Appendix

Benefit Schedule ― Basic Plan

(A) Hospital and Surgical

Plan A Plan B
Reimbursement Percentage 100% 100%

1. Hospital Room and Board

Cost of room, including meals, in any
hospital for up to 45 days per disability
Limit per day HK$850 HK$700

2. Hospital Services
Limit per disability HK$20,000 HK$12,000

3. Hospital Physician’s Services

Limit per day up to 45 days per disability HK$850 HK$700

4. Surgeon’s Fees (Limit per disability)

Complex HK$60,000 HK$33,750
Major HK$40,000 HK$22,500
Intermediate HK$20,000 HK$11,250
Minor HK$8,000 HK$4,500

5. Anaesthetist’s Fees (Limit per disability)

Complex HK$21,000 HK$10,200
Major HK$14,000 HK$6,800
Intermediate HK$7,000 HK$3,400
Minor HK$2,800 HK$1,360

6. Operation Theatre Fees (Limit per disability)

Complex HK$21,000 HK$10,200
Major HK$14,000 HK$6,800
Intermediate HK$7,000 HK$3,400
Minor HK$2,800 HK$1,360

7. Hospital Specialist’s Services

(If certified to be necessary by the
physician attending the insured person)
Limit per disability HK$4,000 HK$2,500

8. Day Confinement
Limit per disability HK$4,000 HK$4,000
Reimbursement Percentage 90% 90%

9. Emergency Assistance Service Unlimited Unlimited

10. Companion Bed (for child under age 18)

Limit per day up to 30 days per disability HK$150 HK$150

Manulife (International) Limited

Incorporated in Bermuda with limited liability

18/F., Manulife Tower, One Bay East, 83 Hoi Bun Road, Kwun Tong, Kowloon, Hong Kong
Tel: (852) 2202 1888 Fax: (852) 2104 2695 www.manulife.com.hk
(B) Clinical
Plan A Plan B
Reimbursement Percentage 80% 80%

1. General Practitioner’s Visit at the Clinic

Consultation and medication, including
Accident and Emergency (A&E)
Services in a public hospital, limited to
one call per day HK$300 HK$250

2. General Practitioner’s Visit at Home

Consultation and medication limited to one call per day HK$520 HK$440

3. Specialist’s Visit at the Clinic or at home

Doctor’s referral letter is required except Gynaecology
婦科, Paediatrics 兒科, Otorhinolaryngology (ENT) 耳鼻
喉科, Ophthalmology (Eye) 眼科, Orthopaedics and
Traumatology 骨科, Dermatology 皮膚科 and Urology 泌
尿科; consultation and medication limited to one call per
day HK$600 HK$500

4. Chinese Medicine Practitioner

Consultation and medication limited to one call per day HK$240 HK$200

5. Physiotherapist or Chiropractor Treatment

Doctor’s referral letter is required for Physiotherapist
treatment
Consultation and medication limited to one call per day HK$260 HK$220

Overall maximum number of visits for General

Practitioner ’s Visit at Clinic, General Practitioner’s
Visit at Home, Specialist’s Visit, Chinese Medicine
Practitioner, Physiotherapy and Chiropractor, per
year 40 40

6. Diagnostic X-ray and Laboratory Fees

Doctor’s referral letter is required
Limit per year HK$1,680 HK$1,200

7. Prescription Outside Clinic

Doctor’s referral letter is required
For purchasing medicine and drugs from a pharmacy or
dispensary as prescribed in writing by the attending
doctor on account of injury or sickness
Limit per year HK$1,440 HK$1,200

8. Routine yearly physical check-up

Each insured person is allowed one
routine physical examination per year
with a limit up to fee subject to
reimbursement percentage; includes
doctor’s consultation, X-ray and
laboratory test
Limit per year HK$240 HK$180
Manulife (International) Limited
Incorporated in Bermuda with limited liability

18/F., Manulife Tower, One Bay East, 83 Hoi Bun Road, Kwun Tong, Kowloon, Hong Kong
Tel: (852) 2202 1888 Fax: (852) 2104 2695 www.manulife.com.hk
Benefit Schedule ― Voluntary Supplementary Major Medical

Supplementary Major Medical

Plan A Plan B
Reimbursement Percentage 80% 80%
Maximum Limit per disability HK$250,000 HK$250,000
Deductible per disability HK$3,000 HK$3,000
Room and Board limited to Semi-Private Semi-Private

Manulife (International) Limited

Incorporated in Bermuda with limited liability

18/F., Manulife Tower, One Bay East, 83 Hoi Bun Road, Kwun Tong, Kowloon, Hong Kong
Tel: (852) 2202 1888 Fax: (852) 2104 2695 www.manulife.com.hk