_________________________________________________________________________________________________________________________________________________________________________________________________
YOUR BENEFITS
Libyan People's
Bureau (Libyan Embassy)
|
Benefit Summary |
Scholarship Student & Dependant |
|
Outpatient GP Care |
All Clinics Nationwide |
|
Routine Consultation
Medication
Injection
Diagnostic Lab / X-Ray Procedures
Outpatient Surgical Procedures |
Covered |
|
|
|
Outpatient Specialist Care |
Direct Access |
|
Consultation
Medication
Injection
Diagnostic Lab / X-Ray Procedures
Outpatient Surgical Procedures |
Covered |
|
Overall Annual Outpatient Limit |
Unlimited |
|
Dental Care (Pay & Claim Basis) |
Direct Access |
|
Extraction
Scaling
Filling
Polishing |
RM 3,000 per member per annum |
|
Optical Benefit (Pay & Claim Basis) |
RM1,500 per family per annum |
|
Maternity Benefit (Inclusive pre & post natal) |
|
|
Normal Delivery |
RM 7,000 per member per annum |
|
Caesarian |
RM 15,000 per member per annum |
|
Hospital & Surgical Care (max per
disability) |
|
|
In-Hospital Care |
|
|
(a)
Hospital Room & Board (Private/Government) |
|
|
(i) Ordinary Room (up to 120 days) |
300 |
|
(ii) Intensive Care Unit (up to 20 days) |
500 |
|
(b)
Hospital Supplies and Services |
As charged |
|
(c)
Surgical Fees |
As charged |
|
(d)
Anaesthetist Fees |
As charged |
|
(e)
Operating Theatre Fees |
As charged |
|
(f)
In-Hospital Physician’s Fees (up to 120 days) |
As charged |
|
(g)
Malaysian Government Hospital Daily Cash Allowance
(up to 120 days) |
60 |
|
(h)
Hospital Service Tax (On eligible Room & Board
charges paid) |
5% |
|
Ambulatory Care |
|
|
(a)
Pre-Surgical / Medical Diagnostic Services (within
60 days) |
As charged |
|
(b)
Pre-Surgical / Medical Specialist Consultation
(within 60 days) |
As charged |
|
(c)
Second Surgical Opinion |
As charged |
|
(d)
Post-Hospitalization Treatment.(up to 60 days,
following discharge from hospital) |
As charged |
|
(e)
Emergency Out-Patient Accidental Treatment (within
24 hours up to 60 days) |
3,500 |
|
(f)
Accidental Dental Treatment (within 24 hours up to
14 days) |
500 |
|
(g)
Daycare Procedure (Surgical/Medical) (inclusive all
incidental costs, pre-daycare visits up to 60 days
and post-daycare visits up to 60 days) |
As charged |
|
(h)
Ambulance Fees (emergency & non-emergency services) |
250 |
|
(i)
Emergency Out-Patient Treatment (from 10:00pm to
8:00am) |
100 |
|
(j)
Medical Report Fee Reimbursement (applicable for
In-Hospital Care and Ambulatory Care) |
80 |
|
Overall Limit (per annum) |
70,000 |
Note :
1.
The insurance risk is underwritten by ING
Insurance Berhad.
2.
Any medical costs in excess of the benefit
limit provided by your Embassy will be borne by you.
3.
Claims must be submitted to ING Insurance
within 30 days from the date of consultation or service.
4.
Some hospitals do not include meal allowance
under the Room & Board Limit.
5.
Long term medications will only be issued on
a monthly basis
6.
ING does not issue Guarantee Letters for
members who seek treatment at Specialist Unit or Hospital by the
medical officer(MO)
Direct
Access
1.
You have direct access to any registered
Dental Clinic/Specialist centre nationwide.
2.
For dental, pay for treatment and go through
the reimbursement procedure.
3.
For Specialist, please call our Call Center
for LOG issuance.
4.
For Non Panel Specialist, please pay and
claim.
No benefit shall be payable
for any of the following services, products or conditions or
injuries resulting from:-
1. Acne
treatment or cosmetic surgery and treatment (inclusive of
double eyelids, keloids) or treatment of their complications
except as necessitated by accidental injuries.
2. Care
and treatment that is experimental, investigative and not
according to accepted professional standards and care that is
not medically indicated.
3.
Treatment for injuries sustained while committing a crime
or felony, or while under the influence of alcohol,
narcotics, or mind altering substance or injuries
which are self inflicted while sane or insane.
4. Any
treatment for or arising from substance abuse such as
alcohol, narcotics, etc.
5.
Private nursing care engaged by member or services for rest
cure provided by rest/nursing home for purely recuperative
purposes and house calls by doctors for any reason.
6.
Contraceptive medications and devices, sterilization procedures,
treatment for complications, reversal of such procedures and the
work up or treatment of sexual dysfunction or
infertility.
7.
Investigation and treatment relating to pregnancy
including childbirth and all complications arising there from
except for miscarriage due to motor vehicle accident under
Hospital & Surgical coverage, subject to its limitations.
Otherwise Member must have Maternity coverage, subject to its
limitations.
8. Sex
transformation surgery and sex hormone therapy
related to such surgery.
9. Any
circumcision unless medically indicated.
10.
Conditions related to sexually transmitted diseases, AIDS
and AIDS Related Complex or its sequelae.
11.
Alternative therapies e.g. Acupuncture, Chiropractic,
Osteopathy, Reflexology, etc.
12.
Vitamins, Food Supplements, Herbal Cures
and Anti Obesity / Weight Reducing Agents including any
off the counter medications.
13.
Soaps, Shampoos, Vitamin Creams and Vitamin
Ointment.
14.
Psychotic, mental or nervous disorders and behavioral
conditions including any neurosis and their physiological or
psychosomatic manifestations.
15.
Treatment, therapy or surgical operation for congenital or
hereditary diseases, deformities and disabilities and any
medical or surgical complication arising there from e.g.
childhood hernias, clubfoot, VSD, ASD, Thalassemia etc..
16.
Diseases or disabilities of a newborn child contracted
prior to or during birth or within the first 30 days thereafter.
17.
Blood and topical allergy testing.
18.
Routine physical examination, health check-ups or tests
not incident to treatment or diagnosis of a covered disability.
19.
Speech and Occupational therapy when not part of a
rehabilitation program following hospitalization due to trauma,
unless it is a follow-up to an inpatient disability and subject
to its limitations.
20.
Any process solely for the determination of eye refraction
and the correction of the same by radial keratotomy,
orthoptic or visual training or by any other means.
21.
Supply of corrective glasses, or contact lens except
intraocular lens in cataract surgery or eye injury while insured
or any associated material for correction of visual
acuity.
22.
Any dental treatment or surgery except when required due
to an injury sustained in an accident under Hospital & Surgical
coverage, subject to its limitations. Otherwise Member must
have Dental coverage, subject to its limitations.
23. Use or acquisition of all external appliances (e.g.
artificial limbs, hearing aids, aero chambers and equipment for
nebulising, orthopedic pads) and the rental charges of such
devices except during hospital confinement under Hospital &
Surgical coverage, subject to its limitations. Otherwise Member
must have Major Medical coverage, subject to its limitations.
24.
Effects from radiation or contamination by radioactivity from
any source.
25.
War, riot, rebellions, insurrection, civil commotion, explosion
of war weapons, terrorism related activity, nuclear war,
biological and chemical warfare/activities.
26.
Illness or injury sustained during air travel except as a
fare paying passenger on a recognized airline operating on
scheduled air routes and air travel by any chartered aircraft
duly licensed as a recognized air carrier and flown by
professional crews between properly established and maintained
airports
27.
Services of a non-medical nature provided by a hospital
such as television, telephone, fax, radio or similar
facilities. Charges for these services must be paid by the
Member prior to discharge from hospital or daycare centre unless
otherwise specified.
28.
Out-Patient physical therapy or physio therapy is not
covered and cannot be referred at GP level. This service would
only be covered when referred by a Specialist and treatment must
be provided by a registered physiotherapist. Member must have
Hospital & Surgical coverage, subject to its limitations.
29.Outpatient
rehabilitation therapy, chemotherapy, radiation therapy,
immunotherapy, photodynamic therapy, kidney dialysis and
other selected treatment protocols (e.g antiviral / interferon
therapy for hepatitis / multiple sclerosis, Lucrin injections
for endometriosis etc), unless an Insured Person has basic Group
Health Plan coverage, subject to its limitations.
30.
Preventive vaccinations except for the following that are
applicable to eligible children only (subject to Out-Patient
benefit limit, if any): -
|
BCG (booster);
Hepatitis B (infants up to 1 year old);
Triple Antigen & TetrAct Hib (infants up to 1 year old); |
Double Antigen (booster), including Oral Polio;
MMR;
Rubella; |
Please note that the physician is free to provide the above
services to you at your request or on recommendation by the
attending physician (other than the covered services). However,
the cost of these services has to be borne by you. Any claims
for the above services will not be entertained.
In An Emergency
Definition of Emergency: Emergency shall mean treatment needed
in the event whereby immediate medical attention is required
within twelve (12) hours of injury, illness or symptoms which
are sudden and severe failing which the member’s life could be
threatened (e.g. accident and heart attack), or lead to
significant deterioration of health.
1. Seek medical care at the nearest GP Clinic or Accident
and Emergency Unit (A&E) of the nearest Hospital (please note
that direct specialist care is not covered as an emergency).
2. Pay for your treatment and submit your claim to ING
Insurance. Indicate in the Claim Form that it was an emergency
case, the time of visit and reason.
3. If you are
admitted, please call ING Employee Benefits Call Centre at 1
800 88 7818 for a Letter Of Guarantee.
Non-Cashless Specialist (Hospitals)
1.
ING Letter of Guarantee (LOG) will
not be issued to Non-Cashless Specialist / Medical Centers.
However, if any member wishes to seek consultation at Non-
Cashless Specialists / Medical Centers, please pay first and
submit your claim for reimbursement. Claims will be reimbursed
according to the MMA Schedule of Fees and members’ benefit
entitlement.
2.
Please refer to your Embassy / Self
serve at ING@MyService for the latest Non-Cashless Specialist
list.
Claims Submission
1. Complete and sign the ING Member Claim Form which is
available at your respective Embassy.
2. Attach original receipts and itemised bill with the
breakdown of the charges when:-
|
• GP claim exceeds RM50 |
• Pediatric claim exceeds RM80 |
|
• Specialist claim exceeds RM125 |
• Hospital claim exceeds RM500 (Medical
report is also required) |
3. Send the completed claim form (fill in the
diagnosis, date of visit & member details) with attached
documents to your Embassy.
4. Eligible claims with full and complete documents will
be reimbursed within 21 days from the date of receipt of claims
by ING Insurance Berhad.
5. You are advised to keep a copy of all documents sent
to ING Insurance Berhad.
6. Claims must be submitted to ING Insurance Berhad
within 30 days from the date of treatment.
|
*Outpatient Claim Form (green colour) – GP, SP & Dental |
Part A - to be completed by member. |
|
*Inpatient Claim Form (pink colour). |
Part B - to be completed by the attending doctor. |
|
|
|
7. For Claims enquiries, please call 03 2719 7818 ext
8104 (Monday to Friday, 9.00 am to 5.00 pm)
Types of Claims (Reimbursable Basis / Pay and File the Claim)
Reimbursable claims (Emergency Case)
1. Emergency Outpatient Treatment at Hospital Accident &
Emergency Unit.
3.
Outpatient
Government Hospital treatment.
Reimbursable claims (Non Panel Clinics)
1. No panel clinics within 5 km of your location.
2. Panel clinic closed down.
3. Waiting for new ING Member ID Card / Loss of ING
Member ID Card.
4. Emergency claim
Claims which are not payable
1. Submission of claims from panel or non panel clinics
without reason given.
2. Non covered items or excluded services, treatments and
medication.
3. Claim from non-panel Clinics.
Loss / Faulty of ING Member ID Card
1. Report your loss / faulty card to your Embassy
immediately. Your Panel GP claims will not be reimbursed if you
do not report your loss.
2. There will be a RM10 replacement fee except when a
reported loss is accompanied with a police report or you have a
faulty card (cannot be read by EDC Terminal).
3. If you need medical care and you have not yet received
your replacement card, please pay first and submit your claim.
Care of ING Member ID Card
To avoid distortion to the data on your ING Member ID Card,
please DO NOT
1.
Place it directly with any
object with magnetic field, such as hand phone, PDA, laptop,
speaker system, white board magnet, etc.
2.
Expose it to high temperature
for a long period, like under the sun or leaving it in your car.
3.
Bend it.
4.
Staple or clip it.
