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PROTECTION

About AIA Bhd.


American International Assurance Bhd. (AIA Bhd.) began
operations in Kuala Lumpur, Malaysia in 1948 as a branch
of American International Assurance Company, Limited
(AIA). With over 60 years of local market presence, AIA
Bhd. has now become one of the countrys largest life
insurers, with a network of 23 branches nationwide. The
companys focus is on designing new and innovative
products to meet the changing needs of the market. AIA
Bhd. is a member of the AIA Group.
About the AIA Group
AIA Group Limited and its subsidiaries (collectively the AIA
Group or the Group) comprise the largest independent
publicly listed pan-Asian life insurance group in the world,
with a broad footprint spanning 15 markets in Asia Pacific.
The Group traces its roots in the region back more than 90
years and has total assets of US$107.9 billion.

Alor Setar
Wisma AIA
999 Jalan Telok Wanjah
05200 Alor Setar
Kedah Darul Aman
Tel: 04 - 735 5372
Fax: 04 - 731 9325
Batu Pahat
Wisma AIA
54A Jalan Rahmat
83000 Batu Pahat
Johor Darul Takzim
Tel: 07 - 431 1821
Fax: 07 - 433 1488
Bukit Mertajam
Wisma AIA
543 Jalan Sungai Rambai
14000 Bukit Mertajam
Seberang Perai
Tel: 04 - 538 6421
Fax: 04 - 538 9078
Ipoh
Wisma AIA
118 Jalan C M Yusuff
30250 Ipoh
Perak Darul Ridzuan
Tel: 05 - 255 7479
Fax: 05 - 255 9163

Kluang
Wisma AIA
230 Taman Kurnia
Jalan Mersing
86000 Kluang
Johor Darul Takzim
Tel: 07 - 774 5145
Fax: 07 - 772 0908
Kota Bharu
2nd and 3rd Floor
Lot 164, Section 8
Jalan Pintu Pong
15000 Kota Bharu
Kelantan Darul Naim
Tel: 09 - 747 3523
Fax: 09 - 747 0761
Kota Kinabalu
Wisma AIA
13 Jalan Karamunsing
88000 Kota Kinabalu
Sabah
Tel: 088 - 248 545
Fax: 088 - 221 775
Kuala Lumpur
Menara AIA
99 Jalan Ampang
50450 Kuala Lumpur
Tel: 03 - 2056 1111

Johor Bahru
Wisma AIA
2 Jalan Bukit Timbalan
80000 Johor Bahru
Johor Darul Takzim
Tel: 07 - 227 8440
Fax: 07 - 223 7579

Kuantan
Wisma AIA
103 Jalan Tun Ismail
25000 Kuantan
Pahang Darul Makmur
Tel: 09 - 517 8795
Fax: 09 - 515 7151

Klang
Ground Floor, Menara A&M
No 3, Jalan Istana
41000 Klang
Selangor Darul Ehsan
Tel: 03 - 3373 2367
Fax: 03 - 3371 7615

Kuching
Wisma AIA
216 Jalan Song Thian Cheok
93100 Kuching
Sarawak
Tel: 082 - 422 684
Fax: 082 - 245 408

EXCELCARE PLUS & MEDICOVER PLUS

The AIA Group meets the protection, savings and


investment needs of individuals by offering a
comprehensive suite of products and services covering
accident and health insurance, life insurance and
retirement planning. It also provides employee benefits,
credit life and pension services to corporate clients.
The Group has operations in Hong Kong, Thailand,
Singapore, China, Malaysia, Korea, the Philippines,
Australia, Indonesia, Taiwan, Vietnam, New Zealand,
Macau, Brunei and India. It is a market leader in the Asia
Pacific region based on life insurance premiums, and holds
number one positions in six of its geographical markets.
AIA Group Limited is listed on the Main Board of The Stock
Exchange of Hong Kong Limited under the stock code 1299.

Kulim
67-I Jalan Raya
09000 Kulim
Kedah Darul Aman
Tel: 04 - 495 9645
Fax: 04 - 491 2858
Melaka
Wisma AIA
96 Jalan Munshi Abdullah
75100 Melaka
Tel: 06 - 286 2364
Fax: 06 - 281 3088
Miri
Wisma AIA
Lot 663 Jalan Merbau
98000 Miri
Sarawak
Tel: 085 - 426 413
Fax: 085 - 414 355
Petaling Jaya
Level 3, Menara Axis
No 2, Jalan 51A/223
46100 Petaling Jaya
Tel: 03 - 7680 8686
Fax: 03 - 7680 8666
Pulau Pinang
Ground Floor
Wisma Leader
No 8, Jalan Larut
10050 Pulau Pinang
Tel: 04 - 222 6262
Fax: 04 - 222 6222
Sandakan
Wisma AIA
Block 30
Jalan Dua
90000 Sandakan
Sabah
Tel: 089 - 220 486
Fax: 089 - 218 308

Seremban
20 Jalan Dato' Lee Fong Yee
70000 Seremban
Negeri Sembilan
Darul Khusus
Tel: 06 - 763 5768
Fax: 06 - 764 4312
Sibu
17, 1st Floor
Jalan Bindang
(Brooke Drive 1)
96000 Sibu
Sarawak
Tel: 084 - 347 740
Fax: 084 - 343 900
Sungai Petani
Wisma AIA
8 Taman Patani Baru
Jalan Kampong Baru
08000 Sungai Petani
Kedah Darul Aman
Tel: 04 - 421 2327
Fax: 04 - 423 4257
Taiping
Wisma AIA
28 Jalan Long Jaafar
34000 Taiping
Perak Darul Ridzuan
Tel: 05 - 808 4845
Fax: 05 - 806 8988
Tawau
Wisma AIA,
TB 275 Block 29
Jalan Haji Karim
91000 Tawau
Sabah
Tel: 089 - 754 166
Fax: 089 - 752 949

We ensure long term


protection for your
lifetime needs
A medical protection plan that has invaluable hospitalisation
coverage till age 100 with an option to attach an unlimited overall
lifetime limit plan.

PT0810209

The Power of We

AIA Bhd. is licensed under the Insurance Act 1996


& regulated by the Central Bank (Bank Negara Malaysia).
Rev 0611

AIA.COM.MY

ExcelCare Plus & MediCover Plus

ExcelCare Plus / MediCover Plus


Hospitalisation and Surgical Insurance
What are ExcelCare Plus and MediCover Plus about?
ExcelCare Plus
Would you compromise the recovery of your loved ones by settling for less?

Few of us actually plan for hospitalization expenses. On top of that, with the rise in medical
inflation, this can easily bring medical expenses to ten-thousands of ringgit. The truth is, a
completely unforeseen and unavoidable operation can sometimes dry up our savings.
ExcelCare Plus provides for hospitalization and surgical expenses incurred and offers protection
up to age 100.
MediCover Plus
Worried that your basic ExcelCare Plus medical reimbursement lifetime limit may be insufficient
for you and your familys long term medical needs?

As a dedicated child, parent or spouse, you would try to seek the best possible medical attention
available and for as long as possible. Your existing plan may be insufficient for a better and
longer term protection. As a result, the hard-earned savings meant for your familys future will be
eroded.
With MediCover Plus rider, you can rest assure that your insurance is sufficient to cover you
and your family for life with minimal additional premium payable on top of your ExcelCare Plus
premium.
MediCover Plus provides for hospitalization and surgical expenses and offers higher protection
limits to complement ExcelCare Plus.
BENEFITS
What are the coverage / benefits provided?
ExcelCare Plus offers:
A choice of medical reimbursement lifetime limit ranging from RM200,000 to as high as
RM700,000
24-hour protection
Lifelong protection to age 100
Zero co-insurance for claims within a specified amount1
Lower rates via the Family Plan
Hassle-free assistance in your admission to the hospital via AIA Health Services2
Worldwide coverage3

ExcelCare Plus & MediCover Plus

The schedule of benefits of Excelcare Plus is as follows:


Schedule of benefits of ExcelCare Plus
BENEFIT LIMITS
Per Policy Year

100

150

200

250

300

350

Hospital Daily Room & Board


(120 days)

100

150

200

250

300

350

Additional Hospital Room &


Board whilst Overseas5 (120 days)

100

150

200

250

300

350

ICU (120 days)


Hospital Supplies and Services
Surgical Fees Benefit
Operating Theatre Fees Benefit

Reasonable and Customary charges up to


Co-insurance Free amount.
Balance exceeding Co-insurance Free amount up to
Annual Limit is further subject to Co-insurance.

Anaesthetists Fees Benefit


In-Hospital Physicians Visit
(240 days maximum per policy year)6
Pre-Hospitalization Benefit7 (within
60 days prior to Hospitalization)
- Diagnostic Tests
- Specialist Consultation Benefit8
Post-Hospitalization Treatment
Benefit7
(within 60 days after hospitalization)
- Outpatient Diagnostic X-ray & Lab
Tests Benefit
- Medical Expenses & Consultation8
Benefit including Acupuncture &
Physiotherapy
Day Procedure9
Organ/Bone Marrow Transplant10
(not subject to co-insurance)

Reasonable and customary charges up to Annual Limit

ExcelCare Plus & MediCover Plus

100

BENEFIT LIMITS
Per Policy Year

Daily Cash Allowance at Government


Hospital (120 days)

Daily Guardian Benefit (120 days)

40

150

200

250

300

350

45

50

55

60

65

Out Patient Benefits

60
90
110
130
160
190

15,000 22,000 25,000 28,000 33,000 36,000


60,000 90,000 115,000 140,000 165,000 190,000

Emergency Accidental Out-patient


Treatment & 30 days Follow-up
Treatment at Hospital & Clinic

1,500
2,000
2,500
3,000
3,500

Co-insurance Free Amount


per policy year1
Annual Limit

4,000

Value Added Benefit


Emergency Evacuation Benefit
Per Lifetime
Out-patient Kidney Dialysis
Treatment Benefit

100,000 100,000 100,000 100,000 100,000 100,000




30,000

40,000

50,000

60,000

70,000

80,000


Out-patient Cancer Treatment Benefit 10,000 12,500 15,000 17,500 20,000 22,500

200,000 300,000 400,000 500,000 600,000 700,000
Overall Lifetime Limit
per Insured Person
Note: All amount shown are in Ringgit Malaysia

ExcelCare Plus & MediCover Plus

MediCover Plus additional benefits include:


No lifetime limit4
High Cancer and Kidney Dialysis Treatment Limit
Extended coverage for Post-Hospitalization Benefit
The schedule of benefits of MediCover Plus is as follows:
Schedule of benefits of MediCover Plus
BENEFIT LIMITS
Per Policy Year

Post-Hospitalization Treatment Benefit7


(starting on the 61st day and within 120 days
after hospitalization)

150

Day Procedure11

250

300

350

Reasonable and Customary charges up to


Co-insurance Free amount. Balance
exceeding Co-insurance Free amount up to
Annual Limit is further subject to Co-insurance.
Share with ExcelCare Plus and
limit remains unchanged

Co-insurance Free Amount


per policy year1
Home Nursing Care (per Confinement)
(180 days lifetime limit)

200

3,000

4,000

5,000

6,000

7,000

Share with ExcelCare Plus and


limit remains unchanged

Annual Limit
Out-Patient Benefits
Emergency Accidental Out-Patient Dental
Treatment (per accident)

3,000

4,000

5,000

6,000

7,000

Value Added Benefit


Emergency Evacuation Benefit

400,000 400,000 400,000 400,000 400,000

Per Lifetime

Out-patient Kidney Dialysis Treatment Benefit

40,000

Out-patient Cancer Treatment Benefit

100,000 150,000 200,000 250,000 300,000

Overall Lifetime Limit per Insured Person

Note: All amount shown are in Ringgit Malaysia

NA

60,000 80,000 100,000 120,000

NA

NA

NA

NA

ExcelCare Plus & MediCover Plus

If you opt for ExcelCare Plus with MediCover Plus, please see the consolidated schedule below for
the benefits provided:
Schedule of combined benefits of ExcelCare Plus and MediCover Plus
BENEFIT LIMITS
Per Policy Year

Hospital Daily Room & Board


(120 days)


Additional Hospital Room &
Board whilst Overseas5
(120 days)

150

200

250

300

350

150

200

250

300

350


150

200

250

300

350

ICU (120 days)


Hospital Supplies and Services
Surgical Fees Benefit
Operating Theatre Fees Benefit
Anaesthetists Fees Benefit

Reasonable and Customary charges up to


Co-insurance Free amount.
Balance exceeding Co-insurance Free amount
up to Annual Limit is further subject to
Co-insurance.

In-Hospital Physicians Visit


(240 days maximum per policy year)6
Pre-Hospitalization Benefit7
(within 60 days prior to Hospitalization)
- Diagnostic Tests
- Specialist Consultation Benefit8

Post-Hospitalization Treatment Benefit7


(within 120 days after hospitalization)
- Outpatient Diagnostic X-ray & Lab
Tests Benefit
- Medical Expenses & Consultation8
Benefit including Acupuncture &

Physiotherapy
Day Procedure11
Home Nursing Care (per Confinement)
(180 days life time limit)
Organ/Bone Marrow Transplant10
(not subject to co-insurance)

3,000

4,000

5,000

6,000

7,000

Reasonable and customary charges


up to Annual Limit

ExcelCare Plus & MediCover Plus

BENEFIT LIMITS
Per Policy Year

150

Daily Cash Allowance at Government Hospital 45


(120 days)

Daily Guardian Benefit (120 days)
90

Co-insurance Free Amount per policy year1
22,000
Annual Limit

200

250

300

350

50

55

60

65

110

130

160

190

25,000

28,000

33,000

36,000

90,000 115,000 140,000 165,000 190,000

Out-Patient Benefits
Emergency Accidental Out-patient Treatment
& 30 days Follow-up Treatment at
Hospital & Clinic

2,000

2,500

3,000

3,500

4,000

Emergency Accidental Out-Patient Dental


Treatment (per accident)

3,000

4,000

5,000

6,000

7,000

Value Added Benefit


Emergency Evacuation Benefit


500,000 500,000 500,000 500,000 500,000

Per Lifetime
Out-patient Kidney Dialysis Treatment Benefit

80,000

110,000 140,000 170,000 200,000

Out-patient Cancer Treatment Benefit

112,500 165,000 217,500 270,000 322,500

Overall Lifetime Limit per Insured Person

NA

NA

NA

NA

NA

Note: All amount shown are in Ringgit Malaysia and please refer to the policy contract for full details
of the benefit coverage.
ELIGIBILITY
How ExcelCare Plus and MediCover Plus can be purchased?
ExcelCare Plus and MediCover Plus can be purchased as a premium paying rider attachable
to any non-participating plan. ExcelCare Plus can also be purchased as a standalone plan. Unit
deducting ExcelCare Plus and MediCover Plus can be purchased with investment-linked plans.
Am I eligible to apply for ExcelCare Plus and MediCover Plus?
This policy is available to individuals from 4 weeks to 60 years of age, subject to underwritings
approval. For Insured & Children and Family plans, children (dependants) between 2 weeks and
under 23 years of age, and who are in good health, are eligible.

ExcelCare Plus & MediCover Plus

Can I attach MediCover Plus to my ExcelCare Plus plan 100?


No, MediCover Plus is only available to plan 150 and above. You will need to upgrade your
ExcelCare Plus to plan 150 & above if you wish to enjoy the extra coverage provided by
MediCover Plus.
How do I apply?
Please talk to your AIA Agent. He or she will take you through the various application forms and
offer any help you need to complete them. Alternatively, you can call the AIA Customer Service
Hotline at 1300-88-1899 or visit any AIA branch. You will find a list of AIA branches in Malaysia on
the back of this document.
COVERAGE AMOUNT
What is the coverage amount for family members in a plan?
All family members covered under one policy will be covered for the same amount.
PREMIUMS
How much premium do I need to pay?
This will depend on your age, gender and type of plan which you choose, occupation and
condition of health. Please refer to Appendix 1 at the end of this brochure for the table of
premiums for a standard life.
How can I pay the premiums?
You should first ensure that this policy will best serve your needs and that the premium payable
under the policy is an amount that you can afford.







Premiums are payable in one of the following ways:


a) In cash or cheque. For payments in cheque, please make it payable to
American International Assurance Bhd.
b) Autopay:
i) Credit card
ii) Auto debit (HSBC, BSN and MBB)
c) Standing instruction
d) AIA Maybank Corporate Collection Account (AIA MCCA)

You may change the frequency of premium payments by submitting a written request. Subject
to our minimum premium requirements, premiums may be paid on an annually, semi-annually,
quarterly or monthly mode at the premium rates applicable on the Issue Date.





Please note that for auto debit, standing instruction or AIA MCCA payment methods, the following
additional conditions will apply:
For payment made annually, semi-annually and quarterly: the first payment has to be payable in
cash or cheque.
For payment made once a month: a minimum of first 2 payments have to be payable in cash or
cheque.

What is the minimum premium for ExcelCare Plus?


For ExcelCare Plus bought as a standalone plan, the minimum premium must be at least RM300
for any frequency of payment. However, this amount can be reduced to a minimum of RM75 if it
is bought together with another basic plan (term plan excluded).

ExcelCare Plus & MediCover Plus

If I have both ExcelCare Plus and MediCover Plus, do I still have to pay premiums when
my ExcelCare Plus lifetime limit has been reached?
So long as MediCover Plus is attached to the ExcelCare Plus plan, the ExcelCare Plus plan
will remain effective, even if the lifetime limit of ExcelCare Plus on its own has been reached.
The premium will continue to be payable and all the benefits under the ExcelCare Plus plan will
continue unchanged.
When do my premium payments end?
Premiums are payable until the expiry at age 100 or, until the cessation of premium paying
duration of the basic plan to which this rider is attached to, whichever is earlier. Benefits of
ExcelCare Plus and MediCover Plus will stop thereafter.
Can my premiums increase as I age?
Yes. The premium payable will depend on your attained age at the next birthday when the
premium is due.
When do I pay my renewal premiums?
We recommend that you pay each renewal premium before it is due. The latest you can pay each
renewal premium is 31 days from the due date. If we do not receive your renewal premium within
31 days of the due date, your cover will stop. Cessation of premium payment before the end of
the premium payment term will lead to an early termination of your coverage.
Is the premium for ExcelCare Plus and MediCover Plus guaranteed?
The premium rates are not guaranteed and the Company reserves the right to revise the rates
upon renewal. One of the possible factors contributing to the increase in premium rates is claim
experience.



The possible factors contributing to premium revision and renewal above are not exhaustive
and the premium rates may be reviewed under other justified circumstances. The Company
will give ninety (90) days prior notice in writing by ordinary post to your last known address in the
Companys records if such revision takes place.

Past trends on the increase in premium rates do not necessarily reflect the future trend.
For unit deducting versions of the products, we charge insurance coverage charges that are
deducted monthly from the value of your units. The insurance charges will increase as you grow
older. Details of insurance charges are given in the sales illustration.
FEES & CHARGES
What are the fees and charges that I have to pay?
There are no fees and charges other than the premiums payable.

ExcelCare Plus & MediCover Plus

TERMS & CONDITIONS


What are some of the key terms and conditions that I should be aware of?
Importance of disclosure you must disclose all material facts such as medical condition, and
state your age correctly.
Free-look period you may cancel your policy by returning us the policy contract and giving us
a written notice that has been signed by you. Both written notice and policy contract must be
received by us within 15 days after you have received the policy contract. The premium that you
have paid (less any medical fee incurred) will be refunded to you.
Grace period you are given a grace period of 31 days from the due date for payment of each
subsequent premium. If premium remains unpaid at the end of this grace period, the policy
may lapse. Unless renewed, the coverage of this policy will cease and the insurance company
shall strictly not be liable for any expenses that takes place after the expiry date.
Waiting period - you will have to wait for a specified duration (from the date your policy began
or last reinstatement date) before your coverage takes effect:
a) 120 days for tonsils, adenoids, hernia or a disease related to the female generative organs;
b) 60 days for Out-patient Cancer Treatment;
c) 30 days for Out-patient Kidney Dialysis and for all other illnesses.
Note:
This list is non-exhaustive. Please refer to the policy contract for the terms and conditions under
this policy.
EXCLUSIONS
What are the major exclusions to this plan?
This plan shall not cover:
a) Pre-existing illnesses;
b) Any medical or physical abnormalities existing at the time of birth, as well as neo-natal
physical abnormalities;
c) Self-inflicted injuries and illegal acts;
d) Wars, strikes or riots;
e) Any armed forces or military operations;
f) Pregnancy, miscarriage or child births;
g) Mental or nervous disorders;
h) Alcoholism and drug abuse or its related conditions;
i) Cosmetic, elective or plastic surgery;
j) Dental treatment unless necessitated by accidental injury;
k) Routine health checks and any investigations not directly related to admission;
l) Treatment which is not medically necessary;
m) Medical expenses which is payable by any laws, medical program or insurance policy;
n) The following exclusions are only applicable to Out-patient Cancer Treatment benefit:
i) All cancers which are histologically classified as pre-malignant; non-invasive; carcinoma;
in-situ; having either borderline malignancy; or having low malignant potential;
ii) All tumours of the prostate, thyroid and urinary bladder histologically classified as T1N0M0
(TNM classification);
iii) Chronic Lymphocytic Leukemia less than RAI Stage 3;
iv) All cancers in the presence of HIV;
v) Any skin cancer other than malignant melanoma;
o) Overseas treatment if Insured Person resides or travels outside Malaysia for more than 90
consecutive days;

10

ExcelCare Plus & MediCover Plus

p) Overseas protection if Insured is a foreigner;


q) Other additional exclusions that apply to specific benefits of MediCover Plus.
This list is non-exhaustive. Please refer to the policy contract for the full list of exclusions under
this policy. For a sample of the policy contract, please talk to your AIA agent.
COVERAGE
When does my coverage starts?
Your coverage starts from the date on which you completed and the signed application form is
approved by us and when we have received the full premium due.
Where am I covered?
You are covered worldwide but subject to a maximum of 90 days protection if you are traveling
overseas. If you are a foreigner, your coverage is confined to within Malaysia only.
Does this plan pay in addition to any other insurance policy that I may have?
No, we will only reimburse eligible medical expenses that have yet to be claimed by you.
What expenses are covered by the Emergency Medical Evacuation Benefit?
Expenses for the necessary transportation, medical services and medical supplies provided
and/or arranged by American International Assistance Services (AIAS) as a result of an
emergency medical evacuation are covered. All decisions as to the means of transportation and
the final destination will be made by AIAS, based solely on medical necessity.
Do I have to bear any of the expenses incurred for hospitalization?
ExcelCare Plus and MediCover Plus have a co-insurance free amount. You may need to pay
for certain portion of your hospitalization expenses if the cost exceeded the co-insurance free
amount. Eligible expenses exceeding the co-insurance free amount are subject to a co-insurance
of 90% payable by the Company and 10% payable by you. However, you will only be required to
pay up to a maximum of RM3,000 per policy year. Please refer to the example below:
Example:
Mrs. Chan is a 30 year-old store manager with ExcelCare Plus and MediCover Plus riders plan
150. During her check-up, she discovered a breast lump. One week later, she was hospitalized
to have the lump removed. Two weeks after being discharged, Mrs. Chan went back for a
follow-up visit.
Prior to her hospitalization, Mrs. Chans diagnostic bill came up to RM750. The actual
hospitalization bill totaled RM25,000. Her follow-up visit incurred a total bill of RM250 for
consultation and medication.

Expenses incurred for the entire treatment:
Stages of hospitalization
1. Pre-hospitalization:
2. In-hospitalization:
3. Post-hospitalization:
Total Cost

Type of benefit

Amount incurred

Diagnostic X-ray

RM750

Hospitalization bill

RM25,000

Consultation and medication

RM250

RM26,000

ExcelCare Plus & MediCover Plus

Based on the above expenses, please find the following breakdown on the amount claimable
under ExcelCare Plus and MediCover Plus 150 and that are borne by Mrs. Chan:
Total expenses incurred

RM26,000

Co-insurance Free Amount (borne by Company)

RM22,000

Total expenses subject to co-insurance


Co-insurance expenses borne by Mrs. Chan
Co-insurance expenses borne by Company

RM4,000
RM400 (10% of RM4,000)
RM3,600 (90% of RM4,000)

Hence, the total expense to be paid by Mrs. Chan is only RM400. The balance RM25,600 will be
covered under ExcelCare Plus and MediCover Plus.
Can I switch my ExcelCare Plus and MediCover Plus plans from a lower plan to a higher
plan, or vice versa?
It may not be advantageous to switch from one health plan to another, as you may be subject
to new underwriting requirements, full waiting period and applicable period for the exclusion of
specified illnesses of the new plans.
CANCELLATION
Can AIA cancel my policy based on my individual claims experience?
No.
Can I cancel my policy?
You may cancel your policy by giving a written notice to us. Upon cancellation, you are entitled to
a refund of a portion of your premium provided that you have not made a claim on the policy.
REINSTATEMENT
Can I reinstate my policy after it has lapsed?
Yes, you may reinstate your policy subject to companys terms and conditions. You may be
required to provide health evidence to prove your insurability at the time of reinstatement.
CLAIMS
How do I make a claim?
You need to complete the relevant claims forms which you can obtain from your AIA agent, by
calling the AIA Customer Service Hotline at 1300-88-1899 or visit any AIA branch. You will find a
list of AIA branches in Malaysia on the back of this document.
What other documentation is required to be submitted together with the claim?
In addition to the relevant claims forms, we require additional medical reports (as listed at the
back of the claims form) to support the claim.
When do I have to notify AIA of a claim?
In the event of a claim, it is advisable that you notify us immediately+.

+ The notification period varies in accordance with the types of claim made. Please refer to the policy contract.

11

12

ExcelCare Plus & MediCover Plus

TAX RELIEF
Can I use the premiums paid for ExcelCare Plus and MediCover Plus for tax relief purposes?
This policy may qualify you for personal tax relief subject to the final decision of the Inland
Revenue Board.
INFORMATION
What do I need to do if there are changes to my contact details?
It is important that you inform us of any change in your contact details to ensure that all
correspondences reach you in a timely manner.

Where can I get further information?
About ExcelCare Plus & MediCover Plus
Should you require additional information on ExcelCare Plus and MediCover Plus or about any
other AIA insurance plans or riders, you can contact your AIA agent, call our AIA Customer
Service Hotline at 1300-88-1899 or by visiting any AIA branch nationwide. You will find a list of
AIA branches on the back of this document. You can also contact us via email by visiting
www.aia.com.my.



About Medical and Health Insurance


Should you require additional information about medical and health insurance, you may refer to
the insuranceinfo booklet on Medical & Health Insurance available at all our branches or you
can obtain a copy from the insurance agent or visit www.insuranceinfo.com.my

NOTE:
1 10% co-insurance applies on claims in excess of the co-insurance free amount, subject to an
overall maximum co-insurance of RM3,000 per year.
2 All services are subject to eligibility and benefit limit of your plan.
3 This coverage applies only if your hospitalization occurs within the first 90 days of your
overseas stay. The treatment costs are paid according to those reasonably charged by a
hospital in Malaysia. For a foreigner, coverage is only provided within Malaysia.
4 Subject to annual limit continues to apply.
5 Applicable to countries in North America, the EC (European Community) and Japan only.
6 Subject to two consultations per day.
7 For each confinement.
8 Subject to one consultation per day.
9 Covered Day Procedure Schedule:
- Arthroscopy, Colonoscopy, Laparoscopy, Extracorporeal Shock Wave Lithotripsy, Cataract
surgery.
10 Limited to once per lifetime.
11 Covered Day Procedure Schedule:
- Adenoidectomy; Arthroscopy; Bone Marrow Aspiration and Biopsy; Cataract Surgery;
Cholecystectomy; Colonoscopy; Coronary Artery Catheterization; Cystectomy;
Cystourethroscopy; Diagnostic Dilatation and Curettage; Endolaser Venous Surgery;
Endoscopic Retrograde Cholangiopancreatography; Excision of Bunions; Excision of
Ganglion, Fibroma(s) and Breast Lump(s); Excision of Pterygium; Extracorporeal Shock
Wave Lithotripsy; Herniotomy / Herniorapphy; Insertion of Pacemaker; Insertion or Removal
of Ureteric J-Stent; Laparoscopic Endometrial Ablation; Laparoscopy; Marsupialisation
and drainage of Bartholins Cysts; Myringotomy or Myringoplasty; Reduction of Bone
Fracture(s); Release of Carpal Tunnel Syndrome (Carpal Tunnel Decompression); Release of
Dupuytrens Contracture (Release of Trigger Finger); Removal of Cervical or Vaginal Polyps;
Removal of Nasal Polyps; Removal of Plate and Orthopedic Implants; Retinal Detachment
Surgery; Rubber Banding of Haemorrhoids; Stapling Haemorrhoidectomy; Tonsillectomy.

ExcelCare Plus & MediCover Plus

IMPORTANT NOTE:
YOU SHOULD SATISFY YOURSELF THAT THIS POLICY WILL BEST SERVE YOUR NEEDS.
THE EXCLUSIONS AND LIMITATIONS OF BENEFITS HIGHLIGHTED ARE NOT EXHAUSTIVE.
YOU SHOULD READ AND UNDERSTAND THE INSURANCE POLICY AND DISCUSS WITH THE
AGENT OR CONTACT THE INSURANCE COMPANY DIRECTLY FOR MORE INFORMATION.

13

14

ExcelCare Plus & MediCover Plus

ExcelCare Plus / MediCover Plus


Insurans Penghospitalan dan Pembedahan
Apakah itu ExcelCare Plus dan MediCover Plus?
ExcelCare Plus
Sanggupkah anda melihat yang tersayang terlantar sakit dengan memilih perlindungan yang
kurang?

Segelintir sahaja daripada kita yang merancang untuk perbelanjaan hospital. Tambahan pula,
dengan kenaikan inflasi perubatan, perbelanjaan perubatan boleh mencecah puluhan ribu ringgit.
Hakikatnya pembedahan yang langsung tidak dijangka dan tidak dapat dielakkan adakalanya
boleh mengeringkan simpanan kita.
ExcelCare Plus menyediakan perbelanjaan penghospitalan dan pembedahan serta menawarkan
perlindungan sehingga umur 100 tahun.
MediCover Plus
Bimbang had seumur hidup pembayaran ganti perubatan asas Excelcare Plus anda tidak
mencukupi untuk keperluan perubatan jangka panjang anda sekeluarga?

Sebagai anak yang berdedikasi, ibu bapa atau pasangan, anda akan cuba mencari perlindungan
perubatan yang sebaik mungkin untuk selama yang boleh. Pelan anda yang sedia ada mungkin
tidak memadai untuk perlindungan yang lebih baik dan bagi tempoh yang lebih panjang. Justeru
itu, wang simpanan hasil titik peluh anda untuk masa depan keluarga anda akan menyusut.
Dengan rider MediCover Plus, anda boleh pasti bahawa insurans anda mencukupi untuk
melindungi anda sekeluarga seumur hidup dengan premium tambahan minimum yang perlu
dibayar di samping premium ExcelCare Plus anda.
MediCover Plus menyediakan perbelanjaan penghospitalan dan pembedahan serta menawarkan
had perlindungan yang lebih tinggi untuk melengkapi ExcelCare Plus.
MANFAAT
Apakah perlindungan / manfaat yang disediakan?
ExcelCare Plus memberikan:
Pilihan had seumur hidup pembayaran ganti perubatan daripada RM200,000 hingga setinggi
RM700,000
Perlindungan 24 jam
Perlindungan sepanjang hayat sehingga umur 100 tahun
Ko-insurans sifar bagi tuntutan dalam amaun yang ditetapkan1
Kadar yang lebih rendah melalui Pelan Keluarga
Bantuan bebas kerenah semasa kemasukan anda ke hospital melalui AIA Health Services2
Perlindungan di seluruh dunia3

ExcelCare Plus & MediCover Plus

Jadual manfaat ExcelCare Plus adalah seperti berikut:


Jadual manfaat ExcelCare Plus
HAD MANFAAT
Setiap Tahun Polisi

100

150

200

250

300

350

Bilik Penginapan Harian Hospital


(120 hari)

100

150

200

250

300

350

Bilik & Penginapan Tambahan


Hospital Semasa Di Luar Negara5
(120 hari)

100

150

200

250

300

350

Unit Rawatan Rapi (120 hari)


Bekalan dan Perkhidmatan Hospital
Manfaat Yuran Pembedahan
Manfaat Yuran Bilik Pembedahan
Manfaat Yuran Pakar Bius

Caj Munasabah dan Biasa Diamalkan sehingga


amaun Bebas Ko-insurans. Baki yang melebihi
amaun Bebas Ko-insurans sehingga Had
Tahunan akan tertakluk kepada Ko-insurans.

Lawatan Pakar Perubatan Dalam Hospital


(maksimum 240 hari setiap tahun polisi)6
Manfaat Sebelum Penghospitalan7
(dalam tempoh 60 hari sebelum)
- Ujian Diagnostik
- Manfaat Rundingan Doktor Pakar8
Manfaat Rawatan Selepas Penghospitalan7
(dalam tempoh 60 hari selepas
penghospitalan)
- Manfaat X-ray Diagnostik & Ujian
Makmal Pesakit Luar
- Manfaat Perbelanjaan Perubatan &
Rundingan8 termaksuk Akupunktur &
Fisioterapi
Prosedur Harian9
Pemindahan Organ/Sumsum Tulang10
(tidak tertakluk kepada ko-insurans)

Caj Munasabah dan Biasa Diamalkan


sehingga Had Tahunan

15

16

ExcelCare Plus & MediCover Plus

HAD MANFAAT
Setiap Tahun Polisi

100

150

200

250

300

350

Elaun Tunai Harian di Hospital


kerajaan (120 hari)

45

50

55

60

65

Manfaat Penjaga Harian (120 hari)

Manfaat Pesakit Luar

60
90
110
130
160
190

15,000 22,000 25,000 28,000 33,000 36,000


60,000 90,000 115,000 140,000 165,000 190,000

Rawatan Kecemasan Pesakit Luar


Akibat Kemalangan & Rawatan
susulan 30 hari di Hospital & Klinik

1,500
2,000
2,500
3,000
3,500

Amuan Bebas Ko-insurans bagi


setiap tahun polisi1
Had Tahunan

40

4,000

Manfaat Nilai Tambahan


Manfaat Pemindahan Perubatan
Kecemasan
Had Seumur Hidup

100,000 100,000 100,000 100,000 100,000 100,000



Manfaat Rawatan Dialisis Buah


Pinggang Pesakit Luar

30,000

40,000

50,000

60,000

70,000

80,000

Manfaat Rawatan Kanser


Pesakit Luar

10,000

12,500

15,000

17,500

20,000

22,500

Had Seumur Hidup Keseluruhan


setiap Orang Yang Diinsuranskan

200,000 300,000 400,000 500,000 600,000 700,000

Nota: Semua amaun ditunjukkan dalam Ringgit Malaysia

ExcelCare Plus & MediCover Plus

Manfaat tambahan MediCover Plus ialah:


Tiada had seumur hidup4
Had yang Tinggi bagi Rawatan Kanser dan Dialisis Buah Pinggang
Perlindungan diperluas untuk Manfaat Selepas Penghospitalan
Jadual Manfaat MediCover Plus adalah seperti di bawah:
Jadual Manfaat MediCover Plus
HAD MANFAAT
Setiap Tahun Polisi

Per

Manfaat Rawatan Selepas Penghospitalan7


(bermula pada hari yang ke-61 dan dalam
tempoh 120 hari selepas penghospitalan)
Prosedur harian11
Amaun Bebas Ko-insurans setiap tahun polisi1
Rawatan Di Rumah (setiap Pengasingan)
(had seumur hidup 180 hari)

150

200

250

300

350

Caj Munasabah dan Biasa Diamalkan sehingga


amaun Bebas Ko-insurans.
Baki melebihi amaun Bebas Ko-insurans
sehingga Had Tahunan akan tertakluk
kepada ko-insurans.

Berkongsi dengan ExcelCare Plus
dan had kekal tidak berubah
3,000

4,000

5,000

6,000

7,000

Berkongsi dengan ExcelCare Plus


dan had kekal tidak berubah

Had Tahunan
Manfaat Pesakit Luar
Rawatan Pergigian Kecemasan Pesakit Luar
Akibat Kemalangan (setiap kemalangan)

3,000

4,000

5,000

6,000

7,000

Manfaat Nilai Tambahan


Manfaat Pemindahan Kecemasan

400,000 400,000 400,000 400,000 400,000

Had Seumur Hidup

Manfaat Rawatan Dialisis Buah Pinggang


Pesakit Luar

40,000

Manfaat Rawatan Kanser Pesakit Luar


Had Seumur Hidup Keseluruhan
setiap Orang Yang Diinsuranskan

60,000

80,000 100,000 120,000


100,000 150,000 200,000 250,000 300,000
Tiada

Nota: Semua amaun ditunjukkan dalam Ringgit Malaysia

Tiada

Tiada

Tiada

Tiada

17

18

ExcelCare Plus & MediCover Plus

Jika anda memilih ExcelCare Plus dengan MediCover Plus, sila rujuk kepada jadual gabungan di
bawah untuk manfaat yang diberikan:
Jadual manfaat gabungan ExcelCare Plus dan MediCover Plus
HAD MANFAAT
Setiap Tahun Polisi

Per

Bilik & Penginapan Harian Hospital


(120 hari)


Bilik & Penginapan Tambahan Hospital
Semasa di Luar Negara5
(120 hari)

150

200

250

300

350

150

200

250

300

350

150

200

250

300

350

Unit Rawatan (120 hari)


Bekalan dan Perkhidmatan Hospital
Manfaat Yuran Pembedahan
Manfaat Yuran Bilik Pembedahan
Manfaat Yuran Pakar Bius
Lawatan Pakar Perubatan Dalam Hospital
(maksimum 240 hari setiap tahun polisi)6
Manfaat Sebelum Penghospitalan7
(dalam tempoh 60 hari sebelum
Penghospitalan)
- Ujian Diagnostik
- Manfaat Rundingan Doktor Pakar8
Manfaat Rawatan Selepas Penghospitalan7
(dalam tempoh 120 hari selepas
penghospitalan)
- Manfaat X-ray Diagnostik Pesakit Luar &
Ujian Makmal
- Manfaat Perbelanjaan Perubatan &
Rundingan8 termasuk Akupunktur &
Fisioterapi
Prosedur Harian11
Rawatan Di Rumah (setiap Pengasingan)
(had seumur hidup 180 hari)
Pemindahan Organ/Sumsum Tulang10 (tidak
tertakluk kepada ko-insurans)

Caj Munasabah dan Biasa Diamalkan


sehingga amaun Bebas ko-insurans.
Baki yang melebihi amaun Bebas
ko-insurans sehingga Had Tahunan
akan tertakluk kepada Ko-insurans.



3,000

4,000

5,000

6,000

7,000

Caj Munasabah dan Biasa Diamalkan


sehingga Had Tahunan

ExcelCare Plus & MediCover Plus

150

200

250

300

350

45

50

55

60

65

110

130

160

190

Amaun Bebas Ko-insurans setiap tahun polisi1

90

22,000

25,000

28,000

33,000

36,000

Had Tahunan

90,000 115,000 140,000 165,000 190,000

HAD MANFAAT
Setiap Tahun Polisi

Elaun tunai harian di Hospital Kerajaan


(120 hari)

Manfaat Penjaga Harian (120 hari)

Manfaat Pesakit Luar


Rawatan Kecemasan Pesakit Luar Akibat
Kemalangan & Rawatan Susulan 30 hari di
Hospital & Klinik

2,000

2,500

3,000

3,500

4,000

Rawatan Pergigian Kecemasan Pesakit Luar


Akibat Kemalangan (setiap kemalangan)

3,000

4,000

5,000

6,000

7,000

Manfaat Nilai Tambahan


Manfaat Pemindahan Kecemasan


500,000 500,000 500,000 500,000 500,000

Had Seumur Hidup


Manfaat Rawatan Dialisis Buah Pinggan
Pesakit Luar

80,000

110,000 140,000 170,000 200,000

Manfaat Rawatan Kanser Pesakit luar

112,500 165,000 217,500 270,000 322,500

Had Seumur Hidup Keseluruhan setiap orang


Yang Diinsuranskan

Tiada

Tiada

Tiada

Tiada

Tiada

Nota: Semua amaun ditunjukkan dalam Ringgit Malaysia. Untuk maklumat penuh berkenaan
perlindungan manfaat, sila rujuk kepada kontrak polisi .

KELAYAKAN
Bagaimana ExcelCare Plus dan MediCover Plus boleh dibeli?
ExcelCare Plus dan MediCover Plus boleh dibeli sebagai rider pembayaran premium yang boleh
dilampirkan pada mana-mana pelan tanpa penyertaan. ExcelCare Plus juga boleh dibeli sebagai
pelan bersendirian. ExcelCare Plus dan MediCover Plus potongan unit boleh dibeli dengan pelan
berkaitan pelaburan.
Adakah saya layak memohon ExcelCare Plus and MediCover Plus?
Polisi ini boleh disertai oleh individu yang berumur daripada 4 minggu hingga 60 tahun,
tertakluk kepada kelulusan penajajaminan. Bagi pelan Insured & Anak dan pelan Keluarga, anak
(tanggungan) berumur di antara 2 minggu hingga di bawah 23 tahun dan sihat tubuh badan,
layak memohon.

19

20

ExcelCare Plus & MediCover Plus

Bolehkah saya melampirkan MediCover Plus pada ExcelCare Plus pelan 100?
Tidak, MediCover Plus hanya boleh dilampikan pada pelan 150 dan ke atas. Anda perlu menaik
taraf ExcelCare Plus anda kepada pelan 150 & ke atas jika anda ingin menikmati perlindungan
tambahan yang disediakan oleh MediCover Plus.
Bagaimana saya hendak memohon?
Sila hubungi ejen AIA anda. Beliau akan menjelaskan kepada anda butir-butir dalam

borang permohonan dan menawarkan bantuan yang anda perlukan untuk melengkapkannya,
ataupun anda boleh menghubungi Hotline Khidmat pelanggan AIA di talian 1300-88-1899 atau
mengunjungi mana-mana cawangan AIA. Senarai cawangan AIA di Malaysia boleh didapati di
belakang dokumen ini.
AMAUN PERLINDUNGAN
Apakah amaun perlindungan untuk ahli keluarga dalam sesuatu pelan?
Semua ahli keluarga yang dilindungi di bawah satu polisi akan dilindungi untuk amaun yang
sama.
PREMIUM
Berapakah premium yang perlu saya bayar?
Ini akan bergantung pada umur anda, jantina dan jenis pelan yang anda pilih, pekerjaan
dan keadaan kesihatan anda. Sila rujuk kepada Lampiran 1 pada penghujung Lembaran
Pendedahan Produk ini untuk jadual premium bagi hayat standard.
Bagaimana boleh saya membayar premium?
Anda hendaklah memastikan bahawa pelan ini menepati keperluan anda dan anda mampu
membayar amaun premium yang perlu dibayar di bawah polisi ini.
Premium boleh dibayar dengan salah satu cara berikut:
a) Secara tunai atau dengan cek. Bagi bayaran dengan cek, sila bayar atas nama American
International Assurance Bhd..
b) Bayaran automatik:
i) Kad kredit
ii) Autodebit (HSBC, BSN dan MBB)
c) Arahan tetap
d) Akaun Kutipan Korporat AIA Maybank (AIA MCCA)
Bayaran premium anda boleh dibuat sekali setahun, dua kali setahun, empat kali setahun atau
sekali sebulan.
Sila ambil perhatian bahawa untuk autodebit, arahan tetap atau kaedah bayaran AIA MCCA,
syarat-syarat tambahan berikut akan dikenakan:
Bagi bayaran yang dibuat sekali setahun, dua kali setahun dan empat kali setahun: bayaran
pertama hendaklah dibuat secara tunai atau dengan cek.
Bagi bayaran yang dibuat sekali sebulan, minimum 2 bayaran pertama hendaklah dibuat
secara tunai atau dengan cek.
Berapakah premium minimum bagi ExcelCare Plus?
Bagi ExcelCare Plus yang dibeli sebagai pelan bersendirian, premium minimum mestilah
sekurang-kurangnya RM300 bagi mana-mana kekerapan bayaran. Walau bagaimanapun,
amaun ini boleh dikurangkan kepada minimum RM75 jika ia dibeli bersama dengan pelan asas
lain (tidak termaksuk pelan bertempoh).

ExcelCare Plus & MediCover Plus

Jika saya mempunyai ExcelCare Plus dan juga MediCover Plus, adakah saya masih perlu
membayar premium apabila had seumur hidup Excelcare Plus saya telah dicapai?
Selagi MediCover Plus dilampirkan pada pelan ExcelCare Plus, pelan ExcelCare Plus akan terus
berkuat kuasa meskipun had umur hidup ExcelCare Plus itu sendiri telah dicapai. Premium akan
terus perlu dibayar dan semua manfaat di bawah pelan ExcelCare Plus akan terus tidak berubah.
Bila bayaran premium saya berakhir?
Premium perlu dibayar sehingga tamat tempoh pada umur 100 tahun atau sehingga berakhirnya
tempoh bayaran premium pelan asas yang rider ini dilampirkan padanya, mana-mana yang
dahulu. Manfaat ExcelCare Plus dan MediCover Plus akan berhenti selepas itu.

Bolehkan premium saya meningkat mengikut umur saya?
Ya. Premium yang perlu dibayar akan bergantung pada umur tercapai anda pada hari jadi yang
berikutnya apabila premium genap tempoh.
Bilakah saya membayar premium pembaharuan saya?
Kami menasihatkan anda supaya membayar setiap premium pembaharuan sebelum ia
genap tempoh. Paling lewat anda boleh membayar setiap premium pembaharuan ialah
31 hari dari tarikh genap tempoh. Jika kami tidak menerima premium pembaharuan anda dalam
masa 31 hari dari tarikh genap tempoh itu, perlindungan anda akan terhenti. Pemberhentian
bayaran premium sebelum akhir tempoh bayaran premium akan menyebabkan penamatan awal
perlindungan anda.
Adakah premium bagi ExcelCare Plus dan MediCover Plus dijamin?
Kadar premium tidak dijamin dan Syarikat berhak menyemak kadar semasa pembaharuan.
Salah satu faktor yang boleh menyumbang kepada kenaikan kadar premium ialah pengalaman
tuntutan.




Faktor yang boleh menyumbang kepada semakan premium dan pembaharuan di atas adalah
tidak terperinci dan kadar premium boleh disemak dalam keadaan-keadaan lain yang wajar.
Syarikat akan memberi notis terdahulu dalam tempoh sembilan puluh (90) hari secara bertulis
melalui pos biasa ke alamat terakhir anda yang diketahui di dalam rekod Syarikat jika semakan
tersebut dibuat.

Trend kenaikan kadar premium pada masa yang lepas tidak semestinya menggambarkan trend
pada masa akan datang.
Bagi versi produk potongan unit, kami mengenakan caj perlindungan insurans yang dipotong
setiap bulan daripada nilai unit anda. Semakin usia anda meningkat caj insurans juga akan turut
meningkat. Butir-butir caj insurans diberikan dalam ilustrasi jualan.
YURAN DAN CAJ
Apakah yuran dan caj yang perlu saya bayar?
Tiada yuran dan caj lain selain jumlah premium yang dibayar.

21

22

ExcelCare Plus & MediCover Plus

TERMA DAN SYARAT


Apakah antara terma-terma dan syarat-syarat penting yang perlu saya ketahui?
Kepentingan pendedahan anda mesti mendedahkan semua fakta-fakta penting seperti
keadaan kesihatan dan menyatakan umur anda dengan betul.
Tempoh percubaan anda boleh membatalkan polisi anda dengan memulangkan kontrak
polisi anda berserta dengan notis bertulis yang anda tandatangani kepada pihak syarikat.
Notis bertulis serta kontrak polisi tersebut perlu diterima terus oleh kami dalam masa 15 hari
selepas anda menerima kontrak anda. Premium yang anda telah bayar (ditolak sebarang yuran
perubatan yang ditanggung) akan dipulangkan kepada anda.
Tempoh ihsan anda diberi tempoh ihsan selama 31 hari dari tarikh genap tempoh bagi
pembayaran setiap premium berikutnya. Jika premium tetap tidak dibayar pada akhir ihsan
polisi ini, polisi ini mungkin luput. Melainkan di perbaharui, perlindungan polisi ini akan terhenti
dan syarikat insurans tidak akan bertanggungjawab terhadap sebarang perbelanjaan yang
dibuat selepas tarikh tamat tempoh.
Tempoh tangguh anda perlu menunggu tempoh tertentu (dari tarikh polisi anda bermula atau
tarikh pemgembalian semula yang terakhir) sebelum perlindungan anda berkuat kuasa:
a) 120 hari bagi tonsil, adenoid, hernia atau penyakit berkaitan dengan organ pembiakan wanita;
b) 60 hari bagi Rawatan Kanser Pesakit Luar;
c) 30 hari bagi Dialisis Buah Pinggang Pesakit Luar dan bagi semua penyakit lain.
Nota: Senarai ini adalah tidak terperinci. Sila rujuk kepada kontrak polisi untuk terma-terma dan
syarat-syarat polisi ini.
PENGECUALIAN
Apakah pengecualian utama untuk pelan ini?
Pelan ini tidak melindungi:
a) Penyakit sedia ada;
b) Sebarang keabnormalan perubatan atau fizikal yang wujud semasa lahir, serta

keabnormalan fizikal neo-natal;
c) Kecederaan diri yang disengajakan dan tindakan yang menyalahi undang-undang;
d) Peperangan, mogok atau rusuhan;
e) Sebarang operasi angkatan bersenjata atau tentera;
f) Kehamilan, keguguran atau melahirkan anak;
g) Kecelaruan mental atau penyakit saraf;
h) Ketagihan alkohol dan penyalahgunaan dadah atau keadaan yang berkaitan dengannya;
i) Pembedahan kosmetik, elektif atau plastik;
j) Rawatan pergigian melainkan diperlukan kerana kecederaan akibat kemalangan;
k) Pemeriksaan kesihatan rutin dan sebarang penyiasatan yang tidak berkaitan secara
langsung dengan kemasukan ke hospital;
l) Rawatan yang tidak perlu dari segi perubatan;
m) Perbelanjaan perubatan yang untuknya pampasan atau pembayaran ganti peril dibayar di
bawah mana-mana undang-undang, program perubatan atau polisi insurans;
n) Keadaan berikut adalah dikecualikan daripada Manfaat Rawatan Kanser Pesakit Luar:
i) Semua kanser yang secara histologinya diklasifikasikan sebagai pramalignan, tidak
menyerang; karsinoma in situ; sama ada mempunyai risiko hampir malignan atau
mempunyai potensi malignan yang rendah;
ii) Semua tumor prostat, tiroid dan pundi kencing yang secara histologinya diklasifikasikan
sebagai T1N0M0 (klasifikasi TNM);
iii) Leukemia Limfositik Kronik yang kurang daripada RAI Tahap 3;
iv) Semua kanser akibat daripada HIV;
v) Sebarang kanser kulit selain daripada melanoma malignan;

ExcelCare Plus & MediCover Plus

o) Rawatan di luar negara jika orang yang diinsuranskan tinggal atau mengembara di luar
Malaysia selama lebih daripada 90 hari berturut-turut;
p) Perlindungan luar negara jika orang yang diinsuranskan adalah warga negara asing;
q) Pengecualian tambahan lain yang dikenakan kepada manfaat tertentu MediCover Plus.
Senarai ini adalah tidak terperinci. Sila rujuk kepada kontrak polisi untuk senarai penuh

pengecualian-pengecualian di bawah polisi ini. Untuk contoh kontrak polisi, sila hubungi ejen AIA anda.
PERLINDUNGAN
Bilakah perlindungan insurans hayat saya bermula?
Perlindungan anda bermula dari tarikh permohonan anda yang telah lengkap diisi dan
ditandatangani itu diluluskan oleh kami dan apabila kami menerima premium yang sewajarnya.
Di manakah saya dilindungi?
Anda dilindungi di seluruh dunia tetapi tertakluk kepada perlindungan maksimum 90 hari jika
anda mengembara ke luar negara. Jika anda adalah seorang warga negara asing, perlindungan
anda terhad dalam Malaysia sahaja.
Adakah pelan ini membayar di samping mana-mana polisi insurans lain yang saya
mungkin ada?
Tidak, kami hanya akan membayar ganti perbelanjaan perubatan layak sahaja yang belum
dituntut oleh anda.
Apakah perbelanjaan yang dilindungi oleh Manfaat Pemindahan Perubatan Kecemasan?
Perbelanjaan bagi pengangkutan, khidmat perubatan dan bekalan perubatan perlu yang
disediakan dan/atau diuruskan oleh American International Assistance Services (AIAS) akibat
pemindahan perubatan Kemalangan adalah dilindungi. Semua keputusan mengenai cara
pengangkutan dan destinasi akhir akan dibuat oleh AIAS, semata-mata berdasarkan
keperluan perubatan.
Adakah saya perlu menanggung sebarang perbelanjaan untuk penghospitalan?
ExcelCare Plus dan MediCover Plus mempunyai amaun bebas ko-insurans. Anda mungkin perlu
membayar bahagian tertentu daripada perbelanjaan penghospitalan anda jika kos ini melebihi
amaun bebas ko-insurans. Perbelanjaan layak yang melebihi amaun bebas ko-insurans adalah
tertakluk kepada ko-insurans 90% yang dibayar oleh Syarikat dan 10% dibayar oleh anda.
Walaubagaimanapun, anda akan hanya dikehendaki membayar sehingga maksimum RM3,000
setiap tahun polisi. Sila rujuk contoh berikut:
Contoh:
Puan Chan adalah seorang pengurus stor berumur 30 tahun yang menyertai ExcelCare Plus dan
rider MediCover Plus pelan 150. Semasa menjalani pemeriksaan kesihatan, beliau mendapati
terdapat ketulan pada payu daranya. Seminggu kemudian, beliau dimasukkan ke hospital untuk
menjalani pembedahan membuang ketulan itu. Dua minggu selepas keluar hospital, Puan Chan
kembali ke hospital untuk lawatan susulan.
Sebelum penghospitalan, bil diagnostik Puan Chan berjumlah RM750. Bil penghospitalan
sebenar berjumlah RM25,000. Lawatan susulannya menelan kos sebanyak RM250 untuk
rundingan dan ubat.

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Perbelanjaan yang terlibat bagi seluruh rawatan:


Peringkat penghospitalan

Jenis manfaat

Amaun terlibat

1. Sebelum Penghospitalan:

X-ray diagnostik

RM750

2. Semasa Penghospitalan:

Bil hospital

RM25,000

3. Selepas Penghospitalan:

Rundingan dan ubat

RM250

RM26,000

Jumlah kos

Berdasarkan perbelanjaan di atas, berikut ialah pecahan bagi amaun yang boleh dituntut di
bawah ExcelCare Plus dan MediCover Plus 150 dan amaun yang ditanggung oleh Puan Chan:
Jumlah perbelanjaan yang terlibat

RM26,000

Amaun Bebas Ko-insurans (ditanggung oleh Syarikat)

RM22,000

Jumlah perbelanjaan yang tertakluk kepada ko-insurans


Perbelanjaan ko-insurans ditanggung oleh Puan Chan
Perbelanjaan ko-insurans ditanggung oleh Syarikat

RM4,000
RM400 (10% daripada RM4,000)
RM3,600 (90% daripada RM4,000)

Jadi, jumlah perbelanjaan yang perlu dibayar oleh Puan Chan cuma RM400. Baki RM25,600 itu
akan dilindungi di bawah ExcelCare Plus dan MediCover Plus.
Bolehkah saya menukar pelan ExcelCare Plus dan MediCover Plus saya daripada pelan
yang lebih rendah kepada pelan yang lebih tinggi, atau sebaliknya?
Adalah tidak menguntungkan untuk bertukar daripada satu pelan kesihatan kepada pelan lain
kerana anda mungkin tertakluk kepada keperluan penajajaminan baru, tempoh tangguh penuh
dan tempoh yang dikenakan bagi pengecualian penyakit tertentu pelan baru itu.
PEMBATALAN
Bolehkah AIA membatalkan polisi saya?
Tidak.
Bolehkah saya membatalkan polisi saya?
Anda boleh membatalkan polisi anda dengan memberi notis bertulis kepada kami. Setelah
dibatalkan, anda berhak mendapat bayaran balik sebahagian daripada premium anda dengan
syarat anda tidak membuat tuntutan ke atas polisi.
PENGEMBALIAN SEMULA
Bolehkah saya mengembalikan polisi saya jika ia telah luput?
Ya, anda boleh mengembalikan semula polisi anda tertakluk pada terma-terma dan syarat-syarat
Syarikat. Anda mungkin diminta untuk mengemukakan bukti untuk membuktikan kebolehinsuransan
kesihatan anda pada saat penerimaan kembali.
TUNTUTAN
Bagaimana saya hendak membuat tuntutan?
Anda perlu melengkapkan borang tuntutan yang berkaitan yang boleh didapati daripada ejen
AIA anda, dengan menelefon Hotline Perkhidmatan Pelanggan AIA di 1 300-88-1899 atau
mengunjungi sebarang cawangan AIA di Malaysia dinyatakan di belakang dokumen ini.

ExcelCare Plus & MediCover Plus

Apakah dokumen lain yang perlu diserahkan bersama tuntutan?


Di samping borang tuntutan yang diberikan, kami juga memerlukan laporan perubatan tambahan
(seperti yang dinyatakan di belakang borang tuntutan) untuk menyokong tuntutan.
Bilakah saya perlu memberitahu AIA mengenai tuntutan?
Sekiranya berlaku tuntutan, anda hendaklah memberitahu kami dengan segera+.

+ Tempoh pemberitahuan berbeza mengikut jenis tuntutan yang dibuat. Sila rujuk pada kontrak polisi.

PELEPASAN CUKAI
Bolehkah saya menggunakan premium yang telah dibayar untuk ExcelCare Plus and
MediCover Plus untuk tujuan pelepasan cukai?
Polisi ini boleh melayakkan anda mendapat pelepasan cukai perseorangan tertakluk kepada
keputusan muktamad Lembaga Hasil Dalam Negeri.
MAKLUMAT
Apa yang perlu saya lakukan jika butir-butir hubungan saya bertukar?
Adalah penting bagi anda memberitahu kami mengenai sebarang pertukaran butir-butir hubungan
anda bagi memastikan semua surat-menyurat sampai kepada anda tepat pada masanya.

Di mana saya boleh mendapatkan maklumat lanjut?
Mengenai ExcelCare Plus dan MediCover Plus
Sekiranya anda memerlukan maklumat tambahan mengenai ExcelCare Plus dan MediCover
Plus atau mengenai mana-mana pelan insurans atau rider AIA yang lain, anda boleh menelefon
Hotline Perkhidmatan Pelanggan AIA kami di 1300-88-1899 atau mengunjungi mana-mana
cawangan AIA di seluruh negara. Senarai cawangan AIA dinyatakan di belakang dokumen ini.
Anda juga boleh menghubungi kami melalui emel dengan melayari www.aia.com.my.
Mengenai Insurans Perubatan Dan Kesihatan
Sekiranya anda memerlukan maklumat tambahan mengenai insurans perubatan dan kesihatan,
anda juga boleh merujuk buku kecil insuranceinfo mengenai Insurans Perubatan Dan Kesihatan
yang boleh didapati di semua cawangan kami atau anda boleh mendapatkan satu naskah
daripada ejen insurans atau kunjungi www.insuranceinfo.com.my.
NOTA:
1 10% ko-insurans dikenakan bagi tuntutan yang melebihi amaun percuma ko-insurans, tertakluk
kepada ko-insurans maksimum keseluruhan RM3,000 setahun.
2 Semua perkhidmatan adalah tertakluk kepada kelayakan dan had manfaat pelan anda.
3 Perlindungan ini terpakai hanya sekiranya penghospitalan anda berlaku dalam tempoh
90 hari pertama anda berada di luar negara. Kos rawatan dibayar mengikut caj berpatutan
yang dikenakan oleh hospital di Malaysia. Bagi warga asing, perlindungan hanya disediakan
di Malaysia.
4 Sentiasa tertakluk kepada had tahunan.
5 Untuk negara-negara di Amerika Utara, EC (Komuniti Eropah) dan Jepun sahaja.
6 Tertakluk kepada dua perundingan sehari.
7 Untuk setiap kemasukan ke hospital.
8 Tertakluk kepada satu perundingan sehari.
9 Jadual Prosedur Harian Yang Dilindungi:
- Artroskopi, Kolonoskopi, Laparoskopi, Litotripsi Gelombang Kejutan Ekstrakorporeum,
pembedahan Katarak.
10 Terhad kepada sekali seumur hidup.

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Jadual Prosedur Harian Yang Dilindungi:


- Adenoidektomi; Artroskopi; Aspirasi dan Biopsi Sumsum Tulang; Pembedahan

Katarak; Kolesistektomi; Kolonoskopi; Pengkateteran Arteri Koronari; Sistektomi;

Sistouretroskopi; Pendilatan dan Pengkuretan Diagnostik; Pembedahan


Vena Endolaser; Kolangiopankreatografi Retrogred Endoskopi; Eksisi Bunion; Eksisi
Ganglion, Fibroma dan Gumpalan Payu Dara; Eksisi Pterigium; Litotripsi Gelombang
Kejutan Ekstrakorporeum; Herniotomi / Herniorafi; Insisi Perentak; Insisi atau Pembuangan
J-Sten Ureterik; Ablasi Endometrium Laparoskopi; Laparoskopi; Marsupialisasi dan Penyaliran
Sista Bartholin; Miringotomi atau Miringoplasti; Pengurangan Fraktur Tulang; Pelepasan
Sindrom Terowong Karpus (Penyahmampatan Terowong Karpus); Pelepasan Kontraktur
Dupuytren (Pelepasan Jari Membengkok); Pembuangan Polip Servikal atau Vagina;
Pembuangan Polip Hidung; Pembuangan Plat dan Implan Ortopedik; Pembedahan Pemisalah
Retina; Pengikatan Hemoroid dengan Gelung Getah; Hemoroidektomi Mengokot; Tonsilektomi.

NOTA PENTING:
ANDA HENDAKLAH MEMASTIKAN BAHAWA POLISI INI MENEPATI KEPERLUAN ANDA.
PENGECUALIAN DAN HAD-HAD MANFAAT YANG DITERANGKAN ADALAH TIDAK LENGKAP.
ANDA HENDAKLAH MEMBACA DAN MEMAHAMI POLISI INSURANS ITU DAN BERBINCANG
DENGAN EJEN ATAU MENGHUBUNGI TERUS SYARIKAT INSURANS UNTUK MAKLUMAT
LANJUT.

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