SKIM INSURAN PERLINDUNGAN KEMALANGAN PERIBADI SECARA BERKELOMPOK GROUP

SKIM INSURAN PERLINDUNGAN KEMALANGAN PERIBADI SECARA BERKELOMPOK (GROUP PERSONAL ACCIDENT INSURANCE) PIHAK PENGURUSAN DAN KAKITANGAN KERAJAAN NEGERI SARAWAK

SKOP TAKLIMAT • Pengenalan • Punca Kuasa • Polisi Skim Insuran Perlindungan Kemalangan Peribadi Secara Berkelompok Kerajaan Negeri Sarawak (SG GPA)

PENGENALAN • Kerajaan Negeri telah melaksanakan Skim Insuran Perlindungan Kemalangan Peribadi Secara Berkelompok bagi pihak Pengurusan dan Pegawaipegawai Kerajaan Negeri Sarawak mulai 11 Januari 1999 melalui Syarikat Transnational Insurance Brokers (M) Sdn. Bhd. • Surat Pekeliling (Per. Bil. No. : 7/1999) ruj:

PUNCA KUASA Peraturan Skim Insuran Perlindungan Kemalangan Peribadi Secara Berkelompok (Group Personal Accident Insurance) tertakluk di bawah; i) The Financial Procedure (Contingencies and Trust Funds Ordinance, 1963) dan; ii) Surat Pekeliling (Per. Bil. No. : 7/1999) ruj:

TANGGUNGJAWAB UNIT SUMBER MANUSIA NEGERI • Merancang Belanjawan/Peruntukan dan bayaran premium Tahunan kepada TIB Sdn. Bhd. . • Memantau, menyelaras dan menyampaikan keputusan urusan tuntutan insuran kepada pegawai/waris yang layak. • Memastikan pelaksanaan Skim Insuran berkenaan selaras dengan The Financial Procedure (Contingencies and

POLISI DAN PERLINDUNGAN • Memberi perlindungan kemalangan seperti yang diperuntukkan dalam polisi berkenaan untuk tempoh 24 jam sama ada semasa menjalankan tugas rasmi atau tidak • Untuk rawatan perubatan - masih tertaluk kepada PAPAN 1996 dan Pekeliling-Pekeliling yang berkuatkuasa

PROSEDUR TUNTUTAN • Notis Pemberitahuan kepada TIB (M) Sdn Bhd • Borang Tuntutan pampasan dari TIB (M) Sdn Bhd (Chop Rasmi JKM) • Dikemukakan kepada TIB (M) Sdn Bhd dalam tempoh 60 hari • Kemalangan tidak melibatkan kematian - dibuat oleh pegawai sendiri, disahkan oleh Ketua Jabatan • Kemalangan melibatkan kematian -

GROUP PERSONAL ACCIDENT INSURANCE WHAT IT COVERS? - The policy indemnifies for bodily injury solely and directly caused by violent, accidental means resulting in death and/or permanent disability during and outside office hours. - Operates on a 24 hours worldwide basis.

GROUP PERSONAL ACCIDENT INSURANCE INTEREST INSURED All employees of THE STATE GOVERNMENT OF SARAWAK. 1. Permanent Employees 2. Contract or Temporary Employees 3. Seconded Employees to The State Government

GROUP PERSONAL ACCIDENT INSURANCE BASIS OF SUM INSURED SECTION 1 - YEARS) SECTION 2 - TUAN YANG TERUTAMA (TYT) (FIXED SUM INSURED) CABINETS (AGE LIMIT : 16 – 85 (FIXED SUM INSURED) EMPLOYEES (10 TIMES OF ANNUAL BASIC SALARY) AGE LIMIT : 16 – 65 YEARS

GROUP PERSONAL ACCIDENT INSURANCE SCOPE OF COVER - Accidental Death 10 times annual basic salary - Permanent Disablement benefits. As per schedule of - Temporary Total Disablement Weekly Salary Cabinet - RM 2, 000. 00 Employees - Actual - Temporary Partial Disablement 50% of the TTD

GROUP PERSONAL ACCIDENT INSURANCE SCOPE OF COVER - Medical Expenses capita per event RM 5, 000. 00 per - Repatriation Expenses. RM 2, 500. 00 per capita per event - Funeral Expenses capita per event RM 1, 500. 00 per

GROUP PERSONAL ACCIDENT INSURANCE

GROUP PERSONAL ACCIDENT INSURANCE BENEFICIARY UNDER THIS PROGRAMME Kerajaan Negeri Sarawak. Beneficiary will administer the compensation amount and disburse according to Letter of Administration / Faraid Law.

GROUP PERSONAL ACCIDENT INSURANCE POLICY ENHANCEMENT - Approved Adjusters Clause - Travelling on Unscheduled Flights Extension Clause (Limit RM 25 million anyone conveyance) - Amateur Martial Art of Self Defeence - Automatic Additions and Deletions clause - Convulsion of Nature - Disappearance Clause (1 year) - Drowning Clause - Exposure Clause - Funeral Expenses Clause

GROUP PERSONAL ACCIDENT INSURANCE POLICY ENHANCEMENT - Gas Inhalation, Drink or Food Poisoning - Harmful Insects and Snakes Bites - Hijacking Clause - Hunting Risks - Loss Notification Clause (60 days) - Motorcycling Clause - Murder & Assault (Unprovoked) - Mountaineering - Payment on Account (Claim)

GROUP PERSONAL ACCIDENT INSURANCE POLICY ENHANCEMENT - Scuba Diving Clause - Strike, Riot & Civil Commotion - Sport Activities Clause (Amateur) - Worldwide Clause - Bitten & attack by animals - Woodworking machinery

GROUP PERSONAL ACCIDENT INSURANCE POLICY EXCLUSION - War or warlike operation, act of foreign enemy, hostilities (whether war be declared or not), civil war, revolution, insurrection, mutiny or usurped power, military or popular uprising and rebellion - Injury sustained whilst the insured is under the influence of intoxicants by alcohol or drugs or is suffering from insanity - Insanity/Suicide - Intentionally inflicting self-injury

GROUP PERSONAL ACCIDENT INSURANCE POLICY EXCLUSION - Committing, unlawful act - Radiation and Nuclear activity - Professional sports - Miscarriage, pregnancy - Venereal disease, infection or parasites - Provoked murder or assault - Terrorism - AIDS Clause

GROUP PERSONAL ACCIDENT INSURANCE PANEL OF INSURERS Jointly co-insured by a panel of four reputable Malaysian insurance companies: - - QBE Insurance Bhd - Syarikat Takaful Malaysia Bhd - AXA Affin General Insurance Bhd - The Pacific Insurance Bhd

GROUP PERSONAL ACCIDENT INSURANCE CLAIM PROCEDURES 1 2 POLICE (road traffic accident only) NOTIFY OFFICER-IN-CHARGE OF INSURANCE NOTIFY TIB OBTAIN REPORT - DATE & TIME ACCIDENT OCCUR - EXTENT OF INJURY - CAUSE OF ACCIDENT - BASIC SALARY NOTIFICATION TO INSURER AND APPOINTMENT OF ADJUSTER, IF NECESSARY

GROUP PERSONAL ACCIDENT INSURANCE CLAIMS DOCUMENTS Non-Fatal Claim - Duly completed claim form - ORIGINAL police report - Medical report - Original sick leave certificate or certified true copy - Certified true copy of 3 months salary slip prior to accident - ORIGINAL medical bills and receipt.

GROUP PERSONAL ACCIDENT INSURANCE CLAIMS DOCUMENTS Fatal Claim - Duly completed claim form - Medical report on cause of death or post mortem report - Copy of death certificate or extract report of death - Original copy of police report - Photocopy of the employee’s identity card/ birth certificate - Certified true copy of 3 months salary slip prior to

CONTOH PENGIRAAN i) Kemalangan Melibatkan Kematian kepada Pegawai A, Gred N 41 (Pengurusan dan Profesional) *Gaji Pokok Terakhir ialah RM 1, 627. 11 Gaji Pokok Terakhir X 10 X 12 = RM 195, 253. 20 ii) Kemalangan Tidak Melibatkan Kematian kepada Pegawai A, Gred N 41 (Pengurusan dan Profesional) *Gaji Pokok Terakhir ialah RM 1, 627. 11/4 = RM 406. 77 (Weekly Benefit) TTD = RM 406. 77 TPD = RM 203. 385 (50% from TTD) Jika pegawai tersebut Cuti Sakit 51 hari jumlah bayaran adalah seperti berikut; TTD = 51/7 X 406. 77 = RM 3, 311. 92