Who is the Policy Owner?
The Policy Owner is the person who has the legal title to a policy.
Can new riders/benefits be attached to my policy after it is issued?
Inclusion of riders will depend on the plan type of the basic policy, the policy duration and the availability of riders at the time of application. Supplementary benefits [e.g. Accident and Hospital benefits] can be included any time after the policy is issued. Applications for inclusion of riders/supplementary benefits are subject to underwriting and a policy fee of RM30.00 will be levied for inclusion of riders. Our underwriters may call for medical report if medical evidence is required. Medical costs, if incurred, will be borne by the policyholder.
Q: What are the services provided by HSD for customers with Hospitalization & Surgical policy?
A: HSD provides round-the-clock (24 hours and 7 days/week) Guarantee Letter facility for eligible customers requiring hospitalization and or/surgery, processes reimbursement of medical claims and handles enquiries related to medical policy.
Q: How do I contact HSD?
A: You can call the Healthcare Hotline number at 1-300-1300-18 or sent an email through e-Partner (ICM) or to healthcareservices@greateasternlife.com for assistance.
Q: How does customer use the Health Care Card for hospital admission?
A: Upon admission to the Panel Hospital, customer can present their Health Care Card and NRIC to the hospital’s admission counter for Guarantee Letter arrangement.
Q: How long before customer’s admission that they must inform HSD?
A: To provide sufficient time for HSD to process the Guarantee Letter for admission, it is recommended for customer to request their attending doctor to complete Part II, which is the Admission Section of the Guarantee Letter Request Form and send the completed form to HSD as soon as possible.
Q: What is the process for Guarantee Letter arrangement?
A: Hospital will assist to process the necessary documentation for Guarantee Letter request and send it to HSD for validation. Once it is confirmed that customer’s hospitalization fulfills the policy’s terms and conditions, Initial Guarantee Letter (IGL) will be issued and sent to the hospital for their handling.
If customer’s Guarantee Letter request is not approved, the Decline Guarantee Letter (DGL) will be sent to the hospital. Hospital will advise customer to pay for their medical expenses and submit the claim to GELM for reimbursement consideration.
An SMS will be sent to the servicing agent (if mobile number is registered with CAD) and customer (if customer provides their mobile number in the GL Form) to notify them of the Guarantee Letter status.
Q: How long is the Guarantee Letter valid for after it has been approved?
A: The Guarantee Letter is valid for 30 days from the date of issuance.
Q: In what circumstances/condition that Guarantee Letter will be declined?
A: The decision to decline Guarantee Letter may due to the following reasons below but it is not an exhaustive list:
Note: You may contact the Healthcare Hotline for more specific information on the decline reason.
Q: Will the hospital accept the Health Care Card as a guarantee for admission deposit?
A: No, the Health Care Card is meant for the Panel Hospital to identify customer with GELM medical policy and cannot be used as a guarantee for hospital deposit.
Q: If Guarantee Letter has been approved, does customer still need to pay any admission deposit?
A: Yes, most hospitals will request for deposit payment as part of the admission requirement. However, the deposit payment will be refunded by the hospital after deducting the non-covered charges such as coinsurance/deductible, telecommunication fee, extra meals, miscellaneous expenses, service tax, braces, special aids etc (if any).
Q: Can the customer still enjoy the room and board discount rate if Guarantee Letter was declined?
A: No, hospital discount is not a policy entitlement so customer has to pay the published rate as advised by the hospital.
Q: How long does customer need to wait at the hospital after the doctor has certified that they are fit for discharge?
A: Normally, the attending doctor has to complete the medical report (Discharged Section) before hospital billing staff can prepare the hospitalisation bills. The whole process takes about a few hours subject to the hospital’s available resources.
Q: How long does HSD take to process the Discharge/Final Guarantee Letter (FGL)?
A: Upon receiving the complete document from the hospital, HSD will process the FGL within 75 minutes for straightforward cases. However, if the documentation or information received is incomplete, it may take longer or until the necessary documentation has been received to process the FGL.
Q: Where can customer get the list of Panel Hospitals or Specialist?
A: The list of panel hospitals and specialist is available in e-Partner under HSD or GELM website at www.greateasternlife.com.my. Please note that list of panel hospitals and specialist is subject to change and the latest listing can be viewed at both e-Partner and the website.
Q: Why not all specialists in the Panel Hospitals are GELM’s panel specialist?
A: There are some specialists (doctors) within the appointed panel hospitals who are not included in the list of panel specialists for various reasons. Therefore, Guarantee Letter facility is not available for any admission or treatment by non-panel specialist.
Q: What if customer was admitted to a non-panel hospital or specialist, can they still submit their claim?
A:Yes, customers who choose to be treated at a non-panel hospital or specialist can settle their medical expenses and submit their claim for reimbursement consideration according to the policy’s terms and conditions.
Q: Can customer use their Health Care Card for hospital admission overseas?
A:No. The Health Care Card is only applicable to GELM Panel Hospitals in Malaysia. Customer has to pay the medical expenses and submit their claim for reimbursement consideration according to policy’s terms and conditions after they return from overseas.
Q: What are the documents required for reimbursement of claims?
A:The documents required are as follow:
Note: Please refer to the requirement listed in the Health Claims Checklist for other type of claims
Q: Where can I get the required forms?
A:You can obtain the forms from company’s website, e-Partner or Agent’s Counter at Menara Great Eastern or branches.
Q: Where can I submit the claims document?
A: You can submit the documents through the Health Claims Drop-box at Level 1 of Menara Great Eastern or Agent’s Counter at branches.
Q: Can I submit photocopy of hospital bill or receipt in case my customer is unable to provide or lost these documents?
A: Photocopy of hospital bill and receipt is not acceptable as it is part of the policy’s requirement to submit the original hospital bill and receipt for reimbursement of medical claim.
Q: If my customer has submitted their claim to another insurance company, can they also claim from GELM?
A: Once the medical claim has been reimbursed by another insurance company, GELM will not compensate the claim again unless the medical expenses are not fully covered by the other insurance company. Then customer can submit the uncovered amount to GELM for consideration according to their policy’s Schedule of Benefits, terms and conditions.
Q: For reimbursement of pre and/or post-hospitalization claim where Guarantee Letter has been issued to cover customer’s hospitalization, what are the documents I need to submit?
A: The documents required are:
Q: How does customer or agent know if the document submitted is incomplete?
A: If the claims document is incomplete, HSD will notify customer through pending requirement letter which is sent by mail. A copy of this letter will be published in the e-Partner for servicing agent and Group Sales Manager’s reference.
Q: What is Reasonable & Customary charges?
A: Reasonable and Customary charges means 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. All medical claims are reimbursed up to the Reasonable and Customary charges, including overseas treatments. Excess shall be borne by the Policyholder.
Q: What if my customer is not happy with their claim settlement/decision?
A: Normally, claim assessment is based on whether the claim fulfills the policy’s contractual benefits and if it is admissible, then the settlement is based on the Schedule of Benefits including the relevant terms of the benefits. If there is any dispute, the customer may submit a letter of appeal and supporting document(if any) to the Healthcare Services Department for reconsideration.
Q: How long does it take for the Company to process a claim?
A: The estimated timeframe to process a claim is within 10 - 14 working days upon receiving the complete claim documents.
| Summary of Coverage | Reimbursement of the Reasonable and Customary Charges incurred for Medically Necessary treatments received when the life assured is hospitalised due to COVID-19 during the Coverage Period. The reimbursement will be provided based on the limits, terms and conditions* stated in the policy documents of the eligible medical plan. *Except for the general exclusion in the medical policies referring to communicable disease requiring quarantine by law where COVID-19 coverage is excluded. |
| Eligibility | This Programme is complimentary to existing and new life assured of Great Eastern Life who have any individual medical plan(s)/ rider(s) with exclusion on communicable disease requiring quarantine by law. |
| Coverage Period | Hospital admission date from 18 August 2021 until 31 December 2023, or the amount of the RM20 million fund set aside for this Programme is fully exhausted, whichever comes first. |
Terms and conditions |
1. A waiting period of 30 days applies from the risk commencement date/ risk effective date of the medical plan/ rider, or reinstatement date of the policy, whichever is later. 2. The policies that result in the eligibility of this coverage must be in-force upon diagnosis, during the treatment due to COVID-19 and upon claims submission. 3. 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 a covered Disability, 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 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 the Disability. 4. The RM20 million is a combined limit for Great Eastern Life Assurance (Malaysia) Berhad, Great Eastern General Insurance (Malaysia) Berhad and Great Eastern Takaful Berhad. 5. The claim must be submitted no later than 31 January 2024. 6. The Company reserves the right to change and/or terminate the Programme earlier, should the prevailing conditions and circumstances change such as when COVID-19 is no longer required to be quarantined by law. |
Q: What is COVID-19 Medical Plan Coverage Programme?
A: COVID-19 Medical Plan Coverage Programme (“Programme”) is a special programme set up by Great Eastern to provide RM20 million* goodwill medical plan coverage on COVID-19 for all life assured of Great Eastern Life who own any of the eligible medical plans.
*The RM20 million is a combined limit for Great Eastern Life Assurance (Malaysia) Berhad, Great Eastern General Insurance (Malaysia) Berhad and Great Eastern Takaful Berhad.
Q: Who is eligible for this Programme?
A: This Programme is applicable to existing and new life assured of Great Eastern Life who have any individual medical plan(s)/ rider(s) with exclusion on communicable disease requiring quarantine by law.
Q: What are the benefits covered under this Programme?
A: Great Eastern Life will provide reimbursement for medical expenses resulting from medically necessary hospitalisation treatment due to COVID-19 infection, in accordance with the respective medical plan’s benefits, terms and conditions* stated in the policy documents.
*Except for the general exclusion in the medical policies referring to communicable disease requiring quarantine by law where COVID-19 coverage is excluded. With this Programme, the eligible medical plans do not exclude COVID-19 coverage during the validity period of this Programme.
Q: What is the coverage period of this Programme?
A: The period covered under this Programme is based on hospital admission date from 18 August 2021 until 31 December 2023, or the amount of the RM20 million fund set aside for this Programme is fully exhausted, whichever comes first.
Q: What are other terms and conditions of this Programme?
A:
Q: Is there any cost (i.e. additional premium/ insurance charge) that the life assured has to pay for this Programme?
A: No, there is no additional premium/ insurance charge that the life assured has to pay for the complimentary protection under this Programme. This Programme is provided by Great Eastern on goodwill basis.
Q: Will a claim under this Programme reduce the Overall Annual limit and Overall Lifetime Limit under the life assured’s medical plan?
A: No, any claim from this Programme will NOT reduce the Overall Annual Limit and Overall Lifetime Limit of the life assured’s medical plan.
Q: Will a claim under this Programme impact the SmartMedic Xtra/ SmartMedic “Increase to Initial Overall Annual Limit” benefit, where the Overall Annual Limit will be increased by 10% at the end of every 3rd policy year provided there is no claim?
A: No, the medical claim under this Programme will not be counted as a normal claim pursuant to the terms of the policy contract. Hence, it will not affect the “Increase to Initial Overall Annual Limit” benefit.
Meaning to say if there is a claim under this Programme within any 3 consecutive policy years, the life assured will still be entitled to this “Increase to the Initial Overall Annual Limit” benefit as any claim from this Programme will NOT be counted as a claim under the medical policy.
Q: Will the COVID-19 claims cost from this Programme impact future repricing of the eligible medical plans?
A: No, the total COVID-19 claims paid from this Programme will be on goodwill basis by Great Eastern. Hence, the cost will not be considered as part of the adverse claim experience contributing to future repricing of medical plans.
Q: Can the life assured claim under this Programme if he/she is a Category 1 or 2 COVID-19 patient but was recommended by his/her doctor to be hospitalised?
A: In general, for a COVID-19 patient with no symptoms (Category 1 - asymptomatic) or who does not require active treatment i.e. in quarantine only (Category 1 - asymptomatic or Category 2 - symptomatic, no pneumonia), any services received during such hospitalisation including quarantine at quarantine centres, quarantine at hospitals or home quarantine would not be deemed as Medically Necessary. Hence, the expenses incurred will not be reimbursed under this Programme, unless there is evidence showing the hospitalisation and treatment received are Medically Necessary and active treatment is required for the patient during the hospitalisation.
Q: Are all COVID-19 claims under Category 3, 4 or 5 deemed as Medically Necessary?
A: Yes, all COVID-19 patients receiving active treatment in a hospital as a Category 3, 4 or 5 patient would be deemed as Medically Necessary.
Q: What is considered as Medically Necessary for COVID-19 hospitalisation?
A: When the life assured receives among others, active treatments such ventilation support, oxygen supports, intubation or intravenous medication during hospitalisation due to positive diagnosis.
“Medically Necessary” means a medical service which is:-
(a) consistent with the diagnosis and customary medical treatment for a covered Disability, 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 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 the Disability.
Q: If the life assured has made a claim from the Financial Assistance Programme/ COVID-19 Vaccine Fund/ COVID-19 Private Hospitalisation Assistance Programme, is he/she still eligible for this Programme?
A: Yes, the life assured is still eligible for this Programme as long as he/she fulfils the eligibility criteria for this Programme.
Q: Is the earlier announced COVID-19 Private Hospitalisation Assistance Programme still applicable?
A: With the launch of this Programme, the earlier COVID-19 Private Hospitalisation Assistance Programme, will no longer be applicable for Great Eastern Life effective 18 August 2021 (based on hospital admission date) as eligible customers will be covered under this new Programme.
Kindly submit any earlier claim(s) for this COVID-19 Private Hospitalisation Assistance Programme no later than 3 months from the diagnosis date and claim(s) reimbursement is subject to fund availability.
Nonetheless, the Daily-Cash Allowance and Pre-Hospitalisation Benefits in Malaysian government hospital, COVID-19 Vaccine Fund (RM1.0 million) and COVID-19 Vaccine Fund Campaign for non-customers are still applicable as per earlier announcements.
Q: If the hospitalisation due to COVID-19 happened overseas, is the life assured eligible for this Programme?
A: Yes, the claim will be processed and administered under this Programme based on the terms and conditions stated in the respective policy contracts, including terms related to Reasonable and Customary Charges, Medically Necessary and Residence Overseas clause.
Q: Will there be any guaranteed letter issued if the life assured is hospitalised due to COVID-19?
A: No, any claim from this Programme will be on medical reimbursement basis.
Cashless facility is not applicable for hospital admission when the life assured is diagnosed with COVID-19. This means when a life assured is admitted to a private hospital for non-COVID-19 related treatment, and also tested positive with COVID-19; cashless admission will NOT be applicable and no Guaranteed Letter (GL) will be issued.
Q: If the life assured has been admitted for some other conditions that is not related to COVID-19 and subsequently become COVID-19 positive, is cashless facility available for the entire hospitalisation?
A: No, even if the other conditions are covered on cashless basis, all Reasonable and Customary Charges related to Medically Necessary treatment for COVID-19 infection will only be covered on reimbursement basis.
Q: Would the life assured be reimbursed for COVID-19 diagnostic test & Personal Protective Equipments (PPEs) used during such Medically Necessary hospitalisation?
A: Yes, COVID-19 test & Medically Necessary usage of PPEs during hospitalisation due to COVID-19 infection would be reimbursed based on Reasonable and Customary Charges.
Q: Can the life assured submit claim under this Programme for expenses incurred for in-hospitalisation treatment for subsequent complication sustained due to COVID-19, e.g: Pneumonia? Would the life assured be covered under this Programme, if the life assured has recurrence of COVID-19 infection and he/she is hospitalised as a result of the recurrence?
A: Yes, as long as it is for reimbursement of Reasonable and Customary Charges incurred for the Medically Necessary treatment received by the life assured when the life assured is hospitalised due to COVID-19 during the coverage period of this Programme.
Q: Can the life assured submit claim under this Programme for pre-hospitalisation and/or post-hospitalisation expenses incurred?
A: Yes, provided the life assured’s medical plan is an eligible medical plan under this Programme and the medical plan provides coverage for pre-hospitalisation and post-hospitalisation expenses, as well as in-hospitalisation expenses.
Q: Can the life assured submit a claim under this Programme, if he/she was quarantined in a hospital or quarantine center or makeshift hospital for COVID-19 infection?
A: No, a claim for quarantine is not payable under this Programme.
Q: Can the life assured submit a claim under this Programme where the life assured was hospitalised due to COVID-19 prior to 18 August 2021 or after 31 December 2023?
A: No, this Programme starts from 18 August 2021 until 31 December 2023 and it is for hospitalisation due to COVID-19 based on hospital admission date within 18 August 2021 and 31 December 2023 (both dates inclusive).
Q: Will the life assured be covered under this Programme if the policy with the eligible medical plan was lapsed and subsequently reinstated?
A: Yes, the life assured will be covered under this Programme after the policy is reinstated, provided the reinstatement date is within the coverage period, and subject to the waiting period again.
Q: If a customer holds multiple policies from more than one (1) insurance company, can he/she reimburse any eligible medical expenses for COVID-19 from Great Eastern Life?
A: Yes, he/she can claim from the Programme, subject to meeting terms and conditions as well as based on the principle of indemnity. Upon meeting the criteria, the Company will reimburse up to the benefit limit of their medical plan.
For instance, a life assured may be first claiming from other insurance company, if any, as such the Company will indemnify the balance of the eligible medical expense up to the benefit limit provided by their medical plan under this Programme.
Q: If a life assured progressed from being a Category 2 COVID-19 patient to Category 4 COVID-19 patient and admitted to a hospital in Malaysia for medically necessary treatment, can he/she submit a claim for reimbursement under this Programme?
A: Yes, as long as the COVID-19 treatment is medically necessary, where the claims will be assessed based on the terms and conditions of the Programme, and subject to the limits of the eligible medical plan.
Q: If a life assured has a medical plan which does not have the exclusion clause on communicable diseases requiring quarantine by law, is he/she entitled for the Programme?
A: No, this Programme is only for life assured of medical plan(s) with exclusion clause on communicable diseases requiring quarantine by law. Medical plans which do not have the exclusion clause on communicable diseases requiring quarantine by law are already covered for COVID-19 treatment, subject to the features and benefits as well as terms and conditions of the respective plans.
Q: How do I make a claim?
A: Please refer to the guides on how to submit a claim here.
Q: How long does it take for the Company to process a claim?
A: The estimated timeframe to process a claim is within 10 to 20 working days upon receiving complete claim documents.
Q: Who should I contact if I have further questions?
A: Please contact our HealthCare Service Careline at 1300-1300 18 or email to healthcareservices@greateasternlife.com
Important Note:
The answers provided to the FAQs herein set out how this Programme will be administered by Great Eastern Life Assurance (Malaysia) Berhad. It is important to recognise that how this Programme is administered by the other Great Eastern entities in Malaysia may differ with different terms and conditions applied. Hence, please refer to the answers provided under the FAQs issued by Great Eastern General Insurance (Malaysia) Berhad and Great Eastern Takaful Berhad respectively for information on how these companies will administer this Programme.
The terms “Great Eastern Life”, “Company”, “we” and “us” shall refer to Great Eastern Life Assurance (Malaysia) Berhad.
The term “Great Eastern” shall refer to Great Eastern Life Assurance (Malaysia) Berhad, Great Eastern General Insurance (Malaysia) Berhad and Great Eastern Takaful Berhad.
Q: Am I entitled to this benefit?
A: You are entitled to this benefit if your policy document is attached with Endorsement No. 259 (CAP)
Q: What is the contact number for car assistance?
A: You may contact the 24 hours service hotline at 03-76604799.
Q: What is covered in the Car Assistance Program?
A: The services offered in this program are:
Note: Please refer to the Endorsement No. 259 (CAP) for more details on this program.
Q: How can I register or change customer’s car registration number?
A: You may submit a written request through Health Servicing Drop Box at Level 1 of Menara Great Eastern or Agent’s Counter at the nearest branches.
Q: Can customer use this service if they did not register their car registration number?
A: No, customer has to register their car registration number with GELM before they are eligible for this service.
Q: Can customer submit their car towing fee for reimbursement?
A: No, customer must contact the service hotline to arrange for towing services.
Q: What is the contact number for Emergency Medical Assistance?
A: You may contact the 24 hours Service Centre Hotline at 03-4259 8853 (same number for Executive Second Opinion).
Q: What is covered in the Emergency Medical Assistance?
A: The key benefits are listed below. However, for more details on this benefit, you may refer to policy Endorsement No. 249 (SAssist) or contact Supreme Assist.
For customer who travels outside Malaysia for a period not exceeding 120 consecutive days on any one trip, the benefits are:
For customer who travels within Malaysia for a period not exceeding 120 consecutive days on any one trip, the benefits are:
Q: What is Executive Second Opinion (ESO)?
A: Executive Second Opinion is an arrangement where customer can obtained a second opinion on their diagnosis and treatment from an approved medical institution in the United States in the form of a documented report. Customer then has the option to request for a telephone consultation not exceeding one hour from the specialist. The Second Opinion service does not include treatment and only applies to the diagnosis of those medical conditions and eligibility is as defined in the policy document under Endorsement no. 278.
Q: How many times can the customer use the Executive Second Opinion service?
A: One time per covered condition per policy year and limited to three times per lifetime.
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