1.1.1. Lyndung is a Community Sharing Programme (“the Programme”) that unites people to improve a person’s well-being and standard of life. The Programme is founded and administered by Lyndung Sdn Bhd (“the Administrator ”).
1.1.2. The Administrator formed a strategic partnership with Eximius Medical Administration Solutions Sdn. Bhd. (“e-MAS ”), an established professional medical Third-Party Administrator ("TPA") to administer the hospitalisation and claim processes for the Lyndung Community.
1.1.3. The Administrator has further appointed a Shariah Compliance Trustee Company, Amanah Warisan Berhad (AWARIS) ("the Trustee") as an independent trustee to monitor and manage the fund contributed by the Lyndung Community.
1.1.4. The Administrator appointed CTOS Data Systems Sdn. Bhd. as an eKYC provider to provide eKYC solutions during onboarding of new Lyndung members..
1.2.1. The Programme serves as a trusted online-based platform that connects individuals who share the same interest in improving the community (“Lyndung Community”) by alleviating, supporting and caring for each other’s well-being, particularly health.
1.2.2. The Programme is built on the principles of mutual aid (Ta’awun), community support and responsibility among the Lyndung Community. The concept of the Programme is to share the medical expenses between the Lyndung Community, not for their convenience or cost savings but they are prompted by conscience to support, care and aid one another in times of distress.
1.2.3. The ultimate goal of the Programme is for every active member of the Lyndung Community to have access to a convenient health care.
Lyndung Programme Structure
The Lyndung Community committed to contribute (Iltizam Bi Al-Tabarru’) their contribution ("Community Sharing") into a Sharing Contribution Pool ("Share Pool") to share the medical expenses of any active members in need of medical treatment equally among the community members by deducting their contribution from the Share Pool.
It is essential to understand that the Administrator does not own the Share Pool. Instead, the Trustee shall monitor and manage the disbursement and any reimbursement to the TPA.
1.4.1. Tabarru’ refers to the donation for charitable purposes whereby under this Programme, the members will donate a portion of the contribution to the Sharing Contribution Pool to help the Lyndung Community upon medical treatment needed.
1.4.2. Iltizam Bi Al-Tabarru’ means the commitment to make Tabarru’ whereby under this Programme, the members will commit to provide donations upon request by Lyndung.
1.4.3. Wakalah refers to contract where a party as principal (i.e. Members) authorises another party (i.e. Lyndung) as his/her Administrator to perform a particular task on matters that may be delegated, with or without the imposition of fee. Under this Programme, the members will appoint Lyndung as his/her Administrator on behalf of members to manage the Sharing Contribution Pool with the imposition of Membership fees (or known as Wakalah Fee).
1.4.4. Ju’alah refers to a contract where a party offers a specific reward to another party who achieved a determined result. Under this Programme, the members allow Lyndung to receive a portion of the surplus from the contribution pool as performance incentive for Lyndung’s achievement in managing the pool effectively.
1.4.5. Qard refers to a contract of lending money by lender to a borrower where the latter is bound to repay an equivalent replacement amount to the lender. Under this programme, Lyndung will lend an amount of money to the share pool/contribution pool without any profit, in the event of a deficit occurring to the share pool to help the Lyndung Community upon medical treatment needed.
A person may sign up for the Programme directly through the Lyndung website, or official referral link. Prior to signing up, a working SIM card with a phone number and an internet connection or data plan connected to a mobile device or personal computer is required. During the sign-up procedure, one must build a profile by supplying the following information:
The person is to confirm that he/she is healthy and does not suffer from any Pre-Existing Medical Condition, has read, understood and agreed to the Programme Guideline, the Terms of Use, Legal Disclaimer and the Privacy Policy and also authorising the Administrator to automatically debit the necessary amount that may be required from a person a source of payment described in the Programme Guideline.
3.1. Upon signing up, a person may opt to pay an Annual Membership Fee of RM120.00 OR Monthly Membership Fees of RM10.00, and the Initial Sharing Contribution of RM100.00 and the payment gateway fee (if any). Append below are the breakdown of the details:
**Payment Gateway Fees (if any) may vary based on the payment gateway provider engaged by the Administrator and the method of payment chosen by the member.
3.2 Annual Membership Renewal Fee
Members are required to pay the Annual Membership Fee to maintain an active member status. After the initial payment has been made, the membership fee will reoccur every 365 days and monthly mode will reoccur in the following month. The fee breakdown for a member who joins on January 3rd 2022, is as follows:
**Payment Gateway Fees (if any) may vary based on the payment gateway provider engaged by the Administrator and the method of payment chosen by the member.
4.1 Members
A member is a person who signs up and takes part in the Programme. The members shall deposit an Annual (RM120.00)/Monthly (RM10.00) membership fee and at least commit to contribute the Initial Sharing Contribution amount of RM 100.00 to share in the monthly medical expenses of other members
4.2 The Member’s Qualifications
To qualify and remain as the Lyndung Community members, a person must meet all the following requirements: -
4.2.1 Entry Age Eligibility
Individuals between the ages of 18 years old or over the age of 40 years old are eligible to join the Programme. According to this Programme Guideline, a member's age is defined as "age of last birthday," i.e., a person's age at a specific period plus one year.
For instance: -
If a person's birthday falls on 12.05.2000, he will be 21 years old from 01.05.2022 to 11.05.2022, but 22 from 12.05.2022 onwards.
From time to time, the Administrator may update/reset the age limit to include those below the age of 18 years old or over the age of 40 years old, subject to a different ratio of Monthly Community Sharing Limit that indicates their relative health risk attributable to age. Once a member, a person shall remain a member until he/she discontinues sharing.
4.2.2 Open to all
The Programme is open to all Malaysians of any race or ethnicity who live in Malaysia and meet all qualifying requirements. The Eligible Medical Expenses shall be paid only if the treatment occurred in Malaysia and provided by or under the supervision of a Panel Hospital. Please visit the Lyndung Official Website at https://lyndung.my/ for the latest list of panel hospitals
4.2.3 Health Status
A person's health status may affect his/her eligibility to participate in the Programme. During the sign-up process, a person is obliged to disclose any Pre-Existing Condition to the Administrator. Failure to adequately disclose facts relevant to his/her Pre-existing Condition at the time of registration is a severe breach of the members’ shared trust. It may result in disqualification from the Programme under Section 9. The Administrator has the authority to disqualify any person from participating in the Programme due to the Pre-existing Condition.
RM10.00 incentive will be granted to each successful referral to encourage the Lyndung Community members to help promote the Programme to others. Lyndung Community members can transfer their incentive at any amount to their Pocket at any time. The incentive can also be withdrawn to a bank account with a minimum withdrawal value of RM100.00.
Pocket refers to the Initial Sharing Contribution that has been deposited by the Members. Members may check his/her Sharing Contribution balance in his/her Pocket on their profile page.
A member who wishes to remain as a member and continue to enjoy the benefits of this Programme, he/she must continue to comply with the following obligations:
Under this Programme, each member is entitled to the following:
A member can freely withdraw from the Programme by clicking the ‘Retreat’ button in the Lyndung Portal. The members will receive a verification code through SMS that must be inserted into the Lyndung Portal to complete the withdrawal process. The members’ status will remain “Active” for 26 days after completion. After 26-days, the Trustee shall proceed to refund any available balance in his/her Sharing Contribution. However, the members are still accountable for any Actual Community Sharing Amount for the period within the 26-day grace period.
In terms of failure to make payment for Sharing Contribution top-up or payment for Annual/Monthly Membership Fee, a member will be suspended for 26 days. Member’s status will be immediately reinstated if payment is made within the time frame (suspended period). If no payment is received within the time frame, the member will be permanently disqualified and no longer be eligible for any Lyndung Community Programme benefits. The Trustee shall process the refund of whatsoever remaining balance of his/her Sharing Contribution. However, the member is still responsible for the Actual Community Sharing Amount within the 26 days (if any) from the remaining balance of his/her sharing contribution.
The Administrator has full authority to blacklist a member(s) from the Programme if in any event found a member willfully concealed his/her previous medical history or any relevant facts regarding his/her health. This action is deemed as fraud or abuse against the Lyndung Community member.
If any of the Lyndung Community members has been blacklisted, the refund process shall initiate immediately to refund any remaining balance of his/her Sharing Contribution.
The Lyndung Community members shall be entitled to a refund of any unused portion of the Initial Sharing Contribution as determined by the Administrator. The Administrator will require up to 60-days to refund whatsoever sum to the members. Please note that the Annual/Monthly Membership Fee is strictly non-refundable save and except in the case of duplicate charges. The Administrator may require up to 30-days to refund the members for any duplicate charges.
The account of the Lyndung Community members who have already withdrawn/suspended/ blacklisted from the Programme will be terminated upon refunding the remaining unused Sharing Contribution. A member may re-enroll or reinstate his/her membership through the Lyndung Portal if they wish to do so. Nevertheless, all rewards and incentives previously attained will be reset to zero. However, the reinstatement is subject to the Administrator’s approval.
13.1 Monthly Community Sharing Limit
13.1.1 Monthly Community Sharing Limit
Once signed up, the Lyndung Community members are obligated to a monthly Community Sharing Limit of RM50.00 or any lesser amount published on the Official Website on the 25th day of each month and shall be advised by the Administrator upon registration.
13.1.2. The Monthly Cut-Off Date is currently set on the 25th day of each calendar month. Every 25th day of the month, the Administrator will post the Community Sharing Case on the website, Lyndung Portal, and/or social media platforms. Thus, each month is defined as commencing on the 26th and ending on the 25th of the following month.
13.1.3. The Administrator reserves the right to vary the Monthly Community Sharing Limit from time to time.
13.2 Actual Community Sharing Amount
13.2.1. Actual Community Sharing Amount is the Actual Community Sharing payment commitment made by an active member of the Lyndung Community for a certain month and is calculated by the total amount of medical bills paid as of the Monthly Cut-Off Date. This amount is then divided among the Lyndung Community members.
13.2.2. Actual Community Sharing Amount shall be collected monthly or as determined by the Administrator. The total Actual Community Sharing Amount collected must not exceed the Monthly Community Sharing Limit as shown below:
Illustration 1:
Monthly Community Sharing Limit of RM50.00
Total Medical Bills Eligible for Community Sharing: RM30,000.00
Number of Active Members: 1,000
Actual Community Sharing Amount per Active Members: RM30.00
In the above illustration, each Active Sharing Contribution shall be deducted by Actual Community Sharing Amount of RM30.00 which is less than the Monthly Community Sharing Limit of RM50.00.
In the instance where the total Actual Community Sharing Amount is more than the Monthly Community Sharing Limit of RM50.00, the Actual Community shall be limited at RM50.00 and the remaining unshared amount would be carried forward to the next month as indicated below:
Illustration 2:
Monthly Community Sharing Limit of RM50.00
Total Medical Bills Eligible for Community Sharing: RM70,000.00
Number of Active Members: 1,000
Actual Community Sharing Amount per Active Members: RM50.00
Amount unshared: RM70,000.00 - RM50,000.00 = RM20,000.00
RM20,000.00 will be carried forward to next month.
13.2.3 Annual or Monthly Membership Fee
A total of RM120.00 or RM10.00 shall be paid Annually/Monthly by the Lyndung Community members being the Membership Fee during the signing up of the Programme. The fee collected is utilised as Wakalah fees to cover the management expenses primarily in hiring the service of TPA, and eKYC of the Programme. The Administrator may vary the Annual Membership Fee and/or levy any additional charges as and when it is judged fit and appropriate.
13.2.4 Initial Sharing Contribution
During sign-up, a Lyndung Community member is required to place an Initial Sharing Contribution to the Pocket and maintain the Pocket balance at all times. If the members’ Pocket balance is lower than the Monthly Community Sharing Limit i.e. RM50.00, the members’ credit card/debit card shall be debited with an amount required to bring the balance of the Pocket Balance to RM100.00.
Lyndung may utilise the Sharing Contribution for Shariah-compliance investment purposes whenever the Administrator deems appropriate according to the Manner of Investment as specified in this Programme Guideline.
13.2.5 Transaction Fee and Taxes
Each Lyndung Community member is expected to bear any expenses for the community sharing contributions including payment gateway charges, service tax and any relevant charges and taxes at the prevailing rates as may be stipulated by the Government of Malaysia.
13.3 Manner of Investment
13.3.1. Sharing Contribution Pool will only be invested after the deduction of membership fees, payment of medical bills, and administrative fees by TPA. The investment of Sharing Contribution shall be as follows:
Sharing Contribution Pool Balance | Target Asset Allocation | |
---|---|---|
Shariah-compliant Equities | Sukuk, Shariah-compliant money market instruments and/or cash | |
Less or equal to RM100,000 | 100% | |
RM100,000 and above | Up to 70% | Minimum 30% |
13.3.2. At the end of every financial year in December, the Administrator will calculate the surplus.
13.3.3. The Administrator shall only invest in Shariah-compliant portfolios as approved by the Shariah Advisor.
13.3.4. The Administrator will not be entitled to any profit or loss. However, Lyndung is entitled to be remunerated based on the fixed percentages of Surplus for managing the investment of the Sharing Contribution Pool.
13.3.5. After deducting all the necessary fees, including but not limited to trustee fee, brokerage fee, clearing fee, stamp duty, and government tax, 50% of Surplus will be declared and distributed to active members' Sharing Contribution Pocket.
13.3.6. After deducting all the necessary fees, including but not limited to trustee fee, brokerage fee, clearing fee, stamp duty, and government tax, 50% of Surplus will be transferred to Lyndung Sdn. Bhd. bank account based on the Jualah concept in which the members agree to reward Lyndung for its achievement or good performance in managing the investment that leads to a Surplus of the pool.
13.3.7. In the event of Lyndung as an administrator, misconduct, negligence, or breach of specified terms that result in a loss of such investment, Lyndung shall:
13.3.8. Asset allocation does not contravene the Shariah principles as indicated through the Shariah Negative Criteria checklist. List of businesses categorise as Shariah non-compliant and could not be applied to invest:-
The Programme is an alternative healthcare option that is convenient, affordable and fully funded by members of the Lyndung Community. It is the most cost-effective and innovative solution to the challenges of rising healthcare and medical costs, as well as prohibitively high health insurance premiums/takaful contributions. The Programme which makes extensive use of technology, also enables rapid and uncomplicated access to healthcare. As opposed to the time-consuming and restrictive procedure of obtaining a standard health insurance/takaful coverage. The following are many reasons why the Monthly Community Sharing Limit under the Programme is maintained low:
14.1 It is a profit controlled oriented Programme
The Administrator does not profit from the members’ Community Sharing on medical expenditures. The total amount of allowable medical expenses certified by TPA is conveyed to all Lyndung Community members. Under the Programme, no contribution or any other fees shall be received from the Lyndung Community members. The Lyndung Community members shall only pay for their part of the eligible medical expenses and the Annual/Monthly Membership Fee.
14.2 The administrative cost of this Programme
The Administrator charged a minimal Annual Membership Fee of RM120.00 or a Monthly Membership Fee of RM10.00 to those interested to join the Lyndung Community Programme. Expenses such as hiring TPA shall be utilised from the said membership fees.
14.3 Members’ share in actual Medical Expenses not projection value
The Programme nor the Administrator are not in the position to forecast the expected medical expenses of the members. The members agreed to share only the actual medical expenses incurred. The more members joining the Programme resulting in lower value of each member's share.
14.4 Lifetime community sharing and benefits
The Lyndung Community members shall remain as “Active” members upon joining as long as they continue their contribution sharing even though they have exceeded the age eligibility stated in Section 4.2.1.
14.5 Members are committed to live healthy lifestyle
To ensure the sustainability of the Programme, The Lyndung Community members are encouraged to lead a healthy lifestyle, mental health and create a socially responsible community. The Lyndung Community members have to be accountable for their own actions throughout the Programme.
14.6 Members are committed to be honest about their declaration
Members are required to thoroughly comprehend the Programme's concepts as outlined in the Programme Guideline and make a list of declarations regarding their health and lifestyle. False declarations will result in immediate disqualification. The Administrator shall have full access to all the Lyndung Community members medical reports, pertinent tests and previous medical claim records (if any) before joining the Programme.
14.7 Hospital Admission and Medical Treatment are examined upfront and effectively managed for the best possible outcome
To administer the Programme’s hospitalisation and claims processes, the Administrator has formed a strategic partnership with established and professional TPA which guarantees an effective management of the Medical Expenses for the Lyndung Community. The Lyndung Community members are also provided with continuous education on managing health and medical expenditures throughout the Programme.
15.1 RM100.00 will be set aside as the Share Pool by every member who joins the Programme. The amount of this contribution will be reflected in the members’ Pocket Balance (“Pocket”). The Share Pool will be utilised to settle the medical cost of the other active Lyndung Community. Contribution can be made through an agreed payment method, i.e. by debiting his/her credit/debit card.
15.2 The Share Pool will be deposited into a trust account of the Trustee (“Trust Account”) established exclusively for this medical cost-sharing to match the Lyndung Community’s actual sharing amount. The Trust Account shall be administered by the Trustee where the Share Pool shall be held within a Shariah compliant financial instrument.
The Trust Account is owned by the Lyndung Community and managed by the Trustee under the direction of the Administrator. The Surplus, if any, will be determined and declared from the Trust Account at the end of every financial year by the Administrator. Based on the Shariah Principle of Jualah, the surplus may be distributed between the Administrator as Jualah (performance fees) for Lyndung achievement in managing the pool effectively and the balance shall be directly placed into the active Lyndung Community’s Pocket.
15.3 By contributing a sum for the Initial Sharing Contribution, the Lyndung Community is considered to have granted the Administrator permission to use the amount to cover the Eligible Medical Expenses following the Programme Guidelines.
15.4 The Lyndung Community members must adhere to two types of deferment periods of 60 days and 180 days ("Waiting Period") from the date of the signing up subject to all payments in Section 15.1 hereinabove of this Programme Guideline have been made. The Lyndung Community members are not eligible to receive from the Community Sharing any charges for medical assistance charged by the Panel Hospital ("Panel Hospital") under the Programme, save and except for accidental injury within the 60 days deferment period. During this Waiting Period, a new Lyndung Community member is required to contribute to the Actual Community Sharing Amount if any critical case arises for other active Lyndung Community members.
15.5 During the 60 days Waiting Period, the Lyndung Community Members are allowed to seek community sharing for medical assistance due to accidental injury up to a total of RM20,000 and receive death beneficiary support (Khairat Kematian) amounting to RM5,000. Following the expiration of the 60 days Waiting Period, the Lyndung Community members may begin to seek Community Sharing of any expenses incurred while receiving medical care from the Panel Hospital under the Programme, with the exception of cases falling under Specific Illnesses under Section 10 of the Members’ Manual.
15.6 Upon the expiration of the 180 days Waiting Period, the Lyndung Community members may seek and receive medical assistance through the Community Sharing for all types of medical treatment, except for all the items listed under Exclusions and Non-covered Items for Sharing in Section 8 of the Members’ Manual.
15.7 For pre-authorization purposes, the TPA identification card and TPA admission card must be presented to the Panel hospital admission counter. Memberships are required to present their card from their user portal profile (“Lyndung Portal”) before proceeding with the intended treatment.
15.8 In any case which requires hospital admission, the Panel hospital will seek an approval from TPA and make admission appointments upon permission is obtained. The Lyndung Community members may call the TPA hotline number 03-2779 0012 or via Whatsapp to +6018-788 3627 if they have any questions or issues regarding the admission.
15.9 TPA will notify the Panel Hospital following the approval of the member’s admission application and the hospital will advise the member immediately of the status.
15.10 Once approved, the TPA will issue an initial guarantee letter (“GL”) and Top-Up guarantee letter (“Top-Up GL”) if necessary.
15.11 Prior to the discharge, the Panel Hospital will send the bill of the medical expenses directly to the TPA.
15.12 The TPA receives and processes the medical expenses for sharing eligibility.
15.13 When a Member is discharge, TPA will issue a Final Guarantee Letter ("FGL") to the Panel Hospital on behalf of the Lyndung Community members and the aggregate of the FGLs will be calculated as at the monthly cut-off date (every 25th of the month). Then only the sharing amount for that particular month shall be determined.
15.14 The exact amount committed must be reported to the Trustee by the Administrator. The Actual Community Sharing Amount shall be deducted from each Lyndung Community members’ Pocket. If the Pocket balance is less than or equal to RM50.00, the Lyndung Community members' debit/credit card will be charged the amount required to get the Pocket balance to RM100.00.
15.15 Panel Hospital
Medical expenses incurred at any non-Panel Hospital are not eligible for sharing.
15.16 Pre-Existing Condition
15.16.1 Pursuant to Section 14.6 hereinabove, a Lyndung Community member is required to disclose all Pre-Existing Conditions to the Administrator during the signing up process. Failure to fully disclose information pertaining to his/her Pre-existing Condition at the time of signing up is a material violation of the shared trust between the Lyndung Community members and may subject to the disqualification of the said members from the Programme pursuant to Section 10 of this Programme Guideline.
15.16.2 If the Lyndung Community members is admitted for hospitalisation or seeks treatment on the basis of his/her Pre-Existing Conditions, or otherwise is found to possess any Pre-existing Condition, the said members shall lose his/her eligibility as Lyndung Community members and shall be terminated. All deposits of the said members shall be forfeited and be used towards the Community Sharing.
15.16.3 Medical expenses incurred and submitted for sharing within the first 90-days from the Eligibility Date may be subject to a Pre-Existing Condition review by the Administrator, including, but not limited to, request for medical notes/records, hospital charts, surgical records, tests result or other relevant medical history information.
16.1 The Programme is administered on behalf of the Lyndung Community members as principal (muwakkil) by the Administrator as agent (Wakil) and as a platform for the Lyndung Community members to share their healthcare and medical burden in accordance with the Programme Guideline. Neither the Administrator nor the Lyndung Community members guarantee or promise that the Eligible Medical Expenses will be shared by the other Lyndung Community members of the Programme due to the payment of the Sharing Contribution are not totally under the Administrator nor the other Lyndung Community members’ control. The Administrator as the agent appointed by the members may utilise the sharing contribution pool for Shariah-compliance investment purposes whenever the Administrator deems appropriate.
16.2 Neither the Lyndung Community members nor the Administrator will be compelled by law to make such a sharing contribution. However, a members’ failure to contribute will result in disqualification from the Programme.
16.3 The Administrator encourages the Lyndung Community members to consult a health insurance/takaful professional for advice on the difference between regulated health insurance/takaful and community sharing programmes such as this Programme.
16.4 The Programme is not provided by an insurance/takaful provider, nor considered as an insurance/takaful contract. The Programme is also not a substitute for any insurance/takaful policy authorised by law. No risk transferred from the members to the Administrator or from among the Lyndung Community members. No indemnity or guarantee contract exists between the Administrator and any of the Lyndung Community members or among the members themselves.
16.5 Neither the Administrator nor the Lyndung Community members are considered insurers under the Malaysian Law. The Programme is not subject to the country's insurance/takaful regulatory standards or consumers’ rights.
17.1 Programme Guideline
The Programme is governed and regulated by this Programme Guideline. The Administrator is responsible to formulate and enforce this Programme Guideline according to the Applicable Law including Shariah Law. By becoming a member of the Programme, a member agrees to adhere to this Programme Guideline. The Programme Guideline shall vary from time to time or the Administrator shall notify members against the amendment made in the Programme Guideline and members may indicate their acceptance towards the amendment. The Programme Guideline is final and will overrule any verbal statement made by employees or representatives of the Administrator.
17.2 Amending the Programme Guideline
The Programme Guideline may be amended from time to time as circumstances require and as determined to be appropriate by the Administrator. The Administrator has the obligation to ensure that the amendment made to the Programme Guideline shall abide by the Shariah Principle at all times. The Administrator has the option, at its full discretion, of first taking an advisory vote among, or feedback and recommendations from the Lyndung Community members prior to making such amendments. Amendments to the Programme Guideline will go into effect as soon as is administratively practical or as otherwise designated by the Administrator (“Effective Date”) and such amended Programme Guideline shall supersede all previous editions of the Programme Guideline and any other communication, written or verbal. communication, written or verbal.
For the avoidance of doubt, Medical Expenses submitted to the Administrator for sharing after the Effective Date will be subject to the new amendments of the Programme Guideline regardless of when the Medical Expenses are incurred.
The latest Programme Guideline can be accessed via the link in the Lyndung Portal and website. It is the Administrator responsibility to notify members against the amendment made in the Programme Guideline.
17.3 Dispute Resolutions and Appeal
The Programme is a community-based effort where its members voluntarily come together to support, care, and assist each other in a mutually beneficial way. The Programme may not be successfully implemented without its members’ understanding and adhering strictly to this Programme Guideline. As such, it is important that in the event any question, issue, complaint, claim, dispute, or disagreement arising out of, or related to, this Programme Guideline or the Programme (“Dispute”) occurs, a methodology for determining and addressing the Dispute must be made available. By agreeing to participate in the Programme, the Lyndung Community members agrees that any Dispute arise, the Programme, the Administrators and/or its directors, employees, representatives, and associates, will be settled using the following procedures: -
17.3.1 Determining the dispute
Any Dispute shall be referred to the Administrator for determination. Lyndung Community members may contact the Administrator’s service representatives. However, the oral opinions offered by the service representatives do not constitute binding decisions of the Administrator. Formal enquiries by the Lyndung Community members shall be in writing explaining circumstances and specifically seeking a binding decision from the Administrator (“Decision”). The Administrator shall reply in writing on the Decision and will explicitly indicate if it is a decision that will bind the Administrator and the Programme.
17.3.2 Review by Appeal Committeee
If a Lyndung Community member is not satisfied with the Decision (“the Appellant”) and has logical reasons to believe that the Decision is incorrectly made, the appellant may file an appeal for review and reconsideration to the Programme’s appeal committee (“Appeal Committee”). The appeal for a review must be made within 30 days from the day the Decision was made and must be in writing, stating the elements of the Dispute and all the relevant facts.
If required, the Internal Appeal Committee may call for a meeting with the Appellant to discuss and/or require the Appellant to furnish further documents or commence further investigation.
Within 30 days from the appeal or such other longer time as shall be required, the Appeal Committee will deliberate on the Dispute and initial Decision and render a written decision to the Membership. The Appeal Committee’s Decision is final and binding on both the Administrator and the Appellant.
The Administrator reserves the right to impose an appeal fee payable by the Appellant.
17.3.3 Decision made by the Appeal Committee is Final and Binding
In the interest of this Programme, the Lyndung Community members agree that the above methods of resolving Dispute shall be the sole remedy for any Dispute and expressly waive his right to file a lawsuit in any civil court against one another, the Administrator and/or its directors, employees, associates or representatives, for such Disputes.
17.4 Applicable Law
For all matters of procedure and substance regarding any Dispute that comes within these above requirements, the laws of Malaysia shall govern.
18.1 Nearly all medical expenses can be determined to be eligible for sharing as provided in this Programme Guideline and the Lyndung Members’ Manual. However, in matters where this Programme Guideline or the Members’ Manual may not provide absolute clarity, the Administrator has the absolute discretion to determine whether the medical expenses should be shared according to the procedure and precedent the Administrator deems fit.
18.2 If the Lyndung Community members believe the Administrator is misinterpreting this Programme Guideline or his/her circumstances, the aggrieved members may seek reconsideration through the appeal procedure outlined above. Regardless of the appeal’s outcome, the existence of this appeal procedure should not be interpreted as creating any expectation of sharing or a legally enforceable right since there are no contractual rights of sharing under this Programme Guideline. Rather, the procedure is an alternate method by which the Lyndung Community members can be sure that the Administrator is reconsidering the sharing of the medical expenses according to this Programme Guideline.