Bupa Wise Choice Brochure SOB

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1 Bupa Wise Choice Health Insurance Scheme 保柏智康健醫療保障計劃 Schedule of Benefits 保障金額表 1 January 2019 Edition 2019 年 1 月 1 日版本 Maximum Limit per Member (HK$) 每位會員最高賠償額 ( 港幣 ) A Hospital and Surgical Benefit 住院及手術保障 Plan 計劃 1 Privatee 私家房 e Plan 計劃 2 Semi-privatee 半私家房 e Plan 計劃 3 Ward e 大房 e This Benefit is payable for eligible expenses of the following items (a) to (i) incurred by the Member during his Hospital Confinement, Clinical Operation or Day Case Surgery in Hong Kong only unless such confinement or surgery performed outside Hong Kong is directly resulting from medical Emergency outside Hong Kong as certified by a Registered Medical Practitioner subject to the applicable Overall Annual Limit, deductible and reimbursement percentage as shown in the Schedule of Benefits. 在此保障金額表列出每年最高賠償額墊底費及賠償率的規限下, 此保障只支付會員有關下列 (a) 至 (i) 項在香港的住院診所手術或日症手術所需合資格費用 ( 若於香港以外因緊急情況之醫療事故而須入住當地醫院或於當地進行手術並獲註冊西醫簽署證明則除外 ) Overall Annual Limit 每年最高賠償額 600, , ,000 (a) Room and Board 住房及膳食費 (b) Miscellaneous Hospital Services 住院雜費 (c) Intensive Care 深切治療 (d) Surgeon and Attendance Fees (For surgical case only) 外科醫生費及巡房費 ( 只適用於外科手術 ) (e) Anaesthetist s Fees 麻醉科醫生費 (f) Operating Theatre Fees 手術室費用 (g) In-patient Physician s Fees (For non-surgical case only) 住院醫生巡房費 ( 只適用於非手術治療 ) 80% of eligible medical expenses 支付合資格醫療費用的 80% 80% of eligible medical expenses 支付合資格醫療費用的 80% 80% of eligible medical expenses 支付合資格醫療費用的 80% (h) In-patient Specialist s Fees 住院專科醫生費 Subject to written referralr from the attending Registered Medical Practitioner (Except for services performed by pathologist, radiologist or Physiotherapist during Hospital Confinement) 須獲主診註冊西醫以書面轉介 r ( 病理學家放射學家及物理治療師在住院期間所提供之服務除外 ) (i) Companion Bed 住院加床費 Deductible 墊底費 Per Hospital Confinement / Treatment 每次住院 / 診治 Per Disability (Only applicable to cancer and kidney dialysis) 每病症 ( 只適用於癌症及洗腎 ) 300, ,000 30,000 Reimbursement percentage 賠償率 80% Benefit calculation for Hospital and Surgical Benefit: 住院及手術保障之賠償計算 : Amount of eligible medical expenses incurred and actually paid during Hospital Confinement, less Day Case Surgery or Clinical Operation The higher of deductible for Hospital and Surgical Benefit as stated in the Schedule of Benefits or actual amount reimbursed by any other sources under the same medical bill times 80% times Adjustment factor t for room upgrade, if applicable 於住院日症手術或診所手術期間所導致並已支付的合資格醫療費用減保障金額表所示的住院及手術保障之墊底費或從其他途徑對相同醫療費單索償所得的金額 ( 以較高者為準 ) 乘 80% 乘住房升級之調整值 t ( 如適用 ) B Free Overseas Medical Contingency Top-up Benefit (Each Contract Year) 免費海外緊急額外醫療保障 ( 每合約年度計 ) Plan 計劃 1 Privatee 私家房 e Plan 計劃 2 Semi-privatee 半私家房 e Plan 計劃 3 Ward e 大房 e This Benefit covers Emergency medical treatment overseas or treatment for a specific medical condition which should be performed outside Hong Kong upon the medical advice of a Specialist with Bupa s prior approval provided that Hospital and Surgical Benefit of Part A (if applicable) is exhausted. 此保障適用於海外緊急之治療或因特別病況而由專科醫生建議於香港以外地方接受治療, 必須於接受治療之前, 預先取得保柏之同意, 並於 A 項之住院及手術保障 ( 如適用 ) 已耗盡後才適用 250, ,000 75,000 Notes 附註 All the medical expenses incurred by a Member must first be claimed under any laws or regulations or any other insurance policy, or other sources, if any. The amount of eligible medical expenses that was not reimbursed shall be payable under this Benefit as a secondary insurance. All Benefits shall not be payable for Hospital Confinement in class of suite / VIP / deluxe room of a Hospital. e For in-patient treatments at Gleneagles Hong Kong Hospital, please visit or call Bupa to get details of the room types and how they are classified under Bupa s cover prior to your hospital stay. r A referral letter is valid for the same or related medical condition for six months from the issue date. Another referral letter is required for a new or unrelated medical condition. t Adjustment factors for room upgrade will be applied if Member is hospitalised not in accordance with plan level: From Semi-private Room to Private Room :50% From Ward to Semi-private Room :50% From Ward to Private Room :25% 會員所有的醫療費用必須先向任何法律或規例或其他保險計劃或其他途徑 ( 如有 ) 申請索償未能獲得賠償的合資格醫療費用, 可於本保障下以輔助保險形式作出賠償此保障並不會就入住總統套房 / 貴賓房 / 豪華房的住院費用作出賠償 e 入住港怡醫院接受治療前, 請瀏覽或致電保柏查詢有關住房類別及在保柏保障計劃下相應之住房等級 r 會員可在轉介信發出日起計 6 個月內, 就相同或相關病症使用該轉介信若須診治全新或不相關的病症, 則須提交新的轉介信 t 如會員住院時並非根據原有之計劃住房, 保障額將因應升級住房而作出調整 : 半私家房至私家房 :50% 大房至半私家房 :50% 大房至私家房 :25% MP039/16/1118/2.5K 1

2 Bupa Wise Choice Health Insurance Scheme 保柏智康健醫療保障計劃 Table of Subscriptions 保費表 1 January 2019 Edition 2019 年 1 月 1 日版本 All figures in HK$ 以港幣計算 Hospital and Surgical Benefit 住院及手術保障 Attained Age 已屆年齡 Plan 計劃 1 Private 私家房 Plan 計劃 2 Semi-private 半私家房 Plan 計劃 3 Ward 大房 Monthly 按月 Annual 按年 Monthly 按月 Annual 按年 Monthly 按月 Annual 按年 15 days 日 17 years 歲 149 1, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,189 Subscription rates are not guaranteed and Bupa may adjust them on an annual basis. 保費並非保證, 保柏有可能每年作出調整 About Levy payment Starting from 1 January 2018, insurance subscription payment is subject to the Hong Kong Insurance Authority s levy. The amount of levy charged will be based on a percentage of the total amount of subscription under an insurance contract. Payable levy is not included in the subscription rates shown in the Table of Subscriptions and is subject to the applicable levy rate. For general information on the applicable levy rates, please visit 有關保費徵費由 2018 年 1 月 1 日起, 保險業監管局按保費徵收徵費, 徵費額是以每份合約的保費的某個百分比計算保費表上的保費尚未包括應繳徵費, 應繳徵費將按適用的徵費率計算有關徵費率詳情, 請瀏覽 In the event of any discrepancy in respect of the meaning between the Chinese version and the English version, the English version shall prevail. All terms and conditions are subject to the Contract. 中英文之意思如有任何差別, 概以英文為準所有條款及細則以合約為準 Please refer to the Contract for definitions of the capitalised terms in the Schedule of Benefits. 請參考合約查閱保障金額表內大楷詞語之定義 Bupa (Asia) Limited 保柏 ( 亞洲 ) 有限公司 Address: 18/F, Berkshire House, 25 Westlands Road, Quarry Bay, Hong Kong 地址 : 香港鰂魚涌華蘭路 25 號栢克大廈 18 樓 Telephone 電話 :(852) Facsimile 傳真 :(852) Website 網址 : Bupa Hong Kong MP039/16/1118/2.5K 2

3 Bupa Wise Choice Ideal boost for your group cover

4 Supporting you with medical expertise throughout your life Bupa Wise Choice is designed to cater to the specific needs of employees who are currently covered under their company s medical plan. For a minimal subscription, you will enjoy valuable additional cover as a top-up for your company s health insurance. You will also be assured of lifelong protection from Bupa even if your employment status changes. Guaranteed renewal and conversion for lifelong protection We guarantee the renewal of your Bupa Wise Choice cover all the way to the year end of the contract year on your 60th birthday. During each renewal year, you will also have the option of converting to Bupa CarePro s Hospital and Surgical Benefit at the same benefit level, without any underwriting or medical examinations. With Bupa CarePro, you will enjoy quality lifelong protection, regardless of your claims or changes in health condition. As your family members can also be covered under Bupa Wise Choice with guaranteed acceptance to Bupa CarePro or Bupa Care Kid, you can be certain that your whole family is well taken care of for life. Guaranteed Cover for pre-existing conditions If you are no longer covered by your company s medical plan and wish to apply for a new individual health insurance plan, your pre-existing conditions are usually excluded or you might be required to pay extra subscription. With our guaranteed acceptance, pre-existing medical conditions that developed after you joined Bupa Wise Choice will be covered at the same benefit level when you transfer to Bupa CarePro. Valuable top-up for your group cover As healthcare costs continue to increase, your company s medical plan may no longer be sufficient to cover your medical expenses. Bupa Wise Choice provides a boost for your company s medical insurance at a modest subscription. For less than HK$2 a day, you will receive a benefit of HK$180,000 each year to take care of your medical expenses. Bupa Wise Choice covers 80% of your eligible expenses after a deductible has been applied, and this deductible can usually be offset by your company s plan. There are no individual item limits to worry about, thus reducing your chances of incurring shortfalls. You also have the flexibility to choose from a range of benefit levels to suit your needs and budget. Overseas protection and medical treatment Bupa Wise Choice gives you protection wherever you go by covering your overseas accidental or medical emergency costs. In addition, we will take care of the costs if you need to receive medical treatment outside of Hong Kong as advised by your specialist and approved by Bupa, making sure that you always receive the best care possible. Furthermore, you will get up to HK$250,000 extra to cover these expenses if your plan s Hospital and Surgical Benefit is used up.

5 Bupa Wise Choice offers you lifelong protection with guaranteed renewal q and the right to convert to Bupa CarePro. q 60 2 w Bupa guarantees that your cover can be renewed for life as long as you meet the requirements as stated in the Renewal Clause of your contract. Bupa reserves the right to amend the subscription, benefits, terms and conditions upon your contract renewal. Please refer to your contract for further details. w Based on the annual subscription of a 35-year-old member at ward level 35

6 Bupa Wise Choice supplements your company s medical plan, giving you extra protection for your healthcare needs. Helping you minimise your out-of-pocket expenses How Bupa Wise Choice benefits you Bupa Wise Choice member Ms Chan, aged 45, was admitted into a private hospital for percutaneous coronary intervention surgery, which cost a total of HK$70,000. She was entitled to a Hospital and Surgical Benefit of HK$180,000 each year at a monthly subscription of HK$ Under Bupa Wise Choice: Medical expenses Deductible of Bupa Wise Choice Remaining amount Benefit paid by Bupa Wise Choice Out-of-pocket expenses HK$70,000 HK$30,000 (Covered by company plan) HK$40,000 HK$40,000 x 80% = HK$32,000 HK$8,000 If Ms Chan had not enrolled in Bupa Wise Choice, she would have been required to bear the full remainder of HK$40,000. In addition, if she joins a different health insurance scheme in the future, her condition will likely be excluded or she will have to pay extra loading for her subscription. Under Bupa Wise Choice, Ms Chan s condition will still be covered if she takes advantage of the guaranteed acceptance to Bupa CarePro before she turns

7 Eligibility You can apply for Bupa Wise Choice if you are: aged 15 days to 59 years currently insured as an employee or dependant under a company medical insurance scheme covering hospital and surgical expenses normally residing in Hong Kong Each of your family members has to submit a separate application. Please note that each member can only enrol in one Bupa individual health insurance scheme (unless enrolling in Bupa Together or Bupa Hospital Cash). Renewal and conversion Your renewal of Bupa Wise Choice is guaranteed until you turn 60, regardless of whether you are still covered by a company health insurance scheme. At each annual renewal of Bupa Wise Choice, you can choose to convert your membership to the Hospital and Surgical Benefit of Bupa CarePro at the same or lower benefit level without any underwriting. The last date to make the conversion is the anniversary of your Bupa Wise Choice membership on or immediately after your 60th birthday. Bupa Wise Choice does not cater to the upgrade of benefit level. You may apply to upgrade your benefit level or add optional benefits at any renewal date after you convert your membership to Bupa CarePro, but all applications are subject to Bupa s underwriting approval The World of Bupa Bupa A global healthcare specialist Bupa began in the UK in We fund and provide healthcare services to fulfil our purpose of helping people live longer, healthier, happier lives. Our diversified services include health insurance, clinics, hospitals, dental centres, care homes, and more. We employ over 78,000 people, principally in the UK, Australia, Spain, Poland, Chile, New Zealand, Hong Kong, the USA, Brazil, the Middle East and Ireland. With no shareholders, we reinvest our profits to provide more and better healthcare for customers. Bupa s presence in Hong Kong Bupa is a leading provider in healthcare funding and provision with two independent units, Bupa Hong Kong and Quality HealthCare. Bupa Hong Kong In Hong Kong, we are known as the health insurance specialist providing domestic and international health insurance. We have gained the trust of more than 400,000 individuals, and 3,200 companies including major corporations in public utility and telecom industry. We have provided quality health insurance for Hong Kong s civil servants for more than 20 years. We have applied our expertise to provide our members with comprehensive and flexible insurance plans to suit every life stage and lifestyle. Through our extensive provider network in Hong Kong, we offer our members a wide choice of doctors. Quality HealthCare Quality HealthCare Medical Services Limited (QHMS), Hong Kong, became part of Bupa, an international healthcare group, in October QHMS operations span diagnostics, primary healthcare and day care specialties. With roots tracing back to 1868, QHMS serves the community through a network of over 110 multi-specialty centres and over 1200 affiliated clinics offering Western Medicine, Traditional Chinese Medicine, Diagnostics & Imaging, Dental, Physiotherapy services, etc. It also operates a private nursing agency. QHMS is one of the largest providers of healthcare services to corporates in Hong Kong. In 2017, the Group recorded more than 3 million healthcare visits. QHMS endeavors to enhance the quality of our professional services continuously to satisfy the needs of customers and patients , ,

8 General Exclusions We want to help you understand your coverage before enrolment. Below are the general exclusions: Pre-existing conditions (unless such conditions have been disclosed in the application and accepted by Bupa). Treatment or investigation which is not medically necessary. Any injury or sickness for which compensation is payable under any laws or regulations or any other insurance policy or other source except to the extent that such charges are not reimbursed by such laws or regulations or other insurance policy or other source. Any charges for accommodation, nursing and services received in health hydros, nature cure clinics, convalescent home, rest home, home for the aged or similar establishments. Any charges in respect of surgical and non-surgical cosmetic treatment, or hearing tests, routine blood tests, general check-ups, vaccinations or inoculations, Hair Mineral Analysis (HMA), health supplements or body weight control, eye refraction including but not limited to routine eye tests or any costs of fitting of spectacles or lens. Congenital conditions, developmental conditions or hereditary conditions. Treatment that commenced during the first five years as a member under the contract and which in any way arises from, is attributable to, or is consequential upon Human Immunodeficiency Virus Infection. Sexually transmitted (Venereal) diseases or their sequel. Treatment relating to pregnancy, including diagnostic tests for pregnancy or resulting childbirth, abortion or miscarriage; birth control or sterilisation of either sex; infertility including in-vitro fertilisation or any other artificial method of inducing pregnancy; or sexual dysfunction including but not limited to impotence, erectile dysfunction, pre-mature ejaculation, regardless of cause. Misuse or overdose of drugs or being under the influence of alcohol, selfinflicted injuries or attempted suicide. Treatment relating to any injury or disease resulting from participation in criminal activities. Alternative treatment including but not limited to Chinese medicines treatment, acupuncture, acupressure, Tui Na, hypnotism, rolfing, massage therapy, aromatherapy. Senile Dementia (including Alzheimer s disease), Parkinson s disease, psychological or psychiatric condition(s) of any and all kinds, including but not limited to psychoses, neuroses, depression, anxiety, anorexia nervosa, schizophrenia, behavioural disorders, delirium, insomnia, neurasthenia. Any charges for the procurement or use of special braces and appliances including but not limited to spectacles, hearing aids and other equipments such as wheel chairs and crutches. Any treatment or investigation related to dental or gum conditions except for emergency treatment arising from accidents or the extraction of impacted wisdom teeth during hospital confinement. Follow-up treatment from such hospital confinement shall not be covered. Treatment arising from war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or military or usurped power or terrorist acts. Non-medical services, including but not limited to guest meals, radio, telephone, photocopy, taxes (except the Value-Added Tax or Goods and Services Tax for medical services), medical report charges and the like. Experimental and/or new medical technology/procedure not yet approved by Bupa. If you have any pre-existing medical conditions, special exclusions may be added after underwriting. Bupa (Asia) Limited Address: 18/F, Berkshire House, 25 Westlands Road, Quarry Bay, Hong Kong Telephone (852) Facsimile (852) Website 5 / / This scheme is insured by Bupa (Asia) Limited. Bupa (Asia) Limited is authorised and regulated by the Hong Kong Insurance Authority to carry out general insurance business in the HKSAR. This brochure is a product summary for reference only. Please refer to the contract for detailed coverage, exclusions and terms and conditions. In the event of any discrepancy between the Chinese version and the English version of this brochure, the English version will prevail. Bupa Hong Kong MP040/14/1118/1K Printed on recycled paper

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