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HEALTHCARE INSURANCE INSTRUCTION
The Insured : YI DA VIETNAM LIMITED (Member of Crystal International Group Limited)
Policy Number : HCM7.D12.ITC.19.HD19
Address : Song Thao Industrial Cluster - Cam Khe town - Cam Khe district - Phu Tho province, Vietnam
Period of Insurance : From 01/01/2020 to 31/12/2020 (both days inclusive)
Scope of territory : Worldwide
Insurance Company : Baoviet Insurance Corporation
Claims settlement unit
: Baoviet Claim Settlement Department – Baoviet Insurance Corporation
Type of insurance : BAOVIET INTERCARE
The broker
: GiNET Vietnam
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A. BENEFIT
I. CORE PLAN: IN-PATIENT TREATMENT DUE TO DISEASES/ILLNESS AND ACCIDENT (IP) Coverage The Benefits mentioned in this Policy are provided to the Insured Person for medical and
emergency transportation expenses following an illness/accident in the scope of insurance as
specified in this Policy
Currency: VND
IP Select Essential
Area of coverage Worldwide Worldwide
Maximum Aggregate Limit/Sum Insured for the whole insurance
period subject to corresponding sub-limits below: 1.050.000.000 2.100.000.000
1. Room and Board/day 4.200.000 6.300.000
2. Intensive care unit (max 30 days/ disease) Full cover Full cover
3. Companion Accommodation/ person/ day (max 10 days/ year) 1.260.000 1.890.000
4. Hospital Miscellaneous Expenses (charges incurred for medical
supplies and services during an in-patient and/or day-patient treatment)
MRI, PET, CT scans, X-rays, pathology, diagnostic tests
Full cover Full cover
5. Pre-hospitalization examination within 30 days prior to the hospital
admission 21.000.000/year 42.000.000/ year
6. Post hospitalization treatments immediately following hospital
discharge but not exceeding 90 days from the hospital discharge 21.000.000/ year 42.000.000/ year
7. Home nursing (as prescribed by Doctor) - Maximum 30 days/ year 21.000.000/ year 42.000.000/ year
8. Surgical Operation includes:
- Drugs, and materials,
- Necessary surgical appliances prescribed by Physician (not excluded
by the Policy)
- Operating theatre, surgeon, Anesthetizing fees
- Fees for consultation before surgery and post-operation recovery
- Redone operation
(Extend to Day-patient sugery/ Minor surgery/ Out-patient surgery/
Surgical procedures for treatment)
Full cover Full cover
9. Organ Transplantation of Heart, Lung, Liver, Pancreas, Kidney or
Bone Marrow.
Limit per lifetime (*) for each organ
630.000.000 840.000.000
10. In-hospital Specialist Consultation (max. one visit /day and 90
days/year) 4.200.000 /day Full cover
11. Emergency Accidental Pregnancy treatment immediately after an
accident per policy (exl .embryo trophic) Full cover Full cover
12. Emergency Accidental Dental Inpatient Treatment (treatment received
within 24 hours at the emergency room of a hospital immediately
following an accident) per insurance period
21.000.000 Full cover
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IP Select Essential
13. Expenses for transportation in emergency case 21.000.000/year 42.000.000/ year
14. Emergency Medical Evacuation & Repatriation (including by air) Full cover Full cover
15. Emergency Ward Treatment Full cover Full cover
16. Acute mental disorder (in-patient only)
21.000.000 year
105.000.000 /lifetime
(*)
63.000.000 /year
210.000.000 / lifetime
(*)
17. Daily Allowance per night (Up to 20 nights/ year) 105.000 210.000
18. Government Hospital Allowance (Up to 20 nights/ year) 210.000 420.000
19. AIDS/HIV
Cover for treatment occurring during the Insured Period, including the
subsequent renewal year(s), provided that it manifests itself after the
policy has been continuously in effect for a period of five (5) years
since the Entry date.
105.000.000/
lifetime(*)
210.000.000/ lifetime
(*)
20. Burial costs and repatriation of mortal remains/ ashes 60.000.000 100.000.000
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II. OPTIONAL PLANS
PERSONAL ACCIDENT (PA) Manager Executive
Area of coverage Worldwide
Maximum Aggregate Limit/Sum Insured for the whole insurance
period 1.365.000.000 2.730.000.000
Benefit:
This benefit is cover for Death, total/partial permanent disablement due to accident occurring within 104 weeks from the date
of accident provided that the causes of death or disablement must incur within the insurance period and are not excluded by
the Policy:
+ In case of death, total permanent disablement: The Insurer shall pay 100% of Sum Insured
+ In case of partial permanent disablement: The Insurer shall pay reimbursement in accordance with Appendix II – Table of
disability percentage
+ In case an accident resulting in partial permanent disablement
which has been paid by the Insurer, and within 104 weeks from the date of the accident, the insured person is death or totally
permanently disabled as a result of such accident, the Insurer will pay the difference amount between the sum insured stated
in the insurance policy and the amount paid earlier;
+ The total amount of reimbursement for an insured shall not exceed 100% of the Sum insured.
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III. EXTENSION CLAUSES
N
o
.
Extension Clauses Baoviet Intercare
1.
Automatic additional/deletion clause - full year benefit - prorata premium
(Premium of endorsements issued in the year will be paid on balance basic at
the end of the policy)
Applied
2. Premium Warranty (30 days) Applied
3. Motor Cycling Extension Clause Applied - for insured event in scope
of coverage
4. Deleterious food and drink poisoning, gas poisoning and poison gas
suffocation (under Personal Accident schedule) 2,100,000,000/occurrence/policy
5. Expanded to cover for medical materials: physiological saline, deep sea
water (Sodium Clorid, Sterima, Humer ...)
Max: 200,000 VND/visit
Max 500,000 VND/ person/ year
6. Insurance for abnormalities in biochemistry, body metabolism such as
hyperlipidemia, High liver enzyme, low calcium levels or the like Applied
7. Equipment implanted inside the body such as pacemakers, aerosols, stent and
Longo knife for hemorrhoid surgery Fully covered
8.
Diseases due to swine flu, bird flu, influenza A (H1N1), H5N1
(maximum accumulative VND 2.1 billion VND / contract), exclusion of
disease notified by the health authorities (coverage for medical expenses)
Applied
9. Tendon and ligament treatment surgery (apply for new insured) Fully covered
10. Occupational disease extension Applied
11.
Vitamins and minerals supporting the treatment of diseases
Bao Viet shall consider reimbursing the expenses of minerals and vitamins
provided that:
These minerals and vitamins are prescribed by a Physician, and
- These minerals and vitamins are used to accommodate treatment, and
- The prescription of minerals/vitamins must be accompanied by drugs for
treatment, and
- Total expenses for these minerals/ vitamins shall not exceed VND
2,000,000/ year
Applied
12. Counted as one hospitalization day when an Insured Person stay less than 24
consecutive hours in case of overnight in the hospital Fully covered
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Extension Clauses Baoviet Intercare
13. Re-examination directed by doctors but results are normal in medical report Applied
14.
Exemptions for list of medical expenses (for inpatients and outpatients)
Apply for inpatient records less than VND 5,000,000 and outpatient records
less than VND 500,000
Applied
15. Exemption for company stamp and manager's signature on Claim form Applied
16. Exemption for hospital stamp on test results if the test results are enough the
signatures and stamps of doctors (Apply at public hospital). Applied
17. Accepting VAT invoice of medicine issued within 30 days from the date of
prescription Applied
18. Accepting prescription at a hospital with an electronic barcode, no need to be
stamped Applied
19.
Accepting prescription up to 60 days directed by the doctor, but not
exceeding the insurance period and in the list of diseases that require long-
term treatment: applied for chronic diseases
Applied
20.
Coverage for Medical expenses, Death, Permanent Total & Partial
Disablement due to Accident if the insured drives a vehicle without the
driver's license or not valid (Co-pay 50/50).
Applied
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IV. WAITING PERIOD
WAITING PERIOD BAO VIET INTERCARE
For insured who engaged full and over 365 days of insurance time Not applied
For insured who engaged but not enough 365 days of insurance time Apply the waiting period for the remaining time
For new insured person
Accident Not applied
Normal Illness and Diseases Not applied
Special diseases, Pre-existing diseases Not applied
Death due to Normal diseases 90 days
Death due to Pre-existing diseases, Special diseases 365 days
Special Disease
- Cancer and tumors of any kind
- Diseases of heart, liver (hepatitis A, B, C), pancreas, kidney, lung failure
- Diseases related to hematopoietic (blood forming) system including pancreatic failure, acute and chronic
leukemia.
- Growth hormone deficiency.
- Diabetes mellitus. Parkinson’s disease.
Pre-existing conditions
Any medical conditions of the Insured Person which have been diagnosed; or for which symptoms existed
that would cause an ordinary prudent person to seek diagnosis, care or treatment; or for which medical
treatment was recommended by a medical practitioner, irrespective of whether treatment was actually
received or not.
Adenoidectomy, Tonsillectomy, Septoplasty (Deviated nasal septum surgery), vestibular disorders,
asthma, middle ear infection (otitis media) surgery, Sinusitis, Degenerative diseases of the vertebral
column/joints, Hemorrhoid Surgery, Herniated disc, polyps.
Normal Diseases
They are acute diseases which have no long-term incubation period, newly arising and treating completely,
no repeating many times as chronic disease
For example: dengue fever, urticaria, allergic rhinitis, appendicitis, fever….
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IV. GENERAL EXCLUSIONS
War, invasion, act of enemy, hostilities or warlike operations, civil war …
Injury, sickness, illness or disease sustained as a result of a criminal act of the policyholder
or insured person, violation or attempted violation of law and resistance to lawful arrest or any
resultant imprisonment.
Suicide, self-injury or willful exposure to peril (other than in an attempt to save human life),
The Insured’s act of fighting, unless such act can be proved that it is only a defense against
an attack, participation in or training for any professional sport activities or any form of
professional race or competition.
Treatment for sleep related breathing disorders (including snoring), fatigue, or stress.
The Insured is under treatment for alcoholism, drug or substance abuse or any addictive
condition of any kind and any injury or illness arising directly or indirectly from such abuse or
addiction.
Any normal eye test/examination, normal hearing test/examination, non-medical/natural
refractive eye defects and any corrective surgery for non-medical/natural degenerative sight and
hearing defects
Any type of treatment for Beauty purpose, cosmetic or plastic surgery unless it is re-
constructive surgery necessitated by an accidental injury that occurred during the period of
insurance stated on the Policy. Treatment for obesity, weight reduction and weight improvement
programs.
Cost of acquisition of organ for transplant
Any investigation test or treatment which directly or indirectly results from or is related to infection
by, which includes sero-positivity to, any Human Immunodeficiency Virus (HIV) or Acquired Immune
Deficiency Syndrome (AIDS)
(Other exclusions please refer to the exclusions in insurance policy)
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C. CLAIM INSTRUCTION
I. DIRECT BILLING
Insurance card is issued to each employee for inpatient treatment/ surgery following by diseases/sickness/illness
at the hospital/ clinic in Bao Viet’s direct billing network.
DIRECT BILLING PROCEDURE
Note 1: The insured person / representative should carefully check all charges during the treatment
process, compare with the amount of the Direct billing Division and the payment of fees paid by Bao
Viet Insurance before signing the insurance vouchers
Note 2:
- Customers can call the Hotline Guarantee Department of Bao Viet (after the card) for direct
instructions in emergency case and for emergency medical transportation services.
- Customers can call GiNET directly for instructions on collecting documents or direct billing
procedure.
2
Deposit (if any)
Some hospitals (Vinmec, Viet Phap, etc.)
may require a deposit in advance depending
on the severity of the case in order to prove
financial
3
Check direct-billing
At the time of discharge, after
completing the medical procedures, Bao
Viet and the hospital will consider and
approve the direct billing for customers
1
Present the Insurance card
The Insured or his representative must
present the insurance card and ID
card/passport to the Direct billing
department of hospital
4
Sign the claim form
Before hospital discharge, Insured or his
representative recheck all charges when
signing the claim form & any medical
treatment documents, invoices that the staff
of the hospital/ clinic guide and pay medical
expense which is not under direct billing (if
any) 5
Case of refusal of direct billing
In case of refusal of direct billing, the
insured will pay to the hospital charges
and claim with the insurance company
later
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Note 3: During the holidays, Bao Viet may not handle direct billing due to insufficient information or
the Direct billing Division of hospital does not work. In that case, please kindly pay in advance and
claim later.
Note 4: Hospital guarantee does not apply to:
- Treatment of accidents; Emergency treatment
- Allowance
- Expenses for examination and testing before admission and re-examination after discharge
(*)
(*) The claim back will be resolved after Baoviet received the guarantee medical papers from
the hospital.
- Dental treatment
Note 5: In case of Bao Viet can not haldle direct billing lack of information or need to evaluate and
confirm further information, please kindly pay in advance and claim later.
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II. CLAIM BACK
1. Claim back Procedure
Note 1: Please kindly declare exaclty and sufficiently information in Claim form
Note 2: In order to check online claim document, please kindly send photos of medical papers via email:
Title mail: Yi Da – Claim document – Name of Insured
Cc: [email protected] - Ms Mai: 0904990910
[email protected] - Ms Hường: 0913908559
[email protected] - Ms Thảo: 0396694364
Note 3: Please kindly send the hard copy of claim document to GiNET as following address:
GiNET Vietnam - Room 3, Floor 11, Harec Building, 4A Lang Ha, Ba Đinh Dist, Hanoi
Mr Hùng Chiến: Tel: +84 247 1080 668 (ext: 106) - Phone: 0838 830 038
Note 4: The Insured Person is entitled to claim compensation for Bao Viet Insurance within 6 months from
the date of receiving the notice of Bao Viet Insurance and any claim can not exceed 03 years from The date
of the event that resulted in the complain
Note 5: Deadline of making a claim request is within 180 working days form the end date of treatment
period or date of death.
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2. Claim document
Document for inpatient treatment
1 Claim Form
2 Hospital discharge form
3 List of hospitalization expenses (including room charge)
4 Minor surgery/ surgery certificate (in case of minor surgery / surgery)
5 Prescriptions, indications and results of examination, testing
6 VAT invoice/ Particular invoice
Document for out patient treatment
1 Claim Form
2 Examination form /medical examination book (clarify doctor's diagnosis and conclusions)
3 Prescription
4 VAT invoice/ electronic invoice
5 Retail invoice with the seal of the pharmacy/ hospital in case of under 200,000 VND
Document for medical treatment due to accident
Beside the documents as above instruction (inpatient and out patient), in case of accident Insured need have:
1 Accident report
2 Minutes for handling accidents and other documents of the police (if any)
3 Minutes of injury assessment (if any)
4 Photo of driving license (in case of driving from 50cc)
5 Death certificate (death case)
Note: - Medical documents need to have a sign of the hospital/ medical establishment.
- Insured fill information in Claim form with company stamp and signature of management.
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D. CONTACT FOR SUPPORT
Address
Address for sending
claim papers
GiNET Vietnam - Room 3, 11st Floor, Harec Building, No. 4A Lang Ha, Ba Dinh, Hanoi
Mr. Hùng Chiến: [email protected]
Tel: +84 247 1080 668 (ext: 106) - Phone: 0838 830 038
BaoViet’s hotline
BAOVIET Insurance Corporation
Hotline 24/7: 0904 832 888/ 0906 633 757
GiNET’s hotline
Hotline in Vietnamese:
Ms Quỳnh Mai [email protected]
Tel: +84 247 1080 668 (ext: 103) - SĐT 0904 99 0910
Ms Huong [email protected]
Tel: +84 247 1080 668 (ext:124) - SĐT 0913908559
Hotline in English:
Ms Quỳnh Mai [email protected]
Tel: +84 247 1080 668 (ext: 103) - SĐT 0904 990 910
Ms Bích Thảo [email protected]
Tel: +84 247 1080 668 (ext: 105) - SĐT 0396 694 364