S MMA Hospital Benefit Leaflet (HK) Revision V1

Size: px

Start display at page:

Download "S MMA Hospital Benefit Leaflet (HK) Revision V1"

梦蔺
9 years ago
Views:

1 Hospital Benefits

2 What is the likelihood of your being admitted to hospital? + High Possibility of Hospitalization: According to Hospital Authority statistics +, over recent years, annual hospitalizations due to accidents and diseases in Hong Kong have averaged over 1.9 million, with almost one in four people needing in-patient treatment each year. Long Queues for Public Medical Services: Over-stretched public medical services inevitably result in long queues for medical treatment. Worst of all, the types of treatment and medicines available are limited. ^ Expensive Private Medical Treatment: Immediate and quality medical treatment is available in private hospitals. However, such treatment is usually much more expensive. For example, the hospital expenses for the most common cancer in Hong Kong, colorectal cancer, involve costs easily mounting to between HK$100,000 and HK$200,000, and using targeted therapy costs even up to HK$500,000 for each phase^. The best way to care for yourself and show your love for your family is to have comprehensive medical insurance in place - because nothing is more valuable than good health. Fees for Medical Treatment of Major Illnesses Illness Medical Treatment ^ Reference medical fee^ (HK$) 100, ,000 - $480,000 and 00,000 - $180,000 v ^ ^

3 MassMutual Asia is proud to offer you its comprehensive Hospital & Surgical Plus. To give you extra peace of mind, three supplementary benefits are available, including Extra Major Medical Benefit, Extra Cancer Benefit and Hospital Income Benefit. Hospital & Surgical Plus Extensive Coverage The plan provides you with comprehensive coverage and reimburses the actual hospitalization and medical expenses incurred due to sickness or accident. It gives you total peace of mind knowing that you can always get immediate treatment at private hospitals without suffering any devastating financial set-backs. There are 5 plan levels to choose from, with a maximum reimbursement of medical expenses of up to HK$1.72 million for each illness or accident. Hospitalization Benefit Clinical Surgery Benefit Convalescence Others In-hospital Doctor's Call, In-hospital Specialist Consultation, Surgical Benefit, Intensive Care and Room, Board and General Nursing Benefit. Some specified surgical procedures, including removal of cataract, colonoscopy, gastroscopy, endoscopy, removal of stones in bladder by endoscopic treatment performed in the day case unit of a Hospital or a clinic in Hong Kong / Macau 1 are also eligible for the benefit. Home Nursing Benefit, Post-Surgery Out-Patient Benefit Chemotherapy, radiotherapy for cancer treatment and renal dialysis performed in Hospital or in the day case unit of a Hospital or a clinic in Hong Kong / Macau 1 are also covered. Lifetime Coverage Till Age 100 To ensure you are well covered at all times, this yearly renewal plan offers a maximum benefit term up to age 100, enabling you to easily cope with unexpected medical expenses. Moreover, the coverage may be reviewed upon renewals 2 in order to ensure adequate protection for you and to combat soaring medical costs. Renewal premium will be adjusted based on the attained age of the insured and at the premium rate in effect of the same level of benefit at the time of renewal. No Claim Bonus Provided that the policy has been in force for three consecutive policy years and no claims were made under the Hospital & Surgical Plus and Extra Major Medical Benefit, you will be entitled to a No Claim Bonus discount for both benefits upon paying the renewal policy premium. The discount is based on a percentage of the annual premium of the preceding year up to a maximum of 15%. Consecutive years of policy in force and without claims 3 4 > 5 No Claim Bonus Rate 5% 10% 15%

4 Worldwide Emergency Support Wherever in the world you happen to be, the plan is available around the clock. At the same time, it offers free "Worldwide Emergency Assistance Benefits" in the event of an emergency. Instant assistance, including deposit guarantees for hospital admission and emergency evacuation, will be available through Inter Partner Assistance Hong Kong Ltd. 3 Extra Major Medical Benefit For extra peace of mind, you may also opt for the Extra Major Medical Benefit. If the actual hospital expenses 3 incurred are in excess of those covered by Hospital & Surgical Plus, this supplementary benefit will pay for a maximum reimbursement of over HK$430,000. Extra Cancer Benefit Provides adequate financial support for cancer therapy, with a maximum reimbursement of actual expenses per cancer up to HK$2,000, Benefit1 Medical Treatment Benefit Comprehensive cancer treatment benefit includes the costly target therapy, chemotherapy, radiotherapy, hormonal therapy, immunotherapy, laser surgery for skin cancer, photodynamic therapy for esophagus, lung or skin cancers, cryosurgery and radiofrequency ablation. In addition, the plan also covers charges for anti-rejection and anti-nausea drugs Benefit 2 Extra Care Benefit To relieve the insured's discomfort and the side-effects due to cancer treatment, the plan offers Chinese herbalist consultation and palliative care, as well as reconstructive surgery of the face and/or breast due to cancer. Benefit 3 Medical Consultation and Diagnostic Benefit To help the insured to receive timely and quality treatment in the early stages, the plan covers cancer diagnostic tests and medical consultations, as well as cancer monitoring investigation and medical consultations within 5 years after completion of treatment of cancer. In addition, the following services are available at more than 4,000 US hospitals within the MediNet Pro network: 1) second medical opinion provided by US medical specialists 5, and 2) quality treatment referrals in the USA 5. 4 Benefit 4 Extension of Life Protection We understand that, if diagnosed with a cancer, you may also wish to give extra protection to your family. We therefore offer you the option of taking out a permanent life insurance plan within 90 days following the end of one year after the diagnosis of a later-stage cancer, without the need to provide any satisfactory proof of insurability, with the aggregate sum insured up to HK$1,000,000.

5 6 Hospital Income Benefit Flexible Cash Benefit The plan provides a daily cash benefit 6 of up to HK$1,200 if the insured is hospitalized for eight hours or more due to sickness or injury, up to a maximum of 1,000 days, to offset any temporary income loss as well as day-to-day expenses. And, more importantly, you can spend the cash at your total discretion. Double Cash Benefit While receiving treatment in an Intensive Care Unit, the Hospital Income Benefit will be doubled, to up to HK$2,400 per day. 7 Death Benefit In the unfortunate event that the insured passes away, a death benefit 7 of up to HK$15,000 will be paid. 24-Hour Worldwide Coverage Hospital Income Benefit is available all around the world, including North America, Europe, Australia, New Zealand, Japan, Singapore, Malaysia, Taiwan, South Korea, Hong Kong and Macau. For hospitalization in other areas, half of the daily benefit is available, for up to a maximum of 90 days The Company reserves the right to determine the eligibility of a clinic. 2. A written notice will be given no less than 30 days prior to each policy anniversary date regarding the adjustment of benefit coverage, premium, or non-renewal of the policy. 3. Cancer Treatment Benefit, Renal Dialysis Benefit, Home Nursing Benefit and Post-surgery Out-patient Treatment are not included. 4. The followings are not included: 1) treatment undergone solely for complications and adverse effects of cancer treatment; 2) cost of surgical procedures except specifically covered; 3) room and board charges. 5. MediNet Pro is provided by Inter Partner Assistance Hong Kong Ltd. The current administration fee for each Second Medical Opinion is HK$500. For each referral to medical treatment in the USA, the current administration fee is US$500. The Insured is also responsible for paying the administration fee and for any medical treatment and other related costs in the USA. Inter Partner Assistance Hong Kong Ltd. reserves the right to review the price and the number of hospitals from time to time without prior notice. 6. The maximum combined daily benefit from both Hospital Income Benefit and Money-Back Hospital Income Protector for the same insured person with our company is HK$1,200. And the combined maximum daily benefit from Hospital Income Benefit, Money-Back Hospital Income Protector, Lifetime Health Protector, Whole Life MediCare and Refundable Hospital Cash Plan for the same insured person with our company is HK$2,000. The Company reserves the right to make adjustments of the maximum combined daily benefit without any prior notice. 7. Only applicable to the insured age of 18 or above.

6 Table 1 Major Benefits Max. Benefit per Disability HK$ Plan Extra Plan Plan 2 Plan 3 Plan 4 Hospitalization Benefit Room, Board & General Nursing Benefit (Max. days per disability) In-hospital Doctor's Call (Max. days per disability) Hospital Special Services In-hospital Specialist Consultation Intensive Care Surgical Benefit 8,9 Surgeon's Fee 8,9 8,9 Anesthetist's Fee 8,9 8,9 Operating Theatre Fee 8,9 Convalescence Benefit Home Nursing Benefit (Max. days per disability) 8,9 Post-surgery Out-patient Treatment 8,9 Other Benefits Cancer Treatment Benefit Renal Dialysis Benefit Additional Benefits for Accident 7 Death Benefit 7 Worldwide Emergency Assistance Benefits Total Maximum Payable Per Disability 580/day 810/day 1,460/day 2,890/day 4,880/day (60 days) (90 days) (90 days) (120 days) (120 days) 580/day 810/day 1,460/day 2,890/day 4,880/day (60 days) (90 days) (90 days) (120 days) (120 days) 6,010 8,040 10,700 16,030 28,690 4,530 6,470 6,470 7,530 11,140 12,850 16,060 21,410 25,710 33,470 34,400 46,360 57,950 74,460 97,410 13,750 18,180 23,300 29,900 38,960 13,750 18,180 23,300 29,900 38, /day 365/day 485/day 730/day 1,070/day (31 days) (31 days) (31 days) (31 days) (31 days) 680 1,000 1,670 2,500 3,820 16,240 27,060 54,110 81, ,220 16,240 27,060 54,110 81, ,220 7,050 10,460 16,710 20,910 32,470 1,000 5,000 10,000 15,000 20,000 Applicable 205, , ,565 1,100,530 1,725,730 8 Maximum subject to Surgical Fees Schedule 9 1 Applicable to the specified surgical procedures arranged in the day case unit of a hospital or a clinic 1 in Hong Kong / Macau. The Company reserves the right to determine the eligibility of a clinic. Table 2 Optional Extra Major Medical Benefit 3 If the hospital expenses 3 exceed the maximum benefit per disability as shown in Table 1, 80% of the extra expenses will be reimbursed subject to the limit of (a), (b) & (c). (a) 10 Room, Board & General Nursing Benefit 10 (b) 10 In-hospital Doctor's Call 10 Max. Benefit per Disability HK$ Plan Extra Plan Plan 2 Plan 3 80% of the max. benefit per day shown in Table 1 80% of the max. benefit per day shown in Table 1 Plan 4 (c) Maximum Benefit 73,600 80, , , ,940 (d) Deductible (a) & (b) benefits are payable starting on the 61st day (Plan Extra), 91st day (Plan 1 & Plan 2) or 121st day (Plan 3 & Plan 4) of hospitalization. Table 3Hospital Income Benefit Max. Benefit per Disability HK$ Plan Plan 2 Plan 3 Daily Benefit ,200 Intensive Care 1,200 1,800 2,400 7 Death Benefit 7 5,000 10,000 15, Hour Worldwide Coverage Applicable

7 Table 4 Extra Cancer Benefit Benefit Summary Plan Plan 2 Plan 3 Overall Per Cancer Limit Maximum Lifetime Limit Medical Treatment Benefit 4 Target Therapy Radiotherapy Hormonal Therapy Immunotherapy Chemotherapy Laser Surgery for Skin Cancer Photodynamic Therapy for Esophagus, Lung or Skin Cancers Cryosurgery Radiofrequency Ablation Anti-Rejection and Anti-Nausea Drugs Medical Consultation and Diagnostic Benefit Medical treatment performed in a Hospital, the day case unit of a Hospital, Cancer Specialist, Cancer Clinic, or clinic in Hong Kong/Macau. Plus, the cost of drugs (including oral drugs taken at home). For Chemotherapy, blood transfusion and Granulocyte Colony Stimulating Factor are also covered. Anti-rejection and anti-nausea medication during the treatment of cancer. 1,000,000 1,500,000 2,000,000 3,000,000 4,500,000 6,000,000 No limit per course of medical treatment, full reimbursement of actual charges incurred Cancer Diagnostic Investigation Cancer Monitoring Investigation Pre or Post-treatment Consultation (Max. limit per visit & no. of visits) 5 MediNet Pro 5 Extra Care Benefit Chinese Herbalist Consultation (Max. limit per visit & no. of visits) Palliative Care Reconstructive Surgery Life Protection Laboratory tests, X-ray, CT, MRI, PET Scans, fine needle aspiration cytology (FNAC), histopathology or cytology biopsies, other investigation modalities deemed medically necessary, and genetic testing to aid the identification of appropriate chemotherapy drugs. Physical examinations and diagnostic tests to monitor the response and progress of the cancer treatment received, and follow-up evaluation to rule out any relapse of cancer for up to 5 years from the completion of cancer treatment. Cancer specialist consultation before and up to 5 years after the completion of cancer treatment. "Second Medical Opinion provided by US Medical Specialists" and "Quality Treatment Referrals in the USA" Chinese medical practitioner consultation during and up to 5 years after the completion of the cancer treatment. Medical and surgical treatment to relieve the insured's discomfort or sideeffects due to the treatment. Procedures to reshape or rebuild the face and/or breast, including surgeon, anesthetist, operating theatre, prescribed medication, diagnostic radiology or laboratory charges, nursing, Doctor or specialist visit, and cost of implants. No limit per course of medical treatment, full reimbursement of actual charges incurred 1,000 per visit 20 visits 30 visits 40 visits 600 per visit 20 visits 30 visits 40 visits 20,000 30,000 40,000 No limit per course of medical treatment, full reimbursement of actual charges incurred Extension of Life Protection (maximum aggregate sum insured for each Extra Cancer Benefit) 7 Death Benefit 7 500, ,000 1,000,000 1,000 1,500 2,000

8 - - -

9 Frequently Asked Questions 1. If medical treatment due to sickness or injury was carried out in a hospital without any overnight stay, will there be any protection under the Hospital Benefits Plan? If the insured is advised to be admitted to a hospital, or receive a specified surgical procedure in the day case unit of a hospital or a clinic in Hong Kong / Macau 1, by a registered medical practitioner for the treatment of sickness or accidental injury, Hospital & Surgical Plus will provide the coverage. However, Hospital Income Benefit will only provide daily cash benefits to the insured for any period of hospitalization over eight hours as recommended by a registered medical practitioner due to sickness or accidental injury. 2. What is the definition of "Hospitalization"? "Hospitalization" refers to necessary residence in a Hospital as an inpatient while under the care of a Doctor for which the Hospital makes a charge for the room and board. To keep the plan as economical and affordable, the "Hospital" refers to an entity which provides facilities for major surgery and full-time nursing service and is not primarily a convalescent or nursing home, rest home, home for the aged, a place for rehabilitation of alcoholics or drug addicts, or for any similar purpose. 3. Why are "Pre-existing Conditions" excluded from the plan? "Pre-existing Conditions" are defined as the signs or symptoms of an illness or injury which had existed before the Policy Date or date of reinstatement (whichever is later). It is common to exclude "Pre-existing Conditions" from a health insurance plan as the principle of insurance is to protect you from an uncertain future and not to cover any existing condition. 4. Upon approval of the insurance application, will coverage become immediately effective? Is there any "waiting period"? - Hospitalization due to accident does not have any "waiting period". - Hospital & Surgical Plus Extra Major Medical Benefit and Hospital Income Benefit: any sickness occurred 15 days after the effective date of coverage or 10 days after the date of reinstatement would be covered. - Extra Cancer Benefit: any cancer occurred 60 days after the effective date of coverage or the date we approve the reinstatement application would be covered. 5. Could there be any changes to the premium for Hospital & Surgical Plus, Extra Major Medical Benefit and Extra Cancer Benefit? The Hospital & Surgical Plus, Extra Major Medical Benefit and Extra Cancer Benefit are yearly renewable plans. Thirty days prior to the policy anniversary date, you will receive a written notice regarding the renewal decision. The benefits of the plans may be reviewed regularly and adjusted to ensure you have adequate coverage and to combat soaring medical cost. Renewal premium will be based on the attained age of the insured and at the premium rate in effect of the same level of benefit at the time of renewal. Besides, if the No Claim Bonus conditions are fulfilled, you will be entitled to a discount on the renewal premium for Hospital & Surgical Plus and Extra Major Medical Benefit. 6. Does Extra Cancer Benefit only provide coverage for cancer treatment that requires hospitalization? No. The plan offers a comprehensive cancer treatment protection ranging from oral target therapy drugs taken at home, cancer specialist consultation and diagnostic charges, to Chinese herbalist consultation. The plan will reimburse the actual expenses incurred for the cancer treatment based on the policy terms and conditions.

10 Hospital Benefits - At a Glance Basic Information Issue Age (At Last Birthday) Maximum Benefit Term Payment Term Policy Information Plan Type Currency 2 Premium 2 Minimum Sum Insured Maximum Sum Insured Type of Benefit Hospital & Surgical Plus Age 0 to 70 To Age 100 To Age 100 / / / Yearly renewable. The renewal premium will be adjusted based on the insured's attained age and at the premium rate in effect of the same level of benefit at the time of policy renewal. If the No-Claim Bonus conditions are fulfilled, a discount on the renewal premium can be enjoyed. (Only applicable to Hospital & Surgical Plus and Extra Major Medical Benefit). Annual / Semi-annual / Quarterly / Monthly Payment Extra Major Medical Benefit Supplementary Plan Reimburses the actual hospitalization and medical expenses (subject to the maximum limit of each benefit item of the plan) HK$ Extra Cancer Benefit Age 0 to 70 To Age 100 To Age Reimburses the actual medical treatment expenses 4, extra care, consultation and diagnosis expenses Hospital Income Benefit Age 0 to 65 To Age 75 To Age 75 HK$600 HK$1,200 6 Provides daily cash benefits during the period of hospitalization 7. Other Exclusions: To keep "Hospital & Surgical Plus", "Extra Major Medical Benefit" and "Hospital Income Benefit" as economical as possible, there are some standard exclusions. These include injury and sickness, for example: 1. claims due to sickness occurring within 15 days of effective date of coverage; 2. pre-existing conditions (which presented signs or symptoms of which the Insured has been aware or should reasonably have been aware); 3. drug addiction or alcoholism; 4. resulting from general check-up; 5. childbirth- or pregnancy-related conditions; 6. cosmetic or plastic surgery; 7. congenital deformities or anomalies; 8. dental care or surgery (unless necessitated by injury caused by an accident); 9. treatment for tonsils, adenoids or hernia (which occurs within 120 days after the policy effective) 10. refractive errors of the eyes; 11. procurement or use of special equipment such as artificial limbs, hearing aids or dentures etc. 12. racing on wheels or horse; 13. suicide or self-inflicted injuries; 14. acts of war, riots or civil commotion or illegal acts; 15. nuclear radiation, asbestos; 16. Human Immunodeficiency Virus (including AIDS); 17. treatment by Chinese bonesetter, acupuncturist or herbalist;18. if the insured is hospitalized for circumcision before attaining the age of 12, and such hospitalization occurs within two years of the Policy Date, no coverage will be provided (except Hospital Income Benefit). The exclusions of the above points nos. 2, 3, 4, 13, 14, 15, 16 also apply to "Extra Cancer Benefit", plus the following: 1. Any cancer of the Insured occurred within 60 days after the effective date of coverage; 2. Cosmetic or plastic surgery (except reconstructive surgery of the face and/or breast due to cancer) ; 3. Experimental or unproven treatment or procedures and its related medical condition or complication; 4. Genetic testing or any treatment undergone based on genetic test results; 5. Preventative screening or checkups; 6. Any treatment modality undergone without a definite diagnosis of the presence of cancer; 7. Vaccines for the prevention of cancer. In addition, for "Hospital & Surgical Plus", "Extra Major Medical Benefit", and "Extra Cancer Benefit", expenses for which compensation is payable under any government law or any other insurance policy, no coverage will be provided. This brochure contains general information, is for reference only and does not form part of the policy. Please refer to the policy document for benefit coverage and exact terms and conditions. For enquiries, please contact our consultants, franchised agents or brokers, or call our Customer Service Hotline: (852) MassMutual Asia Ltd. 27/F MassMutual Tower, 33 Lockhart Road, Wanchai, Hong Kong MS-009-V H

閣下有權改變主意 15 行使取消保單權益須遵守以下規定 : 15 (852) 2867 8678 安盛保險有限公司 90852 (852) 3070 5010 (852) 2867 8678

閣下有權改變主意 15 行使取消保單權益須遵守以下規定 : 15 (852) 2867 8678 安盛保險有限公司 90852 (852) 3070 5010 (852) 2867 8678 摯關懷醫療計劃保單請詳細參閱本保單閣下有權改變主意 15 行使取消保單權益須遵守以下規定 : 15 (852) 2867 8678 安盛保險有限公司 90852 (852) 3070 5010 (852) 2867 8678 收集個人資料的聲明本公司 486 條例目的 : 有關目