Medical insurance

1. Full coverage/ cover/ fully cover means no itemised benefit sublimit, the actual amount of Eligible Expenses charged after deducting the Balance of Annual Deductible (if any) and is subject to the Annual Limit. Full cover applies to selected benefit items only, while other benefit items are not fully covered and are subject to respective benefit item’s limits. Please refer to Benefit Schedule and policy provisions for details. For Psychiatric Treatments covered by MyMillion, full cover is not applicable and sublimit applies.
2. Standard Ward Room refers to a room type in a Hospital that is of a quality below a Standard Semi-Private Room. Standard Semi-Private Room refers to a single or double occupancy room in a Hospital, with a shared bath or shower room. Standard Private Room refers to a standard single occupancy room with an adjoining bathroom for the Insured’s use during his or her Confinement, but does not include any Hospital room that has its own kitchen, dining or sitting room.
   If on any day of Confinement, the Insured is voluntarily Confined in a ward class of Hospital accommodation higher than Standard Ward Room, the ward class adjustment factor shall be applied to the Eligible Expenses incurred on that day, please refer to clause 5.4 of “Limitation of Claim” under the policy provisions for details.
3. Treatments covered here only include radiotherapy, chemotherapy, targeted therapy, immunotherapy and hormonal therapy.
4. Prescribed Diagnostic Imaging Tests refers to computed tomography (“CT” scan), magnetic resonance imaging (“MRI” scan), positron emission tomography (“PET” scan), PET-CT combined and PET-MRI combined. FWD will pay for the Eligible Expenses charged on Prescribed Diagnostic Imaging Test performed during Confinement or in a setting for providing Medical Services to a Day Patient recommended in writing by the attending Physician for the investigation or treatment of a Disability.
5. While the Policy is in force, if the Insured suffers the following designated crises (as defined herein below and Appendix 2 in policy provision) and is upon the recommendation of the attending Physician, Surgeon and Specialist in writing, receives any Medical Services as a direct result of the designated crises, in calculation of benefits payable under sections I to III under Benefit Schedule, the payment of the Balance of Annual Deductible (if any and if applicable) will be reduced to zero. We will pay the Eligible Expenses charged on such Medical Services for designated crises before the entire Annual Deductible is met. Designated crises will include:
   i) Cardiac Impairment Caused By Cardiomyopathy;
   ii) Cardiac Impairment Due To Primary Pulmonary Arterial Hypertension;
   iii) Chronic Liver Disease;
   iv) Coronary Artery Bypass Operation;
   v) End Stage Lung Disease;
   vi) Fulminant Hepatitis;
   vii) Heart Attack (Acute Myocardial Infarction);
   viii) Kidney Failure;
   ix) Major Organ Transplantation;
   x) Open Heart Valve Surgery;
   xi) Parkinson’s Disease;
   xii) Severe Rheumatoid Arthritis;
   xiii) Specified Cancer;
   xiv) Stroke;
   xv) Surgery to Aorta; and
   xvi) Terminal Illness.
   This benefit will not be applicable to the Medical Services arising from any designated crisis that You or Insured is aware of, or will be reasonably aware of within the first 90 days from the Policy Date. You or the Insured will be reasonably aware of a designated crisis where:
   i) the designated crisis has been diagnosed;
   ii) the designated crisis has manifested clear and distinct signs or symptoms; or
   iii) medical advice or treatment has been sought, recommended or received for the designated crisis. This benefit is applicable to the Policies with Annual Deductible only.
6. For the Insured covered by any other hospital and surgical reimbursement plans issued by a licensed insurance company other than FWD, regardless of whether it is an individual or group policy, if the Eligible Expenses incurred for any Confinement of the Insured are payable under the Policy after any reimbursement has been paid by such other licensed insurance companies, this benefit will be payable for each day of Confined period in Hospital, subject to the limits as specified in the Benefit Schedule.
7. PREMIER THE ONEcierge is currently provided by HealthMutual Group Limited (“HMG”) and its healthcare network team, it is not a part of the policy or benefit item under the policy provisions of the Plan and it is not guaranteed renewable. FWD reserves the right to terminate or vary PREMIER THE ONEcierge in its sole discretion without further notice. FWD will not be responsible for any act, negligence or failure to act on the part of HMG and its healthcare network team. For details, please refer to the flyer attached to the product brochure.
8. The services are currently provided by International SOS and are not guaranteed renewable. All relevant fees and charges (if any) of these services must be paid by you. FWD will not be responsible for any act, negligence or failure to act on the part of International SOS and/or any of its affiliates. Details of the services may be revised from time to time without prior notice from FWD. For details, please refer to the flyer attached to the product brochure.
9. FWD will guarantee the renewal at each Policy Anniversary up to the Policy Anniversary immediately following the Insured’s 100th birthday. The automatic renewal is only applicable if the policy premiums are paid when due without the requirement of evidence of insurability. FWD has the right to review and adjust the policy’s premium each Policy Anniversary. FWD determines the premium rates for each renewal based on factors including but not limited to the Age of the Insured at the time of renewal, claims experience, medical inflation and policy persistency, provided any premium review will be applied to all other policies of the same kind and these premium rates are not guaranteed.
10. FWD will pay this benefit in lieu of items (a) to (d) and (f) to (g) in section I. Hospitalisation benefits, section II. Surgical benefits and items (a) and (b) in section III Other benefits. under Benefit Schedule. For the avoidance of doubt, where a Confinement is not solely for the purpose of psychiatric treatments, this benefit will only be payable for the Eligible Expenses charged on the Medical Services related to psychiatric treatments. Where the Eligible Expenses involve both psychiatric and non-psychiatric treatments and apportionment of the expenses is not available, the expenses in entirety will be payable under this benefit if the Confinement is initially for the purpose of psychiatric treatments. If the Confinement initially is not for the purpose of psychiatric treatment, the expenses in entirety will be payable for items (a) to (d) and (f) to (g) in section I. Hospitalisation benefits, section II. Surgical benefits and items (a) and (b) in section III Other benefits under Benefit Schedule.
11. Asia refers to Afghanistan, Australia, Bangladesh, Bhutan, Brunei, Cambodia, Mainland China, Hong Kong, India, Indonesia, Japan, Kazakhstan, Kyrgyzstan, Laos, Macau, Malaysia, Maldives, Mongolia, Myanmar, Nepal, New Zealand, North Korea, Pakistan, the Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Tajikistan, Thailand, Timor-Leste, Turkmenistan, Uzbekistan and Vietnam.
12. If this benefit is paid, benefit item (a) in section I Hospitalisation benefits under Benefit Schedule will not be paid.
13. The benefit will only be payable if benefit item (a) or (b) in section I Hospitalisation benefits under Benefit Schedule has been paid.
14. The benefit will only be payable if one of the benefit items (a) or (b) in section I Hospitalisation benefits or section II Surgical benefits under Benefit Schedule has been paid.
15. The benefit will only be payable if one of the benefit item (b) in section I Hospitalisation benefits or section II Surgical benefits under Benefit Schedule has been paid.
16. FWD will pay the Eligible Expenses incurred for the benefit items (a) to (d) and (g) in section I. Hospitalisation benefits and section II Surgical benefits under Benefit Schedule where a surgical procedure is performed by a Surgeon during Confinement or in a setting for providing Medical Services to a Day Patient as a result of the following pregnancy related complications arising during antepartum stages of pregnancy or childbirth – (i) ectopic pregnancy; (ii) molar pregnancy; (iii) disseminated intravascular coagulopathy; (iv) pre-eclampsia; (v) miscarriage; (vi) threatened abortion; (vii) medically prescribed induced abortion; (viii) foetal death; (ix) postpartum hemorrhage requiring hysterectomy; (x) eclampsia; (xi) amniotic fluid embolism; or (xii) pulmonary embolism of pregnancy. This benefit will only be payable provided that the date of diagnosis of such pregnancy complication is at least 1 year after the Policy Date.

Credit Risk

MyMillion is an insurance Policy issued by FWD. The Application of this insurance product and all benefits payable under your Policy are subject to the credit risk of FWD. You will bear the default risk in the event that FWD is unable to satisfy its financial obligations under this insurance contract.

Exchange Rate and Currency Risk

The Application of this insurance product with the Policy currency denominated in a foreign currency is subject to that foreign currency’s exchange rate and currency risk. The foreign currency may be subject to the relevant regulatory bodies’ control (for example, exchange restrictions). If your home currency is different from the Policy currency, please note that any exchange rate fluctuation between your home currency and the Policy currency of this insurance product will have a direct impact on the amount of premium required and the value of benefit(s) to be received. For instance, if the Policy currency of the insurance product depreciates substantially against your home currency, there is a negative impact on the benefits you receive from MyMillion. If the policy currency of the insurance product appreciates substantially against your home currency, your burden of the premium payment is increased.

Inflation Risk

The cost of living in the future may be higher than now due to the effects of inflation. Therefore, the benefits under MyMillion may not be sufficient for the increasing protection needs in the future even if FWD fulfills all of its contractual obligations.

Premium Adjustment

The premium is non-guaranteed and will be determined annually based on the Age of the Insured at the time of renewal. The premium may increase significantly due to factors including but not limited to Age of the Insured at the time of renewal, claims experience, medical inflation and policy persistency, provided any premium review will be applied to all other policies of the same kind and these premium rates are not guaranteed.

Premium Term and Non-Payment of Premium

The premium payment term of MyMillion is up to the Age 101 of the Insured.
FWD allows a grace period of 30 days after the premium due date for payment of each premium. This Policy shall continue to be in effect during the grace period but no benefits shall be payable unless the premium is paid. If a premium is still unpaid at the expiration of the grace period, the Policy will be terminated from the date the first unpaid premium was due. Please note that once the Plan is terminated on this basis, you will lose all of your benefits.

Termination Conditions

The policy will be automatically end on the earliest of the followings:

1. The Insured dies;
2. The Expiry Date of the policy;
3. You cancel the policy. FWD will determine the cancellation date based on FWD’s rules and regulations at that time;
4. If the change of place of residence or occupation means that the residence or occupation is not insurable according to FWD’s underwriting rules, FWD may terminate the policy or refuse to pay benefits under relevant policy after the change;
5. If a claim is false, fraudulent, intentionally exaggerated or if any person has used fraudulent means to attempt to claim a benefit, premium paid and insurance levy will not be refunded and any benefit paid because of such means will be recovered; or
6. The premium grace period expires and FWD has not received the premium payment.

Under the policy, FWD will not pay any benefits in relation to or arising from the following expenses:

1. war, invasion, acts of foreign enemies, hostilities or warlike operations (whether war be declared or not), civil war, rebellion, revolution, insurrection, riot, strike, civil commotion assuming the proportions of or amounting to an uprising, military or usurped power, terrorist act, naval, military or air-force services, any operation or combat duty with any armed force of any country, territory, or organization, nuclear reactions, nuclear radiation, nuclear contamination, biological contamination or chemical contamination;
2. the willful participation of the Insured in any criminal offence or illegal acts;
3. AIDS or any complications associated with a HIV infection, unless the First Symptoms appear of a relevant Illness due to AIDS or any complications associated with HIV infection occur 2 years or more after the Policy Date. HIV Infection refers to an infection where blood or other relevant test(s) indicate, in FWD’s opinion, either the presence of any Human Immunodeficiency Virus, antigens or antibodies to such virus;
4. Non-Emergency Treatment outside Asia; and
5. Pre-existing Condition(s) or any Eligible Expenses incurred for Pre-existing Condition(s) that You and/or Insured was not aware and would not reasonably have been aware on or before the 30th day of the Policy Date.

Suicide

If the Insured commits suicide (whether sane or insane at that time) within 13 calendar months from the Policy Date, FWD’s liability under the policy will be limited to the refund of premiums paid (without interest) less any outstanding insurance levy and any benefit which has been paid under the policy.

Cancellation Right within Cooling-off Period
If you are not fully satisfied with this policy, you have the right to change your mind.
FWD trusts that this policy will satisfy your financial needs. However, if you are not completely satisfied, you have the right to cancel and obtain a full refund of the insurance premium paid by you and insurance levy paid by you without interest by giving FWD written notice. Such notice must be signed by you and received directly by the office of FWD within 21 calendar days immediately following either the day of delivery of the policy or a Cooling-off Notice to you or your nominated representative, whichever is the earlier. The notice is the one sent to you or your nominated representative (separate from the policy) notifying you of your right to cancel within the stated 21 calendar day period. No refund can be made if a claim payment under the policy has been made prior to your request for cancellation. Should you have any further queries, you may (1) call FWD’s Service Hotline on 3123 3123; (2) visit FWD Insurance Solutions Centres; or (3) email to cs.hk@fwd.com and FWD will be happy to explain your cancellation rights further.

Cancellation Right after Cooling-off Period
To cancel the policy, the Policy Owner needs to send FWD a completed cancellation form or by any other means acceptable by FWD.

Renewal
FWD will automatically renew the policy at each Policy Anniversary until the Expiry Date. This automatic renewal is only applicable if the Policy premiums are paid when due without the requirement of evidence of insurability.
FWD reserves the right to revise, amend or modify the policy, including the premium, at each Policy Anniversary, and FWD will notify you in writing at least 30 calendar days before the Policy Anniversary after which the revisions will take effect.

Refund from Other Sources
If you can obtain a refund of any expenses from any other sources, FWD will only pay for any excess costs of these expenses up to the limit set out in the Policy Schedule or any Endorsement.

You must tell FWD if you or the Insured can obtain a refund of all or part of expenses from any other sources. The reimbursement from those other sources will count towards the Balance of Annual Deductible (if any and if applicable) provided that required documents including but not limited to the original receipts are submitted to FWD. If FWD has paid a benefit which is recoverable from another source, you must refund this amount to FWD.

Notice of Claim
You must inform FWD in written as soon as possible, and no later than 6-month of the Insured’s discharge from Hospital, the date of completion of Day Case Procedure, the date the Medical Service is performed and completed, or the date of death of the Insured, for which a claim will be made on the policy. FWD has the right to reject any written claims submitted after this 6-month notice period.

Obligation to Provide Information
FWD and FWD’s affiliates are obliged to comply with legal and/or regulatory requirements in various jurisdictions as promulgated and amended from time to time, such as the United States Foreign Account Tax Compliance Act, and the automatic exchange of information regime (“AEOI”) followed by the Inland Revenue Department (the “Applicable Requirements”). These obligations include providing information of clients and related parties (including personal information) to relevant local and international authorities and/or to verify the identity of the clients and related parties. In addition, FWD’s obligations under the AEOI are to:
i. identify accounts as non-excluded “financial accounts” (NEFAs);
ii. identify the jurisdiction(s) in which NEFA-holding individuals and NEFA-holding entities reside for tax purposes;
iii. determine the status of NEFA-holding entities as “passive non-financial entities (NFEs)” and identify the jurisdiction(s) in which their controlling persons reside for tax purposes;
iv. collect information on NEFAs (“Required Information”) which is required by the authorities; and
v. furnish Required Information to the Inland Revenue Department.

The Policy Owner must comply with requests made by FWD to comply with the above Applicable Requirements.

Incorrect Disclosure or Non-disclosure
Your policy is based on the information you and the Insured gave FWD during the application process. It is important that you and the Insured were truthful and accurate with all of the information, including but not limited to Age and gender you provided, as this information helped FWD to decide if you and they were eligible for the policy, and what you need to pay.
You or the Insured are/is required to disclose all material facts in response to FWD's underwriting questions. Material facts are the facts, information or circumstances, in particular medically-related facts, e.g. medical history, smoking status, etc., that would influence the judgment of FWD in setting the premium, or in determining whether to insure the risk. If you or the Insured are/is uncertain as to whether or not a certain piece of information is material, please take a cautious approach and disclose it to FWD.
You should let FWD know immediately if the information you or the Insured gave FWD was inaccurate, misleading or exaggerated. If you or the Insured did not provide accurate and truthful information, or you or they gave misleading or exaggerated information, your benefits or premium under your policy may be affected, and in some cases FWD may cancel your policy.
You should also let FWD know if the Insured’s place of residence or occupation changes and FWD will re-underwriting in respect of such changes based on the then underwriting rules and the re-underwriting result may be more advantageous or adverse to you and the Insured.

Accident and Accidental
refers to a sudden, unexpected and unintentional external event which causes an Injury to the Insured, and occurs while he or she is insured by the policy. An Accident does not include an Illness, degenerative process or any other naturally occurring condition.

Age
refers to the age next birthday of the Insured of the policy, unless otherwise specified.

Annual Deductible
refers to a fixed amount of Eligible Expenses in a Policy Year that the Policy Owner must pay before FWD will reimburse the remaining Eligible Expenses.

Annual Limit
refers to the maximum amount of benefits FWD pays to you in a Policy Year irrespective of whether any limits of any benefit items stated in the Policy Schedule or any Endorsement have been reached. The Annual Limit is counted afresh in a new Policy Year.

Balance of Annual Deductible
refers to the remaining amount of Annual Deductible to be borne by you or the Insured within the relevant Policy Year under the policy.

Confinement or Confined
refers to an admission of the Insured to a Hospital that is recommended by a Physician for Medical Service and as an In-Patient as a result of a Medically Necessary condition. Confinement will be evidenced by a daily room charge invoiced by the Hospital and the Insured must stay in the Hospital continuously for the entire period of Confinement.

Congenital Condition(s)
refers to (a) any medical, physical or mental abnormalities existed at the time of or before birth, whether or not being manifested, diagnosed or known at birth; or (b) any neo-natal abnormalities developed within 6 months of birth.

Day Case Procedure
refers to a Medically Necessary surgical procedure for investigation or treatment listed in the Appendix 1 of the policy provision to the Insured performed in a medical clinic, or day case procedure centre or Hospital with facilities for recovery as a Day Patient.

Disability
refers to an Illness or Injury, including Disabilities arising from the same cause, and any complications arising from that Illness or Injury.

Eligible Expenses
refers to the Reasonable and Customary charges for Medically Necessary treatment or services for a Disability.

Expiry Date
refers to the Policy Anniversary immediately following the Insured’s 100th birthday.

Medically Necessary
refers to a medical recommendation by a Physician, Surgeon or Specialist as part of his or her diagnosis and/or treatment of an Illness or Injury. The medical recommendation must meet each of the following criteria:

1. the Insured’s medical condition will be adversely affected if the medical recommendation is not followed;
2. The recommendation is widely accepted within the medical profession in Hong Kong or the country of treatment as being effective, appropriate and essential to diagnose, relieve or cure the Insured’s Illness or Injury based on recognised western medical standards of the specialty involved;
3. The recommended medical management and/or treatment is not experimental in nature; and
4. The recommended diagnosis and/or treatment is not preventative, investigational or screening in nature, is not opted or selected by the Insured alone, nor is it for the personal convenience or comfort of the Insured or any medical service provider. This precludes:

• general check-up unrelated to an Illness or Injury;
• preventative screening or check-up looking for the presence of an Illness or Injury where there are no symptoms or history of that Illness or Injury;
• vaccinations for the prevention of an Illness or Injury;
• convalescence, custodial or rest care unrelated to an Illness or Injury;
• cosmetic surgery for aesthetic purposes, including gender identity treatment or procedures of any kind (even if not for aesthetic purposes);
• dental treatment, eye tests and/or optical treatment and surgery, unless this treatment is directly related to an Illness or Injury covered by the policy.

Policy Date
refers to the date when coverage under the policy begins as shown in the Policy Schedule (document attached to the policy which shows important information about the policy, including the policy number, premium payable and the policy benefits) or the date that FWD reinstates the coverage of the policy, whichever is later.

Pre-existing Conditions
refers to any Illness, Injury, physical, mental or medical condition or physiological degradation, including Congenital Condition of the Insured, that has existed prior to the Policy Date. An ordinary prudent person will be reasonably aware of a Pre-existing Condition, where:

1. it has been diagnosed;
2. it has manifested clear and distinct signs or symptoms; or
3. medical advice or treatment has been sought, recommended or received.

Reasonable and Customary
refers to a fee or expense which:

1. is actually charged for Medically Necessary treatment, supplies or Medical Services;
2. does not exceed the usual or reasonable average level of charges for similar treatment, supplies or Medical Services in the location where the expense is incurred;
3. does not include charges that would not have been made if no insurance existed.

FWD may adjust benefit(s) payable under the policy for fees or expenses that FWD judges not to be Reasonable and Customary after comparing with fee schedules used by the government, relevant authorities or recognised medical association in the location where the fee or expense is incurred.

If Insured is diagnosed with a designated crisis (such as Specified Cancer, Heart Attack and Stroke), Balance of Annual Deductible (if any and if applicable) in respect of the claim of such designated crisis will be reduced to zero under benefit “First-dollar Coverage – Annual Deductible Waived for Designated Crises” of MyMillion, means the relevant benefit payable will be paid without deducting any Balance of Annual Deductible. And such claim amount shall be deducted from the Balance of Annual Deductible of such Policy Year (if any and if applicable) . For the definitions and details of designated crisis and the relevant waiting period, please refer to policy provisions.