schedule of benefits (Effective from 15 April 2011 until further notice) Basic Cover Hospitalization Benefits Maximum Limits, Per Person (HK$) Gold Pl

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1 healthcare smart solutions for your medical needs Family Discount 5% off for each additional family member when enroll together! SmartCare Executive the flexible individual health insurance with options to suit your needs guaranteed renewal Once you have taken out SmartCare Executive, you will be entitled to continuous renewable protection, regardless of your health conditions. annual hospitalization benefits up to $375,000 (apply to all age groups) Covers a wide range of benefits including Daily Room & Board, Intensive Care Unit, Surgeon s fees & Anaesthetist s fees, up to a maximum of $375,000 per policy year. choice of 3 plans To suit your own need, SmartCare Executive provides 3 levels of benefits, room accommodation could be Private, Semi-Private or Ward type. comprehensive cover for hospital in-patient charges Hospital charges will be reimbursed as per Benefit limits. For items of Intensive Care Unit, Prescribed Drugs, Physiotherapy, Operating Theatre, Anaesthetist & Specialist s Consultation, full refund of the charges could be provided. optional cover 1. Supplementary Major Medical Benefits (apply to all age groups) Provides a supplementary coverage up to $100,000 per disability per year for payment of large medical bills brought about by serious disability in the event that the Hospitalization Benefit is exhausted. 2. Outpatient Benefits (80% or 100% reimbursement) Clinical Consultation Specialist Consultation Chinese Herbalist & Bonesetter Physiotherapy & Chiropractic Treatment X-Ray & Laboratory Expenses Prescribed Drugs & Medicine 3. Hospital Cash Benefits (SmartCare Essential ) Daily Hospital Cash Choice of $1,000, $750 or $500 per day during hospitalized Annual Benefits up to a maximum of $500, Hour Emergency Assistance Service AXA Assistance Hotline for unlimited cover on the following: Telephone medical advice Emergency medical evacuation Repatriation after treatment Repatriation of mortal remains/ashes Compassionate visit Return of unattended dependent child(ren) Travel information Legal assistance China Hospital Deposit Guarantee Card Worry free as no cash deposit required Cover over 200 Hospitals Network in China Allow immediate hospital admission arrangement Eligibility You must be a Hong Kong resident (with Hong Kong Identity Card), aged 18 and below 61 on the first entry. You may also apply to cover your family members for the same plan including your legal spouse aged 18 to 60, and any unmarried child(ren) aged over 14 days to 17 years (or below 23 if in full time education). NB : Policy annual renew is guaranteed. AXA General Insurance Hong Kong Limited reserves its right to amend premium rates, benefits, terms and conditions upon policy renewal. The information of this leaflet does not form part of a contract of insurance. For full terms and conditions, please refer to the policy for complete details. A specimen policy can be made available upon request. HPX-B-0411

2 schedule of benefits (Effective from 15 April 2011 until further notice) Basic Cover Hospitalization Benefits Maximum Limits, Per Person (HK$) Gold Plan Silver Plan Bronze Plan Overall Annual Limit $375,000 $250,000 $175,000 Room Type Private (Standard) Semi-Private Ward Room & Board + (Max. limit per day) Max. 90 days per disability $1,900 $1,100 $650 Intensive Care Unit (Max. 21 days per disability) Prescription Drugs Full Refund + Full Refund + Full Refund + In-Hospital Physiotherapy* Overseas Overall Overseas Overall Overseas Overall In-Hospital Specialist s Consultation* Limit $32,500 Limit $20,000 Limit $13,500 Operating Theatre Fee (Max. up to 30% of Surgeon s Fee) per disability per disability per disability Anaesthetist s Fee (Max. up to 30% of Surgeon s Fee) Surgeon s Fee + (Per Surgical Schedule) Max. limit per disability $75,000^ $45,000^ $30,000^ Hospital Expenses + Max. limit per disability $25,000 $17,500 $12,000 In-Hospital Doctor s Visit + (Max. limit per day) Max. 90 days per disability $1,900 $1,100 $650 Home Nursing* (Max. limit per day) $500 $400 $300 Max. no. of days per disability Post-Hospitalization Treatment (42 days after discharge from hospital) Max. limit per disability $3,000 $2,000 $1,000 Hospital Cash (Subject to Hong Kong SAR Government Public Ward only) (Max. limit per day) Max. 90 days per disability $900 $500 $350 Outpatient Kidney Dialysis & Outpatient Cancer Treatment (Max. limit per year) $50,000 $35,000 $25,000 Organ Transplantation +# (Max. limit per year) $100,000 $60,000 $40,000 Artificial Prosthesis* (Max. limit per year) $5,000 $3,000 $2,000 Additional Optional Cover (1) Supplementary Major Medical Benefits +## (Applicable after Hospitalization Benefit is exhausted) Maximum per disability $100,000^ $75,000^ $50,000^ Deductible $1,000 $1,000 $1,000 80% Reimbursement (2) Outpatient Benefits (80% or 100% Reimbursement) (a) Clinical Consultation (Max. limit per day) ~ $250 $200 $150 Max. 30 visits per year (b) Chinese Herbalist & Bonesetter (Max. limit per day) ~ $250 $200 $150 Max. 5 visits per year (c) Specialist Consultation* (Max. limit per day) ~ $500 $400 $300 Max. 10 visits per year (d) Physiotherapy & Chiropractic Treatment* (Max. limit per day) ~ $250 $200 $150 Max. 10 visits per year (e) X-Ray & Laboratory Expenses* $3,000 $2,000 $1,000 Max. limit per year (f) Prescribed Drugs & Medicine* (at pharmacy) $3,000 $2,000 $1,000 Max. limit per year (3) Hospital Cash Benefits (SmartCare Essential ) (a) Maximum Annual Limit $500,000 $375,000 $250,000 (b) Hospital Cash Benefit - per day $1,000 $750 $500 no pre-set maximum period (c) Double Hospital Cash Benefit - per day $2,000 $1,500 $1,000 no pre-set maximum period (i) Confinement Overseas (ii) Intensive Care Unit (iii) Critical Illness (d) Accidental Death Benefit $100,000 $75,000 $50,000 (e) Accidental Dental Benefit - per year $10,000 $7,500 $5,000 Unlimited 24-Hour Emergency Assistance Service (e.g. Medical evacuation/repatriation of mortal remains) China Hospital Deposit Guarantee Card NB : All expenses must be medical necessary and reasonable and customary. Overseas cover & Emergency Assistance Service will be ceased if stay longer than 90 consecutive days outside Hong Kong SAR. * Recommended or referred by the attending physician. + If the Insured confines in a higher level of room type, the relevant medical expenses will be adjusted subject to the applicable terms and conditions of the policy. Per Surgical Table under the policy. ^ Overseas Overall Limit: 50% of Eligible benefits. # Includes all expenses of operating theatre & materials, anaesthetist, surgeon and hospital service for the transplantation for heart, kidney, liver or bone marrow. ## Not applicable for Organ Transplantation, Outpatient Kidney Dialysis, Outpatient Cancer Treatment, Post-Hospitalization Treatment, Home Nursing and Artificial Prosthesis. ~ Limit to 1 visit per day. Major Exclusions Some of the exclusions under this Plan are: The following conditions that require treatment within the first six months of the policy: tumors of any kind, anal fistulae, cholecystitis, calculi of kidney, urethra or bladder, diabetes mellitus, gastric or duodenal ulcer, hallux valgus, hypertension or cardio vascular disease, tuberculosis, cataracts, endometriosis, diseased tonsils requiring surgery, hemorrhoids, hyperthyroidism, pathological abnormalities of nasal septum or turbinates, sinus conditions requiring surgery Pre-existing conditions Drug addiction or alcoholism Suicide or self-inflicted injury Cosmetic or plastic surgery Pregnancy, childbirth, birth control and treatment for infertility Congenital anomalies Sexually transmitted diseases, AIDS or HIV-related conditions Routine health checks, rest cure Dental treatment (except caused by accident) Professional and hazardous sports War or warlike operation, strike, riot and civil revolution Other exclusions as per our underwriting decisions AXA: a world leader in financial protection AXA Group in billion euros in consolidated revenues 1,104 billion euros in assets under management 216,000 employees worldwide working to deliver the right solutions and top quality service to our customers 97.3 million customers across the globe have placed their trust in AXA to: Insure their property (vehicles, homes, equipment) Provide health and personal protection coverage for their families or employees Manage their personal or corporate assets Standard & Poor s Rating: AA- AXA General Insurance Hong Kong Limited One of the top general insurers in Hong Kong, leading in motor insurance Over 170 years of local experience in Asia Over 220 professional, well-trained and caring staff Wide range of SMART products for individual and business needs To apply or for more details, please contact your agent or broker, or you can contact us on AXA General Insurance Hong Kong Limited 21/F, Manhattan Place, 23 Wang Tai Road, Kowloon Bay, Kowloon, Hong Kong Tel: Fax:

3 $375,000 $375, $100, % 100% X

4 3. $1,000 $750 $500 $500, HPX-B $375,000 $250,000 $175, $1,900 $1,100 $ * * $32,500 $20,000 $13,500 + $75,000^ $45,000^ $30,000^ + $25,000 $17,500 $12, $1,900 $1,100 $650 * $500 $400 $ $3,000 $2,000 $1, $900 $500 $350 $50,000 $35,000 $25,000 +# $100,000 $60,000 $40,000 * $5,000 $3,000 $2,000 (1) +## $100,000^ $75,000^ $50,000^ $1,000 $1,000 $1,000 80% (2) 80%100% (a) $250 $200 $ (b) $250 $200 $150 5 (c) * $500 $400 $ (d) * $250 $200 $ (e) X* $3,000 $2,000 $1,000 (f) * $3,000 $2,000 $1,000 (3) (a) $500,000 $375,000 $250,000 (b) $1,000 $750 $500 (c) $2,000 $1,500 $1,000 (i) (ii) (iii) (d) $100,000 $75,000 $50,000 (e) $10,000 $7,500 $5, * + # ## ~ 6

5 (852) (852) Proposal Form SmartCare Executive Individual Health Insurance Please fill in this form in English block letters and tick the boxes where appropriate *Mandatory fields PROPOSER DETAILS * Name of Proposer - Surname (as on HKID) * Given Name For broker business * Sex * HKID Card No * Correspondence Address * Date of Birth (dd/mm/yyyy) Nationality * Height (cm) * Weight (kg) * Smoker Yes, cigarette per day No HK KLN NT Contact No (Please fill in at least one)* Mobile No Office Tel Home Tel Marital Status /* Occupation/Job Position Job Nature Single Married # Smoked cigarette, pipe or cigar in the past 3 years. COMPANY DETAILS If the proposer is a business entity/company Company Name (as on Business Registration) Business Registration No Business Type Company Address (if different from above mentioned correspondence address) HK KLN NT Mobile No Office Tel In case the Proposer is a business entity/company, above Proposer will be interpreted as Insured Person/Member. BANK ACCOUNT DETAILSFor claim payment purpose only Account Holder: Company Proposer Bank Name Account No. INSURANCE COVER The plan(s) selected should be the same for all insured person. Select Plan I) - Basic Cover - Hospitalization Benefits II) Additional Optional Cover 1) 2) 3) Gold Plan Silver Plan Supplementary Major Medical Benefits Outpatient Benefits Reimbursement Options - Hospital Cash Benefits - SmartCare Essential Gold Plan Silver Plan Policy to commence on / / for one year. The liability of the Company does not commence until this proposal has been accepted by the Company and the premium is received. Please refer to the product brochure of SmartCare Essential for details. Bronze Plan 80% 100% or Bronze Plan AXA General Insurance Hong Kong Limited /F, Manhattan Place, 23 Wang Tai Road, Kowloon Bay, Kowloon, Hong Kong p.1

6 DETAILS OF THE DEPENDENT(S) TO BE INSURED 1) * Surname 2) * Given Name 3) * Sex 4) * HKID Card No 5) * Date of Birth (dd/mm/yyyy) 6) * Nationality 7) * Relationship to Proposer 8) * Height (cm) 9) * Weight (kg) 10) /* Occupation/Job Position 11) * Job Nature #12) * Smokers Insured Dependent (1) Yes, cigarette per day Insured Dependent (2) Yes, cigarette per day Insured Dependent (3) Yes, cigarette per day 1822 NB: Your unmarried child(ren) can be insured under this policy if they are aged 18 to 22 and are full time students. Please provide student identification document(s) or other documentation(s) for validation (photocopies are acceptable). INSURANCE INFORMATION The person(s) to be insured will be interpreted as Insured Person/Member and/or Insured Dependent(s). 1. Full name, address and telephone number of the usual Physician for the person(s) to be insured. (Please complete) Physician s Full Name Address Tel No Full name, address and telephone number of any Physician(s) that the person(s) to be insured have visited in the last 6 months. (Please complete) Physician s Full Name Address Address & Tel No Diagnosis Address Current Condition 2. Has any person to be insured ever been rejected, postponed, accepted under special terms and conditions for a Life or Health application by an insurance company, or its renewal been refused? 3. Does any person to be insured have any Life or Health insurance policy currently in force? If the answer to any of the above questions is Yes, please provide details below. (including Name of the Insurance Company & Period of Insurance) Yes Should there be insufficient space, please continue on a separate sheet. p.2

7 MEDICAL QUESTIONNAIRE 1. Does any person to be insured take alcohol/medication? 2. X Has any person to be insured been admitted to a hospital or received any surgery, medical advice, treatment or examination including X-ray/imaging/ECG/MRI/laboratory test, etc.? [If Yes, please provide a copy of the original medical report(s)] 3. Has any person to be insured suffer, or have ever suffered from any of the disorders, deformations or symptoms described below? a) Endocrine System thyroid, adrenal, pituitary, diabetes, obesity, etc. b) Nervous System neuritis, stroke, paralysis, concussion, epilepsy, spastic disorders, etc. c) Eyes eye diseases, squinting, amblyopia, other disorders d) Ears ear disorders, deafness or partial deafness, hard of hearing, etc. e) Bronchial Tubes inflammation of nasal cavity, bronchitis, asthma, pneumonia, pleuritis, tuberculosis, etc. f) Heart and Vascular System heart attack, heart (valve) disorder, varicose veins, high blood pressure, high cholesterol level, etc. g) Blood and / or Lymphatic System, Leukemia, etc. h) Female Genital Organs and Breast disease of the internal organs, menstrual disorders and breast operation / breast tests, etc. i) Digestive System gullet, stomach, intestines, liver, hemorrhoids, gall-bladder, groin, etc. j) Kidney and Urinary System stones, inflammation of the bladder, bed wetting, prostate, etc. k) Male Genital Organs prepuce narrowing, undescended testicles, inflammations, etc. l) Bone and Musculo-skeletal System back and / or hip disorders, rheumatism, fractures (arm, leg), muscular system, amputations, etc. m) Skin and Limbs chronic skin diseases, e.g. psoriasis, plastic surgery, shape, size and positional deviations, etc. n) Psychiatry psychological disorders, prolonged headaches, overstrains, schizophrenia, etc. o) Allergies 4. Has any person to be insured suffer from any disease not mentioned above? 5. Has any direct relatives of the person to be insured suffered from heart disease, stroke, high blood pressure, diabetes, cancer or other hereditary disease? 6. If you have answered Yes to any of the above questions, please give full details: a) b) c) d) e) f) g) h) i) j) k) l) m) n) o) Yes No Question No Name (in Full) Relationship with Insured Nature of Complaint Diagnosis Treatment Received / Date (mm/yyyy) From To Current Situation Name, Address & Telephone No of Attending Physician Should there be insufficient space, please continue on a separate sheet. p.3

8 DECLARATION Please read the following statements and Important Notes to Proposer carefully and sign in the space provided. I declare that All statements and answers to all questions stated in this proposal are to the best of my knowledge and belief complete and true and I hereby agree that these statements and answers shall form the basis and become a part of any policy issued hereunder. I hereby authorize any licensed physician, hospital, clinic or insurance company that has any records or knowledge of me or any members listed above to give any such information to AXA General Insurance Hong Kong Limited. I also understand that any credit facility for the Policy is to be used for admission to hospitals for treatments falling under the scope of the Policy. In the event the charges incurred which are in excess of my benefits entitlement or any ineligible benefit not provided under the Policy, I shall undertake to pay AXA General Insurance Hong Kong Limited within two weeks from the date of the Debit Note. I have not withheld any material information and accept that this proposal and declaration shall be the basis of, and be incorporated in, the contract between AXA General Insurance Hong Kong Limited and myself. I have obtained all necessary consent from my dependents to supply their information and data to the Company by myself otherwise if they fails to provide any such information requested, it may result in the Company s inability to process and deal with this application. My dependents agree that these information and data can be used by the Company to carry on its businesses. PERSONAL INFORMATION COLLECTION STATEMENT 486/ (1) (/ / (2) / (3) / (4) // (5) (6) / (7) (8) (9) (10) // (11) (12) (13) (1) (2) // (3) / (4) (5) (6) (1) (2) (a) (b) (3) / (a) (b) (c) 2. / (d) (4) AXA General Insurance Hong Kong Limited (referred to hereinafter as the Company ) recognises its responsibilities in relation to the collection, holding, processing, use and/or transfer of personal data under the Personal Data (Privacy) Ordinance (Cap. 486) ( PDPO ). Personal data will be collected only for lawful and relevant purposes and all practicable steps will be taken to ensure that personal data held by the Company is accurate. The Company will take all practicable steps to ensure security of the personal data and to avoid unauthorised or accidental access, erasure or other use. Please note that if you do not provide us with your personal data, we may not be able to provide the information, products or services you need or process your request. Purpose: From time to time it is necessary for the Company to collect your personal data which may be used, stored, processed, transferred, disclosed or shared by us for purposes ( Purposes ), including: (1) offering, providing and marketing to you the products/services of the Company, other companies of the AXA Group ( our affiliates ) or our business partners (see Use and provision of personal data in direct marketing below), and administering, maintaining, managing and operating such products/services; (2) processing and evaluating any applications or requests made by you for products/services offered by the Company and our affiliates; (3) providing subsequent services to you, including but not limited to administering the policies issued; (4) any purposes in connection with any claims made by or against or otherwise involving you in respect of any products/services provided by the Company and/or our affiliates, including investigation of claims; p.4

9 (5) evaluating your financial needs; (6) designing products/services for customers; (7) conducting market research for statistical or other purposes; (8) matching any data held which relates to you from time to time for any of the purposes listed herein; (9) making disclosure as required by any applicable law, rules, regulations, codes of practice or guidelines or to assist in law enforcement purposes, investigations by police or other government or regulatory authorities in Hong Kong or elsewhere; (10) conducting identity and/or credit checks and/or debt collection; (11) complying with the laws of any applicable jurisdiction; (12) carrying out other services in connection with the operation of the Company s business; and (13) other purposes directly relating to any of the above. Transfer of personal data: Personal data will be kept confidential but, subject to the provisions of any applicable law, may be provided to: (1) any of our affiliates, any person associated with the Company, any reinsurance company, claims investigation company, your broker, industry association or federation, fund management company or financial institution in Hong Kong or elsewhere and in this regard you consent to the transfer of your data outside of Hong Kong; (2) any person (including private investigators) in connection with any claims made by or against or otherwise involving you in respect of any products/services provided by the Company and/or our affiliates; (3) any agent, contractor or third party who provides administrative, technology or other services (including direct marketing services) to the Company and/or our affiliates in Hong Kong or elsewhere and who has a duty of confidentiality to the same; (4) credit reference agencies or, in the event of default, debt collection agencies; (5) any actual or proposed assignee, transferee, participant or sub-participant of our rights or business; and (6) any government department or other appropriate governmental or regulatory authority in Hong Kong or elsewhere. For our policy on using your personal data for marketing purposes, please see the section below Use and provision of personal data in direct marketing. Transfer of your personal data will only be made for one or more of the Purposes specified above. Use and provision of personal data in direct marketing: The Company intends to: (1) use your name, contact details, products and services portfolio information, transaction pattern and behaviour, financial background and demographic data held by the Company from time to time for direct marketing; (2) conduct direct marketing (including but not limited to providing reward, loyalty or privileges programmes) in relation to the following classes of products and services that the Company, our affiliates, our co-branding partners and our business partners may offer: (a) insurance, banking, provident fund or scheme, financial services, securities and related products and services; (b) products and services on health, wellness and medical, food and beverage, sporting activities and membership, entertainment, spa and similar relaxation activities, travel and transportation, household, apparel, education, social networking, media and high-end consumer products; (3) the above products and services may be provided by the Company and/or: (a) any of our affiliates; (b) third party financial institutions; (c) the business partners or co-branding partners of the Company and/or affiliates providing the products and services set out in (2) above; (d) third party reward, loyalty or privileges programme providers supporting the Company or any of the above listed entities (4) in addition to marketing the above products and services, the Company also intends to provide the data described in (1) above to all or any of the persons described in (3) above for use by them in marketing those products and services, and the Company requires your written consent (which includes an indication of no objection) for that purpose; Before using your personal data for the purposes and providing to the transferees set out above, the Company must obtain your written consent, and only after having obtained such written consent, may use and provide your personal data for any promotional or marketing purpose. You may in future withdraw your consent to the use and provision of your personal data for direct marketing. If you wish to withdraw your consent, please inform us in writing to the address in the section on Access and correction of personal data. The Company shall, without charge to you, ensure that you are not included in future direct marketing activities. Access and correction of personal data: Under the PDPO, you have the right to ascertain whether the Company holds your personal data, to obtain a copy of the data, and to correct any data that is inaccurate. You may also request the Company to inform you of the type of personal data held by it. Requests for access and correction or for information regarding policies and practices and kinds of data held by the Company should be addressed in writing to: Data Privacy Officer AXA General Insurance Hong Kong Limited 21/F Manhattan Place, 23 Wang Tai Road, Kowloon Bay, Kowloon, Hong Kong A reasonable fee may be charged to offset the Company s administrative and actual costs incurred in complying with your data access requests. ////// /// / [ I/WE ACKNOWLEDGE AND CONFIRM that I/we have read and understood the Personal Information Collection Statement ( PICS ). I/We confirm that I/we have been advised to read carefully the PICS, and I/we have read it carefully its effect and impact in respect of my/our personal data collected or held by the Company (whether contained in this application or otherwise). Based on the foregoing, I/we hereby give my/our acknowledgement and agree to the use and transfer of my/our personal data by AXA General Insurance Hong Kong Limited in accordance with the PICS, including the use and provision of my/our personal data for the purpose of direct marketing. [Important: If you do not agree to the use and provision of your personal data for direct marketing as set out in the section Use and provision of personal data in direct marketing, please tick the box below and we will not use your personal data for direct marketing.] // I/ we do not agree with the use and provision of my/our personal data for direct marketing purposes as set out above in the Personal Information Collection Statement (see Use and provision of personal data in direct marketing ) and do not wish to receive any promotional and direct marketing materials. COMMISSION DISCLOSURE DECLARATION I/We understand, acknowledge and agree that, as a result of the my/our purchasing and taking up the policy to be issued by the Company, the Company will pay the authorized insurance broker commission during the continuance of the policy including renewals, for arranging the said policy. Where I/We am/are a body corporate, the authorized person who signs on my/our behalf further confirms to the Company that he or she is authorized to do so. I/We further understand that the above agreement is necessary for the Company to proceed with the application. / Proposer s Signature/Company Chop and Authorized Signature (if the proposer is a business entity) Do not sign a blank form Date (dd/mm/yyyy) If you or anyone acting on your behalf applies for this insurance or makes a claim knowing that the information supplied is untrue, we will not pay any claim and this policy shall be void. p.5

10 PAYMENT METHOD I wish to pay my premium HK$ by Cheque payable to AXA General Insurance Hong Kong Limited VISA MasterCard Credit Card No Credit Card Expiry Date mm yyyy Cardholder s Name I hereby authorize AXA General Insurance Hong Kong Limited to charge my above credit card for the insurance premiums of this insurance policy. Cardholder s Signature Date (dd/mm/yyyy) Important Notes to Proposer 1 Any other facts known to you which are likely to affect acceptance or assessment of the insurance cover you are requesting must be disclosed. Should you have any doubt about what you should disclose, do not hesitate to ask us or your insurance agent/broker. We recommend you keep a record (including copies of letters) for your future reference of any additional information given. Providing correct answers and making sure we are informed is for your own protection, as failure to disclose such information may mean that your policy will not provide you with the cover you require and may even invalidate the policy altogether. 2 Our Company is committed to developing products to meet your personal insurance requirements. As you are a valued customer of our Company we will keep you informed of new products and services when they become available. If you do not want to receive this information either now or in the future, please write and tell us. HPX-P-0413-B p.6

11 Annual Premium Table for SmartCare Executive Individual Health Insurance Effective from 15 April 2011 until further notice. Gold, Silver or Bronze Plan I) Basic Cover Hospitalization Benefits Gold Plan Silver Plan Bronze Plan Age Band Female Male Female Male Female Male 0-5 $3,665 $3,555 $2,960 $2,830 $1,945 $1, $3,505 $3,400 $2,780 $2,705 $1,670 $1, $3,505 $3,400 $2,780 $2,705 $1,670 $1, $3,225 $3,070 $2,625 $2,430 $1,665 $1, $3,035 $2,850 $2,675 $2,380 $1,665 $1, $4,150 $3,665 $3,350 $2,910 $1,945 $1, $4,335 $3,825 $3,510 $3,050 $2,035 $1, $5,745 $5,200 $4,150 $3,640 $2,830 $2, $5,745 $5,200 $4,345 $3,810 $2,890 $2, $7,050 $6,955 $5,720 $5,080 $3,930 $3, $7,050 $6,955 $6,125 $5,440 $4,005 $3, $9,270 $9,250 $7,950 $7,950 $5,495 $5, * $11,420 $11,390 $9,930 $9,930 $6,870 $6, * $11,420 $11,390 $10,150 $10,150 $7,005 $7, * $13,890 $13,805 $12,565 $12,565 $8,860 $8, * $13,890 $13,805 $13,110 $13,110 $9,065 $9,065 II) Additional Optional Cover Supplementary Major Medical Benefits Gold Plan Silver Plan Bronze Plan Age Band Female Male Female Male Female Male 0-5 $800 $800 $655 $655 $430 $ $800 $800 $655 $655 $430 $ $800 $800 $655 $655 $430 $ $800 $800 $655 $655 $430 $ $825 $825 $675 $675 $445 $ $970 $855 $800 $695 $430 $ $1,000 $880 $825 $715 $430 $ $1,365 $1,260 $1,075 $945 $780 $ $1,405 $1,300 $1,110 $975 $800 $ $1,705 $1,680 $1,475 $1,315 $1,090 $1, $1,755 $1,730 $1,520 $1,355 $1,125 $1, $1,850 $1,850 $1,725 $1,725 $1,580 $1, * $2,260 $2,260 $2,100 $2,100 $1,610 $1, * $2,330 $2,330 $2,165 $2,165 $1,660 $1, * $2,785 $2,785 $2,625 $2,625 $2,075 $2, * $2,925 $2,925 $2,755 $2,755 $2,095 $2,095 p.7

12 Annual Premium Table for SmartCare Executive Individual Health Insurance Flexible Outpatient Benefits 80%100% You can choose 80% or 100% reimbursement. (2) Outpatient Benefits 100%Reimbursement Gold Plan Silver Plan Bronze Plan Age Band Female Male Female Male Female Male 0-5 $5,050 $5,050 $4,350 $4,350 $3,365 $3, $4,585 $4,585 $3,950 $3,950 $3,060 $3, $4,585 $4,725 $3,950 $4,070 $3,060 $3, $3,975 $3,975 $3,365 $3,365 $2,605 $2, $3,570 $3,570 $2,975 $2,975 $2,300 $2, $4,300 $3,720 $3,850 $3,350 $3,170 $2, $4,430 $3,835 $3,965 $3,450 $3,265 $2, $4,980 $4,210 $4,420 $3,715 $3,850 $3, $5,130 $4,335 $4,555 $3,825 $3,965 $3, $5,920 $5,295 $5,045 $4,330 $4,390 $3, $6,100 $5,455 $5,195 $4,460 $4,520 $3, $7,020 $7,020 $5,700 $5,700 $5,045 $5, * $8,425 $8,425 $6,845 $6,845 $6,055 $6, * $8,845 $8,680 $7,050 $7,050 $6,240 $6, * $9,715 $9,430 $8,165 $8,165 $6,900 $6, * $9,900 $9,715 $8,410 $8,410 $7,110 $7,110 (2) Outpatient Benefits 80%Reimbursement Gold Plan Silver Plan Bronze Plan Age Band Female Male Female Male Female Male 0-5 $4,640 $4,640 $4,000 $4,000 $3,100 $3, $4,220 $4,220 $3,635 $3,635 $2,820 $2, $4,220 $4,350 $3,635 $3,745 $2,820 $2, $3,655 $3,655 $3,095 $3,095 $2,400 $2, $3,280 $3,280 $2,740 $2,740 $2,110 $2, $3,960 $3,420 $3,540 $3,080 $2,920 $2, $4,075 $3,530 $3,650 $3,175 $3,005 $2, $4,585 $3,875 $4,060 $3,420 $3,540 $2, $4,720 $3,990 $4,190 $3,520 $3,650 $3, $5,450 $4,870 $4,640 $3,985 $4,040 $3, $5,610 $5,020 $4,780 $4,105 $4,160 $3, $6,460 $6,460 $5,245 $5,245 $4,640 $4, * $7,750 $7,750 $6,295 $6,295 $5,570 $5, * $8,140 $7,985 $6,490 $6,490 $5,740 $5, * $8,940 $8,675 $7,515 $7,515 $6,350 $6, * $9,110 $8,940 $7,740 $7,740 $6,540 $6,540 (3) Hospital Cash Benefits SmartCare Essential Gold Plan Silver Plan Bronze Plan Age Band Female Male Female Male Female Male $1,030 $910 $735 $650 $500 $ $1,650 $1,160 $1,185 $835 $785 $ $2,145 $1,700 $1,540 $1,220 $1,015 $ $3,005 $2,660 $2,155 $1,905 $1,410 $1, $3,720 $3,720 $2,670 $2,670 $1,740 $1,740 5% Special Offer Get an Extra Premium Discount Now! 5% Off for each Additional Family Member NB: * Age 61 or above for Renewal Only All amounts are in Hong Kong Dollars and are applicable to each Insured Person, whereas their plan(s) selected should be the same. HPX-P-0413-B p.8