Benefit Schedule

Certified Plan

Benefit Items1 Benefit Limit (HK$)
Type of Certified Plan Standard Plan
Ward Class No Restriction
I. Basic Benefits
a. Room and Board (Per day)
Max. 180 days per policy year
 750
b. Miscellaneous Charges (Per policy year) 14,000
c. Attending Doctor’s Visit Fee (Per day)
Max. 180 days per policy year
 750
d. Specialist's Fee2 (Per policy year) 4,300
e. Intensive Care (Per day)
Max. 25 days per policy year
 3,500
f. Surgeon's Fee (Per surgery)
•
Complex
 50,000
•
Major
 25,000
•
Intermediate
 12,500
•
Minor
 5,000
Subject to surgical category for the surgery/procedure in the Schedule of Surgical Procedures
g. Anaesthetist's Fee 35% of the amount payable under Surgeon's Fee3
h. Operating Theatre Charges 35% of the amount payable under Surgeon's Fee3
i. Prescribed Diagnostic Imaging Tests2,4(Per policy year) 20,000
Subject to 30% coinsurance
j. Prescribed Non-surgical Cancer Treatments5 (Per policy year) 80,000
k. Pre- and Post-confinement /Day Case Procedure6Outpatient Care2(Per policy year) 3,000
Limit per visit 580
•
1 prior outpatient visit or emergency consultation per confinement/day case procedure
•
3 follow-up outpatient visits per confinement/day case procedure (within 90 days after discharge from hospital or completion of day case procedure)
l. Psychiatric Treatments (Per policy year) 30,000
Other Limits
Annual Benefit Limit for Benefit Items (a) – (l) of I. Basic Benefits (Per policy year) 420,000
Lifetime Benefit Limit for Benefit Items (a) – (l) of I. Basic Benefits Nil
II. Other Benefits
a. Hospital Cash Benefit7(Per day)
Max. 10 days per policy year
 400

Remarks

1.Unless otherwise specified, eligible expenses incurred in respect of the same item shall not be recoverable under more than one benefit item in the table above.
2.Blue Cross shall have the right to ask for proof of recommendation e.g. written referral or testifying statement on the claim form by the attending doctor or Registered Medical Practitioner.
3.The percentage here applies to the Surgeon's Fee actually payable or the benefit limit for the Surgeon's Fee according to the surgical categorisation, whichever is the lower.
4.Tests covered here only include computed tomography (“CT” scan), magnetic resonance imaging (“MRI” scan), positron emission tomography (“PET” scan), PET-CT combined and PET-MRI combined. This benefit item is subject to 30% coinsurance. If the eligible expenses incurred for the test is HK$10,000, Blue Cross will reimburse HK$7,000 and the customer will have to bear the remaining HK$3,000.
5.Treatments covered here only include radiotherapy, chemotherapy, targeted therapy, immunotherapy and hormonal therapy.
6."Day Case Procedure" shall mean a medically necessary surgical procedure for investigation or treatment to the insured person performed in a medical clinic, or day case procedure centre or hospital with facilities for recovery as a day patient.
7.Please refer to the Supplement for the terms and conditions applicable to this benefit item.
All expenses incurred must be Reasonable and Customary and Medically Necessary#.
For details of note #, please refer to "Points to Note".
Notes:
1. The above information does not contain the full terms of the policy and is for reference only. Both English and Chinese versions are official versions and neither one shall prevail over the other. Any inconsistency shall be interpreted in favour of the policyholder. Please refer to the policy for the exact terms and conditions and the full list of policy exclusions.
2. The above product(s) is/are offered for sale in Hong Kong only and is/are underwritten by Blue Cross (Asia-Pacific) Insurance Limited, an authorised insurer in Hong Kong.
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