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GROUP HOSPITALISATION AND SURGICAL INSURANCE

GROUP HOSPITALISATION AND SURGICAL INSURANCE

PRODUCT DISCLOSURE SHEET

(Please read this Product Disclosure Sheet before you decide to take up the Group Hospitalisation & Surgical Insurance. Be sure to also read the general terms and conditions.)

What is this product about ?

This policy covers the cost of medical treatment incurred by your employee(s) for hospitalisation due to accident or sickness.

What are the covers / benefits provided ?

This policy offers the following benefits:-

a) Hospital Room & Board
b) Intensive Care Unit
c) Hospital Supplies & Service
d) Surgical Fees
e) Anaesthetic Fees
f) Operating Theatre Fees
g) In Hospital Physician Fees
h) Pre-Hospitalisation Diagnostic Services
i) Pre-Hospitalisation Specialist Fees
j) Follow-up Medical Treatment & Services
l) Emergency Accidental Outpatient Treatment
m) Ambulance Fee
n) Government Hospital Daily Cash Allowance

How much premium do I have to pay?

The premium you have to pay may vary depending on the plan selected, group size of your employees, the ages, health status of your employees and our underwriting requirements.

The minimum premium per policy is USD52.50.

What is the payment mode and how do I pay the premium?

You may pay your premium either by cash, or cheque.

What are some of the key terms and conditions that I should be aware of ?

• Duty of disclosure

  • You must give all the facts which you know or ought to know.
  • You must ensure that the proposal form is completed accurately as it forms the basis of the insurance contract.

• Qualifying / waiting period

Your eligibility for benefits under the policy will only start (30) days after the effective date of the policy except for accidental injury.

• Pre-existing Conditions

These are disabilities that the Insured Person has reasonable knowledge of. A person may be considered to have reasonable knowledge of a pre-existing condition where the condition is one for which:-

a) the Insured Person had received or is receiving treatment;
b) medical advice, diagnosis, care or treatment has been recommended;
c) clear and distinct symptoms are or were evident; or
d) its existence would have been apparent to a reasonable person in the circumstances.

• Specific Illness

These are disabilities and its related complications, occurring within the first 120 days of Insurance.

a) Hypertension, diabetes mellitus and cardiovascular disease.
b) All tumours, cancers, cysts, nodules, polyps, stones of the urinary system and biliary system.
c) All ear, nose (including sinuses) and throat conditions.
d) Hernias, haemorrhoids, fistulae, hydrocele, varicocele.
e) Endometriosis including diseases of the Reproductive system.
f) Vertebro-spinal disorders (including disc) and knee conditions.

• Upgraded Room & Board Co-Payment

If the Insured Person is hospitalized at a published Room & Board rate which is higher than his/her eligible benefit, the Insured Person shall bear 20% of the other eligible benefits described in the Schedule of Benefits.

• Eligibility for cover

a) Full time employees who are below 65 years old.
b) Legal spouse of employee below 65 years old.
c) Unmarried child with age of 30 days or higher but is under age of 19 years or or 23 years if still on full time higher
education at a recognised institution, and who are not gainfully employed

• Claims

You must notify us with full details of the incident/accident within 30 days of occurrence and submit the claim form, medical report, and original itemised bills, receipts and other relevant claims documents.

• Premium Warranty

Premium must be paid and received by us within 30 days from the inception date of the cover, otherwise the cover is automatically cancelled and you will still be responsible to pay the proportion of premium for the period we have been on risk.

What are the major exclusions under this policy?

This policy does not cover unless specifically waived:

  • Pre-Existing Condition / illness.
  • Specific Illnesses are not covered for the first 120 days
  • Waiting Period – any medical or physical conditions arising within the first 30 days
  • Congenital conditions, dental and maternity conditions, AIDS/HIV related conditions
  • Self-inflicted injury or suicide, circumcision of all causes Psychotic, mental or nervous disorders
  • Cosmetic or plastic surgery
  • War, strike, riot, civil commotion
  • Routine medical or physical examination, investigative procedures

Note: This list is not exhaustive. Please refer to the policy contract for the full list of terms and conditions under this policy.

What are the pre-acceptance conditions for this product?

• Favourable past claims experience.
• Insured has never been declined, cancelled or refused coverage previously.

Can I cancel my policy?

You may cancel the policy at any time by giving written notice to us. Upon cancellation, you are entitled to a refund of the premium based on the unexpired period of insurance less 10% administration charge.

Where can I obtain further information?

If you have any enquiries, please contact us at:

Customer Service
Dara Insurance Plc
Canadia Tower, 3rd Floor
No. 315, Corner of Ang Duong St.and Preah Monivong Blvd.,
Sangkat Wat Phnom, Khan Daun Penh, Phnom Penh, Cambodia.

Tel : 023 901353
E-mail : enquiries@darainsurance.com.kh
Website: www.darainsurance.com.kh