Health: " Finally, A Medical Plan That Rewards Us For Being Healthy, and Covers Us When We Are Not! "
Health: " Finally, A Medical Plan That Rewards Us For Being Healthy, and Covers Us When We Are Not! "
Health: " Finally, A Medical Plan That Rewards Us For Being Healthy, and Covers Us When We Are Not! "
An example of the bonus mechanism, for a 30-year old male policyholder with a PRUhealth
Note: Co-insurance is a cost-sharing arrangement under which the policyholder pays a 200 plan, expiring at age 70 and pays an annual premium of RM1,032:
specified percentage of the cost of an eligible benefit. The remaining balance is paid
by the Company. Years Annual Any Claims Qualify Amount of Bonus
Premium (RM) Made? for Bonus? Received (RM)
The total benefits payable in a year are subject to the Overall Annual Limit. The total benefits 1 1,032 No Yes -
payable during the lifetime is subject to the Lifetime Limit. Cover begins immediately on
acceptance, for hospitalisation caused by accidents and 30 days after acceptance for any 2 1,032 Yes No 300
other causes and 120 days for specified illnesses. 3 1,032 No Yes -
Premium rates for Occupation Class 3 & 4 are 1.25 & 1.5 times of the premium for Occupation Class 1 & 2. Premium rates for Occupation Class 3 & 4 are 1.25 & 1.5 times of the premium for Occupation Class 1 & 2.
Note: PRUannual limit waiver rider is not available for PRUhealth 100 and 150 plans.
Exclusions 10. Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.
PRUhealth does not cover any hospitalisation, surgery or charges caused directly or indirectly, 11. War or any act of war, declared or undeclared, criminal or terrorist activities, active
wholly or partly, by any one (1) of the following occurrences: duty in any armed forces, direct participation in strikes, riots and civil commotion or
insurrection.
1. Pre-existing illness.
12. Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear
2. Specified Illnesses occurring during the first 120 days of continuous cover for: waste from process of nuclear fission or from any nuclear weapons material.
a. Hypertension, diabetes mellitus and cardiovascular disease
13. Expenses incurred for donation of any body organ by an Insured Person and costs of
b. All tumours, cancers, cysts, nodules, polyps, stones of the urinary system and
acquisition of the organ including all costs incurred by the donor during organ transplant
biliary system
and its complications.
c. All ear, nose (including sinuses) and throat conditions
d. Hernias, haemorrhoids, fistulae, hydrocele, varicocele 14. Investigation and treatment of sleep and snoring disorders, hormone replacement
e. Endometriosis including disease of the reproduction system therapy and alternative therapy such as treatment, medical service or supplies, including
but not limited to chiropractic services, acupuncture, acupressure, reflexology, bone
f. Vertebro-spinal disorders (including disc) and knee conditions
setting, herbalist treatment, massage or aroma therapy or other alternative treatment.
3. Any medical or physical conditions arising within the first 30 days of the Insured Person’s
15. Care or treatment for which payment is not required or to the extent which is payable
cover or date of reinstatement whichever is latest except for accidental injuries.
by any other insurance or indemnity covering the Insured and Disabilities arising out of
4. Plastic / Cosmetic surgery, circumcision, eye examination, glasses and refraction or duties of employment or profession that is covered under a Workman's Compensation
surgical correction of nearsightedness (Radial Keratotomy) and the use or acquisition of Insurance Contract.
external prosthetic appliances or devices such as artificial limbs, hearing aids, implanted
16. Psychotic, mental or nervous disorders (including any neuroses and their physiological or
pacemakers and prescriptions thereof.
psychosomatic manifestations).
5. Dental conditions including dental treatment or oral surgery except as necessitated
17. Costs / expenses of services of a non-medical nature, such as television, telephones,
by Accidental Injuries to sound natural teeth occurring wholly during the Period of
Insurance. telex services, radios or similar facilities, admission kit / pack and other ineligible non-
medical items.
6. Private nursing (save and except for Home Nursing Care Benefit), rest cures or sanitaria
care, illegal drugs, intoxication, sterilisation, venereal disease and its sequelae, AIDS 18. Sickness or Injury arising from racing of any kind (except foot racing), hazardous sports
(Acquired Immune Deficiency Syndrome) or ARC (AIDS Related Complex) and HIV such as but not limited to skydiving, water skiing, underwater activities requiring breathing
related diseases, and any communicable diseases required quarantine by law. apparatus, winter sports, professional sports and illegal activities.
7. Any treatment or surgical operation for congenital abnormalities or deformities including 19. Private flying other than as a fare-paying passenger in any commercial scheduled airlines
hereditary conditions. licensed to carry passengers over established routes.
8. Pregnancy, child birth (including surgical delivery), miscarriage, abortion and prenatal 20. Expenses incurred for sex changes.
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.
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