AXA SmartCare SME. At AXA, protection is our calling. Give your employees the protection they deserve with AXA SmartCare SME.

Transcription

1 EMPLOYEE BENEFITS AXA SmartCare SME Comprehensive protection for your company s most prized assets At AXA, protection is our calling. Give your employees the protection they deserve with AXA SmartCare SME.

2 About the Plan AXA SmartCare SME 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 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 BASIC PLAN Group Hospital and Surgical Covers hospitalisation and surgical expenses RIDERS Group Extended Major Medical 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 Group Outpatient General Practitioner Covers eligible expenses incurred at a general practitioner, polyclinic or A&E department of any hospital in Singapore Group Outpatient Specialist Care 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 Group Dental Reimburses eligible dental expenses incurred at a dental clinic of your choice Group Personal Accident Covers loss of life, permanent disablement or dismemberment due to an accident Group Optical Covers comprehensive eye examination and offers allowance on eyewear GROUP SIZE PREMIUM DISCOUNT Applicable Plan and Riders Group Hospital and Surgical Group Extended Major Medical Group Outpatient General Practitioner Group Outpatient Specialist Care Group Dental Group Size 5 9 employees 5% discount Group Size 10 or more employees 10% discount AXA SmartCare SME 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) 75,000 20,000 15,000 10,000 20,000 10,000 Outpatient Cancer Treatment (Max. per policy year) 75,000 20,000 15,000 10,000 20,000 10,000 4 AXA SmartCare SME

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 5

6 RIDERS GROUP EXTENDED MAJOR MEDICAL RIDER BENEFITS SCHEDULE (S$) PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN 6 Policy Limits (applicable to all benefits) Eligible medical expenses payable for: Hospitalisation of more than 20 days; or Surgical procedure of at least 75% of the benefit payable under the Schedule of Surgical table Maximum Per Disability 100, ,000 80,000 50, ,000 50,000 Type of Hospital Private Private Private Private Govt / Restructured Govt / Restructured Room & Board (standard) 1 Bed 1 Bed 2 Bed 4 Bed 1 Bed 4 Bed Surgical Implants 10,000 10,000 8,000 5,000 10,000 5,000 Co-Insurance NIL NIL NIL NIL NIL NIL ANNUAL PREMIUM PER INSURED MEMBER INCLUSIVE OF GST (S$) 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 AXA SmartCare SME

7 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 7

8 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

9 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 9

10 RIDERS GROUP PERSONAL ACCIDENT RIDER PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN 6 Sum Insured S($) 500, , , , ,000 50,000 ANNUAL PREMIUM PER INSURED MEMBER INCLUSIVE OF GST (S$) OCCUPATION 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. 10 AXA SmartCare SME

11 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 11

12 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. 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 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. 12 AXA SmartCare SME

13 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 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 insured members based in Singapore only. b) Premium rates are quoted in Singapore Dollar and not guaranteed, subject to change without prior notice. c) Premium rates are inclusive of GST. d) All ages, if applicable, refer to the age next birthday. APPLICATION DOCUMENTS a) Enrolment form b) An Accounting & Corporate Regulatory Authority (ACRA) search report dated not earlier than 6 months OR Copy of Certificate of Incorporation/Registration. AXA SmartCare SME 13

14 NOTES

15 NOTES

16 IMPORTANT NOTES This brochure is not a contract of insurance and is published for general information only. For full terms & conditions, please refer to the Policy which is the operative document. We reserve the right to amend any of the information shown without prior notice. You may wish to seek advice from an Accident & Health (A&H) insurance intermediary before making a commitment to purchase the product. A product summary is available and may be obtained from AXA Insurance Pte Ltd. You should read the product summary before deciding whether to purchase the policy. In the event that you choose not to seek advice from an A&H insurance intermediary, you should consider whether the products in question are suitable for you. This policy 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. For more information on the types of benefits that are covered under the scheme as well as the limits of coverage, where applicable, please contact your insurer or visit the GIA or SDIC websites ( or 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: