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Home l Products & Services l Medical Insurancel Medic Plus
    Download Fact Sheet Download Proposal Form Download Product Disclosure Sheet
All eligible expenses are reimbursable up to the Limits of Policy
No requirement of re–declaration of health status at renewal
Reimburses the professional fees for the supply and administration of anaesthesia
 

   
 

Tokio Marine’s Medic Plus is here to take away your fear of insufficient medical coverage.

Medic Plus is designed to complement and provide protection as a secondary level of cover to the Hospitalisation & Surgical Insurance that you may have purchased or where you are covered by a policy arranged by your employer.

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All eligible expenses shall be reimbursed up to the Limits of Policy.
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Renewal guaranteed after 12 months of ’claims–free’ period.
•
No requirement of re–declaration of health status at renewal.
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’Hassle Free’ facility for admission & discharge from hospitals for disabilities and illnesses covered.
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Medical costs for organ transplant are fully reimbursable up to the Limits of Policy.
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Medical costs for organ transplants fully reimbursable up to the Limits of Policy.
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Covered:
 
- Out–patient treatment for Cancer &/or Kidney Dialysis.
-

 Out–patient Physiotherapy Treatments & Home Nursing Care after hospitalisation.
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Max Lifetime Limit: RM750,000
 
   
1.
Medic Plus is designed to complement and provide protection as a secondary level of cover to the Hospitalisation & Surgical Insurance that you may have purchased or where you are covered by a policy arranged by your employer.
2.
The benefits of a basic/standard cover are unlikely to be adequate to meet the ever–increasing cost of medical expenses and health care for complicated, serious or complex surgeries.
3.
Medic Plus helps to bridge the gap with its limits intentionally set at a high level and it operates when the benefits/limits of your existing insurance cover have become exhausted.
4.
Accidental Death benefits payable.
5. High limits of cover at low and affordable premium.
 
6.
One common level of premium regardless of gender and classes of occupations.
7.
30% automatic increase of Overall Annual Limit when you hold a Medic Partner Policy with us for not less than 2 consecutive years.
8.
High maximum entry age: 65 years and renewable up to 70 years.
9.
Deductible per Disability:
– RM10,000
– RM5,000 (if confined to Malaysian Government Hospital)
10.
Only one Deductible shall apply if family members are injured in the same accident.
 
   
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Hospital Room & Board
Reimburses the daily charges made by the hospital for room accommodation and meals incurred by the Insured Person for each day of confinement as registered bed–paying patient in a Hospital.
   
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Intensive Care Unit
Reimburses daily charges for confinement in an Intensive Care Unit or Cardiac Care Unit where prescribed by attending Physician or Surgeon.
   
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Surgeon Fees
Reimburses professional fees charged by the Surgeon for a Surgery performed. This includes Surgeon’s ward visits, pre–surgical assessment and all normal post–surgical care up to 60 days before and after the operation.

Surgeon Fee shall also includes professional fees charged by a second Physician or Surgeon who may be consulted prior and during Hospitalisation of Insured Person for the Surgery.
 
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Anaesthetist Fees
Reimburses professional fees charged by the Anaesthesiologist for the supply and administration of anaesthesia incidental to the performance of a Surgery.
 
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Operating Theatre
Reimburses Operating Room charges incidental to the performance of a Surgery.
   
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Hospital Services and Supplies
Reimburses charges for general nursing, prescribed and consumed drugs and medicines, dressings, splints, plaster casts, x–ray, diagnostic tests, laboratory examinations, electrocardiograms, physiotherapy, rental of appliances, surgical implants, basal metabolism tests, intravenous injections and solutions, administrations of blood and blood plasma, oxygen and its administration, and eligible Government Service Tax whilst the Insured Person is confined as a bed–paying patient in a Hospital.
   
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In–Hospital Physician Visits
Reimburses professional fees charged by a Physician for visiting bed–paying patient while confined for a non-surgical Disability.
 
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Pre-Hospital Diagnostic Tests
Reimburses charges for ECG, X–ray, laboratory and diagnostic tests which are performed for diagnostic purposes and when in connection with a Disability preceding Hospitalisation within sixty (60) days and which are recommended by a Physician. No benefit shall be made if upon such diagnostic services, the Insured Person does not result in Hospitalisation for the treatment of the medical condition diagnosed. Cost incurred for any medications and consultation will not be payable under this benefit.
 
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Pre–Hospital Specialist Consultation
Reimburses the professional fees charged for the first time consultation by a Specialist in connection with a Disability within sixty (60) days preceding Hospitalisation and provided that such consultation has been recommended in writing by a Doctor. No benefit shall be made for clinical treatment (including medications and subsequent consultation after the Disability is diagnosed) or where the Insured Person does not result in Hospitalisation for the treatment of the medical condition diagnosed.
 
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Post–Hospitalisation Treatment
Reimburses medical charges for follow–up treatment by the same attending Physician and incurred within sixty (60) days immediately following discharged from Hospital for a non–surgical Disability. This shall include medicines prescribed during the follow–up treatment but shall not exceed the supply needed for the said sixty (60) days period.
 
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Home Nursing Care
Reimburses the daily professional fees for the services rendered by a medically qualified and licensed Nurse in the Insured Person’s home and incurred within sixty (60) days immediately following discharged from Hospital Provided that such services is deemed to be Medically Necessary by the attending Physician in writing. The Plan and schedule of the treatment for this Home Nursing Care must be established and prescribed in writing by the attending Physician. No payment will be made for custodial care, meal, general housekeeping services, companion, rest cure or personal comfort items.
 
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Organ Transplant
Reimburses medical charges incurred on transplantation surgery for the Insured Person being the recipient of the transplant of a Kidney, Heart, Lung, Liver or Bone Marrow. Payment for this Benefit is applicable only once per Lifetime of an Insured Person whilst the Policy in force. The costs of acquisition of the organ and all costs incurred by the donors are not covered.
   
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Outpatient Physiotherapy Treatment
Reimburses the daily professional fees charged by a legally and medically qualified Physiotherapist for outpatient physiotherapy treatment and incurred within one hundred (100) days immediately following discharged from Hospital Provided that such service is deemed to be Medically Necessary by the attending Physician in writing.
 
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Outpatient Cancer &/or Kidney Dialysis Treatment
 If an Insured Person is diagnosed with Cancer or Kidney Failure as defined herein, the Company will reimburse medical charges incurred for the treatment of Cancer or Kidney Failure provided such treatment (radiotherapy &/or chemotherapy for Cancer and Dialysis for Kidney Failure but excluding costs for consultation, examination tests, take home drugs) is received at the outpatient department of a Hospital or a legally registered Cancer treatment center of Kidney Dialysis center immediately following discharge from Hospital confinement or surgery.
 
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Accidental Death Benefit
Pays the Insured a stated lump sum benefit in the event of Accidental Death of an Insured Person if death occurs within six (6) months from the date of the Accident.
 
 
 
BENEFIT PLANS
BENEFITS
MPA
MPB
MPC
MPD
 
 
 
RM
  
RM
  
RM
  
RM
 
 
1. Hospital Room & Board (Daily Limit)
500
300
200
150
  
2. Intensive Care Unit          
3. Surgeon Fees          
4. Anaesthetist Fees          
5. Operating Theatre          
6. In–Hospital Physician Visits
7. Hospital Services & Supplies
As Charge
8. Organ Transplant (limited to Kidney, Heart, Lung, Liver or Bone Marrow only)
Subject to the respective Annual / Lifetime
9. Pre–Hospital Diagnostic Tests
stated below
10. Pre–Hospital Specialist Consultation          
11. Post Hospitalisation Treatment          
12. Home Nursing Care          
13. Outpatient Physiotherapy Treatment          
14. Outpatient Cancer Treatment          
15. Outpatient Kidney Dialysis Treatment, per policy year
50,000
40,000
30,000
20,000
  
16. Accident Dental Benefits
10,000
7,500
5,000
5,000
  
17. Deductible per Disability per policy year
10,000
10,000
10,000
10,000
  
18. Overall Annual Limit
150,000
100,000
75,000
50,000
  
19. Overall Annual Limit (applicable only under Policy Condition No.10)
195,000
130,000
97,500
65,000
  
20. Lifetime Limit
750,000
500,000
375,000
250,000
  
             
 Age at next birthday (years)
Annual Premium
1 to 18 years
178
153
135
118
  
19 – 35 years
245
210
185
160
  
36 – 40 years
284
243
214
184
  
41 – 45 years
323
276
242
209
  
46 – 50 years
389
332
292
251
  
51 – 55 years
467
398
349
300
  
56 – 60 years
556
474
415
356
  
61 – 65 years
712
606
531
453
  
66 – 70 years (Renewal only)
956
813
712
607
  
           
Note:          
i. An unmarried child below 18 years old can only be insured along at least one Parent.
ii. Premium charged is based on age at next birthday and it will be increase with age upon renewal.
 
     
 
   
1. Who is eligible to apply for Medic Plus?
 
Any Malaysian or Permanent Resident of Malaysia aged 19 – 65 and policy is renewable up to the age 70.
   
2. When does my cover begin?
 
From the day your proposal form is acceptable and upon full settlement of your premium. But in respect to sickness/illness only, there is a Qualifying Period of 30 days before the insurance commences.
   
3.

 Will it be easy for me to get admitted into a ‘Panel Hospitals’ with ‘Hassle-Free’ facility?
 
Yes, it is easy for any of Disability which is confirmed to be covered by the Policy. All you have to do is to make a phone call to our service provider at the time of admission.
   
4. Am I covered outside Malaysia?
  Yes, you are covered up to 90 days from the day you leave Malaysia but only for emergency and non chronic illnesses, and upon written referral.
(Please refer to the policy condition on ’Overseas Treatment’)
   
5. What are the Exclusions?
  Generally the Policy does not cover:
a)
Pre–existing conditions. However, Disabilities that are declared to the Company in the proposal form and for which the Company does not impose any condition will be covered after 12 months of your insurance cover.
b)

 Specified illnesses occurring during the first one hundred twenty (120) days of continuous cover of an Insured Person.
c)






Cosmetic treatments, Dental conditions or refractive errors of the eyes except due to accidental injury, Congenital abnormalities, Pregnancy related conditions, AIDS or Sexually Transmitted Disease, self–inflicted injuries, drug addiction, mental or nervous disorders, non–medically necessary expenses, weight control, sexual dysfunction, medical examinations, investigative procedures, preventive treatment, nuclear or military–related activities, racing (other than foot racing), professional sports and criminal activities.
 
6. What is Pre–existing Condition?
 
Pre–existing Condition means Disability that the Insured Person has reasonable knowledge of on or before the effective date of Insurance of the insured Person. An Insured Person may be considered to have reasonable knowledge of a Pre–existing Condition where the condition is one for which:–
i) the Insured Person had received or is receiving treatment;
ii) medical advice, diagnosis, care or treatment has been recommended;
iii) clear and distinct symptoms are or were evident; or
iv) its existence would have been apparent to a reasonable person.
   
7. What are Specified Illnesses?
  Specified Illnesses mean the following Disabilities and its related complications:
i) Hypertension, cardiovascular disease and diabetes mellitus
ii)
All tumours, cancers, cysts, nodules, polyps, stones of the urinary and biliary System
iii) All ear, nose (including sinuses) and throat conditions
iv) Hernias, haemorrhoids, fistulae, hydrocele, varicocele
v) Endometriosis including disease of the reproductive system
vi) Vertebro-spinal disorders (including disc) and knee conditions
   
8. What is Deductible?
 
This is the amount that must be done by you before Medic Plus can indemnify you.
   
9. What if I am also covered under Medic Partner Policy?
 
If you are covered by our Medic Partner Insurance for 24 months or more at the date of hospital admission, then your Overall annual Limit is automatically increased by 30% subject to a Lifetime Limit.
   
10. What happens if I want to restart my lapsed policy?
 
You will be subjected to the usual Exclusions on Pre–existing Conditions, Specified Illnesses and Qualifying Period of 30 days all over again. Hence we encourage you not to let your Medic Plus Policy lapse.
 
• Medic Partner
• Premier Medic Partner
• Group Hospital & Surgical