至尊「萬健寶」醫療保障計劃
Product
至尊「萬健寶」醫療保障計劃
主要醫療費用不設上限，讓您盡享最佳的照顧
保障重點
- 保證終生續保
- 主要住院費用全額賠償，不設分項限額 (標準計劃及醫療增值計劃除外)
- 全額賠償醫院所提供的化療、電療及洗腎服務之非住院治療費用
Plan Highlights
- 多項自負額選擇，保費折扣優惠低至三五折
- 與家人同時投保，可享額外九折優惠
- 住院前後保障期長達90天
- 全球入院付款保證
- 每年一次免費醫療保健服務
新增額外保障:
- 手術或癌症治療後復康保障 - 保障於手術或癌症治療後90天內進行下列復康治療的費用，每年每項最多5次：
- 心理輔導
- 職業治療
- 營養諮詢
- 言語治療
- 中醫及針灸治療
- 日間手術現金津貼添加白內障手術津貼
- 器官移植保障伸延至精選計劃
多種自選保障以配合您的獨特需要:
- 附加醫療保障
- 牙科保障
- 12種或 28種危疾保障的選擇，保障年齡亦擴闊至:
- 年齡介乎15日至17歲之兒童
- 年齡已屆79歲之人士
- 產科保障伸延至精選計劃
其他保障:
- 全額賠償兒童住院時家人留院陪伴的陪床費用 (標準計劃除外)
- 私家看護費用保障長達26週
- 公立醫院現金保障高達每日港幣2,500元
- 24小時海外緊急支援服務
- 全球緊急醫療運送服務（只適用於特選計劃及智選計劃)
計劃細節
Benefits
| 保障範圍 | 每年最高賠償額（以港幣計） | ||||
|---|---|---|---|---|---|
| 基本保障 | 標準計劃 | 精選計劃 | 特選計劃 | 智選計劃 | 醫療增值計劃a |
| 每宗傷病最高總保障額 | $250,000 | $500,000 | $2,500,000 | $10,000,000 | 不適用 |
1. 醫院及有關服務保障最高保障額 (每年) |
$250,000 | $500,000 | $750,000 | $1,500,000 | $250,000 |
| 住院及膳食費用b (每日) | $1,000 (每症最多120日) | $2,000 | $2,800 | $3,900 | 每宗合資格索償的賠償額為索償額的50% 以不超過每年最高保障額為限 |
|
加床費用 (每日)
|
$1,000 (每症最多120日) | 全額賠償 | 全額賠償 | 全額賠償 | |
|
深切治療費用 (每症)
|
$15,500 | 全額賠償 | 全額賠償 | 全額賠償 | |
| 住院雜費 (每症) | $15,500 | 全額賠償 | 全額賠償 | 全額賠償 | |
| 醫生巡房費用 (每日) | $1,000 (Up to 120 days per disability) | $2,000 | $2,800 | $3,900 | |
| 專科醫生費用 (每症) | $5,000 | 全額賠償 | 全額賠償 | 全額賠償 | |
| 手術費用 (每宗手術) | 50,000c | 320,000c | 全額賠償 | 全額賠償 | |
| 麻醉師費用 (每宗手術) | 15,500c | 全額賠償 | 全額賠償 | ||
| 手術室費用 (每宗手術) | 15,500c | 全額賠償 | 全額賠償 | ||
| 非住院化療／電療／洗腎費用 (每症) | $16,500 | 全額賠償 | 全額賠償 | 全額賠償 | |
|
入院前之門診診斷費用及出院後之覆診費用 (每症)
|
$1,300 | 全額賠償 | 全額賠償 | 全額賠償 | |
|
私家看護費用c (每日)
|
$300 | 全額賠償 | 全額賠償 | 全額賠償 | |
手術或癌症治療後復康保障 (每日)
|
$400 80% |
$600 80% |
$800 80% |
$1000 80% |
$400 50% |
| 公立醫院現金保障 (每日) | $900 (Up to 120 days per disability) |
$1,500 | $2,000 | $2,500 | $900 |
| 日間手術現金津貼 (每宗手術) | $1,000 | $1,000 | $1,000 | $1,000 | $1,000 |
| 終生保障額 (每位受保人於70歲或以上適用) |
$1,000,000 | $2,000,000 | $3,000,000 | $6,000,000 | 不適用 |
| 轉職住院保障d | 不適用 | 不適用 | 不適用 | 不適用 | 不適用 |
2. 海外緊急醫療額外保障 (當醫療費用超出醫院及有關服務的每年最高保障額時之額外保障)最高保障額 (每年) |
不適用 | 不適用 | 不適用 | 不適用 | 不適用 |
3. 器官移植保障 (每年及每宗傷病最高保障額)保障移植器官包括腎臟，肺臟，心臟，骨髓，肝臟之住院及有關費用。 不包括購買器官的費用或捐贈者所招致之開支。 |
$250,000 | $500,000 | $750,000 | $1,500,000 | 每宗合資格索償的賠償額為索償額的50% 以不超過每年最高保障額為限 |
4. 額外保障於指定醫療中心享用免費醫療服務 |
每年一次 | 每年一次 | 每年一次 | 每年一次 | 每年一次 |
| 全球入院付款保證e | 適用 | 適用 | 適用 | 適用 | 不適用 |
| 24小時海外緊急支援服務 | 適用 | 適用 | 適用 | 適用 | 適用 |
| 緊急醫護運送服務 (每年及每宗傷病) | 不適用 | 不適用 | $1,000,000 | $1,500,000 | 不適用 |
| 免費旅遊人身意外保障 (每年及每宗意外) | 不適用 | 不適用 | 不適用 | $1,000,000 | 不適用 |
自選保障 |
|||||
A. 門診保障最高保障額 (每年) |
不適用 | 不適用 | 不適用 | $25,000 | 不適用 |
| 普通科門診服務 (每日一次) | 不適用 | 不適用 | 不適用 | Full Cover | |
| 專科門診服務 (每日一次) | 不適用 | 不適用 | 不適用 | Full Cover | |
| 普通科及專科服務最高總次數 (每年) | 不適用 | 不適用 | 不適用 | $30 | |
| 醫生處方藥物費用 (每年) | 不適用 | 不適用 | 不適用 | $9,500 | |
| 診斷性X光檢查及化驗服務費用 (每年) | 不適用 | 不適用 | 不適用 | $9,500 | |
跌打、針炙及脊醫治療 (每日)
|
不適用 | 不適用 | 不適用 | $450 | |
B. 附加醫療保障每宗傷病最高保障額 |
$100,000 | $200,000 | $300,000 | $600,000 | 不適用 |
| 每次索償墊底費 | $1,000 | $1,000 | $1,000 | $1,000 | |
| 賠償率 | 80% | 80% | 80% | 80% | |
C. 牙科保障每年最高保障額
|
$2,500 | $2,500 | $2,500 | $2,500 | $2,500 |
D. 產科保障 (等候期為12個月)自然分娩 (每次懷孕) |
$30,000 | $30,000 | $30,000 | $30,000 | $30,000 |
手術分娩 (每次懷孕)
|
$30,000 | $30,000 | $30,000 | $60,000 | $30,000 |
E. 危疾保障g
|
|||||
| 危疾保障最高總保障額 | $250,000 | $500,000 | $500,000 | $500,000 | $250,000 |
| 女性保障最高保障額g | $50,000 | $100,000 | $100,000 | $100,000 | $50,000 |
重要事項:
- 受保人於住院或治療時，必須持有一份有效的住院及手術醫療保險，否則醫療增值的保障將無效。
- 根據您已選擇的計劃之最高賠償額，賠償有關住院及膳食費用。如住院及膳食費用超出保障範圍之最高賠償額，醫院及有關治療費用將按比例作賠償（即95％）
- 在住院期間或出院後家中聘請全職或兼職私家看護以繼續治療當初住院醫治的有關傷病。保障每年最多長達26週。
保障條款：
須經由住院主診醫生轉介。
由合資格註冊護士提供。
私家看護服務乃醫療上必須。 - 轉職住院保障之等侯期為醫療增值計劃生效後之首90天，而最長保障期則為離職日後之首120天，受保人必須索償時提供離職證明。
- 三井住友海上火災保險（香港）有限公司（「三井住友保險」）取得受保人以住院病人方式入住醫院治療的預先通知後，會確定保險的保障範圍、監察索償程序、簽發（在可能情況下）適當之付款信用保證及／或根據保單條款與規章安排直接付款予醫院、醫生或其他服務供應者。如受保人未能預先通知三井住友保險有關上述的詳情，三井住友保險將不會簽發付款信用保證或安排直接付款。鑑於三井住友保險不會就本保單承保之門診服務提供信用保證或安排直接付款，受保人必須先自行付費，再根據本保單索取賠償。
- 標準保障（保障12種危疾）包括：癌症（已擴散）、冠狀動脈手術（拾橋手術）、主要器官移植手術、雙目失明、中風（永久性神經損傷）、末期肝衰竭、運動神經細胞疾病、嚴重燒傷、心臟疾突發、末期腎衰竭、雙耳失聰、昏迷。
全面保障（28種危疾），除以上所述危疾外，以及：柏金遜症、因輸血感染人體免疫力缺乏病毒、失語症、肌肉萎縮症、多發性硬化症、主動脈手術、良性腦腫瘤、腦炎、癱軟／半身不遂、心瓣手術、末期疾病、頭部意外受傷導致嚴重腦損傷、喪失獨立生活能力、認知障礙症、斷肢、肺動脈高血壓。
危障保障條款及細則：
等候期－60日
生存期－21日
危疾保障投保年齡限制：15日-59歲
續保年齡上限－79歲
如您不幸罹患您所選擇的計劃內闡明的其中一種疾病，您將會獲得保障限額表所列之現金賠償。當最高保障額全數繳付後，您的危疾保障將會終止，但您仍可享有終生醫療保障。 - 保障以下女性嚴重疾病：女性原位癌：乳房、陰道／外陰、輸卵管、子宮、子宮頸（第三級或以上）、卵巢。女性疾病：類風濕性關節炎、骨質疏鬆導致髖骨骨折、系統性紅斑狼瘡導致狼瘡性腎炎。
女性保障條款及細則：
等候期－60日
生存期－21日
續保年齡上限－79歲
如您不幸罹難您所選擇的計劃內闡明的其中一種女性嚴重疾病，您將會獲得保障限額表所列之現金賠償。當最高保障額全數繳付之後，您的危疾保障將會終止，但您仍可享有終生醫療保障。
女性保障乃危疾保障之附加保險，不可獨立投保。
女性保障一經索償，危疾保障之最高保障額將相應遞減。
1. 「入院前之門診診斷費用」及「出院後之覆診費用」保障須根據診斷或治療每宗傷病的首次入院計算，而每宗傷病亦須為同一原因引致的任何傷病。
2. 投保人須為18至75歲(以上一次生日計算)之香港居民，可為自己及家庭成員投保，倘兒童單獨投保將加收10%保費。
3. 首次投保年齡最高為75歲。
4. 首次投保醫療增值計劃、危疾保障及女性保障最高年齡為59歲。
5. 保單將於投保申請獲批核及投保人繳付保費後下一個月的首天生效。
6. 保單一經發出，保費概不退還。
7. 保費及保單條款可能會於續保時作出修訂，並由三井住友海上火災保險(香港)有限公司釐定。
8. 一切費用必須合理及慣常。
中、英文版本內容如有歧義，在任何情況下將以英文版本為準。有關保障範圍及承保條款，請參閱保單。
Premium
| 保費（港幣/元 | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 計劃 | 標準計劃 | 精選計劃 | 特選計劃 | 智選計劃 | 醫療增值計劃 | |||||
| 年繳 | 月繳 | 年繳 | 月繳 | 年繳 | 月繳 | 年繳 | 月繳 | 年繳 | 月繳 | |
| 1. 基本保障 | ||||||||||
| 15日至6歲 | $2,862 | $265 | $4,698 | $435 | $7,992 | $740 | $13,500 | $1,250 | $1,404 | $130 |
| 7 - 17歲 | $2,538 | $235 | $4,266 | $395 | $6,966 | $645 | $11,826 | $1,095 | $1,188 | $110 |
| 18 - 29歲 | $3,672 | $340 | $6,264 | $580 | $9,720 | $900 | $15,066 | $1,395 | $1,728 | $160 |
| 30 - 39歲 | $4,374 | $405 | $7,506 | $695 | $11,556 | $1,070 | $18,036 | $1,670 | $2,106 | $195 |
| 40 - 49歲 | $5,562 | $515 | $9,666 | $895 | $14,526 | $1,345 | $21,816 | $2,020 | $2,484 | $230 |
| 50 - 59 歲 | $8,208 | $760 | $13,770 | $1,275 | $20,574 | $1,905 | $30,402 | $2,815 | $3,510 | $325 |
| 60 - 69歲 | $12,960 | $1,200 | $22,194 | $2,055 | $32,562 | $3,015 | $47,358 | $4,385 | 5,724* | 530* |
| 70 - 75歲 | $16,254 | $1,505 | $27,594 | $2,555 | $40,392 | $3,740 | $58,806 | $5,445 | ||
| 76歲或以上* | $16,740 | $1,550 | $28,404 | $2,630 | $41,580 | $3,850 | $60,480 | $5,600 | ||
| 2. 門診保障（自選保障 | ||||||||||
| 15日至6歲 | $9,504 | $880 | ||||||||
| 7 - 17歲 | $9,504 | $880 | ||||||||
| 18 - 29歲 | $8,910 | $825 | ||||||||
| 30 - 39歲 | $10,314 | $955 | ||||||||
| 40 - 49歲 | $11,070 | $1,025 | ||||||||
| 50 - 59 歲 | $13,716 | $1,270 | ||||||||
| 60 - 69歲 | $17,982 | $1,665 | ||||||||
| 70 - 75歲 | $22,950 | $2,125 | ||||||||
| 76歲或以上* | $22,950 | $2,125 | ||||||||
| 2. 附加醫療保障（自選保障） | ||||||||||
| 15日至6歲 | $864 | $80 | $1,404 | $130 | $2,376 | $220 | $4,050 | $375 | ||
| 7 - 17歲 | $756 | $70 | $1,296 | $120 | $2,106 | $195 | $3,564 | $330 | ||
| 18 - 29歲 | $1,080 | $100 | $1,890 | $175 | $2,916 | $270 | $4,536 | $420 | ||
| 30 - 39歲 | $1,296 | $120 | $2,268 | $210 | $3,456 | $320 | $5,400 | $500 | ||
| 40 - 49歲 | $1,674 | $155 | $2,916 | $270 | $4,374 | $405 | $6,534 | $605 | ||
| 50 - 59歲 | $2,484 | $230 | $4,158 | $385 | $6,156 | $570 | $9,126 | $845 | ||
| 60 - 69歲 | $3,888 | $360 | $6,642 | $615 | $9,774 | $905 | $14,202 | $1,315 | ||
| 70 - 75歲 | $4,860 | $450 | $8,262 | $765 | $12,096 | $1,120 | $17,658 | $1,635 | ||
| 76歲或以上* | $5,022 | $465 | $8,532 | $790 | $12,474 | $1,155 | $18,144 | $1,680 | ||
| 3. 牙科保障（自選保障） | ||||||||||
| 15日或以上 | $1,458 | $135 | $1,458 | $135 | $1,458 | $135 | $1,458 | $135 | $1,458 | $135 |
| 4. 產科保障（自選保障） | ||||||||||
| 18 - 49歲 | $7,398 | $685 | $7,398 | $685 | $7,398 | $685 | $8,208 | $760 | $7,398 | $685 |
| 5. 危疾保障: 標準保障（自選保障） | ||||||||||
| 15日17歲 | $540 | $50 | $1,026 | $95 | $1,026 | $95 | $1,026 | $95 | $540 | $50 |
| 18 - 29歲 | $486 | $45 | $918 | $85 | $918 | $85 | $918 | $85 | $486 | $45 |
| 30 - 39歲 | $1,080 | $100 | $2,106 | $195 | $2,106 | $195 | $2,106 | $195 | $1,080 | $100 |
| 40 - 49歲 | $1,890 | $175 | $3,726 | $345 | $3,726 | $345 | $3,726 | $345 | $1,890 | $175 |
| 50 - 59歲 | $5,346 | $495 | $10,638 | $985 | $10,638 | $985 | $10,638 | $985 | $5,346 | $495 |
| 60 - 69歲* | $9,882 | $915 | $19,710 | $1,825 | $19,710 | $1,825 | $19,710 | $1,825 | $9,882 | $915 |
| 70 - 79歲* | $19,494 | $1,805 | $38,880 | $3,600 | $38,880 | $3,600 | $38,880 | $3,600 | ||
| 6. 危疾保障: 全面保障 | ||||||||||
| 15日至17歲 | $756 | $70 | $1,458 | $135 | $1,458 | $135 | $1,458 | $135 | $756 | $70 |
| 18 - 29歲 | $702 | $65 | $1,296 | $120 | $1,296 | $120 | $1,296 | $120 | $702 | $65 |
| 30 - 39歲 | $1,512 | $140 | $2,970 | $275 | $2,970 | $275 | $2,970 | $275 | $1,512 | $140 |
| 40 - 49歲 | $2,646 | $245 | $5,238 | $485 | $5,238 | $485 | $5,238 | $485 | $2,646 | $245 |
| 50 - 59歲 | $7,506 | $695 | $14,904 | $1,380 | $14,904 | $1,380 | $14,904 | $1,380 | $7,506 | $695 |
| 60 - 69歲* | $13,824 | $1,280 | $27,594 | $2,555 | $27,594 | $2,555 | $27,594 | $2,555 | $13,824 | $1,280 |
| 70 - 79歲* | $27,270 | $2,525 | $54,432 | $5,040 | $54,432 | $5,040 | $54,432 | $5,040 | ||
| 7. 女性計劃（自選保障 | ||||||||||
| 18 - 29歲 | $432 | $40 | $864 | $80 | $864 | $80 | $864 | $80 | $432 | $40 |
| 30 - 39歲 | $378 | $35 | $756 | $70 | $756 | $70 | $756 | $70 | $378 | $35 |
| 40 - 49歲 | $324 | $30 | $648 | $60 | $648 | $60 | $648 | $60 | $324 | $30 |
| 50 - 59歲 | $378 | $35 | $756 | $70 | $756 | $70 | $756 | $70 | $378 | $35 |
| 60 - 69歲* | $756 | $70 | $1,512 | $140 | $1,512 | $140 | $1,512 | $140 | $756 | $70 |
| 70 - 79歲* | $1,512 | $140 | $2,970 | $275 | $2,970 | $275 | $2,970 | $275 | ||
| 每年自負總額^ | 基本保障的保費折扣 |
|---|---|
每人每年 (港幣/元) |
精選計劃 |
| $10,000 | 25% |
| $20,000 | 35% |
| $40,000 | 45% |
| $80,000 | 55% |
| $120,000 | 65% |
重要事項:
*只接受續保年齡組別以上一次生日計算。
^每年自負總額只應用於基本保障，其餘保障仍維持不變。
中、英文版本內容如有歧義，在任何情況下將以英文版本為準。
以上提供之產品資料只供參考，有關保障範圍及承保條款，請參閱保單。
Exclusions
| 主要不保項目 | |||||
|---|---|---|---|---|---|
| 計劃 | 標準計劃 | 精選計劃 | 特選計劃 | 智選計劃 | 醫療增值計劃 |
|
|||||
重要事項:
中、英文版本內容如有歧義，在任何情況下將以英文版本為準。
以上提供之產品資料只供參考，有關保障範圍及承保條款，請參閱保單。
Faq Section
What is the waiting period for core cover?
"Waiting period" normally means that no coverage on any illnesses other than treatment necessitated by accident will be offered during that period. To provide you with instant protection, MediSure Plus does not have a waiting period. However, illnesses that are excluded or existing before the date of policy inception will not be covered at any time within the policy period.
I was requested to stay in a hospital for 14 hours to receive several medical treatments. Am I able to claim for in-patient benefit under MediSure Plus?
Yes. MediSure Plus covers all medically necessary treatment and services provided when you are admitted as a registered in-patient to a hospital regardless of the number of hours you have stayed in a hospital, provided that room and board charges were billed by the hospital.
If I undergo surgical operation, what compensation can I receive from MediSure Plus?
You will be compensated according to the percentage of the Surgical Schedule for the operation up to the maximum limit of Surgeon Fee, Anaesthetist Fee and Operation Theatre Charge as indicated in the Table of Benefit. If the type of surgical procedure is not specially mentioned in the schedule in MediSure Plus, it will be assessed by us and made consistent with the percentages indicated in the surgical schedule.
For more details, please kindly refer to the Surgical Schedule.
Does MediSure Plus cover cosmetic or plastic surgery?
Any cosmetic or plastic surgery is not covered under MediSure Plus as it is usually not medically necessary.
Please seek advice from us on your policy coverage details before receiving any non-emergency operation.
What is pre-existing condition?
Pre-existing conditions are excluded in MediSure Plus. A reasonable interpretation of pre-existing conditions is any injury, illness, medical condition or symptom prior to the commencement of the policy:
- that has been diagnosed
- that has been treated or advised to be treated
- that has been investigated or advised to be investigated
- for which a patient has been given medication or advised to have medication
- for which a patient has symptoms that manifested
- for which a patient has been hospitalised or advised to be hospitalised
- that has been known to exist
- that has a strong medical indication that it originated prior to the commencement of the policy, e.g. size of a tumour or stage of cancer
Can I upgrade to a higher benefit plan upon time of renewal?
Yes. You can request to upgrade or downgrade your benefit plan in writing at the time of policy renewal and you are required to declare your health condition for underwriting assessment. Renewal terms, conditions and premium rate may be adjusted after underwriting review.
For any illness/disease that has been diagnosed and is covered under the original plan before the upgrade, the maximum benefits for that illness/disease will remain the same as the original plan even when the upgraded plan has been approved.
Question Set
Faq Question
Faq Answer
"Waiting period" normally means that no coverage on any illnesses other than treatment necessitated by accident will be offered during that period. To provide you with instant protection, MediSure Plus does not have a waiting period. However, illnesses that are excluded or existing before the date of policy inception will not be covered at any time within the policy period.
Faq Question
Faq Answer
Yes. MediSure Plus covers all medically necessary treatment and services provided when you are admitted as a registered in-patient to a hospital regardless of the number of hours you have stayed in a hospital, provided that room and board charges were billed by the hospital.
Faq Question
Faq Answer
You will be compensated according to the percentage of the Surgical Schedule for the operation up to the maximum limit of Surgeon Fee, Anaesthetist Fee and Operation Theatre Charge as indicated in the Table of Benefit. If the type of surgical procedure is not specially mentioned in the schedule in MediSure Plus, it will be assessed by us and made consistent with the percentages indicated in the surgical schedule.
For more details, please kindly refer to the Surgical Schedule.
Faq Question
Faq Answer
Any cosmetic or plastic surgery is not covered under MediSure Plus as it is usually not medically necessary.
Please seek advice from us on your policy coverage details before receiving any non-emergency operation.
Faq Question
Faq Answer
Pre-existing conditions are excluded in MediSure Plus. A reasonable interpretation of pre-existing conditions is any injury, illness, medical condition or symptom prior to the commencement of the policy:
- that has been diagnosed
- that has been treated or advised to be treated
- that has been investigated or advised to be investigated
- for which a patient has been given medication or advised to have medication
- for which a patient has symptoms that manifested
- for which a patient has been hospitalised or advised to be hospitalised
- that has been known to exist
- that has a strong medical indication that it originated prior to the commencement of the policy, e.g. size of a tumour or stage of cancer
Faq Question
Faq Answer
Yes. You can request to upgrade or downgrade your benefit plan in writing at the time of policy renewal and you are required to declare your health condition for underwriting assessment. Renewal terms, conditions and premium rate may be adjusted after underwriting review.
For any illness/disease that has been diagnosed and is covered under the original plan before the upgrade, the maximum benefits for that illness/disease will remain the same as the original plan even when the upgraded plan has been approved.
Remark
以上提供之常見問題資料只供參考，有關保障範圍及承保條款，請參閱保單。