Goodwill Cashless Health Claims Assistance - FAQ

𝘕𝘰𝘵𝘦: 𝘖𝘶𝘳 𝘱𝘳𝘦𝘷𝘪𝘰𝘶𝘴 𝘊𝘖𝘝𝘐𝘋-19 𝘊𝘰𝘮𝘱𝘭𝘪𝘮𝘦𝘯𝘵𝘢𝘳𝘺 𝘊𝘢𝘴𝘩 𝘈𝘴𝘴𝘪𝘴𝘵𝘢𝘯𝘤𝘦 𝘧𝘶𝘯𝘥 𝘪𝘴 𝘤𝘭𝘰𝘴𝘦𝘥. 𝘗𝘭𝘦𝘢𝘴𝘦 𝘳𝘦𝘧𝘦𝘳 𝘵𝘰 𝘵𝘩𝘦 𝘎𝘰𝘰𝘥𝘸𝘪𝘭𝘭 𝘏𝘦𝘢𝘭𝘵𝘩 𝘊𝘭𝘢𝘪𝘮𝘴 𝘈𝘴𝘴𝘪𝘴𝘵𝘢𝘯𝘤𝘦 𝘍𝘈𝘘 below 𝘧𝘰𝘳 𝘢𝘭𝘭 𝘊𝘖𝘝𝘐𝘋-19 𝘳𝘦𝘭𝘢𝘵𝘦𝘥 𝘤𝘭𝘢𝘪𝘮𝘴.

1. What is Goodwill Health Claims Assistance for COVID-19 Campaign?

This Medical Plan COVID-19 Coverage Campaign is specially designed by AXA AFFIN Life Insurance Berhad to help our customers during this challenging time, by covering hospitalisation treatment due to COVID-19 for eligible customers. This means, we will provide reimbursement on goodwill basis for hospitalisation treatment due to COVID-19.

This reimbursement is payable on goodwill basis and will not reduce your medical plan annual limit.

Please refer to the terms and conditions of the campaign.

2. Do I need to pay additional cost to sign-up for this campaign?

There will be no additional cost required from you for this COVID-19 Medical Plan Coverage Campaign.

3. What are the eligibility criteria for this campaign?

Customer (Insured) has completed COVID-19 vaccination, as follows:
- 2 doses of Pfizer, AstraZeneca or Sinovac; or
- 1 dose of Cansino or Johnson&Johnson; or
- any new vaccine that will be added to the Immunisation Schedule for National Immunisation Program of Malaysia, and must be administered by the Ministry of Health Malaysia.

Customer who purchased the following medical plan listed below will be automatically enrolled in this campaign at no additional cost:
(a) OneMedic
(b) AXA Medic Essential
(c) Medic Assure
(d) HOPE Medic 3
(e) HOPE Medic 2
(f) HOPE Medic
(g) Medical Care Plus
(h) Medical Care
(i) iMed
(j) AXA eMedic

4. I am currently covered under AXA AFFIN Life Insurance Berhad policies, but without any of the eligible medical plans, am I still eligible for this campaign?

No, only policies with the eligible medical plans are entitled for this campaign.

5. I bought a medical policy for my child and he has not been vaccinated. Is my child eligible for this campaign?

Yes. For Insureds below the age of 18 at the time of hospitalisation due to COVID-19, a claim for the goodwill assistance can be made up to the Maximum Limits and condition as defined in this campaign.

However, We reserve the right to change or withdraw this consideration upon commencement of the National Vaccination program for children.

6. I am currently covered under 2 eligible medical plans under this campaign, am I eligible for 2 reimbursements?

No, only one reimbursement per insured will be payable. Only the highest Maximum Limit shall be applied for the same hospitalisation.

Only limited to one claim per insured under this campaign.

7. Is cashless facility available for this campaign?

Yes. You can apply cashless facility under this campaign. Please check with your servicing agent / financial executive / sales representative / our Customer Care Center on the application process, terms and conditions.
Customer Care Centre (available Mon - Thurs 8:30am to 5:30pm, Friday, 8:30am to 5pm):
Contact No. -- 1300 88 1616
Email Add -- customer.care@axa-life.com.my

8. If I am hospitalised overseas due to COVID-19, am I eligible for this campaign?

No.

9. If I was hospitalised due to COVID-19 before the campaign period, can I submit for reimbursement under this campaign?

No. The onset date of hospitalisation due to COVID-19 must happen during the Campaign Period.

10. If I have already made claims on my medical plan and have already exhausted the annual limit for that policy year, am I still eligible for this campaign?

Yes, as long as you fulfil the eligibility criteria for this campaign. This reimbursement of the eligible claim under this campaign will not reduce your medical plan annual limit.

Important Note: Please note that the reimbursement will be capped at the Maximum Limit stated above or the respective plan’s annual limit, whichever is lower. For example:

Eligible Medical Plan and Plan Type and their Annual Limits

- HOPE Medic – Bronze: RM 50,000
- HOPE Medic 2 – Bronze: RM 50,000
- HOPE Medic 3 – Bronze: RM 50,000
- Medic Assure – Bronze: RM 50,000
- HOPE Medic – Silver: RM 100,000
- HOPE Medic 2 – Silver: RM 100,000
- HOPE Medic 3 – Silver: RM 100,000
- Medic Assure – Silver: RM 100,000
- Medical Care – Bronze: RM 50,000
- Medical Care Plus – Bronze: RM 50,000
- AXA eMedic – Plan 50: RM 50,000
- AXA eMedic – Plan 20: RM 20,000
- iMed – Plan 60: RM 60,000

11. Can I submit claim under this campaign for any out-patient treatment (inclusive of pre-hospitalisation, post-hospitalisation etc)?

No. We will only reimburse the Reasonable and Customary Charges incurred for Medically Necessary treatments received by the Insured of the eligible medical plans as stated above, who undergoes hospitalisation for the purpose of COVID-19 Condition medical treatments during the Campaign Period.

A patient shall not be considered as an In-Patient if the patient does not physically stay in the Hospital for the whole period of hospitalisation. In-Patient means an overnight admission of an Insured into a Hospital in order to receive treatment.

12. Will a claim under this campaign use up the annual limit under my medical plan?

No, any reimbursement that is provided under this campaign shall not reduce any annual limit that applies to your medical plan.

13. Is there any waiting period imposed for any claims made under this campaign?

Yes. A 30-day waiting period is for this campaign eligibility and commenced concurrently from your medical plan policy effective date.

14. Can I still claim if I am hospitalised due to COVID-19 under Stage 1 and 2?

No.

15. If my condition progresses from Stage 1 or 2 to Stage 3, 4 or 5, am I eligible for this campaign?

Yes, as long as you fulfil the criteria defined by Stage 3, 4 and 5 of COVID-19, you are eligible for one claim during the campaign period.

16. If my condition progresses from Stage 4 to Stage 5 during the same hospitalisation period, what is the reimbursement amount that I am entitled to?

If there is more than one claim under different stage of COVID-19 condition, the reimbursement shall only be limited to the the highest Maximum Limit. For this instances, the reimbursement amount shall be capped to the Maximum Limit of Stage 5 or the medical plan’s annual limit, if applicable. Only the highest Maximum Limit shall be applicable for the same hospitalisation. Only limited to one claim per insured under this campaign.

17. How do I submit a claim under this campaign?

The required documents as below must be submitted to us:
- Proof of COVID-19 Vaccination / Vaccination Certificate;
- Duly Completed Claim Form (By Claimant);
- Discharge Summary;
- Hospital bills (detailed / itemized);
- COVID-19 test report; and
- Any Imaging and laboratory reports such as x-rays and blood test results.

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