Stepup Medical Protection Plan 2

1. You need to pay the premium for this plan for life. If you do not pay the premium within 31 days of the due date, the policy will be terminated and you / the insured will lose the cover.
2. You may request for the termination of your policy by notifying us in written notice. Also, we will terminate your policy and you / the insured will lose the cover when one of the following happens:
   • the insured passes away;
   • you do not pay the premium within 31 days of the due date.
   We reserve the right to cancel this policy at any time by giving a 30-day prior written notice without cause to the policy owner. The unearned portion of the premium and the corresponding portion of levy paid by you at the time of cancellation without interest shall be returned to you after deducting any debt owed by you to us under the policy.
3. We underwrite the plan and you are subject to our credit risk. If we are unable to satisfy the financial obligations of the policy, you may lose your cover and the remaining premium for that policy year.
4. Future medical costs will be higher than they are today due to inflation. Hence, the benefit amounts and the future premium of this plan may be adjusted to reflect inflation.

Under this plan, we will not cover the expenses that result from any of the following events:

• Any treatment, investigations, services or supplies which are not medically necessary.
• Any pre-existing conditions for which the insured received medical treatment, diagnosis, consultation or prescribed medicines / drugs during 90 days preceding the effective date of the coverage of StepUp 2 unless the insured affected by these conditions has been insured under the AIA group medical policy and / or StepUp 2 for a total duration of at least 12 continuous months.
• Any congenital defect that appears or is diagnosed before the insured reaches the age of 17.
• Self-destruction, intentional self-inflicted injury or drug abuse.
• War or warlike operations, civil commotion, any violation or attempted violation of law or resisting arrest, acts of terrorism where the insured is a terrorist, the use of atomic, biological or chemical contamination due to any act of terrorism, when the insured travels to a country at war, or where there is warlike operation, mutiny, riot, civil commotion, martial law or a state of siege, or a war zone as recognised by the United Nations.
• Pregnancy, miscarriage, child birth, voluntary termination of pregnancy, or complications of them, mental or nervous disorder, except for the mental or nervous disorder benefit (see benefits schedule, item 14 for details) and Psychiatric treatment (see benefits schedule of optional outpatient benefit, item 5 for details), AIDS or any complications associated with HIV infection.
• Cosmetic or plastic surgery, dental care or surgery, corrective aids and the treatment of refractive errors unless necessitated by injury caused by an accident, body check-up, gradual recovery of health or rest care.
  
  

Under this plan, for the accidental death benefit, we will not cover accidents that result from any of the following events:

• Assault or murder.
• Racing on wheels or on horse.
• Accident occurring while or because the insured is under the influence of alcohol or any non-prescribed drug.
• Entering, exiting, operating, servicing, or being transported by any aerial device or conveyance except when the insured is on a commercial passenger airline on a regular scheduled passenger trip over its established passenger route.
  
  

The above-mentioned are for reference only. Please refer to your policy contract for the complete list and details of exclusions.

1. Premium Adjustment

   In order to provide you with continuous protection, we will annually review and adjust the premium of your plan 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 coming year which reflects the impact of medical trend, medical cost inflation and product feature revisions
   • 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
     
     
2. Product Features Revision

We reserve the right to revise the benefit structure, terms and conditions and / or product features, so as to keep pace with the times for medical advancement and to provide you with continuous protection.

We will give you a written notice of any revision 30 days before the end of policy year or upon renewal.

1. 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,
     

   but excludes experimental, screening, and preventive services or supplies.

   "Reasonable and customary" means:
   • the medical services, diagnosis and / or treatments are medically necessary and delivered according to standards of good medical practice; and
   • the costs of your medical services and the duration of your hospital stay are within the usual level of charges or duration for similar treatment in the locality of such service delivered.
   
   We may adjust any and all benefits payable in relation to any hospital / medical charges which is not a reasonable and customary charge.
   
   
2. If the insured is covered by both AIA group medical insurance scheme and StepUp 2, where the contract terms and / or claim approach vary between two covers, we will make reference to the contract terms and / or claim approach of AIA group medical insurance scheme and assess the claim under StepUp 2 at the Company’s discretion. After membership termination in an AIA group medical insurance scheme / not covering in an AIA group medical insurance scheme, we will assess the claim application in accordance with the contract terms of StepUp 2.
   
   
3. If any confinement, surgery and / or medical treatment covered by StepUp 2 is also covered by other group medical policy (if any), benefits under StepUp 2 will be paid only after all such group medical policies have been claimed.
   
   
4. An “adjustment factor” is applied to the calculation of the benefit payable when the insured is confined in a hospital room of a type that is at a higher level than the room type corresponding to the plan option chosen, the benefit payable shall be paid according to the benefits schedule, and the adjustment factor will also apply. For details, please refer to the “Adjustment Factor” in the product brochure.
   
   
5. If the eligible expenses have been reimbursed under any law, or medical programme or other insurance policy provided by any government, company, other third party or us, such will not be reimbursable by us under this policy.
   
   
6. All services under worldwide emergency assistance services are covered during the trip only (except that 24-hour worldwide telephone enquiring services are covered before and during the trip), which are additional benefits. While trip is referring to a journey taken by the insured to leave the country or place of which the insured was a permanent resident at the time of leaving (being Hong Kong, Macau or Mainland China). The services are provided by third party service provider(s). AIA shall not be responsible for any act, negligence or omission of medical advice, opinion, service or treatment on the part of them. AIA reserves the right to amend, suspend or terminate the service without further notice.
   
   
7. Credit Facility Service for Hospitalisation and Medical Expense Pre-approval Service are not contractual services and non-guaranteed, but the administrative arrangements offered in our absolute discretion. AIA reserves the right to amend, suspend or terminate these services without further notice.
   
   
8. The Personal Medical Case Management Services with Rehabilitation Management is not contractual services and non-guaranteed, but the administrative arrangements offered in our absolute discretion. The Personal Medical Case Management Services with Rehabilitation Management is provided by third party service provider(s). AIA shall not be responsible for any act, negligence or omission of medical advice, opinion, service or treatment on the part of them. AIA reserves the right to amend, suspend or terminate the service without further notice.
   
   
9. Medical network services are provided by network doctor. AIA shall not be responsible for any act or omission of network doctor in the provision of medical network services. AIA reserves the right to amend, suspend or terminate the list of network doctor without further notice. Please seek independent advice from doctors before receiving any medical treatment to ensure such treatment is suitable to your health condition.
   
   
10. If you would like to change your benefits or coverage after policy inception, such a request shall be subject to AIA’s approval. Upgrade of plan level is not allowed after policy inception.

If you wish to make a claim, you must send us the appropriate forms and proof within 90 days of the date on which the covered event happened. You can get the appropriate claims forms from your financial planner, or by calling the AIA Customer Hotline on (852) 2232 8888 in Hong Kong, or by visiting any AIA Customer Service Centre. 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.

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 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 earlier.