Professional Documents
Culture Documents
MARKETING
Marketing Name
Distribution Channel
Plan Code
J27
Plan Name
i-Medik Xtra Rider
Plan Abbreviation
IL MX150
J28
J29
J30
IL MX200
IL MX300
IL MX400
PLAN DESCRIPTION
(a)
(b)
(c)
This product is a regular unit-deducting rider that can be attached to the investment-linked
family takaful basic plan:
i-Great Damai (Plan Code: A003);
i-Great Iqra (Plan Code: 0701);
i-Great Damai for conversion products (Plan Code: 0704);
i-Great Iqra for conversion products (Plan Code: 0706);
any other future plans that we may introduce from time to time;
at any time, effective at next monthly due.
Tabarru is deducted from the Participants Unit Account (PUA) and channeled to the
Tabarru Fund.
This rider cannot co-exist with i-Medik Rider (Plan Code: A410-A414).
PLAN BENEFITS
This rider provides coverage for medical expenses incurred on the Person Covered due to illness
(subject to Exclusions, if any) or accidental injury or any other covered eventuality, the plan will
reimburse such expenses, up to the maximum number of days and limits according to the plan
participated as stated in the Schedule of Benefits.
Compensation may be claimed from the start of a course of covered treatment until the time it is
confirmed by the medical opinion acceptable to the Takaful Operator that such treatment is no longer
necessary.
a) Co-takaful
Co-takaful is not applicable for this plan.
b) Waiting Period
Medical reimbursements provided under this rider shall commence for:
i. illness occurring more than 30 days after the rider effective date; or
ii. accidental injury occurring after the rider effective date.
For specified illnesses, 120 days waiting period shall apply.
Specified illness means the following disabilities and its related complications, occurring within the
first 120 from the Rider Effective Date:
Hypertension, diabetes mellitus and Cardiovascular Disease;
All tumours, cancers, cysts, nodules, polyps;
Stones of the urinary system and biliary system;
All ear, nose (including sinuses) and throat conditions;
Hernias, haemorrhoids, fistulae, hydrocele, varicocele;
Diseases of the Reproduction system including endometriosis;
Vertebro-spinal disorders (including disc) and knee conditions.
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Covered Benefits
21
22
23
24
25
26
Plan Type
IL MX150 IL MX200 IL MX300 IL MX400
(RM)
(RM)
(RM)
(RM)
Total of Initial Overall Annual Limit and any
cumulative increase to the Initial Overall Annual
Limit.
900,000
1,200,000
1,600,000
2,000,000
10,000
15,000
20,000
20,000
10,000
15,000
20,000
20,000
Note:
1
Double amount of Accidental Death Benefit or Accidental TPD Benefit, based on the plan chosen,
will be payable if the Person Covereds death or TPD is resulted while the Person Covered:
i) travels in public conveyance (other than a cable car, taxi, hired car or any form of transport
chartered for private travel); or
ii) is in electric lift; or
iii) is in any hotel or other public buildings which is on fire.
Description of Benefits
1.
2.
3.
Page 3 of 10
Surgical Fees
Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary
surgery by the Specialists, including Pre-Hospital Specialist Consultation and Posthospitalisation Treatment, subject to the limits stated 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 limits stated in the Schedule of Benefits.
5.
Operating Theatre
Reimbursement of the Reasonable and Customary Charges incurred for operating room
incidental to Medically Necessary surgical procedure, subject to the limits stated in the
Schedule of Benefits.
6.
Anaesthetist Fees
Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary
administration of anaesthesia by the anaesthetist, subject to the limits stated in the Schedule of
Benefits.
7.
8.
9.
10.
Post-hospitalisation Treatment
Reimbursement of the Reasonable and Customary Charges incurred within ninety (90) days
immediately following discharge from Hospital for a Disability, for Medically Necessary follow-up
treatment by the same attending Physician, subject to the limits stated in the Schedule of
Benefits. This shall include Prescribed Medicines during the follow-up treatment but shall not
exceed the supply needed for the maximum of ninety (90) days from the date of discharge.
11.
Organ Transplant
Reimbursement of the Reasonable and Customary Charges incurred on transplantation surgery
for the Person Covered being the recipient of the transplant of a kidney, heart, lung, liver or
bone marrow. This benefit is applicable only once per lifetime while this rider is in force and
shall be subject to the limits stated in the Schedule of Benefits. The costs of acquisition of the
organ and all costs incurred by the donors are not covered under this rider.
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Ambulance Fees
Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary
domestic ambulance services (inclusive of attendant) to and/or from the Hospital, subject to the
limits stated in the Schedule of Benefits. No payment shall be made if the Person Covered is
not hospitalised.
13.
Day Surgery
Reimbursement of the Reasonable and Customary Charges incurred for a Medically Necessary
Day Surgery. This shall include the following surgical procedures which are commonly
performed safely as Day Surgery:
- Adenoidectomy;
- Bone Marrow Aspiration and Biopsy;
- Cataract removal;
- Colonoscopy;
- Cystourethroscopy;
- Endolaser Venous Surgery;
- Endoscopic Retrograde Cholangiopancreatography;
- Excision of Bunions;
- Excision of Ganglion, Fibroma(s) and Breast Lump(s);
- Excision of Pterygium;
- Extra corporeal Shock Wave Lithotripsy;
- Herniotomy / Herniorapphy;
- Insertion or Removal of Ureteric J-Stent;
- Laparoscopic Endometrial Ablation;
- Laparoscopy;
- Laryngoscopy;
- Laser Photocoagulation treatment for Retinal Detachment ;
- Marsupialisation and drainage of Bartholin's Cysts;
- Myringotomy or Myringoplasty;
- Reduction of Bone Fracture(s);
- Release of Carpal Tunnel (Carpal Tunnel Decompression);
- Release of Dupuytren's contracture;
- Removal of Cervical Polyps;
- Removal of Nasal Polyps;
- Removal of Plate and Screw/implants;
- Rubber Banding of Haemorrhoids.
The Takaful Operator may extend the above list of surgical procedures which are commonly
performed safely as Day Surgery, from time to time, at its sole discretion. If any such surgical
procedure is performed while the Person Covered is an Inpatient, only the equivalent benefit of
Day Surgery shall be paid, unless the Takaful Operators appointed medical practitioner has
given prior approval.
14.
Page 5 of 10
16.
17.
18.
Intraocular Lens
Reimbursement of Reasonable and Customary Charges incurred for Medically Necessary
Intraocular Lenses up to Ringgit Malaysia ONE THOUSAND (RM1,000) per eye, subject to a
maximum of Ringgit Malaysia TWO THOUSAND (RM2,000) per lifetime. This benefit is further
subject to the limits stated in the Schedule of Benefits.
Page 6 of 10
g) Overseas Treatment
If the Person Covered elects to be treated outside of Malaysia or is referred to be treated outside
of Malaysia by the attending physician, benefits in respect of the treatment shall be limited to the
Reasonable and Customary Charges for such equivalent treatment in Malaysia and shall exclude
the cost of transportation to the place of treatment.
h) Residence Overseas
No benefit shall be payable for any medical treatment received by the Person Covered outside of
Malaysia if the Person Covered resides or travels outside of Malaysia for more than 90
consecutive days.
UNDERWRITING GUIDELINES
Minimum/Maximum Age at Entry
Entry Age
Minimum
Maximum
IL MX150
60 years next
birthday
Minimum/Maximum Term
Maximum expiry age:
Plan Type
IL MX200
IL MX300
IL MX400
30 days attained age
65 years next birthday
(Entry age is 61 to 65 is subject to medical underwriting and
compulsory medical checkup)
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CHARGES
Tabarru
(a) Tabarru is deducted monthly by cancellation of units at the beginning of each certificate month.
(b) Tabarru rates are not guaranteed and varies by the attained age, gender, and occupation
classification of the Person Covered.
(c) Tabarru rates are subjected to GST of 6%.
The Takaful Operator reserves to revise the charges by giving 30 days advance written notice. Any
revision of the Tabarru shall take effect on the certificate anniversary immediately following the expiry
of the 30 days notice.
Female Rates
Separate Tabarru rates applicable for male and female.
Occupational Class Rates
The standard rates are applicable to occupation classes 1 and 2. Separate rates are applicable to
occupation class 3 and class 4.
Non-smoker Discount / Large Sum Covered Discount / Staff Discount
Not applicable.
AGENCY COMPENSATION
Basic Commission & Overriding Commission & Other Agency Compensation
Not applicable since these are unit deducting riders. Commission is only payable on the Basic
Contributions.
OTHER PRIVILEGES
1.
Nomination
Not applicable, as all benefits are given to the Person Covered.
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3.
Free-look period
Participant is allowed to cancel this rider within 15 days after the Participant have received the
certificate. The Tabarru that have been deducted will be credited back into the PUA.
4.
Reinstatement
Follow basic plan.
EXCLUSIONS
(In the event of discrepancies, please refer to sample certificate).
The Takaful Operator will not pay any benefit under this rider as a result of, including of any of the
following whether directly or indirectly:
1.
Pre-existing Illness;
2.
Specified Illnesses occurring within the first 120 days from the Rider Effective Date;
3.
any medical or physical conditions arising within the Waiting Period except for Injury;
4.
plastic/cosmetic Surgery, circumcision, eye examination, glasses, and refraction or surgical
correction of nearsightedness (Radial Keratotomy or Lasik) and the use or acquisition of external
prosthetic appliances or devices such as artificial limbs, hearing aids, implanted pacemakers and
prescriptions thereof;
5.
dental conditions including dental treatment or oral Surgery, except as necessitated by Injury to
sound natural teeth occurring in any Certificate Year and performed by Dentist;
6.
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;
7.
any treatment or surgical operation for Congenital Conditions or deformities including hereditary
conditions;
8.
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;
9.
Hospitalisation 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;
10.
suicide, attempted suicide or intentionally self-inflicted Injury, while sane or insane;
11.
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;
12.
ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from
process of nuclear fission or from any nuclear weapons material;
13.
for the transplantation Surgery with the Person Covered being the recipient of the transplant,
cost of acquisition of the organ including all costs incurred by the donor during organ transplant
and its complications;
14.
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 aromatherapy or other alternative treatment;
Page 9 of 10
16.
17.
18.
19.
20.
21.
22.
care or treatment for which payment is not required or to the extent which is payable by any
other insurance / family takaful or indemnity covering the Person Covered and disabilities
arising out of duties of employment or profession that is covered under a Workmans
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 or Injury arising from racing of any kind (except for foot racing), hazardous sports
such as but not limited to sky-diving, 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 change;
any Outpatient treatment not related to Inpatient treatment, except as provided under this rider;
charges which are not Reasonable and Customary Charges, or any Surgery or treatment
which is not Medically Necessary, or charges in excess of Reasonable and Customary
Charges, or charges which are incurred for Hospitalisation, pre-hospitalisation and/or posthospitalisation after the Expiry Date.
In addition to the above, the Takaful Operator will not pay Accidental Death Benefit and Accidental
TPD Benefit, for any Injury resulting in loss suffered, as a result of, including any of the following
whether directly or indirectly:
1.
Suicide, attempted suicide or intentionally self-inflicted injuries, while sane or insane;
2.
bodily infirmity, or mental or functional disorder, or Illness or Disease of any kind, or any
infections, other than infections occurring simultaneously with and in consequence of an
accidental cut or wound;
3.
mosquito bite which leads to any Illness including but not limited to dengue fever, malaria, viral
encephalitis or worm infestations such as Hookworms and allergic reaction to insect bites;
4.
war or any act of war, declared or undeclared, criminal activities, active duty in any armed
forces, direct participation in strike, riots and civil commotion or insurrection;
5.
from the action of any armed forces, or from Accident or violence arising by reason of the
existence of a state of armed conflict;
6.
engaging in aerial flights other than as a crew member or as a fare-paying passenger of a
licensed commercial airline operating on a regular scheduled route;
7.
as a result of the Person Covered committing, attempting or provoking an assault or a felony,
or from any violation or attempted violation of law by the Person Covered or resistance to
arrest;
8.
while under the influence of alcohol or drugs unless taken as prescribed by a Physician. For
the avoidance of doubt, a person is considered as under the influence of alcohol if the breath,
blood or urine test result is over the following limit:
8.1
35 mcg of alcohol per 100ml of breath
8.2
80mg of alcohol per 100ml of blood
8.3
107 mg alcohol per 100ml of urine;
9
Injury arising from racing of any kind (except for foot racing), hazardous sports or activities that
involve speed, height, high level of physical exertion, highly specialized gear or spectacular
stunts such as but not limited to bungee jumping, parachuting, scuba diving, sky-diving, water
skiing, underwater activities requiring breathing apparatus, winter sports, Professional Sports
and illegal activities. For the avoidance of doubt, Professional Sports means engaging in any
physical activity in a professional capacity or where the Person Covered would or could earn
income or remuneration from engaging in such activity;
10
from childbirth, pregnancy and/or any complications thereof;
11
ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from
process of nuclear fission or from any nuclear weapons material; or
12
from the Person Covered engaging in commando or bomb disposal duties/training.
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