Information you should know when buying an insurance policy.

Information you should know when buying an insurance policy.

What are the fees and charges that I have to pay ?

In addition to the premium, you have to pay: Amount

• Government Service Tax, if applicable 6% of premium
• Stamp duty RM10.00

What are some of the key terms and conditions that I should be aware of ?

• Duty of disclosure : You must disclose all material facts which you know or ought to know which would affect our underwriting consideration of your proposal, such as your occupation, your personal pursuits, the number of personal accident policies that you have purchased from any insurance companies.
• You must ensure that the proposal form is completed accurately as it forms the basis of your insurance contract.
• Cooling-off period : You may cancel your policy by returning the policy within 15 days after you have received the policy and you will be refunded the full premium that you paid. No refund is made if a claim was made during the said period.
• Qualifying / waiting period : Your eligibility for benefits under the policy will only start [30] days after the effective date of the policy.

NOTE
This list is not exhaustive. Please refer to the policy contract for the full list of terms and conditions.

What are the major exclusions under normal insurance policy ?

The policy does not cover:

• Illnesses contracted within the first 30 days for Part I ¡V Basic Benefits, and Major Disability diagnosed within the first 30 days
• Pre-Existing Conditions for the first 12 months.
• Specific Illnesses are not covered for the first 120 days
• Congenital conditions, dental and maternity conditions, AIDS/HIV related conditions
• Self-inflicted injury or suicide, circumcision of all causes
• Psychotic, mental or nervous disorders
• Cosmetic or plastic surgery other than accidents
• War, strike, riot, civil commotion
• Routine medical or physical examination, investigative procedures
• Persons who resides outside Malaysia for more than 90 days consecutively while the Policy is in force

NOTE:
This list is not exhaustive. Please refer to the policy contract for the full list of terms and conditions.

What is Pre-existing Condition ?

These are disabilities that the Insured Person has reasonable knowledge of. A 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.

What is Specific Illnesses?

These are disabilities and its related complications, occurring within the first 120 days of Insurance:-

• 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 diseases of the Reproductive system
• Vertebro-spinal disorders (including disc) and knee conditions.

Can I cancel my policy?

You may cancel your policy at anytime by giving written notice to us. Upon cancellation, any refund of the premium would be based on the conditions stipulated in the policy contract.

Is Policy renewal guaranteed?

Policy will be renewable at the option of the Insured Person subject to the terms and conditions prevailing at the time of renewal. The renewal premium payable is may not guaranteed depending on the individual insurance company. The insurance Company reserves the right to revise the premium rate that is applicable at the time of renewal.

What should you do when you need to be admitted to the hospital?

You will receive a Medical Card upon receiving your  policy schedule. Hospital admission will be made simpler for any Covered Conditions with the usage of this card. Diffident company may have different set of guideline.

With MPIB Medical Card

Appointed Managed Care Organisation (MCO) will arrange for your hospital admission if the hospital is one of the participating panel hospitals. A pre-certification of your coverage and medical condition will be carried by our MCO, and when everything is in order, an initial guarantee will be placed with the hospital for your admission.

With Tokio Marine Medical Card

Contact TMI Assist 24-hour Hotline at 603-7660 8330

With MSIG Medical Assist Card

General Claims Guidelines
On Reimbursement Basis:
i) Notify MSIG immediately for any event that may give rise to a claim under the policy.
   Complete the appropriate claim form(s) and submit to MSIG within 30 days of discharged:
   Healthcare Claim Form
   Critical illness if applicable - please contact MSIG Claims Department for addional form.
ii)  Attach originals of all relevant documents and bills/receipts (no photocopies).
iii) The attending doctor must complete all questions in Section ll of the claims form, rubber stamp and sign it.
iv) Submit the completed Claim Form (Sections l and ll)  together with all originals of relevant document/bills/receipts to MSIG.

On Payment Guarantee Arrangement for Hospital In-patient Treatment: (Subject to your claim being covered by the policy)
i)   This is only applicable if you have MSIG Assist Card.

ii)  Contact MSIG Assist 24-hour Hotline at 603-7628 3980.

iii) Unless for emergency hospital admission, prior notification is advisable to avoid any delay in admission.
iv) Verification on the validity of the policy is required.
v) Completed claims details must be made available to the MSIG Assist Centre.
vi) Applicable to admission to Panel Hospitals only.

What should you do in the event of loss?

You must notify us in writing with full details as soon as possible. Early notification is required to
avoid any prejudice to your claim.

What should you do when making a claim?

You must submit your claim with all the supporting information and documents to us, and give full
cooperation to us in assessing your claim.

What do I need to do if there are changes to my contact details?

It is important that you inform us of any change in your contact details to ensure that all
correspondences reach you in a timely manner.

To make an appointment or question, please

Email to: opulence.consultancy@gmail.com
SMS or Call:  +6012 2098986      

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