Health Insurance
Policy Documents

Customer Shaped Policy Wording

 
We use customer feedback to shape our T&Cs so they are easier to understand

We want to make our health insurance policies as clear and easy to understand for you as we can. So our managers review and update our policy wording regularly to remove any grey areas. If you have any questions about your health insurance policy, please give us a call so one of our Customer Care Specialists can help.

Policy documents & wording

This document gives you complete information about your health insurance policy with DirectAsia.

Claims

Please complete the following documents which you are required to submit when it comes to making a health insurance claim.

 

Health Insurance FAQs

If you are willing to pay for a deductible, then you can buy the policy with a cheaper premium.

Pay only for what you need :

  1. Select the hospital tier plan according to your needs
  2. Choose your preferred  room and board 
  3. Decide on a deductible option

The premium is based on a number of factors including your age, gender, marital status, historical claim record and any deductible of your choice.

Yes, you can look forward to a yearly renewal on your plan. Exceptions will be considered in the event of abuse of cover, overdue payments or shortfall arising from a claim or claims made by deception.

No, it is not. Other companies sometimes have sub-limits by disability, for example there is a table which determines how much you will receive for each type of surgery or disability. Other insurers will impose an annual sub-limit, for example room and board will only be paid up to a certain amount per year.

We have removed all the sub-limits imposed by most other insurers. The only sub-limit we maintain is the daily limit on meal allowance.

The following costs are not covered: standard outpatient, routine checkup, maternity, dental or optical, percutaneous transluminal coronary angioplasty (PTCA), medical equipment and cosmetic/plastic surgery which are not required for medical purposes.

For more details read our policy details.

Waiting period refers to the period when you will have no coverage for any illnesses during that period. There is no waiting period with DirectAsia.com Health insurance and Top-up Health insurance so you enjoy continuous coverage.

In respect of a medical condition you may have, you are trouble free if you:

  • have not had any medical symptoms  from a medical practitioner including general practitioners, specialists or health professional or alternative practitioner; and
  • have not taken any medication (including over the counter drugs) or followed a special diet; and
  • have not had any medical treatment.
for the medical condition or any associated medical condition.

If you are trouble free for 2 continuous policy years with us, your pre-existing conditions will be covered.

Pre-existing conditions are covered after two continuous policy years with us, provided that you are trouble free during these two years.

Pre-existing condition is defined as any medical condition sustained in the past 5 years before you take up our health insurance policy:
  • for which you have been diagnosed; or
  • for which you have received medication, advice or treatment; or
  • for which you should, in our opinion, have known about; or
  • for which you have experienced signs or symptoms even if you have not consulted a medical practitioner

We have classified the private hospitals into tiers to allow you to benefit from a cheaper premium. Select the hospital tiers you are most comfortable with for your needs.

Find out more about Hospital networks.

ICU is covered. Of course there are some exclusions. Please check your policy details or contact our customer service hotline 2884 8888 for more information.

If you choose to upgrade, then you will pay for the difference between the lowest cost available single room and the upgraded room price. Additionally, all other fees associated with the upgraded room will be at your own cost. Reasonable and customary charges will be applied when assessing the cost of the claim.

You would have to downgrade to the next available room type.

A standard double room is the lowest cost available double room.

A standard single room is the lowest cost available single room.

This is dependent on the scenario. If you have exceeded the annual excess limit and have not made any claims towards hospitalisation expenses, you can claim the hospital cash benefit.

Hospitalisation expenses reimbursement refers to the amount you are entitled to claim from the medical expenses incurred.

Hospital cash is a cash benefit you will receive for the period which you were hospitalized, if no cost is borne by DirectAsia.com for your hospitalisation expenses.

The maximum claimable amount is cumulative sums of both hospitalisation expenses and hospital cash; please refer to your policy details.

If you are admitted into hospital and no cost is borne by DirectAsia.com, you will receive a hospital cash benefit based on the number of nights spent in the hospital.

No medical check-up is required. Applying for health insurance is simple and easy - just answer a few questions and you are instantly covered.

Yes, just call us at 2884 8888 or come to our office at 1101, 11/F, Allied Kajima Building, 138 Gloucester Road, Wan Chai, Hong Kong.

We will give you 21 days to review your policy from the date you receive it. If you decide to cancel the policy, you must inform us and return the policy documents within 21 days and we will refund the premium in full on the condition that no claim has been made during this period.

Please note that the free look period does not apply to renewals.

If you have selected a plan that covers countries other than Hong Kong, please call our 24-hour international emergency assistance hotline 852-2884 8899 and provide your policy number, full name, location and incident details. Rest assured you will be assisted throughout.

Yes if you purchase our plan with hospital tier 3 and with single occupancy room type.

No, DirectAsia.com health insurance is available to all occupations.

Yes you can, on the condition that you reside in Hong Kong for a minimum of 185 days in a year.

Yes, if you have an existing health insurance policy with us, you can buy health insurance for your child who must be at least 15 days old. A child aged between 15 days and 9 years must be enrolled with a parent or guardian.

If the child is aged between 10 years and 17 years, we would require the parent or guardian to facilitate the purchase of the policy on the child’s behalf.

No, outpatient benefits will not be covered. Only post hospitalisation follow up will be covered.

Only the surgery required to administer the replacement of donor organs are covered.

The administrative and collection costs for donor organs are not covered.

No, treatment for all types of sleep disorders including sleep apnoea, sleep study test, insomnia, snoring are not covered.

Breast reconstruction is covered only when the surgery is carried out following diagnosis of carcinoma breast and a mastectomy has been done on the patient. Also, the breast reconstruction surgery should be done at the same time as the mastectomy.

Cosmetic surgery or treatment will not be covered.

However we will pay for reconstructive surgery if it is recommended by the attending doctor following an accident or surgery or post medical condition.

Please seek confirmation for the treatment cost from DirectAsia.com, prior to proceeding.

You will be covered if it is not related to a pre-existing condition. Please check the definition of pre-existing in policy documents.

Your health insurance will cover you if you require hospitalisation. This however excludes injuries sustained from playing professional sports or from base jumping, cliff diving, flying in an unlicensed aircraft or as a learner, martial arts, hot air balloon, free climbing, mountaineering with or without ropes, scuba diving to a depth of more than 10 meters, trekking to a height of over 2,500 meters, bungee jumping, canyoning, hangliding, paragliding or microlighting, parachuting, potholing, skiing off piste or any other winter sports activity carried out off piste.

No, your health insurance does not provide any pre-natal and post-natal maternity benefits.

Any treatments to correct the refractive defects of the eyes, such as long or short sightedness or astigmatism, are not covered.

All forms of dental treatments (regardless whether it is due to an accident or injury or illness) are not covered.

No, it does not include the expenses associated with any medical check-up.

If hospitalisation to treat dengue fever is prescribed by the attending doctor, this will be covered by the plan

Common cold does not require hospitalisation and therefore will not be covered under your policy.

If the doctor recommends hospitalisation for the flu treatment, it will be covered subject to terms and conditions prescribed in your policy.

The list below is a guide and is not exhaustive nor definitive:

  • Backache
  • Hyperlipidemia
  • Hypertension
  • Cataracts
  • Kidney
  • Cancers
  • Chronic obstructive lung disease
  • Knee
  • Diabetes
  • Prostate
  • Bleeding disorders
  • Varicose veins
  • Long-standing indigestion/gastric symptoms
  • Gallstones

The Top-up plan provides you additional coverage on your existing primary medical insurance.
Assuming:

  • your top up annual excess is HK$ 65,000
  • the incurred hospitalisation cost is HK$150,000
  • your group health insurance scheme reimburses HK$50,000
  • The Top-up plan will cover you for HK$85,000. 
  • This means you will only need to pay HK$15,000. 
  • Without the Top-up plan, you will have to pay HK$100,000.

There is no pre-authorisation required for the Top-up plan unless the cumulative medical expenses exceed the annual excess limit.

Yes, they are covered for ‘rest cure’ or rehabilitation in the event that:

  • it is an integral part of treatment; and
  • it is carried out by a medical practitioner specialising in rehabilitation; and
  • it is carried out in a rehabilitation hospital or unit which is recognised by us; and
  • the costs have been agreed, in writing, by us before the rehabilitation begins.

DirectAsia.com will not pay for in-patient rehabilitation beyond 28 days with the exception of severe central nervous system damage caused by external trauma. Please see our Policy Details.

In an emergency situation, the doctor will administer the required treatment to help the patient.

When possible, the patient is required to complete the necessary insurance documentation, with the endorsement of the attending doctor. In the event that the doctor is not available, please request the Hospital Administration Office to assist in completing this claim form. 

Yes, we cover daycare surgery at your selected hospital tier.

The balance of the medical expenses following the claim made to another insurer will be assessed by DirectAsia.

If you choose not to claim the remaining medical expenses from us, you will be entitled to a hospital cash benefit and your NCD will not be affected.

No, there is no charge for ambulances if you call 999 under normal situation.

Pre-authorisation is required to protect the insured from unexpected costs. If the insured has no issues paying the deposit and settling the hospital bill first and claiming after, he/she does not require pre-authorisation.

If pre-authorisation is successful, no deposit is required.

Once all the required documents have been received by the claims specialist, a response will be provided within 5 working days.

For DirectAsia.com to settle the cost of the in-patient treatment directly with the hospital, the hospital first requires a Letter of Guarantee prior to commencing treatment.

This arrangement is set up to safeguard the hospital’s interests by ensuring they will receive payment for their services. 

Patients admitted without a Letter of Guarantee may be required to give a deposit upfront and settle the bill in full upon discharge. This bill may be forwarded to DirectAsia.com for reimbursement.

Five days prior to hospital admission, please call the customer service hotline to inform us of your impending admission. You are also required to complete the Health Pre-authorisation Claim Form and attach the medical report endorsed by the attending doctor. In the event that the doctor is not available, please request the Hospital Administration Office to assist in completing this claim form. 

The attending doctor needs to complete this. In the event that the doctor is not available, please request the Hospital Administration office to assist in completing this claim form.

If you have opted for the Hospital Tier 3 and single occupancy plan, you will also be covered in Brunei, Cambodia, China, Hong Kong, India, Indonesia, Japan, Laos, Macau, Malaysia, Myanmar, Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Thailand and Vietnam.

If you are admitted into hospital and no cost is borne by DirectAsia.com, you will receive a hospital cash benefit based on the number of nights spent in the hospital.

This benefit is useful in situations where you have to be admitted into a general ward at a public hospital. In such instances, medical reimbursements are often likely to be very low and below the hospital cash benefit.

Yes, you can login to My Account on our website to track the progress of your claims.

On confirmation that all necessary documentation has been submitted, you will receive a response from us in approximately 5 working days.

Either is fine. You can fax to 2884 8833 or email to Claim@DirectAsia.com.hk
You are still required to mail the original claim form and supporting documents to Direct Asia Insurance (Hong Kong) Limited, Room 1101, 11/F, Allied Kajima Building, 138 Gloucester Road, Wan Chai, Hong Kong. Please also keep copies for your own reference.

You are required to provide the following:

  • Original signed claim form
  • Original hospital receipts
  • Original medical reports
  • Copy of written pathological medical findings
  • Claim adjustment if any
  • Copy of HKID
  • Copy of relationship proof
  • Copy of policy report if accident

You are required to inform DirectAsia.com within 30 days of your claim and submit the completed form and supporting documents within 60 days following this notification.

Have questions?  Speak with us directly at (852) 2884 8888 or provide your details and we’ll call you back on the next working day.