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| Schedule of Benefits |
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MEDICAL : BASIC - HOSPITALISATION
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PLAN 350
(RM)
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PLAN 200
(RM)
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PLAN 150
(RM)
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PLAN 80
(RM)
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1. In - Hospital Care |
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1.1 Hospital Room & Board |
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(i) Ordinary Room |
350
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200
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150
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80
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( up to 120 days max per disability ) |
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(ii) Intensive Care |
500
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350
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350
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350
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( up to 20 days max per disability ) |
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1.2 Hospital Miscellaneous Services |
Full Reimbursement
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1.3 Surgical Fees |
Full Reimbursement
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1.4 Anesthetic Fees |
Full Reimbursement
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1.5 Operating Theatre Charges |
Full Reimbursement
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1.6 In - Hospital Physician Fees |
Full Reimbursement
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( up to 120 days max per disability ) |
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1.7 Hospital Service Tax |
5%
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5%
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5%
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5%
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( on eligible Room & Board charges paid ) |
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2. Ambulatory Care |
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2.1 Pre - Surgical / Medical Diagnostic Services |
Full Reimbursement
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( within 60 days ) |
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2.2 Pre - Surgical / Medical Specialist Consultation |
Full Reimbursement
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( within 60 days ) |
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2.3 Second Surgical Opinion |
Full Reimbursement
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2.4 Follow - up Treatment |
Full Reimbursement
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( up to 60 days ) |
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2.5 Out - Patient Accidental Treatment |
Full Reimbursement
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( within 24 hours up to 60 days ) |
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2.6 Daycare Procedure |
Full Reimbursement
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2.7 Ambulance Services |
Full Reimbursement
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2.8 Medical Report Fee Reimbursement |
50
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50
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50
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50
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3. Compassionate Allowance |
5000
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5000
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3000
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3000
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OVERALL LIMIT |
100 000
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50 000
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30 000
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10 000
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(max per annum) |
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NOTE : Overall Limit - The maximum benefit payable within the policy year regardless of number of disabilities
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MEDICAL : OPTIONAL RIDER - OUTPATIENT CLINICAL |
(RM)
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1. Primary Care |
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(i) Panel GP Clinic Visit |
Cash Free
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(ii) Emergency Non-Panel Clinic Visit |
Full Reimbursement
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2. Preventive Screening |
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Pap Smear ( at Panel GP Clinic only ) |
Full Reimbursement
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( max once per policy year ) |
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3. Specialist Care |
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With referral from Panel GP Clinic |
100
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( max limit per visit ) |
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4. Diagnostic Services |
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X Ray & Laboratory Tests |
250
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With referral from Panel GP Clinic or Specialist |
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( max limit per visit ) |
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GROUP TERM LIFE - BASIC
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PLAN 1
(RM)
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PLAN 2
(RM)
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PLAN 3
(RM)
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PLAN 4
(RM)
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PLAN 5
(RM)
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| 1 Death (all causes) |
100 000
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80 000
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60 000
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40 000
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20 000
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| 2 Permanent Total Disability (all causes) |
100 000
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80 000
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60 000
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40 000
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20 000
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| 3 Permanent Partial Disability (all causes - as per Scale of Indemnity) |
100 000
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80 000
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60 000
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40 000
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20 000
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GROUP TERM LIFE : OPTIONAL RIDER - CRITICAL ILLNESS
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PLAN 1 - PLAN 5
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| 1. Critical Illness |
Lump Sum payment of 50% of the Basic Sum Assured upon diagnosis of a critical illness. Full sum (100%) is payable if death/disability occurs during the remaining period
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MEDICAL & GROUP TERM LIFE : OPTIONAL RIDER ¨C
EXECUTIVE SCREENING |
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| 1. 18 KS Screening A comprehensive and general blood & urine screening
profile covering 41 test
(max once per policy year) |
Cash Free
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| EXCLUSIONS |
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Medical |
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- Cosmetic surgery or treatment
- Experimental procedures
- Treatment for injuries while committing a crime or while under the influence of alcohol / narcotics
- Treatment for self inflicted injuries
- Treatment for drug abuse or alcoholism
- Private nursing care and house calls by doctors for any reasons
- Treatment and test relating to sexual dysfunction, infertility, pregnancy ( except for miscarriage due to a motor vehicle accident ), childbirth, sterilization and circumcision
- Sex transformation surgery and sex hormone therapy
- Treatment for sexually transmitted diseases, AIDS or AIDS related complex
- Alternative therapies such as acupuncture, chiropractic, osteopath, reflexology etc
- Vitamins, Food Supplements, Herbal Cures, Anti Obesity / Weight Reducing Agents including any off the counter medications
- Soaps, shampoos, vitamin creams and vitamin ointment
- Psychotic, mental, nervous disorders and behavioral conditions including neurosis, physiological or psychosomatic manifestations
- Treatment for congenital, hereditary diseases / deformities
- Diseases or disabilities of a newborn child contracted prior to or during birth or within the first 14 days hereafter
- Blood and topical allergy testing
- Routine physical examination, health check-ups
- Speech and Occupational Therapy
- Eye Refraction
- Supply of any material ( glasses, lens etc ) for the correction of visual acuity, except for cataract surgery or eye injury
- Non accidental dental treatment and / or surgery
- Use, acquisition or rental of external appliances such as artificial limbs, hearing aids, aero chambers, equipment for nebulising, orthopaedic pads except during hospital confinement
- Treatment for the exposure to ionising radiation, radioactivity contamination and from the use of atomic, biological, nuclear and chemical weapons
- Treatment for any sickness or injury as a result of terrorism, military, naval or air force operations, direct / indirect participation in strikes, riots and civil commotion or insurrection
- Illness or injury sustained during air travel except as a fare paying passenger
- Non-medical services provided by a hospital such as television, telephone, fax, radio etc
- Outpatient physical therapy or physiotherapy cannot be referred at GP level. Must be referred by Specialist and treatment must be provided by a registered physiotherapist. Member must have Hospitalisation Coverage subject to its limitations
- Outpatient rehabilitation therapy, chemotherapy, radiation therapy, kidney dialysis, chronic illness unless Member has Hospitalisation Coverage subject to its limitations
- Preventive vaccinations except for mandatory vaccinations for children
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| EXCLUSIONS |
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Group Term LifePermanent Total & Partial Disability (all causes) |
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- Suicide or self inflicted injuries while sane or insane or deliberate exposure to unnecessary danger
- Injury sustained while under the influence or narcotics or illegal drugs
- Injury sustained while on full-time active duty in the armed forces, naval or military
- Injuries sustained during participation of dangerous sports such as hunting, mountaineering, racing ( other than foot racing ), diving , parachuting etc
- Injury sustained during air travel, except as a fare paying passenger on a recognized airline
- Pregnancy which term includes abortion, miscarriage or related complications
- War invasion, terrorism, civil was, rebellion, revolution, insurrection, military or usurped power or direct / indirect participation in riots, strikes and civil commotion
- Atomic, biological and nuclear energy reactions, radiation and contamination
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| Annual Premium Schedule (RM) - NON CASHLESS PREMIUM |
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MEDICAL
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| BASIC : HOSPITALISATION |
PLAN 350
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PLAN 200
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PLAN 150
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PLAN 80
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| Employee Only |
616.00
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426.00
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324.00
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198.00
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| Employee & Spouse |
1540.00
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1065.00
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810.00
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495.00
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| Employee & Children |
1540.00
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855.00
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650.00
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395.00
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| Employee & Family |
2464.00
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1704.00
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1296.00
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792.00
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OPTIONAL: OUTPATIENT CLINICAL
Premium Per Employee / Dependent
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345.00
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GROUP TERM LIFE - CASHLESS PLAN
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Age
( Nearest Birthday)
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Premium Rate per RM 1000
( PTD & PPD )
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Premium Rate per RM 1000
( PTD,PPD & CI )
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Age
( Nearest Birthday)
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Premium Rate per RM 1000
( PTD & PPD )
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Premium Rate per RM 1000
( PTD,PPD & CI )
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16
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1.37
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1.58
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41
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2.36
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3.85
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17
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1.37
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1.58
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42
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2.64
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4.33
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18
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1.37
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1.58
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43
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2.96
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4.78
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19
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1.37
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1.58
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44
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3.35
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5.37
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20
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1.37
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1.58
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45
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3.75
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5.93
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21
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1.37
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1.64
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46
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4.21
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6.66
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22
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1.37
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1.64
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47
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4.72
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7.42
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23
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1.37
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1.64
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48
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5.25
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8.21
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24
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1.37
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1.64
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49
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5.83
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9.09
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25
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1.37
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1.67
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50
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6.47
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9.89
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26
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1.37
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1.71
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51
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7.26
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10.98
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27
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1.37
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1.76
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52
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8.14
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12.24
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28
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1.37
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1.77
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53
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9.15
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13.61
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29
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1.37
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1.82
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54
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10.22
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15.03
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30
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1.37
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1.84
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55
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11.39
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16.29
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31
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1.37
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1.91
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56
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12.61
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17.77
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32
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1.37
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1.97
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57
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13.84
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19.44
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33
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1.37
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2.03
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58
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15.02
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21.05
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34
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1.37
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2.08
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59
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16.24
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22.67
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35
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1.37
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2.10
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60
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17.61
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24.62
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36
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1.57
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2.43
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61
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19.31
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26.41
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37
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1.69
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2.64
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62
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21.40
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28.81
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38
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1.82
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2.87
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63
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23.78
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31.78
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39
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1.96
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3.06
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64
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26.47
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35.73
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40
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2.14
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3.49
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65
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29.51
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39.50
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MEDICAL & GROUP TERM LIFE
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OPTIONAL : EXECUTIVE SCREENING
Premium per Employee / Dependent
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80.00
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- Please note that, except for for companies located in the Free Trade Zones, all business organizations are subjected to 5% Services Tax on insurance premiums which are borne by the organization.
- Premium rate is based on policy commencement date & individual date of birth. If difference is less than 6 months, the lower age is applicable. Otherwise, the higher age is applicable for any difference of 6 months & above.
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Note :PTD - Permanent Total Disability
PPD - Permanent Partial Disability
CI - Critical Illness |
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