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Insurance Coverage - Insurance

TABLE OF BENEFITS / SCOPE OF COVERAGE

Plan 1

Plan 2

 

CATEGORY 1 : PERSONAL ACCIDENT & DEATH

RM

RM

GROUP TERM LIFE ("GTL") AND GROUP PERSONAL ACCIDENT ("GPA")

   

1.

 

 

Death (Natural Cause/ Sickness)

RM20,000.00

RM30,000.00

Death (Accidental Cause)

RM20,000.00

RM30,000.00

2

 

 

 

 

Total Permanent Disablement (Natural Cause/ Sickness)

RM20,000.00

RM30,000.00

Total Permanent Disablement due to accidental cause

RM20,000.00

RM30,000.00

inclusive of all types of physical injury- as per table of benefits

   

3

 

 

Partial Permanent Disablement due to accidental cause

Max.

RM20,000.00

RM30,000.00

inclusive of all types of physical injury cause by accident- as per table of benefit

 

CATEGORY 2 : IN-PATIENT SERVICES (CASHLESS)

RM

RM

GROUP HOSPITAL AND SURGICAL ("GHS")

   

Third Party Adminstrator/Medical Card Provider : Mediexpress Sdn Bhd

   

Hospital Benefit, Fees and Services

   

1

 

 

Room & Board per day

RM120.00

RM150.00

Ordinary ( up to 120 days in Private Hospital / Government Hospital)

 

2

Insentive Care Unit (daily maximum up to 30 days)

RM350.00

RM380.00

 

3

Hospital Miscellaneous Services

as charged

as charged

4

Surgical Fees

as charged

as charged

5

Anaesthetic Fees

as charged

as charged

6

Operating Theatre Fees

as charged

as charged

7

In-Hospital Physician (daily maximum up to 120 days)

as charged

as charged

8

Pre-Surgical / Medical Diagnostic Services (Follow-up within 60 days prior to admission)

as charged

as charged

9

Pre-Surgical/ Medical Specialist Consultation (Follow-up within 60 days prior to admission)

as charged

as charged

10

Second Surgical Opinion

as charged

as charged

11

Post Hospitalisation Treatment (within 60 days of discharge)

as charged

as charged

12

Ambulance Services Fees (Private ambulance or Inhouse ambulance)

RM250.00

RM250.00

13

Claim/Reimbursement Medical Report Fee

RM50.00

RM80.00

14

Government Hospital Cash Benefit Allowance (up to a maximum of 120 days)

RM30.00

RM45.00

15

Reimbursement of Government Service Tax

6%

6%

16

Day Surgery Benefit / Day Care - > 6 hours

as charged

as charged

 

CATEGORY 3 : EMERGENCY OUT-PATIENT SERVICES

RM

RM

1

 

 

Emergency Outpatient Accidental Treatment (maximum per case)

RM2,000.00

RM2,500.00

(Follow-up within 14 days of first treatment)

   

2

Emergency Outpatient Dental Treatment

as charged

as charged

3

Emergency Outpatient Sickness Treatment - (between 12.00 midnight to 6.00 am only)

as charged

as charged

OVERALL ANNUAL LIMIT FOR CATEGORY 2 & 3

RM15,000.00

RM20,000.00

 

CATEGORY 4 - GP OUT-PATIENT SERVICES

RM

RM

 

1

 

 

 

 

 

 

Outpatient for Sickness Treatment

- as charged -

- as charged -

i)Routine Consultation, Medication, Injection

subject to annual limit

subject to annual limit

ii)Diagnostic Lab/X-Ray Procedure

of RM350.00

of RM500.00

iii) Out-patient Surgical Procedures

Panel Clinic - cashless UM Student's Clinic (KKPUM)

Excess : Nil

Panel Clinic - cashless UM Student's Clinic (KKPUM)

Excess : Nil

 

 

Cronic illness (including pre-existing illness)

Additional Terms

  1. Outpatient GP treatment annual limit is RM350 (Plan 1) and RM500 (Plan 2) per students
  2. Non Panel Clinics bills will be on "Pay and Claim Basis" (Reimbursement Claim)
  3. Maximum Limit claimable amount per visit is RM100 (Plan 1) and RM150 (plan 2)
  4. OP treatment at PPUM/UMMC is covered on pay and claim basis
    The above OP Benefits does not cover outpatient specialist visit

 

 

 

 

 

IMPORTANT NOTES (applicable for Category 4 only) :

COVERED

  • Outpatient treatment at KKPUM (UM Clinic) is covered and on "cashless basis" subject to availability limit, standard terms, conditions and exclusions.

  • Outpatient treatment at any GP clinics outside UM are covered on "Pay and Claim Basis" (reimbursement)

  • Outpatient treatment at PPUM (UM Hospital-Government wing) is covered on "Pay and Claim Basis" (reimbursement)

(For ii and iii above, please submit the original medical receipt and fill-up OP form at our Etiqa Agency’s office @ UM)

NOT COVERED

  • Outpatient treatment at any specialist hospital are not covered EXCEPT for
    • Emergency Accidental and Sickness Treatment (Covered under category 3 above)
    • Sixty (60) days pre admission date and sixty (60) days post discharge date (Covered under category 2 above)
  • As per Standard Policy Exclusions.

 

 

 

2

 

 

 

 

 

 

Outpatient for Accidental Treatment - pay and claim basis (GP Clinic and Specialist Visit)

- as charged -

- as charged -

i)Routine Consultation, Medication, Injection

subject to annual limit

subject to annual limit

ii)Other related expenses

of RM1,000.00

of RM2,000.00

 

CATEGORY 5 : FUNERAL / REPATRIATON

RM

RM

 

1

 

 

 

 

 

 

 

 

 

 

Funeral Expenses / Repatriation Expenses

RM10,000.00

RM15,000.00

Funeral Expenses is inclusive of other necessary cost incurred such as

   

a) Repatriation Allowance

   

b) Place of Interment

   

c) Cremation or Funeral Ceremony in Malaysia

   

d) Transportation

   

 

OVERALL ANNUAL CONTRIBUTION RATE
(ALL-IN COST PER STUDENT)

RM

RM

 

STUDENT ONLY - PER ANNUM (INCLUSIVE 6% GST)

RM370.00

RM530.00

         

 

NOTE:

1) 6% GST is imposed to the premium charge to the student with effect from 2016/2017 policy renewal.
2) The actual premium rate before GST is RM350.00 (plan 1) and RM500 (plan 2).

 

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