Fourth_Set_Questions_and_Answers_Health_Insurance_FedBizOpps.pdf

U.S. Consulate General Hong Kong

Fourth Set of Questions and Answers

Solicitation Number SHK30015R0001- Group Health Insurance Services

Q1.: For Hospitalization Benefit under Section C.1.1.1.

(a) For item (8), please confirm whether the medical expenses of anesthetist fee + operating theatre are subject to a maximum limit of HKD 30,500 per illness in total OR a maximum limit of HKD 30,500 per illness is covered for anesthetist fee and another HK$30,500 per illness is covered for operating theatre separately

A1(a): The maximum limit of HKD 30,500 per illness is the combined limit for both medical expenses of anesthetist fee and operating theatre fee incurred while hospitalized.

(b) Refer to the Third Set of Questions and Answers, Q1.2: For item (2), what is the meaning of “not to exceed 100% of the costs of a semi-private room”? Basically, the costs of daily semi-private room charges in all private hospitals of HKSAR should be more than

HK$1,000. Is there any special meaning? And answer A1.2 in third set of questions and answers: The maximum daily reimbursement for a private room is limited to 100% of the cost of a semi-private or up to HK$1,000, whichever is lower.

Basically, the semi-private room charge in all private hospitals of HKSAR is more than

$1,000. To make it simple, can we adopt the accommodation level of “semi-private” and then rely on the maximum daily limit of HK$1,000 for reimbursement of room and board benefit?

A1.(b): The maximum daily reimbursement is HK$1,000 for a semi-private room. If a private room is selected and the cost of a semi-private room is lower than HK1,000, the daily reimbursement is limited to the cost of the semi-private room. If a private room is selected and the cost of the semi-private room is HK$1,000 or higher, the daily reimbursement is limited to

HK1,000 .

(c) If the patient is confined in a room of a class higher than the entitled semi-private level, is there any adjustment factors to be applied for the catastrophic coverage under Section

C.1.1.14? Basically, it is common in the market to reduce the eligible reimbursed amount by 50% and 75% if the patient has confined in private and deluxe room level respectively.

A1.(c): Refer to Section C.1.1.14 for maximum reimbursement amount under catastrophic coverage. Adjustment factors are not listed in the solicitation and will not apply.

Q2: For Catastrophic Coverage under Section C.1.1.14

Refer to the Third Set of Questions and Answers, Q3: What is the meaning of “major medical conditions” as well as the definition of “per illness”? and answer A3: Just as the supplementary major medical benefits, catastrophic coverage will supplement the basic medical policy to provide additional coverage for expenses incurred both in and out of the hospital. When medical expenses exceed the basic policy’s limits, the catastrophic coverage begins to pay. Thus

“major medical conditions” are those whose expenses exceed the basic policy coverage. For a definition of “illness,” see Q.1, part 4.

Question: Please confirm whether your mentioned basic policy’s limits or basic policy coverage have included all benefits under Section C.1.1.1. Hospitalization and C.1.1.2.

Outpatient and C.1.1.3. Prescription Drugs and Medicines + C.1.1.13 Chinese Herbalist, Bonesetter Treatment and Acupuncturist.

A2: Refer to Section C.1.1.14 which defines Catastrophic Coverage. For Catastrophic

Coverage to apply, the standard maximum coverage limit must be exceeded.

Q3: For Medical Expenses Incurred Out of Country under Section C.1.1.15

Refer to the Third Set of Questions and Answers, Q4: Is it implied all medical expenses incurred out of country and without the attending physician certification can be excluded for reimbursement. And answer A4: The certification requirement applies for cases where the patient travels out of country for the purpose of receiving medical treatment.

Question: To make it simple, can we make an interpretation that all medical expenses can be excluded for reimbursement where the patient travels out of country solely for the purpose of receiving medical treatments but without any certification being provided in advance by his/her attending physician

A3: Only with an advance certification by the attending physician, will medical expenses be covered if the patient travels out of country and solely for the purpose of receiving medical treatment.