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HOSPITAL ROOM & BOARD - Reimbursement
of the room accommodation and meals during confinement in
a hospital as an in-patient.
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INTENSIVE CARE UNIT -
Reimbursement of the actual room and board incurred during
confinement as an in-patient in the Intensive Care Unit of
the Hospital.
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SURGICAL FEES -
Reimbursement of the charges for a surgery by the Specialists,
pre-surgical assessment, Specialist's visits and post-surgery
care from the date of surgery.
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OPERATING THEATRE -
Reimbursement of operating room charges incidental to the
surgical procedure.
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ANAESTHETIST FEE -
Reimbursement of fees charged by the Anaesthetist for the
administration of anaesthesia.
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PRE-HOSPITAL DIAGNOSTIC
TESTS - Reimbursement of fees charged for ECG, x-ray
and laboratory examinations recommended by a qualified
medical practitioner for the determination of an illness
or injury. Medications and consultation charged by the
medical practitioner will not be payable.
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PRE-HOSPITAL SPECIALIST
CONSULTATION - Reimbursement of the first consultation
fees charged by a Specialist in connection with a Disability
and provided that such consultation has been recommended
in writing by the attending general practitioner. Payment
will not be made for clinical treatment (including medications
and subsequent consultation after the illness is diagnosed).
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IN-HOSPITAL PHYSICIAN
VISIT - Reimbursement of fees charged by the attending
physician for visiting an in-paying patient while confined
for a non-surgical Disability, subject to a maximum of
1 visit per day.
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POST-HOSPITALIZATION
TREATMENT - Reimbursement of charges for follow-up
treatments following discharge from a hospital for a non-surgical
confinement administered by the same physician.
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HOSPITAL SUPPLIES & SERVICES -
Reimbursement of charges made by the Hospital for general
nursing, dressings, splints, plaster casts, x-ray, laboratory
examinations, electrocardiograms, physiotherapy, basal metabolism
tests, intravenous injections and solutions, administration
of blood and blood plasma but excluding the cost of blood
and plasma.
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PRESCRIBED MEDICINES -
Reimbursement of charges for medicines that are dispensed
by a Physician, a Registered Pharmacist or a Hospital and
which have been prescribed by a Physician or Specialist in
respect of treatment for a covered Disability during in-patient
stay and following hospitalization.
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AMBULANCE FEES -
Reimbursement for necessary domestic ambulance services (inclusive
of attendant) to and/or from the Hospital of confinement.
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ANNUAL OUT-PATIENT KIDNEY
DIALYSIS TREATMENT - Reimbursement of the charges incurred
for out-patient kidney dialysis treatment which performed
in a Hospital or registered dialysis treatment centre for
end stage chronic kidney failure. Benefit will not be payable
for any Insured Person who has developed chronic renal
diseases and/or is receiving dialysis treatment prior to
the effective date of Insurance.
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ANNUAL OUT-PATIENT CANCER
TREATMENT - Reimbursement of the charges incurred for
out-patient cancer treatment in a hospital or registered
cancer treatment centre.
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EMERGENCY ACCIDENTAL & DENTAL
OUT-PATIENT TREATMENT - Reimbursement of expenses incurred
as a result of a bodily injury/to sound natural teeth arising
from an ACCIDENT for treatment as an out-patient at any
registered clinic or hospital within 24 hours.
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OUT-PATIENT PHYSIOTHERAPY
TREATMENT - Reimbursement of the expenses for out-patient
physiotherapy treatment which is recommended in writing
by attending physician or surgeon.
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ORGAN TRANSPLANT -
Reimbursement of charges incurred on transplantation surgery
for the Insured Person being the recipient of the transplant
of a kidney, heart, lung, liver or bone marrow. Payment for
this benefit is applicable only once per lifetime. The costs
of acquisition of the organs and all costs incurred by the
donors are not covered.
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DAILY-CASH ALLOWANCE
AT GOVERNMENT HOSPITAL - Pays a daily allowance for
each complete day of confinement for a covered Disability
in a Malaysian Government Hospital provided confinement
in a Room and Board rate that does not exceed the plan
chosen.
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MEDICAL REPORT -
Reimbursement of expenses for pursuing the medical report.
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SECOND SURGICAL OPINIONS -
Reimbursement of the consultation fees with a second Specialist
to determine necessity of a surgical operation.
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GOVERNMENT SERVICE TAX -
Reimbursement of the charges imposed by the Malaysian government
for service tax levied on Hospital Room & Board charges.
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ACQUIRED IMMUNE DEFICIENCY
SYNDROME (AIDS) - Upon diagnosis of AIDS, this benefit
shall be paid in full sum and only once during the Insured
Person lifetime.
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HOME NURSING - Reimbursement
of charges for home nursing care plan established and periodically
reviewed by a registered medical practitioner and is only
payable after a minimum of 3 days hospitalization beginning
within 7 days of hospital discharge.
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FEMALE CANCER -
A lump sum payment as stated in the Schedule of Benefit shall
be payable once during the Insured Person lifetime upon diagnosis
of a Female Cancer.
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ACCIDENTAL FACIAL /
DENTAL COSMETIC - Reimbursement for a necessary treatment
or reconstructive surgery of facial and neck disfigurement
or damage to sound natural teeth following injuries sustained
as a result of accident. This benefit shall be paid in
full sum and only once during the Insured Person lifetime.
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PREGNANCY COMPLICATIONS -
Reimbursement of expenses incurred for treatment arising
from the following pregnancy complications: disseminated
intravascular coagulation, ectopic pregnancy, still birth
and hydatidiform mole (molar pregnancy). In the event of
maternal mortality (death) following Pregnancy Complications,
aggregate sum payable for pregnancy complications and maternal
mortality shall not exceed the Maternity Death benefit.
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MATERNITY DEATH -
A lump sum payment upon death directly caused by a pregnancy
disorder or complications arising within 30 days from childbirth
or miscarriage. In the event of maternal mortality (death)
following pregnancy complications, the sum payable shall
be balance after deducting the accelerated amount reimbursed
for Pregnancy Complications.
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DOUBLE OVERALL ANNUAL
LIMIT FOR ACCIDENTAL INJURY WHILST TRAVELING OVERSEAS -
Overall Annual Limit is doubled in the event of Accidental
Injury while traveling outside of Malaysia, subject only
to the Lifetime Limit whichever is lower.
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MAJOR MEDICAL -
Increase of annual benefit limits on top of the Overall Annual
Limit if the Insured Person suffers from one of the Major
Disability (Stroke or Cerebrovascular Accident, Heart Attack,
Kidney Failure, Cancer, Coronary Artery Disease Requiring
By-Pass, Chronic Liver Disease, Fulminant Viral Hepatitis,
Coma, Paralysis/Paraplegia, Major Burns, Chronic Lung Disease,
Encephalitis, Major Organ Transplant, Brain Surgery, Heart
Valve Replacement, Multiple Sclerosis, Open Heart Surgery,
Total Blindness, Total Loss of Hearing/Deafness, Bacterial
Meningitis). Major Medical is subject to the Lifetime Limit.
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ACCIDENTAL DEATH / BEREAVEMENT
BENEFIT ON ACCIDENTAL DEATH ONLY - A lump sum payment
shall be payable to legal representative or next of kin,
when injury results in loss of life of the Insured Person,
provided death occurring within twelve (12) months from
the date of accident.
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PERMANENT TOTAL DISABLEMENT
DUE TO ACCIDENTAL INJURY - A lump sum payment shall
be payable, when Accidental Injury is sustained by an Insured
Person resulting in permanent total disablement, total
paralysis or permanently bedridden.
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OUT-PATIENT GP CARE -
Reimbursement of charges for general practitioner (GP) consultation
during normal clinical hours including basic medications
and treatment for an illness or injury as an out-patient.
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OUT-PATIENT SPECIALIST
CARE - Reimbursement of charges for specialist consultation
(SP) during normal clinical hours including basic medications
and treatment for an illness or injury as an out-patient
with a Panel Doctor's referral.
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PREVENTIVE SCREENING
(PAP SMEAR / PROSTATE SPECIFIC ANTIGEN) - Reimbursement
of fees charged for an annual pap smear examination or
prostate specific antigen (PSA) test performed by a Panel
Doctor.
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