SME Group Medical Insurance | Employees' Benefits l MSIG

Flexibility for Employers & Care for Employees

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Plan Highlights

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Six Different Levels of Hospitalisation and Surgical Plan

Ranging from essential to premium “high end” cover, each one offers a well balanced combination of inpatient benefits

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Innovative “One Level Up/Down” Feature

Employers have the flexibility to assign different Hospitalisation and Surgical plans to different groups of employees and choose their level of Optional Outpatient Benefit

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Affordable Comprehensive Benefits

Employers can choose 100% reimbursement of outpatient medical claims (up to plan limits) for optimal coverage or 80% reimbursement to reduce costs

Competitive Premiums

Competitive premiums are based on the age of each insured person, using 5-year age bands. This suits the needs of dynamic young and SME businesses

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Easy Access to Digital Platform

Our digital health platform, MediGo, empowers every employer and employee to manage their polices quickly and easily

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Simplified Application Process

Individual health declarations are not required for companies with 5 or more employees

Plan details

Benefits

		(Effective from 01 Mar 2024)
		Maximum Benefits Payable per Policy Year (HK$)
		Plan 1	Plan 2	Plan 3	Plan 4	Plan 5	Plan 6
Hospitalisation & Surgical Benefit
Entitled Room Level		Ward	Ward	Ward	Semi-Private	Standard Private	Standard Private
Reimbursement Percentage		100%	100%	100%	100%	100%	100%
Room and Board Limit per day		330	650	980	1,950	2,600	4,100
Maximum days per disability		120	120	120	120	120	120
Inpatient Physician’s Fees Limit per day		330	650	980	1,950	2,600	4,100
Maximum days per disability		120	120	120	120	120	120
Companion Bed Limit per day		165	330	490	980	1,300	2,050
Maximum days per disability		120	120	120	120	120	120
Miscellaneous Hospital Services Limit per disability		5,400	10,800	21,500	32,200	43,000	85,500
Surgeon’s Fees Limit per disability
Complex		10,800	42,900	64,400	85,800	107,200	192,800
Major		10,800	21,500	32,200	42,900	53,600	96,400
Intermediate		5,400	10,800	16,100	21,500	26,800	48,200
Minor		2,700	5,400	8,100	10,800	13,400	24,100
Anaesthetist’s Fees Limit per disability
Complex		3,750	15,000	22,500	30,000	37,500	67,500
Major		3,750	7,500	11,300	15,000	18,800	33,700
Intermediate		1,900	3,750	5,650	7,500	9,400	16,900
Minor		950	1,900	2,850	3,750	4,700	8,400
Operating Theatre Fees Limit per disability
Complex		3,750	15,000	22,500	30,000	37,500	67,500
Major		3,750	7,500	11,300	15,000	18,800	33,700
Intermediate		1,900	3,750	5,650	7,500	9,400	16,900
Minor		950	1,900	2,850	3,750	4,700	8,400
Inpatient Specialist’s Fees^{^} Limit per disability		1,350	2,700	5,400	8,100	10,800	16,100
Intensive Care Limit per disability		10,000	20,000	30,000	40,000	50,000	80,000
Private Nursing^{^} Limit per day		150	300	450	600	750	1,500
Maximum days per disability		90	90	90	90	90	90
Cancer Treatment and Renal Dialysis Benefit^{^} Limit per disability		10,000	20,000	40,000	60,000	80,000	150,000
Inpatient Psychiatric Treatment^{^} Limit per policy year		5,000	10,000	20,000	30,000	40,000	50,000
Increased Overseas Accidental Hospitalisation Benefit Reimbursement Percentage		200%	200%	200%	200%	200%	200%
Pre-admission and Post-hospitalisation Outpatient Care Limit per disability Including one outpatient visit within 30 days before hospitalisation/day care surgery (consultation fee only) and all outpatient follow-up visits within 6 weeks after discharge from the hospital or day care surgery		500	1,000	1,500	2,000	2,500	5,000
Day Surgery Cash Allowance* Limit per day surgery (maximum one claim per day, regardless of the number of surgical procedure performed)		600	600	1,200	1,200	2,000	2,000
Daily Hospital Cash for Government Public Ward Limit per day		600	600	1,200	1,200	2,000	2,000
Maximum days per disability		120	120	120	120	120	120
Second Claim Cash Benefit Limit per day		600	600	1,200	1,200	2,000	2,000
Maximum days per disability		120	120	120	120	120	120
24-hour Worldwide Assistance Services		Included	Included	Included	Included	Included	Included
Supplementary Major Medical Benefit⁺ (Optional)
Entitled Room Level		Ward	Ward	Ward	Semi-Private	Standard Private	Standard Private
Reimbursement Percentage		80%	80%	80%	80%	80%	80%
Deductible per disability		1,000	1,000	1,000	1,000	1,000	1,000
Maximum limit per disability		30,000	60,000	80,000	100,000	120,000	200,000
If an insured person has chosen a level of hospital facilities and services higher than the entitled room level, the following scale of adjustment factor shall be applied in addition to reimbursement percentage for Supplementary Major Medical Benefit. The Supplementary Major Medical Benefit shall not be payable for hospital confinement in class of suite, VIP and deluxe room of a hospital.
Entitled Room Level	Actual Room Level				Adjustment Factor
Ward	Semi-Private Room				50%
Ward	Standard Private Room				25%
Semi-Private Room	Standard Private Room				50%
Ward, Semi-Private Room, Standard Private Room	Any room level above Standard Private Room (including Suite, VIP and Deluxe)				0% (no benefit shall be payable)
Outpatient Benefit^~(Optional)
Reimbursement Percentage		100% / 80%	100% / 80%	100% / 80%	100% / 80%	100% / 80%	100% / 80%
1. General Medical Practitioner Limit per day per visit		205	245	325	385	485	910
Panel doctor co-payment per visit		45	25	0	0	0	0
2. Chinese Herbalist, Bone-setting & Acupuncture Limit per day per visit Panel doctor service is not available		165	195	235	305	385	730
Maximum visits per day (1+2)		1	1	1	1	1	1
3. Specialist Medical Practitioner^# Limit per day per visit		405	495	580	770	960	1,800
Panel doctor co-payment per visit		85	45	0	0	0	0
4. Physiotherapist & Chiropractor^{^} Limit per day per visit		295	365	425	575	730	1,360
Panel doctor co-payment per visit (Panel doctor is applicable to Physiotherapist only)		70	0	0	0	0	0
Maximum visits per policy year (1+2+3+4)		30	30	30	30	30	30
5. Diagnostic Imaging & Laboratory Tests^{^} Maximum limit per policy year		960	1,490	2,130	2,760	3,400	10,600
Dental Benefit (Optional)
Reimbursement Percentage		100% / 80%	100% / 80%	100% / 80%	100% / 80%	100% / 80%	100% / 80%
Limit per policy year Oral examination Scaling, polishing and cleansing Filling and extraction Oral X-ray Medication Drainage of abscesses Pins for cusp restoration Root canal fillings Apicoectomy Dentures, crowns and bridges (Only if necessitated by an accident)		1,060	1,600	2,130	3,200	5,300	10,600
		Maximum Benefits Payable per Life (HK$)
		Plan 1	Plan 2	Plan 3	Plan 4	Plan 5	Plan 6
Personal Accident Benefit (Optional)
Accidental Death & Permanent Disablement Limit per life		50,000	100,000	150,000	200,000	250,000	300,000

Remarks

⁺Supplementary Major Medical Benefit applies to Hospitalisation & Surgical Benefit items 1 to 13 only.

*Day Surgery Cash Allowance is applicable to the following day case procedures:

1. Gastroscopy
2. Oesophagogastroduodenscopy (OGD)
3. Sigmoidoscopy
4. Colonoscopy
5. Endoscopic Retrograde Cholangio-pancreatography (ERCP)
6. Cystoscopy
7. Arthroscopic examination of joint
8. Colposcopy
9. Bronchoscopy
10. Extracapsular/intracapsular extraction of lens (Cataract)
11. Extracorporeal Shock Wave Lithotripsy (ESWL)

^~An insured person can access our outpatient network of General Medical Practitioner, Specialist Medical Practitioner and Physiotherapist. Members can present the MSIG e-card to the clinic and we will pay for eligible expenses for doctor visits. Please submit claim for reimbursement of Chinese Herbalist, Bone-setting, Acupuncture, and Chiropractor visits.

^Written referral from a Registered Medical Practitioner is required. Written referral from a Registered Chinese Medical Practitioner/Registered Chiropractor is accepted for X-ray examination and laboratory test.

^#Written referral from a Registered Medical Practitioner is required except for visiting the following Specialist Medical Practitioners:

1. Gynaecology
2. Ophthalmology
3. Paediatrics
4. Otorhinolaryngology
5. Orthopaedics and traumatology
6. Dermatology
7. Urology
8. Oncology

Eligibility & Requirements

Minimum 2 employees
Individual health declaration is required for group with 4 employees or below
Eligibility:
- Full time employees aged under 65 can enroll the scheme, with renewal up to aged 69
- Employees' spouse aged under 65 can enroll the scheme, with renewal up to aged 69
- Employees’ unmarried child(ren) aged between 15 days and 17 years, or below 26 years if in full-time education (with valid student identification for 18 years or above)
All eligible permanent full-time employees must be enrolled
Premiums are payable annually in advance

Plan Groupings of Employee

The company can assign eligible employees to different plans by grade, class or service, depending on the number of full-time employees and subject to their Human Resources policy.
All employees with the same eligibility must be enrolled into the same plan.
If dependant coverage is provided, all eligible dependants must also be enrolled into the same plan as the employees.
The company can set a maximum of 5 plans depending on the number of employees as shown below:
- 2 Employees: 1 Plan
- 3-6 Employees: 2 Plans
- 7-10 Employees: 3 Plans
- 11-20 Employees: 4 Plans
- 21 Employees or above: 5 Plans
Maximum number of plans per scheme is 5.

Flexibility of Plan Selection

Step 1	Select a plan level for the Hospitalisation & Surgical Benefit
Step 2	Select Optional Benefits:
	Supplementary Major Medical Benefit	Must be the same level as the Hospitalisation & Surgical Benefit
	Outpatient Benefit	Plan level can be the same, one level above, or one level below the plan level of the Hospitalisation & Surgical Benefit. There are 2 Reimbursement Percentages to choose from: 100% 80%
	Dental Benefit	Free choice from plan level 1 to 6 There are 2 Reimbursement Percentages to choose from: 100% 80%
	Personal Accident Benefit	Free choice from plan level 1 to 6

Major Exclusions

Pre-existing condition. This exclusion shall not apply to an insured person who has not undergone any medical underwriting for the policy and has been insured under the policy continuously for a minimum of 12 months
Congenital and hereditary conditions
Drug addiction or alcoholism
Suicide or self–inflicted injury
Cosmetic surgery
Dental (unless covered under Dental Benefit) and optical treatment
Pregnancy, childbirth, birth control and treatment for infertility
Sexually transmitted disease
Routine medical check-ups ‎
Professional and hazardous sports
Appliances and equipment
War or warlike operation, strike, riot and civil revolution

The above is a summary of Major Exclusions only. For details please refer to policy provisions.

Remarks

The premium rates may be adjusted based on the factors including but not limited to the medical cost inflation, our overall claims experience and expenses incurred by and in relation to this product.
In the event of any inconsistency or conflict between English and Chinese language versions of this material, the English version shall prevail. All terms and conditions are subject to the contract.

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Hong Kong

Macau

Flexibility for Employers & Care for Employees

Apply_now_title

Plan Highlights

Six Different Levels of Hospitalisation and Surgical Plan

Innovative “One Level Up/Down” Feature

Affordable Comprehensive Benefits

Competitive Premiums

Easy Access to Digital Platform

Simplified Application Process

Plan details

Hospitalisation & Surgical Benefit

Entitled Room Level

Reimbursement Percentage

Room and Board

Inpatient Physician’s Fees

Companion Bed

Miscellaneous Hospital Services

Surgeon’s Fees

Anaesthetist’s Fees

Operating Theatre Fees

Inpatient Specialist’s Fees^

Intensive Care

Private Nursing^

Cancer Treatment and Renal Dialysis Benefit^

Inpatient Psychiatric Treatment^

Increased Overseas Accidental Hospitalisation Benefit

Pre-admission and Post-hospitalisation Outpatient Care

Day Surgery Cash Allowance*

Daily Hospital Cash for Government Public Ward

Second Claim Cash Benefit

24-hour Worldwide Assistance Services

Supplementary Major Medical Benefit+ (Optional)

Entitled Room Level

Reimbursement Percentage

Entitled Room Level

Actual Room Level

Adjustment Factor

Outpatient Benefit~ (Optional)

Reimbursement Percentage

1. General Medical Practitioner

2. Chinese Herbalist, Bone-setting & Acupuncture

3. Specialist Medical Practitioner#

4. Physiotherapist & Chiropractor^

5. Diagnostic Imaging & Laboratory Tests^

Dental Benefit (Optional)

Reimbursement Percentage

Personal Accident Benefit (Optional)

Accidental Death & Permanent Disablement

Remarks

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Inpatient Specialist’s Fees^{^}

Private Nursing^{^}

Cancer Treatment and Renal Dialysis Benefit^{^}

Inpatient Psychiatric Treatment^{^}

Supplementary Major Medical Benefit⁺ (Optional)

Outpatient Benefit^~(Optional)

3. Specialist Medical Practitioner^#

4. Physiotherapist & Chiropractor^{^}

5. Diagnostic Imaging & Laboratory Tests^{^}