Important Information
This brochure does not contain the full terms and conditions of the policy. It is not, and does not form part of, a contract of insurance and is designed to provide an overview of the key features of this product. The precise terms and conditions of this plan are specified in the policy contract. Please refer to the policy contract for the definitions of capitalised terms, and the exact and complete terms and conditions of cover. This brochure should be read along with other relevant marketing materials (if any), which may include additional information and important considerations about this product. We would like to remind you to review the relevant product materials provided to you and seek independent professional advice if necessary.
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.
Key Product Risks
- You need to pay the premium for the plan. If you do not pay the premium within 30 days of the premium due date, the policy will lapse from the premium due date and the insured will lose the cover.
- Unless the policy is renewed by us, the benefits under the policy shall be terminated at the expiry of the period of insurance.
- We underwrite the plan and you are subject to our credit risk. If we are unable to meet our financial obligations under the policy, the insureds may lose the cover and you may also lose the remaining premium paid for that policy year.
- Future medical costs will be higher than they are today due to inflation. Hence, the benefit amounts and the future premium of the plan may be adjusted to reflect the inflation.
Major Exclusions
- 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 in Section C.7 (Vaccination or Routine Checkup) of the Benefits Provisions, 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 the Company), 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 in Section D (Optional Dental Benefits) of the Benefits Provisions, 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.
- Treatment directly or indirectly arising from any psychotic, psychological, or psychiatric conditions and any physiological or psychosomatic manifestations thereof.
- Experimental, unproven and/or new medical technology or procedure not yet approved by the Company with reference to the common standard in the locality where the treatment is received.
The above-mentioned exclusions are for reference only. Please refer to the terms and conditions of the policy for the complete list and details of the exclusions.
Premium Adjustment and Product Features Revision
Premium Adjustment
In order to provide you with continuous protection, we will annually review the premium of your plan and if necessary, the renewal premium will be adjusted at the end of the policy year. We will consider factors including but not limited to the following during the review process:
• claim costs incurred from all policies under the plan and the expected claim outgo in the coming year which reflects the impact of medical trend, medical cost inflation and product feature revisions
• expenses directly related to the policy and indirect expenses allocated to this product
• age-related adjustment of the insured, a particular risk class or change of risk class
Product Features Revision
We reserve the right to revise the benefit structure under the policy, so as to keep pace with the times for medical advancement and to provide you with continuous protection.
Product Limitation
1. We only cover the charges and/or expenses of the insured on medically necessary and reasonable and customary basis.
“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.
“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.
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.
2. If any confinement, surgery and/or medical treatment covered by the plan is also covered by other group medical policy (if any), benefits under the plan will be paid only after all such group medical policies have been claimed.
3. In the event that an insured is entitled to recover all or part of the expenses from the group medical insurance plans provided by other insurance companies, and/or Blue Cross group medical insurance policy, such expenses shall firstly be reimbursed under such group medical insurance plans, and/or Blue Cross group medical insurance policy.
4. Medical network services are provided by network doctors, network hospitals and network medical units. Blue Cross shall not be responsible for any act or omission of network doctors, network hospitals and network medical units in the provision of medical network services. Blue Cross reserves the right to amend, suspend or terminate the list of network doctors, network hospitals and network medical units without further notice. Insureds are advised to seek independent advice from doctors before receiving any medical treatment to ensure such treatment is suitable to their health condition.
5. “Pre-assessment Service” is an additional value-added service and does not form part of the plan. Assessment of the estimated eligible claim reimbursement amounts is for reference only. The actual eligible claim amount will be subject to the final claim decision of Blue Cross. All benefits will be payable subject to the terms and conditions of the policy and the full list of policy exclusions. Blue Cross reserves the right to amend, suspend or terminate the service without further notice.
6. “Cashless Service” is an additional value-added service. Blue Cross reserves the right to amend, suspend or terminate the service without further notice.
7. All services under “24-Hour Worldwide Emergency Aid Service“ are covered during a journey outside of the place of residence only. The services are provided by third party service provider(s). Blue Cross shall not be responsible for any act, negligence or omission of medical advice, opinion, service or treatment on the part of them. Blue Cross reserves the right to amend, suspend or terminate the service without further notice. Services under “24-Hour Worldwide Emergency Aid Service“ are additional value-added services and do not form part of the plan.
8. If you would like to change the benefits or coverage after policy inception, such a request shall be subject to Blue Cross’ approval.
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.
Claim Process
If an insured wishes to make a claim, he/she must send us the prescribed form, or submit the claim via e-claim platform at Blue Cross website or “Blue Cross HK” Mobile App, together with all necessary original documents, within 90 days after clinic visit or discharge from confinement.
Cancellation Right
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).
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.
