Employee Medical Care Plan


Underwritten by Blue Cross (Asia-Pacific) Insurance Limited

 

Medical protection is a key component of employee benefits. Extensive 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 dependantsØ an extensive medical coverage, allowing employees to work worry-free, thereby fostering further development of the company.

 
Ø Referring to the employee’s spouse and child(ren).

 
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

    • Extensive and Flexible Medical Benefits
      • Well-rounded Basic Hospital and Surgical Benefits and 3 optional benefits below for extra protection:
      • Optional Supplementary Medical Benefits
      • Optional Outpatient Benefits
      • Optional Dental Benefits
      • Flexible combinations of inpatient and outpatient benefits, with options of ward class and reimbursement percentage for different grades of employees, suiting employers’ budgets and needs
      • Worldwide coverage for members (including employees and their dependantsØ)
  •  
    • Easy Access to Extensive High-quality Outpatient Medical Network
      • Healthcare Card offers extra convenience at over 3,000 designated service points from different medical disciplines in Hong Kong and Macau
      • Apart from General Practitioner’s and Specialist’s Consultations, credit facilities services are also extended to Chinese Medicine Practitioner Treatment and Physiotherapy under the Optional Outpatient Benefits
      • Each consultation at a designated network clinic is only subject to a co-payment of HK$30 under the 80% reimbursement option, while no co-payment is required under the 100% reimbursement option
      • Referral letter is not required for outpatient Specialist’s Consultation
  •  
    • Top-up Overseas Accidental Medical Expenses Benefits
      • In the event of accidental injury requiring hospitalisation overseas, the maximum benefit limit of the designated benefit items under the Basic Hospital and Surgical Benefits will be increased by 100%.

    • Pre-assessment Service
      • Simply provide the required information online at least 7 working days before receiving the medical procedure or treatment. We will provide an estimate of the eligible claim reimbursement amount1 based on the policy coverage, allowing the insured to plan his/her budget in advance and undergo the medical procedure or treatment with peace of mind.

    • Cashless Service2
      • If necessary, the insured can apply for the “Cashless Service” from Blue Cross before admission to private hospitals in Hong Kong. If the application is approved, we will settle his/her hospital bill directly with no prepayment upon admission and no claims upon discharge.
  •  
    • 24- Hour Worldwide Emergency Aid Service
      • Our “24-Hour Worldwide Emergency Aid Service” operates round-the-clock. Whenever and wherever the insured needs medical and emergency assistance and/or services while abroad, our designated service provider will provide a hotline for services including but not limited to medical evacuation, repatriation after treatment, hospital admission deposit guarantee and legal assistance service, providing the insured with peace of mind.

    • Emergency Medical Assistance in China Service
      • In case of emergency requiring hospitalisation in China, the insured can simply call our hotline and he/she will be able to access an extensive network of hospitals and medical units without paying any deposits.

    • “Blue Cross HK” Mobile App
      • By downloading the “Blue Cross HK” mobile app and logging in to BlueCross+, the insured will enjoy one-stop digital medical insurance services. He/she can easily search for network doctors nearby, and enjoys speedy registration at designated network clinics with electronic medical card. He/she can also submit claims3, and keep track of claim status, claim history and policy details round-the-clock.

 

Remarks:
1. 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.

2. “Cashless Service” is one of the Credit Facilities Services provided by Blue Cross. It is only applicable to admission to private hospitals in Hong Kong. The Pre-assessment Form is required to be completed and returned to Blue Cross for application and approval 4-7 working days prior to admission. Blue Cross reserves the right to determine whether to approve any such application. Blue Cross may withdraw or suspend the Credit Facilities Services anytime without prior written notice. All matters and disputes in relation to the Credit Facilities Services will be subject to the final decision of Blue Cross.

3. Any insured who wishes to make a claim must, within 90 days after clinic visit or discharge from confinement, submit claims application (i) via BlueCross+, or (ii) by sending us the prescribed form, together with all necessary original documents. 


Please refer to the Product Leaflet fot the details, benefits/ coverage, premium, major exclusions, important notes of the plan.

 

 

[ Policy Terms & Conditions]



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:

  1. 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.
  2. Treatment or test which is not Medically Necessary; or purchase of drugs which are not prescribed by a Registered Medical Practitioner.
  3. 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.
  4. Treatment related to Congenital Conditions (except Hernias, Strabismus and Phimosis) or Developmental Conditions or disease of similar kind.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. Treatment directly or indirectly arising from any psychotic, psychological, or psychiatric conditions and any physiological or psychosomatic manifestations thereof.
  13. Alternative treatment including but not limited to acupressure, cupping, tianjiu, tui na, hypnotism, qigong, massage therapy, aroma therapy and such alike.
  14. 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.
  15. 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.
  16. 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.