Home > Medical > Medical Care Plus > Introduction

takes the worries out of you while you recover

An unforeseen hospitalisation can wipe out your hard earned savings. With escalating medical care costs it is even more important to protect yourself and your loved ones. Let us help you take care of your medical bills while you focus on recovering.

Key Benefits at a Glance:

  • no lifetime limit on the total amount that you claim#
  • medical care up to age 81##
  • cashless admission###
  • no co-insurance
  • high protection of up to RM500,00 every year
     
# Except for Special Benefits
## or up to basic plan maturity date, whichever is earlier
### You may be required to pay a deposit amount that may vary from hospital to hospital 

 

 

benefits for you and your loved ones

 

no lifetime limit on the total amount that you claim#

Our Medical Care Plus plan has no lifetime limit on the amount that you can claim in a lifetime regardless of the claim amount you made previously#. It is like starting on a fresh page each year, thus reassuring you of continuous and uninterrupted access to the medical care you need.
 

comprehensive medical care up to age 81##

Medical Care plan covers you up to age 81##, well into your retirement years, ensuring that you have access to medical care when you need it most. You can choose from 4 different plans to suit your needs and affordability. It ranges from the affordable Bronze plan to the Platinum plan with high protection of RM500,000 every year.
 

no co-insurance

You will not be burdened with partial payment of the medical bill as long as you stay in the Room & Board within your eligible benefit, thus making sure that you are not hit with out-of-pocket medical care expenses. However, the following may apply when necessary:
  • If the Room and Board (R&B) stayed is of the same room category but with higher R&B rate, you will have to bear the difference in the R&B rate; or
  • If both R&B rate and room category stayed is higher and better than the eligible benefit, you will have to bear the difference in R&B rate and 20% of the total eligible expenses incurred (excluding the R&B rate), being the Upgraded R&B Co-Payment.
 

cashless admission###  to a nationwide panel of hospitals

What’s more, our Medical Care Plus plan provides cashless admission facility to a wide selection of private hospitals, ensuring that you have quick access to medical care.
 
# Except for Special Benefits
## or up to basic plan maturity date, whichever is earlier
### You may be required to pay a deposit amount that may vary from hospital to hospital
 
 

schedule of benefits
 

Plans Platinum Gold Silver Bronze
Overall Annual Limit*
(for Section A and Section B only)
RM500,000 RM200,000 RM100,000 RM50,000
Section A           In-patient & Daycare Surgical Procedure (per Disability)
Room & Board, daily maximum
Total number of Days
 
 RM500 RM300 RM150  RM80 
 Room Category  Basic Suite
Standard
Single
Room 
 Double
Bedded Room
Four
Bedded Room
Total number of days 150 days 120 days 120 days 120 days
Intensive Care Unit, daily maximum
Total number of Days
 
Full Reimbursement
60 Days
Ambulance Fees Full Reimbursement RM350 RM350
Insured Child’s Daily Guardian Benefit
(for child below 15 years old, up to 60 days)
Full Reimbursement Not Applicable
Prescription Drugs Full Reimbursement
Nursing, Theatre Consumables & other Ancillary Charges
 Full Reimbursement
(up to RM50 for medical report)
Surgeons’ Fees
(up to 31 Days for pre-surgical assessment and up to 31 Days for post-surgery care)

 
 
 
 
Full Reimbursement subject to
Overall Annual Limit provided the charges
are within the recommendations of the Malaysian Medical Association Guidelines and Reasonable
and Customary charges.
 
Anaesthetist’s Fees
Diagnostic Procedures & Physiotherapy
Physician Fees, one visit per Day
Specialist Fees, one visit per Day
Operating Theatre Full Reimbursement
Section B           Out-patient Treatment (per Disability)
Consultation & Diagnostic Procedures within 31 Days before Hospital confinement RM5,000 RM3,000 RM2,000 RM1,000
Post-Hospitalisation Care and Physiotherapy Treatment within 60 Days from Hospital discharge RM10,000 RM6,000 RM4,000 RM2,000
Accident & Emergency Treatment within 14 Days from the date of the accident Full Reimbursement
Section C          Special Benefits (additional limit on top of the Overall Annual Limit)
Home Nursing Care, up to 180 days, lifetime maximum RM6,000 RM5,000 RM4,000 RM3,000
Out-patient Kidney Dialysis, lifetime maximum RM190,000 RM150,000 RM110,000 RM20,000
Out-patient Cancer Treatment, lifetime maximum RM310,000 RM240,000 RM170,000 RM20,000
International Emergency Medical Evacuation and Repatriation, per annual maximum RM500,000 Not Applicable
 
* Not subject to lifetime limit.

 

important notes 

 
AXA AFFIN Life Insurance Berhad believes it is important that you fully appreciate and understand all the benefits and charges under this plan.
 
1. This insurance plan is underwritten by AXA AFFIN Life Insurance Berhad (723739-W), a company licensed under the Insurance Act 1996 and regulated by Bank Negara Malaysia.
 
2. Medical Care Plus is a comprehensive medical rider that reimburses medical expenses incurred.
 
3. You should satisfy yourself that this plan will best serve your needs and that the premium payable under the plan is an amount you can afford.
 
4. If you are not completely satisfied with this plan, you may return this plan and request the cancellation of the policy within 15 days from the date the policy is delivered to you provided no claim has been made. We will then refund the premium paid less any medical expenses incurred.
 
5. Please read this brochure together with the basic plan’s brochure.
 
6. The plan does not cover any hospitalisation, surgery or charges caused directly or indirectly, wholly or partly, by any one of the following occurrences:
  
i. Pre-existing illness.

ii. Specified Illnesses as stated below occurring during the first 120 days of continuous cover:
 
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
 
 iii. Any medical or physical conditions arising within the first 30 days following the Plan Effective Date or date of reinstatement whichever is latest except for accidental injuries.
  
iv. Plastic/Cosmetic surgery, circumcision, 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.
  
v. 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.
 
 vi. 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 related diseases, and any communicable diseases requiring quarantine by law.
  
vii. Any treatment or surgical operation for congenital abnormalities or deformities including hereditary conditions.
  
viii. Pregnancy, pregnancy related condition or its complications, 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 sterilisation.
  
ix. Hospitalisation primarily for investigatory purposes, diagnosis, X-ray examination, general physical or medical examinations, not incidental to treatment or diagnosis of a covered Disability or any treatment which is not Medically Necessary and any preventive treatments, preventive medicines or examinations carried out by a Physician, and treatments specifically for weight reduction or gain.
  
x. Suicide, attempted suicide or intentionally self-inflicted Injury while sane or insane.
  
xi. 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.
  
xii. Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material.
  
xiii. Expenses incurred for donation of any body organ by the Insured and costs of acquisition of the organ including all costs incurred by the donor during organ transplant and its complications.
  
xiv. 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 aroma therapy or other alternative treatment.
  
xv. Care or treatment of which payment is not required or to the extent which is payable by other insurance or indemnity covering the Insured and disabilities out of duties of employment or profession that is covered under a Workman’s Compensation Insurance Contract.
  
xvi. Psychotic, mental or nervous disorders (including any neuroses and their physiological or psychosomatic manifestations) and any other conditions classified under the “Diagnostic and Statistical Manual of Mental Disorders (DSM-IV Codes)” as published by American Psychiatric Association. 
  
xvii. 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.
  
xviii. 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.
  
xix. Private flying other than as a fare-paying passenger in any commercial scheduled airline licensed to carry passengers over established routes.
  
xx. Expenses incurred for sex changes.
  
xxi. Any Treatment directed towards developmental delays and/or learning disabilities in Insured children.
  
xxii. Cosmetic (aesthetic) Surgery or Treatment, or any Treatment which relates to or is needed because of previous cosmetic Treatment. However, we will pay for reconstructive surgery if: 
 
a) it is carried out to restore function or appearance after an Accident or following Surgery for a medical condition, provided that the Insured has been continuously covered under the supplement since before the Accident or Surgery happened; and
b) it is done at a medically appropriate stage after the Accident or Surgery; and
c) we agree, in writing, to the cost of the treatment before it is done.
 
xxiii. Any Treatment which only offers temporary relief of symptoms on any long term Illness and Disease rather than dealing with the underlying medical condition.
 
 
7. This brochure contains only general information about the plan and does not in any way represent a policy. For a detailed description of the terms and conditions and exclusions of the plan please refer to the official policy issued by AXA AFFIN Life Insurance Berhad. 
 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
Definition of Occupation Classes
 
Class 1: Persons engaged in professional, administration, managerial, clerical and non-manual occupations generally.
 
Class 2: Persons engaged in work of a supervisory nature and others not in Class 1 whose duties may involve occasional light manual work but not using tools or machinery or not exposing them to any special hazards. Persons who are required to travel outside office for business or professional purposes but not engaging in manual labour.
 
Class 3: Persons engaged in manual work not of particularly hazardous nature but involving the use of tools or light machinery.
 
Class 4: Persons engaged in heavy manual work involving the use of heavy tools and machinery.
 
  
For more information, contact us at 1 300 88 1616
 
Get in Touch
1 300 88 1616
(03) 2117 3698
Personal Data Policy | Disclaimer & Ownership | Notice | Copyright AXA AFFIN Life Insurance Berhad