the flexible plan that lets you ... - prudential singapore · protect your greatest assets – your...

26
PRUtreasures flexi | 01 Protecting your employees now comes with greater flexibility. The flexible plan that lets you choose how you protect your greatest assets – your employees. PRU treasures flexi Your relationships are precious. Protect them.

Upload: hatram

Post on 19-Apr-2018

249 views

Category:

Documents


7 download

TRANSCRIPT

Page 1: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

PRUtreasures flexi | 01

Protecting your employees now comes with greater flexibility.The flexible plan that lets you choose how you protect your greatest assets – your employees.

PRUtreasures flexi

Your relationships are precious.

Protect them.

Page 2: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

A good protection plan can increase productivity at work. That’s why, apart from providing your employees a stable income and career growth, their protection needs are just as important.

PRUtreasures flexi offers a comprehensive plan to ensure your employees are protected from the financial impact of unforeseen illnesses and accidents.

PRUtreasures flexi lets you choose your group protection plan according to your organisation’s unique needs by selecting the amount of coverage, medical protection and benefits.

Help your employees cope with their healthcare

are diagnosed with cancer every day in Singapore

Sharp rise in numbers diagnosed with cancer

Source: Singapore Cancer Society (2017 November 8), retrieved from https://www.singaporecancersociety.org.sg/learn-about-cancer/cancer-basics/common-types-of-cancer-in-singapore.html

Source: Aon Hewitt 2017 Global Medical Trend Rates Report

15

35

%in 2016

PEOPLE

Gross Medical Inflation

02 | PRUtreasures flexi

Page 3: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

PRUtreasures flexi allows you to select the coverage for your employeesWe help you protect your employees against uncertainties with a comprehensive coverage – protection against

death, total and permanent disability, terminal illness and critical illness, hospitalisation, outpatient clinic,

specialist, dental and even Traditional Chinese Medicine (TCM) treatments.

Flexibility• Choice of plans to suit your needs and budget.

Comprehensive Solutions• High sum assured of up to S$500,000 upon death, total and permanent disability or terminal illness.

• Repatriation of Mortal Remains of up to S$50,000 per member.

• Coverage of up to S$250,000 upon diagnosis of any of the covered critical illnesses.

• Coverage of up to 1-bedded wards in private hospitals.

• Coverage for outpatient clinical with TCM option, specialist and dental.

Small Group Size• You can start policy coverage with just 3 employees.

Guaranteed Coverage• Eligible employees enjoy guaranteed coverage of up to S$200,000 for Group Term Life and up to S$100,000 for Group Crisis Cover Accelerated.

Portfolio Pricing• Premiums are calculated based on the claims experience of the entire PRUtreasures flexi portfolio.

PRUtreasures flexi | 03

Page 4: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

04 | PRUtreasures flexi

Convenience & Ease of Access• Cashless access at Prudential's panel of General Practitioners.

• Go paperless and submit your claims online.

Double Sum Assured• Double death benefit due to accident while travelling as a fare-paying passenger in a Public Land Conveyance in Singapore, including Uber and Grab service.

Complimentary Health Screening• Complimentary health screening is offered to group size with more than 10 insured employees covered in Group Hospital & Surgical at no additional cost*.

Extended Coverage• Extended coverage to dependants for medical products.

• Extended coverage to employees residing outside of Singapore1.

Group Size Discount• Discount is applied to group size of at least 11 employees.

*Subject to availability.1 Please refer to the Underwriting Guideline for covered countries found on page 14 and 15.

Terms and Conditions apply. Please refer to www.prudential.com.sg/ptrf for more details.

Page 5: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

PRUtreasures flexi | 05

Benefits at a GlanceYou can choose between the Group Term Life and Group Hospital & Surgical plans as your core plans. These plans, along with additional optional supplementary benefits, give you more options to customise an employee's insurance scheme that can keep pace with their evolving needs.

Group Term Life (GTL)Receive up to S$500,000 due to death,

total and permanent disability or terminal illness.

Group Crisis Cover Accelerated (GCCA)

Be covered against 37 critical illnesses.

Group Outpatient General Practitioner & Specialist (GP & SP)

Cashless for GP Panel Clinics and reimbursement for outpatient specialist

medical expenses.

Group Accidental Death & Dismemberment (GADD)

Receive up to S$500,000 due to accidental death and injuries.

Group Accidental Death & Dismemberment (GADD)

Receive up to S$500,000 due to accidental death and injuries.

Group Extended Major Medical (GEMM)

Reimbursement of hospital expenses in excess of eligible hospital expenses.

Group Outpatient General Practitioner (GP)

Cashless for GP Panel Clinics.Or

Group Outpatient General Practitioner & Specialist (GP & SP)

Cashless for GP Panel Clinics and reimbursement for outpatient specialist medical expenses.

Group Dental (GDEN)Reimbursement for eligible dental expenses.

Group Hospital & Surgical (GHS)Reimbursement of hospital expenses

due to a sickness or injury.

ADD ON RIDERS (OPTIONAL) ADD ON RIDERS (OPTIONAL)

ADD ON RIDERS (OPTIONAL)

ADD ON RIDERS (OPTIONAL)

ADD ON RIDERS (OPTIONAL)

ADD ON RIDERS (OPTIONAL)

ADD ON RIDERS (OPTIONAL)

Page 6: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

06 | PRUtreasures flexi

BENEFITS / PLAN TYPE PLAN 12 PLAN 2 PLAN 3 PLAN 4 PLAN 5

Group Term Life(Double Death Benefits payable in the event of death due to accident in a public land conveyance) - Death- Total and Permanent Disability (TPD)- Terminal Illness (TI)

S$ 500,000 S$ 200,000 S$ 150,000 S$ 80,000 S$ 50,000

Repatriation of Mortal Remains (per member) S$ 50,000 S$ 50,000 S$ 50,000 S$ 50,000 S$ 50,000

CORE PLAN – GROUP TERM LIFE

AGE LAST BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5

16 – 19 S$ 397.00 S$ 183.00 S$ 143.00 S$ 78.00 S$ 50.00

20 – 24 S$ 379.00 S$ 176.00 S$ 137.00 S$ 74.00 S$ 48.00

25 – 29 S$ 333.00 S$ 154.00 S$ 120.00 S$ 65.00 S$ 42.00

30 – 34 S$ 372.00 S$ 172.00 S$ 133.00 S$ 73.00 S$ 47.00

35 – 39 S$ 417.00 S$ 195.00 S$ 151.00 S$ 82.00 S$ 52.00

40 – 44 S$ 574.00 S$ 277.00 S$ 215.00 S$ 116.00 S$ 73.00

45 – 49 S$ 944.00 S$ 450.00 S$ 349.00 S$ 187.00 S$ 118.00

50 – 54 S$ 1,611.00 S$ 765.00 S$ 592.00 S$ 317.00 S$ 199.00

55 – 59 S$ 2,582.00 S$ 1,246.00 S$ 964.00 S$ 515.00 S$ 323.00

60 – 64 S$ 4,320.00 S$ 2,084.00 S$ 1,612.00 S$ 861.00 S$ 539.00

65 – 69 S$ 7,207.00 S$ 3,480.00 S$ 2,692.00 S$ 1,437.00 S$ 899.00

70 – 743 S$ 13,856.00 S$ 6,688.00 S$ 5,171.00 S$ 2,759.00 S$ 1,726.00

GROUP SIZE (INSURED EMPLOYEES) DISCOUNT

11 – 15 5%

16 and above 10%

3 For renewals only.

ANNUAL PREMIUM RATE – GROUP TERM LIFE

GROUP SIZE DISCOUNT FOR GROUP TERM LIFE

BENEFITS / PLAN TYPE PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5

1Daily Room and Board Benefit (Per day, up to 120 days per disability)

1-Bed Ward Private

2-Bed Ward Private

4-Bed Ward Private

4-Bed Ward Government Restructured

1-Bed Ward Government Restructured

2Intensive Care Unit (ICU) (Max. per day, up to 30 days per disability) 3 x 1-Bedded 3 x 2-Bedded 3 x 4-Bedded S$15,000

per disability limit for items

2 to 8

S$20,000 per disability limit for items

2 to 83High Dependency Ward (HDW) (Max. per day, up to 30 days per disability) 2 x 1-Bedded 2 x 2-Bedded 2 x 4-Bedded

CORE PLAN – GROUP HOSPITAL & SURGICAL

2 Health declaration required.

Page 7: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

PRUtreasures flexi | 07

4 i. Waiver of surgical schedule if insured member is admitted to government restructured hospital. ii. Surgical fee more than S$1,500 is subject to surgical schedule if insured member is admitted to a private hospital.

BENEFITS / PLAN TYPE PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5

4Other Hospital Services Benefits – Including implants(Max. per disability)

S$25,000 per disability limit for items

4 to 8

S$20,000 per disability limit for items

4 to 8

S$15,000 per disability limit for items

4 to 8

S$15,000 per disability limit for items

2 to 8

S$20,000 per disability limit for items

2 to 8

5Surgical Fees (subject to surgical schedule)4

6In-Hospital Doctor'sConsultation Benefit (Max. 120 days)

7

Pre (90 days) & Post (90 days) Hospitalisation/Surgery, Specialist Consultation, Diagnostic X-Ray and Lab Test, Traditional Chinese Medicine

8Emergency Accidental Outpatient Treatment Benefit (Including Accidental Dental Treatment)

9 Miscarriage Benefit Covered under benefits (items 1 to 8), as per the respective benefit limits

10Outpatient Cancer Treatment (Max. per policy year) S$ 10,000 S$ 10,000 S$ 10,000 N.A N.A

11Outpatient Kidney Dialysis (Max. per policy year) S$ 10,000 S$ 10,000 S$ 10,000 N.A N.A

12Overseas Hospitalisation for Accident Benefit 150% of GHS benefit (for items 1 to 7)

13Rehabilitation Benefit (Max. per disability, up to 31 days) S$ 5,000 S$ 5,000 S$ 5,000 S$ 5,000 S$ 5,000

14Hospital Cash Benefit(Max. per day, up to 90 days per disability)

– Singapore Government Restructured B1 Ward S$ 50 S$ 40 Nil Nil Nil

– Singapore Government Restructured B2 Ward S$ 100 S$ 80 S$ 40 Nil Nil

– Singapore Government Restructured C Ward S$ 150 S$ 120 S$ 80 Nil Nil

15In-Hospital Psychiatric Treatment(Max. per policy year, applicable to Singapore GRH only)

S$ 1,000 S$ 1,000 S$ 1,000 S$ 1,000 S$ 1,000

16

Death Benefit(Double Death Benefits payable in the event of death due to accident in a public land conveyance)

S$ 5,000 S$ 5,000 S$ 5,000 S$ 5,000 S$ 5,000

17

Pro-ration factor for:

Plan 2 & 3Applicable to items 4 – 7

Plan 4 & 5Applicable to items 2 – 7

Nil

75% applies if Insured

Member stays in 1 Bedded

ward (Private or

Government Restructured)

75% applies if Insured

Member stays in 2 Bedded

or higher ward (Private or

Government Restructured)

75% applies if Insured

Member stays in 4 Bedded

or higher ward (Private) or

2 Bedded or higher ward

(Government Restructured)

75% applies if Insured

Member stays in 1 Bedded

ward (Private)

18 Complimentary Health Screening (For employee only)

Applicable for group size > 10 eligible employees

Page 8: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

08 | PRUtreasures flexi

AGE LAST BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5

16 – 19 S$ 395.00 S$ 324.00 S$ 252.00 S$ 129.00 S$ 180.0020 – 24 S$ 408.00 S$ 328.00 S$ 260.00 S$ 134.00 S$ 187.0025 – 29 S$ 444.00 S$ 341.00 S$ 274.00 S$ 139.00 S$ 194.0030 – 34 S$ 472.00 S$ 365.00 S$ 294.00 S$ 148.00 S$ 206.0035 – 39 S$ 505.00 S$ 388.00 S$ 312.00 S$ 170.00 S$ 237.0040 – 44 S$ 551.00 S$ 430.00 S$ 343.00 S$ 219.00 S$ 306.0045 – 49 S$ 641.00 S$ 502.00 S$ 401.00 S$ 267.00 S$ 373.0050 – 54 S$ 903.00 S$ 713.00 S$ 563.00 S$ 362.00 S$ 506.0055 – 59 S$ 1,158.00 S$ 921.00 S$ 721.00 S$ 473.00 S$ 661.0060 – 64 S$ 1,586.00 S$ 1,249.00 S$ 968.00 S$ 627.00 S$ 877.0065 – 69 S$ 2,500.00 S$ 1,927.00 S$ 1,559.00 S$ 823.00 S$ 1,151.00

70 – 745 S$ 3,437.00 S$ 2,649.00 S$ 2,141.00 S$ 1,126.00 S$ 1,575.00

AGE LAST BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5

16 – 19 S$ 888.75 S$ 729.00 S$ 567.00 S$ 290.25 S$ 405.0020 – 24 S$ 918.00 S$ 738.00 S$ 585.00 S$ 301.50 S$ 420.7525 – 29 S$ 999.00 S$ 767.25 S$ 616.50 S$ 312.75 S$ 436.5030 – 34 S$ 1,062.00 S$ 821.25 S$ 661.50 S$ 333.00 S$ 463.5035 – 39 S$ 1,136.25 S$ 873.00 S$ 702.00 S$ 382.50 S$ 533.2540 – 44 S$ 1,239.75 S$ 967.50 S$ 771.75 S$ 492.75 S$ 688.5045 – 49 S$ 1,442.25 S$ 1,129.50 S$ 902.25 S$ 600.75 S$ 839.2550 – 54 S$ 2,031.75 S$ 1,604.25 S$ 1,266.75 S$ 814.50 S$ 1,138.5055 – 59 S$ 2,605.50 S$ 2,072.25 S$ 1,622.25 S$ 1,064.25 S$ 1,487.2560 – 64 S$ 3,568.50 S$ 2,810.25 S$ 2,178.00 S$ 1,410.75 S$ 1,973.2565 – 69 S$ 5,625.00 S$ 4,335.75 S$ 3,507.75 S$ 1,851.75 S$ 2,589.75

70 – 745 S$ 7,733.25 S$ 5,960.25 S$ 4,817.25 S$ 2,533.50 S$ 3,543.75

AGE LAST BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5

16 – 19 S$ 1,382.50 S$ 1,134.00 S$ 882.00 S$ 451.50 S$ 630.0020 – 24 S$ 1,428.00 S$ 1,148.00 S$ 910.00 S$ 469.00 S$ 654.5025 – 29 S$ 1,554.00 S$ 1,193.50 S$ 959.00 S$ 486.50 S$ 679.0030 – 34 S$ 1,652.00 S$ 1,277.50 S$ 1,029.00 S$ 518.00 S$ 721.0035 – 39 S$ 1,767.50 S$ 1,358.00 S$ 1,092.00 S$ 595.00 S$ 829.5040 – 44 S$ 1,928.50 S$ 1,505.00 S$ 1,200.50 S$ 766.50 S$ 1,071.0045 – 49 S$ 2,243.50 S$ 1,757.00 S$ 1,403.50 S$ 934.50 S$ 1,305.5050 – 54 S$ 3,160.50 S$ 2,495.50 S$ 1,970.50 S$ 1,267.00 S$ 1,771.0055 – 59 S$ 4,053.00 S$ 3,223.50 S$ 2,523.50 S$ 1,655.50 S$ 2,313.5060 – 64 S$ 5,551.00 S$ 4,371.50 S$ 3,388.00 S$ 2,194.50 S$ 3,069.5065 – 69 S$ 8,750.00 S$ 6,744.50 S$ 5,456.50 S$ 2,880.50 S$ 4,028.50

70 – 745 S$ 12,029.50 S$ 9,271.50 S$ 7,493.50 S$ 3,941.00 S$ 5,512.50

ANNUAL PREMIUM RATE – GROUP HOSPITAL & SURGICAL

For Employee and Spouse or Children Coverage Only (inclusive of 7% GST)

For Employee Only (inclusive of 7% GST)

For Employees and Spouse and Children Coverage (inclusive of 7% GST)

5 For renewals only.

GROUP SIZE (INSURED EMPLOYEES) DISCOUNT

11 – 15 5%

16 and above 10%

GROUP SIZE DISCOUNT FOR GROUP HOSPITAL & SURGICAL

Page 9: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

PRUtreasures flexi | 09

GROUP CRISIS COVER ACCELERATED/ RIDER TO GROUP TERM LIFE

ANNUAL PREMIUM RATE – GROUP CRISIS COVER ACCELERATED

BENEFITS / PLAN TYPE PLAN 16 PLAN 2 PLAN 3 PLAN 4 PLAN 5

Group Crisis Cover Accelerated S$ 250,000 S$ 100,000 S$ 75,000 S$ 40,000 S$ 25,000

AGE LAST BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5

16 – 19 S$ 211.00 S$ 94.00 S$ 72.00 S$ 39.00 S$ 24.00

20 – 24 S$ 212.00 S$ 95.00 S$ 74.00 S$ 40.00 S$ 25.00

25 – 29 S$ 291.00 S$ 127.00 S$ 98.00 S$ 52.00 S$ 33.00

30 – 34 S$ 366.00 S$ 157.00 S$ 122.00 S$ 65.00 S$ 41.00

35 – 39 S$ 551.00 S$ 238.00 S$ 184.00 S$ 99.00 S$ 62.00

40 – 44 S$ 954.00 S$ 421.00 S$ 326.00 S$ 174.00 S$ 109.00

45 – 49 S$ 1,378.00 S$ 622.00 S$ 481.00 S$ 257.00 S$ 161.00

50 – 54 S$ 1,927.00 S$ 873.00 S$ 675.00 S$ 360.00 S$ 225.00

55 – 59 S$ 3,301.00 S$ 1,489.00 S$ 1,151.00 S$ 615.00 S$ 384.00

60 – 64 S$ 5,479.00 S$ 2,476.00 S$ 1,915.00 S$ 1,022.00 S$ 639.00

65 – 697 S$ 7,423.00 S$ 3,413.00 S$ 2,639.00 S$ 1,407.00 S$ 880.00

Enhance Your PRUtreasures flexi Plan According To Your NeedsPRUtreasures flexi offers supplementary benefits to complement the core coverage. Depending on the core plans selected, you can choose up to 7 optional supplementary benefits to suit your company’s budget and needs.

6 Health declaration required.7 For renewals only. Note: Coverage for Group Crisis Cover Accelerated benefit ceases at age 70 last birthday.

ANNUAL PREMIUM RATE (inclusive of 7% GST) – GROUP ACCIDENTAL DEATH & DISMEMBERMENT

BENEFITS / PLAN TYPE PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5

Group Accidental Death & Dismemberment S$ 500,000 S$ 200,000 S$ 150,000 S$ 80,000 S$ 50,000

Optional Benefit: Accidental Medical Reimbursement

S$ 5,000

OCCUPATIONAL CLASS

AGE LAST BIRTHDAY

PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5

Class 116 – 69 S$ 154.00 S$ 66.00 S$ 50.00 S$ 27.00 S$ 17.00

70 – 748 S$ 631.00 S$ 274.00 S$ 205.00 S$ 110.00 S$ 69.00

Class 216 – 69 S$ 183.00 S$ 80.00 S$ 60.00 S$ 32.00 S$ 20.00

70 – 748 S$ 752.00 S$ 332.00 S$ 249.00 S$ 133.00 S$ 83.00

Class 316 – 69 S$ 241.00 S$ 107.00 S$ 81.00 S$ 43.00 S$ 27.00

70 – 748 S$ 993.00 S$ 447.00 S$ 335.00 S$ 179.00 S$ 112.00

GROUP ACCIDENTAL DEATH & DISMEMBERMENT / RIDER TO GROUP TERM LIFE OR GROUP HOSPITAL & SURGICAL WITH OPTIONAL BENEFIT: GROUP ACCIDENTAL MEDICAL REIMBURSEMENT

Page 10: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

10 | PRUtreasures flexi

GROUP EXTENDED MAJOR MEDICAL / RIDER TO GROUP HOSPITAL & SURGICAL

BENEFITS / PLAN TYPE PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5

Provides reimbursement of eligible expenses in excess of Basic GHS if:a) Hospitalisation is at least 20 days; orb) Surgical Percentage is at least 75% per incision

S$ 80,000 per disability

S$ 60,000 per disability

S$ 40,000 per disability

S$ 20,000 per disability

S$ 60,000 per disability

Daily Home Nursing Benefit (max. per day, up to 30 days per disability)

S$ 80 per day for all plans (subject to respective benefit limit)

HIV Due to Blood Transfusion and Occupationally Acquired HIV

S$ 5,000 per policy year for all plans (subject to respective benefit limit)

Parent Accommodation (up to 60 days for accompanying child age 12 and below)

S$ 100 per day for all plans (subject to respective benefit limit)

Deductible As per Basic GHS

Co-Insurance 20%

ANNUAL PREMIUM RATE (inclusive of 7% GST) – GROUP ACCIDENTAL MEDICAL REIMBURSEMENT

OCCUPATIONAL CLASS

AGE LAST BIRTHDAY

PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5

Class 116 – 69 S$ 37.00 S$ 37.00 S$ 37.00 S$ 37.00 S$ 37.00

70 – 748 S$ 155.00 S$ 155.00 S$ 155.00 S$ 155.00 S$ 155.00

Class 216 – 69 S$ 46.00 S$ 46.00 S$ 46.00 S$ 46.00 S$ 46.00

70 – 748 S$ 193.00 S$ 193.00 S$ 193.00 S$ 193.00 S$ 193.00

Class 316 – 69 S$ 64.00 S$ 64.00 S$ 64.00 S$ 64.00 S$ 64.00

70 – 748 S$ 270.00 S$ 270.00 S$ 270.00 S$ 270.00 S$ 270.00

8 For renewals only.

Page 11: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

PRUtreasures flexi | 11

ANNUAL PREMIUM RATE – GROUP EXTENDED MAJOR MEDICAL

AGE LAST BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5

16 – 69 S$ 37.00 S$ 29.00 S$ 19.00 S$ 10.00 S$ 14.00

70 – 749 S$ 37.00 S$ 29.00 S$ 19.00 S$ 10.00 S$ 14.00

For Employee Only (inclusive of 7% GST)

AGE LAST BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5

16 – 69 S$ 83.25 S$ 65.25 S$ 42.75 S$ 22.50 S$ 31.50

70 – 749 S$ 83.25 S$ 65.25 S$ 42.75 S$ 22.50 S$ 31.50

For Employee and Spouse or Children Coverage Only (inclusive of 7% GST)

AGE LAST BIRTHDAY PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5

16 – 69 S$ 129.50 S$ 101.50 S$ 66.50 S$ 35.00 S$ 49.00

70 – 749 S$ 129.50 S$ 101.50 S$ 66.50 S$ 35.00 S$ 49.00

For Employee and Spouse and Children Coverage Only (inclusive of 7% GST)

9 For renewals only.

Page 12: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

12 | PRUtreasures flexi

GROUP OUTPATIENT SPECIALIST/ RIDER TO GROUP TERM LIFE10 OR GROUP HOSPITAL & SURGICAL

ANNUAL PREMIUM RATE (inclusive of 7% GST) – GROUP OUTPATIENT SPECIALIST

BENEFITS / PLAN TYPE PLAN 1 PLAN 2 PLAN 3 PLAN 4

a

Specialist Consultation at Singapore Govt Restructured Hospital (GRH) (recommended by a Registered Medical Practitioner)

S$ 2,000 per policy year

S$ 1,500 per policy year

S$ 1,000 per policy year

Overall policy year limit of S$ 500

b

Specialist Consultation at Private Hospital (PTE) (recommended by a Registered Medical Practitioner)

S$ 800 per policy year

S$ 400 per policy year

S$ 200 per policy year

cAll other Diagnostic X-Ray and Lab Test (GP or SP referral required)

S$ 800 per policy year

S$ 400 per policy year

S$ 200 per policy year

PLAN TYPE PLAN 1 PLAN 2 PLAN 3 PLAN 4

Annual Premium S$214.00 S$177.00 S$160.00 S$122.00

ANNUAL PREMIUM RATE (inclusive of 7% GST) – GROUP OUTPATIENT GENERAL PRACTITIONER

PLAN TYPE PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN 6

Annual Premium S$ 304.00 S$ 267.00 S$ 234.00 S$ 256.00 S$ 219.00 S$ 186.00

GROUP OUTPATIENT GENERAL PRACTITIONER / RIDER TO GROUP TERM LIFE10 OR GROUP HOSPITAL & SURGICAL

BENEFITS / PLAN TYPE PLAN 1 PLAN 2 PLAN 3 PLAN 4 PLAN 5 PLAN 6

a Panel Registered Medical Practitioner Cashless

b Non-Panel Registered Medical Practitioner (covers treatment in Singapore only) Reimbursement up to S$30 per visit

c Singapore Government Polyclinic Full Reimbursement

d Accident & Emergency Department in Singapore Hospitals Reimbursement up to S$100 per visit (capped at 2 visits per policy year)

e Paediatrician Direct Access Reimbursement up to S$30 per visit

f Overseas Registered Medical Practitioner Reimbursement up to S$100 per visit

g Registered Traditional Chinese Medicine Practitioner (TCM) (Consultation and Medicine)

Reimbursement of up to S$30 per visit (capped

at 6 visits per policy year) Not Applicable

h Co-Payment per visit (applicable for all benefits)

NIL S$ 5 S$ 10 NIL S$ 5 S$ 10

10 GP and SP are to be taken up together if they are taken up as a rider to GTL.

Page 13: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

PRUtreasures flexi | 13

GROUP DENTAL / RIDER TO GROUP HOSPITAL & SURGICAL

BENEFITS / PLAN TYPE PLAN 1

1 Medication Fee

As charged for items 1 to 9

2 X-Ray

3 Prophylaxis Treatment (General Scaling and Polishing)

4 Fillings

5 Simple and Surgical Extraction

6 Root Canal Treatment

7 Gum Treatment (including Curettage)

8 Periodontal Surgery

9 Repairs of Dentures, Crowns and Bridges Due to Accident

10 Overall Dental's Limit (per policy year) S$500

11 Co-insurance 20%

PLAN TYPE PLAN 1

Annual Premium S$295.00

ANNUAL PREMIUM RATE (inclusive of 7% GST) – GROUP DENTAL

Occupational Class

Class 1 Clerical, administrative or other similar non-hazardous occupations

Class 2 Occupations where some degree of risk is involved, e.g. supervision of manual workers, totally administrative job in an industrial environment

Class 3 Occupations involving regular light to medium manual work but no substantial hazard which may increase the risk of sickness or accident

Class 4 Not covered

Call your Prudential Financial Consultant or our PruCustomer Line at 1800 333 0 333 today, or visit www.prudential.com.sg

Page 14: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

14 | PRUtreasures flexi

Underwriting Guidelines for PRUtreasures flexi

Period of Insurance:

• Duration of coverage is for 12 months. Coverage starts from stated effective date upon clearance of required MAS 314 and Compliance checks.

Age Eligibility:

1) Employees• All benefits, except Group Crisis Cover Accelerated, are available to eligible employees of age 16 to 69 inclusive, and

renewable up to age 74.• Group Crisis Cover – Accelerated is available to eligible employees of age 16 to 64 inclusive, and renewable up to age 69.

2) DependantsA) the Insured Member’s spouse who is: – below 69 years old at his last birthday, and up to 74 years old at his last birthday; and – not an Insured Member under this Policy; orB) the Insured Member’s natural or step child from a legal marriage or legally adopted child who is: – two (2) weeks old; or – up to 25 years old at his last birthday, and is single and unemployed. (Note: National Service Personnel are not covered)

• Based on age last birthday.

Eligibility and Participation Requirements:

• All full time and work-active employees, directors, partners and proprietors.

• Eligible dependants can select Group Hospital & Surgical and its supplementary benefits. Dependant's plan must be the same as Employee’s plan.

• The Company can choose Group Term Life and/or Group Hospital & Surgical as their basic core plan(s).

• If dependant’s coverage is taken up, it will apply to all eligible employees in the same classification.

• PRUtreasures flexi is available to companies with a minimum of 3 employees.

• Insurance cover must be provided to all specified categories of employees on a compulsory basis. All benefits are applicable for Occupational Class 1 to 3 only.

• For employees holding a Singapore Ministry of Manpower's S Pass or work permit, the Company can choose any plan under Group Hospital & Surgical with Group Extended Major Medical.

• Take-over clause is applicable if the Company has prior Group Employee Insurance cover with a headcount of 25 standard life employees and above. Take-over refers to waiver of pre-existing conditions. This feature is only available for GHS and its medical riders. However, the 12 months waiting period will apply to members who have not been continuously insured under the existing group insurance policy for 12 months. Member listing from previous insurer is required to be provided for take-over to be approved.

• Coverage is only applicable to groups with the majority of employees (at least 50%) working in Singapore, and the rest of the employees based in the following countries:

i. Brunei ii. Indonesia (Jakarta only) iii. Japan iv. Malaysia v. Macau vi. Philippines (Manila only) vii. People's Republic of China (except Xinjiang and Tibet) viii. South Korea ix. Taiwan x. Thailand

14 | PRUtreasures flexi

Page 15: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

PRUtreasures flexi | 15

An individual is considered a resident of Singapore or a resident of the above countries on the basis that the individual does not travel or work outside of Singapore or the above countries for more than 180 cumulative days in any 365 consecutive days.

• Plan selection for GTL and GCCA must be the same if GCCA is taken up.

• Crossing of plans between GTL and GADD is allowed i.e. GADD’s plan selection/Sum Assured can be higher than GTL.

• Plan selection for GHS and GEMM must be the same if GEMM is taken up.

• GP and SP are to be taken up together as a rider to GTL and GHS.

• GP can be taken up on stand-alone basis as a rider to GHS.

Pre-Existing Conditions – GHS: • Shall not pay if the loss or disability arises out of a pre-existing condition, unless the insured member has been insured under this policy continuously for 12 months. • All pre-existing conditions are permanently excluded for outpatient kidney dialysis or outpatient cancer treatment benefits.

Pre-Existing Conditions – GEMM: • Shall not pay if the loss or disability arises out of a pre-existing condition for which the insured member received medical treatment, diagnosis, consultation or prescribed drugs during the 24 months preceding the policy effective date of the coverage. • All pre-existing conditions are permanently excluded for outpatient kidney dialysis or outpatient cancer treatment benefits.

Pre-Existing Conditions – GTL: • Shall not pay if the loss or disability arises out of a pre-existing condition, unless the insured member has been insured under this policy continuously for 12 months.

Pre-Existing Conditions – GCCA: • Shall not pay if the loss or disability arises out of a pre-existing condition.

Premium: • Premium rates are in Singapore Dollars. • The premium rates are based on age last birthday of individual employees. • Payment of premium is to be made annually.

Medical Underwriting: • Employee (16 to 64 age last birthday) selecting Plan 1 of Group Term Life will require underwriting. • Employee (16 to 64 age last birthday) selecting Plan 1 of Group Crisis Cover Accelerated will require underwriting. • Employee (from 65 age last birthday onwards) selecting Group Term Life will require underwriting. • For Group Term Life, employee of 70 to 74 age last birthday will require underwriting at each renewal.

Required Documents: • Application Form. • A copy of the duly completed, company stamped and signed MAS Notice 314 Declaration on Parties Relevant to the Policyholder Form. • Business Profile report from the Account & Corporate Regulatory Authority (ACRA). • Health Declaration Form when Medical Underwriting is required.

Note:You are recommended to seek advice from a qualified Prudential Financial Consultant for a financial analysis before purchasing a policy suitable to meet your needs. This plan has no cash value. Buying health insurance products that are not suitable for you may impact your ability to finance your future healthcare needs. Premiums are not guaranteed and may be adjusted based on future claims experience. This brochure is for reference only and is not a contract of insurance. Please refer to the exact terms and conditions, specific details and exclusions applicable to these insurance products in the policy documents that can be obtained from your Prudential Financial Consultant. This brochure is for distribution in Singapore only and shall not be construed as an offer to sell or solicitation to buy or provision of any insurance product outside Singapore.

Information is correct as at 30 Nov 2017.

PRUtreasures flexi | 15

Page 16: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

16 | PRUtreasures flexi

Dec

lara

tio

n

Plea

se re

ad c

aref

ully

bef

ore

signi

ng th

is P

RU

trea

sure

s fle

xi a

pplic

atio

n fo

rm.

I und

erst

and

that

the

assu

ranc

e w

ill no

t com

men

ce u

ntil

the

prop

osal

has

bee

n of

ficia

lly a

ccep

ted

by P

rude

ntia

l Ass

uran

ce C

ompa

ny S

inga

pore

(Pte

) Lim

ited

("Pru

dent

ial S

inga

pore

"), p

rem

ium

s ha

ve b

een

paid

and

an

offic

ial l

ette

r ind

icat

ing

cove

r has

com

men

ced

has b

een

issue

d. I

decl

are

that

the

info

rmat

ion

give

n in

this

form

and

any

info

rmat

ion

supp

lied

to P

rude

ntia

l Sin

gapo

re o

r the

Med

ical

Exa

min

er o

f Pru

dent

ial S

inga

pore

is tr

ue, a

nd th

at n

o m

ater

ial f

acts

, tha

t is,

fact

s lik

ely

to in

fluen

ce th

e as

sess

men

t and

acc

epta

nce

of th

is pr

opos

al, h

ave

been

with

held

and

to th

e be

st o

f my

know

ledg

e an

d be

lief t

he in

form

atio

n gi

ven

here

in is

true

and

com

plet

e. I

agre

e to

pay

Pru

dent

ial S

inga

pore

the

amou

nt o

f any

med

ical

fee

incu

rred

shou

ld I

fail t

o ta

ke u

p th

e co

vera

ge a

fter t

he d

ate

of P

rude

ntia

l Sin

gapo

re's

lette

r not

ifyin

g m

e of

the

acce

ptan

ce o

f the

pro

posa

l's st

anda

rd ra

tes.

We

decl

are

and

conf

irm th

at o

ur e

mpl

oyee

s hav

e gi

ven

us th

eir c

onse

nt to

Pru

dent

ial S

inga

pore

, its

offi

cers

and

em

ploy

ees,

in c

olle

ctin

g, u

sing

and

disc

losin

g an

y an

d al

l info

rmat

ion

rela

ting

to th

em in

this

form

to a

ny o

f Pru

dent

ial S

inga

pore

's co

ntra

ctor

s or t

hird

par

ty se

rvic

e pr

ovid

ers o

r dist

ribut

ion

partn

ers,

any

regu

lato

ry, s

uper

viso

ry o

r oth

er a

utho

rity,

cou

rt of

law

, for

the

purp

ose(

s) o

f und

erw

ritin

g, c

laim

s ass

essm

ent a

nd c

usto

mer

serv

icin

g.

Nam

e of

("C

ompa

ny")

:

Com

pany

Add

ress

:

Nat

ure

of B

usin

ess

:

Effe

ctiv

e da

te o

f Pol

icy (D

D/M

M/Y

Y) :

(d

ate

mus

t be

on o

r afte

r the

dat

e of

app

licat

ion)

Effe

ctiv

e da

te o

f new

em

ploy

ees

: □

on

the

date

of e

mpl

oym

ent O

R

m

onth

s fro

m th

e da

te o

f em

ploy

men

t

Che

cklis

t of

Req

uire

d D

ocum

ents

□ A

pplic

atio

n Fo

rm

□ A

cop

y of

the

duly

com

plet

ed, c

ompa

ny st

ampe

d an

d sig

ned

MA

S N

otic

e 31

4 D

ecla

ratio

n on

Par

ties R

elev

ant t

o th

e

Polic

yhol

der F

orm

and

MA

S 31

4 D

ecla

ratio

n on

Ben

efic

ial O

wne

r(s)

For

m (i

n th

e ev

ent t

hat t

here

are

Cor

pora

te

Sh

areh

olde

rs O

wni

ng ≥

25%

of t

he c

ompa

ny).

□ H

ealth

Dec

lara

tion

(App

licab

le if

GTL

Pla

n 1

is s

elec

ted

for e

mpl

oyee

or m

edic

al u

nder

writ

ing

is re

quire

d)

Nam

e of

Aut

horis

ed S

igna

tory

:

Des

igna

tion

:

HR

Emai

l Add

ress

:

HR

Con

tact

No

: D

ate

of A

pplic

atio

n :

Com

pany

Sta

mp

: S

igna

ture

of A

utho

rised

Sig

nato

ry :

Nam

e of

Fin

anci

al C

onsu

ltant

:

Fina

ncia

l Con

sulta

nt C

ode

: L

ocat

ion

:

Con

tact

No

: S

igna

ture

:

Tick

whe

re a

ppro

pria

te

If a

mat

eria

l fa

ct i

s no

t d

iscl

osed

in

this

pro

pos

al,

any

pol

icy

issu

ed m

ay n

ot b

e va

lid.

If y

ou a

re i

n d

oub

t as

to

whe

ther

a f

act

is

mat

eria

l, yo

u ar

e ad

vise

d t

o d

iscl

ose

it. T

his

incl

udes

any

info

rmat

ion

that

you

may

hav

e p

rovi

ded

to

the

agen

t b

ut w

as n

ot in

clud

ed

in t

he p

rop

osal

. Pl

ease

che

ck t

o en

sure

you

are

ful

ly s

atis

fied

wit

h th

e in

form

atio

n d

ecla

red

in t

his

pro

pos

al.

WA

RN

ING

: PU

RSU

AN

T TO

SEC

TIO

N 2

5(5)

OF

THE

INSU

RA

NC

E A

CT

(CA

P 14

2), Y

OU

AR

E TO

DIS

CLO

SE IN

TH

IS A

PPLI

CA

TIO

N F

OR

M F

ULL

Y A

ND

FA

ITH

FULL

Y A

LL T

HE

FAC

TS W

HIC

H

YOU

KN

OW

OR

OU

GH

T TO

KN

OW

, OTH

ERW

ISE

YOU

MA

Y R

ECEI

VE

NO

THIN

G F

RO

M T

HE

POLI

CY.

PRU

trea

sure

s fle

xi A

PPLI

CAT

ION

FO

RM

PruC

usto

mer

Lin

e: 1

800-

333

0 33

3

CO

RE

OPT

ION

S

□ G

TL (G

roup

Ter

m L

ife)

□ G

CC

A (G

roup

Cris

is C

over

– A

ccel

erat

ed)

□ G

AD

D (G

roup

Acc

iden

tal D

eath

& D

ismem

berm

ent)

□ G

AD

D +

GA

MR

(Gro

up A

ccid

enta

l Dea

th &

Dism

embe

rmen

t with

Acc

iden

tal M

edic

al R

eim

burs

emen

t)□

GP

+ SP

(Gro

up O

utpa

tient

Gen

eral

Prac

titio

ner w

ith

G

roup

Out

patie

nt S

pecia

list)

□ G

HS

(Gro

up H

ospi

tal

&

Sur

gica

l Pla

n)

□ G

EMM

(Gro

up E

xten

ded

Majo

r Med

ical )

□ G

P (G

roup

Out

patie

nt G

ener

al Pr

actit

ione

r)□

GP

+ SP

(Gro

up O

utpa

tient

Gen

eral

Pra

ctiti

oner

with

Gro

up O

utpa

tient

Spe

cial

ist)

□ G

DEN

(Gro

up D

enta

l)□

GA

DD

(Gro

up A

ccid

enta

l Dea

th &

Dism

embe

rmen

t)□

GA

DD

+ G

AM

R (G

roup

Acc

iden

tal D

eath

& D

ismem

berm

ent

w

ith A

ccid

enta

l Med

ical R

eim

burs

emen

t)

Cho

ice

of O

ptio

ns

Page 17: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

No.Name

(Please underline surname)

NRIC / Passport

no.

Gender (M/F)

DOB (DD/MM/

YYYY)

Age Last Birthday

Marital Status

OccupationDependants

(S/C)Nationality

Country of Residence1

Date of Employment (DD/MM/

YYYY)

Corporate Email Address

(Please note that e-claims can only be set up for employees

with corporate email addresses)

GTL Core (Employee Only)

GCCA3

(Option to GTL Core)

(Employee Only)

GADD (Option to GTL Core or GHS Core)

(Employee Only)GHS Core

GEMM4 (Option to GHS Core)

GP2

(Option to GTL Core or GHS Core)

SP2

(Option to GTL Core or GHS Core)

Dental (Option to GHS Core)

Plan no. Premium Plan no. Premium Plan no. Occ Class PremiumWith

GAMR (Y/N)

Premium Plan no.

Plan Type5

(EO/ES/EC/EF)

Total Lives

Premium Plan no.Plan Type5 (EO/ES/EC/EF)

Total Lives

Premium Plan no.

No. of Deps Covered for GP

Premium Plan no.

No. of Deps Covered

for SP

Premium Plan no.

No. of Deps Covered

for Dental

Premium

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

$

DECLARATION BY COMPANY

I / We hereby declare that, to the best of my / our knowledge and belief, the information given here is true and complete, and agree that if a contract of insurance is effected, all information submitted in connection with this application shall form the basis of such contract between the Company and the Insurer.

___________________________________________________Signature & Name of Authorised Officer

NRIC / Passport no. : ______________________________

Designation : ______________________________

Company Stamp : ______________________________

DECLARATION BY INSURANCE REPRESENTATIVE

I / We hereby declare and acknowledge that I / we have reviewed this form with the authorised officer of the Company, and that I / we have verified that all information in this form is true and complete.

___________________________________________________Signature & Name of Insurance Representative

NRIC / Passport no. : ______________________________

Agency Code : ______________________________

Agency Location : ______________________________

NOTE: Premium amounts may differ due to the rounding factor and the entitled group discount (if any). Please pay the stated amount based on the Premium Notice.

1 Please refer to the brochure for the list of accepted countries where the employees are residing. Kindly note that the following provinces/areas are not covered.

2 For Option to GTL Core, GP is to be bundled with SP. For Option to GHS Core, the selection can be either GP only or GP + SP.3 Plan selection for GTL and GCCA must be the same if GCCA is taken up.4 Plan selection for GHS and GEMM must be the same if GEMM is taken up. 5 Plan Type: EO – for employee coverage only. ES – for employee and spouse coverage. EC – for employee and children coverage. EF – for employee and spouse and children coverage.

Total Amount Payable:(before group size discount if any)

Country Provinces/areas

Indonesia All except Jakarta

Philippines All except Manila

People's Republic of China Xinjiang and Tibet

Page 18: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

GROUP HEALTH DECLARATION

WARNING: YOU ARE REQUIRED TO FULLY AND FAITHFULLY DISCLOSE ALL THE FACTS THAT YOU KNOW OR OUGHT TO KNOW. OTHERWISE, YOUR INSURANCE COVERAGE PROVIDED UNDER THIS PLAN MAY BE VOID.

Name of Company Group Policy No.

Details of Employee

Full Name of Employee in Block (as shown in NRIC - underline surname)

NRIC/FIN/Passport No. Date of Birth

Gender

Male / Female

Marital Status

Occupation Date of Employment Monthly Salary

S$

Country of Residence Nationality

Height (cm) Weight (kg)

Health Declaration

(All questions must be answered and any alteration must be signed) Employee

Yes No

1. Do you engage in military or private flying other than as passenger travelling solely for transport or in hazardous pursuits such as but not limited to scuba diving, mountain and climbing sport, free fall parachuting, sky diving and motor racing?

If ‘Yes’, please state details on activity, depth dived, locations and frequency in the box provided on the right.

□ □

2. Have you taken narcotics, any habit forming drugs or ever been treated for drug or alcohol addiction?

If ‘Yes’, please provide details including name of substance, date, treatment, name & address of doctor in the box provided on the right.

□ □

PTRFFOR OFFICE USE ONLY

GTL/TPD GCCA

Sum Assured

Sum Assured (FCL)

Page 1 of 4

PruCustomer Line: 1800-333 0 333

Continued next page

Page 19: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

Health Declaration

(All questions must be answered and any alteration must be signed) Employee

Yes No

GROUP HEALTH DECLARATION

Page 2 of 4

6. Do you consume alcohol?

If ‘Yes’, please state the type, quantity and frequency

□ □

Type:

Quantity:

Frequency (per week):

7. Have you or any of your family members, ever been told to have, received any medical advice, counseling or treatment in connection with sexually transmitted disease, AIDS, AIDS Related Complex or any other AIDS related conditions?

If ‘Yes’, please provide details including date, relationship, diagnosis, treatment, name & address of doctor in the box provided on the right.

□ □

8. In the past 5 years, have you attended to any tests such as X ray, ultrasound, CT scan, biopsy, electrocardiogram (ECG), endoscopy, blood or urine test?

If ‘Yes’, please provide details including date/type/reason/results of test done, treatment, name & address of doctor in the box provided on the right.

□ □

9. Have either of your natural parents or siblings died or suffered from cancer, heart disease, stroke, high blood pressure, diabetes, kidney disease, mental disorder, dementia, tuberculosis, Down’s syndrome or any hereditary disease?

If ’Yes, please provide full details in the box provided on the right.

□ □

Relationship Condition/ Cause of Death Age of Onset If Deceased,

Age of Death

3. Do you have any health or life insurance application that has been rejected, postponed or accepted at special rates or terms by any insurance company?

If ‘Yes’, please provide details on date/type of application and reason for special terms in the box provided on the right.

□ □

4. Have you in the last 3 months had any of the following symptoms for more than one week continuously: fatigue, weight loss, diarrhoea, enlarged nodes or unusual skin lesions?

If ‘Yes’, please provide details including date, diagnosis, treatment, name & address of doctor in the box provided on the right.

□ □

5. Do you smoke any cigarettes?

If ‘Yes’, please state number of years and the number of sticks per day

□ □

No. of years:

No. of sticks (per day):

Name of Employee: NRIC/ FIN/ Passport No.: Group Policy No.

Page 20: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

GROUP HEALTH DECLARATIONHealth Declaration

(All questions must be answered and any alteration must be signed) Employee

Yes No

Page 3 of 4

Continued next page

10. Have you EVER had or been told you had or been treated for:

□ □ a) asthma, bronchitis, persistent cough, tuberculosis or respiratory disorder?

b) epilepsy, fits, stroke, paralysis, weakness of limb, prolonged headache/giddiness, unconsciousness, nervous breakdown, depression or any other nervous/mental disorders or any disease of the brain?

□ □

c) gastritis, stomach or duodenal ulcer, blood in stools, fistula, piles or any other stomach or bowel disorders? □ □

d) blood, protein or sugar in urine, kidney stones, infection or any other disorders of the kidney, bladder or genital organs? □ □

e) anaemia, diabetes, thyroid disorders or any other endocrine disorder? □ □

f) cancer, tumour, cyst or growth of any kind? □ □

g) any form of eye, hearing or speech disorder or disease? □ □

h) jaundice, Hepatitis B carrier or any form of hepatitis, liver or gallbladder disorders? □ □ i) slipped disc, gout, arthritis, pain or deformity or disorders of the muscles, spine, limbs or joints or severe injury? □ □

j) raised cholesterol, high blood pressure, heart attack, heart murmur, irregular or fast heart rate, chest discomfort or pain, diseases or any other disorders of the heart, heart valves or blood vessels?

□ □

k) any other illness, disorder, injury, disability, operation or hospitalisation not mention above? □ □

11. For Female Insured only

□ □ a) Have you ever had any abnormal pap smear test or been told by a doctor to have a repeat pap smear within the next 6 months? If yes, advise the date and result of the test and enclose a copy of the result, if available.

b) Have you had an abnormal mammogram or been advised to have mammogram,ultrasound, biopsy, operation of the breasts, ultrasound of pelvis or attended to any other gynecological investigations?

□ □

c) Have you ever consulted a doctor for irregular, painful menstruation or other problems(s) involving the female organs? □ □

d) Have any of your family members been diagnosed with breast cancer?

If ’Yes, please provide full details in the box provided on the right. Relationship to Insured Age of Diagnosis

e) Are you currently pregnant? If ‘Yes’, please state no of months _________________________ □ □

Name of Employee: NRIC/ FIN/ Passport No.: Group Policy No.

Page 21: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

If any of the answer to Questions 10 and 11 is “Yes”, please provide details below for each condition:

Qn No. Name of InsuredName of

Condition /Treatment

Date of Test / Diagnosis

Duration ofIllness / injury

Result / Reasonfor Test done

Name & Address ofDoctors / Clinics / Hospitals

Consent, Declaration and Authorisation - Please read carefully before signing this Group Health Declaration Form.

I/We consent to Prudential Assurance Company Singapore (Pte) Limited (“Prudential”), its officers and employees :

a) Collecting and using at their sole discretion any and all information relating to me/us, including my/our personal particulars, in this Group Health Declaration for the purposes of underwriting;

and

b) Disclosing at their sole discretion any and all information relating to me/us, including my/our personal particulars, in this Group Health Declaration to the servicing intermediary for the above group policy for the purpose of customer service.

I/We declare that no material facts, that are facts likely to influence the assessment and acceptance of my/our group application, have been withheld and the Information given above is true and complete and best to my/our knowledge and they shall be the basis of the issuance of my/our group insurance coverage.

I/We agree to inform Prudential if there is any change in the state of my/our health/activity between the date of this Health Declaration or medical examination and the date of full insurance coverage provided by Prudential to me/us. I/We understand that the terms of accepting me/us as a risk for insurance coverage may vary according to such information received.

I/We agree and authorise any medical source (i.e. physician and hospital), insurance office or organisation that has my/our records to release to Prudential any relevant information at any time for the purpose of underwriting this group application. A photographic copy of this authorisation shall be as valid as the original.

I/We further declare that I/we have read and understood the “Your Guide To Health Insurance” and “Product Summary” (applicable to voluntary coverage only).

Signature of Employee

Date:

Signature/Name/Designation of Witness (Employer)

Date:

GROUP HEALTH DECLARATION

Name of Employee: NRIC/ FIN/ Passport No.: Group Policy No.

Prudential Assurance Company Singapore (Pte) Limited (Reg. No. 199002477Z)Employee Benefit Solutions Address: Singapore Post Centre Post Office PO Box 399 Singapore 914014

Email: [email protected] Fax: 6233-3285

Page 4 of 4

EBS HD Oct 2017 (PTRF)

Page 22: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

MAS NOTICE 314 DECLARATION ON PARTIES RELEVANT TO THE POLICYHOLDERProposal / Policy Number

The information requested in this form must be provided in order to comply with the mandatory requirements of MAS Notice 314 – Preventing Money Laundering and Countering the Financing of Terrorism – Life Insurance (MAS 314).

The personal data collected in this form, in other documents or provided to Prudential Assurance Company Singapore (Pte) Limited (“Prudential”) shall be used for the purposes stated in the proposal form and Prudential’s Privacy Notice (which is available at www.prudential.com.sg). The personal data may be collected, used and/or disclosed by Prudential, its officers, associated organisation(s) employee representative(s), third party distributors and other organisations stated in Prudential's Privacy Notice whether in Singapore or outside Singapore.

(A) Name of Policyholder / Insured Company(ies) / Assignee(s) / Applicant(s) / Beneficiary(ies) (delete accordingly)

(B) Principal Place of Business (“PPOB”) PPOB refers to the main operating office where the senior management of the policyholder resides.

Is the PPOB different from the registered or business address □ Yes □ NoIf yes please provide PPOB in the space provided

(C) Information on Chairman / CEO / Managing Partner of the company(ies) stated in (A):

Full Name (including any aliases : (1) Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)

Designation : Chairman / CEO / Managing Partner (delete accordingly) Company Name :

NRIC / Passport No. :

Date of Birth :

Nationality :

(2) Mr / Mrs / Ms / Mdm (delete accordingly)

Chairman / CEO / Managing Partner (delete accordingly)

Full Name (including any aliases : (3) Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)

Designation : Chairman / CEO / Managing Partner (delete accordingly) Company Name :

NRIC / Passport No. :

Date of Birth :

Nationality :

(4) Mr / Mrs / Ms / Mdm (delete accordingly)

Chairman / CEO / Managing Partner (delete accordingly)

Full Name (including any aliases : (5) Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)

Designation : Chairman / CEO / Managing Partner (delete accordingly) Company Name :

NRIC / Passport No. :

Date of Birth :

Nationality :

(6) Mr / Mrs / Ms / Mdm (delete accordingly)

Chairman / CEO / Managing Partner (delete accordingly)

Page 1 of 2

PruCustomer Line: 1800-333 0 333

Continued next pageVersion Oct 2017

Page 23: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

Page 2 of 2

MAS NOTICE 314 DECLARATION ON PARTIES RELEVANT TO THE POLICYHOLDER

Version Oct 2017

Proposal / Policy Number

(D) Person(s) authorised to act on matters relating to the purchase of the Policy / assigned Policy

Declaration by Representative of the policyholder/ insured company/ assignee / applicant / beneficiary/ trustee (This Representative could be the CEO, Directors (listed in the ACRA), Managing Director, Partner or Managing Partner of the company/policyholder.)

I declare that the information given in this form is complete and accurate. I shall promptly inform Prudential of changes to such natural person’s information in this form. I acknowledge and agree that if the information disclosed in this form is incomplete and/or inaccurate, some or all of the benefits under the policy issued to the Policyholder may not be available. I further acknowledge and agree that Prudential has the right to request supporting documents in relation to the information disclosed in this form.

Note: This declaration shall be accompanied by a copy of the NRIC/Passport/FIN containing a clear photograph of the representative and all authorised person(s).

Full Name (including any aliases : Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)

Designation :

NRIC / Passport No. :

Date of Birth :

Nationality :

Country of Residence :

Signature with company stamp:

Date:

□ Please tick this box if the representative is also an authorised person.

If there are other authorised person(s) appointed to act on matters relating to the policy(s), please provide their details in the fields below:

Full Name (including any aliases : Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)

Designation :

NRIC / Passport No. :

Date of Birth :

Nationality :

Country of Residence :

Signature:

Full Name (including any aliases : Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)

Designation :

NRIC / Passport No. :

Date of Birth :

Nationality :

Country of Residence :

Signature:

Full Name (including any aliases : Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)

Designation :

NRIC / Passport No. :

Date of Birth :

Nationality :

Country of Residence :

Signature:

Note: Please complete a separate form, signed by the Representative, if fields provided are insufficient under items (A) - (D).

Page 24: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

MAS 314 DECLARATION ON BENEFICIAL OWNER(S)

Page 1 of 2

Continued next page

Proposal / Policy Number

The information requested in this form must be provided in order to comply with the mandatory requirements of MAS Notice 314 – Preventing Money Laundering and Countering the Financing of Terrorism – Life Insurance (MAS 314).

The personal data collected in this form, in other documents or provided to Prudential Assurance Company Singapore (Pte) Limited (“Prudential”)shall be used for the purposes stated in the proposal form and Prudential’s Privacy Notice (which is available at www.prudential.com.sg). The personal data may be collected, used and/or disclosed by Prudential, its officers, associated organisation(s), employees, representative(s), third party distributors and other organisations stated in Prudential’s Privacy Notice whether in Singapore or outside Singapore.

(I) Name of Policyholder / Insured Company(ies) / Assignee(s) / Applicant(s) / Beneficiary(ies) (delete accordingly)

(II) Beneficiary owner(s) is either a

(a) natural person who ultimately owns or controls the beneficiary /proposer /assignee /applicant (with shareholding of ≥25% of the company’s ordinary shares) or the natural person on whose behalf business relations are established; or

(b) natural person who does not meet the shareholder threshold and who exercises significant influence (i.e. board of directors of corporate shareholder owing the policyholder, person financing the policy) over the beneficiary /proposer /assignee /applicant.

(III) Information on all shareholder(s) or ultimate shareholder who are non-natural person with shareholding of ≥25% of the ordinary shares of company stated in (I):

Section (A): Corporate Shareholder(s) (“CSH”) directly owning ≥25% of the policyholder

(1) Name of Corporate Shareholder (“CSH”) (2) Percentage of shareholding

A1

A2

A3

A4

( ) %

( ) %

( ) %

( ) %

Section (B): CSHs owning ≥25% of the policyholder through ordinary shares of CSHs listed in (A)

(3) Name of CSH(B) owing CSH(A) listed in section (A) (4) * CSH of (5) % owned in CSH [listed in section (A)]

B1

B2

B3

B4

A( )

A( )

A( )

A( )

%

%

%

%

(4)* Please indicate within the bracket the corresponding number in Part II Section (A). In the event that there are CSHs owning ≥25% of the company in Section B, please provide their details on a separate form signed by the Representative.

(IV) Details of all beneficial owner(s) as defined in (II) of the companies listed in Part (III) A and/or B or any natural person who exercise significant influence over the Policyholder(s) / Insured Companies / Assignee(s) / Applicant(s) / Beneficiary(ies).

Full Name (including any aliases : Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)

Relationship to the Policyholder :

NRIC / Passport No. :

Date of Birth :

Nationality :

Country of Residence :

Percentage of Shareholding (ordinary shares):

Name of company:

PruCustomer Line: 1800-333 0 333

Version Oct 2017

Page 25: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

Proposal / Policy Number

Full Name (including any aliases : Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)

Relationship to the policyholder :

NRIC / Passport No. :

Date of Birth :

Nationality :

Country of Residence :

Percentage of Shareholding (ordinary shares):

Name of Company:

Full Name (including any aliases : Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)

Relationship to the policyholder :

NRIC / Passport No. :

Date of Birth :

Nationality :

Country of Residence :

Percentage of Shareholding (ordinary shares):

Name of Company:

Full Name (including any aliases : Mr / Mrs / Ms / Mdm (delete accordingly) as per identification document)

Relationship to the policyholder :

NRIC / Passport No. :

Date of Birth :

Nationality :

Country of Residence :

Percentage of Shareholding (ordinary shares):

Name of Company:

Note: Please complete a separate form, signed by the Representative, if fields provided are insufficient.

Declaration

Declaration by Representative of the policyholder / insured company / assignee / applicant / beneficiary / trustee (This Representative could be the CEO, Directors (listed in the ACRA), Managing Director, Partner or Managing Partner of the company /policyholder.)

I declare that the information given in this form is complete and accurate. I shall promptly inform Prudential of changes to such natural person’s information in this form. I acknowledge and agree that if the information disclosed in this form is incomplete and /or inaccurate, some or all of the benefits under the policy issued to the Policyholder may not be available. I further acknowledge and agree that Prudential has the right to request supporting documents in relation to the information disclosed in this form.

Full Name of Representative (including any aliases as per identification document) :

Designation :

Company Name :

NRIC / Passport No. :

Nationality :

Country of Residence :

Signature with company stamp:

Date:

Page 2 of 2

MAS 314 DECLARATION ON BENEFICIAL OWNER(S)

Version Oct 2017

Page 26: The flexible plan that lets you ... - Prudential Singapore · protect your greatest assets – your employees. ... day in Singapore ... • Cashless access at Prudential's panel of

Prudential Assurance Company Singapore (Pte) Limited. (Reg. No. 199002477Z)7 Straits View #06-01 Marina One East Tower, Singapore 018936

Tel: 1800 333 0 333 Fax: 6734 6953Part of Prudential plc