HealthNet Premier is designed to provide you and your family with a comprehensive health plan with an option of Overseas Inpatient Treatment that will facilitate hospital admission when it matters most. This invaluable facility offers admission into panel hospitals within Malaysia through the issue of a Medical Card for covered disability. Kindly note that the Medical Card is neither a Credit Card nor a Charge Card. The Medical Card is to facilitate hospital admission through Pre-Certification procedures.
HealthNet Premier Individual Plans
|SCHEDULE OF BENEFITS (RM)||PLAN|
|OVERALL LIFETIME LIMIT||500,000||350,000||200,000||120,000|
|OVERALL ANNUAL LIMIT||120,000||100,000||70,000||40,000|
|Hospital Room & Board
(up to 150 days)
|Intensive Care Unit||As Charged|
(up to 150 days)
|Daily Cash Allowance at Government Hospital
(up to 150 days)
|Malaysian Government Service Tax
|6% of Eligible Expenses|
|Operating Theatre||As Charged|
|Hospital Services & Supplies||As Charged|
|PROFESSIONAL FEES & SERVICES|
|Pre-Hospital Diagnostic Tests
(within 60 days preceding confinement)
|Pre-Hospital Specialist Consultation
(within 60 days preceding confinement)
|Second Surgical Opinion||500||500||500||500|
|In-Hospital Physician's Visit
(up to 150 days)
(non-surgical within 60 days from discharge)
|Ambulance Fee||As Charged|
|Medical Report Fee||100||100||100||100|
|Emergency Accidental Treatment
(within 24 hours and follow-up treatment up to 31 days)
|Emergency Accidental Dental Treatment
(within 24 hours and follow-up treatment up to 14 days)
|Home Nursing Care
(up to 60 days)
|Annual Outpatient Cancer Treatment||72,000||60,000||48,000||36,000|
|Monthly Outpatient Kidney Dialysis Treatment||6,000||5,000||4,000||3,000|
|Lifetime Limit for Outpatient Kidney Dialysis Treatment||216,000||180,000||144,000||108,000|
(once per lifetime)
|Outpatient Physiotherapy Treatment
(within 90 days from discharge)
|In-Hospital Treatment for Mental Illness
(once per lifetime)
|ANNUAL PREMIUM ON NEXT BIRTHDAY (RM)|
|30 days to 10 years||790||650||550||350|
|11 years to 20 years||680||550||460||300|
|21 years to 35 years||900||720||600||430|
|36 years to 45 years||1,100||820||670||480|
|46 years to 50 years||1,500||1,150||945||660|
|51 years to 55 years||1,620||1,360||1,120||770|
|56 years to 60 years (Renewal Only)||2,200||1,760||1,520||970|
|61 years to 65 years (Renewal Only)||3,200||2,530||2,070||1,350|
|66 years to 69 years (Renewal Only)||3,960||3,250||2,520||1,800|
|70 years to 76 years (Renewal Only)||5,650||4,630||3,660||2,500|
|Supplementary Cover for Overseas Inpatient Treatment Clause||Additional 30% of the annual premium to be charged|
- Occupational Class 3 will have a 15% loading on annual premium.
- A family discount of 10% 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 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.
Charges for operating theatre incidental to the surgical procedure.
HOSPITAL SERVICES & SUPPLIES
Charges during confinement which shall include general nursing, prescribed medicines, dressing, X-rays, laboratory examinations, electrocardiograms, physiotherapy, administration of blood and blood plasma but excluding the cost of blood and plasma.
Charges for Medically Necessary Implants during surgery but excluding and not limited to plastic/cosmetic implants, hormone implants, pacemakers and defibrillators, corrective lens for correction of visual acuity, prosthetic appliances or devices and prescriptions.
PRE-HOSPITAL DIAGNOSTIC TESTS
Charges for diagnostic tests which are recommended by a general practitioner within 60 days preceding hospital confinement. No payment shall be made if upon such diagnosis, the Insured does not result in hospital confinement for the treatment of the medical condition so diagnosed. Medications and consultation charged by the general practitioner will not be payable.
PRE- HOSPITAL SPECIALIST CONSULTATION
Fees charged by the Specialist which are recommended by a general practitioner in writing within 60 days preceding hospital confinement. Payment will not be made for clinical treatment (including medication and subsequent consultation) or where the Insured does not result in hospital confinement for the treatment of the medical condition so diagnosed.
Surgical fees and normal pre and post-operative care up to 60 days inclusive both before and after the operation.
Fees charged by the Anaesthetist for the supply and administration of anaesthesia.
SECOND SURGICAL OPINION
Charges for consultation or opinion with a second specialist to determine the necessity of a surgical operation. When considered medically necessary by the second specialist and such that this reaffirms the opinion expressed by the first specialist, the second specialist consultation fee incurred shall be payable provided the second consultation is rendered within 30 days of the first consultation.
IN-HOSPITAL PHYSICIAN'S VISIT
Fees charged by the Physician for the treatment of the Insured Person when confined for a non-surgical disability.
Charges for treatment within 60 days following discharge from hospital for a non-surgical confinement administered by the same Physician.
Charges for ambulance services for transporting the Insured Person to and from hospital. Payment is not made if the Insured Person is not hospitalised.
MEDICAL REPORT FEE
Reimbursement of the fee actually charged for the completion of the Medical Report up to the maximum limit as stated in the Schedule of Benefits.
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 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.
LIFETIME LIMIT FOR OUTPATIENT KIDNEY DIALYSIS TREATMENT
The total amount of reimbursement that can be received in the lifetime of the Insured for outpatient kidney dialysis treatment as stated in the Schedule of Benefits. Once the limit is reached, the Benefit for this disability will cease.
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.
If an Insured Person is suffering from a covered disability which, in the opinion of an appropriate medical consultant or specialist, is highly likely to lead to death within twelve (12) months, the Policy shall pay this Benefit as provided under the Schedule of Benefits.
OVERALL ANNUAL LIMIT
The maximum annual reimbursement for all benefits payable subject to the limit as stated in the Schedule of Benefits.
OVERALL LIFETIME LIMIT
The total amount of reimbursement an Insured Person can receive in his/her lifetime subject to the limit as stated in the Schedule of Benefits. Once the limit is reached, the policy cover will automatically cease and cannot be renewed any further.
OVERSEAS INPATIENT TREATMENT (OPTIONAL)
If the Insured elects to or is referred to be treated outside Malaysia by the Attending Physician, and subsequently proceeds with such treatment, benefits in respect of the treatment shall be limited to the Reasonable and Customary and Medically Necessary charges for such equivalent local treatment in Malaysia and shall exclude the cost of transport to the place of treatment.
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:
|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.|
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, hydroceles, varicoceles|
|e.||Endometriosis including diseases of the Reproductive System|
|f.||Vertebro-spinal disorders (including disc) and knee conditions|
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.
The Policy shall not cover:
- Pre-existing illness.
- Specified Illnesses occurring during the first 120 days of continuous cover.
- 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.
- 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 Workmen’s Compensation Insurance Contract.
- 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.
- 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.
- 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.
- Any treatment or surgical operation for congenital abnormalities / deformities including hereditary conditions.
- 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.
- Psychotic, mental or nervous disorders (including any neuroses and their physiological or psychosomatic manifestations).
- 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.
- 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.
- 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.
- Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.
- Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes.
- War or acts 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.
- Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste, from the process of nuclear fission, or from any nuclear weapons material.
- Expenses incurred for the 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.
- Expenses incurred for sex changes.
- 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 treatments, massage or aroma therapy, or other alternative treatments.