OptimaCEO Medical Plan / OptimaCEO Medical Plan (Worldwide) /OptimaCEO Medical Plan – First Gift

Life Insurance - Medical Protection

Underwritten by AIA International Limited (Incorporated in Bermuda with limited liability)


Revolutionising wellness and medical solutions for a future of health and longevity

PRESTIGIOUS WELLNESS AND MEDICAL SOLUTIONS AGAINST HEALTH CHALLENGES

FOR A FUTURE FLOURISHING WITH HEALTH AND ENJOYMENT

 

 

Please refer to the Product Brochure for the details, coverage, key risks, major exclusions, terms and conditions of the plan.

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Important Information for OptimaCEO Medical Plan

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. In case you want to read policy contract sample before making an application, you can obtain a copy from AIA. This brochure should be read along with the illustrative document (if any) and other relevant marketing materials, which 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.

You have the right to purchase OptimaCEO Medical Plan as a standalone plan without purchasing other insurance products at the same time.

This plan is an insurance plan without any savings element. All premiums are paid for the insurance and related costs.

This brochure is for distribution in Hong Kong only.


Key Product Risks
1. You need to pay the premium for this plan for life as long as you renew for this plan or for this add-on plan until the basic plan it is attached to is terminated. If you do not pay the premium within 31 days of the premium due date, the policy will be terminated and you / the insured will lose the cover.
2. You may request for the termination of your policy by notifying us in written notice. Also, we will terminate your policy and you / the insured will lose the cover on the occurrence of the earliest of any of the following:
• the insured passes away;
• you do not pay the premium within 31 days of the premium due date;
• when the aggregate benefits (excluding compassionate death benefit) paid under your policy and all other relevant insurance policies covering the same insured have reached the overall lifetime limit; or
• when you take this plan as add-on plan of any basic plan which has been terminated, matured, cancelled or converted to a non-participating insurance plan; or such add-on plan is cancelled or terminated pursuant to the terms of the corresponding basic plan.
If your OptimaCEO Medical Plan policy is terminated because you do not pay the premium within 31 days of the premium due date, and the insured is confined in a hospital for a covered illness or covered injury on the date when your OptimaCEO Medical Plan policy is terminated, we will extend the cover of your OptimaCEO Medical Plan policy while the insured is confined in hospital for up to an additional 30 days without the need for you to make any premium payments, subject to the same benefit limits which apply to your OptimaCEO Medical Plan policy.
3. We underwrite the plan and you are subject to our credit risk. If we are unable to satisfy the financial obligations of the policy, the insured may lose his / her cover and you may lose the remaining premium for that policy year.
4. You are subject to exchange rate risks for plans denominated in currencies other than the local currency. Exchange rates fluctuate from time to time. You may suffer a loss of your benefit values and the subsequent premium payments (if any) may be higher than your initial premium payment as a result of exchange rate fluctuations. You should consider the exchange rate risks and decide whether to take such risks.
5. The future medical costs will be higher than they are today due to inflation. Hence, the benefit amounts and the future premium rate of this plan may be revised to reflect the inflation (Please refer to Annual Premium Table for the first year premium provided by your financial planner).


Key Exclusions
Under this plan, we will not cover any confinement, treatment, surgery or charges relating to or caused directly or indirectly, wholly or partly, by any of the following:

• any treatment, investigation, service or supplies which is not medically necessary
• any pre-existing condition or congenital condition that appears or is diagnosed before the insured reaches the age of 8
• self-destruction, intentional self-inflicted injury or drug abuse
• war or warlike operations, and civil commotion, any violation or attempted violation of the law or resisting arrest, acts of terrorism where the insured is a terrorist, the use of atomic, biological or chemical weapons as well as radioactive, biological or chemical contamination due to any act of terrorism (except where the insured is injured during a trip outside the insured’s permanent residence country or place); or when the insured travels to a country at war, or where there is warlike operation, mutiny, riot, civil commotion, martial law or state of siege, or a war zone as recognised by the United Nations
• pregnancy, miscarriage, child birth, abortion, or related complications, except for “pregnancy complications benefit” (see benefits schedule for OptimaCEO Medical Plan, item 22 for details), mental or nervous disorder, except for the “mental or nervous disorder benefit” (see benefits schedule for OptimaCEO Medical Plan, item 19 for details)
• “HIV” and its related injury or illness which manifested within the first 5 policy years, unless it is proven with evidence that HIV and its related injury or illness was first contracted or occurred after the effective date of the coverage
• cosmetic or plastic surgery, except if such occurrence is covered under the “reconstructive surgery benefit” (see benefits schedule for OptimaCEO Medical Plan, item 20 for details), dental care or surgery, except for the “routine dental treatment” under “Dental Benefits” (see benefits schedule for OptimaCEO Medical Plan, item 40 for details), corrective aids and treatments of refractive errors unless necessitated by injury caused by an accident, body check-up, except for the “vaccinations, health check-up and child development assessment” under “Outpatient Benefits”(see benefits schedule for OptimaCEO Medical Plan, item 39 for details), gradual recovery of health or rest care
• consumption of any of the following traditional Chinese medicines, except for the “post-hospitalisation / day surgery ancillary benefit” and “heart attack / stroke ancillary benefit” (see benefits schedule for OptimaCEO Medical Plan, items 15 ii) and 21 ii) III) for details): cordyceps 冬蟲夏草 / ganoderma 靈芝 / antler 鹿茸 /cubilose 燕窩 / donkey-hide gelatin 阿膠 / hippocampus 海馬 / ginseng 人參 / red ginseng 紅參 / American Ginseng 花旗參 / Radix Ginseng Silvestris 野山參 / antelope horn powder 羚羊角尖粉 / placenta hominis 紫河車 / Agaricus blazei murill 姫松茸 / musk 麝香 / pearl powder 珍珠粉

The above list is for reference only. Please refer to the policy contract of this plan for the complete list and details of exclusions.


Premium Adjustment and Product Features Revision
1. Premium Adjustment

In order to provide you with continuous protection, we will annually review and adjust the premium of your plan accordingly at the end of the policy year if necessary. There could be overall premium adjustment on the policies of this plan or policies of certain coverage options under this plan. During the reviews, we may consider factors including but not limited to the following:

• claim costs incurred from policies under this plan and any other similar plans as determined by us, and the expected claim outgo in the coming policy year of such policies, which reflects the impact of medical trend, medical cost inflation and product feature revisions
• historical investment returns and the future outlook of this plan’s backing asset
• policy surrenders and lapses of this plan
• expenses directly related to this plan and indirect expenses allocated to this plan

2. Product Features Revision
We reserve the right to revise the benefit structure, terms and conditions and / or product features, so as to keep pace with the times for medical advancement and to provide you with continuous protection.
We will give you a written notice of any revision 31 days before the end of policy year or upon renewal.


Product Limitation

1. Cover for specific items will be effective on the following dates:

Items	Effective Date (after the policy commences)
Accidental injury	Immediately
Illness	30 days
Investigation / treatment / surgery for tonsils, adenoids, hernias or a disease particular to female generative organs	120 days
Signature Healthcare Circle	30 days
Pregnancy complications benefit	10 months
Usage of Health Wallet	120 days
Items	Effective Date (after the optional benefit commences)
Optional outpatient benefits	30 days (except for treatment of an injury caused by an accident)
Optional dental benefits	6 months (except for treatment of an injury caused by an accident)

 

2. We only cover the charges and / or expenses of the insured on medically necessary and reasonable and customary basis.
"Medically necessary" means that the medical services, diagnosis and / or treatments are:

Regions	Countries
North America	United States and Canada
Western Europe	Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Monaco, Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, United Kingdom and Vatican City

 

Important Information for OptimaCEO Medical Plan – First Gift

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. In case you want to read policy contract sample before making an application, you can obtain a copy from AIA. This brochure should be read along with the illustrative document (if any) and other relevant marketing materials, which 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 plan is an insurance plan without any savings element. All premiums are paid for the insurance and related costs.

This brochure is for distribution in Hong Kong only.

Key Product Risks

1. You should pay premium on time and according to the premium payment schedule.
2. We will terminate your policy and you / the insured will lose the cover on the occurrence of the earliest of any of the following:
   • the 1^st policy anniversary;
   • the insured expectant mother passes away during pregnancy stage and there is no surviving child insured under the policy;
   • the insured child passes away after birth; or
   • the date on which the pregnancy is terminated with loss or death of the fetus (whether due to miscarriage or termination of pregnancy or otherwise and whether occurring spontaneously or otherwise), or the date the expectant mother suffers a stillbirth, regardless of whether compassionate refund of premium benefit is payable.
3. We underwrite the plan and you are subject to our credit risk. If we are unable to satisfy the financial obligations of the policy, the insured may lose his / her cover and you may lose the remaining premium for that policy year.
4. You are subject to exchange rate risks for plans denominated in currencies other than the local currency. Exchange rates fluctuate from time to time. You may suffer a loss of your benefit values and the subsequent premium payments (if any) may be higher than your initial premium payment as a result of exchange rate fluctuations. You should consider the exchange rate risks and decide whether to take such risks.
5. The future medical costs will be higher than they are today due to inflation. Hence, the benefit amounts and the future premium rate of this plan may be revised to reflect the inflation (Please refer to Premium Table for the premium provided by your financial planner).

Key Exclusions

• any treatment, investigation, service or supplies which is not medically necessary
• self-destruction, intentional self-inflicted injury or drug abuse
• war or warlike operations, and civil commotion, any violation or attempted violation of the law or resisting arrest, acts of terrorism where the insured is a terrorist, the use of atomic, biological or chemical weapons as well as radioactive, biological or chemical contamination due to any act of terrorism (except where the insured is injured during a trip outside the insured’s permanent residence country or place); or when the insured travels to a country at war, or where there is warlike operation, mutiny, riot, civil commotion, martial law or state of siege, or a war zone as recognised by the United Nations
• pregnancy, miscarriage, child birth, abortion, or related complications, except for the compassionate refund of premium benefit (see benefits schedule for OptimaCEO Medical Plan – First Gift, item 10 for details), mental or nervous disorder
• cosmetic or plastic surgery, dental care or surgery, corrective aids and treatments of refractive errors unless necessitated by injury caused by an accident, body check- up, gradual recovery of health or rest care
• consumption of any of the following traditional Chinese medicines:
• cordyceps 冬蟲夏草 / ganoderma 靈芝 / antler 鹿茸 / cubilose 燕窩 / donkey-hide gelatin 阿膠 / hippocampus 海馬 / ginseng 人參 / red ginseng 紅參 / American Ginseng 花旗參 / Radix Ginseng Silvestris 野山參 / antelope horn powder 羚羊角尖粉 / placenta hominis 紫河車 / Agaricus blazei murill 姫松茸 / musk 麝香 / pearl powder 珍珠粉

The above list is for reference only. Please refer to the policy contract of this plan for the complete list and details of exclusions.

 

Premium Adjustment

• claim costs incurred from policies under this plan and any other similar plans as determined by us, and the expected claim outgo in the coming policy year of such policies, which reflects the impact of medical trend, medical cost inflation and product feature revisions
• historical investment returns and the future outlook of this plan’s backing asset
• expenses directly related to this plan and indirect expenses allocated to this plan

Therefore, the actual premiums payable by you may be adjusted when you purchase OptimaCEO Medical Plan – First Gift.

 

Product Limitation

1. The coverage period for specific cover items are as follows:

Items	Coverage Period
Accidental injury and illness	For the insured newborn baby: On the date of birth and within 90 days after birth

 

2. We only cover the charges and / or expenses of the insured on medically necessary and reasonable and customary basis.

"Medically necessary" means that the medical services, diagnosis and / or treatments are:
• delivered according to standards of good medical practice;
• necessary; and
• cannot be safely delivered in a lower level of medical care,

but excludes experimental, screening, and preventive services or supplies.

"Reasonable and customary" means:
• the medical services, diagnosis and / or treatments are medically necessary and delivered according to standards of good medical practice; and
• the costs of your medical services and the duration of your hospital stay are within the usual level of charges or duration for similar treatment in the locality of such services delivered.

If you wish to make a claim, you must notify us in writing within 20 days of the date the covered event happened, and send us the appropriate forms and relevant proof within 90 days of the same date. You can get the appropriate claim forms from your financial planner, by calling the AIA Customer Hotline (852) 2232 8968 or by visiting any AIA Customer Service Centre. If you wish to know more about claim related matter, you may visit "File A Claim" section under our company website www.aia.com.hk.

 

Warning Statement and Cancellation Right

OptimaCEO Medical Plan - First Gift is an insurance plan without any savings element. All premiums are paid for the insurance and related costs. If you are not happy with your policy, you have a right to cancel it within the cooling-off period and obtain a refund of any premiums and levy paid. A written notice signed by you should be received by the Customer Service Centre of AIA International Limited at 12/F, AIA Tower, 183 Electric Road, North Point, Hong Kong within the cooling-off period (that is, 21 calendar days immediately following either the day of delivery of the policy or cooling-off notice (informing you / your nominated representative about the availability of the policy and expiry date of the cooling- off period, whichever is earlier). After the expiration of the cooling-off period, if you cancel the policy before the end of the term, you will not receive the refund of premiums paid.

 

Remarks for OptimaCEO Medical Plan – First Gift:

1. The insured of the OptimaCEO Medical Plan – First Gift policy must have been changed from the expectant mother to the newborn baby before AIA will process any claims related to the newborn baby under the policy. You shall notify AIA of the birth of the newborn baby and provide a certified true copy of the newborn baby’s birth certificate as soon as possible and within 30 days after his / her birth. We may request for any other information or documents which we may reasonably require.
2. Total Basic Premiums Paid refers to the total amount of due and payable premium(s) paid to the OptimaCEO Medical Plan – First Gift policy and received by the Company from the policy date up to the end of the 1st policy year. Total Basic Premiums Paid does not include additional premium payable due to any special terms imposed on the policy, any premium(s) paid to us but not yet due and / or any payment in excess of premium(s) currently due and payable.
3. Compassionate refund of premium benefit is equivalent to 105% of the Total Basic Premiums Paid. Upon payment of the compassionate refund of premium benefit under the OptimaCEO Medical Plan – First Gift policy, AIA shall have no further liability under the policy.
4. "OptimaCEO Medical Plan policy with designated plan option" refers to OptimaCEO Medical Plan policy with annual premium payment mode. Under this designated plan option, you will be eligible to apply for OptimaCEO Medical Plan – First Gift as long as the proposed insured of the OptimaCEO Medical Plan – First Gift policy is an expectant mother (aged 18 to 45 with gestation period of 22nd week or above), and who is an existing insured of an in-force OptimaCEO Medical Plan policy. On the date of issuance of the OptimaCEO Medical Plan – First Gift policy, the insured expectant mother must remain the existing insured of an in-force OptimaCEO Medical Plan policy with designated plan option.
5. Once your newborn baby has become the insured of the OptimaCEO Medical Plan – First Gift policy, within the period of 15 days to 90 days after the date of birth of your newborn baby (both dates inclusive) while such policy remains in force ("designated period"), you may apply for one "designated medical policy" with the same newborn baby as the insured of such "designated medical policy" by simplified medical underwriting. The "designated medical policy" is subject to the choices of insurance products made available by us under this option at the time of your application for the "designated medical policy". The "designated medical policy" currently available for selection is OptimaCEO Medical Plan which will be subject to change by AIA from time to time. After the designated period, standard medical underwriting shall apply to policy application for the "designated medical policy". If your newborn baby does not meet the Company’s requirements for simplified medical underwriting, the newborn baby will be required to undergo standard medical underwriting during application for the "designated medical policy". Application for the "designated medical policy" is subject to the Company’s approval at its sole discretion.