aia confidential and proprietary information. not for distribution. disclaimer: these presentation...

AIA confidential and proprietary information. Not for distribution.

Disclaimer: These presentation slides have been prepared by AIA Bhd. solely for use during this presentation only and may not be reproduced or redistributed without the written consent of AIA Bhd. These slides serve only as a guide in the selling concept of the products mentioned. In the actual selling process, the customer's needs, affordability and preference must be considered to deliver fair value to the customer. The detailed product benefits and cost must be explained to help customers make informed decisions. Only AIA Bhd. authorized sales materials are to be used when prospecting. The contents have been summarized to suit presentation needs. For actual definitions, descriptions and exclusions, please refer to the actual policy contract.

Presented by MyClient Planning Solutions Sdn Bhd

Insurance Programme for Students of CURTIN UNIVERSITY


Please refer to the Disclaimer Notice on the first page of these slides.

AIA2

Medical Benefits Structure* Outpatient Clinical

* Inpatient Hospitalization

Group Term Life

COVERAGE



AIA3

* Outpatient General Practitioner (GP)

* Inpatient Hospitalization (GHS)

Coverage – Medical Benefits Structure

Medical Benefits Structure



Must be used when seeking care at any Panel GP Clinics

If you lose your Member ID card, inform StudentServices Department immediately

There will be a RM10 replacement fee except in cases of loss with police report or faulty card (cannot be read by EDC Terminal)

You can get waiver of RM10 replacement fee if you submit request online via aia@MyService-Corporate.

4

Front Back

Coverage : Outpatient Clinic with Member ID Card



Visiting Panel GP Clinic

You can only visit a non-Panel clinic in an Emergency or there are no Panel GP Clinics within a 5 km radius of your location.

Log on to AIA@MyService for the Directory of Panel GP ClinicsAlways check with your Student Services Department for Monthly Directory updates

Clinic staff swipes Card at EDC terminal

Benefits / Limits verified & rejected

EDC PrintoutMember to sign and keep a copy

for records

EDC PrintoutMember to pay

Benefits / Limits verified & approved

Member

Member seeks treatment

EDC terminal linked To AIA

Note: Max 1 visit per day. NO limit per visit

AIA Panel GP Clinic

5

Member presents member ID card & passport / IC



Sample EDC Printout

Name of ClinicPatient Name

Membership NumCompany Name

Visit Date Transaction Code

Total Transaction Amount (billed to AIA)

Amount Payable by Patient (RM10)

DATE/TIME : 08 JUNE 13 11:55MERCHANT ID : 000000000000000TERMINAL ID : 12376925BATCH NUM : 000001INVOICE UM : 000003CARD NUM : 8000146803440373

PAYAIA CORPORATE SOLUTIONSPOLIKLINIK ABCTAN YEN YEN75090710508202ABC COMPANY08/01/2006 TRAN# 000771DIAG:1028/0 MC: 0 DAYCONSULTATION 15.00MEDICATION 25.00INJECTION 10.00LAB TEST 10.00X.RAY 10.00PROCEDURE 10.00TRANSACTION AMT: 70.00TOTAL BILLED: 80.00(PATIENT TO PAY) 10.00---------------------------------------------SIGNATUREX __________________________________

Total Billed Amount

MC Days Diagnosis Code

Bill Itemization

Name of ClinicPatient Name

Visit Date

6



Employee Benefits7

Coverage – Medical Benefits Outpatient General Practitioner (GP)–PANEL CLINICS

Categories International Students Local Covered Students

Outpatient GP Care

• Routine Consultation• Medication• Injection• Diagnostic Lab / X-Ray Procedures• Outpatient Surgical Procedures

Covered @

AIA PANEL CLINICSCovered @

AIA PANEL CLINICS

Out-patient GP care (NON PANEL)

Out-Patient Specialists care

Not Cover,

Only for emergency

Not Cover

Not Cover,

only for emergency

Not Cover

VALID WITHIN MALAYSIA ONLYDefinition of Emergency: "Emergency" shall mean treatment needed in the event whereby immediate medical attention is required within twelve (12) hours for injury, illness or symptoms which are sudden and severe failing which will be life-threatening (eg. accident and heart attack), or lead to significant deterioration of health.



Student – Admission @ Panel Hospital

At Government Medical Centers/Hospitals - Pay first, retain itemised bill & receipt and submit claim to AIA Insurance for reimbursement of covered services.

AIA will fax LOG* to the Member’s Hospital for covered services based on entitlement

Hospital Doctor’s Consultation

Member to Hospital admission counter to sign & pre-arrange admission procedure 48 hour prior to schedule admission.Hospital will fax Pre-Admission forms to AIA to request for LOG /admission deposit

Hospital*

Follow-up Call to AIA Member Serives at Toll free no. 1300 8888 60 / 70

*Pre-Admission Assessment Form (PAAF) must be duly completed by the attending doctor prior to requesting a LOG for an admission / Day care procedure. Member

Doctor issue “Pre-Admission Order

Form” for schedule Hospital

Admission



Student – Discharge @ Panel Hospital

At Government hospital / non-panel Hospitals - Pay first, retain ORIGINAL itemizd bill(s) & receipt (s) including deposit receipt . Submit claim to AIA for reimbursement of covered services.

AIA will process for covered services based on entitlementPrior discharge, hospital will

forward hospital final bill + Doctor’s report to AIA for covered

services. Benefits / Limits

verified & approved


Member discharge & pay excess / non-covered item(s), if any & hospital will bill ING for

covered service

Member to pay



Employee Benefits 10

During an Emergency

Emergency – An illness or injury that is life or limb threatening which needs immediate medical attention.

Hospital, A&EAccident & Emergency

> Pay & Claim

OR

Panel

Non-Panel > Pay & Claim

Any GP Clinic

Hospital

Member



Employee Benefits11

Coverage – Medical BenefitsInpatient / Hospitalization


In-Hospital Care

• Hospital Room & Board (Max. 120 days) 100 100

• Intensive Care Unit (Max. 20 days) 350 350

• Hospital Supplies and Services

As Charged

• Surgical Fees

• Anaesthetic Fees

• Operating Theatre Charges

• In-Hospital Physician’s Fees (Max. 120 days)

• Malaysian Government Hospital Daily Cash Allowance (Max. 120 days) 30 30

• Hospital Service Tax (on eligible room & board charges paid

6% 6%

…..cont /-



Employee Benefits12



Ambulatory Care P100 P100

• Pre-Surgical/Medical Diagnostic Services (within 60 days prior to admission)

As Charged

• Pre-Surgical/Medical Specialist Consultation (within 60 days prior to admission)

• Second Surgical Opinion

• Post Hospitalization Treatment (Max 60 days following discharge from hospital)

• Day care Procedure (surgical / medical)

• Emergency Outpatient Accidental Treatment (within 24 hours up to max 60 Days)

2,500 2,500

• Ambulance Service (Emergency & Non-Emergency)

250 250

• Accidental Dental Treatment (within 24 hours up to max 14 days) 500 500

…..cont /-



Employee Benefits13



Ambulatory Care

• Medical Report Fee Reimbursement (applicable for In-hospital Care & Ambulatory Care)

80 80

• Emergency Out-Patient Treatment (max per disability from 10pm – 8am)

100 100

• Basic Overall Limit - Per Student Per Year 20,000 20,000

Definition of Emergency: "Emergency" shall mean treatment needed in the event whereby immediate medical attention is required within twelve (12) hours for injury, illness or symptoms which are sudden and severe failing which will be life-threatening (eg. accident and heart attack), or lead to significant deterioration of health.



Employee Benefits14



Extended Benefits

• Compassionate Allowance 2,000 2,000

Long Term Care Benefits

Kidney Dialysis Chemotherapy

10,00010,000

10,00010,000



Employee Benefits15

What’s Not Covered

Cosmetic surgery or treatment

Experimental procedures

Substance abuse

Private nursing care

Sexual dysfunction or infertility

Pregnancy

Alternative therapies

Psychotic, mental or nervous disorders

Congenital or hereditary illnesses

Routine physical examination

Refractive errors



AIA16

Important Notes

PERSONAL DEPOSITSome hospitals may require personal deposits (on top of depositgranted by AIA) upon admission to pay excess or non-covered Item(s) under the policy. This deposit is refundable upon discharge.

DEPOSIT

TREATMENT PERSONAL

Please refer to your Student Services Department for detailed information on your benefits



AIA17

Important Notes

Things to be avoided during hospitalization

Examples of non-covered items :

extra food admission kit / discharge pack telephone calls, laundry unrelated tests, drugs vitamins & supplements



ING 18

Important Notes

A GP clinic is under the conduct of a registered medical practitioner whoprovides primary care and specializes in family medicine.

Your policy recognizes treatment at GP clinics ONLY.

A Specialist Clinic is a clinic with in-depth diagnosis or treatment on Diseases of specific parts of the body.

Outpatient Specialist Treatment is EXCLUDED.



AIA19

Important Notes

Non-emergency cases, if LOG is not arranged in advance within 48 hours, please pay first and submit your claim to AIA

For emergency (i.e. life & limb threatening) cases, AIA will give immediate approval to the hospital.

Pre-Admission Assessment (PAAF) form needs to be signed by member and completed by your attending doctor and hospital needs to submitted to AIA call centre before we could proceed to issue LOG.

Long term medications will only be issued on monthly basis.

Claims must be submitted to student centre for submission to AIA within 30 days from the date of consultation or service.



Reimbursement Claims ( “Pay & Claim basis” )

1. Outpatient Clinical (Complete Member Outpatient Claim Form)* Non-panel clinic emergency claim* No panel clinic within 5 km of your location* Panel clinic closed * Emergency outpatient treatment at hospital Accident & Emergency (A&E) unit* Waiting for new / loss of AIA member ID card

2. Inpatient Hospital Admission (Complete Member Hospitalization & Surgical Claim Form)* Non-panel Hospitals admission* Government Hospital admission* Pre –Specialist & Post (follow up) hospitalization

Employee Benefits 20



Employee Benefits21

In the event you have to pay first for your • Outpatient GP, or • Emergency/Accidental Outpatient Treatment @ Accident & Emergency Unit of a hospital, please submit the followings to AIA

Documents Required for medical Claim

Itemized bill(s) with breakdown of charges Original bill(s) & Receipt(s) including deposit receipt AIA Claim Form (obtain from shared folder) Please indicate the reason for Pay & Claim in the claim form



Employee Benefits22

How to Submit a Claim

Payment & Notification on member claims

Fill in AIA Claim Form.

Claim Form

Attach Original Receipt & itemized Billing & sign the Claim Form.

Receiptand Itemized Billing

AIA processes claims.

Place Claim Form & attachments to Students

Services Dept

.

Reimbursements for complete claims will be credited into members account within 21 calendar days from date of receipt.All claims will be reimbursed according to benefit entitlements, subject to the 13th MMA Fee Schedule.

Benefits / Limits verified & approved


Issue cheque to member

Documents returned



Non-Reimbursement Claims

1. Outpatient Clinical* Panel clinic claim without the use of the AIA member ID card* Claim from non-panel clinics in a non-emergency* Outpatient Specialist Treatment

2. Inpatient Hospital Admission* Non-covered or excluded services, treatments and medication

Employee Benefits23



Employee Benefits24

1. Report your loss/ faulty card to your student services department immediately. Your panel GP claims will not be reimbursed if you do

not report your loss.

2. There will be a RM10 replacement fee except when a reported loss is accompanied with a police report or you have a faulty card (cannot be read by EDC terminal)

3. If you need medical care and you have not yet received your replacement card, please pay first and submit your claim.

Faulty / Loss of ING Member ID Card



AIA25

Interactive Voice Response (IVR) serviceStep by step guide to the information / services provided

Press

1

Press

2

Press

3

Status of Letter of Guarantee (LOG) / Referral Letters

Room & Board entitlement

Request to re-fax of LOG

1 for English2 for Bahasa

1 If you are AIA Member or HR2 If you are Specialist Centre3 If you are GP Clinic Staff

Select

Press

Key-in• Membership Number

or IC or Passport Number

Call 1300 8888 60/70

Note:

For claim and any other enquiries, please call 1300 8888 60/70 at extension no. 8104. For enquiry member ID and member status at the following extension 8205 or 8213 or 8235 or 8285 from 8.30am to 5.00pm from Monday to Thursday and 8.30am to 4.30pm on Friday

For service

Press

4 Balance of Utilization

Press

5

Letter of Guarantee (LOG) request & benefits enquiries



AIA26

Group Term Life

Coverage

• Total & Permanent Disability• Death



Employee Benefits27

Coverage : Group Term Life

CategoryGroup Term Life

(GTL)

Death

Permanent Total Disability (PTD) due to

natural causes

Permanent Partial Disability (PPD) – Subject

to Schedule

Accidental Personal

Accident

International

Students

RM20,000

Each

RM20,000

Each

RM20,000

EachNot

Applicable


Disclaimer: These presentation slides have been prepared by AIA Bhd. solely for use during this presentation only and may not be reproduced or redistributed without the written consent of AIA Bhd. These slides serve only as a guide in the selling concept of the products mentioned. In the actual selling process, the customer's needs, affordability and preference must be considered to deliver fair value to the customer. The detailed product benefits and cost must be explained to help customers make informed decisions. Only AIA Bhd. authorized sales materials are to be used when prospecting. The contents have been summarized to suit presentation needs. For actual definitions, descriptions and exclusions, please refer to the actual policy contract.

THANK YOU

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