Dear Sir / Madam,
Good News! We are pleased to inform that PruBSN medical plans** cover for hospitalisation due to COVID-19, under the campaign "COVID-19 Medical Plan Coverage Campaign". The coverage** is subject to each of our customers’ medical benefit limits and terms and conditions of the certificate.
This coverage** starts on 6th August 2021 (subject to any existing waiting period under the medical plan) until further notice.
Please note that all the coverage** provided for hospitalisations due to COVID-19 is available on reimbursement basis (HAS facility is not available), subject to Medically Necessary and Reasonable & Customary Charges. Hence, please assist our customers to prepare necessary documents for reimbursement submission (e.g. original receipts, summary invoice, detail breakdown invoice, all lab and imaging reports, discharge summary, and any other supporting documents).
Please be informed that this campaign will cease on 31 July 2022
Kindly inform all relevant departments (business office, front office, patient administration, Accident & Emergency Department, admission & discharge counter, insurance counter, finance & billing department etc.)
Thank you for your understanding and cooperation.
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FAQ: COVID-19 Medical Plan Coverage Campaign
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- If PruBSN customer has been admitted for some other conditions (not related to COVID-19) & then become COVID-19 positive, is HAS (cashless facility) available for the entire hospitalisation? Even if the other conditions are covered on cashless basis, all Reasonable and Customary Charges related to Medically Necessary treatment for COVID-19 infection will only be covered on reimbursement basis.
- What is considered as Medically Necessary treatment received for COVID-19 hospitalisation? When PruBSN customer receives among others, active treatments such ventilation support, oxygen support, intubation or intravenous medication during hospitalisation due to positive diagnosis.
- Would PruBSN customer be reimbursed for COVID-19 Test & PPEs used during such Medically Necessary hospitalisation? Yes, COVID-19 test & Medically Necessary usage of PPEs during hospitalisation due to COVID-19 infection would be reimbursed based on Reasonable and Customary Charges.
- Will PruBSN issue pre-authorisation of medical claims (Guarantee Letter) if our customer hospitalized in panel hospitals due to COVID-19? No, HAS (cashless facility) is not available for COVID-19 related admissions. The claims submitted are on reimbursement basis. This means PruBSN customers need to pay the bills first, then submit the claims for reimbursement.
- Can PruBSN customer submit a claim under this Campaign, if he/she is a Category 1 or 2 COVID-19 patient but is asked to be hospitalised in a private hospital according to the doctor’s recommendation? In general, for a COVID-19 patient with no symptoms (Category 1 - asymptomatic) or who does not require active treatment i.e. in quarantine only (Category 1 - asymptomatic or Category 2 - symptomatic, no pneumonia), any services received during such hospitalisation including quarantine at Quarantine centers, Quarantine at Hospitals or Home quarantine would not be deemed as Medically Necessary. Hence, the expenses incurred will not be reimbursed under this Campaign, unless there is evidence showing the hospitalisation and treatment received are Medically Necessary and active treatment is required for the patient during the hospitalisation.
- If the condition progressed from being a Category 2 COVID-19 patient to Category 4 COVID-19 patient. Will the hospitalisation be coverable? PruBSN customer can submit reimbursement claims for medical expenses incurred to treat COVID-19 during the hospitalisation. We will assess the claims based on the terms and conditions set for this Campaign.
- If PruBSN customer was hospitalised due to COVID-19 prior to 6th August 2021. Can he/she submit reimbursement for such hospitalisation under this Campaign? No, this Campaign starts from 6th August 2021 and it is for hospitalisation due to COVID-19 that happened on or after 6th August 2021. Any COVID-19 related hospitalisation prior to 6th August 2021 can be considered under COVID-19 Hospitalisation Assistance and COVID-19 Upgraded Plan Assistance (depending on the eligibility), as long as the claim is submitted within 3 months from the date of diagnosis.
**Terms & conditions apply; you may refer to our corporate website for more details:
https://www.prubsn.com.my/en/campaigns-announcements/covid-19-medical-plan-coverage/