CARING Family Medical Insurance Plan

Transcription

1 General Insurance Company Limited CAR amily edical Insurance Plan GENERAL INSURANCE CAR amily edical Insurance Plan CAR is specially designed for you and your family to protect against the high cost of medical treatments. It provides comprehensive coverage for your entire peace of mind and offers flexibility in the choice of benefits best suited to your need. Special eatures of CAR CAR Health Check-up Profiles at a preferential rate 24-hour Worldwide Emergency Assistance Services Services provide the following services A choice of 4 hospitalisation benefit levels to suit your need ree Annual Health Check-up Profile Worldwide coverage with free Emergency Assistance Services Option for the Supplementary ajor edical Benefits which gives an extra protection for major illness and serious injury and covers 80% of eligible expenses in excess of the basic hospital cover Option for the Supplementary Outpatient Benefits Renewable up to age 100 (for Basic Hosptalisation Benefits) CAR provides comprehensive medical coverage to release you from the worries of the expensive medical cost. It also gives you extra peace of mind by assisting you and your family to monitor your health status and detect any health disorder in an early stage through the provision of our health screening profiles. The insured family member is entitled to a REE annual Basic Check-up Profile at one of the designated laboratory centres and may choose to take any of the following screening profiles Comprehensive Check-up Profile Gentleman Check-up Profile Lady Check-up Profile Cancer arkers In case emergency assistance is needed while travelling abroad for a period not exceeding 90 days, the Worldwide Emergency Assistance 24-hour telephone hotline service Emergency medical evacuation and repatriation (up to US$1,000,000) Guarantee of any required hospital admission deposit up to US$5,000 Compassionate visit for more than 7 days of overseas hospitalisation (includes the cost of a returned economy class air ticket and hotel accommodation up to US$250 per day at a maximum of US$1,000) Return of minor children to home country or usual country of residence Hotel accommodation for convalescence (up to US$250 per day at a maximum of US$1,000) Unexpected return in the event of the death of a close relative Transportation of mortal remains (up to US$1,000,000) edical and legal referrals Lost luggage assistance Emergency travel service assistance China edical Assistance Services In case of emergency requiring hospitalisation in ainland China, by presenting the "China edical Assistance Card", the insured member can be admitted to any one of the network hospitals without paying any admission deposit ( US$1,000,000) US$5,000 7 ( US$1,000 US$250) ( US$1,000 US$250) ( US$1,000,000)

2 General Insurance Company Limited General Insurance Company Limited CAR Health Check-up Profiles REE Basic Check-up Profile Anaemia & Blood Disease Screening - Complete Blood Count (CBC) - Platelet Diabetic Screening - Glucose Lipids Pattern Screening - Total Cholesterol - Triglyceride edical Evaluation on Laboratory Reports You are entitled to the following optional health check-up profiles at preferential rates. Optional Comprehensive Check-up Profile Anaemia & Blood Disease Screening - ESR Blood Group and Rh actor - ABO group & Rh-D Rh Gout Screening - Uric acid Heart & Lung Disease Screening - Chest X-Ray X - Electrocardiogram (ECG) Cardiac & Stroke Risk Evaluation - HDL cholesterol - LDL cholesterol Intestinal Disease Screening - Stool, Routine Examination Liver unction Tests - SGOT - SGPT Renal unction Tests - Urea - Creatinine - Urine, Routine Examination Thyroid unction Test - Thyroxine (T4) (BP) (CP) Optional Lady Check-up Profile - Breast Examination - Trichomonas and onilia Culture - Pelvis Examination - Pap Smear ajor Exclusions h Pre-existing/Congenital Conditions, sexually transmitted diseases, AIDS, pregnancy/abortion, cosmetic treatments, dental treatments (except for arising from accident), routine physical examinations, mental disorders, alcoholism/drug abuse, professional/hazardous sports, self-inflicted injury, illegal activities, war, nuclear fallout. Optional Cancer arkers (C) All illnesses occurring in the first 30 days of cover. 30 (LP) The level of individual cancer markers (Cancer antigens) in the blood may reflect the related cancer cells in the body. The blood test is to assist to detect the cancers in an early stage. - CEA (Colon / Rectum Cancer ) - AP (Liver Cancer ) - CA125 (Ovary / Cervix Cancer ) - CA19.9 (Pancreatic Cancer ) - SCC (Respiratory, Lung and digestive tracts ) - BetaHCG (Trophoblast ) - EBV (Naso-Pharyngeal Carcinoma ) The following illnesses occurring in the first 180 days of cover Stones in the urinary or biliary systems, Hypertension or Cardio-Vascular Diseases, Cataracts, Nasal condition requiring surgery, Haemorrhoids, Gastric and Duodenal Ulcers, Endometriosis, Tonsils requiring surgery, Diabetes ellitus, Hyperthyroidism, Tuberculosis, Tumor of skin or muscular tissue, bone tumors or malignancies of blood or bone marrow. 180 Company Profile Group is one of the first integrated financial service providers in the world resulting from a full merger of the largest insurance company in the Netherlands with one of the country's largest banks. Its roots could be traced back to the year 1845 when The Netherlands Insurance Company was established. The Group is active in the fields of banking, investments, life insurance and retirement services in more than 40 countries. With its substantial worldwide experience and over 107,000 employees, Group provides a full range of integrated financial services to more than 85 million customers globally and has total assets of EUR 1,164 billion*. Its business operations in Hong Kong include General Insurance - Established in 1989, General provides quality services and offers most types of non-life insurance products to individuals and businesses in the local market. The company's extensive scope of insurance products which includes property, employees' compensation, motor vehicles, medical, personal accident, travel and marine, etc., - is tailored to meet the needs of individuals and business alike. Life Insurance - Since its establishment in 1984, Life has always been committed to offering customers a comprehensive range of quality insurance products and services. Pension Trust - Pension Trust is committed to contributing its expertise to provide quality pension trust services to corporate customers. inancial Planning - Established in 2002, inancial Planning is committed to setting the standard as a market leader in Independent inancial Advice, and attracting the best financial advisors in the industry to deliver quality financial planning advice to clients. The customer-centric focus of P ensures that clients receive the best solution from advisors, based on a broad suite of products from many companies. * Source Group Annual Report ,000 8,500 11,640 * 1984 * General Insurance Company Limited The following illnesses occurring in the first 12 months of cover Circumcision, Hallux Valgus, Tumor of internal organs. 12

3 General Insurance Company Limited General Insurance Company Limited Basic Hospitalisation Benefits Benefit Level Cover Limit per Disability (HK$) HS600B Ward HS1200B Semi-Private HS1700B Private HS2600B Private Supplementary ajor edical Benefits (Optional) Supplementary ajor edical Benefits (S) provide additional benefits to items 1 to 8 under the Basic Hospitalisation Benefits (BHB). 80% of the excess amount of actual charges incurred over the amount of benefits payable under benefit items 1 to 8 of the BHB will be reimbursed % Cover Limit per Disability (HK$) C1B C2B C3B C4B 60, , , ,000 Benefit level Ward Semi-Private Private Private te If the hospital confinement is at a higher accommodation level than the insured benefit level, the Rembursement % shall be reduced as follow Ward to Semi-Private 50% Ward to Private 25% Semi-Private to Private 50% IPORTANT NOTES 1. You are required to disclose all material facts which you know General Insurance Company Limited as an insurer would regard them as likely to influence the acceptance and assessment of this Application. If you are in doubt whether certain facts are material you should disclose them. We recommend you to keep a record (including a copy of the completed Application) for your future reference of all information given. Providing correct answers and making sure we are informed is for your own protection, as failure to disclose such information may mean that your policy will not provide you with the cover you require and may even invalidate the policy altogether. General Insurance Company Limited Emergency Assistance Services 2. The liability of the company does not commence until this Application has been formally accepted and the premium has been paid. US$1,000,000 CAR 09/2010

4 General Insurance Company Limited Supplementary Outpatient Benefits (Optional) (100% Reimbursement) ( 100%) 1. Consultation & edicine per visit per day (aximum 25 visits per year) ( 25 ) 2. Physiotherapist's & Chiropractor's Treatment per visit per day (aximum 10 visits per year) ( 10 ) 3. Specialist's Consultation per visit per day (aximum 10 visits per year) ( 10 ) 4. Diagnostic X-Ray & Laboratory Tests per year 5. Prescribed edicines & Drugs per year (rom any legitimate source outside clinic) Cover Limit (HK$) OP190B OP220B OP270B OP340B ,600 2,000 2,400 2,800 2,400 3,000 3,600 4,200 Annual Premium Table (HK$) Basic Hospitalisation Benefits Age Last Birthday *65-69 *70-74 *75-79 *80-84 *85-89 *90-94 *95-99 Supplementary ajor edical Benefits (Optional) Renewal up to Age 75 only ( 75 ) Age Last C1B C2B C3B C4B Birthday *65-69 *70-74 HS600B 1,715 1,715 1,372 1,372 1,425 1,490 1,501 1,709 1,886 2,289 3,010 3,376 4,541 4,736 5,607 5,607 7,289 7,289 9,532 9,532 11,610 11,610 13,578 13,578 14,414 14,414 15,153 15,153 15,771 15, ,013 1,362 1,421 1,682 1,682 2,187 2,187 2,860 2,860 HS1200B HS1700B HS2600B 2,564 2,564 2,051 2,051 2,130 2,240 2,251 2,583 2,856 3,497 4,602 5,189 6,990 7,308 8,670 8,670 11,271 11,271 14,739 14,739 17,694 17,694 20,515 20,515 21,778 21,778 22,891 22,891 23,822 23,822 3,389 3,389 2,711 2,711 2,814 2,967 2,978 3,431 3,797 4,669 6,146 6,948 9,368 9,804 11,642 11,642 15,135 15,135 19,791 19,791 24,083 24,083 29,021 29,021 30,805 30,805 32,380 32,380 33,697 33, ,017 1, , ,049 1,139 1,401 1,381 1,557 1,844 2,084 2,097 2,192 2,810 2,941 2,601 2,601 3,493 3,493 3,381 3,381 4,541 4,541 4,422 4,422 5,937 5,937 4,609 4,609 3,687 3,687 3,835 4,168 4,062 4,831 5,201 6,601 8,696 9,850 13,289 13,922 16,544 16,544 21,507 21,507 28,125 28,125 34,220 34,220 41,236 41,236 43,771 43,771 46,006 46,006 47,877 47,877 1,383 1,383 1,106 1,106 1,151 1,250 1,219 1,449 1,560 1,980 2,609 2,955 3,987 4,177 4,963 4,963 6,452 6,452 8,438 8,438 te Written referral by the attending physician is required for Physiotherapist's & Chiropractor's treatment, Specialist's Consultation, Diagnostic X-Ray & Laboratory Tests, Prescribed edicines & Drugs. This brochure gives only an outline of the terms and conditions of the insurance cover and any information given herein is subject to the precise terms and conditions in our Policy, a specimen copy of which will be furnished to you on request. X Supplementary Outpatient Benefits (Optional) Age Last OP190B Birthday *65-69 *70-74 *or renewal only 5,525 5,525 3,376 3,376 2,652 3,094 2,707 3,177 2,763 3,315 3,315 3,979 3,755 4,310 4,219 4,641 5,485 6,033 7,172 7,890 OP220B OP270B OP340B 6,433 6,433 3,930 3,930 3,088 3,603 3,152 3,698 3,216 3,860 3,860 4,631 4,371 5,017 4,912 5,403 6,386 7,024 8,350 9,185 Renewal up to Age 75 only ( 75 ) 7,835 7,835 4,788 4,788 3,761 4,388 3,839 4,506 3,917 4,701 4,701 5,641 5,325 6,112 5,983 6,581 7,778 8,555 10,171 11,188 9,728 9,728 5,945 5,945 4,670 5,448 4,766 5,594 4,864 5,837 5,837 7,005 6,610 7,588 7,429 8,172 9,658 10,624 12,629 13,892

5 CAR amily edical Insurance Application Choice of Benefit Please tick as appropriate Basic Hospitalisation Benefits Supplementary ajor edical Benefits (Optional) HS600B C1B HS1200B C2B Supplementary Outpatient Benefits (Optional) OP190B OP220B te The level of optional Supplementary ajor edical Benefit must be the same as the Basic Hospitalisation Benefit. Applicant's Name Contact Tel General Insurance Company Limited HS1700B C3B OP270B HS2600B C4B OP340B Applicant's Address Policy Effective Date (D//Y) ( / / ) Name of amily embers to be Insured Applicant HKID/ Passport. / Date of Birth (D//Y) ( / / ) Sex Height/Weight (m/kg) / ( / ) Occupation Total Premium Spouse Children Grand Total HK$ Please read the following questions carefully & answer in full. 1. Have you or any of your family members to be insured ever had any disease, injury, surgical operation or treatment or observation in hospital or sanatorium?? 2. Have you or any of your family members to be insured ever had taken or been advised to have any diagnostic tests (e.g. X-Ray, ECG or blood test) in the last 5 years? 5 ( x ) 3. Are you or any of your family members to be insured currently under medical observation or receiving any treatment or medication or having any symptoms which may indicate a health disorder? If your answer is "" for any of the questions (1) to (3), please give full details below 1 3 Name of Person Treated Details of Diagnosis & Treatment Period of Treatment Degree of Recovery Name & Address of Attending Physician 4. Have you or any of your family members to be insured ever had any medical, accident or life insurance application rejected or insurance policy cancelled, rated or restricted or renewal declined? If yes, please give full details below 5. Please provide place of Residence of the Person to be insured Hong Kong Other 6. Average stay of the person to be insured in Hong Kong per year months 7. Bank Name & Account. for claim settlement (Account-Holder must be the Applicant) Bank Name Bank Code PERSONAL INORATION COLLECTION STATEENT The information you provide to General Insurance Company Limited("") is collected to enable to carry on insurance business and may be used for the purpose of any insurance or financial related product or service or any alterations, variations, cancellation or renewal of such product or service; any claim or investigation or analysis of such claim; exercising any right of subrogation; and may be transferred to any related company or any other company carrying on insurance or reinsurance related business or an intermediary or a claim or investigation; or other service provider providing services relevant to insurance business for any of the above or related purposes; any association, federation or similar organisation of insurance companies ("ederation") that exists or is formed from time to time for any of the above or related purposes or to enable the ederation to carry out its regulatory functions or such other functions that may be assigned to the ederation from time to time and are reasonably required in the interest of the insurance industry or any member(s) of the ederation; and any members of the ederation by the ederation for any of the above or related purposes. oreover, is hereby authorised to obtain access to and/or to verify any of your data with the information collected by the ederation from the insurance industry. You have the right to obtain access to and to request correction of any personal information concerning yourself held by. Requests for such access can be made to the Corporate Data Protection Officer at 1/, Tower, 308 Des Voeux Road Central, Hong Kong. Branch Code Account. General Insurance Company Limited(" " ) DECLARATION AND AUTHORISATION I hereby declare that, to the best of my knowledge and belief, all particulars and statements given in this Application are true and complete. I agree that this Application shall be the basis of the contract between me and. I further authorise any physician, hospital, clinic, insurance company or organisation that has any records or knowledge of me or my health, to furnish to or its authorised representative, any and all information with respect to any illness or injury, medical history, consultation prescriptions or treatment and copies of all hospital or medical records. A photostat copy of this authorisation shall be considered as effective and valid as the original / Agent/Broker / Applicant's Signature Date Account Code Contact Tel Credit Card Payment Authorisation VISA astercard Card Expiry Date Credit Card. Yr te If payment mode is monthly, the monthly premium is equal to annual premium times ode of Payment Yearly onthly I hereby authorise General Insurance Company Limited to charge my above credit card account for the premium of this insurance. General Insurance Company Limited Cardholder's Name Cardholder's Signature Date HI-ohp 09/2010

6 General Insurance Company Limited CAR amily edical Insurance Plan Subscription for Optional Health Check-up Profile Name of Applicant Policy. (for existing client only) Name Comprehensive Check-up Profile (CP) HK$550 Gentleman Check-up Profile (GP) HK$600 Lady Check-up Profile (LP) HK$600 Cancer arkers (C) HK$880 Total Subscription ( HK$) Grand Total HK$ Terms and Conditions 1. The subscriber must be the insured member covered under a medical insurance policy with entitlement of the free annual Basic Health Check-up Profile. 2. This subscription form must be completed and submitted together with a. the new application form; and b. a cheque in amount of the total subscription fees make payable to " General Insurance Company Limited". 3. All check-ups must be completed at the designated laboratory centre following the procedures of the user guide. 4. The subscription fees are non-refundable a. b. General Insurance Company Limited Declaration I, the applicant, on behalf of each subscriber(s), hereby declare that 1. I/We accept the terms and conditions specified in this subscription form and agree to disclose my personal information and health checkup reports to General Insurance Company Limited ("") and the designated health service providers. 2. I/We understand and agree that the information collected may be used, disclosed and transferred to any related company or any selected third party for the purposes of processing this application and providing subsequent services for this, and promotion of any insurance or financial related product or service by and its affiliated companies. 3. I/We understand that I/We have the right to obtain access to and to request correction of any personal information concerning myself/ourselves held by. Request for such access can be made to the Corporate Data Protection Officer at 1/., Tower, 308 Des Voeux Road Central, Hong Kong. 1. General Insurance Company Limited("") Applicant's/Policyholder's Signature Date General Insurance Company Limited 7/., Tower, 308 Des Voeux Road Central, Hong Kong T