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| Hospital Services | Plan M4 - Diamond | Plan M3 - Gold | Plan M2 - Silver | Plan M1 - Bronze |
|---|
- Overall Annual Limit
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Hospital Services Plan M4 - Diamond Plan M3 - Gold Plan M2 - Silver Plan M1 - Bronze Hospital Services Overall Annual Limit 1.000.000.000 500.000.000 250.000.000 120.000.000 All Hospital Services
including surgeon fee, operation room, surgical appliances, investigations, nursing and hospital charges, etcFully covered Fully covered Fully covered Fully covered Room and Board – per day 4.000.000 2.500.000 1.500.000 1.000.000 Intensive Care Unit – per day 15.000.000 6.000.000 4.000.000 2.500.000 Companion Bed – per day
(accompanied dependent child below 18, maximum 10 days/year)1.000.000 Not applicable Not applicable Not applicable Oncology Treatment
Treatment given for cancer received as an In-patient or Day-patient at the Hospital
Maximum per policy yearFully covered 250.000.000 100.000.000 50.000.000 Day Case Treatment
Admitted to a Hospital bed but does not stay overnight
Maximum per policy yearFully covered Fully covered Fully covered Fully covered Local Ambulance Services
The medically necessary road ambulance transportation services to and from a local HospitalFully covered Fully covered Fully covered Fully covered Organ Transplant
In respect of kidney, heart, liver and bone narrow transplants
Maximum per Sickness or InjuryFully covered 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 hospitalisation20.000.000 10.000.000 8.000.000 6.000.000 Emergency Ward Treatment
Services performed in a Hospital casualty ward or emergency room for a period of not more than 24 hoursFully covered 15.000.000 10.000.000 6.000.000 Nursing at Home
Maximum 182 days per policy yearFully covered Fully covered Fully covered Fully covered Emergency Dental Treatment
Immediately following an accident and the teeth repaired must have been sound and natural
Maximum per policy year50.000.000 20.000.000 Not applicable Not applicable 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 Date10% of Annual Overall Limit/lifetime Not applicable Not applicable Not applicable Emergency Medical Evacuation/Repatriation Fully covered Fully covered Fully covered Fully covered Repatriation of Mortal Remains Fully covered Fully covered Fully covered Fully covered Medical/Legal information and assistance 24-hour access 24-hour access 24-hour access 24-hour access
Optional Coverage
|
Outpatient Services |
O4 | O3 | O2 | O1 |
|---|
- Outpatient Services
-
Outpatient Services
O4 O3 O2 O1 Outpatient Annual Overall Limit 30.000.000 20,000,000 15,000,000 10,000,000 General Outpatient Services Fully covered Fully covered Fully covered Fully covered Specialist Outpatient Services Fully covered Fully covered Fully covered Fully covered Laboratory and x-ray Services (upon referral) Fully covered Fully covered Fully covered Fully covered Prescribed Drugs (upon referral) Fully covered Fully covered Fully covered Fully covered Chinese Herbalist, Bonesetter & Acupuncture
(Limit per visit, maximum 10 visits per policy year)300.000 per visit limit 200.000 per visit limit 150.000 per visit limit 150.000 per visit limit Physiotherapy and Chiropractor Treatment (upon referral) (Limit per visit, maximum 15 visits per policy year) 600.000 per visit limit 400.000 per visit limit 300.000 per visit limit 200.000 per visit limit - Dental Service
-
Dental Services1
O4 O3 O2 O1 Dental Overall Annual Limit 10.000.000 10.000.000 10.000.000 10.000.000 Routine Oral Examination (including scaling & polishing) (once per year, maximum per policy year) 2.000.000 2.000.000 2.000.000 2.000.000 Basic Dental Services
(Extraction, amalgam fillings, x-rays, periodontal scaling)Fully covered Fully covered Fully covered Fully covered Major Dental Services
Removal of impacted, buried or unerupted teeth, Root Canal Treatment, Removal of Solid Odonomes, ApicectomyFully covered Fully covered Fully covered Fully covered - Maternity Care
-
Maternity Care2
O4 O3 O2 O1 Maternity Overall Annual Limit 40.000.000 40.000.000 40.000.000 40.000.000 Pre-natal, postnatal services, cost of delivery including all hospital and profession fees and up to 30 days for new-born baby care (subject to 12 months waiting period) Fully covered Fully covered Fully covered Fully covered
1 Available when applying together with optional outpatient and subject to 20% co-payment
2 Available when applying together with Hospitalisation Plan
Eligibility Criteria
Insured persons
- Full-time employees
- Dependents of employees, including spouses and children
Age of inception
- New members: from 15 days up to 64 years old
- Renewal members: maximum 74 years old
Minimum number of insureds
- Plan M1 & M2: 20 members
- Plan M3 & M4: 2 members
Area of coverage
- Vietnam
Important note
- The premium rates are effective from 15 Sept 2015 and are applicable to Occupation I and II and for standard risks
- 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
- 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
- This brochure is for reference only. For complete details of plan benefits, conditions, limitations, and exclusions, please refer to the policy schedule, wording and endorsement (if any), copies of which will be provided upon request
