Glossary

An unforeseen and involuntary event.

An independent person who is an herbalist, a bonesetter or an acupuncturist registered with the Chinese Medicine Council of Hong Kong according to the Chinese Medicine Ordinance or with the local medical authorities at the place of treatment if such treatment is received outside Hong Kong.

An independent person who is registered with the Chiropractors Council of Hong Kong according to the Chiropractors Registration Ordinance or with the local medical authorities at the place of treatment if such treatment is received outside Hong Kong and renders chiropractic treatment to diagnose and cure the disorders of the musculoskeletal system and the effects of these disorders on the nervous system and general health.

"Coinsurance" shall mean a percentage of eligible expenses you must contribute after paying the deductible (if any).

 

Coinsurance Example:
 

Note: the final compensation amount will be determined according to terms of individual policy document.

An illness that has been diagnosed or has displayed symptoms after the waiting period of the policy.

An Injury caused directly, independently and solely by an Accident that occurs after the later of the Issue Date or the latest Commencement Date of this Policy.

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. 

A patient receiving medical services or treatments given in a medical clinic, day case procedure centre or Hospital where the patient is not in Confinement. 

"Deductible" shall mean a fixed amount of eligible expenses you must pay before the company shall reimburse the remaining eligible expenses.

 

Deductible Example:

 

Subject to the availability of deductible options under the product, if you are looking for full medical protection or top-up cover to supplement your current medical plan, annual deductible choices allow you to specify how much you are willing to pay before you claim. Choosing a higher deductible amount could lower the premiums for your policy. For example, say you chose an annual deductible of HKD16,000 and your eligible medical expense is HKD100,000, you would receive HKD100,000 less your deductible, which would be HKD84,000.

 

Note: the final compensation amount will be determined according to terms of individual policy document.

An event or situation that medical service is needed immediately in order to prevent death, permanent impairment or other serious consequences of the patient's health. 

A lawfully operated institution licensed as a hospital for the care and treatment of injured or ill persons which provides facilities for diagnosis, major surgery and 24-hour nursing service and is not primarily a rest or convalescent home, or similar establishment or, other than incidentally, a place for alcoholics or drug addicts. 

Admission to a Hospital as an In-Patient upon the recommendation of a registered medical practitioner for a continuous physical stay for medically necessary treatment, provided that the duration of such stay is six (6) hours or more.

Any abnormal bodily condition caused solely by Accident and independent of any other causes and not therefore due to illness or disease, which (except in cases of drowning or internal injury) is evidenced by external signs such as contusion, bruise and wound.

A patient who stays in a hospital for a covered illness or injury and is charged for the room & board facilities used during the stay.

The need to have medical service for the purpose of investigating or treating the relevant disability in accordance with the generally accepted standards of medical practice and such medical service must –
 

A patient who receives medical or surgical services in a private medical clinic, or in the outpatient or emergency department of a hospital to treat a covered illness or injury, but is not confined as a registered bed patient.

An independent person who is legally authorized in the geographical area of his practice to render assessment and treatment service on physical disability by means of cryotherapy, heat therapy, electrotherapy, manual therapy, traction, exercise therapy and hydrotherapy.

Any physical, medical or mental condition (including any sickness, disease, injury, physical, mental or medical condition or physiological degradation, including congenital condition):
 

before the later of the date the policy is issued and becomes effective or resumes coverage (whichever is the later).

"Reasonable and customary" means in relation to a charge for medical service, such level which does not exceed the general range of charges being charged by the relevant service providers in the locality where the charge is incurred for similar treatment, services or supplies to individuals with similar conditions, e.g. of the same sex and similar age, for a similar disability, as reasonably determined by the Company in utmost good faith. The reasonable and customary charges shall not in any event exceed the actual charges incurred.

 

In determining whether a charge is reasonable and customary, we shall make reference to the followings (if applicable):

 

Reasonable & Customary Charges Example:

If there are two doctors (Dr. A and Dr. B) who will perform the same medical procedure with Dr. A's charges being within the same level of almost all doctors. However, Dr. B's charges are significantly higher under the same medical procedures. In this circumstance, unless Dr. B can provide some reasonable proof (such as special expertise), we may otherwise consider Dr. B's charges as not being "Reasonable and customary" charges.

 

A Doctor's professional service charge should follow a hospital's published price list, and the service charge for the same procedures or operation should not differ substantially. Besides, the fee for medical procedure should also not be outside a patients' expectation and budget. Patients can request doctors to explain the charge and rationale for each item.

 

How AIA decides what's Reasonable & Customary?

AIA will check and refer to the market data objectively to determine reasonable and customary charges, including that of a high-end medical network's doctor operation fee, private room fee of government hospital, private hospitals' average medical operation fee and internal data.

 

Regarding the charges, we will evaluate and make appropriate adjustment based on various factors, including but limited to qualification, experience of doctors and the complexity of the operation.

 

Note: the final compensation amount will be determined according to the terms of each individual policy document.

 

Any person with a degree in western medicine and authorised locally to provide medical services. It excludes the following:

 

a. the doctor is the insured

b. the doctor is the insured's financial planner, business partner, employer or employee

c. the doctor is a member of the insured's immediate family

We regard multiple hospital confinements as a single one if they are:

 

Reasonable and usual expenses for surgical procedures performed on an insured outpatient or inpatient, including the fees for the surgeon, anaesthetist and operating room, plus the costs of items and equipment used during the surgery.

A period immediately following the effective date of the policy with the number of days stated in the policy. If there are symptoms of an illness before the waiting period has finished, the illness is not covered by the policy.

An unforeseen and involuntary event.

"Activities of Daily Living" mean the following:
 

An illness that has been diagnosed or has displayed symptoms after the waiting period of the policy.

An Injury caused directly, independently and solely by an Accident that occurs after the later of the Issue Date or the latest Commencement Date of this Policy.

A lawfully operated institution licensed as a hospital for the care and treatment of injured or ill persons which provides facilities for diagnosis, major surgery and 24-hour nursing service and is not primarily a rest or convalescent home, or similar establishment or, other than incidentally, a place for alcoholics or drug addicts. 

 

Admission to a Hospital as an In-Patient upon the recommendation of a registered medical practitioner for a continuous physical stay for medically necessary treatment, provided that the duration of such stay is six (6) hours or more.

Any kinds of infectious disease with human-to-human spread in a large cluster(s) of a local population and which is announced by the World Health Organization.

Any abnormal bodily condition caused solely by Accident and independent of any other causes and not therefore due to illness or disease, which (except in cases of drowning or internal injury) is evidenced by external signs such as contusion, bruise and wound.

A patient who stays in a hospital for a covered illness or injury and is charged for the room & board facilities used during the stay.

The need to have medical service for the purpose of investigating or treating the relevant disability in accordance with the generally accepted standards of medical practice and such medical service must –
 

Any physical, medical or mental condition (including any sickness, disease, injury, physical, mental or medical condition or physiological degradation, including congenital condition):
 

(a) that existed;

(b) that was investigated, diagnosed, or treated by a registered medical practitioner;

(c) for which a registered medical practitioner was consulted; or

(d) the signs or symptoms of which commenced,
 

before the later of the date the policy is issued and becomes effective or resumes coverage (whichever is the later).

Any person with a degree in western medicine and authorised locally to provide medical services. It excludes the following:

 

 

A period immediately following the effective date of the policy with the number of days stated in the policy. If there are symptoms of an illness before the waiting period has finished, the illness is not covered by the policy.

An unforeseen and involuntary event.

The person or persons designated in the application form as the beneficiary under this Policy (as may be amended from time to time in accordance with this Policy).

The person named by the Owner as "Contingent Owner" in the Company's prescribed form, who may become the Owner pursuant to the "CHANGE OF OWNERSHIP" provisions under the "OWNERSHIP PROVISIONS" of the Policy. It is only applicable for Policy with Insured under 18 years old when the Policy is issued.

Any person with a degree in western medicine and authorised locally to provide medical services. It excludes the following:

 

An unforeseen and involuntary event.

An illness that has been diagnosed or has displayed symptoms after the waiting period of the policy.

An Injury caused directly, independently and solely by an Accident that occurs after the later of the Issue Date or the latest Commencement Date of this Policy.

"Deductible" shall mean a fixed amount of eligible expenses you must pay before the company shall reimburse the remaining eligible expenses .

 

Deductible Example:

 

Subject to the availability of deductible options under the product, if you are looking for full medical protection or top-up cover to supplement your current medical plan, annual deductible choices allow you to specify how much you are willing to pay before you claim. Choosing a higher deductible amount could lower the premiums for your policy. For example, say you chose an annual deductible of HKD16,000 and your eligible medical expense is HKD100,000, you would receive HKD100,000 less your deductible, which would be HKD84,000.

 

Note: the final compensation amount will be determined according to terms of individual policy document.

Advance payment of a deposit guarantee to the Hospital so as to allow the Insured to be admitted to the Hospital.

An event or situation that medical service is needed immediately in order to prevent death, permanent impairment or other serious consequences of the patient's health. 

A lawfully operated institution licensed as a hospital for the care and treatment of injured or ill persons which provides facilities for diagnosis, major surgery and 24-hour nursing service and is not primarily a rest or convalescent home, or similar establishment or, other than incidentally, a place for alcoholics or drug addicts. 

Admission to a Hospital as an In-Patient upon the recommendation of a registered medical practitioner for a continuous physical stay for medically necessary treatment, provided that the duration of such stay is six (6) hours or more.

Any kinds of infectious disease with human-to-human spread in a large cluster(s) of a local population and which is announced by the World Health Organization.

Any abnormal bodily condition caused solely by Accident and independent of any other causes and not therefore due to illness or disease, which (except in cases of drowning or internal injury) is evidenced by external signs such as contusion, bruise and wound.

A patient who stays in a hospital for a covered illness or injury and is charged for the room & board facilities used during the stay.

The need to have medical service for the purpose of investigating or treating the relevant disability in accordance with the generally accepted standards of medical practice and such medical service must –
 

A patient who receives medical or surgical services in a private medical clinic, or in the outpatient or emergency department of a hospital to treat a covered illness or injury, but is not confined as a registered bed patient.

Any physical, medical or mental condition (including any sickness, disease, injury, physical, mental or medical condition or physiological degradation, including congenital condition):
 

before the later of the date the policy is issued and becomes effective or resumes coverage (whichever is the later).

Any person with a degree in western medicine and authorised locally to provide medical services. It excludes the following: