Savings Insurance
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An unforeseen and involuntary incident.
“Coinsurance” shall mean a percentage of eligible expenses you must contribute after paying the deductible (if any).
Coinsurance Example:
Coinsurance is a percentage of Eligible Expenses that you need to pay after paying the deductible (if any). For example:
(i) if no deductible is selected, for an Eligible Expenses of HKD10,000 with 30% coinsurance, you are responsible for HKD3,000 (i.e. 30% of Eligible Expenses), while we pay the remaining HKD7,000 (i.e. 70% of Eligible Expenses).
(ii) if there is HKD5000 deductible, for an Eligible Expenses of HKD100,000 with 20% coinsurance, you are firstly responsible for HKD5,000 (i.e. the deductible amount), and secondly responsible for HKD19,000 (i.e. 20% of remaining Eligible Expenses after deducting the deductible amount), while we pay the remaining HKD76,000 (i.e. 80% of remaining Eligible Expenses after deducting the deductible amount).
However, the final compensation amount will be determined according to terms of individual policy document.
An illness that has been diagnosed or has displayed symptons after the waiting period of the policy.
A body condition caused by an accident , not an illness.
“Deductible” shall mean a fixed amount of eligible expenses you must pay before the company shall reimburse the remaining eligible expenses .
Deductible Example:
Subject to the availability of deductible options under the product, if you are looking for full medical protection or top-up cover to supplement your current medical plan, annual deductible choices allow you to specify how much you are willing to pay before you claim. Choosing a higher deductible amount could lower the premiums for your policy. For example, say you chose an annual deductible of HKD16,000 and your eligible medical expense is HKD100,000, you would receive HKD100,000 less your deductible, which would be HKD84,000.
However, the final compensation amount will be determined according to terms of individual policy document.
An institution that offers medical care for injured and sick people. It does not refer to any establishment that mainly serves as a convalescenet home or a drug and alcohol rehab centre.
Staying in a hospital as an inpatient for at least 6 hours continuously on the advice of a doctor. To verify the confinement, you must provide hospital receipts for the daily room & board charges. We will only pay for one room per day of confinement.
A patient who stays in a hospital for a covered illness or injury and is charged for the room & board facilities used during the stay.
The diagnosis and treatments are considered standard medical practice based on the opinion of a doctor.
A patient who receives medical or surgical services in a private medical clinic, or in the outpatient or emergency department of a hospital to treat a covered illness or injury, but is not confined as a registered bed patient.
Being permanently, totally and continuously disabled, and totally restricted from any paid work, occupation or business consistent with their qualifications or experience.
Any physical condition that has existed before the date the policy is issued and becomes effective or resumes coverage (whichever is the later), and is EITHER:
a. checked, diagnosed or treated by a registered doctor
b. consulted about with a registered doctor
c. with symptoms noticed
"Reasonable and customary" means in relation to a charge for medical service, such level which does not exceed the general range of charges being charged by the relevant service providers in the locality where the charge is incurred for similar treatment, services or supplies to individuals with similar conditions, e.g. of the same sex and similar age, for a similar disability, as reasonably determined by the Company in utmost good faith. The reasonable and customary charges shall not in any event exceed the actual charges incurred.
In determining whether a charge is reasonable and customary, we shall make reference to the followings (if applicable):
Reasonable & Customary Charges Example:
Any person with a degree in western medicine and authorised locally to provide medical services. It excludes the following:
a. the doctor is the insured
b. the doctor is the insured’s financial planner, business partner, employer or employee
c. the doctor is a member of the insured’s immediate family
Compensation of reasonable and usual expenses for hospitalisation or treatment given by a registered doctor , a registered or graduate nurse, a physiotherapist, or a chiropractor based on a doctor’s advice and due to an injury caused by an accident within 52 weeks.
We regard multiple hospital confinements as a single one if they are:
Compensation of reasonable and usual expenses for surgical procedures performed on an insured outpatient or inpatient, including the fees for the surgeon, anaesthetist and operating room, plus the costs of items and equipment used during the surgery.
Being disabled and restricted from some work of their job continuously from the date of the accident or following a period of temporary total disability.
Being disabled continuously from the date of the accident and thus restricted from all work of their job.
A period immediately following the effective date of the policy; the number of days is stated in the policy. If there are symptoms of an illness before the waiting period has finished, the illness is not covered by the policy.
Remark: Exact definitions are specified in the policy.