Cashless Medical Service

Cashless Medical Service is applicable to designated Cigna medical plans, and the covered medical expenses are subject to the terms & conditions and benefit coverage of your policy. If you fail to meet the requirements for the Cashless Medical Service, you may need to pay for the consultation and/or medical expenses upfront, then submit a claim to Cigna Healthcare for reimbursement, which shall be subject to the terms & conditions and benefit coverage of your policy.

The Policy Holder is responsible for settling any amount if there is any remaining deductible in any Policy Year (if applicable). 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, the Policy Holder is required to settle the remaining amount.

Upon receipt of the Cashless Medical Service request with completed information, we will inform you the pre-approval result, approved credit amount and out-of-pocket amount (if any) via email or phone call within 5 working days.

Cashless medical service is subject to ongoing review throughout the admission after initial approval, for example, for extended hospitalization, based on medical necessity, policy terms and conditions, and applicable benefit coverage.

Your Cashless Medical Service pre-approval request might be declined due to but not limited to the following reasons:

• The treatment or surgery is not medically necessary
• The medical condition for application is under and/or related to an exclusion
• Incomplete information on the Pre-approval Form for Cashless Medical Service
• Overdue premiums and/or shortfalls have not been fully paid
• Unable to submit the application 5 working days before admission/procedure date, for example, emergency admission
• Treatment or surgery performed in public hospitals under the Hospital Authority
• Treatments in non-network doctors/clinics
• Medical expenses within annual deductible
• Not applicable for Cigna Plus Medical Plan, Cigna DIY Health Plan and Cigna Telehealth Service

Cashless Medical Service is a value-added service which provides preliminary review of requested treatment/procedure based on medical information received, policy coverage, benefit and Term & Condition. If your application is declined (except for the following circumstances), you may submit a claim to Cigna Healthcare for reimbursement, which shall be subject to the terms & conditions and benefit coverage of your policy.

• The treatment or surgery is not medically necessary
• The medical condition for application is under and/or related to an exclusion