HealthEnrich - Prudential BSN Takaful

Transcription

HealthEnrich
THE MEDICAL PLAN THAT DEFINES YOU
HealthEnrich is Uniquely You
Your health is a privilege and you deserve a plan that reflects your medical needs.
At Prudential BSN Takaful Berhad (PruBSN), we want you to live your life without
compromising your health.
HealthEnrich is designed to ensure you experience unparallelled medical treatment, fully
covered. Feel secure when you receive medical advice from leading experts around the
world. Be at ease during pregnancy with our exclusive maternity complications coverage.
You can also enjoy the comfort and privacy of a suite with a dedicated medical attendant
taking care of your needs.
All these features and more crafted to complement your unique lifestyle.
Now, let’s discover your lifestyle.
Are You...
YOUNG AND LOOKING
FOR FREEDOM IN LIFE?
Start Early
DEDICATED AND TAKING
MORE COMMITMENTS
IN LIFE?
Fulfil Life
A HIGH ACHIEVER AND
SEEKING FOR THE BEST
IN LIFE?
Take the Lead
ACCOMPLISHED AND
LIVING A DISTINGUISHED
LIFESTYLE?
Enjoy Exclusive Privileges
HealthEnrich Vital
Start Early with
HealthEnrich Vital
The moment is here for you to stand on your own
feet. Start early with a plan that provides vital medical
protection and suits your vibrant lifestyle.
HealthEnrich Vital gives you...
MEDICAL TREATMENT
that is within easy
reach at our nationwide
network of
70
hospitals
SECURITY when you explore the
world knowing that
you are covered worldwide
FLEXIBILITY to upgrade the
plan as your needs grow
with your changing lifestyle
HealthEnrich Vital
Co-Takaful
If You are Hospitalised
Hospital Daily Room and Board (maximum 120 days per year)
Intensive Care Unit (maximum 30 days per year)
Surgical Procedure and Treatment
In-Hospital and Related Services
RM150
As charged
subject to
Co-Takaful
If You Need Outpatient Treatment
Day Surgery
As charged
Pre-Hospitalisation and Post-Hospitalisation Treatment
(within 90 days before and after hospitalisation)
As charged
subject to
Co-Takaful
If You are Coping with Life-changing Illnesses
Cancer Treatment
As charged
If You are in an Emergency
Emergency Treatment for Accidental Injury (Annual Limit)
Worldwide Emergency Medical Assistance
RM1,500
Yes
Overall Annual Limit
RM30,000
Lifetime Limit
RM300,000
HealthEnrich Select
Fulfil Life with
HealthEnrich Select
Your lifestyle changes when you have a family. Select
a plan that fulfils life with optimum protection and
satisfies your growing responsibilities.
HealthEnrich Select offers you...
COMPREHENSIVE
hospitalisation
and surgical cover
Unique benefits
for the COMFORT of
EXPECTING MOTHERS
MEDICAL BILL
PAID
FULL COVER for your
MEDICAL BILLS giving
you added security
and peace of mind
HealthEnrich Select
Co-Takaful
Full Coverage
RM200
RM200
As charged
subject to
Co-Takaful
As charged
Hospital Daily Room and Board
(maximum 200 days per year)
Day Surgery
As charged
Home Nursing Care (180 days per lifetime)
As charged
subject to
Co-Takaful
As charged
As charged
As charged
Maternity Complications (Annual Limit)
RM6,000
RM6,000
Emergency Treatment for Accidental Injury
(Annual Limit)
RM2,000
RM2,000
Yes
Yes
RM60,000
RM60,000
Lifetime Limit
RM600,000
RM600,000
If You are Coping With Life-changing Illnesses
Cancer Treatment
Kidney Dialysis Treatment
HealthEnrich Advanced
Take the Lead with
You progress so quickly in life that you seldom pause
and think about your future healthcare needs. Take the
lead with a plan that provides advanced protection and
fulfils your hectic lifestyle.
HealthEnrich Advanced provides you...
EASY ADMISSION with pre-arranged
hospitalisation and waiver of hospital
deposit at our Preferred Hospitals
DIRECT CONSULTATION
with leading local and
international medical experts
REWARDS for healthy living
with a NO CLAIM BONUS
under the co-takaful option
Co-Takaful
Full Coverage
RM250
Not offered
Hospital Daily Room and Board
RM300
RM300
Hospital Daily Cash Allowance
RM100
RM100
As charged
subject to
Co-Takaful
As charged
Waived
Waived
Reward for Healthy Living
No Claim Bonus
Hospital Deposit at Preferred Hospitals
Day Surgery
As charged
As charged
subject to
Co-Takaful
As charged
RM500
RM500
Yes
Yes
As charged
As charged
RM100,000
RM100,000
RM10,000
RM10,000
Emergency Treatment for Accidental Injury
(Annual Limit)
RM3,000
RM3,000
Pre-Hospitalisation and
Post-Hospitalisation Treatment
Second Medical Opinion
• Consultation and Diagnosis in Malaysia
(Annual Limit)
• Consultation with World Leading Experts
Cancer Treatment
Organ Transplant (Additional Lifetime Limit)
Lifetime Limit
Yes
Yes
RM100,000
RM100,000
RM1,000,000
RM1,000,000
HealthEnrich Premier
Enjoy Exclusive Privileges with
You want to experience the finest things in life while
living healthily. Enjoy exclusive privileges with a plan
that offers superior protection and addresses your
prominent lifestyle.
HealthEnrich Premier offers you...
LUXURIOUS ACCOMMODATION
in a suite and exclusive treatment
at our Preferred Hospitals nationwide
A DEDICATED MEDICAL
attendant to meet
your every need
SUPERIOR HOSPITALISATION LIMITS
xim
um
M ini m
Ma
um
Average
for your medical needs
Full Coverage
Hospital Daily Room and Board (maximum 365 days per year)
• Preferred Hospitals
• Other hospitals
RM1,000
RM500
Hospital Daily Cash Allowance (maximum 365 days per year)
RM200
Dedicated Daily Medical Attendant (maximum 365 days per year)
RM200
As charged
Hospital Deposit at Preferred Hospitals
Waived
Day Surgery
As charged
Second Medical Opinion
• Consultation and Diagnosis in Malaysia (Annual Limit)
• Consultation with World Leading Experts
Cancer Treatment
Organ Transplant (Additional Lifetime Limit)
RM1,000
Yes
As charged
RM200,000
RM20,000
Emergency Treatment for Accidental Injury (Annual Limit)
RM5,000
Lifetime Limit
Yes
RM200,000
RM4,000,000
What you need to know about HealthEnrich
1. What is HealthEnrich?
HealthEnrich is a regular contribution medical rider plan that reimburses major medical
expenses incurred in the event of hospitalisation, surgery or outpatient treatment. It has
four plans – HealthEnrich Vital, HealthEnrich Select, HealthEnrich Advanced and
HealthEnrich Premier – where each comes with a medical card to give you immediate
access to any of our panel hospitals.
2. How much contribution do I need to pay?
The contribution that you pay is based on your age at entry and does not increase as you
get older. The contribution rates are available in Appendix 2.
3. What is Organ Transplant benefit?
Organ Transplant benefit is an additional lifetime limit when you undergo one of the
transplant surgeries on kidney, heart, lung, liver, bone marrow or cornea. This additional
once-in-a-lifetime benefit is on top of the annual limit and lifetime limit for HealthEnrich
Advanced and HealthEnrich Premier.
4. What are the advantages of Cancer Treatment and Kidney Dialysis Treatment?
You can seek treatments such as hemodialysis, radiotherapy and chemotherapy at our
panel hospitals using the medical card without any payment of co-takaful. On top of
that, HealthEnrich covers any consultations, examination tests and take-home drugs.
5. What are the options available for HealthEnrich?
Options
HealthEnrich
Vital
HealthEnrich
Select
HealthEnrich
Advanced
HealthEnrich
Premier
Entry Age
20 gestational
weeks to
45 years old
20 gestational
weeks to
70 years old
14 days to
70 years old
14 days to
70 years old
Expiry Age
25, 70 or
80 years old
25, 70 or
80 years old
25, 70 or
80 years old
25, 70 or
80 years old
Costsharing
Co-takaful
only
Co-takaful or
Full Coverage
Co-takaful or
Full Coverage
Full Coverage
only
6. What are the charges and deductions involved in HealthEnrich?
The details of charges and deductions are listed in the table below.
Type of
Charges and
Deductions
Upfront
wakalah
charge
Details
This charge allows us to pay commission and distribution related
expenses as well as management expenses. The percentage
below is based on term 20 years or more. For term less than
20 years, you may refer to the Plan Illustration.
Certificate year
1
2
3
4
5&6
7&
above
Upfront wakalah
charge
60%
60%
50%
30%
20%
0%
Tabarru’
We deduct an amount each month from your protection account
based on your age, health status, occupation (if applicable), and
amount of coverage for the duration of the coverage.
What is Day Surgery Benefit?
Hospital admissions are costly and at times unnecessary.
Hospitalisation means more costs such as admission fee, room
and board, nursing care and meals. Although we need rest to
recover, hospitals are not always as comforting as our own homes.
One of the uniqueness of HealthEnrich is the Day Surgery benefit.
No matter which plan you choose, Co-Takaful or Full Coverage,
this benefit fully covers the cost of your surgeries or treatments.
Also, with the Day Surgery benefit, you can recuperate in the comfort of your home on
the same day. You do not have to stay overnight at a hospital and worry about exhausting
your medical coverage. You can undergo radiotherapy, haemodialysis or chemotherapy as
outpatient under this convenient plan.
It also covers*:
1. Gastroscopy/Endoscopy
2. Colonoscopy
3. Angiography
4. I & D of abscess except wide excision
5. Cataract extraction
6. Excision of breast nodule/lump except wide excision
7. Dilatation & Curettage
8. Diagnostic laparoscopic procedure
9. Removal of foreign body
10. Excision of Chalazion/Pterygium
11. Radiotherapy
12. Diagnostic Bronchoscopy
13. Removal of Ganglion/fibroma
14. Diagnostic cystoscopy
15. Insertion of Chemoport/Hickman line
16. AV fistula creation
17. Lump – Excision biopsy (all types)
18. Removal of warts
19. Closed manipulation of fracture
20. Injection of Trigger finger
21. Intra-articular injection of joints
22. Corrective surgery for blepharoptosis not
related to congenital/cosmetic
23. Haemodialysis
24. Suture and other operations on tendons and
tendon sheath
25. Chemotherapy
26. Arthroscopic knee evaluation/
aspiration/joint toilet
27. Carpal tunnel release
* You may undergo any other day surgery or
treatment that is not listed above as advised by your doctor.
Please refer to the certificate document for further information.
Important Notes
1. This brochure does not form a contract between you and PruBSN. Please refer to the
Plan Illustration and Product Disclosure Sheet before participating in the plan. The full
Terms and Conditions are set out in the certificate documents. Please ask for a sample
of the Terms and Conditions should you need detailed information of the plan.
2. For HealthEnrich, you are entitled to medical tax relief in respect of your contributions of
up to RM3,000 a year. Any tax relief is subject to the terms and conditions of the Inland
Revenue Board (IRB).
3. You should continue paying your contributions regularly until the maturity of your plan
to ensure that you are fully protected under the plan at all times. Failing to do so may
cease your coverage prematurely. Coverage to expiry age is subject to the Protection
Unit Account (PUA) being sufficient for deduction of Tabarru’ and applicable charges.
4. HealthEnrich is a guaranteed renewable plan. The contribution is level but it is not
guaranteed. PruBSN reserves the right to revise the contribution rates and/or Tabarru’ by
giving 30 days written notice. The rates may be revised due to unfavorable circumstances
such as medical cost inflation. Any changes in contributions and/or Tabarru’ will only
take effect on the next certificate anniversary.
5. HealthEnrich does not provide any benefit amount from the Tabarru’ Fund on
termination, expiry or maturity of certificate.
6. Co-takaful is a cost-sharing arrangement under which the participant pays a specified
percentage of the cost of an eligible benefit. If co-takaful is selected, participant will have
to pay 10% of the cost of an eligible benefit, subject to minimum co-takaful amount of
RM400 and maximum co-takaful amount of RM2,000. No minimum co-takaful amount
applies for benefits under If You Need Outpatient Treatment.
7. The full coverage plan requires no payment from the participant in respect of bills for
covered medical conditions subject to limits in each plan and terms and conditions as
stated in the certificate documents.
8. Preferred Hospitals are selected hospitals that will provide complimentary services
to preferred customers who take up plan HealthEnrich Advanced or HealthEnrich
Premier. Please refer to PruBSN website for the current list of Preferred Hospitals.
9. You can only seek Second Medical Opinion when you are diagnosed with one of the
covered critical illnesses.
10.HealthEnrich is based on Wakalah Bil Ajr model which is an arrangement for PruBSN to
manage your takaful plan. Your contribution will be placed into the PUA after deducting a
wakalah charge which constitutes the fee for the overall management services provided.
The takaful protection comes from the Tabarru’ Fund.
11.Tabarru’ means a donation of a specified portion from the contribution into the Tabarru’
Fund for the purpose of mutual aid and assistance among fellow participants according
to the agreed benefits under the plan.
12.You are entitled to receive any distributable surplus inclusive of investment profit
(if any) at the end of each financial year. Together with other participants, you are entitled
to at least 50% of the surplus and PruBSN will receive the balance of up to 50% as
incentive for managing the Tabarru’ Fund. Your portion of the distributable surplus will be
placed back into your PUA. The exact amount of distributable surplus will be determined
annually and is subject to approval by both the Shariah Committee and the Board of
Directors of PruBSN.
Exclusions
HealthEnrich does not cover any hospitalisation, surgery or charges caused directly or
indirectly, wholly or partly, by any one of the following occurrences:
1. Pre-existing condition.
2. Specified illnesses during the first 120 days of cover.
3. Any medical or physical conditions arising within 30 days from the date of coverage or
date of reinstatement, except for accidental injuries.
4. Cosmetic surgery, circumcision, eye examination, glasses, lens, Lasik and the use of
prosthetic and medical devices.
5. Dental conditions including treatment or oral surgery to natural teeth except as
necessitated by accidental injuries.
6. Experimental surgery or elective procedures except as a result of accidental injury,
surgery or illness.
7. Bed rest, illegal drugs, intoxication, sterilisation, AIDS, HIV, all sexually transmitted
diseases requiring quarantine by law.
8. Any treatment or surgery for congenital conditions including hereditary conditions.
9. Treatments or procedures relating to pregnancy or childbirth and its complications,
prenatal or postnatal care except all those stated in certificate document and,
miscarriage, abortion, any contraceptive methods of birth control, treatments pertaining
to infertility or erectile dysfunction and impotence.
10.Routine medical examinations, hospitalisation solely for investigatory purposes/
diagnostic imaging not coincidental to treatment of covered disability or any treatments,
medicines or examinations deemed not medically necessary or preventive in nature and
treatments specifically for weight reduction or gain example sleeve gastrectomy.
11.Suicide, attempted suicide or self-inflicted bodily injury while sane or insane.
12.Any injury or illness caused by any act of war, any violation or attempted violation of the
law or to resist arrest, direct participation in riot, strike and civil commotion.
13.Ionising radiation or radioactive contamination from any nuclear fuel or waste from
nuclear fission or any nuclear materials.
14.Expenses incurred by donor or covered person for donation of any body organ and all
costs of organ acquisition and its complications.
15.Investigation and treatment of sleep and snoring disorders, treatment of abnormal
perspiration, therapy of hormone replacement, stem cells, hyperbaric oxygen therapy,
chiropodist consultation and treatment, chiropractic services, aromatherapy and any
form of alternative therapies.
16.Care or treatment for which payment is not required or to the extent which is payable
by other Takaful operators or indemnity covered under the Workman’s Compensation
Takaful Contract.
17.Psychiatric, mental or nervous disorders and those due to senile disorders.
18.Expenses of non-medical services including but not limited to television, telephone,
broadband, electricity bill, radio or admission kit except all those stated in certificate
document.
19.Sickness or injury arising from any kind of racing, hazardous sports, aerial flights except
as a crew member or a fare-paying passenger, or on a licensed passenger-carrying
commercial aircraft operating on a regular scheduled route.
20.Expenses incurred for sex changes or gender transformation.
21.Any insect bite including mosquito bites and worm infestation during the waiting period.
22.Charges which are not within Reasonable and Customary Charges or charges
incurred after the Expiry Date.
The exclusion and limitations above are not exhaustive and you should refer to the certificate
document for further information.
Appendix 1
List of Maternity Complications
1.
Disseminated Intravascular Coagulation
2.
Ectopic Pregnancy
3.
Hydatidiform Mole
4.
Postpartum Hemorrhage Requiring Hysterectomy
5.
Eclampsia
6.
Amniotic Fluid Embolism
7.
Pulmonary Embolism of Pregnancy
8.
Toxaemia of Pregnancy
Appendix 2
Annual Contribution Rates for HealthEnrich Select for Expiry Age 70.
Entry Age
Cost-sharing Options
Co-Takaful (RM)
Full Coverage (RM)
1 – 15
808
995
16
818
1,004
17
830
1,014
18
841
1,023
19
852
1,056
20
863
1,089
21
882
1,118
22
901
1,147
23
920
1,177
24
939
1,206
25
958
1,235
26
976
1,265
27
995
1,294
28
1,013
1,323
29
1,031
1,353
30
1,049
1,382
31
1,083
1,412
32
1,101
1,441
33
1,115
1,470
34
1,130
1,500
35
1,144
1,529
36
1,177
1,577
37
1,210
1,626
38
1,242
1,674
39
1,312
1,722
40
1,352
1,770
Entry Age
Cost-sharing Options
Co-Takaful (RM)
Full Coverage (RM)
41
1,396
1,829
42
1,446
1,887
43
1,516
1,946
44
1,585
2,005
45
1,654
2,063
46
1,742
2,182
47
1,828
2,302
48
1,963
2,421
49
1,988
2,540
50
2,057
2,660
51
2,125
2,710
52
2,193
2,760
53
2,261
2,810
54
2,329
2,860
55
2,396
2,910
56
2,480
3,001
57
2,564
3,093
58
2,646
3,185
59
2,730
3,276
60
2,812
3,368
The contribution rates are for a standard risk of occupation class 1 and 2. The contribution
rates for occupation class 3 and 4 are 1.25 and 1.5 times more than the contribution
rates for occupation class 1 and 2 respectively. The rates are subject to underwriting. Your
actual contribution amount shall depend on your age (based on Age Next Birthday), health
status, occupation class, plan type and duration of coverage. For HealthEnrich contribution
rates with other combinations of plan, expiry age and cost-sharing options please refer to
www.prubsn.com.my.
HealthEnrich is a Shariah-compliant product.
Prudential BSN Takaful Berhad is a registered Takaful Operator under
the Islamic Financial Services Act 2013 and is regulated by Bank Negara Malaysia.
For more information/enquiries, please contact:
PRUDENTIAL BSN TAKAFUL BERHAD (740651-H)
Level 8A, Menara Prudential, No. 10, Jalan Sultan Ismail, 50250 Kuala Lumpur.
Tel: (03) 2053 7188 Fax: (03) 2072 6188
E-mail: [email protected] SMS PruBSN and send to 33080
You can also log on to
www.prubsn.com.my
Important: You must ensure that you are satisfied that this product will best serve your needs
and that the contribution payable under the certificate is an amount you can afford.
All information is correct at the time of print.
Printed 1 November 2013

HealthEnrich - Prudential BSN Takaful

Transcription

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