AIRPORT AUTHORITY

MEDICAL BENEFITS SCHEME BOOKLET

(effective 1 January 2024)

I. Medical Plans

There are two medical plans available for staff selection. The selected plan will also apply to
staff’s eligible dependants.

A. Option 1: Free Choice + Network Service (“Free Choice”) Plan

1. For out-patient benefits, members can consult registered medical practitioners of their
own choice and claim reimbursement subject to the specified maximum limits per visit,
maximum number of visits per annum and any applicable exclusions, OR they can
consult registered medical practitioners on the list of network doctors by presenting the
AXA eHealth card*. For details, please refer to the benefits schedule in Appendix 1a.

2. For hospitalisation, members can visit any hospitals subject to the specified maximum
limits and any applicable exclusions. Supplementary Major Medical (SMM) Benefit of
this plan covers 80% of the eligible medical expenses above basic hospitalisation
benefits up to the maximum benefit specified for each benefit group. For details, please
refer to the benefits schedule in Appendix 1b.

3. List of doctors/hospitals accepting the AXA eHealth card* is available on your member
mobile app EMMA by AXA.

B. Option 2: Network Service (“Network”) Plan

1. Network Plan provides clinical and hospital benefits through AXA’s designated medical
network. Specialists covering different medical disciplines, physiotherapists and
Chinese Medicine Practitioners are available. Various diagnostic centres and private
hospitals in Hong Kong are included in the AXA network.

2. When using the medical services provided by Network Plan, members are required to
present the AXA eHealth card to the network doctors or hospitals upon registration. List
of doctors/hospitals accepting the AXA eHealth card* is available on your member
mobile app EMMA by AXA.

3. For out-patient benefits, members can visit any of the network doctors including Chinese
Medicine Practitioners subject to the annual overall visits limit. For details, please refer
to the benefits schedule of the Network Plan in Appendix 1a.

4. For hospitalisation, members can visit any of the network hospitals (Note 1) or Hospital
Authority hospitals (Note 2) subject to the specified maximum limits and any applicable
exclusions. The Supplementary Major Medical Benefit covers 90% of the eligible
medical expenses above basic hospitalisation benefits up to the maximum benefit
specified for each benefit group. For details, please refer to the benefits schedule in
Appendix 1b.

5. Pre-authorization (Note 3) is required for hospitalization and may also be required for
clinical operations, day case surgery, diagnostic imaging and laboratory test subjected
to AXA’s provider guidelines.

*List of doctors/hospitals accepting the AXA eHealth card is subject to change without notification. For latest
information, please refer to your member mobile app EMMA by AXA.

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 6. Reimbursement of eligible expenses outside network doctor service can be made under
the following circumstances subject to the provisions under the Free Choice Plan and
applicable exclusions:

6.1 in the case of emergency as defined (Note 4) (applicable both inside and outside
Hong Kong) where network clinic and hospitals are not available, members can
visit any registered medical practitioners and hospitals and claim reimbursement

6.2 where the use of AXA eHealth card* is not applicable:

(a) confinement in the ward level of Hospital Authority hospitals
(b) prescribed western medication obtained at any legitimate source other than
doctor’s clinic
(c) routine medical check-up by a Registered Medical Practitioner, if applicable
(d) routine eye examination performed by a Registered Medical Practitioner or
Registered Optometrist, if applicable
(e) treatment by a Registered Dentist at the Registered Dentist’s clinic, if
applicable

II. Worldwide Assistance

Members can obtain medical or legal assistance through a hotline service in case of emergency
when travelling overseas. For hospitalisation in mainland China, members can present the AXA
eHealth card which is accepted as a deposit guarantee at about 170 designated hospitals in
China (please refer to your member mobile app EMMA by AXA). For details on the worldwide
assistance programme, please refer to the LEAFLET.

III. Exclusions

A. Medical services not covered under both medical plans are given in the list of exclusions.
Please refer to Appendix 2 for details.

B. If members incur payment in excess of their entitlement or receive treatment/services which

are excluded from the Authority’s medical plan, members are required to settle the balance
or payment of the exclusion items at the clinic or to AXA directly.

The provision of the medical benefits and the applicable limits are subject to periodic review by the
Airport Authority and may be revised at any time as the Authority shall deem appropriate. The
information provided in this booklet is a general summary for reference. In the event of any discrepancy
between the booklet and the provision of the contract with the Insurer, the contract shall prevail.

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IV. Useful Contact Information and On-line Service

24-hour AXA Customer Care Help Desk

Designated line for the Authority +852 8106 0811

Scope of Services:

Within office hour (9:00 am – 6:00 pm

Mon to Fri, except public holidays): Provide all information of the scheme

Outside office hours: Provide information of benefit entitlement, claims

and other policy administration procedures and list
of network doctors, claim forms

E-mail vip.health@axa.com.hk

Web site www.axa.com.hk

Pre-authorization Office # Mon to Fri (except public holidays): 9:00 am–6:00pm

Enquiry / Approval hotline +852 8106 0811

# For Network plan, pre-authorization (Note 3) is required for hospitalization at network hospitals
and may also be required for clinical operations, day case surgery, diagnostic imaging and
laboratory test subjected to AXA’s provider guidelines.

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 Appendix 1a
SCHEDULE OF BENEFITS

Free Choice + Network Service Network Service

Outpatient Group 1 Group 2 Group 3 All Groups

Reimbursement % per visit 100% No reimbursement is required

General Consultation (Note 5)

(i) at the doctor's clinic (Note 6), Consultation fee and basic
$550 $400 $300
one visit per day, limit per visit OR medication

(ii) at home, one visit per day, limit per

visit $760 $460 $340 Not applicable

Subject to
Maximum no. of visit per annum
Subject to annual overall visits* annual overall visits*
(including clinical & home visits)
and one visit per day

Specialist Fees (Note 5 & 7)

Consultation fee and basic
One visit per day, limit per year medication

Maximum no. of visits per annum Subject to annual overall visits*

Subject to Subject to Subject to and one visit per day
the annual the annual the annual
Physiotherapist (Note 8)
limit of limit of limit of
One visit per day, limit per year $8,500 $7,000 $6,000 Treatment fee only
Subject to annual overall visits*
Maximum no. of visits per annum and one visit per day
Chiropractor (Note 8)
One visit per day, limit per year Not applicable
Maximum no. of visits per annum
Chinese Herbalist / Bonesetter (Note 9)
Consultation fee and basic
One visit per day, limit per visit $270
Chinese medicines
Co-payment per visit Not applicable $30
12 visits within annual overall visits* 20 visits within
Maximum no. of visits per annum on reimbursement basis annual overall visits*
(network service is not applicable) and one visit per day
Diagnostic Imaging and Laboratory Unlimited with referral
Tests (Note 10)
$4,500 $3,500 $2,500 (Pre-authorization may be
Limit per year required) (Note 3)
Long Term Prescribed Western Group 1: $3,500
Medication (Note 5) from any legitimate Group 2: $3,000
source other than doctor's clinic (Note 10) $3,500 $3,000 $2,000
Group 3: $2,000
Limit per year (For Reimbursement Only)

Annual overall visits* 30 50

Routine Medical Check-up and Group 1: $3,000

Vaccination (Note 14) for Employee at B7 Group 2: $2,500
$3,000 $2,500 $2,000
& below (employees only) Group 3: $2,000
Limit per year (For Reimbursement Only)
Routine Medical Check-up and
Vaccination (Note 14) for Employee at B8 Per separate schedule
& above (employees only) (For Reimbursement Only)
Limit per year

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 Appendix 1b

SCHEDULE OF BENEFITS

Free Choice + Network Service Network Service

Hospitalization / Surgical Group 1 Group 2 Group 3 All Groups

No reimbursement
Reimbursement % per visit 100%
is required

Room and Board

Limit per day $2,500 $1,500 $1,000
Maximum days per year 182 182 182
In-patient Physician’s Fees
Limit per day $2,200 $1,200 $800
Maximum days per year 182 182 182
Private Nursing
Limit per day $1,000 $800 $600
Maximum days per year 182 182 182
Miscellaneous Hospital Service
(Note 11)

Limit per year $41,000 $19,000 $14,000

Surgeon Fees Limit (Note 12)

Per disability per year Same limits as

Complex Operation $100,000 $57,800 $32,000 Free Choice Plan
Major Operation $50,000 $28,900 $16,000 according to Group levels
Intermediate Operation $25,000 $14,450 $8,000 (pre-authorization required)
Minor Operation $12,500 $7,225 $4,000
(Note 3)
Anaesthetist's Fees Limit
Per disability per year
Complex Operation $30,000 $20,000 $11,000
Major Operation $15,000 $10,000 $5,500
Intermediate Operation $7,500 $5,000 $2,500
Minor Operation $3,750 $2,500 $1,250
Operating Theatre Fees Limit
Per disability per year
Complex Operation $30,000 $20,000 $11,000
Major Operation $15,000 $10,000 $5,500
Intermediate Operation $7,500 $5,000 $2,500
Minor Operation $3,750 $2,500 $1,250
In-patient Specialist's Fees
$9,200 $6,800 $4,600
Limit per year

Supplementary Major Medical Group 1 Group 2 Group 3 All Groups

(Note 13)

Room & Board Restricted Level Private Semi-Private Ward

Same limits as
Maximum benefit
$690,000 $345,000 $174,000 Free Choice Plan
Per disability per year
according to Group levels
Deductible per disability per year $500 $375

Reimbursement Percentage (%) 80% 80% 90%

(Shortfall from eligible Basic Hospital & Surgical Benefits - Deductible) x

Reimbursement Formula (Note 13)
Reimbursement % x Adjustment Factor if applicable

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 Appendix 1c

SCHEDULE OF BENEFITS

Free Choice + Network Network

Service Service

Dental (Employee only) (Note 15) Group 1 Group 2 Group 3 All Groups

Reimbursement % per visit 100%

Overall Limit per year

(i) Scaling and Polishing (Max. 2 visits per annum)

(ii) Dental Consultation

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 Same limits as
j. Apicoectomy Free Choice Plan
$3,000 $2,500 $2,000
k. Periodontal surgery according to
l. Gold inlay Group levels
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 Month-guard (for prevention
of continuous wearing of teeth)

(iii) Dentures (only if necessitated by an Accident)

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 Appendix 1d

SCHEDULE OF BENEFITS

Free Choice + Network

Network Service
Service
Maternity Benefits (Employees and spouses
only) (Note 16) Group 1 Group 2 Group 3 All Groups

Reimbursement % per visit 100%

Medical expenses incurred in hospital and doctor

clinics arising from pregnancy (including pre-
natal and post-natal visits)
Maximum limit per pregnancy:
Normal Delivery $20,000 $15,000 $12,000 Same limits as
Free Choice Plan
Caesarean Section $27,000 $23,000 $18,000
according to Group
Miscarriage $10,000 $8,000 $6,000 levels

1. Maternity Benefit shall be payable for the following expenses:

(a) the eligible medical expenses incurred during Hospital Confinement on account of pregnancy or related
condition;
(b) the charges for consultation, prenatal and postnatal check-up, diagnostic tests and prescribed Medically
Necessary Western Medication incurred in any obstetric visit to a Registered Medical Practitioner for
prenatal and postnatal care; and
(c) the expenses incurred for newborn baby care during Hospital Confinement.

2. The Benefit shall be payable up to the relevant Maximum Limit according to the delivery date, delivery option
or final procedure received for such pregnancy. Normal Delivery Benefit and Caesarean Section Benefit as
stated in the Schedule of Benefits shall be payable for normal delivery and caesarean section respectively. If
the pregnancy is terminated due to miscarriage, abortion advised by a Registered Medical Practitioner or
complications of pregnancy, Miscarriage Benefit shall be payable.

3. The amount payable under this Benefit shall be equal to the actual charges for such services but shall in no
event exceed for any one pregnancy the applicable Maximum Limit for Normal Delivery Benefit, Caesarean
Section Benefit or Miscarriage Benefit.

4. This Benefit shall not cover any medical expenses incurred by the newborn baby in respect of any illness or
injury during Hospital Confinement.

5. Benefit shall be paid according to the level of Benefits at the time that expenses are incurred. In no event
shall Benefit be payable for a prepaid maternity package that requires advance payment to a Hospital or
Registered Medical Practitioner until after all such treatments have been rendered.

6. For avoidance of doubt, this Benefits shall not be payable for any psychiatric, psychological, mental, or
behavioural conditions arising from or in connection with maternity conditions (including its complications).

7. No Benefit shall be paid for expenses incurred after termination of coverage of a Member.

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 Appendix 1e

NOTES

Note 1 - For Network members, hospital confinement should be referred by a network doctor and treatment
has to be performed by a network doctor at the same time.

Note 2 - For Network members, confinement in Hospital Authority hospitals is limited to ward level only.

Note 3 - Pre-authorization is required for Network plan and the Registered Medical Practitioner will help
member seek pre-authorization from AXA for the following services, if applicable:

1. Hospital confinement
2. Clinical operation or day case surgery (as required by AXA’s provider guidelines)
3. Diagnostic imaging and laboratory tests (as required by AXA’s provider guidelines)
4. Treatment by a Non-AXA panel Specialist (only if referred by an AXA panel General Practitioner
when the necessary specialty is not available within AXA panel)

 If pre-authorization is required outside the operation hours of the hotline service of the pre-
authorization office, subsequent authorization should be made from the network doctor
immediately on the next working day after treatment.
 In case of emergency situations where the staff member may not be able to consult network
doctors, s/he is required to obtain “pre-authorization” by the next working day or the earliest
possible time by calling the Pre-authorization Office.
 If a pre-authorization is not obtained or approved, all medical expenses will not be reimbursed.

Note 4 - Under Network plan, emergency outpatient visits and hospitalization confinements are defined as
unplanned treatment and condition that is acute in nature and wherein the initial sign or symptom, and
the consultation or treatment for this condition cannot be and are not separated by more than 48 hours.

In case of emergency: outpatient visits after office hours (9:00pm – 9:00am) where the staff member
may not be able to consult network doctors, s/he should use the outpatient departments of Hospital
Authority hospitals or any private hospitals in Hong Kong and is required to notify AXA by calling AXA
on the first working day following the treatment (in advance of your claim submission).

Note 5 - Western medication covered means medication legally registered by the Pharmaceutical Service of
Department of Health in Hong Kong or the equivalent legal authority of any other place rendering
western medicine. Please visit the following link for registered western medications.
https://www.drugoffice.gov.hk/eps/do/en/pharmaceutical_trade/search_drug_database.html for
reference only

Note 6 - This Benefit shall also be payable for medical consultation conducted by a video consultation service
provider designated by AXA and paid by the AXA eHealth card. The benefit shall cover consultation
fee and Medically Necessary Western Medication prescribed by the video consultation service
provider and obtained at the clinic. For the avoidance of doubt, any medication delivery charge
might be borne by the Member and such fees might not be payable under this Benefit.

Note 7 - Referral letter from a general practitioner for specialist consultation is not required.

Note 8 - Referral letter from a general practitioner for Non-AXA-panel physiotherapist and chiropractor is
waived. Chiropractor is excluded under Network Plan.

Referral letter is required for consultation with an AXA panel physiotherapist. Referral letter is valid for
the same disability for 6 months from the issue date and keep valid for 9 months from the last
consultation of the same AXA panel physiotherapist.

Note 9 - Includes any Hong Kong Registered Chinese herbalist/bonesetter. Lists of Registered Chinese
herbalist can be obtained from the website of Chinese Medicine Council of Hong Kong
(http://www.cmchk.org.hk). Acupuncture, Tui Na and Medically Necessary Chinese Medicines
prescribed by a registered Chinese Medicine Practitioner and obtained at a legitimate source (at or
outside the treating Registered Chinese Medicine Practitioner's clinic) are covered under Free Choice
plan but are excluded under Network plan.

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Note 10 - Referral letter / Prescription from a registered medical practitioner is required. For X-ray and laboratory
tests, referral letters from a registered Chinese Medical Practitioner or Chiropractor will also be
accepted.

Note 11 - For members of Free Choice plan, medical claim for MRI, CT scan and PET scan carried out at clinic
or laboratory centres will be claimed under inpatient benefits – miscellaneous hospital service and
SMM benefit.

Note 12 - All the doctor fees for chemotherapy or radiotherapy will be claimed under in-patient physician’s fees
whilst all the medication fee or laboratory fee incurred will be claimed under Major Operation of
“Surgeon Fees” service. Any eligible amount of the above benefits but exceeding the limits under the
Hospitalization Benefits will be covered under SMM benefit.

Note 13 - Supplementary Major Medical Benefit provides additional benefit to cover eligible medical expenses
exceeding the applicable maximum limit or maximum number of days payable under hospitalization
and surgical benefits, subject to a fixed amount for respective levels of entitlement for each benefit
group. No benefit will be payable for confinement in VIP suite or deluxe suite under SMM. If a member
is admitted to a higher room & board facility beyond one’s entitlement, the reimbursement applicable
will be adjusted as follows:

Restricted Level Chosen Level Adjustment Factor

Semi-Private Private 50%
Ward Bed Semi-Private 50%
Ward Bed Private 25%
The Benefits payable under Supplementary Major Medical Benefit shall not be subject to the
adjustment factor if the Member stays in a room level higher than the entitled room level during
Hospital Confinement as a result of (i) unavailability of the applicable room as shown in the Schedule
of Benefits or lower room level due to room shortage at the Hospital for Emergency treatment; or (ii)
Hospital Confinement in isolation that requires a specific room level.

Note 14 - All full time permanent and fixed-term contract employees are eligible for this benefit. It is not
applicable to dependents, temporary and part-time employees.

This Benefit is payable if employee undergoes a physical examination for routine medical check-up
purposes by a Registered Medical Practitioner, routine eye examination performed by a Registered
Medical Practitioner or Registered Optometrist, and vaccination received in a medical clinic. The
amount payable shall be equal to the actual charges for such service and subject to the applicable
Maximum Limits. This benefit is also subject to the General Exclusion, such as dental check-up and
those relating to pregnancy.

Note 15 - All full time permanent and fixed-term contract employees are eligible for this benefit. It is not
applicable to dependents, temporary and part-time employees.

This Benefit is payable when the employee is treated by a Registered Dentist at the Registered
Dentist’s clinic and incurs treatment fees. This Benefit shall also be payable for scaling and polishing
performed by Registered Dental Hygienists. The amount payable under this Benefit shall be equal to
the actual charges for such dental treatment and subject to the applicable Maximum Limits, Overall
Limit, maximum number of visits and reimbursement percentage as shown in the Schedule of Benefits
(Appendix 1c).

Note 16 - The Maternity Benefits are provided to full time permanent and fixed-term contract employees and
their spouses on a reimbursement basis. AXA eHealth card should not be used for this purpose.
Medical claims should be submitted to AXA within 90 days from the date of treatment or discharge
from hospital; otherwise, they may be declined for settlement.

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 Appendix 2

LIST OF EXCLUSIONS

1. Treatment in any hospital that is not registered with the government or any person other than a
registered doctor or which is not Medically Necessary; or

2. General check-up, convalescence, custodial or rest care, preventive inoculation or medication

(unless it is payable under the relevant Benefits); or

3. Any elective treatment or procedure such as but not limited to cosmetic surgery (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), sterilization or beautification; or

4. Congenital anomalies conditions, or infertility; or

5. Pregnancy, childbirth, miscarriage or abortion; (unless it is payable under the relevant Benefits); or

6. Dental treatment or surgery unless necessitated by injury caused by an accident, provided such
treatment or surgery is given by a legally licensed dentist or dental surgeon within ninety (90) days
from the date of an Accident (unless it is payable under the relevant Dental Benefit); or

7. Any physiotherapy treatment or treatment by a chiropractor unless recommended by a registered

doctor and treated in a registered clinic or hospital (unless it is payable under the relevant Benefits);
or

8. Correction of eye vision or fitting of eye glasses; or

9. Rental or purchase of prosthetic appliances such as but not limited to hearing aids, artificial limbs,
glasses or corset; or

10. Participation in illegal acts (except traffic and pedestrian offences) such as but not limited to robbery,
drug abuse or assault; or

11. Declared or undeclared war or any act thereof; or

12. Any Injury or Sickness for which compensation is payable under any Government law or any other
health insurance policy except to the extent that such charges are not reimbursed by such laws or
other policies; or

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

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