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Policy Coverage & Plans |
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B.HealthNet Individual
Plans
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SCHEDULE OF BENEFITS |
PLAN |
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HN350
|
HN200
|
HN120
|
HN80 |
|
OVERALL ANNUAL LIMIT |
120,000
|
60,000
|
45,000
|
30,000 |
|
HOSPITAL BENEFITS |
Hospital Room & Board
(up to 150 days) |
350
|
200
|
120
|
80
|
|
Intensive Care Unit |
Full Reimbursement
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|
Lodger (up to 150
days) |
250
|
150
|
90
|
60
|
|
Daily Cash Allowance
at Government Hospital (up to 150 days) |
150
|
100
|
60
|
40
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Malaysian Government Service Tax
(room charges) |
5% Eligible Paid Expenses
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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 Tests within 60 days preceding
confinement |
Full Reimbursement
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|
Pre-Hospital
Specialist consultation within 60 days
preceding confinement |
Full Reimbursement
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Surgeon Fee |
60,000
|
30,000
|
17,500
|
12,500
|
|
Anaesthetist Fee |
20,000
|
10,000
|
5,000
|
4,000
|
In-Hospital
Physician's Visit
(up to 150 days) |
Full Reimbursement
|
Post Hospitalisation
Treatment
(For non-surgical within 60 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 |
Full Reimbursement
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Emergency Accidental
Dental Treatment |
Full Reimbursement
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Home Nursing Care |
100
|
80
|
70
|
50
|
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Annual Outpatient
Cancer Treatment |
60,000
|
48,000
|
36,000
|
24,000
|
|
Monthly Outpatient
Kidney Dialysis Treatment |
5,000
|
4,000
|
3,000
|
2,000
|
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Lifetime Limit for
Outpatient Kidney Dialysis Treatment |
180,000
|
144,000
|
108,000
|
72,000
|
|
Organ Transplant (once
per lifetime) |
Full Reimbursement
|
|
Outpatient
Physiotherapy Treatment (within 90 days from
discharge) |
Full Reimbursement
|
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In-Patient Treatment
for Mental Illness |
2,500
|
2,500
|
2,500
|
2,500
|
Medical Evacuation &
Repatriation Benefits
(Not Applicable to Children) |
100,000
|
100,000
|
N/A
|
N/A
|
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ANNUAL PREMIUM ON
NEXT BIRTHDAY(RM) |
HN350
|
HN200
|
HN120
|
HN80
|
|
AGE |
|
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30 days to 10 years |
625
|
480
|
375
|
300
|
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11 - 18 years |
500
|
385
|
300
|
250
|
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19 - 35 years |
630
|
480
|
420
|
350
|
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36 - 45 years |
730
|
550
|
480
|
400
|
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46 - 55 years |
950
|
710
|
600
|
530
|
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56 - 60 years (Renewal
Only) |
1,450
|
1,050
|
890
|
750
|
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61 - 70 years (Renewal
Only) |
2,300
|
1,500
|
1,180
|
950
|
Supplementary Benefit
Due To Accident Confinement
Hospital Income per
day
(Up to 150 days with 1 day excess) |
100
|
100
|
100
|
100
|
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ADDITIONAL ANNUAL
PREMIUM |
30
|
30
|
30
|
30
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Note :
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Class 3 will have a 15%
loading on overall total premium.
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Children from 30 days to 18
years must be enrolled together with one of
their parents. |
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For corporate policyholders,
5% Government Service Tax is applicable. |
 
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.
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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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LODGER
Lodger fee charged for accompanying the
insured child (below 15 years of age) during
the hospital confinement.
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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
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.
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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 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 60 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 60 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 TREATMENT
Charges incurred for the alleviation of
neoplastic condition and received at the
outpatient department of a hospital or
registered cancer treatment center following
discharge from hospital.
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MONTHLY OUTPATIENT KIDNEY
DIALYSIS TREATMENT
Charges incurred for the treatment of kidney
dialysis at a legally registered dialysis
center due to end-stage renal failure
following discharge from hospital.
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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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IN-PATIENT 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.
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OVERALL ANNUAL LIMIT
The maximum annual reimbursement for all
benefits payable subject to the limit as
stated in the Schedule of Benefits.
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HOSPITAL INCOME (If Applicable)
Daily cash allowance for each day of
hospital confinement due to Accidental
Injury with one (1) day excess.
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For detailed description of the covered benefits,
please refer to the Policy Contract.
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