Cigna HealthFirst Choice Medical Plan

Terms & Conditions

Important Information

Premium

1. Premium Level
The premium of the plan level selected by you is determined based on the age, sex and smoking habit of the person insured at policy commencement and at the time of renewal upon each anniversary date of the policy.

2. Non-payment of Premium
If you fail to pay the initial premium, your policy will not take effect from the commencement date of your policy. Except for the initial premium payment, there will be a grace period of 1 month after any premium due date. Your policy will remain effective during this grace period. If any premium is not paid at the end of the grace period, your policy will lapse on the premium due date and you will lose the insurance cover.
We will not make any claim payment or any other payment payable under the policy, until we receive payment of all outstanding premium up to the date of the claim payment or when the policy terminates.

3. Mis-statement of Age or Smoking Habit
If age, sex or smoking habit has been mis-stated by you or any person insured but the relevant person insured would still be eligible for coverage, we have the right to adjust the premiums payable based on the correct information.

4. Premium Adjustment
The Company reserves the right to revise the premium of the policy on the anniversary date or upon renewal. Factors leading to premium adjustment may include but are not limited to our experience in claims and expenses incurred by and/or in relation to this product.

Benefits

1. Extent of Benefits
The coverage under this policy is worldwide, except under the Optional Insurance Benefits, which is subject to emergency conditions if expenses are incurred outside of Hong Kong. We reserve the right to request that the person insured obtain preapproval from us before incurring such relevant expenses.

2. Supplementary Major Medical Benefit
If the person insured uses a higher level of hospital facilities and services than he is entitled under this policy, the benefit amount payable shall be lowered according to the adjustment factor. This benefit shall not be payable for class of suite/ VIP/ deluxe room of a hospital.

Under the Supplementary Major Medical Benefit, the following terms and conditions shall apply regarding the Lifetime Limit starting from the anniversary date after the person insured reaches age 75:

1. Any benefit payable under this section will be deducted from the Lifetime Limit, the balance of the Lifetime Limit as at the end of the current policy year will be carried forward to the next policy year.
2. If the person insured’s application for a change in the benefit level is approved by the Company, the Lifetime Limit applicable to the next policy year will be equivalent to the Lifetime Limit of the new benefit level, minus all benefits paid since the anniversary date following the person insured reaching age 75.
3. This benefit will automatically terminate upon the first anniversary date after the Lifetime Limit is exhausted.

Duplicated Policy

Person insured can only be covered under one single "Cigna HealthFirst Medical Plan Series" policy. The series includes "Cigna HealthFirst Elite Medical Plan", "Cigna HealthFirst Choice Medical Plan", "Cigna HealthFirst DiaMedic Plan" and any other insurance policies that fall under the "Cigna HealthFirst Medical Plan Series", "Cigna VHIS Series" and "Cigna Cathay Premier Health Plan Series" as defined and issued by the Company from time to time.

Co-ordination of Benefits

If any Medically Necessary charges shall be reimbursed by another party or by us under another insurance plan, we shall only be liable for the difference between such reimbursement and the total amount of benefits which would otherwise be payable in respect of such medical expenses under the policy.

Renewal

The Hospital and Surgical Benefits will be effective for an initial period of 12 months and thereafter guaranteed and automatically renewable, for successive periods of 12 months each provided that we continue to issue new policy(ies) under the "Cigna HealthFirst Choice Medical Plan", and upon payment of the premium at the time of renewal. The Company reserves the right to revise the terms of the policy and/or the premium and/or the benefit schedule upon each renewal.

Termination

1. The policy will be automatically terminated when one of the following happens:

• The person insured passes away;
• Any premium is not paid at the end of the grace period; or
• The policy is terminated by the Company or the policyholder.

2. If there is any fraud, mis-statement or concealment in the application or declaration, or if you or your beneficiary makes a dishonest claim, we have the right to cancel the policy immediately. In such case, all the premium paid will not be returned and you shall immediately return all payment includingclaims paid by us under the policy.

3. The Company may terminate any Optional Insurance Benefit, by giving not less than 30 days’ advance notice in writing to you.

4. If the policy is terminated by the policyholder during the policy year, we reserve the right to charge the premium until the end of such policy year after the termination.

Inflation risk

Your current planned benefit may not be sufficient to meet your future needs since the future cost of living may become higher than they are today due to inflation. Where the actual rate of inflation is higher than expected, you may receive less in real terms even if we meet all of our contractual obligations.

KEY EXCLUSIONS

The following list is for reference only. Please refer to the policy provisions for the complete list and details of exclusions.

We shall not be liable for any claims or the expenses incurred through, directly or indirectly caused by, or resulting from any one or more of the following:

Applicable to all benefits (including Optional Insurance Benefit) :

1. Pre-existing medical conditions;
2. War, invasion, act of a foreign enemy, hostilities (whether war is declared or not), civil commotion, rebellion, revolution, insurrection, military or usurped power or terrorism;
3. The person insured’s suicide, attempted suicide or intentionally self-inflicted injuries while sane or insane;
4. The person insured being under the influence of alcohol or drugs unless, in the case of drug consumption, it is proven that such drug was taken in accordance with a proper medical prescription by a physician other than for the treatment of drug addiction;
5. Pregnancy, childbirth and miscarriage of or abortion by the person insured, including complications resulting therefrom notwithstanding that such incident may have been accelerated or induced by bodily injury or sickness; infertility or sterilization or any type of fertility;
6. Infection with Human Immunodeficiency Virus (HIV) or variants including Acquired Immune Deficiency Syndrome (AIDS) and AIDS-related complex (ARC); sexually-transmitted diseases or treatment thereof;
7. Birth defects, congenital conditions, development conditions, hereditary conditions or any disabilities arising therefrom; congenital conditions; developmental conditions; or hereditary conditions;
8. Cosmetic and elective surgery;
9. Vaccination and immunization injections;
10. All dental treatment prescribed by a dentist except emergency treatments by a physician during hospital confinement due to bodily injury; follow-up treatment from such hospital confinement (unless the Dental Benefit applies under this policy);
11. Mental, psychiatric or nervous illness;
12. Treatment for a related condition resulting from addictive conditions and disorders; sleep disorders including insomnia, snoring, sleep-related breathing problems or sleep studies;
13. Treatment that is not medically necessary;
14. The person insured’s voluntarily exposing himself/herself to any hazard or danger;
15. Fees/expenses incurred due to the following reasons:
    1. Convalescence accommodation, treatment or services rendered at any sanatorium or similar establishment;
    2. Prosthesis, corrective devices and medical appliances, that are not intra-operatively required;
    3. All organ transplantation, transplant procedures and acquisition of the organ itself to be used for organ transplantation;
    4. Routine medical examinations or health screening checks;
    5. Alternative treatment including but not limited to Chinese medicine treatment, acupuncture, acupressure, Tui Nai, hypnotism, rolfing, massage therapy, aromatherapy (unless provided under the Acupuncturist benefit, Chinese Herbalist benefit and Chinese Bonesetter benefit payable under the Benefit Schedule).
    6. Experimental and/or new medical technology/procedure not yet approved by the Company; or
    7. Non medical services, including but not limited to guest meals, radio, telephone, photocopy, taxes (apart from VAT and GST charged on eligible expenses), medical report charges and similar charges.

Applicable only to the Optional Dental Benefit :

1. Appliances or restoration necessary to increase vertical dimension or restore an occlusion;
2. Dental implants;
3. Cosmetic dentistry procedures such as bleaching and veneers;
4. Orthodontic services;
5. Repair or replacement of orthodontic appliances;
6. Placement of bone grafts or extra-oral substances in the treatment of periodontal disorders;
7. Procedures or appliances to correct congenital malformations;
8. Treatment of malignancies, cysts, or neoplasms;
9. Replacement of lost or stolen dentures;
10. Services or treatment for, or associated with, temporomandibular joint (TMJ) dysfunction or disorder or for orthognathic surgery;
11. Services or supplies intended to diagnose or treat any condition that is an occupational injury or disease; or
12. Replacement of or additions to existing dentures or bridgework.

The above insurance plan is underwritten by Cigna Worldwide General Insurance Company Limited.

The above information is for reference only and does not constitute any contract or any part thereof between Cigna Healthcare and any other parties. Please read the product brochure for details. For details of full terms, conditions and exclusions, please refer to the policy provisions. Cigna Healthcare will be happy to provide a specimen of policy upon your request.