Yes, premium saving options are applicable to Group Hospitalisation and Surgical (GHS) plan as below:

SME Group Health Insurance is available to companies with 200 employees or below.

The eligible age requirement is as follow:

No, Outpatient Clinical (OPC) is only available if the employer purchases Group Hospitalisation and Surgical (GHS) on a cashless facility basis.

No, Outpatient Clinical (OPC) cannot be purchased as a standalone plan. It is only available when employer purchases Group Hospitalisation and Surgical (GHS) on a cashless facility basis.

No, Outpatient Clinical (OPC) coverage should be provided on a non-selective basis in accordance with the eligibility criteria established by the employer.

No, co-insurance does not apply to Outpatient Clinical (OPC).

No medical examination is required.

Just complete and submit the following documents:
i. SME Group Health Insurance Proposal Form
ii. Listing of employees or dependants to be insured
iii. Personal Health Declaration form (required for person to be insured who is above 65 years of age)

Yes, an employee’s plan or coverage category may be changed during the policy period due to a promotion or demotion, provided we are notified within 30 days of the change. Any additional premium payable or premium refund will be calculated on a pro-rated basis.

No. Premiums are not guaranteed and may be revised in the future based on our overall underwriting experience for this class of business.

Any change in premium will apply to all policyholders of this product and will take effect from the next policy renewal date. We will provide at least 30 days' prior written notice of any such change.

For Group Hospitalisation and Surgical (GHS), pre-existing conditions are not covered during the first 12 months from the commencement date of continuous coverage or the reinstatement date, whichever is later. After this 12-month period, pre-existing conditions will be covered, subject to the terms and conditions of the policy.
The pre-existing condition exclusion does not apply to Outpatient Clinical (OPC).

Yes. The following waiting periods apply to Group Hospitalisation and Surgical (GHS):

The 30-day waiting period and 120-day waiting period for Specified Illnesses do not apply to Outpatient Clinical (OPC).

Group Hospitalisation and Surgical (GHS) provides overseas coverage under the following circumstances:

• the Insured Person requires emergency hospitalisation while travelling overseas for a purpose other than seeking medical treatment; or
• a Specialist recommends treatment outside Malaysia because the required treatment, expertise or facilities are not available in Malaysia.

Benefits are subject to the terms, conditions, exclusions and limits of the Policy. Transportation costs to the place of treatment are not covered.

No benefits will be payable for any medical treatment received outside Malaysia if the insured person resides or travels outside Malaysia for more than ninety (90) consecutive days.
Outpatient Clinical (OPC) provides coverage is within Malaysia only.

Yes, 1 month supply of medication is allowed for each visit subject to the benefit limit for the following chronic conditions: Arthritis, Asthma, High Blood Pressure, Hypertension, Coronary Artery Disease, Cerebrovascular Disease, Cerebrovascular Accident, Diabetes Mellitus, Epilepsy, Gout, Hyperlipidemia, Parkinson’s disease, Peptic Ulcer, Psoriasis and Thyroid disorders.

No, treatment received at a non-Panel clinic is not covered, except in the event of an emergency.
An emergency refers to condition where:

• treatment is required between 10pm and 8am, or
• immediate medical attention is required within 12 hours for an Injury, Illness or symptoms which are sudden and severe, where failure to receive treatment may result in life-threatening condition or significant deterioration of health.

Benefits are paid based on the selected option:

You can submit the claim by using the following methods:

• By post: Mail the completed claim form(s) with all supporting document(s) to the mailing address listed on the Pre-Authorisation Form.
• Through Insurance Adviser: Submit the completed Pre-Authorisation Form with all supporting document(s) to your Insurance Adviser.
• E-submission via email at myMSIG@my.msig-asia.com: Provide scanned copies of the originals claims documents.

For reimbursement claim, please submit the following documents within 30 days from the date of discharge from the hospital:

1. Duly completed Pre-Authorisation Form Part II by the attending doctor
2. Original itemised invoices, bills & official receipts
3. Copy of Laboratory Test Result, X-Ray, MRI/CT scan, Ultrasound, Histopathology report & etc
4. Referral letter, if applicable

For claims involving outpatient treatment, similar documentation is required, including receipts and medical reports relevant to the treatment.

Once a claim has been made, you’ll receive an email acknowledgement. For any enquiries, you may send via email at myMSIG@my.msig-asia.com

No. A group policy must be issued to a legal entity as the policyholder. As a sole proprietorship is not a separate legal entity from its owner, it does not qualify as a group policyholder under the SME Group Health Insurance.