An Employee Benefits

SMI/TISB Product
FOR
SMI CLIENTS

05 MARCH 2009
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Experience: ING Insurance in MALAYSIA

• 3,000 Corporate Clients with 1 million members
in Malaysia
• Largest Employee Benefits Provider (about
RM300 mil premiums) Malaysia
• Second Largest purchaser of healthcare
• Over 10 years experience
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Group: Market Share of ING & Key Competitors:
Total Premium
New Business 2006 Q3 New Business 2007 Q3

ING 37.8% 40.9%

ING
COM LIFE 25.3% CIMB AVIVA 29.2%
Name of Company

Name of Company
GE 12.8% 10.7%
GE
ALLNZ 4.6% ALLNZ 4.1%

AIA 4.1% 3.0%

MAA
3.6% 2.7%
AM ASSURANCE AIA
MAA 3.6% 2.3%
MNI
MNI 2.4% 1.7%
AM ASSURANCE

0 100 200 300 400 0 100 200 300 400

Premium Total (in millions) Premium Total (in millions)

RP SP (New Biz & Renew al) SP (Others) RP SP (New Biz & Renew als) SP (Others)

Notes: 1) Figures extracted from LIAM New Business Group Statistics

2) Total Premium consists of 100% RP + 100% SP (New Business/renewals) + 10% SP (Others)
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Some Of Our Other Valued Partners

UEM Group Sony
PLUS KPMG
Texas Instrument Putrajaya Holdings
DiGi
RHB Bank 95% Client Retention
Hewlett Packard
Citibank

Bursa Malaysia Mesiniaga

Siemens IBM
Halliburton KLCC Group
Perbadanan Putrajaya Institut Jantung Negara
SPNM Western Digital
Panasonic MPSJ
INTELOur ability to meet individual needs has enabled us to
form strategic partnerships with many leading companies
(3,000 Corporate Clients and 1 million members)
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Experience in Malaysia
Client Base : 3,000 Corporate Business Partners with 1,000,000 Members

No Size of Business Percentage of clientele

1 > 1,000 members 49%

2 500-1,000 members 13%

3 < 500 members & Small Medium Industry (5-100 members) 38%
No Length of Relationship Percentage of clientele

1 1 - 2 years 28%

2 3 - 5 years 45%
3 6 - 10 years 27%

Type of Services
•Outpatient GP & Specialist Care
•Hospitalization & Surgical

ING 5
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What is TISB / SMI Plan?

 Group Insurance products

which has been packaged
for Small & Medium
Industries
 A master contract or master
policy.
 Target Market – SMI
Companies which have 11 to
100 employees
 Cash before cover
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The Reason Behind The Offer

For Employer For Employee

 Takes care of your valuable asset  Financial security for employee

– your employees  Promotes employee loyalty
 Attracts & retains employee – low  Enjoy Protection – outpatient and
turnover inpatient benefits
 Improve moral & high productivity
 Minimize your company’s
exposure to rising healthcare costs
 Employee Benefits premiums – tax
deductible
 Create a “caring” employer image
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Benefits

 Worldwide coverage
 Medical Provider Network – 2,000 Panel GP
Clinics & Major Hospitals nationwide
 Cashless Access to Medical Care (outpatient
clinical only) with ING Member ID Card
 24 Hours Toll Free Assistance
 Flexible Plan Design
 Affordable
 Administrative Ease
 Yearly renewable
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Products

 Medical Basic Benefit

 Hospitalization
 Medical Optional Benefit
 Outpatient Care
 General Practitioner (GP)
 Specialist (SP)
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Schedule of Basic Benefits - Hospitalisation

Plan Plan Plan

Hospital & Surgical Care Plan 80
350 200 150
1. In-Hospital Care
• Hospital Room & Board (max. daily benefits)
(i) Ordinary Room 350 200 150 80
(up to 120 days max. per disability)
(ii) Intensive Care (max. daily benefits) 500 500 500 500
(up to 20 days max. per disability)
• Hospital Supplies & Services
• Surgical Fees
• Anaesthetic Fees
Full Reimbursement
• Operating Theatre Charges
• In-Hospital Physician’s Fees
(Max. 120 days per disability)
• Hospital Service Tax
5% 5% 5% 5%
(on eligible Room & Board charges paid)
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Schedule of Basic Benefits - Hospitalisation

Medical: Basic - Hospitalisation Plan 350 Plan 200 Plan 150 Plan 80
2. Ambulatory Care
• Pre-Surgical/Medical Diagnostic Services
(within 60 days)
• Pre-Surgical/Medical Specialist Consultation
(within 60 days)
• Second Surgical Opinion
• Post-Hospitalisation Treatment (up to 60 Full Reimbursement
days following discharged from hospital)
• Emergency Outpatient Accidental Treatment
(within 24 hours up to 60 days)
• Daycare Procedure (Surgical/Medical)
• Ambulance Fees
• Medical Report Fee Reimbursement 80 80 80 80
• Outpatient Rehabilitation Therapy,
Chemotherapy, Radiation Therapy, Kidney Full Reimbursement
Dialysis
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Schedule of Basic Benefits - Hospitalisation

Hospital and Surgical Care Plan 350 Plan 200 Plan 150 Plan 80

Overall Limit (per policy year) 100,000 50,000 30,000 10,000

Note:
• Overall Limit – The maximum benefit payable within the Policy year regardless of
number of disabilities.
• Please refer to the Insurance Policy for a detailed description of the benefits.
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Schedule of Optional Benefits

Medical: Outpatient GP & Specialist RM

1. Outpatient GP Care
(i) Panel GP Clinic Visit Cash Free
(ii) Emergency Non-Panel Clinic Visit Full reimbursement
(iii) Pap Smear at Panel GP Clinic only (max once per Full reimbursement
Policy year)

2. Specialist Care
• Specialist Visit - with Referral from Panel GP
Clinic 100 per visit

3. Outpatient Diagnostic Services

• With Referral from Panel GP Clinic or Specialist 250 per visit
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Outpatient ID Card

The Member ID Card

Must be used when seeking care at any Panel GP

Back

Front
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Dependant’s Identification

The Employee’s Spouse and Children ID Card

(A) The employee's name and IC A

number is printed on the top
right hand corner of each of
the Dependant's card.

(B) Dependant’s Membership

No.

B
Please use the membership number in the claim forms whenever seek
care at our GP Panel, submitting reimbursement member claim forms, etc.
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Visiting Panel GP Clinic

Toll Free Help Line

1·800·88·7818

Member presents ING Insurance Panel GP Clinic

member ID card & IC (2000 Panel GP nationwide)

Always refer to the Directory of Panel GP Clinics for the nearest clinic in your area
Always check with your HR Department for Monthly Directory updates
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At the Hospital

Toll Free Help Line

1·800·88·7818

Fax Referral
Panel GP Clinic Letter to MCO(ING) Specialist
(Referral Letter) 03-2715 7915 / 7916
Will fax a LOG to the
Member, Specialist or
Hospital

Follow-up Call
at the Toll Free
Number
Hospital

Member
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During an Emergency

OR
Toll Free Help Line
1·800·88·7818

GP Clinic Hospital
Member Panel / Non-Panel Accident & Emergency
Unit

Emergency - An illness or injury that is life or limb threatening which needs

immediate medical attention.
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Overseas Hospitalization Treatment

 Emergency treatment while traveling overseas for not more than 90

consecutive days
 Necessary and reasonable charges of such equivalent treatment in
Malaysia
 Treatment not available locally subject to referral letter from Attending
Physician and approval from TISB/ING
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Hospitalization – Special Conditions

 Waiting Period:
Eligibility for benefits starts 30 days after the Insured has been included in the Policy, except
for a covered Accident occurring after the effective date of coverage.
 Specified Illnesses.
No benefits shall be payable for hospitalization, surgery and/or charges incurred which are
caused directly or indirectly by Specified Illnesses and its related complications.
“Specified Illnesses” shall mean the following disabilities and its related complications,
occurring within the first 120 days of Insurance of the Insured Person:
(a) Hypertension, diabetes mellitus and Cardiovascular disease
(b) All tumours, cancers, cysts, nodules, polys, stones of the urinary system and biliary
system
(c) All ear, nose (including sinuses) and throat conditions
(d) Hernias, haemorrhoids, fistulae, hydrocele, varicocele
(e) Endometriosis including disease of the Reproduction system
(f) Vertebro-spinal disorders(including disc) and knee conditions.
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What’s Not Covered

 Cosmetic surgery or treatment  Psychotic, mental or

nervous disorders
 Experimental procedures
 Congenital or hereditary
 Substance abuse illnesses

 Private nursing care  Routine physical

examination
 Sexual dysfunction or infertility
 Refractive errors
 Pregnancy
 Dental
 Alternative therapies
 Terrorism & atomic
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Guidelines for LOG Issuance

No Item Final Guideline (20050401)

1 Premium per annum Medical premium >= RM10K pa

Premium < RM10k Deposit RM5K

2 Deposit
Premium > RM30k Deposit RM10K
Upon receipt of first year premium and
3 LOG issuance
deposit

4 Excess bills Must settle within 30 days

5 LOU (letter of undertaking) Client to sign LOU

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Letter of Guarantee Limit by Plans

Plan Limit
Plan Room & Board LOG Limit
per Annum

1 350 100K RM2,500

2 200 50K RM2,500

3 150 30K RM2,500

4 80 10K RM2,500

Limits to be indicated in LOG

*Once LOG issued, no top ups even if
more benefit available
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Pricing

 Group Health Plan

 Plan selected and eligibility (EO/ES/EC/EF)

 Out Patient
 Pricing is the same for employee/dependent
 Based on individual employee/dependent
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Pricing - Hospitalization
Medical Benefit

Plan 350 Plan 200 Plan 150 Plan 80

W/O With W/O With W/O With W/O With

Basic Hospital
LOG LOG LOG LOG LOG LOG LOG LOG

Employee Only 616 632 426 442 324 340 198 214

Employee &
1540 1572 1065 1097 810 842 495 527
Spouse

Employee &
1540 1588 1065 1113 810 858 495 543
Children

Employee &
2464 2528 1704 1768 1296 1360 792 856
Family
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Pricing - Optional

Optional - Out Patient Clinical

Annual Premium per Employee / Dependent RM345.00

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Eligibility

 Employee
 All present and full-times active employees
 Entry age : 18 to 59 years of age
 Renewable up to 64 years old

 Dependent
 Spouse’s entry age <= 64 years & not an employee of the Employer.
 Renewable (spouse) up to 64 years old
 Child’s entry age >= 15 days <= 19 years, or 23 years, still on full-time higher
education & not employed.
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Participation & Movement

 Participation Requirement
 Compulsory participation for all eligible employees
 Premiums are paid by employer

 Employee/Dependent Movement
 To provide complete listing of employee/ dependent within 30 days to Insurer
 Return of OPC card if termination happens
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Individual Termination

Based on the earliest happening :

 Date of termination with employer

 Termination of policy by either Employer or Insurer

 Premium payment is discontinued

 At the end of the policy year following an insured employee/dependent

attaining of 65 years of age

 At the end of the policy year following an insured employee’s child attaining
of 20/24 years of age
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Separation Period

 Disabilities arising from the same cause is defined as one period of

disability

 After active full-time work of not less than 14 active working days, any
subsequent disability shall be considered as a new disability

 For dependents, the separation period is 30 days

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Change of Benefits

 Can only be made on the Policy Anniversary date & is subject to

acceptance

 The claim payable shall be computed based on the limit of benefits under
the old plan if it:
 Arises within 30 days from the acceptance date of change
 Any specific illness within 12 months from the acceptance date of change
 Medical condition diagnosed prior to the accepted date of change
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Submission of cases

• New business
Before submission : Microsoft Excel
Worksheet

• Form A – application form

• Form B2 – enrolment form. Ensure that all employees & dependents details are
completed.
• Form C – Personal Health Declaration form
• Payment of premium
• Submit at least 2 weeks prior to the effective date for those with OPC, one week
for those with GHP
• Late submission – grace period of one week will be given.
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Premium & Commission

 Premium
 Must be paid and received on or before (cash before cover ) the inception date
 Subject to review on a yearly basis and subject to adjustment
 Based on small group pool – 5,000 headcount
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Why TISB/ING SMI Plan?

 Integrated insurance solution
 Provides protection against financial burden due to loss of life, disability and
medical expenses.

 Customer Services
 You and your employees can have direct access to us through our toll-free
telephone line - 1-800-88-7818.

 Easy Access
 Cashless with Member ID Card
 No limit to the number of visits made to any nominated panel Primary Care
Physician (General Practitioner) clinic
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Why TISB/ING SMI Plan?

 High insurance protection at economical premium

 At RM1.46 per day for :
 Hospitalisation (Room & Board RM80)
 Outpatient Clinical (on a panel clinic arrangement)
 Benefits Payment
 Hospitalisation and Outpatient Clinical (emergency cases) -
on a reimbursement basis.
THANK YOU
AND
WASSALAM