Employee Medical Care Plan

Underwritten by Blue Cross (Asia-Pacific) Insurance Limited

Employee Medical Care Plan

Medical protection is a key component of employee benefits. Comprehensive medical protection can help attract and retain high-calibre employees, maintain manpower stability, enhance productivity and create a positive, caring company culture.

Blue Cross fully understands the needs of small and medium enterprises and thus we have tailored Employee Medical Care Plan, a cost-effective and flexible medical plan that benefits both employers and employees. At a modest premium, employers can offer employees and their families an all-round medical coverage, allowing employees to work worry-free, thereby fostering further development of the company.

Plan Highlights

Easy Enrolment

• SMEs with as few as 3 employees can enrol

• Personal health record form is not required if the number of insured employees reaches 5 or above

• Broad enrolment age from 12 days to age 70, with renewal up to age 75

Comprehensive and Flexible Benefits

• All-round Basic Hospital and Surgical Benefits and 3 optional benefits below for extra protection:

  - Optional Supplementary Medical Benefits

  - Optional Outpatient Benefits

  - Optional Dental Benefits

Easy Access to Extensive High-quality Outpatient Medical Network

Top-up Overseas Accidental Medical Expenses Benefits

Pre-hospitalisation Claim Assessment

24-hour Worldwide Emergency Aid

Emergency Medical Assistance in China

Blue Cross Nursing Care Hotline

Blue Cross HK” Mobile App

Enhanced Protection

Exclusive Top–up Option/Conversion Option to Enhance or Maintain Protection

Without underwriting³, a member of Employee Medical Care Plan can enrol in a selected individual medical insurance plan offered by Blue Cross (i.e. “Caring Medical Protection Plus” ⁴) as a “top-up” cover to the company’s medical protection. At a modest premium, the member can enhance the medical protection by “leveraging” the group cover.

Even if the member retires or moves to a new job, the member will be eligible to join Caring Medical Protection Plus, enjoying the same level of medical cover as before. Features of Caring Medical Protection Plus include:

• Guaranteed acceptance of all disabilities covered by the group medical plan
• Guaranteed renewal up to age 99

Basic Hospital and Surgical Benefits

The benefits cover 100% of eligible expenses⁵ up to the following maximum benefit limit per disability:

^# Only applicable to confinement in general ward of eligible public hospitals in Hong Kong.

^• Only applicable to the following day case surgical procedures: oesophagogastroduodenoscopy, colonoscopy, cystoscopy, arthroscopy, colposcopy, bronchoscopy, repair of retinal detachment and hysteroscopy.

⁺Blue Cross will pay this benefit when the insured is covered by another insurance company which is the first payer of the medical benefits regardless of whether the insured is covered by an individual or group policy.

Optional Supplementary Medical Benefits

Must be enrolled together with the Basic Hospital and Surgical Benefits (with the same plan level and corresponding entitled level of accommodation)

The benefits cover 80% of eligible expenses⁵ payable in excess of the maximum benefit limit of the designated benefit items^* under the Basic Hospital and Surgical Benefits (with the corresponding entitled level of accommodation), up to the following maximum benefit limit per disability. Blue Cross will reimburse 80% of the eligible expenses incurred and the insured will have to bear the remaining 20%.

^*The designated benefit items shall mean Room and Board, Miscellaneous Hospital Charges, Surgeon’s Fees, Anaesthetist’s Fees, Operating Theatre Charges, Physician’s Hospital Visits, Specialist’s Fees, Charges for Intensive Care, Registered Private Nurse’s Fees and Top-up Overseas Accidental Medical Expenses Benefits.

If the insured is confined in a room of a class higher than the insured’s entitled level of accommodation, the eligible expenses will be calculated based on below scale of reimbursement:

^{^} Only applicable to the Optional Supplementary Medical Benefits.

Optional Outpatient Benefits

Must be enrolled together with the Basic Hospital and Surgical Benefits

The benefits offer 2 reimbursement options – 80% or 100% of eligible expenses⁵. The insured may visit any clinic of their own choice. Subject to the maximum benefit limit, when the 80% reimbursement percentage option applies, Blue Cross will reimburse 80% of the eligible expenses incurred, and the insured will have to bear the remaining 20%; while the full amount of the eligible expenses incurred will be paid by Blue Cross under the 100% reimbursement percentage option.

The insured will be issued with a Blue Cross Healthcare Card which entitles the insured to use it at any designated network clinic for General Practitioner’s Consultation, Chinese Medicine Practitioner Treatment, Specialist’s Consultation or Physiotherapy. Each consultation at a network clinic is subject to a co-payment of HK$30 under the 80% reimbursement option; while no co-payment is required for the 100% reimbursement option.

^▲ Max. 30 visits per policy year for General Practitioner’s Consultation, Chinese Medicine Practitioner Treatment and Vaccination or Routine Checkup.

Optional Dental Benefits

Must be enrolled together with the Optional Outpatient Benefits

The benefits offer 2 reimbursement options – 80% or 100% of eligible expenses⁵. Subject to the maximum benefit limit, when the 80% reimbursement percentage option applies, Blue Cross will reimburse 80% of the eligible expenses incurred, and the insured will have to bear the remaining 20%; while the full amount of the eligible expenses incurred will be paid by Blue Cross under the 100% reimbursement percentage option.

Premium Table (HK$)^6,7

^{^^} 100% of the full premium should be paid by the policyholder.

^## Age refers to the nearest birthday. If the insured’s next birthday falls within the coming 6 months from the enrolment date, the premium rate will be charged according to the insured’s next  age attained. Otherwise, it will be charged based on the insured’s current age. Policy effective date will be used to determine the age attained if it is different from the enrolment date.

** The applicant needs to verify the eligibility for enrolment in accordance with the definition of “Child” as stated in the Policy Terms and Conditions.

^ Applicable to renewal only.

Plan Summary

⁺⁺ Except for Top-up Overseas Accidental Medical Expenses Benefits and Daily Hospital Cash Allowance under the Basic Hospital and Surgical Benefits.

Application Checklist

Remarks

1. Assessment of the estimated eligible claim amounts is for customer’s reference only, the actual eligible claim amounts will be subject to the final claim decision. All benefits will be payable subject to the terms and conditions and the full list of policy exclusions. 
2. Any claims must be submitted within 90 days after discharge from hospital or the date on which relevant medical services are performed and completed. Customer can submit a completed claim form and required full documentation to Blue Cross via Blue Cross website or “Blue Cross HK” mobile app. Claim form can be downloaded from Blue Cross website. 
3. Only applicable when the members enrol in a corresponding plan level based on their existing Employee Medical Care Plan policy. 
4. For details of Caring Medical Protection Plus, please refer to the respective product brochure and policy. 
5. All expenses incurred must be Reasonable and Customary and Medically Necessary. 
   “Reasonable and Customary” shall mean a charge for medical treatments, services or supplies which does not exceed the general level of charges being charged by the relevant service providers or suppliers of similar standing in the locality where the charge is incurred for similar treatment, services or supplies to individuals of the same sex and age, for a similar disease or injury. The “Reasonable and Customary” charges shall not in any event exceed the actual charges incurred. In determining whether an expense is “Reasonable and Customary”, Blue Cross may make reference to the following (if applicable): 
   a) the gazette issued by the Hong Kong government which sets out the fees for the private patient services in public hospitals in Hong Kong;
   b) industrial treatment or service fee survey;
   c) internal claim statistics;
   d) extent or level of benefit insured; and/or
   e) other pertinent source of reference in the locality where the treatments, services or supplies are provided.
   
    “Medically Necessary” shall mean the need to have treatment or service for the purpose of treating a disability or dental condition in accordance with the generally accepted standards of medical practice and such treatment or service must: 
   
   a) require the medical expertise of qualified medical practitioner;
   b) be consistent with the diagnosis and necessary for the treatment of the condition;
   c) be rendered in accordance with professional and prudent standards of medical practice, and not be rendered primarily for the convenience or the comfort of the insured, his family members, caretaker or attending practitioner; and
   d) be rendered in the most cost-efficient manner and setting appropriate in the circumstances.
6. Blue Cross reserves the right to adjust the premium rate and the subsequent renewal premium upon policy renewal due to, for example, claim history, and revise the terms and conditions of the policy. 
7. The Insurance Authority will collect a levy on insurance premiums from policyholders through insurance companies in accordance with the law. For further information about the levy imposed by the Insurance Authority, please visit Blue Cross website at http://bluecross.com.hk/document/general/levy_collection.

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 benefit upgrade will not apply to the current confinement and will only take effect after the insured is discharged from the current confinement.

Cancellation

No premium will be refunded to the policyholder after the end of the 8^th 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 its 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:

For more details, please visit any BEA Business Centre

or contact the Blue Cross Customer Service Hotline 2839 6377

[ Policy Terms & Conditions]