|
Product
SCHEDULE OF BENEFITS
|
HOSPITALIZATION
|
| |
|
|
|
| |
EXECUTIVE
|
MAJOR
|
PRIMARY
|
| ANNUAL OVERALL LIMIT |
|
|
|
|
•
|
per person per policy year (US$) |
|
500,000
|
250,000
|
50,000
|
| |
|
|
|
|
|
|
|
|
|
|
400
|
180
|
100
|
|
|
AS CHARGED
|
AS CHARGED
|
100
|
| |
- Intensive Care Unit (per day) |
|
800
|
360
|
200
|
| |
- Companion Bed of One Family Member (per
day) |
|
45
|
25
|
10
|
| |
- Hospital Miscellaneous Services |
|
AS CHARGED
|
AS CHARGED
|
3,000 per
disability
|
|
|
|
|
|
|
|
|
|
|
|
|
AS CHARGED
|
AS CHARGED
|
6,000 per
disability
|
| |
|
|
[Subject to
Surgical Schedule of Fees]
|
|
|
AS CHARGED
|
AS CHARGED
|
30% of surgical
fee payable
|
|
|
AS CHARGED |
AS CHARGED |
30% of surgical
fee payable
|
|
|
|
|
|
|
|
|
|
|
|
|
no limit
|
no limit
|
no limit
|
| |
- maximum per policy year |
|
182 days
|
91 days
|
30 days
|
|
|
|
|
|
|
•
|
Emergency Medical
Transportation |
|
|
|
|
| |
per person per policy year |
|
Full Refund
|
100,000
|
50,000
|
|
|
|
|
|
|
•
|
Emergency Dental Treatment |
|
10,000
|
2,000
|
500
|
| |
(following accident) per policy year |
|
|
|
|
|
|
|
|
|
|
•
|
Post Hospital Treatment |
|
|
|
|
| |
up to 90 days per person per policy year |
|
2,500
|
1,000
|
500
|
|
|
|
|
|
|
•
|
Repatriation/Local Burial |
|
5,000
|
3,000
|
1,000
|
|
|
|
|
|
|
•
|
Local Ambulance Service |
|
AS CHARGED
|
AS CHARGED
|
AS CHARGED
|
|
|
|
|
|
|
|
|
|
|
| |
per person per policy year |
|
100,000
|
75,000
|
15,000
|
|
|
OPTIONAL
OUT-PATIENT
|
| |
|
|
|
|
| |
|
EXECUTIVE
|
MAJOR
|
PRIMARY
|
| ANNUAL OVERALL LIMIT |
|
|
|
| - per person per policy year (US$) |
3,000
|
2,500
|
1,500
|
| |
|
|
|
|
| A) General Out-patient Services |
COVERED
|
COVERED
|
25 [max. 30
visits per year]
|
| B) Specialist Out-patient Services |
COVERED
|
COVERED
|
40 [max. 10
visits per year]
|
| C) Prescribed Drugs |
COVERED
|
COVERED
|
200 per year
|
| D) Laboratory and X-Ray Services |
COVERED
|
COVERED
|
300 per year
|
| E) Physiotherapy/Chiropractic Treatment |
COVERED
|
COVERED
|
25 per visit
|
| |
- max no. of visits per policy year
|
10
|
10
|
10
|
| F) Emergency Ward Treatment up to 24 hours |
COVERED
|
COVERED
|
100 per year
|
| G) Chinese Herbalist, Bonesetter and |
|
|
|
| |
Acupuncturist Services (provided in H.K.) |
|
|
|
| |
- per visit limit |
COVERED
|
COVERED
|
25
|
| |
- maximum per policy year |
500
|
300
|
5 visits
|
| |
|
|
|
|
| Percentage of Reimbursement |
80%
|
80%
|
80%
|
| |
|
|
|
| Overall maximum no. of visits per policy year |
N/A
|
N/A
|
30 visits
|
| |
- sum of the number of visits for benefit
items A, B, E & G |
|
|
|
|
| |
| |
|
Territorial Scope
|
| |
| There is no cover available for permanent
residents of the USA or Canada of whatever nationality. |
| |
| Area 1: Worldwide excluding
USA/Canada. |
| |
| Area 2: Worldwide including
USA/Canada. |
| Treatment in USA/Canada is subject to a 20%
co-insurance on the first US$10,000 of covered medical expenses
incurred. |
| This co-insurance is applicable to
hospitalization benefits only. |
|
 |
