SME Group Health
Behind every successful SME is a healthy and supported workforce.
Important notice
You should satisfy yourself that this policy will best serve your needs and that the premium payable is an amount you can afford. You should read and understand the insurance policy and discuss with your insurance adviser or contact the insurance company directly for more information.
MSIG Insurance (Malaysia) Bhd is a member of PIDM. The benefit(s) payable under eligible product is protected by PIDM up to limits. Please refer to PIDM's TIPS Brochure or contact MSIG Insurance (Malaysia) Bhd or PIDM (visit www.pidm.gov.my).
Key benefits
Comprehensive Employee Healthcare Protection
- Group Hospitalisation & Surgical (GHS) with optional Outpatient Clinical (OPC) coverage.
- Eligible group size: 200 employees or fewer.
- Eligible age:
Employee / Spouse Entry age : 18-65 years
Renewability : Up to 70 years, subject to a satisfactory health declarationChild 15 days to 18 years or 23 years if still studying full time in an institution of higher learning.
- Outpatient Clinical (OPC) is available only as an add-on to the Group Hospitalisation & Surgical (GHS) Cashless Facility option.
5 Group Hospitalisation & Surgical (GHS) Plans to Choose From
Flexible plan options to suit different business needs and budgets.
Flexible Claims Settlement Options
Choose between Cashless or Reimbursement facility for GHS coverage.
Premium Savings
- Enjoy a 25% premium discount with the Reimbursement Option or a 5% premium discount with the Co-Insurance Option*.
* For Co-Insurance Option, insured has to bear 10% of covered eligible medical expenses incurred per hospitalisation up to max of RM500 per hospitalisation.
Optional Outpatient Clinical (OPC)
- Cashless outpatient consultation and treatment at panel clinics.
- Available only with the GHS Cashless Facility Option.
Cashless Access
Convenient treatment at an extensive network of panel hospitals and panel clinics.
Coverage
Read the product disclosure sheet and general terms and conditions before taking out this insurance. View downloads
- Daily hospital room & board
- Intensive care unit
- Hospital supplies & services
- Operating theatre
- Surgical fees
- Anaesthetist fees
- In-hospital physician visit
- Pre-hospital specialist consultation
- Ambulance fee/medical report fees
- Plastic/Cosmetic surgery
- Dental treatment or oral surgery
- AIDS or AIDS-related complex (ARC)
- Pregnancy or miscarriage
- Suicide or self-inflicted injury while sane or insane
- War and related risks
- Accidental injuries or illnesses arising from racing (except foot racing) or hazardous sports
- Any unlawful or illegal act
- Any communicable diseases requiring quarantine by law
Note: This list is non-exhaustive. Please refer to the sample policy contract for the full list of exclusions under this policy.
Plans
Premium rates below is applicable to the Cashless Facility option only.
Plan 1
Starting from RM578.00 per person
Benefits
Max (RM)
Hospital Room and Board (per day, up to 180 days)
120
Intensive Care Unit (up to 30 days)
As Charged
Hospital Supplies and Services
As Charged
Surgical Fees
As Charged
Anaesthetist Fees
As Charged
Operating Theatre
As Charged
In-Hospital Physician Visit (up to 180 days)
As Charged
Pre-Hospital Diagnosis Test (within 60 days prior to admission)
As Charged
Pre-Hospital Specialist Consultation (within 60 days prior to admission)
As Charged
Post-Hospitalisation Treatment (within 60 days following discharge from hospital)
As Charged
Ambulance Fee (by road only)
As Charged
Daycare Procedure
As Charged
Second Surgical Opinion (within 60 days prior to admission)
As Charged
Emergency Accidental Outpatient Treatment
As Charged
Emergency Accidental Dental Treatment
As Charged
Home Nursing Care (up to 26 weeks following discharge from hospital)
As Charged
Outpatient Cancer Treatment
As Charged
Outpatient Kidney Dialysis Treatment
As Charged
Outpatient Stroke Treatment
As Charged
Outpatient Physiotherapy Treatment
As Charged
Daily Cash Allowance at Malaysian Government Hospitals (per day, up to 180 days)
100
Medical Report Fees
100
Compassionate Allowance
10,000
Overall Annual Limit (per person)
30,000
Plan 2
Starting from RM784.00 per person
Benefits
Max (RM)
Hospital Room and Board (per day, up to 180 days)
150
Intensive Care Unit (up to 30 days)
As Charged
Hospital Supplies and Services
As Charged
Surgical Fees
As Charged
Anaesthetist Fees
As Charged
Operating Theatre
As Charged
In-Hospital Physician Visit (up to 180 days)
As Charged
Pre-Hospital Diagnosis Test (within 60 days prior to admission)
As Charged
Pre-Hospital Specialist Consultation (within 60 days prior to admission)
As Charged
Post-Hospitalisation Treatment (within 60 days following discharge from hospital)
As Charged
Ambulance Fee (by road only)
As Charged
Daycare Procedure
As Charged
Second Surgical Opinion (within 60 days prior to admission)
As Charged
Emergency Accidental Outpatient Treatment
As Charged
Emergency Accidental Dental Treatment
As Charged
Home Nursing Care (up to 26 weeks following discharge from hospital)
As Charged
Outpatient Cancer Treatment
As Charged
Outpatient Kidney Dialysis Treatment
As Charged
Outpatient Stroke Treatment
As Charged
Outpatient Physiotherapy Treatment
As Charged
Daily Cash Allowance at Malaysian Government Hospitals (per day, up to 180 days)
100
Medical Report Fees
100
Compassionate Allowance
10,000
Overall Annual Limit (per person)
50,000
Plan 3
Starting from RM1,067.00 per person
Benefits
Max (RM)
Hospital Room and Board (per day, up to 180 days)
200
Intensive Care Unit (up to 30 days)
As Charged
Hospital Supplies and Services
As Charged
Surgical Fees
As Charged
Anaesthetist Fees
As Charged
Operating Theatre
As Charged
In-Hospital Physician Visit (up to 180 days)
As Charged
Pre-Hospital Diagnosis Test (within 60 days prior to admission)
As Charged
Pre-Hospital Specialist Consultation (within 60 days prior to admission)
As Charged
Post-Hospitalisation Treatment (within 60 days following discharge from hospital)
As Charged
Ambulance Fee (by road only)
As Charged
Daycare Procedure
As Charged
Second Surgical Opinion (within 60 days prior to admission)
As Charged
Emergency Accidental Outpatient Treatment
As Charged
Emergency Accidental Dental Treatment
As Charged
Home Nursing Care (up to 26 weeks following discharge from hospital)
As Charged
Outpatient Cancer Treatment
As Charged
Outpatient Kidney Dialysis Treatment
As Charged
Outpatient Stroke Treatment
As Charged
Outpatient Physiotherapy Treatment
As Charged
Daily Cash Allowance at Malaysian Government Hospitals (per day, up to 180 days)
100
Medical Report Fees
100
Compassionate Allowance
10,000
Overall Annual Limit (per person)
80,000
Plan 4
Starting from RM1,276.00 per person
Benefits
Max (RM)
Hospital Room and Board (per day, up to 180 days)
250
Intensive Care Unit (up to 30 days)
As Charged
Hospital Supplies and Services
As Charged
Surgical Fees
As Charged
Anaesthetist Fees
As Charged
Operating Theatre
As Charged
In-Hospital Physician Visit (up to 180 days)
As Charged
Pre-Hospital Diagnosis Test (within 60 days prior to admission)
As Charged
Pre-Hospital Specialist Consultation (within 60 days prior to admission)
As Charged
Post-Hospitalisation Treatment (within 60 days following discharge from hospital)
As Charged
Ambulance Fee (by road only)
As Charged
Daycare Procedure
As Charged
Second Surgical Opinion (within 60 days prior to admission)
As Charged
Emergency Accidental Outpatient Treatment
As Charged
Emergency Accidental Dental Treatment
As Charged
Home Nursing Care (up to 26 weeks following discharge from hospital)
As Charged
Outpatient Cancer Treatment
As Charged
Outpatient Kidney Dialysis Treatment
As Charged
Outpatient Stroke Treatment
As Charged
Outpatient Physiotherapy Treatment
As Charged
Daily Cash Allowance at Malaysian Government Hospitals (per day, up to 180 days)
150
Medical Report Fees
100
Compassionate Allowance
10,000
Overall Annual Limit (per person)
100,000
Plan 5
Starting from RM1,468.00 per person
Benefits
Max (RM)
Hospital Room and Board (per day, up to 180 days)
350
Intensive Care Unit (up to 30 days)
As Charged
Hospital Supplies and Services
As Charged
Surgical Fees
As Charged
Anaesthetist Fees
As Charged
Operating Theatre
As Charged
In-Hospital Physician Visit (up to 180 days)
As Charged
Pre-Hospital Diagnosis Test (within 60 days prior to admission)
As Charged
Pre-Hospital Specialist Consultation (within 60 days prior to admission)
As Charged
Post-Hospitalisation Treatment (within 60 days following discharge from hospital)
As Charged
Ambulance Fee (by road only)
As Charged
Daycare Procedure
As Charged
Second Surgical Opinion (within 60 days prior to admission)
As Charged
Emergency Accidental Outpatient Treatment
As Charged
Emergency Accidental Dental Treatment
As Charged
Home Nursing Care (up to 26 weeks following discharge from hospital)
As Charged
Outpatient Cancer Treatment
As Charged
Outpatient Kidney Dialysis Treatment
As Charged
Outpatient Stroke Treatment
As Charged
Outpatient Physiotherapy Treatment
As Charged
Daily Cash Allowance at Malaysian Government Hospitals (per day, up to 180 days)
200
Medical Report Fees
100
Compassionate Allowance
10,000
Overall Annual Limit (per person)
150,000
Add-on
Outpatient Clinical (OPC)
| OUTPATIENT CLINICAL (OPC) - OPTIONAL | ||
| Outpatient General Practitioner Care |
Plan 1 (RM) |
Plan 2 (RM) |
| Consultation | Max. 100 per visit | Max. 200 per visit |
| Medication | ||
| Injection | ||
| Diagnostic Services | ||
| Outpatient Surgical Procedure | ||
| Outpatient Annual Limit (per person) | Unlimited | |
| Outpatient Specialist Care | ||
| Consultation | Max. 200 per visit | Max. 400 per visit |
| Medication | ||
| Injection | ||
| Diagnostic Services | ||
| Outpatient Surgical Procedure | ||
| Physiotherapy | ||
| Outpatient Annual Limit (per person) | 1,500 | 2,500 |
Please refer to the SME Group Health Leaflet for the list of OPC exclusions.
Available with
Outpatient Clinical (OPC)
| OUTPATIENT CLINICAL (OPC) - OPTIONAL | ||
| Outpatient General Practitioner Care |
Plan 1 (RM) |
Plan 2 (RM) |
| Consultation | Max. 100 per visit | Max. 200 per visit |
| Medication | ||
| Injection | ||
| Diagnostic Services | ||
| Outpatient Surgical Procedure | ||
| Outpatient Annual Limit (per person) | Unlimited | |
| Outpatient Specialist Care | ||
| Consultation | Max. 200 per visit | Max. 400 per visit |
| Medication | ||
| Injection | ||
| Diagnostic Services | ||
| Outpatient Surgical Procedure | ||
| Physiotherapy | ||
| Outpatient Annual Limit (per person) | 1,500 | 2,500 |
Please refer to the SME Group Health Leaflet for the list of OPC exclusions.
Available with
Frequently asked questions
| Group Hospitalisation and Surgical (GHS) |
: 5 plans available on both cashless facility and reimbursement basis |
| Outpatient Clinical (OPC) |
: 2 plans available on a cashless facility basis |
Yes, premium saving options are applicable to Group Hospitalisation and Surgical (GHS) plan as below:
| Reimbursement option | 25% premium discount |
| Co-insurance option | 5% premium discount, where the insured bears 10% of the covered eligible medical expenses incurred for each hospitalisation, subject to a maximum of RM500 per hospitalisation. |
SME Group Health Insurance is available to companies with 200 employees or below.
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. The following waiting periods apply to Group Hospitalisation and Surgical (GHS):
| 30-day waiting period | : Any disability due to illness (other than injury) and any signs or symptoms of such illness that first appear within 30 days from the commencement date of continuous coverage or the reinstatement date, whichever is later, are not covered. |
| 120-day waiting period for Specified Illnesses | The following disabilities or any related complications that occur within the first 120 days of continuous coverage or from the reinstatement date, whichever is later, are not covered: (a) Hypertension, diabetes mellitus and cardiovascular disease; (b) Growth of any kind including tumours, cancers, cysts, nodules, polyps; (c) Stones of the urinary system and biliary system; (d) Any disease of the ear, nose (including sinuses) or throat; (e) Hernias, haemorrhoids, fistulae, hydrocele or varicocele; (f) Any disease of the reproductive system including endometriosis; (g) Any disorders of the spine (including a slipped disc) or any knee conditions; or (h) Any disease of the autoimmune system. |
The 30-day waiting period and 120-day waiting period for Specified Illnesses do not apply to Outpatient Clinical (OPC).
Downloads
SME Group Health Leaflet (EN)
SME Group Health Proposal Form (EN, BM)
SME Group Health Product Disclosure Sheet (EN)
SME Group Health Optional Cover Product Disclosure Sheet - Outpatient Clinical (EN)
SME Group Health FAQ (EN)
SME Group Health Panel Hospitals List
SME Group Health Panel Clinics List
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