ETIQA SME

GROUP HOSPITAL AND SURGICAL TAKAFUL

FOR JABATA AGAMA ISLAM - BHG PENGUATKUASAAN
SCHEDULE OF BENEFITS AND ANNUAL CONTRIBUTION
RB500 RB350 RB250 RB200 RB150
SCHEDULE OF BENEFITS
DETAILS OF
BENEFITS PLAN1 PLAN2 PLAN3 PLAN4 PLAN5
RM RM RM RM RM
Room & Board
a) Ordinary 500 350 250 200 150
Daily maximum up to 180 days - Private Hosp.
Daily maximum up to 180 days - Govt. Hosp.
b) ICU as charged as charged as charged as charged as charged
Daily maximum up to 30 days

Hospital Supplies & Services as charged as charged as charged as charged as charged

(Maximum per disability)

Surgical Fees as charged as charged as charged as charged as charged

(Maximum per disability)

Operating Theatre as charged as charged as charged as charged as charged

Anaesthetist Fees as charged as charged as charged as charged as charged

In-Hospital Physician Visit (max of two (2) visits per day) as charged as charged as charged as charged as charged
(Daily maximum up to 180 days)

Pre-Hospital Diagnostic Tests as charged as charged as charged as charged as charged

(Within 60 days to hospitalisation)

Pre-Hospitalisation Specialist Consultation as charged as charged as charged as charged as charged

(Within 60 days to hospitalisation)

Post-Hospitalisation Treatment as charged as charged as charged as charged as charged

(Follow up within 60 days of discharge)

Emergency Accidental Outpatient Treatment as charged as charged as charged as charged as charged

(Follow up within 60 days of first treatment)

Emergency Accidental Dental Treatment as charged as charged as charged as charged as charged

(within 24 hours after the accident & follow-up treatment up to 14 days)

Second Surgical Opinion as charged as charged as charged as charged as charged

Ambulance Fees as charged as charged as charged as charged as charged

Government Hospital Cash Benefit Allowance 200 200 200 200 200

OVERALL LIMIT FOR GH ADMISSION 200,000 150,000 100,000 75,000 30,000

Day Care Procedure as charged as charged as charged as charged as charged

Emergency Outpatient Sickness Treatment as charged as charged as charged as charged as charged

between 10 p.m to 8 a.m only
(Maximum per disability)

Reimbursement of Medical Report Fees 100 100 100 100 100

Outpatient Cancer Treatment - Subject to Overall Annual Limit as charged as charged as charged as charged as charged

Outpatient Kidney Dialysis Treatment - Subject to Overall Annual Limit as charged as charged as charged as charged as charged

OVERALL MAXIMUM PER ANNUM 200,000 150,000 100,000 75,000 30,000

Funeral Expenses 10,000 10,000 10,000 10,000 10,000

ANNUAL CONTRIBUTION (WITH TPA FEE)

PLAN1 PLAN2 PLAN3 PLAN4 PLAN5
1. Employee only 1,300 1,100 900 750 630
2. Employee & Spouse 3,240 2,740 2,240 1,865 1,565
3. Employee & Children 3,265 2,765 2,265 1,890 1,590
4. Employee & Family 5,207 4,407 3,607 3,007 2,527

Number of Members
1. Employee only 12 0 0 0 0
2. Employee & Spouse 0 0 0 0 0
3. Employee & Children 0 0 0 0 0
4. Employee & Family 0 0 0 0 0

Total Annual Contribution

1. Employee only 15,600 0 0 0 0
2. Employee & Spouse 0 0 0 0 0
3. Employee & Children 0 0 0 0 0
4. Employee & Family 0 0 0 0 0

Contribution SST 6% Total

Total Annual Contribution : 15,600.00 936.00 16,536.00
Total Amount Payable : 15,600.00 936.00 16,536.00

Notes:-

1 The contributions are guaranteed for 60 days from the date of proposal.
2 Sales and Services Tax (SST) on the contribution of 6% are chargeable.
3 This proposal includes Third Party Administration Service by Etiqa Healthcare.
4 Participation is compulsory to all eligible members.
5 All employees are required to complete the Personal Health Declaration Form if the number of employees is equal to or less than ten (10) employees.
6 The Annual Contribution, after deducting Wakalah Fee of 21%, will be allocated into the Tabarru' Fund.
7 Participation in the distributable surplus of the Participant Risk Fund shall be based on the surplus allocation ratio specified in the
Takaful Schedule.
8 This quotation is subject to change if the initial information provided is found to be incomplete, inaccurate or entirely different from
the final information.
9 This plan is supplementary plan for Group Term Product (GTL/GPA).
10 Eligible age between 16 to 64 years old, age next birthday. Renewable up to age 69 years old, age next birthday.
11 The waiting period for eligibility of benefits is 30 days, except for accidental injuries.
12 Pre-existing illnesses condition waived for new and existing member.
13 Specified Illnesses occuring during the first 120 days is not covered.
14 Waiver of Co-payment clause.
15 Standard exclusion list applies.
16 Renewal rate is subject to claim experience and yearly revision by Etiqa .
17 This quotation includes the Letter of Guarantee facility.

Prepared by : Basis of Coverage : Mandatory

UMI KALSOM MAT ISA Scheme Category : Employer-Employee
Etiqa Family Takaful Berhad Intermediary : Coop
20/Dec/21 Date of released : 20/Dec/21
Hospital Panel List : Platinum