MasterCare Medical Plan
Health is invaluable. We understand you would have the best health protection for yourself and your family. Therefore, we present MasterCare Medical Plan (“the Plan”) to our most prestigious customers like you, providing you comprehensive and quality health protection plan with true peace of mind.
The Plan not only covers the medical expenses for Hospital stays in a Standard Private Room1 and surgery, but also covers medical expenses before and after Confinement, including cancer treatment, stroke rehabilitation benefit, rehabilitation, traditional Chinese medicine. The Plan has no lifetime limit2, while most benefit items such as room and board and surgical fees are fully covered.
What’s more, you have the choice of 3 plans covering different regions, namely Worldwide, Worldwide (exclude USA)3 and Asia4, which you can select according to your budget and protection needs.
?Options of Various Geographical Coverage and Deductibles
The Plan comes with 3 options for you to choose providing different geographic coverage :
|Entitles you to worldwide medical care, including leading Hospitals in the USA|
|Worldwide (exclude USA)3|
|You can select this option if you always travel between Europe and Asia|
|Entitles you to medical care in Asia at an afforable premium|
The Plan also provides 5 levels of Deductibles, namely the amount you pay towards covered expenses for each policy year before we will start paying, for you to choose the most suitable one financially. Choices of Deductibles include:
If you have a medical plan, you can top up your cover with the Plan to enhance your protection by choosing a higher Deductible in order to lower the premium. Alternatively, you may opt for a lower or even zero Deductible to enjoy a higher benefit amount.
?Guaranteed Renewal without a Lifetime Limit
Upon successful enrolment, regardless of your subsequent health conditions and claims history, renewal is guaranteed. Also, the Plan has no lifetime limit2, so you do not have to worry about medical expenses.
?Full Coverage for Most Benefit Items of Hospitalization and Surgical Expenses
The Plan provides you with full coverage for room and board charges during hospitalization, doctor’s fees, miscellaneous Hospital expenses, intensive care and surgeon’s fees, etc., (please refer to the Benefits Schedule for the maximum benefit amount) helping to relieve the financial burden that substantial medical expenses may bring to you and your family. The Plan also covers the medical expenses incurred for day-case surgery. What’s more, the Plan provides a cash allowance for surgery to enhance your protection.
?Hospitalization Direct Billing Service
Prior to your Hospital7 admission, all you have to do is to complete the pre-approval procedures8 and receive our notification of arrangement, and we will settle your medical expenses directly with the Hospital after your discharge, so you can focus on your recovery without the need of going through complex claims procedures.
?All-round Protection Before and After Hospitalization
In addition to hospitalization and surgical benefits, the Plan also covers medical expenses incurred for consultation before and after your Hospital Stay, private nurse’s fees and rehabilitation. Furthermore, the Plan offers you an array of extended benefits (please refer to the Benefits Schedule for details) including:
- Ancillary services, including treatments by Registered Physiotherapists, Chiropractors, Speech Therapists, Osteopathic Therapists, Occupational Therapists and Dietitians
- Cancer treatments, including chemotherapy, radiotherapy, target therapy, hormonal therapy, immunotherapy, etc.
- Kidney Dialysis9
- Traditional Chinese Medicines
- Reconstructive Surgery Benefit
- HIV/AIDS Treatment10
- Pregnancy Complications11
- Hospice Care
As your lifetime health partner, the Plan also provides you with a medical check-up once every 2 years, enabling you to keep track of your health status.
?Options to Reduce Deductibles at Designated Ages Without Medical Underwriting
We understand you may need different levels of medical protection when going through different stages in your life. The Plan offers you the right to reduce your existing Deductible without having to undergo any medical underwriting6 once you reach the ages 50, 55, 60 or 65. This assists you in better planning or your life in retirement.
?No Claim Deductible Discount
Starting from the 2nd Policy anniversary, you can enjoy a 15% discount on Deductibles in the following Policy year if you take out plan 2, 3 or 4 (excluding plan 1 and 5) and no benefits have been paid12 in the past 2 consecutive Policy Years. If no benefits have been paid12 in every subsequent policy year, you can enjoy an additional 5% discount on Deductibles annually, with the maximum discount up to 100%.
MasterCare Medical Plan
|Issue Age||15 days after birth to age 70|
|Plan Currency||HKD/ USD/ RMB|
|Coverage area||Worldwide, Worldwide (exclude USA)3 and Asia4|
|Deductible options||Plan 1: HKD0/ USD0/ RMB0
Plan 2: HKD9,000/ USD1,125/ RMB7,200
Plan 3: HKD28,000/ USD3,500/ RMB22,400
Plan 4: HKD100,000/ USD12,500 / RMB80,000
Plan 5: HKD500,000 / USD62,500 / RMB400,000
|Premium Payment Method||Annual, Semi-annual, Quarterly or Monthly|
|Benefit Term||To age 100 of the Insured|
|Premium Payment Term||To age 99 of the Insured|
Please refer to the Benefit Schedule in the product brochure for details.
1Standard Private Room refers to a room for single occupancy and private use of the Insured during his/her Confinement, which contains a private bedroom, lavatory and bathroom without any or all of the en-suite facilities: companion room, lavatory for visitor, kitchen, dining room or sitting room. The Standard Private Room shall exclude any deluxe, suite, executive rooms and other upgraded rooms or the equivalence.
2Annual Limit is applicable to this Plan. Please refer to the “Benefits Schedule” for details.
3If the medical expenses are incurred in the USA, the Plan will only cover the medical expenses arising from Accidents.
4Asia refers to Afghanistan, Australia, Bangladesh, Bhutan, Brunei, Cambodia, China, Hong Kong, India, Indonesia, Japan, Kazakhstan, Kyrgyzstan, Laos, Macau, Malaysia, Maldives, Mongolia, Myanmar, Nepal, New Zealand, North Korea, Pakistan, the Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Tajikistan, Thailand, Timor-Leste, Turkmenistan, Uzbekistan and Vietnam. If the medical expenses are incurred outside the covered areas, the Plan will only cover the medical expenses arising from Accidents.
5China Life (Overseas) reserves the right to review the premium rates on each Policy anniversary and revises the terms and conditions and/or the benefit items of the Policy from time to time. If we decide to no longer offer the Plan, we will endeavor to enroll the Insured in another available medical plan.
6The Insured is entitled to reduce the Deductible without the need to undergo underwriting for one time only. After reduction of the Deductible, China Life (Overseas) will adjust the premium according to the premium rate applicable to a particular risk class, the actual age of the Insured and the special condition(s) applicable to his/her policy. After reduction of the Deductible, the new Deductible will apply to the claims over the covered diseases and covered injuries. The Annual Deductible under Plan 5 shall not be lower than HKD100,000 or the currency equivalent.
7Hospital does not include any establishment or that portion of an establishment which is operated as a convalescent or nursing home, rest home, home for the aged, or an establishment for rehabilitation of alcoholics or drug addicts, or any similar purpose. For the list of designated hospitals located in China, please refer to China Life (Overseas)’s website http://www.yaxiet.tw/customerservice/hospitals-in-china.
8Please refer to MasterCare Medical Plan Direct Billing Pre-approval Form for details.
9The Insured must be diagnosed as having chronic and irreversible kidney failure.
10The waiting period of HIV/AIDS Treatment Benefit is 5 years. The benefit is only payable if the signs or symptoms of such illness occur for the first time. This benefit is only payable once and the payment of this benefit shall be in lieu of all other benefits provided by the policy in respect of such Confinement and treatment. This benefit is not applicable to the Asia Plan.
11The waiting period of Pregnancy Complications Benefit is 1 year. This benefit is not applicable to the Asia Plan.
12benefits payable under Hospital Cash Benefit, Lower Room Class Cash Benefit, Day Case Surgery Fee and Cash Allowance for Day Case Surgery.
13In the case of organ transplantation of heart, kidney, liver, lung or bone marrow performed on the Insured as recipient, China Life (Overseas) shall reimburse the Reasonable and Customary charges of the actual surgical costs to remove the organ or bone marrow from the donor which are charged to the Insured (including the Surgeon’s Fee, Anaesthetist’s Fee and Operating Theatre Fee, but excluding the costs of the organ or bone marrow).
14Designated medical appliances include pacemaker, stents for percutaneous transluminal coronary angioplasty, intraocular lens, artificial cardiac valve, metallic or artificial joints for joint replacement, prosthetic ligament for replacement or implantation between bones and prosthetic intervertebral disc.
15All services are provided by third party supplier(s) appointed by China Life (Overseas). China Life (Overseas) is not the service provider(s), and is not liable for the service quality provided. China Life (Overseas) reserves the right to amend the terms and conditions thereof from time to time without prior notice.
16Reasonable and Customary means the charges for Treatment, procedure, supplies or other medical services which are Medically Necessary but do not exceed the general level of charges at the location for such Treatment, procedure, supplies or other medical services. China Life (Overseas) reserves the right to determine whether any of such charge is Reasonable and Customary with reference but not limited to, any relevant publication or information made available, such as schedule of fees, by the government, relevant authorities and recognized medical association at the location where such expenses are incurred.
This product brochure is for reference only. Please refer to the Policy documents for the complete definitions of the capitalised terms, as well as all the terms and conditions of this product. You are reminded to review all of the relevant product materials provided to you and to seek independent professional advice if necessary.
- The Policy is underwritten by China Life Insurance (Overseas) Company Limited (“China Life (Overseas)” or "us/we/our"). China Life (Overseas) is responsible for the features, underwriting and benefit payments under the Policy. You should fully understand all of the risks involved in this product and consider whether this product is affordable and suitable to you before making your application.
- China Life (Overseas) shall make the final decisions on the underwriting and claims. We shall rely on your submitted information to assess whether to accept or decline your application, and shall refund any Premium and levy (if any)paid without interest for declined cases.
- No dividend will be paid in the Policy and therefore dividends are not available to the Plan.
- Exclusions – unless otherwise indicated, the following tests, investigations, treatments, items, conditions, activities and their related or consequential expenses (caused directly or indirectly) are excluded from this Policy and China Life (Overseas) shall not be liable for:
(1) any Pre-existing Condition (including associated medical conditions) prior to the effective of this Policy;
(2) pregnancy or childbirth. For the avoidance of doubt, pursuant to the "Pregnancy Complications" in section 4.8 under Part IV Extended Benefits of the ”Benefits” section in the Benefit Provision, China Life (Overseas) will pay for treatment of a complications which is due to and occurs during the pregnancy or childbirth except if the pregnancy was a result of any form of assisted conception or through non Medically Necessary caesarean section, termination of pregnancy or any consequences of it, China Life (Overseas) will not pay any related treatment or medical cost;
(3) treatment begun, or for which the need had arisen, during the first 90 days after birth for any child conceived by artificial means or any form of assisted conception including artificial insemination;
(4) investigations into and treatment of infertility, contraception, assisted reproduction, sterilization (or its reversal), treatment of impotence or any consequence of any of them or of any treatment for them;
(5) sex change including treatment which arises from or is directly or indirectly made necessary by a sex change;
(6) treatment of any medical condition which arises in any way from Human Immunodeficiency Virus (HIV) infection or Acquired Immune Deficiency Syndrome (AIDS) unless specified in section 4.5 “HIV／AIDS treatment” under Part IV Extended Benefits of the ”Benefits” section;
(7) treatment of obesity, the removal of fat or surplus tissue from any part of the body whether or not it is needed for medical or psychological reasons;
(8) cosmetic (aesthetic) surgery or treatment;
(9) any form of dental care or surgery unless otherwise specified in this Policy, but in all circumstances shall not cover replacement of natural teeth, denture and prosthetic services such as bridges and crowns, their replacement and related expenses;
(10) Hormone replacement therapy (unless specified in section 4.1 (iii) of Cancer Treatment Benefit under Part IV Extended Benefits of the ”Benefits” section);
(11) the costs of collecting donor organs for transplant surgery or any administration costs involved, even if such transplants are allowed by the terms of this Policy;
(12) treatment which arises from, directly or indirectly, caused by a deliberately self-inflicted injury or an attempt at suicide;
(13) treatment which arises from or is in any way connected with alcohol abuse or drug or substance abuse;
(14) treatment to correct long-sightedness or short-sightedness or astigmatism;
(15) treatment which directs towards developmental delay (whether physical or psychological) or learning difficulties;
(16) preventive treatment, vaccinations and routine or preventative medical examinations, including routine follow-up consultations;
(17) standard toiletries such as (but not limited to) shampoos, soaps, tooth-pastes, contraceptives, proprietary headache and cold cures, and vitamins which may be bought over the counter at a local pharmacy without prescription, nor does China Life (Overseas) pay for telephone calls;
(18) orthodontics, periodontics, endodontics, preventative dentistry, and general dental care including fillings, no matter who gives the treatment;
(19) claims in respect of treatment received outside the Area of Cover except emergency treatment due to Accident;
(20) playing professional sport or from base jumping, cliff diving, flying in an unlicensed aircraft or as a learner, martial arts, free climbing, mountaineering (with or without ropes), scuba diving to a depth of more than 10 metres, trekking to a height of over 2,500 metres, bungee jumping, canyoning, hang gliding, hot air balloon, paragliding or microlighting, parachuting, potholing, skiing off the ski track or any other winter sports activity carried out off the ski track;
(21) any treatment specifically excluded by the terms shown on an endorsement or any documents forming part of this Policy;
(22) any charges which are incurred for social or domestic reasons or for reasons which are not directly connected with treatment;
(23) any charges from spas, hot springs, nature cure clinics (or practitioners) or any similar place, even if it is registered as a Hospital;
(24) Annual Deductible amount that set out in the Policy Schedule of this Policy. China Life (Overseas) will only pay the balance of the claim after we have deducted the excess (or Annual Deductible or co-insurance) amount;
(25) any charges made by Registered Medical Practitioner, Hospital, laboratory or any such medical services which are not Reasonable and Customary16
(26) any charges for treatment related to and/or the correction of Congenital Conditions and/or deformities (whether or not manifest and/or diagnosed or known about at birth);
(27) any charges for items not listed in the Benefit Schedule applicable to this Policy;
(28) genetic tests, including any counseling made necessary following genetic tests, even when those tests are undertaken to establish whether or not the Insured may be genetically disposed to the development of a Medical Condition in future;
(29) treatment which, in the opinion of China Life (Overseas), has not been established as being effective or is experimental or is in trial stage, unless such treatment is recognized as appropriate by a local public authority and China Life (Overseas) has agreed about the costs, before such treatment begins, in writing with the treating Registered Medical Practitioner;
(30) treatment required as result of engaging in criminal activities;
(31) treatment for all types of sleep disorders including for insomnia and snoring;
(32) cryopreservation, implantation or re-implantation of living cells or living tissue (whether autologous or provided by a donor);
(33) any treatment or if they are rendered as a result of nuclear contamination, biological contamination or chemical contamination, or as a result of the Insured’s participation in war (whether declared or not), terrorist act, act of foreign enemy, invasion, civil war, riot, rebellion, insurrection, revolution, overthrow of a legally constituted government, explosions of war weapons or any event similar to one of those listed. This includes any treatment needed as a result of Insured deliberately exposing himself/herself to needless peril, such as going to a place of unrest as an active onlooker or a spectator; (34) any of the following traditional Chinese medicines: (i) cordyceps; (ii) ganoderma; (iii) antler; (iv) cubilose; (v) donkey-hide gelatin; (vi) hippocampus; (vii) ginseng; (viii) red ginseng; (ix) American ginseng; (x) radix ginseng silvestris; (xi) antelope horn powder; (xii) placenta hominis; (xiii) agaricus blazei murill; (xiv) musk; (xv) pearl powder; (xvi) cauda cervi; and
(35) any non-Medically Necessary Confinement or non-Medically Necessary therapy, diagnosis, service or items.
In addition, the Covered Illness must be an illness occurring more than 30 days after the later of the Issue Date or the latest Commencement Date of this Policy.
Furthermore, the information stated herein is for reference only. Please refer to the General Provisions for the exact terms and conditions and limitations such as incontestability, suicide and fraud etc. or all exclusions.
- Limitation – Limitation of the Plan includes:
(1) China Life (Overseas) is not liable for any Confinement, surgery and/or medical treatment for which compensation or reimbursement is payable under any law, medical program, or insurance policy provided by any government, company or other insurer except to the extent that such charges are not reimbursed by such law, medical program or insurance policy. However, this compensation or reimbursement will count towards the Deductible provided that certified copy(s) of all the bills are submitted to China Life (Overseas) as the evidence;
(2)benefits under Parts IV herein are payable subject to the limitations described herein and any applicable Coverage/Maximum Limits shown on the Benefit Schedule and are further subject in the case of each Insured to: (i) the Annual Limit of each Benefit Level in the Benefit Schedule, in respect of total benefits paid in any one Policy Year; (ii) the Deductible in the Benefit Schedule of the Basic Plan. In no event shall the total amount of any benefit(s) payable hereunder exceed 100% of the relevant charges, costs or fees incurred after the Deductible has been met in full, in respect of any covered Confinement, surgery and/or medical treatment;
(3) for the purpose of applying the Annual Limit, Confinement Benefit(s) paid under the Part I “Confinement Benefits” of section 4 “Benefits” of the Benefit Provisions shall be attributed to the Policy Year in which the relevant admission to Hospital occurred, and not the Policy Year in which Discharge from Hospital occurred if this is different;
(4) if the Insured is Confined in a room of the class above Covered Room, whether voluntarily or involuntarily, on any days of a Confinement, any reimbursable charges under Part I “Confinement Benefits”, Part II “Surgical Benefits” and Part IV “Extended Benefits” of section 4 “Benefits” of the Benefit Provision herein in relation to such days of Confinement shall be reduced by 30%;
(5) Any benefits payable under Parts I-V of the section 4 “Benefits” of Benefit Provisions herein shall be permanently reduced to 60% of the relevant reimbursable charges if the Insured has taken up residence in the United State for at least 183 days in the last 12 months (only applicable under the Benefit Schedule of the Basic Plan or indicated as “Worldwide Plan” at the latest endorsement (if any)
(6) for benefits relating to Confinement, the Confinement must be evidenced by a daily room/room & board charge by the Hospital. China Life (Overseas) will not be liable to pay any benefit: (i) for more than one daily room/room & board charge for each day of Confinement; or (ii) for any Confinement that is not a Reasonable and Customary16 charges.
- Non-payment of Premium - You should pay Premium(s) on time according to the selected Premium payment schedule. If the due Premium remains unpaid upon the expiry of the Grace Period, the Policy will be lapsed in accordance to the “Grace Period” clause under the General Provision, and you will lose the related insurance coverage and suffer a financial loss. If an insured event occurs during the Grace Period, China Life (Overseas) shall still be responsible for the insurance coverage but any outstanding Premium for the Policy year wherein the insured event occurs shall be deducted from any amount which may be payable under the Policy.
- Cooling-off Right - You have the right to cancel the Policy within the Cooling-off Period and obtain a refund of any Premiums and levy (if any)paid by giving written notice to us provided that you have not made any claims under the Policy. Such notice must be signed by you and submitted to China Life (Overseas) at 22/F, CLI Building, 313 Hennessy Road, Wan Chai, Hong Kong within 21 days after the delivery of the Policy or issue of a Notice to you or your representative informing you that the Policy is available, whichever is earlier.
|What are the key product risks?|
|Credit risk||This product is a life insurance Policyissued by China Life (Overseas). Any Premium paid will become part of our assets and our financial strength will affectour ability to meet our contractual obligations toyou under the Policy. Therefore this product is subject to our credit risk.|
|Exchange rate and Currency risks||Any Policy with foreign currencies involves risks, such as potential changes in political or economic conditions that may substantially affect the price or liquidity of a currency. The fluctuations in exchange rates may also cause financial losses to you during currency conversions. You should consider the potential currency and exchange rate risks before deciding which Policy currency you should take.|
|Inflation risk||The cost of living in the future may be higher than expected due to the effects of inflation. Therefore, your current planned benefits and/or returns maybe insufficient to meet your future needs even if we fulfill all of our contractual terms and obligations.|
|Policy Termination||The Policy will be terminated if (a) the Insured died; or (b) the lapse of the Policy pursuant to the “Grace Period” clause under the General Provision; or (c) the Policyholder request to surrender or terminate the Policy, all attached rider(s) will be terminated simultaneously.In case the Plan terminates within the Policy year, no Premium will be refunded, no matter any claim is made in that Policy year.|
|Premium adjustment and renewal||China Life (Overseas) has the absolute right and discretion to adjust the renewal premium payable under the Policy at the end of each Coverage Period (that is every year). Factors leading to premium adjustment may include but are not limited to the experience in claims, policy surrender, investment return, and expenses incurred by and/or in relation to this product.
Effective from 1 January 2018, all policyholders are required to pay a levy on each premium payment made for both new and in-force policies to the Insurance Authority (the “IA”). For levy details, please visit our website at www.yaxiet.tw/customerservice/levy or IA’s website at www.ia.org.hk.
brochure is for reference only andcontains descriptions of the key features of this product. For all the terms and conditions and exclusions of this product, please refer to the policy documents of this product. In the event of any ambiguity or inconsistency between the terms of this brochure and the policy documents, the Chinese version of the policy documentsshall prevail.
only and shall not be construed as any provision of or offer to sell or solicitation to buy any insurance product outside Hong Kong. China Life Insurance (Overseas) Company Limited ("China Life (Overseas)") does not provide or offer to sell any insurance product outside Hong Kong. The above information is for reference only. The detailed terms, conditions and exclusions of the Plan are subject to the terms and conditions of the policy contract of the Plan. For a copy of the terms and conditions of the policy contract, please contact China Life (Overseas) for enquiry.
The information and descriptions contained herein are not intended to be complete descriptions of all terms, exclusions and conditions applicable to the products and services, but are provided solely for general informational purposes. For complete details please refer to the actual policy or the relevant product or services agreement.