AXA SmartCare SME Plus
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1 EMPLOYEE BENEFITS AXA SmartCare SME Plus Your company s most prized assets deserve the most complete protection At AXA, protection is our calling. Give your employees the protection they deserve with AXA SmartCare SME Plus.
2 About the Plan AXA SmartCare SME Plus is a comprehensive employee benefits protection solution for Small and Medium Enterprises (SMEs) or new start-ups with a minimum of 2 employees. Lean teams need coverage too. You can start a policy with just 2 employees^. À la carte rider options, including optical rider, to maximize the benefits for each of your employees. Bigger groups enjoy a bigger discount on premium #. 6 inpatient plans including a premier Plan 1 for those looking for superior coverage. A waiting period of just 12 months for pre-existing medical conditions* to be covered under the inpatient plans. Premium rates are determined by the entire SmartCare SME Plus portfolio. Claims made by your company alone will not directly increase your renewal premium. ^ For group size of 2, the maximum entry age is 50 years old. # Group size discount applies to Medical Plans only. * Pre-existing cancer and renal failure are permanently excluded.
3 BENEFITS Group Hospital and Surgical BASIC PLAN Covers hospitalisation and surgical expenses Group Term Life Covers death and total & permanent disability Provides advance payment upon diagnosis of a terminal illness, from which death is highly probable within the next 12 months If the employee was terminated on medical grounds, benefits can be extended for another 12 months RIDERS Group Extended Major Medical (Rider to Group Hospital & Surgical) Group Outpatient General Practitioner (Rider to Group Hospital & Surgical) Group Outpatient Specialist Care (Rider to Group Hospital & Surgical) Group Dental (Rider to Group Hospital & Surgical) Group Critical Illness (Rider to Group Term Life) Group Personal Accident (Rider to Group Term Life or Group Hospital and Surgical) Group Optical (Rider to Group Hospital & Surgical) Provides reimbursement of eligible expenses in excess of Group Hospital and Surgical where: Hospitalisation more than 20 days; or Surgical procedure of at least 75% of the benefit payable under the surgical table Covers eligible expenses incurred at a general practitioner, polyclinic or A&E department of any hospital in Singapore Reimburses eligible expenses incurred at specialist clinics and diagnostic scan, X-ray and laboratory tests referred by general practitioner Covers Physiotherapy/ Chiropractic Treatment (referred by physician) and Traditional Chinese Medicine Reimburses eligible dental expenses incurred at a dental clinic of your choice. Covers 37 critical illnesses (pls refer to policy contract for definition of these illnesses) Choice of acceleration or additional basis: Acceleration basis The sum insured shall be payable in advance from the Group Term Life Benefit. The balance of the Group Term Life Benefit will be payable upon subsequent death. Additional basis This is an additional benefit and does not affect the Group Term Life Benefit. Covers loss of life, permanent disablement or dismemberment due to an accident. Covers comprehensive eye examination and offers allowance on eyewear. GROUP SIZE PREMIUM DISCOUNT Applicable Plan and Riders Group Size 5 9 employees Group Size 10 or more employees Group Hospital and Surgical Group Extended Major Medical Group Outpatient General Practitioner Group Outpatient Specialist Care Group Dental 5% discount 10% discount AXA SmartCare SME Plus 3
4 BASIC PLANS GROUP HOSPITAL AND SURGICAL BENEFITS SCHEDULE (S$) PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN 6 Policy Limit (applicable to all benefits except items marked*) 250,000 per policy year Maximum Per Disability Type of Hospital Private Private Private Private Govt / Restructured Govt / Restructured Room & Board (standard) 1 Bed 1 Bed 2 Bed 4 Bed 1 Bed 4 Bed ICU/CCU/HDU 10,000 10,000 10,000 10,000 10,000 Hospital Miscellaneous Services Surgeon s Fees (Subject to Surgical Table for Private Hospital)^ In-Hospital Physician s Fees Ambulance Charges (not subject to Surgical Table) 25,000 20,000 15,000 25,000 15,000 Pre-Hospitalisation / Surgery Specialist s Consultation (Up to 90 days before hospitalisation / surgery) Pre-Hospitalisation/Surgery Diagnostic Services (Up to 90 days before surgery) 2,000 1,500 1,000 2,000 1,000 Post-Hospitalisation/ Surgery Treatment (Up to 90 days) Medical Report Fees Accidental Miscarriage / Abortion due to Medical Reason / Ectopic Pregnancy Emergency Outpatient Treatment (due to accident only) Emergency Outpatient Dental Treatment (due to accident) 3,000 1,000 1,000 1,000 1,000 1,000 2,000 1,500 1,000 2,000 1,000 5,000 2,000 1,500 1,000 2,000 1,000 Surgical Implants 5,000 2,000 1,500 1,000 2,000 1,000 Outpatient Kidney Dialysis (Max. per policy year) Outpatient Cancer Treatment (Max. per policy year) 75,000 20,000 15,000 10,000 20,000 10,000 75,000 20,000 15,000 10,000 20,000 10,000 4 AXA SmartCare SME Plus
5 BASIC PLANS GROUP HOSPITAL AND SURGICAL (CONT D) BENEFITS SCHEDULE (S$) PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN 6 Special Grant 5,000 5,000 5,000 5,000 5,000 5,000 Hospital Cash Benefit (per day) up to 90 days of hospital confinement in Government / Restructured Hospital B1 Ward N.A. 100 N.A. B2/B2+ Ward C Ward Daily Recovery Benefit (after 3 days of hospitalisation, up to 30 days) 150 Dread Disease Recuperation Benefit (Multiple Sclerosis, Heart Attack, Cancer & Stroke) + 10,000 Parent Accommodation (up to 60 days per year for child below age 12) Home Nursing (up to 26 weeks) Emergency Medical Evacuation / Repatriation * Repatriation of Mortal Remains or Local Burial * Unlimited Unlimited N.A. * The above benefits are not subject to annual policy limits. ^ Plan 1 and surgical fee incurred at a Singapore Government Hospital or Singapore Government Restructured Hospitals are not subjected to Surgical Table. + Dread Disease Recuperation benefit is subject to a waiting period of 90 days. The Life Insurance Association Singapore (LIA) has standard Definitions for 37 severe-stage Critical Illness (Version 2014). These Critical Illness fall under Version You may refer to for the standard Definitions (Version 2014). ANNUAL PREMIUM PER INSURED MEMBER INCLUSIVE OF GST (S$) AGE NEXT BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN , , , , , , , , , , , , , , ** 5, , , , , , ** 6, , , , , , ** For renewal only. The last entry age on all plans is 70. AXA SmartCare SME Plus 5
6 BASIC PLANS GROUP TERM LIFE PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN 6 Sum Insured (S$) 500, , , , ,000 50,000 ANNUAL PREMIUM PER INSURED MEMBER (S$) [GST EXEMPTED] AGE NEXT BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN 6 35 and below , , , , , , , , , , , , , , , , , , AXA SmartCare SME Plus
7 RIDERS GROUP EXTENDED MAJOR MEDICAL RIDER BENEFITS SCHEDULE (S$) PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN 6 Policy Limit (applicable to all benefits) Eligible medical expenses payable for: Hospitalisation of more than 20 days; or Surgical procedure of at least 75% of the benefit payable under the Schedule of Surgical table Maximum Per Disability 100, ,000 80,000 50, ,000 50,000 Type of Hospital Private Private Private Private Govt / Restructured Govt / Restructured Room & Board (standard) 1 Bed 1 Bed 2 Bed 4 Bed 1 Bed 4 Bed Surgical Implants 10,000 10,000 8,000 5,000 10,000 5,000 Co-Insurance NIL NIL NIL NIL NIL NIL ANNUAL PREMIUM PER INSURED MEMBER INCLUSIVE OF GST (S$) AGE NEXT BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN ** ** ** For renewal only. The last entry age on all plans is 70. AXA SmartCare SME Plus 7
8 RIDERS GROUP OUTPATIENT GENERAL PRACTITIONER RIDER BENEFITS SCHEDULE (S$) PLAN 1 PLAN 2 Panel Clinics Visit to Polyclinic X-Ray and Laboratory tests (referred by panel clinic or polyclinic) Non-panel Clinics 35 per visit 35 per visit A&E Departments 100 per visit 100 per visit Overseas Outpatient Treatment 35 per visit 35 per visit Number of visits per year Unlimited Unlimited Co-payment per visit (applicable to all benefits) NA 10 ANNUAL PREMIUM INCLUSIVE OF GST (S$) PLAN 1 PLAN 2 Per insured member AXA SmartCare SME Plus
9 RIDERS GROUP OUTPATIENT SPECIALIST CARE RIDER BENEFITS SCHEDULE (S$) PLAN 1 PLAN 2 Outpatient Specialist Consultation Outpatient Diagnostic Scan, X-Ray & Laboratory Tests Physiotherapy/Chiropractic Treatment (referred by physician) 2,000 per policy year 1,000 per policy year 2,000 per policy year 1,000 per policy year 500 per policy year 500 per policy year Traditional Chinese Medicine (TCM) 35 per visit (max. 3 visits per year) 35 per visit (max. 3 visits per year) ANNUAL PREMIUM INCLUSIVE OF GST (S$) PLAN 1 PLAN 2 Per insured member AXA SmartCare SME Plus 9
10 RIDERS GROUP DENTAL RIDER BENEFITS SCHEDULE (S$) PLAN 1 PLAN 2 Consultation Medication (including administration of Local Anaesthesia) X-Rays i) Periapical Film ii) Bite-Wing iii) Occlusal Film iv) Orthopantomograph Prophylaxis i) Scaling/Polishing ii) Fluoride application Amalgam Restorations - fillings Per Surface Tooth-Coloured Restorations - fillings Per Surface Extractions (inclusive of LA) i) Anterior Tooth ii) Posterior Tooth Oral Surgery (inclusive of LA) i) Surgical Root Removal (Per Tooth) ii) Surgical Removal of Wisdom Tooth Pulp/Root Canal Treatment i) Pulp Capping ii) Root Canal Treatment (inclusive of temporary fillings) - One Canal - Two Canals Periodontal Treatment Root Planing (Per Tooth) up to 1,200 per policy year up to 800 per policy year Miscellaneous Treatment i) Sedative Dressings ii) Retention pins - restoration of tooth Crowning - due to accident only Bridges - due to accident only Co-insurance (applicable to all benefits) 20% 20% ANNUAL PREMIUM INCLUSIVE OF GST (S$) PLAN 1 PLAN 2 Per insured member AXA SmartCare SME Plus
11 RIDERS GROUP CRITICAL ILLNESS RIDER PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN 6 Sum Insured (S$) 250, , ,000 75,000 50,000 25,000 ACCELERATION BASIS ANNUAL PREMIUM PER INSURED MEMBER (S$) [GST EXEMPTED] AGE NEXT BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN 6 35 and below , , , , , , , , , , , , , , ADDITIONAL BASIS ANNUAL PREMIUM PER INSURED MEMBER (S$) [GST EXEMPTED] AGE NEXT BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN 6 35 and below , , , , , , , , , , , , , , , AXA SmartCare SME Plus 11
12 RIDERS GROUP PERSONAL ACCIDENT RIDER RIDER PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN 6 Sum Insured S($) 500, , , , ,000 50,000 ANNUAL PREMIUM PER INSURED MEMBER INCLUSIVE OF GST (S$) Occupational Class PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN 6 Occupation Class Occupation Class Occupation Class 3 N/A OCCUPATIONAL CLASS CLASS 1 = Professional, administrative, managerial, clerical and non-manual work solely in office or similar non-hazardous places. E.g. Accountant, Bank teller, Programmers, Doctor / Dentist (non-veterinary), Lawyer, Receptionist. CLASS 2 = Office or supervisory work which involves outdoor, travelling or light manual work, and does not involve the use of tools or machinery or exposure to any special hazard. E.g. Beautician, Homemaker, Insurance Intermediary, Retail Assistant, Tour Guide. CLASS 3 = Occupation which involves manual work which is not of hazardous nature but involves the use of tools or machinery. E.g. Baker, Chauffer, Hawker (Food), Mechanic, Painter (not involving work at heights), Plumber. 12 AXA SmartCare SME Plus
13 RIDERS GROUP OPTICAL RIDER Each insured member is eligible to one (1) comprehensive eye examination or refraction eye test and one (1) frame & lens package or contact lenses Benefits (S$) Key Features Comprehensive Essential Comprehensive Eye Examination (Exam) OR Refraction Eye Test Written Prescription (Refraction Eye Test only) Full Written Report (Comprehensive Eye Exam only) Lens Benefit Comprehensive exam focuses on eyes and overall wellness -OR- Refraction eye test focuses on visual acuity only Insured member s copy of prescription will be provided upon request Summary of Optometrist clinical findings and observations from exam, includes fundus photo (3 to 4 days processing time) - Upon Insured Member request Single Vision: House Brand* (Anti-reflective & EMI Shielding included) -OR- Any other lens of your choice Covered in full Covered in full No charge (if requested at time of exam) No charge (if provided to Insured Member) Covered 120 (Discount of 20% on the amount over the allowance) Covered in full Covered in full No charge (if requested at time of exam) No charge (if provided to Insured Member) Covered 120 (Discount of 20% on the amount over the allowance) * House brand lenses with an index of 1.5 are generally covered under the plan, while higher indexes will fall under lens of your choice Frame Allowance Contact Lens Allowance Contact Lens Examination Progressive: House Brand* (Anti-reflective & easy-to-clean coatings included) -OR- Any other lens of your choice Amount provided to spend on frame Amount provided to spend on contact lens instead of glasses Fitting & evaluation - performed during a contact lens exam to evaluate vision with contacts Covered 280 (Discount of 20% on the amount over the allowance) 300 (Discount of 20% on the amount over the allowance) 300 (Discount of 10% on the amount over the allowance) No fee applicable if contact lens are purchased 20 fee applicable if contact lens are not purchased Covered 280 (Discount of 20% on the amount over the allowance) 190 (Discount of 20% on the amount over the allowance) 160 (Discount of 10% on the amount over the allowance) No fee applicable if contact lens are purchased 20 fee applicable if contact lens are not purchased Insured members get a fully-covered comprehensive eye examination at Optical 88 s Professional Eyecare Center in Vivocity plus additional saving on eyewear at any Optical 88 retail locations - including Vivocity ANNUAL PREMIUM INCLUSIVE OF GST (S$) Comprehensive Essential Per insured member AXA SmartCare SME Plus 13
14 UNDERWRITING GUIDELINES ELIGIBILITY Cover under this policy shall be subjected to the fulfillment of all of the following eligibility requirements by the Insured Persons: (i) (ii) Your employee and your employee s legal spouse are from Age 16 years to 70 years old and who is a Resident of Singapore; Your employee s natural child, step-child or legally adopted child, who is a Resident of Singapore, unmarried and not employed, between 15 days old and Age 25, and in the case between Age 19 and Age 25, the child must be studying full-time in a recognised institution of higher learning (and not in full-time national service). Resident of Singapore shall mean Singapore Citizens and Permanent Residents (holders of re-entry permits) as well as holders of employment passes, work permits, students passes or dependents passes. An Insured Person s cover will cease automatically if he remains outside of his Country of Residence for a period in excess of one hundred eightyfive (185) consecutive days. Applicable to Medical and Optical Plans only: Where Insured Member commenced Cover between Age 16 and Age 70, Insured Member will be eligible for renewal of Cover up to Age 80. PARTICIPATION AND PLAN SELECTION a) Dependents are not eligible for Group Term Life, Group Critical Illness and Group Personal Accident. b) Participation of employees and dependents (if applicable) must be on compulsory basis. c) Coverage shall be the same for all employees within the same category in the company. d) Dependent participation (where applicable) must follow the same plan(s) selected for the employees. e) For group size of 2 employees only, maximum entry age is 50 (age next birthday). f) For Extended Major Medical Rider, plan selected for the employees must be the same as the Basic plan selected. g) For General Practitioner Rider, the same plan type must be applied across all categories who opt for the general practitioner coverage. h) For Specialist Care Rider, General Practitioner Benefit must be selected before Specialist benefit is purchased. LIMITATION OF COVER a) Admission to higher ward or Hospital type that differs from plan entitlement: If the insured member is admitted to a ward or hospital type higher than what he is entitled to under the policy, we will pay 60% of the eligible medical expenses subject to the maximum limit stated in the policy schedule. b) Outside Country of Residence:- This policy covers an insured member while he is outside his Country of Residence provided that where the treatment is otherwise than Emergency Treatment, our liability is limited to 60% of the eligible expenses payable, subject to the maximum limits set out in the policy schedule 14 AXA SmartCare SME Plus
15 EXCLUSIONS There are certain conditions under which no benefits will be payable. These are stated as exclusions in the contract. The following is a list of some of the exclusions for the respective plans. The exclusions include, but are not limited to, the following conditions. You are advised to read the policy contract for the full list of exclusions. For Group Term Life: For Sum Insured up to $100,000, all pre-existing medical conditions are excluded for the first 18 months of continuous coverage. This is only applicable to members entering the policy on/before the age of 65 next birthday. For members entering from age 66 next birthday, their proposed sum insured shall be subject to underwriting before confirmation of cover. For Group Critical Illness: a) Pre-existing medical conditions, b) Attempted suicide or self-inflicted injuries, c) Under the influence of narcotics or drugs. For Group Hospital and Surgical and Group Extended Major Medical: Pre-existing medical conditions are excluded for the first 12 months of continuous coverage except for pre-existing cancer or renal failure for which the conditions will be permanently excluded. For Group Outpatient General Practitioner and Specialist Care, charges in respect of the following: a) Routine or preventative physical examinations, investigation, medical check-up, vaccinations, treatments or follow-up consultations. b) 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. For Group Dental: a) Orthodontic treatment and temporary dentures. b) Treatment consisting of cosmetic or plastic surgery or for beautification not necessitated by injury or illness. For Group Personal Accident: a) Suicide, attempted suicide or self-inflicted injuries, regardless of the Insured member s mental condition. b) War (declared or undeclared), invasion, act of foreign enemies, hostilities, civil war, rebellion, revolution, insurrection, military or usurped power c) Participation in racing on wheels d) Participation in a riot or civil commotion, violation or attempted violation of law, or resistance to lawful arrest or imprisonment. e) Air travel, other than as a fare paying passenger on a licensed commercial aircraft. For Group Optical: a) Lasik eye surgery, surgery of any kind or eyewear required during medical procedures b) Expenses incurred outside Optical 88 retail stores PREMIUM a) Premium rates quoted are for standard lives based in Singapore only. b) Premium rates are quoted in Singapore Dollar and not guaranteed, subject to change without prior notice. c) Prevailing GST applies to all plans except Group Term Life and Group Critical Illness. d) All ages, if applicable, refer to the age next birthday. APPLICATION DOCUMENTS a) Enrolment form b) Business Profile report from the Accounting & Corporate Regulatory Authority (ACRA) OR copy of Certificate of Incorporation / Registration AND list of persons with executive authority within the company c) List of names, identification numbers and specimen signatures of authorised persons to sign on the enrolment form d) Health Declaration Form for: i) Group Term Life / Group Critical Illness (Acceleration) sum insured applied in excess of $100,000 for members up to age 65 next birthday ii) Group Term Life / Group Critical Illness (Acceleration) application for members above age 65 next birthday iii) Group Critical Illness (Additional) application AXA SmartCare SME Plus 15
16 IMPORTANT NOTES This is not a contract of insurance. The standard terms and conditions of this plan are provided in the policy contract. A product summary is available and may be obtained from AXA Insurance Private Limited and the participating distributors offices. You should read the product summary before deciding whether to purchase the policy. The above is for your information only and does not have any regard to your specific investment objectives, financial situation and any of your particular needs. 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 Owner s 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 LIA or SDIC websites ( or for a copy of the SDIC guide on PPF Scheme (Life Insurance). Speak to your financial consultant customer.care@axa.com.sg /2017 AXA Insurance Pte Ltd Company Reg No M 8 Shenton Way #24-01 AXA Tower Singapore AXA Customer Care #B1-01 Tel:
AXA SmartCare SME. At AXA, protection is our calling. Give your employees the protection they deserve with AXA SmartCare SME.
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