Help me analyse 2 plans for Zurich. I attached the brochures and policy wordings for your reference. Which plan is better for me in terms of coverage for serious illness.

Medical Insurance
Medical Insurance
2
ZURICH
Z-MedProtect
Comprehensive solutions for your healthcare needs
Comprehensive solutions for your healthcare needs

Just focus on getting well,
we will take care of the rest!
Illnesses and accidents are part and parcel of our lives. No one can ever be too
prepared for these mishaps, and the last thing you want to worry about is how much
it will cost you should anything happen.
Hospitalisation charges, surgical treatments, medication, examination and
consultation fees all added up could be financially exhausting for many. While the
rise of medical costs cannot be prevented, it is only wise to have a solution to put a
stop to these worries.
At Zurich, we have taken note of your concern and that is why we designed
Z-MedProtect, a yearly renewable medical insurance with comprehensive coverage
that covers your medical bills, ensuring you and your loved ones total peace of mind
and will not be financially burdened.
Don't worry!
We have got you covered!
High Overall Annual Limit, No Lifetime Limit
Enjoy high Overall Annual Limit up to RM2,000,000 to help you get through
your every healthcare need.
Flexible and Customisable Plan
Everyone’s needs are different, so choose any of the 5 plans that offer
various features and premiums that suit you best.
Guaranteed Renewable up to 100 years old
Enjoy the rewards of a well-lived life with continuous coverage into your
golden age.
Deductible Option (Applicable for Section A - Inpatient & Daycare Benefits)
Flexibility to choose from 4 Deductible Options to manage your medical
expenses and enjoy premium discount up to 50%.
1
Ie

No Claim Bonus
Staying healthy is always rewarding! Get 10% premium discount on your
next renewal policy if you do not file a claim during the preceding year.
Multiple Insured Person Discount
We understand that you need to provide and care for your loved ones.
Enjoy up to 10% premium discount when you insure your parent, spouse
or children in the same policy!
Unlimited In-Hospital Physician Visits
Get extensive care from your attending in-hospital physicians while you are
focusing on recovery.
Second Opinion for Surgeries
In some cases, it may be necessary to seek another specialist to obtain a
second opinion prior to a surgery. To ease your mind, we will reimburse you
the charges incurred for the consultation.
Organ Transplant
We will reimburse you charges incurred on the transplantation surgery if you
are the recipient of a Heart, Kidney, Lung, Liver or Bone Marrow.
Hassle-free Hospital Admission
In an emergency, just show your medical card or e-medical card for speedy
admission and medical attention at any of our panel hospitals nationwide.
Accidental Death or Permanent Disablement Benefit
Extra financial security with additional RM50,000 on top of the Overall
Annual Limit in the unfortunate event of Accidental Death or Permanent
Disablement.
Funeral Expenses
Providing your loved ones with a lump sum of RM2,000 to supplement the
final expense of your life, so no burden is left when you are no longer
around to care for them.
2
eI
grat
oo
EG eS

Schedule of Benefits
Z-MedProtect is available in 5 plans that cater to different needs and budget.
Here are the full schedule of benefits of each plan:
Beneﬁts
Overall Annual Limit
For Section A & Section B
No Claim Bonus
Section A – Inpatient & Daycare Beneﬁts
Hospital Room & Board
Intensive Care Unit
Hospital Supplies & Services
Daycare Procedures
Surgical Fees
Anaesthetist’s Fee
Operating Theatre Fee
In-Hospital Physician Visit (unlimited)
Ambulance Fees
Daily-Cash Allowance At Government Hospital
Insured Child’s Daily Guardian Beneﬁt
Medical Reports Fees
Organ Transplant
(Heart, Kidney, Lung, Liver or Bone Marrow)
Tax on Eligible Expenses
Plan 1 Plan 2 Plan 3 Plan 4 Plan 5
Limit (RM)
100,000 300,000 500,000 1,000,000 2,000,000
Reduction of 10% on renewal premium
(if no claims made)
100 150 180 200
(maximum 365 days per annum)
As Charged (maximum 180 days per annum)
As Charged
As Charged
As Charged
As Charged
As Charged
As Charged
As Charged
100 (maximum 365 days per annum)
250 (maximum per disability)
150
As Charged
As Charged
500
3

Beneﬁts
Plan 1 Plan 2 Plan 3 Plan 4 Plan 5
Limit (RM)
Section B – Outpatient Beneﬁts
Pre-Hospital Diagnostic Tests
Pre-Hospital Specialist Consultation
Post Hospitalisation Treatment
Emergency Accident Outpatient Treatment
Outpatient Physiotherapy Treatment
Outpatient Kidney Dialysis Treatment
Outpatient Cancer Treatment
Emergency Accident Outpatient Dental
Treatment
Home Nursing Care
Second Surgical Opinion
As Charged (within 60 days prior to hospitalisation)
As Charged (within 60 days prior to hospitalisation)
As Charged (within 90 days from hospitalisation)
As Charged (within 24 hours and follow-up
treatment to a maximum of 60 days)
As Charged (within 90 days from discharge)
As Charged
As Charged
4,000 (per accident)
4,000 (up to 180 days, lifetime maximum)
As Charged
Section C – Special Beneﬁts (Additional Limit On Top Of The Overall Annual Limit)
Accidental Death And Permanent Disablement
50,000
International Emergency Medical Evacuation
and Repatriation
Funeral Expenses (All Causes)
Section D - Optional
Deductible (Per Any One Disability)
Applicable for Section A Only
50,000 (maximum per annum)
2,000
Option A B C D
Deductible Amount 0 5,000 10,000 20,000
Premium Discount 0% 15% 30% 50%
4

Birthday
Annual Premium
Male Female Male Female Male Female Male Female Male Female
Age
Next
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Annual Premium (RM)
Plan 1
Plan 2
Plan 3
Plan 4
Plan 5
1,038 1,020 1,145 1,127 1,213 1,195 1,313 1,295 1,905 1,888
982
965 1,082 1,065 1,146 1,129 1,241 1,224 1,799 1,783
913
848
772
717
672
632
599
576
559
547
543
544
555
578
579
584
589
594
608
617
626
636
656
675
693
711
729
749
773
790
807
824
852
886
909
930
948
964
896 1,007 990 1,066 1,049 1,154 1,137 1,671 1,655
831 934 917
989
755 850 833
699 789 771
655 740 722
615 695 677
581 658 640
505 633 557
465 614 512
455 601 500
451 595 496
452 597 498
462 609 508
478 634 525
479 634 526
483 640 530
487 645 535
492 651 540
504 666 554
512 676 562
520 686 571
556 697 611
574 719 631
593 740 652
610 760 670
627 781 689
676 800 743
695 822 764
711 848 782
727 867 800
743 886 818
759 904 836
786 935 865
900
835
782
735
696
669
649
972 1,069 1,053 1,548 1,531
883 973
817 903
765 845
717 794
678 752
589 722
541 700
956 1,406 1,390
885 1,304 1,286
828 1,218 1,201
776 1,143 1,126
734 1,081 1,063
637 1,037 921
585 1,004 843
635 529 685 572
629 525 679 567
631 526 681 569
644 537 695 580
669
555 721
669
675
681
687
703
714
725
735
759
781
803
825
846
869
896
916
936
956
988
556 721
561 728
566 734
571 741
585 757
594 769
604 781
646 793
668 818
689 842
709 866
729 890
786 912
809 938
828 967
847 988
981
973
976
996
824
817
820
837
600 1,028 861
600 1,029 861
605 1,038 869
611 1,047 877
616 1,058 886
631 1,079 905
642 1,097 920
652 1,114 935
698 1,132 1,003
721 1,169 1,037
744 1,204 1,070
766 1,239 1,102
787 1,274 1,133
850 1,307 1,225
874 1,344 1,260
895 1,383 1,291
915 1,415 1,321
866 1,010 936 1,447 1,351
885 1,031 956 1,478 1,381
916 1,067 990 1,530 1,431
821 972 903 1,027 956 1,108 1,033 1,587 1,488
843 998 928 1,054 981 1,138 1,061 1,630 1,529
863 1,020 949 1,079 1,005 1,164 1,086 1,669 1,566
880 1,041 968 1,100 1,025 1,187 1,108 1,703 1,598
895 1,058 985 1,118 1,042 1,207 1,127 1,733 1,626
41 1,003 969 1,099 1,065 1,160 1,127 1,250 1,217 1,784 1,751
42 1,015 981 1,112 1,079 1,174 1,141 1,266 1,232 1,807 1,773
43 1,074 1,040 1,178 1,144 1,244 1,210 1,342 1,308 1,918 1,884
44 1,135 1,101 1,245 1,211 1,315 1,281 1,419 1,385 2,031 1,997
45 1,197 1,163 1,314 1,280 1,389 1,355 1,498 1,464 2,148 2,114
46 1,240 1,206 1,359 1,325 1,434 1,401 1,546 1,512 2,205 2,171
47 1,281 1,247 1,404 1,370 1,482 1,448 1,598 1,564 2,282 2,248
48 1,339 1,305 1,469 1,435 1,551 1,517 1,673 1,639 2,391 2,357
49 1,430 1,461 1,569 1,607 1,658 1,700 1,789 1,837 2,562 2,649
50 1,537 1,573 1,688 1,732 1,784 1,832 1,926 1,981 2,763 2,860
5

Age
Next
Birthday
Plan 1
Plan 2
Annual Premium (RM)
Plan 3
Plan 4
Plan 5
Male Female Male Female Male Female Male Female Male Female
51 1,657 1,686 1,815 1,852 1,916 1,958 2,064 2,114 2,944 3,037
52 1,748 1,781 1,916 1,958 2,023 2,070 2,181 2,236 3,114 3,216
53 1,864 1,904 2,044 2,093 2,160 2,214 2,329 2,392 3,332 3,445
54 2,011 2,058 2,207 2,264 2,333 2,396 2,517 2,590 3,608 3,735
55 2,194 2,251 2,410 2,478 2,548 2,623 2,751 2,836 3,952 4,097
56 2,601 2,436 2,854 2,676 3,015 2,829 3,252 3,054 4,654 4,387
57 2,891 2,580 3,174 2,835 3,355 2,998 3,622 3,238 5,198 4,657
58 3,121 2,788 3,430 3,065 3,626 3,243 3,916 3,504 5,630 5,047
59 3,387 3,028 3,724 3,332 3,940 3,525 4,256 3,811 6,129 5,498
60 3,690 3,301 4,059 3,634 4,295 3,846 4,642 4,159 6,695 6,009
61 4,157 3,707 4,563 4,073 4,822 4,306 5,203 4,650 7,458 6,682
62 4,526 4,039 4,971 4,440 5,256 4,696 5,674 5,073 8,151 7,304
63 4,922 4,397 5,410 4,837 5,721 5,117 6,180 5,531 8,893 7,975
64 5,357 4,791 5,892 5,273 6,234 5,581 6,736 6,034 9,710 8,715
65 5,849 5,237 6,438 5,767 6,813 6,106 7,365 6,604 10,633 9,551
66* 6,709 6,065 7,363 6,655 7,780 7,032 8,394 7,586 12,025 10,866
67* 7,191 6,504 7,896 7,141 8,346 7,548 9,009 8,146 12,929 11,688
68* 7,686 6,954 8,445 7,640 8,929 8,078 9,642 8,722 13,858 12,534
69* 8,192 7,416 9,006 8,151 9,525 8,621 10,289 9,312 14,809 13,400
70* 8,754 7,928 9,628 8,719 10,186 9,224 11,007 9,967 15,864 14,361
71* 9,708 8,791 10,639 9,634 11,234 10,172 12,109 10,964 17,283 15,649
72* 10,250 9,285 11,240 10,181 11,871 10,753 12,801 11,595 18,301 16,576
73* 10,802 9,789 11,852 10,740 12,521 11,346 13,507 12,239 19,338 17,523
74* 11,366 10,303 12,476 11,310 13,185 11,952 14,228 12,897 20,397 18,489
75* 11,990 10,874 13,168 11,942 13,920 12,624 15,026 13,627 21,570 19,561
76* 13,322 11,959 14,562 13,084 15,354 13,802 16,520 14,860 23,414 21,114
77* 13,915 12,503 15,220 13,687 16,053 14,443 17,279 15,555 24,530 22,136
78* 14,520 13,056 15,890 14,301 16,764 15,095 18,052 16,263 25,667 23,177
79* 15,135 13,621 16,572 14,926 17,489 15,759 18,839 16,985 26,824 24,238
80* 15,823 14,254 17,335 15,627 18,300 16,504 19,720 17,794 28,119 25,427
81* 16,460 14,839 18,040 16,276 19,049 17,193 20,534 18,542 29,317 26,527
82* 17,107 15,434 18,758 16,936 19,811 17,894 21,362 19,304 30,534 27,647
83* 17,765 16,040 19,487 17,607 20,586 18,607 22,203 20,078 31,771 28,785
84* 18,432 16,655 20,226 18,288 21,371 19,330 23,056 20,865 33,026 29,941
85* 19,186 17,351 21,062 19,059 22,259 20,150 24,021 21,755 34,445 31,249
86* 19,873 17,985 21,823 19,762 23,068 20,897 24,900 22,566 35,738 32,442
87* 20,569 18,629 22,595 20,475 23,887 21,654 25,790 23,389 37,047 33,651
88* 21,274 19,281 23,376 21,199 24,718 22,422 26,692 24,223 38,373 34,878
89* 21,989 19,943 24,168 21,932 25,559 23,201 27,606 25,070 39,717 36,122
90* 22,807 20,702 25,075 22,773 26,523 24,095 28,653 26,040 41,257 37,548
91* 23,539 21,381 25,886 23,525 27,384 24,894 29,589 26,908 42,633 38,824
92* 24,279 22,069 26,706 24,287 28,255 25,704 30,536 27,788 44,025 40,117
93* 25,027 22,765 27,536 25,059 29,137 26,523 31,493 28,678 45,433 41,426
94* 25,783 23,469 28,373 25,839 30,027 27,351 32,460 29,578 46,855 42,748
95* 26,664 24,290 29,349 26,748 31,064 28,318 33,587 30,628 48,512 44,292
96* 27,435 25,009 30,204 27,545 31,971 29,165 34,573 31,547 49,962 45,643
97* 28,298 25,737 31,160 28,352 32,987 30,021 35,675 32,478 51,580 47,012
98* 29,185 26,471 32,143 29,166 34,030 30,886 36,809 33,418 53,244 48,393
99* 30,087 27,214 33,141 29,989 35,091 31,760 37,960 34,367 54,935 49,788
100* 31,004 27,964 34,157 30,820 36,169 32,643 39,131 35,326 56,654 51,198
*On renewal basis only
6

Note:
• The annual premiums shown in the table above are applicable to standard risks and occupation classes
1 and 2 only. For occupation class 3, 15% loading is applicable.
• The total premium payable will vary depending on the occupational class, health condition and the plan
selected you have selected.
• Premiums are payable at the premium rate according to your age next birthday on each policy year
anniversary.
• The company reserves the right to change the rate at which premium shall be calculated, at the start of
any policy year, provided that policyholders are notified at least thirty (30) days in advance of the date
such premium is due.
• All policies may be subject to 6% Sales and Service Tax (SST) and RM10 Stamp Duty.
Frequently Asked Questions
Q. What is Z-MedProtect?
A. Z-MedProtect is a yearly-renewal medical insurance policy with comprehensive coverage for
hospitalisation and surgical expenses incurred due to illnesses. It also provides coverage for bodily
injuries, disablement or death.
Q. Who is eligible for Z-MedProtect?
A. Anyone between 30 days old and 65 years old (age next birthday) are eligible to purchase
Z-MedProtect. This product is renewable up to 100 years old (age next birthday).
Q. What are the available plans to choose from?
A. Z-MedProtect is available in 5 plans. You have the flexibility to choose the plan that suits your health
care needs and budget.
Q. How long is the coverage duration of Z-MedProtect?
A. The duration of cover is one (1) year, you will need to renew your policy annually.
Q. How does the Deductible works in Z-MedProtect?
A. The deductible is a monetary sum that shall be deducted from the eligible expenses incurred under
Section A on per any one disability basis when you are admitted to any private hospital. However, the
eligible expenses incurred will not be subject to the deductible amount if you are admitted to any
Malaysian government hospital.
It is an optional benefit in Z-MedProtect. By enabling the Deductible, you will enjoy a premium
discount up to 50% on your total premium, depending on the option you selected.
Q. Can a foreigner purchase Z-MedProtect?
A. Z-MedProtect is open to any Malaysian, or any foreigner who has a valid work permit, student permit,
permanent resident status or Malaysia My Second Home (MM2H) status.
7

Q. Can I purchase Z-MedProtect for my whole family?
A. Yes, you can purchase Z-MedProtect for your parents, spouse or children.
Depending on the number of family members you would like to include, you are entitled to Multiple
Insured Person Discount up to 10% of your total premium.
The policy will be issued as a group family policy. However, the premium will be charged individually
with one-time stamp duty fee.
Q. How do you classify Occupation?
A. Occupations are classified into 3 classes as follows:
Occupation Class 1
Persons engaged in professional administrative, managerial, clerical and non-manual occupations
Occupation Class 2
Persons engaged in work of supervisory nature but not involved in manual labour
Occupation Class 3
Persons engaged either occasionally or generally in manual work which involves the use at tools or
machinery
Q. What are the key terms and conditions that I should be aware of?
A. Portfolio Withdrawal - The company reserves the right to cancel the portfolio as a whole if the
company decides to discontinue underwriting this insurance product. Cancellation of the portfolio as a
whole shall be given by reasonable written notice in advance with valid reasons to you and the
company will run off all policies to expiry of the period of cover within the portfolio.
Co-payment (Sub-standard policy only) - Co-payment borne by you under cost-sharing or
coinsurance terms shall not exceed twenty percent (20%) of the claimable expenses (i.e. excluding
Deductibles) per Disability, subject to an absolute maximum limit of Ringgit Malaysia Three Thousand
(RM3,000) (inclusive of Deductibles) per Disability.
Note: Please refer to the policy wording for full list of terms and conditions under this product.
8

Exclusions
This product does not cover any hospitalisation, surgery or charges incurred directly or indirectly, wholly or
partly, by any one (1) of the following occurrences:
Section A - Inpatient & Daycare Benefits and
Section B - Outpatient Benefits
1. Pre-existing condition
2. Specified illnesses occurring during the first one hundred and twenty (120) days of continuous cover
3. Waiting period of thirty (30) days for all except accidental injuries
4. Pregnancy, childbirth (including surgical delivery), miscarriage, abortion and prenatal or postnatal care
5. Epidemic and/or pandemic
Section C – Special Benefits
1. Pre-existing condition
2. War, civil war
3. Suicide while sane or insane
4. Provoked murder or assault
Note: This exclusion list is not exhaustive. Please refer to the policy wording for the full list of exclusions
under this product.
Important Notes
1. The brochure is for illustrative purposes only. For further details of terms and conditions, please refer
to product disclosure sheet and policy wording.
2. You should satisfy yourself that this policy best serves your needs and the premium payable under
the policy is an amount you can afford.
3. You may cancel your policy by returning the policy to us within fifteen (15) days after the policy has
been delivered to you. The premium that you have paid (after deducting any medical expenses
incurred) will be refunded to you provided there is no claim incurred on the policy.
4. The premium for this product is not guaranteed and shall be based on the premium rates in-force at
the time of renewal.
5. No benefit is payable for any medical treatment received by insured person outside Malaysia if the
insured person resides or travels outside Malaysia for more than ninety (90) consecutive days.
6. All premiums and fees shown may be subject to tax or other government levies.
For more information and assistance on Z-MedProtect, please contact our agents or Zurich Call Centre at
1-300-888-622 or email us at <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS>
In the event of discrepancy, ambiguity and conflict in interpreting any terms or conditions, the English
version shall prevail and supersede the Bahasa Malaysia version.
9

Utamakan penyembuhan anda,
kami akan menjaga yang lain!
Penyakit dan kemalangan adalah sebahagian daripada hidup kita. Tiada sesiapa pun yang
boleh menyediakan pencegahan yang sempurna untuk kecelakaan, dan perkara terakhir yang
anda perlu risaukan adalah kos yang harus ditanggung sekiranya berlaku sebarang kejadian
yang tidak diingini.
Caj penghospitalan, rawatan pembedahan, ubat-ubatan, pemeriksaan kesihatan dan yuran
perundingan perubatan boleh menjadi sebuah bebanan untuk ramai individu jika semua kos
tersebut digabungkan. Kenaikan kos perubatan tidak boleh dielakkan, oleh itu amat
digalakkan untuk anda mencari sebuah penyelesaian untuk mengurangkan kerisauan yang
timbul disebabkan oleh bebanan kewangan.
Di Zurich, kami mendengar keluhan anda dan telah menghasilkan sebuah pelan insurans
perubatan komprehensif yang boleh diperbaharui setiap tahun, Z-MedProtect. Pelan ini
merangkumi bil perubatan anda supaya anda dan insan tersayang tidak perlu mengharungi
bebanan kewangan dan boleh mendapat ketenangan minda yang berterusan.
Jangan risau!
Kami akan melindungi anda!
Had Tahunan Keseluruhan Yang Tinggi, Tiada Had Seumur Hidup
Nikmati Had Tahunan Keseluruhan yang tinggi sehingga RM2,000,000
untuk membantu anda mengharungi setiap keperluan penjagaan kesihatan
anda.
Pelan Yang Fleksibel dan Boleh Disesuaikan
Keperluan setiap individu adalah berbeza, jadi pilih mana-mana daripada 5
pelan yang ditawarkan untuk mendapat manfaat dan kadar premium yang
memenuhi keperluan dan kemampuan anda.
Pembaharuan Dijamin Sehingga 100 Tahun
Nikmati ganjaran hidup yang baik dengan liputan perlindungan yang
berterusan sehingga usia emas anda.
Pilihan Penolakan (Terpakai untuk Seksyen A – Manfaat Pesakit
Dalam & Pembedahan Harian)
Fleksibiliti untuk memilih daripada 4 Pilihan Penolakan untuk mengurus kos
perbelanjaan perubatan anda dan nikmati diskaun premium sehingga 50%.
10
9000

Bonus Tanpa Tuntutan
Amat berbaloi jika anda kekal sihat! Dapatkan 10% diskaun atas premium
untuk polisi pembaharuan anda yang seterusnya jika anda tidak memfailkan
tuntutan pada tahun yang sebelumnya.
Diskaun Berkumpulan Orang Yang Diinsuranskan
Kami memahami bahawa anda perlu menyara dan menjaga insan tersayang.
Oleh itu, nikmati sehingga 10% diskaun atas premium apabila ibu bapa,
pasangan atau anak anda diinsuranskan dalam polisi yang sama!
Lawatan Pakar Perubatan Dalam Hospital Tanpa Had
Dapatkan penjagaan ekstensif daripada pakar perubatan dalam hospital
semasa perjalanan pemulihan anda.
Pendapat Kedua untuk Pembedahan
Dalam sesetengah kes, mungkin terdapat keperluan untuk anda mencari pakar
perubatan yang lain untuk mendapatkan pendapat kedua sebelum
pembedahan. Untuk menenangkan fikiran anda, kami akan membayar balik
yuran yang dikenakan untuk konsultasi tersebut.
Transplan Organ
Kami akan membayar balik yuran yang dikenakan untuk pembedahan
transplan jika anda merupakan penerima organ Hati, Buah Pinggang,
Jantung, Paru-paru atau Sum-sum Tulang.
Kemasukan Ke Hospital Yang Mudah
Dalam kecemasan, anda hanya perlu menunjukkan kad perubatan atau e-kad
perubatan anda untuk kemasukan ke hospital serta perkhidmatan perubatan
secara segera di mana-mana hospital panel kami seluruh negara.
Manfaat Kematian atau Hilang Upaya Kekal Akibat Kemalangan
Keselamatan kewangan yang ekstra dengan penambahan RM50,000 atas
Had Tahunan Keseluruhan jika berlakunya Kematian atau Hilang Upaya
Kekal Akibat Kemalangan.
Perbelanjaan Pengebumian
Menyediakan pembayaran sekali gus sebanyak RM2,000 kepada insan
tersayang untuk membantu dengan pembayaran terakhir anda. Ini adalah
supaya tiada bebanan ditinggalkan kepada insan tersayang apabila anda sudah
tiada untuk menyara hidup mereka.
11
e
6)
:
©
gta
faye
©
Q
o-
o
©
Ie

Jadual Manfaat
Z-MedProtect boleh didapati dalam 5 pelan yang disediakan mengikut keperluan dan
kemampuan yang berbeza.
Di bawah menunjukkan jadual manfaat yang penuh untuk setiap pelan:
Manfaat
Pelan 1 Pelan 2 Pelan 3 Pelan 4 Pelan 5
Had (RM)
Had Tahunan Keseluruhan
(untuk Seksyen A dan Seksyen B)
Bonus Tanpa Tuntutan
100,000 300,000 500,000 1,000,000 2,000,000
Pengurangan 10% atas premium pembaharuan
(jika tiada tuntutan dibuat)
Seksyen A - Manfaat Pesakit Dalam & Pembedahan Harian
Bilik Hospital dan Makanan
Unit Rawatan Rapi
100 150 180 200
(maksimum 365 hari setahun)
Bayaran Dikenakan (maksimum 180 hari setahun)
Bekalan dan Khidmat Hospital
Prosedur Pembedahan Harian
Bayaran Pembedahan
Bayaran Pakar Bius
Bayaran Bilik Bedah
Lawatan Pakar Perubatan Dalam Hospital
(tidak terhad)
Bayaran Ambulans
Elaun Tunai Harian Di Hospital Kerajaan
Manfaat Penjagaan Harian Anak Orang Yang
Diinsuranskan
Bayaran Laporan Perubatan
Transplan Organ (Hati, Buah Pinggang, Jantung,
Paru-paru atau Sum-sum Tulang)
Cukai Ke Atas Perbelanjaan Layak
Bayaran Dikenakan
Bayaran Dikenakan
Bayaran Dikenakan
Bayaran Dikenakan
Bayaran Dikenakan
Bayaran Dikenakan
Bayaran Dikenakan
100 (maksimum 365 hari setahun)
250 (maksimum setiap hilang upaya)
150
Bayaran Dikenakan
Bayaran Dikenakan
500
12

Manfaat
Pelan 1 Pelan 2 Pelan 3 Pelan 4 Pelan 5
Had (RM)
Seksyen B – Manfaat Pesakit Luar
Ujian Diagnostik Prahospital
Rundingan Pakar Prahospital
Rawatan Selepas Penghospitalan
Rawatan Pesakit Luar Bagi Kemalangan
Secara Kecemasan
Rawatan Fisioterapi Pesakit Luar
Rawatan Dialisis Buah Pinggang Pesakit Luar
Rawatan Kanser Pesakit Luar
Rawatan Pergigian Pesakit Luar Bagi
Kemalangan Secara Kecemasan
Penjagaan Kejururawatan Di Rumah
Rundingan Pembedahan Pendapat Kedua
Bayaran Dikenakan
(dalam masa 60 hari sebelum penghospitalan)
Bayaran Dikenakan
(dalam masa 60 hari sebelum penghospitalan)
Bayaran Dikenakan
(dalam masa 90 hari dari penghospitalan)
Bayaran Dikenakan (dalam masa 24 jam dan
rawatan susulan sehingga maksimum 60 hari)
Bayaran Dikenakan
(dalam masa 90 hari dari tarikh keluar)
Bayaran Dikenakan
Bayaran Dikenakan
4,000 (setiap kemalangan)
4,000 (sehingga 180 hari, maksimum seumur hidup)
Bayaran Dikenakan
Seksyen C – Manfaat Khas (Had tambahan di atas Had Tahunan Keseluruhan)
Kematian dan Hilang Upaya Kekal Akibat
Kemalangan
Pemindahan Kecemasan Perubatan dan
Penghantaran Pulang Antarabangsa
Perbelanjaan Pengebumian (semua sebab)
Seksyen D – Pilihan
Penolakan (setiap Mana-mana Satu Hilang
Upaya) (terpakai untuk Seksyen A sahaja)
50,000
50,000 (maksimum setahun)
2,000
Pilihan A B C D
Jumlah Penolakan 0 5,000 10,000 20,000
Diskaun Premium 0% 15% 30% 50%
13

Premium Tahunan
Umur
Pada
Tarikh
Lahir
Berikutnya
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Pelan 1
Pelan 2
Premium Tahunan (RM)
Pelan 3
Pelan 4
Pelan 5
Lelaki Perempuan Lelaki Perempuan Lelaki Perempuan Lelaki Perempuan Lelaki Perempuan
1,038 1,020 1,145 1,127 1,213 1,195 1,313 1,295 1,905 1,888
982
913
848
772
717
672
632
599
576
559
547
543
544
555
578
579
584
589
594
608
617
626
636
656
675
693
711
729
749
773
790
807
824
852
886
909
930
948
964
965 1,082 1,065 1,146 1,129 1,241 1,224 1,799 1,783
896 1,007 990 1,066 1,049 1,154 1,137 1,671 1,655
831 934 917
755 850 833
699 789 771
655 740 722
615 695 677
581 658 640
505 633 557
465 614 512
455 601 500
451 595 496
452 597 498
462 609 508
478 634 525
479 634 526
483 640 530
487 645 535
492 651 540
504 666 554
512 676 562
520 686 571
556 697 611
574 719 631
593 740 652
610 760 670
627 781 689
676 800 743
695 822 764
711 848 782
727 867 800
743 886 818
759 904 836
786 935 865
989
900
835
782
735
696
669
649
972 1,069 1,053 1,548 1,531
883 973
956 1,406 1,390
817 903
765 845
717 794
678 752
589 722
541 700
885 1,304 1,286
828 1,218 1,201
776 1,143 1,126
734 1,081 1,063
637 1,037 921
585 1,004 843
635 529 685 572
629 525 679 567
631 526 681 569
644 537 695 580
669
555 721
669
675
681
687
703
714
725
735
759
781
803
825
846
869
896
916
936
956
988
556 721
561 728
566 734
571 741
585 757
594 769
604 781
646 793
668 818
689 842
709 866
729 890
786 912
809 938
828 967
847 988
981
973
976
996
824
817
820
837
600 1,028 861
600 1,029 861
605 1,038 869
611 1,047 877
616 1,058 886
631 1,079 905
642 1,097 920
652 1,114 935
698 1,132 1,003
721 1,169 1,037
744 1,204 1,070
766 1,239 1,102
787 1,274 1,133
850 1,307 1,225
874 1,344 1,260
895 1,383 1,291
915 1,415 1,321
866 1,010 936 1,447 1,351
885 1,031 956 1,478 1,381
916 1,067 990 1,530 1,431
821 972 903 1,027 956 1,108 1,033 1,587 1,488
843 998 928 1,054 981 1,138 1,061 1,630 1,529
863 1,020 949 1,079 1,005 1,164 1,086 1,669 1,566
880 1,041 968 1,100 1,025 1,187 1,108 1,703 1,598
895 1,058 985 1,118 1,042 1,207 1,127 1,733 1,626
41 1,003 969 1,099 1,065 1,160 1,127 1,250 1,217 1,784 1,751
42 1,015 981 1,112 1,079 1,174 1,141 1,266 1,232 1,807 1,773
43 1,074 1,040 1,178 1,144 1,244 1,210 1,342 1,308 1,918 1,884
44 1,135 1,101 1,245 1,211 1,315 1,281 1,419 1,385 2,031 1,997
45 1,197 1,163 1,314 1,280 1,389 1,355 1,498 1,464 2,148 2,114
46 1,240 1,206 1,359 1,325 1,434 1,401 1,546 1,512 2,205 2,171
47 1,281 1,247 1,404 1,370 1,482 1,448 1,598 1,564 2,282 2,248
48 1,339 1,305 1,469 1,435 1,551 1,517 1,673 1,639 2,391 2,357
49 1,430 1,461 1,569 1,607 1,658 1,700 1,789 1,837 2,562 2,649
50 1,537 1,573 1,688 1,732 1,784 1,832 1,926 1,981 2,763 2,860
14

Umur
Pada
Tarikh
Lahir
Pelan 1
Pelan 2
Premium Tahunan (RM)
Pelan 3
Pelan 4
Pelan 5
Berikutnya Lelaki Perempuan Lelaki Perempuan Lelaki Perempuan Lelaki Perempuan Lelaki Perempuan
51 1,657 1,686 1,815 1,852 1,916 1,958 2,064 2,114 2,944 3,037
52 1,748 1,781 1,916 1,958 2,023 2,070 2,181 2,236 3,114 3,216
53 1,864 1,904 2,044 2,093 2,160 2,214 2,329 2,392 3,332 3,445
54 2,011 2,058 2,207 2,264 2,333 2,396 2,517 2,590 3,608 3,735
55 2,194 2,251 2,410 2,478 2,548 2,623 2,751 2,836 3,952 4,097
56 2,601 2,436 2,854 2,676 3,015 2,829 3,252 3,054 4,654 4,387
57 2,891 2,580 3,174 2,835 3,355 2,998 3,622 3,238 5,198 4,657
58 3,121 2,788 3,430 3,065 3,626 3,243 3,916 3,504 5,630 5,047
59 3,387 3,028 3,724 3,332 3,940 3,525 4,256 3,811 6,129 5,498
60 3,690 3,301 4,059 3,634 4,295 3,846 4,642 4,159 6,695 6,009
61 4,157 3,707 4,563 4,073 4,822 4,306 5,203 4,650 7,458 6,682
62 4,526 4,039 4,971 4,440 5,256 4,696 5,674 5,073 8,151 7,304
63 4,922 4,397 5,410 4,837 5,721 5,117 6,180 5,531 8,893 7,975
64 5,357 4,791 5,892 5,273 6,234 5,581 6,736 6,034 9,710 8,715
65 5,849 5,237 6,438 5,767 6,813 6,106 7,365 6,604 10,633 9,551
66* 6,709 6,065 7,363 6,655 7,780 7,032 8,394 7,586 12,025 10,866
67* 7,191 6,504 7,896 7,141 8,346 7,548 9,009 8,146 12,929 11,688
68* 7,686 6,954 8,445 7,640 8,929 8,078 9,642 8,722 13,858 12,534
69* 8,192 7,416 9,006 8,151 9,525 8,621 10,289 9,312 14,809 13,400
70* 8,754 7,928 9,628 8,719 10,186 9,224 11,007 9,967 15,864 14,361
71* 9,708 8,791 10,639 9,634 11,234 10,172 12,109 10,964 17,283 15,649
72* 10,250 9,285 11,240 10,181 11,871 10,753 12,801 11,595 18,301 16,576
73* 10,802 9,789 11,852 10,740 12,521 11,346 13,507 12,239 19,338 17,523
74* 11,366 10,303 12,476 11,310 13,185 11,952 14,228 12,897 20,397 18,489
75* 11,990 10,874 13,168 11,942 13,920 12,624 15,026 13,627 21,570 19,561
76* 13,322 11,959 14,562 13,084 15,354 13,802 16,520 14,860 23,414 21,114
77* 13,915 12,503 15,220 13,687 16,053 14,443 17,279 15,555 24,530 22,136
78* 14,520 13,056 15,890 14,301 16,764 15,095 18,052 16,263 25,667 23,177
79* 15,135 13,621 16,572 14,926 17,489 15,759 18,839 16,985 26,824 24,238
80* 15,823 14,254 17,335 15,627 18,300 16,504 19,720 17,794 28,119 25,427
81* 16,460 14,839 18,040 16,276 19,049 17,193 20,534 18,542 29,317 26,527
82* 17,107 15,434 18,758 16,936 19,811 17,894 21,362 19,304 30,534 27,647
83* 17,765 16,040 19,487 17,607 20,586 18,607 22,203 20,078 31,771 28,785
84* 18,432 16,655 20,226 18,288 21,371 19,330 23,056 20,865 33,026 29,941
85* 19,186 17,351 21,062 19,059 22,259 20,150 24,021 21,755 34,445 31,249
86* 19,873 17,985 21,823 19,762 23,068 20,897 24,900 22,566 35,738 32,442
87* 20,569 18,629 22,595 20,475 23,887 21,654 25,790 23,389 37,047 33,651
88* 21,274 19,281 23,376 21,199 24,718 22,422 26,692 24,223 38,373 34,878
89* 21,989 19,943 24,168 21,932 25,559 23,201 27,606 25,070 39,717 36,122
90* 22,807 20,702 25,075 22,773 26,523 24,095 28,653 26,040 41,257 37,548
91* 23,539 21,381 25,886 23,525 27,384 24,894 29,589 26,908 42,633 38,824
92* 24,279 22,069 26,706 24,287 28,255 25,704 30,536 27,788 44,025 40,117
93* 25,027 22,765 27,536 25,059 29,137 26,523 31,493 28,678 45,433 41,426
94* 25,783 23,469 28,373 25,839 30,027 27,351 32,460 29,578 46,855 42,748
95* 26,664 24,290 29,349 26,748 31,064 28,318 33,587 30,628 48,512 44,292
96* 27,435 25,009 30,204 27,545 31,971 29,165 34,573 31,547 49,962 45,643
97* 28,298 25,737 31,160 28,352 32,987 30,021 35,675 32,478 51,580 47,012
98* 29,185 26,471 32,143 29,166 34,030 30,886 36,809 33,418 53,244 48,393
99* 30,087 27,214 33,141 29,989 35,091 31,760 37,960 34,367 54,935 49,788
100* 31,004 27,964 34,157 30,820 36,169 32,643 39,131 35,326 56,654 51,198
*Berdasarkan pembaharuan sahaja
15

Nota:
• Premium tahunan yang dicatatkan dalam jadual di atas hanya terpakai untuk risiko yang standard dan
kelas pekerjaan 1 dan 2 sahaja. Untuk kelas pekerjaan 3, bebanan 15% akan dikenakan.
• Jumlah premium yang perlu dibayar mungkin berbeza bergantung kepada kelas pekerjaan, keadaan
kesihatan serta pelan yang anda pilih.
• Premium yang perlu dibayar adalah pada kadar premium mengikut umur anda pada tarikh lahir yang
berikutnya pada setiap ulangtahun tahun polisi.
• Kami berhak untuk mengubah kadar pada mana premium dikira pada permulaan mana-mana tahun
polisi, dengan syarat bahawa pemilik polisi akan dimaklumkan sekurang-kurangnya tiga puluh (30) hari
sebelum tarikh premium tersebut perlu dibayar.
• Semua polisi mungkin tertakluk kepada 6% Cukai Jualan dan Perkhidmatan (SST) serta RM10 Duti
Setem.
Soalan Lazim
S. Apakah Z-MedProtect?
J. Z-MedProtect adalah polisi insurans perubatan yang boleh diperbaharui setiap tahun dengan liputan
perlindungan komprehensif untuk perbelanjaan penghospitalan dan pembedahan yang disebabkan
oleh penyakit. Polisi ini juga menyediakan perlindungan untuk kecederaan, hilang upaya serta
kematian.
S. Siapakah yang layak untuk Z-MedProtect?
J. Sesiapa yang berumur antara 30 hari dan 65 tahun (umur tarikh lahir yang seterusnya) adalah layak
untuk membeli Z-MedProtect. Produk ini boleh diperbaharui sehingga umur 100 tahun (umur tarikh
lahir yang seterusnya).
S. Apakah antara pelan yang ditawarkan?
J. Z-MedProtect ditawarkan dalam 5 pelan. Anda mempunyai fleksibiliti untuk memilih pelan yang
bersesuaian dengan keperluan kesihatan dan kemampuan anda.
S. Berapa lamakah liputan perlindungan Z-MedProtect?
J. Liputan perlindungan disediakan untuk satu (1) tahun. Anda perlu memperbaharui polisi anda setiap
tahun.
S. Apakah fungsi Penolakan dalam Z-MedProtect?
J. Penolakan merupakan sebuah jumlah kewangan yang akan ditolak daripada perbelanjaan layak yang
dikenakan di bawah Seksyen A untuk setiap mana-mana satu hilang upaya apabila anda dimasukkan
ke mana-mana hospital swasta. Walau bagaimanapun, penolakan tidak akan diguna pakai untuk
perbelanjaan layak yang dikenakan apabila anda dimasukkan ke mana-mana hospital kerajaan
Malaysia.
Penolakan adalah manfaat pilihan dalam Z-MedProtect. Dengan memilih Penolakan, anda akan
nikmati diskaun atas jumlah premium anda sehingga 50%, bergantung kepada pilihan anda.
S. Bolehkah bukan warga negara Malaysia membeli Z-MedProtect?
J. Z-MedProtect ditawarkan kepada semua warga Malaysia atau mana-mana bukan warga negara
Malaysia yang mempunyai permit pekerjaan yang sah, permit pelajar, berstatus pemastautin tetap
atau status Malaysia Rumah Keduaku (MM2H).
16

S. Bolehkah saya membeli Z-MedProtect untuk seluruh keluarga?
J. Ya, anda boleh membeli Z-MedProtect untuk ibu bapa, pasangan atau anak anda.
Bergantung kepada bilangan ahli keluarga yang anda ingin lindungi, anda layak untuk Diskaun
Berkumpulan Orang Yang Diinsuranskan sehingga 10% daripada jumlah premium anda.
Polisi anda akan dikeluarkan sebagai sebuah polisi keluarga berkumpulan. Walau bagaimanapun,
premium akan dikenakan secara individu dengan bayaran duti setem hanya sekali.
S. Bagaimanakah anda mengklasifikasikan Pekerjaan?
J.
Pekerjaan diklasifikasikan dalam 3 kelas seperti berikut:
Kelas Pekerjaan 1
Orang yang terlibat dalam pentadbiran, pengurusan, perkeranian dan pekerjaan bukan manual
Kelas Pekerjaan 2
Orang yang terlibat dalam kerja penyeliaan tetapi tidak terlibat dalam kerja manual
Kelas Pekerjaan 3
Orang yang terlibat sama ada secara sambilan atau secara amnya dalam kerja manual yang
melibatkan penggunaan alatan atau mesin
S. Apakah terma dan syarat utama yang perlu saya ketahui?
J. Penarikan Balik Portfolio - Kami berhak membatalkan portfolio secara keseluruhan jika kami
memutuskan untuk menghentikan produk insurans ini. Pembatalan portfolio secara keseluruhan akan
diberitahu melalui notis bertulis yang munasabah terlebih dahulu dengan alasan yang sah kepada
anda dan kami akan menanggung semua polisi hingga ke tarikh tamat tempoh perlindungan dalam
portfolio.
Bayaran Bersama (Polisi sub-standard sahaja) - Bayaran Bersama ditanggung oleh anda dengan
syarat perkongsian kos atau terma insurans bersama tidak boleh melebihi dua puluh peratus (20%)
daripada perbelanjaan yang boleh dituntut (tidak termasuk Penolakan) bagi setiap Hilang Upaya,
tertakluk kepada had maksimum mutlak Ringgit Malaysia Tiga Ribu (RM 3,000) (termasuk Penolakan)
untuk setiap Hilang Upaya.
Nota: Sila rujuk kepada kontrak polisi untuk terma dan syarat yang penuh di bawah produk ini.
17

Pengecualian
Produk ini tidak melindungi mana-mana penghospitalan, pembedahan atau bayaran yang disebabkan
secara langsung atau tidak langsung, sepenuhnya atau sebahagiannya, oleh mana-mana satu (1) kejadian
yang berikut:
Seksyen A – Manfaat Pesakit Dalam & Pembedahan Harian dan
Seksyen B – Manfaat Pesakit Luar
1. Penyakit sedia ada
2. Penyakit tertentu yang berlaku dalam tempoh seratus dua puluh (120) hari pertama perlindungan
berterusan
3. Tempoh tangguh tiga puluh (30) hari untuk semua kecuali kecederaan kemalangan
4. Kehamilan, melahirkan anak (termasuk kelahiran secara pembedahan), keguguran, menggugurkan
kandungan dan jagaan serta pembedahan pranatal atau posnatum
5. Wabak dan/atau pandemik
Seksyen C – Manfaat Khas
1. Penyakit sedia ada
2. Peperangan, perang saudara
3. Bunuh diri sama ada dalam keadaan siuman atau tidak siuman
4. Pembunuhan atau serangan disebabkan provokasi
Nota: Senarai ini adalah tidak menyeluruh. Sila rujuk kepada kontrak polisi untuk senarai menyeluruh
pengecualian yang terdapat dalam produk ini.
Nota Penting
1. Risalah ini adalah untuk tujuan ilustrasi sahaja. Untuk maklumat lanjut mengenai terma dan syarat,
sila rujuk kepada lembaran pendedahan produk atau kontrak polisi.
2. Anda harus memastikan bahawa polisi ini memenuhi keperluan anda dan jumlah premium yang
perlu dibayar adalah sesuai dengan kemampuan anda.
3. Anda boleh membatalkan polisi anda dengan memulangkan polisi dalam masa lima belas (15) hari
selepas anda menerima polisi tersebut. Premium yang telah dibayar akan dikembalikan kepada anda
dengan syarat tiada tuntutan dilakukan atas polisi tersebut.
4. Premium untuk produk ini tidak dijamin dan akan berdasarkan kepada kadar premium yang dikuat
kuasa pada masa pembaharuan.
5. Tiada manfaat akan dibayar untuk sebarang rawatan perubatan yang diterima oleh Orang Yang
Diinsuranskan di luar Malaysia jika Orang Yang Diinsuranskan tinggal atau melakukan perjalanan di
luar Malaysia untuk lebih daripada sembilan puluh (90) hari yang berterusan.
6. Semua premium dan yuran mungkin tertakluk kepada cukai atau levi kerajaan yang lain.
Untuk maklumat lanjut dan bantuan mengenai Z-MedProtect, sila hubungi ejen kami atau Pusat
Khidmat Pelanggan Zurich di 1-300-888-622 atau emel kami di <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS>
Sekiranya terdapat percanggahan, kekaburan dan konflik dalam pentafsiran sebarang terma atau syarat,
versi Bahasa Inggeris akan diguna pakai dan menggantikan versi Bahasa Malaysia.
18

Zurich General Insurance Malaysia Berhad
Registration No. 201701035345 (1249516-V)
Level 23A, Mercu 3, No. 3, Jalan Bangsar, KL Eco City,
59200 Kuala Lumpur, Malaysia
Tel: 03-2109 6000 Fax: 03-2109 6888 Call Centre: 1-300-888-622
www.zurich.com.my
@
zurich @ ncn
3551/1/P/G/B/M
The trademarks depicted are registered in the name of
Zurich Insurance Company Ltd in many jurisdictions worldwide
Z U RI C H :


Page # 1
Zurich Life Insurance Malaysia Berhad
Registration No. 196801000442 (8029-A)

Level 23A, Mercu 3

No. 3, Jalan Bangsar, KL Eco City,

59200 Kuala Lumpur, Malaysia.

Tel: 03-2109 6000 Fax: 03-2109 6888

Call Centre: 1-300-888-622 —www.zurich.com.my

 

 

@

zurich’ @ zurich

sser/ueiuan ZURICH

GB ZURICH

Zurich iCare Medic

Big journeys begin with small steps. Start here.

 


Page # 2
 


Page # 3
Zurich iCare Medic

Provides Just What You Need

 

Worry not about having cash on hand. Just show your medical
card at any one of our panel hospitals for a hassle-free
admission. We will ease your worries with necessary
coverage, including cashless claims.

 

 
      
 
 
       

  

Covid-19 Coverage

If you contract Covid-19 or experience Covid-19 vaccination
side effects, you are well covered for hospitalisation admission.’

Affordable Premium with

Long-Term Protection

Get protected and enjoy medical coverage with no lifetime
limit up to L00 years of age. No excuses for not living your life
to the fullest.

 
       
       
 

Enjoy More Savings

Your medical bills are well taken care of. Have your
Deductibles waived so that you can focus on recovering
whilst enjoying Daily Cash Allowance of RM180 if you are
admitted into a government hospital.

Compassionate Benefit

In the event of death of the Life Assured, your family will
receive RM10,000 to assist them with funeral expenses.

 

Enjoy the option of upgrading your plan to a new medical plan
after 5 years and enhance your benefits in the future with a more
comprehensive medical protection. No medical underwriting
required and is subject to terms and conditions. A

 

Note:

‘Life Assured must be vaccinated with at least 2 doses of vaccine approved
by local authority to be entitled for this benefit [except for Life Assured
age 4 years and below.]

 


Page # 4
    

Schedule of Benefits

Annual Limit
(for In-Patient Benefits, Out-Patient Benefits plus
Other Benefits)
Lifetime Limit
Deductible (amount per Policy Year)
In-Patient Benefits
1. Daily Hospital Room & Board
(limit per day, unlimited number of days)
2. Daily Cash Allowance at Government Hospital
(limit per day, unlimited number of days)
3. Intensive Care Unit or High Dependency Unit
(maximum 120 days per Policy Year)
Hospital Supplies & Services
Surgical Fees
Anaesthetist Fees
Operating Theatre Fees
Ambulance Fees
Pre-Hospitalisation Diagnostic Tests
(within 90 days prior to Hospitalisation)
+ Diagnostic Tests
+ Specialist / General Practitioner Consultation
+ Medication and Treatment
10. In-Hospital Specialist Visit
* Surgical — unlimited number of visits
+ Non-surgical — max 2 visits / day
11. Post-Hospitalisation Treatment
(within 180 days after discharge)
+ Diagnostic Tests
+ Specialist Consultation
+ Medication and Treatment

OMONOASHK

. Organ Transplant
(any organ, unlimited number of transplant)
Hospitalisation due to Covid-19 or Complication
arising from Covid-19 vaccination

Limit (RM)
500,000

No lifetime limit
250

180

180

As Charged, subject
to any Deductible.
Deductible will be

waived for admission

to Malaysian
Government /
Semi-Government
Hospital.

Out-Patient Benefits
14. Out-Patient Kidney Dialysis Treatment
15. Out-Patient Cancer Treatment

16. Emergency Accidental Out-Patient Treatment
(within 72 hours from accident and follow-up

treatment up to a maximum of 31 days)

17. Day-Care Surgery

18. Out-Patient Physiotherapy Treatment
(limit per Policy Year, within 180 days after
discharge / surgery)

Other Benefits

19. Intraocular Lens — Monofocal / Multifocal
(limit per life on each eye)

20. Medical Report Fees

Special Benefits

21. Step Up Advantage

22. Compassionate Benefit
23. Emergency Assistance Program (EAP)

Note:

As Charged, subject to any
Deductible. Deductible will
be waived for admission to
Malaysian Government /
Semi-Government
Hospital.

5,000

3,000

As Charged

The privilege to upgrade
this plan to anew medical
plan without medical
underwriting, subject to
terms and conditions.
10,000
In accordance with the
benefit provisions in
EAP agreement

Compassionate Benefit and Emergency Assistance Programme are not included in

the Annual Limit.

 


Page # 5
    
 

  

How Does iCare Medic Work?

Let us look at the scenario below.

Hospitalisation for Knee Replacement Surgery
Patient: John
Days of Hospitalisation: 6 days

Comparison between treatment received at
Government and Private Hospital:

Government
Hospital

 

Total Eligible Medical

Expenses for Knee RM15,000
Replacement Surgery

Required to Pay Deductible No
Deductible paid by John Waived

Cae ees apance at RM180 x 6 days = RM1,080
overnment Hospital

If John chooses to be
admitted into a Government
Hospital, his Deductible of
RM250 will be waived and
the total eligible medical
expenses will be fully paid
by Us. Additionally, John will
be paid a total Daily Cash
Allowance of RM1,080.00

Tin

Description

Private
Hospital

 

RM60,000

Yes

RM250

Not Applicable

If John chooses to be
admitted into a Private
Hospital, he will need to
pay a Deductible of RM250
and the remaining eligible
medical expenses will be
paid by Us. John will not
be entitled to the Daily
Cash Allowance.

 

Annual Premium

Age Band (Age Last Birthday)

0
1 year
2 years
3 years
4 years
5 years
6 — 10 years
11-15 years
16 - 20 years
21-25 years
26 — 30 years
31-35 years
36 — 40 years
41 - 45 years
46 years
47 years
48 years
49 years
50 years
51 years
52 years
53 years
54 years
55 years
56 years
57 years
58 years
59 years
60 years

    
 

Rates

Annual Premium (RM)

1,972 1,661
1,701 1,540
1,567 1,416
1,433 1,299
1,303 1,212
1,236 1,124
1,195 1,042
1,195 1,042
1,361 1,067
1,361 1,119
1,361 1,119
1,375 1,255
1,431 1,452
1,558 1,888
1,708 2,261
1,772 2,385
1,931 2,503
2,089 2,619
2,249 2,688
2,412 2,783
2,572 2,849
2,695 2,947
2,800 3,013
2,883 3,108
3,100 3,317
3,316 3,415
3,655 3,723
3,991 4,028
4,328 4,145

 


Page # 6
Annual Premium (RM) Pee aed (a)

 

61 years 5,365 4,997 90 years! 27,849 27,612

62 years WOO) 5,327 91 years! 28,655 28,404

63 years 5,935 5,772 92 years! 29,481 29,228

64 years 6,113 6,220 93 years! 30,405 30,073

65 years 6,291 6,411 94 years! 31,853 30,944

66 years 9,960 9,684 95 years! 33,303 31,841

67 years 10,237 10,292 96 years! 34,749 32,765

68 years 10,773 10,833 97 years! 36,199 33,712

69 years 11,316 11,372 98 years! 37,708 34,693

70 years 11,853 11,913 99 years' 39,277 35,701 :
71 years' 12,389 12,453

72 years! 12,929 12,995

73 years! 13,611 13,679 Note:

74 years! 14,289 14,363 | | | | ;

75 years! 14,9714 15,044 1. The premiums payable will vary according to the attained age, gender and occupational

class. Please speak to our Zurich Wealth Planner to obtain the premium rates that are

76 years! 15,6514 15,731 applicable to you.
77 years! 16,331 16,415

78 years! 17,191 17,279 2.1 On renewal basis only.
79 years! 18,053 18,144

80 years! 18,912 19,0114

81 years' 19,772 19,875

82 years! 20,636 20,743

83 years! 21,721 21,835

84 years! 22,813 22,929

85 years! 23,903 24,024

86 years! 24,877 24,663

87 years! 25,591 25,367

88 years! 26,319 26,092

89 years! 27,076 26,837

 


Page # 7
    
    

Frequently Asked Questions (FAQ)

What is Zurich iCare Medic?

Zurich iCare Medic is a standalone medical plan with Deductible of RM250 which provides
cashless hospitalisation benefits, out-patient benefits, and other medical benefits up to age 100.

    

Who is eligible for Zurich iCare Medic?

Anyone between 14 days old to 70 years old (attained age) is eligible to purchase
Zurich iCare Medic.

 
   
 

What is Deductible and how does it work?

Deductible is a fixed amount you are required to pay per Policy Year for eligible medical expenses
incurred as cost sharing. You will need to pay the initial RM250 if you are admitted to private
hospital and we will pay the rest of the eligible medical expenses incurred within a Policy Year.

    

Is the premium paid for Zurich iCare Medic eligible for income tax relief?

Yes. The premium paid for this standalone medical plan may qualify you for personal income tax
relief subject to the final decision of the Inland Revenue Board of Malaysia (IRB).

    

Am | covered for medical treatment received outside Malaysia?

Yes, but if you are residing or traveling outside Malaysia, the worldwide coverage is subject
to a maximum of 90 consecutive days.

 

Exclusions

Medical & Hospitalisation Benefit
This plan does not cover any hospitalisation, surgery or charges caused directly or indirectly,
wholly or partly, by any one of the following occurrences:

1. Pre-existing conditions; or

2.  Plastic/Cosmetic surgery or treatment (except medically necessary surgery),
circumcision (except circumcision due to infection), 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; or

3. Dental conditions including dental treatment or oral surgery except as necessitated by
Accidental Injuries to sound natural teeth occurring wholly during the coverage period
of the Policy Contract; or

4. 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 (Human Immunodeficiency Virus) related
diseases, and any communicable diseases requiring quarantine by law except for the
Eligible Expenses covered under Hospitalisation due to Covid-19 or complication
arising from Covid-19 vaccination; or

5. Any treatment or surgical operation for Congenital Conditions or deformities including
hereditary conditions; or

6. Pregnancy, childbirth (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 sterilisation; or

7. 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 General
Practitioner and/or Specialist; or

8. Treatments specifically for weight reduction or gain; or
9. Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane; or
10. 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; or


Page # 8
11.

12.

13.

14.

15.

16.

17.

18.

lonising radiation or contamination by radioactivity from any nuclear fuel or nuclear
waste from process of nuclear fission or from any nuclear weapons material; or

Expenses incurred for donation of any body organ by the Life Assured and costs of
acquisition of the organ including all costs incurred by the donor during organ
transplant and its complications; or

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; or

Psychotic, mental or nervous disorders, (including any neuroses and their physiological
or psychosomatic manifestations); or

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; or

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; or

Private flying other than as a fare-paying passenger in any commercial scheduled
airlines licensed to carry passengers over established routes; or

Expenses incurred for sex changes.

Note: This exclusion list is not exhaustive. Please refer to the policy documents for the full list
of exclusions under this plan.

Important Notes

. The brochure is for illustrative purposes only. For further details of terms and conditions,
please refer to the product disclosure sheet, and policy documents.

. You should be certain that this plan meets your needs and that the premium payable
under the policy is an amount you can afford.

. If the policy is cancelled within the 15 days free-look period from the date of delivery of
the policy, the full premium paid less medical expenses (if any) will be refunded.

. Waiting period - The eligibility for benefits under this policy will only start 30 days after the
effective date of the policy, except for a covered accident occurring after the effective date of
coverage. For Specified Illnesses, the waiting period is 120 days from the Commencement
Date or effective date of change or reinstatement date whichever is latest.

. The premium is not guaranteed and subject to review in future. The revision in premium, if
any, is affected by claim experience, cost of medical treatment, medical inflation,
advancement in medical technology and other circumstances. Such revisions shall be
applicable to all policyholders regardless of their policy coverage term and claim
experience. Zurich Life Insurance Malaysia Berhad reserves the right to revise the premium
by notifying the policyholder at least 30 days before the anniversary date.

. It may not be advantageous to switch from one medical and health policy to another
medical and health policy, as you may be subject to new underwriting requirements waiting
period, exclusion of specified illness or pre-existing conditions under the new policy.

. Medical treatment received outside Malaysia is limited to the Reasonable and Customary
and Medically Necessary Charges that are equivalent to the local treatment found in
Malaysia and shall exclude the cost of transport to the place of treatment. No benefit shall
be payable for any medical treatment received by the Life Assured outside Malaysia, if the
Life Assured resides or travels outside Malaysia for more than 90 consecutive days.

. All premium and fees shown in this document may be subject to tax or other
government levies.

Panel of Hospitals

Please visit www.zurich.com.my to download the list of participating hospitals.

For more information and assistance on Zurich iCare Medic, please contact our Zurich Wealth
Planner or Zurich Call Centre at 1300-888-622 or email us at <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS>

In the event of discrepancy, ambiguity, and conflict in interpreting any term or condition, the
English version shall prevail and supersede the Bahasa Malaysia, Chinese and Tamil versions.


ZURICH iCARE MEDIC POLICY CONTRACT

FORM NO:


This is a non-participating Whole Life medical plan that provides comprehensive coverage on hospitalisation, surgical and, out-patient
treatments expenses due to accidental Injuries or illnesses up to the Maturity/Expiry Date.


While this Policy is in-force, upon receipt of due proof and subject to the provisions of this Policy Contract, We shall provide the following medical benefits.



SECTION A


SCHEDULE OF BENEFITS


Plan 180


PLANS

Limit (RM)
Annual Limit
500,000
(for In-Patient Benefit, Out-Patient Benefit plus Other Benefit)
Lifetime Limit
No lifetime limit
Deductible
(amount per Policy Year)
250
In-Patient Benefit

1
Daily Hospital Room & Board
180
(limit per day, unlimited number of days)
2
Daily Cash Allowance at Government Hospital
180
(limit per day, unlimited number of days)
3
Intensive Care Unit or High Dependency Unit
(maximum 120 days per Policy Year)
4
Hospital Supplies & Services
5
Surgical Fees
6
Anaesthetist Fee
7
Operating Theatre
8
Ambulance Fee
9
Pre-Hospitalisation Diagnostic Tests
(within 90 days prior to Hospitalisation)
• Diagnostic Tests
• Specialist/General Practitioner Consultation
As Charged, subject to any deductible. Deductible
• Medication and Treatment
will be waived for admission to Malaysian
10
In-Hospital Specialist Visit
Government / Semi-Government Hospital.

• Surgical – unlimited number of visits
• Non-surgical – max 2 visits per day
11
Post-Hospitalisation Treatment
(within 180 days after discharge)
• Diagnostic Tests
• Specialist Consultation
• Medication and Treatment
12
Organ Transplant
(any organ, unlimited number of transplant)
13
Hospitalisation due to Covid-19 or Complication arising from Covid-19
Vaccination
Out-Patient Benefit
14
Out-Patient Kidney Dialysis Treatment
15
Out-Patient Cancer Treatment
As Charged, subject to any deductible. Deductible
16
Emergency Accidental Out-Patient Treatment
will be waived for admission to Malaysian
(within 72 hours from accident and follow-up treatment up to a
Government / Semi-Government Hospital.

maximum of 31 days)
17
Day-Care Surgery
18
Out-Patient Physiotherapy Treatment
5,000
(limit per Policy Year, within 180 days after discharge/ surgery)


Other Benefit

19

Intraocular Lens – Monofocal / Multifocal
3,000
(limit per life on each eye)
20
Medical Report Fees
As Charged


Special Benefit

Step Up Advantage

Life Assured is allowed to upgrade this plan to a

new medical plan without medical underwriting

subject to terms and conditions.

Compassionate Benefit*
10,000
Emergency Assistance Program (EAP)*
In accordance with the benefit provisions in EAP
agreement
*Compassionate Benefit and Emergency Assistance Programme are not included in the Annual Limit.



DESCRIPTION OF BENEFITS

IN-PATIENT BENEFIT


DAILY HOSPITAL ROOM AND BOARD

Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary room accommodation and meals. The
amount of the benefit shall be the charges made by the Hospital during the Life Assured’s Hospital Confinement, but in no event shall the
benefit exceed, for any one day, the rate of Daily Hospital Room and Board Benefit as stated in the Schedule of Benefits.


DAILY CASH ALLOWANCE AT GOVERNMENT HOSPITAL
Pays a daily allowance for each day of Hospital Confinement for a covered Disability in a Malaysian Government Hospital, provided that
the Life Assured shall be confined in a room of Room and Board rate that does not exceed the amount as shown in the Schedule of Benefits. This benefit is not applicable to Malaysian Semi-Government Hospital.


INTENSIVE CARE UNIT OR HIGH DEPENDENCY UNIT
Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary Intensive Care Unit or High Dependency
Unit room accommodation and meals. This amount of benefit shall be the charges made by the Hospital subject to the maximum number
of days, as stated in the Schedule of Benefits. Where the period of confinement in an Intensive Care Unit or High Dependency Unit exceeds the maximum number of days as stated in the Schedule of Benefits, reimbursement will be restricted to the standard Daily Hospital Room and Board rate.


No Daily Hospital Room and Board Benefits will be payable for the same confinement period where the Intensive Care Unit or High Dependency Unit benefit is payable.


HOSPITAL SUPPLIES & SERVICES
Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary general nursing, prescribed and consumed
drugs and medicines, dressings, splints, plaster casts, x-ray, laboratory examinations, electrocardiograms, physiotherapy, basal metabolism tests, intravenous injections and solutions, administration of blood and blood plasma but excluding the cost of blood and plasma during the Life Assured’s Hospital Confinement.



SURGICAL FEES

Reimbursement of the Reasonable and Customary Charges for a Medically Necessary Surgery by the Specialists, including Specialist’s
pre-surgical assessment visits to the Life Assured and post-surgical care up to the number of days as indicated in the Schedule of Benefits.

If more than one Surgery is performed, the total payments for all the Surgeries performed shall not exceed the Annual Limit stated in the
Schedule of Benefits, where applicable.



ANAESTHETIST FEES

Reimbursement of the Reasonable and Customary Charges by the anaesthetist for the Medically Necessary administration of
anaesthesia.



OPERATING THEATRE FEES

Reimbursement of the Reasonable and Customary operating room charges incidental to the surgical procedure.



AMBULANCE FEES

Reimbursement of the Reasonable and Customary Charges incurred for necessary road domestic ambulance services (inclusive of attendant) to and/or from the Hospital of confinement. Payment will not be made if the Life Assured is not hospitalised.


PRE-HOSPITALISATION DIAGNOSTIC TEST
Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary diagnostic tests which include but not limited to ECG, X-ray and laboratory tests recommended by a General Practitioner and/or a Specialist which are performed for diagnostic
purposes on account of an Injury or Illness in connection with the Hospitalisation within the maximum number of days as set forth in the
Schedule of Benefits preceding Hospitalisation. No payment shall be made if upon such diagnostic services, it does not result in Hospital
Confinement of the Life Assured for the treatment of the medical condition diagnosed.

PRE-HOSPITALISATION SPECIALIST/GENERAL PRACTITIONER CONSULTATION
Reimbursement of the Reasonable and Customary Charges incurred for the first (1st) time consultation by a General Practitioner and/or
a Specialist in connection with an Injury or Illness that leads to Hospitalisation, within the maximum number of days as set forth in the
Schedule of Benefits preceding Hospital Confinement and provided that such Specialist consultation are Medically Necessary, and the
Specialist consultation has been recommended in writing by the attending General Practitioner.


Payment will not be made for clinical treatment (and subsequent consultation or medication after the Illness is diagnosed) where it does
not result in Hospital Confinement of the Life Assured for the treatment of the medical condition diagnosed.


PRE-HOSPITALISATION MEDICATION AND TREATMENT
Reimbursement of the Reasonable and Customary Charges incurred for the first (1st) time treatment and medicines prescribed by a General Practitioner and/or a Specialist in connection with an Injury or Illness that leads to Hospitalisation, within the maximum number
of days as set forth in the Schedule of Benefits preceding Hospital Confinement and provided that such Specialist medication and treatment are Medically Necessary and the Specialist consultation has been recommended in writing by the attending General Practitioner.


Payment will not be made for clinical treatment (and subsequent consultation or medication after the Illness is diagnosed) where it does
not result in Hospital Confinement of the Life Assured for the treatment of the medical condition diagnosed.


IN-HOSPITAL SPECIALIST VISIT
Reimbursement of the Reasonable and Customary Charges by a Specialist for Medically Necessary visit during Life Assured’s Hospital
Confinement for a surgical or non-surgical Disability subject to the maximum number of visits per day as stated in the Schedule of Benefits.



POST-HOSPITALISATION TREATMENT
Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary follow-up diagnosis, treatment and
consultation by the same attending Specialist, within the maximum number of days as set forth in the Schedule of Benefits immediately
following discharge from Hospital. This shall include medicines prescribed during the follow-up treatment but shall not exceed the supply
needed for the maximum number of days as set forth in the Schedule of Benefits.



ORGAN TRANSPLANT

Reimbursement of the Reasonable and Customary Charges incurred on transplantation Surgery for the Life Assured being the recipient
of the transplant of any organ. The costs of acquisition of the organs being transplanted and all costs incurred by the donor are not covered.


HOSPITALISATION DUE TO COVID-19 OR COMPLICATION ARISING FROM COVID-19 VACCINATION
Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary treatments received when the Life Assured
is hospitalised due to Covid-19 or complication arising from Covid-19 vaccination. For Medically Necessary Hospitalisation due to Covid-
19, the Life Assured must be diagnosed with severe Covid-19 complications including but not limited to pneumonia, hypoxemic respiratory
failure, sepsis or septic shock. Life Assured must be vaccinated with at least two (2) doses of vaccine approved by local authority to be
entitled for this benefit [except for Life Assured age four (4) years and below].



OUT-PATIENT BENEFIT

OUT-PATIENT KIDNEY DIALYSIS TREATMENT
If a Life Assured is diagnosed with Kidney Failure, We will reimburse the Reasonable and Customary Charges incurred for the Medically
Necessary treatment of kidney dialysis performed at the Out-patient department of a Hospital or a legally registered dialysis treatment
centre.


Kidney Failure means end-stage kidney failure 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.


OUT-PATIENT CANCER TREATMENT
If a Life Assured is diagnosed with Cancer, We will reimburse the Reasonable and Customary Charges incurred for the Medically Necessary treatment of Cancer (radiotherapy, chemotherapy, immunotherapy, hormonal therapy and targeted therapy) performed at the
Out-patient department of a Hospital or a legally registered Cancer treatment centre.


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. The following
are not covered:
(i)
All cancers which are histologically classified as any of the following:
- pre-malignant
- non-invasive
- carcinoma in situ
- having borderline malignancy
- 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
(vii)
Any skin cancer other than malignant melanoma

EMERGENCY ACCIDENTAL OUT-PATIENT TREATMENT
Reimbursement of the Reasonable and Customary Charges incurred for up to the maximum number of days as stated in the Schedule of
Benefits, as a result of a covered bodily Injury arising from an Accident for Medically Necessary treatment as an Out-Patient at any registered clinic or Hospital within seventy-two (72) hours of the Accident causing the covered bodily Injury. Follow up treatment by the
same General Practitioner and/or Specialist or same registered clinic or Hospital for the same covered bodily Injury will be provided up to the maximum number of days as set forth in the Schedule of Benefits.


DAY-CARE SURGERY
Reimbursement of the Reasonable and Customary Charges for Medically Necessary Surgery incurred for a surgical procedure performed
(including all professional fees, services & supplies) in an Out-Patient setting at the Hospital / Specialist clinic / Day Surgery centre on a pre-planned basis.


OUT-PATIENT PHYSIOTHERAPY TREATMENT
Reimbursement of the Reasonable and Customary Charges incurred for Out-Patient Physiotherapy Treatment in Hospital, or a legally
registered facility or centre referred in writing by a Specialist to be performed by a licensed physiotherapist after Surgery or in-hospital treatment, within the maximum number of days from the date of Hospital discharge or Surgery, whichever is later and subject to the maximum limit per year as set forth in the Schedule of Benefits.



OTHER BENEFIT


INTRAOCULAR LENS

Reimbursement of Reasonable and Customary Charges incurred for the Medically Necessary Intraocular Lens including both monofocal
and multifocal lens for cataract or eye Injury, subject to the maximum limit per life as shown in the Schedule of Benefits.



MEDICAL REPORT FEES

Reimbursement of the fee charged for completion of a medical report by the attending General Practitioner and/or Specialist in respect of
the covered Disability.



SPECIAL BENEFIT


STEP UP ADVANTAGE


At the beginning of 6th Policy Year, this Policy may be upgraded to a medical plan without any evidence of insurability, subject to the
following conditions:
a)
If a new basic plan is being taken up, the coverage of the basic plan shall be limited to Death and TPD benefits only. The Basic
Sum Assured shall not exceed fifty thousand Ringgit Malaysia (RM 50,000).

b)
Maximum daily Room and Board of the new medical plan shall not exceed 200% of the Room and Board of this Policy, and
c)
The new medical plan must either have a Deductible or Co-insurance feature.



We shall notify Applicant/Owner of the option ninety (90) days prior to the 6th Policy Year. Applicant/Owner must exercise the option by
replying to us no later than the specified timeline.


The terms and conditions applicable to existing Policy which include premium loading and exclusion (if any) shall apply to the new medical plan and basic plan, if applicable. The insurance charge and premium of the new medical plan and basic plan, if applicable, will be determined based on our rates at the time of upgrade. This privilege is only available to Life Assured up to 35 years old at the inception of this Policy.



COMPASSIONATE BENEFIT

In the event of death of the Life Assured, We will pay ten thousand Ringgit Malaysia (RM10,000) as Compassionate Benefit in one (1)
lump sum. Upon payment of Compassionate Benefit, this Policy shall be terminated.



DEFINITIONS

FORM NO:


ACCIDENT shall mean a sudden, unintentional, unexpected, unusual and specific event that occurs at an identifiable time and place, which shall, independently of any other cause, be the sole cause of bodily Injury.


ANNUAL LIMIT shall mean benefits payable in respect of expenses incurred for treatment provided to Life Assured during the period of insurance shall be limited to Annual Limit as stated in the Schedule of Benefits. Compassionate Benefit and Emergency Assistance Programme are not included in the Annual Limit. Once the Annual Limit is reached, all insurance coverage for Life Assured shall immediately cease to be payable for that remaining Policy Year except for Compassionate Benefit and Emergency Assistance
Programme.


AS CHARGED refers to charges incurred for reasonable, necessary and customary medical care provided in the treatment of a covered
Disability.


BASIC SUM ASSURED shown in the Policy Information Page is the Annual Limit of this Zurich iCare Medic.


CONGENITAL CONDITIONS shall mean any medical or physical abnormalities existing at the time of birth, as well as neo-natal physical abnormalities developing within six (6) months from the time of birth. These will include hernias of all types and epilepsy except when
caused by a trauma, which occurred after the date that the Life Assured was continuously covered under this Policy Contract.


DAY SURGERY shall mean a pre-planned surgical procedure where the patient needs the use of a recovery facility for less than twelve (12) consecutive hours (but not for overnight stay at the Hospital).


DEDUCTIBLE shall mean the initial Eligible Expenses amount paid per Policy Year by the Life Assured/ Policyowner before the insurer pays the balance Eligible Expenses. Only the Eligible Expenses of the following benefits as set forth in the Schedule of Benefits are subject to Deductible:
1)
In-Patient Benefit (except Daily Hospital Room & Board and Daily Cash Allowance at Government Hospital)
2)
Out-Patient Benefit (except Out-Patient Physiotherapy Treatment)

Deductible will be waived for admission to Malaysian Government/Semi-Government Hospital.


DENTIST shall mean a person who is duly licensed or registered dental practitioner that specialises in the diagnosis, prevention and treatment of diseases or conditions of the oral cavity in the geographical area in which the service is provided but excluding a Dentist who is the Life Assured himself/herself or the spouse or the immediate family member of the Life Assured.


DISABILITY shall mean Sickness, Disease, Illness or the entire Injuries arising out of a single or continuous series of causes.


ELIGIBLE EXPENSES shall mean Medically Necessary expenses incurred due to a covered Disability but not exceeding the limits in the
Schedule of Benefits.


GENERAL PRACTITIONER shall mean a registered medical practitioner qualified and licensed to practice western medicine and who, in
rendering such treatment, is practicing within the scope of his licensing and training in the geographical area of practice but excluding a General Practitioner who is the Life Assured himself/herself or the spouse or the immediate family member of the Life Assured.


HOSPITAL shall mean only an establishment duly constituted and registered as a hospital for the care and treatment of sick and injured persons as paying bed-patients, and which: -
a)
Has facilities for diagnosis and major Surgery,
b)
Provides twenty-four (24) hour a day nursing services by registered and qualified nurses,
c)
Is under the supervision of a Specialist, and
d)
Is not primarily a clinic; a place for alcoholics or drug addicts; a nursing, rest or convalescent home or a home for the aged or
similar establishment.


HOSPITAL CONFINEMENT shall mean the Life Assured being registered and admitted as an in-patient in a Hospital for more than twelve
(12) consecutive hours.


HOSPITALISATION shall mean admission to a hospital as a registered in-patient for Medically Necessary treatments for a covered Disability upon recommendation of a General Practitioner or Specialist. A patient shall not be considered as an in-patient if the patient
does not physically stay in the Hospital for the whole period of confinement.


INJURY shall mean bodily injury caused solely by Accident.


INTENSIVE CARE UNIT OR HIGH DEPENDENCY UNIT shall mean a section within a Hospital which is designated as an Intensive Care
Unit or High Dependency Unit by the Hospital, and which is maintained on a twenty-four (24) hour basis solely for treatment of patients in critical condition and is equipped to provide special nursing and medical services not available elsewhere in the Hospital.


LIFE ASSURED shall mean the person described in the Policy Information Page of this Policy Contract.

MALAYSIAN GOVERNMENT HOSPITAL shall mean a Hospital established, maintained, operated or provided by the Malaysian
government which charges of services are subject to the Fee Act 1951 - Fees (Medical) Order 1982 and/or its subsequent amendments
if any, but excludes privatised or corporatised Malaysian Government Hospital.


MALAYSIAN SEMI-GOVERNMENT HOSPITAL shall mean Full Paying Patient (FPP) Services offered through Malaysian Government
Hospitals where patients need to bear the cost of treatment on their own.


MANAGED CARE ORGANISATION (MCO) shall mean a third party appointed by Zurich Life Insurance Malaysia Berhad to provide service in managing the hospital admission and claims administration as per provisions of this Policy Contract.



MEDICALLY NECESSARY shall mean a medical service which is:
a)
Consistent with the diagnosis and customary medical treatment for a covered Disability, and
b)
In accordance with standards of good medical practice, consistent with current standard of professional medical care, and of
proven medical benefits, and
c)
Not for the convenience of the Life Assured or the General Practitioner and/or Specialist, and unable to be reasonably rendered
out of Hospital (if admitted as an inpatient), and
d)
Not of an experimental, investigational or research nature, preventive or screening nature, and
e)
For which the charges are fair and reasonable and customary for the Disability.


OUT-PATIENT shall mean the Life Assured is receiving medical care or treatment without being hospitalized and includes treatment in a day-care centre.


POLICYOWNER shall mean a person or a corporate body to whom this Policy has been issued in respect of cover for persons specifically identified as Life Assured in the Policy Information Page.

PRE-EXISTING CONDITION shall mean any conditions, illnesses or Disabilities which existed before the Commencement Date or effective date of change or date of reinstatement, whichever is later, and for which the Life Assured has reasonable knowledge of. A Life
Assured is considered to have reasonable knowledge of a pre-existing condition is one for which: -
a)
The Life Assured had received or is receiving treatment.

b)
Medical advice, consultation, diagnosis, care or treatment has been recommended.

c)
Clear and distinct signs or symptoms are or were evident; or
d)
Its existence would have been apparent to a reasonable person in the circumstances.


PRESCRIBED MEDICINES shall mean medicines that are dispensed by a General Practitioner, a Specialist, a registered pharmacist or
a Hospital and which have been prescribed by a General Practitioner or Specialist in respect of treatment of a covered Disability.


PRIVATE HOSPITAL shall mean any Hospital which licensed and governed under Private Healthcare Facilities and Services Act 1998
including any regulations and all the re-enactments thereof.


REASONABLE AND CUSTOMARY CHARGES shall mean charges for medical care which is Medically Necessary shall be considered
reasonable and customary to the extent that it does not exceed the general level of charges being made by others of similar standing in
the locality where the charge is incurred, when furnishing like or comparable treatment, services or supplies to individual of the same sex and of comparable age for a similar Sickness, Disease or Injury and in accordance with accepted medical standards and practice could
not have been omitted without adversely affecting the Life Assured medical condition.


POLICY ANNIVERSARY shall be one (1) year after the effective date of this Policy and annually thereafter.

POLICY YEAR shall mean the one (1) year period from and including the effective date of commencement of coverage or effective date
of change (as stated in the Policy Information Page or Endorsement), or the one (1) year period following the renewal of this Policy.

SICKNESS, DISEASE OR ILLNESS shall mean a physical condition marked by a pathological deviation from the normal healthy state.


SPECIALIST shall mean a medical practitioner registered and licensed as such in the geographical area of his practice where treatment takes place and who is classified by the appropriate health authorities as a person with superior and special expertise in specified fields of medicine but excluding a Specialist who is the Life Assured himself/herself or the spouse or the immediate family member of the Life
Assured. A Specialist shall also include a physician or a surgeon.


SPECIFIED ILLNESSES shall mean the following Disabilities and its related complications, occurring within the first one hundred and twenty (120) days from the Commencement Date or effective date of change or date of reinstatement, whichever is later, of this Policy
Contract:
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.


POLICY OR POLICY CONTRACT shall mean this Zurich iCare Medic Policy Contract.

SURGERY shall mean any of the following medical procedures:
a)
To incise, excise or electrocauterize any organ or body part, except for dental services.

b)
To repair, revise, or reconstruct any organ or body part.

c)
To reduce by manipulation a fracture or dislocation.

d)
Use of endoscopy to remove a stone or object from the larynx, bronchus, trachea, esophagus, stomach, intestine, urinary
bladder, or urethra.


WAITING PERIOD shall mean the period of time between the Commencement Date or date of reinstatement of this Policy, whichever is
later, and the beginning of a Life Assured’s symptoms of the Illness, after which the Life Assured is eligible for the Illness benefit described herein.


WE, US and OUR shall mean Zurich Life Insurance Malaysia Berhad.


YOU and YOUR shall mean the owner of this Policy Contract.


Whenever the context is requiring in this Policy, masculine form shall apply to feminine and singular term shall include the plural.



PREMIUM PROVISIONS

FORM No.:


GRACE PERIOD

A Grace Period of thirty-one (31) days from its due date will be allowed for payment of each premium due after the first payment during
which period this Policy will remain in-force. During such thirty-one (31) days, we shall remain liable thereunder if by the last of such days, the premium is actually paid.


If any premium is not paid in respect of this Policy before the end of the Grace period, the Policy shall be deemed as lapsed at the expiry of Grace Period.



PREMIUM

During the period of insurance, the premiums under this Policy are not guaranteed and shall be based on the rates in force at the time of
renewal. Premiums are payable at the premium rate according to the Life Assured’s age, sex and occupational class on each Policy Year
anniversary. We may change the rates at which premiums shall be calculated, at the start of any Policy Year, provided that we notify
the Applicant/Owner at least thirty (30) days in advance of the date such premium is due with valid reason.


The total premium of this Policy shall include the fee for the services provided by a Managed Care Organization (MCO).



REINSTATEMENT

In the event the Policy has lapsed, it may be reinstated within one (1) year after the due date of the premium in default subject to:
a)
Submission of evidence of insurability; and
b)
Payment of overdue premiums with interest as required at the time of reinstatement (if any); and
c)
Repayment or reinstatement of any loan indebtedness outstanding at the due date of the premium in default with interest., if
any.


Such reinstatement shall only cover any eligible losses thereafter subject to the Waiting Period as defined. No claim will be paid for any losses that occur during the lapsation period.



OWNERSHIP PROVISIONS

FORM NO.:


POLICY OWNER

Only the Policyowner can, exercise all rights, privileges and options provided under this Policy subject to any assignees and trustee’s rights.

In the event of the Policyowner’s death, such rights, privileges, and options shall vest in the legal representative of the Policyowner if any.



OWNERSHIP OF POLICY

Unless otherwise expressly provided for by Endorsement in the Policy Contract, We shall be at liberty to treat the Policyowner as the absolute owner of the Policy. We shall not be bound to recognise any equitable or other claim to or interest in the Policy.



CHANGE OF OWNERSHIP

While the Policy is in-force, the Owner may change the ownership of this Policy by written notice to Us. A change of ownership shall be
effective only if endorsed in this Policy Contract. When the ownership is changed, it will be deemed effective as of the date the notice is signed whether the Life Assured is living at the time of such recording and Endorsement.



THE NOMINEE

The nominee is named in the nomination form unless subsequently changed or revoked as provided for under the Revocation of Nomination clause.


Where the nominee of the Policy is the spouse, child or parent (when there is no spouse or child living at the time of nomination) of the
Policyowner, other than a Muslim Policyowner, a trust is created in favour of the nominee for the policy moneys payable upon death of
the Policyowner. The Policyowner may by completing the Trustee Nomination Form appoint trustee(s) of for the policy moneys payable
under this Policy.


Where a trust for the policy moneys is created, the Policyowner shall not deal with the Policy by revoking a nomination, by varying or
surrendering the Policy, or by assigning or pledging the Policy as security, without written consent of the trustee(s).



REVOCATION OF NOMINATION

During the lifetime of the Life Assured and while the Policy is in-force, the Policyowner may revoke the nominee of this Policy, by written notice and completing the appropriate form to Us, except where the nominee is the spouse, child, or parent (when there is no spouse or
child living at the time of nomination) of the Policyowner. For such nomination, written consent of the trustee is required for revocation of nomination.


When the nominee is changed, it will be deemed effective as of the date the notice is signed whether Life Assured is living at the time of such recording.



JUVENILE OWNERSHIP PROVISION

Policyowner shall have the right to exercise every option, benefit or privilege conferred by the provisions of the Policy as long as he/she survives the Life Assured. If Policyowner predeceases the Life Assured, such right:
a)
Shall be reverted to the Life Assured provided the Life Assured has attained the age of majority; or
b)
Shall be vested with the contingent owner and where no contingent owner is appointed, the legal representative of the
Policyowner, if the Life Assured has not attained the age of majority. Subsequently, when the Life Assured has attained the age
of majority such right shall be reverted to the Life Assured.



GENERAL PROVISIONS

FORM NO.:


THE CONTRACT

This Policy is issued in consideration of the payment of premium as specified in the Policy Information Page and pursuant to:
(a) the answers given by Applicant/Owner or the Life Assured in the application/proposal form or any subsequent questionnaires given by Us on any matters relating to the proposal and any disclosures made by Applicant/Owner or Life Assured between the
time of submission of the application/ proposal and the time this contract is entered into; and
(b) medical reports and any other reports and questionnaires.

(Collectively referred to as ‘the material information’)

and such material information shall form part of this contract of insurance between Us and Applicant/Owner. However, in the event of
any pre-contractual misrepresentation made in relation to such material information, only the remedies in Schedule 9 of the Financial Services Act 2013 will apply.


If Applicant/Owner or Life Assured are required by Us, before the Policy is renewed or varied, to answer any questions or if Applicant/Owner or Life Assured are required to confirm or amend any matter previously disclosed by Applicant/Owner to Us in relation
to this Policy, it is Applicant/Owner’s duty to take reasonable care not to make a misrepresentation when answering the questions or
confirming or amending any matter previously disclosed.


Applicant/Owner must inform Us of any change to the information given to Us in his/her answers or in respect of any matter previously
disclosed to Us in relation to the Policy if such changes had taken place after Applicant/Owner have submitted the application for renewal/variation but before the Policy is renewed or varied.



ALTERATION

No alterations in the terms of this Policy or any Endorsement thereon will be held valid unless the same is signed or initialled by Our
authorised representative with three (3) months prior written notice by providing valid reason.



AGE AND SEX

This Policy is issued at the age shown on the Policy Information Page, which is the Life Assured’s age at last birthday. If the age or sex was misstated in the application form, the benefits or premium will be adjusted according to the Policy which had been purchased based
on the true age or sex.


CERTIFICATION, INFORMATION AND EVIDENCE
All Contracts, information, medical reports and evidence as required by Us shall be furnished at the expense of the Life Assured, and in
such a form that We may require. In any event all notices which We shall require the Applicant/Owner to give must be in writing and addressed to Us. The Life Assured shall, at our request and expense, submit to Us a medical examination whenever such is deemed necessary.



CHANGE IN RISK

The Applicant/Owner shall give immediate notice in writing to Us of any material change in the Life Assured’s occupation, business, duties or pursuits and any additional premium that may be required by Us shall be collected accordingly. If such change in risk has rendered the
Life Assured to be no longer insurable by Us, this Policy will be terminated.



CLAIM PROCEDURES

a)
The Life Assured shall within thirty (30) days of a covered Disability, give written notice to us stating full particulars of such event,
including all original bills and receipts, and a full General Practitioner and/or Specialist's report stipulating the diagnosis of the condition treated and the date the Disability commenced in the General Practitioner and/or Specialist's opinion and the summary of
the cost of treatment including medicines and services rendered. Failure to furnish such notice within the timeline stipulated shall
not invalid any claim if it is shown not to have been reasonably possible to furnish such notice and that such notice was furnished
as soon as was reasonably possible.

b)
The Life Assured shall immediately procure and act on proper medical advice and we shall not be held liable in the event a treatment
or service becomes necessary due to failure of the Life Assured to do so.


CLAIM PERIOD SPANNING ACROSS TWO POLICY YEAR
If the Eligible Expenses flow into the next Policy Year, the benefits to be reimbursed will be apportioned based on the itemized expenses
incurred on a daily basis in the relevant Policy Year.


If there is no itemization of the expenses by daily breakdown, such expenses shall be apportioned as a percentage of the days of confinement (including day of admission) for each respective Policy Year.


In no situations will the benefit limit exceed the Policy Year as stipulated in the Schedule of Benefits and evidence of Hospitalisation is required for other than out-patient benefits and day procedure benefits.



CONVERSION OF POLICIES

If the eligible benefits as stipulated under the Schedule of Benefits provided under this Policy Contract shall have been converted from an existing coverage of an ‘Inner Limits’ to an ‘As Charged/Full Reimbursement’ coverage, and if such Life Assured shall have been afflicted
with a Disability prior to or at the time the benefits were converted the benefits payable in respect of the Disability shall be in accordance with the Schedule of Benefits prior to the date the eligible benefits were converted.



CURRENCY AND PLACE OF PAYMENT

All amounts payable either to Us or by Us will be in Malaysian Ringgit and at Our office shown on the Policy Information Page or any
payment channel which has been approved by Us. Should any payment be requested by the Applicant/Owner to be payable in any other


currency, then such amount shall be payable in the demand currency as may be purchased in Malaysia at the prevailing currency market
rates on the date of the claim settlement.


COOLING-OFF PERIOD
The Applicant/Owner shall have the right to cancel the Policy by giving written notice to Us within fifteen (15) days after the delivery of this Policy. Upon cancellation, the premiums that You have paid less any medical fee incurred will be refunded to You.



CANCELLATION

Applicant/Owner may cancel this policy at any time by giving written notice to Us. Upon cancellation, Applicant/Owner is entitled for a
refund of premium as per the schedule below, provided that Life Assured have not made a claim during the current policy year. The amount of premium refund shall be based on the duration the Policy has been in force in a Policy Year:
Period Not Exceeding


Refund of Annual Premium

15 days

90% (applicable to renewal only)

1 month
80%

2 months
70%

3 months
60%

4 months
50%

5 months
40%

6 months
30%

7 months
25%

8 months
20%

9 months
15%
10 months
10%

11 months
5%

Period Exceeding 11 months
No refund

For quarter and semi-annual premium payment mode, refund of premium will be pro-rated accordingly. There is no refund for monthly
mode premium payment.



DEDUCTION FROM PROCEEDS

Any indebtedness on this Policy will be deducted by Us from any payment or proceeds under this Policy at the time of settlement.



GEOGRAPHICAL TERRITORY

All benefits provided in this Policy are applicable worldwide for twenty-four (24) hours a day subject to Overseas Treatment and Residence Overseas clause.



GOVERNING LAW

This Policy is issued under the laws of Malaysia and is subject and governed by the laws prevailing in Malaysia.


HOSPITAL CONSULTATION, PROCEDURE AND MISCELLANEOUS FEE
Fees or charges as mentioned under the Schedule of Benefits for various descriptions of medical services and/or treatment in this Policy
Contract shall refer to the Thirteenth Schedule of the Private Healthcare Facilities and Services (Private Hospital and Other Private Healthcare Facilities) Regulations 2006 and as amended from time to time.



INCONTESTABILITY AND MISREPRESENTATION

If this Policy has been in-force for more than two (2) years from the Issue Date (as stated in the Policy Information Page), this Policy not be contestable except for fraud.


If this Policy has been in-force during the lifetime of the Life Assured for two (2) years or less from the Issue Date (as stated in the Policy Information Page), We shall apply the remedies in Schedule 9 of the Financial Services Act 2013 accordingly in respect of the pre-contractual misrepresentation.



INCOMPLETE CLAIMS

All claims must be submitted to Us within thirty (30) days of completion of the events for which the claim is being made. Claims are not
deemed complete and eligible benefits are not payable unless all original bills and receipts for such claims have been submitted and agreed upon by Us. Only Reasonable and Customary Charges incurred shall be considered for reimbursement.


INFORMATION AND TERMS AND CONDITONS RELATING TO INTERNATIONAL AUTOMATIC EXCHANGE OF INFORMATION
FOR TAX PURPOSES AND CUSTOMER TAX COMPLIANCE
In connection with legal and regulatory requirements regarding the international exchange of information for tax purposes, including the
U.S. Foreign Account Tax Compliance Act (FATCA) and laws and regulations related thereto, We are required to apply certain due diligence procedures to identify the tax residency or tax residencies of certain persons related to the policy. In order to comply with this obligation, the Policyowner and any person entitled to access the cash value, change the beneficiary or perform certain other actions with respect to the policy as described by law (together in this Clause, to be referred to as “Policyowner”) must at Our request provide Us with an accurate self-certification regarding the jurisdiction or jurisdictions in which the Policyowner is a tax resident and, if applicable, respond to Our request for documentary evidence and a taxpayer identification number or equivalent as is requested under the relevant regulation.


In accordance with applicable law, We will periodically report certain information about Policyowners, including name and address, date
of birth, place of birth and financial details relating to the policy to the appropriate tax authority/ies or other authority/ies designated by law.


If the Policyowner moves to another country and/or if the tax residency of any Policy-holder changes or differs from the information provided in a self-certification of tax residency or in documentation provided in connection with the policy, the Policyowner providing that self-certification or documentation must give Us written notice prior to such change but no later than within 30 days or such lesser number of days as required by law of such change.



Please note that should you move to another country you may no longer be eligible to make payments into your policy or to make any
investment decision relating to your policy. The local laws and regulations of the jurisdiction to which you move may affect our ability to continue to service your policy in accordance with its terms and conditions. therefore, we reserve all rights to take any steps that we deem appropriate, including the right to cancel or terminate the policy with immediate effect or with a notice period of the minimum number of
days permitted by law.


If this policy is transferred/assigned to a new Policyowner or a new Policyowner is added to the policy the original Policyowner must give Us prior written notice of such change to the Policy. each new or additional Policyowner must promptly or with the minimum number of
days permitted by law respond to Our request for an accurate self-certification regarding the jurisdiction or jurisdictions in which the new/additional Policyowner is a tax resident and respond to Our request for documentary evidence and a taxpayer identification number
or equivalent. In addition to the actions described herein, failure to provide Us with such notice or provide Us the full requested information may impair the rights of the Policyowner under the policy or result in the termination of the policy.


We execute payments under the policy such as payments due to maturity of the policy, partial or full surrender, or policy loans only to the Policyowner or beneficiary indicated in the relevant contractual document. These payments can only be made by wire transfer and to a
bank account in the name of such Policyowner or beneficiary located in the same jurisdiction as the Policyowner’s or, as applicable, the
beneficiary’s (tax) residency. An exception to these restrictions may be granted at Our sole discretion and after evaluation of the facts and circumstances. Under no circumstances We will execute any policy related cash payments to US residents.


At Our request and based upon an indication that the most recent self-certification or tax residency is required respectively may no longer be reliable or accurate, a Policyowner must promptly or with the minimum number of days permitted by law provide a new self-certification
and other supporting documentation as requested by Us.


We reserve all rights to take any steps that We deem appropriate, including the right not to execute payment instructions until we have
received all information and documentation to our satisfaction, or to cancel the policy, with immediate effect or with a notice period of the minimum number of days permitted by law, in the event that We discover that a Policyowner and/or beneficiary provided an incorrect self-certification, that any other information or documentation provided in connection with identification and due diligence procedures is inaccurate or incomplete or a Policyowner did not provide Us with a self-certification or other information as requested by Us within the
response time set out in Our request.


Failure to fully respond to Our request within the time period allowed may result in the reporting of information about the Policyowner to the appropriate tax authority or other authorities.


We do not provide any tax advice. Any information relating to applicable tax laws and regulations is of a general nature only. This policy is designed for Policyowners who are resident in Malaysia. If you decide to live outside of Malaysia after this policy has been issued, and if you have questions or wish to receive additional information with respect to any of the provisions set forth above We recommend you
obtain independent advice.


We reject any responsibility or liability whatsoever for any adverse tax consequences that may arise in respect of your policy and/ or any payments made under your policy as a result of you changing the country of residency.


Your insurance contract has been concluded based on the legal and regulatory requirements in force and applicable at the time of conclusion. Should the mandatory legal and regulatory requirements applicable to this policy change, in particular if you change your country of residency, and as a consequence We are not able to continue performing the contract without potential material adverse effect
to Us, to meet the changed legal and regulatory requirements We are entitled to modify the contractual terms and conditions as We deem
appropriate at Our own discretion and without your consent, or to terminate the policy.


We will inform you whenever reasonably possible in advance about the changes in the contractual terms and conditions. In the case of
termination of the policy, We will send you a termination notice and the contract will terminate in accordance with the termination notice.


We reject any responsibility or liability whatsoever for any cost incurred by, or liability imposed on, a Policyowner as a result of Our good faith efforts to comply with requirements regarding the identification, due diligence or reporting of information relating to Policyowners for tax purposes.



NOTICE

Every notice or communication to Us shall be in writing and sent to Us.


Any notices, requests, instructions, or correspondences to be given by Us shall be sent by either post, electronic means or any other
methods deemed practicable to the last known address provided by the Applicant/Owner to Us in writing, and such communication
shall be conclusively deemed to have been received by the Applicant/Owner.


NON-PARTICIPATING IN PROFITS
A non-participating policy shall not be entitled to share in Our profits.



OTHER CONTRACT

If the Life Assured is covered under other Life policy covering any Disability covered by this Policy Contract, We shall only pay the remaining of Eligible Expenses incurred if the Life Assured received any reimbursement from other Life policy covering any Disability covered by this Policy Contract.



OVERSEAS TREATMENT

If the Life Assured is referred to be treated outside Malaysia by the attending Specialist, benefits in respect of the treatment shall be limited to the Reasonable and Customary and Medically Necessary charges for such equivalent local treatment in Malaysia and shall
exclude the cost of transport to the place of treatment.



PERIOD OF COVER AND RENEWAL

This Policy shall become effective as of the date stated in the Policy Information Page or Endorsement. The Policy Anniversary shall be one (1) year after the Commencement date of this Policy and annually thereafter. On each such anniversary, this Policy is renewable at the
premium in effect at that time as notified by us.

This Policy is renewable up to age ninety-nine (99).



PROOF OF AGE

Where the Life Assured’s age has not been verified, We may require proof of age of the Life Assured before the payment of benefits under
this Policy.



RESIDENCE OVERSEAS

No benefit whatsoever shall be payable for any medical treatment received by the Life Assured outside Malaysia, if the Life Assured
resides or travels outside Malaysia for more than ninety (90) consecutive days.



SANCTIONS

All financial transactions are subject to compliance with applicable trade or economic sanctions laws and regulations. We will not provide you with any services or benefits including but not limited to acceptance of premium payments, claim payments and other reimbursements, if in doing so We violate applicable trade sanctions laws and regulations.


We may terminate the policy if We identify you or any of your directors, shareholders or officers as sanctioned persons, or you conduct an activity which is sanctioned, according to trade or economic sanctions laws and regulations.



SUBROGATION

If We shall become liable for any payment under this Policy Contract, We shall be subrogated to the extent of such payment to all the
rights and remedies of the Applicant/Owner against any party and shall be entitled at its own expense to sue in the name of the Applicant/Owner. The Applicant/Owner shall give or cause to be given to Us all such assistance in his/her power as We shall require
securing the rights and remedies and at our request shall execute or cause to be executed all documents necessary to enable Us to effectively to bring suit in the name of the Applicant/Owner.



TAX

All premium and fees payable under this policy may be subject to Tax. If Tax is imposed, it will be stated in the invoice, and We may claim or collect the Tax from the Applicant/Owner in addition to the premium and/or fees payable under this Policy.



TERMINATION

This policy shall automatically terminate on the first occurrence of the following events:
a)
On the death of the Life Assured; or
b)
On the Policy Anniversary following the hundredth (100th) birthday of the Life Assured; or
c)
If any premium on this Policy remains unpaid at the end of the Grace Period; or.

d)
If this policy becomes terminated, lapsed, matures/expires, or is surrendered; or
e)
When the change in risk as stated in the Change In Risk clause below has rendered the Life Assured to be no longer insurable
by Us; or
f)
When a written request for termination of this Policy is submitted to Us for endorsement to that effect.


Termination of this Policy Contract will have no effect to any claim arising prior to such termination.


We reserve the right to terminate this Policy Contract if the Life Assured makes any claim which is fraudulent or exaggerated, or if the Life Assured makes any false declaration or statements in support of any claim.


TAKE-OVER POLICIES
This Policy shall commence immediately upon termination of a preceding Policy if take-over benefit is granted. If the Waiting Period of the previous Policy has not expired immediately before the take-over, the said Waiting Period shall continue until they are fulfilled.



EXCLUSIONS

This Policy Contract shall not cover any Hospitalisation, Surgery or charges caused directly or indirectly, wholly or partly, by any one (1) of the following occurrences:
1)
Pre-existing Conditions; or
2)
Plastic/Cosmetic Surgery or treatment (except medically necessary Surgery), circumcision (except circumcision due to infection), eye examination, glasses and refraction or surgical correction of near sightedness (Radial Keratotomy) and the use or acquisition of
external prosthetic appliances or devices such as artificial limbs, hearing aids, implanted pacemakers and prescriptions thereof; or
3)
Dental conditions including dental treatment or oral Surgery except as necessitated by Accidental Injuries to sound natural teeth occurring wholly during the coverage period of the Policy Contract; or
4)
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 (Human Immunodeficiency Virus) related
diseases, and any communicable diseases requiring quarantine by law except for the Eligible Expenses covered under
Hospitalisation Due To Covid-19 Or Complication Arising From Covid-19 Vaccination; or
5)
Any treatment or surgical operation for Congenital Conditions or deformities including hereditary conditions; or
6)
Pregnancy, childbirth (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; or
7)
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 General Practitioner and/or Specialist; or
8)
Treatments specifically for weight reduction or gain; or
9)
Suicide, Attempted suicide or intentionally self-inflicted injury while sane or insane; or
10) 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; or
11) Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material; or
12) Expenses incurred for donation of any body organ by the Life Assured and costs of acquisition of the organ including all costs incurred by the donor during organ transplant and its complications; or
13) 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; or
14) Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations); or
15) 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; or
16) 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; or
17) Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes; or
18) Expenses incurred for sex changes.



COMPASSIONATE BENEFIT

Compassionate Benefit shall not be paid if the Life Assured commits suicide within one (1) year from the Issue Date.



WAITING PERIOD

Eligibility for benefits begins thirty (30) days after the Commencement Date or effective date of change or date of reinstatement of this
Policy, except for a covered Accident occurring after the Commencement Date or effective date of change or date of reinstatement as
stated in the Policy Information Page or Endorsement. For Specified Illnesses including Cancer, the Waiting Period is occurring during the first one hundred and twenty (120) days from the Commencement Date or effective date of change or reinstatement date whichever is latest.



SECTION B


REFERRAL EMERGENCY ASSISTANCE PROGRAMME (EAP)

We have an agreement with Integrated Health Plans (Malaysia) Sdn Bhd, the appointed MCO (hereinafter known as the “Service Provider”), to provide a comprehensive international medical assistance programme. This value-added service programme is specially
provided to all Life Assured (hereinafter known as “the Member”) under this Policy Contract.


Member may place a reverse charge call/call collect to the Service Provider’s Service Hotline at any time seven (7) days a week for any
of the services described below:

Integrated Health Plans (Malaysia)


24 Hours Service Hotline

1-800-82-6100


All the benefits under this programme will automatically cease on the earliest happening of the events as stated under Termination clause.


1.



International Medical Assistance Programme

Services described herein are available to the Member traveling anywhere outside Malaysia with each trip not exceeding ninety
(90) consecutive days.


1.1
Tele-medical consultation and evaluation of the Member’s condition
When medical advice is needed during travel outside Malaysia, the Member is to call the Service Provider for
assistance and advice. The Service Provider’s duty doctor will provide help over the phone.

Important:
The telephone conversation does not amount to the establishment of a diagnosis and must be considered as advice
only.


1.2
Medical Referral and Arrangement of Medical Appointments
Upon request, the Service Provider shall provide the names, addresses and telephone numbers of medical
practitioner (including both General Practitioners and Specialists), Hospitals, Dentists, and dental clinics. The Service
Provider will attempt upon request to confirm the availability of the applicable medical or dental professional to make
an appointment for treatment.


1.3
Arrangement of Hospital Admission Guarantee
In the event that the emergency admission is needed, and Member has no means for the required Hospital admission
deposit, the Service Provider will provide admission guarantee on behalf of the Member, such service shall be
subjected to the Service Provider having first securing payment guarantee through credit card or funds from the
Member’s family.


1.4
Dispatch of Medication Not Available Locally
The Service Provider will dispatch the necessary medication not available locally in case of an emergency and where
local laws, rules and regulations allow such dispatch. Cost of medicine shall be borne by the Member and the Service
Provider shall pay for the cost of such dispatching.


1.5
Medical Evacuation
Following a medical emergency and Hospitalisation, when the Service Provider’s doctor in consultation with the
attending General Practitioner and/or Specialist determines that local medical facility is inadequate to treat the
Member, the Service Provider will arrange for medical evacuation under constant medical supervision to the nearest
adequate medical facility.


1.6
Medical Supervised Repatriation
If the Service Provider’s doctor, in consultation with the local attending General Practitioner and/or Specialist,
determines the treatment should continue at a medical facility nearer home following stabilisation, the Service
Provider will arrange for the repatriation under constant medical supervision.

All decisions as to the means of transportation and the final destination will be made by the Service Provider or its
authorised representative and will be based solely upon medical necessity.


The Medical Evacuation and Medical Supervised Repatriation services described in 1.5 and 1.6 above shall be organised by
the Service Provider and paid by Us subject to the provisions of this Policy Contract. All costs incurred are subject to a limit of
US Dollar One Million (USD 1,000,000) per Member per event.


1.7
Medical Monitoring & Emergency Message Transmission
The Service Provider will monitor the Member’s condition if the Member is hospitalised and will keep the Member’s
employer/family informed, with prior agreement of the Member in writing, unless this is not practicable.


1.8 Repatriation of Mortal Remains
If the Member dies while on the trip due to a Sickness or an Accident, the Service Provider or its authorized
representative will organise and pay for all expense incurred for the return of the body or remains to the Member’s
country of origin. All costs incurred for such repatriation is subject to a maximum limit of Ringgit Malaysia Fifty
Thousand (RM 50,000).


1.9 Visit to Bedside by a Friend/Relative
Should the Member’s hospitalisation outside Malaysia be expected to last more than seven (7) consecutive days, and
the Service Provider’s duty doctor agrees that it is medically necessary for a relative/friend to be by the Member’s
bedside provided no travel companion is with the Member, the Service Provider will arrange and We shall pay for one


economy class return transportation and hotel room accommodation for a relative/friend to visit the Member. The cost
of hotel room accommodation is subject to a limit of Ringgit Malaysian Eight Hundred (RM 800) per night up to a
maximum of Ringgit Malaysian Three Thousand Five Hundred (RM 3,500).


1.10 Return of Children Travelling with the Member
In the event of the Member’s Hospitalisation and the Member’s medical condition prevents the Member from caring
for the Member’s minor children (below age of eighteen (18) years) travelling with the Member and no relative is on
the spot able is to care for them, the Service Provider will arrange for one way economy class transportation for the
children to be sent back to their country of origin. We shall pay for the cost incurred for the one-way economy class
ticket for all minor children travelling with the Member.


2.



Travel Assistance


2.1
Visa, Passport and Inoculation Requirements
The Service Provider will provide information concerning Visa, inoculation, passport or immunization requirements of
the foreign countries in which the Member will be travelling.


2.2
Location of Lost Items
The Service Provider will assist the Member in the location of lost luggage, documents and personal items. Airlines,
government authorities and credit card issuers are among those who will be contacted, if necessary.


2.3
Emergency Message Relay
In case of an emergency, the Service Provider will attempt to establish a national or international message relay to a
designated addressee.


2.4
Arrangement of Flights
The Service Provider will assist with the arrangement of flights for family return if travelling with the Member.


2.5
Legal Referral
Should the Member seek legal assistance for an emergency while on a trip, the Service Provider will refer the Member
to local legal advisors.


2.6
Referral to Interpreter/Translator
Should the Member needs translation assistance for an emergency in the course of the Member’s trip, the Service
Provider will refer the Member to a local translator.



2.7
Weather and Foreign Exchange Information
The Service Provider shall provide information on foreign weather condition as well as foreign exchange rates when
required.


3.



Car Assistance

3.1
24 hours Emergency Towing and Minor Roadside Repair
In the event that a Member’s car is immobilised due to accident or breakdown, the Member shall be entitled to contact
the Service Provider for assistance.

Should it be deemed possible to repair the Member’s car on the spot, the Service Provider shall arrange for such
minor roadside repair. In the event it is not possible to repair the car on the site, the Service Provider shall arrange
for the car to be towed to the nearest workshop for repairs. Any cost incurred for the towing and minor roadside repair
shall be borne by the Member.

Territorial Limits
The emergency towing and minor roadside repair referred to in this Clause shall be available where such services
are required within Peninsular Malaysia and Singapore excluding the islands except for Penang and Langkawi. In
East Malaysia, services shall only be available in Kota Kinabalu, Sandakan, Tawau, Labuan, Sibu, Bintulu, Miri and
Kuching.


3.2
Car Rental Assistance
Should the Member require a car replacement in the event of a car breakdown, the Service Provider shall refer to
designated third party service providers and assist the Member in arranging for car rental. Cost of car rental shall be
borne by the Member.


3.3
Arrangement for Hotel Accommodation
As a result of a car breakdown, should a Member needs hotel accommodation, the Service Provider shall refer the
Member to hotels designated by the Service Provider in order to make reservation and arrangement for hotel
accommodation. All costs incurred for such hotel accommodation and ancillary charges shall be solely borne by the
Member concerned.



3.4
Referral to Service Centre
The Member may contact the Service Provider to arrange for referral to the nearest repair and service centre for car
servicing or repair. The Service Provider shall also arrange for prior appointment for the Member. All costs incurred
in such car repair or servicing shall be borne by the Member.



4.



Home Assistance

The following Home Assistance Services shall only be available to Members residing in major towns of Peninsular Malaysia.


4.1
Plumbing Assistance
Should the Members require plumbing services at home, the Service Provider shall provide referral information to
plumbers. The Service Provider will also assist in arranging for house call if necessary.



4.2
Locksmith Assistance
The Service Provider will arrange for referral or house call service in the event that the Member requires the services
of a locksmith.


4.3
General Repair Assistance
The Service Provider will also provide information for general repair services such as repairs of home electrical
appliances.


4.4 Air conditioning Assistance
Should the Member require repair in relation to air conditioners, the Service Provider shall refer the Member to
persons who can provide such services and would also arrange for house call if necessary.


4.5
Pest Control Assistance
The Service Provider shall assist the Members by referring them to pest control, pest prevention, soil treatment, anti-
termite, and mosquito control services. The Service Provider will also arrange for house call if necessary.


The services described in the Travel, Car and Home Assistance above shall be purely on referral and arrangement basis. We
and the Service Provider shall not be responsible for any third-party cost incurred; such cost shall be borne directly by the Member.



DEFINITIONS


MEDICAL EMERGENCY

A situation which in the opinion of the Service Provider’s doctor constitutes a serious medical emergency requiring urgent remedial treatment to avoid death or serious impairment to the Member’s immediate or long-term health prospects. The severity of the medical
condition will be judged within the context of the Member’s geographical location, the nature of the medical emergency and the local
availability of appropriate medical care or facilities.



MINOR ROADSIDE REPAIR

Minor repairs are such that are deemed possible to be repaired on the spot including but not limited to change of tyres, minor wiring work and change of battery. The minor roadside repairs are also subject to the availability of parts and component at the time of the breakdown.



EXCLUSIONS

The International Medical Assistance Programme described above is subject to the list of exclusions below:
1)
Emergency medical evacuation, repatriation or costs not approved in advance and in writing by the Service Provider and/or not
arranged by the Service Provider. This exclusion shall not apply to Emergency Medical Evacuation from remote or primitive
areas which the Service Provider cannot be contacted in advance and delay might reasonably be expected to result in loss of
life or extreme prejudice to the well-being of the Member.

2)
If the Member is traveling contrary to the advice of a medical practitioner or for the purpose of obtaining medical treatment or
for the rest and recuperation following any prior accident or illness.

3)
If in the opinion of the Service Provider, the Member is not suffering from a serious medical condition or if the treatment can be
reasonably delayed until the Member returns to Malaysia or usual country of residence.

4)
If the Member is participating or engaging in war or any act of war (whether war be declared or not), invasion acts of foreign
enemies, hostilities, rebellion, revolution, insurrection, military or usurped power, illegal activities, active servicing in any of the
military or armed forces other than peace time reservist training.

5)
If the Member is suffering from any condition resulting from ionising radiation or contamination by radioactivity from any nuclear
fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material.

6)
Failure by the Member to take reasonable precautions following warnings of any intended strike, riot or civil commotion via the
mass media.

7)
Self-inflected injury or attempted suicide, mental or psychiatric disorder, drug addiction or abuse, alcohol abuse, sexually transmitted diseases, Acquired Immune Deficiency Syndrome (AIDS) or any AIDS related conditions or diseases.

8)
Any expenses arising from childbirth, miscarriage, pregnancy (except abnormal pregnancy or vital complication of pregnancy
which endangers the life of the mother and/or unborn children).

9)
Any Injuries arising from racing of any kind (other than racing on foot), sports exhibitions, bungee jumping, mountaineering or
rock climbing necessitating the use of guides or ropes, scuba diving, aeronautics or aviation activities other than as a fare paying passenger in a properly licensed commercial or private aircraft or professional sports.

10) Any health condition constitutes one of the reasons to undertake the trip.



ADDITIONAL CONDITIONS

a)
We and the Service Provider shall not be held responsible for the failure or delay to provide the services caused by strikes or
conditions beyond Our and the Service Provider’s control including, but not limited to, flight conditions or where local laws of
regulatory agencies prohibit the Service Provider from rendering such services.


b)
The legal professionals, medical professionals, car assistance and/or home assistance providers referred by the Service
Provider to provide direct services to the Member are not employees or agents of the Service Provider and/or its subsidiaries
or affiliated companies. We and the Service Provider and/or its subsidiaries or affiliated companies cannot be held responsible
for the quality or results of any services provided by independent practitioners to whom the Service Provider refers the Member.


c)
This programme shall cease in the event that the Policy Contract is terminated.


d)
We shall be entitled to vary any of the provisions herein and withdraw from this programme at any time by giving thirty (30)
days’ notice in writing with accompanying notification letter detailing the reason of change.



Z-MedProtect Policy


OUR AGREEMENT WITH YOU


Consumer Insurance Contract

This Policy is issued in consideration of the payment of premium as specified in the Policy Schedule and pursuant to the answers given in the Policyholder’s Proposal Form (or when the Policyholder applied for this insurance) and any other disclosures made by the Policyholder between the time of submission of the Policyholder’s Proposal Form (or when the Policyholder applied for this insurance) and the time this
contract is entered into. The answers and any other disclosures given by the Policyholder shall form part of this contract of insurance between
the Policyholder and Us. However, in the event of any pre-contractual misrepresentation made in relation to the Policyholder’s answers or in
any disclosures given by the Policyholder, only the remedies in Schedule 9 of the Financial Services Act 2013 will apply.

This Policy reflects the terms and conditions of the contract of insurance as agreed between the Policyholder and Us.


Non-Consumer Insurance Contract
This Policy is issued in consideration of the payment of premium as specified in the Policy Schedule and pursuant to the answers given in the
Policyholder’s Proposal Form (or when the Policyholder applied for this insurance) and any other disclosures made by the Policyholder between the time of submission of the Policyholder’s Proposal Form (or when the Policyholder applied for this insurance) and the time this
contract is entered into. The answers and any other disclosures given by the Policyholder shall form part of this contract of insurance between
the Policyholder and Us. In the event of any pre-contractual misrepresentation made in relation to the Policyholder’s answers or in any disclosures made by the Policyholder, it may result in avoidance of the Policyholder’s contract of insurance, refusal or reduction of Policyholder’s claim(s), change of terms or termination of the Policyholder’s contract of insurance.

This Policy reflects the terms and conditions of the contract of insurance as agreed between the Policyholder and Us.



DEFINITIONS

Certain words have been defined below. These have the same meaning wherever they are used in the Policy. They are bold and begin with a
capital letter (e.g. Insured Person, You, Your).


ACCIDENT or ACCIDENTAL shall mean a sudden, unforeseen and fortuitous event that happens unexpectedly during the Period of Insurance.


ACCIDENTAL DENTAL TREATMENT shall mean dental procedure necessary as a result of Accident.


ACT OF TERRORISM shall mean an act, including the use of force or violence, of any person or group of persons, whether acting alone or on
behalf of or in connection with any organisation, committed for political, religious or ideological purposes including the intention to influence any
government and/or to put the civilian population in fear for such purposes.


ANY ONE DISABILITY shall mean the whole period of Disability arising from the same cause including any and all complications therefrom
except that if You completely recover and remain free from further treatment (including drugs, medicines, special diet or injection or advice for
the condition) of the Disability for at least ninety (90) days following the latest date of discharge and subsequent Disability from the same cause
shall be considered as though it were a new Disability.


AS CHARGED refers to actual charges incurred for reasonable, necessary and customary medical care provided in the treatment of a covered
Disability.


CONGENITAL CONDITIONS shall mean any medical or physical abnormalities existing at the time of birth, as well as neo-natal physical
abnormalities developing within six (6) months from the time of birth. They will include hernias of all types and epilepsy except when caused by
trauma, which occurred after the date You were continuously covered under this Policy.


DAY shall mean the definition of a charging Day adopted by the Hospital concerned.


DAY SURGERY shall mean a patient who needs the use of a recovery facility for a surgical procedure on a pre-plan basis at the Hospital /
Specialist Clinic (but not for overnight stay).


DENTIST shall mean a registered dental practitioner qualified and licensed to practice dentistry and who, in rendering such treatment, is
practicing within the scope of his licensing and training in the geographical area in which a service is provided, but excluding a Dentist who is
the Insured Person himself or his immediate family i.e. siblings, spouse, child or parent.


DISABILITY shall mean a Sickness, Disease, Illness or the entire Injuries arising out of a single or continuous series of causes.


DOCTOR or PHYSICIAN or SURGEON shall mean a registered medical practitioner qualified and licensed to practice Western medicine and
who, in rendering such treatment, is practicing within the scope of his licensing and training in the geographical area of practice, but excluding
a Doctor, Physician or Surgeon who is the Insured Person himself or his immediate family i.e. siblings, spouse, child or parent.



Z-MedProtect/PW/20220113

Page 1 of 14

ELIGIBLE EXPENSES shall mean Medically Necessary expenses incurred due to a covered Disability but not exceeding the limits in the Schedule of Benefits.


EMERGENCY shall mean treatment needed in the event whereby immediate medical attention is required within the twelve (12) hours of Injury,
Illness or symptoms which are sudden and severe failing where Your life could be threatened or lead to significant deterioration of health.


FAMILY MEMBERS shall mean Your legal spouse(s), parents and child(ren).


HOSPITAL shall mean only an establishment duly constituted and registered as a Hospital for the care and treatment of sick and injured person
as paying bed-patients, and which:
(a) has facilities for diagnosis and major Surgery,
(b) provides twenty-four (24) hours a day nursing service by registered and graduate nurse,
(c) is under supervision of a Physician, and
(d) is not primarily a clinic; a place for alcoholics or drug addicts; a nursing, rest or convalescent home or a home for the aged or similar establishment.


HOSPITALISATION shall mean admission to a Hospital as a registered in-patient for Medically Necessary treatments for a covered Disability
upon recommendation of a Physician. A patient shall not be considered as an in-patient if the patient does not physically stay in the Hospital
for the whole period of confinement.


INJURY shall mean bodily Injury caused solely by an Accident.


POLICYHOLDER shall mean a person or a corporate entity or an association/affinity to which the Policy has been issued in respect of cover for
persons specifically identified as the Insured Person in this Policy and can exercise all rights, privileges and options available under this Policy.


INSURED PERSON / YOU / YOUR shall mean the person(s) covered described in the Policy Schedule.


INTENSIVE CARE UNIT shall mean a section within a Hospital which is designated as an Intensive Care Unit by the Hospital, and which is
maintained on a twenty-four (24) hours basis solely for treatment of patients in critical condition and is equipped to provide special nursing and
medical services not available elsewhere in the Hospital.


LOSS OF HEARING shall mean permanent irrecoverable loss of hearing.


LOSS OF LIMB shall mean loss by physical separation at or above the wrist or ankle joint.


LOSS OF SIGHT shall mean the entire and permanent irrecoverable loss of sight.


LOSS OF SPEECH shall mean total permanent inability to communicate verbally.


LOSS OF USE shall mean permanent total functional disablement and is treated like total loss of said limb or organ and not in terms of Your professional or occupational incapacity or covered event.


MALAYSIAN GOVERNMENT HOSPITAL shall mean a Hospital which charges of services are subject to the Fee Act 1951 Fees (Medical)
Order 1982 and/or its subsequent amendments if any.


MEDICALLY NECESSARY shall mean a medical service which is:
(a) consistent with the diagnosis and customary medical treatment for a covered Disability, and
(b) in accordance with standards of good medical practice, consistent with current standard of professional medical care, and of proven medical
benefits, and
(c) not for Your convenience or the Physician, and unable to be reasonably rendered out of Hospital (if admitted as an inpatient), and
(d) not of an experimental, investigational or research nature, preventive or screening nature,
(e) for which the charges are fair and reasonable and customary for the Disability.


NO CLAIM BONUS shall mean upon renewal of this Policy (provided such renewal is continuous, the Policy has not been lapse in any one (1)
given year, and no claim has been made during the preceding year of cover), the No Claim Bonus of ten percent (10%) shall be applicable. The
No Claim Bonus is not cumulative and in the event of a claim being made by any one of You, the No Claim Bonus will be forfeited totally.


OUTPATIENT shall mean You are receiving medical care or treatment without being hospitalised and includes treatment in a daycare centre.


OVERALL ANNUAL LIMIT shall mean benefits payable in respect of expenses incurred for treatment provided to You during the Period of
Insurance shall be limited to Overall Annual Limit as stated in the Schedule of Benefits irrespective of type / types of Disability. In the event the
Overall Annual Limit having been paid in full, all insurance for You hereunder shall immediately cease to be payable for the remaining Policy
Year.


OVERSEAS shall mean any destination outside of Malaysia.


PERIOD OF INSURANCE shall mean the duration of the Policy as stated in the Policy Schedule.


PERMANENT TOTAL DISABLEMENT shall mean disablement that result solely, directly and independently of all other causes from bodily Injury and which occurs within three hundred sixty-five (365) consecutive days will in all probability entirely prevent You from engaging in
employment of any and every kind for the remainder of Your life and from which there is no hope of improvement.


POLICY SCHEDULE shall refer to the document issued by Us that is issued to verify the existence of Insurance coverage granted to You.



Z-MedProtect/PW/20220113

Page 2 of 14

POLICY YEAR shall mean the one (1) year period including the effective date of commencement of Insurance and immediately following that
date, or the one (1) year period following the Renewal or Renewed Policy.


PRE-EXISTING CONDITION shall be limited to Disabilities which existed before the effective date of cover and for which You should have
reasonably been aware of. You may be considered to have reasonable knowledge of a Pre-Existing Condition where the condition is one for
which:
(a) You have received or are receiving treatment;
(b) medical advice, diagnosis, care or treatment has been recommended;
(c) clear and distinct symptoms are or were evident; or
(d) its existence would have been apparent to a reasonable person in the circumstances.


PRESCRIBED MEDICINES shall mean medicines that are dispensed by a Physician, registered pharmacist or a Hospital and which have
been prescribed by a Physician / Specialist in respect of treatment for a covered Disability.


REASONABLE AND CUSTOMARY CHARGES shall mean charges for medical care which is Medically Necessary shall be considered
reasonable and customary to the extent that it does not exceed the general level of charges being made by others of similar standing in the
locality where the charge is incurred, when furnishing like or comparable treatment, services or supplies to individual of the same gender and of
comparable age for a similar Sickness, Disease or Illness and in accordance with accepted medical standards and practice could not have
been omitted without adversely affecting Your medical condition.


RENEWAL OR RENEWED POLICY shall mean a Policy which has been renewed without any lapse of time upon expiry of a preceding Policy
with the same content.


RM shall mean in Ringgit Malaysia, the currency of Malaysia.


SERIOUS INJURY OR SERIOUS ILLNESS shall mean a critical or dangerous Disability which in the opinion of a Physician or Service Provider, requires urgent remedial treatment to avoid death or serious impairment to immediate or long-term health conditions.


SERVICE PROVIDER shall mean the twenty-four (24) hours worldwide emergency assistance.


SICKNESS, DISEASE OR ILLNESS shall mean a physical condition marked by a pathological deviation from the normal healthy state.


SPECIALIST shall mean a medical or dental practitioner registered and licensed as such in the geographical area of his practice where treatment
takes place and who is classified by the appropriate health authorities as a person with superior and special expertise in specified fields of
medicine or dentistry, but excluding a Physician or Surgeon or Dentist who is the Insured Person himself or his immediate family i.e. siblings, spouse, child or parent.


SPECIFIED ILLNESSES shall mean the following disabilities and its related complications, occurring within the first one hundred and twenty
(120) days of continuous cover:
(a) Hypertension, Diabetes Mellitus and Cardiovascular Disease.

(b) All tumours of any kind, 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 discs) and knee conditions.


SURGERY shall mean any of the following medical procedures:
(a) To incise, excise or electrocauterize any organ or body part, except for dental services.

(b) To repair, revise or reconstruct any organ or body part.

(c) To reduce by manipulation a fracture or dislocation.

(d) Use of endoscopy to remove a stone or object from the larynx, bronchus, trachea, oesophagus, stomach, intestine, urinary bladder or
urethra.


TAX shall mean any present or future, direct or indirect, Tax, levy or duty, including consumption Tax or any Tax of similar nature, which is imposed on goods and services by government or Tax authority.


WAITING PERIOD shall mean the first thirty (30) days between the beginning of Your Disability and the commencement of this Policy date /
reinstatement date and is applied only when the person is first covered. This shall not be applicable after the first year of cover. However, if there
is a break in insurance, the Waiting Period will apply again.


WAR shall mean a contest by force between two (2) or more nations, carried on for any purpose, or armed conflict of sovereign powers, or
declared or undeclared and open hostilities or the state of nations among whom there is an interruption of peaceful relations and a general
contention by force, both authorised and unauthorised, by the sovereign.


WE / OUR / US shall mean Zurich General Insurance Malaysia Berhad, who is the insurer / issuer of the Policy.



Z-MedProtect/PW/20220113

Page 3 of 14

DESCRIPTION OF BENEFITS
SCHEDULE OF BENEFITS
Benefits
Plan 1
Plan 2
Plan 3
Plan 4


Plan 5

Overall Annual Limit (RM)
100,000
300,000
500,000
1,000,000
2,000,000
(for Section A & Section B)
No Claim Bonus
Reduction of 10% on renewal premium (if no claims made)
Section A – Inpatient & Daycare Benefits
100
150
180
200
500
Hospital Room & Board (RM)
(maximum 365 days per annum)
As Charged
Intensive Care Unit
(maximum 180 days per annum)
Hospital Supplies & Services
As Charged
Daycare Procedures
As Charged
Surgical Fees
As Charged
Anaesthetist's Fee
As Charged
Operating Theatre Fee
As Charged
As Charged
In-Hospital Physician Visit
(unlimited)
Ambulance Fees
As Charged
100
Daily-Cash Allowance at Government Hospital (RM)
(maximum 365 days per annum)
250
Insured Child's Daily Guardian Benefit (RM)
(maximum per disability)
Medical Report Fees (RM)
150
Organ Transplant
As Charged
(Heart, Kidney, Lung, Liver or Bone Marrow)
Tax on Eligible Expenses
As Charged
Section B – Outpatient Benefits
As Charged
Pre-Hospital Diagnostic Tests
(within 60 days prior to hospitalisation)
As Charged
Pre-Hospital Specialist Consultation
(within 60 days prior to hospitalisation)
As Charged
Post Hospitalisation Treatment
(within 90 days from hospitalisation)
As Charged
Emergency Accidental Outpatient Treatment
(within 24 hours and follow-up treatment to a maximum of 60 days)
As Charged
Outpatient Physiotherapy Treatment
(within 90 days from discharge)
Outpatient Kidney Dialysis Treatment
As Charged
Outpatient Cancer Treatment
As Charged
Emergency Accidental Outpatient Dental Treatment
4,000 (per accident)
(RM)
4,000
Home Nursing Care (RM)
(up to 180 days, lifetime maximum)
Second Surgical Opinion
As Charged
Section C - Special Benefits (Additional limit on top of the Overall Annual Limit)
Accidental Death and Permanent Disablement (RM)
50,000
International Emergency Medical Evacuation and
50,000
Repatriation (RM)
(maximum per annum)
Funeral Expenses (all causes) (RM)
2,000
Section D – Optional

Options
A
B
C


D

Deductible

Deductible (per Any One Disability)
RM 0
RM 5,000
RM 10,000
RM 20,000
Amount
(applicable for Section A only)
Premium
0%
15%
30%
50%
Discount


Z-MedProtect/PW/20220113

Page 4 of 14

SECTION A – INPATIENT & DAYCARE BENEFITS (subject to Overall Annual Limit)
(a) HOSPITAL ROOM AND BOARD
We shall reimburse the Reasonable and Customary Charges Medically Necessary for room accommodation and meals. The amount
of the benefit shall be equal to the actual charges made by the Hospital during Your confinement, but in no event shall the benefit exceed,
for any one Day, the rate of Room and Board Benefit, and the maximum number of Days as set forth in the Schedule of Benefits. You will
only be entitled to this benefit while confined to a Hospital as an inpatient.


(b) INTENSIVE CARE UNIT
We shall reimburse the Reasonable and Customary Charges for actual room and board incurred during confinement as an inpatient in
the Intensive Care Unit of the Hospital. This benefit shall be payable equal to the actual charges made by the Hospital subject to the
maximum benefit for any one Day, and maximum number of Days, as set forth in the Schedule of Benefits. Where the period of confinement
in an Intensive Care Unit exceeds the maximum set forth in the Schedule of Benefits, reimbursement will be restricted to the standard
daily Hospital Room and Board rate. No Hospital Room and Board Benefits shall be paid for the same confinement period where the daily
Intensive Care Unit Benefits is payable.


(c) HOSPITAL SUPPLIES & SERVICES
We shall reimburse the Reasonable and Customary Charges actually incurred for general nursing, prescribed and consumed drugs and
medicines, dressings, splints, plaster casts, x-ray, laboratory examinations, electrocardiograms, physiotherapy, basal metabolism tests,
intravenous injections and solutions, administration of blood and blood plasma, including the cost of blood and plasma whilst You are
confined as an inpatient in a Hospital, up to the amount stated in the Schedule of Benefits.


(d) DAYCARE PROCEDURES
We shall reimburse the Reasonable and Customary Charges for medical and professional charges incurred in respect of a Day Surgery
(Surgical and Medical) performed in an Outpatient setting (without Hospital admission) up to maximum limit per Disability stated in the
Schedule of Benefits. This shall include follow-up treatment by the same Attending Physician / Specialist / Surgeon within the maximum
amount as stated in the Schedule of Benefits. Any Daycare Procedure done for investigative and diagnostic purposes not related to
Treatment for any specific Disabilities is not covered.


(e) SURGICAL FEES
We shall reimburse the Reasonable and Customary Charges for a Surgery by the Specialist/Surgeon, including pre-surgical
assessment, Specialist’s/Surgeon’s visits to You and post-surgery care from the date of Surgery, subject to the maximum amount of
benefits indicated 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 maximum amount of benefit stated in the Schedule of Benefits.


(f)
ANAESTHETIST’S FEE
We shall reimburse the Reasonable and Customary Charges by the Anaesthetist for the administration of anaesthesia not exceeding the
limits as set forth in the Schedule of Benefits.


(g) OPERATING THEATRE FEE
We shall reimburse the Reasonable and Customary Operating Room charges incidental to the surgical procedure not exceeding the limits
as set forth in the Schedule of Benefits.


(h) IN-HOSPITAL PHYSICIAN VISIT
We shall reimburse the Reasonable and Customary Charges by a Physician for Medically Necessary visiting an in-paying patient while
confined for a non-surgical Disability not exceeding the maximum amount as set forth in the Schedule of Benefits.


(i)


AMBULANCE FEES

We shall reimburse the Reasonable and Customary Charges incurred for necessary domestic road ambulance services (inclusive of
attendant) to and/or from the Hospital of confinement. Payment will not be made if You are not hospitalised and subject to the limits set
forth in the Schedule of Benefits.


(j)
DAILY-CASH ALLOWANCE AT GOVERNMENT HOSPITAL
We shall pay daily cash allowance for each Day of confinement for a covered Disability in a Malaysian Government Hospital, provided
that You shall be confined in a Room and Board at a rate that does not exceed the amount and number of Days shown in the Schedule of
Benefits.


(k) INSURED CHILD’S DAILY GUARDIAN BENEFIT
We shall reimburse the expenses for meals and lodging incurred to accompany Your Child (aged below fifteen (15) years) in the Hospital
but shall not exceed the limits set forth in the Schedule of Benefits.


(l)


MEDICAL REPORT FEES

We shall reimburse the actual fee charged for completion of a medical report by the attending Physician / Surgeon in respect of each
Disability but not to exceed the amount as stated in the Schedule of Benefits.


(m) ORGAN TRANSPLANT
We shall reimburse the Reasonable and Customary Charges incurred on transplantation Surgery for You being the recipient of the transplant of a heart, kidney, lung, liver or bone marrow. Payment for this benefit shall be subject to the limit as set forth in the Schedule of
Benefits. The costs of acquisition of the organs and all costs incurred by the donors are not covered.


(n) TAX ON ELIGIBLE EXPENSES
We shall reimburse the amount of the Tax On Eligible Expenses levied by the clinics or Hospitals on taxable supplies and services provided to You that are payable under this policy subject to the limits set forth in the Schedule of Benefits.



Z-MedProtect/PW/20220113

Page 5 of 14

SECTION B – OUTPATIENT BENEFITS (subject to Overall Annual Limit)
(a) PRE-HOSPITAL DIAGNOSTIC TESTS
We shall reimburse the Reasonable and Customary Charges for ECG, X-ray and laboratory tests which are performed for diagnostic
purposes on account of an Injury or Illness when in connection with a Disability preceding Hospitalisation within the maximum number
of Days and amount as set forth in the Schedule of Benefits in a Hospital and which are recommended by a Physician / Specialist. No
payment shall be made if upon such diagnostic services, You do not result in Hospital confinement for the treatment of the medical
condition diagnosed.

(b) PRE-HOSPITAL SPECIALIST CONSULTATION
We shall reimburse the Reasonable and Customary Charges for the consultation by a Specialist in connection with a Disability within
the maximum number of Days and amount as set forth in the Schedule of Benefits preceding confinement in a Hospital and provided that
such consultation is Medically Necessary and has been recommended in writing by the attending Physician / Specialist, which includes
prescription for medication and any subsequent consultation which is subject to the Schedule of Benefits limit. Payment will not be made
where You do not result in Hospital confinement for the treatment of the medical condition diagnosed.

(c) POST-HOSPITALISATION TREATMENT
We shall reimburse the Reasonable and Customary Charges incurred in follow-up treatment for the same Disability as during
Hospitalisation immediately following discharge from Hospital for a non-surgical Disability which includes prescription for medication,
within the maximum number of Days and amount as stated in the Schedule of Benefits.

(d) EMERGENCY ACCIDENTAL OUTPATIENT TREATMENT
We shall reimburse the Reasonable and Customary Charges incurred for up to the maximum stated in the Schedule of Benefits, as a
result of a covered bodily Injury arising from an Accident for Medically Necessary treatment as an Outpatient at any registered clinic or
Hospital within twenty-four (24) hours of the Accident causing the covered bodily Injury. Follow-up treatment by the same Doctor or same
registered clinic or Hospital for the same covered bodily Injury will be provided up to the maximum amount and the maximum number of
days as set forth in the Schedule of Benefits.

(e) OUTPATIENT PHYSIOTHERAPY TREATMENT
We shall reimburse the Reasonable and Customary Charges incurred for Outpatient physiotherapy treatment referred in writing by a
licensed Specialist / Physician after Surgery or In-Hospital Treatment, within ninety (90) days from the date of Hospital discharge up
to the maximum as set forth in the Schedule of Benefits.

(f)


OUTPATIENT KIDNEY DIALYSIS TREATMENT

If You are diagnosed with Kidney Failure as defined below, We will reimburse the Reasonable and Customary Charges incurred for the
Medically Necessary treatment of kidney dialysis performed at a legally registered dialysis centre subject to the limit of this Disability as
specified 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 centre or immediately following discharge from Hospital Confinement or Surgery.

Kidney Failure means end-stage renal failure presenting as chronic, irreversible failure of both kidneys to function as a result of which
renal dialysis is initiated.

It is a specific condition of this Benefit that notwithstanding the exclusion of Pre-Existing Conditions, this Benefit will not be payable for
You, if You have developed chronic renal diseases and/or are receiving dialysis treatment prior to the effective date of Insurance.

(g) OUTPATIENT CANCER TREATMENT
If You are diagnosed with Cancer as defined below, We will reimburse the Reasonable and Customary Charges incurred for the treatment
of cancer performed at a legally registered cancer treatment centre subject to the limit of this Disability as specified in the Schedule of
Benefits. The treatment types covered as cancer treatment are only limited to radiotherapy and chemotherapy (injectable or oral), including
consultation, examination tests and take-home drugs.

Such treatment must be received or advised at the Outpatient department of a Hospital or a registered cancer treatment centre or
immediately following discharge from the Hospital Confinement or after the Surgery.

Cancer is defined as the uncontrollable growth and spread of malignant cells and the invasion and destruction of normal tissue for which
major interventionist treatment or Surgery (excluding endoscopic procedures alone) is considered necessary. The cancer must be
confirmed by histological evidence of malignancy.

It is a specific condition of this Benefit that notwithstanding the exclusion of Pre-Existing Conditions, this Benefit will not be payable for
You who had been diagnosed as a Cancer patient and/or is receiving Cancer treatment prior to the effective date of Insurance.

(h) EMERGENCY ACCIDENTAL OUTPATIENT DENTAL TREATMENT
We shall reimburse the Reasonable and Customary Charges incurred for up to the maximum stated in the Schedule of Benefits, as a
result of an Accidental Injury and received as an Outpatient Accidental Dental Treatment within twenty-four (24) hours of the occurrence
of the Accident in a registered dental clinic or Hospital and the subsequent follow-up treatment by the same Dentist will be provided up
to the maximum amount as set forth in the Schedule of Benefits.

(i)


HOME NURSING CARE

We shall reimburse the Reasonable and Customary Charges, up to the maximum number of days and amount stated in the Schedule of
Benefits, for Medically Necessary continued nursing care by a registered nurse to You in a home. Such nursing care must be
recommended by the attending Physician or Surgeon and be for a minimum duration of four (4) hours each day. This benefit is only
payable if there has been an earlier claim paid for in respect of the medical condition for which Hospitalisation was required by You.

Home Nursing Care cover under this Policy includes:
(i) Physical, occupational or speech therapies;
(ii) Therapy, treatments for wound, respiratory, diabetes care, colostomy care, tube feeding, injection and other medication administration
to You at home.

Custodial care, meals, general house-keeping services, companions and personal comfort item, or any services for activities of daily living
that are not Medically Necessary will not be payable. The benefit payable shall not exceed the maximum number of days and amount for
the plan as stated in the Schedule of Benefits.



Z-MedProtect/PW/20220113

Page 6 of 14

(j)


SECOND SURGICAL OPINION

We shall reimburse the Reasonable and Customary Charges for consultation with a Specialist to obtain a second opinion prior to Surgery in respect of an Illness or Injury requiring Surgery up to the maximum amount as set forth in the Schedule of Benefits. Payment
will not be made where You do not result in Hospital confinement for the treatment of the medical condition diagnosed.



SECTION C – SPECIAL BENEFITS (Additional limit on top of the Overall Annual Limit)
(a) ACCIDENTAL DEATH AND PERMANENT DISABLEMENT
If You suffer a bodily Injury, which shall within twelve (12) consecutive months result in death or disablement as provided in the Table of
Benefits described herein, We will pay the amount stated in the Schedule of Benefits according to the respective percentage of the sum
insured as stated in the Table of Benefits.

Percentage of Sum


Description of Disablement

Insured (%)
Loss of life
100
Loss of Limbs (two limbs)
100
Loss of both hands, or of all fingers and both thumbs
100
Total paralysis
100
Total insanity
100
Injuries resulting in being permanently bedridden
100
Any other injury causing Permanent Total Disablement
100
Loss of arm at shoulder
100
Loss of arm between shoulder and elbow
100
Loss of arm at elbow
100
Loss of arm between elbow and wrist
100
Loss of hand at wrist

100
Loss of leg
-
at hip
100

-
between knee and hip
100

-
below knee
100
Eye: Loss of
-
Sight of whole eye
100

-
Sight, except perception of light
50

-
lens
50
Loss of four (4) fingers and thumb of one (1) hand
50%
Loss of four (4) fingers

40
Loss of thumb
-
both phalanges
25

-
one (1) phalanx
10
Loss of index finger
-
three (3) phalanges
10

-
two (2) phalanges
8

-
one (1) phalanx
4
Loss of middle finger
-
three (3) phalanges
6

-
two (2) phalanges
4

-
one (1) phalanx
2
Loss of ring finger
-
three (3) phalanges
5

-
two (2) phalanges
4

-
one (1) phalanx
2
Loss of little finger
-
three (3) phalanges
4

-
two (2) phalanges
3

-
one (1) phalanx
2
Loss of metacarpals
-
first or second (additional)
3

-
third, fourth or fifth (additional)
2
Loss of toes
-
all phalanges
15

-
great, both phalanges
5

-
great, one (1) phalanx
2

-
other than great, if more than one (1) toe lost each
1


Loss of Hearing

-

both ears
75

-
one (1) ear
15


Loss of Speech

50

The degree of shortening of limbs must be certified by a Physician.

Where the bodily Injury is not specified, We reserve the right to adopt a percentage of sum insured based on the disablement, which, in
Our opinion, is consistent with the provisions of the above Table of Benefits.

“Loss” of limb or member or part thereof shall mean loss by actual physical severance or total and permanent Loss of Use.

Loss of Use of body member shall be treated as loss of body member.

The aggregate of all percentages payable in respect of any one (1) Accident shall not exceed 100%. In the event a total of 100% is paid,
all coverage hereunder shall immediately cease to be in force. All other losses less than 100% if having been paid shall reduce the coverage
under this benefit by that amount from the date of Accident until the expiry of the Policy Schedule.

Z-MedProtect/PW/20220113

Page 7 of 14


Special Provisions

•
Coma
Upon certification by a Physician that You have been in a state of coma for at least one (1) year due to an Accident, We will pay
100% of the Sum Insured. However, We have the right to recover the payment made if You regain consciousness provided that a
deduction of 10% of the aforesaid payment be made for each year You were in a state of coma.

•
Disappearance
It will be presumed that death has occurred if You have been missing for twelve (12) consecutive months and We have examined all
available evidence provided to support the conclusion that death was caused by an Accident covered.


(b) INTERNATIONAL EMERGENCY MEDICAL EVACUATION AND REPATRIATION
If You suffer a Serious Injury or Serious Illness in Overseas, and in Our or the Service Provider’s opinion, it is judged medically appropriate to move You to another location for medical treatment, the Service Provider will arrange the evacuation utilising the means
We or the Service Provider believe to be the most appropriate based on the medical severity of Your condition, subject to the limits set
forth in the Schedule of Benefits.

If You suffer a Serious Injury or Serious Illness in Overseas, and in Our or the Service Provider’s opinion, it is judged medically appropriate to return You to Malaysia, the Service Provider will arrange the repatriation utilising the means We or the Service Provider
believe to be the most appropriate based on the medical severity of Your condition, subject to the limits set forth in the Schedule of Benefits.

If You suffer a Disability in Overseas and result in death, Our Service Provider will make:
(i)
all the necessary transportation arrangements (including any procedures or arrangements necessary to meet local formalities) for the
return of Your mortal remains to Malaysia; and
(ii) all the necessary arrangements for funeral, cremation, casket or embalming (if so selected) at the place of death in Overseas, but
excluding any expenses related to religious rights, ceremonies or burial posts.

Specific Conditions Applicable to Benefit (b):
The decisions on the means of transportation and final destination will be made by the Service Provider at Our sole discretion. You must
follow Our or the Service Provider’s instruction and direction at all times.

Specific Exclusions Applicable to Benefit (b):
We shall not be liable in respect of any claims for, directly or indirectly caused by any of the following:
(i)
services rendered without the authorisation and/or intervention of the Service Provider;
(ii) services provided by any parties other than the Service Provider for which no charge is usually made;
(iii) medical treatment administered by Your relatives and/or family member whether qualified or not;
(iv) Disability which in the opinion of the Service Provider’s Physician that You are physically able to travel sitting as a normal passenger and without medical escort.


(c) FUNERAL EXPENSES (ALL CAUSES)
We shall pay a lump sum as specified in the Schedule of Benefits, if You die during the Period of Insurance.


SECTION D – OPTIONAL
(a) DEDUCTIBLE
The Policy is subject to a deductible amount which is stated in the Schedule of Benefits. Deductible means a monetary sum that shall be
deducted from the Eligible Expenses under Section A incurred by You, and on per Any One Disability basis when You are admitted to
any private hospital. However, if You are admitted to any Malaysian Government Hospital, the Eligible Expenses incurred will not be
subject to the deductible amount.



CONDITIONS
1.



AGE LIMIT

The age eligibility to qualify for this Policy ranges from thirty (30) days old to sixty five (65) years old, and renewable up to one hundred
(100) years old. All ages refer to the age at Your next birthday.

2.



ALTERATIONS

We reserve the right to amend the terms and provisions of this Policy by giving a thirty (30) days prior notice in writing by ordinary post to
Policyholder’s last known address in Our records with a valid reason, and such amendment will be applicable from the next renewal of
this Policy. No alteration to this Policy shall be valid unless authorised by Us and such approval is endorsed thereon. We would also give
thirty (30) days prior written notice to the Policyholder according to the last recorded address for any alterations made.

3.



ARBITRATION

All differences arising out of this Policy shall be referred to an Arbitrator who shall be appointed in writing by the parties in difference. In the
event they are unable to agree on who is to be the Arbitrator within one (1) month of being required in writing to do so then both parties
shall be entitled to appoint an Arbitrator each who shall proceed to hear the differences together with an Umpire to be appointed by both
Arbitrators. However, this is provided that any disclaimer of liability by Us for any claim hereunder must be referred to an Arbitrator within
twelve (12) calendar months from date of such disclaimer.

4.



AUTOMATIC TERMINATION

The policy shall automatically terminate on the earliest happening of the following events:
(a) on the date the Policy Schedule is cancelled; or
(b) on Your death; or
(c) on the next renewal date if You attain the maximum age limit at one hundred (100) years old; or
(d) on the next renewal date or premium due date, whichever earlier, if the required premium is not paid within fourteen (14) days from
Policy expiry date.

Termination of this Policy shall be without prejudice to any claim arising prior to such termination. The payment or acceptance of any
premium hereunder subsequent to termination of this Policy shall not create any liability but We shall refund any such premium.



Z-MedProtect/PW/20220113

Page 8 of 14

5.



CANCELLATION

This Policy may be cancelled by the Policyholder at any time by giving a written notice to Us, and provided that no claims have been made
during the current Policy Year, the Policyholder shall be entitled to a refund of the premium as follows:
Period Not Exceeding


Refund of Annual Premium

15 days (for renewal only)
90%
1 month
80%
2 months
70%
3 months
60%
4 months
50%
5 months
40%
6 months
30%
7 months
25%
8 months
20%
9 months
15%
10 months
10%
11 months
5%
Period exceeding 11 months
No refund
There shall be no refund of premium for non-annual payment mode.

6.



CASH BEFORE COVER

It is fundamental and an absolute special condition of this contract of insurance that the premium due must be paid and received by Us
before insurance cover is effective.



7.

CERTIFICATION, INFORMATION AND EVIDENCE
All certificates, information, medical reports and evidence as required by Us shall be furnished at the expense of the Policyholder, and in
such a form that We may require. In any event all notices which We shall require the Policyholder to give must be in writing and addressed
to Us. Policyholder shall, at Our request and expense, submit to a medical examination whenever such is deemed necessary.

8.



CLAIM PROCEDURES

(a) You shall within thirty (30) days of a Disability that incurs claimable expenses, give written notice to Us stating full particulars of such event, including all original bills and receipts, and a full Physician’s report stipulating the diagnosis of the condition treated and the
date the Disability commenced in the Physician’s opinion and the Physician’s summary of the cost of treatment including medicines
and services rendered. Failure to furnish such notice within the time allowed shall not invalidate any claim if it is shown not to have
been reasonably possible to furnish such notice and that such notice was furnished as soon as was reasonably possible.

(b) You shall immediately procure and act on proper medical advice and We shall not be held liable in the event a treatment or service
becomes necessary due to Your failure to do so.



9.

CO-PAYMENT (sub-standard policy only)
Co-payment borne by the Policyholder under cost-sharing or coinsurance terms shall not exceed twenty percent (20%) of the claimable
expenses (i.e. excluding Deductibles) per Disability, subject to an absolute maximum limit of Ringgit Malaysia Three Thousand (RM
3,000) (inclusive of Deductibles) per Disability. The limit mentioned above is not applicable to Upgraded Room and Board Co-Payment
and policies that provide for Overall Annual Limit exceeding Ringgit Malaysia One Hundred Thousand (RM 100,000).



10. CONDITION PRECEDENT TO LIABILITY

The due observance and the fulfilment of the terms, provisions and conditions of this Policy by each of You and in so far as they relate to
anything to be done or complied with by You shall be conditions precedent to any liability of Ours.



11. CONTRIBUTION

If You carry other insurance/takaful covering any Illness or Injury insured by this Policy, We shall not be liable for a greater proportion of such Illness or Injury than the amount applicable hereto under this Policy bears to the total amount of all valid insurance/takaful covering
such Illness or Injury.

12. COOLING-OFF PERIOD
If the Policyholder decides not to take up the Policy after it has been issued, the Policyholder may return the Policy to Us for cancellation
provided such request for cancellation is delivered by the Policyholder to Us within fifteen (15) days from the date of Policyholder’s receipt of the Policy. The Policyholder is entitled to the refund of the full premium paid less deduction of medical expenses incurred by Us
in the issue of the Policy. In the event of a claim(s) has been made, no refund of premium shall be payable.



13. CURRENCY OF PAYMENT

All payments under this Policy shall be made in the legal currency of Malaysia. Should any payment be requested by You to be payable in
any other currency, then such amount shall be payable in the demand currency as may be purchased in Malaysia at the prevailing currency
market rates on the date of the claim settlement.



14. DUTY OF DISCLOSURE

(a) Consumer Insurance Contract
Where the Policyholder has applied for this Insurance wholly for himself/family/dependants, the Policyholder had a duty to take
reasonable care not to make a misrepresentation in answering the questions in the Proposal Form (or when the Policyholder applied
for this insurance) i.e. the Policyholder should has answered the questions fully and accurately. Failure to have taken reasonable
care in answering the questions may result in avoidance of the Policyholder’s contract of insurance, refusal or reduction of the
Policyholder’s claim(s), change of terms or termination of the Policyholder’s contract of insurance in accordance with the remedies
in Schedule 9 of the Financial Services Act 2013. The Policyholder is also required to disclose any other matter that the Policyholder
knews to be relevant to Our decision in accepting the risks and determining the rates and terms to be applied.

The Policyholder also has a duty to tell Us immediately if at any time after the Policyholder’s contract of insurance has been entered
into, varied or renewed with Us any of the information given in the Proposal Form (or when the Policyholder applied for this insurance)
is inaccurate or has changed.

(b) Non-Consumer Insurance Contract
Where the Policyholder has applied for this Insurance for the purpose of providing medical insurance benefits to the Policyholder’s
Z-MedProtect/PW/20220113

Page 9 of 14

employees and their dependants, the Policyholder had a duty to disclose any matter that the Policyholder knows to be relevant to
Our decision in accepting the risks and determining the rates and terms to be applied and any matter a reasonable person in the
circumstances could be expected to know to be relevant otherwise it may result in avoidance of the Policyholder’s contract of
insurance, refusal or reduction of the Policyholder’s claim(s), change of terms or termination of the Policyholder’s contract of
insurance.

The Policyholder also has a duty to tell Us immediately if at any time after the Policyholder’s contract of insurance has been entered
into, varied or renewed with Us any of the information given in the Proposal Form (or when the Policyholder’s applied for this
insurance) is inaccurate or has changed.

15. FULL REIMBURSEMENT IN A GOVERNMENT HOSPITAL
Charges for eligible medical expenses are covered in full for treatment in a Malaysian Government Hospital for each Illness or Injury.



16. GENERAL CONDITIONS

This Policy and the Schedule of Benefits shall be read together as one (1) contract and any words or expression to which a specific meaning
has been attached in any part of this Policy or of the Schedules shall bear such specific meaning wherever it may appear.



17. GEOGRAPHICAL TERRITORY

All benefits provided in this Policy are applicable worldwide for twenty-four (24) hours a day. If You are non- Malaysian, Your coverage will
be limited to Hospitals within Malaysia only.



18. GRACE PERIOD

Notwithstanding the Cash before Cover condition, a Grace period of fourteen (14) days from the premium due date will be allowed for
payment of each premium. During such fourteen (14) days, We shall remain liable thereunder if by the last of such days, the premium is
actually paid. If any premium is not paid in respect of this Policy Contract before the end of the Grace period, this Policy Contract shall be
deemed as terminated at the expiry date of the Policy.



19. GOVERNING LAW

This Policy is issued under the laws of Malaysia and is subject to and governed by the laws prevailing in Malaysia.



20. IMPORTANT NOTICE

We wish to draw Your attention to the following important information:
(a) Proof of Age will be required at times of maturity / claims, if Age has not been admitted.

(b) You can contact Our Agents, Branch Officers, and Customer Service Department at Our Head Office for any enquiry or service relating
to Your Policy.

(c) The change of address of the Policyholder should be notified to Us so that all correspondence can be directed promptly.



21. INCOMPLETE CLAIMS

All claims must be submitted to Us within thirty (30) days of completion of the events for which the claim is being made. Claims are not
deemed complete and Eligible Benefits are not payable unless all bills for such claims have been submitted and agreed upon by Us. Only
actual costs incurred shall be considered for reimbursement. Any variation or waiver of the foregoing shall be at Our sole discretion.



22. INTEPRETATION OF THE POLICY

Where the context so permits, words importing the singular number only shall include the plural number and vice versa and words importing
the masculine gender only shall include the feminine gender and neuter gender and words importing persons shall include corporations.



23. MEDICAL EXAMINATION

We shall have the right to examine Your body whenever it may reasonably require and to conduct an autopsy in case of death where it is
not forbidden by law.



24. MISSTATEMENT OF AGE

If Your age had been misstated and the premium paid as a result thereof is insufficient, any claim payable under this Policy shall be prorated
based on the ratio of the actual premium paid to the correct premium which should have been charged for the year. Any excess premium,
which may have been paid as a result of such misstatement of age, shall be refunded without interest. If at Your correct age would not
have been eligible for cover under this Policy, no benefit shall be payable.

25. MISTATEMENT OR OMMISSION OF MATERIAL FACT
This Policy shall be void if:
(a) any answer, disclosure or representation by the Policyholder, before this contract of insurance is entered into, varied or renewed, in
or to any proposal or declaration or query, has been deliberately or recklessly incorrectly stated in any respect; or
(b) before this contract of insurance is entered into, varied or renewed, the Policyholder has failed to disclose any fact the Policyholder
knew to be relevant to Our decision on whether to accept the risk or not and the rates and the terms to be applied; or
(c) any claim made shall be fraudulent or exaggerated, or if any false declaration or statement shall be made in support of such claim.



26. MULTIPLE INSURED PERSON DISCOUNT

If the Policyholder purchase a policy with multiple Insured Persons which are his/her Family Members, a Multiple Insured Person Discount is applicable. The Multiple Insured Person Discount percentage is depending on the total number of Insured Persons specified
in the Policy Schedule. The Multiple Insured Person Discount is not cumulative and in the event of a revision in total number of Insured
Persons, the Multiple Insured Person Discount will be revised accordingly.



27. NOMINATION

Nomination shall mean the process of the Policyholder appointing individual(s) to receive the policy monies in the event of the death of
Policyholder (who is also the Insured Person) at any time after the Policy Schedule has been issued. If You are the Insured Person, You may nominate a person(s) to receive the policy moneys payable under this Policy Schedule. Where Policyholder or You die without
having made a nomination, We shall pay the policy moneys to the lawful executor or administrator of Policyholder or Your estate. Payment
of policy moneys will be made in accordance to the Financial Services Act 2013.



28. NOTICE

Every notice or communication to Us shall be in writing and sent to Us. No alterations in the terms of this Policy or any endorsement thereon, will be held valid unless the same is signed or initiated by Our authorised representative.

Z-MedProtect/PW/20220113

Page 10 of 14


29. OVERSEAS TREATMENT

If You seek treatment Overseas, benefits in respect of the treatment shall be covered subject to the exclusions, limitations and conditions
specified in this Policy and all benefits will be payable based on the official exchange rate ruling on the last Day of the Period of Confinement
and shall exclude the cost of transport to the place of treatment provided:
(a) You are travelling abroad for a reason other than for medical treatment, need to be confined to a Hospital outside Malaysia as a
consequence of an Emergency.

(b) Upon recommendation of a Physician and You have to be transferred to a Hospital outside Malaysia because the specialised nature
of the treatment, aid, information or decision required can neither be rendered nor furnished nor taken in Malaysia.

Overseas treatment of a Disease, Sickness or Injury which is diagnosed in Malaysia and non-emergency or chronic conditions where
treatment can reasonably be postponed until return to Malaysia are excluded.



30. OWNERSHIP OF POLICY

Unless otherwise expressly provided for by Endorsement in the Policy, We shall be entitled to treat the Policyholder as the absolute owner
of the Policy. We shall not be bound to recognise any equitable or other claim to or interest in the Policy, and the receipt of the Policy or a
Benefit by the Policyholder (or by his legal or authorised representative) alone shall be an effective discharge of all Our obligations and
liabilities. The Policyholder shall be deemed to be responsible Principal or Agent of You covered under this Policy.

31. PERIOD OF COVER AND RENEWAL
This Policy will be renewable at the option of Policyholder subject to the terms, conditions and termination at each of the anniversary of
the Policy date. The renewal premiums payable is not guaranteed and We reserve the right to revise the premium rate applicable at the
time of renewal. Such changes, if any, shall be applicable to all Policyholders irrespective of their claim experience according to Our risk
assessment.

This Policy is renewable at the option of Policyholder until the occurrence of any of the following:
(a) non-payment of premium or premium not made on time
(b) fraud or misrepresentation of material fact during application
(c) the policy is cancelled at the request of the Policyholder
(d) the death of You
(e) You attain the coverage age limit specified
(f)
termination of coverage for all policies in a certain market and We withdraw this Policy completely from the market in accordance with
the Portfolio Withdrawal Condition.



32. PORTFOLIO WITHDRAWAL

We reserve the right to cancel the portfolio as a whole if We decide to discontinue underwriting this insurance product. Cancellation of the
portfolio as a whole shall be given by reasonable written notice in advance with valid reasons to the Policyholder and We will run off all
policies to expiry of the period of cover within the portfolio.



33. PREMIUM

During the Period of Insurance, the premiums for insurance under this Policy are not guaranteed and shall be based on the premium rates
in force at the time of renewal. Premiums are payable at the premium rate according to each member’s age next birthday on each Policy
year anniversary. We shall have the right to change the rate at which premiums shall be calculated, at the start of any Policy Year, provided
that We notify the Policyholder at least thirty (30) days in advance of the date such premium is due.



34. PROOF OF LOSS

Upon receipt of such notice, We will furnish to the Claimant forms for filing proof of loss. If the forms are not furnished within fifteen (15)
days, the Claimant by submitting written proof covering the occurrence, the character and the extent of the loss for which claim is made
shall be deemed to have complied with the requirement of this provision.

Proof of loss must be furnished to Us in case of claim for Disability within ninety (90) days after termination of the period of Disability for
which We are liable, and in case of claim of any other loss, within ninety (90) days after the date of such loss.



35. REINSTATEMENT

If You do not pay a premium within the Grace Period and the Policy terminates, You will not have any Insurance cover or benefit. If the
Policy terminates, You may apply to reinstate the Policy within one (1) year after the premium’s due date which was not paid. However,
You must:
(a) fill in and sign a reinstatement form;
(b) truthfully declare all facts in the reinstatement form;
(c) produce all the information (if any) We have asked for; and
(d) pay all overdue premiums.



36. RESIDENCE OVERSEAS

No benefit whatsoever shall be payable for any medical treatment received by You outside Malaysia, if You reside or travel outside Malaysia
for more than ninety (90) consecutive days.



37. SANCTION

We shall not be deemed to provide coverage or will make any payments or provide any service or benefit to the Policyholder, You or other
party to the extent that such cover, payment, service, benefit would violate any applicable trade or economic sanctions law or regulation.

38. TAKE-OVER POLICIES
If this Policy shall have commenced immediately upon termination of a preceding Policy and if You shall have been afflicted with a medical
Disability prior or at the time this Policy started (and benefits under the preceding Policy would have been available to You), You shall
continue to be covered for the existing Disability, but not to exceed the limits of the previous Policy on condition We have secured a copy
of the preceding Policy.



39. UPGRADED POLICIES

If the Eligible Benefits to You under the terms of this Policy be increased while it is in force or at the time of Renewal or replacement and if
You have been afflicted with a Disability prior or at the time the Benefits were increased, the Limits of Benefits payable in respect of such
Disability shall not exceed the Limit of Benefits prior to the date the Benefits were upgraded.



Z-MedProtect/PW/20220113

Page 11 of 14

40. UPGRADED ROOM AND BOARD CO-PAYMENT
If You are hospitalised at a published Room & Board rate which is higher than Your eligible benefit, You shall bear the difference in Room
& Board only.



41. TAX PROVISION

All premium and fees payable under this Policy may be subject to Tax. If Tax is imposed, it will be stated in the invoice and We reserve the
right to claim or collect the Tax from You in addition to the premium and/or fees payable under this Policy.



EXCLUSIONS

EXCLUSIONS APPLICABLE TO SECTION A & SECTION B
This contract does not cover any Hospitalisation, Surgery or charges caused directly or indirectly, wholly or partly, by any one (1) of the following occurrences:
1.

Pre-Existing Condition.

2.

Specified Illnesses occurring during the first one hundred and twenty (120) days of continuous cover.

3.

Waiting Period of thirty (30) days for all except Accidental Injuries.

4.

Elective cosmetic or plastic Surgery except reconstructive Surgery necessary to restore function after an Accident that has occurred during the period of cover.

5.

Eye Examinations, glasses, contact lenses and surgical procedures for the correction of eye refractive errors and the use or acquisition of
external prosthetic appliances or corrective devices such as artificial limbs, hearing aids, implanted pacemakers, prescription thereof.

6.

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.

7.

Private nursing, rest cures or sanitaria care, any treatment received purely as an Outpatient Hospitalisation primarily for investigatory
purposes, diagnosis, X-ray examination, general physical or medical examinations, not incidental to the treatment or diagnosis of a covered
Disability or any treatment which is not Medically Necessary and any preventive treatment, preventive medicines or examination carried
out by a Physician and treatments specifically for weight reduction or gain.

8.

Any treatment or surgical operation for congenital abnormalities or deformities including hereditary conditions.

9.

Pregnancy, child birth (including surgical delivery), miscarriage, abortion and prenatal or postnatal care and any surgical, mechanical or
chemical contraceptive methods of birth control or treatment pertaining to infertility, gender change, sexual dysfunction including impotency,
tests or treatment related to sterilization and circumcision performed due to any reason other than Illness or infection.

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. Treatment for any medical conditions arising directly or indirectly from radioactivity contamination or any nuclear material whatsoever,
including the combustion of nuclear fuel.

13. Expenses incurred for donation of any body organ by You and costs of acquisition of the organ including all costs incurred by the donor
during organ transplant and its complications.

14. Investigation into and treatment of sleep and snoring disorders, psychiatric, psychotic, mental or nervous disorders, including neuroses and
their physiological or psychosomatic manifestations, psychiatric disorders such as neuro-psychosis, schizophrenia and others.

15. Hormone replacement therapy and alternative therapy such as treatment, medical services or supplies, including but not limited to
chiropractic services, acupuncture, acupressure, reflexology, bone setting, herbalist treatment, massage or aromatherapy.

16. Care or treatment for which payment is not required or to the extent which is payable by any other insurance or indemnity covering You
and Disabilities arising out of duties of employment or profession that is covered under a Workmen’s Compensation Insurance Contract.

17. Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations).

18. 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.

19. 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, mountaineering with use of ropes or mountain guides
and illegal activities.

20. Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established
routes.

21. Epidemic and/or pandemic.


EXCLUSIONS (APPLICABLE TO SECTION C – Benefit a)
We shall not be liable for claims directly or indirectly caused by or which results from: 1.

You when engaging in or taking part in: -
(a) Armed forces, naval or air force service or operations;
(b) Professional sports, winter sports other than skating;
(c) Rock climbing or mountaineering (necessitating the use of ropes or mountain guides), potholing, martial arts or boxing, underwater
activities exceeding fifty (50) metres in depth, aerial activities including parachuting, hang-gliding, bungee jumping or any kind of race
other than on foot;
(d) Air travel except as a fare-paying passenger on a recognised airline operating on regular scheduled air routes and air travel by any
charter aircraft duly licensed as a recognised air carrier and flown by professional crews between properly established and maintained
airports;
(e) Criminal act or any illegal activities.

2. Intoxication of alcohol or drug, unless the drug is taken under the direction of a Physician provided such direction is not for the treatment of
drug addiction.

3. Provoked murder or assault, intentional self-injury, suicide or attempted suicide while sane or insane.

4. Pregnancy, childbirth, miscarriage.

5. Mosquito bites.

6. Sickness, Disease or medical disorder.

7. Pre-Existing Condition.

8. Deliberate exposure to exceptional danger (except in an attempt to save human life).

9. HIV (Human Immunodeficiency Syndrome) and/or any HIV related illnesses including AIDS (Acquired Immune Deficiency Syndrome) or
Z-MedProtect/PW/20220113

Page 12 of 14

AIDS Related Complex (ARC) however caused and/or any mutant derivatives, variations or treatment thereof however caused.

10. Direct participation in riot or civil commotion, invasion, acts of foreign enemies, hostilities (whether War be declared or not), rebellion,
revolution, insurrection, mutiny or usurped power.

11. Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear
fuel. For the purpose of this exclusion combustion shall include any self-sustaining process of nuclear fission.

12. War, civil War – whether declared or not.

13. Any Act of Terrorism.

14. Epidemic and/or pandemic (also applicable to Section C – Benefit c).



NOTICE UNDER PERSONAL DATA PROTECTION ACT 2010 (PDPA)
The Personal Data Protection Act 2010 which regulates the processing of personal data in commercial transactions, applies to Us. You may
make inquiries, complaints, request for access, update, correct or change any of Your personal data, limit the processing of Your personal data
and/or to opt-out of Our use at any time hereafter by submitting such request to Us by sending an email to <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS>. Requests
for opt-out must state clearly the full name, identity document number, policy number, telephone number and address of the person making such
request.

The processing of Your personal data is subject to Our Personal Data Protection Notice as published on https://www.zurich.com.my/pdpa.



Z-MedProtect/PW/20220113

Page 13 of 14


PROCEDURES FOR MAKING INSURANCE COMPLAINTS

We are committed to delivering the best customer experience. If you have any complaints or dissatisfactions with any of our products
or services, we would like to hear from you. You can contact us at:


Zurich General Insurance Malaysia Berhad

Level 23A, Mercu 3, No. 3, Jalan Bangsar, KL Eco City, 59200 Kuala Lumpur, Malaysia.

Tel: 03-2109 6000
Fax: 03-2109 6888
Call Centre: 1-300-888-622
E-mail: <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS>


Other Avenues to Seek Redress

If you are not satisfied with our final response or decision, you may write to Ombudsman for Financial Services (OFS) (formerly known
as Financial Mediation Bureau) with details of the dispute and particulars of your policy.

If the OFS makes an award against us, you are required to inform the OFS of your decision to accept or deny the award within fourteen
(14) days. If you do not accept the award, you may reject the decision of the OFS. you may choose to institute a court proceeding
against us or refer it to Arbitration.

The OFS can be contacted through:
Ombudsman for Financial Services (OFS)
Level 14, Main Block, Menara Takaful Malaysia, No. 4, Jalan Sultan Sulaiman, 50000 Kuala Lumpur
Tel: <PRESIDIO_ANONYMIZED_PHONE_NUMBER>
Fax: 03-2272 1577
Email: <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS>
Website: www.ofs.org.my

If your complaint does not fall within the purview of the OFS, you may refer your complaint to Laman Informasi Nasihat dan Khidmat
(LINK) of Bank Negara Malaysia (BNM) at the following address:
Write to:
Customer Service Centre (BNMLINK), Bank Negara Malaysia, P.O. Box 10922, 50929 Kuala Lumpur.

Tel: 1 300 88 5465
Fax: 03 2174 1515
Email: <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS>
Website: www.bnm.gov.my

Walk-in:
Ground Floor, Block D, Bank Negara Malaysia, Jalan Dato’ Onn, 50480 Kuala Lumpur.



Zurich General Insurance Malaysia Berhad

Registration no. 201701035345 (1249516-V)
Level 23A, Mercu 3, No.3, Jalan Bangsar, KL Eco City, 59200 Kuala Lumpur, Malaysia.

Tel: 03 2109 6000 Fax: 03 2109 6888 Call Centre: 1 300 888 622
www.zurich.com.my

Z-MedProtect/PW/20220113

Page 14 of 14


Polisi Z-MedProtect


PERJANJIAN ANTARA KITA


Kontrak Insurans Pengguna

Polisi dikeluarkan sejajar dengan pembayaran dari premium yang ditentukan dalam Jadual Polisi dan menurut kepada kenyataan yang telah
dikemukakan di dalam borang cadangan (atau semasa Pemilik Polisi membuat permohonan insurans ini) dan segala kenyataan yang telah
dibuat oleh Pemilik Polisi pada atau semasa penyerahan borang cadangan (atau semasa Pemilik Polisi mebuat permohonan insurans ini)
dan pada masa perjanjian ini ditandatangani. Jawapan dan sebarang pernyataan lain yang Pemilik Polisi berikan akan menjadi sebahagian
daripada kontrak insurans antara Pemilik Polisi dan pihak Kami. Walau bagaimanapun, sekiranya terdapat sebarang salah nyata semasa pra-
kontrak berhubung dengan jawapan Pemilik Polisi atau di mana-mana pernyataan yang diberikan oleh Pemilik Polisi, hanya remedi yang
terdapat dalam Jadual 9 Akta Perkhidmatan Kewangan 2013 akan diguna pakai.

Polisi ini bertindak atas terma-terma dan syarat-syarat kontrak insurans seperti yang telah dipersetujui antara Pemilik Polisi dan pihak Kami.



Kontrak Insurans Bukan Pengguna

Polisi dikeluarkan sejajar dengan pembayaran dari premium yang ditentukan dalam Jadual Polisi dan menurut kepada kenyataan yang telah
dikemukakan di dalam borang cadangan (atau semasa Pemilik Polisi membuat permohonan insurans ini) dan segala kenyataan yang telah
dibuat oleh Pemilik Polisi pada atau semasa penyerahan borang cadangan (atau semasa Pemilik Polisi membuat permohonan insurans ini)
dan pada masa perjanjian ini ditandatangani. Jawapan dan sebarang pernyataan lain yang Pemilik Polisi berikan akan menjadi sebahagian
daripada kontrak insurans antara Pemilik Polisi dan pihak Kami. Sekiranya terdapat sebarang salah nyata pada pra-kontrak berhubung dengan
jawapan Pemilik Polisi atau di mana-mana pernyataan yang diberikan oleh Pemilik Polisi, ia mungkin mengakibatkan pembatalan kontrak
insurans, keengganan atau pengurangan gantirugi, perubahan terma atau penamatan kontrak insurans Pemilik Polisi.

Polisi ini bertindak atas terma-terma dan syarat-syarat kontrak insurans seperti yang telah dipersetujui antara Pemilik Polisi dan pihak Kami.



DEFINISI

Terdapat beberapa perkataan tertentu yang ditakrifkan seperti yang di bawah. Perkataan ini mempunyai maksud yang sama apabila digunakan
dalam Polisi ini. Perkataan ini telah ditebalkan dan bermula dengan huruf besar (contoh: Orang Yang Diinsuranskan, Anda).


KEMALANGAN bermaksud kejadian yang berlaku secara tiba-tiba, tidak dijangka dan secara kebetulan tanpa diduga dalam Tempoh Insurans.


RAWATAN KEGIGIAN AKIBAT KEMALANGAN bermaksud prosedur pergigian yang diperlukan akibat Kemalangan.


TINDAKAN KEGANASAN bermaksud suatu tindakan, termasuk penggunaan kekerasan atau keganasan, mana-mana orang atau kumpulan
orang, sama ada bertindak secara perseorangan atau bagi pihak atau berhubung kait dengan mana-mana organisasi, untuk tujuan politik,
agama atau ideologi termasuk niat untuk mempengaruhi mana-mana kerajaan dan/atau membuatkan orang awam dalam ketakutan.


MANA-MANA SATU HILANG UPAYA hendaklah bermaksud semua tempoh Hilang Upaya yang timbul daripada sebab yang sama termasuk
mana-mana dan semua komplikasinya kecuali jika Anda pulih sepenuhnya dan tidak perlu menjalani apa-apa rawatan lanjut (termasuk dadah,
ubat, diet khas atau suntikan atau nasihat tentang keadaannya) bagi Hilang Upaya itu selama sekurang-kurangnya sembilan puluh (90) hari
selepas tarikh terakhir keluar Hospital dan Hilang Upaya berikutnya akibat daripada sebab yang sama hendaklah dianggap seolah-olah Hilang
Upaya itu adalah yang baru.


BAYARAN DIKENAKAN merujuk kepada bayaran sebenar yang dikenakan untuk rawatan perubatan yang munasabah, perlu dan biasa dalam
merawat Hilang Upaya yang dilindungi.


PENYAKIT KONGENITAL hendaklah bermaksud apa-apa keabnormalan perubatan atau fizikal yang wujud sejak lahir, dan juga keabnormalan
fizikal neonatal yang berkembang dalam tempoh enam (6) bulan dari tarikh kelahiran. Ini termasuk semua jenis hernia dan epilepsi kecuali
disebabkan oleh trauma yang berlaku selepas tarikh Anda dilindungi secara berterusan di bawah Polisi ini.


HARI bermaksud pentafsiran Hari yang dikenakan bayaran oleh Hospital yang berkenaan.


PEMBEDAHAN HARIAN bermaksud pesakit yang perlu menggunakan kemudahan pemulihan untuk prosedur pembedahan yang dirancang
terlebih dahulu di Hospital / Klinik Pakar (tetapi bukan untuk bermalam).


DOKTOR GIGI hendaklah bermaksud orang yang berlesen atau berdaftar sewajarnya untuk mengamalkan pergigian dalam kawasan geografi
di mana khidmat diberikan, tetapi tidak termasuk Doktor Gigi yang merupakan Orang Yang Diinsuranskan sendiri atau keluarga terdekat iaitu
adik-beradik, pasangan suami isteri, anak atau ibu bapa.


HILANG UPAYA hendaklah bermaksud Sakit, Wabak, Penyakit atau semua Kecederaan yang timbul daripada satu atau beberapa sebab
yang berterusan.


DOKTOR atau PAKAR PERUBATAN atau PAKAR BEDAH hendaklah bermaksud pengamal perubatan berdaftar yang layak dan berlesen
untuk mengamalkan Perubatan Barat dan yang, semasa memberikan rawatan itu, mengamalkannya mengikut skop pelesenan dan latihannya
di kawasan geografi profesion tersebut diamalkan, tetapi tidak termasuk Doktor, Pakar Perubatan atau Pakar Bedah yang merupakan Orang
Yang Diinsuranskan sendiri atau keluarga terdekat iaitu adik-beradik, pasangan suami isteri, anak atau ibu bapa.



Z-MedProtect/PW/20220113

Halaman 1 dari 14

PERBELANJAAN LAYAK hendaklah bermaksud perbelanjaan yang Perlu Dari Segi Perubatan yang ditanggung disebabkan oleh Hilang
Upaya yang dilindungi tetapi tidak melebihi had manfaat dalam Jadual Manfaat.


KECEMASAN bermaksud perubatan yang diperlukan dalam keadaan di mana perhatian perubatan segera diperlukan dalam tempoh dua belas
(12) jam Kecederaan, Penyakit atau gejala yang tiba-tiba dan gagal di mana kehidupan Anda boleh diancam atau membawa kepada
kemerosotan kesihatan yang ketara.

AHLI-AHLI KELUARGA hendaklah bermaksud pasangan Anda yang sah, ibu bapa dan anak-anak.


HOSPITAL hendaklah bermaksud hanya pertubuhan yang ditubuhkan dan didaftarkan sewajarnya sebagai Hospital untuk jagaan dan rawatan
orang yang sakit dan cedera sebagai pesakit atas katil berbayar, dan yang:
(a) mempunyai kemudahan untuk diagnosis dan Pembedahan utama,
(b) menyediakan khidmat jagaan dua puluh empat (24) jam sehari oleh jururawat berdaftar dan berkelayakan,
(c) di bawah penyeliaan Pakar Perubatan, dan
(d) bukan klinik, tempat untuk orang ketagih alkohol dan dadah, pusat jagaan atau rumah pemulihan atau rumah orang tua atau pertubuhan
yang serupa.


PENGHOSPITALAN hendaklah bermaksud dimasukkan ke Hospital sebagai pesakit dalam yang berdaftar untuk rawatan yang Perlu Dari
Segi Perubatan bagi Hilang Upaya yang dilindungi apabila disyorkan oleh Pakar Perubatan. Pesakit tidak boleh dianggap sebagai pesakit
dalam jika pesakit tidak tinggal di Hospital secara fizikal sepanjang tempoh dimasukkan ke Hospital.


KECEDERAAN hendaklah bermaksud kecederaan anggota badan yang semata-mata disebabkan oleh Kemalangan.


ORANG YANG DIINSURANSKAN / ANDA hendaklah bermaksud orang yang diinsuranskan dan dinyatakan dalam Jadual Polisi.


UNIT RAWATAN RAPI hendaklah bermaksud satu bahagian di Hospital yang dinamakan sebagai Unit Rawatan Rapi oleh Hospital, dan yang
diselenggara dua puluh empat (24) jam hanya untuk rawatan bagi pesakit dalam keadaan kritikal dan dilengkapi khidmat jagaan dan perubatan
khas yang tidak disediakan di mana-mana bahagian lain Hospital itu.


KEHILANGAN PENDENGARAN bermaksud kehilangan pendengaran secara kekal dan tidak boleh dipulihkan.


KEHILANGAN ANGGOTA BADAN bermaksud kehilangan akibat permisahan secara fizikal pada atau di atas pergelangan tangan atau sendi
buku lali.


KEHILANGAN PENGLIHATAN bermaksud kehilangan penglihatan yang tidak dapat dipulihkan secara keseluruhan dan kekal.


KEHILANGAN UPAYA BERTUTUR bermaksud ketidakupayaan kekal dan menyeluruh untuk berkomunikasi secara lisan.


KEHILANGAN PENGGUNAAN bermaksud kehilangan upaya fungsian secara menyeluruh dan kekal dan dianggap sebagai kehilangan seluruh
anggota badan atau organ tersebut dan bukan dari segi ketidakupayaan profesional atau pekerjaan Anda.


HOSPITAL KERAJAAN MALAYSIA hendaklah bermaksud Hospital yang bayaran khidmatnya tertakluk kepada Akta Fi 1951, Perintah Fi
(Perubatan) 1982 dan/atau pindaan berikutnya jika ada.


KEPERLUAN DARI SEGI PERUBATAN hendaklah bermaksud khidmat perubatan yang:
(a) selaras dengan diagnosis dan rawatan perubatan biasa bagi Hilang Upaya yang dilindungi, dan
(b) menurut piawai amalan perubatan yang baik, selaras dengan piawai semasa bagi rawatan perubatan profesional, juga dengan manfaat
kesihatan yang sah, dan
(c) bukan untuk kemudahan Anda atau Pakar Perubatan, dan tidak dapat diperoleh sewajarnya di luar Hospital (jika dimasukkan ke wad sebagai pesakit dalam), dan
(d) bukan berbentuk eksperimen, penyelidikan atau kajian, pencegahan atau penyaringan, dan
(e) yang bayarannya berpatutan, munasabah dan biasa bagi Hilang Upaya itu.


BONUS TANPA TUNTUTAN hendaklah bermaksud selepas pembaharuan polisi ini (dengan syarat pembaharuan tersebut berterusan, polisi
tidak pernah luput dalam mana-mana satu (1) tahun tertentu, dan tiada tuntutan dibuat selama tahun perlindungan sebelumnya), Bonus Tanpa
Tuntutan sebanyak sepuluh peratus (10%) akan diguna pakai. Bonus Tanpa Tuntutan tidak terkumpul dan sekiranya tuntutan dibuat oleh mana-
mana satu Anda, Bonus Tanpa Tuntutan akan dilucutkan sepenuhnya.


PESAKIT LUAR hendaklah bermaksud Anda yang menerima jagaan atau rawatan perubatan tanpa dimasukkan ke Hospital dan merangkumi
rawatan di pusat rawatan harian.


HAD TAHUNAN KESELURUHAN bermaksud manfaat yang dibayar bagi belanja yang dikenakan untuk rawatan yang diberikan kepada Anda
dalam Tempoh Insurans hendaklah dihadkan mengikut Had Tahunan Keseluruhan seperti yang dinyatakan dalam Jadual Manfaat tanpa
mengira jenis Hilang Upaya. Jika Had Tahunan Keseluruhan telah dibayar, maka semua insurans untuk Anda di bawah ini hendaklah dihentikan
bayarannya serta-merta bagi baki Tahun Polisi tersebut.


LUAR NEGARA bermaksud mana-mana destinasi di luar Malaysia.


TEMPOH INSURANS bermaksud tempoh Polisi seperti yang dinyatakan dalam Jadual Polisi.


HILANG UPAYA MENYELURUH DAN KEKAL bermaksud hilang upaya yang disebabkan semata-mata secara langsung dan bebas daripada
semua sebab lain kecuali akibat Kecederaan badan serta berlaku dalam tempoh tiga ratus enam puluh lima (365) hari berturut-turut dan
kemungkinan besar mencegah Anda secara sepenuhnya daripada melakukan sebarang pekerjaan untuk seumur hidup dan yang mana tiada
harapan untuk sembuh.


JADUAL POLISI hendaklah merujuk kepada dokumen yang dikeluarkan oleh Kami yang dikeluarkan untuk mengesahkan kewujudan
perlindungan Insurans yang diberikan kepada Anda.


Z-MedProtect/PW/20220113

Halaman 2 dari 14

PEMILIK POLISI hendaklah bermaksud orang atau badan korporat atau persatuan/pertalian yang kepadanya Polisi dikeluarkan bagi melindungi
orang yang secara khusus dikenal pasti sebagai Orang Yang Diinsuranskan dalam Polisi ini dan dapat menggunakan semua hak,
keistimewaan dan pilihan yang terdapat di bawah polisi ini.


TAHUN POLISI hendaklah bermaksud tempoh satu (1) tahun termasuk tarikh mula kuat kuasa Insurans dan sebaik sahaja selepas tarikh itu,
atau tempoh satu tahun selepas Pembaharuan Atau Polisi Yang Diperbaharui.

PENYAKIT SEDIA ADA hendaklah bermaksud Hilang Upaya sedia ada yang diketahui sewajarnya oleh Anda. Anda dianggap mengetahui
sewajarnya keadaan sedia ada itu apabila:
(a) Anda telah atau sedang menerima rawatan;
(b) nasihat perubatan, diagnosis, jagaan atau rawatan telah disyorkan;
(c) gejala yang jelas dan tepat dapat atau telah dilihat dengan nyata; atau
(d) kewujudannya dapat diperhatikan dengan jelas bagi orang yang mengalami keadaan itu.


UBAT YANG DIPRESKRIPSIKAN hendaklah bermaksud ubat yang diberikan oleh Pakar Perubatan, ahli farmasi berdaftar atau Hospital dan
yang dipreskripsikan oleh Pakar Perubatan atau Pakar bagi rawatan Hilang Upaya yang dilindungi.


BAYARAN MUNASABAH DAN BIASA DIAMALKAN hendaklah bermaksud bayaran rawatan perubatan yang Perlu Dari Segi Perubatan,
yang dianggap munasabah dan biasa selagi bayaran itu tidak melebihi had biasa bayaran yang dibuat oleh pihak lain yang sama kedudukannya
di tempat bayaran itu dikenakan, apabila memberikan rawatan, khidmat atau bekalan seumpamanya atau yang serupa kepada individu dengan
jantina yang sama dan kategori umur yang sama untuk Sakit, Penyakit atau Kecederaan serta selaras dengan piawai dan amalan perubatan
yang diterima dan tidak boleh diabaikan tanpa menjejaskan keadaan perubatan Anda.


PEMBAHARUAN ATAU POLISI YANG DIPERBAHARUI hendaklah bermaksud Polisi yang telah dibaharui tanpa apa-apa tempoh luput sebaik
sahaja tamatnya tempoh Polisi sebelumnya dengan kandungan yang sama tempoh.


RM bermaksud dalam Ringgit Malaysia, mata wang Malaysia.


KECEDERAAN SERIUS ATAU PENYAKIT SERIUS bermaksud Hilang Upaya kritikal atau berbahaya yang pada pendapat Pakar Perubatan
atau Penyedia Perkhidmatan, memerlukan rawatan pemulihan segera untuk mengelakkan kematian atau masalah serius kepada keadaan
kesihatan semasa atau jangka panjang.


PENYEDIA PERKHIDMATAN bermaksud bantuan kecemasan sedunia dua puluh empat (24) jam.


SAKIT, WABAK ATAU PENYAKIT hendaklah bemaksud keadaan fizikal yang ditunjukkan dari segi patologi berbeza daripada keadaan
kesihatan yang normal.


PAKAR hendaklah bermaksud pengamal perubatan atau pergigian yang berdaftar dan berlesen sewajarnya di kawasan geografi yang khidmat
tersebut diberikan, dan yang diklasifikasikan oleh pihak berkuasa kesihatan yang berkenaan sebagai orang yang mempunyai kepakaran yang
tinggi dan khusus dalam bidang perubatan atau pergigian yang tertentu, tetapi tidak termasuk Pakar Perubatan atau Pakar Bedah atau Doktor
Gigi yang merupakan Orang Yang Diinsuranskan sendiri atau keluarga terdekat iaitu adik-beradik, pasangan suami isteri, anak atau ibu bapa.


PENYAKIT TERTENTU hendaklah bermaksud Hilang Upaya berikut dan komplikasi yang berkaitan dengannya, yang wujud dalam tempoh
seratus dua puluh (120) hari pertama insurans Anda:
(a) Hipertensi, diabetes melitus dan penyakit kardiovaskular.

(b) Semua tumor, kanser, sista, nodul, polip, batu dalam sistem kencing dan sistem billari.

(c) Semua penyakit telinga, hidung (termasuk sinus) dan tekak.

(d) Hernia, hemoroid, fistula, hidrosele, varikosele.

(e) Endometriosis termasuk penyakit sistem pembiakan.

(f) Gangguan spina vertebro (termasuk diska) dan penyakit lutut.


PEMBEDAHAN hendaklah bermaksud mana-mana prosedur perubatan yang berikut:
(a) Untuk menginsisi, mengeksisi atau mengelektrokauterisasi mana-mana bahagian organ atau badan kecuali untuk khidmat pergigian.

(b) Untuk membaiki, mengubah atau membentuk semula mana-mana bahagian organ atau badan.

(c) Untuk mengurangkan fraktur atau dislokasi melalui manipulasi.

(d) Penggunaan endoskopi untuk mengeluarkan batu atau objek dari larinks, bronkus, trakea, esofagus, perut, usus, pundi kencing atau uretra.


CUKAI hendaklah bermaksud sebarang cukai, levi atau duti langsung atau tidak langsung, masa kini atau masa depan, termasuk cukai
penggunaan atau sebarang cukai sepertinya yang dikenakan ke atas barangan dan perkhidmatan oleh kerajaan atau pihak berkuasa cukai.


TEMPOH TANGGUH hendaklah bermaksud tiga puluh (30) hari pertama antara masa bermulanya Hilang Upaya Anda dan bermulanya tarikh
Polisi / tarikh pengembalian semula, dan terpakai hanya apabila orang itu dilindungi pertama kalinya. Ini tidak terpakai selepas tahun pertama
perlindungan. Walau bagaimanapun, jika insurans terhenti, maka Tempoh Tangguh akan terpakai sekali lagi.


PEPERANGAN bermaksud suatu aktiviti kekerasan antara dua (2) atau lebih negara, yang dijalankan bagi sebarang tujuan, atau konflik
bersenjata antara kuasa berdaulat, atau permusuhan terbuka yang diisytiharkan atau tidak diisytiharkan dan permusuhan terbuka atau keadaan
negara di mana terdapat gangguan perhubungan aman, dan perbalahan umum menggunakan kekerasan, yang kedua-duanya dibenarkan atau
tidak dibenarkan oleh pemerintahnya.


KAMI bermaksud Zurich General Insurance Malaysia Berhad, yang merupakan syarikat insurans / pengeluar polisi.



Z-MedProtect/PW/20220113

Halaman 3 dari 14

KETERANGAN MANFAAT
JADUAL MANFAAT
Manfaat
Pelan 1
Pelan 2
Pelan 3
Pelan 4


Pelan 5

Had Tahunan Keseluruhan (RM)
100,000
300,000
500,000
1,000,000
2,000,000
(untuk Seksyen A dan Seksyen B)
Bonus Tanpa Tuntutan
Pengurangan 10% atas premium pembaharuan (jika tiada tuntutan dibuat)
Seksyen A – Manfaat Pesakit Dalam & Pembedahan Harian
100
150
180
200
500
Bilik Hospital dan Makanan (RM)
(maksimum 365 hari setahun)
Bayaran Dikenakan
Unit Rawatan Rapi
(maksimum 180 hari setahun)
Bekalan dan Khidmat Hospital
Bayaran Dikenakan
Prosedur Pembedahan Harian
Bayaran Dikenakan
Bayaran Pembedahan
Bayaran Dikenakan
Bayaran Pakar Bius
Bayaran Dikenakan
Bayaran Bilik Bedah
Bayaran Dikenakan
Bayaran Dikenakan
Lawatan Pakar Perubatan Dalam Hospital
(tidak terhad)
Bayaran Ambulans
Bayaran Dikenakan
100
Elaun Tunai Harian Di Hospital Kerajaan (RM)
(maksimum 365 hari setahun)
Manfaat Penjagaan Harian Anak Orang Yang
250
Diinsuranskan (RM)
(maksimum setiap hilang upaya)
Bayaran Laporan Perubatan (RM)
150
Transplan Organ (Hati, Buah Pinggang, Jantung, Paru-
Bayaran Dikenakan
paru atau Sum-sum Tulang)
Cukai Ke Atas Perbelanjaan Layak
Bayaran Dikenakan
Seksyen B – Manfaat Pesakit Luar
Bayaran Dikenakan
Ujian Diagnostik Prahospital
(dalam masa 60 hari sebelum penghospitalan)
Bayaran Dikenakan
Rundingan Pakar Prahospital
(dalam masa 60 hari sebelum penghospitalan)
Bayaran Dikenakan
Rawatan Selepas Penghospitalan
(dalam masa 90 hari dari penghospitalan)
Rawatan Pesakit Luar Bagi Kemalangan Secara
Bayaran Dikenakan
Kecemasan
(dalam masa 24 jam dan rawatan susulan sehingga maksimum 60 hari)
Bayaran Dikenakan
Rawatan Fisioterapi Pesakit Luar
(dalam masa 90 hari dari tarikh keluar)
Rawatan Dialisis Buah Pinggang Pesakit Luar
Bayaran Dikenakan
Rawatan Kanser Pesakit Luar
Bayaran Dikenakan
Rawatan Pergigian Pesakit Luar Bagi Kemalangan
4,000 (setiap kemalangan)
Secara Kecemasan (RM)
4,000
Penjagaan Kejururawatan Di Rumah (RM)
(sehingga 180 hari, maksimum seumur hidup)
Rundingan Pembedahan Pendapat Kedua
Bayaran Dikenakan
Seksyen C – Manfaat Khas (Had tambahan di atas Had Tahunan Keseluruhan)
Kematian dan Hilang Upaya Kekal Akibat Kemalangan
50,000
(RM)
Pemindahan Kecemasan Perubatan dan Penghantaran
50,000
Pulang Antarabangsa (RM)
(maksimum setahun)
Perbelanjaan Pengebumian (semua sebab) (RM)
2,000
Seksyen D – Pilihan
Pilihan
A
B
C


D

Jumlah

Penolakan (setiap Mana-mana Satu Hilang Upaya)
RM 0
RM 5,000
RM 10,000
RM 20,000
Penolakan
(terpakai untuk Seksyen A sahaja)
Diskaun
0%
15%
30%
50%
Premium


Z-MedProtect/PW/20220113

Halaman 4 dari 14

SEKSYEN A – MANFAAT PESAKIT DALAM & PEMBEDAHAN HARIAN (tertakluk kepada Had Tahunan Keseluruhan)
(a) BILIK HOSPITAL DAN MAKANAN
Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang Perlu Dari Segi Perubatan untuk penginapan di bilik dan
makan. Jumlah manfaat hendaklah sama dengan bayaran sebenar yang dikenakan oleh Hospital semasa Anda dimasukkan ke Hospital,
tetapi manfaat tidak boleh melebihi bagi mana-mana satu Hari, kadar manfaat Bilik dan Makan, dan bilangan maksimum Hari seperti yang
ditetapkan dalam Jadual Manfaat. Anda hanya Iayak menerima manfaat ini apabila dimasukkan ke Hospital sebagai pesakit dalam.

(b) UNIT RAWATAN RAPI
Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan untuk bilik dan makan yang sebenarnya ditanggung semasa
dimasukkan ke Hospital sebagai pesakit dalam di Unit Rawatan Rapi Hospital. Bayaran manfaat ini hendaklah sama dengan bayaran
sebenar yang dikenakan oleh Hospital tertakluk kepada manfaat maksimum bagi mana-mana satu Hari, dan bilangan maksimum Hari,
seperti yang ditetapkan dalam Jadual Manfaat. Apabila tempoh dimasukkan ke Hospital di Unit Rawatan Rapi melebihi tempoh maksimum
yang ditetapkan dalam Jadual Manfaat, maka pembayaran balik akan dihadkan kepada kadar harian Bilik Hospital dan Makan. Tiada
manfaat Bilik Hospital dan Makan akan dibayar untuk tempoh dimasukkan ke Hospital yang sama di mana manfaat Unit Rawatan Rapi
dibayar.

(c) BEKALAN DAN KHIDMAT HOSPITAL
Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang sebenarnya ditanggung untuk jagaan am, dadah dan ubat
yang dipreskripsikan dan dimakan, pencucian dan pembalutan luka, anduh, acuan plaster, sinar-x, pemeriksaan makmal,
elektrokardiogram, fisioterapi, ujian metabolisma basal, suntikan dan larutan intravena, pemberian darah dan plasma darah, termasuk kos
darah dan plasma semasa Anda dimasukkan ke Hospital sebagai pesakit dalam di Hospital, hingga jumlah yang dinyatakan dalam Jadual
Manfaat.

(d) PROSEDUR PEMBEDAHAN HARIAN
Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan untuk bayaran perubatan dan bayaran pakar yang dikenakan ke
atas Pembedahan Harian (Pembedahan dan Perubatan) yang dilakukan sebagai Pesakit Luar (tanpa kemasukan ke Hospital) sehingga
had maksimum bagi Hilang Upaya yang dinyatakan dalam Jadual Manfaat. Ini termasuk rawatan susulan oleh Pakar Perubatan / Pakar
/ Pakar Bedah merawat yang sama tertakluk kepada jumlah maksimum yang dinyatakan dalam Jadual Manfaat. Mana-mana Prosedur
Pembedahan Harian yang dilakukan untuk tujuan penyiasatan dan diagnostik yang tidak berkaitan dengan rawatan untuk sebarang Hilang
Upaya tertentu yang tidak dilindungi.

(e) BAYARAN PEMBEDAHAN
Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan untuk Pembedahan oleh Pakar / Pakar Bedah, termasuk
lawatan penilaian pra-pembedahan Anda oleh Pakar / Pakar Bedah dan rawatan selepas Pembedahan dari tarikh Pembedahan,
tertakluk kepada jumlah maksimum yang dinyatakan dalam Jadual Manfaat. Jika lebih daripada satu Pembedahan dijalankan bagi Mana-
mana Satu Hilang Upaya, jumlah bayaran untuk semua Pembedahan yang dijalankan tidak boleh melebihi jumlah maksimum yang
dinyatakan dalam Jadual Manfaat.

(f)


BAYARAN PAKAR BIUS

Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan oleh Pakar Bius untuk pemberian bahan bius yang tidak melebihi
had yang ditetapkan dalam Jadual Manfaat.

(g) BAYARAN BILIK BEDAH
Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan untuk Bilik Bedah yang berkaitan dengan prosedur pembedahan
yang tidak melebihi had yang ditetapkan dalam Jadual Manfaat.

(h) LAWATAN PAKAR PERUBATAN DALAM HOSPITAL
Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan oleh Pakar Perubatan untuk lawatan yang Perlu Dari Segi
Perubatan ke atas pesakit dalam berbayar semasa dimasukkan ke Hospital kerana Hilang Upaya bukan pembedahan yang tidak melebihi
jumlah maksimum yang ditetapkan dalam Jadual Manfaat.

(i)


BAYARAN AMBULANS

Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang ditanggung untuk perkhidmatan ambulans domestik yang
diperlukan (termasuk atendan) ke dan/atau dari Hospital berkaitan. Bayaran tidak akan dibuat jika Anda tidak dimasukkan ke Hospital dan
tertakluk kepada had yang ditetapkan dalam Jadual Manfaat.

(j)
ELAUN TUNAI HARIAN DI HOSPITAL KERAJAAN
Kami akan membayar elaun tunai harian bagi setiap Hari semasa dimasukkan ke Hospital untuk Hilang Upaya yang dilindungi di Hospital
Kerajaan Malaysia, dengan syarat Anda dihadkan kepada kadar Bilik dan Makan yang tidak melebihi jumlah dan bilangan Hari yang
dinyatakan dalam Jadual Manfaat.

(k) MANFAAT PENJAGAAN HARIAN ANAK ORANG YANG DIINSURANSKAN
Kami akan membayar balik perbelanjaan untuk makan dan penginapan yang ditanggung semasa menjaga anak-anak Anda (berumur di
bawah lima belas (15) tahun) di Hospital tidak melebihi had yang ditetapkan dalam Jadual Manfaat.

(l)


BAYARAN LAPORAN PERUBATAN

Kami akan membayar balik bayaran sebenar bagi laporan perubatan yang lengkap oleh Pakar Perubatan / Pakar Bedah yang merawat
untuk setiap Hilang Upaya tetapi tidak melebihi jumlah yang dinyatakan dalam Jadual Manfaat.

(m) TRANSPLAN ORGAN
Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang ditanggung bagi Pembedahahn transplan untuk Anda
sebagai penerima transplan hati, pinggang, jantung, paru-paru atau sum-sum tulang. Bayaran untuk manfaat ini adalah terhad kepada had
yang dinyatakan dalam Jadual Manfaat. Kos pemerolehan organ dan semua kos yang ditanggung oleh penderma adalah tidak dilindungi.

(n) CUKAI KE ATAS PERBELANJAAN LAYAK
Kami akan membayar balik jumlah Cukai Ke Atas Perbelanjaan Layak yang dikenakan oleh klinik atau Hospital ke atas pembekalan
bercukai dan perkhidmatan yang diberikan kepada Anda yang akan dibayar di bawah polisi ini tertakluk kepada had yang ditetapkan dalam
Jadual Manfaat.



Z-MedProtect/PW/20220113

Halaman 5 dari 14

SEKSYEN B – MANFAAT PESAKIT LUAR (tertakluk kepada Had Tahunan Keseluruhan)
(a) UJIAN DIAGNOSTIK PRAHOSPITAL
Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan untuk ECG, sinar-x dan ujian makmal yang dijalankan di Hospital
untuk tujuan diagnostik bagi Kecederaan atau Penyakit apabila berkaitan dengan Hilang Upaya sebelum Penghospitalan dalam
bilangan Hari dan jumlah maksimum seperti yang ditetapkan dalam Jadual Manfaat dan yang disyorkan oleh Pakar Perubatan / Pakar.

Bayaran tidak akan dibuat jika dalam khidmat diagnostik itu, Anda tidak dimasukkan ke Hospital untuk rawatan bagi keadaan perubatan
yang didiagnosis itu.

(b) RUNDINGAN PAKAR PRAHOSPITAL
Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan untuk rundingan oleh Pakar yang berkaitan dengan Hilang
Upaya dalam bilangan Hari dan jumlah maksimum seperti yang ditetapkan dalam Jadual Manfaat sebelum dimasukkan ke Hospital dan
dengan syarat rundingan itu Perlu Dari Segi Perubatan dan telah disyorkan secara bertulis oleh Pakar Perubatan / Pakar yang merawat,
termasuk preskripsi untuk ubat dan rundingan berikutnya yang tertakluk kepada had Jadual Manfaat. Bayaran tidak akan dibuat apabila
Anda tidak dimasukkan ke Hospital untuk rawatan bagi keadaan perubatan yang didiagnosis itu.

(c) RAWATAN SELEPAS PENGHOSPITALAN
Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang ditanggung dalam rawatan susulan untuk Hilang Upaya
yang sama seperti semasa Penghospitalan sebaik sahaja keluar dari Hospital untuk Hilang Upaya bukan pembedahan termasuk
preskripsi untuk ubat, dalam bilangan Hari dan jumlah maksimum seperti yang ditetapkan dalam Jadual Manfaat.

(d) RAWATAN PESAKIT LUAR BAGI KEMALANGAN SECARA KECEMASAN
Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang ditanggung hingga jumlah maksimum yang dinyatakan
dalam Jadual Manfaat, bagi Kecederaan anggota badan yang dilindungi yang timbul daripada Kemalangan untuk rawatan yang Perlu
Dari Segi Perubatan sebagai Pesakit Luar di mana-mana klinik atau Hospital berdaftar dalam tempoh dua puluh empat (24) jam dari
masa berlaku Kemalangan yang menyebabkan Kecederaan anggota badan yang dilindungi. Rawatan susulan oleh Doktor yang sama
atau klinik atau Hospital berdaftar yang sama untuk Kecederaan anggota badan yang dilindungi yang sama akan disediakan hingga
jumlah maksimum dan bilangan hari maksimum seperti yang ditetapkan dalam Jadual Manfaat.

(e) RAWATAN FISIOTERAPI PESAKIT LUAR
Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan bagi rawatan fisioterapi Pesakit Luar yang dirujuk secara bertulis
oleh Pakar / Pakar Perubatan berlesen selepas Pembedahan atau rawatan dalam Hospital, dalam tempoh sembilan puluh (90) hari dari
tarikh keluar Hospital sehingga jumlah maksimum yang ditetapkan di Jadual Manfaat.

(f)
RAWATAN DIALISIS BUAH PINGGANG PESAKIT LUAR
Jika Anda didiagnosis sebagai mengalami Kegagalan Buah Pinggang seperti yang dinyatakan di bawah, Kami akan membayar balik
Bayaran Munasabah dan Biasa Diamalkan yang ditanggung yang Perlu Dari Segi Perubatan untuk rawatan dialisis buah pinggang
yang dijalankan di pusat dialisis berdaftar yang sah tertakluk kepada had Hilang Upaya ini seperti yang ditetapkan dalam Jadual Manfaat.

Rawatan tersebut (dialisis termasuk rundingan, ujian pemeriksaan, dadah yang dibawa pulang) hendaklah diterima di jabatan Pesakit Luar
Hospital atau di pusat rawatan dialisis berdaftar atau sebaik sahaja selepas keluar dari Hospital atau Pembedahan.

Kegagalan Buah Pinggang bermaksud kegagalan renal peringkat akhir yang menyebabkan kegagalan kronik dan tidak boleh pulih kedua-
dua buah pinggang untuk berfungsi dan oleh itu dialisis renal perlu dimulakan.

Ini adalah syarat khas bagi manfaat ini walaupun pengecualian Penyakit Sedia Ada, manfaat ini tidak akan dibayar kepada Anda, jika
Anda mengalami penyakit renal kronik dan/atau sedang menerima rawatan dialisis sebelum tarikh mula insurans.

(g) RAWATAN KANSER PESAKIT LUAR
Jika Anda didiagnosis menghidap kanser seperti yang dinyatakan di bawah, Kami akan membayar balik Bayaran Munasabah dan Biasa
Diamalkan yang ditanggung untuk rawatan kanser yang dijalankan di pusat rawatan kanser berdaftar yang sah tertakluk kepada had bagi
Hilang Upaya ini seperti yang ditetapkan dalam Jadual Manfaat. Jenis rawatan yang dilindungi sebagai rawatan kanser hanya terhad
kepada radioterapi atau kemoterapi (suntikan atau oral), termasuk rundingan, ujian pemeriksaan, dadah yang dibawa pulang.

Rawatan itu hendaklah diterima atau disarankan di jabatan Pesakit Luar Hospital atau di pusat rawatan kanser berdaftar atau sebaik
sahaja selepas keluar dari Hospital atau Pembedahan.

Kanser ditakrifkan sebagai sel malignan yang tumbuh dan merebak secara tidak terkawal dan serangan serta pemusnahan tisu normal
tersebut dianggap memerlukan rawatan perantaraan atau Pembedahan (tidak termasuk prosedur endoskopi). Kanser mesti disahkan
melalui tanda malignansi histologi.

Ini adalah syarat khas bagi manfaat ini walaupun pengecualian Penyakit Sedia Ada, manfaat ini tidak akan dibayar kepada Anda yang
telah didiagnosis sebagai pesakit kanser dan/atau sedang menerima rawatan kanser sebelum tarikh mula insurans.

(h) RAWATAN PERGIGIAN PESAKIT LUAR BAGI KEMALANGAN SECARA KECEMASAN
Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan yang ditanggung hingga jumlah maksimum yang dinyatakan
dalam Jadual Manfaat, bagi Kecederaan Kemalangan dan diterima sebagai Rawatan Pergigian Pesakit Luar Bagi Kemalangan dalam
tempoh dua puluh empat (24) jam dari masa berlaku Kemalangan di klinik pergigian atau Hospital berdaftar dan rawatan susulan oleh
Doktor Gigi yang sama akan disediakan hingga jumlah maksimum seperti yang ditetapkan dalam Jadual Manfaat.

(i)


PENJAGAAN KEJURURAWATAN DI RUMAH

Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan, sehingga hari dan jumlah maksimum seperti yang ditetapkan
dalam Jadual Manfaat, untuk penjagaan kejururawatan berterusan oleh jururawat berdaftar yang Perlu Dari Segi Perubatan kepada Anda
di rumah. Penjagaan kejururawatan tersebut mesti disyorkan oleh Pakar Perubatan atau Pakar Bedah yang merawat dan untuk tempoh
minimum empat (4) jam setiap hari. Manfaat ini adalah berbayar hanya jika terdapat tuntutan sebelumnya yang dibayar bagi keadaan
kesihatan yang mana Penghospitalan diperlukan oleh Anda.

Perlindungan Penjagaan Kejururawatan Di Rumah di bawah Polisi ini termasuk:
(i) Terapi fizikal, pekerjaan atau ucapan;
(ii) Terapi, rawatan untuk luka, pernafasan, penjagaan diabetes, penjagaan kolostomi, tiub pemakanan, suntikan dan ubat-ubatan lain
untuk Anda di rumah.

Penjagaan kustodian, makanan, perkhidmatan penjagaan rumah am, sahabat dan barangan keselesaan peribadi, atau sebarang
perkhidmatan untuk aktiviti harian yang tidak Perlu Dari Segi Perubatan tidak akan dibayar. Manfaat yang dibayar tidak boleh melebihi
bilangan hari dan jumlah maksimum pelan ini seperti yang ditetapkan dalam Jadual Manfaat.



Z-MedProtect/PW/20220113

Halaman 6 dari 14

(j)


RUNDINGAN PEMBEDAHAN PENDAPAT KEDUA

Kami akan membayar balik Bayaran Munasabah dan Biasa Diamalkan bagi rundingan dengan Pakar bagi memperoleh pendapat kedua
sebelum Pembedahan bagi Penyakit atau Kecederaan yang memerlukan Pembedahan sehingga jumlah maksimum yang dinyatakan
dalam Jadual Manfaat. Bayaran tidak akan dibuat apabila Anda tidak dimasukkan ke Hospital untuk rawatan bagi keadaan perubatan
yang didiagnosis itu.



SEKSYEN C – MANFAAT KHAS (Had tambahan di atas Had Tahunan Keseluruhan)
(a) KEMATIAN DAN HILANG UPAYA KEKAL AKIBAT KEMALANGAN
Sekiranya Anda mengalami Kecederaan badan, di mana dalam tempoh dua belas (12) bulan yang berturut-turut menyebabkan kematian
atau hilang upaya yang dinyatakan di dalam Jadual Manfaat berikut, Kami akan membayar jumlah yang dinyatakan di dalam Jadual
Manfaat mengikut peratusan jumlah yang diinsuranskan seperti yang dinyatakan di dalam Jadual Manfaat.

Peratusan Jumlah Yang


Keterangan Hilang Upaya

Diinsuranskan (%)
Kehilangan nyawa
100
Kehilangan Anggota Badan (dua anggota badan)
100
Kehilangan kedua-dua belah tangan, atau kesemua jari dan kedua-dua ibu jari
100
Kecederaan yang mengakibatkan terlantar sakit di katil secara kekal
100
Tidak siuman sepenuhnya
100
Kecederaan yang mengakibatkan kekal terlantar di katil
100
Sebarang kecederaan lain yang menyebabkan Hilang Upaya Menyeluruh dan Kekal
100
Kehilangan tangan dari paras bahu
100
Kehilangan tangan antara paras bahu dan siku
100
Kehilangan tangan dari paras siku
100
Kehilangan tangan antara siku dan pergelangan tangan
100
Kehilangan tangan diparas pergelangan tangan
100
Kehilangan kaki
-
di paras pinggul
100

-
di antara lutut dan pinggul
100

-
di bawah lutut
100
Mata: Kehilangan
-


Penglihatan

100


-
Penglihatan, kecuali bayangan cahaya
50

-
kanta
50
Kehilangan empat (4) jari dan satu (1) ibu jari di sebelah tangan
50
Kehilangan empat (4) jari
40
Kehilangan ibu jari
-
kedua-dua falanks
25

-
satu (1) falanks
10
Kehilangan jari telunjuk
-
tiga (3) falanks
10

-
dua (2) falanks
8

-
satu (1) falanks
4
Kehilangan jari hantu
-
tiga (3) falanks
6

-
dua (2) falanks
4

-
satu (1) falanks
2
Kehilangan jari manis
-
tiga (3) falanks
5

-
dua (2) falanks
4

-
satu (1) falanks
2
Kehilangan jari kelengkeng
-
tiga (3) falanks
4

-
dua (2) falanks
3

-
satu (1) falanks
2
Kehilangan metakarpus
-
pertama atau kedua (tambahan)
3

-
ketiga, keempat atau kelima (tambahan)
2
Kehilangan jari kaki
-
semua falanks
15

-
ibu jari, kedua-dua falanks
5

-
Ibu jari, satu (1) falanks
2

-
selain ibu jari, jika lebih daripada satu (1) jari setiap satu
1


Kehilangan Pendengaran

-

kedua-dua belah telinga
75

-
sebelah telinga
15


Kehilangan Upaya Bertutur

50

Tahap kependekan anggota mesti disahkan menerusi laporan Pakar Perubatan.

Sekiranya Kecederaan Badan tidak dinyatakan secara khusus, Kami berhak untuk menggunapakai peratusan jumlah yang diinsuranskan
berdasarkan hilang upaya, yang pada pendapat Kami tidak bercanggah dengan peruntukan Jadual Manfaat di atas.

“Kehilangan” anggota badan atau sebahagian daripadanya hendaklah bermaksud sebarang kehilangan akibat pemisahan secara fizikal
sebenar atau Kehilangan Penggunaan yang menyeluruh dan kekal.

Kehilangan Penggunaan anggota badan hendaklah dianggap sebagai kehilangan anggota badan.

Agregat semua peratusan yang boleh dibayar bagi mana-mana satu (1) Kemalangan tidak boleh melebihi seratus peratus (100%).

Sekiranya 100% telah dibayar, semua perlindungan di bawah ini hendaklah berhenti berkuatkuasa. Semua kehilangan lain yang kurang
daripada 100%, jika dibayar, akan mengurangkan perlindungan bagi manfaat ini sebanyak jumlah tersebut dari tarikh Kemalangan
sehingga tamat Jadual Polisi.

Z-MedProtect/PW/20220113

Halaman 7 dari 14


Peruntukan Khas

•
Koma
Setelah mendapat pengesahan oleh Pakar Perubatan bahawa Anda telah berada dalam keadaan koma selama sekurang-kurangnya
satu (1) tahun akibat Kemalangan, Kami akan membayar 100% Jumlah Yang Diinsuranskan. Walau bagaimanapun, Kami
mempunyai hak untuk mendapatkan pulangan pembayaran yang dibuat jika Anda memperoleh semula kesedaran dengan syarat
potongan sebanyak 10% daripada pembayaran yang disebut di atas untuk setiap tahun Anda berada dalam keadaan koma.

•
Kehilangan
Kematian akan dianggap telah berlaku sekiranya Anda telah hilang selama dua belas (12) bulan yang berturut-turut dan Kami telah
memeriksa segala bukti yang ada untuk menyokong kesimpulan bahawa kematian adalah disebabkan oleh Kemalangan yang
dilindungi oleh Polisi ini. Jika pada bila-bila masa selepas bayaran dibuat oleh Kami bagi tuntutan sedemikian, Anda ditemui masih
hidup, bayaran balik sepenuhnya hendaklah dibuat kepada Kami.

(b) PEMINDAHAN KECEMASAN PERUBATAN DAN PENGHANTARAN PULANG ANTARABANGSA
Sekiranya Anda mengalami Kecederaan Serius atau Penyakit Serius di Luar Negara, dan pada pendapat Kami atau Penyedia Perkhidmatan, adalah dianggap munasabah dari segi perubatan untuk memindahkan Anda ke lokasi yang lain untuk rawatan perubatan,
Penyedia Perkhidmatan akan mengatur pemindahan dengan menggunakan kaedah yang Kami atau Penyedia Perkhidmatan percaya
adalah paling sesuai berasaskan tahap keterukan keadaan perubatan Anda, tertakluk kepada had yang dinyatakan di dalam Jadual
Manfaat.

Sekiranya Anda mengalami Kecederaan Serius atau Penyakit Serius di Luar Negara, dan pada pendapat Kami atau Penyedia Perkhidmatan, adalah dianggap munasabah dari segi perubatan untuk menghantar Anda pulang ke Malaysia, Penyedia Perkhidmatan
akan mengatur penghantaran balik dengan menggunakan kaedah yang Kami atau Penyedia Perkhidmatan percaya adalah paling sesuai
berasaskan tahap keterukan keadaan perubatan Anda, tertakluk kepada had yang dinyatakan di dalam Jadual Manfaat.

Sekiranya Anda mengalami Hilang Upaya di Luar Negara yang menyebabkan kematian, Penyedia Perkhidmatan Kami akan membuat:
(i)
semua rancangan pengangkutan yang perlu (termasuk sebarang prosedur atau rancangan yang perlu untuk memenuhi kelaziman
tempatan) bagi penghantaran balik jenazah Anda ke Malaysia; dan
(ii) semua rancangan untuk pengebumian, pembakaran, penyediaan keranda atau pengawetan (sekiranya dipilih) di tempat kematian di
Luar Negara, tetapi tidak termasuk sebarang perbelanjaan berkaitan hak, upacara keagamaan atau tiang pengebumian.

Syarat-Syarat Khas yang berkenaan dengan Manfaat (b):
Keputusan mengenai kaedah pengangkutan dan destinasi akhir akan dibuat oleh Penyedia Perkhidmatan atas budi bicara mutlak Kami.

Anda mesti mengikut arahan dan petunjuk Kami atau Penyedia Perkhidmatan pada setiap masa.

Pengecualian Khas yang berkenaan dengan Manfaat (b):
Kami tidak akan bertanggungjawab terhadap sebarang tuntutan yang disebabkan secara langsung atau tidak langsung oleh mana-mana
yang berikut:
(i)
perkhidmatan yang diberikan tanpa kebenaran dan/atau campur tangan Penyedia Perkhidmatan;
(ii) perkhidmatan yang disediakan oleh mana-mana pihak selain daripada Penyedia Perkhidmatan dengan caj biasanya tidak dikenakan;
(iii) rawatan perubatan yang diberikan oleh saudara mara dan/atau ahli keluarga Anda sama ada layak atau tidak;
(iv) Hilang Upaya yang pada pendapat Pakar Perubatan Penyedia Perkhidmatan masih membolehkan Anda melancong secara fizikal
dengan duduk sebagai penumpang biasa dan tanpa pengiring perubatan.

(c) PERBELANJAAN PENGEBUMIAN (SEMUA SEBAB)
Kami akan membayar jumlah seperti yang dinyatakan di dalam Jadual Manfaat, jika Anda meninggal dua dalam Tempoh Insurans.



SEKSYEN D – PILIHAN
(a) PENOLAKAN
Polisi ini adalah tertakluk kepada jumlah yang boleh ditolak seperti dinyatakan dalam Jadual Manfaat. Jumlah yang boleh ditolak bermaksud
jumlah wang yang akan ditolak daripada Perbelanjaan Layak di bawah Seksyen A yang ditanggung oleh Anda, dan berdasarkan setiap
Mana-mana Satu Hilang Upaya apabila Anda dimasukkan ke mana-mana hospital swasta. Walau bagaimanapun, jika Anda dimasukkan
ke mana-mana Hospital Kerajaan Malaysia, Perbelanjaan Layak yang ditanggung tidak akan tertakluk kepada jumlah yang boleh ditolak.



SYARAT-SYARAT
1.



HAD UMUR

Kelayakan umur untuk melayak bagi Polisi ini adalah dari tiga puluh (30) hari hingga enam puluh lima (65) tahun, dan boleh diperbaharui
hingga seratus (100) tahun. Semua umur merujuk kepada umur Anda pada tarikh lahir yang berikutnya.

2.



PINDAHAN

Kami berhak meminda terma dan peruntukan Polisi ini dengan memberikan notis awal tiga puluh (30) hari secara bertulis melalui pos biasa
ke alamat terakhir Pemilik Polisi yang diketahui mengikut rekod Kami dengan alasan yang sah, dan pindaan tersebut akan terpakai dan
pembaharuan berikutnya bagi Polisi ini. Pindaan kepada Polisi ini tidak sah kecuali jika diluluskan oleh Kami dan kelulusan itu hendaklah
diendorskan pada Polisi tersebut. Kami hendaklah memberikan notis awal tiga puluh (30) hari secara bertulis kepada Pemilik Polisi
mengikut alamat terakhir yang direkodkan bagi mana-mana pindaan yang dibuat.

3.



TIMBANG TARA

Semua perbezaan yang timbul daripada Polisi ini hendaklah dirujuk kepada penimbang tara yang hendaklah dilantik secara bertulis oleh
pihak dalam percanggahan. Jika mereka tidak berjaya mendapatkan persetujuan tentang siapa yang akan menjadi Penimbang Tara dalam
tempoh satu (1) bulan apabila diminta secara bertulis untuk berbuat demikian, maka kedua-dua pihak Iayak melantik Penimbang Tara
setiap seorang yang akan mendengar percanggahan itu bersama-sama dengan Pengadil yang akan dilantik oleh kedua-dua Penimbang
Tara itu. Walau bagaimanapun, dengan syarat apa-apa penafian liabiliti oleh Kami bagi apa-apa tuntutan di bawah ini hendaklah dirujuk
kepada Penimbang Tara dalam tempoh dua belas (12) bulan kalendar dari tarikh penafian tersebut.

4.



PENAMATAN AUTOMATIK

Polisi akan tamat secara automatik pada tarikh kejadian-kejadian berikut yang mana Iebih awal:
(a) pada tarikh Jadual Polisi ditamatkan; atau
(b) apabila Anda meninggal dunia; atau
Z-MedProtect/PW/20220113

Halaman 8 dari 14

(c) pada tarikh pembaharuan jika Anda mencapai had umur maksimum pada seratus (100) tahun; atau
(d) pada tarikh pembaharuan atau tarikh tamat tempoh premium, yang mana lebih awal, sekiranya premium yang diperlukan tidak dibayar
dalam tempoh empat belas (14) hari dari tarikh tamat Polisi.

Penamatan Polisi ini adalah tanpa prejudis kepada sebarang tuntutan yang timbul sebelum penamatan tersebut. Pembayaran atau
penerimaan sebarang premium yang berikutan penamatan Polisi ini tidak akan membentuk sebarang liabiliti tetapi pihak Kami akan
mengembalikan sebarang premium.

5.



PEMBATALAN

Polisi ini boleh dibatalkan oleh Pemilik Polisi pada bila-bila masa dengan memberikan notis bertulis kepada Kami, dan dengan syarat
tiada tuntutan dibuat dalam Tahun Polisi semasa. Pemilik Polisi Iayak menerima bayaran balik premium seperti yang berikut:

Tempoh Tidak Boleh Melebihi


Bayaran Balik Premium Tahunan

15 hari (untuk pembaharuan sahaja)
90%
1 bulan
80%
2 bulan
70%
3 bulan
60%
4 bulan
50%
5 bulan
40%
6 bulan
30%
7 bulan
25%
8 bulan
20%
9 bulan
15%
10 bulan
10%
11 bulan
5%
Tempoh melebihi 11 bulan
Tiada bayaran balik
Tidak akan ada bayaran balik premium untuk mod pembayaran bukan tahunan.

6.



TUNAI SEBELUM PERLINDUNGAN

Adalah menjadi syarat mutlak khas kontrak insurans ini bahawa premium mesti dibayar dan diterima oleh Kami sebelum perlindungan
insurans berkuatkuasa.



7.

PENSIJILAN, MAKLUMAT DAN KETERANGAN
Semua sijil, maklumat, laporan dan bukti perubatan seperti yang dikehendaki oleh Kami hendaklah diserahkan atas belanja Pemilik Polisi,
dan dalam borang tertentu yang mungkin dikehendaki oleh Kami. Semua notis apabila dikehendaki oleh Kami supaya diberikan oleh
Pemilik Polisi, hendaklah secara bertulis dan dialamatkan kepada Kami. Pemilik Polisi hendaklah, atas permintaan dan belanja Kami,
menyerahkan kepada pemeriksaan perubatan apabila ia dianggap perlu.

8.



PROSEDUR TUNTUTAN

(a) Anda hendaklah dalam tempoh tiga puluh (30) hari Hilang Upaya yang melibatkan belanja boleh tuntut, memberikan notis bertulis
kepada Kami dengan menyatakan butiran lengkap kejadian tersebut, termasuk semua bil dan resit asal, serta laporan lengkap Pakar
Perubatan yang menyatakan diagnosis keadaan yang dirawat dan tarikh Hilang Upaya bermula mengikut pendapat Pakar
Perubatan dan rumusan kos rawatan oleh Pakar Perubatan termasuk ubat dan khidmat yang diberikan. Kegagalan memberikan
notis tersebut dalam tempoh yang dibenarkan tidak boleh membatalkan apa-apa tuntutan jika ditunjukkan tidak munasabah untuk
memberikan notis itu dan notis itu telah diberikan secepat yang mungkin.

(b) Anda hendaklah mendapatkan dan bertindak berdasarkan nasihat perubatan yang sewajarnya dan Kami tidak bertanggungjawab
jika rawatan atau khidmat diperlukan berikutan kegagalan Anda berbuat demikian.



9.

BAYARAN BERSAMA (polisi sub-standard sahaja)
Bayaran Bersama ditanggung oleh Pemilik Polisi dengan syarat perkongsian kos atau terma insurans bersama tidak boleh melebihi dua
puluh peratus (20%) daripada perbelanjaan yang boleh dituntut (i.e. tidak termasuk Penolakan) bagi setiap Hilang Upaya, tertakluk kepada
had maksimum mutlak Ringgit Malaysia Tiga Ribu (RM 3,000) (termasuk Penolakan) setiap Hilang Upaya. Had yang dinyatakan di atas
tidak terpakai untuk Bayaran Bersama Bilik dan Makan Dinaikkan dan polisi yang memperuntukkan Had Tahunan Keseluruhan melebihi
Ringgit Malaysia Seratus Ribu (RM 100,000).



10. PRASYARAT LIABILITI

Pematuhan dan pelaksanaan terma, peruntukan dan syarat Polisi ini dengan sewajarnya oleh Anda dan selagi berkaitan dengan apa-apa
yang perlu dilakukan atau dipatuhi oleh Anda hendaklah menjadi prasyarat apa-apa liabiliti Kami.



11. SUMBANGAN

Jika Anda mempunyai insurans/takaful lain yang melindungi mana-mana Penyakit atau Kecederaan oleh Polisi ini, Kami tidak
bertanggungjawab membayar jumlah yang lebih besar bagi Penyakit atau Kecederaan itu daripada jumlah yang terpakai bersama-sama
ini yang ditanggung oleh Polisi ini bagi jumlah keseluruhan semua insurans/takaful yang sah yang melindungi Penyakit atau Kecederaan
itu.



12. TEMPOH BERTENANG

Jika Pemilik Polisi membuat keputusan untuk tidak mengambil Polisi ini selepas Polisi telah dikeluarkan, Pemilik Polisi boleh
mengembalikan Polisi kepada Kami untuk pembatalan dengan syarat permohonan untuk pembatalan diserahkan oleh Pemilik Polisi
kepada Kami dalam tempoh lima belas (15) hari dari tarikh Polisi diterima oleh Pemilik Polisi. Pemilik Polisi layak menerima pulangan
penuh premium yang telah dibayar tolak belanja perubatan yang ditanggung oleh Kami untuk mengeluarkan Polisi tersebut. Sekiranya
tuntutan telah dibuat, premium tidak akan dipulangkan.



13. MATA WANG BAYARAN

Semua bayaran di bawah Polisi in hendaklah dibuat dalam mata wang Malaysia yang sah. Sekiranya apa-apa bayaran yang diminta oleh
Anda supaya dibayar dalam mata wang lain, maka jumlah tersebut hendaklah dibayar dalam mata wang yang diminta seperti yang boleh
dibeli di Malaysia pada kadar pasaran mata wang semasa pada tarikh penyelesaian tuntutan.



14. KEWAJIPAN PENDEDAHAN

(a) Kontrak Insurans Pengguna
Apabila Pemilik Polisi telah memohon Insurans ini sepenuhnya untuk tujuan diri sendiri/keluarga/tanggungan, Pemilik Polisi
Z-MedProtect/PW/20220113

Halaman 9 dari 14

mempunyai kewajipan untuk mengambil langkah yang munasabah untuk tidak salah nyata dalam Borang Cadangan (atau semasa
cadangan Insurans ini). Dalam kata lain, Pemilik Polisi haruslah menjawab soalan dengan penuh dan tepat. Kegagalan dalam
mengambil langkah munasabah dalam menjawab soalan-soalan boleh mengakibatkan pembatalan kontrak Insurans, keengganan
atau pengurangan gantirugi, perubahan kepada terma atau penamatan kontrak Insurans Pemilik Polisi selaras dengan remedi di
Jadual 9 Akta Perkhidmatan Kewangan Islam 2013.

Pemilik Polisi juga dikehendaki mendedahkan perkara-perkara lain yang Pemilik Polisi tahu akan mempengaruhi keputusan Kami
dalam menerima risiko dan menentukan kadar dan terma yang akan dikenakan. Pemilik Polisi juga mempunyai kewajipan untuk
memberitahu Kami dengan serta-merta jika pada bila-bila masa selepas kontrak Insurans Pemilik Polisi ditandatangani, diubah atau
diperbaharui dengan Kami, apa-apa maklumat yang diberikan di dalam Borang Cadangan (atau semasa cadangan Insurans ini) tidak
tepat atau telah berubah.

(b) Kontrak Insurans Bukan Pengguna
Apabila Pemilik Polisi telah memohon Insurans ini untuk memberi manfaat Insurans perubatan kepada pekerja Pemilik Polisi dan
tanggungan mereka, Pemilik Polisi mempunyai tanggungjawab untuk mendedahkan apa-apa perkara yang Pemilik Polisi tahu yang
akan mempengaruhi keputusan Kami dalam menerima risiko dan menentukan kadar dan terma yang dikenakan, dan apa-apa perkara
yang munasabah yang boleh dijangka, jika tidak ia boleh menyebabkan pembatalan kontrak Insurans, keengganan atau pengurangan
ganti rugi, perubahan terma atau penamatan kontrak Insurans Pemilik Polisi.

Pemilik Polisi juga mempunyai kewajipan untuk memberitahu Kami dengan serta-merta jika pada bila-bila masa selepas kontrak
Insurans Pemilik Polisi ditandatangani, diubah atau diperbaharui dengan Kami, apa-apa maklumat yang diberikan di dalam Borang
Cadangan (atau semasa Pemilik Polisi memohon untuk Insurans ini) tidak tepat atau telah berubah.

15. PEMBAYARAN BALIK PENUH BAGI HOSPITAL KERAJAAN
Bayaran untuk belanja perubatan yang layak adalah dilindungi secara penuh untuk rawatan di Hospital Kerajaan Malaysia untuk setiap
Penyakit atau Kecederaan.

16. SYARAT-SYARAT AM
Polisi ini dan Jadual Manfaat hendaklah dibaca bersama sebagai satu kontrak dan sebarang perkataan atau penyataan yang disertakan
dengan makna khusus dalam mana-mana bahagian Polisi atau Jadual hendaklah membawa makna khusus yang sama di mana juga ia
digunakan.



17. WILAYAH PASARAN GEOGRAFI

Semua manfaat yang disediakan dalam Polisi ini terpakai dua puluh empat (24) jam sehari di seluruh dunia. Jika Anda bukan warganegara
Malaysia, lindungan Anda akan terhad kepada Hospital di Malaysia sahaja.



18. TEMPOH IHSAN

Walaupun terdapat syarat Tunai Sebelum Perlindungan, Tempoh lhsan selama empat belas (14) hari dari tarikh premium perlu dibayar
dibenarkan untuk bayaran sebarang premium. Dalam tempoh empat belas (14) hari tersebut, Kami akan bertanggungjawab jika pada akhir
tempoh berkenaan, premium telah dibayar. Jika sebarang premium Polisi tidak dibayar sebelum akhir tempoh ihsan, Kontrak Polisi akan
dianggap telah ditamatkan pada tarikh luput Polisi.

19. UNDANG-UNDANG YANG MENGAWAL POLISI
Polisi in dikeluarkan di bawah undang-undang Malaysia dan tertakluk dan dikawal oleh undang-undang lazim di Malaysia.



20. NOTIS PENTING

Kami ingin Anda mengambil perhatian terhadap maklumat penting yang berikut:
(a) Bukti umur dikehendaki pada masa polisi matang/tuntutan, jika umur belum dimaklumkan.

(b) Anda boleh menghubungi Ejen, Pegawai Cawangan, Bahagian Perkhidmatan Pelanggan di Ibu Pejabat Kami bagi sebarang
pertanyaan atau perkhidmatan berkaitan dengan polisi Anda.

(c) Pertukaran alamat Pemilik Polisi harus dimaklumkan kepada Kami supaya semua urusan surat-menyurat boleh diuruskan dengan
segera.



21. TUNTUTAN TIDAK LENGKAP

Semua tuntutan hendaklah diserahkan kepada Kami dalam tempoh tiga puluh (30) hari setelah kejadian itu selesai yang untuknya tuntutan
itu dibuat. Tuntutan tidak dianggap lengkap dan manfaat layak diterima tidak akan dibayar kecuali semua bil untuk tuntutan itu telah
diserahkan dan dipersetujui oleh Kami. Hanya kos sebenar yang ditanggung akan dipertimbangkan untuk pembayaran balik. Apa-apa
perbezaan atau penepian bagi perkara di atas adalah mengikut budi bicara Kami semata-mata.



22. PENAFSIRAN POLISI

Di mana konteksnya dibenarkan, perkataan yang menyatakan nombor tunggal sahaja hendaklah termasuk nombor majmuk dan sebaliknya
dan perkataan yang menyatakan jantina maskulin sahaja hendaklah termasuk jantina feminin dan jantina neuter dan perkataan yang
menyatakan orang hendaklah termasuk perbadanan.



23. PEMERIKSAAN PERUBATAN

Kami berhak untuk memeriksa tubuh Anda bilamana ia perlu secara munasabah dan melakukan bedah siasat dalam kes kematian yang
mana ia tidak dilarang oleh undang-undang.



24. SILAP NYATA UMUR

Jika umur Anda telah tersilap nyata dan akibatnya premium yang dibayar tidak mencukupi, maka apa-apa tuntutan yang dibayar di bawah
Polisi ini hendaklah dikira secara pro rata berasaskan nisbah premium sebenar yang dibayar dengan premium yang betul yang sepatutnya
dikenakan selama setahun. Apa-apa premium yang berlebihan, yang mungkin telah dibayar akibat silap nyata umur, hendaklah dibayar
balik tanpa faedah. Jika pada umur yang betul, sekiranya Anda tidak layak dilindungi di bawah Polisi ini, maka tiada manfaat akan dibayar.

25. SALAH NYATA ATAU TIDAK MENYATAKAN FAKTA PENTING
Polisi ini akan terbatal jika:
(a) sebarang jawapan, pendedahan atau pernyataan oleh Pemilik Polisi, sebelum kontrak insurans ini bermula, dipelbagai atau
diperbaharui, dalam atau pada mana-mana cadangan atau perisytiharan atau pertanyaan, telah dinyatakan dengan salah secara
sengaja atau dengan cuai; atau\
(b) sebelum kontrak insurans ini bermula, dipelbagai atau diperbaharui, Pemilik Polisi gagal memdedahkan sebarang fakta yang Pemilik
Polisi tahu berkaitan dengan keputusan Kami samada untuk menerima risiko atau tidak, serta kadar dan syarat-syarat terpakai; atau
(c) sebarang tuntutan dibuat yang didapati palsu atau ditokok tambah, atau terdapat sebarang pengisytiharan atau kenyataan palsu
dalam menyokong tuntutan tersebut.


Z-MedProtect/PW/20220113

Halaman 10 dari 14

26. DISKAUN BERKUMPULAN ORANG YANG DIINSURANSKAN
Sekiranya Pemilik Polisi membeli polisi untuk beberapa Orang Yang Diinsuranskan yang merupakan Ahli-ahli Keluarganya, Diskaun
Berkumpulan Orang Yang Diinsuranskan akan diguna pakai. Peratus Diskaun Berkumpulan Orang Yang Diinsuranskan bergantung pada
jumlah Orang Yang Diinsuranskan seperti dinyatakan dalam Jadual Polisi. Diskaun Berkumpulan Orang Yang Diinsuranskan adalah
tidak terkumpul dan sekiranya berlaku perubahan dalam jumlah Orang Yang Diinsuranskan, Diskaun Berkumpulan Orang Yang
Diinsuranskan akan diubah semula.



27. PENAMAAN

Penamaan bermaksud proses Pemilik Polisi melantik seorang atau lebih penerima wang polisi sekiranya berlaku kematian Pemilik Polisi
(yang juga Orang Yang Diinsuranskan) dilakukan pada bila-bila masa selepas Jadual Polisi dikeluarkan. Sekiranya Anda ialah Orang
Yang Diinsuranskan, Anda boleh membuat penamaan seorang atau lebih penerima wang polisi yang perlu dibayar di bawah Jadual
Polisi ini. Jika Pemilik Polisi atau Anda meninggal dunia tanpa membuat penamaan, Kami akan membayar wang polisi kepada wasi atau
pentadbir harta pusaka Pemilik Polisi atau Anda yang sah. Bayaran wang polisi adalah berdasarkan Akta Perkhidmatan Kewangan 2013.



28. NOTIS

Setiap notis atau komunikasi kepada Kami hendaklah dibuat secara bertulis dan dihantar kepada Kami. Pindaan bagi syarat dalam Polisi
ini atau apa-apa pengendorsan padanya, tidak sah kecuali pindaan itu ditandangani atau diparap oleh wakil Kami yang diberi kuasa.



29. RAWATAN LUAR NEGARA

Jika Anda menerima rawatan di Luar Negara, manfaat berkenaan rawatan tersebut akan dilindungi tertakluk kepada pengecualian, had
dan peruntukan yang dinyatakan dalam Polisi ini dan semua manfaat akan dibayar berdasarkan kadar pertukaran rasmi pada Hari terakhir
tempoh dimasukkan ke Hospital dan tidak termasuk kos pengangkutan ke tempat rawatan sekiranya:
(a) Anda melancong ke luar negara atas sebab selain daripada rawatan perubatan, perlu dimasukkan ke Hospital di luar Malaysia akibat
Kecemasan; atau
(b) Anda dicadangkan oleh Pakar Perubatan dan perlu dipindahkan ke Hospital di luar Malaysia kerana rawatan khusus, bantuan,
maklumat atau keputusan yang dikehendaki tidak boleh diberikan, dikemukakan atau diambilkan di Malaysia.

Rawatan di Luar Negara untuk Wabak, Sakit atau Kecederaan yang didiagnosis di Malaysia dan bukan kecemasan atau dalam keadaan
kronik yang mana rawatan boleh ditangguhkan sewajarnya sehingga pulang ke Malaysia hendaklah dikecualikan.



30. PEMILIKAN POLISI

Kecuali diperuntukkan sebaliknya secara nyata melalui Endorsemen dalam Polisi, Kami berhak menganggap Pemilik Polisi sebagai
pemilik mutlak Polisi. Kami tidak terikat untuk mengiktiraf apa-apa tuntutan ekuiti atau tuntutan lain ke atas Polisi atau kepentingan dalam
Polisi, dan penerimaan Polisi atau Manfaat oleh Pemilik Polisi (atau oleh wakilnya yang sah atau yang diberi kuasa) sahaja hendaklah
merupakan pelepasan efektif bagi semua obligasi dan liabiliti Kami. Pemilik Polisi hendaklah dianggap sebagai prinsipal atau ejen
bertanggungjawab bagi Anda yang dilindungi di bawah Polisi ini.



31. TEMPOH PERLINDUNGAN DAN PEMBAHARUAN

Polisi ini boleh dibaharui mengikut pilihan Pemilik Polisi tertakluk kepada terma, syarat dan penamatan pada setiap tarikh ulangtahun
Polisi. Premium pembaharuan yang dibayar tidak dijamin dan Kami berhak menentukan premium yang berkuatkuasa pada masa
pembaharuan. Perubahan berkenaan jika ada, adalah terpakai untuk semua Pemilik Polisi walau apa pun rekod tuntutan mereka mengikut
penilaian risiko Kami.

Polisi ini boleh dibaharui mengikuti pilihan Pemilik Polisi sehingga berlaku mana-mana berikut:
(a) premium tidak dibayar atau premium tidak dibayar mengikut masa
(b) penipuan atau salah nyataan fakta penting semasa membuat permohonan
(c) polisi dibatalkan atas permintaan Pemilik Polisi
(d) Anda meninggal dunia
(e) Anda mencapai had umur perlindungan yang ditentukan
(f)
penamatan perlindungan semua polisi dalam pasaran tertentu dan Kami menarik balik Polisi ini sepenuhnya dari pasaran menurut
Syarat Penarikan Balik Portfolio.



32. SYARAT PENARIKAN BALIK PORTFOLIO

Kami berhak membatalkan portfolio secara keseluruhan jika Kami memutuskan untuk menghentikan produk insurans ini. Pembatalan
portfolio secara keseluruhan hendaklah diberitahu melalui notis bertulis yang munasabah terlebih dahulu dengan alasan yang sah kepada
Pemilik Polisi dan Kami akan menanggung semua polisi hingga ke tarikh tamat tempoh perlindungan dalam portfolio.



33. PREMIUM

Ketika Tempoh Insurans, premium untuk insurans di bawah Polisi ini adalah tidak dijamin dan adalah berasaskan kadar premium yang
berkuatkuasa ketika pembaharuan. Premium perlu dibayar pada kadar premium mengikut umur setiap ahli pada tarikh lahir yang berikutnya
pada setiap ulangtahun Tahun Polisi. Kami berhak untuk mengubah kadar pada mana premium dikira, pada permulaan mana-mana
Tahun Polisi, dengan syarat bahawa Kami memberitahu Pemilik Polisi sekurang-kurangnya tiga puluh (30) hari sebelum tarikh premium
tersebut perlu dibayar.



34. BUKTI KERUGIAN

Setelah menerima notis berkaitan, Kami akan menyediakan borang kepada Pembuat Tuntutan bagi mengemukakan bukti kerugian. Jika
borang tidak disediakan dalam masa lima belas (15) hari, Pembuat Tuntutan dengan mengemukakan bukti secara bertulis mengenai
kejadian, bentuk dan tahap kerugian untuk tuntutan yang dibuat akan dianggap telah memenuhi keperluan mengikut peruntukan in.

Bukti kerugian mesti dikemukakan kepada Kami bagi kes tuntutan Hilang Upaya, dalam masa sembilan puluh (90) hari selepas tamat
tempoh Hilang Upaya yang mana Kami bertanggungjawab, dan dalam kes tuntutan mana-mana kerugian lain, dalam masa sembilan
puluh (90) hari dan selepas tarikh kerugian tersebut.



35. PENGEMBALIAN SEMULA

Jika Anda tidak membayar premium dalam tempoh ihsan dan polisi ini telah luput, Anda tidak akan mempunyai apa-apa perlindungan
insurans atau manfaat. Sekiranya polisi luput, Anda boleh memohon untuk mengembalikan semula polisi ini dalam masa satu (1) tahun
selepas tarikh premium patut dibayar yang tidak dijelaskan. Walau bagaimanapun, Anda mesti:
(a) melengkapkan dan menandatangani borang pengembalian semula;
(b) memperakui dengan jujur kesemua fakta di dalam borang pengembalian semula;
(c) menyediakan semua maklumat (jika ada) yang telah Kami minta; dan
(d) membayar semua tunggakan premium.



Z-MedProtect/PW/20220113

Halaman 11 dari 14


36. TINGGAL DI LUAR NEGARA

Tiada manfaat akan dibayar untuk apa-apa rawatan perubatan yang diterima oleh Anda di luar Malaysia, jika Anda tinggal atau membuat
perjalanan di luar Malaysia lebih daripada sembilan puluh (90) hari berturut-turut.



37. SEKATAN

Kami tidak akan dianggap memberikan perlindungan atau akan membuat apa-apa bayaran atau memberikan apa-apa perkhidmatan atau
manfaat kepada mana-mana Pemilik Polisi, Anda atau pihak lain setakat perlindungan, pembayaran, perkhidmatan, manfaat itu akan
melanggar mana-mana perdagangan atau ekonomi yang berkenaan undang-undang atau peraturan sekatan.



38. PENGAMBILALIHAN POLISI

Jika polisi ini bermula sebaik sahaja selepas penamatan polisi terdahulu dan jika Anda mengalami Hilang Upaya perubatan sebelum atau
pada masa polisi ini bermula (dan manfaat di bawah polisi terdahulu disediakan untuknya), Anda hendaklah terus dilindungi bagi Hilang
Upaya sedia ada, tetapi tidak melebihi had polisi terdahulu dengan syarat Kami telah memperoleh satu salinan polisi terdahulu.



39. POLISI DITINGKATKAN

Jika Manfaat Layak Diterima bagi pihak Anda di bawah syarat Polisi ini ditambah semasa ia berkuat kuasa atau pada masa Pembaharuan
atau penggantian dan jika Anda mengalami Hilang Upaya sebelum atau pada masa Manfaat ditambah, maka Had Manfaat yang dibayar
bagi Hilang Upaya itu tidak boleh melebihi Had Manfaat sebelum tarikh Manfaat itu ditingkatkan.

40. BAYARAN BERSAMA NAIK TARAF BILIK DAN MAKANAN
Jika Anda dimasukkan ke Hospital pada kadar Bilik dan Makanan yang lebih tinggi daripada manfaat yang Anda layak, Anda perlu membayar perbezaan kadar Bilik dan Makanan sahaja.



41. PERUNTUKAN CUKAI

Semua premium dan yuran yang perlu dibayar di bawah Polisi ini mungkin tertakluk kepada Cukai. Sekiranya Cukai dikenakan, ia akan
dinyatakan dalam invois dan Kami berhak untuk menuntut atau mengutip Cukai daripada Anda sebagai tambahan kepada premium
dan/atau yuran yang perlu dibayar di bawah Polisi ini.



PENGECUALIAN


PENGECUALIAN (BERKENAAN DENGAN SEKSYEN A & SEKSYEN B)
Kontrak ini tidak melindungi apa-apa Penghospitalan, Pembedahan atau bayaran yang disebabkan secara langsung atau tidak langsung,
sepenuhnya atau sebahagiannya, oleh mana-mana satu (1) kejadian yang berikut:
1.

Penyakit Sedia Ada.

2.

Penyakit Tertentu yang wujud dalam tempoh seratus dua puluh (120) hari pertama bagi perlindungan berterusan.

3.

Tempoh Tangguh tiga puluh (30) hari untuk semua kecuali Kecederaan Kemalangan.

4.

Pembedahan pilihan kosmetik atau plastik kecuali Pembedahan pembentukan semula diperlukan untuk memulihkan fungsi selepas
Kemalangan yang berlaku dalam tempoh insurans.

5.

Pemeriksaan mata, cermin mata, kanta sentuh dan prosedur pembedahan untuk pembetulan ralat refraktif mata dan penggunaan atau
pemerolehan perkakas atau alat prostetik pembetulan seperti anggota tiruan, alat pendengaran, perentak yang diimplankan dan
preskripsinya.

6.

Penyakit pergigian termasuk rawatan pergigian atau Pembedahan oral kecuali apabila diperlukan kerana Kecederaan akibat Kemalangan
pada gigi asli yang sihat yang berlaku sepenuhnya dalam Tempoh Insurans.

7.

Penjagaan peribadi, rehat pulih atau jagaan kebersihan, apa-apa rawatan yang diterima semata-mata sebagai Penghospitalan Pesakit
Luar terutamanya untuk tujuan penyiasatan, diagnosis, pemeriksaan sinar-x, pemeriksaan fizikal atau perubatan am, tidak berkaitan
dengan rawatan atau diagnosis Hilang Upaya yang dilindungi yang tidak Perlu Dari Segi Perubatan dan apa-apa rawatan pencegahan,
ubat atau pemeriksaan pencegahan yang dijalankan oleh Pakar Perubatan dan rawatan khusus untuk mengurangkan atau menaikkan
berat badan.

8.

Apa-apa rawatan atau operasi pembedahan untuk keabnormalan atau kecacatan kongenital termasuk penyakit keturunan.

9.

Kehamilan, melahirkan anak (termasuk kelahiran secara pembedahan), keguguran, menggugurkan kandungan dan jagaan serta
Pembedahan pranatal atau posnatal, kaedah kawalan kelahiran kontraseptif mekanikal atau kimia atau rawatan berkaitan ketaksuburan,
menukar jantina, disfungsi seksual termasuk impotensi, ujian atau rawatan berkaitan pensterilan dan khatan dilakukan disebabkan apa-
apa sebab selain daripada Penyakit atau jangkitan.

10. Bunuh diri, percubaan bunuh diri atau Kecederaan diri sendiri yang disengajakan ketika siuman atau tidak siuman.

11. Peperangan atau apa-apa tindakan perang, diisytiharkan atau tidak diisytiharkan, aktiviti jenayah atau pengganas, bergiat cergas dalam
mana-mana angkatan bersenjata, penyertaan secara langsung dalam mogok, rusuhan dan kekecohan awam atau penderhakaan tentera.

12. Rawatan untuk sebarang keadaan perubatan yang timbul secara langsung atau tidak langsung dari pencemaran radioaktif atau apa-apa
bahan nuklear, termasuk pembakaran bahan api nuklear.

13. Belanja yang ditanggung untuk menderma mana-mana organ tubuh oleh Anda dan kos pemerolehan organ termasuk semua kos yang
ditanggung oleh penderma ketika transplan organ dan komplikasinya.

14. Penyiasatan ke atas dan rawatan gangguan tidur dan dengkur, gangguan psikiatri, psikotik, gangguan mental atau saraf, termasuk apa-
apa neurosis dan manifestasi fisiologi atau psikosomatiknya, gangguan psikiatri seperti neuro-psikosis, skizofrenia dan lain-lain.

15. Terapi penggantian hormon dan terapi pilihan seperti rawatan, khidmat atau bekalan perubatan, termasuk tetapi tidak terhad kepada
khidmat kiropraktik, akupunktur, akutekanan, refleksologi, pengikatan tulang, rawatan pakar herba, urut atau aroma terapi.

16. Jagaan atau rawatan yang pembayarannya tidak dikehendaki atau setakat yang ia dibayar oleh mana-mana pihak insurans lain atau
tanggung rugi yang melindungi Anda dan Hilang Upaya yang timbul daripada tugas dalam pekerjaan atau kerjaya yang dilindungi di bawah
Kontrak Insurans Pampasan Pekerja.

17. Psikotik, gangguan mental atau saraf (termasuk apa-apa neurosis dan manifestasi fisiologi atau psikosomatiknya).

18. Kos / belanja bagi khidmat yang bersifat bukan perubatan, seperti televisyen, telefon, khidmat teleks, radio atau kemudahan yang serupa,
kit/pek kemasukan dan barang bukan perubatan lain yang tidak layak.

19. Sakit atau Kecederaan yang timbul daripada apa-apa jenis perlumbaan (kecuali perlumbaan jalan kaki), sukan berbahaya seperti tetapi
tidak terhad kepada terjun udara, luncur air, aktiviti dalam air yang memerlukan alat pernafasan, sukan musim sejuk, sukan profesional,
mendaki gunung dengan menggunakan tali atau panduan gunung dan aktiviti yang tidak dibenarkan.

20. Penerbangan peribadi selain sebagai penumpang yang membayar tambang dalam mana-mana penerbangan komersil berjadual untuk
mengangkut penumpang melalui laluan yang ditetapkan.

21. Wabak dan/atau pandemik.



Z-MedProtect/PW/20220113

Halaman 12 dari 14

PENGECUALIAN (BERKENAAN DENGAN SEKSYEN C – Manfaat a)
Kami tidak akan bertanggungjawab terhadap tuntutan yang secara langsung atau tidak langsung disebabkan oleh atau berpunca daripada:
1.

Penglibatan atau penyertaan Anda dalam:-
(a) Anggota berpakaian seragam dan bersenjata, perkhidmatan atau operasi angkatan tentera laut atau udara;
(b) Sukan profesional, sukan musim sejuk selain daripada meluncur ais;
(c) Memanjat batu atau mendaki gunung (dengan keperluan penggunaan tali atau pemandu gunung), meneroka gua, seni
mempertahankan diri atau tinju, aktiviti dalam air yang melebihi lima puluh (50) meter dalam, aktiviti udara termasuk payung terjun,
peluncuran gantung, terjun bungee atau sebarang jenis perlumbaan selain daripada yang menggunakan kaki;
(d) Perjalanan udara kecuali sebagai penumpang yang membayar tambang dalam penerbangan yang diiktiraf dan dioperasi oleh mana-
mana pesawat di laluan dan perjalanan udara yang dijadualkan dan perjalanan udara oleh mana-mana pesawat yang disewa dan
dilesenkan dengan sewajarnya sebagai pengangkut udara yang diiktiraf dan diterbangkan oleh krew profesional di antara lapangan
terbang yang ditubuhkan dan dikendalikan dengan betul;
(e) Perbuatan jenayah atau sebarang kegiatan haram.

2.

Dipengaruhi oleh alcohol atau dadah, kecuali dadah tersebut diambil atas arahan Pakar Perubatan dengan syarat arahan tersebut bukan
untuk merawat penagihan dadah.

3.

Pembunuhan atau serangan akibat provokasi, sengaja mencederakan diri sendiri, membunuh diri atau cubaan membunuh diri atau sebarang
percubaan untuk berbuat demikian sama ada dalam keadaan siuman atau tidak siuman.

4.

Kehamilan, kelahiran anak, keguguran.

5.

Gigitan nyamuk.

6.

Sakit, Wabak atau sebarang masalah kesihatan.

7.



Penyakit Sedia Ada.

8.

Sengaja mendedahkan diri kepada bahaya yang luar biasa (kecuali dalam usaha untuk menyelamatkan nyawa manusia).

9.

HIV (Virus Kurang Daya Ketahanan Manusia) dan/atau sebarang penyakit berkaitan dengan HIV termasuk AIDS (Sindrom Kurang Daya Tahan
Penyakit) atau Kompleks Berkaitan AIDS (ARC), namun disebabkan dan/atau sebarang derivatif mutan, variasi atau rawatan yang disebabkan
olehnya.

10. Penyertaan secara langsung dalam rusuhan atau kekecohan awam, pencerobohan, tindakan musuh asing, permusuhan (sama ada
Peperangan diisytiharkan atau tidak), pemberontakan, revolusi, kebangkitan, pemberontakan tentera atau rampasan kuasa.

11. Radiasi pengionan atau pencemaran oleh aktiviti radio dari sebarang bahan api nuklear atau dari sebarang sisa nuklear daripada pembakaran
bahan api nuklear. Bagi tujuan pengecualian ini, pembakaran hendaklah termasuk sebarang proses pembelahan nuklear sendiri.

12. Peperangan, Peperangan saudara – sama ada diisytiharkan atau tidak.

13. Sebarang Tindakan Keganasan.

14. Wabak dan/atau pandemik (juga berkenaan bagi Seksyen C – Manfaat c).



NOTIS DI BAWAH AKTA PERLINDUNGAN DATA PERIBADI 2010 (PDPA)
Akta Perlindungan Data Peribadi 2010 yang mengawal selia pemprosesan data peribadi dalam transaksi komersial, berkuat kuasa ke atas
Kami. Anda boleh membuat pertanyaan, aduan, permintaan mengakses, mengemas kini, membetulkan atau mengubah mana-mana data
peribadi Anda, mengehadkan pemprosesan data peribadi dan/atau untuk memilih keluar daripada penggunaan Kami pada bila-bila masa
selepas ini dengan mengemukakan permintaan tersebut kepada Kami dengan menghantar e-mel ke <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS>. Permintaan
untuk memilih keluar mesti menyatakan dengan jelas nama penuh, nombor dokumen pengenalan, nombor polisi, nombor telefon dan alamat
orang yang membuat permintaan tersebut.

Pemprosesan data peribadi Anda tertakluk kepada Notis Perlindungan Data Peribadi Kami, seperti yang diterbitkan di
https://www.zurich.com.my/pdpa.



Z-MedProtect/PW/20220113

Halaman 13 dari 14


PROSEDUR UNTUK MEMBUAT ADUAN INSURANS

Kami sentiasa bersedia memberikan pengalaman perkhidmatan pelanggan yang terbaik. Jika anda mempunyai sebarang aduan atau
tidak berpuas hati berkaitan dengan sebarang produk atau perkhidmatan, kami bersedia memberikan perhatian. Anda boleh
menghubungi Kami di:


Zurich General Insurans Malaysia Berhad

Aras 23A, Mercu 3, No. 3, Jalan Bangsar, KL Eco City, 59200 Kuala Lumpur, Malaysia
Tel: 03 2109 6000
Faks: 03 2109 6888
Pusat Panggilan: 1 300 888 622
E-mel: <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS>


Alternatif Lain untuk Membuat Aduan

Jika anda tidak berpuas hati dengan keputusan akhir kami, anda boleh boleh menulis surat kepada kepada Ombudsman Perkhidmatan
Kewangan (OPK) dengan butir-butir mengenai pertikaian dan maklumat Polisi anda.

Jika keputusan OPK memihak kepada anda berbanding kami, anda hendaklah memaklumkan OPK sama ada anda menerima atau
menolak bayaran dalam tempoh (14) empat belas hari. Jika anda tidak setuju dengan bayaran tersebut, anda boleh menolak keputusan
OPK. Anda bebas untuk memulakan tindakan mahkamah terhadap kami atau merujuk kes kepada Penimbangtaraan.

OPK boleh dihubungi di alamat berikut:


Ombudsman Perkhidmatan Kewangan

Tingkat 14, Blok Utama, Menara Insurans Malaysia, No. 4, Jalan Sultan Sulaiman, 50000 Kuala Lumpur
Tel: <PRESIDIO_ANONYMIZED_PHONE_NUMBER>
Faks: 03 2272 1577
E-mel: <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS>
Laman web:www.ofs.org.my


Jika aduan anda berada di luar bidang OPK, anda boleh menyatakan ketidakpuasan hati anda kepada Laman Informasi Nasihat dan
Khidmat (LINK) Bank Negara Malaysia di alamat berikut:
Secara Bertulis:
Pusat Perhubungan Pelanggan Bank Negara Malaysia (BNMLINK), Peti Surat 10922, 50929 Kuala Lumpur.

Tel: 1 300 88 5465 (1-300-88-LINK) (Luar Negara: <PRESIDIO_ANONYMIZED_PHONE_NUMBER>)
Faks: 03 2174 1515
E-mel: <PRESIDIO_ANONYMIZED_EMAIL_ADDRESS>

Secara Bersemuka:
Tingkat Bawah, Blok D, Bank Negara Malaysia, 50480 Kuala Lumpur.



Zurich General Insurans Malaysia Berhad

No. Pendaftaran 201701035345 (1249516-V)
Aras 23A, Mercu 3, No.3, Jalan Bangsar, KL Eco City, 59200 Kuala Lumpur, Malaysia.

Tel: 03 2109 6000 Fax: 03 2109 6888 Call Centre: 1 300 888 622
www.zurich.com.my


Z-MedProtect/PW/20220113

Halaman 14 dari 14