[ Insurance benefits 保險保障 IH IH IH1600 IHS0 IHS100 IHS10 1. Hospitalization & day care treatment benefits 住院及日間護理保障 10. Hospital cash (for confinement

Size: px

Start display at page:

Download "[ Insurance benefits 保險保障 IH IH IH1600 IHS0 IHS100 IHS10 1. Hospitalization & day care treatment benefits 住院及日間護理保障 10. Hospital cash (for confinement"

惇牧
7 years ago
Views:

1 FlexiCare Group Medical Insurance Plan 智識揀僱員醫療保險計劃 Table of Benefits 保障賠償表 Hospitalization & day care treatment benefits 住院及日間護理保障 The insured member who has selected this benefit will be reimbursed for the following expenses up to the maximum benefit limit under each insurance benefit. 倘受保成員已選擇此保障, 便可獲賠償以下開支, 但不超過每項保險保障的最高保障額 Insurance benefits 保險保障 IH IH IH1600 IHS0 IHS100 IHS10 1. Hospitalization & day care treatment benefits 住院及日間護理保障 Maximum benefits (HKD) 最高保障額 ( 港幣 ) 1. Room and board 房租及膳食費 Ward Semi-private Private 大房半私家房私家房 2. Room and board for intensive care unit 深切治療部房租及膳食費 3. Accompanying bed benefits 陪伴床位保障. In-hospital doctor's call fees 醫生巡房費 1 Days( 日 ) 20 1 Days( 日 ) 1 Days( 日 ) 3, Ward with supplementary major medical Benefit 大房及附加醫療保障 1 Days( 日 ) 20 Semi-private with supplementary major medical benefit 半私家房及附加醫療保障 1 Days( 日 ) Private with supplementary major medical benefit 私家房及附加醫療保障 1 Days( 日 ) 3,. Hospital special services charges 醫院雜費 7, 12,000 2,000 7, 12,000 2, Surgical charges 手術費 Complex 複雜 Major 大型 Intermediate 中型 Minor 小型 7. Anaesthetist's fee 麻醉科醫生 Complex 複雜 Major 大型 Intermediate 中型 Minor 小型 8. Operating theatre charges 手術室費 Complex 複雜 Major 大型 Intermediate 中型 Minor 小型 9. In-hospital specialist consultation fees 住院專科醫生診費 36,000 3,600 10,, 2,700 1,080 10,, 2,700 1,080 60,000 6,000, 1,, 1, 100,000 0,000 2,000 10,000 7, 3, , 3,000 36,000 3,600 10,, 2,700 1,080 10,, 2,700 1,080 60,000 6,000, 1,, 1, 100,000 0,000 2,000 10,000 7, 3, , 3,000, 6,000 8,000, 6,000 8,000

2 [ Insurance benefits 保險保障 IH IH IH1600 IHS0 IHS100 IHS10 1. Hospitalization & day care treatment benefits 住院及日間護理保障 10. Hospital cash (for confinement in general ward of public hospital in Hong Kong only) 住院現金 ( 在香港之公立醫院內之大房內住院 ) 11. Nursing fees 看護費用 12. Supplementary major medical 附加醫療保障 Deductible 扣除額 Reimbursement percentage 賠償百分比 Maximum limit per disability 每宗傷病最高限額 Maximum benefits (HKD) 最高保障額 ( 港幣 ) % 0,000 Supplementary major medical benefits covered items: (I) Daily room and board charges that exceeds the maximum number of days covered according to the schedule*; (Ii) In-hospital doctor s call fees that exceeds the maximum number of days covered according to the schedule*; (Iii) Hospital special services charges; (Iv) Surgical charges; (V) Anaesthetist s fee; (Vi) Operating theatre charge; (Vii) In-hospital specialist consultation fees, if applicable * Subject to the daily limit and the maximum limit specified in the schedule. 80% 100,000 80% 10,000 Limitations (1) No benefit will be payable for any hospital accommodation level higher than a regular private room (e.g. VIP suite or deluxe suite). (2) The adjustment factors on the amount payable for accommodation level higher than the permitted accommodation level as set forth in the schedule: Restricted accommodation level Semi-private Ward Ward (3) The amount payable under this benefit is calculated as follows: Actual accommodation level Private Semi-private Private Adjustment factor 0% 0% 2% [ Amount of eligible medical expenses incurred Benefit payable under hospital & surgical benefit Deductible for SMM Reimbursement percentage for SMM Adjustment factor, if applicable 附加醫療保障受保項目 : (i) 每日房租及膳食費超出附表所保障的最高日數之部分 *; (ii) 醫生巡房費超出附表所保障的最高日數之部分 *; (iii) 醫院雜費 ; (iv) 手術費 ; (v) 麻醉科醫生費 ; (vi) 手術室費 ; (vii) 駐院專科醫生顧問費 ( 如適用 ) * 受限於附表所訂明的每日限額及最高限額限制 (1) 概不賠償任何較普通私人房等級高的住房等級之費用 ( 如貴賓套房或豪華套房 ) (2) 如住房等級較附表訂明的指定住房等級為高, 賠償金額將受限於以下調整因素 : 指定住宿層級半私人大房大房 (3) 本保障下應付賠償額按以下公式計算 : [ 合資格醫療開支金額醫院及手術保障下應付賠償額附加醫療保障的自負額實際住宿層級私人半私人私人 [ 附加醫療保障的賠償百分比調整因素 ( 如適用 ) 調整比率 0% 0% 2% shall prevail in case of inconsistency. Zurich Insurance Company Ltd reserves the right of final approval and decision. 2. The above medical expenses wil be reimbursed on a per disability per year basis. 2. 上述醫療費用之賠償額以每年每宗傷疾計算

3 Outpatient benefits 門診保障 The insured member who has selected this benefit will be reimbursed for the following expenses according to the relevant reimbursement percentage under each insurance benefit and subject to the corresponding maximum benefit limit. 倘受保成員已選擇此保障, 便可按每項保險保障的賠償比率, 獲賠償以下開支, 但不超過每項保險保障的最高保障額 Insurance benefits 保險保障 OP120 OP220 OP Outpatient benefits 門診保障 Maximum benefits (HKD) 最高保障額 ( 港幣 ) Reimbursement percentage 賠償比率 80% 80% 100% 1. Doctor's consultation 普通科醫生診症 Maximum no. of visit per policy year 每保單年度之診症次數上限 Co-payment per visit (designated clinic) 每次診症需自負費用 ( 指定診所 ) Maximum per day limit (non-designated clinic) 每日最高限額 ( 非指定診所 ) 2. Specialist consultation 專科醫生診症 Maximum no. of visit per policy year 每保單年度之診症次數上限 Co-payment per visit (designated clinic) 每次診症需自負費用 ( 指定診所 ) Maximum per day limit (non-designated clinic) 每日最高限額 ( 非指定診所 ) 3. X-ray & laboratory examination x 光及化驗測試 Maximum limit per policy year 每保單年度之最高限額 1, 2,. Total chinese medicine 中醫診症 Maximum no. of visit per policy year 每保單年度之診症次數上限 Co-payment per visit (designated clinic) 每次診症需自負費用 ( 指定診所 ) Maximum per day limit (non-designated clinic) 每日最高限額 ( 非指定診所 ). Physiotherapy and chiropractor 物理及脊椎治療 Maximum no. of visit per policy year 每保單年度之診症次數上限 Co-payment per visit (designated clinic) 每次診症需自負費用 ( 指定診所 ) Maximum per day limit (non-designated clinic) 每日最高限額 ( 非指定診所 ) shall prevail in case of inconsistency. Zurich insurance company ltd reserves the right of final approval and decision

4 Hospital cash benefits 住院現金保障 The insured member who has selected this benefit will be entitled to the following daily cash benefit up to the maximum benefit limit under each insurance benefit should he/she be confined in a hospital. 倘受保成員已選擇此保障, 並在醫生建議下需要住院, 將獲得以下現金保障, 但不超過每項保險保障的最高保障額 Insurance benefits 保險保障 HC HC70 HC Hospital cash benefits 住院現金保障 Maximum benefits (HKD) 最高保障額 ( 港幣 ) 1. Hospital cash 住院現金保障 2. Double indemnity for intensive care 雙倍住院現金保障 ( 深切治療 ) 3. Health tonic cover 補品保障 Waiting period 等候期 days( 日 ) days( 日 ) days( 日 ) 70 1, days( 日 ) days( 日 ) 2,000 days( 日 ) shall prevail in case of inconsistency. Zurich Insurance Company Ltd reserves the right of final approval and decision.

5 Critical illnesses benefits 危疾保障 The insured member who has selected this benefit will receive the following benefit if diagnosed with one of the critical illnesses covered under this benefit and subject to a maximum of five claims per policy. 倘受保成員已選擇此保障, 並被診斷出此保障範圍內的其中一種危疾, 將獲得以下保障, 每保單最多可索償五次 Insurance benefits 保險保障 CI100 CI CI300. Critical illness benefits 危疾保障 Maximum benefits (HKD) 最高保障額 ( 港幣 ) 1. Critical illness 危疾保障 Maximum of illness claims 最多疾病索償次數 No. of illnesses covered 涵蓋疾病種類 Maximum limit per disability 每宗傷病最高限額 Group A to group E Major illnesses 組別 A 至 E 主要疾病 Group F Early stage illnesses 組別 F 早期疾病 Group G Juvenile illnesses 組別 G 青少年疾病 ,000 Covered major illnesses (group A to group E) 受保的主要疾病 ( 組別 A 至 E) Group A Cancer 組別 A 癌症 Group B Illnesses related to major organs and functions 組別 B 有關主要器官及功能的疾病 Group C Illnesses related to heart 組別 C 心臟疾病 Group D Illnesses related to nervous system 組別 D 神經系統疾病 68, , ,000, ,000 60,000 90,000 60,000 90, Cancer 癌症 2. Chronic Relapsing Pancreatitis 復發性慢性胰臟炎. End Stage Lung Disease 末期肺病 8. Medullary Cystic Disease 腎髓質囊腫病 9. Acute Myocardial Infarction 急性心肌梗塞 12. Heart Valve Surgery 心瓣手術 1. Surgery to Aorta 主動脈手術 16. Alzheimer s Disease 亞爾茲默氏病 19. Bacterial Meningitis 細菌性腦膜炎 22. Creutzfeldt-Jacob Disease 克雅二氏症 2. Multiple Sclerosis 多發性硬化 28. Parkinson Disease 柏金遜症 31. Progressive Bulbar Palsy 進行性延髓麻痺 3. Stroke 中風 3. Chronic and Irreversible Renal Failure 慢性及不可逆轉性腎衰竭 6. Fulminant Viral Hepatitis 暴發性病毒性肝炎 10. Coronary Artery By-pass Surgery 冠狀動脈手術 13. Infective Endocarditis 感染性心內膜炎 17. Amyotrophic Lateral Sclerosis 肌萎縮性脊髓側索硬化症 20. Benign Brain Tumour 腦部良性腫瘤 23. Encephalitis 腦炎 26. Muscular Dystrophy 肌營養不良症 29. Poliomyelitis 脊髓灰質炎 32. Severe Myasthenia Gravis 嚴重重肌無力症 3. Tuberculosis Meningitis 結膜性腦膜炎. End Stage Liver Disease 末期肝病 7. Major Organ Transplant 主要器官移植 11. Dissecting Aortic Aneurysm 夾層主動脈瘤 1. Primary Pulmonary Arterial Hyperten 肺動脈高血壓 ( 原發性 ) 18. Apallic Syndrome 植物人 21. Coma 昏迷 2. Major Head Trauma 嚴重頭部創傷 27. Paralysis 癱瘓 30. Primary Lateral Sclerosis 原發性側索硬化 33. Spinal Muscular Atrophy 脊髓性肌萎縮症

6 Covered major illnesses (Group A to Group E) 受保的主要疾病 ( 組別 A 至 E) Group E Other major illnesses 組別 E 其他主要疾病 Group F Early stage illnesses (the insured member must attain aged 18 or above at the time of first diagnosis) 組別 F 早期疾病 ( 在首次確診時年齡必須為 18 歲或以上 ) Group G Juvenile illnesses (the insured member must be at age 17 or below at the time of first diagnosis) 組別 G 青少年疾病 ( 在首次確診時年齡必須為 17 歲或以下 ) 36. Aplastic Anaemia 再生障礙性貧血 39. Deafness 失聰 2. HIV due to Blood Transfusion 因輸血而感染人類免疫力缺乏病毒. Loss of Speech 喪失說話能力 8. Occupational Acquired HIV 因職業而感染人類免疫力缺乏病毒 1. Severe Ulcerative Colitis 嚴重潰瘍性結腸炎. Carcinoma in situ of the Breast 乳房原位癌 7. Carcinoma in situ of the Ovaries 卵巢原位癌 60. Carcinoma in situ of the Testes 睾丸原位癌 63. Haemophilia A and Haemophilia B 甲型血友病及乙型血友病 66. Osteogenesis Imperfecta (Type III) 成骨不全症第三型 37. Blindness 失明 0. Ebola 伊波拉病毒 3. Loss of Independent Existence (coverage from aged 18 to aged70) 喪失獨立能力 ( 受保年齡為 18 至 70 歲 ) 6. Major Burns 嚴重燒傷 9. Severe Crohn's Disease 嚴重克隆氏症 2. Systemic Lupus Erythematosus 有狼瘡性腎炎的系統性紅斑狼瘡症. Carcinoma in situ of the Cervix Uteri 子宮頸原位癌 8. Carcinoma in situ of the Fallopian Tubes 輸卵管原位癌 61. Early Stage Cancer of the Prostate 前列腺之初期癌症 6. Insulin Dependant Diabetes Mellitus (Type I DM) 胰島素依賴型糖尿病 ( 一型糖尿病 ) 67. Rheumatic Fever with Valvular Impairment 風濕性心瓣疾病 38. Chronic Adrenal Insufficiency (Addison s Disease) 慢性腎上腺功能不全 ( 愛狄信病 ) 1. Elephantiasis 象皮病. Loss of Limbs 失肢 7. Necrotising Fasciitis 壞死性筋膜炎 0. Severe Rheumatoid Arthritis 嚴重類風濕性關節炎 3. Terminal Illness 末期危疾 6. Carcinoma in situ of the Uterus 子宮原位癌 9. Carcinoma in situ of the Vagina 陰道原位癌 62. Minimally invasive surgery for Coronary Artery Diseases including Angioplasty 治療冠心病微創手術包括血管形成術 6. Kawasaki Disease with Heart Complications 川崎氏病 ( 附帶心臟併發症 ) 68. Still's Disease 斯蒂爾病 shall prevail in case of inconsistency. Zurich Insurance Company Ltd reserves the right of final approval and decision.

7 Personal accident insurance benefits 個人意外保障 The following benefits will be payable up to the maximum benefit limit under each insurance benefit should the insured member who has selected this benefit, sustain injury due to an accident and resulting in death or permanent disablement within 12 consecutive months 倘受保成員已選擇此保障, 並意外受傷及於 12 個月內導致死亡或永久傷殘, 將獲得以下賠償, 但不超過每項保險保障的最高保障額 Insurance benefits 保險保障 PA0 PA100 PA10. Personal accident insurance benefits 個人意外保障 A. Personal accident 個人意外 < 18 Sum insured per insured member / Policy year (HKD) 每名受保成員每年最高保障額 ( 港幣 ) 18 < < A1. Accidental death and permanent disablement (AD& PD) 意外死亡及永久傷殘 (AD& PD) Sum insured per policy year 每年最高保障額 20,000,000,000,000 70,000 1,,000 A2. Extra indemnity for accidents on public common carrier, or as a victim of robbery, or as a result of natural disaster or happen during saturday, sunday or general holidays in Hong Kong 乘搭公共交通工具遇劫或遭遇天災或於星期六日在香港額外賠償 Sum insured per policy year 每年最高保障額 N/A,000 N/A 2,000,000 N/A 3,000,000 A3. Burns 燒傷 Sum insured per policy year 每年最高保障額 0% of A1or,000 (whichever is lower) 0% A1 投保額或港幣,000( 以較低者為準 ) A. Burial / cremation costs 殮葬費用 Sum insured per policy year 每年最高保障額 A. Home nursing fee 家庭看護津貼 Maximum no. of visits per accident 每次意外最長為 A6. Broken bones 骨折 Sum Insured per policy year 每年最高保障額 0,000 0,000 0,000 0,000 0,000 0,000 A7. Home renovation expenses 家居裝置費用 Sum insured per policy year 每年最高保障額 2,000 2,000 2,000 2,000 2,000 2,000 B. Accidental medical expenses 意外醫療費用 hospital & outpatient inclusive of chinese medicine bone-setting expenses, chinese medicine acupuncture expenses, chiropractic expenses and physiotherapy expenses 住院及門診醫療費用包括 : 中醫跌打費中醫針灸費脊椎治療費及物理治療費 B1. Sub-limit for chinese medicine bone-setting, chinese medicine acuputure expenses and/or chiropractic expenses under section B 包括於 B 部份的中醫跌打費中醫針灸費及脊椎治療費 Maximum no. of visits per accident 每次意外最多為 B2. Sub-limit for physiotherapy expenses under section B 包括於 B 部份的物理治療費 Maximum no. of visits per accident 每次意外最多為 Maximum limit per year (B1 & B2) 每年最高保障限額 (B1 及 B2) Overall maximum per accident (section B) 每次意外合共最高限額 (B 部分 ) ,000 2,000 2,000 2,000 2,000 2,000 10,000 10,000 20,000 20,000 shall prevail in case of inconsistency. Zurich Insurance Company Ltd reserves the right of final approval and decision. 2. For personal accident benefit, children aged below 18 or full time students aged below 23 are only entitled to 0% of sum insured as listed in the schedule. 2. 個人意外保障下,18 歲以下的兒童或 23 歲以下的全職學生只享有附表所列的 0% 保障額

8 Dental benefits (designated clinic) 牙科保障 ( 指定診所 ) The insured member who has selected this benefit can obtain the following dental services provided by our network dentists subject to the maximum benefit limit under each insurance benefit. 倘受保成員已選擇此保障, 便可於網絡牙醫接受牙科服務, 但不超過每項保險保障的診症上限 Insurance benefits 保險保障 DEN100 DEN 6. Dental benefits 牙科保障 Designed clinic 網絡牙醫 Maximum benefits (HKD) 最高保障額 ( 港幣 ) 1. Scaling and polishing 洗牙石 / 牙漬 Maximum no. of visit per policy year 每保單年度之診症次數上限 2.Oral examination including oral hygiene instruction 口腔檢查及口腔健康講解 3. Intra-oral small film radiograph (as necessary) 口腔 X - 光片檢查 ( 按需要 ). Amalgam filling for posterior teeth (carious) and composite filling for anterior teeth (carious) 銀粉補牙 ( 只限後牙蛀牙 ) 瓷粉補牙 ( 只限前牙蛀牙 ). Simple extraction (not requiring bone resection) 普通脫牙 ( 不需要切除牙骨 ) 6. Drainage of abscesses (without surgery) 牙瘡治理 ( 不需要手術治療 ) 7. Emergency consultations & dressings for pain relief 緊急治療及臨時補牙止痛服務 8. Medications (anti-biotics & pain killers) 藥物 ( 抗生素止痛藥 ) 1 2 shall prevail in case of inconsistency. Zurich Insurance Company Ltd reserves the right of final approval and decision. Zurich Insurance Company Ltd (a company incorporated in Switzerland) 蘇黎世保險有限公司 ( 於瑞士註冊成立之公司 ) 2-26/F, One Island East, 18 Westlands Road, Island East, Hong Kong 香港港島東華蘭路 18 號港島東中心 2-26 樓 Telephone 電話 : Fax 傳真 : Website 網址 : GSF/SCH/07/201

危疾指引這份指引可助您了解自己危疾保單內所承保的疾病及療程每種受保的危疾均會加以及我們更會扼要地列出各種除外責任及所須長短我們凡在這份指引中提及專科醫

危疾指引這份指引可助您了解自己危疾保單內所承保的疾病及療程每種受保的危疾均會加以及我們更會扼要地列出各種除外責任及所須長短我們凡在這份指引中提及專科醫危疾指引永明危疾保險驕陽永明, 人生更燦爛危疾指引這份指引可助您了解自己危疾保單內所承保的疾病及療程每種受保的危疾均會加以及我們更會扼要地列出各種除外責任及所須長短我們凡在這份指引中提及專科醫生, 皆指在所索