Thank you for insuring with EasyCare PA. You can feel confident you’ve made the right choice. EasyCare PA is provided by Tune Insurance Malaysia Berhad, one of Malaysia’s leading insurance providers, so you can relax knowing you’re with a company you can rely on.
- Your Schedule
- Any endorsements, which change your insurance cover as shown on your Schedule
- The Certificate of EasyCare PA.
Please read all these documents carefully and keep them safe.
If you need to make a claim, or contact us to tell us about any changes, then you will need to refer to these documents. The Documents will be available for you to see and print at www.tuneprotect.com
Important Notice
Please be informed that Service Tax will be implemented by the Government of Malaysia with effect from 1 September 2018 at a rate of six (6) per centum.
The Company reserves the right to collect from you an amount equivalent to the Service Tax payable on the applicable premium for the policy period, or in the event that the policy period commences before but expires after 1 September 2018, to collect from you an amount equivalent to the Service Tax payable on the applicable premium calculated from 1 September 2018 on a pro-rated basis.
Your obligation to pay Service Tax shall form part of the Terms and Conditions in your insurance policy.
The laws governing Service Tax are as per the Service Tax Act, 2018 and all Regulations passed by the Government of Malaysia from time to time.
EasyCare PA Insurance Policy
This is Your EasyCare PA Policy. Please read it carefully and if You find any information contained herein as incorrect, immediately return it to Us for correction.
Your Policy comprises this document, the Policy Schedule and any endorsement. They should be read as one document and any word or expression which has a particular meaning shall have the same meaning wherever it may appear throughout the Policy.
The written proposal and the declaration submitted by You shall form the contract of this insurance. The conditions appearing in this Policy or in any endorsement are part of this contract and must be complied with by You and/or the Insured Person before We pay a claim.
Our Agreement
STATEMENT Pursuant to Schedule 9 of the Financial Services Act 2013
A 'consumer insurance contract' is a contract of insurance entered into, varied or renewed by an individual wholly for purposes unrelated to Your trade, business or profession.
Consumer Insurance Contract (Insurance wholly for purposes unrelated to Your trade, business or profession)
This Policy is issued in consideration of the payment of premium as specified in the Policy Schedule and pursuant to the answers given in Your Proposal Form (or when You applied for this insurance) and any other disclosures made by You between the time of submission of Your Proposal Form (or when You applied for this insurance) and the time this contract is entered into. The answers and any other disclosures given by You shall form part of this contract of insurance between You and Us. However, in the event of any pre-contractual misrepresentation made in relation to Your answers or in any disclosures given by You, the remedies in Schedule 9 of the Financial Services Act 2013 will apply.
If You are required by Us, before this Policy is renewed or varied, to answer questions or if You are required to confirm or amend any matter previously disclosed by You to Us in relation to this Policy, it is Your duty not to make a misrepresentation when answering the questions or confirming or amending any matter previously disclosed.
You must inform Us of any change to the information given to Us in Your answers or in respect of any matter previously disclosed to Us in relation to this Policy if such changes had taken place after You have submitted the application for renewal or variation but before this Policy is renewed or varied.
This Policy reflects the terms and conditions of the contract of insurance as agreed between You and Us.
DEFINITIONS
The following definitions apply:
1. “Accident” shall mean a sudden, unforeseen and fortuitous external event happening during the period of insurance anywhere in the world.
2. “Accidental Death” shall mean any death that is due to an Accident and not from any natural causes.
3. “Sum Insured” shall mean the Sum Insured payable for Accidental Death and/or Permanent Disablement as specified in the Schedule of Benefits attached with this Policy, according to the selected plan.
4. “Chiropractor/Sinseh/Bonesetter” shall mean a person qualified by a medical degree/certification and duly licensed or registered to practice medicine in the geographical area of his practice and who in rendering such services is practicing within the scope of his licensing and training.
5. "Chiropractor/Sinseh/Bonesetter/Traditional Treatment" shall mean treatment by a Chiropractor, or any traditional form of treatment by a Sinseh, Bonesetter, or any other traditional and complementary physicians registered with the Ministry of Health.
6. “Hospital” shall mean an establishment lawfully constituted and registered as a Hospital for the care and treatment of sick and injured persons, and which:
(a) has facilities for diagnosis and major surgery;
(b) provides a 24-hour daily nursing service by registered and graduate nurses;
(c) is under the supervision of one or more Physicians; and
(d) is not primarily a clinic, a place for alcoholics or drug addicts, a nursing, rest or convalescence home or a home for the aged or similar establishments.
7. “Injury” shall mean bodily injuries caused solely and directly by an Accident.
8. “Insured Person” shall mean You or the person named as the Insured Person in the Policy Schedule.
9. “Loss” as used in reference to limbs shall mean physical severance or total and irrecoverable Loss of use.
10. “Loss of hearing” shall mean total and irrecoverable Loss of hearing which is medically certified as beyond remedy by surgical or other treatment.
11. “Loss of sight of eye” shall mean the total and irrecoverable Loss of sight of the eye which is medically certified as beyond remedy by surgical or other treatment.
12. “Loss of speech” shall mean total and permanent inability to communicate verbally which is medically certified as beyond remedy by surgical or other treatment.
13. “Medical Expenses” shall mean expenses paid by the Insured Person to a Medical Practitioner, medical clinic, nurse, Hospital and/or ambulance services for medical, medical report, surgical, X-ray, Hospital or nursing treatment including the cost of medical supplies, ambulance hire, cost of Dental Treatment and physiotherapy treatment due to accident. All treatment including specialist treatment must be prescribed or referred by a Medical Practitioner, Surgeon or Physician in order for expenses to be reimbursed.
14. “Medical Practitioner” or “Physician” or “Surgeon” shall mean a person qualified by a degree in western medicine and legally registered to practice western medicine in the geographical area of practice, and who also possess a current Annual Practising Certificate issued by the Malaysian Medical Council.
15. “Nuclear, Chemical or Biological Terrorism” shall mean the use of any nuclear weapon or device or the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous chemical agent and/or biological agent during the period of this insurance by any person or group(s) of persons, whether political, religious or ideological purposes or reasons including the intention to influence any government and/or to put the public, or any section of the public, in fear.
16. “Permanent Disablement” shall mean an Injury which:
(a) falls into any of the injuries listed under Benefit 2 in the Table of Benefits Payable in
Percentage; and
(b) where applicable, has lasted for a continuous period of 365 days from the date of
the Accident with no hope of improvement at the end of that period.
17. "Pre-existing Illness" shall mean an illness which has been diagnosed or presents symptoms
which would have required medical treatment prior to the commencement date of
insurance of the Insured Person, irrespective of whether treatment was actually received.
18. “Sum Insured” shall mean the Sum Insured inclusive of any renewal bonus.
19. “Total Permanent Disablement” means an Injury suffered by the Insured Person resulting in the Insured Person being permanently bedridden or causing permanent disablement from gainful employment of any kind and is medically certified by a legally qualified Medical Practitioner as beyond hope of improvement or recovery by surgical or other treatment and will continue for the remainder of the Insured Person’s life.
20. “We/Us/Our/the Company” shall mean TUNE INSURANCE MALAYSIA BERHAD.
21. “You/Your” shall mean the person named as the Insured in the Policy Schedule.
ELIGIBILITY
Underwriting Criteria:
1. A Malaysian citizen or a permanent resident of Malaysia or an expatriate having a valid
working permit in Malaysia.
2. Age Limit: 16 years old to 70 years old
3. Only one plan is allowed per Insured Person.
4. The policy is applicable to Kad OKU holders.
SCHEDULE OF BENEFITS
| No. | Benefits | Sum Insured (RM) | |
|---|---|---|---|
| Silver Plan | Gold Plan | ||
| 1. | Accidental Death | 25,000.00 | 50,000.00 |
| 2. | Permanent Disablement (Refer to Table of Benefits Payable in Percentage) |
25,000.00 | 50,000.00 |
| 3. | Medical Expenses | Up to 1,000.00 | Up to 2,000.00 |
| 4. | Ambulance Fees (per accident) | Up to 500.00 | |
| 5. | Bereavement Allowance | 2,000.00 | |
| 6. | Rehabilitation Allowance | 2,000.00 | |
TABLE OF BENEFITS PAYABLE IN PERCENTAGE
|
Benefit |
Benefits Payable To Any One Person Per Accident |
Percentage of Sum Insured Payable |
||||
|
1 |
Permanent Disablement, under any of the following categories: |
|
||||
|
1.1 |
Total Permanent Disablement |
100% |
||||
|
1.2 |
Loss of both hands |
100% |
||||
|
1.3 |
Loss of both feet |
100% |
||||
|
1.4 |
Total and irrecoverable loss of sight in both eyes |
100% |
||||
|
1.5 |
Loss of one hand and one foot |
100% |
||||
|
1.6 |
Loss of arm at shoulder |
100% |
||||
|
1.7 |
Loss of arm between shoulder and elbow |
100% |
||||
|
1.8 |
Loss of arm at elbow |
100% |
||||
|
1.9 |
Loss of arm between elbow and wrist |
100% |
||||
|
1.10 |
Loss of hand at wrist |
100% |
||||
|
1.11 |
Loss of leg at hip |
100% |
||||
|
1.12 |
Loss of leg between knee and hip |
100% |
||||
|
1.13 |
Loss of leg below knee |
100% |
||||
|
1.14 |
Loss of whole eye or loss of sight of eye |
100% |
||||
|
1.15 |
Total and irrecoverable perception of light loss of sight in one eye except |
50% |
||||
|
1.16 |
Loss of four fingers and thumb of one hand |
53% |
||||
|
1.17 |
Loss of four fingers |
40% |
||||
|
1.18 |
Loss of thumb |
|
||||
|
1.19 |
Loss of index finger |
|
||||
|
1.20 |
Loss of middle finger |
|
||||
|
1.21 |
Loss of ring finger |
|
||||
|
1.22 |
Loss of little finger |
|
||||
|
1.23 |
Loss of metacarpals |
|
||||
|
1.24 |
Loss of toes |
|
||||
|
1.25 |
Loss of hearing of |
|
||||
|
1.26 |
Loss of speech |
60% |
||||
DESCRIPTION OF BENEFITS
BENEFIT 1 – ACCIDENTAL DEATH
We will pay the Sum Insured in accordance with the Insured Person’s age at the time of the Accident if the Insured Person sustains Injury as a result of an Accident which solely and independently of any other cause shall within 365 days result in Accidental Death. Thereafter, the insurance of such Insured Person shall immediately cease to be in force.
For the avoidance of doubt, if any amount(s) has been paid under Benefit 2 and there is a subsequent claim under Benefit 1, We will pay the Sum Insured, less the amount(s) earlier paid in relation to Benefit 2.
BENEFIT 2 – PERMANENT DISABLEMENT
We will pay the Sum Insured in accordance with the Insured Person’s age at the time of the Accident and the percentage as specified in the Table of Benefits Payable in Percentage, if the Insured Person sustains an Injury as a result of an Accident which solely and independently of any other cause shall within 365 days result in Permanent Disablement. The insurance of such Insured Person shall immediately cease to be in force in the event We have paid 100% of the Sum Insured.
For the avoidance of doubt, if any amount(s) has been paid under Benefit 2 and there is a subsequent claim arising under Benefit 2, We will pay the Sum Insured in accordance with the Insured Person’s age at the time of the Accident and the percentage as specified in the Table of Benefits Payable in Percentage, less the amount(s) earlier paid under Benefit 2.
BENEFIT 3 – MEDICAL EXPENSES
In the event of accidental injury where medical treatment is inevitable, We will reimburse you up to the Sum Insured for the actual, necessary and reasonable medical, clinical and surgical treatment (including subsequent expenses for sinseh or traditional treatment but limited to RM 80 per visit)
BENEFIT 4 - AMBULANCE FEES
As a result of a covered Accident occurring during the period of insurance, the Insured Person is hospitalised or discharged from a Hospital and requires the use of ambulance services for the purpose of transportation to, from or between Hospitals, We will reimburse the actual expense incurred by the Insured Person up to the amount specified in the Schedule of Benefit. All claims must be evidenced and supported by original bill(s) and receipt(s).
BENEFIT 5 – BEREAVEMENT ALLOWANCE
In the event of the Insured Person’s Accidental Death where the Sum Insured for Accidental Death is payable, We will, upon receipt of the police report (for Accidental Death) and death certificate, pay a lump sum of RM 2,000 as bereavement allowance.
BENEFIT 6 – REHABILITATION ALLOWANCE
If You are required to undergo rehabilitation as deemed medically necessary by the consulting physician for his convalescence from the injury, We will pay a lump sum of RM 2,000 as Rehabilitation Allowance.
EXCLUSIONS APPLYING TO THE WHOLE POLICY
Subject to the benefits and extensions applicable to this Policy, We will not pay the Benefits if the Injury is directly or indirectly caused by or resulted from or traceable to:
1. any consequence of war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or military or usurped power.
2. nuclear weapons material, ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion including any self-sustaining process of nuclear fission of nuclear fuel.
3. any Nuclear, Chemical or Biological Terrorism.
4. any Pre-existing Illness, physical or mental defect or infirmity, pregnancy, childbirth, miscarriage or any complications associated with pregnancy.
5. disease or sickness of any kind, parasitic, bacterial or viral infection.
6. HIV (Human Immunodeficiency Virus) and/or HIV related illness including Acquired Immune Deficiency Syndrome (AIDS) and/or any mutant derivatives or variations thereof
howsoever caused.
7. provoked murder or assault, intentional self-injury, suicide or attempted suicide while sane or insane, the effects of drugs unless taken as prescribed by a registered Medical
Practitioner for an illness and not for the treatment of drug addiction, or where the Insured Person is a driver intoxicated by alcohol as provided under the law.
8. the Insured Person engaging in or taking part in:
- winter sports, ice hockey, sea-angling, boating or yachting beyond five (5) kilometers off any coastline, scuba diving unless the Insured Person is a member of a recognised diving club and holds a valid diving license or is diving under the guidance of a professional diving instructor, horseback polo playing, steeple- chasing, boxing, wrestling, go-karting, parachuting, hang-gliding, skydiving, bare hand rock or cliff scaling, hunting outside the territorial limits of Malaysia, motor sports rallies or competitions, speed testing, reliability trials or racing of any kind other than on foot, professional or semi-professional sports.
- flying or any aerial activities otherwise than as a fare-paying passenger in an aircraft provided and operated by an airline which is duly licensed for the regular transportation over an established air route.
- any field operations undertaken by the military, police or security services, fire- fighting, airline as pilot or aircrew, or mining of mineral as miners (whether voluntarily or otherwise)
- the use of any kind of power driven woodworking machinery or circular saw for the purpose of his occupation or for reward.
- other occupations such as jockey, professional entertainer, social escort, explosive handler/maker, sailor, acrobat, bodyguard, debt collector, demolition worker, quarry worker, steeplejack, sawyer, security guard, oil rig worker, plantation/ estate worker (other than owner) or construction worker.
- criminal or illegal activities.
- travelling (whether as driver, attendant or passenger) in any tanker lorry and/or lorry or truck used for the carriage of timber and/or logs.
- motorcycling
CONDITIONS APPLYING TO THE WHOLE POLICY
1. Alterations
This Policy shall not be altered in any manner unless with Our prior written approval and evidenced by endorsement.
2. Change in Risk
You and/or the Insured Person must notify Us in writing immediately upon the occurrence of You and/or the Insured Person changing occupation or profession.
Upon receipt of the notification, We reserve the right to or not to impose certain terms and conditions of the Policy or to terminate the Policy.
If there is a change in risk and at the time of Accident giving rise to a claim under this Policy,
We had not received any prior notification of such change, We shall reserve the right to:
- refuse the claim;or
- reduce the claim amount payable proportionately by the percentage difference in the premium charged under the Policy if the change of risk warrants a higher premium to be charged under the Policy.
If the Insured Person’s occupation or profession is changed to an excluded occupation or profession stated in the Policy, this Policy shall be deemed null and void from the date of the change regardless whether You and/ or the Insured Person has informed Us. The premium for the unexpired period from the date of the change shall be refunded to You.
3. Transfer of Interest
No interest in this Policy may be transferred without Our written consent. We will only recognize and be bound to accept those interests which are notified to Us at the time of issue of cover, or which are notified to Us from time to time and accepted by Us. All persons entitled to any benefit under this Policy shall be bound by the terms of this Policy and a receipt from such persons shall effectively discharge Us from this Policy.
4. Fraud
We may refuse a claim or cancel this Policy or do both if You are found to have made a misrepresentation or was untruthful in any statement made in the proposal and declaration or the claim is fraudulent or exaggerated.
5. Remedies for misrepresentation for consumer insurance contract
- We may, at Our sole and absolute discretion, avoid the Policy in the event of any pre- contractual misrepresentation made by You in relation to any answers or disclosure made in Your Proposal Form and declaration:-
- is a deliberate or reckless misrepresentation;or
- is a careless or innocent misrepresentation.
In the event this Policy is invalidated or is avoided pursuant to this Clause 5.1, Our liability shall be limited to the refund of premiums paid without interest less any indebtedness by You to Us under this Policy.
- In the event of any pre-contractual misrepresentation(s) made by You in relation to any answer(s) or disclosure(s) made by You in Your Proposal Form and Declarationis a careless or innocent misrepresentation, and but for the misrepresentation, We would have issued or renewed this Policy but on different terms and conditions,We may, at Our sole and absolute discretion:-
- vary any of the terms and conditions of this Policy and treat this Policy as if it had been issued or renewed on the varied terms and conditions; and
- in addition to Clause 5.2(a), reduce proportionately the amount to be paid on a claim in accordance with Our relevant Policy at the material time.
6. Cancelling The Policy
- You may cancel this Policy at any time by giving Us notice in writing and, provided that no claim was made during the current period of insurance, We will, subject to Our retention of a minimum premium of RM5.00 (excluding Services Tax), make a refund of premium paid for the unexpired period of insurance calculated on pro-rated basis.
- We may also cancel this Policy at any time by giving You fourteen (14) days' written notice by registered letter at Your address last known to Us. Upon cancellation of the Policy, We will refund to You a proportionate part of the premium corresponding to the unexpired period of insurance.
7. Making a Claim
In the event of a claim:
- The Claimant must notify Us within thirty (30) days after the happening of the Accident, complete Our claim form and at his own expense furnish Us with all information, medical and other certificates and evidence which We may reasonably require to assess the claim.
- Failure to notify Us within the above time limit shall not invalidate a claim if the Claimant can satisfy Us that it was not reasonably possible to give such notice within the prescribed time..
- In order to further assess the claim, the Insured Person may be required to undergo any medical examination at Our expense during such period or periods as We may reasonably require.
- In the event of Accidental Death of the Insured Person, We shall be entitled at Our expense to conduct a post-mortem examination where it is not prohibited by law.
- In the event of a dispute relating to the cause of the Insured Person’s death that is not due solely from an Accident but may be caused by the Insured Person’s underlying medical condition, We shall only pay 25% of the Sum Insured to Your Legal Representative.
- In the event of a dispute relating to the cause of the Insured Person’s Permanent Disablement that is not due solely from an Accident but may be caused by the Insured Person’s underlying medical condition, no claims shall be payable.
8. Payment of Benefits
- If You are not the Insured Person, all Benefits (including the Sum Insured for Accidental Death) payable under this Policy shall be paid to You and Your receipt of the said payment shall effectively discharge Us from all liabilities under this Policy.
- If You are also the Insured Person and in the event of Your Accidental Death, where You currently have valid nominee(s) with or without trustee(s) under this Policy, the Accidental Death Benefit will be paid in accordance with the provisions of the Financial Services Act 2013.
9. Currency Exchange Rates
All Benefits under this Policy are payable in Malaysian Ringgit. Medical bills incurred in foreign currency shall be converted to Malaysian Ringgit based on the quoted exchange rate (open market rate if a free market, official rate if not a free market) on the date the Insured Person is discharged from Hospital.
10. Arbitration
All differences arising out of this Policy shall be referred to the decision of an arbitrator who shall be appointed in writing by You and Us. If there is no agreement on a single arbitrator, then two arbitrators are to be appointed in writing, one by You and the other by Us, within one (1) calendar month of the disagreement. In case of disagreement between the arbitrators, an umpire is to be appointed by the arbitrators in writing before hearing the reference. The arbitrator or arbitrators and/or umpire must make an award before You can commence legal proceedings against Us.
11. Time Limitation
We will not be liable to pay any claim made after the expiration of twelve (12) calendar months from the happening of the Accident. Also, if We disclaim liability for any claim, You must refer the claim to arbitration within twelve (12) calendar months from the date of Our disclaimer. If You do not do so, then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable under this Policy.
12. Applicable Law
This Policy is governed by and shall be construed in accordance with the laws of Malaysia.
13. Auto Renewal
We will automatically renew Your Policy upon the expiry of Your Policy unless You have informed otherwise. This auto renewal condition is further subject to the Cash Before Cover Clause.
14. Cash Before Cover Clause
It is a fundamental and absolute special condition of this contract of insurance that the premium due must be paid and received by Us before cover commences. If this condition is not complied with, then this insurance will be null and void.
We reserve the right to refuse any coverage and/or reject any claim resulting from non- payment of premium to Us.
15. Notification on Service Tax Implementation effective 1 September 2018
Please be informed that a 6% Service Tax will be charged for all taxable general insurance policies with period of insurance commencing on or after 1st September 2018 or policies spanning across 1st September 2018 (pro-rated charge).
You are obligated to pay all applicable taxes (which include but are not limited to service tax and stamp duty) imposed by the Malaysian tax authorities in relation to this Policy.
16. Sanction Limitation and Exclusion Clause (SANC)
At the sole discretion of the Company, the Company shall not be deemed to provide cover and shall not receive any payment(s) under the Policy; or be liable to pay any sums (including but not limited to payment of claims, refund of premiums, surrender or cancellation payments); or provide any benefit under the Policy; to the extent that the provision of such cover, payment of such sum or provision of such benefit would expose the Company to any sanction, prohibition or restriction under any laws and/or regulations, administered by any governmental, regulatory or competent authority, or any law enforcement in any country.
IMPORTANT NOTICE
Every effort will be made by Us to fulfill Our obligation under the Policy. If You are unhappy or dissatisfied with Our service or have any complaints, You may call or write to Us at:
Tune Insurance Malaysia Berhad
Complaint Unit
Level 9, Wisma Tune
No. 19, Lorong Dungun Damansara Heights
50490 Kuala Lumpur
Customer Hotline: 1800 88 5753
Tel: 603-2087 9000
Fax: 603-2094 1366
Website: www.tuneprotect.com
Email: [email protected]
If You are not satisfied with the response of Our decision, You may submit Your complaint either to The Ombudsman For Financial Services (OFS) within 6 months from the date of Our final decision or to Bank Negara Malaysia (BNM).
Your complaint shall be submitted to either OFS or BNM based on the following limits:-
- RM250,000 for a dispute involving financial services or products other than a dispute in (b) and (c) below
- RM10,000 for a dispute on motor third party property damage insurance claims; and
- RM25,000 for a dispute on an unauthorized transaction through the use of a designated payment instrument or a payment channel such as internet banking, mobile banking, telephone banking or an unauthorized use of cheque
Complaint refers to BNM shall not exceed RM500,000 involving claims, except if the complaint relates to the quality of service and unfair handling
The following are the contact details for FMB and OFS:
Laman Informasi Nasihat dan Khidmat (LINK)
Bank Negara Malaysia
Ground Floor Block C
Jalan Dato’ Onn
50480 Kuala Lumpur
Tel: 1-300-88-5465
Fax: 03-21741515
Email: [email protected]
OR
Ombudsman for Financial Services (664393P)
(Formerly known as Financial Mediation Bureau)
Level 14, Main Block, Menara Takaful Malaysia
No. 4, Jalan Sultan Sulaiman, 50000 Kuala Lumpur
Tel: 03-2272 2811
Fax: 03-2272 1577
Email: [email protected]
Website:www.ofs.org.my