Kad Klinik dan Pakar

KLINIKGUARD

POLICY DETAILS Introduction Benefits / Plan Coverage Exclusions How To Buy

INTRODUCTION   The rising cost of medication and treatment significantly affects companies and business owners. A full range of healthcare insurance that includes Out-Patient Clinical (OPC) coverage are a necessity. In response to the prevailing healthcare needs, Kurnia Insurans is proud to introduce its Out-Patient Clinical insurance, klinikGUARD.   Objective To make available a full range of healthcare insurance products for the needs of Corporations. To provide convenience to Corporations via an extensive network of panel Clinics and panel Hospitals. To ease the staff healthcare administrative work of Corporations. To enforce staff healthcare cost containment for Corporations.   Advantage Value for money and competitively priced. Availability of detailed Utilization Reports with multiple information which are user friendly. Taking care of the Non Core staff healthcare administrative work from the HR Department. Free access to Medical Insurance / Healthcare technical and professional information and advices. OPC compliments In-Patient Group Hospital & Surgical Scheme. Policy Benefits can be tailored made to suit the needs of each client e.g. Pap Smear, Prostate Specific Antigen. Annual Premium per Member starts from RM268.00.* * Subject to terms & conditions BENEFITS / PLAN COVERAGE   Out-Patient Without Specialist Standard Rate Option 1 Option 2 Co-Payment RM5 - Out-Patient GP Care Yes Yes Out-Patient SP Care No No Overall Annual Limit Per Person (RM) 1500 1500 Premium starts from (RM) 268 303   Out-Patient With Specialist Standard Rate Option 1 Option 2 Co-Payment RM5 - Out-Patient GP Care Yes Yes Out-Patient SP Care Yes Yes Overall Annual Limit Per Person (RM) 1500 1500 Premium starts from (RM) 338 373   Note: On condition Group Hospital & Surgical (GHS) is also to be insured with KIMB.   GP = General Practitioner SP = Specialist Non Panel Utilization Any utilization of health services outside the Company's network panel of clinics would be on reimbursement basis up to a maximum of 80% of the actual charges or RM20 whichever is lower and is limited to "emergency" situations only except for Accidental Injury. EXCLUSIONS   This policy does not cover any loss damage liability or costs directly caused by or contributed to or arising out of or in consequence of:   1. Plastic/Cosmetic surgery, circumcision, eye examination, glasses and refraction or surgical correction of nearsightedness (Radial Keratotomy or Lasik) and the use or acquisition of external prosthetic appliances or devices such as artificial limbs, hearing aids, aero chambers, equipment from nebulising, implanted pacemakers and prescriptions thereof.     2. 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.     3. 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 related diseases, and any communicable diseases required quarantine by law.     4. Any treatment or surgical operations for congenital abnormalities of deformities including hereditary conditions.     5. Pregnancy, child birth (including surgical delivery), miscarriage, abortion, 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.     6. Consultation primarily for investigatory purposes, diagnosis, x-ray examination, general physical or medical examinations, not incidental to treatment or diagnosis of a covered Disability or any treatment which is not medically necessary and any preventive treatments, preventive medicines or examinations carried out by a Physician, and treatments specifically for weight reduction or gain.     7. Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.     8. 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.     9. Ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material.     10. Investigation and treatment of sleep and snoring disorders, hormone replacement therapy and alternative therapy such as treatment, medical services or supplies, including but not limited to chiropractic services, acupuncture, acupressure, reflexology, bonesetting, herbalist treatment, massage or aroma therapy or other alternative treatment.     11. Care or treatment for which payment is not required or to the extent which is payable by any other insurance or indemnity covering the Insured Person and Disabilities arising out of duties of employment or profession that is covered under a Workman’s Compensation Insurance Contract.     12. Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations.)     13. 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.     14. Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes.     15. Long term medications for the following conditions are excluded: Arthritis, Asthma, High Blood Pressure, Coronary Artery Disease, Cerebrovascular Disease, Cerebrovascular Accident, Diabetes Mellitus, Epilepsy, Gout, Hyperlipidemia, Parkinson, Peptic Ulcer, Psoriasis and Thyroid.     16. Personal comfort and convenience items (e.g. soaps, shampoos, vitamin creams and vitamin ointment) or services and similar incidental services and supplies, durable medical equipment including supplement medication even though prescribed by a physician.     17. Upper and lower jaw bone surgery (including that related to the temporomandibular joint) except for direct treatment of acute traumatic injury or cancer. Orthognathic surgery, jaw alignment, or treatment for the temporomandibular joint.     18. Services and supplies for smoking cessation programs and the treatment of nicotine addiction.     19. Services rendered by a provider with the same legal residence as an Insured Person or who is a member of a Insured Person’s family, including spouse, brother, sister, parent or child.     20. Education services such as speech improvement, diabetic classes and nutritional services, or group support services, unless authorized by the Company.     21. Out-Patient prescribed or non-prescribed medical supplies including elastic stockings, ace bandages, gauze, syringes, diabetic test strips, and like products; over the counter drugs and treatments.     22. Any preventive vaccination or childhood immunization (unless specifically included in the Schedule of Benefit).     23. Topical skin testing at GP Clinic.     24. General screening profiles at a GP clinic (unless specifically included in the Schedule of Benefit).     25. Growth hormone therapy.     26. Out-Patient physical therapy, physiotherapy and/or rehabilitation therapy is not covered and cannot be referred at general practitioner level. This service would only be covered when referred by a specialist and treatment must be provided by a registered physiotherapist. (applicable if specialist care is covered).