Benefits
Coverage
Coverage
The Annual Limit and Benefits for each plan under this Policy are specified in the following table in accordance with the Schedule.
Benefits HK$
Plan Plan 1 Plan 2 Plan 3
Coverage Worldwide Worldwide
(excluding USA)
Asia1
Annual Limit 5,000,000 2,500,000 1,000,000
Lifetime Limit 15,000,000 7,500,000 3,000,000
Room Type Private Room Private Room Semi-Private Room
 
Hospitalization & Surgical Benefits      
1.Room and Board
2.Companion Bed
3.In-Patient Physician’s Fee
4.In-Patient Specialist’s Fee
5.Intensive Care
6.Miscellaneous Hospital Expenses
7.MRI, CT Scan & PET Scan2
Full Cover Full Cover Full Cover
8.Private Nursing Care
Full Cover
( max 60 days per year;
180 days lifetime )
Full Cover
( max 45 days per year;
180 days lifetime )
Full Cover
( max 30 days per year;
180 days lifetime )
9.Psychiatric Treatment
Full Cover
( max 30 days per year;
180 days lifetime )
Full Cover
( max 30 days per year;
180 days lifetime )
N/A
10.Daily Hospital Cash (General Ward of Eligible Public Hospital)
1,200
( max 30 days per year )
900
( max 30 days per year )
600
( max 30 days per year )
11.Daily Hospital Cash (Voluntary Room Level Change)
1,200
( max 30 days per year )
900
( max 30 days per year )
N/A
12.Daily Hospital Cash (Coordination of Benefits)
1,200 900 N/A
13.Surgery
Full Cover Full Cover Full Cover
14.Organ and Bone Marrow Transplant
Full Cover Full Cover Full Cover
15.Medical Appliances
Specified Items: Full Cover
Other Items: 100,000 per item per lifetime
16.Day Case Endoscopy Allowance
800 600 400
17.Pre-Hospitalization Outpatient (within 30 days prior to hospitalization)
Full Cover
( max 1 visit per day )
18.Post-Hospitalization Outpatient (within 60 days after discharge)
Full Cover
( max 1 visit per day )
19.Post-Hospitalization Home Nursing (within 30 days after discharge)
Full Cover
( max 1 visit per day; max 30 days per year )
 
Designated Critical Illness Benefits      
Waiver of Deductible3 Applicable to designated critical illness
including Cancer, Stroke, Heart Attack, Major Burn
Cancer Treatment and / or Kidney Dialysis
including chemotherapy, radiotherapy, cyberknife and gamma knife for cancer treatment or regular hemodialysis or peritoneal dialysis as a result of chronic and irreversible kidney failure
Full Cover Full Cover Full Cover
Extra Annual Limit for Cancer Treatment and / or Kidney Dialysis 5,000,000 2,500,000 1,000,000
HIV / AIDS Treatment (per lifetime) 800,000 600,000 400,000
Reconstructive Surgery4 Full Cover Full Cover Full Cover
 
Other Benefits      
Guaranteed Conversion (once in lifetime) Available at age 50, 55, 60 or 65
Worldwide Emergency Assistance Services and Benefits Actual Cost
Major Exclusions
  • Pre-existing conditions unless such conditions have been fully disclosed in the application and accepted by us.
  • Any charges that are not reasonable and customary.
  • Birth defects, congenital conditions, developmental conditions or hereditary conditions.
  • Any confinement primarily for physiotherapy or for the investigation of signs and symptoms with diagnostic imaging, laboratory investigation or other diagnostic procedures.
  • Professional sports, hazardous activities such as scuba diving and mountaineering, or engaging in any kind of race other than on foot.
  • Treatment relating to pregnancy, surrogacy, childbirth or termination of pregnancy, birth control, infertility or human assisted reproduction, or sterilization of either sex.
  • Narcotics unless prescribed by a physician, or abuse of drugs or alcohol, self-inflicted injuries or attempted suicide while sane or insane.
  • Mental disorder, psychological or psychiatric conditions, behavioral problems or personality disorder unless such occurrence is covered by the psychiatric treatment benefit under this Policy.
  • Treatment of obesity (including morbid obesity), weight control programs or bariatric surgery.
  • Donation of organ, or transplant service for which the cost incurred in connection with identifying service and procuring a replacement organ or any costs incurred for removal of the organ from the donor, all associated transportation costs and administrative costs.
Notes
  1. Asia means Afghanistan, Australia, Bangladesh, Bhutan, Brunei, Cambodia, Mainland China, Hong Kong, India, Indonesia, Japan, Kazakhstan, Kyrgyzstan, Laos, Macau, Malaysia, Maldives, Mongolia, Myanmar, Nepal, New Zealand, North Korea, Pakistan, The Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Tajikistan, Thailand, Timor-Leste, Turkmenistan, Uzbekistan and Vietnam.
  2. MRI, CT Scan & PET Scan benefit is subject to pre-authorization.
  3. Waiver of Deductible benefit is effective only after 90 days of the Policy Effective Date.
  4. Reconstructive Surgery means the actual undergoing of plastic or reconstructive surgery on the head or on the breast which is deemed to be Medically Necessary to restore function or appearance following previous surgery on the head or breast due to Carcinoma-in-situ or Cancer or Accident. Surgery solely for isolated dental restorations is not included, and is excluded from coverage under the terms of this Policy.
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