Benefit Summary 福利概要

C/E/H/Q/R/T/V/W
Plan 040 計劃 040 Network 網絡 7 Non-Network 非網絡
HOSPITALISATION BENEFITS 住院福利 1 100% per disability per policy year up to 全數支付, 每保單年度每病症最高
Inpatient Facilities Services 住院設施服務 7 Designated Room Level: Semi-Private 指定住房級別: 半私家病房
 Room and Board 膳宿費 (Max. 182 days 最高 182 日) $1,200 per day 每日$1,200
 Intensive Care Unit 深切治療病房費 $50,000
 Operating Room 手術室費
Complex 複雜手術 $20,800
Major 大型手術 $10,400
Intermediate 中型手術 $5,200
Minor 小型手術 $2,600
 Other Hospital Services 醫院雜費 2 $20,790
 Special Nursing 特別護士服務 4 (Max. 91 days 最高 91 日) $630 per day 每日$630
Inpatient Physician Services 住院醫生服務
100%全數支付 9
 Surgeon’s Fee 醫生手術費
Complex 複雜手術 $63,000
Major 大型手術 $31,500
Intermediate 中型手術 $15,800
Minor 小型手術 $7,900
 Anesthetist’s fee 麻醉師費
Complex 複雜手術 $20,800
Major 大型手術 $10,400
Intermediate 中型手術 $5,200
Minor 小型手術 $2,600
 Physician Consultation 醫生診症費 (Max. 182 days 最高 182 日) $1,575 per day 每日$1,575
 Specialist Consultation 專科醫生診症費 4 $5,800
Increased Overseas Hospitalisation Benefit n/a Up to 200% of above Hospitalisation Benefits
(Due to accidental cause only), Limit per disability
不適用 最高賠償相等於以上住院福利之 200%
額外海外住院保障 (只限於意外), 每病症最高限額 10
Post-Hospitalisation Out-Patient Consultation 出院後門診覆診費
(within 180 days after discharge from Hospitalisation
$1,575 per visit 每次診症最高$1,575
出院後 180 日內之覆診費)
(Max. 5 visits per disability per year 每保單年度每病症最多 5 次) n/a
HA Hospitals Reimbursement (General Ward) 不適用
醫管局住院保障 (普通病房)
 Daily Cash 每日現金保障 6 (Max. 182 days 最高 182 日)
$630 per day 每日$630
 Surgical supplies 手術醫療用品賠償 5 $20,790
Home Care 家居護理 (Replacement for inpatient care) 100% 全數支付 n/a 不適用
Special Services 專科服務
 Chemotherapy 化學治療 100% up to $160,000 per policy year
 Radiotherapy 放射治療 全數支付, 每保單年度最高$160,000

 Renal Dialysis Treatment 腎透析治療

Medication and Emergency/Overseas Out-patient Consultation
藥物及緊急/海外門診諮詢 8
(Overall maximum is $13,000 per policy year 每保單年度最高 $13,000)
 Extra medication or Long-term medication prescribed within 100% 全數支付 n/a 不適用
designated networks appointed by the policyholder, pharmacy of an
HA Hospital or HA clinic which shall also be covered 在保單持有人
指定的網絡診所或醫管局藥房內購買之額外藥物及長期病患之藥物
n/a 不適用 100% 全數支付
 Out-Patient Prescribed Medicine 非住院處方藥物
(with a prescription and obtained from any legitimate source
outside clinic, except pharmacies of HA hospitals or clinics which
shall also be covered
必須由西醫處方及在西醫診所以外之合法藥房或醫管局藥房購買) 100% up to $1,000 per visit
n/a 不適用
 Emergency / Overseas Out-patient Consultation 緊急/海外門診之診 全數支付,每次診症最高$1,000
症費
(Max. 5 visits per policy year 每保單年度限於 5 次)
Overall Maximum for Hospitalization Benefits Per Disability Per
$300,000
Policy Year 住院福利每病症每保單年度最高保障額
Supplementary Major Medical
90% up to $120,000 after $1,000 deductible
Limit per disability per policy year
扣除自付費$1,000 後，餘額九成賠償，最高限額$120,000
附加住院醫療福利, 每保單年度每病症最高限額 9

Note: All above figures are expressed in the following currency: HKD 以上限額以港元計算
Benefit Summary 福利概要

Plan 040 計劃 040 Network 網絡 Non-Network 非網絡

Outpatient Benefits 門診福利
General Physician's Consultation 普通科門診諮詢 (GP) $0 copay 自付$0 80% up to $260 per visit
(Max. 25 visits per policy year 每保單年度最高限額 25 次) 100% (within HK and Macau)
八成支付, 每次診症最高$260
(Max. 1 visit per day 每日一次) 全數支付(適用於香港及澳門)

Chinese Herbalist & Bonesetter 中醫及跌打治療 (HERB) (BS) $0 copay 自付$0 80% up to $160 per visit
(Max. 10 visits per policy year 每保單年度最高限額 10 次) 100% (HK only)
八成支付, 每次診症最高$160
(Max. 1 visit per day 每日一次) 全數支付(適用於香港)

Overall maximum number of visits per Policy Year for 25

每保單年度最多賠償次數 (GP)+(HERB)+(BS)

Specialist Physician's Consultation 專科門診諮詢 (SP) 12 $0 copay 自付$0 80% up to $470 per visit
(Max. 10 visits per policy year 每保單年度最高限額 10 次) 100% (within HK and Macau)
八成支付, 每次診症最高$470
(Max. 1 visit per day 每日一次) 全數支付(適用於香港及澳門)

$0 copay 自付$0
Physiotherapy 物理治療 / Chiropractor 脊醫 (PHY) (CHIRO) 4
100% (within HK and Macau) 80% up to $420 per visit
(Max. 10 visits per policy year 每保單年度最高限額 10 次)
全數支付(適用於香港及澳門) 八成支付, 每次診症最高$420
(Max. 1 visit per day 每日一次)
(for Physiotherapy only 只限物理治療)

Overall maximum number of visits per Policy Year for 15

每保單年度最多賠償次數 (SP)+(PHY)+(CHIRO)
100% 全數支付 80% 八成支付
Basic Diagnostic Testing 基本診斷測試 2, 4
up to $3,500 per policy year 每保單年度最高限額$3,500
Psychiatric Treatment 精神科診症 4
(For employees only 只適用於僱員) n/a 100% up to $1,200 per visit
Max. 10 visits per policy year 每保單年度最高限額 10 次) 不適用 全數支付, 每次診症最高$1,200

(Max. 1 visit per day 每日一次)

Overall maximum number of visits per Policy Year for Outpatient Benefits
每保單年度門診最多賠償次數 35
(GP)+(HERB)+(BS)+(SP)+(PHY)+(CHIRO)
OTHER BENEFITS 其他福利
Emergency Cash Benefit (Death benefit for employees only)
$10,000
緊急現金保障 (身故賠償，只適用於僱員)
Emergency Evacuation & Repatriation Benefit 緊急醫療運送 3, 11

 Emergency Medical Evacuation 緊急醫療運送 100% 全數支付

 Repatriation of Remains 遺體運返 100% 全數支付
 Emergency Medical Repatriation 緊急醫療運返 100% 全數支付
 Worldwide Hospitalization Deposit Guarantee 全球住院按金保証 Maximum $60,000 per Trip
每行程最高限額 $60,000
 Compassionate Visit (if the Insured Person is hospitalized for more than 7
consecutive days) 家屬恩恤探訪(如受保人需住院超過連續 7 日)
- Return Common Carrier ticket (economy class)
n/a Included 已包括
探訪家屬來回機票乙張 (經濟客位)
- Visitor’s accommodation expenses 不適用
Maximum $12,000 per Trip 每行程最高限
探訪家屬之住宿費用
額 $12,000
 Return of Children (under 18 years of age)
子女護送 (只限十八歲以下子女)
- One-way Common Carrier ticket (economy class)
Included 已包括
單程 (送返之) 機票乙張 (經濟客位)
- Qualified escort when necessary
Included 已包括
如有需要將由專人陪同送返
 Overseas medical monitoring & repatriation after discharge from overseas
Included 已包括
Hospitalization 海外住院期間醫療跟進及出院後醫療運返
 Hotel Room Accommodation for Convalescence (Maximum 5 days per Trip) Maximum $2,000 per day 每日最高限額
療癒期間酒店住宿費用 (每行程最多 5 日) $2,000
Remarks for accessing Benefits 接受醫療服務條件之備註:
1 Network Hospitalisation Benefits require prior authorisation (for emergency, notification should be made within 24 hours) 網絡住院服務需預先核准（若緊急事故，需 24 小時內通知）
2 Basic Diagnostic Testing includes basic diagnostic imaging (X-Ray, mammograms, ultrasound, electrocardiogram, echocardiogram, treadmill, blood test, urinalysis and other laboratory tests).
Advanced diagnostic imaging (MRI, CT scans, nuclear medicine) shall be payable under Other Hospital Services and for Network Benefit, prior authorization by AIA shall be required. 基本診斷檢驗包
括基本診斷性造影(Ｘ光，乳房造影，超聲波，心電圖，超聲心動圖，運動心電圖，血液測試，尿液分析及其他實驗室測試)。先進診斷性造影(磁力共振影像，電腦掃描，核子醫學科) 於網絡服務須獲友
邦保險預先批核，此保障福利包括於住院雜費內
3 Prior Authorization by AIA or AIAS Provider shall be required 需預先通知友邦保險或友邦國際支援服務
4 Referral letter is required 需轉診推薦書
5 Surgical Supplies shall be payable under Other Hospital Services 手術醫療用品賠償包括於醫院雜費內
6 The specified maximum number of days set forth in this benefit shall be included in that of Daily Room & Board 本福利之最多賠償日數已包括在「每日膳宿費」的最多賠償日數內
7 Network Hospitalization Services must be rendered by Network Physicians / Hospitals and stay at the designated level or lower, otherwise such claim will only be reimbursed according to Non-
Network benefit 網絡住院服務需由網絡醫生 / 醫院提供，並入住指定或較低級別之住房，否則賠償將按非網絡福利辦理
8 Excessive claim amount will not fall into Supplementary Major Medical benefit 超出之索償將不能撥入附加住院醫療福利內作賠償
9 This Benefit will not be payable for Hospital Accommodation at VIP / Deluxe Room. Reimbursement percentage will be adjusted to 50% if the Insured Person is confined in a room one level above
the Designated Room Level (i.e. private room against semi-private room for this plan) 此保障並不會就入住貴賓房 / 豪華房的住院費用作出賠償，若入住較指定住房級別高一級之住房(即私家病房)，餘
額將按五成賠償
10 Only applicable for Overseas Hospitalisation due to accident cause only (Overseas exclude China, Hong Kong S.A.R., Macau S.A.R. and country of residence) 只限海外住院意外索償 (海外不包括
中國, 香港, 澳門及其居住地)
11 Only applicable when the Insured Person is traveling outside Hong Kong, Macau, or place of residence, if different 只適用於受保人在香港，澳門或其居住地以外旅遊時之緊急醫療運送
12 Referral letter is required (except for Gynaecology, Paediatrics, Otorhinolaryngology(ENT), Ophthalmology(Eye), Orthopaedics & Traumatology and Dermatology). 需轉診推薦書 (婦科,兒科, 耳鼻喉科,
眼科,骨科及皮膚科服務除外)

Note: All above figures are expressed in the following currency: HKD 以上限額以港元計算
The final interpretation of the benefit coverage or its applicability is subject to the provisions of the master policy issued by AIA International Limited (Incorporated in Bermuda with limited liability).
此團體保險計劃之福利賠償的最後詮釋及執行, 均以友邦保險(國際)有限公司(於百慕達註冊成立之有限公司)之英文保單為準
0000017872_040_Benefit Effective From 07/01/2022 To 06/30/2023