So Tay BH 2013 - Nhan Vien VNG

INSURANCE HANDBOOK

S TAY BO HIM

Combined Personal Accident & Healthcare Insurance

Chng Trnh Bo Him Tai Nn V Sc Khe

Nhm

Nhn Vin

Cng ty TNHH Mi gii bo him Gras Savoye Willis Vit nam

- Vn phng chnh: P.708, 37 Tn c Thng, Q. 1, TP.HCM

- Chi nhnh : P.415, ta nh Corner Stones, 16 Phan Chu Trinh, H Ni

Phng bo him tai nn & sc khe:

Ms. Nguyn Th Ngc Tuyt Chuyn vin khch hng.

T: (84-8) 3910 0976 Ext. 175

Email: [email protected]

Ms. Bi Th Hong Yn Gim c nghip v

T: (84-8) 3910 0976 Ext. 123


Cng ty gii quyt bi thng

Cng ty TNHH dch v Nam

(tn ting Anh: South Asia Services company limited (SAS))

C: tng 3A, ta nh Central Park,

208 Nguyn Tri, Q.1, HCM.

T: (84 8) 39256780 / (84 8) 39256192/ (84 8) 39256193


Cng ty Bo Vit Si Gn:

C: 233 ng Khi, qun 1, TP.HCM.

Ms. L Th Thy Tm Trng phng

T: (84 8) 38251500 Ext 123


Nu c bt k thc mc no lin quan n chng trnh bo him ny,

vui lng lin h vi chng ti theo thng tin sau:

I N S U R A N C E B R O K E R S

I N S U R A N C E B R O K E R S

S tay bo him ny ch mang tnh cht tham kho,

khng c gi tr thay th hay b sung cho hp ng bo him.

PHM VI BO HIM

Hp ng ny bo him 24/7, trong phm vi lnh th Vit Nam.

CNG TY BO HIM

Cng ty Bo Vit Si Gn.

I TNG C BO HIM

- Nhn vin VNG

- Ngi thn c chuyn quyn: bao gm b m, v chng, con ci.

- Ngi thn (nhm Coreteam, SMT) c cng ty mua bo him: bao gm b m, v chng, con ci, anh

ch em rut.

Lu : Nhng i tng sau khng thuc i tng bo him: Nhng ngi b bnh tm thn, phong; nhng

ngi b tn ph hoc thng tt vnh vin t 50% tr ln;

NI IU TR

Ngi c bo him c th s dng dch v ti tt c cc c s y t c cp giy php hot ng hp php

trong lnh th Vit Nam (c th cp ha n ti chnh (ha n VAT) cho dch v ca h) bao gm: bnh vin,

trung tm y t, phng khm cng, t, lin doanh hoc 100% vn nc ngoi. Tuy nhin, khi iu tr ni tr ti bt

c bnh vin t hay 100% vn nc ngoi, tin phng c gii hn phng n tiu chun.

M rng : Chi ph khm hoc iu tr ti phng mch bc s t vi cc iu kin sau:

- Chi ph khm bnh: yu cu cung cp bin lai tin khm bnh vi s tin theo quy nh.

- Tin thuc s c thanh ton nu thuc c mua ti nh thuc c cp php ch khng phi ti phng

mch (bc s t khng c quyn bn thuc).

- Toa thuc trn VND200,000 yu cu nh thuc cp ha n VAT. Nu di VND200,000 xut ha n bn

l c ng du ca nh thuc.

- Bc s t c nh ngha nh sau: Mt bc s c cp giy php hnh ngh hp php, c lut php nc

s ti cng nhn v bc s ang iu tr, hnh ngh trong phm vi giy php c cp v trong phm vi

chuyn ngnh o to ca mnh, loi tr nhng bc s chnh l ngi c bo him, hay v (chng) hoc ngi

thn ca Ngi c bo him. Mt bc s c th c cng nhn nh l 1 bc s chuyn khoa hay c vn y t.

1 THNG TIN CHUNG

TERRITORIAL LIMIT

This Policy provides the cover for accident / illness and eligible medical expenses incurred in Vietnam.

THE INSURER

Bao Viet Sai Gon

ELIGIBLE INSURED

- VNGs employee

- Dependants recieving healthcare insurance from employees: including parents, parents in law, spouse,

children.

- Dependants (of Coreteam and SMT) paid by VNG: including parents, parents in law, spouse, children and

siblings.

Note : This policy shall not accept to cover for Person who suffers from mental, disorder disease, leprosy, or

person who is disabled or are informative internally from 50% upward

AVAILABLE HOSPITALS & CLINICS

State-owned and private hospitals or medical centers, joint venture hospitals or 100% foreign-owned hospitals

that are legally licensed for operation in Vietnam. However, when the insured is hospitalized at private hospitals

or 100% foreign-owned hospitals, room & board is limited to standard room.

Extenstion : Treatment at Private doctor's office is covered with the following conditions:

- Consultation charge: the invoice for consultation charge is required and the cost does not exceed the

prescribed amount.

- Drug cost is reimbursed provided that drugs are bought at drug store that are legally licensed and can

provide VAT invoice.

- VAT invoice is required for any drug cost from VND 200,000. Invoice under VND 200,000 must have

drug store's steal.

- Private doctor is defined: Legally licensed medical practitioner recognized by the law of the country where

treatment is provided and who, in rendering such Treatment, is practicing within the scope of his licensing

and training but excluding a Physician who is the Insured Person himself, or the spouse or legal relative of

the Insured Person. A physician may be recognized as a Specialist or a Consultant.

GENERAL INFORMATION1

NI DUNG

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Thng tin chung

Quyn li bo him

Nhng im loi tr

Qui trnh gii quyt bi thng

Danh sch cc chng t cn thit cho vic bi thng

Danh sch bo lnh vin ph.

a ch lin h.

General information

Insurance Benefits

General Exclusion

Claim Settlement procedure.

How to file a claim document.

Direct Billing Network (for Inpatient and Outpatient)

Contact person.

GENERAL INFORMATION

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Khng p dng THI GIAN CH :

THI HN BO HIM

- Thi hn ca mi c nhn c bo him bt u t ngy th hin trn th bo him v kt thc khi nhn vin

ngh vic.

- Thi hn chung ca hp ng bo him ny c th hin trang ba v quyn li bo him/nm l tnh theo

nm ca hp ng ny.

TH BO HIM

c cp 1 ln trong sut thi gian tham gia bo him. Th s khng in li sau mi nm ti tc.

Lu : Trong trng hp Mt th: thng bo vi Phng nhn s c cp li.

WAITING PERIOD: Non- applicable.

PERIOD OF COVER

- The period of cover of each insured member is stated on insurance card until further notice by HR

department.

- The period of cover of this Policy is mentioned on the Cover page.

VIETNAM CARE INSURANCE CARD

The Vietnam Care insurance card is issued once during the whole policy year.

Note : In case Insured lose their Vietnam Care insurance card: Notice HR Department for reissuance.

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QUYN LI BO HIM2 INSURANCE BENEFITS2

CC QUYN LI BO HIM

T gi quy i: 1 USD = 20.880 VND c nh trong sut thi gian bo him

Quyn li c bn

A. T vong & Thng tt vnh vin do Tai nn

- T vong hay thng tt vnh vin ton phn: bi thng 100% s tin c bo him.

- Thng tt vnh vin mt phn: bi thng theo t l thng tt.

B. T vong & Thng tt vnh vin do Bnh / Thai sn

- T vong hay thng tt vnh vin ton phn: bi thng 100% s tin c bo him.

- Thng tt vnh vin mt phn: bi thng theo t l thng tt.

C. Chi ph y t do tai nn (Ni v ngoi tr):

Chi ph cp cu, chi ph phu thut, chi ph nhp vin, chi ph thuc men khng vt qu s tin c bo

him.

D. Chi ph nm vin, phu thut do Bnh / Thai sn v Tai nn

- Chi ph iu tr trong khi nm vin v/hay phu thut, cp cu, thuc men, xt nghim trong phm vi s

tin ti a c bo him.

- Chi ph chm sc thai sn: gm chi ph sinh, sy thai, no thai v l do y t hay bt c bin chng no trong

qu trnh mang thai khi sinh thng hay sinh kh. Khng bao gm chi ph phu thut theo yu cu, phng

sinh gia nh, sinh khng au, sinh hn gi, may thm m, bc s ch nh, chi ph hu vi trng hp

Ngi c bo him (NBH) b bnh v gan, chi ph em b nh tm sot khim thnh, sa, chi ph tr bnh

tt bm sinh ca em b...

Quyn li m rng:

A. iu tr ngoi tr:

- Cc chi ph khm cha bnh, chi ph xt nghim y khoa, chp X quang, chi ph thuc men, vt l tr liu, chp

hnh ct lp, iu tr rng, v.vda theo Hn mc chi ph do Ngi c Bo Him chn.

INSURANCE BENEFITS

Currency exchange rate: $1 = VND 20.880 fixed for the policy period.

Core Benefits:

A. Death, Permanent Disablement following Accident

- In case of Death or Total Permanent Disablement: 100% of Sum Insured.

- In case of Partial Permanent Disablement: Compensation as per scale of permanent disability.

B. Death, Permanent Disablement following Illness

- In case of Death or Total Permanent Disablement: 100% of Sum Insured.

- In case of Partial Permanent Disablement: Compensation as per scale of permanent disability.

C. Medical expenses following accident (Inpatient and Outpatient):

Emergency Costs, Surgical and Hospitalization Costs, Medicine, etc: up to the Limit selected by the

Insured;

D. Hospitalization and Surgical Procedures following Illness, Childbirth & Accident

- Up to the Limit selected by the Insured.

- Maternity care costs: the cost of childbirth, miscarriage, abortion for medical reasons or any other

complications during pregnancy, childbirth or caesarean section.

Additional Benefits:

A. Outpatient Treatment :

- Consultation charges, laboratory tests, X-rays, medical aids, radiotherapy, heat therapy, phototherapy,

medicine, etc: up to limit selected by the Insured.

PH LC V CC NHM QUYN LI BO HIM APPENDIX

BNG QUYN LI BO HIM INSURANCE BENEFIT SCHEDULE

PHN 1: BO HIM TAI NN

Package 1: Personal Accident + Heathcare Insurance (SMT)

Package 2: Personal Accident + Heathcare Insurance (Coreteam)

Package 3: Personal Accident + Heathcare Insurance (Clicker Non sales)

Package 4: Personal Accident + Heathcare Insurance (Clicker Saleman)

SMT PA only: SMT staff transferred healthcare insurance to their dependants, remaining

Personal Accident Insurance only.

Salesman PA only: SMT staff transferred healthcare insurance to their dependants,

remaining Personal Accident Insurance only

Non Salesman PA only: SMT staff transferred healthcare insurance to their dependants,

remaining Personal Accident Insurance only

Dependant of SMT : personal accident + healthcare insurance paid by VNG

Dependant of Coreteam : personal accident + healthcare insurance paid by VNG

Dependant of SMT, Healthcare only: receiving healthcare insurance from SMT staff.

Dependant of Coreteam, Healthcare only: receiving healthcare insurance from Coreteam

staff.

Dependant of Clicker, Healthcare only: receiving healthcare insurance from Clicker staff.

Dependant of SMT: receiving healthcare insurance from SMT staff, personal accident

insurance paid by SMT staff.

Dependant of Coreteam: receiving healthcare insurance from SMT staff, personal accident

insurance paid by Coreteam staff.

Dependant of Clicker: receiving healthcare insurance from SMT staff, personal accident

insurance paid by Clicker staff.

Definition

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Healthcare

Insurance

Accident

Insurance

Insurance benefits

Group 1

Group 2

Group 2

Group 3

Group 1

Group 3

Group 2

Group 4

Group 5

Group 4

Group 5

Group 5

Group 1

Group 2

Group 3

Group 3

Group 1

Group 2

Group 1

Group 2

Group 3

Group 1

Group 2

Group 3

Gi BH 1 BH Sc khe + BH Tai nn (SMT)

Gi BH 2 BH Sc khe + BH Tai nn (Coreteam)

Gi BH 3 BH Sc khe + BH Tai nn (Clicker Non-Sales)

Gi BH 4 BH Sc khe + BH Tai nn (Clicker Salesman)

Gi BH Tai nn ca thnh vin SMT chuyn quyn cho ngi thn

Gi BH Tai nn ca Salesman chuyn quyn cho ngi thn

Gi BH Tai nn ca Non Salesman chuyn quyn cho ngi thn

Gi BH Sc khe + BH Tai nn cho ngi thn SMT bo lnh chi ph bi VNG

Gi BH Sc khe + BH Tai nn cho ngi thn Coreteam bo lnh chi ph bi VNG

Gi BH Sc khe cho ngi thn c chuyn quyn ca thnh vin SMT

Gi BH Sc khe cho ngi thn c chuyn quyn ca thnh vin Coreteam

Gi BH Sc khe cho ngi thn c chuyn quyn ca thnh vin Clicker

Gi BH Sc khe + Tai nn cho ngi thn c chuyn quyn ca thnh vin SMT (mua

thm BH Tai nn)

Gi BH Sc khe + Tai nn cho ngi thn c chuyn quyn ca thnh vin Coreteam

(mua thm BH Tai nn)

Gi BH Sc khe + Tai nn cho ngi thn c chuyn quyn ca thnh vin Clicker

(mua thm BH Tai nn)

nh ngha

Nh

m

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2

3

4

5

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10

11

12

13

14

15

Quyn li bo him

Bo him

sc khe

Bo him

tai nn

Nhm 1

Nhm 2

Nhm 2

Nhm 3

Nhm 1

Nhm 3

Nhm 2

Nhm 4

Nhm 5

Nhm 4

Nhm 5

Nhm 5

Nhm 1

Nhm 2

Nhm 3

Nhm 3

Nhm 1

Nhm 2

Nhm 1

Nhm 2

Nhm 3

Nhm 1

Nhm 2

Nhm 3

PART 1: PERSONAL ACCIDENT INSURANCE

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BASIC COVER

I. DEATH & PERMANENT DISABLEMENT DUE TO

ACCIDENT

II. MEDICAL EXPENSES FOLLOWING

ACCIDENT(Inpatient+Outpatient)

III. DAY OFF WORK CASH BENEFIT FOLOWING

ACCIDENT

IV. DEATH & PERMANENT DISABLEMENT DUE TO

ILLNESS

30 thng

lng

$3,000

06 thng

lng

$10,000

30 thng

lng

$3,000

06 thng

lng

$5,000

50 thng

lng

$3,000

06 thng

lng

$5,000

$10,000

$3,000

Khng

p dng

$10,000

$10,000

$3,000

Khng

p dng

Nhm 1 Nhm 2 Nhm 3 Nhm 4 Nhm 5

$5,000

QUYN LI CHNH

I. T VONG & THNG TT VNH VIN DO TAI NN

II. CHI PH Y T DO TAI NN (Ni v ngoi tr)/nm

III. TR CP LNG DO TAI NN (6 thng)

IV. T VONG & THNG TT VNH VIN DO BNH

Group 1

30 monthly

salary

$3,000

06 monthly

salary

$10,000

Group 2

30 monthly

salary

$3,000

06 monthly

salary

$5,000

Group 3

50 monthly

salary

$3,000

06 monthly

salary

$5,000

Group 4

$10,000

$3,000

Non

Applicable

$10,000

Group 5

$10,000

$3,000

Non

Applicable

$5,000

$5,000

$250/ngy

(m rng

phng VIP)

Bi thng theo

chi ph thc t

$250

$250

$200

$5/ngy

($7/ngy i vi

bnh vin cng)

$300

Bi thng theo

gii hn $250/ngy

nm vin v gii

hn phu thut

Bao gm trong

gii hn $250/ngy

nm vin

$3,000

$150/ngy

(m rng

phng VIP)

Bi thng theo

chi ph thc t

$150

$150

$150

$3/ngy

($5/ngy i vi

bnh vin cng)

i vi nhm nhn vin

Coreteam: $3/ngy,

$6/ngy nu nm

ti bnh vin cng

$250

Bi thng theo

gii hn $150/ngy

nm vin v gii

hn phu thut

Bao gm trong

gii hn $150/ngy

nm vin

$2,000

$100/ngy

Bi thng theo

chi ph thc t

$150

$150

$100

$2/ngy

($3/ngy i vi

bnh vin cng)

Non Coreteam: $2/ngy

$4/ngy nu nm

ti bnh vin cng

$200

Bi thng theo

gii hn $100/ngy

nm vin v gii

hn phu thut

Bao gm trong

gii hn $100/ngy

nm vin

Bi thng theo

chi ph thc t

Bi thng theo

chi ph thc t

Bi thng theo

chi ph thc t

Bi thng theo

chi ph thc t

Bi thng theo

chi ph thc t

Bi thng theo

chi ph thc t

i vi nhm nhn vin

V. HOSPITALIZATION & SURGICAL FOLLOWING$5,000

$250/day

( extend for

VIP room)

Full refund

$250

$250

$200

Full refund

Full refund

$5/day

($7/day for state

own hospital)

$300

Subject to daily

limit $250/day and

Surgical Operation

Limit

Included in the daily

limit US$250/day

$3,000

$150/day

( extend for

VIP room)

Full refund

$150

$150

$150

Full refund

Full refund

$3/day

($5/day for

state own hospital)

Coreteam staff: $3/day

$6/day for state

own hospital

$250

Subject to daily

limit $150/day and

Surgical Operation

Limit


limit US$150/day

$2,000

$100/day

Full refund

$150

$150

$100

Full refund

Full refund

$2/day

($3/day for state

own hospital)

Non Coreteam

Staff: $2/day

$4/day for state

own hospital

$200

Subject to daily

limit $100/day and

Surgical Operation

Limit


limit US$100/day

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PHN 2: BO HIM SC KHE

V. PHU THUT & NM VIN DO BNH

TT/THAI SN (Ni tr + iu tr trong ngy)

Gii hn/nm

1. a. Tin phng (bao gm phng cp cu)

b. Phng chm sc c bit

c. Chi phi y t cho vic iu tr bnh (ph pht

sinh trong thi gian nm vin)

Ti a 90 ngy/nm

2. Chi ph iu tr cp cu (ni tr, ngoi tr, iu

tr trong ngy.

3. iu tr y t trong vng 30 ngy trc khi nhp

vin

4. iu tr sau khi xut vin (45 ngy ngay sau khi

xut vin)

5. Y t chm sc ti nh (ti a 30 ngy/nm)

6. Phu thut k c phu thut trong ngy / cy

ghp ni tng

7. Dch v xe cp cu trong phm vi Vit Nam

8. Tr cp mi ngy nm vin, ti a 60 ngy

9. Chi ph mai tng

10. Chm sc thai sn (khng bao gm

khm thai nh k)

10.1. Bin chng thai sn: iu tr cc bin

chng tin sn, bin chng khi sinh

10.2. Sinh thng: chi ph sinh gm chi ph

thuc men, chi ph sinh thng,

vin ph

10.3. Sinh m

10.4. Chm sc tr s sinh (chi ph chm sc cho em

b trong thi gian m cn nm vin, ti a 7 ngy

sau khi sinh)

ILLNESS (Inpatient only & Day patient)

Limit/year

1. a. Room & Board

b. Intensitive Care Unit

c. Hospital Miscellaneous Expenses due to

illness (charges incurred during an in-patient stay

for medically necessary supplies and services)

Maximum 90 days/year

2. Emergency ward treatment (Inpatient +

Outpatient + Daypatient)

3. Pre-hospitalization treatments (30 days prior to

the hospital admission)

4. Post hospitalization treatments (45 days

immediately following hospital discharge )

5. Home nursing (Up to 30 days / year)

6. Surgical Operation (including Out-patient

Surgery and Organ Transplantation)

7. Local Ambulance Services within Vietnam

8. Hospital cash income - Daily allowance (Up to

60 days)

9. Burial Cost

10.Maternity Care (excluding prenatal check-up)

10.1. Complications of Pregnancy & Childbirth:

treatment of Medical Condition which arises

during the antenatal stages of pregnancy, or a

Medical Condition which arises during childbirth

and requires a recognized obstetric procedure.

10.2. Normal Pregnancy and Childbirth : delivery

costs including medicine, normal delivery,

hospitalization, etc

10.3. Ceasarean Section

10.4. Newborn Care (Limit to 7 days after birth

QUYN LI CHNH BASIC COVERNhm 1 Group 1Nhm 2 Group 2Nhm 3 Group 3

PART 2: HEALTHYCARE INSURANCE

$1,000

(SMT Staff: $1,100)

$20/day

(SMT Staff: $22/day)

$220

Limit $60/year

Full refund,

up to limit

$220/year

$60/ pregnancy

$700

(Coreteam

Staff: $720)

$15/day

$150

Limit $50/year

Full refund,

up to limit

$150/year

$40/ pregnancy

$500

No limit No limit No limit

$10/day

$120

Limit $40/year

Full refund,

up to limit

$120/year

$30/ pregnancy

$1,000

(Nhm nhn vin

SMT: $1,100 )

Khng gii hn

$20/ngy

(Nhm nhn vin

SMT: $22/ngy)

$220

Ti a $60/nm

Theo chi ph

thc t n

$220/nm

$60/thai k

$700

(Nhm nhn vin

Coreteam: $720)

Khng gii hn

$15/ngy

$150

Ti a $50/nm

Theo chi ph

thc t n

$150/nm

$40/thai k

$500

Khng gii hn

$10/ngy

$120

Ti a $40/nm

Theo chi ph

thc t n

$120/nm

$30/thai k

IU TR NGOI TR

Gii hn/nm

1. Gii hn ti a 1 ln khm

2. Vt l tr liu

ti a 60 ngy

3. Chm sc rng (gii hn/nm)

3.1. Co vi rng

3.2. C bn: khm v chn on bnh, chp

xquang, tr vim nu, trm rng bng cht liu

thng thng (c th amalgam, composite), tr

ty, chn rng, nh rng bnh l.

3.3. c bit: ly vi rng, nh rng phu thut,

ly chn rng, ly u vi rng, phu thut ly

nh chn rng

4. Khm thai nh k (5 ln/thai k)

QUYN LI M RNG Nhm 1 Nhm 2 Nhm 3

OUTPATIENT TREATMENT

Limit/year

1. Limit of indemnity per doctor visit

2. Physiotherapy (Maximum 60 days )

3. Dental Care (Limit/year)

3.1. Scaling treatment

3.2. Basic dental care: Examination & Diagnosis,

X-ray, gingivitis, normal compound filling

(amalgam or composite or fuji), root canal

treatment, extraction of decayed teeth

3.3. Special Treatment: removal of solid

adontomes, Removal of roots, Removal of

impacted, buried or un-erupted teeth

4. Prenatal check up, maximum 5

times/pregnancy

ADDITIONAL COVERGroup 1 Group 2 Group 3

Note: In respect of Hospitalization & surgical following illness, maternity:

1. The maximum amount of compensation/year: The total amount which the insurer pays for hospitalization, surgery,

childbirth of the Insured in the policy year.

2. The maximum limit for a day at the hospital: the maximum amount the insurance company pays to the insured in a

day at hospital. If the number of days in the hospital as "a", the maximum compensation limit/day is "b". The

maximum amount of compensation for hospitalization period = a * b

3. The maximum limit for surgery: The maximum amount the insurance company pays for the surgery. In the case of

surgery, the cost will be divided into two parts: the cost of the surgery: paid the practical expense; cost of

hospitaliztion before and after surgery (if any) paid by the term hospitalization charges per day.

4. Hospital cash income is not paid in case of day-patient (not enough 24 hours)

5. Calculation of hospital cash income daily allowance: based on hospital discharge record (taken on discharge date

minus admission date). For public hospitals: discharge date - admission date + 1.

9 10

SMT Coreteam Staff

NHNG IM LOI TR3 GENERAL EXCLUSION3

P DNG CHO TT C CC IU KIN BO HIM (Bao gm c cc iu khon m rng)

Bo Vit khng chu trch nhim chi tr tin bo him i vi cc trng hp di y:

1. Hnh ng c ca Ngi c bo him hoc ngi tha k hp php;

2. Ngi c bo him t 14 tui tr ln vi phm nghim trng php lut phi th n hnh s v vi phm lut

l an ton giao thng;

3. Hu qu ca vic ung ru bia vt qu nng qui nh 50 miligam/100mililit mu hoc 25 miligam/ 1 lt

kh th. Ngi c bo him b nh hng bi cc cht kch thch khc l nguyn nhn trc tip ca tai

nn;

APPLIED TO ALL CONDITIONS (including all extension clauses)

The Insurer shall not be liable in respect of death or injury or illness or disease caused by:

01. Wilful misconduct of the Insured Person or the legal heir.

02. Grave violation of law, regulation and other rule of the local authority or other social bodies and serious

violation of traffic regulations by the 14 year-old and over Insured Person.

03. The use of and under the influence of alcohol, beer or other similar stimulants by the Insured Person,

when it is proven that it has been the direct cause of the accident.

Lu : i vi Nm vin, Phu thut do Bnh, Thai sn

1. S tin bi thng ti a/nm : Tng s tin cng ty bo him phi chi tr cho vic nm vin, phu thut, sinh

con ca Ngi c bo him trong nm bo him.

2. Gii hn ti a cho mt ngy nm vin : s tin ti a cng ty bo him tr cho ngi c bo him trong mt

ngy nm vin. Nu s ngy nm vin l a, gii hn bi thng ti a/ ngy l b. S tin bi thng ti a cho

thi gian nm vin = a *b

3. Gii hn ti a cho phu thut : S tin ti a cng ty bo him tr cho mt ca phu thut. Vi trng hp phu

thut, chi ph s c chia thnh 2 phn: Chi ph ca phu thut: thanh ton theo chi ph thc t; Chi ph cho thi

gian nm vin trc & sau phu thut (nu c): thanh ton theo gii hn ngy nm vin

4. Tr cp ngy nm vin khng chi tr trong trng hp iu tr trong ngy (nm vin cha 24h)

5. Cn c tnh s ngy tr cp ngy nm vin: da vo giy ra vin (ly ngy xut vin tr ngy nhp vin). i

vi bnh vin cng: ly ngy xut vin tr ngy nhp vin + 1.

11 12

04. The Insured Person's act of fighting, unless such act can be proved that it is self-defence.

05. Medical treatment or use of medicaments or medicines without applying prescription or indication of the

physician.

06. Participating in air transport activities (except in the capacity of an air passenger), military demonstration

or training, fighting in armed forces.

07. Earthquake, volcanic eruption, radioactive contamination;

08. War, civil war, strike, terrorism, riots, civil commotion, rebellion or any civil activities of the head of any

organizations aiming to overthrow, threaten the government or control by force.

09. Training or competing in any professional sports, any racing activity.

10. Syphilis, gonorrhoea, pulmonary tuberculosis; malaria fever.

11. Treatment of sexually transmitted disease, Human Immunodeficiency Virus (HIV) related illness

including Acquired Immune Deficiency Syndrome (AIDS) Related Complex and/or any mutation,

derivation, or variation thereof, impotence treatment or sex- transformation, any AIDS-related Complex

(ARC) and any other AIDS related conditions or diseases.

12. Treatment and/or surgical operation for on birth diseases; congenital anomaly, operations which is

planned before the insurance takes effect.

13. Routine health Check-ups (In-patient or Out-patient): hospitalization for the purpose of clinical test or

medical expertise which in manner that has no relationship to the treatment of illness or injury; including

gynaecological/urological examination, newborn neo-natal care, inoculations, vaccinations and

preventive medicines, periodical prenatal care. However, in cases of periodical checkups detect

diseases and have diagnostics of doctors, Bao Viet agrees to pay costs related to the examination and

treatment of this disease.

14. Normal eye tests, normal hearing tests, non-medical/natural degenerative eye defects, including, but not

limited to myopia, presbyopia and astigmatism and any corrective surgery for non-medical/natural

degenerative sight and hearing defects.

15. Treatment or operation at the request of the Insured Person which is in anyway not the normal

therapeutics.

16. Aesthetic surgery and orthopaedics, functional rehabilitation not following an insured illness.

17. Cost of providing, maintaining, fixing or replacing any external and internal (organ) prostheses, as stated

in Definition section (applied for D condition and Out-patient). Other false parts like dentures, hearing

aids, medical glasses, crutches, medical stockings, blood glucose meter, stent, longo scapel,

wheelchairs and other orthopaedic devices.

18. Dietary supplements and substances which are available naturally and that can be purchased without

prescription, including but not limited to vitamins, mineral and organic substances.

19. Implementing measures of birth control, the consequences of abortion due to psychological or social

causes, infertility treatment, artificial insemination, treatment of impotence, or sex changes and any

consequences or complications of above treatments.

20. Treatment for weight control (increase or decrease in weight).

21. Treatment at private doctors' offices, licensed dental clinic which can issue red invoices according to the

regulations unless it is stated otherwise in the schedule.

22. Treated for mental/nervous or mental disorder, accept to cover cases of acute mental.

4. Cc hnh ng nh nhau ca Ngi c bo him, tr khi chng minh c hnh ng nh nhau

ch vi mc ch t v;

5. iu tr y t hoc s dng thuc khng c n thuc v s ch dn ca bc s;

6. Tham gia vo cc hot ng hng khng (tr khi vi t cch l hnh khch), tham gia cc cuc din tp

hun luyn qun s, tham gia chin u ca lc lng v trang;

7. ng t, ni la, nhim phng x;

8. Chin tranh, ni chin, nh cng, khng b, bo ng, dn bin, phin lon cc hot ng dn s hoc

hnh ng ca bt k ngi cm u ca t chc no nhm lt , e da chnh quyn, kim sot bng v

lc;

9. Tham gia tp luyn hoc tham gia thi u cc mn th thao chuyn nghip, bt k hot ng ua no;

10. Bnh giang mai, bnh lu, bnh lao phi bnh st rt;,

11. iu tr cc bnh ly lan qua ng tnh dc, m au lin quan n cc bnh thuc hi chng suy gim

min dch (HIV) bao gm cc hi chng lin quan n AIDS v/hoc bt c bin chng hoc bin i no,

iu tr bnh lit dng hoc bnh ly truyn qua ng tnh dc hay bt c hi chng lin quan n AIDS

hoc cc bnh lin quan n AIDS khc;

12. iu tr v/hoc phu thut cho cc bnh di truyn, d tt, khuyt tt bm sinh, bnh d dng v gien, nhng

ch nh phu thut c t trc ngy bt u bo him;

13. Kim tra sc khe nh k (ni tr hay ngoi tr); Gim nh y khoa hoc t vn y t khng lin quan n

iu tr m au hoc thng tt, bao gm c kim tra ph khoa/nam khoa; Xt nghim nh k, khm nh

k cho tr mi sinh, tt c cc hnh thc tim chng, vc-xin v thuc phng nga (tr trng hp tim vc-

xin sau khi b tai nn hay sc vt, cn trng cn); Khm thai nh k cho nhm di 50 ngi

Tuy nhin, khi ngi c bo him c triu chng bnh, i khm v bc s a ra chn on bnh ban

u v ch nh lm nhng kim tra, xt nghim cn thit phc v cho vic tm nguyn nhn bnh

nhng kt qu cui cng l bnh thng hoc cha tm ra bnh l c th no, Hp ng ny vn ng chi

tr cho nhng chi ph kim tra, xt nghim nh vy;

14. Kim tra th lc, thnh gic thng thng, iu tr suy bin t nhin/khng phi v l do bnh l ca cho vic

suy gim thnh th lc, bao gm nhng khng gii hn cho cc tt khc x nh cn th, vin th v lon th

v bt k phu thut phc hi hiu chnh no i vi cc khuyt tt thoi ha thnh gic v th gic;

15. iu tr hoc phu thut theo yu cu ca Ngi c bo him m khng phi iu tr theo cch thng

thng;

16. Phu thut thm m, chnh hnh thm m

17. Cc iu tr mang tnh cht thm m bao gm nhng khng gii hn vic iu tr tng sc t (nm da),

iu tr mn, trng c, iu tr chng rng tc b loi tr ring i vi iu kin ngoi tr. Trng hp

ngi c bo him b nhng bnh ny phi iu tr ni tr th vn c gii quyt theo iu kin D- iu

tr ni tr do m au, bnh tt, thai sn.

18. Chi ph cung cp, bo dng, sa cha hay thay th thit b h tr iu tr hay b phn gi (v d nh

nng chng, my o ng huyt, v y t, stent, dao m tr trong phng php m Longo). Tuy nhin

ring phn s dng a m, np, vis c nh vo c th c p dng nh sau:

o i vi iu tr bnh c xng khp : loi tr i vi c iu kin D v ngoi tr

o i vi trng hp tai nn : p dng sublimit 10% STBH ca chi ph y t do tai nn

19. Cc cht b sung hoc thay th phc v cho vic n king c sn trong t nhin v c th c mua m

khng cn ch nh, bao gm nhng khng gii hn vi cc loi vitamin, khong cht v cc cht hu c(

tr trng hp cc loi vitamin c ch nh ca bc s v chi ph cho cac loi thuc ny khng ln hn chi

ph thuc iu tr)

20. Thc hin cc bin php k hoch ha gia nh, hu qu ca ph thai do nguyn nhn tm l hay x hi,

iu tr v sinh nam/ n, th tinh nhn to, iu tr bt lc, hoc thay i gii tnh v bt k hu qu hay

bin chng no t nhng iu tr trn;

21. iu tr kim sot trng lng c th (tng hoc gim cn);

22. iu tr bnh tm thn/ thn kinh hoc ri lon tm thniu tr ri lon gic ng, mt ng, suy nhc v

hi chng cng thng do cng vic (stress) hoc cc bnh c lin quan t hi chng ;

23. iu tr ti phng mch bc s t, phng nha t nhn khng c giy php hnh ngh v khng cung cp

c chng t/ha n ti chnh theo quy nh ca lut php tr trng hp c quy nh khc c ghi r

trong Bng tm tt hp ng bo him hoc Sa i b sung;CLAIM SETTLEMENT PROCEDURE4

INPATIENT & OUTPATIENT TREATMENTS WITHIN DIRECT BILLING NETWORK IN VIETNAM

Please refer on the Direct Billing Network list in Index, or contact South Asia Service company limited (SAS) for

the updated list.

Show your Membership Card and proof of identification to the receptionist prior to the consultation.

Sign the Letter of Guarantee for the hospital expenses or the claim form to acknowledge receipt of

the treatments before discharge from hospital.

Settle any co-payment amount, excess amounts or uninsured items with the hospital prior to

leaving.

INPATIENT & OUTPATIENT TREATMENTS OUTSIDE DIRECT BILLING NETWORK

Settle all medical expenses to treatment provider.

Collect proof of claim: medical records, original invoices and receipts. VAT invoice is required for

any expense from VND 200,000 as regulated by the Ministry of Finance.

Carefully fill the Claim form.

Submit claim file to South Asia Service company limited.

SAS nhn h s yu

cu bi thng

SAS xc nhn vic

h s bng email

H s

khng y

H s

y

SAS email yu cu b

sung h s (nhc nh 3 ln

mi 5 ngy lm vic)

SAS khng nhn c

y h s

H s c gi tr li

cho khch hng

SAS thng bo bi

thng bng email

2 ngy lm vic

5-8 ngy

lm vic

SAS recieves claim

documents

SAS confirm receipt

by e-mail

Documents

uncompleted

Documents

completed

SAS requests additional

documents by e-mail (remind

3 times each 5 working days

SAS did not recieved

missing documents

Claim documents are

sent back to client

SAS sends notice of

settlement by e-mail

2 working day

5-8 working

days

13 14

QUY TRNH GII QUYT BI THNG4

IU TR NI TR & NGOI TR TRONG MNG LI BO LNH VIN PH TI VIT NAM

bit cc phng khm, bnh vin no c bo lnh vin ph, vui lng tham kho danh sch nh km hoc

lin h vi Cng ty TNHH dch v Nam (SAS) c danh sch mi nht.

Truc khi nhp vin:

Xut trnh th bo him v giy CMND (hoc giy khai sinh nu l con ca nhn vin cha c giy

CMND) ti quy nhn bnh ca bnh vin.

Trc khi xut vin:

K tn vo cc bin nhn, bin lai xc nhn vic iu tr hay cc dch v y t s dng.

Thanh ton cc chi ph y t khng thuc phm vi bo him hoc vt qu hn mc trch nhim cho

php trc khi xut vin.

IU TR NI TR & NGOI TR NGOI MNG LI BO LNH VIN Ph

Khch hng t thanh ton chi ph iu tr.

Thu thp h s chng t y t & cc ha n. Mi chi ph trn 200,000 VND phi c ha n VAT.

in Giy yu cu bi thng. Np h s v cho cng ty TNHH Dch v Nam (SAS).

Lu : nn copy h s yu cu bi thng trc khi gi i phng trng hp tht lc.

Giy yu cu tr tin bo him (claim form): c in y thng tin ca ngi c bo him.

Chng t: vui lng xem chi tit bn di. Trong tt c cc trng hp, chi ph trn 200.000VND bt buc phi c ha

n ti chnh.

Note: Insured should make copies of all claim file for record. Required documents:

Claim form: The Insured information is a must.

Documents: Please refer to the following list. VAT invoice is required for any expense from VND 200,000 as

regulated by the Ministry of Finance.

DANH SCH CC CHNG T CN THIT CHO VIC BI THNG5 LIST OF DOCUMENTS5

15 16

Chng t y t

Chng t ti chnh

Giy ngh bi thng

Ch nh ngh ca bc s v Xc nhn ca

phng nhn s v s ngy ngh vic thc t

(Trong trng hp ngh iu tr)

Bin bn tai nn

Giy t xe, bng li xe (nu tai nn giao thng)

STT Chng t Lu

Bn photo c chp thun

Bn gc

Ti t website www.gsw.com.vn

Tai

nn

Ni

tr

Ngoi

tr

Bn photo c chp thun

Bn gc

Sao y bn chnh

Medical documents

Financial documents

Claim form

The request for day-off work by attending

doctor or the verification of the actual days

off work by HR Department

Accident report

Vehicle registration, Driving license (if

traffic accident)

No. Documents Accident In-patient Out-patient

1

2

3

4

5

6

x

x

x

x

x

x

x

x

x

x

x

x

x

Note

1

2

3

4

5

6

Photocopy is acceptable

Original

Download from: www.gsw.com.vn

Photocopy is acceptable

Original

Notarized copy

x

x

x

x

x

x

x

x

x

x

x

x

x

Chi tit yu cu i vi tng loi chng t Speacific documents for each kind of above documents

Chng t Documents

H s iu tr ngoi tr (tai nn) Documents for Out-patient treatment (accident)I I

I.1 I.1

Cc yu cu Requirements

1. Tn y ca ngi c bo him (bt buc phi c)

2. Ngy thng nm sinh (DD/MM/YYY) (bt buc phi chnh xc)

3. M s th bo him (bao gm c phn sau / nu c)

4. Tn cng ty ni ngi tham gia bo him ang lm vic

5. S in thoi lin lc (s di ng)

6. a ch email lin lc

7. Thng tin ti khon ngn hng

Full name of Insured person (requested)

Date of birth (DD/MM/YYY) (must follow format)

Vietnam Care insurance card number (include the part following / if any)

Name of the Insured's employer

Contact phone number (cell-phone number)

Email

Bank account information

Ch nh v kt qu cc xt nghim, siu m, chp XQ (nu c) vi cc thng tin sau:

1. Tn bnh vin/phng khm c in sn hoc th hin qua con du

2. Ngy iu tr

3. Thng tin ngi bnh: H tn, ngy thng nm sinh hoc tui (phi chnh xc)

4. Kt qu xt nghim, siu m, chiu chp theo ch nh ca bc s

Ch k v h tn ca ngi c bo him hoc ca b (m) nu ngi ngi c bo

him di 18 tui.

Giy yu

cu bi

thng

(claim

form)

Claim

form

a a

b b

S khm bnh hoc phiu khm vi cc thng tin sau:a a

1. Tn bnh vin/phng khm (c in sn hoc th hin qua con du - du vung hoc

du trn) ng trn s khm bnh/ phiu khm)

2. Ngy iu tr

3. Thng tin ngi bnh: H tn, ngy thng nm sinh hoc tui (chnh xc)

4. Chn on bnh, kt lun ca bc s (rt quan trng, ngh bc s ghi r tn bnh)

5. K tn, ghi r h tn ca bc s iu tr & ng du ca c s y t (nu c)

n thuc vi cc thng tin sau:

1. Tn bnh vin/phng khm (c in sn hoc th hin qua con du bnh vin -du

vung hoc du trn)

b b

cc

Chng t

y t

Medical

documentsI.2 I.2

Signature and full name of Insured person or parents if Insured person is under 18 years

old.

Medical book or treatment note with following information:

1. Hospital/ clinic name (being printed or seals square seals or round seals)

2. Date of treatment

3. Patient's information: Full name, date of birth or age

4. Diagnosis, doctor's conclusions (This information is very important, request the treating

doctor show the disease name)

5. Doctor's name and signature and seals of the hospital/ clinic (if any)

Doctor's indication and results of tests, ultrasound, X-ray (if any) with following information:




4. Results of tests, ultrasound, X-ray due to indication of treating doctor

Prescription with following information




Tham kho hng dn phn I.1

S khm/ phiu khm/ phiu iu tr rng vi cc thng tin sau:

1. Tn bnh vin/phng nha (c in sn hoc th hin qua con du - du vung hoc du

trn) ng trn s khm bnh/ phiu khm)

2. Ngy iu tr

3. Thng tin ngi bnh: H tn, ngy thng nm sinh hoc tui.

4. Chi tit iu tr rng (chn on bnh rng cn iu tr, cht trm c s dng trong

trng hp trm rng, phng php iu tr) (v d: nh rng su s 8, hn rng su s 12

bng amalgam....)

5 Kt qu XQ/Panorex hoc cc kt qu xt nghim khc phc v cho mc ch iu tr

rng (nh rng)

6. K tn, ghi r h tn ca bc s iu tr & ng du ca c s y t

n thuc sau iu tr rng ( nu c) - tham kho hng dn I.2.b

Ha n iu tr ghi r khon mc iu tr + Bng k chi tit nu ha n ghi gp

Ha n tin thuc - tham kho hng dn I.3.b

Refer to the instruction section I.1

Medical book/ treatment note/ dental treatment report with following information:




4. Details treatment (dental diagnosis, material used in teeth filling, treatment method...) (i.e.

extraction of decayed teeth number 8, filling decaying teeth number 12 by amalgam...)

5. X-ray/ Panorex results or other diagnostic tests served for treatment purpose (extraction

of decaying teeth...)

6. Signature, Full name of treating doctor and seals of hospital/ clinic

Prescription after dental treatment (if any) refer to the instruction section I.2.b

Treatment invoices clearly show the treatment items...and the detail list if the invoice is a

gross receipt

Medicine invoice refer to the instruction section I.3.b

Chng t

ti chnh

(Ha n

VAT cho

chi ph t

200.000)

Accounting

documents

(VAT

invoice for

any

expense

from VND

200,000)

2. Ngy iu tr


4. Chn on bnh rt quan trng

5. Trong ni dung n thuc ghi r: Tn thuc, s lng thuc, liu dng

6. K tn, ghi r h tn ca bc s iu tr & ng du ca c s y t

Lu : Trng hp bc s sa n thuc, ngh bc s k nhy v ghi ngy sa bn cnh

ch sa.

Trng hp tp vt l tr liu, chm cu, xng hng, ra xoang cc thng tin sau cn

cung cp:

1. Cc ch nh iu tr ny ca bc s phi c th hin trn s khm bnh/ n thuc

2. Cn yu cu ghi r: ngy bt u, kt thc, s ln iu tr

Ha n tin khm, tin chp, chiu, xt nghim + Bng k chi tit nu ha n ghi gp

cc loi chi ph vi cc thng tin sau:

1. Thng tin bnh vin/phng khm (c in sn hoc th hin qua du (trn/ vung) ng

trn ha n)

2. H tn (chnh xc), a ch ngi bnh

3. S tin

4. K tn ngi thu tin & ng du ca n v cp ha n

Ha n tin thuc vi cc thng tin sau:

1. Con du nh thuc (ghi tn & a ch nh thuc, in thoi)

2. H tn (chnh xc), a ch ngi iu tr

3. Lit k cc loi thuc & tin thuc theo n thuc: phn nh ng s lng thuc, tn

thuc theo ch nh bc s, ghi r gi n v & thnh tin

4. Ch k ngi bn & ngi mua.

Lu : Ngy vit ha n c th trng vi ngy i khm hoc sau ngy ny. Nu khng

trng ngy khm, bnh nhn cn np km phiu thu tm thi th hin ngy mua thuc thc

t m bo tnh hp l ca h s).

d

d

a

a

b

b

H s iu tr rng

Dental treatment report

II

II

I.3 I.3

Giy yu cu Claim form

bi thng

Chng t

y t

Medical

documents

II.1

II.1

II.2 II.2

Chng t

ti chnhII.3

II.3

a

a

b

b

b

ba

a

Consultation charges, charges made for laboratory tests or X-rays that are used in the

diagnosis of a covered disability... and the detail lists of gross invoices with following

information:


2. Patient's information: Full name, home address

3. Amount of money

4. Signature of the cashier and the seals of the drugstore that issue the invoices

Medicine invoices with following information:

1. The seals of the drugstore (name, address and phone number)

2. Patient's information: Full name, home address

3. List all kinds of medicines and cost of medicines: reflex the correct amount of medicines,

prescribed drug name, amount per unit and total amount

4. Signature of the seller and buyer.

Note: The date on Medicine invoice is possibly the same as the date patient visit the doctor

or later. If they are not the same, patient need to submit the temporary receipt that show the

real purchasing date to ensure the validity of the Medicine invoice.

17 18

Accounting

documents

4. Diagnosis very important

5. Prescription must reflect the correct amount of medicines & number of days having those

medicines

6. Doctor's name and signature and seals of the hospital/ clinic

Notes: In case doctor modifies the prescription, request him to sign the blink signature and

the date beside

In case of physical therapy, acupuncture, throat sauna, sinus washing... The following

information is required:

1. Doctor's indication needs to be clarified on the medical book/prescription

2. Specify the admission date, the discharge date and the days of treatment

H s iu tr ni tr, sinh con Documents for In-patient and childbirthIII III

III.1III.1

Cc giy t ny ch cn cung cp trong trng hp bnh nhn c ch nh ca bc s & phi

tr trc chi ph cho vic thc hin xt nghim, chiu, chpTrn giy t ny phi ghi r

thng tin sau:

1. Tn bnh vin/phng khm (c in sn hoc th hin qua con du bnh vin -du

vung hoc du trn)


3. Ngy Ch nh, h tn bc s ch nh,

4. Ngy tr kt qu cc xt nghim, siu m, chp XQ & h tn bc s thc hin

The following documents are required if tests are doctor's indication. Patient has to pay for

those tests before reimbursement. The documents should show information below:



3. Date of service, doctor's name

4. Date of test results and doctor's name.

a

a

b

b

cc

Chng t

y t

Chng t

y tIII.2 III.2

Giy yu cu

bi thng

Claim formTham kho hng dn phn I.1

Refer to section I.1

Giy ra vin trng hp Nm vin/ Sinh thng vi cc thng tin sau:

1. Tn bnh vin (c in sn hoc th hin qua con du bnh vin - du vung hoc du

trn)

2. Thng tin ngi bnh: H tn, ngy sinh hoc tui

3. Thi gian nm vin (t ngy. n ngy.)

4. Chun on bnh hay kt lun bnh ca bc s ( ngh bc s ghi r tn bnh, v triu

chng cha th hin bnh l)

5. Phng php iu tr ca bc s

6. K tn & ghi r h tn ca bc s iu tr, ng du

Lu quan trng: Trn giy ra vin phi c ghi tn bnh (nu bc s ch ghi tnh trng sc

khe trc thi im xut vin, bnh nhn lu ngh bnh vin ghi b sung ngay thng

tin v bnh/ tai nn c iu tr trnh vic phi quay li bnh vin yu cu b sung)

Giy chng nhn phu thut (trong trng hp phu thut / sinh m) vi cc thng tin sau:

1. Thng tin bnh vin

2. Thng tin ngi bnh: H tn, ngy sinh hoc tui

3. Phng php phu thut & iu tr

4. K tn & ghi r h tn ca bc s iu tr, ng du

Giy chuyn vin th hin r tnh trng bnh l v l do chuyn vin

n thuc iu tr sau khi xut vin (nu c) - tham kho hng dn I.2.b

Ti khm sau xut vin & Ha n cho chi ph ti khm, xt nghim, ung thuc - tham

kho hng dn phn iu tr ngoi tr

Ch nh ti khm ny phi c bc s ghi trn Giy ra vin/ n thuc sau xut vin

Ha n tin chp, chiu, xt nghim trc khi xut vin + Bng k chi tit cho ha n -

tham kho hng dn I.3.b

Ha n cho cc chi ph iu tr trong thi gian nm vin + Bng k chi tit vin ph -

tham kho hng dn I.3.b

Ha n tin thuc sau khi xut vin - tham kho hng dn I.3.b

Hospital discharge certificate in case of hospitalization/ normal delivery with following

information:



3. Days of hospitalization (from date...to date...)

4. Diagnosis or illness conclusion (request doctor show the illness name, hence the

symptoms cannot show the disease)

5. Doctor's treatment method

6. Signature, Full name of treating doctor and seals of hospital/ clinic

Important note: the Hospital discharge certificate must show the illness name (If treating

doctor show patient's health status before discharge only, patient should ask for additional

information about treated illness/ accident to avoid the fact that patient has to come back

the hospital later)

Surgery certificate (in case of surgery/ caesarean) with following information:

1. Hospital/clinic information


3. Surgery method and treatment

4. Doctor's name and signature and seals of the hospital/ clinic

Certificate to change hospital show the illness status and the reason to transfer

Cc ch nh, cc kt qu xt nghim, chp chiu, siu m thc hin theo yu cu ca bc

s trc khi nhp vin

(Lu thi gian quy nh vi cc ch nh trn: tham kho trong Bng quyn li 1)

Laboratory tests, X-ray, ultrasound,...prescribed by doctor before hospitalization.

(Note: time limit for these tests: refer to Table 1)

Cc giy t lin quan n thi gian Nm vin

Cc giy t lin quan n iu tr sau xut vin

(Lu : Vic iu tr phi c thc hin trong thi gian quy nh ti Bng quyn li 1)

Chng t

ti chnhAccounting

documents

III.3III.3

cc

bb

aa

b

b

aa Prescription after discharge (if any) refer to instruction section I.2.b

Follow-up examination & costs, laboratory costs, medicines refer to out-patient treatment

instruction

This follow-up examination should be advised by doctor on discharge certificate/

prescription after discharge

Invoices of laboratory tests, X-ray before discharge and detail list for invoices refer to

instruction section I.3.b

Invoices for treatments during hospitalization...and detail list for invoices refer to

instruction section I.3.b

Medicine invoices after discharge refer to instruction section I.3.b

Documents relating to hospitalization

Documents relating to treatment after discharge

(Note: Treatment must be done within time period prescribed on Table 1)

19 20

Chng t b sung - Trng hp iu tr tai nn Additional documents - Accidental treatmentIV IV

- Trng hp Tai nn sinh hot v Tai nn lao ng: Bn tng trnh tai nn do ngi c

bo him khai v c xc nhn ca Cng ty

- Trng hp Tai nn giao thng

1. Bin bn cng an hay chnh quyn a phng (nu c).

2. Bn copy giy php li xe, bng li xe v bin bn kt lun nng cn trong

mu trong trng hp NBH b tai nn khi ang li xe

(Lu : Trng hp ngi c bo him khng phi l ngi iu khin phng

tin giao thng khi b tai nn, cn ghi r trong bng tng trnh tai nn).

- Accident and labor accident: accident report undertaken by the Insured and certified by

the Insured's company

- Traffic accident :

+ Accident report certified by police or local authority (if any).

+ Certified copy of driving license, vehicle registration, record about alcohol rate in

blood in case Insured get accident while he/she is driving.

(Note: if the Insured was not the person who drove that vehicle, present on the

accident report)

Ngoi cc chng t yu cu vi tng H s iu tr ngoi tr, ni tr; Ngi c BH cn b sung thm

Bn tng

trnh

tai nn

Accident

report

Chng t

yu cu

bi thng

Documents

for claim

- i vi tr cp lng khi ngh vic iu tr thng tt do tai nn:

1. Ch nh ngh ca bc s trn Giy ra vin, s khm, phiu khm

2. Giy ngh hng BHXH (nu c)

3. Xc nhn lng v s ngy ngh vic thc t ca Phng nhn s

For salary compensation due to accident:

- Doctor's prescription on Hospital discharge certificate, Medical book, treatment note...

- Day off work for social insurance (if any)

- Salary verification of the actual days off work by HR Department

Lu :

1. Khi tng chi ph t 1 c s cung cp dch v (bnh vin, phng khm..) t VND 200,000 tr ln, yu cu phi cung cp ha n VAT cho tng chi ph

ny. Nu cc chi ph t cng 1 ngun vt qu VND 200,000 nhng c tch thnh nhng ha n bn l di VND 200,000/ha n th Bo Vit

khng chp nhn.

V d: trong 1 ln khm ti 1 phng khm: chi ph khm l VND 100,000, chi ph xt nghim l VND 150,000 th ngi c bo him phi cung cp

ha n VAT cho s tin tng VND250,000.

2. Nh rng bnh l: phi c xc nhn ca bc s v nguyn nhn nh rng th hin trn phiu iu tr rng v nguyn nhn ny phi lin quan n

bnh l v rng.

3. Dc m phm v thc phm chc nng khng thuc phm vi bo him.

4.Toa thuc: ch c gi tr trong vng 5 (nm) ngy k t ngy cp theo quy nh ca B y t. Do , lu khng s dng toa thuc qu 05(nm) ngy

mua thuc m hy quay li bc s xin cp li toa thuc mi trc khi mua. Ngy xut ha n mua thuc khng c vt qu 30 ngy k t

ngy k toa thuc, nh bo him khng chp nhn bt c trng hp no vt qu 30 ngy. Cc toa thuc c gi tr trn VND200,000 nu tch ra

thnh cc ha n bn l s khng c chp nhn.

5. Ch c bnh vin mi c chc nng iu tr ni tr, phng khm th khng c chc nng ny.

6. H s c gi n Cng ty TNHH dch v Nam (SAS) c hiu l khch hng khng cn ly li v cng ty TNHH dch v Nam khng c trch

nhim hon tr; ngoi tr i vi nhng chng t khng thuc phm vi bo him th ngi yu cu bi thng c th yu cu tr li trong vng 1

thng sau khi nhn c Thng bo t chi bi thng.

Thi hn yu cu bi thng:

- Chng t cn thit yu cu bi thng phi c gi n Cng ty TNHH dch v Nam (SAS) trong vng 1 nm k t ngy khm cha bnh hoc

ngy xut vin bao gm c trng hp mang thai v sinh n. Qu thi hn trn, mi yu cu v bi thng coi nh khng c gi tr.

Thi hn gii quyt bi thng:

- Trong trng hp chng t y : Cng ty TNHH dch v Nam (SAS) gii quyt h s trong vng 10-15 ngy lm vic & thanh ton trong vng 5-8

ngy lm vic k tip.

- Trong trng hp chng t khng y : Cng ty TNHH dch v Nam (SAS) gi email yu cu b sung chng t trong vng 5 ngy lm vic k t

khi tip nhn h s. Sau khi h s c b sung chng t y , Cng ty TNHH dch v Nam (SAS) s gii quyt trong vng 10 ngy lm vic &

thanh ton trong vng 5-8 ngy lm vic k tip.

ng nhp ti khon

- Tn ng nhp: S th bo him (cc s trc du /)

- Password: Ngy thng nm sinh theo th t: YYYYMMDD

V d: S th 12345/0

Ngy sinh 25/06/1979

Tn ng nhp: 12345

Password: 19790625

Cc thng tin c cung cp trn website:

- Thng tin chi tit: cung cp thng tin v khch hng do Cng ty TNHH dch v

Nam (SAS) lu trn h thng

- Lch s bi thng: cung cp thng tin v cc h s yu cu bi thng ca ngi

c bo him c Cng ty TNHH dch v Nam (SAS) tip nhn.

- Chi tit thanh ton: cung cp thng tin v s tin bi thng Cng ty TNHH dch

v Nam (SAS) thanh ton cho ngi c bo him

- Thng tin lin h: cung cp cc thng tin lin lc vi Cng ty TNHH dch v

Nam (SAS) cng nh cc mu giy t cn thit phc v cho vic bi thng nh:

Claimform, danh sch bnh vin bo lnh thanh ton.

Hng dn tra cu thng tin bi thng trc tuyn ti website: http://www.gsw.com.vn

21 22

Note:

1. When the total cost from one service provider (hospitals, clinics ..) is from VND 200,000 or more, it's required to provide VAT invoice for total costs.

Bo Vit does not accept the act of splitting the invoice into two or more invoices which values are under VND 200,000 / invoice.

For example: In a visit at hospital, the consultation charge is VND 100,000 and laboratory test charge is VND 150,000. So the insured have to

provide VAT invoice for the total amount of VND 250,000.

2. In case of extraction of fault teeth, the reason of extraction has to be shown on the dental treatment slip.

3. Cosmeceuticals and functional foods are not covered in the insurance.

4. Prescription: is valid within 5 days from the issued date in accordance with the regulations of Ministry of Health. Date on the drug receipt may not

exceed 30 days from the date on the prescription, the insurer does not accept any circumstances exceed 30 days. Therefore, do not buy out of date

prescription drugs. You should go back to the doctor and ask for another prescription. The act of spliting the invoice which valued over VND 200,

000 into two or more retail invoices will not be accepted.

5. The insured should get inpatient treatments at hospitals, inpatient treatments got at clinic are not reimbursed.

6. Claim documents which are sent to South Asia Services Ltd (SAS). is understood that customers do not need to get back and South Asia Services

Ltd (SAS) is not responsible for returning them to the customers, except for documents are not covered by the insurance, the claimant can require

to return these documents within one month after receiving denial of payment letter.

Timelines for claim submission:

Claims documents must be sent to South Asia Services Ltd (SAS) within 365 (three hundred and sixty five) days from the last treatment or discharge

date including pregnancy and childbirth. Beyond this period, all requests for compensation have no value.

Claim processing period:

In case of completed claim: South Asia Services Ltd (SAS) process claim within 10-15 working days & payment within next 5-8 working days.

In case of uncompleted claim: South Asia Services Ltd (SAS) sends email to Insured to request for additional documents within 5 working days

from the date GSW receive documents. After completing the claim, South Asia Services Ltd (SAS) will process claim within 10-15 working days and

payment within next 5-8 working days.

Instruction to lookup online compensation information at website: http://www.gsw.com.vn

Sign in account:

- User name: Vietnam Care insurance card number (before /)

- Password: Date of birth: YYYYMMDD (must follow format)

- For example: Vietnam Care insurance card number 12345/0

Date of birth 25/06/1979

User name: 12345

Password: 19790625

Information in website:

- Detail information: Information about Insured saved on South Asia Services

Ltd (SAS)'s system

- Compensation history: Information about Insured's claims that South Asia

Services Ltd (SAS) has received.

- Payment detail: Information about the amount that South Asia Services Ltd

(SAS) paid for Insured

- Contact information: Provide information to contact with South Asia Services

Ltd (SAS)and necessary documents for compensation: Claim form, direct

billing network hospitals.

Beside documents required for In-patient or Out-patient treatment; These additional documents are required:

DANH SCH BO LNH VIN PH - DIRECT BILLING NETWORK6

PH LC:

nh ngha tham kho

- Bnh c bit: L nhng bnh ung th v u cc loi, huyt p, tim

mch, lot d dy, vim a khp mn tnh, lot rut, vim gan, vim

mng trong d con, tr, si trong cc h thng tit niu v ng

mt, c thy tinh th, vim xoang Parkinson, bnh i tho ng, ,

bnh lin quan n h thng ti to mu nh lc mu, thay mu,

chy thn nhn to.

- Nm vin: l vic bnh nhn cn thit nm ti bnh vin iu tr

cho n khi ra vin k c vic sinh hoc iu tr trong thi gian thai k.

Tha thun c bit:

Hp ng ny ng chi tr cho nhng chi ph kim tra, xt nghim theo

ch nh ca bc s khi ngi c bo him c triu chng bnh lm

sng. Vic kim tra,xt nghim ny phc v cho vic tm nguyn

nhn bnh nhng kt qu cui cng c th l bnh thng hoc cha tm

ra bnh l c th no.

Tuy nhin, hp ng s loi tr nhng chi ph kim tra, xt nghim

lin quan n vic kim tra sc khe nh k hoc khng lin quan

n triu chng bnh lm sng.

INDEX:

Definitions for reference

- Special diseases: are cancer and all kinds of tumor, high or low

blood pressure, heart and blood vessel disease, chronic stomach ulcer

or gastritis, chronic gastroenteritis, asthma, chronic polyarthritis,

chronic hepatitis, endometritis, hemorrhoids, tuberculosis, stone in

secretion system, cataract, sinusitis, diabetes.

- Hospitalization: The necessity for a patient to stay in the hospital for

treatment until clinical release including that for childbirth or treatment

during pregnancy

Special Agreements:

This contract agrees to pay for the cost of inspection and testing as

prescribe by the treating doctor when the insured person has clinical

symptoms. The inspection and test service for finding the cause of

disease but the end result may be normal or have not found any specific

pathology.

However this contract will exclude the cost of inspection and testing

related to periodic health check or not related to clinical symptoms.

Danh sch ny ch mang ngha tham kho ti thi im in s

BNH VIN MT

CAO THNG

BNH VIN A KHOA

HNG C

BNH VIN T D

BNH VIN A KHOA

QUC NH

PHNG KHM VICTORIA

HEALTHCARE M M

PHNG KHM VIGOR

PHNG KHM VIT GIA

NHA KHOA N CI

NHA KHOA MINH KHAI

NHA KHOA NO.1

NHA KHOA SAIDO

NHA KHOA ELITE

NHA KHOA SAINT PAUL

NHA KHOA SONG PHT

BNH VIN FORTIS

HON M CU LONG

23 24

Yu cu

tm ng

BNH VIN A KHOA

QUC T V ANH

BNH VIN QUC T

COLUMBIA ASIA - GIA NH

BNH VIN TAI MI HNG

SI GN

BNH VIN FORTIS

HON M

SI GN NNG

BNH VIN PHP VIT

BNH VIN A KHOA

T NHN TRIU AN

BNH VIN A KHOA

PH TH

BNH VIN AN SINH

BNH VIN / PHNG KHM A CH Ni trNgoi

trGhi ch

15-16 Phan Vn Tr, Phng 7, Qun G Vp, TP.HCM

Tel : (84 8) 3 989 4989

Website: [email protected]

01 N Trang Long, Qun Bnh Thnh, TP.HCM

Tel : (84 8) 3 803 0678

Website: http://www.columbiaasia.com

1-3 Trnh Vn Cn, Qun 1, TP.HCM

Tel : (84 8) 3 821 3456

Website: http://www.taimuihongsg.com

60-60A Phan Xch Long, P.1, Q. Ph Nhun, TP.HCM

Tel: (84 8) 3 995 9862

Webstie: www.hoanmysaigon.com

6 Nguyn Lng Bng, P.Tn Ph, Q.7, TP.HCM

Tel : (84 8) 5 411 3333

Website: http://www.fvhospital.com

165 Kinh Dng Vng, P.An Lc, Q.Bnh Tn, TP.HCM

Tel : (84 8) 3 750 9999

Website: http://www.trieuan.com

226 ng c Lp, P.Tn Qu, Q.Tn ph, Tp. HCM

Tel : (84 8) 3 810 9518

Website: http://www.benhvienphutho.com

10 Trn Huy Liu, Qun Ph Nhun, TP.HCM

Tel: (84 8) 3 845 7777

Website: http://www.ansinh.com.vn

135B Trn Bnh Trng, Qun 5, TP.HCM

Tel : (84 8) 3 838 1188 - 3 923 9135

Website: http://www.caothang.vn

32/2- Thng Nht, Phng 10, Qun G Vp, TP.HCM

Tel : (84 8) 3996 9999

Website: http://www.hongduchospital.vn

284 Cng Qunh, P.Phm Ng Lo, Qun 1, TP.HCM

Tel: (84 8) 5 404 2829

Website: http://www.tudu.com.vn

104-110, 54 ng 54 (QL1A), KCN Tn To, Q.Bnh Tn

Tel: (84 8) 5 407 3878

Website: http://www.benhvienquocanh.com.vn/

Cn1: 79 in Bin Ph, P. a Kao, Q.1

Tel : (84 8) 3 910 4545

Cn2: 135A Nguyn Vn Tri, P. 12, Q.Ph Nhun

Tel : (84 8) 3 997 4545 http://www.vitctoriavn.com

Ta Nh Miss o Di, 21 Nguyn Trung Ngn, Q.1

Tel : (84 8) 3 911 5315

Website: http://www.healthcare.com.vn

166 Nguyn Vn Th, P.aKao, Q.1, TP.HCM

Tel : (84 8) 3 911 8485 - 3 911 8486

Website: http://www.vietgiaclinic.com/

112 Phan nh Phng, P.2, Q.Ph Nhun, TP.HCM

Tel : (84 8) 3 995 0848

Website: http://www.nhakhoanucuoi.com

199 Nguyn Th Minh Khai, Qun 1,TP.HCM

Tel : (84 8) 3 925 3399 3 925 3700

Website: http://www.nhakhoaminhkhai.com

51 ng 3/2, Phng 11, Qun 10, TP.HCM

Tel : (84 8) 3 929 0909

99 Trn Huy Liu, Phng 12, Qun Ph Nhun, TP.HCM

Tel : (84 8) 3 997 5654

Website: http://www.nhakhoasaido.vn

57A Trn Quc Tho, Phng 7, Qun 3, Ho Chi Minh

Tel : (84 8) 3 933 3737

Website: www.elitedental.com.vn

C1: 50 Nguyn Th Minh Khai, P.akao, Q.1, TP.HCM

Tel : (84 8) 3 827 9449

C 2: 33 X Vit Ngh Tnh, P.17, Q.Bnh Thnh, TP.HCM

Tel : (84 8) 3 840 4707

Website: www.nhakhoasaintpaul.com

C1: 186 Phan ng Lu, Q.Ph Nhun, TP.HCM

Tel : (84 8) 3 995 8149

C2: 331 in Bin Ph, P.4, Q.3, TP.HCM

Tel : (84 8) 3 929 1337

CN TH

Lot 20, Quang Trung, Ci Rng, TP. Cn Th

Tel : (84 8) 0710 391 7901

Website: www.hoanmycuulong.com

H NI

CC

Yu cu

tm ngCC

CC

KhngC

KhngCYu cu

tm ng

KhngC

KhngC

KhngCYu cu

tm ng

KhngC

KhngCYu cu

tm ng

KhngC

KhngC

Khng C

Khng C

Khng C

Khng C

Khng C

Khng C

Khng C

Khng C

Khng C

Khng C

KhngC

NG NAI

H NI

Mt s nh thuc c th cung cp ha n VAT / List of some pharmacies can provide VAT invoices

(Vui lng kim tra li vi nh thuc trc khi mua / Please double check with the pharmacy before processing)

H thng nh thuc M Chu 124 Trn Quc Tho, Q.3

243 Hai B Trng, Q.1 338 L Vn S, Q.3

119 L T Trng, Q.1 02 Nguyn Thng, Q.3

27 Chu Vn Lim, Q.5 254 Ha Ho, Q.10

215 Hng Bng, Q.5 520 Nguyn Tri Phng, Q.10

18-20 Nguyn Trng T, Q.4 72 Bch ng, Bnh Thnh

01 T Ngc Vn, Th c

03 N Trang Long, Bnh Thnh

212 L c Th, G Vp

11 Nguyn Kim, G Vp

HI PHNG

VINH

QUNG NAM

NNG

LT

BNH DNG

BNH VIN PH SN

QUC T PHNG CHU

BNH VIN A KHOA

QUC T HNH PHC

BNH VIN COLUMBIA ASIA

BNH DNG

NHA KHOA

VN THNH - SI GN

BNH VIN

HON M LT

BNH VIN FORTIS

HON M NNG

BNH VIN

THI BNH DNG

BNH VIN

THNH AN - SI GN

BNH VIN

HNG PHC

BNH VIN

VN CAO

BNH VIN VIT C

(Khu iu tr t nguyn 1C)

BNH VIN VIT PHP

H NI

BNH VIN A KHOA

HNG NGC

BNH VIN A KHOA

TR C

BNH VIN

I HC Y H NI

BNH VIN NHI

TRUNG NG

(Khu iu tr t nguyn 1A)

BNH VIN MT

VIT - NGA

BNH VIN BU IN

BNH VIN QUC T

VINMEC

PHNG KHM MEDELAB

PHNG KHM VIETLIFE

NHA KHOA NGUYN DU

NHA KHOA HA AN

25 26

300 Nguyn Vn C (ni di), P. An Khnh, Q.Ninh Kiu

Tel : (84 8) 0710 389 6767

Website: www.phuongchau.com

i l Bnh Dng, Th X Thun An, Tnh Bnh Dng

Tel : (84 8) 0650 363 6068

Website: http://www.hanhphuchospital.com

178 Hoa Lan, Thun Giao, Thun An, Bnh Dng

Tel : (84 8) 0650 381 9933

Website: www.columbiaasia.com/binh-duong/

C1: 269 Cch Mng Tthng 8, P. Ha Bnh, TP. Bin Ha

Tel : (84 8) 061 869 0945

C2: 13 Nguyn A Quc, P. Tn Phong, TP. Bin Ha

Tel : (84 8) 061 384 0908

C3: 5-6/1B Phc Nhc, Gia Tn, Thng Nht, ng Nai

Tel : (84 8) 061 891 1668

C4: 1/3 Hng Vng, P.Xun Trung, Long Khnh, ng Nai

Tel : (84 8) 061 364 7842

C5: 129, p 114, TT nh Qun, H.nh Qun, ng Nai

Tel : (84 8) 061 361 6186

C6: 75 Bch ng, P.Phc Trung, B Ra, Vng Tu

Tel : (84 8) 064 371 2186

Website: www.nhakhoavanthanh.com.vn

ng Mimosa Tiu Khu 156, P.10, TP. Lt

Tel: (84 8) 063 351 0878

Webstie: www.hoanmydalat.com

161 Nguyn Vn Linh Q.Thanh Kh - TP Nng

Tel : (84 8) 511 365 0676

Website: http://www.hoanmydanang.com

06 Phan nh Phng, th x Hi An, Qung Nam

Tel : (84 8) 510 921 656 - 510 921 887

Website: www.pacifichospital.com

54 L Thng Kit, Phng L Li, TP Vinh

Tel : (84) 03 88 6969 68

10 H Xun Hng, Qun Hng Bng, Hi Phng

Tel : (84) 0313 747 267 - 0313 747 762

207 Vn Cao, Qun Hng Bng, Hi Phng

Tel : (84) 0313 730 699

8 Ph Don, Qun Hon Kim, H Ni

Tel : (84 4) 3 828 9402

Website: http://www.vietduchospital.edu.vn/

01 Phng Mai, ng a, H Ni

Tel : (84 4) 577 1100

http://www.hfh.com.vn

95 Yn Ninh, Ba nh, H Ni

Tel : (84 4) 716 1239

http://www.hongngochospital.vn

219 L Dun - Hai B Trng - H Ni

Tel : (84 4) 942 9999

http://www.triduchospital.com

01 Tn Tht Tng, ng a, H Ni

Tel : (84 4) 3 852 3798

18/879 La Thnh, ng a, H Ni

Tel : (84 4) 6 273 8574

Website: http://www.nhp.org.vn

Nh C2, Lng quc t Thng Long, Dch Vng, Cu Giy

Tel : (84 4) 3 793 1968

Website: http://www.matvietnga.com

49 Trn in, Hong Mai, H Ni

Tel : (84 4) 3 640 2308

Website: http://www.hospitalvnpt.com.vn

458 Minh Khai Hai B Trng H Ni

Tel : (84 4) 3 974 3556

Website: http://www.vinmec.com

41 Nguyn Thng Hin, Hai B Trng, H Ni

Tel : (84 4) 6 673 5697 - 3 941 1696

Website: http://www.medelab.vn

Villa 05, TT4, Ph Trn Vn Lai,

KT M nh - M Tr, T Lim / Tel : (84 4) 3 787 7755

Website: http://www.vietlifemedical.com

2-4 Nguyn Du - Hon Kim - H Ni

Tel : (84 4) 3 943 2715

Website: http://www.nhakhoanguyendu.com.vn

6 Phm Ngc Thch - ng a

Tel : (84 4) 2 211 7476 - 3 573 9447

Website: http://www.nhakhoahoaan.vn

KhngC

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tm ng

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Khng C

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