AIA Voluntary Health Insurance Flexi Scheme  

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 terms and benefits upon renewal by giving a 30 days advance notice. As long as we maintain the registration as a VHIS provider, we guarantee you the terms and benefits will not be less favourable than the existing version and the latest version of the Standard Plan terms and benefits published by the Government at the time of renewal.

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

Cover of this plan will be effective on the following dates:

1. We only cover the charges and / or expenses of the insured person on medically necessary and Reasonable and Customary basis.
   
   “Medically necessary” means the need to have medical service for the purpose of investigating or treating the relevant disability in accordance with the generally accepted standards of medical practice and such medical service must:
   

   • require the expertise of, or be referred by, a registered medical practitioner;
     
   • be consistent with the diagnosis and necessary for the investigation and treatment of the disability;
     
   • be rendered in accordance with standards of good and prudent medical practice, and not be rendered primarily for the convenience or the comfort of the insured person, his family, caretaker or the attending registered medical practitioner;
     
   • be rendered in the setting that is most appropriate in the circumstances and in accordance with the generally accepted standards of medical practice for the medical services; and
     
   • be furnished at the most appropriate level which, in the prudent professional judgment of the attending registered medical practitioner, can be safely and effectively provided to the insured person
     
     

   “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 us 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):
   

   In determining whether a charge is Reasonable and Customary, we shall make reference to the followings (if applicable):

   • treatment or service fee statistics and surveys in the insurance or medical industry;
     
   • internal or industry claim statistics;
     
   • gazette published by the government; and / or
     
   • other pertinent source of reference in the locality where the treatments, services or supplies are provided.
     
     
2. The maximum limit of surgeon’s fee is subject to the relevant surgical category and the categorization of such surgical procedure.
   
   
3. Only the eligible expenses charged on the psychiatric treatments during confinement in Hong Kong as recommended by a specialist is payable under psychiatric treatments (see benefit schedule, benefit item I (l)).
   
   
4. Worldwide emergency assistance services are covered during trip only (except for 24-hour worldwide telephone enquiring services), which are additional benefits and do not form part of the VHIS Certified Plan, the policyholder can remove this additional benefit by sending a written notice to the Company. 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.
   
   
5. SMM benefit limits of benefit item II(b) are on per disability per policy year basis, except where any specified medical service involves more than 1 disability, 1 SMM benefit limit shall be applied.
   
   Within the same policy year, SMM benefit limits shall be counted afresh for the same disability involved in the specified medical service, which is separated by at least 90 days from the immediately preceding specified medical service involving the same disability.
   
   Specified medical service shall mean any payable confinement, or day case procedure or prescribed diagnostic imaging tests performed on the insured person as a day patient.


6. Adjustment factor is applied to the calculation of the benefit payable for supplemental major medical benefits, benefit item II(b), when the insured person is confined in a type of room in a hospital which is at a higher level than the ward class corresponding to the plan level chosen (“selected room type”), according to the table below, except in the case of:
   
   
   • unavailability of the selected room type for emergency treatment as a result of the capacity shortfall of that hospital
     
   • isolation reasons that require a specific class of accommodation; or
     
   • other reasons not involving personal preference of you and /or the insured person.
     
     

7. 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.
   
   
8. Credit Facility Service for Hospitalisation and Medical Expense Pre-approval Service are additional benefits and do not form part of the VHIS Certified Plan. Credit Facility Service for Hospitalisation is provided by third party service provider(s). 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.
   

If you wish to make a claim, you must send us the appropriate forms and proofs within 90 days after discharge from hospital or the date on which relevant medical services are performed and completed. You can get the appropriate claim forms from your financial planner, by calling the AIA Customer Hotline (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 Policyholder or Policyholder’s nominated representative, whichever is the earlier. After the cooling-off period, you can request cancellation of this policy by giving 30 days prior written notice to us, provided that there has been no benefit payment under this policy during the relevant policy year.