HSBC HealthPlus

Member Booklet

Updated in December 2021

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Contents

1. Using this Member Booklet ................................................................................................... 2

2. Welcome ............................................................................................................................... 3

3. Becoming a member............................................................................................................. 4

4. Your benefits......................................................................................................................... 7

5. Your outpatient benefits ...................................................................................................... 10

6. Your hospital and surgical benefits ..................................................................................... 12

7. Your supplementary major medical benefit ......................................................................... 15

8. The maternity subsidy ......................................................................................................... 16

9. Wellness Claims ................................................................................................................. 19

10. HealthPlus Exclusions ........................................................................................................ 21

11. How to make a claim/use the e-Health Card or medical card ............................................. 22

12. Other information ................................................................................................................ 29

13. Appendix 1 – Schedule of Benefits ..................................................................................... 30

13.1.Tier I – Employee and dependant .............................................................................. 31

13.2.Tier II – Employee and dependant ............................................................................. 34

13.3.Tier III – Employee ..................................................................................................... 37

13.4.Tier III – Dependant ................................................................................................... 40

14. Appendix 2 – Classification Schedule of Surgical Operations ............................................ 43

15. Appendix 3 – Overview of Supporting Documents.............................................................. 45

16. Appendix 4 – Websites of Medical Practitioners in Hong Kong .......................................... 48

If there is any inconsistency or conflict between the Chinese version and English version of this booklet, the English
version will prevail.

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1. Using this Member Booklet

HealthPlus covers:

 Outpatient benefits such as general medical practitioners (GP), and

specialist (SP), test and prescribed medicine. See section “5. Your
 outpatient benefits” for details
 Hospital & surgical benefits and supplementary major medical benefits
where applicable. See section “6. Your hospital and surgical benefits”
Step 1 for more details
Learn about the worldwide cover
 Maternity subsidy. See section “8. The maternity subsidy”
HealthPlus provides you and your
family
Wellness Claims

HealthPlus members are entitled to Wellness Claims which is an annual dollar

 amount per member that can be used to claim against a range of preventative
and well-being services such as dental, eyesight checks and Chinese Medicine
consultation.

See section “9. Wellness Claims” for more details of what HealthPlus covers.

Panel

Visits to Panel Doctors and Physiotherapists* offer the convenience of credit

arrangements and a simple $20 co-pay per visit through the use of the e-Health
 Card/red medical card. There is no co-pay for other outpatient services.

Read section “11. How to make a claim / use the e-Health Card or medical
card” for further details.
Step 2 *including occupational therapists
Use Panel or Non-Panel
Non-Panel

You can visit any eligible practitioner of your choice and pay and claim.

Reimbursement is 80% up to a specified limit.

Read section “11. How to make a claim / use the e-Health Card or medical
card” for details on how to claim.

Your level of benefits depends on your Global Career Band (GCB):

 Group Executive band (GE), General Manager band (GM), Managing
Director band (MD) and GCB 3 receive Tier I
 GCB 4 to 6 receive Tier II
 GCB 7 to 8 receive Tier III

Step 3 If you are GCB 6 or above, your dependants receive generally the same level of

Check your benefit amount benefits as you do.

For GCB 7 and 8, there are some differences between the benefits of you and
your dependants. These are set out clearly in the Schedule of Benefits for Tier
III in Appendix 1.

Read Appendix 1 for the benefits provided by each Tier.

How can I get the Panel Doctor list, check my claims results?
All are in HealthPlus’ new app HSBC Life Benefits+ starting from 19 October 2020. You can view the
Panel Doctor list and your claim results through your smartphone. Get all the information you need at your
fingertips!
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2. Welcome
HSBC cares for the wellbeing of our employees and their families by providing valuable health and medical benefits for eligible
employees and their dependants. This booklet summarises the benefits of HSBC HealthPlus.

HSBC Life (International) Limited (HSBC Life)1 is the insurer of the plan. The agreement between HSBC and HSBC Life is the
final authority for interpretation of any specific provisions of HSBC HealthPlus. HSBC Life has appointed AXA General Insurance
Hong Kong Limited (AXA General Insurance) as the plan administrator, including providing claim administration services and
member services outlined in this booklet.

HSBC Life Benefits+

Available starting from 19 October 2020, HSBC Life Benefits+ is HealthPlus’ new digital wellness solution that allows HealthPlus
scheme members to understand their health, improve lifestyle and manage their HealthPlus benefits (i.e. access to eHealth card,
claim results, panel doctor list, dependant own account and useful forms), all from the convenience of their computer and
smartphone. Know more about HSBC Life Benefits+ at HRDirect.

Plan Administrator Helpline and Email Address

For queries about HSBC HealthPlus, please contact the plan administrator through the following helpline or email to
medicalservice@axa.com.hk:
Location Plan Full Member Services** Essential Language
Administrator Information
Helpline Tel. / Support*
Number

Hong Kong +852 3070 5005 09:00 to 17:30

Cantonese
Monday to Friday (except Hong Kong Public Holidays)
24 x 7 English
Macau +853 0800 284 09:00 to 17:30
Putonghua
Monday to Friday (except Macau Banking Holidays)

*Essential Information / Support includes emergency hospital admission arrangement in Hong Kong and Macau, enquiries on
panel doctor information, claim procedures and standard benefit schedules.
**Full Member Services include the above “Essential Information / Support” and other basic services e.g. enquiries on benefit
usage, claim status, medical card application, checkpoint extension application, form request, etc.

For queries about HSBC Life Benefits+, please email: employee.benefits.hsbclife@hsbc.com.hk

Medical Advice by AXA Assistance Helpline Outside Doctors’ Normal Consultation Hours
If you have a health concern and you are not sure what to do outside doctors’ normal consultation hours, please call AXA
Assistance Helpline. Medical advice will be provided by a registered nurse or doctor as appropriate in helping you make an
informed decision about how to manage your health concerns.

Please note that for enquiries relating to HSBC HealthPlus, such as benefit cover, claims status, hospital admission, etc., they
should be referred to the above Plan Administrator Helpline.
Location AXA Assistance Operating Hours for AXA Assistance Helpline to provide medical Language
Helpline Tel. advice
Number

Hong Kong +852 2862 0179 24 hours for Saturdays, Sundays and all Hong Kong Public Holidays
Cantonese
17:30 to 09:00 for others
English
Macau +853 0800 439 24 hours for Saturdays, Sundays and all Macau Banking Holidays
Putonghua
17:30 to 09:00 for others

1
HSBC Life (International) Limited (HSBC Life) Incorporated in Bermuda with limited liability
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3. Becoming a member
HSBC HealthPlus provides coverage for eligible medical and health expenses that you or your dependants incur worldwide. This
section explains who is covered under the plan and how to join.

Eligibility
HSBC HealthPlus covers all eligible permanent and fixed term employees locally hired in Hong Kong and Macau. It also covers
their dependants, including legal spouse/domestic partner2 and their children. Children refer to:
 Biological, step- and legally adopted children of the employee and
 Biological and legally adopted children of the domestic partner

Coverage is provided for children below age 23. It will cease at the end of the plan year during which the child reaches age 23.
Benefits will cease earlier if:
 The child ceases to be financially dependant on the employee or
 The child ceases to be a full-time student

If any of the employee’s dependants no longer fulfil the eligibility requirements under HSBC HealthPlus at any time after they are
enrolled, the employee must notify the HSBC Human Resources Department by updating MyBenefits within 30 days of the change
in eligibility. Please go to the medical benefit card on the ‘Benefit selections’ page on MyBenefits and turn off the toggle button for
this dependant. Remember to checkout to confirm your decision to stop this dependant’s medical coverage. Please refer to HKG:
MyBenefits user guide/FAQ on how to update your Dependant in My Benefits. If the employee fails to comply with this requirement
and the plan insurer pays out benefits which it would otherwise not be required to, the employee will be required to repay all such
benefits to the plan insurer. Disciplinary action may also be taken.
If an employee wilfully makes a false declaration regarding his/her domestic partnership, the employee may be subject to
disciplinary action, loss of benefits coverage, and/or the recovery of the cost of benefits received as a result of the false declaration.
The employee may also be subject to legal action, including prosecution for a criminal offence.

Married Couple/Domestic Partners both working in HSBC

Where a married or domestic couple both work for HSBC (regardless of whether in the same or different HSBC Group companies),
each of them and their dependants (if any) is only eligible for one membership, at any time, in any medical or health benefit plan
provided by HSBC.

If the couple are eligible for different levels of medical/health benefits, one of them can choose to take up “dependant” status in
the plan of the other. All children (if any) will be enrolled in the plan of the partner with “employee” status.
If the couple are eligible for the same benefit, each of them will have “employee” status and all their children must be enrolled as
“dependants” of one partner only.

Under this arrangement, the "employee" or "dependant" status of an employee cannot be changed unless:
 One partner leaves the employment of HSBC#; or
 There is a change in the benefit entitlement of one of the employees (e.g. promotion); or
 The relationship has changed, e.g. divorce, domestic partner relationship ended
 2
A domestic partner is defined as a person (of the same or opposite gender) who has been in a continuous relationship with
the employee, during which period, neither the employee nor the partner were or are still married to or partnered with any
other person. Furthermore, the partner and the employee have been publicly represented in a committed relationship for a
minimum period of twelve months at the date of notifying the Human Resources Department. If the enrolment of/declaration
of relationship with any domestic partner is found at any time to be false or factually incorrect to any degree, all benefits related
to the domestic partner will cease immediately. The employee(s) may be subject to disciplinary action as well as action for
recovery of amounts incorrectly paid or incurred as a result.
# Upon the departure of the partner who had “employee” status, the medical coverage of the remaining employee who had taken “dependant” status will be terminated

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as well. In order to ensure continued coverage, the remaining employee should inform HR to change the member status by raising a case attaching a completed
supporting documents via HRDirect. Once completed, you can enrol the departing partner as dependant in MyBenefits within 30 days of the change in eligibility.
Please refer to HKG: MyBenefits user guide/FAQ on how to update your Dependant in My Benefits.

Member type
There are two types of members in HSBC HealthPlus, depending on where you are employed:
 If you are employed in Hong Kong, you and your dependants are referred as “Hong Kong Members”
 If you are employed in Macau, you and your dependants are referred as “Macau Members”.

If you are on business trips, your membership remains as where you are employed.

Joining HSBC HealthPlus

New employees must complete and return the appropriate forms and provide supporting documents to Human Resources
Department within the first week of starting employment. For dependant enrolment, coverage will commence from employee’s
date of hire if supporting documents are received within ONE month from date of hire. Otherwise, the coverage for the
dependant(s) will commence from the submission date of required supporting documents.

Change or add dependants

To change or add spouse/domestic partner dependants after you have become a HealthPlus member, please visit MyBenefits.
Go to ‘Benefit selections’ page, select Medical benefit card under Mind & body and fill in the necessary details and upload any
supporting documents required within 30 days of the change in eligibility. Coverage will commence from the submission date of
required supporting documents.

If you have a new-born baby, please update your dependant data in MyBenefits. Go to ‘Benefit selections’ page, select Medical
benefit card under Mind & body and fill in the necessary details and upload any supporting documents required within THREE
months of birth or of adoption. Coverage will commence from the date of birth or of adoption. Otherwise, the coverage will
commence from the submission date of required supporting documents.

Please Note: The plan insurer CANNOT backdate the benefits effective date if the employee fails to enrol their spouse and/or
dependants within the benefits enrolment window.

Please refer to HKG: MyBenefits user guide/FAQ on how to update your Dependant in MyBenefits.

Where you are covered

HSBC HealthPlus covers eligible medical expenses incurred in Hong Kong, Macau and overseas. Provisions relating to “Panel
Doctors" only apply to Hong Kong and Macau.

Plan year
The plan year commences on 1 January each year. Visits and expenses from 1 January to 31 December each year count towards
your limits.

Currency
Generally, monetary values ($) in this booklet or elsewhere relating to HSBC HealthPlus are expressed in HKD for Hong Kong
Members and MOP for Macau Members, unless otherwise specified.

Forms
All of the forms in relation to HSBC HealthPlus are available on HRDirect. You can also obtain the most frequently used forms
from HSBC Life Benefits+.

Where can I get the most updated “Panel Doctor List”?

You can get the most updated “Panel Doctor List” through
- HRDirect 5
- HSBC Life Benefits+
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Can I get the claim forms from HSBC Life Benefits+?

You can download the following claim forms from HSBC Life Benefits+:
- Claim Form – Outpatient Benefit/Wellness Claims Claim Form
- Claim Form – Maternity Subsidy Claim Form
- Claim Form – Hospitalisation & Surgical Claim Form

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4. Your benefits
HSBC HealthPlus covers a wide range of reasonable and customary health and medical expenses that are medically necessary**.
The level of benefits you receive depends on your Global Career Band (GCB). This section provides an overview of your benefits.
More detail on specific benefits is provided on the following pages and in the appendices at the end of this booklet.

Benefits provided
HSBC HealthPlus provides the following type of benefits:
 Outpatient benefits
 Hospital and surgical benefits
 Supplementary major medical benefit (SMM)
 Maternity subsidy
 Wellness Claims

Health service providers

HSBC HealthPlus offers a designated network of health service providers (“Panel” / “Panel Doctor”) throughout Hong Kong and
Macau covering the most common treatments. The addresses, telephone numbers and hours of operation are shown in the Panel
Doctors List on HSBC intranet. If you visit a general practitioner, specialist or physiotherapist on the Panel Doctor List as an
outpatient using the e-Health Card/red medical card, you will be asked to make a co-payment of HK$20* per visit directly to them.
For the case of Hospital Out-patient service, the HK$20 co-payment will be collected from you as a shortfall payment (i.e. direct
debit from your salary account) after the hospital has charged the service to the scheme.

HSBC HealthPlus also provides coverage for facilities outside the network (“Non-Panel” / “Non-Panel Doctor”), with 80%
reimbursement and subject to relevant benefit limits.
(*HKD if the practitioner is in Hong Kong and MOP if in Macau)

Benefit levels
There are three tiers with different levels of benefits depending on your Global Career Band (GCB).
Global Career Band Benefit entitlement
GE, GM, MD and GCB 3 Tier I
GCB 4 to 6 Tier II
GCB 7 to 8 Tier III

If you are GCB 6 or above, you and your eligible adult dependants (i.e. spouse / partner) have the same level of benefits. The
Wellness Claims for your eligible child dependants is 50% of yours. If you are GCB 7 or 8, your dependants’ benefits are slightly
different to yours. See Appendix 1 – Schedule of Benefits for the coverage provided for each benefit item at each level.

** ‘Medically Necessary’ shall mean a condition in which health services or supplies provided must:
1) require the medical expertise of the medical practitioner;
2) be consistent with the diagnosis and necessary for the treatment of the condition;
3) be rendered in accordance with standards of good and prudent medical practice, and not be rendered primarily for the convenience or the comfort of the
insured, his/her family, caretaker or his/her physician; and
4) be rendered in the most cost-efficient manner and setting appropriate in the circumstances.

‘Reasonable and Customary’ expenses or charges shall mean, in relation to fees, a sum not exceeding the reasonable average of the prevailing charges being made
under similar conditions by persons of equivalent experience and professional status in the area in which the service was provided when providing like or comparable
treatment, services, or supplies for a similar injury or sickness; and in relation to material or services, shall mean a sum not exceeding a reasonable average of the
charges for similar material or services in equivalent circumstances of quality and economic consideration in the same area as that in which any such material or
services were obtained. Benefits shall not be payable for amount in excess of Reasonable and Customary expenses or charges.

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e-Health Card/Medical cards
There are two different medical cards for different member status and tiers:
 Red medical card: provides a credit facility for members using the card/e-Health Card for outpatient and inpatient services in
the Panel.
 Blue medical card: for members to present at the Panel to obtain a preferential rate (if any) for outpatient services.

Benefit entitlement Member status Medical card

Tier I Employees/dependants Red medical card

Tier II Employees/dependants Red medical card

Tier III Employees Red medical card

Dependants Blue medical card

The e-Health card is available in HSBC Life Benefits+, as a digital image version of physical medical card. E-Health card can be
used at Hong Kong panel clinics and the QR code can be used at 3 Hong Kong private hospitals (St. Teresa’s Hospital, St. Paul’s
Hospital and Gleneagles Hospital Hong Kong).

Currently you cannot use e-Health card in Macau panel clinics and other Hong Kong private hospitals. Please use physical medical
cards at these locations.

For Hong Kong Members, the plan administrator will issue medical cards provided that you agree to repay any shortfall incurred
by you and your dependants when using the cards and complete the direct debit authorisation form to enable the plan administrator
to debit your salary account for shortfall repayment. The shortfall means expenses incurred which are not covered in HSBC
HealthPlus or are in excess of the applicable benefit limits.

For the repayment of shortfall:

 Hong Kong Members: you are required to authorise the plan administrator to debit your salary account at HSBC. If you change
your salary account after you have had the e-Health Card /medical cards, you need to inform the plan administrator to debit
your new salary account by completing the direct debit authorisation form which is available on HRDirect and submit it to the
plan administrator.
 Macau Members: direct debit from your salary account by the plan administrator is not available currently. Hence, you are
required to repay to the plan administrator by cheque payment until the direct debit is set up.
 For any unsuccessful shortfall payment, AXA reserve the right to charge you an additional administration fee of HK$100 per
transaction for recovering the debit payment or suspend the medical card service.

For new hires, once you have enrolled in HealthPlus and completed the setup of direct debit authorisation with plan administrator,
you will receive a registration invitation email that invites you to register in HSBC Life Benefits+ and your eHealth Card within 3
weeks. The delivery of physical card will be issued within 1 month. Once you registered, within HSBC Life Benefits+, you can invite
your dependants whose age is 18 and above to registered.

For existing employees, medical cards issued to current employees will only be valid from the date that they are issued to the
employee, which may be within 1 month from receipt of the application.
.

If you are eligible for a red medical card (i.e. an employee or dependant of Tier I and Tier II or an employee of Tier III) but you
choose not to apply for it or you do not use it when seeking services rendered by the Panel (e.g. you forget to present your e-
Health Card / medical card), you need to pay for the services first and then claim reimbursement. The reimbursement will be
subject to the benefit limits applicable for Non-Panel doctors.

If you present your red medical card / e-Health Card but refuse to pay the co-payment, the Panel reserves the right not to offer the
credit facility to you and you will be required to pay for the services first and then claim reimbursement as well. The reimbursement

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will be subject to the benefit limits applicable for Non-Panel doctors. If the Panel offers the credit facility to you, the plan
administrator will later issue a debit note to recover the co-payment from you and they reserve the right to charge you an additional
administration fee of HK$100 per visit for recovering the co-payment.

You and/or your dependants must discontinue using the e-Health Card /medical cards and it is your full responsibility to destroy or
return all the physical medical cards (including that of the dependants) to the plan insurer, if:
 you and/or your dependants cease to be eligible for the plan (e.g. termination of employment, divorce, your child’s age has
exceeded the limit, etc.);
 the direct debit facility is not successfully set up or is terminated or altered; or
 you refuse to pay the shortfall incurred by you and/or your dependants under the plan.
Under these circumstances, if you and/or your dependants continue using the e-Health Card /medical cards, you are required to
repay all the cost incurred by you and/or your dependants to the plan insurer and/or the plan administrator, failing which disciplinary
action and/or legal action may be taken against you.

If a physical medical card is lost, you should report the loss to the plan administrator by completing the form available from HRDirect.
A fee of HK$50 will be charged by the plan administrator for each replacement card issued.

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5. Your outpatient benefits
This benefit covers eligible expenses incurred while you are being treated or examined at the outpatient department of a hospital,
clinic, medical laboratory, or other facility endorsed by registered medical practitioners, not including admission to hospital and
treatment received for surgical operation at a doctor’s clinic or at a hospital outpatient unit. Expenses covered include those shown
below.

General Medical Practitioner Consultation

Eligible medical expenses charged by a registered medical practitioner (i.e. medical doctor/physician) in western medicine for
consultation, injection and medication.
If you visit a registered medical practitioner for a mental illness or emotional disorder, the eligible medical expenses will be covered
under the “Mental Illness and Emotional Disorder” as shown below.

Effective 14 October 2021 and for Hong Kong members, the General Medical Practitioner Consultation also includes Video
Consultation via the Benefits+ app. Please refer to the Benefits+ app’s FAQ about Video Consultation’s specifics.

Video Consultation via the Benefits+ app will have the consultation fee auto-deducted from HealthPlus hence no payment from
the members. Video Consultation will be counted against the General Medical Practitioner Consultation annual check-point visit
limit (30 times a year).

Diagnostic X-ray, Laboratory Tests and Imaging

Eligible medical expenses for x-ray, laboratory examination and imaging with written referral from a registered medical practitioner
(i.e. medical doctor/physician) in western medicine.

Specialist Consultation
Eligible medical expenses charged by a registered medical specialist (i.e. medical doctor/physician) in western medicine for
consultation, injection and medication. Written referral from a registered medical practitioner (i.e. medical doctor/physician) in
western medicine is required, except for consultation by specialists in Gynaecology, Paediatrics, Dermatology,
Otorhinolaryngology (Ear, Nose & Throat), Ophthalmology (Eye) and Orthopaedics and Traumatology.
If you visit a registered medical practitioner for a mental illness or emotional disorder, the eligible medical expenses will be covered
under the “Mental Illness and Emotional Disorder” as shown below.
Please refer to Appendix 3 for referral letter requirement and Appendix 4 for the website showing the list of registered medical
specialists in Hong Kong.

Prescribed Medicine purchased outside a Doctor’s Clinic

Eligible medical expenses for medicine (excluding over-the-counter medicines) which is prescribed by a registered medical
practitioner (i.e. medical doctor/physician) in western medicine and purchased from a medical dispensary licensed as a pharmacy
under the laws of Hong Kong, Macau or other jurisdiction where the medicine is purchased (which is not a doctor’s clinic or the
hospital outpatient unit).

Mental Illness and Emotional Disorder

Eligible expenses charged by a registered medical practitioner, i.e. a general practitioner or psychiatrist, for the treatment of mental
illness and emotional disorder. Psychiatrists use various treatments which may include psychotherapy, medications, psychosocial
interventions and other treatments, depending on the needs of each patient. Any associated eligible costs (e.g. diagnostic
laboratory tests, etc.) referred by the registered medical practitioner will be covered according to the respective terms under the
Outpatient Benefit of HealthPlus.

Written referral from a registered medical practitioner is required when a specialist (e.g. psychiatrist) is consulted. Please refer to
HealthPlus’ Panel Doctor List for HealthPlus’ panel psychiatrists, and to Appendix 4 for the website that lists Hong Kong Medical
Council registered doctors in western medication including registered psychiatrists.

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Any other expenses relating to mental illness and emotional disorder cannot be claimed under any other benefits provided under
HSBC HealthPlus.

Physiotherapy
Eligible medical expenses charged by a registered physiotherapist or occupational therapist for consultation and treatment with
written referral must be obtained from a registered medical practitioner (i.e. medical doctor/physician) in western medicine.
Please refer to Appendix 4 for the website showing the list of registered physiotherapists or occupational therapists in Hong Kong.

Gender Dysphoria Outpatient Treatments (Effective 1 October 2020)

Effective 1 October 2020, the following medically necessary outpatient treatment for an individual with gender
dysphoria will be covered by HealthPlus:
 Behavioural health services, including but not limited to, mental illness counselling for gender dysphoria and related
psychiatric conditions (e.g., anxiety, depression)
 Hormonal therapy, including but not limited to androgens, anti-androgens, GnRH analogues, estrogens, and progestins.
 Laboratory testing to monitor prescribed hormonal therapy

Written referral from a registered medical practitioner is required when a specialist (e.g. Psychiatrist, Endocrinology) is consulted.

Checkpoint visits per year

There is a checkpoint on the number of visits per year for consultations at general medical practitioners or specialists,
physiotherapy (by physiotherapists or occupational therapists) and for mental illness and emotional disorder. The number of visits
is reviewed on reaching the checkpoints and can be waived or extended on medical grounds.

If you or your dependants have a medical need for such a waiver or extension of a checkpoint, please make an application in
advance to the plan administrator by completing the form on HRDirect and provide the medical documentation to support the
application. To process the application, the plan administrator will review the claim history to date and the accompanied medical
document which you provide and may request additional information from you. Any associated fees for the doctor to provide
medical documentation to support your application will be borne by you. If needed, the plan administrator may request the applicant
to undergo an independent medical assessment and in this case, the cost will be taken by the plan.

Backdated application is not allowed. Any waiver or extension of the checkpoint is granted at the discretion of the plan administrator
and the plan insurer, and this decision is final.

If the waiver or extension is not applied for or granted, services incurred for visits exceeding the checkpoint will not be covered by
the plan.

Where can I find Panel Doctor List?

HealthPlus Panel Doctor List can be found on HRDirect and on HSBC Life Benefits+. At HSBC Life
Benefits+, HealthPlus panel doctors can be found via “Lifestyle”, “Search for panel clinics”.

How to keep track of my outpatient checkpoint visits through HSBC Life Benefits+?

On HSBC Life Benefits+, via “Me”, “My benefits”, “Outpatient”, you can view your outpatient checkpoint visits
for:

 General Medical Practitioner Consultation

 Specialist Consultation
 Physiotherapy
 Mental Illness and Emotional Disorder

Please note that there is a time lag between your actual visit and the record in HSBC Life Benefits+ because
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of the time needed for processing your claims or receiving relevant bills from panel doctors. The number of
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visits in the record only reflects those that have been processed. Hence, it may be less than the actual
number.
6. Your hospital and surgical benefits
This benefit covers eligible medical expenses provided by a registered medical practitioner (i.e. medical doctor / physician) in
western medicine while you are admitted to hospital for treatment or you receive a surgical operation at a doctor’s clinic or at a
hospital outpatient unit. Covered expenses per disability include those shown below.

Room, Board and General Nursing Care

Expenses for bed, meals and general nursing care during hospitalisation. Expenses incurred for an extra bed will also be covered
in the case of hospitalisation of an eligible child under the age of five.

Hospital Services
Expenses relating to services provided by the hospital during the period of confinement, such as drugs, dressings, x-ray and
laboratory tests, etc.

Cancer treatment (e.g. chemotherapy, radiotherapy, target therapy, etc.) and renal dialysis provided at an outpatient setting will
also be covered under inpatient Hospital Services and falls under each benefit tier’s Hospital Services benefit limits.

Physician’s Services
Expenses relating to visits, treatments or consultations made by a registered medical practitioner for non-surgical hospitalisation
only.

Surgeon’s, Anaesthetist’s and Operating Theatre Fees

If it is necessary for you to undergo any form of surgical procedure during your hospital confinement, then it must be performed by
a qualified registered medical practitioner for benefits to be payable, subject to the limits stated in Appendix 1 – Schedule of
Benefits.

The Surgeon’s Fees Benefit also covers the fees for doctor’s visits during hospital confinement for a surgical case. For the
maximum reimbursement amount for a particular surgical procedure, please refer to Appendix 2 –Classification Schedule of
Surgical Operations.

Note that effective 1 October 2020, breast reconstruction after diagnostic mastectomy will be included as a covered surgical
operation.

Note that effective 1 October 2021, the following arrangement for warts treatment procedures will be imposed:

 Each member is entitled to 2 visits per policy year (i.e. 1 January to 31 December of the same year) for warts treatment
procedures;
 For each warts treatment visit with a panel doctor:
o maximum coverage for the whole claim is HKD 8,000;
o Supplementary major medical benefit (SMM) is not applicable.
 For each warts treatment visit with a non-panel doctor:
o maximum reimbursement for the whole claim is HKD 8,000 or 80% of the total claim cost, whichever is lower;
o Supplementary major medical benefit (SMM) is not applicable;
o maximum reimbursement per disability is subject to the Surgeon’s Fees benefit limit for minor operation.

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In-Hospital Specialist’s Fee
Fees for specialist consultations are paid up to the maximum per disability shown in Appendix 1 – Schedule of Benefits. You must
have been referred to the specialist by the attending registered medical practitioner during your hospital confinement.

Intensive Care
A benefit is payable for intensive care services recommended by the attending registered medical practitioner.

Additional Hospitalisation and Surgical Benefits Effective 1 October 2020

Effective 1 October 2020, the following hospitalisation & surgical benefits are covered by HealthPlus. No credit facility is available
for these claims, hence eligible medical expenses are on a pay-and-claim basis, reimbursed at 80% up to the maximum limit
specified in Appendix 1.

If, however, claims relate to expenses incurred at non-private section of hospitals managed by (a) the Hospital Authority in Hong
Kong or (b) government hospital in Macau, the reimbursement will be 100% subject to the maximum limit specified in Appendix 1.

These coverages are listed as “Additional hospitalisation and surgery benefits” in Appendix 1. They cannot be claimed under any
other benefits provided under HealthPlus, including the SMM and Wellness Claims.

1) Psychiatric Inpatient
Effective 1 October 2020, the expense for medically necessary psychiatric hospitalisation as recommended by a Psychiatrist
will be covered by HealthPlus. Such hospitalisation will be reimbursed at 80% up to the maximum per year limit.

For the avoidance of doubt, where a confinement is not solely for the purpose of psychiatric treatments, this benefit shall only
be payable for the eligible expenses charged on the medical services related to psychiatric treatments. Where the eligible
expenses involve both psychiatric and non-psychiatric treatments and apportionment of the expenses is not available, the
expenses in entirety shall be payable under this benefit if the confinement is initially for the purpose of psychiatric treatments.
If the confinement initially is not for the purpose of psychiatric treatment, the expenses in entirety shall be payable under the
Scheme’s other Inpatient benefits.

Psychiatrist inpatient services are not covered for:

 Recreational or diversional activities. If the only activities prescribed for the patient are primarily diversional in nature,
(i.e., to provide some social or recreational outlet for the patient), it would not be regarded as treatment to improve the
patient's condition.
 Inpatient psychiatric services where the member receives medical or surgical care but does not have an individual
comprehensive treatment plan.

2) BRCA-related Prophylactic Mastectomy and Subsequent Breast Reconstruction

Effective 1 October 2020, when the below conditions are met, BRCA-related prophylactic mastectomy surgery and hospitalisation
are covered by HealthPlus, reimbursed at 80% up to the maximum per surgery limit.

 Female members who carry a pathogenic or likely pathogenic BRCA1 or BRCA2 mutation confirmed by molecular
susceptibility testing for breast cancer according to the 5-tier classification system per ACMG guideline
 A second medical opinion has been received from geneticist or physician with expertise in understanding and
interpreting genetic test results for ratification or modification of suggested risk reducing surgery, with the
consideration of pros and cons, personal and family history of cancers, psychological and social context factors and
other options to manage cancer risk etc.
 A secondary confirmation of test results from a diagnostic laboratory that is well versed in clinical-grade variant
detection and classification has been received
 Genetic counselling has been completed to address psychosocial, social, and quality of life aspects of undergoing risk
reducing surgery. Also, options for intense/early surveillance are discussed

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 Also effective 1 October 2020, breast reconstruction following a mastectomy that has been performed prophylactically to
reduce the risk of breast cancer in high-risk women are also covered by HealthPlus, subject to clinical documentations set
out in Appendix 3. The reimbursement is at 80% up to the maximum per surgery limit.

For the avoidance of doubt, these surgeries’ medically necessary post-surgery outpatient consultation will be covered under
HealthPlus’ outpatient benefit, same as post-surgery outpatient consultation of HealthPlus’ other Hospital & Surgical
treatments.

3) BRCA-related Prophylactic Salpingo-oophorectomy

Effective 1 October 2020, subject to all of the below conditions being met, BRCA-related prophylactic salpingo-oophorectomy
surgery and hospitalisation are covered by HealthPlus, reimbursed at 80% up to the maximum per surgery limit.

 Female members who carry a pathogenic or likely pathogenic BRCA1 or BRCA2 mutation confirmed by molecular
susceptibility testing for breast ovarian cancer according to the 5-tier classification system per ACMG guideline
 Female members who are beyond childbearing age, typically after 35 years of age in carriers of pathogenic or likely
pathogenic BRCA1 mutation and after 40 years of age in carriers of pathogenic or likely pathogenic BRCA2 mutation
due to differences in cancer onset
 A second medical opinion has been received from geneticist or physician with expertise in understanding and
interpreting genetic test results for ratification or modification of suggested risk reducing surgery, with the
consideration of pros and cons, personal and family history of cancers, psychological and social context factors and
other options to manage cancer risk etc.
 A secondary confirmation of test results from a diagnostic laboratory that is well versed in clinical-grade variant
detection and classification has been received
 Genetic counselling has been completed to address psychosocial, social, and quality of life aspects of undergoing risk
reducing surgery. Also, options for intense/early surveillance have been discussed

For the avoidance of doubt, this surgery’s medically necessary post-surgery outpatient consultation will be covered under
HealthPlus’ outpatient benefit, same as post-surgery outpatient consultation of HealthPlus’ other Hospital & Surgical
treatments.

4) Gender Affirming Surgeries

Effective 1 October 2020, medically necessary multiple surgical treatments related to alleviating gender dysphoria are covered by
HealthPlus subject to the benefit limits shown in Appendix 1. The following conditions need to be met for reimbursing gender
affirming surgeries under HealthPlus.

 Individual is 18 years or older

 Individual has the capacity to make a fully informed consent to treatment
 Any significant medical concerns are well controlled (e.g. hypertension, diabetes, coronary artery disease)
 Any significant mental health concerns are well controlled (e.g. anxiety, depression, conduct disorder, substance
abuse, dissociative identity disorders, borderline personality disorder)
 Documentation shows persistent and well documented gender dysphoria as evidenced by ALL of the following:
o The condition is associated with clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
o A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6
months’ duration, as manifested by two or more of the following:
 A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex
characteristics
 A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked
incongruence with one’s experienced/expressed gender
 A strong desire for the primary and/or secondary sex characteristics of the other gender
 A strong desire to be of the other gender
 A strong desire to be treated as the other gender
 A strong conviction that one has the typical feelings and reactions of the other gender
 Documentation shows that the individual has lived continuously for 12 months in a real-life experience, in
the gender role that is congruent with their gender identity

Additional Hospitalisation and Surgical Benefits are not displayed on MyAXA. However, the entitlement is
available and you can make claims following Section 11.9.
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7. Your supplementary major medical benefit
The supplementary major medical benefit (“SMM”) provides a supplementary benefit for those reasonable and customary medically
necessary expenses which exceed the maximum amount of reimbursement/coverage payable under the hospital and surgical
benefits. The amount of this benefit is subject to the plan insurer’s discretion and the amount may vary.

The SMM is paid for medically necessary, reasonable and customary inpatient charges incurred in the treatment of a disability,
subject to the applicable terms and limits. This benefit covers the excess of charges after deducting all the benefits payable under
the Hospital and Surgical Benefits provisions (as calculated in accordance with those applicable limits). The following expenses
are not covered under the SMM:
 Daily room and board charges specified under the Hospital and Surgical Benefits
 Additional Hospitalisation and Surgical Benefits that are effective 1 October 2020, i.e. Psychiatric Inpatient, BRCA-related
Prophylactic Mastectomy and Subsequent Breast Reconstruction, BRCA-Related Prophylactic Salpingo-oophorectomy,
Gender Affirming Surgeries
 Warts treatment procedures expenses (effective 1 October 2021)
 Maternity-related expenses

The amount payable for all eligible charges (excluding the above uncovered items) will only be paid in the proportion that the
benefit payable for room and board bears to the actual amount charged for room and board by the hospital.

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8. The maternity subsidy
This subsidy covers conditions or complications resulting directly from any one pregnancy, childbirth, miscarriage or legal abortion.
It is available to female employees or your female spouse or domestic partner.

What is covered?
The benefit is payable immediately from the date coverage starts in HSBC HealthPlus, regardless of when any pregnancy
commences. This subsidy covers eligible medical costs relating to the pregnancy, child birth and other conclusions of pregnancy
as provided by the qualified medical practitioners. No credit facility is available for maternity and all claims are on a pay-and-claim
basis, and eligible medical expenses would be reimbursed at 80% up to the maximum limit specified in Appendix 1.

1) A lump sum maternity benefit to cover the following costs in relation to the pregnancy / child birth and other conclusions of
pregnancy:
 X-ray / Imaging and laboratory tests (performed at doctors’ clinics or laboratory / imaging centres) that have not been claimed
under the up to 20 antenatal and/or post-natal check-ups
 Prescribed medicines purchased outside the doctor's clinic
 Labour and delivery costs relating to child birth by either vaginal delivery, caesarean section, or other conclusions to pregnancy
(miscarriages or legal abortion) as performed by a registered midwife or a registered medical practitioner (i.e. medical doctor
/ physician).
 Consultations by dieticians, registered physiotherapist, occupational therapist or Chinese medicine practitioners#
 When the maternity involves any of the below 6 maternity complications, effective 1 January 2022 (i.e. for such maternity
complications that incur on or after that date), the maternity subsidy will have additional maximum reimbursement limit, as
specified in Appendix 1.
i) Abruptio Placentae
ii) Amniotic Fluid Embolism
iii) Choriocarcinoma and Malignant Hydatidiform Mole
iv) Increta/Percreta
v) Postpartum Haemorrhage requiring Hysterectomy
vi) Still Birth

2) In addition to the lump sum maternity benefit above, up to a total of 20 check-ups (antenatal / post-natal, excluding X-
ray/Imaging and laboratory tests) per pregnancy subject to the following:
 the check-ups are conducted by a registered midwife or a registered medical practitioner (i.e. medical doctor / physician)
including general medical practitioner or specialist. (No referral is required.)
 it mainly covers the consultation costs of the registered medical practitioners or midwives during the check-ups
 for registered medical practitioners, it also covers the treatment costs of any pregnancy related illnesses or complications (e.g.
morning sickness, pre-eclampsia, gestational diabetes, hyperemesis gravidarum, placenta previa, threatened abortion, etc.)
as well as the costs for any eligible injection and medication given in the clinic
 each visit will be reimbursed at 80% up to the maximum per visit limit
 if the number of check-ups exceeds 20 for the pregnancy, further visits will be reimbursed at 80% provided the lump sum
maternity benefit has not been used up
 Postnatal visits are covered up to two months after date of delivery

Maternity-related expenses, including expenses exceeding the maternity subsidy, cannot be claimed under any other benefits
provided under the HSBC HealthPlus, including the SMM and Wellness Claims. The benefit limit will not be raised for multiple
births.

# Herbal medicine prescribed by the Chinese medicine practitioner and the cost for other services (e.g. decoction of herbal
medicine) will also be covered provided that the consultation, medicine and services are charged by the same Chinese medicine
practitioner on the same date through the same receipt. The prescribed medicine does not cover precious herbal medicine, for
example, Agaricus blazei murill, antelope horn powder, antler, cordyceps, cubilose, donkeyhide gelatin, ganoderma, all kinds of

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Ginseng, hippocampus, moschus, pearl powder and alacenta hominis, etc. This is subject to the plan insurer’ s ’review and
discretion.)

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What is not covered under maternity subsidy?
Maternity subsidy does not cover the following services:
 Routine nursery care or care of new-born babies
 Antenatal/parent craft classes or breastfeeding / lactation class
 Procurement and use of maternity products, e.g. abdominal binder, breast-pump, etc.
 Non-medical service
 Expenses that are recoverable from a third party or covered by any other existing insurance
 Any studies, laboratory workup, investigations or treatment relating to the underlying cause of miscarriages
 Surgical, mechanical or chemical contraceptive methods of birth control or sterilisation of either sex
 Investigation or treatment relating to infertility or in-vitro fertilisation or surrogacy
 Deposit or pre-payment of any packages or services
 Other items shown in the exclusion list

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9. Wellness Claims
Each member is entitled to Wellness Claims which helps you and your family to keep healthy. You have one total limit which gives
you the flexibility to choose the range of health services covered you wish to claim each plan year.

What is covered?
Employees and their eligible dependants can enjoy a wide range of health services. These include:
 Pap smear tests**
 Prostatic Specific Antigen (PSA) tests**
 Routine physical check-up**
 Dental care (limited to: consultation/examination, scaling & polishing, oral X-rays, treatment and medications)
 Eyesight check (including astigmatism, colour blindness, myopia, presbyopia and refractive error)
 Hearing test**
 Vaccination/inoculations
 Consultation by Chinese medicine practitioner*and the related medication
 Consultation by dietician / chiropractor / podiatrist / speech therapist / osteopath
 Childhood Developmental Assessment (for dependant children only and must be conducted by a paediatrician, neurologist,
psychiatrist, psychologist, speech therapist, osteopath and / or audiologist.) including doctor recommended initial test for
the assessment

The cost of these services, as performed by the registered/qualified practitioners (i.e. doctor, dentist, dietician, nutritionist,
chiropractor, optician, optometrist, ophthalmologist, Chinese medicine practitioner, podiatrist, audiologist, speech therapist,
osteopath, and psychologist) can be reimbursed at 100% up to the maximum amount of the Wellness Claims annual entitlement.
Please refer to Appendix 4 for the list of websites showing the qualified practitioners in Hong Kong.

Once a member’s entitlement has been used up, no further benefits can be claimed under the plan for these services. The
entitlement cannot be transferred between family members or across plan year ends.

* Herbal medicine prescribed by the Chinese medicine practitioner and the cost for other services (e.g. decoction of herbal
medicine) will also be covered provided that the consultation, medicine and services are charged by the same Chinese medicine
practitioner on the same date through the same receipt. The prescribed medicine does not cover precious herbal medicine, for
example, Agaricus blazei murill, antelope horn powder, antler, cordyceps, cubilose, donkeyhide gelatin, ganoderma, all kinds of
Ginseng, hippocampus, moschus, pearl powder and alacenta hominis, etc. This is subject to the plan insurer’s review and
discretion.
** These tests and check-ups are for screening and preventive purposes only and does not include any investigation for known
health issues. Check-ups involving genetic testing or test involving experimental techniques are also excluded.

What is not covered?

This benefit will not cover the following:
 Fees for pre-paid packages/courses of treatments or consultations (e.g. annual fee for participating in the voluntary dental
scheme)
 Expenses undergone for cosmetic reasons
 Services not performed by registered/qualified practitioners
 Non-medical services
 Services for maternity purposes
 Procurement or rental of lumbar corsets, neck collars, hearing aids, glasses, contact lenses, mouthguards, dental braces,
wheelchairs, crutches, ventilation machines, oxygen or any other similar equipment
 DNA test
 Other items shown in the exclusion list unless otherwise specified in the Wellness Claims above

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
How to check the balance of my Wellness Claims?

In HSBC Life Benefits+, via “Me”, “My benefits”, “Wellness claim amount”, you can view the balance of your
 Wellness Claims immediately!

Please note that there is a time lag between the service incurred and the record in HSBC Life Benefits+
because of the time needed for processing your claims. The record only reflects those that have been
processed. Hence, while there are Wellness Claims being in process, the “Amount left” shown in HSBC
Life Benefits+ will may be more than the actual.

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10. HealthPlus Exclusions
HSBC HealthPlus will not be liable for and will not pay any claims for inpatient and outpatient services regarding:
 Expenses that are recoverable from a third party
 Any expenses related to cosmetic, plastic surgery and treatment of refractive errors or the like
 Surgical, mechanical or chemical contraceptive methods of birth control or treatment relating to infertility or in-vitro fertilisation,
or sterilisation of either sex
 Expenses that are recoverable under the insurance policy for Employees’ Compensation
 Procurement or rental of lumbar corsets, neck collars, hearing aids, glasses, contact lenses, mouthguards, dental braces,
wheelchairs, crutches, ventilation machines, oxygen or any other similar equipment, except the splints and plaster casts used
of finger or toe fracture case or the like
 Injury, illness, sickness or disease directly or indirectly resulting from:
- Self-inflicted injuries that is not as a result of mental illness
- High risk occupations or professional activities activities (to the extent that they are not done on an amateur basis as a
hobby or pastime), including but not limited to engaging in, or taking part in:
- naval, military or air force service or operations
- aviation other than as a fare-paying passenger in an aircraft provided and operated by an airline or air
charter company which is duly licensed for the regular transportation of fare-paying passengers
- technical or non-recreational diving; bungee jumping; mountaineering; hand gliding; parachuting;
parasailing; pot-holing; daring feats or stunts; powered motor-racing or work activities involving dangerous
or contaminable substances
- sport activity in a professional capacity or where the member would or could earn income or remuneration
from engaging in such sport
- airline personnel and aircrew, shipcrews
 Active or direct involvement in war or any act of war, declared or undeclared, invasion, act of foreign enemies, hostilities
(whether war be declared or not), civil war, rebellion, revolution, insurrection or military or usurped power
 Charges for accommodation and nursing in any establishment which for any reason is or has effectively become the place of
domicile or permanent abode
 Hospitalisation primarily for diagnostic scanning, x-ray examinations or physical therapy
 Expenses covered by any other existing insurance, or directly or indirectly arising from healthcare services provided by
Government facilities or by medical practitioners employed by Government facilities unless there is a legal obligation for the
member to pay
 Any expense, regardless of any contributory cause(s), involving the use of or release or the threat thereof of any nuclear
weapon or device or chemical or biological agent, where the member has active or direct involvement; including but not limited
to expenses in any way caused or contributed to by the members’ active and direct involvement in an act of terrorism
 Any expenses which are a direct or indirect result of nuclear reaction or radiation where the member has active or direct
involvement
 Developmental conditions e.g. speech delay, failure to thrive, short stature, etc.
 Prescription drugs used in connection with treatment of baldness, aphrodisiac purpose, weight management and the like
 Medical Treatments which are experimental, investigative in nature, including the Treatment procedure, facility, equipment,
drugs, drug usage, devices or supplies which have not been recognised as accepted medical practice in Hong Kong
 Non-medications, including but not limited to vitamins, supplements, shampoo, tonic stimulants, minerals, bath oil/lotion, and
the like
 Non-medical services, including but not limited to photocopying, medical report charges, telephone, internet service, newspaper,
taxi fare, ambulance fee, travelling expenses, guest meal, companion bed and the like
 Any services for preventative purpose (except for the covered items under BRCA-related Prophylactic Mastectomy, BRCA-
related Prophylactic Salpingo-oophorectomy, and the Wellness Claims.)

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11. How to make a claim/use the e-Health Card or
medical card
The procedures vary depending on the service type and location as well as whether the medical card is used or not. Please refer
to the relevant topic in this section and Appendix 3 for an overview of supporting documents.

Note that for Video Consultation via the Benefits+ app, expenses are auto-deducted from HealthPlus and there is no need to make
co-pay and to make claims.

11.1 Outpatient services – if you consult a Panel Doctor in Hong Kong presenting your red medical card/ e-Health Card
11.2 Outpatient services – if you consult a Panel Doctor in Macau presenting your red medical card
11.3Outpatient services – if you consult a Panel Doctor in Hong Kong or Macau presenting your blue medical card OR without
presenting any medical card
11.4 Outpatient services – if you consult a Non-Panel Doctor in any places
11.5 Hospitalisation in Hong Kong – using your red medical card
11.6 Hospitalisation in Macau – if you are admitted to an Appointed Hospital in Macau using your red medical card
11.7 Hospitalisation in Hong Kong / Macau – if you are admitted by a Panel Doctor in Hong Kong or to an Appointed Hospital in
Macau without presenting a red medical card
11.8 Hospitalisation – if you are using the Non-Panel arrangement in any places
11.9 Additional Hospitalisation & Surgical Benefits effective 1 October 2020
11.10 Wellness Claims and Maternity Subsidy
11.11 Make a Claim including e-claim

How to find the Panel Doctor List on HSBC Life Benefits+?

At HSBC Life Benefits+ via “Lifestyle”, “Search for panel clinics”. Panel doctors in both Hong Kong and
Macau can be found here.

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11.1 Outpatient services - if you consult a Panel Doctor in Hong Kong presenting your red medical card/ e-
Health Card
 Credit facilities are available at the Panel when you present your red medical card/ e-Health Card and your proof of identity
(e.g. Hong Kong identity card) prior to the consultation or treatment. The Panel will record your name and membership
number and ask you to sign a claim voucher. If you visit a general practitioner, specialist or physiotherapist on the Panel,
you will be asked to make a co-payment directly to them. If, for any reason, the Panel do not collect the co-payment, the
plan administrator will later issue a debit note to recover the co-payment from you. If you use your e-Health Card, you can
simply access HSBC Life Benefits+ app in your own mobile phone and present your e-Health card to the registration
counter at panel clinic3. The panel clinic staff will verify the information before providing credit facilities.
 If you refuse to make the co-payment, panel clinics reserve the right to decline any appointment for consultations
 If you are found not complying with the co-payment guideline, you will be subject to suspension of medical benefits
 When medically necessary, the Panel Doctor will refer you to a specialist/ physiotherapist/ laboratory centre. You should
obtain a referral letter issued by the doctor and present it to the specialist/physiotherapist /laboratory at the time of
consultation. Please refer to Appendix 3 for details of the referral letter. You are advised to keep a photocopy of these
referral letters for your own records.
 No referral is required when you consult a specialist in Gynaecology, Paediatrics, Dermatology, Otorhinolaryngology (Ear,
Nose& Throat), Ophthalmology (Eye) and Orthopaedics and Traumatology.
 A referral letter is valid for 90 days from the date of issue. Once you have consulted the specialist/physiotherapist within
the period, you can continue to consult the same specialist/physiotherapist for the same disability without requiring a new
referral letter. However, if no further treatment for that disability is required after 90 days following the last visit to the
specialist / physiotherapist, a new referral letter is then required.
 For any medication prescribed by the Panel Doctor which is not available or out of stock at the clinic, you can purchase
the medication for up to a maximum stock of 2 months from any licensed pharmacy. The prescription is valid within 2
weeks from date of issue and can be used to make one purchase. To obtain full reimbursement for the medication, please:
- obtain a prescription from the doctor and an official receipt from the pharmacy as supporting documents for making a
claim. Please refer to Appendix 3 for details of the supporting documents
- complete the outpatient claim form and attach the above supporting documents
- keep a photocopy of the form and all the supporting documents for your own records
- submit the claim within 90 days from the date of purchase (late submission will be rejected)
- provided the information is adequate, the plan administrator will settle your claim subject to the applicable terms
 If you consult a doctor of the outpatient department at a private hospital in Hong Kong during emergency hours (i.e.
Sunday/Public Holidays: all day, Saturday: 1:00 pm to 12:00 midnight and Monday to Friday 5:00 pm to 9:00 am):
- Credit facilities are available there by presenting your red medical card/ e-Health Card provided that the
consultation/treatment is attended by the hospital resident doctor without prior appointment. Eligible medical expenses
will be covered subject to the terms applicable to the Panel Doctors. Should you incur any expenses not covered under
the Panel Doctor (e.g. maternity related expenses), the plan administrator will recover the cost from you.
- Additionally, e-Health Card QR Code can be presented to the registration counters at St. Teresa’s Hospital, St. Paul’s
Hospital and Gleneagles Hospital.
- No credit facility will be provided during emergency hours if you (a) make a prior appointment to see a hospital doctor or
(b) request to see a doctor who is not a hospital resident doctor with or without any prior appointment. You will have to
settle the expenses first and make a claim subject to the limits and procedures applicable for the Non-Panel.
- For emergency conditions which require immediate specialist consultation and/or diagnostic x-ray, lab-test & imaging as
recommended by the hospital resident doctor and arranged by the hospital, eligible medical expenses will be covered
subject to the terms applicable to the Panel Doctors. However, the hospital may not offer the credit facility to you. You
will have to settle the expenses first and obtain the referral letter (regardless of which specialty) to show that it is of an
immediate need and the official receipt for reimbursement afterwards. Before submitting the claim, please contact the
plan administrator so that they can make a remark in their system. Other claims procedures are the same as when you
use the Non-Panel arrangement. Please refer to the respective section below.
- For non-emergency follow up consultations (e.g. general practitioner / specialist / lab test, etc.) as recommended by the
hospital resident doctor, you can use any other Panel or Non-Panel practitioners, subject to the applicable terms and
limits during non-emergency hours.


3
This includes St. Teresa Hospital which is a Panel OPD. E-Health Card QR Code can be used at St. Teresa OPD. At Matilda Hospital which is another Panel OPD,
only physical medical card is accepted.
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
11.2 Outpatient services - if you consult a Panel Doctor in Macau presenting your red medical card
 Credit facilities are available at the Panel when you present your red medical card and your proof of identity (e.g. Macau
identity card) prior to the consultation or treatment. The Panel will record your name and membership number and ask you
to sign a claim voucher. If you visit a general practitioner, specialist or physiotherapist on the Panel, you will be asked to
make a co-payment directly to them. If, for any reason, the Panel do not collect the co-payment, the plan administrator will
later issue a debit note to recover the co-payment from you.
 When medically necessary, the Panel Doctor will refer you to a specialist / physiotherapist / laboratory centre. You should
obtain a referral letter issued by the doctor and present it to the specialist/physiotherapist /laboratory at the time of
consultation. Please refer to Appendix 3 for details of the referral letter. You are advised to keep a photocopy of these
referral letters for your own records.
 No referral is required when you consult a specialist in Gynaecology, Paediatrics, Dermatology, Otorhinolaryngology (Ear,
Nose & Throat), Ophthalmology (Eye) and Orthopaedics and Traumatology.
 A referral letter is valid for 90 days from the date of issue. Once you have consulted the specialist/physiotherapist within
the period, you can continue to consult the same specialist/physiotherapist for the same disability without requiring a new
referral letter. However, if no further treatment for that disability is required after 90 days following the last visit to the
specialist / physiotherapist, a new referral letter is then required.
 For any medication prescribed by the Panel Doctor which is not available or out of stock at the clinic, please obtain a
prescription from the doctor. The prescription is valid within 2 weeks from date of issue and can be used to make one
purchase.
- If you present your red card together with the prescription at the Panel Pharmacy in Macau, you can enjoy the credit
facility and the medication (up to a maximum of 2 months’ stock) will be covered according to the applicable terms for
Panel Doctor. Please refer to Appendix 3 to see what information is required on the prescription.
- If you do not present your red medical card at the Panel Pharmacy or you purchase the medication at a Non-Panel
Pharmacy, you will need to pay settle the expense first and obtain an official receipt from the pharmacy to make a claim
to the plan administrator. The reimbursement will be processed according to the terms applicable for Non-Panel Doctors.
To make a claim, please:
o obtain a prescription from the doctor and an official receipt from the pharmacy as supporting documents. Please
refer to Appendix 3 for details of these supporting documents
o complete the outpatient claim form and attach the above supporting documents
o keep a photocopy of the form and all the supporting documents for your own records
o submit the claims within 90 days from the date of purchase (late submission will be rejected)
o provided the information is adequate, the plan administrator will settle your claim subject to the applicable terms
- No credit facility will be offered by the outpatient department of any hospitals in Macau at any time. Hence, you will have
to settle the payment at the time of consultation and make a claim to the plan administrator. The claim procedures are
the same as when you consult a Non-Panel and will be processed subject to the applicable terms and limits for the Non-
Panel. Please refer to the respective section below.

11.3 Outpatient services - if you consult a Panel Doctor in Hong Kong or Macau presenting your blue
medical card OR without presenting any medical card

 No credit facility will be provided. You are required to settle the expenses first and make a claim for reimbursement.
 If you are an employee or dependant of Tier I and Tier II, or an employee of Tier III, the reimbursement will be made subject to
the benefit limits applicable for Non-Panel Doctors.
 Other claims procedures are the same as when you consult a Non-Panel Doctor. Please refer to the respective section below.

11.4 Outpatient services - if you consult a Non-Panel Doctor in any places

 No credit facility will be provided. You are required to settle the expenses first and make a claim for reimbursement.
 When medically necessary, the doctor will refer you to a specialist / physiotherapist / laboratory centre. You should obtain a
referral letter issued by the doctor and present it to the specialist/physiotherapist /laboratory at the time of consultation. Please

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 refer to Appendix 3 for details of the referral letter. You are advised to keep a photocopy of these referral letters for your own
records.
 No referral is required when you consult a specialist in Gynaecology, Paediatrics, Dermatology, Otorhinolaryngology (Ear,
Nose& Throat), Ophthalmology (Eye) and Orthopaedics and Traumatology.
 A referral letter is valid for 90 days from the date of issue. Once you have consulted the specialist/physiotherapist within the
period, you can continue to consult the same specialist/physiotherapist for the same disability without requiring a new referral
letter. However, if no further treatment for that disability is required after 90 days following the last visit to the specialist /
physiotherapist, a new referral letter is then required.
 For any extra or long-term medication prescribed by the doctor, you can purchase the medication from any licensed pharmacy
and make a claim to the plan administrator.
 To make a claim, please:
- complete the outpatient claim form and attach the following supporting documents. Please refer to Appendix 3 for details
of supporting documents:
- for consultations at the general practitioners or specialists in Gynaecology, Paediatrics, Dermatology,
Otorhinolaryngology (Ear, Nose & Throat), Ophthalmology (Eye) and Orthopaedics & Traumatology), only
the original receipt is required
- for consultations / treatments at other specialists, physiotherapists, laboratory, the original receipt and a
photocopy of the referral letter are required
- for prescribed medicine outside doctor’s clinic, the original receipt from the pharmacy and a photocopy of
the doctor’s prescription are required.
- for claims in relation to specialist consultations (regardless of whether a referral letter is required), please specify on the
claim form if you would like to claim the benefit for a general practitioner or a specialist consultation. These claims cannot
be adjusted after they are submitted.
- for claims in relation to the outpatient department of a hospital managed by Hospital Authority (HA) in Hong Kong, please
request the attending doctor to write the diagnosis on the receipt of your Outpatient Registration Form issued by HA.
- keep a photocopy of the form and all the supporting documents for your own records.
- submit the claims within 90 days from the date of consultation or purchase (late submission will be rejected).
- provided the information is adequate, the plan administrator will settle your claim subject to the applicable terms and limits
 The maximum amount that can be claimed is subject to the benefit level of your plan for Non-Panel (refer to Appendix 1 –
Schedule of Benefits for details). For claims relating to expenses incurred at an outpatient facility managed by (a) the Hospital
Authority in Hong Kong or (b) the government hospital in Macau, if the outpatient facility is under the non-private section, the
reimbursement will be made subject to the applicable limits for Panel Doctors.

Can I submit the claims through electronic means?

If your non-panel outpatient consultation in Hong Kong is at receipt amount HK$4,000 or less and it is
either General Practitioner or for Wellness Claims, you can submit the claim through HSBC Life
Benefits+.

There is no need to mail the original outpatient claim receipt to AXA but please keep the original documents
and receipts for at least 6 months.

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11.5 Hospitalisation in Hong Kong – using your red medical card

11.5.1 Admitted by a Panel Doctor

 The Panel Doctor will contact the plan administrator to arrange a credit facility for your hospitalisation.
 You are required to present your /red medical card and proof of identity (e.g. Hong Kong identity card) to the hospital admission
officer who will record your name and membership number and request you to sign a claim voucher. You are not required to
make any payment to the hospital provided you are admitted to the room level for which you are eligible.
 For cases when the amount incurred by you or your dependant for hospitalisation exceeds your benefit level, you are
responsible for the excess amount and the plan administrator will issue a debit note to notify the excess amount to be
recovered from you.
 If you request to stay at a room level higher than your benefit entitlement, no credit facility will be provided and you are required
to settle the expenses first and make a claim subject to the terms and limits applicable for Non-Panel.
 If there is no room available for your benefit entitlement (e.g. in the case of Tier I, all standard private room occupied), you are
required to use a lower room class for admission. No reimbursement of the difference in benefit will be made to you. If you
choose to stay at a room level higher than your benefit entitlement, no credit facility will be provided and you are required to
settle the expenses first and make a claim subject to the terms and limits applicable for Non-panel.

11.5.2 Emergency Admission by Resident Medical Officer of Private Hospitals

 For emergency admission recommended by Resident Medical Officer (RMO) of the Outpatient Department of a private hospital
in Hong Kong at any time, you or your companion should call the plan administrator immediately so that the plan administrator
can liaise with the hospital admission officer directly for the credit facility and arrange a Panel Doctor to take over the case as
soon as possible.
 You are required to present your red medical card and proof of identity (e.g. Hong Kong identity card) to the hospital admission
officer who will record your name and membership number and request you to sign a claim voucher. You are not required to
make any payment to the hospital provided you are admitted to the room level for which you are eligible.
 If you or your companion do not call the plan administrator before the admission or you do not use your red medical card for
the admission, no credit facility can be offered by the hospital and you will be required to settle the expenses first and make
a claim for reimbursement subject to the terms and limits applicable for Non-Panel.
 For cases when the amount incurred by you or your dependant for hospitalisation exceeds your benefit level, you are
responsible for the excess amount and the plan administrator will issue a debit note to notify the excess amount to be
recovered from you.
 If you request to stay at a room level higher than your benefit entitlement, no credit facility will be provided and you are required
to settle the expenses first and make a claim subject to the terms and limits applicable for Non-Panel.

11.6 Hospitalisation in Macau - if you are admitted to an Appointed Hospital in Macau presenting your red
medical card
 Please refer to the Panel Doctor List for the Appointed Hospitals in Macau that offer credit facility to our red card members.
 If you are admitted by one of the following doctors of the Appointed Hospitals (emergency or non-emergency), it will be covered
subject to the applicable terms and limits for Panel Doctors, otherwise, it will be covered subject to the terms and limits for
Non-Panel Doctors:
- Resident Medical Officers / Resident Doctors of the Appointed Hospitals
- Contracted Doctors of the Appointed Hospitals who are on the Hong Kong Panel Doctor List
 For non-emergency admission, you should inform the plan administrator prior to the admission so that the hospitalisation will
be covered subject to the applicable terms and limits for Panel Doctors. For emergency admission, either you or your
companion should inform the plan administrator prior to the admission so that the hospitalisation will be covered subject to
the applicable terms and limits for Panel Doctors.
 To enjoy the credit facility, you are required to present your red medical card and proof of identity (e.g. Macau identity card) to
the hospital admission officer who will record your name and membership number and request you to sign a claim voucher.
You are not required to make any payment to the hospital provided you are admitted to the room level for which you are
eligible to.
 If the plan administrator is not informed by you or your companion prior to your admission or you do not use your red medical
card for the admission, no credit facility can be offered by the hospital and you will be required to settle the expenses first and
make a claim for reimbursement subject to the terms and limits applicable for Non-Panel.

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 For cases when the amount incurred by you or your dependant for hospitalisation exceeds your benefit level, you are
responsible for the excess amount, and the plan administrator will issue a debit note to notify you the excess amount to be
recovered from you.
 If you request to stay at a room level higher than your benefit entitlement or you provide incorrect information to the hospital
about your own entitlement, no credit facility will be provided and you are required to settle the expenses first, and obtain the
original receipts from the hospital for reimbursement afterwards. The reimbursement will be made subject to the applicable
terms and limits for Non-Panel Doctors. The claims procedures are the same as when you use the Non-Panel arrangement.
Please refer to the section below.

11.7 Hospitalisation in Hong Kong / Macau - if you are admitted by a Panel Doctor in Hong Kong or to an
Appointed Hospital in Macau without presenting your red medical card
 Without presenting your red medical card, no credit facility will be provided. You are required to settle the expenses first and
make a claim for reimbursement adhering to non-panel benefit limits.
 For hospitalisation in Macau of Tier III dependants, if you are admitted by one of the following doctors of the Appointed Hospitals
(emergency or non-emergency), it will be covered subject to the applicable terms and limits for Panel Doctors, otherwise, it
will be covered subject to the terms and limits for Non-Panel Doctors:
- Resident Medical Officers / Resident Doctors of the Appointed Hospitals
- Contracted Doctors of the Appointed Hospitals who are on the Hong Kong Panel Doctor List
 If you are an employee or dependant of Tier I and Tier II, or an employee of Tier III, the reimbursement will be made subject to
the benefit limits applicable for Non-Panel Doctors.
 The claim procedures are the same as when you use a Non-Panel arrangement. Please refer to the section below.

11.8 Hospitalisation - if you are using a Non-Panel arrangement in any places

 No credit facility will be provided. You are required to settle the expenses first and follow the steps below to make a claim
for reimbursement:
- obtain the original hospital statement of account showing the cost breakdown by items and payment receipt as supporting
documents. Please refer to Appendix 3 for details of the supporting documents.
- complete the Hospitalisation and Surgical Claim Form. Part I of the claim form should be completed and signed by you
or your dependant (the patient) while Part II must be filled in by your attending doctor and attach the above supporting
documents.
- for claims in relation to a hospital managed by Hospital Authority (HA) in Hong Kong, please attach a “Discharge
Summary/Slip” from the hospital which indicates information including the diagnosis and name of any operation
undergone. Then, it is not necessary to complete Part II of the claim form.
- keep a photocopy of the form and supporting documents for your own records
- submit the claims within 90 days from the date of discharge (late submission will be rejected)
- provided the information is complete, the plan administrator will settle your claim subject to the applicable terms and limits
 The maximum amount that can be claimed is subject to the benefit level of your plan (refer to Appendix 1 – Schedule of
Benefits for details). For claims relating to expenses incurred at hospitals managed by (a) the Hospital Authority in Hong
Kong or (b) government hospital in Macau, if the inpatient facility is under the non-private section, the reimbursement
will be made subject to the applicable limits for Panel Doctors. If the inpatient facility is under the private section, the
reimbursement will be made subject to the applicable limits for Non-Panel Doctors.

11.9 Additional Hospitalisation and Surgical Benefits Effective 1 October 2020

 No credit facility will be provided. You are required to settle the expenses first and make a claim for reimbursement.
Please hence contact the Plan Administrator before you are to have the related hospitalisation for prior advice on medical
services arrangement and specific claims process.
 The maximum amount that can be claimed is subject to the benefit level of your plan (refer to Appendix 1 – Schedule of
Benefits for details)

11.10 Wellness Claims and Maternity Subsidy

 No credit facility will be provided. You are required to settle the expenses first and follow the steps below to make a claim
for reimbursement:
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 - complete the claim form and specify on the form if you would like to claim the benefit as Wellness Claims or Maternity
Subsidy
- attach the original receipt as a supporting document. Please refer to Appendix 3 for details of supporting documents
- keep a photocopy of the form and all the supporting documents for your own records
- submit the claims within 90 days from the date of consultation or 90 days from the date of discharge for maternity related
hospitalisation charges (late submission will be rejected)
- provided the information is adequate, the plan administrator will settle your claim subject to the applicable terms and limits
 The maximum amount that can be claimed is subject to the benefit level of your plan (refer to Appendix 1 – Schedule of
Benefits for details)

11.11 Make a claim including e-Claims
 HSBC Life Benefits+ app allows you to submit outpatient claims directly from the app.
 Only staff members (principle member of the family) can submit claims including e-claims subject to the applicable terms
and limits

Which claim forms can I download from HSBC Life Benefits+?

You can download the following claim forms from HSBC Life Benefits+:
- Claim Form – Outpatient Benefit/Wellness Claims Claim Form
- Claim Form – Maternity Subsidy Claim Form
- Claim Form – Hospitalisation & Surgical Claim Form

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12. Other information
Packages
Packages with different health service providers (e.g. dentist) will be sourced by the plan administrator for the convenience of the
employees who can take it up voluntarily at their own cost. Annual check-up packages (which are not offered on a pre-paid basis)
can be claimed under the Wellness Claims. Information about the packages can be found on HRDirect.

“Second Claims” under HealthPlus

If you have already made a partial claim from a third party (e.g. your private medical insurance plan, medical benefit plan from
your spouse’s employer, etc.), you can still submit the claim to the plan administrator as a “second claim” under HealthPlus by
providing either the original receipt or a certified true copy of the receipt from the third party. Provided it is an eligible medical
expense under HealthPlus, the plan administrator will process the claim based on the applicable reimbursement % on the
remaining balance and subject to the monetary limit applicable to you.

Travelling on Business
If you are required to travel on business, the necessary medical expenses incurred during the trip will be covered under the
business travel insurance policy arranged by the Group. For details, please refer to the HSBC Group Business Travel page on
HSBC intranet.
Necessary travel vaccines taken and oral drugs for the prevention of infectious diseases before the business trip are fully covered
under HealthPlus. Please make a claim by completing the “Claim form – Travel Vaccines/Medication for Business Trips” on HSBC
intranet with the supporting document (e.g. Business Unit written proof for the air ticket/ hotel accommodation or any confirmation
for the business trip) for claim process.

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13. Appendix 1 – Schedule of Benefits

13.1 Tier I – Employee and dependant

13.2 Tier II – Employee and dependant
13.3 Tier III – Employee
13.4 Tier III – Dependant

Where can I get my benefits schedule if I am not in the office?

HSBC Life Benefits+ allows you to get your benefits schedule anytime anywhere! Please view this at HSBC
Life Benefits+, via “Me”, “My benefits”

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13.1. Tier I – Employee and dependant

Panel Doctor Non-Panel Doctor

Outpatient
100% coverage 80% reimbursement
General Medical Practitioner $20 co-payment/visit. For Video Up to $750/visit
Consultation via the Benefits+ app:
Consultation inclusive of medicines $0 co-payment
Checkpoint visits per year 30
Specialist consultation inclusive of $20 co-payment/visit Up to $1,200/visit
medicine (referral required)*
Consultation inclusive of medicine
Checkpoint visits per year 20

Physiotherapy1 (referral required)* $20 co-payment/visit Up to $750/visit

Referral by Panel Doctor
Checkpoint visits per year 25

Mental Illness & Emotional Disorder $20 co-payment/visit Up to $2,000/visit

Checkpoint visits per year 25

Diagnostic x-ray, Laboratory Tests & Referral by Panel Doctor Up to $5,000/year

Imaging (referral required)*

Medication purchased outside doctor’s Max 2 months’ supply for Up to $4,000/year

clinic (prescription required)* per visit to Panel Doctor

Panel Doctor Non-Panel Doctor

Hospital & Surgical
100% coverage 80% reimbursement
Room, Board & General Nursing Care
Max limit per day Basic Private Ward $3,200
Max days per disability^ N/A 100

Intensive Care
Max limit per disability^ N/A $62,400

Meal Subsidy
Max limit per day $200 Under room & board benefit limit
(if meal is not included in the
room & board charge)

Hospital Services
Max limit per disability^ N/A $65,000

Physician Services#
(non-surgical case only)
Max limit per day N/A $3,200
Max days per disability^ N/A 100

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 Panel Doctor Non-Panel Doctor
Hospital & Surgical
100% coverage 80% reimbursement
In-Hospital Specialist Fees
Max limit per disability^ N/A $13,000
Surgeon Fees
Max limit per disability
Complex N/A $240,000
Major N/A $96,000
Inter N/A $48,000
Minor@ N/A $19,200
Anaesthetist’s Fee
Max limit per disability
Complex N/A $72,000
Major N/A $28,800
Inter N/A $14,400
Minor N/A $5,760
Operating Theatre Charge
Max limit per disability
Complex N/A $72,000
Major N/A $28,800
Inter N/A $14,400
Minor N/A $5,760
Annual Overall Limit^^ N/A $1,500,000
Panel Doctor Non-Panel Doctor
Supplementary Major Medical
100% coverage 70% reimbursement
Max limit per disability N/A $400,000
Additional hospitalisation & surgical
Free Choice Doctor, 80% reimbursement
benefits effective 1 October 2020
Max limit
Psychiatric inpatient $50,000 per year
BRCA-related Related Prophylactic
$120,000 per bilateral mastectomy surgery
Mastectomy
Breast Reconstruction that follows
$120,000 per bilateral breast reconstruction
BRCA-related Prophylactic Mastectomy

BRCA-Related Prophylactic Salpingo-

$100,000 per bilateral oophorectomy surgery
oophorectomy

Gender Affirming Surgeries $200,000 per life time

Maternity Subsidy Free Choice Doctor, 80% reimbursement
Antenatal / Post-natal check-up
Consultation inclusive of medicines Up to $1,200/visit
Max number of visits per pregnancy Total 20

Lump sum benefit max limit per

pregnancy $75,000

Effective 1 January 2022**: Lump sum
benefit max limit per pregnancy that
involves any of the 6 maternity
complications
 Abruptio Placentae
 Amniotic Fluid Embolism
 Choriocarcinoma and Malignant Hydatidiform Mole
 Increta/Percreta
 Postpartum Haemorrhage requiring Hysterectomy
 Still Birth
Additional lump sum benefit max limit per pregnancy $75,000

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 Wellness Claims Free Choice Doctor, 100% reimbursement
Employee/spouse/domestic partner: $8,000per year per member
Max limit
Child: $4,000per year per member

1
Physiotherapy includes Occupational Therapy
* Written referral (except for those waived under “Specialist consultation” of Section 5) /prescription is required from a registered medical
practitioner in western medicine
^ Disability means injury, sickness, disease or illness and shall include all disabilities rising from the same cause including any and all
complications arising therefrom, except that where after 90 days following the latest medical treatment or consultation no further treatment for
that disability is required, any subsequent disability from the same cause shall be considered a separate disability.
# Visit(s) by Registered Medical Practitioner other than Surgeon(s) who perform(s) the operation(s). No payment shall be made for visits or
treatment related to the Disability which required such operation or during convalescence.
^^ For hospital and surgical benefits listed above this row. This is annual overall limit means the aggregate sum of benefits during the twelve-
month period measured from the commencement date of each plan year.
@
New arrangement for warts treatment procedures effective 1 October 2021: each member is entitled to 2 visits per policy year for warts
treatment procedures. Supplementary major medical benefit (SMM) is not applicable. For panel visits, the maximum coverage per visit is
HKD 8,000. For non-panel visits, the maximum reimbursement is HKD 8,000 or 80% of total claim cost, whichever is lower; maximum
reimbursement per disability is also subject to the Surgeon’s Fees benefit limit for minor operation. The expenses for the whole claim shall be
covered under Surgeon’s Fees benefit for minor operation.
** For the specified maternity complication that incurs on or after 1 January 2022

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13.2. Tier II – Employee and dependant

Panel Doctor Non-Panel Doctor

Outpatient
100% coverage 80% reimbursement
General Medical Practitioner $20 co-payment/visit. For Video Up to $500/visit
Consultation inclusive of medicines Consultation via the Benefits+ app: $0
co-payment
Checkpoint visits per year 30
Specialist consultation inclusive of $20 co-payment/visit Up to $800/visit
medicine (referral required)*
Consultation inclusive of medicine
Checkpoint visits per year 20
Physiotherapy1 (referral required)* $20 co-payment/visit Up to $500/visit
Referral by Panel Doctor
Checkpoint visits per year 25
Mental Illness & Emotional Disorder $20 co-payment/visit Up to $1,200/visit
Checkpoint visits per year 25
Diagnostic x-ray, Laboratory Tests & Referral by Panel Doctor Up to $3,500/year
Imaging (referral required)*
Medication purchased outside doctor’s Max 2 months’ supply for Up to $3,000/year
clinic (prescription required)* per visit to Panel Doctor
Panel Doctor Non-Panel Doctor
Hospital & Surgical
100% coverage 80% reimbursement
Room, Board & General Nursing Care
Max limit per day Semi Private Ward** $1,700

Max days per disability^ N/A 100

Intensive Care
Max limit per disability^ N/A $33,800
Meal Subsidy
Max limit per day $200 Under room & board benefit limit
(if meal is not included in the
room & board charge)
Hospital Services
Max limit per disability^ N/A $45,000
Physician Services#
(non-surgical case only)
Max limit per day N/A $1,700
Max days per disability^ N/A 100

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 Panel Doctor Non-Panel Doctor
Hospital & Surgical
100% coverage 80% reimbursement
In-Hospital Specialist Fees

Max limit per disability^ N/A $9,200

Surgeon Fees
Max limit per disability
Complex N/A $127,500
Major N/A $51,000
Inter N/A $25,500
Minor@ N/A $15,100
Anaesthetist’s Fee
Max limit per disability
Complex N/A $38,800
Major N/A $15,300
Inter N/A $7,650
Minor N/A $4,460
Operating Theatre Charge
Max limit per disability
Complex N/A $38,800
Major N/A $15,300
Inter N/A $7,650
Minor N/A $4,460
Annual Overall Limit^^ N/A $850,000
Panel Doctor Non-Panel Doctor
Supplementary Major Medical
100% coverage 70% reimbursement
Max limit per disability N/A $250,000

Additional hospitalisation & surgical benefits

Free Choice Doctor, 80% reimbursement
effective 1 October 2020
Max limit
Psychiatric inpatient $50,000 per year
BRCA-related Related Prophylactic
$120,000 per bilateral mastectomy surgery
Mastectomy
Breast Reconstruction that follows BRCA-
$120,000 per bilateral breast reconstruction
related Prophylactic Mastectomy
BRCA-Related Prophylactic Salpingo-
$100,000 per bilateral oophorectomy surgery
oophorectomy
Gender Affirming Surgeries $200,000 per lifetime
Maternity Subsidy Free Choice Doctor, 80% reimbursement
Antenatal / Post-natal check-up
Consultation inclusive of medicines Up to $800/visit
Max number of visits per pregnancy Total 20

Lump sum benefit max limit per pregnancy $50,000

Effective 1 January 2022***: Lump sum
benefit max limit per pregnancy that involves
any of the 6 maternity complications
 Abruptio Placentae
 Amniotic Fluid Embolism
 Choriocarcinoma and Malignant Hydatidiform Mole
 Increta/Percreta
 Postpartum Haemorrhage requiring Hysterectomy

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  Still Birth
Additional lump sum benefit max limit per pregnancy $50,000
Wellness Claims Free Choice Doctor, 100% reimbursement
Max limit Employee/spouse/domestic partner: $6,000 per year per member
Child: $3,000 per year per member

1
Physiotherapy includes Occupational Therapy
* Written referral (except for those waived under “Specialist consultation” of Section 5) / prescription is required from a registered medical
practitioner in western medicine
^ Disability means injury, sickness, disease or illness and shall include all disabilities rising from the same cause including any and all
complications arising therefrom, except that where after 90 days following the latest medical treatment or consultation no further treatment for
that disability is required, any subsequent disability from the same cause shall be considered a separate disability.
# Visit(s) by Registered Medical Practitioner other than Surgeon(s) who perform(s) the operation(s). No payment shall be made for visits or
treatment related to the Disability which required such operation or during convalescence.
^^ For hospital and surgical benefits listed above this row. An annual overall limit means the aggregate sum of benefits during the twelve-month
period measured from the commencement date of each plan year.
** Employees who were at GCB 4 to 6 participating in one of the following medical plans in Hong Kong as at 31 December 2012, the Room and
Board level for hospitalisation admitted through a Panel Doctor using the red medical card will be “Basic Private Ward” instead of “Semi
Private Ward”. This also applies to their eligible dependants.
– Local Staff Medical Benefits Scheme (Scheme A) offered by HBAP and other entities before July 2007
– Local Staff Medical Benefits Scheme (B1-6) offered by HSBC Insurance before July 2010
– HSBC Trustee Staff Medical Benefits Scheme (Executive) offered before April 2005
– HSBC Bank USA Staff Medical Benefits Scheme (Executive) offered before April 2005
– Investment Bank (IBAS) Staff Medical Benefits Scheme (Executive) offered before January 2009
@
New arrangement for warts treatment procedures effective 1 October 2021: each member is entitled to 2 visits per policy year for warts
treatment procedures. Supplementary major medical benefit (SMM) is not applicable. For panel visits, the maximum coverage per visit is
HKD 8,000. For non-panel visits, the maximum reimbursement is HKD 8,000 or 80% of total claim cost, whichever is lower; maximum
reimbursement per disability is also subject to the Surgeon’s Fees benefit limit for minor operation. The expenses for the whole claim shall be
covered under Surgeon’s Fees benefit for minor operation.
*** For the specified maternity complication that incurs on or after 1 January 2022

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13.3. Tier III – Employee (effective 1 October 2021)

Panel Doctor Non-Panel Doctor

Outpatient
100% coverage 80% reimbursement
General Medical Practitioner $20 co-payment/visit. For Video Up to $375/visit
Consultation inclusive of medicines Consultation via the Benefits+ app: $0 co-
payment

Checkpoint visits per year 30

Specialist consultation inclusive of $20 co-payment/visit Up to $600/visit
medicine (referral required)*
Consultation inclusive of medicine
Checkpoint visits per year 20
Physiotherapy1 (referral required)* $20 co-payment/visit Up to $375/visit
Referral by Panel Doctor
Checkpoint visits per year 25
Mental Illness & Emotional Disorder $20 co-payment/visit Up to $1,000/visit
Checkpoint visits per year 25
Diagnostic x-ray, Laboratory Tests & Referral by Panel Doctor Up to $2,750/year
Imaging (referral required)*
Medication purchased outside doctor’s Max 2 months’ supply for Up to $2,200/year
clinic (prescription required)* per visit to Panel Doctor
Panel Doctor Non-Panel Doctor
Hospital & Surgical
100% coverage 80% reimbursement
Room, Board & General Nursing Care

Max limit per day General Ward $910

Max days per disability^ N/A 100
Intensive Care
Max limit per disability^ N/A $18,200
Meal Subsidy

Max limit per day $200 Under room & board benefit limit
(if meal is not included in the
room & board charge)
Hospital Services
Max limit per disability^ N/A $30,000
Physician Services#
(non-surgical case only)
Max limit per day N/A $910
Max days per disability^ N/A 100

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 Panel Doctor Non-Panel Doctor
Hospital & Surgical
100% coverage 80% reimbursement
In-Hospital Specialist Fees

Max limit per disability^ N/A $4,400

Surgeon Fees

Max limit per disability

Complex N/A $75,000

Major N/A $30,000

Inter N/A $15,000

Minor@ N/A $9,000

Anaesthetist’s Fee

Max limit per disability

Complex N/A $22,500

Major N/A $9,000

Inter N/A $4,500

Minor N/A $2,700

Operating Theatre Charge

Max limit per disability

Complex N/A $22,500

Major N/A $9,000

Inter N/A $4,500

Minor N/A $2,700

Annual Overall Limit^^ $480,000

Panel Doctor Non-Panel Doctor
Supplementary Major Medical
100% coverage 70% reimbursement
Max limit per disability N/A $140,000
Additional hospitalisation & surgical benefits
Free Choice Doctor, 80% reimbursement
effective 1 October 2020
Max limit
Psychiatric inpatient $50,000 per year
BRCA-related Related Prophylactic
$120,000 per bilateral mastectomy surgery
Mastectomy
Breast Reconstruction that follows BRCA-
$120,000 per bilateral breast reconstruction
related Prophylactic Mastectomy
BRCA-Related Prophylactic Salpingo-
$100,000 per bilateral oophorectomy surgery
oophorectomy
Gender Affirming Surgeries $200,000 per life time
Maternity Subsidy Free Choice Doctor, 80% reimbursement
Antenatal / Postnatal check-up
Up to $600/visit
Consultation inclusive of medicines
Total 20
Max number of visits per pregnancy
Lump sum benefit max limit per pregnancy $35,000
Effective 1 January 2022**: Lump sum benefit  Abruptio Placentae
max limit per pregnancy that involves any of  Amniotic Fluid Embolism
the 6 maternity complications
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  Choriocarcinoma and Malignant Hydatidiform Mole
 Increta/Percreta
 Postpartum Haemorrhage requiring Hysterectomy
 Still Birth
Additional lump sum benefit max limit per pregnancy $35,000
Wellness Claims Free Choice Doctor, 100% reimbursement
Max limit Employee: $4,000 per year per member

1 Physiotherapy includes Occupational Therapy

* Written referral (except for those waived under “Specialist consultation” of Section 5) /prescription is required from a registered medical
practitioner in western medicine
^ Disability means injury, sickness, disease or illness and shall include all disabilities rising from the same cause including any and all
complications arising therefrom, except that where after 90 days following the latest medical treatment or consultation no further treatment for
that disability is required, any subsequent disability from the same cause shall be considered a separate disability.
# Visit(s) by Registered Medical Practitioner other than Surgeon(s) who perform(s) the operation(s). No payment shall be made for visits or
treatment related to the Disability which required such operation or during convalescence.
^^ For hospital and surgical benefits listed above this row. An annual overall limit means the aggregate sum of benefits during the twelve-month
period measured from the commencement date of each plan year.
@
New arrangement for warts treatment procedures effective 1 October 2021: each member is entitled to 2 visits per policy year for warts
treatment procedures. Supplementary major medical benefit (SMM) is not applicable. For panel visits, the maximum coverage per visit is
HKD 8,000. For non-panel visits, the maximum reimbursement is HKD 8,000 or 80% of total claim cost, whichever is lower; maximum
reimbursement per disability is also subject to the Surgeon’s Fees benefit limit for minor operation. The expenses for the whole claim shall be
covered under Surgeon’s Fees benefit for minor operation.
*** For the specified maternity complication that incurs on or after 1 January 2022

39

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13.4. Tier III – Dependant

Panel Doctor Non-Panel Doctor

Outpatient
100% reimbursement 80% reimbursement
General Medical Practitioner Up to $375/visit. For Video Consultation Up to $375/visit
Consultation inclusive of medicines via the Benefits+ app, expenses are
covered by HealthPlus and no pay-and-
claim from members.
Checkpoint visits per year 30
Specialist consultation inclusive of Up to $600/visit Up to $600/visit
medicine (referral required)*
Consultation inclusive of medicine
Checkpoint visits per year 20
1
Physiotherapy (referral required)* Up to $375/visit Up to $375/visit
Referral by Panel Doctor
Checkpoint visits per year 25
Mental Illness & Emotional Disorder Up to $1,000/visit Up to $1,000/visit
Checkpoint visits per year 25
Diagnostic x-ray, Laboratory Tests & Up to $2,750/year
Imaging (referral required)*
Medication purchased outside Up to $2,200/year
doctor’s clinic (prescription
required)*
Panel Doctor Non-Panel Doctor
Hospital & Surgical
100% reimbursement 80% reimbursement
Room, Board & General Nursing
Care
Max limit per day $910 $910
Max days per disability^ 100
Intensive Care
Max limit per disability^ $18,200
Meal Subsidy

Max limit per day Under room & board benefit limit Under room & board benefit limit
Hospital Services

Max limit per disability^ $30,000

Physician Services#
(non-surgical case only)
Max limit per day $910 $910
Max days per disability^ 100

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 Panel Doctor Non-Panel Doctor
Hospital & Surgical
100% reimbursement 80% reimbursement
In-Hospital Specialist Fees

Max limit per disability^ $4,400

Surgeon Fees

Max limit per disability

Complex $75,000
Major $30,000
Inter $15,000
Minor@ $9,000
Anaesthetist’s Fee

Max limit per disability

Complex $22,500
Major $9,000
Inter $4,500
Minor $2,700
Operating Theatre Charge

Max limit per disability

Complex $22,500
Major $9,000
Inter $4,500
Minor $2,700
Annual Overall Limit^^ $480,000
Panel Doctor Non-Panel Doctor
Supplementary Major Medical
100% reimbursement 70% reimbursement
Max limit per disability $140,000
Additional hospitalisation & surgical benefits
Free Choice Doctor, 80% reimbursement
effective 1 October 2020
Max limit
Psychiatric inpatient $50,000 per year
BRCA-related Related Prophylactic
$120,000 per bilateral mastectomy surgery
Mastectomy
Breast Reconstruction that follows BRCA-
$120,000 per bilateral breast construction
related Prophylactic Mastectomy
BRCA-Related Prophylactic Salpingo-
$100,000 per bilateral oophorectomy surgery
oophorectomy
Gender Affirming Surgeries $200,000 per life time
Maternity Subsidy Free Choice Doctor, 80% reimbursement
Antenatal/ Post-natal check-up
Up to $600/visit
Consultation inclusive of medicines
Total 20
Max number of visits per pregnancy
Lump sum benefit max limit per
pregnancy
$35,000
Effective 1 January 2022**: Lump sum  Abruptio Placentae
benefit max limit per pregnancy that  Amniotic Fluid Embolism
involves any of the 6 maternity  Choriocarcinoma and Malignant Hydatidiform Mole
complications
 Increta/Percreta

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  Postpartum Haemorrhage requiring Hysterectomy
 Still Birth
Additional lump sum benefit max limit per pregnancy $35,000
Wellness Claims Free Choice Doctor, 100% reimbursement
Max limit Spouse/domestic partner: $4,000 per year per member
Child: $2,000 per year per member

1
Physiotherapy includes Occupational Therapy
* Written referral (except for those waived under “Specialist consultation” of Section 5) / prescription is required from a registered medical
practitioner in western medicine
^ Disability means injury, sickness, disease or illness and shall include all disabilities rising from the same cause including any and all
complications arising therefrom, except that where after 90 days following the latest medical treatment or consultation no further treatment for
that disability is required, any subsequent disability from the same cause shall be considered a separate disability.
# Visit(s) by Registered Medical Practitioner other than Surgeon(s) who perform(s) the operation(s). No payment shall be made for visits or
treatment related to the Disability which required such operation or during convalescence.
^^ For hospital and surgical benefits listed above this row. An annual overall limit means the aggregate sum of benefits during the twelve-month
period measured from the commencement date of each plan year.
@
New arrangement for warts treatment procedures effective 1 October 2021: each member is entitled to 2 visits per policy year for warts
treatment procedures. Supplementary major medical benefit (SMM) is not applicable. For panel visits, the maximum coverage per visit is
HKD 8,000. For non-panel visits, the maximum reimbursement is HKD 8,000 or 80% of total claim cost, whichever is lower; maximum
reimbursement per disability is also subject to the Surgeon’s Fees benefit limit for minor operation. The expenses for the whole claim shall be
covered under Surgeon’s Fees benefit for minor operation.
** For the specified maternity complication that incurs on or after 1 January 2022

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14. Appendix 2 – Classification Schedule of Surgical Operations
The Classification Schedule of Surgical Operations is for reference only, and will be subject to change from time to time without
prior notice.
Description of Surgical Operations Category
APPENDIX OPERATIONS
Appendectomy (open/laparoscopic) Intermediate
BILIARY TRACT OPERATIONS
Cholecystectomy, total/partial (open/laparoscopic) Major
Lobectomy of liver/Hemihepatectomy Complex
Liver transplant Complex
BREAST OPERATIONS
Excision or destruction of breast tissue/nipple Intermediate
Mastectomy except simple and subtotal Major
Unilateral simple mastectomy Intermediate
Breast reconstruction4 Major
CARDIAC OPERATIONS
Coronary artery bypass graft Complex
Percutaneous transluminal coronary angioplasty and related procedures Major
EAR OPERATIONS
Fenestration of inner ear Major
Labyrinthectomy Major
Mastoidectomy, any kind Major
Myringoplasty Intermediate
Myringotomy with/without insertion of tube Minor
Tympanoplasty, any type Major
EYE OPERATIONS
Excision/removal of lesion of eyelid Minor
Excision of lacrimal gland Major
Operation on pterygium Intermediate
Extraction of lens Major
Evisceration of eyeball/ocular contents Major
Iridotomy Intermediate
Iridectomy Intermediate
Retinal detachment laser or similar operations Intermediate
GASTROINTESTINAL TRACT OPERATIONS
Colonoscopy with/without biopsy Minor
Destruction of hemorrhoids by cryotherapy/cauterisation/excision Intermediate
Closed biopsy of pancreas/Closed (endoscopic) biopsy of pancreatic duct Intermediate
Sigmoidoscopy with/without biopsy Minor
Open biopsy of pancreas Major
Repair of inguinal hernia Intermediate
Splenectomy Major
Oesophagectomy and colonic replacement Complex
GYNAECOLOGICAL OPERATIONS
Bilateral Oophorectomy Intermediate
Destruction of lesion of cervix by cryosurgery/cauterisation/laser/excision Minor
Loop diathermy excision of lesion of cervix Minor
Conisation of cervix Minor
Dilation and curettage of uterus Minor
Marsupialisation of Bartholin’s gland Minor
Total abdominal hysterectomy with/without salpingo-oophorectomy Major
Uterine myomectomy, vaginal approach Intermediate
Salpingectomy, total/partial, unilateral/bilateral (open/laparoscopic) Major

4
Added effective 1 October 2020
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 Description of Surgical Operations Category
HEAD AND NECK OPERATIONS
Cervical lymphadenectomy Intermediate
Sistrunk’s operation Intermediate
Parathyroidectomy Major
Thyroidectomy Major
MALE GENITAL TRACT OPERATIONS
Circumcision Minor
Epididymectomy Intermediate
Excision of Hydrocele (of tunica vaginalis) Intermediate
Orchidectomy (open/laparoscopic/inguinal), removal of remaining testis Major
Transurethral prostatectomy or related procedures Major
NEUROSURGERY OPERATIONS
Craniectomy Complex
Cranioplasty Major
Craniotomy Complex
Burr hole for drainage of chronic subdural hematoma Major
Hemispherectomy Complex
NOSE OPERATIONS
Functional endoscopic sinus surgery Major
Tonsillectomy with/without adenoidectomy Intermediate
Submucous resection of nasal septum with/without Septoplasty Intermediate
ORTHOPAEDIC OPERATIONS
Arthroscopy of elbow/knee Intermediate
Arthoroscopicmenisectomy Major
Repair of the cruciate ligaments Major
Closed reduction of fracture of upper arm/lower arm/wrist/hand/leg/foot without internal fixation Intermediate
Joint aspiration/injection Minor
Removal of implants from arm/forearm/wrist/hand/patella/leg/ankle/foot (superficial or deep) Minor
Release of tendon sheath by incision Minor
Release of carpal/tarsal tunnel Intermediate
Laminectomy Major
Spinal fusion, atlas-axis/craniocervical Complex
SKIN OPERATIONS
Aspiration/Incision with drainage skin and subcutaneous tissue Minor
Local excision or destruction of lesion of tissue of skin and subcutaneous tissue Minor
RESPIRATORYOPERATIONS
Fiber-optic bronchoscopy Minor
Lobectomy of lung Complex
Lung Transplant Complex
Resection/Excision/Incision of lung Major
Thoracentesis/Chest tapping Minor
RENAL OPERATIONS
Cystoscopy with/without biopsy Minor
Cystoscopy andelectro-cauterisation Intermediate
Partial cystectomy (open/laparoscopic) Major
Extracorporeal shock wave lithotripsy (ESWL) Intermediate
Nephrolithotomy Major
Nephrectomy (open/laparoscopic/retroperitoneoscopic) Major

Note:If the operation performed is not shown in the Classification Schedule of Surgical Operations, HSBC Life reserves the right
to determine the Classification for such operations. HSBC Life will take reference from the Relative Value Unit (RVU) which is
published by the Relative Value Unit Inc. (RVUI) and by making reference from the classification of surgical operations contained
in Hong Kong Government Gazette to determine the classification of such operation.

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15. Appendix 3 – Overview of Supporting Documents
Supporting Document
1 Outpatient services - official Out-patient services
receipt (including General
Practitioners (GP),
Specialists (SP),
Physiotherapists,
Occupational Therapists, X-
ray / Lab test / Imaging)
2 Referral letter from doctors
in western medicine
(valid for 90 days from date
of issue)
3 Prescription from doctors in
western medicine
 original will be kept by
the pharmacy, please
make a copy for
making a claim
 valid for 2 weeks for
one purchase from date
of issue
4 Official receipt for
medication from pharmacy
5 Official receipt from
Chinese medicine
practitioner
Services / Claims Information Required on the Document
 Patient’s full name
 Diagnosis
 Itemised cost breakdown with currency (e.g.
consultation, treatment, medication, services,
lab test, x-ray, imaging, minor operation)
 Incurred date
 Specialty of the doctor (if applicable)
 Official signature and stamp of the
practitioner
 Special  Patient’s full name
consultation  Diagnosis
 Physiotherapist  Treatment / consultation / test being referred
treatment  Issue date
 X-ray / lab test /  Official signature and stamp of the
Imaging practitioner
Prescription  Patient’s full name
purchased outside  Diagnosis
doctor’s clinic  Name of medication
 Quantity of medication
 Issue date
 Official signature and stamp of the
practitioner
Prescription  Patient’s full name
purchased outside  Name of medication
doctor’s clinic  Quantity of medication
 Cost with currency (if more than one
medication, please show the breakdown of
each)
 Purchase date
 Official signature and stamp of the
practitioner
Wellness Claims  Patient’s full name
 Diagnosis
 Itemised cost breakdown with currency (e.g.
consultation, treatment, medication, services,
etc.)
 Incurred date
 Name and quantity of medication
 Official signature and stamp of the Chinese
medicine practitioner
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 Supporting Document
6 Official receipt from other
registered/qualified
practitioners (i.e. dentist,
dietician, nutritionist,
chiropractor, optician,
optometrist,
ophthalmologist, podiatrist,
speech therapist,
osteopath, audiologist,
psychologist)
7 Official receipt in relation to
maternity expenses by
Gynaecologist /
Obstetricians, and
registered midwives
8 Official receipt in relation to
maternity expenses for
hospital confinement
by Gynaecologist /
Obstetricians and
registered midwives
 all package fees must
show a breakdown of
charges and be
supported by an
attending slip /
certificate for each
incurred visit or service
9 Clinical documents about
BRCA-related surgeries
Services / Claims Information Required on the Document
Wellness Claims  Patient’s full name
 Incurred date
 Diagnosis / treatment / service details
 Cost with currency
 Official signature and stamp of the
practitioner

Maternity Subsidy  Patient’s full name
antenatal & post-natal  Incurred date
check-ups  Diagnosis / treatment / service details
 Official signature and stamp of the
practitioner

Maternity Subsidy  Patient’s full name
lump sum benefits  Incurred date
 Diagnosis / treatment / service details
 Actual / expected date and nature of
confinement
 Cost with currency
 Official signature and stamp of the
practitioner
BRCA-related  Medical certificate from attending doctor
mastectomy and indicating pathogenic or likely pathogenic
breast reconstruction BRCA1 or BRCA2 mutation for breast and/or
that follows; BRCA- ovarian cancer supporting the risk reducing
related Salpingo surgery;
Oophorectomy
 Laboratory report showing genetic
susceptibility of BRCA1 and BRCA2 to
malignant neoplasm of breasts and/or
ovaries;
 Medical certificate after second opinion
obtained from geneticist or physician with
expertise in understanding and interpreting
genetic test results supporting the risk
reducing surgery;
 Second confirmation of laboratory report
showing genetic susceptibility of BRCA1 and
BRCA2 confirmed by molecular susceptibility
testing and related imaging report;
 Medical certificate proofing genetic
counselling has been completed to address
psychosocial, social, and quality of life
aspects of undergoing risk reducing surgery.
Also, options for intense/early surveillance
have been discussed;
 The most recent evaluation including a
summary of medical history and last physical
examination
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 Supporting Document
10 Clinical documents about
gender affirming surgeries
11 Hospital statement of
account
12 Official receipt from hospital
Services / Claims Information Required on the Document
Gender affirming  Please contact the Plan Administrator on
surgeries 3070 5005 or email
medicalservice@axa.com.hk for detailed
advice.
Hospitalisation &  Patient’s full name
Surgical, or Maternity  Admission date
Subsidy for Labour /  Discharge date
Delivery / Miscarriage  Itemised cost breakdown with currency (e.g.
/ Legal Abortion) room & board, anaesthetist’s fee, etc.)
 Official signature / stamp
Actual date and nature of confinement (if
Maternity Subsidy for Labour / Delivery /
Miscarriage / Legal Abortion)
Hospitalisation &  Patient’s full name
Surgical, and  Payment date
Maternity Subsidy for  Official signature and stamp of the
Labour / Delivery / practitioner
Miscarriage / Legal
Abortion
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16. Appendix 4 – Websites of Medical Practitioners in Hong Kong
For the list of registered or qualified health practitioners in Hong Kong, please refer to the corresponding websites
below.

Health Practitioner Relevant Association Website

Registered Doctors in The Medical Council of Hong Kong www.mchk.org.hk
Western Medicine
(General Practitioner
and Specialist,
including
Psychiatrists)

Registered Physiotherapists Board https://www.smp-

Physiotherapist council.org.hk/pt/en/intro.php

Registered Occupational Therapists Board https://www.smp-

occupational therapist council.org.hk/ot/en/intro.php

Registered Dentist The Dental Council of Hong Kong https://www.dchk.org.hk/en/index.htm

Chinese Medicine Chinese Medicine Council of Hong Kong www.cmchk.org.hk

Practitioner

Registered Optometrists Board https://www.smp-

Optometrist council.org.hk/op/en/intro.php

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