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HomeSocial NewsGreat Eastern: COVID-19 Private Hospitalisation Assistance Programme

Great Eastern: COVID-19 Private Hospitalisation Assistance Programme

Hospitalisation Assistance Benefit

Great Eastern Life will provide reimbursement on goodwill basis for hospitalisation claims due to COVID-19 during the Coverage Period, of which the eligible life assured has received active treatment as Category 3, 4 or 5 COVID-19 patient at a Ministry of Health (MOH) designated private hospital in Malaysia.

Reference can be made to current Ministry of Health guidance to understand the clinical management of confirmed COVID-19 patients.

The reimbursement is per individual basis and each eligible life assured is entitled to only one (1) claim subject to the following limits:

  • i. Up to RM5,000 for Category 3 COVID-19 patient, or
  • ii. Up to RM15,000 for Category 4 COVID-19 patient, or 
  • iii. Up to RM25,000 for Category 5 COVID-19 patient.

Subject to a total claims limit of RM1 million.

Eligibility

This Programme is complimentary to all life assured of Great Eastern Life who are registered e-Connect users and have any in-force primary medical plan(s) with exclusion on communicable disease requiring quarantine by law (except for compulsory Group Employee Benefits).

Coverage Period

Hospital admission date from 27 March 2021 to 30 September 2021, both dates inclusive, or upon reaching maximum claims limit of RM1 million, whichever is earlier.

Terms and conditions

1.   A waiting period of 30 days applies from the risk commencement date of new business policies or reinstatement date, whichever is later of the policy.

2.   Great Eastern Life will assess the reimbursement claim based on Medically Necessary and Reasonable and Customary Charges, as explained below.

–  “Medically Necessary” means a medical service which is:-

(a)   consistent with the diagnosis and customary medical treatment for COVID-19, and

(b)   in accordance with standards of good medical practice, consistent with current standard of professional medical care, and of proven medical benefits, and

(c)    not for the convenience of the eligible life assured or the doctor, physician or surgeon, and unable to be reasonably rendered out of hospital (if admitted as an Inpatient), and

(d)   not of an experimental, investigational or research nature, preventive or screening nature, and

(e)   for which the charges are fair, reasonable and customary for COVID-19.

–  “Reasonable and Customary Charges” means Medically Necessary charges for medical care which is considered reasonable and usual to the extent that it does not exceed the general level of charges being made by others of similar standing in the locality where the charge is incurred, when furnishing like or comparable treatment, services or supplies to individual of the same sex and of comparable age for a similar illness, sickness, disease or injury and in accordance with accepted medical standards and practice which could not have been omitted without adversely affecting the eligible life assured’s medical condition.

3.   The policies that resulted in the eligibility of this coverage must be in-force upon diagnosis, during the treatment due to COVID-19 and upon claims submission.

4.   The maximum amount that can be paid for the same person covered under this Programme is the amount based on the highest Category (3/4/5) that this person is diagnosed. For example, if an eligible life assured’s condition at admission is diagnosed as Category 4 COVID-19 patient and subsequently progressed as Category 5 COVID-19 patient, he/she can claim for Category 5 benefit in which he/she can reimburse up to RM25,000.

5.   Only one claim can be made per life from Great Eastern Life Assurance (Malaysia), Great Eastern General Insurance (Malaysia) or Great Eastern Takaful Berhad.

6.   The RM1 million fund is a combined limit for Great Eastern Life Assurance (Malaysia), Great Eastern General Insurance (Malaysia) and Great Eastern Takaful Berhad.

7.   The company reserves the right to change and/or terminate the Programme earlier, should the prevailing conditions and circumstances change.

For more information, visit www.greateasternlife.com.

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