HIGH COST OF MEDICAL CARE
Have you ever thought of what follows in the event a loved one is hospitalised due to an accident or illness? Not only is your mind filled with concern over their well being, you will also have to bear the financial expenses - from a deposit, financial guarantee to settlement of a huge bill on discharge.
Why take chances? SIHAT MALAYSIA prepares you for these costly expenses and ensures comprehensive coverage in terms of medical, surgical and hospital costs, ambulance fees and other related medical charges. It is a Malaysian product for all Malaysians. SIHAT MALAYSIA is a product by the National Insurance Association of Malaysia (NIAM) in collaboration with Managed Care Organisation (MCO). All policyholders of SIHAT MALAYSIA will be enrolled as members of an MCO.
One of the MCO's roles is to facilitate your convenient admission to and discharge from a hospital. SIHAT MALAYSIA offers you a way to be free from the usual hassle in claims procedures. SIHAT MALAYSIA has been designed to relieve you of this burden with the issuance of a Medical Card. Use this Medical Card for guaranteed immediate hospital admission and on discharge, you need to only settle the excess charges, if any. The Medical Card also offers a range of other benefits specially tailored for all policyholders.
BENEFITS
SIHAT MALAYSIA Medical Card
As a policyholder, just present the card at any participating hospital to facilitate your admission.
Wide Acceptance of SIHAT MALAYSIA Medical Card
The SIHAT MALAYSIA Medical Card is accepted by all participating hospitals nationwide. These hospitals have been invited to participate as "Member Choice Hospitals" and offer certain privileges and benefits to members on admission. Look out for the MCO's sign!
SIHAT MALAYSIA 24-Hour Call Centre
Membership entitles you to a 24-hour assistance on medical referrals, monitoring and other travel information both locally and overseas. It's just a phone call away. Toll free: 1-800-88-1320 (MediExpress).
SIHAT MALAYSIA Easy Claims
Don't worry about preparing and submitting claims because all expenses under the SIHAT MALAYSIA plans will be paid directly to the hospitals. No more hefty bills, just settle the excess charges, if any. SIHAT MALAYSIA makes it easy for all policyholders when they need it most.
FREQUENTLY ASKED QUESTIONS
Q :Why do I need this plan?
A :Because hospital costs can be substantial and could wipe out your precious savings. The last thing you want to worry about when you go to a hospital is money!
Q :When does my coverage begin?
A :From the day we approve your proposal form.
Q :Is there a waiting period?
A :Yes, 30 days from the effective date of policy unless the hospitalisation is caused by an accident.
Q :If I renew my SIHAT MALAYSIA insurance policy, will the 30-day waiting period apply?
A :No.
Q :How much can I claim?
A :You may claim up to the Overall Annual Limit under the chosen plan.
Q :May I upgrade my Plan?
A :Yes, you may. However, any request to upgrade will be treated as a new application.
Q :How do I make a claim?
A :Just call 1-800-88-1320 (MediExpress)
DEFINITIONS
A) Pre-existing Illness 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.
B) 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 and cardiovascular disease
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
C) Residence Overseas no benefit whatsoever shall be payable for any medical treatment received by the Insured Person outside Malaysia, if the Insured Person resides or travels outside Malaysia for more than ninety (90) consecutive days.
D) Exclusions
This policy does not cover any hospitalisation, surgery or charges caused directly or indirectly, wholly or partly, by any one (1) of the following occurrences:-
1. Pre-existing illness.
2. Specified illnesses occurring during the first 120 days of continuous cover.
3. Any medical or physical conditions arising within the first 30 days of the Insured Person's cover or date of reinstatement whichever is latest except for accidental injuries.
4. Plastic/Cosmetic surgery, circumcision, eye examination, glasses and refraction or surgical correction of nearsightedness (Radial Keratotomy) and the use or acquisition of external prosthetic appliances or devices such as artificial limbs, hearing aids, implanted pacemakers and prescriptions thereof.
5. 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.
6. 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.
7. Any treatment or surgical operation for congenital abnormalities or deformities including hereditary conditions.
8. 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.
9. Hospitalization 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.
10. Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.
11. 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.
12. Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material.
13. 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.
14. Investigation and treatment of sleep and snoring disorders, hormone replacement therapy and alternative therapy such as treatment, medical service or supplies, including but not limited to chiropractic services, acupuncture, acupressure, reflexology, bonesetting, herbalist treatment, massage or aromatherapy or other alternative treatment.
15. 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.
16. Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations).
17. Costs/expenses of services of a non-medical nature, such as television, telephones, telex services, radios or similar facilities, admission kit/pack and other ineligible non-medical items.
18. 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.
19. Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes.
20. Expenses incurred for sex changes.
SCHEDULE OF BENEFITS |
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PLANS BENEFITS |
PLAN 1 (RM) |
PLAN 2 (RM) |
PLAN 3 (RM) |
PLAN 4 (RM) |
PLAN 5 (RM) |
PLAN 6 (RM) |
OVERALL ANNUAL LIMIT |
10,000 |
20,000 |
30,000 |
50,000 |
100,000 |
150,000 |
|
(MAXIMUM PER DISABILITY) |
|||||
HOSPITAL BENEFITS Daily Room & Board (Max. 150 days) Intensive Care Unit (Max. 75 days) Hospital Supplies & Services Operating Theatre |
60 120 |
80 160 |
120 250 |
200 400 |
350 500 |
450 600 |
As Charged (Subject to Reasonable and Customary Charges) |
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SURGICAL BENEFITS Surgical expenses comprising the following, but excluding organ transplantation • Pre-Surgical Diagnostic Services (Within 60 days prior to surgery) • Pre-Surgical Specialist Consultation (Within 60 days prior to surgery) • Surgical Fees • Anaesthetist's Fees |
7,000 |
12,000 |
20,000 |
30,000 |
65,000 |
100,000 |
MEDICAL BENEFITS Medical expenses for non-surgical treatment, comprising • Pre-Hospital Diagnostic Services (Within 60 days prior to admission) • Pre-Hospital Specialist Consultation (Within 60 days prior to admission) • Daily In-Hospital Physician's Visits (Max. 60 days) • Post Hospitalisation Treatment (within 31 days from discharge) |
7,000 |
12,000 |
20,000 |
30,000 |
65,000 |
100,000 |
OUT-PATIENT BENEFITS Emergency Outpatient Treatment for Accident only (within 24 hours and follow-up treatment to a Max. of 31 days)
Outpatient Physiotherapy Treatment (Within 90 days from discharge/surgery)
Ambulance Fees
Monthly Outpatient Kidney Dialysis & Cancer Treatment |
200 1,000 |
250 2,000 |
300 3,500 |
500 4,000 |
700 5,000 |
1,000 6,000 |
ORGAN TRANSPLANTATION Heart, Kidney, Lung, Liver or Bone Marrow Transplantation |
5,000 |
12,500 |
20,000 |
30,000 |
50,000 |
60,000 |
OTHER BENEFITS Daily Government Hospital Cash Allowance (Max. 150 days) Insured Child's Daily Guardian Benefit (Max. 60 days) |
25
25 |
35
50 |
45
75 |
50
100 |
55
175 |
60
200 |
|
(ANNUAL PREMIUM (age last birthday) |
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AGE BAND*
|
|
|
|
|
|
|
17 - 34 years |
210 |
279 |
340 |
407 |
527 |
622 |
35 - 44 years |
253 |
341 |
408 |
486 |
624 |
728 |
45 - 54 years |
358 |
485 |
579 |
691 |
888 |
1042 |
55 - 59 years |
493 |
685 |
830 |
1004 |
1329 |
1590 |
60 - 64 years (renewal only) |
608 |
891 |
1097 |
1366 |
1916 |
2327 |
65 - 69 years (renewal only) |
690 |
1037 |
1317 |
1662 |
2432 |
3006 |
AGE LIMIT :The plans shall cover eligible persons between the ages of 30 days to 60 years, renewable up to 70 years.
CONDITIONS :*Premiums payable will increase with age, as indicated by the relevant Age Band for the SIHAT MALAYSIA Plans purchased.
*RM10 Stamp Duty will be incurred for every policy
NOTE : FAMILY MAY BE INSURED
1. Your policy may cover your spouse and dependent children subject to the following:
a) a spouse who is below the age of sixty (60) at the time of first inclusion. Once included, the spouse may continue to be included up to the age of seventy (70).
b) unmarried children between the age of thirty (30) days and nineteen (19) years. For dependent children who are fulltime students of institutions of higher education, the age limit is twenty- three (23) years.
2. Each family member is entitled to the full benefits up to separate overall annual limits.
3. Premium will be charged separately for each member according to the plan and age.
FAMILY DISCOUNT
A family discount of 12% is allowed on the total premium for families with three (3) members or more.
RENEWAL DISCOUNT
If your policy is accepted for renewal by your insurer, you will enjoy a 10% renewal discount on the published premium rate from the first renewal onwards.
PREMIUM
Current Increase/Decrease in Premiums revised since 1st April 2003 |
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AGE BAND*
|
PLAN1 |
PLAN2 |
PLAN3 |
PLAN4 |
PLAN5 |
PLAN6 |
Age 30 |
-5 |
3 |
1 |
2 |
-1 |
-7 |
Age 40 |
2 |
15 |
17 |
19 |
17 |
10 |
Age 50 |
4 |
20 |
23 |
26 |
25 |
15 |
Age 60 |
6 |
21 |
23 |
24 |
19 |
9 |
While the new premiums may have shown an increase or decrease as compared to the premium rates revised since 1st April 2003, this does not necessarily reflect the future trend of Sihat Malaysia's premium revision as any future adjustment will be based on the portfolio's claims experience.
NOTE:
Upgraded Room & Board Co-Payment Ð If the Insured Person is hospitalised at a Room & Board rate which is higher than his/her eligible benefit, the Insured Person shall bear 20% of the other eligible benefits, described in the Schedule of Benefits for each and every claim.
This brochure is for general information only. It is not a contract of Insurance. The precise terms and conditions of this insurance plan are specified in the policy.
In the event of discrepancies, ambiguity and conflict in interpreting any terms or conditions of the contract, the English version shall prevail and supercede the Bahasa Malaysia version.
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