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保单附表 （本附件构成集团医院及外科保单编号 ： 00104164 的一部分）
POLICY SCHEDULE
(This attachment forms part of the Group Hospital and Surgical Policy No. : 00104164)
POLICY SCHEDULE (This attachment forms part of the Group Hospital and Surgical Policy No. : 00104164)| POLICY SCHEDULE | | :--- | | (This attachment forms part of the Group Hospital and Surgical Policy No. : 00104164) |
Policyholder  投保人 : STANFORT ACADEMY PTE LTD
： 斯坦福学院私人有限公司
Policy Effective Date  保单生效日期 : 01 March 2024
： 01 三月 2024		 Policy Anniversary :  保单周年日： Every 1 March  每 3 月 1 日
Members  成员 : All full-time Employees in Active Service aged from 16 to 70 last birthday
： 所有年龄介乎16岁至70岁的全职现役雇员
Maximum Age of Coverage
最长承保年龄		 : 100 age last birthday
： 100岁最后生日
Waiting Period for New Employees
新员工的等待期		 : Nil - Coverage starts on the date of employment
： 无 - 承保范围从受雇之日开始
Classification & Plan  分类与计划

： 计划 002 ： 计划 003
: Plan 002
: Plan 003
: Plan 002 : Plan 003| : Plan 002 | | :--- | | : Plan 003 |

- 所有员工和学生，包括新加坡公民、新加坡永久居民、教师和校长- FW（S-Pass 和工作许可证持有者）
- All Employees & Students, including Singapore Citizen, Singapore Permanent Resident, Teacher and Principal
- FW (S-Pass & Work Permit Holders)
- All Employees & Students, including Singapore Citizen, Singapore Permanent Resident, Teacher and Principal - FW (S-Pass & Work Permit Holders)| - All Employees & Students, including Singapore Citizen, Singapore Permanent Resident, Teacher and Principal | | :--- | | - FW (S-Pass & Work Permit Holders) |
"POLICY SCHEDULE (This attachment forms part of the Group Hospital and Surgical Policy No. : 00104164)" Policyholder : STANFORT ACADEMY PTE LTD Policy Effective Date : 01 March 2024 Policy Anniversary : Every 1 March Members : All full-time Employees in Active Service aged from 16 to 70 last birthday Maximum Age of Coverage : 100 age last birthday Waiting Period for New Employees : Nil - Coverage starts on the date of employment Classification & Plan ": Plan 002 : Plan 003" "- All Employees & Students, including Singapore Citizen, Singapore Permanent Resident, Teacher and Principal - FW (S-Pass & Work Permit Holders)" | POLICY SCHEDULE <br> (This attachment forms part of the Group Hospital and Surgical Policy No. : 00104164) | | | | | | :--- | :--- | :--- | :--- | :--- | | Policyholder | : STANFORT ACADEMY PTE LTD | | | | | Policy Effective Date | : 01 March 2024 | | Policy Anniversary : | Every 1 March | | Members | : All full-time Employees in Active Service aged from 16 to 70 last birthday | | | | | Maximum Age of Coverage | : 100 age last birthday | | | | | Waiting Period for New Employees | : Nil - Coverage starts on the date of employment | | | | | Classification & Plan | : Plan 002 <br> : Plan 003 | | - All Employees & Students, including Singapore Citizen, Singapore Permanent Resident, Teacher and Principal <br> - FW (S-Pass & Work Permit Holders) | |
Changes in Classification to be Effective : On the date of such change
生效的分类变更 ： 变更之日
Benefits  好处 Maximum Per Any One Disability
每项任何一项残疾的最高限额
Plan 002  计划 002 Plan 003  计划 003
S$  新元 S$  新元
1 Daily Room & Board (maximum 120 days)
1 每日食宿（最多 120 天）		 4-Bedded (Singapore Government/ Restructured Hospitals)
4 床位（新加坡政府/重组医院）		 4-Bedded (Singapore Government / Restructured Hospitals)
4 床位（新加坡政府/重组医院）
2 Intensive Care Unit (maximum 30 days)
2 重症监护病房（最多 30 天）		 3 × 3 × 3xx3 \times Daily Room & Board
3 × 3 × 3xx3 \times 每日食宿		 3 × 3 × 3xx3 \times Daily Room & Board
3 × 3 × 3xx3 \times 每日食宿
3 High Dependency Ward (maximum 30 days)
3 高依赖病房（最长 30 天）		 2 × 2 × 2xx2 \times Daily Room & Board
2 × 2 × 2xx2 \times 每日食宿		 2 × 2 × 2xx2 \times Daily Room & Board
2 × 2 × 2xx2 \times 每日食宿
4 Other Hospital Services
4 其他医院服务		 7,000 7,000
5 Surgical Fees (Subject to Surgical Schedule)
5 手术费用（视手术时间表而定）		 9,000 9,000
6 In-Hospital Doctor's visit (maximum 120 days)
6 住院医生探访（最长 120 天）		 60 60
7 Pre & Post Hospitalisation treatment
7 住院前后治疗		 2,000 2,000
8 Emergency Accidental Outpatient Treatment (including dental treatment due to accident)
8 紧急意外门诊治疗（包括因意外而进行的牙科治疗）		 2,000 2,000
9 Pre & Post Hospitalisation treatment - Traditional Chinese Medicine
9 住院前后治疗 - 中医		 NIL NIL
10 Miscarriage Benefit :
10 流产福利：		 As per disability  根据残疾 As per disability  根据残疾
11 Outpatient Kidney Dialysis and Cancer Treatment
11 门诊肾透析和癌症治疗		 : NIL NIL
12 Overseas Hospitalisation due to Accident
12 因意外在海外住院		 NIL NIL
13 Rehabilitation Benefit
13 康复福利		 : NIL NIL
14 Hospital Cash Benefit (for stay in government/restructured hospital) B1 B2/B2+ C
14 住院现金保障 （入住政府/改组医院） B1 B2/B2+ C		 NIL NIL
15 In Hospital Psychiatric Treatment
15 住院精神科治疗		 NIL NIL
16 Repatriation Expense  16 遣返费用 75,000 NIL
17 Ambulance Fees  17 救护车费用 NIL NIL
18 Death Benefit  18 身故赔偿 : 5,000 5,000
19 Double Death Benefit (when Death caused by Accident)
19 双倍身故赔偿（因意外身故）		 NIL NIL
Overall Limit (admission to Government / Restructured Hospitals) 20 (Excluding Room & Board, High Dependency ward and ICU) *Refer to Overall limits 4 to 7
总限额（政府/改组医院）：20人（不包括病房及膳食、高依赖病房及深切治疗部）*请参阅总限额：4至7		 20,000 60,000
Benefits Maximum Per Any One Disability Plan 002 Plan 003 S$ S$ 1 Daily Room & Board (maximum 120 days) 4-Bedded (Singapore Government/ Restructured Hospitals) 4-Bedded (Singapore Government / Restructured Hospitals) 2 Intensive Care Unit (maximum 30 days) 3xx Daily Room & Board 3xx Daily Room & Board 3 High Dependency Ward (maximum 30 days) 2xx Daily Room & Board 2xx Daily Room & Board 4 Other Hospital Services 7,000 7,000 5 Surgical Fees (Subject to Surgical Schedule) 9,000 9,000 6 In-Hospital Doctor's visit (maximum 120 days) 60 60 7 Pre & Post Hospitalisation treatment 2,000 2,000 8 Emergency Accidental Outpatient Treatment (including dental treatment due to accident) 2,000 2,000 9 Pre & Post Hospitalisation treatment - Traditional Chinese Medicine NIL NIL 10 Miscarriage Benefit : As per disability As per disability 11 Outpatient Kidney Dialysis and Cancer Treatment : NIL NIL 12 Overseas Hospitalisation due to Accident NIL NIL 13 Rehabilitation Benefit : NIL NIL 14 Hospital Cash Benefit (for stay in government/restructured hospital) B1 B2/B2+ C NIL NIL 15 In Hospital Psychiatric Treatment NIL NIL 16 Repatriation Expense 75,000 NIL 17 Ambulance Fees NIL NIL 18 Death Benefit : 5,000 5,000 19 Double Death Benefit (when Death caused by Accident) NIL NIL Overall Limit (admission to Government / Restructured Hospitals) 20 (Excluding Room & Board, High Dependency ward and ICU) *Refer to Overall limits 4 to 7 20,000 60,000| Benefits | | Maximum Per Any One Disability | | | :--- | :--- | :--- | :--- | | | | Plan 002 | Plan 003 | | | | S$ | S$ | | 1 Daily Room & Board (maximum 120 days) | | 4-Bedded (Singapore Government/ Restructured Hospitals) | 4-Bedded (Singapore Government / Restructured Hospitals) | | 2 Intensive Care Unit (maximum 30 days) | | $3 \times$ Daily Room & Board | $3 \times$ Daily Room & Board | | 3 High Dependency Ward (maximum 30 days) | | $2 \times$ Daily Room & Board | $2 \times$ Daily Room & Board | | 4 Other Hospital Services | | 7,000 | 7,000 | | 5 Surgical Fees (Subject to Surgical Schedule) | | 9,000 | 9,000 | | 6 In-Hospital Doctor's visit (maximum 120 days) | | 60 | 60 | | 7 Pre & Post Hospitalisation treatment | | 2,000 | 2,000 | | 8 Emergency Accidental Outpatient Treatment (including dental treatment due to accident) | | 2,000 | 2,000 | | 9 Pre & Post Hospitalisation treatment - Traditional Chinese Medicine | | NIL | NIL | | 10 Miscarriage Benefit : | | As per disability | As per disability | | 11 Outpatient Kidney Dialysis and Cancer Treatment | : | NIL | NIL | | 12 Overseas Hospitalisation due to Accident | | NIL | NIL | | 13 Rehabilitation Benefit | : | NIL | NIL | | 14 Hospital Cash Benefit (for stay in government/restructured hospital) B1 B2/B2+ C | | NIL | NIL | | 15 In Hospital Psychiatric Treatment | | NIL | NIL | | 16 Repatriation Expense | | 75,000 | NIL | | 17 Ambulance Fees | | NIL | NIL | | 18 Death Benefit | : | 5,000 | 5,000 | | 19 Double Death Benefit (when Death caused by Accident) | | NIL | NIL | | Overall Limit (admission to Government / Restructured Hospitals) 20 (Excluding Room & Board, High Dependency ward and ICU) *Refer to Overall limits 4 to 7 | | 20,000 | 60,000 |
Mode of Payment  付款方式 : : :: Annual   : : :: 年刊
Premium Due Date  保费到期日 : : :: Every 1 March
: : :: 每 3 月 1 日
Mode of Payment : Annual Premium Due Date : Every 1 March| Mode of Payment | $:$ Annual | | :--- | :--- | | Premium Due Date | $:$ Every 1 March |
Annual Premium Rates  年度保费率 Plan 002  计划 002 Plan 003  计划 003
S$  新元 S$  新元
Employee Only  仅限员工 : 216.00
Employee & Spouse or Child(ren)
员工和配偶或子女（任任）		 : NA
Employee & Family  员工与家人 : NA
Annual Premium Rates Plan 002 Plan 003 S$ S$ Employee Only : 216.00 Employee & Spouse or Child(ren) : NA Employee & Family : NA| Annual Premium Rates | Plan 002 | Plan 003 | | :--- | :--- | :--- | | | S$ | S$ | | Employee Only | : | 216.00 | | Employee & Spouse or Child(ren) | : | NA | | Employee & Family | : | NA |
Currency Basis : Singapore Dollars
货币基础 ： 新加坡元
Place of Issue  签发地点 : Singapore  ：新加坡
Issuing Office  发证处 : Singapore Office  ： 新加坡办事处
Date of Issue  发行日期 : 07 June 2024
： 07 六月 2024
Currency Basis : Singapore Dollars Place of Issue : Singapore Issuing Office : Singapore Office Date of Issue : 07 June 2024| Currency Basis : Singapore Dollars | | | :--- | :--- | | Place of Issue | : Singapore | | Issuing Office | : Singapore Office | | Date of Issue | : 07 June 2024 |