Smart Baby Shield Plus (H72A-H74A & H72B-H74B) Agency Manual PDF

Agency Manual (For Internal Reference Only) Smart Baby Shield Plus (H72A-H74A & H72B- H74B) Plan Name : Smart Baby Shield Plus Plan Code : H72A - H74A; H72B - H74B Product Abbreviation : SBSP-M & SBSP-C Launch Date : 16...

Agency Manual (For Internal Reference Only) Smart Baby Shield Plus (H72A-H74A & H72B- H74B) Plan Name : Smart Baby Shield Plus Plan Code : H72A - H74A; H72B - H74B Product Abbreviation : SBSP-M & SBSP-C Launch Date : 16 June 2023 Distribution Channel : Agency & Financial Adviser PLAN DESCRIPTION a) Smart Baby Shield Plus is two-unit deduction riders attachable to SmartProtect Junior (Plan Code: 0495). Should one of these riders is terminated upon policyholder’s request or due to miscarriage, the other rider will be terminated as well. If the mother passes away due to childbirth but the child survives, the coverage for the child will continue. b) Smart Baby Shield Plus - Mother (Plan Code: H72A – H74A) has the expecting mother as the life assured with coverage on the mother expiring 60 days after delivery (for H72A – H73A) or 1 year after the child’s birth (for H74A). c) Smart Baby Shield Plus - Child (Plan Code: H72B – H74B) has the unborn child as the life assured with coverage on the child expiring at the policy anniversary on which the child’s attained age of 7 years next birthday. d) Insurance charges will be deducted in 5 instalments on a yearly basis. Please refer to Appendix – Insurance Charges. BENEFITS 1. Benefits for the mother Benefit Amount Benefits for Smart Baby Shield Plus - No. Essential Superior Grand Mother (H72A) (H73A) (H74A) 1. Death of mother due to childbirth/ pregnancy complications RM7,500 RM15,000 RM30,000 a) Prior to delivery, or b) Up to 60 days after delivery. 2. Upon diagnosis of any of the following Pregnancy Complications: a) Abruptio Placentae b) Amniotic Fluid Embolism c) Eclampsia d) Placenta Increta / Percreta RM2,500 + RM5,000 + RM10,000 + e) Postpartum Haemorrhage Requiring additional 500 additional 1,000 additional 2,000 Hysterectomy if accompanied if accompanied if accompanied f) Acute Fatty Liver of Pregnancy with GDM with GDM with GDM g) Disseminated Intravascular Coagulation (D.I.C.) h) Uterine Rupture i) Vasa Previa j) Pulmonary Embolism of Pregnancy Page 1 of 6  Agency Manual (For Internal Reference Only) Smart Baby Shield Plus (H72A-H74A & H72B- H74B) Benefit Amount Benefits for Smart Baby Shield Plus - No. Essential Superior Grand Mother (H72A) (H73A) (H74A) For pregnancy complications listed above accompanied by Gestational Diabetes Mellitus (GDM), an additional 20% of the benefit above shall be payable. (Up to 60 days after delivery) 3. Hospitalisation Benefit As charged, As charged, As charged, Upon admission of the mother into subject to subject to subject to Intensive Care Unit (ICU) / High Reasonable Reasonable Reasonable Dependency Unit (HDU) due to childbirth/ and and Customary and Customary pregnancy complications Customary Charges up to Charges up to (Up to 60 days after delivery) Charges up to RM5,000 RM10,000 RM2,500 4. Maternity Cancer Benefit Upon diagnosis of cancer and there is a RM2,500 RM5,000 RM8,000 waiting period of 30 days. (Up to 60 days after delivery) 5. Emergency Caesarean Section for Early Delivery N/A N/A RM8,000 (before 36 weeks of gestation) 6. Psychological Consultation Benefit Upon diagnosis of: a) Major Depressive Disorder (MDD); or N/A N/A RM8,000 b) Generalised Anxiety Disorder (Up to 1 year after delivery) 2. Benefits for the child Benefit Amount Benefits for Smart Baby Shield Plus – No. Essential Superior Grand Child (H72B) (H73B) (H74B) 1. Death of child a) Death of foetus, or RM2,500 + TIV RM5,000 + TIV RM10,000 + b) From birth up to 1 year after the child’s (if any) (if any) TIV (if any) birth 2. Hospitalisation Benefit Upon admission into Neonatal Intensive As charged, As charged, As charged, Care Unit (NICU)/ ICU/ HDU subject to subject to subject to (within the first 30 days from birth) Reasonable Reasonable Reasonable 3. Incubation of Newborn and Customary and Customary and Customary (within the first 60 days from birth) Charges up to Charges up to Charges up to RM2,500 per RM5,000 per 4. Phototherapy Treatment for Neonatal RM10,000 per lifetime lifetime Jaundice of specified severity lifetime (within the first 60 days from birth) 5. Hospitalisation due to Congenital Conditions As charged, As charged, As charged, Reimbursement for Hospitalisation due to subject to subject to subject to the following Congenital Conditions: Reasonable Reasonable Reasonable Page 2 of 6  Agency Manual (For Internal Reference Only) Smart Baby Shield Plus (H72A-H74A & H72B- H74B) Benefit Amount Benefits for Smart Baby Shield Plus – No. Essential Superior Grand Child (H72B) (H73B) (H74B) a) Anal Atresia and Customary and Customary and Customary b) Atrial Septal Defect Charges up to Charges up to Charges up to c) Congenital Cataract RM15,000 per RM30,000 per RM60,000 per d) Congenital Deafness year year year e) Congenital Diaphragmatic Hernia f) Infantile Hydrocephalus g) Tetralogy of Fallot h) Transposition of Great Vessel i) Truncus Arteriosis j) Ventricular Septal Defect k) Coarctation of the Aorta l) Cerebral Palsy m) Spina Bifida n) Oesophageal Atresia o) Trachea-oesophageal Fistula p) Cleft Lip and/or Cleft Palate q) Down’s Syndrome r) Retinopathy of Prematurity s) Absence of Two Limbs t) Club Foot u) Biliary Atresia v) Congenital Abnormalities of the Kidney and Urinary Tract (CAKUT) w) Congenital Blindness x) Congenital Hypertrophic Pyloric Stenosis y) Development Dysplasia of the Hip z) Patent Ductus Arteriosus aa) Congenital Dislocation of Hip bb) All Structural Congenital Conditions (Only for Grand version) (Up to age 7 years next birthday) 6. Child Development Disorder Benefit Upon seeking treatment due to any of the following Child Development Disorder a) Autism Spectrum Disorder As charged, b) Attention Deficit Hyperactivity subject to c) Language Disorder Reasonable d) Specific Learning Disorder N/A N/A and Customary e) Stereotypic Movement Disorder Charges up to f) Tourette Syndrome RM8,000 per g) Gross Motor or Speech Developmental year Delay (Up to age 7 years next birthday) Page 3 of 6  Agency Manual (For Internal Reference Only) Smart Baby Shield Plus (H72A-H74A & H72B- H74B) 3. Easy enrolment for subsequent pregnancy If the mother has an existing policy with Smart Baby Shield Plus, she will be entitled to purchase the subsequent Smart Baby Shield Plus plan without going through the medical underwriting, subject to terms and conditions including but not limited to the following criteria: a. The latest fully underwriting prenatal application of SmartProtect Junior where Smart Baby Shield Plus had been attached to is inforce and less than 10 years from policy commencement date. b. The previous SBSP plan was accepted at standard life rate. c. No claims made for SBSP under the latest policy. d. The mother has not made any H&S claims for more than RM5,000 in the past 2 years. Any H&S claims that are under pending or in progress status will not be entitled for this easy enrolment. e. The mother has not made any TPD or CI claim (including paid & pending). f. Mother’s age next birthday is from 19 to 45 years and a non-smoker in respect of this pregnancy. g. Current gestation period is 13 weeks to 17 weeks. h. Current pregnancy is capped at 2 foetuses. i. The mother and the spouse are not diagnosed to have disease(s) that is caused directly or indirectly by the existence of AIDS or by the presence of any HIV infection. j. Have not undergone artificial insemination and/or assisted reproductive technology in respect of this pregnancy. k. Have not performed any prenatal genetic testing in respect of this pregnancy. UNDERWRITING 1. Age at Entry Smart Baby Shield Plus – Mother (Plan Code: H72A – H74A) Minimum : 19 years next birthday Maximum : 45 years next birthday Smart Baby Shield Plus – Child (Plan Code: H72B – H74B) Minimum : 13 weeks of gestation Maximum : 36 weeks of gestation 2. Coverage Term Smart Baby Shield Plus – Mother (Plan Code: H72A – H74A) Plan Code Coverage Term H72A Up to 60 days after the child’s birth H73A Up to 60 days after the child’s birth H74A Up to 1 year after the child’s birth Smart Baby Shield Plus – Child (Plan Code: H72B – H74B) Up to child’s age 7 years next birthday. 3. Underwriting Requirement  Underwriting will be undertaken on the mother based on the standard proposal declaration (including information on any previous pregnancy complication and (natural) child with congenital defect) and a current obstetrician report with an antenatal ultrasound scan.  This plan will be applicable for foreigner mothers, subject to underwriting. Page 4 of 6  Agency Manual (For Internal Reference Only) Smart Baby Shield Plus (H72A-H74A & H72B- H74B)  For the application under the Easy Enrolment for Subsequent Pregnancy, Health Declarations are required from the expectant mother. Notes:  Expectant mother of Malaysian PR, Singaporean, Bruneian or selected nationality (developed or SEA countries) must be legally married to a Malaysian and is residing in Malaysia with occupational Class 1 or 2 only.  Mothers carrying triplets or more is not eligible for this product.  Subject to one pre-natal product per life (except for twins). 4. Backdating Not allowed. OTHER FEATURES 1. Cash Surrender Value / Partial Surrender / Policy Loan / Automatic Premium Loan / Extended Term Assurance / Paid-up Assurance / Replacement of Policy Not applicable. 2. Free-look Period Refer to basic plan. 3. Assignment / Third Party Policy / Nomination Follow basic plan. TERMINATION 1. The cover for mother of life assured will be terminated on the earliest of the following:-  upon death of the mother of life assured; or  upon death of the life assured; or  the expiry date for SBSP-M. 2. The cover for life assured will be terminated on the earliest of the following:-  upon death of the life assured; or  the expiry date for SBSP-C. 3. This rider will be terminated:-  upon occurrence of a miscarriage; or  when the Company receives your request for termination in writing; or  when the policy is surrendered; or  when the policy lapses, becomes void or is terminated in any other manner. EXCLUSIONS The Company will not pay any Cover for the Mother of Life Assured benefit for death or illnesses or conditions that:  existed prior to the Risk Effective Date; or  is caused directly or indirectly by self-inflicted injuries, while sane or insane; or Page 5 of 6  Agency Manual (For Internal Reference Only) Smart Baby Shield Plus (H72A-H74A & H72B- H74B)  is resulted from the Mother of Life Assured committing, attempting or provoking an assault or a felony or from any violation of law by Mother of Life Assured; or  is caused while under the influence of alcohol or drugs unless taken as prescribed by a Doctor. For the avoidance of doubt, a person is considered as under the influence of alcohol if the breath, blood or urine test result is over the following limit:  35 mcg of alcohol per 100ml of breath  80mg of alcohol per 100ml of blood  107 mg alcohol per 100ml of urine; or  is caused directly or indirectly by the existence of Acquired Immune Deficiency Syndrome (AIDS) or by the presence of any Human Immuno-deficiency Virus (HIV) infection. The Company reserves the right to require the Mother of Life Assured to undergo a blood test for HIV as a condition precedent to acceptance of any of the claims; or  is resulted from Mother of Life Assured choosing to have a termination of pregnancy other than for medical reasons; or  is caused by any unlawful, criminal or deliberate act or failure to act; or  is resulted from war, whether declared or undeclared. The Company will not pay any Cover for the Life Assured benefit for death or illnesses or conditions that:  is caused by usage of drugs unless taken as prescribed by a Doctor; or  is caused directly or indirectly by the existence of AIDS or by the presence of any HIV infection. The Company reserves the right to require the Life Assured to undergo a blood test for HIV as a condition precedent to acceptance of any of the claims; or  is caused by any unlawful, criminal or deliberate act or failure to act; or  is resulted from war, whether declared or undeclared; or  is caused by experimental treatment, including medication and/or unconventional medical technology/procedure, which has not been proven to be effective, based on established medical practice, or which has not been approved by a recognised body in Malaysia. Note: The exclusion list may not be exhaustive. For full list of the exclusions, please refer to the policy contract. APPENDIX Insurance Charges Policy Year Charged Essential Superior Grand 1 Upon policy inforced 894 1,346 2,526 2 188 190 599 3 At anniversary of 188 190 599 4 policy in-force date 120 126 599 5 59 61 268 Total 1,449 1,913 4,591 Page 6 of 6