promedico Medical Insurance Plan Member Booklet

Transcription

1 promedico Medical Insurance Plan Member Booklet

2 F O R E W O R D Dear Insured Member, Thank you for choosing Liberty International Insurance Ltd as your health insurance provider. As our premier insured member, you will not only enjoy the medical coverage but you can enjoy the value added services for your travelling or hospital admission in Hong Kong or overseas. This booklet contains the details of the Cashless Hospitalization Arrangement - Credit Facility Service, International Emergency Medical Evacuation / Repatriation / Assistance Services, Greater China Card Assistance Program and promedico Plan Claims Procedure. To ensure that you will understand the guideline of our value added services, please take a few minutes to go through this booklet carefully. Should you have any enquiry, please call our Customer Services Hotline at (from 9 a.m. 5:30 p.m. weekday, except Saturday and Public Holiday). During non-office hour, you may call our 24-hour Assist Hotline at We are willing to serving you at anytime. Yours sincerely, promedico Department Liberty International Insurance Ltd. Page 1

3 CONTENTS Page (1) Foreword 1 (2) Contents 2 (3) Cashless Hospitalization Arrangement - Credit Facility Service 3 (4) International Emergency Medical Evacuation / Repatriation / Assistance Services 4 (5) Greater China Card Assistance Program 4 (6) Claims Procedures 5 6 Effective from Oct Page 2

4 Cashless Hospitalization Arrangement Credit Facility Service As our premier Insured Member, you can enjoy the Cashless Hospitalization Arrangement to ease your mind for hospitalization. Surgical operation charges are expensive in Hong Kong. The expenses for overseas hospitalization are even much higher. Sometimes, Insured Members are surprised by an unexpectedly high and unaffordable Hospital charges upon discharge. If using traditional reimbursement approach, you have to pay the bill first before getting reimbursement from the Insurer. Sudden financial burden undoubtedly makes you more stressful when you are sick. Cashless Hospitalization Arrangement can free you from the financial burden and relax you for a speedy recovery. Also, you do not need to go through the claim application after discharging from Hospital once the Cashless Hospitalization is arranged. The Cashless Hospitalization Arrangement can be used in both Hong Kong and overseas Hospitals. It is easy to enjoy. Simply call our 24-hour Assist Hotline which is supported by AA International at Cashless Hospitalization Arrangement Procedure Call promedico 24-hour Assist Hotline to check the Cashless Hospitalization Arrangement application procedure and your benefit entitlement. You need to complete and sign the Cashless Hospitalization Arrangement application form and request the attending Physician to sign and provide the details about your Sickness. Please return the duly completed form 3 days before your Hospital admission. * In emergency, we will try to assist in the cashless admission subject to assessment of medical report and Plan Rules. Cashless Hospitalization Arrangement will be set-up if it is approved. Note: (1) The Cashless Hospitalization Arrangement is a convenient service specially provided to promedico s Insured Members in the event when a Hospital Services is required. It is not an admission of claims eligibility and the actual reimbursement entitlement is subject to the Policy s benefits and Plan Rules. We reserve the rights to recover any shortfall from you in the event when non-eligible medical and related expenses that are not covered under your policy upon discharged. (2) In the event when Cashless Hospitalization Arrangement cannot be placed, you need to follow the standard Hospital Services claim procedure for the reimbursement. Page 3

5 International Emergency Medical Evacuation / Repatriation / Assistance Services Our International Emergency Medical Evacuation / Repatriation / Assistance Services is provided by AA International. You may contact the dedicated 24-hour Assist Hotline to obtain immediate access to the available services and/ or advice in relation to the promedico Insurance Plan. You shall be assisted by a team of trained multilingual personnel of AA International including the panel of AA International s designated Physicians who are qualified, experienced and possesses good credentials. This service also includes medically necessary transportation, appropriate medical care during transportation and ancillary services in moving the patient to the nearest medical facility where appropriate care is available. Below are the services provided by AA International. (1) Emergency Medical Evacuation (5) Return of Dependent Child/Children (2) Emergency Medical Repatriation (6) Overseas Medical Referral Service (3) Repatriation of Mortal Remains (7) Overseas Legal Referral (4) Compassionate Visit by Relative/ Friend (8) Emergency Travel Service Assistance International Emergency Medical Evacuation / Repatriation / Assistance Services 24-hour Assist Hotline : Greater China Card Assistance Program ( GCCAP ) Greater China Card Assistance Program ( GCCAP ) is arranged by AA International. This program specifically useful to a traveler whether on leisure or business trip and setup for the convenience of travelers outside of their Country of Residence and/or country of origin in the event when Inpatient admission is required and when Insured Members are not familiar with the local medical facilities and protocols in China, Hong Kong, Macau and Taiwan (i.e.: The Greater China Region ). GCCAP can be activated 24/7 by an Insured Members requesting for Outpatient Services and dental referral. In the case of Inpatient admission, AA International shall liaise directly with the Hospital to arrange for cashless admission arrangement. You are entitled to Outpatient Services appointment booking arrangement at designated clinics in China Greater China Card Assistance Program ( GCCAP ) 24-hour Assist Hotline : Note: (1) All Outpatient and dental service are on arrangement basis and you shall pay first and submit the claim to us for reimbursement subject to you are insured the Outpatient Services or Dental Care benefit and Plan Rules. If you did not insure the Out-patient / Dental benefit, such expenses will not be reimbursed. (2) Any third party services arranged by AA International not specifically covered under promedico Plan Rules shall be payable by you by means of credit card payment or cash. (3) GCCAP is not a first response medical service and not meant to be treated as the Local Ambulance Services. In the event of a medical emergency, you should proceed to the nearest medical facility for immediate treatment first and call the 24-hour Assist Hotline for assistance thereafter. (4) Exclusions are applied to the GCCAP. Details please refer to the Plan Rules. AA International and we will not liable any expense(s) or service(s) without the prior approval and arranged by us or AA International. Page 4

6 Claim Procedures All claims are required to be submitted within three months from date of treatment and send to us by post. Claims will be settled through autopay into your bank account or by cheque. The claim settlement will be issued to you once the claim was settled. You will be able to access the claim details through our website, (1) Claims for Non-pre-authorized Hospital Services If Cashless Hospitalization Arrangement Credit Facility Service is not used, you would be required to follow below procedures to file the application for the Hospital Services claim. I. You need to obtain the original receipts and account statements from the attending Physician and/ or Hospital with precise details of the diagnosis and treatment of the Sickness. II. Submit the original documents together with a duly completed Hospitalization Claim Form which is filled by you and your attending Physician to us by post for reimbursement within three months from the date of discharge from Hospital. (2) Claims for Outpatient Services I. You need to obtain an original receipt from clinic / attending Physician with the following information. (1) Name of patient (2) Date of treatment (3) Name of diagnosis (4) Physician s signature and chop (5) Breakdown of charges (6) Referral letter (for physiotherapy or chiropractor treatment, X-ray & Lab. Test only). II. You re required to complete an Outpatient Claim Form and submit together with all original receipts to us by post for reimbursement within three months from the date of consultation. For Chinese Herbalist claims, both original receipt(s) and prescription list must be submitted together. III. The referral letter shall be valid for three months from the date of recommendation as stated on the referral letter; or the initial consultation is made within three months from the date of recommendation and the subsequent follow-up consultation is made within every three months from the last consultation date by consulting the same Physician / Physiotherapist / Chiropractor / X-Ray & Lab. Test for the same diagnosis. A new referral letter is required if the last treatment for the referred disability was undertaken more than three months ago. Page 5

7 (3) Claims for Dental Care You need to obtain an original receipt from dental clinic / attending Dentist with the following information. (1) Name of patient (2) Date of treatment (3) Diagnosis and name of treatment (4) Dentist s signature and chop (5) Breakdown of charges I. You and your Dentist are required to complete a Dental Care Claim Form and submit together with all original receipts to us by post for reimbursement within three months from the date of consultation. (4) Claims for Maternity Care You / Your spouse may keep all original receipts of your / your spouse s pre-natal check and submit together with a completed Hospitalization Claim Form and all original receipts and account statements of the Maternity confinement and any post-natal check to us by post for reimbursement within three months from the date of delivery. Page 6

8 序言 親愛的受保人 : 您好! 多謝您選擇利寶國際保險有限公司的醫療保障 作為您的醫療保險提供者, 我們除了提供醫療保障之外, 還特別安排了一些額外的增值服務, 令您在需要住院時或海外旅行時可享用到 本小冊子詳細介紹了我們的增值服務, 包括住院免繳費服務 國際緊急醫療撤離 / 運送 / 協助服務 大中華卡計劃及索償程序 希望您可花數分鐘細心閱讀此小冊子, 以了解我們的增值服務和索償程序 如您有任何查詢, 歡迎在辦公時間 * 致電我們的服務專線 在非辦公時間, 如需要特別協助, 您亦可致電我們的二十四小時援助專線 利寶國際保險有限公司 * 辦公時間為星期一至五上午九時至下午五時半, 星期六 日及公眾假期除外 第七頁

9 目錄 頁數 (1) 序言 七 (2) 目錄 八 (3) 住院免繳費服務 九 (4) 國際緊急醫療撤離 / 運送 / 協助服務 十 (5) 大中華卡計劃 十 (6) 索償程序 十一至十二 生效日期 :2013 年 10 月 1 日 第八頁

10 住院免繳費服務 貴為我們的尊貴受保人, 我們特意為您安排了住院免繳費服務, 免卻了您在出院時為應付醫療開支而導致的煩惱 在香港, 如因為生病而需要動手術, 相關的醫療費用是十分高昂的 萬一需要到海外醫院接受治療時, 費用會更高 有些人在出院時, 便因為這些意想不到的高昂費用而被嚇倒和未能負擔 如果使用傳統的程序, 您需要先付款, 之後才向保險公司索償, 令您大失預算 住院免繳費服務便可令您無憂無慮地休養, 可以更快痊癒 住院免繳費服務申請程序 致電我們的二十四小時援助專線 查詢住院免繳費服務申請程序和您的保障額 您需要填寫住院免繳費服務申請表及簽署, 並交由您的主診醫生填寫, 以提供您的疾病資料 請在入院前 3 日將已填妥的表格交回 * 如遇到緊急情況, 我們可因應當時的醫療報告和根據保單條款作出評估, 嘗試為您向醫院安排住院免繳費服務 Cashless Hospitalization Arrangement will be set-up if it is approved. 成功審批後, 住院免繳費服務便可在醫院使用 備註 : (1) 住院免繳費服務能為您因為患病而需要住院時提供方便 成功獲得住院免繳費服務, 並不代表您的醫療開支已獲得我們全面審核 所有醫療開支最終會在您出院後, 根據您的保障項目及保單條款而重新審視 我們保留最終權利, 經醫院 / 我們直接向您收取我們已預先為相關不保的醫療開支而已繳付的差額 (2) 假如住院免繳費服務未能審批, 您需要根據一般的索賠程序申請索償 第九頁

11 國際緊急醫療撤離 / 運送 / 協助服務 我們的國際緊急醫療撤離 / 運送 / 協助服務由 AA International 提供 當您身處海外時, 萬一遇到緊急情況, 您可以致電二十四小時援助專線要求即時協助或查詢您的保單資料 能操多國語言的援助專線專員, 亦能為您即時安排已獲認證和有豐富經驗的網絡醫生提供醫療服務和意見 國際緊急醫療撤離 / 運送 / 協助服務當中包括有需要的醫療運送服務 運送時的醫療護理和運送到就近擁有適合醫療設施的地方 AA International 亦會提供以下服務給您, 包括 : (1) 緊急醫療撤離 (5) 將小童送回原居地 (2) 醫療運送服務 (6) 醫療轉介服務 (3) 遺體運送服務 (7) 法律轉介 (4) 家屬探望 (8) 緊急旅遊支援服務 等等 國際緊急醫療撤離 / 運送 / 協助服務二十四小時援助專線 : 大中華卡計劃 大中華卡計劃由 AA International 提供 此計劃特別為一些經常往來中國內地 台灣 澳門的受保人而設 不論您是到以上地方工幹或旅行, 此服務亦不受影響 從前, 當您到當地時, 如需要住院 / 門診 / 牙科服務, 可能會因為不太熟悉他們的醫療設施而感到徬徨無助 現在, 您只需要致電二十四小時援助專線, 服務專員可為您安排門診 / 牙科服務轉介 如需要住院服務時, 我們更可以協助您繳交保證金及住院醫療費用 在中國, 如需要到指定的門診接受治療, 服務專員更可為您預約, 免卻您等候的時間 大中華卡計劃二十四小時援助專線 : 備註 : (1) 所有經 AA International 預約之門診 / 牙科服務, 您在接受治療後, 需要先支付醫療費用, 之後需以一般的索償程序索償 如您沒有投保門診 / 牙科福利, 該次之醫療費用則不會獲得賠償 (2) 如 AA International 或第三者所提供之服務, 並不是保單列明可獲賠償的開支, 您需要向服務提供者繳交相關費用 (3) 大中華卡計劃並不是一項即時提供當地醫療服務及救護車的計劃 萬一需要緊急醫療援助, 您應即時到就近的醫療設施接受治療, 之後亦可致電二十四小時援助熱線 要求協助 (4) 不保條款適用於此大中華卡計劃 詳情請參閱保單條款 AA International 及我們並不會對任何未經 AA International 或我們批准及安排之服務及相關費用而負責 第十頁

12 索償程序 所有索償申請需於接受治療後三個月內遞交及寄到我們的辦公地址 我們會經由支票或自動轉帳到您的銀行帳戶來支付所有索償賠款 在索償賠付後, 我們會向您發出賠償紀錄 您亦可以瀏覽我們的網頁 並登入以查詢您的賠償紀錄 (1) 沒有申請住院免繳費服務之索償 假如您沒有申請住院免繳費服務, 您需要跟隨以下程序申請索償 I. 出院時, 您需要向醫院索取詳細的正本收據 醫生發出之醫生報告或詳列您的患病資料及所接受之治療的文件 II. 您需要在出院後三個月內, 將 I 部所列之文件連同已填好的索賠表格寄到本公司 請留意索賠表格分為兩部分, 第一部分需要由您填寫, 第二部分則由您的主診醫生填寫 (2) 門診福利索償 I. 在門診接受治療後, 您需要向診所或醫生索取正本收據並寫有以下資料 (1) 病人姓名 (2) 診症日期 (3) 病症名稱 (4) 醫生簽署及蓋印 (5) 詳列相關收費 (6) 醫生轉介信 ( 只適用於物理治療 脊骨治療 X- 光及化驗費之索償 ) II. 您需要填寫門診福利索償申請表格並連同正本收據, 在接受治療後三個月內寄到我們的辦公地址 如申請中醫診療索償, 您需要連同正本配藥方寄給我們 III. 醫生轉介信有效期為轉介信發出日起計三個月內, 並需作第一次求診 否則, 轉介信便會無效 如您在上一次診症日後之三個月內, 因為同一病症需要再進行物理治療 脊骨治療 X- 光或化驗, 您無需再遞交新的轉介信 當您在最後一次診症日之三個月後覆診, 您便需要在索償時遞交新的轉介信 第十一頁

13 (3) 牙齒護理福利索償 I. 在牙科診所接受治療後, 您需要向診所或牙科醫生索取正本收據並寫有以下資料 (1) 病人姓名 (2) 診症日期 (3) 病症和治療名稱 (4) 牙科醫生簽署及蓋印 (5) 詳列相關收費 II. 您需要填寫牙齒護理福利索償申請表格並連同正本收據, 在接受治療後三個月內寄到我們的辦公地址 請留意索償表格分為兩部分, 第一部分需要由您填寫, 第二部分則由您的牙科主診醫生填寫 (4) 妢娩福利索償 I. 您或您的配偶可以將所有產前檢查費用的收據先行保留 當您或您的配偶妢娩後, 可以將所有先前保留的收據連同是次的妢娩費用收據 主診醫生報告 產後檢查費用收據及已填好的住院福利索償表格, 一併於妢娩日後三個月內寄到我們的辦公地址 第十二頁

14 Office Address 13/F, DCH Commercial Centre, 25 Westlands Road, Quarry Bay, Hong Kong S.A.R. Website Fax General Enquiry Hotline (from Monday to Friday 9 a.m. 5:30 p.m. except Saturday and Public Holiday) 24-hour Assist Hotline for the following services (1) Cashless Hospitalization Arrangement - Credit Facility Service (2) Greater China Card Assistance Program (3) International Emergency Medical Evacuation / Repatriation / Assistance Service Note: The interpretation of the benefits, services, procedures and terms and conditions of this booklet is subject to the provisions of promedico Plan Rules. promedico