maa smartmedic200 - the best medical takaful plan
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IntroducingIntroducing SmartMedic 200
A Complete Complete SolutionSolution for All Your Hospitalisation Needs.
AgendaAgenda
1. The 6 Pillars of SmartMedic 2002. What’s New in SmartMedic 200?3. Competitor’s Analysis4. Table of Benefits5. Underwriting Guidelines6. Exclusions7. Table of Contribution8. Commission Structure9. Managed Care Organisation (MCO)10. Panel Hospitals
The 6 Pillars of SmartMedic 200
The 6 Pillars of SmartMedic 200The 6 Pillars of SmartMedic 200
5 Plans for Both Standalone & Rider
High Room & Board of Up to RM1,000
No Lifetime Limit
High Annual Limit of Up to RM250,000
Funeral Expense of RM5,000 for both Standalone & Rider
No *Co-takaful
Note: *Except for Juvenile (Age 30 days to 15 years old).
What’s New in SmartMedic 200?
What’s New in SmartMedic 200?
Higher Room & Board of Up to RM1,000
5 Plans for Both Standalone & Rider
Higher Annual Limit of Up to RM250,000
No Lifetime Limit
Funeral Expense of RM5,000 for Both Standalone & Rider
What’s New in SmartMedic 200?
Co-takaful for Juvenile (Age 30 days to 15)
Post-Hospitalisation Treatment extended to 60 days from discharge
As Charged for Out-patient Kidney Dialysis, Cancer Treatment, Medical Report Fees & Government Service Tax
High Daily Cash Allowance and Home Nursing Care
Competitor’s Analysis
Competitor’s AnalysisCompetitor’s AnalysisCompany MAAT Company AI Company
PRCompany
GTCompany
ET
Product Type Standalone & Rider
Standalone & Rider Rider Rider Rider
Choice of Plan
5 Plans of up to RM1,000
5 Plans of up to RM350
5 Plans of up to RM400
5 Plans of up to RM400
5 Plans of up to RM500
Product Term
Guaranteed Renewal Up
to Age 80
Renewal Up to Age 99
Guaranteed Renewal Up to Age 25,
70, 80, & 100
Renewal Up to Age 80
Renewal Up to Age 88
Overall Annual Limit
Max RM250k Max RM190k Max RM250k Max RM200k Max RM300k
Lifetime Limit
No Lifetime Limit
No Lifetime Limit
Max RM1.5M
Max RM1.6M
Max RM1.5M
Funeral Expense
RM5,000 N/A N/A N/A N/A
Competitor’s AnalysisCompetitor’s Analysis
Company MAAT Company AI Company PR
Company GT
Company ET
Plan (RM)1 22,0002 25,0003 28,0004 33,0005 36,000
Co-takaful
For Juvenile Plan only.
10% co-takaful
subject to minRM300 & max RM1000 per
admission
10% of the balance exceeding co-takaful Free Amount per cert. year, max RM 3000
Yes. 10% of total expenses Min RM300, Max RM1,000 (H&S) & a Max: RM2000 (Outpatient Treatment Benefit)
Yes.10% co-takaful per disabilityMin RM300MaxRM1000
N/A
Table of Benefits
Table of BenefitsTable of BenefitsPLAN BENEFIT
P150(RM)
P200 (RM)
P300 (RM)
P500(RM)
P1000 (RM)
Annual Limit 50,000 100,000 150,000 200,000 250,000Lifetime Limit No Lifetime LimitFuneral Expenses RM5,000
Hospital BenefitsHospital Room & Board(max 200 days per annum)
150 200 300 500 1,000
Intensive Care Unit(max 60 days per annum)
Age 16 years & above (adult): As chargedAge 30 days to 15 years (juvenile): As charged,
with 10% co-takaful subject to minimumco-takaful of RM300 and maximum co-takaful
of RM1,000 per admission
Hospital Supplies & Services
Surgical Fee
Anaesthetist Fee
Operating Theater
PLAN BENEFITP150(RM)
P200 (RM)
P300 (RM)
P500(RM)
P1000 (RM)
Hospital BenefitsPre-Hospitalisation Diagnostic Tests(within 60 days prior to admission)
Age 16 years & above (adult): As chargedAge 30 days to 15 years (juvenile): As charged,
with 10% co-takaful subject to minimumco-takaful of RM300 and maximum co-takaful
of RM1,000 per admission
Pre-Hospitalisation Specialist Consultation(within 60 days prior to admission)
In-Hospitalisation Physician Visit(maximum 200 days per annum)
Post-Hospitalisation Treatment(within 60 days after discharge)
Table of BenefitsTable of Benefits
PLAN BENEFITP150(RM)
P200 (RM)
P300 (RM)
P500(RM)
P1000 (RM)
Out-Patient BenefitsEmergency Accidental Out-patient Treatment(within 24 hours and follow up treatment toa maximum of 31 days)
As charged
Out-patient Physiotherapy Treatment(within 90 days after discharge/surgery)
Ambulance Fees
Out-patient Kidney Dialysis Treatment
Out-patient Cancer Treatment
Table of BenefitsTable of Benefits
PLAN BENEFITP150(RM)
P200 (RM)
P300 (RM)
P500(RM)
P1000 (RM)
Other BenefitsDaily Cash Allowance at Government Hospital(maximum 200 days per annum)
100 100 100 100 100
Home Nursing Care(maximum per admission) 500 750 1,000 1,500 2,000
Person Covered Child’s Daily Guardian Benefit(maximum per admission)
150 200 300 450 600
Medical Report FeesAs charged
Government Service Tax
Table of BenefitsTable of Benefits
Underwriting Guidelines
Underwriting GuidelinesUnderwriting GuidelinesBenefits New
1. Eligibility
2. Term of Coverage
Eligibility Minimum Maximum
Person Covered 30 days Age 59
Participant Age 18 No Limit
Plan ExpiryBasic Age 80
RiderUp to Age 80
(follow basic plan term, whichever is lower)
Underwriting GuidelinesUnderwriting GuidelinesBenefits New
3. Plan Code
4. Payment Mode
Plan Standalone Rider
Plan 1 P150 PR150Plan 2 P200 PR200Plan 3 P300 PR300Plan 4 P500 PR500Plan 5 P1000 PR1000
Plan Payment Channel
MonthlyDirect Debit/Auto Debit
or Easy Contribution Payment facility
Quarterly, Semi Annually & Annually All
Underwriting GuidelinesUnderwriting GuidelinesBenefits New
5. Contribution Mode Factor
6. Wakalah Fee
Mode Modal ContributionMonthly 0.090Quarterly 0.250
Semi-Annually 0.500Annually 1.000
Certificate Year Wakalah Fee %1 752 503 354 305 206 20
7 onwards 8
Underwriting GuidelinesUnderwriting GuidelinesBenefits New
7. Upgraded Room & Board
• If the Person Covered is hospitalised at a Room & Board which is higher than his/her entitlement, 10% co-payment will be waived if there is a written evidence from authorized hospital personnel to confirm on the unavailability of his/her eligible Room & Board. • The Person Covered only need to pay the
difference of his/her upgraded Room & Board.
8. Co-takaful (Juvenile only)
• The Person Covered will have to pay 10% of the cost of an eligible hospital benefit, subject to minimum co-takaful amount of RM300 and maximum co-takaful amount of RM1,000. • The remaining balance of the eligible benefit will be
paid by MAA Takaful Berhad up to the Overall Annual Limit.
Underwriting GuidelinesUnderwriting GuidelinesBenefits New
9. Foreigner
Below are the group of foreigners who are eligible to participate in SmartMedic 200 Plan 1 until Plan 5.1. Expatriates/Professional2. With PR status (except for manual workers)3. Malaysia My Second Home (MM2H)
10. Payment Grace Period 31 days
11. Take Over Option
MTL1 with SM100 SM200 Standalone MTL2 with SM100 SM200 Rider/StandaloneSM100 Standalone SM200 StandaloneSubject to minimum 1 year anniversary
Exclusions
Exclusions
What are the major exclusions that you should know?
Any medical or physical conditions arising within the first thirty (30) days of the Person Covered’s cover or Reinstatement Date, whichever is the later, except for accidental Injuries.
Pre-existing Illness. Specified Illnesses occurring during the first one hundred
and twenty (120) days of continuous cover.
Exclusions
1. Abuse of alcohol & drugs2. AIDS or ARC (AIDS Related Complex) and HIV3. Congenital abnormalities or deformities4. Pregnancy related conditions 5. Treatment related to infertility or impotence6. Hospitalization for investigatory purposes7. Suicide or intentionally self-inflicted injury while sane or
insane8. War, criminal or terrorist activities9. Contamination by radioactivity10. Donation of body organ
Exclusions11. Cosmetic surgery12. Circumcision13. Eye examination, surgical correction of nearsightedness14. Dental treatment or oral surgery except as necessitated by
accidental injury 15. Private nursing16. Treatment of sleep disorder17. Hormone replacement therapy18. Weight control19. Alternative therapy such as acupuncture, reflexology,
herbalist treatment, aroma therapy & etc20. Mental disorder21. Participation in dangerous sports or profession22. Private flying23. Sex changes
Table of Contributions
Table of Annual Contribution (Standalone – Male)
Age/Plan MaleP150 P200 P300 P500 P1000
0 – 5 1,078 1,402 1,822 2,369 3,0806 – 15 564 733 952 1,238 1,609
16 – 21 910 1,137 1,479 1,922 2,49922 – 29 803 1,017 1,322 1,719 2,23530 – 39 878 1,061 1,379 1,792 2,33040 – 49 1,049 1,316 1,710 2,223 2,89050 – 54 1,552 1,911 2,484 3,229 4,19855 – 59 2,649 3,246 4,219 5,485 7,131
60 – 64* 2,421 2,919 3,795 4,933 6,41365 – 69* 4,339 5,227 6,795 8,834 11,48470 – 74* 5,845 7,041 9,154 11,900 15,46975 – 79* 9,912 11,937 15,518 20,173 26,225
Note: *For renewal only.
Table of Annual Contribution (Standalone – Female)
Age/Plan FemaleP150 P200 P300 P500 P1000
0 – 5 1,078 1,402 1,822 2,369 3,0806 – 15 564 733 952 1,238 1,609
16 – 21 951 1,189 1,546 2,009 2,61222 – 29 839 1,063 1,382 1,796 2,33530 – 39 919 1,111 1,444 1,877 2,44040 – 49 1,102 1,381 1,796 2,334 3,03550 – 54 1,599 1,968 2,559 3,326 4,32455 – 59 2,696 3,304 4,296 5,584 7,259
60 – 64* 2,421 2,919 3,795 4,933 6,41365 – 69* 4,339 5,227 6,795 8,834 11,48470 – 74* 5,845 7,041 9,154 11,900 15,46975 – 79* 9,912 11,937 15,518 20,173 26,225
Note: *For renewal only.
Table of Annual Tabarru’ Rate (Standalone – Male)
Age/Plan MaleP150 P200 P300 P500 P1000
0 – 5 734.04 954.00 1,239.96 1,611.96 2,094.966 – 15 390.00 507.00 659.04 855.96 1,113.00
16 – 21 621.00 777.00 1,010.04 1,313.04 1,707.0022 – 29 549.96 696.96 906.00 1,176.96 1,530.9630 – 39 585.00 708.00 920.04 1,197.00 1,556.0440 – 49 675.00 846.96 1,101.00 1,431.96 1,860.9650 – 54 951.00 1,172.04 1,524.00 1,980.96 2,574.9655 – 59 1,523.04 1,866.96 2,427.96 3,156.00 4,103.04
60 – 64* 2,045.04 2,466.00 3,206.04 4,167.96 5,418.0065 – 69* 3,660.00 4,410.00 5,733.00 7,452.96 9,689.0470 – 74* 4,929.00 5,937.96 7,719.00 10,035.00 13,044.9675 – 79* 8,352.96 10,059.96 13,077.96 17,001.00 22,101.96
Note: *For renewal only.
Table of Annual Tabarru’ Rate (Standalone – Female)
Age/Plan FemaleP150 P200 P300 P500 P1000
0 – 5 734.04 954.00 1,239.96 1,611.96 2,094.966 – 15 390.00 507.00 659.04 855.96 1,113.00
16 – 21 648.96 812.04 1,056.00 1,373.04 1,784.0422 – 29 575.04 728.04 945.96 1,230.00 1,599.9630 – 39 612.96 741.00 963.96 1,253.04 1,629.0040 – 49 708.96 888.96 1,155.96 1,503.00 1,953.9650 – 54 980.04 1,206.96 1,569.96 2,040.96 2,652.9655 – 59 1,550.04 1,901.04 2,471.04 3,213.00 4,176.96
60 – 64* 2,045.04 2,466.00 3,206.04 4,167.96 5,418.0065 – 69* 3,660.00 4,410.00 5,733.00 7,452.96 9,689.0470 – 74* 4,929.00 5,937.96 7,719.00 10,035.00 13,044.9675 – 79* 8,352.96 10,059.96 13,077.96 17,001.00 22,101.96
Note: *For renewal only.
Managed Care Organisation (MCO)
Managed Care Organisation (MCO)
Note: *For renewal only.Note: *For renewal only.
Metronic iCares (MiCares)
Hospital Admission WorkflowNote: *For renewal only.Note: *For renewal only.
Hospital updates interim bills (if exceeds
GL limit)
Person Covered arrives at hospital, produces IC &
Medical CardHospital verifies card and
name via our 24x7 call center / web-system
Hospital faxes relevant docs with Admission Request
Form
Our Call Center validates & authenticate info, issues GL/DL upon
receipt of relevant documents
Person Covered gets admitted into hospital
Our Call Center issues Top-up GL
Hospital Discharge WorkflowNote: *For renewal only.Note: *For renewal only.
Person Covered ready to be discharged
Hospital prepares payment notice breakdown with details
Hospital faxes all relevant docs & medical report
Our Call Center validates, Audits & processes payment
notice, issues final GL upon receipt of full
documents
Hospital receives final GLPerson Covered pays
for uncovered charges (if any)
Person Covered discharged
Panel Hospitals
Panel HospitalsNote: *For renewal only.Note: *For renewal only.
State Hospital Name
Wilayah Persekutuan Kuala Lumpur
Pantai Cheras Medical CentreDamai Service Hospital
Hospital Universiti Kebangsaan Malaysia (HUKM)Institut Jantung Negara (IJN)
Kampung Baru Medical Centre (Al-Islam Specialist Hospital)Hospital Pantai Indah Kuala Lumpur
Hospital Pusrawi (Formerly Pusat Rawatan Islam)KPJ Sentosa Medical Center
Sentul Medical Centre Tung Shin Hospital
Damai Service Hospital ( Melawati)Gleneagles Intan Medical CentreKPJ Tawakal Specialist Hospital
Taman Desa Medical CentreUKM Specialist CentrePantai Medical Centre
Prince Court Medical CentreUM Specialist Centre
Panel HospitalsNote: *For renewal only.Note: *For renewal only.
State Hospital Name
Selangor
Assunta HospitalDarul Ehsan Medical Centre Kajang Plaza Medical Centre Kelana Jaya Medical Centre
Pantai Klang Specialist Medical Centre Sunway Medical Centre
Puteri Klang Medical Centre (Sentosa Medical Centre)Tropicana Specialist Centre (Damansara Woman Specialist)
QHC Medical CentreSime Darby Medical Megah
KPJ Kajang Specialist Hospital (Sentosa Medical Centre)Sri Kota Specialist Medical Centre
Sime Darby Medical Centre (Subang Jaya Medical Centre)The Tun Hussein Onn Eye Hospital
Arunamari Specialist Medical CentreAlpha Specialist Centre
KPJ Damansara Specialist HospitalColombia Asia Medical Centre Puchong
Panel HospitalsNote: *For renewal only.Note: *For renewal only.
State Hospital Name
Kedah
KPJ Kedah Medical Centre Metro Specialist Centre
Putra Medical CentreStrand Hospital & Retirement Home
State Hospital Name
Pulau Pinang
Gleneagles Medical CentreHospital Pantai Mutiara
Island HospitalMount Miriam HospitalLam Wah Ee Hospital
Tanjung Medical CentrePenang Adventist Hospital & Clinic Services
KPJ Penang Specialist HospitalBagan Specialist Hospital
Panel HospitalsNote: *For renewal only.Note: *For renewal only.
State Hospital Name
Melaka
Pantai Ayer Keroh Melaka Medical CentrePutra Specialist Hospital Melaka (formerly The Southern
Hospital Melaka) Mahkota Medical Centre
State Hospital Name
Perak
Fatimah HospitalKinta Medical Centre
Hospital Pantai Putri IpohPerak Community Specialist Hospital
Taiping Medical CentreKPJ Ipoh Specialist Hospital
Sri Manjung Specialist CentreColumbia Asia Hospital Taiping
Panel HospitalsNote: *For renewal only.Note: *For renewal only.
State Hospital Name
Negeri Sembilan
Columbia Asia Medical Center, SerembanNilai Cancer Institute
Senawang Specialist HospitalKPJ Seremban Specialist Hospital
NS Chinese Maternity Hospital
State Hospital Name
Johor
Hospital Pantai Batu PahatMedical Specialist Centre
KPJ Johor Specialist HospitalColumbia Asia Nusajaya
KPJ Puteri Specialist HospitalKPJ Hospital Penawar
Putra Specialist Hospital, Batu Pahat (formely The Southern Hospital, Batu Pahat)
Pusat Pakar Kluang UtamaKempas Medical Centre
Regency Specialist Hospital
Panel HospitalsNote: *For renewal only.Note: *For renewal only.
State Hospital Name
Kelantan Kota Bharu Medical CentreKPJ Perdana Specialist Hospital
State Hospital Name
Pahang
Hospital Pakar PRKMUIP Sdn. BhdKPJ Kuantan Specialist HospitalDarul Makmur Medical Centre
Kuantan Clinical Diagnostic CentreKuantan Medical Centre
State Hospital NameTerengganu Kuala Terengganu Specialist Hospital
Panel HospitalsNote: *For renewal only.Note: *For renewal only.
State Hospital Name
SabahKPJ Damai Specialist Centre
Sabah Medical CentreRafflesia Medical Centre
State Hospital Name
Sarawak
KPJ Kuching Specialist HospitalNormah Specialist Medical Centre
Timberland Medical CentreColumbia Asia Medical Center, Miri
Rejang Medical CentreMiri City Medical Centre
Sibu Specialist Medical CentreBintulu Medical Centre
What medical surgeons can do for you is to cure your physical and some
mental sicknesses. But what they certainly cannot do is
to solve your financial illnesses. One especially caused by your
deteriorating health conditions if not monitored and planned for
wisely.
Thank You
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