HEALTHCARE INSURANCE – BAO VIET FAMILY CARE – DIAMOND PLAN

HEALTHCARE INSURANCE – BAO VIET FAMILY CARE

Bao Viet’s Family Care Healthcare Insurance has been trusted by millions of Vietnamese people to care for and protect the health of themselves and their families. When participating in health insurance products of Bao Viet Insurance, customers can fully enjoy life because our goal is “to take care and protect your health”.

Advantages when enrol in HealthCare Insurance of Bao Viet

Insure for people aged 15 days to 60 years old, renew till 65 years old.
Cover Maternity.
No physical examination is required before enrol
Access to over 150 hospitals for direct billing and all hospitals across the country
Various insurance benefits, suitable premium.
Premium Hospital Direct Billing Service 24/7: Customers do not waste time collecting claim documents and do not have to pay hospital fees

Bao Viet Family Care is designed into 5 outstanding programs: Bronze, Silver, Gold, Platinum, Diamond corresponding to 5 prices from low to high and fully meet the insurance needs.

BENEFIT SCHEDULE – BAOVIET FAMILY CARE

Issued with the Decision No. 4542 dated Oct 13, 2016 of the Chief Executive Officer – Bao Viet Insurance

Unit: Vietnam dong

PLAN	BRONZE	SILVER	GOLD	PLATINUM	DIAMOND
A. CORE PLAN – Inpatient treatment due to illness, disease or accident
Maximum limit per person per year	93,800,000 /person/year	137,600,000 /person/year	230,000,000 /person/year	342,000,000 /person/year	454,000,000 /person/year
Territorial Scope	Việt Nam	Việt Nam	Việt Nam	Việt Nam	Việt Nam
1. Hospitalization charges · Room & board · Intensive care unit (ICU) · Hospital Miscellaneous Expenses	2,000,000/day Up to 40,000,000/year, Max. 60 days/year.	3,000,000/day Up to 60,000,000/year Max. 60 days/year	5,000,000/day Up to 100,000,000/year Max. 60 days/year	7,500,000/day Up to 150,000,000/year Max. 60 days/year	10,000,000/day Up to 200,000,000year Max. 60 days/year
2. Pre-hospitalization treatments within 30 days prior to the date of hospital admission	2,000,000/year	3,000,000/year	5,000,000/year	7,500,000/year	10,000,000/year
3. Post-hospitalization treatments within 30 days from the date of hospital discharge	2,000,000/year	3,000,000/year	5,000,000/year	7,500,000/year	10,000,000/year
4. Ambulance services/ conveyance on road	5,000,000/year	5,000,000/year	10,000,000/year	10,000,000/year	10,000,000/year
5. Surgical Operation (excluding the costs of acquisition and transportation of the organs)	40,000,000/year	60,000,000/year	100,000,000/year	150,000,000/year	200,000,000/year
6. Rehabilitation	4,000,000/year	6,000,000/year	10,000,000/year	15,000,000/year	20,000,000/year
7. Public hospital allowance	80,000/day Max. 60 days/year	120,000/day Max. 60 days/year	200,000/day Max. 60 days/year	300,000/day Max. 60 days/year	400,000/day Max. 60 days/year
8. Burial hospital in case of Death in the hospital	500,000/ occurrence	500,000/ occurrence	500,000/ occurrence	500,000/ occurrence	500,000/ occurrence
B. OPTIONAL PLAN
1. Out-patient treatment due to illness, disease or accident	6,000,000/year	6,000,000/year	6,000,000/year	10,000,000/year	15,000,000/year
· Limit /visit	1,200,000/visit Max. 10 visits/year	1,200,000/visit Max. 10 visits/year	1,200,000/visit Max. 10 visits/year	2,000,000/visit Max. 10 visits/year	3,000,000/visit Max. 10 visits/year
· Physiotherapy prescribed by a physician	50,000/day Max. 60 days/year	50,000/day Max. 60 days/year	50,000/day Max. 60 days/year	100,000/day Max. 60 days/year	150,000/day Max. 60 days/year
2. Personal Accident *Sum Insured/Person/year*	Up to 01 billion	Up to 01 billion	Up to 01 billion	Up to 01 billion	Up to 01 billion
3. Term life *Sum Insured/Person/year*	Up to 01 billion	Up to 01 billion	Up to 01 billion	Up to 01 billion	Up to 01 billion
4. Dental care · Examination and diagnosis · Tooth cleaning · Normal compound fillings · Extractions of diseased teeth · Removal of solid Odon tome (deep under gum) · Apicoectomy (cut the top of tooth’s root) · Root canal Treatments · Gingivitis (blow the gums) Periodontics	2,000,000/year 1,000,000/visit	2,000,000/year 1,000,000/visit	5,000,000/year 2,500,000/visit	10,000,000/year 5,000,000/visit	15,000,000/year 7,500,000/visit
5. Maternity care	Not applicable	Not applicable	Not applicable	21,000,000/ year	31,500,000/ year

* CO-PAYMENT APPLIED FOR CHILDREN AGED FROM 15 DAYS TO 03 YEARS OLD:

Bao Viet will apply 30/70 co-payment (or co-insurance as defined) (the Insured shall be responsible for paying 30%, Bao Viet shall cover 70%)
Co-payment is not applicable when medical services performed in public facilities/ hospitals (excluding Optional supplementary/ pay-for-service alternative/ elective service Departments/ Specialties in public hospitals)

PREMIUM TABLE – BAOVIET FAMILY CARE

Issued with the Decision No. 4542 dated Oct 13, 2016 of the Chief Executive Officer – Bao Viet General Insurance Company

Unit: Vietnam dong/ person/ year

PLAN		BRONZE	SILVER	GOLD	PLATINUM	DIAMOND
A. CORE PLAN – Inpatient treatment due to illness, disease or accident
· 1 – 3 (years old)		2,585,000	3,707,000	5,616,000	7,582,000	9,267,000
· 4 – 6 (years old)		1,450,000	2,081,000	3,153,000	4,257,000	5,203,000
· 7 – 9 (years old)		1,320,000	1,900,000	2,867,000	3,870,000	4,730,000
· 10 – 18 (years old)		1,255,800	1,801,800	2,730,000	3,685,500	4,504,500
· 19 – 30 (years old)		1,196,000	1,716,000	2,600,000	3,510,000	4,290,000
· 31 – 40 (years old)		1,315,600	1,887,600	2,860,000	3,861,000	4,719,000
· 41 – 50 (years old)		1,375,400	1,973,400	2,990,000	4,036,500	4,933,500
· 51 – 60 (years old)		1,435,200	2,059,200	3,120,000	4,212,000	5,148,000
· 61 – 65 (years old)		1,554,800	2,230,800	3,380,000	4,563,000	5,577,000
B. OPTIONAL PLAN		BRONZE	SILVER	GOLD	PLATINUM	DIAMOND
Out-patient treatment due to illness, disease or accident
· 1 – 3 (years old)		3,370,000	3,370,000	3,370,000	5,516,000	8,424,000
· 4 – 6 (years old)		1,900,000	1,900,000	1,900,000	3,153,000	4,730,000
· 7 – 9 (years old)		1,720,000	1,720,000	1,720,000	2,867,000	4,300,000
· 10 – 18 (years old)		1,638,000	1,638,000	1,638,000	2,730,000	4,095,000
· 19 – 30 (years old)		1,560,000	1,560,000	1,560,000	2,600,000	3,900,000
· 31 – 40 (years old)		1,716,000	1,716,000	1,716,000	2,860,000	4,290,000
· 41 – 50 (years old)		1,794,000	1,794,000	1,794,000	2,990,000	4,485,000
· 51 – 60 (years old)		1,872,000	1,872,000	1,872,000	3,120,000	4,680,000
· 61 – 65 (years old)		2,028,000	2,028,000	2,028,000	3,380,000	5,070,000
2. Personal Accident		0.09% of SUM INSURED	0.09% of SUM INSURED	0.09% of SUM INSURED	0.09% of SUM INSURED	0.09% of SUM INSURED
3. Term Life		0.2% of SUM INSURED	0.2% of SUM INSURED	0.2% of SUM INSURED	0.2% of SUM INSURED	0.2% of SUM INSURED
4. Dental care	1 – 18 (years old)	600,000	600,000	1,500,000	2,600,000	3,900,000
	19 – 65 (years old)	490,000	490,000	1,200,000	2,000,000	3,000,000
5. Maternity care	18 – 45 (years old)	Not applicable	Not applicable	Not applicable	4,800,000	5,500,000

Note:

The main insurance term (clause A): is the compulsory clause for customers to participate.
Terms of additional insurance (Clause B – including outpatient insurance, personal accident insurance, personal life insurance, dental insurance, maternity insurance): are not required to participate.
Customer’s premium is calculated as follows: Totel Premium = A + B.

In which clause A is required to buy. Clause B can buy or not, or only buy one of the terms: outpatient, maternity, dental, personal life, personal accident.

For example: Customer Nguyen Van A is 35 years old and insured. Customers choose the Bronze program. If the customer buys only the compulsory clause (clause A), the cost of buying insurance is: 1,315,600 VND. If customers want to participate in additional terms (Clause B) and choose only outpatient conditions, the premium is: 1,315,600 + 1,716,000 = 3,031,600 vnd

(***) In case children from 15 days old to 1 year old are insured with the condition:

Insurance with father or/and mother
Buy insurance at Platinum or Diamond programs.
Premium = 150%% of age band 1 – 3 years old.

BAOVIET FAMILY CARE are effective on most hospitals / health facilities nationwide. For hospitals and clinics affiliated with Bao Viet, customers presenting a guarantee card then will be direct billing without having to pay cash. In other clinics, customers need to provide doctor’s bills, documents and claim form to Bao Viet to get paid for the insurance.

ELIGIBILITY OF THE INSURED PERSONS.

The Insurable Person is any Vietnamese or Foreigner residing legally within the territory of Vietnam whose age is from fifteen (15) days to sixty (60) years (calendar year) on the policy inception date. The enrollment age for this Wording is only allowed up to sixty-five (65) years in case of continuous renewal from sixty (60) years old.
The child under 9 years old shall be only covered, provided that (s)he enters into this Policy with his/ her father and/ or mother, or his/ her father/ mother has been covered by at least one valid Bao Viet’s plan of health or medical expenses insurance. The dependents are only eligible for benefits equivalent to or lower than those of the Insured persons.
For children from 15 days to 03 years old, the Inpatient and Out-patient treatment benefit must be applied co-payment at the proportion specified in the Benefit Schedule.

WAITING PERIOD:

The insurance coverage shall come into effect after the following waiting periods are applied from the Inception date stated in the Insurance Certificate:

30 days in case of disease, illness (including the period from the date of first symptom until the end date of treatment; based on the first onset of illness/ disease, not on the time of treatment)
90 days from the joining date for pregnancy complications as defined
01 year for pre-existing conditions and the diseases detailed in No.36 of the General Exclusion of this Wording
01 year for special diseases as defined
06 months for children from 15 days to 06 years old: all kinds of bronchitis, bronchiolitis, pneumonia.

Following diseases shall not be covered during the first year whether they occur before or after Inception date:

+ Diseases of the respiratory system: Tonsillitis requiring surgical removal, Sinusitis, Deviated nasal septum, asthma; In particular, 06 months of waiting period will be applied to Bronchitis, Bronchiolitis, all types of Pneumonia in case of the insured person from 15 days to 06 years old.

+ Diseases of the ear-nose-throat: Middle ear infections (otitis media) requiring surgery, Adenoid hypertrophy (or enlarged adenoids), Turbinate reduction (also known as turbinoplasty or turbinectomy)

+ Diseases of the circulatory system: Phlebitis, Thrombophlebitis, Varicose veins of lower extremities, Carpal tunnel syndrome, Diseases of lymphatic vessels and lymph nodes, Hemorrhoids

+ All types of Metabolic disorders

+ Diseases of the musculoskeletal system and connective tissues: Chronic Arthritis/ Polyarthritis (Inflammatory polyarthropathies), Spinal degenerative disease (Spondylosis), Degenerative spinal disorders, Spondylosis, Herniated disc, Disorders of bone density and structure, Gout

+ Diseases of the digestive system: Gastric ulcer, Duodenal diseases

+ Other diseases: Calculi (stones), Cysts, Warts, Moles of all kinds, Vestibular disorders

Treatment related to ligament re-construction and/ or Torn Meniscus shall be excluded during the first year and covered from the second year onwards after the Insured continuously renews his/ her coverage under the policy, provided that 70/30 co-payment is applicable. The Insured is responsible to pay 30% of eligible expenses according to above definition of co-payment;

PRE-EXISTING DISEASES

Illness or injury which existed before the effective date of coverage under this Policy and any sickness/ illness/ Injury:

for which treatment has been received during the last three (03) years by the Insured;
for which diagnosis has been received, which presented signs or symptoms of which the Insured was aware or should reasonably have been aware before signing the policy, whether or not consultation/ treatment/advice/medication was received.

SPECIAL DISEASES

In this Wording, the following diseases are understood as Special Diseases:

a. Diseases of the nervous system:	Inflammatory diseases of the central nervous system (brain), Systemic atrophies primarily affecting the central nervous system (Huntington’s disease, Hereditary ataxia, Spinal muscular atrophy and related syndromes), Extrapyramidal and movement disorders (Parkinson’s disease, Dystonia, other extrapyramidal and movement disorders), Alzheimer, Apalic/ Amnesia, Epilepsy, Coma, Cerebral palsy and other paralytic syndromes
b. Diseases of the respiratory system:	Lung failure, Pneumothorax
c. Diseases of the circulatory system:
d. Diseases of the digestive system:	Hepatitis A, B, C, Cirrhosis of the liver, Liver failure, Cholelithiasis
e. Diseases of the genitourinary system:	Glomerular disease, Renal tubulo-interstitial diseases, Calculus of kidney and ureter, Calculus of lower urinary tract, Renal failure
f. Endocrine diseases:	Disorders of thyroid gland, Diabetes mellitus and pancreatic internal secretion, Adrenal gland diseases, Coma, Disorders of other endocrine glands
g. Neoplasms:	Benign neoplasms of any kind
h. Diseases of the blood:	Coagulation defects, Functional disorders of polymorpho-nuclear neutrophils, Certain diseases involving lymphoreticular tissue and reticulohistiocystic system, Marrow transplant
i. Diseases of skin and connective tissue and others:	Lupus erythematosus, Systemic sclerosis, Multiple Sclerosis, Diffuse systemic sclerosis / Amyotrophic Lateral Sclerosis, Muscular dystrophy and any of their complications, Penphygus, Psoriasis, Chronic urticaria (treated with imported antigen)

GENERAL EXCLUSIONS

(Applied to the core plan and all optional plans)

Bao Viet shall not be liable to pay any claims caused by any of the following reasons:

Wilful misconduct of the Insured Person or the legal heir;
Violation of law, regulations and other rules leading to the enforcement of judgments and/ or violation of traffic regulations and/ or violation of labour laws by the Insured Person aged 14 or over;
The Insured drives any kind of transportation whilst having a blood alcohol content higher than the limit specified in traffic laws and the Insured is affected by alcohol, wine, beer, or substances or stimulants which may result in any accident or illness/ disease;
The Insured Person’s act of fighting, unless such act can be proved that it is only a defence against an attack;
Consequences of accidents occur outside the Coverage Period;
Any type of treatment or medication without any Physician’s indication or prescription; herbal medicines of unknown origin; oriental medicine private clinics/ facilities;
The Insured takes part in aviation activities other than as a licensed fare-paying passengers, participates in military rehearsals training, fights in armed forces;
Disaster risks such as earthquakes, volcanoes, tsunamis, radioactive contamination, epidemics officially declared by the authorities (including SARS, H5N1, Ebola);
War, civil war, strikes, terrorism, military uprising, insurrection, rebellion, or usurped power or any act of any person acting on or on behalf of or in connection with any organization actively directed towards the overthrow or to the influencing of any government or ruling body by force;
Participation in or training for any professional sport activities or any form of race or competition/ contest;
Tuberculosis of any kind, malaria, occupational diseases, leprosy;
Cancer;
Person who is undergoing treatment due to illness/ disease or any disability, or suffering from permanent disability from 50% and above at the time when (s)he joins the Policy or the Policy comes into effect;
Pancreatic failure, leukemia, dialysis, hemodialysis and any consequence or complication thereof;

Hormone replacement therapies for the growth period, or the pre-menopausal or menopausal period of women;
Any treatment in connection with sexually transmitted diseases such as syphilis, gonorrhea, genital dysfunction (sexual malfunction/ sexual disorder), illness/ disease related to Acquired Immune Deficiency Syndrome (AIDS) including AIDS related complex, and/ or any consequence or complication thereof, or sexually transmitted diseases, or any of related syndromes/ diseases;
Any treatment and/ or surgery in connection with birth defects, hereditary illness/ congenital anomalies/ conginental malformations/ conginental disorders, genetic deformities/ diseases, and any related complications or consequence thereof; surgical treatment indicated before the inception date, including the categories listed hereof and/ or in the Endorsement as an integral part of Wording/ Policy such as congenital heart disease, Down syndrome, cleft lip and palate, hydrocephalus, anal stricture, phimosis, congenital deviated septum;

Routine medical examinations (in-patient or out-patient), check-ups, cancer screening tests with normal results, medical examination or consultation which are not associated with medical treatment of Illness/ Disease/ Injury, including gynaecological examination/ male genital examination, routine laboratory tests, routine check-ups for newborns, immuzination, vaccinations and preventative medicines (excluding vaccinations given after an accident or being bitten or stung by animals or insects);
Normal eye tests, cataract, normal hearing test, aging, degradation, any corrective treatment for non-medical/ natural degenerative eyesight and hearing, including the categories listed hereof and/ or in the Endorsement as an integral part of Wording/ Policy such as eyes refraction including myopia, presbyopia and astigmatism, and any corrective surgery for sight and hearing defects;
Dry eyes, eye strain/ eye fatigue will be covered up to 5% of limit per visit but not exceeding the sum insured of out-patient optional plan;
Delivery (Delivery is also deemed to include Childbirth or preterm delivery as a consequence of complications of pregnancy); This exclusion is not applied if the Insured Person enrolls “Maternity care” optional plan;
All dental treatments and any related treatments of teeth including in-patient and out-patient. This exclusion is not applied if the Insured Person enrolls “Dental Care” optional plan;
Treatment and operation performed as requested by the Insured Person and not associated with common treatment/ procedure or operation; but this exclusion clause will not be applied to medical services performed in Optional supplementary/ pay-for-service alternative/ elective service Departments/ Specialties in public hospitals. Check-ups, examinations and tests without any attending physician’s specific diagnosis or indication of treatment;
Any type of treatment for Beauty purpose, cosmetic or plastic surgery;
Increased skin pigmentation treatment (Hyper pigmentation), acne treatment, alopecia treatment shall be excluded in case of out-patient treatment. If the Insured is required to be admitted in a Hospital for such treatment, the Insurer shall reimburse with respect to In-patient benefit due to illness, disease;
Costs of providing, maintaining, fitting or replacing any prostheses or medical supportive appliances or devices as defined;
Costs related to operations or treatment in respect of Stem cell transplant procedure, including the categories listed hereof and/ or in the Endorsement as an integral part of Wording/ Policy such as expenses of extracting, processing, transplanting, follow-up care of stem cell, and the consequences thereof. In such cases, the Insurer shall only cover for hospital charges in public hospitals;
Dietary supplements and substitutes which are available naturally and possibly purchased without physician’s prescription or indication, including the categories listed hereof and/ or other similar substances such as vitamins, tonics, minerals, functional foods, immune boosting drugs, medical preparations;
Family planning, consequence of any abortion due to psychological or social causes, male/ female infertility, artificial insemination, sexual dysfunction/ impotence, or sex change, or any related consequence or complication thereof;
Any treatment of weight control (weight loss or gain), malnutrition, rickets, obesity;
Psychiatric and behavioral disorders, mental illness/ mental disorders or mental retardation, Attention deficit disorder (ADD), Autism spectrum disorder (ASD), sleep disorders, insomania, snoring with unknown causes, asthenia, anxiety disorders (stress) or any of related syndromes/ diseases;
Costs related to treatment at a clinic which fails to comply with definition hereinabove, including expenses for medications, tests and/ or treatment indicated by the Physician at such clinic, even though those expenses are incurred in legal clinics, hospitals, drug stores thereafter;
Examination and treatment failing to comply with procedures of hospitals, clinics and medical facilities;
Pre-existing conditions as defined shall be covered from the second year onwards after the Insured continuously renews his/ her coverage under the Policy;
Special diseases as defined shall be covered from the second year onwards after the Insured continuously renews his/ her coverage under the Policy;

+ Diseases of the circulatory system: Phlebitis, Thrombophlebitis, Varicose veins of lower extremities, Carpal tunnel syndrome, Diseases of lymphatic vessels and lymph nodes, Hemorrhoids

+ All types of Metabolic disorders