PROTECT

Number of employees

• The company must have 3 to 19 full-time employees
  

Age of employees

• Full-time employees: age 64 or below
  

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 the following happens:
   
   • the insured member passes away.
     
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:

All benefits exclusions

1. Any benefit not available under an insured member’s plan or charges exceeding the limits specified in the benefits schedule.
   
2. Any claim arising directly or indirectly as a result of HIV/AIDS.
   

Life benefit exclusions

1. Any pre-existing condition, which directly or indirectly, wholly or partly, caused the death of the insured employee, unless the insured employee affected by such condition has been covered under this policy continuously for 12 months.
   
2. Suicide, whether while sane or insane, within 1 year from the effective date of the insured employee’s cover. In such event, AIA’s liability shall be limited to a refund of the total premiums paid for the life insurance coverage for the insured employee. (For any subsequent increase in life insurance coverage within 1 year from the effective date of the increase in coverage, AIA’s liability in respect of the increase in cover shall be limited to a refund of the total premiums paid in respect of such increase for the insured employee.)
   

Accident benefits exclusions

1. Suicide, self-inflicted injuries or any attempt thereat, while sane or insane.
   
2. War, declared or undeclared, revolution or any warlike operations.
   
3. Riot and civil commotion, strikes or terrorist activities.
   
4. Violation or attempted violation of the law or resistance to arrest.
   
5. Entering, operating or serving, riding in or on, ascending or descending from or with any aerial device, or conveyance except while the insured employee is a fare-paying passenger in an aircraft operated by a commercial passenger airline on a regular scheduled passenger trip over its established passenger route.
   
6. Racing on horse or wheels.
   

Medical benefits exclusions

Medical benefits include hospital income and surgical benefits, network outpatient benefits and worldwide emergency assistance services.

1. Pre-existing conditions for which the insured member showed symptoms or received medical treatment, diagnosis, consultation or prescribed drugs within the 12 months preceding the effective date of the policy, unless the insured member has been insured under the policy continuously for 12 months.
   
2. Investigation and treatment of psychological, emotional, mental or behavioral conditions; alcoholism or drug addiction; rest cure or sanitaria care; treatment of an optional nature; intentionally self-inflicted Injuries while sane or insane.
   
3. Injuries arising directly or indirectly from war, declared or undeclared.
   
4. Special nursing care; general physical or medical check-up or tests that are not incidental to treatment or diagnosis of an actual sickness or injury, or not medically necessary; immunisation, vaccination or inoculation.
   
5. Procurement or use of any special braces, appliances, equipment, prosthetic devices, implants, contact lenses, eye glasses, hearing aids or the fitting of the same and non-medical services such as television, telephone and the like.
   
6. Any dental or eye examination/treatment, surgical procedure for correction of eye refraction, cosmetic procedures or plastic surgery, unless such surgery is necessary for the repair of damage caused solely by accidental injury covered under the policy.
   
7. 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.
   
8. Birth control measures, investigation or treatment pertaining to infertility, genetic testing or counseling, treatment occasioned by or resulting from pregnancy, childbirth or abortion.
   
9. Non-medically necessary health services.
   
10. Experimental, investigational or unproven services unless authorised by the Company.
    
11. Services and supplies for smoking cessation programmes and the treatment of nicotine addiction.
    
12. Services rendered by a doctor, Surgeon or Chinese Medicine Practitioner (whether legally registered or not) with the same legal residence as the insured member, or is his family member, including spouse, brother, sister, parent or child; or services delivered by an agent of the Company.
    
13. Acupuncture, tui na, hypnotism, massage therapy, aroma therapy, and other forms of alternative treatments.
    
14. Clinical home care, custodial care in any setting, day care, hospice, private duty nursing or respite care unless prior approval is obtained from the Company.
    
15. Other education services such as speech improvement, diabetic classes and nutritional services, or group support services.

Additional network outpatient benefits exclusions

1. Treatment arising from infertility including in-vitro fertilisation or any other artificial method of inducing pregnancy.
   
2. Charges related to birth control or sterilisation of either sex.
   
3. Pregnancy and all matters related to pregnancy, childbirth, abortion or miscarriage.
   
4. Accommodation, nursing and services received in health hydro, nature cure clinics, convalescent homes, rest home or similar establishments.
   
5. Treatment arising from the abuse of drugs or alcohol.
   
6. Treatment arising from self-inflicted injuries, whether sane or insane.
   
7. Treatment arising from sexually transmitted diseases.
   
8. Treatment arising from Human Immunodeficiency Virus Infection.
   
9. Treatment for congenital abnormalities and complications arising from congenital abnormalities.
   
10. Treatment arising from any psychogeriatric or psychiatric condition, including but not limited to psychoses, neuroses, depression, anxiety, anorexia nervosa, schizophrenia, behavioural disorders etc.
    
11. Treatment arising from sexual dysfunction including but not limited to impotence, erectile dysfunction, premature ejaculation, regardless of cause.
    
12. Charges for blood or blood plasma.
    
13. Treatment arising from war, invasion, acts of foreign enemies, hostilities (whether war is declared or not), civil war, rebellion, revolution, insurrection or military or usurped power; or racing on horses or wheels or any form of powered water sports.
    
14. Procurement or use of special braces, appliances, spectacles, hearing aids, wheelchairs, crutches or other equipment.
    
15. Cosmetic surgery or treatment for cosmetic purpose such as consultation for Acne Vulgaris, weight problem, hair loss etc.
    
16. Routine eye or hearing tests, routine or screening blood test, general check-ups, vaccination or inoculations.
    
17. Correction of vision or eye refraction error such as myopia, hyperopia, presbyopia.
    
18. Dental treatment unless necessitated by accidental injury to healthy teeth.
    
19. Routine physical examinations and investigations.
    
20. X-ray using contrast media such as Ba Meal, intravenous pyelogram etc.; advanced imaging including but not limited to computerised axial tomography scan, magnetic resonance imaging scan, positron emission tomography scan, and investigations involving radioactive substances.
    
21. Radiotherapy and chemotherapy.
    
22. Chronic illness; any diseases and disorders, with or without signs and symptoms, that persists for more than 6 months and requires regular medical attention, including but not limited to:
    
    • AIDS • Chronic Hepatitis • Hyperthyroidism
      
    • Allergic Rhinitis • Coronary Heart Disease • Hypothyroidism
      
    • Alzheimer’s Disease • Diabetes Mellitus • Arthritis
      
    • Mental Illness & Psychiatric Disorder • Asthma
      
    • Gout • Onychomycosis • Cancer
      
    • Heart Disease • Parkinson’s Disease • Chronic Bronchitis
      
    • Heart Failure • Psoriasis • Chronic Eczema
      
    • Hyperlipoidema • Renal Failure
      
    • Hypertension • Systemic Lupus Erythematosus
      

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. We only cover the charges or expenses of the insured member which are “medically necessary”.
   “Medically necessary” means that health services or supplies provided are determined by the Company to be:
   • necessary to meet the basic health needs of the insured member;
   • consistent with the diagnosis of the condition;
   • provided in the most cost-effective manner; and type of setting appropriate for the delivery of the health service; and of demonstrated medical value; and
   • required for reasons other than the convenience of the insured member or his physician.
   
   Experimental, screening, and preventive services or supplies are not considered medically necessary. We may adjust any and all benefits payable in relation to any hospital / medical charges which is not a reasonable and customary charge.
   
   
2. PROTECT is applicable to companies with 3 to 19 proposed employees. For companies with 20 or more proposed employees, a tailor-made proposal can be provided upon request.
   
   
3. Worldwide emergency assistance services are covered during the trip only (except for 24-hour worldwide telephone enquiring services), which are additional benefits. 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.
   
   
4. If the eligible expenses have been reimbursed under any law, or medical program or other insurance policy provided by any government, company, other third party or us, such will not be reimbursable by us under this policy.
   
   
5. Network outpatient 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 these services without further notice.

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.