Eligible persons to this insurance must be between 16 and 60 years of age at the date of inception of the policy, except otherwise agreed by CAMINCO. The latter shall indemnify the insured subject to the terms, exclusions, provisions, and conditions contained herein or endorsed hereon the Company shall indemnify the Insured against expenses on hospitalization as defined herein arising during the period of insurance in the manner and to the extend hereinafter provided.
SCOPE OF COVERS
- Territorial Limit
Geographical coverage of this insurance is generally limited within the Kingdom of Cambodia, except otherwise agreed by CAMINCO.
- Benefits Coverages
- In-hospital Treatment : CAMINCO shall reimburse the regular charges of services rendered to the insured as an in-patient resulted from disease, in any one hospitalization during consecutive period of at least 8 hours, such as: daily room and board, use of operation room, diagnosis, nursing, drugs, specialists, physicians, surgeons, anesthetists, surgical appliances, radiotherapy, chemotherapy and oncology. CAMINCO shall reimburse the services charges only for diagnosis which has direct connection with the resulting disease of insured.
CAMINCO shall reimburse the regular charges for treatment of insured resulted from disease(s) in accordance with the actual expenses which are not exceeding the maximum amount stipulated in the schedule.
- Surgical Fees : CAMINCO shall reimburse the regular charges of surgical services rendered to the insured as an in-patient resulted from disease, as follows: For one surgical procedure CAMINCO shall reimburse such charges not exceeding the percentage shown in the surgical schedule fees nor maximum liability for surgical fees as indicated in the insurance schedule. If two or more surgical procedures are performed through a single incision of the same illness, reimbursement for expenses for all such procedures shall not exceed the maximum amount indicated in the one incision. CAMINCO shall reimburse the regular charges for surgical services in accordance with the actual expenses but not exceeding the maximum amount specified in the insurance schedule.
- Post-hospital Treatment: After release from in-hospital treatment, the beneficiary of this insurance shall enjoy coverage of treatment services directly related to the medical condition that necessitated in-patient treatment in the first place, for a period extended to thirty (30) days. CAMINCO shall reimburse the regular charges of post-hospital treatment services only for the use of drugs in accordance with the actual expenses which are not exceeding the maximum stipulated in the insurance schedule.
- Emergency Treatment: CAMINCO shall reimburse the regular charge of ambulance for transporting the insured bearing serous illness.
- Mainly based on proposal form
- Mainly based on:
- Group fact find form
- Health declaration form (if required)
Termination of Cover
- Standard documents required by CAMINCO:
- Claim form
- Physician statement
- Original medical bills
- CAMINCO reserves the right to call for any other documents
- Death of the insured
- Date on which the insured enters into full-time military service
- The insured attains the max, age covered under the policy
- Date on which the policy is terminated
- Non-payment of premium by the insured
- Total amount of claims exceed lifetime limit
- The insured ceases to be employed by the employer*