Small Medium Industry Insurance

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 500 350 350 350 ( 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 50 50 50 50 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 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 CLINICAL Premium 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 SCREENING Premium 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