Common use of HOSPITAL SPECIALIST CONSULTATION Clause in Contracts

HOSPITAL SPECIALIST CONSULTATION. Reimbursement of the Reasonable and Customary Charges for the first time consultation by a Specialist in connection with a Disability within 60 days preceding confinement in a Hospital and provided that such consultation is Medically Necessary and has been recommended in writing by the attending general practitioner. Payment will not be made for clinical treatment (including medications and subsequent consultation after the illness is diagnosed) or where the Insured does not result in hospital confinement for the treatment of the medical condition diagnosed. EMERGENCY ACCIDENTAL OUTPATIENT TREATMENT - Reimbursement of the Reasonable and Customary Charges incurred for up to the maximum stated in the Schedule of Benefits, as a result of a covered bodily injury arising from an Accident for Medically Necessary treatment as an outpatient at any registered clinic or hospital within 24 hours of the Accident causing the covered bodily Injury. Follow up treatment by the same doctor or same registered clinic or Hospital for the same covered bodily injury will be provided up to 31 days as set forth in the Schedule of Benefits. EMERGENCY ACCIDENTAL DENTAL TREATMENT - Reimbursement of the Reasonable and Customary Charges incurred for up to the maximum stated in the Schedule of Benefits as a result of a bodily injury arising from an ACCIDENT occurring to wholly sound natural teeth, and received as an out-patient within 24 hours of the occurrence of the accident. Follow-up treatment will be provided up to 14 days of the Accident causing the Injury and in a legally registered dental clinic or Hospital. POST-HOSPITALISATION TREATMENT - Reimbursement of the Reasonable and Customary Charges incurred in Medically Necessary follow-up treatment by the same attending Physician, within the maximum number of days and amount as set forth in the Schedule of Benefits immediately following discharge from Hospital for a non-surgical disability. This shall include medicines prescribed during the follow-up treatment but shall not exceed the supply needed for maximum number of days as set forth in the Schedule of Benefits. AMBULANCE FEE - Reimbursement of the Reasonable and Customary Charges incurred for necessary domestic ambulance services inclusive of attendant to and or from the Hospital of confinement. Payment will not be made if the Insured Person is not hospitalised and subject to the limits set forth in the Schedule of Benefits. DAILY CASH ALLOWANCE AT GOVERNMENT HOSPITAL - Pays a daily allowance for each day of confinement for a covered Disability in a Malaysian Government Hospital, provided that the Insured shall confine to a Room and Board rate that does not exceed the amount shown in the Schedule of Benefit. No Payment will be made for any transfer to or from any Private Hospital and Malaysian Government Hospital for the covered disability.

HOSPITAL SPECIALIST CONSULTATION. Reimbursement of the Reasonable and Customary Charges for the first time consultation by a Specialist in connection with a Disability within 60 days preceding confinement in a Hospital and provided that such consultation is Medically Necessary and has been recommended in writing by the attending general practitionerNecessary. Payment will not be made for clinical treatment (including medications and subsequent consultation after the illness is diagnosed) or where the Insured does not result in hospital confinement for the treatment of the medical condition diagnosed. SURGEON FEE - Reimbursement of the Reasonable and Customary Charges for a Medically Necessary surgery by the Specialists, including pre-surgical assessment Specialist’s visits to the Insured Person and post-surgery care up to 90 days inclusive both before and after the date of surgery, but within the maximum indicated in the Schedule of Benefits. If more than one surgery is performed for Any One Disability, the total payments for all the surgeries performed shall not exceed the maximum stated in the Schedule of Benefits. ANAESTHETIST FEE - Reimbursement of the Reasonable and Customary Charges by the Anaesthetist for the Medically Necessary administration of anaesthesia not exceeding the limits as set forth in the Schedule of Benefit. SECOND SURGICAL OPINION – Charges for consultation or opinion with a second specialist to determine whether a surgical operation for the same disease or injury is required in view of the Insured’s medical condition. When considered medically necessary by the second specialist and such that this reaffirms the opinion expressed by the first specialist, the consultation fee incurred shall be payable but not exceed the maximum limit as stated in the Schedule of Benefits. The second consultation must be rendered within 30 days of the first consultation for this benefit to be payable. Payment will not be made for clinical treatment (including medications) or where the Insured does not result in hospital confinement or the treatment of the medical condition diagnosed. IN-HOSPITAL PHYSICIAN VISIT - Reimbursement of the Reasonable and Customary Charges by a Physician for Medically Necessary visiting an in-paying patient while confined for a non-surgical disability subject to a maximum of 2 visits per day not exceeding the maximum number of days as set forth in the Schedule of Benefit. POST-HOSPITALISATION TREATMENT - Reimbursement of the Reasonable and Customary Charges incurred in Medically Necessary follow-up treatment by the same attending Physician, within 90 days and amount as set forth in the Schedule of Benefits immediately following discharge from Hospital for a non-surgical disability. This shall include medicines prescribed during the follow-up treatment but shall not exceed the supply needed for 31 days as set forth in the Schedule of Benefits. AMBULANCE FEE - Reimbursement of the Reasonable and Customary Charges incurred for necessary domestic ambulance services inclusive of attendant to and or from the Hospital of confinement. Payment will not be made if the Insured Person is not hospitalised and subject to the limits set forth in the Schedule of Benefits. HOSPITAL MISCELLANEOUS FEE – Reimbursement of Admission fee, registration fee, medical record, billing fee, name tag/ID band, dispensing fee and other items deemed fit and necessary for medical purposes up to the maximum limit as stated in the Schedule of Benefits. MEDICAL REPORT FEE – Reimbursement of the fee actually charged for the completion of the Medical Report up to the maximum limit as stated in the Schedule of Benefits. EMERGENCY ACCIDENTAL OUTPATIENT TREATMENT - Reimbursement of the Reasonable and Customary Charges incurred for up to the maximum stated in the Schedule of Benefits, as a result of a covered bodily injury arising from an Accident for Medically Medical Necessary treatment as an outpatient at any registered clinic or hospital within 24 hours of the Accident causing the covered bodily Injury. Follow up treatment by the same doctor or same registered clinic or Hospital for the same covered bodily injury will be provided up to 31 60 days as set forth in the Schedule of Benefits. EMERGENCY ACCIDENTAL DENTAL TREATMENT - Reimbursement of the Reasonable and Customary Charges incurred for up to the maximum stated in the Schedule of Benefits as a result of a bodily injury arising from an ACCIDENT occurring to wholly sound natural teeth, and received as an out-patient within 24 hours of the occurrence of the accident. Follow-up treatment will be provided up to 14 days of the Accident causing the Injury and in a legally registered dental clinic or Hospital. POST-HOSPITALISATION TREATMENT - Reimbursement of the Reasonable and Customary Charges incurred in Medically Necessary follow-up treatment by the same attending Physician, within the maximum number of days and amount as set forth in the Schedule of Benefits immediately following discharge from Hospital for a non-surgical disability. This shall include medicines prescribed during the follow-up treatment but shall not exceed the supply needed for maximum number of days as set forth in the Schedule of Benefits. AMBULANCE FEE HOME NURSING CARE - Reimbursement of the Reasonable and Customary Charges incurred for up to 180 days and up to maximum limit as stated in the Schedule of Benefits for services rendered by a qualified and Government licensed Nurse which are medically necessary domestic ambulance services inclusive for the care of attendant to an Insured who is totally disabled and or who would otherwise have been confined as a bed patient in a Hospital. The plan of treatment for the home nursing care must be established and prescribed by the attending Physician after the Insured has been hospitalised and discharge from the Hospital of confinementHospital. Payment No payment will not be made if for custodial care, meal, general housekeeping services, companion and personal comfort items. BEREAVEMENT ALLOWANCE – shall pay an amount as provided in the Schedule of Benefits to the Insured Person’s next of kin or legal personal representative in the event of death of the Insured Person caused by illness or accident. The death of the Insured Person shall be established by an official Death Certificate. ALTERNATIVE MEDICINE – Reimbursement of the charges incurred for any traditional form of treatment rendered by a sinseh, traditional bone-setters or other alternative treatment regime, where such services are provided under a valid Business Licence by relevant authorities, following an accidental bodily injury. Medical Treatments including medicine that must be supported by receipts. Such reimbursement shall be limited to RM100 per visit up to maximum of RM1,000 in respect of anyone accident. ORGAN TRANSPLANT - Reimburses Reasonable and Customary Charges incurred on transplantation surgery for the Insured Person being the recipient of the transplant of a kidney, heart, lung, liver or bone marrow. Payment for this Benefit is not hospitalised applicable only once per lifetime whilst the Policy is in force and shall be subject to the limits limit as set forth in the Schedule of Benefits. DAILY CASH ALLOWANCE AT GOVERNMENT HOSPITAL - Pays a daily allowance for each day of confinement for a covered Disability in a Malaysian Government Hospital, provided that the Insured shall confine to a Room and Board rate that does not exceed the amount shown in the Schedule of Benefit. No Payment The costs of acquisition of the organs and all costs incurred by the donors are not covered. OUT-PATIENT PHYSIOTHERAPY / CHIROPRACTIC TREATMENT - Reimburses charges for out-patient physiotherapy / chiropractic treatment referred in writing by a licensed specialist Physician after Surgery or Hospital confinement treatment within 90 days from the date of discharge from Hospital/Surgery. However, no payment will be made for any transfer to or from any Private Hospital medication / treatment and Malaysian Government Hospital for subsequent consultations with the covered disabilitysame attending specialist Physician who treated the Insured.

HOSPITAL SPECIALIST CONSULTATION. Reimbursement of the Reasonable and Customary Charges for the first time consultation by a Specialist in connection with a Disability within 60 the maximum number of days and amount as set forth in the Schedule of Benefits preceding confinement in a Hospital and provided that such consultation is Medically Necessary and has been recommended in writing by the attending general practitioner. Payment will not be made for clinical treatment (including medications and subsequent consultation after the illness is diagnosed) or where the Insured Person does not result in hospital confinement for the treatment of the medical condition diagnosed. EMERGENCY ACCIDENTAL OUTPATIENT TREATMENT - PRE-SURGICAL DIAGNOSTIC TESTS Reimbursement of the Reasonable and Customary Charges incurred for up to Medically Necessary ECG, X-ray and laboratory tests which are performed for diagnostic purposes on account of an injury or illness when in connection with a Disability preceding hospitalization within the maximum stated number of days and amount as set forth in the Schedule of BenefitsBenefits in a Hospital and which are recommended by a qualified medical practitioner. No payment shall be made if upon such diagnostic services, as the Insured Person does not result in surgery of the medical condition diagnosed. Medications and consultation charged by the medical practitioner will not be payable. IN-HOSPITAL PHYSICIAN VISIT Reimbursement of the Reasonable and Customary Charges by a result of a covered bodily injury arising from an Accident Physician for Medically Necessary treatment as visiting an outpatient at any registered clinic or hospital within 24 hours in-paying patient while confined for a non-surgical disability subject to a maximum of 1 visit per day not exceeding the Accident causing the covered bodily Injury. Follow up treatment by the same doctor or same registered clinic or Hospital for the same covered bodily injury will be provided up to 31 maximum number of days and amount as set forth in the Schedule of Benefits. EMERGENCY ACCIDENTAL DENTAL TREATMENT - Reimbursement of the Reasonable and Customary Charges incurred for up to the maximum stated in the Schedule of Benefits as a result of a bodily injury arising from an ACCIDENT occurring to wholly sound natural teeth, and received as an out-patient within 24 hours of the occurrence of the accident. Follow-up treatment will be provided up to 14 days of the Accident causing the Injury and in a legally registered dental clinic or Hospital. POST-HOSPITALISATION TREATMENT - Reimbursement of the Reasonable and Customary Charges incurred in Medically Necessary follow-up treatment by the same attending Physician, within the maximum number of days and amount as set forth in the Schedule of Benefits immediately following discharge from Hospital for a non-surgical isurgical disability. This shall include medicines prescribed during the follow-up treatment but shall not exceed the supply needed for the maximum number of days as set forth in the Schedule of Benefits. AMBULANCE FEE - Reimbursement of the Reasonable and Customary Charges incurred for necessary domestic ambulance services inclusive of attendant to and or from the Hospital of confinement. Payment will not be made if the Insured Person is not hospitalised and subject to the limits set forth in the Schedule of Benefits. DAILY CASH ALLOWANCE AT GOVERNMENT HOSPITAL - Pays a daily allowance for each day of confinement for a covered Disability in a Malaysian Government Hospital, provided that the Insured shall confine to a Room and Board rate that does not exceed the amount shown in the Schedule of Benefit. No Payment will be made for any transfer to or from any Private Hospital and Malaysian Government Hospital for the covered disability.

HOSPITAL SPECIALIST CONSULTATION. Reimbursement of the Reasonable and Customary Charges for the first time consultation by a Specialist in connection with a Disability within 60 days preceding confinement in a Hospital and provided that such consultation is Medically Necessary and has been recommended in writing by the attending general practitionerNecessary. Payment will not be made for clinical treatment (including medications and subsequent consultation after the illness is diagnosed) or where the Insured does not result in hospital confinement for the treatment of the medical condition diagnosed. SURGEON FEE - Reimbursement of the Reasonable and Customary Charges for a Medically Necessary surgery by the Specialists, including pre-surgical assessment Specialist’s visits to the Insured Person and post-surgery care up to 90 days inclusive both before and after the date of surgery, but within the maximum indicated in the Schedule of Benefits. If more than one surgery is performed for Any One Disability, the total payments for all the surgeries performed shall not exceed the maximum stated in the Schedule of Benefits. ANAESTHETIST FEE - Reimbursement of the Reasonable and Customary Charges by the Anaesthetist for the Medically Necessary administration of anaesthesia not exceeding the limits as set forth in the Schedule of Benefit. SECOND SURGICAL OPINION – Charges for consultation or opinion with a second specialist to determine whether a surgical operation for the same disease or injury is required in view of the Insured’s medical condition. When considered medically necessary by the second specialist and such that this reaffirms the opinion expressed by the first specialist, the consultation fee incurred shall be payable but not exceed the maximum limit as stated in the Schedule of Benefits. The second consultation must be rendered within 30 days of the first consultation for this benefit to be payable. Payment will not be made for clinical treatment (including medications) or where the Insured does not result in hospital confinement or the treatment of the medical condition diagnosed. IN-HOSPITAL PHYSICIAN VISIT - Reimbursement of the Reasonable and Customary Charges by a Physician for Medically Necessary visiting an in-paying patient while confined for a non-surgical disability subject to a maximum of 2 visits per day not exceeding the maximum number of days as set forth in the Schedule of Benefit. POST-HOSPITALISATION TREATMENT - Reimbursement of the Reasonable and Customary Charges incurred in Medically Necessary follow-up treatment by the same attending Physician, within 90 days and amount as set forth in the Schedule of Benefits immediately following discharge from Hospital for a non-surgical disability. This shall include medicines prescribed during the follow-up treatment but shall not exceed the supply needed for 31 days as set forth in the Schedule of Benefits. AMBULANCE FEE - Reimbursement of the Reasonable and Customary Charges incurred for necessary domestic ambulance services inclusive of attendant to and or from the Hospital of confinement. Payment will not be made if the Insured Person is not hospitalised and subject to the limits set forth in the Schedule of Benefits. HOSPITAL MISCELLANEOUS FEE – Reimbursement of Admission fee, registration fee, medical record, billing fee, name tag/ID band, dispensing fee and other items deemed fit and necessary for medical purposes up to the maximum limit as stated in the Schedule of Benefits. MEDICAL REPORT FEE – Reimbursement of the fee actually charged for the completion of the Medical Report up to the maximum limit as stated in the Schedule of Benefits. EMERGENCY ACCIDENTAL OUTPATIENT TREATMENT - Reimbursement of the Reasonable and Customary Charges incurred for up to the maximum stated in the Schedule of Benefits, as a result of a covered bodily injury arising from an Accident for Medically Medical Necessary treatment as an outpatient at any registered clinic or hospital within 24 hours of the Accident causing the covered bodily Injury. Follow up treatment by the same doctor or same registered clinic or Hospital for the same covered bodily injury will be provided up to 31 60 days as set forth in the Schedule of Benefits. EMERGENCY ACCIDENTAL DENTAL TREATMENT - Reimbursement of the Reasonable and Customary Charges incurred for up to the maximum stated in the Schedule of Benefits as a result of a bodily injury arising from an ACCIDENT occurring to wholly sound natural teeth, and received as an out-patient within 24 hours of the occurrence of the accident. Follow-up treatment will be provided up to 14 days of the Accident causing the Injury and in a legally registered dental clinic or Hospital. POST-HOSPITALISATION TREATMENT - Reimbursement of the Reasonable and Customary Charges incurred in Medically Necessary follow-up treatment by the same attending Physician, within the maximum number of days and amount as set forth in the Schedule of Benefits immediately following discharge from Hospital for a non-surgical disability. This shall include medicines prescribed during the follow-up treatment but shall not exceed the supply needed for maximum number of days as set forth in the Schedule of Benefits. AMBULANCE FEE HOME NURSING CARE - Reimbursement of the Reasonable and Customary Charges incurred for up to 180 days and up to maximum limit as stated in the Schedule of Benefits for services rendered by a qualified and Government licensed Nurse which are medically necessary domestic ambulance services inclusive for the care of attendant to an Insured who is totally disabled and or who would otherwise have been confined as a bed patient in a Hospital. The plan of treatment for the home nursing care must be established and prescribed by the attending Physician after the Insured has been hospitalised and discharge from the Hospital of confinementHospital. Payment No payment will not be made if for custodial care, meal, general housekeeping services, companion and personal comfort items. BEREAVEMENT ALLOWANCE – shall pay an amount as provided in the Schedule of Benefits to the Insured Person’s next of kin or legal personal representative in the event of death of the Insured Person caused by illness or accident. The death of the Insured Person shall be established by an official Death Certificate. ALTERNATIVE MEDICINE – Reimbursement of the charges incurred for any traditional form of treatment rendered by a sinseh, traditional bone-setters or other alternative treatment regime, where such services are provided under a valid Business Licence by relevant authorities, following an accidental bodily injury. Medical Treatments including medicine that must be supported by receipts. Such reimbursement shall be limited to RM100 per visit up to maximum of RM1,000 in respect of anyone accident. ORGAN TRANSPLANT - Reimburses Reasonable and Customary Charges incurred on transplantation surgery for the Insured Person being the recipient of the transplant of a kidney, heart, lung, liver or bone marrow. Payment for this Benefit is not hospitalised applicable only once per lifetime whilst the policy is in force and shall be subject to the limits limit as set forth in the Schedule of Benefits. DAILY CASH ALLOWANCE AT GOVERNMENT HOSPITAL - Pays a daily allowance for each day of confinement for a covered Disability in a Malaysian Government Hospital, provided that the Insured shall confine to a Room and Board rate that does not exceed the amount shown in the Schedule of Benefit. No Payment The costs of acquisition of the organs and all costs incurred by the donors are not covered. OUT-PATIENT PHYSIOTHERAPY / CHIROPRACTIC TREATMENT - Reimburses charges for out-patient physiotherapy / chiropractic treatment referred in writing by a licensed specialist Physician after Surgery or Hospital confinement treatment within 90 days from the date of discharge from Hospital/Surgery. However, no payment will be made for any transfer to or from any Private Hospital medication / treatment and Malaysian Government Hospital for subsequent consultations with the covered disabilitysame attending specialist Physician who treated the Insured.