CLAIM INSURANCE INSTRUCTION - GOLDEN HEALTH - OPTION 1 1 TABLE OF CONTENT I GENERAL INFORMATION ………………………………………………………… 2 II BENEFIT TABLE ………………………………………………………… 3 III DEFINITION ………………………………………………………… 6 IV WAITING PERIOD ………………………………………………………… 7 V EXTENSION CLAUSES ………………………………………………………… 8 VI MAIN EXCLUSIONS ………………………………………………………… 10 VII DIRECT BILLING AND CLAIM PROCEDURE ………………………………………………………… 11 7.1 DIRECT BILLING PROCEDURE ………………………………………………………… 11 7.2 CLAIM BACK PROCEDURE ………………………………………………………… 13 7.3 CLAIM DOCUMENT ………………………………………………………… 14 7.4 FREQUENTLY ASKED QUESTIONS ………………………………………………………… 15 VIII DIRECT BILLING NETWORK ………………………………………………………… 16 IX CONTACTS FOR SUPPORT ………………………………………………………… 27
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TABLE OF CONTENT€¦ · CLAIM INSURANCE INSTRUCTION - GOLDEN HEALTH - OPTION 1 3 II. BENEFIT TABLE I PERSONAL ACCIDENT INSURANCE 1 ACCIDENT VND 1.500.000.000/year AREA OF COVERAGE
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CLAIM INSURANCE INSTRUCTION - GOLDEN HEALTH - OPTION 1 1
TABLE OF CONTENT
I GENERAL INFORMATION ………………………………………………………… 2
II BENEFIT TABLE ………………………………………………………… 3
III DEFINITION ………………………………………………………… 6
IV WAITING PERIOD ………………………………………………………… 7
V EXTENSION CLAUSES ………………………………………………………… 8
VI MAIN EXCLUSIONS ………………………………………………………… 10
VII DIRECT BILLING AND CLAIM
PROCEDURE
………………………………………………………… 11
7.1 DIRECT BILLING PROCEDURE ………………………………………………………… 11
7.2 CLAIM BACK PROCEDURE ………………………………………………………… 13
CLAIM INSURANCE INSTRUCTION - GOLDEN HEALTH - OPTION 1 3
II. BENEFIT TABLE
I PERSONAL ACCIDENT INSURANCE
1 ACCIDENT VND 1.500.000.000/year
AREA OF COVERAGE WORLDWIDE
1.1 Dealth or permanent total disablement due to accident 100% sum insured
1.2 Partial permanent disablement due to accident A percentage of Capital Sum
as per Scale of Compensation
2 MEDICAL TREATMENT FOLLOWING ACCIDENT VND 100.000.000/ year
AREA OF COVERAGE VIETNAM
2.1 Hospital miscellaneous charges Paid up to limit
2.2 Daily allowance per night when the Insured is paid from and above 70% total expenses by compulsory medical insurance (maximum 60 days/year)
VND 200.000/day
2.3 Expenses for transportation in emergency case (excluding by air and IPA, and limit for taxi: VND 500.000/person/year)
Paid up to limit
2.4 Educational support: VND 5,000,000/child, maximum 2 children under 18 years old whose mother/father is VietJet Air’s employee and die due to accident under coverage
VND 5.000.000
II HEALTH INSURANCE (EXCLUDING MATERNITY BENEFIT)
1 DEATH/ PERMANENT TOTAL DISABLEMENT FOLLOWING ILLNESS/ SICKNESS/ DISEASE (EXCLUDING MATERNITY BENEFIT)
NOT APPLIED
2 IN PATIENT TREATMENT FOLLOWING ILLNESS/ SICKNESS/DISEASE (EXCLUDING MATERNITY BENEFIT)
2.1.1 Daily accommodation charges (standard single room)
VND 5.000.000/day Maximum 60 days/year
2.1.2 Diagnostics Test charges
2.1.3 Drugs during treatment
2.1.4 Blood, dressings, plasma
2.1.5 Other charges during inpatient treatment
2.1.6 Intensive care unit charges; Emergency ward
CLAIM INSURANCE INSTRUCTION - GOLDEN HEALTH - OPTION 1 4
2.2 Surgical charges (including Inpatient/ Day-patient/ Minor surgery) VND 100.000.000/year
Surgical charges including but not limit: - Surgeon and anesthetist charges - Operating theatre charges - Medical supplies - In-hospital specialist consultation; - Rehabilitation after surgery - Organ transplant charges (excluding organ procurement costs as well as the costs incurred by the donor) - Re-surgical charges
Paid up to limit
2.3 Pre - hospitalization treatment (only 1 examination/test before the hospital admission)
VND 5.000.000/year
2.4 Post - hospitalization treatment (the nearest time within 30 days after discharge)
VND 5.000.000/year
2.5 Home nursing care after discharge (immediately following the date of charge and maximum 15 days/year)
VND 5.000.000/year
2.6 Rehabilitation VND 10.000.000/year
2.7 Daily allowance (Insured choose 1 allowance)
2.7.1 Daily allowance per night (maximum 60days/year) VND 100.000/day
2.7.2 Daily allowance per night when the Insured is paid from and above 70% total expenses by compulsory medical insurance (maximum 60 days/year)
VND 200.000/day
2.8 Local emergency transportation by all the transport, including taxi (max VND 500,000/year) and excluding airplane and IPA service
Paid up to limit
2.9 Burial Allowance (Death during hospitalization) VND 2.000.000/year
3 OUT PATIENT TREATMENT FOLLOWING SICKNESS/ILLNESS/DISEASE (EXCLUDING MATERNITY BENEFIT)
VND 10.000.000/year
AREA OF COVERAGE VIETNAM
3.1
- General Practitioners and Specialist fees, - Prescribed medicines, - Laboratory tests, X-ray tests, - Diagnostic and treatment prescribed by a physician within scope of coverage, including the first examination for physiotherapy
VND 2.000.000 / visit
Limit of visit/year Not limited
3.2
Dental treatment - Diagnostic, x-rays - Gingivitis, pyorrhoea - Normal filling (amalgam or composite, fuji) - Root canal treatment - Removal of decayed teeth - Extractions of diseased teeth (including surgery and minor surgery)
VND2.000.000/year
CLAIM INSURANCE INSTRUCTION - GOLDEN HEALTH - OPTION 1 5
3.3 Physiotherapy, radiotherapy, heat therapy or phototherapy, other similar therapies prescribed by a physician (maximum 60 days/ year)
VND 100.000/day
Note:
Dental treatment is limited at the following medical establishment:
- Dental departments at all legal hospitals in Vietnam.
- HCMC and Hanoi: besides Dental departments at legal hospitals, Bao Viet only accept treatment at
the clinics/ dental clinics in the Direct Billing System signed with Bao Viet Insurance.
- Other cities/ provinces: besides Dental departments at legal hospitals, the insurer shall extend to
cover treatments at legally licensed clinics/ dental clinics and being able to issue legal invoices in
accordance with Ministry of Finance’s regulation.
Bao Viet will not cover for treatments at Happy dental clinic (26 Ham Nghi, Da Nang), Dai Nam dental
clinic (328 Ong Ich Khiem, Thanh Khe District, Da Nang). For full details of black-list please see the website
CLAIM INSURANCE INSTRUCTION - GOLDEN HEALTH - OPTION 1 6
III. DEFINITION
Eligible medical expenses: refer to the expenses incurred for medically necessary treatments
provided to an insured for illness, disease and injury by accidents.
Hospitalization: refers to the necessity for a patient to stay at least 24 hours in the hospital for medical
treatment, shown in the Admission or Discharge Form or in the detail medical record and bills.
Day-patient: An insured Person who is admitted to the Hospital, incurring expenses for bed but does
not stay overnight
Room and board: refers to the costs, limited to a standard private room rate (excluding VIP room),
and associated charges, including admittance to the intensive care unit, and charges for nursing by a
qualified nurse
Physician: refers to a legally licensed medical practitioner recognized by the law of the country where
treatment is provided and who, in rendering such treatment, is practicing within the scope of his
licensing and training but excluding a Physician who is the Insured Person himself, or the spouse or lineal
relative of the Insured Person. A physician may be recognized as a Consultant or a Specialist.
Accident: Any sudden and unforeseen event, caused by an external, violent and visible means during
the period of insurance, and a directly cause resulting in Bodily Injury to the Insured and occurs beyond the
Insured’s control.
Out-patient: An insured person who receives treatment at a recognized licensed medical facility
(registered at Provincial or City Health Department and Taxation Bureau) but is not admitted to a hospital
bed as an In-patient or Day-patient
Ambulance service means the ambulance car service provided by any legal Hospital or Clinic in the
event of a Medical Emergency or serious accident/illness or diseases to evacuate the Insured to the
nearest Hospital/Clinic or from a Hospital/Clinic to another
In-patient: An insured Person who is admitted to a bed in a Hospital or Clinic which incurs expenses
including pre-hospitalization expenses, hospitalization expenses, day-patient expenses, surgical
expenses
Pre-hospitalization expenses refer to the examinations such as X-ray, scan and laboratory tests,
ordered by a Physician and resulting directly from a condition for which hospitalization is required and
performed during 30 days before hospitalization
Post-hospitalization treatment: refer to medical treatment received immediately discharge from
Hospital for a continuous period not exceeding 30 days, such treatment being provided or ordered by a
physician and resulting directly from the condition for which hospitalization is required
Home nursing: refer to services of a legally licensed nurse in the Insured’s Person abode
immediately following a covered in-patient stay in the hospital (the minimum number of hospitalization days
is from 7 days). This sevice must be prescribed by a physician for medical due to specific reasons of
medical vision
CLAIM INSURANCE INSTRUCTION - GOLDEN HEALTH - OPTION 1 7
IV. WAITING PERIOD
Waiting period Employee Dependants
1. Accident Waived Waived
2. Normal illness, sickness, disease Waived 30 days
3. Special Diseases, Pre-existing conditions, diseases excluded in the first year (excluding ligament surgery)
Waived 365 days
4. Death/Permanent Disablement due to normal illness, disease
Waived 30 days
5. Death/Permanent Disablement due to Special Diseases, Pre-existing conditions
365 days 365 days
Pre-existing Diseases/ Injury
Illness or injury which exists before applying for insurance and due to such medical condition, the Insured
Person:
a) has been under treatment within three (03) previous years
b) has recognised or has been aware or should reasonably be aware of symptoms of such illness/ injury
before the date of applying for the insurance, regardless of whether a consultation/ treatment is received or
not
For example: tonsillectomy, VA curettage, disc herniation, spine spine, vestibular disorder…
Special Diseases
Refers to cancer and tumor of all types, hypertension, cardio-vascular diseases, stomach ulcers, chronic
inflame of bone joints, intestine ulcers, liver inflammation, inflammation of inside uterus, haemorrhoids,
different kinds of stones in the urinary and biliary systems, cataract, sinusitis, Parkinson, diabetes, disease
relating to recreating blood system such as blood purification, blood transfusion, hemodialysis.
Normal Diseases
They are acute diseases which have no long-term incubation period, newly arising and treating completely, no
repeating many times as chronic disease
For example: dengue fever, urticaria, allergic rhinitis, appendicitis, fever….
CLAIM INSURANCE INSTRUCTION - GOLDEN HEALTH - OPTION 1 8
IV. EXTENSION CLAUSES
EXTENSION CLAUSE FOR RISKS WITH HUGE CONSEQUENCES
Toxic Poisoning through eating and drinking Maximum overall compensation limit (accumulation loss):
VND2.100.000.000/each and every occurrence and in the aggregate Toxic Poisoning due to inhalation of toxic gases, compound
Diseases due to swine flu, bird flu, influenza A (H1N1), H5N1 (maximum accumulative VND 2.1 billion VND / contract), exclusion of disease notified by the health authorities (coverage for medical expenses )
Applied
Exposure & Disappearance Clause Applied
Hijacking Clause Applied
Army forces activities Applied
Motor Cycling Extension Applied
Occupational disease clause Pay to benefit “Medical expenses due to
accident”
EXTENSIONS CLAUSES FOR DIAGNOSTICS
Homeopath and traditional Chinese medicine practitioner; Applied
Medical materials in outpatient treatment include but not limit:Natri clorid, Sterima, Humer, Marinmer, Xisat.
VND 500.000/year
Longo knife for hemorrhoid surgery Applied
Extension for stent, coronary arteries, cathenter in heart surgery and net in inguinal hernia surgery
Applied
Vitamins and minerals supporting the treatment of diseases
max 20% of total description value for complemantory medecines and full covered
if they are main medecine for treatment. Maximum 500,000 VND/person/year
Extension for medical supplies for treatment of illnesses including but not limited to: metal splint, disc, vis
Limit to 1,500,000 VND/ person/year
Extension forbiochemical and metabolic abnormalitiesincluding but not limited for treatment of increasing lipid level in blood serum, high liver enzyme, hypocalcemia or similar conditions
Applied
CLAIM INSURANCE INSTRUCTION - GOLDEN HEALTH - OPTION 1 9
EXTENSION CLAUSES FOR CLAIM PROCEDURE
Waiver of medical detailed and breakdown lists at public hospitals (applicable for inpatient and outpatient)
Apply for inpatient records of under VND 2,000,000 and outpatient visits of under
VND 500,000
Extension for all types of service rooms in international departments, voluntary departments, on-demand care departments at standard public hospitals (excluding deluxe and VIP room)
Applied
Daily hospital expenses include standard meal (as part of medical expenses) and other reasonable expenses during treatment
Applied
Accepting VAT invoice of medecines issued within 30 days from the date of prescription
Applied
Accepting prescriptions of up to 60 days as indicated by doctor but it must be not longer than insurance period and in the list of chronic diseases
Appied for Chronic diseases
Company stamp and signature of management on claim form Applied
ADDITIONAL SERVICES
Claim handling and settlement within 15 working days since receiving valid and sufficent claim document. Payment within 07 working days since receiving notification.
Applied
Quarter claim report Applied
CLAIM INSURANCE INSTRUCTION - GOLDEN HEALTH - OPTION 1 10
VI. MAIN EXCLUSIONS
Wilful misconduct of the Insured Person or the legal Beneficiary
Grave violation of law, regulation and other rule of the local authority or other social bodies and serious
violation of traffic regulations
The use of and under the influence of alcohol, beer or other similar stimulants by the Insured Person,
when it is proven that it has been the direct cause of the accident
Medical treatment or use of medicaments or medicines without applying prescription or indication of the
8 Dr Hung Dental Clinic 235 Road 30/4,W. Rach Dua, Vung Tau City
(0254) 6 270 279
x Mon - Sun: 8h - 11h30, 14h30-20h30
KIEN GIANG
1 Vinmec Phu Quoc Hospital (see the note No. 6)
Bai Dai, W. Ganh Dau, Dist. Phu Quoc
(0297) 398 5588 x x x Mon - Fri: 8h - 17h Sat: 8h - 11h30
CA MAU
1 Hoan My Minh Hai Hospital
09 Lac Long Quan, 7 Dist, Can Tho
(0290) 3575 859 x x x Mon- Sat: 7h-11h30, 12h30-16h Sun: 7h-12h
CLAIM INSURANCE INSTRUCTION - GOLDEN HEALTH - OPTION 1 26
NOTES
1. Usage of Health Insurace Card: v Out - patient & In - patient : Golden Cards v In - patient : Blue or Silver Cards v Foreign Direct Billing Services : VIP Cards
2. Contacts of Direct Billing Department v Tel : (04) 3936 8888 / (04) 3936 9550 (Monday - Friday: 8h - 11h30 ; 13h - 17h) v Hotline: 0904 832 888 / 0906 633 757 (24/7) v International assistance service: +662 039 5705
3. Clients should present Health Insurance Card and identity document when requiring direct billing sevice at any Hospitals or Clinics under Bao Viet Insurance's Direct Billing Network
4. In case of in-patient treatment, hospitals may have requirement of deposit. The deposit shall be refunded when Client discharge
5. In case of out-patient treament, some medical facilities may have requirement of deposit. The deposit shall be refunded when the procedure of out patient treament completes and Bao Viet Insurance sends the confirmation of coverage for the expenses of those tests.
6. Direct billing service might not be available in case part of medical expenses is not covered by Bao Viet Insurcance
7. Direct billing service will not be available for prescriptions in case of out-patient treatment
8. Special Notes of New World Clinic: Direct billing service will not be available in case of treatment for accident. Client should settle payment to the Clinic and send the Claims to Bao Viet Insurance
9. Special Notes of Hong Phuc Hospital: Client might be charged document delivery fee
10. This list is subject to change without prior notice. Please visit the website below for updated information http://www.baoviet.com.vn/insurance/Dich-vu-khach-hang/Dich-vu-bao-lanh-vien-phi--chi-tra-boi-thuong/CustomerServices/159/
CLAIM INSURANCE INSTRUCTION - GOLDEN HEALTH - OPTION 1 27
IX. CONTACTS FOR SUPPORT
Note: This documents is not insurance policy and for reference only.
Item Address
Address for sending
claim papers
1. Hanoi
GiNET Vietnam - Room 3, 11st Floor, Harec Building, No. 4A Lang Ha, Ba Dinh, Hanoi