IKHLAS MEDICAL TAKAFUL

IKHLAS PHM VIP MEDICAL TAKAFUL
(Hospitalisation and Surgical Takaful Coverage)

WHEREAS the Participant named in the Certificate Schedule has applied to Takaful Ikhlas Sdn Bhd (hereinafter called "the
Company") or the takaful herein described and has paid or agreed to pay the contribution stated in the Certificate Schedule as
consideration for the takaful hereinafter contained.
NOW THIS CERTIFICATE WITNESSETH that if the Covered Person is confined to a hospital for treatment or is surgically
treated as a day case during the Period of Takaful stated In the Certificate Schedule, the Company will pay to the Participant or
his legal personal representative the sum or sums stated in the Certificate Schedule. Payment is subject to reasonable and
customary charges and will only be made upon receipt and approval of proofs of expenses incurred.
THIS CERTIFICATE is subject to the provisions, conditions and limitations as contained herein or as may be endorsed hereon.

SCHEDULE OF BENEFITS
DESCRIPTION BENEFIT

SECTION A MEDICAL EXPENSES BENEFIT PVM 1(a) PVM 2(a)
1. Hospital Room & Board, daily maximum up to 365 days 500 350
2. Intensive Care Unit, daily maximum up to 365 days
3. Hospital Supplies & Services
4. Pre-Surgical Consultation & Diagnosis, within 31 days prior to surgery
5. Surgical Fees (including Anaesthetist Fee and Operating Theatre) and
post-surgery care up to 31 days
6. Pre-Hospital Specialist Consultation & Diagnostic Tests, within 31
days prior to admission As Charged
7. In-Hospital Physician Visit, daily maximum up to 365 days (subject to reasonable and customary
8. Post Hospitalisation Treatment, within 60 days from the date of charges)
discharge
9. Ambulance Fees
10. Emergency Accidental Outpatient Treatment, per accident including
follow-up up to 31 days
11. Emergency Dental Treatment, per accident including follow-up up to
31 days
12. Covered Child s Daily Guardian Benefit, daily maximum up to 365
Covered Covered
days
13. Medical Report Fee, per disability 100 100
14. Government Service Tax Covered Covered
15. Funeral Expenses 5,000 3,000
16. Hospitalisation Cash Benefit, up to 60 days (payable from 3rd day
500 300
onwards)
17. Outpatient Cancer Treatment , per year 60,000 36,000
18. Outpatient Kidney Dialysis , per year 60,000 36,000
Limit Per Disability 200,000 150,000
Overall Annual Limit 600,000 450,000
LIFETIME LIMIT 600,000 450,000

SECTION B PERSONAL ACCIDENT BENEFIT
Accidental Death & Permanent Disablement 200,000 150,000

1

GENERAL PROVISIONS

1. PERSONS ELIGIBLE
Persons eligible to be covered under this Certificate are:-
(a) the Participant aged below 80 years;
(b) the Participant s legal spouse aged below 80 years, unless legally separated from the Participant; and
(c) the Participant s child who has attained the age of 30 days and is an unmarried person, is financially dependent
upon the Participant and is under the age of 19 or up to the age of 23 for those registered as full time students at a
recognized educational institution.
2. PERIOD OF COVER AND RENEWAL
This Certificate shall become effective as of the date stated in the Schedule. The Certificate Anniversary shall be one
year after the effective date and annually thereafter. On each such anniversary, this Certificate is renewable at the
contribution rates in effect at that time as notified by the Company.
This Certificate will be renewable at the option of Participant subject to the terms, conditions and termination at each of
the anniversary of the Certificate date. The renewal contribution payable is not guaranteed and the Company reserves
the right to determine the contribution applicable specifically to each Participant at the time of renewal.
During renewal, the terms and conditions of coverage shall not be amended, except where a particular disability has
reached the maximum limit per disability. In such situation, the Company reserves the right to specifically exclude such
disability from the certificate.
This Certificate is renewable at the option of Participant until the occurrence of any of the following:
(a) non payment of contribution or contribution not made on time
(b) fraud or misrepresentation of material fact during application
(c) the Certificate is cancelled at the request of the Participant
(d) total claims of the Certificate have reached the lifetime limit specified and/or on the death of the Covered Person
(e) the Covered Person ceases to qualify as a dependant based on the definition of the Certificate
(f) the Covered Person attains the coverage age limit specified
(g) termination of coverage for all Certificates in a certain market and the Company withdraws this Certificate
completely from the market in accordance with the Portfolio Withdrawal Condition.
The Company shall give the Participant a 30 day written notice in the event of revision of contribution or portfolio
withdrawal.
3. GEOGRAPHICAL TERRITORY
All benefits provided in this Certificate are applicable worldwide for twenty-four (24) hours a day.
4. SUCCEEDING PARTICIPANT
(a) In the event of death of the Certificate Owner while this Certificate is in force, the Certificate Owner s legal spouse
may become the new Certificate Owner upon signing of a new aqad, and all references in this Certificate to the
Certificate Owner shall hereafter mean such spouse.
(b) When a Covered Person ceases to be a dependant child, the Covered Person may continue to renew the
Certificate in the Covered Person s own name as a Participant and all references in this Certificate to the
Participant shall thereafter mean such Covered Person.

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SECTION A
MEDICAL EXPENSES BENEFITS

DEFINITIONS

1 ACCIDENT shall mean a sudden, unintentional, unexpected, unusual and specific event that occurs at an identifiable
time and place which shall, independently of any other cause, be the sole cause of bodily injury.
2 ANY ONE DISABILITY shall mean all of the periods of disability arising from the same cause including any and all
complications there from except that if the Covered Person completely recovers and remain free from further treatment
(including drugs, medicines, special diet or injection or advice for the condition) of the disability for at least ninety (90)
days following the latest date of discharge and subsequent disability from the same cause shall be considered as though
it were a new disability.
3 AS CHARGED refers to actual charges incurred for reasonable, necessary and customary medical care provided in the
treatment of a covered disability.
4 CHILD shall mean any person who has attained the age of 30 days and is an unmarried person is financially dependent
upon the Participant and is under the age of 19 or up to the age of 23 for those registered as full time students at a
recognized educational institution.
5 CONGENITAL CONDITIONS shall mean any medical or physical abnormalities existing at the time of birth, as well as
neo-natal physical abnormalities developing within 6 months from the time of birth. They will include hernias of all types
and epilepsy except when caused by a trauma which occurred after the date that the participant was continuously
covered under this Certificate.
6 DOCTOR or PHYSICIAN or SURGEON shall mean a registered medical practitioner qualified and licensed to practice
western medicine and who, in rendering such treatment, is practicing within the scope of his licensing and training in the
geographical area of practice, but excluding a doctor, physician or surgeon who is the Participant himself.
7 DENTIST shall mean a person who is duly licensed or registered to practice dentistry in the geographical area in which a
service is provided, but excluding a physician or surgeon who is the Participant himself.
8 DEPENDANT shall mean any of the following persons:
(a) a legally married spouse
(b) unmarried children over 30 days old but under nineteen (19) years of age or twenty-three (23) years of age is still
on full-time higher education, and who are not gainfully employed.
9 DAY SURGERY - A patient who needs the use of a recovery facility for a surgical procedure on a pre-plan basis at the
hospital/specialist clinic (but not for overnight stay).
10 DISABILITY shall mean a Sickness, Disease, Illness or the entire Injuries arising out of a single or continuous series of
causes.
11 ELIGIBLE EXPENSES shall mean Medically Necessary expenses incurred due to a covered Disability but not exceeding
the limits in the schedule.
12 HOSPITAL shall mean only an establishment duly constituted and registered as a hospital for the care and treatment of
sick and injured persons as paying bed-patients, and which:
(a) has facilities for diagnosis and major surgery
(b) provides 24 hours a day nursing services by registered and graduate nurses
(c) is under the supervision of a Physician, and
(d) is not primarily a clinic, a place for alcoholics or drug addicts, a nursing, rest or convalescent home or a home for
the aged or similar establishment.
13 HOSPITALISATION shall mean admission to a Hospital as a registered in-patient for Medical Necessary treatment for a
covered Disability upon recommendation of a physician. A patient shall not be considered as an in-patient if the patient
does not physically stay in the hospital for the whole period of confinement.
14 INTENSIVE CARE UNIT shall mean a section within a Hospital which is designated as an Intensive Care Unit by the
Hospital and which is maintained on a twenty-four (24) hour basis solely for treatment of patients in critical condition and
is equipped to provide special nursing and medical services not available elsewhere in the Hospital.
15 INJURY shall mean bodily injury caused solely by Accident.

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16 COVERED PERSON shall mean the person described in the Certificate Schedule including his/her Dependent (if
applicable).
17 LIFETIME LIMIT shall mean the maximum amount payable in the lifetime of the Covered Person. Once the lifetime limit is
reached, the Certificate is automatically terminated. Where stated in the Certificate, the Iifetime limit shall apply.
18 MALAYSIAN GOVERNMENT HOSPITAL shall mean a hospital which charges of services are subject to the Fee Act
1951, Fees (Medical) Order 1982 and/or its subsequent amendments if any.
19 MEDICALLY NECESSARY shall mean a medical service which is:
(a) consistent with the diagnosis and customary medical treatment for a covered Disability, and
(b) in accordance with standards of good medical practice, consistent with current standard of professional medical care,
and of proven medical benefits, and
(c) not for the convenience of the Participant or the Physician, and unable to be reasonably rendered out of hospital (if
admitted as an inpatient), and
(d) not of an experimental, investigational or research nature, preventive or screening nature, and
(e) for which the charges are fair and reasonable and customary for the Disability.
20 OUT-PATIENT shall mean the Covered Person is receiving medical care or treatment without being hospitalised and
includes treatment in a Daycare centre.
21 OVERALL ANNUAL LIMIT
Benefits payable in respect of expenses incurred for treatment provided to the Covered Person during the period of
takaful shall be Iimited to Overall Annual Limits as stated in the Schedule of Benefits irrespective of the type/types of
disability. In the event the Overall Annual Limit having been paid, all coverage for the Covered Person hereunder shall
immediately cease to be payable for the remaining Certificate year.
22 PARTICIPANT shall mean a person or corporate body to whom the Certificate has been issued in respect of cover for
persons specifically identified as Covered Persons in this Certificate.
23 CERTIFICATE YEAR shall mean the one year period including the effective date of commencement of takaful and
immediately following that date, or the one year period following the Renewal or Renewed Certificate.
24 PRE-EXISTING ILLNESS shall mean disabilities that the Covered Person has reasonable knowledge of. A Covered
Person may be considered to have reasonable knowledge of a pre-existing condition where the condition is one for
which:-
(a) the Covered Person had received or is receiving treatment;
(b) medical advice, diagnosis, care or treatment has been recommended;
(c) clear and distinct symptoms are or were evident; or
(d) its existence would have been apparent to a reasonable person in the circumstances.
25 PRESCRIBED MEDICINES shall mean medicines that are dispensed by a Physician, a Registered Pharmacist or a
Hospital and which have been prescribed by a Physician or Specialist in respect of treatment for a covered Disability.
26 REASONABLE AND CUSTOMARY CHARGES shall mean charges for medical care which is medically necessary shall
be considered reasonable and customary to the extent that it does not exceed the general level of charges being made
by others of similar standing in the locality where the charge is incurred, when furnishing like or comparable treatment,
services or supplies to individual of the same sex and of comparable age for a similar sickness, disease or injury and in
accordance with accepted medical standards and practice could not have been omitted without adversely affecting the
Covered Person s medical condition.
27 RENEWAL OR RENEWED CERTIFICATE shall mean a Certificate which has been renewed without any lapse of time
upon expiry of a preceding Certificate with the same content.
28 SICKNESS, DISEASE or ILLNESS shall mean a physical condition marked by a pathological deviation from the normal
healthy state.
29 SPECIALIST shall mean a medical or dental practitioner registered and licensed as such in the geographical area of his
practice where treatment takes place and who is classified by the appropriate health authorities as a person with superior
and special expertise in specified fields of medicine or dentistry but excluding a physician or surgeon who is the
Participant himself.
30 SURGERY shall mean any of the following medical procedures:
(a) To incise, excise or electrocauterize any organ or body part, except for dental services.
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(b) To repair, revise or reconstruct any organ or body part.
(c) To reduce by manipulation a fracture or dislocation.
(d) Use of endoscopy to remove a stone or object from the larynx, bronchus, trachea, esophagus, stomach,
intestine, urinary bladder, or urethra.

DESCRIPTION OF BENEFITS

SECTION A
1 HOSPITAL ROOM AND BOARD
Reimbursement of the Reasonable and Customary Charges Medically Necessary for room accommodation and meals.
The amount of the benefit shall be equal to the actual charges made by the Hospital during the Covered Person s
confinement, but in no event shall the benefit exceed, for any one day, the rate of Room and Board Benefit and the
maximum number of days as set forth in the Schedule of Benefits. The Participant will only be entitled to this benefit
while confined to a Hospital as in-patient.
2 INTENSIVE CARE UNIT
Reimbursement of the Reasonable and Customary Charges Medically Necessary for actual room and board incurred
during confinement as an in-patient in the Intensive Care Unit of the Hospital. This benefit shall be payable equal to the
actual charges made by the Hospital subject to the maximum benefit for any one day, and maximum number of days,
as set forth in the Schedule of Benefits. Where the period of confinement in an Intensive Care Unit exceeds the
maximum set forth in the Schedule of Benefits, reimbursement will be restricted to the standard Daily Hospital Room
and Board rate.
No Hospital Room and Board Benefits shall be paid for the same confinement period where the Daily Intensive Care
Unit Benefits is payable.
3 HOSPITAL SUPPLIES & SERVICES
Reimbursement of the Reasonable and Customary Charges actually incurred for Medically Necessary general nursing,
prescribed and consumed drugs and medicines, dressings, splints, plaster casts, x-ray, laboratory examinations,
electrocardiograms, physiotherapy, basal metabolism tests, intravenous injections and solutions, administration of
blood and blood plasma but excluding the cost of blood and plasma whilst the Covered Person is confined as an in-
patient in a Hospital, up to the amount stated in the Schedule of Benefits.
4 PRE-SURGICAL CONSULTATION & DIAGNOSIS
Specialists fees for consultation, pathology and radiography following referral from a general practitioner, for each
illness or injury requiring confinement in a hospital. Benefit is not payable for outpatient treatment (including
medications and any subsequent consultations after the illness is diagnosed), nor if the patient is not subsequently
surgically treated after such diagnostic services have been performed.
5 PRE-HOSPITAL SPECIALIST CONSULTATION
Reimbursement of the Reasonable and Customary Charges for the first time consultation by a Specialist in connection
with a Disability within the maximum number of days as set forth in the Schedule of Benefit preceding confinement in a
Hospital and provided that such consultation is Medically Necessary and has been recommended in writing by the
attending general practitioner. Payment will not be made for clinical treatment (including medications and subsequent
consultation after the illness is diagnosed) or where the Participant does not result in hospital confinement for the
treatment of the medical condition diagnosed.
6 PRE-HOSPITAL DIAGNOSTIC TESTS
Reimbursement of the Reasonable and Customary Charges for Medically Necessary ECG, X-ray and laboratory tests
which are performed for diagnostic purposes on account of an injury or illness when in connection with a Disability
preceding hospitalisation within the maximum number of days and amount as set forth in the Schedule of Benefit in a
Hospital and which are recommended by a qualified medical practitioner. No payment shall be made if upon such
diagnostic services, the Participant does not result in hospital confinement for the treatment of the medical condition
diagnosed. Medications and consultation charged by the medical practitioner will not be payable.
7 IN-HOSPITAL PHYSICIAN VISIT
Reimbursement of the Reasonable and Customary Charges by a Physician for Medically Necessary visiting an in-
paying patient while confined for a non-surgical disability subject to a maximum of 1 visit per day not exceeding the
maximum number of days as set forth in the Schedule of Benefit.

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8 POST-HOSPITALISATION TREATMENT
Reimbursement of the Reasonable and Customary Charges incurred in Medically Necessary follow-up treatment by the
same attending Physician, within the maximum number of days and amount as set forth in the Schedule of Benefits
immediately following discharge from Hospital for a non-surgical disability. This shall include medicines prescribed
during the follow-up treatment but shall not exceed the supply needed for the maximum number of days as set forth in
the Schedule of Benefits.
9 SURGICAL FEES
Reimbursement of the Reasonable and Customary Charges for a Medically Necessary surgery by the Specialists,
including pre-surgical assessment Specialist s visits to the Covered Person and post-surgery care up to the maximum
of 31 days from the date of surgery, but within the maximum amount indicated in the Schedule of Benefits. If more than
one surgery is performed for Any One Disability, the total payments for all the surgeries performed shall not exceed the
maximum stated in the Schedule of Benefits.
10 ANAESTHETIST FEE
Reimbursement of the Reasonable and Customary Charges by the Anaesthetist for the Medically Necessary
administration of anesthesia not exceeding the limits as set forth in the Schedule of Benefits.
11 OPERATING THEATRE
Reimbursement of the Reasonable and Customary Operating Room charges incidental to the surgical procedure.
12 AMBULANCE FEES
Reimbursement of the Reasonable and Customary Charges incurred for necessary domestic ambulance services
(inclusive of attendant) to and/or from the Hospital of confinement. Payment will not be made if the Covered Person is
not hospitalised and subject to the limits set forth In the Schedule of Benefits.
13 EMERGENCY ACCIDENTAL OUTPATIENT TREATMENT
Reimbursement of the Reasonable and Customary Charges incurred for up to the maximum stated in the Schedule of
Benefits, as a result of a covered bodily injury arising from an Accident for Medical Necessary treatment as an
outpatient at any registered clinic or hospital within 24 hours of the Accident causing the covered bodily injury. Follow
up treatment by the same doctor or same registered clinic or Hospital for the same covered bodily injury will be
provided up to the maximum amount and the maximum number of days as set forth in the Schedule of Benefits.
14 EMERGENCY DENTAL TREATMENT
Reimburses expenses incurred as a result of an injury to wholly sound natural teeth arising from an Accident for
treatment as an outpatient at any registered dental clinic or hospital within twenty four (24) hours of the Accident
causing Injury. Follow-up treatment by will be provided up to 31 days by the same dentist at the same registered dental
clinic or Hospital.
15 COVERED CHILD S DAILY GUARDIAN BENEFIT
Reimburses (up to stipulated limits set forth on the Schedule of Benefits) the expenses for meals and lodging incurred
to accompany a covered Child (aged below fifteen (15) years) in the hospital up to the maximum number of days set
forth in the Schedule of Benefits.
16 REIMBURSEMENT OF MEDICAL REPORT FEE
It is hereby declared and agreed that notwithstanding anything contained herein to the contrary, the certificate is
extended to reimburse Medical Report Fee not exceeding the amount stated in the Schedule of Benefits in respect of
each disability.
17 REIMBURSEMENT OF SERVICE TAX
Reimburses the actual payable in respect of treatment received for illnesses or conditions covered under the
Certificate.
18 FUNERAL EXPENSES
It is hereby declared and agreed that the Certificate is extended to pay a lump sum as specified in the Schedule of
Benefits if the Covered Person dies during surgery or hospitalisation or within 14 days from the date of discharge from
a Hospital.
19 HOSPITALISATION CASH BENEFIT
It is hereby declared and agreed that the Certificate is extended to pay, in addition to any other items reimbursable
under any policy, a daily cash allowance for each day patient is confined to a Hospital as specified in the Schedule of
Benefits
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20 OUT-PATIENT CANCER TREATMENT
If a Covered Person is diagnosed with Cancer as defined below, the Company will reimburse the Reasonable and
Customary Charges incurred for the Medically Necessary treatment of cancer performed at a legally registered cancer
treatment centre subject to the limit of this disability as specified in the Schedule of Benefit.
Such treatment (radiotherapy or chemotherapy excluding consultation, examination tests, take home drugs) must be
received at the out-patient department of a Hospital or a registered cancer treatment centre immediately following
discharge from Hospital confinement or surgery
Cancer is defined as the uncontrollable growth and spread of malignant cells and the invasion and destruction of
normal tissue which major interventionist treatment or surgery (excluding endoscopic procedures alone) is considered
necessary. The cancer must be confirmed by histological evidence of malignancy. The following conditions are
excluded:-
(a) Carcinoma in situ including of the cervix;
(b) Ductal Carcinoma in situ of the breast;
(c) Papillary Carcinoma of the bladder & Stage I Prostate Cancer;
(d) All skin cancers except malignant melanoma;
(e) Stage 1 Hodgkin s disease;
(f) Tumors manifesting as complications of AIDS.
It is a specific condition of this Benefit that notwithstanding the exclusion of pre-existing conditions, this Benefit will not
be payable for any Participant who had been diagnosed as a cancer patient and/or is receiving cancer treatment prior
to the effective date of Takaful.
21 OUT-PATIENT KIDNEY DIALYSIS TREATMENT
If a Covered Person is diagnosed with Kidney Failure as defined below, the Company will reimburse the Reasonable
and Customary Charges incurred for the Medically Necessary treatment of kidney dialysis performed at a legally
registered dialysis centre subject to the limit of this disability as specified in the Schedule of Benefit.
Such treatment (dialysis excluding consultation, examination tests, take home drugs) must be received at the out-
patient department of a Hospital or a registered dialysis treatment centre immediately following discharge from Hospital
confinement or surgery.
Kidney Failure means end stage renal failure presenting as chronic, irreversible failure of both kidneys to function as a
result of which renal dialysis is initiated.
It is a specific condition of this Benefit that notwithstanding the exclusion of pre-existing conditions this Benefit will not
be payable for any Participant who has developed chronic renal diseases and/or is receiving dialysis treatment prior to
the effective date of Takaful.

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EXCLUSIONS FOR SECTION A

This contract does not cover any hospitalisation, surgery or charges caused directly or indirectly, wholly or partly, by any one (1)
of the following occurrences:
1. Pre-existing illness.
2. Any medical or physical conditions arising within the first thirty (30) days of the Covered Person s cover or date
reinstatement whichever is latest except for accidental injuries.
3. Care or treatment for which payment is not required or to the extent which is payable by any other takaful or indemnity
covering the Participant and Disabilities arising out of duties of employment or profession that is covered under a
Workman s Compensation Insurance Contract.
4. Plastic/Cosmetic surgery, circumcision, eye examination, glasses and refraction or surgical correction of
nearsightedness (Radial Keratotomy or Lasik) and the use or acquisition of external prosthetic appliances or devices
such as artificial limbs, hearing aids, implanted pacemakers and prescriptions thereof.
5. Dental conditions including dental treatment or oral surgery except as necessitated by Accidental injuries to sound
natural teeth occurring wholly during the Period of Takaful.
6. Private nursing, rest cures or sanitaria care, illegal drugs, intoxication, sterilization, venereal disease and its sequelae,
AIDS (Acquired Immune Deficiency Syndrome) or ARC (AIDS Related Complex) and HIV related diseases, and any
communicable diseases required quarantine by law.
7. Any treatment or surgical operation for congenital abnormalities or deformities including hereditary conditions.
8. Pregnancy, child birth (including surgical delivery), miscarriage, abortion and prenatal or postnatal care and surgical,
mechanical or chemical contraceptive methods of birth control or treatment pertaining to infertility. Erectile dysfunction
and tests or treatment related to impotence or sterilization.
9. Psychotic mental or nervous disorders (including any neuroses and their physiological or psychosomatic
manifestations).
10. Hospitalisation primarily for investigatory purposes, diagnosis, X-ray examination, general physical or medical
examinations, not incidental to treatment or diagnosis of a covered Disability or any treatment which is not Medically
Necessary and any preventive treatments, preventive medicines or examinations carried out by a Physician, and
treatments specifically for weight reduction or gain.
11 Costs/ expenses of services of a non-medical nature, such as television, telephones, telex services, radios or similar
facilities, admission kit/ pack and other ineligible non-medical items.
12. Sickness or injury arising from racing of any kind (except foot racing), hazardous sports such as but not limited to
skydiving, water skiing, underwater activities requiring breathing apparatus, winter sports, professional sports and
illegal activities.
13. Suicide, attempted suicide or intentionally self-inflicted injury while sane or insane.
14. Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers
over established routes.
15. War or any act of war, declared or undeclared, criminal or terrorist activities, active duty in any armed forces, direct
participation in strikes, riots and civil commotion or insurrection.
16. Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear
fission or from any nuclear weapons material.
17. Expenses incurred for donation of any body organ by a Covered Person and costs of acquisition of the organ including
all costs incurred by the donor during organ transplant and its complications.
18. Expenses Incurred for sex changes.
19. Investigation, and treatment of sleep and snoring disorders, hormone replacement therapy and alternative therapy such
as treatment, medical service or supplies, including but not limited to chiropractic services, acupuncture, acupressure,
reflexology, bonesetting, herbalist treatment, massage or aroma therapy or other alternative treatment.

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SPECIFIC CONDITIONS FOR SECTION A

1. CONVERSION CERTIFICATES (applicable only if specified in the Certificate Schedule)
If the Eligible Benefits provided under this Certificate shall have been converted from an existing coverage of an Inner
Limits to an As Charged/Full Reimbursement coverage, and if such Participant shall have been afflicted with a
Disability prior or at the time the Benefits were converted, the benefits payable in respect of the Disability shall be in
accordance with the Schedule of Benefits prior to the date the Eligible Benefits were converted.

2. FULL REIMBURSEMENT IN A GOVERNMENT HOSPITAL
Charges for eligible medical expenses are covered in full for treatment in a Malaysian Government Hospital for each
Illness or Injury, provided the claimant does not transfer from or to a private hospital for treatment and the room and
board charge is not greater than that provided under the chosen Plan applicable to the claimant.

3. OVERSEAS TREATMENT
If the Covered Person seeks treatment overseas, benefits in respect of the treatment shall be covered subject to the
exclusions, limitations and conditions specified in this Certificate and all benefits will be payable based on the official
exchange rate ruling on the last day of the Period of Confinement and shall exclude the cost of transport to the place of
treatment provided;
(a) a Covered Person traveling abroad for a reason other than for medical treatment, needs to be confined to a
Hospital outside Malaysia as a consequence of a Medical Emergency.
(b) a Covered Person upon recommendation of a Physician and has to be transferred to a Hospital outside
Malaysia because the specialised nature of the treatment, aid, information or decision required can neither be
rendered nor furnished nor taken in Malaysia.
Overseas treatment of a disease, sickness or injury which is diagnosed in Malaysia and non-emergency or chronic
conditions where treatment can reasonably be postponed until return to Malaysia are excluded.

4. REIMBURSEMENT OF SERVICE TAX
Notwithstanding anything contained herein to the contrary, the certificate is extended to cover reimbursement of
Government Service Tax payable in respect of treatment received for illnesses or conditions covered under the
certificate. Such expenses shall be payable under Hospital Services and Supplies.

5. RESIDENCE OVERSEAS
No benefit whatsoever shall be payable for any medical treatment received by the Covered Person outside Malaysia, if
the Covered Person resides or travels Outside Malaysia for more than ninety (90) consecutive days.
6. TAKE-OVER CERTIFICATES (applicable only if specified in the Certificate Schedule)
If this certificate shall have commenced immediately upon termination of a preceding Certificate and if a Covered
Person shall have been afflicted with a medical disability prior or at the time this Certificate started (and benefits under
the preceding Certificate would have been available to him), such Covered Person shall continue to be covered for the
existing disability, but not to exceed the limits of the previous certificate on condition the Company has secured a copy
of the preceding Certificate.
7. UPGRADED CERTIFICATES (applicable only if specified in the Certificate Schedule)
If the Eligible Benefits to any Covered Person under the terms of this Certificate be increased while it is in force or at
the time of Renewal or replacement and if such Covered Person shall have been afflicted with a Disability prior or at
the time the Benefits were increased, the Limits of Benefits payable in respect of such Disability shall not exceed the
Limit of Benefits prior to the date the Benefits were upgraded.
8. UPGRADED ROOM AND BOARD CO-PAYMENT
If the Covered Person is hospitalised at a published Room & Board rate which is higher than his/ her eligible benefit,
the Covered Person shall bear 20% of the other eligible benefits described in the Schedule of Benefits.
9. WAITING PERIOD
Eligibility for benefits starts thirty (30) days after the Participant has been included in the Certificate, except for a
covered Accident occurring after the effective date of coverage.

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SECTION B
PERSONAL ACCIDENT BENEFITS

DEFINITIONS

1. ACCIDENTAL DEATH & PERMANENT DISABLEMENT
Accidental death and permanent disablement shall mean a sudden, unintentional, unexpected, unusual and specific
event that occurs at an identifiable time and place which shall, independently of any other cause, be the sole cause of
bodily injury. The Company shall pay the Sum Covered specified in the Schedule of Benefits if death occurs within 365
days from the date of accident. If the Covered Person becomes permanently disabled within 365 days from the date of
accident, the Company shall pay a percentage of the Sum Covered as specified in the Scale of Compensation for
Permanent Disablement. If death occurs within 365 days from the date of accident following permanent disablement,
the aggregate amount payable under all sections of the certificate shall not exceed the Sum Covered on death.
SCALE OF COMPENSATION FOR PERMANENT DISABLEMENT
Result Description % of Sum Covered
1. Total and permanent disablement from following any employment or occupation 100%
2. Total and permanent loss of all sight in one or both eyes 100%
3. Total loss by physical severance or total and permanent loss of use of:-
(a) one or both hands at wrist 100%
(b) arm at shoulder 100%
(c) arm between shoulder and elbow 100%
(d) arm at or below elbow 100%
(e) leg at hip 100%
(f) leg between knee and hip 100%
(g) leg at or below knee 100%
4. Total and permanent loss of:-
(a) sight in one eye, except perception of light 50%
(b) lens of one eye 50%
5. Total and permanent loss of:-
(a) hearing in both ears 75%
(b) hearing in one ear 15%
6. Total and permanent loss of speech 50%
7. Total loss by physical severance or total and permanent loss of use of:-
(a) thumb & 4 fingers of one hand 50%
(b) 4 fingers of one hand 40%
(c) thumb
- 2 phalanges 25%
- 1 phalanx 10%
(d) index finger
- 3 phalanges 15%
- 2 phalanges 8%
- 1 phalanx 4%
(e) middle finger
- 3 phalanges 10%

10

- 2 phalanges 4%
- 1 phalanx 2%
(f) ring finger
- 3 phalanges 8%
- 2 phalanges 4%
- 1 phalanx 2%
(g) little finger
- 3 phalanges 6%
- 2 phalanges 4%
- 1 phalanx 2%
(h) metacarpals
- first & second (additional) 3%
- third, fourth or fifth (additional) 2%
(i) all toes of one foot 18%
(j) great toe
- 2 phalanges 6%
- 1 phalanx 3%
(k) any other toe 3%

Where the injury is not specified, the Company reserves the right to adopt a percentage of disablement which in its
opinion is not inconsistent with the provisions of the above Scale of Compensation. Total and permanent loss shall
include total and permanent loss of use.
2. EXTENSIONS
a) EXPOSURE
If following an accident the Covered Person is unavoidably exposed to the natural elements and as result of such
exposures suffers an injury as specified in the Certificate Schedule, such injury shall be considered as constituting a
claim but only in respect of death or permanent disablement.
b) DISAPPEARANCE
Notwithstanding anything contained herein to the contrary, if the body of the Covered Person has not been found
within a year after the date of disappearance following an accident, the Company may in its absolute discretion upon
being satisfied on the evidence available accept that the death of the Covered Person has been established provided
that if at any time after the payment has been made by the Company in settlement of a claim in such circumstances,
the Covered Person is found to be living any sum so paid by the Company shall be refunded forthwith.
c) STRIKE, RIOT AND CIVIL COMMOTION
This Certificate is extended to cover the Covered Person as within defined directly or indirectly caused by Strike, Riot
or Civil Commotion not amounting to the proportion of a popular uprising except in so far as the Covered Person
himself is actively participating when this extension becomes null and void.

d) MOTORCYCLING
This Certificate is extended to cover the Covered Person as within mentioned resulting from the Covered Person
engaging in motorcycling, provided always that this extension does not apply to any accidents arising out of motorcycle
racing, pace-making, reliability trial or speed testing.

11

EXCLUSIONS FOR SECTION B

This Takaful shall not apply to any accident consequent upon or caused by or contributed by or arising from:-
1. war, invasion, act of foreign enemy, hostilities or war-like operations (whether war be declared or not), civil war, mutiny,
civil commotion assuming the proportions of or amounting to a popular rising, military rising, insurrection, rebellion, revolution,
conspiracy, military or usurped power, or any act of any person acting on behalf of or in connection with any organization with
activities directed towards the overthrow by force of any de jure or de facto Government or to the influencing of it by terrorism
or violence.
2. nuclear weapon materials, ionising materials or contamination by radioactivity from any nuclear waste from the combustion of
nuclear fuel and for this exclusion combustion shall include self sustaining process of nuclear fusion.
3. the Covered Person being in or upon or entering or descending from Aircraft of any kind or caused by or resulting from a
descent or fall from such Aircraft whilst traveling as a pilot or a member of the aircrew.

4. the Covered Person engaging in professional sports, speed contest, racing of any kind (other than on foot), hunting,
mountaineering as a profession, water ski jumping, hang-gliding, under-water activities involving the use of breathing
apparatus, or using wood-working machinery driven by mechanical power other than portable tools applied by hand.

5. the Covered Person being affected (temporarily or otherwise) by drug or alcohol unless it can be established to the Company s
satisfaction by the claimant that the alcohol or drug was not a factor contributing to the happening of the event.

6. sickness or disease of any kind, pregnancy or childbirth or pre-existing physical defect or infirmity, insanity, suicide, or
intentional self injury.

7. provoked murder or assault.
8. the Covered Person while committing or attempting to commit any unlawful act.
9. Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) howsoever this syndrome has been
acquired or may be named.

10. the Covered Person who is actively involved in any of the following occupations or duties:-

a) Police, army, military and law enforcement officers
b) Aircraft testers, pilots and crew
c) Divers, unless as a hobby
d) Racing drivers
e) Jockeys
f) Persons engaged in professional sports activities
g) Persons engaged in underground mining and tunneling
h) Seamen and sea fishermen
i) Oil rig workers
j) Steeplejacks
k) Stevedores
l) Persons engaged in demolition of buildings
m) Wood working machinist
n) Fireman
o) War Correspondents
p) Explosive handlers
q) Sawyer, timber, logging workers, drivers and attendants of timber lorries and winches

12

GENERAL CONDITIONS

1. ALTERATIONS
The Company reserves the right to amend the terms and provisions of this Certificate by giving a 30 day prior notice in
writing by ordinary post to the Participant s last known address in the Company s records, and such amendment will be
applicable from the next renewal of this Certificate. No alteration to this Certificate shall be valid unless Authorized by
the Company and such approval is endorsed thereon. The Company should give 30 days prior written notice to the
Participant according to the last recorded address for any alterations made.
2. ARBITRATION
All differences arising out of this Certificate shall be referred to an Arbitrator who shall be appointed in writing by the
parties in difference. In the event they are unable to agree on who is to be the Arbitrator within one (1) month of being
required in writing to do so, then both parties shall be entitled to appoint an Arbitrator each who shall proceed to hear
the differences together with an Umpire to be appointed by both Arbitrators. However this is provided that any
disclaimer of liability by the Company for any claim hereunder must be referred to an Arbitrator within twelve (12)
calendar months from date of such disclaimer.
3. CHANGE IN RISK
The Covered Person shall give immediate notice in writing to the Company of any material change in his or her
occupation, business, duties or pursuits and pay any additional contribution that may be required by the Company.
4. CANCELLATION OF CERTIFICATE (applicable to yearly renewable Certificate only)
This Certificate may be cancelled by the Participant at any time by giving a written notice to the Company, and
provided that no claims have been made during the current Certificate year, the Participant shall be entitled to a refund
of the contribution as follows:-
Period Refund of Annual Contribution
Not exceeding 15 days 90% (applicable to renewal only)
Not exceeding 1 month 80%
Not exceeding 2 months 70%
Exceeding 11 months No refund of Contribution

5. CASH BEFORE COVER
It is a fundamental and absolute special condition of this contract of takaful that the contribution due must be paid and
received by the Company before takaful cover is effective.
6. CERTIFICATION, INFORMATION AND EVIDENCE
All certificates, information, medical reports and evidence as required by the Company shall be furnished at the
expense of the Participant, and in such a form that the Company may require. In any event all notices which the
Company shall require the Participant to give must be in writing and addressed to the Company. A Participant shall, at
the Company s request and expense, submit to a medical examination whenever such is deemed necessary.

13

7. CLAIM PROCEDURES
(a) The Participant shall within thirty (30) days of a Disability that incurs claimable expenses give written notice to
the Company stating full particulars of such event, including all original bills and receipts, and a full Physician s
report stipulating the diagnosis of the condition treated and the date the Disability commenced in the Physician s
opinion and the Physician s summary of the cost of treatment including medicines and services rendered.
Failure to furnish such notice within the time allowed shall not invalidate any claim if it is shown not to have been
reasonably possible to furnish such notice and that such notice was furnished as soon as was reasonably
possible.
(b) The Participant shall immediately procure and act on proper medical advice and the Company shall not be held
liable in the event a treatment or service becomes necessary due to failure of the Participant to do so.
8. CONDITION PRECEDENT TO LIABILITY
The due observance and the fulfillment of the terms, provisions and conditions of this Certificate by the Covered
Person and in so far as they relate to anything to be done or complied with by the Covered Person shall be conditions
precedent to any liability of the Company.
9. CONTRIBUTION
If a Covered Person carries other takaful or insurance covering any illness or injury covered by this Certificate, the
Company shall not be liable for a greater proportion of such illness or injury than the amount applicable hereto under
this Certificate bears to the total amount of all valid takaful or insurance covering such illness or injury.
10. PERIOD OF KHIYAR (RIGHT OF CANCELLATION)
If this Certificate shall have been issued and for any reason whatsoever the Covered Person shall decide not to take up
the Certificate, the Covered Person may return the Certificate to the Company for cancellation provided such request
for cancellation is delivered by the Covered Person to the Company within fifteen (15) days from the date of delivery of
the Certificate. The Covered Person is entitled to the return of the full contribution paid less deduction of medical
expenses incurred by the Company in the issue of the Certificate.
11. CURRENCY OF PAYMENT
All payments under this Certificate shall be made in the legal currency of Malaysia. Should any payment be requested
by the Participant to be payable in any other currency, then such amount shall be payable in the demand currency as
may be purchased in Malaysia at the prevailing currency market rates on the date of the claim settlement.
12. GOVERNING LAW
This Certificate is issued under the laws of Malaysia and is subject and governed by the laws prevailing in Malaysia.
13. GRACE PERIOD (only applicable to annual contribution)
Notwithstanding the Cash Before Cover Condition, a Grace Period of fourteen (14) days following the expiry date shall
be allowed to the Participant for the payment of any contributions after the first Certificate year. If any contribution is not
paid in respect of this Certificate or any supplementary contracts before the end of the Grace Period, this Certificate
and the relevant supplementary contracts shall be deemed as terminated at the expiry date of the Certificate. Even if
payment is made during the Grace Period, any disability occurring during the period from the expiry date to the
payment date shall not be payable.
14. INCOMPLETE CLAIMS
All claims must be submitted to the Company within thirty (30) days of completion of the events for which the claim is
being made. Claims are not deemed complete and Eligible Benefits are not payable unless all bills for such claims
have been submitted and agreed upon by the Company. Only actual costs incurred shall be considered for
reimbursement. Any variation or waiver of the foregoing shall be at the Company s sole discretion.
15. LEGAL PROCEEDINGS
No action at law or in equity shall be brought to recover on this Certificate prior to expiration of sixty (60) days after
written proof of loss has been furnished in accordance with the requirements of this Certificate. If the Covered Person
shall fail to supply the requisite proof of loss as stipulated by the terms, provisions and conditions of the Certificate, the
Covered Person may, within a grace period of one calendar year from the time that the written proof of loss to be
furnished, submit the relevant proof of loss to the Company with cogent reason(s) for the failure to comply with the
Certificate terms, provisions and conditions. The acceptance of such proof of loss shall be at the sole and entire
discretion of the Company. After such grace period has expired, the Company will not accept, for any reason
whatsoever, such written proof of loss.

14

16. MISREPRESENTATION / FRAUD
If the proposal or declaration of the Covered Person is untrue in any respect or if any material fact affecting the risk be
incorrectly stated herein or omitted therefrom, or if this takaful, or any renewal thereof shall have been obtained through
any misstatement, misrepresentation or suppression, or if any claim made shall be fraudulent or exaggerated, or if any
false declaration or statement shall be made in support thereof, then in any of these cases, this Certificate shall be
void.
17. MISSTATEMENT OF AGE
If the age of the Covered Person has been misstated and the contribution paid as a result thereof is insufficient, any
claim payable under this Certificate shall be prorated based on the ratio of the actual contribution paid to the correct
contribution which should have been charged for the year. Any excess contribution which may have been paid as a
result of such misstatement of age shall be refunded without interest. If at the correct age the Covered Person would
not have been eligible for cover under this Certificate, no benefit shall be payable.
18. NOTICE
Every notice or communication to the Company shall be in writing and sent to the Company. No alterations in the terms
of this Certificate or any endorsement thereon will be held valid unless the same is signed or initialed by an authorised
representative of the Company.
19. OFF-DUTY CLAUSE
It is hereby agreed and understood that notwithstanding anything contained herein to the contrary, the exclusion
regarding the occupations/duties will only apply whilst at work or whilst engaged in work-related activities including
traveling to and from the place of work.
20. OWNERSHIP OF CERTIFICATE
Unless otherwise expressly provided for by Endorsement in the Certificate, the Company shall be entitled to treat the
Participant as the absolute owner of the Certificate. The Company shall not be bound to recognise any equitable or
other claim to or interest in the Certificate, and the receipt of the Certificate or a Benefit by the Participant (or by his
legal or authorized representative) alone shall be an effective discharge of all obligations and liabilities of the Company.
The Participant shall be deemed to be responsible Principal or Agent of the Covered Persons covered under this
Certificate.
21. PORTFOLIO WITHDRAWAL CONDITION
The Company reserves the right to cancel the portfolio as a whole if it decides to discontinue underwriting this takaful
product. Cancellation of the portfolio as a whole shall be given by a thirty (30) day prior written notice to the Participant
and the Company will run off all policies to expiry of the period of cover within the portfolio.
22. SUBROGATION
If the Company shall become liable for any payment under this Certificate, the Company shall be subrogated to the
extent of such payment to all the rights and remedies of the Covered Person against any party and shall be entitled at
its own expense to sue in the name of the Covered Person. The Covered Person shall give or cause to be given to the
Company all such assistance in his/ her power as the Company shall require to secure the rights and remedies and at
the Company s request shall execute or cause to be executed all documents necessary to enable the Company to
effectively to bring suit in the name of the Covered Person.
23. TERMINATION OF COVERED PERSON AND COMPANY LIABILITY
A Covered Person shall cease to be a Covered Person on:
(a) the Certificate anniversary following the attainment of the 80th birthday and for children on the Certificate
th rd
anniversary following the attainment of the 19 birthday or the 23 birthday for those registered as full time
students at a recognised educational institution.
(b) the date of termination of the Certificate or any person s coverage.
In any case, the Company s liability shall cease with the date of termination of the Certificate or any person s coverage.
24. CONTRIBUTION ALLOCATION
Payment of the takaful Contribution as shown in the Schedule paid by the Participant shall be placed in the General
Risk Investment Account (GRIA) where the Company will manage the fund according to the Wakalah Principle as
defined by the Company and in accordance with Shariah principles. A single drip from the GRIA will be made towards
the Expense Fund, Risk Fund and Special Fund at inception, for the Wakalah Fee and Tabarru charges respectively.

15

25. SURPLUS
At each financial year-end, the Actuary will assess the surplus position of the Risk Fund.
The company shall charge a Surplus Administration Charge (SAC) of up to 50% of the gross surplus arising from the
Risk Fund at the end of the financial year. Any net surplus arising (after the SAC) shall be apportioned between the
Participant and the Special Fund. The apportionment for Participant shall not be less than provision for the SAC. If the
amount due to Participant is less than RM10 per Certificate, the amount shall be transferred to the Special Fund.

Any deficit in the Risk Fund will first be paid from the Special Fund. If such fund is not sufficient, it would be met
through an interest free loan (Qard) from the Shareholders Fund. Such loan would be a first charge against the future
surplus arising from the Risk Fund.

26. MODAL CONTRIBUTION CLAUSE
Notwithstanding anything contained herein to the contrary, it is hereby declared and agreed that the contribution is
payable on a modal frequency and is subject to the modal contribution factor determined by the Company.
It is further declared and agreed that in consequence of the modal payment of contribution, the Certificate is subject to
the following:-
(a) Grace Period Condition is deemed to be deleted.
(b) No refund of contribution will be allowed under the monthly contribution payment mode if the Certificate is
cancelled by the Participant under the Cancellation of Certificate Condition.
Subject otherwise to the provisions, terms, exclusions and conditions of this Certificate.

IMPORTANT NOTICE
We care about the service that we provide for our customers, and our staff makes every effort to maintain as high a standard as
possible. In the event that we do not meet your expectations and you are dissatisfied in some way, we would like to know and
would ask you:
Step 1: To speak first to the intermediary who arranged the Certificate for you.
Step 2: If you remain dissatisfied, ask to speak to our branch manager. Our manager will give personal attention to your
enquiry and point you in the right direction if you wish to take the matter further.
Step 3: If the matter is not resolved, write to our Customer Relationship Management, Takaful Ikhlas Sdn Bhd, IKHLAS
Point, Tower 11A, Avenue 5, Bangsar South, No. 8 Jalan Kerinchi, 59200 Kuala Lumpur, who will make sure that
your case is examined thoroughly. In the event that you are still not satisfied, you must address your complaint to
the following for investigation into unfair market practices by Takaful Operators / Insurers.

Financial Mediation Bureau Pengarah
Level 25, Jabatan Komunikasi Korporat
Dataran Kewangan Darul Takaful Bank Negara Malaysia
No 4, Jalan Sultan Sulaiman Peti Surat 10922
50000 Kuala Lumpur. 50929 Kuala Lumpur
Tel : 03-2272 2811 Tel : 03-2698 8044
Fax : 03-2274 5752 Fax : 03-2693 6919
E-mail address : enquiry@fmb.org.my

16

CLAUSES/ENDORSEMENTS/PERILS & WARRANTIES

The following perils, clauses, endorsements and/or warranties only apply to this certificate when specifically mentioned in the
Schedule and subject otherwise to the Terms of this Certificate.
MD01 REASONABLE AND CUSTOMARY CHARGES
It is hereby declared and agreed that for treatment in Malaysia, the Malaysian Medical Association Schedule of Fees
th
(4 Edition) shall be used for determining reasonable and customary charges.
MD02 EXCLUSION CLAUSE
The Company shall not be liable for any claims arising directly or indirectly from treatment pertaining to the
disability in respect of Participant, as stated under Exclusions for Section A
MD03 AUTOMATIC TERMINATION OF COVER (foreigner only)
Notwithstanding anything contained herein to the contrary, it is hereby declared and agreed that the insurance
coverage shall automatically terminate upon expiry of work permit or when the Participant Person cease to reside in
Malaysia. No contribution will be refunded.
MD04 LOCAL TREATMENT CLAUSE (foreigner only)
Notwithstanding anything contained herein to the contrary, if the Participant Person is a non-Malaysian, the coverage
and benefits provided shall be restricted to treatment in Malaysia only.

MD05 TREATMENT IN SINGAPORE AND BRUNEI DARUSSALAM CLAUSE
It is hereby declared and agreed that in consideration of a contribution loading of 20%, the Certificate is hereby
extended to cover treatment in Singapore and Brunei Darussalam.
It is further declared and agreed that the eligible claim shall be paid on the basis of One Ringgit Malaysia to One
Singapore Dollar or One Brunei Dollar respectively. For the purpose of determining the applicable Co-Payment for
Upgraded Room, the Room Rate shall also be considered on the basis of One Ringgit Malaysia to One Singapore
Dollar or One Brunei Dollar respectively.
It is also declared and agreed that in consideration of this extension, the Residence Overseas Clause restricting travel
overseas to ninety (90) consecutive days shall not apply to Singapore and Brunei Darussalam.
Notwithstanding anything contained herein to the contrary, if the Covered Person is a Singaporean/Bruneian, the
coverage and benefits provided shall be restricted in Malaysia, Singapore and Brunei only.

MD06 TAKE-OVER CERTIFICATES

If this Certificate shall have commenced immediately upon termination of a preceding Certificate and if a Covered
Person shall have been afflicted with a medical disability prior or at the time this Certificate started (and benefits
under the preceding Certificate would have been available to him), such Covered Person shall continue to be covered
for the existing disability, but not to exceed the limits of the previous Certificate on condition the Company has
secured a copy of the preceding Certificate.

MD07 CONVERSION CERTIFICATES
If the Eligible Benefits provided under this Certificate shall have been Converted from an existing coverage of an
Inner Limits to an 'As Charged/Full Reimbursement coverage, and if such Covered Person shall have been afflicted
with a Disability prior or at the time the Benefits were converted, the benefits payable in respect of the Disability shall
be in accordance with the Schedule of Benefits prior to the date the Eligible Benefits were converted.

MD08 UPGRADED CERTIFICATES
If the Eligible Benefits to any Covered Person under the terms of this Certificate be increased while it is in force
or at the time of renewal or replacement and if such Covered Person shall have been afflicted with a Disability prior or
at the time the Benefits were increased, the Limits of Benefit payable in respect of such Disability shall not exceed
the Limit of Benefits prior to the date the Benefits were upgraded.

17

IKHLAS PHM VIP MEDICALTAKAFUL
(Perlindungan Penghospitalan dan Pembedahan Takaful)

DIMANA Peserta yang dinamakan di dalam Jadual Sijil telah memohon kepada Takaful Ikhlas Sdn Bhd (selepas daripada ini
dipanggil Syarikat ) ataupun takaful sepertimana dinyatakan di dalam ini dan telah membayar atau bersetuju membayar
sumbangan yang dinyatakan di dalam Jadual Sijil sebagai pertimbangan bagi takaful yang terkandung didalamnya.
DENGAN INI SIJIL INI MEMPERAKUKAN bahawa jika Orang Yang Dilindungi dimasukkan ke hospital untuk rawatan atau
dirawat kerana pembedahan bagi kes harian semasa Tempoh Takaful yang dinyatakan di dalam Jadual Sijil, Syarikat akan
membayar kepada Peserta atau wakil sah peribadinya jumlah atau jumlah dinyatakan di dalam Jadual Sijil. Pembayaran
adalah tertakluk kepada caj-caj munasabah dan yang diamalkan dan hanya akan dibuat sebaik sahaja bukti-bukti perbelanjaan
yang ditanggung telah diterima dan diluluskan.
SIJIL INI adalah tertakluk kepada peruntukan syarat dan pengecualian seperti yang terkandung di dalam ini atau sebagaimana
yang mungkin disahkan selepas daripada ini.

JADUAL MANFAAT
KETERANGAN MANFAAT

SEKSYEN A MANFAAT PERBELANJAAN HOSPITAL PVM 1(a) PVM 2(a)
1. Bilik Hospital Serta Makan, maksimum harian sehingga 365 hari 500 350
2. Unit Kawalan Rapi, maksimum harian sehingga 365 hari
3. Bekalan & Perkhidmatan Hospital
4. Khidmat rundingan & diagnosa pra pembedahan, dalam tempoh
31 hari sebelum pembedahan
5. Pembayaran Pembedahan (termasuk Pembayaran Pakar Bius dan
Bilik Bedah)
6. Perundingan Pakar & Ujian Diagnostik Pra- Hospital, dalam
tempoh 31 hari sebelum penghospitalan Seperti dikenakan (tertakluk kepada caj-
caj munasabah dan yang diamalkan)
7. Lawatan Pakar Di Dalam Hospital, maksimum harian sehingga 365
hari
8. Rawatan Selepas Penghospitalan, dalam tempoh 60 hari daripada
tarikh keluar daripada hospital
9. Bayaran Ambulans
10. Rawatan Kecemasan Kemalangan Bagi Pesakit Luar, setiap
kemalangan temasuk rawatan susulan sehingga 31 hari
11. Rawatan Kecemasan Pergigian, setiap kemalangan termasuk
rawatan susulan sehingga 31 hari
12. Manfaat Harian Penjagaan Anak, maksimum harian sehingga 365 Dilindungi Dilindungi
hari
13. Bayaran Laporan Perubatan, setiap kehilangan upaya 100 100
14. Cukai Perkhidmatan Kerajaan Dilindungi Dilindungi
15. Perbelanjaan Pengkebumian 5,000 3,000
16. Manfaat Tunai Penghospitalan, sehingga 60 hari (dibayar daripada Dilindungi Dilindungi
hari ketiga dan berikutnya)
17. Rawatan Pesakit Luar Bagi Kanser, setahun 60,000 36,000
18. Rawatan Pesakit Luar bagi Dialisis Buah Pinggang, setahun 60,000 36,000
Had Setiap Kehilangan Upaya 200,000 150,000
Had Tahunan Keseluruhan 600,000 450,000
HAD SEUMUR HIDUP 600,000 450,000

SEKSYEN B- MANFAAT KEMALANGAN DIRI
Kematian Akibat Kemalangan & Keilatan Kekal 200,000 150,000

18

PERUNTUKAN-PERUNTUKAN AM

1. ORANG YANG LAYAK
Orang yang layak untuk dilindungi di bawah Sijil ini adalah:
(a) Peserta yang berumur di bawah 80 tahun;
(b) Suami/isteri Peserta yang sah berumur di bawah 80 tahun, kecuali berpisah secara sah daripada Peserta
mengikut perundangan, dan
(c) Anak Peserta yang telah mencapai umur tiga puluh (30) hari dan belum berkahwin, yang bergantung dari segi
kewangan pada Peserta dan berumur kurang daripada sembilan belas (19) tahun atau hingga dua puluh tiga (23)
tahun bagi mereka yang didaftarkan sebagai pelajar sepenuh masa di institusi pengajian yang diiktiraf.
2. TEMPOH PERLINDUNGAN DAN PEMBAHARUAN
Sijil ini akan berkuatkuasa seperti tarikh yang dinyatakan di dalam Jadual. Ulang Tahun Sijil adalah satu tahun selepas
tarikh berkuatkuasa dan setiap tahun berikutnya. Pada setiap ulang tahun tersebut, Sijil ini boleh diperbaharui pada
kadar sumbangan yang berkuatkuasa pada masa itu dan seperti yang dimaklumkan oleh Syarikat.
Sijil ini boleh diperbaharui mengikut pilihan Peserta tertakluk kepada terma, syarat dan penamatan pada setiap tarikh
ulang tahun Sijil. Sumbangan pembaharuan yang dibayar tidak dijamin dan Syarikat berhak menyemak semula kadar
sumbangan yang digunapakai untuk setiap Peserta pada masa pembaharuan itu.

Pada masa pembaharuan, terma dan syarat perlindungan tidak boleh dipinda, kecuali apabila hilang upaya tertentu telah
mencapai had maksimum bagi setiap hilang upaya. Dalam keadaan itu, Syarikat berhak secara khusus mengeluarkan
hilang upaya itu daripada peruntukan Sijil ini.

Sijil ini boleh diperbaharui mengikut pilihan Peserta sehinggalah berlaku mana-mana daripada yang berikut:
(a) tiada pembayaran sumbangan atau sumbangan tidak dibuat pada masanya
(b) penipuan atau salah-nyata bahan fakta penting semasa membuat permohonan
(c) Sijil dibatalkan atas permintaan Peserta
(d) jumlah tuntutan Sijil telah mencapai had seumur hidup ditetapkan dan/atau berlaku kematian Orang Yang
Dilindungi
(e) Orang Yang Dilindungi tidak lagi layak menjadi tanggungan berdasarkan takrif Sijil
(f) Orang Yang Dilindungi mencapai had umur perlindungan ditetapkan
(g) Penamatan perlindungan bagi semua Sijil dalam pasaran tertentu dan Syarikat menarik-balik Sijil ini sepenuhnya
daripada pasaran berdasarkan Syarat Penarikan-Balik Portfolio.
Syarikat akan memberi 30 hari notis bertulis kepada Peserta sekiranya berlaku penyemakan semula dalam sumbangan
atau penarikan-balik portfolio.
3. WILAYAH GEOGRAFI
Semua Manfaat yang ditawarkan di dalam Sijil ini adalah digunapakai di seluruh sedunia, dua puluh-empat (24) jam
sehari.
4. WARIS PESERTA (PEMEGANG SIJIL BERIKUTNYA)
(a) Sekiranya berlaku kematian kepada Peserta semasa Sijil ini berkuatkuasa, suami/isteri sah Peserta secara
automatik akan menjadi Peserta setelah menandatangani akad baru dan semua rujukan di bawah Sijil ini terhadap
Peserta akan selepas daripada ini bermaksud suami/isteri tersebut.
(b) Bila Orang Yang Dilindungi tidak lagi layak dikira sebagai anak tanggungan, Orang Yang Dilindungi ini boleh terus
membaharui Sijil di atas namanya sendiri sebagai Peserta dan semua rujukan di dalam Sijilnya ke atas Peserta
selepas daripada ini akan bermaksud Orang Yang Dilindungi tersebut.

19

SEKSYEN A
MANFAAT PERBELANJAAN HOSPITAL

DEFINISI

1. KEMALANGAN bermaksud kejadian yang berlaku secara tiba-tiba, tidak disengajakan, tidak dijangka, luar biasa dan
kejadian tertentu pada masa dan di tempat yang dikenal pasti, yang hendaklah, tanpa bergantung pada apa-apa sebab
lain, menjadi satu-satunya sebab bagi kecederaan anggota badan.
2. MANA-MANA SATU HILANG UPAYA hendaklah bermaksud mana-mana hilang upaya yang timbul daripada sebab
yang sama termasuk mana-mana dan semua komplikasinya kecuali jika Orang yang Dilindungi pulih sepenuhnya dan
tidak perlu menjalani apa-apa rawatan lanjut (termasuk dadah, ubat, diet khas atau suntikan atau nasihat tentang
keadaannya) bagi hilang upaya itu selama sekurang-kurangnya sembilan puluh (90) hari selepas tarikh terakhir
dibenarkan keluar hospital dan hilang upaya berikutnya daripada sebab yang sama akan dikira sepertimana ianya adalah
hilang upaya baru.
3. SEPERTI CAJ DIKENAKAN merujuk kepada caj-caj sebenar yang dkenakan bagi penjagaan perubatan munasabah,
mustahak dan biasa diamalkan seperti yang dinyatakan di dalam rawatan bagi perlindungan hilang upaya.
4. ANAK bermaksud mana-mana orang yang telah mencapai umur tiga puluh (30) hari dan tidak berkahwin, yang
bergantung dari segi kewangan pada Peserta dan berumur kurang daripada sembilan belas (19) tahun atau hingga dua
puluh tiga (23) tahun bagi mereka yang didaftarkan sebagai pelajar sepenuh masa di institusi pengajian yang diiktiraf.
5. PENYAKIT KONGENITAL bermaksud apa-apa keabnormalan perubatan atau fizikal yang wujud sejak lahir, dan juga
keabnormalan fizikal neo-natal yang berkembang dalam tempoh enam (6) bulan dari tarikh kelahiran. Ini termasuk semua
jenis hernia dan epilepsi kecuali disebabkan oleh trauma yang berlaku selepas tarikh Peserta dilindungi secara
berterusan di bawah Sijil ini.
6. DOKTOR atau PAKAR PERUBATAN atau PAKAR BEDAH akan bermaksud pengamal perubatan yang didaftarkan,
berkelayakan dan dilesenkan untuk mengamalkan perubatan cara barat dan memberikan khidmat rawatan tersebut
mengikut skop perlesenan dan latihannya di kawasan geografi perkhidmatannya, tetapi tidak termasuk doktor, pakar
perubatan atau pakar bedah yang merupakan Peserta sendiri.
7. DOKTOR GIGI akan bermaksud orang yang berlesen atau berdaftar sewajarnya untuk mengamalkan khidmat pergigian
dalam kawasan geografi yang menyediakan khidmat, tetapi tidak termasuk pakar perubatan atau pakar bedah yang
merupakan Peserta itu sendiri.
8. TANGGUNGAN akan bermaksud mana-mana orang berikut:
(a) suami/isteri yang berkahwin secara sah
(b) anak yang tidak berkahwin yang umurnya melebihi tiga puluh (30) hari tetapi di bawah sembilan belas (19) tahun
atau dua puluh tiga (23) tahun bagi yang masih menjadi pelajar sepenuh masa di pusat pengajian tinggi, dan
yang tidak mempunyai pekerjaan bergaji
9. PEMBEDAHAN HARIAN Bermaksud pesakit yang perlu menggunakan kemudahan pemulihan untuk prosedur
pembedahan yang dirancang terlebih dahulu di hospital/klinik pakar (tetapi bukan untuk bermalam).

10. HILANG UPAYA bermaksud Sakit, Wabak, Penyakit atau semua Kecederaan yang timbul daripada satu atau beberapa
sebab yang berterusan.

11. PERBELANJAAN LAYAK bermaksud belanja yang Perlu Dari Segi Perubatan yang ditanggung disebabkan oleh Hilang
Upaya yang dilindungi tetapi tidak melebihi had manfaat dalam jadual.
12. HOSPITAL bermaksud hanya pertubuhan yang ditubuhkan dan didaftarkan sewajarnya sebagai hospital untuk jagaan
dan rawatan orang yang sakit dan cedera sebagai pesakit atas katil berbayar, dan yang:-
(a) mempunyai kemudahan bagi diagnosis dan pembedahan utama
(b) menyediakan khidmat kejururawatan dua puluh empat (24) jam sehari oleh jururawat berdaftar dan siswazah,
(c) di bawah penyeliaan Pakar Perubatan, dan
(d) bukan klinik, tempat untuk orang ketagih alkohol atau dadah, pusat jagaan atau rumah pemulihan atau rumah
orang tua atau pertubuhan yang serupa.
20

13. PENGHOSPITALAN bermaksud dimasukkan ke Hospital sebagai pesakit dalaman yang berdaftar untuk rawatan
yang Perlu Dari Segi Perubatan bagi Hilang Upaya yang dilindungi apabila disyorkan oleh pakar perubatan. Pesakit tidak
boleh dianggap sebagai pesakit dalaman jika pesakit tidak tinggal di hospital secara fizikal sepanjang tempoh
dimasukkan ke hospital.
14. UNIT RAWATAN RAPI bermaksud satu bahagian di Hospital yang dinamakan sebagai Unit Rawatan Rapi oleh
Hospital, dan yang diselenggara dua puluh empat (24) jam hanya untuk rawatan bagi pesakit dalam keadaan kritikal dan
dilengkapi khidmat jagaan dan perubatan khas yang tidak disediakan di mana-mana bahagian lain Hospital itu.
15. KECEDERAAN bermaksud kecederaan anggota badan yang semata-mata disebabkan oleh Kemalangan.
16. ORANG YANG DILINDUNGI bermaksud orang yang dinyatakan dalam Jadual Sijil, termasuk Tanggungannya (jika
berkenaan).
17. HAD SEUMUR HIDUP akan bermaksud jumlah maksimum yang dibayar ke atas Orang Yang Dilindungi bagi seumur
hidupnya. Sebaik sahaja had seumur hidup telah dicapai, Sijil secara automatiknya akan ditamatkan. Di mana dinyatakan
di dalam Sijil, had seumur hidup adalah terpakai.
18. HOSPITAL KERAJAAN MALAYSIA bermaksud hospital yang bayaran perkhidmatannya tertakluk kepada Akta Fee
1951, Perintah Fee (Perubatan) 1982 dan/atau pindaan berikutnya jika ada.
19. PERLU DARI SEGI PERUBATAN bermaksud khidmat perubatan yang:
(a) selaras dengan diagnosis dan rawatan perubatan yang diamalkan bagi Hilang Upaya yang dilindungi, dan
(b) menurut piawai amalan perubatan yang baik, selaras dengan piawai semasa bagi rawatan perubatan profesional,
dan juga dengan manfaat kesihatan yang sah terbukti, dan
(c) bukan untuk kemudahan Peserta atau Pakar Perubatan, dan tidak dapat diperoleh sewajarnya di luar hospital (jika
dimasukkan ke wad sebagai pesakit dalaman), dan
(d) bukan berbentuk eksperimen, penyelidikan atau kajian, pencegahan atau penyaringan, dan
(e) bayarannya berpatutan, munasabah dan biasa diamalkan bagi Hilang Upaya itu.

20. PESAKIT LUAR bermaksud Orang yang Dilindungi yang menerima jagaan atau rawatan perubatan tanpa dimasukkan
ke hospital dan termasuk rawatan di pusat Rawatan Harian.
21. HAD TAHUNAN KESELURUHAN
Manfaat yang dibayar bagi perbelanjaan yang dikenakan untuk rawatan yang diberikan kepada Orang yang Dilindungi
dalam tempoh takaful hendaklah dihadkan mengikut Had Tahunan Keseluruhan seperti yang dinyatakan dalam Jadual
Manfaat tanpa mengira jenis hilang upaya. Jika Had Tahunan Keseluruhan telah dibayar, maka semua perlindungan bagi
Orang yang Dilindungi di bawah Sijil ini hendaklah dihentikan bayarannya serta-merta bagi baki tahun Sijil tersebut.
22. PESERTA bermaksud orang atau badan korporat yang kepadanya Sijil dikeluarkan bagi melindungi orang yang secara
khusus dikenalpasti sebagai Orang yang Dilindungi dalam Sijil ini.
23. TAHUN SIJIL bermaksud tempoh satu tahun termasuk tarikh mula kuatkuasa Takaful dan sebaik sahaja selepas tarikh
itu, atau tempoh satu tahun selepas Sijil Pembaharuan atau Sijil Baru.
24. PENYAKIT SEDIA ADA bermaksud hilang upaya yang diketahui sewajarnya oleh Orang yang Dilindungi. Pemegang Sijil
dianggap mengetahui sewajarnya keadaan sedia ada itu apabila:-
(a) Orang yang Dilindungi telah atau sedang menerima rawatan;
(b) nasihat perubatan, diagnosis, jagaan atau rawatan telah disyorkan;
(c) gejala yang jelas dan tepat dapat atau telah dilihat dengan nyata; atau
(d) kewujudannya dapat diperhatikan dengan jelas bagi orang yang munasabah yang mengalami keadaan itu.
25. UBAT YANG DIPRESKRIPSIKAN bermaksud ubat yang diberikan oleh Pakar Perubatan, Ahli Farmasi Berdaftar atau
Hospital dan yang dipreskripsikan oleh Pakar Perubatan atau Pakar bagi rawatan Hilang Upaya yang dilindungi.

26. BAYARAN MUNASABAH DAN BIASA DIAMALKAN bermaksud bayaran rawatan perubatan yang perlu dari segi
perubatan, yang dianggap munasabah dan biasa diamalkan selagi bayaran itu tidak melebihi had biasa bayaran yang
dibuat oleh pihak lain yang sama kedudukannya di tempat bayaran itu dikenakan, apabila memberikan rawatan, khidmat
atau bekalan seumpamanya atau yang serupa kepada individu dengan jantina yang sama dan kategori umur yang sama
untuk sakit, wabak atau kecederaan serta selaras dengan piawaian dan amalan perubatan yang diterima dan tidak boleh
diabaikan tanpa menjejaskan keadaan perubatan Orang yang Dilindungi.

27. SIJIL PEMBAHARUAN ATAU SIJIL BARU bermaksud Sijil yang telah dibaharui tanpa apa-apa tempoh luput sebaik
sahaja tamatnya tempoh setelah Sijil sebelumnya dengan kandungan yang sama.
21

28. SAKIT, WABAK ATAU PENYAKIT bermaksud keadaan fizikal yang ditunjukkan dari segi patologi berbeza daripada
keadaan kesihatan yang normal.

29. PAKAR bermaksud pengamal perubatan atau pergigian yang berdaftar dan berlesen sewajarnya di kawasan geografi
yang khidmat tersebut diberikan, dan yang diklasifikasikan oleh pihak berkuasa kesihatan yang berkenaan sebagai orang
yang mempunyai kepakaran yang tinggi dan khusus dalam bidang perubatan atau pergigian yang tertentu, tetapi tidak
termasuk pakar perubatan atau pakar bedah yang merupakan Peserta itu sendiri.
30. PEMBEDAHAN bermaksud mana-mana prosedur perubatan yang berikut:
(a) Untuk menginsisi (incise), mengeksisi (excise) atau mengeletrokauteri (electrocauterize) mana-mana bahagian
organ atau badan kecuali untuk khidmat pergigian.
(b) Untuk membaiki, mengubah atau membentuk semula mana-mana bahagian organ atau badan.
(c) Untuk mengurangkan fraktur atau dislokasi melalui manipulasi.
(d) Penggunaan endoskopi untuk mengeluarkan batu atau objek dari larinks, bronkus, trakea, esophagus, perut, usus,
pundi kencing, atau uretra.

KETERANGAN MANFAAT-MANFAAT

SEKSYEN A
1 BILIK HOSPITAL DAN MAKAN
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan yang Perlu Dari Segi Perubatan untuk penginapan
bagi bilik dan makanan. Jumlah manfaat hendaklah sama dengan bayaran sebenar yang dikenakan oleh Hospital
semasa Orang yang Dilindungi dimasukkan ke hospital, tetapi manfaat tidak boleh melebihi, bagi mana-mana satu
hari, kadar Manfaat Bilik dan Makan, dan bilangan maksimum hari seperti yang ditetapkan dalam Jadual Manfaat.
Orang yang Diilindungi hanya layak menerima manfaat ini apabila dimasukkan ke Hospital sebagai pesakit dalam.
2 UNIT RAWATAN RAPI
Pembayaran balik bagi Bayaran Munasabah dan Diamalkan yang Perlu Dari Segi Perubatan untuk bilik dan makan
yang sebenarnya ditanggung semasa dimasukkan ke hospital sebagai pesakit dalaman di Unit Rawatan Rapi Hospital.
Bayaran manfaat ini hendaklah sama dengan bayaran sebenar yang dikenakan oleh Hospital tertakluk kepada manfaat
maksimum bagi mana-mana satu hari, dan bilangan maksimum hari, seperti yang ditetapkan dalam Jadual Manfaat.
Apabila tempoh dimasukkan ke hospital di Unit Rawatan Rapi melebihi tempoh maksimum yang ditetapkan dalam
Jadual Manfaat, maka pembayaran balik akan dihadkan kepada kadar Bilik dan Makan Harian Hospital.

Manfaat Bilik dan Makan Hospital tidak boleh dibayar bagi tempoh dimasukkan ke hospital tersebut apabila Manfaat
Unit Rawatan Rapi Harian dibayar.

3 BEKALAN & PERKHIDMATAN HOSPITAL
Pembayaran balik bagi caj-caj yang ditanggung bagi Bayaran Munasabah dan Diamalkan yang Perlu Dari Segi
Perubatan ke atas perkhidmatan penjagaan am, dadah dan ubat-ubatan yang dipreskripsi dan digunakan, membalut
luka, alatan penganduh (splint), acuan plaster, sinar-x, ujian makmal, elektrokardiogram, fisioterapi, ujian metabolisma
basal, suntikan dan larutan intravena, pengurusan darah dan plasma darah tetapi tidak termasuk kos darah dan
plasma semasa Orang Yang Dilindungi dimasukkan ke hospital sebagai pesakit dalaman, hingga kepada amaun yang
dinyatakan di dalam Jadual Manfaat.
4 KHIDMAT RUNDINGAN & DIAGNOSIS PRA-PEMBEDAHAN
Bayaran ke atas khidmat rundingan, patologi dan radiografi setelah dirujukkan oleh pengamal am bagi setiap penyakit
atau kecederaan yang memerlukan pesakit dimasukkan ke hospital. Manfaat tidak akan dibayar bagi rawatan pesakit
luar (termasuk perubatan dan mana-mana khidmat rundingan berikutnya selepas penyakit didiagnosis) dan tidak juga
jika pesakit tidak menerima rawatan pembedahan selepas khidmat diagnosis telah dijalankan.
5 RUNDINGAN PAKAR PRA-HOSPITAL
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan untuk rundingan kali pertama oleh Pakar yang
berkaitan dengan Hilang Upaya mengikut bilangan hari maksimum seperti yang ditetapkan dalam Jadual Manfaat
sebelum dimasukkan ke Hospital, dan dengan syarat rundingan itu Perlu Dari Segi Perubatan dan telah disyorkan
secara bertulis oleh pengamal perubatan am yang memberikan rawatan. Bayaran tidak akan dibuat untuk rawatan
klinikal (termasuk ubat dan rundingan berikutnya selepas penyakit didiagnosis) atau apabila Peserta tidak dimasukkan
ke hospital untuk rawatan bagi keadaan perubatan yang didiagnosis itu.
22

6 UJIAN DIAGNOSTIK PRA-HOSPITAL
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan untuk ECG, sinar-X dan ujian makmal yang Perlu
Dari Segi Perubatan yang dijalankan di Hospital untuk tujuan diagnostik bagi kecederaan atau penyakit apabila
berkaitan dengan Hilang Upaya sebelum dimasukkan ke hospital mengikut bilangan hari dan jumlah maksimum yang
ditetapkan dalam Jadual Manfaat dan yang disyorkan oleh pengamal perubatan yang layak. Bayaran tidak akan dibuat
jika dalam khidmat diagnostik itu, Peserta tidak perlu dimasukkan ke hospital untuk rawatan bagi keadaan perubatan
yang didiagnosis itu. Bayaran ubat dan rundingan yang dikenakan oleh pengamal perubatan tidak akan dibayar.
7 LAWATAN PAKAR PERUBATAN DALAM HOSPITAL
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan oleh Pakar Perubatan untuk lawatan yang Perlu
Dari Segi Perubatan ke atas pesakit dalaman berbayar semasa dimasukkan ke hospital kerana hilang upaya bukan
pembedahan dan tertakluk kepada maksimum satu (1) lawatan sehari tidak melebihi bilangan hari maksimum yang
ditetapkan dalam Jadual Manfaat.
8 RAWATAN SELEPAS PENGHOSPITALAN
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan yang ditanggung bagi rawatan susulan yang Perlu
Dari Segi Perubatan oleh Pakar Perubatan yang sama yang telah memberikan rawatan, mengikut bilangan hari dan
jumlah maksimum seperti yang ditetapkan dalam Jadual Manfaat sebaik sahaja selepas keluar dari Hospital kerana
hilang upaya bukan pembedahan. Ini hendaklah termasuk ubat yang dipreskripsikan dalam rawatan susulan tetapi
tidak boleh melebihi bekalan yang diperlukan untuk bilangan hari maksimum seperti yang ditetapkan dalam Jadual
Manfaat.

9 BAYARAN PEMBEDAHAN
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan untuk pembedahan yang Perlu Dari Segi Perubatan
oleh Pakar, termasuk lawatan penilaian pra-pembedahan Orang Yang Dilindungi oleh Pakar dan rawatan selepas
pembedahan hingga bilangan hari maksimum tiga puluh satu (31) hari dari tarikh pembedahan, tetapi dalam amaun
maksimum yang dinyatakan dalam Jadual Manfaat. Jika lebih daripada satu pembedahan dijalankan bagi Mana-mana
Satu Hilang Upaya, jumlah bayaran untuk semua pembedahan yang dijalankan, tidak boleh melebihi jumlah
maksimum yang dinyatakan dalam Jadual Manfaat.

10 PEMBAYARAN PAKAR BIUS
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan oleh Pakar Bius untuk pemberian bahan bius yang
Perlu Dari Segi Perubatan tidak melebihi had yang ditetapkan dalam Jadual Manfaat.
11 BAYARAN BILIK BEDAH
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan untuk Bilik Bedah yang berkaitan dengan prosedur
pembedahan.
12 BAYARAN AMBULANS
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan yang ditanggung untuk khidmat ambulans di rumah
(domestik) (termasuk atendan) ke dan/atau dari Hospital di mana Orang yang Dilindungi itu dimasukkan ke hospital.
Bayaran tidak akan dibuat jika Orang yang Dilindungi itu tidak dimasukkan ke hospital dan tertakluk kepada had yang
ditetapkan dalam Jadual Manfaat.
13 RAWATAN KECEMASAN KEMALANGAN, PESAKIT LUAR
Pembayaran balik bagi Bayaran Munasabah dan Biasa Diamalkan yang ditanggung hingga jumlah maksimum yang
dinyatakan dalam Jadual Manfaat, bagi kecederaan anggota badan yang dilindungi yang timbul daripada Kemalangan
bagi rawatan yang Perlu Dari Segi Perubatan sebagai pesakit luar di mana-mana klinik atau hospital berdaftar dalam
tempoh dua puluh empat (24) jam dari masa berlaku Kemalangan yang menyebabkan kecederaan anggota badan
yang dilindungi. Rawatan susulan oleh doktor yang sama atau klinik atau Hospital berdaftar yang sama untuk
kecederaan anggota badan yang dilindungi yang sama akan disediakan hingga jumlah maksimum dan bilangan hari
maksimum seperti yang ditetapkan dalam Jadual Manfaat.
14 RAWATAN KECEMASAN PERGIGIAN
Pembayaran balik caj-caj sebenar yang ditanggung bagi rawatan gigi asli yang sihat akibat kecederaan kemalangan
dan diterima sebagai pesakit luar dalam tempoh dua-puluh empat (24) jam kejadian kemalangan di klinik pergigian
atau hospital yang berdaftar. Rawatan susulan oleh pakar pergigian yang sama di klinik pergigian atau hospital yang
berdaftar akan diberi sehingga bilangan hari maksimum tiga puluh satu (31) hari.

23

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