SME Group Medical Insurance (Revamp 2023)
Flexibility for Employers & Care for Employees
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Plan Highlights
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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 |
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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 |
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Affordable Comprehensive BenefitsEmployers can choose 100% reimbursement of outpatient medical claims (up to plan limits) for optimal coverage or 80% reimbursement to reduce costs |
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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 |
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Easy Access to Digital PlatformOur digital health platform empowers every employer and employee to manage their polices quickly and easily
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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 |
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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 |
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| 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 |
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| 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 |
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| 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
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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) |
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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) |
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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) |
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Reimbursement Percentage |
100% / 80% | 100% / 80% | 100% / 80% | 100% / 80% | 100% / 80% | 100% / 80% |
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Limit per policy year
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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) |
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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 | |
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| Step 2 | Select Optional Benefits: | |
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Must be the same level as the Hospitalisation & Surgical Benefit | |
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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:
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Free choice from plan level 1 to 6 | |
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Free choice from plan level 1 to 6 | |
Major Exclusions
- Pre-existing conditions, unless an insured person has been insured under the scheme for a minimum of 12 consecutive months.
- 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.
Promotional Video
The promotional video highlights the features, enrolment eligibility, terms and conditions of SME Group Medical Insurance, and an introduction to MediGo Member and Employer Portals.