medisecure booster policy polisi medisecure ... - … · jadual polisi telah memohon kepada lonpac...
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Class Of Policy: LONPAC INSURANCE BHD (307414-T)
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MEDISECURE BOOSTER POLICY (Hospitalisation & Surgical Insurance)
POLISI MEDISECURE BOOSTER (Insurans Hospital dan Pembedahan)
FOR CONSUMER INSURANCE CONTRACTS (INSURANCE WHOLLY FOR PURPOSES UNRELATED TO YOUR TRADE, BUSINESS OR PROFESSION)
This Policy is issued in consideration of the payment of premium as specified in the Policy Schedule and pursuant to the answers given in your Proposal Form (or when you applied for this insurance) and any other disclosures made by you between the time of submission of your Proposal Form (or when you applied for this insurance) and the time this contract is entered into. The answers and any other disclosures given by you shall form part of this contract of insurance between you and us. However, in the event of any pre-contractual misrepresentation made in relation to your answers or in any disclosures given by you, only the remedies in Schedule 9 of the Financial Services Act 2013 will apply.
This Policy reflects the terms and conditions of the contract of insurance as agreed between you and us.
BAGI KONTRAK INSURANS PENGGUNA (INSURANS SEPENUHNYA YANG TIDAK BERKAITAN DENGAN PERDAGANGAN, PERNIAGAAN ATAU PROFESION)
Polisi dikeluarkan sejajar dengan pembayaran dari premium yang ditentukan dalam Jadual Polisi dan menurut kepada kenyataan yang telah dikemukakan di dalam borang cadangan (atau semasa permohonan insurans ini) dan segala kenyataan yang telah dibuat oleh pihak anda pada atau semasa penyerahan borang cadangan (atau semasa permohonan insurans ini) dan pada masa perjanjian ini ditandatangani. Jawapan dan sebarang pernyataan lain yang anda berikan akan menjadi sebahagian daripada kontrak insurans antara anda dan pihak kami. Walau bagaimanapun, sekiranya terdapat sebarang salah nyata semasa pra-kontrak berhubung dengan jawapan anda atau di mana-mana pernyataan yang diberikan oleh anda, hanya remedi yang terdapat dalam Jadual 9 Akta Perkhidmatan Kewangan 2013 akan diguna pakai.
Polisi ini bertindak atas terma-terma dan syarat-syarat kontrak insurans seperti yang telah dipersetujui antara anda dan pihak kami.
FOR NON – CONSUMER INSURANCE CONTRACTS (INSURANCE FOR PURPOSES RELATED TO YOUR TRADE, BUSINESS OR PROFESSION)
This Policy is issued in consideration of the payment of premium as specified in the Policy Schedule and pursuant to the answers given in your Proposal Form (or when you applied for this insurance) and any other disclosures made by you between the time of submission of your Proposal Form (or when you applied for this insurance) and the time this contract is entered into. The answers and any other disclosures given by you shall form part of this contract of insurance between you and us. In the event of any pre-contractual misrepresentation made in relation to your answers or in any disclosures made by you, it may result in avoidance of your contract of insurance, refusal or reduction of your claim(s), change of terms or termination of your contract of insurance.
This Policy reflects the terms and conditions of the contract of insurance as agreed between you and us.
BAGI KONTRAK INSURANS KOMERSIAL (INSURANS BAGI TUJUAN PERDAGANGAN, PERNIAGAAN ATAU PROFESION)
Polisi dikeluarkan sejajar dengan pembayaran dari premium yang ditentukan dalam Jadual Polisi dan menurut kepada kenyataan yang telah dikemukakan di dalam borang cadangan (atau semasa permohonan insurans ini) dan segala kenyataan yang telah dibuat oleh pihak anda pada atau semasa penyerahan borang cadangan (atau semasa permohonan insurans ini) dan pada masa perjanjian ini ditandatangani. Jawapan dan sebarang pernyataan lain yang anda berikan akan menjadi sebahagian daripada kontrak insurans antara anda dan pihak kami. Sekiranya terdapat sebarang salah nyata pada pra-kontrak berhubung dengan jawapan anda atau di mana-mana pernyataan yang diberikan oleh anda, ia mungkin mengakibatkan pembatalan kontrak insurans, keengganan atau pengurangan gantirugi, perubahan terma atau penamatan kontrak insurans anda.
Polisi ini bertindak atas terma-terma dan syarat-syarat kontrak insurans seperti yang telah dipersetujui antara anda dan pihak kami.
WHEREAS the Policyholder named in the Policy Schedule has applied to Lonpac Insurance Bhd (hereinafter called 'the Company') for the insurance herein described and has paid or agreed to pay the premium stated in the Policy Schedule as consideration for the insurance hereinafter contained.
BAHAWASANYA Pemegang Polisi yang dinamakan di dalam Jadual Polisi telah memohon kepada Lonpac Insurance Bhd (selepas dari ini dirujuk sebagai 'Syarikat') untuk insurans yang dinyatakan dan telah membayar atau bersetuju untuk membayar premium yang dinyatakan di dalam Jadual Polisi sebagai pertimbangan untuk insurans yang terkandung.
NOW THIS POLICY WITNESSES that if the Insured Person is confined to a hospital for treatment or is surgically treated as a day case during the Period of Insurance stated in the Policy Schedule, the Company will pay to the Policyholder or his legal personal representative the sum or sums stated in Policy Schedule. Payment is subject to reasonable and customary charges and will only be made upon receipt and approval of proofs of expenses incurred.
DENGAN INI POLISI INI MENYAKSIKAN jika sekiranya semasa Tempoh Insurans, Orang Yang Diinsuranskan dimasukkan ke hospital untuk rawatan atau menjalani pembedahan sebagai kes hari, Syarikat akan bayar kepada Pemegang Polisi atau kepada wakil diri sah di sisi undang-undang Pemegang Polisi jumlah atau sejumlah wang seperti yang dinyatakan di dalam Jadual Insurans. Pembayaran akan tertakluk kepada bayaran munasabah dan biasa diamalkan dan hanya akan dibayar selepas bukti perbelanjaan diterima dan diluluskan.
THIS POLICY is an excess major medical insurance policy and will only pay after the Insured Person has exhausted all other avenues of compensation from other basic or major medical insurances and is subject to provisions, conditions and limitations as contained herein or as may be endorsed hereon.
POLISI INI adalah insurans perubatan major ekses dan hanya akan membayar selepas Orang Yang Diinsuranskan telah kehabisan semua kemudahan pampasan lain dari insurans perubatan asas atau insurans perubatan major lain dan tertakluk kepada peruntukan, syarat dan batasan seperti yang terkandung di sini atau sebagaimana yang diendorskan di sini.
Class Of Policy: LONPAC INSURANCE BHD (307414-T)
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SCHEDULE OF BENEFITS
Section Description of Benefits (as at 01 January 2018)
Plan 1 (RM)
Plan 2 (RM)
Plan 3 (RM)
Plan 4 (RM)
Plan 5 (RM)
Plan 6 (RM)
A HOSPITALISATION AND SURGICAL EXPENSES
1. Before the patient is admitted to hospital or surgically treated in a hospital
As Charged, subject to reasonable, customary and necessary expenses which is incurred within 31 days prior to hospital admission or surgery
a. Pre-Surgical Consultation & Diagnosis b. Pre-Hospital Specialist Consultation c. Pre-Hospital Diagnostic Tests 2. When the patient is being treated as a
bed-paying patient in a hospital or is surgically treated
As Charged, subject to reasonable, customary and necessary expenses which is incurred during the policy period
a. Intensive Care Unit
b. Hospital Supplies & Services
c. Surgical Fees (including Anaesthetist & Operating Theatre Fees)
d. In-Hospital Physician Visit not exceeding two visits a day
3. After the patient is discharged from hospital for a non-surgical treatment
As Charged, subject to reasonable, customary and necessary expenses which is incurred up to 60 days from the date of discharge from the hospital
a. Post Hospitalisation Treatment 4. If the patient needs to be moved by
road ambulance to an appropriate location for treatment or diagnosis
As Charged, subject to reasonable, customary and necessary expenses which is incurred during the policy period
a. Ambulance Fees
5. Other Benefits As Charged, subject to reasonable, customary and necessary expenses which is incurred during the policy period a. Organ Transplant
b. Goods and Services Tax
c. Medical Report Fee
d. Nursing at Home
B SPECIFIC OUTPATIENT TREATMENTS (Sub-Limit included in the Per Disability Limit)
1. Outpatient Cancer Treatment, per annum (inclusive in the Per Disability Limit)
300,000 300,000 225,000 225,000 150,000 150,000
2. Outpatient Kidney Dialysis, per annum (inclusive in the Per Disability Limit)
300,000 300,000 225,000 225,000 150,000 150,000
LIMITS OF COVERAGE (Section A & B)
a. Room & Board, per day limit (incurred during the policy period)
1,000 1,000 750 750 500 500
b. Deductible Per Disability (Top-Up Basis)
15,000 150,000 10,000 100,000 7,500 75,000
c. Per Disability Limit
1,000,000 1,000,000 750,000 750,000 500,000 500,000
d. Overall Annual Limit
2,000,000 2,000,000 1,500,000 1,500,000 1,000,000 1,000,000
Important Note: The Room and Board Limit, Per Disability Limit, Sub-Limit and Overall Annual Limit will increase every five years as stipulated in the Schedule of Limits, subject to the following but the Deductible Per Disability remains unchanged during the increase in limits:- a. The respective new limits will only apply to new policies issued or policies renewed on or after the effective date of the respective increase
in limits.
b. The limits applicable for the respective claims shall be the limits applicable to the policy during the first intimation of the respective claim and the increased limits will not be applicable to claims already reported.
Class Of Policy: LONPAC INSURANCE BHD (307414-T)
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JADUAL MANFAAT
Seksyen Keterangan Manfaat (pada 01 Januari 2018)
Pelan 1 (RM)
Pelan 2 (RM)
Pelan 3 (RM)
Pelan 4 (RM)
Pelan 5 (RM)
Pelan 6 (RM)
A PERBELANJAAN HOSPITAL DAN PEMBEDAHAN
1. Sebelum pesakit dimasukkan ke hospital atau menjalani pembedahan di hospital
Seperti yang Dicajkan, tertakluk kepada perbelanjaan munasabah, biasa dan perlu yang dilakukan dalam masa 31 hari sebelum kemasukan atau
pembedahan hospital a. Rundingan Pakar dan Ujian
Diagnostik Pra-pembedahan
b. Rundingan Pakar Pra-hospital c. Ujian Diagnostik Pra-hospital 2. Apabila pesakit sedang dirawat
sebagai pesakit dalam di hospital atau menjalani pembedahan
Seperti yang Dicajkan, tertakluk kepada perbelanjaan munasabah, biasa dan perlu yang dilakukan semasa tempoh polisi
a. Unit Rawatan Rapi
b. Bekalan dan Khidmat Hospital
c. Bayaran Pembedahan (termasuk Bayaran Pakar Bius dan Bayaran Bilik Bedah)
d. Lawatan Pakar Perubatan Dalam Hospital, tidak melebihi dua lawatan sehari
3. Selepas pesakit keluar dari hospital untuk rawatan bukan pembedahan
Seperti yang Dicajkan, tertakluk kepada perbelanjaan munasabah, biasa dan perlu yang ditanggung sehingga 60 hari dari tarikh selepas keluar dari hospital
a. Rawatan selepas penghospitalan 4. Jika pesakit perlu dipindahkan oleh
ambulans darat ke lokasi yang sesuai untuk rawatan atau diagnosis
Seperti yang Dikenakan, tertakluk kepada perbelanjaan munasabah, biasa dan perlu yang dilakukan semasa tempoh polisi
a. Bayaran Ambulans 5. Manfaat Lain Seperti yang Dikenakan, tertakluk kepada perbelanjaan munasabah, biasa dan
perlu yang dilakukan semasa tempoh polisi a. Transplan Organ b. Cukai Barang dan Perkhidmatan
c. Bayaran Laporan Perubatan
d. Jagaan Jururawat Di Rumah
B RAWATAN PESAKIT LUAR YANG TERTENTU (Had yang termasuk dalam Had Setiap Hilang Upaya)
1. Rawatan Kanser Pesakit Luar, setiap tahun (termasuk dalam Had Setiap Hilang Upaya)
300,000 300,000 225,000 225,000 150,000 150,000
2. Dialisis Buah Pinggang Pesakit Luar, setiap tahun (termasuk dalam Had Setiap Hilang Upaya)
300,000 300,000 225,000 225,000 150,000 150,000
HAD PERLINDUNGAN (Seksyen A & B)
a. Bilik Hospital dan Makan, had harian yang dikenakan semasa tempoh polisi
1,000 1,000 750 750 500 500
b. Deduktibel Setiap Hilang Upaya (berasaskan perlindungan tambahan)
15,000 150,000 10,000 100,000 7,500 75,000
c. Had Setiap Hilang Upaya
1,000,000 1,000,000 750,000 750,000 500,000 500,000
d. Had Tahunan Keseluruhan
2,000,000 2,000,000 1,500,000 1,500,000 1,000,000 1,000,000
Nota Penting: Had Harian Bilik Hospital dan Makan, Had Setiap Hilang Upaya dan Had Tahunan Keseluruhan akan meningkat setiap lima tahun seperti yang dinyatakan di dalam Jadual Had dan tertakluk kepada berikut tetapi Deduktibel Setiap Hilang Upaya tidak akan berubah pada masa had perlindungan meningkat:- a. Had baru masing-masing hanya akan terpakai kepada polisi baru yang dikeluarkan atau polisi yang diperbaharui pada atau selepas
tarikh berkuat kuasa peningkatan had tersebut.
b. Had Perlindungan yang dikenakan untuk tuntutan masing-masing adalah had yang dikenakan terhadap polisi pada hari pertama tuntutan masing-masing dibuat dan peningkatan Had Perlindungan tidak akan terpakai kepada tuntutan yang telah dilaporkan.
Class Of Policy: LONPAC INSURANCE BHD (307414-T)
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SCHEDULE OF LIMITS JADUAL HAD
Schedule of Limits – Plan 1 (Ringgit Malaysia)
Jadual Had – Pelan 1 (Ringgit Malaysia)
Effe
ctiv
e R
evis
ion
Dat
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Tar
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Sem
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Per
Dis
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Set
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Hila
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Ded
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Dia
lisis
Bua
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Pes
akit
Luar
Ove
rall
Ann
ual L
imit
Had
Tah
unan
Kes
elur
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Effe
ctiv
e R
evis
ion
Dat
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Tar
ikh
Sem
akan
Ber
kuat
kua
sa
Roo
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Boa
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Bili
k &
Mak
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Per
Dis
abili
ty L
imit
Had
Set
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Hila
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Ded
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Pes
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Luar
Out
Pat
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Kid
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Dia
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Dia
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Bua
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ingg
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Pes
akit
Luar
Ove
rall
Ann
ual L
imit
Had
Tah
unan
Kes
elur
uhan
1/1/2018 1,000 1,000,000 15,000 300,000 300,000 2,000,000 1/1/2068 2,000 2,000,000 15,000 600,000 600,000 4,000,000
1/1/2019 1,000 1,000,000 15,000 300,000 300,000 2,000,000 1/1/2069 2,000 2,000,000 15,000 600,000 600,000 4,000,000
1/1/2020 1,000 1,000,000 15,000 300,000 300,000 2,000,000 1/1/2070 2,000 2,000,000 15,000 600,000 600,000 4,000,000
1/1/2021 1,000 1,000,000 15,000 300,000 300,000 2,000,000 1/1/2071 2,000 2,000,000 15,000 600,000 600,000 4,000,000
1/1/2022 1,000 1,000,000 15,000 300,000 300,000 2,000,000 1/1/2072 2,000 2,000,000 15,000 600,000 600,000 4,000,000
1/1/2023 1,100 1,100,000 15,000 330,000 330,000 2,200,000 1/1/2073 2,100 2,100,000 15,000 630,000 630,000 4,200,000
1/1/2024 1,100 1,100,000 15,000 330,000 330,000 2,200,000 1/1/2074 2,100 2,100,000 15,000 630,000 630,000 4,200,000
1/1/2025 1,100 1,100,000 15,000 330,000 330,000 2,200,000 1/1/2075 2,100 2,100,000 15,000 630,000 630,000 4,200,000
1/1/2026 1,100 1,100,000 15,000 330,000 330,000 2,200,000 1/1/2076 2,100 2,100,000 15,000 630,000 630,000 4,200,000
1/1/2027 1,100 1,100,000 15,000 330,000 330,000 2,200,000 1/1/2077 2,100 2,100,000 15,000 630,000 630,000 4,200,000
1/1/2028 1,200 1,200,000 15,000 360,000 360,000 2,400,000 1/1/2078 2,200 2,200,000 15,000 660,000 660,000 4,400,000
1/1/2029 1,200 1,200,000 15,000 360,000 360,000 2,400,000 1/1/2079 2,200 2,200,000 15,000 660,000 660,000 4,400,000
1/1/2030 1,200 1,200,000 15,000 360,000 360,000 2,400,000 1/1/2080 2,200 2,200,000 15,000 660,000 660,000 4,400,000
1/1/2031 1,200 1,200,000 15,000 360,000 360,000 2,400,000 1/1/2081 2,200 2,200,000 15,000 660,000 660,000 4,400,000
1/1/2032 1,200 1,200,000 15,000 360,000 360,000 2,400,000 1/1/2082 2,200 2,200,000 15,000 660,000 660,000 4,400,000
1/1/2033 1,300 1,300,000 15,000 390,000 390,000 2,600,000 1/1/2083 2,300 2,300,000 15,000 690,000 690,000 4,600,000
1/1/2034 1,300 1,300,000 15,000 390,000 390,000 2,600,000 1/1/2084 2,300 2,300,000 15,000 690,000 690,000 4,600,000
1/1/2035 1,300 1,300,000 15,000 390,000 390,000 2,600,000 1/1/2085 2,300 2,300,000 15,000 690,000 690,000 4,600,000
1/1/2036 1,300 1,300,000 15,000 390,000 390,000 2,600,000 1/1/2086 2,300 2,300,000 15,000 690,000 690,000 4,600,000
1/1/2037 1,300 1,300,000 15,000 390,000 390,000 2,600,000 1/1/2087 2,300 2,300,000 15,000 690,000 690,000 4,600,000
1/1/2038 1,400 1,400,000 15,000 420,000 420,000 2,800,000 1/1/2088 2,400 2,400,000 15,000 720,000 720,000 4,800,000
1/1/2039 1,400 1,400,000 15,000 420,000 420,000 2,800,000 1/1/2089 2,400 2,400,000 15,000 720,000 720,000 4,800,000
1/1/2040 1,400 1,400,000 15,000 420,000 420,000 2,800,000 1/1/2090 2,400 2,400,000 15,000 720,000 720,000 4,800,000
1/1/2041 1,400 1,400,000 15,000 420,000 420,000 2,800,000 1/1/2091 2,400 2,400,000 15,000 720,000 720,000 4,800,000
1/1/2042 1,400 1,400,000 15,000 420,000 420,000 2,800,000 1/1/2092 2,400 2,400,000 15,000 720,000 720,000 4,800,000
1/1/2043 1,500 1,500,000 15,000 450,000 450,000 3,000,000 1/1/2093 2,500 2,500,000 15,000 750,000 750,000 5,000,000
1/1/2044 1,500 1,500,000 15,000 450,000 450,000 3,000,000 1/1/2094 2,500 2,500,000 15,000 750,000 750,000 5,000,000
1/1/2045 1,500 1,500,000 15,000 450,000 450,000 3,000,000 1/1/2095 2,500 2,500,000 15,000 750,000 750,000 5,000,000
1/1/2046 1,500 1,500,000 15,000 450,000 450,000 3,000,000 1/1/2096 2,500 2,500,000 15,000 750,000 750,000 5,000,000
1/1/2047 1,500 1,500,000 15,000 450,000 450,000 3,000,000 1/1/2097 2,500 2,500,000 15,000 750,000 750,000 5,000,000
1/1/2048 1,600 1,600,000 15,000 480,000 480,000 3,200,000 1/1/2098 2,600 2,600,000 15,000 780,000 780,000 5,200,000
1/1/2049 1,600 1,600,000 15,000 480,000 480,000 3,200,000 1/1/2099 2,600 2,600,000 15,000 780,000 780,000 5,200,000
1/1/2050 1,600 1,600,000 15,000 480,000 480,000 3,200,000 1/1/2100 2,600 2,600,000 15,000 780,000 780,000 5,200,000
1/1/2051 1,600 1,600,000 15,000 480,000 480,000 3,200,000 1/1/2101 2,600 2,600,000 15,000 780,000 780,000 5,200,000
1/1/2052 1,600 1,600,000 15,000 480,000 480,000 3,200,000 1/1/2102 2,600 2,600,000 15,000 780,000 780,000 5,200,000
1/1/2053 1,700 1,700,000 15,000 510,000 510,000 3,400,000 1/1/2103 2,700 2,700,000 15,000 810,000 810,000 5,400,000
1/1/2054 1,700 1,700,000 15,000 510,000 510,000 3,400,000 1/1/2104 2,700 2,700,000 15,000 810,000 810,000 5,400,000
1/1/2055 1,700 1,700,000 15,000 510,000 510,000 3,400,000 1/1/2105 2,700 2,700,000 15,000 810,000 810,000 5,400,000
1/1/2056 1,700 1,700,000 15,000 510,000 510,000 3,400,000 1/1/2106 2,700 2,700,000 15,000 810,000 810,000 5,400,000
1/1/2057 1,700 1,700,000 15,000 510,000 510,000 3,400,000 1/1/2107 2,700 2,700,000 15,000 810,000 810,000 5,400,000
1/1/2058 1,800 1,800,000 15,000 540,000 540,000 3,600,000 1/1/2108 2,800 2,800,000 15,000 840,000 840,000 5,600,000
1/1/2059 1,800 1,800,000 15,000 540,000 540,000 3,600,000 1/1/2109 2,800 2,800,000 15,000 840,000 840,000 5,600,000
1/1/2060 1,800 1,800,000 15,000 540,000 540,000 3,600,000 1/1/2110 2,800 2,800,000 15,000 840,000 840,000 5,600,000
1/1/2061 1,800 1,800,000 15,000 540,000 540,000 3,600,000 1/1/2111 2,800 2,800,000 15,000 840,000 840,000 5,600,000
1/1/2062 1,800 1,800,000 15,000 540,000 540,000 3,600,000 1/1/2112 2,800 2,800,000 15,000 840,000 840,000 5,600,000
1/1/2063 1,900 1,900,000 15,000 570,000 570,000 3,800,000 1/1/2113 2,900 2,900,000 15,000 870,000 870,000 5,800,000
1/1/2064 1,900 1,900,000 15,000 570,000 570,000 3,800,000 1/1/2114 2,900 2,900,000 15,000 870,000 870,000 5,800,000
1/1/2065 1,900 1,900,000 15,000 570,000 570,000 3,800,000 1/1/2115 2,900 2,900,000 15,000 870,000 870,000 5,800,000
1/1/2066 1,900 1,900,000 15,000 570,000 570,000 3,800,000 1/1/2116 2,900 2,900,000 15,000 870,000 870,000 5,800,000
1/1/2067 1,900 1,900,000 15,000 570,000 570,000 3,800,000 1/1/2117 2,900 2,900,000 15,000 870,000 870,000 5,800,000
Class Of Policy: LONPAC INSURANCE BHD (307414-T)
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Schedule of Limits – Plan 2 (Ringgit Malaysia)
Jadual Had – Pelan 2 (Ringgit Malaysia)
Effe
ctiv
e R
evis
ion
Dat
e
Tar
ikh
Sem
akan
Ber
kuat
kua
sa
Roo
m &
Boa
rd
Bili
k &
Mak
an
Per
Dis
abili
ty L
imit
Had
Set
iap
Hila
ng U
paya
Ded
uctib
le P
er D
isab
ility
Ded
uktib
el S
etia
p H
ilang
Upa
ya
Out
Pat
ient
Can
cer
Tre
atm
ent
Raw
atan
Kan
ser
Pes
akit
Luar
Out
Pat
ient
Kid
ney
Dia
lysi
s
Dia
lisis
Bua
h P
ingg
ang
Pes
akit
Luar
Ove
rall
Ann
ual L
imit
Had
Tah
unan
Kes
elur
uhan
Effe
ctiv
e R
evis
ion
Dat
e
Tar
ikh
Sem
akan
Ber
kuat
kua
sa
Roo
m &
Boa
rd
Bili
k &
Mak
an
Per
Dis
abili
ty L
imit
Had
Set
iap
Hila
ng U
paya
Ded
uctib
le P
er D
isab
ility
Ded
uktib
el S
etia
p H
ilang
Upa
ya
Out
Pat
ient
Can
cer
Tre
atm
ent
Raw
atan
Kan
ser
Pes
akit
Luar
Out
Pat
ient
Kid
ney
Dia
lysi
s
Dia
lisis
Bua
h P
ingg
ang
Pes
akit
Luar
Ove
rall
Ann
ual L
imit
Had
Tah
unan
Kes
elur
uhan
1/1/2018 1,000 1,000,000 150,000 300,000 300,000 2,000,000
1/1/2068 2,000 2,000,000 150,000 600,000 600,000 4,000,000
1/1/2019 1,000 1,000,000 150,000 300,000 300,000 2,000,000
1/1/2069 2,000 2,000,000 150,000 600,000 600,000 4,000,000
1/1/2020 1,000 1,000,000 150,000 300,000 300,000 2,000,000
1/1/2070 2,000 2,000,000 150,000 600,000 600,000 4,000,000
1/1/2021 1,000 1,000,000 150,000 300,000 300,000 2,000,000
1/1/2071 2,000 2,000,000 150,000 600,000 600,000 4,000,000
1/1/2022 1,000 1,000,000 150,000 300,000 300,000 2,000,000
1/1/2072 2,000 2,000,000 150,000 600,000 600,000 4,000,000
1/1/2023 1,100 1,100,000 150,000 330,000 330,000 2,200,000
1/1/2073 2,100 2,100,000 150,000 630,000 630,000 4,200,000
1/1/2024 1,100 1,100,000 150,000 330,000 330,000 2,200,000
1/1/2074 2,100 2,100,000 150,000 630,000 630,000 4,200,000
1/1/2025 1,100 1,100,000 150,000 330,000 330,000 2,200,000
1/1/2075 2,100 2,100,000 150,000 630,000 630,000 4,200,000
1/1/2026 1,100 1,100,000 150,000 330,000 330,000 2,200,000
1/1/2076 2,100 2,100,000 150,000 630,000 630,000 4,200,000
1/1/2027 1,100 1,100,000 150,000 330,000 330,000 2,200,000
1/1/2077 2,100 2,100,000 150,000 630,000 630,000 4,200,000
1/1/2028 1,200 1,200,000 150,000 360,000 360,000 2,400,000
1/1/2078 2,200 2,200,000 150,000 660,000 660,000 4,400,000
1/1/2029 1,200 1,200,000 150,000 360,000 360,000 2,400,000
1/1/2079 2,200 2,200,000 150,000 660,000 660,000 4,400,000
1/1/2030 1,200 1,200,000 150,000 360,000 360,000 2,400,000
1/1/2080 2,200 2,200,000 150,000 660,000 660,000 4,400,000
1/1/2031 1,200 1,200,000 150,000 360,000 360,000 2,400,000
1/1/2081 2,200 2,200,000 150,000 660,000 660,000 4,400,000
1/1/2032 1,200 1,200,000 150,000 360,000 360,000 2,400,000
1/1/2082 2,200 2,200,000 150,000 660,000 660,000 4,400,000
1/1/2033 1,300 1,300,000 150,000 390,000 390,000 2,600,000
1/1/2083 2,300 2,300,000 150,000 690,000 690,000 4,600,000
1/1/2034 1,300 1,300,000 150,000 390,000 390,000 2,600,000
1/1/2084 2,300 2,300,000 150,000 690,000 690,000 4,600,000
1/1/2035 1,300 1,300,000 150,000 390,000 390,000 2,600,000
1/1/2085 2,300 2,300,000 150,000 690,000 690,000 4,600,000
1/1/2036 1,300 1,300,000 150,000 390,000 390,000 2,600,000
1/1/2086 2,300 2,300,000 150,000 690,000 690,000 4,600,000
1/1/2037 1,300 1,300,000 150,000 390,000 390,000 2,600,000
1/1/2087 2,300 2,300,000 150,000 690,000 690,000 4,600,000
1/1/2038 1,400 1,400,000 150,000 420,000 420,000 2,800,000
1/1/2088 2,400 2,400,000 150,000 720,000 720,000 4,800,000
1/1/2039 1,400 1,400,000 150,000 420,000 420,000 2,800,000
1/1/2089 2,400 2,400,000 150,000 720,000 720,000 4,800,000
1/1/2040 1,400 1,400,000 150,000 420,000 420,000 2,800,000
1/1/2090 2,400 2,400,000 150,000 720,000 720,000 4,800,000
1/1/2041 1,400 1,400,000 150,000 420,000 420,000 2,800,000
1/1/2091 2,400 2,400,000 150,000 720,000 720,000 4,800,000
1/1/2042 1,400 1,400,000 150,000 420,000 420,000 2,800,000
1/1/2092 2,400 2,400,000 150,000 720,000 720,000 4,800,000
1/1/2043 1,500 1,500,000 150,000 450,000 450,000 3,000,000
1/1/2093 2,500 2,500,000 150,000 750,000 750,000 5,000,000
1/1/2044 1,500 1,500,000 150,000 450,000 450,000 3,000,000
1/1/2094 2,500 2,500,000 150,000 750,000 750,000 5,000,000
1/1/2045 1,500 1,500,000 150,000 450,000 450,000 3,000,000
1/1/2095 2,500 2,500,000 150,000 750,000 750,000 5,000,000
1/1/2046 1,500 1,500,000 150,000 450,000 450,000 3,000,000
1/1/2096 2,500 2,500,000 150,000 750,000 750,000 5,000,000
1/1/2047 1,500 1,500,000 150,000 450,000 450,000 3,000,000
1/1/2097 2,500 2,500,000 150,000 750,000 750,000 5,000,000
1/1/2048 1,600 1,600,000 150,000 480,000 480,000 3,200,000
1/1/2098 2,600 2,600,000 150,000 780,000 780,000 5,200,000
1/1/2049 1,600 1,600,000 150,000 480,000 480,000 3,200,000
1/1/2099 2,600 2,600,000 150,000 780,000 780,000 5,200,000
1/1/2050 1,600 1,600,000 150,000 480,000 480,000 3,200,000
1/1/2100 2,600 2,600,000 150,000 780,000 780,000 5,200,000
1/1/2051 1,600 1,600,000 150,000 480,000 480,000 3,200,000
1/1/2101 2,600 2,600,000 150,000 780,000 780,000 5,200,000
1/1/2052 1,600 1,600,000 150,000 480,000 480,000 3,200,000
1/1/2102 2,600 2,600,000 150,000 780,000 780,000 5,200,000
1/1/2053 1,700 1,700,000 150,000 510,000 510,000 3,400,000
1/1/2103 2,700 2,700,000 150,000 810,000 810,000 5,400,000
1/1/2054 1,700 1,700,000 150,000 510,000 510,000 3,400,000
1/1/2104 2,700 2,700,000 150,000 810,000 810,000 5,400,000
1/1/2055 1,700 1,700,000 150,000 510,000 510,000 3,400,000
1/1/2105 2,700 2,700,000 150,000 810,000 810,000 5,400,000
1/1/2056 1,700 1,700,000 150,000 510,000 510,000 3,400,000
1/1/2106 2,700 2,700,000 150,000 810,000 810,000 5,400,000
1/1/2057 1,700 1,700,000 150,000 510,000 510,000 3,400,000
1/1/2107 2,700 2,700,000 150,000 810,000 810,000 5,400,000
1/1/2058 1,800 1,800,000 150,000 540,000 540,000 3,600,000
1/1/2108 2,800 2,800,000 150,000 840,000 840,000 5,600,000
1/1/2059 1,800 1,800,000 150,000 540,000 540,000 3,600,000
1/1/2109 2,800 2,800,000 150,000 840,000 840,000 5,600,000
1/1/2060 1,800 1,800,000 150,000 540,000 540,000 3,600,000
1/1/2110 2,800 2,800,000 150,000 840,000 840,000 5,600,000
1/1/2061 1,800 1,800,000 150,000 540,000 540,000 3,600,000
1/1/2111 2,800 2,800,000 150,000 840,000 840,000 5,600,000
1/1/2062 1,800 1,800,000 150,000 540,000 540,000 3,600,000
1/1/2112 2,800 2,800,000 150,000 840,000 840,000 5,600,000
1/1/2063 1,900 1,900,000 150,000 570,000 570,000 3,800,000
1/1/2113 2,900 2,900,000 150,000 870,000 870,000 5,800,000
1/1/2064 1,900 1,900,000 150,000 570,000 570,000 3,800,000
1/1/2114 2,900 2,900,000 150,000 870,000 870,000 5,800,000
1/1/2065 1,900 1,900,000 150,000 570,000 570,000 3,800,000
1/1/2115 2,900 2,900,000 150,000 870,000 870,000 5,800,000
1/1/2066 1,900 1,900,000 150,000 570,000 570,000 3,800,000
1/1/2116 2,900 2,900,000 150,000 870,000 870,000 5,800,000
1/1/2067 1,900 1,900,000 150,000 570,000 570,000 3,800,000
1/1/2117 2,900 2,900,000 150,000 870,000 870,000 5,800,000
Class Of Policy: LONPAC INSURANCE BHD (307414-T)
Page 6 of 30
18
/PR
N/T
NC
/HT
16
/Jan
v-1
.0.0
Schedule of Limits – Plan 3 (Ringgit Malaysia)
Jadual Had – Pelan 3 (Ringgit Malaysia)
Effe
ctiv
e R
evis
ion
Dat
e
Tar
ikh
Sem
akan
Ber
kuat
kua
sa
Roo
m &
Boa
rd
Bili
k &
Mak
an
Per
Dis
abili
ty L
imit
Had
Set
iap
Hila
ng U
paya
Ded
uctib
le P
er D
isab
ility
Ded
uktib
el S
etia
p H
ilang
Upa
ya
Out
Pat
ient
Can
cer
Tre
atm
ent
Raw
atan
Kan
ser
Pes
akit
Luar
Out
Pat
ient
Kid
ney
Dia
lysi
s
Dia
lisis
Bua
h P
ingg
ang
Pes
akit
Luar
Ove
rall
Ann
ual L
imit
Had
Tah
unan
Kes
elur
uhan
Effe
ctiv
e R
evis
ion
Dat
e
Tar
ikh
Sem
akan
Ber
kuat
kua
sa
Roo
m &
Boa
rd
Bili
k &
Mak
an
Per
Dis
abili
ty L
imit
Had
Set
iap
Hila
ng U
paya
Ded
uctib
le P
er D
isab
ility
Ded
uktib
el S
etia
p H
ilang
Upa
ya
Out
Pat
ient
Can
cer
Tre
atm
ent
Raw
atan
Kan
ser
Pes
akit
Luar
Out
Pat
ient
Kid
ney
Dia
lysi
s
Dia
lisis
Bua
h P
ingg
ang
Pes
akit
Luar
Ove
rall
Ann
ual L
imit
Had
Tah
unan
Kes
elur
uhan
1/1/2018 750 750,000 10,000 225,000 225,000 1,500,000
1/1/2068 1,500 1,500,000 10,000 450,000 450,000 3,000,000
1/1/2019 750 750,000 10,000 225,000 225,000 1,500,000
1/1/2069 1,500 1,500,000 10,000 450,000 450,000 3,000,000
1/1/2020 750 750,000 10,000 225,000 225,000 1,500,000
1/1/2070 1,500 1,500,000 10,000 450,000 450,000 3,000,000
1/1/2021 750 750,000 10,000 225,000 225,000 1,500,000
1/1/2071 1,500 1,500,000 10,000 450,000 450,000 3,000,000
1/1/2022 750 750,000 10,000 225,000 225,000 1,500,000
1/1/2072 1,500 1,500,000 10,000 450,000 450,000 3,000,000
1/1/2023 825 825,000 10,000 247,500 247,500 1,650,000
1/1/2073 1,575 1,575,000 10,000 472,500 472,500 3,150,000
1/1/2024 825 825,000 10,000 247,500 247,500 1,650,000
1/1/2074 1,575 1,575,000 10,000 472,500 472,500 3,150,000
1/1/2025 825 825,000 10,000 247,500 247,500 1,650,000
1/1/2075 1,575 1,575,000 10,000 472,500 472,500 3,150,000
1/1/2026 825 825,000 10,000 247,500 247,500 1,650,000
1/1/2076 1,575 1,575,000 10,000 472,500 472,500 3,150,000
1/1/2027 825 825,000 10,000 247,500 247,500 1,650,000
1/1/2077 1,575 1,575,000 10,000 472,500 472,500 3,150,000
1/1/2028 900 900,000 10,000 270,000 270,000 1,800,000
1/1/2078 1,650 1,650,000 10,000 495,000 495,000 3,300,000
1/1/2029 900 900,000 10,000 270,000 270,000 1,800,000
1/1/2079 1,650 1,650,000 10,000 495,000 495,000 3,300,000
1/1/2030 900 900,000 10,000 270,000 270,000 1,800,000
1/1/2080 1,650 1,650,000 10,000 495,000 495,000 3,300,000
1/1/2031 900 900,000 10,000 270,000 270,000 1,800,000
1/1/2081 1,650 1,650,000 10,000 495,000 495,000 3,300,000
1/1/2032 900 900,000 10,000 270,000 270,000 1,800,000
1/1/2082 1,650 1,650,000 10,000 495,000 495,000 3,300,000
1/1/2033 975 975,000 10,000 292,500 292,500 1,950,000
1/1/2083 1,725 1,725,000 10,000 517,500 517,500 3,450,000
1/1/2034 975 975,000 10,000 292,500 292,500 1,950,000
1/1/2084 1,725 1,725,000 10,000 517,500 517,500 3,450,000
1/1/2035 975 975,000 10,000 292,500 292,500 1,950,000
1/1/2085 1,725 1,725,000 10,000 517,500 517,500 3,450,000
1/1/2036 975 975,000 10,000 292,500 292,500 1,950,000
1/1/2086 1,725 1,725,000 10,000 517,500 517,500 3,450,000
1/1/2037 975 975,000 10,000 292,500 292,500 1,950,000
1/1/2087 1,725 1,725,000 10,000 517,500 517,500 3,450,000
1/1/2038 1,050 1,050,000 10,000 315,000 315,000 2,100,000
1/1/2088 1,800 1,800,000 10,000 540,000 540,000 3,600,000
1/1/2039 1,050 1,050,000 10,000 315,000 315,000 2,100,000
1/1/2089 1,800 1,800,000 10,000 540,000 540,000 3,600,000
1/1/2040 1,050 1,050,000 10,000 315,000 315,000 2,100,000
1/1/2090 1,800 1,800,000 10,000 540,000 540,000 3,600,000
1/1/2041 1,050 1,050,000 10,000 315,000 315,000 2,100,000
1/1/2091 1,800 1,800,000 10,000 540,000 540,000 3,600,000
1/1/2042 1,050 1,050,000 10,000 315,000 315,000 2,100,000
1/1/2092 1,800 1,800,000 10,000 540,000 540,000 3,600,000
1/1/2043 1,125 1,125,000 10,000 337,500 337,500 2,250,000
1/1/2093 1,875 1,875,000 10,000 562,500 562,500 3,750,000
1/1/2044 1,125 1,125,000 10,000 337,500 337,500 2,250,000
1/1/2094 1,875 1,875,000 10,000 562,500 562,500 3,750,000
1/1/2045 1,125 1,125,000 10,000 337,500 337,500 2,250,000
1/1/2095 1,875 1,875,000 10,000 562,500 562,500 3,750,000
1/1/2046 1,125 1,125,000 10,000 337,500 337,500 2,250,000
1/1/2096 1,875 1,875,000 10,000 562,500 562,500 3,750,000
1/1/2047 1,125 1,125,000 10,000 337,500 337,500 2,250,000
1/1/2097 1,875 1,875,000 10,000 562,500 562,500 3,750,000
1/1/2048 1,200 1,200,000 10,000 360,000 360,000 2,400,000
1/1/2098 1,950 1,950,000 10,000 585,000 585,000 3,900,000
1/1/2049 1,200 1,200,000 10,000 360,000 360,000 2,400,000
1/1/2099 1,950 1,950,000 10,000 585,000 585,000 3,900,000
1/1/2050 1,200 1,200,000 10,000 360,000 360,000 2,400,000
1/1/2100 1,950 1,950,000 10,000 585,000 585,000 3,900,000
1/1/2051 1,200 1,200,000 10,000 360,000 360,000 2,400,000
1/1/2101 1,950 1,950,000 10,000 585,000 585,000 3,900,000
1/1/2052 1,200 1,200,000 10,000 360,000 360,000 2,400,000
1/1/2102 1,950 1,950,000 10,000 585,000 585,000 3,900,000
1/1/2053 1,275 1,275,000 10,000 382,500 382,500 2,550,000
1/1/2103 2,025 2,025,000 10,000 607,500 607,500 4,050,000
1/1/2054 1,275 1,275,000 10,000 382,500 382,500 2,550,000
1/1/2104 2,025 2,025,000 10,000 607,500 607,500 4,050,000
1/1/2055 1,275 1,275,000 10,000 382,500 382,500 2,550,000
1/1/2105 2,025 2,025,000 10,000 607,500 607,500 4,050,000
1/1/2056 1,275 1,275,000 10,000 382,500 382,500 2,550,000
1/1/2106 2,025 2,025,000 10,000 607,500 607,500 4,050,000
1/1/2057 1,275 1,275,000 10,000 382,500 382,500 2,550,000
1/1/2107 2,025 2,025,000 10,000 607,500 607,500 4,050,000
1/1/2058 1,350 1,350,000 10,000 405,000 405,000 2,700,000
1/1/2108 2,100 2,100,000 10,000 630,000 630,000 4,200,000
1/1/2059 1,350 1,350,000 10,000 405,000 405,000 2,700,000
1/1/2109 2,100 2,100,000 10,000 630,000 630,000 4,200,000
1/1/2060 1,350 1,350,000 10,000 405,000 405,000 2,700,000
1/1/2110 2,100 2,100,000 10,000 630,000 630,000 4,200,000
1/1/2061 1,350 1,350,000 10,000 405,000 405,000 2,700,000
1/1/2111 2,100 2,100,000 10,000 630,000 630,000 4,200,000
1/1/2062 1,350 1,350,000 10,000 405,000 405,000 2,700,000
1/1/2112 2,100 2,100,000 10,000 630,000 630,000 4,200,000
1/1/2063 1,425 1,425,000 10,000 427,500 427,500 2,850,000
1/1/2113 2,175 2,175,000 10,000 652,500 652,500 4,350,000
1/1/2064 1,425 1,425,000 10,000 427,500 427,500 2,850,000
1/1/2114 2,175 2,175,000 10,000 652,500 652,500 4,350,000
1/1/2065 1,425 1,425,000 10,000 427,500 427,500 2,850,000
1/1/2115 2,175 2,175,000 10,000 652,500 652,500 4,350,000
1/1/2066 1,425 1,425,000 10,000 427,500 427,500 2,850,000
1/1/2116 2,175 2,175,000 10,000 652,500 652,500 4,350,000
1/1/2067 1,425 1,425,000 10,000 427,500 427,500 2,850,000
1/1/2117 2,175 2,175,000 10,000 652,500 652,500 4,350,000
Class Of Policy: LONPAC INSURANCE BHD (307414-T)
Page 7 of 30
18
/PR
N/T
NC
/HT
16
/Jan
v-1
.0.0
Schedule of Limits – Plan 4 (Ringgit Malaysia)
Jadual Had – Pelan 4 (Ringgit Malaysia)
Effe
ctiv
e R
evis
ion
Dat
e
Tar
ikh
Sem
akan
Ber
kuat
kua
sa
Roo
m &
Boa
rd
Bili
k &
Mak
an
Per
Dis
abili
ty L
imit
Had
Set
iap
Hila
ng U
paya
Ded
uctib
le P
er D
isab
ility
Ded
uktib
el S
etia
p H
ilang
Upa
ya
Out
Pat
ient
Can
cer
Tre
atm
ent
Raw
atan
Kan
ser
Pes
akit
Luar
Out
Pat
ient
Kid
ney
Dia
lysi
s
Dia
lisis
Bua
h P
ingg
ang
Pes
akit
Luar
Ove
rall
Ann
ual L
imit
Had
Tah
unan
Kes
elur
uhan
Effe
ctiv
e R
evis
ion
Dat
e
Tar
ikh
Sem
akan
Ber
kuat
kua
sa
Roo
m &
Boa
rd
Bili
k &
Mak
an
Per
Dis
abili
ty L
imit
Had
Set
iap
Hila
ng U
paya
Ded
uctib
le P
er D
isab
ility
Ded
uktib
el S
etia
p H
ilang
Upa
ya
Out
Pat
ient
Can
cer
Tre
atm
ent
Raw
atan
Kan
ser
Pes
akit
Luar
Out
Pat
ient
Kid
ney
Dia
lysi
s
Dia
lisis
Bua
h P
ingg
ang
Pes
akit
Luar
Ove
rall
Ann
ual L
imit
Had
Tah
unan
Kes
elur
uhan
1/1/2018 750 750,000 100,000 225,000 225,000 1,500,000
1/1/2068 1,500 1,500,000 100,000 450,000 450,000 3,000,000
1/1/2019 750 750,000 100,000 225,000 225,000 1,500,000
1/1/2069 1,500 1,500,000 100,000 450,000 450,000 3,000,000
1/1/2020 750 750,000 100,000 225,000 225,000 1,500,000
1/1/2070 1,500 1,500,000 100,000 450,000 450,000 3,000,000
1/1/2021 750 750,000 100,000 225,000 225,000 1,500,000
1/1/2071 1,500 1,500,000 100,000 450,000 450,000 3,000,000
1/1/2022 750 750,000 100,000 225,000 225,000 1,500,000
1/1/2072 1,500 1,500,000 100,000 450,000 450,000 3,000,000
1/1/2023 825 825,000 100,000 247,500 247,500 1,650,000
1/1/2073 1,575 1,575,000 100,000 472,500 472,500 3,150,000
1/1/2024 825 825,000 100,000 247,500 247,500 1,650,000
1/1/2074 1,575 1,575,000 100,000 472,500 472,500 3,150,000
1/1/2025 825 825,000 100,000 247,500 247,500 1,650,000
1/1/2075 1,575 1,575,000 100,000 472,500 472,500 3,150,000
1/1/2026 825 825,000 100,000 247,500 247,500 1,650,000
1/1/2076 1,575 1,575,000 100,000 472,500 472,500 3,150,000
1/1/2027 825 825,000 100,000 247,500 247,500 1,650,000
1/1/2077 1,575 1,575,000 100,000 472,500 472,500 3,150,000
1/1/2028 900 900,000 100,000 270,000 270,000 1,800,000
1/1/2078 1,650 1,650,000 100,000 495,000 495,000 3,300,000
1/1/2029 900 900,000 100,000 270,000 270,000 1,800,000
1/1/2079 1,650 1,650,000 100,000 495,000 495,000 3,300,000
1/1/2030 900 900,000 100,000 270,000 270,000 1,800,000
1/1/2080 1,650 1,650,000 100,000 495,000 495,000 3,300,000
1/1/2031 900 900,000 100,000 270,000 270,000 1,800,000
1/1/2081 1,650 1,650,000 100,000 495,000 495,000 3,300,000
1/1/2032 900 900,000 100,000 270,000 270,000 1,800,000
1/1/2082 1,650 1,650,000 100,000 495,000 495,000 3,300,000
1/1/2033 975 975,000 100,000 292,500 292,500 1,950,000
1/1/2083 1,725 1,725,000 100,000 517,500 517,500 3,450,000
1/1/2034 975 975,000 100,000 292,500 292,500 1,950,000
1/1/2084 1,725 1,725,000 100,000 517,500 517,500 3,450,000
1/1/2035 975 975,000 100,000 292,500 292,500 1,950,000
1/1/2085 1,725 1,725,000 100,000 517,500 517,500 3,450,000
1/1/2036 975 975,000 100,000 292,500 292,500 1,950,000
1/1/2086 1,725 1,725,000 100,000 517,500 517,500 3,450,000
1/1/2037 975 975,000 100,000 292,500 292,500 1,950,000
1/1/2087 1,725 1,725,000 100,000 517,500 517,500 3,450,000
1/1/2038 1,050 1,050,000 100,000 315,000 315,000 2,100,000
1/1/2088 1,800 1,800,000 100,000 540,000 540,000 3,600,000
1/1/2039 1,050 1,050,000 100,000 315,000 315,000 2,100,000
1/1/2089 1,800 1,800,000 100,000 540,000 540,000 3,600,000
1/1/2040 1,050 1,050,000 100,000 315,000 315,000 2,100,000
1/1/2090 1,800 1,800,000 100,000 540,000 540,000 3,600,000
1/1/2041 1,050 1,050,000 100,000 315,000 315,000 2,100,000
1/1/2091 1,800 1,800,000 100,000 540,000 540,000 3,600,000
1/1/2042 1,050 1,050,000 100,000 315,000 315,000 2,100,000
1/1/2092 1,800 1,800,000 100,000 540,000 540,000 3,600,000
1/1/2043 1,125 1,125,000 100,000 337,500 337,500 2,250,000
1/1/2093 1,875 1,875,000 100,000 562,500 562,500 3,750,000
1/1/2044 1,125 1,125,000 100,000 337,500 337,500 2,250,000
1/1/2094 1,875 1,875,000 100,000 562,500 562,500 3,750,000
1/1/2045 1,125 1,125,000 100,000 337,500 337,500 2,250,000
1/1/2095 1,875 1,875,000 100,000 562,500 562,500 3,750,000
1/1/2046 1,125 1,125,000 100,000 337,500 337,500 2,250,000
1/1/2096 1,875 1,875,000 100,000 562,500 562,500 3,750,000
1/1/2047 1,125 1,125,000 100,000 337,500 337,500 2,250,000
1/1/2097 1,875 1,875,000 100,000 562,500 562,500 3,750,000
1/1/2048 1,200 1,200,000 100,000 360,000 360,000 2,400,000
1/1/2098 1,950 1,950,000 100,000 585,000 585,000 3,900,000
1/1/2049 1,200 1,200,000 100,000 360,000 360,000 2,400,000
1/1/2099 1,950 1,950,000 100,000 585,000 585,000 3,900,000
1/1/2050 1,200 1,200,000 100,000 360,000 360,000 2,400,000
1/1/2100 1,950 1,950,000 100,000 585,000 585,000 3,900,000
1/1/2051 1,200 1,200,000 100,000 360,000 360,000 2,400,000
1/1/2101 1,950 1,950,000 100,000 585,000 585,000 3,900,000
1/1/2052 1,200 1,200,000 100,000 360,000 360,000 2,400,000
1/1/2102 1,950 1,950,000 100,000 585,000 585,000 3,900,000
1/1/2053 1,275 1,275,000 100,000 382,500 382,500 2,550,000
1/1/2103 2,025 2,025,000 100,000 607,500 607,500 4,050,000
1/1/2054 1,275 1,275,000 100,000 382,500 382,500 2,550,000
1/1/2104 2,025 2,025,000 100,000 607,500 607,500 4,050,000
1/1/2055 1,275 1,275,000 100,000 382,500 382,500 2,550,000
1/1/2105 2,025 2,025,000 100,000 607,500 607,500 4,050,000
1/1/2056 1,275 1,275,000 100,000 382,500 382,500 2,550,000
1/1/2106 2,025 2,025,000 100,000 607,500 607,500 4,050,000
1/1/2057 1,275 1,275,000 100,000 382,500 382,500 2,550,000
1/1/2107 2,025 2,025,000 100,000 607,500 607,500 4,050,000
1/1/2058 1,350 1,350,000 100,000 405,000 405,000 2,700,000
1/1/2108 2,100 2,100,000 100,000 630,000 630,000 4,200,000
1/1/2059 1,350 1,350,000 100,000 405,000 405,000 2,700,000
1/1/2109 2,100 2,100,000 100,000 630,000 630,000 4,200,000
1/1/2060 1,350 1,350,000 100,000 405,000 405,000 2,700,000
1/1/2110 2,100 2,100,000 100,000 630,000 630,000 4,200,000
1/1/2061 1,350 1,350,000 100,000 405,000 405,000 2,700,000
1/1/2111 2,100 2,100,000 100,000 630,000 630,000 4,200,000
1/1/2062 1,350 1,350,000 100,000 405,000 405,000 2,700,000
1/1/2112 2,100 2,100,000 100,000 630,000 630,000 4,200,000
1/1/2063 1,425 1,425,000 100,000 427,500 427,500 2,850,000
1/1/2113 2,175 2,175,000 100,000 652,500 652,500 4,350,000
1/1/2064 1,425 1,425,000 100,000 427,500 427,500 2,850,000
1/1/2114 2,175 2,175,000 100,000 652,500 652,500 4,350,000
1/1/2065 1,425 1,425,000 100,000 427,500 427,500 2,850,000
1/1/2115 2,175 2,175,000 100,000 652,500 652,500 4,350,000
1/1/2066 1,425 1,425,000 100,000 427,500 427,500 2,850,000
1/1/2116 2,175 2,175,000 100,000 652,500 652,500 4,350,000
1/1/2067 1,425 1,425,000 100,000 427,500 427,500 2,850,000
1/1/2117 2,175 2,175,000 100,000 652,500 652,500 4,350,000
Class Of Policy: LONPAC INSURANCE BHD (307414-T)
Page 8 of 30
18
/PR
N/T
NC
/HT
16
/Jan
v-1
.0.0
Schedule of Limits – Plan 5 (Ringgit Malaysia)
Jadual Had – Pelan 5 (Ringgit Malaysia)
Effe
ctiv
e R
evis
ion
Dat
e
Tar
ikh
Sem
akan
Ber
kuat
kua
sa
Roo
m &
Boa
rd
Bili
k &
Mak
an
Per
Dis
abili
ty L
imit
Had
Set
iap
Hila
ng U
paya
Ded
uctib
le P
er D
isab
ility
Ded
uktib
el S
etia
p H
ilang
Upa
ya
Out
Pat
ient
Can
cer
Tre
atm
ent
Raw
atan
Kan
ser
Pes
akit
Luar
Out
Pat
ient
Kid
ney
Dia
lysi
s
Dia
lisis
Bua
h P
ingg
ang
Pes
akit
Luar
Ove
rall
Ann
ual L
imit
Had
Tah
unan
Kes
elur
uhan
Effe
ctiv
e R
evis
ion
Dat
e
Tar
ikh
Sem
akan
Ber
kuat
kua
sa
Roo
m &
Boa
rd
Bili
k &
Mak
an
Per
Dis
abili
ty L
imit
Had
Set
iap
Hila
ng U
paya
Ded
uctib
le P
er D
isab
ility
Ded
uktib
el S
etia
p H
ilang
Upa
ya
Out
Pat
ient
Can
cer
Tre
atm
ent
Raw
atan
Kan
ser
Pes
akit
Luar
Out
Pat
ient
Kid
ney
Dia
lysi
s
Dia
lisis
Bua
h P
ingg
ang
Pes
akit
Luar
Ove
rall
Ann
ual L
imit
Had
Tah
unan
Kes
elur
uhan
1/1/2018 500 500,000 7,500 150,000 150,000 1,000,000
1/1/2068 1,000 1,000,000 7,500 300,000 300,000 2,000,000
1/1/2019 500 500,000 7,500 150,000 150,000 1,000,000
1/1/2069 1,000 1,000,000 7,500 300,000 300,000 2,000,000
1/1/2020 500 500,000 7,500 150,000 150,000 1,000,000
1/1/2070 1,000 1,000,000 7,500 300,000 300,000 2,000,000
1/1/2021 500 500,000 7,500 150,000 150,000 1,000,000
1/1/2071 1,000 1,000,000 7,500 300,000 300,000 2,000,000
1/1/2022 500 500,000 7,500 150,000 150,000 1,000,000
1/1/2072 1,000 1,000,000 7,500 300,000 300,000 2,000,000
1/1/2023 550 550,000 7,500 165,000 165,000 1,100,000
1/1/2073 1,050 1,050,000 7,500 315,000 315,000 2,100,000
1/1/2024 550 550,000 7,500 165,000 165,000 1,100,000
1/1/2074 1,050 1,050,000 7,500 315,000 315,000 2,100,000
1/1/2025 550 550,000 7,500 165,000 165,000 1,100,000
1/1/2075 1,050 1,050,000 7,500 315,000 315,000 2,100,000
1/1/2026 550 550,000 7,500 165,000 165,000 1,100,000
1/1/2076 1,050 1,050,000 7,500 315,000 315,000 2,100,000
1/1/2027 550 550,000 7,500 165,000 165,000 1,100,000
1/1/2077 1,050 1,050,000 7,500 315,000 315,000 2,100,000
1/1/2028 600 600,000 7,500 180,000 180,000 1,200,000
1/1/2078 1,100 1,100,000 7,500 330,000 330,000 2,200,000
1/1/2029 600 600,000 7,500 180,000 180,000 1,200,000
1/1/2079 1,100 1,100,000 7,500 330,000 330,000 2,200,000
1/1/2030 600 600,000 7,500 180,000 180,000 1,200,000
1/1/2080 1,100 1,100,000 7,500 330,000 330,000 2,200,000
1/1/2031 600 600,000 7,500 180,000 180,000 1,200,000
1/1/2081 1,100 1,100,000 7,500 330,000 330,000 2,200,000
1/1/2032 600 600,000 7,500 180,000 180,000 1,200,000
1/1/2082 1,100 1,100,000 7,500 330,000 330,000 2,200,000
1/1/2033 650 650,000 7,500 195,000 195,000 1,300,000
1/1/2083 1,150 1,150,000 7,500 345,000 345,000 2,300,000
1/1/2034 650 650,000 7,500 195,000 195,000 1,300,000
1/1/2084 1,150 1,150,000 7,500 345,000 345,000 2,300,000
1/1/2035 650 650,000 7,500 195,000 195,000 1,300,000
1/1/2085 1,150 1,150,000 7,500 345,000 345,000 2,300,000
1/1/2036 650 650,000 7,500 195,000 195,000 1,300,000
1/1/2086 1,150 1,150,000 7,500 345,000 345,000 2,300,000
1/1/2037 650 650,000 7,500 195,000 195,000 1,300,000
1/1/2087 1,150 1,150,000 7,500 345,000 345,000 2,300,000
1/1/2038 700 700,000 7,500 210,000 210,000 1,400,000
1/1/2088 1,200 1,200,000 7,500 360,000 360,000 2,400,000
1/1/2039 700 700,000 7,500 210,000 210,000 1,400,000
1/1/2089 1,200 1,200,000 7,500 360,000 360,000 2,400,000
1/1/2040 700 700,000 7,500 210,000 210,000 1,400,000
1/1/2090 1,200 1,200,000 7,500 360,000 360,000 2,400,000
1/1/2041 700 700,000 7,500 210,000 210,000 1,400,000
1/1/2091 1,200 1,200,000 7,500 360,000 360,000 2,400,000
1/1/2042 700 700,000 7,500 210,000 210,000 1,400,000
1/1/2092 1,200 1,200,000 7,500 360,000 360,000 2,400,000
1/1/2043 750 750,000 7,500 225,000 225,000 1,500,000
1/1/2093 1,250 1,250,000 7,500 375,000 375,000 2,500,000
1/1/2044 750 750,000 7,500 225,000 225,000 1,500,000
1/1/2094 1,250 1,250,000 7,500 375,000 375,000 2,500,000
1/1/2045 750 750,000 7,500 225,000 225,000 1,500,000
1/1/2095 1,250 1,250,000 7,500 375,000 375,000 2,500,000
1/1/2046 750 750,000 7,500 225,000 225,000 1,500,000
1/1/2096 1,250 1,250,000 7,500 375,000 375,000 2,500,000
1/1/2047 750 750,000 7,500 225,000 225,000 1,500,000
1/1/2097 1,250 1,250,000 7,500 375,000 375,000 2,500,000
1/1/2048 800 800,000 7,500 240,000 240,000 1,600,000
1/1/2098 1,300 1,300,000 7,500 390,000 390,000 2,600,000
1/1/2049 800 800,000 7,500 240,000 240,000 1,600,000
1/1/2099 1,300 1,300,000 7,500 390,000 390,000 2,600,000
1/1/2050 800 800,000 7,500 240,000 240,000 1,600,000
1/1/2100 1,300 1,300,000 7,500 390,000 390,000 2,600,000
1/1/2051 800 800,000 7,500 240,000 240,000 1,600,000
1/1/2101 1,300 1,300,000 7,500 390,000 390,000 2,600,000
1/1/2052 800 800,000 7,500 240,000 240,000 1,600,000
1/1/2102 1,300 1,300,000 7,500 390,000 390,000 2,600,000
1/1/2053 850 850,000 7,500 255,000 255,000 1,700,000
1/1/2103 1,350 1,350,000 7,500 405,000 405,000 2,700,000
1/1/2054 850 850,000 7,500 255,000 255,000 1,700,000
1/1/2104 1,350 1,350,000 7,500 405,000 405,000 2,700,000
1/1/2055 850 850,000 7,500 255,000 255,000 1,700,000
1/1/2105 1,350 1,350,000 7,500 405,000 405,000 2,700,000
1/1/2056 850 850,000 7,500 255,000 255,000 1,700,000
1/1/2106 1,350 1,350,000 7,500 405,000 405,000 2,700,000
1/1/2057 850 850,000 7,500 255,000 255,000 1,700,000
1/1/2107 1,350 1,350,000 7,500 405,000 405,000 2,700,000
1/1/2058 900 900,000 7,500 270,000 270,000 1,800,000
1/1/2108 1,400 1,400,000 7,500 420,000 420,000 2,800,000
1/1/2059 900 900,000 7,500 270,000 270,000 1,800,000
1/1/2109 1,400 1,400,000 7,500 420,000 420,000 2,800,000
1/1/2060 900 900,000 7,500 270,000 270,000 1,800,000
1/1/2110 1,400 1,400,000 7,500 420,000 420,000 2,800,000
1/1/2061 900 900,000 7,500 270,000 270,000 1,800,000
1/1/2111 1,400 1,400,000 7,500 420,000 420,000 2,800,000
1/1/2062 900 900,000 7,500 270,000 270,000 1,800,000
1/1/2112 1,400 1,400,000 7,500 420,000 420,000 2,800,000
1/1/2063 950 950,000 7,500 285,000 285,000 1,900,000
1/1/2113 1,450 1,450,000 7,500 435,000 435,000 2,900,000
1/1/2064 950 950,000 7,500 285,000 285,000 1,900,000
1/1/2114 1,450 1,450,000 7,500 435,000 435,000 2,900,000
1/1/2065 950 950,000 7,500 285,000 285,000 1,900,000
1/1/2115 1,450 1,450,000 7,500 435,000 435,000 2,900,000
1/1/2066 950 950,000 7,500 285,000 285,000 1,900,000
1/1/2116 1,450 1,450,000 7,500 435,000 435,000 2,900,000
1/1/2067 950 950,000 7,500 285,000 285,000 1,900,000
1/1/2117 1,450 1,450,000 7,500 435,000 435,000 2,900,000
Class Of Policy: LONPAC INSURANCE BHD (307414-T)
Page 9 of 30
18
/PR
N/T
NC
/HT
16
/Jan
v-1
.0.0
Schedule of Limits – Plan 6 (Ringgit Malaysia)
Jadual Had – Pelan 6 (Ringgit Malaysia)
Effe
ctiv
e R
evis
ion
Dat
e
Tar
ikh
Sem
akan
Ber
kuat
kua
sa
Roo
m &
Boa
rd
Bili
k &
Mak
an
Per
Dis
abili
ty L
imit
Had
Set
iap
Hila
ng U
paya
Ded
uctib
le P
er D
isab
ility
Ded
uktib
el S
etia
p H
ilang
Upa
ya
Out
Pat
ient
Can
cer
Tre
atm
ent
Raw
atan
Kan
ser
Pes
akit
Luar
Out
Pat
ient
Kid
ney
Dia
lysi
s
Dia
lisis
Bua
h P
ingg
ang
Pes
akit
Luar
Ove
rall
Ann
ual L
imit
Had
Tah
unan
Kes
elur
uhan
Effe
ctiv
e R
evis
ion
Dat
e
Tar
ikh
Sem
akan
Ber
kuat
kua
sa
Roo
m &
Boa
rd
Bili
k &
Mak
an
Per
Dis
abili
ty L
imit
Had
Set
iap
Hila
ng U
paya
Ded
uctib
le P
er D
isab
ility
Ded
uktib
el S
etia
p H
ilang
Upa
ya
Out
Pat
ient
Can
cer
Tre
atm
ent
Raw
atan
Kan
ser
Pes
akit
Luar
Out
Pat
ient
Kid
ney
Dia
lysi
s
Dia
lisis
Bua
h P
ingg
ang
Pes
akit
Luar
Ove
rall
Ann
ual L
imit
Had
Tah
unan
Kes
elur
uhan
1/1/2018 500 500,000 75,000 150,000 150,000 1,000,000
1/1/2068 1,000 1,000,000 75,000 300,000 300,000 2,000,000
1/1/2019 500 500,000 75,000 150,000 150,000 1,000,000
1/1/2069 1,000 1,000,000 75,000 300,000 300,000 2,000,000
1/1/2020 500 500,000 75,000 150,000 150,000 1,000,000
1/1/2070 1,000 1,000,000 75,000 300,000 300,000 2,000,000
1/1/2021 500 500,000 75,000 150,000 150,000 1,000,000
1/1/2071 1,000 1,000,000 75,000 300,000 300,000 2,000,000
1/1/2022 500 500,000 75,000 150,000 150,000 1,000,000
1/1/2072 1,000 1,000,000 75,000 300,000 300,000 2,000,000
1/1/2023 550 550,000 75,000 165,000 165,000 1,100,000
1/1/2073 1,050 1,050,000 75,000 315,000 315,000 2,100,000
1/1/2024 550 550,000 75,000 165,000 165,000 1,100,000
1/1/2074 1,050 1,050,000 75,000 315,000 315,000 2,100,000
1/1/2025 550 550,000 75,000 165,000 165,000 1,100,000
1/1/2075 1,050 1,050,000 75,000 315,000 315,000 2,100,000
1/1/2026 550 550,000 75,000 165,000 165,000 1,100,000
1/1/2076 1,050 1,050,000 75,000 315,000 315,000 2,100,000
1/1/2027 550 550,000 75,000 165,000 165,000 1,100,000
1/1/2077 1,050 1,050,000 75,000 315,000 315,000 2,100,000
1/1/2028 600 600,000 75,000 180,000 180,000 1,200,000
1/1/2078 1,100 1,100,000 75,000 330,000 330,000 2,200,000
1/1/2029 600 600,000 75,000 180,000 180,000 1,200,000
1/1/2079 1,100 1,100,000 75,000 330,000 330,000 2,200,000
1/1/2030 600 600,000 75,000 180,000 180,000 1,200,000
1/1/2080 1,100 1,100,000 75,000 330,000 330,000 2,200,000
1/1/2031 600 600,000 75,000 180,000 180,000 1,200,000
1/1/2081 1,100 1,100,000 75,000 330,000 330,000 2,200,000
1/1/2032 600 600,000 75,000 180,000 180,000 1,200,000
1/1/2082 1,100 1,100,000 75,000 330,000 330,000 2,200,000
1/1/2033 650 650,000 75,000 195,000 195,000 1,300,000
1/1/2083 1,150 1,150,000 75,000 345,000 345,000 2,300,000
1/1/2034 650 650,000 75,000 195,000 195,000 1,300,000
1/1/2084 1,150 1,150,000 75,000 345,000 345,000 2,300,000
1/1/2035 650 650,000 75,000 195,000 195,000 1,300,000
1/1/2085 1,150 1,150,000 75,000 345,000 345,000 2,300,000
1/1/2036 650 650,000 75,000 195,000 195,000 1,300,000
1/1/2086 1,150 1,150,000 75,000 345,000 345,000 2,300,000
1/1/2037 650 650,000 75,000 195,000 195,000 1,300,000
1/1/2087 1,150 1,150,000 75,000 345,000 345,000 2,300,000
1/1/2038 700 700,000 75,000 210,000 210,000 1,400,000
1/1/2088 1,200 1,200,000 75,000 360,000 360,000 2,400,000
1/1/2039 700 700,000 75,000 210,000 210,000 1,400,000
1/1/2089 1,200 1,200,000 75,000 360,000 360,000 2,400,000
1/1/2040 700 700,000 75,000 210,000 210,000 1,400,000
1/1/2090 1,200 1,200,000 75,000 360,000 360,000 2,400,000
1/1/2041 700 700,000 75,000 210,000 210,000 1,400,000
1/1/2091 1,200 1,200,000 75,000 360,000 360,000 2,400,000
1/1/2042 700 700,000 75,000 210,000 210,000 1,400,000
1/1/2092 1,200 1,200,000 75,000 360,000 360,000 2,400,000
1/1/2043 750 750,000 75,000 225,000 225,000 1,500,000
1/1/2093 1,250 1,250,000 75,000 375,000 375,000 2,500,000
1/1/2044 750 750,000 75,000 225,000 225,000 1,500,000
1/1/2094 1,250 1,250,000 75,000 375,000 375,000 2,500,000
1/1/2045 750 750,000 75,000 225,000 225,000 1,500,000
1/1/2095 1,250 1,250,000 75,000 375,000 375,000 2,500,000
1/1/2046 750 750,000 75,000 225,000 225,000 1,500,000
1/1/2096 1,250 1,250,000 75,000 375,000 375,000 2,500,000
1/1/2047 750 750,000 75,000 225,000 225,000 1,500,000
1/1/2097 1,250 1,250,000 75,000 375,000 375,000 2,500,000
1/1/2048 800 800,000 75,000 240,000 240,000 1,600,000
1/1/2098 1,300 1,300,000 75,000 390,000 390,000 2,600,000
1/1/2049 800 800,000 75,000 240,000 240,000 1,600,000
1/1/2099 1,300 1,300,000 75,000 390,000 390,000 2,600,000
1/1/2050 800 800,000 75,000 240,000 240,000 1,600,000
1/1/2100 1,300 1,300,000 75,000 390,000 390,000 2,600,000
1/1/2051 800 800,000 75,000 240,000 240,000 1,600,000
1/1/2101 1,300 1,300,000 75,000 390,000 390,000 2,600,000
1/1/2052 800 800,000 75,000 240,000 240,000 1,600,000
1/1/2102 1,300 1,300,000 75,000 390,000 390,000 2,600,000
1/1/2053 850 850,000 75,000 255,000 255,000 1,700,000
1/1/2103 1,350 1,350,000 75,000 405,000 405,000 2,700,000
1/1/2054 850 850,000 75,000 255,000 255,000 1,700,000
1/1/2104 1,350 1,350,000 75,000 405,000 405,000 2,700,000
1/1/2055 850 850,000 75,000 255,000 255,000 1,700,000
1/1/2105 1,350 1,350,000 75,000 405,000 405,000 2,700,000
1/1/2056 850 850,000 75,000 255,000 255,000 1,700,000
1/1/2106 1,350 1,350,000 75,000 405,000 405,000 2,700,000
1/1/2057 850 850,000 75,000 255,000 255,000 1,700,000
1/1/2107 1,350 1,350,000 75,000 405,000 405,000 2,700,000
1/1/2058 900 900,000 75,000 270,000 270,000 1,800,000
1/1/2108 1,400 1,400,000 75,000 420,000 420,000 2,800,000
1/1/2059 900 900,000 75,000 270,000 270,000 1,800,000
1/1/2109 1,400 1,400,000 75,000 420,000 420,000 2,800,000
1/1/2060 900 900,000 75,000 270,000 270,000 1,800,000
1/1/2110 1,400 1,400,000 75,000 420,000 420,000 2,800,000
1/1/2061 900 900,000 75,000 270,000 270,000 1,800,000
1/1/2111 1,400 1,400,000 75,000 420,000 420,000 2,800,000
1/1/2062 900 900,000 75,000 270,000 270,000 1,800,000
1/1/2112 1,400 1,400,000 75,000 420,000 420,000 2,800,000
1/1/2063 950 950,000 75,000 285,000 285,000 1,900,000
1/1/2113 1,450 1,450,000 75,000 435,000 435,000 2,900,000
1/1/2064 950 950,000 75,000 285,000 285,000 1,900,000
1/1/2114 1,450 1,450,000 75,000 435,000 435,000 2,900,000
1/1/2065 950 950,000 75,000 285,000 285,000 1,900,000
1/1/2115 1,450 1,450,000 75,000 435,000 435,000 2,900,000
1/1/2066 950 950,000 75,000 285,000 285,000 1,900,000
1/1/2116 1,450 1,450,000 75,000 435,000 435,000 2,900,000
1/1/2067 950 950,000 75,000 285,000 285,000 1,900,000
1/1/2117 1,450 1,450,000 75,000 435,000 435,000 2,900,000
Class Of Policy: LONPAC INSURANCE BHD (307414-T)
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GENERAL PROVISIONS
PERUNTUKAN AM
1. PERSONS ELIGIBLE
Persons eligible to be covered under this Policy are:-
a. Policyholder up to age 70 on the first inception date of insurance, or
b. Policyholder's legal spouse up to age 70 on the first inception date of insurance, unless legally separated from the Policyholder, or
c. Policyholder’s child who has attained the age of 30 days and is an unmarried person, is financially dependent upon the Insured and is under the age of 19, or up to the age of 23 for those registered as full time students at a recognised educational institution, or
d. Policyholder’s parent up to age 70 on the first inception date of insurance, or
e. Employee up to age 70 on the first inception date of insurance.
1. ORANG YANG LAYAK
Orang yang layak untuk dilindungi di bawah Polisi ini adalah:-
a. Pemegang polisi sehingga umur 70 pada tarikh permulaan pertama insurans, atau
b. Pasangan sah pemegang polisi sehingga umur 70 pada tarikh permulaan pertama insurans, melainkan jika berpisah secara sah dari pemegang polisi, atau
c. Anak pemegang polisi yang telah mencapai umur 30 hari dan tidak berkahwin, yang bergantung dari segi kewangan pada Pemegang polisi dan berumur di bawah 19 tahun, atau sehingga usia 23 tahun bagi mereka yang didaftarkan sebagai pelajar sepenuh masa di institusi pengajian yang diiktiraf, atau
d. Ibubapa Pemegang Polisi sehingga umur 70 pada tarikh permulaan pertama insurans, atau
e. Pekerja sehingga umur 70 tahun pada tarikh permulaan pertama insurans.
2. PERIOD OF INSURANCE AND RENEWAL
This Policy shall become effective as of the date stated in the Schedule. The Policy Anniversary shall be one year after the effective date and annually thereafter. On each such anniversary, this Policy is renewable at the premium rates in effect at that time as notified by the Company.
This Policy will be renewable at the option of policyholder subject to the terms, conditions and termination at each of the anniversary of the Policy date. During renewal, the terms and conditions of coverage shall not be amended.
The renewal premiums payable is not guaranteed and the Company shall revise the premium rate every five years and the respective revised premium shall be applicable at the time of renewal. Such changes, if any shall be applicable to all policyholders irrespective of their claim experience according to the Company’s risk assessment.
This policy is renewable at the option of policyholder until the occurrence of any of the following:
a. non-payment of premium or premium not made on time
b. fraud or misrepresentation of material fact during application
c. the policy is cancelled at the request of the policyholder
d. on the death of the Insured Person
e. the Insured Person ceases to qualify as a dependant based on the definition of the policy
The Company will give thirty (30) days written notice prior to Policy renewal in the event of premium revision.
2. TEMPOH INSURANS DAN PEMBAHARUAN
Polisi ini akan berkuat kuasa mengikut tarikh yang dinyatakan di dalam Jadual. Ulang Tahun Polisi adalah satu tahun selepas tarikh kuat kuasa dan setiap tahun berikutnya. Pada setiap ulang tahun itu, Polisi ini boleh diperbaharui pada kadar premium yang berkuat kuasa pada masa itu seperti yang diberitahu oleh Syarikat.
Polisi ini boleh diperbaharui mengikut pilihan pemegang polisi tertakluk kepada terma, syarat dan penamatan pada setiap tarikh ulang tahun Polisi. Semasa pembaharuan, terma dan syarat perlindungan tidak boleh dipinda.
Premium pembaharuan yang dibayar tidak dijamin dan Syarikat akan menyemak semula kadar premium setiap lima tahun dan premium disemak semula masing-masing hendaklah terpakai pada masa pembaharuan. Perubahan tersebut, jika ada, hendaklah terpakai kepada semua pemegang polisi tanpa mengambil kira pengalaman tuntutan mereka mengikut penilaian risiko Syarikat.
Polisi ini boleh diperbaharui mengikut pilihan pemegang polisi sehingga berlaku mana-mana yang berikut:
a. tidak pembayaran premium atau premium tidak dibayar mengikut masa
b. penipuan atau salah nyataan fakta penting semasa membuat permohonan
c. polisi dibatalkan atas permintaan pemegang polisi
d. kematian Orang yang Diinsuranskan
e. Orang yang Diinsuranskan tidak lagi layak menjadi tanggungan berdasarkan takrif polisi
Syarikat akan memberi tiga puluh (30) hari notis bertulis sebelum pembaharuan Polisi sekiranya kadar premium dipinda.
3. GEOGRAPHICAL TERRITORY All benefits provided in this policy are applicable worldwide for
twenty-four (24) hours a day.
3. WILAYAH PASARAN GEOGRAFI Semua manfaat yang disediakan dalam polisi ini terpakai dua
puluh empat (24) jam sehari di seluruh dunia.
4. SUCCEEDING POLICYHOLDER
a. In the event of death of the Policyholder while this Policy is in force, the Policyholder's legal spouse shall automatically become the Policyholder and all references in this Policy to the Policyholder shall thereafter mean such spouse.
b. When an Insured Person ceases to be a dependent child, the Insured Person may continue to renew the policy in the Insured Person’s own name as a policyholder and all references in this Policy to the Policyholder shall thereafter mean such Insured Person.
4. PEWARISAN PEMEGANG POLISI
a. Sekiranya berlaku kematian Pemegang Polisi semasa Polisi ini berkuat kuasa, pasangan sah Pemegang Polisi akan secara automatik menjadi Pemegang Polisi dan semua rujukan dalam Polisi ini kepada Pemegang Polisi selepas itu merujuk kepada pasangan tersebut.
b. Apabila Orang yang Diinsuranskan tidak lagi menjadi anak tanggungan, Orang yang Diinsuranskan boleh terus memperbaharui polisi itu atas nama Orang yang Diinsuranskan sendiri sebagai pemegang polisi dan semua rujukan dalam Polisi ini kepada Pemegang Polisi selepas itu merujuk kepada Orang Yang Diinsuranskan.
Class Of Policy: LONPAC INSURANCE BHD (307414-T)
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5. VALIDITY PERIOD
This product shall only be valid for 100 years from the launch date. The launch date is 01 January 2018 and the product will no longer be valid after 31 December 2117.
5. TEMPOH SAH
Produk ini hanya sah selama 100 tahun dari tarikh pelancaran. Tarikh pelancaran adalah 01 Januari 2018 dan produk ini tidak lagi sah selepas 31 Disember 2117.
6. PREMIUM PRICING
The pricing of the premium and all subsequent revisions shall be done on a portfolio basis. New applications will be subjected to individual underwriting and premium loadings applicable at the first inception date will be applicable to the standard premium rates as well as all subsequent revisions.
6. HARGA PREMIUM
Penetapan harga premium dan semua pindaan yang kemudiannya hendaklah dilakukan berasaskan portfolio keseluruhannya. Permohonan baru akan tertakluk kepada pengunderaitan dan penambahan Premium yang dikenakan pada tarikh permulaan pertama akan dikenakan pada kadar premium setiap pindaan berikutnya.
7. PORTABILITY OF COVERAGE
a. In the event of an Insured Person leaving the employment with the Policyholder, the Insured Person and/or the insured dependants may take up individual policies bearing the same plan and benefit without being subject to re-underwriting.
b. The new individual policies shall be issued to the respective Insured Persons and the respective Insured Persons shall be required to pay the premium applicable to individual policies, subject to similar premium loading and exclusions applicable to the respective Insured Persons in the previous policy with the Policyholder.
7. KEMUDAHALIHAN PERLINDUNGAN
a. Sekiranya Pemegang Polisi adalah Majikan dan Orang yang Diinsuranskan berhenti kerja dengan Pemegang Polisi, Orang yang Diinsuranskan dan / atau tanggungan diinsuranskan boleh memohon untuk polisi individu yang mengandungi pelan dan faedah yang sama tanpa dikenakan semula pengunderaitan.
b. Polisi individu baru akan dikeluarkan kepada Orang yang Diinsuranskan masing-masing dan Orang yang Diinsuranskan masing-masing dikehendaki untuk membayar premium yang berkenaan bagi polisi individu, tertakluk kepada penambahan premium dan pengecualian yang berkenaan kepada Orang yang Diinsuranskan masing-masing dalam polisi sebelumnya.
Class Of Policy: LONPAC INSURANCE BHD (307414-T)
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DEFINITIONS
TAKRIFAN
1. ACCIDENT shall mean a sudden, unintentional, unexpected, unusual, and specific event that occurs at an identifiable time and place which shall, independently of any other cause, be the sole cause of bodily injury.
1. KEMALANGAN hendaklah bermaksud kejadian yang berlaku secara tiba-tiba, tidak disengajakan, tidak dijangka, luar biasa dan yang tertentu pada masa dan di tempat yang dikenal pasti, yang hendaklah, tanpa bergantung pada apa-apa sebab lain, menjadi satusatunya sebab bagi kecederaan anggota badan.
2. ANY ONE DISABILITY shall mean all of the periods of disability arising from the same cause including any and all complications there from except that if the Insured Person completely recovers and remain free from further treatment (including drugs, medicines, special diet or injection or advice for the condition) of the disability for at least ninety (90) days following the latest date of discharge and subsequent disability from the same cause shall be considered as though it were a new disability.
2. MANA-MANA SATU HILANG UPAYA hendaklah bermaksud semua tempoh hilang upaya yang timbul daripada sebab yang sama termasuk mana-mana dan semua komplikasinya kecuali jika Orang yang Diinsuranskan pulih sepenuhnya dan tidak perlu menjalani apa-apa rawatan lanjut (termasuk dadah, ubat, diet khas atau suntikan atau nasihat tentang keadaannya) bagi hilang upaya itu selama sekurang-kurangnya sembilan puluh (90) hari selepas tarikh terakhir keluar hospital dan hilang upaya berikutnya akibat daripada sebab yang sama hendaklah dianggap seolah-olah hilang upaya itu adalah yang baru.
3. AS CHARGED refers to actual charges incurred for reasonable, necessary and customary medical care provided in the treatment of an insured disability.
3. SEPERTI YANG DICAJKAN merujuk kepada caj sebenar yang ditanggungkan dan caj ini haruslah munasabah, perlu dan biasa diamalkan bagi pembayaran perubatan seperti yang dinyatakan di dalam rawatan bagi hilang upaya yang dilindungi.
4. CHILD shall mean any person who has attained the age of 30 days and is an unmarried person, is financially dependent upon the Insured and is under the age of 19, or up to the age of 23 for those registered as full time students at a recognised educational institution.
4. ANAK hendaklah bermaksud mana-mana orang yang telah mencapai umur 30 hari dan tidak berkahwin, yang bergantung dari segi kewangan pada Orang yang Diinsuranskan dan berumur kurang daripada 19 tahun atau hingga 23 tahun bagi mereka yang didaftarkan sebagai pelajar sepenuh masa di institusi pengajian yang diiktiraf.
5. CONGENITAL CONDITIONS shall mean any medical or physical abnormalities existing at the time of birth, as well as neo-natal physical abnormalities developing within 6 months from the time of birth. They will include hernias of all types and epilepsy except when caused by a trauma which occurred after the date that the Insured Person was continuously covered under this Policy.
5. PENYAKIT KONGENITAL hendaklah bermaksud apa-apa keabnormalan perubatan atau fizikal yang wujud sejak lahir, dan juga keabnormalan fizikal neonatal yang berkembang dalam tempoh 6 bulan dari tarikh kelahiran. lni termasuk semua jenis hernia dan epilepsi kecuali disebabkan oleh trauma yang berlaku selepas tarikh Orang yang Diinsuranskan dilindungi secara berterusan di bawah Polisi ini.
6. DOCTOR or PHYSICIAN or SURGEON shall mean a registered medical practitioner qualified and licensed to practice western medicine and who, in rendering such treatment, is practicing within the scope of his licensing and training in the geographical area of practice, but excluding a doctor, physician or surgeon who is the Insured himself.
6. DOKTOR atau PAKAR PERUBATAN atau PAKAR BEDAH hendaklah bermaksud pengamal perubatan berdaftar yang layak dan berlesen untuk mengamalkan perubatan barat dan yang, semasa memberikan rawatan itu, mengamalkannya mengikut skop pelesenan dan latihannya di kawasan geografi profesion tersebut diamalkan, tetapi tidak termasuk doktor, pakar perubatan atau pakar bedah yang merupakan Orang yang Diinsuranskan itu sendiri.
7. DAY SURGERY - A patient who needs the use of a recovery facility for a surgical procedure on a pre-plan basis at the hospital / specialist clinic (but not for overnight stay).
7. PEMBEDAHAN HARIAN - Pesakit yang perlu menggunakan kemudahan pemulihan untuk prosedur pembedahan yang dirancang terlebih dahulu di hospital/klinik pakar (tetapi bukan untuk bermalam).
8. DEDUCTIBLE PER DISABILITY refers to the amount of expenses that the Policyholder will bear for each disability. Only the amount exceeding this deductible (and all other avenues of compensation from other basic or major medical insurance policies) will be payable by this policy.
8. DEDUKTIBEL SETIAP HILANG UPAYA merujuk kepada jumlah perbelanjaan yang akan ditanggung oleh Pemegang Polisi bagi setiap hilang upaya. Hanya jumlah yang melebihi deduktibel ini (dan semua saluran pampasan dari lain-lain polisi insurans perubatan asas atau insurans perubatan major) akan dibayar oleh polisi ini.
9. DENTIST shall mean a person who is duly licensed or registered to practice dentistry in the geographical area in which a service is provided, but excluding a physician or surgeon who is the Insured himself.
9. DOKTOR GIGI hendaklah bermaksud orang yang berlesen atau berdaftar sewajarnya untuk mengamalkan pergigian dalam bidang geografi yang menyediakan khidmat, tetapi tidak termasuk doktor gigi yang merupakan Orang yang Diinsuranskan itu sendiri.
Class Of Policy: LONPAC INSURANCE BHD (307414-T)
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10. DEPENDANT shall mean any of the following persons:
a. a legally married spouse
b. unmarried children over 30 days old but under nineteen (19) years of age or twenty-three (23) years of age if still on full-time higher education, and who are not gainfully employed.
10. TANGGUNGAN hendaklah bermaksud mana-mana orang yang berikut:
a. suami/isteri yang berkahwin secara sah
b. anak yang tidak berkahwin yang umurnya melebihi 30 hari tetapi kurang daripada sembilan belas (19) tahun atau dua puluh tiga (23) tahun bagi yang masih menjadi pelajar sepenuh masa di pusat pengajian tinggi, dan yang tidak mempunyai pekerjaan bergaji.
11. DISABILITY shall mean a Sickness, Disease, Illness or the entire Injuries arising out of a single or continuous series of causes.
11. HILANG UPAYA hendaklah bermaksud Sakit, Wabak, Penyakit atau semua Kecederaan yang timbul daripada satu atau beberapa sebab yang berterusan.
12. ELIGIBLE EXPENSES shall mean Medically Necessary expenses incurred due to a covered Disability but not exceeding the limits in the schedule.
12. BELANJA LAYAK hendaklah bermaksud belanja yang Perlu Dari Segi Perubatan yang ditanggung disebabkan oleh Hilang Upaya yang dilindungi tetapi tidak melebihi had manfaat dalam Jadual.
13. HOSPITAL shall mean only an establishment duly constituted and registered as a hospital for the care and treatment of sick and injured persons as paying bed-patients, and which:-
a. has facilities for diagnosis and major surgery,
b. provides 24 hour a day nursing services by registered and graduate nurses,
c. is under the supervision of a Physician, and
d. is not primarily a clinic, a place for alcoholics or drug addicts, a nursing, rest or convalescent home or a home for the aged or similar establishment.
13. HOSPITAL hendaklah bermaksud hanya pertubuhan yang ditubuhkan dan didaftarkan sewajarnya sebagai hospital untuk jagaan dan rawatan orang yang sakit dan cedera sebagai pesakit atas katil berbayar, dan yang:-
a. mempunyai kemudahan untuk diagnosis dan pembedahan utama,
b. menyediakan khidmat jagaan 24 jam sehari oleh jururawat berdaftar dan siswazah,
c. di bawah penyeliaan Pakar Perubatan, dan
d. bukan klinik, tempat untuk orang ketagih alkohol dan dadah, pusat jagaan, rumah pemulihan atau rumah orang tua atau pertubuhan yang serupa.
14. HOSPITALISATION shall mean admission to a Hospital as a registered in-patient for Medically Necessary treatments for a covered Disability upon recommendation of a physician. A patient shall not be considered as an in-patient if the patient does not physically stay in the hospital for the whole period of confinement.
14. PENGHOSPITALAN hendaklah bermaksud dimasukkan ke Hospital sebagai pesakit dalam yang berdaftar untuk rawatan yang Perlu Dari Segi Perubatan bagi Hilang Upaya yang dilindungi apabila disyorkan oleh pakar perubatan. Pesakit tidak boleh dianggap sebagai pesakit dalam jika pesakit tidak tinggal di hospital secara fizikal sepanjang tempoh dimasukkan ke hospital.
15. INTENSIVE CARE UNIT shall mean a section within a Hospital which is designated as an Intensive Care Unit by the Hospital, and which is maintained on a twenty-four (24) hour basis solely for treatment of patients in critical condition and is equipped to provide special nursing and medical services not available elsewhere in the Hospital.
15. UNIT RAWATAN RAPI hendaklah bermaksud satu bahagian di Hospital yang dinamakan sebagai Unit Rawatan Rapi oleh Hospital, dan yang diselenggara dua puluh empat (24) jam hanya untuk rawatan bagi pesakit dalam keadaan kritikal dan dilengkapi khidmat jagaan dan perubatan khas yang tidak disediakan di mana-mana bahagian lain Hospital itu.
16. INJURY shall mean bodily injury caused solely by Accident.
16. KECEDERAAN hendaklah bermaksud kecederaan anggota badan yang semata-mata disebabkan oleh Kemalangan.
17. INSURED shall mean the Policyholder described in the Policy Schedule.
17. YANG DIINSURANSKAN hendaklah bermaksud Pemegang Polisi yang dinyatakan di dalam Jadual Polisi.
18. INSURED PERSON shall mean the person described in the Policy Schedule including his/her Dependant (if applicable).
18. ORANG YANG DIINSURANSKAN hendaklah bermaksud orang yang dinyatakan di dalam Jadual Polisi termasuk Tanggungannya (jika berkenaan).
19. MALAYSIAN GOVERNMENT HOSPITAL shall mean a hospital which charges of services are subject to the Fee Act 1951 Fees (Medical) Order 1982 and/or its subsequent amendments if any.
19. HOSPITAL KERAJAAN MALAYSIA hendaklah bermaksud hospital yang bayaran khidmatnya tertakluk kepada Akta Fee 1951, Perintah Fee (Perubatan) 1982 dan/atau pindaan berikutnya jika ada.
20. MEDICALLY NECESSARY shall mean a medical service which is:-
a. consistent with the diagnosis and customary medical treatment for a covered Disability, and
b. in accordance with standards of good medical practice, consistent with current standard of professional medical care, and of proven medical benefits, and
c. not for the convenience of the Insured or the Physician, and unable to be reasonably rendered out of hospital (if admitted as an inpatient), and
d. not of an experimental, investigational or research nature, preventive or screening nature, and
20. PERLU DARI SEGI PERUBATAN hendaklah bermaksud khidmat perubatan yang:-
a. selaras dengan diagnosis dan rawatan perubatan biasa bagi Hilang Upaya yang dilindungi, dan
b. menurut piawai amalan perubatan yang baik, selaras dengan piawai semasa bagi rawatan perubatan profesional, dan juga dengan manfaat kesihatan yang sah, dan
c. bukan untuk kemudahan Orang yang diinsuranskan atau Pakar Perubatan, dan tidak dapat diperoleh sewajarnya di luar hospital (jika dimasukkan ke wad sebagai pesakit dalam), dan
d. bukan berbentuk eksperimen, penyelidikan atau kajian, pencegahan atau penyaringan, dan
Class Of Policy: LONPAC INSURANCE BHD (307414-T)
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e. for which the charges are fair and reasonable and customary for the Disability.
e. yang bayarannya berpatutan, munasabah dan biasa diamalkan bagi Hilang Upaya itu.
21. OUT-PATIENT shall mean the Insured Person is receiving medical care or treatment without being hospitalised and includes treatment in a Daycare Centre.
21. PESAKIT LUAR hendaklah bermaksud Orang yang Diinsuranskan yang menerima jagaan atau rawatan perubatan tanpa dimasukkan ke hospital dan termasuk rawatan di pusat Rawatan Harian.
22. OVERALL ANNUAL LIMIT
Benefits payable in respect of expenses incurred for treatment provided to the Insured Person during the period of insurance shall be limited to Overall Annual Limits as stated in the Schedule of Benefits irrespective of a type/types of disability. In the event the Overall Annual Limit having been paid, all insurance for the Insured Person hereunder shall immediately cease to be payable for the remaining policy year.
22. HAD TAHUNAN KESELURUHAN
Manfaat yang dibayar bagi belanja yang dikenakan untuk rawatan yang diberikan kepada Orang yang Diinsuranskan dalam tempoh insurans hendaklah dihadkan mengikut Had Tahunan Keseluruhan seperti yang dinyatakan dalam Jadual Manfaat tanpa mengira jenis hilang upaya. Jika Had Tahunan Keseluruhan telah dibayar, maka semua insurans untuk Orang yang Diinsuranskan di bawah ini hendaklah dihentikan bayarannya serta-merta bagi baki tahun polisi tersebut.
23. PARENT refers to the Policyholder’s mother or father whose age does not exceed 70 years next birthday at the time of purchasing the insurance policy.
23. IBU-BAPA merujuk kepada ibu atau bapa Pemegang Polisi yang berumur tidak melebihi 70 tahun hari jadi berikutnya pada masa membeli polisi insurans.
24. PER DISABILITY LIMIT
Benefits payable in respect of expenses incurred for treatment provided to the Insured Person during the period of insurance shall be limited to Per Disability Limit as stated in the Schedule of Benefits. A disability shall be deemed to be the same disability unless the Insured Person completely recovers and remain free from further treatment (including drugs, medicines, special diet or injection or advice for the condition) of the disability for at least ninety (90) days following the latest date of discharge and subsequent disability from the same cause shall be considered as though it were a new disability.
24. HAD SETIAP HILANG UPAYA
Manfaat yang perlu dibayar berkenaan dengan perbelanjaan yang ditanggung untuk rawatan yang diberikan kepada Orang Yang Diinsuranskan dalam tempoh insurans adalah terhad kepada Had Hilang Upaya sebagaimana dinyatakan dalam Jadual Manfaat. Setiap satu hilang upaya adalah dianggap sebagai hilang upaya yang sama kecuali jika Orang yang Diinsuranskan pulih sepenuhnya dan tidak perlu menjalani apa-apa rawatan lanjut (termasuk dadah, ubat, diet khas atau suntikan atau nasihat tentang keadaannya) bagi hilang upaya itu selama sekurang-kurangnya sembilan puluh (90) hari selepas tarikh terakhir keluar hospital dan hilang upaya berikutnya akibat daripada sebab yang sama adalah dianggap seolah-olah hilang upaya itu adalah yang baru.
25. POLICYHOLDER shall mean a person or a corporate body to whom the Policy has been issued in respect of cover for persons specifically identified as Insured Persons in this Policy. The Policyholder shall also be referred to as the Insured.
25. PEMEGANG POLISI hendaklah bermaksud orang atau badan korporat yang kepadanya Polisi dikeluarkan bagi melindungi orang yang secara khusus dikenal pasti sebagai Orang Yang Diinsuranskan dalam Polisi ini. Pemegang Polisi hendaklah juga dirujuk sebagai Yang Diinsuranskan.
26. POLICY YEAR shall mean the one year period including the effective date of commencement of Insurance and immediately following that date, or the one year period following the Renewal or Renewed Policy.
26. TAHUN POLISI hendaklah bermaksud tempoh satu tahun termasuk tarikh mula kuat kuasa lnsurans dan sebaik sahaja selepas tarikh itu, atau tempoh satu tahun selepas Polisi Pembaharuan atau Polisi Baru.
27. 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.
27. PENYAKIT SEDIA ADA hendaklah bermaksud hilang upaya yang diketahui sewajarnya oleh Orang yang Diinsuranskan. Orang yang Diinsuranskan dianggap mengetahui sewajarnya keadaan sedia ada itu apabila:-
a. Orang yang Diinsuranskan telah atau sedang menerima rawatan;
b. nasihat perubatan, diagnosis, jagaan atau rawatan telah disyorkan;
c. gejala yang jelas dan tepat dapat atau telah dilihat dengan nyata; atau
d. kewujudannya dapat diperhatikan dengan jelas bagi orang yang mengalami keadaan itu.
28. PRESCRIBED MEDICINES shall mean medicines that are dispensed by a Physician, a Registered Pharmacist or a Hospital and which have been prescribed by a Physician or Specialist in respect of treatment for a covered Disability.
28. UBAT YANG DIPRESKRIPSIKAN hendaklah bermaksud ubat yang diberikan oleh Pakar Perubatan, Ahli Farmasi Berdaftar atau Hospital dan yang dipreskripsikan oleh Pakar Perubatan atau Pakar bagi rawatan Hilang Upaya yang dilindungi.
29. REASONABLE AND CUSTOMARY CHARGES shall mean charges for medical care which is medically necessary shall be considered reasonable and customary to the extent that it does not exceed the general level of charges being made by others of similar standing in the locality where the charge is incurred, when furnishing like or comparable treatment, services or supplies to individual of the same sex and of comparable age for a similar sickness, disease or injury and in accordance with accepted medical standards and practice could not have been omitted
29. BAYARAN MUNASABAH DAN BIASA DIAMALKAN hendaklah bermaksud bayaran rawatan perubatan yang perlu dari segi perubatan, yang dianggap munasabah dan biasa diamalkan selagi bayaran itu tidak melebihi had biasa bayaran yang dibuat oleh pihak lain yang sama kedudukannya di tempat bayaran itu dikenakan, apabila memberikan rawatan, khidmat atau bekalan seumpamanya atau yang serupa kepada individu dengan jantina yang sama dan kategori umur yang sama untuk sakit, penyakit
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without adversely affecting the Insured Person’s medical condition.
atau kecederaan serta selaras dengan piawai dan amalan perubatan yang diterima dan tidak boleh diabaikan tanpa menjejaskan keadaan perubatan Orang yang Diinsuranskan.
30. RENEWAL OR RENEWED POLICY shall mean a Policy which has been renewed without any lapse of time upon expiry of a preceding Policy with the same content.
30. POLISI PEMBAHARUAN ATAU POLISI BARU hendaklah bermaksud Polisi yang telah diperbaharui tanpa apa-apa tempoh luput sebaik sahaja tamatnya tempoh setelah Polisi sebelumnya dengan kandungan yang sama tamat tempoh.
31. SICKNESS, DISEASE OR ILLNESS shall mean a physical condition marked by a pathological deviation from the normal healthy state.
31. SAKIT, WABAK ATAU PENYAKIT hendaklah bemaksud keadaan fizikal yang ditunjukkan dari segi patologi berbeza daripada keadaan kesihatan yang normal.
32. SPECIALIST shall mean a medical or dental practitioner registered and licensed as such in the geographical area of his practice where treatment takes place and who is classified by the appropriate health authorities as a person with superior and special expertise in specified fields of medicine or dentistry, but excluding a physician or surgeon who is the Insured himself.
32. PAKAR hendaklah bermaksud pengamal perubatan atau pergigian yang berdaftar dan berlesen sewajarnya di kawasan geografi yang khidmat tersebut diberikan, dan yang diklasifikasikan oleh pihak berkuasa kesihatan yang berkenaan sebagai orang yang mempunyai kepakaran yang tinggi dan khusus dalam bidang perubatan atau pergigian yang tertentu, tetapi tidak termasuk pakar perubatan atau pakar bedah yang merupakan Orang yang Diinsuranskan itu sendiri.
33. SURGERY shall mean any of the following medical procedures:
a. to incise, excise or electro-cauterize any organ or body part, except for dental services
b. to repair, revise, or reconstruct any organ or body part
c. to reduce by manipulation a fracture or dislocation
d. use of endoscopy to remove a stone or object from the larynx, bronchus, trachea, esophagus, stomach, intestine, urinary bladder, or urethra
33. PEMBEDAHAN hendaklah bermaksud mana-mana prosedur perubatan yang berikut:
a. untuk menginsisi, mengeksisi atau mengelektrokauteri mana-mana bahagian organ atau badan kecuali untuk khidmat pergigian.
b. untuk membaiki, mengubah atau membentuk semula mana-mana bahagian organ atau badan.
c. untuk mengurangkan fraktur atau dislokasi melalui manipulasi.
d. penggunaan endoskopi untuk mengeluarkan batu atau objek dari larinks, bronkus, trakea, esofagus, perut, usus, pundi kencing, atau uretra.
34. WAITING PERIOD shall mean the first thirty (30) days between the beginning of an Insured Person's disability and the commencement of this Policy date/reinstatement date and is applied only when the person is first covered. This shall not be applicable after the first year of cover. However, if there is a break in insurance, the Waiting Period will apply again.
34. TEMPOH TANGGUH hendaklah bermaksud tiga puluh (30) hari pertama antara masa bermulanya hilang upaya Orang yang Diinsuranskan dan bermulanya tarikh Polisi/tarikh pengembalian semula, dan terpakai hanya apabila orang itu dilindungi pertama kalinya. Hal ini tidak terpakai selepas tahun pertama perlindungan. Walau bagaimanapun, jika insurans terhenti, maka Tempoh Tangguh akan terpakai sekali lagi.
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DESCRIPTION OF BENEFITS
KETERANGAN MANFAAT
1. HOSPITAL ROOM AND BOARD
Reimbursement of the Reasonable and Customary Charges Medically Necessary for room accommodation and meals. The amount of the benefit shall be equal to the actual charges made by the Hospital during the Insured Person’s confinement, but in no event shall the benefit exceed, for any one day, the rate of Room and Board Benefit, and the maximum number of days as set forth in the Schedule of Benefits. The Insured Person will only be entitled to this benefit while confined to a Hospital as an in-patient.
1. BILIK HOSPITAL DAN MAKAN
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan yang Perlu Dari Segi Perubatan untuk penginapan di bilik dan makan. Jumlah manfaat hendaklah sama dengan bayaran sebenar yang dikenakan oleh Hospital semasa Orang yang Diinsuranskan dimasukkan ke hospital, tetapi manfaat tidak boleh melebihi, bagi mana-mana satu hari, kadar Manfaat Bilik dan Makan, dan bilangan maksimum hari seperti yang ditetapkan dalam Jadual Manfaat. Orang yang Diinsuranskan hanya layak menerima manfaat ini apabila dimasukkan ke Hospital sebagai pesakit dalam.
2. INTENSIVE CARE UNIT
Reimbursement of the Reasonable and Customary Charges Medically Necessary for actual room and board incurred during confinement as an in-patient in the Intensive Care Unit of the Hospital. This benefit shall be payable equal to the actual charges made by the Hospital subject to the maximum benefit for any one day, and maximum number of days, as set forth in the Schedule of Benefits. Where the period of confinement in an Intensive Care Unit exceeds the maximum set forth in the Schedule of Benefits, reimbursement will be restricted to the standard Daily Hospital Room and Board rate. No Hospital Room and Board Benefits shall be paid for the same confinement period where the Daily Intensive Care Unit Benefits is payable.
2. UNIT RAWATAN RAPI
Pembayaran balik bagi Bayaran Munasabah dan Diamalkan yang Perlu Dari Segi Perubatan untuk bilik dan makan yang sebenarnya ditanggung semasa dimasukkan ke hospital sebagai pesakit dalam di Unit Rawatan Rapi Hospital. Bayaran manfaat ini hendaklah sama dengan bayaran sebenar yang dikenakan oleh Hospital tertakluk kepada manfaat maksimum bagi mana-mana satu hari, dan bilangan maksimum hari, seperti yang ditetapkan dalam Jadual Manfaat. Apabila tempoh dimasukkan ke hospital di Unit Rawatan Rapi melebihi tempoh maksimum yang ditetapkan dalam Jadual Manfaat, maka pembayaran balik akan dihadkan kepada kadar Bilik dan Makan Harian Hospital. Manfaat Bilik dan Makan Hospital tidak boleh dibayar bagi tempoh dimasukkan ke hospital tersebut apabila Manfaat Unit Rawatan Rapi Harian dibayar.
3. HOSPITAL SUPPLIES & SERVICES
Reimbursement of the Reasonable and Customary Charges actually incurred for Medically Necessary general nursing, prescribed and consumed drugs and medicines, dressings, splints, plaster casts, x-ray, laboratory examinations, electrocardiograms, physiotherapy, basal metabolism tests, intravenous injections and solutions, administration of blood and blood plasma but excluding the cost of blood and plasma whilst the Insured Person is confined as an in-patient in a Hospital, up to the amount stated in the Schedule of Benefits.
3. BEKALAN DAN KHIDMAT HOSPITAL
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan yang sebenarnya ditanggung dan yang Perlu Dari Segi Perubatan untuk jagaan am, dadah dan ubat yang dipreskripsikan dan dimakan, pencucian dan pembalutan Iuka, anduh, acuan plaster, sinar-x, pemeriksaan makmal, elektrokardiogram, fisioterapi, ujian metabolisma basal, suntikan dan larutan intravena, pemberian darah dan plasma darah, tetapi tidak termasuk kos darah dan plasma semasa Orang yang Diinsuranskan dimasukkan ke hospital sebagai pesakit dalam di Hospital, hingga jumlah yang dinyatakan dalam Jadual Manfaat.
4. PRE-SURGICAL CONSULTATION & DIAGNOSIS
Specialists' fees for consultation, pathology and radiography following referral from a general practitioner, for each illness or injury requiring confinement in a hospital. Benefit is not payable for outpatient treatment (including medications and any subsequent consultations after the illness is diagnosed), nor if the Insured Person is not subsequently surgically treated after such diagnostic services have been performed.
4. RUNDINGAN PAKAR DAN UJIAN DIAGNOSTIK PRA-PEMBEDAHAN
Pembayaran Pakar untuk perundingan, patologi dan radiografi dengan syarat rundingan itu telah dirujuk oleh pengamal perubatan am, bagi setiap penyakit atau kecederaan yang memerlukan kemasukan ke hospital. Manfaat tidak akan dibayar untuk rawatan pesakit luar (termasuk ubat-ubatan dan apa-apa rundingan berikutnya selepas penyakit didiagnosis), ataupun jika Orang Yang Diinsuranskan tidak kemudiannya menjalani pembedahan selepas perkhidmatan diagnostik itu telah dilakukan.
5. PRE-HOSPITAL SPECIALIST CONSULTATION
Reimbursement of the Reasonable and Customary Charges for the first time consultation by a Specialist in connection with a Disability within the maximum number of days as set forth in the Schedule of Benefits preceding confinement in a Hospital and provided that such consultation is Medically Necessary and has been recommended in writing by the attending general practitioner. Payment will not be made for clinical treatment (including medications and subsequent consultation after the illness is diagnosed) or where the Insured Person does not result in hospital confinement for the treatment of the medical condition diagnosed.
5. RUNDINGAN PAKAR PRA-HOSPITAL
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan untuk rundingan kali pertama oleh Pakar yang berkaitan dengan Hilang Upaya dalam bilangan hari maksimum seperti yang ditetapkan dalam Jadual Manfaat sebelum dimasukkan ke Hospital, dan dengan syarat rundingan itu Perlu Dari Segi Perubatan dan telah disyorkan secara bertulis oleh pengamal perubatan am yang memberikan rawatan. Bayaran tidak akan dibuat untuk rawatan klinikal (termasuk ubat dan rundingan berikutnya selepas penyakit didiagnosis) atau apabila Orang yang Diinsuranskan tidak dimasukkan ke hospital untuk rawatan bagi keadaan perubatan yang didiagnosis itu.
6. PRE-HOSPITAL DIAGNOSTIC TESTS
Reimbursement of the Reasonable and Customary Charges for Medically Necessary ECG, X-ray and laboratory tests which are performed for diagnostic purposes on account of an injury or illness when in connection with a Disability preceding
6. UJIAN DIAGNOSTIK PRA-HOSPITAL
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan untuk ECG, sinar-x dan ujian makmal yang Perlu Dari Segi Perubatan yang dijalankan di Hospital untuk tujuan diagnostik bagi kecederaan atau penyakit apabila berkaitan
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hospitalisation within the maximum number of days and amount as set forth in the Schedule of Benefits in a Hospital and which are recommended by a qualified medical practitioner. No payment shall be made if upon such diagnostic services, the Insured Person does not result in hospital confinement for the treatment of the medical condition diagnosed. Medications and consultation charged by the medical practitioner will not be payable.
dengan Hilang Upaya sebelum dimasukkan ke hospital mengikut bilangan hari dan jumlah maksimum yang ditetapkan dalam Jadual Manfaat dan yang disyorkan oleh pengamal perubatan yang layak. Bayaran tidak akan dibuat jika dalam khidmat diagnostik itu, Orang yang Diinsuranskan tidak perlu dimasukkan ke hospital untuk rawatan bagi keadaan perubatan yang didiagnosis itu. Bayaran ubat dan rundingan yang dikenakan oleh pengamal perubatan tidak akan dibayar.
7. IN-HOSPITAL PHYSICIAN VISIT
Reimbursement of the Reasonable and Customary Charges by a Physician for Medically Necessary visiting a in-paying patient while confined for a non-surgical disability subject to a maximum of 2 visits per day not exceeding the maximum number of days as set forth in the Schedule of Benefits.
7. LAWATAN PAKAR PERUBATAN DALAM HOSPITAL
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan oleh Pakar Perubatan untuk lawatan yang Perlu Dari Segi Perubatan ke atas pesakit dalam berbayar semasa dimasukkan ke hospital kerana hilang upaya bukan pembedahan tertakluk kepada maksimum 2 lawatan sehari tidak melebihi bilangan hari maksimum yang ditetapkan dalam Jadual Manfaat.
8. POST-HOSPITALISATION TREATMENT
Reimbursement of the Reasonable and Customary Charges incurred in Medically Necessary follow-up treatment by the same attending Physician, within the maximum number of days and amount as set forth in the Schedule of Benefits immediately following discharge from Hospital for a non-surgical disability. This shall include medicines prescribed during the follow-up treatment but shall not exceed the supply needed for the maximum number of days as set forth in the Schedule of Benefits.
8. RAWATAN SELEPAS PENGHOSPITALAN
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan yang ditanggung dalam rawatan susulan yang Perlu Dari Segi Perubatan oleh Pakar Perubatan yang sama yang telah memberikan rawatan, mengikut bilangan hari dan jumlah maksimum seperti yang ditetapkan dalam Jadual Manfaat sebaik sahaja selepas keluar dari Hospital kerana hilang upaya bukan pembedahan. lni hendaklah termasuk ubat yang dipreskripsikan dalam rawatan susulan tetapi tidak boleh melebihi bekalan yang diperlukan untuk bilangan hari maksimum seperti yang ditetapkan dalam Jadual Manfaat.
9. SURGICAL FEES
Reimbursement of the Reasonable and Customary Charges for a Medically Necessary surgery by the Specialists, including pre-surgical assessment Specialist’s visits to the Insured Person and post-surgery care up to the maximum of 60 days from the date of surgery, but within the maximum indicated in the Schedule of Benefits. If more than one surgery is performed for Any One Disability, the total payments for all the surgeries performed shall not exceed the maximum stated in the Schedule of Benefits.
9. BAYARAN PEMBEDAHAN
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan untuk pembedahan yang Perlu Dari Segi Perubatan oleh Pakar, termasuk lawatan penilaian pra-pembedahan oleh Pakar terhadap Orang Yang Diinsuranskan dan rawatan selepas pembedahan sehingga 60 hari maksimum dari tarikh pembedahan, tetapi hendaklah dalam maksimum yang dinyatakan dalam Jadual Manfaat. Jika lebih daripada satu pembedahan dijalankan bagi Mana-mana Satu Hilang Upaya, jumlah bayaran untuk semua pembedahan yang dijalankan, tidak boleh melebihi jumlah maksimum yang dinyatakan dalam Jadual Manfaat.
10. ANAESTHETIST FEE
Reimbursement of the Reasonable and Customary Charges by the Anaesthetist for the Medically Necessary administration of anaesthesia not exceeding the limits as set forth in the Schedule of Benefits.
10. BAYARAN PAKAR BIUS
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan oleh Pakar Bius untuk pemberian bahan bius yang Perlu Dari Segi Perubatan tidak boleh melebihi had yang ditetapkan dalam Jadual Manfaat.
11. OPERATING THEATRE
Reimbursement of the Reasonable and Customary Operating Room charges incidental to the surgical procedure.
11. BAYARAN BILIK BEDAH
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan untuk Bilik Bedah yang berkaitan dengan prosedur pembedahan.
12. AMBULANCE FEES
Reimbursement of the Reasonable and Customary Charges incurred for necessary domestic ambulance services (inclusive of attendant) to and/or from the Hospital of confinement. Payment will not be made if the Insured Person is not hospitalised and subject to the limits set forth in the Schedule of Benefits.
12. BAYARAN AMBULANS
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan yang ditanggung untuk khidmat ambulans domestik (termasuk atendan) ke dan/atau dari Hospital di mana Orang yang Diinsuranskan itu dimasukkan ke hospital. Bayaran tidak akan dibuat jika Orang yang Diinsuranskan itu tidak dimasukkan ke hospital dan tertakluk kepada had yang ditetapkan dalam Jadual Manfaat.
13. NURSING AT HOME
Actual charges incurred for the services of a government licensed nurse in the Insured Person’s abode when prescribed by a physician for medical as distinct from domestic reasons. The medical reason must be the medical condition for which hospital treatment was sought. Cover will be limited to the time period as stated in the applicable Schedule of Benefits starting from the date of hospital discharge.
13. JAGAAN JURURAWAT DI RUMAH
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan yang ditanggung untuk perkhidmatan jururawat di tempat tinggal Orang Yang Diinsuranskan, apabila ditetapkan oleh doktor, yang dilakuan oleh jururawat yang dilesen oleh kerajaan untuk perkhidmatan perubatan berbeza daripada sebab domestik. Perkhidmatan perubatan perlu berkaitan dengan keadaan perubatan yang mana rawatan hospital telah diterima. Bayaran akan terhad untuk tempoh masa yang dinyatakan dalam Jadual Manfaat bermula dari tarikh keluar hospital.
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14. ORGAN TRANSPLANT
Reimburses Reasonable and Customary Charges incurred on transplantation surgery for the Insured Person being the recipient of the transplant of a kidney, heart, lung, liver or bone marrow. Payment for this Benefit is applicable only once per lifetime whilst the policy is in force and shall be subject to the limit as set forth in the Schedule of Benefits. The costs of acquisition of the organs and all costs incurred by the donors are not covered.
14. TRANSPLAN ORGAN
Pembayaran balik Bayaran yang Munasabah dan Biasa Diamalkan yang ditanggung dalam pembedahan transplan untuk Orang yang Diinsuranskan yang menjadi penerima transplan buah pinggang, jantung, paru-paru, hati atau sum-sum tulang. Bayaran manfaat ini terpakai hanya sekali seumur hidup semasa polisi berkuat kuasa dan hendaklah tertakluk kepada had yang ditetapkan dalam Jadual Manfaat. Kos pemerolehan organ dan semua kos yang ditanggung oleh penderma tidak dilindungi.
15. OUT-PATIENT CANCER TREATMENT
If an Insured Person is diagnosed with Cancer as defined below, the Company will reimburse the Reasonable and Customary Charges incurred for the Medically Necessary treatment of cancer performed at a legally registered cancer treatment centre subject to the limit of this disability as specified in the Schedule of Benefits.
Such treatment (radiotherapy or chemotherapy excluding consultation, examination tests, take-home drugs) must be received at the out-patient department of a Hospital or a registered cancer treatment centre immediately following discharge from Hospital confinement or surgery.
Cancer is defined as the uncontrollable growth and spread of malignant cells and the invasion and destruction of normal tissue for which major interventionist treatment or surgery (excluding endoscopic procedures alone) is considered necessary. The cancer must be confirmed by histological evidence of malignancy. The following conditions are excluded:
a. Carcinorma in situ including of the cervix;
b. Ductal Carcinorma in situ of the breast;
c. Papillary Carcinorma of the bladder & Stage 1 Prostate Cancer;
d. All skin cancers except malignant melanoma;
e. Stage 1 Hodgkin's disease;
f. Tumours manifesting as complications of AIDS.
It is a specific condition of this Benefit that notwithstanding the exclusion of pre-existing conditions, this Benefit will not be payable for any Insured Person who had been diagnosed as a cancer patient and/or is receiving cancer treatment prior to the effective date of Insurance.
15. RAWATAN KANSER PESAKIT LUAR
Jika Orang yang Diinsuranskan didiagnosis menghidap kanser seperti yang dinyatakan di bawah, Syarikat akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang ditanggung untuk rawatan kanser yang Perlu Dari Segi Perubatan yang dijalankan di pusat rawatan kanser berdaftar yang sah tertakluk kepada had bagi hilang upaya ini seperti yang ditetapkan dalam Jadual Manfaat.
Rawatan itu (radioterapi atau kemoterapi tidak termasuk rundingan, ujian pemeriksaan, dadah yang dibawa pulang) hendaklah diterima di jabatan pesakit luar Hospital atau di pusat rawatan kanser berdaftar sebaik sahaja selepas keluar dari Hospital atau pembedahan.
Kanser ditakrifkan sebagai sel malignan yang tumbuh dan merebak secara tidak terkawal, dan serangan serta pemusnahan tisu normal tersebut dianggap memerlukan rawatan perantaraan atau pembedahan utama (tidak termasuk prosedur endoskopi). Kanser mesti disahkan melalui tanda malignansi histologi. Keadaan yang berikut dikecualikan:
a. Karsinoma in situ termasuk pada serviks;
b. Karsinoma duktus in situ pada buah dada;
c. Karsinoma Papilari pada pundi & Kanser Prostat Peringkat 1;
d. Semua kanser kulit kecuali melanoma malignan;
e. Penyakit Hodgkin Peringkat 1;
f. Tumor yang menunjukkan dengan jelas komplikasi AIDS.
Adalah menjadi syarat khas bagi Manfaat ini, tanpa menyentuh pengecualian keadaan sedia ada, bahawa ia tidak akan dibayar untuk mana-mana Orang yang Diinsuranskan yang telah didiagnosis sebagai pesakit kanser dan/atau menerima rawatan kanser sebelum tarikh kuat kuasa lnsurans.
16. OUT-PATIENT KIDNEY DIALYSIS
If an Insured Person is diagnosed with Kidney Failure as defined below, the Company will reimburse the Reasonable and Customary Charges incurred for the Medically Necessary treatment of kidney dialysis performed at a legally registered dialysis centre subject to the limit of this disability as specified in the Schedule of Benefits.
Such treatment (dialysis excluding consultation, examination tests, take home drugs) must be received at the out-patient department of a Hospital or a registered dialysis treatment centre immediately following discharge from Hospital confinement or surgery.
Kidney Failure means end stage renal failure presenting as chronic, irreversible failure of both kidneys to function as a result of which renal dialysis is initiated.
It is a specific condition of this Benefit that notwithstanding the exclusion of pre-existing conditions, this Benefit will not be payable for any Insured Person who has developed chronic renal diseases and/or is receiving dialysis treatment prior to the effective date of Insurance.
16. DIALISIS BUAH PINGGANG PESAKIT LUAR
Jika Orang yang Diinsuranskan didiagnosis sebagai mengalami Kegagalan Buah Pinggang seperti yang dinyatakan di bawah, Syarikat akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang ditanggung yang Perlu Dari Segi Perubatan untuk rawatan dialisis buah pinggang yang dijalankan di pusat dialisis berdaftar yang sah tertakluk kepada had hilang upaya ini seperti yang ditetapkan dalam Jadual Manfaat.
Rawatan tersebut (dialisis tidak termasuk rundingan, ujian pemeriksaan, dadah yang dibawa pulang) hendaklah diterima di jabatan pesakit luar Hospital atau di pusat rawatan dialisis berdaftar sebaik sahaja selepas keluar dari Hospital atau pembedahan.
Kegagalan Buah Pinggang bermaksud kegagalan renal peringkat akhir yang menyebabkan kegagalan kronik dan tidak boleh pulih kedua-dua buah pinggang untuk berfungsi dan oleh itu dialisis renal perlu dimulakan.
Adalah menjadi syarat khas bagi Manfaat ini, tanpa menyentuh pengecualian keadaan sedia ada, bahawa ia tidak akan dibayar untuk mana-mana Orang yang Diinsuranskan yang mengalami penyakit renal kronik dan/atau menerima rawatan dialisis sebelum tarikh kuat kuasa lnsurans.
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17. MEDICAL REPORT FEE
It is hereby declared and agreed that notwithstanding anything contained herein to the contrary, the policy is extended to reimburse Medical Report Fee not exceeding the amount stated in the Schedule of Benefits in respect of each disability.
17. BAYARAN LAPORAN PERUBATAN
Adalah dengan ini diisytiharkan dan dipersetujui bahawa walau apapun yang dinyatakan sebaliknya, polisi ini diperluaskan untuk membayar balik Bayaran Laporan Perubatan tidak melebihi amaun yang dinyatakan di dalam Jadual Manfaat bagi setiap hilang upaya
18. GOODS AND SERVICES TAX
Reimburses the actual amount of goods and services tax payable in respect of treatment received for illnesses or conditions covered under the policy.
18. CUKAI BARANG DAN PERKHIDMATAN
Membayar balik jumlah sebenar cukai barangan dan perkhidmatan yang perlu dibayar bagi rawatan yang diterima untuk penyakit atau keadaan yang dilindungi di bawah polisi.
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EXCLUSIONS
PENGECUALIAN
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:
Kontrak ini tidak melindungi apa-apa penghospitalan, pembedahan atau bayaran yang disebabkan secara langsung atau tidak langsung, sepenuhnya atau sebahagiannya, oleh mana-mana satu (1) kejadian yang berikut:
1. Pre-existing illness.
1. Penyakit sedia ada.
2. 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.
2. Apa-apa keadaan perubatan atau fizikal yang berlaku dalam tempoh 30 hari pertama perlindungan atau tarikh pengembalian semula bagi Orang yang Diinsuranskan, mengikut mana-mana yang terakhir kecuali untuk kecederaan akibat kemalangan.
3. 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.
3. Pembedahan plastik/kosmetik, khatan, pemeriksaan mata, cermin mata dan pembetulan penglihatan dekat melalui pembiasan atau pembedahan (Keratotomi Radial atau Lasik) dan penggunaan atau pemerolehan perkakas atau alat prostetik seperti anggota tiruan, alat pendengaran, perentak yang diimplankan dan preskripsinya.
4. 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.
4. Penyakit pergigian termasuk rawatan pergigian atau pembedahan oral kecuali apabila diperlukan kerana Kecederaan Akibat Kemalangan pada gigi asli yang sihat yang berlaku sepenuhnya dalam Tempoh lnsurans.
5. 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.
5. Penjagaan peribadi, rehat pulih atau jagaan kebersihan, dadah yang tidak dibenarkan, intoksikasi, pensterilan, penyakit venereal dan sekuelanya, AIDS (Sindrom Kurang Daya Tahan Penyakit) atau ARC (Kompleks Berkaitan AIDS) dan penyakit berkaitan HIV, dan apa apa penyakit berjangkit yang memerlukan kuarantin oleh undang-undang.
6. Any treatment or surgical operation for congenital abnormalities or deformities including hereditary conditions.
6. Apa-apa rawatan atau operasi pembedahan untuk keabnormalan atau kecacatan kongenital termasuk penyakit keturunan.
7. 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.
7. Kehamilan, melahirkan anak (termasuk kelahiran secara pembedahan), keguguran, menggugurkan kandungan dan jagaan serta pembedahan pranatal atau postnatum, kaedah kawalan kelahiran kontraseptif mekanikal atau kimia atau rawatan berkaitan ketaksuburan, disfungsi erektil dan ujian atau rawatan berkaitan impoten atau pensterilan.
8. 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.
8. Penghospitalan terutamanya untuk tujuan penyiasatan, diagnosis, pemeriksaan sinar-x, pemeriksaan fizikal atau perubatan am, tidak berkaitan dengan rawatan atau diagnosis Hilang Upaya yang dilindungi yang tidak Perlu Dari Segi Perubatan dan apa-apa rawatan pencegahan, ubat atau pemeriksaan pencegahan yang dijalankan oleh Pakar Perubatan, dan rawatan khusus untuk mengurangkan atau menaikkan berat badan.
9. Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.
9. Bunuh diri, percubaan bunuh diri atau kecederaan diri sendiri yang disengajakan ketika siuman atau tidak siuman.
10. 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.
10. Perang atau apa-apa tindakan perang, diisytiharkan atau tidak diisytiharkan, aktiviti jenayah atau pengganas, bergiat cergas dalam mana-mana angkatan bersenjata, penyertaan secara langsung dalam mogok, rusuhan dan kekecohan awam atau penderhakaan tentera.
11. Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material.
11. Radiasi pengionan atau pencemaran melalui radioaktiviti daripada mana-mana bahan api nuklear atau sisa nuklear daripada proses pembelahan nuklear atau daripada apa-apa bahan senjata nuklear.
12. 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.
12. Belanja yang ditanggung untuk menderma mana-mana organ tubuh oleh Orang yang Diinsuranskan dan kos pemerolehan organ termasuk semua kos yang ditanggung oleh penderma ketika transplan organ dan komplikasinya.
13. Investigation and treatment of sleep and snoring disorders, 13. Penyiasatan dan rawatan gangguan tidur dan dengkur, terapi
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hormone replacement therapy and alternative therapy such as treatment, medical service or supplies, including but not limited to chiropractic services, acupuncture, acupressure, reflexology, bone-setting, herbalist treatment, massage or aroma therapy or other alternative treatment.
penggantian hormon dan terapi pilihan seperti rawatan, khidmat atau bekalan perubatan, termasuk tetapi tidak terhad kepada khidmat kiropraktik, akupunktur, akutekanan, refleksologi, pengikatan tulang, rawatan pakar herba, urut atau terapi aroma atau rawatan pilihan yang lain.
14. 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 Person and Disabilities arising out of duties of employment or profession that is covered under a Workman's Compensation Insurance Contract.
14. Jagaan atau rawatan yang pembayarannya tidak dikehendaki atau setakat yang ia dibayar oleh mana-mana insurans lain atau tanggung rugi yang melindungi Orang yang diinsuranskan dan Hilang Upaya yang timbul daripada tugas dalam pekerjaan atau kerjaya yang dilindungi di bawah Kontrak lnsurans Pampasan Pekerja.
15. Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations).
15. Psikotik, gangguan mental atau saraf (termasuk apa-apa neurosis dan manifestasi fisiologi atau psikosomatiknya).
16. 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.
16. Kos/belanja bagi khidmat yang bersifat bukan perubatan, seperti televisyen, telefon, khidmat teleks, radio atau kemudahan yang serupa, kit/pek kemasukan dan barang bukan perubatan lain yang tidak layak.
17. 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.
17. Sakit atau kecederaan yang timbul daripada apa-apa jenis perlumbaan (kecuali perlumbaan jalan kaki), sukan berbahaya seperti tetapi tidak terhad kepada terjun di udara, luncur air, aktiviti dalam air yang memerlukan alat pernafasan, sukan musim sejuk, sukan profesional dan aktiviti yang tidak dibenarkan.
18. Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes.
18. Penerbangan peribadi selain sebagai penumpang yang membayar tambang dalam mana-mana penerbangan komersial berjadual yang dilesen untuk mengangkut penumpang melalui laluan yang ditetapkan.
19. Expenses incurred for sex change.
19. Belanja yang ditanggung untuk menukar jantina.
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CONDITIONS
SYARAT
1. MISSTATEMENT OF AGE
If the age of the Insured Person has been misstated and the premium paid as a result thereof is insufficient, any claim payable under this Policy shall be prorated based on the ratio of the actual premium paid to the correct premium which should have been charged for the year. Any excess premium, which may have been paid as a result of such misstatement of age, shall be refunded without interest.
If at the correct age the Insured Person would not have been eligible for cover under this Policy, no benefit shall be payable.
1. SILAP NYATA UMUR
Jika umur Orang yang Diinsuranskan telah tersilap nyata dan akibatnya premium yang dibayar tidak mencukupi, maka apa-apa tuntutan yang dibayar di bawah Polisi ini hendaklah dikira secara pro rata berasaskan nisbah premium sebenar yang dibayar dengan premium yang betul yang sepatutnya dikenakan selama setahun. Apa-apa premium yang berlebihan, yang mungkin telah dibayar akibat silap nyata umur, hendaklah dibayar balik tanpa faedah.
Jika pada umur yang betul, Orang yang Diinsuranskan itu tidak layak dilindungi di bawah Polisi ini, maka tiada manfaat akan dibayar.
2. TERMINATION OF INSURED PERSON AND COMPANY LIABILITY
An Insured Person shall cease to be an Insured Person on :-
a. for children, on the anniversary following attainment of the 19th birthday or 23rd birthday for those registered as full time students at a recognised educational institution.
b. the date of termination of the Policy of any person's coverage.
In any case the Company’s liability shall cease with the date of termination of the policy or any person's coverage.
2. PENAMATAN PERLINDUNGAN ORANG YANG DIINSURANSKAN DAN LIABILITI SYARIKAT
Orang yang Diinsuranskan akan berhenti menjadi Orang yang Diinsuranskan pada:
a. bagi anak, ulang tahun polisi pada hari lahir ke sembilan belas (19) tahun atau hari lahir ke dua puluh tiga (23) tahun bagi mereka yang didaftarkan sebagai pelajar sepenuh masa di institusi pengajian berdaftar.
b. tarikh tamat polisi bagi mana-mana perlindungan seseorang.
Dalam mana-mana liabiliti Syarikat akan terhenti pada tarikh penamatan polisi atau mana-mana perlindungan seseorang.
3. FULL REIMBURSEMENT IN A GOVERNMENT HOSPITAL
Charges for eligible medical expenses are covered in full for treatment in a Malaysian Government Hospital for each Illness or Injury, provided the Insured Person does not transfer from or to a private hospital for treatment and the room and board charge is not greater than that provided under the chosen Plan applicable to the Insured Person.
3. PEMBAYARAN BALIK SEPENUHNYA BAGI HOSPITAL KERAJAAN
Bayaran untuk perbelanjaan perubatan yang layak dilindungi sepenuhnya untuk rawatan di Hospital Kerajaan Malaysia bagi setiap Penyakit atau Kecederaan, dengan syarat Orang yang Diinsuranskan tidak berpindah dari atau ke sebuah hospital swasta untuk rawatan serta caj bilik dan makan tidak melebihi daripada yang diberikan di bawah Pelan yang dipilih berkenaan kepada Orang yang Diinsuranskan.
4. AMENDMENTS
No amendment to this policy shall be valid unless mutually agreed upon by the Company and the Policyholder, and such amendment is endorsed thereon.
4. PINDAAN
Tiada pindaan kepada Polisi ini akan sah melainkan jika dipersetujui bersama oleh Syarikat dan Pemegang Polisi, dan pindaan tersebut diendorskan ke atasnya.
5. CHANGE IN RISK
The Insured Person shall give immediate notice in writing to the Company of any material change in his or her occupation, business, duties or pursuits and pay any additional premium that may be required by the Company.
5. PERUBAHAN DALAM RISIKO
Orang yang Diinsuranskan hendaklah segera memberikan notis secara bertulis kepada Syarikat tentang apa-apa perubahan penting dalam pekerjaan, perniagaan, tugas atau hobi dan membayar apa-apa premium tambahan yang mungkin dikehendaki oleh Syarikat.
6. COOLING-OFF PERIOD
If this Policy shall have been issued and for any reason whatsoever the Insured shall decide not to take up the Policy, the Insured may return the Policy to the Company for cancellation provided such request for cancellation is delivered by the Insured to the Company within fifteen (15) days from the date of delivery of the Policy. The Insured is entitled to the return of the full premium paid less deduction of medical expenses incurred by the Company in the issuance of the Policy.
6. TEMPOH BERTENANG
Jika Polisi ini telah dikeluarkan dan atas apa-apa alasan, Orang yang Diinsuranskan membuat keputusan untuk tidak mengambil Polisi itu, Orang yang Diinsuranskan itu boleh mengembalikan Polisi itu kepada Syarikat untuk pembatalan dengan syarat permohonan untuk pembatalan diserahkan oleh Orang yang Diinsuranskan kepada Syarikat dalam tempoh lima belas (15) hari dari tarikh penyerahan Polisi. Orang yang Diinsuranskan itu layak menerima pulangan penuh premium yang telah dibayar tolak belanja perubatan yang ditanggung oleh Syarikat untuk mengeluarkan Polisi tersebut
7. CANCELLATION OF POLICY
This Policy may be cancelled by the Policyholder at any time by giving a written notice to the Company; and provided that no claims have been made during the current policy year, the Policyholder shall be entitled to a refund of the premium as follow:-
Period Not exceeding 15 days :
90% Refund of Annual Premium
(applicable to renewal only)
7. PEMBATALAN POLISI
Polisi ini boleh dibatalkan oleh Pemegang Polisi pada bila-bila masa dengan memberikan notis bertulis kepada Syarikat, dan dengan syarat tiada tuntutan dibuat dalam tahun polisi semasa. Pemegang Polisi layak menerima bayaran balik premium seperti yang berikut:-
Tempoh Tidak Melebihi 15 hari :
90% Bayaran Balik Premium Tahunan
(terpakai hanya kepada pembaharuan)
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Period Not exceeding 1 month :
80% Refund of Annual Premium
Period Not exceeding 2 months :
70% Refund of Annual Premium
Period Not exceeding 3 months :
60% Refund of Annual Premium
Period Not exceeding 4 months :
50% Refund of Annual Premium
Period Not exceeding 5 months :
40% Refund of Annual Premium
Period Not exceeding 6 months :
30% Refund of Annual Premium
Period Not exceeding 7 months :
25% Refund of Annual Premium
Period Not exceeding 8 months :
20% Refund of Annual Premium
Period Not exceeding 9 months :
15% Refund of Annual Premium
Period Not exceeding 10 months :
10% Refund of Annual Premium
Period Not exceeding 11 months :
5% Refund of Annual Premium
Period exceeding 11 months :
No refund of Premium
Tempoh Tidak Melebihi 1 bulan :
80% Bayaran Balik Premium Tahunan
Tempoh Tidak Melebihi 2 bulan :
70% Bayaran Balik Premium Tahunan
Tempoh Tidak Melebihi 3 bulan :
60% Bayaran Balik Premium Tahunan
Tempoh Tidak Melebihi 4 bulan :
50% Bayaran Balik Premium Tahunan
Tempoh Tidak Melebihi 5 bulan :
40% Bayaran Balik Premium Tahunan
Tempoh Tidak Melebihi 6 bulan :
30% Bayaran Balik Premium Tahunan
Tempoh Tidak Melebihi 7 bulan :
25% Bayaran Balik Premium Tahunan
Tempoh Tidak Melebihi 8 bulan :
20% Bayaran Balik Premium Tahunan
Tempoh Tidak Melebihi 9 bulan :
15% Bayaran Balik Premium Tahunan
Tempoh Tidak Melebihi 10 bulan :
10% Bayaran Balik Premium Tahunan
Tempoh Tidak Melebihi 11 bulan :
5% Bayaran Balik Premium Tahunan
Tempoh Melebihi 11 bulan :
Tiada Bayaran Balik
8. CASH BEFORE COVER
It is fundamental and absolute special condition of this contract of insurance that the premium due must be paid and received by the Company before insurance cover is effective.
8. TUNAI SEBELUM PERLINDUNGAN
Adalah perkara asas dan mutlak pada syarat khas dalam kontrak insurans ini dimana premium yang dikenakan mesti dibayar dan diterima oleh Syarikat sebelum perlindungan insurans berkuat kuasa
9. GRACE PERIOD
Notwithstanding the Cash Before Cover Condition, a Grace Period of fourteen (14) days following the expiry date shall be allowed to the Policyholder for the payment of any premiums after the first policy year. If any premium is not paid in respect of this Policy or any supplementary contracts before the end of the Grace Period, this Policy and the relevant supplementary contracts shall be deemed as terminated at the expiry date of the policy. Even if payment is made during the grace period any disability occurring during the period from the expiry date to the payment date shall not be payable.
9. TEMPOH IHSAN
Meskipun dengan Syarat Tunai Sebelum Perlindungan, Tempoh Ihsan selama empat-belas (14) hari selepas tarikh luput akan dibenarkan kepada Pemegang Polisi bagi pembayaran sebarang premium selepas tahun polisi pertama.Sekiranya mana-mana premium tidak dibayar seperti di dalam Polisi ini atau apa-apa kontrak tambahan sebelum tamat Tempoh Ihsan, Polisi ini dan kontrak tambahan berkenaan itu adalah dianggap sebagai sudah tamat pada tarikh tamat tempoh polisi. Walaupun bayaran telah dibuat semasa Tempoh Ihsan, sebarang hilang upaya yang berlaku semasa dalam tempoh dari tarikh tamat sehingga ke tarikh pembayaran tidak akan dibayar.
10. CLAIM PROCEDURES
a. The Insured shall within 30 days of a Disability that incurs claimable expenses, give written notice to the Company stating full particulars of such event, including all original bills and receipts, and a full Physician’s report stipulating the diagnosis of the condition treated and the date the Disability commenced in the Physician’s opinion and the Physician’s summary of the cost of treatment including medicines and services rendered. Failure to furnish such notice within the time allowed shall not invalid any claim if it is shown not to have been reasonably possible to furnish such notice and that such notice was furnished as soon as was reasonably possible.
b. The Insured shall immediately procure and act on proper medical advice and the Company shall not be held liable in the event a treatment or service becomes necessary due to failure of the Insured to do so.
10. PROSEDUR TUNTUTAN
a. Orang yang Diinsuranskan hendaklah dalam tempoh 30 hari Hilang Upaya yang melibatkan belanja boleh tuntut, memberikan notis bertulis kepada Syarikat dengan menyatakan butiran lengkap kejadian tersebut, termasuk semua bil dan resit asal, serta laporan lengkap Pakar Perubatan yang menyatakan diagnosis keadaan yang dirawat dan tarikh Hilang Upaya bermula mengikut pendapat Pakar Perubatan dan rumusan kos rawatan oleh Pakar Perubatan termasuk ubat dan khidmat yang diberikan. Kegagalan memberikan notis tersebut dalam tempoh yang dibenarkan tidak boleh membatalkan apa-apa tuntutan jika ditunjukkan tidak munasabah untuk memberikan notis itu dan notis itu telah diberikan secepat yang mungkin.
b. Orang yang Diinsuranskan hendaklah mendapatkan dan bertindak berdasarkan nasihat perubatan yang sewajarnya dan Syarikat tidak bertanggungjawab jika rawatan atau khidmat diperlukan berikutan kegagalan Orang yang Diinsuranskan berbuat demikian.
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11. INCOMPLETE CLAIMS
All claims must be submitted to the Company within 30 days of completion of the events for which the claim is being made. Claims are not deemed complete and Eligible Benefits are not payable unless all bills for such claims have been submitted and agreed upon by the Company. Only actual costs incurred shall be considered for reimbursement. Any variation or waiver of the foregoing shall be at the Company's sole discretion.
11. TUNTUTAN TIDAK LENGKAP
Semua tuntutan hendaklah diserahkan kepada Syarikat dalam tempoh 30 hari setelah kejadian itu selesai yang untuknya tuntutan itu dibuat. Tuntutan tidak dianggap lengkap dan Manfaat Layak Diterima tidak akan dibayar kecuali semua bil untuk tuntutan itu telah diserahkan dan dipersetujui oleh Syarikat. Hanya kos sebenar yang ditanggung akan dipertimbangkan untuk pembayaran balik. Apa-apa perbezaan atau penepian bagi perkara di atas adalah mengikut budi bicara Syarikat semata-mata.
12. MISSTATEMENT OR OMISSION OF MATERIAL FACT
If:
a. any answer, disclosure or representation by You, before this contract of insurance is entered into, varied or renewed, in or to any proposal or declaration or query, has been deliberately or recklessly stated in any respect; or
b. before this contract of insurance is entered into, varied or renewed, You have failed to disclose any fact You knew to be relevant to Our decision on whether to accept this risk or not and the rates and the terms to be applied; or
c. any claim made shall be fraudulent or exaggerated, or if any false declaration or statement shall be made in support of such claim.
then in any of the above cases, this Policy shall be void.
12. SALAH NYATA ATAU KETINGGALAN FAKTA PENTING
Jika:
a. sebarang jawapan, pendedahan atau pernyataan yang Anda berikan, sebelum kontrak insurans ini dimeterai, diubah atau diperbaharui, dalam atau kepada mana-mana cadangan atau perakuan atau pertanyaan, yang dibuat secara sengaja atau melulu dari segenap segi; atau
b. sebelum kontrak insurans ini dimeterai, diubah atau diperbaharui, Anda gagal mendedahkan apa-apa fakta yang Anda ketahui yang berkaitan dengan keputusan Kami untuk menerima risiko dan menentukan kadar dan terma yang dikenakan; atau
c. apa-apa tuntutan yang dibuat berbentuk penipuan atau ditokok-tambah, atau sebarang perakuan atau kenyataan palsu dibuat untuk menyokong tuntutan tersebut.
maka dalam mana-mana hal di atas, Polisi ini adalah batal.
13. CURRENCY OF PAYMENT
All payments under this Policy shall be made in the legal currency of Malaysia. Should any payment be requested by the Insured to be payable in any other currency, then such amount shall be payable in the demand currency as may be purchased in Malaysia at the prevailing currency market rates on the date of the claim settlement.
13. MATA WANG BAYARAN
Semua bayaran di bawah Palisi ini hendaklah dibuat dalam mata wang Malaysia yang sah. Sekiranya apa-apa bayaran yang diminta oleh Orang yang Diinsuranskan supaya dibayar dalam mata wang lain, maka jumlah tersebut hendaklah dibayar dalam mata wang yang diminta seperti yang boleh dibeli di Malaysia pada kadar pasaran mata wang semasa pada tarikh penyelesaian tuntutan.
14. CERTIFICATION, INFORMATION AND EVIDENCE
All certificates, information, medical reports and evidence as required by the Company shall be furnished at the expense of the Insured, and in such a form that the Company may require. In any event all notices which the Company shall require the Policyholder to give must be in writing and addressed to the Company. An Insured shall, at the Company's request and expense, submit to a medical examination whenever such is deemed necessary
14. PERAKUAN, MAKLUMAT DAN BUKTI
Semua sijil, maklumat, laporan dan bukti perubatan seperti yang dikehendaki oleh Syarikat hendaklah diserahkan atas belanja Orang yang Diinsuranskan, dan dalam borang tertentu yang mungkin dikehendaki oleh Syarikat. Semua notis apabila dikehendaki oleh Syarikat supaya diberikan oleh Pemegang Polisi, hendaklah secara bertulis dan dialamatkan kepada Syarikat. Orang yang Diinsuranskan hendaklah, atas permintaan dan belanja Syarikat, menyerahkan kepada pemeriksaan perubatan apabila ia dianggap perlu.
15. OVERSEAS TREATMENT
If the Insured Person seeks treatment overseas, benefits in respect of the treatment shall be covered subject to the exclusions, limitations and conditions specified in this Policy and all benefits will be payable based on the official exchange rate ruling on the last day of the Period of Confinement and shall exclude the cost of transport to the place of treatment provided:
a. an Insured Person travelling abroad for a reason other than for medical treatment, needs to be confined to a Hospital outside Malaysia as a consequence of a Medical Emergency.
b. an Insured Person upon recommendation of a Physician and has to be transferred to a Hospital outside Malaysia because the specialised nature of the treatment, aid, information or decision required can neither be rendered nor furnished nor taken in Malaysia.
Overseas treatment of a disease, sickness or injury which is diagnosed in Malaysia and non-emergency or chronic conditions where treatment can reasonably be postponed until return to Malaysia are excluded.
15. RAWATAN LUAR NEGARA
Jika Orang yang Diinsuranskan ingin mendapatkan rawatan luar negara, manfaat berkaitan rawatan hendaklah dilindungi tertakluk kepada pengecualian, had dan syarat yang ditetapkan dalam Polisi ini dan semua manfaat akan dibayar berdasarkan keputusan kadar pertukaran mata wang rasmi pada hari terakhir Tempoh Dimasukkan Ke hospital dan tidak termasuk kos pengangkutan ke tempat rawatan disediakan:
a. Orang yang Dinsuranskan yang pergi ke luar negara atas sebab selain mendapatkan rawatan perubatan, perlu dimasukkan ke Hospital di luar Malaysia kerana Kecemasan Perubatan
b. Orang yang Diinsuranskan, atas syor Pakar Perubatan dan perlu dipindahkan ke Hospital di luar Malaysia disebabkan oleh jenis yang khusus bagi rawatan, bantuan, maklumat atau keputusan yang dikehendaki tidak boleh diberikan atau disediakan atau diambil di Malaysia
Rawatan luar negara bagi wabak, sakit atau kecederaan yang didiagnosis di Malaysia dan keadaan bukan kecemasan atau kronik yang rawatannya boleh ditangguhkan sewajarnya hingga pulang ke Malaysia dikecualikan.
16. RESIDENCE OVERSEAS
No benefit whatsoever shall be payable for any medical treatment
16. TINGGAL DI LUAR NEGARA
Tiada manfaat akan dibayar bagi sebarang rawatan
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received by the Insured Person outside Malaysia, if the Insured Person resides or travels outside Malaysia for more than ninety (90) consecutive days.
perubatan yang diterima oleh Orang yang Diinsuranskan di luar Malaysia, jika Orang yang Diinsuranskan tinggal atau membuat perjalanan di luar Malaysia lebih daripada sembilan puluh (90) hari berturut-turut.
17. LOCAL TREATMENT CLAUSE
Notwithstanding anything contained herein to the contrary, if the Insured Person is not a Malaysian, the coverage and benefits provided by this Policy shall be limited to treatment in Malaysia only.
17. FASAL RAWATAN TEMPATAN
Walau apa pun yang terkandung di dalam ini yang sebaliknya, jika Orang Yang Diinsuranskan bukan rakyat Malaysia, perlindungan dan manfaat yang disediakan oleh Polisi ini adalah terhad kepada rawatan di Malaysia sahaja.
18. UPGRADED ROOM AND BOARD CO-PAYMENT
If the Insured Person is hospitalised at a published 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.
18. BAYARAN BERSAMA BILIK DAN MAKAN DINAIKKAN
Jika Orang yang Diinsuranskan dimasukkan ke hospital pada kadar Bilik dan Makan yang diumumkan yang lebih tinggi daripada manfaat yang dia layak, Orang yang Diinsuranskan hendaklah menanggung 20% daripada manfaat lain yang dia layak yang diterangkan dalam Jadual Manfaat
19. SUBROGATION
If the Company shall become liable for any payment under this Policy, the Company shall be subrogated to the extent of such payment to all the rights and remedies of the Insured Person against any party and shall be entitled at its own expense to sue in the name of the Insured Person. The Insured Person shall give or cause to be given to the Company all such assistance in his/her power as the Company shall require to secure the rights and remedies and at the Company’s request shall execute or cause to be executed all documents necessary to enable the Company to effectively to bring suit in the name of the Insured Person.
19. SUBROGASI
Jika Syarikat bertanggungan untuk membuat apa-apa bayaran di bawah Polisi ini, Syarikat hendaklah mensubrogasi setakat bayaran itu ke atas semua hak dan remedi bagi Orang yang Diinsuranskan terhadap mana-mana pihak dan berhak atas belanjanya sendiri membuat dakwaan atas perintah Orang yang Diinsuranskan. Orang yang Diinsuranskan hendaklah memberikan atau mengarahkan agar diberikan kepada Syarikat semua bantuan seumpamanya yang di bawah kuasanya seperti yang mungkin dikehendaki oleh Syarikat untuk menjamin hak dan remedi dan atas permintaan Syarikat, hendaklah melaksanakan atau menyebabkan dilaksanakan semua dokumen yang perlu bagi membolehkan Syarikat mengambil tindakan guaman secara berkesan atas perintah Orang yang Diinsuranskan.
20. CONTRIBUTION
If an Insured Person carries other insurance covering any illness or injury insured by this Policy, the Company shall not be liable for a greater proportion of such illness or injury than the amount applicable hereto under this Policy bears to the total amount of all valid insurance covering such illness or injury.
20. SUMBANGAN
Jika Orang yang Diinsuranskan mempunyai insurans lain yang melindungi mana-mana penyakit atau kecederaan yang diinsuranskan oleh Polisi ini, Syarikat tidak bertanggungjawab membayar jumlah yang lebih besar bagi penyakit atau kecederaan itu daripada jumlah yang terpakai bersama-sama ini yang ditanggung oleh Polisi ini bagi jumlah keseluruhan semua insurans yang sah yang melindungi penyakit atau kecederaan itu.
21. OWNERSHIP OF POLICY
Unless otherwise expressly provided for by Endorsement in the Policy, the Company shall be entitled to treat the Policyholder as the absolute owner of the Policy. The Company shall not be bound to recognise any equitable or other claim to or interest in the Policy, and the receipt of the Policy or a Benefit by the Policyholder (or by his legal or authorised representative) alone shall be an effective discharge of all obligations and liabilities of the Company. The Policyholder shall be deemed to be responsible Principal or Agent of the Insured Persons covered under this Policy.
21. PEMILIKAN POLISI
Kecuali diperuntukkan sebaliknya secara nyata melalui Endorsemen dalam Polisi, Syarikat berhak menganggap Pemegang Polisi sebagai pemilik mutlak Polisi. Syarikat tidak terikat untuk mengiktiraf apa-apa tuntutan ekuiti atau tuntutan lain ke atas Polisi atau kepentingan dalam Polisi, dan penerimaan Polisi atau Manfaat oleh Pemegang Polisi (atau oleh wakilnya yang sah atau yang diberi kuasa) sahaja hendaklah merupakan pelepasan efektif bagi semua obligasi dan liabiliti Syarikat. Pemegang Polisi hendaklah dianggap sebagai Prinsipal atau Ejen bertanggungjawab bagi Orang yang Diinsuranskan yang dilindungi di bawah Polisi ini.
22. WAITING PERIOD
Eligibility for benefits starts 30 days after the Insured Person has been included in the Policy, except for a covered Accident occurring after the effective date of coverage.
22. TEMPOH TANGGUH
Kelayakan menerima manfaat bermula 30 hari selepas Orang yang Diinsuranskan dimasukkan ke dalam Polisi, kecuali untuk Kemalangan yang dilindungi yang berlaku selepas tarikh kuat kuasa perlindungan.
23. TAKE-OVER POLICIES (applicable only if specified in the Policy Schedule)
If this policy shall have commenced immediately upon termination of a preceding policy and if an Insured Person shall have been afflicted with a medical disability prior or at the time this policy started (and benefits under the preceding policy would have been available to him), such Insured Person shall continue to be covered for the existing disability, but not to exceed the limits of the previous policy on condition the Company has secured a copy of the preceding policy.
23. PENGAMBILALIHAN POLISI (terpakai hanya jika ditetapkan dalam Jadual Polisi)
Jika polisi ini bermula sebaik sahaja selepas penamatan polisi terdahulu dan jika Orang yang Diinsuranskan mengalami hilang upaya perubatan sebelum atau pada masa polisi ini bermula (dan manfaat di bawah polisi terdahulu disediakan untuknya), Orang yang Diinsuranskan itu hendaklah terus dilindungi bagi hilang upaya sedia ada, tetapi tidak melebihi had polisi terdahulu dengan syarat Syarikat telah memperoleh satu salinan polisi terdahulu.
24. GOVERNING LAW
This Policy is issued under the laws of Malaysia and is subject and governed by the laws prevailing in Malaysia.
24. UNDANG-UNDANG YANG MENGAWAL POLISI
Polisi ini dikeluarkan di bawah undang-undang Malaysia dan tertakluk dan dikawal oleh undang-undang lazim di Malaysia.
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25. CONDITION PRECEDENT TO LIABILITY
The due observance and the fulfilment of the terms, provisions and conditions of this Policy by the Insured Person and in so far as they relate to anything to be done or complied with by the Insured Person shall be conditions precedent to any liability of the Company.
25. PRASYARAT LIABILITI
Pematuhan dan pelaksanaan terma, peruntukan dan syarat Polisi ini dengan sewajarnya oleh Orang yang Diinsuranskan dan selagi berkaitan dengan apa-apa yang perlu dilakukan atau dipatuhi oleh Orang yang Diinsuranskan hendaklah menjadi prasyarat apa-apa liabiliti Syarikat.
26. NOTICE
Every notice or communication to the Company shall be in writing and sent to the Company. No alterations in the terms of this Policy or any endorsement thereon, will be held valid unless the same is signed or initialled by an authorised representative of the Company.
26. NOTIS
Setiap notis atau komunikasi kepada Syarikat hendaklah dibuat secara bertulis dan dihantar kepada Syarikat. Pindaan bagi syarat dalam Polisi ini atau apa-apa pengendorsan padanya, tidak sah kecuali pindaan itu ditandangani atau diparap oleh wakil Syarikat yang diberi kuasa.
27. LEGAL PROCEEDINGS
No action at law or in equity shall be brought to recover on this Policy prior to expiration of sixty (60) days after written proof of loss has been furnished in accordance with the requirements of this Policy. If the Insured Person shall fail to supply the requisite proof of loss as stipulated by the terms, provisions and conditions of the Policy, the Insured Person may, within a grace period of one calendar year from the time that the written proof of loss to be furnished, submit the relevant proof of loss to the Company with cogent reason(s) for the failure to comply with the Policy terms, provisions and conditions. The acceptance of such proof of loss shall be at the sole and entire discretion of the Company. After such grace period has expired, the Company will not accept, for any reason whatsoever, such written proof of loss.
27. PROSIDING UNDANG-UNDANG
Tindakan undang-undang atau ekuiti tidak boleh dibawa ke mahkamah untuk mendapatkan semula Polisi ini sebelum tamat tempoh enam puluh (60) hari selepas bukti bertulis tentang kerugian diberikan menurut keperluan Polisi ini. Jika Orang yang Diinsuranskan gagal memberikan bukti kerugian yang diperlukan seperti yang dinyatakan oleh terma, peruntukan dan syarat Polisi, maka Orang yang Diinsuranskan boleh, dalam tempoh bertenang bagi satu tahun kalendar dari masa bukti bertulis bagi kerugian itu diberikan, menyerahkan bukti kerugian yang berkaitan kepada Syarikat dengan alasan yang kukuh kerana kegagalan mematuhi terma, peruntukan dan syarat Polisi. Penerimaan bukti kerugian itu adalah semata-mata dan sepenuhnya mengikut budi bicara Syarikat. Selepas tempoh bertenang itu tamat, Syarikat tidak akan menerima, walau dengan apa-apa alasan sekalipun, bukti bertulis tentang kerugian itu.
28. ARBITRATION
All differences arising out of this Policy shall be referred to an Arbitrator who shall be appointed in writing by the parties in difference. In the event they are unable to agree on who is to be the Arbitrator within one (1) month of being required in writing to do so then both parties shall be entitled to appoint an Arbitrator each who shall proceed to hear the differences together with an Umpire to be appointed by both Arbitrators. However this is provided that any disclaimer of liability by the Company for any claim hereunder must be referred to an Arbitrator within twelve (12) calendar months from date of such disclaimer.
28. TIMBANG TARA
Semua perbezaan yang timbul daripada Polisi ini hendaklah dirujuk kepada Penimbang Tara yang hendaklah dilantik secara bertulis oleh pihak dalam perbezaan. Jika mereka tidak berjaya mendapatkan persetujuan tentang siapa yang akan menjadi Penimbang Tara dalam tempoh satu (1) bulan apabila diminta secara bertulis untuk berbuat demikian, maka kedua-dua pihak layak melantik Penimbang Tara yang setiap seorang akan mendengar perbezaan itu bersama-sama dengan Pengadil yang akan dilantik oleh kedua-dua Penimbang Tara itu. Walau bagaimanapun, dengan syarat apa-apa penafian liabiliti oleh Syarikat bagi apa-apa tuntutan di bawah ini hendaklah dirujuk kepada Penimbang Tara dalam tempoh dua belas (12) bulan kalendar dari tarikh penafian tersebut.
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DUTY OF DISCLOSURE
KEWAJIPAN PENDEDAHAN
Consumer Insurance Contracts
Where you have applied for this Insurance wholly for yourself/family/dependants, you had a duty to take reasonable care not to make a misrepresentation in answering the questions in the Proposal Form (or when you applied for this insurance) i.e. you should have answered the questions fully and accurately. Failure to have taken reasonable care in answering the questions may result in avoidance of your contract of insurance, refusal or reduction of your claim(s), change of terms or termination of your contract of insurance in accordance with the remedies in Schedule 9 of the Financial Services Act 2013. You were also required to disclose any other matter that you knew to be relevant to our decision in accepting the risks and determining the rates and terms to be applied.
You also have a duty to tell us immediately if at any time after your contract of insurance has been entered into, varied or renewed with us any of the information given in the Proposal Form (or when you applied for this insurance) is inaccurate or has changed.
Kontrak Insurans Pengguna
Apabila anda telah memohon Insurans ini sepenuhnya untuk diri sendiri/keluarga/tanggungan, anda mempunyai kewajipan untuk mengambil langkah yang munasabah untuk tidak salah nyata di dalam Borang Cadangan (atau semasa permohonan insurans ini). Dalam kata lain, anda haruslah menjawab soalan-soalan dengan penuh dan tepat. Kegagalan dalam mengambil langkah munasabah dalam menjawab soalan-soalan boleh mengakibatkan pembatalan kontrak insurans, keenggangan atau pengurangan gantirugi, perubahan kepada terma atau penamatan kontrak insurans anda selaras dengan remedi di Jadual 9 Akta Perkhidmatan Kewangan 2013. Anda juga dikehendaki mendedahkan perkara-perkara lain yang anda tahu akan mempengaruhi keputusan pihak kami dalam menerima risiko dan menentukan kadar dan terma yang akan dikenakan.
Anda juga mempunyai kewajipan untuk memberitahu kami dengan serta-merta jika pada bila-bila masa selepas kontrak insurans anda ditandatangani, diubah atau diperbaharui dengan kami, apa-apa maklumat yang diberikan di dalam Borang Cadangan (atau semasa permohonan insurans ini) tidak tepat atau telah berubah.
Non-Consumer Insurance Contracts
Where you have applied for this Insurance for the purpose of providing insurance benefits to your employees and their family/dependants, you had a duty to disclose any matter that you know to be relevant to our decision in accepting the risks and determining the rates and terms to be applied and any matter a reasonable person in the circumstances could be expected to know to be relevant otherwise it may result in avoidance of your contract of insurance, refusal or reduction of your claim(s), change of terms or termination of your contract of insurance.
You also have a duty to tell us immediately if at any time after your contract of insurance has been entered into, varied or renewed with us any of the information given in the Proposal Form (or when you applied for this insurance) is inaccurate or has changed.
Kontrak Insurans Komersial
Apabila anda telah memohon insurans ini untuk memberi manfaat insurans kepada pekerja anda dan keluarga/tanggungan mereka, anda mempunyai tanggungjawab untuk mendedahkan apa-apa perkara yang anda tahu yang akan mempengaruhi keputusan kami dalam menerima risiko dan menentukan kadar dan terma yang dikenakan, dan apa-apa perkara yang munasabah yang boleh dijangka, jika tidak ia boleh menyebabkan pembatalan kontrak insurans, keengganan atau pengurangan ganti rugi, perubahan terma atau penamatan kontrak insurans anda.
Anda juga mempunyai kewajipan untuk memberitahu kami dengan serta-merta jika pada bila-bila masa selepas kontrak insurans anda ditandatangani, diubah atau diperbaharui dengan kami, apa-apa maklumat yang diberikan di dalam Borang Cadangan (atau semasa anda memohon untuk insurans ini) tidak tepat atau telah berubah.
IMPORTANT NOTICE
NOTIS PENTING
IMPORTANT NOTICE
NOTIS PENTING
This Policy with its conditions should be carefully examined and in the event of any correction being found necessary, should be communicated to the Company at once.
Notice of every accident whether a claim is anticipated or not under this Policy should be given immediately to the nearest office of the Company.
Polisi ini dengan syarat-syarat perlu diperiksa dengan teliti dan sekiranya berlaku apa-apa pembetulan yang perlu, harus disampaikan kepada Syarikat dengan segera.
Notis setiap kemalangan sama ada tuntutan yang dijangka atau tidak di bawah Polisi ini perlu diberikan dengan segera kepada pejabat yang terdekat Syarikat.
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Proposal Form
&
Other Supporting Documents
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