Medical Insurance Zurich MegaMed Mega solutions for your healthcare needs Zurich Insurance Malaysia Berhad (8029-A) 11th Floor, Menara Zurich, No.12, Jalan Dewan Bahasa, 50460 Kuala Lumpur, Malaysia Tel: 03-2146 8000 Fax: 03-2144 1622 Call Centre: 1-300-888-622 www.zurich.com.my The trademarks depicted are registered in the name of Zurich Insurance Company Ltd in many jurisdictions worldwide. 3382/3/P/L/B/M
Extend your medical protection for total peace of mind At every stage of our lives, there are new challenges to deal with some easy enough to overcome, others a little more difficult. Financial planning is an ever-present challenge that affects all aspects of life perhaps most importantly, health and it can be a difficult one to manage. With all life s ups and downs, you can never be too prepared. Least of all when it comes to medical costs, which are increasing every year, and are only set to continue. Surveys show that Malaysians are increasingly concerned about the rising costs of medical care and treatment. They worry that by the time they are old and need special care, inflation will have made it much harder to obtain. Let s look at the facts. Nearly half of all Malaysian cancer patients experience financial struggles a year after being diagnosed with cancer. Source : The Asean Costs in Oncology (Action) study by Sydney-based George Institute for Global Health. The medical inflation rate, which is the increase of medical costs, is between 10% - 15% every year. Medical Treatment Cataract Heart Attack Knee Replacement Hip Replacement Cancer Stroke Kidney Failure Current Cost (RM) 3,500 to 5,000 10,000 to 30,000 15,000 to 40,000 18,000 to 50,000 18,000 to 300,000 35,000 to 75,000 150,000 and above Cost in 20 Years (RM) 24,000 to 34,000 67,000 to 202,000 101,000 to 270,000 121,000 to 336,000 121,000 to 2,018,000 235,000 to 505,000 1,009,000 and above (It serves only as a guide for healthcare costs from government as well as private hospitals. Conservative assumption: Healthcare inflation of 10% a year). Source : Planning for healthcare costs in retirement, 2015, The Star. Most of us share the same concerns over being able to pay for special care when we truly need it, or becoming financially exhausted due to any medical treatment we might require. But at Zurich, we believe that with the right advice and planning, these challenges are surmountable. That s why we developed Zurich MegaMed a unit deducting rider that you can add on to your basic regular premium investment-linked plan for higher medical protection and total peace of mind. With Zurich MegaMed, you not only enjoy a high Annual Limit you also benefit from invaluable additional features, including protection against dengue fever, and overseas hospitalisation coverage. 2 3
A medical protection that gives you assurance Protection up to RM2.25 million, no Lifetime Limit*, up to age 100 Designed to give you total protection, Zurich MegaMed offers an unparalleled Annual Limit of up to RM2.25 million. This figure aims to help with rising medical costs that may take their toll over the years to come. So as long as your policy remains active, you ll be able to receive any medical treatment you might need up to your Annual Limit. There s also the added bonus of no Lifetime Limit* until you re 100 years old, which gives you the assurance you need in your retirement years. *For Plan 2 and above only Four plans designed with you in mind Everyone s needs are different, so choose any of the four plans that offer various features and premiums that might suit you best. From the essential coverage in Plan 1, to the other 3 plans that offer the opportunity to eliminate your Lifetime Limit, you will be able to enjoy the same Annual Limit every year for as long as your policy is active very useful in cases where expensive long-term medical treatment might be needed. Out-patient Kidney Dialysis and Cancer Treatment As Charged Basis If you re diagnosed with Kidney Failure or Cancer, rest assured that you ll be reimbursed for your medical treatment, based on your annual limit and lifetime limit. That way, you can focus on getting well, while we take care of the rest. Be protected against dengue fever We understand that dengue fever is a special concern in Malaysia, where heatwaves can bring an onslaught of the illness. With Zurich MegaMed, you re more than protected, with a substantial per-event limit for Out-Patient Dengue Fever Treatment. So in the unfortunate event of you contracting dengue as defined in the policy documents, your active policy would afford you the best care and help you make recovery. Receive specialist treatment in Singapore Sometimes an illness may require more or different expertise that may not be available in Malaysia. In these cases, it may be necessary to seek treatment elsewhere in the region. Overseas Medical Treatment in Singapore is a unique feature offered with Plan 4, and means that eligible expenses incurred up until the day of discharge will be fully reimbursed* upon your return to Malaysia. For certain illnesses or complications, this allowance would be invaluable. *Subject to terms and conditions Stay covered with Accidental Death Benefit Enjoy a complete peace of mind knowing that you re covered for as long as 365 days after an unfortunate accident. Should the unexpected happen to you as a direct result of the accident, your loved ones will be entitled to accidental death benefit as stated in the Schedule of Benefits. 4 5
Schedule of Benefits Additional protection with Infectious Disease Benefit Infectious diseases are not easy to deal with. That s why we provide extra protection of up to RM10,000 per infectious disease diagnosed before age 70. While each infectious disease is only claimable once, you can be sure that the additional protection will get you and your loved ones adequately covered. Zurich MegaMed is available in four plans that cater to different needs and budgets. Please see below for a full schedule of benefits: Plans Plan 1 Plan 2 Plan 3 Plan 4 Overall Limit* Overall Annual Limit Overall Lifetime Limit 375,000 1,000,000 1,750,000 2,250,000 750,000 Limit (RM) No Limit Age 15 and below Infectious Disease* Age 16 and above 1 Hospital Benefits Daily Hospital Room & Board (unlimited number of days) 160 210 280 380 Cholera Tuberculosis (TB) Influenza A Avian Influenza A(H7N9) & A(H5N1) Malaria 2 Intensive Care Unit/ High Dependency Unit (max. 60 days per annum) *Please refer to policy contract for detailed definitions of the infectious diseases covered. Cashless convenience at our local hospitals 3 4 5 Hospital Supplies and Services Surgical Fees (for post-surgical care, within 90 days from discharge) Anaesthetist Fees When you re at a local hospital, you have enough on your mind. Let our cashless facility ease your admission and discharge hassles. Just show your medical card at the counter to enjoy a much smoother hospital experience. You ll only have to settle any outstanding fees, while we take care of the rest. Most importantly, you ll be admitted and attended to immediately. Worry-Free with Emergency Assistance Programme 6 7 8 9 10 Operating Theatre Ambulance Fees Day Surgery Pre-Hospital Diagnostic Tests (within 60 days prior to admission) Pre-Hospital Specialist Consultation (within 60 days prior to admission) As charged When travelling abroad, a medical emergency isn t part of your itinerary. But in the event that you do need medical attention, certain countries may have difficulty processing your medical coverage. With our International Medical Assistance Programme, you will get all the information and care you need. Please refer to page 9 for the list of services offered. 11 12 In-Hospital Physician Visit (unlimited number of days) Post-Hospitalisation Treatment (within 90 days from discharge) 13 Organ Transplant (once per lifetime) * Out-patient Dengue Fever Treatment, Accidental Death Benefit, Infectious Disease Benefit and Emergency Assistance Programme are not included in the overall limit. 6 7
Out-Patient Benefits Emergency Assistance Programme 14 Out-Patient Dengue Fever Treatment (max. limit per event) 1,600 2,100 2,800 3,800 15 16 17 Out-Patient Kidney Dialysis Treatment Out-Patient Cancer Treatment Out-Patient Physiotherapy Treatment (within 180 days from discharge/ surgery) As charged Emergency Assistance Programme is an international assistance programme facilitated by MediExpress (M) Sdn Bhd. Just call 1-300-80-0020 from any part of the world for extended services: Services Offered 18 19 20 21 22 23 24 25 26 Emergency Accidental Out-Patient Treatment (within 72 hours and follow-up treatment up to a max. of 31 days) Other Benefits Overseas Medical Treatment in Singapore** (max. limit per annum) Daily Cash Allowance at Government Hospital (unlimited number of days) Guardian Benefit (max. limit per disability) Medical Report Fees (max. limit per disability) Home Nursing Care (max. 200 days per lifetime) Goods and Services Tax (GST) Accidental Death Benefit Infectious Disease Benefit Not Available 50 60 75 85 200 250 300 400 100 120 120 120 As charged 10,000 20,000 30,000 40,000 5,000 per Infectious Disease 500,000 10,000 per Infectious Disease International Medical Assistance Programme Travel Assistance* Car Assistance* Home Assistance* Tele-medical consultation and evaluation of the member s condition, medical referral and arrangement of medical appointments, arrangement of hospital admission guarantee, dispatch of medication not available locally, medical evacuation, medically supervised repatriation, medical monitoring and emergency message transmission, repatriation of mortal remains, visit to bedside by a friend/relative and return of children travelling with the member. Visa, passport and inoculation requirements, location of lost items, emergency message relay, arrangement of flights, legal referral, referral to interpreter/ translator and weather and foreign exchange information. 24-hour emergency towing and minor roadside repair, territorial limits, car rental assistance, arrangement for hotel accommodation and referral to service centre. Plumbing assistance, locksmith assistance, general repair assistance, air-conditioning assistance and pest control assistance. *Referral service only. Any expenses and/or liabilities incurred for such service shall be borne by the policyholders. These services are not guaranteed as they are provided by a third party and the continuation of these services are subject to the agreement between the company and the third party service provider. 27 Emergency Assistance Programme In accordance with the benefit provision in Emergency Assistance Programme agreement **Company shall reimburse the charges payable (after converting to Ringgit Malaysia in accordance with the exchange rate on the day of discharge) for eligible expenses incurred in a Rider Policy Year for all items in the Schedule of Benefits above (except for Out-Patient Dengue Fever Treatment, Out-Patient Kidney Dialysis Treatment, Out-Patient Cancer Treatment, Daily Cash Allowance at Government Hospital, and Emergency Assistance Programme) subject to the limit of this benefit. Note: The amount of benefit payable will be subject to medically necessary, reasonable and customary charges incurred for a covered disability. 8 9
Frequently Asked Questions Exclusions What is Zurich MegaMed? Zurich MegaMed is a unit deducting rider attachable to selected individual basic regular premium investment-linked plans. It provides comprehensive medical coverage up to age 100. Who is eligible for Zurich MegaMed? Anyone between 30 days old and 69 years old (attained age) can purchase Zurich MegaMed as a rider attachable to selected regular premium investment-linked plans. If you are an existing policyholder with Flex Maternity Care rider, you can activate the Option to Purchase New Policy for Child and attach this rider to your child s policy immediately after birth. What are the available plans to choose from? Zurich MegaMed is available in 4 plans. You have the flexibility to choose the plan that suits your health care needs and budget. Please refer to page 7 and 8 for the plans available. No benefit shall be payable under the following circumstances: 1. Hospitalisation, surgery or charges caused, directly or indirectly, wholly or partly, by any one of the following occurrences: a) Pre-existing illness. b) Specified Illnesses occurring during the first 120 days of continuous coverage. c) Any medical or physical conditions arising within the first 30 days of the Life Assured coverage or date of reinstatement whichever is later except for accidental injuries. d) Plastic/cosmetic surgery, circumcision, eye examination, glasses and refraction or surgical correction of near-sightedness (Radial Keratotomy or Lasik), long-sightedness, astigmatism and the use or acquisition of external prosthetic appliances or devices such as artificial limbs, hearing aids, implanted pacemakers and prescriptions thereof. e) Dental conditions including dental treatment or oral surgery except as necessitated by accidental Injuries to sound natural teeth occurring wholly during the period of insurance and performed by a dentist. In addition, expenses arising from placement of denture or prosthetic services such as bridges, implants and crowns or their replacement will not be payable. f) Private nursing (except if recommended by the attending Physician as stated in the Home Nursing Care clause), rest cures or sanitaria care, illegal drugs, intoxication, sterilisation, venereal disease and its sequelae, AIDS (Acquired Immune Deficiency Syndrome) or ARC (AIDS Related Complex) and HIV (Human Immunodeficiency Virus) related diseases, and any communicable diseases requiring quarantine by law. g) Any treatment or surgical operation for congenital abnormalities or deformities including hereditary conditions. h) Pregnancy, pregnancy related or its complications, 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 sterilisation. i) 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. j) Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane. k) 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. l) Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material. m) Expenses incurred for donation of any body organ by a Life Assured and costs of acquisition of the organ including all costs incurred by the donor during organ transplant and its complications. 10 11
n) 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. o) Care or treatment for which payment is not required or to the extent which is payable by any other insurance or indemnity covering the Life Assured and Disabilities arising out of duties of employment or profession that is covered under a Workman's Compensation Insurance Contract. p) Psychotic, mental or nervous disorders (including any neuroses and their physiological or psychosomatic manifestations). q) Costs/expenses of services of a non-medical nature, such as television, telephones, telex services, radios or similar facilities, admission/inpatient kit/pack, discharge pack, laundry, electricity, extra meal and other ineligible non-medical items. r) Sickness or Injury arising from racing of any kind (except foot racing), hazardous sports such as but not limited to skydiving, water skiing, underwater activities requiring breathing apparatus, winter sports, professional sports and illegal activities. s) Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes. t) Expenses incurred for sex changes. 2. Any accidental death caused, directly or indirectly, wholly or partly, by any one of the following occurrences: a) Self-destruction or any attempt thereat or self-inflicted injury while sane or insane, intoxication by alcohol or drugs/narcotics of any kind (other than those taken in accordance with treatment prescribed and directed by the registered medical practitioner, but not for the treatment of drug or alcohol addiction); b) Participation in professional sports (including caving, potholing and bungee jumping); c) All kinds of diseases (including dengue fever and Japanese Encephalitis), pregnancy, childbirth or any form of miscarriage; 3. Infectious Diseases as a consequence of the following occurrences: a) Symptoms of any of the Infectious Diseases that manifested prior to or within ninety (90) days from the commencement date/effective date of change/reinstatement date of this rider, whichever is later; b) Infectious Diseases arise directly or indirectly from any pre-existing conditions; c) The presence of the Acquired Immune Deficiency Syndrome ("AIDS") / Human Immunodeficiency Virus ("HIV") infection. Note: This exclusion list is not exhaustive. Please refer to the policy documents for the full list of exclusions under this plan. Important Notes The brochure is for illustrative purposes only. For further details of terms and conditions, please refer to the product disclosure sheet, sales illustration and policy documents. You should be certain that this plan meets your needs and that the premium payable under the policy is an amount you can afford. If the policy is cancelled within the fifteen (15)-day free-look period from the date of delivery of the policy, any unallocated premium, Investment Account Value (if any), insurance charge and policy fee that has been deducted, less medical expenses (if any) will be refunded. Zurich MegaMed is a unit deducting rider attachable to selected basic regular premium investment-linked plans. The insurance charges are collected throughout the coverage term on a monthly basis through unit deduction, depending on the attained age, gender, occupation, health condition and the plan selected. The insurance charges are not guaranteed. The company reserves the right to revise the insurance charges by notifying the policyholder at least thirty (30) days before the anniversary date of the rider. No benefit is payable for any medical treatment received by Life Assured outside Malaysia if the Life Assured resides or travels outside Malaysia for more than ninety (90) consecutive days. Goods and Services Tax (GST), if any, will be imposed on the applicable processing fee, policy fee, service fee, premium or insurance changes at prevailing rate of 6%. Panel of Hospitals Please visit www.zurich.com.my to download the list of participating hospitals. For more information and assistance on Zurich MegaMed, please contact our Zurich Sales Advisor or Zurich Call Centre at 1-300-888-622 or email us at callcentre@zurich.com.my In the event of discrepancy, ambiguity and conflict in interpreting any term or condition, the English version shall prevail and supersede Bahasa Malaysia, Chinese and Tamil versions. 12 13