CIGNA HEALTHFIRST ELITE
MEDICAL PLAN
Enroll with children to enjoy 50% premium discount
5-star coverage up to $50,000,000 per year
PLAN BENEFITS
Cigna HealthFirst Elite Medical Plan offers comprehensive worldwide medical & hospital insurance coverage with no lifetime limit1.
Cigna Care Manager Service
Staffed by registered nurses with a wealth of clinical experience. They can offer personalized healthcare concierge services, making sure you receive the most suitable care and a speedy recovery experience.
Comprehensive Medical Insurance Coverage
Unlimited lifetime cover1, a range of hospital and surgical benefits, cashless hospitalization subject to pre-approval, and an annual limit of up to HK$50 Million2.
Global Medical Network
With over 7,000 hospitals and globally accessible 24-hour Cigna HealthFirst Elite Hotline.
Flexible Options
Tailor your insurance plan with a range of geographical options, accommodation room types, annual deductibles7, and optional riders - Pharmacy, Outpatient, Dental, Premium Waiver due to Cancer, and Deductible Discount.
5 STAR RATED IN THE HIGH END CATEGORY
Cigna HealthFirst Elite Medical Plan has been recognized by 10Life as a preferred choice for high-end medical insurance plan in the market. It garnered a 5-star Rating and Medical Coverage Score of 10/10 at both Private Room Level and Semi-Private Room Level3 (As of 31 March 2023).
Medical Insurance Coverage Details
PLAN TYPE, POLICY TERM AND PREMIUM STRUCTURE OF BASIC PLAN
HOSPITALIZATION AND SURGICAL BENEFITS
EXCLUSIVE PRIVILEGES
ISSUE AGE
INSURANCE COVERAGE AMOUNT
CASHLESS HOSPITALIZATION ARRANGEMENT
ADDITIONAL SERVICES
PLAN TYPE, POLICY TERM AND PREMIUM STRUCTURE OF BASIC PLAN
- This product is a standalone individual policy. The basic plan provides hospitalization benefits which can be added with optional benefits of outpatient or other medical protection. The policy provides both indemnity and non-indemnity benefits. It does not contain any cash value.
- 1 year and Annually Renewable.
- The plan provides a protection period of one year, and is guaranteed renewable for the lifetime of the Person Insured, with payment period until the end of protection period. Premiums will increase with age and are subject to annual adjustment at policy renewal.
HOSPITALIZATION AND SURGICAL BENEFITS
Comprehensive cover for hospital benefits, with full health insurance coverage in various medical expenses.
All your basic needs are fully covered, from hospital room and board to surgery, attending physician, specialist, intensive care, and private nursing fees, cancer treatment and kidney dialysis, rehabilitation, palliative care, and psychiatric inpatient treatment fees.
We offer you up to HK$2,000 in cash benefit for each day you’re in hospital or during compulsory quarantine4 for Notifiable Infectious Diseases5.
We cover all the medical appliances you may need, including pacemakers, stents, prosthetic ligaments, and metallic or artificial joints.
Extended benefits cover pre-admission and post-hospitalization outpatient expenses, post-hospitalization auxiliary treatment, traditional Chinese medicine, home nursing expenses, accident emergency outpatient treatment and accident emergency dental treatment, accidental death, and costs of local ambulance.
EXCLUSIVE PRIVILEGES
Additional Discounts
First year premium discount: 10% discount on your policy for the first year.
Spouse discount: An extra 10% discount on both you and your spouse’s policies for the first year.
Children’s discount: Enroll with your children (aged below 18) and enjoy a premium discount on their policies (not applicable to Optional Dental Benefits) - 50% discount until they reach the age 18.
ISSUE AGE
From 15 days to 75 years.
INSURANCE COVERAGE AMOUNT
Elite medical plan provides you with comprehensive medical coverage. Our superior annual limit is up to HK$50 Million2.
Unlimited lifetime claims apply to all basic benefits and most optional benefits, including:
- Hospital Room & Board
- Surgical Expenses
- Cancer Treatment (covers treatments of cancer including radiotherapy, chemotherapy, targeted therapy, immunotherapy, hormonal therapy, proton therapy, gamma knife and cyberknife therapies, as well as any ; andphysician consultation charges associated with these treatments (including planning, monitoring, follow-up etc.) whether in hospital, clinic or at home.
- Kidney Dialysis
- Advanced Diagnostic Imaging
For detailed coverage amounts for each of the Hospitalization and Surgical Benefits and Recommended Additional Benefits, please click here.
CASHLESS HOSPITALIZATION ARRANGEMENT
To enjoy our speedy “Cashless Hospitalization” service, we recommend that you submit an application via MyCigna or call the Cigna Customer Service Hotline as soon as possible once you know your treatment date, so we have time to make the proper arrangements. Once the Customer Service Department has looked into your case, we will assign a dedicated Care Manager to help you follow up on hospital surgery or treatment arrangements until your recovery. At the same time, we will provide emotional support to you and your family, allowing you to recover with comfort and peace of mind. Simply check this procedure to arrange pre-approval and obtain a Guarantee of Payment Letter.
ADDITIONAL SERVICES
Cigna Virtual Consultation
Cigna has partnered with DoctorNow to bring you a convenient telemedicine service. Customers can simply download the app to obtain medical advice through video medical video consultations with locally-registered physicians. You can also enjoy same-day medicine delivery and receive a doctor’s certificate and receipt. If you need a specialist referral, the doctor will help prepare you may request a referral letter from the doctor and you can access this through the app. To enjoy, download the DoctorNow app (search for "DoctorNow" via App Store / Google Play).
For more details about DoctorNow, you may refer to this video .
Cigna Medical Card
Just show your Cigna e-medical card on your smartphone via MyCigna app to enjoy discounts of up to 40% off when getting access to our extensive medical network throughout Hong Kong6.
Free annual physical health check-up
To give you a clear and up-to-date understanding about the state of your health, we will send you a free body check-up coupon 30 days after each policy anniversary date.
Remark:
- The unlimited lifetime cover does not apply to Optional Pharmacy Benefits.
- The Basic Benefit and Optional Outpatient Benefits under standard private room and semi-private room types are subject to an overall maximum annual limit of HK$50 Million and HK$30 Million respectively.
- 10Life is a digital platform that provides professional and unbiased insurance information for consumers. Using factors that matter the most to the consumers, 10Life produces objective high-end medical insurance scores and rankings based on medical coverage and auxiliary benefits. Only medical insurance plans that have 10Life Overall Medical Score (includes Medical Coverage Score and Auxiliary Benefits Score) higher than 9, which also means both medical coverage and auxiliary benefits are higher than market average can be recognized with a 5-star rating. 10Life actuarie refers to the benefit limits on each expense category to calculate the estimated coverage amount (to be paid by the insurer) and out of pocket expenses (to be paid by the policyholder). The 10Life Medical Coverage Score (out of 10) is calculated according to the Estimated Average Coverage Ratio, so higher the score means higher the medical coverage for the insurance plan. For more, please refer to 10Life ratings.
- Compulsory Quarantine applies if as required by the government on a mandatory basis, the Person Insured is being confined in an isolated ward of a Hospital or kept in an isolated site appointed and provided by the government for at least twenty-four (24) consecutive hours due to Notifiable Infectious Disease(s) suffered by the Person Insured and the Person Insured continuously stays in there until discharged from quarantine. For the avoidance of doubt, this benefit does not include cases where the Person Insured stays at home or any premises not being a Hospital or an isolated site appointed and provided by the government.
- Notifiable Infectious Diseases refers to any kind of notifiable infectious diseases identified and defined and published by Hong Kong Government in accordance with the Prevention and Control of Disease Ordinance (Cap. 599) or any kind of infectious diseases for which an outbreak alert is issued by the World Health Organization.
- Discounts offered by different Cigna medical network doctors may vary. In case of any dispute, Cigna’s decision shall be final.
- Different deductible options may vary across different sales channels.
RECOMMENDED ADDITIONAL BENEFITS
OUTPATIENT BENEFITS
Covers visits to a general practitioner, specialist, Chinese medicine practitioner, and acupuncturist, as well as expenses for dietetic guidance, prescribed western medicine, and diagnostic imaging and laboratory tests.
PHARMACY BENEFITS
A rider that covers medication costs for over 50 major diseases, including cancer and strokes.
DENTAL BENEFITS
Coverage includes scaling and polishing, fillings, dentures, crowns and bridges (only if necessitated by an accident), drainage of abscesses, intraoral extractions, X-ray, root canal fillings and routine oral examination.
DEDUCTIBLE DISCOUNT BENEFITS
With no-claim records in each policy year, you will be entitled to 10% deductible discount at next policy year which can be accumulated up to 100%. The higher your deductible discount, the lower the amount of deductible you need to bear.
PREMIUM WAIVER DUE TO CANCER
A lump sum benefit amount which is equivalent to half of the annualized premium of the basic benefits is payable if the person insured suffers from first confirmed diagnosis of cancer.
ILLUSTRATIONS
End-to-end medical protection
Customized protection for family
Kathy 40 years old
End-to-end medical protection
Kathy worries about rising medical costs. She wants a medical plan that provides her with comprehensive coverage. She enrolls in Cigna HealthFirst Elite Medical Plan at age 40. The plan Kathy enrolled in is Cigna HealthFirst Elite Medical Plan – Standard Private Room, Asia coverage with annual deductible of HK$25,000, with optional benefit Premium Waiver due to Cancer.
Cigna HealthFirst Elite Medical Plan offers comprehensive and superior benefit to ensure Kathy receives adequate protection throughout life’s journey. Kathy continues to pay her Elite premiums for 5 years. Over this time, Cigna HealthFirst Elite Medical Plan offers her ongoing support to help her maintaining her good health by providing free health check-up every year.
At age 45, Kathy was advised by her doctor to consult an oncologist following an annual health check-up. She was eventually diagnosed with a malignant tumor in her left breast, requiring 5 days of hospitalization for the surgical removal of the tumor. Kathy called Cigna’s Customer Service Hotline to inquire about her coverage. She was assigned a dedicated Care Manager, Jackie who arranged the appropriate follow-up services for her, from hospitalization to recovery.
Plan Level: Cigna HealthFirst Elite Medical Plan – Standard Private Room, Asia coverage, No Deductible
Premium Payment Frequency: Annual
| Benefit Items | Benefit Paid(HK$) |
| Prevention: | |
Free health check-up is offered every year (5 years x HK$1,200) | HK$6,000 |
|---|---|
| Diagnosis & Treatment: | |
Premium Waiver due to Cancer (6 months of premium) | +HK$5,921 |
Hospitalization Expenses (cashless) including mastectomy and breast reconstruction1 | +HK$250,000 |
Cancer Treatment (including chemotherapy and targeted therapy) | +HK$450,000 |
Hospital Cash for Confinement in a Lower Room Level of a Private Hospital (Semi-Private) (5 days x HK$2,000)2 | +HK$10,000 |
| Recovery: | |
Post-Hospitalization Outpatient Expenses (20 follow-up consultations over the 6 months following her surgery) | +HK$27,920 |
Traditional Chinese Medicine Treatment (10 visits to a Traditional Chinese Medical Practitioner to help manage side-effects and restore immune system, valued at HK$600 per visit)Nutritional guidance and meal delivery service (3 meals per day x 10 days) HK$2,000 | +HK$6,000 |
Deductible | -HK$25,000 |
| Total benefit paid: | =HK$726,841 |
| Total premium paid from age 40 - 453: | -HK$64,656 |
| Net benefit from Cigna HealthFirst Elite Medical Plan: | =HK$668,185 |
Apart from the financial coverage, what Kathy found most unexpected was the level of service provided by her dedicated Care Manager, Jackie. An experienced nurse, Jackie provided her with options of doctors4 prior to her admission, visited her following surgery, and made arrangements regarding her recovery after she was discharged. This support gave Kathy peace of mind during her sickness, while at the same time relieving the burden on her husband as her caretaker.
Remark:
- Breast reconstruction is covered under the Surgical Expense benefits.
- Deductible does not apply to Hospital Cash for Confinement in a Lower Room Level of a Private Hospital.
- The premium quoted above are indicative only and subject to rounding. It may change from time to time at Cigna's discretion
- Applicable to network doctors only.
Stephen 38 years old
Family protection, customized to each individual’s needs
Stephen wants to arrange a comprehensive medical protection for his family, so he enrolls with his family together at age of 38. Stephen and his wife Mabel are entitled to group medical coverage through their employers. To take advantage of this, they opt for higher deductibles to coordinate with their group plan while enjoying comprehensive protection from Elite. As their son Adrian is about to move to Canada to study, they select the optional outpatient benefit to avoid any protection gap while he is abroad.
Stephen (age 38) and Mabel (age 35) insured Cigna HealthFirst Elite Medical Plan – Private Room, Worldwide (excluding the US) coverage with annual deductible of HK$75,000 with an optional benefit of Deductible Discount; Their son, Adrian (age 13) insured Cigna HealthFirst Elite Medical Plan – Private Room, Worldwide (excluding the US) with annual deductible of HK$15,000 and the optional benefits of Deductible Discount and Outpatient Benefit.
Three years later, Stephen and Mabel went to visit Adrian in Vancouver during Christmas and went skiing together. Unfortunately, Adrian broke his leg. Adrian stayed in hospital for 4 days. He also needed follow up physiotherapy after discharge.
| Benefit Items | Benefit Paid(HK$) |
| The following benefits are provided in full claims: | |
| Hospitalization and surgical expenses | HK$220,000 |
|---|---|
| Companion Bed | HK$8,400 |
| Local Ambulance Benefit | HK$1,440 |
| Full cover for the 20 visits to a physiotherapy after discharge | HK$27,000 |
| Hospital Cash for Confinement in a Lower Room Level of a Private Hospital1 (Semi-Private) for 4 days of hospitalization , HK$2,000/day | HK$8,000 |
| Total Medical Expenses with Hospital Cash | HK$264,840 |
| Deductible2 | －HK$12,000 |
| Total Benefit paid | HK$252,840 |
| Total Premium3 paid for the 3 years for Adrian $(17,840+814+23,851) x 40% = HK$17,002 $(18,338+839+24,501) x 50% = HK$21,839 $(18,984+873+25,334) x 50% = HK$22,595.5 | HK$61,437 |
| Net benefit from Cigna HealthFirst Elite Medical Plan | HK$191,404 |
Remark:
- Deductible does not apply to Hospital Cash for Confinement in a Lower Room Level of a Private Hospital.
- Deductible: $15,000 x (1-20% deductible discount ) = $12,000
- The premium quoted above are indicative only and subject to rounding. It may change from time to time at Cigna's discretion.
FAQS
Application
How to enroll in Cigna HealthFirst Elite Medical Plan (“Elite”) ?
You may submit your application through our website, or by calling Cigna on (852) 8100 3705, or contact your insurance brokers for details.
What do I need to be able to buy online now?
Before you start your online purchase, please make sure you have below information ready:
- Your HKID no.
- The ID (HKID or otherwise) of any family members you wish to cover
- Your basic contact information
- The height, weight, and medical history details of you or any family members you wish to cover
- Your credit card information
How can I pay?
You can pay online with your credit card. We accept VISA and Mastercard. If you wish to pay using a different method, please call our hotline on (852) 8100 3705
What can I do if I encounter problems on the online application?
Just sit back and relax. If you have entered your contact number in the application process, our Cigna representatives will contact you within 2 days. You may also call (852) 8100 3705 for enquiry.
If I am already covered by other Cigna policy, could I be still enrolled in Elite?
If you are already covered under “Cigna HealthFirst Medical Plan Series”, including “Cigna HealthFirst Choice Medical Plan”, “Cigna HealthFirst DiaMedic Plan”, or “Cigna VHIS Series” products, you may call (852) 8100 3705 for an underwriting of the new Elite Plan. If you accept the underwriting results and the new coverage details, we will arrange you to migrate from your old policy to the new Elite Plan.
Coverage
What’s the area of coverage for Elite?
There are 3 area of coverage options so you can choose where you want your coverage for Elite. They are Asia only (including Australia and New Zealand), Worldwide excluding USA and Worldwide including USA.
What are the annual limits and lifetime limits for benefits of Elite?
If you choose semi-private as accommodation room type, the annual limit would be HK$30,000,000. If you choose standard private room as the accommodation room type, the annual limit would be HK$50,000,000.
There’s unlimited lifetime claims for Elite. The annual limit would start over every policy year.
Are there any optional benefits on top of the basic benefits of Elite?
Elite’s core coverage is focused on hospitalization and surgical coverage. However, there are various optional benefits for Elite customers to extend coverage to enhance your protection:
- Outpatient Benefits: Extensive treatments including Western and Chinese Medicine and much more
- Pharmacy Benefits: Prescription medication for Major Diseases up to HK$80,000 per year
- Dental Benefit: Scaling and polishing twice a year, with full coverage of X-rays and common dental procedures
- Deductible Discount Benefits: 10% discount on your deductible for each eligible year
- Premium Waiver due to Cancer: 6-month premium waiver upon a cancer diagnosis to help focus on recovery
Deductibles
What is a deductible? Why include a deductible for Elite?
Cigna will start paying for the covered medical expenses once the deductible amount has been reached. The deductibles will be covered either by you or your other insurance plan(s) (e.g. group medical insurance).
For the higher deductible levels for the same coverage level, the lower the premium could be. It’s a way to coordinate the protection with your other insurance plans (including employee coverage) to achieve a lower premium.
Discounts
Any premium discount for Elite?
- First year premium discount: 10% discount on your policy for the first year
- Spouse discount: An extra 10% discount on both you and your spouse’s policies for the first year
- Children's Discount: For parents covered by Elite, their child would enjoy a 50% premium discount until the age of 18
- Discount is only eligible for customer who has not cancelled any individual medical insurance scheme Cigna HealthFirst Elite Medical Plan underwritten Cigna Worldwide General Insurance Company Limited within 12 months prior to the date of submitting the application for Cigna Healthfirst Elite Medical Plan. Subject to the arrangement upon enrollment
Premium Adjustment
Would premium be adjusted upon renewal?
Cigna 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 overall experience in claims and expenses incurred by and /or in relation to this product. However, we will not adjust your premium based on your own health status or personal claims record.
Renewal
Would I be rejected for renewal for the change of my health conditions?
The basic benefits and optional insurance 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 Cigna continue to issue new policy(ies) under the Basic Benefits and respective Optional Insurance benefits (if applicable) of Elite, and upon payment of the premium at time of renewal. This means any change in your health won’t have any impact on your eligibility to renew your policy.
Claims
Would the benefits pay to policyholder or insured?
We shall pay any benefits directly to the policyholder, except in case of the person insured’s death, when we shall pay the benefit amount to the beneficiary. (if applicable)
Any limitation on claims for hospitalization in mainland China?
If the diagnosis or Hospital Confinement takes place in mainland China, the Hospital must be of Tier 3 Class A or above or included on our list of designated Hospitals as advised from time to time, otherwise no benefit shall be payable.
How to claim?
Please login to our customer portal at www.mycigna.com.hk or download our MyCigna HK application from the App Store or Google Play store.
Written notification of a claim must be given to the Company within 30 days after the occurrence of the event giving rise to the claim. Such notification shall include information sufficient.
When submitting a claim through MyCigna HK, please have the below documents ready.
Written notification of a claim must be given to the Company within 30 days after the occurrence of the event giving rise to the claim. Such notification shall include information sufficient.
When submitting a claim through MyCigna HK, please have the below documents ready.
- Hospitalization / Medical Expenses Claim
- Accident or Medical Expenses Doctor Form completed by your attending doctor
- Medical Receipt(s)
- Hospital statement of charges / invoice / bill with breakdown of charges
- Hospital Discharge Summary or any document(s) issued by doctor/hospital with diagnosis proof
- Identity card copy of the Policyholder
- If you have submitted a claim to other insurer(s), please provide a copy of the relevant Compensation Breakdown
How to use the Cashless hospitalization arrangement?
You need to apply for Guarantee of Payment (GOP) before hospitalization. Please have your admission note ready for the application. If you don’t organize GOP, you can still submit a claim (on reimbursement basis) after you are discharged from hospital. You may call Cigna HealthFirst Elite 24 hours Hotline at 8100 3269 for further assistance.
Termination
What should I do if I need to terminate my policy? What would happen to the premium paid for the policy year?
You may cancel your policy and get back your premium paid within the cooling off period (the earlier of 30 days after the delivery of the policy or the issue of a notice to you or your representative), you have to tell us by giving a written notice if you decide to terminate the policy.
After cooling off period, the policyholder may terminate the policy by giving not less than 30 days’ notice in writing to the Company. Such termination shall become effective on the Premium Due Date. There shall be no refund of Premium paid and Cigna reserves the right to charge the Premium until the end of such Policy year after the termination.
Enquiry and Others
How does the All-round healthcare concierge service work?
It is an exclusive 24-hour Cigna HealthFirst Elite hotline in Hong Kong, the services include:
- Manned by experienced nurse to provide professional opinion
- Understands and analyzes the health condition of customers, and offers network doctor options
- Care Manager to provide hospital admission advice and assistance and post-discharge follow-up in person
- Referral for personalized services, including local limousine transportation to the hospital, medication delivery, and home modification.
Any contact points for enquiry?
For enquiries, you may contact Cigna Customer Service Hotline : 2560 1990 during office hours (Mon – Fri, 0900 - 1900, except Public Holidays).
Cigna HealthFirst Elite 24 hours Hotline at 8100 3269 (applicable to Elite customers only)
Cigna HealthFirst Elite 24 hours Hotline at 8100 3269 (applicable to Elite customers only)
TERMS & CONDITIONS
IMPORTANT INFORMATION
Premium
- Premium Level
The premium corresponding to the accommodation room type, area of cover and annual deductible option you select is determined based on the age and smoking habit of the person insured at policy commencement and at the time of renewal upon each anniversary date of the policy.
- 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.
- Mis-statement of Age or Smoking Habit
If age or smoking habit has been mis-stated by you or any person insured, the relevant person insured would still be eligible for coverage, we have the right to adjust the premiums payable based on the correct information.
- 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.
First Year Discount
First year discount is only eligible for customer who has not cancelled any HealthFirst Elite Medical Plan underwritten by Cigna Worldwide Life Insurance Company Limited or Cigna Worldwide General Insurance Company Limited within 12 months prior to the date of submitting the application for Cigna Healthfirst Elite medical plan.
Benefits
- Benefit in General
For hospitalization in mainland China, benefit is payable only if the diagnosis and hospital confinement are made in a hospital of Tier 3 Class A or above. Except for the benefit payment in case of death of the person insured, we shall pay the benefit amount to the policyholder.For the benefit payment in case of death of the person insured, we shall pay the benefit amount to the beneficiary.
- Hospitalization and Surgical Benefits
Under Hospitalization and Surgical Benefits and Extended Benefits, the Company will reimburse the actual medical expenses incurred of insured event according to the following calculation formula:{(Amount of eligible medical expenses incurred) LESS (-) (The medical expenses of same insured event is reimbursed by another party or by us under another insurance plan or the deductible (per policy year) under this policy, whichever is the larger)} TIMES (x) (Adjustment factor in room type confined (if applicable))If the person insured uses a higher level of hospital facilities and services than he is entitled to under the policy, the benefit amount payable will be lowered according to the adjustment factor. This benefit will not be payable for class of suite/ VIP/ deluxe room of a hospital
Accomodation Room Type Room type confined Adjustment factor Semi-Prtivate Room Standard Private Room 50% - Deductible Discount and Premium Waiver due to Cancer
For the avoidance of doubt, while the Deductible Discount and/or Premium Waiver due to Cancer are inforce, the Basic Benefits including the selected accommodation room type, area of cover, deductible and/or payment frequency are not allowed to change. Otherwise, the Company will not pay any benefit under the Deductible Discount and/or Premium Waiver due to Cancer.
Area of Cover
If the person insured’s country of residence is the United States (US) at the time of loss incurred, all benefits payable under the Basic Benefits and the Optional Insurance Benefits (if any) which takes place in the US will be reduced to 60% of relevant reimbursable charges, while the maximum benefit limit, lifetime limit and deductible shall remain unchanged under your policy. Country of residence refers to the country where person insured has stayed in for 185 days or more during the period of 365 consecutive days before the loss incurred date. For the area cover of “Asia”, if the person insured’s country of residence is Australia and/or New Zealand at the time of loss incurred, all benefits payable under the Basic Benefits and the Optional Insurance Benefits (if any) which takes place in Australia and/or New Zealand will be reduced to 60% of relevant reimbursable charges, while the maximum benefit limit, lifetime limit and deductible shall remain unchanged under your policy. Country of residence refers to the country where person insured has stayed in for 185 days or more during the period of 365 consecutive days before the loss incurred date.
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 Basic Benefits and Optional Insurance 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 Basic Benefits and respective Optional Insurance Benefits (if applicable) of “Cigna HealthFirst Elite Medical Plan”, and upon payment of the premium at time of renewal. If the Basic Benefits are renewed by the Company, but the Optional Deductible Discount is not renewed by the Company, the coverage period of the Optional Deductible Discount will be extended to 12 months following the next policy anniversary. If the policy is not renewed by the Company, the Optional Deductible Discount will be terminated at the end of the policy year. In such case, the coverage period of Optional Deductible Discount will not be extended. 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
- The policy will be automatically terminated when one of the following happens:
- The Person Insured passes away; or
- The Policy is terminated or not renewed by the Policyholder; or
- Any premium is not paid at the end of the grace period.
- The Optional Maternity Benefits will be terminated upon the policy anniversary after the person insured reaches age 50.
- The Optional Pharmacy Benefits will be terminated if 100% of the lifetime limit has been paid.
- 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 including claims paid by us under the policy.
- The person insured is required to settle any shortfall of expenses incurred with the use of the Cigna HealthFirst Elite Medical Card which is not covered by the policy or exceeding the maximum limit. If such shortfall amount is not settled within 14 days after receipt of a payment advice from us or our designated medical service providers, the Company reserves the right to terminate this policy.
- The person insured aged below 6 applying for Elite Medical Plan must be enrolled in the same Basic Benefits and Optional Insurance Benefits with those of the policyholder’s. If the policyholder terminates or changes his/ her policy, the policy of the child must be terminated or changed accordingly as per the policyholder’s with effect from the next anniversary date. The policyholder is required to notify us in writing the request of changes.
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.
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.
The following items are applicable to all benefits:
(a) Pre-existing Medical Conditions and any special exclusion(s);
(b) War, invasion, act of foreign enemy, hostilities (whether war is declared or not), Civil Commotion, rebellion, revolution, insurrection, military or usurped power or Terrorism;
(c) The Person Insured’s engaging in or taking part in:
- Naval, military or air force service or operations, armed force or service with the police of any nation;
- Professional sports or hazardous activities such as but not limited to rock climbing or mountaineering, parachuting, hang-gliding (whether powered or not), para-gliding, bungee-jumping or any kind of race other than by foot;
- 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;
- professional, semiprofessional or competitive winter sports, cross country skiing or snowboarding, ski or snowboard jumping, heli-skiing, off-piste skiing or snowboarding, Speed Skiing;
- Working at height (over 20 feet);
- Operating heavy machinery;
- 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
- Manufacture, storage, filling, breakdown, handling and transport of any explosive (including but not limited to firework or firecracker) or chemical material;
(d) The Person Insured's suicide, attempted suicide or intentionally self-inflicted injuries, whether sane or insane;
(e) 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 proper medical prescription by a Physician other than for the treatment of drug addiction;
(f) The Person Insured’s driving any kind of vehicle while the alcohol content of his/her blood exceeds the level permitted by the laws of the country or territory where the Accident resulting in Bodily Injury or Sickness occurs;
(g) Any act of the Person Insured being contrary to the law of the country or territory in which the Bodily Injury or Sickness occurs as a result of such act;
(h) 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 except such occurrence are covered under “Pregnancy Complications” section of the Basic Policy and Maternity Benefits (optional benefit);
(i) Infection with Human Immunodeficiency Virus (HIV) or variants including Acquired Immune Deficiency Syndrome (AIDS) and AIDS-related complex (ARC) except such occurrence are covered under the “HIV/AIDS Treatment” section of the Basic Policy and “HIV Inflection due to Blood Transfusion and Occupational acquired HIV” of Pharmacy Benefits (optional benefit);
(j) Sexually-transmitted diseases or treatment thereof except such occurrence are covered under the “HIV/AIDS Treatment” section of the Basic Policy and “HIV Inflection due to Blood Transfusion” of Pharmacy Benefits (optional benefit);
(k) Infertility or sterilization or any type of fertility;
(l) Birth defects, Congenital Conditions, Hereditary Conditions or any disabilities arising therefrom except such occurrence are covered under “Medullary Cystic Disease” of Pharmacy Benefits (optional benefit);
(m) Cosmetic and elective surgery including but not limited to:
- facelifts (rhytidectomy);
- nose reshaping (rhinoplasty);
- liposuction and other procedures which remove fat tissue;
- hair transplants; and
- surgery to change the shape of, enhance or reduce breast (other than breast reconstruction following treatment for breast cancer);
(n) 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;
(o) Routine eye/ear examinations, cost of spectacles, contact lenses, hearing aids and artificial lens except such occurrence are covered under the “Medical Appliances” section of the Basic Policy;
(p) Vaccination and immunisation injections except such occurrence are covered under the “Vaccination” of the Outpatient Benefits (optional benefit).
(q) 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. This exclusion is not applicable to Dental Benefits;
(r) Mental, psychiatric or nervous illness, personality disorder and character disorders except such occurrence are covered under “Psychiatric Inpatient Treatment” and “Post-hospitalization Auxiliary Treatment” section of the Basic Policy and “Psychiatric Outpatient Treatment or Psychological Outpatient Treatment” of Outpatient Benefits and “Alzheimer’s Disease/Dementia” of Pharmacy Benefits;
(s) Organ transplantation except such occurrence is covered under the “Organ Transplantation” section of the Basic Policy and “Major Organ Transplantation” of Pharmacy Benefits (optional benefit);
(t) Footcare by a chiropodist or podiatrist;
(u) Developmental Conditions including but not limited to:
- learning difficulties such as dyslexia;
- behavioral problems such as autism or attention deficit disorder (ADHD); or
- physical development problems such as short height.
(v) Treatment for obesity, or which is necessary because of obesity. This includes, but is not limited to, slimming class, aids and drugs. The Company shall only pay for gastric banding or gastric bypass surgery if the Person Insured;
- has a body mass index (BMI) of 40 or over and had been diagnosed as being morbidly obese; and
- can provide documented evidence of other methods of weight loss which have been tried over the past twenty-four (24) Calendar Months;
(w) Artificial life maintenance including mechanical ventilation, where such treatment will not or is not expected to result in the Person Insured’s recovery, or restore the Person Insured to his/her previous state of health;
(x) Fetal surgery or treatment;
(y) Treatment for a related condition resulting from addictive conditions and disorders, including but not limited to smoking cessation;
(z) Sleep disorders including insomnia, snoring, sleep-related breathing problems unless there are medical proofs that the Person Insured is suffering from sleep apnoea. In these circumstances, we will only pay the expenses incurred for Hospital Confinement for:
- One sleep study/year; and
- Surgery, only if Medically Necessary;
(aa) Not Medically Necessary;
(bb) The Person Insured’s voluntarily exposing himself/herself to any hazard or danger.
(cc) Routine medical examinations or health screening checks;
(dd) Any Bodily Injury or Sickness for which compensation is payable under any laws or regulations or any other insurance plan except to the extent that such charges are not reimbursed by such laws or regulations or other insurance plan;
(ee) Alternative treatment including but not limited to Chinese Medicines treatment, acupuncture, acupressure, Tui Na, hypnotism, rolfing, massage therapy, aromatherapy (except where covered under Traditional Chinese Medicine Treatment, Acupuncturist Benefit, Chinese Herbalist Benefit and Chinese Bonesetter Benefit under the Benefit Schedule;
(ff) Experimental and/or new medical technology/procedure not yet approved by the Company;
(gg) 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, fax and the like; or
(hh) Treatment for or in connection with speech therapy that is not restorative in nature, or if such therapy:
- is used to improve speech skills that have not fully developed;
- can be considered custodial or educational; or
- is intended to maintain speech communication.
(ii) Sex change operations or any treatment needed to prepare for or recover from these operations including complications arising out of such treatment; and
(jj) Treatment for sexual dysfunction disorders (such as impotence) or other sexual problems regardless of underlying cause.
The following exclusions items are applicable to Dental Benefits only:
(a) Appliances or restoration necessary to increase vertical dimension or restore an occlusion;
(b) Dental implants or transplants;
(c) Cosmetic dentistry procedures such as bleaching and veneers;
(d) Orthodontic services;
(e) Repair or replacement of orthodontic appliances;
(f) Placement of bone grafts or extra-oral substances in the treatment of periodontal disorders;
(g) Procedures or appliances to correct congenital malformations;
(h) Treatment of malignancies, cysts, or neoplasms;
(i) Replacement of lost or stolen dentures;
(j) Services or treatment for, or associated with, temporomandibular joint (TMJ) dysfunction or disorder, or for orthognathic surgery;
(k) Services or supplies intended to diagnose or treat any condition that is occupational injury or disease; or
(l) Replacement or additions to existing dentures or bridgework;
The following exclusions items are applicable to Pharmacy Benefits only:
(a) Any drugs that are experimental or investigational; or
(b) Cost or expense incurred for replacement of claimed western medications due to loss, theft, damaged, spoiled or expired;
The following exclusions items are applicable to Accidental Death Benefit only:
(a) Illness, disease, bacterial or viral infection, even if contracted by an accident. This does not exclude bacterial infection that is the direct result of an accidental cut or wound or accidental food poisoning;
(b) Medical or surgical treatment, except where such treatment is rendered necessary by bodily injury within the scope of this accidental death benefit;
(c) Pregnancy, childbirth, miscarriage, abortion or complications arising from any of them even though such loss may have been accelerated or induced by bodily injury;
(d) Any illegal act of the Person Insured in the country or territory where Bodily Injury occurs;
(e) Being in a state of insanity or psychiatric or psychological disturbance;
(f) Being under the influence of alcohol or drugs unless the drugs are properly prescribed by a physician and were not taken for the treatment of drug addiction;
(g) Driving any kind of vehicle while the alcohol level in Person Insured’s breath, blood or urine is higher than the legal limit in the country or territory where Bodily Injury occurs;
(h) Service in any armed force while:
- in the time of War;
- under orders for warlike operations; or
- restoration of public order. For the avoidance of doubt, armed force shall include any police force of a country or territory;
(i) 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;
(j) Taking part in any air sport, air travel or any other kind of aviation activities, other than travelling as a fare-paying passenger on regular scheduled commercial aircraft which is provided and operated by an airline or air charter company which is properly licensed to do so;
(k) Suicide, attempted suicide, suicide pact or deliberate self-inflicted injury, while sane or insane.
(l) Workers involved in the manufacture, storage, filling, breakdown, handling and transport of any explosive (including but not limited to firework or firecracker); or
(m) The Person Insured participating in or conducting training for any of the following activities:
- underwater swimming or diving and use any type of equipment to aid breathing;
- any kind of climbing, or mountaineering using rope or guides;
- pot-holing;
- parachuting, any kind of gliding, ballooning, bungee-jumping or micro-lighting;
- 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;
- professional, semiprofessional or competitive winter sports, cross country skiing or snowboarding, ski or snowboard jumping, heli-skiing, off-piste skiing or snowboarding, Speed Skiing;
- hunting;
- driving or riding in any kind of race; or
- professional sports.
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 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 will be happy to provide a specimen of policy upon your request.
