In response to the Guideline on Cooling-off Period (GL29) issued by the Insurance Authority, the relevant Terms and Conditions of our Certified Plans under the Voluntary Health Insurance Scheme (“VHIS”) have been amended accordingly, which have been re-certified by the Food and Health Bureau effective from 1 Apr 2021. The Certification Numbers of “TopCare” Medical Insurance Plan have been updated to: F00037-01-000-02 / F00037-02-000-02 / F00037-03-000-02 / F00037-04-000-02 / F00037-05-000-02 / F00037-06-000-02 / F00037-07-000-02 / F00037-08-000-02
UP TO AGED 128Issue age
15 days to age 80You can buy this from
YOUR FINANCIAL CONSULTANT
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“TopCare” offers 4 benefit levels with ward class choices of ward, semi-private room and standard private room. There is no lifetime benefit limit and deductible1 for all benefit levels, you can choose the most suitable benefit level according to your needs. The plan also provides basic plan and rider to meet your needs flexibly.
Individuals aged between 15 days and age 80 are eligible to apply for this plan. Moreover, regardless of your health conditions in the future, renewal is guaranteed up to age 128. Renewal premium will not increase with age after age 70, which makes the premium more affordable after retirement.
- Covering Prescribed Diagnostic Imaging Tests2
- Coverage for Surgical Cancer Treatments
- Coverage for Prescribed Non-Surgical Cancer Treatments
- Major cancer top up benefit3 provides a double up non- surgical cancer treatments benefit every 6 years
“TopCare” covers cancer treatment expenses from diagnosis to treatment and accompanies you on the road to recovery all the way.
Coverage for expenses of outpatient or inpatient Prescribed Diagnostic Imaging Tests to alleviate the financial burden arising from medical treatments.
In addition to coverage for surgical cancer treatments, the plan will reimburse the attending doctor's visit fee, specialist's fee, intensive care fee, etc.
The plan covers non-surgical cancer treatments. Getting appropriate treatments will lead to better chances of recovery. To give you a peace of mind, the maximum reimbursement is calculated per policy year.
We understand some cancers take longer time for treatment. To provide patients with timely proper treatment timely, the plan provides major cancer top up benefit once per benefit period (i.e. every 6-consecutive policy years), therefore benefit limit will be raised up to HKD 320,000 for non-surgical cancer treatments.
Unlike conventional medical plans in the market, “TopCare” offers an annual premium discount of 16% immediately following successful new application until the first claim is made. Medical services performed during day case procedure, special cash allowances or emergency outpatient treatment (accident) will not affect the no-claim discount.
If there is a claim, you can still enjoy 8% premium discount in the next policy year and 0% afterwards. If no claim is made for 3 consecutive policy years (No-Claim Period), the rate of no-claim discount will revert to 16% to encourage you to stay healthy.
- Major Medical Benefit
- Severe Urban Chronic Disease Additional Benefit
- Loss of Income Medical Booster
The plan covers you against medical expenses which exceed the limit of basic and additional benefit. Major medical benefit will reimburse up to 100% of the remaining medical expenses, giving you total peace of mind.
Benefit limits up to HKD 280,000 per year with 85% reimbursement rate (15% coinsurance).
Reimbursement will increase to 100% for diagnosis of heart attack / stroke / diabetes complications requiring surgery / medical conditions requiring major organ or bone marrow transplant.
If the insured person loses income or medical benefit during unemployment or between jobs, the reimbursement percentage of major medical benefit will increase from 85% to 100%4. If the insured person unfortunately become total and permanent disabled, the reimbursement percentage will also be increased to 100%4.
If you5 or your family members6 enroll in the plan, the eligible premiums7 paid for the plan will be allowed for tax deduction each year. Taxpayer can enjoy tax deductible limit up to HKD 8,000 per insured person per year, and there is no cap on the number of family members6 that are eligible for tax deduction. Therefore, you can prepare the suitable medical protection for your loved ones and also enjoy a more affordable premium through tax deduction.
“TopCare” covers unknown pre-existing conditions of which you were not aware and would not reasonably have been aware at the time of application. This plan provides full reimbursement according to the benefit limits from the 31st day after the policy effective date. The plan is superior to VHIS standard plans and provides you with better peace of mind.
The coverage also extends to congenital conditions which have manifested or been diagnosed after the insured person has attained age 8 or after. For details of pre-existing conditions, please refer to “Important Note” ‒ “Pre-existing Conditions” section.
The enhanced medical protection of “TopCare” fully covers expenses of inpatient and day case procedure incurred for treatment, and for outpatient2 care before confinement or day case procedure. Taking care for long term diseases and ad-hoc treatment during pregnancy, the plan specially provides comprehensive protection for kidney dialysis2,8, psychiatric treatment9, Chinese medical protection during inpatient and outpatient and pregnancy complications2.
We understand you will lose income during injury, therefore, the plan offers multiple cash allowances including hospital cash allowance, day case procedure cash allowance, hospitalization transportation cash allowance and even health tonic cash after organ donation, we stay with you all the time.
In the unfortunate event of the insured person’s death, compassionate death benefit of up to HKD 50,000 will be paid to the beneficiary. To encourage organ donation to help those patients in need, if the insured person lawfully donate an organ in compliance with the criteria for deceased organ donation set out by the Department of Health after death, the beneficiary will receive additional death benefit for organ donor of up to HKD 400,00010,11. If the insured person unfortunately die (payable to beneficiary) or become permanently disabled (payable to policyholder), medical negligence benefit allowance12 up to HKD 400,000 will be paid.
- Pioneer Medical Support Service13
- Free Worldwide Emergency Assistance Services13
We offer various value-added services for our customers with VHIS policies, whether you are in Hong Kong or overseas, we always care about your needs.
Provides cancer consultation, cashless arrangement, rehabilitation, nursing service and specialist referral service14. Even a sudden illness comes, you can get more than one professional consultations and get referred to the appropriate specialist for treatment and follow-up.
You will have access to free 24-hour worldwide emergency assistance for immediate support wherever you may be. The maximum benefit (per incident) reaches up to USD 1,000,000, including services of emergency evacuation or repatriation and delivery of mortal remains.
- There is no deductible for this plan, but designated benefit items are subject to coinsurance, including the 20% coinsurance (performed during day patient) or 30% coinsurance (performed during confinement) which must be borne by the policy holder for prescribed diagnostic imaging tests and 15% coinsurance which must be bore by the policy holder for major medical benefit.
- The Company shall have the right to ask for proof of recommendation e.g. written referral or testifying statement on the claim form by the attending doctor or registered medical practitioner.
- Major cancers do not include carcinoma-in-situ. For details of major cancer top up benefit, please refer to policy terms and benefits.
- If the insured fulfills any of the below condition and policy already in force for at least one Policy Year; reimbursement percentage of the eligible expenses of major medical benefit will be increased to 100%:
- (a) Involuntary unemployment; or
- (b) One permanent job changes to another permanent job;
- Total and permanent disablement (applicable for insured age 18 - 65 only)
(Applicable to (a) or (b): once per 5 Policy Year and maximum protection for 6 months per claim)
- Tax deduction is applicable to you and your spouse (not being a spouse living apart) as a policy holder to pay the VHIS premium for yourself / eligible family members (must be a Hong Kong resident in the year of assessment).
- Eligible family members refer to your spouse and child; or your and your spouse’s parent, grandparent, brother or sister. The eligibility of the eligible family members is subject to the prevailing administrative rules of the Company.
- Eligible premiums paid for the plan will be allowed for tax deduction each year. The ceiling for annual deduction per insured person is HKD8,000.
- When the payment of this benefit has reached the benefit limit as stated in the benefit schedule, the eligible expenses charged for service, dressing, consumable, medicine and equipment used in dialysis treatment performed on the insured person during confinement shall be payable under miscellaneous charges. Regard the eligible expenses for the room and board and attending doctor’s visit fee incurred for haemodialysis or peritoneal dialysis shall be benefit under relevant protection item and shall not be reimburse under this kidney dialysis benefit.
- This benefit shall only be payable for the eligible expenses charged on the medical services related to psychiatric treatments during confinement in Hong Kong. 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 other benefit items of the plan benefit schedule (if applicable).
- This benefit is payable in addition to “compassionate death benefit”.
- This benefit is payable for once when a major organ of the insured person is donated after death. “Major organ” is limited to kidney, liver, heart, lung, cornea, bone and skin of the insured person and/or the organs allowed for deceased organ donation published by the Department of Health of the Government.
- This benefit is payable if the insured person dies or suffers from total and permanent disablement within 30 days resulting directly from a consequence of any erroneous or negligent action by a health care professional of a hospital during the course of any medical procedure or treatment in a Hospital which a public admission of such negligence and liability is made and verified by the relevant parties.
- Pioneer Medical Support Service and Worldwide Emergency Assistance Services are provided by the third party service providers. We reserve the right to change the terms and conditions of Pioneer Medical Support Service and Worldwide Emergency Assistance Service and will not be liable for any services provided by the third party service providers.This is a service with no additional premium.
- For details of “Pioneer Medical Support Service”, please refer to the “Pioneer Medical Support Service” flyer.
- The above product information does not contain the full terms of the plan and the full terms can be found in the policy document.
- This plan may be purchased as a standalone plan without bundling with other type(s) of insurance product.
*Government's VHIS Flexi Plan Certification Number: F00037-01-000-02 / F00037-02-000-02 / F00037-03-000-02 / F00037-04-000-02 / F00037-05-000-02 / F00037-06-000-02 / F00037-07-000-02 / F00037-08-000-02
The above product summary is for reference only. For more details on the product, please refer to the policy terms and benefits.
If you are interested in this product, please contact your insurance consultant.