Health Insurance

 

Objective

By taking out the health insurance, the intention is:- to get some extent of relief or the cost of hospitalization:- to take out the insurance by installment system for the payment of the premium rate: - to be able to purchase the basic insurance coverage as well as the optional insurance coverage jointly.

 

Person competent to insure

Among the Myanmar Citizens and Foreigners who came to Myanmar for various purposes, between the ages of 6 to 65 years can be accepted by dividing them into groups according to age and for those of age 6 to 18, can be insured through their parents/guardians.

 

Term of Insurance

It is one year from the day of payment of premium.

 

Payment system of premium

Group - 3 months(installment), 6months(installment) and lump sum
Individual - 6months(installment) and lump sum

 

Purchasable Unit

• Basic Coverage
• Additional Unit 1 Unit to 8 Units
• Optional Coverage 1 Unit to 10 Units

 

Premium rate schedule in accordance with the kind of insurance coverage

	Insurance Coverage	Age group	Monthly paid premium (Kyat)	3 months quarterly paid premium (Kyat)	6 months biannually paid premium (Kyat)	Lump sum premium (Kyat)
1.	Basic Insurance Coverage(Basic Unit)	6-40	4000	11600	22400	44000
		41-50	4500	13100	25200	49500
		51-60	6500	18900	36400	71500
		61-65	8500	24700	47600	93500
2.	Basic Insurance Coverage(Additional unit 1 Unit)	6-40	2000	5800	11200	22000
		41-50	3000	8700	16800	33000
		51-60	4500	13100	25200	49500
		61-65	6000	17400	33600	66000
3.	Choosable Insurance Coverage (1) 1 Unit	6-65	2000	5800	11200	22000
4.	Choosable Insurance Coverage (2) 1 Unit	Male (6-40)	1500	4400	8400	16500
		Male(41-65)	2000	5800	11200	22000
		Female(6-40)	2000	5800	11200	22000
		Female(41-65)	2500	7300	14000	27500

 

Benefit Schedule 

Serial	Insurance Coverage and Unit	Insurance benefit	Cause of Indemnity	Amount of cash in kyats for benefit
1.	Basic Insurance Coverage (Basic Unit)	Hospitalization due to disease Hospitalization due to accident Death due to accident Death due to disease Permanent disablement	When hospitalized with the intention of taking medical treatment When died due to accident When died due to the cause other than accident When the conditions are conformable to permanent disablement	K 20,000/- per day of hospitalization Only up to maximum 60 days K 2,000,000/- K 1,000,000/- K 1,000,000/
2.	Basic Insurance coverage (Additional Unit)	Hospitalization due to disease Hospitalization due to accident Death due to accident Death due to disease Permanent disablement	When hospitalized with the intention of taking medical treatment When died due to the accident When died due to the cause other than accident When the conditions are conformable to permanent disablement	K 10,000/- per day of hospitalization Only up to maximum 60 days K 1,000,000/- K 1,000,000/ K 1,000,000/-
3.	Optional Insurance Coverage (1) Unit 1	Surgery/ Operation Miscarriage	When operation was done by general anaesthesia or by spinal anaesthesia When hospitalized operation or treatment for the natural miscarriage or miscarriage due to disease was done.	Actual direct expense for the operation but the minimum be 5 lakhs K 3 lakhs not related to the unit purchased. he amount, K 5 lakhs for both(operation or miscarriage) x the total insured unit shall be stipulated as the total maximum amount.
4.	Optional Insurance Coverage (2)Unit 1	Treatment for severe disease (Cancer Tumour Myocardial Infarction, Paralysis)	When the treatment was started as the Tumour was considered to be Cancer for the first time When hospitalization started due to sudden Myocardial Infarction when hospitalization started due to Paralysis.	K 1,000,000/-

 

Bonus without indemnity 

Entitled to set off the 10% of the premium paid in previous year from premium of recent year.

 

Facts to be complied with in claiming benefit

• When hospitalized, notice shall be given to the company in advance.
• The claim shall be made within 10 days from the day of discharge from the hospital.
• Should the company, if necessary, ask for more facts and if the insured shall not be able to give them within 3 months, then the benefits shall be lost.
• In the event of claim for cost of hospitalization within 1 month after having insured, the diseases being treated treatment in the hospital shall be examined again by the experts of the company.

 

Matters for which the benefit cannot be obtained 

• Person who is getting treatment and has obtained the doctor’s recommendation for hospitalization.
• Normal delivery, unnatural miscarriage.
• When operated without purchasing the choosable coverage (1) for the delivery.
• Psychiatric patients
• Diagnosing the disease
• Treatments for fertility
• Dental treatment other than the injury due to accident.
• Eye test including spectacles other than the injury due to accident.
• Cosmetic operations.
• Fitting of Hearing Aid device
• Abnormality by birth
• Using Narcotic drugs
• Self-committing crime
• Suffering from AIDS/HIV
• Taking treatment abroad
• Treatment due to Terrorism, Riot, War and War like event.
• Treatment for 3 days in hospital due to disease
• Fraudulent claims
• Suicide
• During the treatment of severe disease, the treatment for cancer within 90 days from the date of starting the insurance.
• Causing Tumour in the epithelial layer and skin, in the cavity of organs of respiration, stomach and urinary tracts.

 

Hospitals and Clinics available for medical treatments

Hospitals and clinic having the Health Ministry’s recognized license for treatment of in-patients.

 

Special Caution

If the health insured himself states carelessly, wrongly and intentionally untrue facts and makes omission and cheating in the proposal, the benefits of the policy shall be lost and the premium already paid shall not be refunded.