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Medical and Health Takaful - Coggle Diagram
Medical and Health Takaful
Benefits
reimbursement of medical expenses
lump sum payment of sum participated
payment of an allowance or income steam for a specific period in the event participant incapacitation or hospitalization
Type of Cover
Indemnity Certificate
reimburse participant
hospitalization and surgica
l reimbursement
will place covered in same financial position before occurrence of risk
Benefit Certificate
predetermine sum money covered if event occurred
hospitalization
cash benefits and critical illness takaful
Characteristics
a. Non termination coverage with claim payment
payment of claim does not terminate the cert except in the event of death
per disability limit : max amount per disability
overall annual limit : max benefit to a participant in a year
lifetime limit : max benefit during his lifetime
b. Increase risk with time
morbidity of participants, risk increases with age
Hospital Services and Professional Benefits
expenses regarding hospitalization treatment cost
1. Pre Hospitalization
specialist consultation and all diagnosis test which recommended by doctor before hospitalization
if not required to be hospitalized after the test, full payment must be done
cover 30 to 60 days expenses before hospitalization
2. In House Hospitalization Benefits
surgical expenses and non surgical expenses
3. Post Hospitalization
follow up treatment, 30 to 90 days after hospitalization
4. Other Benefits
outpatient surgery, cancer and dialysis treatment
emergency outpatient accidental. dental and physiotherapy
home nursing and ambulance
5. Hospitalization
daily cash benefits
stand alone cert or as riders
6. Critical Illness
cover a lump sum benefits upon diagnosed
Group Medical and Health
employer sponsored coverage
calculated based on
age of group
degree of occupation
General Exclusion
pre existing illness
/ conditions prior join the scheme
specified illness : illness occurred in first 120 days of coverage
waiting or
qualifying period period
: any medical and physical condition arise within 30 days of cover or date of reinstatement
plastic / cosmetic surgery
dental conditions
treatment or surgical for abnormalities or deformities
pregnancy / child birth , erectile dysfunction
hospitalization for non incidental treatment
suicide, war, ionizing radiation
expenses incurred during organ donation
sleep and snoring disorder
alternative therapy - chiropractic, acupuncture etc
private flying, racing
non medical nature, mental disorders
care or treatment for which payment is not required
3rd Party Administration
2. Claims Settlement
advising customer on hospital network
approving cashless and disburse claims to customer
3. Maintaining database
administer records and future communications to customer
1. Cashless Service
bill paid directly by TO if admitted in hospital listed by TO
participant does not make advance payment
Important Terms
pre existing illness
*
/ conditions prior join the scheme
qualifying period period
*
: any medical and physical condition arise within 30 days of cover or date of reinstatement
misstatement of age
lead to lower contribution, claim will be prorated based on the actual contribution paid to the contribution should have charged
overseas treatment
receiving treatment overseas
Co Payment
participant choses room & board higher, than stated , participant bear 20% of total medical bills
remaining 80%, participant bear 10% Co Takaful and balance paid by TO
Co Takaful
90% covered by Takaful and 10% paid by participant upon discharge