Major Terms and Conditions
Change of Benefits
Any change of benefits or coverage under the policy as requested by the policyholder shall only take effect at renewal or subject to the approval by Blue Cross.
In respect of the Basic Hospital and Surgical Benefits and the Optional Supplementary Medical Benefits, if an insured is afflicted with a disability prior to the benefit upgrade, the insured shall only be entitled to the benefit level in force at the time when the disability commences. However, if the benefit upgrade has been in force for 365 days when the insured receives medical treatment for a disability that precedes the benefit upgrade, the insured shall be entitled to the benefit level after the benefit upgrade. Nevertheless, if the insured is confined in a hospital at the time when the benefit upgrade first takes effect (the “Current Confinement”), the benefit upgrade will have no application to the Current Confinement and will only take effect after the insured is discharged from the Current Confinement.
Cancellation
The policyholder may cancel the policy by giving not less than 30 days’ prior written notice to Blue Cross. The policyholder may be entitled to a refund of part of the premium paid without interest during the first period of insurance if the following conditions are fulfilled: a) no claims have been made; b) there is no outstanding annual premium under the policy; and c) all healthcare cards (if any) and coupons (if any) are returned to Blue Cross. The premium will be refunded in accordance with the table below:
Period Covered from the Effective Date of the First Period of Insurance |
Premium to be Refunded |
Not exceeding |
2 months |
75% |
of the annual premium |
4 months |
55% |
6 months |
35% |
8 months |
15% |
Over 8 months |
Nil |
No premium will be refunded to the policyholder after the end of the 8th month of the first period of insurance.
Notwithstanding anything to the contrary, any indebtedness which may be owing under the policy shall be deducted from the premium to be refunded.
If cancellation shall take place after the policy has been renewed upon the expiry of the first period of insurance, no premium will be refunded to the policyholder.
Blue Cross may cease to provide cover to any insured if any requirement under the policy has not been complied with and in such event, Blue Cross may refund the premium to the policyholder on a pro-rata basis for the unexpired policy period of that insured. For the avoidance of doubt, the policy shall remain effective for the remainder of the policy period in respect of other insured(s).
Exclusions
Unless specifically included in the Schedule of Benefits or any endorsement to the policy, Blue Cross shall not pay any claims, costs or expenses in relation to or arising out of the following:
- Where any loss, costs or expenses is recoverable under any law, medical program, or other insurance policy provided by any government, company, other insurers or any other third party.
- Treatment or test which is not Medically Necessary; or purchase of drugs which are not prescribed by a Registered Medical Practitioner.
- Confinement solely for the purpose of general checkup, rehabilitation, rest cures, sanitaria care or allied health service, including but not limited to physiotherapy, occupational therapy and speech therapy.
- Treatment related to Congenital Conditions (except Hernias, Strabismus and Phimosis) or Developmental Conditions or disease of similar kind.
- Pre-existing Conditions, which shall mean any disability which presented signs or symptoms of which the insured was aware or should reasonably have been aware or for which the insured received medical or surgical care or treatment within 90 days immediately preceding the Insured Effective Date, unless the insured has been covered under the policy for not less than 365 days.
- Expenses directly or indirectly arising from Human Immunodeficiency Virus (“HIV”) and its related disability, including Acquired Immune Deficiency Syndrome (AIDS) and/or any mutations, derivation or variations thereof, consequential upon an HIV infection occurring before the Insured Effective Date. For the purposes of this exclusion, any HIV related disability emerging within 5 years after the Insured Effective Date will be conclusively presumed to proceed from an HIV infection occurring prior to the Insured Effective Date.
- Treatment or disability directly or indirectly arising from or consequent upon:
the abuse of drugs or alcohol, self-inflicted injuries or attempted suicide, illegal activity, or driving or maneuvering machines whilst exceeding the prescribed alcohol and drug limit, or venereal and sexually transmitted disease or its sequelae.
- Any charges in respect of services for beautification or cosmetic purposes; except as otherwise provided by Vaccination or Routine Checkup under the Optional Outpatient Benefits, expenses in relation to but not limited to hearing tests, routine blood tests, general check-ups, vaccinations or inoculations, prophylaxis treatment, Hair Mineral Analysis (HMA), bird's nest, lingzhi, ginseng and other specialised Chinese tonic medicine, health supplements (unless approved by Blue Cross); over-the-counter drugs; charges for correcting visual acuity or refractive errors including but not limited to eye refractive therapy, visual tests, fitting of spectacles or lens and any related operational procedures and services.
- Except as otherwise provided by the Optional Dental Benefits, dental treatment and oral surgery (except emergency treatment and surgery arising from an accident received by the insured during confinement); follow up dental treatment or oral surgery after inpatient stay or at outpatient dental facility.
- Investigation, treatment, surgical procedure and counselling service relating to maternity conditions and its complications, including diagnostic tests for pregnancy or resulting childbirth, abortion or miscarriage; birth control or reversal of birth control; sterilisation or sex reassignment of either sex; infertility including in-vitro fertilisation or any other artificial method of inducing pregnancy; and sexual dysfunction including but not limited to impotence, erectile dysfunction, pre-mature ejaculation regardless of cause.
- Purchase of artificial limbs, body organs and prosthetic devices including those prosthetic devices that are surgically implanted. Purchase or rental of durable medical equipment or appliances including but not limited to wheelchairs, beds and furniture, airway pressure machines and masks, portable oxygen and oxygen therapy devices, dialysis machines, exercise equipment, spectacles, hearing aids, special braces, walking aids, air purifiers or conditioners and heat appliances for home use.
- Treatment directly or indirectly arising from any psychotic, psychological, or psychiatric conditions and any physiological or psychosomatic manifestations thereof.
- Alternative treatment including but not limited to acupressure, cupping, tianjiu, tui na, hypnotism, qigong, massage therapy, aroma therapy and such alike.
- Experimental, unproven and/or new medical technology or procedure not yet approved by Blue Cross with reference to the common standard in the locality where the treatment is received.
- Non-medical services, including but not limited to guest meals, radio or TV rentals, telephone charges, photocopy charges, medical report charges, taxes and the like.
- Treatment or disability directly or indirectly arising from war (declared or undeclared), civil war, invasion, acts of foreign enemies, hostilities, rebellion, revolution, riot, insurrection or military or usurped power; resulting from taking part in military, air force, naval and other disciplinary services.
Notes:
This brochure is for distribution in Hong Kong only. The distribution of this brochure is not and shall not be construed as an offer to sell or a solicitation to buy or a provision of any insurance product outside Hong Kong.
Employee Medical Care Plan is underwritten by Blue Cross (Asia-Pacific) Insurance Limited, an authorised insurer in Hong Kong.
Blue Cross (Asia-Pacific) Insurance Limited is a subsidiary of AIA Group Limited. It is not affiliated with or related in any way to Blue Cross and Blue Shield Association or any of its affiliates or licensees.
For more details, please visit any BEA Business Centre
or contact the Blue Cross Customer Service Hotline 2839 6377
This webpage is for reference only. Please refer to the policy for the exact terms and conditions and the full list of policy exclusions. Should there be any discrepancy between the English and the Chinese versions of this material, the English version shall apply and prevail. All insurance product information available on this website is not and shall not be construed as an offer to sell or a provision of insurance products to any person in any jurisdiction outside Hong Kong or a solicitation to such person to buy insurance products.
The insurance plan is underwritten by Blue Cross (Asia-Pacific) Insurance Limited (“Blue Cross”), a subsidiary of AIA Group Limited. The Bank of East Asia, Limited (“BEA”) is an appointed insurance agency of Blue Cross. The insurance plan is a product of Blue Cross but not BEA. All benefits payable under the insurance plan are subject to the credit risk of Blue Cross.
In respect of an eligible dispute (as defined in the Terms of Reference for the Financial Dispute Resolution Centre in relation to the Financial Dispute Resolution Scheme) arising between BEA and the customer out of the selling process or processing of the related transaction, BEA is required to enter into a Financial Dispute Resolution Scheme process with the customer.
BEA’s sales staff (including direct sales staff and authorised agents) are remunerated not only based on their financial performance, but also according to a range of other factors, including their adherence to best practices and their dedication to serving customers’ interests.
Blue Cross (Asia-Pacific) Insurance Limited is a subsidiary of AIA Group Limited. It is not affiliated with or related in any way to Blue Cross and Blue Shield Association or any of its affiliates or licensees.