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Claims FAQs - Hospital or Medical Claims

You can give them to us through your insurance consultant, or mail them to us at:
Units 16-18, 11/F., China Merchants Tower, Shun Tak Centre, 168-200 Connaught Road Central, Sheung Wan, Hong Kong
Please send us the Claim Form with the supporting documents within 90 days after the Life Insured was discharged from the hospital.

For Claims relating to Well Care Silver Medical Plan
Pre-existing conditions are normally not be covered under the medical insurance plan as the already-existing conditions are not the coverage intention of the insurance companies. Therefore, any condition that has started, exists, with signs and symptoms appearing before your insurance went into effect will not be covered under the policy. Please refer to the policy provisions for the definition of the pre-existing conditions.
Firstly, the start date of which the symptom or the disease has to be confirmed.  Under many circumstances, the symptoms only appear or become significant after a period of time.  Therefore, if the symptoms or the medical condition happen within 90 days after your insurance went into effect, it is still not covered.  Please refer to the policy provisions for details.
For Well Care Silver Medical Plan, we only accept the hospital confinement or treatment in Hong Kong or specified hospitals in PRC.  We will not cover any hospitalization overseas.
There is a 180-days limit per each Policy year for Daily Hospital Income Benefit.  The usage will be reset every Policy Year but subject to a combined lifetime limit of 730 days together with the Daily Rehabilitation Benefit.

For Claims relating to Well Protect VHIS Series

We will reimburse the medical expense arises from a pre-existing condition that you were not aware of at the time of application, according to below schedule:

Policy Year Reimbursement Arrangement
1st year No coverage
2nd year 25% reimbursement
3rd year 50% reimbursement
4th year onwards 100% Full coverage

Except psychiatric treatments that are required to be hospitalized in Hong Kong, all other benefits are applicable worldwide.

If the congenital conditions manifested or diagnosed before the Insured Person attained age 8, the resulted expenses incurred for the medical services are not covered.

If you are confined in a type of room that is higher than the entitled ward class of the plan, the following adjustment factors will apply:

Entitled Ward Class in the Plan Confined Ward Class Ward Class adjustment factor
Ward Semi-Private Room 50%
Ward Standard Private Room or any room type that is higher than a Standard Private Room 25%
Semi-Private Room Standard Private Room 50%
Semi-Private Room Any room type that is higher than a Standard Private Room 25%
Standard Private Room Any room type that is higher than a Standard Private Room 50%

The above adjustment factors do not apply when the confinement in a type of room in a Hospital higher than the entitled Ward Class is due to –
(i) unavailability of entitled Ward Class due to ward or room shortage in the hospital of confinement for emergency treatment;
(ii) isolation reasons that require a specific class of accommodation; or
(iii) other reasons not involving your personal preference.


For Claims relating to Well Protect 108 Refundable Hospital Income Insurance Plan
The death benefit amount equals to 150% of the total equivalent annual premiums paid. If there is any indebtedness outstanding, it will be deducted from the death benefit.
Total equivalent annual premiums paid means the accumulated premiums due and paid at the relevant date which is calculated as “annual premium” (i.e. premium payable for annual mode) divided by 12 then multiplied by the corresponding number of months that the premium has been paid. Therefore, the amount calculated for monthly mode will be same as annual mode. Levy or premiums of other benefit items (if any) will be excluded.
Firstly, the start date of which the symptom or the disease has to be confirmed. Under many circumstances, the symptoms only appear or become significant after a period of time. Therefore, if the symptoms or the medical condition happen within 30 days after your insurance went into effect, it is still not covered. Please refer to the policy provisions for details.
Hospital confinement means the admission and confinement of the Life Insured as an in-patient in a hospital upon recommendation of a physician for treatment for a minimum of 6 hours and continuously stay in the hospital prior to discharge. Such confinement must also be medically necessary in order to fulfill the definition.
If the life insured is confined in a hospital in places other than Hong Kong and designated areas (please refer to the policy provisions for details of designated areas), any benefit payable will be reduced to 50% of the relevant benefits; and the maximum period for which the daily hospital income benefit is payable per hospital confinement will be reduced to 90 days. If the life insured is confined in a hospital in Mainland China, the hospital confined must also be listed on the prevailing “List of Specified Hospitals in PRC” maintained by the Company and uploaded onto the website, otherwise, no benefit is payable.