Group Hospitalisation

This tailor-made comprehensive health plan is designed for your company or organization to ensure that your employees are sufficiently protected.

Introduction

BERJAYA SOMPO INSURANCE BERHAD provides a tailor-made comprehensive health plan for any company/organisation who ensures that their employees are sufficiently protected. In certain instances, the Company may extend coverage to the employee's family for the benefit of the employee's welfare. The type of coverage normally provided under the Group Hospitalisation & Surgical (H&S) Policy includes:

 

  • Room & Board / Intensive Care Unit
  • Hospital Supplies & Services
  • Surgeon Fees
  • Anaesthetist Fees
  • Operating Theatre
  • Pre-Hospital Diagnostic Test / Specialist Consultation
  • In-Hospital Physician's Visit
  • Post-Hospitalisation Treatment
  • Emergency Accidental Outpatient Treatment
  • Emergency Accidental Dental Treatment
  • Ambulance Fees
  • Daily Cash Allowance at Government Hospitals
  • Reimbursement of Medical Report Fees

 

For more information, please contact us personally so that we can customise the benefits to meet your specific requirements.

 

Pre-Existing Illness shall mean:

 

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: 

 

  • the Insured Person had received or is receiving treatment;
  • medical advice, diagnosis, care or treatment has been recommended;
  • clear and distinct symptoms are or were evident; or
  • its existence would have been apparent to a reasonable person in the circumstances.

 

SPECIFIED ILLNESSES shall mean the following disabilities and its related complications occurring within the first 120 days of Insurance of the Insured Person:

 

  • Hypertension, diabetes mellitus and Cardiovascular Disease
  • All tumours, cancers, cysts, nodules, polyps, stones of the urinary system and biliary system
  • All ear, nose (including sinuses) and throat conditions
  • Hernias, haemorrhoids, fistulae, hydrocele, varicocele
  • Endometriosis including disease of the Reproductive System
  • Vertebro-spinal disorders (including disc) and knee conditions

 

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.

This 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 appliances or devices such as artificial limbs, hearing aids, implanted pacemakers and prescriptions 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, all 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, and 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 treatments, massage or aroma therapy or other alternative treatments.

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