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.
“Confinement” or “Confined in a Hospital” shall mean admission in a Hospital for a minimum period of six (6) hours upon the recommendation of a Physician and continuous stay in the Hospital prior to the Covered Person’s discharge. Confinement shall be evidenced by a daily room/room and board charged by the Hospital.
“Covered Person” shall mean the person(s) covered whom must meet the following eligibility and has/have successfully applied for this free coverage:
- Age last birthday at the time of registration is between sixteen (16) years old and seventy (70) years old; and a Malaysian citizen residing in Malaysia.
“Hazardous Activity” refers to mountaineering or abseiling necessitating the use of ropes and other climbing equipment, offshore activities beyond five (5) kilometres off any coastline and including rafting or canoeing involving white water rapids, bungee jumping, flying or other aerial activities (unless as a fare-paying passenger in a fully licensed aircraft), underwater activities involving the use of any artificial breathing apparatus to a depth of more than eighteen (18) metres, horseback polo playing, steeple chasing, any form of martial arts, racing (other than on foot or swimming) or trial of speed or reliability, ski-jumping, ski-bob racing, freestyle skiing including the use of bob sleighs, professional sporting activities and competitions of any kind, any organised sporting holiday and any other activities that require a degree of skill.
“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:
- has facilities for diagnosis and major surgery;
- provides twenty-four (24) hour a day nursing services by registered and Graduate Nurses;
- is under the supervision of a Physician; and
- 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 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:
- consistent with the diagnosis and customary medical treatment for a covered disability and/or Injury;
- in accordance with standards of good medical practice, consistent with current standard of professional medical care, and of proven medical benefits;
- 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);
- not of an experimental, investigational or research nature, preventive or screening nature; and
- for which the charges are fair and reasonable and customary for the disability and/or Injury.
“Physician”, “Registered Medical Practitioner” or “Surgeon” 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.
“Reasonable and Customary” shall mean any medical fee or expense which is charged for treatment, supplies or medical services Medically Necessary to treat an Covered Person’s condition under the care, supervision or order of a Physician; does not exceed the usual level of charges for similar treatment, supplies or medical services in the locality where the expense is incurred; and does not include charges that would not have been made if no insurance existed.
Whenever the context requires, masculine form shall apply to feminine and singular term shall include the plural.
