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Except for the Compassionate Death Benefit, we will not cover conditions that result from any of the following events:

• war, declared or undeclared, or revolution;
• served in the armed forces in time of declared or undeclared war or while under orders for warlike operations or restoration of public order;
• violation or attempted violation of the law or resistance to arrest;
• suicide or attempted suicide or self-inflicted Injury or deliberate exposure to exceptional danger (except in an attempt to save human life), or injur sustained whilst the insured is in a state of insanity;
• ptomaines or bacterial infection (except pyogenic infection which shall occur with and through an accidental cut or wound);
• accident occurring while or because the insured is under the influence of alcohol or any non-prescribed drug;
• in the case of a woman, pregnancy, miscarriage, childbirth, or any complications concerning therewith notwithstanding that such event may have been accelerated or induced by Injury;
• the insured entering, exiting, operating, servicing, or being transported by any aerial device or conveyance , except as a fare-paying passenger (not as a pilot / operator or a member of the aircrew) in any properly licensed private aircraft and / or Commercial Aircraft;
• the insured engaging in a sport in a professional capacity or income capacity; where the insured would or could earn income or remuneration from engaging in such sport;
• the insured, while on duty as a professional driver, entering, driving, operating, servicing, riding in or exiting any land vehicle or conveyance outside the territorial limits of Hong Kong and Macau;
• assault, murder, riot, civil commotion, strikes or making an arrest while the insured is employed as a full or part time police officer, or cadet officer or is an officer or member of the Correctional Services Department;
• riot, civil commotion or strikes while the insured is employed as a fireman or is on duty as a fireman in the course of extinguishing fires or protecting life and property in case of fire;

Accidental Medical Expenses Reimbursement Benefit (including Double Accidental Medical Expenses Reimbursement Benefit), in addition to the above key exclusions, will not cover the following:

• any treatment or investigation which is not Medically Necessary or consistent in accordance with standards of good medical practice;
• any kind of disease and illness;
• Acquired Immunodeficiency Syndrome (AIDS) or any complications associated with infection by any Human Immunodeficiency Virus (HIV);
• any congenital defect or anomaly which has manifested or was diagnosed before the insured attains seventeen (17) years of age;
• routine health checks, any investigation(s) not directly related to admission, diagnosis, illness or Injury, or any treatment or investigation which is not Medically Necessary, or convalescence, custodian or rest care;
• cosmetic or plastic surgery or any elective surgery; or
• treatment for dental care or surgery, unless necessitated by Injury caused by an Accident to sound natural teeth (excluding denture and related expenses).

The above list is for reference only. Please refer to the policy contract of this plan for the complete list and details of exclusions.

1. Accidental Death & Dismemberment Benefit and Permanent Total Disability Benefit

These benefits are only applicable for the loss resulted from a covered injury within 180 days after an accident. The loss must be listed in the Benefit Schedule for the Accidental Death & Dismemberment Benefit or defined as a Permanent Total Disability.

In the event that a series of losses shall arise out of the same Accident, benefit shall only be paid for one of the losses, for which the amount of benefit payable shall be the greatest amount of benefit as shown in the Benefit Schedule for the Accidental Death & Dismemberment Benefit.

2. Accidental Medical Expenses Reimbursement Benefit

This benefit is only applicable for the reasonable and customary charges for actual medical expenses incurred within 52 weeks from the date of an accident.

In the case of bone-setting or acupuncture treatment, whether a covered injury involves fracture of bone(s), the aggregate amount of the benefit to be paid is subject to US$100 per visit per day and 5 visits per policy year.

3. Reasonable and customary charges

   We only cover the charges and / or expenses of the insured on medically necessary and reasonable and customary basis.
   
   “Medically necessary” means that the medical services, diagnosis and / or treatments are:

   • delivered according to standards of good medical practice;
   • necessary; and
   • cannot be safely delivered in a lower level of medical care.
   
   

   Experimental, screening, and preventive services or supplies are not considered medically necessary. “Reasonable and customary” means:

   • the medical services, diagnosis and / or treatments are medically necessary and delivered according to standards of good medical practice;
   • the costs of your medical services and the duration of your hospital stay are not more expensive or longer than the usual level of charges or duration for similar treatment in the locality of such services delivered; and
   • does not include charges that would not have been made if no insurance existed.



We may adjust any and all benefits payable in relation to any hospital / medical charges which is not a reasonable and customary charge.


4. Calculation of the adjustment of sum assured and premium of Accidental Death & Dismemberment Benefit, Permanent Total Disability Benefit and Accidental Medical Expenses Reimbursement Benefit
   
   
   • Once there is any claim payable for Accidental Death & Dismemberment Benefit or Permanent Total Disability Benefit and the aggregate benefit amount has not yet reached 100% of sum assured, both sum assured and premium of Accidental Death & Dismemberment Benefit, Permanent Total Disability Benefit and Accidental Medical Expenses Reimbursement Benefit (if applicable) will be reduced.
   • The reduction of sum assured will be subject to the percentage of benefit paid of Accidental Death & Dismemberment Benefit or Permanent Total Disability Benefit. And the new sum assured will be applied for next accident. The new premium will be calculated according to the new sum assured of Accidental Death & Dismemberment Benefit or Permanent Total Disability Benefit.
   • If there is only claim payable for Accidental Medical Expenses Reimbursement Benefit, both sum assured and premium of the policy for the next accident will not be reduced.

In order to provide you with continuous protection, we will annually review the premium of your plan and adjust it accordingly at the end of policy year if necessary. During the review, we may consider factors including but not limited to the following:

• claim costs incurred from all policies under this plan and the expected claim outgo in the future, which reflect the impact of change in the incidence rates of accidental deaths and dismemberments / permanent total disabilities, medical trends and medical cost inflation (where applicable)
• historical investment returns and the future outlook of the product's backing asset
• policy surrenders and lapses
• expenses directly related to the policy and indirect expenses allocated to this product
  
  

We will give you a written notice of any revision 30 days before renewal.

If you wish to make a claim, you must notify us in writing within 30 days of the date the covered event happened, and send us the appropriate forms and relevant proof within 90 days of the same date. You can get the appropriate claim forms from your financial planner, by calling the AIA Customer Hotline (852) 2232 8888 in Hong Kong, or (853) 8988 1822 in Macau, or by visiting any AIA Customer Service Centre. For details of claim procedures, please refer to the Claim Procedure section in the policy contract. If you wish to know more about claim related matter, you may visit File A Claim section under our company website www.aia.com.hk.

The benefits under this plan will be paid to you, or in the unfortunate event of the insured’s death, to your beneficiary.

• You have the right to cancel and obtain a refund of any premiums and any levy paid by giving written notice to us. 
• Such notice must be signed by you and submitted to the Customer Service Centre of AIA International Limited at 12/F, AIA Tower, 183 Electric Road, North Point, Hong Kong or the Customer Service Centre of AIA International Limited at Unit 1903, 19/F, AIA Tower, 251A-301 Avenida Comercial de Macau, Macau within 21 calendar days immediately following either the day of delivery of the policy or the Cooling-off Notice to you or your nominated representative , whichever is the earlier.