Day Procedure Centre Cashless Service in Hong Kong

Terms and conditions for Day Procedure Centre Cashless Service:

1. The Day Procedure Centre Cashless Service will be provided on the Medical Necessary and Reasonable and Customary basis. The Day Procedure Centre Cashless Service is not a service or benefit stipulated in the relevant policy contract but an additional administrative arrangement offered at the absolute discretion of Cigna Healthcare which, if approved, will facilitate the payment of the medical expenses incurred during the Insured Person’s Day Procedure, subject to these terms and conditions. For the avoidance of doubt, the payment of the expenses by Cigna Healthcare for the Insured Person does not mean that the claim of such expenses (or any part thereof) is automatically approved by Cigna Healthcare and such claim will remain subject to the terms and conditions of the policy. Cigna Healthcare reserves the right to suspend, amend or cancel the Day Procedure Centre Cashless Service at any time without prior notice. Any such Day Procedure Centre Cashless Service offered by Cigna Healthcare will be subject to the terms and conditions set out in this section which shall be read in conjunction with the relevant insurance policy.
2. Day Procedure Centre Cashless Service is applicable to Day Procedure conducted by medical service providers within Cigna Healthcare Medical Network in Hong Kong only.
3. Medical service providers under the Cigna Healthcare Medical Network are independent third-party contractors and not our agents or employees, and vice versa. Cigna Healthcare makes no representation, warranty or undertaking as to the quality and availability of the services provided by the medical service providers. Under no circumstance shall Cigna Healthcare be responsible or liable for the acts or omissions of the medical service providers in the provision of their services.
4. Day Procedure Centre Cashless Service is only applicable to the Insured Person of below selected medical plans and subject to the terms and conditions, including but not limited to the exclusions, of the policy:
   • Cigna HealthFirst Elite 360 Medical Plan*
   • Cigna HealthFirst Elite-GEH Medical Plan*
   • Cigna HealthFirst Elite Medical Plan*
   • Cigna HealthFirst Choice Medical Plan (with optional Supplementary Major Medical Benefit)
   • Cigna VHIS Series － Flexi Plan (SMM)
   • Cigna VHIS Series － Flexi Plan (Superior)*
   • Cigna Cathay Premier Health Plan*
   • Cigna HealthFirst Core Medical Plan (with optional Supplementary Major Medical Benefit)

   Note: * Day Procedure Centre Cashless Service is applicable only where the balance of the deductible for the policy year is HK$0 on the treatment incurred date.

5. [(Applicable to Cigna HealthFirst Choice Medical Plan (with optional Supplementary Major Medical Benefit) and Cigna HealthFirst Core Medical Plan (with optional Supplementary Major Medical Benefit) only)] For eligible cases of Day Procedure Centre Cashless Service in designated network provider, the Insured Person can enjoy an extension of medical coverage, including:
   1. For anaesthetist’s and operation theatre expenses, will now be payable in corresponding benefit items.
   2. The HK$500 deductible and 20% co-payment of the Supplementary Major Medical Benefit will be waived for eligible cases of Day Procedure Centre Cashless Service in designated network Day Procedure Centres and the associated eligible expenses payable under such benefit would not be subject to the lifetime and annual limit of such benefit.
6. For any application for Day Procedure Centre Cashless Service, the Insured Person must show a medical need for the Day Procedure:
   1. For medical plans without an outpatient rider, if the doctor determines that the Insured Person has no medical necessity for the Day Procedure after the 1st specialist consultation, then Day Procedure Centre Cashless Service will not be available and the Insured Person shall bear the medical expenses of the 1st specialist consultation.
   2. For medical plans with an outpatient rider, if the doctor determines that the Insured Person has no medical necessity for the Day Procedure after the 1st specialist consultation, then Day Procedure Centre Cashless Service will not be available and the medical expenses for the 1st specialist consultation will be settled by Cigna Healthcare under the terms of the outpatient rider (and if the specialist benefit has been fully claimed, Cigna Healthcare will bear such specialist consultation fee).
   3. For medical plans with or without an outpatient rider, if the doctor determines that the Insured Person has medical necessity for the Day Procedure, Day Procedure Centre Cashless Service application can be made and the medical expenses for the 1st specialist consultation will be settled by Cigna Healthcare under the terms of the policy or otherwise borne by Cigna Healthcare.
7. Cigna Healthcare has the absolute discretion to decline the Cashless Medical Service application based on information provided by the Insured Person and/or Policyholder about the Insured Person’s medical condition, the terms and conditions of the policy and other related information available at the time of the assessment of the application, or if the Insured Person does not fulfill the eligibility of the Day Procedure Centre Cashless Service, or if the Cashless Medical Service application does not include valid, sufficient, and complete information for credit card authorization. In case of rejection by Cigna Healthcare of the application, Cigna Healthcare may, at its absolute discretion, offer an agreed rate of the Day Procedure and the charges of the Day Procedure shall be paid by the Insured Person.
8. Cigna Healthcare will confirm the application approval by issuing the Insured Person an approval letter for the Day Procedure Centre Cashless Service which sets out the terms and conditions of the arrangement ("Approval Letter"). Neither the Cashless Medical Service application form ("Pre-approval Form") nor the Approval Letter shall be construed as an admission of any liability on the part of Cigna Healthcare. The actual eligible or payable amount shall be based on the final claim decision of Cigna Healthcare that is subject to the terms and conditions, including but not limited to the exclusions, in the policy. If any information provided to Cigna Healthcare is incorrect or incomplete which results in Cigna Healthcare approving the application, the Insured Person shall be liable to compensate Cigna Healthcare against all losses suffered by Cigna Healthcare.
9. The approval for the Day Procedure Centre Cashless Service is valid for 30 days. The approved Day Procedure must be conducted within 30 days after the pre-authorization approval.
10. You are required to pay all the medical expenses which exceed the benefit limits stated in the benefit schedule and policy provisions, and any charges not covered in the policy or exceed the approved amount stated in the Approval Letter.
11. If the medical expense exceeds the payable amount under the eligible benefit of the policy, or is otherwise not eligible for reimbursement under the policy, a shortfall collection notice will be sent to the Policyholder and the shortfall or ineligible amount will be debited from the authorized credit card account provided by the Insured Person in the Pre-approval Form within 21 days after issuance of the shortfall collection notice. If the final costs of the Day Procedure exceed the approved amount mentioned in the Approval Letter, the excessive amount will be collected by the medical service provider from the Insured Person directly. In assessing a Cashless Medical Service application, Cigna Healthcare would consider multiple factors including but not limited to any outstanding shortfall or ineligible amount or outstanding premium balance.
12. You are required to settle the consultation and/or related fees directly with the medical service provider if you are not eligible to enjoy Cashless Service.
13. Cigna Healthcare has the sole and absolute discretion in relation to all matters arising from or in connection with the Day Procedure Centre Cashless Service, and that in the event of disputes, the decision of Cigna shall be final, conclusive and binding.
14. To the extent the terms and conditions for Day Procedure Centre Cashless Service are inconsistent with the relevant provisions under the Policy, such policy provisions shall be deemed to be amended accordingly.
15. The terms and conditions for Day Procedure Centre Cashless Service shall be governed by and interpreted in accordance with law of Hong Kong. The courts of Hong Kong shall have exclusive jurisdiction over any disputes arising from the term and conditions, including the validity and enforceability thereof.

Remarks:

1. "Cigna Healthcare", "We", "our" or "us" herein refers to Cigna Worldwide General Insurance Company Limited.
2. Cigna Healthcare reserves the right to change any of the terms and conditions of the above services or promotion, and to terminate the services or promotion at any time without prior notice. In case of any disputes, Cigna Healthcare’s decision shall be final, conclusive and binding.
3. This leaflet is for distribution in Hong Kong only. It does not constitute an offer to sell, a solicitation to purchase, or the provision of any insurance product of Cigna Healthcare outside Hong Kong. The information contained in this leaflet does not constitute a contract of insurance or an offer, invitation, or solicitation to any person to enter into any contract of insurance.
4. The English version of this leaflet shall prevail if there is any discrepancy between the English and Chinese versions.