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2014

Introduction To Artificial
Intelligence

EMGS Medical Insurance


Expert System
Submitted To:
Ms.
VINOTHINI KASINATHAN

Emad Afaq Khan (TP030460)


Sree Prakash (TP032890)
Omar Abdullah (TP031102)

Intake Code: UC1F1308-SE


Submission Date: 03/06/2014
Module Code: CT017-3-1-IAI

Acknowledge:

Maybe the only significant difference between a really smart simulation and a human being
was the noise they made when you punched them.

I would like to thank Ms. Vino, our lecturer, for sharing her knowledge about Introduction to
Artificial Intelligence

I would also like to thank APU for providing great quality of Education.

Contents
Acknowledge: ............................................................................................................................ 2
Introduction ................................................................................................................................ 4
The Proposal .............................................................................................................................. 5
Implementation of the Project:............................................................................................... 5
Expert Suitability: .................................................................................................................. 5
Need For the Expert System: ................................................................................................. 6
User Level: ............................................................................................................................. 6
Problem Specification ................................................................................................................ 7
The Aim of the Expert System: ............................................................................................. 7
Domain Expert: ...................................................................................................................... 8
The Project Team: .................................................................................................................. 8

Sree Prakash ................................................................................................................ 8

Emad Afaq Khan ......................................................................................................... 8

Omar Abdullah ............................................................................................................ 8

Knowledge Acquisition ............................................................................................................. 9


Interview with the Domain Expert:........................................................................................ 9
Summary of the Interview/Findings: ................................................................................... 10
Knowledge Representation ...................................................................................................... 11
Semantic Nets: ..................................................................................................................... 11
Test Plan/Screenshots .............................................................................................................. 12
Conclusion ............................................................................................................................... 28
References ................................................................................................................................ 29
Appendices ............................................................................................................................... 30
The Source Code of the Verbot: .......................................................................................... 30
Work load Matrix:................................................................................................................ 48

Introduction

Since past 10 years, a very large amount of students are coming to Malaysia for studies. And
the Malaysian government is leaving no stone unturned to make this place good for the
students and provide high quality services for their safety and health. Many students want to
have high quality education with internationally recognized degrees. So to take care of them
in the health department a new insurance system was introduced called as Education
Malaysia Global Services Insurance. This insurance is made compulsory for the students as it
is the best service for the insurance available. In this EMGS students are to pay some
premium amount every year for the insurance. If a student is injured or sick or needs an
operation then the EMGS will pay for them and makes it easy for the student to get treated. It
also covers some of the following areas:

Medicines

Medical Expenses

Stays in the Hospital due to any reason etc

But all of these things might not be covered in one package. Thats why they have packages
and policies. And depending upon those packages, areas are covered.
When a student goes to a hospital then it is due to some of the reasons mentioned above and
the insurance policy of EMGS covers things such as:

Operations

Nursing care

Doctors fees

Pathology

Test for diagnosing a problem

Hospital accommodation

Pre and Post hospitalization expenses

Therefore an expert system is made using Verbot to facilitate students in the university and
let them know what EMGS actually is, the policies and packages in the EMGS. Just to
summarize to create awareness and help students get all the information about EMGS.

The Proposal

Implementation of the Project:

A student who needs to acquire any investigation with respect to the EMGS medical inside
APU and additionally the system gives extensive variety of data on how EMGS Medical
Insurance is handled. It likewise permits the client to communicate with the expert system.
It really works when any student stops by and requests any request with respect to the EMGS
Insurance plan and basically the expert system answers him/her in an enlightening and
benevolent way.

Expert Suitability:

A great deal of universal students face issues in regards to their medicinal protection and with
system they will have the capacity to get all the responses and clear their disarrays.

This venture has the accompanying modules:

Completely coordinated Expert Systems

Different yield and information sorts

Expert system programming

The System ready to give any data needed to the EMGS Insurance process.

Need For the Expert System:

We have manufactured this expert system to make it less demanding for students around the
college acquire wide information in a shrewd manner. We made our expert system to present
another method for robotic communication with a correct stream of information that is given
to the user in a benevolent manner.
Our principle aim is to satisfy all the obliged information and subtle elements of how the
medical insurance arrangement is transformed. EMGS Medical insurance is a standout
amongst the most vital administrations given by universitys inside and out the world,
particularly for non-natives, on the grounds that as long as they leave their nations for the
purpose of instruction and venture into the university, here is the place, the complete
obligation of the college goes the distance, whereby they have to verify that all the students
are well protected inside and outside the college.
Then again, we from our spot we have concocted our expert system to verify the EMGS
medical insurance arrangement is overall worked and oversaw and surely to secure
everything the needs to be in charge of such a condition.
In this manner this expert system is completely occupied with all the information and fine
elements needed to be supplanted as a source of perspective to the EMGS Medical Insurance,
therefore, in this case we have invested exertion to think of, for example, a system to verify
that the information is accessible at all energy.

User Level:

This is on the grounds that the expert system we have created is a benevolent system through
which any user (novice) can cooperate with the expert system and without any difficulty,
which makes our expert system special.

Problem Specification

The Aim of the Expert System:

We have constructed this expert system to make it simpler for students around the college
acquire wide information in a keen manner. We made our expert system to present another
method for robotic communication with a precise stream of information that is given to the
user in a benevolent manner.
Our fundamental aim is to satisfy all the obliged information and points of interest of how the
medical insurance plan is prepared. Medical insurance plan is a standout amongst the most
critical administrations given by college's inside and out the world, particularly for outsiders,
on the grounds that as long as they leave their nations for the purpose of training and venture
into the university, here is the place the complete obligation of the university delivers the
goods, whereby they have to verify that all the students are well protected inside and outside
the college.
Then again, we from our spot we have thought of our expert system to verify the EMGS
Medical insurance plan is generally operated and managed and surely to get everything the
needs to be in charge of such a condition.
Consequently this expert system is completely occupied with all the information and points
of interest needed to be supplanted as a kind of perspective to the EMGS Medical insurance,
so this case we have invested exertion to concoct, for example, a system to verify that the
information is available at all energy.

Domain Expert:

Our domain expert was Mr. Tay. He is the person who helped us with all the information
about the EMGS Medical insurance plan. And all the information given by him was in point
of interest and extremely valuable.
First of all a meeting was set with him and accumulate everything, the needed information for
our information base.
He was so agreeable with us, and he wasn't egotistical about any points of interest that he had
in regards to the EMGS Insurance plan.
Finally we initially demonstrated to him the inquiries we ready for the question, with the goal
that we can check whether he is fine with it or not, and surely he acknowledged to answer the
greater part of the inquiries given by us. And one more thing he and even our lecturer
mentioned was that a lot of information about the EMGS is available on their official website
and it helped us create a really big knowledge database for the expert system.

The Project Team:


Everyone in the team has worked really hard to achieve and ace the assignment. This
assignment is a great example of team work and managing a great deal of work efficiently.
Our team consisted of:

Sree Prakash (Group leader/Programmer)


Sree is the group leader for the assignment and also the Verbot programmer. He was
the one supervising everyone too and set up a great example of a group leader.

Emad Afaq Khan (Knowledge Engineer)


Emad is responsible for the gathering of knowledge, setting up meetings and
documentation.

Omar Abdullah (Knowledge engineer)


Omar along with Emad gathered knowledge and was passed to the group leader Sree
for the programming and Sree worked really hard on the system.

Knowledge Acquisition

Interview with the Domain Expert:

Q1. How can one apply for the EMGS Medical Insurance?
A. You are required to apply for a student pass through APU and APU will submit student
pass applications to EMGS on behalf of international students.

Q2. When will I get the Insurance card?


A. You will get the card after a month once you arrive here.

Q3. Is there any age limit for the student for the insurance?
A. The age limit is from 18 to 65 years old.

Q4. How long is the period for the insurance?


A. The Department of Immigration issues Student Passes for a maximum of 12 months or if
the course duration is less than 12 months the Pass will be for the duration of the course.

Q5. Is there more than one option for insurance packages?


A. Yes, there are 3 packages which is the Silver, Gold and Platinum package. Each of it has a
different maximum limit and insurance premium.

Q6. Is there any geographical limit for this insurance?


A. All benefits provided in this Policy are applicable worldwide for twenty-four (24) hours a
day.

Q7. If I want to get treated overseas, does my insurance still cover me?
A. Yes, if the Insured Person elects to or is referred to be treated outside Malaysia by the
Attending Physician, 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.

Q8. What are the costs of payments for doctor visits?


A. It is 50 RM for the visit.

Q9. If I am overseas, vacationing or staying with my family, does the insurance still cover
me?
A. No. There is no benefit whatsoever shall be payable for any medical treatment received by
the Insured outside Malaysia, if the Insured resides or travels outside Malaysia for more than
ninety (90) consecutive days.

Q10. Who do I call if I have questions about the student health insurance plan?
A. 24/7 medical and health insurance helpdesk is available to provide assistance to foreign
students. The contact information is available on the EMGS website.

Summary of the Interview/Findings:

The researchers have found sufficient information regarding EMGS Medical and Health
Insurance from the domain expert. The domain expert has given us the EMGS website link
where all the information is located. All the relevant information regarding EMGS and
EMGS Medical and Health Insurance was found on the website.

Knowledge Representation

Semantic Nets:

Figure 1 Semantic Nets

Test Plan/Screenshots
1. Main Menu

2. Medical and health insurance packages

a. Silver package

b. Gold package

c. Platinum package

3. General terms and conditions


a. Preview

b. Portions of full list

4. Insurance Policy

a. Group Hospital & Surgical Policy For International Students & Dependants

b. General Policy Definitions

c. Policy Exclusion

d. Policy Conditions

5. Eligibility and Scope

a. Person Eligible

b. Addition of insured persons

c. Conditions for obtaining insurance

d. Geographical territory

e. Overseas treatment

f. Oversea residence

6. Benefits
a. Preview

b. Portions of full list

7. EMGS

8. Online Resources

Conclusion

The Group planned and assembled this expert system to help the students in APU to know all
the information they need with respect to the EMGS Medical insurance. Really taking shape
of our expert system we utilized Verbot. Verbot is an expert system requisition that has an
interface like a visit box, where there is a female addressing present the expert system to the
users, and asks users to sort user's name in a container, and then it will give a criticism by
talking and reacting back in the response box.
This Expert system comprises of three components that are of

Information base,

User interface

Surmising Motor

Thusly the learning base we got from the information that we got structure sites and believer
it into a group of information and information. In this expert system the users can get an
extensive variety of helpful information of how to utilize such an expert system. Hence we
can say that now students wont have any problem in knowing the unknown about the EMGS
Medical Insurance.

References

Andrew, A. (1983). Artificial intelligence. 1st ed. Tunbridge Wells, Kent: Abacus Press.
Harris, M. (2011). Artificial intelligence. 1st ed. New York: Marshall Cavendish
Rich, E. (1983). Artificial intelligence. 1st ed. New York: McGraw-Hill.

Appendices

The Source Code of the Verbot:


KnowledgeBase Name: C:\Users\Jonathan Michael\Documents\Verbots\Assignment.vkb
KnowledgeBase Version: 1.0
KnowledgeBase Build: 29
KnowledgeBase Info:
Author:
Author's Website:
Copyright:
License:
Creation Date: 29/5/2014 11:06:43 PM
Last Update Date: 3/6/2014 5:39:19 PM
Rating: Unknown
Rating Description:
Category: Other
Language: English
Comment: Describe your KnowledgeBase here
ResourceFiles:
Default.vsn
Default.vrp
Rules:
Rule Name: _startup
Input Text: _startup
Input Text: menu
Output Text: Hi, my name is Monica and I am here to assist you with any queries you have regarding EMGS Medical
and Health Insurance for APU students.
To begin, please key in the number from the following topics:
1. Medical and health insurance packages
2. General terms and conditions
3. Insurance Policy
4. Eligibility and Scope
5. Benefits
6. EMGS
7. Online Resources
8. Exit
Hint: Type "menu" anytime to return back to this menu.
Rule Name: menu
Input Text: menu
Output Text: <send menu>
Rule Name: 1. Medical and health insurance packages
Input Text: 1
Input Text: Medical and health insurance packages
Input Text: packages
Input Text: package
Input Text: one
Input Text: 1st
Input Text: first
Input Text: 1. Medical and health insurance packages
Output Text: There are 3 types of medical and health insurance packages made available for foreign students as
follows:
1. Silver package
2. Gold package
3. Plantinum package
Please select one based on their number.
Type 'menu" to return to the main menu.
Rule Name: 2. Gold

Input Text: 2
Input Text: gold
Input Text: gold package
Input Text: second
Input Text: 2nd
Input Text: two
Input Text: 2. Gold
Output Text: For the gold package:
Maximum limit per disability:
RM30,000
Insurance premium per annum (Aged >=18 but <= 60): RM750
Insurance premium per annum (Aged >60 but <= 65):
RM2800
Type "back" to return to the previous menu.
Type "menu" to return to the main menu.
Rule Name: back
Input Text: back
Output Text: <send 1. Medical and health insurance packages>
Rule Name: 3. Platinum
Input Text: Platinum
Input Text: 3
Input Text: three
Input Text: 3rd
Input Text: third
Input Text: platinum package
Input Text: 3. Platinum
Output Text: For the platinum package:
Maximum limit per disability:
RM50,000
Insurance premium per annum (Aged >=18 but <= 60): RM850
Insurance premium per annum (Aged >60 but <= 65):
RM3800
Type "back" to return to the previous menu.
Type "menu" to return to the main menu.
Rule Name: back
Input Text: back
Output Text: <send 1. Medical and health insurance packages>
Rule Name: 1. Silver
Input Text: 1
Input Text: silver
Input Text: silver package
Input Text: 1st
Input Text: one
Input Text: first
Input Text: 1. Silver
Output Text: For the silver package:
Maximum limit per disability is RM20,000.
Insurance premium per annum for those 18 to 60 years old is RM500.
Insurance premium per annum for those above 60 to 65 years old is RM2,150.
Type "back" to return to the previous menu.
Type "menu" to return to the main menu.
Rule Name: back
Input Text: back
Output Text: <send 1. Medical and health insurance packages>
Rule Name: 2. General terms and conditions
Input Text: 2
Input Text: terms and conditions
Input Text: general terms and conditions
Input Text: second
Input Text: 2nd
Input Text: two
Input Text: 2. General terms and conditions
Output Text: This is a preview of General Terms and Conditions:
Cashless for inpatient medical treatment at network hospitals in Malaysia and full reimbursement for
inpatient medical treatment at non-network hospitals in Malaysia, up to the maximum limit cover per
annum
Full reimbursement for outpatient treatment less deductible of RM50 per visit in accordance with

schedule of benefits
The insurer is connected to more than 70 hospitals and 2,000 clinics in Malaysia
Type "more" for the full terms and conditions.
Type "menu" to return back to the main menu.
Rule Name: more
Input Text: more
Output Text: Here is the full list of General Terms and Conditions:
Cashless for inpatient medical treatment at network hospitals in Malaysia and full reimbursement for
inpatient medical treatment at non-network hospitals in Malaysia, up to the maximum limit cover per
annum
Full reimbursement for outpatient treatment less deductible of RM50 per visit in accordance with
schedule of benefits
The insurer is connected to more than 70 hospitals and 2,000 clinics in Malaysia
Insurance cover commences from the date of entry. In the event that the foreign students applied in
Malaysia, they will be covered from the date of Visa Approval Letter (VAL)
No health declaration is required upfront for foreign students to obtain medical and health insurance
cover but they are required to attend a medical screening in Malaysia within 7 working days from the
date of entry or the date of VAL if the students applied in country
DOWNGRADE of insurance package is NOT ALLOWED but foreign students are allowed to UPGRADE
his/her insurance package and the insurance company reserves the right not to cover for pre-existing
conditions that are currently covered in the existing insurance package. The additional insurance
premium for UPGRADE of insurance package can only be determined after the upgrade request is
made to EMGS
Medical card will be made available within 14 working days from the date of insured
Insurance claims reimbursement will be processed within 14 working days from the date of claim
submitted with complete documents
24/7 medical and health insurance helpdesk is available to provide assistance to foreign students
Type "back" to return to the previous menu.
Type "menu" to return to the main menu.
Rule Name: back
Input Text: back
Output Text: <send 2. General terms and conditions>
Rule Name: 3. Insurance Policy
Input Text: 3. Insurance Policy
Input Text: 3rd
Input Text: 3
Input Text: third
Input Text: three
Input Text: Insurance
Input Text: Insurance Policy
Output Text: Here is a list of Insurance Policy:
Choose one of the options below.
1. Group Hospital & Surgical Policy For International Students & Dependants
2. General Policy Definitions
3. Policy Exclusion
4. Policy Conditions
Type "menu" to return to the main menu.
Rule Name: 1. Group Hospital & Surgical Policy For International Students & Dependants
Input Text: 1st
Input Text: 1
Input Text: one
Input Text: 1. Group Hospital & Surgical Policy For International Students & Dependants
Input Text: Group Hospital & Surgical Policy For International Students & Dependants
Output Text: Choose from this list below:

1. Important Notice
2. How Your Insurance Operates
Type "back" to return back to the previous menu.
Type" menu" to return back to the main menu.
Rule Name: 1. Important Notice
Input Text: 1
Input Text: one
Input Text: 1st
Input Text: first
Input Text: important notice
Input Text: 1. important notice
Output Text: IMPORTANT NOTICE
Welcome to your Group Hospital & Surgical Policy.
Please read this Policy carefully together with your Schedule to ensure that you understand the terms and
conditions and that the cover you require is being provided.
If you have any questions after reading this document, please contact your insurance advisor or AXA AFFIN
GENERAL INSURANCE BERHAD.
If there are any changes in your circumstances that may affect the insurance provided, please notify us immediately,
otherwise you may not receive the full benefits of this policy.
To help preserve the environment, AXA will send you one policy booklet only. Please keep this policy booklet in a
safe place.
In case of renewal and/or policy condition amendment, the company will send you the policy schedule and
endorsement only.
If at any time you would like a replacement for this document, please contact us and we will be happy to provide
one.
If, for any reason, you are unhappy with the service you have received from us, you can take the following steps:1. In the first instance, please write to our Customer Service Department at our current address. Alternatively, you
can e-mail us at: customer.service@axa.com.my
2. If you are still not satisfied with the way any issue has been handled you can:
(a) Refer matters concerning claims to:
Financial Mediation Bureau - Level 25, Dataran Kewangan Darul Takaful,
No 4 Jalan Sultan Sulaiman, 50000 Kuala Lumpur.
Tel: (603) 2272 2811 Fax: (603) 2274 5752
(b) Submit your complaints/ feedback at Laman Informasi, Nasihat dan Khidmat (LINK), Bank Negara
Malaysia;
or call BNMTELELINK at 1-300-88-5465;
or fax to 03-21741515;
or e-mail to bnmtelelink@bnm.gov.my;
or send an SMS to 15888.
Type "back" to return to the previous menu.
Type "menu" to return back to the main menu.
Rule Name: back
Input Text: back
Output Text: <send 1. Group Hospital & Surgical Policy For International Students & Dependants>
Rule Name: 2. How Your Insurance Operates
Input Text: 2. How Your Insurance Operates
Input Text: How Your Insurance Operates
Input Text: two
Input Text: 2
Input Text: second
Input Text: 2nd
Output Text: HOW YOUR INSURANCE OPERATES
Your Group Hospital & Surgical Policy is a contract between you and AXA AFFIN GENERAL INSURANCE
BERHAD and it consists of:
the Policy Contract,
the Policy Schedule and Schedule of Benefits, which has details relating to you, the type of cover and Period
of Insurance.

The Application Form, declaration and any other information given form the basis of this contract.
The Policy Schedule, conditions, exclusions, endorsements and memoranda shall be read together as one contract
and any word or expression to which a specific meaning has been attached in any part shall bear the same meaning
wherever it appears.
This Policy shall become effective on the date specified in the Schedule and continue for the Period of Insurance
specified, ending at 23:59 hours Standard Malaysia Time on the last day of the Period of Insurance.
At the end of each Period of Insurance, this Policy may be renewed for another year subject to our consent.
Having received and accepted your first premium, and any subsequent premiums required, we will provide the cover
shown in the sections of the Policy you have chosen for confinement in a hospital as an inpatient or for daily
surgery, up to the Limit stated in your Schedule of Benefits for any one Period of Insurance.
Type "back" to return to he previous menu.
Type "menu" to return back to the main menu.
Rule Name: back
Input Text: back
Output Text: <send 1. Group Hospital & Surgical Policy For International Students & Dependants>
Rule Name: back
Input Text: back
Output Text: <send 3. Insurance Policy>
Rule Name: 2. General Policy Definitions
Input Text: 2nd
Input Text: 2
Input Text: second
Input Text: two
Input Text: 2. General Policy Definitions
Input Text: General Policy Definitions
Output Text: GENERAL POLICY DEFINITIONS
This is a preview of the General Policy Definitions
Any word or expression, which has a specific meaning, should have this meaning attached to the word or
expression found in the Policy and/or Schedule.
1. We/Us/Insurer/AXA/Company Shall mean AXA AFFIN GENERAL INSURANCE BERHAD.
2. You/Your/Yourself/Insured Refers to the Policyholder.
3. Accident Shall mean a sudden unintentional, unexpected, unusual, and specific event that occurs at an
identifiable time and place which shall, independently of any other cause, be the sole cause of bodily injury.
Type "more" to view the full General Policy Definitions.
Type "back" to return to the previous menu.
Type "menu" to return back to the main menu.
Rule Name: back
Input Text: back
Output Text: <send 3. Insurance Policy>
Rule Name: more
Input Text: more
Output Text: GENERAL POLICY DEFINITIONS
Any word or expression, which has a specific meaning, should have this meaning attached to the word or
expression found in the Policy and/or Schedule.
1. We/Us/Insurer/AXA/Company Shall mean AXA AFFIN GENERAL INSURANCE BERHAD.
2. You/Your/Yourself/Insured Refers to the Policyholder.
3. Accident Shall mean a sudden unintentional, unexpected, unusual, and specific event that occurs at an
identifiable time and place which shall, independently of any other cause, be the sole cause of bodily injury.
4. Child Shall mean any person who has attained the age of fifteen (15) days, is an unmarried person,
financially dependent upon the Insured and is under the age of eighteen (18).
5. Clinic - Shall mean any establishment duly licensed and registered as a Clinic intended to be used for the
medical care and Treatment of the sick and injured persons and which:
(a) is under the conduct of a registered medical practitioner at all times;
(b) has facilities for diagnosis and has on its immediate premises services for the dispensation of drugs and
medications and;
(c) includes a Hospital but is not primarily a place for alcoholics or drug addicts, a nursing home, rest or
convalescent home or home for the aged or a mental institution.
6. Consultation Shall mean a deliberate act of conferment in person with a medical practitioner for advice and
diagnosis or Treatment of a Disability.
7. Congenital Conditions Shall mean any medical or physical abnormalities existing at the time of birth, as well
as neo-natal physical abnormalities developing within six (6) months from the time of birth. This will include ALL
congenital conditions as classified and listed by World Health Organization on Congenital Malformations,
Deformations and Chromosomal Abnormalities. They will include hernias of all types and epilepsy except when
caused by a trauma which occurred after the date that the insured was continuously covered under this Policy.

8. Day Shall mean the definition of a charging Day adopted by the Hospital concerned.
9. Day Surgery Shall mean a patient who needs the use of a recovery facility for a surgical procedure on a
preplan
basis at the hospital/ specialist clinic (but not for overnight stay).
10. Deductible Shall mean an amount that must be paid by Insured before an Insurer will pay any expenses.
11. Dental Treatment - Shall mean treatment required to establish or maintain oral health, tooth repair, scaling,
fillings, tooth extraction, malocclusion, restoration of tooth function and alignment.
12. Dentist Shall mean a person who is duly licensed or registered to practice dentistry in the geographical
area in which a service is provided, but excluding a physician or surgeon who is the insured himself.
13. Dependent Shall mean any of the following persons:
(a) A legally married spouse, up to aged sixty-five (65);
(b) Unmarried Children over fifteen (15) days old but under eighteen (18) years of age, who are not gainfully
employed;
14. Parent/Legal Guardian Shall mean a person who is a parent/legal guardian of the Student, up to aged
sixtyfive
(65).
15. Disability Shall mean a Sickness, Disease, Illness or the entire Injuries arising of a single or continuous series
of causes.
ANY ONE DISABILITY shall mean all of the periods of disability arising from the same cause including any and all
complications there from there that if the Insured Person completely recovers and remain free from further
treatment (including drugs, medicines, special diet or injection or advice for the condition) of the disability for at
least sixty (60) days following the latest date of discharge and subsequent disability from the same cause shall be
considered as though it were a new disability.
Benefits payable in respect of expenses incurred for Treatment provided to the Insured Person during the period
of insurance shall be limited to the maximum limit per one disability as stated in the Schedule of Benefits
irrespective of the several types of Disability treated in a single admission.
16. Doctor or Physician or Surgeon or Anesthetist Shall mean a registered medical practitioner qualified and
licensed to practice western medicine and who, in rendering such treatment, is practicing within the scope of his
licensing and training in the geographical area of practice, but excluding a doctor, physician or surgeon who is the
Insured himself.
17. Eligible Expenses Shall mean Medically Necessary expenses incurred due to a covered Disability but not
exceeding the limits in the schedule.
18. Emergency Shall mean Treatment needed under the conditions:
(a) between the hours of 12 am and 6 am; or
(b) in the event whereby immediate medical attention is required within twelve (12) hours for an Injury, Illness
or symptoms which are sudden and severe failing which will be life-threatening (such as Accident and heart
attack), or lead to significant deterioration of health permanently.
19. Hospital . Shall mean only an establishment duly constituted and registered as a hospital for the care and
treatment of sick and injured persons as paying bed-patients, and which:
(a) has facilities for diagnosis and major surgery,
(b) provides twenty-four (24) hour a day nursing services by registered and graduate nurses,
(c) is under the supervision of a Physician, and
(d) is not primarily a clinic; a place for alcoholics or drug addicts; a nursing, rest or convalescent home or a
home for the aged or similar establishment.
20. Hospitalisation Shall mean admission to a Hospital as a registered in-patient for Medically Necessary
treatments for a covered Disability upon recommendation of a physician. A patient shall not be considered as an
in-patient if the patient does not physically stay in the hospital for the whole period of confinement.
21. Injury Shall mean bodily injury caused solely by Accident.
22. Illness, Disease or Sickness Shall mean a physical condition marked by a pathological deviation from the
normal healthy state.
23. In-patient Refers to the admission overnight of an insured person into a Hospital in order to receive
treatment.
24. Insured Persons Shall mean any Foreign Student or their dependent and parent/legal guardian (if
applicable) who has paid the relevant insurance premium through EMGS and who enters or remains in Malaysia as
a student pass holder or dependant of a student pass holder.
25. Intensive Care Unit Shall mean a section within a Hospital which is designated as an Intensive Care Unit by
the Hospital, and which is maintained on a twenty-four (24) hour basis solely for treatment of patients in critical
condition and is equipped to provide special nursing and medical services not available elsewhere in the Hospital.
26. Malaysian Government Hospital Shall mean a hospital which charges of services are subject to the Fee Act
1951 Fees (Medical) Order 1982 and/or its subsequent amendments if any.
27. Medically Necessary Shall mean a medical service which is:
(a) consistent with the diagnosis and customary medical treatment for a covered Disability, and
(b) in accordance with standards of good medical practice, consistent with current standard of professional
medical care, and of proven medical benefits, and
(c) not for the convenience of the Insured or the Physician, and unable to be reasonably rendered out of
hospital (if admitted as an inpatient),
(d) not of an experimental, investigational or research nature, preventive or screening nature, and
(e) for which the charges are fair and reasonable and customary for the Disability.
28. Out-patient Shall mean the Insured Person is receiving medical care or treatment without being
hospitalized and includes treatment in a Daycare center.
29. Prescribed Medicines / Drugs Shall mean medicines that are dispensed by a Physician, a Registered
Pharmacist or a Hospital and which have been prescribed by a Physician or Specialist in respect of treatment for a

covered Disability.
30. Policy Year Shall mean the one (1) year period including the effective date of commencement of Insurance
and immediately following that date, or the one (1) year period following the Renewal or Renewed Policy.
31. Policyholder or Policy Owner Shall mean Education Malaysia Global Services (EMGS) to whom the Policy
has been issued in respect of cover for persons specifically identified as Insured Persons in this Policy.
32. Reasonable and Customary Charges Shall mean charges for medical care which is medically necessary shall
be considered reasonable and customary to the extent that it does not exceed the general level of charges being
made by others of similar standing in the locality where the charge is incurred, when furnishing like or comparable
treatment, services or supplies to individual of the same sex and of comparable age for a similar sickness, disease
or injury and in accordance with accepted medical standards and practice could not have been omitted without
adversely affecting the Insured Persons medical condition. In Malaysia, Reasonable and Customary Charges shall
be deemed to be those laid down in the Malaysian Medical Associations Schedule of Fees.
33. Renewal or Renewed Policy Shall mean a Policy which has been renewed without any lapse of time upon
expiry of a preceding Policy with the same content.
34. Student - Shall mean any Foreign Student who has paid the relevant insurance premium through EMGS and
who enters or remains in Malaysia as a student pass holder.
35. Specialist Shall mean a medical or dental practitioner registered and licensed as such in the geographical
area of his practice where treatment takes place and who is classified by the appropriate health authorities as a
person with superior and special expertise in specified fields of medicine or dentistry, but excluding a physician or
surgeon who is the insured himself.
36. Surgery / Surgical Procedure Shall mean any of the following medical procedures:
(a) To incise, excise or electrocauterize any organ or body part, except for dental services;
(b) To repair, revise, or reconstruct any organ or body part;
(c) To reduce by manipulation a fracture or dislocation;
(d) Use of endoscopy to remove a stone or object from the larynx, bronchus, trachea, esophagus, stomach,
intestine, urinary bladder, or urethra.
37. Treatment Shall mean Surgery or medical procedures carried out by a Specialist (other than for diagnostic
procedures).
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Rule Name: back
Input Text: back
Output Text: <send 3. Insurance Policy>
Rule Name: 4. Policy Conditions
Input Text: 4. Policy Conditions
Input Text: Policy Conditions
Input Text: 4
Input Text: fourth
Input Text: 4th
Input Text: four
Output Text: POLICY CONDITIONS
This is a preview of the Policy Conditions.
1. Alterations
The Company reserves the right to amend the terms and provisions of this Policy by giving a thirty (30) day prior
notice in writing by ordinary post to the Owners last known address in the Companys records, and such
amendment will be applicable from the next renewal of this Policy. No alteration to this Policy shall be valid unless
Authorized by the Company and such approval is endorsed thereon. The Insurer should give thirty (30) days prior
written notice to the Policyholder according to the last recorded address for any alterations made.
2. Certification, Information and Evidence
All certificates, information, medical reports and evidence as required by the Company shall be furnished at the
expense of the Insured, and in such a form that the Company may require. In any event all notices which the
Company shall require the Policyholder to give must be in writing and addressed to the Company. An Insured shall,
at the Company's request and expense, submit to a medical examination whenever such is deemed necessary.
3. Governing Law
This Policy is issued under the laws of Malaysia and is subject and governed by the laws prevailing in Malaysia.
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Input Text: back
Output Text: <send 3. Insurance Policy>
Rule Name: more
Input Text: more
Output Text: POLICY CONDITIONS
1. Alterations
The Company reserves the right to amend the terms and provisions of this Policy by giving a thirty (30) day prior

notice in writing by ordinary post to the Owners last known address in the Companys records, and such
amendment will be applicable from the next renewal of this Policy. No alteration to this Policy shall be valid unless
Authorized by the Company and such approval is endorsed thereon. The Insurer should give thirty (30) days prior
written notice to the Policyholder according to the last recorded address for any alterations made.
2. Certification, Information and Evidence
All certificates, information, medical reports and evidence as required by the Company shall be furnished at the
expense of the Insured, and in such a form that the Company may require. In any event all notices which the
Company shall require the Policyholder to give must be in writing and addressed to the Company. An Insured shall,
at the Company's request and expense, submit to a medical examination whenever such is deemed necessary.
3. Governing Law
This Policy is issued under the laws of Malaysia and is subject and governed by the laws prevailing in Malaysia.
4. Cancellation
This Policy may be cancelled by the Policyholder at any time by giving a written notice to the Company; and
provided that no claims have been made during the current policy year, the Policyholder shall be entitled to a
prorated
premium refund based on number of days.
5. Misstatement of Age
If the age of the Insured Person has been misstated and the premium paid as a result thereof is insufficient, any
claim payable under this Policy shall be prorated based on the ratio of the actual premium paid to the correct
premium which should have been charged for the year. Any excess premium, which
may have been paid as a result of such misstatement of age, shall be refunded without interest.
If at the correct age the Insured Person would not have been eligible for cover under this Policy, no benefit shall be
payable.
6. Period of Cover and Renewal
This Policy shall become effective as of the date stated in the Schedule. The Policy Anniversary shall be one year
after the effective date or such other pro-rated period as applicable.
This Policy is renewable at the option of AXA. Application for change of benefits to a higher plan can only be made
on renewal and is subject to acceptance by AXA upon renewal.
7. Change in Risk
The Insured Person shall give immediate notice in writing to the Company of any material change in his or her
occupation, business, duties or pursuits and pay any additional premium that may be required by the Company.
8. Subrogation
If the Company shall become liable for any payment under this Policy, the Company shall be subrogated to the
extent of such payment to all the rights and remedies of the Insured Person against any party and shall be entitled
at its own expense to sue in the name of the Insured Person. The Insured Person shall give or cause to be given to
the Company all such assistance in his/her power as the Company shall require to secure the rights and remedies
and at the Companys request shall execute or cause to be executed all documents necessary to enable the
Company to effectively to bring suit in the name of the Insured Person.
9. Contribution
If an Insured Person carries other insurance covering any illness or injury insured by this Policy, the Company shall
not be liable for a greater proportion of such illness or injury than the amount applicable hereto under this Policy
bears to the total amount of all valid insurance covering such illness or injury.
10. Ownership of Policy
Unless otherwise expressly provided for by Endorsement in the Policy, the Company shall be entitled to treat the
Policyholder as the absolute owner of the Policy. The Company shall not be
bound to recognise any equitable or other claim to or interest in the Policy, and the receipt of the Policy or a
Benefit by the Policyholder (or by his legal or authorized representative) alone
shall be an effective discharge of all obligations and liabilities of the Company. The Policyholder shall be deemed to
be responsible Principal or Agent of the Insured Persons covered under this Policy.
11. Take Over Policies
If this policy shall have commenced immediately upon termination of a preceding policy and if an Insured shall
have been afflicted with a medical disability prior or at the time this policy started (and benefits under the
preceding policy would have been available to him), such Insured shall continue to be covered for the existing
disability, but not to exceed the limits of the previous policy on condition the Company has secured a copy of the
preceding policy.
12. Premium Warranty Clause
All premiums due must be paid to and received by the Insurer within sixty (60) days from the inception date of the
Policy. If this condition is not complied with, then the contract is automatically cancelled and the Insurer is entitled
to a pro-rated premium for the period the Insurer has been on risk.
13. Clerical Error
A clerical error by AXA shall not invalidate insurance otherwise validly in force, nor continue insurance otherwise
not validly in force.
14. Claim Procedures
The Insured shall within thirty (30) days of a Disability that incurs claimable expenses, give written notice to the
Company stating full particulars of such event, including all original bills and receipts, and a full Physician's report
stipulating the diagnosis of the condition treated and the date the Disability commenced in the Physician's opinion
and the Physician's summary of the cost of treatment including medicines and services rendered. Failure to furnish
such notice within the time allowed shall not invalid any claim if it is shown not to have been reasonably possible
to furnish such notice and that such notice was furnished as soon as was reasonably possible.
The Insured shall immediately procure and act on proper medical advice and the Company shall not be held liable
in the event a treatment or service becomes necessary due to failure of the Insured to do so.
15. Incomplete Claims

All claims must be submitted to the Company within thirty (30) days of completion of the events for which the
claim is being made. Claims are not deemed complete and Eligible Benefits are not payable unless all bills for such
claims have been submitted and agreed upon by the Company. Only actual costs incurred shall be considered for
reimbursement. Any variation or waiver of the foregoing shall be at the Company's sole discretion.
16. Currency of Payment
All payments under this Policy shall be made in the legal currency of Malaysia. Should any payment be requested
by the Insured to be payable in any other currency, then such amount shall be payable in the demand currency as
may be purchased in Malaysia at the prevailing currency market rates on the date of the claim settlement.
17. Condition Precedent to Liability
The due observance and the fulfilment of the terms, provisions and conditions of this Policy by the Insured Person
and in so far as they relate to anything to be done or complied with by the Insured Person shall be conditions
precedent to any liability of the Company.
18. Notice
Every notice or communication to the Company shall be in writing and sent to the Company. No alterations in the
terms of this Policy or any endorsement thereon will be held valid unless the same is signed or initialled by an
authorised representative of the Company.
19. Automatic Termination
The insurance shall automatically terminate on the earliest happening of the following events:
(a) on the death of the Insured Person ; or
(b) on the Policy Anniversary immediately following the 65th birthday of the Insured Person; or
(c) for a Dependent child, on his 18th birthday
(d) at midnight standard Malaysian time on the last day of the Period of Insurance unless the Insured Person is
confined to a Hospital at such time. If this being the case, the time of termination shall be extended to: (i) the time the Insured Person is discharged from Hospital; or
(ii) the time the Maximum Limit Per Disability shall have been exhausted.
(e) on the date in which the Student Pass is cancelled or expired.
20. Legal Proceedings
No action at law or in equity shall be brought to recover on this Policy prior to expiration of sixty (60) days after
written proof of loss has been furnished in accordance with the requirements of this Policy. If the Insured Person
shall fail to supply the requisite proof of loss as stipulated by the terms, provisions and conditions of the Policy, the
Insured Person may, within a grace period of one calendar year from the time that the written proof of loss to be
furnished, submit the relevant proof of loss to the Company with cogent reason(s) for the failure to comply with
the Policy terms, provisions and conditions. The acceptance of such proof of loss shall be at the sole and entire
discretion of the Company. After such grace period has expired, the Company will not accept, for any reason
whatsoever, such written proof of loss.
21. Gender
Words or phrases denoting one gender include all other genders and similarly if denoting the singular include the
plural and vice versa.
22. Arbitration
All differences arising out of this Policy shall be referred to an Arbitrator who shall be appointed in writing by the
parties in difference. In the event they are unable to agree on who is to
be the Arbitrator within one (1) month of being required in writing to do so then both parties shall be entitled to
appoint an Arbitrator each who shall proceed to hear the differences together with an Umpire to be appointed by
both Arbitrators. However this is provided that any disclaimer of liability by the Company for any claim hereunder
must be referred to an Arbitrator within twelve (12) calendar months from date of such disclaimer.
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Rule Name: back
Input Text: back
Output Text: <send 3. Insurance Policy>
Rule Name: 3. Policy Exclusion
Input Text: 3
Input Text: 3rd
Input Text: three
Input Text: third
Input Text: 3. Policy Exclusion
Input Text: Policy Exclusion
Output Text: POLICY EXCLUSION
This is a preview of the Policy Exclusion.
This Policy does not cover any hospitalisation, surgery or charges caused directly or indirectly, wholly or partly, by
any one (1) of the following occurrences:
1. Plastic/Cosmetic Surgery or Treatment of their complications (inclusive of double eyelids, acne, keloid etc),
circumcision unless Medically Necessary, eye examination, glasses and refraction or surgical correction of
nearsightedness (Radial Keratotomy), longsightedness, astigmatism and the use, rental or acquisition of
external prosthetic appliances or devices such as artificial limbs, hearing aids, aero chambers, equipment for
nebulising, implanted pacemakers, lens (except for basic lens) and prescriptions thereof.
2. 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.

3. 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.
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Input Text: back
Output Text: <send 3. Insurance Policy>
Rule Name: more
Input Text: more
Output Text: POLICY EXCLUSION
This Policy does not cover any hospitalisation, surgery or charges caused directly or indirectly, wholly or partly, by
any one (1) of the following occurrences:
1. Plastic/Cosmetic Surgery or Treatment of their complications (inclusive of double eyelids, acne, keloid etc),
circumcision unless Medically Necessary, eye examination, glasses and refraction or surgical correction of
nearsightedness (Radial Keratotomy), longsightedness, astigmatism and the use, rental or acquisition of
external prosthetic appliances or devices such as artificial limbs, hearing aids, aero chambers, equipment for
nebulising, implanted pacemakers, lens (except for basic lens) and prescriptions thereof.
2. 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.
3. 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.
4. Treatment, therapy for congenital or hereditary Diseases, deformities and Disabilities and any medical or
surgical complication arising therefrom e.g. childhood hernias, clubfoot, Ventricular Septal Defect, Atrial
Septal Defect, Thalassemia etc.
5. Pregnancy, pregnancy related or its complications, 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.
6. 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, and treatments specifically for weight reduction or gain.
7. Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.
8. 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.
9. Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of
nuclear fission or from any nuclear weapons material.
10. Expenses incurred for donation of any body organ by an Insured Person and costs of acquisition of the organ
including all costs incurred by the donor during organ transplant and its complications.
11. Investigation and treatment of sleep and snoring disorders, hormone replacement therapy and alternative
therapy such as treatment, medical service or supplies, including but not limited to chiropractic services,
acupuncture, acupressure, reflexology, bonesetting, herbalist treatment, massage or aroma therapy or other
alternative treatment.
12. Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic
manifestations) and any other conditions classified under the Diagnostic & Statistical Manual of Mental
Disorders (DSM-IV Codes) as pulished by American Psychiatric Association.
13. Costs/expenses of services of a non-medical nature, such as newspapers, television, telephones, telex
services, radios or similar facilities, admission/inpatient kit/pack, discharge pack, laundry, electricity, extra
meal and other ineligible non-medical items.
14. Sickness or injury arising from illegal activities, playing professional sports, racing of any kind (except foot
racing) or hazardous sports such as but not limited to sky diving, base jumping, cliff diving, flying in an
unlicensed aircraft or as a learner, martial arts, free climbing, mountaineering with or without ropes, water
skiing, scuba diving to a depth of more than 10 metres, trekking to a height of over 2,500 metres, bungee
jumping, canyoning, hangliding, paragliding or microlighting, parachuting, potholing, skiing off piste or any
other winter sports activity carried out off piste.
15. Private flying other than as fare-paying passenger in any commercial scheduled airlines licensed to carry
passengers over established routes.
16. Expenses incurred for sex changes.
17. Any treatment directed towards developmental delays and/or learning disabilities in Insured children.
18. Cosmetic (aesthetic) surgery or treatment, or any treatment which relates to or is needed because of
previous cosmetic treatment. However we will pay for reconstructive surgery if:
(a) it is carried out to restore function or appearance after an accident or following surgery for a medical
condition, provided that member has been continuously covered under a plan of ours since before the
accident or surgery happened; and
(b) it is done at a medically appropriate stage after the accident or surgery; and
(c) we agree to the cost of the treatment in writing before it is done.

19. Any treatment which only offers temporary relief of symptoms on any long term illness and disease rather
than dealing with the underlying medical condition.
20. More than one (1) Outpatient Consultation per day to a General Practitioner.
21. Cost of prescribed medicine without Consultation.
22. Private nursing care and house calls by Doctors for any reasons.
23. Hormone therapy
24. Vitamins, Food Supplement, Herbal Cures, Anti Obesity/Weight Reducing Agents including off the counter
medications.
25. Soaps, shampoos, vitamin creams and vitamin ointment.
26. Blood and topical allergy testing.
27. Routine physical examination, health check-ups or tests not incidental to Treatment or diagnosis of a covered
Disability.
28. Outpatient physical therapy or physiotherapy is not covered under Outpatient General Practitioner Clinical
Treatment.
29. Care and Treatment that is experimental, investigative and not according to accepted professional standards
and care that is not Medically Necessary.
30. Any Treatment for or arising from substance abuse such as alcohol, narcotics, etc.
31. Diseases or Disabilities of a newborn Child contracted prior to or during birth of within the first 14 days
hereafter.
32. Speech and Occupational Therapy.
33. Outpatient rehabilitation therapy, chemotherapy, radiation therapy and kidney dialysis is not covered under
Outpatient General Practitioner Clinical Treatment.
34. Chronic Illnesses such as Diabetes, High Blood Pressure, Asthma, Hepatitis B and C carriers, nerve disorders or
degenerative Diseases, endometriosis, transverse myelitis and conditions arising therefrom or associated
therewith.
35. Preventive Vaccinations / Immunisations except for the following that are applicable to eligible Children only
(subject to Outpatient Benefit limit, if any) : BCG (booster);
Hepatitis B (infants up to 1 year old);
Triple Antigen & TetrAct Hib (infants up to 1 year old);
Double Antigen (booster), including Oral Polio;
MMR;
Rubella.
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Rule Name: back
Input Text: back
Output Text: <send 3. Insurance Policy>
Rule Name: 4. Eligibility and Scope
Input Text: 4. Eligibility and Scope
Input Text: 4
Input Text: fourth
Input Text: four
Input Text: Eligibility and Scope
Output Text: Eligilibilty and Scope
Choose one of the options below.
1. Person Eligible
2. Addition of Insured Persons
3. Conditions for Obtaining Insurance
4. Geographical Territory
5. Overseas Treatment
6. Oversea Residence
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Rule Name: 1. Person Eligible
Input Text: 1
Input Text: 1st
Input Text: one
Input Text: first
Input Text: 1. Person Eligible
Input Text: Person Eligible
Output Text: Person Eligible
Persons eligible to be covered under this Policy must be:
(a) A Foreign Student who has been approved for a Student Pass applied for through the Policyholder and is aged
between twelve (12) to sixty-five (65) years;
(b) A Dependent of the Foreign Student (subject to the Student being insured); or
(c) A Parent/Legal Guardian of a Student (subject to the Student being insured).

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Rule Name: back
Input Text: back
Output Text: <send 4. Eligibility and Scope>
Rule Name: 2. Addition of Insured Persons
Input Text: 2. Addition of Insured Persons
Input Text: Addition of Insured Persons
Input Text: 2
Input Text: second
Input Text: two
Input Text: 2nd
Output Text: Addition of Insured Persons
For eligible persons who have applied to be included as an Insured Person under this Policy if:
(a) The Policyholder requests such inclusion in writing within thirty (30) days from date of eligibility,
(b) the Dependents are eligible to be insured in accordance with the terms and standards of acceptance of the
Company, and
(c) the required additional premium is paid.
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Rule Name: back
Input Text: back
Output Text: <send 4. Eligibility and Scope>
Rule Name: 3. Conditions For Obtaining Insurance
Input Text: 3. Conditions For Obtaining Insurance
Input Text: Conditions For Obtaining Insurance
Input Text: 3rd
Input Text: 3
Input Text: three
Input Text: third
Output Text: Conditions For Obtaining Insurance
(a) The eligibility date of each Student shall commence from the date of entry into Malaysia,
(b) The persons eligible for insurance are the present and future Students who apply for their Pass through the
Policyholder,
(c) A newborn childs eligibility for Insurance is subject to him being in a normal and healthy condition on the
fifteenth day following the birth.
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Input Text: back
Output Text: <send 4. Eligibility and Scope>
Rule Name: 4. Geographical Territory
Input Text: 4. Geographical Territory
Input Text: Geographical Territory
Input Text: fourth
Input Text: four
Input Text: 4
Input Text: 4th
Output Text: Geographical Territory
All benefits provided in this Policy are applicable worldwide for twenty-four (24) hours a day.
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Input Text: back
Output Text: <send 4. Eligibility and Scope>
Rule Name: 5. Overseas Treatment
Input Text: 5. Overseas Treatment
Input Text: Overseas Treatment
Input Text: five
Input Text: 5
Input Text: 5th
Input Text: fifth
Output Text: Overseas Treatment
If the Insured Person elects to or is referred to be treated outside Malaysia by the Attending Physician, 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.
Reasonable and Medically Necessary Charges shall be deemed to be those laid down in the Malaysian Medical
Associations Schedule of Fees.
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Output Text: <send 4. Eligibility and Scope>
Rule Name: 6. Oversea Residence
Input Text: 6. Oversea Residence
Input Text: Oversea Residence
Input Text: 6th
Input Text: 6
Input Text: sixth
Input Text: six
Output Text: Oversea Residence
No benefit whatsoever shall be payable for any medical treatment received by the Insured outside Malaysia, if the
Insured resides or travels outside Malaysia for more than ninety (90) consecutive days.
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Input Text: back
Output Text: <send 4. Eligibility and Scope>
Rule Name: 5. Benefits
Input Text: 5
Input Text: five
Input Text: fifth
Input Text: 5th
Input Text: benefits
Input Text: 5. Benefits
Output Text: DESCRIPTION OF BENEFITS
This is preview of the Description of Benefits.
Important Notice: The Benefits described below may be subject to maximum limits or to a deductible. Please check
the Schedule of Benefits for details.
1. Hospital Room & Board
Reimbursement of the Reasonable and Customary Charges Medically Necessary for room accommodation and
meals. The amount of the benefit shall be equal to the actual charges made by the Hospital during the Insured
Persons confinement, but in no event shall the benefit exceed, for any one day, the rate of Room and Board
Benefit, and the maximum number of days as set forth in the Schedule of Benefits. The Insured Person will only be
entitled to this benefit while confined to a Hospital as an in-patient or for Day Surgery.
2. Intensive Care Unit
Reimbursement of the Reasonable and Customary Charges Medically Necessary for actual room and board
incurred during confinement as an in-patient in the Intensive Care Unit of the Hospital. This benefit shall be
payable equal to the actual charges made by the Hospital subject to the maximum benefit for any one day, and
maximum number of days, as set forth in the Schedule of Benefits. Where the period of confinement in an
Intensive Care Unit exceeds the maximum set forth in the Schedule of Benefits, reimbursement will be restricted
to the standard Daily Hospital Room and Board rate.
No Hospital Room and Board Benefits shall be paid for the same confinement period where the Daily Intensive
Care Unit Benefits is payable.
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Output Text: DESCRIPTION OF BENEFITS
Important Notice: The Benefits described below may be subject to maximum limits or to a deductible. Please check
the Schedule of Benefits for details.
1. Hospital Room & Board
Reimbursement of the Reasonable and Customary Charges Medically Necessary for room accommodation and
meals. The amount of the benefit shall be equal to the actual charges made by the Hospital during the Insured
Persons confinement, but in no event shall the benefit exceed, for any one day, the rate of Room and Board
Benefit, and the maximum number of days as set forth in the Schedule of Benefits. The Insured Person will only be
entitled to this benefit while confined to a Hospital as an in-patient or for Day Surgery.
2. Intensive Care Unit

Reimbursement of the Reasonable and Customary Charges Medically Necessary for actual room and board
incurred during confinement as an in-patient in the Intensive Care Unit of the Hospital. This benefit shall be
payable equal to the actual charges made by the Hospital subject to the maximum benefit for any one day, and
maximum number of days, as set forth in the Schedule of Benefits. Where the period of confinement in an
Intensive Care Unit exceeds the maximum set forth in the Schedule of Benefits, reimbursement will be restricted
to the standard Daily Hospital Room and Board rate.
No Hospital Room and Board Benefits shall be paid for the same confinement period where the Daily Intensive
Care Unit Benefits is payable.
3. Hospital Miscellaneous Services
Reimbursement of the Reasonable and Customary Charges actually incurred for Medically Necessary general
nursing, ancillary services and consumable items, in-patient diagnostic procedures such as but not limited to X-ray,
laboratory examinations and electrocardiograms, in-patient physiotherapy, prescribed and consumed drugs and
medicines, dressings, splints, plaster casts, basal metabolism tests, intravenous injections and solutions,
administration of blood and blood plasma but excluding the cost of blood and plasma which relate directly to the
Treatment whilst the Insured Person is confined as an In-Patient in a Hospital, up to the amount stated in the
Schedule of Benefits.
Admission fee, registration fee, medical record, billing fee, name tag/ID band, dispensing fee and other items
deemed fit and necessary for medical purposes are payable.
Payment will not be made for the acquisition, extraction procedure and cultivation of tissues and cells (inclusive of
stem cells) required for treatment. Only the cost of drugs used for the treatment of the Disability are covered and
must be listed in the Malaysian Index Medical Supplies (MIMS), excluding traditional/complementary medicines,
supplementary medicines, vitamins or nutritional herbs. Drugs prescribed for use within fourteen (14) days after
discharge from the Hospital shall be reimbursable.
4. Surgeon Fee
Reimbursement of the Reasonable and Customary Charges for a Medically Necessary surgery by the Specialists,
including pre-surgical assessment Specialists visits to the Insured Person subject to one (1) visit per day and
postsurgery
care up the maximum amount and the maximum number of days as set forth in the Schedule of Benefits. If
more than one surgery is performed for Any One Disability, the total payments for all the surgeries performed shall
not exceed the maximum stated in the Schedule of Benefits.
5. Anaesthetist Fee
Reimbursement of the Reasonable and Customary Charges by the Anaesthetist for the Medically Necessary
administration of anaesthesia not exceeding the limits as set forth in the Schedule of Benefit.
6. Operating Theatre Charges
Reimbursement of the Reasonable and Customary Operating Room charges incidental to the surgical procedure.
7. Daily In-Hospital Physicians Visit
Reimbursement of the Reasonable and Customary Charges by a Physician for Medically Necessary visit(s) to a
patient subject to a maximum of two (2) visits per day for a non-surgical confinement and one (1) visit per day for a
surgical confinement, and not exceeding the maximum number of days and amount per day as set forth in the
Schedule of Benefit.
8. Pre-Hospitalisation Specialist Consultation
Reimbursement of the Reasonable and Customary Charges for the first time consultation by a Specialist in
connection with a Disability within the maximum number of days and amount as set forth in the Schedule of
Benefit preceding confinement in a Hospital and provided that such consultation is Medically Necessary and has
been recommended in writing by the attending general practitioner.
Payment will not be made for clinical treatment (including medications and subsequent consultation after the
illness is diagnosed) or where the Insured does not result in hospital confinement for the treatment of the medical
condition diagnosed.
9. Pre-Hospital Diagnostic Tests
Reimbursement of the Reasonable and Customary Charges for Medically Necessary ECG, X-ray and laboratory tests
which are performed for diagnostic purposes on account of an injury or illness when in connection with a Disability
preceding hospitalization within the maximum number of days and amount as set forth in the Schedule of Benefit
in a Hospital and which are recommended by a qualified medical practitioner. No payment shall be made if upon
such diagnostic services, the Insured does not result in hospital confinement for the treatment of the medical
condition diagnosed. Medications and consultation charged by the medical practitioner will not be payable.
10. Post-Hospitalisation Treatment
Reimbursement of the Reasonable and Customary Charges incurred in Medically Necessary follow-up treatment by
the same attending Physician, within the maximum number of days and amount as set forth in the Schedule of
Benefits immediately following discharge from Hospital for a non-surgical disability. This shall include medicines
prescribed during the follow-up treatment but the total supply needed shall not exceed the maximum number of
days as set forth in the Schedule of Benefits.
11. Outpatient General Practitioner Clinical Treatment
Reimbursement of Reasonable and Customary Charges for Treatment or Consultation services rendered by a
legally registered Doctor on AXAs list of Panel Clinics as a result of common Sicknesses and bodily Injuries, where
Hospitalisation is not required, up to the maximum limits as stated in the Schedule of Outpatient Benefits. This
benefit is applicable within Malaysia only. Services provided by a non-panel Clinic will not be covered, except in
the event of an Emergency.
i) Routine Consultation
Reimbursement of Reasonable & Customary Charges incurred for the routine Consultation by a Physician at a
Panel Clinic.
ii) Medication
Reimbursement of Reasonable & Customary Charges incurred for the medication relevant to the Treatment of the

Disability, which requires a Physicians prescription at a Panel Clinic.


iii) Injection
Reimbursement of Reasonable & Customary Charges incurred for the injection which requires a Physicians or
Physician assistants administration at a Panel Clinic for Treatment of an Illness, Injury and mandatory
vaccinations/immunization for children.
iv) Diagnostic Lab / X-Ray Procedures
Reimbursement of Reasonable & Customary Charges for all laboratory examinations and diagnostic x-ray done at a
Panel Clinic for the determination and diagnosis of a Disability.
v) Outpatient Surgical Procedures
Reimbursement of Reasonable & Customary Charges incurred or Outpatient surgical procedure done at a Panel
Clinic.
12. Emergency Accidental Out-Patient Treatment
Reimbursement of the Reasonable and Customary Charges incurred for up to the maximum stated in the Schedule
of Benefits, as a result of a covered bodily injury arising from an Accident for Medical Necessary treatment as an
outpatient at any registered clinic or hospital within twenty-four (24) hours of the Accident. Follow up treatment
by the same doctor or same registered clinic or Hospital for the same covered bodily injury will be provided up to
the maximum amount and the maximum number of days as set forth in the Schedule of Benefits.
13. Accidental Dental Treatment
If as a result of an Accident pain relieving dental treatment for sound natural teeth is required, the Company will
reimburse charges up to a maximum limit as stated in the Schedule of Benefits. Follow up treatment by the same
doctor or same registered clinic or Hospital for the same covered dental injury will be provided up to the maximum
amount and the maximum number of days as set forth the Schedule of Benefits. If as a result of an Accident on
sound natural teeth, the Company will reimburse charges for pain relieving dental treatment excluding restorative
procedure such as crowning, bridging as well as root canal treatment.
14. Daycare Procedure
Reimbursement of fees actually charged by the hospital or specialist centre and for all professional fees charged
for minor Daycare Surgical Procedures performed as an outpatient without confinement in hospital. Such fees or
charges shall include all incidental services and supplies provided for the procedures up to the maximum limit as
stated in the Schedule of Benefits. The Daycare Surgical Procedures should include minor operations such as but
not limited to: Adenoidectomy, Arthroscopy, Broncoscopy, Bunionectomy, Cataract removal, Cholecystectomy,
Colonoscopy, Coronary Angiography, Digestive tract endoscopy, Dilatation and curettage of uterus, simple excision
of pilonodal cyst, Haemorrhoidectomy, Hammer toe repair, Laparascopy, Laryngoscopy and tracheoscopy,
Lumbosacral manipulation, Myringotomy, Prostate biopsy, Reduction of nasal fracture, Strabismus repair and
Tonsillectomy, that is commonly performed safely on an outpatient basis.
Any Daycare Surgical Procedures done for investigative and diagnostic purposes not related to treatment for any
specified disabilities is not covered.
15. Ambulance Charges
Reimbursement of the Reasonable and Customary Charges incurred for necessary domestic ambulance services
inclusive of attendant) to and/or from the Hospital of confinement subject to the limits set forth in the Schedule of
Benefits. Payment will not be made if the Insured Person is not hospitalised for treatment that is not a covered
Disability.
16. Government Service Tax
Reimbursement of the charges imposed by the Government for Service Tax levied on the eligible Room & Board
charges. Such reimbursement shall be limited to an amount not exceeding 6% of the eligible Room & Board
charges.
17. Accidental Death
An amount payable should an Insured Person sustain a bodily injury caused by an accident resulting directly and
independently of any other cause within one year in death. Death shall be established by an official Death
Certificate.
18. Permanent Disablement
An amount payable should an Insured Person sustain a bodily injury caused by an accident resulting directly and
independently of any other cause within one year in disablement (total or partial).
19. Government Hospital Daily Cash Allowance
Pays a daily allowance for each complete day of confinement for a covered Disability in a Malaysian Government
Hospital, provided that the Insured Person shall confine to a Room and Board rate that does not exceed the
amount shown in the Schedule of Benefit.
No payment will be made for any transfer to or from any Private Hospital and Malaysian Government Hospital for
the covered disability.
20. Medical Report Fee Reimbursement
An amount equal to actual charges for any Medical Report required will be reimbursed by the Insurer up to the
maximum limit per disability stated in the Schedule of Benefits. This is applicable for In-Hospital Care and
Ambulatory care.
21. Out-Patient Cancer Treatment
If an Insured is diagnosed with Cancer as defined below, the Company will reimburse the Reasonable and
Customary Charges incurred for the Medically Necessary treatment of cancer performed at a legally registered
cancer treatment centre subject to the limit of this disability as specified in the Schedule of Benefit.
Such treatment (radiotherapy or chemotherapy including consultation, examination tests, take home drugs) must
be received at the out-patient department of a Hospital or a registered cancer treatment centre.
Cancer is defined as the uncontrollable growth and spread of malignant cells and the invasion and destruction of
normal tissue for which major interventionist treatment or surgery (excluding endoscopic procedures alone) is
considered necessary. The cancer must be confirmed by histological evidence of malignancy.
22. Out-Patient Kidney Dialysis Treatment

If an Insured is diagnosed with Kidney Failure as defined below, the Company will reimburse the Reasonable and
Customary Charges incurred for the Medically Necessary treatment of kidney dialysis performed at a legally
registered dialysis centre subject to the limit of this disability as specified in the Schedule of Benefit.
Such treatment (dialysis including consultation, examination tests, take home drugs) must be received at the
outpatient
department of a Hospital or a registered dialysis treatment centre.
Kidney Failure means end stage renal failure presenting as chronic, irreversible failure of both kidneys to function
as a result of which renal dialysis is initiated.
23. Reimbursement Of College Tuition Fees Due To Prolonged Period Of Disability (Per Semester)
In the event of a prolonged disability, which actually prevents the Insured person from attending to his academic
session at his registered college and as a direct result of this non-attendance such that the Insured person has to
repeat his coursework in a new academic session, this Benefit will reimburse the actual college tuition fees paid for
the academic session which was missed.
In the context of this Benefit, a prolonged disability is defined as a covered medical condition which renders the
Insured person being confined to the hospital continuously for a period of not less than 14 days and shall include
any post hospital convalescence immediately following the discharge from the hospital.
24. Compassionate Visitation Benefit
Additional accommodation and travelling expenses for a parent/ legal guardian located outside Malaysia required
on medical advice from the treating physician to remain with the Insured Person(s) during hospitalization and if
the Insured Person is hospitalised for more than five (5) consecutive days and the medical condition does not allow
repatriation up to the maximum amount as set forth in the Schedule of Benefits.
25. Emergency Medical Evacuation
Medical necessary expense for emergency transportation and medical care to move an Insured Person who has a
critical medical condition to the nearest Hospital where appropriate care and facilities are available.
This benefit shall include Return of Minor Child, whereby if an Insured is hospitalised or repatriated under this
Policy their dependent children under the age of 18, who would otherwise be left without any adult supervision as
the result of their parents eligible treatment, will be covered under this policy for the cost of a one way economy
fare to their home country.
26. Emergency Medical Repatriation
Reimbursement of the costs of repatriating the Insured Person or the mortal remains back to their home country
in the event of the Insured Person having suffered a total and permanent disability or death caused by a covered
illness or accident. Death shall be established by an official death certificate.
27. Funeral Expenses
In the event of the death of an insured person, upon presentation of sufficient proof of the death through all
causes, a death benefit will be paid according to the amount stated in the Schedule of Benefits.
Type "back" to return to the previous menu.
Type "menu" to return back to the main menu.
Rule Name: back
Input Text: back
Output Text: <send 5. Benefits>
Rule Name: 6. EMGS
Input Text: Education Malaysia Global Services
Input Text: 6
Input Text: 6th
Input Text: sixth
Input Text: six
Output Text: EMGS stands for Education Malaysia Global Services.
Education Malaysia Global Services (Company No: 986610-U)
(EMGS) is wholly owned subsidiary of the Ministry of Education of Malaysia. It is a company limited by guarantee
incorporated under the laws of Malaysia and plays the following roles:
-- Assisting the Ministry of Education in the implementation of policies relating to students
-- Carrying out research and development in the field of education
-- Collecting, publishing and disseminating student information
-- Providing marketing and awareness with a view to promoting Malaysia as a global destination for education services
-- Facilitating an efficient, transparent and auditable process for issuing and tracking student passes
Type "menu" to return back to main menu.
Rule Name: 7. Online Resources
Input Text: 7. Online Resources
Input Text: 7
Input Text: online resources
Input Text: 7th
Input Text: seventh
Input Text: seven
Output Text: Here is a list of Online Resources:

Please choose one based on their number.


1. Clinics
2. Hospital
3. View PDF document of EMGS Medical and Health Insurance
4. Youtube videos
5. FAQ
Type "menu" to return back to the main menu.
Rule Name: 1.Clinics
Input Text: panel clinics
Input Text: panel clinic
Input Text: clinic
Input Text: insurance panel clinics listing
Input Text: clinic listing
Input Text: 1
Input Text: 1st
Input Text: one
Input Text: first
Input Text: clinics
Input Text: 1. clinics
Output Text: The full Insurance Panel Clinics Listing will be shown to you shortly.
<run http://www.educationmalaysia.gov.my/skin/frontend/emgsv4/default/documents/Insurance-Panel-ClinicsListing(14.12.2012)v1.1.pdf>
Type "back" to return to the previous menu.
Type "menu" to return back to the main menu.
Rule Name: back
Input Text: back
Output Text: <send 7. Online Resources>
Rule Name: 3. View pdf document of EMGS Medical and Health Insurance
Input Text: Where can I view all this information in one document?
Input Text: Can all this information be put in one document for me to see?
Input Text: Where can I view a summary of this?
Input Text: Summary of EMGS Insurance
Input Text: summary
Input Text: three
Input Text: 3
Input Text: third
Input Text: 3. View pdf document of EMGS Medical and Health Insurance
Input Text: View pdf document of EMGS Medical and Health Insurance
Output Text: You can view it here.
<run http://www.educationmalaysia.gov.my/skin/frontend/emgsv4/default/documents/EMGS-Insurance-Packages-forStudentsv1.4.pdf>
Type "back" to return to the previous menu.
Type "menu" to return back to the main menu.
Rule Name: back
Input Text: back
Output Text: <send 7. Online Resources>
Rule Name: 4. Youtube videos
Input Text: youtube
Input Text: emgs youtube channel
Input Text: youtube channel
Input Text: emgs youtube
Input Text: emgs videos
Input Text: videos
Input Text: 4. Youtube videos
Input Text: 4
Input Text: Youtube videos
Input Text: fourth
Input Text: four
Input Text: 4th
Output Text: EMGS videos can be found from their youtube channel and their facebook link. No worries, I will open it
for you.
<run https://www.youtube.com/channel/UCI0U6YvkoujwSUQmQzyRTvQ>
<run https://www.facebook.com/pages/Education-Malaysia-GlobalServices/176820335796911?id=176820335796911&sk=app_212104595551052>
Type "back" to return to the previous menu.
Type "menu" to return back to the main menu.

Rule Name: back


Input Text: back
Output Text: <send 7. Online Resources>
Rule Name: 5. FAQ
Input Text: faq
Input Text: list of faq
Input Text: frequently asked questions
Input Text: 5
Input Text: 5. FAQ
Input Text: fifth
Input Text: five
Output Text: Here is a full list of some frequently asked questions (FAQ).
<run http://www.educationmalaysia.gov.my/faqs/>
Type "back" to return to the previous menu.
Type "menu" to return back to the main menu.
Rule Name: back
Input Text: back
Output Text: <send 7. Online Resources>
Rule Name: 2. Hospital
Input Text: panel hospital
Input Text: hospital
Input Text: list of panel hospital
Input Text: panel hospital list
Input Text: 2. Hospital
Input Text: Hospital
Input Text: 2
Input Text: two
Input Text: second
Output Text: The full Insurance Panel Hospital Listing will be shown to you shortly.
<run http://www.educationmalaysia.gov.my/skin/frontend/emgsv4/default/documents/Insurance-Panel-HospitalsListing%20(1.2.2013)v1.0.pdf>
Type "back" to return to the previous menu.
Type "menu" to return back to the main menu.
Rule Name: back
Input Text: back
Output Text: <send 7. Online Resources>
Rule Name: 8. Exit
Input Text: 8. Exit
Input Text: 8
Input Text: exit
Input Text: 8th
Input Text: eight
Input Text: eighth
Output Text: <exit>

Work load Matrix:

Task

Group Members
Sree Prakash

Emad Afaq Khan

Omar Abdullah

Knowledge Gathering

50%

30%

20%

Expert Interview

30%

30%

40%

Programming

90%

5%

5%

Testing

70%

20%

10%

Expert Opinion

20%

60%

20%

Proposal

20%

60%

20%

Identification

50%

40%

10%

Problem Specification

20%

50%

30%

30%

40%

30%

Knowledge Representation

50%

30%

20%

Knowledge Acquisition

34%

33%

33%

Evaluation of Prototype

60%

20%

20%

100%

Verbot

Documentation

Analysis of Problem Domain

Conclusion

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