Policy : Group Medical Policy

1. Outpatient and Inpatient Hospitalization Policy

  • This Policy applies to all SPA/FMI/YSH Group of Companies’ employees on full-time appointment. Employees who have completed their probation period are eligible regardless of their level of position. 
  • The company provides the medical coverage and ensures that benefits are offered to all employees who are taking medical treatment as outpatient and/or confined in hospital for a period of time. The hospitalization insurance is arranged in-house for employees who are admitted for emergency operations and illnesses within Myanmar. 

2. Terms and conditions

This Policy is intended to provide hospital expenses incurred by an employee as a consequence of hospitalization in Pun Hlaing Hospital. Employee from other location/township out of Yangon area can be eligible for hospitalization at other hospital. The company will bear the medical expense by reimbursement basis to the employee within the coverage limits. 

The company will bear the medical expense to the employee. (pro rata for under one year service employee). 

  • Outpatient medical coverage is a maximum of up to 200,000 Ks per year for an employee. The company will reimburse 80% of medical expense and the medicine prescribed by a licensed Medical Doctor for each medical bill.
  • Inpatient hospitalization expenses is a maximum of up to 1,000,000 Ks per year for an employee. The company will reimburse 100% of inpatient medical expense for each medical bill.   

If the Inpatient hospitalization expenses are between 1,000,000 Ks. To 3,000,000 Ks per year. The company will bear 50%of the medical expense to the employee. 

Outpatient and Inpatient (IPD and OPD)services, the exclusion of the coverage will be:

  • Obstetrics including prenatal, antenatal land postnatal 
  • Plastic Surgery
  • Dental Care 
  • Cosmetics 
  • Optical 
  • Preexisting Conditions
  • Preventive Medical Checkup/ Health screening 

Chronic Illness 

Diseases which are regarded as long term illness which may affect the employee’s ability to do their job now or in future would be subject to consider alternative actions taken under the Chronic Illness . 

Special Payment in Case of Death 

The company will provide a compassionate payment to the deceased family as per the beneficiary list provided. 

  • Over10 year services – No. of service years x last withdrawn salary
  • Below 10 years services – 6 x last withdrawn salary 

The Human Resources Department will check and submit for the CEO’s approval. 

  • Respective line manager or HR Department will contact the family of the deceased.  
  • The family member will need to bring relevant information or document (National Registration Certificate) for verification. 

…………………………………………
Martin Appel
Group Head Human Resources

Appendix 

General Conditions applying to claim for reimbursement for medical bill 

The following conditions apply to all parts of this medical : 

Full compliance with terms and conditions of this  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 HR department.  
  2. HR department shall verify and process for the payment through finance department.
  3. In all cases the company require a completed Claim Form, within 30 days of the date of medical bill together with full original supporting evidence to substantiate the expense, such as receipts and reports. 

General Exclusions Applying to Whole Medical 

  1. Any sum in excess of the cover age 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, sterilization (or its reversal), fertilization, 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  Schedule. 
  9. Artificial heart implantation.
  10. Drugs and other medicines purchased without a Physician’s prescription and routine or preventative medicines, vaccinations and check–ups. 
  11. 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. 
  12. Surgery to correct short or long sight or any other eye defect, unless caused as a result of an Accident or illness.
  13. 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 Participant’s home or permanent residence and the admission is arranged wholly or partly for domestic reasons. 
  14. Medical Treatment for mental or nervous disorders, psychiatric Treatment and the costs of a psychotherapist, psychologist, family therapist or bereavement counsellor.  
  15. 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.  
  16. 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 organization(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). 

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