SME Group Medical Insurance

Flexibility for Employers & Care for Employees

SME Group Medical Insurance

Plan Highlights

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Comprehensive Coverage Icon
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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Double Daily Cash Benefit Icon
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

Defending Claims Costs and Expenses 
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

 MediGo

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Simplified Application Process 

Individual 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 Board 

Limit per day 

300 600 900 1,800 2,400 3,800
Maximum days per disability 120 120 120 120 120 120

Companion Bed

Limit per day 

150 300 450 900 1,200 1,900
Maximum days per disability  120 120 120 120 120 120

Miscellaneous Hospital Services 

Limit per disability 

5,000 10,000 20,000 30,000 40,000 80,000

Surgeon’s Fees

Limit 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 Fees

Limit 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 Fees 

Limit 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 Fees

Limit 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 Care

Limit per disability 

10,000 20,000 30,000 40,000 50,000 80,000

Pre-admission and Post-hospitalisation Outpatient Care 

  • Limit per disability 
  • Including one pre-admission visit (consultation fee only) and all related post-hospitalisation follow-up visits on an outpatient basis within 6 weeks after discharge from the hospital 
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^ 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

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

Increased Overseas Accidental Hospitalisation Benefit 

Reimbursement 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 Practitioner 

Limit 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 & Acupuncture  

Limit 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 

  • 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)
1,000 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 Disablement

Limit 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

  1. Minimum 2 employees
  2. Individual health declaration is required for group with 5 employees or below
  3. 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)
  4. All eligible permanent full-time employees must be enrolled
  5. Premiums are payable annually in advance 

Plan Groupings of Employee

  1. 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.
  2. All employees with the same eligibility must be enrolled into the same plan.
  3. All eligible dependents must also be enrolled into the same plan as the employees.
  4. With the exception of the top plan, all other plans in the scheme must contain a minimum of 3 employees.
  5. 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
 
  • Personal Accident Benefit
Free choice from plan level 1 to 6

Major Exclusions

  1. 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.
  2. Congenital and hereditary conditions 
  3. Drug addiction or alcoholism 
  4. Suicide or self–inflicted injury 
  5. Cosmetic surgery 
  6. Dental and optical treatment 
  7. Pregnancy, childbirth, birth control and treatment for infertility 
  8. Sexually transmitted disease, AIDS or HIV-related conditions 
  9. Routine medical check-ups ‎
  10. Professional and hazardous sports 
  11. Appliances, equipment and implants 
  12. 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
  1. Renewal premium will be adjusted based on terms and premium prevailing at the time of renewal and claim experience of client.
  2. 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.