+ 1. Certified Plan

Benefit Items¹		Benefit Limit (HK$)
Plan Level		Plan A	Plan B	Plan C	Plan D
Ward Class		No Restriction
I. Basic Benefits
a.	Room and Board (Per day) Max. 180 days per policy year	4,000	2,200	1,000	800
b.	Miscellaneous Charges (Per policy year)	42,000	27,500	22,000	14,000
c.	Attending Doctor's Visit Fee (Per day) Max. 180 days per policy year	4,000	2,200	1,000	750
d.	Specialist's Fee² (Per policy year)	10,000	7,400	6,300	4,300
e.	Intensive Care (Per day) Max. 30 days per policy year	10,000	6,600	5,600	3,500
f.	Surgeon's Fee (Per surgery)
	• Complex	150,000	120,000	90,000	50,000
	• Major	50,000	40,000	35,000	25,000
	• Intermediate	30,000	22,000	18,000	12,500
	• Minor	12,000	9,000	7,000	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 Tests^2,4 (Per policy year)	40,000	30,000	20,000	20,000
i.	Prescribed Diagnostic Imaging Tests^2,4 (Per policy year)	Subject to 30% coinsurance
j.	Prescribed Non-surgical Cancer Treatments⁵ (Per policy year)	120,000	100,000	80,000	80,000
k.	Pre- and Post-confinement /Day Case Procedure⁶Outpatient Care² (Per policy year)
	• 2 prior outpatient visits or emergency consultations per confinement/day case procedure	10,800	8,800	4,800	3,000
	• All related follow-up outpatient visits per confinement/day case procedure within 90 days after discharge from hospital or completion of day case procedure	10,800	8,800	4,800	3,000
l.	Psychiatric Treatments (Per policy year)	40,000	35,000	30,000	30,000
II. Enhanced Benefits
a.	Kidney Dialysis⁷(Per policy year)	120,000	100,000	80,000	50,000
b.	Stroke Rehabilitation⁷(Per policy year)	120,000	100,000	80,000	50,000
c.	Emergency Outpatient Treatment⁷(Per policy year)	15,000	11,000	7,000	2,500
d.	Hospital Companion Bed⁷(Per day) Max. 90 days per policy year	3,400	2,040	860	800
e.	Registered Private Nurse's Fees⁷(Per day) Max. 90 days per policy year	3,400	2,040	860	800
f.	Post-confinement/Day Case Procedure⁶ Chinese Medicine Practitioner Outpatient Care⁷(Per visit) Limit per visit 1 follow-up outpatient visit per day, maximum 5 follow-up outpatient visits per confinement/day case procedure (within 90 days after discharge from hospital or completion of day case procedure)	200	180	150	150
g.	Supplementary Medical Benefit⁷ (Per policy year)
		Optional			Included
	Designated Ward Class⁸	Private	Semi-private	Ward	Ward
	Coinsurance⁹	20%	20%	20%	20%
	Limit per policy year	600,000	450,000	300,000	120,000
	This benefit shall be payable for: (1) eligible expenses payable in excess of any of the benefit limits under benefit items (a) – (j) of I. Basic Benefits; (2) expenses payable in excess of any of the benefit limits under benefit item (d) of II. Enhanced Benefits; and (3) any coinsurance which should be paid by the insured person under benefit item (i) of I. Basic Benefits.
Other Limits
Annual benefit limit for benefit items (a)-(l) of I. Basic Benefits and (a)-(f) of II. Enhanced Benefits (Per policy year) (For insured person at age 75 or below)		Nil
Annual benefit limit for benefit items (a)-(l) of I. Basic Benefits and (a)-(f) of II. Enhanced Benefits (Per policy year) (For insured person at age 76 or above)		830,000	540,000	540,000	420,000
Lifetime benefit limit for benefit items (a)-(l) of I. Basic Benefits and (a)-(g) of II. Enhanced Benefits		Nil
III. Other Benefits
a.	Outpatient Surgery Cash Allowance^7,10 (Per Day Case Procedure⁶)	1,000	1,000	1,000	1,000
b.	Hospital Cash Benefit⁷(Per day) Max. 45 days per policy year	1,700	1,010	425	400
c.	Isolation Room Cash Benefit⁷(Per day) Max. 30 days per policy year	1,000	1,000	1,000	1,000
d.	Cash Benefit for Top-up Subsidy^7,11 (Per day of confinement) Max. 90 days per policy year	1,200	600	500	500

+ 2. Optional Outpatient Benefits (Plan A or B)^12,13,14

+ Remarks

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.

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.

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.

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.

Treatments covered here only include radiotherapy, chemotherapy, targeted therapy, immunotherapy and hormonal therapy.

“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.

Please refer to the Supplement for the terms and conditions applicable to these benefit items.

If the insured person is voluntarily confined to a level of hospital facilities and services higher than the designated ward class of the plan selected, the eligible claims made in respect of the Supplementary Medical Benefit will be calculated based on scale of reimbursement below:

Designated Ward Class	Actual Confined Ward Class	Reimbursement Percentage of All Eligible Claims
Ward	Semi-private	50%
Ward	Private	25%
Ward	Above Private	12.5%
Semi-private	Private	50%
Semi-private	Above Private	25%
Private	Above Private	50%

Subject to the benefit limit for each benefit item, (i) if the eligible expenses incurred for a relevant benefit item is HK$400 and the 20% coinsurance option applies, Blue Cross will reimburse HK$320 and the customer will have to bear the remaining HK$80; (ii) if the 0% coinsurance option applies, Blue Cross will reimburse the full cost of eligible expenses.

10.

Only applicable to the following day case procedures: oesophagogastroduodenoscopy, colonoscopy, cystoscopy, arthroscopy, colposcopy, bronchoscopy, repair of retinal detachment and hysteroscopy.

11.

For the insured person covered by any other hospital reimbursement plans offered by a licensed insurance company other than Blue Cross, regardless of whether it is an individual or group policy, if any reimbursement for any confinement of the insured person is payable under the relevant terms and benefits after any reimbursement has been paid from such licensed insurance company, this benefit shall be payable as extra cash benefit for each day of confined period in hospital subject to the limits as specified in the Benefit Schedule.

12.

Optional Outpatient Benefits are optional medical benefits available under the Certified Plan. For details, please refer to the Benefit Schedule and the Premium Table. These benefits are not required to be certified by the Health Bureau and therefore do not form part of the Certified Plan. The premiums paid for these benefits will not be eligible for tax deduction. Please refer to the relevant terms and conditions for details.

13.

Semi-annual, quarterly and monthly payment modes are not available for policies with Optional Outpatient Benefits.

14.

You will receive an electronic medical card to access designated Blue Cross network clinics for medical consultations with general practitioners, Chinese medicine practitioners and specialists.

15.

Except for gynecology, orthopaedics & traumatology, dermatology, ophthalmology, oncology, urology, nephrology and paediatrics.

Notes:

1.		The above information does not contain the full terms and conditions 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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Benefit Items	Benefit Limit (HK$)
Plan Level	Plan A(I)	Plan A(II)	Plan A(III)
Coinsurance⁹	20% or 0%
1. General Practitioner's Consultation 1 visit per day, limit per visit	350	260	200
2. Chinese Medicine Treatment Including Chinese bone-setting and acupuncture 15 visits per policy year, 1 visit per day, limit per visit	180	150	120
Max. 35 visits per policy year in total for benefit items 1 and 2
3. Specialist's Consultation Referral letter is required¹⁵ 10 visits per policy year, 1 visit per day, limit per visit	520	400	300
4. Prescribed Medicines and Drugs Applicable to purchase from a registered pharmacy outside hospital or clinic where the medical consultation takes place and prescription letter is required Limit per policy year	7,800	5,800	4,300
5. Diagnostic X-rays and Laboratory Tests Referral letter is required Limit per policy year	2,500	1,900	1,500
6. Physiotherapy Services 10 visits per policy year, 1 visit per day, limit per visit	350	260	200
7. Chiropractic Services 10 visits per policy year, 1 visit per day, limit per visit	350	260	200
Max. 10 visits per policy year in total for benefit items 6 and 7
8. Psychiatric Treatments (including medication) • Written referral of registered physician is required for consultation rendered by specialist of psychiatry • Written referral of specialist of psychiatry is required for consultation rendered by qualified clinical psychologist • 6 visits per policy year, 1 visit per day, limit per visit	520	400	300

Benefit Items	Maximum Benefit Limit (HK$)
Plan Level	Plan B(I)	Plan B(II)	Plan B(III)
Coinsurance⁹	20% or 0%
1. General Practitioner’s Consultation 1 visit per day, limit per visit	350	260	200
2. Chinese Medicine Treatment Including Chinese bone-setting and acupuncture 10 visits per policy year, 1 visit per day, limit per visit	180	150	120
Max. 30 visits per policy year in total for benefit items 1 and 2
3. Specialist’s Consultation Referral letter is required¹⁵ 10 visits per policy year, 1 visit per day, limit per visit	520	400	300
4. Physiotherapy Services 10 visits per policy year, 1 visit per day, limit per visit	350	260	200
5. Chiropractic Services 10 visits per policy year, 1 visit per day, limit per visit	350	260	200
Max. 10 visits per policy year in total for benefit items 4 and 5
6. Psychiatric Treatments (including medication) • Written referral of registered physician is required for consultation rendered by specialist of psychiatry • Written referral of specialist of psychiatry is required for consultation rendered by qualified clinical psychologist • 6 visits per policy year, 1 visit per day, limit per visit	520	400	300