Assured peace of mind for a carefree life

Transcription

1 PROTECTION (CEOE) Assured peace of mind for a carefree life CEO Essence Medical Plan offers superb medical protection that will allow you to embrace a worry-free future at all times. aia.com.hk

2 1 PROTECTION You are striving to achieve in your career and the best for your family, but unforeseen challenges to your health can arise at any time. What you need is a flexible and comprehensive health care plan that will enable you to move ahead at your own pace, so you can secure a bright future. As your reliable partner, AIA has launched the CEO Essence Medical Plan to support you. Besides covering medical expenses for hospitalisation, surgery and outpatient consultations, the plan gives you access to comprehensive quality protection that will cover all your future needs. Superior Medical Protection throughout Asia CEO Essence Medical Plan always has your health and well-being at heart. It fully reimburses on major medical expenses 1 for hospitalisation, surgery and rehabilitation with no benefit sub-limit for major benefit items (subject to the terms and conditions of the Policy). It comes with an Overall Lifetime Limit of up to HK$/MOP 25,000,000 and an Annual Limit of HK$/MOP 10,000,000 per coverage year to cover your medical expenses. You can choose to stay in semi-private wards 2 in Hong Kong, Macau and China, and even private wards 2 in some parts of Asia, including Australia and New Zealand. You are always assured of leading-edge medical protection, wherever you are in Asia. A Flexible Plan to Suit Your Budget CEO Essence Medical Plan offers three different deductible amounts, so that customers can choose a plan to give them high-quality protection whatever their budget. You can opt for a plan with a higher deductible to keep your premium low, or sign up for a plan with zero deductible to maximise your eligible benefits. No matter what your needs are, a comprehensive medical insurance package, or simply to top up your current group or individual medical cover, our plan will suit you perfectly. Furthermore, medical insurance provided by your employer ends when you retire. CEO Essence Medical Plan however allows you to keep your cover. You can switch to a plan without deductible 3 upon the anniversary of your cover at the age of 50, 55, 60 or 65 without needing to provide us with current details of your health. You can then make a claim of medical expenses in full if you are hospitalised. Remarks: 1. Subject to a maximum Annual Limit of HK$/MOP 10,000,000, an Overall Lifetime Limit of HK$/MOP 25,000,000, deductible amounts, the Reasonable and Customary charges as stated in Important Notes and the terms, conditions and exclusions of the Policy. Benefit items are subject to respective cover / maximum limits set out in the Schedule of Benefits attached to the Policy. 2. Please refer to Important Notes for details about the Covered Room. 3. The premium will be adjusted based on the selected deductible amount and the attained age of the Insured.

3 PROTECTION 2 Lifetime Guaranteed Renewable Cover 4 No Additional Premium after Medical Claims By taking up lifelong medical insurance plan early, you can minimise the chances of having to pay additional premium later or being declined for application if you have health problems. Once the plan is effective, the premium for renewal of cover will not be raised because of any claim you have made under the plan. You can rest assured that you will be able to renew your medical cover for continued protection. Up to 100% Deductible Discount to Ease Your Burden The plan comes with a no-claim deductible discount and offers 10% discount 5 on the amount of deductible for every two consecutive years of cover in which no reimbursement are made. The discount will apply from the following coverage year once you qualify for it and can be accumulated up to 100%. Once you are entitled to 100% discount, you can make a claim for the full amount of subsequent medical expenses as the deductible amount has been reduced to zero. Illustration of No Claim Deductible Discount Deductible of HK$25,000 is selected Deductible is reduced by 20% to HK$20,000 if you do not make a claim for 4 consecutive years Deductible is reduced by 10% to HK$22,500 if you do not make a claim for 2 consecutive years Deductible is reset to HK$25,000 on reimbursement Deductible is reduced again by 10% to HK$22,500 if you do not make a claim in the previous 2 years Coverage year A claim of HK$40,000 is reimbursed in the fifth coverage year 5 4. This cover may be renewed annually during the lifetime of the Insured provided the plan continues to be available. The renewal premium will be based on the attained age of the Insured and the applicable premium table upon renewal. Such premium table is not guaranteed and is subject to change. Premium may increase with the increase of age. We will regularly (not less than once per year) review the impact of medical inflation and claim performance on premium. As a result, premium may be adjusted in order to continuously provide customers with long term medical protection. The Company also reserves the right to revise the benefit structure and / or any other product features as determined by us, on any Policy Anniversary Date or upon renewal by giving a 30-day prior written notice. You may renew this cover by advance payment of the appropriate annual premiums on each Policy Anniversary. We reserve the right to determine the terms and conditions for renewal. 5. The discount applies to the original deductible amount of your plan, and will be reset to 0% in the next coverage year upon claim payment.

4 3 PROTECTION All-round Post-hospitalisation Care Post-hospitalisation care and treatment during convalescence are crucial to your recovery. We offer the following benefits for the best care during that period: Post-hospitalisation / Outpatient surgery outpatient consultation Post-surgery home nursing benefit Post-hospitalisation / Outpatient surgery ancillary treatment and consultation with a physiotherapist, chiropractor, occupational therapist, speech therapist and Chinese medicine practitioner Rehabilitation benefit Extended Caring Protection for Your Specific Needs In line with our efforts to provide you with protection that perfectly matches your circumstances, we provide support to you whenever you need it. This includes: Pre-hospitalisation / Outpatient surgery outpatient consultation Chemotherapy, radiotherapy, and oral targeted therapy Dialysis treatment HIV/AIDS treatment (applicable after the Policy has been effective for five consecutive years) Mental or nervous disorder treatment Reconstructive surgery reimbursement, including the costs incurred from breast reconstruction surgery and reconstructive materials after mastectomy because of disease

5 PROTECTION 4 Worry-free Credit Facility Service for Hospitalisation 6 The plan offers a credit facility service for hospitalisation 6. Once the arrangement is set up, we will settle directly with the private hospital for medical expenses incurred during hospitalisation. You can then focus fully on your treatment without having to worry about paying hospital bills and making a claim. Time-saving and Convenient Outpatient Surgeries tedious arrangements for admission and discharge, you can speed up the treatment and recovery and get back on your feet with minimal interruption. This plan offers cover for outpatient surgery and related outpatient consultations for your comprehensive protection. Rider version is available to suit your needs You have the flexibility to take CEO Essence Medical Plan as either a stand-alone insurance policy or take the cover as a rider of specified basic plans. Nowadays, advances in medical technology mean that some types of surgery can be performed at outpatient clinics or day surgery centres that are equipped with the proper medical equipment. In terms of safety, minor surgery performed at outpatient clinics or day surgery centres is comparable to those carried out in hospitals. Avoiding the wait for a hospital bed and Please contact your financial planner or call AIA Customer Hotline for details Hong Kong (852) Macau (853) visit aia.com.hk AIA Hong Kong 6. The Credit Facility Service for Hospitalisation is not a contractual service but an administrative arrangement offered in our absolute discretion with respect of covered expenses incurred during the Insured s Confinement in Hospital. It is subject to termination at any time without prior notice. Besides, if the hospital expenses incurred have exceeded the eligible claim amount, the shortfall will be borne by the Policy Owner. This service is only available after cover has been in force for 180 days.

6 5 PROTECTION

7 PROTECTION 6 Case Smart Pro Policyholder: Alan (aged 30) Occupation: Account Director Marital status: Married with a daughter Current cover: Group medical plan Highly motivated and with a positive outlook, Alan is always working hard at his career so he can provide his family with a good quality of life. He is also very health-conscious because, as the breadwinner, he knows good health is important for protecting that quality of life. However, he realises that his employer s group medical plan does not give him sufficient cover and decides to take a comprehensive and flexible medical plan. CEO Essence Medical Plan offers Alan superior protection that includes an Overall Lifetime Limit of up to HK$25,000,000 2, at an affordable premium. Not only does this effectively supplement his employer's group medical plan, it also allows him the flexibility to reduce his deductible 3 when he reaches retirement age. He can then make a claim of his medical expenses in full. 30 years old (employed) 60 years old (retired) Age of the Insured Takes CEO Essence Medical Plan (HK$25,000 deductible version) Reduce deductible to zero 1. First Year Annual Premium: HK$4, Can make a claim of medical expenses in full 2. Overall Lifetime Limit: HK$25,000, Does not need to resubmit health information Guaranteed lifetime renewal 4 Premium will not be increased following claims CEO Essence Medical Plan offers the flexibility to reduce the deductible 3 at retirement age of 50, 55, 60 or 65. Remarks: The above case and figures are hypothetical and for illustrative purpose only. For details, please refer to the relevant product brochure and policy document for product features, contents and terms & conditions. 1. The above case assumes the Insured is a 30-year-old male who takes up a CEO Essence Medical Plan with a deductible amount of HK$25,000 and pays the premium annually. The premium is non-guaranteed and is based on the attained age of the Insured and the applicable premium table at the time of application. 2. Annual Limit of HK$10,000, The premium will be adjusted based on the selected deductible amount and the attained age of the Insured. 4. This cover may be renewed annually during the lifetime of the Insured provided the plan continues to be available. The renewal premium will be based on the attained age of the Insured and the applicable premium table upon renewal. Such premium table is not guaranteed and is subject to change. Premium may increase with the increase of age. We will regularly (not less than once per year) review the impact of medical inflation and claim performance on premium. As a result, premium may be adjusted in order to continuously provide customers with long term medical protection. The Company also reserves the right to revise the benefit structure and / or any other product features as determined by us, on any Policy Anniversary Date or upon renewal by giving a 30-day prior written notice. You may renew this cover by advance payment of the appropriate annual premiums on each Policy Anniversary. We reserve the right to determine the terms and conditions for renewal.

8 7 PROTECTION Schedule of Benefits i Overall Lifetime Limit Annual Limit Geographical Coverage Coverage / Maximum Limit HK$/MOP25,000,000 HK$/MOP10,000,000 Asia Referral Description The maximum aggregate amount of benefits payable (excluding Compassionate Death Benefit and Worldwide Emergency Assistance Services) per the Insured s lifetime The maximum aggregate amount of benefit payable under Parts I-V (excluding Worldwide Emergency Assistance Services) of Benefits in any one Policy Year / Coverage Period Hospitalisation, surgery and / or medical treatment taking place outside Asia are not covered under Parts I-IV of Benefits, except for the purpose of emergency treatment Covered Room Type Deductible Choices Benefits I. Confinement Benefits (a) Hospital Daily Room & Board Benefit II. (b) Physician s Visit Semi-Private Room Standard Private Room HK$/MOP 0 or HK$/MOP16,000 or HK$/MOP25,000 (c) Specialist s Fee (d) Miscellaneous Hospital Expenses Benefit (e) Intensive Care Benefit (f) Private Nurse s Fee (g) Hospital Companion Bed Benefit (h) Hospital Cash Benefit Surgical Benefits (a) Surgery Benefit (b) Outpatient Surgery Benefit (c) Medical Appliances Benefit up to 30 days per Policy Year / Coverage Period HK$/MOP1,600 per day up to 90 days per Policy Year / Coverage Period (1) Specified items (2) Other items (3) Reconstructive device / materials HK$/MOP96,000 per item per life HK$/MOP96,000 per item per life Applicable to hospitals in Hong Kong, Macau and China Applicable to hospitals in Asia (excluding Hong Kong, Macau and China) Any deductible borne by the Insured shall be deducted from any benefit amount payable under Parts I-V (excluding Worldwide Emergency Assistance Services) of the Benefits in each Policy Year / Coverage Period Actual room and board charges for a Covered Room Actual charges made by the attending medical practitioner for visiting Insured during his / her stay in hospital Actual charges made by a specialist for the Insured s treatment during his / her stay in hospital Actual charges made by the hospital for specified services customarily rendered by hospital Actual charges made by the hospital for the Insured s stay in Intensive Care Unit (ICU) of hospital Actual charges incurred for private nursing service during hospitalisation following surgery or after discharge from ICU Actual charges incurred for one extra bed for Insured s companion during his / her stay in hospital Amount shown is payable for each day the Insured is hospitalised in a government hospital or in a hospital without charge Actual charges of surgeon s fee, anaesthetist s fee and operating theatre fee. In case of organ transplantation of heart, kidney, liver, lung or bone marrow on the Insured as recipient, the actual surgical cost to remove the organ or bone marrow from the donor is also covered ii Actual charges of surgery performed on an outpatient basis, including surgeon s fee, anaesthetist s fee and operating theatre fee Actual charges for prosthetic device implanted during surgery and / or replacement of body organ or body part items include: pace maker; stents for Percutaneous Transluminal Coronary Angioplasty; intraocular lens; artificial cardiac valve; metallic or artificial joints for joint replacement; prosthetic ligaments for replacement or implantation between bones; and prosthetic intervertebral disc Prosthetic device other than specified in part (1) above External or prosthetic device or reconstructive materials implanted during the surgery which is payable under the Reconstructive Surgery Benefit

9 PROTECTION 8 Coverage / Maximum Limit Referral Description III. Post-Hospitalisation Benefits (a) Post-Hospitalisation / Outpatient Surgery Outpatient Consultation (b) Post Surgery Home Nursing Benefit (c) Rehabilitation Benefit (d) Hospice Care Benefit (e) Post-Hospitalisation / Outpatient Surgery Ancillary Benefit (1) Chiropractor / Physiotherapist / Speech Therapist / Occupational Therapist (2) Chinese Medicine Practitioner IV. Extended Benefits up to 28 weeks per Policy Year / Coverage Period 60 days up to HK$/MOP80,000 per Policy Year / Coverage Period HK$/MOP80,000 per life HK$/MOP30,000 (per Confinement / out-patient procedure subject to 1 visit per day) Up to HK$/MOP1,000 per visit Up to HK$/MOP600 per visit (up to 15 visit per Confinement / out-patient procedure) Actual charges of the Insured s outpatient follow-up consultation and diagnostic tests within 60 days after the discharge from hospital or the outpatient surgery Actual charges for home nursing service after the Insured s discharge from hospital following surgery or admission to ICU Actual charges incurred for the Insured s stay in a Rehabilitation Centre and rehabilitation treatment Actual charges incurred for the Insured s stay in, and care and nursing service provided by a hospice Actual charges of the Insured s rehabilitation treatment for a Covered Illness / Covered Injury within 90 days after discharge from hospital or the out-patient procedure for the same Covered Illness / Covered Injury Actual charges for consultation with and / or treatment made by Chiropractor, Physiotherapist, Speech Therapist or Occupational Therapist Actual charges for consultation with, treatment made and / or medicines prescribed by Chinese Medicine Practitioner (a) Pre-Hospitalisation / Outpatient Surgery Outpatient Consultation (b) Chemotherapy, Radiotherapy and Oral Targeted Therapy Benefit (c) Dialysis Benefit (d) HIV / AIDS Treatment Benefit (e) Mental or Nervous Disorder Benefit (f) Reconstructive Surgery Benefit HK$/MOP800,000 per life 30 days up to HK$/MOP40,000 per Policy Year / Coverage Period HK$/MOP160,000 (Per Covered Injury / Covered Illness) Actual charges incurred for outpatient consultation and diagnostic tests for a Covered Illness / Covered Injury which occurs within 30 days immediately prior to the Insured s hospitalisation or outpatient surgery for the same Covered Illness / Covered Injury Actual charges of chemotherapy or radiotherapy performed on inpatient or outpatient basis, and oral targeted therapy and oral chemotherapy to be consumed at home or during hospitalisation Actual charges incurred for dialysis (whether on an inpatient or outpatient basis) Actual charges incurred for HIV infection related treatment during hospitalisation for Covered Illness / Covered Injury iii Actual charges for hospitalisation and treatment in a Mental or Psychiatric Hospital, or in the mental or psychiatric unit of a hospital 1. Actual surgical charges for reconstructive surgery to restore the function of a body part or the appearance as recommended by a doctor undergone within 12 months from the date of accident causing the Covered Injury 2. Actual surgical charges for reconstructive surgery to restore the breast undergone at the same time or within 12 months from the date of mastectomy due to illness

10 9 PROTECTION V. Emergency Treatment Benefits Coverage / Maximum Limit Referral Description (a) Emergency Outpatient Treatment Benefit (b) Emergency Dental Benefit (c) Worldwide Emergency Assistance Services VI. Compassionate Death Benefit HK$/MOP1,000,000 per trip HK$/MOP80,000 Actual charges for emergency outpatient treatment within 24 hours of the accident causing a Covered Injury Actual charges for emergency dental treatment within 2 weeks of the accident causing injury to teeth Emergency assistance services including: Emergency Medical Evacuation Repatriation of Remains If the Insured is hospitalised for more than 5 consecutive days: Compassionate visit by one immediate family member Return of Minor Children (under 18 years old) to Hong Kong or Macau (if they are travelling alone with the Insured on the trip) Death benefit payable regardless of the cause of death US$1 = HK$/MOP8 i. Each of the itemised expenses as shown in the official statement of accounts or receipts submitted to us for the reimbursement of the Benefits (excluding Hospital Cash Benefit, Compassionate Death Benefit and Worldwide Emergency Assistant Services) is subject to Reasonable and Customary Charges. ii. The maximum coverage of the donor s surgical costs is 30% of the aggregate of the surgical costs of removal of the organ or bone marrow from the donor and the surgical costs of procedures performed on the Insured as recipient. iii. This benefit is only payable when the signs or symptoms of the HIV Infection related illness first occur after this cover has been effective for five consecutive Policy Year / Coverage Period. The above information is for reference only. Please refer to the Policy contract of this cover for the definitions of the capitalised terms and the exact and complete terms and conditions of the benefits. The Company reserves the right to revise the Schedule of Benefits from time to time.

11 PROTECTION 10 Major Exclusions Hospitalisation, surgery, medical treatment and / or charges that relate to or result from any of the following, amongst others, will be excluded: Any congenital defect that has manifested or is diagnosed before the Insured attains 17 years of age; Any Pre-existing Condition; Self-destruction or intentional self-inflicted injury while sane or insane; War or warlike operations, riots and civil commotion; Any violation or attempted violation of the law or resistance to arrest; Act of Terrorism; The use of atomic, biological or chemical weapons as well as radioactive, biological or chemical contamination due to any Act of Terrorism; The Insured s travelling to a country where there is a war (whether declared or not), warlike operation, hostilities, mutiny, riot, civil commotion, civil war, rebellion, revolution, insurrection, military or usurped power, martial law or state of siege, or a war zone as recognised by the United Nations; Pregnancy, miscarriage, child birth, voluntary termination of pregnancy, or related complications; mental or nervous disorder (except for the Mental or Nervous Disorder Benefit under Part IV(e) of the Benefits under the Schedule of Benefits), drug abuse; cosmetic or plastic surgery; dental care or surgery, corrective aids and treatment of refractive errors unless necessitated by injury caused by an accident; body checkup; convalescence or rest care; any treatment, investigation, service or supplies which is not Medically Necessary. AIDS or any complications associated with HIV Infection except for HIV / AIDS Treatment Benefit under Part IV(d) of the Benefits under the Schedule of Benefits; Any of the following traditional Chinese medicines: (i) cordyceps; (ii) ganoderma; (iii) antler; (iv) cubilose; (v) donkey-hide gelatin; (vi) hippocampus; (vii) ginseng; (viii) red ginseng; (ix) American Ginseng; (x) Radix Ginseng Silvestris; (xi) antelope horn powder; (xii) placenta hominis; (xiii) Agaricus blazei murill; (xiv) musk; and (xv) pearl powder, except for Post-Hospitalisation / Outpatient Surgery Ancillary Benefit under Part III(e)(2). The foregoing list is for reference only. Please refer to the Policy contract of this cover for the complete list and details of exclusions. Important Notes AIA, the Company, we, us or our herein refers to AIA International Limited (Incorporated in Bermuda with limited liability). This brochure is for general information purposes only. It is not a contract of insurance nor does it form any part of the Policy contract. Details are subject to the terms, conditions, provisions and exclusions of the Policy contract. Benefits are only payable with respect to illness that commences 30 days after the later of the Issue Date or the latest Commencement Date of this cover, whereas immediate coverage is provided for any injury caused by accident which occurs after the later of the Issue Date or the latest Commencement Date of this cover. Investigation, treatment or surgery for tonsils, adenoids, hernia and disease peculiar to the female generative organs are covered if this cover has continuously been in-force for 120 days before such investigation, treatment or surgery. Reasonable and Customary charges are the expense which (a) is charged for treatment, supplies (inclusive of medication) or medical services that are Medically Necessary and in accordance with standards of good medical practice for the care of an injured or ill person under the care, supervision or order of a Registered Medical Practitioner; (b) does not exceed the usual level of charges for similar treatment, supplies (inclusive of medication) or medical services in the locality where the expense is incurred, which for the avoidance of doubt, shall not exceed the level of such charges applicable to a Covered Room for treatment, supplies (inclusive of medication) or medical services provided during a covered Confinement; and (c) does not include charges that would not have been made if no insurance existed. AIA may determine whether any particular Hospital / medical charge is a Reasonable and Customary charge with reference but not limited to any relevant publication or information made available, such as schedule of fees, by the government, relevant authorities and recognized medical association in the locality. AIA may also adjust any and all benefits payable in relation to any Hospital / medical charges which is not a Reasonable and Customary charge. Reasonable and customary Hospital Confinement means a Confinement in Hospital for Injury or illness is Medically Necessary, where the admission of the Insured, length of Confinement, and medical services and treatment received during Confinement (a) are all in accordance with standards of good medical practice and (b) do not exceed the usual standard for the treatment if similar Injury or illness at the location where such Confinement takes place. For the avoidance of doubt, a Confinement is not a Reasonable and Customary Hospital Confinement if it is in respect of a medical procedure or treatment which, having regard to standards of good medical practice is (i) routinely performed on other patients on an outpatient basis and (ii) could reasonable have been performed on the Insured as an Outpatient. Parts I-IV of the Benefits covers hospitalisation, stay in hospice, medical procedures and / or treatment taking place in Asia, and emergency treatment for a Covered Illness or Covered Injury taking place anywhere in the world. Part V of the Benefits covers specified emergency out-patient medical or dental treatment for a Covered Injury taking place anywhere in the world. Parts I-V of Benefits shall be permanently reduced to 60% of the relevant reimbursable charges with respect to (1) any covered hospitalisation, stay in hospice, surgery, medical procedures / treatment and / or emergency out-patient treatment which takes place in Australia or New Zealand if the Insured has taken up residence in that country and commencing from the date of such taking up of residence; and (2) any covered emergency treatment which takes places in North America or Western Europe if the Insured has taken up residence in that location and commencing from the date of such taking up of residence. However, the Annual Limit and Overall Lifetime Limit as well as any selected deductible amount will remain unchanged. The Insured is regarded to have taken up residence in Australia, New Zealand, North America or Western Europe (as the case may be) if s/he has been present in that location for a period of 365 or more consecutive days, including the days of arrival and departure. Asia means Afghanistan, Australia, Bangladesh, Bhutan, Brunei, Cambodia, 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. North America means the United States and Canada. Western Europe means Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Monaco, Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, United Kingdom and Vatican City. The benefits payable is cap at the charge level of Covered Room. If the Insured is confined in a room of a class higher than Covered Room, the benefits payable will be adjusted. Adjustment Factor is calculated by dividing the daily room charge of a Covered Room in the Hospital admitted by the Insured by the daily actual room charge of each such days of Confinement. Covered Room means 1) Semi-Private Room in the case of Confinement in Hospital in Hong Kong, Macau or China; and 2) Standard Private Room in the case of Confinement in Hospital anywhere else in the world (excluding Hong Kong, Macau and China). Semi-Private Room means a single or double occupancy room, with a shared bath / shower room, in a Hospital. Standard Private Room means a basic single occupancy room with adjoining bathroom in a Hospital. For the avoidance of doubt, Standard Private Room does not include any room with amenities upgraded beyond a basic single occupancy room with adjoining bathroom, in a Hospital. PTA

12