Voluntary Health Insurance Scheme Flexi Plan - Healthy Life Medical Insurance Plan series
Voluntary Health Insurance Scheme - Flexi Plan Certification Number: F00024 and F00030
Voluntary Health Insurance Scheme Provider Registration No: 00021 (Registration Effective Date: 28 Feb 2019)
With your increasing demand on a better living standard, a medical plan with basic coverage can no longer meet your needs.
With your increasing demand on a better living standard, a medical plan with basic coverage can no longer meet your needs. In view of the increasing medical expenses along with your needs to stay in a higher-level ward for treatment, we have prepared the Healthy Life Medical Insurance Plan series (the “Plan”), which provides comprehensive reimbursable medical coverage for well-planning people like you. The Plan is divided into 2 classes, namely Healthy Life Medical Insurance Plan and Healthy Life Premier Medical Insurance Plan, and there are 5 plan levels in total. You can choose one of the plan levels that best fits your budget to enjoy a quality protection.
?5 Plan Levels for Your Selection
The 5 plan levels include the ward level coverage Healthy Life Medical Insurance Plan, and the semi-private room or private room coverage Healthy Life Premier Medical Insurance Plan. Upon enrolment, you may select a plan level of Healthy Life Premier Medical Insurance Plan that has attached with Supplementary Major Medical Benefit for higher protection. If the actual medical expenses exceed the benefit limit, the Supplementary Major Medical Benefit will pay maximum 80% of the excess amount. This way you can focus on your treatment. For details of the benefit item and amount of each plan level, please refer to the Benefit Schedule.
?Guaranteed Renewal to Age 100
So long as you have enrolled in the Plan successfully, the Plan is guaranteed to renew to age 100 regardless of your health condition and claim history after enrolment.
?No Claim Discount
There will be a discount on Premium if no benefits have been paid in the past 3 consecutive Policy Years or more. The discount will be 15% of the Premium of next Policy Year and to be deducted upon Premium payment.
?No Lifetime Benefit Limit whilst Covering Pre-existing Conditions
There is no Lifetime benefit limit set in the Plan but it is subject to an aggregate benefit limit for each year. In addition, pre-existing conditions are also covered where certain limitation are applied in the first 3 years after the Plan becomes effective. For more information, please refer to item 6 of the Important Note stated in this product brochure.
?Room & Board and Surgeon's Fee
The expenses related to Room & board, Attending doctor's visit fee, Specialist's fee, surgical fees and Miscellaneous charges are covered, releasing you from any kind of financial burden. Please refer to the Benefit Schedule for the benefit amount of each item.
?Extended Benefit - Pre- and post- Confinement/Day Case Procedure Outpatient Care
The Plan not only provides hospital confinement and surgical benefits, it also covers the expenses related to pre- and post-confinement / day case procedure outpatient care.
?Prescribed Non-surgical Cancer Treatments, Prescribed Diagnostic Imaging Tests and Psychiatric Treatments
The cost for treating cancer is expensive. This is why the Plan offers coverage on Prescribed Non-surgical Cancer Treatment procedures, including radiotherapy, chemotherapy, targeted therapy, immunotherapy and hormonal therapy. Furthermore, the Plan also covers Prescribed Diagnostic Imaging Tests (e.g. MRI) for the investigation or treatment of a Disability, as well as Psychiatric treatments during the Confinement in Hong Kong.
The Healthy Life Premier Medical Insurance Plan of the Plan also provides the following enhanced benefits：
- Emergency out-patient care (accidental injury) - the Insured Person is treated as a Day Patient in the Emergency department of a Hospital within 24 hours of an Accident occurred that causes the Disability
- Home nursing (post surgery) - the service is provided at home by a registered nurse within 60 days from the date on which the Insured Person is discharged from the Hospital
- Organ donor benefit
- Outpatient kidney dialysis
- Rehabilitative care
- Companion bed
The Plan is a qualified Voluntary Health Insurance Scheme where the Policy Holder may enjoy a tax deduction. Please refer to the information provided by the government of the Hong Kong Special Administrative Region for details.
Voluntary Health Insurance Scheme Flexi Plan - Healthy Life Medical Insurance Plan series
|Issue Age||From 15 days after birth to 80 years old|
|Premium Payment Term4||To age 99 of the Insured|
|Benefit Term||To age 100 of the Insured|
|Premium Payment Method||Annual or Monthly|
1 Confinement means an admission of the Insured Person to a Hospital that is recommended by a Registered Medical Practitioner for Medical Service and as an Inpatient as a result of a Medically Necessary condition for a period of no less than 6 consecutive hours. No minimum period is required for Confinement in connection with any Emergency Treatment in a Hospital as a result of an Emergency for the performance of a surgical procedure or other Medical Service in a Hospital.
2 Day Case Procedure means a Medically Necessary surgical procedure for investigation or treatment to the Insured Person performed in a medical clinic, or day case procedure centre or Hospital with facilities for recovery as a Day Patient.
3 Coinsurance means a percentage of Eligible Expenses the Policy Holder must contribute after paying the Deductible (if any) in a Policy Year. For the avoidance of doubt, Coinsurance does not refer to any amount that the Policy Holder is required to pay if the actual expenses exceed the benefit limits under the Policy.
4 Medically Necessary mean the need to have medical service for the purpose of investigating or treating the relevant Disability in accordance with the generally accepted standards of medical practice.
5 Hospital means an establishment duly constituted and registered as a hospital under the laws of the relevant territory in which it is established, which is for providing Medical Service for sick and injured persons as Inpatients, and which (a) has facilities for diagnosis and major operations; (b) provides 24 hours nursing services by licensed or registered nurses; (c) has 1 or more Registered Medical Practitioners; and (d) is not primarily a clinic, a place for alcoholics or drug addicts, a nature care clinic, a health hydro, a nursing, rest or convalescent home, a hospice or palliative care centre, a rehabilitation centre, an elderly home or similar establishment.
Please refer to the Policy documents for the complete definitions of the capitalised terms, as well as all the terms and conditions of this product. You are reminded to review all of the relevant product materials provided to you and to seek independent professional advice if necessary.
- The Policy is underwritten by China Life Insurance (Overseas) Company Limited (“China Life (Overseas)” or "us/we/our"). China Life (Overseas) is responsible for the features, underwriting and benefit payments under the Policy. You should fully understand all of the risks involved in this product and consider whether this product is affordable and suitable to you before making your application.
- China Life (Overseas) shall make the final decisions on the underwriting and claims. We shall rely on your submitted information to assess whether to accept or decline your application, and shall refund any Premium paid without interest for declined cases.
- The Plan is a non-participating life insurance plan and therefore dividends are not available to the Plan.
- Exclusions - China Life (Overseas) shall not pay any benefits in relation to or arising from the following expenses: (1) expenses incurred for treatments, procedures, medications, tests or services which are not Medically Necessary; (2) expenses incurred for the whole or part of the Confinement solely for the purpose of diagnostic procedures or allied health services, including but not limited to physiotherapy, occupational therapy and speech therapy, unless such procedure or service is recommended by a Registered Medical Practitioner for Medically Necessary investigation or treatment of a Disability which cannot be effectively performed in a setting for providing Medical Services to a Day Patient; (3) expenses arising from Human Immunodeficiency Virus (“HIV”) and its related Disability, which is contracted or occurs before the Policy Effective Date. Irrespective of whether it is known or unknown to the Policy Holder or the Insured Person at the time of submission of Application, including any updates of and changes to such requisite information (if so requested by China Life (Overseas)) such Disability shall be generally excluded from any coverage of the Policy if it exists before the Policy Effective Date. If evidence of proof as to the time at which such Disability is first contracted or occurs is not available, manifestation of such Disability within the first 5 years after the Policy Effective Date shall be presumed to be contracted or occur before the Policy Effective Date, while manifestation after such 5 years shall be presumed to be contracted or occur after the Policy Effective Date. However, the exclusion under this entire Section 3 shall not apply where HIV and its related Disability is caused by sexual assault, medical assistance, organ transplant, blood transfusions or blood donation, or infection at birth, and in such cases the other terms of the Policy shall apply; (4) expenses incurred for Medical Services as a result of Disability arising from or consequential upon the dependence, overdose or influence of drugs, alcohol, narcotics or similar drugs or agents, self-inflicted injuries or attempted suicide, illegal activity, or venereal and sexually transmitted disease or its sequelae; (5) any charges in respect of services for (a) beautification or cosmetic purposes, unless necessitated by Injury caused by an Accident and the Insured Person receives the Medical Services within 90 days of the Accident; or (b) correcting visual acuity or refractive errors that can be corrected by fitting of spectacles or contact lens, including but not limited to eye refractive therapy, LASIK and any related tests, procedures and services; (6) expenses incurred for prophylactic treatment or preventive care, including but not limited to general check-ups, routine tests, screening procedures for asymptomatic conditions, screening or surveillance procedures based on the health history of the Insured Person and/or his family members, Hair Mineral Analysis (HMA), immunisation or health supplements. For the avoidance of doubt, this Section 6 does not apply to (a) treatments, monitoring, investigation or procedures with the purpose of avoiding complications arising from any other Medical Services provided; (b) removal of pre-malignant conditions; and (c) treatment for prevention of recurrence or complication of a previous Disability; (7) expenses incurred for dental treatment and oral and maxillofacial procedures performed by a dentist except for Emergency Treatment and surgery during Confinement arising from an Accident. Follow?up dental treatment or oral surgery after discharge from Hospital shall not be covered; (8) expenses incurred for Medical Services and counselling services relating to maternity conditions and its complications, including but not limited to diagnostic tests for pregnancy or resulting childbirth, abortion or miscarriage; birth control or reversal of birth control; sterilisation or sex reassignment 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 or pre-mature ejaculation, regardless of cause; (9) expenses incurred for the purchase of durable medical equipment or appliances including but not limited to wheelchairs, beds and furniture, airway pressure machines and masks, portable oxygen and oxygen therapy devices, dialysis machines, exercise equipment, spectacles, hearing aids, special braces, walking aids, over-the-counter drugs, air purifiers or conditioners and heat appliances for home use. For the avoidance of doubt, this exclusion shall not apply to rental of medical equipment or appliances during Confinement or on the day of the Day Case Procedure; (10) expenses incurred for traditional Chinese medicine treatment, including but not limited to herbal treatment, bone-setting, acupuncture, acupressure and tui na, and other forms of alternative treatment including but not limited to hypnotism, qigong, massage therapy, aromatherapy, naturopathy, hydropathy, homeotherapy and other similar treatments; (11) expenses incurred for experimental or unproven medical technology or procedure in accordance with the common standard, or not approved by the recognised authority, in the locality where the treatment, procedure, test or service is received; (12) expenses incurred for Medical Services provided as a result of Congenital Condition(s) which have manifested or been diagnosed before the Insured Person attained the Age of 8 years; (13) Eligible Expenses which have been reimbursed under any law, or medical program or insurance policy provided by any government, company or other third party; and (14) expenses incurred for treatment for Disability arising from war (declared or undeclared), civil war, invasion, acts of foreign enemies, hostilities, rebellion, revolution, insurrection, or military or usurped power.
In addition, the information stated herein is for reference only. Please refer to the General Provisions for the exact terms and conditions or all exclusions.
- Cooling-off Right - You have the right to cancel the Policy within the Cooling-off Period and obtain a refund of any Premiums paid by giving written notice to us provided that you have not made any claims under the Policy. Such notice must be signed by you and submitted to China Life (Overseas) at 22/F, CLI Building, 313 Hennessy Road, Wan Chai, Hong Kong within 21 days after the delivery of the Policy or issue of a Notice to you or your representative informing you that the Policy is available, whichever is earlier.
- Pre-existing Condition - China Life (Overseas) may impose Case-based Exclusion(s) to the Policy by reason of a Pre-existing Condition or other factor that affects the insurability of the Insured Person notified to China Life (Overseas) in the Application and any subsequent information or document submitted to China Life (Overseas) for the purpose of the application, including any updates of and changes to such requisite information. Eligible Expenses arising from Pre-existing Condition(s) that the Policy Holder and/or Insured Person was not aware and would not reasonably have been aware of at the time of submission of Application, including any updates of and changes to the required information, shall be payable subject to the following waiting period and reimbursement arrangement:
First Policy Year – no coverage
Second Policy Year – 25% reimbursement
Third Policy Year – 50% reimbursement
Fourth Policy Year onwards – full coverage
If the Policy Holder or the Insured Person is requested but fails to disclose to China Life (Overseas) upon submission of Application, including any updates of and changes to the required information, that the Insured Person is suffering from a Pre?existing Condition, and such Pre-existing Condition has been treated or diagnosed or has manifested signs or symptoms of which the Policy Holder or the Insured Person is aware or should have reasonably been aware of at the time of submission of Application, including any updates of and changes to the required information, China Life (Overseas) has the right to declare the Policy void, demand repayment of any benefits paid and/or refuse to provide coverage under the Policy.
- Limitation - If the Insured Person is voluntarily Confined in a ward class of Hospital accommodation higher than his/her entitled ward class as specified in the Benefit Schedule, the benefit amount will be adjusted:
Such limitation will not apply if the Insured Person is confined in a ward class higher than his/her entitlement under the following circumstances:
Insured Person’s entitled ward class as specified in Benefit Schedule specified in Benefit Schedule Actual ward class occupied by the Insured Person during Confinement Adjustment Factor Ward Semi-private room 50% Ward Standard private room or above 25% Semi-private room Standard private room or above 50% Standard private room Any ward class above standard private room 50%
(a) unavailability of accommodation at the specified ward class due to ward or room shortage for emergency treatment;
(b) isolation reasons that require a specific class of accommodation; or
(c) other reasons not involving personal preference of the Policy Holders and/or the Insured Persons.
|What are the key product risks?|
|Credit risk||This product is a life insurance Policy issued by China Life (Overseas). Any Premium paid will become part of our assets and our financial strength will affect our ability to meet our contractual obligations to you under the Policy. Therefore this product is subject to our credit risk.|
|Exchange rate and Currency risks||Any Policy with foreign currencies involves risks, such as potential changes in political or economic conditions that may substantially affect the price or liquidity of a currency. The fluctuations in exchange rates may also cause financial losses to you during currency conversions. You should consider the potential currency and exchange rate risks.|
|Inflation risk||The cost of living in the future may be higher than expected due to the effects of inflation. Therefore, your current planned benefits and/or returns may be insufficient to meet your future needs even if we fulfill all of our contractual terms and obligations.|
|Policy Termination||The Policy shall be automatically terminated on the earliest of the followings and at 00:00 hours of the effective date of termination: (a) non-payment of Premiums after the grace period; (b) the day immediately following the death of the Insured Person; and (c) China Life (Overseas) has ceased to have the requisite authorisation under the Insurance Ordinance to write or continue to write the Policy.
If the Policy is terminated under (a) or (c), in the case where the Insured Person is being Confined or is undergoing Prescribed Non-surgical Cancer Treatment for a Disability suffered before such termination, then, with respect to the Confinement or treatment in relation to the same Disability, Eligible Expenses incurred shall continue to be covered under this Policy until (i) the Insured Person is discharged or the treatment is completed or (ii) 30 days after the termination of this Policy, whichever is the earlier.
|Premium adjustment and renewal||Irrespective of whether China Life (Overseas) revises the Policy upon Renewal, China Life (Overseas) shall have the right to adjust the Standard Premium according to the prevailing Standard Premium schedule adopted by China Life (Overseas) on an overall Portfolio basis. For the avoidance of doubt, if the Premium Loading is set as a percentage of the Standard Premium (i.e. rate of Premium Loading), the amount of Premium Loading payable shall be automatically adjusted according to the change in Standard Premium.
During each Policy Year and upon Renewal, China Life (Overseas) shall not impose any additional rate of Premium Loading (or any additional amount of Premium Loading if the Premium Loading is set in monetary terms rather than as a percentage of the Standard Premium) or Case-based Exclusion(s) on the Insured Person by reason of any change in the Insured Person's health conditions.
In addition, the Policy is Renewable for each Policy Year in accordance with the terms set out in “Part 4 – Renewal Provisions” of the Policy Provision, and the renewal is guaranteed up to the Age of 100 of the Insured Person. For details of the terms, please refer to the Policy Provision.
Regarding the collection of Premium Levy by the Insurance Authority, please refer to http://www.boeqit.tw/customerservice/levy
The information and descriptions contained herein are not intended to be complete descriptions of all terms, exclusions and conditions applicable to the products and services, but are provided solely for general informational purposes. For complete details please refer to the actual policy or the relevant product or services agreement.