SME Group Medical Insurance
Flexibility for Employers & Care for Employees
Plan Highlights
 |
Six Different Levels of Hospitalisation and Surgical PlanRanging from essential to premium “high end” cover, each one offers a well balanced combination of inpatient benefits |
 |
Innovative “One Level Up/Down” FeatureEmployers have the flexibility to assign different Hospitalisation and Surgical plans to different groups of employees and choose their level of Optional Outpatient Benefit |
 |
Affordable Comprehensive BenefitsEmployers can choose 100% reimbursement of outpatient medical claims (up to plan limits) for optimal coverage or 80% reimbursement to reduce costs |
 |
Competitive PremiumsCompetitive 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
|
 |
Easy Access to Digital PlatformOur digital health platform, MediGo, empowers every employer and employee to manage their polices quickly and easily |
 |
Simplified Application ProcessIndividual health declarations are not required for companies with 6 or more employees |
Plan details
Benefits
| (Effective from 01 Mar 2021) | ||||||
|---|---|---|---|---|---|---|
| Maximum Benefits Payable per Policy Year (HK$) | ||||||
| Plan 1 | Plan 2 | Plan 3 | Plan 4 | Plan 5 | Plan 6 | |
Hospitalisation & Surgical Benefit |
||||||
Reimbursement Percentage |
100% | 100% | 100% | 100% | 100% | 100% |
Room and BoardLimit per day |
300 | 600 | 900 | 1,800 | 2,400 | 3,800 |
| Maximum days per disability | 120 | 120 | 120 | 120 | 120 | 120 |
Companion BedLimit per day |
150 | 300 | 450 | 900 | 1,200 | 1,900 |
| Maximum days per disability | 120 | 120 | 120 | 120 | 120 | 120 |
Miscellaneous Hospital ServicesLimit per disability |
5,000 | 10,000 | 20,000 | 30,000 | 40,000 | 80,000 |
Surgeon’s FeesLimit per disability |
||||||
| Complex | 10,000 | 40,000 | 60,000 | 80,000 | 100,000 | 180,000 |
| Major | 10,000 | 20,000 | 30,000 | 40,000 | 50,000 | 90,000 |
| Intermediate | 5,000 | 10,000 | 15,000 | 20,000 | 25,000 | 45,000 |
| Minor | 2,500 | 5,000 | 7,500 | 10,000 | 12,500 | 22,500 |
Anaesthetist’s FeesLimit per disability |
||||||
| Complex | 3,500 | 14,000 | 21,000 | 28,000 | 35,000 | 63,000 |
| Major | 3,500 | 7,000 | 10,500 | 14,000 | 17,500 | 31,500 |
| Intermediate | 1,750 | 3,500 | 5,250 | 7,000 | 8,750 | 15,750 |
| Minor | 875 | 1,750 | 2,625 | 3,500 | 4,375 | 7,875 |
Operating Theatre FeesLimit per disability |
||||||
| Complex | 3,500 | 14,000 | 21,000 | 28,000 | 35,000 | 63,000 |
| Major | 3,500 | 7,000 | 10,500 | 14,000 | 17,500 | 31,500 |
| Intermediate | 1,750 | 3,500 | 5,250 | 7,000 | 8,750 | 15,750 |
| Minor | 875 | 1,750 | 2,625 | 3,500 | 4,375 | 7,875 |
Inpatient Physician’s FeesLimit per day |
300 | 600 | 900 | 1,800 | 2,400 | 3,800 |
| Maximum days per disability | 120 | 120 | 120 | 120 | 120 | 120 |
Inpatient Specialist’s Fees^Limit per disability |
1,250 | 2,500 | 5,000 | 7,500 | 10,000 | 15,000 |
Intensive CareLimit per disability |
10,000 | 20,000 | 30,000 | 40,000 | 50,000 | 80,000 |
Pre-admission and Post-hospitalisation Outpatient Care
|
500 | 1,000 | 1,500 | 2,000 | 2,500 | 5,000 |
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^ BenefitLimit 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 |
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 WardLimit 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 BenefitLimit per day |
600 | 600 | 1,200 | 1,200 | 2,000 | 2,000 |
| Maximum days per disability | 120 | 120 | 120 | 120 | 120 | 120 |
Increased Overseas Accidental Hospitalisation BenefitReimbursement Percentage |
200% | 200% | 200% | 200% | 200% | 200% |
24-hour Worldwide Assistance Services |
Included | Included | Included | Included | Included | Included |
Supplementary Major Medical Benefit (Optional) |
||||||
Reimbursement Percentage |
80% | 80% | 80% | 80% | 80% | 80% |
| Deductible | 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 |
Outpatient Benefit (Optional) |
||||||
Reimbursement Percentage |
100% / 80% | 100% / 80% | 100% / 80% | 100% / 80% | 100% / 80% | 100% / 80% |
1. General Medical PractitionerLimit per day per visit |
190 | 230 | 300 | 360 | 450 | 850 |
| Panel doctor co-payment per visit | 40 | 20 | 0 | 0 | 0 | 0 |
2. Chinese Herbalist, Bone-setting & AcupunctureLimit per day per visit |
150 | 180 | 220 | 280 | 360 | 680 |
| Maximum visits per day (1+2) | 1 | 1 | 1 | 1 | 1 | 1 |
3. Specialist Medical Practitioner#Limit per day per visit |
380 | 460 | 540 | 720 | 900 | 1,700 |
| Panel doctor co-payment per visit | 80 | 40 | 0 | 0 | 0 | 0 |
4. Physiotherapist & Chiropractor^Limit per day per visit |
280 | 340 | 400 | 540 | 680 | 1,280 |
| Maximum visits per policy year (1+2+3+4) | 30 | 30 | 30 | 30 | 30 | 30 |
5. Diagnostic X-ray & Laboratory Tests^Maximum limit per policy year |
900 | 1,400 | 2,000 | 2,600 | 3,200 | 10,000 |
Dental Benefit (Optional) |
||||||
Reimbursement Percentage |
100% / 80% | 100% / 80% | 100% / 80% | 100% / 80% | 100% / 80% | 100% / 80% |
|
Limit per policy year
|
1,000 | 1,500 | 2,000 | 3,000 | 5,000 | 10,000 |
| 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 DisablementLimit per life |
50,000 | 100,000 | 150,000 | 200,000 | 250,000 | 300,000 |
Remarks
*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)
^Written referral from a Registered Medical Practitioner is required.
#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
6. Dermatology
Eligibility & Requirements
- Minimum 2 employees
- Individual health declaration is required for group with 5 employees or below
- Eligibility:
- Full time employees aged under 65
- Employees’ spouse aged under 65
- 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.
- All eligible dependents must also be enrolled into the same plan as the employees.
- With the exception of the top plan, all other plans in the scheme must contain a minimum of 3 employees.
- 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: | |
|
Must be the same level as the Hospitalisation & Surgical 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:
|
|
|
Free choice from plan level 1 to 6 | |
|
Free choice from plan level 1 to 6 | |
Major Exclusions
- Pre-existing condition, unless an insured person has been insured under the policy for a minimum of 12 months and the policy has not less than 10 employees at the beginning of each policy year.
- Congenital and hereditary conditions
- Drug addiction or alcoholism
- Suicide or self–inflicted injury
- Cosmetic surgery
- Dental and optical treatment
- Pregnancy, childbirth, birth control and treatment for infertility
- Sexually transmitted disease, AIDS or HIV-related conditions
- Routine medical check-ups
- Professional and hazardous sports
- Appliances, equipment and implants
- 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
- Renewal premium will be adjusted based on terms and premium prevailing at the time of renewal and claim experience of client.
- 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.