Group Medical Platinum Scheme

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prudential

Group Medical Platinum Scheme

Price: Negotiable / Piece(s)
Min. Order: 1 Piece(s)
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prudential

Location:: ,Korea
Main Category:: Business Services
Main Products:: N/A

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Product Description



	Features
	Schedule of Benefits
	Eligibility
	Remarks

PRUbenefits Platinum Scheme is a comprehensive medical product that covers both Hospital & Surgical and Clinical Benefits.

Members can enjoy using HealthNet ( panel doctors ) and non-HealthNet ( free choice of doctors ) services.

Features

I. To suit your company's need, we offer:

Six levels of Hospital & Surgical Benefits
Plan 1/4 : Private Room
Plan 2/5 : Semi-Private Room
Plan 3/6 : Ward Room
Two Options for Clinical Benefits
Option 1 (Plan 1,2,3): No co-payment for "Network" Benefits and 100% reimbursement for Non-network Benefits, up to Maximum Limits
Option 2 (Plan 4,5,6): With co-payment for "Network" Benefits and 80% reimbursement for "Non-Network" Benefits, up to Maximum Limits
Preferential subscription for over 30 persons (as of Contract Effective Date)
Same subscription is used for members under the same plan (not rated by age)

II. To provide your employees with comprehensive benefits, we offer:

?Full benefit with no shortfall for all eligible Hospital and Surgical medical expenses under "Network" Benefits, subject to Overall Annual Limit.
Free Hospital Cash to lighten member's financial anxiety during hospitalization.
Free Inpatient Top Up Medical to cushion hospital or surgical expenses exceeding the Basic Scheduled Plan. It is not limited by the length of stay or classification of surgery.
Free choice of registered doctors and hospitals.
Free membership for Worldwide Assistance Programme.
Chinese Herbalist and Bonesetter treatments are covered under "Non-Network" Clinical Benefits.
Chiropractor and Physiotherapy treatments are covered as Specialist Consultant under "Non-Network" Clinical Benefits.
Simple enrollment in which no medical examination or health declaration is required.

Schedule of Benefits

Prudential Group Medical Insurance -
Platinum Scheme (Schedule of Benefits)

Hospital & Surgical Benefits

Hospital and Surgical Benefit Items

Maximum Limits Per Member (HK$)

"Network" Benefits
(HK Coverage Only)

Plan 1 / 4

Plan 2 / 5

Plan 3 / 6

Private

Semi - Private

Ward

Network Hosipitals

Canossa Hospital
St. Paul's Hospital
HK Baptist Hospital
Union Hospital

Section A : Basic Scheduled Plan

Room & Board, per day limit (max.

120 days per Disability)

Full Benefits
with no Shortfall for
all eligible medical expenses
(subject to Overall Annual Limit)

Miscellaneous Hospital Services, per Contract Year limit

Intensive Care (supplement to Room & Board), per Disability limit

Special Nursing, per day limit (max.

120 days per Contract Year)

Surgeon & Attendance Fees, per Disability limit (for surgical case only)
- Complex
- Major
- Intermediate
- Minor

Anaesthetist's Fees, per Disability limit
- Complex
- Major
- Intermediate
- Minor

Operating Theatre Fees, per Disability limit
- Complex
- Major
- Intermediate
- Minor

In-patient Physician's Fees, (for non-surgical case only), per day limit (max.

120 days per Contract Year)

	In-patient Specialist's Fees, per Contract Year limit
	-	must be referred by the attending doctor
	-	include pathology, radiology, physiotherapy during hospitalisation

	Pre-admission & Post-hospitalisation Out-patient Care, per Contract Year limit
	-	include 1 pre-admission visit (consultation fee only) & all related post-hospitalisation visits within 6 weeks right after discharge from hospital

Overall Annual Limit Per Member
(apply to Section A only)

Combined with "Non-Network" Benefits

Section B : Free In-patient Top Up Medical (80% Reimbursement), per Disability limit

-	apply after the Hospital & Surgical Benefits under Section A is exhausted
-	in case of overseas hospitalisation, only medical Emergency case will be covered

N/A

Section C : Free Hospital Cash, per day limit

-	apply only if confined in Ward Bed of Hospital Authority Hospital in Hong Kong
-	pay from the 3rd day of hospital confinement up to a max. of 120 days per Contract Year

N/A

Section D : Free Worldwide Assistance Programme, major services include :

-	24-Hour hotline for travel, medical or legal information and assistance
-	Emergency medical evacuation and repatriation (unlimited cover)
-	Repatriation of mortal remains/ashes (unlimited cover)
-	Hospital deposit guarantee (up to HK$39,000)
-	Extra benefit (up to HK$120,000) for hospitalisation in Hong Kong right after the medical repatriation provided that the Hospital & Surgical Benefits under Section A & B above is exhausted

Hospital & Surgical Benefits

Hospital and Surgical Benefit Items

Maximum Limits Per Member (HK$)

"Non-Network" Benefits
(Worldwide Coverage)

Plan 1 / 4

Plan 2 / 5

Plan 3 / 6

Private

Semi - Private

Ward

Section A : Basic Scheduled Plan

Room & Board, per day limit (max.

120 days per Disability)

2,000

1,200

500

Miscellaneous Hospital Services, per Contract Year

30,000

22,000

11,000

Intensive Care (supplement to Room & Board), per Disability limit

30,000

22,000

11,000

Special Nursing, per day limit (max.

120 days per Contract Year)

800

500

200

Surgeon & Attendance Fees, per Disability limit (for surgical case only)
- Complex
- Major
- Intermediate
- Minor

98,000
39,000
22,000
10,000

56,000
25,000
12,000
6,000

42,000
18,000
10,000
5,000

Anaesthetist's Fees, per Disability limit
- Complex
- Major
- Intermediate
- Minor

28,000
11,000
4,500
3,000

15,000
7,500
4,000
2,500

12,000
5,000
3,500
2,000

Operating Theatre Fees, per Disability limit
- Complex
- Major
- Intermediate
- Minor

28,000
11,000
4,500
3,000

15,000
7,500
4,000
2,500

12,000
5,000
3,500
2,000

In-patient Physician's Fees, (for non-surgical case only), per day limit (max.

120 days per Contract Year)

2,000

1,200

500

	In-patient Specialist's Fees, per Contract Year limit
	-	must be referred by the attending doctor
	-	include pathology, radiology, physiotherapy during hospitalisation

12,000

8,700

6,650

	Pre-admission & Post-hospitalisation Out-patient Care, per Contract Year limit
	-	include 1 pre-admission visit (consultation fee only) & all related post-hospitalisation visits within 6 weeks right after discharge from hospital

8,400

5,500

4,400

Overall Annual Limit Per Member
(apply to Section A only)

1,000,000

600,000

4,400

Section B : Free In-patient Top Up Medical (80% Reimbursement), per Disability limit

-	apply after the Hospital & Surgical Benefits under Section A is exhausted
-	in case of overseas hospitalisation, only medical Emergency case will be covered

150,000

100,000

50,000

Section C : Free Hospital Cash Plan, per day limit

-	apply only if confined in Ward Bed of Hospital Authority Hospital in Hong Kong
-	pay from the 3rd day of hospital confinement up to a max. of 120 days per Contract Year

1,000

600

250

Section D : Free Worldwide Assistance Programme, major services include :

-	24-Hour hotline for travel, medical or legal information and assistance
-	Emergency medical evacuation and repatriation (unlimited cover)
-	Repatriation of mortal remains/ashes (unlimited cover)
-	Hospital deposit guarantee (up to HK$39,000)
-	Extra benefit (up to HK$120,000) for hospitalisation in Hong Kong right after the medical repatriation provided that the Hospital & Surgical Benefits under Section A & B above is exhausted

Clinical Benefits

Clinical Benefit Items

Maximum Limits Per Member (HK$)

"Network" Benefits
(HK Coverage Only)

Plan 1 / 4

Plan 2 / 5

Plan 3 / 6

Network Doctors & Diagnostic Centres Network Size

Premiercare Limited*

a.	General Practitioner (GP), per visit per day limit
	-	consultation fee (including Medically Necessary medication prescribed & obtained at the doctor's clinic)

Full Benefits for all eligible medical expenses (subject to co-payment, if any)

(incl. consultation and up to 3 days' basic necessary medication for item a & b)

b.	Specialist (SP), per visit per day limit
	-	consultation fee (including Medically Necessary medication prescribed & obtained at the doctor's clinic) subject to written referral from General Practitioner
	-	including Physiotherapist and Chiropractor

c.	Diagnostic X-ray and Laboratory Tests, per Contract Year limit
	-	subject to written referral from Registered Medical Practitioner

d.	Prescribed Medication, per Contract Year limit
	-	extra, long term or expensive Medically Necessary western medication prescribed & obtained at the doctor's clinic on the same day of consultation

1,200

800

N/A

e.	Chinese Herbalist and Bonesetter, per visit per day limit
	-	consultation fee (including Medically Necessary medication prescribed at the doctor's office & obtained at any legitimate source on the same day of consultation)

N/A

Option 1

Plan 1, 2, 3 No co-payment

Option 2

Plan 4, 5, 6 HK$30 co-payment per claim
(for items a & b only)

Clinical Benefits

Clinical Benefit Items

Maximum Limits Per Member (HK$)

"Non-Network" Benefits
(Worldwide Coverage)

Plan 1

Plan 2

Plan 3

a.	General Practitioner (GP), per visit per day limit
	-	consultation fee (including Medically Necessary medication prescribed & obtained at the doctor's clinic)

350 or 880 (Home Visit)

200 or 500 (Home Visit)

150 or 380 (Home Visit)

b.	Specialist (SP), per visit per day limit
	-	consultation fee (including Medically Necessary medication prescribed & obtained at the doctor's clinic) subject to written referral from General Practitioner
	-	including Physiotherapist and Chiropractor

700

400

300

c.	Diagnostic X-ray and Laboratory Tests, per Contract Year limit
	-	subject to written referral from Registered Medical Practitioner

3,500

2,000

1,500

d.	Prescribed Medication, per Contract Year limit
	-	extra, long term or expensive Medically Necessary western medication prescribed & obtained at the doctor's clinic on the same day of consultation

N/A

e.	Chinese Herbalist and Bonesetter, per visit per day limit
	-	consultation fee (including Medically Necessary medication prescribed at the doctor's office & obtained at any legitimate source on the same day of consultation)

120

Option 1

Plan 1, 2, 3 100% reimbursement

Option 2

Plan 4, 5, 6 80% reimbursement

Notes:

	(i)	Minor Operations or Day Case Surgery or Special Services performed at a clinic or Hospital will be paid under Hospital & Surgical Benefits.
	(ii)	Minor Operations and Day Case Surgery mean Medically Necessary surgical procedures which may be carried out at clinic or day case unit of a Hospital by a GP or SP and a stay in Hospital is not required.
	(iii)	Special Services mean Medically Necessary (a) treatment of chemotherapy, radiotherapy, radioactive isotope; and (b) diagnostic test of CT Scan or Magnetic Resonance Imaging services.
	The maximum number of days applies to combined Hospital stays at "Network" and "Non-Network" Hospitals.
	To enjoy benefit for eligible medical expenses under "Network" Benefits: All treatments must be provided in "Network" facilities (Hospital - at or below restricted room level, clinics and diagnosic centres) Specialist consultation (except for Gynaecology, Paediatrics & Family Medicine) must be referred by"Network" General Practitioner Pre-authorisation must be obtained from for : - Hospitalisation and Special Services - Minor Operations or Day Case Surgery exceeding HK$2,000 - Diagnostic X-ray or laboratory tests exceeding HK$1,000 Notwithstanding the fulfillment of all the above requirements, Special Services are still subject to a maximum limit of HK$100,000 (includes all doctor charges and other medical related charges) per Contract Year under "Network" Benefits.
	Number of visits per Contract Year for item a, b and e is 30 in total (combined benefits of "Network" & "Non-Network") and is subject to a maximum of 1 visit per day. * The Company reserves the right to change the Network Service Provider without prior notice.
	Application for clinical benefits must be submitted with 5 members or above. No premium shall be refunded should the number of members for the clinical benefits be withdrawn to be lesser than 5 during the policy period.



Eligibility
All full time permanent employees (and their dependents) who are under 65 years old on the Coverage Commencement Date and are stationed in Hong Kong. Dependents shall include (a) legal spouse under 65 years old; and (b) unmarried child(ren) at or over 15 days and under 18 years old or under 23 years old if in full time education (subject to valid proof) on the Coverage Commencement Date.


Remarks
Major Exclusions: Illness or injury which commence prior to the Coverage Commencement Date and consultation, investigation or treatment is made within 6 months before or 3 months after the Coverage Commencement Date. AIDS or HIV-related conditions which originate during the first 5 years of membership; or venereal disease. Congenital, Developmental or Hereditary Conditions (incl. medical abnormalities existing at time of birth & neo-natal abnormalities developed within 6 months of birth), geriatric, psychiatric conditions or mental disorders, pregnancy, infertility, or sterilization. Dental or oro-surgery treatment (except for emergency in-patient treatment arising from an accident); or cosmetic surgery. Treatment arising from war, armed force, terrorist or criminal acts; self inflicted injury or suicide; abuse of drugs or alcohol; or professional sports. Rest cure, general check-ups, hearing or eye test, vaccination, inoculations, supportive treatment of renal failure such as dialysis. Use of special braces or implant appliances (e.g. prosthesis, lens, stent, etc), blood or blood plasma, non-medical services (e.g. medical reports, telephone charges, etc), experimental or new medical technology (unless approved by Prudential).

prudential

Company Introduction

Academic Achievements Bachelor and Master Degree in Economics Professional Qualifications FCCA AHKSA United States Life Insurance Institute Fellow Member Work Experience Trained with KPMG Peat Marwick UK 15 years financial controllership in international corporations and regional office Specialized in accounting, personal income tax and trust management. Expert consultant in insurance financial planning