A-SME FLEX by AIA

A-SME FLEX by AIA

Frequently Asked Question (FAQ)

Q: Who is eligible for coverage?

A: All full time and actively at work employees (below sixty five (65) years of age), in occupational classes 1 to 4 are eligible for Medical and Group Term Life coverage. An employee’s spouse (below sixty five (65) years of age) and unmarried children (over fourteen (14) days but below nineteen (19) years of age or twenty three (23) years of age if still studying full time and not gainfully employed) are eligible for Medical (basic and optional) coverage only.

Q: How do I enroll my company for the A-SME Flex?

A: It’s simple, just speak to an AIA representative and he/she will help to complete and submit your application through AIA electronic platform. Please submit the completed application together with the premium payment. Coverage for your company will commence upon AIA’s acceptance, subject to satisfactory evidence of insurability.

Q: Are there any other forms to be completed/requirements to be met?

A: For the Group Term Life Benefit, all employees are required to complete the Personal Health Declaration Form in any of the following circumstance(s):

1. Number of employees equals to or is less than ten (10); or
2. Employees with Sum Insured exceeding the No-Evidence Limit amount.

However, for the Medical Benefit, the completed Personal Health Declaration Form is required for companies with ten (10) employees or less.

Q: How are premium charged and are they guaranteed?

A: Premium rates are charged based on the type of benefits and options selected. The policy is issued for the term of one (1) year and the premium may be revised for subsequent renewals, hence they are not guaranteed. The renewal term will be issued thirty (30) days before the policy expiry. To find out more on premium rates, please contact your AIA Life Planner / AIA authorised representative or fill up the “Get In Touch” form via https://www.aia.com.my/en/our-products/employee-benefits/get-in-touch.html and we will be in touch with you.

Q: What happens when an employee resigns or when there are new employees?

A: The addition and deletion of employees can be done via MYAIA CORPORATE PORTAL which is made available to you 24/7 at your fingertips. Similarly, the request can be done via email to my.mbrupdate@aia.com or contact your servicing agent. AIA will charge premium on a pro-rated basis upon your policy bill adjustment frequency.

Q: Can I change/upgrade my employees’ benefits?

A: Yes, change/upgrade of benefits can be done at Policy Anniversary and is subject to acceptance by AIA.

Q: What do you mean by an emergency?

A: An emergency means treatment needed where immediate medical attention is required within twenty four (24) hours from the injury, illness or symptoms which are sudden and severe failing which, it will be life threatening (eg. accident and heart attack) or lead to significant deterioration of health.

Q: Does the A-SME Flex provide overseas coverage?

A: Yes, all benefits are applicable worldwide for twenty-four (24) hours a day. However, if the Insured member chooses to or is referred to be treated outside Malaysia by the attending doctor, benefits payable will be based on the reasonable and customary and medically necessary charges for such an equivalent to treatment in Malaysia excluding the cost of transport to the place of treatment. For outpatient care, the insured members are covered up to max limit per visit of RM40 for General Practitioner (GP) and RM150 for Specialist Care (SP).

Q: What is Deductible?

A: If a deductible amount of RM300 for hospitalisation is selected for example, the Insured Member/ Policyholder will need to pay for the first RM300 incurred per disability, while we will take care of the eligible expenses balance. For example, if an Insured Member incurs a RM1,000 medical bill, the Insured Member/Policyholder would pay a RM300 deductible and the insurance plan would pay for the remaining RM700.

Q: What are the coverages under Government Hospital (GH Only) plan?

A: If “GH only” plan is selected, insured member is entitled to maximum overall limit of RM20,000 per policy year and the maximum cost of Room and Board that he/she can claim is RM80 per day. For Specialist Care (SP) benefit, the maximum overall limit is RM1,000 per policy year.

Q: What is the difference between “Per Member Limit” and “Per Family Limit”?

A: “Per Member Limit” is referring to the maximum amount of money AIA will pay for covered claims for each insured individual. This means, the employee and his/her dependents will each have a separate limit. In case of a claim by one member, the limit available for other members remain intact. “Per Family Limit” means the employee and his/her dependents is covered under one single limit per policy year. This means, the limit can be utilised by any or all members including the employee and his/her eligible spouse and children and not restricted to one individual as in the case of “Per Member Limit”. Please note that “Per Family Limit” is applicable only for In Hospital Care Benefits.

Q: What is the difference between “Standalone Limit” and “Combined GP & SP Limit”?

A: “Standalone Limit” means the Outpatient General Practitioner (GP) Care and Outpatient Specialist (SP) Care will have its own limit. For example, RM2,000 for GP and RM1,000 for SP. Whilst, “Combined GP & SP Limit” means it is a shared limit for GP and SP. The minimum requirement for a “Combined GP & SP Limit” is RM2,000. In this instance, if the “Combined GP & SP Limit” is RM2,000, the insured member can claim up to RM2,000 in full for GP or SP or combination of GP and SP.

Q: How can I enroll my employees for the Group MedCare – Personal Medical Case Management (PMCM) benefit?

A: You need to take up the hospitalisation plan for your employees in order to enroll them for Group Medcare – Personal Medical Case Management (PMCM). This benefit can also be extended to their dependents.

Q: How does the PMCM work?

A: Our service provider, Medix, will appoint a dedicated and personal medical case management team (“PMCM team”), led by a personal medical case manager, to reassess and manage your medical condition. The PMCM team will first help you to gather and review your existing medical information and test results. The PMCM team will also consult leading specialists around the world, across multiple disciplines, to reach the correct diagnosis for your medical condition, monitor your progress and support you throughout your medical journey until recovery. Please contact AIA Care Line at 1300 88 1899 to check your policy eligibility.