Policy Terms & Conditions - Insurance
IMPORTANT CONDITIONS FOR GHS
Eligibility for benefits starts 30 days after the person covered has been included in the takaful contract , except for a covered accident occurring after the effective date of coverage.
Upgraded Room and Board Co-payment
If the Insured Person is hospitalized 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.
No benefit whatsoever shall be payable for any medical treatment received by the Insured outside Malaysia for more than ninety (90) consecutive days.
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 the 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 :
- an Insured Person traveling 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.
- an Insured Person upon recommendation of a Physician and has to be transferred to a Hospital outside Malaysia because the specialized nature of the treatment , aid, information or decision required can neither be rendered nor furnished nor taken in Malaysia.
EMERGENCY OUTPATIENT TREATMENT
1. Emergency Accidental Out-Patient Treatment
We shall reimburse to You an amount equal to the actual charges incurred by covered members for up to the maximum limit as stated in the Schedule of Benefits, as a result of a covered external bodily injury arising from an Accident for Medical Necessary treatment as an outpatient at any registered clinic or hospital within twenty-four (24) hours of the Accident causing the covered bodily injury. Follow up treatment by the same doctor or same registered clinic or Hospital for the same covered bodily injury will be provided up to the maximum amount (as charged) and within the maximum number of fourteen (14) days as set forth in the Schedule of Benefits.
2. Emergency Accidental Dental Treatment (if applicable)
We shall reimburse to You an amount equal to the actual charges incurred by the Covered Member for emergency dental treatment to sound natural teeth (crown and dentures excluded) rendered in a Hospital or registered dental clinic and received as an Out-Patient.
The emergency dental treatment must be due to an Accident and rendered within twenty-four (24) hours after the Accident.
Eligible Expenses thereafter for follow-up treatment by the same Dentist will be reimbursed, subject to the maximum number of days stated in the Schedule of Benefits.
3. Emergency Out-patient Sickness Treatment
We shall reimburse to You all expenses (excluding transportation) incurred by the Covered Member for consultation and medical treatment of an illness that is of an acute and emergency nature, but is not caused by an Accident, requiring the Covered Member to be attended to and is actually seen by a Physician as an Out-Patient at any twenty-four (24) hours service clinic or hospital between the times stated (from 12.00 midnight until 6.00am) in the Schedule of Benefits. All claims for this benefit must be accompanied by an original official receipt from the hospital/clinic specifying the nature of sickness, diagnosis and date and time of attendance by a Physician.