Sepanjang empat bulan berunding dan memohon subsidi daripada Pengurusan ke atas caruman Perlindungan Rawatan Hospital dan Surgeri anggota dan kakitangan, menjadi punca kepada kelewatan pembaharuan perlindungan Skim Rawatan Anggota. Walau bagaimana pun, demi mempastikan anggota terus mendapat rawatan keatas pelbagai jenis penyakit, bermula 1hb Jun 2020 hingga 31 Oktober 2020, Koperasi telah melaksanakan skim tersebut secara 'self-insured'.
Koperasi pada 12hb Oktober 2020 telah memuktamadkan kaedah self-insured ini dengan melantik Great Eastern Takaful Berhad (GETB) sebagai Penanggung Risiko dan Metronic iCares Sdn Bhd (Micares) sebagai Pentadbir Skim (Third Party Administrator) berkuatkuasa 1 November 2020.
|
Item |
Covered Benefits |
A |
B |
C |
D |
|
1 |
Hospital Room and Board
(R&B) (Limit
per day, subject to a maximum of 180 days per certificate year for Items (1)
and (2) in aggregate) |
400 |
300 |
200 |
150 |
|
2 |
Intensive Care Unit (ICU) (Limit
per day, subject to a maximum of 30 days per certificate year for Items (1)
and (2) in aggregate) |
As
Charged |
As
Charged |
As
Charged |
As
Charged |
|
3 |
Hospital
Supplies and Services Maximum per Any One Disability |
As
Charged |
As
Charged |
As
Charged |
As
Charged |
|
4 |
Surgical Fees Maximum per Any One
Disability |
As
Charged |
As
Charged |
As
Charged |
As
Charged |
|
5 |
Operating Theatre Maximum per Any One
Disability |
As
Charged |
As
Charged |
As
Charged |
As
Charged |
|
6 |
Anaesthetist Fees Maximum per Any One
Disability |
As
Charged |
As
Charged |
As
Charged |
As
Charged |
|
7 |
In Hospital Physician Visit (Maximum
2 visits per day up to 180 days) Maximum per Any One Disability |
As
Charged |
As
Charged |
As
Charged |
As
Charged |
|
8 |
Pre-Hospitalisation
Specialist Consultation (Within 90 days before hospitalisation) Maximum per
Any One Disability |
As
Charged |
As
Charged |
As
Charged |
As
Charged |
|
9 |
Pre-Hospitalisation
Diagnostic Tests (Within 90 days before hospitalisation) Maximum per Any One
Disability |
As
Charged |
As
Charged |
As
Charged |
As
Charged |
|
10 |
Post-Hospitalisation
Treatment (Within
90 days after hospital discharge) Maximum per Any One Disability |
As
Charged |
As
Charged |
As
Charged |
As
Charged |
|
11 |
Ambulance Fees Maximum per Any One
Disability |
As
Charged |
As
Charged |
As
Charged |
As
Charged |
|
12 |
Day Surgery Maximum per Any One
Disability |
As
Charged |
As
Charged |
As
Charged |
As
Charged |
|
13 |
Malaysian Tax |
As
Charged |
As
Charged |
As
Charged |
As
Charged |
|
Item |
Optional Benefits |
A |
B |
C |
D |
|
14 |
Daily-Cash
Allowance at Malaysian Government Hospital (Maximum 180 days in a Certificate
Year) |
150 |
150 |
100 |
100 |
|
15 |
Second
Surgical Opinion (Option 1) Maximum per Any One Disability |
As
Charged |
As
Charged |
As
Charged |
As
Charged |
|
16 |
Organ Transplant (Once Per
Lifetime) |
30,000 |
30,000 |
30,000 |
30,000 |
|
17 |
Outpatient Cancer Treatment |
30,000 |
30,000 |
30,000 |
30,000 |
|
18 |
Outpatient Kidney Dialysis
Treatment |
30,000 |
30,000 |
30,000 |
30,000 |
|
19 |
Emergency
Accidental Outpatient Treatment (Maximum 60 days from the date of accident)
Maximum per Any One Disability |
As
Charged |
As
Charged |
As
Charged |
As
Charged |
|
20 |
Accidental Dental Treatment (Maximum
14 days from the date of accident) Maximum per Any One Disability |
As
Charged |
As
Charged |
As
Charged |
As
Charged |
|
21 |
Emergency
Sickness Outpatient Treatment (10pm to 8am) Maximum per Any One Disability |
100 |
100 |
100 |
100 |
|
22 |
Medical
Report Reimbursement (Per report) Maximum per Any One Disability |
80 |
80 |
80 |
80 |
|
23 |
Compassionate
Allowance (Death due to all causes) |
5,000 |
5,000 |
5,000 |
5,000 |
|
Overall
Annual Limit (for
items 1 to 12, 14 to 15, 19 to 22) |
80,000 |
60,000 |
55,000 |
45,000 |
|
Notes:
Benefits with
'As Charged' are still subject to the overall limit selected.
Demi menjaga kebajikan dan kemaslahatan anggota, koperasi telah berjaya mendapatkan manafaat berikut:-
- Kelayakan untuk menyertai skim ini adalah diantara 18 hingga 70 tahun ( the renewal coverage age is up to 75 ANB)
- Upgraded Room & Board tidak dikenakan 20% co-payment. Anggota cuma perlu membayar lebihan tuntutan keatas perbezaan kos Room & Board tersebut.
- Take-Over Scheme - walau pun perlindungan telah luput pada 1hb June 2020, GETB bersetuju untuk memperbaharui skim ini secara skim pengambilalihan keseluruhan. Ini memberi kelebihan
- Pre-existing Condition tidak perlu tunggu 12 bulan untuk mendapatkan rawatan
- Specified Illness - Tidak perlu menunggu 120 hari
- Waiting Period selama 30 hari juga dimansuhkan.
Lain-lain syarat dan terma sebagaimana kaedah Skim Perlindungan terdahulu masih digunapakai dan tidak berubah.
Pekeliling rasmi akan dikeluarkan oleh Pengurusan Koperasi berkaitan hal-hal berkaitan pembaharuan Skim Rawatan ini kepada anggota.
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