COVID-19 Medical Plan Coverage Campaign

In the early stage of the pandemic, Prudential Malaysia had on a goodwill basis, covered medical treatment costs for Prudential Malaysia customers treated for COVID-19 at designated government hospitals, until further notice and subsequently introduced Special COVID-19 Coverage 2021 and COVID-19 Hospitalisation Campaign (COVID-19 Hospitalisation Assistance and COVID-19 Upgraded Plan Assistance), also on a goodwill basis, to assist Prudential Malaysia customers during this difficult period (collectively referred to as “Campaigns”).

Prudential Malaysia will now introduce the COVID-19 Medical Plan Coverage Campaign for Prudential Malaysia customers where its terms and conditions are as set out below. With this, the Campaigns will end.

COVID-19 Medical Plan Coverage Campaign Terms and Conditions

1. This COVID-19 Medical Plan Coverage Campaign (“Campaign”) is provided by Prudential Assurance Malaysia Berhad and Prudential BSN Takaful Berhad (collectively referred to as “Prudential Malaysia”) on goodwill basis for Prudential Malaysia customers. Prudential Malaysia reserves the right to change any part of this Campaign or withdraw any part (or in whole) of this Campaign at any time with or without notice.

2. This Campaign will be administered based on the terms and conditions set for this Campaign, Frequently Asked Questions as well as the eligibility criteria, which are made available in the corporate website of Prudential Malaysia (“Prevailing Document”). Please note that the Prevailing Document shall prevail, in the event of any inconsistencies between the Prevailing Document and any other materials relating to this Campaign.

Below is the list of eligible Medical Plans under this Campaign:

3. Prudential Malaysia customer means Life Assured/Covered Person, who is covered under the eligible Medical Plans under this Campaign.

4. Prudential Malaysia will on goodwill basis, reimburse Reasonable and Customary Charges incurred for Medically Necessary treatments received when Prudential Malaysia Customer undergoes hospitalisation due to COVID-19 during the Coverage Period of this Campaign. The reimbursement will be provided based on the terms and conditions stated in the Prudential Malaysia’s insurance contract/ takaful certificate, where  the eligible Medical Plan will be treated as if it does not have a pandemic exclusion clause*.

   This means, Prudential Malaysia will provide the reimbursement based on the limits (such as annual limit, lifetime limit, maximum amount payable for each benefit), and all other terms and conditions stated in the insurance contract/ takaful certificate, including terms concerning Medically Necessary and Reasonable and Customary Charges. Therefore, the reimbursement provided shall reduce any annual limit, lifetime limit and med value point that apply to the Prudential Malaysia Customer’s Medical Plan.
   
   *Pandemic exclusion clause refers to a clause that states the Medical Plan does not cover communicable disease requiring quarantine by law.

5. The Medical Plan that resulted in the eligibility of the coverage provided under this Campaign must be in-force upon diagnosis, hospitalisation due to COVID-19 and upon claims submission.

6. Prudential Malaysia customers, who are eligible for this Campaign, can only start enjoying the coverage under this Campaign, after the expiry of 30 days waiting period Medical Plans.

7. Claims must be submitted within 3 months from the hospitalisation date. Prudential Malaysia requires the Policy Owner/ Certificate Owner to accept specifically that the claims will be processed, managed and reimbursed based on Prevailing Document.

8. All documents as stated above must be submitted via PRUServe Plus or customers may email us at customer.mys@prudential.com.my or customer@prubsn.com.my. Customers can also submit the documents via Pulse by Prudential app, when the function is made available.

9. This Campaign shall supersede all other campaigns or communications relating to Prudential Malaysia reimbursing hospitalisation expenses incurred to treat COVID-19.

10. In case of dispute, Prudential Malaysia shall have the absolute right of final decision.

11. If there are any inconsistencies between the English and other versions of this document in other languages, for the purposes of interpretation and construction, the English language version of this document shall prevail and be given effect to.

Campaign’s Background Information

1. What is COVID-19 Medical Plan Coverage Campaign?
   

   • This COVID-19 Medical Plan Coverage Campaign (“Campaign”) is specially designed by Prudential Assurance Malaysia Berhad and Prudential BSN Takaful Berhad (collectively referred to as “Prudential Malaysia”) to support our Prudential Malaysia customers so that we can provide them with financial freedom and peace of mind during this challenging time.

   • This Campaign will be administered based on the terms and conditions set, Frequently Asked Questions, as well as the eligibility criteria.

   • Briefly, when a Prudential Malaysia customer is eligible for this Campaign, Prudential Malaysia will provide reimbursement on goodwill basis for medical expenses resulting from the hospitalisation treatment due to COVID-19 infection.

   
   Prudential Malaysia customer means Life Assured/Covered Person, who are covered under eligible Medical Plans under this Campaign (as listed in the terms and conditions of this Campaign). The Medical Plan that resulted in the eligibility of the coverage provided under this Campaign must be in-force upon diagnosis, hospitalisation and claims submission.
   
   Eligibility Criteria & Enrollment

2. What are the eligibility criteria for the coverage and coverage period provided under this Campaign?

COVID-19 Medical Plan Coverage Campaign

Below is the list of eligible Medical Plans under this Campaign:

3. How much does this COVID-19 Medical Plan Coverage Campaign cost me with eligible medical plans as defined under item #2?
   There will be no additional cost required from you for this COVID-19 Medical Plan Coverage Campaign.

4. Do I need to sign up for this COVID-19 Medical Plan Coverage Campaign?
   You have been automatically enrolled in this Campaign if you have any of the eligible Medical Plans.
   
   Claims Information – Eligibility Items

5. I have made a claim under COVID-19 Hospitalisation Assistance/COVID-19 Upgraded Plan Assistance. Am I still eligible for this Campaign?
   Yes, as long as you fulfil the eligibility criteria for this Campaign.
   
   Please note that this Campaign shall supersede all other campaigns or communications relating to Prudential Malaysia reimbursing hospitalisation expenses incurred to treat COVID-19. This includes superseding COVID-19 Hospitalisation Assistance and COVID-19 Upgraded Plan Assistance.
   
   On another note, Special COVID-19 Coverage 2021 that provides for cash relief has also ended with the launch of this Campaign.

6. If the hospitalisation due to COVID-19 happened overseas, am I eligible for this Campaign?
   Yes, the claim will be processed and administered under this Campaign based on the terms and conditions stated in the policy/certificate, including terms related to Reasonable and Customary Charges and Overseas Residence clause.

7. I have been admitted for some other conditions (not related to COVID-19) & then become COVID-19 positive, is HAS (cashless facility) available for the entire hospitalisation?
   Even if the other conditions are covered on cashless basis, all Reasonable and Customary Charges related to Medically Necessary treatment for COVID-19 infection will only be covered on reimbursement basis.

8. What is considered as Medically Necessary treatment received for COVID-19 hospitalisation?
   When customer receives among others, active treatments such ventilation support, oxygen support, intubation or intravenous medication during hospitalisation due to positive diagnosis.

9. Would I be reimbursed for COVID-19 Test & PPEs used during such Medically Necessary hospitalisation?
   Yes, COVID-19 test & Medically Necessary usage of PPEs during hospitalisation due to COVID-19 infection would be reimbursed based on Reasonable and Customary Charges. 

10. I am a Prudential Malaysia Customer, as explained under this Campaign. Can I submit claim under this Campaign for expenses incurred for in-hospitalisation treatment for subsequent complication sustained due to COVID-19, e.g: Pneumonia? Would I be covered under this Campaign, if I have recurrence of Covid-19 infection and I am hospitalised as a result of the recurrence?
    Yes, as long as it is for reimbursement of Reasonable and Customary Charges incurred for the Medically Necessary treatment received by you when you are hospitalised due to COVID-19 during this Campaign’s Coverage Period.

11. Can I submit claim under this Campaign for pre-hospitalisation and/or post-hospitalisation expenses incurred?
    Yes, if your Medical Plan is an eligible Medical Plan under this Campaign and the Medical Plan provides for coverage for pre-hospitalisation and post-hospitalisation expenses, as well as in-hospitalisation expenses.

12. Will a claim under this COVID-19 Medical Plan Coverage Campaign use up the annual limit and lifetime limit under my Medical Plan?
    Yes, any reimbursement that is provided under COVID-19 Medical Plan Coverage Campaign shall reduce any annual limit and lifetime limit that apply to your Medical Plan.
    
    Claims Information – Non-eligibility Items

13. I am currently covered under a medical plan that does not have pandemic exclusion clause^#. I also noticed that my medical plan is not one of the eligible Medical Plans under this Campaign. Am I still eligible for this Campaign?
    No, you are not eligible for this Campaign. You can submit your claims under your medical plan, which already covers for COVID-19 related admission. 
    
    ^#Refers to: PRUMajor Med 1 to PRUMajor Med 5, PRUSenior Med, PRUGuard My Medical, PRUParent issued by PAMB; Major Medical Cover and Major Medical Cover 2 issued by PruBSN.

14. I am currently covered under a medical plan that is not listed as one of the eligible Medical Plans under this Campaign. Am I eligible for this Campaign?
    No, you are not eligible for this Campaign.

15. Is Hospital Alliance Services (“HAS”) (cashless facility) available for hospitalisation due to COVID-19?
    No, HAS (cashless facility) is not available for COVID-19 related admissions. The claims submitted are on reimbursement basis. This means you need to pay the bills first, then submit the claims for reimbursement.

16. Can I submit a claim under this Campaign, if I am a Category 1 or 2 COVID-19 patient but I am asked to be hospitalised in a private hospital according to my doctor’s recommendation?
    In general, for a COVID-19 patient with no symptoms (Category 1 - asymptomatic) or who does not require active treatment i.e. in quarantine only (Category 1 - asymptomatic or Category 2 - symptomatic, no pneumonia), any services received during such hospitalisation including quarantine at Quarantine centers, Quarantine at Hospitals or Home quarantine would not be deemed as Medically Necessary. Hence, the expenses incurred will not be reimbursed under this Campaign, unless there is evidence showing the hospitalisation and treatment received are Medically Necessary and active treatment is required for the patient during the hospitalisation.

17. Can I submit a claim under this Campaign, if I am quarantined in a hospital or quarantine center or makeshift hospital for COVID-19 infection?
    No, a claim for quarantine is not payable under this Campaign.

18. I was hospitalised due to COVID-19 prior to 6^th August 2021. Can I submit reimbursement for such hospitalisation under this Campaign?
    No, this Campaign starts from 6^th August 2021 and it is for hospitalisation due to COVID-19 that happened on or after 6^th August 2021. 
    
    Any COVID-19 related hospitalisation prior to 6^th August 2021 can be considered under COVID-19 Hospitalisation Assistance and COVID-19 Upgraded Plan Assistance (depending on the eligibility), as long as the claim is submitted within 3 months from the date of diagnosis. 

19. If the hospitalisation happened before 6^th August 2021, am I eligible under this Campaign for pre-hospitalisation & post-hospitalisation claim?
    No, this Campaign starts from 6^th August 2021 and it is for hospitalisation due to COVID-19 that happened on or after 6^th August 2021. 
    
    Claims Information – Submission Process

20. How do I submit a claim for hospitalisation due to COVID-19?
    You can submit the required documents as below and submit to our nearest branch or submit them to your agent for the agent’s submission via PRUServe Plus (“PSP”) or via email. 

    	Prudential Assurance Malaysia Berhad	Prudential BSN Takaful Berhad
    E-mail	customer.mys@prudential.com.my	customer@prubsn.com.my

    You can also submit the documents via Pulse by Prudential app, when the function is made available.

    The documents required are as follows:

    i. Claim Form
    ii. Original hospital invoices & payment receipts
    iii. Copy of itemised bills
    iv. Discharge Summary
    v. All Imaging and laboratory reports such as x-rays and blood test results
    vi. Signed confirmation of acceptance for this Campaign
    vii. Supporting documents.
    
    

    Claims forms are available on Corporate Website. Kindly note that the list of documents above may be revised as and when required for claim assessment.

21. My condition progressed from being a Category 2 COVID-19 patient to Category 4 COVID-19 patient. What can I claim for under this Campaign?
    You can submit reimbursement claims for medical expenses incurred to treat COVID-19 during your hospitalisation.
    
    We will assess the claims based on the terms and conditions set for this Campaign, as well as the Frequently Asked Questions. Please refer to the above FAQs, which we explain on Medically Necessary treatment and  hospitalisation that are covered under this Campaign.

22. Is there any waiting period imposed for claim made under this Campaign?
    Yes. Prudential Malaysia customers, who are eligible for COVID-19 Medical Plan Coverage Campaign, can only start enjoying their coverage under this Campaign after the expiry of waiting period of 30 days medical plan.

23. I am covered under 2 eligible Medical Plans under this Campaign, one that is issued by Prudential Assurance Malaysia Berhad and the other that is issued by Prudential BSN Takaful Berhad. Am I eligible for 2 times reimbursement under COVID-19 Medical Plan Coverage Campaign?
    No. You can submit the claim either to Prudential Assurance Malaysia Berhad or Prudential BSN Takaful Berhad.

24. Why am I still able to sign up for COVID-19 Hospitalisation Campaign under PRUShoppe in Pulse by Prudential app?
    We are still updating the COVID-19 Hospitalisation Assistance & Post Vaccination Coverage Campaign information under PRUShoppe in Pulse by Prudential app. Even though you are still able to sign up for COVID-19 Hospitalisation Campaign, please note that COVID-19 Hospitalisation Assistance and COVID-19 Upgraded Plan Assistance have ended and have been superseded by this Campaign.
    
    Once the maintenance works complete, you will be able to sign up for Post COVID-19 Vaccination Coverage only.

25. Who do I contact for further clarification?

    	Prudential Assurance Malaysia Berhad	Prudential BSN Takaful Berhad
    Customer Service	603-2771 0228	603-2775 7188
    E-mail	customer.mys@prudential.com.my	customer@prubsn.com.my

Download here