CIGNA VHIS SERIES FLEXI PLAN (SMM)

Transcription

1 HOSPITAL / SURGICAL General Insurance CIGNA VHIS SERIES FLEXI PLAN (SMM) i

2 ABOUT CIGNA CORPORATION Our mission At Cigna, we are dedicated to improve the health, well-being, and peace of mind of those we serve. Sales capability in over 30 countries and jurisdiction 1 Named a Caring Company for the 16th consecutive year by the Hong Kong Council of Social Service More than 160 million customer relationships 1,2 Ranked 73rd on the 2018 Fortune 500 list More than 1 million relationships with healthcare providers, clinics and facilities 1 74,000 employees around the world 1 US$49 billion total revenue 1 Remarks: 1. The above data is for informational purposes only and may not relate to a particular subsidiary of Cigna Corporation. Data is based on Cigna internal reporting as of December 31, 2018 and is subject to change. 2. Per policy holder.

3 BACKGROUND Waiting times for some common conditions: 24 months Maximum waiting time for new case booking (Specialty of Surgery - stable case) 1 22 months Average waiting time for cataract surgery 2 76 months Average waiting time for joint replacement surgery 3 only 34% of Hong Kong s population have individual health insurance around 50% of the working population have some form of group insurance cover 4 over1/ 3 of medical expenses in Hong Kong are paid out-of-pocket 5 9% average annual medical inflation rising every year 6 It really is time to think again about the benefits of medical insurance for getting access to high-quality medical care slashing treatment waiting times $ significantly reducing personal medical costs The good news is that the Government s new Voluntary Health Insurance Scheme (VHIS) is now making some kinds of private health care affordable for just about everybody. Sources: 1. Longest waiting time for new case booking (Specialty of Surgery-stable case): 96 weeks (Kowloon East), Hospital Authority, Estimated average waiting time for cataract surgery: 22 months (Kowloon Central), Hospital Authority, Estimated average waiting time for joint replacement surgery: 76 months (Kowloon East), Hospital Authority, Thematic Household Survey Report No. 63, Census and Statistics, Hong Kong s Domestic Health Accounts 2016/17, Food and Health Bureau Medical Trends Around the World, Mercer Marsh Benefits 1

4 WHAT IS THE VHIS? The Voluntary Health Insurance Scheme (VHIS) is a government-endorsed scheme that aims to give the Hong Kong public better access to timely, high quality private medical treatment. Private health insurance plans that meet the Government s criteria are officially registered as Certified Plans by Food and Health Bureau. Certified Plans are different from ordinary private health insurance in a number of important ways: They are regulated under the VHIS, so they all include transparent and comparable benefits; They include tax incentive on top of reimbursement benefit to encourage people to take out private health insurance; They come in two formats Standard Plan and Flexi Plan with different benefits tailored to individual needs Under the VHIS, Cigna offers three plans each offering private medical treatment for you and your family and covering a range of common problems. WHY SHOULD I CONSIDER IT? Tax deduction Unknown pre-existing condition cover Guaranteed renewal up to age of 100 Tax deduction for premium paid Max premiums allow for tax deduction: HK$8,000 per insured person per tax year No cap on no. of eligible dependants 1 No lifetime benefit limit Partial cover in first 3 years 2 Full cover from 4th year onwards Non-surgical cancer treatment cover Confidence that you will have protection into your later years Surgery and advanced diagnostic imaging cover on out-patient basis Exemptions allowed for high-end Flexi Plans with a limit of at least HK$20M Covers chemotherapy, radiotherapy, targeted therapy, immunotherapy and hormonal therapy for cancer treatment Computed Tomography ( CT scan), Magnetic Resonance Imaging ( MRI scan), Positron Emission Tomography ( PET scan), PET-CT combined and PET-MRI combined 1. We will consider applications to cover yourself, your spouse, your parents and grandparents over age 55, and your children and siblings under age Refer to Important Information for details of unknown pre-existing condition cover. 2

5 IN CIGNA, WE CARE AND OFFER MORE. Cigna is delighted to offer all its VHIS clients a range of added-value extras to make their insurance experience a very special one. ADDITIONAL BENEFITS 1. DoctorNow app for virtual consultation and medication Easy to obtain doctor s advice, able to get early diagnosis before anything gets worse, and simply book a virtual consultation appointment from inside the app Freedom to choose from a range of general practitioners and specialists in Hong Kong, without geographical restrictions Medication delivery to your door, referral services if needed and stress-free recovery without needing to go outside 2. Cashless hospitalisation 1 $ $ If hospitalisation is required, you can call us before your admission and we will arrange a credit facility for you at the private hospital of your choice. This means you will not need to pay any deposit to the hospital, and need not worry about initiating claims after discharge while you focus on recovery. 3. Medical Classification Hotline and Care Manager If you are recommended to have surgery, you may contact our hotline for us to help classify the treatment (e.g. Minor, Intermediate, Major, or Complex) and estimate the coverage available under your VHIS plan. This way, if there is any out-of-pocket amount that you need to bear yourself, you can prepare beforehand. For Major or Complex surgeries, our registered nurses will step in to help with everything you need, from pre-treatment preparation to post-hospitalisation care, providing you and your family with both professional advice and emotional support. 1. Only applicable to Eligible Expenses. 3

6 PLAN AT A GLANCE Certified Plan(s) Cigna VHIS Series Standard Plan Affordable care for all-round assurance Cigna VHIS Series Flexi Plan (SMM) Supplementary benefits for enhanced confidence Cigna VHIS Series Flexi Plan (Superior) Comprehensive protection for total peace of mind Type of medical insurance product Standalone plan Standalone plan Standalone plan Key benefit of the product Indemnity hospital insurance plan Indemnity hospital insurance plan Indemnity hospital insurance plan FHB certification no. S F F F F F Hospitalisation benefits Surgical benefits Diagnostic Imaging Standard VHIS cover Standard VHIS cover Full compensation Cancer Treatment Other VHIS benefits Standard VHIS cover Enhanced benefit: Outpatient Kidney Dialysis Full compensation Enhanced benefit: Supplementary Major Medical as core benefits already enjoy full compensation Annual Benefit Limit $420,000 $540,000 $5,000,000 Lifetime Benefit Limit $20,000,000 Annual Deductible $0 $15,000 $25,000 $50,000 Entry age 15 days to 80 years Protection period 1 year and guaranteed renewable to age 100 Premium payment term Premium structure Premium payment frequency Policy currency Until the end of protection period Yearly adjustable Annual / Monthly HKD WHAT IS A DEDUCTIBLE? We will start paying for the covered medical expenses once the deductible amount has been reached. The deductible will be covered either by you or your other insurance plans. 4

7 Cigna SMM CIGNA VHIS SERIES - FLEXI PLAN (SMM) Cigna s Flexi Plan (SMM) further extends the cover offered under the Standard Plan, and additionally provides valuable cover against costs associated with one of the most common of the urban diseases chronic kidney disease. Area of coverage Worldwide 1 Choice of Healthcare Services Providers No restriction Level of ward class Annual Benefit Limit (HK$) (Applies across benefit items) No restriction, except for Supplementary major medical benefit 2 $540,000 per Policy Year Cigna SMM Lifetime Benefit Limit Nil Outpatient Kidney Dialysis Kidney disease requires fast, efficient care and typically involves ongoing dialysis treatment. The last thing any kidney patient wants is to have to shoulder the serious financial burden associated with having dialysis treatment two to three times every week. Cigna s Flexi Plan (SMM) takes away that worry by providing you with up to $30,000 a year to cover the costs of outpatient dialysis treatment sufficient for most dialysis circumstances. Supplementary Major Medical Benefit Apart from dialysis coverage, Flexi Plan (SMM) includes an extra $120,000 of cover in the form of a Supplementary major medical benefit. This means your total annual benefit rises to $540,000, and once again there is no lifetime limit on the amount paid out. That extra SMM figure is sufficient to cover most treatment in standard hospital wards, providing an excellent buffer against unexpected major accidents which may exceed the individual item limits of the Standard Plan. 1. Except for the psychiatric treatments benefit which is limited to Hong Kong. 2. Supplementary major medical benefit is restricted to Eligible Expenses incurred in Standard Ward only. 6

8 BENEFIT SCHEDULE Benefit items (1) Benefit limit (in HKD) (a) Room and board $750 per day Maximum 180 days per Policy Year (b) Miscellaneous charges $14,000 per Policy Year (c) Attending doctor s visit fee $750 per day Maximum 180 days per Policy Year (d) Specialist s fee (2) $4,300 per Policy Year (e) Intensive care $3,500 per day Maximum 25 days per Policy Year (f) Surgeon s fee Per surgery Complex $50,000 Major $25,000 Intermediate $12,500 Minor $5,000 (g) Anaesthetist s fee 35% of Surgeon s fee payable (3) (h) Operating theatre charges 35% of Surgeon s fee payable (3) (i) Prescribed Diagnostic Imaging Tests (2) CT scan, MRI scan, PET scan, PET-CT combined and PET-MRI combined $20,000 per Policy Year Subject to 30% Coinsurance (j) Prescribed Non-surgical Cancer Treatments Radiotherapy, chemotherapy, targeted therapy, immunotherapy and hormonal therapy $80,000 per Policy Year (k) Pre- and post-confinement/day Case Procedure outpatient care (2) $580 per visit, up to $3,000 per Policy Year 1 prior outpatient visit or Emergency consultation per Confinement/Day Case Procedure 3 follow-up outpatient visits per Confinement/Day Case Procedure (within 90 days after discharge from Hospital or completion of Day Case Procedure) (l) Psychiatric treatments $30,000 per Policy Year (m) Outpatient kidney dialysis $30,000 per Policy Year (n) Supplementary major medical benefit (4) $120,000 per Policy Year Subject to 20% Coinsurance Notes (1) Unless otherwise specified, Eligible Expenses incurred in respect of the same item shall not be recoverable under more than one benefit item in the table above. (2) Written recommendation by Registered Medical Practitioner is required. (3) The percentage here applies to the Surgeon s fee actually payable or the benefit limit for the Surgeon s fee according to the surgical categorisation, whichever is the lower. (4) For Eligible Expenses resulting from Confinement, this benefit shall only be payable for Medical Services provided in a Standard Ward, or in a higher ward class where proof of involuntary ward upgrade is available from the service provider. 7

9 CASE ILLUSTRATIONS Cigna VHIS series Flexi Plan (SMM): Vanessa s story Policy Holder Age Background Plan level Vanessa 30 (non-smoker) Vanessa tied the knot at the age of 30. For her, it s essential that such an important step is backed by solid, reliable protection against health and financial risks. She s aware of the many benefits of the Cigna VHIS series Standard Plan, but strongly feels that she and her husband deserve above average medical protection. Cigna VHIS series Flexi Plan (SMM) Cigna SMM The couple are shocked when Vanessa unexpectedly suffers a mild heart attack later. Her doctors say that an angioplasty is essential, a procedure which would not have been adequately covered by the Standard Plan. She is relieved to discover that her Flexi Plan (SMM) comfortably accommodates all of the cost associated with this lifesaving treatment. Benefit item (HK$) Room and board $ 2,250 Operating theatre charges $ 8,750 Pre- and post-confinement/ Day Case Procedure outpatient care $ 1,500 Surgeon s fee $ 25,000 In excess of item limit $ 80,000 Miscellaneous charges $ 14,000 In excess of item limit $ 50,000 Supplementary major medical benefit $(50,000+80,000) x 80% $ 104,000 $ First year premium paid for both policies HK$ 8,408* HK$(4,204+4,204) Cigna VHIS Total claim payable HK$ 155,500 Tax benefit in first year for both policies (based on 15% Standard Rate) HK$ 1,261 HK$8,408 x 15% Co-insurance borne by Vanessa out-of-pocket HK$ 26,000 HK$(80,000+50,000) x 20% *Premium level is subject to change from time to time due to medical inflation. 10

10 IMPORTANT INFORMATION The product information included in the brochure does not contain the full terms of the Policy and the full terms can be found in the Policy document. Cooling-off right You may cancel your Policy and obtain a refund of any premium(s) and any levy paid by you within the coolingoff period. The cooling-off period is 30 days after (i) the delivery of the Policy, or (ii) issue of a notice (informing the availability of the Policy and expiry date of the cooling-off period), whichever is the earlier. You have to tell us by giving a written notice if you decide to exercise your cooling-off right. Such written notice must be signed by you and received directly by us at 15/F, 28 Hennessy Road, Wanchai, Hong Kong. No refund can be made if a claim has been made. Unknown pre-existing condition cover Pre-existing Condition means any sickness, disease, injury, physical, mental or medical condition or physiological degradation, including congenital condition, that has existed prior to the cover under the Policy starts. You are considered to be aware of a Pre-existing Condition where (a) it has been diagnosed; (b) it has manifested clear and distinct signs or symptoms; or (c) medical advice or treatment has been sought, recommended or received. Eligible Expenses arising from unknown Pre-existing Condition(s) that you would not reasonably have been aware of are payable according to the following waiting period and reimbursement arrangement. 1st Policy Year : no coverage 2nd Policy Year : 25% reimbursement 3rd Policy Year : 50% reimbursement 4th Policy Year onwards : full coverage Premium 1. Premium Level The premium corresponding to the plan you select is determined based on the Age and smoking habit of the Insured Person at the Policy Effective Date. 2. Non-payment of Premium If you fail to pay the initial premium, your Policy will not take effect from the commencement date of your Policy. Except for the initial premium payment, there will be a grace period of 30 days after any premium due date. Your Policy will remain effective during this grace period. If any premium is not paid at the end of the grace period, your Policy will lapse on the premium due date and you will lose the insurance cover. We will not make any claim payment or any other payment payable under the Policy, until we receive payment of all outstanding premium up to the date of the claim payment or when the Policy terminates. 14

11 3. Mis-statement of Age or Smoking Habit If age or smoking habit is mis-stated by you or any Insured Person (and the relevant Insured Person would still be eligible for coverage), we have the right to adjust the premiums payable based on the correct information. 4. Premium adjustment The Company reserves the right to revise the Standard Premium of the Policy on the anniversary date or upon renewal. Factors leading to premium adjustment may include but are not limited to our overall experience in claims and expenses incurred by and/or in relation to this product. Duplicated policy Each person can only be covered under one single Cigna VHIS Series policy. The series includes Cigna VHIS Series Standard Plan, Cigna VHIS Series Flexi Plan(SMM), Cigna VHIS Series Flexi Plan (Superior) and any other insurance policies that fall under the Cigna VHIS Series as defined and issued by the Company from time to time. Existing holders of Cigna HealthFirst Medical Plan Series policies should contact the Company to discuss their options with regard to policy migration. Renewal This Policy shall be effective for an initial period of twelve (12) months and is thereafter guaranteed to be automatically renewable for successive periods of twelve (12) months up to the age of one hundred (100) years of the Insured Person. The Company shall have the right to revise the Terms and Benefits of the Policy and/or the Premium upon each renewal. Termination 1. The Policy will be automatically terminated when one of the following happens: The Insured Person passes away; Any premium is not paid at the end of the grace period; The Policy is terminated or not renewed by the Policy Holder; or The Company has ceased to have the requisite authorisation under the Insurance Ordinance to write or continue to write this Policy. 2. If there is any fraud, mis-statement or concealment in the application or declaration, or if you or your beneficiary makes a dishonest claim, we have the right to cancel the policy immediately. In such case, all the premium paid will not be returned and you shall immediately return all payment including claims paid by us under the Policy. Inflation risk Please be aware that future medical costs may be higher than they are today due to inflation. 15

12 KEY EXCLUSIONS The following list is for reference only and it is not a full list of exclusions. Please refer to the Terms and Conditions for the complete list and details of exclusions. Cigna shall not pay any benefits in relation to or arising from the following: 1. Medical Services that are not Medically Necessary. 2. Confinement solely for the purpose of diagnostic procedures or allied health services, including but not limited to physiotherapy, occupational therapy and speech therapy. 3. Human Immunodeficiency Virus ( HIV ) and its related Disability. 4. Dependence, overdose or influence of drugs, alcohol, narcotics or similar drugs or agents, self-inflicted injuries or attempted suicide, illegal activity, or venereal and sexually transmitted disease or its sequelae. 5. Services for beautification or cosmetic purposes, or correcting visual acuity or refractive errors that can be corrected by fitting of spectacles or contact lens. 6. Prophylactic treatment or preventive care, including but not limited to general check-ups, routine tests, screening procedures for asymptomatic conditions, immunisation or health supplements. 7. Dental treatment and oral and maxillofacial procedures performed by a dentist. 8. Maternity conditions and its complications. 9. Purchase of durable medical equipment or appliances. 10. Traditional Chinese Medicine treatment. 11. Experimental or unproven medical technology or procedure in accordance with the common standard, or not approved by the recognised authority, in the locality where the treatment, procedure, test or service is received. 12. Congenital Condition(s) which have manifested or been diagnosed before the Insured Person attained the Age of eight (8) years. 13. Eligible Expenses which have been reimbursed under any law, or other medical program or insurance policy. 14. War, civil war, invasion, acts of foreign enemies, hostilities, rebellion, revolution, insurrection, or military or usurped power. 16

13 Cigna VHIS Series - Flexi Plan (SMM) - Standard Premium schedule (Effective from 1 April 2019) 信諾自願醫保系列 - 靈活計劃 ( 附加保障 )- 標準保費表 (2019 年 4 月 1 日生效 ) Premium for Non Smoker 非吸煙人士保費 Age 年齡 Annual 年繳 Cigna VHIS Series Flexi Plan (SMM) 信諾自願醫保系列 - 靈活計劃 ( 附加保障 ) Monthly 月繳 Age 年齡 Annual 年繳 0 4, , , , , , , , , , , , , , , , , , , , Monthly 月繳 10 3, ,537 1, , ,091 1, , ,671 1, , ,279 1, , ,916 1, , ,584 1, , ,313 1, , ,079 1, , ,883 1, , ,727 1, , ,613 1, , ,581 1, , ,599 1, , ,670 1, , ,797 1, , ,982 2, , ,277 2, , ,642 2, , ,081 2, , ,597 2, , ,195 2, , * 31,507 2, , * 31,822 2, , * 32,140 2, , * 32,461 2, , * 32,786 2, , * 33,114 2, , * 33,445 2, , * 33,779 2, , * 34,117 2, , * 34,458 2, , * 34,803 3, , * 35,151 3, , * 35,503 3, , * 35,858 3, , * 36,217 3, , * 36,579 3, , * 36,945 3, , * 37,314 3, , * 37,687 3,279 * These rates apply only to policy Renewal. 此保費只供續保之用 1. All the currencies in this table are in Hong Kong dollars. 本保費表內之所有貨幣均以港元計算 2. The initial premium is determined by the age and smoking habit of the Insured Person at the Policy Effective Date. 初始保費是根據受保人於保單生效日的年齡及吸煙習慣而計算 3. The premium is adjusted at each Renewal based on the age of the Insured Person, according to the prevailing Standard Premium schedule. 保費會於每次續保時根據受保人的年齡按當時生效的標準保費表調整 4. This Standard Premium schedule is subject to update from time to time at Cigna s sole discretion. 信諾保留權利以不時更新此標準保費表 5. This Standard Premium Schedule does not include levy which is collected by the Insurance Authority. 此標準保費表並未包括由保險業監管局徵收的保費徵費

14 Cigna VHIS Series - Flexi Plan (SMM) - Standard Premium schedule (Effective from 1 April 2019) 信諾自願醫保系列 - 靈活計劃 ( 附加保障 )- 標準保費表 (2019 年 4 月 1 日生效 ) Premium for Smoker 吸煙人士保費 Age 年齡 Annual 年繳 Cigna VHIS Series Flexi Plan (SMM) 信諾自願醫保系列 - 靈活計劃 ( 附加保障 ) Monthly 月繳 Age 年齡 Annual 年繳 , , , , , , , , ,717 1, ,256 1, ,819 1, ,434 1, ,079 1, ,754 1, ,462 1, ,204 1, ,014 1, ,866 1, , ,759 1, , ,697 1, , ,681 1, , ,757 1, , ,888 1,991 Monthly 月繳 23 3, ,078 2, , ,330 2, , ,647 2, , ,086 2, , ,602 2, , ,201 2, , ,886 2, , ,661 3, , * 35,008 3, , * 35,358 3, , * 35,711 3, , * 36,068 3, , * 36,429 3, , * 36,793 3, , * 37,161 3, , * 37,532 3, , * 37,908 3, , * 38,287 3, , * 38,670 3, , * 39,057 3, , * 39,448 3, , * 39,842 3, , * 40,241 3, , * 40,643 3, , * 41,050 3, , * 41,460 3, , * 41,874 3,643 * These rates apply only to policy Renewal. 此保費只供續保之用 1. All the currencies in this table are in Hong Kong dollars. 本保費表內之所有貨幣均以港元計算 2. The initial premium is determined by the age and smoking habit of the Insured Person at the Policy Effective Date. 初始保費是根據受保人於保單生效日的年齡及吸煙習慣而計算 3. The premium is adjusted at each Renewal based on the age of the Insured Person, according to the prevailing Standard Premium schedule. 保費會於每次續保時根據受保人的年齡按當時生效的標準保費表調整 4. This Standard Premium schedule is subject to update from time to time at Cigna s sole discretion. 信諾保留權利以不時更新此標準保費表 5. This Standard Premium Schedule does not include levy which is collected by the Insurance Authority. 此標準保費表並未包括由保險業監管局徵收的保費徵費

15 The above insurance plan is underwritten by Cigna Worldwide General Insurance Company Limited, an authorized insurer to carry on general insurance business in or from Hong Kong. This brochure is intended to be distributed in Hong Kong only and shall not be construed as an offer to sell or a solicitation to buy or provision of any products of Cigna outside Hong Kong. It is designed to provide you with a brief summary of the named insurance plan, its terms, conditions and exclusions, and is not a contract of insurance. You are recommended to seek professional advice from your independent advisors if you find it necessary. For complete details of terms, conditions and exclusions, please refer to the Terms and Conditions. If there is any conflict between the Terms and Conditions and this brochure, the Terms and Conditions shall prevail. This Policy is excluded from the application of the Contracts (Rights of Third Parties) Ordinance (the Ordinance ). Other than the Company and the Policy Holder, a person who is not a party to the Policy (including, but not limited to, the person insured or the beneficiary) shall have no right under the Ordinance to enforce any term of this Policy. Cigna reserves the right to change any of the details in this brochure. In case of any disputes about the content of this brochure, Cigna s decision shall be final. Notes: Cigna, the Company, We, our or us herein refers to Cigna Worldwide General Insurance Company Limited. This product brochure is also available in Chinese. You may request for the Chinese version from us. 此產品小冊子同時備有中文版本, 閣下可向本公司索取中文版本

16 Cigna Worldwide General Insurance Company Limited Hotline : (852) Issued by Cigna CA/Brochure/0033/0419_E