Hong Kong Police Protection Plan Personal Accident and Medical Cover

Transcription

1 Hong Kong Police Protection Plan Personal Accident and Medical Cover Protection to the employees of the Hong Kong Police Force and their family members Effective from January 1, 2018

2 Hong Kong Police Protection Plan Personal Accident and Medical Cover The Police Force faces constant challenges on duty that put them at a great deal of risk in their service to the public. Understanding your job nature and special needs, Zurich has launched the Hong Kong Police Protection Plan Personal Accident and Medical Cover, a tailor-made insurance plan to protect you and your beloved family members, so that you can have the peace of mind of getting a reliable cover in case of accidents or diseases. Premier cover Customized protection tailor-made for the needs of you and your family Flexibility to select Personal Accident Cover and/or Medical Cover You can also select Supplementary Major Medical Cover together with Medical Cover for more assurance Accidental death and permanent disablement coverage - up to HKD 3,850,000 Cash Benefit Up to HKD 3,850,000* cash benefit for the death, loss of limbs, loss of sight or permanent total disablement resulting from accident Free enhanced coverage - Loyalty Bonus up to HKD 750,000 Automatic 5% increase of the sum insured of Accidental Death and Permanent Disablement benefits upon renewal annually It can be accumulated up to 25% of the sum insured for a maximum of 5 consecutive years Free additional coverage - HKD 100,000 for Police Force Member On Duty Accidental Death Cover Extra HKD 100,000 cash benefit for accidental death whilst on duty Guaranteed settlement of the benefit payment within three working days from the date of death Take care of your - medical expenses Cover eligible to medical expenses incurred in both private and public hospitals Cover surgeries performed at day care centre or clinic without staying in hospital No claim discount to reward your wellness We offer no claim discount at 5% per annum, up to a maximum of 15% to your renewal premium for Medical Cover and Supplementary Major Medical Cover if you have not claimed under Medical Cover within a specific period. Ensure continuity of your coverage You and your family members can choose to convert your Personal Accident Cover or Medical Cover to Zurich s designated individual insurance plans and enjoy continued coverage without having to undergo further underwriting process when you leave the Police Force or retire. Eligibility The applicant Employees of the Hong Kong Police Force at the age of 18-65, renewable up to age 69 Family members Spouse, domestic partner, parents, parents-in-law or parents of domestic partners of the applicant aged years, renewable up to age 69 Unmarried and unemployed children of the applicant aged 15 days 21 years, renewable up to age 21; and for full-time students, renewable up to age 25 Section 1 Personal Accident Cover Coverage Accidental Death and Permanent Disablement We shall pay for the benefits in case an insured person sustains injury by an accident where death or permanent disablement results within 12 consecutive months from the date of such accident. The definition of permanent disablement includes but is not limited to permanent loss of any earning abilities or limbs, eyes or sight of eyes, fingers, toes, hearing or speech etc. (please refer to the compensation table below for details) Benefits highlight Up to HKD 3,850,000* cash benefit for the death, loss of limbs, loss of sight or permanent total disablement resulting from accident Additional HKD 100,000 for Police Force Member On Duty Cover if the insured employee passed away due to accident on duty. We guarantee to settle the benefit payment within three working days from the date of death, relieving the financial burden of his/her family members immediately 24-hour worldwide coverage while on or off duty Enjoy an automatic 5% increase of the sum insured of Accidental Death and Permanent Disablement Benefit upon renewal, accumulated up to 25% at maximum Provide protection to some amateur and dangerous sports such as water jet surfing, water skiing, canoeing, parachuting and accident resulting from food poisoning, murder, riot and civil commotion Extend family protection to your spouse, domestic partner and child(ren) Applicable to your parents, parents-in-law and parents of your domestic partner on this protection *This includes up to HKD 3,000,000 Accidental Death and Permanent Disablement Cover, HKD 100,000 Police Force Member On Duty Accidental Death Cover and up to HKD 750,000 Loyalty Bonus. 2

3 Table of benefits Coverage Sum Insured per Insured Person (HKD ) Unit 1 Unit 2 Unit 3 Unit 4 Unit 5 Accidental Death and Permanent Disablement* 500,000 1,000,000 1,500,000 2,000,000 3,000,000 Police Force Member On Duty Accidental Death Cover 100, , , , ,000 * Loyalty Bonus: The sum insured of Accidental Death and Permanent Disablement benefits will be automatically increased by 5% free of charge annually upon policy renewal, up to 25% of the sum insured for maximum 5 consecutive years. Premium table Monthly Premium (HKD ) Unit 1 Unit 2 Unit 3 Unit 4 Unit 5 Self/each parent/each parent-in-law/each parent of domestic partner Self and spouse/domestic partner Self, spouse/domestic partner and children* Self and children* * The sum insured of each insured child shall be 15% of the sum insured of the applicant. Compensation table Accidental Death and Permanent Disablement If an insured person sustains injury by an accident during the period of insurance, where death or permanent disablement listed in below compensation table results within 12 consecutive months from the date of such accident, Zurich will pay in accordance with the percentage of the sum insured for the relevant event(s) shown in below table. Event Percentage of sum insured Event Percentage of sum insured 1. Accidental death 100% 2. Permanent total disablement 100% 3. Permanent and incurable paralysis of all limbs 100% 4. Permanent total loss of sight of both eyes 100% 5. Permanent total loss of sight of one eye 100% 6. Loss of or the permanent total loss of use of two limbs 100% 7. Loss of or the permanent total loss of use of one limb 100% 8. Loss of speech and hearing 100% 9. Permanent and incurable insanity 100% 10. Permanent total loss of hearing in (a) both ears 75% (b) one ear 15% 11. Loss of speech 50% 12. Permanent total loss of the lens of one eye 50% 13. Loss of or the permanent total loss of use of four fingers and thumb of # (a) right hand 70% (b) left hand 50% 14. Loss of or the permanent total loss of use of four fingers of # (a) right hand 40% (b) left hand 30% 15. Loss of or the permanent total loss of use of one thumb # (a) Both right joints 30% (b) One right joint 15% (c) Both left joints 20% (d) One left joint 10% 16. Loss of or the permanent total loss of use of fingers # (a) Three right joints 10% (b) Two right joints 7.5% (c) One right joint 5% (d) Three left joints 7.5% (e) Two left joints 5% (f) One left joint 2% 17. Loss of or the permanent total loss of use of toes (a) All toes one foot 15% (b) Great toe- both joints 5% (c) Great toe one joint 3% 18. Fractured leg or patella with established non-union 10% 19. Shortening of leg by at least 5 cm 7.5% 20. Permanent disability not otherwise provided for under Events 10 to 19 inclusive, such Percentage of sum insured as we shall in our absolute discretion determine and being in our opinion not inconsistent with the compensation provided under Events 10 to 19 inclusive. # If an insured person is left-handed, please state clearly in the enrollment form. We shall reverse the percentage of right hand and left hand sum insured under Events 13 to 16 inclusive in the above compensation table. 3

4 Section 2 Medical Cover Coverage (2.1) Medical Expenses Reimbursement Benefits (a) (b) (c) (d) Room and board We shall pay for the room and board charges actually incurred up to HKD 2,580 per day if the insured person is confined in a hospital due to injury arising from accident or illnesses, with a maximum of 45 days per disability. Room and board for intensive care unit We shall double the room and board charges actually incurred if the insured person is confined in the intensive care unit, with a maximum of 7 days per disability. In-hospital doctor s call fees We shall pay for the attending medical practitioner s charges for treatment during the confinement up to HKD 2,500 per day, with a maximum of 45 days per disability. Hospital special services charges We shall pay for the actual reasonable and customary charges in respect of dressings, medicines, x-rays, etc. during the hospital confinement of the insured person, up to the total benefits chosen. (e-g) Surgical charges, anaesthetist s fee and operating theatre charges We shall pay for the actual reasonable and customary charges for surgical operation by a medical practitioner, anaesthetist s fees and operating theatre charges, up to the total benefits chosen. The coverage in Part d-g extends to cover day patient or outpatient surgery. (2.2) Hospital Cash for Confinement in Public Hospital (a) Daily hospital cash benefit We shall pay for daily hospital cash up to HKD 1,300 if the insured person is confined in a public hospital in Hong Kong due to injury arising from accident or illnesses, up to 365 days per disability. (b) Additional daily hospital cash for confinement in intensive care unit We shall double the hospital cash payment if the insured person is confined in the intensive care unit of a public hospital in Hong Kong due to injury arising from accident or illnesses, with a maximum of 30 days per disability. We shall not pay for the (1) Medical Expenses Reimbursement benefits and/or Supplementary Major Medical Cover and (2) Hospital Cash for Confinement in Hong Kong Public Hospital benefits at the same time in any circumstances. Benefits highlight Provide hospitalization cover for either private or public hospitals including surgeries performed at day care or clinic without staying in hospital Up to HKD 40,000 of surgical charges, with additional coverage for anaesthetist s fees and operating theatre charges If no claim has been made within a policy year under Medical Cover, the no claim discount on the renewal premium for Medical Cover and Supplementary Major Medical Cover (if applicable) in the following policy year will be increased by 5%, up to a maximum of 15%. You can start to enjoy this reward after the first claim-free year. No medical examination is required Table of benefits Maximum Benefit per insured person per disability (HKD) Medical Cover # Plan A Plan B Plan C (2.1) Medical Expenses Reimbursement (a) Daily room and board Daily maximum limit (max. 45 days per disability) (b) Room and board for intensive care unit Daily maximum limit (max. 7 days per disability) (c) In-hospital doctor s call fees Daily maximum limit (max. 45 days per disability) * Under Medical Cover or Supplementary Major Medical Cover, the sum insured of each insured person should be 100% ,860 2,580 1,840 3,720 5, ,800 2,500 (d) Hospital special services charges (maximum limit per disability) 18,000 24,000 35,000 (e) Surgical charges (maximum limit per disability) 15,000 30,000 40,000 (f) Anaesthetist s fee (maximum limit per disability) 7,500 10,000 12,500 (g) Operating theatre charges 7,500 10,000 12,500 (2.2) Hospital Cash For Confinement in Hong Kong Public Hospital (a) Daily hospital cash benefit Daily maximum limit (max. 365 days per disability) (b) Additional hospital cash for confinement in intensive care unit Daily maximum limit (max. 30 days per disability) , ,300 # We shall not pay for the (1) Medical Expenses Reimbursement benefits and (2) Hospital Cash for Confinement in Hong Kong Public Hospital benefits at the same time in any circumstances. Premium table Monthly Premium per insured person (HKD ) Age Plan A Plan B Plan C

5 Section 3 Supplementary Major Medical Cover (only applicable if Section 2 Medical Cover is applied) Coverage The insured person can further enroll in Supplementary Major Medical Cover. If specific types of hospital and surgical charges exceed the maximum limit of Medical Cover, this supplementary cover will provide an additional coverage: Pay 80% of the charges for the room and board and in-hospital doctor s call fees from 46th day confinement, subject to the daily limit under the selected plan. Pay 80% of the remaining medical expenses on hospital special services charges, surgical charges, anaesthetist's fee and operating theatre charges exceeded the limit of the selected plan in Section 2 (2.1) (d) to (g). Table of benefits Maximum Benefit per insured person (HKD) Plan A Plan B Plan C Hospital and surgical charges (maximum limit per disability) 50, , ,000 Reimbursement % of the remaining balance 80% The insured person must enroll in the Section 2 Medical Cover in order to apply for Section 3 - Supplementary Major Medical Cover under the same plan. Premium table Monthly Premium per insured person (HKD) Age Plan A Plan B Plan C Notes (applicable to Sections 1, 2 and 3) 1. The coverage level of the employee s family members (i.e. spouse, domestic partner, children, parents, parents-in-law or parents of domestic partner) cannot exceed the employee s coverage level. 2. If the employee is no longer covered under the Section 1 Personal Accident Cover, Section 2 Medical Cover or Section 3 Supplementary Medical Cover of this policy, the corresponding coverage of his / her family members, if applicable, will be terminated. 3. For Section 2 Medical Cover & Section 3 Supplementary Major Medical Cover, no benefit will be payable for any treatment or expenses incurred during the waiting period of 30 days from the policy inception date. 4. Premium will not be increased as a result of the insured person s claims experience during the policy term. 5. Zurich reserves the right to revise or adjust the premium table according to its applicable premium rate at the time of the premium due date by giving 30 days written notice to the insured person. 6. If a claim has been made by the insured person under Medical Cover within the policy year prior to the upcoming policy anniversary, the no claim discount on the renewal premium for Medical Cover and Supplementary Major Medical Cover, if any, of the policy year following such policy anniversary will be decreased by 5%, subject to a minimum of 0%. 7. The employee and his / her family members can choose to convert their benefits to the designated Zurich individual insurance plans and enjoy premium discount upon retirement, termination of employment or attaining the maximum renewable age: For Section 1 Personal Accident Cover, you can have free choice of coverage levels upon conversion. For Section 2 Medical Cover, you have to choose the same or lower coverage levels in respect of your coverage level of Hong Kong Police Protection Plan (according to the benefit limit of Room and Board Benefit) all medical conditions currently covered under Hong Kong Police Protection Plan will be covered under the designated Zurich individual insurance plan, subject to the terms and conditions of such designated plan, after conversion medical underwriting is required if you want to upgrade to a higher coverage level For Section 3 Supplementary Major Medical (SMM), medical underwriting is required if you want to opt for such benefit after conversion. 8. Zurich Insurance Company Ltd reserves the right of final approval and decision for conversion arrangement. Major exclusions (applicable to Section 1, 2 and 3): Any illnesses (only applicable to Section 1 Personal Accident Cover); any pre-existing injuries or illnesses; intentional self-injury; illnesses or injuries arising directly or indirectly from war, participation in armed force (except for the Police Force member) or professional sports, any illegal activities, insanity or any functional disorder or psychiatric condition of the mind; under the influence of alcohol or drugs other than as prescribed by medical practitioner; general check-up; AIDS; suicide; pregnancy; contraceptive or contraceptive devices; cosmetic surgery; congenital abnormalities at the time of birth, screening and preventive care, convalescence or travelling as a non-fare paying passenger on a licensed chartered aircraft. Important notes 1. You must inform us if there are any changes in respect of the information provided in the enrollment form for this policy. 2. We have the right to cancel your policy if you do not pay the premium within 31 days from the due date. Also, we reserve the right to cancel this policy by giving 30 days advance notice in writing to you. A pro-rata premium for the period starting at the time of cancellation to the last date of the period of insurance shall be refunded provided that no claim has been made during such period of insurance of the policy. 3. You have the right to cancel this policy by giving notice in writing with signature and return the policy to us within 14 days from the delivery of this policy document if you have not made any claim during this period of insurance. We will refund to you the premiums you have paid. 4. You must send us the completed claim form and required information within 30 days upon the completion of the treatment. 5. This brochure is only an illustration and does not constitute any part of the insurance contract. For full terms and conditions and exclusions, please refer to the policy document itself which shall prevail in case of inconsistency. Zurich Insurance Company Ltd reserves the right of final approval and decision. The English version shall prevail in case of inconsistency between the English and Chinese versions. 5

6 Frequently Asked Questions 1. How can I enroll in this plan? The application procedure is simple and easy, without any medical examination. Simply complete and submit enrollment form to Zurich. 2. When will the policy be effective? If we receive your application on the dates between the 1st and 15th of the month, the policy will take effect on the 1st day of the next coming month upon our approval. If we receive your application on the dates between the 16th and 31st of the month, the policy will take effect on the 15th day of the next coming month upon our approval. Please note the waiting period for Section 2 Medical Cover. 3. Can I enroll my family members in the Hong Kong Police Protection Plan? Yes, you can enroll your family members, including spouse, domestic partner, children, parents, parents-in-law or parents of domestic partner in this plan as long as you are covered as an insured person. Please note that: The coverage level of your family members cannot exceed your own coverage level If you are no longer covered under the Section 1 Personal Accident Cover, Section 2 Medical Cover or Section 3 Supplementary Major Medical Cover of this policy, the corresponding coverage of your family members, if applicable, will be terminated For Section 1 Personal Accident Cover, the sum insured for each insured child is 15% of your sum insured 4. Can I renew this plan when my employment with the Hong Kong Police Force is terminated? Yes, but you need to fulfill the following requirements: You need to inform us in written notice for any changes of occupation You are not switching to a higher risk occupation or excluded occupation Please note that the Police Force Member On Duty Accidental Death Cover will no longer be available after your termination of employment. You and your family members may also consider converting the benefits to a designated Zurich individual insurance plan without further underwriting process and enjoy premium discount. 5. What if existing policyholder of non - Zurich Hong Kong Police Safety Protector wants to transfer the Loyalty Bonus under existing insurance plan to the Hong Kong Police Force Insurance Plan provided by Zurich? The existing policyholder is required to submit the copy of existing policy contract which details the Loyalty Bonus together with this plan s application to Zurich. The Loyalty Bonus under existing insurance plan will be transferred to this new plan. Enrollment Hotline Service hours: Mon to Fri: 9 a.m. to 5:30 p.m. Sat: 9 a.m. to 1 p.m. Closed on public holidays Online Application: About Zurich Being part of Zurich Insurance Group, Zurich Insurance (Hong Kong) offers a full range of flexible general insurance and life insurance products for individuals as well as corporate customers, catering to their insurance, protection and investment needs. Our presence in Hong Kong dates back to We are one of the top five general insurance providers in Hong Kong*. Zurich Insurance Group (Zurich) is a leading multi-line insurer that serves its customers in global and local markets. With about 54,000 employees, it provides a wide range of property and casualty, and life insurance products and services in more than 210 countries and territories. Zurich s customers include individuals, small businesses, and mid-sized and large companies, as well as multinational corporations. The Group is headquartered in Zurich, Switzerland, where it was founded in The holding company, Zurich Insurance Group Ltd (ZURN), is listed on the SIX Swiss Exchange and has a level I American Depositary Receipt (ZURVY) program, which is traded over-the-counter on OTCQX. Further information about Zurich is available at * Source: Insurance Authority, based on gross premiums, HKP E Zurich Insurance Company Ltd (a company incorporated in Switzerland) 25-26/F, One Island East, 18 Westlands Road, Island East, Hong Kong Tel: Fax: Website: