DRIVING PROFESSIONAL STANDARDS
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<strong>DRIVING</strong> <strong>PROFESSIONAL</strong> <strong>STANDARDS</strong><br />
2015 MII PROGRAMME DIRECTORY<br />
Title<br />
1.41 Intermediate Course in Medical and Health Insurance (Non-Medical Aspect of Claims) - (Updated)<br />
Title<br />
1.42 Intermediate Course In Medical & Health Insurance – (Claims) - (Updated)<br />
Venue<br />
Who Should<br />
Attend<br />
Pre-Requisite<br />
Key Learning<br />
Outcomes<br />
Key Course<br />
Contents<br />
Duration<br />
Time<br />
2 Days 9.00 am to 5.00 pm<br />
The Malaysian Insurance Institute City Centre<br />
Suite 6.0W, 6th Floor, Wisma Sime Darby, Jalan Raja Laut, 50350 Kuala Lumpur, Malaysia.<br />
Underwriters, claims assessors, sales intermediaries, customer service officers, trainers, product designers and<br />
those involved in pricing, healthcare professionals, software programmers, employee benefit professionals,<br />
Third party administrators managing medical insurance claims.<br />
Those who have attended the Foundation Course in Health & Medical Insurance or with at least 6 months<br />
working experience in insurance related positions.<br />
At the end of the programme, participants would be able to:<br />
• Explain the key terminology/definition and calculate the various elements of the Hospital & Surgical<br />
Insurance benefit structure<br />
• Match the various expense items to their respective benefit category and to calculate the amount of<br />
admissible and non-admissible claims<br />
• Explain the situation where an upgrading of room becomes medically necessary<br />
• Explain the meaning of specialist, customary & reasonable charges<br />
• Tabulate a simple H&S insurance work sheet<br />
• State the various warning signs relating to possible fraud<br />
• Identify and state the responsibilities of the various parties involved in using, delivering and financing healthcare<br />
DAY 1<br />
Session 1<br />
Overview of Hospital & Surgical<br />
Insurance and Component of Claims<br />
Assessment<br />
Session 2<br />
Structure of Hospital& Surgical<br />
Insurance<br />
Session 3<br />
Determine Claims Quantum Based On:<br />
- Per one Disability<br />
Session 4<br />
Determine Claims Quantum Based On:<br />
- Hospitalization vs Daycare<br />
- Length of Stay<br />
- Room and Board<br />
Session 5<br />
Determine Claims Quantum Based On:<br />
- Specialist Consultation and Procedural Charges<br />
DAY 2<br />
Session 6<br />
Annual and Lifetime Limit<br />
Session 7<br />
Family Annual Limit Profit /<br />
Experience Refund<br />
Session 8<br />
Claims Decision and<br />
Documentation<br />
Session 9<br />
Managing Excesses and Non<br />
payable Items<br />
Session 10<br />
Hospital & Surgical Insurance<br />
Fraud<br />
Session 11<br />
Obligations of:<br />
- The Policy-Owner<br />
- Insurance Company<br />
- Healthcare Providers<br />
Venue<br />
Who Should<br />
Attend<br />
Pre-Requisite<br />
Key Learning<br />
Outcomes<br />
Key Course<br />
Contents<br />
Duration<br />
Time<br />
2 Days 9.00 am to 5.00 pm<br />
The Malaysian Insurance Institute City Centre<br />
Suite 6.0W, 6th Floor, Wisma Sime Darby, Jalan Raja Laut, 50350 Kuala Lumpur, Malaysia.<br />
Underwriters, claims assessors, sales intermediaries, customer service officers, trainers, product designers and<br />
those involved in pricing, healthcare professionals, software programmers, employee benefit professionals,<br />
Third party administrators managing medical insurance claims.<br />
Those who have attended the Foundation Course in Health & Medical Insurance or with at least 9 months<br />
working experience in insurance related positions.<br />
At the end of the programme, participant would be able to:<br />
• Interpret and explain commonly used medical terminologies and abbreviations<br />
• Explain key medical terminologies, medical conditions, medical related clauses and limitations commonly<br />
used in Hospital & Surgical policies and their effects on medical claims<br />
• Explain the definition, intent and effects of Congenital, Pre-existing, Medically Necessary and Customary &<br />
Reasonable clauses on medical claims<br />
Day 1<br />
Session 1<br />
Medical Jargons and Abbreviations<br />
Day 2<br />
Session 2<br />
Structure of Hospital & Surgical<br />
Insurance Policy<br />
Session 3<br />
What is Sickness and Injuries<br />
Session 4<br />
Congenital Conditions<br />
Session 5<br />
Pre-existing and Long- standing<br />
conditions<br />
FEES<br />
MEMBER<br />
RM 1,200<br />
GROUP MEMBER<br />
RM 1,150<br />
Day 3<br />
Session 6<br />
Waiting Period<br />
Session 7<br />
Medically Necessary<br />
Session 8<br />
Customary and Reasonable<br />
Charges<br />
Session 9<br />
Wrap Up Discussion<br />
FEES<br />
MEMBER<br />
RM 1,200<br />
GROUP MEMBER<br />
RM 1,150<br />
NON MEMBER<br />
RM 1,400<br />
GROUP NON MEMBER<br />
RM 1,350<br />
NON MEMBER<br />
RM 1,400<br />
GROUP NON MEMBER<br />
RM 1,350<br />
INTERNATIONAL<br />
USD 400<br />
GROUP INTERNATIONAL<br />
USD 380<br />
INTERNATIONAL<br />
USD 400<br />
GROUP INTERNATIONAL<br />
USD 380<br />
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