KlinikGUARD



POLICY DETAILS
Introduction
Benefits / Plan Coverage
Exclusions
How To Buy

INTRODUCTION
 
The rising cost of medication and treatment significantly affects companies and business owners. A full range of healthcare insurance that includes Out-Patient Clinical (OPC) coverage are a necessity. In response to the prevailing healthcare needs, Kurnia Insurans (M) Berhad (KIMB) is proud to introduce its Out-Patient Clinical insurance, klinikGUARD.
 
Objective
To make available a full range of healthcare insurance products for the needs of Corporations.
To provide convenience to Corporations via an extensive network of panel Clinics and panel Hospitals.
To ease the staff healthcare administrative work of Corporations.
To enforce staff healthcare cost containment for Corporations.
 
Advantage
Value for money and competitively priced.
Availability of detailed Utilization Reports with multiple information which are user friendly.
Taking care of the Non Core staff healthcare administrative work from the HR Department.
Free access to Medical Insurance / Healthcare technical and professional information and advices.
OPC compliments In-Patient Group Hospital & Surgical Scheme.
Policy Benefits can be tailored made to suit the needs of each client e.g. Pap Smear, Prostate Specific Antigen.
Annual Premium per Member starts from RM268.00.*

* Subject to terms & conditions and numbers of the staff group size.



POLICY DETAILS
Introduction
Manfaat / Jenis Plan Perlindungan
Pengecualian
Cara Permohonan 


PENDAHALUAN
 
Kenaikan kos ubat-ubatan dan rawatan ketara memberi kesan kepada syarikat-syarikat dan pemilik perniagaan. Pelbagai jenis insurans liputan penjagaan kesihatan yang termasuk Klinikal Pesakit Luar (OPC) adalah satu keperluan. Demi kepentingan atas keperluan penjagaan kesihatan semasa, Kurnia Insurans (M) Berhad (KIMB) adalah bangga untuk memperkenalkan insurans Pesakit Luar Klinikal, klinikGUARD.
 
Objektif
Untuk menyediakan rangkaian penuh produk insurans penjagaan kesihatan untuk keperluan Perbadanan.
Untuk menyediakan kemudahan kepada syarikat melalui rangkaian Panel Klinik dan Hospital panel yang luas .
Untuk meringankan kerja kakitangan penjagaan kesihatan pentadbiran Perbadanan.
Untuk menguatkuasakan peruntukan kos penjagaan kesihatan kakitangan Perbadanan.
 
Kelebihan
Nilai untuk PREMIUM dan harga yang kompetitif.
Ketersediaan Laporan Penggunaan terperinci dengan maklumat berganda yang MEMUDAHKAN pengguna.
Mengendali urusan kerja "Kurang Penting" penjagaan kesihatan kakitangan pentadbiran dari Jabatan Sumber Manusia.
Akses percuma ke Kesihatan, Insurans Perubatan / maklumat teknikal dan nasihat profesional .
Manfaat tambahan OPC Pesakit Hospital Skim Kumpulan & Pembedahan.
Manfaat Polisi boleh diubahsuai untuk  keperluan setiap pelanggan, misalnya Pap Smear, Prostat Specific Antigen.
Premium Tahunan setiap Ahli bermula dari  RM268.00.*

* Tertakluk kepada terma & syarat-syarat dan jumlah pekerjayang terlibat.


BENEFITS / PLAN COVERAGE
 
Out-Patient Without Specialist
Standard RateOption 1Option 2
Co-PaymentRM5-
Out-Patient GP CareYesYes
Out-Patient SP CareNoNo
Overall Annual Limit Per Person (RM)15001500
Premium starts from (RM)268303
 
Out-Patient With Specialist
Standard RateOption 1Option 2
Co-PaymentRM5-
Out-Patient GP CareYesYes
Out-Patient SP CareYesYes
Overall Annual Limit Per Person (RM)15001500
Premium starts from (RM)313348
 
Note: On condition Group Hospital & Surgical (GHS) is also to be insured with KIMB.
 
GP = General Practitioner
SP = Specialist


Non Panel Utilization
Any utilization of health services outside the Company's network panel of clinics would be on reimbursement basis up to a maximum of 80% of the actual charges or RM20 whichever is lower and is limited to "emergency" situations only except for Accidental Injury.


EXCLUSIONS
 
This policy does not cover any loss damage liability or costs directly caused by or contributed to or arising out of or in consequence of:
 
1.
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, aero chambers, equipment from nebulising, implanted pacemakers and prescriptions thereof.
  
2.
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.
  
3.
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 communicable diseases required quarantine by law.
  
4.
Any treatment or surgical operations for congenital abnormalities of deformities including hereditary conditions.
  
5.
Pregnancy, child birth (including surgical delivery), miscarriage, abortion, 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.
  
6.
Consultation 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.
  
7.
Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.
  
8.
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.
  
9.
Ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material.
  
10.
Investigation and treatment of sleep and snoring disorders, hormone replacement therapy and alternative therapy such as treatment, medical services or supplies, including but not limited to chiropractic services, acupuncture, acupressure, reflexology, bonesetting, herbalist treatment, massage or aroma therapy or other alternative treatment.
  
11.
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 Person and Disabilities arising out of duties of employment or profession that is covered under a Workman’s Compensation Insurance Contract.
  
12.
Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations.)
  
13.
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.
  
14.
Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes.
  
15.
Long term medications for the following conditions are excluded: Arthritis, Asthma, High Blood Pressure, Coronary Artery Disease, Cerebrovascular Disease, Cerebrovascular Accident, Diabetes Mellitus, Epilepsy, Gout, Hyperlipidemia, Parkinson, Peptic Ulcer, Psoriasis and Thyroid.
  
16.
Personal comfort and convenience items (e.g. soaps, shampoos, vitamin creams and vitamin ointment) or services and similar incidental services and supplies, durable medical equipment including supplement medication even  though prescribed by a physician.
  
17.
Upper and lower jaw bone surgery (including that related to  the temporomandibular joint) except for direct treatment of acute traumatic injury or cancer. Orthognathic surgery, jaw alignment, or treatment for the temporomandibular joint.
  
18.
Services and supplies for smoking cessation programs and the treatment of nicotine addiction.
  
19.
Services rendered by a provider with the same legal residence as an Insured Person or who is a member of a Insured Person’s family, including spouse, brother, sister, parent or child.
  
20.
Education services such as speech improvement, diabetic classes and nutritional services, or group support services, unless authorized by the Company.
  
21.
Out-Patient prescribed or non-prescribed medical supplies including elastic stockings, ace bandages, gauze, syringes, diabetic test strips, and like products; over the counter drugs and treatments.
  
22.
Any preventive vaccination or childhood immunization (unless specifically included in the Schedule of Benefit).
  
23.
Topical skin testing at GP Clinic.
  
24.
General screening profiles at a GP clinic (unless specifically included in the Schedule of Benefit).
  
25.
Growth hormone therapy.
  
26.
Out-Patient physical therapy, physiotherapy and/or rehabilitation therapy is not covered and cannot be referred at general practitioner level. This service would only be covered when referred by a specialist and treatment must be provided by a registered physiotherapist. (applicable if specialist care is covered).



NameAddressContact No.Fax No.
Ampang Puteri Specialist Hospital1, Jalan Mamanda 9, Taman Dato Ahmad Razali, 68000 Ampang, Selangor03 4270 250003 4270 2443
An-Nur Specialist HospitalNo. 14 & 16, Medan PB1, Seksyen 9, 43650 Bandar Baru Bangi, Selangor03 8926 606003 8926 6067
Apollo Medical Centre271, Jalan Taming Sari, 34000 Taiping, Perak05 805 600005 807 6000
Arunamari Specialist Medical Centre162A, Jalan Batu Unjur 1, Bayu Perdana, 41200 Klang, Selangor03 3324 328803 3324 3218
Assunta HospitalJalan Templer, 46990 Petaling Jaya, Selangor03 7680 700003 7781 4933
Bagan Specialist CentreJalan Bagan 1, 13400 Butterworth, Penang04 332 280004 331 2806
Columbia Asia Medical Center292, Jalan Haruan 2, Oakland Commercial Center, 70300 Seremban06 601 198806 601 1848
Damai Service Hospital115-119, Jalan Ipoh, 51200 Kuala Lumpur03 4043 490003 4043 5399
Damai Specialist CentreLorong Pokok Tepus 1, Off Jalan Damai, 88300 Kota Kinabalu, Sabah088 222 922088 243 540
Damansara Specialist Hospital119, Jalan SS20/10, Damansara Utama, 47400 Petaling Jaya, Selangor03 7722 269203 7722 2617
NameAddressContact No.Fax No.
Hope Children Hospital25B, C&D, Jalan Gottlieb, 10350 Penang04 228 655704 228 6559
Hope Children Hospital26A, 28A Bintang Paya Terubong 3, 11060 Penang04 829 792604 829 7982
Hope Children Hospital66 & 68, Jalan Dato' Ismail Hashim, Sg Ara, 11900 Bayan Lepas, Penang04 644 755704 646 1559
Hospital Fatimah25B, Jalan Datuk Lau Pak Khuan, Ipoh Garden, 31400 Ipoh, Perak05 545 577705 549 9237
Hospital Lam Wah Ee141, Jalan Tan Sri Teh Ewe Lim, 11600 Penang04 657 188804 657 0940
Hospital Pantai Ayer Keroh2418-1, KM8, Lebuh Ayer Keroh, 75450 Melaka06 231 999906 231 3299
Hospital Pantai Batu Pahat9S, Jalan Bintang Satu, Taman Koperasi Bahagia, 83000 Batu Pahat, Johor07 433 881107 433 1881
Hospital Pantai IndahJalan Perubatan 1, Pandan Indah, 55100 Kuala Lumpur03 4289 282803 4289 2829
Hospital Pantai Mutiara82, Jalan Tengah, Bayan Baru, 11900 Bayan Lepas, Penang04 643 388804 643 2888
Hospital Pantai Putri126, Jalan Tambun, 31400 Ipoh, Perak05 548 433305 545 1163
NameAddressContact No.Fax No.
Hospital PenawarNo 16-18, Pusat Perniagaan Pasir Gudang, 81700 Pasir Gudang, Johor07 252 180007 251 8199
Hospital PusrawiLot 149, Jalan Tun Razak, 40500 Kuala Lumpur03 2687 500003 2687 5001
Institute Jantung Negara145, Jalan Tun Razak, 50400 Kuala Lumpur03 2617 820003 2698 2824
Island Hospital308, Macalister Road, 10450 Penang04 228 822204 226 7989
Johor Specialist Hospital39-B, Jalan Abdul Samad, 80100 Johor Bahru, Johor07 225 300007 224 8213
Kedah Medical Centre175, Jalan Pumpong, Mukim Alor Merah, 05250 Alor Setar, Kedah04 730 887804 733 2869
Kota Bharu Medical CentrePT 179-184, Jalan Sultan Yahya Petra Lundang, 15200 Kota Bahru, Kelantan09 743 339909 743 3800
KPJ Ipoh Specialist Hospital26, Jalan Raja Dihilir, 30350 Ipoh, Perak05 241 877705 254 1388
KPJ Kajang Specialist HospitalJalan Cheras, 43000 Kajang, Selangor03 8769 299903 8769 2808
KPJ Kuching Specialist HospitalLot 10420, Block 11, Tabuan Stutong Commercial Centre, Jalan Setia Raja, 93350 Kuching, Sarawak082 365 777082 364 666
NameAddressContact No.Fax No.
KPJ Penang Specialist Hospital570, Jalan Perda Utama, Bandar Perda, 14000 Bukit Mertajam, Seberang Perai04 548 668804 548 6791
KPJ Perdana Specialist HospitalPT 37 & 600, Seksyen 14, Jalan Bayam, 15200 Kota Bahru, Kelantan09 745 800009 747 2877
KPJ Selangor Specialist HospitalLot 1, Jalan Singa 20/1, Section 20, 40300 Shah Alam, Selangor03 5543 111103 5543 1722
KPJ Seremban Specialist HospitalLot 6219 & 6220, Jalan Toman 1, Kemayan Square, 70200 Seremban06 797 780006 767 5900
KPJ Tawakkal Specialist HospitalNo. 1, Jalan Pahang Barat, 53000 Kuala Lumpur03 4026 777703 4021 0635
Kuala Terengganu Specialist HospitalNo. 443-B, Jalan Kamaruddin, 20400 Kuala Terengganu, Terengganu09 624 535309 626 5211
Kuantan Specialist Hospital51, Jalan Alor Akar, Taman Kuantan, 25250 Kuantan, Pahang09 567 858809 567 8098
Loh Guan Lye Specialist Centre19 & 21, Logan Road, 10400 Penang04 238 888804 238 8983
Mahkota Medical Centre3, Mahkota Melaka, Jalan Merdeka, 75000 Melaka06 281 333306 281 0560
Medical Specialist CentreWisma Maria, Jalan Ngee Heng, 80100 Johor Bahru, Johor07 224 388807 223 6785
NameAddressContact No.Fax No.
Metro Specialist Hospital1, Lorong Metro, 08000 Sungai Petani, Kedah04 423 888804 423 4848
Miri City Medical CentreLot 916 - 920 & 1203, Jalan Hokkien CDT 100, 98009 Miri, Sarawak085 426 622085 438 096
N.S. Chinese Maternity HospitalJalan Tun Dr, Ismail, 70200 Seremban, Negeri Sembilan06 762 210406 762 2511
Normah Medical Specialist CentreLot 937, Section 30 KTLD, Jalan Tun Datuk Patinggi Hj Abd Rahman Yakub, 93050 Petra Jaya, Kuching, Sarawak082 440 055082 443 787
Pantai Cheras Medical Centre1, Jalan 1/96A, Taman Cheras Makmur, 56100 Kuala Lumpur03 9132 202203 9133 0687
Pantai Hospital Sungai Petani Sdn Bhd1, Persiaran Cempaka, Bandar Aman Jaya, 08000 Sg Petani, Kedah04 442 888804 442 8889
Pantai Klang Specialist HospitalLot 5921, Persiaran Raja Muda Musa, 41200 Klang, Selangor03 3374 202003 3374 2010
Pantai Medical Centre8, Jalan Bukit Pantai, 59100 Kuala Lumpur03 2296 088803 2282 1557
Penang Adventist Hospital465, Burma Road, 10350 Penang04 222 720004 226 3366
Perak Community Specialist Hospital227, Kampar Road, 30250 Ipoh, Perak05 254 891805 255 4288
NameAddressContact No.Fax No.
Prince Count Medical Centre39, Jalan Kia Peng, 50450 Kuala Lumpur03-2160 000003-2782 3377
Pusat Pakar Kluang Utama1, Susur 1, Jalan Besar, 86000 Kluang, Johor07 771 899907 772 8999
Pusat Rawatan Islam Az-ZahrahNo 34, Medan Pusat Bandar 1, Seksyen 9, 43650 Bandar Baru Bangi, Selangor03 8921 252503 8921 2689
Puteri Specialist Hospital33, Jalan Tun Abdul Razak (Susur 5), 80000 Johor Bahru, Johor07 225 322207 222 6961
Putra Medical Centre888, Jalan Sekerat, Off Jalan Putra, 05100 Alor Setar, Kedah04 734 288804 734 8882
Rejang Specialist Hospital70, Pusat Pedada, Jalan Pedada, 96000 Sibu, Sarawak084 330 733084 327 342
Sabah Medical CentreLorong Bersatu, Off Jalan Damai, Luyang, 88300 Kota Kinabalu, Sabah088 211 333088 272 622
Sibu Specialist Medical Centre52A-F, Brooke Drive, 96000 Sibu, Sarawak084 218 800084 329 900
Sime Darby Medical Centre Subang Jaya1, Jalan SS12/1A, Subang Jaya, 47500 Petaling Jaya, Selangor03 5639 121203 5632 6075
Sri Kota Medical CentreJalan Mohet, 41000 Klang, Selangor03 3373 363603 3373 6888


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