| | Schedule of Benefits | | | | | MEDICAL : BASIC - HOSPITALISATION
| PLAN 350 (RM) | PLAN 200 (RM) | PLAN 150 (RM) | PLAN 80 (RM) | | 1. In - Hospital Care | | | | | | 1.1 Hospital Room & Board | | | | | | (i) Ordinary Room | 350 | 200 | 150 | 80 | | ( up to 120 days max per disability ) | | | | | | (ii) Intensive Care | 500 | 500 | 500 | 500 | | ( up to 20 days max per disability ) | | | | | | 1.2 Hospital Miscellaneous Services | Full Reimbursement | | 1.3 Surgical Fees | Full Reimbursement | | 1.4 Anesthetic Fees | Full Reimbursement | | 1.5 Operating Theatre Charges | Full Reimbursement | | 1.6 In - Hospital Physician Fees | Full Reimbursement | | ( up to 120 days max per disability ) | | | | | | 1.7 Hospital Service Tax | 5% | 5% | 5% | 5% | | ( on eligible Room & Board charges paid ) | | | | | | 2. Ambulatory Care | | | | | | 2.1 Pre - Surgical / Medical Diagnostic Services | Full Reimbursement | | ( within 60 days ) | | | | | | 2.2 Pre - Surgical / Medical Specialist Consultation | Full Reimbursement | | ( within 60 days ) | | | | | | 2.3 Second Surgical Opinion | Full Reimbursement | | 2.4 Follow - up Treatment | Full Reimbursement | | ( up to 60 days ) | | | | | | 2.5 Out - Patient Accidental Treatment | Full Reimbursement | | ( within 24 hours up to 60 days ) | | | | | | 2.6 Daycare Procedure | Full Reimbursement | | 2.7 Ambulance Services | Full Reimbursement | | 2.8 Medical Report Fee Reimbursement | 80 | 80 | 80 | 80 | | 3. Compassionate Allowance | 5000 | 5000 | 3000 | 3000 | | OVERALL LIMIT | 100 000 | 50 000 | 30 000 | 10 000 | | (max per annum) | | | | | | NOTE : Overall Limit - The maximum benefit payable within the policy year regardless of number of disabilities
| | | | MEDICAL : OPTIONAL RIDER - OUTPATIENT CLINICAL | (RM) | | 1. Primary Care | | | (i) Panel GP Clinic Visit | Cash Free | | (ii) Emergency Non-Panel Clinic Visit | Full Reimbursement | | 2. Preventive Screening | | | Pap Smear ( at Panel GP Clinic only ) | Full Reimbursement | | ( max once per policy year ) | | | 3. Specialist Care | | | With referral from Panel GP Clinic | 100 | | ( max limit per visit ) | | | 4. Diagnostic Services | | | X Ray & Laboratory Tests | 250 | | With referral from Panel GP Clinic or Specialist | | | ( max limit per visit ) | | | | | GROUP TERM LIFE - BASIC | PLAN 1 (RM) | PLAN 2 (RM) | PLAN 3 (RM) | PLAN 4 (RM) | PLAN 5 (RM) | |
| | | 1 Death (all causes) | 100 000 | 80 000 | 60 000 | 40 000 | 20 000 | |
| | | 2 Permanent Total Disability (all causes) | 100 000 | 80 000 | 60 000 | 40 000 | 20 000 | |
| | | 3 Permanent Partial Disability (all causes - as per Scale of Indemnity) | 100 000 | 80 000 | 60 000 | 40 000 | 20 000 | |
| | | | GROUP TERM LIFE : OPTIONAL RIDER - CRITICAL ILLNESS | PLAN 1 - PLAN 5 | | | 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 | |
| | | | MEDICAL & GROUP TERM LIFE : OPTIONAL RIDER ¨C EXECUTIVE SCREENING | | | | 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 | | Medical | | - 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
| | EXCLUSIONS | | Group Term LifePermanent Total & Partial Disability (all causes) | | - 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
| | Annual Premium Schedule (RM) - NON CASHLESS PREMIUM | | | MEDICAL | | | BASIC : HOSPITALISATION | PLAN 350 | PLAN 200 | PLAN 150 | PLAN 80 | | | Employee Only | 616.00 | 426.00 | 324.00 | 198.00 | | | Employee & Spouse | 1540.00 | 1065.00 | 810.00 | 495.00 | | | Employee & Children | 1540.00 | 855.00 | 650.00 | 395.00 | |
| | | Employee & Family | 2464.00 | 1704.00 | 1296.00 | 792.00 | |
| | OPTIONAL: OUTPATIENT CLINICALPremium Per Employee / Dependent | 345.00 | |
| | | | GROUP TERM LIFE - CASHLESS PLAN | | Age ( Nearest Birthday) | Premium Rate per RM 1000 ( PTD & PPD ) | Premium Rate per RM 1000 ( PTD,PPD & CI ) | Age ( Nearest Birthday) | Premium Rate per RM 1000 ( PTD & PPD ) | Premium Rate per RM 1000 ( PTD,PPD & CI ) | | 16 | 1.37 | 1.58 | 41 | 2.36 | 3.85 | | 17 | 1.37 | 1.58 | 42 | 2.64 | 4.33 | | 18 | 1.37 | 1.58 | 43 | 2.96 | 4.78 | | 19 | 1.37 | 1.58 | 44 | 3.35 | 5.37 | | 20 | 1.37 | 1.58 | 45 | 3.75 | 5.93 | | 21 | 1.37 | 1.64 | 46 | 4.21 | 6.66 | | 22 | 1.37 | 1.64 | 47 | 4.72 | 7.42 | | 23 | 1.37 | 1.64 | 48 | 5.25 | 8.21 | | 24 | 1.37 | 1.64 | 49 | 5.83 | 9.09 | | 25 | 1.37 | 1.67 | 50 | 6.47 | 9.89 | | 26 | 1.37 | 1.71 | 51 | 7.26 | 10.98 | | 27 | 1.37 | 1.76 | 52 | 8.14 | 12.24 | | 28 | 1.37 | 1.77 | 53 | 9.15 | 13.61 | | 29 | 1.37 | 1.82 | 54 | 10.22 | 15.03 | | 30 | 1.37 | 1.84 | 55 | 11.39 | 16.29 | | 31 | 1.37 | 1.91 | 56 | 12.61 | 17.77 | | 32 | 1.37 | 1.97 | 57 | 13.84 | 19.44 | | 33 | 1.37 | 2.03 | 58 | 15.02 | 21.05 | | 34 | 1.37 | 2.08 | 59 | 16.24 | 22.67 | | 35 | 1.37 | 2.10 | 60 | 17.61 | 24.62 | | 36 | 1.57 | 2.43 | 61 | 19.31 | 26.41 | | 37 | 1.69 | 2.64 | 62 | 21.40 | 28.81 | | 38 | 1.82 | 2.87 | 63 | 23.78 | 31.78 | | 39 | 1.96 | 3.06 | 64 | 26.47 | 35.73 | | 40 | 2.14 | 3.49 | 65 | 29.51 | 39.50 | |
| | | | MEDICAL & GROUP TERM LIFE | | OPTIONAL : EXECUTIVE SCREENINGPremium per Employee / Dependent | 80.00 | |
| | - 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.
| | Note :PTD - Permanent Total Disability PPD - Permanent Partial Disability CI - Critical Illness PANEL HOSPITAL UPDATED FEB 2011 | | |
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