MEDICAL FISCAL AFFAIRS DIVISION:

17.5.1 Charges each referral cost to the related SP account instead of A/C 742-512. Puts the
entry code wherever possible with SP numbers.

17.5.2 Reviews sub ledger cost reports and cost sheets for accuracy of charges.

17.5.3 Initiates an SA-690 or writes a letter to open or close an SP account and forwards it to
Ledger Accounting.

17.5.4 Charges all patient and escort expenses which are related to medical treatment, travel,
per diem, service fee, nurse and physician escort to the assigned referral SP account
instead of A/C 742-512 and give the referral entry code, nature of expense and
location.

17.5.5 Credits refunds (e.g. air ticket refund) to the related SP account.

17.5.6 Informs Accounting by SA-690 or letter of referral SP Account closure/cancellation.

17.5.7 Obtains SP account numbers, each year, and informs the Medical Referral Committee.
If the assigned block of the SP is totally used before the end of the year, a new SP
series will be requested to cover the remaining period of that year. In this case, an
alphabetical prefix will be used to differentiate between the two SP series, for
example, SR-US-B961.

17.5.8 Coordinates with the Medical Referral Committee, Social Insurance & Retirement
Affairs Division, Accounting, ASC and other Aramco agents about SP related
functions.

17.6 SOCIAL INSURANCE & RETIREMENT AFFAIRS DIVISION:

17.6.1 Charges per diem and travel cost to the appropriate SP account as shown on form
Medical Referral Notice SA-2462.

17.6.2 Charges initial cash advances to A/C 10-401-10.

17.6.3 Credits air ticket refunds to the appropriate SP account.

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17.6.4 Charges per diem payments for In-Kingdom referrals to the appropriate SP account.

17.7 OTHER:

17.7.1 Leased apartment rent will be charged to A/C 742-512.

17.7.2 In-Kingdom medical invoices will be charged to the appropriate SP account.

17.8 ASC:

17.8.1 Charges all referral related costs to the appropriate SP account instead of account 742-
512 uses proper entry code with SP number to identify nature of expenses.

17.8.2 Charges per diem, medical bills, hotel and transportation expenses to the appropriate
SP account on each referral.

17.8.3 Charges cash advances to account 10-401-10.

18.0 EXPENSES REIMBURSABLE FOR SELF-REFERRALS:

The following expenses, as determined justified by the MRC, may be reimbursed under the plan:

18.1 Saudi and Expatriate employees except U.S. Canadian Dollar:

18.1.1 One-hundred percent (100%) of diagnostic work and treatment unless otherwise
specified.

18.1.2 Eighty percent (80%) of surgery cost, including surgeon, consultant, anesthetist fees,
anesthetics and their administration, operating room and recovery room.

18.1.3 Sixty-five percent (65%) of transportation cost including justified family escort as
determined by the MRC. Transportation costs will not be reimbursed if treatment is
taken in connection with authorized vacation.

18.2 U.S. and Canadian Employees covered by Medical Payment Plan:

18.2.1 Under the Medical Payment Plan, the Insurance Company pays eighty percent (80%)
of covered medical expenses which exceed the cash deductible. Charges for second
and third surgical opinions, outpatient surgery and pre-admission tests related to the
performance of scheduled surgery prior to confinement as a resident inpatient are
covered in full. No reimbursement is made by Saudi Aramco.

18.2.2 Sixty-five percent (65%) of transportation costs if treatment is not taken in

conjunction with authorized vacation.

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19.0 EXPENSES NOT COVERED FOR SELF-REFERRALS:

The following expenses are not covered under Self-Referred Cases:

19.1 Living expenses, including lodging, meals, taxis, telephone, laundry, etc., are not reimbursed.

19.2 Cost of dental treatment, dental prosthetic appliances, eye refraction, prescription glasses,
cosmetic procedures, chiropractic treatments, podiatry, herbal therapy, acupuncture, learning
disabilities, temporomandibular joint, pain clinics, infertility clinics, long-term referrals to
including speech and certain rehabilitation therapy, and procedures performed by non-
physicians without Saudi Aramco authorization will not be reimbursed by Saudi Aramco.
Expenses of a personal nature, such as in-hospital guests/extra meals/telephone calls, etc., will
also be deducted from the employee's own account.

20.0 PROCESSING SELF-REFERRAL CLAIMS:

Medical Fiscal Affairs Division:

20.1 Records the claim when received from the MRC.

20.2 Reviews bills and receipts with reference to this policy, the MRC decision and SI&RAD
comments.

20.3 Determines SI&RAD expenses reimbursable.

20.4 Initiates an SA-60 in the name of employee for the amount recommended for reimbursement,
charging SP.

20.4.1 The SA-60 will be approved by the Director, Medical Support Services Department
and forwarded to Payable Accounting with medical bills and receipts attached:

20.4.2 If bills or receipts contain confidential information, the originals will be retained by
Medical Fiscal Affairs Division and copies with confidential parts blocked out, will be
attached to the SA-60. A note will be made on the SA-60 or on the copies of bills that
originals have been retained by Medical Support Services Department for
confidentiality.

20.5 Returns the claim and all attachments to the Social Insurance & Retirement Affairs Division, if
the claim has been rejected by the MRC or Medical Support Services Department for lack of
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proper receipts, bills, and satisfactory evidence of expenses incurred, or for expenses not
covered under the Self-Referral Medical Claims policy. A memo explaining the reason for
rejection should accompany the claim.

21.0 MEDICAL DESIGNATED FACILITIES DIVISION REFERRALS:

Medical designated referrals are handled as follows:

21.1 Patients referred by the MRC to In-Kingdom or Out-Of-Kingdom medical facilities other than
contracted medical facilities will be considered normal referral and handled under the general
terms and conditions of the Medical Referrals Plan.

21.2 Intra-Regional Medical designated referrals (e.g. referrals from one region to another region
within the contracted medical facilities):

21.2.1 Employees will arrange their own transportation, living, lodging and claim on per
diem rates as specified in paragraphs 12.4 and 12.5 above as applicable, except for
remote areas, when MDFD will provide air tickets for patients and escorts through
Aramco Global Travel.

21.3 Medical designated facilities referrals within the same region:

21.3.1 Employees will only be reimbursed for the associated transportation cost in
accordance with the following:
A. Actual economy class airfare based on ticket stubs submitted for reimbursement.

B. Actual taxi fare based on payment receipt.

C. If taxi receipt or ticket stubs are not available, reimbursement will be made on equivalent
economy class airfare cost R/T.
21.3.2 Paragraph 21.2 above is applied if the attending physician recommends an overnight
stay

21.4 All medical designated facilities reimbursement claims are to be submitted by the employees to
the respective regional Medical Designated Facility Unit head for review and forwarding to the
Chief, Medical Designated Facility for recommendation, who will forward to the Medical
Fiscal Affairs Division for further review and payment approval by the Director, Medical
Support Services Department.

22.0 CDPNE, ASDPNE, Apprentice, COOP, Summer Students & EAP.

22.1 Industrial Relations Manual Chapters 5 & 14 and G.I. 151.004 define eligibility.

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22.2 All non-dependents, non-employees medical referrals are subject to the discretion of the
Company.

23.0 ONCOLOGY TREATMENT CENTER (OTC) REFERRALS.

23.0 Patients referred to the Oncology Treatment Center (OTC), Dhahran Health Center for
treatment and who live 150 kilometers from Dhahran are eligible for a per diem payment as
follows:

Adults: SR 400.00 per day (excluding weekends)

Children: SR 200.00 per day (excluding weekends)

The Oncology Services Division, upon approval by the Director, Clinical Medicine
Department, will issue an authorization form to the Medical Fiscal Affairs Division to cover the
patient’s treatment period.

The Medical Fiscal Affairs Division will issue SA-60 to cover the per diem allowance.

The Social Insurance and Retirement Affairs Division will handle the timekeeping of OTC
patients and their escorts.

Recommended: Recommended:

___________________________________ _____________________

Administrator, Medical fiscal Affairs Division. Director, Medical referrals

Concurred: Concurred:

_________________________________ ___________________________
Director, Employee Relations Services Dep. Director, Medical Support Services Dep.

Endorsed:

_________________________________________
Director, Employee relations policy & planning Dep.

Approved:

___________________________
Vice President, Medical Services.
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