Health - AGICMB Care - SMI

Notice : We have stop transacting Allianz General Insurance Co (M) Berhad insurance business effective 2012.

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Your Employees Health Care

Your employees are the main asset of your company. It is therefore very important that their welfare is well
taken care of.

All____ Care - SMI is designed to administer Employee Benefit plans for Small and Medium
Sized Industries of mainly 5 to 100 employees. As a provider of Medical Insurance, our utmost concern is to
protect and take care of your most valuable asset.

Benefits
Admission Assistance to Care Covered services are provided on a 24 Hours Admission Assistance basis
to the Insured Person.

Flexibility of Plan
Just select from the variety of plans available according to your needs. 24 Hours Toll Free Assistance. Just
call toll free No. 1-800-88-1138 if you have any enquires regarding the coverage purchased and for admission assistance.

Easy Administration
Leave the administration of your employee benefit to us and focus on your core business.

Plan Features
The All____ Care - SMI provides medical coverage together with health screening in a single comprehensive plan. It is
designed in this manner to suit you and your employee needs.

Medical Coverage
The plan provides comprehensive coverage for medical expenses incurred due to hospitalization.
You and your employees can be assured of quality care when it matters most.

Optional
Mediclinic Outpatient /Clinical Visitation Management Services Facilitates visitation to a wide spread of panel
clinics nationwide.
Comprehensive Health Screening
Subsidized Health Screening that helps in early detection rather than treating the disease itself.
Prevention is better than cure.


Medical Benefits TABLE
All Care - SMI
Medical Benefits TABLE
Plan 1
(RM)

 Plan 2
(RM)
 Plan 3
(RM)
 Plan 4
(RM)
Hospital Room & Board (max daily benefit)        
(a) Ordinary Room (up to 120 days max per disability)  350 200
150
80
         
(b) Intensive Care Unit (up to 20 days max per disability)
350
350 350
350
Hospital Supplies & Services As Charged
Surgical Fees As Charged
Operating Theater As Charged
In-Hospital Physician's Visit (up to 120 days max per disability) As Charged
Hospital Service Tax (on eligible Room & Board charges paid) 5%
 5% 5%
 5%
Pre-Hospital Diagnostic Tests (within 60 days)  As Charged
Pre-Hospital Specialist Consultation (within 60 days)   As Charged 
Second Surgical Opinion (60 days)  As Charged
Post-Hospitalization Treatment (up to 60 days)  As Charged
Emergency Accidental Outpatient Treatment
(within 24 hours up to 60 days)
 As Charged
Day-Care Procedure
 As Charged
Ambulance Fees
 As Charged
Daily-Cash Allowance at Government Hospital  200 150
100
80
Medical Report Fee Reimbursement (max per disability)  50 50
50
50
Overall Annual Limit
 70000  50000  30000  10000
Optional  
Mediclinic Outpatient /Clinical Visitation
Management Services
 As per Company's Instructions
Comprehensive Health Screening
Comprise of 44 Tests
 Cashless
Annual Premium Schedule  Plan 1
(RM)
Plan 2
(RM)
Plan 3
(RM)
Plan 4
(RM)
Employee only
580 
456
342 247
Employee & Spouse  1,449 1,140
856 
618 
Employee & Children
 1449 1,140
856 
618
Employee & Family  2,318 1,825
1,369
988
         


   Annual MCO Fees Schedule










Optional


RM


MCO Fees for combined Outpatient/Clinical Visitation Management Services and Hospitalization
Annual Fee Per Employee/Dependent



48


Comprehensive Health Screening
Annual Fee Per Employee/Dependent



110














                                                                                                                                                                                                          

Exclusions - Hospitalisation


This contract does not cover any hospitalization, surgery or charges caused directly or indirectly, wholly or partly,
by any one of the following occurrences:


   Specified Illness occurring during the first one hundred and twenty (120) days of continuous cover.
    Any medical or physical conditions arising within the first thirty (30) days of the Insured Person’s cover or date         
     reinstatement whichever is latest except for Accidental Injuries
    Plastic/cosmetic surgery, circumcision, eye examination, glasses and refraction
    or surgical correction of 
nearsightedness (Radial Keratotomy or Lasik) and the     
    use or acquisition of external prosthetic appliances or
 devices such as artificial
    limbs, hearing aids, implanted pacemakers and prescriptions thereof. 
                                       
    
    Dental conditions including dental treatment or oral surgery except as necessitated by Accidental Injuries to
     sound natural teeth occurring wholly during the Period of Insurance.
    Private nursing, rest cures or sanitaria care, illegal drugs, intoxication, sterilization, venereal disease and its         
     sequelae, AIDS (Acquired Immune Deficiency Syndrome) or ARC (AIDS Related Complex) and HIV related
     diseases, and any communinicable diseases required quarantine by law.
    Any treatment or surgical operation for congenital abnormalities or deformities including hereditary conditions.
    Pregnancy, child birth (including surgical delivery), miscarriage, abortion and prenatal or postnatal care and                
    
surgical, mechanical or chemical contraceptive methods of birth control or treatment pertaining to infertility.
     Erectile dysfunction and tests or treatment related to impotence or sterilization.

    Hospitalization primarily for investigatory purposes, diagnosis, X-ray examination, general physical or medical        
     examinations, not incidental to treatment or diagnosis of a covered Disability or any treatment which is not                            
    Medically Necessary and any preventive treatments, preventive medicines or examinations carried out by a                 
    Physician, and treatments specifically for weight reduction or gain.
    Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.
    War or any act of war, declared or undeclared, criminal or terrorist activities, active duty in any armed forces,
     direct participation in strikes, riots and civil commotion or insurrection.
    Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of
     nuclear fission or from any nuclear weapons material.

    Expenses incurred for donation of any body organ by an Insured Person and costs of acquisition of the organ
     including all costs incurred by the donor during organ transplant and its complication.
    Investigation and treatment of sleep and snoring disorders, hormone replacement therapy and alternative therapy        
    
such as treatment, medical service or supplies, including but not limited to chiropractic services, acupuncture,                     
     acupressure, reflexology, bone setting, herbalist treatment, massage or aroma therapy or other alternative
     treatment,

    Care or treatment for which payment is not required or to the extent which is payable by any other insurance or
     indemnity covering the Insured and Disabilities arising out of duties of employment or profession that is covered
     under a Workman’s Compensation Insurance Contract.
    Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic                    
     manifestations).
    Costs/expenses of services of a non-medical nature, such as television, telephones, telex services, radios or
     similar facilities, admission kit/pack and other ineligible non-medical items.
    Sickness or Injury arising from racing of any kind (except foot racing), hazardous sports such as but not limited to
     skydiving, water skiing, underwater activities requiring breathing apparatus, winter sports, professional sports and
     illegal activities.

    Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry
     passengers over established routes.
    Expenses incurred for sex changes.
    Terrorism.



Special Condition - Medical



    In the event of any inconsistency in this brochure, the English version of 
    this brochure shall prevail over all
   other versions.                                                                                                                                                                                             

It may not be advantageous to switch from one health Policy to another, as  you may be subjected to new underwriting requirements for waiting period/ exclusion of specified illness/pre-existing conditions of the new Policy.

Please note that for any disability arising out of injury during employment, whereby the Insured has received benefits under Workmen’s Compensation Ordinance, SOCSO or similar legislation, the Insurer shall bear no charges unless benefits received do not fully cover incurred charges, which are covered under the Policy.

Please note that if an Insured has received other medical insurance or government plans, the Insurer shall bear no charges unless benefits received do not fully cover incurred charges, which are covered under the Policy.

Please note that the exclusions, limitations, terms and conditions as stated in this proposal are not exhaustive. 
Please refer to the actual Policy Contract for detailed benefits, exclusions, limitations, terms and conditions.

The information enclosed is accurate as at the date of print.

You are to ascertain that this product will best serve the needs of your company’s employees and that you are agreeable to the premium payable under the Policy.

You should ensure that important information regarding the Policy is disclosed to you and that you understand the information disclosed. Where there is ambiguity, you should seek clarification from the Insurer.

       
Exclusions – Outpatient GP and Outpatient Specialist Care
      

Members cannot purchase or acquire all types of external and internal appliances or devices (i.e. wheelchairs,
implants, hearing aids, walking aids and etc.                           

Dental conditions including dental treatment or surgery except as a result of an accident.

Plastic/cosmetic consultation and surgery including eye examination, glasses, refractive errors of the eyes and its
correction.

Hormone replacement therapy(s) which is not medically necessary.

Alternative therapies (i.e. acupuncture chiropractic, reflexology and etc).

Surgical, mechanical or chemical contraceptive methods.

   Sexual dysfunction, sex transformation whether by surgical or chemical.

   Sexually transmitted diseases and its sequelae, AIDS or HIV and its related complications.

    Pregnancy, childbirth (including delivery), pre-natal, post-natal care, abortion, infertility and miscarriage.

    Suicide, attempted suicide, self inflicted injury or overdose of any kind intentional or otherwise while sane or    
    insane.

    Routine or health check-ups including gynaecology check-ups.

    Outpatient physical or physiotherapy.

    Speech and occupational therapy.

    Treatment for congenital abnormalities, deformities and disabilities.

    Vitamins, food supplements, preventive medicine which is not Medically Necessary, herbal cures, weight       
    deduction or induction agents.

    Soaps, shampoos or any toiletries items.

    Treatment injuries sustained while under the influence of alcohol or narcotics or whilst in participation in any    
    illegal or dangerous activities.

    Allergy testing.

    Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic       
    manifestations).

    House calls by doctors for any reason.

    Purchase of treatment by rehabilitation drugs (i.e. smoking patches and etc).

    Facial or treatment for Acne.

    Dispense of member’s current medication for a period of more than two (2) weeks except for member with  
    chronic conditions e.g. diabetes, hypertension, etc where one (1) month supply is allowed.

    Treatment/dispense of medication which are not consistent with diagnosis.

Exclusions – Group SMI All____ Care


War, invasion, act of foreign enemy, hostilities (whether declared or not), civil war, rebellion, revolution, insurrection,
mutiny or usurped power, military or popular uprising.

Insanity, suicide (whether sane or insane), intentional self-inflicted injuries or any attempt thereat.

Any form of disease, infection or parasites and AIDS or AIDS Related Complex (ARC) or HIV.

Childbirth, miscarriage, pregnancy or any complications thereof.

Provoked murder or assault.

Intoxication by alcohol or drugs.

While travelling in an aircraft as a member of the crew, except only as a fare-paying passenger in an aircraft licensed
for passenger service.

While committing or attempting to commit any unlawful act.

While participating in any professional sports.

Martial arts or boxing, aerial activities including parachuting and hang-gliding, underwater activities exceeding fifty
(
50) metres in depth, mountaineering involving the use of ropes or mechanical guides.

Racing (other than on foot), pace-making, speed or reliability trials.

Riding/driving without a valid driving licence.

Death or disablement or any other loss consequent upon the Insured Person involved in any of the occupations
mentioned under Excluded occupations.occupations mentioned under Excluded occupations.

Terrorism.

Cooling-Off Period
If this Policy shall have been issued and for any reason whatsoever the Insured Person shall decide not to take up the
Policy, the Insured Person may return the Policy to the Company for cancellation provided such request for cancellation is delivered by the Insured Person to the Company within fifteen (
15) days from the date of delivery of the Policy. The Insured Person is entitled to the return of the full premium paid less deduction of medical expenses incurred by the Company in the issue of the Policy.


CLAIMS: HOSPITAL AND SURGICAL INSURANCE (exclude Europe Assist cases)
1. Original medical bills / Official receipt
2. Completed claim form





 

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I would like to use third party illustration cause they are no advertising and commercial interest with SIMON POON AGENCY as we are not Health Practitioners. USA is a highly litigitious country in the world so that I use them as benchmark for health care reference.  Nov 29, 2009, 11:57 AM Simon Poon
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AllianzCare SMI_ProposalForm_P.Health for group of employees of 5 to unlimited number of person. 20 employees above might not need to declare their health condition by company.  1289k v. 4 Nov 29, 2009, 8:19 AM Simon Poon
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AllianzCare SMI_Proposal Form_P.Health Declaration for group of employees of 5 to 20 person. 20 employees above might not need to declare their health condition by company.  Nov 29, 2009, 8:14 AM Simon Poon
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Credit Card Payment Instruction can fax to us at 03-7785 3699 or call us at 016 2348808  Nov 29, 2009, 8:14 AM Simon Poon
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STATEMENT OF CLAIM For Group Hospital, Surgical and Medical Benefits  Feb 10, 2012, 9:41 PM Simon Poon
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Allianz Care SMI_ProposalForm_P.Health for group of employees of 5 to unlimited number of person. 20 employees above might not need to declare their health condition by company.  Nov 29, 2009, 8:13 AM Simon Poon
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Allianz General Health Care Panel Hospital for admission. Updated 2009 11 30.  Nov 29, 2009, 10:50 AM Simon Poon
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Policy wording that spells the terms and condition, limitations,exclusions and do and don't and claim procedures.  1981k v. 5 Jan 31, 2012, 9:45 AM Simon Poon
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