Group Hospitalisation & Surgical

Product Information

Group Hospitaliszation & Surgical Disclosure Sheet (English)

Group Hospitaliszation & Surgical Disclosure Sheet (BM)

The benefit(s) payable under eligible policy is protected by PIDM up to limits. Please refer to PIDM’s TIPS Brochure or contact TMIM or PIDM (visit www.pidm.gov.my).

Why Group
Hospitalisation &
Surgical?

Benefits at a glance.

Comprehensive

Covers outpatient, inpatient and extended benefits.

Key coverage

An overview of your protection

Hospitalisation and surgical benefits

Outpatient benefits:

Pre-hospitalisation and pre-surgical diagnostic services
Pre-hospitalisation specialist fees
Post-hospitalisation treatment
Emergency accidental outpatient treatment
Emergency accidental dental treatment
Day care surgery

Inpatient benefits:

Hospital room and board
Surgeon fees.
Anaesthetist fees
Intensive Care Unit
Hospital services and supplies
Operation theatre
In-hospital physician visit

Extended benefits:

Outpatient cancer treatment / kidney dialysis
Funeral expenses
Organ transplant

How much is my premium?

Your premium depends on your employees’

age
health status
selection of plan and limit
group size
claim experience

However, it may vary depending on the other factors not mentioned above. Written quotation will be provided upon request.

What we
don’t cover

✖ Congenital abnormalities.

✖ Pre-existing condition occuring during the first 12 months of the policy.

✖ Care or treatment for which payment is not required, or is payable by other insurance or indemnity covering the insured and disabilities.

✖ Cosmetic/plastic surgery and treatment, refractive errors of the eyes and its correction by any means, hearing aids, acquisition of prosthetic appliances such as artificial limbs, dialysis machine and prescriptions thereof except as necessitated by injuries occurring wholly during the period of insurance.

✖ Dental care and treatment, except as necessitated by accidental injuries to sound natural teeth.

✖ AIDS (Acquired Immune Deficiency Syndrome), ARC (AIDS Related Complex) and all illnesses or diseases in the presence of Human Immune-Deficiency Virus (HIV), and Sexually Transmitted Diseases.

✖ Pregnancy, childbirth, miscarriage, abortion, infertility, prenatal or postnatal care, any means of birth control, tests or treatment related to sexual dysfunction or sterilisation.

✖ Mental or nervous disorder, psychiatric conditions (including any neuroses and their physiological or psychosomatic manifestations), senile or geriatric conditions of any kind, self-inflicted injury or attempted suicide, treatment of alcohol dependence syndrome and drug addiction.

✖ Routine medical or physical examinations, health check-up, investigating procedures or tests not incidental to treatment or diagnosis of a covered disability, or any treatment which is not medically necessary including any preventive treatments, preventive medicines or examinations and treatment for weight control.

✖ Cost/expenses of services of a non-medical nature.

✖ Racing of any kind (except foot racing), underwater activities requiring breathing apparatus, professional sports and criminal activities.

✖ Illnesses or disabilities of a newborn child contracted prior to or during birth or in the first 14 days thereafter.

✖ War or any act of war, declared or undeclared, terrorist activities, active duty in any armed forces, direct participation in strikes, riots and civil commotion or insurrection.

✖ Ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission, or from any nuclear weapons material.

Note:
This list is non-exhaustive. Please refer to the sample policy contract for the full list of exclusions under this policy.

Important information

This plan is underwritten by Tokio Marine Insurans (Malaysia) Berhad. All benefits and features mentioned herein are subject to terms and conditions of the policy. It is in your best interest to refer to the policy contract for the precise terms and conditions of this insurance plan. The information shown here is for reference only and is accurate as of 1st September 2018.

Duration of cover is for one year. You need to renew your insurance policy annually before the policy expires so as to ensure continuity of coverage.

You are to truthfully, correctly, and completely answer all questions in the proposal form and disclose fully and faithfully all the facts which you know or reasonably in the circumstances could be expected to know to be relevant to our decision on whether to accept the risk or not and the rate and terms to be applied, otherwise the policy issued may be void.

It is important that you read and understand the terms, conditions and exclusions of the policy, and at all times, feel free to contact us for more information.