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| Hospital Services | Plan H1 - Classic | Plan H2 - Executive | Plan H3 - Premier |
|---|
- Hospital Services
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Hospital Services Plan H1 - Classic
Plan H2 - Executive
Plan H3 - Premier
Hospital Services Overall Annual Limit 2.200.000.000 6.600.000.000 22.000.000.000 All Hospital Services
Including surgeon fee, operation room, surgical appliance, investigations, nursing and hospital charges, etc
Fully covered Fully covered Fully covered Room and Board – per day Standard Private Room up to 5.500.000 Standard Private Room up to 7.150.000 Standard Private Room Intensive Care Unit – per day 16.500.000 16.500.000 Fully covered Companion Bed – per day
(accompanied dependent child below 18, maximum 10 days/year)
2.200.000 3.960.000 Fully covered Oncology Treatment
Treatment given for cancer received as an In-patient or Day-patient at the Hospital (Maximum per policy year)
Fully covered Fully covered Fully covered Day Case Treatment
Admitted to a Hospital bed but does not stay overnight (Maximum per policy year)
110.000.000 Fully covered Fully covered Local Ambulance Services
The medically necessary road ambulance transportation services to and from a local Hospital
Fully covered Fully covered Fully covered Organ Transplant
In respect of kidney, heart, liver and bone narrow transplants (Maximum per Sickness or Injury)
Fully covered Fully covered Fully covered Pre and Post Hospitalisation Treatment
Outpatient expenses incurred within 30 days before admission & 90 days following hospital discharge (Maximum per hospitalisation)
33.000.000 44.000.000 110.000.000 Emergency Ward Treatment
Services performed in a Hospital casualty ward or emergency room for a period of not more than 24 hours
Fully covered Fully covered Fully covered Nursing at Home
Maximum 182 days per policy year
Fully covered Fully covered Fully covered Psychiatric Treatment
For a maximum of 30 days hospitalisation per policy year after 24 months cover
Maximum per policy year
Not application Not application 220.000.000 Emergency Dental Treatment
Immediately following an accident and the teeth repaired must have been sound and natural
Maximum per policy year
220.000.000 440.000.000 1.100.000.000 AIDS/HIV
occurring during the Period of Insurance of this Policy, including the subsequent renewal year(s) and manifests itself after five years of continuous coverage under the Policy from the first Effective Date
10% of Annual Overall Limit/lifetime 10% of Annual Overall Limit/lifetime 10% of Annual Overall Limit/lifetime Emergency Medical Evacuation/Repatriation Fully covered Fully covered Fully covered Repatriation of Mortal Remains Fully covered Fully covered Fully covered Medical/Legal information and assistance 24-hour access 24-hour access 24-hour access Compassionate Visit 1 Economy Class Return Ticket 1 Economy Class Return Ticket 1 Economy Class Return Ticket Return of Minor Child 1 Economy Class One Way Ticket 1 Economy Class One Way Ticket 1 Economy Class One Way Ticket
Optional Coverage
| Outpatient Services | Plan H1 - Classic | Plan H2 - Executive | Plan H3 - Premier |
|---|
- Outpatient Services
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Outpatient Services Plan H1 - Classic
Plan H2 - Executive
Plan H3 - Premier
Outpatient Annual Overall Limit: Plan H1 and H2 110.000.000 110.000.000 Fully covered inclusive in the Basic Cover Overall Limit General Outpatient Services Fully covered Fully covered Fully covered Specialist Outpatient Services Fully covered Fully covered Fully covered Laboratory and x-ray Services (upon referral) Fully covered Fully covered Fully covered Prescribed Drugs (upon referral) Fully covered Fully covered Fully covered Chinese Herbalist, Bonesetter & Acupuncture
(Limit per visit, maximum 10 visits per policy year)
990.000 per visit limit 990.000 per visit limit 990.000 per visit limit Physiotherapy and Chiropractor Treatment (upon referral)
(Limit per visit, maximum 15 visits per policy year)
1.320.000 per visit limit 1.320.000 per visit limit 1.320.000 per visit limit Hormone Replacement Therapy
Maximum per policy year
44.000.000 44.000.000 44.000.000 Annual Medical Examination/Vaccination/Work Permit Medical Check-up
Maximum per policy year
3.000.000 3.000.000 3.000.000 - Dental Services (*)
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Dental Services (*) Plan H1 - Classic Plan H1 - Classic Plan H2 - Executive Plan H3 - Premier Dental Overall Annual Limit 33.000.000 33.000.000 33.000.000 33.000.000 Routine Oral Examination (including scaling & polishing)
(once per year, maximum per policy year)
2.200.000 2.200.000 2.200.000 2.200.000 Basic Dental Services
(Extraction, amalgam fillings, x-rays, periodontal scaling)
Fully covered Fully covered Fully covered Fully covered Major Dental Services
- After 9 months’ insurance cover - Removal of impacted, buried or unerupted teeth, Root Canal Treatment, Removal of Solid Odonomes, Apicectomy
- After 12 months’ insurance cover - Crown and Bridges, Dentures
Fully covered Fully covered Fully covered Fully covered
(*) Available when applying together with optional outpatient
Standard Outpatient deductible is VND550,000 per visit, which can be removed with a loading of 30%
Area of coverage:
- Zone 1 (Z1): Worldwide subject to VND44,000,000 deductible for any Disability in USA and Canada
- Zone 2 (Z2): Vietnam, China, Thailand, Singapore, Taiwan, South Korea, Japan, Malaysia, Indonesia and Philippines
- Zone 3 (Z3): Worldwide
- Zone 4 (Z4): Worldwide excluding USA and Canada.
Eligibility Criteria:
Insured persons:
- Full-time employees
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Dependants of employees, including spouses and children
Age of inception:
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New members: from 15 days up to 64 years old
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Renewal members: maximum 74 years old
Important Note:
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The premium rates are effective from 15 Sep 2015 and are applicable to Occupation I and II and for standard risks
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The summary in this brochure supports customers to evaluate the benefits of Liberty HealthCare insurance. Reasonable and customary charges will apply to any benefit payment
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This insurance policy is only available to Vietnamese citizens and permanent residents in Vietnam, excluding citizens of countries under sanctions or embargoes by the United Nations, the United States of America, the European Union or the United Kingdom
