Cigna Health4Kids
PREMIUM REFUNDABLE PLAN

Premium

1. Premium Level and Adjustment

The premium level of Cigna Health4Kids Premium Refundable Plan corresponding to the plan level you select is determined based on age of the person insured at policy commencement. The premium of basic benefits is level and guaranteed, while that of optional outpatient benefit is yearly adjustable and we have the absolute right and discretion to adjust annually. Factors leading to premium adjustment may include but are not limited to our experience in claims, surrender, investment return, and expenses incurred by and/or in relation to this benefit.

2. Non-payment of premium

If you fail to pay the initial premium, your policy will not commence or take effect. 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 shall deduct any outstanding premium from any benefit(s) payable.

3. Mis-statement of Age

If mis-statement of the Person Insured’s age by you or any Person Insured means that the Person Insured is still eligible for coverage, we have the right to adjust the premiums payable based on the correct information.

If mis-statement of the Person Insured’s age by you or any Person Insured means that there is a period during which the Person Insured is ineligible for coverage, all coverage during this period will be void. Our liability shall be limited to a refund (upon written request) of any premium relating to this period, to be paid out without interest. In case of fraud on the part of the Person Insured and/or the Policyholder, no premium refunds are payable. If any claims are made during such a period, we retain the right to recover them

4. Premium Term and Early Surrender

The premium term of Cigna Health4Kids Premium Refundable Plan will be payable up to age 11 of person insured for Plan 1 while up to age of 15 of person insured for Plan 2 and Plan 3. If you surrender the policy before the end of policy term, the amount of benefit getting back (i.e. Cash Value) will be less than the total Basic Premium paid and you may suffer a loss of money and insurance coverage.

Benefits

1. Kids Critical Illness Benefit

   The Kids Critical Illness Benefit will be paid if the person insured suffers from a first confirmed diagnosis of the major diseases and has survived for 30 days thereafter. If the person insured dies within 30 days after the first confirmed diagnosis of major diseases, only Compassionate Death Benefit will be paid.

2. Premium Waiver Benefit

   The Premium Waiver Benefit will be paid if the policyholder suffers from the following conditions:

• The policyholder passes away subsequent from the diagnosis of major diseases and has survived for 15 days thereafter ; or
• The policyholder dies due to an accident; or
• The policyholder becomes permanently disabled for continuous 6 months

To entitle the Benefit, the policyholder must be aged 50 or below when the policy is firstly issued. The Benefit is subject to a waiting period, which refers to 2 years from the issue date or the commencement date (whichever is the later) or any approval date of reinstatement of your policy.

Termination

1. This Policy shall terminate forthwith upon the occurrence of the earliest of the following:
1. the anniversary date on or the first anniversary date immediately following the person insured’s fifteenth (15^th) birthday for Plan 1 shown under the policy schedule and the person insured’s nineteenth (19^th) birthday for Plan 2 and 3 shown under the policy schedule(i.e. the maturity date of the policy);
2. the death of the person insured;
3. the Kids Critical Illness Benefit is fully paid;
4. at the end of a grace period when the premium payable or any part thereof remains unpaid; or
5. the policy is terminated by 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 of the premium paid will not be returned and you shall immediately return all payment including claims paid by us under the policy.
• Inflation Risk
  While your current planned benefits will not be adjusted during the policy term, future medical costs may be higher than they are today due to inflation.
• Cooling Off Righ
  You may cancel your policy and obtain a refund of any premium(s) paid by you within the cooling-off period. The cooling-off period is 30 days after (i) the delivery of the policy, or (ii) issue of a notice (informing the availability of the policy and expiry date of the cooling off period), whichever is the earlier. You have to tell us by giving a written notice if you decide to exercise your cooling-off right. Such written notice must be signed by you and received directly by us at 15/F, 28 Hennessy Road, Wanchai, Hong Kong. No refund can be made if a claim has been made.
• Key Exclusions
  The following list is for reference only and does not represent a full list of exclusions. Please refer to the policy provisions for the complete list and details of exclusions.Cigna shall not be liable to pay any claim or expenses incurred directly or indirectly resulting from or consequent upon or contributed by the following items:
  1. Any congenital abnormality or disorder.
  2. Pre-existing medical conditions and any special exclusion(s) set out under this policy;
  3.  Any accident, bodily injury or illness sustained or suffered during the Waiting Period;
  4.  Suicide, attempted suicide, suicide pact or deliberate self-inflicted injury, while sane or insane;
• Under the Hospital Cash and Outpatient Benefits (optional benefit), we do not cover expenses directly or indirectly caused by or resulting from any one or more of the following:
1. Pre-existing medical conditions and any special exclusion(s) set out under this policy;
2. Any accident, bodily injury or sickness sustained or suffered by the person insured which has occurred or which has been diagnosed or which has exhibited symptoms or which has required medical advice and/or treatment and/or the prescription of drugs prior to and/or during the Waiting Period (applicable for Hospital Cash only);
3. War, invasion, act of foreign enemy, hostilities (whether war is declared or not), civil commotion, rebellion, revolution, insurrection, military or usurped power or terrorism;
4. Suicide, attempted suicide or intentionally self-inflicted injuries, whether sane or insane;
5. Any act being contrary to the law of the country or territory in which the bodily injury or sickness occurs as a result of such act;
6. Infection with Human Immunodeficiency Virus (HIV) or variants including Acquired Immune Deficiency Syndrome (AIDS) and AIDS-related complex (ARC);
7. Birth defects, congenital conditions, hereditary conditions or any disabilities arising therefrom;
8. Eye refraction error and the treatment(s) of which involve but not limited to, laser treatment, refractive keratotomy or photorefractive keratectomy, except due to Bodily Injury. The Company shall pay for treatment to correct or restore eyesight if it is medically necessary as a result of a sickness or bodily injury, such as cataracts or a detached retina;
9. Routine eye／ear examinations, cost of spectacles, contact lenses, hearing aids and artificial lens;
10. Vaccination and immunisation injections.
11. All dental treatment prescribed by dentist except emergency treatments by a physician during hospital confinement due to bodily injury. No claims shall be payable for any follow up treatment from such hospital confinement;
12. Mental, psychiatric or nervous illness, personality disorder and character disorders;
13. Organ transplantation as a donor;
14. Footcare by a chiropodist or podiatrist;
15. Developmental conditions including but not limited to:
1. Learning difficulties such as dyslexia;
2. Behavioral problems such as autism or attention deficit disorder (ADHD); and
3. Physical development problems such as short height.
16. Not medically necessary;
17. The person insured’s voluntarily exposing himself／herself to any hazard or danger.
18. Convalescence accommodation or treatment or services rendered in any sanatorium or similar establishment;
19. Medical treatment received after termination of this policy or the expiry of the period of insurance notwithstanding that such expense may arise from bodily injury or sickness occurring during the period of insurance;
20. Routine medical examinations or health screening checks;
21. Any bodily injury or sickness for which compensation is payable under any laws or regulations or any other insurance plan, unless such charges are not reimbursed by such laws or regulations or other insurance plan;
22. Alternative treatment including but not limited to Chinese Medicines treatment, acupuncture, acupressure, Tui Nai, hypnotism, rolfing, massage therapy, aromatherapy except such occurrence are covered under “Acupuncture” or “Chinese Medicine Practitioner Consultation” or “Chinese Bone-setting” of Outpatient Benefits (optional benefit);
23. Experimental and／or new medical technology／procedure not yet approved by the Company;
24. Non-medical services, including but not limited to guest meals, radio, telephone, photocopy, taxes, medical report charges, fax and the like;
25. Treatment which is provided by anyone who lives at the same address as the Person Insured or who is a member of Person Insured’s family
• The following exclusions are applicable to Wellness Child Benefit only:
1. Cost of spectacles, contact lenses, hearing aids and artificial lens; and
2. For cosmetic purpose.

• The following exclusions are applicable to Premium Waiver Benefit only:

1. Pre-existing medical conditions and any special exclusion(s) set out under this policy;

2. Any accident, bodily injury or illness sustained or suffered by the policyholder which has occurred or which has been diagnosed or which has exhibited symptoms or which has required medical advice and／or treatment and／or the prescription of drugs prior to and/or during the Premium Waiver Waiting Period;

3. The policyholder's suicide, attempted suicide or intentionally self-inflicted injuries, whether sane or insane; 

4. Alcohol abuse, the consumption of drugs not follow a Physician’s prescription, Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or infection with the Human Immunodeficiency Virus except “Infection due to Blood Transfusion” and “Occupationally acquired HIV” as defined in this Policy;

5. Birth defects, congenital conditions, hereditary conditions or any disabilities arising therefrom;

6. The policyholder’s engaging in or taking part in:

   1. Naval, military or air force service or operations, armed force or service with the police of any nation;

   2. Professional sports or hazardous activities such as but not limited to rock climbing or mountaineering, parachuting, hang-gliding (whether powered or not), para-gliding, bungi-jumping or any kind of race other than by foot;

   3. Cave, wreck or free diving, professional diving, diving without holding the correct diving certification such as a Professional Association of Diving Instructors (PADI) and diving at depths below 40 meters;

   4. Professional, semiprofessional or competitive winter sports, cross country skiing or snowboarding, ski or snowboard jumping, heli-skiing, off piste skiing or snowboarding, Speed Skiing;

   5. Working at height (over 20 feet);

   6. Operating heavy machinery; 

   7. Aviation or aerial activities except air travel as a fare-paying passenger in or as a member of the aircrew of a properly licensed, fixed-wing multi-engined aircraft constructed to carry passengers and operated by a licensed commercial air carrier or in a helicopter owned and operated by a commercial concern which is licensed for the regular transportation of fare-paying passengers provided such helicopter is operating only between commercial airports and／or licensed commercial heliports and provided further that in either event such travel is not for the purpose of any trade or technical operation in or on the aircraft; or

   8. Manufacture, storage, filling, breakdown, handling and transport of any explosive (including but not limited to firework or firecracker) or chemical material;
7. Medical or surgical treatment, except where such treatment is rendered necessary by bodily injury within the scope of this policy;
8. Pregnancy, childbirth, miscarriage, abortion or complications arising from any of them even though such loss may have been accelerated or induced by Bodily Injury;
9. Any illegal act of the policyholder in the country where bodily injury occurs;
10. Being in a state of insanity or psychiatric or psychological disturbance;
11. Driving any kind of vehicle while the alcohol level in policyholder’s breath, blood or urine is higher than the legal limit in the country where bodily injury occurs;
12. War or any act of war, invasion, act of foreign enemy, hostilities (whether war be declared or not), strike, riot and/or civil commotion, civil war, rebellion, revolution, insurrection, military or usurped power or terrorism.