PRODUCT WRITE-UP
PLAN NAME: GREAT MEDICARE 2
PLAN CODES: H209 (for GMC2–150)
H210 (for GMC2–200)
H211 (for GMC2–300)
H212 (for GMC2–400)
nd
LAUNCH DATE: 2 JUNE 2009
PLAN DESCRIPTION
This is an individual non-participating, stand-alone comprehensive medical insurance policy.
Premium may be renewable up to the age of 79 years next birthday, subject to portfolio withdrawal. Annual
premium chargeable in any policy year depends on the attained age next birthday of the life assured at
renewal.
Benefits provided are subjected to individual annual and life time limits, as stated in the Schedule of
Benefits.
PLAN BENEFITS
In the event of medical expenses incurred on the life assured due to accident or illness (subject to
exclusions) or any other covered eventuality, the policy will reimburse such expenses based on the relevant
co-insurance percentages and minimum co-insurance amounts, up to the limits and sub-limits according to
the plan purchased as stated in the Schedule of Benefits.
Compensation may be claimed from the start of a course of the covered treatment until the time it is
confirmed by the medical opinion acceptable to the Company that such treatment is no longer necessary.
SCHEDULE OF BENEFITS
14 Outpatient Cancer Treatment As charged subject to Overall Annual Limit and Overall
Lifetime Limit.
15 Outpatient Kidney Dialysis Treatment
Subject to 10% co-insurance.
16 Emergency Accidental Outpatient
Treatment 3,000 4,000 6,000 8,000
(Maximum 30 days from date of accident)
17 Daily-Cash Allowance at Malaysian
Government Hospital 50 per day
(Maximum 120 days)
18 Overall Annual Limit for Items (1) to (17) 90,000 120,000 160,000 200,000
(Based on Paid Amount)
19 Overall Lifetime Limit for items (1) to (17) 360,000 480,000 640,000 800,000
(Based on Paid Amount)
20 Executive Second Opinion (ESO) In accordance with benefit provisions in
Executive Second Opinion
21 Supreme Assist In accordance with benefit provisions in
(Emergency Medical Assistance Services) Supreme Assist agreement
DESCRIPTION OF BENEFITS
For the avoidance of doubt, if Intensive Care Unit benefit is payable for a confinement period, no
Hospital Room and Board benefit shall be payable for the same confinement period.
Such treatment (radiotherapy or chemotherapy excluding consultation, examination tests and take
home drugs) must be received at the Outpatient department of a Hospital or a registered cancer
treatment center immediately following discharge from Hospital.
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. The following conditions are excluded:
(a) Carcinorma in situ including of the cervix;
(b) Ductal Carcinorma in situ of the breast;
(c) Papillary Carcinorma of the bladder & Stage 1 Prostate Cancer;
(d) All skin cancers except malignant melanoma;
(e) Stage 1 Hodgkin's disease;
(f) Tumours manifesting as complications of AIDS.
In addition to the exclusion of Pre-existing Illness, this benefit shall not be payable for any Life
Assured who had been diagnosed as a cancer patient and/or is receiving cancer treatment prior to
the Risk Commencement Date.
Such treatment (dialysis excluding consultation, examination tests and take home drugs) must be
received at the Outpatient department of a Hospital or a registered dialysis treatment center
immediately following discharge from Hospital.
Kidney Failure means end stage renal failure presenting as chronic and irreversible failure of both
kidneys to function as a result of which renal dialysis is initiated.
In addition to the exclusion of Pre-existing Illness, this benefit shall not be payable for any Life
Assured who has developed chronic renal diseases and/or is receiving dialysis treatment prior to
the Risk Commencement Date.
The Company reserves the right to amend the provision of this benefit at any time, by giving 30-day
notice, subject to the availability of this benefit at reasonable costs from the Service Provider.
Note:
Please refer to Appendix on page 14 - 15 for the List of Covered Conditions.
(ii) The following services are applicable to the Life Assured traveling outside his state
of residence in Malaysia for a period not exceeding 120 consecutive days for any
one trip:
• Arrangement and Payment of Emergency Medical Evacuation
• Arrangement and Payment of Emergency Medical Repatriation
• Arrangement for Hospital Admission
The Company reserves the right to amend the provision of this benefit at any time, by giving a 30-
day notice, subject to the availability of this benefit at reasonable costs from the Service Provider.
The maximum amount payable by the Company in respect of this benefit on the same Life Assured
is limited to RM500,000.
UNDERWRITING GUIDELINES
2. Policy Term
80 minus entry age next birthday (Only one term is allowed)
4. Non-Medical Limits
In general, Medical Examination is not required. However, the Company reserves the absolute right
to call for a medical examination, if necessary.
PREMIUM
In case where premium payments are made other than annual premium, the following factors are to
be applied to the annual premium to arrive at the installment premium:
2. Premium Payment
Premium can be paid by cash, cheque, or credit card for all modes of payments. Cash / cheque is
not applicable for monthly premium payment mode.
4. Female Rates
Separate rates applicable to males and females.
5. Occupational Rates
The standard male and female rates are applicable to Occupation Classes 1 and 2.
Separate premium rates are chargeable for Occupation Classes 3 and 4.
7. Backdating
Not allowed.
Note:
Kindly refer to page 12 - 13 for the indicative premium rates.
DISCOUNTS
1. Non-smoker Discount
Not applicable.
Note:
Except for attachment of Premier Comprehensive Accident Benefits Exclusive Rider (P-CABE) from 02
June 2009 to 13 July 2009.
OTHER FEATURES
1. Surrender Values
This plan has no surrender value. However, upon cancellation of the policy by policyowner and
provided that no claims have been made during the policy year, the policyowner shall be entitled to
a refund of the proportionate premium paid as follows:
Note: Under such circumstance the commissions payable will be clawed-back accordingly.
2. Free-look Period
Policyowner is allowed to cancel the policy within 15 days. Under such circumstance, total premium
paid minus the expenses incurred for medical examination (if any) will be refunded and
commissions will be clawed back accordingly.
3. Assignment / Nomination
Not allowed.
4. Third-Party Policy
Allowed.
5. Reinstatement
As per current practice.
EXCLUSIONS
The Company will not pay any benefit under this Policy as a result of, including of any of the following whether
directly or indirectly:
1. Pre-existing Illness;
2. Specified Illnesses occurring within the first 120 days from the Risk Commencement Date;
3. Any medical or physical conditions arising within the first thirty (30) days from the Risk
Commencement Date except for Injury;
4. Plastic/cosmetic surgery, circumcision, eye examination, glasses, lens and refraction or surgical
correction of nearsightedness and farsightedness (Radial Keratotomy or Lasik) and the use or
acquisition of external prosthetic appliances or devices such as artificial limbs, hearing aids, implanted
pacemakers and prescriptions thereof;
5. Dental conditions including dental treatment or oral surgery; except as necessitated due to Injury to
sound natural teeth occurring in any Policy Year and performed by Dentist. In addition, expenses
arising from placement of denture and prosthetic services such as bridges, implants and crowns or
their replacement will not be payable;
6. Private nursing, rest cures or sanitaria care, illegal drugs, intoxication (including but not limited to
alcohol and drugs), 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;
7. Any treatment or surgical operation for Congenital Conditions or deformities including hereditary
conditions;
8. Pregnancy, childbirth (including surgical delivery and any surgical or non surgical procedure of the
female reproductive system during 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;
9. 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;
10. Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane;
11. 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;
12. Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from
process of nuclear fission or from any nuclear weapons material;
13. Expenses incurred for donation of any body organ by an Life Assured and cost of acquisition of the
organ including all costs incurred by the donor during organ transplant and its complications;
14. Investigations and treatment of sleep and snoring disorders, hyperhidrosis treatment, hormone
replacement therapy, stem cell therapy, PET scan and alternative therapy such as treatment,
medical service or supplies, including but not limited to chiropractic services, acupuncture,
acupressure, reflexology, bone setting, herbalist treatment, massage, hyperbaric oxygen therapy or
aromatherapy or other alternative treatment;
15. Care or treatment for which payment is not required or to the extent which is payable by any other
insurance or indemnity covering the Life Assured and disabilities arising out of duties of
employment or profession that is covered under a Workman’s Compensation Insurance Contract or
from either sources in respect of Injury or Illness or Disease for which the claim is made;
16. Psychotic, mental or nervous disorders, (including any neuroses and their physiological or
psychosomatic manifestations);
17. Costs/expenses of services of a non-medical nature, such as television, telephones, telex services,
broadband services, electricity bills for hand phone charging, radios or similar facilities, admission
kit/pack and other ineligible non-medical items;
18. Sickness or Injury arising from racing of any kind (except foot racing), hazardous sports such as but
not limited to parachuting, sky-diving, water skiing, underwater activities requiring breathing apparatus,
winter sports, professional sports and illegal activities;
19. Engaging in aerial flights other than as a crew member or as a fare-paying passenger of an
International Airline operating on a regular scheduled route;
21. Any Outpatient treatment not related to Inpatient treatment, except as provided under this Policy;
22. Any Accident caused by mosquito bites, worm infestations such as “Hookworms” and allergic
reaction to insect bites during the first thirty (30) days from the Risk Commencement Date;
23. Charges which are not Reasonable and Customary Charges, or any surgery or treatment which is
not Medically Necessary, or charges in excess of Reasonable and Customary Charges, or charges
which are incurred for hospitalisation, pre-hospitalisation and/or post-hospitalisation after the Expiry
Date;
24. Any medical treatment received by the Life Assured outside Malaysia, if the Life Assured resides or
travel outside Malaysia for more than ninety (90) consecutive days.
Note:
Kindly refer to individual policy contract for details of exclusions.
MALE FEMALE
ANB GMC2- GMC2- GMC2- GMC2- ANB GMC2- GMC2- GMC2- GMC2-
150 200 300 400 150 200 300 400
(H209) (H210) (H211) (H212) (H209) (H210) (H211) (H212)
1-5 846 1,008 1,360 1,768 1-5 616 730 981 1,275
6-10 609 726 980 1,274 6-10 533 633 850 1,105
11-15 515 615 829 1,078 11-15 450 535 718 933
16-20 526 627 847 1,101 16-20 460 546 733 953
21-25 521 622 842 1,095 21-25 536 639 868 1,128
26-30 521 621 840 1,092 26-30 539 644 876 1,139
31-35 523 624 847 1,101 31-35 541 648 883 1,148
36-40 657 787 1,070 1,391 36-40 678 815 1,116 1,451
41-45 849 1,018 1,391 1,808 41-45 842 1,015 1,394 1,812
46-50 1,080 1,298 1,778 2,311 46-50 1,104 1,333 1,837 2,388
51-55 1,215 1,462 2,006 2,608 51-55 1,367 1,653 2,284 2,969
56-60 1,675 2,021 2,779 3,613 56-60 1,689 2,047 2,833 3,683
61-65* 2,513 3,032 4,169 5,420 61-65* 2,534 3,071 4,250 5,525
66-70* 3,770 4,548 6,254 8,130 66-70* 3,801 4,607 6,375 8,288
71-75* 5,655 6,822 9,381 12,195 71-75*
5,702 6,911 9,563 12,432
76-79* 8,483 10,233 14,072 18,293 76-79* 8,553 10,367 14,345 18,648
*
For renewal only.
2. Occupation Class 3
MALE FEMALE
ANB GMC2- GMC2- GMC2- GMC2- ANB GMC2- GMC2- GMC2- GMC2-
150 200 300 400 150 200 300 400
(H209) (H210) (H211) (H212) (H209) (H210) (H211) (H212)
1-5 1,058 1,260 1,700 2,210 1-5 770 913 1,226 1,594
6-10 761 908 1,225 1,593 6-10 666 791 1,063 1,381
11-15 644 769 1,036 1,348 11-15 563 669 898 1,166
16-20 658 784 1,059 1,376 16-20 575 683 916 1,191
21-25 651 778 1,053 1,369 21-25 670 799 1,085 1,410
26-30 651 776 1,050 1,365 26-30 674 805 1,095 1,424
31-35 654 780 1,059 1,376 31-35 676 810 1,104 1,435
36-40 821 984 1,338 1,739 36-40 848 1,019 1,395 1,814
41-45 1,061 1,273 1,739 2,260 41-45 1,053 1,269 1,743 2,265
46-50 1,350 1,623 2,223 2,889 46-50 1,380 1,666 2,296 2,985
51-55 1,519 1,828 2,508 3,260 51-55 1,709 2,066 2,855 3,711
56-60 2,094 2,526 3,474 4,516 56-60 2,111 2,559 3,541 4,604
61-65* 3,141 3,790 5,211 6,775 61-65* 3,168 3,839 5,313 6,906
66-70* 4,713 5,685 7,818 10,163 66-70* 4,751 5,759 7,969 10,360
71-75* 7,069 8,528 11,726 15,244 71-75* 7,128 8,639 11,954 15,540
76-79* 10,604 12,791 17,590 22,866 76-79* 10,691 12,959 17,931 23,310
*
For renewal only.
3. Occupation Class 4
MALE FEMALE
ANB GMC2- GMC2- GMC2- GMC2- ANB GMC2- GMC2- GMC2- GMC2-
150 200 300 400 150 200 300 400
(H209) (H210) (H211) (H212) (H209) (H210) (H211) (H212)
1-5 1,269 1,512 2,040 2,652 1-5 924 1,095 1,472 1,913
6-10 914 1,089 1,470 1,911 6-10 800 950 1,275 1,658
11-15 773 923 1,244 1,617 11-15 675 803 1,077 1,400
16-20 789 941 1,271 1,652 16-20 690 819 1,100 1,430
21-25 782 933 1,263 1,643 21-25 804 959 1,302 1,692
26-30 782 932 1,260 1,638 26-30 809 966 1,314 1,709
31-35 785 936 1,271 1,652 31-35 812 972 1,325 1,722
36-40 986 1,181 1,605 2,087 36-40 1,017 1,223 1,674 2,177
41-45 1,274 1,527 2,087 2,712 41-45 1,263 1,523 2,091 2,718
46-50 1,620 1,947 2,667 3,467 46-50 1,656 2,000 2,756 3,582
51-55 1,823 2,193 3,009 3,912 51-55 2,051 2,480 3,426 4,454
56-60 2,513 3,032 4,169 5,420 56-60 2,534 3,071 4,250 5,525
61-65* 3,770 4,548 6,254 8,130 61-65* 3,801 4,607 6,375 8,288
66-70* 5,655 6,822 9,381 12,195 66-70* 5,702 6,911 9,563 12,432
71-75* 8,483 10,233 14,072 18,293 71-75* 8,553 10,367 14,345 18,648
76-79* 12,725 15,350 21,108 27,440 76-79* 12,830 15,551 21,518 27,972
*
For renewal only.
Appendix:
1) Heart Attack
2) Stroke
3) Coronary Artery Disease Requiring Surgery
4) Cancer
5) Kidney Failure
6) Fulminant Viral Hepatitis
7) Major Organ Transplant
8) Paralysis / Paraplegia
9) Multiple Sclerosis
10) Primary Pulmonary Arterial Hypertension
11) Blindness
12) Heart Valve Replacement
13) Loss Of Hearing / Deafness
14) Surgery To Aorta
15) Loss of Speech
16) Alzheimer’s Disease / Irreversible Organic Degenerative Brain Disorders
17) Major Burns
18) Coma
19) Terminal Illness
20) Motor Neuron Disease
21) AIDS Due To Blood Transfusion
22) Parkinson’s Disease
23) Chronic Liver Disease
24) Chronic Lung Disease
25) Major Head Trauma
26) Aplastic Anaemia
27) Muscular Dystrophy
28) Benign Brain Tumour
29) Encephalitis
30) Poliomyelitis
31) Brain Surgery
32) Bacterial Meningitis
33) Other Serious Coronary Artery Disease
34) Apallic Syndrome
35) AIDS Cover of Medical Staff
36) Full Blown AIDS
37) Angioplasty
38) Medullary Cystic Kidney
39) Cardiomyopathy
40) Systemic Lupus Erythematosus with Lupus Nephritis (SLE)
ESO Service will be arranged for a Covered Condition under (41) to (49) if the Life Assured is diagnosed of
any such Covered Conditions after the Waiting Period and before he attains the age of twenty-one (21)
years next birthday. If the evidence or opinion of a consultant paediatrician is required for any of the
Covered Conditions (41) to (49) on a Life Assured over the age of fourteen (14) years next birthday, the
requirement for evidence or opinion of a consultant paediatrician may be substituted by that of an
appropriate attending medical practitioner at the sole discretion of the Company or Supreme Assist.
41) Bone Marrow Transplant
42) Glomerulonephritis with Nephrotic Syndrome
43) Insulin Dependent Diabetes Mellitus
44) Intellectual Impairment due to Accident or Sickness
(B) Definition:
“Specified Illnesses” means the following disabilities and its related complications, occurring within the
first 120 days from the Risk Commencement Date. However, if there is a break in coverage prior to the
expiry of the said 120 days, a fresh period of 120 days shall apply again from the date of reinstatement:
(a) Hypertension, diabetes mellitus and Cardiovascular disease;
(b) All tumours, cancers, cysts, nodules, polyps, stones of the urinary system and biliary system;
(c) All ear, nose (including sinuses) and throat conditions, excluding flu and sore-throat;
(d) Hernias, haemorrhoids, fistulae, hydrocele, varicocele;
(e) Endometriosis including disease of the Reproduction system;
(f) Vertebro-spinal disorders (including disc) and knee conditions.
-End-