WHAT POLICY TO BUY

“NO ONE PLAN TO BE POOR IN OLD AGE.

BUT MANY JUST DON’T MAKE A PLAN NOT TO BE”

WHAT POLICY TO BUY

The most important I will recommend is a Life policy with full Medical Benefit

      

        (Not a standalone Medical Card)

 

WHY

Medical is very expensive today and you will never know whether you will be able to buy a Medical plan again based on my personal experience of 18 years in insurance.

Case 1

Child 2 months old father bought a Life policy with full medical benefits. On the

 3^rd month child was diagnosed with a hole in the heart , if the father had waited for few months the child will never be able to own a medical plan, now he will enjoy the insurance free for the rest of his life or his medical limit.

Case 2

A young Engineer starts working and bought his first policy with full Medical benefits. Just one month after his policy was in force he fell from a building under construction and became total permanent disable. He will enjoy the full medical benefit the rest of his life for free or until his medical limit and received Total Permanent Disable Benefits every year.

Case 3

A 1 9 year old girl bought her first policy after getting her first salary just after 3 months she was diagnosed with Leukemia. She will enjoy full medical benefits for the rest of her life or until her medical limit.

Case 4

A 32 year old man bought a policy just 24 hours and died in a motorcycle accident. The policy was still underwriting. Full amount was paid to the wife.

Case 5

Simon bought a Medical cards for his family he have been paying for more than 7 years. In 2008 have some financial problem and was unable to make the payment all the family medical Policy's lapse.

In 2009 Simon apply for new policy and when for a medical checkup. Simon medical record show's he was having diabetics since 2005. Simon will never be able to buy any medical Insurance . 

 

“YOU PAY A BANK 9% OR MORE FOR A DEBT WHY NOT PAY US 3% - 5% FOR AN ASSET”

About the author:Kertar Singh has joint Great Eastern Life Assurance in August 1995 as a part time agent.

Became a full time agent in 2000 after retiring from the army after 22 years.

He deal with all kind of Insurance from Life Insurances to General Insurances and Will Writing.

Kertar.en@gmail.com

H.P 013-322 8582

Notes: Reference have been made from MII and Gela

Medical Card

Medical Card (Most of the Problems) 

Medical card is a cashless card and it do not guarantee you a 100% admission to hospital's  sometime it can be decline if the Insurance company find something not right and can ask for more information from you.

When you are getting a medical card my personal advice is to get a life policy with a medical card as you will lock up your payment. You will know how much you will be paying for the rest of your life or as long as you want to be covered. A stand alone medical card is for a short period of time and I don't recommend for long terms as the payment will increase as you age and a time will come you will be unable to make the payment. And there are lot of other reasons which I can't write here. 

 

1. Before you get admitted to a hospital make sure the hospital is  a Panel.
2. Make sure the hospital has sent an admission report to your insurance company.
3. If you have any problem for you guarantee letter, call your agent for help or call the Insurance Company to confirm.  

Guarantee letter approval

If you have a problem for your guarantee letter  it's normally because:

1. Your policy is less than 1 year.
2. You are in specified illnesses waiting period.
3. You have Exclusion in the policy.
4. Company needs more information about the sickness
5. Suspect fraud case.
6. Pr-existing illness.( You have this problem before you bought the policy)
7. Have not declared it in your policy. (Most of the problem)
8. Others

In this cases you may need to pay the Hospital first and do a reimbursement. (I know it is hard but that is the only way).

You need to get the claim forms and send all the medical report to the company. If the company is satisfied they will pay you.

The company may ask additional reports. If the company declines your claim you can appeal to the company. (Get your Agent’s help if you have problem there is nothing much he/she can do but he/she can go to the root of the problem.)

4. When you get discharged from the hospital make sure the hospital have send all the information to your insurance company. Check the time they have faxed it as most of the problems are:

1. Doctor came to see you at 10am and he discharged you. You can go home. Doctor is still visiting his patient in the hospital. But you are ready to go home.
2. The doctor have not wrote his report for the insurance company but he has gone to operation theater or went to another hospital / clinic .The report is not done yet.
3. The staff are unable to send your report to your insurance company,  You are waiting to go home when you ask the hospital staffs. They will say’s we have not received anything from your insurance company. They will blame the insurance company.
4. Make sure and ask them what time they have faxed the report to the insurance company and call your insurance company or your Agent. Otherwise you will have to wait 2 to 6 hours for the doctor to come back and make the report before you can go home.

Co-Insurance

A co-insurance provision is a policy provision that requires the insured to pay a certain percentage of the eligible medical expenses in excess of the deductible.

The purpose of this clause is to reduce premium and prevent over utilization policy benefits since the insured has to pay part of the bill.

Premium can be offered at cheaper rates it is also for the insured to check the hospital's bills so as not to be over charged by the hospital for treatment not received. 

                                                                                 Extender

Most Insurance company have came up with a extender which is very important to make unlimited claim over life time. You need to remember your basic medical card still may have a life time limit, if you have use up you basic limit you may need to pay before you can use the extended.  Make sure use your medical card wisely don't think it is unlimited you can just use it.

About the author:Kertar Singh has joint Great Eastern Life Assurance in August 1995 as a part time agent.

Became a full time agent in 2000 after retiring from the army after 22 years.

He deal with all kind of Insurance from Life Insurances to General Insurances and Will Writing.

Kertar.en@gmail.com

H.P 013-322 8582

Notes: Reference have been made from MII and Gela

DEFINITIONS OF COVERED EVENTS 31 -36

(31)“Brain Surgery”:
The actual undergoing of surgery to the brain under general anesthesia during which a craniotomy is performed.
The following are excluded:
(a) Burr hole procedures, transphenoidal procedures or other minimally invasive procedures
(b) Brain surgery as a result of an accident.

(32)“Bacterial Meningitis”:
Bacterial meningitis causing inflammation of the membranes of the brain or spinal cord resulting in permanent neurological deficit lasting for a minimum period of thirty (30) days and resulting in a permanent inability to perform at least three (3) of the Activities of Daily Living.
The diagnosis is to be confirmed by:
(a) an appropriate specialist
(b) the presence of bacterial infection in the cerebrospinal fluid by lumbar puncture.

(33)“Other Serious Coronary ArteryDisease”:
The narrowing of the lumen of at least three (3) major coronary arteries (not inclusive of their branches) by a minimum of sixty percent (60%) or more as proven by coronary arteriography (non-invasive diagnostic procedures are excluded). Coronary Arteries herein refer to the Circumflex Artery, Right Coronary Artery (RCA), Left Anterior Descending Artery (LAD) and Left Main Stem (a narrowing of sixty percent (60%) or more of the Left Main Stem will be considered as a narrowing of two (2) major arteries). This benefit is payable regardless of whether or not any form of coronary artery surgery has been performed.

(34)“Loss Of Independent Existence”
Confirmation by an appropriate specialist of the loss of independent existence lasting for a minimum consecutive period of six (6) months and resulting in a permanent inability to perform at least three (3) of the Activities of Daily Living.

(35)“Systemic Lupus Erythematosus (SLE) With Lupus Nephritis”:
A multi-system, autoimmune disorder characterized by the development of auto-antibodies, directed against various self-antigens.
Within the context of this endorsement, SLE is restricted to only those forms of systemic lupus Erythematosus, which involve the kidneys (Type III to Type V Lupus Nephritis, established by renal biopsy). Other forms such as discoid lupus or those forms with only hematological or joint involvement are specifically excluded.
WHO Lupus Classification:
Class I - Minimal change glomerulonephritis
Class II - Mesangial glomerulonephritis
Class III - Focal Segmental glomerulonephritis
Class IV - Diffuse glomerulonephritis
Class V - Membranous glomerulonephritis

(36)“Full Blown AIDS”:
The clinical manifestation of AIDS (Acquired Immuno-deficiency Syndrome) must be supported by the results of a positive HIV (Human Immuno-deficiency Virus) antibody test and a confirmatory Western Blot test. In addition, the Life Assured must have a CD4 cell count of less than two hundred (200) and one or more of the following criteria are met:
(a) Weight loss of more than ten percent (10%) of body weight over a period of six (6) months or less (wasting syndrome);
(b) Kaposi Sarcoma;
(c) Pneumocystis Carinii Pneumonia;
(d) Progressive multifocal leukoencephalopathy;
(e) Active Tuberculosis;
(f) Less than one-thousand (1000) lymphocytes;
(g) Malignant Lymphoma.

About the author:Kertar Singh has joint Great Eastern Life Assurance in August 1995 as a part time agent.

Became a full time agent in 2000 after retiring from the army after 22 years.

He deal with all kind of Insurance from Life Insurances to General Insurances and Will Writing.

Kertar.en@gmail.com

H.P 013-322 8582

Notes: Reference have been made from MII and Gela

DEFINITIONS OF COVERED EVENTS 25 -30

(25)“Major Head Trauma”:
Physical head injury causing permanent functional impairment lasting for a minimum period of three (3) months from the date of the trauma or injury. The resultant permanent functional impairment is to be verified by a Consultant Neurologist and must result in an inability to perform at least three (3) of the Activities of Daily Living.

(26)“Chronic Aplastic Anemia”:
Irreversible persistent bone marrow failure which results in anemia, neutropenia and thrombocytopenia requiring treatment with at least two (2) of the following:
(a) Regular blood product transfusion;
(b) Marrow stimulating agents;
(c) Immunosuppressive agents; or
(d) Bone marrow transplantation.
The diagnosis must be confirmed by a bone marrow biopsy.

(27)“Muscular Dystrophy”:
The diagnosis of muscular dystrophy shall require a confirmation by a Consultant Neurologist of the combination of 3 out of 4 of the following conditions:
(a) Family history of other affected individuals
(b) Clinical presentation including absence of sensory disturbance, normal cerebro-spinal fluid and mild tendon reflex reduction
(c) Characteristic electromyogram
(d) Clinical suspicion confirmed by muscle biopsy
No benefit will be payable under this Covered Event before the Life Assured has reached the age of twelve (12) years next birthday.

(28)“Benign Brain Tumor”:
A life-threatening, non-cancerous tumor in the brain or meninges within the cranium, giving rise to characteristic signs of increased intra-cranial pressure such as papilloedema, mental symptoms, seizures and sensory impairment. The presence of the underlying tumor must be confirmed by imaging studies such as CT Scan or MRI.
The following are excluded:
(a) Cysts
(b) Granulomas
(c) Malformations in or of the arteries or veins of the brain
(d) Haematomas
(e) Tumors in the pituitary gland or spine;
(f) Tumors of the acoustic nerve.

(29)“Encephalitis”:
Severe inflammation of brain substance, resulting in permanent neurological deficit lasting for a minimum period of thirty (30) days and certified by a Consultant Neurologist. The permanent neurological deficit must result in an inability to perform at least three (3) of the Activities of Daily Living.
Encephalitis in the presence of HIV infection is specifically excluded.

(30)“Angioplasty And Other Invasive Treatments For Major Coronary Artery Disease”:
The actual undergoing for the first time of Coronary Artery Balloon Angioplasty, artherectomy, laser treatment or the insertion of a stent to re-vascularise a narrowing or blockage of one or more coronary arteries as shown by angiographic evidence.
Intra-arterial investigative procedures are not included. Payment under this clause is limited to ten percent (10%) of the Covered Event coverage under the relevant endorsement or annexure, subject to a maximum of RM 25,000. This benefit is payable once only and shall be deducted from the amount of the relevant endorsement or annexure, thereby reducing the amount of the lump sum payment which may be payable herein.

About the author:Kertar Singh has joint Great Eastern Life Assurance in August 1995 as a part time agent.

Became a full time agent in 2000 after retiring from the army after 22 years.

He deal with all kind of Insurance from Life Insurances to General Insurances and Will Writing.

Kertar.en@gmail.com

H.P 013-322 8582

Notes: Reference have been made from MII and Gela

DEFINITIONS OF COVERED EVENTS 20 - 24

(20)“Motor Neuron Disease”:
A progressive degeneration of the corticospinal tracts and anterior horn cells or bulbar efferent neurons. These include spinal muscular atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis and primary lateral sclerosis.
The diagnosis must be confirmed by a Consultant Neurologist as progressive and resulting in permanent neurological deficit.

(21)“HIV Due To Blood Transfusion”:
Infection with the Human Immunodeficiency Virus (HIV) through a blood transfusion, provided that all of the following conditions are met:-
(a) The blood transfusion was medically necessary or given as part of a medical treatment;
(b) The blood transfusion was received in Malaysia or Singapore after the commencement of the policy;
(c) The source of the infection is established to be from the institution that provided the blood transfusion and the institution is able to trace the origin of the HIV tainted blood;
(d) The Life Assured does not suffer from hemophilia; and
(e) The Life Assured is not a member of any high risk groups such as but not limited to intravenous drug users.

(22)“Parkinson’s Disease”:
Unequivocal diagnosis of Parkinson’s Disease by a Consultant Neurologist where the condition:
(a) Cannot be controlled with medication;
(b) Shows signs of progressive impairment.
Activities of Daily Living assessment confirm the inability of the Life Assured to perform without assistance three (3) or more of the Activities of Daily Living.
Only idiopathic Parkinson’s Disease is covered. Drug-induced or toxic causes of Parkinsonism are excluded.

(23)“End Stage Liver Failure”:
End stage liver failure as evidenced by all of the following:
(a) Permanent jaundice;
(b) Ascites; and
(c) Hepatic encephalopathy.
Liver failure secondary to alcohol or drug abuse is excluded.

(24)“End Stage Lung Disease”:
End stage lung disease causing chronic respiratory failure.
All of the following criteria must be met:
(a) Requiring permanent oxygen therapy as a result of a consistent FEV1 test value of less than one (1) liter.
(Forced Expiratory Volume during the first second of a forced exhalation);
(b) Baseline Arterial Blood Gas analysis with partial oxygen pressures of 55mmHg or less;
(c) Dyspnea at rest.

About the author :Kertar Singh has joint Great Eastern Life Assurance in August 1995 as a part time agent.

Became a full time agent in 2000 after retiring from the army after 22 years.

He deal with all kind of Insurance from Life Insurances to General Insurances and Will Writing.

Kertar.en@gmail.com

H.P 013-322 8582

Notes: Reference have been made from MII and Gela

DEFINITIONS OF COVERED EVENTS 12-19

DEFINITIONS OF COVERED EVENTS 12-19

(12)“Heart Valve Surgery”:
The actual undergoing of open-heart surgery to replace or repair cardiac valves as a consequence of heart valve defects or abnormalities.
Repair via intra-arterial procedure, key-hole surgery or similar techniques are excluded.

(13)“Deafness / Total Loss Of Hearing ”:
Total and irreversible loss of hearing in both ears as a result of illness or accident. Total means “the loss of at least eighty (80) decibels in all frequencies of hearing”.
Medical evidence in the form of an audiometry and sound-threshold tests must be provided and certified by an Ear, Nose, and Throat (ENT) specialist.

(14)“Surgery To Aorta”:
The actual undergoing of surgery via a thoracotomy or laparotomy to repair or correct an aortic aneurysm, an obstruction of the aorta or a dissection of the aorta. For the purpose of this definition, aorta shall mean the thoracic and abdominal aorta but not its branches.
Angioplasty, other intra-arterial or catheter based techniques or keyhole or laser procedures are excluded.

(15)“Loss Of Speech”:
Total and irrecoverable loss of the ability to speak for a continuous period of twelve (12) months. Medical evidence to confirm injury or illness to the vocal cords to support this disability must be supplied by an Ear, Nose and Throat specialist.
All psychiatric related causes are excluded.

(16)“Alzheimer’s Disease / Irreversible Organic Degenerative Brain Disorders”:
Deterioration or loss of intellectual capacity or abnormal behavior as evidenced by the clinical state and accepted standardized questionnaires or tests arising from Alzheimer’s Disease or irreversible organic degenerative brain disorders resulting in significant reduction in mental and social functioning (such that continuous supervision is required). The diagnosis must be clinically confirmed by a Consultant Neurologist.
The following are excluded:
(a) Non organic brain disorders such as neurosis
(b) Psychiatric illnesses
(c) Drug or alcohol related brain damage

(17)“Major Burns”:
Third degree (i.e. full thickness) skin burns covering at least twenty percent (20%) of the total body surface area.

(18)“Coma”:
A state of unconsciousness with no reaction or response to external stimuli or internal needs, persisting continuously for at least ninety-six (96) hours, requiring the use of life support systems and resulting in a permanent neurological deficit, lasting more than thirty (30) days. Confirmation by a Consultant Neurologist must be present.
Coma resulting directly from self-inflicted injury, alcohol or drug abuse is excluded.

(19)“Severe Cardiomyopathy”:
An impaired function of the heart muscle, unequivocally diagnosed as Cardiomyopathy by a cardiologist, and resulting in permanent physical impairment of at least Class III of the New York Heart Association's classification of cardiac impairment. The diagnosis has to be supported by echocardiographic findings of compromised ventricular performance.The NYHA Classification of Cardiac Impairment for Class III and Class IV means the following:-
Class III: Marked limitation of physical activity. Comfortable at rest but less than ordinary activity causes symptoms.
Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.
Cardiomyopathy directly related to alcohol or drug abuse is excluded

About the author :Kertar Singh has joint Great Eastern Life Assurance in August 1995 as a part time agent.

Became a full time agent in 2000 after retiring from the army after 22 years.

He deal with all kind of Insurance from Life Insurances to General Insurances and Will Writing.

Kertar.en@gmail.com

H.P 013-322 8582

Notes: Reference have been made from MII and Gela

DEFINITIONS OF COVERED EVENTS 5 - 11

 DEFINITIONS OF COVERED EVENTS 5 - 11


(5)“End Stage Kidney Failure”
:
End stage kidney failure presenting as chronic irreversible failure of both kidneys to function, as a result of which regular renal dialysis is initiated or renal transplantation is carried out.

(6)“Fulminant Viral Hepatitis”
:
A sub massive to massive necrosis of the liver caused by any virus leading precipitously to liver failure.
The diagnostic criteria to be met are:
(a) A rapidly decreasing liver size as confirmed by abdominal ultrasound;
(b) Necrosis involving entire lobules, leaving only a collapsed reticular framework;
(c) Rapidly deteriorating liver functions tests; and
(d) Deepening jaundice.
Hepatitis B infection or carrier status alone does not meet the diagnostic criteria.

(7)“Major Organ / Bone Marrow Transplant”:
The receipt of a transplant of:
(a) Human bone marrow using hematopoietic stem cells preceded by total bone marrow ablation; or
(b) One of the following human organs: heart, lung, liver, kidney, pancreas that resulted from irreversible end stage failure of the relevant organ.
Other stem cell transplants are excluded.

(8)“Paralysis / Paraplegia”:
The complete and permanent loss of use of both arms or both legs, or of one arm and one leg, through paralysis caused by illness or injury persisting for at least six (6) months from the date of trauma or illness.

(9)“Multiple Sclerosis”:
Unequivocal diagnosis by a Consultant Neurologist confirming the following combination, which has persisted for at least a continuous period of six (6) months:
(a) Symptoms referable to tracts (white matter) involving the optic nerves, brain stem and spinal cord, producing well-defined neurological deficits;
(b) A multiplicity of discrete lesions; and
(c) A well-documented history of exacerbation and remissions of said symptoms / neurological deficits.

(10)“Primary Pulmonary Arterial Hypertension”:
Primary Pulmonary Arterial Hypertension with substantial right ventricular enlargement established by investigations including cardiac catheterization, resulting in permanent physical impairment to the degree of at least Class III of the New York Heart Association (NYHA) classification of cardiac impairment.
Pulmonary arterial hypertension resulting from other causes shall be excluded from this benefit.
The NYHA Classification of Cardiac Impairment for Class III and Class IV means the following:-
Class III: Marked limitation of physical activity. Comfortable at rest but less than ordinary activity causes symptoms.
Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.

(11)“Blindness / Total Loss Of Sight”:
Total and irrecoverable loss of sight in both eyes as a result of illness or accident. The blindness must be confirmed by an ophthalmologist.

Ref: Gela

About the author:Kertar Singh has joint Great Eastern Life Assurance in August 1995 as a part time agent.

Became a full time agent in 2000 after retiring from the army after 22 years.

He deal with all kind of Insurance from Life Insurances to General Insurances and Will Writing.

Kertar.en@gmail.com

H.P 013-322 8582