Smart Care Optimum

Hospital & Surgical Insurance

With the escalating and unexpected medical charges, you would prefer to stay healthy and avoid suffering from any illnesses or injuries. An illness or accident can put a real strain on your well being as well as your finances. But now you don’t have to worry about expenses. At AFFINBANK, let SmartCare Optimum concentrate on the bills whilst you concentrate on getting better.

SmartCare Optimum is a premium health plan with the widest and comprehensive coverage that gives customers a high range of benefits. From a full refund on inpatient and day surgery costs to high benefits for various outpatient treatments.

SmartCare Optimum is the only health plan that offers renewal up to age 80 provided you were already a member on your 59th birthday.

  • Wider protection and flexibility from four different plans with coverage up to RM500,000.00
  • Outpatient treatment including
    • accident and emergency treatment
    • kidney dialysis
    • cancer treatmen
  • Deductible Option
    • Customer may choose to buy Deductible Option where they pay the first RM7,500, RM10,000, RM15,000 or RM20,000 of their hospitalization bills.
    • Customer will be entitled to a premium discount up to 50%
  • Cashless Admission facilities
    • Eliminates the need for an admission deposit into any of our AXA 's panel hospitals
  • 24 hours a day, 7 days a week
    • Just call AXA’s 24 hour assistance hotline to arrange cashless admission to any of their panel hospitals in Malaysia. If customer choose Plan 1, customer will also have access to 24-hour emergency medical assistance throughout the world , in addition to having customer’s medical cost reimbursed for emergency treatment oversea.
  • Income tax relief
    • You can qualify for income tax relief up to RM3,000 for medical insurance premium

Table of Benefits

BENEFITS PLAN 1 PLAN 2 PLAN 3 PLAN 4
OVERALL ANNUAL LIMIT (benefit within Malaysia, annual maximum) RM500,000 RM200,000 RM100,000 RM50,000
INPATIENT & DAYCARE TREATMENT (per disability)
Room & Board, daily maximum Total number of days RM500 RM350 RM180 RM100
150 days 120 days 120 days 120 days
Intensive care unit, daily maximum Total number of days Full Reimbursement
60 days 60 days 60 days 60 days
Ambulance Full Reimbursement RM350 RM350
Insured Child's Daily Guardian Benefits (for child below 15 years old, up to 60 days) Full Reimbursement Not Applicable
Prescription Drugs Full Reimbursement
Nursing, Theatre Consumables & other Ancillary Charges Full Reimbursement
Surgeon's Fees Anesthetist's Fee Diagnostic Procedures & Physiotherapy Physician Fees, one visit per day Specialist fees, one visit per day Full Reimbursement subject to Overall Annual Limit provided the charges are within the recommendations of the Malaysian Medical Association Guidelines and Reasonable and Customary charges
Operating Theatre Full Reimbursement
Daily Government Hospital Cash Allowance RM100
150 days
RM100
120 days
RM100
120 days
RM100
120 days
OUTPATIENT TREATMENT (per disability)
Consultations & Diagnostic Procedures within 31 days before hospital confinement RM5,500 RM3,500 RM2,500 RM1,500
Post Hospitalisation Care and Physiotherapy Treatment within 31 days from hospital discharge RM5,500 RM3,500 RM2,500 RM1,500
Accident & Emergency Treatment within 14 days from the date of the accident Full Reimbursement
SPECIAL BENEFITS
Kidney Dialysis, lifetime maximum RM150,000 RM100,000 RM40,000 RM30,000
Cancer Treatment, lifetime maximum RM150,000 RM100,000 RM40,000 RM30,000
Accidental death RM3,000 RM3,000 RM3,000 RM3,000
International Emergency Medical Evacuation and Repatriation, per annual maximum RM500,000 Not applicable

Don't let an illness accident stop you from enjoying life.

Frequently Asked Questions

1. Who is eligible to join?

If you are in the age group of 1 to 59 as of your next birthday, you are eligible to join. We offer renewal up to age 80 provided you were already a member on your 59th birthday. Dependent children (unmarried & unemployed) must be above 15 days and under 19 years of age, or under 23 years of age if the child is still on full-time higher education in Malaysia. Children under 2 years of age can only be included on a policy held by one or both their parents, and cannot take out a policy themselves.

2. Is there a surgical schedule?

No. There is no surgical schedule. Benefits are payable on a full refund basis.

3. What is cashless admission?

This means that you don't have to pay full hospital bills if you are admitted to one of our AXA Panel Hospitals. AXA will pay, provided the nature of accident or illness is covered under the policy. You may be required to make deposit payments as required by the hospital’s regulations

4. Does the policy cover Daycare Procedures?

Yes, the policy covers the fees charged by the hospital or specialist center and for all professional fees charged for minor Daycare Surgical Procedures performed as an outpatient without confinement in hospital. Examples of daycare Surgical Procedures include minor operations such as but not limited to : Cataract Removal, Cholecystectomy, Colonoscopy, Simple Excision of Pilonodal Cyst, Haemorrohoidectomy, Tonsillectomy. The claims will be on a reimbursement basis where you are required to pay and claim for reimbursement later.

5. What does international emergency medical assistance provide?

It provides 24 hours telephone medical consultation, telephone referral to doctors and hospitals, emergency medical evacuation and repatriation services outside Malaysia.

6. Are the Premiums Guaranteed?

AXA may charge the premiums in the future as the premium rates are not guaranteed. If we need to change, this will be based on our overall experience in underwriting this class of business and any changes in Premiums will be notified and made on your policy anniversary.

7. Is the Renewal Guaranteed?

There is no selective Renewal Loading or Exclusion on individual if claim is made during previous year. No restriction on lifetime limit and full annual limit is restated at Policy Renewal . However, the renewal of the Policy is conditionally guaranteed until the occurrence of any of the following:-

  1. non payment of premiums or premiums not made on time
  2. fraud or misrepresentation of material fact during application
  3. the Policy is cancelled at the request of the policyholder
  4. on the death of the policyholder or an Insured Person
  5. the Insured Person ceases to qualify as a dependent based on the definitions of the Policy
  6. the Insured Person attains the coverage age limit specified
  7. termination of coverage for all policies in a certain market
8. What are the disadvantages on switching policy from one insurer to another?

One of the main disadvantages is if your current health status is less favourable to the new insurer, new terms may be imposed to exclude such illness To ensure continuous cover is provided, you are advised to check with us on the accepting terms prior to your policy expiry date.

9. Is Medical Examination Required?

For applicants who are aged 55 (next birthday) and above, a medical examination and blood test are required for underwriting purposes. The cost of these tests will be borne by the applicant. For other ages, we may request for medical if deemed necessary.

10. What is Top Up Rider?

It is a rider tailored to substantially increase your limit on Out-Patient Kidney Dialysis and Out-Patient Cancer Treatment. The Top Up Rider also comes with the extended coverage for Post-Hospitalisation benefit up to 60 days and Home Nursing Care benefit. By paying additional premium, you may include Top Up Rider during a new application or upon renewal of your policy, before age 59 of your next birthday.

11. Who is AXA Affin General Insurance Berhad?

AXA Affin General Insurance Berhad is a licensed general insurer incorporated in 1975. AXA General are a member of the AXA Group, one of the world’s leading insurer. In Malaysia, AXA are a member of the Affin Group, a leader in financial services sector. AXA have expertise in personal, business and health insurances. AXA product range includes Motor, Household, Health, Accidental and Travel Insurance for individual customer as well as comprehensive plans specially designed for SMEs and other businesses.

Contact us at 03-2055 9733 / 03-2731 5338/ 03-2731 5384 or you may download, complete and fax the Proposal Form to 03-2026 4090.

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03-5522 3000

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