AXXESS | Medical Benefits

Schedule of Benefits


PLAN
(A) IN-HOSPITAL CARE RM
a) (i) Hospital Room and Board
(up to maximum 180 days per Disability)
(ii) Intensive Care Unit
(up to maximum 30 days per Disability inclusive of Room & Board)
150

350
b) Hospital Supplies and Services
(Maximum per Disability)
As Charged
c) Surgical Fees
(Maximum per Disability)
As Charged
d) Anaesthetic Fee
(Maximum per Disability)
As Charged
e) Operating Theatre
(Maximum per Disability)
As Charged
f) In-Hospital Physician Visit
(up to maximum 180 days per Disability)
As Charged
g) Malaysian Government Hospital Daily Cash Allowance
(Up to maximum 180 days per disability)
45
h) Overall Maximum Limit for Malaysian Government Hospital
(Not subjected to any limit except Room and Board limit and overall maximum limit per disability/annum)
50,000 per annum
(B) AMBULATORY CARE RM
a) Pre-Surgical/Medical Diagnostic Services
(Maximum per Disability within 60 days prior to hospitalization)
As Charged
b) Pre-Surgical/Medical Specialist Consultation
(Maximum per Disability for first time consultation within 60 days prior to hospitalization)
As Charged
c) Second Surgical Opinion
(Maximum per Disability)
As Charged
d) Post-Hospitalization Treatment
(Up to 60 days maximum per Disability following discharge from hospital)
As Charged
e) Emergency Out-Patient Accidental Treatment
(Maximum per Disability within 24 hours after the accident & follow-up treatment up to 60 days)
2,750
f) Accidental Dental Treatment
(Maximum per Disability within 24 hours after the accident & follow-up treatment up to 14 days)
500
g) Daycare Procedure (Surgical/Medical)
(Maximum per Disability inclusive of all incidental costs, pre-daycare visits up to 60 days and post-daycare visits up to 60 days)
As Charged
h) Ambulance Fees
(Maximum per Disability for emergency and non-emergency services)
250
i) Emergency Out-Patient Treatment
(Maximum per Disability from 10:00pm to 8.00am)
100
j) Medical Report Fee Reimbursement
(Maximum per Disability applicable for In-Hospital Care and Ambulatory Care)
100
Overall Limit
- Maximum per annum
50,000
EXTENDED BENEFIT (EXT)
a) Accidental Death Benefit
(One time payment due to death from Accidental Causes)
15,000

Please see following page for major exclusions. Click here for panel hospital

Major Exclusions

"PRE-EXISTING CONDITIONS” shall mean any disabilities, injury, sickness or disease (physical or mental) prior to the Effective Date or Date of Reinstatement, whichever is later, that the Policy Owner/Insured has reasonable knowledge of and which was not disclosed to Us. A Policy Owner/Insured may be considered to have reasonable knowledge of a pre-existing condition where the condition is one for which:

  1. The Insured had received or is receiving treatment
  2. Medical advice, diagnosis, care or treatment has been recommended
  3. The Insured had received or is receiving treatment
  4. Its existence would have been apparent to a reasonable person in the circumstances

90 DAYS WAITING PERIOD: Eligibility for benefits starts 90 days after the Insured Members has been included in the Policy, except for a covered Accident occurring after the effective date of coverage.

120 DAYS SPECIFIED ILLNESSES: No benefits shall be payable for hospitalization, surgery and/or charges incurred which are caused directly or indirectly by Specified Illnesses and its related complications. "Specified Illnesses" shall mean the following disabilities and its related complications, occurring within the first 120 days of Insurance of the Insured Member:

  1. Hypertension, diabetes mellitus and Cardiovascular disease
  2. All tumours, cancers, cysts, nodules, polys, stones of the urinary system and biliary system
  3. All ear, nose (including sinuses) and throat conditions
  4. Hernias, haemorrhoids, fistulae, hydrocele, varicocele
  5. Endometriosis including disease of the Reproduction system
  6. Vertebro-spinal disorders (including disc) and knee conditions