GLOBAL LEADER IN HEALTH SERVICES About Cigna Rooted in health expertise dating back over 200 years through its predecessor companies, Cigna was established in 1982 following the merger of the INA Corporation and Connecticut General Corporations. A respected leader in worldwide health services, we continue to innovate, expand and grow globally. As of 2013, our multi-national office network spans 30 countries and serves over 80 million customers. Over the years our reliability and trustworthiness have been recognized with consistently strong ratings by internationally reputable bodies, as well as being ranked 103 on the Fortune 500. International Rating Company A.M. Best Moody s Standard & Poor s Fitch Rating A (Excellent) A2 (Good) A+ (Strong) A (Strong) Remark: Rating of Connecticut General Life Insurance Company as of 2013. About Cigna Hong Kong Cigna has been committed to improving people s health, wellbeing and sense of security since its presence in Hong Kong in 1933. Having delivered on this promise for over 80 years, we continue to provide a broad range of insurance solutions that are designed to satisfy our customers and their loved ones every unique need. Innovative to our products and services, we have garnered a number of leading industry awards and recognitions in Hong Kong: Winner of the Capital Outstanding Enterprise Awards the Outstanding Life & Health Insurance Company for two consecutive years (2013 & 2014) Capital Honor Grand Awards the Most Customer- Centric Company (2013) Annual Grand awards and a number of service excellence awards from HK Call Centre Association (2007-2013) One of the first local insurers to achieve the Payment Card Industry Data Security Standard s (PCI-DSS) highest level of compliance (2012) First dedicated local telemarketing insurance channel to receive certification by ISO 27001, the international best practice standard for Information Security Management Systems (2007) 1
CIGNA HEALTHFIRST CHOICE PLAN HIGHLIGHTS A helping hand in the event of emergency, HealthFirst Choice saves your hassle at times when you need to focus on your own health. Cigna HealthFirst Medical Plans Cashless hospitalization - No admission deposit, no claim required after discharge 1 You can be admitted in the private hospitals in Hong Kong for medical treatment without deposit at hospital admission or claim procedures after discharge. Simply call our 24-hour Cigna HealthFirst Hotline to arrange pre-approval to enjoy this hassle-free service that allows you to concentrate on your health. 24-hour hotline 8203 2202 provides cashless hospitalization pre-approval services and you can seek advice directly from medical professionals. Extra protection when you are in deepest need When serious illness comes, one needs extra medical and daily care. The plan covers not only your hospitalization expenses but also other common expenses such as pre-admission and post-hospitalization treatment and private nursing expenses. It also includes additional coverage for cancer treatment and dialysis. In addition, the Second Medical Opinion Service offers you alternative medical opinions through a network of world-leading medical centers and experts. Cancer treatment and dialysis benefit up to HK$160,000, giving you an extra peace of mind. 2
Flexible plan that fits your unique needs The medical advances make many treatments and check-ups easier without the need of hospitalization. Saving the hassle of being admitted to hospital, the plan even covers MRI, CT Scan and PET Scan carried out in a clinic for medical conditions related to the hospital confinement. What s more? The plan offers an array of optional benefits 2 to customize your coverage: Supplementary Major Medical Benefit additional benefit of up to HK$575,000 per year Hospital Cash Benefit a daily HK$600 hospital cash per day Outpatient Benefit Chinese Herbalist, Chinese Bonesetter, Acupuncturist, Physiotherapist, Home Consultation, etc. Dental Benefit scaling and polishing, oral examination, extractions, fillings, X-ray, root canal fillings, etc. An array of optional benefits giving you an all-round protection. For a few more dollars a day, you can also take up HealthFirst TopUp plan to extend your coverage to HK$1 million. APPLY NOW FOR EXCLUSIVE PRIVILEGES Remarks: 1 You are required to settle any expenses exceeding your maximum benefit limit. 2 For details of coverage, please refer to Cigna HealthFirst Choice Benefit Schedule. You have to enroll on the same benefit level for both Hospital and Surgical Benefits and optional benefits. 3
EXCLUSIVE PRIVILEGES Complimentary Cigna Lifelong Preventive Program The plan offers free annual influenza vaccination, body check and skin consultation. There are also various health and wellness services at a discounted price. Please visit www.cigna.com.hk/cignaclub for details. Health Reward To celebrate your good health, you can enjoy a premium discount at renewal. Number of consecutive policy years of no Hospital and Surgical claim record Discount at Renewal (for whole policy) 2 5% 3 8% 5 or above 15% Guaranteed Lifetime Renewal The policy is guarantee renewable 1 every year regardless to your individual health/ claims record. Children s Discount 30% premium discount 2 on the first year for child (from 15 days to age 17) enrolling policy with his/her parent. Remarks: 1 You are guaranteed lifetime renewal of your policy subject to the continuing issuance of HealthFirst Choice medical plan and the payment of the premium. Cigna reserves the right to revise policy premiums, terms and conditions, and /or the Benefit Schedule upon each renewal. 2 Discount applies to Hospital and Surgical Benefits and other optional benefits. Parent and child have to enroll on the same plan level and same option of riders in order to obtain the discount. 4
For more details, please talk to your financial consultant or visit www.cigna.com.hk. 5
CASE ILLUSTRATION 6
How HealthFirst Choice helped Mr. Wong? Cashless hospitalization can be easily arranged through the 24-hour hotline. Chemotherapy is covered by Cancer Treatment and Dialysis, leaving the Other Medical Expenses benefit to cover the miscellaneous hospital charges. The plan covers the PET scan conducted in a clinic that saved him the hassle of admission to a hospital. Total amount covered (HK$): Cigna HealthFirst Choice Benefits Maximum Limit of Plan 2 (Semi-private) Medical Expense Incurred Amount Covered Room & Board 1,600 x 14 days = 22,400 1,600 x 14 days = 22,400 22,400 Surgical (complex) 65,000 60,000 60,000 Anaesthetist (complex) 16,000 16,000 16,000 Operation Theatre (complex) 16,600 15,000 15,000 Other Medical Expenses (including outpatient PET scan) 21,500 48,000 21,500 Chemotherapy 120,000 8,500 x 15 times = 127,500 120,000 Total 288,900 254,900 Expenses paid by Mr. Wong 34,000 Remarks: The above Surgical Expenses are for reference and illustration purpose only. Actual amount may differ from case to case. 7
Cigna HealthFirst Choice Benefit Schedule The issue age is from 15 days to 75 years old, policy renewal till 100 years old. Hospital and Surgical Benefits Maximum Limit (HK$) Plan 1 (Private) Plan 2 (Semi-Private) Plan 3 (Ward) Hospital Room and Board (maximum 270 days per Policy Year) 3,200 per day 1,600 per day 750 per day Surgical Expenses (Per Surgery) Complex 95,000 65,000 48,000 Major 47,500 32,500 25,000 Intermediate 20,500 13,600 10,000 Minor 7,500 6,500 5,500 Anaesthetist s Expenses (Per Surgery) Complex 26,900 16,000 12,300 Major 13,200 9,100 7,100 Intermediate 6,000 4,000 3,000 Minor 3,200 2,200 2,000 Operation Theatre Expenses (Per Surgery) Complex 27,400 16,600 12,500 Major 13,500 10,000 8,100 Intermediate 6,500 4,200 3,500 Minor 3,250 2,200 2,000 Inpatient Doctor's Call (for non-surgical case only, maximum 270 days per Policy Year) 3,200 per day 1,600 per day 750 per day Cancer Treatment and Dialysis 160,000 120,000 80,000 Intensive Care Unit Expenses 25,500 22,000 20,100 Inpatient Specialist's Fee 10,000 3,800 2,500 Companion Bed (maximum 270 days per Policy Year) 1,500 per day 750 per day 350 per day Pre-admission and Post-Hospitalization Outpatient Expenses (maximum 2 pre-admission and 2 post-hospitalization clinic visits) 4,500 2,500 1,800 Private Nursing Expenses (maximum 120 days per Policy Year) 850 per day 500 per day 325 per day Other Medical Expenses include in-hospital / clinical expenses of MRI, CT scan, PET scan, hospital miscellaneous charges, etc. (per Policy Year) 35,000 21,500 13,600 Overall Annual Limit Below attained age of 65 on the Commencement Date Unlimited Attained age of 65 or above on the Commencement Date 700,000 375,000 175,000 No Claim Discount No claim record for 2 consecutive years 5% 5% 5% No claim record for 3 consecutive years 8% 8% 8% No claim record for 5 consecutive years or more 15% 15% 15% Life Benefit 5,000 8
Cigna HealthFirst Choice (Optional Benefits) Benefit Schedule Supplementary Major Medical Benefit Maximum Benefit (HK$) Plan 1 (Private) Plan 2 (Semi-Private) Plan 3 (Ward) Maximum limit per Policy Year 575,000 290,000 120,000 Lifetime Limit (applicable from age 75 onwards) 850,000 450,000 220,000 Remarks: For each claim, HK$500 will be deducted from the claim amount and the reimbursement amount is 80% of the remaining balance. The claim amount will be adjusted if the actual hospital confinement is higher than the eligible plan level. Please refer to the policy provisions for details. Hospital Cash Benefit Covers from the 3rd day of hospital confinement, maximum 182 days per Policy Year Outpatient Benefit Maximum Benefit (HK$) Plan 1 (Private) Plan 2 (Semi-Private) Plan 3 (Ward) 600 per day Maximum Benefit (HK$) Plan 1 (Private) Plan 2 (Semi-Private) Plan 3 (Ward) 1. General Practitioner (include 3-day basic medication) 380 240 180 2. Specialist* (include 3-day basic medication) 660 480 350 3. Physiotherapist* (treatment fee only) 630 430 330 4. Chiropractor* (treatment fee only) 630 430 330 5. Chinese Herbalist (include 2 packs of Chinese medicines) 230 180 150 6. Chinese Bonesetter 230 180 150 7. Acupuncturist (treatment fee only) 230 180 150 8. Home Consultation (consultation fee only, per visit) 720 520 350 9. Prescribed Western Medicine (per Policy Year) 2,500 1,500 1,000 10. Diagnostic Imaging and Laboratory Tests* (per Policy Year) 3,500 2,000 1,500 Remarks: * Referral from a Physician required. Maximum 30 visits for items 1 to 8, within which a maximum of 10 visits for items 4 to 8 per Policy Year. For items 1 to 7, full cover for network clinic or 80% reimbursement up to the respective maximum benefit limit for non-network clinic. Maximum Benefit (HK$) Dental Benefit Scaling and Polishing (per Policy Year) Fillings; dentures, crowns and bridges; drainage of abscesses; extractions; X-rays; root canal fillings; routine oral examination Plan 1 (Private) Plan 2 (Semi-Private) Plan 3 (Ward) 2 visits Unlimited visits, with maximum limit of 5,000 for all items per Policy Year 9
Recommended plan for extra protection CIGNA HEALTHFIRST TOPUP Thanks to advancement in medical technology, many new medical treatments have emerged. You may thus choose a better treatment, but also implies higher medical fees. For as low as a few extra dollars a day, HealthFirst TopUp offers an annual coverage of up to HK$1 million to help ease your financial burden in the event of unexpected medical expenses. Case Illustration How Cigna HealthFirst TopUp helped Mr. Lee? Though the ward level plan of HealthFirst Choice is enough to cover basic medical expenses, TopUp makes a difference when it comes to very complex and high risk surgery which involves substantial medical expense like in Mr. Lee s case. Since the benefit payable under Cigna HealthFirst Choice is higher than the HK$50,000 deductible of Cigna HealthFirst TopUp, Mr. Lee did not need to pay any deductible. Total amount covered (HK$): Cigna HealthFirst Top Up Benefits Medical Expenses Incurred Maximum Limit of HealthFirst Choice (Ward level) Covered by TopUp (90% of remaining balance) Surgical (complex) 300,000 48,000 226,800 Anaesthetist (complex) 90,000 12,300 69,930 Operation Theatre (complex) 120,000 12,500 79,380 Other Medical Expenses 90,000 13,600 68,760 Total 600,000 86,400 444,870 Expenses paid by Mr. Lee 68,730 Remarks: The above Surgical Expenses are for reference and illustration purpose only. Actual amount may differ from case to case. 10
Cigna HealthFirst TopUp Benefit Schedule The issue age is from 15 days to 65 years old, policy renewal is till 100 years old. Hospital and Surgical Benefits Maximum Limit (HK$) Plan 1 (Private) Plan 2 (Semi-Private) Plan 3 (Ward) Hospital Room and Board (maximum 270 days per Policy Year) Surgical Expenses Anaesthetist's Expenses (Subject to 35% of Surgical Expenses payable) Operation Theatre Expenses (Subject to 35% of Surgical Expenses payable) Inpatient Doctor's Call (maximum 270 days per Policy Year) Cancer Treatment and Dialysis Intensive Care Unit Expenses Inpatient Specialist's Fees $1,000,000 (Pays 90% of Hospital and Surgical Benefits after an annual Deductible 2 ) Companion Bed (maximum 270 days per Policy Year) Pre-admission and Post-Hospitalization Outpatient Expenses 1 (maximum 2 pre-admission and 2 post-hospitalization clinic visits) Private Nursing Expenses (maximum 120 days per Policy Year) Other Medical Expenses Life Benefit 5,000 Deductible options (per year) 150,000 / 200,000 100,000 / 150,000 50,000 / 100,000 Remarks: 1 The maximum benefit limit for this item is HK$10,000 per Policy year. 2 If the benefit payable under Hospital and Surgical Benefits of Cigna HealthFirst Choice is higher than your selected deductible, then the reimbursement amount is 90% of the claim without any deductible. 11
12 EXCLUSION PROVISIONS Cigna shall not be liable for the expenses incurred in the following situations: Applicable to Cigna HealthFirst Choice and Cigna HealthFirst TopUp: 1. Pre-existing Medical Conditions; 2. War, invasion, act of foreign enemy, hostilities (whether war is declared or not), civil commotion, rebellion, revolution, insurrection, military or usurped power or terrorism; 3. The Person Insured s engaging in or taking part in: a ) Naval, military or air force service or operations, armed force or service with the police of any nation; b ) Professional sports or hazardous activities such as but not limited to scuba diving involving the aid of breathing apparatus, rock climbing or mountaineering, parachuting, hang-gliding (whether powered or not), paragliding, bungee-jumping, winter sports or any kind of race other than by foot; c ) Working at height (over 20 feet); d ) Operating heavy machinery; e ) Aviation or aerial activities except air travel as a fare-paying passenger in or as a member of the aircrew; or f ) Manufacture, storing, filling, breaking down, handling or transport of any explosive (including but not limited to fireworks or firecrackers) or chemical material; 4. The Person Insured s suicide, attempted suicide or intentionally self-inflicted injuries while sane or insane; 5. The Person Insured being under the influence of alcohol or drugs unless, in the case of drug consumption, it is proven that such drug was taken in accordance with proper medical prescription by a physician other than for the treatment of drug addiction; the Person Insured s driving any kind of vehicle while the alcohol content of his/her blood exceeds the level permitted by the laws of the country or territory where the accident resulting in bodily injury or sickness occurs; or any act of the person insured being contrary to the law of the country or territory in which the bodily injury or sickness occurs as a result of such act; 6. Pregnancy, childbirth and miscarriage of or abortion by the Person Insured, including complications resulting therefrom notwithstanding that such incident may have been accelerated or induced by bodily injury or sickness; 7. Infection with Human Immunodeficiency Virus (HIV) or variants including Acquired Immune Deficiency Syndrome (AIDS) and AIDS-related complex (ARC); sexually-transmitted diseases or treatment thereof; infertility or sterilization or any type of fertility; 8. Birth defects, congenital conditions, development conditions, hereditary conditions or any disabilities arising therefrom; cosmetic and elective surgery; 9. Eye refraction error except due to bodily Injury, routine eye/ear examinations, cost of spectacles, contact lenses, hearing aids and artificial lens; vaccination and immunization injections; 10. All dental treatment prescribed by dentist except emergency treatments by a physician during hospital confinement due to bodily injury. Follow up treatment from such hospital confinement shall not be covered (unless the Dental Benefit is covered under this Policy); 11. Mental, psychiatric or nervous illness; congenital conditions; developmental conditions; or hereditary conditions; 12. Artificial life maintenance including mechanical ventilation, where such treatment will not or is not expected to result in the person insured s recovery, or restore the person insured to his/her previous state of health; or fetal surgery or treatment; 13. Treatment for a related condition resulting from addictive conditions and disorders; sleep disorders including insomnia, snoring, sleep-related breathing problems or sleep studies; 14. Not medically necessary; 15. Nuclear energy related (Nuclear reaction, radiation or contamination; and this clause only applies to Cigna HealthFirst TopUp); 16. The Person Insured s voluntarily exposure of the person insured to any hazard or danger; and 17. Fees / expenses incurred from the following reasons: a ) Convalescence accommodation or treatment or services rendered in any sanatorium or similar establishment; b ) Prosthesis, corrective devices and medical appliances, which are not intra-operatively required; c ) All organ transplantation, transplant procedures and acquisition of the organ itself to be used for organ transplantation; d ) Medical treatment received after termination of this Policy or the expiry of the period of insurance notwithstanding that such expense may arise from bodily injury or sickness occurring during the Period of Insurance; e ) Routine medical examinations or health screening checks; f ) Subject to the Clause on Co-Ordination of Benefits in Policy Provision, any bodily injury or sickness for which compensation is payable under any laws or regulations or any other insurance plan except to the extent that such charges are not reimbursed by such laws or regulations or other insurance plan; g ) Alternative treatment including but not limited to Chinese medicine treatment, acupuncture, acupressure, Tui Nai, hypnotism, rolfing, massage therapy, aromatherapy (unless it is an acupuncturist benefit, Chinese herbalist benefit and Chinese bonesetter benefit payable under the Benefit Schedule); h ) Experimental and/or new medical technology/procedure not yet approved by Cigna; and i ) Non-medical services, including but not limited to guest meals, radio, telephone, photocopy, taxes, medical report charges and the like. Applicable only to Optional Dental Benefit: 1. Appliances or restoration necessary to increase vertical dimension or restore an occlusion; 2. Dental implants; 3. Cosmetic dentistry procedures such as bleaching and veneers; 4. Orthodontic services; 5. Repair or replacement of orthodontic appliances; 6. Placement of bone grafts or extra-oral substances in the treatment of periodontal disorders; 7. Procedures or appliances to correct congenital malformations; 8. Treatment of malignancies, cysts, or neoplasms; 9. Replacement of lost or stolen dentures; 10. Services or treatment for, or associated with, temporomandibular joint (TMJ) dysfunction or disorder or for orthognathic surgery; 11. Services or supplies intended to diagnose or treat any condition that is occupational injury or disease; or 12. Replacement or additions to existing dentures or bridgework. Notes: 1. The above insurance plans are underwritten by Cigna Worldwide Life Insurance Company Limited. 2. This brochure is prepared to provide you with a brief summary of the insurance plans, their terms, conditions and exclusions and is not a contract of insurance. For details of coverage and exclusions, please refer to the policy provisions. 3. Any case example extracted in this brochure is for illustrative purpose only. It shall not be construed as an admission of our liability under any claim. Claim payment depends on facts of different cases. Cigna reserves its right to make final decision on all claims payment. 4. If there is any discrepancy between the English and Chinese version of this brochure, the English version shall prevail.