GROUP HEALTH INSURANCE PLAN
FOR THE EMPLOYEES
 
ELIGIBILITY
 
All regular employee under 65 years of age who are engaged in service on or before the effective date of this plan are eligible to participate in this plan. New staff will be eligible to join the plan only after they have completed their probation period.
 
BENEFITS COVERAGES
 
Daily Room & Board :
Reimbursement of the charges made by a lawfully operation public or private hospital for room, board during any one hospitalization as a registered bed patient subject to the daily maximum stipulated.
Hospital General Services :
Reimbursement of hospital charges made in respect of services rendered to an insured staff as an in-patient subject to the maximum stipulated. “Hospital Services” includes only regular hospital charges such as anesthesia, drugs, X-rays, laboratory examination, use of operating room, administration of blood, ambulance service, etc.
Surgical Fee :
Reimbursement of the charges made by the surgeon subject to such charges not exceeding the percentage valuations shown in the surgical schedule of fees nor surgical schedule maximum per disability. If two or more procedures are performed through a single incision, reimbursement for expenses for all such procedures shall not exceed the amount indicated for the one surgical procedure performed for which the largest amount is payable.
Consultation :
The amount of this benefit shall be equal to the sum actually charged forin-hospital consultation provided, however, that the maximum benefit shall not exceed the maximum consultation fee benefit stipulated in the total of the maximum Hospital General Services benefit or the maximum payable as shown in Surgical Schedule of Fees.
Emergency Treatment :
Reimbursement up to the maximum benefit will be made for (Accident Only) emergency treatment of bodily injury arising from an accident and received as an out-patient within 24 hours of the accident.
 
These benefits are available immediately once the staff are eligible and become insured. Benefits are not available for hospital admissions or at clinic commencing prior to the effective date of their insurance.
 
EXCLUSIONS
 
In order that cost of the medical insurance be within the reach of all employees, certain services must be limited. Benefits are not provided for :

1.
Rest cure or sanitarium care.
2.
Services in connection with physical therapy, medical check-up, examination by X-ray or other means purely for diagnostic purposes, any preventive treatment such as vaccinations, routine health checks.
3.
Services of intern or special nurse, services not related to medical treatment such as furnishing of radio, television, telephone or newspaper.
4. Treatment or surgical operation in a hospital which has not been recommended by a physicians or surgeon, treatment that is not scientifically recognized or Family doctor treatment.
5.
Treatment of nervous or mental disorder, alcoholism, drug addiction, Venereal Disease or congenital anomaly, Sterillization of either sex.
6.
Diagnosis & treatment of Severe Acute Respiratory Syndrome (SARS) & Avian Influenza (Bird Flu).
7. Treatment of sexually transmitted disease, treatment or test in connection with Acquired Immune Deficiency Syndrome (AIDS), any AIDS – related Complex (ARC) & any other AIDS related conditions or disease.
8.
Services, Surgical Operation in connection with pregnancy including childbirth, services of supplies in connection with care of a newborn child, Birth control, Sterile treatment, any miscarriage, abortion, performed due to psychological or social reasons and all consequences thereof.
9. Dental care, dental treatment, footcare (corns, calluses or thickened or misshapen nails), cosmetic surgery or plastic surgery except when necessary for repair or alleviation of damage to the insured person caused by accidental bodily injury.
10.
Treatment of chronic condition, allergic condition or disorder, dialysis, obesity, complications from excluded or restricted conditions.
11. Treatment to relieve symptoms commonly associated with any bodily change arising from any physiological or natural cause such as ageing, menopause or puberty.
12.
Eye examination, Eyesight treatment to correct for long or short sight, a corneal ulcer or failing eyesight due to ageing.
13.
Treatment of deafness caused by a congenital abnormality, maturing or ageing.
14.
Supplying or fitting physical aids and devices (for example : hearing aids, spectacles, contact lenses, crutches and walking sticks)
15. Services, Surgical Operation in connection with disability resulting from injury or sickness for which the employee is entitled to benefits under any workmen’s compensation or similar law.
16. Services, Surgical Operation in connection with disability resulting from injury or sickness arising out of or in the course of any employment for wage or profit.
17. “Pre-existing conditions” means any illness, injury or condition which the Insured or Dependant had its symptoms of the condition on or before the date of application for insurance and of which the Assured was aware or should have reasonably been aware or for which a licensed physician was consulted or for which treatment or medication was received prior Commencement Date of the Policy. Pre-existing conditions will be covered after the Insured or Dependant’s coverage has been in force for 2 years.
 
Form 001
 
CONDITION
 
The Asia Insurance (Cambodia) Plc. (hereinafter called the Company), in reliance upon the statements in the application, in consideration of the premium payable and subject to the exclusions, conditions and other terms of this policy, agrees with the Employer named in the Schedule as follows :-
 
INSURING AGREEMENTS
 
1.1 Coverage The Company will pay benefits in accordance with the coverage agreements attached.
 
1.2 Insured Persons
(1) If the insurance is afforded under a noncontributory plan, insured persons are those eligible for insurance as specified in the Schedule.
(2) If the insurance is afforded under a contributory plan, persons who are eligible as specified in the Schedule and who agree to contribute become insured persons :-
(a)
upon the date of eligibility if request for insurance is made prior to that date, or
(b)
upon that date of such request if made within 31 days of eligibility, or
(c)
upon the date the Company determines evidence of insurability to be satisfactory, such evidence to be furnished at the expense of those persons who request insurance more than 31 days after it has been discontinued because of their failure to make any agreed contributions when due.
If an employee is not at work on the date when he would otherwise become insured the effective date of such employee’s insurance shall be the date of his return to work.
 
1.3 Dependents' Coverage
(1)
No dependents of an employee shall be insured unless that dependent is insured or simultaneously becomes insured.
(2)
If a dependent is confined in a hospital on the date the insurance with respect to that dependent would otherwise become effective, such insurance shall not become effective until the dependent has recovered and is discharged from the hospital.
 
1.4 Individual Termination
Such insurance as is afforded an insured employee shall terminate:-
(1) on the date this policy is terminated
(2) on the date of termination of employment
Cessation of active work in the classes of employees eligible for insurance shall be deemed termination of employment, provided that :-
(a)
while an employee is temporarily on part time employment or is absent on account of injury or sickness, insurance shall be deemed to continue until premium payments for such employee are discontinued.
(b)
the insurance of an employee who is laid off may be continued, but not beyond the end of the policy month following the policy month in which the layoff starts.
(c)
the insurance of an employee who is granted a leave of absence may be continued, but not beyond the end of the policy month following the policy month in which the leave starts.
(3) at the end of the policy month in which an employee is retired or pensioned, or
(4) on the premium due date if the employer fails to pay the required premium for the insured employee, except as a result of error of the employer.
(5) such insurance as is afforded an employee with respect to his dependents shall terminate:-
(a)
on the date of termination of insurance afforded to the employee or
(b)
on the date such dependent ceases to be dependent as defined herein.
 
1.5 Change of Class
Any change in the insurance afforded an employee, which is due to a change in the insurance afforded an employee, which is due to a change in the class of such employee, shall become effective on the last day of the policy month in which the employee’s class changes; provided an employee who is entitled to an increased in insurance as of said date who is absent form work for any reason, other than absence during the authorized vacation period of such employee, shall not have his insurance increased until the first day thereafter on which the employee is actively at work.
 
1.6 Policy Period
This policy shall become effective as of the date stated in the Schedule. The policy anniversary shall be one year after the effective date. On each such anniversary this policy is renewable at the Company’s premium rates in effect at the time of such renewal, provided the number of insured employee is, if the insurance is under a contributory plan, not less than 75% of those eligible, or if the insurance is under a noncontributory plan, not less than 100% of those eligible.
 
1.7 General Exclusions
This policy does not cover injury or sickness fatal or non fatal, caused by or contributed to by:-
(1) diagnostic service if confined in a hospital for less than 12 consecutive hours.
(2)
suicide or intentionally inflicted self injury or any attempt thereat, while sane or insane.
(3)
accident occurring in consequence of travelling in any vehicle or device for aerial navigation, submarine transportation; except while riding as passenger in or boarding or alighting form an aircraft licensed for carriage of passengers provided by a commercial airline or regular schedule or non scheduled or chartered flight and operated by a properly licensed pilot flying between duly established and maintained airports.
(4) war, invasion, acts of foreign enemies, hostilities or warlike operations (whether war be declared or not), civil war, mutiny, rebellion, revolution, insurrection, military or usurped power, Strikes, riots and civil commotions.
(5) while the insured person is serving in any of the armed forces, whether land, water or air, of any country or international authority whether in peace or war.
(6) This policy does not apply to loss or injury sustained or expenses incurred after the 65th birthday of an insured person.
 
1.8 Conditions
(1) Definitions When used in this policy or in coverage agreements
Schedule means schedule of this policy.
Insured person
means an employee or a dependent of that employee who is insured.
Injury
means accidental bodily injury to an insured person occurring while the policy is in force and resulting directly and independently of all other causes in loss covered by the policy.
Sickness
means sickness or disease contracted by an insured person while the policy is in force.
Hospital
means any lawfully operating public or private hospital for the care and treatment of injured or sick person which has
(a) facilities for diagnosis and surgery
(b)
provided 24 hours nursing services by registered nurses and
(c) is under the supervision of physician.
Physician
means a person legally authorized to render medical and surgical services in the geographical area of practice.
Surgeon
means a person legally authorized to render surgical services in the geographical area of practice.
Dependent
means any of the following persons not employed by the employer :
(a)
spouse of the insured employee unless legally separated from the employee.
(b)
Unmarried children of the insured employee but only if not less than 2 weeks of age and more than 20 years of age.
 
(2)
Premium Payment: All premiums are payable by the employer on or before the date upon which they become due. A grace period of 30 days shall be allowed for payment of each premium after the first.
The premium bases and rates for benefits specified in the Schedule and coverage agreements which are attached to the policy are stated therein and are applied to all benefits in force on the date premium is due including benefits for any insured person then receiving benefits. Upon anniversary of this policy the Company may charge the rates at which further premiums shall be computed.
 
(3)
Records of Insured Persons: The Employer shall keep a record of persons insured containing for each insured person, the essential particulars of the insurance.
The Employer shall furnish to the Company at the beginning of each policy month such information relating to new employees becoming insured, adjustments because of changes in classification, and termination of insurance as may be required by the Company to administer this insurance.
Insurance shall not be invalidated as to any employee by failure of the Employer to record or report his request for insurance. Such error when discovered shall be reported immediately to the Company.
 
(4)
Audit: The Company shall be permitted to examine and audit the Employer’ s books and records at reasonable times during the policy period and any renewal thereof, or within one year after the final termination of this policy, as far as they relate to the premiums or the subject matter of this insurance.
 
(5)
Changes: No agent has authority to change this policy or waive any of its provisions. No change in this policy shall be valid unless approved by an authorized representative of the Company and such approval be endorsed hereon.
 
(6)
Notice & Proof of Loss: Written notice of injury or sickness on which claim may be based must be given to the Company within 30 days after the occurrence of commencement of any loss covered by the policy.
In the event of accidental death, notice given by or on behalf of a claimant with particulars sufficient to identify the insured person shall be deemed to be notice to the Company.

Failure to furnish notices within the time provided in the policy shall not invalidate any claim if it shall be shown not to have been reasonably possible to furnish such notice and that such notice was furnished as soon as reasonably possible.
Affirmative proof of loss must be furnished to the Company within 45 days after termination of the period for which claim is made.

All indemnities afforded under this policy will be payable within 30 days after receipt of proof of loss which is adequate.
 
(7)
Examination: The Company at its own expense shall have the right and opportunity to examine the person whose injury or sickness is the basis of claim when and so often as it may reasonably require during the pendency of any claim hereunder and to make an autopsy in case of death where it is not forbidden by law.
 
(8)
Other Insurance: If an insured person carries other insurance covering any loss insured by this policy, other than personal accident insurance, the Company shall not be liable for a greater proportion of such loss than the amount applicable thereto under this policy bears to the total amount of all valid insurance covering such loss.
 
(9)
Certificate of Insurance: The Company shall issue to the Employer for delivery to each employee who is insured under this policy an individual certificate setting forth a statement of the insurance protection to which each insured person is entitled and to whom benefits are payable.
 
(10)
Action Against the Company: No action at law shall be brought to recover from this policy unless brought within two years by the date of loss.
 
(11)
Time Limit Conformed to Statute: If any time limitation of this policy with respect to giving notice of claim or furnishing proof of loss of commencing an action at law is less than that permitted by the law of the country in which loss is sustained, such limitation is hereby extended to agree with the minimum period permitted by such law.
 
(12)
Cancellation: This policy may be cancelled by the Employer by mailing written notice of cancellation to the Company, such notice to state when thereafter cancellation shall become effective.
This policy may be cancelled by the Company by mailing written notice to the employer at the business address of the Employer shown in the Schedule. Not less than 30 days advance notice shall be given. Mailing of notice aforesaid, shall be sufficient proof of notice and the insurance under this policy shall end on the effective date of such notice.
Delivery of written notice of cancellation either by the Employer or by the Company shall be equivalent to mailing.
Cancellation or termination of this policy for any cause shall be without prejudice to any loss arising prior to termination.
 
Form 002
 
HOSPITAL CARE
 
The Company will pay benefits to an insured person as follows:
 
2.1 Inpatient Benefits
For services while confined in hospital for at least 12 consecutive hours because of injured or sickness
(1)
The amount of charges for hospital room and board during such confinement. The Company will pay for this benefit with respect to each injury or sickness not more than the actual amount incurred or the amount computed at the limit each day or the maximum benefit stated in the Schedule, whichever is less.
(2)
The amount of charges for general services furnished during such confinement including :-
(a)
charge for use of operating room, laboratory examination, medicines consumed, administration of blood, physical therapy but excluding room and board.
(b)
physician’s charges for anaesthesia and its administration.
(c)
ambulance charges but not in excess of US$ 25.00. each injury or sickness.
(d)
specialist consultation fee when no surgery has been performed but not in excess of 10% of maximum benefit.
The Company will pay for this benefit with respect to each injury or sickness not more than the actual amount incurred or the maximum benefit stated in the Schedule, whichever is less.
 
2.2 Emergency Treatment
For services in connection with emergency treatment or surgical operation in a hospital because of injury within 24 hours after the accident including :-
(1)
charges for use of operating room, laboratory examination, medicines consumed, administration of blood but excluding room and board.
(2)
physician’s charges for anaesthesia and its administration.
(3)
ambulance charges but not in excess of US$ 25.00 each disability.
The Company will pay for this benefit with respect to each injury not more than the amount of charges actually incurred or the maximum benefit stated in the Schedule, whichever is less.
 
2.3 Definitions
If an employee is an insured person, successive periods of confinement shall be considered as confinement arising out of one injury or sickness unless the subsequent period of confinement :-
(1)
commences after return to active work on full time for a period of not less than 2 weeks and after recovery from the injury or sickness causing the previous confinement, or
(2)
is due to causes entirely, unrelated to causes of previous confinement. If a dependent is an insured person, successive period of confinement shall be considered as confinement arising out of one injury or sickness unless the subsequent period of confinement :-
(a)
commences after 4 weeks or more and after recovery from the injury or sickness causing the previous confinement, or
(b)
is due to causes entirely unrelated to the causes of the previous confinement
 
 
Form 003
 
SURGICAL CARE
 
The Company will pay benefits to an insured person as follows:
 
3.1 For surgical operation because of injury or sickness performed by a physician or surgeon provided that :-
(1)
for any one operation, the Company shall pay not more than the surgical fee actually incurred or the applicable amount specified for that operation in the schedule of surgical benefits, whichever is less.
(2)
If more than one operation is performed through the same opening into the body, the Company shall pay not more than the benefit for the one operation with the largest benefit.
(3)
for all operations performed during any one injury or sickness, the Company shall pay not more than the maximum benefit stated in the Schedule.
 
3.2 For consultation with a specialist in connection with an operation provided that:
(1)
the Company shall pay for this benefit not more than the actual fee incurred or 10% of the maximum benefit stated in the Schedule, which ever is less.
(2)
consultation fee shall be included with the surgical fee and the Company shall pay not more than the applicable amount specified in the schedule of surgical benefits or the maximum benefit stated in the Schedule, whichever is less.
 
3.3 Definition
If an employee is an insured person, successive operations shall be considered as operations arising out of one injury or sickness unless the subsequent operation :-
(1)
is performed after return to active work on full time for a period of not less than 2 weeks and after recovery from the injury or sickness causing the previous operation, or
(2)
is due to causes entirely unrelated to the causes of the previous injury or sickness.
If a dependent is an insured person, successive operations shall be considered as operations arising out of one injury or sickness unless the subsequent operation :-
(3)
is performed 4 weeks or more and after recovery from the injury or sickness causing the previous operation, or
(4)
is due to causes entirely unrelated to the causes of the previous injury or sickness.
 
 
SURGICAL SCHEDULE OF FEES
 
Description of Surgical Operation Percentage of Maximum Benefit
 
ABDOMEN…………………… Appendectomy   50.00
  Resection of bowel   75.00
  Resection of stomach   75.00
  Gastro-enterostomy   62.50
  Removal of gall-bladder   75.00
  Cutting into abdominal cavity for diagnosis,
Treatment or removal of one or more organs therein except as otherwise herein provided
Two or more surgical procedures performed through the same abdominal incision will be considered as one operation.
  50.00
ABSCESS………………………… Incision of superficial abscess, boil or furuncle, one or more   5.00
  Treatment of carbuncle or abscess requiring hospitalization, one or more   12.50
AMPUTATION OF……………… Fingers or toes, each   7.50
  Hand, forearm or foot at ankle   25.00
  Leg, arm of thigh   37.50
BREAST…………………………… Amputation of one or both, radical with resection into axilla   75.00
  Amputation of one or both, simple   37.50
CHEST……………………………… Complete thoracoplasty   100.00
  Removal of lung or portion of lung   75.00
  Cutting into thoracic cavity for diagnosis, or treatment of organs therein, tapping excepted   25.00
  Removal of pus, tapping excepted   12.50
  Artificial pneumothorax   12.50
  Refills-each but not more than six   2.50
  Bronchoscopy-Diagnostic   12.50
  Operative, excluding biopsy   25.00
EAR………………………………… Cutting car drum   5.00
  Mastoidectomy-radical-one side   50.00
  Mastoidectomy-radical-both sides   62.50
  Fenestration, one or both sides   100.00
ESOPHAGUS…………………… Operation for stricture   37.50
  Use of gastroscope   12.50
EYE………………………………… Removal of foreign body, from cornea   2.50
Detached retina-multiple fusions   100.00
Cateract   50.00
Glaucoma   31.25
Removal of eyeball   31.25
Incision of style or chalazion   5.00
FRACTURES…………………… Treatment of-Simple Collar bone, shoulder blade, or forearm, one bone   15.00
Coccyx, tarsals, metatarsals or os calcis   10.00
Thigh   37.50
Upper arm or leg, one bone   25.00
Fingers or toes, each, or rib   5.00
Forearm-two bones, knee cap, or pelvis not requiring traction   20.00
Leg two bones   30.00
Jaw, lower   17.50
Carpals, metacarpals, nose, ribs-two or more, or Sternum   7.50
Pelvis, requiring traction   31.25
Vertebrae, transverse processes, each   6.25
Vertebrae, compression fracture, one or more   37.50
Wrist   11.25
COMPOUND OPEN…………… For a compound fracture increase the above benefit 50%. For a fracture requiring an open operation including bone grafting or bone splicing, increase the above 100% except that the maximum benefit shall not exceed   100.00
GENITO-URINARY TRACT
Removal of kidney   75.00
Fixation of kidney   75.00
Removal of tumors or stones in Kidney, ureter, or bladder-by cutting operation   62.50
By cauterization or endoscopic means   20.00
Stricture of urethra-open operation   30.00
Intra-urethral cutting operation   15.00
Prostrate-entire removal by open operation-complete procedure   75.00
Partial removal-by endoscopic means   25.00
By other cutting operation   50.00
Orchidectomy or epididymectomy   25.00
Hydrocele or varicocele   12.00
Hysterectomy, radical for cancer   75.00
Hysterectomy with complete removal of tubes and ovaries, with or without appendectomy   62.50
Curettage or cauterization of cervix non- puerperal   10.00
Dilations and curettage, non-puerperal   12.50
Repair of perineal or vaginal laceration, not immediately post partum, including cystocele and rectocele   37.50
Removal of fibroid tumors, without abdominal approach   20.00
GOITRE…………………………… Removal of Thyroid, including all stages of operative procedure   75.00
HERNIA…………………………… Injection treatment, complete course- single hernia   18.75
Double hernia   25.00
Radical operation, including injection treatment for cure of single hernia   37.50
Double hernia   50.00
JOINTS AND DISLOCATIONS
Incision into joint for disease and disorder, except as herein otherwise provided and except tapping   12.50
Incision into shoulder, elbow, hip or Knee joint, tapping excepted   37.50
Excision, fixation by cutting operation, disarticulation or arthroplasty on-Shoulder, hip, or spine   75.00
Knee, elbow, wrist, or ankle   37.50
Dislocation of-Fingers or toes, each   5.00
Shoulder, or elbow, wrist or ankle   15.00
Lower Jaw   6.25
Hip or knee, knee cap excepted   20.00
Knee cap   5.00
For a dislocation requiring an open operation, the maximum benefit for such dislocation shall be twice the applicable amount listed above.    
NOSE……………………………… Antrum puncture   2.50
Intranasal sinus operation   17.50
Extranasal sinus operation   37.50
Polypus, removal one or more   5.00
Submucous resection   25.00
Turbinectomy   7.50
PARACENTESIS……………… Tapping of-Abdomen   12.50
Chest or bladder, catheterization excepted   7.50
Ear drum, hydrocele, joints or spine   5.00
RECTUM………………………… Radical resection for malignancy, all stages, including colostomy   100.00
Hemorrhoids, external only, excision-complete procedure   7.50
Hemorrhoids, internal or internal and external including prolapsed rectum, total for excision or complete injection treatment   20.00
Fitstula in ano   17.50
Fissure in ano   5.00
Other cutting operations on rectum   17.50
SKULL…………………………… Cutting into cranial cavity, trephining and tapping excepted   100.00
Removal of bone, trephining or decompression   31.25
THROAT………………………… Tonsillectomy or tonsillectomy and adenoidectomy   25.00
Use of Laryngoscope for diagnosis   5.00
TUMORS………………………… Surgical removal of Malignant tumors except those of the mucous membrance, skin and subcutaneous tissue   50.00
Malignant tumors of the mucous membrane, skin and subcutaneous tissue   25.00
Pilonidal sinus or cyst, cutting operation   25.00