Upload
others
View
0
Download
0
Embed Size (px)
Citation preview
HealthEnrichTHE MEDICAL PLAN THAT DEFINES YOU
HealthEnrich is Uniquely You
Your health is a privilege and you deserve a plan that reflects your medical needs. At Prudential BSN Takaful Berhad (PruBSN), we want you to live your life without compromising your health.
HealthEnrich is designed to ensure you experience unparallelled medical treatment, fully covered. Feel secure when you receive medical advice from leading experts around the world. Be at ease during pregnancy with our exclusive maternity complications coverage. You can also enjoy the comfort and privacy of a suite with a dedicated medical attendant taking care of your needs.
All these features and more crafted to complement your unique lifestyle.
Now, let’s discover your lifestyle.
Are You...
YOUNG AND LOOKING FOR FREEDOM IN LIFE?
DEDICATED AND TAKING MORE COMMITMENTS IN LIFE?
A HIGH ACHIEVER AND SEEKING FOR THE BEST IN LIFE?
ACCOMPLISHED AND LIVING A DISTINGUISHED LIFESTYLE?
Start Early
Fulfil Life
Take the Lead
Enjoy Exclusive Privileges
HealthEnrich Vital
Start Early withHealthEnrich Vital
The moment is here for you to stand on your own feet. Start early with a plan that provides vital medical protection and suits your vibrant lifestyle.
MEDICAL TREATMENTthat is within easy reach at our nationwide network of
SECURITY when you explore theworld knowing thatyou are covered worldwide
FLEXIBILITY to upgrade the plan as your needs grow with your changing lifestyle
70 hospitalsHealthEnrich Vital gives you...
HealthEnrich Vital
Co-Takaful
If You are Hospitalised
Hospital Daily Room and Board (maximum 120 days per year) RM150
Intensive Care Unit (maximum 30 days per year)As charged subject to Co-Takaful
Surgical Procedure and Treatment
In-Hospital and Related Services
If You Need Outpatient Treatment
Day Surgery As charged
Pre-Hospitalisation and Post-Hospitalisation Treatment (within 90 days before and after hospitalisation)
As charged subject to Co-Takaful
If You are Coping with Life-changing Illnesses
Cancer Treatment As charged
If You are in an Emergency
Emergency Treatment for Accidental Injury (Annual Limit) RM1,500
Worldwide Emergency Medical Assistance Yes
Overall Annual Limit RM30,000
Lifetime Limit RM300,000
HealthEnrich Select
Fulfil Life withHealthEnrich Select
Your lifestyle changes when you have a family. Select a plan that fulfils life with optimum protection and satisfies your growing responsibilities.
HealthEnrich Select offers you...
COMPREHENSIVEhospitalisation and surgical cover
Unique benefits for the COMFORT ofEXPECTING MOTHERS
FULL COVER for your MEDICAL BILLS giving you added security and peace of mind
MEDICAL BILL
PAID
HealthEnrich Select
Co-Takaful Full Coverage
If You are Hospitalised
Hospital Daily Room and Board (maximum 200 days per year)
RM200 RM200
Intensive Care Unit (maximum 60 days per year)As charged subject to Co-Takaful
As chargedSurgical Procedure and Treatment
In-Hospital and Related Services
If You Need Outpatient Treatment
Day Surgery As charged
As chargedHome Nursing Care (180 days per lifetime) As charged
subject to Co-Takaful
Pre-Hospitalisation and Post-Hospitalisation Treatment (within 90 days before and after hospitalisation)
If You are Coping With Life-changing Illnesses
Cancer TreatmentAs charged As charged
Kidney Dialysis Treatment
If You are in an Emergency
Maternity Complications (Annual Limit) RM6,000 RM6,000
Emergency Treatment for Accidental Injury (Annual Limit)
RM2,000 RM2,000
Worldwide Emergency Medical Assistance Yes Yes
Overall Annual Limit RM60,000 RM60,000
Lifetime Limit RM600,000 RM600,000
HealthEnrich Advanced
Take the Lead withHealthEnrich Advanced
You progress so quickly in life that you seldom pause and think about your future healthcare needs. Take the lead with a plan that provides advanced protection and fulfils your hectic lifestyle.
HealthEnrich Advanced provides you...
EASY ADMISSION with pre-arrangedhospitalisation and waiver of hospital deposit at our Preferred Hospitals
DIRECT CONSULTATIONwith leading local and international medical experts
REWARDS for healthy livingwith a NO CLAIM BONUS under the co-takaful option
HealthEnrich Advanced
HealthEnrich Advanced
Co-Takaful Full Coverage
Reward for Healthy Living
No Claim Bonus RM250 Not offered
If You are Hospitalised
Hospital Daily Room and Board (maximum 200 days per year)
RM300 RM300
Hospital Daily Cash Allowance (maximum 200 days per year)
RM100 RM100
Intensive Care Unit (maximum 60 days per year)As charged subject to Co-Takaful
As chargedSurgical Procedure and Treatment
In-Hospital and Related Services
Hospital Deposit at Preferred Hospitals Waived Waived
If You Need Outpatient Treatment
Day Surgery As charged
As chargedHome Nursing Care (250 days per lifetime)
As charged subject to Co-Takaful
Pre-Hospitalisation and Post-Hospitalisation Treatment (within 90 days before and after hospitalisation)
If You are Coping With Life-changing Illnesses
Second Medical Opinion• ConsultationandDiagnosisinMalaysia
(Annual Limit)• ConsultationwithWorldLeadingExperts
RM500
Yes
RM500
Yes
Cancer TreatmentAs charged As charged
Kidney Dialysis Treatment
Organ Transplant (Additional Lifetime Limit) RM100,000 RM100,000
If You are in an Emergency
Maternity Complications (Annual Limit) RM10,000 RM10,000
Emergency Treatment for Accidental Injury (Annual Limit)
RM3,000 RM3,000
Worldwide Emergency Medical Assistance Yes Yes
Overall Annual Limit RM100,000 RM100,000
Lifetime Limit RM1,000,000 RM1,000,000
HealthEnrich Premier
Enjoy Exclusive Privileges withHealthEnrich Premier
You want to experience the finest things in life while living healthily. Enjoy exclusive privileges with a plan that offers superior protection and addresses your prominent lifestyle.
HealthEnrich Premier offers you...
LUXURIOUS ACCOMMODATION in a suite and exclusive treatment at our Preferred Hospitals nationwide
A DEDICATED MEDICALATTENDANT to meetyour every need
SUPERIOR HOSPITALISATION LIMITS
for your medical needs
Min
imum
Average M
aximum
HealthEnrich Premier
Full Coverage
If You are Hospitalised
Hospital Daily Room and Board (maximum 365 days per year)• Preferred Hospitals• Otherhospitals
RM1,000RM500
Hospital Daily Cash Allowance (maximum 365 days per year) RM200
Dedicated Daily Medical Attendant (maximum 365 days per year) RM200
Intensive Care Unit (maximum 120 days per year)
As chargedSurgical Procedure and Treatment
In-Hospital and Related Services
Hospital Deposit at Preferred Hospitals Waived
If You Need Outpatient Treatment
Day Surgery
As chargedHome Nursing Care (365 days per lifetime)
Pre-Hospitalisation and Post-Hospitalisation Treatment (within 90 days before and after hospitalisation)
If You are Coping With Life-changing Illnesses
Second Medical Opinion• ConsultationandDiagnosisinMalaysia(AnnualLimit)• ConsultationwithWorldLeadingExperts
RM1,000Yes
Cancer TreatmentAs charged
Kidney Dialysis Treatment
Organ Transplant (Additional Lifetime Limit) RM200,000
If You are in an Emergency
Maternity Complications (Annual Limit) RM20,000
Emergency Treatment for Accidental Injury (Annual Limit) RM5,000
Worldwide Emergency Medical Assistance Yes
Overall Annual Limit RM200,000
Lifetime Limit RM4,000,000
What you need to know about HealthEnrich
1. What is HealthEnrich?
HealthEnrich is a regular contribution medical rider plan that reimburses major medical expenses incurred in the event of hospitalisation, surgery or outpatient treatment. It has four plans – HealthEnrich Vital, HealthEnrich Select, HealthEnrich Advanced and HealthEnrich Premier – where each comes with a medical card to give you immediate access to any of our panel hospitals.
2. How much contribution do I need to pay?
The contribution that you pay is based on your age at entry and does not increase as you get older. The contribution rates are available in Appendix 2.
3. What is Organ Transplant benefit?
Organ Transplant benefit is an additional lifetime limit when you undergo one of the transplant surgeries on kidney, heart, lung, liver, bone marrow or cornea. This additional once-in-a-lifetime benefit is on top of the annual limit and lifetime limit for HealthEnrich Advanced and HealthEnrich Premier.
4. What are the advantages of Cancer Treatment and Kidney Dialysis Treatment?
You can seek treatments such as hemodialysis, radiotherapy and chemotherapy at our panel hospitals using the medical card without any payment of co-takaful. On top of that, HealthEnrich covers any consultations, examination tests and take-home drugs.
5. What are the options available for HealthEnrich?
OptionsHealthEnrich
VitalHealthEnrich
SelectHealthEnrich
AdvancedHealthEnrich
Premier
Entry Age20 gestational
weeks to 45 years old
20 gestational weeks to
70 years old
14 days to 70 years old
14 days to 70 years old
Expiry Age25, 70 or
80 years old25, 70 or
80 years old25, 70 or
80 years old25, 70 or
80 years old
Cost-sharing
Co-takaful only
Co-takaful or Full Coverage
Co-takaful or Full Coverage
Full Coverage only
6. What are the charges and deductions involved in HealthEnrich?
The details of charges and deductions are listed in the table below.
Type of Charges and Deductions
Details
Upfront wakalah charge
This charge allows us to pay commission and distribution related expenses as well as management expenses. The percentage below is based on term 20 years or more. For term less than 20 years, you may refer to the Plan Illustration.
Certificate year 1 2 3 4 5 & 67 &
above
Upfront wakalah charge
60% 60% 50% 30% 20% 0%
Tabarru’ We deduct an amount each month from your protection account based on your age, health status, occupation (if applicable), and amount of coverage for the duration of the coverage.
What is Day Surgery Benefit?
Hospital admissions are costly and at times unnecessary. Hospitalisation means more costs such as admission fee, room and board, nursing care and meals. Although we need rest to recover, hospitals are not always as comforting as our own homes.
One of the uniqueness of HealthEnrich is the Day Surgery benefit. No matter which plan you choose, Co-Takaful or Full Coverage, this benefit fully covers the cost of your surgeries or treatments.
Also, with the Day Surgery benefit, you can recuperate in the comfort of your home on the same day. You do not have to stay overnight at a hospital and worry about exhausting your medical coverage. You can undergo radiotherapy, haemodialysis or chemotherapy as outpatient under this convenient plan.
It also covers*:1. Gastroscopy/Endoscopy2. Colonoscopy3. Angiography4. I & D of abscess except wide excision5. Cataract extraction6. Excision of breast nodule/lump except wide excision7. Dilatation & Curettage8. Diagnostic laparoscopic procedure9. Removal of foreign body10. Excision of Chalazion/Pterygium11. Radiotherapy12. Diagnostic Bronchoscopy13. Removal of Ganglion/fibroma14. Diagnostic cystoscopy15. Insertion of Chemoport/Hickman line16. AV fistula creation17. Lump – Excision biopsy (all types)18. Removal of warts19. Closed manipulation of fracture20. Injection of Trigger finger21. Intra-articular injection of joints22. Corrective surgery for blepharoptosis not
related to congenital/cosmetic23. Haemodialysis24. Suture and other operations on tendons and
tendon sheath25. Chemotherapy26. Arthroscopic knee evaluation/
aspiration/joint toilet27. Carpal tunnel release
* You may undergo any other day surgery or treatment that is not listed above as advised by your doctor. Please refer to the certificate document for further information.
Important Notes
1. This brochure does not form a contract between you and PruBSN. Please refer to the Plan Illustration and Product Disclosure Sheet before participating in the plan. The full Terms and Conditions are set out in the certificate documents. Please ask for a sample of the Terms and Conditions should you need detailed information of the plan.
2. For HealthEnrich, you are entitled to medical tax relief in respect of your contributions of up to RM3,000 a year. Any tax relief is subject to the terms and conditions of the Inland Revenue Board (IRB).
3. You should continue paying your contributions regularly until the maturity of your plan to ensure that you are fully protected under the plan at all times. Failing to do so may cease your coverage prematurely. Coverage to expiry age is subject to the Protection Unit Account (PUA) being sufficient for deduction of Tabarru’ and applicable charges.
4. HealthEnrich is a guaranteed renewable plan. The contribution is level but it is not guaranteed. PruBSN reserves the right to revise the contribution rates and/or Tabarru’ by giving 30 days written notice. The rates may be revised due to unfavorable circumstances such as medical cost inflation. Any changes in contributions and/or Tabarru’ will only take effect on the next certificate anniversary.
5. HealthEnrich does not provide any benefit amount from the Tabarru’ Fund on termination, expiry or maturity of certificate.
6. Co-takaful is a cost-sharing arrangement under which the participant pays a specified percentage of the cost of an eligible benefit. If co-takaful is selected, participant will have to pay 10% of the cost of an eligible benefit, subject to minimum co-takaful amount of RM400 and maximum co-takaful amount of RM2,000. No minimum co-takaful amount applies for benefits under If You Need Outpatient Treatment.
7. The full coverage plan requires no payment from the participant in respect of bills for covered medical conditions subject to limits in each plan and terms and conditions as stated in the certificate documents.
8. Preferred Hospitals are selected hospitals that will provide complimentary services to preferred customers who take up plan HealthEnrich Advanced or HealthEnrich Premier. Please refer to PruBSN website for the current list of Preferred Hospitals.
9. You can only seek Second Medical Opinion when you are diagnosed with one of the covered critical illnesses.
10. HealthEnrich is based on Wakalah Bil Ajr model which is an arrangement for PruBSN to manage your takaful plan. Your contribution will be placed into the PUA after deducting a wakalah charge which constitutes the fee for the overall management services provided. The takaful protection comes from the Tabarru’ Fund.
11. Tabarru’ means a donation of a specified portion from the contribution into the Tabarru’ Fund for the purpose of mutual aid and assistance among fellow participants according to the agreed benefits under the plan.
12. You are entitled to receive any distributable surplus inclusive of investment profit (if any) at the end of each financial year. Together with other participants, you are entitled to at least 50% of the surplus and PruBSN will receive the balance of up to 50% as incentive for managing the Tabarru’ Fund. Your portion of the distributable surplus will be placed back into your PUA. The exact amount of distributable surplus will be determined annually and is subject to approval by both the Shariah Committee and the Board of Directors of PruBSN.
Exclusions
HealthEnrich does not cover any hospitalisation, surgery or charges caused directly or indirectly, wholly or partly, by any one of the following occurrences:
1. Pre-existing condition.
2. Specified illnesses during the first 120 days of cover.
3. Any medical or physical conditions arising within 30 days from the date of coverage or date of reinstatement, except for accidental injuries.
4. Cosmetic surgery, circumcision, eye examination, glasses, lens, Lasik and the use of prosthetic and medical devices.
5. Dental conditions including treatment or oral surgery to natural teeth except as necessitated by accidental injuries.
6. Experimental surgery or elective procedures except as a result of accidental injury, surgery or illness.
7. Bed rest, illegal drugs, intoxication, sterilisation, AIDS, HIV, all sexually transmitted diseases requiring quarantine by law.
8. Any treatment or surgery for congenital conditions including hereditary conditions.
9. Treatments or procedures relating to pregnancy or childbirth and its complications, prenatal or postnatal care except all those stated in certificate document and, miscarriage, abortion, any contraceptive methods of birth control, treatments pertaining to infertility or erectile dysfunction and impotence.
10. Routine medical examinations, hospitalisation solely for investigatory purposes/diagnostic imaging not coincidental to treatment of covered disability or any treatments, medicines or examinations deemed not medically necessary or preventive in nature and treatments specifically for weight reduction or gain example sleeve gastrectomy.
11. Suicide, attempted suicide or self-inflicted bodily injury while sane or insane.
12. Any injury or illness caused by any act of war, any violation or attempted violation of the law or to resist arrest, direct participation in riot, strike and civil commotion.
13. Ionising radiation or radioactive contamination from any nuclear fuel or waste from nuclear fission or any nuclear materials.
14. Expenses incurred by donor or covered person for donation of any body organ and all costs of organ acquisition and its complications.
15. Investigation and treatment of sleep and snoring disorders, treatment of abnormal perspiration, therapy of hormone replacement, stem cells, hyperbaric oxygen therapy, chiropodist consultation and treatment, chiropractic services, aromatherapy and any form of alternative therapies.
16. Care or treatment for which payment is not required or to the extent which is payable by other Takaful operators or indemnity covered under the Workman’s Compensation Takaful Contract.
17. Psychiatric, mental or nervous disorders and those due to senile disorders.
18. Expenses of non-medical services including but not limited to television, telephone, broadband, electricity bill, radio or admission kit except all those stated in certificate document.
19. Sickness or injury arising from any kind of racing, hazardous sports, aerial flights except as a crew member or a fare-paying passenger, or on a licensed passenger-carrying commercial aircraft operating on a regular scheduled route.
20. Expenses incurred for sex changes or gender transformation.
21. Any insect bite including mosquito bites and worm infestation during the waiting period.
22. Charges which are not within Reasonable and Customary Charges or charges incurred after the Expiry Date.
The exclusion and limitations above are not exhaustive and you should refer to the certificate document for further information.
Appendix 1
List of Maternity Complications
1. Disseminated Intravascular Coagulation
2. Ectopic Pregnancy
3. Hydatidiform Mole
4. Postpartum Hemorrhage Requiring Hysterectomy
5. Eclampsia
6. Amniotic Fluid Embolism
7. Pulmonary Embolism of Pregnancy
8. Toxaemia of Pregnancy
Appendix 2
Annual Contribution Rates for HealthEnrich Select for Expiry Age 70.
Entry AgeCost-sharing Options
Co-Takaful (RM) Full Coverage (RM)
1 – 15 808 995
16 818 1,004
17 830 1,014
18 841 1,023
19 852 1,056
20 863 1,089
21 882 1,118
22 901 1,147
23 920 1,177
24 939 1,206
25 958 1,235
26 976 1,265
27 995 1,294
28 1,013 1,323
29 1,031 1,353
30 1,049 1,382
31 1,083 1,412
32 1,101 1,441
33 1,115 1,470
34 1,130 1,500
35 1,144 1,529
36 1,177 1,577
37 1,210 1,626
38 1,242 1,674
39 1,312 1,722
40 1,352 1,770
Entry AgeCost-sharing Options
Co-Takaful (RM) Full Coverage (RM)
41 1,396 1,829
42 1,446 1,887
43 1,516 1,946
44 1,585 2,005
45 1,654 2,063
46 1,742 2,182
47 1,828 2,302
48 1,963 2,421
49 1,988 2,540
50 2,057 2,660
51 2,125 2,710
52 2,193 2,760
53 2,261 2,810
54 2,329 2,860
55 2,396 2,910
56 2,480 3,001
57 2,564 3,093
58 2,646 3,185
59 2,730 3,276
60 2,812 3,368
The contribution rates are for a standard risk of occupation class 1 and 2. The contribution rates for occupation class 3 and 4 are 1.25 and 1.5 times more than the contribution rates for occupation class 1 and 2 respectively. The rates are subject to underwriting. Your actual contribution amount shall depend on your age (based on Age Next Birthday), health status, occupation class, plan type and duration of coverage. For HealthEnrich contribution rates with other combinations of plan, expiry age and cost-sharing options please refer to www.prubsn.com.my.
HealthEnrich is a Shariah-compliant product.
Prudential BSN Takaful Berhad is a registered Takaful Operator under the Islamic Financial Services Act 2013 and is regulated by Bank Negara Malaysia.
For more information/enquiries, please contact:
PRUDENTIAL BSN TAKAFUL BERHAD (740651-H)Level 8A, Menara Prudential, No. 10, Jalan Sultan Ismail, 50250 Kuala Lumpur.
Tel: (03) 2053 7188 Fax: (03) 2072 6188 E-mail: [email protected] SMS PruBSN and send to 33080
You can also log on to www.prubsn.com.my
Important: You must ensure that you are satisfied that this product will best serve your needs and that the contribution payable under the certificate is an amount you can afford.
All information is correct at the time of print.� Printed 1 November 2013