Overview

Hong Kong Health Insurance Definitions and Exclusions

CCW understands that the language used in relation to health insurance, especially some of the terms and conditions found on many policy documents, can be confusing to individuals who are not expert insurance professionals.

To help you get a better idea of how your Hong Kong health insurance policy will work we have compiled a list of common health insurance terms and their corresponding definitions.

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List of Hong Kong Health Insurance Definitions

01

Acute serious illness

An “acute serious illness” shall be determined to exist only after review and agreement by both the attending physician and the Company’s medical consultant.

02

Anniversary date

The renewal of the worldwide health insurance.

03

Applicant

A person named on the Application Form and the Medical Questionnaire as an applicant for insurance.

04

Application

The Application Form and Medical Questionnaire you fill in when making an application.

05

Claim

A claim is the financial demand covered in whole or in part by the insurance. In the Company’s evaluation/determination of the claim, the time of treatment is decisive, not the time of the occurrence of the injury/illness.

06

Commencement date

The date indicated in the policy schedule on which the worldwide health insurance commences, unless otherwise stated in the Policy Conditions.

07

Deductible

The total amount of money noted in the policy schedule which each insured agrees to pay each policy year before being reimbursed by the Company.

08

Documents

Any written information related to the insurance including original bills, policy schedules and the like.

09

Due date

Date on which a premium is due to be paid.

10

Hospitalization

Surgery or medical treatment in a hospital or clinic as an in patient when it is medically necessary to occupy a bed overnight.

11

Inpatient

Surgery or medical treatment in a hospital. It usually means that you will occupy a bed or stay overnight, but can include anything that hospitalizes you.


12

Insurance

The Policy Conditions and policy schedule representing the insurance contract with the Company and setting out the scope of the insurance terms, the premium payable, deductible and reimbursement rates.


13

Insured

The policyholder and/or all other insured persons as listed in the valid policy schedule.

14

Outpatient

Surgery or medical treatment in a hospital or clinic where it is not medically necessary to occupy a bed.

15

Policy Conditions

The terms and conditions of the worldwide health insurance purchased.

16

Policyholder

The person identified as the policyholder on the Application Form.

17

Policy schedule

Policy details showing the type of insurance purchased, deductible and any special terms.

18

Pre-existing condition

The medical history, including the illnesses and conditions listed in the Medical Questionnaire, which may affect the Company’s decision to insure or not to insure or to impose special terms.


19

Reimbursement rates

The maximum amount of money which will be paid by way of reimbursement of medical expenses in one year from the commencement date or from each anniversary date, as further detailed in the Policy Conditions.

20

Region

The name of the region as stated on the policy schedule determines the area of cover. Global Health Insurance can provide cover for many regions. Follow the link for a complete list of countries where we can obtain insurance for you.

21

Renewal

The automatic renewal of the insurance as per the anniversary date.

22

Serious injury

A “serious injury” shall be determined to exist only after review and agreement by both the attending physician and the Company’s medical consultant.

23

Special terms

Restrictions, limitations or conditions applied to our standard terms as detailed in the policy schedule.

24

Standard terms

The Company’s standard insurance terms with no special restrictions, limitations or conditions.

25

Subrogation

The insurer’s right to enforce a remedy which the insured has against a third party and the insurer’s right to require the insured to repay the insurer if the insurer has paid expenses recouped by the insured from a third party.

26

Surgery

A surgical treatment/intervention, which does not include endoscopies and scannings even though these examinations may require anesthesia.

27

Terminal phase

When the advent of death is highly probable and medical opinion has rejected active therapy in favor of the relief of symptoms and support of both patient and family. This decision must be confirmed by the Company’s medical consultants.

28

Waiting period

A waiting period is the duration of time from the commencement date where the insurance provides no cover. Often found with maternity cover.

Insurance Exclusions

Common Hong Kong Health Insurance Exclusions

Outside of defining the specific terms which you will encounter on your Global Health Insurance policy, it is also important to understand what an international medical insurance plan will normally exclude from coverage. Common coverage exclusions with Global Health Insurance plans offered by CCW may include:

• Cosmetic surgery or treatment (unless previously approved by the insurer)
• Obesity surgery e.g. gastric bypass surgery
• AIDS or HIV related diseases. These will be covered however; if it is proven that the condition was contracted due to a blood transfusion after commencement of the insurance, or as a result of an accident during the course of your normal occupation.
• Conditions contracted due to the abuse of alcohol, drugs or medicines will not be covered in any case.
• Any intentionally self-inflicted bodily injuries.
• Conditions arising due to contraception, including sterilization.
• Induced abortion unless medically prescribed.
• Any fertility related treatment including fertility testing.
• Induced abortion unless medically prescribed.
• Any kind of fertility testing or treatment, including hormone treatment or examinations and any related procedures.
• Treatment of sexual dysfunction.
• Any kind of care which is experimental, not part of a medical or surgical treatment, including stays in nursing homes.
• Treatment by naturopaths or homeopaths and naturopathic or homeopathic medications and other alternative methods of treatment. Unless stated in the specific insurer’s list of reimbursements.
• Health certificates.
• Treatment of diseases during military service.
• Treatment for sickness or injuries directly or indirectly caused while actively engaging in: war, invasion, acts of a foreign enemy, hostilities (whether war has been declared or not), civil war, terrorist acts, rebellion, revolution, insurrection, civil commotion, military or usurped power, martial law, riots or the acts of any lawfully constituted authority, or army, naval or air services operations whether war has been declared or not.
• Nuclear reactions or radioactive fallout.
• Treatment performed by the insured, his/her spouse, parents or children or an enterprise owned by one of the aforementioned persons.
• Epidemics which have been placed under the direction of public authorities.
• Treatment by a psychologist

Please note that not all insurers will include the same exclusions under their plans. The exclusions applicable to your policy will vary dependent on the insurance company you choose to work with and the type of plan you have purchased. The above list of exclusions should be used for informational purposes only and should not be taken to construe a comprehensive list of coverage exclusions applied to all HK health insurance plans.


Quotation

Free Hong Kong Health Insurance Quotes, Comparisons, and Advice

If you would like to learn more about a specific term which is included in your international Hong Kong health insurance plan, or if you would like to enquire about an exclusion which may affect your policy, please Contact a Global Insurance Advisor for more information today.

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