Bupa Care Kid 保柏童康健

For their
growing needs
照顧健康成長的需要
www.bupa.com.hk
Introduction to
Bupa Care Kid
保柏童康健醫療保障計劃簡介

Bupa Care Kid gives your little ones a running start with
cover from 15 days old and guaranteed transfer to Bupa
CarePro at 18 years old, securing them with a lifetime
of protection. The comprehensive cover comes at an
affordable rate, and with optional extras you can afford to
protect their growing health needs within a budget that
suits you.
從您的子女出生15天起，「保柏童康健」便開始保障他們的健康，
一直伴隨他們成長。當子女年滿18歲，我們更保證將他們的會籍轉
移至「保柏卓康健」以享終生保障。此計劃保費實惠，保障全面，
您更可因應您的預算和子女的成長需要額外增添自選保障。
 There is no waiting period, meaning
that your child is protected as soon
as their membership starts.
此計劃不設等候期，子女的會籍生效後即
可獲得保障。

Overview of their cover

子女的保障概要
Cover at a glance 保障一覽表

Basic benefit Hospital and Surgical Benefit

基本保障 住院及手術保障
Optional benefits Full Cover Benefit
自選保障 全數賠償保障
Supplementary Major Medical Benefit
附加醫療保障
Hospital Cash Benefit
住院現金保障
Clinical Benefit
門診保障
Free Benefit Free Bupa Worldwide Assistance Programme
免費保障 免費保柏國際援助計劃
Medical card Yes (For members choosing Full Cover Benefit and/or Supplementary Major Medical Benefit)
醫療卡 有 (適用於已加入全數賠償保障及/或附加醫療保障之會員)
Choice of benefit levels Private (Plan 1 or 4)
保障等級選擇 私家房 (計劃 1 或 4)
Semi-private (Plan 2 or 5)
半私家房 (計劃 2 或 5)
Ward (Plan 3 or 6)
大房 (計劃 3 或 6)
Child discount 25% discount when the child enrols with one parent
子女保費折扣 父或母與子女一同投保可享25%保費折扣
50% discount when the child enrols with both parents
父母與子女一同投保可享50%保費折扣
This discount will apply to both Hospital and Surgical Benefit and Full Cover Benefit
子女保費折扣適用於「住院及手術保障」及「全數賠償保障」
Eligibility 投保資格

Issue age 15 days to 17 years

投保年齡 由出生15天至17歲
Renewal of scheme Guaranteed renewal up to age 18, followed by transfer to Bupa CarePro which offers lifetime
續保 guaranteed renewal
保證續保至18歲，其後可轉保至保證終生續保的「保柏卓康健」
Please refer to the Schedule of Benefits for more information.
詳情請參閱保障金額表。

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 Wrap them up in a
world of benefits
照顧子女成長的周全保障

Our healthcare expertise means that we are able to offer

unparalleled benefits to your child, from higher cover to expert
healthcare and a lifetime of support.
我們在醫療保健上擁有豐富經驗，因此能為您的子女提供卓越的保障，
包括更高賠償、專業的醫療保健服務以及終生的支援。

Supporting you and

your family always…
時刻支援您和子女的需要⋯⋯

Higher pay-out from a lump sum benefit at any local private hospital. We will pay all your child’s eligible
medical expenses directly up to their credit limit, so you don’t
The optimal combination of our Hospital and Surgical Benefit
have to submit any claims.
and Full Cover Benefit can cover your child’s basic hospital
expenses. The Full Cover Benefit guarantees that 100% of the
No claims renewal bonus
hospital expenses will be paid, regardless of each individual item
limit, as long as the total bill falls within the annual limit If you do not claim within a specific period, you can enjoy an
(from HK$215,000 to HK$760,000). To enjoy the Full Cover increasing renewal discount on your child’s Hospital and Surgical
Benefit, simply select an attending doctor from our network Benefit and Full Cover Benefit. You will receive 5% discount
providers. And in eight renowned private hospitals appointed if you do not claim for two or three consecutive years, 10%
by Bupa, your child can receive quality treatment without any discount for four or five consecutive years and 15% discount for
payment or claims thanks to our pioneering medical card. six or more consecutive years.
If you wish to consult a doctor outside our network, your child
will still be covered under the Hospital and Surgical Benefit. No extra subscription
Regardless of your child’s claims history or changes in health
Top-up benefit to cover serious illnesses after joining Bupa Care Kid, there will be no increase in their
Some serious illnesses can rack up unexpected costs. The subscription on an individual basis when you renew their
Supplementary Major Medical Benefit will help to reduce contract.
potential out-of-pocket expenses by boosting your child’s
basic cover. It pays 80% of their medical expenses in excess Companion Bed Benefit
of the amount covered by the Hospital and Surgical Benefit or We cover the expenses of a companion bed for parents or family
Full Cover Benefit. Similar to Full Cover Benefit, you will members who look after their children during hospitalisation.
receive a medical card. Before a hospital stay, simply call us to
complete a simple registration process and present this card

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 If you choose to add the Full Cover Benefit to your child’s
cover, we will pre-authorise their medical expenses before
their hospital admission meaning all you have to think
about is your little one’s recovery.
如您選擇為子女附加「全數賠償保障」，我們將會在子女入院前，
預先批核醫療費用，讓您可安心照顧您的子女。

一筆過保障額 賠償更高 無索償保費折扣

「住院及手術保障」和「全數賠償保障」的組合可助您應付子女 若在指定期間內未曾提出索償，便可享有「住院及手術保障」和
基本的住院支出。「全數賠償保障」不限制於每項住院費用，只 「全數賠償保障」的續保保費折扣。如連續兩年或三年未有索
要住院總支出在每年保障額內(由港幣21萬5千元至76萬元)，您 償，可獲享5%保費折扣；連續四年或五年，可享10%保費折扣；
便可獲100%賠償。要享有「全數賠償保障」，您只須從保柏網 連續六年或以上，更可享15%保費折扣。
絡內選擇子女的主診醫生，並可憑醫療卡於8間著名的特選私家
醫院接受治療，而不用繳費及索償。如果有需要時您亦可選擇 不收個人額外保費
網絡以外的醫生，而獲得「住院及手術保障」的賠償。 在投保「保柏童康健」後不論子女的索償紀錄或健康變化，在子
女續保時我們絕不會收取個人額外保費。
加添保障 應付嚴重疾病
嚴重疾病的醫療支出往往在您意料之外，「附加醫療保障」可為 住院加床費保障
您減低自付費用。當醫療費用超出「住院及手術保障」或「全數 於子女住院期間，父母或家人的住院加床費亦會獲得賠償。
賠償保障」的賠償額時，「附加醫療保障」將賠償差額的8成。
與「全數賠償保障」一樣，您將會獲發醫療卡。您只須於入院前
致電保柏完成簡單的登記程序，並於子女入住本港任何一間私家
醫院時出示醫療卡，我們便會直接向醫院支付醫療費用（以信用
額為上限），無須申請索償。  Please refer to the Question Time section for more details.
詳情請參閱常見問題部分。
 Supplementary Major Medical Benefit is not applicable to
Pre-admission and Post-hospitalisation Out-patient Care and
Emergency Out-patient Benefit for Accidents. A small
deductible is required.
附加醫療保障」不適用於入院前、出院後之門診護理及緊急意外門診保障，
並設有小額墊底費。

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 Claims service pledge
No claims procedure is required if you use the
Bupa medical card. All other hospitalisation and
consultation claims will be settled within 5 – 7
working days after full documentation is received.
賠償服務承諾
如您使用保柏醫療卡，無需索償手續。其他住院及門診賠
償，於收妥所需文件後5 – 7個工作天內支付。

with medical expertise…

更佳保障　因為我們了解醫療⋯⋯
Higher cover thanks to per-surgery benefit 逐次手術賠償，保障更高　
Most insurance schemes pay for surgical fees per disability. 大部分醫療保障計劃的手術賠償均以每病症計，即因相同病症而
This means that all operations related to the same condition will 引致的手術費用均會在同一保障額內扣除。當保障額耗盡後，您
be paid out of a single maximum benefit limit. Once the limit 便須要自付餘下的費用。保柏則逐次手術賠償至最高賠償額，如
is exhausted, you will need to pay the excess. With Bupa, you 須要進行超過一次手術，您可獲更高的實際賠償金額。
can claim up to the maximum benefit limit for each operation,
allowing you to enjoy higher cover if your child require more 照顧意外受傷
than one operation.
小孩活潑好動，撞傷擦傷或誤吞異物等很常見。如果這些意外發
Cover for accidental injuries 生，您一定想立刻找醫生為他們診治。我們賠償您的子女到醫院
門診或急症室診治的醫療費用，包括診症費、藥費及診斷影像費
Children’s play can often lead to accidental injuries from
bumps and bruises to eating inedible substances. Should any 等。如須接受小手術如縫針或打石膏等，無論是否意外引致，亦
of these accidents occur, you may want to seek your doctor’s 可獲得賠償。
advice immediately. We cover the related expenses including
consultation, medication and diagnostic imaging examinations 額外癌症治療及洗腎保障
received at the out-patient or accident and emergency 保柏集團對治療和診斷癌症及腎病有逾70年經驗，我們明白患者
department of a hospital. If a procedure or surgery such as 有長期治療的需要，所以特別提供高達每年港幣13萬元的額外保
wound sutures or plaster cast is required, we will pay the 障，讓您能負擔較昂貴的最新療法。此外，每年賠償額用盡後亦
expenses, whether or not the injury is incurred by an accident.
可於下一年還原，直至終生。
Extra Cancer Treatment and Kidney Dialysis
Benefit
Bupa Group has been dealing with the diagnosis and treatment
of serious illness like cancer and kidney failure for over 70 years.
As we understand that they often require prolonged treatment,
we offer additional coverage of up to HK$130,000 per year,
making it easier for you to afford more costly and advanced
treatment options. What’s more, if this cover is fully claimed in
any one year, it will be reinstated in the following year for the
rest of your child’s lifetime.

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throughout your lives…
照顧您和子女人生不同階段⋯⋯

Guaranteed lifetime renewal 保證終生續保

We guarantee that your child’s cover is renewable
無論子女在投保後的健康有任何變化，我們均保證終
生續保他們的保障。當您的子女年滿18歲，我們將會
for life, regardless of any changes in their health
轉移子女的會籍至相同保障等級的「保柏卓康健」，
condition after becoming our member. When
無須審核，一切在投保「保柏童康健」後發生的傷病
your child turns 18, we will arrange a conversion
仍可在「保柏卓康健」內繼續受保。
of membership to the same benefit level of Bupa
CarePro. No further underwriting is needed and 高達50%家庭投保優惠
any medical conditions developed after your child 隨著您的家庭增添成員，我們的支援仍伴您左右。如
has joined Bupa Care Kid will be covered by Bupa 您投保「保柏卓康健」，並與子女一同投保「保柏童
CarePro. 康健」，每名子女可獲「住院及手術保障」及「全數
賠償保障」(如適用) 的折扣優惠。如父母其中一人投
Up to 50% discount for family enrolment 保，子女可享25%保費折扣；如父母二人均投保，子
女更可享50%保費折扣。在您會籍生效期間，子女可
We want to support you as your family grows. If you 一直享有此折扣。
enrol Bupa CarePro and your children enrol Bupa
Care Kid, each child can enjoy a discount on Hospital 投保簡易
and Surgical Benefit and Full Cover Benefit, if any, for 無須驗身，快捷簡單。
as long as your membership continues. If one parent  Bupa reserves the right to amend the subscription,
benefits, terms and conditions upon your contract
enrols on Bupa CarePro, each child will receive a 25% renewal.Bupa guarantees that your cover can be renewed
discount and if both parents enrol, then they will for life, unless you change your residency to the US after
subscribing to this scheme. This is a restriction imposed
receive a 50% discount. by the US legislation where any offshore insurance
company cannot provide health cover to US residents.
保柏保留在續保時更改保費、保障、條款及細則的權利。保柏保證終
Easy enrolment 生續保您的保障，除非您於投保後居住國家更改為美國，這是美國法
例的規定，任何美國境外的保險公司均不能為美國居民提供醫療保
No medical examinations are required. 障。

5
The World of Bupa
環球保柏
Bupa Group 保柏集團
Established in the UK in 1947, Bupa is a leading international 保柏於1947年在英國成立，至今已成為領先於同業的國際醫療保
healthcare group serving over 32 million customers in more than 健集團，在全球190多個國家為3,200萬名客戶服務。保柏是英
190 countries. We are the largest health insurer in the UK. 國最大的醫療保險集團。
Our diversified healthcare services include health insurance, 我們提供多元化的醫療保健服務，包括醫療保險、醫院服務，基
hospitals, primary care and diagnostic centres, dental centres,
層醫護及診斷中心、牙科護理中心、職場健康、家居醫療護理、
workplace health services, home healthcare, health assessments,
健康評估、慢性疾病管理服務、看護服務及長者家居護理服務。
chronic disease management services, nursing and residential
我們不設股東，因此可將所有盈餘投資於業務當中，以提供更廣
care for elderly people.
及更佳的醫療保健服務，實踐我們的目標。
With no shareholders, we invest our profits to provide more and
better healthcare and fulfill our purpose. 保柏擁有約84,000名員工，主要市場包括英國、澳洲、西班
牙、波蘭、新西蘭和智利，以及沙特阿拉伯、香港、印度、泰國
We employ almost 84,000 people, principally in the UK, 和美國。
Australia, Spain, Poland, New Zealand and Chile, as well as Saudi
Arabia, Hong Kong, India, Thailand, and the USA.

Bupa’s purpose is helping people live longer,

healthier, happier lives.
保柏的目標是助人活出更長壽、更健康和更愉快的人生。

Bupa’s presence in Hong Kong

Bupa is a leading provider in healthcare funding and provision
with two independent units, Bupa Hong Kong and Quality
HealthCare.

Bupa Hong Kong

Bupa Hong Kong has been a health insurance specialist since
1976. Our expertise in healthcare has gained the trust of more
than 400,000 individuals, 3,200 companies and the Hong Kong
Government, who for 20 consecutive years has recommended
Bupa as the provider of quality health insurance for civil
servants.
保柏於香港的業務
We have applied our expertise to provide our members with 保柏透過旗下兩間獨立營運的公司 – 保柏香港及卓健醫療，為
comprehensive and flexible insurance plans to suit every life 市民提供醫療保險及醫療保健服務，兩者皆具領導地位。
stage and lifestyle. Through our extensive provider network in
Hong Kong, we offer our members a wide choice of doctors. 保柏香港
保柏香港自1976年成立，為本港首間及唯一專注醫療保險的公
Quality HealthCare 司。植根香港逾40載，我們的專業醫療保險服務為超過40萬
Quality HealthCare Medical Services Limited (QHMS), Hong
名會員及3,200間公司所信賴。我們更連續20年獲香港政府推
Kong, became part of Bupa in October 2013. QHMS’ operations
薦，為本港公務員提供醫療保險。憑藉專業知識，我們為會員提
span diagnostics, primary healthcare and day care specialties.
供全面而靈活的醫療保險計劃，切合您人生每一階段的需要。透
With roots tracing back to 1868, QHMS serves the community
過擁有龐大本港醫療網絡，我們讓會員有更多醫生選擇。
through a network of around 100 multi-specialty centres and
卓健醫療
over 500 affiliated clinics offering Western Medicine, Traditional
Chinese Medicine, Diagnostics & Imaging, Dental, Physiotherapy 卓健醫療服務有限公司（卓健醫療）於2013年10月正式加入保
services, etc. It also operates a private nursing agency. QHMS 柏。卓健醫療的服務涵蓋診斷、基層保健及專科服務。自1868年
is the largest provider of healthcare services to corporates in 起植根香港，卓健醫療透過約100間多項專科設施齊備的醫療中心
Hong Kong. In 2015, the Group recorded more than 2.8 million 及500多間聯營診所，為香港市民及訪港旅客提供西醫、中醫、
healthcare visits. QHMS continues to extend its existing portfolio 放射診斷、牙科及物理治療等服務。卓健醫療並營運護理介紹所，
into high end specialty services. For more information, please 是為香港最大規模為企業提供醫療服務的機構。於2015年度，卓
visit www.qhms.com. 健醫療錄得超過280萬求診人次，並繼續拓展其服務版圖至高質專
科服務。詳情請瀏覽www.qhms.com。

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 Health Coaching Services
健康支援服務

We are here for you at all times, offering utmost peace of mind. Apart from paying your child’s medical bills, we minimise your
worries through personal support when your child is unwell. For more complicated conditions, our medical expertise can offer
guidance throughout your child’s recovery journey.
保柏時刻伴您左右，讓您安枕無憂。除支付您子女的醫療費用外，保柏在您子女患病時給您貼身支援，減輕您的憂慮。當遇上較
嚴重的疾病時，我們以專業知識為您提供指引，助您的子女復原。

Assisting you ° Our 24/7 Customer Care helpdesk operates 24 hours every day, with a “live” person to directly
at all times answer your queries.
時刻為您提供協助 ° Our 24/7 Healthline is staffed with a team of qualified nurses and healthcare professionals,
supported by doctors, providing assistance and guidance from how to care for a sick child or
elderly to discussing your child’s symptoms, diagnosis and treatment options.

° 我們的24小時客戶服務專線由專人每天24小時，即時解答您的查詢。
° 我們的24小時健康專線由合資格護士及健康管理團隊為您提供協助及指導，例如怎樣照顧患病小
孩或長者，以至助您了解子女的病徵、診斷及治療方案，背後更有醫生作為顧問。

Supporting you ° A dedicated Care Manager can be in touch with you to follow up on your claims, and can make a
personally courtesy call or visit, with your consent, when your child is admitted into a local private hospital.
給您個人支援服務
° 個人健康顧問可與您緊密聯絡，跟進您的索償；當您的子女入住本港私家醫院時並得到您的同意
下，我們可前往醫院探望或致電慰問。

Guiding you through ° A second medical opinion can be arranged and paid for in the event of serious illnesses, so you
your recovery will be assured of a professional opinion from a global panel of medical specialists, helping you
康復期間提供指引 make an informed decision for your child’s treatment options.
° A qualified nurse can support you throughout your child’s treatment and recovery, from
explaining the treatment in everyday language and overseeing costs to arranging consultations
after hospital discharge in the event of major and complex surgeries.
° Doctor referrals can be made based on your child’s condition and needs.
° 提供第二醫療意見服務，當患上嚴重疾病時，您可免費獲得國際醫療專家為您提供專業意見，讓
您掌握病情從而決定子女的治療方法。
° 合資格護士可跟進您子女的治療和康復安排，助您了解子女的治療計劃和醫療開支，以及當您的
子女在接受了大型及複雜手術後，可安排出院後的跟進治療。
° 提供醫生轉介服務，可根據您子女的病況及需要建議醫生給您。

Availability of the above services is dependent on room level. Ward level members can only access 24/7 Customer Care helpdesk and 24/7
Healthline. Care Manager will support you in the event of cancer or heart disease.
The use of Health Coaching Services is free of charge. If the services suggested by us are not covered under your Bupa Care Kid Health Insurance
Scheme, you will be responsible for the fees incurred.
會員是否可享用以上的服務視乎投保的病房級別而定。投保大房級別的會員只可享24小時客戶服務專線及24小時健康專線服務，而健康顧問將於會員患上癌症或心臟
病時提供協助。
使用健康支援服務並不需額外費用。若我們建議的服務不在您的「保柏童康健」醫療保障計劃之賠償範圍內，您便須支付有關費用。

 Doctors will be available during scheduled office hours to support the nurses for answering enquiries. Office hours: Mon – Fri, from 9am to 7pm
(Hong Kong time), except public holidays.
醫生會於辦公時間內支援護士解答問題。辦公時間為星期一至五，上午9時至下午7時(香港時間)，公眾假期除外。

7
 Question Time
常見問題

1 Is there any minimum length of hospital stay? 1 是否設有最低住院時數？

There is no minimum length of stay, meaning that procedures 此計劃沒有最低住院時數限制，因此無須住院的常見治療如
such as a plaster cast, wound sutures, radiotherapy and 打石膏、傷口縫合、電療、化療等，均可獲賠償。
chemotherapy, which do not require hospital confinement,
are covered.
2 保費繳付方法如何？
2 How do I pay my subscription? 您可選擇以月供或年供支付保費。
You can pay your subscription monthly or annually according
to your preference.
3 如何以保柏醫療卡盡享「全數賠償保障」賠償？

3 How do I use the Bupa medical card to get the most from the 子女須向保柏特選的專科醫生及診所求診，於登記時出示醫
Full Cover Benefit? 療卡。如須入院治療，專科醫生會代您向保柏為有關的醫療
Your child will need to visit a specialist and clinic appointed 費用索取初步保障審核。您可選擇入住專科醫生已掛單的保
by Bupa and present the medical card upon registration. 柏康健特選私家醫院。當初步保障審核確認後，您將會獲
The specialist will then get pre-authorisation of the medical 發「初步保障審核確認 / 付款保證信」以作入院之用。入院
expenses for you if hospital confinement is required. You 時，請向醫院出示醫療卡及此信以享住院免繳費服務。出院
can choose from one of the Bupa HealthCare Appointed 時您只須於醫院為您填妥的住院賠償申請表上簽署，保柏便
Hospitals where your specialist is registered. Once the pre- 會代您向醫院繳付費用，您無須申請索償。
authorisation is confirmed, we will issue you with a Pre-
您亦可使用醫療卡支付由特選專科醫生於指定的診所提供的手
authorisation Confirmation / Guarantee of Payment Letter for
your hospital confinement. You will need to show the medical
術治療。如費用不超過港幣4,000元，您便無須索取初步保障
card and this letter to your selected hospital to enjoy cashless 審核。
treatment. Upon discharge, all you need to do is sign on the 如在辦公時間外入院進行緊急治療，您可於下一個工作天補辦
claim form provided by the hospital. You are not required to 審核。
submit any claims as Bupa will directly settle your expenses
您可於《會員指引》中細閱有關詳情。
with the hospital.
You can also use the medical card to settle the expenses
for medical procedure taken at the appointed specialist’s 4 如子女只有「附加醫療保障」，應如何使用保柏醫療卡？
designated clinic. If the expenses are under HK$4,000, pre- 您只須於子女入院前致電保柏，並填妥登記表格，您將獲發
authorisation is not required. 「初步保障審核確認 / 付款保證信」。如在我們的辦公時間外
For emergency hospital confinement outside our office hours, 入院進行緊急治療，您可於下一個工作天補辦登記。
the pre-authorisation can be arranged on the next working
day.
5 若要查詢會籍資料或索償情況可怎辦？
Step-by-step details will be provided in the Membership
Guide. 您可登入保柏網站內的「保柏互動網」，使用24小時網上服
務。您亦可致電保柏客戶服務專線查詢。如您已向我們提供正
4 If my child’s cover only includes the Supplementary Major 確的手提電話號碼，我們會在辦妥賠償後發出短訊通知您。
Medical Benefit, how do I use the Bupa medical card?
Call us and submit a registration form before your child
is admitted to hospital. We will then give you a
Pre-authorisation Confirmation / Guarantee of Payment
Letter. For emergency hospital confinement outside our office
hours, the registration can be submitted on the next working
day.

5 How can I check my child’s membership details or claim

status?
You can log in to Bupa Active on our website to access a host
of 24-hour online services or call our dedicated Customer
Care helpdesk. If you have submitted a claim, once it has
been processed you will also receive our SMS confirmation if
you provide us with an up-to-date mobile phone number.

8
 General Exclusions
不受保障項目
We want to help you understand your coverage before 我們想讓您在投保前清楚了解保障範圍，因此列出所有不受保障項目如
enrolment. Below are the general exclusions: 下：
Pre-existing conditions (unless such conditions have been disclosed in 已存在病症（已於申請表披露並於登記加入時獲保柏接納為承保範圍
the application and accepted by Bupa). 內則除外）。
Treatment, medical service, medication or investigation which is not
medically necessary. 不是醫療必需的治療、醫療服務、藥物或檢驗。
Any illness or injury for which compensation is payable under any 任
 何在法例下或其他保險計劃內或從其他途徑可獲賠償之治療疾病或
laws or regulations or any other insurance policy or any other sources 捐傷費用，除非此等費用未能在該等補償、保險計劃或途徑獲得賠
except to the extent that such charges are not reimbursed by any such
compensation, insurance policy or sources. 償。
Any charges for accommodation, nursing and services received in 在
 水療中心、天然治療中心、康復院、療養院、老人院或類似機構所
health hydros, nature cure clinics, convalescent home, rest home, home 提供之住宿、護理或服務的費用。
for the aged or similar establishments.
Any charges in respect of surgical or non-surgical cosmetic treatment, 手
 術性或非手術性整容或整形治療、聽覺測驗、常規驗血、例行檢
or hearing tests, routine blood tests, general check-ups, vaccinations or 驗、預防注射或接種疫苗、毛髮礦物質含量分析、健康補品或體重控
inoculations, Hair Mineral Analysis (HMA), health supplements or body
制，及因視力不正常而引致之治療，包括但不限於常規視力測驗或所
weight control, eye refraction including but not limited to routine eye
tests or any costs of fitting of spectacles or lens. 需之眼鏡或鏡片費用。
Congenital conditions, developmental conditions or hereditary 先天性疾病、發育異常或遺傳性疾病。
conditions.
由保障開始日起首5年內，因感染人體免疫力缺損病毒所引致的治療。
Treatment that commenced during the first five years of the member’s
coverage commencement date of this contract and which in any 性病及其後遺症。
way arises from, is attributable to, or is consequential upon Human
Immunodeficiency Virus infection. 與
 懷孕有關的治療，包括診斷性產科檢查、生育、墮胎或小產；與男
Sexually transmitted (venereal) diseases or their sequel. 女任何一方的節育或絕育有關的治療；由於不育而直接或間接進行的
Treatment relating to pregnancy, including diagnostic tests for 治療，包括體外受孕，任何非自然受孕或人工受孕；與性機能失常有
pregnancy or resulting childbirth, abortion or miscarriage; birth control 關之治療，包括但不限於陽萎、不舉、早泄（不論任何原因導致）。
or sterilisation of either sex; infertility including in-vitro fertilisation or
any other artificial method of inducing pregnancy; sexual dysfunction 誤
 用或服用過量藥物或受酒精影響、蓄意自傷身體或意圖自殺而直接
including but not limited to impotence, erectile dysfunction, premature 或間接引致的治療。
ejaculation, regardless of cause.
Misuse or overdose of drugs or being under the influence of alcohol, 任何因參與犯罪活動而引致之疾病或捐傷。
self-inflicted injuries or attempted suicide. 另
 類治療，包括但不限於中藥治療、針灸、穴位按摩、推拿、催眠治
Treatment relating to any illness or injury resulting from participation in 療、羅爾夫按摩療法、按摩治療、香薰治療（計劃內已包括之保障除
criminal activities.
外）。
Alternative treatment including but not limited to Chinese medicines
treatment, acupuncture, acupressure, Tui Na, hypnotism, rolfing, 老
 年性痴呆（包括亞爾茲海默氏病）、帕金森氏病、心理病或精神病
massage therapy, aromatherapy, unless benefit is available.
症，包括但不限於精神病、神經機能病、抑鬱、焦慮、神經性厭食、
Senile Dementia (including Alzheimer’s disease), Parkinson’s disease,
精神分裂、行為失常、譫妄症、失眠、神經衰弱等直接或間接引致的
psychological or psychiatric condition(s) of any and all kinds, including
but not limited to psychoses, neuroses, depression, anxiety, anorexia 治療。
nervosa, schizophrenia, behavioural disorders, delirium, insomnia,
購
 買或使用輔助器具，包括但不限於眼鏡、助聽器及其他設備例如輪
neurasthenia.
椅、枴杖的費用。
Any charges for the procurement or use of special braces and
appliances, including but not limited to spectacles, hearing aids and 任
 何與牙齒或牙肉疾病有關的治療或檢查，因意外引致緊急入院治療
other equipments such as wheel chairs and crutches.
或住院脫除阻生智慧齒則除外。但不包括該住院後之跟進治療。
Any treatment or investigation related to dental or gum conditions
except for emergency treatment arising from accidents or the 因
 戰爭、入侵、外敵行動、開戰（不論是否已宣戰）、內戰、暴動、
extraction of impacted wisdom teeth during hospital confinement. 革命、叛亂或軍人奪權、恐怖活動等直接或間接引致的治療。
Follow-up treatment from such hospital confinement shall not be
covered. 非
 醫療性服務，包括但不限於客人膳食、收音機、電話、影印、稅項
Treatment arising from war, invasion, acts of foreign enemies, hostilities （就醫療服務所徵收的增值稅或商品及服務稅除外）、醫療報告等費
(whether war be declared or not), civil war, rebellion, revolution, 用。
insurrection or military or usurped power or terrorist acts.
Non-medical services, including but not limited to guest meals, radio, 所有未經保柏批准之實驗性及 / 或最新治療。
telephone, photocopy, taxes (except the Value-Added Tax or Goods
and Services Tax for medical services), medical report charges and the 如您有任何已存在病症，核保後可能加入除外條款。
like.
Experimental and / or new medical technology or procedure not yet
approved by Bupa.

If you have any pre-existing medical conditions, special exclusions may be

added after underwriting.

9
 Bupa (Asia) Limited
保柏（亞洲）有限公司

18/F, Berkshire House

25 Westlands Road,
Quarry Bay, Hong Kong
香港鰂魚涌華蘭路25號
克大廈18樓

Telephone 電話 ：(852) 2517 5175

Facsimile 傳真 ：(852) 2548 1848

Care homes
Printed on recycled paper 以再造紙印刷

Cash plans
Dental insurance
Health analytics
Health assessments
Health at work services
Health centres
Health coaching
Health information
Health insurance
Home healthcare
Hospitals
International health insurance
Personal medical alarms
Retirement villages
Travel insurance
MP056/23/1116/6K

www.bupa.com.hk
Bupa Hong Kong

保柏香港
Bupa Care Kid Health Insurance Scheme
保柏童康健醫療保障計劃

Schedule of Benefits 保障金額表

Effective from 1 January 2017 自2017年1月1日起生效 Maximum Limit (HK$) 最高賠償額 (港幣)

A Hospital and Surgical Benefit Plan 計劃 1, 4 Plan 計劃 2, 5 Plan 計劃 3, 6
Private Semi-private Ward
住院及手術保障 私家房 半私家房 大房

1 Room and Board (Maximum 270 days each Contract Year)

每日3,350 each day 每日1,610 each day 每日820 each day
住房及膳食費 (每合約年度最多270日)

2 Miscellaneous Hospital Services (Each Contract Year)

39,500 23,000 14,400
住院雜費 (每合約年度計)

3 Intensive Care (Supplement to Room and Board)(Each Contract Year)

27,800 23,500 21,700
深切治療 (住房及膳食費之補足)(每合約年度計)

4 Private Nursing (Maximum 120 days each Contract Year)

私家看護費 (每合約年度最多120日)
Nursing services during Hospital Confinement or at home after discharge from Hospital 每日920 each day 每日580 each day 每日350 each day
rendered by a Qualified Nurse, subject to written referral from the attending Registered
Medical Practitioner
經主診註冊西醫書面轉介下由合資格護士於住院期間或出院後在家中提供之護理服務

5 Surgeon and Attendance Fees (For surgical case only)(Each operation)

外科醫生費及巡房費 (只適用於外科手術)(每次手術計)
Complex 複雜 108,000 65,800 50,000
Major 大型 53,700 36,900 27,300
Intermediate 中型 23,100 15,500 11,100
Minor 小型 8,050 6,600 5,300

6 Anaesthetist’s Fees (Each operation)

麻醉科醫生費 (每次手術計)
Complex 複雜 33,200 19,300 14,600
Major 大型 15,900 10,800 8,420
Intermediate 中型 7,400 4,800 3,640
Minor 小型 3,850 2,500 2,180

7 Operating Theatre Fees (Each operation)

手術室費用 (每次手術計)
Complex 複雜 33,500 19,500 14,900
Major 大型 16,100 11,000 8,640
Intermediate 中型 7,630 5,000 3,750
Minor 小型 4,210 2,550 2,280

8 In-patient Physician’s Fees (For non-surgical case only)

(Maximum 270 days each Contract Year) 每日2,670 each day 每日1,200 each day 每日680 each day
住院醫生巡房費 (只適用於非手術治療)(每合約年度最多270日)

9 In-patient Specialist’s Fees (Each Contract Year)

住院專科醫生費 (每合約年度計)
Subject to written referral from the attending Registered Medical Practitioner (except for 11,600 4,150 2,430
services performed by pathologist, radiologist or Physiotherapist during Hospital Confinement)
須獲主診註冊西醫以書面轉介(病理學家、放射學家及物理治療師在住院期間所提供之服務除外)

10 Cancer Treatment and Kidney Dialysis (Each Contract Year)

癌症治療及洗腎 (每合約年度計)
Chemotherapy, radiotherapy, cyberknife or gamma knife for cancer treatment or kidney dialysis
during Hospital Confinement or in day-case unit of a Hospital or clinic upon recommendation 130,000 100,000 65,000
by the attending Registered Medical Practitioner
經主診註冊西醫建議下於住院期間或醫院日症房或診所進行之化療、電療、使用數碼導航刀或伽碼刀以治療
癌症或洗腎

11 Companion Bed (Maximum 270 days each Contract Year)

每日1,680 each day 每日800 each day 每日410 each day
住院加床費 (每合約年度最多270日)

12 Pre-admission and Post-hospitalisation Out-patient Care (Each Contract Year)

Printed on recycled paper 以再造紙印刷

入院前及出院後之門診護理 (每合約年度計)
Including two pre-admission visits and all related post-hospitalisation follow-up visits on an 5,170 2,980 1,920
out-patient basis within six weeks after discharge from Hospital
包括2次入院前及出院後6星期內所有與住院治療有關之跟進療程門診費用

13 Emergency Out-patient Benefit for Accidents (Each Contract Year)

緊急意外門診保障 (每合約年度計)
Cover expenses for consultation, Western Medication, diagnostic imaging and laboratory
tests, as well as other related medical fees incurred on an out-patient basis in the out-patient 10,700 8,300 6,200
department or accident and emergency department of a Hospital as a result of an Accident
賠償因意外引致而於醫院門診部或急症部以門診形式接受治療的費用，包括診症費、西藥費、診斷影像及化
驗費，以及其他有關醫療費用
MP073/12/1116/30K

1
Bupa Care Kid Health Insurance Scheme
保柏童康健醫療保障計劃

Schedule of Benefits 保障金額表

Effective from 1 January 2017 自2017年1月1日起生效 Maximum Limit (HK$) 最高賠償額 (港幣)

B Full Cover Benefit (Optional) Plan 計劃 4 Plan 計劃 5 Plan 計劃 6
Private Semi-private Ward
全數賠償保障 (自選保障) 私家房 半私家房 大房

This Benefit is payable for eligible expenses of the following items B1 to B11 incurred during Hospital Confinement, Clinical Operation or Day Case Surgery
provided by the Hospitals, Specialists and day-case centres appointed by Bupa subject to the Maximum Limit per Contract Year. The treatment must be
referred and attended by a Bupa HealthCare Appointed Specialist.
此保障將支付有關下列B1至B11項由保柏特選的醫院、專科醫生及日症中心所提供的住院、診所手術或日症手術所需的合資格費用，以每年最高賠償額為限。有關的治療必須經由
保柏康健特選專科醫生轉介、進行及提供。

Canossa Hospital
嘉諾撒醫院
HK Adventist Hospital - Stubbs Road
香港港安醫院 - 司徒拔道
HK Adventist Hospital - Tsuen Wan
香港港安醫院 - 荃灣
HK Baptist Hospital
Bupa HealthCare Appointed Hospitals 香港浸信會醫院
保柏康健特選醫院 HK Sanatorium & Hospital
養和醫院
St Paul’s Hospital
聖保祿醫院
St Teresa’s Hospital
聖德肋撒醫院
Union Hospital
仁安醫院

No. of Bupa HealthCare Appointed Specialists 保柏康健特選專科醫生數目 Around 約600

1 Room and Board 住房及膳食費

2 Miscellaneous Hospital Services 住院雜費

3 Intensive Care 深切治療

4 Private Nursing 私家看護費

Nursing services during Hospital Confinement or at home after discharge from Hospital
rendered by a Qualified Nurse, subject to written referral from the attending Registered
Medical Practitioner
經主診註冊西醫書面轉介下由合資格護士於住院期間或出院後在家中提供之護理服務

5 Surgeon and Attendance Fees 外科醫生費及巡房費

Full cover Full cover Full cover
6 Anaesthetist’s Fees 麻醉科醫生費 全數賠償 全數賠償 全數賠償

7 Operating Theatre Fees 手術室費用

8 In-patient Physician’s Fees 住院醫生巡房費

9 In-patient Specialist’s Fees 住院專科醫生費

Subject to written referral from the attending Registered Medical Practitioner (except for
services performed by pathologist, radiologist or Physiotherapist during Hospital Confinement)
須獲主診註冊西醫以書面轉介(病理學家、放射學家及物理治療師在住院期間所提供之服務除外)

10 Cancer Treatment and Kidney Dialysis 癌症治療及洗腎

11 Companion Bed 住院加床費

Maximum Limit (Each Contract Year)

760,000 430,000 215,000
最高賠償額 (每合約年度計)

Full Cover Benefit is payable for eligible medical expenses incurred during Hospital Confinement, Day Case Surgery and Clinical Operation up to the
Printed on recycled paper 以再造紙印刷

Maximum Limit per Contract Year. Pre-admission and Post-hospitalisation Out-patient Care, and Emergency Out-patient Benefit for Accidents will be
paid under items A12 and A13.
The Bupa HealthCare (BHC) Card can be used to settle payment for Hospital Confinement or Clinical Operation(s) at the Bupa HealthCare Appointed
Hospitals and Specialists’ clinics, subject to a credit limit approved by Bupa.
After Full Cover Benefit is exhausted, you can claim the Hospital and Surgical Benefit for the next treatment.
全數賠償保障將支付住院、日症手術及診所手術之合資格醫療費用，以每年最高賠償額為上限。入院前及出院後之門診護理，以及緊急意外門診保障將於A12及A13項下作出
賠償。
您可使用保柏康健卡支付保柏康健特選醫院及專科醫生收取之住院及診所手術費用，以保柏批核之信用額為限。
全數賠償保障耗盡後，您可於下一次治療時索償住院及手術保障。
MP073/12/1116/30K

2
Bupa Care Kid Health Insurance Scheme
保柏童康健醫療保障計劃

Schedule of Benefits 保障金額表

Effective from 1 January 2017 自2017年1月1日起生效 Maximum Limit (HK$) 最高賠償額 (港幣)

C Supplementary Major Medical Benefit (Optional) Plan 計劃 1, 4 Plan 計劃 2, 5 Plan 計劃 3, 6
Private Semi-private Ward
附加醫療保障 (自選保障) 私家房 半私家房 大房

Reimbursement percentage 賠償率 80%

Maximum Limit (Each Contract Year) 最高賠償額 (每合約年度計) 580,000 300,000 118,000

This Benefit is payable after any item of A1 - A11 under Hospital and Surgical Benefit or Full Cover Benefit (if applicable) is exhausted
and is subject to HK$500 deductible per claim.
The Bupa HealthCare (BHC) Card can be used to settle payment for Hospital Confinement at any local private Hospitals, subject to
a credit limit approved by Bupa.
In case of overseas hospitalisation, only medical Emergency cases will be covered.
Adjustment factors will be applied if your child is confined in a higher room level than the chosen level:
- From Semi-private Room to Private Room : 50%
- From Ward to Semi-private Room : 50%
- From Ward to Private Room : 25%
此保障將於住院及手術保障下A1 - A11任何一項或全數賠償保障(如適用)已耗盡後才開始支付，每次索償的墊底費為港幣500元。
您可使用保柏康健卡支付本港任何私家醫院之住院費用，以保柏批核之信用額為限。
如身處海外，只適用於因急症之住院治療。
如您的子女入住比原有保障級別更高的病房級別，保障額將作出如下調整：
- 半私家房至私家房 : 50%
- 大房至半私家房 : 50%
- 大房至私家房 : 25%

D Hospital Cash Benefit (Optional) Plan 計劃 1, 4 Plan 計劃 2, 5 Plan 計劃 3, 6

住院現金保障 (自選保障)
Payable from the third day of Hospital Confinement
(Maximum 182 days each Contract Year) 每日1,000 each day 每日500 each day 每日300 each day
由住院第3天起開始支付 (每合約年度最多182日)

E Clinical Benefit (Optional) Plan 計劃 1, 4 Plan 計劃 2, 5 Plan 計劃 3, 6

門診保障 (自選保障)
1 General Practitioner (Consultation fee only) 普通科醫生 (只限診症費) 每次460 each visit 每次280 each visit 每次210 each visit

2 Specialist (Consultation fee only) 專科醫生 (只限診症費)

每次750 each visit 每次550 each visit 每次410 each visit
Subject to written referral from a Registered Medical Practitioner 須獲註冊西醫書面轉介

3 Home Consultation (Consultation fee only) 家中應診 (只限診症費) 每次820 each visit 每次560 each visit 每次410 each visit

4 Physiotherapist (Treatment fee only) 物理治療師 (只限診療費)

每次700 each visit 每次480 each visit 每次370 each visit
Subject to written referral from a Registered Medical Practitioner 須獲註冊西醫書面轉介

5 Chiropractor (Treatment fee only) 脊醫 (只限診療費)

每次700 each visit 每次480 each visit 每次370 each visit
Subject to written referral from a Registered Medical Practitioner 須獲註冊西醫書面轉介

6 Chinese Herbalist 中醫師

Consultation fee (including basic Medically Necessary Chinese Medicines prescribed at the
Registered Chinese Medicine Practitioner’s clinic and obtained at a legitimate source on the
same day of consultation) 每次330 each visit 每次240 each visit 每次200 each visit
Payable for acupuncture performed by a Registered Chinese Medicine Practitioner
診症費 (包括於診治當日由註冊中醫在診所處方並由合法來源取得的基本醫療必需中藥費用)
此保障支付由註冊中醫進行的針灸治療

7 Chinese Bonesetter 跌打醫師

Consultation fee (including basic Medically Necessary Chinese Medicines prescribed at the
Registered Chinese Medicine Practitioner’s clinic and obtained at a legitimate source on the
same day of consultation) 每次330 each visit 每次240 each visit 每次200 each visit
Payable for acupuncture performed by a Registered Chinese Medicine Practitioner
Printed on recycled paper 以再造紙印刷

診症費 (包括於診治當日由註冊中醫在診所處方並由合法來源取得的基本醫療必需中藥費用)
此保障支付由註冊中醫進行的針灸治療

8 Prescribed Western Medication (Each Contract Year) 醫生處方西藥 (每合約年度計)

Medically Necessary Western Medication prescribed by a Registered Medical Practitioner and 5,100 3,150 1,950
obtained at a legitimate source
經由註冊西醫處方並由合法來源取得之醫療必需西藥費用

9 Diagnostic Imaging and Laboratory Tests (Each Contract Year)

診斷影像及化驗 (每合約年度計) 4,000 2,250 1,750
Subject to written referral from a Registered Medical Practitioner 須獲註冊西醫書面轉介

Number of visits per Contract Year for items E1 – E7 above is 30 in total and is subject to a maximum of one visit per item per day. Number of visits per
Contract Year for items E6 - E7 above is 10 in total.
每一合約年度內有關上文E1至E7項之診治次數合共為30次，每一項目並以每日一次診治為限。每一合約年度內有關上文E6至E7項之診治次數合共為10次。

F Free Bupa Worldwide Assistance Programme (Each Contract Year)

MP073/12/1116/30K

免費保柏國際援助計劃 (每合約年度計)
Provides admission deposit in the event of hospitalisation overseas and in Mainland China, unlimited cover for emergency medical evacuation and
repatriation, and an extra hospital benefit of HK$120,000 after repatriation to Hong Kong. A 24-hour hotline for travel, medical or legal information and
assistance is also available.
提供海外及國內住院按金墊支服務，全數支付緊急醫療運送費用及送返香港後高達港幣12萬元的額外住院保障，並設有24小時熱線提供旅遊、醫療或法律資訊及支援。

3
Bupa Care Kid Health Insurance Scheme
保柏童康健醫療保障計劃

Schedule of Benefits 保障金額表

Effective from 1 January 2017 自2017年1月1日起生效
Notes 附註
 About Hospital and Surgical Benefit
Clinical Operation or Day Case Surgery, if eligible, will be paid under Hospital and Surgical Benefit. Clinical Operation and Day Case Surgery mean Medically Necessary
surgical procedures which may be carried out at a clinic or day-case unit of a Hospital by a Registered Medical Practitioner where a stay in Hospital is not required,
provided that the surgical procedure is classified as such by Bupa.
 Referral letter
A referral letter is valid for the same or related medical condition for six months from the issue date. Another referral letter is required for treatment of a new or
unrelated medical condition.
 About Full Cover Benefit
Please follow the requirements below to enjoy Full Cover Benefit:
(i) Always present the doctor’s referral letter (except for gynaecology, paediatrics and family medicine) and the BHC Card to the Bupa HealthCare Appointed
Specialist upon registration.
(ii) Pre-authorisation confirmation must be obtained from Bupa for the following situations:
- Hospital Confinement or Day Case Surgery
- Clinical Operation(s) exceeding HK$4,000
- Specialist treatment for which the relevant specialty is not practised by any Bupa HealthCare Appointed Specialist.
(iii) If your child has received treatment outside our office hours, please obtain authorisation from Bupa on the next working day.
(iv) Treatment at any Bupa HealthCare Appointed Service Providers must be referred and attended by the Bupa HealthCare Appointed Specialist.
(v) Please present the BHC Card with Bupa’s Pre-authorisation Confirmation / Guarantee of Payment letter to the Bupa HealthCare Appointed Hospital upon admission
and use it to pay the medical expenses.
(vi) Your child must be confined at the restricted room level or lower.
If the above requirements are not followed, the claims, if eligible, will be paid under Hospital and Surgical Benefit.
If your child receives treatment at the day-case centre of an appointed Hospital, there is no need to show the BHC Card. Please settle the expenses with the Hospital
and submit the claim to us.
Please settle the out-patient expenses at the Bupa HealthCare Appointed Specialist’s clinic, unless Hospital Confinement, Day Case Surgery or Clinical Operation is
Medically Necessary and pre-authorisation, if required, is obtained during the same clinic visit.
 About Supplementary Major Medical (SMM) Benefit
This Benefit will not be payable for Hospital Confinement in the suite, VIP or deluxe room of a Hospital.

 有關「住院及手術保障」
。 合資格之診所手術或日症手術，將於「住院及手術保障」下賠償。診所手術及日症手術指註冊西醫於診所或醫院日症房進行之醫療必需手術而無必要留院，但該等手術須獲保柏分類為診所手
術或日症手術。
 轉介信
。 會員可在轉介信發出日起計6個月內，就相同或相關病症使用該轉介信。若須診治全新或不相關的病症，則須提交新的轉介信。
 有關「全數賠償保障」
。 要享有「全數賠償保障」的賠償，請依循以下的規定：
(i) 請於登記時向保柏康健特選專科醫生出示醫生轉介信 (婦科、兒科及家庭醫學科除外)及「保柏康健卡」。
(ii) 在以下的情況，必須獲得保柏初步保障審核確認：
- 住院或日症手術
- 超過港幣4,000元的診所手術
- 專科治療而該專科並不屬於保柏康健特選專科醫生可提供之專科。
(iii) 如您的子女於保柏辦公時間外接受治療，請於下一個工作日向保柏補辦審核。
(iv) 於保柏康健特選服務供應商接受的治療，必須經由保柏康健特選專科醫生轉介、進行及提供。
(v) 請於入住保柏康健特選醫院時，向醫院出示「保柏康健卡」及保柏的初步保障審核確認 / 付款保證信，並以此卡繳付醫療費用。
(vi) 必須入住原有保障級別或較低保障級別的病房。
。 如沒有依循以上規定，合資格的醫療費用將於「住院及手術保障」下作出賠償。
。 如您的子女於保柏康健特選醫院之日症中心接受治療，無須出示「保柏康健卡」。請先向醫院支付醫療費用，然後再向保柏申請索償。
。 請向保柏康健特選專科醫生之診所繳付您的門診費用，如住院、日症手術或診所手術為醫療必需及於該次診症同時申請初步保障審核則除外。
 有關「附加醫療保障」
。 此保障並不會就入住總統套房 / 貴賓房 / 豪華房的住院費用作出賠償。

Printed on recycled paper 以再造紙印刷

MP073/12/1116/30K

4
Bupa Care Kid Health Insurance Scheme
保柏童康健醫療保障計劃

Table of Subscriptions 保費表

Effective from 1 January 2017 自2017年1月1日起生效

Child enrols independently 子女獨立投保 All figures in HK$ 以港幣計算

Attained Age of 15 days - 17 years Plan 計劃 1, 4 Plan 計劃 2, 5 Plan 計劃 3, 6

Private Semi-private Ward
已屆年齡15日至17歲 私家房 半私家房 大房

Scheme Options 計劃選擇 Annual 按年 Monthly 按月 Annual 按年 Monthly 按月 Annual 按年 Monthly 按月

A Hospital and Surgical Benefit

8,254 743 4,549 409 2,453 221
住院及手術保障

A Hospital and Surgical Benefit B Full Cover Benefit

住院及手術保障 + 全數賠償保障
9,250 833 5,105 459 2,748 248

A Hospital and Surgical Benefit

住院及手術保障 + C Supplementary
附加醫療保障
Major Medical Benefit
10,224 920 5,594 503 3,131 282

A Hospital and Surgical Benefit B Full Cover Benefit

住院及手術保障 + 全數賠償保障 +
11,220 1,010 6,150 553 3,426 309
C Supplementary Major Medical Benefit
附加醫療保障

Additional Options 額外自選保障 Additional Subscription 額外保費

D Hospital Cash Benefit

958 86 469 42 282 25
住院現金保障

E Clinical Benefit
7,190 647 5,739 517 4,510 406
門診保障

Child enrols with one parent - 25% discount on Hospital and Surgical Benefit as well as Full Cover Benefit
子女與父或母同時投保 - 住院及手術保障及全數賠償保障保費75折
Attained Age of 15 days - 17 years Plan 計劃 1, 4 Plan 計劃 2, 5 Plan 計劃 3, 6
Private Semi-private Ward
已屆年齡15日至17歲 私家房 半私家房 大房

Scheme Options 計劃選擇 Annual 按年 Monthly 按月 Annual 按年 Monthly 按月 Annual 按年 Monthly 按月

A Hospital and Surgical Benefit

6,191 557 3,412 307 1,840 166
住院及手術保障

A Hospital and Surgical Benefit

住院及手術保障 全數賠償保障
+ B Full Cover Benefit 6,938 625 3,829 344 2,061 186

A Hospital and Surgical Benefit + C Supplementary Major Medical Benefit

8,161 734 4,457 401 2,518 227
住院及手術保障 附加醫療保障

A Hospital and Surgical Benefit

住院及手術保障 全數賠償保障
+ B Full Cover Benefit +
8,908 802 4,874 438 2,739 247
C Supplementary Major Medical Benefit
附加醫療保障

Additional Options 額外自選保障 Additional Subscription 額外保費

D Hospital Cash Benefit

958 86 469 42 282 25
住院現金保障

E Clinical Benefit
7,190 647 5,739 517 4,510 406
門診保障
Printed on recycled paper 以再造紙印刷
MP073/12/1116/30K

5
Bupa Care Kid Health Insurance Scheme
保柏童康健醫療保障計劃

Table of Subscriptions 保費表

Effective from 1 January 2017 自2017年1月1日起生效

Child enrols with both parents -

50% discount on Hospital and Surgical Benefit as well as Full Cover Benefit
子女與父母同時投保 - 住院及手術保障及全數賠償保障保費半價 All figures in HK$ 以港幣計算

Attained Age of 15 days - 17 years Plan 計劃 1, 4 Plan 計劃 2, 5 Plan 計劃 3, 6

Private Semi-private Ward
已屆年齡15日至17歲 私家房 半私家房 大房

Scheme Options 計劃選擇 Annual 按年 Monthly 按月 Annual 按年 Monthly 按月 Annual 按年 Monthly 按月

A Hospital and Surgical Benefit

4,127 372 2,275 205 1,227 111
住院及手術保障

A Hospital and Surgical Benefit B Full Cover Benefit

住院及手術保障 + 全數賠償保障
4,625 417 2,553 230 1,374 124

A Hospital and Surgical Benefit

住院及手術保障 附加醫療保障
+ C Supplementary Major Medical Benefit 6,097 549 3,320 299 1,905 172

A Hospital and Surgical Benefit B Full Cover Benefit

住院及手術保障 + 全數賠償保障 +
6,595 594 3,598 324 2,052 185
C Supplementary Major Medical Benefit
附加醫療保障

Additional Options 額外自選保障 Additional Subscription 額外保費

D Hospital Cash Benefit

958 86 469 42 282 25
住院現金保障

E Clinical Benefit
7,190 647 5,739 517 4,510 406
門診保障
Subscription rates are not guaranteed and Bupa may adjust them on an annual basis.
保費並非保證，保柏有可能每年作出調整。

In the event of any discrepancy in respect of meaning between the Chinese version and the English version, the English version shall prevail. All terms and conditions are
subject to the Contract.
中、英文之意思如有任何差別，概以英文為準。所有條款及細則以合約為準。

Printed on recycled paper 以再造紙印刷

MP073/12/1116/30K

Bupa (Asia) Limited 保柏(亞洲)有限公司

Address: 18/F, Berkshire House, 25 Westlands Road, Quarry Bay, Hong Kong
地址:香港魚涌華蘭路25號 克大廈18樓
Telephone 電話: (852) 2517 5175 Facsimile 傳真: (852) 2548 1848
Website 網址: www.bupa.com.hk
Bupa Hong Kong

6
Bupa CarePro / Bupa Care Kid Health Insurance Scheme Application Form
保柏卓康健 / 保柏童康健醫療保障計劃申請表
To ensure your cover can take effect on the first day of the following month, please send us the
completed application form at least 5 working days prior to the end of the month. Applications are
subject to underwriting.
如欲合約在下月一號生效，請將填妥的申請表於月底前最少5個工作天寄回保柏。所有申請必須通過核保始能生效。

Please complete this form in ENGLISH and BLOCK LETTERS. Please tick as appropriate. For Bupa use Contract No. 合約編號 :
請以英文正楷填妥本申請表，並於適用地方加「✓」號。 only 保柏專用 Effective Date 生效日期 :

All ages described in this form refer to the age as at the Coverage Commencement Date. 本申請表內所有歲數以保障開始日當日之歲數計算
Application for 投保計劃：
Bupa CarePro 保柏卓康健 (Applicable to aged 18 or above 適用於18歲以上人士)
Bupa Care Kid 保柏童康健 (Applicable to unmarried children aged between 15 days - 17 years inclusive 適用於出生15天至17歲的未婚子女)

Personal Details of Applicant 申請人資料 (Applicant’s age must be 18 years or above 申請人年齡必須為18歲或以上)
Title Surname Given Name (Same as HKID Card) Sex HKID Card No. / Passport No. Date of Birth 出生日期 Relationship with proposed Member
稱謂 姓 名（與香港身份證相同） 性別 香港身份證號碼 / 護照號碼 DD 日 MM 月 YY 年 (if applicable) 與準會員關係 (如適用)
Mr 先生
Mrs 太太 Membership No. (if applicable)
Ms 女士 會員號碼 (如適用)
Miss 小姐
Home Flat / Room Floor Block Correspondence Flat / Room Floor Block
Address* 單位 / 室 層數 座 Address* 單位 / 室 層數 座
住宅地址 通訊地址
Bldg. / Mansion / House (If different from Bldg. / Mansion / House
Home Address
大廈 / 樓 如與住宅地址不同) 大廈 / 樓

Court / Estate / Street Court / Estate / Street

閣 / 屋苑 / 街道 閣 / 屋苑 / 街道

District Kln / HK / NT District Kln / HK / NT

地區 九龍 / 香港 / 新界 地區 九龍 / 香港 / 新界

Business Nature Home / Office Phone No. Email Address #

業務性質 住宅 / 公司電話號碼 電郵地址

Job Position Home / Office Fax No. Mobile Phone No.

職位 住宅 / 公司傳真號碼 手提電話號碼

Country of Residence 居住國家 ^ (If not in Hong Kong 如非香港)

Please give details if your spouse is a proposed / existing Member of Bupa CarePro and / or your child(ren) is a proposed / existing Member of Bupa Care Kid:
如您的配偶為「保柏卓康健」的準會員 / 現時會員，及 / 或您的子女為「保柏童康健」的準會員 / 現時會員，請提供以下資料：
Spouse’s Name Date of Birth HKID Card No. Membership No.
配偶姓名 出生日期 香港身份證號碼 會員號碼

Children’s Name Date of Birth HKID Card No. Membership No.

子女姓名 出生日期 香港身份證號碼 會員號碼

Children’s Name Date of Birth HKID Card No. Membership No.

子女姓名 出生日期 香港身份證號碼 會員號碼

* P. O. Box, hotel address and overseas address are not acceptable. 郵政信箱、酒店地址及海外地址恕不接納。
#
Unless requested below, Bupa will send the claims statement and Shortfall invoice, if applicable, by email only. No printed copy will be provided.
除非特別提出以下要求，保柏會以電郵形式發送電子賠償單和差額通知書（如適用） ，而不會提供列印本。
Please send me printed copies of the claims statement and Shortfall invoice, if applicable. 請將賠償單和差額通知書（如適用）之列印本寄給本人。
^ Unless otherwise specified by Member in writing, Inter Partner Assistance Hong Kong Limited will consider Hong Kong as the Country of Residence of the
Member and repatriate the Member to Hong Kong when Medically Necessary.
除非會員特別以書面通知，國際救援（亞洲）有限公司將設定香港為會員之居住國家，於有醫療需要時送返會員回香港。

Details of Proposed Member 準會員資料

Proposed Member Surname Given Name 名 Sex HKID Card / Date of Birth 出生日期
準會員 姓 (Same as HKID Card / Birth Certificate 性別 Birth Certificate No.
(Please tick one only 與香港身份證 / 出生證明書相同) 香港身份證 / 出生證明書號碼 DD日 MM月 YY 年
請選擇一位準會員)

Applicant 申請人 Details as above / 資料同上

Or 或
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Child 子女

Choice of Cover 投保項目

Core Benefit 主要保障 Optional Benefit 自選額外保障 Total Subscription
Hospital and Surgical Benefit ✝ paid with
✔ Full Cover Benefit 全數賠償保障 (applicable to Plan 4, 5 and 6 適用於計劃4, 5 及 6) Application (HK$)
住院及手術保障
Supplementary Major Medical Benefit 附加醫療保障 (age must be below 60 years 年齡必須為60歲以下) 連同申請表繳付之
Benefit Level 保障等級 (Choose one 任選其一)
保費總額 (港幣)
Plan 計劃 1 / 4 Private 私家房 Hospital Cash Benefit 住院現金保障
Clinical Benefit 門診保障
Plan 計劃 2 / 5 Semi-private 半私家房
Maternity Benefit 產科保障 (age must be between 18–49 years inclusive年齡必須為 18–49歲(首尾歲數包括在內))
Plan 計劃 3 / 6 Ward 大房 ✝
The Full Cover Benefit is payable up to the Maximum Limit per Contract Year. 全數賠償保障以每合約年度最高賠償額為上限。
MP241/4/1116/34K

PAAPP
Payment Method 繳付保費方法
Payment Frequency 繳付保費形式 Payment Method 繳付保費方法 Remarks 備註
Yearly 年繳 Autopay 自動轉賬 Please attach a cheque made payable to “Bupa (Asia) Limited” for
(From renewal payment only 續保繳費起適用) the 1st year’s Subscription with a completed Direct Debit
Authorisation Form 請填妥直接付款授權書，連同首年保費之支票交回本
公司，支票抬頭人為「保柏（亞洲）有限公司」

Cheque 支票 Please attach a cheque made payable to “Bupa (Asia) Limited”

Bank Name 銀行名稱 請將支票交回本公司，支票抬頭人為「保柏（亞洲）有限公司」

Cheque No. 支票號碼

Credit Card 信用卡 Please attach a completed Credit Card Authorisation Form
請連同填妥之信用卡付款授權書寄回
Monthly 月繳 Autopay 自動轉賬 Please attach a cheque made payable to “Bupa (Asia) Limited” for
the first 2 months’ Subscription with a completed Direct Debit
Authorisation Form 請填妥直接付款授權書，連同首兩個月保費之支票交
回本公司，支票抬頭人為「保柏（亞洲）有限公司」

Credit Card 信用卡 Please attach a completed Credit Card Authorisation Form
請連同填妥之信用卡付款授權書寄回

If the cheque issuer is not the applicant, please fill in the following information. 若支票發出人並非申請人，請填寫以下資料。
Relationship with the applicant Reason for paying Subscription on behalf of the applicant
與申請人關係 代申請人支付保費的原因

Bank Account for Reimbursement 支付賠償之銀行戶口

Claims payment will be reimbursed by autopay only. 賠償款項只以自動轉賬方式支付。
I hereby agree and authorise Bupa (Asia) Limited to reimburse claims payment to the account below. 本人同意及授權保柏（亞洲）有限公司轉賬賠償款項於以下戶口。
Account Holder’s Name HKID Card No.
戶口持有人姓名 香港身份證號碼
Personal Hong Kong savings / current account number (HK$ only) 個人香港儲蓄 / 往來銀行戶口號碼（只限港幣）
Bank Name Bank No. Account No.
銀行名稱 銀行編號 戶口號碼

If the above account holder is not the applicant, please fill in the following information. 若上述之戶口持有人並非申請人，請填寫以下資料。
Relationship with the applicant 與申請人關係 Reason for receiving claims payment on behalf of the applicant
(Applicable to spouse, parents or children only 只適用於配偶、父母或子女) 代申請人收取賠款的原因

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MP241/4/1116/34K
Health Declaration 健康聲明
Important Note 重要事項
Please Answer Yes or No to every question in Health Declaration – Section A. 請於所有「健康聲明 - 甲部」中問題回答「是」或「否」。
If you answer Yes to any of the questions, you have to provide the details of the medical conditions in Health Declaration – Section B. You do not need to tell us about
your history of common cold or flu or upper respiratory tract infections. Female proposed Member does not need to tell us about your history of childbirth.
如果您就任何問題的回答為「是」，您須於「健康聲明– 乙部」提供有關疾病之詳情。您無須告知我們傷風、感冒、上呼吸道感染的病史。女性準會員也不用告知我們有關分娩的紀錄。
If you do not provide us with information required in the health declaration, we may terminate your cover or it may stop us from paying your claims.
如您在健康聲明部分沒有提供所需資料，您的保障可能會被終止或您可能不獲支付賠償。

Height 身高** c m 公分 / ft尺 Weight 體重** kg 公斤 / lb磅 Smoker 吸煙者** Yes是 No否

** Not required for proposed Member(s) below 18 years old. 18歲以下之準會員無需填寫。

Health Declaration – Section A 健康聲明 – 甲部

1. In the last 3 years, have you (or the proposed Member) had:
a) consultation or medical investigations (eg scans or blood tests) for any medical condition(s) or symptoms which have continued for
2 weeks or more, and/or occurred more than once during the period;
b) consultation or medical investigations as a result of abnormal findings from medical investigations##; or
c) consultation by a specialist for two times or more for the same medical condition(s)?
在過去三年內，您 (或準會員)是否曾：
a) 因任何持續兩星期或以上，以及 / 或因任何出現多於一次的病症或症狀而就診或接受醫療檢查 (如掃描及血液檢驗)；
b) 因醫療檢查結果異常而就診或接受醫療檢查##；或
c) 因同一病症接受兩次或以上的專科醫生診治？ Yes是 No否

2. In the last 5 years, have you (or the proposed Member) ever taken / been advised to take any medication prescribed by a doctor
regularly for a continuous period of longer than 1 month?
在過去五年內，您 (或準會員) 是否曾定期服用 / 曾被建議定期服用為期超過一個月的醫生處方藥物？ Yes是 No否

3. In the last 7 years, have you (or the proposed Member) been admitted to hospital, had an operation or a procedure?
在過去七年內，您 (或準會員) 是否曾住院，接受手術或治療程序？ Yes是 No否

4. In the last 6 months, have you (or the proposed Member) had any undiagnosed symptoms, or currently undergoing medical
investigations or awaiting results for the said symptoms?
在過去六個月內，您 (或準會員)是否曾有任何未被診斷的症狀，或現正因有關症狀進行醫療檢查或等待檢查結果？ Yes是 No否

5. Have you (or the proposed Member) had a history of cancer, heart condition, stroke or joint replacement; or are there any medical
devices (eg shunts for draining fluids from the brain, pins and plates for fixation of broken bones) currently in your body?
您 (或準會員)是否曾有癌症、心臟病、中風或關節置換的病史；或現在體內有任何醫療儀器(如導引腦積水的分流器，及固定骨折的骨釘和骨板等)? Yes是 No否

Applicable to proposed Member aged 15 days to 24 months only. 此問題只適用於年齡介乎15日至24個月的準會員：

6. Was the proposed Member born before 37 weeks or after 42 weeks of pregnancy?
準會員是否於懷孕37周前或42周後出生? Yes是 No否

## For proposed Members aged 17 and below, this includes abnormalities in growth development (eg height and weight) 於十七歲或以下準會員，此包括生長發育異常(如身高、體重等)

Health Declaration – Section B 健康聲明 – 乙部

Medical condition 病症 Medical condition 病症 Medical condition 病症

Please specify as accurately as possible the name
of the illness or medical problem. Where
applicable, please state the area of the body
affected (eg right knee, left eye).
請盡可能準確註明患上何種疾病或病患。如適用，請說明
受影響的身體部位 (例如右膝，左眼)。

When did the symptoms start?

何時開始出現徵狀?

What investigations did you have?

Please include dates, type of investigations (eg
MRI, blood test) and their results.
您曾接受何種檢查?
請註明日期、檢查種類 (如磁力共振、驗血) 及其結果。
Printed on recycled paper 以再造紙印刷

What treatment did you have?

Please include treatment period, type of treatment
and their details (e.g. name of medication, name of
procedure or surgery)
您曾接受何種治療?
請註明接受治療時期、治療種類及其詳情 (如藥物名稱、治
療程序及手術名稱)

When was the treatment completed?

何時完成治療?

Have you made a full recovery? (Yes/No)

您是否已完全康復? (是/否)
MP241/4/1116/34K

If you have any medical reports or reports of investigations, please enclose them and put a tick in the box. With attachment
如您有任何醫療報告或醫療檢查報告，請隨此表格同時附上，並請於空格加「✓」號。 另有附頁
Declaration and Authorisation 聲明及授權
I apply as a Member of Bupa CarePro Health Insurance Scheme (“Scheme”) / I, on behalf of the proposed Member as list in this Application, apply as a Member of Bupa Care Kid Health
Insurance Scheme (“Scheme”). I acknowledge that Benefit is not payable under this Scheme being applied for any costs of treatment arising from any existing illnesses, injuries or other
conditions presented before the Coverage Commencement Date unless complete details are fully disclosed by me in this Application and accepted by Bupa (Asia) Limited (“Bupa”).
I declare that, to the best of my knowledge and belief, the statements contained in this Application are true and complete.
I acknowledge that Bupa reserves the right to ask for submission of more details of health status or medical reports of me/ the proposed Member at my own cost.
I also authorise any medical practitioner, hospital, clinic, by whom or where I/ the proposed Member have/ has been observed or treated or any insurance company or organisation
that has any records or health information concerning me/ the proposed Member for any reason, to give full particulars thereof including prior medical history to Bupa. A copy of this
authorisation shall be considered as effective and valid as the original.
I have read and agreed to be bound by the terms and conditions of the Contract of this Scheme and I agree that this Health Declaration and the answers given in this Application shall
be the basis of the Contract between me and Bupa.
I acknowledge that Bupa has discretion to appoint Registered Medical Practitioners, Hospitals, Qualified Nurses, cancer centres, day-case centres, diabetic centres, wellness centres
and other service providers to provide health and care services, credit facilities for eligible medical expenses and to do all things and acts incidental to such appointment for the
Member. I acknowledge and agree that such appointment shall be made on such terms and conditions as Bupa shall think fit at its absolute discretion. Bupa shall not be liable for any
claim whatsoever which may be made against any such service provider appointed by Bupa by the Member.
本人申請成為「保柏卓康健」醫療保障計劃（「計劃」）之會員 / 本人代表本申請表列出之準會員，申請成為「保柏童康健」醫療保障計劃（「計劃」）之會員。本人確認根據申請之計劃規定，凡在
保障開始日前因已患之疾病、損傷或其他病況而引致之醫療費用，一律不予賠償，除非本人在本申請表內已詳細列出並獲得保柏（亞洲）有限公司（「保柏」）接納。
本人聲明，就本人所知所信，本申請表上填報之一切資料，均屬實完整。
本人確認保柏有權要求提供更多有關本人 / 準會員之健康狀況及醫療報告，一切費用由本人支付。
本人並且授權任何為本人 / 準會員觀察或治療的醫生、醫院、診所，或持有本人 / 準會員健康或任何資料之保險公司或機構將本人 / 準會員之全部資料（包括病歷）呈交予保柏，本授權書之副本與正
本具同等效力。
本人已細讀並同意遵守此計劃之各條款及細則，並同意本申請表內之健康聲明及回答作為本人與保柏之間所訂合約之根據。
本人確認保柏可酌情委任註冊西醫、醫院、合資格護士、癌症中心、日症中心、糖尿病中心、保健中心及其他服務供應商以提供醫療服務、合資格醫療費用之墊支服務及有關該委任所需之服務予
會員。本人確認並同意有關此委任之條款及細則決定乃基於保柏以其認為合適的情況下而作出。就會員向有關保柏所委任的服務供應商所作出之申索，保柏一概不會負責。
Applicable to Application through authorised insurance broker 適用於透過獲授權保險經紀進行之申請
I understand, acknowledge and agree that, as a result of me purchasing and taking up the policy to be issued by Bupa, Bupa will pay the authorised insurance broker commission during
the continuance of the policy including renewals, for arranging the said policy.
I further understand that the above agreement is necessary for Bupa to proceed with the Application.
本人明白、確知及同意，保柏會就本人購買及接受其簽發的保單， 於保單有效期內 (包括續保期) 向負責安排有關保單的獲授權保險經紀支付佣金。
本人亦明白保柏必須取得本人以上的同意， 才可以處理其保險申請。
Personal Information Collection Statement 個人資料收集聲明
I have read and understand the Personal Information Collection Statement on the last page of this application form. I understand that I have the right to request Bupa to cease using
my personal information for direct marketing purposes by writing to Bupa's Data Protection Officer.
本人已細閱並明白本申請表最後一頁的個人資料收集聲明，並明白本人有權致函保柏的保障資料主任，以要求保柏停止將本人的個人資料作直接市場推廣用途。
I understand that by ticking this box, Bupa may not be able to provide me with any Bupa member exclusive information in relation to subscription discount, benefits or
rewards, as well as any marketing materials and communications from Bupa.
本人明白剔取此項後，保柏可能無法向本人提供有關保費折扣、會員尊享權益或獎賞等的資訊，及保柏的市場推廣資料或信息。

Declaration of residency 居民身份聲明

By ticking this box, I solemnly declare myself (the “Applicant”) and other proposed Member(s) listed in this Application are NOT US permanent resident*. I further
acknowledge that Bupa may terminate the cover of relevant Members with immediate effect if the law of the country in which any of the proposed Member is located,
or the Member’s country of residence or nationality, including but not limited to USA and Japan, or any other law which applies to Bupa or the Contract, prohibits the
provision of healthcare cover by Bupa to local nationals, residents or citizens. Equivalently, I understand that I am obliged to immediately notify Bupa in writing if any of
the Members become a permanent resident of USA during the Contract Year.
本人確認剔取此項即代表本人聲明本人(投保人)及列於此申請表的其他準會員並非美國永久居民*。本人明白如準會員的所在國家或準會員的原居國或國籍所屬國家的法律(包括但不限於美
國和日本)或任何其他對保柏或本合約適用的法律禁止保柏向當地國民、居民或公民提供醫療保障，保柏可終止相關會員的保障並立即生效。本人明白如本人如於合約年度期間成為美國永
久居民，本人有責任立即以書面通知保柏。
* ‘Permanent resident’ mean a person residing in a country who is a citizen of or who is permitted under applicable laws to live and work, on a permanent basis, in that
country. US for this purpose shall include USA, United States Minor Outlying Islands, Virgin Islands, U.S. and Commonwealth of Puerto Rico.
「永久居民」指居於某國家並且身為該國公民或根據適用法律獲許在該國永久性居留及工作的人士。美國為此包括美國本土、美國本土外小島嶼、美屬維京群島及波多黎各自由邦。

I, as the Subscriber, understand that I declare and sign on behalf of the Member listed in this Application under this Scheme who is under the age of 18.
本人茲申請為投保人，明白本人代表此計劃申請表內列出之 18 歲以下會員作出聲明及簽署。
I understand that no cover will be payable under the Contract unless this Application is approved and Subscription is received in full by Bupa (Asia) Limited (“Bupa”).
本人明白此申請表被保柏（亞洲）有限公司 (「保柏」) 批核及保費全額收妥後，保柏方按合約支付保障。

Applicant's Signature Signed in Hong Kong on Agent's / Broker's / Telesales' Name (If applicable and must be completed by the applicant)
申請人簽署 於香港簽署之日期 代理人 / 經紀 / 營業代表姓名（如適用及必須由申請人填寫）

Agent's / Broker's / Telesales' Code

X X 代理人 / 經紀 / 營業代表編號 CATHAYINS
(Name 姓名： ) DD日 / MM月 / YY年 Agent's / Broker's / Telesales' Contact Tel. No.
代理人 / 經紀 / 營業代表聯絡電話號碼

For Transfer Contract Only 只供轉移合約之用

Previous Bupa Membership No.:
前保柏會員編號：
Subject to Bupa's approval of membership transfer, eligible claims related to any sicknesses or injuries that were covered under the previous Contract and commenced before
the effective date of coverage under this Contract will be payable up to the Maximum Limit of the Contract with the lower Benefit level.
如經保柏批核轉移會籍，一切於前合約受保及於本合約保障開始日前已患有之疾病或損傷之合資格賠償，將根據前合約或本合約內所載之最高賠償額，以較低者為準，作出賠償。
If you have chosen to cover Pre-existing Conditions with additional individual subscriptions under the previous Contract, such insured Pre-existing Conditions will be excluded
under this Contract after transfer. 如您在前合約選擇支付個人附加保費以保障已存在疾病，有關受保的已存在疾病在會籍轉移後將於本合約被列為不受保障項目。

Applicant's Signature Date日期 ( DD日 / MM月 / YY年 )

申請人簽署

X X
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MP241/4/1116/34K
Bupa CarePro / Bupa Care Kid Health Insurance Scheme Direct Debit Authorisation Form
保柏卓康健 / 保柏童康健醫療保障計劃直接付款授權書
Subscriber’s Name Tel No.
投保人姓名 電話號碼

If autopay is chosen as the payment method, please complete this form, sign where marked "X" and return the original copy to Bupa with a cheque for the Subscription.
若選擇以自動轉賬付款，請填妥此表格及簽署於「X」位置，並連同此表格正本及繳付保費的支票交回保柏。

Name of party to be credited (The beneficiary) Bank No. Branch No. Account No.
收款之一方（受益人） 銀行編號 分行編號 收款戶口號碼
BUPA (ASIA) LIMITED 0 2 4 7 8 7 6 2 1 7 8 8 0 0 1
I/We hereby authorise my/our above-named bank (the “Bank”) to effect transfer from 本人（等）現授權上述之銀行（「該銀行」），根據收款人不時給予該銀行之指示，
my/our above-mentioned account to the above-named Beneficiary in accordance 自本人（等）上述戶口轉賬予收款人。但每次轉賬金額不得超過以上指定之限額。
with such instructions as the Bank may receive from the Beneficiary from time to time,
provided always that the amount of any one such transfer shall not exceed the limit
indicated above.
I/We agree that the Bank shall not be obliged to ascertain whether or not notice of 本人（等）同意該銀行毋須證實該等轉賬是否已通知本人（等）。
any such transfer has been given to me/us.
I/We jointly and severally accept full responsibility for any overdraft (or increase in 如因該等轉賬而令本人（等）之上述戶口出現透支（或令現時之透支增加），本人
existing overdraft) on my/our above-mentioned account which may arise as a result （等）會共同及各別承擔全部責任。
of any such transfer(s).
I/We confirm that my/our signature(s) on this authorisation is/are the same as filed 本人（等）確證在本授權書內之簽名，與本人（等）上述戶口於該銀行簽署紀錄完
with the Bank for the operation of my/our above-mentioned account to be debited 全相同。
for the transfer.
I/We agree that should there be insufficient funds in my/our above-mentioned 本人（等）同意如上述戶口並無足夠款項支付有關轉賬，該銀行有權不予辦理且可
account to meet any transfer hereby authorised, the Bank shall be entitled, at its 收取有關之手續費用，該等費用一概由本人（等）支付。
discretion, not to effect such transfer in which event the Bank may make the usual
service charge to be paid by me/us.
I/We agree that any notice of cancellation or variation of this authorisation which I/we 本人（等）同意取銷或更改本授權書之任何通知，須於取銷或更改生效日最少兩個
may give to the Bank shall be given at least two working days prior to the date on 工作天之前交予該銀行。
which such cancellation or variation is to take effect.
This authorisation shall have effect until further notice or until the above given expiry 本授權書將繼續生效直至另行通知為止或直至上列到期日為止（以兩者中最早之日
date (whichever first occurs). 期為準）。

My / Our Bank and Branch Name Bank No. My / Our Account No.
本人 / 吾等之銀行及分行名稱 銀行編號 本人 / 吾等之戶口號碼

My / Our name as recorded on Statement / Passbook My / Our Signature(s) HKID Card No. / Passport No.
本人 / 吾等在結單 / 存摺上之姓名 本人 / 吾等之簽署 香港身份證號碼 / 護照號碼

X
My / Our address as recorded on Statement / Passbook Date日期 ( DD日 / MM月 / YY年 )
本人 / 吾等在結單 / 存摺上之地址

Debtor's Name (If other than account holder) Membership No. (Debtor's Reference)
債務人之姓名 (若非戶口持有人) 會員編號 (債務人備註)

If the account holder is not the applicant / Subscriber, please fill in the following information. 若戶口持有人並非申請人 / 投保人，請填寫以下資料。
Relationship with the applicant / Subscriber Reason for paying Subscription on behalf of the applicant / Subscriber
與申請人 / 投保人關係 代申請人 / 投保人支付保費的原因

For bank use only Signature Verified

銀行專用 核實簽署

Notes: 1. The box marked “Membership No.” is to be completed by Bupa. 附註： 1. 會員編號一欄由保柏填寫。
2. The signature on this authorisation form must be the same as the signature of your Bank Account. 2. 在此授權書內之簽署模式必須與閣下之銀行戶口內之簽署相符。
Printed on recycled paper 以再造紙印刷
MP241/4/1116/34K
Bupa CarePro / Bupa Care Kid Health Insurance Scheme Credit Card Authorisation Form
保柏卓康健 / 保柏童康健醫療保障計劃信用卡付款授權書
Subscriber’s Name Subscriber's HKID Card No. Tel No.
投保人姓名 投保人香港身份證號碼 電話號碼

If credit card payment is chosen as the payment method, please complete this form, sign where marked “X” and return this form to Bupa by mail or by fax. If you
have faxed this form to Bupa, please do not return it to us by mail again.
若選擇以信用卡付款，請填妥此表格及簽署於「X」位置，並交回保柏。若您已傳真此表格給我們，請無須寄回此表格。

Annual / Monthly Payment 年繳或月繳

Visa MasterCard

Cardholder’s Name HKID Card No. Credit Card Account No. Credit Card Expiry Date 信用卡到期日
持卡人姓名 香港身份證號碼 信用卡戶口號碼 (MM月 / YY年)

I hereby authorise and direct Bupa (Asia) Limited to debit the Subscription due from my credit card account on an Total Annual / Monthly Subscription
annual / monthly basis until further notice. 年 /月保費總額 (HK$ 港幣)
本人茲授權保柏（亞洲）有限公司從本人的信用卡戶口每年 / 每月支付應繳保費金額，直至另行通知。

If the Cardholder is not the applicant / Subscriber, please fill in the following information. 若信用卡持有人並非申請人 / 投保人，請填寫以下資料。
Relationship with the applicant / Subscriber Reason for paying Subscription on behalf of the applicant / Subscriber
與申請人 / 投保人關係 代申請人 / 投保人支付保費的原因

I hereby confirm to pay the Subscription due of Bupa Health Insurance Scheme for the applicant / Subscriber as listed in this form.
本人同意及承擔列於此表格上的申請人 / 投保人之全數應繳之保柏醫療保障計劃保費金額。

Cardholder's Signature 持卡人簽署 Contact Phone No. 聯絡電話號碼 Date日期 (DD日 / MM月 / YY年)

For Bupa use only 保柏專用

Bupa CarePro / Bupa Care Kid Membership No.:
「保柏卓康健」/「保柏童康健」會員編號： Authorised Code 授權代碼 :

Subscription 保費 (HK$港幣) : Date 日期 (DD日 / MM月 / YY年) :

Printed on recycled paper 以再造紙印刷

MP241/4/1116/34K
 Personal Information Collection Statement 個人資料收集聲明
Bupa (Asia) Limited (the “Company”)
Personal Information Collection Statement (“Statement”) relating to the Personal Data (Privacy) Ordinance (the “Ordinance”)
In compliance with the Ordinance, the Company would like to inform you of the following:
1. From time to time, it is necessary for you, or the Member, to supply the Company with certain personal information when you apply for insurance or financial
products and services from the Company, or when you apply to make changes to your policy, or when you renew a policy;
2. Failure to supply personal information requested by the Company may result in the Company being unable to process your Application and/or provide
products, services and other related services to you, or the Member;
3. During the course of your relationship with the Company, further personal information relating to you, or the Member, may also be collected in the ordinary
course of our business, for example, when you lodge insurance claims with the Company.
4. Personal information relating to you, or the Member, may be used for the following purposes:
a. processing, assessing and determining any Applications for insurance products and services;
b. offering and providing products and services to you, or the Member, and processing requests made by you, or the Member, from time to time, including
but not limited to requests for addition, alteration, deletion, maintenance, management and operation of insurance benefits or insured Members;
c any purposes in connection with any claims made by or against or otherwise involving you, or the Member, in respect of any products and/or services
provided by the Company including, without limitation, making, defending, analyzing, investigating, processing, assessing, determining or responding to
such claims;
d. performing any functions and activities related to the products and/or services provided by the Company including, without limitation, audit, reporting,
market research, general servicing, maintenance of online and other services, identity verification, data matching, research and statistical analysis, and
reinsurance arrangements;
e. provision and design of products and services of the Company;
f. exercising the Company’s rights in connection with provision of insurance products and services to you, or the Member, from time to time, for example,
to determine any amount of indebtedness from you, and collecting and recovering owing from you or any person who has provided any security or
undertaking for your liabilities;
g. communication with you or the Member in relation to any of the purposes set out in this Statement;
h. enabling an actual or proposed assignee, transferee, participant or sub-participant of all or a substantial part of the Company’s rights or business to
evaluate the transaction intended to be the subject of the assignment, transfer, participation or sub-participation; and
i. making disclosure to satisfy the requirements of any laws, rules and regulations, codes of practice, guidance notes or guidelines binding on the Company.
5. Personal information collected or held by the Company relating to you, or the Member, will be kept confidential but the Company may provide such
personal information inside or outside the Hong Kong Special Administrative Region, for the purposes specified in paragraph (4) and (6) to the following
classes of transferees:
a. the Company’s group companies (“Group Company”);
b. any insurance intermediaries authorised by you and the Company;
c. any re-insurance companies authorized by the Company;
d. any agent, contractor or third party service providers who provide administrative, telecommunications, computer, payment, data processing or storage,
printing, research or other services to the Company in connection with the operation of business (including without limitation insurers, banks, lawyers,
accountants, claims investigators, debt collection agencies, data processing companies, research agencies and professional advisors);
e. any actual or proposed assignee, transferee, participant or sub-participant of all or a substantial part of the Company’s rights or business;
f. any person to whom the Company is under an obligation to make disclosure under the requirements of any law, rules, regulations, codes of practice or
guidelines binding on the Company including, without limitation, any applicable regulators, governmental bodies, industry recognized bodies, credit
reference agencies, the Courts, and where otherwise required by law.
6. Only with your consent or with your indication of no objection, the Company may use your, or the Member’s personal information collected from time to
time, including name, contact details, gender, health and family status, to provide you, or the Member with marketing communications relating to the
following of the Company, Group Company, or co-brand partner or business partner of the Company, including:
a. Insurance, medical, healthcare, financial and related services and products;
b. rewards, benefits, referral, member activities, loyalty or privileges programmes and related services and products; and
c. donations and contributions for charitable and/or non-profit making purposes;
The Company will not disclose personal information relating to you, or the Member to third parties for marketing purposes without your consent.
7. Under and in accordance with the terms of the Ordinance, you have the following rights:
a. to check whether the Company holds personal information relating to you or the Member and to access such personal information;
b. to require the Company to correct any personal information relating to you or the Member which is inaccurate;
c. to ascertain our policies and practices in relation to personal data and to be informed of the kind of personal data held by the Company, and
d. to request the Company to cease using your personal information for direct marketing purposes.
Requests can be made in writing to the Company’s Data Protection Officer at the following address:
Data Protection Officer,
18/F, Berkshire House,
25 Westlands Road, Quarry Bay, Hong Kong
8. In accordance with the terms of the Ordinance, the Company has the right to charge a reasonable fee for the processing of any personal information access
or correction request.
9. For any enquiries about this Statement, please do not hesitate to contact our Customer Care helpdesk at 2517 5333.
10. Nothing in this Statement shall limit the rights of customers under the Ordinance.
11. In case of discrepancies between the English and Chinese versions of this Statement, the English version shall prevail.
保柏（亞洲）有限公司（「本公司」）
有關個人資料（私隱）條例（「條例」）之個人資料收集聲明（「本聲明」）
遵照條例，本公司特意通知閣下以下事項：
1. 在閣下或會員向本公司申請保險或金融產品及服務，或當閣下更改保單或續保時，必須不時向本公司提供個人資料；
2. 如閣下未能提供本公司所要求的個人資料，本公司可能無法處理閣下之申請及/或向閣下或會員提供保險產品、服務或其他相關服務；
3. 本公司亦可能會在日常業務運作的過程中向閣下或會員收集更多個人資料，例如當閣下向本公司提出保險索償時。
4. 閣下或會員的個人資料可能會用作下列用途：
a. 處理、評估、決定任何保險產品及服務之申請；
b. 為閣下或會員提供保險產品及服務及處理閣下或會員不時提出的要求，包括但不限於要求增加、更改、刪除、維持及管理保障項目或受保會員；
c. 任何有關閣下或會員對本公司所提供之保險產品及服務提出之索償，包括但不限於賠償、辯護、分析、調查、處理、評估、決定或回應該等索償；
d. 執行與本公司所提供的保險產品及/或服務相關的功能及活動，包括但不限於審計、報告、市場調查、一般服務和維持網上及其他服務、核實身份、資料配對、研究及統計分析及
再保險之安排；
e. 提供及設計本公司的產品及服務；
f. 行使本公司向閣下或會員提供保險和服務時有關的權利，例如釐定閣下拖欠的任何款項的金額，及向閣下或任何已為閣下的債務提供任何擔保或承諾的人士，追收和收回拖欠的
任何款項；
g. 就任何本聲明中所述的用途與閣下或會員聯絡；
h. 允許本公司全部或部份的權益或業務的實際或建議承讓人、受讓人、參與人或次參與人，就涉及的轉讓、出讓、參與或次參與的交易進行評估；及
i. 為遵守任何法例之要求，或根據監管或其他機關所發出對本公司具有約束力或要求其遵守的規則、規例、實務守則、須知或指引，而作出披露。
5. 有關閣下或會員被本公司收集或持有的個人資料將會保密，但本公司可能會向以下不論在香港特別行政區境內或境外之資料承讓人提供該等個人資料作第(4)及第(6)段列出的用途：
a. 本公司的集團公司（「集團公司」）；
b. 任何由閣下及本公司授權的保險代理人；
c. 任何由本公司授權的再保險公司；
d. 任何代理人、承包商、或向本公司提供行政、電訊、電腦、付款、資料處理或儲存、印刷、研究或其他向本公司提供服務的第三方服務供應商（包括但不限於保險公司、銀行、
律師、會計師、理賠調查員、收數公司、資料處理公司、研究服務機構及專業顧問）；
e. 本公司的任何全部或部份的權益或業務的實際或建議承讓人、受讓人、參與人或次參與人；
f. 為遵守任何法例之要求，或根據監管或其他機關所發出對本公司具有約束力或要求其遵守的規則、規例、實務守則或指引，而作出披露，包括但不限於適用監管機構、政府機
構、相關行業認可機構、信貸資料服務機構或法院，及在其他情況下，法律規定本公司必向其披露的人士或機構。
6. 本公司只會在得到閣下同意或表示不反對的情況下，使用閣下或會員的個人資料如姓名、聯絡方法、性別、健康及家庭狀況，向閣下或會員提供本公司、集團公司、聯營品牌合作夥
伴或業務夥伴有關以下的市場推廣資訊，包括：
a. 保險、醫療、康健、財務和相關服務及產品；
b. 獎賞、權益、推薦、會員活動或優惠計劃和相關服務及產品；及 Rem
c. 為慈善及／或非牟利用途的捐款及捐贈。 To h
elp u inde
本公司將不會在沒有閣下的同意及許可下將閣下或會員之個人資料向第三方透露以作市場推廣用途。 plea
se e
s pro r 提提
7. 根據有關條例中的條款，閣下有權： nsur cess you 您
✔ en e tha r
a. 查核本公司是否持有閣下或會員的個人資料及查閱該等個人資料； c losed t you Applica
amo p h tion
b. 要求本公司改正任何有關閣下或會員的不準確的個人資料； unt a ayment o ave: quic
kly,
c. 查明本公司對於資料的政策及處理方法和獲告知本公司持有的個人資料種類；及 ✔ init nd a f the
iall c c
d. 要求本公司停止將閣下的個人資料作直接市場推廣用途。 ✔ enc ed any a opy of yo orrect Su
有關要求請致函本公司保障資料主任，地址如下： losed men ur H b s cr
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8. 根據有關條例之條款，本公司有權就任何處理個人資料查閱或更改的要求收取合理費用。 be fo
und ge fo nal Infor r the
child
9. 如閣下對本聲明有任何查詢，請隨時致電本公司的客戶服務專線 2517 5333。 我們想 on o r you matio
更 u r we r r n Colle
10. 本聲明不會限制客戶在條例下所享有之權利。 一併附 快地助您 bsite eference c
上 完成申 . . This tion
11. 中英文本如有歧義，概以英文為準。 ✔ 正確 ： 請，因 infor
matio
之保費 此請您 n
✔於 及 任 您的 在遞
交申請
✔ 及 何更改之處 香港身份 表時謹
子女出 簽 證或護 記
Bupa (Asia) Limited 保柏（亞洲）有限公司 請 生證明 署作實 照副本
複印本 副本(如
頁
Address: 18/F, Berkshire House, 25 Westlands Road, Quarry Bay, Hong Kong 之用。 的「個人 為子女投
您亦可 資料收 保)
地址: 香港魚涌華蘭路25號　克大廈18樓 於我們 集聲明
的網頁 」
Telephone 電話: (852) 2517 5175 Facsimile 傳真: (852) 2548 1848 Website 網址: www.bupa.com.hk 隨時瀏 以作將來
覽有關 參考
資料。
Bupa Hong Kong
Bupa Care Kid Membership
Important Notes
To help you to understand the key aspects of this scheme clearly, we
would like to call your attention to the following:

° Please take some time to study the general exclusions in your contract, as well
as the additional exclusion(s) listed on the Membership Certificate, if any.
Please note that pre-existing conditions means illness or injury that commenced
or presented sign(s) and symptoms, and are considered to be excluded items
(unless such conditions have been disclosed in the application and accepted by
Bupa). If you child has any presented signs and symptoms before enrolment, all
illnesses related to those symptoms will not be covered even though they are
diagnosed after your enrolment. In case of any dispute, Bupa will consult your
child’s attending doctor to identify whether the illness is a pre-existing condition.

° This contract will last for 1 year and Bupa guarantees that your child’s cover can
be transferred to Bupa CarePro when he or she turns 18, regardless of any
changes to your child’s health condition after joining. Your child can enjoy
lifetime cover* under Bupa CarePro.

° We also understand that your child’s healthcare needs may change throughout
his or her life and thus you have the flexibility to change your child’s benefits
every year upon renewal. If you wish to upgrade the plan or to add any benefit
in future, you are required to complete a health declaration form for medical
underwriting purposes. If approved, all eligible medical expenses related to
illnesses commenced before the benefit and plan level upgrade take effect will
be reimbursed according to the previous plan and benefit.

° The Bupa Healthcare (BHC) Card is provided to members who are entitled to
Supplementary Major Medical Benefit or Full Cover Benefit. You do not need to
make payment when discharged or submit claims if you have the BHC Card.
To enjoy cashless hospital treatment, please call our customer service helpdesk
ahead to obtain pre-authorisation confirmation. We will place a temporary hold
on your credit card for HK$500 until the claim assessment is completed.

° If you have enrolled Full Cover Benefit for your child, please read through the
relevant section in the Membership Guide to make the most of your child’s
benefit. You will need to choose a Bupa HealthCare appointed specialist and
clinic for consultation. Please present your referral letter and BHC card upon
your visit.

° Your renewal subscription will be automatically collected at the next renewal if

you choose to pay by autopay or credit card, unless we have received any
instructions from you to the contrary.

° There is no waiting period to the cover and your child is protected as soon as
his/her membership starts. However, you have the right to cancel this contract.
If you choose to do so, please send us a written notice within 21 days from the
Coverage Commencement Date that is shown on the Membership Certificate
and we will refund you the full subscription paid.

* Bupa guarantees that your child’s cover can be renewed for life. However, Bupa reserves the right to amend the
subscription, benefits, terms and conditions upon the contract renewal. Please refer to the contract for further details.

1 Bupa Care Kid Membership Important Notes

保柏童康健會籍重要資料

請細閱以下各項有關保柏會籍的重要資料：

° 請細閱合約內所列的不受保障項目及其他於會員證書上所列的不受保障項目（如
有），以確保自己了解所適用的保障範圍。請注意，於投保前已存在或出現徵狀
的病症或身體損傷屬於不受保障項目(除非該病症已於申請表披露並於登記加入時
獲保柏以書面接納為承保範圍內則除外)，即使在投保後才確診的病症，如在投保
前已出現徵狀，都不獲保障。如有任何爭議，保柏會徵詢您子女的主診醫生的意
見以界定該病症是否屬於已存在病症。

° 本合約生效期為期一年，而無論子女在投保後的健康狀況有任何改變，我們均保
*
證在子女年滿 18 歲時可將會籍轉移至「保柏卓康健」以享終生保障 。

° 我們亦了解每個人生階段有不同的保險需要，您可以在每年續保時，為您的子女
選擇更改計劃保障。若您選擇為子女提升計劃等級或增加保障項目，您必須填寫
健康聲明作核保之用。一經批核，所有在計劃等級提升或新增保障項目生效前已
患傷病之合資格醫療費用將根據舊有保障項目及等級賠償。

° 如您為子女選擇「附加醫療保障」或「全數賠償保障」，將會獲發「保柏康健
卡」。您可使用此卡盡享住院免找數服務，無需索償手續。請注意 ，在使用住院
免找數服務前，我們須要投保人致電我們的客戶服務專線索取初步保障審核確
認，同時您須要提供信用卡資料並保留港幣 500 元的信用額，直至索償程序完結
為止。

° 如您為子女選擇「全數賠償保障」，請細閱會員指引內所示的步驟。請謹記必須
於保柏康健特選專科醫生及指定的診所求診，並在求診時出示有效的醫生轉介信
及「保柏康健卡」。

° 如選擇以自動轉賬或信用卡繳付保費，續保保費將於下次續保時透過自動轉賬戶
口或信用卡戶口自動扣取（如我們接獲您的其他指示則除外）。

° 此計劃不設等候期，您子女的會籍生效後即可獲得保障。不過，您亦有權選擇取
消此合約。如有需要，請於會員證書上所示的保障開始日起 21 日內以書面通知我
們，我們將安排全數退回已繳保費。

* 保柏保證終生續保您子女的保障，但保柏保留在續保時更改保費、保障、條款及細則的權利。詳情請參閱合約。

1 保柏童康健會籍重要資料