Enterprise HealthNet Group Health Insurance Scheme 企業僱員健康網團體醫療保障計劃 Schedule of Benefits 保障金額表 Effective from 1 January 2016 自 2016 年 1 月 1 日起生效 Maximum Limit per Member (HK$) 每位會員最高賠償額 ( 港幣 ) A Hospital and Surgical Benefit 住院及手術保障 HealthNet Hospitals 網絡醫院 HealthNet Benefit 網絡保障 (HK coverage only 只適用於香港 ) 1, 4 Private 私家房 2, 5 Semi-private 半私家房 3, 6 Ward 大房 Canossa Hospital 嘉諾撒醫院 St. Paul's Hospital 聖保祿醫院 HK Baptist Hospital 香港浸信會醫院 Union Hospital 仁安醫院 St. Teresa's Hospital 聖德肋撒醫院 Non-HealthNet Benefit 非網絡保障 (Worldwide coverage 適用於世界各地 ) 1, 4 Private 私家房 2, 5 Semi-private 半私家房 N/A 不適用 Reimbursement percentage 賠償率 N/A 不適用 100% 100% 100% 1 Room and Board (Maximum 120 days per Disability per Contract Year) 住房及膳食費 ( 每合約年度計每病症最多 120 日 ) 2 Miscellaneous Hospital Services (Per Contract Year) 住院雜費 ( 每合約年度計 ) 3 Intensive Care (Supplement to Room and Board) (Per Disability per Contract Year) 深切治療 ( 住房及膳食費之補足 )( 每合約年度每病症計 ) 4 Private Nursing (Maximum 120 days per Disability per Contract Year) 私家看護費 ( 每合約年度計每病症最多 120 日 ) Nursing services during Hospital Confinement or at home after discharge from Hospital rendered by a Qualified Nurse upon referral by the attending Registered Medical Practitioner 經主診註冊西醫轉介 下由合資格護士於住院期間或出院後在家中提供之護理服務 5 Surgeon and Attendance Fees (For surgical case only) (Per Disability per Contract Year) 外科醫生費及巡房費 ( 只適用於外科手術 )( 每合約年度每病症計 ) Complex 複雜 Major 大型 Intermediate 中型 Minor 小型 6 Anaesthetist s Fees (Per Disability per Contract Year) 麻醉科醫生費 ( 每合約年度每病症計 ) Complex 複雜 Major 大型 Intermediate 中型 Minor 小型 7 Operating Theatre Fees (Per Disability per Contract Year) 手術室費用 ( 每合約年度每病症計 ) Complex 複雜 Major 大型 Intermediate 中型 Minor 小型 8 In-patient Physician s Fees (For non-surgical case only) (Maximum 120 days per Disability per Contract Year) 住院醫生巡房費 ( 只適用於非手術治療 )( 每合約年度計每病症最多 120 日 ) 9 In-patient Specialist s Fees (Per Contract Year) 住院專科醫生費 ( 每合約年度計 ) Subject to written referral from the attending Registered Medical Practitioner (except for services performed by pathologist, radiologist or Physiotherapist during Hospital Confinement) 須獲主診註冊西醫以書面轉介 ( 病理學家 放射學家及物理治療師在住院期間所提供之服務除外 ) 10 Pre-admission and Post-hospitalisation Out-patient Care (Per Contract Year) 入院前及出院後之門診護理 ( 每合約年度計 ) Including one pre-admission visit and all related post-hospitalisation follow-up visits on an out-patient basis within six weeks after discharge from Hospital Payable for consultation fee, Medically Necessary Western Medication, diagnostic tests and physiotherapy 包括一次入院前及出院後 6 星期內所有與住院治療有關之跟進療程門診費用賠償包括診症 醫療必需的西藥 診斷測試及物理治療的費用 11 Special Services (Per Contract Year) 特別服務 ( 每合約年度計 ) Including chemotherapy, dialysis, radiotherapy, treatment involving radioactive isotope, magnetic resonance imaging (MRI), CT Scan and PET Scan Subject to written referral from the attending Registered Medical Practitioner 包括化療 血液透析 放射治療 使用放射同位素的治療 磁力共振 電腦斷層掃描及正電子放射斷層掃描須獲主診註冊西醫書面轉介 Overall Annual Limit (Applicable to Hospital and Surgical Benefit only) 每年最高賠償額 ( 只適用於住院及手術保障 ) Full cover for eligible medical expenses (Subject to the Overall Annual Limit) 全數支付 合資格的醫療費用 ( 以每年最高賠償額為限 ) Subject to an annual limit of HK$100,000 每年最高賠償金額為港幣 10 萬元 This scheme is only available for direct enrolment through Bupa s Health Management Consultant. 此計劃須透過保柏直屬之健康管理顧問直接投保 每日 2,660 每日 1,620 3, 6 Ward 大房 每日 680 35,800 26,000 12,600 33,900 24,300 12,000 每日 1,060 109,000 43,800 24,300 11,200 32,000 12,900 5,650 3,550 34,400 13,250 5,800 3,600 每日 2,660 每日 660 61,700 27,700 13,250 6,600 17,400 8,700 4,650 2,900 17,850 8,750 4,750 3,000 每日 1,620 每日 330 45,200 19,800 11,100 5,550 14,000 5,800 4,050 2,350 14,650 6,000 4,250 2,450 每日 680 13,600 9,500 7,450 9,300 6,120 4,880 The expenses of these treatments will be paid under the above benefit items 此等治療之費用將於上述保障項目內賠償 1,030,000 812,000 356,000 1,030,000 812,000 356,000 MP050/11/1115/1K Printed on recycled paper 以再造紙印刷
Enterprise HealthNet Group Health Insurance Scheme 企業僱員健康網團體醫療保障計劃 Schedule of Benefits 保障金額表 Effective from 1 January 2016 自 2016 年 1 月 1 日起生效 Maximum Limit per Member (HK$) 每位會員最高賠償額 ( 港幣 ) B Clinical Benefit 門診保障 HealthNet Benefit 網絡保障 (HK and Macau coverage only 只適用於香港及澳門 ) 1, 4 2, 5 3, 6 Non-HealthNet Benefit 非網絡保障 (Worldwide coverage 適用於世界各地 ) 1, 4 2, 5 3, 6 Number of HealthNet Service Providers 網絡服務供應商的數目 Items 項目 1,2,4 & 8: 2,090 Items 項目 6-7: 90 N/A 不適用 1 General Practitioner (Per visit) 普通科醫生 ( 每次診治計 ) Consultation (Including consultation fee and Medically Necessary Western Medication prescribed and obtained at the General Practitioner s clinic) 診症 ( 包括診症費及於普通科醫生診所處方及取得的醫療必需西藥 ) 2 Specialist (Per visit) 專科醫生 ( 每次診治計 ) Consultation (Including consultation fee and Medically Necessary Western Medication prescribed and obtained at the Specialist s clinic, subject to written referral from a Registered Medical Practitioner) 診症 ( 包括診症費及於專科醫生診所處方及取得的醫療必需西藥, 該診症須獲註冊西醫書面轉介 ) Full cover for eligible medical expenses, subject to co-payment, if any (Including consultation fee and up to 5 days of basic Medically Necessary Western Medication) 全數支付 合資格的醫療費用, 如有自負費除外 ( 包括診症費及最多 5 日之處方基本醫療必需西藥費用 ) 500 280 195 860 540 390 3 Home Consultation (Per visit) 家中應診 ( 每次診治計 ) Consultation (Including consultation fee and Medically Necessary Western Medication prescribed and obtained from a Registered Medical Practitioner) 診症 ( 包括診症費及由註冊西醫處方及取得的醫療必需西藥 ) N/A 不適用 940 580 465 4 Physiotherapist (Per visit) 物理治療師 ( 每次診治計 ) Treatment fee only and subject to written referral from a Registered Medical Practitioner 只限診療費及須獲註冊西醫書面轉介 Full cover for eligible medical expenses, subject to co-payment, if any 全數支付 合資格的醫療費用, 如有自負費除外 760 470 360 5 Chiropractor (Per visit) 脊醫 ( 每次診治計 ) Treatment fee only and subject to written referral from a Registered Medical Practitioner 只限診療費及須獲註冊西醫書面轉介 N/A 不適用 760 470 360 6 Chinese Herbalist (Per visit) 中醫師 ( 每次診治計 ) Consultation (Including consultation fee and Medically Necessary Chinese Medicines prescribed at a Registered Chinese Medicine Practitioner s clinic and obtained at a legitimate source on the same day of consultation) Payable for acupuncture performed by a Registered Chinese Medicine Practitioner under Non-HealthNet Benefit 診症 ( 包括診症費及當日由註冊中醫在診所處方並由合法來源取得之醫療必需中藥費用 ) 此保障將於非網絡保障下支付由註冊中醫進行的針灸治療 7 Chinese Bonesetter (Per visit) 跌打醫師 ( 每次診治計 ) Consultation (Including consultation fee and Medically Necessary Chinese Medicines prescribed at a Registered Chinese Medicine Practitioner s clinic and obtained at a legitimate source on the same day of consultation) Payable for acupuncture performed by a Registered Chinese Medicine Practitioner under Non-HealthNet Benefit 診症 ( 包括診症費及當日由註冊中醫在診所處方並由合法來源取得之醫療必需中藥費用 ) 此保障將於非網絡保障下支付由註冊中醫進行的針灸治療 8 Diagnostic Imaging and Laboratory Tests (Per Contract Year) 診斷影像及化驗 ( 每合約年度計 ) Subject to written referral from a Registered Medical Practitioner 須獲註冊西醫書面轉介 Full cover for eligible medical expenses, subject to co-payment, if any (Including consultation fee and up to 2 packets of basic Medically Necessary Chinese Medicines) 全數支付 合資格的醫療費用, 如有自負費除外 ( 包括診症費及最多兩劑之基本醫療必需中藥費用 ) Full cover for eligible medical expenses 全數支付 合資格的醫療費用 300 220 195 300 220 195 4,000 2,150 1,700 9 Prescribed Western Medication (Per Contract Year) 醫生處方西藥 ( 每合約年度計 ) Extra, long-term or expensive Medically Necessary Western Medication prescribed and obtained at a Registered Medical Practitioner s clinic on the same day of consultation under HealthNet Benefit 網絡保障下於診症當日於註冊西醫診所處方及取得之額外 長期服用或昂貴醫療必需西藥 1,900 1,160 N/A 不適用 N/A 不適用 N/A 不適用 N/A 不適用 Option 選擇 1 1, 2, 3 No co-payment 無需自負費 100% reimbursement 賠償 Option 選擇 2 4, 5, 6 HK$30 co-payment per claim (For items 1,2,4,6 & 7) 每次索償只需港幣 30 元自負費 ( 只適用於項目 1,2,4,6 & 7) 80% reimbursement 賠償 MP050/11/1115/1K Printed on recycled paper 以再造紙印刷
Enterprise HealthNet Group Health Insurance Scheme 企業僱員健康網團體醫療保障計劃 Schedule of Benefits 保障金額表 Effective from 1 January 2016 自 2016 年 1 月 1 日起生效 Maximum Limit per Member (HK$) 每位會員最高賠償額 ( 港幣 ) C Free Hospital Cash Benefit 免費住院現金保障 Only applicable to Hospital Confinement in ward bed at Hospitals of Hospital Authority in Hong Kong Payable from the third day of Hospital Confinement (Maximum 120 days per Contract Year) 只適用於香港醫院管理局轄下醫院大房病床之住院由住院第 3 天起開始支付 ( 每合約年度計最多 120 日 ) D Free Supplementary Major Medical Benefit (Per Disability per Contract Year) 免費附加醫療保障 ( 每合約年度每病症計 ) 1, 4 Private 私家房 每日 1,000 1, 4 Private 私家房 2, 5 Semi-private 半私家房 每日 600 2, 5 Semi-private 半私家房 3, 6 Ward 大房 每日 350 3, 6 Ward 大房 Reimbursement percentage 賠償率 80% 80% 80% Payable for Hospital Confinement, Day Case Surgery and Clinical Operation in Hong Kong only (Unless the hospitalisation or surgery overseas is directly resulting from medical Emergency outside Hong Kong as certified by a Registered Medical Practitioner) provided that the amount payable under items 1-9 and 11 of Hospital and Surgical Benefit is exhausted No Benefit will be paid for hospitalisation in VIP suite or deluxe suite Adjustment factors for room upgrade will be applied if Member is hospitalised not in accordance with plan level: - From Semi-private Room to Private Room :50% - From Ward to Semi-private Room :50% - From Ward to Private Room :25% 此保障只支付在港之住院 日症手術及診所手術 ( 經由註冊西醫證明, 因在香港以外發生之緊急事故導致在外地住院或進行手術則除外 ), 而住院及手術保障的 1 至 9 項及 11 項之保障須已耗盡保障不適用於貴賓或豪華套房之住院如會員住院時並非根據原有之計劃住房, 保障額將因應升級住房而作出調整 : - 半私家房至私家房 :50% - 大房至半私家房 :50% - 大房至私家房 :25% E Free Bupa Worldwide Assistance Programme (Per Contract Year) 免費保柏國際援助計劃 ( 每合約年度計 ) 150,000 100,000 50,000 Provides admission deposit in the event of hospitalisation overseas and in Mainland China, unlimited cover for emergency medical evacuation and repatriation, and an extra hospital benefit of HK$120,000 after repatriation to Hong Kong. A 24-hour hotline for travel, medical or legal information and assistance is also available. 提供海外及國內住院按金墊支服務, 全數支付緊急醫療運送費用及送返香港後高達港幣 12 萬元的額外住院保障, 並設有 24 小時熱線提供旅遊 醫療或法律資訊及支援 Notes 附註 Clinical Operation or Day Case Surgery, if eligible, will be paid under Hospital and Surgical Benefit. Clinical Operation and Day Case Surgery mean Medically Necessary surgical procedures which may be carried out at a clinic or day-case unit of a Hospital by a Registered Medical Practitioner where a stay in Hospital is not required, provided that the surgical procedure is classified as such by Bupa. The maximum number of days specified under the benefit items of Hospital and Surgical Benefit apply to the aggregate sum of Hospital stays at HealthNet Hospitals and Non-HealthNet Hospitals. A referral letter is valid for the same or related medical condition for six months from the issue date. Another referral letter is required for treatment of a new or unrelated medical condition. To enjoy full benefit under HealthNet Benefit : Bupa HealthNet (BHN) Card must be presented to one of the HealthNet Service Providers shown in the List of HealthNet Service Providers before treatment and used for payment of medical expenses. Pre-authorisation must be obtained from Bupa for: - Hospital Confinement or Special Services - Clinical Operation or Day Case Surgery exceeding HK$4,000 - Diagnostic imaging or laboratory tests exceeding HK$2,000 - Specialist treatment for which the relevant specialty is not available in the List of HealthNet Service Providers. Specialist consultation (Except for gynaecology, paediatrics and family medicine) and physiotherapy must be referred by a General Practitioner or Specialist shown in the List of HealthNet Service Providers and be made by a Specialist and Physiotherapist shown in the same list (Unless the specialty is not available in the list). If the above requirements are not followed, eligible medical expenses will be reimbursed under Non-HealthNet Benefit. Maximum number of visits (For both HealthNet Benefit and Non-HealthNet Benefit in aggregate) per Contract Year for items 1-7 is 30 in total and is subject to a maximum of one visit per item per day. The Overall Annual Limit is the aggregate sum of HealthNet Benefit and Non-HealthNet Benefit. 合資格之診所手術或日症手術, 將於 住院及手術保障 下賠償 診所手術及日症手術指註冊西醫於診所或醫院日症房進行之醫療必需手術而無必要留院, 但該等手術須獲保柏分類為診所手術或日症手術 於 住院及手術保障 下的保障項目中所列之最多日數乃指於網絡醫院及非網絡醫院合併計算之總住院日數 會員可在轉介信發出日起計 6 個月內, 就相同或相關病症使用該轉介信 若須診治全新或不相關的病症, 則須提交新的轉介信 要享有全數賠償的 網絡保障 : 在 網絡服務供應商目錄 內之任何一個網絡服務供應商接受治療前必須出示 保柏網絡醫療卡, 並以此卡來繳付醫療費用 以下各項必須得到保柏初步保障審核 : - 住院或特別服務 - 超過港幣 4,000 元的診所手術或日症手術 - 超過港幣 2,000 元的診斷影像或化驗 - 網絡服務供應商目錄 內之服務供應商未能提供的專科治療 專科醫生診症 ( 婦科 兒科及家庭醫學科除外 ) 及物理治療必須經由 網絡服務供應商目錄 內的普通科或專科醫生轉介, 並由同一目錄內的專科醫生及物理治療師診治 ( 若目錄內未能提供此等專科則除外 ) 如沒有依循以上規定, 合資格的醫療費用將會根據 非網絡保障 作出賠償 每合約年度, 項目 1-7 的總上限 ( 網絡保障 及 非網絡保障 ) 合計為 30 次, 而每項診治以每日最多一次為限 每一合約年度的最高賠償額以 網絡保障 及 非網絡保障 合併計算 MP050/11/1115/1K Printed on recycled paper 以再造紙印刷
Enterprise HealthNet Group Health Insurance Scheme 企業僱員健康網團體醫療保障計劃 Schedule of Benefits 保障金額表 Effective from 1 January 2016 自 2016 年 1 月 1 日起生效 Maximum Limit per Member (HK$) 每位會員最高賠償額 ( 港幣 ) F Maternity Benefit (Optional) 產科保障 ( 自選保障 ) 1, 4 2, 5 3, 6 Reimbursement percentage 賠償率 100% 100% 100% Normal Delivery (Per pregnancy) 順產 ( 每次懷孕計 ) Caesarean Section (Per pregnancy) 剖腹生產 ( 每次懷孕計 ) Miscarriage (Per pregnancy) 流產 ( 每次懷孕計 ) The Maternity Benefit shall cover medical expenses incurred for the following during pregnancy: - Hospital Confinement - Consultation of a Registered Medical Practitioner and Prescribed Western Medication - Diagnostic tests, prenatal check-up and postnatal check-up - Nursery care of newborn baby This Benefit does not cover any medical expenses incurred by the newborn baby during Hospital Confinement. 產科保障將支付因懷孕引致以下項目之醫療費用 : - 住院 - 註冊西醫診症及醫生處方西藥 - 診斷化驗 產前檢查及產後檢查 - 初生嬰兒護理費用此保障不包括任何初生嬰兒在住院期間之醫療費用 G Dental Benefit (Optional)(Per Contract Year) 牙科保障 ( 自選保障 )( 每合約年度計 ) 40,000 20,000 15,000 60,000 30,000 22,500 20,000 10,000 7,500 1, 4 2, 5 3, 6 Reimbursement percentage 賠償率 100% 100% 100% Routine oral examination, scaling and polishing (Once per Contract Year) Intraoral X-ray and medications Fillings and extractions Drainage of abscesses Pins for cusp restoration Dentures, crowns and bridges (Only if necessitated by an Accident) 定期口腔檢查及洗牙 ( 每合約年度一次 ) 口腔 X 光及藥物補牙及脫牙膿瘡排放齒尖或齒邊修復活動假牙 牙冠及牙橋 ( 只適用於因意外而導致 ) 5,100 2,600 1,050 Notes 附註 This Benefit is payable provided that the pregnancy commences after the Member has become eligible for this Benefit and the Member has been continuously covered under this Benefit for 9 months or more. 會員必須於此保障生效後懷孕, 並連續受保於此保障 9 個月或以上, 方可獲得賠償 MP050/11/1115/1K Printed on recycled paper 以再造紙印刷
Enterprise HealthNet Group Health Insurance Scheme 企業僱員健康網團體醫療保障計劃 Subscription Rate Table 保費表 Effective from 1 January 2016 自 2016 年 1 月 1 日起生效 Plan 計劃 1 2 3 4 5 6 Room level 住房級別 Hospital and Surgical Benefit + Free Supplementary Major Medical Benefit + Free Hospital Cash Benefit + Free Bupa Worldwide Assistance Programme 住院及手術保障 + 免費附加醫療保障 + 免費住院現金保障 + 免費保柏國際援助計劃 Clinical Benefit 門診保障 Option 1 (No copayment / 100% reimbursement) 選擇 1 ( 無需自負費 / 100% 賠償 ) Option 2 (HK$30 co-payment / 80% reimbursement) 選擇 2( 港幣 30 元自負費 / 80% 賠償 ) All figures in HK$ 以港幣計算 Annual Subscription per Person (HK$) 每人每年保費 ( 港幣 ) Employee / spouse / children 僱員 / 配偶 / 子女 Optional Benefits 自選保障 Maternity Benefit 產科保障 Dental Benefit 牙科保障 Private 私家房 N/A 不適用 14,853 8,200 1,569 Semi-private 半私家房 N/A 不適用 8,487 4,100 1,009 Ward 大房 N/A 不適用 6,038 3,050 579 Private 私家房 N/A 不適用 13,283 8,200 1,569 Semi-private 半私家房 N/A 不適用 7,539 4,100 1,009 Ward 大房 N/A 不適用 5,293 3,050 579 Notes 附註 All Employees with the same eligibility must be enrolled in the same plan. If Dependant cover is selected in any plan, all eligible Dependants must join the same plan as that of the relevant Employee. All eligible children in the same family will be considered as one Member for Subscription calculation (Except for Dental Benefit). If Maternity Benefit is selected as an optional benefit of any plan, all female Members (Employees and spouses) covered by that plan must be enrolled. If Dental Benefit is selected as an optional benefit of any plan, all Members covered by that plan must be enrolled. 所有資格相同的僱員必須參加同一計劃 如在任何計劃內選擇家屬保障, 所有合資格的家屬必須跟相關僱員參加同一計劃 同一家庭的所有合資格子女在計算保費時將視作一名會員計算 ( 牙科保障 除外) 如在任何計劃內選擇附加 產科保障, 在同一計劃內的所有女性會員 ( 僱員及配偶 ) 必須投保 如在任何計劃內選擇附加 牙科保障, 在同一計劃內的所有會員必須投保 Subscription rates are not guaranteed and Bupa may adjust them on an annual basis. 保費並非保證, 保柏有可能每年作出調整 In the event of any discrepancy in respect of the meaning between the Chinese version and the English version, the English version shall prevail. All terms and conditions are subject to the Contract. 中 英文之意思如有任何差別, 概以英文為準 所有條款及細則以合約為準 Bupa (Asia) Limited 保柏 ( 亞洲 ) 有限公司 Address: 18/F, Berkshire House, 25 Westlands Road, Quarry Bay, Hong Kong 地址 : 香港 魚涌華蘭路 25 號克大廈 18 樓 Telephone 電話 :(852) 2517 5175 Facsimile 傳真 :(852) 2548 1848 Website 網址 : www.bupa.com.hk Bupa Hong Kong MP050/11/1115/1K Printed on recycled paper 以再造紙印刷
Enterprise HealthNet 企業僱員健康網 Fully protect your greatest asset 周全保障您最寶貴的資產 www.bupa.com.hk
Introduction to Enterprise HealthNet 企業僱員健康網團體醫療保障計劃簡介 Your people are your company s greatest asset. With Enterprise HealthNet, you can give your employees ultimate health protection with full cover for hospital expenses of up to HK$1.03 million every year as well as optional benefits for maternity and dental expenses. Members can enjoy a range of premium benefits and use our medical card for cashless treatment at all private hospitals in Hong Kong as well as our extensive network of around 2,200 doctors and medical service providers. We are also committed to serving our members with the best care, so you and your team will be well-supported at all times. 人力資源是企業最重要的資產, 企業僱員健康網 可為您的僱員提供最完備的醫療保障, 全數賠償住院費用, 每年限額高達港幣 103 萬元, 另可自選 產科保障 及 牙科保障 會員可享有一系列的尊貴保障, 並可在全港所有私家醫院和約 2,200 名醫生及醫療服務供應商使用醫療卡, 可享免繳費服務 保柏承諾為會員提供優越的服務, 確保您和您的團隊時刻也得到最佳的支援 1
We use our expertise as a health insurance specialist to provide our members with superior healthcare, from full cover of hospital expenses to our convenient medical card service. 保柏作為醫療保險專家, 擁有專業睿智, 透過全數賠償僱員的住院費用和便利的醫療卡服務, 為會員提供優越的醫療保障 Scheme overview 計劃概要 Cover at a glance 保障一覽表 Basic benefits 基本保障 Optional benefits 自選保障 Free benefits 免費保障 Medical card 醫療卡 Choice of benefit levels 保障等級選擇 Hospital and Surgical Benefit 住院及手術保障 Clinical Benefit 門診保障 Maternity Benefit 產科保障 Dental Benefit 牙科保障 Free Hospital Cash Benefit 免費住院現金保障 Free Supplementary Major Medical Benefit 免費附加醫療保障 Free Bupa Worldwide Assistance Programme 免費保柏國際援助計劃 Yes (Hospital and Surgical Benefit, Clinical Benefit) 有 ( 住院及手術保障和門診保障 ) Private (Plan 1, 4) 私家房 ( 計劃 1 或 4) Semi-private (Plan 2, 5) 半私家房 ( 計劃 2 或 5) Ward (Plan 3, 6) 大房 ( 計劃 3 或 6) Eligibility 投保資格 Company size 公司規模 Employees 僱員 Employees dependants 僱員之家屬 5 50 employees 5 至 50 名僱員 All full-time employees aged under 65 所有 65 歲以下的全職僱員 Spouse aged under 65 65 歲以下的配偶 Unmarried children aged between 15 days and 17 years, or under 23 years for full-time students (with valid proof) 僱員的未婚子女, 年齡介乎 15 日至 17 歲或未滿 23 歲的全日制學生 ( 須提供有效證明文件 ) Enrolment 投保 Submit application form with member details and relevant subscription payment at least 10 working days before the end of the month 請於月底前最少 10 個工作天交回申請表, 填妥會員資料並連同正確保費 Contract will come into effect on the first day of the following month 合約將於下月 1 號生效 Please refer to the Schedule of Benefits for more information. 詳情請參閱保障金額表 2
12 reasons to choose Enterprise HealthNet 選擇企業僱員健康網的 12 大理由 1. Full cover for hospital expenses Members will have complete peace of mind with our full cover for hospital and surgical expenses of up to HK$1.03 million yearly. All eligible expenses will be covered in full without any individual item limits. Simply select an attending doctor from our HealthNet specialists and clinics and complete an easy registration process. Upon approval, members can then enjoy quality treatment at five renowned private hospitals in Hong Kong. 2. Flexibility in choice of doctors Members have the flexibility to consult other doctors of their choice by using our Non-HealthNet Benefit. All benefits are restored every year, which provides higher cover especially for those who require lengthy treatment for serious illnesses. 3. Day-case surgery and clinical operations included To increase the value of our members cover, we have included day-case surgery and clinical operations in our Hospital and Surgical Benefit. This covers many common procedures such as wound sutures, endoscopies and colonoscopies that do not require a hospital stay. 4. Generous out-patient cover Our Clinical Benefit provides full cover without benefit limits when members visit any HealthNet doctor or medical service provider. This covers consultations with GPs, specialists, physiotherapists, and Chinese herbalists and bonesetters, as well as diagnostic imaging and laboratory tests such as X-rays and MRI scans. Members can also obtain reimbursement up to the maximum benefit limits when receiving treatment outside our network. 5. Cashless treatment at extensive medical network With our medical card, members can enjoy a credit facility to pay for eligible medical expenses at all private hospitals in Hong Kong as well as an extensive network of around 2,200 doctors and medical service providers. 1. 全數賠償住院費用 保柏提供全數賠償住院和手術費用, 每年最高賠償額高達港幣 103 萬元, 會員可安心就醫, 早日康復 所有合資格費用均會全數賠償, 不設個別保障項目的限額 會員只須在保柏網絡專科醫生及診所內選擇主診醫生, 辦妥簡單的登記手續, 一經批核, 即可在香港 5 間著名的私家醫院享受優質醫療服務 2. 選擇醫生靈活自主 會員可靈活地選擇向保柏網絡以外的醫生求診 所有保障額均每年重新計算, 對於須要長期治療嚴重疾病的僱員可提供更高的保障 3. 保障涵蓋日症手術及診所手術 為提升會員的保障, 我們的 住院及手術保障 特別涵蓋日症手術和診所手術, 當中包括許多常見的醫療程序, 例如不須要住院的傷口縫針 內窺鏡或結腸鏡等 4. 充裕的門診保障 會員到任何 網絡保障 內的醫生或醫療服務供應商求診, 可透過我們的 門診保障 獲得全數賠償, 不受細項上限所限制 保障涵蓋普通科醫生 專科醫生 物理治療師 中醫師及跌打醫師的診症費用, 以及診斷影像和化驗費用, 例如 X 光造影及磁力共振掃描 此外, 會員也可選擇非網絡醫生或醫療服務供應商, 醫療費用可賠償至最高保障限額 5. 龐大醫療網絡免繳費治療 會員只須出示我們的醫療卡, 便可在香港所有私家醫院和約 2,200 名醫生及醫療服務供應商享用合資格醫療費用的墊支服務 3
Claims service pledge No claims procedure is required when members use the Bupa medical card. All other hospitalisation and out-patient claims will be settled within 5-7 working days after full documentation is received. 賠償服務承諾如您使用保柏醫療卡, 無需索償手續 其他住院及門診索償, 於收妥所需文件後 5-7 個工作天內支付 6. Range of free benefits Members will have added protection against costly medical expenses with our free Supplementary Major Medical Benefit and Hospital Cash Benefit. They will also receive assistance if they are hospitalised overseas due to emergencies with our Free Bupa Worldwide Assistance Programme. 7. Optional cover for maternity and dental needs Our optional Maternity Benefit covers pregnancy expenses for mums-to-be, such as obstetrician fees and hospitalisation charges. You can also add on our Dental Benefit to cover dental expenses such as scaling and polishing, X-rays, fillings and extractions. 8. Stable subscriptions To give you better value, we offer a flat subscription rate for all members under the same plan regardless of age. All eligible children in a family will also be enrolled at the cost of one child's subscription. What s more, your subscription rates will not be affected by the past claim amounts of your company. 9. Access to lifelong cover With access to lifelong protection when they retire or have a change of employment, our group members can enjoy peace of mind. Members have the option of transferring to our designated individual health insurance scheme regardless of their health condition. All eligible illnesses developed during their group membership will be covered for life under the individual scheme. 10. Fast and easy claims We make claims processing fast and easy. Members do not need to file any claims when using our medical card. For other cases, we have a service pledge to settle claims within five to seven working days after receiving full documentation. When the claim is settled, we will send out a SMS to notify your employee. To reimburse the expenses, we simply credit the payments directly to your employee s bank account. 11. Hassle-free enrolment No medical examinations, individual underwriting or health declarations are required for enrolment of new members. 12. Continual support with attentive and convenient services With our helpful and convenient services, managing your scheme is a breeze. Our Customer Care Advisors are available 24 hours every day to answer customer enquiries quickly and accurately. You can also use our online service to view claim statements and add or remove members, while group members can view membership details, search for network doctors and track claims. 6. 多種免費保障 我們特設的 免費附加醫療保障 及 免費住院現金保障, 為所有會員提供額外保障, 應付昂貴的醫療費用 計劃並設有 免費保柏國際援助計劃, 會員若因緊急事故在海外住院, 可即時獲得協助 7. 自選產科及牙科保障 我們的自選 產科保障 將會支付準媽媽於懷孕期間的醫療費用, 包括產科醫生費用和住院費用等 您亦可附加 牙科保障, 保障包括洗牙 X 光 補牙及脫牙等牙科護理 8. 保費平穩更有預算 我們讓同一計劃等級下所有僱員, 不論年齡一律享有劃一保費, 令計劃更物超所值 每個家庭只須繳付一名子女的保費, 所有合資格子女均獲受保 此外, 您的保費亦不會受公司過往的索償金額影響 9. 可獲終生續保 我們的團體會員在退休或轉換工作後, 不論健康狀況如何, 也可選擇將其會籍轉移至指定的個人醫療保障計劃, 令他們安枕無憂 所有於團體計劃會籍生效期間所患的合資格受保疾病均可在該個人醫療保障計劃內獲終生保障 10. 索償快捷簡便 我們的索償程序快捷簡便 會員於求診時只須出示醫療卡, 便無須辦理索償手續 於其他情況下, 保柏的服務承諾是在收妥所需文件後於 5 至 7 個工作天內支付賠償 我們在賠償辦妥後會發出短訊通知您的僱員 付款方法亦很簡便, 賠償款項會直接存入僱員的銀行賬戶 11. 投保方便 加入新會員於此計劃, 無需身體檢查 個別核保或填寫健康聲明 12. 持續支援, 服務體貼周到 保柏為您提供方便周全的服務, 讓您輕鬆管理計劃 我們的客戶服務主任每天 24 小時為您服務, 快捷準確地回答客戶的查詢 您亦可使用我們的網上服務, 瀏覽賠償單及增減計劃會員 而會員則可瀏覽會籍資料 搜尋網絡醫生和查閱索償進度 Subject to the co-payment, if applicable. Reimbursement percentage of 80% or 100% depending on plan. Members who have been covered under Bupa's group insurance for a minimum of six months are entitled to the transfer option, subject to the required process and terms determined by Bupa. The upgrade of plan level or addition of benefit items will require Bupa's underwriting approval. To enjoy the SMS notification service, employees will need to provide Bupa with an up-to-date mobile phone number. 視乎是否須要支付自負費, 如適用 賠償率為 80% 或 100%, 視乎計劃而定 會員只須受保於保柏團體保險最少六個月及依照保柏訂定之所需程序及條款, 便可轉移其會籍 提升計劃等級或增加保障項目須由保柏核保審批 僱員必須向保柏提供最新手機號碼, 方可享用短訊通知服務 4
The World of Bupa 環球保柏 Bupa Group Established in the UK in 1947 Leading international healthcare group serving over 29 million customers in more than 190 countries Diversified healthcare services include health insurance, hospitals, primary care and diagnostic centres, dental centres, workplace health services, home healthcare, health assessments, chronic disease management services, nursing and residential care for elderly people With no shareholders, we invest our profits to provide more and better healthcare and fulfill our purpose of longer, healthier, happier lives Bupa s presence in Hong Kong Bupa is a leading provider in healthcare funding and provision with two independent units, Bupa Hong Kong and Quality HealthCare. Bupa Hong Kong Health insurance specialist since 1976 Expertise in healthcare has gained the trust of more than 390,000 individuals and 3,200 companies Recommended by the Hong Kong Government to provide health insurance to civil servants for 19 consecutive years Offers a wide choice of doctors with one of the largest provider networks in Hong Kong Quality HealthCare A leading private medical network in Hong Kong and has become part of Bupa group since October 2013 Services span across diagnostics, primary healthcare and day-care specialties Network of 100 multi-specialty centres and approximately 500 affiliated clinics offering Western Medicine, Traditional Chinese Medicine, Diagnostics & Imaging, Dental, Physiotherapy and other healthcare services 保柏集團於 1947 年在英國成立 領先於同業的國際醫療保健集團, 在全球 190 多個國家為 2,900 萬名客戶服務 提供多元化的醫療保健服務, 包括醫療保險 醫院服務, 基層醫護及診斷中心 牙科護理中心 職場健康 家居醫療護理 健康評估 慢性疾病管理服務 看護服務及長者家居護理服務 我們不設股東, 因此可將所有盈餘投資於業務當中, 以提供更廣及更佳的醫療保健服務, 實踐我們活出更長壽 更健康和更愉快人生的目標 保柏於香港的業務保柏透過旗下兩間獨立營運的公司 - 保柏香港及卓健醫療, 為市民提供醫療保險及醫療保健服務, 兩者皆具領導地位 保柏香港於 1976 年成立, 為本港醫療保險專家專業醫療保險服務為超過 39 萬名會員及 3,200 間公司所信賴連續 19 年獲香港政府推薦, 為本港公務員提供醫療保險透過龐大的本港醫療網絡, 給您更多醫生選擇 卓健醫療香港領先的私營醫療中心聯網服務商, 於 2013 年 10 月正式加入保柏服務涵蓋診斷 基層保健及日症專科服務透過 100 間綜合醫療中心及近 500 間聯營診所, 提供西醫 中醫 放射診斷 牙科 物理治療及其他保健服務 Keeping you healthy Keeping our members well is as important to us as protecting them when they become unwell. We provide free online health information and tools, from health information factsheets to health risk calculators and fitness apps, using the expertise of Bupa s medical consultants in the UK and Hong Kong. 助您保持健康 保柏不單在會員患病時提供保障, 我們認為助他們保持健康同樣重要 因此, 我們提供免費網上健康資訊及工具, 包括疾病資訊 健康風險評估和健體應用程式, 所有資訊均由英國及香港的保柏專業醫學顧問提供 Use our free services 使用我們的免費服務 www.bupa.com.hk Join Bupa s Facebook 加入保柏 Facebook Bupa Hong Kong 5
General Exclusions 不受保障項目 We want to help you understand the coverage before enrolment. Below are the general exclusions: Pre-existing conditions. Treatment, medical service, medication or investigation which is not medically necessary. Any illness or bodily injury for which compensation is payable under any laws or regulations or any other insurance policy or any other sources except to the extent that such charges are not reimbursed by any such compensation, insurance policy or sources. Any charges for accommodation, nursing and services received in health hydros, nature cure clinics, convalescent home, rest home, home for the aged or similar establishments. Any charges in respect of surgical or non-surgical cosmetic treatment, Hair Mineral Analysis (HMA), health supplements or body weight control (unless approved by Bupa). Any charges in respect of preventive measures, including but not limited to routine blood tests, general check-ups, vaccinations or inoculations, hearing tests, eye refraction including but not limited to routine eye tests or any cost of fitting of spectacles or lens. Congenital conditions, developmental conditions or hereditary conditions. Treatment that commenced during the first five years from the coverage commencement date and which in any way arises from, is attributable to, or is consequential upon Human Immunodeficiency Virus Infection. Sexually transmitted (venereal) diseases or their sequel. Treatment relating to pregnancy, including diagnostic tests for pregnancy or resulting childbirth, abortion or miscarriage (unless benefit is available); birth control or sterilisation of either sex; infertility including in-vitro fertilisation or any other artificial method of inducing pregnancy; or sexual dysfunction including but not limited to impotence, erectile dysfunction and pre-mature ejaculation, regardless of cause. Misuse or overdose of drugs or being under the influence of alcohol, selfinflicted injuries or attempted suicide. Treatment relating to any illness or bodily injury resulting from participation in criminal activities. Alternative treatment including but not limited to Chinese Medicines treatment, acupuncture, acupressure, Tui Na, hypnotism, rolfing, massage therapy and aromatherapy (unless benefit is available). Senile Dementia (including Alzheimer s disease), Parkinson s disease, psychological or psychiatric condition(s) of any and all kinds, including but not limited to psychoses, neuroses, depression, anxiety, anorexia nervosa, schizophrenia, behavioural disorders, delirium, insomnia and neurasthenia. Any charges for the procurement or use of special braces and appliances, including but not limited to spectacles, hearing aids and other equipments such as wheel chairs and crutches. Any treatment or investigation related to dental or gum conditions (unless benefit is available) except for emergency treatment (not followup treatment) arising from accidents or the extraction of impacted wisdom teeth during hospital confinement. Treatment arising from war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or military or usurped power or terrorist acts. Non-medical services, including but not limited to guest meals, radio, telephone, photocopy, taxes (except the Value-Added Tax or Goods and Services Tax for medical services), medical report charges and the like. Experimental and/or new medical technology or procedure not yet approved by Bupa. Engaging or taking part in naval, military or airforce or any operation with any armed force; or any form of professional sports. 我們想讓您在投保前清楚了解保障範圍, 因此列出所有不受保障項目如下 : 已存在病症 不是醫療必需的治療 醫療服務 藥物或檢驗 任何在法例下或其他保險計劃內或從其他途徑可獲賠償之治療疾病或損傷費用, 除非此等費用未能在該等補償 保險計劃或途徑獲得賠償 在水療中心 天然治療中心 康復院 療養院 老人院或類似機構所提供之住宿 護理或服務的費用 手術性或非手術性整容或整形治療 毛髮礦物質含量分析 健康補品或體重控制 ( 經保柏批准則除外 ) 的費用 預防性措施, 包括但不限於常規驗血 例行檢驗 預防注射或接種疫苗 聽覺測驗 因視力不正常而引致之治療, 包括但不限於常規視力測驗或所需之眼鏡或鏡片費用 先天性疾病 發育異常或遺傳性疾病 由保障開始日起首 5 年內, 因感染人體免疫力缺損病毒所引致的治療 性病及其後遺症 與懷孕有關的治療, 包括診斷性產科檢查 生育 墮胎或小產 ( 計劃內已包括之保障除外 ) ; 與男女任何一方的節育或絕育有關的治療 ; 由於不育而直接或間接進行的治療, 包括體外受孕, 任何非自然受孕或人工受孕 ; 與性機能失常有關之治療, 包括但不限於陽萎 不舉及早泄 ( 不論任何原因導致 ) 誤用或服用過量藥物或受酒精影響 蓄意自傷身體或意圖自殺而直接或間接引致的治療 任何因參與犯罪活動而引致之疾病或損傷 另類治療, 包括但不限於中藥治療 針灸 穴位按摩 推拿 催眠治療 羅爾夫按摩療法 按摩治療 香薰治療 ( 計劃內已包括之保障除外 ) 老年性痴呆 ( 包括亞爾茲海默氏病 ) 帕金森氏病 心理病或精神病症, 包括但不限於精神病 神經機能病 抑鬱 焦慮 神經性厭食 精神分裂 行為失常 譫妄症 失眠 神經衰弱等直接或間接引致的治療 購買或使用輔助器具, 包括但不限於眼鏡 助聽器及其他設備例如輪椅 枴杖的費用 任何與牙齒或牙肉疾病有關的治療或檢查 ( 計劃內已包括之保障除外 ), 因意外引致緊急入院治療或住院脫除阻生智慧齒則除外 但不包括該住院後之跟進治療 因戰爭 入侵 外敵行動 開戰 ( 不論是否已宣戰 ) 內戰 暴動 革命 叛亂或軍人奪權 恐怖活動等直接或間接引致的治療 非醫療性服務, 包括但不限於客人膳食 收音機 電話 影印 稅項 ( 就醫療服務所徵收的增值稅或商品及服務稅除外 ) 醫療報告等費用 所有未經保柏批准之實驗性及 / 或最新治療 從事或參與海軍 陸軍或空軍任務或任何武裝部隊之行動 ; 或從事或參與任何類形之專業運動 6
Bupa (Asia) Limited 保柏 ( 亞洲 ) 有限公司 18/F, Berkshire House 25 Westlands Road, Quarry Bay, Hong Kong 香港 魚涌華蘭路 25 號克大廈 18 樓 Telephone 電話 :(852) 2517 5175 Facsimile 傳真 :(852) 2548 1848 MP048/11/1115/500 Printed on recycled paper 以再造紙印刷 Care homes Cash plans Dental insurance Health analytics Health assessments Health at work services Health centres Health coaching Health information Health insurance Home healthcare Hospitals International health insurance Personal medical alarms Retirement villages Travel insurance www.bupa.com.hk Bupa Hong Kong