Transcript JLT Asia Powerpoint Template

Thome Group
(Smartcare Entrepreneur)
Employee Benefits Insurance Programme
2014
Distinctive. Choice.
A Jardine Matheson Associate Company
Content
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Group Term Life (New Cover)
Group Personal Accident
Smartcare Entrepreneur with Major Medical rider
Group Business Travel
Claims Procedures (Smartcare Plans)
Period of Insurance
1 July 2014 to 30 June 2015
GROUP TERM LIFE
(NEW COVER)
Group Term Life
What are the benefits?
Death
• Due to all causes
Total Permanent
Disablement (TPD)
• Unlikely to ever engage in any gainful employment
Terminal Illness
• Upon certification of high probability to die within
12 months
Extended Death
Benefit
• Medical Board Out
• Cover is extended for 12 months
Group Term Life
Who is covered?
All active full-time employees
How much are you covered?
36 x basic monthly salary (maximum S$2 million)
Age Limit
Age 65 (entry age), renewable up to Age 70
Geographical Limit
24 hours, Worldwide basis
Insurer
AXA Life Insurance
Group Term Life
Non-Medical Limit
S$470,000 up to age 65
Within Non-Medical Limit:
No underwriting required – Cover up to full sum insured.
Exceed Non-Medical Limit:
Underwriting is required. Details are in the letters that would be given to the
affected employees.
GROUP PERSONAL ACCIDENT
Group Personal Accident
What are the benefits?
Death &
Permanent
Disablement
• Cover bodily injury caused by accidental
means
• Death (100% of sum insured)
• Permanent Disablement (payment
according to insurer’s compensation scale)
Group Personal Accident
Who is covered?
All active full-time employees
How much are you covered?
All Employees – 36 x basic monthly salary
Age Limit
No age limit.
Reduced payout for 80 years and above (insured at 50% of sum assured)
Geographical Limit
24 hours, Worldwide basis
Insurer
AIG
Group Personal Accident
Major Exclusions…
•
Self inflicted injuries
•
War
•
Participation in Riot
•
Participation in competitive racing on wheels
TERRORISM IS COVERED
SMARTCARE ENTREPRENEUR
Smartcare Entrepreneur
Inpatient Benefits
• Hospitalisation & Surgery
• Major Medical rider
Smartcare Entrepreneur
Who is covered?
All active full-time employees and eligible dependents
Age Limit
Age 65 (entry age), renewable up to Age 72
Geographical Limit
24 hours, Worldwide basis
Insurer
AXA Life Insurance
Smartcare Entrepreneur – Basis of Cover
Plan Type
Category of Staff
Plan 1
Junior Staff
Plan 2
Executive Staff
Plan 3
Managerial Staff
Plan 4
Dependants only (excludes Major Medical rider)
Eligible dependants :
 Legal Spouse (non-working)
 Unmarried and unemployed children
(Child is covered from 15th day or date of discharge from hospital,
whichever is later, to 18 years old. If the child is enrolled in an educational
institution on full-time higher education, he/she is covered till 25 years old)
Smartcare Entrepreneur – Inpatient Benefits
Smartcare Entrepreneur
Maximum Benefits per disability
Plan 1
Plan 2
Plan 3
Plan 4
(S$)
(S$)
(S$)
(S$)
1. Daily Room & Board (max. 120 days)
2-Bed
1-Bed
1-Bed
2-Bed
3 x 2-Bed
3 x 1-Bed
3 x 1-Bed
3 x 2-Bed
3. Miscellaneous Hospital Services
3,500
4,000
5,000
3,500
4. Surgical Fees
(Subj to Surgical Schedule of Fees)
7,000
7,500
8,000
7,000
100
120
140
100
6. Pre and Post Out-patient Specialist
Consultation & Diagnostic X-ray
(90 days before and after)
1,500
2,000
2,500
1,500
7. Singapore Government / Restructured
Hospital Overall
(applicable for items 3 to 6 only)
15,000
30,000
30,000
15,000
2. Intensive Care (max. 30 days)
5. In-Hospital Doctors Call (max. 120 days)
Smartcare Entrepreneur – Inpatient Benefits
Plan 1
Plan 2
Plan 3
Plan 4
(S$)
(S$)
(S$)
(S$)
2,000
2,500
3,000
2,000
600
650
750
600
10. Death Benefit
5,000
5,000
5,000
5,000
11. Out-patient Benefit
- Out-patient Kidney Dialysis
- Out-patient Cancer Treatment
15,000
15,000
20,000
20,000
25,000
25,000
15,000
15,000
(Per policy year)
(Per policy year)
(Per policy year)
(Per policy year)
500
500
500
500
(Per policy year)
(Per policy year)
(Per policy year)
(Per policy year)
Smartcare Entrepreneur
Maximum Benefits per disability
8. Emergency Out-patient Treatment (For
Accident ONLY) – treatment must be sought
within 24 hours
9. Outpatient Dental Treatment (For Accident
ONLY) – treatment must be sought
within 24 hours
12. Outpatient Physiotherapy
(referral by GP / SP)
Smartcare Entrepreneur - Major Medical
Major Medical rider
(80% reimbursement)
Plan 1
(S$)
Plan 2
(S$)
Plan 3
(S$)
Overall Maximum Benefit Payable per policy year
50,000
50,000
100,000
As per H&S
As per H&S
As per H&S
Orthopaedic Appliances and Implants
1,500
1,500
1,500
Out-patient Benefit
- Out-patient Kidney Dialysis
- Out-patient Cancer Treatment
2,500
2,500
2,500
2,500
2,500
2,500
(Per month)
(Per month)
(Per month)
20%
20%
20%
Daily Room & Board
Coinsurance by employee
Smartcare Entrepreneur
Major Exclusions..
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Pre-existing conditions will be covered after 12 continuous months, unless you have been
advised otherwise by AXA.
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Psychological, psychiatric, alcoholism, drug addictions, abortion, birth control, infertility,
impotency
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Cosmetic, obesity, weight improvement / reduction
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Refractive error of the eyes, correction of myopia, lasik surgery, etc
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AIDs, VDs, STDs
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Rest cures, special nursing care
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Items of Non-Medical Nature, e.g. newspaper, GST etc
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Self Inflicted or attempted suicide
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Circumcision
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Disabilities resulting from direct participation in a strike, riot or commotion, insurrection or any act
of war
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Annual Health Screening
GROUP BUSINESS TRAVEL
Group Business Travel
Coverage
Authorised business trip by company including personal deviation before,
during and after a business trip
Duration Per Trip
183 days
Territorial Limit
Worldwide
Age Limit
Age 70 (entry age), renewable up to Age 75
Insurer
ACE
Group Business Travel
Summary of Benefits
A) Personal Accident Coverage
1a. Accidental Death
1b. Accidental Permanent Disablement (ADPD)
B) Medical & Related Expense Coverage
2. Medical Expenses
- Return Treatment
3. Emergency Medical Evacuation
4. Repatriation of Mortal Remains
5. Hospital Confinement Benefit (S$200 / 24 hrs confinement)
6. Compassionate Visit by a Relative or Friend
C) Travel Inconvenience Benefits
7. Loss of and Damage of Personal Baggage and Property
- Max. limit S$1,000 for any one article or pair or set of articles.
8. Loss of Personal Money & Travel Documents
(Personal money limit to max. S$1,000)
9. Trip Cancellation Expenses
10. Trip Curtailment and Rearrangement
11. Baggage Delay (S$200 for every 6 full consecutive hrs)
12. Travel Delay (S$200 for every 6 full consecutive hrs)
13. Personal Liability
14. Hijacking (S$200 for every 8 full consecutive hrs)
Plan
100,000
Percentage as stated in
Table of Benefits
500,000
15,000
Unlimited
Unlimited
30,000
10,000
5,000
3,000
10,000
10,000
2,000
2,000
5,000,000
5,000
Group Business Travel
C) Travel Inconvenience Benefits
15. Travel Misconnection
16. Legal Fees
17. Bail Bond
18. Family Security
19. Get Well Benefit
20. Overbooked Flight
21. Political and Natural Disaster Evacuation
22. Credit Card Indemnity
23. Home Renovation Expenses
24. War Risk Extension
- in the event of death/permanent disablement
- payable in lieu of ADPD benefit
500
15,000
15,000
25,000
1,000
500
20,000
5,000
20,000
25,000
Group Business Travel
Major Exclusions…
•
Self inflicted injuries
•
War
•
Participation in Riot
•
Participation in competitive racing on wheels
(Please refer to policy for full listing of exclusions)
TERRORISM IS COVERED
Claim Process
Inpatient Claims (Without LOG)
Patient has to sign Medisave Form upon
admission and pay all charges when discharged
Private/Overseas Hospital
Govt Restr Hospital
Employee to submit to HR:
1.
Group Hospital & Surgical Claim Form Part 1
2.
All original final itemised medical bills
3.
Copy of Inpatient Discharge Summary
Employee to submit to HR:
1)
Group Hospital & Surgical Claim Form Part 1
2)
All original final itemised medical bills
3)
Medical Report (to be completed by the
attending physician/surgeon)
Any medical report fee is to be borne by the Patient
HR to endorse on Part E and send all originals to JLT
AXA will process claim within 6 working weeks of
receiving full documentation
AXA will settle claim via cheque and if medisave is used,
AXA will settle directly with CPF Board
Claim Process
Inpatient Claims (With LOG)
Govt Restr Hospital
Private/Overseas Hospital
1. LOG Form
- Release of Medical Information Form (ROMIF)
- Pre-admission form (completed by the attending doctor)
2. Financial Counselling Form
3. Inpatient Admission Authorisation Form
4. Inpatient Discharge Summary (to be submitted upon discharge)
1. LOG Form
- Release of Medical Information Form (ROMIF)
- Pre-admission form (completed by the attending doctor)
The member can submit the relevant forms to AXA as follows:
Email: [email protected]
Copy HR Department
AXA will verify the policy coverage
Yes
AXA will issue the LOG directly to
the hospital
Covered?
No
No LOG will be issued. Member will need to
bear the full medical expenses upon discharge.
Important Note:
• Policy Number: 80018653
• TAT for issuance of LOG is 5 working days before scheduled surgery
Contacts
Claims Administration & Queries
Claims – Medical
Norlisa Binte Hashim
DID: 6411 9285
Email: [email protected]
Claims – Travel
Prisica Han
DID: 6411 9216
Email: [email protected]
JLT
Any Other Queries
Eugenia Ho
DID: 6411 9221
Email: [email protected]
Thank You
This presentation is designed solely to provide an overview
of the benefit. Please refer to the relevant policy contracts for
detailed coverage, terms and conditions.
Q&A