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B.Health Major
This provides you with an extensive coverage over
acute medical conditions that might otherwise be
excluded from other basic insurance policies due to
the following reasons :
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Basic Health Insurance
policies do not provide coverage against
major illnesses, diseases and critical
medical conditions
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Insurance policies that are
not upgraded as they gradually mature
increase the probability of the holder not
getting the essential coverage he or she
needs |
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Even with a high coverage,
escalating medical costs can restrict your
present benefits coverage, especially in the
event of a critical medical condition
requiring major surgery.
With these factors in mind, B-Health Major
provides you with the protection and
assurance you need by covering medical
expenses that are not payable or
insufficient under existing basic policies |
Special Features
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Comprehensive Cover
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Full Reimbursement up to the
Overall Annual Limit |
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A choice of deductible
limits - as a policyholder, you have the
freedom of determining the amount you want
the basic policy to cover. You can also
choose a plan that will cover expenses over
and above your deductible limit, in the
event that you decide to pay for medical
fees personally |
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Extensive coverage of major
medical conditions as opposed to the limited
list of medical benefits typically provided
by employers |
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Outpatient Treatments -
Actual charges are reimbursed subject to
benefit limits for outpatient cancer or
kidney dialysis and emergency accidental
injuries at clinics including dental
treatment |
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No medical examination
required |
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Policy Coverage & Plans |
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B.HealthNet Individual
Plans
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SCHEDULE OF BENEFITS (RM) |
M1
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M2
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M3
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M4
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M5
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| HOSPITAL
BENEFITS |
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Hospital Room & Board |
400
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300
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200
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100
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80
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Intensive Care Unit |
Full Reimbursement
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Operating Theatre |
Full Reimbursement
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Hospital Services &
Supplies |
Full Reimbursement
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PROFESSIONAL FEES &
SERVICES |
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Pre-Hospital
Diagnostic Test (Within 31 days preceding
confinement) |
Full Reimbursement
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Pre-Hospital
Specialist consultation (within 31 days
preceding confinement) |
Full Reimbursement
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Surgeon Fee |
Full Reimbursement
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Anaesthetist Fee |
Full Reimbursement
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In-Hospital
Physician's Visit (1 visit per day) |
Full Reimbursement
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Post Hospitalisation
Treatment
(For Non-Surgical within 31 days from
discharge) |
Full Reimbursement
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Ambulance Fee |
Full Reimbursement
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OUT PATIENT/EXTENDED
BENEFITS |
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Emergency Accidental
Outpatient Treatment (Within 24 hours and
follow-up treatment up to 14 days) |
Full Reimbursement
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Emergency Accidental
Dental Treatment (Within 24 hours and
follow-up treatment up to 14 days) |
Full Reimbursement
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Home Nursing Care |
Full Reimbursement
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Annual Outpatient
Cancer or Kidney Dialysis Treatment |
50,000
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40,000
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30,000
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20,000
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15,000
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Organ Transplant (once
per lifetime) |
Full Reimbursement
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Outpatient
Physiotherapy Treatment (within 90 days from
discharge) |
Full Reimbursement
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DEDUCTIBLE PER
DISABILITY |
10,000
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8,000
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6,000
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4,000
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3,000
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OVERALL ANNUAL LIMIT |
100,000
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80,000
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60,000
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40,000
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30,000
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LIFETIME LIMIT |
500,000
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400,000
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300,000
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200,000
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150,000
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Annual Premium On Next Birthday (RM)
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Age |
M1
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M2
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M3
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M4
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M5
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1 - 17 years |
180
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160
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140
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120
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100
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18 - 35 years |
360
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330
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290
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260
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220
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36 - 45 years |
480
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420
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350
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320
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270
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46 - 55 years |
575
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480
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400
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370
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320
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56 - 70 years (Renewal
Only) |
1,200
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890
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650
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520
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460
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Description Of Benefits
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 less deductible
for the account of the Insured.
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HOSPITAL ROOM AND BOARD
Daily charges for room and board and meals
during confinement as a bedpatient.
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INTENSIVE CARE UNIT
Daily charges as a bedpatient in the
Intensive Care Unit of the hospital.
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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
and Malaysian Government Hospital.
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MALAYSIAN GOVERNMENT
SERVICE TAX
5% government service tax on eligible Room &
Board charges. Incurred.
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OPERATING THEATRE
Charges for operating theatre incidental to
the surgical procedure.
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HOSPITAL SERVICES & SUPPLIES
Charges during confinement which shall
include general nursing, prescribed
medicine, dressing, X-rays, laboratory
examinations, electrocardiograms,
physiotherapy, administration of blood and
blood plasma but excluding the cost of blood
and plasma.
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PRE-HOSPITAL DIAGNOSTIC TESTS
Charges for diagnostic tests which are
recommended by a general practitioner within
31 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.
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PRE- HOSPITAL SPECIALIST CONSULTATION
Fees charged by the Specialist which are
recommended by a general practitioner in
writing within 31 days preceding hospital
confinement. Payment will not be made for
clinical treatment (including medications
and subsequent consultation) or where the
Insured does not result in hospital
confinement for the treatment of the medical
condition so diagnosed.
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SURGEON FEE
Surgical fees and normal pre and
post-operative care up to 31 days inclusive
both before and after the operation.
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ANAESTHETIST FEE
Fees charged by the Anaesthetist for the
supply and administration of anaesthesia.
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IN-HOSPITAL PHYSICIAN VISIT
Fees charged by the Physician for the
treatment of the Insured Person when
confined for a non-surgical disability.
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POST-HOSPITALISATION TREATMENT
Charges for treatment within 31 days
following discharge from hospital for a
non-surgical confinement administered by the
same Physician.
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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 hospitalized.
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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 hour of
the accidents. Follow-up treatment is up to
31 days by the same Physician.
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EMERGENCY ACCIDENTAL DENTAL TREATMENT
Fess charged for the treatment of accidental
injuries to sound natural teeth within 24
hour of the accident. Follow-up treatment is
up to 14 days by the same dentist.
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HOME NURSING CARE
Daily charges for the services of licensed
and qualified nurse in the Insureds home
for the continued treatment of the specific
medical condition for which he/she was
hospitalized. Such services must be
recommended by the attending Physician.
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ANNUAL OUT-PATIENT CANCER OR KIDNEY
DIALYSIS TREATMENT
If an Insured is diagnosed with the Cancer
of Kidney Failure as defined below, the
Company will reimburse the Reasonable and
Customary Charges incurred for the Medically
Necessary treatment performed at a legally
registered cancer treatment center or at
registered dialysis center subject to the
limit of this disability as specified in the
Schedule of Benefits.
Such treatment (radiotherapy or chemotherapy
or dialysis excluding consultation,
examination tests, take home drugs) must be
received at the out-patient department of a
Hospital or a registered cancer/dialysis
treatment centre immediately following
discharge from Hospital confinement or
surgery.
Cancer is defined as the uncontrollable
growth and spread of malignant cells and the
invasion and destruction of normal tissue
for which major interventionist treatment or
surgery (excluding endoscopic procedures
alone) is considered necessary. The cancer
must be confirmed by histological evidence
of malignancy. The following conditions are
excluded :
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Carcinoma in situ
including of the cervix; |
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Ductal Carcinoma in situ
of the breast; |
| c) |
Papillary Carcinoma of
the bladder & Stage 1 Prostate Cancer; |
| d) |
All skin cancers except
malignant melanoma; |
| e) |
Stage 1 Hodgkin's
disease; |
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Tumours manifesting as
complications of AIDS. |
Kidney Dialysis means end stage renal failure
presenting as chronic, irreversible failure of
both kidneys to function as a result of which
renal dialysis is initiated.
It is a specific condition of this Benefit that
notwithstanding the exclusion of pre-existing
conditions, this Benefit will not be payable for
any Insured who had been diagnosed as a cancer
patient and/or is receiving cancer treatment
and/or has developed chronic renal diseases
and/or is receiving dialysis treatment prior to
the effective date of insurance.
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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.
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OUT-PATIENT PHYSIOTHERAPY TREATMENT
Charges for outpatient physiotherapy
treatment which is recommended in writing by
the attending Physician within 90 days after
discharge from hospital.
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OVERALL ANNUAL LIMIT
Benefits payable in respect of expenses
incurred for treatment provided to the
Insured Person during the period of
insurance shall be limited to Overall Annual
Limit as stated in the Schedule of Benefits
irrespective of a type/types of disability.
This shall mean the maximum annual
reimbursement for benefits after deducting
the greater of the following:
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Deductible Per
Disability specified in the Schedule of
Benefit, OR |
| b) |
Amounts paid by any
other insurance policy for the same
benefits. |
In the event the Overall Annual Limit having
been paid, all insurance for the Insured Person
hereunder shall immediately cease to be payable
for the remaining policy year.
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LIFETIME LIMIT
The total amount of reimbursement an Insured
Person can receive in his/her lifetime is
subject to the limit as set forth in the
Schedule of Benefit in accordance to the
plan insured. Once the limit is reached, the
policy cover will automatically cease and
cannot be renewed any further.
For detailed description of the
covered benefits, please refer to the Policy
Contract. |
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