aia confidential and proprietary information. not for distribution. disclaimer: these presentation...
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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
AIA confidential and proprietary information. Not for distribution.
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
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
AIA3
* Outpatient General Practitioner (GP)
* Inpatient Hospitalization (GHS)
Coverage – Medical Benefits Structure
Medical Benefits Structure
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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.
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Front Back
Coverage : Outpatient Clinic with Member ID Card
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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
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Member presents member ID card & passport / IC
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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.
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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
Benefits / Limits verified & rejected
Member discharge & pay excess / non-covered item(s), if any & hospital will bill ING for
covered service
Member to pay
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
Employee Benefits11
Coverage – Medical BenefitsInpatient / Hospitalization
Categories International Students Local Covered Students
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 /-
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
Employee Benefits12
Coverage – Medical BenefitsInpatient / Hospitalization
Categories International Students Local Covered Students
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 /-
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
Employee Benefits13
Coverage – Medical BenefitsInpatient / Hospitalization
Categories International Students Local Covered Students
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.
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
Employee Benefits14
Coverage – Medical BenefitsInpatient / Hospitalization
Categories International Students Local Covered Students
Extended Benefits
• Compassionate Allowance 2,000 2,000
Long Term Care Benefits
Kidney Dialysis Chemotherapy
10,00010,000
10,00010,000
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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.
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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.
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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
Benefits / Limits verified & rejected
Issue cheque to member
Documents returned
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
AIA26
Group Term Life
Coverage
• Total & Permanent Disability• Death
AIA confidential and proprietary information. Not for distribution.
Please refer to the Disclaimer Notice on the first page of these slides.
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
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.
THANK YOU
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