(VHIS Provider Registration Number: 00040 Registration Effective Date: 24 October 2019)
(VHIS Plan Certification Number: F00042-01-000-02, F00042-02-000-02 and F00042-03-000-02)
If you suffer from illness and need hospital treatment, you may wish to have high quality medical care or receive treatment in private hospitals. You need a flexible and comprehensive medical care solution covering various kinds of medical treatment expenses, so that you can choose your preferred medical treatment solution for a speedy recovery.
Well Link Life's Well Protect Voluntary Health Insurance Scheme (Flexi) (the "Plan") offers three levels of ward class. The Plan reimburses medical expenses arising from eligible hospital and surgical treatments, and it guarantees renewal up to age 100. Additional extended benefits will be provided, including accident emergency outpatient treatment, outpatient kidney dialysis, post-confinement home nursing and cash benefit for day case procedure, etc. The Plan is a certified plan under the Hong Kong Government's Voluntary Health Insurance Scheme ('VHIS'). You can enjoy tax deductions for the premiums paid for the Plan.
Product Type:
Basic Plan
Issue Age:
Age 0 (15 days) to 80 (on last birthday)
Benefit Term:
Yearly renewable, with guaranteed renewability up to age 100 of the insured person.
Premium Payment Mode:
Annual / monthly
Policy Currency:
HKD
Note：
1. This plan is underwritten by Well Link Life Insurance Company Limited.
2. The above content contains general information for reference only. It is not part of the policy and does not contain the full policy's terms. Please refer to the policy documents for the full terms and conditions of this plan as well as the complete definitions of the capitalized terms. You should read this information alongside the brochure and other relevant materials which cover additional information about this product, including but not limited to benefit illustration (if any), other marketing materials, policy provision and other policy documents, which are available upon request. You may seek independent professional advice if necessary.
Inclusion of value-added taxes and goods and services taxes as Eligible Expenses under VHIS Certified Plans. With respect of any Eligible Expenses under the VHIS Certified Plans incurred on or after 1 March 2022, Eligible Expenses shall include value-added taxes and goods and services taxes (“VAT and GST”) (if any) charged or imposed on the relevant medical expenses incurred, subject to the Terms and Benefits applicable in the relevant Certified Plans. The relevant Supplement will be sent to all policy holders concerned upon policy renewal. For any queries, please contact us at (852) 2830 7500 or email to lifeservice@wli.com.hk.
The Company shall not pay any benefits in relation to or arising from the following expenses:
1. Expenses incurred for treatments, procedures, medications, tests or services which are not medically necessary#.
2. Expenses incurred for the whole or part of the confinement solely for the purpose of diagnostic procedures or allied health services, including but not limited to physiotherapy, occupational therapy and speech therapy, unless such procedure or service is recommended by a registered medical practitioner for medically necessary# investigation or treatment of a disability which cannot be effectively performed in a setting for providing medical services to a day patient.
3. Expenses arising from Human Immunodeficiency Virus ("HIV") and its related disability, which is contracted or occurs before the policy effective date. Irrespective of whether it is known or unknown to the policy holder or the insured person at the time of submission of application, including any updates of and changes to such requisite information such disability shall be generally excluded from any coverage of these terms and benefits if it exists before the policy effective date. If evidence of proof as to the time at which such disability is first contracted or occurs is not available, manifestation of such disability within the first five years after the policy effective date shall be presumed to be contracted or occur before the policy effective date, while manifestation after such five years shall be presumed to be contracted or occur after the policy effective date.
4. Expenses incurred for medical services as a result of disability arising from or consequential upon the dependence, overdose or influence of drugs, alcohol, narcotics or similar drugs or agents, self-inflicted injuries or attempted suicide, illegal activity, or venereal and sexually transmitted disease or its sequelae.
5. Any charges in respect of services for –
(a)beautification or cosmetic purposes, unless necessitated by injury caused by an accident and the insured person receives the medical services within ninety days of the accident; or
(b)correcting visual acuity or refractive errors that can be corrected by fitting of spectacles or contact lens, including but not limited to eye refractive therapy, LASIK and any related tests, procedures and services.
6. Expenses incurred for prophylactic treatment or preventive care, including but not limited to general check-ups, routine tests, screening procedures for asymptomatic conditions, screening or surveillance procedures based on the health history of the insured person and/or his family members, Hair Mineral Analysis (HMA), immunisation or health supplements. For the avoidance of doubt, this Section 6 does not apply to –
(a)treatments, monitoring, investigation or procedures with the purpose of avoiding complications arising from any other medical services provided;
(b)removal of pre-malignant conditions; and
(c)treatment for prevention of recurrence or complication of a previous Disability.
7. Expenses incurred for dental treatment and oral and maxillofacial procedures performed by a dentist except for emergency treatment and surgery during confinement arising from an accident. Follow‑up dental treatment or oral surgery after discharge from hospital shall not be covered.
8. Expenses incurred for medical services and counselling services relating to maternity conditions and its complications, including but not limited to diagnostic tests for pregnancy or resulting childbirth, abortion or miscarriage; birth control or reversal of birth control; sterilisation or sex reassignment of either sex; infertility including in-vitro fertilisation or any other artificial method of inducing pregnancy; or sexual dysfunction including but not limited to impotence, erectile dysfunction or pre-mature ejaculation, regardless of cause.
9. Expenses incurred for the purchase of durable medical equipment or appliances including but not limited to wheelchairs, beds and furniture, airway pressure machines and masks, portable oxygen and oxygen therapy devices, dialysis machines, exercise equipment, spectacles, hearing aids, special braces, walking aids, over-the-counter drugs, air purifiers or conditioners and heat appliances for home use. For the avoidance of doubt, this exclusion shall not apply to rental of medical equipment or appliances during confinement or on the day of the day case procedure.
10. Expenses incurred for traditional Chinese medicine treatment, including but not limited to herbal treatment, bone-setting, acupuncture, acupressure and tui na, and other forms of alternative treatment including but not limited to hypnotism, qigong, massage therapy, aromatherapy, naturopathy, hydropathy, homeotherapy and other similar treatments.
11. Expenses incurred for experimental or unproven medical technology or procedure in accordance with the common standard, or not approved by the recognised authority, in the locality where the treatment, procedure, test or service is received.
12. Expenses incurred for medical services provided as a result of congenital condition(s) which have manifested or been diagnosed before the insured person attained the age of eight years.
13. Eligible expenses** which have been reimbursed under any law, or medical program or insurance policy provided by any government, company or other third party.
14. Expenses incurred for treatment for disability arising from war (declared or undeclared), civil war, invasion, acts of foreign enemies, hostilities, rebellion, revolution, insurrection, or military or usurped power.
# Medically necessary shall mean the need to have medical service for the purpose of investigating or treating the relevant disability in accordance with the generally accepted standards of medical practice and such medical service must –
require the expertise of, or be referred by, a registered medical practitioner;
be consistent with the diagnosis and necessary for the investigation and treatment of the disability;
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 person, his family, caretaker or the attending registered medical practitioner;
be rendered in the setting that is most appropriate in the circumstances and in accordance with the generally accepted standards of medical practice for the medical services; and
be furnished at the most appropriate level which, in the prudent professional judgment of the attending registered medical practitioner, can be safely and effectively provided to the insured person.
** For those expenses not reimbursed by third parties, the Company shall only reimburse the eligible expenses which are reasonable and customary. Reasonable and customary shall mean, in relation to a charge for Medical Service, such level which does not exceed the general range of charges being charged by the relevant service providers in the locality where the charge is incurred for similar treatment, services or supplies to individuals with similar conditions, e.g. of the same sex and similar age, for a similar disability, as reasonably determined by the Company in utmost good faith. The reasonable and customary charges shall not in any event exceed the actual charges incurred.
Nature of the Product
This product is a non-participating policy without any savings element. All premiums are paid for the insurance and related costs. The product is an individual indemnity hospital insurance plan and is of indemnity nature aiming at customers who want hospitalization and surgical benefits, and can pay the premium as long as they want the protection. As a result, customers are advised to save enough money to cover the premiums in the future.
Underwriting Factors
The Company will assess the risk based on the information of the insured person including but not limited to occupation, place of residence and health conditions to decide to accept the application on standard terms, non-standard terms (may impose premium loading and / or exclusions) or reject the application.
Cooling-off Period
If you are not satisfied with the policy and have not made any claim under the policy, you have the right to cancel it and obtain a refund of any premium(s) paid by giving a written notice of cancellation to us within the cooling-off period. The cooling-off period is the period of 21 calendar days immediately following the day of the delivery of (1) the policy; or (2) the Cooling-off Notice, to you or your nominated representative, whichever is the earlier. The Cooling-off Notice will be sent to you or your nominated representative to notify you of the cooling-off period around the time the policy is delivered.
Premium Adjustment
Irrespective of whether the Company revises the terms and benefits of the Plan upon renewal, the Company shall have the right to adjust the standard premium according to the prevailing standard premium schedule adopted by the Company on an overall portfolio basis. Future premiums will be reviewed and adjusted annually, if necessary, to reflect continuous medical inflation and overall claim experience under the Plan. For the avoidance of doubt, we shall not adjust the premium on an individual basis. If the premium loading is set as a percentage of the standard premium (i.e. rate of premium loading), the amount of premium loading payable shall be automatically adjusted according to the change in standard premium.
During each policy year and upon renewal, the Company shall not impose any additional rate of premium loading (or any additional amount of premium loading if the premium loading is set in monetary terms rather than as a percentage of the standard premium) or case-based exclusion(s) on the insured person by reason of any change in the insured person's health conditions.
Claims
All claims must be made in the Company's prescribed form together with all original receipts and relevant supporting materials must be given to the Company within 90 days after discharge from hospital or after the date on which the relevant medical service is performed and completed. You can call our Claims Hotline at +852 2830 7600 for the appropriate claim form.
Termination Conditions
The Plan shall be automatically terminated on the earliest of the following events:
- where this policy is terminated due to non-payment of premiums after the grace period; or
- the day immediately following the death of the insured person; or
- the Company has ceased to have the requisite authorisation under the Insurance Ordinance to write or continue to write this policy
While the Policy is in force, you may terminate this policy before the next premium due date by sending written request to the Company provided that such notice is duly received by the Company 14 days before the next premium due date.
Renewal
Irrespective of whether the Company revises the terms and benefits of the Plan upon renewal, the Company shall give the policy holder a written notice of the revised terms and benefits to the policy holder of not less than thirty days prior to the renewal date.
The written notice shall specify the premium for renewal and renewal date. If the Company revises the terms and benefits of the Plan upon renewal, the Company shall make available the revised terms and benefits to the policy holder together with the written notice. The revised terms and benefits and premium for renewal shall take effect on the renewal date.
At renewal, the Company shall have the right to re-underwrite the terms and benefits of the Plan due to a change in the place of residence or occupation of the insured person. The Company shall have the obligation to request the policy holder to inform the Company of any change in the place of residence or occupation of the insured person, which means that as at the renewal date his place of residence differs from that as at the last renewal date (or the policy effective date in the event of first renewal). After receiving the request, the policy holder shall have the obligation to inform the Company of such a change.
Please contact the following channels for enquiries or complaints about VHIS:
Well Link Life Customer Service
VHIS Office of Food and Health Bureau - for issues specific to the VHIS including product availability, features of Certified Plans and compliance with the relevant Code
Inland Revenue Department – for issues about tax deduction
Insurance Authority – for issues about general conduct of insurance companies and intermediaries
