Protect what you treasure most

Transcription

1 Health Protect what you treasure most SMARTCARE OPTIMUM ENHANCED A comprehensive health insurance plan that provides optimum healthcare coverage for the family.

2 As medical advancements progress rapidly, and lifespans increase, growing medical costs are a reality you cannot ignore. In a changing world, SMARTCARE OPTIMUM ENHANCED is your protection against skyrocketing bills by giving you high cover limits and comprehensive coverage for both inpatient and outpatient services.

3 The perfect solution to meet your everyday healthcare needs Greater reimbursement While most health policies have multiple sub-limits, this plan keeps sub-limits to a minimum and reimburses you in full for eligible medical expenses, up to your annual policy limit. General Practitioner & Specialist Cover General Practitioner and Specialist consultations are now available under the core plan. Comprehensive cover for your dental health Option to add a Dental Rider to your plan is available. Extra layer of protection when you travel Choose to add a Travel Inconvenience Rider to your plan specially designed to complement and enhance the existing overseas benefits that are already built into the plan. Stable Portfolio Pricing There will be no capping on your medical conditions or additional loadings on your premium upon renewal as a result of your personal claims experience. Family Discount Enjoy a 10% family discount when 3 or more family members sign up for the plan.

4 Benefits at a glance SmartCare Optimum Enhanced Plan Platinum Gold Silver Annual Policy Limit Applicable to Part I, II and III S$1,000,000 S$500,000 S$250,000 Part I: Inpatient & Day Surgery Treatment Hospital & Surgical Benefits Per Year Bed Type (Standard) Single Single Single Daily Hospital Room & Board Includes meals & general nursing care Intensive Care Unit Hospital Miscellaneous Expenses Includes Prescription drugs, Inpatient Diagnostic Procedures & Inpatient Physiotherapy, Operating Theatre Fees & Ancillary Charges Ambulance Services Surgeon s Fee Includes Inpatient Surgery & Day Surgery Anaesthetist s Fee Inpatient Physician s Visit Pre-Hospitalisation/Surgery Specialist s Consultation Up to 90 days As Charged As Charged As Charged Pre-Hospitalisation/Surgery Diagnostic Services Up to 90 days Post-Hospitalisation/Surgery Treatment Up to 90 days Major Organ Transplant Living Organ Donor (Insured) Transplant Benefit (24 months waiting period) Congenital Conditions Benefit (24 months waiting period) S$6,000 S$4,000 S$3,000 Inpatient Psychiatric Treatment S$5,000 S$3,000 S$1,000 Miscarriage Due to accident only S$5,000 S$4,000 S$3,000 Ectopic Pregnancy S$5,000 S$4,000 S$3,000 Surgical Implants S$10,000 S$8,000 S$5,000 Medical Report Fees Parent Accommodation Up to 60 days for child below age 12 Home Nursing Up to 182 days Community Hospital Confinement Up to 90 days As Charged As Charged As Charged

5 Benefits at a glance SmartCare Optimum Enhanced Plan Platinum Gold Silver Part II: Outpatient Treatment Outpatient Benefits Per Year Alternative Treatment S$500 S$250 Nil Outpatient Emergency Treatment Due to accident only As charged As charged As charged Dental Treatment Due to accident only S$10,000 S$8,000 S$5,000 Cancer Treatment S$150,000 S$100,000 S$75,000 Kidney Dialysis S$150,000 S$100,000 S$75,000 Maintenance of Chronic Conditions # (12 months waiting period) Included under Outpatient General Practitioner (Non panel) & Specialist Care Per Visit General Practitioner - Primary Care General Practitioner (Panel) * As Charged As Charged As Charged Treatment at an A&E Department S$100 S$100 S$100 Overseas Treatment S$70 S$50 S$35 General Practitioner (Non Panel) Maximum of 12 visit for each Period of Insurance S$70 S$50 S$35 Specialist Care (GP referral required) Per Year Specialist Consultation S$2,000 S$1,000 S$500 Diagnostic Scan, X-Ray and Lab Test S$2,000 S$1,000 S$500 Pediatrician Consultation (waiver of GP referral letter for child below 36 months) S$500 S$250 S$150 Part III: Other Benefits Benefits Specified Sum Basis Daily Recovery Benefits After 3 days of hospitalisation, up to 30 days S$250 S$200 S$150 Dread Disease Recuperation Benefit Multiple Sclerosis, Heart Attack, Cancer & Stroke S$20,000 S$15,000 S$10,000 Special Grant S$10,000 S$8,000 S$5,000 Part IV: Additional Benefits Benefits Emergency Medical Evacuation/Repatriation ** Unlimited Unlimited Unlimited Repatriation of Mortal Remain or Local Burial ** # Please refer to policy for the list of chronic conditions. * Outpatient Panel treatment during the first month upon inception is on reimbursement basis. ** The above benefits are not subject to annual policy limits.

6 Annual Premium Table (inclusive of GST) Age Platinum Gold Silver 1 S$1,672 S$1,426 S$1,290 2 S$1,711 S$1,460 S$1,321 3 S$1,721 S$1,470 S$1,328 4 S$1,736 S$1,482 S$1,340 5 S$1,747 S$1,491 S$1,347 6 S$1,762 S$1,503 S$1,358 7 S$1,773 S$1,513 S$1,367 8 S$1,782 S$1,522 S$1,374 9 S$1,794 S$1,531 S$1, S$1,809 S$1,544 S$1, S$1,820 S$1,554 S$1, S$1,832 S$1,564 S$1, S$1,843 S$1,573 S$1, S$1,867 S$1,594 S$1, S$1,893 S$1,615 S$1, S$1,916 S$1,635 S$1, S$1,939 S$1,655 S$1, S$1,976 S$1,686 S$1, S$2,001 S$1,709 S$1, S$2,025 S$1,727 S$1, S$2,049 S$1,749 S$1, S$2,072 S$1,769 S$1, S$2,108 S$1,800 S$1, S$2,135 S$1,822 S$1, S$2,139 S$1,825 S$1, S$2,158 S$1,843 S$1, S$2,162 S$1,845 S$1, S$2,190 S$1,868 S$1, S$2,222 S$1,898 S$1, S$2,271 S$1,939 S$1, S$2,284 S$1,950 S$1, S$2,331 S$1,990 S$1, S$2,391 S$2,040 S$1, S$2,448 S$2,090 S$1, S$2,492 S$2,127 S$1, S$2,550 S$2,177 S$1, S$2,611 S$2,229 S$2, S$2,696 S$2,301 S$2, S$2,786 S$2,378 S$2, S$2,830 S$2,415 S$2,183 Age Platinum Gold Silver 41 S$2,896 S$2,474 S$2, S$3,009 S$2,568 S$2, S$3,076 S$2,625 S$2, S$3,120 S$2,664 S$2, S$3,249 S$2,773 S$2, S$3,405 S$2,908 S$2, S$3,566 S$3,044 S$2, S$3,736 S$3,189 S$2, S$3,906 S$3,334 S$3, S$4,118 S$3,514 S$3, S$4,328 S$3,695 S$3, S$4,542 S$3,876 S$3, S$4,751 S$4,056 S$3, S$4,987 S$4,257 S$3, S$5,269 S$4,497 S$4, S$5,532 S$4,722 S$4, S$5,822 S$4,970 S$4, S$6,058 S$5,171 S$4, S$6,406 S$5,470 S$4, S$6,722 S$5,737 S$5, S$7,185 S$6,132 S$5, S$7,535 S$6,433 S$5, S$7,842 S$6,695 S$6, S$8,191 S$6,992 S$6, S$8,535 S$7,286 S$6, S$8,881 S$7,581 S$6, S$9,182 S$7,838 S$7, S$9,584 S$8,180 S$7, S$9,986 S$8,523 S$7, S$10,445 S$8,915 S$8, S$11,134 S$9,503 S$8, S$11,823 S$10,091 S$9, S$12,971 S$11,071 S$10, S$14,347 S$12,246 S$11, S$16,069 S$13,716 S$12, S$16,987 S$14,499 S$13, S$17,561 S$14,989 S$13, S$17,906 S$15,283 S$13, S$18,136 S$15,480 S$13, S$18,136 S$15,480 S$13,990 Please Note: Benefits & Premium are quoted in Singapore Dollars. Age 66 to 80 for policy renewal only. All Ages refer to Age next birthday. Rates are subject to change without prior notice.

7 Eligibility 1. Applicants must satisfy the following: Adults from 18 to 65 years old (age next birthday). Policy renewable up to age 80 (age next birthday), subject to yearly review. Children from 15 days old to 18 years old (age next birthday). Policy renewable up to age 25 (age next birthday) provided that they are unmarried, unemployed and full-time students. Singapore Citizens, Permanent Residents of Singapore, Employment Pass Holders, Student Pass Holders, Dependant Pass Holders or Work Permit Holders. Employment Pass Holders, Student Pass Holders, Dependant Pass Holders and Work Permit Holders must supply a copy of their respective pass or work permit and a bona fide residential address in Singapore. 2. Proposal for children must include at least one parent as the main policy holder. Main Exclusions 1. Pre-existing conditions, which refers to an Injury or an Illness which, prior to the date on which an Insured Person is first Covered under the Policy: has been diagnosed; for which Insured Person has received medication, advice or treatment; which Insured Person should reasonably, based on Our appointed Physician s opinion, have known about; or for which Insured Person has experienced symptoms even if Insured Person has not consulted a Physician. This exclusion does not apply to Outpatient General Practitioner and Outpatient Specialist Care Benefit. 2. Congenital Conditions or genetic defects including hereditary conditions existing from the time of birth regardless of the time of discovery of such anomalies or defects (unless they are covered under the Congenital Conditions Benefit). 3. Routine or preventative physical examinations, investigation, medical check-up, vaccinations, treatments or follow-up consultations. 4. Please refer to the Policy for detailed list of exclusions.

8 Comprehensive cover for your dental health You can choose to add on the Dental Rider for enhanced coverage. Dental Rider Plan 1 Plan 2 Overall Annual Limit S$1,000 S$500 Co-pay/Co-insurance 20% 20% Restorative Dental Services i) Oral examinations One visit ii) Prophylaxis (teeth cleaning) per Period of iii) Fluoride application Insurance As Charged As Charged Other Dental Treatment: Extractions, Fillings, Root Canal Treatment, Bridgework, Crowns, Implants, X-Ray, Sealant, Inlays and Onlays, Treatment of gum disease Annual Premium per pax. (inclusive of GST) S$293 S$175 Terms and Conditions If rider is selected, all Insured adults under the Policy are required to take up the rider with the exception of children for whom cover is not compulsory. All family members must be covered under the same plan as the policyholder. This rider can be taken up only during new application or renewal of policy and is only effective from confirmation of the inception date of this rider. No mid-term inclusion allowed. Exclusions The coverage provided does not apply to charges for: Orthodontic treatment and dentures. Treatment consisting of cosmetic or plastic surgery or for beautification not necessitated by Injury or Illness. Expenses for toothbrushes, toothpaste, dental floss, mouthwash, and other consumables for intraoral hygiene.

9 Extra layer of protection when you travel With our new Travel Inconvenience Rider, you can be rest assured that you will be well taken care of on your next vacation or business trip. Travel Inconvenience Rider Plan 1 Personal Accident* Accidental Death & Permanent Disablement Adult up to 70 years old Adult above 70 years old Child S$150,000 S$75,000 S$75,000 S$3,000 Tuition Grant for each dependant child Travel Inconvenience Trip Cancellation S$5,000 Replacement of Travellers S$500 Financial Collapse of Travel Agency S$1,000 Trip Curtailment S$5,000 Travel Delay (pays S$100 for every 6 hours of delay) S$1,000 Travel Diversion (pays S$100 for every 6 hours of delay) S$1,000 Overbooked Flight S$100 Travel Misconnection (for at least 4 consecutive hours) S$100 Trip Postponement S$800 Baggage Delay (pays S$200 for every 6 hours of delay whilst overseas and S$200 if delay occurs in Singapore) S$1,000 Loss of Baggage and Personal Belongings (max. S$800 per item) S$3,000 Loss of Laptops, Wireless Handheld Device and Mobile Phones S$1,000 Loss of Personal Money & Travel Documents (up to S$500 for loss of money whilst overseas) S$2,000 Fraudulent Use of Lost Credit Card S$1,000 Purchase of Essential Items (up to S$50 per item) S$250 Emergency Phone Charges (up to S$50 per day) S$150 Rental Vehicle Excess S$500 Personal Liability S$1,000,000 Travel Security Hijacking (pays for every 6 hours of detention in a public transport) S$2,500 Hostage & Kidnap Benefit (pays S$500 for every 24 hours of detention) S$5,000 Full Terrorism Cover Covered Annual Premium Global - Adult (no GST) S$220 - Child (no GST) S$200 *Personal Accident benefits will only be payable upon an accident occurring. Terms and Conditions This rider can be taken up only during new application or renewal of policy and is only effective from confirmation of the inception date of this rider. No mid-term inclusion allowed. Insured Child must take up this rider with an Insured Adult.

10 Frequently Asked Questions 1. Can my family members take up different plans under the same policy? Yes, but dependant s cover must not be higher than the policyholder. For Dental Rider, all family members must choose the same plan as the policyholder. 2. Is there any family discount? We offer 10% family discount for three (3) or more family members covered under the same policy. Families must include at least 1 Insured Adult. 3. My spouse and I already have medical insurance with another provider. Can I take up Individual SmartCare Optimum Enhanced to cover only my child? No, proposals for children must include at least one parent or guardian. Children must be aged at least eighteen (18) years at their next birthday to be eligible for a standalone policy. 4. Will you re-underwrite my policy at renewal? Will I be penalised if I have made a claim in the current policy year? We will not change the terms of your policy simply as a result of your personal claims experience. Premiums are decided based on the age of each insured member and also the overall claims experience of all individuals insured with us on the same plan. This community pricing helps minimise fluctuations in your premiums year on year. 5. Am I covered if I travel outside Singapore? Yes, if you are outside Singapore for periods not exceeding ninety (90) consecutive days at a time. For inpatient other than Emergency Treatment, our liability is limited to charges for equivalent treatment in Singapore General Hospital, subject to the maximum limits of your Plan. For outpatient treatment, we will cover under the General Practitioner Overseas Treatment benefit up to the maximum limit per visit of your Plan. 6. Are pre-existing conditions covered? Pre-existing (non chronic) are covered under Outpatient General Practitioner & Outpatient Specialist Care only. Pre-existing Chronic conditions are covered under Outpatient General Practitioner (Non panel) & Outpatient Specialist Care after a waiting period of 12 months. 7. What is a chronic condition? A chronic condition is a medical condition or episode of ill health which persists for a long period or indefinitely. The list of chronic conditions include: All forms of Diabetes Asthma Brain Tumour Benign Prostatic Hyperplasia Crohn s disease Chronic Obstructive Pulmonary Disease Dementia Heart Disease Hepatitis B &C Hypertension Hypothyroidism Kidney Failure Lipid Disorders Liver Cirrhosis Multiple Sclerosis Nephrosis/Nephritis Osteoarthritis & Rheumatoid Arthritis Parkinson s Disease Systemic Lupus Erythematosus Stroke Ulcerative Colitis 8. What is the advantage of visiting your General Practitioner Panel of clinics? You can enjoy cashless visits by presenting your membership card, or e-membership card, upon arrival. The only exception is when the appointment is for a chronic condition. In these cases you will be required to make payment to the clinic first and then seek reimbursement from AXA. 9. Does the policy pay for Congenital conditions? Yes. The policy pays for inpatient or daycare treatment of congenital conditions up to the limit shown in Congenital Condition Benefit and subject to the below criteria: The birth defects must be first diagnosed by a Physician or have symptoms which first appear after 24 months from the Effective Date of the policy, whichever is later. 10. Can I take up dental rider without my dependants? When the dental rider is selected, all insured adults under a Policy are also required to take up the Dental Rider (with the exception of Children, for whom Dental Cover is not compulsory). 11. Why does the Travel Rider not include medical expenses or evacuation & repatriation coverage? Our intention is to offer you with a basic level of travel insurance which covers Accidental Death & Total Permanent disability and Travel Inconvenience benefits at a very attractive premium. The cost savings are achieved through the removal of duplicated overseas medical expense benefit and Evacuation & Repatriation Benefit which are already included under the SmartCare Optimum Enhanced plan. However, please note that overseas coverage is available only if you are outside Singapore for periods not exceeding ninety (90) consecutive days at a time. 12. Am I eligible to purchase the Travel Inconvenience Rider? You are eligible to purchase the Adult cover for Travel Inconvenience Rider if: (a) You hold a valid Singapore identification document such as Singapore NRIC, Employment Pass, Work Permit, Long Term Visit Pass, Dependent Pass or Student Pass; and (b) You are at least eighteen (18) years old on the effective date of the Policy. You are eligible to purchase a Child cover for Travel Inconvenience Rider if at the point of travel: (a) You hold a valid Singapore identification document such as Singapore NRIC or Birth Certificate, Long Term Visit Pass, Dependent Pass or Student Pass; and (b) You are below 18 years old, or up to 25 years old if enrolled to study full-time in a recognised institution of higher learning. For any Child below 18 years old, the application must be made in the name of the parent. The benefit limits under Child Cover will apply. Any Child must be accompanied by at least one parent for each trip.

11 Secure your health insurance with these tips Buy the coverage you need Speak with your financial adviser to understand how much health coverage you require, based on your needs and budget. Be prepared for rising healthcare costs Ensure that you and your loved ones are covered with health insurance to protect you against high expenses should any unfortunate events happen. Avoid additional out-of-pocket expenses Check that you are covered for Co-insurance or Deductibles to avoid making additional payments if you have to make a claim. Know the panel healthcare providers Choose from the list of panel hospitals or clinics covered under your plan for seamless claims processing. Manage your health policies anytime, anywhere, with the myaxahealth app Submit, track, and view your claims online Show your E-medical card at AXA panel clinics for cashless visits Read your policy benefits online Find doctors and clinics near you myaxahealth app for when you're on the move Scan To Download The App

12 Important information SmartCare Optimum Enhanced is a plan underwritten by AXA Insurance Pte Ltd. This brochure is not a contract of insurance. The precise terms and conditions of the plan are specified in the policy contract. A product summary is available and may be obtained from AXA Insurance Pte Ltd and the participating distributors offices. You should read the product summary before deciding whether to purchase the policy. Buying health insurance products that are not suitable for you may impact your ability to finance your future healthcare needs. It is usually detrimental to replace an existing accident and health insurance policy with a new one. A penalty may be imposed for early policy termination and the new policy may cost more or have less benefits at the same cost. In the event that you decide that the policy is not suitable after purchasing the policy, you may terminate the policy in accordance with the free-look provision, if any, and AXA Insurance Pte Ltd may recover from you any expense incurred by AXA Insurance Pte Ltd in underwriting the policy. This brochure is published for general information only and does not have regard to the specific investment objectives, financial situation and the particular needs of any specific person. You may wish to seek advice from a financial adviser before making a commitment to purchase the product. In the event that you choose not to seek advice from a financial adviser, you should consider whether the product in question is suitable for you. The insurance policy featured in this brochure is protected under the Policy Owners Protection Scheme which is administered by the Singapore Deposit Insurance Corporation (SDIC). Coverage for your policy is automatic and no further action is required from you should you buy the policy. For more information on the types of benefits that are covered under the Policy Owners Protection Scheme as well as the limits of coverage, where applicable, please visit the AXA website at or visit the GIA or SDIC websites ( or for a copy of the SDIC Guide on PPF Scheme (General Insurance). This policy is not a Medisave-approved policy and you may not use Medisave to pay the premium for this policy. This is a short-term accident and health policy and the insurer is not required to renew this policy. The insurer may terminate this policy by giving you 30 days notice in writing. All information stated in the brochure is correct as of 27 December Contact Us (Singapore) (International) customer.care@axa.com.sg axa.com.sg Download MyAXA Or scan here Like our Facebook Page facebook.com/axasingapore V2