我希望為我的僱員提供全面的人壽及醫療保障 · (1) 所有符合資格的家屬，包括投保僱員之配偶及子女必須參加。 (2) 所有符合資格的家屬，其保障等級必須與有關受保僱員相同。

我希望為我的僱員

提供全面的人壽及醫療保障

SelectCare(A)-bro-1411.indd 2 17/11/2014 6:10 PM

於中國大陸超過200間醫院出示中國醫院網絡醫療卡，毋須

提供一系列價錢相宜的保障，包括團體人壽、意外、住院

保障及自選門診保障。

適用於聘請少至3位僱員的公司。

投保及行政程序簡易 : 一般毋須驗身。

2,000名醫生供您選擇。

全面的緊急支援服務。

顧慮入院保證金。

此醫療保障更可惠及僱員之家屬。

24小時環球保障。

全面而靈活的保障組合當您選用了智選計劃，將可以按照下表，隨意揀選其中一款保障組合：

務服加附圍範障保擇選目項

1 人壽及意外 + 住院保障----

2 人壽及意外 + 住院 + 門診保障

3 科牙障保院住 + 外意及壽人

4 科牙障保診門 + 院住 + 外意及壽人

如客戶設定多於一個僱員級別，所有僱員級別應選擇相同的項目（詳情請參閱下頁投保資格部份）

保障全面周到，迎合您公司所需

給您及您的僱員一系列的保障計劃

障保院住障保外意及壽人

任何死亡事故均會以一筆過現金賠償。

指定金額賠償。

因意外或疾病所致的住院及手術費用最高可獲賠償全數投保額。

其他保障包括每日病房及膳食費、醫院雜項費、外科手術費及麻醉師費、手術室費、深切治療保障等。

^務服科牙絡網選自障保診門選自

賠償門診費用之80%，最高賠償為投保額。

費用。

為客戶提供全面的網絡門診服務（需自付額）。

保險計劃之上，您亦可加入一系列全年牙科服務。

^ 網絡牙科服務由AXA按其絕對權力不時指定之服務提供機構提供，僱主須直接向服務提供機構繳付服務費用。AXA不會對該等服務承擔任何義務或責任。網絡牙科服務內容須受服務提供機構之條款及細則所限制。

AXA是您值得信賴的商業夥伴！我們深明保障您公司及僱員的重要性，故特別

設計了智選僱員福利保險綜合計劃，以協助您的業務發展更蓬勃及提昇僱員

的忠誠度，讓您真正安枕無憂。智選僱員福利保險綜合計劃專為擁有3名

或以上僱員的中小企而設，包括全面的人壽及醫療保障。選用管理簡

易及保費相宜的智選僱員福利保險綜合計劃，正體現了您對僱員們

的重視和關懷。

計劃主要特點

因意外所致而喪失生命、四肢、聽覺、視力及手指等，可獲

其他保障包括普通科醫生、專科醫生、中醫、X光及化驗之

門診保障讓您自由挑選醫生，而網絡醫療卡更提供超過


保障賠償表

保障項目每位會員最高保障金額(港幣$)

計劃 1 計劃 2 計劃 3 計劃 4 計劃 5 計劃 6

人壽及意外保險

死亡保障 150,000 100,000 10,000 10,000 10,000 10,000

意外死亡及斷肢保障* 150,000 100,000 10,000 10,000 10,000 10,000

醫療保險

住院保障

賠償百分比（%） %08%001

每日病房及膳食費（最高賠償60日） 2,000 1,200 600 450 600 450

每日醫生巡房費（最高賠償60日） 2,000 1,200 600 450 600 450

醫院雜費 30,000 18,000 8,000 6,000 8,000 6,000

外科手術費特級大型 95,000 60,000 35,000 25,000 35,000 25,000

大型 47,500 30,000 17,500 12,500 17,500 12,500

中型 23,750 15,000 8,750 6,250 8,750 6,250

小型 9,500 6,000 3,500 2,500 3,500 2,500

麻醉師費特級大型 28,500 18,000 10,500 7,500 10,500 7,500

大型 14,250 9,000 5,250 3,750 5,250 3,750

中型 7,125 4,500 2,625 1,875 2,625 1,875

小型 2,850 1,800 1,050 750 1,050 750

手術室費特級大型 28,500 18,000 10,500 7,500 10,500 7,500

大型 14,250 9,000 5,250 3,750 5,250 3,750

中型 7,125 4,500 2,625 1,875 2,625 1,875

小型 2,850 1,800 1,050 750 1,050 750

每日深切治療費（最高賠償10日） 3,000 2,400 1,200 600 ------- -------

專科治療費（須由主診醫生轉介） 8,000 6,000 4,000 2,000 ------- -------

每日在家中的私家看護費（最高賠償60日。須由主診醫生轉介） 1,000 600 ------- ------- ------- -------

附加意外醫療費 6,000 4,500 ------- ------- ------- -------

手術後醫生出診及診所治療費 1,600 1,600 ------- ------- ------- -------

每位會員以每病症計之最高賠償金額 527,600 330,100 152,000 108,000 136,000 100,000

全面緊急支援服務

透過我們的國際網絡內的緊急支援服務中心，每日24小時，一星期7日提供以下服務：熱線服務，包括旅遊前轉介諮詢、醫療及法律轉介服務。緊急醫療運送及/或遣返服務。遺體遣返。全球性入院保證金（高達5,000美元）#。

中國醫院網絡內覆蓋超過200間中國國內醫院。

# 會員須於45日內償還金額（免息）。

門診保障（自選）

賠償百分比（%） 80%

每日一次的醫生診所治療費 300 240 180 140 140 120

每日一次的醫生出診治療費 600 480 ------- ------- ------- -------

每日一次的專科治療費（須由主診醫生轉介） 600 480 360 280 280 240

每日一次的中醫治療費 200 160 ------- ------- ------- -------

每次病症的X光及化驗費3,000 2,000 1,500 1,000 1,000 500

醫生治療費、專科及中醫門診治療費之總賠償以整個保單年度不超過30次為限。專科門診治療之賠償以整個保單年度不超過10次為限。中醫門診治療之賠償以整個保單年度不超過5次為限。

註：實際之賠償金額以上述所列之最高金額為限。

智選計劃備有六種不同等級的保障供您選擇：

計劃1及2 - 優越私家及半私家房等級保障

計劃3及4 - 綜合大房等級保障，賠償100%住院費用

計劃5及6 - 基本大房等級保障，賠償80%住院費用

（須由主診醫生轉介。）


*意外死亡及斷肢保障賠償表

意外死亡及斷肢保障將按照有關保單之賠償表所列之最高金額百分比計算。

項目最高賠償之百分比項目最高賠償之百分比

喪失喪失

生命 100% 一手之五指 45%

兩肢 100% 姆指兩節 15%

兩眼視力 100% 姆指一節 8%

一肢及一眼視力 100% 食指 10%

一肢 50% 中指 6%

一眼視力 50% 無名指或尾指 4%

一腳之五趾 15%

永久及完全癱瘓大腳趾兩節 5%

四肢 100% 大腳趾一節 2%

三肢 75% 其他腳趾（每趾） 2%

兩肢 50%

一肢 25% 由外科手術移動下顎 30%

永久及完全喪失

兩耳聽覺 70%

一耳聽覺 20%

失肢是指於手腕或腳跟關節較近身以上的切除。

喪失姆指或其他手指是指於手指與手掌間關節較近身以上的切除。

喪失腳趾是指於腳趾與腳掌間關節較近身以上的切除。

如受保成員因同一意外引致多於一項或以上損失，就該等損失的總賠償金額以保障賠償表所列之最高金額為限。

投保資格• 此計劃專為擁有3至15名僱員的公司而設。

• 您可為不同級別的僱員設定不同的保障等級，例如保障等級1為董事級保障，選用福利計劃1 ；保障

等級2則為一般職員保障，選用福利計劃3。如聘用4至9名僱員，您最多可設定兩種保障等級；聘用

10至15名僱員，最多可選擇3種保障等級。

• 保障所有年齡為16至59歲的僱員及其配偶；

投保指引• 家屬保障：

(1) 所有符合資格的家屬，包括投保僱員之配偶及子女必須參加。

(2) 所有符合資格的家屬，其保障等級必須與有關受保僱員相同。

(3) 家屬之保障範圍只限於醫療保障（不包括人壽及意外保障）。

以上保障賠償表只供智選僱員福利保險綜合計劃的一般資料，並不能被視為保單。有關智選僱員福利保險綜合計劃的詳細條款、細則、限額及不保事項，請參閱有關保單。

參加上述計劃須受本公司有關條款及細則限制。本公司保留批核任何投保申請之最終決定權。

年齡為14天至18歲及23歲以下之全日制學生的僱員之

未婚子女。


「網絡」診所牙科服務（自選）+

限不數次導指生衛腔口及查檢腔口

次一多最年每漬/石牙洗

限不數次）要需如（查檢片光X小腔口

限不數次）牙蛀牙後限只（牙補粉銀

限不數次）牙蛀牙前限只（牙補粉瓷

限不數次務服痛止牙補時臨及療治急緊，內間時公辦

限不數次）病疾肉牙或蝕蛀因（牙脫通普

限不數次）要需如（療治肉牙

限不數次）藥痛止及素生抗（物藥

+ 網絡牙科服務須受服務提供機構之條款及細則所限制。

請即行動，給您的公司一份智選僱員福利保險綜合計劃！欲知更多智選計劃詳情，請聯絡您的AXA保險顧問。

年費

HK$400（每位）

人壽保障

• 除在投保首年內因投保人虛報資料及隱瞞事實致令保險公

司可提出爭議之外，任何死亡事故均在賠償之列。

意外死亡及斷肢保障

• 任何疾病 • 自殺 • 戰爭、遊行、暴亂、叛亂及革命 • 觸犯

法紀之行為（違反交通或行人條例除外）• 任何涉及執法行動

或參與打鬥或刑事罪行 • 放射性污染 • 核子、生化恐怖襲擊

醫療保障

• 已存在的疾病 • 例行體格檢查、懷孕，以及任何非急需的

治療如整容、節育及美容 • 觸犯法紀之行為（違反交通或行

人條例除外）• 牙科治療（由意外導致者除外）• 戰爭、遊

行、暴亂、叛亂及革命 • 從其他保單或透過法律程序已獲得

之賠償額 • 先天疾病 • 任何物理治療或脊椎治療（由醫生轉

介及於註冊診所或醫院治療除外）• 作為康復、托管或休養

及預防性注射或治療 • 矯視或配視光鏡 • 租用或購買義肢器

材（包括但不限於助聽器、義肢、眼鏡或矯形衣服）

不受保障項目

(不適合於中國大陸境內使用)

BEB

SC

FM-1

505

AXA安盛簡介AXA安盛為AXA安盛集團之成員，憑藉其超卓的產品及服務，現時於香港及澳門的客戶人數已超過100萬1。AXA安盛不單是香港其中一家最大的醫療保險供應商，其一般保險業務更在香港巿場擁有最大的佔有率 2，而其汽車保險亦是業界的翹楚。

AXA安盛致力為客戶提供涵蓋人壽、健康及財產的全面保障，與及財富管理和退休方案，幫助客戶實踐安定及豐盛的生活。

AXA安盛肩負企業責任，致力透過推廣健康人生、環境保護及社會服務三大範疇回饋社會，推動可持續發展的業務。

1 包括安盛金融有限公司、安盛信託有限公司及安盛保險 (百慕達) 有限公司 (於百慕達註冊成立的有限公司) 的客戶2 根據保險業監理處所發表有關2013年巿場佔有率之數據

安盛金融有限公司僱員福利香港九龍九龍灣宏泰道23號22樓2201-2206室電話：(852) 2519 1166 傳真：(852) 2598 6502 網址：www.axa.com.hk

SelectCare(A)-1505-V1.ai 12 21/04/2015 4:46 PM

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Applicant Information 申請人資料

Applicant/Policyholder 申請人公司/保單持有人名稱 :

Business Nature 業務性質：

Incorporation No. 註冊號碼：

(Please provide copy 請提供副本)

Date of Incorporation 成立日期：

Email Address 電郵地址：

Place of Incorporation 公司註冊地點：

Position 職位：Contact Person 聯絡人：

Fax No. 傳真號碼： Telephone No. 電話號碼：

1. Beneficial Owner(s) 實益擁有人List all persons that own or control, or is directly or indirectly, entitled to exercise or control the exercise, of at least 10% of the issued share capital(corporation)/ capital or profits or voting rights (partnership or unincorporated body)/ capital of the trust property (trust) 請列出所有直接或間接擁有，控制或行使已發行（公司）股本至少10％ / 資本或利潤或投票權（合夥企業或非法人團體）/ 資本的信託財產（信託）的人

Policy No. 保單編號:

Registered Office Address in the Place of Incorporation 成立地點的註冊辦事處地址 ▲：

Business Address 公司地址 (if different from above 如與上述不同) ▲：

a. Individual Owner(s) 個別擁有人★

Relationship between Applicant/Policyholder and the Insured Persons 申請人/保單持有人與受保人之關係

Employer and Employee (with dependants, if applicable) 僱主與僱員（及家屬，如適用）

Others, please specify 其他，請註明

Organization Type 機構類別：

Business Registration No. 商業登記號碼：

(Please provide copy 請提供副本)

Sole Proprietorship 獨資經營

Partnership 合夥經營

Limited Company 有限公司

Other 其它

(Please provide copy of partnership deed 請提供合夥契約副本)

SelectCare Employee Benefits Insurance Package Plan智選僱員福利保險綜合計劃

Application Form 申請表

▲ Please complete in English & provide address proof. P.O. Box address is not accepted ▲ 請以英文填寫並提供住址證明。不接受郵政信箱作為地址。★ Please use supplementary sheets if there is insufficient space. ★ 如空間不足請附加紙張。

BEB

SC

FM(A

)-1505

Name 姓名

Nationality 國籍

Expiry Date 到期日

Percentage of Ownership 百分比之擁有權

Date of Birth 出生日期

HKID/Passport No. 香港身份證 / 護照號碼(please provide certified true copy 請提供認證副本)

Residential Address 住址(P.O. Box is not accepted 不接受郵政信箱)

Permanent Address 永久地址 if different from Residential Address如與住址不同(P.O. Box is not accepted 不接受郵政信箱)


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b. Corporate Owner(s) 企業擁有人★ i. If applicant/policyholder has corporate owner(s), please provide the ownership chart of the applicant/policyholder with a director’s declaration 如果申請人/保單持有人有公司擁有權，請提供申請人/保單持有人的擁有詳請及董事的聲明ii. For each corporate owner indicated below, please provide ownership details 以下每個企業擁有人，請提供擁有權細節


Name 姓名

Name 姓名

Place of Incorporation 公司註冊地點

Percentage of Ownership 百分比之擁有權

Registration No. 註冊號碼(please provide copy 請提供副本)

Date of Incorporation 成立日期

Registered Office Addressin the Place of Incorporation成立地點的註冊辦事處地址(P.O. Box is not accepted 不接受郵政信箱)

Business Address 公司地址if different from Registered Office Address如與註冊辦事處不同(P.O. Box is not accepted 不接受郵政信箱)

2. Person(s) who Exercise Ultimate Management Control 行使最終管理控制權之人士★ (Please provide Organization Chart 請提供公司架構圖表)

3. All Board of Directors of the Applicant/Policyholder 申請人/保單持有人之董事局成員★

Name 姓名



Nationality 國籍



Permanent Address 永久地址 if different from Residential Address如與住址不同(P.O. Box is not accepted 不接受郵政信箱)


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b. Protector(s) or Enforcer(s) 信託的保護人或執行人★

4. Additional Information for Trust 信託附加資料★ (Please provide a copy of trust deed 請提供信託契約副本)a. Settlor(s) 財產授予人

c. Person(s) with Ultimate Control Over the Trust 最終控制信託的人★


Name 姓名



Nationality 國籍



Permanent Address 永久地址if different from Residential Address如與住址不同(P.O. Box is not accepted 不接受郵政信箱)

Name 姓名



Nationality 國籍




Name 姓名



Nationality 國籍





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Policy Particulars 保單資料

Policy Effective Date 保單生效日期

Y 年 /

M

M月 /

1st

D日

Anniversary Date: Each Year on the first day of (Month)

保單週年日期：每年月首日

Plan Classification (please tick the chosen plan) 計劃分類（請選取您所揀選的計劃）

Plan 計劃

Eligibility Definition of Insured Persons*符合投保資格的僱員等級定義*

Plan 計劃 1

Plan 計劃 2

Plan 計劃 3

Plan 計劃 4

Plan 計劃 5

Plan 計劃 6

Plan Options 保障計劃 * Add-on Services 附加服務

Life & Accidental and Hospital Benefits

人壽及意外、住院保障-

Life & Accidental, Hospital and Clinical Benefits人壽及意外、住院及門診保障

-

Life & Accidental and Hospital Benefits人壽及意外、住院保障

+ Dental Services**

牙科服務**

Life & Accidental, Hospital and Clinical Benefits人壽及意外、住院及門診保障

+ Dental Services**

牙科服務**

* 1 option for all plan 所有計劃劃一保障

Employer / Employee Contributions 僱主 / 僱員保費

Employer will pay for 100% of employee’s premiums. 僱主支付僱員保費的100%

If not, please specify the percentage to be paid by Employer %. 如不是，請註明僱主支付的保費為 %

Employer will pay for 100% of dependant’s premium. 僱主支付僱員之家屬的保費的100%

If not, please specify the percentage to be paid by Employer %. 如不是，請註明僱主支付的保費為 %

Coverage Effective Date 保障生效日期

a) Existing employees / members will be eligible for the benefits 現時在職僱員 / 會員可獲享保障於

upon the Policy Effective Date 保單生效日

immediate coverage after months of continuous services. 連續服務滿個月後即時保障

b) Future employees / members will be eligible for the benefits 將來新聘僱員 / 會員可獲享保障於

on the first day of their employment 在職的第一日

immediate coverage after months of continuous services 連續服務滿個月後即時保障 With dependant coverage 保障是否包括僱員之家屬? Yes 是 No 否

Annual Premium 全年保費

1. Life & Accidental and Hospital Benefits 人壽及意外、住院保障

Please provide no. of members. 請在格內填寫參加人數。

# Full-time student from age 19-22, please provide evidence. # 全職學生年齡由19-22歲，請提供證明。

Age 年齡 Plan 計劃 1 (JA1) Plan 計劃 2 (JA2) Plan 計劃 3 (JA3) Plan 計劃 4 (JA4) Plan 計劃 5 (JA5) Plan 計劃 6 (JA6)

Child 子女

0 - 4 1,239 799 478 380 413 335

5 - 9 1,239 799 478 380 413 335

10 - 14 1,239 799 478 380 413 335

1,239 799 478 380 413 335

20 - 22# 1,444 932 557 443 481 390

Employee/Spouse 僱員及配偶

Below 2525歲以下 1,712 1,095 658 518 568 456

25 - 29 1,718 1,099 661 520 571 457

30 - 34 1,962 1,256 754 594 651 523

35 - 39 2,429 1,554 934 735 807 647

40 - 44 3,100 1,979 1,191 936 1,029 824

45 - 49 4,122 2,627 1,582 1,241 1,366 1,092

50 - 54 5,349 3,397 2,050 1,599 1,770 1,408

55 - 59 7,540 4,776 2,886 2,244 2,492 1,975

15 - 19#

*

**

The Applicant agrees that:

i) If the premium is 100% paid by the EMPLOYER, all eligible persons (employee and spouse) must join the scheme.

ii)If the premium is partially paid by the EMPLOYEE, at least 75% of all eligible persons (employee and spouse) must join the scheme.

On top of the insurance plan, you can add a full range of annual dental care services. Network Dental Services are provided by the service provider designated by

AXA from time to time at its sole discretion subject to separate service charges payable by the employer to such service provider. AXA accepts no liability or

responsibility for these services. The Network Dental Services provided will be subject to the terms and conditions of the service provider reviewed from time to

time. For details of the add-on dental services, please refer to the Employee Network Dental Services Plan Enrolment Form provided by our service provider.

* 申請人同意:

i) 如僱主支付全數保費，所有合資格人士（僱員及家屬）必須參加保險計劃。

如僱員需支付部分保費，則必須有最少四份三的合資格人士（僱員及家屬）參加。ii)

** 保險計劃之上，您亦可附加一系列全年牙科服務。網絡牙科服務由 AXA 按其絕對權力不時指定之服務提供機構提供，僱主須直接向服務提供機構繳付服務費用。

AXA 不會對該等服務承擔任何義務或責任。網絡牙科服務須受服務提供機構之條款及細則所限制。有關附加牙科服務詳情，請參閱我們的服務提供機構提供之僱員

網絡牙科服務計劃申


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Volume Discount^ 人數折扣^An extra premium discount will be offered if the policy covers 10 employees or more. 若保單的投保僱員達10名或以上，將獲享額外保費折扣。

No. of Employees 僱員人數 Volume Discount 人數折扣率

10 – 15 5%

Below 10 少於10 Nil 無

^ Volume discount applies to life & accidental, hospital and clinical benefits only ^人數折扣只適用於人壽、意外、住院及門診保障。

^ Volume discount offer is based on no. of insured employees only, dependants are excluded ^人數折扣率只按僱員數目而定，家屬不計算在內。

Total no. of employees 僱員總人數

and dependants 及家屬總人數

Annual Premium (Life, Accidental, Hospital and Clinical (optional) Benefits)

全年保費（人壽、意外、住院及門診（自選）保障）

Volume Discount ^

人數折扣^

Total Annual Premium

全年總保費

HK$ 港幣

元

HK$ 港幣

元

HK$ 港幣

元

Add-on Network Dental Services 附加網絡牙科服務

Please refer to the Employee Network Dental Services Plan Enrolment Form for details .

詳情請參閱僱員網絡牙科服務計劃申請表。

How to Apply 怎樣投保Life & Accidental, Hospital and Clinical Benefits

Please submit the following items to us before the Policy Effective Date:

1. SelectCare Employee Benefits Insurance Package Plan Application Form

2. Individual Employee Enrolment Form

3. Premium payment cheque made payable to “AXA China Region Insurance Company Limited”

人壽及意外、住院及門診保障

請於保單生效日前，向我們提交以下文件：

1. 智選僱員福利保險綜合計劃申請表

2. 僱員個人投保申請表

3. 支票抬頭請註明「安盛金融有限公司」以繳交保費

Add-on Network Dental Services 附加網絡牙科服務

Please refer to the Employee Network Dental Services Plan Enrolment Form for details.

詳情請參閱僱員網絡牙科服務計劃申請表。

Remarks :

1. This plan is specifically for use by companies with 3 – 15 employees. Companies with more than 15 employees can request for a tailor-made proposal from us directly.

2. All insured employees will be required to complete an individual enrolment form. Acceptance will be subject to underwriting.

3. If 1 eligible dependant enrolls in the plan, all other eligible dependants of the family must join at the same time.

備註：

1. 此計劃適用於聘用 3至15名僱員的機構。聘用超過15名僱員的機構可直接要求本公司因應個別需要而提供建議書。

2. 所有投保僱員均須填寫個人投保申請表，保障必須在核保後才正式生效。

3. 如其中一位合資格家屬參與此計劃，其他所有合資格的家屬必須同時參與。

2. Life & Accidental, Hospital and Clinical Benefits 人壽及意外、住院及門診保障

Age 年齡 Plan 計劃 1 (JB1) Plan 計劃 2 (JB2) Plan 計劃 3 (JB3) Plan 計劃 4 (JB4) Plan 計劃 5 (JB5) Plan 計劃 6 (JB6)

Child 子女

Employee/Spouse 僱員及配偶

0 - 4 7,722 5,736 3,577 3,029 2,923 2,606

5 - 9 4,501 3,297 2,049 1,713 1,675 1,474

10 - 14 2,504 1,785 1,102 897 901 772

2,504 1,785 1,102 897 901 772

20 - 22#

15 - 19#

3,974 2,879 1,786 1,477 1,459 1,270

4,239 3,045 1,891 1,550 1,545 1,333

25 - 29 4,663 3,366 2,090 1,721 1,708 1,481

30 - 34 4,905 3,526 2,188 1,795 1,788 1,544

35 - 39 5,281 3,766 2,334 1,900 1,907 1,634

40 - 44 5,743 4,048 2,503 2,016 2,046 1,734

45 - 49 6,757 4,710 2,910 2,318 2,378 1,994

50 - 54 7,973 5,500 3,396 2,673 2,775 2,299

55 - 59 10,143 6,909 4,264 3,310 3,485 2,848

Below 2525歲以下

Please provide no. of members. 請在格內填寫參加人數。

# Full-time student from age 19-22, please provide evidence. # 全職學生年齡由19-22歲，請提供證明。


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Notes:

1. Any amendments to the information provided under this form must be certified by authorized signature and company chop.

2. If there is inconsistency between the English version and the Chinese version of these terms and conditions, the English version shall prevail.

3. This application form contains general information of SelectCare Employee Benefits Insurance Package Plan only. This is not a policy. For detailed terms,

conditions, limitations and exclusion of SelectCare Employee Benefits Insurance Package Plan, please refer to the relevant policy.

4. This plan is subject to our Company’s terms and conditions. Our Company reserves the final right to approve any policy application.

附註：

1. 如此申請表上所提供的資料有任何修改，必須有獲授權人簽署及公司蓋章以作實。

2. 如中英文版本有任何差異，概以英文版本為準。

3. 此申請表只提供智選僱員福利保險綜合計劃的一般資料，並不能被視為保單。有關智選僱員福利保險綜合計劃的詳細條款、細則、限額及不保事項，請參閱有關保單。

4. 參加上述計劃須受本公司有關條款及細則限制。本公司保留批核任何投保申請之最終決定權。

Producer’s Name 營業員姓名： Producer’s Code 營業員編號：

Producer’s Title 營業員職位： Producer’s Branch (if applicable) 營業員分行（如適用）：

Producer’s Signature 營業員簽署：

Producer Channel:Agent / Broker / Others, please specify

(Please circle the appropriate choice)

營業員渠道：

代理人 / 經紀人 / 其他，請註明（請圈出適用者）

PERSONAL INFORMATION COLLECTION STATEMENT收集個人資料的聲明

AXA China Region Insurance Company Limited (referred to hereinafter as the “Company”) recognises its responsibilities in relation to the collection, holding, processing,

use and/or transfer of personal data under the Personal Data (Privacy) Ordinance (Cap. 486) (“PDPO”). Personal data will be collected only for lawful and relevant purposes

and all practicable steps will be taken to ensure that personal data held by the Company is accurate. The Company will take all practicable steps to ensure security of the

personal data and to avoid unauthorised or accidental access, erasure or other use.

安盛金融有限公司（下稱“本公司”）明白其就《個人資料（私隱）條例》（香港法例第486章）（“條例”）收集、持有、處理、使用和／或轉移個人資料所負有的

責任。本公司僅將為合法和相關的目的收集個人資料，並將採取一切切實可行的步驟，確保本公司所持個人資料的準確性。本公司將採取一切切實可行的步驟，確保個

人資料的安全性，及避免發生未經授權或者因意外而擅自取得、刪除或另行使用個人資料的情況。

Please note that if you do not provide us with your personal data, we may not be able to provide the information, products or services you need or process your request.

敬請注意，如果閣下不向本公司提供閣下的個人資料，我們可能無法提供閣下所需的資料、產品或服務，或無法處理閣下的要求。

Purpose: From time to time it is necessary for the Company to collect your personal data which may be used, stored, processed, transferred, disclosed or shared by us for

purposes (“Purposes”), including:

目的：本公司不時有必要收集閣下的個人資料，並可能因下列各項目的（“有關目的”）而供本公司使用、存儲、處理、轉移、披露或共享該等個人資料：

1. offering, providing and marketing to you the products/services of the Company, other companies of the AXA Group (“our affiliates”) or our business partners (see “Use

and provision of personal data in direct marketing” below), and administering, maintaining, managing and operating such products/services;

向閣下推介、提供和營銷本公司、安盛集團的其他公司（“安盛關聯方”）或本公司的商業合作夥伴（參閱下文“在直接促銷中使用及將其個人資料提供予其他人士”

部份）之產品／服務，以及提供、維持、管理和操作該等產品／服務；

2. processing and evaluating any applications or requests made by you for products/services offered by the Company and our affiliates;

處理和評估閣下就本公司及安盛關聯方所提供之產品／服務提出的任何申請或要求；

3. providing subsequent services to you, including but not limited to administering the policies issued;

向閣下提供後續服務，包括但不限於執行／管理已發出的保單；

4. any purposes in connection with any claims made by or against or otherwise involving you in respect of any products/services provided by the Company and/or our affiliates,

including investigation of claims;

與就本公司和／或安盛關聯方提供的任何產品／服務而由閣下或針對閣下提出的或者其他涉及閣下的任何索賠相關的任何目的，包括索賠調查；

5. evaluating your financial needs;

評估閣下的財務需求；

6. designing products/services for customers;

為客戶設計產品／服務；

7. conducting market research for statistical or other purposes;

為統計或其他目的進行市場研究；

8. matching any data held which relates to you from time to time for any of the purposes listed herein;

不時就本條款所列的任何目的核對所持有的與閣下有關的任何資料；

9. making disclosure as required by any applicable law, rules, regulations, codes of practice or guidelines or to assist in law enforcement purposes, investigations by

police or other government or regulatory authorities in Hong Kong or elsewhere;

作出任何適用法律、規則、規例、實務守則或指引所要求的披露或協助在香港或香港以外其他地方的警方或其他政府或監管機構執法及進行調查；

10. conducting identity and/or credit checks and/or debt collection;

進行身份和／或信用核查和／或債務追收；

11. complying with the laws of any applicable jurisdiction;

遵守任何適用的司法管轄區的法律；

12. carrying out other services in connection with the operation of the Company’s business; and

開展與本公司業務經營有關的其他服務；及

13. other purposes directly relating to any of the above.

與上述任何目的直接有關的其他目的。


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Transfer of personal data: Personal data will be kept confidential but, subject to the provisions of any applicable law, may be provided to:個人資料的轉移：個人資料將予以保密，但在遵守任何適用法律條文的前提下，可提供給：

1. any of our affiliates, any person associated with the Company, any reinsurance company, claims investigation company, your broker, industry association or federation, fund management company or financial institution in Hong Kong or elsewhere and in this regard you consent to the transfer of your data outside of Hong Kong;

位於香港或香港以外其他地方的任何安盛關聯方、本公司的任何相關聯人士、任何再保險公司、索賠調查公司、閣下之保險經紀、行業協會或聯會、基金管理公司或

金融機構，以及就此方面而言，閣下同意將閣下的資料轉移至香港境外；

2. any person (including private investigators) in connection with any claims made by or against or otherwise involving you in respect of any products/services provided by the Company and/or our affiliates;

與就本公司和／或安盛關聯方提供的任何產品／服務而由閣下或針對閣下提出的或者其他涉及閣下的任何索賠相關的任何人士（包括私家偵探）；

3. any agent, contractor or third party who provides administrative, technology or other services (including direct marketing services) to the Company and/or our affiliates in Hong Kong or elsewhere and who has a duty of confidentiality to the same;

在香港或香港以外其他地方向本公司和／或安盛關聯方提供行政，技術或其他服務（包括直接促銷服務)並對個人資料負有保密義務的任何代理、承包商或第三方；

4. credit reference agencies or, in the event of default, debt collection agencies; 信貸資料機構或（在出現拖欠還款的情況下）追討欠款公司；

5. any actual or proposed assignee, transferee, participant or sub-participant of our rights or business; and 本公司權利或業務的任何實際或建議的承讓人、受讓方、參與者或次參與者；及

6. any government department or other appropriate governmental or regulatory authority in Hong Kong or elsewhere. 在香港或香港以外其他地方的任何政府部門或其他適當的政府或監管機關。

For our policy on using your personal data for marketing purposes, please see the section below “Use and provision of personal data in direct marketing”.如欲了解本公司為促銷目的使用閣下的個人資料的政策，請參閱下文“在直接促銷中使用及將其個人資料提供予其他人士”部份。

Transfer of your personal data will only be made for one or more of the Purposes specified above.閣下的個人資料將僅為上文中規定的一個或多個有關目的而被轉移。

Use and provision of personal data in direct marketing: The Company intends to:在直接促銷中使用及將其個人資料提供予其他人士：本公司有意：

1) use your name, contact details, products and services portfolio information, transaction pattern and behaviour, financial background and demographic data held by the Company from time to time for direct marketing;

使用本公司不時持有的閣下的姓名、聯絡資料、產品及服務的組合資料、交易模式及行為、財政背景及人口統計數據以進行直接促銷；

2) conduct direct marketing (including but not limited to providing reward, loyalty or privileges programmes) in relation to the following classes of products and services that the Company, our affiliates, our co-branding partners and our business partners may offer:

就本公司、安盛關聯方、本公司合作品牌夥伴及商業合作夥伴可能提供關於下列類別的服務及產品而進行直接促銷（包括但不限於提供獎賞、客戶或會員或優惠計劃）：

a) insurance, banking, provident fund or scheme, financial services, securities and related products and services; 保險、銀行、公積金或公積金計劃、金融服務、證券和相關產品及服務；

b) products and services on health, wellness and medical, food and beverage, sporting activities and membership, entertainment, spa and similar relaxation activities, travel and transportation, household, apparel, education, social networking, media and high-end consumer products;

健康、保健及醫療、餐飲、體育運動及會員服務、娛樂、健身浴或類似的休閒活動、旅遊及交通、家居、服裝、教育、社交網絡、媒體的產品及服務及高級消費

類產品；

3) the above products and services may be provided by the Company and/or: 以上服務及產品將會由本公司及/或以下機構提供：

a) any of our affiliates; 任何安盛關聯方；

b) third party financial institutions; 第三方金融機構；

c) the business partners or co-branding partners of the Company and/or affiliates providing the products and services set out in (2) above; 提供上文(2)所列之服務及產品之本公司及／或安盛關聯方的商業合作夥伴或合作品牌夥伴；

d) third party reward, loyalty or privileges programme providers supporting the Company or any of the above listed entities; 向本公司或任何以上所列機構提供支援的第三方獎賞、客戶或會員或優惠計劃提供者；

4) in addition to marketing the above products and services, the Company also intends to provide the data described in (1) above to all or any of the persons described in (3) above for use by them in marketing those products and services, and the Company requires your written consent (which includes an indication of no objection) for that purpose.

除由本公司促銷上述服務及產品外，本公司亦有意將上文(1)段部份所述的資料提供予上文(3)段部份所述的全部或任何人士，以供該等人士在促銷該等服務及產品中

使用，而本公司為此目的須獲得客戶書面同意(包括表示不反對) 。

Before using your personal data for the purposes and providing to the transferees set out above, the Company must obtain your written consent, and only after having obtained such written consent, may use and provide your personal data for any promotional or marketing purpose.在使用閣下的個人資料作上文所述的目的或提供予上文所述的人士之前，本公司須獲得閣下的書面同意，及只在獲得閣下的書面同意後方可使用閣下的個人資料及提供

予其他人士作任何推廣及促銷用途。

You may in future withdraw your consent to the use and provision of your personal data for direct marketing.閣下日後可撤回閣下給予本公司有關使用閣下的個人資料及提供予其他人士作任何促銷用途的同意。

If you wish to withdraw your consent, please inform us in writing to the address in the section on “Access and correction of personal data”. The Company shall, without charge to you, ensure that you are not included in future direct marketing activities.閣下如欲撤回閣下給予本公司的同意，請發信至下文“個人資料的查閱和更正”部份所列的地址通知本公司。本公司會在不收取任何費用的情況下確保不會將閣下納入

日後的直接促銷活動中。

Access and correction of personal data: Under the PDPO, you have the right to ascertain whether the Company holds your personal data, to obtain a copy of the data, and to correct any data that is inaccurate. You may also request the Company to inform you of the type of personal data held by it.個人資料的查閱和更正：根據條例，閣下有權查明本公司是否持有閣下的個人資料，獲取該資料的副本，以及更正任何不準確的資料。閣下還可以要求本公司告知閣下

本公司所持個人資料的種類。

Requests for access and correction or for information regarding policies and practices and kinds of data held by the Company should be addressed in writing to:查閱和更正的要求，或有關獲取政策、常規及本公司所持的資料種類的資料，均應以書面形式發送至：

Data Privacy Officer 個人資料保護主任AXA China Region Insurance Company Limited 安盛金融有限公司Employee Benefits - Unit 2201 - 2206 22/F Manhattan Place 23 Wang Tai Road Kowloon Bay Kowloon Hong Kong僱員福利 – 香港九龍九龍灣宏泰道23號22樓2201-2206室

A reasonable fee may be charged to offset the Company’s administrative and actual costs incurred in complying with your data access requests.本公司可能會向閣下收取合理的費用，以抵銷本公司為執行閣下的資料查閱要求而引致的行政和實際費用。


8 of 8(Not for use in Mainland China 不適合於中國大陸境內使用 )

BEB

SC

FM(A

)-1505

DECLARATION AND AUTHORIZATION 聲明及授權 1. The applicant/policyholder hereby confirms that on behalf of itself, and any person referred to in this application including without limitation the Insured Persons that it

is not acting on behalf of any other person for this insurance application unless otherwise expressly indicated in this application form or any other documents provided to AXA China Region Insurance Company Limited (“the Company”) for this application.

申請人／保單持有人謹此代表申請人／保單持有人及任何此申請中提及之人士，不受限制地包括受保人確認，申請人／保單持有人並沒有代表任何其他人士向安盛金融有限公司（“貴公司”）提出此投保申請；如在此投保申請表格或就此申請提交的任何其他文件上另有註明則除外。

2. The applicant/policyholder declares and agrees that: 申請人／保單持有人謹此聲明及同意：

a) The insurance coverage will be subject to all terms, conditions and exclusions of the policy contract; 保障範圍將受保單合約中之各項條款、條件及不保事項限制；b) In respect of the hospital and/or clinical benefits under the SelectCare Employee Benefits Insurance Package Plan, the applicant/policyholder authorizes the Company

to act on behalf of the applicant/policyholder (and the Insured Persons) to: (i) arrange and appoint the medical services providers including without limitation any hospitals, clinics and medical practitioners, to provide medical services for the Insured Persons; (ii) accept direct billing from the medical services providers for services rendered to the Insured Persons; (iii) establish, suspend or terminate the said relationship with the medical services providers as necessary; (iv) negotiate all related fees and arrangements with the medical services providers; (v) recover any amounts for any shortfalls or ineligible medical expenses from the Insured Persons;

有關智選僱員福利保險綜合計劃所載的住院及／或門診保障，申請人／保單持有人授權貴公司代表申請人／保單持有人（及受保人）：(i)安排及委任醫療服務提供機構為受保人提供醫療保健服務；(ii)接受醫療服務提供機構就受保人提供醫療服務的直接開帳；(iii)在有需要時，建立、暫停或終止與醫療服務提供機構的關係；(iv)與醫療服務提供機構商議所有有關收費及安排；(v)向受保人追討任何超出保單保障或不合資格的醫療開支；

c) In the event of loss of medical card, the applicant/policyholder must pay for the administrative cost involved in his/her card replacement; 醫療卡如有遺失，申請人／保單持有人必須繳付行政費以換領新卡；d) All Insured Persons must be in full-time work on the Policy Effective Date. If the Insured Person is hospitalized or disabled on the date on, or from which he/she would

otherwise have been entitled to the benefit under this policy, the Insured Person shall not be entitled to any benefit from this policy until the day immediately following the termination of his/her hospitalization or disablement.

所有受保人於保單生效日必須為全職僱員。如受保人於保障生效日當日或之前已入院或染有殘疾，他／她將不能享有保單所載的保障，直至他／她離開醫院或完全康復後翌日，保障計劃才正式生效。

3. The applicant/policyholder further declares and agrees: 申請人／保單持有人聲明及同意：

a) all information that have been provided in connection with this application (whether contained in this application form or otherwise) is complete and true, and together with all information received by the Company as to any subsequent changes in connection with this application shall form the basis and part of the contract;

就此投保申請所提供（不論是否載於此投保申請表格）之一切資料，均為事實之全部並正確無訛，貴公司所收取之一切資料及就此投保申請所有隨後所作之改變將成為訂立合約的基礎及合約的一部份；

b) it has obtained all necessary consent and authorization from its employees and their dependents to supply their information and data to the Company by the applicant/policyholder itself and/or through its representative involved in this application otherwise if the applicant/policyholder fails to provide any such information requested, it may result in the Company’s inability to process and deal with this application. The applicant/policyholder’s employees and their dependents agree that these information and data can be used by the Company to carry on the Company’s businesses.

就此投保申請，已取得所有僱員及其家屬同意及授權，申請人／保單持有人可直接及／或透過其代表向貴公司提供有關資料；倘若申請人／保單持有人未能提供所須資料，貴公司可能因此不能處理此投保申請。申請人／保單持有人之僱員及其家屬均同意該等資料可供貴公司使用，致使貴公司之業務得以順利運作；

c) all its employees have confirmed that they have obtained all necessary consent and authorization from their dependents to supply their information and data to the Company and/or the representative of the Company.

所有僱員確認已向所有其受保家屬取得一切所需同意及授權，可向貴公司及/或其代表提供其有關資料。

4. A photocopy of this authorization shall be valid as the original. 本授權書的影印本與正本均有同等效力。

5. I/We ACKNOWLEDGE AND CONFIRM that I/we have read and understood the Personal Information Collection Statement (“PICS”). I/We confirm that I/we have been advised to read carefully the PICS, and I/we have read it carefully its effect and impact in respect of my/our personal data collected or held by the Company (whether contained in this application or otherwise). Based on the foregoing, I/we hereby give my/our acknowledgement and agree to the use and transfer of my/our personal data by AXA China Region Insurance Company Limited in accordance with the PICS, including the use and provision of my/our personal data for the purpose of direct marketing.

本人／我們確認本人／我們已閱讀並明白收集個人資料的聲明(“該聲明”)。本人／我們確認本人／我們已被通知本人／我們須詳細閱讀該聲明，而本人／我們已詳細閱讀該聲明對貴公司所收集或持有之本人／我們的個人資料的影響(不論是否此表格所載或從其他途徑所取得)。根據以上所述，本人／我們特此確認並同意貴公司根據該聲明使用及轉移本人／我們的個人資料，包括在直接促銷中使用及將本人／我們個人資料提供予其他人士。

[Important: If you do not agree to the use and provision of your personal data for direct marketing as set out in the section “Use and provision of personal data in direct marketing”, please tick the box below and we will not use your personal data for direct marketing.]

[重要通知：如閣下不同意根據“收集個人資料的聲明”使用和轉移閣下的個人資料作直接促銷用途（參閱“在直接促銷中使用及將其個人資料提供予其他人士”部份），請在下列方格內加上剔號（“✓”），本公司將不會使用閣下的個人資料作為直接促銷用途。]

I/We do not agree with the use and provision of my/our personal data for direct marketing purposes as set out above in the “Personal Information Collection Statement” (see “Use and provision of personal data in direct marketing”) and do not wish to receive any promotional and direct marketing materials.

本人／我們不同意貴公司根據“收集個人資料的聲明”使用和轉移本人／我們的個人資料作直接促銷用途（參閱“在直接促銷中使用及將其個人資料提供予其他人士”部份）及並不願意接收任何貴公司的推廣及直接促銷的材料。

Authorized Signature with Company Chop on behalf of the Applicant 獲授權人簽署及公司蓋章：

Position 職位：

Date of Signing 簽署日期： (

Name of Authorized Person 獲授權人姓名：

Identity No. 身份證明文件號碼：

DD日 / MM月 / YY年 )

(please provide Board of Resolution/written authority from Authorized Person 請提供董事會決議/書面授權)

Identity Document Type 身份證明文件類型：(please provide certified true copy 請提供認證副本)

Employee Benefits 僱員福利Unit 2201 - 2206, 22/F., Manhattan Place, 23 Wang Tai Road, Kowloon Bay, Kowloon, Hong Kong 香港九龍九龍灣宏泰道23號22樓2201 - 2206室

Email 電郵: [email protected] Website 網址: www.axa.com.hk Telephone 電話: 2519 1166 Fax 傳真: 2598 6502

AXA China Region Insurance Company Limited 安盛金融有限公司


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Network Dental Services (Optional)+

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Emergency Consultations and Dressings for Pain Relief within office hours

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+ Network Dental Services will be subject to the terms and conditions of the service provider.

Start putting the SelectCare Employee Insurance Package Plan to work for your company today!To find out more about the SelectCare plan, please contact your AXA insurance consultant today.

Annual Fee

HK$400(per person)

LIFE BENEFIT

• No exclusion, except for the contestability of non-disclosed

material facts during the first year of coverage.

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS

•

•

Any disease and sicknesses • Suicide •

civil commotion and revolution • Actions not permitted by law

(except traffic or pedestrian offences) • Any police action or

•

Nuclear, chemical and biological terrorism

MEDICAL BENEFITS

Exclusions

(Not for use in Mainland China)

participation in a brawl or felony Radioactive contamination

War, strikes, riots,

ABOUT AXA HONG KONGAXA Hong Kong, a member of the AXA Group, prides itself of serving over 1 million customers1 in Hong Kong and Macau. Besides being one of the largest health protection providers in Hong Kong, it is also the number 1 General Insurance provider2 and a market leader in motor insurance.AXA Hong Kong is committed to helping its customers achieve stability and prosperity through providing a comprehensive range of life, health, property and casualty protection, as well as wealth management and retirement solutions.We believe it is our inherent responsibility to support the communities we operate in, hence creating a sustainable business via constant and considerable contribution in the dimensions of health, environment and the community.

1 Including customers of AXA China Region Insurance Company Limited, AXA China Region Trustees Limited and AXAChina Region Insurance Company (Bermuda) Limited (incorporated in Bermuda with limited liability)

2 Based on 2013 Office of the Commissioner of Insurance market share statisticsAXA China Region Insurance Company LimitedEmployee BenefitsUnit 2201 - 2206, 22/F., Manhattan Place, 23 Wang Tai Road, Kowloon Bay, Kowloon, Hong KongTel: (852) 2519 1166 Fax: (852) 2598 6502 Website: www.axa.com.hk

• Pre-existing conditions • General check-up, pregnancy, any elective treatment such as cosmetic surgery, sterilization and beautification • Participating in illegal acts (except trafficand pedestrian offences) • Dental care unless resulting from accidental injury • War, strikes, riots, civil commotion and revolution • Benefits compensated by law or other insurance policies • Congenital anomalies • Any Physiotherapy treatmentand treatment by a Chiropractor unless recommended by a Doctor and treated in a registered clinic or hospital • Convalescence, custodial or rest care, preventive inoculation or medication• Correction of eye vision or fitting of eye glasses • Rental or purchase of prosthetic applicances such as but not limited to hearing aids, artifical limbs, glasses or corset


Accidental death and dismemberment benefit scheduleAccidental death or dismemberment benefits will be paid as per a percentage of the maximum benefit as set out in the Schedule to the relevant policy.

ITEM % OF MAXIMUM BENEFIT

ITEM % OF MAXIMUM BENEFIT

For loss of For loss of

Life 100% All fingers of one hand 45%

Two limbs 100% Thumb – both phalanges 15%

Sight of both eyes 100% Thumb – one phalanx 8%

One limb and sight of one eye 100% Index finger 10%

One limb 50% Middle finger 6%

Sight of one eye 50% Ring or little finger 4%

All toes on one foot 15%

For permanent and total paralysis of Great toe – both phalanges 5%

All limbs 100% Great toe – one phalanx 2%

Three limbs 75% Any other toe 2%

Two limbs 50%

One limb 25% For removal of lower jaw by surgical operation 30%

For permanent and total loss of

Hearing in both ears 70%

Hearing in one ear 20%

Loss of a limb refers to an actual severance at or proximal to the wrist or ankle joint.

Loss of a thumb or a finger refers to the actual severance at or proximal to the metacarpophalangeal joint.

Loss of a toe refers to the actual severance at or proximal to the metatarsophalangeal joint.

If an insured member sustains more than one loss in the above list as a result of the same accident, the total amount payable on account of such losses shall be limited to the amount of maximum benefit.

Eligibility• Applicable for companies with 3 – 15 employees.

• You can set different classes of benefits for different employee levels, e.g. Benefits Class 1 with Plan 1 benefits

for Directors and Benefits Class 2 with Plan 3 benefits for your general staff. You may also set a maximum of 2

Benefits Classes for 4 – 9 employees; a maximum of 3 Benefits Classes for 10 – 15 employees.

•

Participation guidelines• For dependant coverage:

(1) all eligible dependants, i.e. spouse and child(ren) of insured employee, must enroll.

(2) all eligible dependants must be insured at the same benefit level as the insured employee.

(3) dependants are entitled to medical benefits only (excluding Life and Accidental benefits).

The above Benefit Schedule contains general information of SelectCare Employee Benefits Insurance Package Plan only. This is not a policy. For detailed terms, conditions, limitations and exclusions of SelectCare Employee Benefits Insurance Package Plan, please refer to the relevant policy. This plan is subject to our Company’s terms and conditions. Our Company reserves the final right to approve any policy application.

Covers employees and spouses aged 16 − 59 years, unmarried children aged 14 days − 18 years and full-time

students below age 23.


Benefits schedule

BENEFIT ITEMMAXIMUM LIMIT PER MEMBER (HK$)

Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6

LIFE AND ACCIDENTAL INSURANCE

Death Benefit 150,000 100,000 10,000 10,000 10,000 10,000

Accidental Death and Dismemberment Benefits* 150,000 100,000 10,000 10,000 10,000 10,000

MEDICAL INSURANCE

HOSPITAL BENEFITS

Reimbursement Percentage (%) %08%001

Daily Room & Board per day (Max. 60 days) 2,000 1,200 600 450 600 450

Doctor’s Visit per day (Max. 60 days) 2,000 1,200 600 450 600 450

Hospital Expenses 30,000 18,000 8,000 6,000 8,000 6,000

Surgeon’s Fee Super Major 95,000 60,000 35,000 25,000 35,000 25,000

Major 47,500 30,000 17,500 12,500 17,500 12,500

Intermediate 23,750 15,000 8,750 6,250 8,750 6,250

Minor 9,500 6,000 3,500 2,500 3,500 2,500

Anaesthetist’s Fee Super Major 28,500 18,000 10,500 7,500 10,500 7,500

Major 14,250 9,000 5,250 3,750 5,250 3,750

Intermediate 7,125 4,500 2,625 1,875 2,625 1,875

Minor 2,850 1,800 1,050 750 1,050 750

Operating Theatre Expenses

Super Major 28,500 18,000 10,500 7,500 10,500 7,500

Major 14,250 9,000 5,250 3,750 5,250 3,750

Intermediate 7,125 4,500 2,625 1,875 2,625 1,875

Minor 2,850 1,800 1,050 750 1,050 750

Intensive Care per day (Max. 10 days) 3,000 2,400 1,200 600 ------- -------

Specialist’s Visits (Referred by attending doctor) 8,000 6,000 4,000 2,000 ------- -------

Home Nursing per day (Max. 60 days referred by attending doctor) 1,000 600 ------- ------- ------- -------

Additional Benefits for Accident 6,000 4,500 ------- ------- ------- -------

Post-Operation Doctor’s Visits (at Home and Office) 1,600 1,600 ------- ------- ------- -------

Maximum Limit Per Disability Per Member 527,600 330,100 152,000 108,000 136,000 100,000

Comprehensive Emergency Assistance Services

Enjoy 24-hour-a-day, 7-day-a-week access to the following services via our worldwide network of emergency assistance service ce ntres: Hotline services, including pre-trip referral information, medical and legal referral services.Medical emergency evacuation and / or repatriation services.Repatriation of mortal remainsWorldwide hospital deposit guarantee (up to US$5,000) . #

Over 200 hospitals in China are included throughout the China Hospital Network.

# Member is required to repay any sum advanced within 45 days (without interest).

CLINICAL BENEFITS (OPTIONAL)

Reimbursement Percentage (%) 80%

Doctor’s Visit at Office per visit per day 300 240 180 140 140 120

Doctor’s Visit at Home per visit per day 600 480 ------- ------- ------- -------

Specialist’s Visit per visit per day (Referred by attending doctor) 600 480 360 280 280 240

Chinese Herbalist’s Visit per visit per day 200 160 ------- ------- ------- -------

X-ray and Lab-Tests per disability (Referred by attending doctor.) 3,000 2,000 1,500 1,000 1,000 500

Total Doctor’s, specialist’s and Chinese Herbalist’s visits limited to a maximum of 30 visits per policy year.Specialist’s visits are limited to a maximum of 10 visits per policy year.Chinese Herbalist’s visits are limited to a maximum of 5 visits per policy year.

Notes: Benefits payable are reimbursements of actual costs with the above figures being the maximum amount.

The SelectCare Plan offers you a choice of six different levels of benefits:Plan 1 and 2 - Top-of-the-range private and semi-private level benefitsPlan 3 and 4 - Comprehensive ward level benefits with 100% reimbursement of hospital expensesPlan 5 and 6 - Basic ward level benefits with 80% reimbursement of hospital expenses


Accident and Hospital Benefits with optional Clinical Benefits

at extremely competitive premiums.

Covers as few as 3 employees.

Simple application procedure and easy administration -

normally, no medical examination is required.

Clinical cover offers a free choice of doctors plus a medical

card covering over 2,000 physicians.

Comprehensive emergency assistance service.

Medical card with China Hospital Network offers hospital

deposits guarantee to over 200 hospitals in Mainland China.

Easy extension of medical benefits to cover dependants.

24-hour worldwide coverage.

A totally flexible choiceWhen your company takes advantage of the SelectCare plan, you will be able to choose one of the benefits options as outlined bel ow:

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----2 Life and Accidental + Hospital + Clinical Benefits

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Same option applies to all classes of employees if more than one class of employees is set.

(Please refer to Eligibility section next page for full details.)

Comprehensive cover choices to suit your business needs

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Payment of a cash lump sum for all causes of death.

Payment of pre-specified accidental death and dismemberment benefit amount for loss of life, limbs, hearing, sight and fingers, etc. as a result of accidents.

Reimbursement up to the full insured amount for hospital and surgical expenses following accident or sickness.

Benefits include daily room and board charges, hospital expenses, surgeon’s and anaesthetist’s fees, operating theatre expenses, intensive care benefits, etc.

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Reimbursement of 80% of clinical expenses up to the insured amount.

Benefits include visits by general practitioners, specialists and Chinese herbalists, X-rays and laboratory test’s expenses.

clinics (with co-payment).

You can add a full range of annual dental care services on top of the insurance plan.

^ Network Dental Services are provided by the service provider designated by AXA from time to time at its sole discretion subject to separate service charges payable by the employer to such service provider. AXA accepts no liability or responsibility for these services. The Network Dental Services provided will be subject to the terms and conditions of the service provider.

As a dependable business companion, AXA understands that it is important to protect

your company and employees in every way you can. To ensure the smooth growth

of your business and build up employee loyalty, we have specially designed

the SelectCare Employ Insurance Package Plan with a

and medium-sized companies with 3 or more employees, SelectCare offers

you a number of easy and remarkably cost-effective ways to show your

staff just how highly you value them.

Key product featuresProvides a wide range of benefits including Group Life,

Extensive panel doctor service facility for visitors to network



employee benefi tsI want a comprehensive range of life and medical benefits for my employees

SelectCare Employee Benefi ts

InsurancePackage Plan

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SelectCare-Emloyee Network Services Plan-1411-V1.indd 1 17/11/2014 6:00 PM

SelectCare-Emloyee Network Services Plan-1411-V1.indd 2 17/11/2014 6:00 PM

Documents

我希望為我的僱員 提供全面的人壽及醫療保障 · (1) 所有符合資格的家屬，包括投保僱員之配偶及子女必須參加。 (2) 所有符合資格的家屬，其保障等級必須與有關受保僱員相同。

我希望為我的僱員提供全面的人壽及醫療保障 · (1) 所有符合資格的家屬，包括投保僱員之配偶及子女必須參加。 (2) 所有符合資格的家屬，其保障等級必須與有關受保僱員相同。