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

The challenges to your and your family's future of health:

Living a long life without good health

• Global life expectancy has risen to 73.1 years, while healthy life expectancy lags behind at 63.5 years¹
• 81% of high-net-worth individuals in Hong Kong and Macau exhibit symptoms of sub-optimal health²

Need of preventive measures to improve health span

• Muscle mass among male and female adults drops about 4.7% and 3.7% per decade respectively³
• 80% of persons aged 65 and above in Hong Kong have at least one chronic condition⁴

Expensive new cancer treatment

• Immunotherapy costs of about HK$60,000 to HK$70,000 every three weeks, and the annual drug cost can exceed HK$1 million⁵
• A 3-year targeted therapy for breast cancer and lung cancer costs around HK$1.13 million and HK$1 million respectively⁶

Developmental disorders are common in children

• 1 in 54 children aged 8 with autism spectrum disorder⁷
• Developmental delay occurs in approximately 10 to 15 per 100 persons⁷

Empower you in achieving optimal health for your vibrant future

OptimaCEO Medical Plan Preserve your holistic health⁸

1. Prestigious concierge services to safeguard your health

• OptimaCEO Service Hotline to connect you to a series of wellness and medical services with just one fingertip
• Rare-in-market⁹  Wellness Relationship Manager to address wellness needs and provide personalised guidance across mental, physical and nutritional aspects
• First-in-market⁹  Child and adolescent growth and development support hotline to support your child through their growth and neuro-developmental milestones

2. Exceptional medical protection with elevated cancer support

• First-in-market⁹  Experimental drugs benefit for your access to quality and state-of-the-art medical treatment 

3. Dedicated medical services with multi-disciplinary care for your cancer journey

• Signature Healthcare Circle¹⁰ with multi-disciplinary cancer care professionals to offer integrated cancer support from diagnosis, treatment to recovery 

4. Reward you for your healthy lifestyle

• First-in-market⁹  Health Wallet to reward you with elevated wellness services and medical coverage 
• Join AIA Vitality to enjoy instant premium discount and reward you to stay healthy

OptimaCEO Medical Plan – First Gift Plan ahead for your child¹¹

• Give your newborn baby an instant hospitalisation and surgical protection¹³ with coverage for congenital conditions within 90 days after birth
• Option to apply for an OptimaCEO Medical Plan policy for your newborn baby by simplified medical underwriting so that you can provide whole life medical protection to your newborn baby¹⁴

Remarks:

1. Global Health Estimates: Life expectancy and leading causes of death and disability, 2019 estimates, World Health Organisation (https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-life-expectancy-and-healthy-life-expectancy)
2. AIA Hong Kong commissioned Kantar Group, an international market research company, to conduct a survey with 3,850 individuals from 25 May 2023 to 21 June 2023, in Hong Kong, Macau, and other cities in the GBA to understand their awareness and level of understanding on “sub-optimal health”.
3. Elderly Health Service, Hong Kong Department of Health
   (https://www.elderly.gov.hk/english/health_information/bones_and_joints/muscle_loss.html)
4. Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings, Hong Kong Department of Health(https://www.healthbureau.gov.hk/phcc/rfs/src/pdfviewer/web/pdf/preventivecareforolderadults/tc/02_coredocument/13_tc_ref_framework_adults.pdf)
5. Mingpao Health.com (https://health.mingpao.com/免疫治療藥費過百萬一年-多數情况需自費/)
6. Assuming that the treatment period is 3 years, the cost of breast cancer and lung cancer treatment includes diagnosis, chemotherapy, radiotherapy and targeted therapy. Source: Union Hospital charges (updated on 15 May 2023), Hong Kong Sanatorium and Hospital price list (updated on 1 August 2023), Hong Kong Breast Cancer And Disease Centre, Hong Kong Cancer Fund and media reports.
7. Child Assessment Service, Hong Kong Department of Health
   (https://www.dhcas.gov.hk/en/common_developmental_disorders.html)
8. For details of OptimaCEO Medical Plan, please refer to page 6 to 33 of this brochure.
9. Regarding the first-in-market statement (i) for Health Wallet, as of 1 November 2024, compared against individual medical plans provided by major Hong Kong insurance companies; (ii) for experimental drugs benefit, this benefit was first launched by AIA on 22 April 2024 which was first-in-market compared against individual medical plans provided by major Hong Kong insurance companies; (iii) for child and adolescent growth and development support hotline, as of 12 August 2024, compared against individual medical plans provided by major Hong Kong insurance companies. Regarding the rare-in-market statement for Wellness Relationship Manager, as of 12 August 2024, compared against individual medical plans provided by major Hong Kong insurance companies.
10. “Signature Healthcare Circle” refers to designated third party medical network service providers engaged by AIA. The medical network service providers are independent contractors and are not agents or employees or representatives of AIA. AIA does not guarantee the provision of services by a particular medical network or the number of medical network(s) available. For details, please refer to page 11 in this brochure.
11. For details of OptimaCEO Medical Plan – First Gift, please refer to page 34 to 45 of this brochure.
12. “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.
13. 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.
14. 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.

OptimaCEO Medical Plan / OptimaCEO Medical Plan (Worldwide)

1. Prestigious concierge services to safeguard your health¹

OptimaCEO Service Hotline

The dedicated concierge support  hotline connects you to the following wellness and medical services with just one fingertip:

Rare-in-market²  Embark on your wellness journey with Wellness Relationship Manager^{^}

• Provide personalised guidance on mental, physical and nutritional aspects
• A dedicated point of contact to promptly address your unique wellness needs
• Reach out via phone calls and messages for seamless communication

Before using the service(s), please refer to the relevant details of the service(s) (including but not limited to usage, locations and arrangement of the service) on AIA’s website / service leaflet(s).

^{^} This service is not applicable to the insured aged below 18.

* The hotline provides general information for reference only and shall not be considered as a medical advice, diagnosis, treatment, or recommendation in any kind. If you are in doubt and / or consider necessary, please seek medical advice from healthcare service provider immediately and do not ignore or delay in seeking medical advice and treatment.

First-in-market²  Child and adolescent growth and development support hotline^☆

• Parenting support to help you cultivate a harmonious parent-child relationship, manage parenting stress and address common challenges
• Professional guidance for your child’s developmental and behavioural concerns, helping support your child going through their growth and neuro-developmental milestones
• Reference to other supports such as non-profit organisations, specialists or healthcare professionals based on the specific needs of the child for further assessment or treatment should you require extra help

Other supports

• 24-hour general health hotline^☆,※
• Care Concierge^~ – One-stop Oncology Service
• Make appointment with Signature Healthcare Circle^#
• Facilitate medical expense pre-approval service⁺ and cashless service⁺

^※During the designated service hours, the service is provided by the designated third party service providers engaged by AIA, subject to change from time to time at our discretion.

^~ The services in Mainland China and Hong Kong are provided by different third party service providers with different scope of services. The services are provided in Mainland China and Hong Kong by the designated third party service providers engaged by AIA, subject to change from time to time at our discretion.

^# “Signature Healthcare Circle” refers to designated third party medical network service providers engaged by AIA. Please also
refer to points 7 and 9 in the “Product Limitation” section of this plan on page 30 of this brochure.

⁺ Availability of the service is subject to designated third party medical service providers.

2. Exceptional medical protection with elevated cancer support

Enhanced cancer protection with cutting-edge medical treatment

• First-in-market²  Experimental drugs benefit

Experimental drugs usually take time for registration, before being used as new drugs. They can be approved for “off label” use with the doctor’s application for named patients with documentation proof. These medications could be effective³ yet more costly and inaccessible to many.

We therefore offer the experimental drugs benefit for stage III and stage IV cancers and incurable haematological malignancy^4,5 with coverage for phase 3 clinical trial drugs⁶ of up to HK$500,000 per policy year⁷.

• Cancer⁴ treatment benefit

Covers chemotherapy, radiotherapy, targeted therapy, hormonal therapy, immunotherapy, proton therapy and the related surgery, consultations, medications and diagnostic tests.

• Waiver of deductible for cancer⁴ for elderly⁸
  If the insured is aged 75 or above and is unfortunately diagnosed with cancer⁴ by a specialist, we will waive the remaining balance of annual deductible in relation to the medical services arising from the insured's cancer⁴.

A lifetime medical shield

OptimaCEO Medical Plan is an elevated medical protection insurance plan that provides you with:

• Worldwide hospitalisation and surgical protection
• Full cover⁹ for core medical expenses with no itemised benefit sublimit
• Overall lifetime limit up to HK$70,000,000; annual limit up to HK$30,000,000; and
  extra annual limit up to HK$10,000,000¹⁰
  The extra annual limit¹⁰ will be available only when all charges actually incurred in the same policy year for medical services, treatments and confinements are provided by Signature Healthcare Circle^#.

^#  “Signature Healthcare Circle” refers to designated third party medical network service providers engaged by AIA. Please also refer to points 7 and 9 in the “Product Limitation” section of this plan on page 30 of this brochure.

Extensive medical protection to empower your recovery journey

• Hospitalisation and surgery

Extensive hospitalisation coverage includes daily room and board, surgeon’s fee, specialist’s consultation, intensive care benefit, private nurse services, hospital companion bed benefit and more.

• Pre- and post- hospitalisation / day surgery outpatient consultation

Outpatient visits within specified periods before and after hospitalisation or day surgery are included. This extends to post-hospitalisation outpatient visits up to 365 days after major or complex surgeries.

• Dialysis treatment

For patients with kidney diseases, we also cover the expenses required for regular dialysis treatment.

• Pregnancy complications benefit

To give expectant mothers extra support, we cover a range of pregnancy complications such as ectopic pregnancy, miscarriage and threatened abortion.

Worry-free safeguarding coverage for heart attack and stroke recovery

• Home facility enhancement

Covers the cost of widening corridors, adapting bathroom facilities and purchasing specialised furniture, as well as other recommendations by occupational therapists.

• Professional medical support

Receive coverage for (i) your necessary consultations and treatments from chiropractor, physiotherapist, speech therapist, occupational therapist and neurosurgeon; and (ii) your necessary consultations, treatments and prescriptions from neurologist, cardiologist and Chinese medicine practitioner, as required by your personal recovery needs.

• Disability subsidy

Should you become unable to independently care for yourself for a period of at least 6 uninterrupted months while confined in a premises other than hospital, we will provide a disability subsidy of HK$5,000 per month for up to 24 months.

3. Dedicated medical services with multi-disciplinary care for your cancer journey¹

Signature Healthcare Circle with multi-disciplinary cancer care professionals^#

Signature Healthcare Circle^# comprises of professional healthcare service providers, including multi-disciplinary medical specialists, healthcare professionals and numerous advanced day case procedure centres, providing you with quality medical services and enhancing your peace of mind in a medical situation.

Robust multi-disciplinary cancer care

You can book day case procedure provided by the Signature Healthcare Circle^#,¹⁰, and the Signature Healthcare Circle^# will then facilitate the medical expense pre-approval service⁺ and the cashless service (which is also known as credit facility service)⁺.

If you select to receive all medical services, treatments and confinements from the Signature Healthcare Circle^#, we will offer an extra annual limit of HK$10,000,000¹⁰, reinforcing your medical coverage.

You can schedule an appointment with the Signature Healthcare Circle^# through:

• AIA mobile application / AIA web portal

Search for doctors > book online

• OptimaCEO Service Hotline

Contact us to make an appointment

Other services 

Hassle-free medical payment at home and overseas 

Cancer Genomic Testing Services

An effective tool that helps you in the shortest time possible  decide on the most suitable cancer treatment with predictable responses based on the genetic information, aiming to result in a higher chance of recovery. We have collaborated with designated medical institutions to bring the services to  you in need at a privileged rate.

Telemedicine service^◊

With just few clicks, you can make appointments and receive video consultation services via the quality, convenient and efficient online platform at a preferential rate without leaving home. The prescribed medicine, medical certificate and / or referral letter will be delivered to your home.

First-in-industry² Care Concierge^~

The Care Concierge connects you to a suite of healthcare services, providing you with personalised support on your healthcare journey from diagnosis, treatment to recovery. This includes (i) One-stop Oncology Service which connects you to a multi-disciplinary team of specialists to provide integrated oncology treatments and services in Hong Kong for the insured and  (ii) a medical home visit service to offer general health assessment online and tips for the insured’s parents in Mainland China.

Personal Medical Case  Management Services with Rehabilitation Management

If you are unfortunately diagnosed with a serious illness, the medical support by an expert team will be found through our designated service provider. Receive medical attention and ongoing updates on your condition, plus  a tailor-made rehabilitation plan.

Your diagnosis and treatment will be assessed by a specialist, so you can count on additional medical expertise to help you overcome your health challenges with confidence.

Worldwide emergency assistance

 4. Reward you for your healthy lifestyle

First-in-market² Elevate your wellness services and medical coverage with Health Wallet Benefits¹¹

If you are entitled to the following Health Wallet Benefits under your OptimaCEO Medical Plan policy, the applicable amount will be credited to your policy’s Health Wallet which can go towards wellness services to boost your health or reimbursement of medical costs to minimise your out-of-pocket expenses as follows:

Multiple ways to earn Health Wallet Benefits

(only applicable to OptimaCEO Medical Plan)

Network treatment reward benefit

Applicable if charges have been reimbursed by us under the core benefits (as set out in the benefits schedule for OptimaCEO Medical Plan in this brochure) of the policy for medical services or treatments carried out by Signature Healthcare Circle^# (excluding charges reimbursed under the day surgery benefit and worldwide emergency assistance services)

Hospital cash benefit

For stay in a government hospital or in a hospital  without charge

Lower room class cash benefit

For stay in a room which is a class lower than the standard private room of a private hospital in Hong Kong or Macau

Day surgery cash benefit

Applicable when day surgery benefit is payable under the policy for a surgical procedure

No claim bonus benefit¹²

Applicable when no claim has been made under the policy for 3 consecutive policy years 

Benefits credited to Health Wallet^**

The more you accumulate, the more you can redeem

Please refer to the benefits schedule for OptimaCEO Medical Plan for details.
^** HK$/US$1 credit to the Health Wallet = HK$/US$1 balance in the Health Wallet

Redeem designated rewards at your choice

(Only applicable to OptimaCEO Medical Plan)

Improve your health^▲

• Wellness treatment
• Check-up services
• Vaccinations

Elevate your medical coverage¹³

• Reimburse the eligible charges which exceed the benefit limits of the policy
• Offset the annual deductible amount
• Reimburse the charges that are incurred for any pre-existing and / or congenital conditions

^# “Signature Healthcare Circle” refers to designated third party medical network service providers engaged by AIA. Please also refer to points 7 and 9 in the “Product Limitation” section of this plan on page 30 of this brochure.

 ^▲ These services are provided in Hong Kong by the designated third party service providers engaged by AIA, subject to change from time to time. The scope and the location of these services shall be determined by AIA at its sole discretion and AIA may change the scope and / or the location of these services at its sole discretion from time to time without prior notice. The details, locations and arrangement of these services can be accessed on AIA’s website after issuance of the policy. AIA is not responsible or liable for any services or advice provided by such third party service providers.

Other plan highlights

Flexibility to suit your needs 

We offer various choices for you to select to suit your personal medical needs:

Versatile deductible reduction for peace of mind

You can also choose to reduce your annual deductible amount to a specified amount provided by OptimaCEO Medical Plan at that time without having to provide us with current details of the insured’s health condition, upon the policy anniversary of your OptimaCEO Medical Plan policy when the insured is at the age of 50, 55, 60 or 65. The annual deductible can be reduced once only during the term of the policy. The premium will be adjusted based on your selected annual deductible amount, and your out-of-pocket limit for a claim will be reduced. Before making your request for this reduction of annual deductible, you should reassess if this reduction can suit your personal needs.

Lifetime renewal

You can renew your cover every policy year for life. Renewal premium will be based on the prevailing premium rates and the insured’s attained age at the time of renewal, but it will not be based on any claim you have made, or any changes in the insured’s health condition.

Plan summary

For more information, please read the benefits schedule for OptimaCEO Medical Plan in this brochure.

Benefits schedule for OptimaCEO Medical Plan

Benefit items 1 – 20, 21 ii), 22 – 25, 34 – 41 are reimbursed on medically necessary and reasonable and customary basis. For more information, please refer to point 2 of the “Product Limitation” section under “Important Information for OptimaCEO Medical Plan”.

Proof of recommendation is required.

Core benefits^(d)

Notes:

a. The annual limit for a policy year will be increased by the amount of extra annual limit if all charges actually incurred in the same policy year for medical services, treatments and confinements which are paid or payable under benefit items 1 - 23 in the benefits schedule for OptimaCEO Medical Plan are provided by Signature Healthcare Circle of OptimaCEO Medical Plan. The extra annual limit can only be applied to charges incurred in the same policy year for medical services, treatments or confinement which have been directly provided by Signature Healthcare Circle of OptimaCEO Medical Plan and are paid or payable under benefit items 1 - 25 and 28 - 31 in the benefits schedule for OptimaCEO Medical Plan and optional outpatient benefits (if applicable).

The network benefit under benefit items 15 i) and 15 ii) in the benefits schedule of OptimaCEO Medical Plan, the network treatment reward benefit under the Health Wallet Benefits, and extra annual limit will only be applicable if (1) the medical services, treatments and confinements have been recommended and provided by the Signature Healthcare Circle of OptimaCEO Medical Plan and (2) you have successfully obtained medical expense pre-approval for such medical services, treatments and confinements from us, subject to our prevailing rules and conditions. Please visit https://www.aia.com.hk/ en/health-and-wellness/medical-expense-pre-approval-service for the latest updates and full terms and conditions. For the benefit items which have not been specified as “network benefit” or “non-network benefit” in the benefits schedule of OptimaCEO Medical Plan, the benefit limits of such benefit items are applicable to both network and non-network medical services, treatments and confinements.

b. Upon the recommendation of the attending specialist in writing, receives any medically necessary medical services as a direct result of the cancer for which benefits are payable under benefit items 1 to 25. This waiver of deductible is not applicable if the policy owner or the insured is aware of, or shall be reasonably aware of, such cancer within the first 90 days from the policy effective date. If the insured is diagnosed with sickness other than cancer with eligible expenses incurred, such eligible expense is subject to the remaining balance of annual deductible amount (if any). The elderly cancer support – waiver of deductible for cancer is not applicable to policy with $0 annual deductible option.

c. Please refer to point 6 of “Product Limitation” under “Important Information for OptimaCEO Medical Plan” on page 30 of this brochure for the definition of cancer.

d. Each of the itemised expenses as shown in the official statement of accounts or receipts submitted to the Company for reimbursement is subject to the reasonable and customary charges requirement. Unless otherwise specified, expenses incurred in respect of the same item shall not be recoverable under more than one benefit item in the benefits schedule above (except benefit item 21 iii)).

e. The Company shall have the right to ask for proof of recommendation except for consultation, treatment and / or medicine prescribed by Chinese medicine practitioner under benefit items 15 ii) and 21 ii) III) and 37, e.g. written referral or testifying statement on the claim form by the attending doctor, registered medical practitioner, specialist, chiropractor, physiotherapist, speech therapist, occupational therapist and registered dietitian (if applicable).

f. Fully covered or full cover shall mean no itemised benefit sublimit, and claim amount is subject to the benefit limits as set out in the benefits schedule for OptimaCEO Medical Plan, which include the annual limit, the extra annual limit (if applicable) and the overall lifetime limit, and also subject to the amount of annual deductible.

g. The benefit limit of this donor’s benefit shall be up to 30% of the aggregate of the surgical costs of removal of the organ or bone marrow from the donor which are charged to the insured (but excluding the costs of the organ or bone marrow) and the surgical costs of procedures performed on the insured as recipient. For avoidance of doubt, the benefit does not cover the expenses incurred for a surgery to remove the organ or bone marrow from the insured as the donor.

h. These surgical categories are defined in detail in the Schedule of Surgical Procedures under Hong Kong’s Voluntary Health Insurance Scheme (VHIS), based on categorisation of surgical procedures and review by the Hong Kong government from time to time. We will follow the surgical categories set out in the latest version of this Schedule of Surgical Procedures in effect at the time of performing the surgery. If the insured undergoes a surgery which is not included in any surgical category under the Schedule of Surgical Procedures, or if this Schedule of Surgical Procedures is no longer valid or is replaced, or if the categories of surgical procedures in this Schedule are renamed or otherwise changed, we will reasonably determine the applicable surgical category based on other surgical procedures with similar difficulty and complexity included in the Schedule of Surgical Procedures and / or any other publication or information from the Hong Kong government, relevant authorities or medical associations.

i. Please refer to item 5 on page 32 of this brochure for more details.

j. The Health Wallet Benefits (excluding no claim bonus benefit) are subject to the overall lifetime limit, the annual limit and the extra annual limit (if applicable) of the policy. The amount in the Health Wallet cannot be refunded or redeemed for cash, and cannot be used to pay any premium of any policy. Upon the cancellation or termination of the policy, any remaining amount in the Health Wallet will be forfeited immediately.

k. No claim bonus benefit will no longer be available once a claim has been made (excluding day surgery benefit, worldwide emergency assistance services, Health Wallet Benefits, redemption of designated rewards under the Health Wallet, optional outpatient benefits and optional dental benefits (if such optional benefits is selected)), and the number of policy year without claim will be recounted from the next policy year.

l. Usage of Health Wallet is available after 120 days from the effective date of the OptimaCEO Medical Plan policy.

m. These services are provided in Hong Kong by the designated third party service providers engaged by AIA, subject to change from time to time. The scope and the location of these services shall be determined by AIA at its sole discretion and AIA may change the scope and / or the location of these services at its sole discretion from time to time without prior notice. The details, locations and arrangement of these services can be accessed on AIA’s website after policy issuance. AIA is not responsible or liable for any services or advice provided by such third party service providers.

n. Coinsurance is a percentage of eligible expenses that you need to pay. For example, for the eligible expenses of HK$10,000 with 20% coinsurance, you are responsible for HK$2,000 (i.e. 20% of eligible expenses), while we pay the remaining HK$8,000 (i.e. 80% of eligible expenses) and the payable amount is further capped by the above benefit sub-limit (if applicable, e.g. HK$8,000 per policy year under alternative treatment), subject to overall lifetime limit, the annual limit and the extra annual limit (if applicable) of the policy.

o. The optional dental benefits must be applied together with the optional outpatient benefits. The optional dental benefits will terminate simultaneously when the optional outpatient benefits is terminated.

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

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

• 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):

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:

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

8.Worldwide emergency assistance services are covered during the trip only (except for 24-hour worldwide telephone enquiring services), which are additional benefits. A trip generally refers to a journey where the insured departs for abroad from Hong Kong, Macau or Mainland China (of which the insured is a permanent resident at the time of departure) and then returns to the place of departure. The services are provided by designated third party service provider(s). AIA shall not be responsible for any act, negligence or omission of medical advice, opinion, service or treatment on the part of them. AIA reserves the right to amend, suspend or terminate the service without further notice.

9.Signature Healthcare Circle refers to designated third party medical network service providers engaged by AIA. The medical network service providers are independent contractors and are not agents or employees or representatives of AIA. AIA does not guarantee the provision of services by a particular medical network / service provider or the number of medical network(s) / service provider(s) available. The scope and location of the medical network services shall be determined by AIA at its sole discretion and may be changed from time to time. AIA shall not be responsible for any act, negligence or omission of Signature Healthcare Circle in the provision of services, treatments, opinions and advice.

10. OptimaCEO Service Hotline, Wellness Relationship Manager, child and adolescent growth and development support hotline, Signature Healthcare Circle, medical expenses pre-approval service, cashless service (also known as credit facility service), Care Concierge, Personal Medical Case Management Services with Rehabilitation Management, telemedicine service, Cancer Genomic Testing Services, and general health hotline as set out in the sections under “1. Prestigious concierge services to safeguard your health” and “3. Dedicated medical services with multi-disciplinary care for your cancer journey” are additional value-added services and do not form part of the contractual service.

11.Wellness Relationship Manager, child and adolescent growth and development support hotline, Care Concierge, Personal Medical Case Management Services with Rehabilitation Management, telemedicine service, Cancer Genomic Testing Services and general health hotline (during designated service hours) are provided by designated third party service provider(s) and AIA shall not be responsible for any act, negligence or omission of medical advice, opinion, service or treatment on the part of them.

12. The value-added services as set out in the sections under “1. Prestigious concierge services to safeguard your health” and “3. Dedicated medical services with multi- disciplinary care for your cancer journey” are subject to the eligibility of the insureds, the availability of the services and the relevant terms and conditions of the services. AIA reserves the right to amend, suspend or terminate any of these services any time without prior notice. For details of each of the value-added services, please refer to the respective leaflets of the value-added services.

Claim Procedure

If you wish to make a claim (including a claim under the Health Wallet), 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 / OptimaCEO Medical Plan (Worldwide) 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:

1. The above value-added services (except for worldwide emergency assistance) as set out in the sections under “1. Prestigious concierge services to safeguard your health” and “3. Dedicated medical services with multi-disciplinary care for your cancer journey” do not form part of the contractual services. Referrals or services provided by third party service providers does not explicitly imply eligibility for claims under OptimaCEO Medical Plan. Customers should be solely responsible for any cost not covered under the value-added services subject to the relevant terms and conditions thereof. Please take note that the actual claim reimbursement under OptimaCEO Medical Plan shall be subject to the provision of complete claim documents, insured's benefits entitlement, exclusion, policy contract, terms and conditions of OptimaCEO Medical Plan. For details, please contact AIA for enquiry. AIA reserves the right to amend, suspend or terminate any of these services any time without further notice.

2. Regarding the first-in-market statement (i) for Health Wallet, as of 1 November 2024, compared against individual medical plans provided by major Hong Kong insurance companies; (ii) for experimental drugs benefit, this benefit was first launched by AIA on 22 April 2024 which was first-in-market compared against individual medical plans provided by major Hong Kong insurance companies; (iii) for child and adolescent growth and development support hotline, as of 12 August 2024, compared against individual medical plans provided by major Hong Kong insurance companies; (iv) for Care Concierge, it refers to Hong Kong insurance industry-first healthcare support that integrates (a) dedicated concierge service with a suite of healthcare and support services for the eligible insured and (b) the medical home visit service in Mainland China for the eligible insured’s parents. As of 31 January 2024, compared against similar services offered by major Hong Kong insurance companies. Regarding the rare-in-market statement for Wellness Relationship Manager, as of 12 August 2024, compared against individual medical plans provided by major Hong Kong insurance companies.

3. Source: Healthcare Thinker, 26 December 2021, www.healthcarethinkers.com/2021/12/藥物進步助與癌共存

4. Please refer to point 6 of “Product Limitation” under “Important information for OptimaCEO Medical Plan” on page 30 of this brochure for the definition of cancer.

5. This benefit will be payable if the insured is diagnosed with a stage III or stage IV malignant tumour, or terminal blood cancer which is deemed incurable with existing non-experimental treatment by a specialist, and with a medical certificate issued by a specialist to certify that the experimental drug is prescribed by and is deemed by the specialist to be an appropriate or recommended active treatment or palliative treatment of the cancer of the insured. Any charges or expenses which are already covered by any other third parties (including sponsorship from the pharmaceutical company, manufacturer and / or marketer of the experimental drug) shall not be covered by this benefit.

6. The prescribed phase 3 clinical trial drug must have been tested in the laboratory and has been approved by one of the following regulatory bodies for undergoing phase 3 of a clinical trial for testing and / or treatment in humans for the treatment of the cancer:
 • United States Food and Drug Administration (FDA)
 • European Medicines Agency (EMA)
 • National Medical Products Administration (NMPA) of China
 • Department of Health of Hong Kong
 • Health Bureau of Macau

and at the time of prescription, such phase 3 clinical trial drug must be undergoing phase 3 of a clinical trial that is approved by the relevant institutional review board in the location where the drug is administered, as being an effective treatment for such cancer upon preliminary review by such board.

7. For any reasonable and customary charges incurred outside of Hong Kong, Macau and Mainland China which are payable under experimental drugs benefit for stage III and stage IV cancers and incurable haematological malignancy, such reasonable and customary charges incurred shall be reduced to 60% in the calculation of the total benefit amount payable, up to a maximum of HK$500,000 or US$62,500 per policy year.

OptimaCEO Medical Plan – First Gift

Instant protection to safeguard your newborns¹

Welcoming a new baby is a joyous experience, however expectant mothers may be worried about unexpected pregnancy complications and baby’s health. OptimaCEO Medical Plan – First Gift provides an instant shield for newborn babies¹, providing immediate hospitalisation and surgical benefits with coverage for congenital conditions after birth. In the unfortunate event of a miscarriage, pregnancy termination that is recommended by a registered specialist doctor, stillbirth, or the passing of both the expectant mother and her fetus during the pregnancy stage, a compassionate refund of premium benefit equivalent to 105% of the Total Basic Premiums Paid² will be paid³.

An expectant mother, who is an existing insured of an OptimaCEO Medical Plan policy with designated plan option⁴, will be eligible to become the insured of an OptimaCEO Medical Plan – First Gift policy. Application for the OptimaCEO Medical Plan – First Gift policy can be made starting from the 22^nd week of pregnancy of an expectant mother, allowing our esteemed expectant mothers to rest easy during the happy advent of motherhood.

Plan summary

For more information, please read the benefits schedule for OptimaCEO Medical Plan – First Gift in this brochure.

Benefits schedule for OptimaCEO Medical Plan – First Gift

Benefit items 1 – 9 are reimbursed on medically necessary and reasonable and customary basis. For more information, please refer to point 2 of the “Product Limitation” section under “Important Information for OptimaCEO Medical Plan – First Gift”.

Notes:

a. Each of the itemised expenses as shown in the official statement of accounts or receipts submitted to the Company for reimbursement is subject to the reasonable and customary charges requirement. Unless otherwise specified, expenses incurred in respect of the same item shall not be recoverable under more than one benefit item in the benefits schedule above.

b. The Company shall have the right to ask for proof of recommendation, e.g. written referral or testifying statement on the claim form by the attending doctor, registered medical practitioner or specialist (if applicable).

c. Fully covered or full cover shall mean no itemised benefit sublimit, and claim amount is subject to the overall policy limit as set out in the benefits schedule for OptimaCEO Medical Plan – First Gift and also subject to the amount of deductible.

d. The benefit limit of this donor’s benefit shall be up to 30% of the aggregate of the surgical costs of removal of the organ or bone marrow from the donor which are charged to the insured (but excluding the costs of the organ or bone marrow) and the surgical costs of procedures performed on the insured as recipient. For avoidance of doubt, the benefit does not cover the expenses incurred for a surgery to remove the organ or bone marrow from the insured as the donor.

f. 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.

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 1st 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

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:

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.

Claim Procedure

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.