The Company shall cover for Hospitalisation and surgical treatment and shall include benefits as below, provided that it is subject to each hospital confinement must be for a minimum of six (6) consecutive hours before any benefits are payable. However, no minimum period of Hospital confinement is required if the confinement is due to a surgical operation/ treatment, accidental emergency treatment.

1.      Daily Room and Board

Hospital charges for accommodation, general nursing services and meals for each day of confinement as an Inpatient in a Hospital at the recommendation of a Physician. The total number of days for which the daily room and board charges are payable shall include confinement in Ordinary Room and Intensive Care Unit of the Hospital but shall not exceed the maximum number of days Per Disability as specified in the Schedule of Benefits.

2.     Hospital Miscellaneous Expenses

Hospital charges incurred while confined in the Hospital, a maximum limit per disability is specified in the Schedule of Benefits:

     a.    Prescription drugs consumed in the Hospital

     b.    Inpatient diagnostic procedures and physiotherapy that are medically necessary

     c.    Oxygen and their administration

     d.    Special nursing and medically necessary ancillary services & consumable items.

3.    Surgical Fee

A surgical benefit shall be payable in accordance with reasonable and customary charges made for the use of an operating theatre, surgeon’s fee and anesthesia, provided that the anesthesia fee shall not exceed 50% of surgeon’s fee necessary for surgery. A maximum limit per disability is specified in the Schedule of Benefits.

4.     In-Hospital Physician’s Visit

Fees charged for daily bedside visits made by the attending Physician during the Insured Person’s confinement in the Hospital. This benefit is limited to one visit per day and shall be payable up to the maximum daily limit specified in the Schedule of Benefits.

5.     Pre-Hospitalisation Consultation and Diagnostic Services

Charges made by a legally licensed and duly qualified medical specialist for his opinion and advice sought diagnostic X-rays and laboratory examinations or tests which are recommended by a Registered Medical Practitioner for a disability resulting from Illness or Bodily injury of the Insured Person within thirty (30) days before Hospitalisation is payable as per Schedule of Benefits.

No benefit shall be payable if the Specialist’s consultation diagnostic X-ray and laboratory examinations or test does not lead to Hospitalisation or surgical treatment within the Period of Insurance.

6.     Post-Hospitalisation Treatment

Charges incurred for follow-up treatment by the same attending Physician received immediately after discharge from a Hospital or Day Surgery, provided the treatment is for the same medical condition for which the Inpatient treatment or Surgery was required. The treatment must be received within ninety (90) days immediately following discharge from hospital as per the Schedule of Benefits.

7.      Emergency Accident Outpatient Treatment

Charges incurred for emergency outpatient medical treatment at a clinic or Hospital for Bodily injury sustained in an Accident. This benefit is payable provided the medical attention is sought within 24 hours of the occurrence of the Accident. Charges incurred for follow-up treatment shall be payable up to thirty (30) days from the time of the Accident but the total benefit shall not exceed the maximum limit specified in the Schedule of Benefits.

8.     Accidental Miscarriage

A benefit Per Disability is payable up to a maximum limit specified in the Schedule of Benefits and shall be payable if an Insured Person meets with an Accident resulting in a miscarriage.

9.     Complication of Pregnancy

Charges incurred by an Insured Person which are medically necessary to treat a complication of pregnancy. It is subject to a waiting period of nine (9) months from the inception date of the Policy without any break in cover. A maximum limit per disability is specified in the Schedule of Benefits.

10.   Ambulance

Ambulance charge is payable if the Insured Person is admitted for Inpatient treatment. A maximum limit per disability is specified in the Schedule of Benefits and it shall be compensated on a reimbursement basis.

11.    Daily Hospital Cash Income

If an Insured Person is hospitalized in a Cambodian Public Hospital where there is no charge for treatment due to an illness or injury, We will pay a daily hospital cash income up to a maximum of thirty (30) days Per Disability as per the Schedule of Benefits.

12.   Special Grant

A contributory fee to funeral services as specified in the Schedule of Benefits is payable if an Insured Person dies from an illness during or after treatment for such illnesses, at a Hospital or in Surgical treatment. (Note: this is a one-time payment not per disability).

This policy covers recognized costs of services, treatment or supplies which are recommended by a medical practitioner, for the treatment of an injury or sickness, as determined by us. The costs which are covered are mentioned in clauses 4.1 to 4.22 below. These costs are subject to the exclusions mentioned in clause 5.

Please note that the benefit limits applicable to you will be as per the plan purchased by you.

All limits mentioned in this table are annual limits that are applicable for the policy year. All benefit amounts are in US Dollars (USD).

4.1 Annual Overall limits

The total aggregate benefits limit that may be claimed in any one Policy Year by an Insured Person as specified in the Schedule of Benefits. In addition to this annual limit, different sub-limits are applicable for different benefits.

4.2 Hospital Miscellaneous Services

Medical treatment and services prescribed by a Physician and rendered to the Insured Person for appropriate treatment procedures and when admitted as a registered in-patient in a Hospital. The Reasonable and Customary charges in the area where treatment is provided for hospital services (Laboratory, Imagine, Medical supplies) and surgery including all hospital medical facilities where this is medically required, operating theatre, anesthesia, oxygen and its administration and Surgeon's/Physician's fee.

4.3 Intensive Care Unit

Usual, Reasonable and Customary Charges actually incurred for intensive care unit up to the benefit limits stated in the Schedule of Benefits if an Insured Person is admitted as Inpatient in the Hospital.

This benefit shall be payable when the Insured Person is charged for intensive care unit expenses for serious medical condition, sickness or bodily injury which necessitated an intensive care phase.

4.4 Room and Board

Usual, Reasonable and Customary Charges actually incurred for room accommodation, meals and general nursing services (except special nurses) up to the benefit limits stated in the Schedule of Benefits if an Insured Person is admitted as Inpatient in the Hospital.

If an Insured Person’s room is upgraded exceeding the benefit limits stated in the Schedule of Benefits only, the Room and Board reimbursement will be paid up to the benefit limits stated in the Schedule of Benefits.

4.5 Daily Cash Benefit

If an Insured Person is admitted in a hospital ward which is lower than the room and board entitlement as stated in the Schedule of Benefits and provided this hospitalization claim is payable under this Policy, the Insurer will pay the Insured Person a daily hospital cash benefit up to the sub-limits stated and for a maximum of thirty (30) days per disability. However, no benefit will be payable if the Hospital admission is for a Day Surgery.

We will offer double the daily limit stated in the Schedule of Benefits, provided that the Insured Person is hospitalized in a public or government hospital in Cambodia.

4.6 Lodger Benefit

This is applicable for policies where the Insured Person is a juvenile who is under the age of 20 years and is admitted as Inpatient in the Hospital. We will pay the Usual, Reasonable and Customary Charges, up to a maximum daily limit of US$100 for a family member or legal guardian staying in the same hospital with the child for up to 30 days in any policy year.

This benefit is limited to only one family member or legal guardian each night the Insured Person is receiving eligible and covered treatments under the Plan.

4.7 Surgeons’ and Anaesthetists’ Fees

Fees for surgery charged by a surgeon, including the surgeon’s visits while in hospital. Charges for Day Surgery are also payable.

4.8 Home Nursing Charges

We will pay for the charges incurred for the cost of a qualified nurse in the Insured Person’s abode when prescribed by a Physician/Specialist for continued treatment of the specific medical condition for which the Insured Person was hospitalized and only when such services are essential for medical as distinct from domestic reasons. Cover will be limited to a maximum of 26 weeks per Policy Year.

We will not pay for home nursing which only provides non-medical care or personal assistance.

4.9 Local Ambulance

This benefit is payable for medically necessary transportation to or from a local hospital, provided by a recognized ambulance service provider.

4.10 Outpatient Pre and Post Hospitalisation

• Pre-Hospitalisation Consultations and Diagnostic Laboratory Services incurred preceding hospitalization or day surgery
• Post-Hospitalisation Follow-up Treatments and Diagnostic/ Laboratory Services, by the same Physician, incurred after hospitalization or day surgery
• This benefit will be applicable within 90 days prior to and post hospital admission
• Payment will not be made for subsequent consultations after an illness is diagnosed, or if the Insured is not subsequently hospitalized or surgically treated after such consultations or examinations
•  We will not pay claims under this part of this policy if the treatments form part of cancer treatment. The cover which we provide in respect of cancer treatment is explained in the cancer treatment benefit of this policy.
•  

4.11 Surgical Implants

This benefit will be paid in respect of a device or devices which are surgically implanted to form a permanent or long-term part of the body but does not include external prosthesis.

4.12 Mobility Aids

This benefit will be paid for the following items and their accessories, if prescribed by a physician for a disability: crutches, canes, walkers, manual wheelchairs.

All these should be necessary to assist the Insured Person following discharge from the Hospital up to the maximum amount as specified in the Schedule of Benefits.

4.13 Day Surgery

Day surgery (including minor surgical procedure in a clinic) performed on an out-of-hospital basis or in an ambulatory surgical facility attached to a hospital shall be payable accordingly.

4.14 Organ Transplantation

The medical treatment costs incurred in respect of kidney, heart, lung and liver transplants only.

Transplantation costs may only be claimed under this section of the Policy provided the benefit is indicated above. No other policy benefits would apply to this organ transplantation. The cost of acquisition of the organ and all costs incurred by the donor are not covered by the Policy.

Maximum amount per person per policy year applies.

This benefit requires pre-approval.

4.15 Emergency Medical Evacuation

The medically necessary expenses of emergency evacuation and medical care en route to move an Insured Person who has a Serious Medical Condition to the nearest Hospital where appropriate care and facilities are available and not necessarily to Insured Person's Home Country or Country of Residence. In the event of such an emergency the designated 24-hours Assistance Centre should be contacted immediately to approve and arrange any Emergency Medical Evacuation. The Policy will cover the costs of medical evacuation if the Insured Person(s) require medical treatment which is not available locally. In dire emergencies in remote or primitive areas where the Assistance Centre cannot be contacted in advance, the Emergency Medical Evacuation must be reported as soon as possible.

The Insurer reserves the right to decide the place to which the Insured Person shall be transported.

This benefit does not apply to any Maternity Care or pregnancy related complications.

This benefit requires pre-approval and is subject to our assistant company’s Terms & Conditions.

4.16 Emergency Medical Repatriation

The medically necessary expenses of emergency repatriation to return an Insured Person to the Home Country or Country of Residence by air and/or surface transportation following an emergency medical evacuation where the Insured Person is evacuated to a place outside the Home Country or Country of Residence for in-hospital treatment.  In the event of such an emergency the designated 24-hours Assistance Centre should be contacted immediately to approve and arrange any Emergency Medical Repatriation. In dire emergencies in remote or primitive areas where the Assistance Centre cannot be contacted in advance, the Emergency Medical Repatriation must be reported as soon as possible.

This benefit does not apply to any Maternity Care or pregnancy related complications.

This benefit requires pre-approval and is subject to our assistant company’s Terms & Conditions.

4.17 Arrangement and Payment of Compassionate Visit

The Insurer will pay reasonable costs of only one other person accompanying the Insured Person on an Emergency Medical Evacuation when this is deemed necessary for medical reasons and when the Insured Person is traveling alone.

This benefit does not apply to any Maternity Care or pregnancy related complications.

This benefit requires pre-approval and is subject to AAI International Indonesia Terms & Conditions.

4.18 Repatriation of Mortal Remains

This cover applies when the insured has a covered illness or injury that results in death and it excludes death in home country. This benefit requires pre-approval.

4.19 Outpatient Cancer Treatment Benefit

This benefit includes oncology, chemotherapy and radiotherapy, hair loss treatment, dietician expenses, psychological counselling and other treatments and prescribed drugs directly associated with a cancer condition.

The amounts mentioned here are the maximum claim limits for this benefit payable under this policy in any policy year.

4.20 Outpatient Kidney Dialysis Treatment Benefit

This benefit includes haemodialysis and peritoneal dialysis, up to the per policy year limits specified in the Schedule of Benefits.

4.21 Emergency Dental Treatment

Charges for dental procedures necessary to restore or replace sound natural teeth lost or damaged in an Accident and received as an outpatient within 24 hours after the Accident.

4.22 Emergency Outpatient Treatment

Charges for services and medical supplies provided by the Hospital or clinic for emergency treatment of an Injury as a result of an Accident and received as an outpatient within 24 hours after the Accident.

Eligible expenses incurred thereafter for follow-up treatment of the specific medical condition will be reimbursed up to 31 days from the date of Accident.