We ensure long term protection for your lifetime needs - AIA

aia.com.my

We ensure long term protection for your lifetime needs - AIA

PROTECTION

EXCELCARE PLUS & MEDICOVER PLUS

About AIA Bhd.

American International Assurance Bhd. (AIA Bhd.) began

operations in Kuala Lumpur, Malaysia in 1948 as a branch

of American International Assurance Company, Limited

(AIA). With over 60 years of local market presence, AIA

Bhd. has now become one of the country’s largest life

insurers, with a network of 23 branches nationwide. The

company’s focus is on designing new and innovative

products to meet the changing needs of the market. AIA

Bhd. is a member of the AIA Group.

About the AIA Group

AIA Group Limited and its subsidiaries (collectively “the AIA

Group” or “the Group”) comprise the largest independent

publicly listed pan-Asian life insurance group in the world,

with a broad footprint spanning 15 markets in Asia Pacific.

The Group traces its roots in the region back more than 90

years and has total assets of US$107.9 billion.

The AIA Group meets the protection, savings and

investment needs of individuals by offering a

comprehensive suite of products and services covering

accident and health insurance, life insurance and

retirement planning. It also provides employee benefits,

credit life and pension services to corporate clients.

The Group has operations in Hong Kong, Thailand,

Singapore, China, Malaysia, Korea, the Philippines,

Australia, Indonesia, Taiwan, Vietnam, New Zealand,

Macau, Brunei and India. It is a market leader in the Asia

Pacific region based on life insurance premiums, and holds

number one positions in six of its geographical markets.

AIA Group Limited is listed on the Main Board of The Stock

Exchange of Hong Kong Limited under the stock code ‘1299’.

Alor Setar

Wisma AIA

999 Jalan Telok Wanjah

05200 Alor Setar

Kedah Darul Aman

Tel: 04 - 735 5372

Fax: 04 - 731 9325

Batu Pahat

Wisma AIA

54A Jalan Rahmat

83000 Batu Pahat

Johor Darul Takzim

Tel: 07 - 431 1821

Fax: 07 - 433 1488

Bukit Mertajam

Wisma AIA

543 Jalan Sungai Rambai

14000 Bukit Mertajam

Seberang Perai

Tel: 04 - 538 6421

Fax: 04 - 538 9078

Ipoh

Wisma AIA

118 Jalan C M Yusuff

30250 Ipoh

Perak Darul Ridzuan

Tel: 05 - 255 7479

Fax: 05 - 255 9163

Johor Bahru

Wisma AIA

2 Jalan Bukit Timbalan

80000 Johor Bahru

Johor Darul Takzim

Tel: 07 - 227 8440

Fax: 07 - 223 7579

Klang

Ground Floor, Menara A&M

No 3, Jalan Istana

41000 Klang

Selangor Darul Ehsan

Tel: 03 - 3373 2367

Fax: 03 - 3371 7615

Kluang

Wisma AIA

230 Taman Kurnia

Jalan Mersing

86000 Kluang

Johor Darul Takzim

Tel: 07 - 774 5145

Fax: 07 - 772 0908

Kota Bharu

2nd and 3rd Floor

Lot 164, Section 8

Jalan Pintu Pong

15000 Kota Bharu

Kelantan Darul Naim

Tel: 09 - 747 3523

Fax: 09 - 747 0761

Kota Kinabalu

Wisma AIA

13 Jalan Karamunsing

88000 Kota Kinabalu

Sabah

Tel: 088 - 248 545

Fax: 088 - 221 775

Kuala Lumpur

Menara AIA

99 Jalan Ampang

50450 Kuala Lumpur

Tel: 03 - 2056 1111

Kuantan

Wisma AIA

103 Jalan Tun Ismail

25000 Kuantan

Pahang Darul Makmur

Tel: 09 - 517 8795

Fax: 09 - 515 7151

Kuching

Wisma AIA

216 Jalan Song Thian Cheok

93100 Kuching

Sarawak

Tel: 082 - 422 684

Fax: 082 - 245 408

Kulim

67-I Jalan Raya

09000 Kulim

Kedah Darul Aman

Tel: 04 - 495 9645

Fax: 04 - 491 2858

Melaka

Wisma AIA

96 Jalan Munshi Abdullah

75100 Melaka

Tel: 06 - 286 2364

Fax: 06 - 281 3088

Miri

Wisma AIA

Lot 663 Jalan Merbau

98000 Miri

Sarawak

Tel: 085 - 426 413

Fax: 085 - 414 355

Petaling Jaya

Level 3, Menara Axis

No 2, Jalan 51A/223

46100 Petaling Jaya

Tel: 03 - 7680 8686

Fax: 03 - 7680 8666

Pulau Pinang

Ground Floor

Wisma Leader

No 8, Jalan Larut

10050 Pulau Pinang

Tel: 04 - 222 6262

Fax: 04 - 222 6222

Sandakan

Wisma AIA

Block 30

Jalan Dua

90000 Sandakan

Sabah

Tel: 089 - 220 486

Fax: 089 - 218 308

Seremban

20 Jalan Dato' Lee Fong Yee

70000 Seremban

Negeri Sembilan

Darul Khusus

Tel: 06 - 763 5768

Fax: 06 - 764 4312

Sibu

17, 1st Floor

Jalan Bindang

(Brooke Drive 1)

96000 Sibu

Sarawak

Tel: 084 - 347 740

Fax: 084 - 343 900

Sungai Petani

Wisma AIA

8 Taman Patani Baru

Jalan Kampong Baru

08000 Sungai Petani

Kedah Darul Aman

Tel: 04 - 421 2327

Fax: 04 - 423 4257

Taiping

Wisma AIA

28 Jalan Long Jaafar

34000 Taiping

Perak Darul Ridzuan

Tel: 05 - 808 4845

Fax: 05 - 806 8988

Tawau

Wisma AIA,

TB 275 Block 29

Jalan Haji Karim

91000 Tawau

Sabah

Tel: 089 - 754 166

Fax: 089 - 752 949

We ensure long term

protection for your

lifetime needs

A medical protection plan that has invaluable hospitalisation

coverage till age 100 with an option to attach an unlimited overall

lifetime limit plan.

The Power of We

PT0810209

AIA Bhd. is licensed under the Insurance Act 1996

& regulated by the Central Bank (Bank Negara Malaysia).

AIA.COM.MY

Rev 0611


ExcelCare Plus & MediCover Plus 1

ExcelCare Plus / MediCover Plus

Hospitalisation and Surgical Insurance

What are ExcelCare Plus and MediCover Plus about?

ExcelCare Plus

Would you compromise the recovery of your loved ones by settling for less?

Few of us actually plan for hospitalization expenses. On top of that, with the rise in medical

inflation, this can easily bring medical expenses to ten-thousands of ringgit. The truth is, a

completely unforeseen and unavoidable operation can sometimes dry up our savings.

ExcelCare Plus provides for hospitalization and surgical expenses incurred and offers protection

up to age 100.

MediCover Plus

Worried that your basic ExcelCare Plus medical reimbursement lifetime limit may be insufficient

for you and your family’s long term medical needs?

As a dedicated child, parent or spouse, you would try to seek the best possible medical attention

available and for as long as possible. Your existing plan may be insufficient for a better and

longer term protection. As a result, the hard-earned savings meant for your family’s future will be

eroded.

With MediCover Plus rider, you can rest assure that your insurance is sufficient to cover you

and your family for life with minimal additional premium payable on top of your ExcelCare Plus

premium.

MediCover Plus provides for hospitalization and surgical expenses and offers higher protection

limits to complement ExcelCare Plus.

BENEFITS

What are the coverage / benefits provided?

ExcelCare Plus offers:

• A choice of medical reimbursement lifetime limit ranging from RM200,000 to as high as

RM700,000

• 24-hour protection

• Lifelong protection to age 100

• Zero co-insurance for claims within a specified amount 1

• Lower rates via the Family Plan

• Hassle-free assistance in your admission to the hospital via AIA Health Services 2

• Worldwide coverage 3


2

ExcelCare Plus & MediCover Plus

The schedule of benefits of Excelcare Plus is as follows:

Schedule of benefits of ExcelCare Plus

BENEFIT LIMITS

Per Policy Year

Hospital Daily Room & Board

(120 days)

Additional Hospital Room &

Board whilst Overseas 5 (120 days)

100 150 200 250 300 350

100 150 200 250 300 350

100 150 200 250 300 350

ICU (120 days)

Hospital Supplies and Services

Surgical Fees Benefit

Operating Theatre Fees Benefit

Reasonable and Customary charges up to

Co-insurance Free amount.

Balance exceeding Co-insurance Free amount up to

Annual Limit is further subject to Co-insurance.

Anaesthetist’s Fees Benefit

In-Hospital Physician’s Visit

(240 days maximum per policy year) 6

Pre-Hospitalization Benefit 7 (within

60 days prior to Hospitalization)

- Diagnostic Tests

- Specialist Consultation Benefit 8

Post-Hospitalization Treatment

Benefit 7

(within 60 days after hospitalization)

- Outpatient Diagnostic X-ray & Lab

Tests Benefit

- Medical Expenses & Consultation 8

Benefit including Acupuncture &

Physiotherapy

Day Procedure 9

Organ/Bone Marrow Transplant 10

(not subject to co-insurance)

Reasonable and customary charges up to Annual Limit


ExcelCare Plus & MediCover Plus 3

BENEFIT LIMITS

Per Policy Year

Daily Cash Allowance at Government

Hospital (120 days)

Daily Guardian Benefit (120 days)

Co-insurance Free Amount

per policy year 1

Annual Limit

100 150 200 250 300 350

40 45 50 55 60 65

60 90 110 130 160 190

15,000 22,000 25,000 28,000 33,000 36,000

60,000 90,000 115,000 140,000 165,000 190,000

Out Patient Benefits

Emergency Accidental Out-patient

Treatment & 30 days Follow-up

Treatment at Hospital & Clinic

1,500 2,000 2,500 3,000 3,500 4,000

Value Added Benefit

Emergency Evacuation Benefit

100,000 100,000 100,000 100,000 100,000 100,000

Per Lifetime

Out-patient Kidney Dialysis

Treatment Benefit

Out-patient Cancer Treatment Benefit

Overall Lifetime Limit

per Insured Person

30,000 40,000 50,000 60,000 70,000 80,000

10,000 12,500 15,000 17,500 20,000 22,500

200,000 300,000 400,000 500,000 600,000 700,000

Note: All amount shown are in Ringgit Malaysia


4

ExcelCare Plus & MediCover Plus

MediCover Plus additional benefits include:

• No lifetime limit 4

• High Cancer and Kidney Dialysis Treatment Limit

• Extended coverage for Post-Hospitalization Benefit

The schedule of benefits of MediCover Plus is as follows:

Schedule of benefits of MediCover Plus

BENEFIT LIMITS

Per Policy Year

Post-Hospitalization Treatment Benefit 7

(starting on the 61st day and within 120 days

after hospitalization)

Day Procedure 11

Co-insurance Free Amount

per policy year 1

Home Nursing Care (per Confinement)

(180 days lifetime limit)

Annual Limit

150 200 250 300 350

Reasonable and Customary charges up to

Co-insurance Free amount. Balance

exceeding Co-insurance Free amount up to

Annual Limit is further subject to Co-insurance.

Share with ExcelCare Plus and

limit remains unchanged

3,000 4,000 5,000 6,000 7,000

Share with ExcelCare Plus and

limit remains unchanged

Out-Patient Benefits

Emergency Accidental Out-Patient Dental

Treatment (per accident)

3,000 4,000 5,000 6,000 7,000

Value Added Benefit

Emergency Evacuation Benefit

400,000 400,000 400,000 400,000 400,000

Per Lifetime

Out-patient Kidney Dialysis Treatment Benefit

Out-patient Cancer Treatment Benefit

Overall Lifetime Limit per Insured Person

40,000 60,000 80,000 100,000 120,000

100,000 150,000 200,000 250,000 300,000

NA NA NA NA NA

Note: All amount shown are in Ringgit Malaysia


ExcelCare Plus & MediCover Plus 5

If you opt for ExcelCare Plus with MediCover Plus, please see the consolidated schedule below for

the benefits provided:

Schedule of combined benefits of ExcelCare Plus and MediCover Plus

BENEFIT LIMITS

Per Policy Year

150 200 250 300 350

Hospital Daily Room & Board

(120 days)

Additional Hospital Room &

Board whilst Overseas 5

(120 days)

150 200 250 300 350

150 200 250 300 350

ICU (120 days)

Hospital Supplies and Services

Surgical Fees Benefit

Operating Theatre Fees Benefit

Anaesthetist’s Fees Benefit

In-Hospital Physician’s Visit

(240 days maximum per policy year) 6

Pre-Hospitalization Benefit 7

(within 60 days prior to Hospitalization)

- Diagnostic Tests

- Specialist Consultation Benefit 8

Reasonable and Customary charges up to

Co-insurance Free amount.

Balance exceeding Co-insurance Free amount

up to Annual Limit is further subject to

Co-insurance.

Post-Hospitalization Treatment Benefit 7

(within 120 days after hospitalization)

- Outpatient Diagnostic X-ray & Lab

Tests Benefit

- Medical Expenses & Consultation 8

Benefit including Acupuncture &

Physiotherapy

Day Procedure 11

Home Nursing Care (per Confinement)

(180 days life time limit)

Organ/Bone Marrow Transplant 10

(not subject to co-insurance)

3,000 4,000 5,000 6,000 7,000

Reasonable and customary charges

up to Annual Limit


6

ExcelCare Plus & MediCover Plus

BENEFIT LIMITS

Per Policy Year

Daily Cash Allowance at Government Hospital

(120 days)

Daily Guardian Benefit (120 days)

Co-insurance Free Amount per policy year 1

Annual Limit

150 200 250 300 350

45 50 55 60 65

90 110 130 160 190

22,000 25,000 28,000 33,000 36,000

90,000 115,000 140,000 165,000 190,000

Out-Patient Benefits

Emergency Accidental Out-patient Treatment

& 30 days Follow-up Treatment at

Hospital & Clinic

Emergency Accidental Out-Patient Dental

Treatment (per accident)

2,000 2,500 3,000 3,500 4,000

3,000 4,000 5,000 6,000 7,000

Value Added Benefit

Emergency Evacuation Benefit

500,000 500,000 500,000 500,000 500,000

Per Lifetime

Out-patient Kidney Dialysis Treatment Benefit

Out-patient Cancer Treatment Benefit

Overall Lifetime Limit per Insured Person

80,000 110,000 140,000 170,000 200,000

112,500 165,000 217,500 270,000 322,500

NA NA NA NA NA

Note: All amount shown are in Ringgit Malaysia and please refer to the policy contract for full details

of the benefit coverage.

ELIGIBILITY

How ExcelCare Plus and MediCover Plus can be purchased?

ExcelCare Plus and MediCover Plus can be purchased as a premium paying rider attachable

to any non-participating plan. ExcelCare Plus can also be purchased as a standalone plan. Unit

deducting ExcelCare Plus and MediCover Plus can be purchased with investment-linked plans.

Am I eligible to apply for ExcelCare Plus and MediCover Plus?

This policy is available to individuals from 4 weeks to 60 years of age, subject to underwriting’s

approval. For Insured & Children and Family plans, children (dependants) between 2 weeks and

under 23 years of age, and who are in good health, are eligible.


ExcelCare Plus & MediCover Plus 7

Can I attach MediCover Plus to my ExcelCare Plus plan 100?

No, MediCover Plus is only available to plan 150 and above. You will need to upgrade your

ExcelCare Plus to plan 150 & above if you wish to enjoy the extra coverage provided by

MediCover Plus.

How do I apply?

Please talk to your AIA Agent. He or she will take you through the various application forms and

offer any help you need to complete them. Alternatively, you can call the AIA Customer Service

Hotline at 1300-88-1899 or visit any AIA branch. You will find a list of AIA branches in Malaysia on

the back of this document.

COVERAGE AMOUNT

What is the coverage amount for family members in a plan?

All family members covered under one policy will be covered for the same amount.

PREMIUMS

How much premium do I need to pay?

This will depend on your age, gender and type of plan which you choose, occupation and

condition of health. Please refer to Appendix 1 at the end of this brochure for the table of

premiums for a standard life.

How can I pay the premiums?

You should first ensure that this policy will best serve your needs and that the premium payable

under the policy is an amount that you can afford.

Premiums are payable in one of the following ways:

a) In cash or cheque. For payments in cheque, please make it payable to

“American International Assurance Bhd”.

b) Autopay:

i) Credit card

ii) Auto debit (HSBC, BSN and MBB)

c) Standing instruction

d) AIA Maybank Corporate Collection Account (AIA MCCA)

You may change the frequency of premium payments by submitting a written request. Subject

to our minimum premium requirements, premiums may be paid on an annually, semi-annually,

quarterly or monthly mode at the premium rates applicable on the Issue Date.

Please note that for auto debit, standing instruction or AIA MCCA payment methods, the following

additional conditions will apply:

• For payment made annually, semi-annually and quarterly: the first payment has to be payable in

cash or cheque.

• For payment made once a month: a minimum of first 2 payments have to be payable in cash or

cheque.

What is the minimum premium for ExcelCare Plus?

For ExcelCare Plus bought as a standalone plan, the minimum premium must be at least RM300

for any frequency of payment. However, this amount can be reduced to a minimum of RM75 if it

is bought together with another basic plan (term plan excluded).


8

ExcelCare Plus & MediCover Plus

If I have both ExcelCare Plus and MediCover Plus, do I still have to pay premiums when

my ExcelCare Plus lifetime limit has been reached?

So long as MediCover Plus is attached to the ExcelCare Plus plan, the ExcelCare Plus plan

will remain effective, even if the lifetime limit of ExcelCare Plus on its own has been reached.

The premium will continue to be payable and all the benefits under the ExcelCare Plus plan will

continue unchanged.

When do my premium payments end?

Premiums are payable until the expiry at age 100 or, until the cessation of premium paying

duration of the basic plan to which this rider is attached to, whichever is earlier. Benefits of

ExcelCare Plus and MediCover Plus will stop thereafter.

Can my premiums increase as I age?

Yes. The premium payable will depend on your attained age at the next birthday when the

premium is due.

When do I pay my renewal premiums?

We recommend that you pay each renewal premium before it is due. The latest you can pay each

renewal premium is 31 days from the due date. If we do not receive your renewal premium within

31 days of the due date, your cover will stop. Cessation of premium payment before the end of

the premium payment term will lead to an early termination of your coverage.

Is the premium for ExcelCare Plus and MediCover Plus guaranteed?

The premium rates are not guaranteed and the Company reserves the right to revise the rates

upon renewal. One of the possible factors contributing to the increase in premium rates is claim

experience.

The possible factors contributing to premium revision and renewal above are not exhaustive

and the premium rates may be reviewed under other justified circumstances. The Company

will give ninety (90) days’ prior notice in writing by ordinary post to your last known address in the

Company’s records if such revision takes place.

Past trends on the increase in premium rates do not necessarily reflect the future trend.

For unit deducting versions of the products, we charge insurance coverage charges that are

deducted monthly from the value of your units. The insurance charges will increase as you grow

older. Details of insurance charges are given in the sales illustration.

FEES & CHARGES

What are the fees and charges that I have to pay?

There are no fees and charges other than the premiums payable.


ExcelCare Plus & MediCover Plus 9

TERMS & CONDITIONS

What are some of the key terms and conditions that I should be aware of?

• Importance of disclosure – you must disclose all material facts such as medical condition, and

state your age correctly.

• Free-look period – you may cancel your policy by returning us the policy contract and giving us

a written notice that has been signed by you. Both written notice and policy contract must be

received by us within 15 days after you have received the policy contract. The premium that you

have paid (less any medical fee incurred) will be refunded to you.

• Grace period – you are given a grace period of 31 days from the due date for payment of each

subsequent premium. If premium remains unpaid at the end of this grace period, the policy

may lapse. Unless renewed, the coverage of this policy will cease and the insurance company

shall strictly not be liable for any expenses that takes place after the expiry date.

• Waiting period - you will have to wait for a specified duration (from the date your policy began

or last reinstatement date) before your coverage takes effect:

a) 120 days for tonsils, adenoids, hernia or a disease related to the female generative organs;

b) 60 days for Out-patient Cancer Treatment;

c) 30 days for Out-patient Kidney Dialysis and for all other illnesses.

Note:

This list is non-exhaustive. Please refer to the policy contract for the terms and conditions under

this policy.

EXCLUSIONS

What are the major exclusions to this plan?

This plan shall not cover:

a) Pre-existing illnesses;

b) Any medical or physical abnormalities existing at the time of birth, as well as neo-natal

physical abnormalities;

c) Self-inflicted injuries and illegal acts;

d) Wars, strikes or riots;

e) Any armed forces or military operations;

f) Pregnancy, miscarriage or child births;

g) Mental or nervous disorders;

h) Alcoholism and drug abuse or its related conditions;

i) Cosmetic, elective or plastic surgery;

j) Dental treatment unless necessitated by accidental injury;

k) Routine health checks and any investigations not directly related to admission;

l) Treatment which is not medically necessary;

m) Medical expenses which is payable by any laws, medical program or insurance policy;

n) The following exclusions are only applicable to Out-patient Cancer Treatment benefit:

i) All cancers which are histologically classified as pre-malignant; non-invasive; carcinoma;

in-situ; having either borderline malignancy; or having low malignant potential;

ii) All tumours of the prostate, thyroid and urinary bladder histologically classified as T1N0M0

(TNM classification);

iii) Chronic Lymphocytic Leukemia less than RAI Stage 3;

iv) All cancers in the presence of HIV;

v) Any skin cancer other than malignant melanoma;

o) Overseas treatment if Insured Person resides or travels outside Malaysia for more than 90

consecutive days;


10

ExcelCare Plus & MediCover Plus

p) Overseas protection if Insured is a foreigner;

q) Other additional exclusions that apply to specific benefits of MediCover Plus.

This list is non-exhaustive. Please refer to the policy contract for the full list of exclusions under

this policy. For a sample of the policy contract, please talk to your AIA agent.

COVERAGE

When does my coverage starts?

Your coverage starts from the date on which you completed and the signed application form is

approved by us and when we have received the full premium due.

Where am I covered?

You are covered worldwide but subject to a maximum of 90 days protection if you are traveling

overseas. If you are a foreigner, your coverage is confined to within Malaysia only.

Does this plan pay in addition to any other insurance policy that I may have?

No, we will only reimburse eligible medical expenses that have yet to be claimed by you.

What expenses are covered by the Emergency Medical Evacuation Benefit?

Expenses for the necessary transportation, medical services and medical supplies provided

and/or arranged by American International Assistance Services (AIAS) as a result of an

emergency medical evacuation are covered. All decisions as to the means of transportation and

the final destination will be made by AIAS, based solely on medical necessity.

Do I have to bear any of the expenses incurred for hospitalization?

ExcelCare Plus and MediCover Plus have a co-insurance free amount. You may need to pay

for certain portion of your hospitalization expenses if the cost exceeded the co-insurance free

amount. Eligible expenses exceeding the co-insurance free amount are subject to a co-insurance

of 90% payable by the Company and 10% payable by you. However, you will only be required to

pay up to a maximum of RM3,000 per policy year. Please refer to the example below:

Example:

Mrs. Chan is a 30 year-old store manager with ExcelCare Plus and MediCover Plus riders plan

150. During her check-up, she discovered a breast lump. One week later, she was hospitalized

to have the lump removed. Two weeks after being discharged, Mrs. Chan went back for a

follow-up visit.

Prior to her hospitalization, Mrs. Chan’s diagnostic bill came up to RM750. The actual

hospitalization bill totaled RM25,000. Her follow-up visit incurred a total bill of RM250 for

consultation and medication.

Expenses incurred for the entire treatment:

Stages of hospitalization Type of benefit Amount incurred

1. Pre-hospitalization: Diagnostic X-ray RM750

2. In-hospitalization: Hospitalization bill RM25,000

3. Post-hospitalization: Consultation and medication RM250

Total Cost

RM26,000


ExcelCare Plus & MediCover Plus 11

Based on the above expenses, please find the following breakdown on the amount claimable

under ExcelCare Plus and MediCover Plus 150 and that are borne by Mrs. Chan:

Total expenses incurred

Co-insurance Free Amount (borne by Company)

Total expenses subject to co-insurance

Co-insurance expenses borne by Mrs. Chan

Co-insurance expenses borne by Company

RM26,000

RM22,000

RM4,000

RM400 (10% of RM4,000)

RM3,600 (90% of RM4,000)

Hence, the total expense to be paid by Mrs. Chan is only RM400. The balance RM25,600 will be

covered under ExcelCare Plus and MediCover Plus.

Can I switch my ExcelCare Plus and MediCover Plus plans from a lower plan to a higher

plan, or vice versa?

It may not be advantageous to switch from one health plan to another, as you may be subject

to new underwriting requirements, full waiting period and applicable period for the exclusion of

specified illnesses of the new plans.

CANCELLATION

Can AIA cancel my policy based on my individual claims experience?

No.

Can I cancel my policy?

You may cancel your policy by giving a written notice to us. Upon cancellation, you are entitled to

a refund of a portion of your premium provided that you have not made a claim on the policy.

REINSTATEMENT

Can I reinstate my policy after it has lapsed?

Yes, you may reinstate your policy subject to company’s terms and conditions. You may be

required to provide health evidence to prove your insurability at the time of reinstatement.

CLAIMS

How do I make a claim?

You need to complete the relevant claims forms which you can obtain from your AIA agent, by

calling the AIA Customer Service Hotline at 1300-88-1899 or visit any AIA branch. You will find a

list of AIA branches in Malaysia on the back of this document.

What other documentation is required to be submitted together with the claim?

In addition to the relevant claims forms, we require additional medical reports (as listed at the

back of the claims form) to support the claim.

When do I have to notify AIA of a claim?

In the event of a claim, it is advisable that you notify us immediately + .

+ The notification period varies in accordance with the types of claim made. Please refer to the policy contract.


12

ExcelCare Plus & MediCover Plus

TAX RELIEF

Can I use the premiums paid for ExcelCare Plus and MediCover Plus for tax relief purposes?

This policy may qualify you for personal tax relief subject to the final decision of the Inland

Revenue Board.

INFORMATION

What do I need to do if there are changes to my contact details?

It is important that you inform us of any change in your contact details to ensure that all

correspondences reach you in a timely manner.

Where can I get further information?

About ExcelCare Plus & MediCover Plus

Should you require additional information on ExcelCare Plus and MediCover Plus or about any

other AIA insurance plans or riders, you can contact your AIA agent, call our AIA Customer

Service Hotline at 1300-88-1899 or by visiting any AIA branch nationwide. You will find a list of

AIA branches on the back of this document. You can also contact us via email by visiting

www.aia.com.my.

About Medical and Health Insurance

Should you require additional information about medical and health insurance, you may refer to

the insuranceinfo booklet on ‘Medical & Health Insurance’ available at all our branches or you

can obtain a copy from the insurance agent or visit www.insuranceinfo.com.my

NOTE:

1 10% co-insurance applies on claims in excess of the co-insurance free amount, subject to an

overall maximum co-insurance of RM3,000 per year.

2 All services are subject to eligibility and benefit limit of your plan.

3 This coverage applies only if your hospitalization occurs within the first 90 days of your

overseas stay. The treatment costs are paid according to those reasonably charged by a

hospital in Malaysia. For a foreigner, coverage is only provided within Malaysia.

4 Subject to annual limit continues to apply.

5 Applicable to countries in North America, the EC (European Community) and Japan only.

6 Subject to two consultations per day.

7 For each confinement.

8 Subject to one consultation per day.

9 Covered Day Procedure Schedule:

- Arthroscopy, Colonoscopy, Laparoscopy, Extracorporeal Shock Wave Lithotripsy, Cataract

surgery.

10 Limited to once per lifetime.

11 Covered Day Procedure Schedule:

- Adenoidectomy; Arthroscopy; Bone Marrow Aspiration and Biopsy; Cataract Surgery;

Cholecystectomy; Colonoscopy; Coronary Artery Catheterization; Cystectomy;

Cystourethroscopy; Diagnostic Dilatation and Curettage; Endolaser Venous Surgery;

Endoscopic Retrograde Cholangiopancreatography; Excision of Bunions; Excision of

Ganglion, Fibroma(s) and Breast Lump(s); Excision of Pterygium; Extracorporeal Shock

Wave Lithotripsy; Herniotomy / Herniorapphy; Insertion of Pacemaker; Insertion or Removal

of Ureteric J-Stent; Laparoscopic Endometrial Ablation; Laparoscopy; Marsupialisation

and drainage of Bartholin’s Cysts; Myringotomy or Myringoplasty; Reduction of Bone

Fracture(s); Release of Carpal Tunnel Syndrome (Carpal Tunnel Decompression); Release of

Dupuytren’s Contracture (Release of Trigger Finger); Removal of Cervical or Vaginal Polyps;

Removal of Nasal Polyps; Removal of Plate and Orthopedic Implants; Retinal Detachment

Surgery; Rubber Banding of Haemorrhoids; Stapling Haemorrhoidectomy; Tonsillectomy.


ExcelCare Plus & MediCover Plus 13

IMPORTANT NOTE:

YOU SHOULD SATISFY YOURSELF THAT THIS POLICY WILL BEST SERVE YOUR NEEDS.

THE EXCLUSIONS AND LIMITATIONS OF BENEFITS HIGHLIGHTED ARE NOT EXHAUSTIVE.

YOU SHOULD READ AND UNDERSTAND THE INSURANCE POLICY AND DISCUSS WITH THE

AGENT OR CONTACT THE INSURANCE COMPANY DIRECTLY FOR MORE INFORMATION.


14

ExcelCare Plus & MediCover Plus

ExcelCare Plus / MediCover Plus

Insurans Penghospitalan dan Pembedahan

Apakah itu ExcelCare Plus dan MediCover Plus?

ExcelCare Plus

Sanggupkah anda melihat yang tersayang terlantar sakit dengan memilih perlindungan yang

kurang?

Segelintir sahaja daripada kita yang merancang untuk perbelanjaan hospital. Tambahan pula,

dengan kenaikan inflasi perubatan, perbelanjaan perubatan boleh mencecah puluhan ribu ringgit.

Hakikatnya pembedahan yang langsung tidak dijangka dan tidak dapat dielakkan adakalanya

boleh mengeringkan simpanan kita.

ExcelCare Plus menyediakan perbelanjaan penghospitalan dan pembedahan serta menawarkan

perlindungan sehingga umur 100 tahun.

MediCover Plus

Bimbang had seumur hidup pembayaran ganti perubatan asas Excelcare Plus anda tidak

mencukupi untuk keperluan perubatan jangka panjang anda sekeluarga?

Sebagai anak yang berdedikasi, ibu bapa atau pasangan, anda akan cuba mencari perlindungan

perubatan yang sebaik mungkin untuk selama yang boleh. Pelan anda yang sedia ada mungkin

tidak memadai untuk perlindungan yang lebih baik dan bagi tempoh yang lebih panjang. Justeru

itu, wang simpanan hasil titik peluh anda untuk masa depan keluarga anda akan menyusut.

Dengan rider MediCover Plus, anda boleh pasti bahawa insurans anda mencukupi untuk

melindungi anda sekeluarga seumur hidup dengan premium tambahan minimum yang perlu

dibayar di samping premium ExcelCare Plus anda.

MediCover Plus menyediakan perbelanjaan penghospitalan dan pembedahan serta menawarkan

had perlindungan yang lebih tinggi untuk melengkapi ExcelCare Plus.

MANFAAT

Apakah perlindungan / manfaat yang disediakan?

ExcelCare Plus memberikan:

• Pilihan had seumur hidup pembayaran ganti perubatan daripada RM200,000 hingga setinggi

RM700,000

• Perlindungan 24 jam

• Perlindungan sepanjang hayat sehingga umur 100 tahun

• Ko-insurans sifar bagi tuntutan dalam amaun yang ditetapkan 1

• Kadar yang lebih rendah melalui Pelan Keluarga

• Bantuan bebas kerenah semasa kemasukan anda ke hospital melalui AIA Health Services 2

• Perlindungan di seluruh dunia 3


ExcelCare Plus & MediCover Plus 15

Jadual manfaat ExcelCare Plus adalah seperti berikut:

Jadual manfaat ExcelCare Plus

HAD MANFAAT

Setiap Tahun Polisi

Bilik Penginapan Harian Hospital

(120 hari)

Bilik & Penginapan Tambahan

Hospital Semasa Di Luar Negara 5

(120 hari)

100 150 200 250 300 350

100 150 200 250 300 350

100 150 200 250 300 350

Unit Rawatan Rapi (120 hari)

Bekalan dan Perkhidmatan Hospital

Manfaat Yuran Pembedahan

Manfaat Yuran Bilik Pembedahan

Manfaat Yuran Pakar Bius

Caj Munasabah dan Biasa Diamalkan sehingga

amaun Bebas Ko-insurans. Baki yang melebihi

amaun Bebas Ko-insurans sehingga Had

Tahunan akan tertakluk kepada Ko-insurans.

Lawatan Pakar Perubatan Dalam Hospital

(maksimum 240 hari setiap tahun polisi) 6

Manfaat Sebelum Penghospitalan 7

(dalam tempoh 60 hari sebelum)

- Ujian Diagnostik

- Manfaat Rundingan Doktor Pakar 8

Manfaat Rawatan Selepas Penghospitalan 7

(dalam tempoh 60 hari selepas

penghospitalan)

- Manfaat X-ray Diagnostik & Ujian

Makmal Pesakit Luar

- Manfaat Perbelanjaan Perubatan &

Rundingan 8 termaksuk Akupunktur &

Fisioterapi

Prosedur Harian 9

Pemindahan Organ/Sumsum Tulang 10

(tidak tertakluk kepada ko-insurans)

Caj Munasabah dan Biasa Diamalkan

sehingga Had Tahunan


16

ExcelCare Plus & MediCover Plus

HAD MANFAAT

Setiap Tahun Polisi

Elaun Tunai Harian di Hospital

kerajaan (120 hari)

Manfaat Penjaga Harian (120 hari)

Amuan Bebas Ko-insurans bagi

setiap tahun polisi 1

Had Tahunan

100 150 200 250 300 350

40 45 50 55 60 65

60 90 110 130 160 190

15,000 22,000 25,000 28,000 33,000 36,000

60,000 90,000 115,000 140,000 165,000 190,000

Manfaat Pesakit Luar

Rawatan Kecemasan Pesakit Luar

Akibat Kemalangan & Rawatan

susulan 30 hari di Hospital & Klinik

1,500 2,000 2,500 3,000 3,500 4,000

Manfaat Nilai Tambahan

Manfaat Pemindahan Perubatan

Kecemasan

100,000 100,000 100,000 100,000 100,000 100,000

Had Seumur Hidup

Manfaat Rawatan Dialisis Buah

Pinggang Pesakit Luar

Manfaat Rawatan Kanser

Pesakit Luar

Had Seumur Hidup Keseluruhan

setiap Orang Yang Diinsuranskan

30,000 40,000 50,000 60,000 70,000 80,000

10,000 12,500 15,000 17,500 20,000 22,500

200,000 300,000 400,000 500,000 600,000 700,000

Nota: Semua amaun ditunjukkan dalam Ringgit Malaysia


ExcelCare Plus & MediCover Plus 17

Manfaat tambahan MediCover Plus ialah:

• Tiada had seumur hidup 4

• Had yang Tinggi bagi Rawatan Kanser dan Dialisis Buah Pinggang

• Perlindungan diperluas untuk Manfaat Selepas Penghospitalan

Jadual Manfaat MediCover Plus adalah seperti di bawah:

Jadual Manfaat MediCover Plus

HAD MANFAAT

Per

Setiap Tahun Polisi

Manfaat Rawatan Selepas Penghospitalan 7

(bermula pada hari yang ke-61 dan dalam

tempoh 120 hari selepas penghospitalan)

Prosedur harian 11

Amaun Bebas Ko-insurans setiap tahun polisi 1

Rawatan Di Rumah (setiap Pengasingan)

(had seumur hidup 180 hari)

Had Tahunan

150 200 250 300 350

Caj Munasabah dan Biasa Diamalkan sehingga

amaun Bebas Ko-insurans.

Baki melebihi amaun Bebas Ko-insurans

sehingga Had Tahunan akan tertakluk

kepada ko-insurans.

Berkongsi dengan ExcelCare Plus

dan had kekal tidak berubah

3,000 4,000 5,000 6,000 7,000

Berkongsi dengan ExcelCare Plus

dan had kekal tidak berubah

Manfaat Pesakit Luar

Rawatan Pergigian Kecemasan Pesakit Luar

Akibat Kemalangan (setiap kemalangan)

3,000 4,000 5,000 6,000 7,000

Manfaat Nilai Tambahan

Manfaat Pemindahan Kecemasan

400,000 400,000 400,000 400,000 400,000

Had Seumur Hidup

Manfaat Rawatan Dialisis Buah Pinggang

Pesakit Luar

Manfaat Rawatan Kanser Pesakit Luar

Had Seumur Hidup Keseluruhan

setiap Orang Yang Diinsuranskan

40,000 60,000 80,000 100,000 120,000

100,000 150,000 200,000 250,000 300,000

Tiada Tiada Tiada Tiada Tiada

Nota: Semua amaun ditunjukkan dalam Ringgit Malaysia


18

ExcelCare Plus & MediCover Plus

Jika anda memilih ExcelCare Plus dengan MediCover Plus, sila rujuk kepada jadual gabungan di

bawah untuk manfaat yang diberikan:

Jadual manfaat gabungan ExcelCare Plus dan MediCover Plus

HAD MANFAAT

Setiap Tahun Polisi

P e r

150 200 250 300 350

Bilik & Penginapan Harian Hospital

(120 hari)

Bilik & Penginapan Tambahan Hospital

Semasa di Luar Negara 5

(120 hari)

150 200 250 300 350

150 200 250 300 350

Unit Rawatan (120 hari)

Bekalan dan Perkhidmatan Hospital

Manfaat Yuran Pembedahan

Manfaat Yuran Bilik Pembedahan

Manfaat Yuran Pakar Bius

Lawatan Pakar Perubatan Dalam Hospital

(maksimum 240 hari setiap tahun polisi) 6

Manfaat Sebelum Penghospitalan 7

(dalam tempoh 60 hari sebelum

Penghospitalan)

- Ujian Diagnostik

- Manfaat Rundingan Doktor Pakar 8

Caj Munasabah dan Biasa Diamalkan

sehingga amaun Bebas ko-insurans.

Baki yang melebihi amaun Bebas

ko-insurans sehingga Had Tahunan

akan tertakluk kepada Ko-insurans.

Manfaat Rawatan Selepas Penghospitalan 7

(dalam tempoh 120 hari selepas

penghospitalan)

- Manfaat X-ray Diagnostik Pesakit Luar &

Ujian Makmal

- Manfaat Perbelanjaan Perubatan &

Rundingan 8 termasuk Akupunktur &

Fisioterapi

Prosedur Harian 11

Rawatan Di Rumah (setiap Pengasingan)

(had seumur hidup 180 hari)

Pemindahan Organ/Sumsum Tulang 10 (tidak

tertakluk kepada ko-insurans)

3,000 4,000 5,000 6,000 7,000

Caj Munasabah dan Biasa Diamalkan

sehingga Had Tahunan


ExcelCare Plus & MediCover Plus 19

HAD MANFAAT

Setiap Tahun Polisi

Elaun tunai harian di Hospital Kerajaan

(120 hari)

Manfaat Penjaga Harian (120 hari)

Amaun Bebas Ko-insurans setiap tahun polisi 1

Had Tahunan

150 200 250 300 350

45 50 55 60 65

90 110 130 160 190

22,000 25,000 28,000 33,000 36,000

90,000 115,000 140,000 165,000 190,000

Manfaat Pesakit Luar

Rawatan Kecemasan Pesakit Luar Akibat

Kemalangan & Rawatan Susulan 30 hari di

Hospital & Klinik

Rawatan Pergigian Kecemasan Pesakit Luar

Akibat Kemalangan (setiap kemalangan)

2,000 2,500 3,000 3,500 4,000

3,000 4,000 5,000 6,000 7,000

Manfaat Nilai Tambahan

Manfaat Pemindahan Kecemasan

500,000 500,000 500,000 500,000 500,000

Had Seumur Hidup

Manfaat Rawatan Dialisis Buah Pinggan

Pesakit Luar

Manfaat Rawatan Kanser Pesakit luar

Had Seumur Hidup Keseluruhan setiap orang

Yang Diinsuranskan

80,000 110,000 140,000 170,000 200,000

112,500 165,000 217,500 270,000 322,500

Tiada Tiada Tiada Tiada Tiada

Nota: Semua amaun ditunjukkan dalam Ringgit Malaysia. Untuk maklumat penuh berkenaan

perlindungan manfaat, sila rujuk kepada kontrak polisi .

KELAYAKAN

Bagaimana ExcelCare Plus dan MediCover Plus boleh dibeli?

ExcelCare Plus dan MediCover Plus boleh dibeli sebagai rider pembayaran premium yang boleh

dilampirkan pada mana-mana pelan tanpa penyertaan. ExcelCare Plus juga boleh dibeli sebagai

pelan bersendirian. ExcelCare Plus dan MediCover Plus potongan unit boleh dibeli dengan pelan

berkaitan pelaburan.

Adakah saya layak memohon ExcelCare Plus and MediCover Plus?

Polisi ini boleh disertai oleh individu yang berumur daripada 4 minggu hingga 60 tahun,

tertakluk kepada kelulusan penajajaminan. Bagi pelan Insured & Anak dan pelan Keluarga, anak

(tanggungan) berumur di antara 2 minggu hingga di bawah 23 tahun dan sihat tubuh badan,

layak memohon.


20

ExcelCare Plus & MediCover Plus

Bolehkah saya melampirkan MediCover Plus pada ExcelCare Plus pelan 100?

Tidak, MediCover Plus hanya boleh dilampikan pada pelan 150 dan ke atas. Anda perlu menaik

taraf ExcelCare Plus anda kepada pelan 150 & ke atas jika anda ingin menikmati perlindungan

tambahan yang disediakan oleh MediCover Plus.

Bagaimana saya hendak memohon?

Sila hubungi ejen AIA anda. Beliau akan menjelaskan kepada anda butir-butir dalam

borang permohonan dan menawarkan bantuan yang anda perlukan untuk melengkapkannya,

ataupun anda boleh menghubungi Hotline Khidmat pelanggan AIA di talian 1300-88-1899 atau

mengunjungi mana-mana cawangan AIA. Senarai cawangan AIA di Malaysia boleh didapati di

belakang dokumen ini.

AMAUN PERLINDUNGAN

Apakah amaun perlindungan untuk ahli keluarga dalam sesuatu pelan?

Semua ahli keluarga yang dilindungi di bawah satu polisi akan dilindungi untuk amaun yang

sama.

PREMIUM

Berapakah premium yang perlu saya bayar?

Ini akan bergantung pada umur anda, jantina dan jenis pelan yang anda pilih, pekerjaan

dan keadaan kesihatan anda. Sila rujuk kepada Lampiran 1 pada penghujung Lembaran

Pendedahan Produk ini untuk jadual premium bagi hayat standard.

Bagaimana boleh saya membayar premium?

Anda hendaklah memastikan bahawa pelan ini menepati keperluan anda dan anda mampu

membayar amaun premium yang perlu dibayar di bawah polisi ini.

Premium boleh dibayar dengan salah satu cara berikut:

a) Secara tunai atau dengan cek. Bagi bayaran dengan cek, sila bayar atas nama “American

International Assurance Bhd.”.

b) Bayaran automatik:

i) Kad kredit

ii) Autodebit (HSBC, BSN dan MBB)

c) Arahan tetap

d) Akaun Kutipan Korporat AIA Maybank (AIA MCCA)

Bayaran premium anda boleh dibuat sekali setahun, dua kali setahun, empat kali setahun atau

sekali sebulan.

Sila ambil perhatian bahawa untuk autodebit, arahan tetap atau kaedah bayaran AIA MCCA,

syarat-syarat tambahan berikut akan dikenakan:

• Bagi bayaran yang dibuat sekali setahun, dua kali setahun dan empat kali setahun: bayaran

pertama hendaklah dibuat secara tunai atau dengan cek.

• Bagi bayaran yang dibuat sekali sebulan, minimum 2 bayaran pertama hendaklah dibuat

secara tunai atau dengan cek.

Berapakah premium minimum bagi ExcelCare Plus?

Bagi ExcelCare Plus yang dibeli sebagai pelan bersendirian, premium minimum mestilah

sekurang-kurangnya RM300 bagi mana-mana kekerapan bayaran. Walau bagaimanapun,

amaun ini boleh dikurangkan kepada minimum RM75 jika ia dibeli bersama dengan pelan asas

lain (tidak termaksuk pelan bertempoh).


ExcelCare Plus & MediCover Plus 21

Jika saya mempunyai ExcelCare Plus dan juga MediCover Plus, adakah saya masih perlu

membayar premium apabila had seumur hidup Excelcare Plus saya telah dicapai?

Selagi MediCover Plus dilampirkan pada pelan ExcelCare Plus, pelan ExcelCare Plus akan terus

berkuat kuasa meskipun had umur hidup ExcelCare Plus itu sendiri telah dicapai. Premium akan

terus perlu dibayar dan semua manfaat di bawah pelan ExcelCare Plus akan terus tidak berubah.

Bila bayaran premium saya berakhir?

Premium perlu dibayar sehingga tamat tempoh pada umur 100 tahun atau sehingga berakhirnya

tempoh bayaran premium pelan asas yang rider ini dilampirkan padanya, mana-mana yang

dahulu. Manfaat ExcelCare Plus dan MediCover Plus akan berhenti selepas itu.

Bolehkan premium saya meningkat mengikut umur saya?

Ya. Premium yang perlu dibayar akan bergantung pada umur tercapai anda pada hari jadi yang

berikutnya apabila premium genap tempoh.

Bilakah saya membayar premium pembaharuan saya?

Kami menasihatkan anda supaya membayar setiap premium pembaharuan sebelum ia

genap tempoh. Paling lewat anda boleh membayar setiap premium pembaharuan ialah

31 hari dari tarikh genap tempoh. Jika kami tidak menerima premium pembaharuan anda dalam

masa 31 hari dari tarikh genap tempoh itu, perlindungan anda akan terhenti. Pemberhentian

bayaran premium sebelum akhir tempoh bayaran premium akan menyebabkan penamatan awal

perlindungan anda.

Adakah premium bagi ExcelCare Plus dan MediCover Plus dijamin?

Kadar premium tidak dijamin dan Syarikat berhak menyemak kadar semasa pembaharuan.

Salah satu faktor yang boleh menyumbang kepada kenaikan kadar premium ialah pengalaman

tuntutan.

Faktor yang boleh menyumbang kepada semakan premium dan pembaharuan di atas adalah

tidak terperinci dan kadar premium boleh disemak dalam keadaan-keadaan lain yang wajar.

Syarikat akan memberi notis terdahulu dalam tempoh sembilan puluh (90) hari secara bertulis

melalui pos biasa ke alamat terakhir anda yang diketahui di dalam rekod Syarikat jika semakan

tersebut dibuat.

Trend kenaikan kadar premium pada masa yang lepas tidak semestinya menggambarkan trend

pada masa akan datang.

Bagi versi produk potongan unit, kami mengenakan caj perlindungan insurans yang dipotong

setiap bulan daripada nilai unit anda. Semakin usia anda meningkat caj insurans juga akan turut

meningkat. Butir-butir caj insurans diberikan dalam ilustrasi jualan.

YURAN DAN CAJ

Apakah yuran dan caj yang perlu saya bayar?

Tiada yuran dan caj lain selain jumlah premium yang dibayar.


22

ExcelCare Plus & MediCover Plus

TERMA DAN SYARAT

Apakah antara terma-terma dan syarat-syarat penting yang perlu saya ketahui?

• Kepentingan pendedahan – anda mesti mendedahkan semua fakta-fakta penting seperti

keadaan kesihatan dan menyatakan umur anda dengan betul.

• Tempoh percubaan – anda boleh membatalkan polisi anda dengan memulangkan kontrak

polisi anda berserta dengan notis bertulis yang anda tandatangani kepada pihak syarikat.

Notis bertulis serta kontrak polisi tersebut perlu diterima terus oleh kami dalam masa 15 hari

selepas anda menerima kontrak anda. Premium yang anda telah bayar (ditolak sebarang yuran

perubatan yang ditanggung) akan dipulangkan kepada anda.

• Tempoh ihsan – anda diberi tempoh ihsan selama 31 hari dari tarikh genap tempoh bagi

pembayaran setiap premium berikutnya. Jika premium tetap tidak dibayar pada akhir ihsan

polisi ini, polisi ini mungkin luput. Melainkan di perbaharui, perlindungan polisi ini akan terhenti

dan syarikat insurans tidak akan bertanggungjawab terhadap sebarang perbelanjaan yang

dibuat selepas tarikh tamat tempoh.

• Tempoh tangguh – anda perlu menunggu tempoh tertentu (dari tarikh polisi anda bermula atau

tarikh pemgembalian semula yang terakhir) sebelum perlindungan anda berkuat kuasa:

a) 120 hari bagi tonsil, adenoid, hernia atau penyakit berkaitan dengan organ pembiakan wanita;

b) 60 hari bagi Rawatan Kanser Pesakit Luar;

c) 30 hari bagi Dialisis Buah Pinggang Pesakit Luar dan bagi semua penyakit lain.

Nota: Senarai ini adalah tidak terperinci. Sila rujuk kepada kontrak polisi untuk terma-terma dan

syarat-syarat polisi ini.

PENGECUALIAN

Apakah pengecualian utama untuk pelan ini?

Pelan ini tidak melindungi:

a) Penyakit sedia ada;

b) Sebarang keabnormalan perubatan atau fizikal yang wujud semasa lahir, serta

keabnormalan fizikal neo-natal;

c) Kecederaan diri yang disengajakan dan tindakan yang menyalahi undang-undang;

d) Peperangan, mogok atau rusuhan;

e) Sebarang operasi angkatan bersenjata atau tentera;

f) Kehamilan, keguguran atau melahirkan anak;

g) Kecelaruan mental atau penyakit saraf;

h) Ketagihan alkohol dan penyalahgunaan dadah atau keadaan yang berkaitan dengannya;

i) Pembedahan kosmetik, elektif atau plastik;

j) Rawatan pergigian melainkan diperlukan kerana kecederaan akibat kemalangan;

k) Pemeriksaan kesihatan rutin dan sebarang penyiasatan yang tidak berkaitan secara

langsung dengan kemasukan ke hospital;

l) Rawatan yang tidak perlu dari segi perubatan;

m) Perbelanjaan perubatan yang untuknya pampasan atau pembayaran ganti peril dibayar di

bawah mana-mana undang-undang, program perubatan atau polisi insurans;

n) Keadaan berikut adalah dikecualikan daripada Manfaat Rawatan Kanser Pesakit Luar:

i) Semua kanser yang secara histologinya diklasifikasikan sebagai pramalignan, tidak

menyerang; karsinoma in situ; sama ada mempunyai risiko hampir malignan atau

mempunyai potensi malignan yang rendah;

ii) Semua tumor prostat, tiroid dan pundi kencing yang secara histologinya diklasifikasikan

sebagai T1N0M0 (klasifikasi TNM);

iii) Leukemia Limfositik Kronik yang kurang daripada RAI Tahap 3;

iv) Semua kanser akibat daripada HIV;

v) Sebarang kanser kulit selain daripada melanoma malignan;


ExcelCare Plus & MediCover Plus 23

o) Rawatan di luar negara jika orang yang diinsuranskan tinggal atau mengembara di luar

Malaysia selama lebih daripada 90 hari berturut-turut;

p) Perlindungan luar negara jika orang yang diinsuranskan adalah warga negara asing;

q) Pengecualian tambahan lain yang dikenakan kepada manfaat tertentu MediCover Plus.

Senarai ini adalah tidak terperinci. Sila rujuk kepada kontrak polisi untuk senarai penuh

pengecualian-pengecualian di bawah polisi ini. Untuk contoh kontrak polisi, sila hubungi ejen AIA anda.

PERLINDUNGAN

Bilakah perlindungan insurans hayat saya bermula?

Perlindungan anda bermula dari tarikh permohonan anda yang telah lengkap diisi dan

ditandatangani itu diluluskan oleh kami dan apabila kami menerima premium yang sewajarnya.

Di manakah saya dilindungi?

Anda dilindungi di seluruh dunia tetapi tertakluk kepada perlindungan maksimum 90 hari jika

anda mengembara ke luar negara. Jika anda adalah seorang warga negara asing, perlindungan

anda terhad dalam Malaysia sahaja.

Adakah pelan ini membayar di samping mana-mana polisi insurans lain yang saya

mungkin ada?

Tidak, kami hanya akan membayar ganti perbelanjaan perubatan layak sahaja yang belum

dituntut oleh anda.

Apakah perbelanjaan yang dilindungi oleh Manfaat Pemindahan Perubatan Kecemasan?

Perbelanjaan bagi pengangkutan, khidmat perubatan dan bekalan perubatan perlu yang

disediakan dan/atau diuruskan oleh American International Assistance Services (AIAS) akibat

pemindahan perubatan Kemalangan adalah dilindungi. Semua keputusan mengenai cara

pengangkutan dan destinasi akhir akan dibuat oleh AIAS, semata-mata berdasarkan

keperluan perubatan.

Adakah saya perlu menanggung sebarang perbelanjaan untuk penghospitalan?

ExcelCare Plus dan MediCover Plus mempunyai amaun bebas ko-insurans. Anda mungkin perlu

membayar bahagian tertentu daripada perbelanjaan penghospitalan anda jika kos ini melebihi

amaun bebas ko-insurans. Perbelanjaan layak yang melebihi amaun bebas ko-insurans adalah

tertakluk kepada ko-insurans 90% yang dibayar oleh Syarikat dan 10% dibayar oleh anda.

Walaubagaimanapun, anda akan hanya dikehendaki membayar sehingga maksimum RM3,000

setiap tahun polisi. Sila rujuk contoh berikut:

Contoh:

Puan Chan adalah seorang pengurus stor berumur 30 tahun yang menyertai ExcelCare Plus dan

rider MediCover Plus pelan 150. Semasa menjalani pemeriksaan kesihatan, beliau mendapati

terdapat ketulan pada payu daranya. Seminggu kemudian, beliau dimasukkan ke hospital untuk

menjalani pembedahan membuang ketulan itu. Dua minggu selepas keluar hospital, Puan Chan

kembali ke hospital untuk lawatan susulan.

Sebelum penghospitalan, bil diagnostik Puan Chan berjumlah RM750. Bil penghospitalan

sebenar berjumlah RM25,000. Lawatan susulannya menelan kos sebanyak RM250 untuk

rundingan dan ubat.


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Perbelanjaan yang terlibat bagi seluruh rawatan:

Peringkat penghospitalan Jenis manfaat Amaun terlibat

1. Sebelum Penghospitalan: X-ray diagnostik RM750

2. Semasa Penghospitalan: Bil hospital RM25,000

3. Selepas Penghospitalan: Rundingan dan ubat RM250

Jumlah kos

RM26,000

Berdasarkan perbelanjaan di atas, berikut ialah pecahan bagi amaun yang boleh dituntut di

bawah ExcelCare Plus dan MediCover Plus 150 dan amaun yang ditanggung oleh Puan Chan:

Jumlah perbelanjaan yang terlibat

Amaun Bebas Ko-insurans (ditanggung oleh Syarikat)

Jumlah perbelanjaan yang tertakluk kepada ko-insurans

Perbelanjaan ko-insurans ditanggung oleh Puan Chan

Perbelanjaan ko-insurans ditanggung oleh Syarikat

RM26,000

RM22,000

RM4,000

RM400 (10% daripada RM4,000)

RM3,600 (90% daripada RM4,000)

Jadi, jumlah perbelanjaan yang perlu dibayar oleh Puan Chan cuma RM400. Baki RM25,600 itu

akan dilindungi di bawah ExcelCare Plus dan MediCover Plus.

Bolehkah saya menukar pelan ExcelCare Plus dan MediCover Plus saya daripada pelan

yang lebih rendah kepada pelan yang lebih tinggi, atau sebaliknya?

Adalah tidak menguntungkan untuk bertukar daripada satu pelan kesihatan kepada pelan lain

kerana anda mungkin tertakluk kepada keperluan penajajaminan baru, tempoh tangguh penuh

dan tempoh yang dikenakan bagi pengecualian penyakit tertentu pelan baru itu.

PEMBATALAN

Bolehkah AIA membatalkan polisi saya?

Tidak.

Bolehkah saya membatalkan polisi saya?

Anda boleh membatalkan polisi anda dengan memberi notis bertulis kepada kami. Setelah

dibatalkan, anda berhak mendapat bayaran balik sebahagian daripada premium anda dengan

syarat anda tidak membuat tuntutan ke atas polisi.

PENGEMBALIAN SEMULA

Bolehkah saya mengembalikan polisi saya jika ia telah luput?

Ya, anda boleh mengembalikan semula polisi anda tertakluk pada terma-terma dan syarat-syarat

Syarikat. Anda mungkin diminta untuk mengemukakan bukti untuk membuktikan kebolehinsuransan

kesihatan anda pada saat penerimaan kembali.

TUNTUTAN

Bagaimana saya hendak membuat tuntutan?

Anda perlu melengkapkan borang tuntutan yang berkaitan yang boleh didapati daripada ejen

AIA anda, dengan menelefon Hotline Perkhidmatan Pelanggan AIA di 1 300-88-1899 atau

mengunjungi sebarang cawangan AIA di Malaysia dinyatakan di belakang dokumen ini.


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Apakah dokumen lain yang perlu diserahkan bersama tuntutan?

Di samping borang tuntutan yang diberikan, kami juga memerlukan laporan perubatan tambahan

(seperti yang dinyatakan di belakang borang tuntutan) untuk menyokong tuntutan.

Bilakah saya perlu memberitahu AIA mengenai tuntutan?

Sekiranya berlaku tuntutan, anda hendaklah memberitahu kami dengan segera + .

+ Tempoh pemberitahuan berbeza mengikut jenis tuntutan yang dibuat. Sila rujuk pada kontrak polisi.

PELEPASAN CUKAI

Bolehkah saya menggunakan premium yang telah dibayar untuk ExcelCare Plus and

MediCover Plus untuk tujuan pelepasan cukai?

Polisi ini boleh melayakkan anda mendapat pelepasan cukai perseorangan tertakluk kepada

keputusan muktamad Lembaga Hasil Dalam Negeri.

MAKLUMAT

Apa yang perlu saya lakukan jika butir-butir hubungan saya bertukar?

Adalah penting bagi anda memberitahu kami mengenai sebarang pertukaran butir-butir hubungan

anda bagi memastikan semua surat-menyurat sampai kepada anda tepat pada masanya.

Di mana saya boleh mendapatkan maklumat lanjut?

Mengenai ExcelCare Plus dan MediCover Plus

Sekiranya anda memerlukan maklumat tambahan mengenai ExcelCare Plus dan MediCover

Plus atau mengenai mana-mana pelan insurans atau rider AIA yang lain, anda boleh menelefon

Hotline Perkhidmatan Pelanggan AIA kami di 1300-88-1899 atau mengunjungi mana-mana

cawangan AIA di seluruh negara. Senarai cawangan AIA dinyatakan di belakang dokumen ini.

Anda juga boleh menghubungi kami melalui emel dengan melayari www.aia.com.my.

Mengenai Insurans Perubatan Dan Kesihatan

Sekiranya anda memerlukan maklumat tambahan mengenai insurans perubatan dan kesihatan,

anda juga boleh merujuk buku kecil insuranceinfo mengenai ‘Insurans Perubatan Dan Kesihatan’

yang boleh didapati di semua cawangan kami atau anda boleh mendapatkan satu naskah

daripada ejen insurans atau kunjungi www.insuranceinfo.com.my.

NOTA:

1 10% ko-insurans dikenakan bagi tuntutan yang melebihi amaun percuma ko-insurans, tertakluk

kepada ko-insurans maksimum keseluruhan RM3,000 setahun.

2 Semua perkhidmatan adalah tertakluk kepada kelayakan dan had manfaat pelan anda.

3 Perlindungan ini terpakai hanya sekiranya penghospitalan anda berlaku dalam tempoh

90 hari pertama anda berada di luar negara. Kos rawatan dibayar mengikut caj berpatutan

yang dikenakan oleh hospital di Malaysia. Bagi warga asing, perlindungan hanya disediakan

di Malaysia.

4 Sentiasa tertakluk kepada had tahunan.

5 Untuk negara-negara di Amerika Utara, EC (Komuniti Eropah) dan Jepun sahaja.

6 Tertakluk kepada dua perundingan sehari.

7 Untuk setiap kemasukan ke hospital.

8 Tertakluk kepada satu perundingan sehari.

9 Jadual Prosedur Harian Yang Dilindungi:

- Artroskopi, Kolonoskopi, Laparoskopi, Litotripsi Gelombang Kejutan Ekstrakorporeum,

pembedahan Katarak.

10 Terhad kepada sekali seumur hidup.


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ExcelCare Plus & MediCover Plus

11 Jadual Prosedur Harian Yang Dilindungi:

- Adenoidektomi; Artroskopi; Aspirasi dan Biopsi Sumsum Tulang; Pembedahan

Katarak; Kolesistektomi; Kolonoskopi; Pengkateteran Arteri Koronari; Sistektomi;

Sistouretroskopi; Pendilatan dan Pengkuretan Diagnostik; Pembedahan

Vena Endolaser; Kolangiopankreatografi Retrogred Endoskopi; Eksisi Bunion; Eksisi

Ganglion, Fibroma dan Gumpalan Payu Dara; Eksisi Pterigium; Litotripsi Gelombang

Kejutan Ekstrakorporeum; Herniotomi / Herniorafi; Insisi Perentak; Insisi atau Pembuangan

J-Sten Ureterik; Ablasi Endometrium Laparoskopi; Laparoskopi; Marsupialisasi dan Penyaliran

Sista Bartholin; Miringotomi atau Miringoplasti; Pengurangan Fraktur Tulang; Pelepasan

Sindrom Terowong Karpus (Penyahmampatan Terowong Karpus); Pelepasan Kontraktur

Dupuytren (Pelepasan Jari Membengkok); Pembuangan Polip Servikal atau Vagina;

Pembuangan Polip Hidung; Pembuangan Plat dan Implan Ortopedik; Pembedahan Pemisalah

Retina; Pengikatan Hemoroid dengan Gelung Getah; Hemoroidektomi Mengokot; Tonsilektomi.

NOTA PENTING:

ANDA HENDAKLAH MEMASTIKAN BAHAWA POLISI INI MENEPATI KEPERLUAN ANDA.

PENGECUALIAN DAN HAD-HAD MANFAAT YANG DITERANGKAN ADALAH TIDAK LENGKAP.

ANDA HENDAKLAH MEMBACA DAN MEMAHAMI POLISI INSURANS ITU DAN BERBINCANG

DENGAN EJEN ATAU MENGHUBUNGI TERUS SYARIKAT INSURANS UNTUK MAKLUMAT

LANJUT.


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