GMS Benefits
1. Deductible Amount = RM300 per disability
每次入住医院，保客须自付 RM300
可能保客或伙伴们会问：为什么需要付 RM300？
其实主要是防止保客滥用医药卡，因为有些保客会觉得保费给那么多年，不用会觉得亏，所有有些小病，比如发烧看医生几十块就可以解决的，结果保客要住院，因为不需自付，所以很多保险公司就设置 RM300自付额。
假设如果一个病 RM100 能解决，保客进院要给 RM300，请问保客愿意给吗？
那么，如果一个病需要RM400,000，保客会不愿给RM300吗？
所有RM300的自付额，是排除掉小事要进院的保客，否则保客滥用医药卡，最后保费起价，受苦的会是谁？
为什么上面写 “Per Disability”，我们却写 “每次” 呢？
因为Per Disability 有很多的条件才能免去同病二次入院的RM300，因此为了不要困扰保客，我们一律说 “每次进院需自付RM300″ ，毕竟如果保客二次进院免付RM300，他们也不会埋怨，对不？
2. Hospital Room and Board ＝R&B150，R&B 200
(Limit per day, subject to a maximum of 180 days per year shared with ICU)
保客可入住的病房价格
如: R&B 200，保客就可选择住 价值 RM200 的医院病房。
每年可用的天数为多少天？
这项利益可使用医药卡的天数为： “每年180天”
这180天是和ICU天数合用的
一旦每年天数用完怎么办？
一旦每年限定的天数用完，那么这张医药卡就无效，需等第二年的生效日期才重算。
3. Intensive Care Unit = As Charged (Annual Limit)
(Subject to a maximum of 180 days per policy year shared with normal w啊热的)
每间医院的 “深切治疗加护病房” 收费都是高过普通病房的，
我们的ICU病房的收费限额和每年可使用的天数是多少？
而我们公司就是直接As Charged 每年限额。就是说无上限ICU病房收费。
并且可使用的天数为 “每年180天”。
如果超过每年ICU天数限额怎么办？
由于是和普通病房合用，超过180天后，医药卡将停止使用至第二年重置
而其他保险公司是有限制 ICU病房收费限额的。
而且他们的天数有些是 “每年30天” 或 “每年90天” 等等。
4. Hospital Supplies and Services = As Charged (Annual Limit)
医院用品和服务
5. Surgical Fees = As Charged (Annual Limit)
手术费用
6. Operating Theatre = As Charged (Annual Limit)
手术室费用
7. Anaesthetist Fees = As Charged (Annual Limit)
麻醉师费用
8. In Hospital Physician Visit = As Charged (Annual Limit)
(2 visits per day)
医生巡房 ，一天限两次。
如果保客要求医生巡第三次以上，那么保客须自付第三次以上的费用
9. Pre-Hospital Diagnostic Tests
10. Pre-Hospital Specialist Consultation, Treatment, Prescribed Medicines and Second Medical Opinion
As Charged (Annual Limit)
(Within 90 days before hospitalisation)
住院前（Pre-Hospital）90天的诊断检验费用，专科医生的费用，治疗的费用，配给的医疗药物 和 第二医疗意见，能索赔。
需要如何符合以上能索赔的条件？
假设某天我们发烧去看医生，医生说是普通发烧，就开有关的药物让我们回家吃。
但是过了几天，发烧还是没退，我们再去看医生。
医生这次就抽血化验，结果诊断后发现，原来是患上蚊症，于是就安排我们住院治疗。
那么前两次我们看医生的所有医疗药物、诊断报告费用、医生门诊费都能索赔。
有些什么是我们需要注意的？
1. 所有之前看病，最后一定要有住院，否则前两次的费用不能索赔。
2. 住院之前的看医生必须是同个病导致，如果第一次是发烧，第二次是胃痛，结果最后是胃痛而住院，那么发烧的那次就不能索赔了
3. 如果医生开的某些药品有维他命之类的辅助品（Supplements)，这类的辅助品将排除理赔，因为辅助品不是治疗的药物。
什么是“第二医疗意见（Second Medical Opinion ）”？
比如小明患癌症，癌症专科医生A 就开了一些药物给小明服用，又安排了化疗疗程
后来小明想要多一个癌症专科医生的意见，于是就找癌症专科医生B询问意见。
所以癌症专科医生B的诊断报告和门诊费用可以索赔。
但是如果小明接受癌症专科医生B开的药物和进行治疗疗程，那么就不能索赔癌症专科医生B开的药物和化疗疗程费用了。
因为上面是写 “第二医疗意见” 而已。
11. Post-Hospitalisation Treatment = As Charged (Annual Limit)
(Within 90 days after hospital discharge)
出院后的90天内的 复诊/跟进 (Follow Up)。
所有的药物（除辅助品外），有关病的检验或证明康复的报告，物理治疗，医生门诊费用等都能索赔。
有些什么是我们需要注意的？
1. 公司只负责保客90天内的复诊费用（出院当天算第一天开始），如果超过90天后就不能索赔
2. 假设医生安排的复诊刚好就落在第91天，也是不能索赔的
3. 假设病人复诊落在第80天，然后医生给于的药物服用是超过第90天，那么第91天后的药费就不能索赔，但是第90天前的药费还是能索赔的。
4. 跟进的主治医生必须是住院时帮保客治疗的同一个医生。如果出院后是保客自己要求更换医生跟进，那么就不能索赔了。
12. Organ Transplant = As Charged (Annual Limit)
(Applicable only once per lifetime)
器官移植，终身只能换一次而已。
主要是些什么器官才接受移植？
肾， 心， 肺， 肝， 骨髓。
这项利益只限受捐患者吗?
别人捐献器官也是要动手术取出器官的对否？
所以捐献器官者的手术费用，医药卡是不涵盖的。
13. Ambulance Fees = As Charged (Annual Limit)
救护车费用
14. Day Surgery = As Charged (Annual Limit)
(At least stay 8 hours in clinic or hospital for the day surgery)
日间手术，就是说能当天就能完成，不需住院过夜的小手术或检查
至少需要在医院 超过 8 个小时 （少于8个小时将不获理赔）
以下为日间手术的小手术和检查。
– 腺样体切除术;
– 骨髓抽吸和活检；
– 白内障摘除；
– 结肠镜检查；
– 膀胱镜检查；
– 内激光静脉手术；
– 内镜逆行胰胆管造影；
– 拇囊炎切除术；
– 切除神经节、纤维瘤和乳房肿块；
– 翼状胬肉切除术；
– 额外的体外冲击波碎石术；
– 疝气切开术/疝气术；
– 置入或取出输尿管 J 型支架；
– 腹腔镜子宫内膜消融术；
– 腹腔镜检查；
– 喉镜检查；
– 视网膜脱离的激光光凝治疗；
– 前庭大腺囊肿的有袋化和引流；
– 鼓膜切开术或鼓膜成形术；
– 减少骨折；
– 腕管释放（腕管减压）；
– 解除掌腱膜挛缩症；
– 切除宫颈息肉；
– 去除鼻息肉；
– 去除骨板和螺钉/植入物；
– 痔疮的橡皮筋。
15. Outpatient Cancer Treatment = As Charged (Annual Limit)
(including consultation, examination tests and prescribed take home drugs)
癌症治疗门诊
只要是政府认可的癌症治疗法都能受保，如果有关治疗法是处于试验阶段则不能受保。
16. Outpatient Kidney Dialysis Treatment = As Charged (Annual Limit)
(including consultation, examination tests and prescribed take home drugs)
肾透析治疗门诊
主要是用于洗肾治疗
17. Outpatient Treatment for Dengue Fever and Zika Virus = As Charged (Annual Limit)
登革热 和 寨卡病毒 治疗门诊
保客可以不需进院治疗以上蚊症，因此保费就不会那么容易起价了，毕竟住院治疗的花费是高过门诊治疗的。
以上三项有包涵些什么？
以上的治疗无需进院，可直接进行门诊治疗，所有的药物（除Suplements)，检验报告，医生门诊费都可理赔
18. Emergency Accidental Outpatient Treatment = As Charged (Annual Limit)
(Subject to a maximum of 30 days from the date of accident)
紧急意外门诊费用
必须是发生意外当天的24小时内看医生，及Follow Up是发生事情的30天内，超过24小时，或30天Follow Up 都不能理赔。
这里虽说医疗费用限额是根据每年限额，但医治费用必须是要合理的，比如割伤小手指，医疗费要 RM500,000就不合理了。
如果伤的很严重，比如被车撞之类大数额医疗费怎么办？
那当然就直接住院了，还门诊吗？
19. Outpatient Imaging (MRI/PET) = RM5000 per policy year
(Subject to a maximum of 30 days from the date of MRI/PET)
门诊成像，正电子放射断层造影 (PET) 和核磁共振成像 (MRI) 扫描
同个病况扫描开始算起30天内的医疗费用，超过就不能理赔。
如果是第二种病况，则第二病况扫描当天开始的30天内可理赔
这个扫描主要是扫描些什么？
主要多数是用来检测患者的癌症细胞部位。
20. Daily-Cash Allowance at Malaysian Government Hospital = RM50 per day
(Per day, subject to a maximum of 120 days per policy year)
入住政府医院每日现金津贴。
入住私人医院能索赔这个利益吗？
只限入住政府医院而已，私人医院须另外购买住院利益
21. Intraocular Lens = RM8000 per lifetime
人工晶状体
保客患白内障，动手术割眼膜后，安在眼睛的镜片
22. Overall Annual Limit for Items (2) to (21)
R&B150 = RM100,000 per year
R&B200 = RM150,000 per year
第2项 至 第21项 的 每年限额
23. Overall Lifetime Limit for Items (2) to (21) = Unlimited
第2项 至 第21项 的 终身限额
24. Accidental Death Benefit
R&B150 = RM10,000
R&B200 = RM15,000
意外死亡利益
这项利益只保障至受保人70岁而已
25. Supreme Assist = RM500,000 per lifetime
(Emergency Medical Assistance Services)
这个利益主要是紧急救援
RM 500,000是额外的限额，没影响医药卡本身的每年限额。
比如，受保人出国旅行，突然意外离世，那么这种情况，死者家属肯定需要过去领取死者遗体。
那么，家属（只限一名家属）过去的机票费用，遗体的运回费用，皆可在这里索偿。
至于其他的，比如出国查询旅店，查询国外大马领事馆等，都可向这里询问。
26. Car Assistance Programme = RM300 per charge
这个利益主要是汽车救援服务
比如汽车故障，需要拖车服务，那么可以通过这个利益求助
唯拖车服务每次限额RM300，比如某地方拖去某地方，路程是RM300内，那么就足够涵盖，如果路程超过RM300，多出的费用则需自付。
至于其他如，电箱坏，车胎漏风需路边更换，电箱过电 (Jump Start) ，都可通过这个服务求助。
有什么费用是不包涵和注意的？
路程是要经过收费站 (Toll) 的费用，保客需给付。
电箱坏需更换，电箱需要付费购买，而更换服务是免费的
这限利益只人“车牌”，不认受保人，如果当初是放什么车牌号码，就只人当时的号码。
汽车服务每次限额RM300，不限每年次数。
GM Million Extender Benefits （Add On）
1. Waiver of Deductible
Deductible feature under Smart Medic Shield will be waived.
入住医院每次自付额 RM300 将豁免。
2. Increase to the Hospital Room and Board Limit = 10% / 3 Yrs
病房利益每三年增加10% 至到 100%
比如说第一年医药卡是 R&B200，第三年增加至 R&B220, 第六年增加至 R&B240，第九年增加至 R&B260。。。
如此类推，三十年后为 100%，最终所持的医药卡为 R&B400
3. Post-Hospitalisation Treatment
(As charged, from 91st day to the 200th day after hospital discharge)
出院后的复诊 / 跟进（Follow Up)，由原本的90天，延长至200天
4. Overall Annual Limit for Items
Extend the Overall Annual Limit of Great Medic Shield by an additional Annual Limit
R&B150 = RM100,000 per year
R&B200 = RM150,000 per year
在以上每个现有的每年限额的基础上
每个医药卡将增加以下每年限额。
R&B150 = RM1,000,000 per year
R&B200 = RM1,500,000 per year
就变成以下的每年限额：
R&B150 = RM1,100,000 per year
R&B200 = RM1,650,000 per year
Download File
Exclusions Of Medical Card
1. Pre-existing Illness;
2. Specified Illnesses occurring within the first 120 days from the Risk Effective Date of this rider;
3. Any medical or physical conditions arising within the Waiting Period except for Injury;
4. Plastic/cosmetic Surgery, circumcision, eye examination, glasses and refraction or surgical correction of nearsightedness (Radial Keratotomy or Lasik) and the use or acquisition of external prosthetic appliances or devices (except for pacemakers, implantable cardio-defibrillator, prosthetic devices such as hearing aid and artificial limbs as provided under Medical Appliances, if applicable) and prescriptions thereof;
5. dental conditions including dental treatment or oral Surgery, except as necessitated by Injury to sound natural teeth occurring in any Policy Year and performed by Dentist;
6. private nursing (except as provided under Post-Hospitalisation Home Nursing Care), rest cures or sanitaria care, illegal drugs, intoxication, sterilisation, venereal Disease and its sequelae, AIDS (Acquired Immune Deficiency Syndrome) or ARC (AIDS Related Complex) and HIV related Diseases, and any communicable Diseases required quarantine by law except for COVID-19 disease for Life Assured who is Fully Vaccinated or Ineligible Unvaccinated;
7. Any treatment or surgical operation for Congenital Conditions or deformities including hereditary conditions;
8. Pregnancy, childbirth (including surgical delivery), miscarriage, abortion and prenatal or postnatal care and surgical, mechanical or chemical contraceptive methods of birth control or treatment pertaining to infertility. Erectile dysfunction and tests or treatment related to impotence or sterilisation;
9. Hospitalisation primarily for investigatory purposes, diagnosis, x-ray examination, general physical or medical examinations, not incidental to treatment or diagnosis of a covered Disability or any treatment which is not Medically Necessary and any preventive treatments, preventive medicines or examinations carried out by a Physician, and treatments specifically for weight reduction or gain;
10. Suicide, attempted suicide or intentionally self-inflicted Injury, while sane or insane;
11. War or any act of war, declared or undeclared, criminal or terrorist activities, active duty in any armed forces, direct participation in strikes, riots and civil commotion or insurrection;
12. Ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material;
13. Expenses incurred for donation of any body organ by the Life Assured, and the cost of acquisition of any body organ donated to the Life Assured including all costs incurred by the donor during organ transplant and its complications;
14. Investigation and treatment of sleep and snoring disorders, hormone replacement therapy, and alternative therapy such as treatment, medical service or supplies, including but not limited to chiropractic services, acupuncture, acupressure, reflexology, bone setting, herbalist treatment, massage or aroma therapy or other alternative treatment (except as provided under PostHospitalisation Chiropractor, Speech Therapist or Occupational Therapist or Post-Hospitalisation Traditional Chinese Medicine Practitioner, if applicable);
15. Care or treatment for which payment is not required or to the extent which is payable by any other insurance or indemnity covering the Life Assured and disabilities arising out of duties of employment or profession that is covered under a Workman’s Compensation Insurance Contract;
16. Psychotic, mental or nervous disorders, (including any neuroses and their physiological or psychosomatic manifestations);
17. Costs/expenses of services of a non-medical nature, such as television, telephones, telex services, radios or similar facilities, admission kit/pack and other ineligible non-medical items;
18. Sickness or Injury arising from racing of any kind (except for foot racing), hazardous sports such as but not limited to sky-diving, water skiing, underwater activities requiring breathing apparatus, winter sports, professional sports and illegal activities;
19. Private flying other than as a fare-paying passenger in any commercial scheduled airlines licensed to carry passengers over established routes;
20. Expenses incurred for sex change;
21. Any Outpatient treatment not related to Inpatient treatment, except as provided under this rider; or
22. Charges which are not Reasonable and Customary Charges, or any Surgery or treatment which is not Medically Necessary, or charges in excess of Reasonable and Customary Charges, or charges which are incurred for Hospitalisation, pre-hospitalisation and/or post-hospitalisation after the Expiry Date.
23. “Intoxication” in Clause 6 above refers to a state where the Life Assured has ingested alcohol or medication (either prescribed or otherwise) or other narcotic (legal or illegal) substances producing or resulting in observable mental or physical condition or impairment, including but not limited to slurred speech, difficulty in walking or keeping balance, disorientation, or odour or any one of the aforesaid characteristics, without the requirement of confirmation through tests such as a breathalyzer, urine or blood tests.
Admit Hospital Procedure
通常住院有三种方式
1. 直接用医药卡入住私人医院
政府医院是不能用医药卡的，保客须自付后，才凭单向公司索偿。
直接进院的流程通常会是：
Step 1：
保客先出示医药卡给医院，医院会向保险公司核实保单是否有效。
Step 2：
医生要填写保客需要住院原因并呈交给公司。（这过程可能会花很长时间，因为须要医生有空写报告）
Step 3：
当一切妥善后，资料没问题，公司就会出 Guarantee Letter(GL)，那么保客就能进院了。
2. 先住院后自己付费后，之后向保险公司索赔
这种情况多是在政府医院 或 Non-Panel Hospital 才会遇到。
当然某些情况下，Panel Hospital也是会要先自付，比如医药卡生效不够两年，保险公司是会 Investigate 的。调查完毕没问题后，保客就凭单索偿。
3. 预先向私人医药提出申请
比如医生说决定下星期某天保客要动手术，那么保客可以通过医院预先申请那天的 Guarantee Letter(GL)，一旦批准，那么就可以那天马上进院了。
出院流程：
主要是等待医生填写呈交“出院报告”，等公司出 Final Guarantee Letter，那么就能出院了