• GS 2072 Livin' Pay Scheme
• GS 2415 Dana Restu Scheme
• Mui Diamond Accident Protector Scheme
• NUTP Health Care Scheme

CHILDREN'S PARTICIPATION IN LIVIN' PAY SCHEME

PLEASE READ THROUGH ALL THE EXCLUSIONS UNDER THIS SCHEME INCLUDING EXCLUSIONS ON CRITICAL ILLNESSES

1. First, notify the Company by telephone, fax or personally to any of our Branch Offices or Customer Service Centre.

2. Next, complete and submit all the required documents to our company. The Requirements List details all the general formal requirements that the Claims Department will require to process a death claim.

Post Mortem Report (also known as Autopsy) is not required if: Policy does not have an accidental benefit cover. Cause of death is clearly due to an accidental.
Accidental Death Benefits Claim form (ADB) is to be submitted only when there are accidental benefits attached to the policy. If ADB form certifies intoxication, a Toxicology Report is required.

1. Inform Company immediately or as soon as it is practicable after being diagnosed or has suffered any one of the condition, illness or event covered. We will then issue the relevant claim forms and it is important that the correct condition or illness suffered is being claimed for.

2. Submit all the required documents to Company and ensure all the necessary documents are submitted at the same time.

• Living Assurance Claim form - Personal Statement
• Relevant Confidential Medical Certificate
• Letter of Authorisation / Consent (3 copies)
• Original Policy (if applicable, for endorsement)
• Police Report (if any, for accidental causes)
• Medical Test, Report, Results, MRI, CTScan, X-Ray, ECG reading etc.

The claim made must be resulted directly from an accident defined as :- injuries effected solely through external, violent and accidental means of which there is evidence of a visible contusion or wound on the exterior of the body.

Forms of disabilities claims under Comprehensive Accident Benefits (CAB) coverage such as (i) Temporary Total & Continuous, (ii) Continuous Partial and (iii) Permanent, Total and Continuous disablement claims.

The claim must be resulted directly from an accident. An accident is defined as an accidental loss to the Insured caused solely directly by accidental, violent, external and visible means and independently of all other causes.

Forms of disabilities claim under Comprehensive Personal Accident (CPA) coverage such as
(i) Temporary Total Disablement and
(ii) Temporary Partial Disablement.

• Hospitalization & Surgical Claim Form - Claimant's Statement
• Hospitalization & Surgical Claim Form - Attending Physician Statement
• Original Hospital Bill / Hospital Invoice
• Original Cash Receipt / Payment Receipt / Deposit Receipt
  

The Hospitalization Fee is paid on a daily basic of the amount of benefits purchased under the cover but the Surgical fee is paid on reimbursement basic. Subject to admission of liability, this benefits will be payable after discharge from hospital.

This means that as long satisfactory proof of hospitalization is established in the claim certification / form; the amount of benefits for hospitalization will be paid according to the rate stated in the policy contract. Whereas the surgical benefits will be paid on production of original bill & receipt that the insured had incurred the expenses concerned.

DEATH CLAIM

Q1 : If the deceased is a Muslim and the nominee is a non-Muslim, whom do you pay to?
A1 : We will pay to the nominee as Executor/ Executrix under Insurance Act 1996, Section 167.

Q2 : Nominee is an uncle and deceased was single at inception. When he died, he was married. Can it be paid to the wife?  
A2 : We will pay to the nominee i.e. uncle who will receive as an Executor under Insurance Act 1996, Section 167 who is supposed to distribute the proceeds according to the Distribution Act.

Q3 : If there are 2 assignments at death, which one is the priority?
A3 : The first one according to Insurance Act 1996, section 168.

Q4 : When does interest start to vest for Death Claim? From notification or upon submission of claim papers?
A4 : From notification (60 days after that) regardless of claim papers.

Q5 : For Muslim deceased with no nomination, do you have to wait for Letter of Administration if he / she has more than 1 wives?
A5 : No, we will pay to the wives in equal share according to Insurance Act 1996, Section 169.

LIVING ASSURANCE CLAIM

Q6 : How many types of critical illness are covered under Living Assurance?
A6 : There are 36 critical illnesses covered under Living Assurance.

Q7 : What are the common types and definitions of illnesses on which claims have been made before?
A7 : Cancer - means the uncontrolled growth and spread of malignant cells and invasion of tissue as evidenced by definite histology and includes leukaemia (excluding chronic lymphocytic leukeamia), lymphoma and Hodgkin's disease but excludes non-invasive carcinoma-in-situ and all skin cancers except malignant melanomas. All cancers are excluded if the Life Assured is HIV-positive.

Heart Attack - means diagnosis of the death of a portion of the heart muscle as a result of inadequate blood supply to the relevant as evidenced by symptoms of typical chest pain, new electrocardiograph changes characteristic of myocardial infarction and by elevated levels of cardiac enzymes.

Coronary Artery By-Pass Surgery - means the actual undergoing of coronary artery by-pass surgery to correct stenosis or occlusion in the coronary arteries but excluding non-surgical techniques such as angioplasty, laser treatment or other non-surgical procedures.
 
Q8 : Is there any waiting period?  
A8 : Yes, the waiting period is 60 days either from the date of risk commencement or date of reinstatement whichever is later.
 
TOTAL & PERMANENT DISABILITY CLAIM (TPD)

Q9 : Is the payment made in full?
A9 : TPD pays according to the terms and conditions of the policy. The older TPD series pays in 10 equal yearly installment, while the 2nd series pays in three installments (10%, 10%, 80%). The latest TPD series pays in one lump sum.
 
Q10 : When do you call for the original policy?
A10 : Original policy must be returned to the Company during the last installment / settlement of the payment.
 
Q11 : What happens if the Assured dies before receiving all the TPD installment payment?
A11 : The balance will be paid in full to the claimant / nominee according to the Insurance Act 1996.
 
Q12 : If my policy matures on the same date of my 4th installment, do I have to wait till 10th year to get full TPD payment?  
A12 : No, you will get your 4th - 10th installments on the maturity of the policy.

Q13 : If it's a third party policy, to whom should the payment made?  
A13 : If the Life Assured becomes TPD, the Assured is the legal policy owner and has the right to receive the payment.

Q14 : What is AETPD?
A14 : AETPD stands for Accelerated Extended Total & Permanent Disability. It's a continuity of TPD payment after the completion of TPD payment under the basic policy (10%, 10%, 80%). It starts on the 4th year on continuity of the disability and shall increase at 5% simple rate every year until prior to the Assured attaining the age of 65. The 1st installment is 10% of the sum assured. If death occurred during the payment of AETPD, nothing is payable.

Q15 : What is ETPD?
A15 : ETPD stands for Extended Total & Permanent Disability. It's the same concept as AETPD but it links to the policy which has TPD payment at 10%x10. The first installment starts on the 11th year. If death occurs during the payment of ETPD, nothing is payable.

ACCIDENT CLAIM

Q16 : What is the maximum claim under Comprehensive Accident Benefit (CAB)?  
A16 : Up to 52 weeks or 364 days - combination of both Total & Temporary Disablement and Total & Partial Disablement.

Q17 : What is the breakdown of the Comprehensive Accident Benefit Claim?  
A17 : A1 - Total & Temporary Disablement; Total & Partial Disablement

Q18 : What is the breakdown of the Supreme Accident Care Benefit?
A18 : A100 - Total & Temporary Disablement
      A101 - Total & Partial Disablement
      A101 - Medical expenses

HOSPITALISATION & SURGICAL BENEFIT CLAIM

Q19 : What is the maximum claim under Surgical Benefit?
A19 : Up to 30 times of your daily rate of compensation and on "reimbursement basic".

Q20 : What is the meaning of "reimbursement basic"?
A20 : It means you will be reimbursed for the expenses incurred upon presentation of original hospital bill and payment receipts. E.g. If your employer has fully settled your Hospital Bill or the bill is settled by another Insurance Company, you are not entitled to any reimbursement.

Q21 : What is the maximum claim under surgical benefit?
A21 : The operating theatre, surgeon (operation) and anaethetist fee.

Q22 : How do I make a claim for Surgical Benefit claim?
A22 : You are required to submit the original hospital bill, original deposit and original payment receipt in addition to the claim form.
 
Q23 : How do I claim for Surgical Benefit if I have submitted the original hospital bill and receipt to another Insurance Company?  
A23 : You are required to submit the claim assessment / offer letter from that Insurance Company together with the certified true copy of hospital bill and receipt. We will pay the difference, if any, provided the other Insurance Company has only paid part of your bill under your Surgical Benefit claim with them.

S1 : What if a member retired at age 55 or earlier, how is the premium payment?
JI : The retired member must continue his membership as "Associate Member" and he must pay his premium directly to KPPK, Semenanjung Malaysia.

S2 : Can spouse of a member whom is younger continue participate in this scheme when the retired member reachage of 65?
J2 : Can. They can still continue particpate this scheme until reach at age 65 but the premium payment must go through KPPK/ NUTP.

S3 : If the applicant also own other policies, is that DANA RESTU policy will pay full amount of claim?
J3 : Yes. This policy will pay full amount of insurance claim although the applicant has already owned other policies.

S4 : If I have claimed for hospital admission from other policy or company, do I still eligible for making claim from this insurance?
J4 : Yes, you are eligible to claim Daily Cash Benefit for staying overnight in the hospital for every night. Besides, you are eligible to claim any difference on Reimbursement of Medical Fees from the earlier claim from other company or policies.

• Children CAN particpate this scheme although statutory spouse for insured member is not participate this scheme
• If fail to comply the above conditions, no benefits will be paid to any claim for the insured children and the assurance of the children will be terminated immediately with all the accepted premium return (if have).
• During the Special promotion, every individual who insured more than RM 44 is subject to the underwriten.

PLEASE READ THROUGH ALL THE EXCLUSIONS UNDER THIS SCHEME INCLUDING EXCLUSIONS ON CRITICAL ILLNESSES

• No Critical Illness Benefit is payable for any claim arising from any disclosed or undisclosed pre-existing critical illness.
• Critical Illness Benefits start from the following date, whichever is earlier :
  (i) 60 days after the receipt of your proposal form by Great Eastern fully, and
  (ii) First date of your salary deduction for insurance premium
• If your child age at joining date has reached age 1, total claim for Critical Illness / Death is 20%, 40%, 60%, 80% and 100% from the total insurance in the first until fifth year of policy.
  
• If your child age at joining date has reached age 2, total claim for Critical Illness / Death is 40%, 60%, 80% and 100% from the total insurance in the first until fourth year of policy.
  
• If your child age at joining date has reached age between 3 to 5, Death Benefit in the first 2 year of assurance is only 50% of total death insurance will be paid for the declared pre-existing illness.
• If your child age at joining date has reached age between 6 to 23, Death / Total Permanent Disability Benefit in the first 2 year of assurance is only 50% of total death / total permanent diability insurance will be paid for the declared pre-existing illness.
• Total Permanent Disability Benefit only covers children of age 6 and above.
• Joining of children is compulsory for the youngest child and children above.

S1 : I have already been a member. Can I upgrade to 2 unit or get my spouse or children involved?
JI : Can. Our system will make sure your salary (premium) is not deducted twice.

S2 : I am not sure whether I have upgraded to 2 unit. When I apply for upgrade again, will my slary be deducted twice?
J2 : No, The maximum participation is only two. Our computer system will make sure every members' salary are not deducted twice.

S3 : Will I receive a new certificate?
J3 : Yes. Every time you upgrade or get your family involved, a new certificate will be issued by us. ALL THE CERTIFICATE WILL BE SENT TO KPPK BRANCHES AND THEN SEND TO YOUR HOUSE ADDRESS.

S4 : Children's premium will be increased when they are beyond age 12 or 18. Do I need to report to company every time when my chldren ae beyond 12 or 18?
J4 : No need. Our computer system automatically will add the premium on your children every time idf they beyond the mentioned age.

S5 : I am not yet accept my certificatel although company already has sent it. Does it mean I am not insured?
J5 : Our computer system will show the date when your certificate is printed out, and also your certificate number before sending out to you. Please confirm your house address or school address is correct by give us or KPPK a call.

S6 : When I has passed away, can my family still continue?
J6 : No. Family only can be insured ONLY WHEN member is still insured.

S7 : When I stop to be a teacher or participate in other profession which is not related with education, what happens to my policy?
J7 : You can still be insured (together with your family) only if you continue your membership as "ASSOCIATE MEMBER" in KPPK Union.

S8 : Does it mean I can still be a KPPK member although I have left teaching profession?
J8 : Yes, you still can be a KPPK member. However, your membership will be changed to "ASSOCIATE MEMBER". If you have any question, please contact KPPK and they will assist you.

S9 : If I have left teaching profession and become an "ASSOCIATE MEMBER", how is my premiun will I pay to?
J9 : If you have left teaching profession, no salary deduction will be carried out through BPA. Therefore, you have to pay through KPPK Union. Besides, you need to pay your premium every year (12 months) and not every month.

S10 : What happens if I retired?
S10 : If you retired, you still can participate this scheme. However, your premium need to be paid through KPPK Union.

S11 : Besides the offered insurance schemes, I still have other two insurans policy (accident and death) from othe company. What happens when I make claim?
J11 : We will fully pay the claim to you if you pass away.

S12 : Can my spouse insures 2 units while I only 1 unit?
J12 : No. Your spouse or children cannot be insured more then yours.

S1 : What can I do after I involved in an accident?
J1 : Report to KPPK or our company immediately. We will send you the "Claim Form".

S2 : Is all the claim will be paid?
J2 : We wil pay all the accident claims only, with the condition you must be hospitalised.

S3 : Who will responsible to take charge of my claims?
J3 : You need to fill out "Claim Form" (can be obtained through KPPK or us) and give all the detailed information. Then you need to get :-
i) Ppolice report
ii) Medical report about your suffred injury
iii) Death Certificate (if death happens)

After that, KPPK will assist you to send all the required document to us and manage the claim matters until you get all the claims from our company. If you have any question, please ask for the help from KPPK or us.

S4 : If I was hospitalised to government hospital, can I make any claim?
J4 : Can. You can claim RM 100.00 for each night you stay overnight in the hospital until RM 3000.00 (max) for 1 unit and RM5000.00 (max) for 2 units.

S : Who is eligible to apply Benefit Plan?
J : You can apply if your age is between 15 days to 60 years old on the next birthday (at the starting of hospitalisation), However, this plan can be renewed until you reach at age 65 on the next birthday.

S : Do I need to do medical check-up?
J : Basically, all the underwritten proposal forms do not need medical check-up. However, for whom having healthy problem, other medical proofs may be required and its fees shall be responsible by proposer.

S : When is the commencement of my policy?
J : Upon the acceptance of your application and the first year premium is accepted by company. It is also depends on 30 days waiting period for hospitalisation and / or medical fees which is not caused by accident.

S : In what situation the assurance is cancelled?
J : On the matured date of policy when your age is 65 on the next birthday, or when whole the claimed benefits have reached the maximum limit for each disability since the Risk Commencement Date.

S : What is Emergency Assistance Service?
J : A special aggreement has been made to provide Emergency Assistance Service to policy holder. This includes services of 24 hours medical consultation through phone, doctor and hospital consultation through phone, emergency evacuation service and supervised repatriation inside or outside Malaysia.

S: Can I renew my policy at the end of one year?
J : Group hospitalisation and surgery benefits insurance can be renewed each year at the premium rate subject to the age, until the matured date of policy when you reach 65 on the next birthday. The benefits can be renewed and depends on the maximum assurance limit and the adopted premium rate at that time and also the acceptance of "can insure" proofs.

S : Can I pay by cash?
J : Can. But all the time you have to pay like this method.

S : Can spouse (non-KPPK member) whom is younger continue to participate in this scheme when the retired member is going to reach 65 on the next birthday?
J : No.

S : If family plan is chosen, is that premium is subjected to age of member?
J : Premium is subjected to the elder age bewteen member and spouse.

S : Can I be admmitted to other hospital which is not stated in the panel hospital list of the poilicy?
J : Can. But you need to fill out hospital reimbursement fees claim form after discharging from the hospital.