Employee Top Up Medical Insurance

Hospital and surgical cover is basic; outpatient cover is optional, with worldwide cover excluding the USA.Public source · Checked: 14 Oct 2026

The annual lump-sum hospital/surgical limits are HKD150,000 for Plans 1–2, HKD300,000 for Plans 3–4 and HKD600,000 for Plans 5–6, subject to deductibles and reimbursement percentages.Public source · Checked: 15 Oct 2026

Premiums may be paid monthly or annually.Public source · Checked: 14 Oct 2026

Premiums adjust yearly by attained age and annual review; premium rates and renewal terms are not guaranteed.Public source · Checked: 14 Oct 2026Public source · Checked: 14 Oct 2026

Lifetime renewal is guaranteed, while renewal rates and terms may change.Public source · Checked: 14 Oct 2026Public source · Checked: 14 Oct 2026

Eligible existing group members need twelve consecutive covered months for covered pre-existing conditions; specified conditions including cataracts and joint replacement have a six-month waiting period.Public source · Checked: 14 Oct 2026Public source · Checked: 14 Oct 2026

General exclusions include non-medically-necessary services, specified cosmetic/vision correction services and experimental treatments; pre-existing conditions have a conditional 12-month group/plan continuity exception.Public source · Checked: 15 Oct 2026

Optional Outpatient Benefit is offered alongside the basic hospital and surgical benefit.Public source · Checked: 14 Oct 2026

Insurer claims guide

Claims can be submitted through EASY Claims online, with a dedicated claims hotline also listed.Public source · Checked: 14 Oct 2026

1. First contact the insurer through its published complaint channel; retain its written reply.Public source · Checked: 13 Oct 2026

2. Insurance Authority: submit the signed complaint form with supporting documents by email, post or fax. It handles insurer/intermediary conduct; it cannot adjudicate claim disputes or order compensation. Eligible claim disputes can go directly to ICB; an IA referral requires the complainant’s consent.Public source · Checked: 13 Oct 2026

3. Insurance Complaints Bureau: eligible monetary disputes under personal policies with member insurers, up to HK$1,500,000. A policyholder, beneficiary, insured or rightful claimant must file within six months of notification of the insurer’s final decision. Industrial, commercial and third-party insurance and cases undergoing or having completed litigation/arbitration are excluded. Non-claim complaints exclude service quality, underwriting decisions, investment performance and levels of fees, premiums, charges or interest. Similar rejected claims across policies are aggregated; periodic/long-tail claims use a five-year total.Public source · Checked: 13 Oct 2026

ICB accepts written complaints by post, fax or email using its complaint form. Include policy and application documents, claim form, relevant evidence and the insurer’s final written decision; no reception counter service.Public source · Checked: 13 Oct 2026