SUPREMETECH COMPANY LIMITED

Global expertise, local diligence

Content

INTRODUCTION

BENEFITS

EXCLUSION

CLAIM REIMBURSEMENT
 Company background

About Us Our Values

• 100% foreign-owned investment • Advise only the best program: Ensure the quality of our
• Leading insurance consultant in Vietnam with more program, from the moment of the consultancy to the
than 30 combined year experience moment it reaches the consumer's hand.

• Our business strategy on developing sustainable • Global expertise: Our employees bring locally their

partnerships with our clients and our international global knowledge and risks solutions in the services of

partners around the globe. their valuable clients.

• Client Focus: Our culture values approachable,
responsive employees who are passionate about
lifelong learning and teaching, and who are committed
to serving clients.
Investment Sectors & Key Clients

Investment Sectors Key Clients

• Property
• Liability
• Employee benefit insurance
Insurance Plan

Effective Period: 15/04/2021 – 14/04/2022

Eligibility:
• Employees & Dependents (Spouse, children, parent)
• Age: 15 days – 65 years old
Exclusion:
- Not suffer from mental illness, epilepsy
- Not suffer more than 80% permanent disabilities
- Not suffer from cancer
 Benefits
Types OPTION 1 OPTION 2

A- Death and Disablement following Accident VND 50,000,000 VND 100,000,000

B- Death and Disablement following Illness, maternity VND 50,000,000 VND 100,000,000

C- Medical Expenses following Accident (In - Out Patient) VND 50,000,000 VND 100,000,000

D- Hospitalization and Surgical following Illness,

VND 150,000,000 VND 300,000,000
childbirth
 Benefits
Sub limit:

(1) Hospitalization charge per day (maximum 60 days/year)

Hospital charges when hospitalization including but not limited to:
- Hospital bed charges. In respect of International, private hospitals, International or
volunteer, service requirement department and other similar departments at State
Own hospital, bed charge is limited to standard single room (excluding VIP room
and/or deluxe room). Standard single room is 01 bed with lowest price at hospital/
treatment department/ treatment ward.
- Meals as standard hospital VND 2,500,000/ VND 5,000,000/
- Intensive care unit charges (ICU) day. Max VND day. Max VND
- Administration fee, cost of blood aid or blood plasma 50,000,000/ 100,000,000/
- Drugs and medicine consumed within time of hospitalization year year
- Dressings, ordinary splints and plaster casts
- Physiotherapy (if it is required by attending doctor and necessary for hospitalization)
- Intravenous infusions
- X-rays, MRI, CT and PET scans, diagnostic test indicated by attending doctor
- Normal delivery charges
- Others as indicated by attending doctor
Max 60 days/ year.

(2) Emergency Treatment (including In-patient, Day-patient and Out-

patient)/ year VND VND
Emergency treatment carried out in emergency ward of hospital or clinic for serious 50.000.000/ 100.000.000/
medical conditions year year
 Benefits
(3) Surgical and procedure expenses / year
Medical expenses relating to an in-patient, day-patient, out-patient surgical
operation, including:
- Fees for the surgery, treatment procedure (including day-patient and in-patient
treatment procedure). List of procedure is stipulated in Minor Operation and
Surgery promulgated by Ministry of Health.
- Fees for drugs, medicine using in surgery case
- Essential prostheses transplanted into the body to maintain life VND 50,000,000/ VND 100,000,000/
- Necessary surgical appliances/materials year year
- Operating theatre
- Anesthetizing fees
- Fees for pre-operation diagnosis
- Fees for post-operation recovery
- Organ transplantation
- Redone operation.

(4) Pre Hospitalization/year

PTI shall pay the Insured Person the cost of visits, necessary examination,
diagnosis and other expenses of the last consultant (indicated by attending
Doctor), which are directly related to the Insured Person’s illness, disease and VND 2,500,000/ VND 5,000,000/
pregnancy. Results of above accesses shall be basic factors that enable Doctor year year
concludes the hospitalization is necessary. This benefit is payable within 30
days prior to the date of hospital admission. Not applicable for childbirth

(5) Post Hospitalization/year

PTI shall pay the Insured Person the cost for follow-up treatment indicated by
attending Doctor for illness, disease and pregnancy, due to which the Insured VND 2,500,000/ VND 5,000,000/
Person must be hospitalized. This benefit includes follow-up examination, tests, year year
follow-up medication. This benefit is payable within 30 days after the date of
hospital discharge. Not applicable for childbirth
 Benefits
(6) Home nursing following
PTI shall pay the Insured Person the cost of nursing care as indicated by
attending Doctor, rendered by a legally licensed nurse at the Insured
VND 2,500,000/ VND 5,000,000/
Person’s resident maximum 30 days follow-up the date of hospital
year year
discharge.
This benefit is not applicable in discharging after childbirth and
complication of pregnancy

(7) Ambulance services within Vietnam

a. Emergency Local Transportation (not including Air transportation and
VND 50,000,000/ VND 100,000,000/
SOS services)
year year
b. Emergency Transportation by Taxi (actual cost as necessary,
customary and reasonable). Maximum VND 500,000/ person/ year.

(8) Daily allowance

VND 150,000/ day VND 300,000/ day
(Maximum: 60 days/year). Not applied for maternity

(9) Burial Cost

In case of death of the Insured Person due to the risks covered under the
VND 2,100,000/ VND 2,100,000/
Policy, despite death while the Insured Person is staying in the hospital or
case case
out-patient, PTI shall pay burial allowance as specified in the Benefit
Schedule

VND 5,000,000/ VND 10,000,000/

(10) Rehabilitation/year
year year
 Benefits
VND 50,000,000/ VND 100,000,000
Maternity/ Year
year / year

Normal delivery or complications of pregnancy:

Up to the sub limit of D1, D3, D4
Caesarean:

New born/ year

Expenses including expenses related to pediatric care, at
VND VND
hospital right after being born at the admission hospital
1,500,000/year 3,000,000/year
and mother has not discharged (Excluding screening
cost, medication, requisites and food for baby)
 Benefits
E- Out-patient treatment following illness, childbirth/
VND 6,000,000 VND 10,000,000
year
Sub-limit:
(1) Maximum number of doctor visit per year No limit No limit
(2) Maximum limit per doctor visit
- Examination fee;
- Drugs prescribed by Doctor;
- X-ray, laboratory tests, necessary radiographic and actinotherapy indicated VND 1,200,000/ visit VND 2,000,000/visit
by Doctor for diagnosis and treatment of the medical condition;
- Out-patient minor operation
- Out-patient complication of pregnancy
(3) Physiotherapy treatment per day
- Reasonable and necessary physiotherapy indicated by Doctor at hospital VND 60,000/day VND 100,000/day
(max 60 days/ year).Maximum 60 days/ year
(4) Limit of indemnity for dental treatment per year –
Basic Dental treatment:
- Examination and diagnosis
- X-ray
- Gingivitis, Pyorrhea
VND 1,200,000/ year VND 2,000,000/year
- Normal compound fillings (amalgam, fuji, composite, gic or other materials
with similar expense)
- Root canal treatments
- Extractions of diseased teeth (including surgery)
- Tooth Cleaning and Polishing ( 2 time/ year)
(5) Pregnancy check-up/ year
Including the following expenses:
- Pregnancy examination; VND
VND 500,000/year
- Ultrasound; 1,000,000/year
- Urine test related to pregnancy;
- Blood count test
Georaphical Scope & Waiting Period
➢ Geography scope: Vietnam
➢ Waiting period:
• No waiting period for employees who have completed one full year
waiting period in 2020- 2021 insurance policy.
• New employees and dependents will be applied as the information below:

Accident 0 day

Illness 0 day

Pre-existing conditions & special

0 day
diseases

Death of Pre-existing conditions & 365 days

special diseases & maternity

Maternity 270 days pro-rata

Miscarriage 60 days pro-rata
 General Exclusions

➢ Any willful act of the Insured Person or his legal successor.

➢ The Insured Person’s grave violation of regulations and laws, for which he is subject to a
criminal sentence or the Insured Person’s violation of traffic regulations such as racing or
driving without a valid driver's license or driving on restricted roads.
➢ Any consequence of drinking alcohol or beer beyond the degree specified in the Law on
Road Traffic Safety, or any other similar substance.
➢ The Insured’s act of fighting, unless such act can be proved that it is only a defense against
an attack.
➢ Medical treatment or use of medications not as indicated by physicians.
➢ The Insured Person’s engagement in air transport activities other than as a fare-paying
passenger or participation in maneuvers, military training, or army forces.
 General Exclusions

➢ Catastrophic perils, such as earthquakes, volcanoes, tsunamis, radioactive contamination

➢ War, civil war, strikes, terrorism, riots, civil commotion, rebellion, civil activities or actions
the leader of any organization to overthrow or threaten the government or take control by
force.
➢ Participation in or training for any professional sport or any racing activity.
➢ Treatment of tuberculosis, malaria, sexually transmitted diseases, syphilis and gonorrhea
and AIDS related illnesses.
➢ Treatment and/or surgery for hereditary diseases, deformities, birth defects or genetic
malformations. Diseases caused by abnormal human body morphology and congenital
defects or lack of body parts and/or congenital diseases. Surgical treatments received
before the inception date of the Policy.
➢ Periodic health examination (whether inpatient or outpatient); medical evaluation or
consultation related to illness or injury treatment, including gynecological/anthological
examination; periodic tests, regular newborn screening, all forms of immunization,
vaccination and preventive medication (except any vaccination due to an accident or
animal or insect bites).
 General Exclusions

➢ Normal eyesight and hearing tests, treatment of natural degeneration or any

degeneration, which is not pathological causes of loss of hearing, including but not limited
to refractive defects such as nearsightedness, farsightedness and astigmatism and any
surgical operations to recover or correct eyesight and hearing degeneration.
➢ Any treatment or surgery, which is not conducted in a usual manner, at the request of the
Insured Person without treatment in the usual manner.
➢ Cosmetic surgery.
➢ Aesthetic treatments, including but not limited to hyperpigmentation (melisma skin)
treatment, acne treatment and hair loss treatment are particularly excluded from the
outpatient treatment benefit.
➢ Costs of providing, maintaining, repairing or replacing treatment support equipment or
prostheses according to Definition 29. However, the use of discs, splints and screws is
excluded as follows:
• In case of treatment of musculoskeletal diseases: This exclusion applies to
Condition D and outpatient treatment.
• In case of an accident: 10% of the Sum Insured for medical expenses following an
accident shall apply.
 General Exclusions

➢ Dietary supplements or substitutes, which are naturally available or can be purchased

without prescription, including but not limited to vitamins, minerals and organic
substances (except for except for those prescribed by a Physician and provided that
their cost is not greater than the cost of treatment drugs).
➢ Family planning measures, consequences of abortion due to psychological or social
causes, infertility/fertility treatment, artificial insemination, treatment of impotence, or
gender transformation, and any consequences or complications thereof.
➢ Body weight control (weight gain or loss treatment).
➢ Treatment of mental illness; psychiatric disorders or epilepsy. Treatment of sleep
disorders, insomnia, depression and work-related stress syndrome and diseases
related to such syndrome.
➢ Treatment at a private clinic or dental clinic, which is unlicensed or fails to provide
vouchers/invoices in accordance with legal regulations, unless otherwise specified in
the Schedule or any Endorsement.
➢ Pregnancy and delivery related costs and expenses. This exclusion shall not apply if
the Insured Person enters into the maternity insurance endorsement.
➢ Any special or pre-existing illness and disease in the first policy year unless otherwise
agreed.
 Claim Reimbursement- Direct Billings System

Choose the appropriate hospitals / clinics

belonged to the direct billing list

Show the insurance card combined

with personal identity (ID card /
Passport)

Confirm payment by sign

and receive insurance
card

Note: Treatment on holidays, days off: please deposit /

prepayment costs of treatment facilities.
Indirect Billings System

• Choice of hospital / clinic appropriate

1

• Prepayment costs of treatment

2

• Collect documents and invoices

3

• Fill out the claim form and send directly to

4 INSMART

Note: Claim submission period not exceeding 60 days

from the last treatment
Claim Documents

1. Claim form (as provided by PTI)

2. Accident report certified by the Policyholder/the local authority or the local

police in the area where the accident took place. Appropriate Certificate of
Registration and driver’s license (where the Insured Person sustains an
accident while driving a motor vehicle with the capacity of higher than 50cc)

3. Medical documents:
• Prescriptions
• Health record
• Hospital admission/discharge certificate
• Surgical certificate (in the case of a surgical operation). Where it is
impossible to provide original documents, copies certified by the Policyholder
or PTI are acceptable.
• PTI reserves the right to request the Insured Person to provide original
documents for inspection purposes;
Claim Documents

4. Payment documents:
• Bills
• Invoices
• Receipts as provided by the Ministry of Finance and the Tax Agency.
• These documents shall be original and shall be in PTI’s possession

5. Daily allowance documents: Admission and discharge certificates.

6. Death Certificate and documents proving legal inheritance (in case of the
Insured Person’s death).
 Notes

• Any information will be added or edited on medical documents must be

confirmed by the signature of the doctor with full name.
• Medical certificate or prescription must have a seal of the medical facility.
Prescriptions must have full information about the diagnosis, the prescription
date, drug name, drug quantity, signature and seal doctor clinic (which can
provide a copy).
• Payment documents: invoices, receipts, receipts ... must be originals.
• If the VAT invoice out after 5 days, need to provide a receipt / invoice showing
the purchase of medication for 5 days.
• Total cost 1 health facility must VND 200,000 VAT invoice.
• Receipts / Receipts / Invoices VAT must be made immediately after completion
of the treatment or exported during the month.
• The information on receipts / Receipts / Invoices VAT according to criteria
prescribed by the Ministry of Finance.
Contact Point
• Claim form will be sent to INSMART:
Nguyen Thi Thanh Phuc (Ms.)
Claim Executive, Claim Department
Insmart Company Limited
HCM Branch Office
Floor 9, Dinh Le Building, 1 Dinh Le Street, Ward 12, District 4, City. HCM City
Tel: (028) 7308 9990 (206) Fax: (08) 39290087
Email: phuc.ntt@insmart.com.
vn
Website: www.Insmart.com.vn Insmart Healthcare Portal: https://ihealthnet.com.vn

• Athena’s customer service department:

Athena Global Consulting - Insurance Consultant
Lý Uyển Nhi (Ms.) C10, Road 5A, Him Lam new urban area, Tan Hung
Client Executive Ward, District 7 Ho Chi Minh City
Office tel.: (+84) 028 7300 5379 ext. 103/198/113
Servicing hotline: 1900 7072
Fax: (+84) 08 62 515 684
Email: services@athenaglobalconsulting.com
Website: www.athenaglobalconsulting.com
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