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TO
Fakulti Sains & Teknologi
Peranan Takaful Am Dalam Pengurusan
Risiko Pekerjaan
Kau Kong Hoi FSA, FASM
21 November 2015
Growing Beyond Expectations
1
IKHLAS Motor Takaful
2
PRESENTATION OUTLINE
IKHLAS Motorist P.A. Takaful
Group Personal Accident
Group Hospital & Outpatient Care
Peranan Takaful Am Adalah Untuk
Membahagikan Risiko dan Bukan
Mengurangkan Risiko
1
2
3
4
IKHLAS MOTOR TAKAFUL
3
Private Car C – Permit Motor
4
SCOPE OF COVERAGE
THE ROAD TRANSPORT ACT 1987
( Requirement of Sec. 90 )
Required all motorists to be insured against
liabilities for injuries to third parties resulting from
the use of any vehicle on Public Roads.
5
IKHLAS MOTOR TAKAFUL
Introduction
Cash Before Cover Regulation (CBC)
• The „Cash Before Cover‟ regulation means no cover can be granted until the contribution has been paid. Failure to comply with the Takaful Act, 1984 under section 25(6) will result in a maximum penalty of Five Thousand ( RM 5,000.00 ).
No Back-Dated Coverage
• Example : If you issue E-Cover Note today 21/2/2015, the period of cover cannot commence on 20/2/2015.
Contribution Must Be Received Within 7
Working Days
• All documentation related to the issuance of the E-Cover Note together with full contribution must be given to Takaful Ikhlas within 7 working days from the issuing date of the E-Cover Note irrespective of the commencement date of Certificate.
Bank Negara Regulations:
7
REGULATION
Act Cover
• Cover the participant against claims from other people for bodily injury (including death) caused by the careless driving of the participant or any participant driver.
• Unlimited Liability of bodily injury ( including death ).
Third Party
• Cover against :-
•Liability to Third Party including death
•Liability to the Third Party Property Damage
• Limit of Liability:-
• Bodily injury (including death Unlimited
• Damage to property belongings to Third Party Limit to RM3,000,000
Comprehensive
•Cover as follows :-
•Own Damage & Liability to Third Party (death )
•Property Damage to Third Party
•Burglary, theft, damage own property due to fire explosion or
• lightning and other damages as stated in the Certificate.
•Limit of Liability :-
•Bodily injury & death to third party
•Unlimited
•Property Damage to third party
•Limited amount to RM3,000,000
•Excess :-
•Excess to Own Damage for claim
•Compulsory Excess of 2(f)
•Limit Liability for Own Damage Accident :-
•The claim limit for payment due to liability whether property damage or theft is based on the Market Value to reinstate to the original position before the accident.
Third Party Fire & Theft
• Cover against :-
• Liability to Third Party including death
• Liability to the Third Party Property Damage
• Vehicle is damaged or lost due to Fire.
• Vehicle is damaged or lost due to Theft.
Bank Negara Regulations:
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TYPES OF COVER
Based on Market Value
Depreciation value must not be more than 10%
If SC below market value “Average Clause” will apply ( Under Participant )
Sum Covered x Total Claim
Market Value
Introduction
Covered below than Market Value / Under Covered
Average clause‟ will apply as follow :-
Example how to calculate „Average Clause‟ :-
Sum Covered: RM 15,000.00
Market Value: RM 24,000.00
Vehicle Model: Perodua Kancil
Claim incurred: RM 6,000.00
Calculation:-
15,000 x 6000 = 3750
24,000
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SUM COVERED
Coverage Comprehensive Third
Party
Breakage Of Glass In Windscreen
•Additional contribution – 15% from the windscreen
sum covered
•Minimum RM 30
√ N/A
Accessories (Radio Cassette, etc)
•Additional contribution – 15% from the accessories
sum covered
•Minimum RM 30
√ N/A
Flood Typhoon Hurricane Earthquake
•Additional contribution – 0.50% from the sum covered
•Minimum RM 15
√ N/A
Strike Riot And Civil Commotion
•Additional contribution – 0.30% from the sum covered
•Minimum RM 5
√ N/A
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ADDITIONAL BENEFITS PRIVATE CAR
The contribution payable may be reduced if the insured have NCD entitlement.
It‟s a „reward‟ scheme for the insured if no claim was made against the policy during
the preceding 12 months of policy
Different NCD rates are applicable for different classes of vehicles
Private Car
Coverage Duration NCD (%)
After 1 Year 25
After 2 Years 30
After 3 Years 38.33
After 4 Years 45
After 5 Years and above 55
Motorcycle
Coverage Duration NCD (%)
After 1 Year 15
After 2 Years 20
After 3 Years 25
The NCD can be transferable to another insurer
or another vehicle that belongs to the insured
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NO CLAIM DISCOUNT (NCD)
Type Of Claim Which Affected The NCD
Type Of Claim Effect To NCD
Own Damage (OD) Affected
Third Party Property Damage Affected
Third Party Bodily Injury Affected
Theft Affected
Windscreen* Not Affected
Accessories* Not Affected
Knock for Knock (KFK) Not Affected
* With additional contribution for additional benefits
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NO CLAIM DISCOUNT (NCD)
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NO CLAIM DISCOUNT (NCD)
Contribution to Takaful Ikhlas is base on the following rating factors :-
1. Sum Covered ( Market Value )
2. Engine Capacity ( c.c )
3. Age of Vehicle
4. Age of Driver
5. History of Claim
6. Type of Vehicle
More than 300 panel workshops nationwide.
ISO 9001 on claims (Theft/Accidental)
No submission of proposal form and cover note.
IKHLAS Motorist P.A is available with contribution as low as RM 50.00 to cover any 5 persons in the vehicle inclusive of the driver.
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Ezi Claim Drive in
In claim settlement below RM3,000, a damage assessor will be on site for an
on the spot claim assessment. The cheque processing will be completed within
the hour.
24 Hours Roadside Assistance (1-800-88-1186)
Towing & Emergency Assistance if the vehicle breaks down and is immobilized,
our call center will arrange & pay up to a maximum amount of RM200.
Includes delivery & installation of new battery, jumpstart, flat tyre assistance &
delivery fuel ( cost of tyre, battery & fuel are borne by the participant.
IKHLAS MOTOR TAKAFUL BENEFITS
IKHLAS MOTORIST
P.A. TAKAFUL
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This product provides protection against accidental death or
permanent disablement to the participant and the
passenger due to road accident whilst entering, riding or
alighting from the covered vehicle.
TABLE OF BENEFITS
IKHLAS MOTORIST P.A. TAKAFUL
Package A (RM) B (RM) C (RM) D (RM) E (RM)
Death & Permanent Disablement 10K 20K 30K 40K 50K
Loss of both hands or both feet 10K 20K 30K 40K 50K
Loss of sight of both eyes 10K 20K 30K 40K 50K
Loss of sight of one eye and one hand or
one foot 10K 20K 30K 40K 50K
Loss of one hand or one foot 5K 10K 15K 20K 25K
Loss of sight of one eye 5K 10K 15K 20K 25K
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Introduction
BENEFITS PLAN & CONTRIBUTION TABLE
WHY CHOOSE IKHLAS MOTORIST P.A TAKAFUL?
IKHLAS MOTORIST P.A. TAKAFUL
Plan Sum Covered Per
Person (RM)
Contribution Per
Vehicle(RM)
Stamp Duty
(RM)
Total Contribution
(RM)
A 10,000.00 40.00 10.00 50.00
B 20,000.00 80.00 10.00 90.00
C 30,000.00 120.00 10.00 130.00
D 40,000.00 160.00 10.00 170.00
E 50,000.00 200.00 10.00 210.00
Easy and fast enrolment
Eligibility :
Issue Ages : 1 – 75 years, age next birthday
Occupational class : 1,2 & 3
One single contribution to cover 5 persons in the vehicle (inclusive driver/authorized driver)
Additional persons are allowed subject to additional contribution RM 10.00 each
Maximum of additional persons subject to seating capacity permitted under JPJ rules and
regulation
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GROUP PERSONAL ACCIDENT
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This certificate provides coverage to protect the employees against Death or Total
Permanent Disablement with Immediate Death Expenses and Hospital Income.
The coverage is 24 hours and worldwide.
GROUP PERSONAL ACCIDENT
Descriptions Coverage /Payable
Basic Benefit :-
Death - In the event of an insured employee died from accident
cause, eligible employees are covered without geographical
limitation for 24 hours a day
Sum Covered as per HR
list
Supplementary Benefits :
Total and Permanent Disability Benefit
Immediate Death Expense
Accidental Death Benefit & Disability
Partial and Permanent Disability Benefit Due To Accidental
Daily Hospital Income
Sum Covered as per HR
list
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Introduction
GROUP HOSPITALISATION &
OUTPATIENT CARE
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Takaful IKHLAS is the Risk underwriter, issues certificates & bills
MediExpress (M) Sdn
Bhd is one of our
appointed third party
administrator
Administration
Medical Management
Member Services
• Entitlements, Claims Review &
Settlement, Letter of Guarantees
• Working Relationship with major
hospitals
• Manage more than 2600 Panel Clinics
Nationwide
• Enquiries on LOG, LOG issuance, 24
hours Emergency Line
GROUP HOSPITAL & OUTPATIENT CARE
21
Introduction
Hospital & Surgical Care Option 1 Option 2 Option 3 Option 4
1.In-Hospital Care
2.Hospital Room & Board (max. daily benefits) (i) Ordinary Room (up to 120 days max. per disability) (ii) Intensive Care (max. daily benefits) (up to 20 days max. per disability)
350
230
180
110
3.Hospital Supplies & Services •As Charged
-Max. 120 days per disability -For non surgical disability, max 2 visit per day, up to 120 days per disability
4.Surgical Fees
5.Anaesthetic Fees
6.Operating Theatre Charges
7.In-Hospital Physician‟s Fees
8.Malaysian GH Daily Allowance ( Max 120 days per disability)
200 150 100 50
SCHEDULE OF BENEFITS FOR INPATIENT - SAMPLE
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Any use, copying or distribution without written permission from MediExpress (M) Sdn Bhd is prohibited.
Participants Hospital
Or Call
Present card at Admission Counter
Go Direct to hospital
Fax
• Medical Form
•Provisional
Diagnosis
Repudiation Letter
If NOT
Coverable
• Treatment
• Final Diagnosis
• Billing
• Lab report
Discharge
Final LG /
Excess Letter
HOSPITALIZATION FLOW CHART – Private
Coverable
Initial Letter of Guarantee (LG)
Admission
MediExpress for Pre-plan Admission
ADMISSION & DISCHARGE
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Coverage Plan 1 Plan 2 Plan 3 Plan 4
Outpatient GP Care
• Routine Consultation
Cover Cover Cover Cover
• Medication
• Injection
• Diagnostic Lab / X-Ray Procedures
• Outpatient Surgical Procedures
Outpatient Specialist Care With Panel GP Referral Letter
• Consultation Cover Cover Cover Cover
• Medication Cover Cover Cover Cover
• Injection Cover Cover Cover Cover
• Diagnostic Lab / X-Ray Procedures Cover Cover Cover Cover
• Outpatient Surgical Procedures Cover Cover Cover Cover
Outpatient Limit Per Employee
Per Annum 5000 3000 2000 1000
SCHEDULE OF BENEFITS FOR OUTPATIENT - SAMPLE
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CONSULTATION FLOW CHART
Participant goes to a
panel clinic.
Doctor fills up claim form
1) Treats patient
2) Dispense Medicine
3) Charges, MC and etc
Participants
1) Signs the claim form
2) Takes medicine.
At the Clinic, present
1) Membership Card,
2) Identity Card.
1) Nurse verifies membership
online
2) Member fills up Patient‟s
Details on Claim Form.
1 2
4
Clinic bills HC monthly or fortnightly
if volume is high. HC will process
invoices, provide reports to
Employer, pays clinics
5
OUT-PATIENT MEDICAL BENEFIT
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OUTPATIENT SPECIALIST FLOW CHART
Participants
1) Calls Specialist Clinic to make an
appointment/ Directly go to specialist
clinic with referral letter.
2) Fax Referral Letter/Appointment Card to
MediExpress. (603-7803 2005)
3) MediExpress faxes GL to the specialist
clinic/member (15min to 30min)
Doctor
1) Treats patient
2) Dispense Medicine (If any)
Participants
1) Signs the claim form
2) Takes medicine. (If any)
1) Nurse checks the Appointment
card/GL
2) Nurse fills up Patient‟s Details
on Medical Form.
At the Specialist Clinic,
present
1) Membership Card
2) Identity Card.
3) Letter of Guarantee
(If any)
1 2
4
OUT-PATIENT MEDICAL BENEFIT
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Sekian, Terima Kasih.
Kau Kong Hoi FSA, FASM
21 November 2015
Growing Beyond Expectations
28