Benefits Clarifications. Other benefits Normal (Routine) pregnancy and childbirth (Plan A only and subject to compulsory co-insurance) Benefit is available and eligible claims are payable for expenses incurred after the member has been continuously covered under Plan A for three hundred sixty-five (365) consecutive days waiting period and has effected the annual renewal of that plan for the coming policy year. We will pay eighty (80%) percent of the eligible expenses up to the benefit limit for routine pre-natal care, inpatient childbirth and routine post-natal care up to forty-two (42)days following the birth. This benefit is only available for female member over the age of eighteen (18) years. We will also pay for normal, routine pregnancy and inpatient childbirth even when such pregnancy was established through assisted conception/assisted pregnancy. This benefit does not cover any expenses related to assisted conception/assisted pregnancy including any complications. The limit shown is the maximum we will pay under this benefit for each: • policy year, even if there is more than one pregnancy in that policy year, • pregnancy, even if a pregnancy, which is eligible for benefit, falls across the policy anniversary, and provided the policy, including this benefit, has been renewed for the subsequent policy year For inpatient birth through vaginal childbirth and medically necessary caesarean section, we will pay for the reasonable and customary childbirth costs of a standard single room, up to the limit shown for this benefit in the benefits table. Any complications of pregnancy will be paid from “Pre- & post-natal complications” benefit. For inpatient birth through non-medically necessary caesarean section, we will pay for the reasonable and customary childbirth costs up to the costs of a natural childbirth in a standard single room. If we are not able to determine that a caesarean section is medically necessary, we will consider it is not medically necessary. The complications arising from such childbirth will be paid up to the remainder of the Normal (Routine) Pregnancy and Childbirth limit. Please take note: This benefit is payable when 365 consecutive days membership is achieved by the member under this plan / cover from the date this cover is attached to the member’s plan.
Benefits Clarifications. Pre and post-hospitalization treatment In-patient rehabilitation This benefit pays for in-patient rehabilitation when: a) it is carried out by a medical practitioner specialising in rehabilitation; and b) it is carried out in a rehabilitation hospital or unit which is recognised by us; and c) the treatment could not be carried out on an out-patient basis, and d) the costs have been agreed, in writing by us before the rehabilitation begins. We will not pay for in-patient rehabilitation for more than twenty-eight (28) days except in cases such as in severe central nervous system damage caused by external trauma. For cases such as in severe central nervous system damage caused by external trauma, we will not pay for in-patient rehabilitation for more than one hundred eighty (180) days Pre-hospitalization treatment We will pay for consultation, prescribed investigations and essential medications by a medical practitioner received as an out-patient within ninety (90) days prior to a hospitalization, where such hospitalization is eligible for cover under member’s plan and where the need for such hospitalization has arisen as a direct result of the medical examination and investigation findings drawn from that consultation. Post-hospitalization treatment We will pay for follow-up out-patient consultation and treatment following an eligible in-patient treatment or daycare surgery when such consultation is carried out by the in-patient treating medical practitioner or a referred medical practitioner and provided such consultation or treatment occurs within ninety (90) days immediately following the date of discharge from hospital for which the member was confined as an in-patient or the date of the daycare surgery. Out-patient treatment – general information Out-patient treatment is treatment given by a medical practitioner at an out-patient clinic, a medical practitioner’s consulting room or in a hospital where the member is not admitted to a bed. A member is covered, subject to the limits shown, for: • medical practitioner charges for consultations; • diagnostic procedures; • prescriptions (note any prescribed drug or other medication required for more than 30 days should be pre-authorized by us); • hormone replacement therapy (pre-authorization is recommended) • physiotherapy, occupational therapy and/or speech therapy for an eligible medical condition received as an out-patient (pre-authorization is recommended); • computerized tomography, magnetic resonance im...
Benefits Clarifications. Primary and specialist care (Plan A and B only) A consultation is a visit to any medical practitioner for the treatment of an eligible medical condition. We will pay for the medical practitioner charges for consultations, prescriptions and diagnostic procedures. Diagnostic tests include and are limited to laboratory, X-ray and ultrasound. Second opinion for the same medical condition: • pre-authorization is recommended Thereafter subsequent opinions and referrals for the same condition: • written pre-authorization is required Surgical procedures We will pay for any surgical procedure received as part of an out-patient treatment. This include one post-surgery consultation within ninety (90) days from the date of the surgical procedure. Emergency treatment due to accident We will pay for out-patient treatment due to accident required immediately (within twenty-four (24) hours) following bodily injury arising from an accident, provided the member has been continuously covered under the policy since before the accident happened. Follow up treatment for the same bodily injury will be covered up to thirty (30) days from the date of the accident. Radiotherapy and chemotherapy We will pay for radiotherapy and chemotherapy received as an out-patient for an eligible medical condition at a registered medical facility recognised by us. Kidney dialysis We will pay for kidney dialysis received as an out-patient for an eligible medical condition at a registered medical facility recognised by us. Computerized tomography, magnetic resonance imaging, positron emission tomography and gait scans We will pay for computerized tomography, magnetic resonance imaging, positron emission tomography and gait scans received as part of an eligible out-patient treatment. Hormone replacement therapy We will pay for the consultations and the cost of the implants, injections, patches or tablets when it is medically necessary and resulting from a medical intervention rather than for the relief of physiological symptoms. Where hormone replacement therapy is only required for the relief of menopausal symptoms, this benefit will pay for consultation and prescribed implants, patches or tablets up to the limit shown in the benefits table applicable to the member’s plan. Benefits Clarifications Physiotherapy, occupational therapy and speech therapy Such treatment must be given by a qualified practitioner who is recognised by us and registered to practice this where the eligible treatment is given...
Benefits Clarifications. Alternative and Wellbeing Medicine Consultation and treatment provided and prescribed by a qualified and registered chiropractor, podiatrist, dietitian, nutritionist, naturopath, acupuncturist, homeopath, osteopath, physiotherapist and traditional Chinese medicine practitioner (Plan A and B only) We will pay for consultation and treatment given by a qualified alternative practitioner and physiotherapist who is recognized by us and registered to practice this where the treatment is given. Within this benefit and up to the limits applicable to the member’s plan, we will also pay for vitamins, supplements, and traditional Chinese medicine when such are prescribed by the alternative practitioner or medical practitioner. The member should obtain a non-contra-indication for the use of alternative treatment from their treating medical practitioner as we will not pay for any complications arising from such alternative treatment in excess of the limit shown for this benefit. Vaccination (Plan A and B only) This benefit becomes available and eligible claims payable for expenses incurred after the member has been continuously covered under Plan A or B for 90 days in the first policy year. Health Screen (Plan A and B only) The limit shown includes the cost of any eligible consultation needed as part of the screening process.
Benefits Clarifications. Alternative and Wellbeing Medicine Consultation and treatment provided and prescribed by a qualified and registered chiropractor, podiatrist, dietitian, nutritionist, naturopath, acupuncturist, homeopath, osteopath, physiotherapist and traditional Chinese medicine practitioner (Plan A and B only) We will pay for consultation and treatment given by a qualified alternative practitioner and physiotherapist who is recognised by us and registered to practice this where the treatment is given. Within this benefit and up to the limits applicable to the member’s plan, we will also pay for vitamins, supplements, and traditional Chinese medicine when such are prescribed by the alternative practitioner or medical practitioner. The member should obtain a non-contra-indication for the use of alternative treatment from their treating medical practitioner as we will not pay for any complications arising from such alternative treatment in excess of the limit shown for this benefit. Vaccination (Plan A and B only) This benefit becomes available and eligible claims payable for expenses incurred after the member has been continuously covered under Plan A or B for 90 days in the first policy year. Health Screen (Plan A and B only) The limit shown includes the cost of any eligible consultation needed as part of the screening process. This benefit covers health screen or medical screening examination in the absence of a medical condition including follow-up consultation, where the member did not experience signs or symptom. This benefit is not payable if the member is receiving a medical screening examination for treatment of a medical condition.
Benefits Clarifications. Daily accommodation charges While admitted as an in-patient or daycare, we will pay for the costs of member’s accommodation in the type of room shown in your benefits table. Wherever a member receive treatment, if the hospital offers several classes for the room type he is entitled for, we will only pay for the cost of a room of a standard class. This corresponds to the lowest cost room class offered in that hospital for that type of room. If a member stays in a room which is more expensive than the standard room, the member may have to pay for the difference in room charges. The member may also have to pay for a share of other medical expenses wherever these increase as a result of the room upgrade. Please check with us prior to admission to avoid unnecessary out of pocket expenses. Hospital charges Subject to the limits shown for your plan, members are covered for hospital charges incurred for eligible treatment given between admission and discharge such as: • diagnostic procedures, • surgical procedures, • operating theatre charges, • nursing care, drugs and dressings, • surgeons’ and anaesthetists’ charges, • intensive care unit charges, • consultations and physiotherapy while admitted for treatment of an eligible medical condition and when such treatment directly relates to it, • radiotherapy and chemotherapy, • kidney dialysis, • computerized tomography, magnetic resonance imaging, x-rays and other such proven medical imaging techniques, • special nursing in hospital. Organ transplant We will pay for transplantation of kidneys, heart, liver, lung or bone marrow required as a result of an eligible medical condition and provided these organ(s) has come from a relative or a certified and verified source of donation. The policy does not cover the costs of collecting donor organs (including but not limited to, transportation and administration costs) or any expenses incurred by the donor or if the organ(s) is not from a relative or a certified and verified source of donation. Reconstructive surgery We will pay for the initial reconstructive surgery and only when it is medically necessary and carried out to restore function after an accident or following surgery for an eligible medical condition, and provided that the member has been continuously covered under the policy since before the accident or surgery happened. Benefit for reconstructive surgery is subject to our pre-authorization and must be done at a medically appropriate stage after the accident o...
Benefits Clarifications. New born accommodation This benefit will pay for the child who is less than sixteen (16) weeks old to stay in the hospital with the mother (being an insured member) while she is receiving eligible in-patient treatment at such hospital. This is paid from the mother’s benefit. New born cover New born cover - acute medical condition This benefit pays for the treatment of acute medical condition, provided there is no underlying congenital condition developed in a new born baby including nursing of pre-mature baby (i.e. where birth is prior to thirty-seven (37) weeks gestation) in Neonatal Intensive Care Unit (NICU). The common acute medical conditions for new born babies include neonatal jaundice, colic, diarrhea, constipation, vomiting and ear infection. This benefit is only available if: (a) the parent of the new born baby has been covered under InternationalExclusive for three hundred sixty-five (365) consecutive days or more when the baby is born; and (b) the new born baby is added into the insured parent’s policy within thirty (30) days from birth; and (c) both parent and baby have been continuously covered under the policy and the policy is in force when the treatment is received. This benefit is paid from the insured baby’s plan. This benefit covers treatment received by a new born baby during the first thirty (30) days after birth. After thirty (30) days, treatment can be covered under the main benefits of the insured baby’s plan. This benefit excludes treatment to the child member (who is conceived by assisted conception/assisted pregnancy) for any condition or complication arising therefrom or associated therewith assisted conception/assisted pregnancy (such as but not limited to premature or multiple births), that has arisen, or for which the need had arisen, during the first ninety (90) days after birth. Please see Section 1.5 - ‘Persons eligible’ for details on eligibility.
Benefits Clarifications. Alternative and Wellbeing Medicine Consultation and treatment provided and prescribed by a qualified and registered chiropractor, podiatrist, dietitian, nutritionist, naturopath, acupuncturist, homeopath, osteopath, physiotherapist and traditional Chinese medicine practitioner We will pay for consultation and treatment given by a qualified alternative practitioner and physiotherapist who is recognized by us and registered to practice this where the treatment is given. Within this benefit and up to the limits applicable to the member’s plan, we will also pay for vitamins, supplements, and traditional Chinese medicine when such are prescribed by the alternative practitioner or medical practitioner. The member should obtain a non-contra-indication for the use of alternative treatment from their treating medical practitioner as we will not pay for any complications arising from such alternative treatment in excess of the limit shown for this benefit. Vaccination This benefit becomes available and eligible claims payable for expenses incurred after the member has been continuously covered for 90 days in the first policy year. Health Screen The limit shown includes the cost of any eligible consultation needed as part of the screening process. This benefit covers health screen or medical screening examination in the absence of a medical condition including follow-up consultation, where the member did not experience signs or symptom. This benefit is not payable if the member is receiving a medical screening examination for treatment of a medical condition.
Benefits Clarifications. Alternative and Wellbeing Medicine Consultation and treatment provided and prescribed by a qualified and registered chiropractor, podiatrist, dietitian, nutritionist, naturopath, acupuncturist, homeopath, osteopath, physiotherapist and traditional Chinese medicine practitioner (Plan A and B only) We will pay for consultation and treatment given by a qualified alternative practitioner and physiotherapist who is recognized by us and registered to practice this where the treatment is given. Within this benefit and up to the limits applicable to the member’s plan, we will also pay for vitamins, supplements, and traditional Chinese medicine when such are prescribed by the alternative practitioner or medical practitioner. The member should obtain a non-contra-indication for the use of alternative treatment from their treating medical practitioner as we will not pay for any complications arising from such alternative treatment in excess of the limit shown for this benefit. Vaccination (Plan A and B only) Benefit is payable for vaccinations up to the limit shown for in a member’s plan. Consultation charge made in conjunction with vaccination can be claimed from this benefit where applicable. Health Screen (Plan A and B only) The limit shown includes the cost of any eligible consultation needed as part of the screening process. Dental Treatment Accidental damage to natural teeth Under accidental damage to teeth, we will pay for treatment required (within thirty (30) days) following accidental damage to natural teeth caused by extra-oral impact when that treatment is given by a medical practitioner, provided that the member has been continuously covered under the policy since before the accident happened. Benefit is not payable if: • the damage was caused by normal wear and tear • the injury was caused when boxing or playing rugby (except school rugby) unless appropriate mouth protection was worn • the damage was caused by tooth brushing or any other oral hygiene procedure • the damage is not apparent within seven (7) days of the impact which caused the injury Please note: There is no cover for treatment required as the result of the consumption of food or drink or any foreign bodies contained in such food or drink. Oral and maxillofacial surgery This benefit pays for the following procedures performed by an oral and maxillofacial surgeon: (i) Surgical removal of impacted/un-erupted teeth and buried teeth which are diseased or causing symptoms; (ii) Surgical removal...
