VMWARE HONG KONG LIMITED - EMPLOYEE BENEFITS SCHEME JAN 2019 - VMware Benefits
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VMWARE HONG KONG LIMITED
EMPLOYEE BENEFITS SCHEME
JAN 2019
Today’s Topics
1. Plan Rules & Eligibility
2. Your Benefits :
- Group Life, AD&D & TPD Benefits
- Group Disability Income Benefits
- Group Medical Benefits
- Emergency Medical Evacuation
3. Exclusions
4. Claim Procedures
5. AXA eService & Mobile Apps
6. Porta Protection
7. Q & A
2
Plan Rules
• Policy No. :05199301GH/02GL/03GE
• Policy Anniversary Date : 1st January of each year
• Scope of Coverage : 24 hours Worldwide
• Free Choice of Doctors and Hospitals
• Eligibility Conditions
* all full-time permanent employees & their dependents (medical only)
* new employees – first day of employment
* new dependents - day of marriage (domestic partner/spouse), 14 days
afterbirth (child)
• Age Limits
* Employees and Domestic Partner/Spouses below age 65
* Child(ren) - 14 days afterbirth up to age 18;
- full-time students between ages 19 to 23
3
Group Life, AD&D and TPD Benefits CONFIDENTIAL
Term Life Benefit
❑ Benefits : 2 x Annual Benefit Salary
❑ Benefit is payable for death result from all causes
❑ No exclusion
5Accidental Death & Dismemberment (“AD&D”) Benefit
❑ Benefits : 2 x Annual Benefit Salary
❑ Benefit is payable for death or dismemberment result from accidental
cause in accordance with a compensation scale, e.g.
❑ Loss of life : 100%
❑ Loss of two limbs: 100%
❑ Loss of sight of both eye : 100%
❑ Permanent and total paralysis of all limbs : 100%
❑ Permanent and total loss of hearing in both ears : 70%
❑ Loss of all fingers of one hand : 45%
❑ For more details, please refer to benefit leaflets
❑ This Benefit is on top of the Term Life coverage.
6AD&D - Exclusions
Accidental Death & Dismemberment Benefits
❑ hernia, disease, or bodily or mental infirmity; or by medical or surgical
treatment thereof
❑ ptomaines, or bacterial infections, except only septic infection of and
through a visible wound accidentally sustained
❑ suicide; or any attempt threat, while sane or insane; or by inhaling any
kind of gas, whether voluntarily or otherwise
❑ war, whether or not declared, strike, riot, civil commotion, or revolution
❑ any police action or participation in a brawl or felony
❑ actions not permitted by law (except traffic or pedestrian offences)
❑ radio-active contamination, whether direct or indirect
❑ losses as a result of nuclear, biological, and chemical terrorism
7Total & Permanent Disability (“TPD”) Benefit
❑ Benefits : 2 x Annual Benefit Salary
❑ Benefit is payable for totally and permanently disabled by reason of injury or
sickness, are unlikely to engage in or to work for any compensation or profit
in any business, occupation or employment which is reasonably qualified by
reason of education, training or experience and suffered by:
▪ Total and irrecoverable loss of sight of both eyes, or;
▪ The complete and permanent paralysis of both hands or feet or actual
severance of both hand or feet at or above to wrists or ankle joints, or;
▪ Total and irrecoverable loss of sight of one eye and either
a) the complete and permanent paralysis of one hand or one
foot, or;
b) actual severance of one hand or feet at or proximal to wrist
or ankle joint.
❑ If you are totally and permanently disabled for 6 consecutive months, your
benefit will be payable in 60 equal monthly installments retroactively from
the date the disability commenced.
❑ If the TPD benefit has fully paid, then the Life benefit will be ceased.TPD - Exclusions Total & Permanent Disability Benefits ❑intentionally self-inflicted injury ❑military, naval or air service for any country at war, declared or undeclared ❑any act due to war declared or undeclared ❑losses as a result of nuclear, biological, or chemical terrorism ❑Radioactive contamination whether direct or indirect
Group Disability Income CONFIDENTIAL
Disability Income Benefit
Disability Income Insurance (DI)
Benefits
Benefit for Sickness at age 60
Benefit for Injury at age 65
Waiting Period 60 days
Benefits Payable Basic Monthly Salary
70% on First HK20,000
50% on Excess
Subject to a maximum of HK$50,000 per month.DI - Exclusions
Disability Income Benefits
❑ Any intentional self-inflicted injury or sickness or any attempt at suicide or
self-distruction while sane or insane; or
❑ Pregnancy, childbirth or miscarriage; or
❑ Declared or undeclared war or any act thereof; or
❑ Service in the armed forces of any country or international organization; or
❑ Action not permitted by law (except traffic or pedestrian offences); or
❑ Radioactive contamination (direct or indirect) ; or
❑ Nuclear, chemical & biological terrorism.
❑ Pre-existing conditions. Benefits shall not be payable for
• any conditions or recurrences of chronic conditions which you received
medical treatment before the participation in the Disability Income plan and
not disclosed in writing to AXA China Region.
• any conditions excluded in writing by AXA China Region.
• Infection with any Human Immunodeficiency Virus (HIV) before
participation.Group Medical Benefits CONFIDENTIAL
Your Benefits
Hospitalization Benefits Maximum limit per disability
100% reimbursement up to the maximum (HK$)
limit per disability Semi-private
1 Daily Room & Board, per day 1,500
- Max. days per disability 60
2 Doctor’s Visit, per day 1,500
- Max. days per disability 60
3 Hospital Expenses 26,000
4 Surgeon’s Fee
- Super Major Operation 69,000
- Major Operation 46,000
- Intermediate Operation 23,000
- Minor Operation 9,200
5 Intensive Care Unit, per day 2,400
- Max. days per disability 10
6 Home Health Care * 45,000
7 In-patient Specialist * 5,000
8 Hospital Cash for Government Ward, per day 750
- Max. days per disability 60
Overall Max. 394,000
Evacuation & Repatriation Fully Covered
14 * Subject to Doctor’s ReferralYour Benefits
Home Health Care Benefit
Eligibility
1. After at least 3 days in the hospital,
2. With the approval of the attending doctor and arrange through AXA
3. Provide continuous hospital treatment at your home.
4. Provided by the home health care service provider – Quality Health Care
Nursing (QHN) @2851-0855
Benefits include:
1. nursing services
2. doctor’s management fee
3. laboratory examination
4. medicine and drugs
5. medical supplies
6. rental of home health care equipment
7. rehabilitation therapy etc.
❖ This benefit is only applied in H.K. and subject to maximum limit per disdbility
and exclusions.
15Your Benefits
Supplementary Major Medical Benefits Maximum limit per disability
limit per disability (HK$)
Maximum limit 150,000
Deductible 500
Reimbursement Percentage 80%
Accommodation Level Semi-private
❑ Supplementary Major Medical Benefit is only applicable when there has:
i) Hospital confinement; and
ii) Room & Board is charged by the hospital.
❑ If the confinement in an accommodation of Higher Level, the reimbursement
percentage of SMM will be reduced as below:
Semi-private → Private : 50%
❑ VIP/Deluxe Room are not covered
16Your Benefits
Maternity Maximum limit per pregnancy
limit per pregnancy (HK$)
Normal Delivery 15,000
Miscarriage 7,500
Caesarian Section 22,500
17Your Benefits
Outpatient Benefits Maximum limit (HK$)
Reimbursement % 100%
1 Doctor’s Consultation – in doctor’s clinic 360
- limit to 1 visit per day
- Max. visits per year 35
- Co-payment (Panel) 0
2 Chinese Herbalist/Bonesetter/Acupuncture 280
- limit to 1 visit per day
- Max. visits per year 15
- Co-payment (Panel – Chinese Herbalist) 0
3 Check up 1,200
- limit to 1 visit per day
- Max. visits per year 1
4 Physiotherapy* & Chiropractor* 400
- limit to 1 visit per day
- Max. visits per year 35
- Co-payment ( Panel – Physiotherapy) 0
Overall maximum limit for 1, 2, 3 & 4 per year 35
* Subject to Doctor’s Referral except Gynaecology, Orthopaedics( for Fracture only)
and Dermatology.
18Your Benefits
Outpatient Benefits Maximum limit (HK$)
Reimbursement % 100%
5 Specialist Consultation * 700
- limit to 1 visit per day
- Max. visits per year 10
- Co-payment (Panel) 0
6 Diagnostic X-Ray/Lab Tests *
- Max. limit per disability 1,800
7 Prescribed Medicine *
(Purchased at Pharmacy outside doctor’s clinic)
- Max. limit per year 2,200
* Subject to Doctor’s Referral except Gynaecology, Orthopaedics( for Fracture only)
and Dermatology.
19Your Benefits
Dental Benefits Maximum limit
100% reimbursement (HK$)
1 Oral Examination / Cleansing
- Limit per visit per day 1,000
2 Root Canal Therapy
- Limit per visit per day 1,000
3 X-ray, extraction, filling & Abscess and relief of pain
- Limit per visit per day 1,000
4 Denture (result from accident only)
- Limit per year 5,500
Overall Maximum per year 5,500
20AXA Health Card
AXA Health Card - Key Functions
1. Access to China Health Link Network
2. Key for Emergency Evacuation/Repatriation
3. Access to seven designated panels including
▪ QHMS
▪ HMMP
▪ Dr Vio
▪ UMP
▪ Ucare
▪ MediNet
▪ Trinity
21Key for Emergency Evacuation/ Repatriation
❑ AXA Assistance Alarm Centre Hotline
▪ Members can access to AXA Assistance Alarm Centre Hotline which are
managed by multi-lingual staff and medical personnel, 24 hours a day, 365
days a year
For policy terms and exclusions, please refer to Policy document for details
22Access to China Health Link Network
❑ Guarantee Hospital Admission Deposit in China
▪ Each covered members will receive a AXA Health Card issued by AXA
▪ Just present the AXA Health Card when hospitalization at the designated
hospitals in China bearing the “Medpass ( 任 中 橫 ) ” logo, guarantee
hospital admission deposit can be arranged
▪ For any assistance, member can contact AXA Assistance (IPA) hotline at
(852) 2862 0168 identify himself by giving the full name, company name,
group medical policy no. location and contact number
23Key for Emergency Evacuation/ Repatriation
AXA Assistance Emergency Evacuation Services
▪ Telephone medical advice and evaluation, referral to doctors
▪ Provision of a doctor and/or other medical personnel
▪ Delivery of essential medication and equipment
▪ Worldwide medical evacuation
▪ Worldwide guarantee of hospital admittance deposit of up to US$5,000
▪ Medical monitoring
▪ Compassionate visit (provided hospitalized abroad for more than 7 days)
▪ Return of dependant children to the country of residence who are left
unattended
▪ Worldwide medically supervised repatriation
▪ Worldwide repatriation of mortal remains
▪ Referral to interpreters and legal assistance
▪ Return of Traveling Companion (US$1,000 for hotel expenses)
▪ Transportation for Return of Member to Original Work Site
▪ Legal fees of up to US$3,900
▪ Unexpected Return to the Country of Residence
For policy terms and exclusions, please refer to Policy document for details
24Group Medical Benefits
Exclusion
CONFIDENTIALExclusions
❑ Treatment in any hospital that is not registered with the government or
consulting any person other than a registered doctor.
❑ General check up (except covered under the Schedule of Benefits),
convalescence, custodial or rest care.
❑ Congenital anomalies conditions, or infertility.
❑ Correction of eye vision or fitting of glasses.
❑ Any physiotherapy treatment or treatment by chiropractor unless recommended
by a registered western practitioner and treated in a registered clinic or hospital.
❑ Any elective treatment or procedure, such as cosmetic surgery, sterilization or
beautification.
❑ Rental or purchase of prosthetic appliances, such as hearing aids, artificial
limbs, glasses or corset.
❑ Sickness or injury arising directly or indirectly from declared or undeclared war.
❑ Participation in illegal acts (except traffic and pedestrian offences) such as
robbery, drug abuse or assault.
❑ Any injury or sickness for which compensation is payable under Government
Law or any other insurance policy.
❑ Pre-existing Conditions
26Exclusions
Pre-existing Conditions:
Definition
▪ Any injury or sickness sustained prior to the insurance effective date that the
member received medical or surgical care or treatment within 3 consecutive
months immediately preceding such date.
▪ If during any consecutive 3 months period after the insurance effective date,
the member does not undergo any medical or surgical care or treatment for the
pre-existing condition, benefits will subsequently be payable.
▪ shall be covered when the insured person has been insured under the policy
continuously for 12 consecutive months (the counted period is starting from 1
Jan 2019 going forward).
▪ Members as the case may be was infected with any Human Immunodeficiency
Virus (HIV).
27Group Medical Benefits
Claims Procedures
CONFIDENTIALClaim Procedure - Hospital & Surgical
❑ Claimant has to complete Part I of the Hospitalization & Surgical Claim Form.
❑ The attending physician/surgeon is required to complete Part II of the
Hospitalization & Surgical Claim Form {except such hospitalization claim
incurred in Government Hospital for which you should obtain a Discharge
Summary to replace Part II of the claim form} .
❑ The following documents should be submitted to AXA China Region – EB Claim
Department, within 90 days from the discharge date.
- Completed claim form
- All original bills and receipts
- Discharged slip {for claims incurred in Government Hospital}
29Claim Procedure - Clinical
Clinical and Dental Claim – Reimbursement Basis
❑ Request from the clinic original receipt showing the following information:
▪ Name of patient
▪ Date of Consultation
▪ Diagnosis
▪ Breakdown charges
▪ Doctor’s signature and chop
❑ For herbalist consultation, original prescription of Chinese medications must be
attached.
❑ For specialist consultation , X-ray & lab tests and physiotherapy / chiropractic
treatment, referral letter must be obtained from the western medical practitioner.
(Except Orthopaedists (for Fracture only), Gynaecology & Dermatologist)
❑ Referral letter is valid for 180 days from last consultation date.
❑ Completed claim form and all original bills and receipts should be submitted to AXA,
within 90 days of treatment.
30Claim Procedure - Clinical
Clinical Claim – Credit Basis (using AXA Health Card)
❑ You are advised to make an appointment with AXA Network clinics in advance
as doctor’s consultation hours and details may change occasionally.
❑ Please produce your AXA Health Card and your HKID Card to the nurse-on-
duty for verification and registration.
❑ The clinic’s receptionist will request you to sign a claim voucher. Do not sign
blank voucher.
❑ Claim voucher will be submitted to insurance company for reimbursement by
the clinic through the panel group.
31Claim Procedure
Notes to Remember:
❑ Hospital and outpatient claim form can be obtained from the Human Resources
Department.
❑ Remember to quote your Names, Certificate No. and the Policy No.05199301GH
to avoid claim delay.
❑ Claims will be settled through auto pay into your bank account and you will receive
an electronic claim settlement advice via e-mail to your company e-mail address
once the claim is processed.
32AXA Digital and Wellness CONFIDENTIAL
MyAXA Key functionalities Self-registration Make a Claim* Track Claim Information Search AXA Healthcare Doctor List e-Health Card e-Prescription China Health Link Hospital List* PortaProtection Application Useful Information Contact us *Only applicable to clients with this service
MyAXA Make a Claim*
“Snap and Submit Claims”
Submit claims through MyAXA
Applicable to outpatient claims incurred in HK (HKD$800 or below)
Consultation type: General practitioner, Chinese herbalist, and bonesetter
Quick processing of claim in 5 working days
Remarks: Please keep the original documents and receipts for at least 6 months
* Only applicable to clients with this serviceDownload MyAXA now
Scant the QR code or scan simply key
in “MyAXA” in App Stores
www.axa.com.hk/MyAXAAXA PortaProtection Plan CONFIDENTIAL
Exclusively for AXA Group
Medical Scheme Members!
38PortaProtection Plan
An individual medical plan exclusively for AXA Group Medical Scheme
Members & their dependents only!
Continuity of your existing group medical benefits
No underwriting required & guaranteed acceptance
Coverage for pre-existing conditions after
12-month AXA Membership
Lifelong protection & guaranteed renewal
Comprehensive reimbursement of
medical expenses
Cost effective Deductible plans available
Design your own medical plan with flexibility
For detailed terms and conditions, please refer to the PortaProtection brochure
39 |IMPORTANT NOTES
Claim payment shall be made against any group medical policy of the insured
person first (if any). Any unpaid portion of such claim shall then be paid under
PortaProtection*. Insured person is required to declare the coverage of group
medical insurance scheme entitled in any insurance companies for any claim.
* According to the maximum limit, reimbursement percentage and deductible amount
All claim must be submitted to AXA within 60 days after the date of discharge from
hospital or treatment is received.
No re-entry to PortaProtection Plan once membership is withdrawn.
Final terms and conditions are subject to the policy contract.
40CONTACT US
Enquiry Hotline 2519 1166
Address 22/F, Manhattan Place
23 Wang Tai Road,
Kowloon Bay, Kowloon
Enquiry Email employee.benefits@axa.com.hk
PortaProtection Enquiry 2519-1213 (Application and enrolment)
Hotline From 9:00 to 17:30, Monday to Friday
41Q&A CONFIDENTIAL
Thank you! CONFIDENTIAL
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