Axcellent Health Partner

Employee Benefits
Insurance Package Plan
(Enhanced verison)

Your partner for

employee medical solutions

Product brochure
As one of the important components of an Employee Benefits package, medical insurance is needed
to help companies to retain staff as well as to attract new talents. Nowadays employees seek medical
insurance benefits for healthcare solutions. Axcellent Health Partner Employee Benefits Insurance
Package Plan (“Axcellent Health Partner”) provides a flexible and optional cover to all small and medium
business. You can easily combine different cover packages for your staff and their families. It provides
financial protection to the employees against a wide range of healthcare expenses resulting from illness
or injury1.

Competitive Premiums for All-Rounded Medical Benefits2

You can provide your employees with comprehensive medical insurance cover with competitive premiums.

Flexible Benefits
With a choice of 6 benefit levels and a full range of optional cover, there is bound to be a solution that meets your needs and
budget.
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n Basic Cover – Hospitalization Benefits
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n Optional Cover – Additional Hospitalization Benefits (including Outpatient Kidney Dialysis and Outpatient Cancer
Treatment), Supplementary Major Medical , Outpatient Benefits A4, Outpatient Benefits B4, Dental Benefits4
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n Additional Free Services – Emergency assistance service , China Health Link Network and easy access to healthcare
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network

Digital Solutions in Pace with Insured Person’s Life

Insured person can access to our Emma by AXA9 app to manage his / her daily medical needs anytime anywhere.

Easy Enrolment Process3

You can apply for this insurance cover with a minimum of 3 employees. If you have 6 employees or more upon insurance
application and subsequent renewals, you do not have to submit any individual declaration of health for employee application
for insurance when the employee joins your company.

Basic Cover
Hospitalization Benefits4
n Room and Board
n Doctor’s Visit
n Hospital Expenses
n Surgeon’s Fees
n Anaesthetist’s Fees
n Operating Theatre
n Specialist Consultation
n Hospital Cash
n Post-Hospitalization Treatment
n Intensive Care
n Organ Transplant

Optional Cover
(1) Additional Hospitalization Benefits4
(i) Outpatient Kidney Dialysis
(ii) Outpatient Cancer Treatment

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(2) Supplementary Major Medical5
Pays benefits in excess of benefits payable under eligible Hospitalization Benefits

(3) Outpatient Benefits A4

(i) Consultation at Doctor’s Office
(ii) Specialist Consultation
(iii) X-Ray & Laboratory Test

(4) Outpatient Benefits B4

Benefits from Outpatient Benefits A and the following benefits:
(i) Chinese Herbalist / Bonesetter / Acupuncturist
(ii) Physiotherapist / Chiropractor

(5) Dental Benefits4

(i) Accidental Denture Treatment
(ii) Extraction & Filling
(iii) Dental X-Ray
(iv) Oral Examination / Cleansing

Additional Free Services

(1) Emergency Assistance Service6
Insured person can access to 24-hour worldwide alarm centers for emergency assistance services when travelling
outside his / her principal country of residence, such as emergency evacuation to the nearest facility capable of
providing adequate care if he / she suffers a serious accident or illness requiring immediate treatment and adequate
medical facilities are not available, and repatriation if it is determined that treatment should continue at a medical
facility in his / her principal country / region of residence.

(2) China Health Link Network6

By presenting the AXA health card, insured person can be admitted to hospitals without worrying about the hospital
admittance deposit at over 110 designated hospitals under China Health Link Network7.

(3) Easy Access to Healthcare Network8

Our network of around 2,000 panel doctors in Hong Kong allows insured person to:
n Access to a vast pool of professionals: general practitioners, specialists, physiotherapists and Chinese herbalists
n Enjoy cashless arrangement: for eligible medical treatments from our network. For the avoidance of doubt, a
co-payment may be required subject to the reimbursement percentages and / or maximum benefits of the relevant
benefits as stated in the benefit schedule.

Emma by AXA 9

Emma by AXA is the new digital self-service experience for AXA customers to easily access and manage policy servicing and a
range of digital lifestyle and health services. The following are key functions from Emma by AXA:

View my policy
n View the eligible policies and associated riders as applicable

Submit and track claims

n Submit medical claims based on eligible and check claim status

Ask Emma
n One-click chat service where AXA customers can engage with service chatbot or connect to our live agent

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Summary of benefits

Basic Cover Maximum Limit Per Disability

Benefit levels Level 1 Level 2 Level 3 Level 4 Level 5 Level 6

(A) Hospitalization Benefits

100% Reimbursement

Room and Board

HKD2,200 HKD1,800 HKD1,200 HKD800 HKD600 HKD450
(Maximum limit per day, up to maximum 90 days)

Doctor’s Visit
HKD2,200 HKD1,800 HKD1,200 HKD800 HKD600 HKD450
(Maximum limit per day, up to maximum 90 days)

Hospital Expenses HKD33,000 HKD27,000 HKD18,000 HKD12,000 HKD10,000 HKD8,000

Surgeon’s Fees
n Super Major HKD99,000 HKD87,000 HKD63,000 HKD45,000 HKD36,000 HKD27,000
n Major HKD66,000 HKD58,000 HKD42,000 HKD30,000 HKD24,000 HKD18,000
n Intermediate HKD33,000 HKD29,000 HKD21,000 HKD15,000 HKD12,000 HKD9,000
n Minor HKD13,200 HKD11,600 HKD8,400 HKD6,000 HKD4,800 HKD3,600

Anaesthetist’s Fees Up to maximum 30% of Surgeon’s Fees

Operating Theatre Up to maximum 30% of Surgeon’s Fees

Specialist Consultation* HKD6,000 HKD5,000 HKD4,000 HKD3,000 HKD2,000 HKD1,500

Hospital Cash**
HKD1,000 HKD800 HKD600 HKD400 HKD300 HKD225
(Maximum limit per day, up to maximum 90 days)

Post-Hospitalization Treatment HKD3,000 HKD2,500 HKD2,000 HKD1,500 HKD1,000 HKD800

Intensive Care
HKD3,500 HKD3,200 HKD2,400 HKD1,600 HKD1,200 HKD900
(Maximum limit per day, up to maximum 14 days)

Organ Transplant*** (Maximum limit per year) HKD100,000 HKD50,000

Remark: The above benefits are only applicable to expenses that are medically necessary and reasonable and customary charges. The above benefits are payable according to the
terms and conditions of the policy.
* Recommended or referred by the attending physician.
** Applicable only when an insured person is confined at a ward accommodation in public hospitals under the administration of the Hospital Authority in Hong Kong. No
other Hospitalization Benefits incurred during the confinement for which Hospital Cash is claimed shall be payable.
*** Includes and limited to the entire costs incurred for Room and Board, Intensive Care, Hospital Expenses, Surgeon's Fee, Anaesthetist's Fees, Operating Theatre,
Doctor's Visit and Specialist Consultation incurred to perform operations for heart, kidney, liver or bone marrow transplantation during hospital confinement. Costs of
acquisition and transportation of the organ are not included.

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 Optional Cover Maximum Limit

Benefit levels Level 1 Level 2 Level 3 Level 4 Level 5 Level 6

(B) Additional Hospitalization Benefits

100% Reimbursement (Maximum limit per year)

Outpatient Kidney Dialysis HKD30,000

Outpatient Cancer Treatment HKD75,000

Benefit levels Level 1 Level 2 Level 3 Level 4 Level 5 Level 6

(C) Supplementary Major Medical

80% Reimbursement (Maximum limit per disability)

Supplementary Major Medical@## HKD200,000 HKD100,000

Deductible HKD1,000

Adjustment factor for the choice of ward class

The insured person shall stay in an accommodation or room not exceeding the maximum benefits per day in relation to Room and Board as designated to the insured person by the
policyholder throughout the period of hospital confinement. In the event of a breach of this condition, AXA shall reduce the benefit payable by applying the adjustment factor, which
equals to the percentage of the maximum benefits per day in relation to Room and Board as specified in the schedule over the actual room rate per day during the hospital confinement.

Benefit levels Level 1 Level 2 Level 3 Level 4 Level 5 Level 6

(D) Outpatient Benefits A △+

Options: 80% or 100% Reimbursement (Maximum limit per visit)

Consultation at Doctor’s Office

HKD350 HKD300 HKD250 HKD200 HKD150 HKD100
(Maximum 1 visit per day and 30 visits per year)

Specialist Consultation###
HKD700 HKD600 HKD500 HKD400 HKD300 HKD200
(Maximum 1 visit per day and 10 visits per year)

X-Ray and Laboratory Test###

HKD5,000 HKD4,000 HKD3,000 HKD2,000 HKD1,500 HKD1,000
(Maximum limit per year)

Benefit levels Level 1 Level 2 Level 3 Level 4 Level 5 Level 6

(E) Outpatient Benefits B △ +

Outpatient Benefits A and the following benefits

Options: 80% or 100% Reimbursement (Maximum limit per visit)

Chinese Herbalist / Bonesetter / Acupuncturist

HKD350 HKD300 HKD250 HKD200 HKD150 HKD100
(Maximum 1 visit per day and 8 visits per year)

Physiotherapist / Chiropractor###
HKD700 HKD600 HKD500 HKD400 HKD300 HKD200
(Maximum 1 visit per day and 10 visits per year)

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 Optional Cover (cont.) Maximum Limit

Benefit levels Level 1 Level 2 Level 3 Level 4 Level 5 Level 6

(F) Dental Benefits+

80% Reimbursement (Maximum limit per year)

Overall maximum limit for the following

HKD3,200 HKD2,200
aggregated benefits

Accidental Denture Treatment HKD1,000 HKD800

Extraction & Filling HKD1,200 HKD800

Dental X-Ray HKD800 HKD500

Oral Examination / Cleansing

HKD400 HKD300
(Maximum limit per visit, maximum 2 visits per year)

Remark: The above benefits are only applicable to expenses that are medically necessary and reasonable and customary charges. The above benefits are payable according to the
terms and conditions of the policy.
@ Insured person shall stay in a room not exceeding the maximum limit per day in relation to Room and Board, otherwise the amount of benefits payable will be
discounted by an adjustment factor. AXA shall reduce the benefit payable by applying the net, which equals to the percentage of the maximum benefits per day in
relation to Room and Board as specified in the schedule over the actual room rate per day during the hospital confinement.
△ An insured person has access to a network of panel doctors offered by AXA. Credit facility can be provided by presenting AXA health card at panel doctor’s visit subject to
indemnification. In case where the insured person uses the credit facility from AXA health card at panel doctor’s visit, co-payment to panel doctor may be required subject
to reimbursement percentage and / or maximum limit(s) of relevant benefits.
## Not applicable for Organ Transplant, Outpatient Kidney Dialysis and Outpatient Cancer Treatment.
### Recommended or referred by the attending physician.
+ When the insured person is covered for less than a full policy year, any maximum benefits per year and / or any maximum number of visits per year for which
reimbursements shall be made in such period shall be pro-rata on monthly basis to the limit for the full policy year.

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Important Information
Disclosure Obligation for Underwriting
If any relevant facts pertaining to the insured person under the policy shall be found to have been incorrectly reported to the policyholder or
to AXA, and if such misstatement affects the existence or the amount of insurance cover, the true facts shall be used in determining;
n whether insurance cover is in force under the terms and conditions of the policy
n the effective date of such person’s insurance cover, the amount of premium and whether there shall be any premium adjustment for such
insured person.
Where a misstatement of age or other relevant facts has caused an insured person to be insured under the policy when he / she is otherwise
ineligible for insurance cover, or where such statement has caused an insured person to remain insured when he / she would otherwise be
disqualified for further insurance cover in accordance with the terms and conditions of the policy:
n his / her insurance cover shall be void and there shall be a return of premiums paid in respect of the insured person
n where there is fraud on the part of the policyholder or the insured person, no premiums paid are to be returned.
If a claim has been paid in respect of the insured person who was in fact ineligible for insurance cover or disqualified for further insurance cover:
n the full amount of that claim shall immediately be repaid to AXA by the policyholder and / or the insured person who shall be jointly and
severally liable for such repayment.
n AXA reserves all its rights to contest in the case of fraud, non-payment of premium and false declaration.

Key Exclusions
n Pre-existing conditions until insured person has been continuously insured under Axcellent Health Partner for at least 12 consecutive
months
n Outpatient treatment unless the Outpatient Benefits A or Outpatient Benefits B is taken
n Pregnancy including childbirth, abortion, miscarriage and all complications
n Birth control, treatment for infertility
n Routine health checks, hospitalization primarily for investigation
n Congenital condition
n Non-hospital nursing care or ambulatory care, rest cures or sanitaria care
n Sexually transmitted diseases, AIDS or HIV-related conditions
n Suicide or self-inflicted injury
n Dental care or its related treatment except as defined under Dental Benefits when such Dental Benefits are indicated in the schedule as
being covered by the policy
n Cosmetic or plastic surgery, treatment of obesity or sleep apnoea
n Professional sports and hazardous activities
n Nuclear or chemical contamination, war, strike, riot or civil revolution
n Violation or attempt of violation of law or resistance of lawful arrest
n Use of non-licensed drugs, experimental medical treatment
n Developmental delay, learning disabilities in children
n Mental disorders
n Drug addiction or alcoholism
n Appliances, equipment and implants
n Benefits payable under any laws, regulations or insurance policies in respect of the same injury / disease
Note: For details and full list of exclusions and dental exclusions, please refer to the policy contract.

Eligibility and requirements

n Applicable for companies with 3 to 50 employees.
n Full-time employees of your company with issue age 64 years old or below are eligible to enroll Axcellent Health Partner. If an insured
employee attains the age of 65 or an employee who is between 65 to 69 years old requests to enroll Axcellent Health Partner, health
underwriting is required.

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n Insured employees’ spouse with issue age 18 to 64 years old are eligible to enroll Axcellent Health Partner. If an insured spouse attains
the age of 65 or an insured employee’s spouse who is between 65 to 69 years old requests to enroll Axcellent Health Partner, health
underwriting is required.
n Insured employee’s unmarried child(ren) with issue age 14 days old to 18 years old (or up till 23 years old if still in full-time education) are
eligible to enroll Axcellent Health Partner.
n Individual declaration of health is required for companies with 5 employees or less upon insurance application and subsequent renewals
(excluding spouse and children).
n Employees must be actively at work at your company upon effective date of employees and their eligible spouse and child(ren)'s policy
coverage.
n Premium must be paid by employer only.
n Minimum premium is HKD3,000 per annum.
n All permanent full-time employees of your company who belongs to any member class covered under the policy must be insured.
n You may set a maximum of 2 member classes for a company with 4 to 9 employees; or a maximum of 3 member classes for a company
with 10 to 50 employees.
n Employees in the same category must enrol in the same member class, and their eligible spouse and child(ren)'s must also be enrolled in
the same member class as the respective employees.
n For each member class, you can set different benefit levels for each benefit cover: for example, for directors belonging to a member class
(say member class 1), you can choose benefit level 1 for Hospitalization Benefits and benefit level 2 for Outpatient Benefits A.
n Benefit level(s) of Outpatient Benefits A or Outpatient Benefits B and / or Dental Benefits (if chosen) must be one benefit level above or
equal to or lower than the benefit level of Hospitalization Benefits for each member class (with benefit level 6 being the lowest).
n Benefit level(s) of Additional Hospitalization Benefits and / or Supplementary Major Medical must be at the same benefit level as
Hospitalization Benefits for each member class.

Renewal
At each policy anniversary, the policy may be renewed on an annual basis by paying the required premium in advance at the time of
renewal. AXA reserves the right not to renew the policy by giving 30 days notice in writing to you prior to any policy anniversary. AXA
also reserves the right not to renew the policy at policy anniversary if the total number of insured employees is less than 3 at policy
anniversary.

Termination
Notice of termination of an insured person must be given to AXA within 31 days from the effective date of termination of his / her insurance
cover.
The insurance cover hereunder of any insured person shall automatically cease on the earlier of the following dates:
(a) the date the policy is terminated;
(b) when any premium in respect of the insured person’s insurance cover remains unpaid at the expiry of the grace period;
(c) the date on which the insured person enters full time military, naval or air service;
(d) the end of the policy year during which the insured person (who is not a child) attains the age of 65, or up to the age of 70 upon approval
by AXA subject to health underwriting. In the case of an insured person who is a child, the end of the policy year during which the child
attains the age of 19 years, or the age of 23 years if he / she is a full-time student;
(e) the date communicated to the policyholder by AXA by virtue of war, act of war, where such date shall be at the discretion of AXA;
(f) in the case of an insured employee, the date on which the insured employee's employment with the policyholder is terminated whether
or not AXA has received notice of termination of employment;
(g) the date when an insured employee ceases to be actively at work, except if an insured employee (1) is temporarily disable or is absent
due to disease, illness or injury; or (2) is temporarily laid-off, given leave of absence or vacation without pay or temporarily on part-time
employment, under which the policyholder may elect to consider such insured employee as remaining in active employment with the
policyholder (but not for a period longer than 6 months following the situations mentioned in (1) and / or (2)), and his / her insurance
cover shall be deemed to continue provided that the premium payments are continued;
(h) in the case of an insured dependant, the date on which the insurance cover under the policy of the depending insured employee ceases.
No premium or proportion of the premium will be refunded to the policyholder or insured person(s) (if applicable) if termination is initiated
by the policyholder and accepted by the Company before the expiry date.

Reasonable and Customary Charges and Medically Necessary

We will only reimburse the reasonable and customary charges actually incurred for eligible hospital confinement, treatment, procedure,
supplies or other medical services that are covered under the policy which are medically necessary. If the charges are higher than the
reasonable and customary charges, we will only pay the amount which is reasonably and customarily charged.

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Premium Adjustment
At the beginning of each policy year, AXA shall revise and / or adjust the premium rates for each member class as specified in the table of
premium rates. The aggregate premium payable by you shall then be equal to the sum of all individual premiums of the insured persons
which are determined in accordance with the premium rates applicable to their respective member classes as specified in the table of
premium rates.

Revision of terms and conditions

AXA reserves the right to revise the benefits, premiums, terms and conditions, and to make changes to the policy upon renewal and any such
revision and adjustment will apply to the policy automatically.

Notification and Proof of Claims

Written notice of injury, disease or illness on which a claim may be based and which is covered by the policy, and written proof of claim
covering the occurrence, character and extent of claim, including original receipts and itemized bills together with a fully completed
claim form must be given to the Company at the insured person’s expenses within 90 days, starting from the first date of treatment of
the injury, disease or illness for which the claim is made.

Rights of third parties

The policy is excluded from the application of the Contracts (Rights of Third Parties) Ordinance (Cap 623 of the Laws of Hong Kong) (“TP
Ordinance”). Any person or entity which is not a party to the policy shall have no rights under the TP Ordinance to enforce any terms of the
policy.

Levy on insurance premium

Levy collected by the Insurance Authority through AXA will be imposed on the policy at the applicable rate. Policyholders must pay the levy
in order to avoid any legal consequences.

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Remarks
1. Subject to age limitation and eligibility. Please refer to the “Eligibility and Requirements” section of this product brochure and terms and conditions of the
policy for details.
2. Premium rates are not guaranteed and terms and conditions of the policy upon renewal may also be changed. AXA reserves the right to (a) review and
adjust the premium rates; and (b) revise the benefits and the terms and conditions of the policy on each policy anniversary of the policy. The premium
may be adjusted based on factors including but not limited to the attained age of the insured person, medical trend and AXA’s claims experience.
3. Full-time employees of your company with issue age 69 years old or below; 18 to 69 years old inclusive for employee’s spouse; and 14 days old to 18 years
old inclusive for employees’ unmarried child(ren) (or up till 23 years old if still in full-time education).
4. Subject to maximum limits listed in the summary of benefits of this product brochure and the terms and conditions of the policy.
5. Subject to maximum limits, deductible, adjustment factors and reimbursement percentage (if applicable) listed in the summary of benefits of this product
brochure and in the policy contract. Deductible (if applicable) shall be the amount which shall be deducted from the eligible incurred expenses and is
generally applied separately to each covered insured person, subject to exceptions.
6. The provision of services is subject to the AXA Assistance Terms and Conditions. This programme is provided by a third-party service provider. AXA and
the third-party service provider reserve the right to amend the terms and conditions thereof from time to time without prior notice. AXA shall not be
responsible for any services so provided or any act or failure to act on the part of the third-party service provider.
7. China Health Link Network is provided by a third-party service provider and designated hospitals under the China Health Link Network is subject to
change from time to time without prior notice. AXA shall not be responsible for any services so provided or any act or failure to act on the part of the third-
party service provider.
8. Only applicable if the coverage of policy includes Outpatient Benefits A or Outpatient Benefits B. An insured person may access to a network of panel
doctors offered by the Company and receive credit facility during the network panel doctors visit by presenting the AXA health card. The directory of
the network is subject to change from time to time at AXA’s sole discretion without prior notice. Please login to Emma by AXA or other channels made
available by AXA or call AXA Customer Care Hotline at (852) 2519 1166 for the latest list. Network panel doctors are independent third parties and are not
agents of AXA. AXA shall not have any obligation or liability whatsoever in relation to the medical services provided by network panel doctors, and shall
not be responsible for any act or failure to act on the part of network panel doctors.
You accept full responsibility for controlling the use of the AXA health card and agrees to reimburse AXA of any shortfall arising from the use of AXA
health card.
9. AXA reserves the right to revise the service coverage of Emma by AXA from time to time without prior notice. Please refer to Emma by AXA for any updates.

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Start putting the Axcellent Health Partner Employee Benefits Insurance
Package Plan to work for your company today!
To find out more, please contact your AXA insurance financial planners today.

Axcellent Health Partner Employee Benefits Insurance Package Plan is underwritten by AXA General Insurance Hong Kong Limited (“AXA”, the “Company”, or “we”).

The plan is subject to the terms, conditions and exclusions of the policy. AXA reserves the final right to approve any application. This product brochure
contains general information only and does not constitute any contract between any parties and AXA. It is not a policy. For detailed terms, conditions
and exclusions of the plan, please refer to the relevant policy provisions, which will be made available by the Company upon request.

ABOUT AXA HONG KONG AND MACAU

AXA Hong Kong and Macau is a member of the AXA Group, a leading global insurer with presence in 54 markets and serving 105 million
customers worldwide. Our purpose is to act for human progress by protecting what matters.
As one of the most diversified insurers offering integrated solutions across Life, Health and General Insurance, our goal is to be the insurance
and holistic wellness partner to the individuals, businesses and community we serve.
At the core of our service commitment is continuous product innovation and customer experience enrichment, which is achieved through
actively listening to our customers and leveraging technology and digital transformation.
We embrace our responsibility to be a force for good to create shared value for our community. We are proud to be the first insurer in
Hong Kong and Macau to address the important need of mental health through different products and services. For example, the
Mind Charger function on our holistic wellness platform “AXA BetterMe”, which is available via our mobile app Emma by AXA, is open to
not just our customers, but the community at large. We will continue to foster social progress through our product offerings and
community investment to support the sustainable development of Hong Kong and Macau.

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 Axcellent Health Partner Employee Benefits Insurance Package Plan
Product brochure

February 2022

Find out more about

Axcellent Health Partner Employee Benefits Insurance Package Plan
HPPM 821-2202E

Tel : (852) 2519 1166

www.axa.com.hk

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