I-Medik Xtender Rider: Arketing

i-Medik Xtender Rider
MARKETING
Marketing Name : i-Medik Xtender Rider
Distribution Channel : Agency
Plan Code Plan Name Plan Abbreviation Deductible Amount (RM)

J33 i-Medik Xtender Rider IL MO60K 60,000
PLAN DESCRIPTIONS
(a) This product is a unit-deducting rider that can be attached to:
 i-Great Damai (Plan Code: A003);
 i-Great Iqra’ (Plan Code: 0701);
 i-Great Damai for conversion products (Plan Code: 0704);
 i-Great Iqra’ for conversion products (Plan Code: 0706);
 any future plans that the Takaful Operator may introduce from time to time;
at any time, effective at next monthly due, PROVIDED i-Medik Rider (“IL M”) (Plan Code: A410-
A414; IL M100, IL M150, IL M200, IL M300, IL M400) or i-Medik Xtra Rider (“IL MX”) (Plan
Code: J27-J30; IL MX150, IL MX200, IL MX300, IL MX400) is also attached.
(b) This rider will have an adjusted first certificate year if the date of inclusion of this rider does not
coincide with the primary medical plan, so that this rider’s certificate anniversary will tally with
the primary plan in the subsequent year.
(c) Tabarru’ is deducted from the Participant’s Unit Account (“PUA”) and channeled to the Tabarru’
Fund.
PLAN BENEFITS
This rider provides coverage for medical expenses incurred on the Person Covered due to accident or
illness (subject to Exclusions, if any) or any other covered eventuality. The plan will reimburse such
expenses after deducting the Deductible of the plan participated as shown below, up to the maximum
number of days and limits according to the plan participated as stated in the Schedule of Benefits.
Compensation may be claimed from the start of a course of covered treatment until the time it is
confirmed by the medical opinion acceptable to the Takaful Operator that such treatment is no longer
necessary.
a) Co-takaful
Co-takaful is not applicable for this plan.
b) Waiting Period
Medical reimbursements provided under this rider shall commence for:
i. illness occurring 30 days after the rider effective date; or
ii. accidental injury occurring after the rider effective date.
For specified illnesses, 120 days waiting period shall apply.
Specified illness means the following disabilities and its related complications, occurring within the
first 120 days from the Rider Effective Date:
 Hypertension, diabetes mellitus and Cardiovascular Disease;
 All tumours, cancers, cysts, nodules, polyps;
 Stones of the urinary system and biliary system;
 All ear, nose (including sinuses) and throat conditions;
 Hernias, haemorrhoids, fistulae, hydrocele, varicocele;
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 Diseases of the Reproduction system including endometriosis;

 Vertebro-spinal disorders (including disc) and knee conditions.
c) Deductible Amount
Please refer to the Schedule of Benefits for the deductible amount available. Deductible for
i-Medik Xtender Rider is per certificate year, which means GETB will reimburse the total eligible
expenses incurred for all covered benefits accumulated in any certificate year, in excess of the
deductible amount.
Example:
Puan A participated in i-Medik Xtra Rider (IL MX150) together with i-Medik Xtender Rider (IL
MO90K) in July 2016. She is admitted to the hospital in Jan 2017, Feb 2017 and Mar 2017.
Assuming all her medical bills are eligible benefits that totaling to RM110,000 during the rider’s
certificate year. As such, the first RM 90,000 will be paid under IL MX150 annual limit and the
balance of
RM 20,000 will be payable under IL MO90K plan.
Total Eligible Medical Bill = RM 110,000
Claimable Amount under MX150 = RM 90,000
Claimable Amount under MO90K

= RM 110,000 – (Deductible: RM 90,000)
= RM 20,000
st nd rd
IL MX150 & 1 Eligible 2 Eligible 3 Eligible
IL MO90K Medical Bill = Medical Bill = Medical Bill =
inforce RM 50,000 RM 40,000 RM 20,000
18 Jul 2016 25 Jan 2017 25 Feb 2017 25 Mar 2017
Note: Please refer to Appendix 2 for more examples on claim scenarios.
The Deductible amount of i-Medik Xtender Rider must match the Initial Overall Annual Limit of the
primary IL medical plan which is attached to the same basic plan. Overview of i-Medik Xtender
Rider and its respective matching primary IL medical plan is as per below:
Plan Code J33 J34 J35 J36 J37
Plan Type IL MO60K IL MO90K IL MO120K IL MO160K IL MO200K

IL M R&B 100 R&B 150 R&B 200 R&B 300 R&B 400
(A410) (A411) (A412) (A413) (A414)
IL MX - R&B 150 R&B 200 R&B 300 R&B 400
(J27) (J28) (J29) (J30)
d) Coordination of Benefits
In the event of expenses incurred on the Person Covered where the expenses is claimed from
other medical plans from other companies or within Great Eastern Takaful (“the Takaful
Operator”), the cotakaful and/or deductible of other medical plans from other companies or within
the Takaful Operator which to be imposed on the Person Covered can be claimed from this plan,
up to the limits and sub-limits according to the plan participated as stated in the Schedule of
Benefits.
e) Schedule of Benefits
There are five riders available for selection with a daily Room and Board rate of RM150, RM200,
RM300, and RM400 respectively.
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Plan Type (RM)

IL MO60K IL MO90K IL MO120K IL MO160K IL MO200K
Deductible Amount
Item Covered Benefits (per certificate year)
60,000 90,000 120,000 160,000 200,000
Hospital Room and Board
1 150 150 200 300 400
(Limit per day, subject to a maximum
of 180 days per certificate year for As charged, subject to the limit stated above.
Items (1) and (2) in aggregate)
Intensive Care Unit As charged.
2
(Subject to a maximum of 180 days
per certificate year for Items (1) and
(2) in aggregate)
3 Hospital Supplies and Services As charged.
4 Surgical Fees
5 Operating Theatre Reimbursement of Reasonable and Customary Charges which is
6 Anaesthetist Fees consistent with those usually charged to a ward or room and board
7 In Hospital Physician Visit accommodation which is approximate to and within the daily limit of
(2 visits per day) the amount stated in Hospital Room and Board benefit under the plan
8 Pre-Hospital Diagnostic Tests covered.
(Within 60 days before hospitalisation)
9 Pre-Hospital Specialist
Consultation
(Within 60 days before hospitalisation)
10 Post-Hospitalisation Treatment
(Within 180 days after hospital
discharge)
11 Organ Transplant
(limit to once per lifetime as receiver)
12 Ambulance Fees
13 Day Surgery
14 Outpatient Cancer Treatment As charged.
15 Outpatient Kidney Dialysis
Treatment
16 Emergency Accidental Outpatient
Treatment
(Limit per certificate year, subject to a
maximum of 30 days from date of
accident)
17 Intraocular Lens Up to 1,000 per eye and maximum of 2,000 per lifetime.
18 Overall Annual Limit 600,000 900,000 1,200,000 1,600,000 2,000,000
10 times of the Deductible Amount
19 Overall Lifetime Limit No limit
20 Malaysian Goods and Services Tax GST incurred on Covered Benefits, for which a claim is payable; is
(GST) subject to Overall Lifetime Limit, but not subject to the Overall Annual
Limit.
Notes:
1. The list of Room & Board (R&B) under i-Medik Xtender Rider is the same as the primary
medical plan (PMP) which this rider is attached to, except for the first plan where it starts at
R&B150 instead of R&B100 in i-Medik Rider.
2. Numbers of days as mentioned in Schedule of Benefits are aggregated with number of days
in PMP.
3. If this rider is attached to i-Medik Xtra Rider where Intraocular Lens is one of the benefits,
Participants can only claim under either one of the rider, whether the benefit is claimed in i-
Medik Xtra Rider OR i-Medik Xtender Rider.
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DESCRIPTION OF BENEFITS
The Covered Benefits are described as follows:
1. Hospital Room and Board

Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary
room accommodation and meals. The amount payable for this benefit shall be equal to the
actual charges made by the Hospital during Hospitalisation of the Person Covered, subject to
the daily rate of Hospital Room and Board, the maximum number of days and the limits stated
in the Schedule of Benefits. A Person Covered will only be entitled to this benefit while confined
to a Hospital as an Inpatient.
2. Intensive Care Unit

Reimbursement of the Reasonable and Customary Charges for Medically Necessary actual
room and board incurred during confinement of a Person Covered as an Inpatient in the
Intensive Care Unit of a Hospital. The amount payable for this benefit shall be equal to the
actual charges made by the Hospital, subject to the maximum number of days and the limits
stated in the Schedule of Benefits. No Hospital Room and Board benefit and Intensive Care
Unit benefit shall be paid concomitantly.
For the avoidance of doubt, if Intensive Care Unit benefit is payable for a confinement period,
no Hospital Room and Board benefit shall be payable for the same confinement period.
3. Hospital Supplies & Services

Reimbursement of the Reasonable and Customary Charges actually incurred for:
- general nursing;
- Prescribed and consumed drugs and medicines;
- dressings, splints and plaster casts;
- x-ray;
- laboratory examinations;
- electrocardiograms;
- physiotherapy;
- basal metabolism tests;
- intravenous injections and solutions; or
- administration of blood and blood plasma but excluding the cost of blood and plasma while
the Person Covered is confined as an Inpatient in a Hospital,
which is Medically Necessary, subject to the limits stated in the Schedule of Benefits.
4. Surgical Fees
surgery by the Specialists, including Pre-Hospital Specialist Consultation and Post-
hospitalisation Treatment, subject to the limits stated in the Schedule of Benefits. If more than
one surgery is performed for Any One Disability, the total payments for all the surgeries
performed shall not exceed the limits stated in the Schedule of Benefits.
5. Operating Theatre
Reimbursement of the Reasonable and Customary Charges incurred for operating room
incidental to Medically Necessary surgical procedure, subject to the limits stated in the
Schedule of Benefits.
6. Anaesthetist Fees
administration of anaesthesia by the anaesthetist, subject to the limits stated in the Schedule of
Benefits.
7. In Hospital Physician Visit

Physician’s visit to an Inpatient who is confined for Disability, subject to a maximum of two (2)
visits per day and the limits stated in the Schedule of Benefits.
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8. Pre-Hospital Diagnostic Tests

Reimbursement of the Reasonable and Customary Charges incurred within sixty (60) days
preceding Hospitalisation, for Medically Necessary ECG, x-ray and laboratory tests which are
recommended by a qualified medical practitioner and performed for diagnostic purposes on
account of an Injury or Illness and in connection with a Disability, subject to the limits stated in
the Schedule of Benefits. No payment shall be made if the Person Covered does not result in
Hospitalisation for the treatment of the medical condition diagnosed upon such diagnostic
services. In addition, medications and consultation charged by the medical practitioner shall not
be payable.
9. Pre-Hospital Specialist Consultation

Reimbursement of the Reasonable and Customary Charges incurred within sixty (60) days
preceding Hospitalisation, for Medically Necessary first time consultation by a Specialist in
connection with a Disability provided that such consultation has been recommended in writing
by the attending general practitioner, subject to the limits stated in the Schedule of Benefits.
No payment shall be made for clinical treatment (including medications and subsequent
consultation after the Illness is diagnosed) or where the Person Covered does not result in
Hospitalisation for the treatment of the medical condition diagnosed.
10. Post-hospitalisation Treatment

Reimbursement of the Reasonable and Customary Charges incurred within one-hundred eighty
(180) days immediately following discharge from Hospital for a Disability, for Medically
Necessary follow-up treatment by the same attending Physician, subject to the limits stated in
the Schedule of Benefits. This shall include Prescribed Medicines during the follow-up treatment
but shall not exceed the supply needed for the maximum of one-hundred eighty (180) days from
the date of discharge.
11. Organ Transplant

Reimbursement of the Reasonable and Customary Charges incurred on transplantation surgery
for the Person Covered being the recipient of the transplant of a kidney, heart, lung, liver or
bone marrow. This benefit is applicable only once per lifetime while this rider is in force and
shall be subject to the limits stated in the Schedule of Benefits. The costs of acquisition of the
organ and all costs incurred by the donors are not covered under this rider.
12. Ambulance Fees

domestic ambulance services (inclusive of attendant) to and/or from the Hospital, subject to the
limits stated in the Schedule of Benefits. No payment shall be made if the Person Covered is
not hospitalised.
13. Day Surgery

Reimbursement of the Reasonable and Customary Charges incurred for a Medically Necessary
Day Surgery. This shall include the following surgical procedures which are commonly
performed safely as Day Surgery:
- Adenoidectomy;
- Bone Marrow Aspiration and Biopsy;
- Cataract removal;
- Colonoscopy;
- Cystourethroscopy;
- Endolaser Venous Surgery;
- Endoscopic Retrograde Cholangiopancreatography;
- Excision of Bunions;
- Excision of Ganglion, Fibroma(s) and Breast Lump(s);
- Excision of Pterygium;
- Extra corporeal Shock Wave Lithotripsy;
- Herniotomy / Herniorapphy;
- Insertion or Removal of Ureteric J-Stent;
- Laparoscopic Endometrial Ablation;
- Laparoscopy;
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- Laryngoscopy;
- Laser Photocoagulation treatment for Retinal Detachment ;
- Marsupialisation and drainage of Bartholin's Cysts;
- Myringotomy or Myringoplasty;
- Reduction of Bone Fracture(s);
- Release of Carpal Tunnel (Carpal Tunnel Decompression);
- Release of Dupuytren's contracture;
- Removal of Cervical Polyps;
- Removal of Nasal Polyps;
- Removal of Plate and Screw/implants;
- Rubber Banding of Haemorrhoids.
The Takaful Operator may extend the above list of surgical procedures which are commonly
performed safely as Day Surgery, from time to time, at its sole discretion. If any such surgical
procedure is performed while the Person Covered is an Inpatient, only the equivalent benefit of
Day Surgery shall be paid, unless the Takaful Operator’s appointed medical practitioner has
given prior approval.
14. Outpatient Cancer Treatment

If a Person Covered is diagnosed with Cancer as defined below, the Takaful Operator shall
reimburse the Reasonable and Customary Charges incurred for the Medically Necessary
cancer treatment performed at a legally registered cancer treatment center, subject to the limits
stated in the Schedule of Benefits.
Such treatment (radiotherapy or chemotherapy including consultation, examination tests and

take home drugs) must be received at the Outpatient department of a Hospital or a registered
cancer treatment centre immediately following discharge from Hospital.
Cancer is defined as any malignant tumour positively diagnosed with histological confirmation
and characterized by the uncontrolled growth of malignant cells and invasion of tissue. The term
malignant tumour includes leukemia, lymphoma and sarcoma.
For the above definition, the following are not covered:

(i) all cancers which are histological classified as any of the following:
(a) pre-malignant;
(b) non-invasive;
(c) carcinoma in situ;
(d) having borderline malignancy;
(e) having malignant potential;
(ii) all tumours of the prostate histologically classified as T1N0M0 (TNM classification);
(iii) all tumours of the thyroid histologically classified as T1N0M0 (TNM classification);
(iv) all tumours of the urinary bladder histologically classified as T1N0M0 (TNM classification);
(v) chronic Lymphocytic Leukemia less than RAI Stage 3;
(vi) all cancers in the presence of HIV; and
(vii) any skin cancer other than malignant melanoma;
In addition to the exclusion of Pre-existing Illness, this benefit shall not be payable for any
Person Covered who had been diagnosed as a cancer patient and/or is receiving cancer
treatment prior to the Rider Effective Date.
15. Outpatient Kidney Dialysis Treatment

If a Person Covered is diagnosed with Kidney Failure as defined below, the Takaful Operator
shall reimburse the Reasonable and Customary Charges incurred for the Medically Necessary
kidney dialysis treatment performed at a legally registered dialysis center, subject to the limits
stated in the Schedule of Benefits.
Such treatment (dialysis including consultation, examination tests and take home drugs) must
be received at the Outpatient department of a Hospital or a registered dialysis treatment center
immediately following discharge from Hospital.
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Kidney Failure – Requiring Dialysis or Kidney Transplant presenting as chronic irreversible

failure of both kidneys to function, as a result of which regular dialysis is initiated or kidney
transplantation is carried out.
In addition to the exclusion of Pre-existing Illness, this benefit shall not be payable for any
Person Covered who has developed chronic renal diseases and/or is receiving dialysis
treatment prior to the Rider Effective Date.
16. Emergency Accidental Outpatient Treatment

treatment as an Outpatient at any registered Clinic or Hospital as a result of a covered bodily
injury arising from an Accident, within 24 hours of such Accident and subject to the maximum
amount and the limits stated in the Schedule of Benefits. Follow-up treatment by the same
Doctor or same registered Clinic or Hospital for the same covered bodily Injury shall be
provided up to a maximum of thirty (30) days from date of Accident, subject to the maximum
amount and the limits stated in the Schedule of Benefits.
17. Intraocular Lens

Reimbursement of Reasonable and Customary Charges incurred for Medically Necessary
Intraocular Lenses up to Ringgit Malaysia ONE THOUSAND (RM1,000) per eye, subject to a
maximum of Ringgit Malaysia TWO THOUSAND (RM2,000) per lifetime. This benefit is further
subject to the limits stated in the Schedule of Benefits.
18. Overseas Treatment

If the Person Covered elects to be treated outside of Malaysia or is referred to be treated
outside of Malaysia by the attending physician, benefits in respect of the treatment shall be
limited to the Reasonable and Customary Charges for such equivalent treatment in Malaysia
and shall exclude the cost of transportation to the place of treatment.
19. Residence Overseas

No benefit shall be payable for any medical treatment received by the Person Covered outside
of Malaysia if the Person Covered resides or travels outside of Malaysia for more than ninety
(90) consecutive days.
UNDERWRITING GUIDELINES
i. Minimum/Maximum Age at Entry
Plan Type
Entry Age
IL MO60K IL MO90K IL MO120K IL MO160K IL MO200K
Minimum 30 days attained age
Maximum 60 years next birthday 65 years next birthday
(Entry age 61 to 65 is subject to compulsory
medical checkup)
ii. Minimum/Maximum Term

Follow primary IL medical plan which is attached to the same basic plan: Certificate
anniversary of 80 years next birthday.
iii. Minimum/Maximum Sum Covered

Not applicable.
iv. Non-Medical Limits

In general, medical examination is not required. However, the Takaful Operator reserves the
absolute right to call for a medical examination, if necessary.
v. Backdating
Not allowed.
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vi. Underwriting for Substandard

The treatment for underwriting substandard lives owing to health condition will be to impose a
percentage extra loading on contribution and the Tabarru’ rates. As for hazardous occupation
and avocation, extra loading is not applicable.
Health condition
1. percentage extra loading (EM%). Health loading applicable as per current i-Medik Rider /
i-Medik Xtra Rider.
Hazardous occupation/avocation
Occupation loading not applicable
vii. Renewal / Change in Occupation

The renewal of this rider is guaranteed subject to portfolio withdrawal. The Tabarru’ rates may
be changed from time to time as the Takaful Operator may determine at its sole discretion.
Such changes, if any, shall be applicable to all Person Covered irrespective of their claim
experience.
The Person Covered must inform the Takaful Operator of any change in the nature of his or
her occupation. The Takaful Operator may at its discretion alter any provisions, terms,
conditions and benefits of the Plan.
CHARGES
Tabarru’
(a) Tabarru’ rates varies by the attained age, gender, and occupation classification of the Person
Covered.
(b) Tabarru’ is deducted monthly by cancellation of units at the beginning of each certificate month.
(c) Tabarru’ rates are subjected to GST of 6%.
The Takaful Operator reserves to revise the charges by giving 30 days’ advance written notice. Any
revision of the Tabarru’ shall take effect on the certificate anniversary immediately following the expiry
of the 30 days’ notice.
Female Rates
Separate Tabarru’ rates applicable for male and female.
Occupational Class Rates

The standard rates are applicable to occupation classes 1 and 2. Separate rates are applicable to
occupation class 3 and class 4.
Non-smoker Discount / Large Sum Covered Discount / Staff Discount

Not applicable.
AGENCY COMPENSATION
Basic Commission & Overriding Commission & Other Agency Compensation
Not applicable since these are unit deducting riders. Commission is only payable on the Basic
Contributions.
OTHER PRIVILEGES
i. Nomination
Not applicable, as all benefits are given to the Person Covered.
ii. Assignment
Not applicable, as all benefits are given to the Person Covered.
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iii. Third Party Certificate

Follow basic plan.
iv. Free-look period

Participant is allowed to cancel this rider within 15 days after the Participant have received the
Takaful certificate. The Tabarru’ that have been deducted will be credited back into the PUA.
v. Reinstatement
Allowed within 3 years (follow basic plan) from the rider’s lapse date and is subject to
underwriting. i-Medik Xtender Rider can be reinstated provided the matching primary IL
medical plan which is attached to the same basic plan is reinstated at the same time.
vi. Change of Deductible Amount

Any change in deductible must be accompanied by the change in annual limit of the existing
primary IL medical plan so that the deductible amount matches.
a) Increase in annual limit of the existing primary IL medical plan (increase in deductible of
i-Medik Xtender Rider) will be considered as upgrading of plan and will be subject to
underwriting.
b) Decrease in annual limit of the existing primary IL medical plan (decrease in deductible of
i-Medik Xtender Rider) will be considered as downgrading of plan and will NOT be subject
to underwriting.
RIDERS / SUPPLEMENTARY BENEFITS

Not applicable.
EXCLUSIONS
(In the event of discrepancies, please refer to sample certificate).
The Takaful Operator will not pay any benefit under this rider as a result of, including of any of the
following whether directly or indirectly:
1. Pre-existing Illness;
2. Specified Illnesses occurring within the first 120 days from the Rider Effective Date;
3. Any medical or physical conditions arising within the Waiting Period except for Injury;
4. 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, implanted pacemakers and
prescriptions thereof;
5. Dental conditions including dental treatment or oral Surgery, except as necessitated by Injury to
sound natural teeth occurring in any Certificate Year and performed by Dentist;
6. 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;
7. Any treatment or surgical operation for Congenital Conditions or deformities including hereditary
conditions;
8. Pregnancy, child birth (including surgical delivery), miscarriage, abortion and 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;
9. 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;
10. Suicide, attempted suicide or intentionally self-inflicted Injury, while sane or insane;
11. 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;
12. Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from
process of nuclear fission or from any nuclear weapons material;
Page 9 of 18
13. For the transplantation Surgery with the Person Covered being the recipient of the transplant,
cost of acquisition of the organ including all costs incurred by the donor during organ transplant
and its complications;
14. 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 aromatherapy or other alternative treatment;
15. Care or treatment for which payment is not required or to the extent which is payable by any
other insurance / family takaful or indemnity covering the Person Covered and disabilities
arising out of duties of employment or profession that is covered under a Workman’s
Compensation Insurance Contract;
16. Psychotic, mental or nervous disorders, (including any neuroses and their physiological or
psychosomatic manifestations);
17. 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;
18. Sickness or Injury arising from racing of any kind (except for foot racing), hazardous sports
such as but not limited to sky-diving, water skiing, underwater activities requiring breathing
apparatus, winter sports, professional sports and illegal activities;
19. Private flying other than as a fare-paying passenger in any commercial scheduled airlines
licensed to carry passengers over established routes;
20. Expenses incurred for sex change;
21. Any Outpatient treatment not related to Inpatient treatment, except as provided under this
rider;
22. Charges which are not Reasonable and Customary Charges, or any Surgery or treatment
which is not Medically Necessary, or charges in excess of Reasonable and Customary
Charges, or charges which are incurred for Hospitalisation, pre-hospitalisation and/or post-
hospitalisation after the Expiry Date.
Page 10 of 18
APPENDICES
Claim Scenarios
Scenario 1:
 i-Medik 150 (Annual Limit of RM 90,000) + i-Medik Xtender 90K (Deductible of RM90,000)
 Certificate effective date 18 July 2016. Stay within Room & Board limit.
i-Medik (R&B 150, Initial Overall Annual Limit: i-Medik Xtender (Deductible: RM 90K, R&B 150)
RM 90K)
Eligible Annual Annual
Event
Claim Event Billed Limit Amount Eligible Eligible Limit
Date
Amount Balance Claimable Amount Not Deductible Deductible Claimable Amount Balance
(Before Claimable (This Claim) Accumulated (Before
Claim) Claim)
Aug i. Room and Board RM150 X RM150 X 10 = = Billed RM 150 X 10 = RM 50,000 Eligible Deductible
2016 of RM 150 for 10 10 = RM1,500 Amount – RM 1,500 Amount < Deductible
days RM1,500 Claimable Amount of RM
1 Amount 90,000
ii. Hospital supplies RM 48,500 RM 48,500 – 500 = RM RM 48,500
and services, =RM 48,000 50,000 – Claimable Amount
surgical fees, RM 49,500 = RM 0
operating theatre, = RM 500 RM
anaesthetist and 900,000
RM 90,000
physician visits
Total RM 50,000 = Min (Annual Limit 1,500 + 48,500
Balance, Eligible = RM 50,000
Claims)
= Min (90,000, 1,500 +
48,000)
= Min (90,000, 49,500)
= RM 49,500
st
Oct i. Room and Board RM150 X RM 90,000 RM150 X 10 = = Billed RM 150 X 10 = 1 claim Total Eligible RM
nd
2016 of RM 150 for 10 10 = – RM RM1,500 Amount – RM 1,500 50,000 + 2 Deductible 900,000 –
days RM1,500 49,500 Claimable claim 50,000 Accumulated during RM 10,000
1
ii. Hospital supplies RM 48,500 = RM RM 48,500 – 500 Amount RM 48,500 = RM 100,000 the year – Max = RM
and services, 40,500 =RM 48,000 = RM (Deductible amount, 890,000
surgical fees, 50,000 – amount claimed from
Page 11 of 18
RM 90K)
Event
Date
Claim) Claim)
operating theatre, RM 40,500 other medical plans)
anaesthetist and = RM 9,500 – previous amount
physician visits claimed under IL MO
Total RM 50,000 = Min (Annual Limit 1,500 + 48,500 plan (if any) =
Balance, Eligible = RM 50,000 100,000 – Max
Claims) (90,000, 90,000) – 0
= Min (40,500, 1,500 + = RM 10,000
48,000)
= Min (40,500, 49,500)
= RM 40,500
 Amount claimable by customer under i-Medik Xtender Rider is RM 10,000
 10% co-takaful is applicable, up to a maximum of RM 500 (within Room & Board limit)
Page 12 of 18
Scenario 2:
 Certificate effective date 18 July 2016. Exceed Room & Board limit of i-Medik & i-Medik Xtender.
RM 90K)
Event
Date
Claim) Claim)
Aug i. Room and Board RM 300 X RM150 X 10 = = Billed RM 150 X 10 = RM 48,500 Eligible Deductible
Amount 90,000
ii. Hospital supplies RM 47,000 RM 47,000 – 9,400 = RM RM 47,000
and services, =RM 37,600 (including co-
50,000 – takaful amount of Claimable Amount
surgical fees, RM 39,100 i-Medik) = RM 0
operating theatre, = RM RM 900,000
anaesthetist and 10,900
RM 90,000
physician visits
Claims)
= Min (90,000, 1,500 +
37,600)
= Min (90,000, 39,100)
= RM 39,100
st
Oct i. Room and Board RM 300 X RM 90,000 RM150 X 10 = = Billed RM 150 X 10 = 1 claim Total Eligible RM 900,000
nd
2016 of RM 300 for 10 10 = – RM RM1,500 Amount – RM 1,500 48,500 + 2 Deductible – RM 7,000
days RM3,000 39,100 Claimable claim 48,500 Accumulated during = RM
ii. Hospital supplies RM 47,000 = RM RM 47,000 – 9,400 Amount RM 47,000 = RM 97,000 the year – Max 893,000
and services, 50,900 =RM 37,600 = RM (including co- (Deductible amount,
50,000 – takaful amount of amount claimed from
surgical fees, i-Medik)
operating theatre, RM 39,100 other medical plans)
anaesthetist and = RM – previous amount
physician visits 10,900 claimed under IL MO
Page 13 of 18
RM 90K)
Event
Date
Claim) Claim)
Total RM 50,000 = Min (Annual Limit 1,500 + 47,000 plan (if any) = 97,000
Balance, Eligible = RM 48,500 – Max (90,000,
Claims) 78,200) – 0
= Min (50,900, 1,500 + = 97,000 – 90,000 –
37,600) 0
= Min (50,900, 39,100) = RM 7,000
= RM 39,100
st
Dec i. Room and Board RM 300 X RM 90,000 RM150 X 10 = = Billed RM 150 X 10 = 1 claim Total Eligible RM 900,000
nd
2016 of RM 300 for 10 10 = – RM RM1,500 Amount – RM 1,500 48,500 + 2 Deductible – RM 7,000
days RM3,000 39,100 – Claimable claim 48,500 + Accumulated during – RM 48,500
rd
RM 39,100 Amount 3 claim the year – Max =
= RM = RM 48,500 (Deductible amount, RM844,500
11,800 50,000 – = RM 145,500 amount claimed from
ii. Hospital supplies RM 47,000 RM 47,000 – 9,400 RM 47,000
RM 11,800 (including co- other medical plans)
and services, =RM 37,600
= RM takaful amount of – previous amount
surgical fees,
38,200 i-Medik) claimed under IL MO
operating theatre,
plan (if any) =
anaesthetist and
145,500 – Max
physician visits
(90,000, 78,200) –
7,000
= 145,500 – 90,000 –
Claims)
7,000
= Min (11,800, 1,500 +
= RM 48,500
37,600)
= Min (11,800, 39,100)
= RM 11,800
 Amount claimable by customer under i-Medik Xtender Rider is RM 7,000 + 48,500 = RM 55,500
 20% co-takaful is applicable, with no maximum cap (upgraded Room & Board)
Page 14 of 18
Scenario 3:
 Certificate effective date 1 Oct 2016. Different Room & Board, i-Medik Xtender 150 > i-Medik 100
RM 90K)
Event
Date
Claim) Claim)
June2 iii. Room and Board RM150 X RM100 X 10 = = Billed RM 150 X 10 = RM 50,000 Eligible Deductible
Amount 90,000
iv. Hospital supplies RM 48,500 RM 48,500 – 500 = RM RM 48,500
and services, =RM 48,000 (including co-
50,000 – takaful amount of Claimable Amount
surgical fees, RM 49,000 i-Medik) = RM 0
operating theatre, = RM 1,000 RM 600,000
anaesthetist and
RM 60,000
physician visits
Claims)
= Min (60,000, 1,000 +
48,000)
= Min (60,000, 49,000)
= RM 49,000
st
Oct iii. Room and Board RM150 X RM 60,000 RM100 X 10 = = Billed RM 150 X 10 = 1 claim Total Eligible
nd
2017 of RM 300 for 10 10 = – RM RM1,000 Amount – RM 1,500 50,000 + 2 Deductible
days RM1,500 49,000 Claimable claim 50,000 Accumulated during
iv. Hospital supplies RM 48,500 = RM RM 48,500 – 500 Amount RM 48,500 = RM 100,000 the year – Max RM600,000
and services, 11,000 =RM 48,000 = RM (including co- (Deductible amount, – RM
50,000 – takaful amount of amount claimed from
surgical fees, i-Medik)
40,000
operating theatre, RM 11,000 other medical plans) =
anaesthetist and = RM – previous amount RM560,000
physician visits 39,000 claimed under IL MO
Page 15 of 18
RM 90K)
Event
Date
Claim) Claim)
Total RM 50,000 = Min (Annual Limit 1,500 + 48,500 plan (if any) =
Balance, Eligible = RM 50,000 100,000 – Max
Claims) (60,000, 60,000) – 0
= Min (11,000, 1,000 + = 100,000 – 60,000 –
48,000) 0
= Min (11,000, 49,000) = RM 40,000
= RM 11,000
 10% co-takaful is applicable, up to a maximum of RM 500 (within Room & Board limit)
Page 16 of 18
Scenario 4:
 Certificate effective date 1 Jan 2017. Stay within Room & Board limit.
 No claim was made during the first 3 certificate years, i-Medik Overall Annual Limit is increased by RM 9,000 to RM 99,000 at the 4 certificate year.
th
Event Claim Event Eligible i-Medik (R&B 150, Initial Overall Annual Limit: i-Medik Xtender (Deductible: RM 90K, R&B 150)
Date Billed RM 90K)
Amount Annual Claimable Amount Amount Eligible Eligible Claimable Amount Annual
Limit Not Deductible Deductible Limit
Balance Claimable (This Claim) Accumulated Balance
(Before (Before
Claim) Claim)
1 Jan Certificate effective
2017
1 Jan No claim was made during the first 3 certificate years, i-Medik’s overall annual limit is increased by RM 9,000 to RM 99,000
2020
Oct iii. Room and Board RM150 X RM150 X 10 = = Billed RM 150 X 10 = RM 100,000 Total Eligible
2020 of RM 150 for 10 10 = RM1,500 Amount – RM 1,500 Deductible
days RM1,500 Claimable Accumulated during
1 Amount the year – Max
iv. Hospital supplies RM 98,500 RM 98,500 – 500 = RM RM 98,500 (Deductible amount,
and services, =RM 98,000 100,000 – amount claimed from
surgical fees, RM 90,000 other medical plans)
operating theatre, = RM – previous amount
anaesthetist and 10,000 claimed under IL MO RM 900,000
physician visits plan (if any) =
Total RM RM 99,000 = Min (Annual Limit 1,500 + 98,500 100,000 – Max
100,000 Balance, Eligible = RM 100,000 (90,000, 90,000) – 0
Claims) = RM 10,000
= Min (99,000, 1,500 +
98,000)
= Min (99,000, 99,500)
= RM 99,000
*Since i-Medik Xtender

deductible is RM
90,000, amount
Page 17 of 18
claimed under i-Medik

is RM 90,000

 *Due to claim best practice, the first RM 90,000 will be payable under i-Medik and the remaining RM 10,000 will be payable under i-Medik Xtender. As
such, the overall lifetime limit of i-Medik will be accelerated by RM 90,000 only and remain with RM 810,000
Page 18 of 18

I-Medik Xtender Rider: Arketing

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i-Medik Xtender Rider

Plan Code Plan Name Plan Abbreviation Deductible Amount (RM)

For specified illnesses, 120 days waiting period shall apply.

 Diseases of the Reproduction system including endometriosis;

Total Eligible Medical Bill = RM 110,000

Claimable Amount under MX150 = RM 90,000

Claimable Amount under MO90K

18 Jul 2016 25 Jan 2017 25 Feb 2017 25 Mar 2017

Note: Please refer to Appendix 2 for more examples on claim scenarios.

Plan Code J33 J34 J35 J36 J37

Plan Type IL MO60K IL MO90K IL MO120K IL MO160K IL MO200K

Plan Type (RM)

1. Hospital Room and Board

2. Intensive Care Unit

3. Hospital Supplies & Services

7. In Hospital Physician Visit

8. Pre-Hospital Diagnostic Tests

9. Pre-Hospital Specialist Consultation

10. Post-hospitalisation Treatment

11. Organ Transplant

12. Ambulance Fees

13. Day Surgery

14. Outpatient Cancer Treatment

Such treatment (radiotherapy or chemotherapy including consultation, examination tests and

For the above definition, the following are not covered:

15. Outpatient Kidney Dialysis Treatment

Kidney Failure – Requiring Dialysis or Kidney Transplant presenting as chronic irreversible

16. Emergency Accidental Outpatient Treatment

17. Intraocular Lens

18. Overseas Treatment

19. Residence Overseas

ii. Minimum/Maximum Term

iii. Minimum/Maximum Sum Covered

iv. Non-Medical Limits

vi. Underwriting for Substandard

vii. Renewal / Change in Occupation

Occupational Class Rates

Non-smoker Discount / Large Sum Covered Discount / Staff Discount

iii. Third Party Certificate

iv. Free-look period

vi. Change of Deductible Amount

RIDERS / SUPPLEMENTARY BENEFITS

*Since i-Medik Xtender

claimed under i-Medik

 Amount claimable by customer under i-Medik Xtender Rider is RM 10,000

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