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Groupon sdn bhd benefit slides 2011 ghs & gtl

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Groupon sdn bhd benefit slides 2011 ghs & gtl

  1. 1. GROUPON SDN BHDEmployee BenefitsAllianz Life Insurance Malaysia Berhad
  2. 2. CONTENTS 1. Schedule of Benefits 2. Policy Conditions 3. Exclusions 4. Admission procedures 5. Claim procedures© Copyright Allianz Life Malaysia 07.03.12 2
  3. 3. The Group Hospitalisation & Surgical benefits coverMedical and surgical treatment by an injury, sickness, disease or illness requiringconfinement in a hospital;Outpatient treatment when the hospital provides services and supplies in connectionwith a surgical procedure or for the emergency treatment of accidental bodily injuries.© Copyright Allianz Life Malaysia 07.03.12
  4. 4. 1. Schedule of Benefits - Group Hospitalisation & Surgical SCHEDULE OF BENEFITS Plan 200 Room & Board (max 120 days) 200 ICU (max 20 days) As Charged Hospital Supplies & Services (With Implant Coverage) As Charged Surgical Fees As Charged (Not Subject to Surgical Schedule) Anaesthetic Fees As Charged Operating Theatre Fees As Charged In-hospital Physician’s Fees As Charged (Daily maximum up to 120days) Pre-Hospitalisation Diagnostic Tests As Charged (within 60 days prior to hospitalisation) Pre-Hospitalisation Specialist Consultation As Charged (within 60 days prior to hospitalisation) Second Surgical Opinion As Charged (Within 60days prior to hospitalisation) Post-Hospitalization Treatment As Charged (within 60days from discharged, with physiotherapy coverage) Daycare Procedure (Within 60days) As Charged Ambulance Fee As Charged
  5. 5. 1. Schedule of Benefits - Group Hospitalisation & Surgical (cont’) SCHEDULE OF BENEFITS Plan 200 Accidental Dental Treatment (within 24 hours after accident and follow up treatment up to 14days) As Charged Emergency Accidental Outpatient Treatment (within 24 hours after the accident & follow up treatment up to 60 days) As Charged Medical Report Fee 80 Government Hospital Daily Cash Allowance 100 (max 120 days) Government Service Tax ( 6% on Room & Board) 6% Emergency Sickness Treatment 100 (Between 12am to 6am) Funeral Expenses (for insured employee only) 5000 Outpatient Kidney Dialysis (Per Policy Year) 10000 10000 Outpatient Cancer Treatment (Per Policy Year) Co-payment (WAIVE) Overall Limit Per Annum 20,000
  6. 6. 2. GHS Policy Conditions Eligibility to participate: Employee: Age 16 to 64. Actively at work. Dependent: Spouse age 16 to 64. Children age over 14 days old but under 19 years of age or under 24 if they are still full time in higher education and not gainfully employed.© Copyright Allianz Life Malaysia 07.03.12 6
  7. 7. 2. GHS Policy Conditions (cont’) Pre-existing illness (120 days) : Applicable Specific illnesses (120days) : Applicable (e.g. Hypertension,Diabetes Mellitus, All tumours of any kind, Cancers,cysts etc. Please refer to Policy for the list of illnesses) Waiting period (30days) : Applicable© Copyright Allianz Life Malaysia 07.03.12 7
  8. 8. 2. GHS Policy Conditions (cont’) Overseas Treatment If the Insured Person seeks treatment overseas, benefits in respect of the treatment shall be covered subject to the exclusions, limitations and conditions specified in this Policy and all benefits will be payable based on the official exchange rate ruling on the last day of Period of Confinement and shall exclude the cost of transport to the place of treatment provided:- a. An Insured Person traveling abroad for a reason other than for medical treatment, needs to be confined to a Hospital outside Malaysia as a consequence of a Medically Necessary Emergency. b. An Insured Person upon recommendation of a Physician and has to be transferred to a Hospital outside Malaysia because the specialized nature of the treatment, aid, information or decision required can neither be rendered nor furnished nor taken in Malaysia. Overseas treatment of a disease, sickness or injury which is diagnosed in Malaysia and non-emergency or chronic conditions where treatment can reasonably be postponed until return to Malaysia are excluded.© Copyright Allianz Life Malaysia 07.03.12
  9. 9. 2. GHS Policy Conditions (con’t) Emergency A condition where as a result of an unforeseen illness or injury, urgent medical treatment is required in order to prevent immediate and/or serious deterioration of an Insured Person’s health and the receipt of medical treatment cannot be reasonably delayed. Customary And Reasonably Charges The charges normally made for the service provided by physicians in the given geographical area. Residence Overseas 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 90 consecutive days.© Copyright Allianz Life Malaysia 07.03.12 9
  10. 10. 3. Exclusions – Group Hospital and Surgical • Air travel except as a fare paying passenger. • Active duty in military, naval, armed forces, police or any uniformed unit. • Ionising radiation or contamination by radioactive • Suicide, attempted suicide, any intentionally self- inflicted injury while sane or insane. • Dental treatment or oral surgery, except due to accident. • Functional disorder of psychic or mental.© Copyright Allianz Life Malaysia 07.03.12 10
  11. 11. 3. Exclusions – Group Hospital and Surgical (cont’) • Treatment for recuperative or rest cure resulted from mental fatigue. • Any congenital disabilities • Birth control, infertility, miscarriage or pregnancy. • Eye test, refractive errors of the eyes or surgical correction of nearsightedness or plastic surgery, and the provision of appliances, including wheelchairs. • Cosmetic surgery, plastic surgery or beautification purposes unless is medically necessary. • Expenses incurred for sex changes© Copyright Allianz Life Malaysia 07.03.12 11
  12. 12. 3. Exclusions – Group Hospital and Surgical (cont’) • Abuse of Alcohol and /or Drugs. • AIDS or Aids Related Complex • Routine medical checkup. • Any treatment purely for investigation purposes • Any circumcision unless it is medically required. • Sleep and snoring disorder. Note:- The above are the simplified version of some important exclusion for the GHS benefits. Please refer to the master policy contract for a complete set of exclusion clauses.© Copyright Allianz Life Malaysia 07.03.12 12
  13. 13. 4. In-Patient Admission Procedure(Pre & Post Hospitalization are on reimbursement basis)(Applicable at panel hospitals only. For admission to a non-panel hospital, member will be required to payand file the claim with Allianz Life.) Member admit to hos pital 2. P re s e nt th e m e d ical card to h os p ital ad m is s ion cou nte r 3.F ill in th e H os p ital Ad m is s ion F orm and s ign th e cons e n t to re le as e m e d ical re p o rt to Allianz *Members are advis able to notify A s ia A s s is tance 3 days before any pre-planned admis s ion N O TE S : 7.C e rtain h os p itals m ay ins is t on a d e p os it for ch arge s n ot cove re d b y in s u ran ce (R M 200 to R M500 d e p e nd ing on h o s p ital) alth ou gh As ia As s is tan ce h as is s u e d a G u arante e Le tte r for ad m is s ion. 8.D e p os it will b e re fu nd e d b y h os p ital if u nu tilize d . HOS PITA L 2. Atte nd ing P h ys ician will com p le te th e m e d ical cond ition p ortion in th e H os p ital Ad m is s io n F orm 3. O nce m e m b e r and th e Atte n d in g P h ys ician h as com p le te d th e H os p ital Ad m is s ion F o rm , th e ad m is s ion d e p artm e nt will fax th e H o s p ital Ad m is s ion F orm to As ia As s is tance to o b tain G u aran te e Le tte r AAN 2. R e ce ive H os p ital Ad m is s ion F orm via fax from h o s p ital 3.Ve rify m e m b e rs h ip d e tails and s tatu s 4.C h e ck Tre atm e nt P roce d u re s again s t p olicy 5. * Is s u e Initial G u aran te e Le tte r (S u b j ct to th e p o licy te rm s and cond itions ) e GUA RA NTE E D NON-GUA RA NTE E D © Copyright Allianz Life Malaysia 07.03.12
  14. 14. A dmis s ion & Dis charge Procedures (GUA RA NTE E D) GUARANTEED A dmis s ion C OVE R within Policy C onditions 2. Is s u e G u arante e Le tte r to h os p ital. 3.As ia As s is tance will m onitor and re vie w th e e xp e n s e s incu rre d 4.Is s u e s u p e r ce d ing G u arante e Le tte r, if re qu ire d u p th e p olicy lim it ME MBE R rec eives treatment from hos pital Hos pital proces s bills 2. H os p ital inform AAN th at m e m b e r will d is ch arge . 3.Th e atte n d ing d o ctor to com p le te th e m e d ical re p ort an d confirm th e final d iagnos is . 4.H os p ital to com p ile all ite m ize d b ills incu rre d and fax th e final b ills to AAN for MEMBER DISCHARGED m e m b e r’s d is ch arge . A A N proces s final G L 2. AAN will confirm th e fin al d iagnos is b as e d on th e m e d ical re p ort com p le te d b y th e atte nd ing p h ys ician . 3.AAN will is s u e F IN AL G L to cove r m e d ical e xp e ns e s accord ing to p olicy te rm s and con d ition s ME MB E R to pay for the following:- 2. In e xce s s of P olicy Lim it 3.E xtra M e als . Lod ge r and oth e r n on-m e d ical re late d ite m© Copyright Allianz Life Malaysia 07.03.12
  15. 15. A dmis s ion & Dis charge Procedures (NON-GUA RA NTE E D) NON-GUARANTEED A dmis s ion NOT C OVE R within Policy C onditions 2. AAN Inform ALLIAN Z & H o s p ital 3.H os p ital inform P atie nt 4.P atie n t to d e cid e to s tay or trans fe r to an oth e r h os p ital ME MBE R rec eives treatment from hos pital HOS PITA L proces s bills to ME MB E R MEMBER DISCHARGED ME MB E R arrange FULL Payment to Hos pital ME MB E R s ubmit for C laims – Reimburs ement C ons ideration by A LLIA NZ 15© Copyright Allianz Life Malaysia 07.03.12
  16. 16. GHS Dis c harge S c enario Doctor advis e patient to be dis charged Doctor continues to vis it other patients A fter finis hed ward vis it, doc tor informs billing officer to prepare final medical bill B illing officer   for patient compiles all A pproximately 1 – 2 medical expens es Hos pital fax hrs incurred final bill to  1 hr  A s ia A s s is tance 16© Copyright Allianz Life Malaysia 07.03.12
  17. 17. GHS Accidental Treatment - During An Emergency 1. Proceed to the nearest clinic (panel or non-panel) or Accident & Emergency Unit at any Hospital. 2. The Doctor or Medical Officer will attend to you. 3. Pay and seek reimbursement from Allianz. m During late night emergency visit, you can request for call centre assistance for LG if you can wait. Member Priority to s eek Hos pital or Panel / Treatment Firs t Non-Panel C linic© Copyright Allianz Life Malaysia 07.03.12 17
  18. 18. 5. Claim Procedures (Reimbursement) Documentation For Reimbursement Claim • Original itemised medical bill • Original official receipt • Claimant Statement duly completed (Claim Form) • Medical Report Note : For GHS, Medical Report is WAIVED if claimed amount is less than RM500 for Private Hospital and RM1,000 for Government Hospital© Copyright Allianz Life Malaysia 07.03.12 18
  19. 19. 5. Claim Procedures (Reimbursement) – con’t Submit documents to Client Allianz Life (via Broker) Claim’s Document Deferment 14 working days Claims Processing Claim settlement within 18 working days© Copyright Allianz Life Malaysia 07.03.12 19
  20. 20. Group Term Life© Copyright Allianz Life Malaysia 07.03.12
  21. 21. CONTENTS 1. Risk Covered 2. Benefits 3. Definition 4. Exclusions 5. Underwriting 6. Claim Procedures© Copyright Allianz Life Malaysia 07.03.12
  22. 22. 1. Risk Covered Benefits Coverage - All Employees Group Term Life (Death) – All Causes RM20,000 Total & Permanent Disability – All Causes RM20,000 Partial & Permanent Disability – All Causes RM20,000 Critical Illness – Accelerated Natural Causes (100%) RM20,000 Accidental Death & Dismemberment (Accidental Causes) RM50,000© Copyright Allianz Life Malaysia 07.03.12
  23. 23. 2. Benefits Group Term Life Features : • Provides financial protection in the event of loss of life from all causes on a 24hours worldwide basis • Terrorism Extension© Copyright Allianz Life Malaysia 07.03.12
  24. 24. 3. Definition – Total Permanent Disability (TPD) 1st definition : Inability to work ever again in any occupation for profit or reward. Must satisfy a 6 months waiting period. 2nd definition : Loss of any two members – eyes or limbs. Limbs – must above wrist or ankle. Loss – permanent loss of use. No waiting period.© Copyright Allianz Life Malaysia 07.03.12
  25. 25. 3. Definition – Partial Permanent Disability  Permanent & partial disability caused by Natural & Accidental causes.  Payment according to schedule of benefits.  Total of all sums cannot exceed 100% in any one policy year.© Copyright Allianz Life Malaysia 07.03.12
  26. 26. 3. Definition – Critical Illness (CI) • The sum assured is payable in the event of the Life Assured is diagnosed as suffering from one of the 36 Critical Illnesses • Waiting period >>> - 30 days : Any Critical Illness (other then Angioplasty & Other Invasive Treatment for Major Coronary Artery Disease, Cancer, Coronary Artery By-pass Surgery, Heary Attack & Other Serious Coronary Artery Disease (as defined in the policy) as defined in the policy) - 60 days : Angioplasty & Other Invasive Treatment for Major Coronary Artery Disease, Cancer, Coronary Artery By-pass Surgery, Heary Attack & Other Serious Coronary Artery Disease (as defined in the policy)© Copyright Allianz Life Malaysia 07.03.12
  27. 27. 3. List of Critical Illnesses • HIV due to blood transfusion  Loss of Hearing/Deafness • Alzheimers Disease  Loss of Speech • Apallic Syndrome  Major Burns • Aplastic Anemia  Major Head Trauma • Bacterial Meningitis  Major Organ Transplantation • Benign Brain Tumor  Motor Neurone Disease • Brain Surgery  Multiple Sclerosis • Cancer • Coma  Muscular Dystrophy • Coronary Artery Disease  Parkinsons Disease • Coronary Artery By-pass Surgery  Primary Pulmonary Arterial Hypertension • Encephalitis  Stroke • End Stage Kidney Failure  Surgery To Aorta • End Stage Liver Failure  Systemic Lupus Erythematosus • End Stage Lung Disease  Terminal Illness • Fulminant Viral Hepatitis • Heart Valve Replacement • Heart Attack Note :- This is a simplified version of Critical Illnesses list. Please refer to policy wording for complete list and definition.© Copyright Allianz Life Malaysia 07.03.12
  28. 28. 3. Definition - Accidental Death and DismembermentSupplementary  Covers death and  Bodily injury effected directly and independently of all causes through accidental means and such injury alone shall within 90 days from date of accident, cause such losses as provided in the Schedule of Benefits In the event of  Accidental Death - 100% payment  Bodily Disablement - based on a percentage of the sum insured, as per Schedule of Benefit. Note :- The above are the simplified version of some important definition of GTL/TPD/PPD/CI/ADD benefits. Please refer to the master policy contract for details
  29. 29. 4. Risk Excluded – TPDThis Supplementary Contract shall not cover Total Permanent Disability caused directly orindirectly, wholly or partly by any of the following occurrences: -  self-inflicted bodily injuries (except in an attempt to save human life) while sane or insane;  participating in a riot, committing a criminal offense;  war, declared or undeclared, civil war, revolution, any warlike operations or restoration of public orders;  engaging in air travel except as a passenger in any properly licensed aircraft;  participation in any organized racing;  pregnancy which term includes abortion, miscarriage or complication therefrom.  accidental events that are directly or indirectly related to the use of atomic, biological or chemical weapons as well as radioactive, biological or chemical warfare agents or substances;© Copyright Allianz Life Malaysia 07.03.12
  30. 30. 4. Risk Excluded – PPD This Supplementary Contract shall not cover loss caused directly or indirectly, wholly or partly by any of the following occurrences: -  The Life Assured having or suffering from any pre-existing illnesses or conditions ;  Suicide, while sane or insane or any attempt thereat or intentionally self inflicted injury (except in an attempt to save human life) ;  Injury sustained while on full-time active duty in the armed forces of any country, or international authority ;  Injury sustained while under the influence of drugs or intoxicating liquor or while insane;  engaging in air travel except as a passenger in any properly licensed aircraft;  pregnancy which term includes abortion, miscarriage or complication therefrom;  war, declared or undeclared, civil war, revolution, any warlike operations or restoration of public orders;© Copyright Allianz Life Malaysia 07.03.12
  31. 31. 4. Risk Excluded – PPD (con’t)  participation in any organized racing;  Nuclear energy reactions, radiations and contaminations;  Any illness caused directly or indirectly, wholly or partly by self-inflicted illness, wilful misuse of drugs or alcohol.© Copyright Allianz Life Malaysia 07.03.12
  32. 32. 4. Risk Excluded – Critical Illness • Any Critical Illness, other than Angioplasty & Other Invasive Treatment for Major Coronary Artery Disease, Cancer, Coronary Artery By-pass Surgery, Heary Attack & Other Serious Coronary Artery Disease (as defined above), which first manifests itself prior to the thirtieth (30th) day following the issue date or any reinstatement date of this Supplementary Contract, whichever is later; • Angioplasty & Other Invasive Treatment for Major Coronary Artery Disease, Cancer, Coronary Artery By-pass Surgery, Heary Attack & Other Serious Coronary Artery Disease (as defined above), which first manifests itself prior to the sixtieth (60th) day following the issue date or any reinstatement date of this Supplementary Contract, whichever is later; or • Pre-existing conditions • Self-inflicted injuries while sane or insane, • Acquired Immune Deficiency Syndrome (AIDS), AIDS-Related Complex or infection by Human Immune Deficiency Virus (HIV) except as provided under one of the CI definition.© Copyright Allianz Life Malaysia 07.03.12
  33. 33. 4. Risk Excluded – ADD This Supplementary Contract shall not cover loss caused directly or indirectly, wholly or partly by any of the following occurrences: - Suicide, while sane or insane or any attempt thereat or intentionally self inflicted injury (except in an attempt to save human life) ; Injury sustained while on full-time active duty in the armed forces of any country, or international authority ; Injury sustained while under the influence of drugs or intoxicating liquor or while insane; engaging in air travel except as a passenger in any properly licensed aircraft; pregnancy which term includes abortion, miscarriage or complication therefrom; war, declared or undeclared, civil war, revolution, any warlike operations or restoration of public orders; participation in any organized racing;
  34. 34. 4. Risk Excluded – ADD (con’t) Nuclear energy reactions, radiations and contaminations; Accidental events that are directly or indirectly related to the use of atomic, biologicalor chemical weapons as well as radioactive, biological/chemical warfare agents orsubstances Note :- The above are the simplified version of some important exclusion for the GTL/TPD/PPD/CI/ADD benefits. Please refer to the master policy contract for a complete set of exclusion clauses
  35. 35. 5. UnderwritingThe persons eligible for insurance under the Policy are the present and futurefull-time employees of the Policyholder:-  who are below sixty-five (65) years of age and  Present employees will be eligible to participate in the insurance at the commencement date of the Policy. Future employees will be eligible to participate in the insurance according to the date mentioned in the Application Form.  Must be actively at work Actively at work mean that the Eligible Person is currently engaged in full- time occupation for regular salary or pay and is physically present during working hour. Absence due to normal holiday, study leave or training as distinct from sick leave shall also satisfy the requirement.© Copyright Allianz Life Malaysia 07.03.12 35
  36. 36. 5. Underwriting (cont’) Waiver of medical evidence for all employees from age 16 to 59 years old and who is actively at work Free Cover Limit (FCL) = RM60,000 / Aged 59 years Free Cover Limit • Amount of coverage where no medical examination is required Free Cover Age • An age where no medical examination is required If any employee’s sum assured has exceeded the Free Cover Limit, the excess amount is subject to medical underwriting.© Copyright Allianz Life Malaysia 07.03.12
  37. 37. 6. Claim Procedures S ub m it d ocum e nts to G rou p on Allianz Life (via Broke r) C laim D ocu m e nts D e fe rm e nt within 1 4 working d ays C laim s Claim se ttl m e nt within e P roce s s ing 1 8working d ays© Copyright Allianz Life Malaysia 07.03.12
  38. 38. 6. GTL Claim Documents Required Documents Required Death TPD PPD CI ADD Claimant’s Statement Yes Yes Yes Yes Yes Physician’s Statement Yes Yes Yes Yes Yes Certified True Copy of Death Certificate Yes No No No No Certified True Copy of Proof of Age – NRIC Yes Yes Yes Yes Yes Certified True Copy of Proof of Relationship Yes Yes Yes Yes Yes – Employment Letter, 2 months last pay slip Police report for Accidental case Yes Yes Yes No Yes Medical board out letter from company No Yes No No No Discharge Receipt – Prerequisite before Yes Yes Yes Yes Yes releasing payment© Copyright Allianz Life Malaysia 07.03.12
  39. 39. Thank youfor your attention.

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