Medical and Surgical Insurance Scheme for Members of the MITDSA.

Medical and Surgical Insurance Scheme for Members of the MITDSA.

STRICTLY CONFIDENTIAL

Medical and Surgical Insurance Scheme for Members of the MITDSA.

TABLE OF CONTENTS

1. Table of Benefits 2. Scheme Conditions 3. Scheme Exclusions 4. Premium

STRICTLY CONFIDENTIAL

Medical and Surgical Insurance Scheme for Members of the MITDSA.

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SECTION A Hospital benefit Overall Annual Limit of Rs 50,000 Annual Extent of cover sub-limit per Insured Person (Rs) 1 In-hospital care a. b. c. d. Clinic Fees Surgical procedures Medical treatment Medical investigations and diagnostic procedures

100% of costs

50,000

Artificial Appliances

a. Pacemaker and artificial limbs, hearing aids as a result of accident or surgical operation b. Includes cochlear implants, auditory brain implants and implantable defibrillators c. Also includes dialysis machine, chemotherapy and radiotherapy

100% of costs

50,000

100% of costs

20,000

100% of costs

50,000

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Medical and Surgical Insurance Scheme for Members of the MITDSA.

Physiotherapy

Treatment illness/surgical road accidents

following operations and

100% of costs

10,000

Overall limit of refund under Section A Refund shall be limited in any one annual period of insurance in respect of any one Insured Person to Rs 50,000. SECTION B Day-to-day benefit Overall Annual Limit of Rs 15,000 Annual Extent of cover sub-limit per Insured Person (Rs) 1 Out-patient care a. GPs & specialists consults and 80% of costs for each Visits illness/accident b. Prescribed medicines 80% of costs for each illness/accident 80% of costs for each illness/accident 80% of costs

6,000

c. Investigations and diagnostic procedures d. Optical costs, being cost of glasses or contact lenses, excluding sunglasses. 2 Dentistry

4,000

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Medical and Surgical Insurance Scheme for Members of the MITDSA.

Includes fillings, extractions, Xrays, orthodontic treatment, crowns and dental implants. 3 Artificial appliance Cost of hearing aids as a result of illness 4 Normal Delivery

80% of costs

6,000

80% of costs 100% of costs

3,000 10,000

Overall limit of refund under Section B Refund shall be limited in any one annual period of insurance in respect of any one Insured Person to Rs 15,000.

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Medical and Surgical Insurance Scheme for Members of the MITDSA.

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Scheme Conditions
1.1. Each member shall be eligible for full benefits immediately in respect of accidents and, in respect of sickness, two months after joining the Scheme. For child delivery, no refund shall be made during the first 10 months of the Scheme. 1.2. 1.3. 1.4. Entry to the Scheme is irrevocable during the policy year of the Scheme. Claims must be submitted on forms prescribed by the Company. Each claim must be supported by appropriate original documents

(e.g, Pharmacys bill, doctors prescription, clinics bill & nature of illness /complaint / treatment as certified by the medical practitioner) setting full details of expenses incurred. 1.5. The choice of the physician / surgeon is left entirely to the Insured, but the Company reserves the right to obtain any material information and to have the Insured examined by a doctor of its choice in the company of the treating doctor. 1.6. Claims must be submitted within 90 days of the consultation date, but within 10 days after the expiry date of the Scheme.

1.7.

Members joining the Scheme after the commencement date, shall be eligible to join the Scheme on the 1st day of a month and the limits and premium for these members will be calculated on a pro-rata basis.

1.8.

Refund of expenses incurred for medicines and drugs will only be considered if prescribed by registered medical practitioners.

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Medical and Surgical Insurance Scheme for Members of the MITDSA.

1.9.

Claims in respect of spectacle frames and/or lenses shall be refunded for first-time users only. Replacement of frames and/or lenses of identical power shall be considered after a period of 3 years.

1.10. All reimbursement of expenses covered under the Scheme will be made in Mauritian currency. 1.11. Any amendment in the terms and conditions of this Rule will be made by Addendum or by correspondence, subject to the approval of the Mauritius Revenue Authority.

Eligibility of Membership
Every employee and his/her dependants shall be eligible to join the Scheme provided that the employee is aged not less than 18 years and not more than 65 years on joining the Scheme and that he/she is not a member of another Medical Insurance Scheme.

Benefits
The amount refundable will be equal to 80% of the expenses incurred subject to the limits per item in the Table of Benefits, subject to an excess of Rs 100. However, in the case of surgical interventions, the refund will consist of 100% of expenses incurred subject to the limits per item as specified in the Table of Benefits.

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Medical and Surgical Insurance Scheme for Members of the MITDSA.

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Scheme Exclusions
The Company shall not be liable for Medical or Surgical expenses in respect of: 1.12. Preventive treatment. 1.13. Cost of sunglasses. 1.14. Scaling and cost of precious metal in dental treatment. 1.15. More than one months supply of any medicine or drug on any one prescription. 1.16. Chronic and recurrent illness. 1.17. Hypertension, diabetes and heart-related disease. 1.18. Attempted suicide whether the member is sane or insane. 1.19. The intake of drugs or intoxicating liquid unless administered on medical advice. 1.20. The commission or attempt by the member to commit any assault or felony or taking part by the member in any illegal occupation.

1.21. Injury intentionally self-inflicted. 1.22. Plastic surgery unless such surgery is necessitated as a result of an accident or sickness covered by the Scheme. 1.23. Surgery performed with a view to remedying congenital infirmities or malformations. 1.24. Mental disease, epilepsy, infertility and insanity. 1.25. Venereal disease or any other sexually transmitted diseases or their sequelae and any condition directly or indirectly caused or arising from or in any way attributable to or aggravated by or related to the Human Immunodeficiency Virus (HIV), or the mutants, derivatives or variants thereof, including Acquired Immuno Deficiency Syndrome (AIDS) and AIDS-Related Complex (ARC). 1.26. Injury or sickness arising directly or indirectly from war (whether declared or not), direct participation in strike, act of foreign enemy, riot and civil commotion, revolution insurrection or military or usurped power.
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Medical and Surgical Insurance Scheme for Members of the MITDSA.

1.27. Injury or sickness directly or indirectly due to mountaineering (with the use of ropes or guides), scuba diving, skiing, tobogganning, bobsleighing or participating in speed or endurance tests or races of any kind (other than athletics and sailing within 10 miles from the coast of Mauritius). 1.28. Boxing or scuffles, except in case of self-defence. 1.29. Air travel other than as a fare-paying passenger by a regular scheduled airline service. 1.30. Travelling expenses of any kind except ambulance fees. 1.31. Treatment received in health hydros, nature cure clinics or similar establishments or private beds registered as a nursing home attached to such establishments. 1.32. Treatment for alcoholism, solvent abuse, drug abuse or addictive conditions of any kind and treatment of any illness or injury arising directly or indirectly from any such abuse or addiction. 1.33. Ionising radiation or contamination by radioactivity from any nuclear waste from the combustion of nuclear fuel.

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Medical and Surgical Insurance Scheme for Members of the MITDSA.

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4. Premium

The monthly premium per member / dependant for the first year shall be Rs 725.00 Monthly premium for subsequent years shall be subject to claims experience.

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