Executive Protect Group Insurance Plan

Number of employees

• There must be a minimum of 3 full-time employees to join the core benefit plan and each optional benefit.

Age of employees

• Full-time employees: age 65 or below
• Employees between the ages of 66 and 69 are allowed to renew their existing policies, but not to enrol for the first time.

Age of employees’ family members

• Spouse: age 65 or below
• Spouses between the ages of 66 and 69 are allowed to renew their existing policies, but not to enrol for the first time.
• Unmarried children: from the age of 2 weeks to 18 years; full-time students are eligible up to the age of 22.

This plan is not applicable to the below industries / organisations:

1. Group where other than a single employer or employee relationship exists
2. Group where eligible employees include seasonal, unskilled, part-time or transient workers
3. Association of individuals or companies
4. Bus, taxi or truck driver (Risks involved with driving in mainland China will be excluded)
5. Construction group
6. Labour union
7. Hospital / doctor / nurse / medical or clinic group
8. Political or religious group
9. Sports team
10. Underground mine worker
11. Farmer / agriculture / animal processing
12. Employee leasing firm or temporary agency
13. Window and/or industrial cleaning service
14. Spa, Turkish bath, massage parlor, gymnasium, health resort or similar enterprises
15. Theatre, amusement park, dance hall, billiard parlor, and bowling alley or sports promoter
16. Group which involves special hazards / risks
    • Commercial airline personnel
    • Nuclear power or chemical production plant
    • Police or security officer
    • Fireman
    • Manufacturer or user of ammunition or explosive
    • Military and military related group
    • Collective traveling group (e.g. Professional sports team, air crew, offshore worker, oil rig worker, ship crew, diver or driller (oil, water, underground coal), underground miner)

1. You need to pay the premium for this plan upon renewal every year.
2. The insured member will lose the cover when one of the following happens:
   • the insured member passes away; or
   • the aggregate benefits of the insured member reaches the overall lifetime limit.
     
3. You may request for the termination of your policy by notifying us in written notice. Also, we will terminate your policy and all the insured members will lose their cover when one of the following happens:
   • you do not pay the premium within 31 days of the premium due date;
   • the number of insured full-time employees falls below 3;
   • the nature of the company’s business changes to another nature that we shall cease to provide cover. For the latest list of the excluded industries / organisations, please refer to the section of “Excluded industry / organisation”; or
   • the company provides incorrect information or is unable to disclose important information regarding the insured members.
4. The insured member may lose the cover when he or she no longer resides in Hong Kong.
5. We reserve the right to terminate your policy and all the insured members will lose their cover when the company transfers to operate out of Hong Kong.
6. Cover renewal is based on the continuing availability of the plan to all existing policies.
7. We underwrite the plan and you are subject to our credit risk. If we are unable to satisfy the financial obligations of the policy, the insured members may lose their cover and you may lose the remaining premium and levy for that policy year.
8. The future medical costs will be higher than they are today due to inflation. Hence, the benefit amounts and the future premium rate of this plan may be revised to reflect the inflation.
   
9. Your current planned benefit may not be sufficient to meet the future needs of the insured members since the future cost of living may become higher than they are today due to inflation. Where the actual rate of inflation is higher than expected, the insured members may receive less in real terms even if we meet all of our contractual obligations.

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

1. expenses that are recoverable from a third party.
2. any benefit not available under an insured member’s plan or charges exceeding the limits specified in the benefits schedule.
3. any surgery, treatment, investigation, service or supplies which is not medically necessary or any confinement that is not a reasonable and customary hospital confinement.
4. any pre-existing condition, unless such condition has been truly, completely and correctly disclosed to the Company in writing on the health declaration form for this insurance and accepted by the Company, and the policy does not expressly exclude treatment relating to such pre-existing condition.
5. self-destruction, intentional self-inflicted injury or drug abuse.
6. Injuries arising directly or indirectly from war (declared or undeclared) or warlike operation; any Act of Terrorism where the Insured Person was involved as a terrorist; participation in riot, strike, civil war, rebellion, revolution and insurrection.
7. AIDS or any complications associated with HIV infection, except for “HIV / AIDS treatment benefit”.
8. Dentures and related expenses; dental care or surgery unless necessitated by injury caused by an accident to sound natural teeth (except if the dental benefit has been opted for); eye refraction, eye tests or fitting of glasses (except if the optical benefit has been opted for), or surgical correction of nearsightedness (such as but not limited to radial keratotomy and keratoectomy).
9. consumption of traditional Chinese medicines for general health maintenance and disease prevention: cordyceps / ganoderma / antler / cubilose / donkey-hide gelatin / hippocampus / ginseng / red ginseng / American ginseng / radix ginseng silvestris / antelope horn powder / placenta hominis / agaricus blazei murill / musk / pearl powder
10. rest cures, services or treatment in any treatment home, spa, health hydro, natural therapy clinic, sanatorium or long-term care facility that is not a registered Hospital, Rehabilitation Centre or registered hospice.
11. birth control, treatment for infertility or in-vitro fertilisation, or sterilisation of either sex.
12. purchase or use of special braces, prosthetic appliances, corrective devices, hearing aids, wheelchairs, crutches, prosthetics, denture or any other similar equipment unless specified in the policy.
13. education treatments such as speech improvement, diabetic classes and nutritional treatments, or group support treatments.
14. any investigation, treatment or surgery for congenital defect that gives rise to signs or symptoms, or is diagnosed, before the insured member reaches the age of 17.
15. treatment as a result of proven medical negligence or malpractice.
16. experimental, investigational or unproven treatment.
17. injury or illness, treatment or testing which is attributed to venereal diseases or sexually-transmitted diseases.
18. All treatments considered elective or carried out by a facility not recognised as a hospital or by a relative of the insured member.

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. 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;
   • 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 the policyholder a written notice of any revision before any policy anniversary or upon renewal.

1. Cover for HIV/AIDS treatment will be effective 5 years after the insured member’s insurance commences.
2. We only cover the charges or expenses of the insured member 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 the medical services and the duration of 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;
   • the medical procedure or treatment during hospital stay is not routinely performed on an outpatient basis and could not reasonably be performed on the insured member as an outpatient according to standards of good medical practice; 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.
3. The insured member will be covered for any room type in which he stays at hospital, but there will be a reduction in his benefit pay-out amount in case the insured members stays in a room type higher than the plan covered. In such a case, the benefit pay-out amount will be adjusted by multiplying the following factor:
   

If any of the insured members wishes to make a claim, he/she must send us the appropriate form and relevant proof within 90 days of the date the covered event happened. The appropriate claim form can be downloaded from our website: aia.com.hk or obtained from the financial planner. 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 the policy by giving no less than 31 days’ prior written notice to us, however this will result in the insured member losing his cover and you losing the remaining premium and levy for that policy year. We also reserve the right to cancel the policy upon the policy renewal by giving you no less than 31 days’ prior written notice.