VHIS Series - Flexi Plan

Notes for Benefits I (a) – (l) & II (1) – (4) &
III & IV(1) – (2)

(1) Eligible Expenses incurred in respect of the same item shall not be recoverable under more than one benefit item in the table above, unless otherwise specified

(2) The Company shall have the right to ask for proof of recommendation e.g. written referral or testifying statement on the claim form by the attending doctor or Registered Medical Practitioner

(3) Tests covered here only include computed tomography (“CT” scan), magnetic resonance imaging (“MRI” scan), positron emission tomography (“PET” scan), PET-CT combined and PET-MRI combined

(4) Treatments covered here only include radiotherapy, chemotherapy, targeted therapy, immunotherapy and hormonal therapy

(5) The percentage here applies to the Surgeon’s fee actually payable or the benefit limit for the Surgeon’s fee according to the surgical categorization, whichever is the lower

(6) This benefit shall be payable for the specific Day Case Procedure specified on the list published by the Company (“Specific Day Case Procedure”) at any one of the Company’s designated medical clinic, day case procedure centre or Hospital in Hong Kong (“Network Provider”). Please refer to Section (1) of Supplement One for details

(7) Adjustment factor will be applied to the calculation of the amount payable under this benefit if the Insured Person is Confined in a Hospital ward class higher than the restricted ward class stated except for the involuntary upgrade. Please refer to Supplement Two for details

(8) “Asia” shall mean Afghanistan, Bangladesh, Bhutan, Brunei, Cambodia, mainland China, Hong Kong, India, Indonesia, Japan, Kazakhstan, Kyrgyzstan, Laos, Macau, Malaysia, Maldives, Mongolia, Myanmar, Nepal, Pakistan, the Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Tajikistan, Thailand, Timor-Leste, Turkmenistan, Uzbekistan, and Vietnam. Please refer to Section (1) of Supplement One for the details of territorial scope of cover

(9) This benefit shall be payable for the cost of companion bed charged by the Hospital for one (1) parent or Guardian of the Insured Person, provided that the Insured Person is below Age of eighteen (18)

Notes for Optional Outpatient Benefits

¹ Outpatient benefit does not form part of the VHIS certified plan. The premiums paid are not eligible for tax deduction

(a) Expenses incurred in respect of the same item shall not be recoverable under more than one benefit item in the table above, unless otherwise specified

(b) Item (1) and (2) shall be limited to one visit for either item per day

(c) Benefit includes consultation fee and 3 days basic Medically Necessary medication, excluding Chinese Herbal Medication. Flexi (Plus): Maximum number of visits for both network benefit and non-network benefit in aggregate per Policy Year is 20 in total

(d) Benefit includes consultation fee and 3 packets of basic Medically Necessary Chinese Herbal Medication. Flexi (Plus): Maximum number of visits for both network benefit and non-network benefit in aggregate per Policy Year is 20 in total

(e) Benefit includes consultation fee and 3 days basic Medically Necessary medication. Flexi (Plus) Maximum number of visits for both network benefit and non-network benefit in aggregate per Policy Year is 10 in total

(f) Referral by a Registered Medical Practitioner or Specialist in writing required

(g) Insured Person has to undertake the test specified by the Company at the Company’s designated health screening test centre. Please refer to Section (5) of Supplement Four for details

General Exclusions

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 (if so requested by the Company under Section 8 of Part 1) 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 (5) years after the Policy Effective Date shall be presumed to be contracted or occur before the Policy Effective Date, while manifestation after such five (5) years shall be presumed to be contracted or occur after the Policy Effective Date. However, the exclusion under this entire Section 3 shall not apply where HIV and its related Disability is caused by sexual assault, medical assistance, organ transplant, blood transfusions or blood donation, or infection at birth, and in such cases the other terms of these Terms and Benefits shall apply.
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 (except for HIV and its related Disability, where Section 3 of this Part 7 applies).
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 (90) 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-thecounter 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, bonesetting, 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 (8) 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.

Inclusion of VAT and GST taxes as Eligible Expenses under VHIS Certified Plans

With respect of any Eligible Expenses under the VHIS Certified Plans incurred on or after 1st 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 2892 3822 or email us through life.medical@libertymutual.com.hk. 

Inclusion of Public Hospitals and Private Hospitals in Hong Kong in the Definition of Hospital under VHIS Policy Terms & Conditions

With effect from 1 April 2023, the definition of "Hospital" in Part 8 "Definition" of your VHIS policy terms and conditions shall be refined to make clear that it shall include public hospitals as defined in the Hospital Authority Ordinance (Cap. 113 of the Laws of Hong Kong) and hospitals for which a licence is issued under the Private Healthcare Facilities Ordinance (Cap. 633 of the Laws of Hong Kong), subject to other conditions of (b), (c) and (d) in the definition. The relevant Supplement will be sent to all policy holders concerned on or before the respective policy renewals from 1 April 2023. For any queries, please contact us at 2892 3822 or email us through life.medical@libertymutual.com.hk. 

This Certified Plan is eligible for tax deduction. Deduction is subject to the relevant laws on tax deduction.
The information contained in this page is intended as a general summary. For more details, please refer to our brochure and policy.