EB1/BR00016B/P01 (12/14)

3656 83622164 8445

3656 83622164 8445

3/F, Berkshire House, 25 Westlands Road,栢克大廈3樓

Contents

Foreword ------------------------------------------------------------------------------------------

Membership --------------------------------------------------------------------------------------- I. Who is covered and when?

Benefit ---------------------------------------------------------------------------------------------- I. Hospital and Surgical BenefitII. Inpatient Top Up Medical BenefitIII. Clinical Benefit

Claims ---------------------------------------------------------------------------------------------- I. Claims ProcedureII. Treatments that require Referral letter

Exclusions -----------------------------------------------------------------------------------------

Glossary of Terms ------------------------------------------------------------------------------- Situations That Require Pre-Authorization ---------------------------------------------------

How to ensure no Shortfall for all eligible Clinical expenses? ----------------------------

How to ensure no Shortfall for all eligible Hospital and Surgical expenses? -----------

24 Hours Emergency Assistance Services Benefit ------------------------------------------

General Provisions ------------------------------------------------------------------------------ I. What shall the insurance cost?II. Changes in coverageIII. What shall happen if you require medical Treatment abroad?IV. What shall happen if you leave Your Company?

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EB1/BR00016B/P01 (12/14)

Foreword

Prudential plc* is an international financial services group with significant operations in Asia, the US and the UK. We serve over 23 million insurance customers and have £427 billion of assets under management as at 30 June 2013. Prudential plc is listed on stock exchanges in Hong Kong, London, New York and Singapore.

Prudential has been serving the people of Hong Kong since 1964. Through Prudential Hong Kong Limited and Prudential General Insurance Hong Kong Limited, we provide a range of financial planning services and products including individual life insurance, investment-linked insurance, retirement solutions, health and medical protection, general insurance and employee benefits.

Please visit www.prudential.com.hk for more information.

We offer a variety of group medical plans, employers can insure for their employees with hospital & surgical benefits, clinical benefits and many more to protect the needs of their employees and their families at all times, so that they can leave their worries behind and work their best for the companies’ business.

Please read this handbook thoroughly to ensure you are familiar with the entire protection offered. Your complete understanding of the insurance shall enable Prudential General Insurance Hong Kong Limited to render a full and efficient healthcare service without delay.

This handbook is for reference only. Should there be any discrepancy of the terms and conditions be-tween this booklet and the master insurance policy with your employer, the later shall prevail.

Membership

Who is covered and when?If you are eligible full time staff working for Your Company (or after probation if applicable), you shall be covered under this insurance. However, if you happen to be sick or not actively at work on the date you would otherwise become a Member, your coverage shall then commence on the day you return to work in good health.

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Prudential plc is not affiliated in any manner with Prudential Financial, Inc., a company whose prin-cipal place of business is in the United States of America.

*

Benefit

Benefit is available immediately when you are entitled to be a Member under this insurance. Benefit is not available, however, for Hospital admissions commencing prior to the date of your eligibility nor in relation to any condition originating prior to this date. All Benefits in the following are available worldwide unless it is specified in the Benefit Schedule. Please refer to the Benefit Schedule for full details.

I.00000Hospital0and0Surgical0Benefit0000000Section0A:0Basic0Benefit

consultation fee for one pre-admission clinical visit

all Medically Necessary follow-up clinical visits including consultation, medication pre-scribed or diagnostic tests* referred by a Registered Medical Practitioner within six (6) weeks after discharge from Hospital, provided that such consultation, medication or tests is directly related to and a result of the Disability necessitating such Hospital Confinement.

(a)

(b)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

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On admission to Hospital, you are entitled to benefit for room and board (including accommoda-tion, meals, general nursing care) up to the daily maximum shown in the Benefit Schedule.For Hospital Confinement, you must continuously stay in the Hospital for the entire period there-after prior to your discharge with room and board or intensive care charges incurred.

Miscellaneous Hospital services (including X-rays or other diagnostic procedures, medications, ambulance charges and transfusions) shall be paid under this benefit.

Intensive care benefit is payable for the charges incurred as a result of your being accommodated in an intensive care unit in a Hospital recommended by the Registered Medical Practitioner in charge up to the maximum shown in the Benefit Schedule.

Charges for special nursing rendered by a Qualified Nurse on the recommendation of a Registered Medical Practitioner shall be paid up to the maximum shown in the Benefit Schedule.

Surgeon and attendance fees (including all Registered Medical Practitioners’ visits for surgical case), anaesthetist’s fees and operating theatre fees shall be paid in accordance with the Benefit Schedule.

In-patient physician’s fee benefit* is payable for attendance fees of non-surgical Hospital Confine-ment in accordance with the maximum shown in the Benefit Schedule.

In-patient Specialist’s fee benefit is payable for fees charged by Specialist in respect of Specialist services provided to you during your Hospital Confinement but not exceed the maximum limit as shown in the Benefit Schedule.

Pre-admission and follow-up out-patient care* is payable for:

Section0B:0Hospital0Cash0BenefitBenefit is payable starting from the number of day(s) stated in the Benefit Schedule of such Hospital Confinement up to the maximum number of day(s) as shown in the Benefit Schedule provided if you are confined to the general ward of a Hospital Authority’s Hospital in Hong Kong under the profes-sional care of a Registered Medical Practitioner and the relevant benefit under Point (1) of Section A is payable.

Section0C:0240Hours0Emergency0Assistance0Services0Benefit024 Hours Emergency Assistance Services benefit is provided by the Inter Partner Assistance Hong Kong Limited for you to use if you suffer serious Bodily Injury or sudden Illness or is in need of medi-cal legal administrative Emergency assistance outside the Country of Residence while arising out of and in the course of your trip. For details, please refer to the part of “24 Hours Emergency Assistance Services Benefit” in page 12.

0II.00Inpatient0Top0Up0Medical0Benefit*Benefit is payable if the relevant Benefit item payable in Section A of Part 1 of such Hospital Confinement is exhausted. The amount payable shall not exceed the applicable maximum benefit limit as shown in the Benefit Schedule. Unless the overseas Hospital Confinement is resulted directly from medical Emergency, you will be only entitled to the benefit provided that you are confined in Hospital in Hong Kong. No benefit will be payable for Hospital Confinement in class of suite/V.I.P./deluxe room of a Hospital. The amount payable is calculated as follow:

0III.0Clinical0Benefit*If as a result of accidental bodily injury, disease or sickness, you necessarily incur expense for care and Treatment by a Registered Medical Practitioner at his/her clinic, benefit shall be paid to cover the cost of consultations, injections, medicines supplied, diagnostic X-ray examinations and laboratory tests. For Benefit details, please refer to your Benefit Schedule.

If a new Member enrolled the scheme during mid term of policy year, the total number of visits for re-spective benefit item and annual overall visits will be counted on pro-rata basis according to the number of days for the membership in that policy year.

* Applicable only as shown in Benefit Schedule for different schemes selected.

If you are confined in a higher level of Hospital facilities and services than that you are entitled to under this Policy, the respective adjustment factors applicable in addition to the reimbursement percentage are as follows:

Restricted LevelSemi-PrivateWard BedWard Bed

Chosen LevelPrivateSemi-PrivatePrivate

Adjustment Factor50%50%25%

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Amount of eligible medical expenses incurred and actually paid during Hospital Confinement

Benefit payable under Section A of Part 1 of Description of Benefit

Less

Reimbursement percentage as stated in the Benefit Schedule

timestimesAdjustment factor below, if applicable

ClaimsI.00000Claims0Procedure00000000Claims0of0Hospital0and0Surgical0Benefit

Obtain a Hospital and Surgical Claim Form from the Human Resources Department of Your Company or us directly.

Ask your attending Registered Medical Practitioner to complete the form with diagnosis during your Hospital stay.

Submit the completed Claim Form together with original receipts, itemized bills and referral let-ters (if applicable) to Human Resources Department of Your Company who shall submit them to us. All original receipts must clearly indicate the date of consultation and Treatment, name of patient, description of charges, diagnosis and operation, if any, together with the signature of at-tending Registered Medical Practitioner.

(1)

(2)

(3)

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Claims0of0Clinical0Benefit

Obtain a Clinical Claim Form from Human Resources Department of Your Company or us directly.

Complete all required information with the diagnosis on the claim form.

Submit the completed Claim Form together with all original receipts, itemized bills and referral letters from either Network or Non-network Registered Medical Practitioner (applicable to Specialist Treatment, Physiotherapy Treatment, Chiropractor Treatment and Diagnostic X-ray and Laboratory Tests if relevant coverages are specified in your Benefit Schedule) to Human Resources Department of Your Company who shall submit them to us. All original receipts must clearly indicate the date of clinical visit, name of patient, diagnosis and breakdown of charges.

Clinical claim must be received to us within ninety (90) days after date of clinical visit, otherwise your claim shall be declined.

Reimbursement shall be made by us through auto-pay or cheque in Hong Kong dollars.

(1)

(2)

(3)

(4)

(5)

(4)

(5)

For the claims of Clinical Benefit other than by use of membership card, you should

Use0of0Membership0CardYou can simply present your membership card in the following places to settle the eligible expenses:

medical facilities listed in the Network Doctors List; or

all Network Hospitals in Hong Kong (except out-patient department) (if applicable).

(1)

(2)

Hospital claim must be submitted to us within ninety (90) days after date of discharge from Hos-pital, otherwise your claim shall be declined.

Reimbursement shall be made by us through auto-pay or cheque in Hong Kong dollars.

Exclusions

Capitalized words are either proper nouns or words with specific meaning as defined in the Group Medical Insurance Policy.

Abuse of Drugs or Alcohol / Self-inflicted

Abuse of drugs or alcohol, self-inflicted injuries or attempted suicide.

Treatment which in any way arises from is attributable to or is con-sequential upon Human Immunodeficiency Virus Infection and which commenced during the first five (5) years from the original inception of this Policy; or Venereal disease or their sequel. The requirement of 5 years’ period for Human Immunodeficiency Virus Infection is to be counted separately for optional benefits.

Alternative Treatment including but not limited to bonesetting, acu-puncture, acupressure, Tui Nai, hypnotism, rolfing, massage therapy, aroma therapy, unless it is provided as shown in the Benefit Schedule.

Engaging or taking part in naval, military or airforce or any operation with any armed force; or any form of professional sports.

Any charges for blood and blood plasma.

Charges for the procurement or use of special braces, any appliances and implant appliances including but not limited to implants prosthesis for hip or knee, pacemaker, intraocular lens, spectacles, hearing aids, stent and other equipments such as wheel chairs, and crutches.

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1.

2.

3.

4.

5.

6.

AIDS / Venereal Disease

Alternative Treatment

Armed Force / Professional Sports

Blood or Blood Plasma

Charges for Procurement or Use of Special Braces Appliances

Hotline0ServiceYou may call our customer service hotline for enquiry of your insurance information at 3656-8362.

II.00Treatments0that0require0Referral0Letter000000

(1) Treatment by Specialist(2) Benefit of Diagnostic X-Ray and Laboratory Tests(3) Treatment by Physiotherapist or Chiropractor

Referral letter is valid for same or related Disability for a period of six (6) months from the date of issuance.

Your membership card can only be used by yourself and non-transferable. It is valid if the Policy is renewed consecutively and no new membership card shall be reissued at renewal. In case of the membership card is lost, damaged or replaced because of change in personal information, a handling fee of HK$100 shall be charged for each replacement.

Any charges in respect of cosmetic surgery, or hearing tests, routine blood tests, general check-ups (except in circumstance provided in the Health Check Up Benefit under Optional Benefit*), vaccination or inoculations, eye refraction including routine eye tests or any costs of fitting of spec-tacles or lenses.

Bodily injury or illness for which compensation whatsoever is payable under any government laws or any other health insurance policy(ies) ex-cept to the extent that such amount is not reimbursed by such government laws or other health insurance policy(ies).

Experimental and/or new medical technology/procedure not yet approved by us.

Treatment or test which is not Medically Necessary including but not limited to hospitalization primarily for diagnostic scanning, X-ray examinations or physiotherapy only, and/or not performed by a Registered Medical Practitioner.

Non-medical services, such as accompanying bed, radio, telephone, pho-tocopy, medical report, taxes, and the likes.

Illness or bodily injury that commenced prior to the Commencement Date of Member’s Coverage, and having consultation, investigation or Treat-ment within six (6) calendar months before or three (3) calendar months after the Commencement Date of Member’s Coverage.

Treatment relating to pregnancy, including diagnostic tests for pregnancy or resulting childbirth, abortion or miscarriage; birth control or steriliza-tion of either sex; infertility including in-vitro fertilization or any other artificial method of inducing pregnancy.

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11.

12.

13.

14.

15.

16.

7. Co-payment

8. Congenital Conditions / Developmental Conditions / Hereditary Conditions

Criminal Acts9.

Dental Treatment or Oral Surgery

10.

Elective Treatment

Expenses Paid by Others

Experimental and / or New Medical Technol-ogy / Procedure

Not Medically Necessary Treatment

Non-medical Services

Pre-existing Condition

Pregnancy / Birth control or Sterilization / Infertility

17.

The amount of applicable co-payment*.

Treatment relating to Congenital Conditions, Developmental Conditions, or Hereditary Conditions.

Bodily Injury or Illness resulting from or in relation to the participation in criminal acts.

Dental Treatment and oral surgery (except in circumstance provided in the Dental Care Benefit under Optional Benefit*) except for Emergency Hospital Treatment arising from an accident. Follow-up Treatment from such Hospital Confinement shall not be covered .

a.

b.

Any charges for accommodations, nursing and services received in health hydros, nature cure clinics, convalescent home, rest home, home for the aged or similar establishments.

Loss, damage, cost or expenses of whatsoever nature directly or in-directly caused by, resulting from or in connection with any of the following regardless of any other cause or event contributing con-currently or in any other sequence to the loss:

Treatment not in a Defined Hospital

War or Act of Terrorism

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21.

22.

This Exclusion shall also exclude loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any action taken in controlling, preventing, sup-pressing or in any way relation to (a) and / or (b) above.

If we allege that by reason of this Exclusion, any loss, damage, cost or expenses is not covered by this Policy, the burden of proving the contrary shall be solely upon you or Your Company.

In the event any portion of this Exclusion is found to be invalid or unenforceable, the remainder shall remain in full force and effect.

War invasion, acts of foreign enemies, hostilities or warlike operations (whether war be declared or not) civil war, rebel-lion, revolution, insurrection, civil commotion assuming the proportions of or amounting to an uprising military or usurped power; or

Any act of terrorismFor the purpose of this General Exclusion, an act of terrorism means an act including but not limited to the use of force or violence and/or the threat thereof of any person or group(s) of person whether acting alone or on behalf of or in connection with any organization(s) or government committed for politi-cal, religious, ideological or similar purpose including the in-tention to influence any government and/or to put the public or any section of the public in fear.

* Applicable only as shown in Benefit Schedule for different scheme selected.

Any geriatric, psychological, psychogeriatricm or psychiatric con-dition of any and all kinds, including but not limited to psychoses neuroses, depression of any kinds, anxiety, anorexia nervosa, schizo-phrenia, behavioural disorders, Alzheimer’s disease, Parkinson’s disease.

Treatment relating or arising from sexual dysfunction including but not limited to impotence erectile dysfunction and pre-mature ejacu-lation, regardless of its cause.

Supportive Treatment of renal failure including dialysis.

Psycho Problems

Sexual Dysfunction

Supportive Treatment of Renal Failure

19.

20.

18.

Glossary0of0TermsBenefit0Scheduleshall mean the schedule as amended from time to time in which the Benefit items and amount of the Benefit are set forth. This shall also include the Benefit Schedule issued at the date of this Insurance and any other schedule thereafter.

Chinese0Bonesettershall mean a Chinese herbal practitioner who practices manipulation of joints and applies herbal Treatment in Chinese traditional approach and,

Chinese0Herbalistshall mean Chinese Herbalist who is registered or otherwise licensed as such under the laws of the territory in which Treatment is received to practise Chinese medicine who has qualifications at least equivalent to those of a Chinese medicine practitioner listed or registered pursuant to the Chinese Medicine Ordinance of Hong Kong.

Chiropractorshall be registered or licensed in the Hong Kong Special Administrative Region USA countries of Com-monwealth or countries of European Union. The coverage is provided only if this is specified on the Benefit Schedule.

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if the Chinese herbal practitioner is required under local law to be registered, he is so registered; or

if the Chinese herbal practitioner is not required under local law to be registered, his/her medical practice is either legally authorised by the local government or recognised by an association in the geographical area to render herbal Treatment and regular services.

Commencement0Date0of0Member’s0Coveragein relation to an Employee, the Commencement Date of Member’s Coverage as defined in the Applica-tion or as provided for by subsequent endorsement if any; and

in relation to a Dependant of an Employee, the later of the Employee’s Commencement Date of Mem-ber’s Coverage or the day of becoming a Dependant of an Employee who is a Member.

Congenital0Conditionsshall mean medical abnormalities existing at the time of birth, as well as neo-natal physical abnormalities developing within six (6) months of birth. They shall include (but not to the exclusion of others which may medically be regarded as Congenital Conditions) Hernias of all types, Strabismus, Hydrocephalus, Unde-scended Testicle, Meckel’s Diverticulum.

Developmental0Conditionsshall mean disorders in which there is either an early development or a delay in development compared to what is expected for at given age level or stage of development. These impairments or disabilities originate before the age of 18 may be expected to continue indefinitely and constitute a substantial impairment. These include disorders with biological or non-biological factors involved.

Disabilityshall mean a bodily injury or sickness, and shall include all disabilities arising from the same cause in-cluding any and all complications therefrom and shall carry forward to next renewal, except that after ninety (90) days following the latest discharge from Hospital, the last consultation or Treatment received in respect of such bodily injury or sickness, whichever is the later and no further Treatment for the same Disability is required; any subsequent Disability from the same cause shall be considered as a separate Disability.

Emergencyshall mean unplanned confinements and conditions that are acute in nature and wherein the initial sign or symptom and consultation or Treatment for this condition cannot be and are not separated by more than twenty-four (24) hours.

General0Practitionerfor the purpose of clinical Benefit, shall mean a Registered Medical Practitioner (other than you, your relatives, family members and business partners) who is registered in the General Register of the Medical Council of Hong Kong or equivalent.

Hereditary0Conditionsshall mean medical conditions genetically transmitted from parent to offspring.

Hospitalshall mean any establishment recognized constituted and registered as a Hospital under the laws of the territory in which that establishment is situated as a Hospital for providing care and Treatment to sick and injured persons as paying bed patients and which (i) has the facilities for diagnosis and major surgery (ii) provides twenty-four (24) hours a day nursing services by Qualified Nurses and (iii) is under the regular care and attendance of Registered Medical Practitioner.

Hospital0Confinementshall mean admission in a Hospital as an in-patient due to a Medically Necessary condition and under the recommended of a Registered Medical Practitioner. You must continuously stay in the Hospital for the entire period thereafter prior to your discharge with room and board or intensive care charges incurred.

Medically0Necessaryshall mean the necessity to have a medical service which is:

• consistent with the diagnosis and customary medical Treatment for the condition; and

• the most expedient and effective Treatment to return the patient to health or discharge from medical facilities; and

• not just for the convenience of you or the Registered Medical Practitioner; and

• on the basis of the medical symptoms or conditions of you cannot be safely provided without Hospital admission.

Membershall mean an employee and his/her dependants (if applicable) who are covered under this insurance.

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Normal0and0Customaryin relation to fees, shall mean a sum not exceeding a reasonable average of the fees charged under similar conditions by persons of equivalent experience and professional status in the area in which the service was provided; and in relation to material or services, shall mean a sum not exceeding a reasonable average of the charges for similar material or services in equivalent circumstances of quality and economic consider-ation in the same area as that in which any such material or services were obtained.

Physiotherapistshall be registered or licensed under the laws of the territory in which Treatment is received. The coverage is provided only if this is specified on the Benefit Schedule.

Pre-existing0Conditionshall mean illness or bodily injury that commenced prior to the Commencement Date of Member’s Cover-age, and having consultation, investigation or Treatment within six (6) calendar months before or three (3) calendar months after the Commencement Date of Member’s Coverage.

Qualified0Nurseshall mean a nurse (other than you, your relatives, family members and business partners) legally qualified under the laws of the territory in which Treatment is received to render nursing services who has quali-fications at least equivalent to those of a registered or enrolled nurse pursuant to the Nurses Registration Ordinance of Hong Kong.

Registered0Medical0Practitionershall mean a medical practitioner (other than you, your relatives, family members and business partners) registered or otherwise licensed as such under the laws of the territory in which Treatment is received to render medical and surgical services who has qualifications at least equivalent to those of a medical practi-tioner registered pursuant to the Medical Registration Ordinance of Hong Kong.

Shortfallshall mean expenses incurred by a person who has used the membership card for payment of such expenses which is not covered by this Policy.

Specialistshall mean a Registered Medical Practitioner, if applicable (other than you, your relatives, family members and business partners) registered or otherwise licensed as such under the laws of the territory in which Treatment is received who holds or has held consultant appointment or appointment of equivalent senior status in a Hospital.

Treatmentshall mean surgical or medical procedures the sole purpose of which is the cure of relief of bodily injury or acute illness.

Your0Companyshall mean the company you are working for now.

Situations0That0Require0Pre-Authorization0(if0applicable)

To0enjoy0full0benefit0under0Network0Benefit,0you0need0to0obtain0pre-authorization0confirmation0from0us0under0any0one0or0more0of0the0following0situations:

Hospitalization

Minor Operation or Day Case Surgery

Diagnostic X-ray or Laboratory Test

(a)

(b)

(c)

Our Pre-authorization Hotline is available from 9:00AM-5:30PM (Monday to Friday, except Saturday, Sunday and Public Holiday). If pre-authorization is required after our office hours, it can be done within the next working day after the treatment or hospitalization provided that all other requirements are satisfied (e.g. must admit to a network Hospital at or below the room level you are entitled to, referred and attended by a network doctor, etc). In case of hospitalization resulting from medical emergency, same procedure applies.

Pre-authorization is a process to assist you identifying the most cost-effective and appropriate medical ap-proach to treat your illness by Network Service Providers. It also helps to confirm that Benefit is available before rendering the medical services.

Please also note that the entitlement of the Benefit shall be subject to our final assessment after receipt of complete medical information.

If0pre-authorization0is0not0done0as0required,0eligible0medical0expenses0shall0be0paid0under0Non-Net-work0Benefit.0Please0remember0to0obtain0the0completed0Pre-Authorization0Form0from0doctor0after0pre-authorization0confirmation.

Visit any Registered Medical Practitioner who is a network doctor associated with designated Network Service Provider(s) appointed by Your Company (refer to your network doctor list)

You are required to sign on the voucher and keep your copy for record.

If you require consultation from Specialist/ Physiotherapist, you shall be referred to a network Specialist/ Physiotherapist as well, which shall assure you with no Shortfall. You are then required to present referral letter when you visit the Specialist/ Physiotherapist as referred.

You may need to pay co-payment for network doctors’ visits, please refer to the Benefit Schedule for details.

(1)

In0order0to0ensure0there0is0no0Shortfall0for0all0your0eligible0clinical0expenses,0please0read0the0following0steps0carefully0before0seeking0Treatments:

(2)

(3)

(4)

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How0to0ensure0no0Shortfall0for0all0eligible0Clinical0expenses?0(if0applicable)

Attend any one network hospitals which must be referred by a network doctor of designated Network Service Provider appointed by Your Company and Prudential. Please note that not all Network Service Providers may provide network hospitalization treatment referral, you may check the details with Your Company.

For each admission, pre-authorization from us is required. Your Network Doctor shall give you a copy of the pre-authorization confirmation for record.

You are required to sign on the voucher and keep your copy for record.

You have to obtain a Hospital and Surgical Claim Form within ninety (90) days after date of discharge from Hospital and ask your attending doctor to complete the form during your Hospital Confinement.

You are required to submit the completed claim form to us.

(1)

In0order0to0ensure0there0is0no0Shortfall0for0all0your0eligible0Hospital0and0Surgical0expenses,0please0read0the0following0steps0carefully0before0seeking0Treatments:

(2)

(3)

(4)

(5)

240Hours0Emergency0Assistance0Services0Benefit

Emergency Assistance Services are provided by the Inter Partner Assistance Hong Kong Limited (“I.P.A.”). As a benefit to you of this insurance, we indemnify costs chargeable by I.P.A. for the Emergency Assis-tance Services provided by I.P.A. to you if and when they are so provided. For the avoidance of doubt, we are not an agent of I.P.A. for the services and makes no representation warranty or undertaking as to the availability of the I.P.A.’s services. Whether or not the I.P.A.’s services are offered or provided is a matter of absolute discretion of I.P.A., for which we shall accept no responsibility or liability. Nor shall we be responsible or liable for the acts or omission or services of I.P.A.. The provision of services by I.P.A. and/or the acceptance thereof by you shall constitute a contract between I.P.A. and you separate and independent from this insurance.

Description0of0Services0of0I.P.A.If you shall suffer serious Bodily Injury or shall suffer sudden Illness, or is in need of medical legal ad-ministrative emergency assistance outside the Country of Residence (except for the coverage under point 8 which may be obtained locally) while arising out of and in the course of your trip, provided that such trip is not undertaken: - against the advice of the physician and /or - for the purpose of obtaining or seeking any medical or surgical treatment abroadthe following Emergency Assistance Services and Benefit are available directly from I.P.A., upon specific verbal notification by you or your personal representative to I.P.A. Alarm Center. You shall not be entitled to any reimbursement of any such expenses incurred, or paid directly by him/her or your representative from I.P.A..

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Please note that you may need to pay the Shortfall for Hospital and Surgical Benefit if the expenses are illegible after our final assessment. The claims for other eligible expenses shall be held until the Shortfall is paid.

How0to0ensure0no0Shortfall0for0all0eligible0Clinical0expenses?0(if0applicable)

How0to0ensure0no0Shortfall0for0all0eligible0hospitalization0expenses?0(if0applicable)

Medical Attention Telephone Medical Advice Evaluation and Referral AppointmentWhen medical advice is needed, you may telephone I.P.A. Alarm Center for medical advice and evaluation from the attending physician. However it is stressed that telephone conversation shall not constitute a diagnosis, and shall be considered as a recommendation only. If medically neces-sary you shall be referred to another physician or to a medical specialist for personal assessment and I.P.A. shall assist you in making the medical appointment.All physician’s fees and related charges shall be borne entirely and directly by you without any reimbursement from I.P.A..

Essential Medication/Medical EquipmentUpon request from an attending physician located at the place where the injury or Illness is suf-fered by you, I.P.A. shall, when possible and legally permissible, dispatch any essential medicine and/or medical equipment required for you which are not locally available.You shall be responsible for the cost of the items dispatched and any shipping costs, unless they are required for an emergency evaluated by the I.P.A. physician.

Dispatch of PhysicianIn the event of an emergency where either you cannot be adequately assessed by telephone for possible evacuation, or you cannot be moved and local treatment is unavailable, I.P.A. shall send an appropriate medical practitioner to you.

Medical MonitoringI.P.A. shall monitor your condition if hospitalized abroad, and shall keep your employer/family informed.

Medical Evacuation (Unlimited Cover)If you suffer from Bodily Injury or sudden Illness such that I.P.A. medical team and the attend-ing physician recommend hospitalization in a medical facility, where you can be suitably treated, I.P.A. shall arrange and pay for:

(1)

(2)

(3)

(4)

(5)

5.1 the transfer of you into one of the nearest hospital and5.2 if necessary on medical grounds:

the transfer of you with necessary medical supervision by any means (including but not limited to air ambulance, scheduled commercial flight and road ambulance) to a hospital more appropriately equipped for the particular Bodily Injury or sudden Illness or

the direct repatriation including road ambulance transfers to and from the airports of you with necessary medical supervision by scheduled airline, to an appropriate hospital or other health care facility near your Country of Residence, if your medical condition permits such repatriation. The medical team and attending physician shall determine the necessary arrangements according to the circumstances.

(a)

(b)

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Repatriation After Treatment (Unlimited Cover)Following the medical evacuation set out in point (5) above, and if continuation of the medical treatment in the other medical facility is necessary, I.P.A. shall arrange and pay for the repatriation of you to appropriate medical institution in your Country of Residence by scheduled airline flight (on economy class), or any other appropriate means of transportation, including any supplemen-tary cost of transportation to and from the airport if your original ticket is not valid for the purpose, provided that you shall surrender any unused portion of your ticket to I.P.A.. Any decision on the repatriation of you shall be made jointly and exclusively by both the attending physician and I.P.A. Alarm Center under constant medical supervision.

Repatriation of Mortal Remains/Ashes (Unlimited Cover)Upon the death of you, I.P.A. shall make all the necessary arrangements (including any steps or arrangements necessary to meet local formalities) and shall pay for:

(6)

the repatriation of your body or ashes to your place of burial in your Country of Residence or at the request of your heirs or representative, the local burial of you provided that I.P.A. financial responsibility for such local burial shall be limited to the equivalent of the cost of repatriation of mortal remains as provided in this benefit.

(7)

7.1

7.2

Travel InformationYou may contact I.P.A. to obtain the following information and services before starting or during your trip:

(8)

8.1 Update immunizations and vaccinations requirement and needs

8.2 Weather information worldwide

8.3 Airport taxes

8.4 Customs requirements

8.5 Passport and visa requirements

8.6 Consulate and embassies addresses and contact numbers

8.7 Exchange rates

8.8 Banking days

8.9 Language information

8.10 Arrangement of interpreter services

8.11 Arrangement of children escort

8.12 Transmission of urgent messages for medical reasons

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Luggage RetrievalIn the event of loss or misrouting of your luggage by a common carrier, I.P.A. shall liaise with the relevant entities, such as but not limited to airline companies, customs officials, and shall organise the dispatch of such luggage if recovered to such place as you may direct, provided that you bear the costs if any.

(9)

Emergency Rerouting ArrangementsI.P.A. shall assist you in reorganizing your flight schedule should an emergency oblige him/her to alter your original plan.

Administration AssistanceIn case of loss or theft of essential documents or personal identification documents (e.g. passport entry visa etc.), I.P.A. shall provide you with the necessary information regarding the formalities to be fulfilled with the appropriate local authorities or entities in order to obtain the replacement of such lost or stolen documents.

Legal ReferralUpon the request of you, I.P.A. shall provide the telephone number and address of the lawyers and solicitors firms on worldwide basis.

Compassionate VisitIn the event of you suffering from serious Bodily Injury or sudden Illness resulting in hospital confinement outside your Country of Residence for more than seven (7) consecutive days, I.P.A. shall arrange and pay for the cost of a return scheduled airline ticket (on economy class) for a relative or designated person of you, to travel from your Country of Residence to your bedside, including the cost of an ordinary room accommodation in any reasonable hotel up to HK$1,950 per day for a maximum period of four (4) consecutive days, but excluding the cost of drinks, meals and other room services.

Return of Unattended Dependant Child(ren) to Country of ResidenceIf any of your travelling dependent child(ren) up to age eighteen (18), or travelling dependant child(ren) up to age twenty-one (21) if in full time education is left unattended by reason of your serious Bodily Injury or sudden Illness resulting in hospital confinement outside your Country of Residence, I.P.A. shall organise and pay for the cost of a scheduled airline ticket (economy class) for such child(ren) to return to your home in your Country of Residence, including any supple-mentary cost of transportation to and from the airport, if the original ticket is not valid for the return provided that you shall surrender any unused portion of the return ticket to I.P.A..If necessary I.P.A. shall also hire and pay for a qualified attendant to accompany any such depen-dant child(ren) in the return trip.

Unexpected Return to the Country of ResidenceIn the event of the death of your Close Relative in your Country of Residence while you are travel-ling overseas (excluding the case of migration) necessitating an unexpected return to your Coun-try of Residence, I.P.A. shall arrange and pay for the cost of a scheduled airline ticket (economy class) for the return of you.

Deposit Guaranteeing of Hospital AdmissionI.P.A. shall provide guarantee or advance for the deposit of hospital admission for you up to HK$39,000. You shall be required to repay such deposit guaranteed or advanced (as the case may be) within forty-five (45) days (without interest). I.P.A. shall require valid credit authorization prior to advancement of funds for such admission as appropriate.

(10)

(11)

(12)

(13)

(14)

(15)

(16)

-15-

Hotel Room Accommodation for ConvalescenceI.P.A. shall arrange and pay for the cost of an ordinary room accommodation in any reasonable hotel up to HK$1,950 per day for a maximum of four (4) consecutive days incurred by you for the sole purpose of convalescence in the country of hospitalization immediately following your discharge from the hospital, and is deemed medically necessary by both attending physician and I.P.A. physician.

Addition Hospital Benefit after a Medical Evacuation and Repatriation back to Hong Kong If the Benefit payable under Hospital & Surgical Benefits is exhausted, eligible medical expenses for Hospital Confinement in Hong Kong immediately following the repatriation under Part 6 of this Section are covered up to a further $120,000.

(17)

(18)

Limitations0and0Liabilities

Territorial LimitsThe benefit mentioned in the above “Description of Services” apply worldwide outside Country of Residence.

Limitation PeriodEvery Assistance Event in respect of a covered event shall be absolutely barred, unless com-menced within 2 years from the date of occurrence of such event.

Liability of I.P.A.Physicians, hospitals, clinics, any kind of professionals to whom you referred by I.P.A. are inde-pendent contractors, responsible for their own acts and are not employees, agents or servants of I.P.A.. I.P.A. shall ascertain that those professionals have appropriate qualification and are certi-fied by the local authority.Furthermore I.P.A. shall not be responsible for any act or omission on the part of such profession-als as including but not limited to physicians, hospitals and clinics.

(1)

(2)

(3)

General0Obligations0/0Procedures

Request for Assistance In case of an Assistance Event and prior to taking personal action where reasonable, you or your representative shall call I.P.A. Alarm Center in Hong Kong, whose contact number is listed here below:HONG KONG : 2862 0111and should state:

(1)

your name and your I.D. card or passport number and

the name of the place and the telephone number where I.P.A. can reach you or your repre-sentative and

a brief description of the accident and the nature of help required.

1.1

1.2

1.3

-16-

Failure to Notify I.P.A.In a life threatening situation, you or your representative should always try to arrange for emer-gency transfer to a hospital near the place of occurrence through the most appropriate and imme-diate means, and then call appropriate I.P.A. Alarm Center to provide the appropriate information as soon as possible. In the event of repatriation in order to facilitate prompt response, you or your representative shall as far as possible provide:

(2)

the name, address and telephone number of the hospital or other medical facility where you have been attended and

the name, address and telephone number of the attending physician and if necessary the fam-ily doctor of member.

2.1

2.2

I.P.A. medical team or other representatives shall have free access to you in order to assess your condition. Without reasonable justification for denial of such an access, you shall not be eligible for further medical assistance.I.P.A. medical team shall decide on a case by case basis, the date and means of such repatriation on the ground of medical necessity.In the event of repatriation of you by I.P.A., you shall surrender the unused portion of your ticket or the value thereof to I.P.A. to offset the cost of such repatriation.

Exceptions

Excluded CasesI.P.A.’s services are not available in any form or manner to you or your representative with respect to Bodily Injury or sudden Illness of you arising from:

(1)

Pre-existing Illnesses or disabilities for which treatment are received prior to effective date of this insurance except:

1.1

if you have not received medical consultation advice or treatment on account of such disability within three (3) months prior to becoming a member hereunder or

having received such medical consultation advice or treatment upon completion of a period of three (3) months or more, during which you are not under the care of treat-ment of a legally qualified physician

(a)

(b)

Injuries due to insanity or self-infliction, or conditions related to functional disorders of the mind, rest cure or sanatorium care, drug addiction or alcoholism, communicable diseases requiring by law isolation or quarantine

Injuries arising directly or indirectly from war, declared or undeclared, strike, riot, revolution or any warlike operation

Congenital a bnormalities

1.2

1.3

1.4

-17-

Cases of pregnancy, unless unexpected complications arise and in no circumstances where the pregnancy has entered the seventh (7th) month at the commencement of this insurance or at the start of any subsequent trip

Injuries arising directly or indirectly as a result of participation in any professional sports, racing (other than running), mountaineering normally involving the use of ropes or guides, aviation (other than as a fare-paying passenger in a duly certified multi-engined passenger-carrying aircraft flown in the course of licensed operations for the transportation of passen-gers by air, by a properly-licensed crew)

Injuries contracted as a result of participation in illegal acts

Services rendered without the authorization and/or intervention of I.P.A.

Costs which would have been payable if the event giving rise to the intervention of I.P.A. had not occurred

Any expense more specifically covered under any insurance policy, except the insurance policy to which this service cover is attached

Cases of minor Illness or injury which, in the opinion of the I.P.A. physician, can be ad-equately treated locally and which do not prevent you from continuing their travels or work

Expenses incurred where you, in the opinion of the I.P.A. physician, are physically able to return to your Country of Residence sitting as a normal passenger and without medical escort unless deemed necessary by the I.P.A. physician

Cases related to psychiatric disorders

You exercising any form of hazardous work in connection with any business, trade or profes-sion

Any consequence or loss which is a direct result of nuclear reaction or radiation.

1.6

1.7

1.8

1.9

1.10

1.11

1.12

1.13

1.14

1.15

Force MajeureI.P.A. shall not accept responsibility for delays or failures in providing assistance caused by any strike, war, invasion act of foreign enemies, armed hostilities (regardless of a formal declaration of war), civil war, rebellion insurrection, terrorism, political coup, riot and civil commotion ad-ministrative or political impediments or radioactivity or any other event of force majeure which prevents I.P.A. from providing such assistance services.

-18-

1.5

Definitions

“Assistance Event”

“Bodily Injury”

“Country of Residence”

“Close Relative”

“Dollar”

“Illness”

-19-

Shall mean any event or occurrence with respect to a member who may receive assistance from I.P.A. in accordance with the insurance occurring within the territorial limits set forth in “Limitations and Li-abilities”.

Shall mean any unforeseen Bodily Injury caused solely and directly by violent, accidental, external and visible means occurring during the period covered by this insurance.

Shall mean that country in which you have your permanent home and as shown on your passport. Immediate family members assume the nationality of you for the purposes of this cover. In the event of dual nationality you must elect only one nationality for the purposes of this cover.

Shall mean the spouse, the child(ren) up to age eighteen (18) or child(ren) up to age twenty-one (21) if in full time education, the brother, the sister, the father, the mother of you.

Shall mean the lawful currency of Hong Kong.

Shall mean any unforeseen Illness or disease first manifested after the effective date of this insurance.

General0Provisions

What0shall0the0Insurance0cost?Your Company has always regarded the welfare of its employees as a paramount importance and shall pay for the full cost of this insurance.

0Changes0in0coverageIf the eligible level of Benefit has been changed, your coverage shall be adjusted automatically on such date the change becomes effective.

What0shall0happen0if0you0require0medical0Treatment0abroad?If you require Emergency Treatment abroad, it shall be necessary for you to pay your bills up front and obtain the original receipts for claim reimbursement from us within ninety (90) days after clinical visit or discharge from Hospital. Bills rendered in any currency other than Hong Kong Dollars shall be converted to Hong Kong Dollars on the basis of the quoted exchange rate in effect on the date of clinical visit or date of discharge in case of hospitalization, or if no such official rate exists, at the rate certified as appropriate by our bankers for the time being.

These arrangements apply whether the visit abroad is in respect of business or holiday travel.

What0shall0happen0if0you0leave0Your0Company?If you leave Your Company for any reason, the coverage to you and your dependants (if applicable) under this insurance shall cease on the date the termination of employment is effective. The member-ship card should return to us by Human Resources Department of Your Company within seven (7) days after it becomes invalid.

I.

II.

III.

IV.

-20-

-21-

目錄

前言 ---------------------------------------------------------------------------------------------

會員 ---------------------------------------------------------------------------------------------- I. 何時及甚麼人可享有保障？

保障 ---------------------------------------------------------------------------------------------- I. 住院及手術保障

II. 住院�加醫療保障

III. 門診保障

索償 --------------------------------------------------------------------------------------------- I. 索償程序

II. 需要轉介信的治療

不受保障項目 -----------------------------------------------------------------------------------

辭彙解釋 ----------------------------------------------------------------------------------------

需要進行預先批核的情況 -------------------------------------------------------------------

如何確保不用支付門診費用的差額？ -----------------------------------------------------

如何確保不用支付住院及手術費用的差額？ --------------------------------------------

24小時緊急支援服務保障 -------------------------------------------------------------------

一般事項 ---------------------------------------------------------------------------------------- I. 是項保險的收費？

II. 保障項目的更改

III. 若身處海外，如何安排接受醫療診治？

IV. 若您離職，如何安排？

22

22

23

24

26

29

32

32

33

33

39

-22-

何時及甚麼人可享有保障？如您是受僱於公司的合資格�職僱員（或試用期滿後，如適用），您將獲得本保險中的保障。但假若您在保障生效當日生病或不能�職工作，則受保日期將由您健康地返回工作崗位之日起開始生效。

前言

保誠財險有限公司（「保誠」）Prudential plc＊為國際性金融服務集團，主要業務位於亞洲、美國及英國。截至2013年6月30日，集團為約2,300萬名保險客戶提供服務及管理資產達4,270億英鎊。Prudential plc於香港、倫敦、紐約及新加坡證券交易所上市。

英國保誠自1964年起為香港市民提供服務。透過保誠保險有限公司及保誠財險有限公司，我們提供多元化的理財策劃服務及產品，包括人壽保險、投資相連保險、退休方案、健康及醫療保障、一般保險及僱員福利。

如要獲得更多資訊，請瀏覽www.prudential.com.hk。

我們提供多種團體醫療保障，僱主可選擇為僱員投保住院及手術保障、門診保障及其他相關僱員福利的保障，令其僱員及其家人隨時隨地得到周�的照顧，使他們更無後顧之憂地努力為公司業務工作。

請詳細閱讀本手冊，以瞭解為您提供的所有保障。此亦協助保誠，在您真正有需要時，提供快捷妥善的醫療保障服務。

本手冊只供參考之用。若中、英版有任何差異，概以英文為準。如會員手冊與僱主的保單有異，概以後者為準。

會員資格

Prudential plc與業務範圍主要在美國的美國保德信金融集團 (Prudential Financial, Inc.) 並沒有任何關係。

*

當您成為此保險的會員，便可開始獲得保障。但如果您在保障生效日期時正在醫院留醫，或在保障生效日期前就所發生之任何情況而需入院留醫時，則就有關醫院留醫便不能獲得保障。另外，除非在保障金額表明確列明，以下均為�球保障。詳情請參閱保障金額表。

I. 住院及手術保障 項目A. 基本保障

當需要入院時，您可獲得住房及膳食費用保障（包括住宿、膳食及一般看護），惟有關賠償不會超過保障金額表中所列的上限。若屬住院情況，您必須於出院前整個階段連續留院，而就該住院亦有收取住房及膳食或深切治療費用。

住院雜項（包括X光片、其他診斷程序、藥物、救護車及輸血）將在此保障下獲得支付。

深切治療保障將支付您經註冊醫生建議下入住醫院的深切治療部所需的費用，惟有關賠償不會超過保障金額表中所列的上限。

假如您在註冊醫生的建議下，需要接受合資格護士的特別看護，在不超過保障金額表中所列的上限前提下，有關賠償將會獲得支付。

外科醫生費用（及因外科手術而引起的註冊醫生巡房費用）、麻醉科醫生費用及手術室租金，均按保障金額表中所列支付。

住院治療醫生費用一項*支付因非外科手術而引起的巡房費用，惟有關賠償不會超過保障金額表中所列的上限。

住院專科醫生費用一項支付住院期間專科醫生提供專科意見時所收取的費用，惟有關賠償不會超過保障金額表中所列的上限。

入院前及出院後之門診護理*，包括支付：

一次入院前與住院有關的門診費用，

出院後六(6)星期內所有醫療必須而與住院治療有關的門診費用，包括診症、藥物或由註冊醫生建議下的診斷性檢查*，惟有關診治、藥物及檢查必須直接與引致住院的傷病有關。

(a)

(b)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

保障

項目B： 住院現金保障

假若您入住香港醫院管理局轄下醫院的大房病床接受註冊醫生專業診治，並在項目A.(1)獲得保障，此項保障將由保障金額表中所列明的日數起開始支付，惟有關賠償不會超過保障金額表中所列日數的上限。

-23-

項目C. 24小時緊急支援服務保障

24小時緊急支援服務保障乃由國際救援（亞洲）公司提供。若您在原居地以外地方，在旅途中遇上嚴重的身體損傷或患上急性疾病；或期間需要醫療、法律、行程安排的緊急服務，均可獲得支援。欲了解詳情，請參閱33頁有關24小時緊急支援服務保障的部份。

I. 索償程序

住院及手術保障索償

(1)

(2)

(3)

索償

透過您公司的人事部或保誠索取一份住院及手術索償申請表。

在您住院期間，請您的主診註冊醫生填妥住院及手術費索償申請表及註明診斷。

將填妥的索償申請表連同所有收據正本、項目清單及轉介信（如適用），一併交予您公司人事部，以便再轉交保誠處理。所有收據正本必須具有主診醫生簽名，並清楚顯示診治日期、治療內容、病人姓名、費用、診斷及手術之描述。

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II. 住院�加醫療保障*

本項目將支付有關住院在I.項目A之賠償金額耗盡後之額外住院費用，惟有關賠償不會超過保障金額表中所列的上限。除非因香港境外發生的醫療緊急事故而直接導致境外住院，否則您只能就香港境內之住院獲得保障。另外我們亦不會就住院等級相等於總統套房/貴賓房/豪華房的住院支付任何賠償。賠償方式將根據以下方法計算：

III. 門診保障*

假如您因意外而身體受傷或生病，而必須於註冊醫生的診所接受診治，此項保障將會支付您有關診治、注射、所提供的藥物、化驗及進行診斷性X光檢驗等費用。有關保障詳情，請參閱保障金額表。

若新會員於保單年度中期加入此計劃，其個別門診保障項目的總診症次數及�年總診症次數會因應會員參加日數於該保單年度按比例調整。

* 當選擇不同計劃，保障各有不同，並以保障金額表所顯示作準。

可索償的醫療費用及於住院期間的實際開支

減已由I .項目A保障下獲得之賠償

乘 乘保障金額表中所列之賠償比率

適用的調整值

如您所使用的住院設施及服務之等級超越您於本保單所保障，賠償準則會按以下調整值調整，然後才根據有關比率計算賠償金額：

保障等級半私家病房大房病床大房病床

選擇住院等級私家病房半私家病房私家病房

調整值50%50%25%

會員咭的使用

您只需在以下地方，簡單地出示會員咭，便可支付合資格的費用：

(1)

(2)

列於網絡醫生名單中醫療設施；或

在香港的網絡醫院（門診部門除外）（如適用）

會員咭只可由您自己（本人）使用及不得轉讓。若保單連續續保，此會員咭仍繼續有效，我們亦不會在續保時再發新咭。若有遺失、損毀或因轉換個人資料而更換會員咭，需付港幣100元手續費。

熱線服務

如欲查詢有關此計劃資料，請致電保誠客戶服務熱線：3656 8362。

II. 需轉介信的治療

專科醫生的治療

診斷性X光檢驗及化驗保障

物理治療師及整脊治療師的治療

醫生轉介信在發出日起計六(6)個月內，在診治與轉介信相同或相關的病症時均為有效。

(1)

(2)

(3)

-25-

(4)

(5)

門診保障索償

若有關門診索償，是由於並未有使用會員咭而產生，您應該：

(1)

(2)

(3)

(4)

(5)

向您公司人事部或保誠索取一份門診索償申請表。

請填妥申請表上所有資料包括有關診斷。

將填妥的索償申請表連同所有收據正本、項目清單及由網絡或非網絡的註冊醫生簽發的轉介信（適用於顯示於您的保障金額表內之保障，包括專科醫生治療、物理治療、整脊治療或診斷性X光及保障），一併呈交予您公司人事部，以便再轉交保誠處理。所有收據正本必須清楚顯示求診日期、病人姓名、診斷及列明每項費用。

所有門診索償申請須於求診後九十(90)天內交予保誠，否則有關索償不獲處理。

賠償將以港元透過自動轉賬或支票支付。

所有住院索償申請，必須於出院後九十(90)天內呈交予保誠，否則有關索償不獲處理。

賠償將以港元透過自動轉賬或支票支付。

濫用藥物或酒精／自殘 濫用藥物或酒精、蓄意自傷身體或意圖自�。

在投保保單後之首五(5)年內，因人體缺乏免疫力過濾性病毒感染所引起或導致之治療；或與性病或其後發病有關之治療。有關人體缺乏免疫力過濾性病毒感染投保後首五(5)年的要求，在參加額外保障時將獨立計算。

另�治療包括但不限於跌打、針灸、指壓、推拿、催眠、羅爾夫治療、按摩治療及香薰治療，除在保障金額表中列明。

從事或參與海軍、陸軍或空軍任務或任何武裝部隊之行動；或任何�形之專業運動。

血液及血漿的收費。

購買或使用特別支架、器材及植入體內儀器，包括但不限於人工髖關節或膝關節、心臟起膊器、植入眼內晶體、眼鏡、助聽器、引流條或導管、輪椅、柺杖或其他設備的費用。

於保障金額表中所述及適用的墊底費*。

有關先天性之症狀、發育上異常之症狀、或遺傳性之症狀的治療

參予犯罪活動而引致之身體損傷或疾病。

牙科或口部的外科治療(除保障金額表中列明已選擇額外牙齒保健保障*)，惟由意外引致之緊急住院治療則屬例外。但不包括就有關住院的跟進治療。

關於整容、聽覺測驗、例行驗血或一般檢驗(除保障金額表中列明已選擇額外健康檢查保障*)、預防注射或接種疫苗、及因視力不正常而引致之治療，包括例行視力測驗或所需之眼鏡或鏡片費用。

1.

2.

3.

4.

5.

6.

7.

8.

9.

不受保障項目

愛�病／性病

另�治療

武裝部隊／專業運動

血液／血漿

特殊器具或支架之費用

墊底費

先天之症狀／發育上異常之症狀／遺傳性之症狀

犯罪活動

請注意黑色粗黑體寫的詞彙在本團體醫療保單中帶有特定的含意。

10. 牙科治療／口腔外科手術

選擇性的診療項目11.

-26-

任何已在政府法例下或其他醫療保險計劃內，獲賠償之身體損傷或疾病，除非此等治療費用未能在該政府法例或其他醫療保險計劃內獲得賠償。

所有未經我們批准之實驗及最新治療法/程序。

不是醫療必須的治療或檢驗，包括但不限於純粹因斷症之掃描、X光化驗、或物理治療的住院，及/或並非由註冊醫生執行的治療。

非醫療性服務，例如陪床、收音機、電話、影印、醫療報告、或任何稅項之費用。

已存在的疾病或身體損傷，並於會員保障生效日期前六(6)個月或會員保障生效日期後三(3)個月已接受診症、查診或治療。

與產科有關的治療，包括診斷性產科檢查；或導致生育、墮胎或小產；或與男女任何一方的節育有關的治療費用，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。

由於任何老年病、心理病、老年精神病、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、亞爾茲默氏病、帕金森氏病。

與不正常性機能有關而引起或導致的治療，包括但不限於陽萎、不舉及早洩（不論任何原因導致）。

因腎機能衰退而引致之輔助性治療，包括洗腎。

在水療中心、天然治療中心、康復院、療養院、老人院或�似機構所提供之住宿、護理或服務的費用。

12. 由第三者繳付的費用

13. 實驗性及／或新式醫療治療法／程序

14. 不是醫療必須的治療

15. 非醫療性服務

16. 已存在之疾病

17. 懷孕／節育或絕育／人工受孕

18. 精神問題

19. 性機能障礙

20. 腎機能衰退之輔助性治療

21. 在未合醫院定義的治療

-27-

因以下的任何一項直接或間接引起、導致或關連的任何�形之損失、損毀、費用或開支，即使當中有其他原因或事件，同時促使或先後發生而導致損失。

22. 戰爭或恐怖主義活動

戰爭、入侵、外敵行動、敵對或�似戰爭的行動（無論是否已宣戰）、內戰、暴動、革命、叛亂、嚴重程度�近叛亂的民亂、軍事或篡權行動；或

任何恐怖主義活動

「恐怖主義活動」在本不受保障項目的定義為：

任何人士或人士們，無論單獨、代表或連繫於任何機構組織或政府，以政治、宗教、意識型態或其他�似原因，包括以意圖影響政府及／或令公眾及／或部份公眾恐慌為目的之行事，有關行為包括但不限於使用武力或暴力及／或帶有威脅成份的活動。

此不受保障項目對直接或間接用於控制、防止、鎮壓或以任何方式而與上述(a)及/或(b)有關的損失、損毀、費用或開支，均不予賠償。

若我們宣稱因此不受保障項目而對任何損失、損毀、費用或開支不予賠償，提出相反證明之責任將需由您或您公司負責。

若此不受保障項目的任何部份被發現無效或不可實施時，其餘部份將仍�面實行及有效。

(a)

(b)

* 當選擇不同計劃，保障各有不同，並以保障金額表所顯示作準。

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辭彙解釋

指於保單承保表，當中並會不時更新以顯示保障項目及保障金額，包括本保險簽發時的保障金額表及其後其他保單承保表。

跌打醫師

指運用傳統中醫方法，治療關節及使用中草藥治療法的中醫師，及

· 如執業區域之法例規定中醫師註冊，其必須依照當地法例註冊；或

· 如執業區域之法例沒有規定中醫師註冊，其報業必須為當地政府授權或為該區域公會認可提供草本治療及一般治療。

中醫師

指依照接受治療區域之法例註冊，或領有執業證明可提供中醫治療之醫務人員，其最低資歷限度相當於香港中醫藥條例的註冊或表列的中醫。

整脊治療師

必須在香港特別行政區、美國、英聯邦國家或歐洲共同體註冊或領有執業證明。若保障金額表上有訂明此項，方可獲提供保障。

會員保障生效日期

· 就僱員方面來說，是指於申請表中或任何其後的團體保單修訂書中所釐定的日期；和

· 就僱員家屬方面來說，是指僱員保障生效日期，或該家屬正式成為合乎會員定義的僱員之家屬的日期，以較後的日期為準。

先天性之症狀

指於出生時已存在及於出生後六(6)個月內形成之不正常症狀。這包括但不限於任何�形的疝、斜視、腦積水、睪丸未降、美克爾氏憩室。

發育異常之症狀

指與同齡或同發育階段者比較後，過早或過遲的發育情況。這些於十八(18)歲前出現的傷害或殘障預期會無限期延續下去及造成實質上的傷害。這亦包括生物或非生物因素在內而引起的擾亂情況。

傷病

指身體損傷或疾病，並由同一原因而引起的所有傷病，包括任何及所有自此及延續至下一次續保時的併發症，除非有關傷病是在最後出院日期的九十(90)日後發生，或在接受最後一次查診或醫治後無須再為同一傷病醫治的九十(90)日後發生（上述兩者以較後者為準）；其後，由同一原因引起的傷病則作個別傷病論。

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保障金額表

普通科醫生

指在門診保障中，其資歷相當於香港醫生註冊條例註冊的普通科醫生（但不包括您本人、您親屬、家庭成員及商業伙伴）。

遺傳性之症狀

指由父母遺傳給子女的醫學情況。

醫院

指向支付病床費形式就診的患病及受傷人士，提供照料及治療的機構，而該機構是依照接受治療區域之法例認可、建立及註冊為醫院，並(i)設有進行診斷及大手術的設備，(ii)由合資格護士提供每日二十四(24)小時的護理服務，及(iii)由註冊醫生給予定時的照料及診治。

緊急

指在急病情況而沒有事先安排的住院，而所有有關此情況之病徵、診斷或治療均須相距不超過二十四(24)小時以上。

住院

指住院病人因醫療必須情況下由註冊醫生轉介入院。您於出院前必須在整個階段內連續留院，而該醫院有收取住房及膳食費費用，或深切治療費用。

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醫療必須

指有接受醫療服務的必要，有關服務須

· 符合病情的診斷及就有關情況給予慣常的治療；及

· 令就診者回復健康、或令其康復後離開醫療設施最適當及最有效的治療方法；及

· 非純為了方便您或註冊醫生而提供的；及

· 就您的病徵或病情，在不入住醫院的情況下難以安�地進行。

會員

指受到本團體醫療保單保障的僱員及其家屬（如適用）。

正常及慣常費用

關於收費方面，指該費用的總額不應超過在�似情況下，其他有相等專業資格及經驗的醫護人員所收之合理和平均費用。關於物料及服務方面，指該費用的總額不應超過在相同質量及經濟環境下，其他�似物料或服務之合理和平均的費用。

物理治療師

必須依照接受治療區域之法例已正式註冊或領有執業證明。若保障金額表上有訂明此項，方可獲提供保障。

合資格護士

指依照接受治療區域之法例已合法領有資格提供看護服務之護士（但不包括您本人、您親屬、家庭成員及商業伙伴），其最低資歷限度相當於香港護士註冊條例的註冊護士或登記護士。

註冊醫生

指依照接受治療區域之法例註冊，或領有執業證明提供醫療及手術服務之醫生（但不包括您本人、您親屬、家庭成員及商業伙伴），其最低資歷限度相當於香港醫生註冊條例的註冊醫生。

差額

指由某人以會員咭繳付非本保單保障範圍的服務所引起的費用。

專科醫生

指依照接受治療區域之法例正式註冊，或領有執業證明的註冊醫生（但不包括您本人、您親屬、家庭成員及商業伙伴），而該註冊醫生過去曾或現時仍在醫院擔任顧問醫生職位，或�似更高職位。

治療

指外科或內科療程，其目的旨在醫治或緩和身體損傷或緊急疾病。

您公司

指您受聘工作的公司。

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已存在病症

指受保會員於會員保障生效日期前，已形成的身體損傷或疾病，並於會員保障生效日期前六(6)個月或保障生效後三(3)個月內接受診症、查診或治療。

若要享有網絡保障下之�數賠償，您必須根據以下一個或多個情況，取得我們的預先

批核：

需要進行預先批核的情況（如適用）

(a) 住院

(b) 小型手術或日症手術

(c) 診斷性X-光檢驗或化驗

(1)

(2)

(3)

(4)

您可在上午9時至下午5時30分（星期一至五，星期六、日及公眾假期除外），致電我們的預先批核熱線。若需於辦公時間後進行預先批核，可於治療或住院後下一個工作日補辦，惟必須符合所有其他條件（例：必須入住網絡醫院及跟其病房�型需在所屬保障等級或以下就醫、並由網絡醫生轉介及診治等)。此手續亦同時適用因醫療緊急事故所引致的住院。

透過預先批核過程，您可經網絡服務提供者接受最有經濟效益及最適當的治理。此預先批核亦能幫助您在接受醫療服務前確定保障。

請注意，此保障獲得與否，須在我們收到有關醫療報告後作最後的批核為準。

為確保您無須支付門診費用的差額，請於尋求治療前小心閱讀以下各步驟︰

如何確保不用支付門診費用的差額？（如適用）

於任何一間由您公司指定之網絡服務供應商並被介定為網絡醫生的註冊醫生求診（請參閱網絡醫生名單）

您須在收據上簽署及保留您的副本以作存錄。

假若您需要接受專科醫生／物理治療師診治，您將被轉介至網絡的專科醫生／物理治療師，而有關安排可以確保您不用支付差額。於轉介專科醫生／物理治療師求診時，您須出示醫生轉介信。

您可能需要在網絡醫生求診時支付墊底費，詳細請參閱保障金額表。

若未有依以上規定完成預先批核，合資格的醫療費用將跟據非網絡保障作出賠償。如

預先批核已被確認，請謹記向您的網絡醫生拿取已填妥的預先批核申請表。

-32-

(1)

(2)

(3)

為確保您無須支付住院及手術費用的差額，請於尋求治療前小心閱讀以下各步驟︰

如何確保不用支付住院費用的差額？（如適用）

入住任何一間網絡醫院，並須由您公司及本公司指定之網絡服務供應商提供之網絡醫生轉介。請留意並非所有網絡服務供應商會提供網絡住院治療轉介 ，請向您的公司查詢詳請。

每次入院前，必須預先獲得我們的批核。您的網絡醫生會將批核確認副本給您以作存錄。

您須在收據上簽署及保留您的副本以作存錄。

在您在住院期間，要求主診醫生填寫住院及手術索償申請表，並於您出院後九十(90)天內取得申請表。

將填妥的索償申請表交予我們。

(4)

(5)

請注意，若您的醫療費用最終被批核為不合資格，您可能需要支付住院及手術費用的差額。其他合資格的醫療費將在支付差額後始會賠付。

24小時緊急支援服務保障

緊急支援服務乃由國際救援（亞洲）公司（以下簡稱I.P.A.）提供。本公司為本保險您提供保障，安排I.P.A.向您提供緊急支援服務（若或當已提供），本公司負責安排有關所需的費用。為免混淆，本公司並非I.P.A.的代理人，並就I.P.A.的服務之可獲性，沒作任何陳述、保證或承諾。I.P.A.提供該等服務與否乃I.P.A.的絕對決定權力，本公司就此將不接受任何責任。同時，本公司亦將無須就I.P.A.的行為或失當負上任何責任。I.P.A.服務的提供及／或您對其服務之接受將構成I.P.A.與您所訂立的合約，與此保險計劃，乃獨立而互不關連。

您如在原居地以外地方開展旅程，遇上嚴重的身體損傷或患上急性疾病；或期間需要醫療、法律、行程安排的緊急服務（您可於原居地，獲得第(8)點所述的旅遊資料諮詢服務則除外），而該旅程

— 並非在違反醫生的勸告下進行或／及

— 並非為接受或尋求任何國外的醫療或手術治療而開展

則您或其個人代表可致電I.P.A.救援中心，要求提供下述緊急支援服務。由於所有有關費用需由I.P.A.直接支付，故任何由您或其個人代表自行支付的費用，將不獲發還。

I.P.A.支援服務介紹

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(1) 電話醫療查詢、建議、評估、轉介及約見當需要醫療建議時，您可致電I.P.A.救援中心，向中心內的當值醫生索取醫療建議及評估；惟必須強調，該電話對話只屬建議性，並不能視作對您的診斷。您亦可就醫療需要，經由I.P.A.轉介及協助，約見其他醫生或專科醫生，以獲取其個人的醫療評估。但所有有關醫生費用及治療費用，I.P.A.一概不負責，一切費用需由您自行直接支付。

(3) 派遣醫生

在發生緊急情況時，您身處的地方，並無足夠的通訊設備，以致I.P.A.未能透過電話聯絡您，及向您作出評估，或您的情況並不適宜運送，或當地並無所需的醫療設備時，I.P.A.將派遣適合的醫療人員到達您身處的地方。

醫療監察 如您在外地入院留醫時，I.P.A.將監察您的病況及向其僱主／家人匯報。

醫療救援（無保障額限制） 若您身體損傷或患有急性疾病，在I.P.A.醫療隊伍及當地駐診醫生的共同建議下，需入住醫療設施以接受適當的治療時，I.P.A.將安排及支付：

(4)

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5.1 運送您到就近醫院，及5.2 在醫學角度認為有需要時

利用一切方法（包括但不限於利用救護飛機、固定班次的商務客機及救傷車），就您的個別身體損傷或急性疾病情況，由所需醫護人員的陪同下，運送您前往更合適的醫院就醫。

若您醫療狀況許可下，由所需醫護人員陪同，利用固定航班及救傷車，直接將您運送到其原居地就近的醫院或醫療護理設施接受治療，I.P.A.醫療隊伍及當地駐診醫生將就當時環境，決定如何安排運送工作。

(a)

(b)

(6) 治療後的護送服務（無保障額限制） 根據上文第(5)點所述之醫療救援後，倘若您仍需前往其原居地的醫療機構繼續接受治療，當原先所持有的機票並未能用於護送您回原居地時，I.P.A.救援中心及當地駐診醫生將共同決定及安排您，在持續醫療監控下，乘坐固定航班的客機（經濟客位）及其他合適的交通工具，返回原居地，一切護送回原居地的費用，包括往返機場的�加費用，均由I.P.A.支付，惟您須將原有而未被使用的機票，退回I.P.A.處理。

運送遺體／骨灰回原居地（無保障額限制） 如您死亡，I.P.A.將安排（包括到當地政府部門辦理手續）：

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及支付運送您的遺體或骨灰返回其原居地下葬處的費用，或

應您的繼承人或其代表要求，支付您於身處地方下葬的費用，惟該費用不得超逾運送您遺體返回原居地的費用。

7.1

7.2

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(2) 所需藥物／醫療設備 在可行及符合當地法律的情況下，I.P.A.應您受身體損傷或患急性疾病之當地駐診醫生的要求，可提供必需而當地缺乏的藥物及／或醫療設備予您。惟您須負責該藥物／醫療設備的費用及其運費，I.P.A.醫生在評估緊急情況下所需的藥物或／及醫療設備則除外。

旅遊資料您可在旅程前或旅程期間聯絡I.P.A.以便獲得以下資料：

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8.1 最新的免疫及防疫規定需要

8.2 世界各地天氣

8.3 機場稅

8.4 海關條例

8.5 護照／簽證要求

8.6 領事館／大使館的地址及聯絡電話

8.7 貨幣對換率

8.8 銀行工作日

8.9 當地語言資料

8.10 安排翻譯員服務

8.11 安排護送小童回國

8.12 因醫療原故轉遞緊急訊息

代尋行李服務

如航空公司遺失或誤送您的行李，I.P.A.可代為向有關機構，包括但不限於航空公司、海關及政府機構查詢代尋，若尋回行李，I.P.A.可將行李轉送到您指定的地方，惟轉送費用需由您自行負責。

更改行程的緊急安排

若您遇緊急事故，需更改原先行程，I.P.A.將協助您重新安排所乘坐的飛機班次。

行政協助

當您所需的文件或個人證件（如護照、簽證等）遺失或遭盜竊，I.P.A.將向您提供資料，當中包括向當地合適部門或公司補辦手續資料，以便您補辦所遺失或遭盜竊的證件。

法律轉介

應您要求，I.P.A.可提供�球律師及律師行的地址及電話。

親友探病費用

若您在原居地以外地方，因嚴重的身體損傷或患上急性疾病，住院連續七(7)天以上，I.P.A.將安排您一名家屬或指定人士，由您的原居地乘坐固定航班的客機（經濟客位）前往探望您，並代其支付來回機票及合理酒店普通房間的住宿費。惟I.P.A.只支付最長連續四天，每天不超逾港幣1,950元的酒店住宿費，其間親友的膳食費及額外房間服務費，I.P.A.一概不負責。

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(12)

(13)

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護送隨行受供養而未能照護的子女返回原居地

若您在原居地以外地方，因嚴重的身體損傷或患上急性疾病而住院，遺下同行而未滿十八(18)歲受供養的子女，或遺下同行而就讀�日制學校未滿二十一(21)歲受供養的子女，未能照護，而當其子女的回程機票失效時，I.P.A.將安排該名（或多名）子女乘坐固定航班的客機（經濟客位）返回原居地，及支付有關機票費用，包括往返機場的�加交通費。惟您須將其子女所持有而未被使用的機票，退回I.P.A.處理。如有需要，I.P.A.亦會聘請合資格人士，陪同您的子女，返回原居地。

安排緊急返回原居地

當您（移民者除外）外遊，獲悉在其原居地的親人身故，須立即折返其原居地時，I.P.A.將安排您乘坐固定航班的客機（經濟客位），返回原居地，並支付有關的機票費用。

住院按金保證

當您入住醫院時，I.P.A.可保證或提供以港幣39,000元為上限的住院按金。惟您須在四十五(45)

天內，償還該保證或所提供的款項（但無須繳付利息）。I.P.A.有權在替您支付保證金以便入住合適醫院前，要求索取有效的信用保證。

出院後療養住宿

如I.P.A.醫生及當地駐診醫生的意見，均認為您在出院後，需要時間康復，I.P.A.可安排及支付連續四(4)天，每天不超逾港幣1,950元合理酒店普通房間的住宿費，以便您入住該國的酒店療養。

醫療護送回港服務後的住院保障

若住院及手術保障已耗盡，並根據此條款內第6章之「治療後的護送服務」返回香港後並即時入院，一切合資格之住院費用將額外賠償至最高達港幣120,000。

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(15)

(16)

(17)

(18)

地區限制您在原居地以外地方，均可獲得上述「支援服務介紹」所提及的支援服務。

有效期 當意外事故發生逾兩年時，I.P.A.將終止受保緊急情況下所需的支援服務。

I.P.A.的責任 獲I.P.A.轉介的醫生、醫院及診所、及任何專業人士，均非I.P.A.的職員、代理或僱員；這些醫生、醫院及診所、及任何專業人士乃獨立而需對自己所作的行為負責。在轉介前，I.P.A.將查核這些醫生、醫院及診所、及任何專業人士是否具備合適資格，並確實其獲當地政府認可。這些專業人士、醫生、診所及醫院的活動與失當行為，I.P.A.一概不負責（並無限制）。

限制及責任

(1)

(2)

(3)

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提出協助需要遇緊急情況，您或其代表，在作出任何個人行動前，應先致電回香港予I.P.A.救援中心，電話28620111，並向中心說出

一般責任／程序

(1)

1.1 您的姓名、身份證或護照號碼，及

1.2 您／或其個人代表所處地方及I.P.A.可聯絡您或其代表的電話號碼，及

1.3 簡述意外經過及所需的援助。

若未能聯絡I.P.A.在生命受威脅時，應用妥當而快捷方法，將您送往就近醫院，及在到達醫院後，設法聯絡I.P.A.救援中心。為了儘快提供護送服務，您或其代表應告知 I.P.A.：

I.P.A.醫療隊伍或代表有權前往接觸您，以便評估您的狀況。若在未有合理原因的情況下，拒絕I.P.A.醫療隊伍或代表接觸您，您將失去繼續享有醫療支援服務的資格。 I.P.A.醫療隊伍將基於醫療需要，就個別您的身體醫療狀況，決定何時及用何種方法護送您。 當I.P.A.決定護送您後，您須將未使用的機票及其票值，退回I.P.A.，用以抵銷護送您所支出的費用。

(2)

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2.1 您所入住醫院或醫療機構設施的名稱、地址及電話號碼，及

2.2 當地駐診醫生及您的家庭醫生（如有必要）的姓名、地址及電話號碼。

1.1 在本保險生效前，已存在並正接受治療的疾病或殘疾，但以下情況則除外：

(a) 在成為會員前三(3)個月內，已存在但並無接受醫生診治、建議或治療的疾病或殘疾，或

您就已存在的疾病或殘疾已曾接受醫療診斷、建議或治療，但在過往至少三(3)個月，並無接受合法合資格醫生的治療。

(b)

1.2 因神智混亂、蓄意自傷、意志機能失控、長期休養或療養，濫用酒精或藥物，及患有可傳染而根據法例需隔離的疾病所引致的損傷。

直接或間接由戰爭活動（無論是否已提出宣戰），參與罷工、暴亂、革命或任何戰爭�型活動而引致的損傷。

先天性的不正常。

與懷孕有關的個案，除非由此而引發不能預期的併發症。惟本保險生效日起或及後旅程的首天，您已懷孕七(7)個月或以上。

損傷是由於直接或間接參與任何職業比賽的活動，或由競步以外的競賽、輔以繩索或由響導帶領的登山活動、飛行活動（以持票乘客身份，乘坐已獲註冊及由合資格領牌人員操控的多引擊客機則除外）而引起。

由於參與非法活動所引致的損傷。

I.P.A.並未授權及／或介入的服務。

即使I.P.A.所介入的事件並沒有發生，您仍需支付的費用。

除提供本服務的保險保單外，任何由其他保險專用承保的費用。

根據I.P.A.醫生的意見，該疾病或損傷只屬輕微，及能在當地獲妥當的治療後，您可繼續上路或返回工作崗位。

如I.P.A.醫生認為您在無醫護人員陪同下，仍能夠乘坐普通航班返回原居地，I.P.A.將不負責其所支出的費用，惟I.P.A.醫生如視該費用為必要支出時則除外。

一切與精神錯亂有關的個案。

您在從事任何與商業、貿易或職業活動有關的危險工作。

因核子反應或輻射禍害所直接引致的損失或其他後果。

1.3

1.4

1.5

1.6

1.7

1.8

1.9

1.10

1.11

1.12

1.13

1.14

1.15

(2) 難以預測的情況

由於罷工、戰爭、入侵、外敵活動、武裝敵對活動（無論是否已正式提出宣戰）、內戰、暴動、起義、恐怖主義、政變、騷亂及內亂、行政或政治幹預、輻射禍害或其他任何難以預測的情況，導致I.P.A.未能提供或延遲提供支援服務，I.P.A.將不會因此負上責任。

不受保障的情況 您若因下列情況，導致身體損傷或患上急性疾病，I.P.A.將不提供緊急支援服務。

不保項目

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「緊急情況」 意指在「限制與責任」一項中的地區限制下，您根據本保險可能獲得由I.P.A提供支援服務的事件。

意指您因暴力、意外、外來因素及可見的原因所直接而單獨引致不能預見的身體傷害。

意指您永久住宅所處的國家，此應與您護照內所示的相同。根據本保障，您直系家屬的國籍，將被視作與您相同。若出現雙重國籍時，您須根據本保障選擇以其中一個國籍作其主要原居地。

意指您的配偶、未滿十八(18)歲的子女，或就讀�日制學校未滿二十一(21)歲的子女，父母及兄弟姊妹。

意指香港合法通用的貨幣。

意指本保險生效後，患有不可預見而首度出現的疾病。

「身體損傷」

「原居地」

「親人」

「元」

「疾病」

一般事項

I. 是項保險的收費?您公司一向重視僱員福利，故將負責是項保險的�部費用。

保障項目的更改假如合資格的保障等級需作更改，您的保障將會在該等更改生效日起自動調整。

若身處海外，如何安排接受醫療診治？假如您身處海外而需要接受緊急診治，您須首先自行繳付醫療費用，然後在求診或出院後九十(90)日內，將取得的收據正本提交予我們作索償申領。凡以港幣以外任何貨幣結算的賬單，我們將會根據求診或出院當日的外幣兌換率折為港幣辦理，若沒有官方兌換率可供參考，則以我們使用的銀行所提供的兌換率為準。

無論在海外工作及旅遊渡假，此安排均適用。

若您離職，如何安排？無論因任何理由離職，您及您家屬（如適用）在本保險下的會員資格將會由您終止受僱當天停止。您必須於保障終止後七(7)日內將會員咭退還予您公司人事部。

II.

III.

IV.

定義

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EB1/BR00016B/P01 (12/14)

3656 83622164 8445

3656 83622164 8445

3/F, Berkshire House, 25 Westlands Road,栢克大廈3樓