AmPreferred Medicare


	1300-88-8800 amassurance@ambg.com.my

		AmPreferred Medicare

Terms of Issue

This is a Hospital & Surgical (H & S) Policy until age 70.
Person eligible to be covered under this Policy are:-
1. Minimum age at entry : Insured Person/Spouse- 18 years old,Dependent Child- 30 days old
2. b) Maximum age at entry: Insured Person/Spouse – 60 years old, Financilly Dependent Child who is full-time student in a recognized Institutions of higher learning – 23 years old
3. Maximum age at expiry :Insured Person/Spouse-70 years old, Dependent Child-24 years old
4. Persons who reside in Malaysia only.
Period of Cover and Renewal
This Policy shall become effective as of the date stated in the First Schedule. The Policy Anniversary shall be one year after the effective date and annually thereafter. On each such anniversary, this Policy is conditionally renewable at the premium rates in effect at that time as notified by the Company. Policy’s renewal is conditionally guaranteed as the Company reserves its rights to exercise the Portfolio Withdrawal Condition in respect of withdrawing the product entirely from the market. The Company further reserves the right to revise the premium rates applicable at policy anniversary by giving thirty (30) days prior written notice to the policyholder. The renewal premium payable for the H & S Policy is not guaranteed;
1. The Company can revise the premium at the time of renewal/policy anniversary according to the Company’s risk assessment and the possible condition disclosed is not exhaustive.
2. The premium rate is banded according to the plan type chosen and is payable according to each member’s age on each Policy year anniversary.
Application for change of benefits to higher plan can only be made on renewal and is subject to acceptance by the Company upon renewal.
Co-payment maybe imposed by the Insurer, depending on underwriting considerations. Notwithstanding this, if the policyholder utilizes a Room & Board rate, which is more than his/her entitlement, then he/she shall also be subject to the Upgraded Room & Board 20% Co-Payment Clause.
If the proposal / declaration of the Policyholder is untrue or misrepresented / misstated in any respect, then this policy shall be void.
Cooling-Off Period may apply if this Policy shall have been issued and for any reason whatsoever the Insured Person shall decide not to take up the Policy, the Insured Person may return the Policy to the Company for cancellation provided such request for cancellation is delivered by the Insured Person to the Company within fifteen (15) days from the date of delivery of the Policy.

The Insured Person is entitled to the return of the full premium paid less deduction of any medical expenses incurred by the Company in the issue of the Policy.

Benefits
In-patient Benefits

Room & Board (maximum 150 days)
ICU (maximum 75 days)
Hospital Miscellaneous Services
Operating Theatre Fees
Surgical Benefit
Anaesthetist’s Fees

Pre & Post Benefits

Pre-hospital Diagnostic Services (within 60 days prior to admission or surgery)
Pre-hospital Specialist Consultation (within 60 days prior to admission or surgery)
Post Hospital Follow-up (within 60 days from discharge)
Second Surgical Opinion (within 60 days prior to surgery)
In-hospital Dr’s Call (max per day / max 150 days)

Out-patient Benefits

Emergency Treatment for Accidental Injury inclusive of Dental injury (within 24 hours & 31 days follow-up)
Out-patient Physiotherapy (with written referral within 90days from hospital discharge / surgery)
Daycare procedure (inclusive of all incidental services & supplies)
Ambulance fees

Special benefits Medical prostheses (actual expenses up to maximum benefit limit). Reimbursement of actual expenses or benefit up to benefit limit whichever is lower. Doctor's certification required to support claims. Special Benefit is inclusive in Overall Annual Limit & Lifetime Limit.

Special benefits Preventive Health checks benefits (at selected medical facilities) - once per policy year

Value Added Benefits

Pharmacy Chain Loyalty Card
Inclusive
Enjoy exclusive discounts at Pharmacy Chain Stores
Points redemption for health products
I year Free subscription to Bi-monthly Health magazine
Other member's only privileges

SOME Major Benefits Limitations
This product does NOT cover:

Pre-existing illness.
Specified Illnesses occurring during the first 120 days of continuous cover.
Any medical or physical conditions arising within the first 30 days of the Insured Person’s cover or date reinstatement whichever is latest except for accidental injuries.
Plastic/Cosmetic surgery, circumcision, eye examination, glasses and refraction or surgical correction of nearsightedness(Radial Keratotomy)and the use or acquisition of external prosthetic appliances or devices such as artificial limbs, hearing aids, implanted pacemakers and prescriptions thereof.
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.
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.
Any treatment or surgical operation for congenital abnormalities or deformities including hereditary conditions.
Pregnancy, 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.
Hospitalization 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.
Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.
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.
Ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material.
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.
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, bone-setting, herbalist treatment, massage or aroma therapy or other alternative treatment.
Care or treatment for which payment is not required or to the extent which is payable by any other insurance or indemnity covering the Insured and Disabilities arising out of duties of employment or profession that is covered under a Workman’s Compensation Insurance Contract.
Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations).
Costs/expenses of services of a non-medical nature, such as television, telephones, telex services, radios or similar facilities, admission kit/pack and other ineligible non-medical items.
Sickness, disease, illness or Injury arising from racing of any kind (except foot racing), hazardous sports such as but not limited to skydiving, water skiing, underwater activities requiring breathing apparatus, winter sports, professional sports and illegal activities.
Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes.
Expenses incurred for sex changes.

Click here for schedule of benefits

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