question:Help me analyse 2 plans for Zurich. I attached the brochures and policy wordings for your reference. Which plan is better for me in terms of coverage for serious illness. Medical Insurance Medical Insurance 2 ZURICH Z-MedProtect Comprehensive solutions for your healthcare needs Comprehensive solutions for your healthcare needs Just focus on getting well, we will take care of the rest! Illnesses and accidents are part and parcel of our lives. No one can ever be too prepared for these mishaps, and the last thing you want to worry about is how much it will cost you should anything happen. Hospitalisation charges, surgical treatments, medication, examination and consultation fees all added up could be financially exhausting for many. While the rise of medical costs cannot be prevented, it is only wise to have a solution to put a stop to these worries. At Zurich, we have taken note of your concern and that is why we designed Z-MedProtect, a yearly renewable medical insurance with comprehensive coverage that covers your medical bills, ensuring you and your loved ones total peace of mind and will not be financially burdened. Don't worry! We have got you covered! High Overall Annual Limit, No Lifetime Limit Enjoy high Overall Annual Limit up to RM2,000,000 to help you get through your every healthcare need. Flexible and Customisable Plan Everyone’s needs are different, so choose any of the 5 plans that offer various features and premiums that suit you best. Guaranteed Renewable up to 100 years old Enjoy the rewards of a well-lived life with continuous coverage into your golden age. Deductible Option (Applicable for Section A - Inpatient & Daycare Benefits) Flexibility to choose from 4 Deductible Options to manage your medical expenses and enjoy premium discount up to 50%. 1 Ie No Claim Bonus Staying healthy is always rewarding! Get 10% premium discount on your next renewal policy if you do not file a claim during the preceding year. Multiple Insured Person Discount We understand that you need to provide and care for your loved ones. Enjoy up to 10% premium discount when you insure your parent, spouse or children in the same policy! Unlimited In-Hospital Physician Visits Get extensive care from your attending in-hospital physicians while you are focusing on recovery. Second Opinion for Surgeries In some cases, it may be necessary to seek another specialist to obtain a second opinion prior to a surgery. To ease your mind, we will reimburse you the charges incurred for the consultation. Organ Transplant We will reimburse you charges incurred on the transplantation surgery if you are the recipient of a Heart, Kidney, Lung, Liver or Bone Marrow. Hassle-free Hospital Admission In an emergency, just show your medical card or e-medical card for speedy admission and medical attention at any of our panel hospitals nationwide. Accidental Death or Permanent Disablement Benefit Extra financial security with additional RM50,000 on top of the Overall Annual Limit in the unfortunate event of Accidental Death or Permanent Disablement. Funeral Expenses Providing your loved ones with a lump sum of RM2,000 to supplement the final expense of your life, so no burden is left when you are no longer around to care for them. 2 eI grat oo EG eS Schedule of Benefits Z-MedProtect is available in 5 plans that cater to different needs and budget. Here are the full schedule of benefits of each plan: Benefits Overall Annual Limit For Section A & Section B No Claim Bonus Section A – Inpatient & Daycare Benefits Hospital Room & Board Intensive Care Unit Hospital Supplies & Services Daycare Procedures Surgical Fees Anaesthetist’s Fee Operating Theatre Fee In-Hospital Physician Visit (unlimited) Ambulance Fees Daily-Cash Allowance At Government Hospital Insured Child’s Daily Guardian Benefit Medical Reports Fees Organ Transplant (Heart, Kidney, Lung, Liver or Bone Marrow) Tax on Eligible Expenses Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Limit (RM) 100,000 300,000 500,000 1,000,000 2,000,000 Reduction of 10% on renewal premium (if no claims made) 100 150 180 200 (maximum 365 days per annum) As Charged (maximum 180 days per annum) As Charged As Charged As Charged As Charged As Charged As Charged As Charged 100 (maximum 365 days per annum) 250 (maximum per disability) 150 As Charged As Charged 500 3 Benefits Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Limit (RM) Section B – Outpatient Benefits Pre-Hospital Diagnostic Tests Pre-Hospital Specialist Consultation Post Hospitalisation Treatment Emergency Accident Outpatient Treatment Outpatient Physiotherapy Treatment Outpatient Kidney Dialysis Treatment Outpatient Cancer Treatment Emergency Accident Outpatient Dental Treatment Home Nursing Care Second Surgical Opinion As Charged (within 60 days prior to hospitalisation) As Charged (within 60 days prior to hospitalisation) As Charged (within 90 days from hospitalisation) As Charged (within 24 hours and follow-up treatment to a maximum of 60 days) As Charged (within 90 days from discharge) As Charged As Charged 4,000 (per accident) 4,000 (up to 180 days, lifetime maximum) As Charged Section C – Special Benefits (Additional Limit On Top Of The Overall Annual Limit) Accidental Death And Permanent Disablement 50,000 International Emergency Medical Evacuation and Repatriation Funeral Expenses (All Causes) Section D - Optional Deductible (Per Any One Disability) Applicable for Section A Only 50,000 (maximum per annum) 2,000 Option A B C D Deductible Amount 0 5,000 10,000 20,000 Premium Discount 0% 15% 30% 50% 4 Birthday Annual Premium Male Female Male Female Male Female Male Female Male Female Age Next 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 Annual Premium (RM) Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 1,038 1,020 1,145 1,127 1,213 1,195 1,313 1,295 1,905 1,888 982 965 1,082 1,065 1,146 1,129 1,241 1,224 1,799 1,783 913 848 772 717 672 632 599 576 559 547 543 544 555 578 579 584 589 594 608 617 626 636 656 675 693 711 729 749 773 790 807 824 852 886 909 930 948 964 896 1,007 990 1,066 1,049 1,154 1,137 1,671 1,655 831 934 917 989 755 850 833 699 789 771 655 740 722 615 695 677 581 658 640 505 633 557 465 614 512 455 601 500 451 595 496 452 597 498 462 609 508 478 634 525 479 634 526 483 640 530 487 645 535 492 651 540 504 666 554 512 676 562 520 686 571 556 697 611 574 719 631 593 740 652 610 760 670 627 781 689 676 800 743 695 822 764 711 848 782 727 867 800 743 886 818 759 904 836 786 935 865 900 835 782 735 696 669 649 972 1,069 1,053 1,548 1,531 883 973 817 903 765 845 717 794 678 752 589 722 541 700 956 1,406 1,390 885 1,304 1,286 828 1,218 1,201 776 1,143 1,126 734 1,081 1,063 637 1,037 921 585 1,004 843 635 529 685 572 629 525 679 567 631 526 681 569 644 537 695 580 669 555 721 669 675 681 687 703 714 725 735 759 781 803 825 846 869 896 916 936 956 988 556 721 561 728 566 734 571 741 585 757 594 769 604 781 646 793 668 818 689 842 709 866 729 890 786 912 809 938 828 967 847 988 981 973 976 996 824 817 820 837 600 1,028 861 600 1,029 861 605 1,038 869 611 1,047 877 616 1,058 886 631 1,079 905 642 1,097 920 652 1,114 935 698 1,132 1,003 721 1,169 1,037 744 1,204 1,070 766 1,239 1,102 787 1,274 1,133 850 1,307 1,225 874 1,344 1,260 895 1,383 1,291 915 1,415 1,321 866 1,010 936 1,447 1,351 885 1,031 956 1,478 1,381 916 1,067 990 1,530 1,431 821 972 903 1,027 956 1,108 1,033 1,587 1,488 843 998 928 1,054 981 1,138 1,061 1,630 1,529 863 1,020 949 1,079 1,005 1,164 1,086 1,669 1,566 880 1,041 968 1,100 1,025 1,187 1,108 1,703 1,598 895 1,058 985 1,118 1,042 1,207 1,127 1,733 1,626 41 1,003 969 1,099 1,065 1,160 1,127 1,250 1,217 1,784 1,751 42 1,015 981 1,112 1,079 1,174 1,141 1,266 1,232 1,807 1,773 43 1,074 1,040 1,178 1,144 1,244 1,210 1,342 1,308 1,918 1,884 44 1,135 1,101 1,245 1,211 1,315 1,281 1,419 1,385 2,031 1,997 45 1,197 1,163 1,314 1,280 1,389 1,355 1,498 1,464 2,148 2,114 46 1,240 1,206 1,359 1,325 1,434 1,401 1,546 1,512 2,205 2,171 47 1,281 1,247 1,404 1,370 1,482 1,448 1,598 1,564 2,282 2,248 48 1,339 1,305 1,469 1,435 1,551 1,517 1,673 1,639 2,391 2,357 49 1,430 1,461 1,569 1,607 1,658 1,700 1,789 1,837 2,562 2,649 50 1,537 1,573 1,688 1,732 1,784 1,832 1,926 1,981 2,763 2,860 5 Age Next Birthday Plan 1 Plan 2 Annual Premium (RM) Plan 3 Plan 4 Plan 5 Male Female Male Female Male Female Male Female Male Female 51 1,657 1,686 1,815 1,852 1,916 1,958 2,064 2,114 2,944 3,037 52 1,748 1,781 1,916 1,958 2,023 2,070 2,181 2,236 3,114 3,216 53 1,864 1,904 2,044 2,093 2,160 2,214 2,329 2,392 3,332 3,445 54 2,011 2,058 2,207 2,264 2,333 2,396 2,517 2,590 3,608 3,735 55 2,194 2,251 2,410 2,478 2,548 2,623 2,751 2,836 3,952 4,097 56 2,601 2,436 2,854 2,676 3,015 2,829 3,252 3,054 4,654 4,387 57 2,891 2,580 3,174 2,835 3,355 2,998 3,622 3,238 5,198 4,657 58 3,121 2,788 3,430 3,065 3,626 3,243 3,916 3,504 5,630 5,047 59 3,387 3,028 3,724 3,332 3,940 3,525 4,256 3,811 6,129 5,498 60 3,690 3,301 4,059 3,634 4,295 3,846 4,642 4,159 6,695 6,009 61 4,157 3,707 4,563 4,073 4,822 4,306 5,203 4,650 7,458 6,682 62 4,526 4,039 4,971 4,440 5,256 4,696 5,674 5,073 8,151 7,304 63 4,922 4,397 5,410 4,837 5,721 5,117 6,180 5,531 8,893 7,975 64 5,357 4,791 5,892 5,273 6,234 5,581 6,736 6,034 9,710 8,715 65 5,849 5,237 6,438 5,767 6,813 6,106 7,365 6,604 10,633 9,551 66* 6,709 6,065 7,363 6,655 7,780 7,032 8,394 7,586 12,025 10,866 67* 7,191 6,504 7,896 7,141 8,346 7,548 9,009 8,146 12,929 11,688 68* 7,686 6,954 8,445 7,640 8,929 8,078 9,642 8,722 13,858 12,534 69* 8,192 7,416 9,006 8,151 9,525 8,621 10,289 9,312 14,809 13,400 70* 8,754 7,928 9,628 8,719 10,186 9,224 11,007 9,967 15,864 14,361 71* 9,708 8,791 10,639 9,634 11,234 10,172 12,109 10,964 17,283 15,649 72* 10,250 9,285 11,240 10,181 11,871 10,753 12,801 11,595 18,301 16,576 73* 10,802 9,789 11,852 10,740 12,521 11,346 13,507 12,239 19,338 17,523 74* 11,366 10,303 12,476 11,310 13,185 11,952 14,228 12,897 20,397 18,489 75* 11,990 10,874 13,168 11,942 13,920 12,624 15,026 13,627 21,570 19,561 76* 13,322 11,959 14,562 13,084 15,354 13,802 16,520 14,860 23,414 21,114 77* 13,915 12,503 15,220 13,687 16,053 14,443 17,279 15,555 24,530 22,136 78* 14,520 13,056 15,890 14,301 16,764 15,095 18,052 16,263 25,667 23,177 79* 15,135 13,621 16,572 14,926 17,489 15,759 18,839 16,985 26,824 24,238 80* 15,823 14,254 17,335 15,627 18,300 16,504 19,720 17,794 28,119 25,427 81* 16,460 14,839 18,040 16,276 19,049 17,193 20,534 18,542 29,317 26,527 82* 17,107 15,434 18,758 16,936 19,811 17,894 21,362 19,304 30,534 27,647 83* 17,765 16,040 19,487 17,607 20,586 18,607 22,203 20,078 31,771 28,785 84* 18,432 16,655 20,226 18,288 21,371 19,330 23,056 20,865 33,026 29,941 85* 19,186 17,351 21,062 19,059 22,259 20,150 24,021 21,755 34,445 31,249 86* 19,873 17,985 21,823 19,762 23,068 20,897 24,900 22,566 35,738 32,442 87* 20,569 18,629 22,595 20,475 23,887 21,654 25,790 23,389 37,047 33,651 88* 21,274 19,281 23,376 21,199 24,718 22,422 26,692 24,223 38,373 34,878 89* 21,989 19,943 24,168 21,932 25,559 23,201 27,606 25,070 39,717 36,122 90* 22,807 20,702 25,075 22,773 26,523 24,095 28,653 26,040 41,257 37,548 91* 23,539 21,381 25,886 23,525 27,384 24,894 29,589 26,908 42,633 38,824 92* 24,279 22,069 26,706 24,287 28,255 25,704 30,536 27,788 44,025 40,117 93* 25,027 22,765 27,536 25,059 29,137 26,523 31,493 28,678 45,433 41,426 94* 25,783 23,469 28,373 25,839 30,027 27,351 32,460 29,578 46,855 42,748 95* 26,664 24,290 29,349 26,748 31,064 28,318 33,587 30,628 48,512 44,292 96* 27,435 25,009 30,204 27,545 31,971 29,165 34,573 31,547 49,962 45,643 97* 28,298 25,737 31,160 28,352 32,987 30,021 35,675 32,478 51,580 47,012 98* 29,185 26,471 32,143 29,166 34,030 30,886 36,809 33,418 53,244 48,393 99* 30,087 27,214 33,141 29,989 35,091 31,760 37,960 34,367 54,935 49,788 100* 31,004 27,964 34,157 30,820 36,169 32,643 39,131 35,326 56,654 51,198 *On renewal basis only 6 Note: • The annual premiums shown in the table above are applicable to standard risks and occupation classes 1 and 2 only. For occupation class 3, 15% loading is applicable. • The total premium payable will vary depending on the occupational class, health condition and the plan selected you have selected. • Premiums are payable at the premium rate according to your age next birthday on each policy year anniversary. • The company reserves the right to change the rate at which premium shall be calculated, at the start of any policy year, provided that policyholders are notified at least thirty (30) days in advance of the date such premium is due. • All policies may be subject to 6% Sales and Service Tax (SST) and RM10 Stamp Duty. Frequently Asked Questions Q. What is Z-MedProtect? A. Z-MedProtect is a yearly-renewal medical insurance policy with comprehensive coverage for hospitalisation and surgical expenses incurred due to illnesses. It also provides coverage for bodily injuries, disablement or death. Q. Who is eligible for Z-MedProtect? A. Anyone between 30 days old and 65 years old (age next birthday) are eligible to purchase Z-MedProtect. This product is renewable up to 100 years old (age next birthday). Q. What are the available plans to choose from? A. Z-MedProtect is available in 5 plans. You have the flexibility to choose the plan that suits your health care needs and budget. Q. How long is the coverage duration of Z-MedProtect? A. The duration of cover is one (1) year, you will need to renew your policy annually. Q. How does the Deductible works in Z-MedProtect? A. The deductible is a monetary sum that shall be deducted from the eligible expenses incurred under Section A on per any one disability basis when you are admitted to any private hospital. However, the eligible expenses incurred will not be subject to the deductible amount if you are admitted to any Malaysian government hospital. It is an optional benefit in Z-MedProtect. By enabling the Deductible, you will enjoy a premium discount up to 50% on your total premium, depending on the option you selected. Q. Can a foreigner purchase Z-MedProtect? A. Z-MedProtect is open to any Malaysian, or any foreigner who has a valid work permit, student permit, permanent resident status or Malaysia My Second Home (MM2H) status. 7 Q. Can I purchase Z-MedProtect for my whole family? A. Yes, you can purchase Z-MedProtect for your parents, spouse or children. Depending on the number of family members you would like to include, you are entitled to Multiple Insured Person Discount up to 10% of your total premium. The policy will be issued as a group family policy. However, the premium will be charged individually with one-time stamp duty fee. Q. How do you classify Occupation? A. Occupations are classified into 3 classes as follows: Occupation Class 1 Persons engaged in professional administrative, managerial, clerical and non-manual occupations Occupation Class 2 Persons engaged in work of supervisory nature but not involved in manual labour Occupation Class 3 Persons engaged either occasionally or generally in manual work which involves the use at tools or machinery Q. What are the key terms and conditions that I should be aware of? A. Portfolio Withdrawal - The company reserves the right to cancel the portfolio as a whole if the company decides to discontinue underwriting this insurance product. Cancellation of the portfolio as a whole shall be given by reasonable written notice in advance with valid reasons to you and the company will run off all policies to expiry of the period of cover within the portfolio. Co-payment (Sub-standard policy only) - Co-payment borne by you under cost-sharing or coinsurance terms shall not exceed twenty percent (20%) of the claimable expenses (i.e. excluding Deductibles) per Disability, subject to an absolute maximum limit of Ringgit Malaysia Three Thousand (RM3,000) (inclusive of Deductibles) per Disability. Note: Please refer to the policy wording for full list of terms and conditions under this product. 8 Exclusions This product does not cover any hospitalisation, surgery or charges incurred directly or indirectly, wholly or partly, by any one (1) of the following occurrences: Section A - Inpatient & Daycare Benefits and Section B - Outpatient Benefits 1. Pre-existing condition 2. Specified illnesses occurring during the first one hundred and twenty (120) days of continuous cover 3. Waiting period of thirty (30) days for all except accidental injuries 4. Pregnancy, childbirth (including surgical delivery), miscarriage, abortion and prenatal or postnatal care 5. Epidemic and/or pandemic Section C – Special Benefits 1. Pre-existing condition 2. War, civil war 3. Suicide while sane or insane 4. Provoked murder or assault Note: This exclusion list is not exhaustive. Please refer to the policy wording for the full list of exclusions under this product. Important Notes 1. The brochure is for illustrative purposes only. For further details of terms and conditions, please refer to product disclosure sheet and policy wording. 2. You should satisfy yourself that this policy best serves your needs and the premium payable under the policy is an amount you can afford. 3. You may cancel your policy by returning the policy to us within fifteen (15) days after the policy has been delivered to you. The premium that you have paid (after deducting any medical expenses incurred) will be refunded to you provided there is no claim incurred on the policy. 4. The premium for this product is not guaranteed and shall be based on the premium rates in-force at the time of renewal. 5. No benefit is payable for any medical treatment received by insured person outside Malaysia if the insured person resides or travels outside Malaysia for more than ninety (90) consecutive days. 6. All premiums and fees shown may be subject to tax or other government levies. For more information and assistance on Z-MedProtect, please contact our agents or Zurich Call Centre at 1-300-888-622 or email us at <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS> In the event of discrepancy, ambiguity and conflict in interpreting any terms or conditions, the English version shall prevail and supersede the Bahasa Malaysia version. 9 Utamakan penyembuhan anda, kami akan menjaga yang lain! Penyakit dan kemalangan adalah sebahagian daripada hidup kita. Tiada sesiapa pun yang boleh menyediakan pencegahan yang sempurna untuk kecelakaan, dan perkara terakhir yang anda perlu risaukan adalah kos yang harus ditanggung sekiranya berlaku sebarang kejadian yang tidak diingini. Caj penghospitalan, rawatan pembedahan, ubat-ubatan, pemeriksaan kesihatan dan yuran perundingan perubatan boleh menjadi sebuah bebanan untuk ramai individu jika semua kos tersebut digabungkan. Kenaikan kos perubatan tidak boleh dielakkan, oleh itu amat digalakkan untuk anda mencari sebuah penyelesaian untuk mengurangkan kerisauan yang timbul disebabkan oleh bebanan kewangan. Di Zurich, kami mendengar keluhan anda dan telah menghasilkan sebuah pelan insurans perubatan komprehensif yang boleh diperbaharui setiap tahun, Z-MedProtect. Pelan ini merangkumi bil perubatan anda supaya anda dan insan tersayang tidak perlu mengharungi bebanan kewangan dan boleh mendapat ketenangan minda yang berterusan. Jangan risau! Kami akan melindungi anda! Had Tahunan Keseluruhan Yang Tinggi, Tiada Had Seumur Hidup Nikmati Had Tahunan Keseluruhan yang tinggi sehingga RM2,000,000 untuk membantu anda mengharungi setiap keperluan penjagaan kesihatan anda. Pelan Yang Fleksibel dan Boleh Disesuaikan Keperluan setiap individu adalah berbeza, jadi pilih mana-mana daripada 5 pelan yang ditawarkan untuk mendapat manfaat dan kadar premium yang memenuhi keperluan dan kemampuan anda. Pembaharuan Dijamin Sehingga 100 Tahun Nikmati ganjaran hidup yang baik dengan liputan perlindungan yang berterusan sehingga usia emas anda. Pilihan Penolakan (Terpakai untuk Seksyen A – Manfaat Pesakit Dalam & Pembedahan Harian) Fleksibiliti untuk memilih daripada 4 Pilihan Penolakan untuk mengurus kos perbelanjaan perubatan anda dan nikmati diskaun premium sehingga 50%. 10 9000 Bonus Tanpa Tuntutan Amat berbaloi jika anda kekal sihat! Dapatkan 10% diskaun atas premium untuk polisi pembaharuan anda yang seterusnya jika anda tidak memfailkan tuntutan pada tahun yang sebelumnya. Diskaun Berkumpulan Orang Yang Diinsuranskan Kami memahami bahawa anda perlu menyara dan menjaga insan tersayang. Oleh itu, nikmati sehingga 10% diskaun atas premium apabila ibu bapa, pasangan atau anak anda diinsuranskan dalam polisi yang sama! Lawatan Pakar Perubatan Dalam Hospital Tanpa Had Dapatkan penjagaan ekstensif daripada pakar perubatan dalam hospital semasa perjalanan pemulihan anda. Pendapat Kedua untuk Pembedahan Dalam sesetengah kes, mungkin terdapat keperluan untuk anda mencari pakar perubatan yang lain untuk mendapatkan pendapat kedua sebelum pembedahan. Untuk menenangkan fikiran anda, kami akan membayar balik yuran yang dikenakan untuk konsultasi tersebut. Transplan Organ Kami akan membayar balik yuran yang dikenakan untuk pembedahan transplan jika anda merupakan penerima organ Hati, Buah Pinggang, Jantung, Paru-paru atau Sum-sum Tulang. Kemasukan Ke Hospital Yang Mudah Dalam kecemasan, anda hanya perlu menunjukkan kad perubatan atau e-kad perubatan anda untuk kemasukan ke hospital serta perkhidmatan perubatan secara segera di mana-mana hospital panel kami seluruh negara. Manfaat Kematian atau Hilang Upaya Kekal Akibat Kemalangan Keselamatan kewangan yang ekstra dengan penambahan RM50,000 atas Had Tahunan Keseluruhan jika berlakunya Kematian atau Hilang Upaya Kekal Akibat Kemalangan. Perbelanjaan Pengebumian Menyediakan pembayaran sekali gus sebanyak RM2,000 kepada insan tersayang untuk membantu dengan pembayaran terakhir anda. Ini adalah supaya tiada bebanan ditinggalkan kepada insan tersayang apabila anda sudah tiada untuk menyara hidup mereka. 11 e 6) : © gta faye © Q o- o © Ie Jadual Manfaat Z-MedProtect boleh didapati dalam 5 pelan yang disediakan mengikut keperluan dan kemampuan yang berbeza. Di bawah menunjukkan jadual manfaat yang penuh untuk setiap pelan: Manfaat Pelan 1 Pelan 2 Pelan 3 Pelan 4 Pelan 5 Had (RM) Had Tahunan Keseluruhan (untuk Seksyen A dan Seksyen B) Bonus Tanpa Tuntutan 100,000 300,000 500,000 1,000,000 2,000,000 Pengurangan 10% atas premium pembaharuan (jika tiada tuntutan dibuat) Seksyen A - Manfaat Pesakit Dalam & Pembedahan Harian Bilik Hospital dan Makanan Unit Rawatan Rapi 100 150 180 200 (maksimum 365 hari setahun) Bayaran Dikenakan (maksimum 180 hari setahun) Bekalan dan Khidmat Hospital Prosedur Pembedahan Harian Bayaran Pembedahan Bayaran Pakar Bius Bayaran Bilik Bedah Lawatan Pakar Perubatan Dalam Hospital (tidak terhad) Bayaran Ambulans Elaun Tunai Harian Di Hospital Kerajaan Manfaat Penjagaan Harian Anak Orang Yang Diinsuranskan Bayaran Laporan Perubatan Transplan Organ (Hati, Buah Pinggang, Jantung, Paru-paru atau Sum-sum Tulang) Cukai Ke Atas Perbelanjaan Layak Bayaran Dikenakan Bayaran Dikenakan Bayaran Dikenakan Bayaran Dikenakan Bayaran Dikenakan Bayaran Dikenakan Bayaran Dikenakan 100 (maksimum 365 hari setahun) 250 (maksimum setiap hilang upaya) 150 Bayaran Dikenakan Bayaran Dikenakan 500 12 Manfaat Pelan 1 Pelan 2 Pelan 3 Pelan 4 Pelan 5 Had (RM) Seksyen B – Manfaat Pesakit Luar Ujian Diagnostik Prahospital Rundingan Pakar Prahospital Rawatan Selepas Penghospitalan Rawatan Pesakit Luar Bagi Kemalangan Secara Kecemasan Rawatan Fisioterapi Pesakit Luar Rawatan Dialisis Buah Pinggang Pesakit Luar Rawatan Kanser Pesakit Luar Rawatan Pergigian Pesakit Luar Bagi Kemalangan Secara Kecemasan Penjagaan Kejururawatan Di Rumah Rundingan Pembedahan Pendapat Kedua Bayaran Dikenakan (dalam masa 60 hari sebelum penghospitalan) Bayaran Dikenakan (dalam masa 60 hari sebelum penghospitalan) Bayaran Dikenakan (dalam masa 90 hari dari penghospitalan) Bayaran Dikenakan (dalam masa 24 jam dan rawatan susulan sehingga maksimum 60 hari) Bayaran Dikenakan (dalam masa 90 hari dari tarikh keluar) Bayaran Dikenakan Bayaran Dikenakan 4,000 (setiap kemalangan) 4,000 (sehingga 180 hari, maksimum seumur hidup) Bayaran Dikenakan Seksyen C – Manfaat Khas (Had tambahan di atas Had Tahunan Keseluruhan) Kematian dan Hilang Upaya Kekal Akibat Kemalangan Pemindahan Kecemasan Perubatan dan Penghantaran Pulang Antarabangsa Perbelanjaan Pengebumian (semua sebab) Seksyen D – Pilihan Penolakan (setiap Mana-mana Satu Hilang Upaya) (terpakai untuk Seksyen A sahaja) 50,000 50,000 (maksimum setahun) 2,000 Pilihan A B C D Jumlah Penolakan 0 5,000 10,000 20,000 Diskaun Premium 0% 15% 30% 50% 13 Premium Tahunan Umur Pada Tarikh Lahir Berikutnya 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 Pelan 1 Pelan 2 Premium Tahunan (RM) Pelan 3 Pelan 4 Pelan 5 Lelaki Perempuan Lelaki Perempuan Lelaki Perempuan Lelaki Perempuan Lelaki Perempuan 1,038 1,020 1,145 1,127 1,213 1,195 1,313 1,295 1,905 1,888 982 913 848 772 717 672 632 599 576 559 547 543 544 555 578 579 584 589 594 608 617 626 636 656 675 693 711 729 749 773 790 807 824 852 886 909 930 948 964 965 1,082 1,065 1,146 1,129 1,241 1,224 1,799 1,783 896 1,007 990 1,066 1,049 1,154 1,137 1,671 1,655 831 934 917 755 850 833 699 789 771 655 740 722 615 695 677 581 658 640 505 633 557 465 614 512 455 601 500 451 595 496 452 597 498 462 609 508 478 634 525 479 634 526 483 640 530 487 645 535 492 651 540 504 666 554 512 676 562 520 686 571 556 697 611 574 719 631 593 740 652 610 760 670 627 781 689 676 800 743 695 822 764 711 848 782 727 867 800 743 886 818 759 904 836 786 935 865 989 900 835 782 735 696 669 649 972 1,069 1,053 1,548 1,531 883 973 956 1,406 1,390 817 903 765 845 717 794 678 752 589 722 541 700 885 1,304 1,286 828 1,218 1,201 776 1,143 1,126 734 1,081 1,063 637 1,037 921 585 1,004 843 635 529 685 572 629 525 679 567 631 526 681 569 644 537 695 580 669 555 721 669 675 681 687 703 714 725 735 759 781 803 825 846 869 896 916 936 956 988 556 721 561 728 566 734 571 741 585 757 594 769 604 781 646 793 668 818 689 842 709 866 729 890 786 912 809 938 828 967 847 988 981 973 976 996 824 817 820 837 600 1,028 861 600 1,029 861 605 1,038 869 611 1,047 877 616 1,058 886 631 1,079 905 642 1,097 920 652 1,114 935 698 1,132 1,003 721 1,169 1,037 744 1,204 1,070 766 1,239 1,102 787 1,274 1,133 850 1,307 1,225 874 1,344 1,260 895 1,383 1,291 915 1,415 1,321 866 1,010 936 1,447 1,351 885 1,031 956 1,478 1,381 916 1,067 990 1,530 1,431 821 972 903 1,027 956 1,108 1,033 1,587 1,488 843 998 928 1,054 981 1,138 1,061 1,630 1,529 863 1,020 949 1,079 1,005 1,164 1,086 1,669 1,566 880 1,041 968 1,100 1,025 1,187 1,108 1,703 1,598 895 1,058 985 1,118 1,042 1,207 1,127 1,733 1,626 41 1,003 969 1,099 1,065 1,160 1,127 1,250 1,217 1,784 1,751 42 1,015 981 1,112 1,079 1,174 1,141 1,266 1,232 1,807 1,773 43 1,074 1,040 1,178 1,144 1,244 1,210 1,342 1,308 1,918 1,884 44 1,135 1,101 1,245 1,211 1,315 1,281 1,419 1,385 2,031 1,997 45 1,197 1,163 1,314 1,280 1,389 1,355 1,498 1,464 2,148 2,114 46 1,240 1,206 1,359 1,325 1,434 1,401 1,546 1,512 2,205 2,171 47 1,281 1,247 1,404 1,370 1,482 1,448 1,598 1,564 2,282 2,248 48 1,339 1,305 1,469 1,435 1,551 1,517 1,673 1,639 2,391 2,357 49 1,430 1,461 1,569 1,607 1,658 1,700 1,789 1,837 2,562 2,649 50 1,537 1,573 1,688 1,732 1,784 1,832 1,926 1,981 2,763 2,860 14 Umur Pada Tarikh Lahir Pelan 1 Pelan 2 Premium Tahunan (RM) Pelan 3 Pelan 4 Pelan 5 Berikutnya Lelaki Perempuan Lelaki Perempuan Lelaki Perempuan Lelaki Perempuan Lelaki Perempuan 51 1,657 1,686 1,815 1,852 1,916 1,958 2,064 2,114 2,944 3,037 52 1,748 1,781 1,916 1,958 2,023 2,070 2,181 2,236 3,114 3,216 53 1,864 1,904 2,044 2,093 2,160 2,214 2,329 2,392 3,332 3,445 54 2,011 2,058 2,207 2,264 2,333 2,396 2,517 2,590 3,608 3,735 55 2,194 2,251 2,410 2,478 2,548 2,623 2,751 2,836 3,952 4,097 56 2,601 2,436 2,854 2,676 3,015 2,829 3,252 3,054 4,654 4,387 57 2,891 2,580 3,174 2,835 3,355 2,998 3,622 3,238 5,198 4,657 58 3,121 2,788 3,430 3,065 3,626 3,243 3,916 3,504 5,630 5,047 59 3,387 3,028 3,724 3,332 3,940 3,525 4,256 3,811 6,129 5,498 60 3,690 3,301 4,059 3,634 4,295 3,846 4,642 4,159 6,695 6,009 61 4,157 3,707 4,563 4,073 4,822 4,306 5,203 4,650 7,458 6,682 62 4,526 4,039 4,971 4,440 5,256 4,696 5,674 5,073 8,151 7,304 63 4,922 4,397 5,410 4,837 5,721 5,117 6,180 5,531 8,893 7,975 64 5,357 4,791 5,892 5,273 6,234 5,581 6,736 6,034 9,710 8,715 65 5,849 5,237 6,438 5,767 6,813 6,106 7,365 6,604 10,633 9,551 66* 6,709 6,065 7,363 6,655 7,780 7,032 8,394 7,586 12,025 10,866 67* 7,191 6,504 7,896 7,141 8,346 7,548 9,009 8,146 12,929 11,688 68* 7,686 6,954 8,445 7,640 8,929 8,078 9,642 8,722 13,858 12,534 69* 8,192 7,416 9,006 8,151 9,525 8,621 10,289 9,312 14,809 13,400 70* 8,754 7,928 9,628 8,719 10,186 9,224 11,007 9,967 15,864 14,361 71* 9,708 8,791 10,639 9,634 11,234 10,172 12,109 10,964 17,283 15,649 72* 10,250 9,285 11,240 10,181 11,871 10,753 12,801 11,595 18,301 16,576 73* 10,802 9,789 11,852 10,740 12,521 11,346 13,507 12,239 19,338 17,523 74* 11,366 10,303 12,476 11,310 13,185 11,952 14,228 12,897 20,397 18,489 75* 11,990 10,874 13,168 11,942 13,920 12,624 15,026 13,627 21,570 19,561 76* 13,322 11,959 14,562 13,084 15,354 13,802 16,520 14,860 23,414 21,114 77* 13,915 12,503 15,220 13,687 16,053 14,443 17,279 15,555 24,530 22,136 78* 14,520 13,056 15,890 14,301 16,764 15,095 18,052 16,263 25,667 23,177 79* 15,135 13,621 16,572 14,926 17,489 15,759 18,839 16,985 26,824 24,238 80* 15,823 14,254 17,335 15,627 18,300 16,504 19,720 17,794 28,119 25,427 81* 16,460 14,839 18,040 16,276 19,049 17,193 20,534 18,542 29,317 26,527 82* 17,107 15,434 18,758 16,936 19,811 17,894 21,362 19,304 30,534 27,647 83* 17,765 16,040 19,487 17,607 20,586 18,607 22,203 20,078 31,771 28,785 84* 18,432 16,655 20,226 18,288 21,371 19,330 23,056 20,865 33,026 29,941 85* 19,186 17,351 21,062 19,059 22,259 20,150 24,021 21,755 34,445 31,249 86* 19,873 17,985 21,823 19,762 23,068 20,897 24,900 22,566 35,738 32,442 87* 20,569 18,629 22,595 20,475 23,887 21,654 25,790 23,389 37,047 33,651 88* 21,274 19,281 23,376 21,199 24,718 22,422 26,692 24,223 38,373 34,878 89* 21,989 19,943 24,168 21,932 25,559 23,201 27,606 25,070 39,717 36,122 90* 22,807 20,702 25,075 22,773 26,523 24,095 28,653 26,040 41,257 37,548 91* 23,539 21,381 25,886 23,525 27,384 24,894 29,589 26,908 42,633 38,824 92* 24,279 22,069 26,706 24,287 28,255 25,704 30,536 27,788 44,025 40,117 93* 25,027 22,765 27,536 25,059 29,137 26,523 31,493 28,678 45,433 41,426 94* 25,783 23,469 28,373 25,839 30,027 27,351 32,460 29,578 46,855 42,748 95* 26,664 24,290 29,349 26,748 31,064 28,318 33,587 30,628 48,512 44,292 96* 27,435 25,009 30,204 27,545 31,971 29,165 34,573 31,547 49,962 45,643 97* 28,298 25,737 31,160 28,352 32,987 30,021 35,675 32,478 51,580 47,012 98* 29,185 26,471 32,143 29,166 34,030 30,886 36,809 33,418 53,244 48,393 99* 30,087 27,214 33,141 29,989 35,091 31,760 37,960 34,367 54,935 49,788 100* 31,004 27,964 34,157 30,820 36,169 32,643 39,131 35,326 56,654 51,198 *Berdasarkan pembaharuan sahaja 15 Nota: • Premium tahunan yang dicatatkan dalam jadual di atas hanya terpakai untuk risiko yang standard dan kelas pekerjaan 1 dan 2 sahaja. Untuk kelas pekerjaan 3, bebanan 15% akan dikenakan. • Jumlah premium yang perlu dibayar mungkin berbeza bergantung kepada kelas pekerjaan, keadaan kesihatan serta pelan yang anda pilih. • Premium yang perlu dibayar adalah pada kadar premium mengikut umur anda pada tarikh lahir yang berikutnya pada setiap ulangtahun tahun polisi. • Kami berhak untuk mengubah kadar pada mana premium dikira pada permulaan mana-mana tahun polisi, dengan syarat bahawa pemilik polisi akan dimaklumkan sekurang-kurangnya tiga puluh (30) hari sebelum tarikh premium tersebut perlu dibayar. • Semua polisi mungkin tertakluk kepada 6% Cukai Jualan dan Perkhidmatan (SST) serta RM10 Duti Setem. Soalan Lazim S. Apakah Z-MedProtect? J. Z-MedProtect adalah polisi insurans perubatan yang boleh diperbaharui setiap tahun dengan liputan perlindungan komprehensif untuk perbelanjaan penghospitalan dan pembedahan yang disebabkan oleh penyakit. Polisi ini juga menyediakan perlindungan untuk kecederaan, hilang upaya serta kematian. S. Siapakah yang layak untuk Z-MedProtect? J. Sesiapa yang berumur antara 30 hari dan 65 tahun (umur tarikh lahir yang seterusnya) adalah layak untuk membeli Z-MedProtect. Produk ini boleh diperbaharui sehingga umur 100 tahun (umur tarikh lahir yang seterusnya). S. Apakah antara pelan yang ditawarkan? J. Z-MedProtect ditawarkan dalam 5 pelan. Anda mempunyai fleksibiliti untuk memilih pelan yang bersesuaian dengan keperluan kesihatan dan kemampuan anda. S. Berapa lamakah liputan perlindungan Z-MedProtect? J. Liputan perlindungan disediakan untuk satu (1) tahun. Anda perlu memperbaharui polisi anda setiap tahun. S. Apakah fungsi Penolakan dalam Z-MedProtect? J. Penolakan merupakan sebuah jumlah kewangan yang akan ditolak daripada perbelanjaan layak yang dikenakan di bawah Seksyen A untuk setiap mana-mana satu hilang upaya apabila anda dimasukkan ke mana-mana hospital swasta. Walau bagaimanapun, penolakan tidak akan diguna pakai untuk perbelanjaan layak yang dikenakan apabila anda dimasukkan ke mana-mana hospital kerajaan Malaysia. Penolakan adalah manfaat pilihan dalam Z-MedProtect. Dengan memilih Penolakan, anda akan nikmati diskaun atas jumlah premium anda sehingga 50%, bergantung kepada pilihan anda. S. Bolehkah bukan warga negara Malaysia membeli Z-MedProtect? J. Z-MedProtect ditawarkan kepada semua warga Malaysia atau mana-mana bukan warga negara Malaysia yang mempunyai permit pekerjaan yang sah, permit pelajar, berstatus pemastautin tetap atau status Malaysia Rumah Keduaku (MM2H). 16 S. Bolehkah saya membeli Z-MedProtect untuk seluruh keluarga? J. Ya, anda boleh membeli Z-MedProtect untuk ibu bapa, pasangan atau anak anda. Bergantung kepada bilangan ahli keluarga yang anda ingin lindungi, anda layak untuk Diskaun Berkumpulan Orang Yang Diinsuranskan sehingga 10% daripada jumlah premium anda. Polisi anda akan dikeluarkan sebagai sebuah polisi keluarga berkumpulan. Walau bagaimanapun, premium akan dikenakan secara individu dengan bayaran duti setem hanya sekali. S. Bagaimanakah anda mengklasifikasikan Pekerjaan? J. Pekerjaan diklasifikasikan dalam 3 kelas seperti berikut: Kelas Pekerjaan 1 Orang yang terlibat dalam pentadbiran, pengurusan, perkeranian dan pekerjaan bukan manual Kelas Pekerjaan 2 Orang yang terlibat dalam kerja penyeliaan tetapi tidak terlibat dalam kerja manual Kelas Pekerjaan 3 Orang yang terlibat sama ada secara sambilan atau secara amnya dalam kerja manual yang melibatkan penggunaan alatan atau mesin S. Apakah terma dan syarat utama yang perlu saya ketahui? J. Penarikan Balik Portfolio - Kami berhak membatalkan portfolio secara keseluruhan jika kami memutuskan untuk menghentikan produk insurans ini. Pembatalan portfolio secara keseluruhan akan diberitahu melalui notis bertulis yang munasabah terlebih dahulu dengan alasan yang sah kepada anda dan kami akan menanggung semua polisi hingga ke tarikh tamat tempoh perlindungan dalam portfolio. Bayaran Bersama (Polisi sub-standard sahaja) - Bayaran Bersama ditanggung oleh anda dengan syarat perkongsian kos atau terma insurans bersama tidak boleh melebihi dua puluh peratus (20%) daripada perbelanjaan yang boleh dituntut (tidak termasuk Penolakan) bagi setiap Hilang Upaya, tertakluk kepada had maksimum mutlak Ringgit Malaysia Tiga Ribu (RM 3,000) (termasuk Penolakan) untuk setiap Hilang Upaya. Nota: Sila rujuk kepada kontrak polisi untuk terma dan syarat yang penuh di bawah produk ini. 17 Pengecualian Produk ini tidak melindungi mana-mana penghospitalan, pembedahan atau bayaran yang disebabkan secara langsung atau tidak langsung, sepenuhnya atau sebahagiannya, oleh mana-mana satu (1) kejadian yang berikut: Seksyen A – Manfaat Pesakit Dalam & Pembedahan Harian dan Seksyen B – Manfaat Pesakit Luar 1. Penyakit sedia ada 2. Penyakit tertentu yang berlaku dalam tempoh seratus dua puluh (120) hari pertama perlindungan berterusan 3. Tempoh tangguh tiga puluh (30) hari untuk semua kecuali kecederaan kemalangan 4. Kehamilan, melahirkan anak (termasuk kelahiran secara pembedahan), keguguran, menggugurkan kandungan dan jagaan serta pembedahan pranatal atau posnatum 5. Wabak dan/atau pandemik Seksyen C – Manfaat Khas 1. Penyakit sedia ada 2. Peperangan, perang saudara 3. Bunuh diri sama ada dalam keadaan siuman atau tidak siuman 4. Pembunuhan atau serangan disebabkan provokasi Nota: Senarai ini adalah tidak menyeluruh. Sila rujuk kepada kontrak polisi untuk senarai menyeluruh pengecualian yang terdapat dalam produk ini. Nota Penting 1. Risalah ini adalah untuk tujuan ilustrasi sahaja. Untuk maklumat lanjut mengenai terma dan syarat, sila rujuk kepada lembaran pendedahan produk atau kontrak polisi. 2. Anda harus memastikan bahawa polisi ini memenuhi keperluan anda dan jumlah premium yang perlu dibayar adalah sesuai dengan kemampuan anda. 3. Anda boleh membatalkan polisi anda dengan memulangkan polisi dalam masa lima belas (15) hari selepas anda menerima polisi tersebut. Premium yang telah dibayar akan dikembalikan kepada anda dengan syarat tiada tuntutan dilakukan atas polisi tersebut. 4. Premium untuk produk ini tidak dijamin dan akan berdasarkan kepada kadar premium yang dikuat kuasa pada masa pembaharuan. 5. Tiada manfaat akan dibayar untuk sebarang rawatan perubatan yang diterima oleh Orang Yang Diinsuranskan di luar Malaysia jika Orang Yang Diinsuranskan tinggal atau melakukan perjalanan di luar Malaysia untuk lebih daripada sembilan puluh (90) hari yang berterusan. 6. Semua premium dan yuran mungkin tertakluk kepada cukai atau levi kerajaan yang lain. Untuk maklumat lanjut dan bantuan mengenai Z-MedProtect, sila hubungi ejen kami atau Pusat Khidmat Pelanggan Zurich di 1-300-888-622 atau emel kami di <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS> Sekiranya terdapat percanggahan, kekaburan dan konflik dalam pentafsiran sebarang terma atau syarat, versi Bahasa Inggeris akan diguna pakai dan menggantikan versi Bahasa Malaysia. 18 Zurich General Insurance Malaysia Berhad Registration No. 201701035345 (1249516-V) Level 23A, Mercu 3, No. 3, Jalan Bangsar, KL Eco City, 59200 Kuala Lumpur, Malaysia Tel: 03-2109 6000 Fax: 03-2109 6888 Call Centre: 1-300-888-622 www.zurich.com.my @ zurich @ ncn 3551/1/P/G/B/M The trademarks depicted are registered in the name of Zurich Insurance Company Ltd in many jurisdictions worldwide Z U RI C H : Page # 1 Zurich Life Insurance Malaysia Berhad Registration No. 196801000442 (8029-A) Level 23A, Mercu 3 No. 3, Jalan Bangsar, KL Eco City, 59200 Kuala Lumpur, Malaysia. Tel: 03-2109 6000 Fax: 03-2109 6888 Call Centre: 1-300-888-622 —www.zurich.com.my @ zurich’ @ zurich sser/ueiuan ZURICH GB ZURICH Zurich iCare Medic Big journeys begin with small steps. Start here. Page # 2 Page # 3 Zurich iCare Medic Provides Just What You Need Worry not about having cash on hand. Just show your medical card at any one of our panel hospitals for a hassle-free admission. We will ease your worries with necessary coverage, including cashless claims. Covid-19 Coverage If you contract Covid-19 or experience Covid-19 vaccination side effects, you are well covered for hospitalisation admission.’ Affordable Premium with Long-Term Protection Get protected and enjoy medical coverage with no lifetime limit up to L00 years of age. No excuses for not living your life to the fullest. Enjoy More Savings Your medical bills are well taken care of. Have your Deductibles waived so that you can focus on recovering whilst enjoying Daily Cash Allowance of RM180 if you are admitted into a government hospital. Compassionate Benefit In the event of death of the Life Assured, your family will receive RM10,000 to assist them with funeral expenses. Enjoy the option of upgrading your plan to a new medical plan after 5 years and enhance your benefits in the future with a more comprehensive medical protection. No medical underwriting required and is subject to terms and conditions. A Note: ‘Life Assured must be vaccinated with at least 2 doses of vaccine approved by local authority to be entitled for this benefit [except for Life Assured age 4 years and below.] Page # 4 Schedule of Benefits Annual Limit (for In-Patient Benefits, Out-Patient Benefits plus Other Benefits) Lifetime Limit Deductible (amount per Policy Year) In-Patient Benefits 1. Daily Hospital Room & Board (limit per day, unlimited number of days) 2. Daily Cash Allowance at Government Hospital (limit per day, unlimited number of days) 3. Intensive Care Unit or High Dependency Unit (maximum 120 days per Policy Year) Hospital Supplies & Services Surgical Fees Anaesthetist Fees Operating Theatre Fees Ambulance Fees Pre-Hospitalisation Diagnostic Tests (within 90 days prior to Hospitalisation) + Diagnostic Tests + Specialist / General Practitioner Consultation + Medication and Treatment 10. In-Hospital Specialist Visit * Surgical — unlimited number of visits + Non-surgical — max 2 visits / day 11. Post-Hospitalisation Treatment (within 180 days after discharge) + Diagnostic Tests + Specialist Consultation + Medication and Treatment OMONOASHK . Organ Transplant (any organ, unlimited number of transplant) Hospitalisation due to Covid-19 or Complication arising from Covid-19 vaccination Limit (RM) 500,000 No lifetime limit 250 180 180 As Charged, subject to any Deductible. Deductible will be waived for admission to Malaysian Government / Semi-Government Hospital. Out-Patient Benefits 14. Out-Patient Kidney Dialysis Treatment 15. Out-Patient Cancer Treatment 16. Emergency Accidental Out-Patient Treatment (within 72 hours from accident and follow-up treatment up to a maximum of 31 days) 17. Day-Care Surgery 18. Out-Patient Physiotherapy Treatment (limit per Policy Year, within 180 days after discharge / surgery) Other Benefits 19. Intraocular Lens — Monofocal / Multifocal (limit per life on each eye) 20. Medical Report Fees Special Benefits 21. Step Up Advantage 22. Compassionate Benefit 23. Emergency Assistance Program (EAP) Note: As Charged, subject to any Deductible. Deductible will be waived for admission to Malaysian Government / Semi-Government Hospital. 5,000 3,000 As Charged The privilege to upgrade this plan to anew medical plan without medical underwriting, subject to terms and conditions. 10,000 In accordance with the benefit provisions in EAP agreement Compassionate Benefit and Emergency Assistance Programme are not included in the Annual Limit. Page # 5 How Does iCare Medic Work? Let us look at the scenario below. Hospitalisation for Knee Replacement Surgery Patient: John Days of Hospitalisation: 6 days Comparison between treatment received at Government and Private Hospital: Government Hospital Total Eligible Medical Expenses for Knee RM15,000 Replacement Surgery Required to Pay Deductible No Deductible paid by John Waived Cae ees apance at RM180 x 6 days = RM1,080 overnment Hospital If John chooses to be admitted into a Government Hospital, his Deductible of RM250 will be waived and the total eligible medical expenses will be fully paid by Us. Additionally, John will be paid a total Daily Cash Allowance of RM1,080.00 Tin Description Private Hospital RM60,000 Yes RM250 Not Applicable If John chooses to be admitted into a Private Hospital, he will need to pay a Deductible of RM250 and the remaining eligible medical expenses will be paid by Us. John will not be entitled to the Daily Cash Allowance. Annual Premium Age Band (Age Last Birthday) 0 1 year 2 years 3 years 4 years 5 years 6 — 10 years 11-15 years 16 - 20 years 21-25 years 26 — 30 years 31-35 years 36 — 40 years 41 - 45 years 46 years 47 years 48 years 49 years 50 years 51 years 52 years 53 years 54 years 55 years 56 years 57 years 58 years 59 years 60 years Rates Annual Premium (RM) 1,972 1,661 1,701 1,540 1,567 1,416 1,433 1,299 1,303 1,212 1,236 1,124 1,195 1,042 1,195 1,042 1,361 1,067 1,361 1,119 1,361 1,119 1,375 1,255 1,431 1,452 1,558 1,888 1,708 2,261 1,772 2,385 1,931 2,503 2,089 2,619 2,249 2,688 2,412 2,783 2,572 2,849 2,695 2,947 2,800 3,013 2,883 3,108 3,100 3,317 3,316 3,415 3,655 3,723 3,991 4,028 4,328 4,145 Page # 6 Annual Premium (RM) Pee aed (a) 61 years 5,365 4,997 90 years! 27,849 27,612 62 years WOO) 5,327 91 years! 28,655 28,404 63 years 5,935 5,772 92 years! 29,481 29,228 64 years 6,113 6,220 93 years! 30,405 30,073 65 years 6,291 6,411 94 years! 31,853 30,944 66 years 9,960 9,684 95 years! 33,303 31,841 67 years 10,237 10,292 96 years! 34,749 32,765 68 years 10,773 10,833 97 years! 36,199 33,712 69 years 11,316 11,372 98 years! 37,708 34,693 70 years 11,853 11,913 99 years' 39,277 35,701 : 71 years' 12,389 12,453 72 years! 12,929 12,995 73 years! 13,611 13,679 Note: 74 years! 14,289 14,363 | | | | ; 75 years! 14,9714 15,044 1. The premiums payable will vary according to the attained age, gender and occupational class. Please speak to our Zurich Wealth Planner to obtain the premium rates that are 76 years! 15,6514 15,731 applicable to you. 77 years! 16,331 16,415 78 years! 17,191 17,279 2.1 On renewal basis only. 79 years! 18,053 18,144 80 years! 18,912 19,0114 81 years' 19,772 19,875 82 years! 20,636 20,743 83 years! 21,721 21,835 84 years! 22,813 22,929 85 years! 23,903 24,024 86 years! 24,877 24,663 87 years! 25,591 25,367 88 years! 26,319 26,092 89 years! 27,076 26,837 Page # 7 Frequently Asked Questions (FAQ) What is Zurich iCare Medic? Zurich iCare Medic is a standalone medical plan with Deductible of RM250 which provides cashless hospitalisation benefits, out-patient benefits, and other medical benefits up to age 100. Who is eligible for Zurich iCare Medic? Anyone between 14 days old to 70 years old (attained age) is eligible to purchase Zurich iCare Medic. What is Deductible and how does it work? Deductible is a fixed amount you are required to pay per Policy Year for eligible medical expenses incurred as cost sharing. You will need to pay the initial RM250 if you are admitted to private hospital and we will pay the rest of the eligible medical expenses incurred within a Policy Year. Is the premium paid for Zurich iCare Medic eligible for income tax relief? Yes. The premium paid for this standalone medical plan may qualify you for personal income tax relief subject to the final decision of the Inland Revenue Board of Malaysia (IRB). Am | covered for medical treatment received outside Malaysia? Yes, but if you are residing or traveling outside Malaysia, the worldwide coverage is subject to a maximum of 90 consecutive days. Exclusions Medical & Hospitalisation Benefit This plan does not cover any hospitalisation, surgery or charges caused directly or indirectly, wholly or partly, by any one of the following occurrences: 1. Pre-existing conditions; or 2. Plastic/Cosmetic surgery or treatment (except medically necessary surgery), circumcision (except circumcision due to infection), eye examination, glasses and refraction or surgical correction of nearsightedness (Radial Keratotomy) and the use or acquisition of external prosthetic appliances or devices such as artificial limbs, hearing aids, implanted pacemakers and prescriptions thereof; or 3. Dental conditions including dental treatment or oral surgery except as necessitated by Accidental Injuries to sound natural teeth occurring wholly during the coverage period of the Policy Contract; or 4. Private nursing, 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 except for the Eligible Expenses covered under Hospitalisation due to Covid-19 or complication arising from Covid-19 vaccination; or 5. Any treatment or surgical operation for Congenital Conditions or deformities including hereditary conditions; or 6. Pregnancy, childbirth (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; or 7. 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 General Practitioner and/or Specialist; or 8. Treatments specifically for weight reduction or gain; or 9. Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane; or 10. 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; or Page # 8 11. 12. 13. 14. 15. 16. 17. 18. lonising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material; or Expenses incurred for donation of any body organ by the Life Assured and costs of acquisition of the organ including all costs incurred by the donor during organ transplant and its complications; or 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; or Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations); or 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; or 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; or Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes; or Expenses incurred for sex changes. 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, 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 15 days free-look period from the date of delivery of the policy, the full premium paid less medical expenses (if any) will be refunded. . Waiting period - The eligibility for benefits under this policy will only start 30 days after the effective date of the policy, except for a covered accident occurring after the effective date of coverage. For Specified Illnesses, the waiting period is 120 days from the Commencement Date or effective date of change or reinstatement date whichever is latest. . The premium is not guaranteed and subject to review in future. The revision in premium, if any, is affected by claim experience, cost of medical treatment, medical inflation, advancement in medical technology and other circumstances. Such revisions shall be applicable to all policyholders regardless of their policy coverage term and claim experience. Zurich Life Insurance Malaysia Berhad reserves the right to revise the premium by notifying the policyholder at least 30 days before the anniversary date. . It may not be advantageous to switch from one medical and health policy to another medical and health policy, as you may be subject to new underwriting requirements waiting period, exclusion of specified illness or pre-existing conditions under the new policy. . Medical treatment received outside Malaysia is limited to the Reasonable and Customary and Medically Necessary Charges that are equivalent to the local treatment found in Malaysia and shall exclude the cost of transport to the place of treatment. No benefit shall be payable for any medical treatment received by the Life Assured outside Malaysia, if the Life Assured resides or travels outside Malaysia for more than 90 consecutive days. . All premium and fees shown in this document may be subject to tax or other government levies. Panel of Hospitals Please visit www.zurich.com.my to download the list of participating hospitals. For more information and assistance on Zurich iCare Medic, please contact our Zurich Wealth Planner or Zurich Call Centre at 1300-888-622 or email us at <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS> In the event of discrepancy, ambiguity, and conflict in interpreting any term or condition, the English version shall prevail and supersede the Bahasa Malaysia, Chinese and Tamil versions. ZURICH iCARE MEDIC POLICY CONTRACT FORM NO: This is a non-participating Whole Life medical plan that provides comprehensive coverage on hospitalisation, surgical and, out-patient treatments expenses due to accidental Injuries or illnesses up to the Maturity/Expiry Date. While this Policy is in-force, upon receipt of due proof and subject to the provisions of this Policy Contract, We shall provide the following medical benefits. SECTION A SCHEDULE OF BENEFITS Plan 180 PLANS Limit (RM) Annual Limit 500,000 (for In-Patient Benefit, Out-Patient Benefit plus Other Benefit) Lifetime Limit No lifetime limit Deductible (amount per Policy Year) 250 In-Patient Benefit 1 Daily Hospital Room & Board 180 (limit per day, unlimited number of days) 2 Daily Cash Allowance at Government Hospital 180 (limit per day, unlimited number of days) 3 Intensive Care Unit or High Dependency Unit (maximum 120 days per Policy Year) 4 Hospital Supplies & Services 5 Surgical Fees 6 Anaesthetist Fee 7 Operating Theatre 8 Ambulance Fee 9 Pre-Hospitalisation Diagnostic Tests (within 90 days prior to Hospitalisation) • Diagnostic Tests • Specialist/General Practitioner Consultation As Charged, subject to any deductible. Deductible • Medication and Treatment will be waived for admission to Malaysian 10 In-Hospital Specialist Visit Government / Semi-Government Hospital. • Surgical – unlimited number of visits • Non-surgical – max 2 visits per day 11 Post-Hospitalisation Treatment (within 180 days after discharge) • Diagnostic Tests • Specialist Consultation • Medication and Treatment 12 Organ Transplant (any organ, unlimited number of transplant) 13 Hospitalisation due to Covid-19 or Complication arising from Covid-19 Vaccination Out-Patient Benefit 14 Out-Patient Kidney Dialysis Treatment 15 Out-Patient Cancer Treatment As Charged, subject to any deductible. Deductible 16 Emergency Accidental Out-Patient Treatment will be waived for admission to Malaysian (within 72 hours from accident and follow-up treatment up to a Government / Semi-Government Hospital. maximum of 31 days) 17 Day-Care Surgery 18 Out-Patient Physiotherapy Treatment 5,000 (limit per Policy Year, within 180 days after discharge/ surgery) Other Benefit 19 Intraocular Lens – Monofocal / Multifocal 3,000 (limit per life on each eye) 20 Medical Report Fees As Charged Special Benefit Step Up Advantage Life Assured is allowed to upgrade this plan to a new medical plan without medical underwriting subject to terms and conditions. Compassionate Benefit* 10,000 Emergency Assistance Program (EAP)* In accordance with the benefit provisions in EAP agreement *Compassionate Benefit and Emergency Assistance Programme are not included in the Annual Limit. DESCRIPTION OF BENEFITS IN-PATIENT BENEFIT DAILY HOSPITAL ROOM AND BOARD Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary room accommodation and meals. The amount of the benefit shall be the charges made by the Hospital during the Life Assured’s Hospital Confinement, but in no event shall the benefit exceed, for any one day, the rate of Daily Hospital Room and Board Benefit as stated in the Schedule of Benefits. DAILY CASH ALLOWANCE AT GOVERNMENT HOSPITAL Pays a daily allowance for each day of Hospital Confinement for a covered Disability in a Malaysian Government Hospital, provided that the Life Assured shall be confined in a room of Room and Board rate that does not exceed the amount as shown in the Schedule of Benefits. This benefit is not applicable to Malaysian Semi-Government Hospital. INTENSIVE CARE UNIT OR HIGH DEPENDENCY UNIT Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary Intensive Care Unit or High Dependency Unit room accommodation and meals. This amount of benefit shall be the charges made by the Hospital subject to the maximum number of days, as stated in the Schedule of Benefits. Where the period of confinement in an Intensive Care Unit or High Dependency Unit exceeds the maximum number of days as stated in the Schedule of Benefits, reimbursement will be restricted to the standard Daily Hospital Room and Board rate. No Daily Hospital Room and Board Benefits will be payable for the same confinement period where the Intensive Care Unit or High Dependency Unit benefit is payable. HOSPITAL SUPPLIES & SERVICES Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary general nursing, prescribed and consumed drugs and medicines, dressings, splints, plaster casts, x-ray, laboratory examinations, electrocardiograms, physiotherapy, basal metabolism tests, intravenous injections and solutions, administration of blood and blood plasma but excluding the cost of blood and plasma during the Life Assured’s Hospital Confinement. SURGICAL FEES Reimbursement of the Reasonable and Customary Charges for a Medically Necessary Surgery by the Specialists, including Specialist’s pre-surgical assessment visits to the Life Assured and post-surgical care up to the number of days as indicated in the Schedule of Benefits. If more than one Surgery is performed, the total payments for all the Surgeries performed shall not exceed the Annual Limit stated in the Schedule of Benefits, where applicable. ANAESTHETIST FEES Reimbursement of the Reasonable and Customary Charges by the anaesthetist for the Medically Necessary administration of anaesthesia. OPERATING THEATRE FEES Reimbursement of the Reasonable and Customary operating room charges incidental to the surgical procedure. AMBULANCE FEES Reimbursement of the Reasonable and Customary Charges incurred for necessary road domestic ambulance services (inclusive of attendant) to and/or from the Hospital of confinement. Payment will not be made if the Life Assured is not hospitalised. PRE-HOSPITALISATION DIAGNOSTIC TEST Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary diagnostic tests which include but not limited to ECG, X-ray and laboratory tests recommended by a General Practitioner and/or a Specialist which are performed for diagnostic purposes on account of an Injury or Illness in connection with the Hospitalisation within the maximum number of days as set forth in the Schedule of Benefits preceding Hospitalisation. No payment shall be made if upon such diagnostic services, it does not result in Hospital Confinement of the Life Assured for the treatment of the medical condition diagnosed. PRE-HOSPITALISATION SPECIALIST/GENERAL PRACTITIONER CONSULTATION Reimbursement of the Reasonable and Customary Charges incurred for the first (1st) time consultation by a General Practitioner and/or a Specialist in connection with an Injury or Illness that leads to Hospitalisation, within the maximum number of days as set forth in the Schedule of Benefits preceding Hospital Confinement and provided that such Specialist consultation are Medically Necessary, and the Specialist consultation has been recommended in writing by the attending General Practitioner. Payment will not be made for clinical treatment (and subsequent consultation or medication after the Illness is diagnosed) where it does not result in Hospital Confinement of the Life Assured for the treatment of the medical condition diagnosed. PRE-HOSPITALISATION MEDICATION AND TREATMENT Reimbursement of the Reasonable and Customary Charges incurred for the first (1st) time treatment and medicines prescribed by a General Practitioner and/or a Specialist in connection with an Injury or Illness that leads to Hospitalisation, within the maximum number of days as set forth in the Schedule of Benefits preceding Hospital Confinement and provided that such Specialist medication and treatment are Medically Necessary and the Specialist consultation has been recommended in writing by the attending General Practitioner. Payment will not be made for clinical treatment (and subsequent consultation or medication after the Illness is diagnosed) where it does not result in Hospital Confinement of the Life Assured for the treatment of the medical condition diagnosed. IN-HOSPITAL SPECIALIST VISIT Reimbursement of the Reasonable and Customary Charges by a Specialist for Medically Necessary visit during Life Assured’s Hospital Confinement for a surgical or non-surgical Disability subject to the maximum number of visits per day as stated in the Schedule of Benefits. POST-HOSPITALISATION TREATMENT Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary follow-up diagnosis, treatment and consultation by the same attending Specialist, within the maximum number of days as set forth in the Schedule of Benefits immediately following discharge from Hospital. This shall include medicines prescribed during the follow-up treatment but shall not exceed the supply needed for the maximum number of days as set forth in the Schedule of Benefits. ORGAN TRANSPLANT Reimbursement of the Reasonable and Customary Charges incurred on transplantation Surgery for the Life Assured being the recipient of the transplant of any organ. The costs of acquisition of the organs being transplanted and all costs incurred by the donor are not covered. HOSPITALISATION DUE TO COVID-19 OR COMPLICATION ARISING FROM COVID-19 VACCINATION Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary treatments received when the Life Assured is hospitalised due to Covid-19 or complication arising from Covid-19 vaccination. For Medically Necessary Hospitalisation due to Covid- 19, the Life Assured must be diagnosed with severe Covid-19 complications including but not limited to pneumonia, hypoxemic respiratory failure, sepsis or septic shock. Life Assured must be vaccinated with at least two (2) doses of vaccine approved by local authority to be entitled for this benefit [except for Life Assured age four (4) years and below]. OUT-PATIENT BENEFIT OUT-PATIENT KIDNEY DIALYSIS TREATMENT If a Life Assured is diagnosed with Kidney Failure, We will reimburse the Reasonable and Customary Charges incurred for the Medically Necessary treatment of kidney dialysis performed at the Out-patient department of a Hospital or a legally registered dialysis treatment centre. Kidney Failure means end-stage kidney failure presenting as chronic irreversible failure of both kidneys to function, as a result of which regular dialysis is initiated or kidney transplantation is carried out. OUT-PATIENT CANCER TREATMENT If a Life Assured is diagnosed with Cancer, We will reimburse the Reasonable and Customary Charges incurred for the Medically Necessary treatment of Cancer (radiotherapy, chemotherapy, immunotherapy, hormonal therapy and targeted therapy) performed at the Out-patient department of a Hospital or a legally registered Cancer treatment centre. Cancer is defined as any malignant tumour positively diagnosed with histological confirmation and characterized by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant tumour includes leukemia, lymphoma and sarcoma. The following are not covered: (i) All cancers which are histologically classified as any of the following: - pre-malignant - non-invasive - carcinoma in situ - having borderline malignancy - having malignant potential (ii) All tumours of the prostate histologically classified as T1N0M0 (TNM classification) (iii) All tumours of the thyroid histologically classified as T1N0M0 (TNM classification) (iv) All tumours of the urinary bladder histologically classified as T1N0M0 (TNM classification) (v) Chronic Lymphocytic Leukemia less than RAI Stage 3 (vi) All cancers in the presence of HIV (vii) Any skin cancer other than malignant melanoma EMERGENCY ACCIDENTAL OUT-PATIENT TREATMENT Reimbursement of the Reasonable and Customary Charges incurred for up to the maximum number of days as stated in the Schedule of Benefits, as a result of a covered bodily Injury arising from an Accident for Medically Necessary treatment as an Out-Patient at any registered clinic or Hospital within seventy-two (72) hours of the Accident causing the covered bodily Injury. Follow up treatment by the same General Practitioner and/or Specialist or same registered clinic or Hospital for the same covered bodily Injury will be provided up to the maximum number of days as set forth in the Schedule of Benefits. DAY-CARE SURGERY Reimbursement of the Reasonable and Customary Charges for Medically Necessary Surgery incurred for a surgical procedure performed (including all professional fees, services & supplies) in an Out-Patient setting at the Hospital / Specialist clinic / Day Surgery centre on a pre-planned basis. OUT-PATIENT PHYSIOTHERAPY TREATMENT Reimbursement of the Reasonable and Customary Charges incurred for Out-Patient Physiotherapy Treatment in Hospital, or a legally registered facility or centre referred in writing by a Specialist to be performed by a licensed physiotherapist after Surgery or in-hospital treatment, within the maximum number of days from the date of Hospital discharge or Surgery, whichever is later and subject to the maximum limit per year as set forth in the Schedule of Benefits. OTHER BENEFIT INTRAOCULAR LENS Reimbursement of Reasonable and Customary Charges incurred for the Medically Necessary Intraocular Lens including both monofocal and multifocal lens for cataract or eye Injury, subject to the maximum limit per life as shown in the Schedule of Benefits. MEDICAL REPORT FEES Reimbursement of the fee charged for completion of a medical report by the attending General Practitioner and/or Specialist in respect of the covered Disability. SPECIAL BENEFIT STEP UP ADVANTAGE At the beginning of 6th Policy Year, this Policy may be upgraded to a medical plan without any evidence of insurability, subject to the following conditions: a) If a new basic plan is being taken up, the coverage of the basic plan shall be limited to Death and TPD benefits only. The Basic Sum Assured shall not exceed fifty thousand Ringgit Malaysia (RM 50,000). b) Maximum daily Room and Board of the new medical plan shall not exceed 200% of the Room and Board of this Policy, and c) The new medical plan must either have a Deductible or Co-insurance feature. We shall notify Applicant/Owner of the option ninety (90) days prior to the 6th Policy Year. Applicant/Owner must exercise the option by replying to us no later than the specified timeline. The terms and conditions applicable to existing Policy which include premium loading and exclusion (if any) shall apply to the new medical plan and basic plan, if applicable. The insurance charge and premium of the new medical plan and basic plan, if applicable, will be determined based on our rates at the time of upgrade. This privilege is only available to Life Assured up to 35 years old at the inception of this Policy. COMPASSIONATE BENEFIT In the event of death of the Life Assured, We will pay ten thousand Ringgit Malaysia (RM10,000) as Compassionate Benefit in one (1) lump sum. Upon payment of Compassionate Benefit, this Policy shall be terminated. DEFINITIONS FORM NO: ACCIDENT shall mean a sudden, unintentional, unexpected, unusual and specific event that occurs at an identifiable time and place, which shall, independently of any other cause, be the sole cause of bodily Injury. ANNUAL LIMIT shall mean benefits payable in respect of expenses incurred for treatment provided to Life Assured during the period of insurance shall be limited to Annual Limit as stated in the Schedule of Benefits. Compassionate Benefit and Emergency Assistance Programme are not included in the Annual Limit. Once the Annual Limit is reached, all insurance coverage for Life Assured shall immediately cease to be payable for that remaining Policy Year except for Compassionate Benefit and Emergency Assistance Programme. AS CHARGED refers to charges incurred for reasonable, necessary and customary medical care provided in the treatment of a covered Disability. BASIC SUM ASSURED shown in the Policy Information Page is the Annual Limit of this Zurich iCare Medic. CONGENITAL CONDITIONS shall mean any medical or physical abnormalities existing at the time of birth, as well as neo-natal physical abnormalities developing within six (6) months from the time of birth. These will include hernias of all types and epilepsy except when caused by a trauma, which occurred after the date that the Life Assured was continuously covered under this Policy Contract. DAY SURGERY shall mean a pre-planned surgical procedure where the patient needs the use of a recovery facility for less than twelve (12) consecutive hours (but not for overnight stay at the Hospital). DEDUCTIBLE shall mean the initial Eligible Expenses amount paid per Policy Year by the Life Assured/ Policyowner before the insurer pays the balance Eligible Expenses. Only the Eligible Expenses of the following benefits as set forth in the Schedule of Benefits are subject to Deductible: 1) In-Patient Benefit (except Daily Hospital Room & Board and Daily Cash Allowance at Government Hospital) 2) Out-Patient Benefit (except Out-Patient Physiotherapy Treatment) Deductible will be waived for admission to Malaysian Government/Semi-Government Hospital. DENTIST shall mean a person who is duly licensed or registered dental practitioner that specialises in the diagnosis, prevention and treatment of diseases or conditions of the oral cavity in the geographical area in which the service is provided but excluding a Dentist who is the Life Assured himself/herself or the spouse or the immediate family member of the Life Assured. DISABILITY shall mean Sickness, Disease, Illness or the entire Injuries arising out of a single or continuous series of causes. ELIGIBLE EXPENSES shall mean Medically Necessary expenses incurred due to a covered Disability but not exceeding the limits in the Schedule of Benefits. GENERAL PRACTITIONER shall mean a registered medical practitioner qualified and licensed to practice western medicine and who, in rendering such treatment, is practicing within the scope of his licensing and training in the geographical area of practice but excluding a General Practitioner who is the Life Assured himself/herself or the spouse or the immediate family member of the Life Assured. HOSPITAL shall mean only an establishment duly constituted and registered as a hospital for the care and treatment of sick and injured persons as paying bed-patients, and which: - a) Has facilities for diagnosis and major Surgery, b) Provides twenty-four (24) hour a day nursing services by registered and qualified nurses, c) Is under the supervision of a Specialist, and d) Is not primarily a clinic; a place for alcoholics or drug addicts; a nursing, rest or convalescent home or a home for the aged or similar establishment. HOSPITAL CONFINEMENT shall mean the Life Assured being registered and admitted as an in-patient in a Hospital for more than twelve (12) consecutive hours. HOSPITALISATION shall mean admission to a hospital as a registered in-patient for Medically Necessary treatments for a covered Disability upon recommendation of a General Practitioner or Specialist. A patient shall not be considered as an in-patient if the patient does not physically stay in the Hospital for the whole period of confinement. INJURY shall mean bodily injury caused solely by Accident. INTENSIVE CARE UNIT OR HIGH DEPENDENCY UNIT shall mean a section within a Hospital which is designated as an Intensive Care Unit or High Dependency Unit by the Hospital, and which is maintained on a twenty-four (24) hour basis solely for treatment of patients in critical condition and is equipped to provide special nursing and medical services not available elsewhere in the Hospital. LIFE ASSURED shall mean the person described in the Policy Information Page of this Policy Contract. MALAYSIAN GOVERNMENT HOSPITAL shall mean a Hospital established, maintained, operated or provided by the Malaysian government which charges of services are subject to the Fee Act 1951 - Fees (Medical) Order 1982 and/or its subsequent amendments if any, but excludes privatised or corporatised Malaysian Government Hospital. MALAYSIAN SEMI-GOVERNMENT HOSPITAL shall mean Full Paying Patient (FPP) Services offered through Malaysian Government Hospitals where patients need to bear the cost of treatment on their own. MANAGED CARE ORGANISATION (MCO) shall mean a third party appointed by Zurich Life Insurance Malaysia Berhad to provide service in managing the hospital admission and claims administration as per provisions of this Policy Contract. MEDICALLY NECESSARY shall mean a medical service which is: a) Consistent with the diagnosis and customary medical treatment for a covered Disability, and b) In accordance with standards of good medical practice, consistent with current standard of professional medical care, and of proven medical benefits, and c) Not for the convenience of the Life Assured or the General Practitioner and/or Specialist, and unable to be reasonably rendered out of Hospital (if admitted as an inpatient), and d) Not of an experimental, investigational or research nature, preventive or screening nature, and e) For which the charges are fair and reasonable and customary for the Disability. OUT-PATIENT shall mean the Life Assured is receiving medical care or treatment without being hospitalized and includes treatment in a day-care centre. POLICYOWNER shall mean a person or a corporate body to whom this Policy has been issued in respect of cover for persons specifically identified as Life Assured in the Policy Information Page. PRE-EXISTING CONDITION shall mean any conditions, illnesses or Disabilities which existed before the Commencement Date or effective date of change or date of reinstatement, whichever is later, and for which the Life Assured has reasonable knowledge of. A Life Assured is considered to have reasonable knowledge of a pre-existing condition is one for which: - a) The Life Assured had received or is receiving treatment. b) Medical advice, consultation, diagnosis, care or treatment has been recommended. c) Clear and distinct signs or symptoms are or were evident; or d) Its existence would have been apparent to a reasonable person in the circumstances. PRESCRIBED MEDICINES shall mean medicines that are dispensed by a General Practitioner, a Specialist, a registered pharmacist or a Hospital and which have been prescribed by a General Practitioner or Specialist in respect of treatment of a covered Disability. PRIVATE HOSPITAL shall mean any Hospital which licensed and governed under Private Healthcare Facilities and Services Act 1998 including any regulations and all the re-enactments thereof. REASONABLE AND CUSTOMARY CHARGES shall mean charges for medical care which is Medically Necessary shall be considered reasonable and customary to the extent that it does not exceed the general level of charges being made by others of similar standing in the locality where the charge is incurred, when furnishing like or comparable treatment, services or supplies to individual of the same sex and of comparable age for a similar Sickness, Disease or Injury and in accordance with accepted medical standards and practice could not have been omitted without adversely affecting the Life Assured medical condition. POLICY ANNIVERSARY shall be one (1) year after the effective date of this Policy and annually thereafter. POLICY YEAR shall mean the one (1) year period from and including the effective date of commencement of coverage or effective date of change (as stated in the Policy Information Page or Endorsement), or the one (1) year period following the renewal of this Policy. SICKNESS, DISEASE OR ILLNESS shall mean a physical condition marked by a pathological deviation from the normal healthy state. SPECIALIST shall mean a medical practitioner registered and licensed as such in the geographical area of his practice where treatment takes place and who is classified by the appropriate health authorities as a person with superior and special expertise in specified fields of medicine but excluding a Specialist who is the Life Assured himself/herself or the spouse or the immediate family member of the Life Assured. A Specialist shall also include a physician or a surgeon. SPECIFIED ILLNESSES shall mean the following Disabilities and its related complications, occurring within the first one hundred and twenty (120) days from the Commencement Date or effective date of change or date of reinstatement, whichever is later, of this Policy Contract: a) Hypertension, diabetes mellitus and cardiovascular disease. b) All tumours, Cancers, cysts, nodules, polyps, stones of the urinary system and biliary system. c) All ear, nose (including sinuses) and throat conditions. d) Hernias, haemorrhoids, fistulae, hydrocele, varicocele. e) Endometriosis including disease of the reproduction system. f) Vertebro-spinal disorders (including disc) and knee conditions. POLICY OR POLICY CONTRACT shall mean this Zurich iCare Medic Policy Contract. SURGERY shall mean any of the following medical procedures: a) To incise, excise or electrocauterize any organ or body part, except for dental services. b) To repair, revise, or reconstruct any organ or body part. c) To reduce by manipulation a fracture or dislocation. d) Use of endoscopy to remove a stone or object from the larynx, bronchus, trachea, esophagus, stomach, intestine, urinary bladder, or urethra. WAITING PERIOD shall mean the period of time between the Commencement Date or date of reinstatement of this Policy, whichever is later, and the beginning of a Life Assured’s symptoms of the Illness, after which the Life Assured is eligible for the Illness benefit described herein. WE, US and OUR shall mean Zurich Life Insurance Malaysia Berhad. YOU and YOUR shall mean the owner of this Policy Contract. Whenever the context is requiring in this Policy, masculine form shall apply to feminine and singular term shall include the plural. PREMIUM PROVISIONS FORM No.: GRACE PERIOD A Grace Period of thirty-one (31) days from its due date will be allowed for payment of each premium due after the first payment during which period this Policy will remain in-force. During such thirty-one (31) days, we shall remain liable thereunder if by the last of such days, the premium is actually paid. If any premium is not paid in respect of this Policy before the end of the Grace period, the Policy shall be deemed as lapsed at the expiry of Grace Period. PREMIUM During the period of insurance, the premiums under this Policy are not guaranteed and shall be based on the rates in force at the time of renewal. Premiums are payable at the premium rate according to the Life Assured’s age, sex and occupational class on each Policy Year anniversary. We may change the rates at which premiums shall be calculated, at the start of any Policy Year, provided that we notify the Applicant/Owner at least thirty (30) days in advance of the date such premium is due with valid reason. The total premium of this Policy shall include the fee for the services provided by a Managed Care Organization (MCO). REINSTATEMENT In the event the Policy has lapsed, it may be reinstated within one (1) year after the due date of the premium in default subject to: a) Submission of evidence of insurability; and b) Payment of overdue premiums with interest as required at the time of reinstatement (if any); and c) Repayment or reinstatement of any loan indebtedness outstanding at the due date of the premium in default with interest., if any. Such reinstatement shall only cover any eligible losses thereafter subject to the Waiting Period as defined. No claim will be paid for any losses that occur during the lapsation period. OWNERSHIP PROVISIONS FORM NO.: POLICY OWNER Only the Policyowner can, exercise all rights, privileges and options provided under this Policy subject to any assignees and trustee’s rights. In the event of the Policyowner’s death, such rights, privileges, and options shall vest in the legal representative of the Policyowner if any. OWNERSHIP OF POLICY Unless otherwise expressly provided for by Endorsement in the Policy Contract, We shall be at liberty to treat the Policyowner as the absolute owner of the Policy. We shall not be bound to recognise any equitable or other claim to or interest in the Policy. CHANGE OF OWNERSHIP While the Policy is in-force, the Owner may change the ownership of this Policy by written notice to Us. A change of ownership shall be effective only if endorsed in this Policy Contract. When the ownership is changed, it will be deemed effective as of the date the notice is signed whether the Life Assured is living at the time of such recording and Endorsement. THE NOMINEE The nominee is named in the nomination form unless subsequently changed or revoked as provided for under the Revocation of Nomination clause. Where the nominee of the Policy is the spouse, child or parent (when there is no spouse or child living at the time of nomination) of the Policyowner, other than a Muslim Policyowner, a trust is created in favour of the nominee for the policy moneys payable upon death of the Policyowner. The Policyowner may by completing the Trustee Nomination Form appoint trustee(s) of for the policy moneys payable under this Policy. Where a trust for the policy moneys is created, the Policyowner shall not deal with the Policy by revoking a nomination, by varying or surrendering the Policy, or by assigning or pledging the Policy as security, without written consent of the trustee(s). REVOCATION OF NOMINATION During the lifetime of the Life Assured and while the Policy is in-force, the Policyowner may revoke the nominee of this Policy, by written notice and completing the appropriate form to Us, except where the nominee is the spouse, child, or parent (when there is no spouse or child living at the time of nomination) of the Policyowner. For such nomination, written consent of the trustee is required for revocation of nomination. When the nominee is changed, it will be deemed effective as of the date the notice is signed whether Life Assured is living at the time of such recording. JUVENILE OWNERSHIP PROVISION Policyowner shall have the right to exercise every option, benefit or privilege conferred by the provisions of the Policy as long as he/she survives the Life Assured. If Policyowner predeceases the Life Assured, such right: a) Shall be reverted to the Life Assured provided the Life Assured has attained the age of majority; or b) Shall be vested with the contingent owner and where no contingent owner is appointed, the legal representative of the Policyowner, if the Life Assured has not attained the age of majority. Subsequently, when the Life Assured has attained the age of majority such right shall be reverted to the Life Assured. GENERAL PROVISIONS FORM NO.: THE CONTRACT This Policy is issued in consideration of the payment of premium as specified in the Policy Information Page and pursuant to: (a) the answers given by Applicant/Owner or the Life Assured in the application/proposal form or any subsequent questionnaires given by Us on any matters relating to the proposal and any disclosures made by Applicant/Owner or Life Assured between the time of submission of the application/ proposal and the time this contract is entered into; and (b) medical reports and any other reports and questionnaires. (Collectively referred to as ‘the material information’) and such material information shall form part of this contract of insurance between Us and Applicant/Owner. However, in the event of any pre-contractual misrepresentation made in relation to such material information, only the remedies in Schedule 9 of the Financial Services Act 2013 will apply. If Applicant/Owner or Life Assured are required by Us, before the Policy is renewed or varied, to answer any questions or if Applicant/Owner or Life Assured are required to confirm or amend any matter previously disclosed by Applicant/Owner to Us in relation to this Policy, it is Applicant/Owner’s duty to take reasonable care not to make a misrepresentation when answering the questions or confirming or amending any matter previously disclosed. Applicant/Owner must inform Us of any change to the information given to Us in his/her answers or in respect of any matter previously disclosed to Us in relation to the Policy if such changes had taken place after Applicant/Owner have submitted the application for renewal/variation but before the Policy is renewed or varied. ALTERATION No alterations in the terms of this Policy or any Endorsement thereon will be held valid unless the same is signed or initialled by Our authorised representative with three (3) months prior written notice by providing valid reason. AGE AND SEX This Policy is issued at the age shown on the Policy Information Page, which is the Life Assured’s age at last birthday. If the age or sex was misstated in the application form, the benefits or premium will be adjusted according to the Policy which had been purchased based on the true age or sex. CERTIFICATION, INFORMATION AND EVIDENCE All Contracts, information, medical reports and evidence as required by Us shall be furnished at the expense of the Life Assured, and in such a form that We may require. In any event all notices which We shall require the Applicant/Owner to give must be in writing and addressed to Us. The Life Assured shall, at our request and expense, submit to Us a medical examination whenever such is deemed necessary. CHANGE IN RISK The Applicant/Owner shall give immediate notice in writing to Us of any material change in the Life Assured’s occupation, business, duties or pursuits and any additional premium that may be required by Us shall be collected accordingly. If such change in risk has rendered the Life Assured to be no longer insurable by Us, this Policy will be terminated. CLAIM PROCEDURES a) The Life Assured shall within thirty (30) days of a covered Disability, give written notice to us stating full particulars of such event, including all original bills and receipts, and a full General Practitioner and/or Specialist's report stipulating the diagnosis of the condition treated and the date the Disability commenced in the General Practitioner and/or Specialist's opinion and the summary of the cost of treatment including medicines and services rendered. Failure to furnish such notice within the timeline stipulated shall not invalid any claim if it is shown not to have been reasonably possible to furnish such notice and that such notice was furnished as soon as was reasonably possible. b) The Life Assured shall immediately procure and act on proper medical advice and we shall not be held liable in the event a treatment or service becomes necessary due to failure of the Life Assured to do so. CLAIM PERIOD SPANNING ACROSS TWO POLICY YEAR If the Eligible Expenses flow into the next Policy Year, the benefits to be reimbursed will be apportioned based on the itemized expenses incurred on a daily basis in the relevant Policy Year. If there is no itemization of the expenses by daily breakdown, such expenses shall be apportioned as a percentage of the days of confinement (including day of admission) for each respective Policy Year. In no situations will the benefit limit exceed the Policy Year as stipulated in the Schedule of Benefits and evidence of Hospitalisation is required for other than out-patient benefits and day procedure benefits. CONVERSION OF POLICIES If the eligible benefits as stipulated under the Schedule of Benefits provided under this Policy Contract shall have been converted from an existing coverage of an ‘Inner Limits’ to an ‘As Charged/Full Reimbursement’ coverage, and if such Life Assured shall have been afflicted with a Disability prior to or at the time the benefits were converted the benefits payable in respect of the Disability shall be in accordance with the Schedule of Benefits prior to the date the eligible benefits were converted. CURRENCY AND PLACE OF PAYMENT All amounts payable either to Us or by Us will be in Malaysian Ringgit and at Our office shown on the Policy Information Page or any payment channel which has been approved by Us. Should any payment be requested by the Applicant/Owner to be payable in any other currency, then such amount shall be payable in the demand currency as may be purchased in Malaysia at the prevailing currency market rates on the date of the claim settlement. COOLING-OFF PERIOD The Applicant/Owner shall have the right to cancel the Policy by giving written notice to Us within fifteen (15) days after the delivery of this Policy. Upon cancellation, the premiums that You have paid less any medical fee incurred will be refunded to You. CANCELLATION Applicant/Owner may cancel this policy at any time by giving written notice to Us. Upon cancellation, Applicant/Owner is entitled for a refund of premium as per the schedule below, provided that Life Assured have not made a claim during the current policy year. The amount of premium refund shall be based on the duration the Policy has been in force in a Policy Year: Period Not Exceeding Refund of Annual Premium 15 days 90% (applicable to renewal only) 1 month 80% 2 months 70% 3 months 60% 4 months 50% 5 months 40% 6 months 30% 7 months 25% 8 months 20% 9 months 15% 10 months 10% 11 months 5% Period Exceeding 11 months No refund For quarter and semi-annual premium payment mode, refund of premium will be pro-rated accordingly. There is no refund for monthly mode premium payment. DEDUCTION FROM PROCEEDS Any indebtedness on this Policy will be deducted by Us from any payment or proceeds under this Policy at the time of settlement. GEOGRAPHICAL TERRITORY All benefits provided in this Policy are applicable worldwide for twenty-four (24) hours a day subject to Overseas Treatment and Residence Overseas clause. GOVERNING LAW This Policy is issued under the laws of Malaysia and is subject and governed by the laws prevailing in Malaysia. HOSPITAL CONSULTATION, PROCEDURE AND MISCELLANEOUS FEE Fees or charges as mentioned under the Schedule of Benefits for various descriptions of medical services and/or treatment in this Policy Contract shall refer to the Thirteenth Schedule of the Private Healthcare Facilities and Services (Private Hospital and Other Private Healthcare Facilities) Regulations 2006 and as amended from time to time. INCONTESTABILITY AND MISREPRESENTATION If this Policy has been in-force for more than two (2) years from the Issue Date (as stated in the Policy Information Page), this Policy not be contestable except for fraud. If this Policy has been in-force during the lifetime of the Life Assured for two (2) years or less from the Issue Date (as stated in the Policy Information Page), We shall apply the remedies in Schedule 9 of the Financial Services Act 2013 accordingly in respect of the pre-contractual misrepresentation. INCOMPLETE CLAIMS All claims must be submitted to Us within thirty (30) days of completion of the events for which the claim is being made. Claims are not deemed complete and eligible benefits are not payable unless all original bills and receipts for such claims have been submitted and agreed upon by Us. Only Reasonable and Customary Charges incurred shall be considered for reimbursement. INFORMATION AND TERMS AND CONDITONS RELATING TO INTERNATIONAL AUTOMATIC EXCHANGE OF INFORMATION FOR TAX PURPOSES AND CUSTOMER TAX COMPLIANCE In connection with legal and regulatory requirements regarding the international exchange of information for tax purposes, including the U.S. Foreign Account Tax Compliance Act (FATCA) and laws and regulations related thereto, We are required to apply certain due diligence procedures to identify the tax residency or tax residencies of certain persons related to the policy. In order to comply with this obligation, the Policyowner and any person entitled to access the cash value, change the beneficiary or perform certain other actions with respect to the policy as described by law (together in this Clause, to be referred to as “Policyowner”) must at Our request provide Us with an accurate self-certification regarding the jurisdiction or jurisdictions in which the Policyowner is a tax resident and, if applicable, respond to Our request for documentary evidence and a taxpayer identification number or equivalent as is requested under the relevant regulation. In accordance with applicable law, We will periodically report certain information about Policyowners, including name and address, date of birth, place of birth and financial details relating to the policy to the appropriate tax authority/ies or other authority/ies designated by law. If the Policyowner moves to another country and/or if the tax residency of any Policy-holder changes or differs from the information provided in a self-certification of tax residency or in documentation provided in connection with the policy, the Policyowner providing that self-certification or documentation must give Us written notice prior to such change but no later than within 30 days or such lesser number of days as required by law of such change. Please note that should you move to another country you may no longer be eligible to make payments into your policy or to make any investment decision relating to your policy. The local laws and regulations of the jurisdiction to which you move may affect our ability to continue to service your policy in accordance with its terms and conditions. therefore, we reserve all rights to take any steps that we deem appropriate, including the right to cancel or terminate the policy with immediate effect or with a notice period of the minimum number of days permitted by law. If this policy is transferred/assigned to a new Policyowner or a new Policyowner is added to the policy the original Policyowner must give Us prior written notice of such change to the Policy. each new or additional Policyowner must promptly or with the minimum number of days permitted by law respond to Our request for an accurate self-certification regarding the jurisdiction or jurisdictions in which the new/additional Policyowner is a tax resident and respond to Our request for documentary evidence and a taxpayer identification number or equivalent. In addition to the actions described herein, failure to provide Us with such notice or provide Us the full requested information may impair the rights of the Policyowner under the policy or result in the termination of the policy. We execute payments under the policy such as payments due to maturity of the policy, partial or full surrender, or policy loans only to the Policyowner or beneficiary indicated in the relevant contractual document. These payments can only be made by wire transfer and to a bank account in the name of such Policyowner or beneficiary located in the same jurisdiction as the Policyowner’s or, as applicable, the beneficiary’s (tax) residency. An exception to these restrictions may be granted at Our sole discretion and after evaluation of the facts and circumstances. Under no circumstances We will execute any policy related cash payments to US residents. At Our request and based upon an indication that the most recent self-certification or tax residency is required respectively may no longer be reliable or accurate, a Policyowner must promptly or with the minimum number of days permitted by law provide a new self-certification and other supporting documentation as requested by Us. We reserve all rights to take any steps that We deem appropriate, including the right not to execute payment instructions until we have received all information and documentation to our satisfaction, or to cancel the policy, with immediate effect or with a notice period of the minimum number of days permitted by law, in the event that We discover that a Policyowner and/or beneficiary provided an incorrect self-certification, that any other information or documentation provided in connection with identification and due diligence procedures is inaccurate or incomplete or a Policyowner did not provide Us with a self-certification or other information as requested by Us within the response time set out in Our request. Failure to fully respond to Our request within the time period allowed may result in the reporting of information about the Policyowner to the appropriate tax authority or other authorities. We do not provide any tax advice. Any information relating to applicable tax laws and regulations is of a general nature only. This policy is designed for Policyowners who are resident in Malaysia. If you decide to live outside of Malaysia after this policy has been issued, and if you have questions or wish to receive additional information with respect to any of the provisions set forth above We recommend you obtain independent advice. We reject any responsibility or liability whatsoever for any adverse tax consequences that may arise in respect of your policy and/ or any payments made under your policy as a result of you changing the country of residency. Your insurance contract has been concluded based on the legal and regulatory requirements in force and applicable at the time of conclusion. Should the mandatory legal and regulatory requirements applicable to this policy change, in particular if you change your country of residency, and as a consequence We are not able to continue performing the contract without potential material adverse effect to Us, to meet the changed legal and regulatory requirements We are entitled to modify the contractual terms and conditions as We deem appropriate at Our own discretion and without your consent, or to terminate the policy. We will inform you whenever reasonably possible in advance about the changes in the contractual terms and conditions. In the case of termination of the policy, We will send you a termination notice and the contract will terminate in accordance with the termination notice. We reject any responsibility or liability whatsoever for any cost incurred by, or liability imposed on, a Policyowner as a result of Our good faith efforts to comply with requirements regarding the identification, due diligence or reporting of information relating to Policyowners for tax purposes. NOTICE Every notice or communication to Us shall be in writing and sent to Us. Any notices, requests, instructions, or correspondences to be given by Us shall be sent by either post, electronic means or any other methods deemed practicable to the last known address provided by the Applicant/Owner to Us in writing, and such communication shall be conclusively deemed to have been received by the Applicant/Owner. NON-PARTICIPATING IN PROFITS A non-participating policy shall not be entitled to share in Our profits. OTHER CONTRACT If the Life Assured is covered under other Life policy covering any Disability covered by this Policy Contract, We shall only pay the remaining of Eligible Expenses incurred if the Life Assured received any reimbursement from other Life policy covering any Disability covered by this Policy Contract. OVERSEAS TREATMENT If the Life Assured is referred to be treated outside Malaysia by the attending Specialist, benefits in respect of the treatment shall be limited to the Reasonable and Customary and Medically Necessary charges for such equivalent local treatment in Malaysia and shall exclude the cost of transport to the place of treatment. PERIOD OF COVER AND RENEWAL This Policy shall become effective as of the date stated in the Policy Information Page or Endorsement. The Policy Anniversary shall be one (1) year after the Commencement date of this Policy and annually thereafter. On each such anniversary, this Policy is renewable at the premium in effect at that time as notified by us. This Policy is renewable up to age ninety-nine (99). PROOF OF AGE Where the Life Assured’s age has not been verified, We may require proof of age of the Life Assured before the payment of benefits under this Policy. RESIDENCE OVERSEAS No benefit whatsoever shall be payable for any medical treatment received by the Life Assured outside Malaysia, if the Life Assured resides or travels outside Malaysia for more than ninety (90) consecutive days. SANCTIONS All financial transactions are subject to compliance with applicable trade or economic sanctions laws and regulations. We will not provide you with any services or benefits including but not limited to acceptance of premium payments, claim payments and other reimbursements, if in doing so We violate applicable trade sanctions laws and regulations. We may terminate the policy if We identify you or any of your directors, shareholders or officers as sanctioned persons, or you conduct an activity which is sanctioned, according to trade or economic sanctions laws and regulations. SUBROGATION If We shall become liable for any payment under this Policy Contract, We shall be subrogated to the extent of such payment to all the rights and remedies of the Applicant/Owner against any party and shall be entitled at its own expense to sue in the name of the Applicant/Owner. The Applicant/Owner shall give or cause to be given to Us all such assistance in his/her power as We shall require securing the rights and remedies and at our request shall execute or cause to be executed all documents necessary to enable Us to effectively to bring suit in the name of the Applicant/Owner. TAX All premium and fees payable under this policy may be subject to Tax. If Tax is imposed, it will be stated in the invoice, and We may claim or collect the Tax from the Applicant/Owner in addition to the premium and/or fees payable under this Policy. TERMINATION This policy shall automatically terminate on the first occurrence of the following events: a) On the death of the Life Assured; or b) On the Policy Anniversary following the hundredth (100th) birthday of the Life Assured; or c) If any premium on this Policy remains unpaid at the end of the Grace Period; or. d) If this policy becomes terminated, lapsed, matures/expires, or is surrendered; or e) When the change in risk as stated in the Change In Risk clause below has rendered the Life Assured to be no longer insurable by Us; or f) When a written request for termination of this Policy is submitted to Us for endorsement to that effect. Termination of this Policy Contract will have no effect to any claim arising prior to such termination. We reserve the right to terminate this Policy Contract if the Life Assured makes any claim which is fraudulent or exaggerated, or if the Life Assured makes any false declaration or statements in support of any claim. TAKE-OVER POLICIES This Policy shall commence immediately upon termination of a preceding Policy if take-over benefit is granted. If the Waiting Period of the previous Policy has not expired immediately before the take-over, the said Waiting Period shall continue until they are fulfilled. EXCLUSIONS This Policy Contract shall not cover any Hospitalisation, Surgery or charges caused directly or indirectly, wholly or partly, by any one (1) of the following occurrences: 1) Pre-existing Conditions; or 2) Plastic/Cosmetic Surgery or treatment (except medically necessary Surgery), circumcision (except circumcision due to infection), eye examination, glasses and refraction or surgical correction of near sightedness (Radial Keratotomy) and the use or acquisition of external prosthetic appliances or devices such as artificial limbs, hearing aids, implanted pacemakers and prescriptions thereof; or 3) Dental conditions including dental treatment or oral Surgery except as necessitated by Accidental Injuries to sound natural teeth occurring wholly during the coverage period of the Policy Contract; or 4) 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 (Human Immunodeficiency Virus) related diseases, and any communicable diseases requiring quarantine by law except for the Eligible Expenses covered under Hospitalisation Due To Covid-19 Or Complication Arising From Covid-19 Vaccination; or 5) Any treatment or surgical operation for Congenital Conditions or deformities including hereditary conditions; or 6) Pregnancy, childbirth (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; or 7) 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 General Practitioner and/or Specialist; or 8) Treatments specifically for weight reduction or gain; or 9) Suicide, Attempted suicide or intentionally self-inflicted injury while sane or insane; or 10) 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; or 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) Expenses incurred for donation of any body organ by the Life Assured and costs of acquisition of the organ including all costs incurred by the donor during organ transplant and its complications; or 13) 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; or 14) Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations); or 15) 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; or 16) 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; or 17) Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes; or 18) Expenses incurred for sex changes. COMPASSIONATE BENEFIT Compassionate Benefit shall not be paid if the Life Assured commits suicide within one (1) year from the Issue Date. WAITING PERIOD Eligibility for benefits begins thirty (30) days after the Commencement Date or effective date of change or date of reinstatement of this Policy, except for a covered Accident occurring after the Commencement Date or effective date of change or date of reinstatement as stated in the Policy Information Page or Endorsement. For Specified Illnesses including Cancer, the Waiting Period is occurring during the first one hundred and twenty (120) days from the Commencement Date or effective date of change or reinstatement date whichever is latest. SECTION B REFERRAL EMERGENCY ASSISTANCE PROGRAMME (EAP) We have an agreement with Integrated Health Plans (Malaysia) Sdn Bhd, the appointed MCO (hereinafter known as the “Service Provider”), to provide a comprehensive international medical assistance programme. This value-added service programme is specially provided to all Life Assured (hereinafter known as “the Member”) under this Policy Contract. Member may place a reverse charge call/call collect to the Service Provider’s Service Hotline at any time seven (7) days a week for any of the services described below: Integrated Health Plans (Malaysia) 24 Hours Service Hotline 1-800-82-6100 All the benefits under this programme will automatically cease on the earliest happening of the events as stated under Termination clause. 1. International Medical Assistance Programme Services described herein are available to the Member traveling anywhere outside Malaysia with each trip not exceeding ninety (90) consecutive days. 1.1 Tele-medical consultation and evaluation of the Member’s condition When medical advice is needed during travel outside Malaysia, the Member is to call the Service Provider for assistance and advice. The Service Provider’s duty doctor will provide help over the phone. Important: The telephone conversation does not amount to the establishment of a diagnosis and must be considered as advice only. 1.2 Medical Referral and Arrangement of Medical Appointments Upon request, the Service Provider shall provide the names, addresses and telephone numbers of medical practitioner (including both General Practitioners and Specialists), Hospitals, Dentists, and dental clinics. The Service Provider will attempt upon request to confirm the availability of the applicable medical or dental professional to make an appointment for treatment. 1.3 Arrangement of Hospital Admission Guarantee In the event that the emergency admission is needed, and Member has no means for the required Hospital admission deposit, the Service Provider will provide admission guarantee on behalf of the Member, such service shall be subjected to the Service Provider having first securing payment guarantee through credit card or funds from the Member’s family. 1.4 Dispatch of Medication Not Available Locally The Service Provider will dispatch the necessary medication not available locally in case of an emergency and where local laws, rules and regulations allow such dispatch. Cost of medicine shall be borne by the Member and the Service Provider shall pay for the cost of such dispatching. 1.5 Medical Evacuation Following a medical emergency and Hospitalisation, when the Service Provider’s doctor in consultation with the attending General Practitioner and/or Specialist determines that local medical facility is inadequate to treat the Member, the Service Provider will arrange for medical evacuation under constant medical supervision to the nearest adequate medical facility. 1.6 Medical Supervised Repatriation If the Service Provider’s doctor, in consultation with the local attending General Practitioner and/or Specialist, determines the treatment should continue at a medical facility nearer home following stabilisation, the Service Provider will arrange for the repatriation under constant medical supervision. All decisions as to the means of transportation and the final destination will be made by the Service Provider or its authorised representative and will be based solely upon medical necessity. The Medical Evacuation and Medical Supervised Repatriation services described in 1.5 and 1.6 above shall be organised by the Service Provider and paid by Us subject to the provisions of this Policy Contract. All costs incurred are subject to a limit of US Dollar One Million (USD 1,000,000) per Member per event. 1.7 Medical Monitoring & Emergency Message Transmission The Service Provider will monitor the Member’s condition if the Member is hospitalised and will keep the Member’s employer/family informed, with prior agreement of the Member in writing, unless this is not practicable. 1.8 Repatriation of Mortal Remains If the Member dies while on the trip due to a Sickness or an Accident, the Service Provider or its authorized representative will organise and pay for all expense incurred for the return of the body or remains to the Member’s country of origin. All costs incurred for such repatriation is subject to a maximum limit of Ringgit Malaysia Fifty Thousand (RM 50,000). 1.9 Visit to Bedside by a Friend/Relative Should the Member’s hospitalisation outside Malaysia be expected to last more than seven (7) consecutive days, and the Service Provider’s duty doctor agrees that it is medically necessary for a relative/friend to be by the Member’s bedside provided no travel companion is with the Member, the Service Provider will arrange and We shall pay for one economy class return transportation and hotel room accommodation for a relative/friend to visit the Member. The cost of hotel room accommodation is subject to a limit of Ringgit Malaysian Eight Hundred (RM 800) per night up to a maximum of Ringgit Malaysian Three Thousand Five Hundred (RM 3,500). 1.10 Return of Children Travelling with the Member In the event of the Member’s Hospitalisation and the Member’s medical condition prevents the Member from caring for the Member’s minor children (below age of eighteen (18) years) travelling with the Member and no relative is on the spot able is to care for them, the Service Provider will arrange for one way economy class transportation for the children to be sent back to their country of origin. We shall pay for the cost incurred for the one-way economy class ticket for all minor children travelling with the Member. 2. Travel Assistance 2.1 Visa, Passport and Inoculation Requirements The Service Provider will provide information concerning Visa, inoculation, passport or immunization requirements of the foreign countries in which the Member will be travelling. 2.2 Location of Lost Items The Service Provider will assist the Member in the location of lost luggage, documents and personal items. Airlines, government authorities and credit card issuers are among those who will be contacted, if necessary. 2.3 Emergency Message Relay In case of an emergency, the Service Provider will attempt to establish a national or international message relay to a designated addressee. 2.4 Arrangement of Flights The Service Provider will assist with the arrangement of flights for family return if travelling with the Member. 2.5 Legal Referral Should the Member seek legal assistance for an emergency while on a trip, the Service Provider will refer the Member to local legal advisors. 2.6 Referral to Interpreter/Translator Should the Member needs translation assistance for an emergency in the course of the Member’s trip, the Service Provider will refer the Member to a local translator. 2.7 Weather and Foreign Exchange Information The Service Provider shall provide information on foreign weather condition as well as foreign exchange rates when required. 3. Car Assistance 3.1 24 hours Emergency Towing and Minor Roadside Repair In the event that a Member’s car is immobilised due to accident or breakdown, the Member shall be entitled to contact the Service Provider for assistance. Should it be deemed possible to repair the Member’s car on the spot, the Service Provider shall arrange for such minor roadside repair. In the event it is not possible to repair the car on the site, the Service Provider shall arrange for the car to be towed to the nearest workshop for repairs. Any cost incurred for the towing and minor roadside repair shall be borne by the Member. Territorial Limits The emergency towing and minor roadside repair referred to in this Clause shall be available where such services are required within Peninsular Malaysia and Singapore excluding the islands except for Penang and Langkawi. In East Malaysia, services shall only be available in Kota Kinabalu, Sandakan, Tawau, Labuan, Sibu, Bintulu, Miri and Kuching. 3.2 Car Rental Assistance Should the Member require a car replacement in the event of a car breakdown, the Service Provider shall refer to designated third party service providers and assist the Member in arranging for car rental. Cost of car rental shall be borne by the Member. 3.3 Arrangement for Hotel Accommodation As a result of a car breakdown, should a Member needs hotel accommodation, the Service Provider shall refer the Member to hotels designated by the Service Provider in order to make reservation and arrangement for hotel accommodation. All costs incurred for such hotel accommodation and ancillary charges shall be solely borne by the Member concerned. 3.4 Referral to Service Centre The Member may contact the Service Provider to arrange for referral to the nearest repair and service centre for car servicing or repair. The Service Provider shall also arrange for prior appointment for the Member. All costs incurred in such car repair or servicing shall be borne by the Member. 4. Home Assistance The following Home Assistance Services shall only be available to Members residing in major towns of Peninsular Malaysia. 4.1 Plumbing Assistance Should the Members require plumbing services at home, the Service Provider shall provide referral information to plumbers. The Service Provider will also assist in arranging for house call if necessary. 4.2 Locksmith Assistance The Service Provider will arrange for referral or house call service in the event that the Member requires the services of a locksmith. 4.3 General Repair Assistance The Service Provider will also provide information for general repair services such as repairs of home electrical appliances. 4.4 Air conditioning Assistance Should the Member require repair in relation to air conditioners, the Service Provider shall refer the Member to persons who can provide such services and would also arrange for house call if necessary. 4.5 Pest Control Assistance The Service Provider shall assist the Members by referring them to pest control, pest prevention, soil treatment, anti- termite, and mosquito control services. The Service Provider will also arrange for house call if necessary. The services described in the Travel, Car and Home Assistance above shall be purely on referral and arrangement basis. We and the Service Provider shall not be responsible for any third-party cost incurred; such cost shall be borne directly by the Member. DEFINITIONS MEDICAL EMERGENCY A situation which in the opinion of the Service Provider’s doctor constitutes a serious medical emergency requiring urgent remedial treatment to avoid death or serious impairment to the Member’s immediate or long-term health prospects. The severity of the medical condition will be judged within the context of the Member’s geographical location, the nature of the medical emergency and the local availability of appropriate medical care or facilities. MINOR ROADSIDE REPAIR Minor repairs are such that are deemed possible to be repaired on the spot including but not limited to change of tyres, minor wiring work and change of battery. The minor roadside repairs are also subject to the availability of parts and component at the time of the breakdown. EXCLUSIONS The International Medical Assistance Programme described above is subject to the list of exclusions below: 1) Emergency medical evacuation, repatriation or costs not approved in advance and in writing by the Service Provider and/or not arranged by the Service Provider. This exclusion shall not apply to Emergency Medical Evacuation from remote or primitive areas which the Service Provider cannot be contacted in advance and delay might reasonably be expected to result in loss of life or extreme prejudice to the well-being of the Member. 2) If the Member is traveling contrary to the advice of a medical practitioner or for the purpose of obtaining medical treatment or for the rest and recuperation following any prior accident or illness. 3) If in the opinion of the Service Provider, the Member is not suffering from a serious medical condition or if the treatment can be reasonably delayed until the Member returns to Malaysia or usual country of residence. 4) If the Member is participating or engaging in war or any act of war (whether war be declared or not), invasion acts of foreign enemies, hostilities, rebellion, revolution, insurrection, military or usurped power, illegal activities, active servicing in any of the military or armed forces other than peace time reservist training. 5) If the Member is suffering from any condition resulting from ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material. 6) Failure by the Member to take reasonable precautions following warnings of any intended strike, riot or civil commotion via the mass media. 7) Self-inflected injury or attempted suicide, mental or psychiatric disorder, drug addiction or abuse, alcohol abuse, sexually transmitted diseases, Acquired Immune Deficiency Syndrome (AIDS) or any AIDS related conditions or diseases. 8) Any expenses arising from childbirth, miscarriage, pregnancy (except abnormal pregnancy or vital complication of pregnancy which endangers the life of the mother and/or unborn children). 9) Any Injuries arising from racing of any kind (other than racing on foot), sports exhibitions, bungee jumping, mountaineering or rock climbing necessitating the use of guides or ropes, scuba diving, aeronautics or aviation activities other than as a fare paying passenger in a properly licensed commercial or private aircraft or professional sports. 10) Any health condition constitutes one of the reasons to undertake the trip. ADDITIONAL CONDITIONS a) We and the Service Provider shall not be held responsible for the failure or delay to provide the services caused by strikes or conditions beyond Our and the Service Provider’s control including, but not limited to, flight conditions or where local laws of regulatory agencies prohibit the Service Provider from rendering such services. b) The legal professionals, medical professionals, car assistance and/or home assistance providers referred by the Service Provider to provide direct services to the Member are not employees or agents of the Service Provider and/or its subsidiaries or affiliated companies. We and the Service Provider and/or its subsidiaries or affiliated companies cannot be held responsible for the quality or results of any services provided by independent practitioners to whom the Service Provider refers the Member. c) This programme shall cease in the event that the Policy Contract is terminated. d) We shall be entitled to vary any of the provisions herein and withdraw from this programme at any time by giving thirty (30) days’ notice in writing with accompanying notification letter detailing the reason of change. Z-MedProtect Policy OUR AGREEMENT WITH YOU Consumer Insurance Contract This Policy is issued in consideration of the payment of premium as specified in the Policy Schedule and pursuant to the answers given in the Policyholder’s Proposal Form (or when the Policyholder applied for this insurance) and any other disclosures made by the Policyholder between the time of submission of the Policyholder’s Proposal Form (or when the Policyholder applied for this insurance) and the time this contract is entered into. The answers and any other disclosures given by the Policyholder shall form part of this contract of insurance between the Policyholder and Us. However, in the event of any pre-contractual misrepresentation made in relation to the Policyholder’s answers or in any disclosures given by the Policyholder, only the remedies in Schedule 9 of the Financial Services Act 2013 will apply. This Policy reflects the terms and conditions of the contract of insurance as agreed between the Policyholder and Us. Non-Consumer Insurance Contract This Policy is issued in consideration of the payment of premium as specified in the Policy Schedule and pursuant to the answers given in the Policyholder’s Proposal Form (or when the Policyholder applied for this insurance) and any other disclosures made by the Policyholder between the time of submission of the Policyholder’s Proposal Form (or when the Policyholder applied for this insurance) and the time this contract is entered into. The answers and any other disclosures given by the Policyholder shall form part of this contract of insurance between the Policyholder and Us. In the event of any pre-contractual misrepresentation made in relation to the Policyholder’s answers or in any disclosures made by the Policyholder, it may result in avoidance of the Policyholder’s contract of insurance, refusal or reduction of Policyholder’s claim(s), change of terms or termination of the Policyholder’s contract of insurance. This Policy reflects the terms and conditions of the contract of insurance as agreed between the Policyholder and Us. DEFINITIONS Certain words have been defined below. These have the same meaning wherever they are used in the Policy. They are bold and begin with a capital letter (e.g. Insured Person, You, Your). ACCIDENT or ACCIDENTAL shall mean a sudden, unforeseen and fortuitous event that happens unexpectedly during the Period of Insurance. ACCIDENTAL DENTAL TREATMENT shall mean dental procedure necessary as a result of Accident. ACT OF TERRORISM shall mean an act, including the use of force or violence, of any person or group of persons, whether acting alone or on behalf of or in connection with any organisation, committed for political, religious or ideological purposes including the intention to influence any government and/or to put the civilian population in fear for such purposes. ANY ONE DISABILITY shall mean the whole period of Disability arising from the same cause including any and all complications therefrom except that if You completely recover and remain free from further treatment (including drugs, medicines, special diet or injection or advice for the condition) of the Disability for at least ninety (90) days following the latest date of discharge and subsequent Disability from the same cause shall be considered as though it were a new Disability. AS CHARGED refers to actual charges incurred for reasonable, necessary and customary medical care provided in the treatment of a covered Disability. CONGENITAL CONDITIONS shall mean any medical or physical abnormalities existing at the time of birth, as well as neo-natal physical abnormalities developing within six (6) months from the time of birth. They will include hernias of all types and epilepsy except when caused by trauma, which occurred after the date You were continuously covered under this Policy. DAY shall mean the definition of a charging Day adopted by the Hospital concerned. DAY SURGERY shall mean a patient who needs the use of a recovery facility for a surgical procedure on a pre-plan basis at the Hospital / Specialist Clinic (but not for overnight stay). DENTIST shall mean a registered dental practitioner qualified and licensed to practice dentistry and who, in rendering such treatment, is practicing within the scope of his licensing and training in the geographical area in which a service is provided, but excluding a Dentist who is the Insured Person himself or his immediate family i.e. siblings, spouse, child or parent. DISABILITY shall mean a Sickness, Disease, Illness or the entire Injuries arising out of a single or continuous series of causes. DOCTOR or PHYSICIAN or SURGEON shall mean a registered medical practitioner qualified and licensed to practice Western medicine and who, in rendering such treatment, is practicing within the scope of his licensing and training in the geographical area of practice, but excluding a Doctor, Physician or Surgeon who is the Insured Person himself or his immediate family i.e. siblings, spouse, child or parent. Z-MedProtect/PW/20220113 Page 1 of 14 ELIGIBLE EXPENSES shall mean Medically Necessary expenses incurred due to a covered Disability but not exceeding the limits in the Schedule of Benefits. EMERGENCY shall mean treatment needed in the event whereby immediate medical attention is required within the twelve (12) hours of Injury, Illness or symptoms which are sudden and severe failing where Your life could be threatened or lead to significant deterioration of health. FAMILY MEMBERS shall mean Your legal spouse(s), parents and child(ren). HOSPITAL shall mean only an establishment duly constituted and registered as a Hospital for the care and treatment of sick and injured person as paying bed-patients, and which: (a) has facilities for diagnosis and major Surgery, (b) provides twenty-four (24) hours a day nursing service by registered and graduate nurse, (c) is under supervision of a Physician, and (d) is not primarily a clinic; a place for alcoholics or drug addicts; a nursing, rest or convalescent home or a home for the aged or similar establishment. HOSPITALISATION shall mean admission to a Hospital as a registered in-patient for Medically Necessary treatments for a covered Disability upon recommendation of a Physician. A patient shall not be considered as an in-patient if the patient does not physically stay in the Hospital for the whole period of confinement. INJURY shall mean bodily Injury caused solely by an Accident. POLICYHOLDER shall mean a person or a corporate entity or an association/affinity to which the Policy has been issued in respect of cover for persons specifically identified as the Insured Person in this Policy and can exercise all rights, privileges and options available under this Policy. INSURED PERSON / YOU / YOUR shall mean the person(s) covered described in the Policy Schedule. INTENSIVE CARE UNIT shall mean a section within a Hospital which is designated as an Intensive Care Unit by the Hospital, and which is maintained on a twenty-four (24) hours basis solely for treatment of patients in critical condition and is equipped to provide special nursing and medical services not available elsewhere in the Hospital. LOSS OF HEARING shall mean permanent irrecoverable loss of hearing. LOSS OF LIMB shall mean loss by physical separation at or above the wrist or ankle joint. LOSS OF SIGHT shall mean the entire and permanent irrecoverable loss of sight. LOSS OF SPEECH shall mean total permanent inability to communicate verbally. LOSS OF USE shall mean permanent total functional disablement and is treated like total loss of said limb or organ and not in terms of Your professional or occupational incapacity or covered event. MALAYSIAN GOVERNMENT HOSPITAL shall mean a Hospital which charges of services are subject to the Fee Act 1951 Fees (Medical) Order 1982 and/or its subsequent amendments if any. MEDICALLY NECESSARY shall mean a medical service which is: (a) consistent with the diagnosis and customary medical treatment for a covered Disability, and (b) in accordance with standards of good medical practice, consistent with current standard of professional medical care, and of proven medical benefits, and (c) not for Your convenience or the Physician, and unable to be reasonably rendered out of Hospital (if admitted as an inpatient), and (d) not of an experimental, investigational or research nature, preventive or screening nature, (e) for which the charges are fair and reasonable and customary for the Disability. NO CLAIM BONUS shall mean upon renewal of this Policy (provided such renewal is continuous, the Policy has not been lapse in any one (1) given year, and no claim has been made during the preceding year of cover), the No Claim Bonus of ten percent (10%) shall be applicable. The No Claim Bonus is not cumulative and in the event of a claim being made by any one of You, the No Claim Bonus will be forfeited totally. OUTPATIENT shall mean You are receiving medical care or treatment without being hospitalised and includes treatment in a daycare centre. OVERALL ANNUAL LIMIT shall mean benefits payable in respect of expenses incurred for treatment provided to You during the Period of Insurance shall be limited to Overall Annual Limit as stated in the Schedule of Benefits irrespective of type / types of Disability. In the event the Overall Annual Limit having been paid in full, all insurance for You hereunder shall immediately cease to be payable for the remaining Policy Year. OVERSEAS shall mean any destination outside of Malaysia. PERIOD OF INSURANCE shall mean the duration of the Policy as stated in the Policy Schedule. PERMANENT TOTAL DISABLEMENT shall mean disablement that result solely, directly and independently of all other causes from bodily Injury and which occurs within three hundred sixty-five (365) consecutive days will in all probability entirely prevent You from engaging in employment of any and every kind for the remainder of Your life and from which there is no hope of improvement. POLICY SCHEDULE shall refer to the document issued by Us that is issued to verify the existence of Insurance coverage granted to You. Z-MedProtect/PW/20220113 Page 2 of 14 POLICY YEAR shall mean the one (1) year period including the effective date of commencement of Insurance and immediately following that date, or the one (1) year period following the Renewal or Renewed Policy. PRE-EXISTING CONDITION shall be limited to Disabilities which existed before the effective date of cover and for which You should have reasonably been aware of. You may be considered to have reasonable knowledge of a Pre-Existing Condition where the condition is one for which: (a) You have received or are receiving treatment; (b) medical advice, diagnosis, care or treatment has been recommended; (c) clear and distinct symptoms are or were evident; or (d) its existence would have been apparent to a reasonable person in the circumstances. PRESCRIBED MEDICINES shall mean medicines that are dispensed by a Physician, registered pharmacist or a Hospital and which have been prescribed by a Physician / Specialist in respect of treatment for a covered Disability. REASONABLE AND CUSTOMARY CHARGES shall mean charges for medical care which is Medically Necessary shall be considered reasonable and customary to the extent that it does not exceed the general level of charges being made by others of similar standing in the locality where the charge is incurred, when furnishing like or comparable treatment, services or supplies to individual of the same gender and of comparable age for a similar Sickness, Disease or Illness and in accordance with accepted medical standards and practice could not have been omitted without adversely affecting Your medical condition. RENEWAL OR RENEWED POLICY shall mean a Policy which has been renewed without any lapse of time upon expiry of a preceding Policy with the same content. RM shall mean in Ringgit Malaysia, the currency of Malaysia. SERIOUS INJURY OR SERIOUS ILLNESS shall mean a critical or dangerous Disability which in the opinion of a Physician or Service Provider, requires urgent remedial treatment to avoid death or serious impairment to immediate or long-term health conditions. SERVICE PROVIDER shall mean the twenty-four (24) hours worldwide emergency assistance. SICKNESS, DISEASE OR ILLNESS shall mean a physical condition marked by a pathological deviation from the normal healthy state. SPECIALIST shall mean a medical or dental practitioner registered and licensed as such in the geographical area of his practice where treatment takes place and who is classified by the appropriate health authorities as a person with superior and special expertise in specified fields of medicine or dentistry, but excluding a Physician or Surgeon or Dentist who is the Insured Person himself or his immediate family i.e. siblings, spouse, child or parent. SPECIFIED ILLNESSES shall mean the following disabilities and its related complications, occurring within the first one hundred and twenty (120) days of continuous cover: (a) Hypertension, Diabetes Mellitus and Cardiovascular Disease. (b) All tumours of any kind, cancers, cysts, nodules, polyps, stones of the urinary system and biliary system. (c) All ear, nose (including sinuses) and throat conditions. (d) Hernias, haemorrhoids, fistulae, hydrocele, varicocele. (e) Endometriosis including Disease of the Reproduction system. (f) Vertebro-spinal disorders (including discs) and knee conditions. SURGERY shall mean any of the following medical procedures: (a) To incise, excise or electrocauterize any organ or body part, except for dental services. (b) To repair, revise or reconstruct any organ or body part. (c) To reduce by manipulation a fracture or dislocation. (d) Use of endoscopy to remove a stone or object from the larynx, bronchus, trachea, oesophagus, stomach, intestine, urinary bladder or urethra. TAX shall mean any present or future, direct or indirect, Tax, levy or duty, including consumption Tax or any Tax of similar nature, which is imposed on goods and services by government or Tax authority. WAITING PERIOD shall mean the first thirty (30) days between the beginning of Your Disability and the commencement of this Policy date / reinstatement date and is applied only when the person is first covered. This shall not be applicable after the first year of cover. However, if there is a break in insurance, the Waiting Period will apply again. WAR shall mean a contest by force between two (2) or more nations, carried on for any purpose, or armed conflict of sovereign powers, or declared or undeclared and open hostilities or the state of nations among whom there is an interruption of peaceful relations and a general contention by force, both authorised and unauthorised, by the sovereign. WE / OUR / US shall mean Zurich General Insurance Malaysia Berhad, who is the insurer / issuer of the Policy. Z-MedProtect/PW/20220113 Page 3 of 14 DESCRIPTION OF BENEFITS SCHEDULE OF BENEFITS Benefits Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Overall Annual Limit (RM) 100,000 300,000 500,000 1,000,000 2,000,000 (for Section A & Section B) No Claim Bonus Reduction of 10% on renewal premium (if no claims made) Section A – Inpatient & Daycare Benefits 100 150 180 200 500 Hospital Room & Board (RM) (maximum 365 days per annum) As Charged Intensive Care Unit (maximum 180 days per annum) Hospital Supplies & Services As Charged Daycare Procedures As Charged Surgical Fees As Charged Anaesthetist's Fee As Charged Operating Theatre Fee As Charged As Charged In-Hospital Physician Visit (unlimited) Ambulance Fees As Charged 100 Daily-Cash Allowance at Government Hospital (RM) (maximum 365 days per annum) 250 Insured Child's Daily Guardian Benefit (RM) (maximum per disability) Medical Report Fees (RM) 150 Organ Transplant As Charged (Heart, Kidney, Lung, Liver or Bone Marrow) Tax on Eligible Expenses As Charged Section B – Outpatient Benefits As Charged Pre-Hospital Diagnostic Tests (within 60 days prior to hospitalisation) As Charged Pre-Hospital Specialist Consultation (within 60 days prior to hospitalisation) As Charged Post Hospitalisation Treatment (within 90 days from hospitalisation) As Charged Emergency Accidental Outpatient Treatment (within 24 hours and follow-up treatment to a maximum of 60 days) As Charged Outpatient Physiotherapy Treatment (within 90 days from discharge) Outpatient Kidney Dialysis Treatment As Charged Outpatient Cancer Treatment As Charged Emergency Accidental Outpatient Dental Treatment 4,000 (per accident) (RM) 4,000 Home Nursing Care (RM) (up to 180 days, lifetime maximum) Second Surgical Opinion As Charged Section C - Special Benefits (Additional limit on top of the Overall Annual Limit) Accidental Death and Permanent Disablement (RM) 50,000 International Emergency Medical Evacuation and 50,000 Repatriation (RM) (maximum per annum) Funeral Expenses (all causes) (RM) 2,000 Section D – Optional Options A B C D Deductible Deductible (per Any One Disability) RM 0 RM 5,000 RM 10,000 RM 20,000 Amount (applicable for Section A only) Premium 0% 15% 30% 50% Discount Z-MedProtect/PW/20220113 Page 4 of 14 SECTION A – INPATIENT & DAYCARE BENEFITS (subject to Overall Annual Limit) (a) HOSPITAL ROOM AND BOARD We shall reimburse the Reasonable and Customary Charges Medically Necessary for room accommodation and meals. The amount of the benefit shall be equal to the actual charges made by the Hospital during Your confinement, but in no event shall the benefit exceed, for any one Day, the rate of Room and Board Benefit, and the maximum number of Days as set forth in the Schedule of Benefits. You will only be entitled to this benefit while confined to a Hospital as an inpatient. (b) INTENSIVE CARE UNIT We shall reimburse the Reasonable and Customary Charges for actual room and board incurred during confinement as an inpatient in the Intensive Care Unit of the Hospital. This benefit shall be payable equal to the actual charges made by the Hospital subject to the maximum benefit for any one Day, and maximum number of Days, as set forth in the Schedule of Benefits. Where the period of confinement in an Intensive Care Unit exceeds the maximum set forth in the Schedule of Benefits, reimbursement will be restricted to the standard daily Hospital Room and Board rate. No Hospital Room and Board Benefits shall be paid for the same confinement period where the daily Intensive Care Unit Benefits is payable. (c) HOSPITAL SUPPLIES & SERVICES We shall reimburse the Reasonable and Customary Charges actually incurred for general nursing, prescribed and consumed drugs and medicines, dressings, splints, plaster casts, x-ray, laboratory examinations, electrocardiograms, physiotherapy, basal metabolism tests, intravenous injections and solutions, administration of blood and blood plasma, including the cost of blood and plasma whilst You are confined as an inpatient in a Hospital, up to the amount stated in the Schedule of Benefits. (d) DAYCARE PROCEDURES We shall reimburse the Reasonable and Customary Charges for medical and professional charges incurred in respect of a Day Surgery (Surgical and Medical) performed in an Outpatient setting (without Hospital admission) up to maximum limit per Disability stated in the Schedule of Benefits. This shall include follow-up treatment by the same Attending Physician / Specialist / Surgeon within the maximum amount as stated in the Schedule of Benefits. Any Daycare Procedure done for investigative and diagnostic purposes not related to Treatment for any specific Disabilities is not covered. (e) SURGICAL FEES We shall reimburse the Reasonable and Customary Charges for a Surgery by the Specialist/Surgeon, including pre-surgical assessment, Specialist’s/Surgeon’s visits to You and post-surgery care from the date of Surgery, subject to the maximum amount of benefits indicated 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 maximum amount of benefit stated in the Schedule of Benefits. (f) ANAESTHETIST’S FEE We shall reimburse the Reasonable and Customary Charges by the Anaesthetist for the administration of anaesthesia not exceeding the limits as set forth in the Schedule of Benefits. (g) OPERATING THEATRE FEE We shall reimburse the Reasonable and Customary Operating Room charges incidental to the surgical procedure not exceeding the limits as set forth in the Schedule of Benefits. (h) IN-HOSPITAL PHYSICIAN VISIT We shall reimburse the Reasonable and Customary Charges by a Physician for Medically Necessary visiting an in-paying patient while confined for a non-surgical Disability not exceeding the maximum amount as set forth in the Schedule of Benefits. (i) AMBULANCE FEES We shall reimburse the Reasonable and Customary Charges incurred for necessary domestic road ambulance services (inclusive of attendant) to and/or from the Hospital of confinement. Payment will not be made if You are not hospitalised and subject to the limits set forth in the Schedule of Benefits. (j) DAILY-CASH ALLOWANCE AT GOVERNMENT HOSPITAL We shall pay daily cash allowance for each Day of confinement for a covered Disability in a Malaysian Government Hospital, provided that You shall be confined in a Room and Board at a rate that does not exceed the amount and number of Days shown in the Schedule of Benefits. (k) INSURED CHILD’S DAILY GUARDIAN BENEFIT We shall reimburse the expenses for meals and lodging incurred to accompany Your Child (aged below fifteen (15) years) in the Hospital but shall not exceed the limits set forth in the Schedule of Benefits. (l) MEDICAL REPORT FEES We shall reimburse the actual fee charged for completion of a medical report by the attending Physician / Surgeon in respect of each Disability but not to exceed the amount as stated in the Schedule of Benefits. (m) ORGAN TRANSPLANT We shall reimburse the Reasonable and Customary Charges incurred on transplantation Surgery for You being the recipient of the transplant of a heart, kidney, lung, liver or bone marrow. Payment for this benefit shall be subject to the limit as set forth in the Schedule of Benefits. The costs of acquisition of the organs and all costs incurred by the donors are not covered. (n) TAX ON ELIGIBLE EXPENSES We shall reimburse the amount of the Tax On Eligible Expenses levied by the clinics or Hospitals on taxable supplies and services provided to You that are payable under this policy subject to the limits set forth in the Schedule of Benefits. Z-MedProtect/PW/20220113 Page 5 of 14 SECTION B – OUTPATIENT BENEFITS (subject to Overall Annual Limit) (a) PRE-HOSPITAL DIAGNOSTIC TESTS We shall reimburse the Reasonable and Customary Charges for ECG, X-ray and laboratory tests which are performed for diagnostic purposes on account of an Injury or Illness when in connection with a Disability preceding Hospitalisation within the maximum number of Days and amount as set forth in the Schedule of Benefits in a Hospital and which are recommended by a Physician / Specialist. No payment shall be made if upon such diagnostic services, You do not result in Hospital confinement for the treatment of the medical condition diagnosed. (b) PRE-HOSPITAL SPECIALIST CONSULTATION We shall reimburse the Reasonable and Customary Charges for the consultation by a Specialist in connection with a Disability within the maximum number of Days and amount as set forth in the Schedule of Benefits preceding confinement in a Hospital and provided that such consultation is Medically Necessary and has been recommended in writing by the attending Physician / Specialist, which includes prescription for medication and any subsequent consultation which is subject to the Schedule of Benefits limit. Payment will not be made where You do not result in Hospital confinement for the treatment of the medical condition diagnosed. (c) POST-HOSPITALISATION TREATMENT We shall reimburse the Reasonable and Customary Charges incurred in follow-up treatment for the same Disability as during Hospitalisation immediately following discharge from Hospital for a non-surgical Disability which includes prescription for medication, within the maximum number of Days and amount as stated in the Schedule of Benefits. (d) EMERGENCY ACCIDENTAL OUTPATIENT TREATMENT We shall reimburse the Reasonable and Customary Charges incurred for up to the maximum stated in the Schedule of Benefits, as a result of a covered bodily Injury arising from an Accident for Medically Necessary treatment as an Outpatient at any registered clinic or Hospital within twenty-four (24) hours of the Accident causing the covered bodily Injury. Follow-up treatment by the same Doctor or same registered clinic or Hospital for the same covered bodily Injury will be provided up to the maximum amount and the maximum number of days as set forth in the Schedule of Benefits. (e) OUTPATIENT PHYSIOTHERAPY TREATMENT We shall reimburse the Reasonable and Customary Charges incurred for Outpatient physiotherapy treatment referred in writing by a licensed Specialist / Physician after Surgery or In-Hospital Treatment, within ninety (90) days from the date of Hospital discharge up to the maximum as set forth in the Schedule of Benefits. (f) OUTPATIENT KIDNEY DIALYSIS TREATMENT If You are diagnosed with Kidney Failure as defined below, We will reimburse the Reasonable and Customary Charges incurred for the Medically Necessary treatment of kidney dialysis performed at a legally registered dialysis centre subject to the limit of this Disability as specified in the Schedule of Benefits. Such treatment (dialysis including consultation, examination tests and take-home drugs) must be received at the Outpatient department of a Hospital or a registered dialysis treatment centre or immediately following discharge from Hospital Confinement or Surgery. Kidney Failure means end-stage renal failure presenting as chronic, irreversible failure of both kidneys to function as a result of which renal dialysis is initiated. It is a specific condition of this Benefit that notwithstanding the exclusion of Pre-Existing Conditions, this Benefit will not be payable for You, if You have developed chronic renal diseases and/or are receiving dialysis treatment prior to the effective date of Insurance. (g) OUTPATIENT CANCER TREATMENT If You are diagnosed with Cancer as defined below, We will reimburse the Reasonable and Customary Charges incurred for the treatment of cancer performed at a legally registered cancer treatment centre subject to the limit of this Disability as specified in the Schedule of Benefits. The treatment types covered as cancer treatment are only limited to radiotherapy and chemotherapy (injectable or oral), including consultation, examination tests and take-home drugs. Such treatment must be received or advised at the Outpatient department of a Hospital or a registered cancer treatment centre or immediately following discharge from the Hospital Confinement or after the Surgery. Cancer is defined as the uncontrollable growth and spread of malignant cells and the invasion and destruction of normal tissue for which major interventionist treatment or Surgery (excluding endoscopic procedures alone) is considered necessary. The cancer must be confirmed by histological evidence of malignancy. It is a specific condition of this Benefit that notwithstanding the exclusion of Pre-Existing Conditions, this Benefit will not be payable for You who had been diagnosed as a Cancer patient and/or is receiving Cancer treatment prior to the effective date of Insurance. (h) EMERGENCY ACCIDENTAL OUTPATIENT DENTAL TREATMENT We shall reimburse the Reasonable and Customary Charges incurred for up to the maximum stated in the Schedule of Benefits, as a result of an Accidental Injury and received as an Outpatient Accidental Dental Treatment within twenty-four (24) hours of the occurrence of the Accident in a registered dental clinic or Hospital and the subsequent follow-up treatment by the same Dentist will be provided up to the maximum amount as set forth in the Schedule of Benefits. (i) HOME NURSING CARE We shall reimburse the Reasonable and Customary Charges, up to the maximum number of days and amount stated in the Schedule of Benefits, for Medically Necessary continued nursing care by a registered nurse to You in a home. Such nursing care must be recommended by the attending Physician or Surgeon and be for a minimum duration of four (4) hours each day. This benefit is only payable if there has been an earlier claim paid for in respect of the medical condition for which Hospitalisation was required by You. Home Nursing Care cover under this Policy includes: (i) Physical, occupational or speech therapies; (ii) Therapy, treatments for wound, respiratory, diabetes care, colostomy care, tube feeding, injection and other medication administration to You at home. Custodial care, meals, general house-keeping services, companions and personal comfort item, or any services for activities of daily living that are not Medically Necessary will not be payable. The benefit payable shall not exceed the maximum number of days and amount for the plan as stated in the Schedule of Benefits. Z-MedProtect/PW/20220113 Page 6 of 14 (j) SECOND SURGICAL OPINION We shall reimburse the Reasonable and Customary Charges for consultation with a Specialist to obtain a second opinion prior to Surgery in respect of an Illness or Injury requiring Surgery up to the maximum amount as set forth in the Schedule of Benefits. Payment will not be made where You do not result in Hospital confinement for the treatment of the medical condition diagnosed. SECTION C – SPECIAL BENEFITS (Additional limit on top of the Overall Annual Limit) (a) ACCIDENTAL DEATH AND PERMANENT DISABLEMENT If You suffer a bodily Injury, which shall within twelve (12) consecutive months result in death or disablement as provided in the Table of Benefits described herein, We will pay the amount stated in the Schedule of Benefits according to the respective percentage of the sum insured as stated in the Table of Benefits. Percentage of Sum Description of Disablement Insured (%) Loss of life 100 Loss of Limbs (two limbs) 100 Loss of both hands, or of all fingers and both thumbs 100 Total paralysis 100 Total insanity 100 Injuries resulting in being permanently bedridden 100 Any other injury causing Permanent Total Disablement 100 Loss of arm at shoulder 100 Loss of arm between shoulder and elbow 100 Loss of arm at elbow 100 Loss of arm between elbow and wrist 100 Loss of hand at wrist 100 Loss of leg - at hip 100 - between knee and hip 100 - below knee 100 Eye: Loss of - Sight of whole eye 100 - Sight, except perception of light 50 - lens 50 Loss of four (4) fingers and thumb of one (1) hand 50% Loss of four (4) fingers 40 Loss of thumb - both phalanges 25 - one (1) phalanx 10 Loss of index finger - three (3) phalanges 10 - two (2) phalanges 8 - one (1) phalanx 4 Loss of middle finger - three (3) phalanges 6 - two (2) phalanges 4 - one (1) phalanx 2 Loss of ring finger - three (3) phalanges 5 - two (2) phalanges 4 - one (1) phalanx 2 Loss of little finger - three (3) phalanges 4 - two (2) phalanges 3 - one (1) phalanx 2 Loss of metacarpals - first or second (additional) 3 - third, fourth or fifth (additional) 2 Loss of toes - all phalanges 15 - great, both phalanges 5 - great, one (1) phalanx 2 - other than great, if more than one (1) toe lost each 1 Loss of Hearing - both ears 75 - one (1) ear 15 Loss of Speech 50 The degree of shortening of limbs must be certified by a Physician. Where the bodily Injury is not specified, We reserve the right to adopt a percentage of sum insured based on the disablement, which, in Our opinion, is consistent with the provisions of the above Table of Benefits. “Loss” of limb or member or part thereof shall mean loss by actual physical severance or total and permanent Loss of Use. Loss of Use of body member shall be treated as loss of body member. The aggregate of all percentages payable in respect of any one (1) Accident shall not exceed 100%. In the event a total of 100% is paid, all coverage hereunder shall immediately cease to be in force. All other losses less than 100% if having been paid shall reduce the coverage under this benefit by that amount from the date of Accident until the expiry of the Policy Schedule. Z-MedProtect/PW/20220113 Page 7 of 14 Special Provisions • Coma Upon certification by a Physician that You have been in a state of coma for at least one (1) year due to an Accident, We will pay 100% of the Sum Insured. However, We have the right to recover the payment made if You regain consciousness provided that a deduction of 10% of the aforesaid payment be made for each year You were in a state of coma. • Disappearance It will be presumed that death has occurred if You have been missing for twelve (12) consecutive months and We have examined all available evidence provided to support the conclusion that death was caused by an Accident covered. (b) INTERNATIONAL EMERGENCY MEDICAL EVACUATION AND REPATRIATION If You suffer a Serious Injury or Serious Illness in Overseas, and in Our or the Service Provider’s opinion, it is judged medically appropriate to move You to another location for medical treatment, the Service Provider will arrange the evacuation utilising the means We or the Service Provider believe to be the most appropriate based on the medical severity of Your condition, subject to the limits set forth in the Schedule of Benefits. If You suffer a Serious Injury or Serious Illness in Overseas, and in Our or the Service Provider’s opinion, it is judged medically appropriate to return You to Malaysia, the Service Provider will arrange the repatriation utilising the means We or the Service Provider believe to be the most appropriate based on the medical severity of Your condition, subject to the limits set forth in the Schedule of Benefits. If You suffer a Disability in Overseas and result in death, Our Service Provider will make: (i) all the necessary transportation arrangements (including any procedures or arrangements necessary to meet local formalities) for the return of Your mortal remains to Malaysia; and (ii) all the necessary arrangements for funeral, cremation, casket or embalming (if so selected) at the place of death in Overseas, but excluding any expenses related to religious rights, ceremonies or burial posts. Specific Conditions Applicable to Benefit (b): The decisions on the means of transportation and final destination will be made by the Service Provider at Our sole discretion. You must follow Our or the Service Provider’s instruction and direction at all times. Specific Exclusions Applicable to Benefit (b): We shall not be liable in respect of any claims for, directly or indirectly caused by any of the following: (i) services rendered without the authorisation and/or intervention of the Service Provider; (ii) services provided by any parties other than the Service Provider for which no charge is usually made; (iii) medical treatment administered by Your relatives and/or family member whether qualified or not; (iv) Disability which in the opinion of the Service Provider’s Physician that You are physically able to travel sitting as a normal passenger and without medical escort. (c) FUNERAL EXPENSES (ALL CAUSES) We shall pay a lump sum as specified in the Schedule of Benefits, if You die during the Period of Insurance. SECTION D – OPTIONAL (a) DEDUCTIBLE The Policy is subject to a deductible amount which is stated in the Schedule of Benefits. Deductible means a monetary sum that shall be deducted from the Eligible Expenses under Section A incurred by You, and on per Any One Disability basis when You are admitted to any private hospital. However, if You are admitted to any Malaysian Government Hospital, the Eligible Expenses incurred will not be subject to the deductible amount. CONDITIONS 1. AGE LIMIT The age eligibility to qualify for this Policy ranges from thirty (30) days old to sixty five (65) years old, and renewable up to one hundred (100) years old. All ages refer to the age at Your next birthday. 2. ALTERATIONS We reserve the right to amend the terms and provisions of this Policy by giving a thirty (30) days prior notice in writing by ordinary post to Policyholder’s last known address in Our records with a valid reason, and such amendment will be applicable from the next renewal of this Policy. No alteration to this Policy shall be valid unless authorised by Us and such approval is endorsed thereon. We would also give thirty (30) days prior written notice to the Policyholder according to the last recorded address for any alterations made. 3. ARBITRATION All differences arising out of this Policy shall be referred to an Arbitrator who shall be appointed in writing by the parties in difference. In the event they are unable to agree on who is to be the Arbitrator within one (1) month of being required in writing to do so then both parties shall be entitled to appoint an Arbitrator each who shall proceed to hear the differences together with an Umpire to be appointed by both Arbitrators. However, this is provided that any disclaimer of liability by Us for any claim hereunder must be referred to an Arbitrator within twelve (12) calendar months from date of such disclaimer. 4. AUTOMATIC TERMINATION The policy shall automatically terminate on the earliest happening of the following events: (a) on the date the Policy Schedule is cancelled; or (b) on Your death; or (c) on the next renewal date if You attain the maximum age limit at one hundred (100) years old; or (d) on the next renewal date or premium due date, whichever earlier, if the required premium is not paid within fourteen (14) days from Policy expiry date. Termination of this Policy shall be without prejudice to any claim arising prior to such termination. The payment or acceptance of any premium hereunder subsequent to termination of this Policy shall not create any liability but We shall refund any such premium. Z-MedProtect/PW/20220113 Page 8 of 14 5. CANCELLATION This Policy may be cancelled by the Policyholder at any time by giving a written notice to Us, and provided that no claims have been made during the current Policy Year, the Policyholder shall be entitled to a refund of the premium as follows: Period Not Exceeding Refund of Annual Premium 15 days (for renewal only) 90% 1 month 80% 2 months 70% 3 months 60% 4 months 50% 5 months 40% 6 months 30% 7 months 25% 8 months 20% 9 months 15% 10 months 10% 11 months 5% Period exceeding 11 months No refund There shall be no refund of premium for non-annual payment mode. 6. CASH BEFORE COVER It is fundamental and an absolute special condition of this contract of insurance that the premium due must be paid and received by Us before insurance cover is effective. 7. CERTIFICATION, INFORMATION AND EVIDENCE All certificates, information, medical reports and evidence as required by Us shall be furnished at the expense of the Policyholder, and in such a form that We may require. In any event all notices which We shall require the Policyholder to give must be in writing and addressed to Us. Policyholder shall, at Our request and expense, submit to a medical examination whenever such is deemed necessary. 8. CLAIM PROCEDURES (a) You shall within thirty (30) days of a Disability that incurs claimable expenses, give written notice to Us stating full particulars of such event, including all original bills and receipts, and a full Physician’s report stipulating the diagnosis of the condition treated and the date the Disability commenced in the Physician’s opinion and the Physician’s summary of the cost of treatment including medicines and services rendered. Failure to furnish such notice within the time allowed shall not invalidate any claim if it is shown not to have been reasonably possible to furnish such notice and that such notice was furnished as soon as was reasonably possible. (b) You shall immediately procure and act on proper medical advice and We shall not be held liable in the event a treatment or service becomes necessary due to Your failure to do so. 9. CO-PAYMENT (sub-standard policy only) Co-payment borne by the Policyholder under cost-sharing or coinsurance terms shall not exceed twenty percent (20%) of the claimable expenses (i.e. excluding Deductibles) per Disability, subject to an absolute maximum limit of Ringgit Malaysia Three Thousand (RM 3,000) (inclusive of Deductibles) per Disability. The limit mentioned above is not applicable to Upgraded Room and Board Co-Payment and policies that provide for Overall Annual Limit exceeding Ringgit Malaysia One Hundred Thousand (RM 100,000). 10. CONDITION PRECEDENT TO LIABILITY The due observance and the fulfilment of the terms, provisions and conditions of this Policy by each of You and in so far as they relate to anything to be done or complied with by You shall be conditions precedent to any liability of Ours. 11. CONTRIBUTION If You carry other insurance/takaful covering any Illness or Injury insured by this Policy, We shall not be liable for a greater proportion of such Illness or Injury than the amount applicable hereto under this Policy bears to the total amount of all valid insurance/takaful covering such Illness or Injury. 12. COOLING-OFF PERIOD If the Policyholder decides not to take up the Policy after it has been issued, the Policyholder may return the Policy to Us for cancellation provided such request for cancellation is delivered by the Policyholder to Us within fifteen (15) days from the date of Policyholder’s receipt of the Policy. The Policyholder is entitled to the refund of the full premium paid less deduction of medical expenses incurred by Us in the issue of the Policy. In the event of a claim(s) has been made, no refund of premium shall be payable. 13. CURRENCY OF PAYMENT All payments under this Policy shall be made in the legal currency of Malaysia. Should any payment be requested by You to be payable in any other currency, then such amount shall be payable in the demand currency as may be purchased in Malaysia at the prevailing currency market rates on the date of the claim settlement. 14. DUTY OF DISCLOSURE (a) Consumer Insurance Contract Where the Policyholder has applied for this Insurance wholly for himself/family/dependants, the Policyholder had a duty to take reasonable care not to make a misrepresentation in answering the questions in the Proposal Form (or when the Policyholder applied for this insurance) i.e. the Policyholder should has answered the questions fully and accurately. Failure to have taken reasonable care in answering the questions may result in avoidance of the Policyholder’s contract of insurance, refusal or reduction of the Policyholder’s claim(s), change of terms or termination of the Policyholder’s contract of insurance in accordance with the remedies in Schedule 9 of the Financial Services Act 2013. The Policyholder is also required to disclose any other matter that the Policyholder knews to be relevant to Our decision in accepting the risks and determining the rates and terms to be applied. The Policyholder also has a duty to tell Us immediately if at any time after the Policyholder’s contract of insurance has been entered into, varied or renewed with Us any of the information given in the Proposal Form (or when the Policyholder applied for this insurance) is inaccurate or has changed. (b) Non-Consumer Insurance Contract Where the Policyholder has applied for this Insurance for the purpose of providing medical insurance benefits to the Policyholder’s Z-MedProtect/PW/20220113 Page 9 of 14 employees and their dependants, the Policyholder had a duty to disclose any matter that the Policyholder knows to be relevant to Our decision in accepting the risks and determining the rates and terms to be applied and any matter a reasonable person in the circumstances could be expected to know to be relevant otherwise it may result in avoidance of the Policyholder’s contract of insurance, refusal or reduction of the Policyholder’s claim(s), change of terms or termination of the Policyholder’s contract of insurance. The Policyholder also has a duty to tell Us immediately if at any time after the Policyholder’s contract of insurance has been entered into, varied or renewed with Us any of the information given in the Proposal Form (or when the Policyholder’s applied for this insurance) is inaccurate or has changed. 15. FULL REIMBURSEMENT IN A GOVERNMENT HOSPITAL Charges for eligible medical expenses are covered in full for treatment in a Malaysian Government Hospital for each Illness or Injury. 16. GENERAL CONDITIONS This Policy and the Schedule of Benefits shall be read together as one (1) contract and any words or expression to which a specific meaning has been attached in any part of this Policy or of the Schedules shall bear such specific meaning wherever it may appear. 17. GEOGRAPHICAL TERRITORY All benefits provided in this Policy are applicable worldwide for twenty-four (24) hours a day. If You are non- Malaysian, Your coverage will be limited to Hospitals within Malaysia only. 18. GRACE PERIOD Notwithstanding the Cash before Cover condition, a Grace period of fourteen (14) days from the premium due date will be allowed for payment of each premium. During such fourteen (14) days, We shall remain liable thereunder if by the last of such days, the premium is actually paid. If any premium is not paid in respect of this Policy Contract before the end of the Grace period, this Policy Contract shall be deemed as terminated at the expiry date of the Policy. 19. GOVERNING LAW This Policy is issued under the laws of Malaysia and is subject to and governed by the laws prevailing in Malaysia. 20. IMPORTANT NOTICE We wish to draw Your attention to the following important information: (a) Proof of Age will be required at times of maturity / claims, if Age has not been admitted. (b) You can contact Our Agents, Branch Officers, and Customer Service Department at Our Head Office for any enquiry or service relating to Your Policy. (c) The change of address of the Policyholder should be notified to Us so that all correspondence can be directed promptly. 21. INCOMPLETE CLAIMS All claims must be submitted to Us within thirty (30) days of completion of the events for which the claim is being made. Claims are not deemed complete and Eligible Benefits are not payable unless all bills for such claims have been submitted and agreed upon by Us. Only actual costs incurred shall be considered for reimbursement. Any variation or waiver of the foregoing shall be at Our sole discretion. 22. INTEPRETATION OF THE POLICY Where the context so permits, words importing the singular number only shall include the plural number and vice versa and words importing the masculine gender only shall include the feminine gender and neuter gender and words importing persons shall include corporations. 23. MEDICAL EXAMINATION We shall have the right to examine Your body whenever it may reasonably require and to conduct an autopsy in case of death where it is not forbidden by law. 24. MISSTATEMENT OF AGE If Your age had been misstated and the premium paid as a result thereof is insufficient, any claim payable under this Policy shall be prorated based on the ratio of the actual premium paid to the correct premium which should have been charged for the year. Any excess premium, which may have been paid as a result of such misstatement of age, shall be refunded without interest. If at Your correct age would not have been eligible for cover under this Policy, no benefit shall be payable. 25. MISTATEMENT OR OMMISSION OF MATERIAL FACT This Policy shall be void if: (a) any answer, disclosure or representation by the Policyholder, before this contract of insurance is entered into, varied or renewed, in or to any proposal or declaration or query, has been deliberately or recklessly incorrectly stated in any respect; or (b) before this contract of insurance is entered into, varied or renewed, the Policyholder has failed to disclose any fact the Policyholder knew to be relevant to Our decision on whether to accept the risk or not and the rates and the terms to be applied; or (c) any claim made shall be fraudulent or exaggerated, or if any false declaration or statement shall be made in support of such claim. 26. MULTIPLE INSURED PERSON DISCOUNT If the Policyholder purchase a policy with multiple Insured Persons which are his/her Family Members, a Multiple Insured Person Discount is applicable. The Multiple Insured Person Discount percentage is depending on the total number of Insured Persons specified in the Policy Schedule. The Multiple Insured Person Discount is not cumulative and in the event of a revision in total number of Insured Persons, the Multiple Insured Person Discount will be revised accordingly. 27. NOMINATION Nomination shall mean the process of the Policyholder appointing individual(s) to receive the policy monies in the event of the death of Policyholder (who is also the Insured Person) at any time after the Policy Schedule has been issued. If You are the Insured Person, You may nominate a person(s) to receive the policy moneys payable under this Policy Schedule. Where Policyholder or You die without having made a nomination, We shall pay the policy moneys to the lawful executor or administrator of Policyholder or Your estate. Payment of policy moneys will be made in accordance to the Financial Services Act 2013. 28. NOTICE Every notice or communication to Us shall be in writing and sent to Us. No alterations in the terms of this Policy or any endorsement thereon, will be held valid unless the same is signed or initiated by Our authorised representative. Z-MedProtect/PW/20220113 Page 10 of 14 29. OVERSEAS TREATMENT If You seek treatment Overseas, benefits in respect of the treatment shall be covered subject to the exclusions, limitations and conditions specified in this Policy and all benefits will be payable based on the official exchange rate ruling on the last Day of the Period of Confinement and shall exclude the cost of transport to the place of treatment provided: (a) You are travelling abroad for a reason other than for medical treatment, need to be confined to a Hospital outside Malaysia as a consequence of an Emergency. (b) Upon recommendation of a Physician and You have to be transferred to a Hospital outside Malaysia because the specialised nature of the treatment, aid, information or decision required can neither be rendered nor furnished nor taken in Malaysia. Overseas treatment of a Disease, Sickness or Injury which is diagnosed in Malaysia and non-emergency or chronic conditions where treatment can reasonably be postponed until return to Malaysia are excluded. 30. OWNERSHIP OF POLICY Unless otherwise expressly provided for by Endorsement in the Policy, We shall be entitled to treat the Policyholder as the absolute owner of the Policy. We shall not be bound to recognise any equitable or other claim to or interest in the Policy, and the receipt of the Policy or a Benefit by the Policyholder (or by his legal or authorised representative) alone shall be an effective discharge of all Our obligations and liabilities. The Policyholder shall be deemed to be responsible Principal or Agent of You covered under this Policy. 31. PERIOD OF COVER AND RENEWAL This Policy will be renewable at the option of Policyholder subject to the terms, conditions and termination at each of the anniversary of the Policy date. The renewal premiums payable is not guaranteed and We reserve the right to revise the premium rate applicable at the time of renewal. Such changes, if any, shall be applicable to all Policyholders irrespective of their claim experience according to Our risk assessment. This Policy is renewable at the option of Policyholder until the occurrence of any of the following: (a) non-payment of premium or premium not made on time (b) fraud or misrepresentation of material fact during application (c) the policy is cancelled at the request of the Policyholder (d) the death of You (e) You attain the coverage age limit specified (f) termination of coverage for all policies in a certain market and We withdraw this Policy completely from the market in accordance with the Portfolio Withdrawal Condition. 32. PORTFOLIO WITHDRAWAL We reserve the right to cancel the portfolio as a whole if We decide to discontinue underwriting this insurance product. Cancellation of the portfolio as a whole shall be given by reasonable written notice in advance with valid reasons to the Policyholder and We will run off all policies to expiry of the period of cover within the portfolio. 33. PREMIUM During the Period of Insurance, the premiums for insurance under this Policy are not guaranteed and shall be based on the premium rates in force at the time of renewal. Premiums are payable at the premium rate according to each member’s age next birthday on each Policy year anniversary. We shall have the right to change the rate at which premiums shall be calculated, at the start of any Policy Year, provided that We notify the Policyholder at least thirty (30) days in advance of the date such premium is due. 34. PROOF OF LOSS Upon receipt of such notice, We will furnish to the Claimant forms for filing proof of loss. If the forms are not furnished within fifteen (15) days, the Claimant by submitting written proof covering the occurrence, the character and the extent of the loss for which claim is made shall be deemed to have complied with the requirement of this provision. Proof of loss must be furnished to Us in case of claim for Disability within ninety (90) days after termination of the period of Disability for which We are liable, and in case of claim of any other loss, within ninety (90) days after the date of such loss. 35. REINSTATEMENT If You do not pay a premium within the Grace Period and the Policy terminates, You will not have any Insurance cover or benefit. If the Policy terminates, You may apply to reinstate the Policy within one (1) year after the premium’s due date which was not paid. However, You must: (a) fill in and sign a reinstatement form; (b) truthfully declare all facts in the reinstatement form; (c) produce all the information (if any) We have asked for; and (d) pay all overdue premiums. 36. RESIDENCE OVERSEAS No benefit whatsoever shall be payable for any medical treatment received by You outside Malaysia, if You reside or travel outside Malaysia for more than ninety (90) consecutive days. 37. SANCTION We shall not be deemed to provide coverage or will make any payments or provide any service or benefit to the Policyholder, You or other party to the extent that such cover, payment, service, benefit would violate any applicable trade or economic sanctions law or regulation. 38. TAKE-OVER POLICIES If this Policy shall have commenced immediately upon termination of a preceding Policy and if You shall have been afflicted with a medical Disability prior or at the time this Policy started (and benefits under the preceding Policy would have been available to You), You shall continue to be covered for the existing Disability, but not to exceed the limits of the previous Policy on condition We have secured a copy of the preceding Policy. 39. UPGRADED POLICIES If the Eligible Benefits to You under the terms of this Policy be increased while it is in force or at the time of Renewal or replacement and if You have been afflicted with a Disability prior or at the time the Benefits were increased, the Limits of Benefits payable in respect of such Disability shall not exceed the Limit of Benefits prior to the date the Benefits were upgraded. Z-MedProtect/PW/20220113 Page 11 of 14 40. UPGRADED ROOM AND BOARD CO-PAYMENT If You are hospitalised at a published Room & Board rate which is higher than Your eligible benefit, You shall bear the difference in Room & Board only. 41. TAX PROVISION All premium and fees payable under this Policy may be subject to Tax. If Tax is imposed, it will be stated in the invoice and We reserve the right to claim or collect the Tax from You in addition to the premium and/or fees payable under this Policy. EXCLUSIONS EXCLUSIONS APPLICABLE TO SECTION A & SECTION B This contract does not cover any Hospitalisation, Surgery or charges caused directly or indirectly, wholly or partly, by any one (1) of the following occurrences: 1. Pre-Existing Condition. 2. Specified Illnesses occurring during the first one hundred and twenty (120) days of continuous cover. 3. Waiting Period of thirty (30) days for all except Accidental Injuries. 4. Elective cosmetic or plastic Surgery except reconstructive Surgery necessary to restore function after an Accident that has occurred during the period of cover. 5. Eye Examinations, glasses, contact lenses and surgical procedures for the correction of eye refractive errors and the use or acquisition of external prosthetic appliances or corrective devices such as artificial limbs, hearing aids, implanted pacemakers, prescription thereof. 6. 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. 7. Private nursing, rest cures or sanitaria care, any treatment received purely as an Outpatient Hospitalisation primarily for investigatory purposes, diagnosis, X-ray examination, general physical or medical examinations, not incidental to the treatment or diagnosis of a covered Disability or any treatment which is not Medically Necessary and any preventive treatment, preventive medicines or examination carried out by a Physician and treatments specifically for weight reduction or gain. 8. Any treatment or surgical operation for congenital abnormalities or deformities including hereditary conditions. 9. Pregnancy, child birth (including surgical delivery), miscarriage, abortion and prenatal or postnatal care and any surgical, mechanical or chemical contraceptive methods of birth control or treatment pertaining to infertility, gender change, sexual dysfunction including impotency, tests or treatment related to sterilization and circumcision performed due to any reason other than Illness or infection. 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. Treatment for any medical conditions arising directly or indirectly from radioactivity contamination or any nuclear material whatsoever, including the combustion of nuclear fuel. 13. Expenses incurred for donation of any body organ by You and costs of acquisition of the organ including all costs incurred by the donor during organ transplant and its complications. 14. Investigation into and treatment of sleep and snoring disorders, psychiatric, psychotic, mental or nervous disorders, including neuroses and their physiological or psychosomatic manifestations, psychiatric disorders such as neuro-psychosis, schizophrenia and others. 15. Hormone replacement therapy and alternative therapy such as treatment, medical services or supplies, including but not limited to chiropractic services, acupuncture, acupressure, reflexology, bone setting, herbalist treatment, massage or aromatherapy. 16. Care or treatment for which payment is not required or to the extent which is payable by any other insurance or indemnity covering You and Disabilities arising out of duties of employment or profession that is covered under a Workmen’s Compensation Insurance Contract. 17. Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations). 18. 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. 19. 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, mountaineering with use of ropes or mountain guides and illegal activities. 20. Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes. 21. Epidemic and/or pandemic. EXCLUSIONS (APPLICABLE TO SECTION C – Benefit a) We shall not be liable for claims directly or indirectly caused by or which results from: 1. You when engaging in or taking part in: - (a) Armed forces, naval or air force service or operations; (b) Professional sports, winter sports other than skating; (c) Rock climbing or mountaineering (necessitating the use of ropes or mountain guides), potholing, martial arts or boxing, underwater activities exceeding fifty (50) metres in depth, aerial activities including parachuting, hang-gliding, bungee jumping or any kind of race other than on foot; (d) Air travel except as a fare-paying passenger on a recognised airline operating on regular scheduled air routes and air travel by any charter aircraft duly licensed as a recognised air carrier and flown by professional crews between properly established and maintained airports; (e) Criminal act or any illegal activities. 2. Intoxication of alcohol or drug, unless the drug is taken under the direction of a Physician provided such direction is not for the treatment of drug addiction. 3. Provoked murder or assault, intentional self-injury, suicide or attempted suicide while sane or insane. 4. Pregnancy, childbirth, miscarriage. 5. Mosquito bites. 6. Sickness, Disease or medical disorder. 7. Pre-Existing Condition. 8. Deliberate exposure to exceptional danger (except in an attempt to save human life). 9. HIV (Human Immunodeficiency Syndrome) and/or any HIV related illnesses including AIDS (Acquired Immune Deficiency Syndrome) or Z-MedProtect/PW/20220113 Page 12 of 14 AIDS Related Complex (ARC) however caused and/or any mutant derivatives, variations or treatment thereof however caused. 10. Direct participation in riot or civil commotion, invasion, acts of foreign enemies, hostilities (whether War be declared or not), rebellion, revolution, insurrection, mutiny or usurped power. 11. Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the purpose of this exclusion combustion shall include any self-sustaining process of nuclear fission. 12. War, civil War – whether declared or not. 13. Any Act of Terrorism. 14. Epidemic and/or pandemic (also applicable to Section C – Benefit c). NOTICE UNDER PERSONAL DATA PROTECTION ACT 2010 (PDPA) The Personal Data Protection Act 2010 which regulates the processing of personal data in commercial transactions, applies to Us. You may make inquiries, complaints, request for access, update, correct or change any of Your personal data, limit the processing of Your personal data and/or to opt-out of Our use at any time hereafter by submitting such request to Us by sending an email to <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS>. Requests for opt-out must state clearly the full name, identity document number, policy number, telephone number and address of the person making such request. The processing of Your personal data is subject to Our Personal Data Protection Notice as published on https://www.zurich.com.my/pdpa. Z-MedProtect/PW/20220113 Page 13 of 14 PROCEDURES FOR MAKING INSURANCE COMPLAINTS We are committed to delivering the best customer experience. If you have any complaints or dissatisfactions with any of our products or services, we would like to hear from you. You can contact us at: Zurich General Insurance Malaysia Berhad Level 23A, Mercu 3, No. 3, Jalan Bangsar, KL Eco City, 59200 Kuala Lumpur, Malaysia. Tel: 03-2109 6000 Fax: 03-2109 6888 Call Centre: 1-300-888-622 E-mail: <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS> Other Avenues to Seek Redress If you are not satisfied with our final response or decision, you may write to Ombudsman for Financial Services (OFS) (formerly known as Financial Mediation Bureau) with details of the dispute and particulars of your policy. If the OFS makes an award against us, you are required to inform the OFS of your decision to accept or deny the award within fourteen (14) days. If you do not accept the award, you may reject the decision of the OFS. you may choose to institute a court proceeding against us or refer it to Arbitration. The OFS can be contacted through: Ombudsman for Financial Services (OFS) Level 14, Main Block, Menara Takaful Malaysia, No. 4, Jalan Sultan Sulaiman, 50000 Kuala Lumpur Tel: <PRESIDIO_ANONYMIZED_PHONE_NUMBER> Fax: 03-2272 1577 Email: <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS> Website: www.ofs.org.my If your complaint does not fall within the purview of the OFS, you may refer your complaint to Laman Informasi Nasihat dan Khidmat (LINK) of Bank Negara Malaysia (BNM) at the following address: Write to: Customer Service Centre (BNMLINK), Bank Negara Malaysia, P.O. Box 10922, 50929 Kuala Lumpur. Tel: 1 300 88 5465 Fax: 03 2174 1515 Email: <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS> Website: www.bnm.gov.my Walk-in: Ground Floor, Block D, Bank Negara Malaysia, Jalan Dato’ Onn, 50480 Kuala Lumpur. Zurich General Insurance Malaysia Berhad Registration no. 201701035345 (1249516-V) Level 23A, Mercu 3, No.3, Jalan Bangsar, KL Eco City, 59200 Kuala Lumpur, Malaysia. Tel: 03 2109 6000 Fax: 03 2109 6888 Call Centre: 1 300 888 622 www.zurich.com.my Z-MedProtect/PW/20220113 Page 14 of 14 Polisi Z-MedProtect PERJANJIAN ANTARA KITA Kontrak Insurans Pengguna Polisi dikeluarkan sejajar dengan pembayaran dari premium yang ditentukan dalam Jadual Polisi dan menurut kepada kenyataan yang telah dikemukakan di dalam borang cadangan (atau semasa Pemilik Polisi membuat permohonan insurans ini) dan segala kenyataan yang telah dibuat oleh Pemilik Polisi pada atau semasa penyerahan borang cadangan (atau semasa Pemilik Polisi mebuat permohonan insurans ini) dan pada masa perjanjian ini ditandatangani. Jawapan dan sebarang pernyataan lain yang Pemilik Polisi berikan akan menjadi sebahagian daripada kontrak insurans antara Pemilik Polisi dan pihak Kami. Walau bagaimanapun, sekiranya terdapat sebarang salah nyata semasa pra- kontrak berhubung dengan jawapan Pemilik Polisi atau di mana-mana pernyataan yang diberikan oleh Pemilik Polisi, hanya remedi yang terdapat dalam Jadual 9 Akta Perkhidmatan Kewangan 2013 akan diguna pakai. Polisi ini bertindak atas terma-terma dan syarat-syarat kontrak insurans seperti yang telah dipersetujui antara Pemilik Polisi dan pihak Kami. Kontrak Insurans Bukan Pengguna Polisi dikeluarkan sejajar dengan pembayaran dari premium yang ditentukan dalam Jadual Polisi dan menurut kepada kenyataan yang telah dikemukakan di dalam borang cadangan (atau semasa Pemilik Polisi membuat permohonan insurans ini) dan segala kenyataan yang telah dibuat oleh Pemilik Polisi pada atau semasa penyerahan borang cadangan (atau semasa Pemilik Polisi membuat permohonan insurans ini) dan pada masa perjanjian ini ditandatangani. Jawapan dan sebarang pernyataan lain yang Pemilik Polisi berikan akan menjadi sebahagian daripada kontrak insurans antara Pemilik Polisi dan pihak Kami. Sekiranya terdapat sebarang salah nyata pada pra-kontrak berhubung dengan jawapan Pemilik Polisi atau di mana-mana pernyataan yang diberikan oleh Pemilik Polisi, ia mungkin mengakibatkan pembatalan kontrak insurans, keengganan atau pengurangan gantirugi, perubahan terma atau penamatan kontrak insurans Pemilik Polisi. Polisi ini bertindak atas terma-terma dan syarat-syarat kontrak insurans seperti yang telah dipersetujui antara Pemilik Polisi dan pihak Kami. DEFINISI Terdapat beberapa perkataan tertentu yang ditakrifkan seperti yang di bawah. Perkataan ini mempunyai maksud yang sama apabila digunakan dalam Polisi ini. Perkataan ini telah ditebalkan dan bermula dengan huruf besar (contoh: Orang Yang Diinsuranskan, Anda). KEMALANGAN bermaksud kejadian yang berlaku secara tiba-tiba, tidak dijangka dan secara kebetulan tanpa diduga dalam Tempoh Insurans. RAWATAN KEGIGIAN AKIBAT KEMALANGAN bermaksud prosedur pergigian yang diperlukan akibat Kemalangan. TINDAKAN KEGANASAN bermaksud suatu tindakan, termasuk penggunaan kekerasan atau keganasan, mana-mana orang atau kumpulan orang, sama ada bertindak secara perseorangan atau bagi pihak atau berhubung kait dengan mana-mana organisasi, untuk tujuan politik, agama atau ideologi termasuk niat untuk mempengaruhi mana-mana kerajaan dan/atau membuatkan orang awam dalam ketakutan. MANA-MANA SATU HILANG UPAYA hendaklah bermaksud semua tempoh Hilang Upaya yang timbul daripada sebab yang sama termasuk mana-mana dan semua komplikasinya kecuali jika Anda pulih sepenuhnya dan tidak perlu menjalani apa-apa rawatan lanjut (termasuk dadah, ubat, diet khas atau suntikan atau nasihat tentang keadaannya) bagi Hilang Upaya itu selama sekurang-kurangnya sembilan puluh (90) hari selepas tarikh terakhir keluar Hospital dan Hilang Upaya berikutnya akibat daripada sebab yang sama hendaklah dianggap seolah-olah Hilang Upaya itu adalah yang baru. BAYARAN DIKENAKAN merujuk kepada bayaran sebenar yang dikenakan untuk rawatan perubatan yang munasabah, perlu dan biasa dalam merawat Hilang Upaya yang dilindungi. PENYAKIT KONGENITAL hendaklah bermaksud apa-apa keabnormalan perubatan atau fizikal yang wujud sejak lahir, dan juga keabnormalan fizikal neonatal yang berkembang dalam tempoh enam (6) bulan dari tarikh kelahiran. Ini termasuk semua jenis hernia dan epilepsi kecuali disebabkan oleh trauma yang berlaku selepas tarikh Anda dilindungi secara berterusan di bawah Polisi ini. HARI bermaksud pentafsiran Hari yang dikenakan bayaran oleh Hospital yang berkenaan. PEMBEDAHAN HARIAN bermaksud pesakit yang perlu menggunakan kemudahan pemulihan untuk prosedur pembedahan yang dirancang terlebih dahulu di Hospital / Klinik Pakar (tetapi bukan untuk bermalam). DOKTOR GIGI hendaklah bermaksud orang yang berlesen atau berdaftar sewajarnya untuk mengamalkan pergigian dalam kawasan geografi di mana khidmat diberikan, tetapi tidak termasuk Doktor Gigi yang merupakan Orang Yang Diinsuranskan sendiri atau keluarga terdekat iaitu adik-beradik, pasangan suami isteri, anak atau ibu bapa. HILANG UPAYA hendaklah bermaksud Sakit, Wabak, Penyakit atau semua Kecederaan yang timbul daripada satu atau beberapa sebab yang berterusan. DOKTOR atau PAKAR PERUBATAN atau PAKAR BEDAH hendaklah bermaksud pengamal perubatan berdaftar yang layak dan berlesen untuk mengamalkan Perubatan Barat dan yang, semasa memberikan rawatan itu, mengamalkannya mengikut skop pelesenan dan latihannya di kawasan geografi profesion tersebut diamalkan, tetapi tidak termasuk Doktor, Pakar Perubatan atau Pakar Bedah yang merupakan Orang Yang Diinsuranskan sendiri atau keluarga terdekat iaitu adik-beradik, pasangan suami isteri, anak atau ibu bapa. Z-MedProtect/PW/20220113 Halaman 1 dari 14 PERBELANJAAN LAYAK hendaklah bermaksud perbelanjaan yang Perlu Dari Segi Perubatan yang ditanggung disebabkan oleh Hilang Upaya yang dilindungi tetapi tidak melebihi had manfaat dalam Jadual Manfaat. KECEMASAN bermaksud perubatan yang diperlukan dalam keadaan di mana perhatian perubatan segera diperlukan dalam tempoh dua belas (12) jam Kecederaan, Penyakit atau gejala yang tiba-tiba dan gagal di mana kehidupan Anda boleh diancam atau membawa kepada kemerosotan kesihatan yang ketara. AHLI-AHLI KELUARGA hendaklah bermaksud pasangan Anda yang sah, ibu bapa dan anak-anak. HOSPITAL hendaklah bermaksud hanya pertubuhan yang ditubuhkan dan didaftarkan sewajarnya sebagai Hospital untuk jagaan dan rawatan orang yang sakit dan cedera sebagai pesakit atas katil berbayar, dan yang: (a) mempunyai kemudahan untuk diagnosis dan Pembedahan utama, (b) menyediakan khidmat jagaan dua puluh empat (24) jam sehari oleh jururawat berdaftar dan berkelayakan, (c) di bawah penyeliaan Pakar Perubatan, dan (d) bukan klinik, tempat untuk orang ketagih alkohol dan dadah, pusat jagaan atau rumah pemulihan atau rumah orang tua atau pertubuhan yang serupa. PENGHOSPITALAN hendaklah bermaksud dimasukkan ke Hospital sebagai pesakit dalam yang berdaftar untuk rawatan yang Perlu Dari Segi Perubatan bagi Hilang Upaya yang dilindungi apabila disyorkan oleh Pakar Perubatan. Pesakit tidak boleh dianggap sebagai pesakit dalam jika pesakit tidak tinggal di Hospital secara fizikal sepanjang tempoh dimasukkan ke Hospital. KECEDERAAN hendaklah bermaksud kecederaan anggota badan yang semata-mata disebabkan oleh Kemalangan. ORANG YANG DIINSURANSKAN / ANDA hendaklah bermaksud orang yang diinsuranskan dan dinyatakan dalam Jadual Polisi. UNIT RAWATAN RAPI hendaklah bermaksud satu bahagian di Hospital yang dinamakan sebagai Unit Rawatan Rapi oleh Hospital, dan yang diselenggara dua puluh empat (24) jam hanya untuk rawatan bagi pesakit dalam keadaan kritikal dan dilengkapi khidmat jagaan dan perubatan khas yang tidak disediakan di mana-mana bahagian lain Hospital itu. KEHILANGAN PENDENGARAN bermaksud kehilangan pendengaran secara kekal dan tidak boleh dipulihkan. KEHILANGAN ANGGOTA BADAN bermaksud kehilangan akibat permisahan secara fizikal pada atau di atas pergelangan tangan atau sendi buku lali. KEHILANGAN PENGLIHATAN bermaksud kehilangan penglihatan yang tidak dapat dipulihkan secara keseluruhan dan kekal. KEHILANGAN UPAYA BERTUTUR bermaksud ketidakupayaan kekal dan menyeluruh untuk berkomunikasi secara lisan. KEHILANGAN PENGGUNAAN bermaksud kehilangan upaya fungsian secara menyeluruh dan kekal dan dianggap sebagai kehilangan seluruh anggota badan atau organ tersebut dan bukan dari segi ketidakupayaan profesional atau pekerjaan Anda. HOSPITAL KERAJAAN MALAYSIA hendaklah bermaksud Hospital yang bayaran khidmatnya tertakluk kepada Akta Fi 1951, Perintah Fi (Perubatan) 1982 dan/atau pindaan berikutnya jika ada. KEPERLUAN DARI SEGI PERUBATAN hendaklah bermaksud khidmat perubatan yang: (a) selaras dengan diagnosis dan rawatan perubatan biasa bagi Hilang Upaya yang dilindungi, dan (b) menurut piawai amalan perubatan yang baik, selaras dengan piawai semasa bagi rawatan perubatan profesional, juga dengan manfaat kesihatan yang sah, dan (c) bukan untuk kemudahan Anda atau Pakar Perubatan, dan tidak dapat diperoleh sewajarnya di luar Hospital (jika dimasukkan ke wad sebagai pesakit dalam), dan (d) bukan berbentuk eksperimen, penyelidikan atau kajian, pencegahan atau penyaringan, dan (e) yang bayarannya berpatutan, munasabah dan biasa bagi Hilang Upaya itu. BONUS TANPA TUNTUTAN hendaklah bermaksud selepas pembaharuan polisi ini (dengan syarat pembaharuan tersebut berterusan, polisi tidak pernah luput dalam mana-mana satu (1) tahun tertentu, dan tiada tuntutan dibuat selama tahun perlindungan sebelumnya), Bonus Tanpa Tuntutan sebanyak sepuluh peratus (10%) akan diguna pakai. Bonus Tanpa Tuntutan tidak terkumpul dan sekiranya tuntutan dibuat oleh mana- mana satu Anda, Bonus Tanpa Tuntutan akan dilucutkan sepenuhnya. PESAKIT LUAR hendaklah bermaksud Anda yang menerima jagaan atau rawatan perubatan tanpa dimasukkan ke Hospital dan merangkumi rawatan di pusat rawatan harian. HAD TAHUNAN KESELURUHAN bermaksud manfaat yang dibayar bagi belanja yang dikenakan untuk rawatan yang diberikan kepada Anda dalam Tempoh Insurans hendaklah dihadkan mengikut Had Tahunan Keseluruhan seperti yang dinyatakan dalam Jadual Manfaat tanpa mengira jenis Hilang Upaya. Jika Had Tahunan Keseluruhan telah dibayar, maka semua insurans untuk Anda di bawah ini hendaklah dihentikan bayarannya serta-merta bagi baki Tahun Polisi tersebut. LUAR NEGARA bermaksud mana-mana destinasi di luar Malaysia. TEMPOH INSURANS bermaksud tempoh Polisi seperti yang dinyatakan dalam Jadual Polisi. HILANG UPAYA MENYELURUH DAN KEKAL bermaksud hilang upaya yang disebabkan semata-mata secara langsung dan bebas daripada semua sebab lain kecuali akibat Kecederaan badan serta berlaku dalam tempoh tiga ratus enam puluh lima (365) hari berturut-turut dan kemungkinan besar mencegah Anda secara sepenuhnya daripada melakukan sebarang pekerjaan untuk seumur hidup dan yang mana tiada harapan untuk sembuh. JADUAL POLISI hendaklah merujuk kepada dokumen yang dikeluarkan oleh Kami yang dikeluarkan untuk mengesahkan kewujudan perlindungan Insurans yang diberikan kepada Anda. Z-MedProtect/PW/20220113 Halaman 2 dari 14 PEMILIK POLISI hendaklah bermaksud orang atau badan korporat atau persatuan/pertalian yang kepadanya Polisi dikeluarkan bagi melindungi orang yang secara khusus dikenal pasti sebagai Orang Yang Diinsuranskan dalam Polisi ini dan dapat menggunakan semua hak, keistimewaan dan pilihan yang terdapat di bawah polisi ini. TAHUN POLISI hendaklah bermaksud tempoh satu (1) tahun termasuk tarikh mula kuat kuasa Insurans dan sebaik sahaja selepas tarikh itu, atau tempoh satu tahun selepas Pembaharuan Atau Polisi Yang Diperbaharui. PENYAKIT SEDIA ADA hendaklah bermaksud Hilang Upaya sedia ada yang diketahui sewajarnya oleh Anda. Anda dianggap mengetahui sewajarnya keadaan sedia ada itu apabila: (a) Anda telah atau sedang menerima rawatan; (b) nasihat perubatan, diagnosis, jagaan atau rawatan telah disyorkan; (c) gejala yang jelas dan tepat dapat atau telah dilihat dengan nyata; atau (d) kewujudannya dapat diperhatikan dengan jelas bagi orang yang mengalami keadaan itu. UBAT YANG DIPRESKRIPSIKAN hendaklah bermaksud ubat yang diberikan oleh Pakar Perubatan, ahli farmasi berdaftar atau Hospital dan yang dipreskripsikan oleh Pakar Perubatan atau Pakar bagi rawatan Hilang Upaya yang dilindungi. BAYARAN MUNASABAH DAN BIASA DIAMALKAN hendaklah bermaksud bayaran rawatan perubatan yang Perlu Dari Segi Perubatan, yang dianggap munasabah dan biasa selagi bayaran itu tidak melebihi had biasa bayaran yang dibuat oleh pihak lain yang sama kedudukannya di tempat bayaran itu dikenakan, apabila memberikan rawatan, khidmat atau bekalan seumpamanya atau yang serupa kepada individu dengan jantina yang sama dan kategori umur yang sama untuk Sakit, Penyakit atau Kecederaan serta selaras dengan piawai dan amalan perubatan yang diterima dan tidak boleh diabaikan tanpa menjejaskan keadaan perubatan Anda. PEMBAHARUAN ATAU POLISI YANG DIPERBAHARUI hendaklah bermaksud Polisi yang telah dibaharui tanpa apa-apa tempoh luput sebaik sahaja tamatnya tempoh Polisi sebelumnya dengan kandungan yang sama tempoh. RM bermaksud dalam Ringgit Malaysia, mata wang Malaysia. KECEDERAAN SERIUS ATAU PENYAKIT SERIUS bermaksud Hilang Upaya kritikal atau berbahaya yang pada pendapat Pakar Perubatan atau Penyedia Perkhidmatan, memerlukan rawatan pemulihan segera untuk mengelakkan kematian atau masalah serius kepada keadaan kesihatan semasa atau jangka panjang. PENYEDIA PERKHIDMATAN bermaksud bantuan kecemasan sedunia dua puluh empat (24) jam. SAKIT, WABAK ATAU PENYAKIT hendaklah bemaksud keadaan fizikal yang ditunjukkan dari segi patologi berbeza daripada keadaan kesihatan yang normal. PAKAR hendaklah bermaksud pengamal perubatan atau pergigian yang berdaftar dan berlesen sewajarnya di kawasan geografi yang khidmat tersebut diberikan, dan yang diklasifikasikan oleh pihak berkuasa kesihatan yang berkenaan sebagai orang yang mempunyai kepakaran yang tinggi dan khusus dalam bidang perubatan atau pergigian yang tertentu, tetapi tidak termasuk Pakar Perubatan atau Pakar Bedah atau Doktor Gigi yang merupakan Orang Yang Diinsuranskan sendiri atau keluarga terdekat iaitu adik-beradik, pasangan suami isteri, anak atau ibu bapa. PENYAKIT TERTENTU hendaklah bermaksud Hilang Upaya berikut dan komplikasi yang berkaitan dengannya, yang wujud dalam tempoh seratus dua puluh (120) hari pertama insurans Anda: (a) Hipertensi, diabetes melitus dan penyakit kardiovaskular. (b) Semua tumor, kanser, sista, nodul, polip, batu dalam sistem kencing dan sistem billari. (c) Semua penyakit telinga, hidung (termasuk sinus) dan tekak. (d) Hernia, hemoroid, fistula, hidrosele, varikosele. (e) Endometriosis termasuk penyakit sistem pembiakan. (f) Gangguan spina vertebro (termasuk diska) dan penyakit lutut. PEMBEDAHAN hendaklah bermaksud mana-mana prosedur perubatan yang berikut: (a) Untuk menginsisi, mengeksisi atau mengelektrokauterisasi mana-mana bahagian organ atau badan kecuali untuk khidmat pergigian. (b) Untuk membaiki, mengubah atau membentuk semula mana-mana bahagian organ atau badan. (c) Untuk mengurangkan fraktur atau dislokasi melalui manipulasi. (d) Penggunaan endoskopi untuk mengeluarkan batu atau objek dari larinks, bronkus, trakea, esofagus, perut, usus, pundi kencing atau uretra. CUKAI hendaklah bermaksud sebarang cukai, levi atau duti langsung atau tidak langsung, masa kini atau masa depan, termasuk cukai penggunaan atau sebarang cukai sepertinya yang dikenakan ke atas barangan dan perkhidmatan oleh kerajaan atau pihak berkuasa cukai. TEMPOH TANGGUH hendaklah bermaksud tiga puluh (30) hari pertama antara masa bermulanya Hilang Upaya Anda dan bermulanya tarikh Polisi / tarikh pengembalian semula, dan terpakai hanya apabila orang itu dilindungi pertama kalinya. Ini tidak terpakai selepas tahun pertama perlindungan. Walau bagaimanapun, jika insurans terhenti, maka Tempoh Tangguh akan terpakai sekali lagi. PEPERANGAN bermaksud suatu aktiviti kekerasan antara dua (2) atau lebih negara, yang dijalankan bagi sebarang tujuan, atau konflik bersenjata antara kuasa berdaulat, atau permusuhan terbuka yang diisytiharkan atau tidak diisytiharkan dan permusuhan terbuka atau keadaan negara di mana terdapat gangguan perhubungan aman, dan perbalahan umum menggunakan kekerasan, yang kedua-duanya dibenarkan atau tidak dibenarkan oleh pemerintahnya. KAMI bermaksud Zurich General Insurance Malaysia Berhad, yang merupakan syarikat insurans / pengeluar polisi. Z-MedProtect/PW/20220113 Halaman 3 dari 14 KETERANGAN MANFAAT JADUAL MANFAAT Manfaat Pelan 1 Pelan 2 Pelan 3 Pelan 4 Pelan 5 Had Tahunan Keseluruhan (RM) 100,000 300,000 500,000 1,000,000 2,000,000 (untuk Seksyen A dan Seksyen B) Bonus Tanpa Tuntutan Pengurangan 10% atas premium pembaharuan (jika tiada tuntutan dibuat) Seksyen A – Manfaat Pesakit Dalam & Pembedahan Harian 100 150 180 200 500 Bilik Hospital dan Makanan (RM) (maksimum 365 hari setahun) Bayaran Dikenakan Unit Rawatan Rapi (maksimum 180 hari setahun) Bekalan dan Khidmat Hospital Bayaran Dikenakan Prosedur Pembedahan Harian Bayaran Dikenakan Bayaran Pembedahan Bayaran Dikenakan Bayaran Pakar Bius Bayaran Dikenakan Bayaran Bilik Bedah Bayaran Dikenakan Bayaran Dikenakan Lawatan Pakar Perubatan Dalam Hospital (tidak terhad) Bayaran Ambulans Bayaran Dikenakan 100 Elaun Tunai Harian Di Hospital Kerajaan (RM) (maksimum 365 hari setahun) Manfaat Penjagaan Harian Anak Orang Yang 250 Diinsuranskan (RM) (maksimum setiap hilang upaya) Bayaran Laporan Perubatan (RM) 150 Transplan Organ (Hati, Buah Pinggang, Jantung, Paru- Bayaran Dikenakan paru atau Sum-sum Tulang) Cukai Ke Atas Perbelanjaan Layak Bayaran Dikenakan Seksyen B – Manfaat Pesakit Luar Bayaran Dikenakan Ujian Diagnostik Prahospital (dalam masa 60 hari sebelum penghospitalan) Bayaran Dikenakan Rundingan Pakar Prahospital (dalam masa 60 hari sebelum penghospitalan) Bayaran Dikenakan Rawatan Selepas Penghospitalan (dalam masa 90 hari dari penghospitalan) Rawatan Pesakit Luar Bagi Kemalangan Secara Bayaran Dikenakan Kecemasan (dalam masa 24 jam dan rawatan susulan sehingga maksimum 60 hari) Bayaran Dikenakan Rawatan Fisioterapi Pesakit Luar (dalam masa 90 hari dari tarikh keluar) Rawatan Dialisis Buah Pinggang Pesakit Luar Bayaran Dikenakan Rawatan Kanser Pesakit Luar Bayaran Dikenakan Rawatan Pergigian Pesakit Luar Bagi Kemalangan 4,000 (setiap kemalangan) Secara Kecemasan (RM) 4,000 Penjagaan Kejururawatan Di Rumah (RM) (sehingga 180 hari, maksimum seumur hidup) Rundingan Pembedahan Pendapat Kedua Bayaran Dikenakan Seksyen C – Manfaat Khas (Had tambahan di atas Had Tahunan Keseluruhan) Kematian dan Hilang Upaya Kekal Akibat Kemalangan 50,000 (RM) Pemindahan Kecemasan Perubatan dan Penghantaran 50,000 Pulang Antarabangsa (RM) (maksimum setahun) Perbelanjaan Pengebumian (semua sebab) (RM) 2,000 Seksyen D – Pilihan Pilihan A B C D Jumlah Penolakan (setiap Mana-mana Satu Hilang Upaya) RM 0 RM 5,000 RM 10,000 RM 20,000 Penolakan (terpakai untuk Seksyen A sahaja) Diskaun 0% 15% 30% 50% Premium Z-MedProtect/PW/20220113 Halaman 4 dari 14 SEKSYEN A – MANFAAT PESAKIT DALAM & PEMBEDAHAN HARIAN (tertakluk kepada Had Tahunan Keseluruhan) (a) BILIK HOSPITAL DAN MAKANAN Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang Perlu Dari Segi Perubatan untuk penginapan di bilik dan makan. Jumlah manfaat hendaklah sama dengan bayaran sebenar yang dikenakan oleh Hospital semasa Anda dimasukkan ke Hospital, tetapi manfaat tidak boleh melebihi bagi mana-mana satu Hari, kadar manfaat Bilik dan Makan, dan bilangan maksimum Hari seperti yang ditetapkan dalam Jadual Manfaat. Anda hanya Iayak menerima manfaat ini apabila dimasukkan ke Hospital sebagai pesakit dalam. (b) UNIT RAWATAN RAPI Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan untuk bilik dan makan yang sebenarnya ditanggung semasa dimasukkan ke Hospital sebagai pesakit dalam di Unit Rawatan Rapi Hospital. Bayaran manfaat ini hendaklah sama dengan bayaran sebenar yang dikenakan oleh Hospital tertakluk kepada manfaat maksimum bagi mana-mana satu Hari, dan bilangan maksimum Hari, seperti yang ditetapkan dalam Jadual Manfaat. Apabila tempoh dimasukkan ke Hospital di Unit Rawatan Rapi melebihi tempoh maksimum yang ditetapkan dalam Jadual Manfaat, maka pembayaran balik akan dihadkan kepada kadar harian Bilik Hospital dan Makan. Tiada manfaat Bilik Hospital dan Makan akan dibayar untuk tempoh dimasukkan ke Hospital yang sama di mana manfaat Unit Rawatan Rapi dibayar. (c) BEKALAN DAN KHIDMAT HOSPITAL Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang sebenarnya ditanggung untuk jagaan am, dadah dan ubat yang dipreskripsikan dan dimakan, pencucian dan pembalutan luka, anduh, acuan plaster, sinar-x, pemeriksaan makmal, elektrokardiogram, fisioterapi, ujian metabolisma basal, suntikan dan larutan intravena, pemberian darah dan plasma darah, termasuk kos darah dan plasma semasa Anda dimasukkan ke Hospital sebagai pesakit dalam di Hospital, hingga jumlah yang dinyatakan dalam Jadual Manfaat. (d) PROSEDUR PEMBEDAHAN HARIAN Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan untuk bayaran perubatan dan bayaran pakar yang dikenakan ke atas Pembedahan Harian (Pembedahan dan Perubatan) yang dilakukan sebagai Pesakit Luar (tanpa kemasukan ke Hospital) sehingga had maksimum bagi Hilang Upaya yang dinyatakan dalam Jadual Manfaat. Ini termasuk rawatan susulan oleh Pakar Perubatan / Pakar / Pakar Bedah merawat yang sama tertakluk kepada jumlah maksimum yang dinyatakan dalam Jadual Manfaat. Mana-mana Prosedur Pembedahan Harian yang dilakukan untuk tujuan penyiasatan dan diagnostik yang tidak berkaitan dengan rawatan untuk sebarang Hilang Upaya tertentu yang tidak dilindungi. (e) BAYARAN PEMBEDAHAN Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan untuk Pembedahan oleh Pakar / Pakar Bedah, termasuk lawatan penilaian pra-pembedahan Anda oleh Pakar / Pakar Bedah dan rawatan selepas Pembedahan dari tarikh Pembedahan, tertakluk kepada jumlah maksimum yang dinyatakan dalam Jadual Manfaat. Jika lebih daripada satu Pembedahan dijalankan bagi Mana- mana Satu Hilang Upaya, jumlah bayaran untuk semua Pembedahan yang dijalankan tidak boleh melebihi jumlah maksimum yang dinyatakan dalam Jadual Manfaat. (f) BAYARAN PAKAR BIUS Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan oleh Pakar Bius untuk pemberian bahan bius yang tidak melebihi had yang ditetapkan dalam Jadual Manfaat. (g) BAYARAN BILIK BEDAH Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan untuk Bilik Bedah yang berkaitan dengan prosedur pembedahan yang tidak melebihi had yang ditetapkan dalam Jadual Manfaat. (h) LAWATAN PAKAR PERUBATAN DALAM HOSPITAL Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan oleh Pakar Perubatan untuk lawatan yang Perlu Dari Segi Perubatan ke atas pesakit dalam berbayar semasa dimasukkan ke Hospital kerana Hilang Upaya bukan pembedahan yang tidak melebihi jumlah maksimum yang ditetapkan dalam Jadual Manfaat. (i) BAYARAN AMBULANS Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang ditanggung untuk perkhidmatan ambulans domestik yang diperlukan (termasuk atendan) ke dan/atau dari Hospital berkaitan. Bayaran tidak akan dibuat jika Anda tidak dimasukkan ke Hospital dan tertakluk kepada had yang ditetapkan dalam Jadual Manfaat. (j) ELAUN TUNAI HARIAN DI HOSPITAL KERAJAAN Kami akan membayar elaun tunai harian bagi setiap Hari semasa dimasukkan ke Hospital untuk Hilang Upaya yang dilindungi di Hospital Kerajaan Malaysia, dengan syarat Anda dihadkan kepada kadar Bilik dan Makan yang tidak melebihi jumlah dan bilangan Hari yang dinyatakan dalam Jadual Manfaat. (k) MANFAAT PENJAGAAN HARIAN ANAK ORANG YANG DIINSURANSKAN Kami akan membayar balik perbelanjaan untuk makan dan penginapan yang ditanggung semasa menjaga anak-anak Anda (berumur di bawah lima belas (15) tahun) di Hospital tidak melebihi had yang ditetapkan dalam Jadual Manfaat. (l) BAYARAN LAPORAN PERUBATAN Kami akan membayar balik bayaran sebenar bagi laporan perubatan yang lengkap oleh Pakar Perubatan / Pakar Bedah yang merawat untuk setiap Hilang Upaya tetapi tidak melebihi jumlah yang dinyatakan dalam Jadual Manfaat. (m) TRANSPLAN ORGAN Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang ditanggung bagi Pembedahahn transplan untuk Anda sebagai penerima transplan hati, pinggang, jantung, paru-paru atau sum-sum tulang. Bayaran untuk manfaat ini adalah terhad kepada had yang dinyatakan dalam Jadual Manfaat. Kos pemerolehan organ dan semua kos yang ditanggung oleh penderma adalah tidak dilindungi. (n) CUKAI KE ATAS PERBELANJAAN LAYAK Kami akan membayar balik jumlah Cukai Ke Atas Perbelanjaan Layak yang dikenakan oleh klinik atau Hospital ke atas pembekalan bercukai dan perkhidmatan yang diberikan kepada Anda yang akan dibayar di bawah polisi ini tertakluk kepada had yang ditetapkan dalam Jadual Manfaat. Z-MedProtect/PW/20220113 Halaman 5 dari 14 SEKSYEN B – MANFAAT PESAKIT LUAR (tertakluk kepada Had Tahunan Keseluruhan) (a) UJIAN DIAGNOSTIK PRAHOSPITAL Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan untuk ECG, sinar-x dan ujian makmal yang dijalankan di Hospital untuk tujuan diagnostik bagi Kecederaan atau Penyakit apabila berkaitan dengan Hilang Upaya sebelum Penghospitalan dalam bilangan Hari dan jumlah maksimum seperti yang ditetapkan dalam Jadual Manfaat dan yang disyorkan oleh Pakar Perubatan / Pakar. Bayaran tidak akan dibuat jika dalam khidmat diagnostik itu, Anda tidak dimasukkan ke Hospital untuk rawatan bagi keadaan perubatan yang didiagnosis itu. (b) RUNDINGAN PAKAR PRAHOSPITAL Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan untuk rundingan oleh Pakar yang berkaitan dengan Hilang Upaya dalam bilangan Hari dan jumlah maksimum seperti yang ditetapkan dalam Jadual Manfaat sebelum dimasukkan ke Hospital dan dengan syarat rundingan itu Perlu Dari Segi Perubatan dan telah disyorkan secara bertulis oleh Pakar Perubatan / Pakar yang merawat, termasuk preskripsi untuk ubat dan rundingan berikutnya yang tertakluk kepada had Jadual Manfaat. Bayaran tidak akan dibuat apabila Anda tidak dimasukkan ke Hospital untuk rawatan bagi keadaan perubatan yang didiagnosis itu. (c) RAWATAN SELEPAS PENGHOSPITALAN Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang ditanggung dalam rawatan susulan untuk Hilang Upaya yang sama seperti semasa Penghospitalan sebaik sahaja keluar dari Hospital untuk Hilang Upaya bukan pembedahan termasuk preskripsi untuk ubat, dalam bilangan Hari dan jumlah maksimum seperti yang ditetapkan dalam Jadual Manfaat. (d) RAWATAN PESAKIT LUAR BAGI KEMALANGAN SECARA KECEMASAN Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang ditanggung hingga jumlah maksimum yang dinyatakan dalam Jadual Manfaat, bagi Kecederaan anggota badan yang dilindungi yang timbul daripada Kemalangan untuk rawatan yang Perlu Dari Segi Perubatan sebagai Pesakit Luar di mana-mana klinik atau Hospital berdaftar dalam tempoh dua puluh empat (24) jam dari masa berlaku Kemalangan yang menyebabkan Kecederaan anggota badan yang dilindungi. Rawatan susulan oleh Doktor yang sama atau klinik atau Hospital berdaftar yang sama untuk Kecederaan anggota badan yang dilindungi yang sama akan disediakan hingga jumlah maksimum dan bilangan hari maksimum seperti yang ditetapkan dalam Jadual Manfaat. (e) RAWATAN FISIOTERAPI PESAKIT LUAR Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan bagi rawatan fisioterapi Pesakit Luar yang dirujuk secara bertulis oleh Pakar / Pakar Perubatan berlesen selepas Pembedahan atau rawatan dalam Hospital, dalam tempoh sembilan puluh (90) hari dari tarikh keluar Hospital sehingga jumlah maksimum yang ditetapkan di Jadual Manfaat. (f) RAWATAN DIALISIS BUAH PINGGANG PESAKIT LUAR Jika Anda didiagnosis sebagai mengalami Kegagalan Buah Pinggang seperti yang dinyatakan di bawah, Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang ditanggung yang Perlu Dari Segi Perubatan untuk rawatan dialisis buah pinggang yang dijalankan di pusat dialisis berdaftar yang sah tertakluk kepada had Hilang Upaya ini seperti yang ditetapkan dalam Jadual Manfaat. Rawatan tersebut (dialisis termasuk rundingan, ujian pemeriksaan, dadah yang dibawa pulang) hendaklah diterima di jabatan Pesakit Luar Hospital atau di pusat rawatan dialisis berdaftar atau sebaik sahaja selepas keluar dari Hospital atau Pembedahan. Kegagalan Buah Pinggang bermaksud kegagalan renal peringkat akhir yang menyebabkan kegagalan kronik dan tidak boleh pulih kedua- dua buah pinggang untuk berfungsi dan oleh itu dialisis renal perlu dimulakan. Ini adalah syarat khas bagi manfaat ini walaupun pengecualian Penyakit Sedia Ada, manfaat ini tidak akan dibayar kepada Anda, jika Anda mengalami penyakit renal kronik dan/atau sedang menerima rawatan dialisis sebelum tarikh mula insurans. (g) RAWATAN KANSER PESAKIT LUAR Jika Anda didiagnosis menghidap kanser seperti yang dinyatakan di bawah, Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang ditanggung untuk rawatan kanser yang dijalankan di pusat rawatan kanser berdaftar yang sah tertakluk kepada had bagi Hilang Upaya ini seperti yang ditetapkan dalam Jadual Manfaat. Jenis rawatan yang dilindungi sebagai rawatan kanser hanya terhad kepada radioterapi atau kemoterapi (suntikan atau oral), termasuk rundingan, ujian pemeriksaan, dadah yang dibawa pulang. Rawatan itu hendaklah diterima atau disarankan di jabatan Pesakit Luar Hospital atau di pusat rawatan kanser berdaftar atau sebaik sahaja selepas keluar dari Hospital atau Pembedahan. Kanser ditakrifkan sebagai sel malignan yang tumbuh dan merebak secara tidak terkawal dan serangan serta pemusnahan tisu normal tersebut dianggap memerlukan rawatan perantaraan atau Pembedahan (tidak termasuk prosedur endoskopi). Kanser mesti disahkan melalui tanda malignansi histologi. Ini adalah syarat khas bagi manfaat ini walaupun pengecualian Penyakit Sedia Ada, manfaat ini tidak akan dibayar kepada Anda yang telah didiagnosis sebagai pesakit kanser dan/atau sedang menerima rawatan kanser sebelum tarikh mula insurans. (h) RAWATAN PERGIGIAN PESAKIT LUAR BAGI KEMALANGAN SECARA KECEMASAN Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang ditanggung hingga jumlah maksimum yang dinyatakan dalam Jadual Manfaat, bagi Kecederaan Kemalangan dan diterima sebagai Rawatan Pergigian Pesakit Luar Bagi Kemalangan dalam tempoh dua puluh empat (24) jam dari masa berlaku Kemalangan di klinik pergigian atau Hospital berdaftar dan rawatan susulan oleh Doktor Gigi yang sama akan disediakan hingga jumlah maksimum seperti yang ditetapkan dalam Jadual Manfaat. (i) PENJAGAAN KEJURURAWATAN DI RUMAH Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan, sehingga hari dan jumlah maksimum seperti yang ditetapkan dalam Jadual Manfaat, untuk penjagaan kejururawatan berterusan oleh jururawat berdaftar yang Perlu Dari Segi Perubatan kepada Anda di rumah. Penjagaan kejururawatan tersebut mesti disyorkan oleh Pakar Perubatan atau Pakar Bedah yang merawat dan untuk tempoh minimum empat (4) jam setiap hari. Manfaat ini adalah berbayar hanya jika terdapat tuntutan sebelumnya yang dibayar bagi keadaan kesihatan yang mana Penghospitalan diperlukan oleh Anda. Perlindungan Penjagaan Kejururawatan Di Rumah di bawah Polisi ini termasuk: (i) Terapi fizikal, pekerjaan atau ucapan; (ii) Terapi, rawatan untuk luka, pernafasan, penjagaan diabetes, penjagaan kolostomi, tiub pemakanan, suntikan dan ubat-ubatan lain untuk Anda di rumah. Penjagaan kustodian, makanan, perkhidmatan penjagaan rumah am, sahabat dan barangan keselesaan peribadi, atau sebarang perkhidmatan untuk aktiviti harian yang tidak Perlu Dari Segi Perubatan tidak akan dibayar. Manfaat yang dibayar tidak boleh melebihi bilangan hari dan jumlah maksimum pelan ini seperti yang ditetapkan dalam Jadual Manfaat. Z-MedProtect/PW/20220113 Halaman 6 dari 14 (j) RUNDINGAN PEMBEDAHAN PENDAPAT KEDUA Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan bagi rundingan dengan Pakar bagi memperoleh pendapat kedua sebelum Pembedahan bagi Penyakit atau Kecederaan yang memerlukan Pembedahan sehingga jumlah maksimum yang dinyatakan dalam Jadual Manfaat. Bayaran tidak akan dibuat apabila Anda tidak dimasukkan ke Hospital untuk rawatan bagi keadaan perubatan yang didiagnosis itu. SEKSYEN C – MANFAAT KHAS (Had tambahan di atas Had Tahunan Keseluruhan) (a) KEMATIAN DAN HILANG UPAYA KEKAL AKIBAT KEMALANGAN Sekiranya Anda mengalami Kecederaan badan, di mana dalam tempoh dua belas (12) bulan yang berturut-turut menyebabkan kematian atau hilang upaya yang dinyatakan di dalam Jadual Manfaat berikut, Kami akan membayar jumlah yang dinyatakan di dalam Jadual Manfaat mengikut peratusan jumlah yang diinsuranskan seperti yang dinyatakan di dalam Jadual Manfaat. Peratusan Jumlah Yang Keterangan Hilang Upaya Diinsuranskan (%) Kehilangan nyawa 100 Kehilangan Anggota Badan (dua anggota badan) 100 Kehilangan kedua-dua belah tangan, atau kesemua jari dan kedua-dua ibu jari 100 Kecederaan yang mengakibatkan terlantar sakit di katil secara kekal 100 Tidak siuman sepenuhnya 100 Kecederaan yang mengakibatkan kekal terlantar di katil 100 Sebarang kecederaan lain yang menyebabkan Hilang Upaya Menyeluruh dan Kekal 100 Kehilangan tangan dari paras bahu 100 Kehilangan tangan antara paras bahu dan siku 100 Kehilangan tangan dari paras siku 100 Kehilangan tangan antara siku dan pergelangan tangan 100 Kehilangan tangan diparas pergelangan tangan 100 Kehilangan kaki - di paras pinggul 100 - di antara lutut dan pinggul 100 - di bawah lutut 100 Mata: Kehilangan - Penglihatan 100 - Penglihatan, kecuali bayangan cahaya 50 - kanta 50 Kehilangan empat (4) jari dan satu (1) ibu jari di sebelah tangan 50 Kehilangan empat (4) jari 40 Kehilangan ibu jari - kedua-dua falanks 25 - satu (1) falanks 10 Kehilangan jari telunjuk - tiga (3) falanks 10 - dua (2) falanks 8 - satu (1) falanks 4 Kehilangan jari hantu - tiga (3) falanks 6 - dua (2) falanks 4 - satu (1) falanks 2 Kehilangan jari manis - tiga (3) falanks 5 - dua (2) falanks 4 - satu (1) falanks 2 Kehilangan jari kelengkeng - tiga (3) falanks 4 - dua (2) falanks 3 - satu (1) falanks 2 Kehilangan metakarpus - pertama atau kedua (tambahan) 3 - ketiga, keempat atau kelima (tambahan) 2 Kehilangan jari kaki - semua falanks 15 - ibu jari, kedua-dua falanks 5 - Ibu jari, satu (1) falanks 2 - selain ibu jari, jika lebih daripada satu (1) jari setiap satu 1 Kehilangan Pendengaran - kedua-dua belah telinga 75 - sebelah telinga 15 Kehilangan Upaya Bertutur 50 Tahap kependekan anggota mesti disahkan menerusi laporan Pakar Perubatan. Sekiranya Kecederaan Badan tidak dinyatakan secara khusus, Kami berhak untuk menggunapakai peratusan jumlah yang diinsuranskan berdasarkan hilang upaya, yang pada pendapat Kami tidak bercanggah dengan peruntukan Jadual Manfaat di atas. “Kehilangan” anggota badan atau sebahagian daripadanya hendaklah bermaksud sebarang kehilangan akibat pemisahan secara fizikal sebenar atau Kehilangan Penggunaan yang menyeluruh dan kekal. Kehilangan Penggunaan anggota badan hendaklah dianggap sebagai kehilangan anggota badan. Agregat semua peratusan yang boleh dibayar bagi mana-mana satu (1) Kemalangan tidak boleh melebihi seratus peratus (100%). Sekiranya 100% telah dibayar, semua perlindungan di bawah ini hendaklah berhenti berkuatkuasa. Semua kehilangan lain yang kurang daripada 100%, jika dibayar, akan mengurangkan perlindungan bagi manfaat ini sebanyak jumlah tersebut dari tarikh Kemalangan sehingga tamat Jadual Polisi. Z-MedProtect/PW/20220113 Halaman 7 dari 14 Peruntukan Khas • Koma Setelah mendapat pengesahan oleh Pakar Perubatan bahawa Anda telah berada dalam keadaan koma selama sekurang-kurangnya satu (1) tahun akibat Kemalangan, Kami akan membayar 100% Jumlah Yang Diinsuranskan. Walau bagaimanapun, Kami mempunyai hak untuk mendapatkan pulangan pembayaran yang dibuat jika Anda memperoleh semula kesedaran dengan syarat potongan sebanyak 10% daripada pembayaran yang disebut di atas untuk setiap tahun Anda berada dalam keadaan koma. • Kehilangan Kematian akan dianggap telah berlaku sekiranya Anda telah hilang selama dua belas (12) bulan yang berturut-turut dan Kami telah memeriksa segala bukti yang ada untuk menyokong kesimpulan bahawa kematian adalah disebabkan oleh Kemalangan yang dilindungi oleh Polisi ini. Jika pada bila-bila masa selepas bayaran dibuat oleh Kami bagi tuntutan sedemikian, Anda ditemui masih hidup, bayaran balik sepenuhnya hendaklah dibuat kepada Kami. (b) PEMINDAHAN KECEMASAN PERUBATAN DAN PENGHANTARAN PULANG ANTARABANGSA Sekiranya Anda mengalami Kecederaan Serius atau Penyakit Serius di Luar Negara, dan pada pendapat Kami atau Penyedia Perkhidmatan, adalah dianggap munasabah dari segi perubatan untuk memindahkan Anda ke lokasi yang lain untuk rawatan perubatan, Penyedia Perkhidmatan akan mengatur pemindahan dengan menggunakan kaedah yang Kami atau Penyedia Perkhidmatan percaya adalah paling sesuai berasaskan tahap keterukan keadaan perubatan Anda, tertakluk kepada had yang dinyatakan di dalam Jadual Manfaat. Sekiranya Anda mengalami Kecederaan Serius atau Penyakit Serius di Luar Negara, dan pada pendapat Kami atau Penyedia Perkhidmatan, adalah dianggap munasabah dari segi perubatan untuk menghantar Anda pulang ke Malaysia, Penyedia Perkhidmatan akan mengatur penghantaran balik dengan menggunakan kaedah yang Kami atau Penyedia Perkhidmatan percaya adalah paling sesuai berasaskan tahap keterukan keadaan perubatan Anda, tertakluk kepada had yang dinyatakan di dalam Jadual Manfaat. Sekiranya Anda mengalami Hilang Upaya di Luar Negara yang menyebabkan kematian, Penyedia Perkhidmatan Kami akan membuat: (i) semua rancangan pengangkutan yang perlu (termasuk sebarang prosedur atau rancangan yang perlu untuk memenuhi kelaziman tempatan) bagi penghantaran balik jenazah Anda ke Malaysia; dan (ii) semua rancangan untuk pengebumian, pembakaran, penyediaan keranda atau pengawetan (sekiranya dipilih) di tempat kematian di Luar Negara, tetapi tidak termasuk sebarang perbelanjaan berkaitan hak, upacara keagamaan atau tiang pengebumian. Syarat-Syarat Khas yang berkenaan dengan Manfaat (b): Keputusan mengenai kaedah pengangkutan dan destinasi akhir akan dibuat oleh Penyedia Perkhidmatan atas budi bicara mutlak Kami. Anda mesti mengikut arahan dan petunjuk Kami atau Penyedia Perkhidmatan pada setiap masa. Pengecualian Khas yang berkenaan dengan Manfaat (b): Kami tidak akan bertanggungjawab terhadap sebarang tuntutan yang disebabkan secara langsung atau tidak langsung oleh mana-mana yang berikut: (i) perkhidmatan yang diberikan tanpa kebenaran dan/atau campur tangan Penyedia Perkhidmatan; (ii) perkhidmatan yang disediakan oleh mana-mana pihak selain daripada Penyedia Perkhidmatan dengan caj biasanya tidak dikenakan; (iii) rawatan perubatan yang diberikan oleh saudara mara dan/atau ahli keluarga Anda sama ada layak atau tidak; (iv) Hilang Upaya yang pada pendapat Pakar Perubatan Penyedia Perkhidmatan masih membolehkan Anda melancong secara fizikal dengan duduk sebagai penumpang biasa dan tanpa pengiring perubatan. (c) PERBELANJAAN PENGEBUMIAN (SEMUA SEBAB) Kami akan membayar jumlah seperti yang dinyatakan di dalam Jadual Manfaat, jika Anda meninggal dua dalam Tempoh Insurans. SEKSYEN D – PILIHAN (a) PENOLAKAN Polisi ini adalah tertakluk kepada jumlah yang boleh ditolak seperti dinyatakan dalam Jadual Manfaat. Jumlah yang boleh ditolak bermaksud jumlah wang yang akan ditolak daripada Perbelanjaan Layak di bawah Seksyen A yang ditanggung oleh Anda, dan berdasarkan setiap Mana-mana Satu Hilang Upaya apabila Anda dimasukkan ke mana-mana hospital swasta. Walau bagaimanapun, jika Anda dimasukkan ke mana-mana Hospital Kerajaan Malaysia, Perbelanjaan Layak yang ditanggung tidak akan tertakluk kepada jumlah yang boleh ditolak. SYARAT-SYARAT 1. HAD UMUR Kelayakan umur untuk melayak bagi Polisi ini adalah dari tiga puluh (30) hari hingga enam puluh lima (65) tahun, dan boleh diperbaharui hingga seratus (100) tahun. Semua umur merujuk kepada umur Anda pada tarikh lahir yang berikutnya. 2. PINDAHAN Kami berhak meminda terma dan peruntukan Polisi ini dengan memberikan notis awal tiga puluh (30) hari secara bertulis melalui pos biasa ke alamat terakhir Pemilik Polisi yang diketahui mengikut rekod Kami dengan alasan yang sah, dan pindaan tersebut akan terpakai dan pembaharuan berikutnya bagi Polisi ini. Pindaan kepada Polisi ini tidak sah kecuali jika diluluskan oleh Kami dan kelulusan itu hendaklah diendorskan pada Polisi tersebut. Kami hendaklah memberikan notis awal tiga puluh (30) hari secara bertulis kepada Pemilik Polisi mengikut alamat terakhir yang direkodkan bagi mana-mana pindaan yang dibuat. 3. TIMBANG TARA Semua perbezaan yang timbul daripada Polisi ini hendaklah dirujuk kepada penimbang tara yang hendaklah dilantik secara bertulis oleh pihak dalam percanggahan. Jika mereka tidak berjaya mendapatkan persetujuan tentang siapa yang akan menjadi Penimbang Tara dalam tempoh satu (1) bulan apabila diminta secara bertulis untuk berbuat demikian, maka kedua-dua pihak Iayak melantik Penimbang Tara setiap seorang yang akan mendengar percanggahan itu bersama-sama dengan Pengadil yang akan dilantik oleh kedua-dua Penimbang Tara itu. Walau bagaimanapun, dengan syarat apa-apa penafian liabiliti oleh Kami bagi apa-apa tuntutan di bawah ini hendaklah dirujuk kepada Penimbang Tara dalam tempoh dua belas (12) bulan kalendar dari tarikh penafian tersebut. 4. PENAMATAN AUTOMATIK Polisi akan tamat secara automatik pada tarikh kejadian-kejadian berikut yang mana Iebih awal: (a) pada tarikh Jadual Polisi ditamatkan; atau (b) apabila Anda meninggal dunia; atau Z-MedProtect/PW/20220113 Halaman 8 dari 14 (c) pada tarikh pembaharuan jika Anda mencapai had umur maksimum pada seratus (100) tahun; atau (d) pada tarikh pembaharuan atau tarikh tamat tempoh premium, yang mana lebih awal, sekiranya premium yang diperlukan tidak dibayar dalam tempoh empat belas (14) hari dari tarikh tamat Polisi. Penamatan Polisi ini adalah tanpa prejudis kepada sebarang tuntutan yang timbul sebelum penamatan tersebut. Pembayaran atau penerimaan sebarang premium yang berikutan penamatan Polisi ini tidak akan membentuk sebarang liabiliti tetapi pihak Kami akan mengembalikan sebarang premium. 5. PEMBATALAN Polisi ini boleh dibatalkan oleh Pemilik Polisi pada bila-bila masa dengan memberikan notis bertulis kepada Kami, dan dengan syarat tiada tuntutan dibuat dalam Tahun Polisi semasa. Pemilik Polisi Iayak menerima bayaran balik premium seperti yang berikut: Tempoh Tidak Boleh Melebihi Bayaran Balik Premium Tahunan 15 hari (untuk pembaharuan sahaja) 90% 1 bulan 80% 2 bulan 70% 3 bulan 60% 4 bulan 50% 5 bulan 40% 6 bulan 30% 7 bulan 25% 8 bulan 20% 9 bulan 15% 10 bulan 10% 11 bulan 5% Tempoh melebihi 11 bulan Tiada bayaran balik Tidak akan ada bayaran balik premium untuk mod pembayaran bukan tahunan. 6. TUNAI SEBELUM PERLINDUNGAN Adalah menjadi syarat mutlak khas kontrak insurans ini bahawa premium mesti dibayar dan diterima oleh Kami sebelum perlindungan insurans berkuatkuasa. 7. PENSIJILAN, MAKLUMAT DAN KETERANGAN Semua sijil, maklumat, laporan dan bukti perubatan seperti yang dikehendaki oleh Kami hendaklah diserahkan atas belanja Pemilik Polisi, dan dalam borang tertentu yang mungkin dikehendaki oleh Kami. Semua notis apabila dikehendaki oleh Kami supaya diberikan oleh Pemilik Polisi, hendaklah secara bertulis dan dialamatkan kepada Kami. Pemilik Polisi hendaklah, atas permintaan dan belanja Kami, menyerahkan kepada pemeriksaan perubatan apabila ia dianggap perlu. 8. PROSEDUR TUNTUTAN (a) Anda hendaklah dalam tempoh tiga puluh (30) hari Hilang Upaya yang melibatkan belanja boleh tuntut, memberikan notis bertulis kepada Kami dengan menyatakan butiran lengkap kejadian tersebut, termasuk semua bil dan resit asal, serta laporan lengkap Pakar Perubatan yang menyatakan diagnosis keadaan yang dirawat dan tarikh Hilang Upaya bermula mengikut pendapat Pakar Perubatan dan rumusan kos rawatan oleh Pakar Perubatan termasuk ubat dan khidmat yang diberikan. Kegagalan memberikan notis tersebut dalam tempoh yang dibenarkan tidak boleh membatalkan apa-apa tuntutan jika ditunjukkan tidak munasabah untuk memberikan notis itu dan notis itu telah diberikan secepat yang mungkin. (b) Anda hendaklah mendapatkan dan bertindak berdasarkan nasihat perubatan yang sewajarnya dan Kami tidak bertanggungjawab jika rawatan atau khidmat diperlukan berikutan kegagalan Anda berbuat demikian. 9. BAYARAN BERSAMA (polisi sub-standard sahaja) Bayaran Bersama ditanggung oleh Pemilik Polisi dengan syarat perkongsian kos atau terma insurans bersama tidak boleh melebihi dua puluh peratus (20%) daripada perbelanjaan yang boleh dituntut (i.e. tidak termasuk Penolakan) bagi setiap Hilang Upaya, tertakluk kepada had maksimum mutlak Ringgit Malaysia Tiga Ribu (RM 3,000) (termasuk Penolakan) setiap Hilang Upaya. Had yang dinyatakan di atas tidak terpakai untuk Bayaran Bersama Bilik dan Makan Dinaikkan dan polisi yang memperuntukkan Had Tahunan Keseluruhan melebihi Ringgit Malaysia Seratus Ribu (RM 100,000). 10. PRASYARAT LIABILITI Pematuhan dan pelaksanaan terma, peruntukan dan syarat Polisi ini dengan sewajarnya oleh Anda dan selagi berkaitan dengan apa-apa yang perlu dilakukan atau dipatuhi oleh Anda hendaklah menjadi prasyarat apa-apa liabiliti Kami. 11. SUMBANGAN Jika Anda mempunyai insurans/takaful lain yang melindungi mana-mana Penyakit atau Kecederaan oleh Polisi ini, Kami tidak bertanggungjawab membayar jumlah yang lebih besar bagi Penyakit atau Kecederaan itu daripada jumlah yang terpakai bersama-sama ini yang ditanggung oleh Polisi ini bagi jumlah keseluruhan semua insurans/takaful yang sah yang melindungi Penyakit atau Kecederaan itu. 12. TEMPOH BERTENANG Jika Pemilik Polisi membuat keputusan untuk tidak mengambil Polisi ini selepas Polisi telah dikeluarkan, Pemilik Polisi boleh mengembalikan Polisi kepada Kami untuk pembatalan dengan syarat permohonan untuk pembatalan diserahkan oleh Pemilik Polisi kepada Kami dalam tempoh lima belas (15) hari dari tarikh Polisi diterima oleh Pemilik Polisi. Pemilik Polisi layak menerima pulangan penuh premium yang telah dibayar tolak belanja perubatan yang ditanggung oleh Kami untuk mengeluarkan Polisi tersebut. Sekiranya tuntutan telah dibuat, premium tidak akan dipulangkan. 13. MATA WANG BAYARAN Semua bayaran di bawah Polisi in hendaklah dibuat dalam mata wang Malaysia yang sah. Sekiranya apa-apa bayaran yang diminta oleh Anda supaya dibayar dalam mata wang lain, maka jumlah tersebut hendaklah dibayar dalam mata wang yang diminta seperti yang boleh dibeli di Malaysia pada kadar pasaran mata wang semasa pada tarikh penyelesaian tuntutan. 14. KEWAJIPAN PENDEDAHAN (a) Kontrak Insurans Pengguna Apabila Pemilik Polisi telah memohon Insurans ini sepenuhnya untuk tujuan diri sendiri/keluarga/tanggungan, Pemilik Polisi Z-MedProtect/PW/20220113 Halaman 9 dari 14 mempunyai kewajipan untuk mengambil langkah yang munasabah untuk tidak salah nyata dalam Borang Cadangan (atau semasa cadangan Insurans ini). Dalam kata lain, Pemilik Polisi haruslah menjawab soalan dengan penuh dan tepat. Kegagalan dalam mengambil langkah munasabah dalam menjawab soalan-soalan boleh mengakibatkan pembatalan kontrak Insurans, keengganan atau pengurangan gantirugi, perubahan kepada terma atau penamatan kontrak Insurans Pemilik Polisi selaras dengan remedi di Jadual 9 Akta Perkhidmatan Kewangan Islam 2013. Pemilik Polisi juga dikehendaki mendedahkan perkara-perkara lain yang Pemilik Polisi tahu akan mempengaruhi keputusan Kami dalam menerima risiko dan menentukan kadar dan terma yang akan dikenakan. Pemilik Polisi juga mempunyai kewajipan untuk memberitahu Kami dengan serta-merta jika pada bila-bila masa selepas kontrak Insurans Pemilik Polisi ditandatangani, diubah atau diperbaharui dengan Kami, apa-apa maklumat yang diberikan di dalam Borang Cadangan (atau semasa cadangan Insurans ini) tidak tepat atau telah berubah. (b) Kontrak Insurans Bukan Pengguna Apabila Pemilik Polisi telah memohon Insurans ini untuk memberi manfaat Insurans perubatan kepada pekerja Pemilik Polisi dan tanggungan mereka, Pemilik Polisi mempunyai tanggungjawab untuk mendedahkan apa-apa perkara yang Pemilik Polisi tahu yang akan mempengaruhi keputusan Kami dalam menerima risiko dan menentukan kadar dan terma yang dikenakan, dan apa-apa perkara yang munasabah yang boleh dijangka, jika tidak ia boleh menyebabkan pembatalan kontrak Insurans, keengganan atau pengurangan ganti rugi, perubahan terma atau penamatan kontrak Insurans Pemilik Polisi. Pemilik Polisi juga mempunyai kewajipan untuk memberitahu Kami dengan serta-merta jika pada bila-bila masa selepas kontrak Insurans Pemilik Polisi ditandatangani, diubah atau diperbaharui dengan Kami, apa-apa maklumat yang diberikan di dalam Borang Cadangan (atau semasa Pemilik Polisi memohon untuk Insurans ini) tidak tepat atau telah berubah. 15. PEMBAYARAN BALIK PENUH BAGI HOSPITAL KERAJAAN Bayaran untuk belanja perubatan yang layak adalah dilindungi secara penuh untuk rawatan di Hospital Kerajaan Malaysia untuk setiap Penyakit atau Kecederaan. 16. SYARAT-SYARAT AM Polisi ini dan Jadual Manfaat hendaklah dibaca bersama sebagai satu kontrak dan sebarang perkataan atau penyataan yang disertakan dengan makna khusus dalam mana-mana bahagian Polisi atau Jadual hendaklah membawa makna khusus yang sama di mana juga ia digunakan. 17. WILAYAH PASARAN GEOGRAFI Semua manfaat yang disediakan dalam Polisi ini terpakai dua puluh empat (24) jam sehari di seluruh dunia. Jika Anda bukan warganegara Malaysia, lindungan Anda akan terhad kepada Hospital di Malaysia sahaja. 18. TEMPOH IHSAN Walaupun terdapat syarat Tunai Sebelum Perlindungan, Tempoh lhsan selama empat belas (14) hari dari tarikh premium perlu dibayar dibenarkan untuk bayaran sebarang premium. Dalam tempoh empat belas (14) hari tersebut, Kami akan bertanggungjawab jika pada akhir tempoh berkenaan, premium telah dibayar. Jika sebarang premium Polisi tidak dibayar sebelum akhir tempoh ihsan, Kontrak Polisi akan dianggap telah ditamatkan pada tarikh luput Polisi. 19. UNDANG-UNDANG YANG MENGAWAL POLISI Polisi in dikeluarkan di bawah undang-undang Malaysia dan tertakluk dan dikawal oleh undang-undang lazim di Malaysia. 20. NOTIS PENTING Kami ingin Anda mengambil perhatian terhadap maklumat penting yang berikut: (a) Bukti umur dikehendaki pada masa polisi matang/tuntutan, jika umur belum dimaklumkan. (b) Anda boleh menghubungi Ejen, Pegawai Cawangan, Bahagian Perkhidmatan Pelanggan di Ibu Pejabat Kami bagi sebarang pertanyaan atau perkhidmatan berkaitan dengan polisi Anda. (c) Pertukaran alamat Pemilik Polisi harus dimaklumkan kepada Kami supaya semua urusan surat-menyurat boleh diuruskan dengan segera. 21. TUNTUTAN TIDAK LENGKAP Semua tuntutan hendaklah diserahkan kepada Kami dalam tempoh tiga puluh (30) hari setelah kejadian itu selesai yang untuknya tuntutan itu dibuat. Tuntutan tidak dianggap lengkap dan manfaat layak diterima tidak akan dibayar kecuali semua bil untuk tuntutan itu telah diserahkan dan dipersetujui oleh Kami. Hanya kos sebenar yang ditanggung akan dipertimbangkan untuk pembayaran balik. Apa-apa perbezaan atau penepian bagi perkara di atas adalah mengikut budi bicara Kami semata-mata. 22. PENAFSIRAN POLISI Di mana konteksnya dibenarkan, perkataan yang menyatakan nombor tunggal sahaja hendaklah termasuk nombor majmuk dan sebaliknya dan perkataan yang menyatakan jantina maskulin sahaja hendaklah termasuk jantina feminin dan jantina neuter dan perkataan yang menyatakan orang hendaklah termasuk perbadanan. 23. PEMERIKSAAN PERUBATAN Kami berhak untuk memeriksa tubuh Anda bilamana ia perlu secara munasabah dan melakukan bedah siasat dalam kes kematian yang mana ia tidak dilarang oleh undang-undang. 24. SILAP NYATA UMUR Jika umur Anda telah tersilap nyata dan akibatnya premium yang dibayar tidak mencukupi, maka apa-apa tuntutan yang dibayar di bawah Polisi ini hendaklah dikira secara pro rata berasaskan nisbah premium sebenar yang dibayar dengan premium yang betul yang sepatutnya dikenakan selama setahun. Apa-apa premium yang berlebihan, yang mungkin telah dibayar akibat silap nyata umur, hendaklah dibayar balik tanpa faedah. Jika pada umur yang betul, sekiranya Anda tidak layak dilindungi di bawah Polisi ini, maka tiada manfaat akan dibayar. 25. SALAH NYATA ATAU TIDAK MENYATAKAN FAKTA PENTING Polisi ini akan terbatal jika: (a) sebarang jawapan, pendedahan atau pernyataan oleh Pemilik Polisi, sebelum kontrak insurans ini bermula, dipelbagai atau diperbaharui, dalam atau pada mana-mana cadangan atau perisytiharan atau pertanyaan, telah dinyatakan dengan salah secara sengaja atau dengan cuai; atau (b) sebelum kontrak insurans ini bermula, dipelbagai atau diperbaharui, Pemilik Polisi gagal memdedahkan sebarang fakta yang Pemilik Polisi tahu berkaitan dengan keputusan Kami samada untuk menerima risiko atau tidak, serta kadar dan syarat-syarat terpakai; atau (c) sebarang tuntutan dibuat yang didapati palsu atau ditokok tambah, atau terdapat sebarang pengisytiharan atau kenyataan palsu dalam menyokong tuntutan tersebut. Z-MedProtect/PW/20220113 Halaman 10 dari 14 26. DISKAUN BERKUMPULAN ORANG YANG DIINSURANSKAN Sekiranya Pemilik Polisi membeli polisi untuk beberapa Orang Yang Diinsuranskan yang merupakan Ahli-ahli Keluarganya, Diskaun Berkumpulan Orang Yang Diinsuranskan akan diguna pakai. Peratus Diskaun Berkumpulan Orang Yang Diinsuranskan bergantung pada jumlah Orang Yang Diinsuranskan seperti dinyatakan dalam Jadual Polisi. Diskaun Berkumpulan Orang Yang Diinsuranskan adalah tidak terkumpul dan sekiranya berlaku perubahan dalam jumlah Orang Yang Diinsuranskan, Diskaun Berkumpulan Orang Yang Diinsuranskan akan diubah semula. 27. PENAMAAN Penamaan bermaksud proses Pemilik Polisi melantik seorang atau lebih penerima wang polisi sekiranya berlaku kematian Pemilik Polisi (yang juga Orang Yang Diinsuranskan) dilakukan pada bila-bila masa selepas Jadual Polisi dikeluarkan. Sekiranya Anda ialah Orang Yang Diinsuranskan, Anda boleh membuat penamaan seorang atau lebih penerima wang polisi yang perlu dibayar di bawah Jadual Polisi ini. Jika Pemilik Polisi atau Anda meninggal dunia tanpa membuat penamaan, Kami akan membayar wang polisi kepada wasi atau pentadbir harta pusaka Pemilik Polisi atau Anda yang sah. Bayaran wang polisi adalah berdasarkan Akta Perkhidmatan Kewangan 2013. 28. NOTIS Setiap notis atau komunikasi kepada Kami hendaklah dibuat secara bertulis dan dihantar kepada Kami. Pindaan bagi syarat dalam Polisi ini atau apa-apa pengendorsan padanya, tidak sah kecuali pindaan itu ditandangani atau diparap oleh wakil Kami yang diberi kuasa. 29. RAWATAN LUAR NEGARA Jika Anda menerima rawatan di Luar Negara, manfaat berkenaan rawatan tersebut akan dilindungi tertakluk kepada pengecualian, had dan peruntukan yang dinyatakan dalam Polisi ini dan semua manfaat akan dibayar berdasarkan kadar pertukaran rasmi pada Hari terakhir tempoh dimasukkan ke Hospital dan tidak termasuk kos pengangkutan ke tempat rawatan sekiranya: (a) Anda melancong ke luar negara atas sebab selain daripada rawatan perubatan, perlu dimasukkan ke Hospital di luar Malaysia akibat Kecemasan; atau (b) Anda dicadangkan oleh Pakar Perubatan dan perlu dipindahkan ke Hospital di luar Malaysia kerana rawatan khusus, bantuan, maklumat atau keputusan yang dikehendaki tidak boleh diberikan, dikemukakan atau diambilkan di Malaysia. Rawatan di Luar Negara untuk Wabak, Sakit atau Kecederaan yang didiagnosis di Malaysia dan bukan kecemasan atau dalam keadaan kronik yang mana rawatan boleh ditangguhkan sewajarnya sehingga pulang ke Malaysia hendaklah dikecualikan. 30. PEMILIKAN POLISI Kecuali diperuntukkan sebaliknya secara nyata melalui Endorsemen dalam Polisi, Kami berhak menganggap Pemilik Polisi sebagai pemilik mutlak Polisi. Kami tidak terikat untuk mengiktiraf apa-apa tuntutan ekuiti atau tuntutan lain ke atas Polisi atau kepentingan dalam Polisi, dan penerimaan Polisi atau Manfaat oleh Pemilik Polisi (atau oleh wakilnya yang sah atau yang diberi kuasa) sahaja hendaklah merupakan pelepasan efektif bagi semua obligasi dan liabiliti Kami. Pemilik Polisi hendaklah dianggap sebagai prinsipal atau ejen bertanggungjawab bagi Anda yang dilindungi di bawah Polisi ini. 31. TEMPOH PERLINDUNGAN DAN PEMBAHARUAN Polisi ini boleh dibaharui mengikut pilihan Pemilik Polisi tertakluk kepada terma, syarat dan penamatan pada setiap tarikh ulangtahun Polisi. Premium pembaharuan yang dibayar tidak dijamin dan Kami berhak menentukan premium yang berkuatkuasa pada masa pembaharuan. Perubahan berkenaan jika ada, adalah terpakai untuk semua Pemilik Polisi walau apa pun rekod tuntutan mereka mengikut penilaian risiko Kami. Polisi ini boleh dibaharui mengikuti pilihan Pemilik Polisi sehingga berlaku mana-mana berikut: (a) premium tidak dibayar atau premium tidak dibayar mengikut masa (b) penipuan atau salah nyataan fakta penting semasa membuat permohonan (c) polisi dibatalkan atas permintaan Pemilik Polisi (d) Anda meninggal dunia (e) Anda mencapai had umur perlindungan yang ditentukan (f) penamatan perlindungan semua polisi dalam pasaran tertentu dan Kami menarik balik Polisi ini sepenuhnya dari pasaran menurut Syarat Penarikan Balik Portfolio. 32. SYARAT PENARIKAN BALIK PORTFOLIO Kami berhak membatalkan portfolio secara keseluruhan jika Kami memutuskan untuk menghentikan produk insurans ini. Pembatalan portfolio secara keseluruhan hendaklah diberitahu melalui notis bertulis yang munasabah terlebih dahulu dengan alasan yang sah kepada Pemilik Polisi dan Kami akan menanggung semua polisi hingga ke tarikh tamat tempoh perlindungan dalam portfolio. 33. PREMIUM Ketika Tempoh Insurans, premium untuk insurans di bawah Polisi ini adalah tidak dijamin dan adalah berasaskan kadar premium yang berkuatkuasa ketika pembaharuan. Premium perlu dibayar pada kadar premium mengikut umur setiap ahli pada tarikh lahir yang berikutnya pada setiap ulangtahun Tahun Polisi. Kami berhak untuk mengubah kadar pada mana premium dikira, pada permulaan mana-mana Tahun Polisi, dengan syarat bahawa Kami memberitahu Pemilik Polisi sekurang-kurangnya tiga puluh (30) hari sebelum tarikh premium tersebut perlu dibayar. 34. BUKTI KERUGIAN Setelah menerima notis berkaitan, Kami akan menyediakan borang kepada Pembuat Tuntutan bagi mengemukakan bukti kerugian. Jika borang tidak disediakan dalam masa lima belas (15) hari, Pembuat Tuntutan dengan mengemukakan bukti secara bertulis mengenai kejadian, bentuk dan tahap kerugian untuk tuntutan yang dibuat akan dianggap telah memenuhi keperluan mengikut peruntukan in. Bukti kerugian mesti dikemukakan kepada Kami bagi kes tuntutan Hilang Upaya, dalam masa sembilan puluh (90) hari selepas tamat tempoh Hilang Upaya yang mana Kami bertanggungjawab, dan dalam kes tuntutan mana-mana kerugian lain, dalam masa sembilan puluh (90) hari dan selepas tarikh kerugian tersebut. 35. PENGEMBALIAN SEMULA Jika Anda tidak membayar premium dalam tempoh ihsan dan polisi ini telah luput, Anda tidak akan mempunyai apa-apa perlindungan insurans atau manfaat. Sekiranya polisi luput, Anda boleh memohon untuk mengembalikan semula polisi ini dalam masa satu (1) tahun selepas tarikh premium patut dibayar yang tidak dijelaskan. Walau bagaimanapun, Anda mesti: (a) melengkapkan dan menandatangani borang pengembalian semula; (b) memperakui dengan jujur kesemua fakta di dalam borang pengembalian semula; (c) menyediakan semua maklumat (jika ada) yang telah Kami minta; dan (d) membayar semua tunggakan premium. Z-MedProtect/PW/20220113 Halaman 11 dari 14 36. TINGGAL DI LUAR NEGARA Tiada manfaat akan dibayar untuk apa-apa rawatan perubatan yang diterima oleh Anda di luar Malaysia, jika Anda tinggal atau membuat perjalanan di luar Malaysia lebih daripada sembilan puluh (90) hari berturut-turut. 37. SEKATAN Kami tidak akan dianggap memberikan perlindungan atau akan membuat apa-apa bayaran atau memberikan apa-apa perkhidmatan atau manfaat kepada mana-mana Pemilik Polisi, Anda atau pihak lain setakat perlindungan, pembayaran, perkhidmatan, manfaat itu akan melanggar mana-mana perdagangan atau ekonomi yang berkenaan undang-undang atau peraturan sekatan. 38. PENGAMBILALIHAN POLISI Jika polisi ini bermula sebaik sahaja selepas penamatan polisi terdahulu dan jika Anda mengalami Hilang Upaya perubatan sebelum atau pada masa polisi ini bermula (dan manfaat di bawah polisi terdahulu disediakan untuknya), Anda hendaklah terus dilindungi bagi Hilang Upaya sedia ada, tetapi tidak melebihi had polisi terdahulu dengan syarat Kami telah memperoleh satu salinan polisi terdahulu. 39. POLISI DITINGKATKAN Jika Manfaat Layak Diterima bagi pihak Anda di bawah syarat Polisi ini ditambah semasa ia berkuat kuasa atau pada masa Pembaharuan atau penggantian dan jika Anda mengalami Hilang Upaya sebelum atau pada masa Manfaat ditambah, maka Had Manfaat yang dibayar bagi Hilang Upaya itu tidak boleh melebihi Had Manfaat sebelum tarikh Manfaat itu ditingkatkan. 40. BAYARAN BERSAMA NAIK TARAF BILIK DAN MAKANAN Jika Anda dimasukkan ke Hospital pada kadar Bilik dan Makanan yang lebih tinggi daripada manfaat yang Anda layak, Anda perlu membayar perbezaan kadar Bilik dan Makanan sahaja. 41. PERUNTUKAN CUKAI Semua premium dan yuran yang perlu dibayar di bawah Polisi ini mungkin tertakluk kepada Cukai. Sekiranya Cukai dikenakan, ia akan dinyatakan dalam invois dan Kami berhak untuk menuntut atau mengutip Cukai daripada Anda sebagai tambahan kepada premium dan/atau yuran yang perlu dibayar di bawah Polisi ini. PENGECUALIAN PENGECUALIAN (BERKENAAN DENGAN SEKSYEN A & SEKSYEN B) Kontrak ini tidak melindungi apa-apa Penghospitalan, Pembedahan atau bayaran yang disebabkan secara langsung atau tidak langsung, sepenuhnya atau sebahagiannya, oleh mana-mana satu (1) kejadian yang berikut: 1. Penyakit Sedia Ada. 2. Penyakit Tertentu yang wujud dalam tempoh seratus dua puluh (120) hari pertama bagi perlindungan berterusan. 3. Tempoh Tangguh tiga puluh (30) hari untuk semua kecuali Kecederaan Kemalangan. 4. Pembedahan pilihan kosmetik atau plastik kecuali Pembedahan pembentukan semula diperlukan untuk memulihkan fungsi selepas Kemalangan yang berlaku dalam tempoh insurans. 5. Pemeriksaan mata, cermin mata, kanta sentuh dan prosedur pembedahan untuk pembetulan ralat refraktif mata dan penggunaan atau pemerolehan perkakas atau alat prostetik pembetulan seperti anggota tiruan, alat pendengaran, perentak yang diimplankan dan preskripsinya. 6. Penyakit pergigian termasuk rawatan pergigian atau Pembedahan oral kecuali apabila diperlukan kerana Kecederaan akibat Kemalangan pada gigi asli yang sihat yang berlaku sepenuhnya dalam Tempoh Insurans. 7. Penjagaan peribadi, rehat pulih atau jagaan kebersihan, apa-apa rawatan yang diterima semata-mata sebagai Penghospitalan Pesakit Luar terutamanya untuk tujuan penyiasatan, diagnosis, pemeriksaan sinar-x, pemeriksaan fizikal atau perubatan am, tidak berkaitan dengan rawatan atau diagnosis Hilang Upaya yang dilindungi yang tidak Perlu Dari Segi Perubatan dan apa-apa rawatan pencegahan, ubat atau pemeriksaan pencegahan yang dijalankan oleh Pakar Perubatan dan rawatan khusus untuk mengurangkan atau menaikkan berat badan. 8. Apa-apa rawatan atau operasi pembedahan untuk keabnormalan atau kecacatan kongenital termasuk penyakit keturunan. 9. Kehamilan, melahirkan anak (termasuk kelahiran secara pembedahan), keguguran, menggugurkan kandungan dan jagaan serta Pembedahan pranatal atau posnatal, kaedah kawalan kelahiran kontraseptif mekanikal atau kimia atau rawatan berkaitan ketaksuburan, menukar jantina, disfungsi seksual termasuk impotensi, ujian atau rawatan berkaitan pensterilan dan khatan dilakukan disebabkan apa- apa sebab selain daripada Penyakit atau jangkitan. 10. Bunuh diri, percubaan bunuh diri atau Kecederaan diri sendiri yang disengajakan ketika siuman atau tidak siuman. 11. Peperangan atau apa-apa tindakan perang, diisytiharkan atau tidak diisytiharkan, aktiviti jenayah atau pengganas, bergiat cergas dalam mana-mana angkatan bersenjata, penyertaan secara langsung dalam mogok, rusuhan dan kekecohan awam atau penderhakaan tentera. 12. Rawatan untuk sebarang keadaan perubatan yang timbul secara langsung atau tidak langsung dari pencemaran radioaktif atau apa-apa bahan nuklear, termasuk pembakaran bahan api nuklear. 13. Belanja yang ditanggung untuk menderma mana-mana organ tubuh oleh Anda dan kos pemerolehan organ termasuk semua kos yang ditanggung oleh penderma ketika transplan organ dan komplikasinya. 14. Penyiasatan ke atas dan rawatan gangguan tidur dan dengkur, gangguan psikiatri, psikotik, gangguan mental atau saraf, termasuk apa- apa neurosis dan manifestasi fisiologi atau psikosomatiknya, gangguan psikiatri seperti neuro-psikosis, skizofrenia dan lain-lain. 15. Terapi penggantian hormon dan terapi pilihan seperti rawatan, khidmat atau bekalan perubatan, termasuk tetapi tidak terhad kepada khidmat kiropraktik, akupunktur, akutekanan, refleksologi, pengikatan tulang, rawatan pakar herba, urut atau aroma terapi. 16. Jagaan atau rawatan yang pembayarannya tidak dikehendaki atau setakat yang ia dibayar oleh mana-mana pihak insurans lain atau tanggung rugi yang melindungi Anda dan Hilang Upaya yang timbul daripada tugas dalam pekerjaan atau kerjaya yang dilindungi di bawah Kontrak Insurans Pampasan Pekerja. 17. Psikotik, gangguan mental atau saraf (termasuk apa-apa neurosis dan manifestasi fisiologi atau psikosomatiknya). 18. Kos / belanja bagi khidmat yang bersifat bukan perubatan, seperti televisyen, telefon, khidmat teleks, radio atau kemudahan yang serupa, kit/pek kemasukan dan barang bukan perubatan lain yang tidak layak. 19. Sakit atau Kecederaan yang timbul daripada apa-apa jenis perlumbaan (kecuali perlumbaan jalan kaki), sukan berbahaya seperti tetapi tidak terhad kepada terjun udara, luncur air, aktiviti dalam air yang memerlukan alat pernafasan, sukan musim sejuk, sukan profesional, mendaki gunung dengan menggunakan tali atau panduan gunung dan aktiviti yang tidak dibenarkan. 20. Penerbangan peribadi selain sebagai penumpang yang membayar tambang dalam mana-mana penerbangan komersil berjadual untuk mengangkut penumpang melalui laluan yang ditetapkan. 21. Wabak dan/atau pandemik. Z-MedProtect/PW/20220113 Halaman 12 dari 14 PENGECUALIAN (BERKENAAN DENGAN SEKSYEN C – Manfaat a) Kami tidak akan bertanggungjawab terhadap tuntutan yang secara langsung atau tidak langsung disebabkan oleh atau berpunca daripada: 1. Penglibatan atau penyertaan Anda dalam:- (a) Anggota berpakaian seragam dan bersenjata, perkhidmatan atau operasi angkatan tentera laut atau udara; (b) Sukan profesional, sukan musim sejuk selain daripada meluncur ais; (c) Memanjat batu atau mendaki gunung (dengan keperluan penggunaan tali atau pemandu gunung), meneroka gua, seni mempertahankan diri atau tinju, aktiviti dalam air yang melebihi lima puluh (50) meter dalam, aktiviti udara termasuk payung terjun, peluncuran gantung, terjun bungee atau sebarang jenis perlumbaan selain daripada yang menggunakan kaki; (d) Perjalanan udara kecuali sebagai penumpang yang membayar tambang dalam penerbangan yang diiktiraf dan dioperasi oleh mana- mana pesawat di laluan dan perjalanan udara yang dijadualkan dan perjalanan udara oleh mana-mana pesawat yang disewa dan dilesenkan dengan sewajarnya sebagai pengangkut udara yang diiktiraf dan diterbangkan oleh krew profesional di antara lapangan terbang yang ditubuhkan dan dikendalikan dengan betul; (e) Perbuatan jenayah atau sebarang kegiatan haram. 2. Dipengaruhi oleh alcohol atau dadah, kecuali dadah tersebut diambil atas arahan Pakar Perubatan dengan syarat arahan tersebut bukan untuk merawat penagihan dadah. 3. Pembunuhan atau serangan akibat provokasi, sengaja mencederakan diri sendiri, membunuh diri atau cubaan membunuh diri atau sebarang percubaan untuk berbuat demikian sama ada dalam keadaan siuman atau tidak siuman. 4. Kehamilan, kelahiran anak, keguguran. 5. Gigitan nyamuk. 6. Sakit, Wabak atau sebarang masalah kesihatan. 7. Penyakit Sedia Ada. 8. Sengaja mendedahkan diri kepada bahaya yang luar biasa (kecuali dalam usaha untuk menyelamatkan nyawa manusia). 9. HIV (Virus Kurang Daya Ketahanan Manusia) dan/atau sebarang penyakit berkaitan dengan HIV termasuk AIDS (Sindrom Kurang Daya Tahan Penyakit) atau Kompleks Berkaitan AIDS (ARC), namun disebabkan dan/atau sebarang derivatif mutan, variasi atau rawatan yang disebabkan olehnya. 10. Penyertaan secara langsung dalam rusuhan atau kekecohan awam, pencerobohan, tindakan musuh asing, permusuhan (sama ada Peperangan diisytiharkan atau tidak), pemberontakan, revolusi, kebangkitan, pemberontakan tentera atau rampasan kuasa. 11. Radiasi pengionan atau pencemaran oleh aktiviti radio dari sebarang bahan api nuklear atau dari sebarang sisa nuklear daripada pembakaran bahan api nuklear. Bagi tujuan pengecualian ini, pembakaran hendaklah termasuk sebarang proses pembelahan nuklear sendiri. 12. Peperangan, Peperangan saudara – sama ada diisytiharkan atau tidak. 13. Sebarang Tindakan Keganasan. 14. Wabak dan/atau pandemik (juga berkenaan bagi Seksyen C – Manfaat c). NOTIS DI BAWAH AKTA PERLINDUNGAN DATA PERIBADI 2010 (PDPA) Akta Perlindungan Data Peribadi 2010 yang mengawal selia pemprosesan data peribadi dalam transaksi komersial, berkuat kuasa ke atas Kami. Anda boleh membuat pertanyaan, aduan, permintaan mengakses, mengemas kini, membetulkan atau mengubah mana-mana data peribadi Anda, mengehadkan pemprosesan data peribadi dan/atau untuk memilih keluar daripada penggunaan Kami pada bila-bila masa selepas ini dengan mengemukakan permintaan tersebut kepada Kami dengan menghantar e-mel ke <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS>. Permintaan untuk memilih keluar mesti menyatakan dengan jelas nama penuh, nombor dokumen pengenalan, nombor polisi, nombor telefon dan alamat orang yang membuat permintaan tersebut. Pemprosesan data peribadi Anda tertakluk kepada Notis Perlindungan Data Peribadi Kami, seperti yang diterbitkan di https://www.zurich.com.my/pdpa. Z-MedProtect/PW/20220113 Halaman 13 dari 14 PROSEDUR UNTUK MEMBUAT ADUAN INSURANS Kami sentiasa bersedia memberikan pengalaman perkhidmatan pelanggan yang terbaik. Jika anda mempunyai sebarang aduan atau tidak berpuas hati berkaitan dengan sebarang produk atau perkhidmatan, kami bersedia memberikan perhatian. Anda boleh menghubungi Kami di: Zurich General Insurans Malaysia Berhad Aras 23A, Mercu 3, No. 3, Jalan Bangsar, KL Eco City, 59200 Kuala Lumpur, Malaysia Tel: 03 2109 6000 Faks: 03 2109 6888 Pusat Panggilan: 1 300 888 622 E-mel: <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS> Alternatif Lain untuk Membuat Aduan Jika anda tidak berpuas hati dengan keputusan akhir kami, anda boleh boleh menulis surat kepada kepada Ombudsman Perkhidmatan Kewangan (OPK) dengan butir-butir mengenai pertikaian dan maklumat Polisi anda. Jika keputusan OPK memihak kepada anda berbanding kami, anda hendaklah memaklumkan OPK sama ada anda menerima atau menolak bayaran dalam tempoh (14) empat belas hari. Jika anda tidak setuju dengan bayaran tersebut, anda boleh menolak keputusan OPK. Anda bebas untuk memulakan tindakan mahkamah terhadap kami atau merujuk kes kepada Penimbangtaraan. OPK boleh dihubungi di alamat berikut: Ombudsman Perkhidmatan Kewangan Tingkat 14, Blok Utama, Menara Insurans Malaysia, No. 4, Jalan Sultan Sulaiman, 50000 Kuala Lumpur Tel: <PRESIDIO_ANONYMIZED_PHONE_NUMBER> Faks: 03 2272 1577 E-mel: <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS> Laman web:www.ofs.org.my Jika aduan anda berada di luar bidang OPK, anda boleh menyatakan ketidakpuasan hati anda kepada Laman Informasi Nasihat dan Khidmat (LINK) Bank Negara Malaysia di alamat berikut: Secara Bertulis: Pusat Perhubungan Pelanggan Bank Negara Malaysia (BNMLINK), Peti Surat 10922, 50929 Kuala Lumpur. Tel: 1 300 88 5465 (1-300-88-LINK) (Luar Negara: <PRESIDIO_ANONYMIZED_PHONE_NUMBER>) Faks: 03 2174 1515 E-mel: <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS> Secara Bersemuka: Tingkat Bawah, Blok D, Bank Negara Malaysia, 50480 Kuala Lumpur. Zurich General Insurans Malaysia Berhad No. Pendaftaran 201701035345 (1249516-V) Aras 23A, Mercu 3, No.3, Jalan Bangsar, KL Eco City, 59200 Kuala Lumpur, Malaysia. Tel: 03 2109 6000 Fax: 03 2109 6888 Call Centre: 1 300 888 622 www.zurich.com.my Z-MedProtect/PW/20220113 Halaman 14 dari 14

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