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Page 1: GLOBAL LEADER IN HEALTH SERVICESprdlib.convoy.com.hk/prdportal/File/Product and Provider Information... · • Winner of the Capital Outstanding Enterprise Awards – the Outstanding
Page 2: GLOBAL LEADER IN HEALTH SERVICESprdlib.convoy.com.hk/prdportal/File/Product and Provider Information... · • Winner of the Capital Outstanding Enterprise Awards – the Outstanding

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GLOBAL LEADER IN HEALTH SERVICES

About CignaRooted in health expertise dating back over 200

years through its predecessor companies, Cigna was

established in 1982 following the merger of the INA

Corporation and Connecticut General Corporations.

A respected leader in worldwide health services, we

continue to innovate, expand and grow globally. As

of 2013, our multi-national office network spans 30

countries and serves over 80 million customers.

Over the years our reliability and trustworthiness have

been recognized with consistently strong ratings by

internationally reputable bodies, as well as being ranked

103 on the Fortune 500.

International Rating Company Rating

A.M. Best A (Excellent)

Moody’s A2 (Good)

Standard & Poor’s A+ (Strong)

Fitch A (Strong)

Remark: Rating of Connecticut General Life Insurance Company as of 2013.

About Cigna Hong Kong Cigna has been committed to improving people’s health,

wellbeing and sense of security since its presence in

Hong Kong in 1933. Having delivered on this promise

for over 80 years, we continue to provide a broad range

of insurance solutions that are designed to satisfy our

customers and their loved ones’ every unique need.

Innovative to our products and services, we have

garnered a number of leading industry awards and

recognitions in Hong Kong:

•WinneroftheCapitalOutstandingEnterpriseAwards–

the Outstanding Life & Health Insurance Company for

two consecutive years (2013 & 2014)

•CapitalHonorGrandAwards– theMostCustomer-

Centric Company (2013)

•Annual Grand awards and a number of service

excellence awards from HK Call Centre Association

(2007-2013)

•Oneofthefirst local insurerstoachievethePayment

Card Industry Data Security Standard’s (PCI-DSS)

highest level of compliance (2012)

•Firstdedicatedlocaltelemarketinginsurancechannelto

receive certification by ISO 27001, the international best

practice standard for Information Security Management

Systems (2007)

Page 3: GLOBAL LEADER IN HEALTH SERVICESprdlib.convoy.com.hk/prdportal/File/Product and Provider Information... · • Winner of the Capital Outstanding Enterprise Awards – the Outstanding

Cigna HealthFirst Medical Plans annsla s Pl

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CIGNA HEALTHFIRST CHOICE

PLAN HIGHLIGHTS

A helping hand in the event of emergency, HealthFirst Choice saves your hassle at times when

you need to focus on your own health.

Cashless hospitalization - No admission deposit, no claim required after discharge1

You can be admitted in the private hospitals in Hong Kong for medical treatment without

deposit at hospital admission or claim procedures after discharge. Simply call our 24-hour Cigna

HealthFirst Hotline to arrange pre-approval to enjoy this hassle-free service that allows you to

concentrate on your health.

Extra protection when you are in deepest needWhenserious illnesscomes,oneneedsextramedicalanddailycare.Theplancoversnot

only your hospitalization expenses but also other common expenses such as pre-admission

and post-hospitalization treatment and private nursing expenses. It also includes additional

coverage for cancer treatment and dialysis. In addition, the Second Medical Opinion Service

offers you alternative medical opinions through a network of world-leading medical centers

and experts.

24-hour hotline 8203 2202 provides cashless hospitalization pre-approval services and

you can seek advice directly from medical professionals.

Cancer treatment and dialysis benefit up to HK$160,000, giving you an extra peace of

mind.

Page 4: GLOBAL LEADER IN HEALTH SERVICESprdlib.convoy.com.hk/prdportal/File/Product and Provider Information... · • Winner of the Capital Outstanding Enterprise Awards – the Outstanding

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APPLY NOW FOR EXCLUSIVE PRIVILEGES

Flexible plan that fits your unique needsThemedicaladvancesmakemanytreatmentsandcheck-upseasierwithout theneedof

hospitalization. Saving the hassle of being admitted to hospital, the plan even covers MRI,

CTScanandPETScancarriedout inaclinic  formedicalconditionsrelatedtothehospital

confinement.What’smore?Theplanoffersanarrayofoptionalbenefits2 to customize your

coverage:

•SupplementaryMajorMedicalBenefit–additionalbenefitofuptoHK$575,000peryear

•HospitalCashBenefit–adailyHK$600hospitalcashperday

•OutpatientBenefit–ChineseHerbalist,ChineseBonesetter,Acupuncturist,Physiotherapist,

Home Consultation, etc.

•DentalBenefit–scalingandpolishing,oralexamination,extractions,fillings,X-ray,rootcanal

fillings, etc.

An array of optional benefits giving you an all-round protection. For a few more dollars a

day, you can also take up HealthFirst TopUp plan to extend your coverage to HK$1 million.

Remarks: 1 You are required to settle any expenses exceeding your maximum benefit limit.2 For details of coverage, please refer to Cigna HealthFirst Choice Benefit Schedule. You have to

enroll on the same benefit level for both Hospital and Surgical Benefits and optional benefits.

Page 5: GLOBAL LEADER IN HEALTH SERVICESprdlib.convoy.com.hk/prdportal/File/Product and Provider Information... · • Winner of the Capital Outstanding Enterprise Awards – the Outstanding

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EXCLUSIVE PRIVILEGES

Complimentary Cigna Lifelong Preventive ProgramTheplanoffersfree annual influenza vaccination, body check and skin consultation.Therearealso

various health and wellness services at a discounted price. Please visit www.cigna.com.hk/cignaclub for

details.

Health RewardTocelebrateyourgoodhealth,youcanenjoyapremiumdiscountatrenewal.

Number of consecutive policy years of no Hospital and Surgical claim record

Discount at Renewal (for whole policy)

2 5%

3 8%

5 or above 15%

Guaranteed Lifetime Renewal Thepolicyisguaranteerenewable1 every year regardless to your individual health/ claims record.

Children’s Discount30% premium discount2 on the first year for child (from 15 days to age 17) enrolling policy with his/her

parent.

Remarks: 1 You are guaranteed lifetime renewal of your policy subject to the continuing issuance of HealthFirst Choice medical plan

and the payment of the premium. Cigna reserves the right to revise policy premiums, terms and conditions, and /or the Benefit Schedule upon each renewal.

2 Discount applies to Hospital and Surgical Benefits and other optional benefits. Parent and child have to enroll on the same plan level and same option of riders in order to obtain the discount.

Page 6: GLOBAL LEADER IN HEALTH SERVICESprdlib.convoy.com.hk/prdportal/File/Product and Provider Information... · • Winner of the Capital Outstanding Enterprise Awards – the Outstanding

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For more details, please talk to your financial consultant or visitwww.cigna.com.hk.

Page 7: GLOBAL LEADER IN HEALTH SERVICESprdlib.convoy.com.hk/prdportal/File/Product and Provider Information... · • Winner of the Capital Outstanding Enterprise Awards – the Outstanding

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CASE ILLUSTRATION

Page 8: GLOBAL LEADER IN HEALTH SERVICESprdlib.convoy.com.hk/prdportal/File/Product and Provider Information... · • Winner of the Capital Outstanding Enterprise Awards – the Outstanding

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How HealthFirst Choice helped Mr. Wong? Cashless hospitalization can be easily arranged through the 24-hour hotline.

Chemotherapyiscoveredby“CancerTreatmentandDialysis”, leavingthe“OtherMedicalExpenses”benefittocover the miscellaneous hospital charges.

TheplancoversthePETscanconductedinaclinicthatsavedhimthehassleofadmissiontoahospital.

Totalamountcovered(HK$):

Cigna HealthFirst Choice Benefits Maximum Limit of Plan 2(Semi-private) Medical Expense Incurred Amount Covered

Room & Board 1,600x14days=22,400 1,600x14days=22,400 22,400

Surgical (complex) 65,000 60,000 60,000

Anaesthetist (complex) 16,000 16,000 16,000

OperationTheatre(complex) 16,600 15,000 15,000

Other Medical Expenses (includingoutpatientPETscan) 21,500 48,000 21,500

Chemotherapy 120,000 8,500x15times=127,500 120,000

Total 288,900 254,900

ExpensespaidbyMr.Wong 34,000

Remarks:

TheaboveSurgicalExpensesareforreferenceandillustrationpurposeonly.Actualamountmaydifferfromcasetocase.

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Theissueageisfrom15daysto75yearsold,policyrenewaltill100yearsold.

Hospital and Surgical BenefitsMaximumLimit(HK$)

Plan 1 (Private) Plan 2 (Semi-Private) Plan3(Ward)

Hospital Room and Board (maximum 270 days per Policy Year) 3,200 per day 1,600perday 750 per day

Surgical Expenses (Per Surgery)

Complex 95,000 65,000 48,000

Major 47,500 32,500 25,000

Intermediate 20,500 13,600 10,000

Minor 7,500 6,500 5,500

Anaesthetist’s Expenses (Per Surgery)

Complex 26,900 16,000 12,300

Major 13,200 9,100 7,100

Intermediate 6,000 4,000 3,000

Minor 3,200 2,200 2,000

OperationTheatreExpenses(PerSurgery)

Complex 27,400 16,600 12,500

Major 13,500 10,000 8,100

Intermediate 6,500 4,200 3,500

Minor 3,250 2,200 2,000

Inpatient Doctor's Call (for non-surgical case only, maximum 270 days per Policy Year) 3,200 per day 1,600perday 750 per day

CancerTreatmentandDialysis 160,000 120,000 80,000

Intensive Care Unit Expenses 25,500 22,000 20,100

Inpatient Specialist's Fee 10,000 3,800 2,500

Companion Bed (maximum 270 days per Policy Year) 1,500 per day 750 per day 350 per day

Pre-admission and Post-Hospitalization Outpatient Expenses (maximum 2 pre-admission and 2 post-hospitalization clinic visits)

4,500 2,500 1,800

Private Nursing Expenses (maximum 120 days per Policy Year) 850 per day 500 per day 325 per day

OtherMedicalExpenses– include in-hospital / clinicalexpensesofMRI,CTscan,PETscan,hospitalmiscellaneouscharges, etc. (per Policy Year)

35,000 21,500 13,600

Overall Annual Limit

Belowattainedageof65ontheCommencementDate Unlimited

Attainedageof65oraboveontheCommencementDate 700,000 375,000 175,000

No Claim Discount

No claim record for 2 consecutive years 5% 5% 5%

No claim record for 3 consecutive years 8% 8% 8%

No claim record for 5 consecutive years or more 15% 15% 15%

Life Benefit 5,000

Cigna HealthFirst Choice – Benefit Schedule

Page 10: GLOBAL LEADER IN HEALTH SERVICESprdlib.convoy.com.hk/prdportal/File/Product and Provider Information... · • Winner of the Capital Outstanding Enterprise Awards – the Outstanding

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Cigna HealthFirst Choice (Optional Benefits) – Benefit Schedule

Supplementary Major Medical Benefit

MaximumBenefit(HK$)

Plan 1 (Private) Plan 2 (Semi-Private) Plan3(Ward)

Maximum limit per Policy Year 575,000 290,000 120,000

Lifetime Limit (applicable from age 75 onwards) 850,000 450,000 220,000

Remarks: • Foreachclaim,HK$500willbedeductedfromtheclaimamountandthereimbursementamountis80%oftheremainingbalance.• Theclaimamountwillbeadjustediftheactualhospitalconfinementishigherthantheeligibleplanlevel.Pleaserefertothepolicy

provisions for details.

Hospital Cash BenefitMaximumBenefit(HK$)

Plan 1 (Private) Plan 2 (Semi-Private) Plan3(Ward)

Covers from the 3rd day of hospital confinement, maximum 182 days per Policy Year 600perday

Outpatient BenefitMaximumBenefit(HK$)

Plan 1 (Private) Plan 2 (Semi-Private) Plan3(Ward)

1. General Practitioner (include 3-day basic medication) 380 240 180

2. Specialist* (include 3-day basic medication) 660 480 350

3. Physiotherapist* (treatment fee only) 630 430 330

4. Chiropractor* (treatment fee only) 630 430 330

5. Chinese Herbalist (include 2 packs of Chinese medicines) 230 180 150

6.ChineseBonesetter 230 180 150

7. Acupuncturist (treatment fee only) 230 180 150

8. Home Consultation (consultation fee only, per visit) 720 520 350

9.PrescribedWesternMedicine(perPolicyYear) 2,500 1,500 1,000

10.DiagnosticImagingandLaboratoryTests*(perPolicyYear) 3,500 2,000 1,500

Remarks: * Referral from a Physician required.•Maximum30visitsforitems1to8,withinwhichamaximumof10visitsforitems4to8perPolicyYear.• Foritems1to7,fullcoverfornetworkclinicor80%reimbursementuptotherespectivemaximumbenefitlimitfornon-networkclinic.

Dental BenefitMaximumBenefit(HK$)

Plan 1 (Private) Plan 2 (Semi-Private) Plan3(Ward)

Scaling and Polishing (per Policy Year) 2 visits

Fillings; dentures, crowns and bridges; drainage of abscesses; extractions;X-rays;rootcanalfillings;routineoralexamination

Unlimited visits, with maximum limit of 5,000 for all items per Policy Year

Page 11: GLOBAL LEADER IN HEALTH SERVICESprdlib.convoy.com.hk/prdportal/File/Product and Provider Information... · • Winner of the Capital Outstanding Enterprise Awards – the Outstanding

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Recommended plan for extra protection

CIGNA HEALTHFIRST TOPUP

Thankstoadvancementinmedicaltechnology,manynewmedicaltreatmentshaveemerged.Youmay

thus choose a better treatment, but also implies higher medical fees. For as low as a few extra dollars a day,

HealthFirstTopUpoffersanannualcoverageofuptoHK$1milliontohelpeaseyourfinancialburdeninthe

event of unexpected medical expenses.

Case Illustration

How Cigna HealthFirst TopUp helped Mr. Lee?ThoughthewardlevelplanofHealthFirstChoiceisenoughtocoverbasicmedicalexpenses,TopUpmakesadifference

when it comes to very complex and high risk surgery which involves substantial medical expense like in Mr. Lee’s case.

SincethebenefitpayableunderCignaHealthFirstChoiceishigherthantheHK$50,000deductibleofCignaHealthFirst

TopUp,Mr.Leedidnotneedtopayanydeductible.

Totalamountcovered(HK$):

CignaHealthFirstTopUpBenefits Medical Expenses Incurred Maximum Limit ofHealthFirstChoice(Wardlevel)

CoveredbyTopUp(90% of remaining balance)

Surgical (complex) 300,000 48,000 226,800

Anaesthetist (complex) 90,000 12,300 69,930

OperationTheatre(complex) 120,000 12,500 79,380

Other Medical Expenses 90,000 13,600 68,760

Total 600,000 86,400 444,870

Expenses paid by Mr. Lee 68,730

Remarks:

TheaboveSurgicalExpensesareforreferenceandillustrationpurposeonly.Actualamountmaydifferfromcasetocase.

Page 12: GLOBAL LEADER IN HEALTH SERVICESprdlib.convoy.com.hk/prdportal/File/Product and Provider Information... · • Winner of the Capital Outstanding Enterprise Awards – the Outstanding

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Cigna HealthFirst TopUp – Benefit Schedule

Remarks: 1ThemaximumbenefitlimitforthisitemisHK$10,000perPolicyyear.2 If the benefit payable under Hospital and Surgical Benefits of Cigna HealthFirst Choice is higher than your selected deductible,

then the reimbursement amount is 90% of the claim without any deductible.

Theissueageisfrom15daysto65yearsold,policyrenewalistill100yearsold.

Hospital and Surgical BenefitsMaximumLimit(HK$)

Plan 1 (Private) Plan 2 (Semi-Private) Plan3(Ward)

Hospital Room and Board (maximum 270 days per Policy Year)

$1,000,000 (Pays 90% of Hospital and Surgical

Benefits after an annual Deductible2)

Surgical Expenses

Anaesthetist's Expenses (Subject to 35% of Surgical Expenses payable)

OperationTheatreExpenses(Subject to 35% of Surgical Expenses payable)

Inpatient Doctor's Call (maximum 270 days per Policy Year)

CancerTreatmentandDialysis

Intensive Care Unit Expenses

Inpatient Specialist's Fees

Companion Bed (maximum 270 days per Policy Year)

Pre-admission and Post-Hospitalization Outpatient Expenses1 (maximum 2 pre-admission and 2 post-hospitalization clinic visits)

Private Nursing Expenses (maximum 120 days per Policy Year)

Other Medical Expenses

Life Benefit 5,000

Deductible options (per year) 150,000 / 200,000 100,000 / 150,000 50,000 / 100,000

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EXCLUSION PROVISIONSCigna shall not be liable for the expenses incurred in the following situations:

Applicable to Cigna HealthFirst Choice and Cigna HealthFirst TopUp: 1. Pre-existing Medical Conditions;2. War,invasion,actofforeignenemy,hostilities(whetherwarisdeclaredornot),civilcommotion,rebellion,revolution,insurrection,militaryorusurped

power or terrorism;3. ThePersonInsured’sengaginginortakingpartin: a ) Naval, military or air force service or operations, armed force or service with the police of any nation; b ) Professional sports or hazardous activities such as but not limited to scuba diving involving the aid of breathing apparatus, rock climbing or

mountaineering, parachuting, hang-gliding (whether powered or not), paragliding, bungee-jumping, winter sports or any kind of race other than by foot; c) Workingatheight(over20feet); d ) Operating heavy machinery; e ) Aviation or aerial activities except air travel as a fare-paying passenger in or as a member of the aircrew; or f ) Manufacture, storing, filling, breaking down, handling or transport of any explosive (including but not limited to fireworks or firecrackers) or chemical

material;4. ThePersonInsured’ssuicide,attemptedsuicideorintentionallyself-inflictedinjurieswhilesaneorinsane;5. ThePersonInsuredbeingundertheinfluenceofalcoholordrugsunless, inthecaseofdrugconsumption, it isproventhatsuchdrugwastakenin

accordance with proper medical prescription by a physician other than for the treatment of drug addiction; 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; or 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;

6. Pregnancy,childbirthandmiscarriageoforabortionbythePersonInsured, includingcomplicationsresultingtherefromnotwithstandingthatsuchincident may have been accelerated or induced by bodily injury or sickness;

7. 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; infertility or sterilization or any type of fertility;

8. Birth defects, congenital conditions, development conditions, hereditary conditions or any disabilities arising therefrom; cosmetic and elective surgery; 9. Eye refraction error except due to bodily Injury, routine eye/ear examinations, cost of spectacles, contact lenses, hearing aids and artificial lens; vaccination

and immunization injections;10. All dental treatment prescribed by dentist except emergency treatments by a physician during hospital confinement due to bodily injury. Follow up

treatment from such hospital confinement shall not be covered (unless the Dental Benefit is covered under this Policy);11. Mental, psychiatric or nervous illness; congenital conditions; developmental conditions; or hereditary conditions;12. 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; or fetal surgery or treatment;13. Treatmentforarelatedconditionresultingfromaddictiveconditionsanddisorders;sleepdisordersincludinginsomnia,snoring,sleep-relatedbreathing

problems or sleep studies;14. Not medically necessary;15. Nuclearenergyrelated(Nuclearreaction,radiationorcontamination;andthisclauseonlyappliestoCignaHealthFirstTopUp);16. ThePersonInsured’svoluntarilyexposureofthepersoninsuredtoanyhazardordanger;and17. Fees / expenses incurred from the following reasons: a ) Convalescence accommodation or treatment or services rendered in any sanatorium or similar establishment; b ) Prosthesis, corrective devices and medical appliances, which are not intra-operatively required; c ) All organ transplantation, transplant procedures and acquisition of the organ itself to be used for organ transplantation; d ) 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; e ) Routine medical examinations or health screening checks; f ) Subject to the Clause on Co-Ordination of Benefits in Policy Provision, 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;

g) Alternativetreatmentincludingbutnot limitedtoChinesemedicinetreatment,acupuncture,acupressure,TuiNai,hypnotism,rolfing,massagetherapy, aromatherapy (unless it is an acupuncturist benefit, Chinese herbalist benefit and Chinese bonesetter benefit payable under the Benefit Schedule);

h ) Experimental and/or new medical technology/procedure not yet approved by Cigna; and i ) Non-medical services, including but not limited to guest meals, radio, telephone, photocopy, taxes, medical report charges and the like.

Applicable only to 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. Placementofbonegraftsorextra-oralsubstancesinthetreatmentofperiodontaldisorders; 7. Procedures or appliances to correct congenital malformations;8. Treatmentofmalignancies,cysts,orneoplasms; 9. Replacement of lost or stolen dentures;10. Servicesortreatmentfor,orassociatedwith,temporomandibularjoint(TMJ)dysfunctionordisorderorfororthognathicsurgery;11. Services or supplies intended to diagnose or treat any condition that is occupational injury or disease; or12. Replacement or additions to existing dentures or bridgework.

Notes:1. TheaboveinsuranceplansareunderwrittenbyCignaWorldwideLifeInsuranceCompanyLimited.2. Thisbrochureispreparedtoprovideyouwithabriefsummaryoftheinsuranceplans,theirterms,conditionsandexclusionsandisnotacontractof

insurance. For details of coverage and exclusions, please refer to the policy provisions.3. Any case example extracted in this brochure is for illustrative purpose only. It shall not be construed as an admission of our liability under any claim. Claim

payment depends on facts of different cases. Cigna reserves its right to make final decision on all claims payment.4. If there is any discrepancy between the English and Chinese version of this brochure, the English version shall prevail.

Page 14: GLOBAL LEADER IN HEALTH SERVICESprdlib.convoy.com.hk/prdportal/File/Product and Provider Information... · • Winner of the Capital Outstanding Enterprise Awards – the Outstanding