EZ Critical Care Insurance

Please fill in your Staff ID:

* Complete the Staff ID field.
* Oops! We couldn't find the Staff ID you entered. Please enter a correct one to proceed.

This insurance plan is for:

* Complete the relationship field.

Get Started

Please make sure you meet the following conditions:

  1. You are between {{productMinAge}} and {{productMaxAge}} years old at the time of application.
  2. You must be a Malaysian or Permanent Resident of Malaysia residing in Malaysia.
For policy renewal:

i.

You may renew until you are 70 years old.

Note:

Please contact us here for your insurance application if:

i.

You are purchasing for your child (below {{productMinAge}} years old).

Please enter the details of Insured Person

* Complete the Country field.
* Complete the Passport No field.
* Complete the DOB field. * Main policyholder age must be between {{productMinAge}} and {{productMaxAge}} years.
* Complete the NRIC field. * Please check NRIC number. * Policyholder age must be between {{productMinAge}} and {{productMaxAge}} years.
* Complete the Passport No field.
* Oops, looks like you haven't ticked the box yet. Please do so to proceed.

Question 1 of 4

Question 2 of 4

Question 3 of 4

Question 4 of 4

Let's Check Your Eligibility

Please enter the details to validate your BMI

Height (cm)

* Complete the Height field.

Weight (kg)

* Complete the Weight field.

BMI Result

{{bmiWordComputed}}

Have you ever suffered from stroke, diabetes, anaemia, hepatitis, heart or circulation disorder, kidney disease, tumour or cancerous growth, physical or mental disability or other disorder?

* Complete Question 2.

Have any of your parents, brothers or sisters suffered from stroke, diabetes, multiple sclerosis, cancer, inherited disease, heart disease or kidney disease before the age of 50?

* Complete Question 3.

Has any of your application for life, injury or illness insurance made by or in respect of any insured person been declined or had special terms imposed, or has any insurer refused to renew any insurance?

* Complete Question 4.

Period of Coverage

Start Date:

?
* Complete the Start Date. * Policy start date must be within 1 year starting from today.

End Date:

Please Select Your Preferred Type

* Please Choose a Coverage Option.

Please Select Your Preferred Plan

* Please Choose a Coverage Plan.

Personal Details

* Complete the Name as per NRIC field. * Please enter only alphabet, "-", "@", "/" and " ' " for Name. * Name cannot be greater than 70 characters.
* Complete the Email field. * Please enter a valid email address. * Email cannot be greater than 50 characters.
* Complete the Mobile field. * Please check mobile number.
* Complete the Address field. * Address field cannot be greater than 70 characters.
* Address 2 field cannot be greater than 70 characters.
* Complete the Postcode field. * Please enter a valid Postcode.

Personal Details

* Complete the Country field.
* Complete the Name as per Passport field. * Please enter only alphabet, "-", "@", "/" and " ' " for Name. * Name cannot be greater than 70 characters.
* Complete the Email field. * Please enter a valid email address. * Email cannot be greater than 50 characters.
* Complete the Mobile field. * Please check mobile number.

Gender:

* Complete the Gender field.
* Complete the Address field. * Address field cannot be greater than 70 characters.
* Address 2 field cannot be greater than 70 characters.
* Complete the Postcode field. * Please enter a valid Postcode.

Personal Details

Country (as per Passport):

{{ findCountryByCode(formData['4'].policyHolderCountry).name }}

Name (as per {{step4PassportOrNric}}):

{{ formData['4'].policyHolderName }}

{{step4PassportOrNric}} No.:

{{ formData['1'].policyHolderNric }}

Email:

{{ formData['4'].policyHolderEmail }}

Mobile No.:

{{ formData['4'].policyHolderMobileNo }}

Gender:

{{ formData['4'].policyHolderGender == 'M' ? 'Male' : 'Female' }}

Date of Birth:

{{ displayDateFormat }}

Address:

{{ fullAddress }}

* Oops, looks like you haven't ticked the box yet. Please do so to proceed.
* Oops, looks like you haven't ticked the box yet. Please do so to proceed.

Payment

Payment Method:

Bank:

* Please select a valid bank.

Note: You need to have an active internet banking account with any of the FPX performing banks to use FPX.

Email Address: (For transaction status)

* Complete the Email field. * Please enter a valid email address.

Credit / Debit Card:

* Please select a Credit/Debit Card provider.

Select Your Preferred E-Wallet:

* Please select an e-Wallet Provider.

By clicking "Pay Now" button, you agree to FPX's Terms & Conditions.

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By clicking "Pay Now" button, you agree to FPX's Terms & Conditions.

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Sorry, we are unable to proceed with your application online.

Please download and fill out the application form here and submit it to us here.

If you have any enquiries you may contact our Customer Service Hotline at:
{{supportTel}} or Contact us from Monday to Friday 9.00 am to 5.00 pm excluding public holidays. Monday to Friday 9.00 am to 6.00 pm excluding public holidays. Monday to Friday 9.00 am to 6.15 pm excluding public holidays. Monday to Friday 8.30 am to 5.00 pm excluding public holidays. Monday to Friday 8.30 am to 5.30 pm excluding public holidays.

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