Vous êtes sur la page 1sur 9

Prime MediPlus Rider (PMP)

Contents Features Benefits Underwriting Guidelines Servicing Guidelines Claim Guidelines

Page 1 1 4 5 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 customers 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 Hospitalisation and Surgical Benefits (a) Hospital Room and Board (daily limit) (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 (g) Daily Cash Allowance at a Malaysian Government Hospital (maximum 60 days per Disability) Out of Hospital Benefits (h) Day Surgery and Day Surgery follow-up up to 60 days from the date of discharge or Day Surgery 50 50 50 PMP1 (RM) 120 PMP2 (RM) 180 PMP3 (RM) 260

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)

As charged (not subject to co-insurance)

As charged (i) Post Hospitalisation up to 60 days from date of discharge 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)

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.

PLAN DESCRIPTION (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 PMP1 (RM) PMP2 (RM) PMP3 (RM)

(m) Home Nursing Care (per Disability) Annual Limit (per Policy Year) Lifetime Limit No Claim Bonus for each year (auto-convert to units) Provided no claim in the previous policy year

500 60,000 600,000 120

1,000 120,000 1,200,000 180

2,000 180,000 1,800,000 260

(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:

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.

(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 Insureds 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 o o There will be co-insurance charged under this rider, as stated in the table of benefits Co-insurance is the portion of the hospital bills that Policy Owner must bear before benefits are payable by the Insurer. 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 o o Where no claim is made for the previous policy year, policyholders will be paid a No Claim Bonus on the following policy year. This bonus is automatically converted to units, which are then allocated to their policy. 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.

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.

UNDERWRITING GUIDELINES a) Issue Age Minimum Entry Age Maximum Entry Age : : 30 days 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 Companys 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.

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.

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 investmentlinked) 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
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.

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) (ii) (iii) (iv) (v) (vi) 3) 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.

Any medical or physical conditions arising within the first thirty (30) days of the Life Insureds cover or Date of Reinstatement or Date of Addition of this Rider (as applicable), whichever is later 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
6

4)

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.

external prosthetic appliances or devices such as artificial limbs, hearing aids, implanted pacemakers and prescriptions. 5) 6) 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 communicable diseases required quarantine by law. Any treatment or surgical operation for congenital abnormalities or deformities including any 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. 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. Any Out-patient treatment unless specifically provided under this Rider. 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. Ionizing 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 the Life Insured and costs of acquisition of the organ including all costs incurred by the donor during organ transplant and its complications. 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. 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 Workmans 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, medical report 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.
7

7) 8)

9)

10) 11) 12) 13) 14)

15)

16)

17) 18)

19)

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.

20) 21) 22)

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. Any treatment following an unlawful act.

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.

Vous aimerez peut-être aussi