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Medical Insurance

FAQs

American Express Medical Protector

Relating to Coverage
Is the coverage only limited to the hospital confinement inside Hong Kong?

American Express Medical Protector covers hospitalization outside Hong Kong for emergency condition. You can choose any hospitals in accordance to your plan and geographical area selected. However, if you are away from Hong Kong for more than 90 days, no benefits shall be paid. Also, any elective surgery or medical treatment outside Hong Kong is not covered unless pre-approval agreement is obtained from Zurich Insurance Company Ltd.

What are the age limitation and eligibilities of the plan?
You must be a Hong Kong citizen or resident in Hong Kong holding a valid HKID cards, with a permanent address and live in Hong Kong as a usual country for residence and not staying outside Hong Kong for more than 120 days consecutively per year, and aged from 15 days to 64 years old (this plan is renewable up to aged 100 years). Zurich Insurance Company Ltd reserves the right of final approval of this Plan.
If I have to station in or migrate to anywhere outside of Hong Kong, can I continue to enjoy the protection of this plan?
Please notify Zurich Insurance Company Ltd within 30 days after you have changed the "Usual Country of Residence" from Hong Kong, the insurance company may adjust the related terms and conditions or cancel the policy immediately based on each policy. In case the "Usual Country of Residence" has been changed without notifying the insurance company, Zurich Insurance Company Ltd reserves the right to decline any claims afterwards.
How long is it required for hospitalization in order to be eligible to claim?

It requires at least 16 hours of hospitalization which has to be continuous until discharged from hospital. The treatment or operation in hospital should be a medically necessary one and advised by doctor.

What criteria are used for the 100% reimbursement for in-patient benefits including surgical fees?

It bases on the plan level and types of room chosen for the calculation and the definition of room is well defined in the Policy Provisions. If the selected room types are semi-private or ward, you are entitled to 100% reimbursement of the reasonable and customary inpatient charges including surgical fees. However, if private room is chosen, the reimbursed percentage will be based on the percentage payable as stated in the Policy Provisions. In case of any dispute over the definition of room type, Zurich Insurance Company Ltd reserves the right of final decision so as the reimbursed amount.

What is pre-existing condition?

It means any injury, sickness, condition for which the insured person showed symptoms or has received medical consultation, diagnosis, treatment or advice or took prescribed drugs or medicine for a period of time of which the insured person was aware of or could reasonably be expected to be aware of before the policy effective date, or the date of reinstatement or upgrade effective date. Unless such conditions have been fully disclosed on the application form and accepted by Zurich Insurance Company Ltd in writing and the policy document does not expressly exclude treatment relating to such pre-existing condition.

Why are pre-existing conditions not covered?

Pre-existing conditions are commonly excluded in medical and hospitalization policies because the rationale of insurance is to indemnify insured from unforeseen or unpredictable medical conditions. Therefore, it is usual to exclude injuries or sicknesses which occur, exist, commence or present signs or symptoms before the commencement of the policy coverage.

What is the waiting period?

Medical insurance normally has a term "waiting period" which means no coverage on any illnesses will be offered during that period. Please take notice that for illnesses that are endorsed as exclusion at the inception of policy, they will not be covered under the policy at any time even after the waiting period.

Why are some sicknesses excluded during the first year and some excluded during the first six months?

The sickness listed as exclusions are mostly common chronic illnesses with incubation period ranging from six months to one year. Incubation periods vary greatly for different diseases, some require longer time for symptoms and signs to be first apparent. In general, those illnesses excluded during the first year are believed to have a longer incubation period (e.g. gall bladder calculi, diabetes mellitus, cataract, tumors of internal organs).

Is hospitalization in relation to pregnancy covered under the policy?

No. Any claims in relation to pregnancy, childbirth (including diagnostic tests for pregnancy and surgical delivery), miscarriage, abortion and pre-natal or postnatal care are excluded.

 

Does the coverage include sanatorium?

No. According to the definition of "hospital" in the policy document, "hospital" does not include a rest or convalescent facility, or similar establishment.

What illnesses are excluded in the coverage?

The plan aims to indemnify insured the cost of hospitalization raised from accident and illnesses. Like other medical insurance plans offered in the market, there are certain items that will not be covered, such as:

  • any pre-existing condition
  • inoculations or general check-up
  • cosmetic surgery or plastic surgery
  • rest care or sanitaria care
  • any condition resulting from pregnancy, AIDS, psychosis, dental treatment of any nature whatsoever
  • pre-natal care and post-natal care
  • Non-emergency overseas treatment planned for in advance
  • Professional or hazardous sports or pastimes such as climbing, mountaineering, pot-holing, skydiving, parachuting, hang-gliding, para-sailing, water skiing, ballooning, all diving, racing of any kind other than on foot, hunting.

All exclusions are listed in the policy documents which also provide Chinese version. If you have any enquiries, please feel free to contact Zurich Insurance Company Ltd at 2903-9446.

If I have been hospitalized more than once due to the same sickness or injury, will it be treated as different cases for handling?

The same sickness or injury, or a continuous sickness or injury are treated as the same sickness or injury, unless they are caused by totally unrelated causes, or they are separated by 90 days following the latest discharge from hospital or last consultation or the latest date receiving medical treatment .

If I need to have a body check in a hospital, am I covered under this plan?

Medical expenses incurred as a result of physiotherapy treatment or medical check-up are not covered. This plan only covers for the medical expenses incurred as a result of injury or sickness and treatments provided which are medically necessary.

If I need to receive a minor surgery in a clinic, such as the excision of sebaceous cyst, can I claim for this?

Yes. According to Section 2.5 "Out-patient Surgery", you can claim for the surgical fees, operation theatre fees or anesthetist's fees of a minor surgery done in hospital clinic or registered clinic.

Relating to Enrollment
Is medical examination required?

Applying for American Express Medical Protector is simple and easy. You are not required to have medical check-up which means you are free from any additional medical check-up fee.

If I have suffered from a certain sickness or certain part of the body has been injured, can I apply for the "American Express Medical Protector"?

This plan does not cover any pre-existing conditions of any illness or injuries. It also subjects to the underwriting result of Zurich Insurance Company Ltd and the company will take reference of medical report certified by doctor if necessary.

If I have enrolled in another medical or hospital cash insurance, can I apply for this medical insurance?

You need to declare the related medical or hospital cash insurance to Zurich Insurance Company Ltd for underwriting purpose. You can also apply for this plan if the application is accepted after underwriting.

If I want to cancel my existing medical insurance from another insurance company and apply for "American Express Medical Protector", does it need to go through underwriting process?

Yes. Zurich Insurance Company Ltd will base on your past and current health condition and consider whether to accept your application. Any pre-existing conditions will not be covered when you apply for this plan.

Relating to Premium
Does "American Express Medical Protector" have any grace period?

Yes, Zurich Insurance Company Ltd will allow you 31 days for the payment of each premium after the first premium. During that time your policy will be kept in force.

Why does this plan charge premium according to different age ranges? If I have enrolled for the plan when I am in younger age, will the premium remain unchanged?

As the chances of being ill are higher when you are getting older, so the premium charged is based on different age ranges. In general, the earlier you enroll for the plan, the better the protection will be, as the pre-existing conditions are supposed to be less when you are younger. Therefore, customers are suggested to enroll for the medical insurance as soon as possible.

If I cancel American Express® card later, how can I pay for the premium?

Of course we hope you keep using our card. However, you can contact Zurich Insurance Company Ltd to arrange other mode of payment, in case your American Express® card has been cancelled.

Claims
Do I need to pay for the medical expenses first when I am confined in hospital and make a claim later?

This plan provides insured person with "Pre-admission Assessment Service". Service provider of Zurich Insurance Company Ltd will settle all the eligible in-patient medical expenses incurred in the private hospitals in Hong Kong. However, please be reminded that you have to apply for the service at least 3 working days before hospital admission with all required documents submitted, which application is subject to approval. Otherwise, you need to settle the hospital bill first and then make a claim later.

As an insured person, if I have not applied for the "Pre-admission Assessment Service" before hospitalization, how should I submit a claim?

You can return the completed Hospitalization Claim Form together with the supporting documents within 30 days from the date of treatment in hospital to Insurance Claim department of Zurich Insurance Company Ltd for the claim. The related claim process will be completed in 7 working days if all documents required are submitted and the claim is under the coverage of this plan. In case it is needed to submit further documents for the claim, staff of Zurich Insurance Company Ltd will follow up with you.

In case the surgical expenses incurred have been claimed from the group medical insurance provided by my employer or another insurance company and get full reimbursement, can I still claim for the related surgical expenses from this plan?

As surgical expense cover is on reimbursement basis, you cannot claim the extra benefit from this plan after you have reimbursed the expense in total from a third party. Conversely, this plan will pay for the remaining expenses which have not be reimbursed by other insurance plans, provided that the claim is eligible and under the coverage of this plan according to the terms and conditions.

If I have chosen "voluntary deductible" option, how the claim be calculated?

Zurich Insurance Company Ltd will calculate the eligible claim amount according to medical receipts supplied by you and related coverage items of the plan. Then, the "voluntary deductible" amount will be deducted from the total eligible claim amount, and this will be actual claim amount to you.

What documents and procedures are required to submit a claim? Are original copies required? Are true copies acceptable?

Please return the Hospitalization Claim Form completed by you and your attending medical practitioner together with all related documents such as medical report etc. In general, original copies are required to submit a claim. Please refer to the Part 7 - "Claims Procedure" of the Policy Provisions for more information.

Should I notify Zurich Insurance Company Ltd when I depart from Hong Kong (include travelling to China and Macau) every time? If I forget to do so, will it impact my claim result or will the claim become unacceptable?

It is not required to notify Zurich Insurance Company Ltd if you depart from Hong Kong for a short overseas trip. Please note that this plan only covers those who stay overseas not more than 90 days and the medical expenses incurred by emergency hospitalization, which is caused by accident or sickness. In case you station in or migrate to another country for a long period of time, please notify Zurich Insurance Company Ltd within 30 days after you have changed the "Usual Country of Residence" from Hong Kong to another country, the insurance company may adjust the related terms and conditions or cancel the policy immediately based on each policy. In case the "Usual Country of Residence" has been changed without notifying the Zurich Insurance Company Ltd, the company reserves the right to refuse any claims afterwards.

Relating to Renewal
Do I need to renew the policy every year?

You will receive the renewal notice one or two months before the policy anniversary. If you decide not to renew the policy, a thirty days' written notice must be given to Zurich Insurance Company Ltd or else the policy will be renewed automatically. If the policy is cancelled after the policy anniversary, the paid premium for the unexpired policy period of this policy will be refunded in accordance with the charges indicated below.

 

Covered Period Charges of Premium
2 months or below 40%
3 months 50%
4 months 60%
5 months 70%
6 months 75%
Over 6 months 100%

 

If the policy is paid on monthly basis and you decide to cancel the policy within the period of insurance, Zurich Insurance Company Ltd will not refund the paid premium. However, you have to settle the premium of the unexpired policy period if any claim is made or any service is used.

If I decide to cancel the policy, can I do it before the policy renewal date?

Yes, a thirty days' written notice must be given to Zurich Insurance Company Ltd if you decide to cancel the policy, the paid premium for the unexpired policy period of this policy will be refunded in accordance with the charges indicated below. If the policy is paid on monthly basis, Zurich Insurance Company Ltd will not refund the paid premium. However, you have to settle the premium of the unexpired policy period if any claim is made or any service is used.

 

Covered Period Charges of Premium
2 months or below 40%
3 months 50%
4 months 60%
5 months 70%
6 months 75%
Over 6 months 100%
How to calculate "No Claim Discount"? If I have made a claim, will it impact the "No Claim Discount"?

The "No Claim Discount" of this plan will be calculated each policy year. If no claim has been made in the policy year, your insurance premium will be discounted for the following years upon renewal, with 2% in the first no claim year, followed by 5% in the second no claim year, and accumulated up to a maximum of 8% in the third no claim year. If a claim has been made before the policy anniversary, the no claim discount on the renewal premium of the following policy year will be decreased to 0%.

Can I change the "voluntary deductible" option within the period of insurance or at policy anniversary date?

You can change your current plan level or "voluntary deductible" option at policy anniversary date. If you choose to change from a lower plan level to a higher plan level or reduce the "voluntary deductible" amount, it is required to go through underwriting process again. However, if you choose to change from a higher plan level to lower plan level or increase the "voluntary deductible" amount, underwriting is not required for this change.

If I have made a claim, will the policy be guaranteed renewed? Is it guaranteed that the premium will remain unchanged?

This plan is renewable up to 100-years old. For the benefit of most of the customers, Zurich Insurance Company Ltd will evaluate policy conditions from time to time. In case of any abusive claim, overdue payment, or fraudulent claim etc., Zurich Insurance Company Ltd has the right to terminate the policy. Moreover, at the time of renewal the premium rate should be adjusted automatically as you enter into the next age band, and Zurich Insurance Company Ltd reserve the right to amend any terms and conditions or exclusions of the policy.