B-Health Net

B-HealthNet is designed to provide you and your family with a comprehensive health plan that will facilitate hospital admission when it matters most.

Introduction

B-HealthNet is designed to provide you and your family with a comprehensive health plan that will facilitate hospital admission when it matters most. This invaluable facility offers admission into panel hospitals within Malaysia through the issue of a B-HealthNet Medical Card for covered disability. Kindly note that the Medical Health Card is not a Credit Card nor a Charge Card but to facilitate only hospital admission through Pre-Certification procedures.

 

  • Comprehensive Cover
  • Hospital Admission Facility to Panel Hospitals
  • Full Reimbursement up to the Overall Annual Limit
  • Accompanying lodger benefits
  • Annual Outpatient Cancer treatment
  • Monthly Outpatient Kidney Dialysis Treatment
  • Outpatient Physiotherapy Treatment
  • Hospital Income for Accident Confinement
  • No medical examination required

B-Health Net Individual Plans

 

SCHEDULE OF BENEFITS (RM) PLAN
  FZ350 FZ200   FZ120  FZ080
OVERALL ANNUAL LIMIT 120,000 60,000 45,000 30,000
HOSPITAL BENEFITS
Hospital Room & Board
(up to 150 days)
350 200 120 80
Intensive Care Unit Full Reimbursement
Lodger
(up to 150 days)
250 150 90 60
Daily Cash Allowance at Government Hospital
(up to 150 days)
150 100 60 40
Malaysian Government Service Tax
(room charges)
6% of Eligible Paid Expenses
Operating Theatre Full Reimbursement
Hospital Services & Supplies Full Reimbursement
PROFESSIONAL FEES & SERVICES
Pre-Hospital Diagnostic Tests
(within 60 days preceding confinement)
Full Reimbursement
Pre-Hospital Specialist Consultation
(within 60 days preceding confinement)
Full Reimbursement
Surgeon Fee 60,000 30,000 17,500  12,500
Anaesthetist Fee 20,000 10,000 5,000 4,000
In-Hospital Physician's Visit
(up to 150 days)
Full Reimbursement
Post Hospitalisation Treatment
(for non-surgical within 60 days from discharge)
Full Reimbursement
Ambulance Fee Full Reimbursement
OUTPATIENT/EXTENDED BENEFITS
Emergency Accidental Outpatient Treatment
(within 24 hours and follow-up treatment up to 31 days)
Full Reimbursement
Emergency Accidental Dental Treatment
(within 24 hours and follow-up treatment up to 14 days)
Full Reimbursement
Home Nursing Care
(up to 60 days)
 100 80 70 50
Annual Outpatient Cancer Treatment 60,000 48,000 36,000 24,000
Monthly Outpatient Kidney Dialysis Treatment 5,000 4,000 3,000 2,000
Lifetime Limit for Outpatient Kidney Dialysis Treatment 180,000 144,000 108,000 72,000
Organ Transplant
(once per lifetime)
Full Reimbursement
Outpatient Physiotherapy Treatment
(within 90 days from discharge)
Full Reimbursement
Inpatient Treatment for Mental Illness
(max per year)
2,500 2,500 2,500 2,500
Medical Evacuation & Repatriation Benefits (Not Applicable to Children) 100,000 100,000 N/A N/A

 

ANNUAL PREMIUM ON NEXT BIRTHDAY (RM)  
AGE FZ350 FZ200 FZ120  FZ080 
30 days to 10 years 756 560  420 364
11 years to 18 years 737 546 410 355
19 years to 35 years 869 644 483 419
36 years to 45 years 1,323 980 735 637
46 years to 55 years 1,890 1,400 1,050 910
56 years to 60 years (Renewal Only) 2,835 2,100 1,575 1,365
61 years to 70 years (Renewal Only) 4,442 3,000 2,360 1,900

Supplementary Benefit due to Accident Confinement

Hospital Income per day
(up to 150 days with 1 day excess)
100 100 100 100
ADDITIONAL ANNUAL PREMIUM 30 30 30 30

 

Note:

  • Occupational Class 3 will have a 15% loading on annual premium.
  • Children from 30 days to 18 years must be enrolled together with one of their parents.
  • For corporate policyholders, 6% Government Service Tax is applicable.
  • A family discount of 15% on the total premium payable will be offered when a family with 4 or more members is insured under a single policy.

The amount payable will not exceed the actual costs of the services and the maximum liability of the company shall not exceed the limits of eligible expenses based on the Reasonable and Customary and Medically Necessary charges incurred.

 

HOSPITAL ROOM AND BOARD

Daily charges for room and board and meals during confinement as a bedpatient.

 

INTENSIVE CARE UNIT

Daily charges as a bedpatient in the Intensive Care Unit of the hospital.

 

LODGER

Lodger fee charged for accompanying the insured child (below 15 years of age) during the hospital confinement. 

 

DAILY CASH ALLOWANCE AT GOVERNMENT HOSPITAL

Daily cash allowance for confinement at Malaysian Government Hospital provided, confined to a Room & Board rate that does not exceed the limit. No payment will be made for any transfer to or from any Private or Malaysian Government Hospital.

 

MALAYSIAN GOVERNMENT SERVICE TAX

6% government service tax on eligible Room & Board charges incurred.

 

OPERATING THEATRE

Charges for operating theatre incidental to the surgical procedure.

 

SURGEON FEE

Surgical fees and normal pre and post-operative care up to 60 days inclusive both before and after the operation. 

 

ANAESTHETIST FEE

Fees charged by the Anaesthetist for the supply and administration of anaesthesia.

 

IN-HOSPITAL PHYSICIAN'S VISIT 

Fees charged by the Physician for the treatment of the Insured Person when confined for a non-surgical disability.

 

POST-HOSPITALISATION TREATMENT

Charges for treatment within 60 days following discharge from hospital for a non-surgical confinement administered by the same Physician.

 

AMBULANCE FEE

Charges for ambulance services for transporting the Insured Person to and from hospital. Payment is not made if the Insured Person is not hospitalised.

 

EMERGENCY ACCIDENTAL OUTPATIENT TREATMENT 

Charges by the hospital or clinic in connection with the emergency treatment of bodily injury arising from an accident and received as an outpatient within 24 hours of the accident. Follow-up treatment is up to 31 days by the same Physician.

 

EMERGENCY ACCIDENTAL DENTAL TREATMENT 

Fees charged for the treatment of accidental injuries to sound natural teeth within 24 hours of the accident. Follow-up treatment is up to 14 days by the same dentist. 

 

HOME NURSING CARE

Daily charges for the services of a licensed and qualified nurse in the Insured’s home for the continued treatment of the specific medical condition for which he/she was hospitalised. Such services must be recommended by the attending Physician.

 

ANNUAL OUTPATIENT CANCER TREATMENT

Charges incurred for the alleviation of neoplastic condition and received at the outpatient department of a hospital or registered cancer treatment centre following discharge from hospital.

 

MONTHLY OUTPATIENT KIDNEY DIALYSIS TREATMENT

Charges incurred for the treatment of kidney dialysis at a legally registered dialysis centre due to end-stage renal failure following discharge from hospital.

 

ORGAN TRANSPLANT

Medical charges and professional fees for the surgical transplantation of the kidney, heart, lung, liver or bone marrow performed in a hospital. Payment is limited to one event per lifetime.

 

OUTPATIENT PHYSIOTHERAPY TREATMENT 

Charges for outpatient physiotherapy treatment which is recommended in writing by the attending Physician within 90 days after discharge from hospital.

 

INPATIENT TREATMENT FOR MENTAL ILLNESS 

If an Insured Person shall be confined to hospital for the treatment of a mental illness, in lieu of all other Benefits, the Policy shall pay this Benefit as provided under the Schedule of Benefits subject to the Annual Limit of this disability and the Overall Annual Limit. "Mental Illness" shall mean a nervous disorder or the functional disorder of the psychic or mental constitution including any physiological or psychosomatic manifestations which necessitate the Insured Person to be confined in hospital for the medically required treatment. 

 

OVERALL ANNUAL LIMIT  

The maximum annual reimbursement for all benefits payable subject to the limit as stated in the Schedule of Benefits. 

 

HOSPITAL INCOME (If Applicable) 

Daily cash allowance for each day of hospital confinement due to Accidental Injury with one (1) day excess.

 

For detailed descriptions of the covered benefits, please refer to the Policy Contract.

Policy Definitions

  1. PRE-EXISTING ILLNESS shall mean:
  2. Disabilities that existed before the Effective date of Insurance 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.
  3. SPECIFIED ILLNESSES shall mean the following disabilities and its related complications occurring within the first 120 days of Insurance of the Insured Person:

    a. Hypertension, diabetes mellitus and Cardiovascular Disease
    b. All tumours, cancers, cysts, nodules, polyps, stones of the urinary system and biliary system.
    c. All ear, nose (including sinuses) and throat conditions
    d. Hernias, haemorrhoids, fistulae, hydrocele, varicocele
    f. Endometriosis including disease of the Reproductive System
    g. Vertebro-spinal disorders (including disc) and knee conditions
  4. WAITING PERIOD 
    Eligibility for benefits starts 30 days after the Insured has been included in the Policy, except for a covered Accident occurring after the effective date of coverage.

 

Exclusions 

The Policy shall not cover:

 

  1. Pre-existing illness. 
  2. Specified Illnesses occurring during the first 120 days of continuous cover. 
  3. 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. 
  4. Care/treatment for which payment is not required or to the extent which is payable by any other insurance/indemnity covering the Insured and disabilities arising out of duties of employment or profession that is covered under a Workman’s Compensation Insurance Contract. 
  5. Plastic/Cosmetic surgery, circumcision, eye examination, glasses and refraction or surgical correction of nearsightedness (Radial Keratotomy or Lasik) and the use or acquisition of prosthetic applicances or devices such as artificial limbs, hearing aids, implanted pacemakers and prescription thereof. 
  6. 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. 
  7. Private nursing, rest cures or sanitaria care, illegal drugs, intoxication, sterilisation, venereal disease and its sequelae, AIDS or ARC and HIV related diseases, any communicable diseases requiring quarantine by law. 
  8. Any treatment or surgical operation for congenital abnormalities / deformities including hereditary conditions. 
  9. Pregnancy, child birth (including surgical delivery) and its related complications, 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 sterilisation. 
  10. Psychotic, mental or nervous disorders (including any neuroses and their physiological or psychosomatic manifestations). 
  11. Hospitalisation primarily for investigatory purposes, diagnostic tests including and not limited to Positron Emission Tomography (PET) Scan, Computed Tomography (CT) Scan, Computed Axial Tomography (CAT) Scan, Magnetic Resonance Imaging (MRI), 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 hyperhidrosis, weight reduction or gain. 
  12. 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. 
  13. 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. 
  14. Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.
  15. Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes. 
  16. War or 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. 
  17. Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material. 
  18. 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. 
  19. Expenses incurred for sex changes. 
  20. Investigation and treatment of sleep and snoring disorders, hormone replacement therapy, stem cell treatment and alternative therapy such as treatment, medical service or supplies, including but not limited to chiropractic services, acupuncture, acupressure, reflexology, bonesetting, herbalist treatment, massage or aroma therapy or other alternative treatment.

Services Provided

The Company has arranged through International SOS (Malaysia) Sdn Bhd on the arrangement of Service Programme to provide emergency assistance services to Insured under certain defined plans subject to the limit as set forth in the Schedule of Benefits.

 

  1. EMERGENCY MEDICAL EVACUATION (INTERNATIONAL & DOMESTIC)
  2. EMERGENCY MEDICAL REPATRIATION (INTERNATIONAL & DOMESTIC)
  3. REPATRIATION OF MORTAL REMAINS (INTERNATIONAL)

 

Routine Medical Services 

  1. Telephone Medical Advice
  2. Medical Service Provider Referral (Applicable to Domestic Assistance)
  3. Arrangement of Appointments with Doctors
  4. Arrangement for Hospital Admission
  5. Guarantee of Medical Expenses Incurred During Hospitalisation
  6. Monitoring of Medical Condition

 

Travel Information Services 

  1. Visa Information Service
  2. Inoculation Information Service
  3. Weather Information Service
  4. Embassy Referral
  5. Interpreter Referral
  6. Legal Referral

Download the following forms and documents to find out more about this policy:

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