Sei sulla pagina 1di 24

HealthEnrich

THE MEDICAL PLAN THAT DEFINES YOU

HealthEnrich is Uniquely You


Your health is a privilege and you deserve a plan that reflects your medical needs.
At Prudential BSN Takaful Berhad (PruBSN), we want you to live your life without
compromising your health.
HealthEnrich is designed to ensure you experience unparallelled medical treatment, fully
covered. Feel secure when you receive medical advice from leading experts around the
world. Be at ease during pregnancy with our exclusive maternity complications coverage.
You can also enjoy the comfort and privacy of a suite with a dedicated medical attendant
taking care of your needs.
All these features and more crafted to complement your unique lifestyle.
Now, lets discover your lifestyle.

Are You...
YOUNG AND LOOKING
FOR FREEDOM IN LIFE?
Start Early

DEDICATED AND TAKING


MORE COMMITMENTS
IN LIFE?
Fulfil Life

A HIGH ACHIEVER AND


SEEKING FOR THE BEST
IN LIFE?
Take the Lead

ACCOMPLISHED AND
LIVING A DISTINGUISHED
LIFESTYLE?
Enjoy Exclusive Privileges

HealthEnrich Vital

Start Early with


HealthEnrich Vital
The moment is here for you to stand on your own
feet. Start early with a plan that provides vital medical
protection and suits your vibrant lifestyle.

HealthEnrich Vital gives you...


MEDICAL TREATMENT
that is within easy
reach at our nationwide
network of

70

hospitals

SECURITY when you explore the


world knowing that
you are covered worldwide
FLEXIBILITY to upgrade the
plan as your needs grow
with your changing lifestyle

HealthEnrich Vital
Co-Takaful
If You are Hospitalised
Hospital Daily Room and Board (maximum 120 days per year)
Intensive Care Unit (maximum 30 days per year)
Surgical Procedure and Treatment
In-Hospital and Related Services

RM150
As charged
subject to
Co-Takaful

If You Need Outpatient Treatment


Day Surgery

As charged

Pre-Hospitalisation and Post-Hospitalisation Treatment


(within 90 days before and after hospitalisation)

As charged
subject to
Co-Takaful

If You are Coping with Life-changing Illnesses


Cancer Treatment

As charged

If You are in an Emergency


Emergency Treatment for Accidental Injury (Annual Limit)
Worldwide Emergency Medical Assistance

RM1,500
Yes

Overall Annual Limit

RM30,000

Lifetime Limit

RM300,000

HealthEnrich Select

Fulfil Life with


HealthEnrich Select
Your lifestyle changes when you have a family. Select
a plan that fulfils life with optimum protection and
satisfies your growing responsibilities.

HealthEnrich Select offers you...


COMPREHENSIVE
hospitalisation
and surgical cover

Unique benefits
for the COMFORT of
EXPECTING MOTHERS

MEDICAL BILL

PAID

FULL COVER for your


MEDICAL BILLS giving
you added security
and peace of mind

HealthEnrich Select
Co-Takaful

Full Coverage

RM200

RM200

As charged
subject to
Co-Takaful

As charged

If You are Hospitalised


Hospital Daily Room and Board
(maximum 200 days per year)
Intensive Care Unit (maximum 60 days per year)
Surgical Procedure and Treatment
In-Hospital and Related Services
If You Need Outpatient Treatment
Day Surgery

As charged

Home Nursing Care (180 days per lifetime)

As charged
subject to
Co-Takaful

As charged

As charged

As charged

Maternity Complications (Annual Limit)

RM6,000

RM6,000

Emergency Treatment for Accidental Injury


(Annual Limit)

RM2,000

RM2,000

Worldwide Emergency Medical Assistance

Yes

Yes

Overall Annual Limit

RM60,000

RM60,000

Lifetime Limit

RM600,000

RM600,000

Pre-Hospitalisation and Post-Hospitalisation Treatment


(within 90 days before and after hospitalisation)
If You are Coping With Life-changing Illnesses
Cancer Treatment
Kidney Dialysis Treatment
If You are in an Emergency

HealthEnrich Advanced

Take the Lead with


HealthEnrich Advanced
You progress so quickly in life that you seldom pause
and think about your future healthcare needs. Take the
lead with a plan that provides advanced protection and
fulfils your hectic lifestyle.

HealthEnrich Advanced provides you...


EASY ADMISSION with pre-arranged
hospitalisation and waiver of hospital
deposit at our Preferred Hospitals
DIRECT CONSULTATION
with leading local and
international medical experts
REWARDS for healthy living
with a NO CLAIM BONUS
under the co-takaful option

HealthEnrich Advanced
Co-Takaful

Full Coverage

RM250

Not offered

Hospital Daily Room and Board


(maximum 200 days per year)

RM300

RM300

Hospital Daily Cash Allowance


(maximum 200 days per year)

RM100

RM100

As charged
subject to
Co-Takaful

As charged

Waived

Waived

Reward for Healthy Living


No Claim Bonus
If You are Hospitalised

Intensive Care Unit (maximum 60 days per year)


Surgical Procedure and Treatment
In-Hospital and Related Services
Hospital Deposit at Preferred Hospitals
If You Need Outpatient Treatment
Day Surgery
Home Nursing Care (250 days per lifetime)

As charged
As charged
subject to
Co-Takaful

As charged

RM500

RM500

Yes

Yes

As charged

As charged

RM100,000

RM100,000

Maternity Complications (Annual Limit)

RM10,000

RM10,000

Emergency Treatment for Accidental Injury


(Annual Limit)

RM3,000

RM3,000

Pre-Hospitalisation and
Post-Hospitalisation Treatment
(within 90 days before and after hospitalisation)
If You are Coping With Life-changing Illnesses
Second Medical Opinion
Consultation and Diagnosis in Malaysia
(Annual Limit)
Consultation with World Leading Experts
Cancer Treatment
Kidney Dialysis Treatment
Organ Transplant (Additional Lifetime Limit)
If You are in an Emergency

Worldwide Emergency Medical Assistance


Overall Annual Limit
Lifetime Limit

Yes

Yes

RM100,000

RM100,000

RM1,000,000

RM1,000,000

HealthEnrich Premier

Enjoy Exclusive Privileges with


HealthEnrich Premier
You want to experience the finest things in life while
living healthily. Enjoy exclusive privileges with a plan
that offers superior protection and addresses your
prominent lifestyle.

HealthEnrich Premier offers you...


LUXURIOUS ACCOMMODATION
in a suite and exclusive treatment
at our Preferred Hospitals nationwide
A DEDICATED MEDICAL
attendant to meet
your every need
SUPERIOR HOSPITALISATION LIMITS

xim

um

M ini m

Ma

um

Average

for your medical needs

HealthEnrich Premier
Full Coverage
If You are Hospitalised
Hospital Daily Room and Board (maximum 365 days per year)
Preferred Hospitals
Other hospitals

RM1,000
RM500

Hospital Daily Cash Allowance (maximum 365 days per year)

RM200

Dedicated Daily Medical Attendant (maximum 365 days per year)

RM200

Intensive Care Unit (maximum 120 days per year)


Surgical Procedure and Treatment

As charged

In-Hospital and Related Services


Hospital Deposit at Preferred Hospitals

Waived

If You Need Outpatient Treatment


Day Surgery
Home Nursing Care (365 days per lifetime)

As charged

Pre-Hospitalisation and Post-Hospitalisation Treatment


(within 90 days before and after hospitalisation)
If You are Coping With Life-changing Illnesses
Second Medical Opinion
Consultation and Diagnosis in Malaysia (Annual Limit)
Consultation with World Leading Experts
Cancer Treatment
Kidney Dialysis Treatment
Organ Transplant (Additional Lifetime Limit)

RM1,000
Yes
As charged
RM200,000

If You are in an Emergency


Maternity Complications (Annual Limit)

RM20,000

Emergency Treatment for Accidental Injury (Annual Limit)

RM5,000

Worldwide Emergency Medical Assistance


Overall Annual Limit
Lifetime Limit

Yes
RM200,000
RM4,000,000

What you need to know about HealthEnrich


1. What is HealthEnrich?
HealthEnrich is a regular contribution medical rider plan that reimburses major medical
expenses incurred in the event of hospitalisation, surgery or outpatient treatment. It has
four plans HealthEnrich Vital, HealthEnrich Select, HealthEnrich Advanced and
HealthEnrich Premier where each comes with a medical card to give you immediate
access to any of our panel hospitals.
2. How much contribution do I need to pay?
The contribution that you pay is based on your age at entry and does not increase as you
get older. The contribution rates are available in Appendix 2.
3. What is Organ Transplant benefit?
Organ Transplant benefit is an additional lifetime limit when you undergo one of the
transplant surgeries on kidney, heart, lung, liver, bone marrow or cornea. This additional
once-in-a-lifetime benefit is on top of the annual limit and lifetime limit for HealthEnrich
Advanced and HealthEnrich Premier.
4. What are the advantages of Cancer Treatment and Kidney Dialysis Treatment?
You can seek treatments such as hemodialysis, radiotherapy and chemotherapy at our
panel hospitals using the medical card without any payment of co-takaful. On top of
that, HealthEnrich covers any consultations, examination tests and take-home drugs.
5. What are the options available for HealthEnrich?

Options

HealthEnrich
Vital

HealthEnrich
Select

HealthEnrich
Advanced

HealthEnrich
Premier

Entry Age

20 gestational
weeks to
45 years old

20 gestational
weeks to
70 years old

14 days to
70 years old

14 days to
70 years old

Expiry Age

25, 70 or
80 years old

25, 70 or
80 years old

25, 70 or
80 years old

25, 70 or
80 years old

Costsharing

Co-takaful
only

Co-takaful or
Full Coverage

Co-takaful or
Full Coverage

Full Coverage
only

6. What are the charges and deductions involved in HealthEnrich?


The details of charges and deductions are listed in the table below.
Type of
Charges and
Deductions
Upfront
wakalah
charge

Details
This charge allows us to pay commission and distribution related
expenses as well as management expenses. The percentage
below is based on term 20 years or more. For term less than
20 years, you may refer to the Plan Illustration.

Certificate year

5&6

7&
above

Upfront wakalah
charge

60%

60%

50%

30%

20%

0%

Tabarru

We deduct an amount each month from your protection account


based on your age, health status, occupation (if applicable), and
amount of coverage for the duration of the coverage.

What is Day Surgery Benefit?


Hospital admissions are costly and at times unnecessary.
Hospitalisation means more costs such as admission fee, room
and board, nursing care and meals. Although we need rest to
recover, hospitals are not always as comforting as our own homes.
One of the uniqueness of HealthEnrich is the Day Surgery benefit.
No matter which plan you choose, Co-Takaful or Full Coverage,
this benefit fully covers the cost of your surgeries or treatments.
Also, with the Day Surgery benefit, you can recuperate in the comfort of your home on
the same day. You do not have to stay overnight at a hospital and worry about exhausting
your medical coverage. You can undergo radiotherapy, haemodialysis or chemotherapy as
outpatient under this convenient plan.

It also covers*:
1. Gastroscopy/Endoscopy
2. Colonoscopy
3. Angiography
4. I & D of abscess except wide excision
5. Cataract extraction
6. Excision of breast nodule/lump except wide excision
7. Dilatation & Curettage
8. Diagnostic laparoscopic procedure
9. Removal of foreign body
10. Excision of Chalazion/Pterygium
11. Radiotherapy
12. Diagnostic Bronchoscopy
13. Removal of Ganglion/fibroma
14. Diagnostic cystoscopy
15. Insertion of Chemoport/Hickman line
16. AV fistula creation
17. Lump Excision biopsy (all types)
18. Removal of warts
19. Closed manipulation of fracture
20. Injection of Trigger finger
21. Intra-articular injection of joints
22. Corrective surgery for blepharoptosis not
related to congenital/cosmetic
23. Haemodialysis
24. Suture and other operations on tendons and
tendon sheath
25. Chemotherapy
26. Arthroscopic knee evaluation/
aspiration/joint toilet
27. Carpal tunnel release

* You may undergo any other day surgery or


treatment that is not listed above as advised by your doctor.
Please refer to the certificate document for further information.

Important Notes
1. This brochure does not form a contract between you and PruBSN. Please refer to the
Plan Illustration and Product Disclosure Sheet before participating in the plan. The full
Terms and Conditions are set out in the certificate documents. Please ask for a sample
of the Terms and Conditions should you need detailed information of the plan.
2. For HealthEnrich, you are entitled to medical tax relief in respect of your contributions of
up to RM3,000 a year. Any tax relief is subject to the terms and conditions of the Inland
Revenue Board (IRB).
3. You should continue paying your contributions regularly until the maturity of your plan
to ensure that you are fully protected under the plan at all times. Failing to do so may
cease your coverage prematurely. Coverage to expiry age is subject to the Protection
Unit Account (PUA) being sufficient for deduction of Tabarru and applicable charges.
4. HealthEnrich is a guaranteed renewable plan. The contribution is level but it is not
guaranteed. PruBSN reserves the right to revise the contribution rates and/or Tabarru by
giving 30 days written notice. The rates may be revised due to unfavorable circumstances
such as medical cost inflation. Any changes in contributions and/or Tabarru will only
take effect on the next certificate anniversary.
5. HealthEnrich does not provide any benefit amount from the Tabarru Fund on
termination, expiry or maturity of certificate.
6. Co-takaful is a cost-sharing arrangement under which the participant pays a specified
percentage of the cost of an eligible benefit. If co-takaful is selected, participant will have
to pay 10% of the cost of an eligible benefit, subject to minimum co-takaful amount of
RM400 and maximum co-takaful amount of RM2,000. No minimum co-takaful amount
applies for benefits under If You Need Outpatient Treatment.
7. The full coverage plan requires no payment from the participant in respect of bills for
covered medical conditions subject to limits in each plan and terms and conditions as
stated in the certificate documents.
8. Preferred Hospitals are selected hospitals that will provide complimentary services
to preferred customers who take up plan HealthEnrich Advanced or HealthEnrich
Premier. Please refer to PruBSN website for the current list of Preferred Hospitals.
9. You can only seek Second Medical Opinion when you are diagnosed with one of the
covered critical illnesses.
10. HealthEnrich is based on Wakalah Bil Ajr model which is an arrangement for PruBSN to
manage your takaful plan. Your contribution will be placed into the PUA after deducting a
wakalah charge which constitutes the fee for the overall management services provided.
The takaful protection comes from the Tabarru Fund.
11. Tabarru means a donation of a specified portion from the contribution into the Tabarru
Fund for the purpose of mutual aid and assistance among fellow participants according
to the agreed benefits under the plan.
12. You are entitled to receive any distributable surplus inclusive of investment profit
(if any) at the end of each financial year. Together with other participants, you are entitled
to at least 50% of the surplus and PruBSN will receive the balance of up to 50% as
incentive for managing the Tabarru Fund. Your portion of the distributable surplus will be
placed back into your PUA. The exact amount of distributable surplus will be determined
annually and is subject to approval by both the Shariah Committee and the Board of
Directors of PruBSN.

Exclusions
HealthEnrich does not cover any hospitalisation, surgery or charges caused directly or
indirectly, wholly or partly, by any one of the following occurrences:
1. Pre-existing condition.
2. Specified illnesses during the first 120 days of cover.
3. Any medical or physical conditions arising within 30 days from the date of coverage or
date of reinstatement, except for accidental injuries.
4. Cosmetic surgery, circumcision, eye examination, glasses, lens, Lasik and the use of
prosthetic and medical devices.
5. Dental conditions including treatment or oral surgery to natural teeth except as
necessitated by accidental injuries.
6. Experimental surgery or elective procedures except as a result of accidental injury,
surgery or illness.
7. Bed rest, illegal drugs, intoxication, sterilisation, AIDS, HIV, all sexually transmitted
diseases requiring quarantine by law.
8. Any treatment or surgery for congenital conditions including hereditary conditions.
9. Treatments or procedures relating to pregnancy or childbirth and its complications,
prenatal or postnatal care except all those stated in certificate document and,
miscarriage, abortion, any contraceptive methods of birth control, treatments pertaining
to infertility or erectile dysfunction and impotence.
10. Routine medical examinations, hospitalisation solely for investigatory purposes/
diagnostic imaging not coincidental to treatment of covered disability or any treatments,
medicines or examinations deemed not medically necessary or preventive in nature and
treatments specifically for weight reduction or gain example sleeve gastrectomy.
11. Suicide, attempted suicide or self-inflicted bodily injury while sane or insane.
12. Any injury or illness caused by any act of war, any violation or attempted violation of the
law or to resist arrest, direct participation in riot, strike and civil commotion.
13. Ionising radiation or radioactive contamination from any nuclear fuel or waste from
nuclear fission or any nuclear materials.
14. Expenses incurred by donor or covered person for donation of any body organ and all
costs of organ acquisition and its complications.
15. Investigation and treatment of sleep and snoring disorders, treatment of abnormal
perspiration, therapy of hormone replacement, stem cells, hyperbaric oxygen therapy,
chiropodist consultation and treatment, chiropractic services, aromatherapy and any
form of alternative therapies.

16. Care or treatment for which payment is not required or to the extent which is payable
by other Takaful operators or indemnity covered under the Workmans Compensation
Takaful Contract.
17. Psychiatric, mental or nervous disorders and those due to senile disorders.
18. Expenses of non-medical services including but not limited to television, telephone,
broadband, electricity bill, radio or admission kit except all those stated in certificate
document.
19. Sickness or injury arising from any kind of racing, hazardous sports, aerial flights except
as a crew member or a fare-paying passenger, or on a licensed passenger-carrying
commercial aircraft operating on a regular scheduled route.
20. Expenses incurred for sex changes or gender transformation.
21. Any insect bite including mosquito bites and worm infestation during the waiting period.
22. Charges which are not within Reasonable and Customary Charges or charges
incurred after the Expiry Date.
The exclusion and limitations above are not exhaustive and you should refer to the certificate
document for further information.

Appendix 1
List of Maternity Complications
1.

Disseminated Intravascular Coagulation

2.

Ectopic Pregnancy

3.

Hydatidiform Mole

4.

Postpartum Hemorrhage Requiring Hysterectomy

5.

Eclampsia

6.

Amniotic Fluid Embolism

7.

Pulmonary Embolism of Pregnancy

8.

Toxaemia of Pregnancy

Appendix 2
Annual Contribution Rates for HealthEnrich Select for Expiry Age 70.

Entry Age

Cost-sharing Options
Co-Takaful (RM)

Full Coverage (RM)

1 15

808

995

16

818

1,004

17

830

1,014

18

841

1,023

19

852

1,056

20

863

1,089

21

882

1,118

22

901

1,147

23

920

1,177

24

939

1,206

25

958

1,235

26

976

1,265

27

995

1,294

28

1,013

1,323

29

1,031

1,353

30

1,049

1,382

31

1,083

1,412

32

1,101

1,441

33

1,115

1,470

34

1,130

1,500

35

1,144

1,529

36

1,177

1,577

37

1,210

1,626

38

1,242

1,674

39

1,312

1,722

40

1,352

1,770

Entry Age

Cost-sharing Options
Co-Takaful (RM)

Full Coverage (RM)

41

1,396

1,829

42

1,446

1,887

43

1,516

1,946

44

1,585

2,005

45

1,654

2,063

46

1,742

2,182

47

1,828

2,302

48

1,963

2,421

49

1,988

2,540

50

2,057

2,660

51

2,125

2,710

52

2,193

2,760

53

2,261

2,810

54

2,329

2,860

55

2,396

2,910

56

2,480

3,001

57

2,564

3,093

58

2,646

3,185

59

2,730

3,276

60

2,812

3,368

The contribution rates are for a standard risk of occupation class 1 and 2. The contribution
rates for occupation class 3 and 4 are 1.25 and 1.5 times more than the contribution
rates for occupation class 1 and 2 respectively. The rates are subject to underwriting. Your
actual contribution amount shall depend on your age (based on Age Next Birthday), health
status, occupation class, plan type and duration of coverage. For HealthEnrich contribution
rates with other combinations of plan, expiry age and cost-sharing options please refer to
www.prubsn.com.my.

HealthEnrich is a Shariah-compliant product.


Prudential BSN Takaful Berhad is a registered Takaful Operator under
the Islamic Financial Services Act 2013 and is regulated by Bank Negara Malaysia.
For more information/enquiries, please contact:

PRUDENTIAL BSN TAKAFUL BERHAD (740651-H)


Level 8A, Menara Prudential, No. 10, Jalan Sultan Ismail, 50250 Kuala Lumpur.
Tel: (03) 2053 7188 Fax: (03) 2072 6188
E-mail: customer@prubsn.com.my SMS PruBSN and send to 33080
You can also log on to

www.prubsn.com.my

Important: You must ensure that you are satisfied that this product will best serve your needs
and that the contribution payable under the certificate is an amount you can afford.

All information is correct at the time of print.


Printed 1 November 2013