a straight copy from their premium table sent by their CS :

Deductible Discount / Diskaun Deduktibel
Deductible Amount / Amaun Deduktibel Discount / Diskaun
RM 7,500 25%
RM10,000 30%
RM15,000 40%
RM20,000 50%

Extracts:
Deductible Option
You may choose our Deductible Option where you pay the first RM7,500, RM10,000, RM15,000 or RM20,000
of your hospitalisation bills. SmartCare Optimum will reimburse the remaining amount, up to the overall annual
limit of your plan. This option comes with a premium discount but is without the cashless admission benefit.
This option is suitable if your employer already provides you with some healthcare benefits. Please refer to our
website or your policy contract for full details of this Option.

Hello guys,

Sorry for interrupting your discussion. Just got a few question to ask:

13) Daily In-Hospital Physician’s Visit:
Reimbursement of the Reasonable and Customary Charges by a Physician for Medically Necessary visiting a in-paying patient while confined for surgical and non-surgical disability subject to a maximum of one (1) visit per day not exceeding the maximum number of days as set forth in the Schedule of Benefit.

- Is it inclusive for ICU? If not how many visit for ICU, i cant find it in policy wording.
- Is it enough for only 1 max visit per day?

14) Daily In-Hospital Specialist’s Visit:
Reimburses of fees charged by the attending Specialist for daily bedside visits to the Insured Person during non-surgical confinement in a Hospital. The Company shall pay to the Insured Person an amount equal to the Reasonable and Customary Charges made by the Specialist for visits limited to one (1) visit per day of Hospital confinement, but in no event shall the benefit exceed the maximum number of days for a Disability as set forth in the Schedule of Benefits.

- This one catch my attention but is it really necessary for visit during non-surgical when we have a surgical/surgeon benefits?
- I so far never experienced about this one, but can you guys name one of the case that we need this benefit?
- Is this cover for ICU?

Sorry if i ask to many question, just want to improve my knowledge in term of policy wording.

Thanks

To PJusa, rockets, numbertwo and other sifus,

I'm a policy holder of AXA SCO (Plan2 RM200,000)
http://www.axa.com.my/132/en/Health-Insura...artCare-Optimum

Can you please recommend a good top up plan to cover the short comings of AXA SCO ? Thank you.

This post has been edited by aeiou228: Mar 25 2011, 04:30 PM

hi aeiou228 , i think PJ has already recommended one combi ... SCO+Tokio Marine's topup plan..

yes, page 2 :

"there are some top-up plans around in the market (i.e. plans with a high deductable i.e. 10 or 20k) that way you can insure the shortcomings of the plan. i liked Tokio Marine's plan best (despite the fact that I am not content with their CS). You can venture around the available plans and single out the one that suits you best. you can look into RHB Medisure (with deductable up to 20k = save up to 60% premiums), TM Medic Plus, Pacific medi-major, Berjaya B.Health Major, Allianz EB MediShield Plus, you could even use AXA SCO with deductable option as burstable insurance and choose another one as the primary H&S plan. mix and match gives multiple options otherwise not available."

and numbertwo already said it: my personal pick right now is Tokio Marine.

What mean by Reimbursement ?

We need to pay the medical cost by our own then only claim from insurance company?

If you admit to Panel Hospital then u entitle for GL...
then would be cashless

Hi all,

I've read thru the product brochure and found out something very misleading. I think this card is non cashless as the cashless clause is only applicable to the admission deposit only! As u may read thru the whole brocure, all the clauses say reimbursement basis meaning pay 1st then claim. I may be wrong on this, but this really caused me scratching my head.

PJusa, pls clear my doubts as u r so familiar with these GI plans. Thanks

well, if you read the website the answer is there already:

What is cashless admission?
This means that you don't have to pay deposits to the hospital if you are admitted to one of the AXA panel hospitals. We will pay, provided the nature of accident or illness is covered under the policy.

detailed in the product disclosure:

Claim Procedures

All Insured Persons will be given an AXA Healthcare Card. With this card, you have access to our panel hospitals
throughout Malaysia. We will obtain the preliminary diagnosis from Medical Report completed by your attending
physician (which may take 1 to 2 hours). It is best for you to arrange such report before hospital admission for preplanned
treatment. You may be required to make personal deposit as required by the hospital’s regulations.

After validation of your preliminary diagnosis to determine that the condition requiring treatment is a covered condition
under the policy, an initial Guarantee Letter will be issued to the hospital for your admission, subject to the benefit
limits.

Upon discharge, the hospital will provide the final diagnosis and itemised bill for us to settle the valid medical bill (which
may take 1 to 2 hours). Any ineligible or excess expenses not covered are to be settled by you.

In the circumstances that your preliminary diagnosis may not be easily ascertainable or that your condition requiring
treatment may not be covered under the policy, you are advised to pay for your own treatment first and file a claim after
discharge.

Please notify us within 30 days of any occurrences for admission to non-panel hospital, outpatient treatment or any
claim which has been settled by you. Please submit the claim form, original itemised bills, receipts and other relevant
claims documents to us for processing. For non-panel hospitals, you will be compensated on reimbursement basis.

The cashless benefit applies to hospital admissions only. Pre-hospitalization, consultations, diagnostic procedures and
post-hospitalization costs are on reimbursement basis.

You cannot make multiple claims on medical expenses.

I dont know where you got the idea that the card is pay first claim later. There are cards around (would have to look who offers it) and this will usually get you a fat discount. People who have to pay the bill first tend to think twice if they really want to spend the money .

Highlighted that caught my attention. It only says don't need to pay deposit and the table of benefits all shows reimbursement clause. Just wanting to clear my doubts as cashless cards normally shows as-charged clause.

Thanks

i really dont get the point. if you get admitted without insurance you pay a deposit first say 5k. then you get the bill and pay the balance. with the card they issue GL letter like normal, you get admited, you sign the final bill, they charge the company. you only pay the stuff not covered (if any) - like extra meals or whatnot. last time my wife was admitted, i show the card in damansara specialist, the get in touch with AXA, get the GL, she was admitted already and in her room - no cash or CC swipe of any kind. when she left, we just signed the bill and AXA paid directly and in full - didnt have to pay a single sen (total bill was around 12k). so i am pretty sure its a cashless card.

Ok, if this is the case then is a card that is worth considering, provide that one need to get a top up card to get ov the windfall for the out outpatient kidney and cancer limits.

ad official answer from AXA CS :

From: MAL-AXA-Customer-Service [mailto:customer.service@axa.com.my]
Sent: Tuesday, 29 March, 2011 10:02 AM
To: ********
Subject: FW: Smartcare Ooptimum : e-Brochure & Premium table request


Dear ********,

Thank you for your email below.

We would like to inform that the renewal is guaranteed even though there is claim made on the current year.
Thank you.


Regards,
Iris

yes we already knew that, my biggest concern was whether loading would be imposed during renewal.

"There is no selective Renewal Loading or Exclusion on individual if claim is made during previous year."

the more i read into this the more loop hole i see to it.

the bolded part, in addition to the possiblity of what it meant that i've described a few post back, it could also mean if you made a claim in year 2001, loading will not be imposed at year 2002, but year 2003 there will be loading even if you're made no claim during 2002. notice that it stated "previous year" not "years", so essentially it is a deferred loading system.

i swear that quoted clause was not there when i download their product brochure last year. PJusa might have the policy that deos not have this clause yet cause as far as i know she bought it quite a while ago?

EDIT: also this one.

Alterations
"The Company reserves the right to amend the terms and provisions
of this Policy by giving a thirty (30) day prior notice in writing by
ordinary post to the Owner’s last known address in the Company’s
records, and such amendment will be applicable from the next
renewal of this Policy. No alteration to this Policy shall be valid
unless Authorized by the Company and such approval is endorsed
thereon. The Insurer should give thirty (30) days prior written notice
to the Policyholder according to the last recorded address for any
alterations made."

This post has been edited by rockets: Mar 29 2011, 11:45 AM

The clause was there even in the '09 brochure...



And , read the terms above on Premium guaranteed.. Most GI policy has a portfolio loading only...not individual. I don't know if you can find any policy contract that specifically says no individual loading upon renewal or something similar. In fact, the 'premium guaranteed' statement is good enuf for me to argue , if needs be!

thank you for bringing that up, guess my memory is not as good as it used to be .

I don't know about others, but AIA has loading based on claim history. i'll post the exact wording here when i get back. i think loading is still pretty common considering a big player like AIA is still doing it.

Basically there are only two cases here after reading some many policy contracts...
i) GI Policy, most if not all, usually tells us their loading will be based on portfolio loading, and no loading is based on individual past claims history.

ii) loading happens... ie. your AIA i believe is one of them..and usually it comes from LI.

agreed with numbertwo and in case you guys are interested. the alteration clause can be found in pretty much every insurance contract.

Need some advice on a topup policy to complement my existing AIA policy :
AIA HS-200, rm200 R&B, RM40000/admission, Emergency OP rm450,Lifetime limit rm400k. No OP kidney/cancer Treatment Benefits. UP to 60yo (9 more years)
Topup policy should have deductible option convertable to full policy at age 60, with 200k OP kidney/cancer Treatment Benefits.

Which of the medical plan in the market worth looking into based on my requirement? Thanks in advance.

This post has been edited by MGM: May 16 2011, 10:13 PM

why u don't want OP kidney/cancer benefit?