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Home l Products & Services l Medical Insurance l Premier Medic Partner
    Download Fact Sheet Download Proposal Form Download Product Disclosure Sheet
All eligible expenses are reimbursable up to the Limits of Policy
Reimburse charges for ECG, X–ray, laboratory and diagnostic tests incurred within 31 days preceding Hospitalisation subject to written referral by a Doctor
Reimburses the professional fees for the supply and administration of anaesthesia
 

   
 

Premier Medic Partner is a comprehensive medical cover that cushions your financial burden of expensive medical treatment. There is also a renewal guarantee feature up to 75 years of age which makes this an attractive and practical coverage to have.




 

HIGHLIGHTS
• All eligible expenses are reimbursable up to the Limits of Policy.
• Renewal is guaranteed after 12 months of ’claims-free’ period.
• Renewal up to 75 years if you insure before the age of 60 years.
• ’Medical Card’ facility for admission & discharge from hospitals for covered disabilities.
• Medical costs for organ transplant are fully reimbursable up to the Limits of Policy.
• Covered:
 
– Out–patient treatment for Cancer &/or Kidney Dialysis.
– Out–patient Physiotherapy Treatments & Home Nursing Care after hospitalisation.
– Day–care Surgery.
– Traditional Medical Treatment.
• Max Lifetime Limit: RM500,000
1.
Premier Medic Partner is designed to provide comprehensive coverage to meet one’s potentially high and yet unexpected medical bills not for just one year but renewable up to age 75 years.
2. It provides wide coverage at an affordable premium to meet the ever spiraling cost of healthcare.
3. No limits to the number of days for Room & Board and ICU.
4. High limits of cover for both Annual and Life–time Limits.
5.
One common level of premium regardless of gender and class of occupation.
6. No requirement for re–declaration of health status at renewal.
7. Covers all amateur sport activities.
8. Covers cost of 2nd opinion prior to Surgery.
9.
Optional for ’Emergency Medical Assistance & Services’ (EMAS) program which provides 24 hours and worldwide medical assistance up to a limit of RM1,750,000.00 at additional premium of RM20.00 per person per year. No geographical restriction is imposed. (Terms and Conditions are stated in the leaflet attached to the EMAS Card).
 
   
• 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 a registered bed–paying patient in a Hospital.
   
• Intensive Care Unit
 
Reimburses daily charges for confinement in an Intensive Care Unit or Cardiac Care Unit where prescribed by the attending Physician or Surgeon
   
• 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 sixty (60) days before and after the operation.

Surgeon Fees shall also include professional fees charged by a second Physician or Surgeon who may be consulted prior to Hospitalisation of Insured Person for a surgical operation.
   
• Anaesthetist Fees
 
Reimburses professional fees charged by the Anaesthesiologist for the supply and administration of anaesthesia incidental to the performance of a Surgery.
   
• Operating Theatre Fees
  Reimburses Operating Room charges incidental to the performance of a Surgery.
   
• In–Hospital Physician Visits
 
Reimburses professional fees charged by a Physician for visiting a bed–paying patient while confined for a non–surgical Disability subject to a maximum of one (1) visit per day up to maximum number of 150 days.
   
• Hospital Services & 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, administration 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.
   
• 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 Thirty-one (31) 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 item.
   
• Pre–hospital Specialist Consultation
 
Reimburses the professional fees charged for the first time consultation by a Specialist in connection with a Disability within Thirty–one (31) days preceding Hospitalisation and provided that such consultation has been recommended in writing by a Doctor. No benefit shall be made for any clinical treatment (including medications and subsequent consultation) or where the Insured Person does not result in Hospitalisation for the treatment of the medical condition diagnosed.
   
• Post–Hospitalisation Treatment
 
Reimburses medical charges for follow–up treatment by the same attending Physician and incurred within sixty (60) days immediately upon discharge 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.
   
• Outpatient Physiotherapy Treatment
 
Reimburses the daily professional fees charged by a legally and medically qualified Physiotherapist for outpatient physiotherapy treatment and incurred within sixty (60) days upon discharge from Hospital provided that such service is deemed to be Medically Necessary by the attending Physician in writing.
   
• Emergency Accidental Outpatient Treatment
 
Reimburses medical expenses incurred as a result of a covered bodily injury arising from an Accident for treatment as an outpatient at any registered clinic or Hospital within twenty–four (24) hours of the Accident causing the Injury. Follow–up treatment by the same Doctor or same registered clinic or Hospital for the same Injury will be provided up to Thirty–one (31) days from the date of the Accident.
 
• Emergency Accidental Dental Treatment
  Reimburses medical expenses incurred in a Hospital or a registered dental clinic for dental treatment of injury or damage to sound natural teeth as a result of an Accident Provided that the dental treatment is received within forty–eight (48) hours of the Accident causing the Injury. Follow–up treatment by the same Dentist will be provided up to Thirty–one (31) days from the date of the Accident.
   
• Ambulance Fee
 
Reimburses charges incurred for road ambulance services (inclusive of attendant) to and/or from the Hospital of confinement. Payment will not be made if the Insured Person is not Hospitalised.
   
• Government Service Tax
  Reimburses the 5% Government Service Tax on the eligible Hospital Room and Board charges.
   
• Lodger Benefit
 
Reimburses the daily expenses for meals and lodging incurred to accompany an insured Child (aged below fifteen (15) years) in the Hospital but not exceeding sixty (60) days.
   
• Traditional Medical Treatment
 
Reimburses medical expenses incurred for treatment of a covered Accidental Injury on outpatient basis and treated by a registered Traditional Medical Practitioner within twenty–four (24) hours after the Accident.
   
• Medical Report
 
Reimburses charges made by Hospital/Physician for completion of medical report of a covered Disability.
   
• 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 one–hundred (100) days immediately upon discharge from Hospital. 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.
   
• Daily Cash Allowance At Government Hospital
 
Pays a daily allowance for each complete day of confinement in a Malaysian Government Hospital up to a maximum number of 150 days. No payment will be made for any transfer to or from any non–Malaysian Government Hospital.
   
• Organ Transplant
 
Reimburses the medical charges incurred for transplantation surgery for the Insured Person being the recipient of the transplant of Kidney, Heart, Lung, Liver or Bone Marrow. No benefit is allowable under this policy other that this particular benefit item (Organ Transplant) and payment for this Benefit is applicable only once per Lifetime of an Insured Person whilst the Policy is in force. The costs of acquisition of the organ and all costs incurred by the donors are not covered.
   
• Funeral Benefit
 
Pays the Insured or the legal representative of the Insured the stated lump sum benefit on the occurrence of ONE of the following events:
a)
Accidental death of an Insured Person if death occurs within six (6) months from the date of the Accident. OR
b)
Death of Insured Person during the period of confinement in the Hospital or within 30 days upon discharge from the hospital provided only if at the date of his/her death, his/her age falls between 19 years and 60 years inclusive.
   
• Outpatient Cancer Treatment
 
If an Insured Person is diagnosed with Cancer as defined herein, the Company will reimburse medical charges incurred for the treatment of Cancer provided such treatment of radiotherapy &/or chemotherapy (but excluding costs for consultation, examination test, take home drugs) is received at the outpatient department of a Hospital or a legally registered Cancer treatment center immediately following discharge from Hospital confinement or surgery.
   
• Outpatient Kidney Dialysis Treatment
 
If an Insured Person is diagnosed with Kidney Failure as defined herein, the Company will reimburse the medical charges incurred for Kidney dialysis performed at the outpatient department of a Hospital or a legally registered Kidney Dialysis center immediately following discharge from Hospital confinement or surgery. (The costs for consultation, examination tests, take home drugs are excluded).
 
 
 
BENEFIT PLANS
BENEFITS
PM500
PM350
PM230
PM160
 
 
   
RM
  
RM
  
RM
  
RM
 
 
1. Hospital Room & Board (Daily Limit)
500
350
230
160
  
2. Intensive Care Unit          
3. Surgeon Fees (including Day Care Surgery and Pre & Post Surgical care up to 60 days)          
4. Anaesthetist Fees          
5. Operating Theatre          
6. In–Hospital Physician Visits (daily up to 150 days)
As Charge
7. Hospital Services & Supplies
Subject to ’Reasonable & Customary Charge’
8. Pre–Hospitalisation Diagnostic Tests & Specialist Consultation (31 days prior to Hospitalisation)
and Overall Limits
9. Post Hospitalisation Treatment (within 60 days upon discharge)          
10. Outpatient Physiotherapy Treatment (within 60 days upon discharge)          
11. Emergency Accident Outpatient Treatment (within 24 hours from time of accident)          
12. Emergency Accident Dental Treatment (within 48 hours from time of accident)          
13. Ambulance Fee & Government Service Tax          
14. Lodger Benefit (daily up to 60 days)
300
200
150
100
  
15. Medical Report Fee
50
50
50
50
  
16. Traditional Medical Treatment
300
250
200
200
  
17. Home Nursing Care (with 100 days upon discharge)
200
175
150
130
  
18. Daily Cash Allowance at Government Hospital (daily up to 150 days)
150
120
110
100
  
19. Organ Transplant once per Life–time
100,000
75,000
50,000
35,000
  
20. Funeral Benefit
4,000
3,000
2,000
1,000
  
21. Outpatient Cancer Treatment, per year
60,000
50,000
40,000
30,000
  
22. Outpatient Kidney Dialysis Treatment, per year
30,000
25,000
20,000
15,000
  
23. Overall Annual Limit per Policy Year
120,000
85,000
60,000
40,000
  
24. Life Time Limit per Person
500,000
350,000
250,000
150,000
  
             
 Age at next birthday (years)
Annual Premium
30 days to 18 years (child)
681
572
485
405
  
19 – 30 years
809
678
574
479
  
31 – 35 years
855
717
607
506
  
36 – 40 years
1,031
863
730
608
  
41 – 45 years
1,236
1,033
872
724
  
46 – 50 years
1,644
1,373
1,156
958
  
51 – 55 years
1,960
1,635
1,374
1,135
  
56 – 60 years
2,580
2,149
1,804
1,487
  
61 – 65 years (Renewal only)
3,311
2,756
2,309
1,899
  
66 – 70 years (Renewal only)
4,470
3,715
3,108
2,548
  
71 – 75 years (Renewal only)
5,914
4,910
4,100
3,351
  
           
Note:          
i. An unmarried child 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. However, the premium rates are not guaranteed.
iii. You should satisfy yourself that this plan will best serve your needs and the premium payable is an amount you could afford.
 
     
 
   
1. Who is eligible to apply for Premier Medic Partner?
 
Any Malaysian or Permanent Resident of Malaysia aged 19 to 60, and policy is renewable up to the age 75.
   
2. When does my cover begin?
 
From the day your proposal form is accepted and upon full settlement of your premium except for sickness/illness only where 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 ’Medical Card’ facility?
 
Yes, it is easy for any Disability that can be readily confirmed to be covered by the Policy. All you have to do is to make a phone call to our service provider for confirmation at 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 in the event of an emergency and for non-chronic illnesses subject to 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 120 days of insurance cover
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–medical 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. 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 ’Upgraded Room and Board Co–payment’?
 
If you are confined at a published Room & Board rate which is higher than your insurance entitlement, you will bear 20% of the other eligible expenses incurred.
   
9. What is ’Portfolio Withdrawal Condition’?
 
The Company reserves the right to cancel the portfolio as a whole if it decides to discontinue underwriting this insurance product. Cancellation as a whole shall be given by written notice to the Insured and the Company will run off all policies to the respective expiry dates.
   
10. What is ’Cooling–off Period’?
 
If you are not fully satisfied with the Policy, you may return the Policy to us within 15 days from the date of delivery of Policy for cancellation. Premium paid will be refunded to you less RM50 or 10% of the premium whichever is lesser.
   
11.

 What is the disadvantage for switching Medical Policy from one insurer to another?
 
The disadvantage is that if your current health status is less favorable to the new insurer, new terms, conditions and exclusions may be imposed on such illness. Thus we would advise you to check for our accepting terms before the expiry date of your current policy.
   
12.

 What is the consequence of non–disclosure of material facts in the proposal form?
 
Pursuant to Section 149(4) of the Insurance Act, 1996, you are to disclose all matters which you know or reasonably in the circumstances could be expected to know to be relevant to our decision whether to accept the risk or not and the rates and terms to be applied, otherwise the policy issued may be void.
   
13. Who is Tokio Marine Insurans (M) Bhd?
 
We are a subsidiary of Tokio Marine Asia Pte. Ltd. which in turn is owned by Tokio Marine Holdings, Inc. Japan – one of the largest insurer in the world.
 
• Medic Plus
• Medic Partner
• Group Hospital & Surgical