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. 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 dependants^Ø an extensive 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

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 dependants^Ø)

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.

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

Enhanced Protection

Caring Medical Protection Plus⁴

Caring Medical Protection Plus is an individual medical insurance plan specifically designed for employees insured under Blue Cross group medical insurance policy, and their spouse and child(ren). Not only will it enhance the medical cover currently enjoyed by the employee, but also it will continue the medical protection for the employee and his/her loved ones even if he/she changes jobs or retire.

Plan Highlights:

• Offering Basic Hospital and Surgical Benefits^§, Optional Outpatient Benefits^‡ and Optional Dental Benefits^‡
• Coverage of pre-existing conditions
• Yearly renewal with coverage until age 100
• Worldwide medical coverage
• 24-Hour Worldwide Emergency Aid Service

^§ Underwriting not required, except under certain specified circumstances
^‡ Underwriting not required

Basic Hospital and Surgical Benefits

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

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.

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

Optional Outpatient Benefits

Must be enrolled together with the Optional Outpatient Benefits

^▲ Max. 30 visits per policy year for General Practitioner’s Consultation, Chinese Medicine Practitioner Treatment and Vaccination or 5 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.

^Ø  Referring to the employees' spouse and child(ren).

Plan Summary

Application Checklist

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.

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 “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

Exclusions

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

[ Policy Terms & Conditions]