SOB - 01 Oct 2022

Company Name: China Overseas Holdings Ltd
Contract Number: 01629000 & Sub-contract(s)

Contract Year: 1 October 2022 to 30 September 2023
Schedule of Benefits – General Information

Class 3
General
1. The Scheme provides 24-hour worldwide coverage except otherwise stated.
2. A 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 requires another referral letter.
3. Bupa Worldwide Assistance Programme is provided. For details, please refer to “Bupa Worldwide Assistance Programme”
leaflet.
4. The Bupa HealthNet Card is accepted for settling payment for clinical consultations and laboratory tests carried out by
HealthNet medical practitioners in Hong Kong and Macau as listed in the List of HealthNet Service Providers.
Provisions for HealthNet Benefit
1. To ensure entitlement to full benefit for eligible medical expenses under HealthNet Benefit, the following requirements must
be followed:
(a) Clinical treatment must be obtained at HealthNet medical practitioner's clinic and performed by a HealthNet General
Practitioner, Specialist, Physiotherapist or Registered Chinese Medicine Practitioner.
(b) Physiotherapy within HealthNet must be referred by a Registered Medical Practitioner.
(c) Diagnostic imaging and laboratory tests must be referred by a Registered Medical Practitioner and carried out at a
HealthNet Diagnostic Centre.
(d) Pre-authorisation must be obtained from Bupa prior to the following treatments:
- diagnostic imaging or laboratory tests exceeding HK$2,000
- treatment by a Non-HealthNet Specialist (only if referred by a HealthNet General Practitioner when the necessary
specialty is unavailable within HealthNet)
(e) The Bupa HealthNet Card must be presented to the HealthNet service providers before treatment and used to settle the
medical expenses.
If any of the above requirements is not fulfilled, you will not be entitled to HealthNet Benefit and all eligible medical
expenses will be paid up to the Maximum Limits under Non-HealthNet Benefit, if any.
Hospital and Surgical Benefit
1. The Maximum Limits of all the benefit items of Hospital and Surgical Benefit shall be increased by 100% for overseas
Emergency medical treatments.
2. Room and Board Benefit shall be extended to cover the charges for accommodation and meals in ward bed at Hospital
Authority’s Hospitals in Hong Kong on account of rehabilitation. Such extension shall not be applicable to Hospital Cash
Benefit.
Clinical Benefit
1. The requirement for referral letters shall be waived for all Specialist consultations.
Schedule of Benefits – General Information

Class 3
Combined Benefit Items
1. Routine Health Check-up Benefit, Vaccination Benefit and Optical Benefit are subject to an aggregate Maximum Limit of
HK$720 per Contract Year.
The information in this leaflet is for reference only. In the event of any conflict in the interpretation between the English
version and the Chinese version of this leaflet, the English version shall prevail. Should there be any discrepancy between
this leaflet and the provisions of the Group Health Insurance Contract, we shall follow the Contract for final interpretation.
Schedule of Benefits – Hospital and Surgical Benefit

(The Maximum Limits shown below are in HK$)
Geographical limit and scope: Worldwide Class 3

Restricted room and board level Ward
Reimbursement percentage 100%
1. Room and Board (per day limit) 800
(maximum 182 days per Disability per Contract Year)
2. Miscellaneous Hospital Services (per Disability per Contract Year) 12,000
- extended to cover MRI, CT Scan and PET Scan carried out at Hospitals, outpatient department of Hospitals, clinics
or laboratory centres
3. Intensive Care (per Disability per Contract Year) 6,000
- supplement to Room and Board
4. Private Nursing (per day limit) 320
- nursing services during Hospital Confinement or at home after discharge from Hospital rendered by a Qualified
Nurse upon referral by the attending Registered Medical Practitioner
5. Surgeon and Attendance Fees (per Disability per Contract Year)
payable for surgeon and medical attendance charges for surgical cases
- complex 50,000
- major 25,000
- intermediate 12,500
- minor 6,250
6. Anaesthetist's Fees (per Disability per Contract Year)
- complex 15,000
- major 7,500
- minor 1,900
7. Operating Theatre Fees (per Disability per Contract Year)
- complex 15,000
- major 7,500
- minor 1,900
8. In-patient Physician's Fees (per day limit) 800
- payable for in-patient medical attendance for non-surgical cases only
9. In-patient Specialist's Fees (per Disability per Contract Year) 1,000
- subject to written referral from the attending Registered Medical Practitioner except for pathologist, radiologist or
Physiotherapist who provides services during Hospital Confinement
10. Pre-admission and Post-hospitalisation Out-patient Care (per Disability per Contract Year) 2,500
- including one pre-hospitalisation/pre-surgery visit and all post-hospitalisation/post-surgery visits on an out-patient
basis within 6 weeks after discharge from Hospital or after surgery
- payable for consultation fee, Western Medication, diagnostic tests and physiotherapy
11. Psychiatric treatments (per Contract Year) 30,000
- This benefit shall be payable for the eligible expenses charged on the psychiatric treatments during Hospital
Confinement in Hong Kong as recommended by a Specialist. All psychiatric treatments shall be exclusively paid
under this Benefit and no Benefit shall be payable under other benefit items of Hospital and Surgical Benefit
12. Hospital Cash ^ (per day limit) 800
- payable in addition to Room and Board from the 1st day of Hospital Confinement in ward bed at Hospitals of
Hospital Authority in Hong Kong
13. Out-patient Surgery Cash Allowance ^ (per day limit) 680
- payable in addition to Surgeon and Attendance Fees for undergoing the below Clinical Operations or Day Case at a
clinic or day-case unit of a Hospital by a Registered Medical Practitioner, provided that no Room and Board Benefit
is payable:
- Arthroscopy, Bronchoscopy, Colonoscopy, Colposcopy, Cystoscopy, Esophagogastroduodenoscopy, Haemorrhoid
Artery Ligation (HAL)/ Rubber Band Ligation (RBL), Hysteroscopy, Loop Electrosurgical Excision Procedure (LEEP),
Stapled Haemorrhoidectomy
Schedule of Benefits – Hospital and Surgical Benefit

14. Second Claims incentive ^ (per day limit) 800

- If any reimbursement is payable in respect of a Hospital Confinement under this Scheme and such reimbursement
has been paid by an insurance company other than Bupa or any company within the Bupa group of companies, this
Benefit shall be paid on a per day basis in which Room and Board Benefit shall be payable for such day of Hospital
Confinement.
^ Hospital Cash Benefit, Second Claims Incentive Benefit and/ or Out-patient Surgery Cash Allowance Benefit (if applicable) are not subject
to the Overall Maximum Limit/ Annual Overall Limit, if any.
Schedule of Benefits – Clinical Benefit

Class 3 HealthNet Non-HealthNet

Benefit Benefit
(Hong Kong (Worldwide)
and Macau)
Reimbursement percentage shown in brackets
1. General Practitioner (per visit) Full cover # 280
- consultation (including consultation fee and Medically Necessary Western Medication (80%)
prescribed and obtained at the General Practitioner's clinic)
2. Specialist (per visit) Full cover # 500
- consultation (including consultation fee and Medically Necessary Western Medication (80%)
prescribed and obtained at the Specialist's clinic)
3. Physiotherapist (per visit) Full cover # 340
- treatment fee only (80%)
- subject to written referral from a Registered Medical Practitioner
4. Chiropractor (per visit) N/A 340
- treatment fee only (80%)
- subject to written referral from a Registered Medical Practitioner
5. Chinese Herbalist (per visit) Full cover # 260
- consultation (including consultation fee and Medically Necessary Chinese Medicines (80%)
prescribed at the Registered Chinese Medicine Practitioner's clinic and obtained at a
legitimate source on the same day of consultation)
- payable for acupuncture and Tui Na performed by a Registered Chinese Medicine
Practitioner under Non-HealthNet Benefit
6. Chinese Bonesetter (per visit) Full cover # 260
- consultation (including consultation fee and Medically Necessary Chinese Medicines (80%)
prescribed at the Registered Chinese Medicine Practitioner's clinic and obtained at a
legitimate source on the same day of consultation)
- payable for acupuncture and Tui Na performed by a Registered Chinese Medicine
Practitioner under Non-HealthNet Benefit
7. Diagnostic Imaging and Laboratory Tests (per Contract Year) Full cover # 2,200
- subject to written referral from a Registered Medical Practitioner for all diagnostic (80%)
imaging and laboratory tests, or from a Registered Chinese Medical Practitioner① or
Chiropractor② for X-ray only and laboratory tests
8. Prescribed Western Medication (per Contract Year) Combined with 1,500
- extra, long-term or expensive Medically Necessary Western Medication prescribed Non-HealthNet (100%)
and obtained at the HealthNet Registered Medical Practitioner's clinic on the same Benefit #
day of consultation under HealthNet Benefit
- Medically Necessary Western Medication prescribed by a Registered Medical
Practitioner and obtained at any legitimate source under Non-HealthNet Benefit
9. Routine Health Check-up (per Contract Year) * N/A 720
(80%)
10. Vaccination (per Contract Year) * N/A 720
(80%)
11. Psychiatric-related treatments (per visit) N/A 500
- Including consultation fee, basic Medically Necessary Western Medication, basic (80%)
Chinese Medicines, acupuncture, diagnostic imaging and laboratory tests for
outpatient psychiatric related treatments
- If the expenses under this Benefit are also covered under other benefit items in the
Clinical Benefit, these expenses shall be exclusively paid under this Benefit
12. Psychological counselling (per visit) N/A 500
- payable for the psychological counselling fee charged by the Psychologist on the (80%)
account of psychiatric, psychological, mental, or behavioural conditions
- subject to written referral from the attending Psychiatrist
Schedule of Benefits – Clinical Benefit

Maximum number of visits per Contract Year (for item(s) 1, 2, 3, 4, 5, 6, 11 and 12) 40
(HealthNet Benefit and Non-HealthNet Benefit in aggregate)
- including the following sub-limit on the number of visits:
- Specialist (HealthNet and Non-HealthNet) 20
- Physiotherapist and Chiropractor (HealthNet and Non-HealthNet) 12
- Chinese Herbalist and Chinese Bonesetter (HealthNet and Non-HealthNet) 30
- Psychiatric-related treatments and Psychological counselling (Non-HealthNet only) 10
- Each of Items 1, 2, 3, 4, 5, 6, 11 and 12 is subject to 1 visit per day.
# For each visit of the following items, HealthNet Benefit provides full cover for eligible medical expenses as below:
- General Practitioner and Specialist: consultation fee and up to 5 days of basic Medically Necessary Western Medication prescribed
at the Registered Medical Practitioner's clinic
- Physiotherapist: treatment fee only
- Chinese Herbalist and Chinese Bonesetter: consultation fee and up to 2 packets of basic Medically Necessary Chinese Medicines
- Diagnostic Imaging and Laboratory Tests (up to the Maximum Limit if specified)
- Prescribed Western Medication (up to the Maximum Limit if specified)
①② Some diagnostic centres may not accept referrals from a Registered Chinese Medicine Practitioner and/or Chiropractor for certain X-ray
and laboratory tests. If you have any queries, please contact the centres directly.
Note:
1. General Practitioner Benefit under HealthNet benefit also covers medical consultation conducted by a video consultation service provider
designated by Bupa and paid for using the Bupa HealthNet Card. This benefit covers consultation fee and Medically Necessary Western
Medication prescribed by the video consultation service provider and obtained at the respective clinic (excluding any medication delivery
charge). The list of designated video consultation service providers can be found on Bupa’s customer service portal. The list may be
updated and amended by Bupa from time to time.
2.* Routine Health Check-up Benefit, Vaccination Benefit and Optical Benefit are subject to an aggregate Maximum Limit of HK$720 per
Contract Year.
Schedule of Benefits – Dental Benefit

Class 3

Overall Limit per Contract Year 2,200
Payable for the following dental treatments performed by a Registered Dentist and (for item 1 only) Registered Dental
Hygienist, subject to the above Overall Limit if specified:
1. Scaling and Polishing (per visit) 600

(maximum 2 visits per Contract Year)
2. Dental Consultation (per Contract Year) 2,200

- including the following items:
(a) Routine oral examination
(b) Intraoral X-ray (periapical or bitewings)
(c) Medications
(d) Fillings
(e) Extractions
(f) Drainage of abscesses (with or without surgery)
(g) Pins for cusp restoration
(h) Root canal treatment
(i) Crowns and bridges
(j) Apicoectomy
(k) Periodontal surgery
(l) Gold inlay
(m) Accident emergency treatment (including X-ray, temporary pain relief, temporary fillings, medication, incision and
drainage of abscess)
(n) Partial and complete soft-tissue impaction
(o) Bony impaction
(p) Orthodontic treatment (necessitated by threat to the health of the Member and recommended as necessary by a
Registered Dentist)
(q) Panoramic film
(r) Night-guard or Mouth-guard (for prevention of continuous wearing of teeth)
3. Dentures (only if necessitated by an Accident) (per Contract Year) 2,200

Schedule of Benefits – Optical Benefit

Class 3

Overall Limit per Contract Year 720
Payable for the following optical services performed by a Registered Medical Practitioner or Registered Optometrist, subject
to the above Overall Limit if specified:
1. Optical Consultation (per Contract Year)

- consultation for eye refraction and routine eye examination performed by a Registered Medical Practitioner or
Registered Optometrist
Note:
1. Routine Health Check-up Benefit, Vaccination Benefit and Optical Benefit are subject to an aggregate Maximum Limit of HK$720 per
Contract Year.
公司名稱： China Overseas Holdings Ltd
合約編號： 01629000 及子合約
合約年度： 2022 年 10 月 1 日至 2023 年 9 月 30 日
保障金額表：一般資料
計劃 3
一般資料
1. 除另行列明外，本計劃提供 24 小時全球保障。
2. 您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。若需診治全新或不
相關的病症，則須提交新的轉介信或西藥處方。
3. 您可享有保柏國際援助計劃，詳情請參閱「保柏國際援助計劃」單張。
4. 您可使用由列於「網絡服務供應商目錄」的本港及澳門網絡醫療服務機構所提供的門診及化驗服務，並以「保柏網絡醫療
卡」為有關服務結賬。
網絡保障的規條
1. 為確保您享有網絡保障所提供的全數賠償保障，您必須依循以下規定：
(i) 門診治療必須由網絡普通科醫生、專科醫生、物理治療師或註冊中醫提供並於網絡服務供應商的診所內進行。
(ii) 物理治療必須由註冊西醫轉介。
(iii) 診斷影像及化驗必須由註冊西醫轉介，並於網絡內的化驗所進行。
(iv) 於進行以下的治療前，您必須取得保柏的初步保障審核：
- 超過港幣 2,000 元的診斷影像及化驗費用；
- 非網絡的專科醫生診症（只限於網絡未能提供該類專科服務並必須由網絡內的註冊西醫轉介）。
(v) 您必須於求診登記時向網絡服務供應商出示「保柏網絡醫療卡」，並以此卡支付合資格的醫療費用。
如沒有依循以上規定，您將不可享有網絡保障，而您的合資格醫療費用將會根據非網絡保障（如有）的最高賠償額作出賠償。
住院及手術保障
1. 住院及手術保障內的所有保障項目之最高賠償額，將增加百分之一百，以賠償於海外進行緊急治療的費用。
2. 住院及膳食費保障將包括因康復入住香港醫院管理局轄下醫院大房病床的住宿和膳食費用。該延伸保障不適用於住院現金保
障。
門診保障
1. 所有專科醫生保障之賠償申請，可豁免提交轉介信。
合併保障項目
1. 例行健康檢查保障、防疫注射保障及眼科保障的最高賠償額合計為每合約年度港幣 720 元。
此保障金額表只供參考之用。若中、英文版本的詮釋有任何差別，概以英文版本為準。若保障金額表內容與團體醫療保險合約
的條文有任何歧異，概以合約為準。
合約年度： 2022 年 10 月 1 日至 2023 年 9 月 30 日
保障金額表：住院及手術保障
（以下的最高賠償額以港幣計算）
地域限制 : 世界各地計劃 3
指定的住房級別大房
賠償率 100%
1. 住院及膳食費（每日限額） 800
（每合約年度每病症計最多 182 日）
2. 住院雜費（每合約年度每病症計） 12,000
- 另支付於醫院、醫院之門診部、診所或化驗所進行的磁力共振掃描、電腦斷層掃描及正電子放射斷層掃描
3. 深切治療（每合約年度每病症計） 6,000
- 住院及膳食費之補足
4. 私家看護費（每日限額） 320
- 經主診註冊西醫建議下由合資格護士於住院期間或出院後在家中提供之護理服務
5. 外科醫生費及巡房費（每合約年度每病症計）
此保障支付外科醫生費及手術性治療的住院醫生巡房費
- 複雜 50,000
- 大型 25,000
- 中型 12,500
- 小型 6,250
6. 麻醉科醫生費（每合約年度每病症計）
- 複雜 15,000
- 大型 7,500
- 中型 3,750
- 小型 1,900
7. 手術室費用（每合約年度每病症計）
- 複雜 15,000
- 大型 7,500
- 中型 3,750
- 小型 1,900
8. 住院醫生巡房費（每日限額） 800
• 非手術性治療的住院醫生巡房費
9. 住院專科醫生費（每合約年度每病症計） 1,000
- 須獲主診註冊西醫以書面轉介（病理學家、放射學家及物理治療師在住院期間所提供之服務除外）
10. 入院前及出院後之門診護理（每合約年度每病症計） 2,500
- 包括一次入院前或手術前的門診診症，以及出院後或手術後 6 星期內所有與住院治療有關之跟進療程門診診症
- 支付診症費、西藥費、診斷影像及化驗費，以及物理治療費用
11. 精神科治療（每合約年度計） 30,000
- 支付在專科醫生建議下於香港住院接受精神科治療所收取的合資格費用。所有與精神科治療相關醫療服務的合資格費
用將在此保障下支付，而不會在住院及手術保障中的其他保障項目賠償
12. 住院現金保障^（每日限額） 800
- 如入住香港醫院管理局轄下醫院大房病床，將同時獲賠償住院及膳食費保障及此項保障，而有關賠償將由住院第 1
天開始支付
13. 門診手術額外現金保障^（每日限額） 680
- 如由註冊西醫在診所或醫院日症房進行以下任何診所手術或日症，此保障將在外科醫生費之上，及在無獲得任何住
房及膳食費賠償的情況下支付額外賠償：
關節鏡檢查、支氣管鏡檢查、結腸鏡檢查、陰道鏡檢查、膀胱鏡檢查、上消化道內視鏡檢查、痔瘡動脈結紮術/ 痔瘡
橡皮圈結紮法、子宮鏡檢查、子宮頸電環切除術、痔瘡環狀切除手術
14. 第二索償現金津貼保障^（每日限額） 800
- 如根據本計劃可獲得住院賠償，及該賠償已由其他保險公司支付（保柏或保柏集團內的任何公司除外），此保障將
就住院當天於住房及膳食費保障適用的情況下，按每日住院支付賠償。
^住院現金保障、第二索償現金津貼保障及/ 或門診手術額外現金保障（如適用）將不會受限於最高賠償額/每年最高賠償額（如有）。
合約年度： 2022 年 10 月 1 日至 2023 年 9 月 30 日
保障金額表：門診保障
計劃 3 網絡保障非網絡保障
（適用於香港及澳門）（適用於世界各地）
賠償率列於括號內
1. 普通科醫生（每次診治計）全數支付 # 280
- 診症（包括診症費及於普通科醫生診所處方及取得醫療必需的西藥費用） (80%)
2. 專科醫生（每次診治計）全數支付 # 500
- 診症（包括診症費及於專科醫生診所處方及取得醫療必需的西藥費用） (80%)
3. 物理治療師（每次診治計）全數支付 # 340
- 只限於診療費 (80%)
- 須獲註冊西醫書面轉介
4. 脊醫（每次診治計）不適用 340
- 只限於診療費 (80%)
- 須獲註冊西醫書面轉介
5. 中醫師（每次診治計）全數支付 # 260
- 診症（包括診症費及於診症當日於註冊中醫診所處方並由合法來源取得的醫療必需中藥 (80%)
費用）
- 由註冊中醫進行針灸治療及推拿治療的費用，會於非網絡保障作出賠償
6. 跌打醫師（每次診治計）全數支付 # 260
- 診症（包括診症費及於診症當日於註冊中醫診所處方並由合法來源取得的醫療必需中藥 (80%)
費用）
- 由註冊中醫進行針灸治療及推拿治療的費用，會於非網絡保障作出賠償
7. 診斷影像及化驗（每合約年度計）全數支付 # 2,200
- 須獲註冊西醫（適用於所有診斷影像及化驗）或註冊中醫①/脊醫②（只適用於 X 光及化 (80%)
驗）書面轉介
8. 醫生處方西藥（每合約年度計）與非網絡保障 1,500
- 於診症當日在網絡內的註冊西醫診所處方及取得之額外、長期服用或昂貴的醫療必需西合併計算 # (100%)
藥費用，會於網絡保障作出賠償
- 由註冊西醫處方並於註冊西醫診所以外的合法來源取得的醫療必需西藥費用，會於非網
絡保障作出賠償
9. 例行健康檢查（每合約年度計）* 不適用 720
(80%)
10. 防疫注射（每合約年度計）* 不適用 720
(80%)
11. 精神科相關治療（每次診治計）不適用 500
- 精神科相關治療包括診症費、基本醫療所需西藥、基本中藥、針灸治療、診斷影像及化 (80%)
驗
- 若本保障所賠償的費用亦受保於門診保障中的其他保障項目，則有關費用將只會於本保
障獲得賠償
12. 臨床心理輔導（每次診治計）不適用 500
- 心理學家就有關精神、心理、情緒或行為症狀的診症所收取的心理輔導費 (80%)
- 須獲主診精神科醫生書面轉介
每合約年度最多診治次數（包括：項目 1, 2, 3, 4, 5, 6, 11 及 12） 40
（網絡保障及非網絡保障合計）
- 包括下列個別保障項目的分項次數：
- 專科醫生（網絡保障及非網絡保障） 20
- 物理治療師及脊醫（網絡保障及非網絡保障） 12
- 中醫師及跌打醫師（網絡保障及非網絡保障） 30
- 精神科相關治療及臨床心理輔導（非網絡保障） 10
- 項目 1, 2, 3, 4, 5, 6, 11 及 12，各以每日一次為限
合約年度： 2022 年 10 月 1 日至 2023 年 9 月 30 日
保障金額表：門診保障
# 網絡保障就下列項目的每次診治所提供的全數賠償之合資格醫療費用如下：
- 普通科醫生及專科醫生：包括診症費及於註冊西醫診所處方及取得最多 5 日之基本醫療必需西藥費用
- 物理治療師：只限於診療費
- 中醫師及跌打醫師：包括診症費及最多兩劑之基本醫療必須中藥費用
- 診斷影像及化驗：以最高賠償額（如列明）為限
- 醫生處方西藥：以最高賠償額（如列明）為限
①② 部分診斷影像中心或不接受由註冊中醫及／或脊醫轉介的某些 X 光及化驗。如有疑問，請直接聯絡有關中心。
附註：
1. 門診網絡保障下的普通科醫生亦涵蓋由本公司指定的視像診症服務供應商進行的醫療診症服務並使用保柏網絡醫療卡繳費。此保障涵蓋診
症費及由視像診症服務供應商處方並於其診所取得的基本醫療所需西藥費用（不包括任何藥物運送費用）。指定的視像診症服務供應商名
單可於本公司的客戶服務網站查閱，此名單可能會不時更改及更新。
2.* 例行健康檢查保障、防疫注射保障及眼科保障的最高賠償額合計為每合約年度港幣 720 元。
合約年度： 2022 年 10 月 1 日至 2023 年 9 月 30 日
保障金額表：牙科保障
計劃 3
賠償率 100%
每合約年度最高總賠償額 2,200
由註冊牙醫提供以下的牙科診治服務及註冊牙齒衛生員（只適用於項目 1）的有關費用可按上述的最高總賠償額（如列明）作出
賠償：
600
1. 洗牙及去除牙石、牙漬（每次診治計）
（每合約年度最多 2 次）
2. 牙科診治（每合約年度計） 2,200
- 包括以下項目：
(i) 定期口腔檢查
(ii) 口腔 X 光（齒根尖周圍或牙齒咬合位置）
(iii) 藥物
(iv) 補牙
(v) 脫牙
(vi) 膿瘡排放（手術治療或非手術治療）
(vii) 齒尖或齒邊修復
(viii) 齒根管治療
(ix) 牙冠及牙橋
(x) 齒根尖切除術
(xi) 牙周病手術
(xii) 金牙鑲嵌
(xiii) 緊急治療（包括 X 光、短期止痛、短期填補、藥物使用、膿瘡切割及排放)
(xiv) 部份及整體軟組織阻生
(xv) 牙骨阻生
(xvi) 牙齒矯正治療（因成員健康理由並經註冊牙醫建議為必需之治療）
(xvii) 全視牙照
(xviii) 夜間護齒套或護齒套（為防止持續性牙齒磨損）
3. 活動假牙（只適用於因意外而導致）（每合約年度計） 2,200
合約年度： 2022 年 10 月 1 日至 2023 年 9 月 30 日
保障金額表：眼科保障
計劃 3
賠償率 100%
每合約年度最高總賠償額 720
由註冊西醫或註冊視光師提供以下的眼科服務的有關費用可按上述的最高總賠償額（如列明）作出賠償：
1. 眼科診治（每合約年度計）
- 由註冊西醫或註冊視光師執行的有關視力之診症及視力檢驗
附註：
1. 例行健康檢查保障、防疫注射保障及眼科保障的最高賠償額合計為每合約年度港幣 720 元。

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Company Name: China Overseas Holdings Ltd

Contract Number: 01629000 & Sub-contract(s)

Schedule of Benefits – General Information

1. The Scheme provides 24-hour worldwide coverage except otherwise stated.

Provisions for HealthNet Benefit

Hospital and Surgical Benefit

Schedule of Benefits – General Information

Combined Benefit Items

Schedule of Benefits – Hospital and Surgical Benefit

Geographical limit and scope: Worldwide Class 3

Schedule of Benefits – Hospital and Surgical Benefit

14. Second Claims incentive ^ (per day limit) 800

Schedule of Benefits – Clinical Benefit

Class 3 HealthNet Non-HealthNet

Schedule of Benefits – Clinical Benefit

Schedule of Benefits – Dental Benefit

Reimbursement percentage 100%

1. Scaling and Polishing (per visit) 600

2. Dental Consultation (per Contract Year) 2,200

3. Dentures (only if necessitated by an Accident) (per Contract Year) 2,200

Schedule of Benefits – Optical Benefit

Reimbursement percentage 100%

1. Optical Consultation (per Contract Year)

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