pss primemediplus
TRANSCRIPT
Prime MediPlus Rider
(PMP)
Contents Page Features 1 Benefits 1 Underwriting Guidelines 4 Servicing Guidelines 5 Claim Guidelines 6
Disclaimer Notice: For internal staff and agent training only. This document is not a sales material and cannot be used for circulation to prospects. It serves only as a training guide to the agent in the selling concept of the products mentioned. In the actual selling process, the customer’s needs, affordability and preference must be considered to deliver fair value to the customer. The detailed product benefits and cost must be explained to help customers make informed decisions. Only ING authorized sales materials are to be used when prospecting.
ING Product Development Launch Date: 10 June 2010 Prime MediPlus Rider – PSS
Prime MediPlus Rider (PMP) FEATURES Prime MediPlus Rider is a unit-deducting investment-linked hospitalization and surgical rider covering Hospitalization & Surgical Expenses and Out of Hospital Benefit for the remaining period of this rider term or until the death of the life assured, whichever is earlier. It is generally a reimbursement scheme subject to benefit limit, overall annual limit and lifetime limit. There are 3 plans that insured can choose from. Both cashless and non-cashless facilities are offered under this rider. This rider is allowed to be attached to a regular premium investment-linked insurance plan i.e. ING Prime Life Insurance (IPLI) and ING Prime EduLife (IPEL). The insurance charges for the rider will be deducted monthly by cancelling units from the investment funds. BENEFITS (i) In the event that life insured is hospitalised and/or receives medical treatment as a result of
illness, disease or injury occurring after the below defined time period, the Company shall pay
the benefits according to the Schedule of Benefits below:
PLAN
DESCRIPTION PMP1 (RM)
PMP2 (RM)
PMP3 (RM)
Hospitalisation and Surgical Benefits
(a) Hospital Room and Board (daily limit)
120
180
260
(b) Intensive Care Unit
(The total period of confinement for the Hospital Room and Board and / or Intensive Care Unit (ICU) benefit is limited to a maximum of 60 days per Disability and 180 days per Policy Year)
(c) Surgical Expenses (Surgical fees, Anaesthetist fee and Operating Theatre charges) including post surgical care up to 60 days from date of discharge
(d) Hospital Expenses
(e) Pre-Surgical / Medical Specialist Consultation (Includes fees incurred for consultation within 31 days prior to hospital admission or Day Surgery)
(f) Pre-Surgical / Medical Diagnostic Tests
As charged
Subject to 10% co-insurance per Disability
(However, if the co-insurance amount is less than RM300, the minimum co-insurance payable shall be RM300 per disability with the maximum
not exceeding RM1,000)
(g) Daily Cash Allowance at a Malaysian Government Hospital (maximum 60 days per Disability)
50 50 50
Out of Hospital Benefits
(h) Day Surgery and Day Surgery follow-up up to 60 days from the date of discharge or Day Surgery
As charged (not subject to co-insurance)
(i) Post Hospitalisation up to 60 days from date of discharge
As charged
Subject to 10% co-insurance per Disability (However, if the co-insurance amount is less
than RM300, the minimum co-insurance payable shall be RM300 per disability with the maximum
not exceeding RM1,000)
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For internal staff and agent training only. Only ING authorized sales materials are to be used when prospecting. Please refer to Disclaimer Notice on the first page of this document.
2
PLAN
DESCRIPTION PMP1 (RM)
PMP2 (RM)
PMP3 (RM)
(j) Out-patient Cancer Treatment
(k) Out-patient Kidney Dialysis Treatment
(l) Emergency Accidental Out-patient Treatment (up to 31 days from date of Accident)
As charged subject to 10% co-insurance per visit
(m) Home Nursing Care (per Disability) 500 1,000 2,000
Annual Limit (per Policy Year) 60,000 120,000 180,000
Lifetime Limit 600,000 1,200,000 1,800,000
No Claim Bonus for each year (auto-convert to units)
Provided no claim in the previous policy year 120 180 260
(ii) The benefit payment under this rider is subject to the following waiting period (measured from
the Policy Date or Date of Reinstatement or Date of Addition of this Rider, whichever is later):
a. 30-day waiting period for all illnesses and diseases except for accidental injuries.
b. 120-day waiting period for treatment or surgery for the following disabilities:
Hypertension, diabetes mellitus and cardiovascular disease;
All tumours, cancers, cysts, nodules, polyps, stones of the urinary system and biliary
system;
All ear, nose (including sinuses) and throat conditions;
Hernias, haemorrhoids, fistulae, hydrocele, varicocele;
Endometriosis including disease of the Reproduction system;
Vertebro-spinal disorders (including disc) and knee conditions.
(iii) Coverage for overseas treatment is as follow:
a. Geographical Territory
All benefits provided in this Policy are applicable worldwide, twenty four (24) hours a day
and subject to the conditions/limitations stated in (iii)b and (iii)c below.
b. Residence Overseas
No benefit whatsoever shall be payable for any medical treatment received by the Life
Insured outside Malaysia apart from Singapore and Brunei, if the Life Insured resides or
travels outside Malaysia for more than ninety (90) consecutive days.
c. Overseas Treatment
If the Life Insured seeks treatment overseas, benefits in respect of the treatment shall be
covered subject to the exclusions, limitations and conditions specified in this Policy. All
benefits in respect of the treatment shall be limited to the Reasonable and Customary and
Medically Necessary Charges for such equivalent local treatment in Malaysia and shall
exclude the cost of transport to the place of treatment provided:
(i) a Life Insured traveling abroad for a reason other than for medical treatment, needs
to be confined to a Hospital outside Malaysia as a consequence of a Medical
Emergency; or
(ii) a Life Insured upon recommendation of a Physician and has to be transferred to a
Hospital outside Malaysia because the specialized nature of the treatment, aid,
information or decision required can neither be rendered nor furnished nor taken in
Malaysia.
(i) and (ii) above are not applicable for treatment sought in Singapore and Brunei. However
all benefits in respect of the treatment sought in Singapore and Brunei shall be limited to
the Reasonable and Customary and Medically Necessary Charges for such equivalent local
treatment in Malaysia.
Benefits will not be payable for overseas treatment (apart from Singapore and Brunei) of a
disease, sickness or injury where there is no medical emergency or for chronic conditions
where treatment can be reasonably be postponed until the Life Insured’s return to Malaysia.
(iv) Non-cashless administration
The life insured is required to settle the hospital bills upon discharge and submit the bills for
reimbursement.
(v) Co-Insurance
o There will be co-insurance charged under this rider, as stated in the table of benefits
o Co-insurance is the portion of the hospital bills that Policy Owner must bear before benefits
are payable by the Insurer.
o The co-insurance shall only be applicable to the relevant benefits and where applicable, the
minimum co-insurance payable shall be RM300 per Disability but not exceeding a maximum
co-insurance of RM1,000 per Disability as stated in the Schedule of Benefits.
o For Out-patient Cancer Treatment, Outpatient Kidney Dialysis Treatment and Emergency
Accidental Out-patient Treatment there is no minimum and maximum amount on the ten
percent (10%) co-insurance payable. (vi) No Claim Bonus
o Where no claim is made for the previous policy year, policyholders will be paid a No Claim
Bonus on the following policy year.
o This bonus is automatically converted to units, which are then allocated to their policy.
o The amount of No Claim Bonus will depend on the level of plan purchased. For example, plan
PMP1 entitles them to a bonus of RM 120 whilst plan PMP3 entitles them to RM 260.
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UNDERWRITING GUIDELINES a) Issue Age
Minimum Entry Age : 30 days Maximum Entry Age : 70 years old*
The entry age is computed at age nearest birthday. * Note: For New Business application, the maximum entry age is 65 years old (follow the maximum
entry age of IPLI). For existing IPLI policies, the maximum entry age to add this rider is 70 years old.
b) Coverage Term
1) This PMP Rider shall become effective as of the date stated in the Policy Information Statement,
any endorsement of this Rider, Date of Reinstatement or Date of Addition of this Rider (as
applicable).
2) The Policy Anniversary shall be one year after the effective date and annually thereafter. On each
such anniversary, this Rider is renewable at the insurance charges in effect at that time as
notified by the Company. This Rider is renewable at the option of policyholder subject to the
terms, conditions and termination at each of the anniversary of the Policy date. The renewal
insurance charges payable is not guaranteed and the Company reserves the right to revise the
insurance charges applicable at the time of renewal. Such changes, if any, shall be applicable to
all policyholders irrespective of their claim experience according to the Company’s risk
assessment.
3) This Rider is renewable at the option of policyholder until the occurrence of any of the following:
(a) Fraud or misrepresentation of material fact during application; or
(b) The Rider is cancelled at the request of the Policy Owner; or
(c) Total claims of the Rider have reached the lifetime limit specified and/or on the death of the
Life Insured; or
(d) The Life Insured attains the coverage age limit specified in the Policy Information Statement; or
(e) Termination of coverage for all policies in a certain market and the Company withdraws this
Policy completely from the market in accordance with the Portfolio Withdrawal Condition.
4) The insurance under this Rider shall automatically terminate: -
a) upon expiry of this Rider; or
b) upon death of the Life Insured; or
c) upon surrender / lapse of the Policy; or
d) if there is a change in occupation to one which is not insurable under this Rider; or
e) if the Policy Anniversary nearest to the eighty-fifth (85th) birthday of the Life Insured is reached;
or
f) if the accumulated total claims paid since the original Policy Date exceeds the lifetime limit of
10 times the Overall Annual limit; or
g) if the total investment value of the Policy is insufficient to settle the Insurance Charges and /or
Policy Fee,
whichever is earlier.
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c) Occupational Class
Open to occupational class 1 to 5 only, subject to underwriting requirements.
d) Backdating
Backdating of this rider is not allowed. e) Cooling Off Period
If a policy is cancelled within the 15 days free look period, the Company will refund
• The unallocated premiums
• Value of units (if any) at unit price at the time of cancellation
• Any insurance charges and policy fee that has been deducted
• Less medical expense (if any)
SERVICING GUIDELINES a) Addition or Cancellation of Rider
Rider may be cancelled at policy monthly anniversary and added at any policy anniversary.
Addition of rider is subject to underwriting and any underwriting requirement at the point of
application to add the rider. If premium is insufficient, addition of premium may be required.
Only one medical plan (regardless of whether it is issued under traditional life or investment-linked) is allowed per life insured.
b) Reinstatement
Reinstatement of the rider is allowed within one year of the date of lapse. Upon reinstatement of lapsed rider, evidence of insurability is required.
c) Change of Occupation Class If the occupation class is higher than class 5, the rider shall be cancelled on the next monthly anniversary date of the policy.
d) Conversion from ULMP to PMP
This is only allowed for ULMP to PMP without further underwriting. Waiting period and pre-existing conditions will be waived based on the original RCD. “Conversion of Medical Rider from UL MediPlus rider to Prime MediPlus Rider” form is required to be submitted when applying for this plan conversion. The plan conversion from ULMP to PMP is subject to following conditions:
Standard life (no medical loading): and No claim history; and Not listed in LIAM sub-standard list; and Only convert to the same level of plan i.e. ULMP 1 to PMP 1; and Upon Policy Anniversary only; and Policy is inforce
Processing fee of RM 20 will be waived for conversion from UL MP to PMP. Existing ULMP policy with substandard life, policy with claim history or wanted to convert to a higher plan is subject to normal underwriting. The policyholder is required to cancel the existing ULMP and
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apply for PMP as “additional rider”. Any backdated claim (claim incurred prior to the plan conversion but submitted later after the application of plan conversion) will not be allowed if the application on the above plan conversion has been submitted and approved.
CLAIM GUIDELINES a) Payment of No-Claim Bonus (NCB)
i) For policies with no pending or approved claims
The no-claim bonus will automatically be converted into units and allocated to the policy on the next business day after the policy anniversary. The NCB credited (if eligible) is based on plan selected.
ii) For policies with pending claims
The no-claim bonus will be granted and converted to units after a pending claim (which cross
over its policy anniversary) is rejected. The unit price will be based on the day the claim is rejected.
NCB will not be granted if there is any pending medical claim under the rider. If claim is approved, no-claim bonus will not be granted.
b) Exclusions
This rider does not cover any hospitalisation, surgery or charges caused directly or indirectly, wholly or partly, by any one (1) of the following occurrences:
1) Pre-Existing Illness, which existed before the Policy Date (as stated in the Policy Information
Statement or any endorsement on this Rider) or Date of Reinstatement or Date of Addition of this Rider (as applicable), shall mean Disabilities that the Life Insured has reasonable knowledge of prior to the Policy Date. The Life Insured may be considered to have reasonable knowledge of a pre-existing condition where the condition is one for which:
(i) the Life Insured had received or is receiving treatment; or (ii) medical advice, diagnosis, care or treatment has been recommended; or (iii) clear and distinct symptoms are or were evident; or (iv) its existence would have been apparent to a reasonable person in the circumstances.
2) Specified Illnesses, which are the following disabilities and its related complications,
occurring within the first one hundred twenty (120) days of insurance of the Life Insured:
(i) Hypertension, diabetes mellitus and cardiovascular disease; (ii) All tumours, cancers, cysts, nodules, polyps, stones of the urinary system and
biliary system; (iii) All ear, nose (including sinuses) and throat conditions; (iv) Hernias, haemorrhoids, fistulae, hydrocele, varicocele; (v) Endometriosis including disease of the Reproduction system; (vi) Vertebro-spinal disorders (including disc) and knee conditions.
3) Any medical or physical conditions arising within the first thirty (30) days of the Life Insured’s
cover or Date of Reinstatement or Date of Addition of this Rider (as applicable), whichever is later except for accidental injuries.
4) Plastic / Cosmetic surgery, circumcision, eye examination, glasses and refraction or surgical
correction of nearsightedness (Radial Keratotomy or Lasik) and the use or acquisition of
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external prosthetic appliances or devices such as artificial limbs, hearing aids, implanted pacemakers and prescriptions.
5) 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. 6) 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.
7) Any treatment or surgical operation for congenital abnormalities or deformities including any
hereditary conditions. 8) 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.
9) Hospitalisation 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, vitamins / food supplements and treatments specifically for weight reduction or gain.
10) Any Out-patient treatment unless specifically provided under this Rider. 11) Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane. 12) 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. 13) Ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste
from process of nuclear fission or from any nuclear weapons material. 14) Expenses incurred for donation of any body organ by the Life Insured and costs of acquisition
of the organ including all costs incurred by the donor during organ transplant and its complications.
15) Investigation and treatment of sleep and snoring disorders, hormone replacement therapy
and alternative therapy such as treatment, medical service or supplies other than Western medicines, including but not limited to chiropractic services, acupuncture, acupressure, reflexology, bone setting, herbalist treatment, massage or aroma therapy or other alternative treatment.
16) Care or treatment for which payment is not required or to the extent which is payable by any
other insurance or indemnity covering the Life Insured and Disabilities arising out of duties of employment or profession that is covered under a Workman’s Compensation Insurance Contract.
17) Psychotic, mental or nervous disorders, (including any neuroses and their physiological or
psychosomatic manifestations). 18) Costs / expenses of services of a non-medical nature, such as television, telephones, telex
services, radios or similar facilities, admission kit / pack, medical report and other ineligible non-medical items.
19) 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.
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For internal staff and agent training only. Only ING authorized sales materials are to be used when prospecting. Please refer to Disclaimer Notice on the first page of this document.
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20) Private flying other than as a fare-paying passenger in any commercial scheduled airlines
licensed to carry passengers over established routes. 21) Expenses incurred for sex changes. 22) Any treatment following an unlawful act.