Bupa HealthNet

保柏網絡

Group Health
Insurance Scheme
Handbook
團體醫療計劃手冊
Contents at a glance

Welcome 1

Useful contacts 2

Web and mobile services 3

Membership
 Starting your membership 4
 Managing your membership 6
 Ending your membership 7
 Topping up your coverage 8

Claim procedures
 General information 9
 Claiming Hospital and Surgical Benefit, SMM Benefit and Maternity Benefit 12
 Claiming Clinical Benefit and Maternity Benefit (Using BHN Card) 14
 Claiming Clinical Benefit, Maternity Benefit and Dental Benefit (Not using BHN Card) 15
 Claiming Network Dental Benefit (Consultation at Network Dental Centre) 17

General exclusions 18

Your personal data 20

目錄

歡迎 21

有用聯絡資料 22

網上及手機服務 23

會籍
 開始成為計劃成員 24
 管理您的會籍 26
 退出計劃 27
 增值您的保障 28

申請賠償程序
 一般資料 29
 申請住院及手術保障、附加醫療保障及產科保障賠償 32
 申請門診保障及產科保障賠償（使用「保柏網絡醫療卡」） 33
 申請門診保障、產科保障及牙科保障賠償（不使用「保柏網絡醫療卡」） 34
 申請網絡牙科保障賠償（於網絡牙科中心診治） 36

不受保障項目 37

您的個人資料 39
 Welcome

Welcome to the Group Health Insurance Scheme (“the Scheme”) provided by your employer! The
Scheme is administered and underwritten by Bupa (Asia) Limited (“Bupa”) and provides you with
24-hour worldwide coverage. From now on, you have access to expert health insurance services
provided by Bupa.

In this booklet, we have put together the key information you need to help you make the most of your
cover, including a step-by-step guide to making a claim. We encourage you to keep this booklet
somewhere that is easy to reach. It will come in handy if you need to make a claim.

As a health insurance specialist in Hong Kong, Bupa is part of the Bupa group established in the UK
in 1947. The Bupa group is now a leading international healthcare organisation serving millions of
customers around the world through diversified healthcare services from health insurance to
hospitals, care homes and health assessments. As Bupa does not have any shareholders, its
profits are invested to provide more and better healthcare to customers and communities. In Hong
Kong, the Bupa group also provides primary healthcare services through another member, Quality
Healthcare which is a leading provider of private outpatient services with an extensive network of
medical centres.

To ensure you understand your benefit entitlements, you are encouraged to read the relevant
sections of this booklet in relation to your entitled benefits thoroughly in conjunction with the
following:
 Schedule of Benefits
 Bupa Worldwide Assistance Programme Leaflet (if applicable)

Should you have any questions regarding the Scheme or your membership, please do not hesitate
to contact Bupa’s Customer Care Helpdesk at (852) 2517 5388.

Note:
The information in this booklet is for member’s reference only. In the event of any conflict in the
interpretation between the English version and the Chinese version, the English version shall prevail.
Should there be any discrepancy between this booklet and the provisions of the Group Health Insurance
Contract, we shall follow the latter for final interpretation.

1
Useful contacts

As our valued member, you can enjoy our professional services anytime. You can contact us or
manage your membership in various ways:

Get in touch for questions, 24-hour Customer Care helpdesk: (852) 2517 5388
claims, suggestions and Office hours
compliments 9:00 am – 7:00 pm, Monday to Friday, (except public holidays)
 We are pleased to answer all your enquiries.
Outside office hours
We are happy to answer the following enquires:
 information of HealthNet Service Providers
 information of benefit entitlement
 claims and other policy administration procedures
 claim forms

E-mail: customercare@bupa.com.hk
Fax: (852) 3973 6970

Download forms Visit:

www.bupa.com.hk > Customer care > Download forms
You can also ask our Customer Care helpdesk to send you any
form by fax.

Write to us or visit us Address:

18/F, Berkshire House, 25 Westlands Road,
Quarry Bay, Hong Kong.

2
 Web and mobile services

Making your life easier is part of our mission. As your healthcare partner, we have created a range
of support services to help you stay in control of your health insurance at a time that is convenient to
you.

Online and mobile services

myBupa is your go-to place to easily manage your cover. You can:
 check your membership details
 submit claims online (if applicable)
 access your eMedical Card (if applicable)
 view membership documents
 check your claims status and any outstanding shortfall
 view claims statements and shortfall invoices (if applicable)
 view clinical benefit usage
 download claim forms and other frequently used forms
 download your List of HealthNet Service Providers and Medpass Network Hospital List (if
applicable)
 search and get information for HealthNet Service Providers and night clinics

Register myBupa at mybupa.bupa.com.hk. It’s free.

To start using myBupa, simply follow the 6 steps for registration:

1. Go to myBupa website or mobile app and click "Register now";
2. Enter your membership number, HKID/passport number and date of birth, then click "Submit";
3. Enter your mobile number and email address, then click "Send Verification Code" to get the
code sent to your email;
4. Enter the verification code;
5. Create your own login ID and password;
6. Click "Submit" to complete the first-time registration.

You can also download the myBupa free mobile app:

Claims notification services

To keep you up-to-date regarding your claims, you will receive a SMS notification as soon as your
claim has been processed, followed by a claims statement by post or a notification by email to
inform you to view your claims statement on myBupa if your employer has opted for our e-Statement
service. To receive SMS notifications, please sign up this service by calling Bupa Customer Care
helpdesk at 2517 5388.

3
 Membership
Starting your membership

Eligibility
All full-time permanent employees aged below 65 years are eligible to join the Scheme.

Your dependants may also be eligible to join if dependant cover is provided under the Scheme.
Dependants include:
 your lawful spouse aged below 65 years; and
 your lawful unmarried child(ren) aged from 15 days to 17 years (or up to 22 years if they are
full-time students with valid proof accepted by Bupa).

Effective date of membership

You will be enrolled into the Scheme on the date as set by your employer. In case you are sick and
not actively at work on such date, your membership will commence on the day you return to work.

Membership for your existing dependants, if applicable, will begin on your membership
commencement date. In case your dependants are hospitalised on such date, their membership
will commence on the day following their discharge from hospital.

4
Membership
Starting your membership

Your Bupa HealthNet Card

Points to note upon  After enrolment in the Scheme, you and your dependants, if
receipt of BHN Card applicable, will each receive a Bupa HealthNet Card (“BHN
Card”).
o Your name and Bupa membership number are imprinted on
the front of the BHN Card.
o You and your dependants should check the accuracy of the
names and sign on the back of the BHN Card.

Use of BHN Card  The BHN Card can be used to settle payment for the following
services if specified in the Schedule of Benefits:
o in-patient treatments at the private hospitals in Hong Kong
as listed in the List of HealthNet Service Providers;
o clinical consultations and laboratory tests carried out by
HealthNet Service Providers in Hong Kong and Macau as
listed in the List of HealthNet Service Providers (payable
under HealthNet Benefit);
o consultations or treatments at the outpatient department of
the private hospitals in Hong Kong as listed in the List of
HealthNet Service Providers (payable under Non-HealthNet
Benefit); and
o video consultation services with eligible BHN card if you
have HealthNet Clinical Benefit. Consult our designated
HealthNet General Practitioners through a video call
comfortably and safely at home. Only eligible medical
expenses are covered and all medication delivery charges
shall not be payable. Visit www.bupa.com.hk/vc for details.

What should I do if I lose  You should inform your employer within 24 hours in case of loss
my BHN Card? or theft of your BHN Card and submit a completed “Declaration
of Membership Card Loss” to your employer. If you do not
report such loss, you may be held liable for any costs arising
from any unauthorised use of the BHN Card.
 The first card replacement is free of charge. An administration
fee of HK$100 per card will be charged for subsequent
replacements in the same contract year.

5
Membership
Managing your membership

Enrolment of new dependants

How do I enrol new dependants? (if applicable)

Newly married spouse  Please notify your employer within 31 days of your marriage.
 Your spouse’s membership will begin on the registered date of
marriage.

Newborn child  Please notify your employer within 45 days of your child’s birth and
submit a photocopy of the birth certificate for verification.
 Your child’s membership will begin on the 15th day from the date of
birth.

Note:
If you inform your employer after the above-mentioned notification period, your new dependant’s
membership commencement date may be postponed to a date as determined by Bupa.

6
 Membership
Ending your membership

Termination of membership
The membership for you and/or your dependant
Event
(if applicable) will automatically end on:
Leaving service The date of leaving service
You or your spouse reaches the The Scheme’s Contract Anniversary Date immediately following
age of 65 the attainment of 65 years old
Children grow up The Scheme’s Contract Anniversary Date immediately following
the attainment of:
 18 years old if the child is not a full-time student; or
 23 years old
Divorce * The date your divorce takes effect
Dependant passes away * The day after the death of your dependant
* If either of these events occurs, you need to notify your employer within 31 days to end the
membership of your dependant(s).

Note:
Please return the BHN Card(s) to your employer no later than the effective date of termination.

7
 Membership
Topping up your coverage

Bupa offers the Scheme members the opportunity to join our designated individual health insurance
scheme at each member’s own cost at different life stages (e.g., upon renewal of your group
scheme, before or after changing jobs, before retirement) to boost your cover.

You and your dependants, if applicable, can enrol in Bupa’s designated individual health insurance
scheme at the same room level under Hospital and Surgical Benefit as your entitled room level
under your current group Scheme at different life stages. Bupa guarantees that your application will
be accepted without underwriting regardless of your health conditions1. Moreover, medical
conditions eligible under your group membership will be covered for life2 under the designated
individual health insurance scheme.

You can enrol in Bupa’s designated individual health insurance scheme during any one of the
following periods3:
1. Within 60 days of joining a Bupa group scheme;
2. Within 60 days after the Contract Anniversary Date of a Bupa group scheme;
3. Within 30 days before or after termination of a Bupa group scheme membership;
4. Within 60 days before age 70; or
5. Within 30 days after marriage or child’s birth.

If you are interested in topping up your coverage, please contact Bupa’s Customer Care helpdesk.

1 Please refer to the "Eligibility" section of the designated individual health insurance scheme brochure for details.
2 All pre-existing conditions which are payable under your Bupa group scheme shall be covered under the designated
individual health insurance scheme if you have been continuously insured under a Bupa group scheme and/or the
designated individual health insurance scheme for a total of at least 12 consecutive months, with the exception of those
specified under the General Exclusions of the designated individual health insurance scheme contract. Bupa guarantees
that your cover under the designated individual health insurance scheme can be renewed every year for life as long as
you meet the requirements as stated in the Renewal Clause of your contract. Bupa reserves the right to amend the
subscription, benefits, terms and conditions upon your contract renewal. You can refer to the designated individual health
insurance scheme contract for further details.
3 If the number of employees joining your company’s Bupa group scheme is between 2 – 9, you can only enrol in the

designated individual health insurance scheme within 30 days before or after termination of your Bupa group scheme
membership when your employment ends (except when you retire).

8
 Claim procedures
General information

No matter you choose HealthNet or Non-HealthNet medical service providers, please read this
section carefully. Details of the claim procedures for the following medical benefits are included in
later sections.
 Hospital and Surgical Benefit
 Supplementary Major Medical Benefit (“SMM Benefit”) (if applicable)
 Clinical Benefit (if applicable)
 Maternity Benefit (if applicable)
 Dental Benefit (if applicable)

You should read the claim procedures for your entitled benefits as shown in the Schedule of Benefits.

Useful tips for claims

No matter you use BHN Card or not, please note:

1 Tips on referral letter for Clinical Benefit:

To be entitled to the following

benefits (if applicable) ….. You need to get a Referral Letter from:

Specialist * General Practitioner

Physiotherapist / Chiropractor /
General Practitioner / Specialist
all Diagnostic Imaging & Laboratory Tests
General Practitioner / Specialist
Prescribed Western Medication
(issue “Prescription”)
Registered Chinese Medicine Practitioner /
X-ray only and Laboratory Tests
Chiropractor
Psychological Counselling The attending Psychiatrist
* Referral is not required for Dermatology, Family Medicine, Gynaecology, Ophthalmology,
Orthopaedics, Otolaryngology, Paediatric Surgery, Paediatrics and Psychiatry within HealthNet.
Referral letter or prescription, if applicable, is valid for the same or related medical condition for
6 months from the issue date. Treatment for a new or unrelated medical condition will require
a new referral letter or prescription.

If you do not use BHN Card, please note:

2 Tips on claiming for reimbursement of medical expenses:

 You need to submit medical claims to Bupa within 90 days from the date of treatment or
discharge from hospital; otherwise, they may be declined for settlement.
 Bupa will reimburse you the eligible amount by crediting your bank account in Hong Kong
dollars within 5 – 7 working days upon receipt of all necessary documents.
 Claim Forms can be downloaded from Bupa’s website at www.bupa.com.hk.

9
Claim procedures
General information

If you use BHN Card, please note:

3 Tips on pre-authorisation for HealthNet Benefit:

HealthNet Registered Medical Practitioner will help you seek pre-authorisation from
Bupa for the following services, if applicable:
1. diagnostic imaging or laboratory tests exceeding HK$2,000
2. treatment by a Non-HealthNet Specialist (only if referred by a HealthNet General
Practitioner when the necessary specialty is not available within Bupa HealthNet)

Note:
1. If pre-authorisation is required for emergency situations after Bupa’s office hours,
subsequent authorisation can be done on the next working day after treatment.
2. If you do not obtain pre-authorisation or pre-authorisation is not approved, all eligible
medical expenses will be paid under Non-HealthNet Benefit, if any.

HealthNet Registered Medical Practitioner fills in

1
the Pre-authorisation Form and faxes it to Bupa.

Pre-authorisation Bupa sends the pre-authorisation confirmation to

2
procedures HealthNet Registered Medical Practitioner.

Pre-authorisation You need to check and sign the pre-authorisation

procedures 3
confirmation and keep the Member’s copy.

4 Tips on shortfall incurred from using BHN Card:

In case the expenses incurred via using the BHN Card exceed the benefit limits or the
expenses are not covered under the Scheme, Bupa will issue a Shortfall Invoice to you and
you have to settle the shortfall amount to Bupa within 14 days after receipt of the Shortfall
Invoice.

10
Claim procedures
General information

Day Procedure Benefit:

1 Tips on Endoscopy and Viral Warts & Skin Lesions Procedures:

Pre-authorisation must be obtained from Bupa prior to Endoscopy and Viral Warts & Skin
Lesions Procedures:

 For Hospital Confinement, Clinical Operation or Day Case exceeding HK$4,000

performed by a HealthNet Registered Medical Practitioner, pre-authorisation must be
obtained through your treating Registered Medical Practitioner;
 For Hospital Confinement, Clinical Operation or Day Case performed by a Non-HealthNet
Registered Medical Practitioner, please apply for pre-authorisation directly from Bupa
following these steps:
1. Submit the Pre-authorisation Form with Part I and Part II completed to Bupa.
2. Bupa will inform you regarding the pre-authorisation result within 2 working days.
3. After treatment, submit the claim to Bupa with the approved pre-authorisation result.

The process above is only applicable to members with Day Procedure Benefit and the
following medical card types:
Clinical, Clinical – Not for X-ray and Lab, Hospital & Clinical medical card types

CLINICAL CLINICAL – NOT FOR X-RAY & LAB HOSPITAL & CLINICAL

11
Claim procedures
Claiming Hospital and Surgical Benefit, SMM Benefit and Maternity Benefit

Using BHN Card Not Using BHN Card

(Applicable to member whose BHN Card is
embossed with “HOSPITAL & CLINICAL”)
At the  Present BHN Card for registration.  Complete Part I of Bupa Hospital Claim
hospital  Sign the voucher. Form.
 Complete Part I of Bupa Hospital  Ask your attending Registered Medical
Claim Form. Practitioner to complete Part II of Bupa
 The hospital administrator will arrange Hospital Claim Form for you.
for completion of Part II of the Claim
Form by the attending Registered
Medical Practitioner.

Upon  Settle payment by BHN Card.  Settle the medical bill by yourself first and
discharge obtain original receipt.
 Obtain medical report or Discharge
Summary, if any.

After  Bupa will settle the expenses directly  Within 90 days after the date of
discharge with the hospital. discharge, submit to Bupa:
 Bupa will notify you to settle shortfall, o completed Bupa Hospital Claim Form
if any. o original hospital receipt
o medical report (if applicable)
o Discharge Summary / Sick Leave
Certificate (if applicable)
 You can also submit your claims online
by uploading the images of the above
documents to myBupa within 90 days
after the date of treatment.
o Please keep the original receipt for 6
months from the date of claim
submission. Bupa may request you to
provide the original receipt for auditing
purpose.
o In case you fail to provide the original
receipt, your claim submission via
myBupa eClaims Service may be
affected.
 Bupa will reimburse you the eligible
amount within 5 – 7 working days.

12
Claim procedures
Claiming Hospital and Surgical Benefit, SMM Benefit and Maternity Benefit

Other useful tips:

 To claim for reimbursement of the expenses for hospital confinement on account of pregnancy
under Maternity Benefit, please follow the above claim procedures. Member whose BHN Card
is embossed with “HOSPITAL & CLINICAL” and “MA” can use the BHN Card to settle
pregnancy-related medical expenses incurred at the private hospitals in Hong Kong as listed in
the List of HealthNet Service Providers. For claims relating to prenatal or postnatal
consultations and check-ups, please refer to the claim procedures for Clinical Benefit.
 All original receipts must include:
o hospitalisation period
o patient’s full name
o name and address of the hospital and attending Registered Medical Practitioner
o diagnosis
o charges nature and breakdown
o official stamp and/or signature of the attending Registered Medical Practitioner and hospital
• If you are admitted in a Hospital Authority’s hospital, you do not need to ask the attending
Registered Medical Practitioner to complete Part II of the Claim Form provided that the
diagnosis and treatment details are provided on the receipts, medical report, Discharge
Summary or Sick Leave Certificate.

13
Claim procedures
Claiming Clinical Benefit and Maternity Benefit
(Using BHN Card)

Consult HealthNet Service Providers

 Visit the HealthNet Service Providers as listed in the List of HealthNet Service Providers.
 You need to consult a General Practitioner or Specialist to obtain a referral letter before
consulting the following HealthNet Service Providers:
o Specialists (except for Dermatology, Family Medicine, Gynaecology, Ophthalmology,
Orthopaedics, Otolaryngology, Paediatric Surgery, Paediatrics and Psychiatry)
o Physiotherapists
o Diagnostic Centres (Bupa also accepts referral letter from a Registered Chinese Medicine
Practitioner or Chiropractor for X-ray only and laboratory tests)
 HealthNet Registered Medical Practitioners will help you seek pre-authorisation from Bupa for
the following services:
o diagnostic imaging or laboratory tests exceeding HK$2,000
o treatment by a Non-HealthNet Specialist (when the necessary specialty is unavailable within
HealthNet)
(See “Tips on pre-authorisation for HealthNet Benefit” on P. 10 for details)

Present BHN Card for registration

 Present the following prior to treatment:
o BHN Card
o referral letter (if applicable)
o pre-authorisation confirmation (if applicable)
 Sign the voucher.

Receive treatment
 HealthNet Registered Medical Practitioners may prescribe you extra, long-term or expensive
medication if required and such expenses will be paid under Prescribed Western Medication
Benefit of HealthNet Benefit, if applicable.

Claim settlement
 Bupa will settle the expenses directly with the HealthNet Service Providers.
 Bupa will notify you to settle shortfall, if any.

Other useful tips:

 Member whose BHN Card is embossed with “MA” can use the BHN Card to settle
pregnancy-related medical expenses incurred at the HealthNet Service Providers.

14
Claim procedures
Claiming Clinical Benefit, Maternity Benefit and Dental Benefit
(Not using BHN Card)

Consult any medical service providers or Registered Dentists of your choice

 Visit any Registered Medical Practitioners, Physiotherapists, Chiropractors, Registered Chinese
Medicine Practitioners, Diagnostic Centres, Psychological Counselling or Registered Dentists.
 You need to consult a General Practitioner or Specialist or the attending Psychiatrist to obtain a
referral letter before consulting the following medical service providers:
o Specialists
o Physiotherapists
o Chiropractors
o Diagnostic Centres (Bupa also accepts referral letter from a Registered Chinese Medicine
Practitioner or Chiropractor for X-ray only and laboratory tests)
o Psychological Counselling (must be referred by the attending Psychiatrist)

Receive treatment and settle the medical bill by yourself first

 Remember to obtain original receipt, referral letter and prescription, if any.

Submit the claim to Bupa

 Within 90 days after the date of treatment, submit to Bupa:
o completed Bupa Clinical Claim Form
o original receipt
o referral letter (if applicable) – original or copy
o prescription (if applicable) – original or copy
 You can also submit your claims online by uploading the images of the above documents to
myBupa within 90 days after the date of treatment.
o Please keep the original receipt for 6 months from the date of claim submission. Bupa may
request you to provide the original receipt for auditing purpose.
o In case you fail to provide the original receipt, your claim submission via myBupa eClaims
Service may be affected.

Claim settlement
 Bupa will reimburse you the eligible amount within 5 – 7 working days.

15
Claim procedures
Claiming Clinical Benefit, Maternity Benefit and Dental Benefit
(Not using BHN Card)

Other useful tips:

 To claim for reimbursement of the expenses for consultations with an Obstetrician and prenatal
or postnatal check-ups on account of pregnancy under Maternity Benefit, please follow the
above claim procedures.
 All original receipts must include:
o consultation date
o patient’s full name
o medical service provider’s name and address
o diagnosis
o charges nature and breakdown
o official stamp and/or signature of medical service providers
 To claim for reimbursement under Chinese Herbalist Benefit or Chinese Bonesetter Benefit, the
original receipt together with the original prescription must be submitted.
 Prescription and medication receipts must include:
Obtain medication from: Clinic Pharmacy

Original Original
Required claim documents: Prescription
medication receipt medication receipt
Documents issued by: Clinic Clinic Pharmacy
Issue date ✓ ✓ ✓
Patient’s name ✓ ✓ ✓
Service provider’s name and address ✓ ✓ ✓
Diagnosis ✓ ✓
Description of medicines ✓ ✓ ✓
Charges nature and breakdown ✓ ✓
Official stamp and/or signature of
✓ ✓ ✓
service provider

16
 Claim procedures
Claiming Network Dental Benefit (Consultation at Network Dental Centre)
(Using BHN Card)

Consult at Network Dental Centre*

 Visit a Network Dental Centre* of your choice.

Present BHN Card for registration

 Present the following prior to treatment:
o BHN Card
o Hong Kong Identity Card
 Sign the voucher.

Receive treatment
 Proceed to the consultation and receive treatment.

Claim settlement
 Bupa will assess the claim submitted by the Network Dental Centre* and settle the payment
directly if direct billing arrangement is available.
 Bupa will notify you to settle shortfall, if any.

* Please make your appointment by calling the Network Dental Centre. Network Dental Centre
refers to the network of dental service providers appointed by Bupa to provide dental services
listed under “Network Dental Benefit” in the Schedule of Benefits. Locations of the Network Dental
Centres include Admiralty, Causeway Bay, Quarry Bay, Tsim Sha Tsui, Tseung Kwan O, Sha Tin,
Tsing Yi, Tung Chung, etc. This list shall be updated from time to time, please log in to myBupa to
view the latest location list. Please contact the Network Dental Centres to understand their
consultation hours.

17
 General exclusions

The Scheme shall not cover any treatment or expenses incurred directly or indirectly relating to:

1. Pre-existing conditions – means illness or injury that commenced or presented sign(s) and
symptom(s), prior to the member’s coverage commencement date.

2. Treatment, medical service, medication or investigation which is not Medically Necessary.

3. Any illness or bodily injury for which compensation is payable under any laws or regulations or
any other insurance policy or any other sources except to the extent that such charges are not
reimbursed by any such compensation, insurance policy or sources.

4. Any charges for accommodation, nursing and services received in health hydros, nature cure
clinics, convalescent home, rest home, home for the aged or similar establishments.

5. Any charges in respect of surgical or non-surgical cosmetic treatment (unless necessitated by

injury caused by an Accident and the Member receives the Medically Necessary treatments or
related services within one (1) year of the Accident), Hair Mineral Analysis (HMA), health
supplements or body weight control (unless approved by Bupa).

6. Any charges in respect of preventive measures including but not limited to routine blood tests,
general check-ups, vaccination or inoculations, hearing tests, eye refraction including routine
eye tests or any cost of fitting of spectacles or lens (unless it is payable under the relevant
Benefits).

7. Congenital Conditions, Developmental Conditions or Hereditary Conditions.

8. Treatment that commenced during the first five (5) years from the Coverage Commencement
Date of this Scheme and which in any way arises from, is attributable to, or is consequential
upon Human Immunodeficiency Virus Infection.

9. Sexually Transmitted (Venereal) Diseases or their sequel.

10. Treatment relating to pregnancy, including diagnostic tests for pregnancy or resulting childbirth,
abortion or miscarriage (unless it is payable under Maternity Benefit); birth control, sterilisation
or sex reassignment of either sex; infertility including in-vitro fertilisation or any other artificial
method of inducing pregnancy; or sexual dysfunction including but not limited to impotence,
erectile dysfunction and pre-mature ejaculation, regardless of cause.

11. Misuse or overdose of drugs or being under the influence of alcohol, self-inflicted injuries or
attempted suicide.

12. Treatment relating to any illness or bodily injury resulting from participation in criminal
activities.

13. Alternative treatment including but not limited to Chinese Medicines treatment, acupuncture,
acupressure, tui na, hypnotism, rolfing, massage therapy and aromatherapy (unless it is
payable under Chinese Herbalist Benefit, Chinese Bonesetter Benefit or Psychiatric-related
Treatments Benefit, if applicable).

18
 General exclusions

14. Senile Dementia (including Alzheimer’s disease) and Parkinson’s disease.

15. Any charges for the procurement or use of special braces and appliances, including but not
limited to spectacles, hearing aids and other equipments such as wheel chairs and crutches.

16. Any treatment or investigation related to dental or gum conditions unless it is covered under
Dental Benefit or Emergency treatment arising from Accidents or the extraction of impacted
wisdom teeth during Hospital Confinement. Follow-up treatment from such Hospital
Confinement shall not be covered unless it is payable under Dental Benefit.

17. Treatment arising from war, invasion, acts of foreign enemies, hostilities (whether war be
declared or not), civil war, rebellion, revolution, insurrection or military or usurped power or
terrorist acts.

18. Non-medical services, including but not limited to guest meals, radio, telephone, photocopy,
taxes (except the Value-Added Tax or Goods and Services Tax for medical services), medical
report charges and the like.

19. Expenses incurred for experimental or unproven medical technology or procedure not in
accordance with the standards of good and prudent medical practice. For the purposes of
interpreting “standards of good and prudent medical practice”, Bupa shall consider (I)
standards that are based on clinically proven evidence in appropriately reviewed, independent
medical journals; (II) relevant specialty body recommendations; and/or (III) the views of
specialists practising in the relevant clinical area.

20. Engaging or taking part in naval, military or airforce or any operation with any armed force; or
any form of professional sports.

19
 Your personal data

1. Keeping your personal data confidential is very important to us. From time to time, it may be
necessary for Bupa to collect personal information relating to you or your dependant including
without limitation your or your dependant’s name, identity card number (and copy of identity
card), or passport number (and copy of passport), contact information, health and medical
information and financial information (‘Personal Information’) in connection with the provision of
health insurance services or the processing of health insurance claims (including where
relevant, credit information and claims history). Failure to supply such Personal Information will
result in Bupa being unable to process/provide insurance products/ services and other related
services to you.
2. Any Personal Information collected or held by Bupa, whether contained in the application form
or obtained in any claim processing procedure or otherwise from time to time may be used by
Bupa only for the purposes of:
(a) processing the application and providing subsequent services;
(b) processing any claims analysis and/or medical or other insurance-related checks;
(c) provision and design of insurance products and services of Bupa;
(d) detecting and preventing fraud (whether or not relating to the policy issued in respect of
any application or claim);
(e) data matching, statistics and research reasonably incidental to or related to the insurance
products and/or services provided by Bupa;
(f) communication with you or your dependants in relation to any of the purposes set out in
Part 2 of this section;
(g) enabling an actual or proposed assignee, transferee, participant or sub-participant of all
or a substantial part of Bupa’s rights or business to evaluate the transaction intended to
be the subject of the assignment, transfer, participation or sub-participation; and
(h) making disclosure to satisfy any applicable legal or regulatory requirements.

3. Such Personal Information may be transferred for the purposes as specified in paragraph 2 of
this section to any of the following classes of transferees (within or outside Hong Kong): any
company within the Bupa group of companies, any insurance intermediaries, any reinsurance
companies authorised by Bupa, healthcare professionals and hospitals, your employer, any
agents, contractors or third party service providers who provide administrative,
telecommunications, computer, payment, data processing or storage, printing, research or
other services to Bupa in connection with the operation of Bupa’s business (including without
limitation insurers, banks, lawyers, accountants, claims investigators, debt collection agencies,
data processing companies, fraud prevention agencies, organisations that consolidate claims
and underwriting information for the insurance industry, research agencies and professional
advisors), any actual or proposed assignee, transferee, participant or sub-participant of all or a
substantial part of Bupa’s rights or business; any person to whom Bupa is under an obligation
to make disclosure under the requirements of any law, rules, regulations, codes of practice or
guidelines binding on Bupa including, without limitation, any applicable regulators,
governmental bodies, industry recognised bodies, credit reference agencies, the Courts, and
where otherwise required by law.

4. You shall have the right to access and request correction of your Personal Information held by
us. You can contact the Data Protection Officer of Bupa (Asia) Limited at 18/F Berkshire House,
25 Westlands Road, Quarry Bay, Hong Kong. If you have any questions, please contact our
Customer Care helpdesk at (852) 2517 5388.

20
歡迎

歡迎參加由您的僱主提供的團體醫療計劃（以下簡稱「計劃」）！本計劃由保柏（亞洲）有限公司（以
下簡稱「保柏」）管理及承保，提供 24 小時全球保障。由現在起，您可享有由保柏為您提供的專業
醫療保障服務。

此計劃手冊詳述有關此計劃的主要資訊及索償步驟，以助您了解如何盡享您的保障。請妥善保存此手
冊，以便在有需要時可隨時參閱。

保柏是本港的醫療保險專家，為保柏集團成員之一，集團在 1947 年於英國成立，至今已成為領導市

場的國際醫療保健機構，在全球多個國家為客戶提供服務。保柏集團提供多元化的醫療保健服務，包
括醫療保險、醫院、安老服務及健康評估。由於保柏集團不實行股東制，因此可將盈利投放於提升客
戶及社會的醫療服務之上。在香港，保柏集團透過另一成員卓健醫療，為市民提供醫療保健服務。卓
健醫療為香港領先的私營門診服務商，有龐大的醫療中心網絡。

為確保您了解所享有的保障，懇請細心閱讀此指引的相關部分及以下隨附文件：
 保障金額表
 保柏國際援助計劃單張（如適用）

如您對本計劃或會籍有任何疑問，歡迎隨時致電保柏客戶服務專線(852) 2517 5388。

附註：
本手冊的資料僅供計劃成員參考。若中、英文版本的詮釋有任何差別，概以英文版本為準。若本手冊內容與團
體醫療保險合約的條文有任何歧異，概以後者為準。

21
有用聯絡資料

貴為我們尊貴的客戶，您將會體驗到我們殷勤的服務。您可透過以下不同方式，聯絡我們或管理您的
會籍。

有關查詢、索償、意見及讚賞 24 小時客戶服務專線： (852) 2517 5388

辦公時間
星期一至星期五（公眾假期除外）上午 9 時至下午 7 時
 我們樂意解答您的所有查詢。
辦公時間以外
我們為您解答以下查詢：
 網絡服務供應商資料
 保障範圍
 申請賠償程序及其他保單行政程序
 賠償申請表

電郵： customercare@bupa.com.hk
傳真： (852) 3973 6970

下載表格 登入﹕
www.bupa.com.hk > 客戶服務 > 下載表格
您亦可致電我們的客戶服務專線以傳真方式索取表格。

致函我們或親臨本公司 地址﹕
香港鰂魚涌華蘭路 25 號栢克大廈 18 樓

22
網上及手機服務

作為您的醫療保健夥伴，我們希望透過以下一系列的服務，讓您隨時輕易地享用您的醫療保障。

網上及手機應用程式服務
myBupa 讓您輕易地使用此保障計劃的服務，您可：
 查閱會籍資料
 網上遞交索償（如適用）
 使用電子醫療卡（如適用）
 瀏覽會籍文件
 查閱賠償進度及所欠差額
 查閱賠償單及差額通知書（如適用）
 查閱門診保障使用量
 下載賠償申請表及其他常用表格
 下載「網絡服務供應商目錄」及「任中橫網絡醫院名單」（如適用）
 搜尋及即時獲得網絡醫療服務供應商及夜間診所的資料

請即瀏覽保柏網頁 mybupa.bupa.com.hk，免費登記使用 myBupa。

首次使用 myBupa 前，只需依照以下 6 個簡單步驟，便可完成登記手續：

1. 登入 myBupa 網頁或手機應用程式，然後按「立即登記」；
2. 輸入您的會員編號、香港身份證/護照號碼及出生日期，然後按「提交」；
3. 輸入您的手提電話號碼及電郵地址後，按「發送驗證編號」，驗證編號便會發送至您的電郵；
4. 輸入驗證編號；
5. 建立您的登入名稱及密碼；
6. 按「提交」，便完成首次登記手續。

myBupa 亦提供免費手機應用程式。

賠償短訊通知服務
為讓您掌握索償的最新情況，您可選擇在賠償辦妥後收取短訊通知，然後您會收到郵寄的賠償單。如
您的公司選擇了電子結算表服務，在收到短訊通知後，您將會收到電郵通知，知會您可於 myBupa 內
查閱賠償單。如欲收到短訊通知，可致電保柏客戶服務專線 2517 5388 登記短訊通知服務。

23
會籍
開始成為計劃成員

參加資格
所有 65 歲以下的全職僱員均可參加本計劃。

如本計劃提供家屬保障，則您的家屬亦可參加本計劃。家屬包括：
 您的合法配偶，年齡須為 65 歲以下；及
 您的合法未婚子女，年齡須介乎出生後 15 日至 17 歲（若能出示獲保柏接納為有效證明之全日
制學生則可延至 22 歲）。

成員資格生效日期
您將根據您的僱主所訂立的日期開始成為計劃成員。若您因病未能於當日上班，您的成員資格將順延
至您康復後首個上班日起開始生效。

您現有的家屬（如適用）也會於您的成員資格生效日起成為計劃成員。若您的家屬於您的成員資格生
效當日正在住院，其成員資格將順延至出院翌日起開始生效。

24
會籍
開始成為計劃成員

您的保柏網絡醫療卡
收到「保柏網絡醫療卡」時需  當您成為計劃成員後，您及您的家屬（如適用）將個別獲發一張
注意的事項 「保柏網絡醫療卡」。
o 「保柏網絡醫療卡」正面印有您的姓名和會員編號。
o 您及您的家屬必須核對卡上姓名，並在背面簽署。

「保柏網絡醫療卡」的用途  您可按照「保障金額表」所述，使用「保柏網絡醫療卡」為以下
服務結賬：
o 由「網絡服務供應商目錄」所列的本港私家醫院提供的住院治
療；
o 由「網絡服務供應商目錄」所列的本港及澳門網絡醫療服務機
構提供的門診服務及化驗服務（於網絡保障作出賠償）；
o 由「網絡服務供應商目錄」所列的本港私家醫院之門診部提供
的門診或治療服務（於非網絡保障作出賠償）；及
o 您可憑合資格醫療卡享用視像診症服務，安坐家中讓我們指定
的網絡普通科醫生為您進行視像診症。只有合資格的醫療費用
方 可 獲 得 保 障 ， 任 何藥 物 運 費 均 不 獲 賠 償。 詳 情 請 瀏 覽
www.bupa.com.hk/vc。

若遺失「保柏網絡醫療卡」，  如發現「保柏網絡醫療卡」遭盜竊或遺失，您須在 24 小時內向您

應如何處理？ 的僱主報失，並把填妥的「遺失網絡醫療卡聲明表」交回僱主。
否則，您將須負責一切因不當使用此卡所引致的費用。
 首張補發的「保柏網絡醫療卡」費用全免，但如於同一合約年度
內須再次補發失卡，則每張卡收取港幣 100 元的手續費。

25
會籍
管理您的會籍

申請新家屬參加計劃

我應如何加入新家屬？（如適用）
新婚配偶  您須於婚後 31 日內通知您的僱主。
 您配偶的成員資格將於註冊結婚日生效。

新生子女  您須於子女出生後 45 日內通知您的僱主，並提交出生證明書副本以

作核實。
 您子女的成員資格將於出生後 15 日生效。

注意：
如您未能於上述時限內通知您的僱主，您新家屬的醫療保障計劃生效日期或會相應延遲，而有關日期
將由保柏決定。

26
 會籍
退出計劃

終止會籍

事由 您及／或您家屬（如適用）的成員資格將於以下日子自動終止：
離職 離職當日
您或您的配偶年屆 65 歲 屆滿 65 歲後的計劃合約週年日
子女長大 屆滿以下年歲的計劃合約週年日：
 年屆 18 歲而不再是全日制學生；或
 年屆 23 歲。
離婚 * 離婚生效當日
家屬離世 * 家屬離世翌日
* 若您家屬因這些原因而令其成員資格終止，您須於 31 日內通知您的僱主。

注意：
請於退出計劃生效日前，把「保柏網絡醫療卡」交回您的僱主。

27
會籍
增值您的保障

保柏為計劃成員提供參加指定個人醫療保障計劃的機會，在團體醫保上更添一重保障。成員可於人生
不同階段（如團體醫保續保時、離職前後／退休前）加入有關計劃，所有有關費用由成員自行支付。

您及您的家屬（如適用）可加入保柏指定的個人醫療保障計劃，享有與現有醫體計劃相同住房級別的
「住院及手術保障」。不論健康狀況如何，均無須核保及保證接受申請 1，而且所有於團體計劃中受
保的疾病均可在保柏指定的個人醫療保障計劃內獲終生保障 2。

您可於以下任何一段時間投保 3：
1. 加入保柏團體醫保計劃的 60 天內；
2. 保柏團體醫保計劃的合約週年日後 60 天內；
3. 保柏團體醫保計劃終止前或後 30 天內；
4. 在年屆 70 歲前的 60 天內；或
5. 在結婚或子女出生後 30 天內。

若您有興趣增值您的保障，請聯絡保柏客戶服務專線。

1 詳情請參閱指定的個人醫療保障計劃產品冊子的「投保資格」部分。
2 只要您受保於保柏團體醫保及／或指定的個人醫療保障計劃合共最少連續 12 個月，所有在您的保柏團體計劃下可獲賠
償的已存在病症將於指定的個人醫療保障計劃下受到保障，除非該病症於指定的個人醫療保障計劃合約內列明為不受保障
項目。保柏保證您在指定的個人醫療保障計劃下的保障可獲每年續保至終生，只要您符合合約內所列明的續保要求。保柏
保留在合約續保時更改保費、保障、條款及細則的權利。您可參閱指定的個人醫療保障計劃合約以了解詳情。
3 若您所屬的企業參加保柏團體醫保計劃的人數為 2 – 9 人，您只可於離職時（退休除外），在您的保柏團體醫保計劃終

止前或後 30 天內投保指定的個人醫療保障計劃。

28
申請賠償程序
一般資料

不論您選用網絡或非網絡醫療服務機構，請細心閱讀此部份。隨後將詳列申請賠償下列醫療保障項目
的程序。
 住院及手術保障
 附加醫療保障（如適用）
 門診保障（如適用）
 產科保障（如適用）
 牙科保障（如適用）

您應按照「保障金額表」，細閱您可享有的保障項目之申請賠償程序。

實用索償提示

無論您是否使用「保柏網絡醫療卡」，請注意：
1 有關門診保障之轉介信的提示：

為享有以下保障（如適用）….. 您必須取得下列醫生發出的轉介信：

專科醫生 * 普通科醫生

物理治療師／脊醫／所有診斷影像及化驗 普通科醫生／專科醫生
普通科醫生／專科醫生
醫生處方西藥
（發出西藥處方）
只適用於 X 光及化驗 註冊中醫／脊醫

臨床心理輔導 主診精神科醫生
* 如前往網絡的皮膚科、家庭醫學科、婦科、眼科、骨科、耳鼻喉科、小兒外科、兒科及
精神科時，無須提交任何轉介信。
成員可在轉介信或西藥處方（如適用）發出日起計 6 個月內，就相同或相關病症使用該轉
介信或西藥處方。若診治全新或不相關的病症，則須提交新的轉介信或西藥處方。

如果您不使用「保柏網絡醫療卡」，請注意：
2 有關申請賠償醫療費用的提示：

 您須於診治或出院後 90 日內向保柏申請賠償醫療費用，逾期申請將不受理。
 保柏將於收到所有有關文件後的 5 – 7 個工作天內透過自動轉賬以港元支付您的合資格費
用。
 賠償申請表可於保柏網頁(www.bupa.com.hk)下載。

29
申請賠償程序
一般資料

如果您使用「保柏網絡醫療卡」，請注意：
3 有關網絡保障之初步保障審核程序的提示：

網絡註冊西醫將協助您就以下項目（如適用）向保柏提出初步保障審核的申請：
1. 費用超過港幣 2,000 元的診斷性 X 光檢驗或化驗
2. 非網絡專科醫生的治療 (必須由網絡普通科醫生轉介，並只限於保柏網絡未能提供有
關專科服務)

附註：
1. 若您於保柏的辦公時間以外遇上需要初步保障審核的緊急情況，您可先接受治療，然
後於下一個工作天補辦初步保障審核手續。
2. 若您沒有申辦初步保障審核或未能獲得初步保障審核，則所有合資格的醫療費用將按
非網絡保障（如有）作出賠償。

1 網絡醫生填寫初步保障審核表，並把表格傳真至保柏。

初步保障審核程序 2 保柏向網絡醫生發出初步保障審核確認書。

3 您必須查核並簽署初步保障審核確認書，並保留成員副本。

4 有關使用「保柏網絡醫療卡」而引致差額的提示：

若以「保柏網絡醫療卡」支付的費用超過本計劃的保障限額或並非屬於保障範圍內，保柏將向
您發出差額通知書，而您須於收到差額通知書後 14 日內向保柏繳付有關差額費用。

30
申請賠償程序
一般資料

日間手術保障:
1 有關內窺鏡和病毒性疣及皮損程序的提示：

在進行內窺鏡和病毒性疣及皮損程序之前，必須獲得保柏的初步保障審核：
• 由網絡註冊西醫進行的住院、診所手術或日症並超過港幣 4,000 元，必須經由進行治療的註
冊西醫申請初步保障審核；
• 由非網絡註冊西醫進行的住院、診所手術或日症，您須根據以下步驟直接向保柏申請初步保
障審核：
1. 填妥初步保障審核表的第一及第二部分並遞交予保柏
2. 保柏會於 2 個工作天內向您通知審核結果
3. 完成治療後，連同審核結果向保柏提交索償申請

以上步驟只適用於持有日間手術保障及以下醫療卡類別的會員：
Clinical, Clinical – Not for X-ray and Lab, Hospital & Clinical 醫療卡類別

CLINICAL CLINICAL – NOT FOR X-RAY & LAB HOSPITAL & CLINICAL

31
申請賠償程序
申請住院及手術保障、附加醫療保障及產科保障賠償

使用「保柏網絡醫療卡」 不使用「保柏網絡醫療卡」
（適用於持印有 “HOSPITAL & CLINICAL”
的「保柏網絡醫療卡」之成員）
住院期間  出示「保柏網絡醫療卡」辦理登記手續  填妥「保柏住院賠償申請表」第一部分
 於已壓印的收據簽署  請您的主診註冊西醫填妥「保柏住院賠償
 填妥「保柏住院賠償申請表」第一部分 申請表」第二部分
 醫院管理人員將安排主診註冊西醫填寫
賠償申請表的第二部分

出院時  以「保柏網絡醫療卡」結賬  自行支付醫療賬單及保留收據正本

 保留醫療報告或出院證明紙（如有）

出院後  保柏會向醫院支付費用  在出院後 90 日內向保柏呈交：

 保柏會通知您繳付差額費用（如有） o 填妥的「保柏住院賠償申請表」
o 醫院收據正本
o 醫療報告（如適用）
o 出院證明紙／病假紙（如適用）
 您亦可在診治後 90 日內透過 myBupa 把
以上文件的圖像上載，於網上遞交賠償申
請。
o 在遞交賠償申請後的 6 個月內，請保留
收據正本。保柏或會要求您提供收據正
本，以作審核。
o 若您未能提供收據正本，您的 myBupa
網上遞交賠償申請服務可能會受影響。
 保柏將於 5 – 7 個工作天內支付您的合資
格費用

其他實用提示：
• 請依照以上索償程序就懷孕而住院的醫療費用申請 產科保障賠償。持印有 “HOSPITAL &
CLINICAL” 及 “MA” 的「保柏網絡醫療卡」之成員可於「網絡服務供應商目錄」所列的本港私家
醫院，使用此卡支付有關懷孕的醫療費用。至於產前檢查、產後檢查及診斷化驗之賠償申請，請
參閱門診保障的索償程序。
 所有收據正本必須列載以下資料：
o 住院治療日期
o 病人姓名
o 醫院及主診醫生的名稱及地址
o 病症
o 收費類別及項目
o 主診醫生／醫院正式蓋印及／或簽署

 如您入住醫管局轄下的醫院，而有關收據、醫療報告、出院證明紙或病假紙已提供病症及診治詳
情，則無須要求醫生填寫賠償申請表的第二部分。

32
申請賠償程序
申請門診保障及產科保障賠償（使用「保柏網絡醫療卡」）

前往網絡醫療服務機構求診
 往「網絡服務供應商目錄」所列的網絡醫療服務機構求診
 您須先往普通科醫生或專科醫生求診，取得有關轉介信後，方可往下列的網絡醫療服務機構求診：
o 專科醫生（皮膚科、家庭醫學科、婦科、眼科、骨科、耳鼻喉科、小兒外科、兒科及精神科除
外）
o 物理治療師
o 化驗中心（保柏亦接受由註冊中醫或脊醫發出用於 X 光及化驗的轉介信）
 網絡註冊西醫將協助您就以下項目向保柏提出初步保障審核的申請：
o 費用超過港幣 2,000 元的診斷性 X 光檢驗或化驗
o 非網絡專科醫生的治療（只限於保柏網絡未能提供的專科服務）
（詳情請參閱第 30 頁的「有關網絡保障之初步保障審核程序的提示」）

出示「保柏網絡醫療卡」辦理登記手續
 於診治前出示下列文件：
o 「保柏網絡醫療卡」
o 轉介信（如適用）
o 初步保障審核確認書（如適用）
 於已壓印的診症收據簽署

接受診治
 在有需要時，網絡註冊西醫或會向您處方額外、長期服用或昂貴的藥物，有關費用將按網絡保障
的醫生處方西藥保障（如適用）作出賠償。

支付賠償
 保柏會向網絡醫療服務機構支付費用
 保柏會通知您繳付差額費用（如有）

其他實用提示：
 持印有 “MA” 的「保柏網絡醫療卡」之成員可於網絡醫療服務機構，使用此卡支付有關懷孕的醫
療費用。

33
申請賠償程序
申請門診保障、產科保障及牙科保障賠償（不使用「保柏網絡醫療卡」）

前往任何自選的醫療服務機構或註冊牙醫求診
 往任何註冊西醫、物理治療師、脊醫、註冊中醫、化驗中心、臨床心理輔導或註冊牙醫求診
 您須先往普通科醫生或專科醫生或主診精神科醫生求診，取得有關轉介信後，方可往下列的醫療
服務機構求診：
o 專科醫生
o 物理治療師
o 脊醫
o 化驗中心（保柏亦接受由註冊中醫或脊醫發出用於 X 光及化驗的轉介信）
o 臨床心理輔導（必須由主診精神科醫生轉介）

接受診治及先行支付醫療賬單
 謹記保留收據正本、轉介信及西藥處方（如有）

向保柏遞交賠償申請
 在診治後 90 日內向保柏呈交：
o 填妥的「保柏門診賠償申請表」
o 收據正本
o 轉介信（如適用）－ 正本或副本
o 西藥處方（如適用）－ 正本或副本
 您亦可在診治後 90 日內透過 myBupa 把以上文件的圖像上載，於網上遞交賠償申請。
o 在遞交賠償申請後的 6 個月內，請保留收據正本。保柏或會要求您提供收據正本，以作審核。
o 若您未能提供收據正本，您的 myBupa 網上遞交賠償申請服務可能會受影響。

支付賠償
 保柏將於 5 – 7 個工作天內支付您的合資格費用

34
申請賠償程序
申請門診保障、產科保障及牙科保障賠償（不使用「保柏網絡醫療卡」）

其他實用提示：
 如因懷孕而需要往婦產科醫生求診及進行產前或產後檢查，請依照以上索償程序就有關醫療費用
申請產科保障賠償。
 所有收據正本必須列載以下資料：
o 診治日期
o 病人姓名
o 醫療服務機構的名稱及地址
o 病症
o 收費類別及項目
o 醫療服務機構的正式蓋印及／或簽署
 如申請中醫師保障或跌打醫師保障賠償，收據正本必須連同處方正本一併遞交。
 西藥處方及西藥收據正本必須列載以下資料：
取藥地點： 診所 藥房

所需索償文件： 西藥收據正本 西藥處方 西藥收據正本

簽發文件的機構： 診所 診所 藥房
簽發日期 ✓ ✓ ✓
病人姓名 ✓ ✓ ✓
醫療服務機構的名稱及地址 ✓ ✓ ✓
病症 ✓ ✓
藥物名稱 ✓ ✓ ✓
收費類別及項目 ✓ ✓
醫療服務機構的正式蓋印及／或簽署 ✓ ✓ ✓

35
申請賠償程序
申請網絡牙科保障賠償（於網絡牙科中心診治）
（使用「保柏網絡醫療卡」）

前往網絡牙科中心*求診
 往網絡牙科中心*求診

出示「保柏網絡醫療卡」辦理登記手續
 於診治前出示下列文件：
o 「保柏網絡醫療卡」
o 香港身份證
 於已壓印的診症收據簽署

接受診治
 接受診治。

支付賠償
 保柏會審批網絡牙科中心*提交之索償，如免繳費服務適用，會直接向牙科中心支付費用。
 保柏會通知您繳付差額費用（如有）

* 請先致電網絡牙科中心預約。網絡牙科中心指由保柏委任的牙科中心網絡以提供保障金額表上「網絡
牙科保障」所列的牙科服務項目。網絡牙科中心地點包括金鐘、銅鑼灣、鰂魚涌、尖沙咀、將軍澳、
沙田、青衣、東涌等。 此名單會不時更新，請登入myBupa查閱最新的牙科中心地址。有關診症時間
請向個別網絡牙科中心查詢。

36
 不受保障項目

本計劃將不會保障因下列各項直接或間接引致之治療／費用：

1. 已存在病症－成員在保障生效日前已存在或出現徵狀的疾病或損傷。

2. 不是醫療必需的治療、醫療服務、藥物或檢驗。

3. 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損傷費用，除非此等費用未
能在該等補償、保險計劃或途徑獲得賠償。

4. 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提供之住宿、護理或服務的
費用。

5. 手術性或非手術性整容或整形治療（會員因意外而受傷，並於意外後一年內接受醫療上必需的服
務則不屬此項）、毛髮礦物質含量分析、健康補品或體重控制（經保柏批准則除外）的費用。

6. 預防性措施，包括但不限於常規驗血、例行檢驗、預防注射或接種疫苗、聽覺測驗、因視力不正
常而引致之治療，包括常規視力測驗或所需之眼鏡或鏡片費用（屬有關保障範圍則除外）。

7. 先天性疾病、發育異常或遺傳性疾病。

8. 由本計劃的保障開始日起首 5 年內，因感染人體免疫力缺損病毒所引致的治療。

9. 性病及其後遺症。

10. 與懷孕有關的治療，包括診斷性產科檢查、生育、墮胎或小產（屬產科保障範圍則除外）；與男
女任何一方的節育、絕育或變性有關的治療；由於不育而直接或間接進行的治療，包括體外受孕，
任何非自然受孕或人工受孕；與性機能失常有關之治療，包括但不限於陽萎、不舉及早泄（不論
任何原因導致）。

11. 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或間接引致的治療。

12. 任何因參與犯罪活動而引致之疾病或損傷。

13. 另類治療，包括但不限於中藥治療、針灸、穴位按摩、推拿、催眠治療、羅爾夫按摩療法、按摩
治療、香薰治療（屬中醫師保障、跌打醫師保障或精神科相關治療保障（如適用）範圍則除外）。

14. 老年性痴呆（包括亞爾茲海默氏病）及帕金森氏病。

15. 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椅、枴杖的費用。

16. 任何與牙齒或牙肉疾病有關的治療或檢查，屬牙科保障或因意外引致緊急入院治療或住院脫除阻
生智慧齒則除外。但不包括該住院後之跟進治療（屬牙科保障範圍則除外）。

17. 因戰爭、入侵、外敵行動、開戰（不論是否已宣戰）、內戰、叛亂、革命、起義或軍人奪權、恐
怖活動等引致的治療。

18. 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（就醫療服務所徵收的增值
稅或商品及服務稅除外）、醫療報告等費用。

37
不受保障項目

19. 因不符合「良好及謹慎的醫療標準」的實驗性或未經證實醫療成效的醫療技術或治療程序而招致
的費用。就「良好及謹慎的醫療標準」之詮釋，保柏將會考慮以(I)醫療標準為必須經過適當審查
的獨立醫學期刊中臨床證明所界定;(II)相關專業機構的建議; 及/或(III)相關臨床領域執業的專家
意見。

20. 從事或參與海軍、陸軍或空軍任務或任何武裝部隊之行動；或從事或參與任何類形之專業運動。

38
 您的個人資料

1. 我們非常重視您的個人資料的保密。保柏須不時收集您或您家屬的個人資料以提供醫療保險服務
或辦理閣下提出之醫療保險索償之用，包括但不限於您或您家屬的姓名、身份證號碼（身份證影
印本）、護照號碼（護照影印本）、聯絡資料、健康及醫療信息和財務信息（以下簡稱「個人資
料」）（包括信用資料和以往申索紀錄，如適用）。如您未能提供這些個人資料，保柏可能無法
為您處理或提供保險產品／服務或其他相關服務。

2. 所有申請表格中包含的、或透過任何索償程序或其他途徑，保柏不時收集或持有的個人資料，保
柏將僅作以下用途：
(i) 處理申請及提供售後服務；
(ii) 處理任何索償分析及／或與醫療或其他保險有關的查核；
(iii) 提供及設計保柏的產品及服務；
(iv) 偵測及防止欺詐行為（無論是否與就此申請而簽發之保單及相關的任何申請或索償）；
(v) 與由保柏提供之保險產品及／或服務有關之資料核對、統計及研究；
(vi) 就任何於第二部分中所述的用途與閣下或您的家屬聯絡；
(vii) 允許保柏全部或部分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
(viii) 為遵守適用的法律或監管要求而作出披露。

3. 個人資料將會轉讓至以下任何受讓人（包括香港以內及以外）以作於本部分第二段所述之用途：
任何屬於保柏集團的公司；任何保險代理人；任何由保柏授權的再保險公司；醫護專業人員及醫
院；您的僱主；任何代理人、承包商、或向保柏提供行政、電訊、電腦、付款、資料處理或儲存、
印刷、研究或其他就保柏業務的營運向保柏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、防止欺詐組織、為保險業
界整合申索及承保資料之組織、研究服務機構及專業顧問）；保柏的任何全部或部分的權益或業
務的實際或建議承讓人、受讓人、參與人或次參與人；為遵守任何法例之要求，或根據監管或其
他機關所發出對保柏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，法律規定保柏必向其披露的人士或機構。

4. 您有權要求查閱及更正我們持有的個人資料。您可聯絡保柏（亞洲）有限公司的保障資料主任，
地址如下：香港鰂魚涌華蘭路 25 號栢克大廈 18 樓。如有任何查詢，請隨時致電我們的客戶服
務專線 (852) 2517 5388。

39
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
栢克大廈18樓

Customer Care helpdesk

客戶服務專線 ：(852) 2517 5388

Facsimile 傳真 ：(852) 2548 1848

www.bupa.com.hk