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  Medical protection is a key component of staff benefits. Comprehensive medical protection can help retain high calibre staff, maintain manpower stability and enhance productivity. Blue Cross fully understands the needs of small and medium enterprises and thus tailored the Employees Medical Contract, providing their employees with a cost-effective and flexible medical plan. At a modest premium, employers can offer their staff an all-round medical coverage, allowing employees to focus on their work worry-free, thereby fostering the further development of the enterprises.  
       
  Plan Highlights    
  Plan Coverage    
  Plan Summary    
  Major Exclusions    
       
Plan Highlights
 
     
  Comprehensive and Flexible Benefits
 
  Flexible combinations of inpatient and outpatient benefits for different grades of employees  
  Optional Supplementary Medical Benefits  
  Optional Outpatient Benefits offer two reimbursement options - 80% or 100% of eligible expenses  
     
  Extensive Medical Network
 
  Healthcare Card offers extra convenience at over 1,500 network clinics in Hong Kong and Macau  
  Apart from General Practitioner’s and Specialist’s consultations, Optional Outpatient Benefits are extended to offer credit facilities for Chinese Medicine Practitioner Treatment and Physiotherapy  
  Consultations in network clinics are only subject to a co-payment of HK$30 for the 80% reimbursement option; no co-payment is required for the 100% reimbursement option  
     
  24-hour Worldwide Emergency Aid  
  If the insured needs assistance in an emergency condition while travelling overseas, just call our 24-hour Worldwide Emergency Aid Hotline at any time, our dedicated officers will provide the insured with appropriate assistance such as hospital admission deposit guarantee service, medical repatriation, travel information, and medical or legal referral service. The insured can be sure help is just a call away in case of emergency.  
     
  Emergency Medical Assistance in China  
  In case of emergency requiring hospitalisation in China, simply present the “Medpass Card” and the insured will be able to access a network of over 200 hospitals or medical units without paying any deposits.  
     
  Top-up Overseas Accidental Medical Expenses Benefits  
  In the event of accidental injury requiring hospitalisation overseas, the maximum limits of the Basic Hospital and Surgical Benefits will be increased by 100%.  
     
  User-friendly “Blue Cross Medical Network” iPhone App  
  The insured can now find the network medical service providers with iPhone App according to their individual needs anytime and anywhere. Key functions include:  
  Find network doctors/clinics or other medical service providers by location, type of doctor or simply by doctor’s name  
  GPS function to find nearby network doctors/clinics, display doctor list with details such as address, telephone number, consultation hours and so on  
  Map function to find the exact location of doctors/clinics  
  Latest insurance news and promotion offers  
     
  Smart MedClaim Hotline  
  Prior to hospital stay, the insured can get to know whether the medical expenses can be fully covered. Simply call our Hotline on 3608 2988 (press 2153) for a Pre-hospitalisation Claim Assessment, our dedicated officer will help the insured estimate the eligible claim amounts# based on the policy coverage, enabling the insured to plan their budget ahead and undergo treatment with peace of mind.  
     
  Easy-to-use Online Services
 
  Member-exclusive “Super Care” website – a one-stop online platform for reviewing the information of policy, claims and doctor list  
  e-claim notice – offers claims-related information for the convenience of the insured  
     
  Exclusive Top–up Option/Conversion Option to Maintain or Enhance Protection  
  Without underwriting, members under Employees Medical Contract can enrol in a selected individual medical insurance plan offered by Blue Cross (“Caring Medical Protection Plus”*) as a “top-up” cover to their company’s medical protection. At a modest premium, members can enhance their medical protection by “leveraging” their group cover. Even if members retire or move to a new job, they will be eligible to join Caring Medical Protection Plus, enjoying the same level of medical cover as before. Features of Caring Medical Protection Plus include:  
  No underwriting is required  
  Guaranteed acceptance of all disabilities covered by group medical plan  
  Guaranteed renewal  
     
 
# Customer must complete and submit the Pre-hospitalisation Claim Assessment Form. Assessment of the estimated eligible claim amounts is for customers’ reference only, the actual eligible claim amounts will be subject to the final claim decision. All benefits will be payable subject to the terms and conditions and the full list of policy exclusions.
* For details of Caring Medical Protection Plus, please refer to the respective product leaflet and policy.
 
     
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Plan Coverage
 
     
  Basic Hospital and Surgical Benefits  
     
  The benefits cover 100% of eligible expenses up to the following maximum limit per disability:  
 
Benefit Items Maximum Limit Per Disability (HK$)
Plan Level HS1 HS2 HS3 HS4 HS5
Entitled Level of Accommodation Private Semi-private Ward Ward Ward

Room and Board
- Max. 90 days, limit per day

2,500 1,500 900 600 450

Miscellaneous Hospital Charges

30,000 20,000 12,000 10,000 5,000
Surgeon’s Fees
‧ Complex
‧ Major
‧ Intermediate
‧ Minor

112,000
56,000
28,000
11,200

88,000
44,000
22,000
8,800

64,000
32,000
16,000
6,400

52,000
26,000
13,000
5,200

40,000
20,000
10,000
4,000
Anaesthetist’s Fees
‧ Complex
‧ Major
‧ Intermediate
‧ Minor
 
33,600
16,800
8,400
3,360
 
26,400
13,200
6,600
2,640
 
19,200
9,600
4,800
1,920
 
15,600
7,800
3,900
1,560
 
12,000
6,000
3,000
1,200
Operating Theatre Charges
‧ Complex
‧ Major
‧ Intermediate
‧ Minor
 
33,600
16,800
8,400
3,360
 
26,400
13,200
6,600
2,640
 
19,200
9,600
4,800
1,920
 
15,600
7,800
3,900
1,560
 
12,000
6,000
3,000
1,200

Physician’s Hospital Visits
- Max. 90 days, limit per day

2,500 1,500 900 600 450

Specialist’s Fees
- Referral letter is required

10,000 7,500 5,000 3,000 1,000

Charges for Intensive Care
- Max. 30 days, limit per day

5,000 5,000 3,000 3,000 2,000
Top-up Overseas Accidental Medical Expenses Benefits (exclude China, Hong Kong and Macau) Increase by 100% of the above Basic Hospital and Surgical Benefits

Daily Hospital Cash Allowance#
- Max. 90 days, limit per day

1,250 750 450 300 225

Outpatient Surgery Cash Allowance*
- Per surgical procedure

2,500 1,500 900 600 450
24-hour Worldwide Emergency Aid Unlimited
Emergency Medical Assistance in China Extended Benefit
 
 
# Daily Hospital Cash Allowance applies to general ward of public hospital in Hong Kong only.
* Only applicable to the following day-case surgical procedures: gastroscopy (including esophagogastroduodenoscopy), colonoscopy, cystoscopy, arthroscopy, colposcopy and bronchoscopy.
 
     
  Optional Supplementary Medical Benefits  
     
  The benefits cover 80% of eligible expenses in excess of Basic Hospital and Surgical Benefits under the entitled level of accommodation, up to the following maximum limit per disability:  
 
Benefit Items Maximum Limit Per Disability (HK$)
Plan Level MM1 MM2 MM3 MM4 MM5
Entitled Level of Accommodation Private Semi-private Ward Ward Ward

Reimbursement Percentage

80%

Overall Maximum Limit Per Disability

150,000 100,000 60,000 55,000 50,000
 
 
Remarks:
- Optional Supplementary Medical Benefits cover Room and Board, Miscellaneous Hospital Charges, Surgeon’s Fees, Anaesthetist’s Fees, Operating Theatre Charges, Physician’s Hospital Visits, Specialist’s Fees and Charges for Intensive Care.
- Optional Supplementary Medical Benefits must be enrolled together with the Basic Hospital and Surgical Benefits of the same level of accommodation.
 
     
  If the insured is confined to a level of hospital facilities and services higher than the entitled level, the eligible expenses will be calculated based on below scale of reimbursement:  
 
Entitled Level of Accommodation Actual Level of Accommodation Reimbursement Percentage of All Eligible Claims*
Ward Semi-private 50%
Ward Private 25%
Ward Deluxe 12.5%
Semi-private Private 50%
Semi-private Deluxe 25%
Private Deluxe 50%
 
 
* Applicable to Optional Supplementary Medical Benefits only.
 
     
  Optional Outpatient Benefits  
     
  Outpatient benefits offer two reimbursement options – 80% or 100% of eligible outpatient expenses. The insured may visit any clinic of their own choice and subject to the maximum reimbursement limits in the table below.  
     
  The insured is entitled to use Blue Cross Healthcare Card in any network clinic for general practitioner’s consultations, Chinese medicine practitioner treatments, specialist’s consultations or physiotherapy. Consultations in network clinics are subject to a co-payment of HK$30 for the 80% reimbursement option and no co-payment is required for the 100% reimbursement option.  
 
Benefit Items (HK$)
  Plan Level
80% Reimbursement Option OP1C OP2C OP3C OP4C OP5C
100% Reimbursement Option OP1N OP2N OP3N OP4N -

General Practitioner’s Consultation*
- 1 visit per day, limit per visit

300 240 180 140 120

Network Doctor Co-payment (80% Reimbursement Option)

30 30 30 30 30

Network Doctor Co-payment (100% Reimbursement Option)

0 0 0 0 N/A

Chinese Medicine Practitioner Treatment*
(General practice, bone-setting and acupuncture)
- 10 visits per year, 1 visit per day, limit per visit

250 200 150 120 100

Network Doctor Co-payment for general practice (80% Reimbursement Option)

30 30 30 30 30

Network Doctor Co-payment for general practice (100% Reimbursement Option)

0 0 0 0 N/A
*Max. 30 visits per year for General Practitioner’s Consultation and Chinese Medicine Practitioner Treatment

Specialist’s Consultation
Referral letter is required^
- 10 visits per year , 1 visit per day, limit per visit

600 480 360 280 240

Network Doctor Co-payment (80% Reimbursement Option)

30 30 30 30 30

Network Doctor Co-payment (100% Reimbursement Option)

0 0 0 0 N/A

Diagnostic X-rays and Laboratory Tests
Referral letter is required
- Limit per year

2,000 1,500 1,000 800 500

Physiotherapy and Chiropractic Services
Referral letter is required for Physiotherapy
- 10 visits per year, 1 visit per day, limit per visit

300 240 180 140 120

Network Doctor Co-payment for Physiotherapy (80% Reimbursement Option)

30 30 30 30 30

Network Doctor Co-payment for Physiotherapy (100% Reimbursement Option)

0 0 0 0 N/A

Prescribed Medicines and Drugs
Procured from outside pharmacy, prescription letter is required
- Limit per year

2,500 2,000 1,500 1,000 500
 
 
^ Except Gynaecology, Orthopaedics & Traumatology, Dermatology, Ophthalmology, Oncology, Urology, Nephrology and Paediatrics.
Remark:
- Optional Outpatient Benefits must be enrolled together with Basic Hospital and Surgical Benefits.
 
     
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Plan Summary
 
       
 
Enrolment Age Aged from 15 days to 65
Protection Period Up to age 76
Policy Renewal Annual renewal up to age 75
Policy Currency HK$
Cover Area Worldwide
Plan Level 5
Premium Payment Mode Annual
Premium Discount 10% first year’s premium discount
 
     
 
Application Checklist
 
       
 
Application Form
Enrolment Form
Business Registration Certificate
Minimum Number of Employees 3 employees or above
Personal Health Record Form (if applicable) Submission of Personal Health Record Form is required if number of insured employees is less than 10
Application of Healthcare Card - Outpatient Complete Application Form and tick “Yes” for Healthcare Card - Outpatient
 
     
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Major Exclusions
 
       
 
1.
Treatment or test which is not Medically Necessary; or purchase of drugs which are not prescribed by a Registered Medical Practitioner.
2.
Confinement solely for the purpose of general checkup, diagnostic X-ray, advanced imaging, laboratory test, or physiotherapy.
3.
Treatment related to Congenital Conditions (except Hernias, Strabismus and Phimosis) or Developmental Conditions or disease of similar kind.
4.
Pre-existing Conditions.
5.
Expenses directly or indirectly arising from Human Immunodeficiency Virus (“HIV”) and its related Disability, including Acquired Immune Deficiency Syndrome (AIDS) and/or any mutation, derivation or variations thereof, consequential upon an HIV infection occurring before the Insured Effective Date.
6.
Treatment or Disability directly or indirectly arising from or consequent upon: the abuse of drugs or alcohol, self-inflicted injuries or attempted suicide, illegal activity, or driving or maneuvering machines whilst exceeding the prescribed alcohol and drug limit, or venereal and sexually transmitted disease or its sequelae.
7.
Any charges in respect of services for beautification or cosmetic purposes; not medically related conditions and expenses including hearing tests, routine blood tests, general check-ups, vaccinations or inoculations, etc.
8.
Dental treatment and oral surgery except for emergency treatment and surgery arising from an Accident received by the Insured during Confinement. Follow up dental treatment or oral surgery after Inpatient stay will not be covered.
9.
Investigations, treatments, surgical procedure and counseling services relating to maternity conditions and its complications, including diagnostic tests for pregnancy or resulting childbirth, abortion or miscarriage; birth control or reversal of birth control; sterilisation of either sex; infertility, etc.
10.
Treatment directly or indirectly arising from any psychotic, psychological, or psychiatric conditions and any physiological or psychosomatic manifestations thereof.
11.
Treatment or Disability directly or indirectly arising from war (declared or undeclared), civil war, invasion, acts of foreign enemies, hostilities, rebellion, revolution, insurrection or military or usurped power; resulting from taking part in military, air force, naval and other disciplinary services.
 
   
   
       
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  For more information and related documents, please download here.   Talk to us directly:
  Product Leaflet Application Forms     3608 2988 or email us
 
  Notes:  
 
1. The above information is for reference only. Please refer to policy for the exact terms and conditions and the full list of policy exclusions. For more information or a copy of the policy terms and conditions, please contact our Customer Service Department on 3608 2988/ by email cs@bluecross.com.hk for enquiry.
2. Should there be any discrepancy between the English and the Chinese versions of the above information, the English version shall apply and prevail.
 
     
  The above product(s) is/are offered for sale in Hong Kong only and is/are underwritten by Blue Cross (Asia-Pacific) Insurance Limited, an authorised insurer in Hong Kong.