the flexible plan that lets you ... - prudential singapore · protect your greatest assets – your...
TRANSCRIPT
PRUtreasures flexi | 01
Protecting your employees now comes with greater flexibility.The flexible plan that lets you choose how you protect your greatest assets – your employees.
PRUtreasures flexi
Your relationships are precious.
Protect them.
A good protection plan can increase productivity at work. That’s why, apart from providing your employees a stable income and career growth, their protection needs are just as important.
PRUtreasures flexi offers a comprehensive plan to ensure your employees are protected from the financial impact of unforeseen illnesses and accidents.
PRUtreasures flexi lets you choose your group protection plan according to your organisation’s unique needs by selecting the amount of coverage, medical protection and benefits.
Help your employees cope with their healthcare
are diagnosed with cancer every day in Singapore
Sharp rise in numbers diagnosed with cancer
Source: Singapore Cancer Society (2017 November 8), retrieved from https://www.singaporecancersociety.org.sg/learn-about-cancer/cancer-basics/common-types-of-cancer-in-singapore.html
Source: Aon Hewitt 2017 Global Medical Trend Rates Report
15
35
%in 2016
PEOPLE
Gross Medical Inflation
02 | PRUtreasures flexi
PRUtreasures flexi allows you to select the coverage for your employeesWe help you protect your employees against uncertainties with a comprehensive coverage – protection against
death, total and permanent disability, terminal illness and critical illness, hospitalisation, outpatient clinic,
specialist, dental and even Traditional Chinese Medicine (TCM) treatments.
Flexibility• Choice of plans to suit your needs and budget.
Comprehensive Solutions• High sum assured of up to S$500,000 upon death, total and permanent disability or terminal illness.
• Repatriation of Mortal Remains of up to S$50,000 per member.
• Coverage of up to S$250,000 upon diagnosis of any of the covered critical illnesses.
• Coverage of up to 1-bedded wards in private hospitals.
• Coverage for outpatient clinical with TCM option, specialist and dental.
Small Group Size• You can start policy coverage with just 3 employees.
Guaranteed Coverage• Eligible employees enjoy guaranteed coverage of up to S$200,000 for Group Term Life and up to S$100,000 for Group Crisis Cover Accelerated.
Portfolio Pricing• Premiums are calculated based on the claims experience of the entire PRUtreasures flexi portfolio.
PRUtreasures flexi | 03
04 | PRUtreasures flexi
Convenience & Ease of Access• Cashless access at Prudential's panel of General Practitioners.
• Go paperless and submit your claims online.
Double Sum Assured• Double death benefit due to accident while travelling as a fare-paying passenger in a Public Land Conveyance in Singapore, including Uber and Grab service.
Complimentary Health Screening• Complimentary health screening is offered to group size with more than 10 insured employees covered in Group Hospital & Surgical at no additional cost*.
Extended Coverage• Extended coverage to dependants for medical products.
• Extended coverage to employees residing outside of Singapore1.
Group Size Discount• Discount is applied to group size of at least 11 employees.
*Subject to availability.1 Please refer to the Underwriting Guideline for covered countries found on page 14 and 15.
Terms and Conditions apply. Please refer to www.prudential.com.sg/ptrf for more details.
PRUtreasures flexi | 05
Benefits at a GlanceYou can choose between the Group Term Life and Group Hospital & Surgical plans as your core plans. These plans, along with additional optional supplementary benefits, give you more options to customise an employee's insurance scheme that can keep pace with their evolving needs.
Group Term Life (GTL)Receive up to S$500,000 due to death,
total and permanent disability or terminal illness.
Group Crisis Cover Accelerated (GCCA)
Be covered against 37 critical illnesses.
Group Outpatient General Practitioner & Specialist (GP & SP)
Cashless for GP Panel Clinics and reimbursement for outpatient specialist
medical expenses.
Group Accidental Death & Dismemberment (GADD)
Receive up to S$500,000 due to accidental death and injuries.
Group Accidental Death & Dismemberment (GADD)
Receive up to S$500,000 due to accidental death and injuries.
Group Extended Major Medical (GEMM)
Reimbursement of hospital expenses in excess of eligible hospital expenses.
Group Outpatient General Practitioner (GP)
Cashless for GP Panel Clinics.Or
Group Outpatient General Practitioner & Specialist (GP & SP)
Cashless for GP Panel Clinics and reimbursement for outpatient specialist medical expenses.
Group Dental (GDEN)Reimbursement for eligible dental expenses.
Group Hospital & Surgical (GHS)Reimbursement of hospital expenses
due to a sickness or injury.
ADD ON RIDERS (OPTIONAL) ADD ON RIDERS (OPTIONAL)
ADD ON RIDERS (OPTIONAL)
ADD ON RIDERS (OPTIONAL)
ADD ON RIDERS (OPTIONAL)
ADD ON RIDERS (OPTIONAL)
ADD ON RIDERS (OPTIONAL)
06 | PRUtreasures flexi
BENEFITS / PLAN TYPE PLAN 12 PLAN 2 PLAN 3 PLAN 4 PLAN 5
Group Term Life(Double Death Benefits payable in the event of death due to accident in a public land conveyance) - Death- Total and Permanent Disability (TPD)- Terminal Illness (TI)
S$ 500,000 S$ 200,000 S$ 150,000 S$ 80,000 S$ 50,000
Repatriation of Mortal Remains (per member) S$ 50,000 S$ 50,000 S$ 50,000 S$ 50,000 S$ 50,000
CORE PLAN – GROUP TERM LIFE
AGE LAST BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5
16 – 19 S$ 397.00 S$ 183.00 S$ 143.00 S$ 78.00 S$ 50.00
20 – 24 S$ 379.00 S$ 176.00 S$ 137.00 S$ 74.00 S$ 48.00
25 – 29 S$ 333.00 S$ 154.00 S$ 120.00 S$ 65.00 S$ 42.00
30 – 34 S$ 372.00 S$ 172.00 S$ 133.00 S$ 73.00 S$ 47.00
35 – 39 S$ 417.00 S$ 195.00 S$ 151.00 S$ 82.00 S$ 52.00
40 – 44 S$ 574.00 S$ 277.00 S$ 215.00 S$ 116.00 S$ 73.00
45 – 49 S$ 944.00 S$ 450.00 S$ 349.00 S$ 187.00 S$ 118.00
50 – 54 S$ 1,611.00 S$ 765.00 S$ 592.00 S$ 317.00 S$ 199.00
55 – 59 S$ 2,582.00 S$ 1,246.00 S$ 964.00 S$ 515.00 S$ 323.00
60 – 64 S$ 4,320.00 S$ 2,084.00 S$ 1,612.00 S$ 861.00 S$ 539.00
65 – 69 S$ 7,207.00 S$ 3,480.00 S$ 2,692.00 S$ 1,437.00 S$ 899.00
70 – 743 S$ 13,856.00 S$ 6,688.00 S$ 5,171.00 S$ 2,759.00 S$ 1,726.00
GROUP SIZE (INSURED EMPLOYEES) DISCOUNT
11 – 15 5%
16 and above 10%
3 For renewals only.
ANNUAL PREMIUM RATE – GROUP TERM LIFE
GROUP SIZE DISCOUNT FOR GROUP TERM LIFE
BENEFITS / PLAN TYPE PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5
1Daily Room and Board Benefit (Per day, up to 120 days per disability)
1-Bed Ward Private
2-Bed Ward Private
4-Bed Ward Private
4-Bed Ward Government Restructured
1-Bed Ward Government Restructured
2Intensive Care Unit (ICU) (Max. per day, up to 30 days per disability) 3 x 1-Bedded 3 x 2-Bedded 3 x 4-Bedded S$15,000
per disability limit for items
2 to 8
S$20,000 per disability limit for items
2 to 83High Dependency Ward (HDW) (Max. per day, up to 30 days per disability) 2 x 1-Bedded 2 x 2-Bedded 2 x 4-Bedded
CORE PLAN – GROUP HOSPITAL & SURGICAL
2 Health declaration required.
PRUtreasures flexi | 07
4 i. Waiver of surgical schedule if insured member is admitted to government restructured hospital. ii. Surgical fee more than S$1,500 is subject to surgical schedule if insured member is admitted to a private hospital.
BENEFITS / PLAN TYPE PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5
4Other Hospital Services Benefits – Including implants(Max. per disability)
S$25,000 per disability limit for items
4 to 8
S$20,000 per disability limit for items
4 to 8
S$15,000 per disability limit for items
4 to 8
S$15,000 per disability limit for items
2 to 8
S$20,000 per disability limit for items
2 to 8
5Surgical Fees (subject to surgical schedule)4
6In-Hospital Doctor'sConsultation Benefit (Max. 120 days)
7
Pre (90 days) & Post (90 days) Hospitalisation/Surgery, Specialist Consultation, Diagnostic X-Ray and Lab Test, Traditional Chinese Medicine
8Emergency Accidental Outpatient Treatment Benefit (Including Accidental Dental Treatment)
9 Miscarriage Benefit Covered under benefits (items 1 to 8), as per the respective benefit limits
10Outpatient Cancer Treatment (Max. per policy year) S$ 10,000 S$ 10,000 S$ 10,000 N.A N.A
11Outpatient Kidney Dialysis (Max. per policy year) S$ 10,000 S$ 10,000 S$ 10,000 N.A N.A
12Overseas Hospitalisation for Accident Benefit 150% of GHS benefit (for items 1 to 7)
13Rehabilitation Benefit (Max. per disability, up to 31 days) S$ 5,000 S$ 5,000 S$ 5,000 S$ 5,000 S$ 5,000
14Hospital Cash Benefit(Max. per day, up to 90 days per disability)
– Singapore Government Restructured B1 Ward S$ 50 S$ 40 Nil Nil Nil
– Singapore Government Restructured B2 Ward S$ 100 S$ 80 S$ 40 Nil Nil
– Singapore Government Restructured C Ward S$ 150 S$ 120 S$ 80 Nil Nil
15In-Hospital Psychiatric Treatment(Max. per policy year, applicable to Singapore GRH only)
S$ 1,000 S$ 1,000 S$ 1,000 S$ 1,000 S$ 1,000
16
Death Benefit(Double Death Benefits payable in the event of death due to accident in a public land conveyance)
S$ 5,000 S$ 5,000 S$ 5,000 S$ 5,000 S$ 5,000
17
Pro-ration factor for:
Plan 2 & 3Applicable to items 4 – 7
Plan 4 & 5Applicable to items 2 – 7
Nil
75% applies if Insured
Member stays in 1 Bedded
ward (Private or
Government Restructured)
75% applies if Insured
Member stays in 2 Bedded
or higher ward (Private or
Government Restructured)
75% applies if Insured
Member stays in 4 Bedded
or higher ward (Private) or
2 Bedded or higher ward
(Government Restructured)
75% applies if Insured
Member stays in 1 Bedded
ward (Private)
18 Complimentary Health Screening (For employee only)
Applicable for group size > 10 eligible employees
08 | PRUtreasures flexi
AGE LAST BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5
16 – 19 S$ 395.00 S$ 324.00 S$ 252.00 S$ 129.00 S$ 180.0020 – 24 S$ 408.00 S$ 328.00 S$ 260.00 S$ 134.00 S$ 187.0025 – 29 S$ 444.00 S$ 341.00 S$ 274.00 S$ 139.00 S$ 194.0030 – 34 S$ 472.00 S$ 365.00 S$ 294.00 S$ 148.00 S$ 206.0035 – 39 S$ 505.00 S$ 388.00 S$ 312.00 S$ 170.00 S$ 237.0040 – 44 S$ 551.00 S$ 430.00 S$ 343.00 S$ 219.00 S$ 306.0045 – 49 S$ 641.00 S$ 502.00 S$ 401.00 S$ 267.00 S$ 373.0050 – 54 S$ 903.00 S$ 713.00 S$ 563.00 S$ 362.00 S$ 506.0055 – 59 S$ 1,158.00 S$ 921.00 S$ 721.00 S$ 473.00 S$ 661.0060 – 64 S$ 1,586.00 S$ 1,249.00 S$ 968.00 S$ 627.00 S$ 877.0065 – 69 S$ 2,500.00 S$ 1,927.00 S$ 1,559.00 S$ 823.00 S$ 1,151.00
70 – 745 S$ 3,437.00 S$ 2,649.00 S$ 2,141.00 S$ 1,126.00 S$ 1,575.00
AGE LAST BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5
16 – 19 S$ 888.75 S$ 729.00 S$ 567.00 S$ 290.25 S$ 405.0020 – 24 S$ 918.00 S$ 738.00 S$ 585.00 S$ 301.50 S$ 420.7525 – 29 S$ 999.00 S$ 767.25 S$ 616.50 S$ 312.75 S$ 436.5030 – 34 S$ 1,062.00 S$ 821.25 S$ 661.50 S$ 333.00 S$ 463.5035 – 39 S$ 1,136.25 S$ 873.00 S$ 702.00 S$ 382.50 S$ 533.2540 – 44 S$ 1,239.75 S$ 967.50 S$ 771.75 S$ 492.75 S$ 688.5045 – 49 S$ 1,442.25 S$ 1,129.50 S$ 902.25 S$ 600.75 S$ 839.2550 – 54 S$ 2,031.75 S$ 1,604.25 S$ 1,266.75 S$ 814.50 S$ 1,138.5055 – 59 S$ 2,605.50 S$ 2,072.25 S$ 1,622.25 S$ 1,064.25 S$ 1,487.2560 – 64 S$ 3,568.50 S$ 2,810.25 S$ 2,178.00 S$ 1,410.75 S$ 1,973.2565 – 69 S$ 5,625.00 S$ 4,335.75 S$ 3,507.75 S$ 1,851.75 S$ 2,589.75
70 – 745 S$ 7,733.25 S$ 5,960.25 S$ 4,817.25 S$ 2,533.50 S$ 3,543.75
AGE LAST BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5
16 – 19 S$ 1,382.50 S$ 1,134.00 S$ 882.00 S$ 451.50 S$ 630.0020 – 24 S$ 1,428.00 S$ 1,148.00 S$ 910.00 S$ 469.00 S$ 654.5025 – 29 S$ 1,554.00 S$ 1,193.50 S$ 959.00 S$ 486.50 S$ 679.0030 – 34 S$ 1,652.00 S$ 1,277.50 S$ 1,029.00 S$ 518.00 S$ 721.0035 – 39 S$ 1,767.50 S$ 1,358.00 S$ 1,092.00 S$ 595.00 S$ 829.5040 – 44 S$ 1,928.50 S$ 1,505.00 S$ 1,200.50 S$ 766.50 S$ 1,071.0045 – 49 S$ 2,243.50 S$ 1,757.00 S$ 1,403.50 S$ 934.50 S$ 1,305.5050 – 54 S$ 3,160.50 S$ 2,495.50 S$ 1,970.50 S$ 1,267.00 S$ 1,771.0055 – 59 S$ 4,053.00 S$ 3,223.50 S$ 2,523.50 S$ 1,655.50 S$ 2,313.5060 – 64 S$ 5,551.00 S$ 4,371.50 S$ 3,388.00 S$ 2,194.50 S$ 3,069.5065 – 69 S$ 8,750.00 S$ 6,744.50 S$ 5,456.50 S$ 2,880.50 S$ 4,028.50
70 – 745 S$ 12,029.50 S$ 9,271.50 S$ 7,493.50 S$ 3,941.00 S$ 5,512.50
ANNUAL PREMIUM RATE – GROUP HOSPITAL & SURGICAL
For Employee and Spouse or Children Coverage Only (inclusive of 7% GST)
For Employee Only (inclusive of 7% GST)
For Employees and Spouse and Children Coverage (inclusive of 7% GST)
5 For renewals only.
GROUP SIZE (INSURED EMPLOYEES) DISCOUNT
11 – 15 5%
16 and above 10%
GROUP SIZE DISCOUNT FOR GROUP HOSPITAL & SURGICAL
PRUtreasures flexi | 09
GROUP CRISIS COVER ACCELERATED/ RIDER TO GROUP TERM LIFE
ANNUAL PREMIUM RATE – GROUP CRISIS COVER ACCELERATED
BENEFITS / PLAN TYPE PLAN 16 PLAN 2 PLAN 3 PLAN 4 PLAN 5
Group Crisis Cover Accelerated S$ 250,000 S$ 100,000 S$ 75,000 S$ 40,000 S$ 25,000
AGE LAST BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5
16 – 19 S$ 211.00 S$ 94.00 S$ 72.00 S$ 39.00 S$ 24.00
20 – 24 S$ 212.00 S$ 95.00 S$ 74.00 S$ 40.00 S$ 25.00
25 – 29 S$ 291.00 S$ 127.00 S$ 98.00 S$ 52.00 S$ 33.00
30 – 34 S$ 366.00 S$ 157.00 S$ 122.00 S$ 65.00 S$ 41.00
35 – 39 S$ 551.00 S$ 238.00 S$ 184.00 S$ 99.00 S$ 62.00
40 – 44 S$ 954.00 S$ 421.00 S$ 326.00 S$ 174.00 S$ 109.00
45 – 49 S$ 1,378.00 S$ 622.00 S$ 481.00 S$ 257.00 S$ 161.00
50 – 54 S$ 1,927.00 S$ 873.00 S$ 675.00 S$ 360.00 S$ 225.00
55 – 59 S$ 3,301.00 S$ 1,489.00 S$ 1,151.00 S$ 615.00 S$ 384.00
60 – 64 S$ 5,479.00 S$ 2,476.00 S$ 1,915.00 S$ 1,022.00 S$ 639.00
65 – 697 S$ 7,423.00 S$ 3,413.00 S$ 2,639.00 S$ 1,407.00 S$ 880.00
Enhance Your PRUtreasures flexi Plan According To Your NeedsPRUtreasures flexi offers supplementary benefits to complement the core coverage. Depending on the core plans selected, you can choose up to 7 optional supplementary benefits to suit your company’s budget and needs.
6 Health declaration required.7 For renewals only. Note: Coverage for Group Crisis Cover Accelerated benefit ceases at age 70 last birthday.
ANNUAL PREMIUM RATE (inclusive of 7% GST) – GROUP ACCIDENTAL DEATH & DISMEMBERMENT
BENEFITS / PLAN TYPE PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5
Group Accidental Death & Dismemberment S$ 500,000 S$ 200,000 S$ 150,000 S$ 80,000 S$ 50,000
Optional Benefit: Accidental Medical Reimbursement
S$ 5,000
OCCUPATIONAL CLASS
AGE LAST BIRTHDAY
PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5
Class 116 – 69 S$ 154.00 S$ 66.00 S$ 50.00 S$ 27.00 S$ 17.00
70 – 748 S$ 631.00 S$ 274.00 S$ 205.00 S$ 110.00 S$ 69.00
Class 216 – 69 S$ 183.00 S$ 80.00 S$ 60.00 S$ 32.00 S$ 20.00
70 – 748 S$ 752.00 S$ 332.00 S$ 249.00 S$ 133.00 S$ 83.00
Class 316 – 69 S$ 241.00 S$ 107.00 S$ 81.00 S$ 43.00 S$ 27.00
70 – 748 S$ 993.00 S$ 447.00 S$ 335.00 S$ 179.00 S$ 112.00
GROUP ACCIDENTAL DEATH & DISMEMBERMENT / RIDER TO GROUP TERM LIFE OR GROUP HOSPITAL & SURGICAL WITH OPTIONAL BENEFIT: GROUP ACCIDENTAL MEDICAL REIMBURSEMENT
10 | PRUtreasures flexi
GROUP EXTENDED MAJOR MEDICAL / RIDER TO GROUP HOSPITAL & SURGICAL
BENEFITS / PLAN TYPE PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5
Provides reimbursement of eligible expenses in excess of Basic GHS if:a) Hospitalisation is at least 20 days; orb) Surgical Percentage is at least 75% per incision
S$ 80,000 per disability
S$ 60,000 per disability
S$ 40,000 per disability
S$ 20,000 per disability
S$ 60,000 per disability
Daily Home Nursing Benefit (max. per day, up to 30 days per disability)
S$ 80 per day for all plans (subject to respective benefit limit)
HIV Due to Blood Transfusion and Occupationally Acquired HIV
S$ 5,000 per policy year for all plans (subject to respective benefit limit)
Parent Accommodation (up to 60 days for accompanying child age 12 and below)
S$ 100 per day for all plans (subject to respective benefit limit)
Deductible As per Basic GHS
Co-Insurance 20%
ANNUAL PREMIUM RATE (inclusive of 7% GST) – GROUP ACCIDENTAL MEDICAL REIMBURSEMENT
OCCUPATIONAL CLASS
AGE LAST BIRTHDAY
PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5
Class 116 – 69 S$ 37.00 S$ 37.00 S$ 37.00 S$ 37.00 S$ 37.00
70 – 748 S$ 155.00 S$ 155.00 S$ 155.00 S$ 155.00 S$ 155.00
Class 216 – 69 S$ 46.00 S$ 46.00 S$ 46.00 S$ 46.00 S$ 46.00
70 – 748 S$ 193.00 S$ 193.00 S$ 193.00 S$ 193.00 S$ 193.00
Class 316 – 69 S$ 64.00 S$ 64.00 S$ 64.00 S$ 64.00 S$ 64.00
70 – 748 S$ 270.00 S$ 270.00 S$ 270.00 S$ 270.00 S$ 270.00
8 For renewals only.
PRUtreasures flexi | 11
ANNUAL PREMIUM RATE – GROUP EXTENDED MAJOR MEDICAL
AGE LAST BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5
16 – 69 S$ 37.00 S$ 29.00 S$ 19.00 S$ 10.00 S$ 14.00
70 – 749 S$ 37.00 S$ 29.00 S$ 19.00 S$ 10.00 S$ 14.00
For Employee Only (inclusive of 7% GST)
AGE LAST BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5
16 – 69 S$ 83.25 S$ 65.25 S$ 42.75 S$ 22.50 S$ 31.50
70 – 749 S$ 83.25 S$ 65.25 S$ 42.75 S$ 22.50 S$ 31.50
For Employee and Spouse or Children Coverage Only (inclusive of 7% GST)
AGE LAST BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5
16 – 69 S$ 129.50 S$ 101.50 S$ 66.50 S$ 35.00 S$ 49.00
70 – 749 S$ 129.50 S$ 101.50 S$ 66.50 S$ 35.00 S$ 49.00
For Employee and Spouse and Children Coverage Only (inclusive of 7% GST)
9 For renewals only.
12 | PRUtreasures flexi
GROUP OUTPATIENT SPECIALIST/ RIDER TO GROUP TERM LIFE10 OR GROUP HOSPITAL & SURGICAL
ANNUAL PREMIUM RATE (inclusive of 7% GST) – GROUP OUTPATIENT SPECIALIST
BENEFITS / PLAN TYPE PLAN 1 PLAN 2 PLAN 3 PLAN 4
a
Specialist Consultation at Singapore Govt Restructured Hospital (GRH) (recommended by a Registered Medical Practitioner)
S$ 2,000 per policy year
S$ 1,500 per policy year
S$ 1,000 per policy year
Overall policy year limit of S$ 500
b
Specialist Consultation at Private Hospital (PTE) (recommended by a Registered Medical Practitioner)
S$ 800 per policy year
S$ 400 per policy year
S$ 200 per policy year
cAll other Diagnostic X-Ray and Lab Test (GP or SP referral required)
S$ 800 per policy year
S$ 400 per policy year
S$ 200 per policy year
PLAN TYPE PLAN 1 PLAN 2 PLAN 3 PLAN 4
Annual Premium S$214.00 S$177.00 S$160.00 S$122.00
ANNUAL PREMIUM RATE (inclusive of 7% GST) – GROUP OUTPATIENT GENERAL PRACTITIONER
PLAN TYPE PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN 6
Annual Premium S$ 304.00 S$ 267.00 S$ 234.00 S$ 256.00 S$ 219.00 S$ 186.00
GROUP OUTPATIENT GENERAL PRACTITIONER / RIDER TO GROUP TERM LIFE10 OR GROUP HOSPITAL & SURGICAL
BENEFITS / PLAN TYPE PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN 6
a Panel Registered Medical Practitioner Cashless
b Non-Panel Registered Medical Practitioner (covers treatment in Singapore only) Reimbursement up to S$30 per visit
c Singapore Government Polyclinic Full Reimbursement
d Accident & Emergency Department in Singapore Hospitals Reimbursement up to S$100 per visit (capped at 2 visits per policy year)
e Paediatrician Direct Access Reimbursement up to S$30 per visit
f Overseas Registered Medical Practitioner Reimbursement up to S$100 per visit
g Registered Traditional Chinese Medicine Practitioner (TCM) (Consultation and Medicine)
Reimbursement of up to S$30 per visit (capped
at 6 visits per policy year) Not Applicable
h Co-Payment per visit (applicable for all benefits)
NIL S$ 5 S$ 10 NIL S$ 5 S$ 10
10 GP and SP are to be taken up together if they are taken up as a rider to GTL.
PRUtreasures flexi | 13
GROUP DENTAL / RIDER TO GROUP HOSPITAL & SURGICAL
BENEFITS / PLAN TYPE PLAN 1
1 Medication Fee
As charged for items 1 to 9
2 X-Ray
3 Prophylaxis Treatment (General Scaling and Polishing)
4 Fillings
5 Simple and Surgical Extraction
6 Root Canal Treatment
7 Gum Treatment (including Curettage)
8 Periodontal Surgery
9 Repairs of Dentures, Crowns and Bridges Due to Accident
10 Overall Dental's Limit (per policy year) S$500
11 Co-insurance 20%
PLAN TYPE PLAN 1
Annual Premium S$295.00
ANNUAL PREMIUM RATE (inclusive of 7% GST) – GROUP DENTAL
Occupational Class
Class 1 Clerical, administrative or other similar non-hazardous occupations
Class 2 Occupations where some degree of risk is involved, e.g. supervision of manual workers, totally administrative job in an industrial environment
Class 3 Occupations involving regular light to medium manual work but no substantial hazard which may increase the risk of sickness or accident
Class 4 Not covered
Call your Prudential Financial Consultant or our PruCustomer Line at 1800 333 0 333 today, or visit www.prudential.com.sg
14 | PRUtreasures flexi
Underwriting Guidelines for PRUtreasures flexi
Period of Insurance:
• Duration of coverage is for 12 months. Coverage starts from stated effective date upon clearance of required MAS 314 and Compliance checks.
Age Eligibility:
1) Employees• All benefits, except Group Crisis Cover Accelerated, are available to eligible employees of age 16 to 69 inclusive, and
renewable up to age 74.• Group Crisis Cover – Accelerated is available to eligible employees of age 16 to 64 inclusive, and renewable up to age 69.
2) DependantsA) the Insured Member’s spouse who is: – below 69 years old at his last birthday, and up to 74 years old at his last birthday; and – not an Insured Member under this Policy; orB) the Insured Member’s natural or step child from a legal marriage or legally adopted child who is: – two (2) weeks old; or – up to 25 years old at his last birthday, and is single and unemployed. (Note: National Service Personnel are not covered)
• Based on age last birthday.
Eligibility and Participation Requirements:
• All full time and work-active employees, directors, partners and proprietors.
• Eligible dependants can select Group Hospital & Surgical and its supplementary benefits. Dependant's plan must be the same as Employee’s plan.
• The Company can choose Group Term Life and/or Group Hospital & Surgical as their basic core plan(s).
• If dependant’s coverage is taken up, it will apply to all eligible employees in the same classification.
• PRUtreasures flexi is available to companies with a minimum of 3 employees.
• Insurance cover must be provided to all specified categories of employees on a compulsory basis. All benefits are applicable for Occupational Class 1 to 3 only.
• For employees holding a Singapore Ministry of Manpower's S Pass or work permit, the Company can choose any plan under Group Hospital & Surgical with Group Extended Major Medical.
• Take-over clause is applicable if the Company has prior Group Employee Insurance cover with a headcount of 25 standard life employees and above. Take-over refers to waiver of pre-existing conditions. This feature is only available for GHS and its medical riders. However, the 12 months waiting period will apply to members who have not been continuously insured under the existing group insurance policy for 12 months. Member listing from previous insurer is required to be provided for take-over to be approved.
• Coverage is only applicable to groups with the majority of employees (at least 50%) working in Singapore, and the rest of the employees based in the following countries:
i. Brunei ii. Indonesia (Jakarta only) iii. Japan iv. Malaysia v. Macau vi. Philippines (Manila only) vii. People's Republic of China (except Xinjiang and Tibet) viii. South Korea ix. Taiwan x. Thailand
14 | PRUtreasures flexi
PRUtreasures flexi | 15
An individual is considered a resident of Singapore or a resident of the above countries on the basis that the individual does not travel or work outside of Singapore or the above countries for more than 180 cumulative days in any 365 consecutive days.
• Plan selection for GTL and GCCA must be the same if GCCA is taken up.
• Crossing of plans between GTL and GADD is allowed i.e. GADD’s plan selection/Sum Assured can be higher than GTL.
• Plan selection for GHS and GEMM must be the same if GEMM is taken up.
• GP and SP are to be taken up together as a rider to GTL and GHS.
• GP can be taken up on stand-alone basis as a rider to GHS.
Pre-Existing Conditions – GHS: • Shall not pay if the loss or disability arises out of a pre-existing condition, unless the insured member has been insured under this policy continuously for 12 months. • All pre-existing conditions are permanently excluded for outpatient kidney dialysis or outpatient cancer treatment benefits.
Pre-Existing Conditions – GEMM: • Shall not pay if the loss or disability arises out of a pre-existing condition for which the insured member received medical treatment, diagnosis, consultation or prescribed drugs during the 24 months preceding the policy effective date of the coverage. • All pre-existing conditions are permanently excluded for outpatient kidney dialysis or outpatient cancer treatment benefits.
Pre-Existing Conditions – GTL: • Shall not pay if the loss or disability arises out of a pre-existing condition, unless the insured member has been insured under this policy continuously for 12 months.
Pre-Existing Conditions – GCCA: • Shall not pay if the loss or disability arises out of a pre-existing condition.
Premium: • Premium rates are in Singapore Dollars. • The premium rates are based on age last birthday of individual employees. • Payment of premium is to be made annually.
Medical Underwriting: • Employee (16 to 64 age last birthday) selecting Plan 1 of Group Term Life will require underwriting. • Employee (16 to 64 age last birthday) selecting Plan 1 of Group Crisis Cover Accelerated will require underwriting. • Employee (from 65 age last birthday onwards) selecting Group Term Life will require underwriting. • For Group Term Life, employee of 70 to 74 age last birthday will require underwriting at each renewal.
Required Documents: • Application Form. • A copy of the duly completed, company stamped and signed MAS Notice 314 Declaration on Parties Relevant to the Policyholder Form. • Business Profile report from the Account & Corporate Regulatory Authority (ACRA). • Health Declaration Form when Medical Underwriting is required.
Note:You are recommended to seek advice from a qualified Prudential Financial Consultant for a financial analysis before purchasing a policy suitable to meet your needs. This plan has no cash value. Buying health insurance products that are not suitable for you may impact your ability to finance your future healthcare needs. Premiums are not guaranteed and may be adjusted based on future claims experience. This brochure is for reference only and is not a contract of insurance. Please refer to the exact terms and conditions, specific details and exclusions applicable to these insurance products in the policy documents that can be obtained from your Prudential Financial Consultant. This brochure is for distribution in Singapore only and shall not be construed as an offer to sell or solicitation to buy or provision of any insurance product outside Singapore.
Information is correct as at 30 Nov 2017.
PRUtreasures flexi | 15
16 | PRUtreasures flexi
Dec
lara
tio
n
Plea
se re
ad c
aref
ully
bef
ore
signi
ng th
is P
RU
trea
sure
s fle
xi a
pplic
atio
n fo
rm.
I und
erst
and
that
the
assu
ranc
e w
ill no
t com
men
ce u
ntil
the
prop
osal
has
bee
n of
ficia
lly a
ccep
ted
by P
rude
ntia
l Ass
uran
ce C
ompa
ny S
inga
pore
(Pte
) Lim
ited
("Pru
dent
ial S
inga
pore
"), p
rem
ium
s ha
ve b
een
paid
and
an
offic
ial l
ette
r ind
icat
ing
cove
r has
com
men
ced
has b
een
issue
d. I
decl
are
that
the
info
rmat
ion
give
n in
this
form
and
any
info
rmat
ion
supp
lied
to P
rude
ntia
l Sin
gapo
re o
r the
Med
ical
Exa
min
er o
f Pru
dent
ial S
inga
pore
is tr
ue, a
nd th
at n
o m
ater
ial f
acts
, tha
t is,
fact
s lik
ely
to in
fluen
ce th
e as
sess
men
t and
acc
epta
nce
of th
is pr
opos
al, h
ave
been
with
held
and
to th
e be
st o
f my
know
ledg
e an
d be
lief t
he in
form
atio
n gi
ven
here
in is
true
and
com
plet
e. I
agre
e to
pay
Pru
dent
ial S
inga
pore
the
amou
nt o
f any
med
ical
fee
incu
rred
shou
ld I
fail t
o ta
ke u
p th
e co
vera
ge a
fter t
he d
ate
of P
rude
ntia
l Sin
gapo
re's
lette
r not
ifyin
g m
e of
the
acce
ptan
ce o
f the
pro
posa
l's st
anda
rd ra
tes.
We
decl
are
and
conf
irm th
at o
ur e
mpl
oyee
s hav
e gi
ven
us th
eir c
onse
nt to
Pru
dent
ial S
inga
pore
, its
offi
cers
and
em
ploy
ees,
in c
olle
ctin
g, u
sing
and
disc
losin
g an
y an
d al
l info
rmat
ion
rela
ting
to th
em in
this
form
to a
ny o
f Pru
dent
ial S
inga
pore
's co
ntra
ctor
s or t
hird
par
ty se
rvic
e pr
ovid
ers o
r dist
ribut
ion
partn
ers,
any
regu
lato
ry, s
uper
viso
ry o
r oth
er a
utho
rity,
cou
rt of
law
, for
the
purp
ose(
s) o
f und
erw
ritin
g, c
laim
s ass
essm
ent a
nd c
usto
mer
serv
icin
g.
Nam
e of
("C
ompa
ny")
:
Com
pany
Add
ress
:
Nat
ure
of B
usin
ess
:
Effe
ctiv
e da
te o
f Pol
icy (D
D/M
M/Y
Y) :
(d
ate
mus
t be
on o
r afte
r the
dat
e of
app
licat
ion)
Effe
ctiv
e da
te o
f new
em
ploy
ees
: □
on
the
date
of e
mpl
oym
ent O
R
□
m
onth
s fro
m th
e da
te o
f em
ploy
men
t
Che
cklis
t of
Req
uire
d D
ocum
ents
□ A
pplic
atio
n Fo
rm
□ A
cop
y of
the
duly
com
plet
ed, c
ompa
ny st
ampe
d an
d sig
ned
MA
S N
otic
e 31
4 D
ecla
ratio
n on
Par
ties R
elev
ant t
o th
e
Polic
yhol
der F
orm
and
MA
S 31
4 D
ecla
ratio
n on
Ben
efic
ial O
wne
r(s)
For
m (i
n th
e ev
ent t
hat t
here
are
Cor
pora
te
Sh
areh
olde
rs O
wni
ng ≥
25%
of t
he c
ompa
ny).
□ H
ealth
Dec
lara
tion
(App
licab
le if
GTL
Pla
n 1
is s
elec
ted
for e
mpl
oyee
or m
edic
al u
nder
writ
ing
is re
quire
d)
Nam
e of
Aut
horis
ed S
igna
tory
:
Des
igna
tion
:
HR
Emai
l Add
ress
:
HR
Con
tact
No
: D
ate
of A
pplic
atio
n :
Com
pany
Sta
mp
: S
igna
ture
of A
utho
rised
Sig
nato
ry :
Nam
e of
Fin
anci
al C
onsu
ltant
:
Fina
ncia
l Con
sulta
nt C
ode
: L
ocat
ion
:
Con
tact
No
: S
igna
ture
:
□
Tick
whe
re a
ppro
pria
te
If a
mat
eria
l fa
ct i
s no
t d
iscl
osed
in
this
pro
pos
al,
any
pol
icy
issu
ed m
ay n
ot b
e va
lid.
If y
ou a
re i
n d
oub
t as
to
whe
ther
a f
act
is
mat
eria
l, yo
u ar
e ad
vise
d t
o d
iscl
ose
it. T
his
incl
udes
any
info
rmat
ion
that
you
may
hav
e p
rovi
ded
to
the
agen
t b
ut w
as n
ot in
clud
ed
in t
he p
rop
osal
. Pl
ease
che
ck t
o en
sure
you
are
ful
ly s
atis
fied
wit
h th
e in
form
atio
n d
ecla
red
in t
his
pro
pos
al.
WA
RN
ING
: PU
RSU
AN
T TO
SEC
TIO
N 2
5(5)
OF
THE
INSU
RA
NC
E A
CT
(CA
P 14
2), Y
OU
AR
E TO
DIS
CLO
SE IN
TH
IS A
PPLI
CA
TIO
N F
OR
M F
ULL
Y A
ND
FA
ITH
FULL
Y A
LL T
HE
FAC
TS W
HIC
H
YOU
KN
OW
OR
OU
GH
T TO
KN
OW
, OTH
ERW
ISE
YOU
MA
Y R
ECEI
VE
NO
THIN
G F
RO
M T
HE
POLI
CY.
PRU
trea
sure
s fle
xi A
PPLI
CAT
ION
FO
RM
PruC
usto
mer
Lin
e: 1
800-
333
0 33
3
CO
RE
OPT
ION
S
□ G
TL (G
roup
Ter
m L
ife)
□ G
CC
A (G
roup
Cris
is C
over
– A
ccel
erat
ed)
□ G
AD
D (G
roup
Acc
iden
tal D
eath
& D
ismem
berm
ent)
□ G
AD
D +
GA
MR
(Gro
up A
ccid
enta
l Dea
th &
Dism
embe
rmen
t with
Acc
iden
tal M
edic
al R
eim
burs
emen
t)□
GP
+ SP
(Gro
up O
utpa
tient
Gen
eral
Prac
titio
ner w
ith
G
roup
Out
patie
nt S
pecia
list)
□ G
HS
(Gro
up H
ospi
tal
&
Sur
gica
l Pla
n)
□ G
EMM
(Gro
up E
xten
ded
Majo
r Med
ical )
□ G
P (G
roup
Out
patie
nt G
ener
al Pr
actit
ione
r)□
GP
+ SP
(Gro
up O
utpa
tient
Gen
eral
Pra
ctiti
oner
with
Gro
up O
utpa
tient
Spe
cial
ist)
□ G
DEN
(Gro
up D
enta
l)□
GA
DD
(Gro
up A
ccid
enta
l Dea
th &
Dism
embe
rmen
t)□
GA
DD
+ G
AM
R (G
roup
Acc
iden
tal D
eath
& D
ismem
berm
ent
w
ith A
ccid
enta
l Med
ical R
eim
burs
emen
t)
Cho
ice
of O
ptio
ns
No.Name
(Please underline surname)
NRIC / Passport
no.
Gender (M/F)
DOB (DD/MM/
YYYY)
Age Last Birthday
Marital Status
OccupationDependants
(S/C)Nationality
Country of Residence1
Date of Employment (DD/MM/
YYYY)
Corporate Email Address
(Please note that e-claims can only be set up for employees
with corporate email addresses)
GTL Core (Employee Only)
GCCA3
(Option to GTL Core)
(Employee Only)
GADD (Option to GTL Core or GHS Core)
(Employee Only)GHS Core
GEMM4 (Option to GHS Core)
GP2
(Option to GTL Core or GHS Core)
SP2
(Option to GTL Core or GHS Core)
Dental (Option to GHS Core)
Plan no. Premium Plan no. Premium Plan no. Occ Class PremiumWith
GAMR (Y/N)
Premium Plan no.
Plan Type5
(EO/ES/EC/EF)
Total Lives
Premium Plan no.Plan Type5 (EO/ES/EC/EF)
Total Lives
Premium Plan no.
No. of Deps Covered for GP
Premium Plan no.
No. of Deps Covered
for SP
Premium Plan no.
No. of Deps Covered
for Dental
Premium
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
$
DECLARATION BY COMPANY
I / We hereby declare that, to the best of my / our knowledge and belief, the information given here is true and complete, and agree that if a contract of insurance is effected, all information submitted in connection with this application shall form the basis of such contract between the Company and the Insurer.
___________________________________________________Signature & Name of Authorised Officer
NRIC / Passport no. : ______________________________
Designation : ______________________________
Company Stamp : ______________________________
DECLARATION BY INSURANCE REPRESENTATIVE
I / We hereby declare and acknowledge that I / we have reviewed this form with the authorised officer of the Company, and that I / we have verified that all information in this form is true and complete.
___________________________________________________Signature & Name of Insurance Representative
NRIC / Passport no. : ______________________________
Agency Code : ______________________________
Agency Location : ______________________________
NOTE: Premium amounts may differ due to the rounding factor and the entitled group discount (if any). Please pay the stated amount based on the Premium Notice.
1 Please refer to the brochure for the list of accepted countries where the employees are residing. Kindly note that the following provinces/areas are not covered.
2 For Option to GTL Core, GP is to be bundled with SP. For Option to GHS Core, the selection can be either GP only or GP + SP.3 Plan selection for GTL and GCCA must be the same if GCCA is taken up.4 Plan selection for GHS and GEMM must be the same if GEMM is taken up. 5 Plan Type: EO – for employee coverage only. ES – for employee and spouse coverage. EC – for employee and children coverage. EF – for employee and spouse and children coverage.
Total Amount Payable:(before group size discount if any)
Country Provinces/areas
Indonesia All except Jakarta
Philippines All except Manila
People's Republic of China Xinjiang and Tibet
GROUP HEALTH DECLARATION
WARNING: YOU ARE REQUIRED TO FULLY AND FAITHFULLY DISCLOSE ALL THE FACTS THAT YOU KNOW OR OUGHT TO KNOW. OTHERWISE, YOUR INSURANCE COVERAGE PROVIDED UNDER THIS PLAN MAY BE VOID.
Name of Company Group Policy No.
Details of Employee
Full Name of Employee in Block (as shown in NRIC - underline surname)
NRIC/FIN/Passport No. Date of Birth
Gender
Male / Female
Marital Status
Occupation Date of Employment Monthly Salary
S$
Country of Residence Nationality
Height (cm) Weight (kg)
Health Declaration
(All questions must be answered and any alteration must be signed) Employee
Yes No
1. Do you engage in military or private flying other than as passenger travelling solely for transport or in hazardous pursuits such as but not limited to scuba diving, mountain and climbing sport, free fall parachuting, sky diving and motor racing?
If ‘Yes’, please state details on activity, depth dived, locations and frequency in the box provided on the right.
□ □
2. Have you taken narcotics, any habit forming drugs or ever been treated for drug or alcohol addiction?
If ‘Yes’, please provide details including name of substance, date, treatment, name & address of doctor in the box provided on the right.
□ □
PTRFFOR OFFICE USE ONLY
GTL/TPD GCCA
Sum Assured
Sum Assured (FCL)
Page 1 of 4
PruCustomer Line: 1800-333 0 333
Continued next page
Health Declaration
(All questions must be answered and any alteration must be signed) Employee
Yes No
GROUP HEALTH DECLARATION
Page 2 of 4
6. Do you consume alcohol?
If ‘Yes’, please state the type, quantity and frequency
□ □
Type:
Quantity:
Frequency (per week):
7. Have you or any of your family members, ever been told to have, received any medical advice, counseling or treatment in connection with sexually transmitted disease, AIDS, AIDS Related Complex or any other AIDS related conditions?
If ‘Yes’, please provide details including date, relationship, diagnosis, treatment, name & address of doctor in the box provided on the right.
□ □
8. In the past 5 years, have you attended to any tests such as X ray, ultrasound, CT scan, biopsy, electrocardiogram (ECG), endoscopy, blood or urine test?
If ‘Yes’, please provide details including date/type/reason/results of test done, treatment, name & address of doctor in the box provided on the right.
□ □
9. Have either of your natural parents or siblings died or suffered from cancer, heart disease, stroke, high blood pressure, diabetes, kidney disease, mental disorder, dementia, tuberculosis, Down’s syndrome or any hereditary disease?
If ’Yes, please provide full details in the box provided on the right.
□ □
Relationship Condition/ Cause of Death Age of Onset If Deceased,
Age of Death
3. Do you have any health or life insurance application that has been rejected, postponed or accepted at special rates or terms by any insurance company?
If ‘Yes’, please provide details on date/type of application and reason for special terms in the box provided on the right.
□ □
4. Have you in the last 3 months had any of the following symptoms for more than one week continuously: fatigue, weight loss, diarrhoea, enlarged nodes or unusual skin lesions?
If ‘Yes’, please provide details including date, diagnosis, treatment, name & address of doctor in the box provided on the right.
□ □
5. Do you smoke any cigarettes?
If ‘Yes’, please state number of years and the number of sticks per day
□ □
No. of years:
No. of sticks (per day):
Name of Employee: NRIC/ FIN/ Passport No.: Group Policy No.
GROUP HEALTH DECLARATIONHealth Declaration
(All questions must be answered and any alteration must be signed) Employee
Yes No
Page 3 of 4
Continued next page
10. Have you EVER had or been told you had or been treated for:
□ □ a) asthma, bronchitis, persistent cough, tuberculosis or respiratory disorder?
b) epilepsy, fits, stroke, paralysis, weakness of limb, prolonged headache/giddiness, unconsciousness, nervous breakdown, depression or any other nervous/mental disorders or any disease of the brain?
□ □
c) gastritis, stomach or duodenal ulcer, blood in stools, fistula, piles or any other stomach or bowel disorders? □ □
d) blood, protein or sugar in urine, kidney stones, infection or any other disorders of the kidney, bladder or genital organs? □ □
e) anaemia, diabetes, thyroid disorders or any other endocrine disorder? □ □
f) cancer, tumour, cyst or growth of any kind? □ □
g) any form of eye, hearing or speech disorder or disease? □ □
h) jaundice, Hepatitis B carrier or any form of hepatitis, liver or gallbladder disorders? □ □ i) slipped disc, gout, arthritis, pain or deformity or disorders of the muscles, spine, limbs or joints or severe injury? □ □
j) raised cholesterol, high blood pressure, heart attack, heart murmur, irregular or fast heart rate, chest discomfort or pain, diseases or any other disorders of the heart, heart valves or blood vessels?
□ □
k) any other illness, disorder, injury, disability, operation or hospitalisation not mention above? □ □
11. For Female Insured only
□ □ a) Have you ever had any abnormal pap smear test or been told by a doctor to have a repeat pap smear within the next 6 months? If yes, advise the date and result of the test and enclose a copy of the result, if available.
b) Have you had an abnormal mammogram or been advised to have mammogram,ultrasound, biopsy, operation of the breasts, ultrasound of pelvis or attended to any other gynecological investigations?
□ □
c) Have you ever consulted a doctor for irregular, painful menstruation or other problems(s) involving the female organs? □ □
d) Have any of your family members been diagnosed with breast cancer?
If ’Yes, please provide full details in the box provided on the right. Relationship to Insured Age of Diagnosis
e) Are you currently pregnant? If ‘Yes’, please state no of months _________________________ □ □
Name of Employee: NRIC/ FIN/ Passport No.: Group Policy No.
If any of the answer to Questions 10 and 11 is “Yes”, please provide details below for each condition:
Qn No. Name of InsuredName of
Condition /Treatment
Date of Test / Diagnosis
Duration ofIllness / injury
Result / Reasonfor Test done
Name & Address ofDoctors / Clinics / Hospitals
Consent, Declaration and Authorisation - Please read carefully before signing this Group Health Declaration Form.
I/We consent to Prudential Assurance Company Singapore (Pte) Limited (“Prudential”), its officers and employees :
a) Collecting and using at their sole discretion any and all information relating to me/us, including my/our personal particulars, in this Group Health Declaration for the purposes of underwriting;
and
b) Disclosing at their sole discretion any and all information relating to me/us, including my/our personal particulars, in this Group Health Declaration to the servicing intermediary for the above group policy for the purpose of customer service.
I/We declare that no material facts, that are facts likely to influence the assessment and acceptance of my/our group application, have been withheld and the Information given above is true and complete and best to my/our knowledge and they shall be the basis of the issuance of my/our group insurance coverage.
I/We agree to inform Prudential if there is any change in the state of my/our health/activity between the date of this Health Declaration or medical examination and the date of full insurance coverage provided by Prudential to me/us. I/We understand that the terms of accepting me/us as a risk for insurance coverage may vary according to such information received.
I/We agree and authorise any medical source (i.e. physician and hospital), insurance office or organisation that has my/our records to release to Prudential any relevant information at any time for the purpose of underwriting this group application. A photographic copy of this authorisation shall be as valid as the original.
I/We further declare that I/we have read and understood the “Your Guide To Health Insurance” and “Product Summary” (applicable to voluntary coverage only).
Signature of Employee
Date:
Signature/Name/Designation of Witness (Employer)
Date:
GROUP HEALTH DECLARATION
Name of Employee: NRIC/ FIN/ Passport No.: Group Policy No.
Prudential Assurance Company Singapore (Pte) Limited (Reg. No. 199002477Z)Employee Benefit Solutions Address: Singapore Post Centre Post Office PO Box 399 Singapore 914014
Email: [email protected] Fax: 6233-3285
Page 4 of 4
EBS HD Oct 2017 (PTRF)
MAS NOTICE 314 DECLARATION ON PARTIES RELEVANT TO THE POLICYHOLDERProposal / Policy Number
The information requested in this form must be provided in order to comply with the mandatory requirements of MAS Notice 314 – Preventing Money Laundering and Countering the Financing of Terrorism – Life Insurance (MAS 314).
The personal data collected in this form, in other documents or provided to Prudential Assurance Company Singapore (Pte) Limited (“Prudential”) shall be used for the purposes stated in the proposal form and Prudential’s Privacy Notice (which is available at www.prudential.com.sg). The personal data may be collected, used and/or disclosed by Prudential, its officers, associated organisation(s) employee representative(s), third party distributors and other organisations stated in Prudential's Privacy Notice whether in Singapore or outside Singapore.
(A) Name of Policyholder / Insured Company(ies) / Assignee(s) / Applicant(s) / Beneficiary(ies) (delete accordingly)
(B) Principal Place of Business (“PPOB”) PPOB refers to the main operating office where the senior management of the policyholder resides.
Is the PPOB different from the registered or business address □ Yes □ NoIf yes please provide PPOB in the space provided
(C) Information on Chairman / CEO / Managing Partner of the company(ies) stated in (A):
Full Name (including any aliases : (1) Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)
Designation : Chairman / CEO / Managing Partner (delete accordingly) Company Name :
NRIC / Passport No. :
Date of Birth :
Nationality :
(2) Mr / Mrs / Ms / Mdm (delete accordingly)
Chairman / CEO / Managing Partner (delete accordingly)
Full Name (including any aliases : (3) Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)
Designation : Chairman / CEO / Managing Partner (delete accordingly) Company Name :
NRIC / Passport No. :
Date of Birth :
Nationality :
(4) Mr / Mrs / Ms / Mdm (delete accordingly)
Chairman / CEO / Managing Partner (delete accordingly)
Full Name (including any aliases : (5) Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)
Designation : Chairman / CEO / Managing Partner (delete accordingly) Company Name :
NRIC / Passport No. :
Date of Birth :
Nationality :
(6) Mr / Mrs / Ms / Mdm (delete accordingly)
Chairman / CEO / Managing Partner (delete accordingly)
Page 1 of 2
PruCustomer Line: 1800-333 0 333
Continued next pageVersion Oct 2017
Page 2 of 2
MAS NOTICE 314 DECLARATION ON PARTIES RELEVANT TO THE POLICYHOLDER
Version Oct 2017
Proposal / Policy Number
(D) Person(s) authorised to act on matters relating to the purchase of the Policy / assigned Policy
Declaration by Representative of the policyholder/ insured company/ assignee / applicant / beneficiary/ trustee (This Representative could be the CEO, Directors (listed in the ACRA), Managing Director, Partner or Managing Partner of the company/policyholder.)
I declare that the information given in this form is complete and accurate. I shall promptly inform Prudential of changes to such natural person’s information in this form. I acknowledge and agree that if the information disclosed in this form is incomplete and/or inaccurate, some or all of the benefits under the policy issued to the Policyholder may not be available. I further acknowledge and agree that Prudential has the right to request supporting documents in relation to the information disclosed in this form.
Note: This declaration shall be accompanied by a copy of the NRIC/Passport/FIN containing a clear photograph of the representative and all authorised person(s).
Full Name (including any aliases : Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)
Designation :
NRIC / Passport No. :
Date of Birth :
Nationality :
Country of Residence :
Signature with company stamp:
Date:
□ Please tick this box if the representative is also an authorised person.
If there are other authorised person(s) appointed to act on matters relating to the policy(s), please provide their details in the fields below:
Full Name (including any aliases : Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)
Designation :
NRIC / Passport No. :
Date of Birth :
Nationality :
Country of Residence :
Signature:
Full Name (including any aliases : Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)
Designation :
NRIC / Passport No. :
Date of Birth :
Nationality :
Country of Residence :
Signature:
Full Name (including any aliases : Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)
Designation :
NRIC / Passport No. :
Date of Birth :
Nationality :
Country of Residence :
Signature:
Note: Please complete a separate form, signed by the Representative, if fields provided are insufficient under items (A) - (D).
MAS 314 DECLARATION ON BENEFICIAL OWNER(S)
Page 1 of 2
Continued next page
Proposal / Policy Number
The information requested in this form must be provided in order to comply with the mandatory requirements of MAS Notice 314 – Preventing Money Laundering and Countering the Financing of Terrorism – Life Insurance (MAS 314).
The personal data collected in this form, in other documents or provided to Prudential Assurance Company Singapore (Pte) Limited (“Prudential”)shall be used for the purposes stated in the proposal form and Prudential’s Privacy Notice (which is available at www.prudential.com.sg). The personal data may be collected, used and/or disclosed by Prudential, its officers, associated organisation(s), employees, representative(s), third party distributors and other organisations stated in Prudential’s Privacy Notice whether in Singapore or outside Singapore.
(I) Name of Policyholder / Insured Company(ies) / Assignee(s) / Applicant(s) / Beneficiary(ies) (delete accordingly)
(II) Beneficiary owner(s) is either a
(a) natural person who ultimately owns or controls the beneficiary /proposer /assignee /applicant (with shareholding of ≥25% of the company’s ordinary shares) or the natural person on whose behalf business relations are established; or
(b) natural person who does not meet the shareholder threshold and who exercises significant influence (i.e. board of directors of corporate shareholder owing the policyholder, person financing the policy) over the beneficiary /proposer /assignee /applicant.
(III) Information on all shareholder(s) or ultimate shareholder who are non-natural person with shareholding of ≥25% of the ordinary shares of company stated in (I):
Section (A): Corporate Shareholder(s) (“CSH”) directly owning ≥25% of the policyholder
(1) Name of Corporate Shareholder (“CSH”) (2) Percentage of shareholding
A1
A2
A3
A4
( ) %
( ) %
( ) %
( ) %
Section (B): CSHs owning ≥25% of the policyholder through ordinary shares of CSHs listed in (A)
(3) Name of CSH(B) owing CSH(A) listed in section (A) (4) * CSH of (5) % owned in CSH [listed in section (A)]
B1
B2
B3
B4
A( )
A( )
A( )
A( )
%
%
%
%
(4)* Please indicate within the bracket the corresponding number in Part II Section (A). In the event that there are CSHs owning ≥25% of the company in Section B, please provide their details on a separate form signed by the Representative.
(IV) Details of all beneficial owner(s) as defined in (II) of the companies listed in Part (III) A and/or B or any natural person who exercise significant influence over the Policyholder(s) / Insured Companies / Assignee(s) / Applicant(s) / Beneficiary(ies).
Full Name (including any aliases : Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)
Relationship to the Policyholder :
NRIC / Passport No. :
Date of Birth :
Nationality :
Country of Residence :
Percentage of Shareholding (ordinary shares):
Name of company:
PruCustomer Line: 1800-333 0 333
Version Oct 2017
Proposal / Policy Number
Full Name (including any aliases : Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)
Relationship to the policyholder :
NRIC / Passport No. :
Date of Birth :
Nationality :
Country of Residence :
Percentage of Shareholding (ordinary shares):
Name of Company:
Full Name (including any aliases : Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)
Relationship to the policyholder :
NRIC / Passport No. :
Date of Birth :
Nationality :
Country of Residence :
Percentage of Shareholding (ordinary shares):
Name of Company:
Full Name (including any aliases : Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)
Relationship to the policyholder :
NRIC / Passport No. :
Date of Birth :
Nationality :
Country of Residence :
Percentage of Shareholding (ordinary shares):
Name of Company:
Note: Please complete a separate form, signed by the Representative, if fields provided are insufficient.
Declaration
Declaration by Representative of the policyholder / insured company / assignee / applicant / beneficiary / trustee (This Representative could be the CEO, Directors (listed in the ACRA), Managing Director, Partner or Managing Partner of the company /policyholder.)
I declare that the information given in this form is complete and accurate. I shall promptly inform Prudential of changes to such natural person’s information in this form. I acknowledge and agree that if the information disclosed in this form is incomplete and /or inaccurate, some or all of the benefits under the policy issued to the Policyholder may not be available. I further acknowledge and agree that Prudential has the right to request supporting documents in relation to the information disclosed in this form.
Full Name of Representative (including any aliases as per identification document) :
Designation :
Company Name :
NRIC / Passport No. :
Nationality :
Country of Residence :
Signature with company stamp:
Date:
Page 2 of 2
MAS 314 DECLARATION ON BENEFICIAL OWNER(S)
Version Oct 2017
Prudential Assurance Company Singapore (Pte) Limited. (Reg. No. 199002477Z)7 Straits View #06-01 Marina One East Tower, Singapore 018936
Tel: 1800 333 0 333 Fax: 6734 6953Part of Prudential plc