THE FOLLOWING ARE THE BASIC AND IMPORTANT FEATURES THAT YOU SHOULD KNOW BEFORE PURCHASING THIS PRODUCT.
We Provide A Comprehensive Medical Coverage Scheme
Where the eligible Medical Expenses will be payable on “AS CHARGED OR FULL REIMBURSEMENT” basis.
We offer four (4) types of Plans for you to choose from.
This is an annual contract and a yearly renewable policy which until terminated shall be renewed each year on the Anniversary of the due date.
1.1 Initial Premium
Your first annual premium you pay is based according to the type of benefits and the plan you purchase and your occupation together with your age (next birthday).
1.2 Renewal Premium
1.2.1 Your annual renewal premium in future will increase by your attained age according to the Age Bands, your claims experience, health status or changes in your policy terms, occupation, business, pursuits or sporting activity or other material changes or risks.
1.2.2 The past trends on the increase in premium rates will not necessarily reflect the future trend of your premium.
1.3 Policy Renewal and Lapsed Policy
1.3.1 The renewal of the policy is guaranteed after the completion of 2 consecutive years of the policy, provided that there is no claim incurred in the previous 2 years. If there is a claim incurred within the first 2 years of policy inception, the insured person would still qualify for the guaranteed renewals subject to exclusion, excess or premium loading.
1.3.2 The policy shall automatically terminate or lapse, if you fail to pay the premium when it is due. Any lapsed policy will be treated as a new application. The above mentioned conditions are not exhaustive and the premium rates may be reviewed or policy renewal declined under other justified circumstances.
2. "Free-Look Period" Of 15 Days
You are given a “Free–Look Period”/“Cooling–Off Period” of up to 15 days from the delivery date of the policy to review the suitability of your policy. If you are not satisfied with the cover you may return the policy to the Company during this period, and we will return the full premiums to you minus the deduction for medical expenses incurred by the Company on the issue of the Policy.
The plans shall cover eligible persons between the ages of 30 days to 60 years, renewable up to 70 years.
3. What Is Not Payable Under The Policy
3.1 Policy Exclusions
This contract does not cover any hospitalisation, surgery or charges caused directly or indirectly, wholly or partly, by any one (1) of the following occurrences:
(a) Pre – existing illness.
(b) Specified illnesses occurring during the first 120 days of continuous cover.
(c) Any medical or physical conditions arising within the first 30 days of the Insured Person’s cover or date reinstatement whichever is latest except for accidental injuries.
(d) Plastic/Cosmetic surgery, circumcision, eye examination, glasses and refraction or surgical correction of nearsightedness (Radial Keratotomy or Lasik) and the use or acquisition of external prosthetic appliances or devices such as artificial limbs, hearing aids, implanted pacemakers and prescriptions thereof.
(e) Dental conditions including dental treatment or oral surgery except as necessitated by accidental injuries to sound natural teeth occurring wholly during the Period of Insurance.
(f) Private nursing, rest cures or sanitaria care, illegal drugs, intoxication, sterilization, venereal disease and its sequelae, AIDS (Acquired Immune Deficiency Syndrome) or ARC (AIDS Related Complex) and HIV related diseases, and any communicable diseases required quarantine by law.
(g) Any treatment or surgical operation for congenital abnormalities or deformities including hereditary conditions.
(h) Pregnancy, child birth (including surgical delivery), miscarriage, abortion and prenatal or postnatal care and surgical, mechanical, or chemical contraceptive methods of birth control or treatment pertaining to infertility. Erectile dysfunction and tests or treatment related to impotence or sterilization.
(i) Hospitalisation primarily for investigatory purposes, diagnosis, X–ray examination, general physical or medical examinations, not incidental to treatment or diagnosis of a covered Disability or any treatment which is not Medically Necessary and any preventive treatments, preventive medicines or examinations carried out by a Physician, and treatments specifically for weight reduction or gain.
(j) Suicide, attempted suicide, or intentionally self–inflicted injury while sane or insane.
(k) War or any act of war, declared or undeclared, criminal or terrorist activities, active duty in any armed forces, direct participation in strikes, riots and civil commotion or insurrection.
(l) Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material.
(m) Expenses incurred for donation of any body organ by an Insured Person and costs of acquisition of the organ including all costs incurred by the donor during organ transplant and its complications.
(n) Investigation and treatment of sleep and snoring disorders, hormone replacement therapy and alternative therapy such as treatment, medical services or supplies, including but not limited to chiropractic services, acupuncture, acupressure, reflexology, bonesetting, herbalist treatment, massage or aroma therapy or other alternative treatment.
(o) Care or treatment for which payment is not required or to the extent which is payable by any other insurance or indemnity covering the Insured and Disabilities arising out of duties of employment or profession that is covered under a Workman’s Compensation Insurance Contract.
(p) Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations).
(q) Costs/expenses of services of non–medical nature, such as television, telephones, telex services, radios or similar facilities, admission kit/pack and other ineligible non–medical items.
(r) Sickness or injury arising from racing of any kind (except foot racing), hazardous sports such as but not limited to skydiving, water skiing, underwater activities requiring breathing apparatus, winter sports, professional sports and illegal activities.
(s) Private flying other than as a fare–paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes.
(t) Expenses incurred for sex changes.
3.2 Residence Overseas
Any person who resides outside Malaysia for more than three (3) months continuously.
3.3 Overseas Treatment
1. Unless you are travelling abroad for a reason other than for medical treatment and as a consequence of Medical Emergency.
2. Unless the specialized nature of the treatment, aid, information or decision required could neither be rendered nor furnished nor taken in Malaysia.
3.4 "Pre-Existing Illnesses
Pre–existing illness/conditions shall mean disabilities that the Insured Person has reasonable knowledge of. An Insured Person may be considered to have reasonable knowledge of a pre–existing condition where the condition is one for which :-
a) the Insured Person had received or is receiving treatment;
b) medical advice, diagnosis, care or treatment has been recommended;
c) clear and distinct symptoms are or were evident; or
d) its existence would have been apparent to a reasonable person in the circumstances.
3.5 Special Illnesses
Specified illnesses shall mean the following disabilities and its related complications, occurring within the first 120 days of Insurance of the Insured Person:
a) Hypertension, diabetes mellitus, Cardiovascular disease and Vericose Veins.
b) All tumours, cancers, cysts, nodules, polyps, stones of the urinary system and biliary system.
c) All ear, nose (including sinuses) and throat conditions
d) Hernias, haemorrhoids, fistulae, hydrocele, varicocele
e) Endometriosis including disease of the Reproduction system
f) Vertebro – spinal disorders (including disc) and knee conditions.
3.6 Waiting Period
Any treatment for illness/injury received within 30 days after the effective date of insurance coverage except treatment for bodily injury arising from a covered accident.
4 Policy Limitations
We will not pay you full or up to the limits shown in the Schedule of Benefits under the following circumstances:
If you have any other insurance in force or is entitled to indemnity from any Other Source in respect of the same bodily injury, sickness, disease, death, or expense, this policy will not provide full compensation other than on a proportionate basis. If you have MORE THAN ONE POLICY UNDER US, we will consider you to be insured under the policy, which provides the largest amount of Benefits.
Medical devices such as stent/lens - Maximum payable is RM5,000 per stent. - Maximum payable is RM700 per lens.
4.4 Eligibility of Dependant
Unmarried children over 30 days old but under 19 years of age or 23 years of age if still on full-time higher education, and who are not gainfully employed.
4.5 Enrollment of Dependant
Children between the ages of 30 days and 18 years must be enrolled together with one of their parents. The plans chosen for spouse and children must be the same as the proposer.