Pre-existing Condition Injury or sickness, physical defect or infirmity which have been diagnosed, caused or originated whether they are known or unkn

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1 Healthplus Medical Insurance Policy Please read this policy carefully upon receipt and promptly request for any necessary amendments. If you would like a copy of this policy in large print, please contact our Customer Care Centre at This policy together with the enclosed schedule and any endorsements subsequently issued should be read as if they are one document and form the contract between you and us. The Zurich Healthplus enrollment form and declaration which you completed and provided to us, verbal or written are the basis of this contract. We will insure you under those sections shown in the schedule during any period of insurance for which we have accepted your premium, provided that all of the terms and conditions of this policy are complied with. This policy is an annual medical policy which will be renewed subject to subsequent premium payments and our acceptance. You are responsible for the annual premium of any policy year when there is a claim made or service used. Should you change any information given on your enrollment form, please keep us informed immediately as the changes may affect your insurance cover. This policy is a legal document and should be kept in a safe place. Part 1 Definitions Certain words in this policy have specific meanings. We have printed these words in italics throughout this policy and have given the meanings below: Accident A sudden and unforeseen event that happens unexpectedly and causes injury to you. Age/ Aged Age at last birthday. Anaesthetist A registered medical practitioner other than you, the insured person or immediate family member, legally registered under Anaesthesiology of Specialist Register of the Medical Council of Hong Kong or the equivalent. Benign Brain Tumour Life threatening, non-cancerous tumour in the brain as confirmed by a neurologist or neurosurgeon. This includes intracranial tumours causing damage to the brain. Tumours must be deemed to require neurosurgical excision or tumours inoperably cause permanent neurological impairment. Cancer The diagnosis of a malignant tumour characterized by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissue. The cancer must be confirmed by histological evidence of malignancy by a qualified oncologist or pathologist. Cancer includes: leukaemia, malignant lymphoma, Hodgkin s disease, malignant bone marrow disorders & metastatic skin cancer. The following are excluded: carcinoma in situ, cervical dysplasia, cervix cancer CIN-1, CIN-2 & CIN-3, and all premalignant conditions or non-invasive cancers; early prostate cancer TNM Classification T1 (including T1a and T1b) or equivalent classification; melanomas of the skin of Stage 1A (<=1mm, level II or III, no ulceration), according to the new AJCC classification of 2002; hyperkeratoses, basal cell and squamous skin cancers; and all tumours in the presence of HIV infection. Chronic Liver Disease End stage liver disease or cirrhosis which means chronic end-stage liver failure that causes at least one of the following: uncontrollable ascites; permanent jaundice; oesophageal or gastric varices; or hepatic encephalopathy. Liver disease secondary to alcohol or drug abuse is excluded. Confined/ Confinement Admission in a hospital as a result of medical necessity for a minimum period of 16 hours upon the recommendation of a registered medical practitioner and continuous stay in the hospital prior to discharge. Hospital confinement will be evidenced by a daily room and board charge by the hospital except when such confinement is in connection with an actual surgical operation which does not require residence in a hospital as an in-patient. Critical Illness Benign brain tumour, cancer, chronic liver disease, heart attack, major organ transplant or kidney failure. Disability/ Disabilities Injury to or sickness of the insured person. In the case of injury, it means all injuries arising from the same event or series of contiguous events. Successive disabilities are treated as one disability unless they result from different or unrelated causes or unless separated by at least ninety (90) days from the date of discharge from the hospital or the last consultation at the doctor's office, whichever is the latest. Doctor or Surgeon or Registered Medical Practitioner A registered medical practitioner under Medical Registration Ordinance, Chapter 161, Laws of Hong Kong, other than you, the insured person, or immediate family member qualified by degree in western medicine, legally licensed and duly qualified in the geographical area of his/her practice to render medical and surgical services. Heart Attack The first occurrence of heart attack or myocardial infarction which means the death of a portion of the heart muscle, as a result of an acute interruption of blood supply to the myocardium. The diagnosis must be based on a history of typical chest pain, new electrocardiography changes proving infarction, and significant elevation of cardiac enzymes. Angina is specifically excluded. Hong Kong The Hong Kong Special Administrative Region of the People s Republic of China. Hospital An establishment which meets all the following requirements: holds a licence as a hospital (if licensing is required in the state or governmental jurisdiction); operates primarily for the reception, care and treatment of sick, ailing or injured persons as in-patients; provides 24-hour a day nursing service by graduated nurses or qualified nurses; has a staff of one or more licensed physicians available at all times; provides organized facilities for diagnosis and major surgical facilities; a medical clinic in which an actual surgical operation is performed and is deemed to be a hospital; and is not primarily a nursing, rest or convalescent home or similar establishment, a place for alcoholics or drug addicts. Immediate Family Member Your or the insured person s spouse, parent, parent-in-law, grandparent, son or daughter, brother or sister, grandchildren, fiance(e). Infectious Disease Any kinds of infectious diseases which are publicly announced and require quarantine by the Hong Kong government. Injury/ Injuries Bodily injury to the insured person evidenced by a bruise or wound caused by an accident solely and independently of any other cause and which results in a loss covered by this policy. Insured Child The insured person named in the schedule who is/are unemployed, unmarried and between the age of 15 days and 17 years (inclusive). Insured Person Those person(s) named in the schedule as insured person. Intensive Care Unit A part of a hospital which is staffed and equipped to provide care for critically ill patients requiring specialized or intensive care not normally provided within such hospital and for which a daily extra charge is made. Kidney Failure Ended stage kidney disease presenting as chronic irreversible failure of both kidneys to function. This must be evidenced by the undergoing of regular renal dialysis or undergoing a renal transplant. Major Organ Transplant The actual undergoing of a transplant of any of the organs below as a recipient or the inclusion on an official organ transplant waiting list for any of the organs below: one of the following whole human organs: heart, lung, liver, kidney or pancreas; or human bone marrow using haematopoietic stem cells preceded by total bone marrow ablation. The transplant must be medically necessary and based on objective confirmation of organ failure. Other than the above stem cell transplants are excluded. Medically Necessary/ Medical Necessity Necessary for having or the necessity to have a medical service which is in accordance with standards of good and prudent medical practice; necessary for such a diagnosis or treatment; not furnished primarily for the convenience of registered medical practitioner or any other medical service providers; furnished at the most appropriate level which can be safely and effectively provided to the insured person; and with respect to confinement, not furnished primarily for diagnostic scanning purpose, imaging examination or physical therapy. Period of Insurance That period for which we have accepted your premium as stated in the schedule. 1

2 Pre-existing Condition Injury or sickness, physical defect or infirmity which have been diagnosed, caused or originated whether they are known or unknown to the insured person before the inception of this policy. Qualified Nurse A qualified nurse other than you, the insured person, or immediate family member, legally authorized by the government of the geographical area of his/her practice to render nursing services. Schedule The schedule attached to and incorporated in this policy. Sickness A physical condition marked by a pathological deviation from the normal healthy state during the period of insurance. Specialist A registered medical practitioner other than you, the insured person or immediate family member, legally registered in the Specialist Register of the Medical Council of Hong Kong or equivalent and qualified to practise specialist care according to the qualified specialty. Waiting Period 30 days from the original effective date of this policy or the effective date of any endorsement or extension of cover which is subsequently added, during such period, no benefit will be payable in respect of treatment required as a result of any cause, other than an accident. War A contest by force between two or more nations, carried on for any purpose; or an armed conflict of sovereign powers, in either case whether such contest or armed conflict is declared or undeclared and open hostilities; or the state of nations among whom there is i) an interruption of pacific relations and ii) a general contention by force, both authorized by the respective sovereigns of such nations. We, Us or Our Zurich Insurance Company Ltd You or Your The policyholder shown in the schedule as the insured person who is the owner of this policy. Part 2 Benefits If any insured person is confined in a hospital on the recommendation of a doctor due to disability occurring during the period of insurance, upon receipt of proof acceptable to us and subject to the terms and conditions of this policy, we will pay the benefits shown as insured in the schedule to you or, in the event of your death, to your estate. The benefits payable will be subject to the relevant plan limits as shown in the following tables. Benefit tables Basic benefit table Basic benefit Room, board and general nursing charges No. of days Limit per day In-hospital doctor's call fees No. of days Limit per day Accompanying bed benefit No. of days Limit per day Maximum benefit per disability (HKD) Classic Extra Deluxe unlimited cover 1,000 1,000 unlimited cover 2,000 2,000 unlimited cover Hospital special services charges 7,000 10,000 18,000 Surgical charges 40,000 60,000 90,000 Anaesthetist's fee 14,000 21,000,500 Operating theatre charges 14,000 21,000,500 In-hospital specialist consultation fees 6,000 8,000 10,000 Intensive care unit charges 10,000 15,000 30,000 Additional accident benefit 10,000 15,000 30,000 Post-surgery specialist treatment due to critical illness Limit per visit Limit per year - - 2,000 30,000 3,000 48,000 Artificial prosthesis and rental of wheel chairs benefit 10,000 20,000 30,000 Hospital cash benefit No. of days Limit per day Infectious disease hospital benefit No. of days Limit per day Post-surgery out-patient benefit 700 1,200 1,500 Home nursing fees No. of days Limit per day Limousine services Limit per ride (One ride per confinement) 1,000 1,000 1,000 Emergency out-patient benefit 1,500 2,000 3,000 Optional benefit table Optional benefit Maximum benefit per disability (HKD) Classic Extra Deluxe Supplementary major medical benefit 60, , ,000 Section 1 Basic cover 1.1 Room, board and general nursing charges We will pay the actual room, board and general nursing charges made by the hospital for the period during which the insured person is confined in a hospital, not exceeding days per disability. The most we will pay for any one day is as shown in the basic benefit table. 1.2 In-hospital doctor's call fees Where the insured person is confined in a hospital, we will pay the attending doctor's actual charges for treatment during such confinement not exceeding days per disability. The most we will pay for any one day is as shown in the basic benefit table. 1.3 Accompanying bed benefit If the insured child is confined in a hospital, we will pay the actual charges made by the hospital for an accompanying bed occupied by one of the insured child's close family members, not exceeding days per disability. The most we will pay for any one day is unlimited. 1.4 Hospital special services charges Where the insured person is confined in a hospital, we will pay the actual charges made by the hospital in respect of: (i) drugs and medicines prescribed by the attending doctor and consumed in the hospital; (ii) dressings, ordinary splints and plaster casts but excluding special braces and appliances equipment; (iii) physiotherapy as recommended by the attending doctor; (iv) oxygen and its administration; (v) x-rays, electrocardiograms and other laboratory examinations and tests and diagnostic procedures, the immediate purpose of which is the cure of sickness as a result of medical necessity; (vi) intravenous infusions; (vii) blood or plasma and their administration; (viii) ambulance service to or from the hospital. The most we will pay for any one disability is as shown in the basic benefit table. 1.5 Surgical charges Where the insured person is confined in a hospital, we will pay the actual surgical operation charges made by a surgeon. The most we will pay for any one disability shall not exceed the amount shown in the basic benefit table and the compensation amount will be paid in accordance with the schedule of surgical operations. 1.6 Anaesthetist's fee If the surgical charges have beed paid, we will also pay the actual anaesthetist charge made by an anaesthetist other than the surgeon or registered medical practitioner who operates on the insured person up to a maximum shown in the basic benefit table for any one disability and the compensaton amount will be paid in accordance with the schedule of surgical operations. 1.7 Operating theatre charges Where we agree to pay the surgical charges, we will pay the actual operating theatre charge made by the hospital up to a maximum shown in the basic benefit table for any one disability and the compensation amount will be paid in accordance with the schedule of surgical operations. 1.8 In-hospital specialist consultation fees Where the insured person is confined in a hospital, we will pay the actual consultation charges of a specialist who is a registered medical practitioner and who has been recommended by the attending doctor in writing. The most we will pay for any one disability is as shown in the basic benefit table. 1.9 Intensive care unit charges For confinement in a recognized and separate intensive care unit of a hospital for which benefits are payable under room, board and general nursing charges and hospital special services charges above, we will pay additional cost over and above the medically necessary charges of the room, board and general nursing charges sustained during any portion of the confinement subject to the maximum limit per disability shown in the basic benefit table Additional accident benefit In the event of the insured person sustaining an injury, as a result of an accident which has occurred solely and independently of any other cause other than the insured person suffering from sickness and resulted in confinement in a hospital, we will pay the actual usual and customary charges made by the hospital or doctor for the treatment of such injury which are in excess of all other amounts that we have agreed to pay under Section 1 of this policy. The most we will pay for any one disability is as shown in the basic benefit table Post-surgery specialist treatment due to critical illness Where we agree to pay for the benefits on the medically necessary cost of postsurgery specialist treatments to any insured person who suffers from any critical illness. 2

3 The most we will pay for any one disability is as shown in the basic benefit table Artificial prosthesis and rental of wheel chairs benefit Where we agree to pay for the benefits on the costs of the installation fees of artificial prosthesis and the rental fees of wheel chairs per disability as required and referred by the attending doctor in writing. The most we will pay for any one disability is as shown in the basic benefit table Hospital cash benefit Where the insured person is confined in a public hospital in Hong Kong in respect of each and every disability, we will pay the limit per day as shown in the basic benefit table. The maximum number of days in total for which we will pay benefit is per disability Infectious disease hospital benefit Where the insured person is confined in a public hospital in Hong Kong due to infectious disease in respect of each and every disability, we will pay the limit per day as shown in the basic benefit table. The maximum number of days in total for which we will pay benefit is 30 per disability Post-surgery out-patient benefit Where we agree to pay the surgical charges, we will pay the actual charges made by the surgeon for out-patient treatment directly relating to and as a result of the surgical operation and which are incurred by the insured person within days after discharge from the hospital following such operation. The most we will pay for any one disability is as shown in the basic benefit table Home nursing fees Where we agree to pay the surgical charges, we will pay the actual charges made by a qualified nurse in respect of services given to the insured person at the insured person's usual residence (not being a nursing or convalescent home) as required in writing by the attending doctor for a period not exceeding days after discharge from the hospital for any one disability. The most we will pay for any one day is as shown in the basic benefit table Limousine services When the insured person is discharged from hospital in Hong Kong after a confinement of no less than 7 consecutive days, then upon request of the insured person by giving one working day s notice to us by calling on , we shall arrange a limousine to transport the insured person to his/her residence where possible in Hong Kong. We will pay for the limousine service only when it is arranged by us. The most we will pay for each ride shall not exceed the amount as shown in the basic benefit table Emergency out-patient benefit We will pay the actual charges made by the hospital or doctor in respect of emergency treatment for an injury of the insured person given in the hospital out-patient department or in a medical clinic within 48 hours of such injury. The most we will pay for any one disability is as shown in the basic benefit table. Section 2 Optional cover 2.1 Supplementary major medical benefit Where the amount of actual charges for medical services for a disability insured hereunder (other than the room, board and general nursing charges and in-hospital doctor s call fees) exceeds the limit of the basic benefits as set out in the basic benefit table, we will pay 80% of the balance of such actual charges in excess of the amount payable under Section 1 - Basic cover. If the insured person suffers from a confinement over days, we will pay the actual charges or fees for the room, board and general nursing charges and in-hospital doctor s call fees as set out in the basic benefits of the basic benefit table subject to a daily limit as shown in the basic benefits of the basic benefit table. The most we will pay for this supplementary major medical benefit in respect of any one disability is as shown in the optional benefit of the optional benefit table. Exclusions relating to supplementary major medical benefit: This optional benefit does not cover post-surgery specialist treatment due to critical illness, artificial prosthesis and rental of wheel chairs benefit, hospital cash benefit, infectious disease hospital benefit, post-surgery out-patient benefit, home-nursing fees and emergency out-patient benefit. Section 3 Worldwide emergency assistance 3.1 Guarantee of medical expenses incurred during hospitalization If the insured person is required to be hospitalized in a hospital approved by us whilst travelling outside Hong Kong, we will pay directly to the hospital the admission guarantee required by the hospital, up to a maximum of USD2,500. If we have paid any amount under item 3.1 whereby it is not covered by this policy, you should repay the amount to us. 3.2 Overseas telephone medical advice assistance We will arrange to provide medical advice and assistance over the telephone whilst the insured person travels outside Hong Kong. 3.3 Medical referral We will provide the insured person with the name, address and telephone number of doctors, dentists, hospitals, clinics, and dental clinics worldwide. 3.4 Emergency house-call nursing assistance (Hong Kong only) Upon the request of the insured person, we will assist in arranging for an emergency house call by a qualified nurse. In respect of overseas telephone medical advice assistance, medical referral and emergency house-call nursing assistance, any hospitalization expenses or medical expenses charged to you by a third party are to be borne by you unless they are covered by this policy. Medical assistance service is rendered by service provider which is nominated by Zurich Insurance Company Ltd. Please call Zurich 24-hour emergency assistance in Hong Kong at for assistance. Part 3 Exclusions This policy will not cover any claim arising directly or indirectly from: 1. Any pre-existing condition; 2. Any treatment or expenses incurred other than as a result of an accident within the waiting period; 3. Any condition resulting from childbirth, miscarriage, abortion, pregnancy, including but not limited to pregnancy test, pre-natal care as well as post-natal care and other complications arising from pregnancy, contraception or contraceptive devices, infertility or sterilization of either sex; 4. Cosmetic surgery or plastic surgery for the purpose of beautification except as necessitated by an injury; 5. Any dental surgery of any nature whatsoever except procedure necessitated by damage to sound natural teeth as a result of an injury occurring during the period of insurance; 6. Vaccination or inoculations, general check-up, convalescence, custodial or rest care or sanitaria care, or expenses incurred not in accordance with the diagnosis and treatment of the condition for which the confinement is required; 7. Congenital abnormalities including but not limited to epilepsy, strabismus, hydrocephalus, hernia up to the age of eight (8) years of insured person; 8. Medical treatment and surgery for anal fistulae; cholecystitis; calculi of kidney, urethra or bladder; gall bladder calculi; diabetes mellitus; gastric or duodenal ulcer; hallux valgus; hypertension or cardio vascular disease; tuberculosis; bone tumors; malignancies of blood or bone marrow until the insured person has been continuously covered by this policy for 180 consecutive days immediately preceding such treatment and surgery; 9. Medical treatment and surgery for cataracts, endometriosis, diseased tonsils, haemorrhoids, hyperthyrodism, vocal nodule, tumors/ cyst of skin/ subcutaneous or muscular tissue, pathological abnormalities of nasal septum or turbinates, sinus conditions, tumors of internal organs or circumcision until the insured person has been continuously covered by this policy for 365 consecutive days immediately preceding such treatment and surgery; 10. Routine eye test, refractive errors of the eyes or their correction by glasses; 11. Procurement or use of appliances, equipment such as, but not limited to balloon for balloon angioplasty; organ; 12. Suicide, attempted suicide, intentional self-injury, insanity or any functional disorder of the mind, or whilst under the influence of alcohol or drugs; 13. Engaging in any kind of sport or race in a professional capacity or where the insured person would or could earn any remuneration from engaging in such sport or race; 14. Participating in any illegal activity such as, but not limited to robbery, drug abuse or assault; 15. Air travel except as a fare-paying passenger in a properly licensed aircraft operated by a licensed commercial air carrier; 16. Treatment by any person other than a registered medical practitioner; 17. Services which are not recommended and prescribed by the insured person s attending doctor; 18. Any costs incurred by any insured person outside any policy period of this policy or for any policy period of this policy for which the appropriate premium has not been paid; 19. Treatment outside Hong Kong except as the result of the need for treatment arising during a temporary absence of less than 90 days of the insured person from his residence in Hong Kong; 20. Any disability for which compensation is payable under any government law or for which benefits are payable under any other insurance policies except to the extent that such claim is not reimbursed under or pursuant to such laws or other policies; 21. Venereal diseases, HIV (Human Immunodeficiency Virus) and/or HIV-related illness including AIDS (Acquired Immune Deficiency Syndrome) and/or any mutant derivative or variations thereof however caused or however named; 22. War, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, military or usurped power, direct participation in strike, riot or civil commotion; 23. Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel, or from any nuclear weapons material; 24. Disease or sickness arising from asbestos. Part 4 Conditions 1. Entire contract This policy including the schedule, endorsements, attachments and amendments, if any, will constitute the entire contract between the parties. No agent or other person has the authority to change or waive any provision of this policy. No changes in this policy shall be valid unless approved by our officer and evidenced by endorsement of amendment. 2. Age limit Unless specifically mentioned to the contrary, the insured person must be under sixtyfive (65) years of age at the effective date of this policy and renewal is allowed up to the age of one hundred (100) years. 3. Notice of claims You must inform us in writing as soon as possible and always within 90 days of the first treatment of any disability likely to give rise to a claim and give us such proofs as we may reasonably require, at your expense. We shall be entitled to call for examination(s) by a medical referee at our expense. If you do not comply with this condition, benefit under this policy may not be paid. 4. Proof of loss Written proof of loss must be furnished to us within 30 days from our receipt of the claims form completed by you. Failure to furnish such proof within the time required shall not invalidate any claims if it was not reasonably practicable to give proof within such time, provided that such proof is furnished as soon as reasonably practicable, and in no event later than 180 days from the time such proof is otherwise required. All certificates information and evidence in such form and of such nature and within such time as we may reasonably require shall be furnished without expense to us. 3

4 5. Medical examination We shall be entitled in the case of non-fatal injury to call for examination by a medical referee or any relevant parties appointed by us whenever required and in the event of death to have a post-mortem examination at our expense. 6. Payment of claims Indemnity for death of the insured person is payable to the estate of the insured person. All other indemnities are payable to the insured person except under Part 2, Section 3 Worldwide emergency assistance where the benefits will be paid based on actual cost directly to the provider of service. 7. Policy examination If you are not satisfied with this policy, you may return it to us within 14 days of receipt. This policy will then be deemed void from the effective date shown in the schedule and we shall not be liable for any loss sustained by you. A full refund of any premium paid will be made. 8. Change of occupation If the insured person changes his/her occupation as stated in the schedule without first notifying us and obtaining written agreement from us to the amendment of this policy (subject to the payment of additional premium as we may require as the consideration for such agreement), then no claim shall be payable by us in respect of any injury arising out of or in the course of such occupation. 9. Misrepresentation If you make or anyone acting for you makes a statement in the enrollment form and declaration or in connection with any claim knowing the statement to be false, we will not be liable for the claim and all cover under this policy shall cease. 10. Premium charge (i) This policy is an annual medical policy. You may pay the premium to us on an annual or a monthly basis. All premiums after the first premium are payable to us on or before the due date. You are responsible for the annual premium of any policy year of this policy when there is a claim made or service used in such policy year. (ii) We reserve the right to revise or adjust the premium under the following circumstances: According to our applicable premium rate at the time of the premium due date by giving 30 days written notice to you. The premium rate should be adjusted automatically as you enter into the next age band at the time of renewal. 11. No claim discount No claim discount on the renewal premium of any policy year of this policy may be available and is calculated as follows: (i) If no claim has been made or has arisen for any insured person under any policy year of this policy, no claim discount on the renewal premium of the following policy year of this policy will be increased by 5%, up to a maximum of 15% discount. (ii) If a claim has been made or has arisen for any insured person under any policy year of this policy, no claim discount on the renewal premium of the following policy year of this policy will be decreased by 5%, subject to a minimum of nil discount. 12. Grace period We will allow you days for the payment of each premium after the first premium. During that time we will keep this policy in force. If after that time the premium remains unpaid, this policy will be deemed to have lapsed from the date that the unpaid premium was due. 13. Reinstatement If we have allowed this policy to lapse due to non-payment of premium, we may allow this policy to be reinstated if you provide to us a satisfactory written application for reinstatement including proof of insurability. The reinstated policy shall only cover an injury sustained by the insured persons after the date of reinstatement and shall only cover sickness of the insured person which begins no sooner than 10 days after the date of reinstatement. 14. Cancellation You may cancel this policy by giving 30 days notice of cancellation by written notice delivered to us, or mailed to our last known address. In such event, the premium for the unexpired policy period of this policy will be refunded in accordance with the charges indicated below, but in no event less than our customary minimum premiums below and provided that no claim has been made during the relevant policy period of this policy in the event that this policy is cancelled by you. We reserve the right to cancel this policy subject to the above Condition 9 Misrepresentation for all covers to cease by giving 7 days notice of cancellation by written notice delivered to you, or mailed to your last known address. Covered Period Charges of Premium 2 months (i.e. our customary minimum premiums) 40% 3 months 4 months 60% 5 months 70% 6 months 75% Over 6 months 15. Termination of coverage Coverage under this policy shall automatically terminate on the earliest of the dates specified below: (i) the premium due date when any or any part of premium pertaining to this policy is not paid within the grace period; (ii) the date when the insured person is aged over one hundred (100) years; (iii) upon your request, termination of coverage will be effective on the date specified in the written notice received by us, provided that 30 days notice of cancellation before premium due date is given; (iv) subject to the above Condition 9 Misrepresentation. 16. Renewal We reserve the right to amend any terms and conditions, including but not limited to the premium rates or benefits or exclusions of this policy at the time of renewal of any policy year of this policy, either before or after your acceptance of such renewal. We will not be obligated to reveal our reasons for such amendments. After all, such renewal will not have to take place eventually if such amendments are not acceptable to the insured person. 17. Misstatement of age or sex If any insured person's age or sex has been misstated, the insured person should pay the difference between the premium actually paid, if any, and the premium for the correct age and sex. 18. Additions and deletions You must notify us in writing of any additions to or deletions from the list of the insured persons. We shall calculate any premium adjustments on a pro-rata basis. Deletions will only be allowed in the event of the death of the insured person or upon the insured person ceasing to be eligible for the insurance under this policy. 19. Claims admittance In no case shall we be liable in respect of any claim after the expiration of 12 months from the occurrence of the disability giving rise to it unless the claim has been admitted or is the subject of a pending legal action or arbitration. 20. Legal action No legal action shall be brought to recover on this policy prior to the expiration of 60 days after written proof of claims has been filed in accordance with the requirements of this policy, nor shall such action be brought at all unless commenced within 2 years from the expiration of the time within which proof of claims is required. 21. Subrogation We have the right to proceed at our own expense in the name of the insured person against third parties who may be responsible for an occurrence giving rise to a claim under this policy. 22. Alternative Dispute Resolution In the event of a dispute arising out of this policy, the parties may settle the dispute through mediation in good faith in accordance with the relevant Practice Direction on civil mediation issued by the Judiciary of Hong Kong and applicable at the time of dispute. All unresolved disputes shall be determined by arbitration in accordance with the Arbitration Ordinance (Chapter 609), Laws of Hong Kong as amended from time to time. The arbitration shall be conducted in Hong Kong by a sole arbitrator to be agreed by the parties. It is expressly stated that the obtaining of an arbitral award is a condition precedent to any right of legal action arising out of this policy. Irrespective of the status or outcome of any form of alternative dispute resolution, if we deny or reject liability for any claim under this policy and insured person does not commence arbitration in the aforesaid manner within twelve (12) calendar months from the date of the our disclaimer, insured person's claim shall then for all purposes be deemed to have been withdrawn or abandoned and shall not thereafter be recoverable under this policy. 23. Compliance with policy provisions Failure to comply with any of the provisions contained in this policy shall invalidate all claims hereunder. 24. Governing law and jurisdiction This policy shall be governed by and interpreted in accordance with the laws of Hong Kong and subject to the exclusive jurisdiction of the Hong Kong courts. 25. Statement of purpose for collection of personal data All personal data collected and held by us will be used in accordance with our privacy policy, as notified to you from time to time and available at the following website: Part 5 Claims procedure Step 1: Step 2: Notify us or our agents/ brokers as soon as possible. Fill in a claim form if necessary and supply the following original documents as appropriate. 1. Hospitalization (i) Hospital statement showing: name of the patient period of confinement itemized charges (ii) Receipts of all attending doctors/ specialists/ anaesthetists/ surgeons/ physiotherapists showing: name of the patient date of consultation diagnosis and/or treatment given amount charged 2. Post-surgery out-patient/ emergency out-patient (i) Doctor's receipt showing: name of the patient date of consultation diagnosis and/or treatment given amount charged 3. Home nursing (i) Written requirement of the attending doctor (ii) Receipt of qualified nurse for services showing: name of the patient period of services amount charged (per day/ total) 4. Hospital cash/ Infectious disease hospital (i) Hospital statement showing: name of the patient name of the hospital period of confinement diagnosis and/or treatment given 4

5 5. Specialist treatment (i) Receipts of all attending doctors/ specialists/ anaesthetists/ surgeons/ physiotherapists showing: name of the patient date of consultation diagnosis and/or treatment given (ii) Specialist's receipt showing: name of the patient date of consultation diagnosis and/or treatment given amount charged 6. Artificial prosthesis and rental of wheel chairs (i) Written requirement of the attending doctor (ii) Receipt of all items purchased showing: date of purchase model and type amount charged Claims promise Claims will be processed within 7 working days if all necessary documentation is provided. Schedule of surgical operations For a cutting operation, fracture or dislocation not listed in this list and not expressly excepted herein or by the other terms of the schedule, we will pay a benefit, the amount of which is to be determined by comparable listed operations, fractures or dislocations as decided by us. If X-ray, radium or any other radioactive substances are used for treatment in place of any cutting operation listed below, we will, subject to the terms and conditions of this policy, pay a benefit which is reasonable and customary for such treatment up to the amount provided by the surgical list for the replaced cutting operation. Description 1. Ear Insertion of grummet with or without Myringotomy Tympanoplasty Mastoidectomy Operation on the contents of middle ear including the middle ear bones and stapedectomy Operation on cochlea Operation on the external ear and/or pre-auricular sinuses Operation on endolymphatic sac Labyrinthectomy Removal of foreign body 2. Nose and sinuses Antral puncture and lavage Removal of nasal polyp under GA Inferior turbinectomy and/or submucous resection operations Cauterisation of nasal mucosa Rhinoscopy or nasopharyngoscopy including rhinoscopic biopsy and foreign body removal Other intranasal operation including laser operation excluding simple rhinoscopy, biopsy and cauterisation of vessels Caldwell Luc operation on accessory sinuses Unilateral Caldwell Luc operation on accessory sinuses Bilateral Ethmoidectomy or frontal sinusotomy Functional endoscopic sinus surgery Dacrocystorinostomy Septorinoplasty with or without graft, implant following trauma or excision of tumor Rhinoplasty Septoplasty (SMR) 3. Throat Vocal cord operation including using laser techniques (carcinoma excluded) Laryngectomy with or without radical neck resection Tracheostomy Laryngoscopy with or without foreign body removal Excision of pharyngeal pouch or diverticulum Tonsillectomy with or without other adenoid tissue removal 4. Eye All conjunctival or corneal operations except corneal grafting, severe corneal wound repair and keratoplasty Corneal grafting, severe wound repair and keratoplasty including corneal transplant Ectropion or tarsorrhaphy Ptosis repair and/or blepharoplasty Surgical treatment for glaucoma Enucleation of eye Removal of intraocular foreign body : - In front of lens - In lens or behind lens Removal of corneal foreign body Maximum percentage Eyeball, perforating wound of, with incarceration or prolapse of uveal tissue repair Lens operation including cataract removal and prosthetic lens insertion Operation on extraocular muscles Operation on retina, resection of buckling or revision operation Operation on retina, removal of encircling silicone Laser photocoagulation on retina Removal of pterygium (one or both sides) Incision of chalazion Open exploration of nasal lacrimal duct except simple probing Lacrimal sac excision of or operation on 5. Brain and central nervous system Excision of brain tumour or brain abscess Excision of brain including lobectomy Hemispherectomy Operation on intra-cranial arterio-venous malformation Blurhole(s) Brain biopsy Creation of ventriculoperitineal shunt or subcutaneous cerebrospinal fluid reservoir Maintenance removal of cerebroventricular shunt (including revision) Irrigation of cerebroventricular shunt Craniectomy Excision of spinal cord tumour Decompression of spinal cord or spinal nerve root Open operation on spinal cord Lumbarpuncture or cisternal puncture Sympathectomy including operation on the sympathetic trunk Operation on cranial nerve including nerve tumour Operation of pituitary tumour Gamma knife, radio surgery for intracranial pathology (all causes) 6. Head and neck Operation on neck vessels including carotid artery operation Parotid gland removal, superficial Parotid gland removal Removal of submandibular salivary gland(s) Thyroidectomy including parathyroid operation, subtotal, partial Thyroidectomy including parathyroid operation, total Thyroglossal cyst, excision Partial glossectomy Radical glossectomy Block dissection of neck lymph nodes for tumour Biopsy of neck mass or excisonal biopsy of lymph node Operation on lip and cheek benign tumour Operation lip and cheek malignant tumour Fine needle aspiration (FNA) and lymph node needle biopsy 7. Thoracic operations Bronchoscopy Segmental lobectomy, pneumonectomy Thoracoplasty Pleurectomy Thoracocentesis or insertion of chest tube for pneumothorax Thymectomy 8. Cardio-vascular operation Heart Insertion of cardiac pacemaker Cardiac catheterisation Open operation on heart or thoracic aorta Percutaneous transluminal coronary angioplasty all types including laser technique, stenting, motor-blade, balloon angioplasty or radiofrequency ablation technique Cardiac transplantation Veins Varicose vein stripping & ligation, bilateral Varicose vein stripping & ligation, unilateral Varicose vein ligation, unilateral or bilateral Embolectomy, artery Thrombectomy, vein Insertion of central venous cathether Insertion of Hickman cather 9. Abdominal operation Exploratory laparotomy Open drainage of abdominal or pelvic abscess Laparoscopy or peritoneoscopy Exploration for peritonitis Operation on intra-abdominal vessels including abdominal aorta operation, portocaval anastomosis and splenorenal anastomosis Removal of adrenal gland(s) Inguinal and/or femoral hernia (all forms, with or without complication, single or multiple) Umbilical hernia or umbilical sinus 5

6 10. Operation on the hepato-biliary system Diagnostic endoscopic retrograde cholangio-pancreatography (ERCP) ERCP associated operation - papilla operation or stone extraction Cholecystectomy, including laparoscopic approach with or without Spincterotomy Operation on the gall bladder with exploration of the biliary system Open operation on liver cyst or abscess Liver biopsy Partial lobectomy of liver Liver transplantation 11. Gastro-intestinal tract operation Oesophageal, stomach & duodenum Upper endoscopy up to the level of duodenum or Oesophagoscopy Oesophagoscopy with removal of foreign body Gastro-enterostomy or gastrostomy Oesophageal varices plication Total oesophagectomy and interposition of intestine Any duodenal operation including closure of perforated peptic ulcer Gastrectomy (all forms) Vagotomy and/or pyloroplasty Proximal geastric vagotomy (HSV) Hiatus hernia repair Jejunum and ileum Reduction of volvulus or intussusception Resection of small intestine and anastomosis Large intestine Diagnostic colonoscopy, with or without biopsy Colonoscopy, with papilloma or polyp removal Appendectomy (appendicectomy) including ruptured appendix and peritonitis (including laparoscopic) Formation of ileostomy or colostomy Resection of large bowel including colectomy (all types) and excision of rectum (all types) Operation for the prolapse of rectum without laparotomy Operation for the prolapse of rectum involving laparotomy colostomy and intestinal anastomosis Incision and drainage for ischio-rectal abscess Haemorrhoidectomy Haemorrhoidectomy with colonscopy, fistulectomy or sigmoidoscopy Operation for fistula-in-ano Operation for anal fissure including radical excision 12. Pancreas and spleen Any operation on pancreas including pancreatic pseudocyst Splenectomy 13. Urinary tract Kidney & ureter Extracorporeal shock wave lithotripsy for urinary stone (ESWL) Nephrectomy (all forms) Open operation to remove urinary stone (nephrolithotomy, pyelolithotomy or ureterolithotomy) Pyeloplasty Diagnostic endoscopic examination of kidney with or without biopsy and other therapeutic procedures Percutaneous insertion of nephrostomy tube Renal biopsy Formation of ileal conduit including ureteric implantation Bilateral reimplantation of ureter into bowel or bladder Unilateral reimplantation of ureter into bowel or bladder Ileal or colonic replacement of ureter Bladder Diagnostic cystoscopy Cystoscopy, ureteric catherisation Cystoscopy, insertion of ureteric stent Cystoscopy, diathermy, fulguration bladder tumour, excision of urethal, or ureteral dilatation Cystoscopy, closed ureterolithomy Cystectomy, partial Cystectomy, total with or without construction of intestinal conduit or bladder Repair of vesico-vaginal fistula Excision of bladder diverticulum (single or multiple) Repair of vesicocolic fistula Urethra Closure of fistula of urethra Repair of urethrorectal fistula Repair of rupture of urethra 14. Male genital tract Penis Amputation of penis Circumcision Prostate Transurethral prostatectomy Open prostatectomy (all forms) Prostate biopsy Transurethral microwave therapy External drainage of prostatic abscess Spermatic Vasectomy Testicles Epididymectomy Exploration of testis Reduction of torsion of testis and fixation (one or both sides) Operation for varicocele (one or both sides) Radical operation for hydrocele Tapping of hydrocele Orchidectomy or orchidopexy Testicular biopsy 15. Female genital tract Cervis Colposcopy (with or without biopsy) Cervicectomy, cone biopsy or cauterization of cervix Excision of cervical stump, all methods Suture of cervix Uterus and adexa Dilatation and curettage with or without polpectomt, cervical diathermy or hesteroscopy Total hysterectomy with or without bilateral salpingo-oophorectomy (including laparoscopic means abdominal or vaginal) Myomectomy (including laparoscopic means) Ventro suspension of uterus Ovary and fallopian tube Excision of ovarian cyst, drainage of tubo-ovarian abscess (including laparoscopic means) Bilateral oophorectomy and salpingectomy Unilateral oophorectomy and salpingectomy Vulvovaginal Marsupilisation of bartholin s cyst Anterior and posterior colpoperineorrhaphy with or without amputation of cervix Vulvectomy Colposuspension Reconstructive surgery of gential tract Operation for simple cyst, wart or benign tumour of vulva and vagina, including simple repair and suturing Operation for malignant tumour of vulva or vagina 16. Breast Incisional breast biopsy Breast tumor excision or excisional biopsy Duct papilloma excision Gynaecomastia excision Modified radical mastectomy Partial or simple mastectomy Partial or radical mastectomy with axillary lymphadectomy 17. Orthropaedic General Operative treatment of compound fracture with external fixators and extensive wound debridement Operative removal of screws, pins and plates, and other metals for old fracture which requires opening up of wounds but exclude simple removal of K-wire Osteotomy of large bone, with or without fixation, including bone graft Diagnostic arthroscopic examination of joint, with or without biopsy Therapeutic arthroscopic operations on cavity of joint Manipulation of joint under aneathesia Excision of curettage of bone cyst or benign bone tumor Excision of ganglion Excision of bursa Excision of lesion of tendon Secondary repair of tendon (including graft, transfer and/or prosthesis) Transposition of tendon Arthrodesis of large joint and bone graft Limited repair of muscle (less than 2cm tear) Extensive (greater than 2cm tear) repair of muscle Lengthening of tendon(s), including tentomy Tenosynovectomy Open biopsy of muscle Release of peripheral nerve Surgical toilet to deep wound under general anaesthetic Head & neck Cervical fusion (one or two level) Cervical ribs Shoulder Acromionectomy Reduction of dislocated shoulder Total shoulder replacement Stabilization of shoulder joint, including anterior, posterior or multi-directional, including arthroscopic Upper limb closed reduction with or without POP Colle s fracture Fractured humerus, radius, around elbow or ulna 6

7 Upper limbs open operation Amputation of finger(s) De Quervain s Arthrodesis of finger(s) (IP joint) Excision of radial head Fixation of Olecranon Internal fixation of radius or ulna Internal fixation of humerus, radius and unla Synovectomy of wrist Tendon repair, upper limb Tennis elbow release Trigger finger or thumb release Ulna nerve transportation Carpal or cubital tunnel release, including endoscopic means, bilateral or unilateral Dupuytren s subcutaneous fasciotomy Dupuytren s radical fasciectomy Fusion of wrist Spine Laminectomy Anterior spinal fusion Posterior spinal fusion - With implant - Without implant Hip AHJ total hip replacement Metal femoral head insertion Moore s pins Nail plate Lower limb closed reduction with or without POP Fracture of dislocation of ankle Knee fracture Fracture tibia and fibula Lower limb open operation Bunionectomy Internal fixation of patella Internal fixation of femur, tibia or ankle Keller s operation Ligament repair knee or ankle McBride operation, bilateral or unilateral Menisecotomy Mitchell s oeteotomy Osteotomy of femur, adult Osteotomy of femur, child Oeteotomy of tibia Patellectomy Amputation of leg or foot Total prosthetic replacement of knee joint Repair Achilles tendon (TA) TA repair with reconstruction Wedge resection of toenail, bilateral Wedge resection of toenail, unilateral Metatarsal osteotomy for Hallux valgu, bilateral Metatarsal osteotomy for Hallux valgus, unilateral 18. Skin Lymph node biopsy or drainage of lymph node abscess Excision of skin lumps or tumour of subcutaneous tissue, including lipoma, neurofibroma or its variants, sebaceous cysts, malignant melanoma, and naevus etc. Incision and drainage of skin abscess Cauterisation of skin lesion with electricity or curosurgery Removal of foreign body Excison of pilonidal cyst Skin grafting or keloid operation - If total area less than or equal 1% of body surface area - If total area more than 1% of body surface area Drainage of subungual haematoma or abscess Skin suturing 19. Dental Any kind of dental surgery due to injury caused by an accident Zurich Insurance Company Ltd (a company incorporated in Switzerland) 25-26/F, One Island East, 18 Westlands Road, Island East, Hong Kong Customer Services Hotline: Fax: Website: HPS