Premier Medic Partner - Comprehensive family medical insurance

• Hospital Room & Board

 

Reimburses the daily charges made by the Hospital for room accommodation and meals incurred by the Insured Person for each day of confinement as a registered bed–paying patient in a Hospital.

 

• Intensive Care Unit

 

Reimburses daily charges for confinement in an Intensive Care Unit or Cardiac Care Unit where prescribed by the attending Physician or Surgeon

 

• Surgeon Fees

 

Reimburses professional fees charged by the Surgeon for a Surgery performed. This includes Surgeon’s ward visits, pre–surgical assessment and all normal post–surgical care up to sixty (60) days before and after the operation.

Surgeon Fees shall also include professional fees charged by a second Physician or Surgeon who may be consulted prior to Hospitalisation of Insured Person for a surgical operation.

 

• Anaesthetist Fees

 

Reimburses professional fees charged by the Anaesthesiologist for the supply and administration of anaesthesia incidental to the performance of a Surgery.

 

• Operating Theatre Fees

  Reimburses Operating Room charges incidental to the performance of a Surgery.

 

• In–Hospital Physician Visits

 

Reimburses professional fees charged by a Physician for visiting a bed–paying patient while confined for a non–surgical Disability subject to a maximum of one (1) visit per day up to maximum number of 150 days.

 

• Hospital Services & Supplies

 

Reimburses charges for general nursing, prescribed and consumed drugs and medicines, dressings, splints, plaster casts, X–ray, diagnostic tests, laboratory examinations, electrocardiograms, physiotherapy, rental of appliances, surgical implants, basal metabolism tests, intravenous injections and solutions, administration of blood and blood plasma, oxygen and its administration, and eligible Government Service Tax whilst the Insured Person is confined as a bed–paying patient in a Hospital.

 

• Pre–hospital Diagnostic Tests

 

Reimburses charges for ECG, X–ray, laboratory and diagnostic tests which are performed for diagnostic purposes and when in connection with a Disability preceding Hospitalisation within Thirty-one (31) days and which are recommended by a Physician. No benefit shall be made if upon such diagnostic services, the Insured Person does not result in Hospitalisation for the treatment of the medical condition diagnosed. Cost incurred for any medications and consultation will not be payable under this benefit item.

 

• Pre–hospital Specialist Consultation

 

Reimburses the professional fees charged for the first time consultation by a Specialist in connection with a Disability within Thirty–one (31) days preceding Hospitalisation and provided that such consultation has been recommended in writing by a Doctor. No benefit shall be made for any clinical treatment (including medications and subsequent consultation) or where the Insured Person does not result in Hospitalisation for the treatment of the medical condition diagnosed.

 

• Post–Hospitalisation Treatment

 

Reimburses medical charges for follow–up treatment by the same attending Physician and incurred within sixty (60) days immediately upon discharge from Hospital for a non–surgical Disability. This shall include medicines prescribed during the follow–up treatment but shall not exceed the supply needed for the said sixty (60) days period.

 

• Outpatient Physiotherapy Treatment

 

Reimburses the daily professional fees charged by a legally and medically qualified Physiotherapist for outpatient physiotherapy treatment and incurred within sixty (60) days upon discharge from Hospital provided that such service is deemed to be Medically Necessary by the attending Physician in writing.

 

• Emergency Accidental Outpatient Treatment

 

Reimburses medical expenses incurred as a result of a covered bodily injury arising from an Accident for treatment as an outpatient at any registered clinic or Hospital within twenty–four (24) hours of the Accident causing the Injury. Follow–up treatment by the same Doctor or same registered clinic or Hospital for the same Injury will be provided up to Thirty–one (31) days from the date of the Accident.

 

• Emergency Accidental Dental Treatment

  Reimburses medical expenses incurred in a Hospital or a registered dental clinic for dental treatment of injury or damage to sound natural teeth as a result of an Accident Provided that the dental treatment is received within forty–eight (48) hours of the Accident causing the Injury. Follow–up treatment by the same Dentist will be provided up to Thirty–one (31) days from the date of the Accident.

 

• Ambulance Fee

 

Reimburses charges incurred for road ambulance services (inclusive of attendant) to and/or from the Hospital of confinement. Payment will not be made if the Insured Person is not Hospitalised.

 

• Government Service Tax

  Reimburses the 5% Government Service Tax on the eligible Hospital Room and Board charges.

 

• Lodger Benefit

 

Reimburses the daily expenses for meals and lodging incurred to accompany an insured Child (aged below fifteen (15) years) in the Hospital but not exceeding sixty (60) days.

 

• Traditional Medical Treatment

 

Reimburses medical expenses incurred for treatment of a covered Accidental Injury on outpatient basis and treated by a registered Traditional Medical Practitioner within twenty–four (24) hours after the Accident.

 

• Medical Report

 

Reimburses charges made by Hospital/Physician for completion of medical report of a covered Disability.

 

• Home Nursing Care

 

Reimburses the daily professional fees for the services rendered by a medically qualified and licensed Nurse in the Insured Person’s home and incurred within one–hundred (100) days immediately upon discharge from Hospital. The plan and schedule of the treatment for this Home Nursing Care must be established and prescribed in writing by the attending Physician. No payment will be made for custodial care, meal, general housekeeping services, companion, rest cure or personal comfort items.

 

• Daily Cash Allowance At Government Hospital

 

Pays a daily allowance for each complete day of confinement in a Malaysian Government Hospital up to a maximum number of 150 days. No payment will be made for any transfer to or from any non–Malaysian Government Hospital.

 

• Organ Transplant

 

Reimburses the medical charges incurred for transplantation surgery for the Insured Person being the recipient of the transplant of Kidney, Heart, Lung, Liver or Bone Marrow. No benefit is allowable under this policy other that this particular benefit item (Organ Transplant) and payment for this Benefit is applicable only once per Lifetime of an Insured Person whilst the Policy is in force. The costs of acquisition of the organ and all costs incurred by the donors are not covered.

 

• Funeral Benefit

 

Pays the Insured or the legal representative of the Insured the stated lump sum benefit on the occurrence of ONE of the following events:

a)

Accidental death of an Insured Person if death occurs within six (6) months from the date of the Accident. OR

b)

Death of Insured Person during the period of confinement in the Hospital or within 30 days upon discharge from the hospital provided only if at the date of his/her death, his/her age falls between 19 years and 60 years inclusive.

 

• Outpatient Cancer Treatment

 

If an Insured Person is diagnosed with Cancer as defined herein, the Company will reimburse medical charges incurred for the treatment of Cancer provided such treatment of radiotherapy &/or chemotherapy (but excluding costs for consultation, examination test, take home drugs) is received at the outpatient department of a Hospital or a legally registered Cancer treatment center immediately following discharge from Hospital confinement or surgery.

 

• Outpatient Kidney Dialysis Treatment

 

If an Insured Person is diagnosed with Kidney Failure as defined herein, the Company will reimburse the medical charges incurred for Kidney dialysis performed at the outpatient department of a Hospital or a legally registered Kidney Dialysis center immediately following discharge from Hospital confinement or surgery. (The costs for consultation, examination tests, take home drugs are excluded).

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To make an appointment or question, please

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

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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      

Connect on facebook:
https://www.facebook.com/myInsurancePartner

https://www.facebook.com/myBusinessInsurance