All ages referred to under this free coverage shall be the age of Covered Person’s last birthday.
“Accident” means a sudden, unintentional, unexpected, unusual, and specific event that occurs at an identifiable time and place which shall, independently of any other cause, be the sole cause of bodily Injury.
“Covered Person” shall mean the person(s) whom must meet the following eligibility and has/have successfully enrolled to this Free Balik Kampung Cover:
- Age last birthday at the time of registration is between fifteen (15) days old and seventy (70) years old; and
- a Malaysian citizen residing in Malaysia.
“Hospital” shall mean only an establishment duly constituted and registered as a Hospital for the care and treatment of sick and injured persons as paying bed-patients, and which:
(a) has facilities for diagnosis and major surgery;
(b) provides twenty-four (24) hour a day nursing services by registered and Graduate Nurses;
(c) is under the supervision of a Physician; and
(d) is not primarily a clinic; a place for alcoholics or drug addicts; a nursing, rest or convalescent home or a home for the aged or similar establishment.
“Injury” means bodily Injury caused solely by Accident.
“Licensed Nurse” or “Graduate Nurse” shall mean any person that upon successful completion of a recognised college or school of nursing, is legally authorised by the government of the geographical area of his/her practice to render nursing services, but excluding a Licensed Nurse or Graduate Nurse who is the Covered Person himself, an insurance agent/authorised insurance intermediary, business partner(s) or employer/employee of the Covered Person’s or a member of the Covered Person’s immediate family or related in similar fashion to the Covered Person.
“Medically Necessary” means a medical service which is:
(a) consistent with the diagnosis and customary medical treatment for a covered disability and/or Injury;
(b) in accordance with standards of good medical practice, consistent with current standard of professional medical care, and of proven medical benefits;
(c) not for the convenience of the Covered Person or the Physician, and unable to be reasonably rendered out of Hospital (if admitted as an in-patient);
(d) not of an experimental, investigational or research nature, preventive or screening nature; and
(e) for which the charges are fair and reasonable and customary for the disability and/or Injury.
“Physician” or “Registered Medical Practitioner” shall mean any person qualified by degree in western medicine and who is legally authorised in the geographical area of his practice to practise medicine and surgery, but excluding the Covered Person himself, an insurance agent/authorised insurance intermediary, business partner(s) or employer/employee of the Covered Person or a member of the Covered Person’s immediate family or related in similar fashion to the Covered Person.
"Pre-Existing Conditions" means illnesses/disabilities prior to the date this enrolment is made that the Covered Person has reasonable knowledge of. A Covered Person may be considered to have reasonable knowledge of a Pre-Existing Condition where the condition is one for which:
(a) the Covered 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.
Whenever the context requires, masculine form shall apply to feminine and singular term shall include the plural.