201911 Bupa Choice Plus Brochure

Bupa Choice Plus 保柏專業寶

Affordable choice for healthy employees 實惠智選 保障僱員健康

www.bupa.com.hk

Introduction to Bupa Choice Plus 保柏專業寶 團體醫療保障計劃簡介 Catering to businesses with five to 50 employees, Bupa Choice Plus is the affordable choice for companies that are looking for quality health cover for their employees. With Bupa Choice Plus, your employees will be well looked after with comprehensive hospitalisation coverage and access to guaranteed lifelong protectionq. At the same time, you have the flexibility to choose from different plan options to suit your budget. 此醫療保障計劃專為 5 至 50 名僱員的公司而設，為僱主提供實惠而優質的 計劃，保障僱員的健康。 「保柏專業寶」備有全面住院保障及終生續保保證 q，周全地照顧您的僱員， 並可靈活選擇多種計劃方案，配合公司的預算。

1

As a specialist health insurer, we use our expertise to provide your employees with comprehensive cover, while keeping costs low for your business. 作為醫療保險專家，我們的專 業睿智為您的僱員提供完善的 保障，而且費用實惠，減低公 司的成本。

Scheme overview 計劃概要

Cover at a glance 保障一覽表 Basic benefit

Hospital and Surgical Benefit

Optional benefit

Clinical Benefit

Free benefits

Free Bupa Worldwide Assistance Programme

Choice of benefit levels

Private (Plan 1, 4, 7)

基本保障 自選保障

免費保障

保障等級選擇

住院及手術保障 門診保障

免費保柏國際援助計劃 私家房（計劃 1, 4, 7）

Semi-private (Plan 2, 5, 8)

半私家房（計劃 2, 5, 8） Ward (Plan 3, 6, 9)

大房（計劃 3, 6, 9） Period of cover

保障期

1 year

1年

Eligibility 投保資格 Company size

5 – 50 employees

Employees

All full-time employees aged under 65

公司規模 僱員

5 至 50 名僱員

所有 65 歲以下的全職僱員

Employees’ dependants Spouse aged under 65

僱員之家屬

65 歲以下的配偶

Unmarried children aged between 15 days and 17 years, or under 23 years for full-time students (with valid proof)

僱員的未婚子女，年齡介乎 15日至17 歲或未滿 23 歲的全日制學生（須提供有效證明文件） Renewal of scheme

續保

This scheme can be renewed on an annual basis

此計劃可每年續保

Enrolment 投保 Submit application form with member details and relevant subscription and levy payment at least 10 working days before the end of the month

請於月底前最少 10 個工作天交回申請表，填妥會員資料並連同正確保費及徵費

Contract will come into effect on the first day of the following month

合約將於下月1 號生效 Please refer to the Schedule of Benefits for more information.

詳情請參閱保障金額表。 2

8 reasons to choose Bupa Choice Plus 選擇保柏專業寶的 8大理由 Our healthcare expertise means that we're able to offer unparalleled benefits to our group members, including comprehensive hospitalisation coverage and expert healthcare, with the flexibility to meet your company's needs. 我們在醫療保健上擁有豐富經驗，因此能為團體計劃會員提供卓越的保障， 包括全面住院保障及專業的醫療保健服務，同時能靈活配合公司的需要。

1. Covers hospital expenses with free choice of doctors Members will receive comprehensive cover for hospital expenses such as surgeries, ICU and miscellaneous services. The benefits are restored every year, which provide higher cover especially for those who require lengthy treatment for serious illnesses. Common procedures such as wound sutures, endoscopies and colonoscopies that are conducted in the day-case unit of a hospital or a clinic are also covered.

1. 保障住院費用，可自由選擇醫生 會員可獲全面住院費用保障，包括手術、深切治療及雜項服 務的費用，保障額每年重新計算，對於須要長期治療嚴重疾 病的僱員可提供更高保障。在醫院日症房或診所進行的常見 醫療程序如傷口縫針、內窺鏡或結腸鏡等亦受保障。

2. 門診費用自選保障 您可自選「門診保障」，保柏會賠償 80% 門診醫療費用，例如 普通科醫生、專科醫生及脊醫診症費用，以及診斷影像和化 驗費用，您還可選擇附加「中醫師保障」及「跌打醫師保障」。

2. Optional cover for out-patient expenses Under our optional Clinical Benefit, members will receive 80% reimbursement for out-patient expenses such as consultations with GPs, specialists and chiropractors, and diagnostic imaging and lab tests. You can also choose to add on our Chinese Herbalist Benefit and Chinese Bonesetter Benefit.

3. 保費平穩更有預算 我們讓同一計劃等級下所有僱員，不論年齡一律享有劃一保 費，令計劃更物超所值。每個家庭只須繳付一名子女的保費， 所有合資格子女均獲受保。此外，您的保費不會受公司過往 的索償金額影響。

3. Stable subscriptions To give you better value, all employees under the same plan level will enjoy a flat subscription rate regardless of age. All eligible children in a family will also be enrolled at the cost of one child's subscription. What’s more, your subscription rates will not be affected by the past claim amounts of your company.

3

4. Overseas protection in the event of accidents

4. 海外意外保障

Members who are hospitalised overseas due to emergencies can receive immediate assistance with our Free Bupa Worldwide Assistance Programme. This includes the hospital admission deposit as well as unlimited cover for emergency medical evacuation and repatriation. They will also receive an extra hospital benefit of HK$120,000 upon repatriation to Hong Kong.

5. Access to lifelong cover With access to lifelong protection when they retire or have a change of employment, our group members can enjoy peace of mind. Members have the option of transferring to our designated individual health insurance scheme regardless of their health condition. All eligible illnesses developed during their group membership will be covered for life under the individual scheme.

會員如因緊急情況在海外入院，可透過「免費保柏國際援助計 劃」得到即時支援，服務包括住院按金墊支和全數支付緊急醫 療運送費用 。送返香港後 更可獲額外港幣 12 萬元的住院 保障。

5. 可獲終生續保 我們的團體會員在退休或轉換工作後，不論健康狀況如何， 也可選擇將其會籍轉移至指定的個人醫療保障計劃 ，令他們 安枕無憂。所有於團體計劃會籍生效期間所患的合資格受保 疾病均可在該個人醫療保障計劃內獲終生保障 。

 會員只須受保於保柏團體保險最少六個月及依照保柏訂定之所需程序及條款，便可轉 移其會籍 。提升計劃等級或增加保障項目須由保柏核保審批。  保柏保證會員在新計劃下的保障可獲每年續保至終生，只要他們符合合約內所列明的 續保要求。保柏保留在合約續保時更改保費、保障、條款及細則的權利 。會員可參閱 他們的個人醫療保險合約以了解詳情。

 Members who have been covered under Bupa's group insurance for a minimum of six months are entitled to the transfer option, subject to the required process and terms determined by Bupa. The upgrade of plan level or addition of benefit items will require Bupa's underwriting approval.  Bupa guarantees that members' cover under the new scheme can be renewed every year for life as long as they meet the requirements as stated in the Renewal Clause of their contract. Bupa reserves the right to amend the subscription, benefits, terms and conditions upon their contract renewal. They can refer to their individual health insurance contract for further details.

4

Claims service pledge All hospitalisation and out-patient claims will be settled within 5 – 7 working days after full documentation is received. 賠償服務承諾 所有住院及門診賠償，於收妥所需文件 後 5 - 7個工作天內支付。

6. Fast and easy claims We make claims processing fast and easy. It is our service pledge to settle claims within five to seven working days after full documentation is provided to us. When a claim is settled, we will send out a SMS to notify your employeee. To reimburse the expenses, we simply credit the payments directly to your employee’s bank account.

6. 索償快捷簡便 我們的索償程序快捷簡便。保柏的服務承諾是在收妥所需文 件後 5 至7 個工作天內支付賠償。我們在賠償辦妥後會發出短 訊通知您的僱員 e。支付方法亦很簡便，賠償款項會直接存入 僱員的銀行賬戶。

7. 投保方便 加入新會員於此計劃，無需身體檢查、個別核保或填寫健康 聲明。

7. Hassle-free enrolment No medical examinations, individual underwriting or health declarations are required for enrolment of new members.

8. Around-the-clock support with attentive and convenient services

8. 全天候支援，服務體貼周到 保柏為您提供方便周全的服務，讓您輕鬆管理計劃。我們的 客戶服務主任每天 24 小時為您服務，快捷準確地回答客戶的 查詢。您亦可使用我們的網上服務，瀏覽賠償單及增減計劃 會員；而會員則可瀏覽會籍資料和查閱索償進度。

With our helpful and convenient services, managing your scheme is a breeze. Our Customer Care Advisors are available 24 hours every day to answer customer enquiries quickly and accurately. You can also use our online service to view claim statements and add or remove members, while members can view membership details and track claims.

e To enjoy the SMS notification service, employees will need to provide Bupa with an up-to-date mobile phone number.

e 僱員必須向保柏提供最新手機號碼，方可享用短訊通知服務 。

5

6

The World of Bupa 環球保柏

Bupa – A global healthcare specialist

保柏－國際醫療保健專家

Bupa began in the UK in 1947. We fund and provide healthcare services to fulfil our purpose of helping people live longer, healthier, happier lives. Our diversified services include health insurance, clinics, hospitals, dental centres, care homes, and more.

保柏在 1947 年於英國成立 ，我們提供醫療保險和醫療保健服務 ， 以達致保柏的公司目標 ，就是幫助人們活得更長壽 、更健康和 更愉快的人生 。我們多元化的服務包括醫療保險 、診所 、醫院 、 牙科中心及護老院等 。

We directly employ around 80,000 people, principally in the UK, Australia, Spain, Poland, Chile, New Zealand, Hong Kong, Turkey, the US, Brazil, the Middle East and Ireland. We also have associate businesses in Saudi Arabia and India. With no shareholders, we reinvest our profits to provide more and better healthcare for customers.

Bupa’s presence in Hong Kong Bupa is a leading provider in healthcare funding and provision with two independent units, Bupa Hong Kong and Quality HealthCare.

全球的員工約 80,000 人 ，主要位於英國 、澳洲 、西班牙 、波 蘭 、智利 、紐西蘭 、香港 、土耳其 、美國 、巴西 、中東及愛爾 蘭 。保柏亦於沙地阿拉伯及印度設有聯營業務 。我們不設股東 ， 所以將盈餘投資於業務當中 ，以提供更佳的醫療服務給客戶 。

保柏於香港的業務 保柏透過旗下兩間獨立營運的公司—保柏香港及卓健醫療 ，為市 民提供醫療保險及醫療保健服務 ，兩者皆具領導地位 。

Bupa Hong Kong In Hong Kong, we are known as the health insurance specialist providing domestic and international health insurance. We have gained the trust of more than 400,000 individuals, and 3,200 companies including major corporations in public utility and telecom industry. We have provided quality health insurance for Hong Kong’s civil servants for more than 20 years. We have applied our expertise to provide our members with comprehensive and flexible insurance plans to suit every life stage and lifestyle. Through our extensive provider network in Hong Kong, we offer our members a wide choice of doctors.

Quality HealthCare Quality HealthCare Medical Services Limited (QHMS), Hong Kong, became part of Bupa, an international healthcare group, in October 2013. QHMS’ operations span diagnostics, primary healthcare and day care specialties. With roots tracing back to 1868, QHMS serves the community through a network of over 1,500 provider service points in the city, including 120 self-owned multi-specialty medical centres and affiliated clinics offering western medicine, traditional Chinese medicine, diagnostics & imaging, dental, physiotherapy, psychological and wellness services. It also operates a private nursing agency. QHMS is one of the largest providers of healthcare services to corporates in Hong Kong. In 2018, the Group recorded more than 3 million healthcare visits. QHMS endeavours to enhance the quality of our professional services continuously to satisfy the needs of customers and patients.

保柏香港 在香港 ，我們是醫療保險專家 ，提供本地和國際醫療保險 ，受超 過40萬名會員及3,200間公司所信賴 ，當中包括公用機構及電訊 公司等大型企業 。我們亦為本港公務員提供優質醫療保障逾20年 。 憑藉專業知識 ，我們為會員提供全面而靈活的醫療保險計劃 ，切 合您人生每一階段的需要 。透過擁有龐大本港醫療網絡 ，我們讓 會員有更多醫生選擇 。

卓健醫療 卓健醫療服務有限公司（卓健醫療 ）於 2013 年 10 月正式加入國 際醫療服務集團—保柏 。卓健醫療的服務涵蓋診斷 、基層保健 及專科服務 。自 1868 年起植根香港 ，卓健醫療透過逾 1,500 多 個遍及全港的服務點 ，包括旗下 120 間多項專科設施齊備的醫療 中心及多間聯營診所 ，為香港市民及訪港旅客提供西醫 、中醫 、 診斷及造影 、牙科 、物理治療 、精神健康及保健等服務 ，並營 運護理介紹所 。卓健醫療是香港最大規模提供企業醫療服務的 機構之一 。於 2018 年度 ，卓健醫療錄得超過 300 萬求診人次 ， 並繼續致力提升其專業服務的質素 ，以滿足客戶及病人的需要 。 7

Keeping you healthy

助您保持健康

Keeping our members well is as important to us as protecting them when they become unwell.

保柏不單在會員患病時提供保 障，我們認為助他們保持健康 同樣重要。

We provide free online health information and tools, from health information factsheets to health risk calculators, using the expertise of Bupa’s medical consultants in the UK and Hong Kong.

因此，我們提供免費網上健康 資訊及工具，包括疾病資訊和 健康風險評估，所有資訊均由 英國及香港的保柏專業醫學顧 問提供。

Use our free services 使用我們的免費服務 www.bupa.com.hk

Join Bupa’s Facebook 加入保柏 Facebook Bupa Hong Kong

8

Important information 重要資料

This brochure is a product summary for reference only. You are strongly advised to read and understand the coverage, exclusions, terms and conditions of the complete insurance contract. We want to help you understand this scheme before you enrol. Please read the information below carefully. Cooling-off period and cancellation rights

本冊子乃資料摘要，僅供參考之用。請務必細閱完整的保險合約，以了 解計劃之保障範圍、不受保障項目、條款及細則。 我們想幫助您在投保前了解本計劃。請細閱以下資料。 冷靜期及取消合約權益

You may not cancel your contract before it expires on the contract anniversary date.

在合約週年日前，您不能取消合約。

Disclosure of information for underwriting

有關核保之資料披露

During the insurance application process, it’s important that you act with utmost good faith and disclose all material facts to Bupa. If you fail to disclose or misrepresent a material fact and this causes Bupa to accept the risk, this will raise questions about members’ entitlement to insurance benefits. Consequences may include cancellation of your contract or reduction of entitlement to claims payments.

在投保申請期間，您應以最高誠信向保柏披露所有重要事實。若您未有 披露或披露失實資料以致保柏蒙受風險，將會影響會員的保障權益，後 果包括合約被取消或索償款項被調低。

Claims procedure Any claim must be made following Bupa’s claim procedures. Members should submit all necessary original documents within 90 days after clinical visit, clinical operation, day case or discharge from hospital. Otherwise, we won’t be able to process their claim and it may be rejected.

索償步驟 任何索償須按照保柏所訂的索償程序進行。會員須於求診、診所手術、 日症或出院後 90 天內遞交所有有關該索償的所須文件正本，否則保柏將 不能處理會員的賠償，或會導致索償被拒。

Subscription adjustment

保費調整

Each member’s initial subscription is primarily determined based on choice of coverage.

每名會員的首期保費會根據保障選擇而定。

Any claims that members make won’t affect the subscription at renewal. Factors affecting subscription rates each year include medical inflation, general operating expenses and revision of benefits to cover increasing medical expenses. Renewal This contract will last for 1 year and may be renewed every year as long as you meet the requirements as stated in the Renewal Clause of your contract, regardless of any changes in members’ health condition. Bupa may revise the benefits, contract terms and conditions from time to time. During the renewal process, we’ll notify you in writing if there are any changes. Payment of subscription You’ll need to pay your subscription yearly. When there’s a change in the number of members or in the benefit of a member, you’ll need to pay the relevant subscription on a pro-rata basis upon presentation of the invoice.

保費並不會因會員曾作出索償而被調高。影響每年保費率的因素包括醫 療通脹、一般營運開支及因應醫療開支增加而作出的保障改動等。 續保 本合約生效期為期一年。無論會員在投保後的健康狀況有任何改變，只 要您符合合約內列明的續保要求，您的合約便可每年續保。 保柏可不時更改合約條款及細則，有關改動將於續保時以書面通知您。 繳付保費 您須以年繳方式繳付保費。如更改會員人數或會員的保障項目，您便須 在收到繳費單後，按比例繳付有關保費。 不受保障項目

General exclusions

已存在病症。

Pre-existing conditions.

不是醫療必需的治療、醫療服務、藥物或檢驗。

 reatment, medical service, medication or investigation which is not T medically necessary.

任何在法例下或其他保險計劃內或從其他途徑可獲賠償之治療疾病 或損傷費用，除非此等費用未能在該等補償、保險計劃或途徑獲得賠 償。

 ny illness or bodily injury for which compensation is payable under A any laws or regulations or any other insurance policy or any other sources except to the extent that such charges are not reimbursed by any such compensation, insurance policy or sources.

在水療中心、天然治療中心、康復院、療養院、老人院或類似機構所 提供之住宿、護理或服務的費用。

 ny charges for accommodation, nursing and services received in A health hydros, nature cure clinics, convalescent home, rest home, home for the aged or similar establishments.

手術性或非手術性整容或整形治療、毛髮礦物質含量分析、健康補品 或體重控制（經保柏批准則除外） 的費用。

 ny charges in respect of surgical or non-surgical cosmetic treatment, A Hair Mineral Analysis (HMA), health supplements or body weight control (unless approved by Bupa).

預防性措施，包括但不限於常規驗血、例行檢驗、預防注射或接種疫 苗、聽覺測驗、因視力不正常而引致之治療，包括但不限於常規視力 測驗或所需之眼鏡或鏡片費用。

 ny charges in respect of preventive measures, including but not A limited to routine blood tests, general check-ups, vaccinations or inoculations, hearing tests, eye refraction including but not limited to routine eye tests or any cost of fitting of spectacles or lens.

先天性疾病、發育異常或遺傳性疾病。

 ongenital conditions, developmental conditions or hereditary C conditions.

9

由保障開始日起首 5 年內，因感染人體免疫力缺損病毒所引致的治 療。

 reatment that commenced during the first five years from the T coverage commencement date and which in any way arises from, is attributable to, or is consequential upon Human Immunodeficiency Virus Infection.

性病及其後遺症。

Sexually transmitted (venereal) diseases or their sequel.

與懷孕有關的治療，包括診斷性產科檢查、生育、墮胎或小產；與男 女任何一方的節育或絕育有關的治療；由於不育而直接或間接進行的 治療，包括體外受孕，任何非自然受孕或人工受孕；與性機能失常有 關之治療，包括但不限於陽萎、不舉及早泄（不論任何原因導致 ）。

 reatment relating to pregnancy, including diagnostic tests for T pregnancy or resulting childbirth, abortion or miscarriage; birth control or sterilisation of either sex; infertility including in-vitro fertilisation or any other artificial method of inducing pregnancy; or sexual dysfunction including but not limited to impotence, erectile dysfunction and pre-mature ejaculation, regardless of cause.

誤用或服用過量藥物或受酒精影響、蓄意自傷身體或意圖自殺而直接 或間接引致的治療。

 isuse or overdose of drugs or being under the influence of alcohol, M self-inflicted injuries or attempted suicide.

任何因參與犯罪活動而引致之疾病或損傷。

 reatment relating to any illness or bodily injury resulting from T participation in criminal activities.

另類治療，包括但不限於中藥治療、針灸、穴位按摩、推拿、催眠治 療、羅爾夫按摩療法、按摩治療、香薰治療（計劃內已包括之保障除 外）。

 lternative treatment including but not limited to Chinese Medicines A treatment, acupuncture, acupressure, Tui Na, hypnotism, rolfing, massage therapy and aromatherapy (unless benefit is available).  enile Dementia (including Alzheimer’s disease), Parkinson’s disease, S psychological or psychiatric condition(s) of any and all kinds, including but not limited to psychoses, neuroses, depression, anxiety, anorexia nervosa, schizophrenia, behavioural disorders, delirium, insomnia and neurasthenia.  ny charges for the procurement or use of special braces and A appliances, including but not limited to spectacles, hearing aids and other equipments such as wheel chairs and crutches.

老年性痴呆（包括亞爾茲海默氏病 ）、帕金森氏病、心理病或精神病 症，包括但不限於精神病、神經機能病、抑鬱、焦慮、神經性厭食、 精神分裂、行為失常、譫妄症、失眠、神經衰弱等直接或間接引致的 治療。 購買或使用輔助器具，包括但不限於眼鏡、助聽器及其他設備例如輪 椅、枴杖的費用。

 ny treatment or investigation related to dental or gum conditions A except for emergency treatment (not follow-up treatment) arising from accidents or the extraction of impacted wisdom teeth during hospital confinement.

任何與牙齒或牙肉疾病有關的治療或檢查，因意外引致緊急入院治療 或住院脫除阻生智慧齒則除外。但不包括該住院後之跟進治療。 因戰爭、入侵、外敵行動、開戰（不論是否已宣戰 ）、內戰、叛亂、革 命、起義或軍人奪權、恐怖活動等直接或間接引致的治療。

 reatment arising from war, invasion, acts of foreign enemies, T hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or military or usurped power or terrorist acts.  on-medical services, including but not limited to guest meals, radio, N telephone, photocopy, taxes (except the Value-Added Tax or Goods and Services Tax for medical services), medical report charges and the like.

非醫療性服務，包括但不限於客人膳食、收音機、電話、影印、稅 項（就醫療服務所徵收的增值稅或商品及服務稅除外）、醫療報告等費 用。

Expenses incurred for experimental or unproven medical technology or procedure not in accordance with the standards of good and prudent medical practice. For the purposes of interpreting “standards of good and prudent medical practice”, Bupa shall consider (I) standards that are based on clinically proven evidence in appropriately reviewed, independent medical journals; (II) relevant specialty body recommendations; and/or (III) the views of specialists practising in the relevant clinical area.

因不符合「良好及謹慎的醫療標準」的實驗性或未經證實醫療成效的 醫療技術或治療程序而招致的費用。就「良好及謹慎的醫療標準」之 詮釋，保柏將會考慮以 (I) 醫療標準為必須經過適當審查的獨立醫學 期刊中臨床證明所界定；(II) 相關專業機構的建議；及／或 (III) 相關臨 床領域執業的專家意見。

 ngaging or taking part in naval, military or airforce or any operation E with any armed force; or any form of professional sports.

從事或參與海軍、陸軍或空軍任務或任何武裝部隊之行動 ; 或從事或 參與任何類形之專業運動。

This scheme is insured by Bupa (Asia) Limited. Bupa (Asia) Limited is authorised and regulated by the Insurance Authority in Hong Kong to carry out general insurance business in the HKSAR. In the event of any discrepancy in respect of the meaning between the Chinese version and the English version of this brochure, the English version shall prevail.

本計劃由保柏（亞洲 ）有限公司承保。保柏（亞洲 ）有限公司已獲保險業監管局授權於香港特別行政區經營一般保險，並受其監管。 本冊子中、英文之意思如有任何差別，概以英文為準。 10

Bupa (Asia) Limited 保柏（亞洲 ）有限公司 18/F, Berkshire House 25 Westlands Road, Quarry Bay, Hong Kong 香港鰂魚涌華蘭路 25 號 栢克大廈 18 樓 Telephone 電話：(852) 2517 5175 Facsimile 傳真 ：(852) 2548 1848 www.bupa.com.hk

MP042/15/1119/600

Printed on recycled paper 以再造紙印刷

Bupa Hong Kong