Employee Benefits at Groupon SDN Bhd

GROUPON SDN BHD
Employee Benefits
Allianz Life Insurance Malaysia Berhad

CONTENTS
1. Schedule of Benefits
2. Policy Conditions
3. Exclusions
4. Admission procedures
5. Claim procedures

© Copyright Allianz Life Malaysia 07.03.12 2

The Group Hospitalisation & Surgical benefits cover

Medical and surgical treatment by an injury, sickness, disease or illness requiring
confinement in a hospital;

Outpatient treatment when the hospital provides services and supplies in connection
with a surgical procedure or for the emergency treatment of accidental bodily injuries.

© Copyright Allianz Life Malaysia 07.03.12

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

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

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.


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


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.


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.


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.


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


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.

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 pay
and 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


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


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


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


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

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


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


Group Term Life


CONTENTS
1. Risk Covered
2. Benefits
3. Definition
4. Exclusions
5. Underwriting
6. Claim Procedures


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


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


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.


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.


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)


3. List of Critical Illnesses

• HIV due to blood transfusion  Loss of Hearing/Deafness
• Alzheimer's 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
 Parkinson's 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.


3. Definition - Accidental Death and Dismemberment
Supplementary

 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

4. Risk Excluded – TPD
This Supplementary Contract shall not cover Total Permanent Disability caused directly or
indirectly, 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;


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;


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.


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.


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;

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, biological
or chemical weapons as well as radioactive, biological/chemical warfare agents or
substances

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

5. Underwriting
The persons eligible for insurance under the Policy are the present and future
full-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.


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.


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


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


Employee Benefits at Groupon SDN Bhd

Recomendados

Recomendados

Más contenido relacionado

La actualidad más candente

La actualidad más candente (18)

Destacado

Destacado (7)

Similar a Employee Benefits at Groupon SDN Bhd

Similar a Employee Benefits at Groupon SDN Bhd (20)

Último

Último (20)

Employee Benefits at Groupon SDN Bhd