HealthNet Premier

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. 

Introduction

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
  HNP500 HNP350 HNP250 HNP100
OVERALL LIFETIME LIMIT 500,000 350,000 200,000 120,000
OVERALL ANNUAL LIMIT 120,000 100,000 70,000 40,000
HOSPITAL BENEFITS
Hospital Room & Board
(up to 150 days)
500 350 250 100
Intensive Care Unit As Charged
Lodger
(up to 150 days)
300 250 150 75
Daily Cash Allowance at Government Hospital
(up to 150 days)
150 150 100 50
Malaysian Government Service Tax
(room charges)
6% of Eligible Expenses
Operating Theatre As Charged
Hospital Services & Supplies As Charged
Surgical Implant 20,000 15,000 10,000 5,000
PROFESSIONAL FEES & SERVICES
Pre-Hospital Diagnostic Tests
(within 60 days preceding confinement)
As Charged
Pre-Hospital Specialist Consultation
(within 60 days preceding confinement)
As Charged
Surgeon Fee 75,000 50,000 30,000 15,000
Anaesthetist Fee 20,000 15,000 10,000 5,000
Second Surgical Opinion 500 500 500 500
In-Hospital Physician's Visit
(up to 150 days)
As Charged
Post-Hospitalisation Treatment
(non-surgical within 60 days from discharge)
As Charged
Ambulance Fee As Charged
Medical Report Fee 100 100 100 100
OUTPATIENT/EXTENDED BENEFITS
Emergency Accidental Treatment
(within 24 hours and follow-up treatment up to 31 days)
As Charged
Emergency Accidental Dental Treatment
(within 24 hours and follow-up treatment up to 14 days)
As Charged
Home Nursing Care
(up to 60 days)
120 100 80 60
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
Organ Transplant
(once per lifetime)
As Charged
Outpatient Physiotherapy Treatment
(within 90 days from discharge)
As Charged
In-Hospital Treatment for Mental Illness
(annual limit)
2,500 2,500 2,500 2,500
Terminal Illness
(once per lifetime)
5,000 5,000 5,000 5,000

 

ANNUAL PREMIUM ON NEXT BIRTHDAY (RM)        
AGE     HNP500  HNP350 HNP250  HNP100 
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

 

Note:

  • 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 

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.

 

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.

 

SURGICAL IMPLANT 

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.

 

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.

 

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.

 

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.

 

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.

 

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.

 

TERMINAL ILLNESS

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.

Policy Definitions

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

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 Workmen’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, 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 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.
  17. 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.
  18. 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.
  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 treatments, massage or aroma therapy, or other alternative treatments.

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

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