Key Terms and Conditions
- You should provide sufficient and accurate information to us or our intermediary to enable us to advise you on the Hospitalisation and Surgical insurance which suits your needs.
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Importance Of Disclosure
Consumer Insurance Contract
Pursuant to Paragraph 5 of Schedule 9 of the Financial Services Act 2013, if you are applying for this Insurance wholly for purposes unrelated to your trade, business or profession, you have a duty to take reasonable care not to make a misrepresentation in answering the questions in the Proposal Form and you must answer the questions fully and accurately. Failure to take reasonable care in answering the questions may result in avoidance of your contract of insurance, refusal or reduction of your claim(s), change of terms or termination of your contract of insurance. You are also required to disclose any other matter that you know to be relevant to our decision in accepting the risks and determining the rates and terms to be applied.
Non-Consumer Insurance Contract
Pursuant to Paragraph 4(1) of Schedule 9 of the Financial Services Act 2013, if you are applying for this Insurance for purposes related to your trade, business or profession, you have a duty to disclose any matter that you know to be relevant to our decision in accepting the risks and determining the rates and terms to be applied and any matter a reasonable person in the circumstances could be expected to know to be relevant, otherwise it may result in avoidance of your contract of insurance, refusal or reduction of your claim(s), change of terms or termination of your contract of insurance.
This duty of disclosure for Consumer and Non-Consumer Insurance Contract shall continue until the time the contract is entered into, varied or renewed. You also have a duty to tell us immediately if at any time after your contract of insurance has been entered into, varied or renewed with us, any of the information given in the Proposal Form is inaccurate or has changed.
- Pre-existing Illnesses
Pre-existing Illnesses 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
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, cancer, cysts, nodules, polyps, stones of the urinary system and biliary system.
- All ear, nose (including sinuses) and throat condition.
- Hernias, haemorrhoids, fistulae, hydrocele, varicocele.
- Endometriosis including disease of the Reproduction System.
- Vertebro-spinal disorders (including disc) and knee conditions.
- Waiting Period
Waiting Period shall mean the first 30 days between the beginning of an Insured Person’s disability and the commencement of this Policy date/reinstatement date and is applied only when the person is first covered.
This shall not be applicable after the first year of cover. However, if there is a break in insurance, the Waiting Period will apply again.
- Upgraded Room & Board Co-payment
If the Insured Person is hospitalised at a published Room & Board rate which is higher than his/her eligible benefit, the Insured Person shall bear 20% of the other eligible benefits described in the Schedule of Benefits.
- Residence Overseas
No benefit whatsoever shall be payable for any medical treatment received by the Insured outside Malaysia, if the Insured resides or travels outside Malaysia for more than ninety (90) consecutive days.
- Overseas Treatment
If the Insured Person 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 Reasonable and Customary and Medically Necessary Charges for such equivalent local treatment in Malaysia based on the official exchange rate ruling on the last day of the Period of Confinement and shall exclude the cost of transport to the place of treatment provided;
Reasonable and Customary charges which are medically necessary shall be deemed to be:- fees laid down in the Malaysian Medical Association’s Schedule of Fees
- average charges of medium-cost hospital treatment shall be the basis of payment for all other related charges applied to similar or equivalent severity of the medical condition being treated.
- Reasonable And Customary Charges
Reasonable and Customary Charges shall mean charges for medical care which is medically necessary and it does not exceed the general level of charges being made by others of similar standing in the locality where the charge is incurred, when furnishing like or comparable treatment, services or supplies to individual of the same sex and of comparable age for a similar sickness, disease or injury and in accordance with accepted medical standards and practice could not have been omitted without adversely affecting the Insured Person’s medical condition.
- Cooling-off Period
If this Policy shall have been issued and for any reason whatsoever the Insured Person shall decide not to take up the Policy, the Insured Person may return the Policy to the Company for cancellation provided such request for cancellation is delivered by the Insured Person to the Company within fifteen (15) days from the date of issue of the Policy. The Insured Person is entitled to the return of the full premium paid less deduction of medical expenses incurred by the Company.
- Unless renewed, the coverage will cease on expiry date and the insurance company shall strictly not be liable for any expenses that take place after the expiry date.
- You are advised to keep the receipt as proof of payment of premium.
- It may not be advantageous to switch insurance policy / insurer because you may be subjected to new terms and conditions of the new policy or of the new insurer.