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Group Medical Policy

This policy outlines the medical benefit entitlement for all Full-time permanent staff regardless of their level or position, unless they are on another Yoma Group Medical Plan.

A) Outpatient and Inpatient Hospitalisation

The Yoma Group preference is that Employees use Pun Hlaing Siloam Hospital but this is not mandatory. The company will pay medical expenses by reimbursing employees within the coverage limits, and subject to the Exclusion listed in this Policy.

  1. All benefits in this policy are based on annual limits.
  • is up to 80% of such annual medical costs and up to a maximum reimbursement of 200,000 Ks per year. Both medical expenses and medicine prescribed by a licensed medical doctor are covered.
  • will be reimbursed as follows:
  1. of inpatient medical expenses up to 1,000,000 Ks.
    1. of the next 2,000,000 Ks.

Example: Employee incurs an inpatient hospital medical bill of 3,000,000 Ks. The reimbursement will be (i) 2,000,000 Ks made up of 100% of first 1,000,000 Ks, and (ii) 50% of next 2,000,000 Ks.

  SPECIAL COVID-19 COVER (Effective from 20 April 2020 – 31 October 2020)   The following additional cover will apply until 31 October in order to cover staff during the COVID-19 pandemic     of inpatient medical expenses up to 2,000,000 ks of the next 4,000,000 ks   Example: Employee incurs a COVID-19 related inpatient hospital medical bill of 6,000,000 ks. The reimbursement will be (i) 4,000,000 ks made up of 100% of first 2,000,000 ks and (ii) 50% of next 4,000,000 ks.  

Exclusions – the following Outpatient and Inpatient (OPD and IPD) services are excluded from this cover:

  • Obstetrics including prenatal, antenatal land postnatal
  • Plastic surgery
  • Dental care
  • Cosmetics
  • Optical
  • Preexisting conditions
  • Preventive medical checkup / health screening

B) Chronic Illness

In the event of a Chronic Illness, you should discuss options with your manager and Entity HR.

C) Special Payment in Case of Death

The Yoma Group will provide a compassionate payment to the family of the deceased Employee (as per the beneficiary list provided):

  • Below 10 years’ service – 6 x last drawn Gross Salary
  • Above10 years’ service – last drawn Gross Salary

……………………………………

                                                                                                Martin Appel
Group Head Human Resources
20 April 2020

Appendix

General Conditions:

The following conditions apply to all parts of this medical policy:

Full compliance with terms and conditions of this policy is necessary before a Claim will be paid.

Claim procedure:

  1. The employee shall provide the Medical Claim Form attached with Doctor’s prescription and medical bill to the relevant entity HR department.
  2. The HR department shall verify and process the payment through the finance department.
  3. In all cases, the company will require a completed Claim Form within 30 days of the date of the medical bill, together with full original supporting evidence to substantiate the expense, such as receipts and reports.

General Exclusions:

  1. Any sum in excess of the coverage limits.
  2. Any expense which the company considers to be unreasonable, unnecessary or excessive.
  3. Any claim involving fraud, misrepresentation or concealment or their consequences.
  4. Contraception, sterilisation (or its reversal), fertilisation, vasectomy, venereal disease, sexually transmitted infections, gender reassignment or any other form of sexual related condition.
  5. Investigations and / or treatment for infertility and any related condition or form of assisted reproduction.
  6. Chronic or end-stage kidney failure which has or will require regular or long-term dialysis.
  7. Any treatment to relieve symptoms caused by ageing or any physiological cause.
  8. Costs for treatment incurred outside the geographical area specified on the Policy Schedule.
  9. Artificial heart implantation.
  10. Drugs and other medicines purchased without a Physician’s prescription.
  11. Routine or preventative medicines, vaccinations and checkups.
  12. Cosmetic surgery, removal of fat or other surplus body issue and any consequences of such medical treatment, weight loss or weight problems / eating disorders, whether or not for psychological purposes, unless required as a direct result of an accident or surgery for cancer.
  13. Surgery to correct short or long sight or any other eye defect, unless caused as a result of an accident or illness.
  14. Accommodation and treatment costs in a nursing home, hydro, spa, nature clinic, health farm or the like or a hospital where the establishing concerned has, effectively, become the Employee’s home or permanent residence and the admission is arranged wholly or partly for domestic reasons.
  15. Medical treatment for mental or nervous disorders, psychiatric treatment and the costs of a psychotherapist, psychologist, family therapist or bereavement counsellor.
  16. Any claim in any way caused or contributed to by the use or release or the treat thereof of any nuclear weapon or device or chemical or biological agent.

Any claims whatsoever resulting from war, invasion, act of foreign enemy, hostilities (whether war be declared or not), act of terrorism, civil war, rebellion, revolution, insurrection, military or usurped power or taking part in civil commotion or riot of any kind. For the purpose of this exclusion, an act of terrorism means an act, including but not limited to the use of force or violence and / or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organisation(s) or government(s), committed for political, religious, ideological or similar purposes or reasons including the intention to influence any government and / or to put the public, or any section of the public, in fear.

Download : Medical Claim Form here