PRUAssist Programme

The PRUAssist programme (“Programme”) is a value-added service which provides valuable assistance in travel related emergencies and other services, at no additional charge. EMA Global Assistance Sdn Bhd (“EMA Global”) is the service provider contracted with Prudential Assurance Malaysia Berhad (“PAMB”) to provide services offered under the PRUAssist programme.

*Subject to exclusion as stipulated in Appendix 1.

PAMB and EMA Global shall not be responsible for any third-party expenses which shall be the responsibility of the policyholder. Self-pay charges may be reimbursed by PAMB, subject to the terms and conditions of the policy.

No, all overseas medical expenses are at the policyholder’s own expense. The policyholder may claim for reimbursement of reasonable and customary charges incurred for the treatment from PAMB, subject to the terms and conditions of the policy.

There are no affiliated panel clinic/hospital overseas. However, the policyholder may call EMA Global if they need a medical referral closest to their location worldwide.

There is no guarantee letter for overseas treatment for both outpatient and inpatient. Reasonable and customary charges incurred for the treatment may be reimbursed under the policyholder’s medical plan, subject to the terms and conditions of the policy.

• Kindly contact EMA Global for them to establish the latest medical progress of the Insured Life.

• Please gather essential information prior to notifying EMA Global, i.e. name of the hospital, contact number, treating doctor’s name and ward details.

• EMA Global will then contact the treating doctor to establish the Insured Life’s medical condition and provide PAMB with a recommendation for such request.

• The Insured Life may call EMA Global for assistance by providing them with the exact location or country and alternatively the type of language assistant required.

• EMA Global will then arrange a conference call with their 24/7 Assistance Centre with the necessary language capabilities to translate.

• The Insured Life is advised to request EMA Global to return call to them for such request to avoid expensive overseas call charges.

• The Insured Life’s family member may contact the Emergency Medical Assistance hotline to notify them of the case and EMA Global will establish the necessary medical information and provide PAMB with their recommendation for cover approval.

• Decision will be based on the following criteria in order for PAMB to cover an evacuation:
  - The Insured Life must be 100km radius away from his/her place of residence to be entitled to such services.
  - Whether the surgical intervention is of an emergency need.
  - Whether the local general hospital has the facility to carry out such surgery.
  - Whether the Insured Life’s location is close to a panel hospital with available medical facility and specialist to carry out such surgery.

No. The Insured Life is required to make a “collect call” / “reverse charge call” via local international operators directly to EMA Global from overseas as and when he/she needs medical assistance.

• He/She may call EMA Global for such request.

• The Insured Life is required to provide EMA Global with their hotel name, location and contact number for such request.

No, the Insured Life is to self-pay for such request.

No, the key consideration for a medical evacuation/ repatriation falls on the “standard of medical care” available at the admitting medical facility towards managing the Insured Life’s medical illness/ condition.

All Insured Life by PAMB medical plans are entitled to utilize this SMO/EMO service. Any charges for such service will be borne by PAMB.

• Second Medical Opinion (SMO) is also known as Expert Medical Opinion (EMO) benefit.

• SMO/EMO is a value-added service provided to all Insured Life of PAMB medical plans at no additional charge.

• PAMB has made an arrangement with a third-party service provider (EMA Global) to provide second medical opinion services to help you learn more about your medical conditions and make an informed decision on your treatment plans.

• This service is non-contractual in nature and does not form part of the policy. Eligible Insured Life may submit medical, laboratory, and imaging reports to EMA Global for EMA Global’s doctor's review.

The medical advice is carried out over the phone by EMA Global’s doctors, and this is part of the value-added services available to the eligible Insured Life at no additional cost.

Upon further medical evaluation by EMA Global’s doctor with the Insured Life over the phone, and it is determined by EMA Global that the Insured Life requires a referral to a medical facility, EMA Global will provide recommendation of a medical facility and arrange for an appointment. The Insured Life is to self-pay for this request and any medical treatment obtained at the medical facility recommended by EMA Global.

We would like to highlight the exclusion “any expense related to accident or injury occurring while the Insured Life is engaged in mountaineering or rock climbing necessitating the use of guides or ropes, potholing, skydiving, parachuting, ballooning, hang-gliding, deep sea diving utilizing hard helmet with airhose attachments, racing of any kind other than on foot, and all professional sports” unless otherwise agreed in writing by PAMB.

Medical Evacuation & Repatriation and Repatriation of Mortal Remains services shall subject to a customary list of exclusion as listed below:

1. Pre-existing condition - disability, illness and/or condition that the Insured Life has reasonable knowledge of before the commencement date of the medical plan or the date the medical plan is revived, if applicable. The Insured Life may be considered to have reasonable knowledge of a pre-existing condition where the disability, illness and/or condition is one for which:
   (a) the Insured Life had received or is receiving treatment;
   (b) medical advice, diagnosis, care or treatment has been recommended;
   (c) clear and distinct symptoms are or were evident; or
   (d) its existence would have been apparent to a reasonable person in the circumstances.

2. Medical Evacuation & Repatriation or cost not approved in advance and in writing by EMA Global and/or not arranged by EMA Global. This exclusion shall not apply to Medical Evacuation & Repatriation from remote or primitive areas which EMA Global cannot be contacted in advance and delay might reasonably be expected to result in loss of life or extreme prejudice to the Insured Life’s long term health prospect.

3. Any event occurring when the Insured Life is within the territory of Malaysia (International Assistance) or within 100km of their place of residence in Malaysia (Domestic Assistance).

4. Any expenses if the Insured Life is travelling outside Malaysia (International Assistance) or 100km away from the place of residence in Malaysia (Domestic Assistance) contrary to the advice of a medical practitioner or for the purpose of obtaining medical treatment or for rest and recuperation following any prior accident or illness.

5. Any expenses if the Insured Life is not suffering from a Serious Medical Condition or if the treatment can be reasonably delayed until the Insured Life returns to Malaysia (International Assistance) or his/her place of residence (Domestic Assistance).

6. Any treatment or expense related to pregnancy, childbirth (except abnormal pregnancy or vital complication of pregnancy which endangers the life of the mother and/or unborn children) and in any event of childbirth, miscarriage (spontaneous abortion) or pregnancy after the 6th month thereof.

7. Any expense incurred for emotional, mental illness and psychiatric disorder as opposed to physical and strictly medical reason.

8. Self-inflicted injury, suicide, alcohol abuse, drug addiction or abuse, sexually transmitted diseases, Acquired Immune Deficiency Syndrome (“AIDS”) or any AIDS related conditions or diseases.

9. Any treatment performed or ordered by a non-registered practitioner not in accordance with the standard medical practice as defined in the country of treatment.

10. Any event resulting from participation in war, riot or civil commotion or any illegal act including resulting in imprisonment or while serving in a police or military unit.

11. Any condition that requires such services after the expiry of the medical plan unless otherwise agreed in writing by PAMB.

12. The cost of burial in the Insured Life’s country of citizenship or Malaysia.

13. Any expense related to accident or injury occurring while the Insured Life is engaged in mountaineering or rock climbing necessitating the use of guides or ropes, potholing, skydiving, parachuting, ballooning, hang-gliding, deep sea diving utilizing hard helmet with airhose attachments, racing of any kind other than on foot, and all professional sports unless otherwise agreed in writing by PAMB.

14. The cost of transporting the Insured Life by means of PAMB or the Insured Life’s owned or leased watercraft unless agreed otherwise in writing by PAMB.

1. Insured Life
   Insured Life means the Life Assured or any of such person’s life is insured under medical plan.

2. Serious Medical Condition
   The serious medical condition defined above means a condition in which in the opinion of EMA Global constitutes a serious medical emergency requiring urgent medical treatment to avoid death or serious impairment to the Insured Life or the Insured Life’s immediate or long-term health prospects. The seriousness of the medical condition will be judged within the context of the Insured Life’s geographical location, the nature of the medical emergency and the local availability of appropriate medical care or facilities.