Medical and Health Takaful
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Questions and Answers

What can happen if material facts are withheld or misrepresented on the Proposal Form?

  • The case can be taken directly to a higher court.
  • The certificate issued will be void and claims can be repudiated. (correct)
  • The Takaful Operator will process the claim efficiently.
  • The proposal will be automatically accepted without questions.

Which of the following actions is explicitly advised against when completing the Proposal Form?

  • Disclosing all material risks.
  • Answering all questions fully and accurately.
  • Leaving any question unanswered. (correct)
  • Using tick marks to answer all questions.

What does the medical card issued by the Takaful Operator provide to the holder?

  • Direct cash payments for all medical expenses.
  • Unlimited hospital visits without any restrictions.
  • Annual rewards based on health assessments.
  • Privileges according to the purchased medical plan. (correct)

What is a primary responsibility of the participant when applying for a Takaful plan?

<p>To comply with all terms, conditions, and endorsements of the certificate. (C)</p> Signup and view all the answers

In the context of health Takaful, which of the following benefits might be included?

<p>Daily hospital allowance benefit. (A)</p> Signup and view all the answers

What is the primary purpose of contributions made to a takaful fund?

<p>To guarantee mutual assistance in case of loss (C)</p> Signup and view all the answers

Which of the following is NOT a benefit of medical and health takaful?

<p>Investment growth on contributions (D)</p> Signup and view all the answers

What type of contract do participants enter into in medical and health takaful?

<p>A participative contribution contract (aqad) (A)</p> Signup and view all the answers

Which of the following medical expenses is explicitly covered by hospital services and professional fees?

<p>Ward charges (A)</p> Signup and view all the answers

The critical illness plan in medical takaful provides what type of benefit?

<p>A lump sum benefit upon diagnosis (C)</p> Signup and view all the answers

What is a common limitation found in hospitalization benefits under medical takaful?

<p>A maximum cash allowance per day (D)</p> Signup and view all the answers

What is the relationship between medical and health takaful and a basic family takaful plan?

<p>Medical takaful can serve as a supplementary contract to family takaful. (A)</p> Signup and view all the answers

What principle underlies the operation of takaful according to Islamic law?

<p>Cooperation and mutual protection among participants (B)</p> Signup and view all the answers

What is the minimum period after the effective date of the certificate before benefits can be claimed?

<p>30 days (B)</p> Signup and view all the answers

Which of the following would be considered a valid reason for rejecting a claim under the medical and health takaful?

<p>Treatment for a pre-existing condition (B)</p> Signup and view all the answers

What document is NOT required when lodging a claim?

<p>A copy of the insurance policy (A)</p> Signup and view all the answers

If a claimant misstates their age and this leads to a lower contribution, how will the claims be adjusted?

<p>Claims will be pro-rated based on the actual contribution paid (A)</p> Signup and view all the answers

Which of the following conditions is explicitly excluded from coverage under the medical and health takaful?

<p>Treatment for a venereal disease (B)</p> Signup and view all the answers

How long does a claimant have to appeal to the IMB from the date of the takaful operator's decision?

<p>6 months (B)</p> Signup and view all the answers

Which situation could result in a takaful operator not being liable for treatment costs?

<p>All of the above (D)</p> Signup and view all the answers

What is the maximum amount the IMB can handle for a claim?

<p>RM100,000 (A)</p> Signup and view all the answers

Which critical illness is NOT covered under the plan?

<p>Fibromyalgia (D)</p> Signup and view all the answers

Which of the following conditions relates specifically to a major surgical procedure listed in the plan?

<p>Heart valve surgery (A)</p> Signup and view all the answers

Which illness listed is associated with the nervous system?

<p>Acute Bacterial Meningitis (D)</p> Signup and view all the answers

What statement best describes 'pre-existing conditions' in relation to the critical illness plan?

<p>Disabilities that exist before the effective date of the plan. (A)</p> Signup and view all the answers

Which of the following is an example of a critical illness that can lead to fully covered hospitalization?

<p>Coma (B)</p> Signup and view all the answers

What benefit is NOT typically included in the medical and health takaful plan?

<p>Routine check-ups (D)</p> Signup and view all the answers

Which disease listed could be categorized as a viral infection?

<p>Full blown AIDS (A)</p> Signup and view all the answers

Which of the following can be classified as a major organ transplant?

<p>Major Organ Transplant (A)</p> Signup and view all the answers

Which of the following illnesses is categorized under chronic diseases in the plan?

<p>Chronic Lung Disease (D)</p> Signup and view all the answers

What is specifically excluded from coverage under the critical illness plan?

<p>Conditions that existed before the plan. (D)</p> Signup and view all the answers

Flashcards

What is a medical card?

A document that provides proof of your medical Takaful coverage and allows you to access medical services within the plan's terms.

What is a rider?

A medical Takaful plan that provides coverage for specific medical needs, such as cancer or critical illness, usually purchased as an add-on to a main medical plan.

What is an annual limit?

The maximum amount of money your Takaful Operator will pay for medical expenses each year.

What is a lifetime limit?

The maximum amount of money your Takaful Operator will pay for medical expenses throughout your lifetime.

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What is daily hospital allowance benefit?

The amount of money your Takaful Operator pays per day for your hospital stay, depending on your plan.

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Takaful

A form of Islamic insurance where members contribute to a pool to protect each other from losses.

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Medical & Health Takaful

Covers the costs of private medical treatment for hospitalization and healthcare, often offered as a separate plan or part of a broader family plan.

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Participative Contribution (Tabarru')

The contribution you make to the takaful fund, showing your commitment to the mutual support system.

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Contract (Aqad)

The agreement you enter into with the takaful provider, outlining the terms of your participation and the benefits you'll receive.

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Hospital Services & Professional Fees Plan

Covers the costs of hospital services, professional fees, and ward charges arising from injury or illness.

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Hospitalization Benefits Plan

Provides a daily cash allowance for each day you're hospitalized due to illness or injury, up to a defined maximum number of days.

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Critical Illness Plan

A plan that offers a lump sum payment if you are diagnosed with any of the critical illnesses listed in the certificate.

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Main Types of Medical & Health Takaful Plans

The main types of medical and health takaful plans, each offering different coverage and benefits.

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Critical Illness

A serious medical condition covered by the critical illness plan. Examples include heart attack, stroke, cancer, and kidney failure.

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Pre-existing Conditions

Medical conditions that existed before your critical illness plan started and may have symptoms or require treatment.

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Effective Date

The date on which your critical illness plan becomes active and starts providing coverage.

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Benefits

The amount of money you receive from the critical illness plan if you are diagnosed with a covered illness.

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Hospitalization

Coverage for medical expenses incurred while staying in a hospital.

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Outpatient Treatment

Coverage for medical expenses incurred while receiving treatment outside a hospital.

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Intensive Unit Care

Coverage for medical expenses incurred while receiving care in an intensive care unit.

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Doctor Visits

Coverage for medical expenses incurred during visits to a doctor.

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Ambulance Services

Coverage for medical expenses incurred during transportation to a hospital in case of an emergency.

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Surgery

Coverage for medical expenses incurred during a surgical procedure.

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What is the qualifying period for medical and health takaful benefits?

A period of 30 days after the effective date of the medical and health takaful certificate, during which benefits are not activated.

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What happens if you misstated your age in a medical and health takaful application?

A claim will be adjusted proportionally, based on the difference between the actual contribution paid and the contribution that should have been paid, if the insured's age was misrepresented at the time of application.

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What is a pre-existing illness?

A pre-existing condition refers to any health issue or illness that existed before the takaful certificate was issued.

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What are exclusions in medical and health takaful?

Conditions that are not covered by the takaful plan are called exclusions.

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What is the meaning of 'disability' in medical and health takaful?

It's a period of time during which you're considered unable to work due to illness or injury.

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What should you do before receiving treatment for a medical condition?

You must inform your takaful operator before receiving treatment to check if the treatment is covered under your certificate.

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What is the Insurance Mediation Bureau (IMB)?

It's a neutral third party organization that helps resolve disputes between insured individuals and takaful operators.

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What is the role of Bank Negara Malaysia in takaful claims?

Bank Negara Malaysia is the central bank of Malaysia, and it can handle disputes related to takaful claims that are not within the scope of IMB.

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Study Notes

Takaful Overview

  • Takaful is a type of Islamic insurance where members contribute money to a pool system to guarantee each other against loss or damage.
  • Takaful-branded insurance is based on Shariah or Islamic religious law, outlining individual responsibilities for cooperation and protection.

Medical and Health Takaful

  • Covers private medical treatment costs, including hospitalization and healthcare, if diagnosed with an illness or injury.
  • Can be a stand-alone policy or a supplementary contract to a basic family takaful plan.

Takaful Concept in Medical and Health Policy

  • Participants contribute a set amount to a takaful fund (participative contribution-tabarru').
  • Participants enter into a contract (aqad) to help each other in case of misfortune, like hospitalization or illness.

Takaful Industry Growth

  • Family Takaful new business gross contribution showed growth from 2014 to 2018 (visual aids - charts).
  • General Takaful total gross contribution also showed growth trends over the same period. (visual aids - charts).

Medical and Health Takaful Policy Types

  • Hospital service and professional fees
  • Hospitalization benefits
  • Critical illness coverage

Hospital Services and Professional Fees

  • Covers expenses arising from injury or illness, including ward charges, surgical fees, and intensive care unit charges.

Hospitalization Benefits

  • Provides daily cash allowances for hospital confinement due to illness or injury.
  • Benefits are subject to a maximum number of days.

Critical Illness Coverage

  • Provides a lump sum benefit if diagnosed with a specified critical illness (a list of 36 common critical illnesses is covered).
    • Example illnesses: heart attack, cancer, brain stroke, motor neurone disease, etc.

Benefits of Medical and Health Takaful Plan

  • Covers various aspects of medical needs, including: hospitalization, doctor visits, anesthesia, pre-hospitalisation visits, outpatient treatment, surgery, ambulance services, and death benefits.

Important Terms

  • Pre-existing conditions: disabilities or symptoms before the plan's effective date.
  • Overseas treatment coverage: conditions, limitations, and exclusions apply.
  • Misstatement of age: claims might be prorated based on the correct age.
  • Qualifying period: eligibility for benefits starts 30 days after the effective date.

Exclusions

  • Pre-existing illness at application time.
  • Claims from illegal or unlawful acts.
  • Pregnancy or childbirth.
  • Venereal disease, infection or parasites.
  • Murder or physical assault.
  • Cosmetic or plastic surgery.

How to Make a Claim

  • Contact your takaful operator before any treatment to confirm coverage.
  • Provide written notice to your takaful operator as soon as possible after incurring covered expenses.
  • Provide necessary documents like bills, receipts, physician's report, and physician's opinion on the commencement of disability/illness.

How to Lodge a Complaint

  • First, lodge a complaint with your takaful operator.
  • If unsatisfied, appeal to the Insurance Mediation Bureau (IMB) or Bank Negara Malaysia within 6 months of the operator's decision.

Applying Takaful Plan

  • Disclosure of all material facts about risks and relevant conditions.
  • Complete and accurately answer all questions on proposal forms.

What is Medical Card?

  • Takaful operator provides a medical card for those who purchase medical plans, granting access to certain privileges as per plan details.

9 Things to know about Medical Cards

  • Definition and function of the medical card.
  • Understanding standalone or riders and co-takaful aspects.
  • Annual and lifetime limits.
  • Daily hospital allowance benefits.
  • Room and board benefits.
  • Panel hospitals covered.

Medical and Health Takaful Products Available in the Market

  • List of various takaful companies and medical card options. (visual aid).

Medical Health Takaful is a Policy/Plan that is Nice to Have or Must Have?

  •  A question regarding the importance and necessity of a medical policy.

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Related Documents

Medical Health Takaful PDF

Description

Explore the concept of Takaful, an Islamic insurance model where members protect each other through collective contributions. This quiz covers various aspects including medical and health Takaful, the principles guiding it, and insights into the industry's growth. Test your knowledge of how Takaful operates under Shariah law.

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