PRODUCT SUMMARY

FOR
ENHANCED HOSPITAL & SURGICAL INSURANCE
AND
GROUP MAJOR MEDICAL INSURANCE
______________
Policyholder : SAP Asia Pte Ltd
Policy No. : 2020761
Period of Insurance : 1 Jan 2019 to 31 Dec 2019

PRODUCT INFORMATION

Group Hospital & Surgical Plan is a medical expense insurance plan that seeks to reimburse the
expenses incurred by an employee and his specified dependents as a result of hospitalization. Through
this insurance scheme, the employee would be able to protect himself against exorbitant and escalating
hospital bills.

Group Major Medical Plan is designed to complement as a perfect-fit to the Group Hospital & Surgical
Insurance.
With the modern urban fast-paced lifestyle, heart attacks, strokes, cancer and other critical illnesses are
no longer confined to older folks. Virtually everyone is at risk. Coupled with the ever increasing cost in
health care, making provision by buying the Major Medical plan to cater for the unexpected is no longer
a luxury but a necessity.

The Major Medical plan will pay 80% of eligible expenses in excess of the amount payable under the
Group Hospital & Surgical cover. In other words, the insured has to bear 20% of the excess eligible
expenses.
There is an annual limit which may be customized according to each company’s needs.

Expenses incurred for outpatient kidney dialysis and/or radiotherapy treatment for cancer shall be
payable up to the maximum limit specified in the Benefit Schedule subject to Co-Insurance.

This cover is extended 24 hours a day on worldwide basis and you will begin to receive benefit when
you are :-

(i) hospitalized for at least 6 consecutive hours and room and board charges made or
(ii) undergoing a surgical intervention

It comprises of two parts : the Group Hospital & Surgical Plan; and the Group Major Medical Plan.

paver.1
Aviva: Public 1
SCHEDULE OF BENEFITS

A. GROUP HOSPITAL & SURGICAL

MAXIMUM PER DISABILITY (S$)

ELIGIBLE EXPENSES PLAN A PLAN B PLAN C
(Optional) (Optional) (Core)
1 Hospitalization Confinement Benefits
A Daily Room and Board Single-Bed Single-Bed Two-Bed
(Max 120 days, inclusive of ICU) (Restructured) (Private) (Restructured)

B Intensive Care Unit (ICU) 10,000 10,000 10,000

C Hospital Miscellaneous Services 6,000 8,000 4,500
D Surgical Benefit 8,000 10,000 6,000
(Subject to Surgical Schedule of Fees)
E In-Hospital Doctor Consultation 120 150 100
(Max 120 days)

2 Outpatient Benefits
A Pre-Hospital Confinement/Surgery 2,000 2,200 1,600
Diagnostic X-ray & Laboratory Test/ Specialist
Consultation (within 90 days) and
Post-Hospital Confinement/Surgery Follow-up
Treatment
(Max.120 days)
B Emergency Outpatient Treatment (Accidental 2,500 2,500 1,500
Injury)

3 Outpatient Kidney Dialysis / Cancer 15,000 15,000 10.000

Treatment (Per Policy Year)
Kidney Dialysis
Erythropoietin and Cyclosporin
Chemotherapy (Including Immunotherapy)
Radiotherapy

4 Miscarriage Benefit As per As per As per

disability disability disability
5 Death Benefit 5,000 5,000 5.000
6 Lump Sum Limit if admitted to Singapore 16,000 21,000 15,000
Govt/Rest Hospitals

B. GROUP MAJOR MEDICAL

paver.1
Aviva: Public 2
 Plan A Plan B Plan C
(Optional) (Optional) (Core)
Single-Bed Single-Bed Two-Bed
Daily Room & Board (Restructured) (Private) (Restructured)

Surgical Implant per disability 5,000 5,000 5,000

Maximum Per Policy Year 60,000 100,000 40,000

Death Benefit 5,000 5,000 5,000

Maximum Per Lifetime 180,000 300,000 120,000

In excess of Basic Group

Deductible
Hospital & Surgical Insurance

Co-insurance 20%

DESCRIPTION OF BENEFITS

PART A – Group Hospital & Surgical

1. Hospital Confinement Benefits

A. Daily Room and Board Benefit

The daily room and board charges incurred by an Insured Person while in Hospital
Confinement shall be payable up to the maximum amount and for a maximum no. of days
per Disability specified in the Benefit Schedule.

B. Intensive Care Unit Benefit

In the event that an Insured Person is confined to the Intensive Care Unit of the Hospital,
the scheme will reimburse up to a maximum amount per Disability specified in the benefit
schedule.

C. Hospital Miscellaneous Services

Reimbursement will be made for expenses such as the use of operating room, drugs and
medicine, laboratory examination, anesthesia and oxygen and their administration,
ambulance service and other eligible miscellaneous expenses.

D. Surgical Benefit

A surgical benefit equal to the sum actually charged for any operation performed by one or
more Registered Medical Practitioners shall be payable, provided that the maximum benefit
for all surgical operations performed per Disability shall not exceed the aggregate amount
obtained by multiplying the respective percentages shown for the operations listed in the
Surgical Schedule of Fees by the maximum Surgical Benefit shown in the Benefit Schedule.

E. In-Hospital Doctor Consultation

paver.1
Aviva: Public 3
 Fees charged by the Registered Medical Practitioner for consultation while an Insured
Person is in Hospital Confinement shall be payable up to the maximum daily limit shown in
the Benefit Schedule. If a surgery has been performed, the consultation fee shall be
payable under the Surgical Benefit instead.

2. Outpatient Benefits

A. Pre-Hospital Confinement/Surgery Diagnostic X-ray and Laboratory Test

Reimbursement will be made for such diagnostic/laboratory tests following referral by a

Registered Medical Practitioner provided subsequent hospitalization or surgery occurs
within 90 days.

B. Pre-Hospital Confinement/Surgery Specialist Consultation

Reimbursement will be made for expenses incurred (excluding medication) following

referral by a Registered Medical Practitioner to a specialist and provided subsequent
hospitalization or surgery occurs within 90 days.

C. Emergency Outpatient Treatment Benefit (Bodily Injury Caused by Accident)

Reimbursement will be made for emergency outpatient treatment of bodily injuries arising
from an accident and not by sickness, disease or gradual physical or mental deterioration
received within 24 hours of the accident and follow-up treatment shall be payable up to 31
days from time of Accident.

D. Post-Hospital Confinement/Surgery Follow-up Treatment

Upon discharge, expenses incurred for follow-up treatment by the same Registered Medical
Practitioner will be reimbursed up to a maximum no. of days specified in the Benefit
Schedule.

E. Miscarriage Benefit

Expenses incurred for Miscarriage that require in-hospital or outpatient treatment by a

Registered Medical Practitioner shall be payable up to the maximum limit specified in the
Benefit Schedule.

F. Death Benefit

Upon receipt of due proof, in the form specified by the Company, of death of an Insured
Person, an amount determined in accordance with the Benefit Schedule shall be payable.
The benefit will be doubled if death is due to an accident (if applicable, subject to a
maximum of $10,000).

G. Outpatient Kidney and Cancer Treatment

The cover may be extended to reimburse expenses incurred for outpatient kidney and/or
cancer treatments received at institutions or premises approved by government health
authorities according to the benefit limits specified in the policy.

Admission to Singapore Government Hospital or Singapore Government Restructured Hospital

paver.1
Aviva: Public 4
If an Insured Person is confined in a Singapore Government Hospital or Singapore Government
Restructured Hospital, the eligible expenses incurred under the above benefits 1C, 1D, 1E, 2A, 2B and
2D shall be reimbursed as charged by the Hospital subject to the maximum lump sum limit per Disability
as specified in the Benefit Schedule.

PART B – Group Major Medical

1. Hospital Confinement Benefits

a. All benefits under the Group Hospital & Surgical Plan;

b. Extension to cover implanted lenses, procurement or use of special braces, pacemakers

and animal tissues, artificial limbs and eyes, crutches and similar orthopedic appliances and
implants; rental of hospital bed type bed, wheel chair, iron lung or similar therapeutic
equipment; use of land ambulance up to a maximum of S$5,000 per Disability.

WHO ARE ELIGIBLE?

i) All full-time active employees up to age 75

ii) Spouse of eligible employee who is below the age of 75 and not divorced or legally separated
from eligible employee
iii) An unmarried and unemployed child of the eligible employee who is between the age of 1 day
and 25 years.

BENEFIT OPTIONS

The benefit options indicated in the Product Summary do not necessarily reflect your
accepted sum assured by insurer, as your chosen sum assured maybe subjected to
underwriting depending on the rules & policies of the Flex program.

Hospital &
Core Benefit Optional Benefits
Surgical

Single Bed Restructured Employee & Spouse

Single Bed Restructured Employee & Child
Single Bed Restructured Employee & Family
Two Bed
Single Bed Private Employee only
All Employees Restructured
Single Bed Private Employee & Spouse
Employee Only
Single Bed Private Employee & Child
Single Bed Private Employee & Family

Major Medical Core Benefit Optional Benefits

paver.1
Aviva: Public 5
 Single Bed Restructured $60k GMM Employee & Spouse
Single Bed Restructured $60k GMM Employee & Child
Single Bed Restructured $60k GMM Employee & Family
Two Bed
Restructured
All Employees Single Bed Private $100k GMM Employee only
$40,000 GMM
Single Bed Private $100k GMM Employee & Spouse
Employee Only
Single Bed Private $100k GMM Employee & Child
Single Bed Private $100k GMM Employee & Family

KEY PRODUCT PROVISIONS

1) EXCLUSIONS

The following are some key provisions found in the policy contract of this plan. This is only a brief
summary and you are advised to refer to the actual terms and conditions in the policy contract.
Please consult your financial advisor or insurance intermediary should you require further
explanation.

(i) Intentional, self-inflicted injury sustained as a result of a criminal act of the Insured Person or
attempted suicide of the Insured Person whether he is sane or insane; psychological,
emotional or mental problems or conditions of the Insured Person; alcoholism or drug addiction
of the Insured Person.
(ii) Congenital anomalies or genetic defects, including hereditary conditions of the Insured Person
present at or existing from the time of his birth regardless of when the Insured Person
discovered or underwent treatment or surgical procedure for the same.
(iii) Treatment relating to birth control, infertility and impotency; treatment or surgical procedures
done at fertility clinics, in-vitro fertilization clinics, reproductive assistance clinics or centres
and reproductive medicine clinics or centres; treatment occasioned by or resulting from
pregnancy, childbirth, abortion, and all complications arising from any of the same, except from
miscarriage.
(iv) Any dental work or treatment, oral surgery, orthodontics and orthognathic surgery; temporo-
mandibular joint disorder except for the cost of surgery required as a result of an injury
sustained by the Insured Person in an Accident.
(v) Eye examination, surgical procedure for correction of eye refraction, procurement or use of
contact lenses or eye glasses; surgical procedure for correction of squint or other eye
misalignment if Insured Person is above 8 years old; cosmetic or plastic surgery except to the
extent that such surgery is necessary for the repair of damage caused solely by bodily injuries
sustained in an Accident.
(vi) Treatment of xanthelasma, syringoma, acne, alopecia, cosmetic skin surgeries, inguinal hernia
and hydrocele and all complications arising from any of the same; except where the Insured
Person who is under treatment for inguinal hernia and hydrocele is more than 5 years old.
(vii) Services for the primary purpose of diagnosis, medical check-up, genetic or health screening
(irrespective of whether there is Hospital Confinement) and outpatient treatment for
physiotherapy, chemotherapy, immunotherapy, radiotherapy, renal treatment; alternative
medicine including acupuncture, chiropractice, and the like, rest cures, sanatoria care or
special nursing care of any treatment or services that are not medically necessary or
reasonably required for Illness or bodily injury caused by an Accident.
(viii) Treatment of sleep apnea, obesity, weight reduction or weight improvement regardless of
whether the same is caused (directly or indirectly) by a medical condition otherwise admissible
under the policy.
(ix) Circumcision (except where it is medically necessary) or treatment relating to the same.
(x) Venereal disease, AIDS, AIDS related complexes and all illnesses or diseases associated with
the HIV.
(xi) Disabilities resulting from direct participation in a strike, riot or civil commotion, insurrection, or
any act of war (whether declared or undeclared).
(xii) Implants (homograft, heterograft, artificial) and prothesis; procurement or use of wheel-chair,
dialysis machine any other hospital-type equipment.

paver.1
Aviva: Public 6
 (xiii) Expenses, administrative or other charges of a non-medical nature in connection with the
provision and/or performance of medical supplies and/or services.
(xiv) For Outpatient Kidney Dialysis and Cancer treatment and Group Major Medical, any pre-
existing conditions which have existed during the 12 months prior to the commencement of
insurance coverage of the insured Person whether known or unknown (as long as the cause
or pathology have already existed) will not be covered.
(xv) When an Insured Person is entitled to benefits payable under any employees’ compensation
legislation, government or public programme of medical benefits, or other group or individual
insurance, the benefits payable under this Policy shall be limited to the balance of expenses
not covered by benefits payable under such legislation, programme or other insurances, or
that computed in accordance with the Benefit Schedule of this Policy, whichever is lesser.

(You are advised to read the policy contract for the full list of exclusions)

2) NON GUARANTEED PREMIUM

Premiums and flex price tags payable for this plan are not guaranteed and may be increased at
Policy Renewal Date at the full discretion of the Company.

3) TERMS OF RENEWAL

This group policy contract may be renewed on the Policy Anniversary Date by payment of the total
annual premium, we can vary the premium and any other terms, conditions or exclusions in this
policy by giving written notice of such change to the Policyholder (employer).

4) CANCELLATION CLAUSE

We may terminate this group Policy on any Renewal Date by giving the Policyholder (employer) at
least 30 days’ prior written notice of termination. Whenever such cancellation occurs, the Company
shall return the unearned portion of premiums paid to the Policyholder (employer). The termination
of coverage shall be without prejudice to payment of claims arising prior to the date of termination.

5) WAITING PERIOD

Not applicable.

6) MISSTATEMENT

A. If the age or date of birth or other relevant facts relating to any Insured Person is misstated
and this affects the scale of benefits or other terms and conditions of this Policy, then we will
use the true age and facts to determine whether insurance coverage is in force and the
benefits payable under this Policy and if, in our opinion is necessary, an equitable adjustment
of premiums will be made and notice of the adjustment will be given to you.

B. Where a misstatement of age or other relevant facts has caused a person to be insured under
this Policy when he is otherwise ineligible for any insurance, or where such statement has
caused a person to remain insured when he would otherwise be disqualified in accordance
with the provisions of this Policy, his entire insurance coverage shall be void and there shall
be a refund of premiums paid. However, if there is a fraud on the part of the Insured Person,
premiums paid shall not be refunded.

7) FREE LOOK PERIOD

Not applicable.

paver.1
Aviva: Public 7
 IMPORTANT NOTICE

This is only product information provided by us and is designed to serve as a guide only. In the
event of clarification or dispute, the prevailing terms and conditions of the Group Insurance
contract with your employer shall apply.

paver.1
Aviva: Public 8