Family Health Protect 2023

#FHP.v23APR.231218.J7R2

Issued on 18/12/2023, valid 30 days

Attention: getaquote

Dear Veasna UK,

Welcome to FAMILY HEALTH PROTECT!

Thank you for contacting us for the provision of FAMILY HEALTH PROTECT. This
indicative quotation has been prepared based on the information provided. All
groups within a community must be covered under the same level of cover and
enjoy the same benefits. Community representatives will have to complete the
Application Form which we will provide upon request.

This quotation is based on the provided census of 4 members aged: 44, 43, 9, 7
years old.

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Enjoy SafetyNet Experience

SafetyNet is an insurance intermediary specialized in health and accident. Born

in Singapore, SafetyNet started operations in Cambodia as a first target market
where it partnered with Forte Insurance (Cambodia) Plc, the very 1st General
Insurer.
After only 4 years of full operations, we are the health protection choice for
thousands of families, embassies, government officials, staff of international
companies, insurance company employees, insurance brokers, our staff family and
friends and even medical executive professionals….
Family Health Protect is a range of health insurance plans designed to protect
You, and those close to You, against medical expenses arising from Accident or
Illness.

Family Health Protect welcomes everyone from birth, without Age limit and
guarantees acceptance with no pre-existing exclusion. Enrolment is not subject to
any medical examination or medical questionnaire.

Each member will receive a Membership Package including detailed terms and
conditions, benefits table, personalized membership cards. Members can register
to our Claim Online Portal to check the remaining benefits, status of your claim as
well as to submit for Claim reimbursement, which will be paid into your Bank
account within maximum 14 working days from full documentation received.

SafetyNet currently has over 80 hospital and clinic partners in Cambodia which
will accept direct billing, i.e. cashless basis through our automated letter of
guarantee process on 24/7 basis. SafetyNet offers a 24/7 helpline for benefits
and claim inquiries. SafetyNet also offers a network of more than 120 hospitals in
neighboring countries who will accept our letter of guarantee.

You will find in the next pages a summary of benefits that you have selected and
the corresponding premiums.

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 “Making Health Insurance Affordable and Accessible for All Ages.’’

Hospital and Surgical (H&S) Plan

Base Plan Limits are per person per year unless otherwise stated. Option 1 Option 2
Currency: USD (United State Dollar) Jade Bronze
Area of cover Worldwide Worldwide
Overall Annual Maximum $18,000 $24,000
Illness Annual Maximum
Year 1* $750 $1,000
Year 2 $1,500 $2,000
Year 3 $18,000 $24,000
Accident Annual Maximum $18,000 $24,000
Childbirth Normal/C-section $400 / $800 $600 / $1,200
In-patient and Day-patient Hospital Treatment
$50 $60
Daily room, Board and Basic Nursing
Per Night Per Night
Intensive Care Unit Limit and Similar Special Medical Units Fully covered Fully covered
Operating Theatre Room Charges Fully covered Fully covered
Diagnostic and Investigation Charges
Fully covered Fully covered
Including Laboratories and Scans – MRI, CT Scan, PET Scan
Drugs, Dressings, and other Consumables Charges Fully covered Fully covered
Physician and Specialists visit fees Fully covered Fully covered
Implants and Internal prosthetics Fully covered Fully covered
Reconstructive Surgery Fully covered Fully covered
Treatment provided with the intention of relieving symptoms once Your
Fully covered Fully covered
Medical Condition has been diagnosed as terminal
Up to 7 days take home medications prescribed before You are
Fully covered Fully covered
discharged
Emergency Road Ambulance $300 $400
Cash Benefit for In-patient and Cancer Treatment
$25 per day $30 per day
Cash compensation per day if your medical expenses are reimbursed by
Max 15 days Max 15 days
another policy or health insurance scheme
Out-Patient Treatment
Surgical Procedures Fully covered Fully covered
Kidney Dialysis Fully covered Fully covered
Cancer Treatment Fully covered Fully covered
Pre and Post hospitalization visits $200 $300
(Limit per hospitalization, 90 days prior to and after hospital stay) Per Case Per Case
Emergency care following accident $200 $300
This includes Accidental damage to natural teeth. Per Case Per Case
Essential Out-Patient Treatment (Community limit)
Doctor’s visits, prescribed medications, investigations, preventative $150 $200
health screening and vaccination Per Community Per Community
Limit per visit $75 Limit per visit $100

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Other Benefits (***)
Maternity Complications Fully covered Fully covered
Pre-existing Conditions Fully covered Fully covered
Congenital Conditions Fully covered Fully covered
International Emergency Medical Assistance (IEMA, Evacuation,
Repatriation of Mortal remains)
We will cover the costs of emergency evacuation if you are, or need to be, admitted as an
emergency in-patient, and Our appointed doctor and the treating doctor believe your
current or nearest medical facilities are not able to provide the treatment you need.

Evacuating you to a suitable medical facility for treatment in the country you are in, or a
different country for treatment.

When you are discharged from the medical facility you were evacuated to, we will cover the
costs of repatriating you to the place or country where you normally live or a country that
you hold a passport for. This includes the cost of transporting mortal remains.
Not Included Not Included
If the member who needs to be evacuated or repatriated is under 18, we will cover the
additional reasonable and necessary transport and accommodation costs for someone aged
18 or over.

If the member who needs to be evacuated or repatriated is over 18, we may agree to cover
these costs if we believe it is medically appropriate. Once our member reaches their
evacuation destination, we will not cover the accompanying person’s further costs.

We will not cover the cost of evacuating or repatriating you if you decide to travel elsewhere
for treatment and we believe the nearest medical facilities are adequate for your treatment
or we have not approved the evacuation first.

Funeral Benefit $300 $400

Accidental Death Benefit $14,000 $16,000
Xtra Safe Program for Annual Maximum Coverage**** $180,000 $240,000
Co-Payment
$125 $200
In Network 10%
Maximum per Maximum per
Community per Year Community per Year
Out of Network 20% No Cap No Cap
Waiting period
Waiting period for treatment following illness 30 days 30 days
Waiting period for IEMA following an illness 6 months 6 months
Waiting Period for funeral benefit 6 months 6 months
Waiting period for maternity delivery 10 months 10 months
Waiting period for HIV/AIDS related illness 24 months 24 months

Optional Out-Patient Plus Plan – Direct Billing available in Cambodia

For doctor’s visits, prescribed medications, investigations, preventative health screening and vaccination
Base Plan Option 1 Option 2
Currency: USD (United State Dollar) Jade Bronze
+$600 +$800
OP Annual Maximum Per Community Per Community
Limit per visit $75 Limit per visit $100

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Special Note
* Members can be upgraded to the highest level of ‘Illness Overall Maximum’ after 30 days of
the first policy year when they are accepted for upgrade while going through our online
medical Questionnaire available on https://medical.safetynet.sg/m/
** Maternity complications which include,
· Ectopic pregnancy (pregnancy where the embryo or fetus grows outside the
womb)
· Retained placenta (after birth retained in the womb)
· Hydatidiform mole (abnormal cell growth in the womb)
· Placenta praevia
· Eclampsia (a coma or seizure during pregnancy and following pre-eclampsia)
· Post-partum haemorrhage (heavy bleeding in the hours and days immediately
after delivery.
· Miscarriage requiring immediate surgical treatment.
*** Other Benefits are covered fully but Treatment type limits will apply, ie Overall annual,
In-patient and out-patient limits.
**** Xtra SAFE Program - member can increase your Annual Maximum Coverage up to 9 times
(meaning a total of 10 times your current Annual Maximum Coverage) during the period of
cover after member have been covered under Year 3 Illness overall Maximum prior to your last
policy renewal AND Have renewed Your Policy for another Year thereafter.

General Exclusions
· Cosmetic Surgery and Aesthetic Treatment
· Treatment resulting from engaging in military activity or professional sport activities.
· Fertility Treatment, sterility and contraception Treatment, sex change, impotence.
· Expenses that are not for medical Treatment such as, but not limited to, telephone, TV
rent, newspaper, moisturizer, creams, toiletries, dietary supplements and vitamins,
toothpaste, or soap.
· Mental Illness, even if it requires Hospital admission.

This quotation is a summary of your coverage benefits, please refer to the Member
Booklet for more details.

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 Annual Premiums based on your community’s selected level of cover.

H&S and ESSENTIAL OP PLANS H&S and OP PLUS PLANS

LEVEL OF COVER TOTAL ANNUAL PREMIUM
TOTAL ANNUAL PREMIUM

Jade (-3%) $1536.48 $1857.55

Bronze (-3%) $1764.43 $2202.87

The premium shown on this quotation may vary depending on the Date of Birth of the member provided at the
start of the policy and the effective date.

Jade Bronze

H&S and ESSENTIAL H&S and OP PLUS H&S and ESSENTIAL H&S and OP PLUS
OP PLANS PLANS OP PLANS PLANS
Premium per Member TOTAL ANNUAL PREMIUM TOTAL ANNUAL PREMIUM TOTAL ANNUAL PREMIUM TOTAL ANNUAL PREMIUM
(-3%)
44 yo $570.36 $649.90 $621.77 $731.38

43 yo $523.80 $604.31 $583.94 $693.55

9 yo $221.16 $301.67 $279.36 $388.97

7 yo $221.16 $301.67 $279.36 $388.97

Premium Payment Option

You can also choose to pay three (3) times if you select our installment offer. For 2% additional premium, pay
35% at policy commencement date, 35% after 3 months and 30% after 6 months.

I agree with this quotation and wish to start the insurance policy with effect from
__ / __ /____.

Date:

Name and Signature:

This product is underwritten in Cambodia by Forte Insurance (Cambodia) Plc.

BRED Bank Building, #30, Preah Norodom Blvd, Sangkat Psar Thmey 3, Khan Daun Penh, Phnom Penh, Cambodia
Tel: 023 23 57 57 | help@safetynet.sg

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