Smart SME

Smart SME - Group Medical Plan is designed to provide comprehensive medical coverage for the SME employees and their family members. This plan is specially designed to cater for small and medium-sized enterprises (SMEs) with 10 to 150 employees.

Product Feature

  • 120 days waiting period for specified illnesses and 30 days waiting period for medical illnesses are applicable. 12 months waiting period for pre-existing illness is waived.
  • Claimant is not subject to 20% co-payment on hospital bill if he/she chooses to stay at a higher room & board.
  • Covers second surgical opinion, emergency sickness treatment, emergency medical evacuation and funeral expenses.
  • Age of coverage is renewable up to 70 years old (next birthday); child is covered from 15 days of birth to 24 years old (next birthday).
  • Flexibility to choose either cashless or reimbursement option for in-patient benefits.
  • Convenient usage of medical card (for cashless option) with more than 100 panel hospitals in Malaysia.
  • Optional clinical rider on cashless basis.

Schedule of Basic Medical Coverage

HOSPITALISATION AND SURGICAL BENEFIT

No. Hospitalisation and Surgical Benefit Plan 1 (RM) Plan 2 (RM) Plan 3 (RM) Plan 4 (RM) Plan 5 (RM)
1 Hospital Room & Board (Daily, max up to 180 days) 350 250 200 160 120
2 Intensive Care Unit (Daily, max up to 30 days) Full reimbursement is subject to Overall Annual Limit provided the changes are within the recommendation of the MMA Guideline and Reasonable and Customary Charges
3 Hospital Miscellaneous Services
4 Surgeon Fee
5 Anesthetist Fee
6 Operation Theatre Charges
7 Daily In-Hospital Physician’s Visit (Max. 180 days)
8 Pre-Hospital Diagnostic Tests (within 60 days before hospital confinement)
9 Pre-Hospitalisation Specialist Consultation (within 60 days before hospital confinement)
10 Second Surgical Opinion (within 60 days before hospital confinement)
11 Post-Hospitalisation Treatment (within 60 days from hospital discharge)
12 Emergency Accidental Out-patient Treatment (within 24 hours after the accident & follow-up up to 60 days)
13 Accidental Dental Treatment (within 24 hours after the accident & follow-up up to 14 days)
14 Daycare Procedure
15 Ambulance Charges (by road)
16 Annual Out-patient Cancer Treatment
17 Annual Out-patient Kidney Dialysis Treatment
18 Government Service Tax
19 Government Hospital Daily Cash Allowance (Max. 180 days) 200 100 100 100 100
20 Emergency Sickness Treatment (10pm – 6am) 100 100 100 100 100
21 Medical Report Fee Reimbursement 80 80 80 80 80
22 Emergency Medical Evacuation** 10,000 10,000 10,000 10,000 10,000
OVERALL ANNUAL LIMIT (Per Person) 80,000 60,000 40,000 30,000 20,000
23 Funeral Expense 10,000 10,000 10,000 10,000 10,000

**Inclusive of Emergency Medical Evacuation which covers medical necessary expense for emergency transportation and medical care to move an Insured Person who has a critical medical condition to the nearest Hospital where appropriate care and facilities are available.


Premiums Table

  1. CASHLESS SCHEME

  2. SCHEDULE OF ANNUAL PREMIUM (RM)
    Plan 1 Plan 2 Plan 3 Plan 4 Plan 5
    Employee Only 720.00 545.00 425.00 355.00 295.00
    Employee & Spouse 1,800.00 1,362.50 1,062.50 887.50 737.50
    Employee & Children 1,800.00 1,362.50 1,062.50 887.50 737.50
    Employee & Family 2,880.00 2,180.00 1,700.00 1,420.00 1,180.00
  3. REIMBURSEMENT SCHEME

  4. SCHEDULE OF ANNUAL PREMIUM (RM)
    Plan 1 Plan 2 Plan 3 Plan 4 Plan 5
    Employee Only 700.00 525.00 405.00 335.00 275.00
    Employee & Spouse 1,750.00 1,312.50 1,012.50 837.50 687.50
    Employee & Children 1,750.00 1,312.50 1,012.50 837.500 687.50
    Employee & Family 2,800.00 2,100.00 1,620.00 1,340.00 1,100.00

Schedule of Optional Rider

CLINICAL BENEFITS

Schedule of Benefits (RM)
1 OUT-PATIENT GP CLINICAL TREATMENT  
Routine Consultation
Medication
Injection
Outpatient Surgical Procedures
Preventive Screening – Pap Smear (once per policy year)
Diagnostic Lab / X-Ray Procedure
At AXA Panel Clinics
Limit per visit
Number of Visit per year per Insured
Co-Payment
Unlimited
Unlimited
Nil
Overseas Treatment (Limit per visit)
50
2 OUT-PATIENT SPECIALIST TREATMENT  
Consultation
Medication
Injection
Out-patient Surgical Procedures
Diagnostic Lab/X-Ray Procedure
With Panel GP Referral
Limit per visit
Number of Visit per year per Insured
Limit per ANNUM
Co-Payment
Unlimited
Unlimited
1200
Nil
Overseas Treatment (Limit per visit)
150 (without GP Referral)

SCHEDULE OF ANNUAL PREMIUM
Per Person 639.00

Occupation Class:

  • Class 1 Person engaged in professional, administration, managerial, clerical and non-manual occupations generally.
  • Class 2 Person engaged in work of a supervisory nature and others (not in Class 1) whose duties may involve occasional light manual work but not using tools or machinery or not exposing them to any special hazards. Persons who are required to travel outside office for Business or Professional purposes, but not engaging in manual labour.
  • Class 3 Persons engaged in mutual work not of particularly hazardous nature but involving the use of tools or light machinery.
  • Class 4 Persons engaged in heavy manual work involving the use of heavy tools and machinery.

Underwritten by AXA AFFIN General Insurance Berhad.

For more information, please call us at 03-2055 9733 /03-2731 5338 /03-27315384

Tariff Charges insert_drive_file
Rates & Charges attach_money
Calculator phonelink_ring