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  • Has FGL Co Sel

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    ethanchoo04
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    Giselle Choo Wen Hui was hospitalized at Sunway Medical Centre Velocity from January 1st to 3rd, 2024 for a Mycoplasma infection. Prudential Assurance Malaysia Berhad paid RM4,537.31 of the total RM4,926.31 medical costs, while Ms. Choo paid RM389 in non-covered expenses and Medisaver deductible. The non-covered expenses included an admission fee and COVID administration fee totaling RM89.

    Original Description:

    Original Title

    34976234-HAS-FGL-CO-SEL

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    Giselle Choo Wen Hui was hospitalized at Sunway Medical Centre Velocity from January 1st to 3rd, 2024 for a Mycoplasma infection. Prudential Assurance Malaysia Berhad paid RM4,537.31 of the total RM4,926.31 medical costs, while Ms. Choo paid RM389 in non-covered expenses and Medisaver deductible. The non-covered expenses included an admission fee and COVID administration fee totaling RM89.

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    © All Rights Reserved
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    3 views2 pages

    Has FGL Co Sel

    Uploaded by

    ethanchoo04
    Giselle Choo Wen Hui was hospitalized at Sunway Medical Centre Velocity from January 1st to 3rd, 2024 for a Mycoplasma infection. Prudential Assurance Malaysia Berhad paid RM4,537.31 of the total RM4,926.31 medical costs, while Ms. Choo paid RM389 in non-covered expenses and Medisaver deductible. The non-covered expenses included an admission fee and COVID administration fee totaling RM89.

    Copyright:

    © All Rights Reserved
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    of 2

    RESTRICTED 11901006

    Final Worksheet

    Claim No : 24000116

    Life Assured : GISELLE CHOO WEN HUI

    NRIC : 150212140878,DD25549

    Hospital Name : Sunway Medical Centre Velocity

    Admission Date : 01/01/2024 Discharge Date : 03/01/2024

    Diagnosis Description : Mycoplasma infection

    Total Amount Paid By PAMB (MYR) : 4,537.31


    Amount Payable By Policy Holder / Self-Pay
    : 389.00
    (MYR)
    Policy No : 34976234

    Effective Date : 19/03/2015

    Medical Plan : PRUValue Med

    Room & Board Entitlement : MYR 200.00 / day


    Paid By Policy
    Benefit Item Actual Incurred Paid By PAMB
    Holder / Self-Pay
    Room & Board (2.0 days) 207.20 207.20 0.00

    Hospital Charges 4,715.11


    4,330.11 389.00
    Surgical Benefit 4.00

    Total Self-Pay Amount 389.00

    Itemised Self-Pay Amount

    Non Coverable Expense 89.00

    Medsaver 300.00

    Grand total Actual Incurred (MYR) 4,926.31

    Grand total paid by PAMB (MYR) 4,537.31


    Grand total paid by Policy Holder / Self-
    389.00
    Pay (MYR)

    Breakdown of Non Coverable Expenses(MYR)

    Hospital & Surgical Benefits


    Administrative / Registration / Admission / Service / Hospital Ancillary Fees -
    ADMISSION FEE - SUBSEQUENT, RM35.0; COVID ADMINISTRATION FEE, 89.00
    RM54.0

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    *Disclaimer:
    Prudential Assurance Malaysia Berhad (PAMB) reserves the right to exclude payment for
    Charges that are deemed unnecessary / unrelated, as stipulated in our Hospital Alliance
    Services Agreement.
    ONLY VALID FOR ONE INPATIENT ADMISSION / DAY SURGERY
    Print Date : 04/01/2024

    Healthcare - Claims

    No signature is required on this computer generated document

    2 of 2

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