Allianz - SME Choice Plus

Pro tips:
Read this Product Disclosure Sheet before you take up Allianz - SME Choice Plus Group Insurance Policy. Be sure to read the general terms and conditions

Product information - Allianz SME Choice Plus

What Allianz products do we offer in Swingvy Benefit Store?
 
Allianz SME Choice:
Basic Plan: Group Basic Medical (GBM)
- Below RM500 Range: Allianz SME Choice Plus - RB 90
- Below RM500 Range: Allianz SME Choice Plus - RB 140
- Between RM501 to RM1,000 Range: Allianz SME Choice Plus - RB 180
- Between RM501 to RM1,000 Range: Allianz SME Choice Plus - RB 250
- Above RM1,000 Range: Allianz SME Choice Plus - RB 400
- Above RM1,000 Range: Allianz SME Choice Plus - RB 600
 
Allianz SME Choice Plus GBM Schedule of Benefits
 
 
*Reasonable and Customary Charges based on Private Health Care Facilities and Services (Private Hospitals and Other Private Healthcare Facilities) Regulation 2006 in Malaysia. 
 
*We shall reimburse the Goods and Services Tax (GST) on taxable supplies and services provided to the Insured Member, incurred in connection with the Eligible Expenses if any, subject to the limits as stated in the Table of Benefits. 
 
Option Supplementary Plan: Group Outpatient Medical (GOM)
 
Allianz SME Choice Plus GOM Schedule of Benefits
 
* Benefits Store only offer Plan 2 GOM in the platform. 
What are the covers/benefits provided?
 
Basic Plan: Allianz SME Choice Plus Group Basic Medical (GBM) 
Cover medical expenses incurred as a result of hospitalisation or surgery due to an illness or an accident:
 
Benefits: 
  • Give your employees peace of mind when they need to be hospitalised.
    • Medical Coverage with High Overall Annual Limit (up to RM300,000).
    • Fully covered Hospital Admissions (No Co-Payment required).
Supplementary Plan: Allianz SME Choice Plus Group Outpatient Medical  (GOM)
Benefits:
  • Cashless medical card for quick, hassle-free convenience at panel clinics.
  • Unlimited outpatient general practitioner care.
  • Outpatient specialist care for up to RM1,800.
Note:
1. Please refer to the full feature and benefits and scale of benefits in the policy contract. 
2. Duration of cover is for one (1) year. You need to renew your insurance coverage annually.
 
How much premium do I have to pay?
The total premium that you have to pay may vary depending on the choice of the plan required and underwriting requirements:
 
Annual Premium Rates (In MYR)
Allianz SME Choice Plus Group Basic Medical (GBM) 
 
Allianz SME Choice Group Outpatient Medical (GOM)
 
Allianz SME Choice Extra Fees / Charge
 
* The premium rate and Management Care Outpatient (MCO) fees shown above are inclusive of Sales and Services Tax (SST), at the prevailing rate. 
 
*Companies wishing to purchase GOM must opt for the cashless basis GBM plan, i.e. the company will need to take up the RM42.00 MCO fee option for the combined GBM and GOM. 
 
Notes:
1. Premium rates are not guaranteed. Factors contributing to the increase in premiums rates are plan specific, medical inflation, age band, occupation and underwriting requirement. 
2. New hires: We will charge the additional premium by the number of days starting from the effective date of coverage to the end of the policy period.
3. Leavers: We will refund the excess premium by the number of days beginning from the effective date of termination to the end of the policy period. 
 
What are the key terms and conditions that I should be aware of?
 
Period of Insurance 
Duration of coverage is for 12 months, renewable annually
 
Territorial Limits
The coverage for twenty-four (24) hours a day. If the insured person elects to or is referred to be treated outside Malaysia by the Attending Physician, benefits payable shall be limited to the Reasonable and Customary and Medically Necessary Charges for such equivalent local treatment in Malaysia which excludes the cost of transport to the place of treatment. 
 
No benefit shall be payable for any medical treatment received by the Insured if he/she resides or travels outside Malaysia for more than ninety (90) consecutive days. 
 
Eligibility
  • All full-time, permanent and actively at-work employee, directors partners and proprietors aged 16 to 66 years old are eligible for medical coverage, renewable up to age 70 (next birthday). 
  • Dependants of employees are also eligible for coverage:
    • employee’s a legally married spouse, the eligible entry age is below 66 years old. 
    • Coverage is extended to unmarried children over fifteen (15) days old and the coverage is up to twenty-four (24) years of age (next birthday).
  • Dependant Plan shall be the same as the Employee Plan. If dependant's coverage is taken, it will apply to all eligible employees in the company within the same basis of coverage. 
Occupational Class
All benefits are available to Occupational Class 1 to 4.
 
Premium 
  • The premium rate is based on the individual's attained age (age next birthday).
  • Mode of payment is Annual.
  • Prevailing GST applies to all plans if any.
What are the major exclusions under this policy?
For Group Basic Medical 
All pre-existing conditions are excluded for first 12 months of coverage, except for Outpatient Cancer & Kidney Treatment, for which pre-existing conditions will be permanently excluded 
 
Notes:
Please refer to the relevant policy contract for full list and details of exclusions
 

General FAQ - Allianz SME Choice

What is the minimum number of employees to start SME Choice policy?
You need to have at least five employees to start SME Choice policy.
 
What is the maximum entry age for my employees?
The maximum entry age is 64 years old which nearest to birthday age.
 
Can my employee choose the products and the level of coverage based on their preference?
No. The company's representative will decide the products and level of coverage, either the same for all employees or differentiated by job category.
 
Can my employees insure their dependents (spouse and children)? If yes, what level of coverage are they covered?
Yes. Your employees' dependants (the relationship must be substantiated legally) will be covered with the same level of coverage as the employee plan. 
 
Can I cover my employees who are based outside Malaysia?
No. This coverage is only for employees and dependents (if any) based in Malaysia.
 

What should you know after purchase the insurance plan?

Waiting period

!!! There are waiting period you need to compliance from the inception date
A waiting period refers to the time an insured must wait before some or all of their coverage comes into effect. The insured may not file claims for insurance policy benefits until the waiting period is up.
 
Type of Claim Waiting Period
All Sickness 
30 Days
Specific Illnesses 
120 Days
Pre-existing Illnesses
120 Days
Accidental Injuries
No Waiting Period
Clinical Visit 
No Waiting Period

 

What are Specific Illnesses?

Common Specific Illnesses :
 
• Hypertension, Diabetes Mellitus, Cardiovascular Disease
• All tumours, cancers, cysts, nodules, polyps, stones of urinary/ biliary system
• All ears, nose (including sinuses) and throat conditions
• Hernias, haemorrhoids, fistulae, hydrocele, varicocele
• Endometriosis, including diseases of the reproductive system
• Vertebral-spinal disorders (including disc) and knee conditions 
 
What are Pre-existing Illnesses?
 
A pre-existing condition is defined as any injury, illness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment that, with reasonable medical certainty, existed at the time of application.
 

Overseas Treatment

You are covered when (insured employee/dependent):
 
If the Insured Member elects or is referred by the attending Physician to receive treatment outside Malaysia, the benefits payable in respect of such treatment shall be limited to the Reasonable and Customary Charges that are Medically Necessary for such equivalent local treatment in Malaysia and shall exclude the cost of transport to the place of treatment.
 

Residence Overseas

There is No Coverage if out of Malaysia apart from Singapore and Brunei if the Insured Member resides or travels outside Malaysia, Singapore and Brunei for more than 90 consecutive days!
 

General Policy Exclusions

Group Hospitalisation & Surgical

The Group Hospitalisation & Surgical plan shall not cover any hospitalisation, surgery or charges caused directly or indirectly, wholly or partly by any of the following occurrences: 
  •  Air travel except as a fare-paying passenger
  • War, declared or undeclared, riots, Civil Commotion etc.
  • Active duty in military, naval, arm force, police or any uniformed unit
  • Ionising radiation or contamination by radiotherapy
  • Any intentionally self-inflicted injury, while sane or insane
  • Dental treatment and cosmetic surgery except due to an accident
  • Functional disorder of psychic or mental
  • AIDS or Aids Related Complex
  • Routine medical checkup or any treatment purely for investigation purposes  Any circumcision unless it is medically required, Sex changes, etc.
  • Sleep and Snoring disorder
  • Abuse of Alcohol and /or Drugs
  • Pregnancy-related
  • Congenital Abnormalities
  • Non-medical items 
Common Non-Medical Related Items but not limited to:
  • Tissues, Toilet rolls
  • Telephone/ Fax Charges 
  • Vitamins (unless medically necessary) 
  • Denture Pot/ Mouth Piece 
  • Dietician Fee 
  • Valuable Envelope/ Mineral Water 
  • CDs/DVDs (patient’s copy) 
  • Electricity charges 
  • Rental of Television / Radio 
  • Newspapers 
  • Sanitary pads/towels (unless utilized for a related medical condition) 
  • Shaving blades (unless utilised for surgery purposes) 
  • Sarongs (unless utilised in Operating Theater) 
  • Discharge Pack 
  • Purchase of appliances such as crutches, wheelchairs and etc. 
  • Lodging Fees/Lodger 
  • Extra meals 
Notes:
 1. Hospitals might collect deposit upon admission for charges not covered by insurance (commonly RM100 to RM1,000)
2. Deposit will be refunded by the hospital if unutilized
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