metlife health-on-the-peak optional rider medical benefit€¦ · cancer treatments like...

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**Important Notice: Please be advised that following approval by the Hong Kong Insurance Authority, the FWD Group (“FWD”) has acquired MetLife Limited and Metropolitan Life Insurance Company of Hong Kong Limited (together, the “Companies”). MetLife is therefore no longer affiliated with the Companies and no longer responsible for matters related to the activities and insurance policies of the Companies. FWD will provide more information on the Companies’ new names and brand at a later date. **重要通知:請注意,經香港保險業監管局批准,富衛集團(“富衛”)已收購大 都會人壽保險有限公司及美商大都會人壽保險香港有限公司(統稱“該等公司”)。 大都會人壽因此不再與該等公司有關聯關係,亦不再負責該等公司之活動及保單有 關的事宜。富衛將在稍後提供有關該等公司新名稱及新品牌的更多資訊。

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Page 1: MetLife Health-on-the-Peak Optional Rider Medical Benefit€¦ · cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy,

**Important Notice: Please be advised that following approval by the Hong Kong

Insurance Authority, the FWD Group (“FWD”) has acquired MetLife Limited and

Metropolitan Life Insurance Company of Hong Kong Limited (together, the

“Companies”). MetLife is therefore no longer affiliated with the Companies and no

longer responsible for matters related to the activities and insurance policies of the

Companies. FWD will provide more information on the Companies’ new names

and brand at a later date.

**重要通知:請注意,經香港保險業監管局批准,富衛集團(“富衛”)已收購大

都會人壽保險有限公司及美商大都會人壽保險香港有限公司(統稱“該等公司”)。

大都會人壽因此不再與該等公司有關聯關係,亦不再負責該等公司之活動及保單有

關的事宜。富衛將在稍後提供有關該等公司新名稱及新品牌的更多資訊。

Page 2: MetLife Health-on-the-Peak Optional Rider Medical Benefit€¦ · cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy,

This product is an individual indemnity hospital insurance product and is available as a basic plan or an optional rider attachable to your basic plan. This leaflet is tailored for the optional rider, MetLife Health-on-the-Peak Medical Benefit. Please note that the information in this leaflet does not contain the full terms of the policy and is intended for reference only. Please refer to the policy provisions of MetLife Health-on-the-Peak Medical Benefit for full terms including but not limited to definitions, detailed terms, conditions and exclusions.

If you wish to learn more about the basic plan version of this product, please refer to the product brochure and policy provisions of MetLife Health-on-the-Peak Medical Plan for more details.

Maximum Benefit Limit (USD)

Geographical Coverage Area Worldwide Worldwide excluding the

United States of America Asia2

Annual Limit $3,125,000 $2,500,000 $1,250,000

Lifetime Limit $7,500,000 $6,250,000 $3,125,000

Room Type Standard Private Room

Standard Private Room

Standard Semi-Private Room

Thanks to technological advances, many twists and turns in life are now treatable hiccups in the hands of top-notch medical experts. To help you preserve your success with total peace of mind, MetLife Health-on-the-Peak Medical Benefit (the “Optional Rider”) which is attachable to your basic plan1 is uniquely designed with the following essential features to back up your health protection:

Comprehensive Coverage to Secure the Best CareWe all know that superior care and treatment can make all the difference when facing health issues. To ensure that you have access to top-quality and advanced medical services, the Optional Rider offers you 3 Plan Level options with different geographical coverage, providing you with an annual coverage of up to US$3,125,000, subject to a lifetime limit of up to US$7,500,000.

Optional RiderMetLife Health-on-the-Peak Medical Benefit

Page 3: MetLife Health-on-the-Peak Optional Rider Medical Benefit€¦ · cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy,

Advanced Cancer Treatments also CoveredThanks to medical advances, many new cancer treatments are in place. To reinforce protection against the prevailing health risks of modern times, our Optional Rider not only covers conventional cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy, hormonal therapy, immunotherapy, proton therapy and specially approved medication3.

Being committed to backing up your health protection all the way, post-hospitalization alternative treatments (physiotherapy, acupuncture, chiropractic treatment, osteopathy, traditional Chinese medicine treatment, occupational therapy, speech therapy and homeopathy) and other extended benefits (kidney dialysis, organ and bone marrow transplants, HIV treatment and reconstructive surgery, etc.) are also within the coverage of the Optional Rider.

Deductible Arrangements that Best Suit Your NeedsThe Optional Rider comes with 3 annual deductible options, which are US$0, US$1,250 and US$5,000. The options allow you to choose the annual amount that would be covered by you or your other insurance plans before you can claim under this Optional Rider. This way you can select the right level of protection you need based on your existing coverage and budget. With a higher deductible amount, the premiums for the Optional Rider would be lower. When you retire and are no longer covered by your company’s group medical benefit, you may choose to exercise the privilege to opt for a lower annual deductible at the age of 55 or 65 without having to provide any proof of insurability4.

Nowadays, day case surgeries are increasingly prevalent. As such, the Optional Rider not only covers day case surgeries, but also applies a lower special annual deductible of US$313 or less which saves you money.

Case Study (All figures below are hypothetical and for illustrative purposes only)

Mr. Chan is covered by MetLife Health-on-the-Peak Medical Benefit with the annual deductible option of US$5,000 and has not made any claim this year. He needs to have a nasal polyp removed. As this is a minor operation, to save the time and hassle of in-patient treatment, he has opted for day case surgery which costs US$1,875.

Under MetLife Health-on-the-Peak Medical Benefit, a lower special annual deductible of US$313 applies to Mr. Chan’s case, instead of the standard annual deductible (i.e. US$5,000 for Mr. Chan’s policy). With other medical plans in the market, the standard annual deductible typically applies to both in-patient and day case surgeries, and Mr. Chan would have to pay US$1,875.

But in this case, Mr. Chan only has to pay US$313 and the rest is covered by the Optional Rider, saving him US$1,562.

Lower Special Annual Deductible of US$313Total cost of the surgery US$1,875Payable by Mr. Chan US$313Covered by the Optional Rider US$1,562

From Pre-hospitalization to Post-hospitalizationYou can enjoy the high coverage without worrying about maxing out the item-by-item limits which typically occurs with ordinary medical insurance plans. Medical costs from pre-hospitalization, confinement, and surgery to post-hospitalization are covered under the Optional Rider, including surgical fees, medical devices, pre-/post-hospitalization out-patient consultations, post-hospitalization home nursing and more.

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Page 4: MetLife Health-on-the-Peak Optional Rider Medical Benefit€¦ · cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy,

Guaranteed Yearly Renewable for Protection up to the Age of 100When it comes to medical protection, having comprehensive coverage is not enough. Rather, it is the guarantee that you can enjoy such coverage throughout your lifetime that really counts. If the Optional Rider continues to be available for renewal, your Optional Rider is guaranteed renewable every year for protection up to the age of 100.

Value-add Services to Upgrade Your HealthCashless Arrangement5 and Second Medical Opinion6 - During the course of treatment, you may need to take time to rest and recover. To save time and spare you the hassle, the Optional Rider provides you with the cashless arrangement service5. Through this service, we handle the settlement of covered medical expenses directly with the hospital, assuming you have completed a simple application process prior to your visit. In specific cases where you need to consult more than one source on a confirmed diagnosis of designated diseases, we can also arrange a free second medical opinion6 for you.

24-hour Worldwide Emergency Assistance Service6 - True protection follows wherever you go. Under the Optional Rider, the 24-hour Worldwide Emergency Assistance Service6 is available for you to seek emergency assistance while you are traveling abroad.

You deserve the best care.Protect your health with

MetLife Health-on-the-Peak Medical Benefit today!

Summary of the Optional Rider

Issue Age 0 – 65 years old (Age last birthday)

Product Type Individual Indemnity Hospital Insurance

Plan Type Optional Rider

Policy Currency US Dollar

Term of Optional Rider Guaranteed Yearly Renewable up to age 100 of the insured person

Premium Payment Term Up to age 100 of the insured person

Premium Structure Yearly renewable and non-guaranteed

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Page 5: MetLife Health-on-the-Peak Optional Rider Medical Benefit€¦ · cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy,

Benefit ScheduleMaximum Benefit Limit (USD)

Plan Level Global Plan Multinational Plan Oriental Plan

Geographical Coverage Area Worldwide Worldwide excluding the United States of America Asia2

Annual Limit $3,125,000 $2,500,000 $1,250,000

Lifetime Limit $7,500,000 $6,250,000 $3,125,000

Room type Standard Private Room

Standard Private Room

Standard Semi-Private Room

Annual Deductible Options(Applies to Medical Reimbursement Benefits only) $0 $1,250 $5,000 $0 $1,250 $5,000 $0 $1,250 $5,000

Day Case Surgery Annual Deductible(Applies to Day Case Surgery Benefit only)

$0 $313 $313 $0 $313 $313 $0 $313 $313

Medical Reimbursement Benefits

I. Confinement Benefits

a. Hospital Room and Board Benefit Full cover

b. Physician’s Visit Full cover

c. Specialist’s Visit7 Full cover

d. Companion Bed Benefit Full cover

e. Intensive Care Benefit7 Full cover

f. Miscellaneous Hospital Expenses Full cover

g. Private Nursing Benefit7Full cover

(maximum 30 days per policy year) (following i) surgery or ii) discharge from admission to Intensive Care Unit)

h. Psychiatric Treatment Benefit8 Full cover(maximum 45 days per policy year)

II. Surgical Benefits

a. Surgical Fee Full cover

b. Anaesthetist’s Fee Full cover

c. Operating Theatre Fee Full cover

d. Day Case Surgery Benefit Full cover

e. Medical Devices Full cover for specified items9

III. Pre- and Post-hospitalization Benefits

a. Pre-hospitalization Out-patient Benefit7Full cover

(maximum 1 general physician consultation and 1 specialist consultation per day)(within 30 days prior to confinement or day case surgery)

b. Post-hospitalization Out-patient Benefit7 Full cover (maximum 1 visit per day) (within 60 days after discharge from confinement or day case surgery)

c.

Post-hospitalization Alternative Treatment Benefit7

(which covers traditional Chinese medicines treatment, chiropractic treatment, acupuncture, homeopathy, osteopathy, physiotherapy, occupational therapy and speech therapy)

$3,750 per policy year (maximum $100 per visit and 1 visit per day)

(within 90 days after discharge from confinement or day case surgery)

d.Post-hospitalization Home Nursing Benefit7

Full cover (maximum 30 days per policy year)

(within 90 days after discharge from hospital following i) surgery or ii) admission to Intensive Care Unit)

e. Rehabilitation Benefit7 $6,250 per policy year (within 90 days after discharge from confinement)

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Page 6: MetLife Health-on-the-Peak Optional Rider Medical Benefit€¦ · cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy,

Remarks1. For basic plans available for attaching the Optional Rider, please contact MetLife Limited or your financial consultant for details.

Please refer to the Policy Provisions of the Optional Rider for the details of termination events.2. Asia covers Afghanistan, Australia, Bangladesh, Bhutan, Brunei, Cambodia, Hong Kong, India, Indonesia, Japan, Kazakhstan,

Kyrgyzstan, Laos, Macau, Mainland China, Malaysia, Maldives, Mongolia, Myanmar, Nepal, New Zealand, North Korea, Pakistan, Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Tajikistan, Thailand, Timor-Leste, Turkmenistan, Uzbekistan and Vietnam.

3. Specifically approved medication means medication which is not registered with the Department of Health in Hong Kong but which is:(i) approved by and registered with the regulatory authority for pharmaceutical products in the United States of America or

Europe or Japan;(ii) imported into Hong Kong from United States of America, Europe or Japan for treatment of the insured person’s cancer under

the Import License (Form 3) granted by Department of Health in Hong Kong, provided that pre-approval is obtained from MetLife Limited before application for the Import License (Form 3) is filed with the Department of Health in Hong Kong;

(iii) Medically Necessary for treatment of the insured person’s cancer and recommended by a specialist in the relevant field in writing; and

(iv) consumed by the insured person in Hong Kong.4. This can only be exercised once per lifetime of the insured person and when the Optional Rider has been in force and effect for

3 consecutive policy years; and within 31 days immediately before the policy anniversary date on or immediately following the insured person’s 55th or 65th birthday.

5. MetLife Limited has engaged Medical Administrators International (Hong Kong) Limited (“MAI”) to provide the relevant services. MetLife Limited shall not be liable for any matters in respect of the services provided and reserves the right to revise the details of the services or withdraw the services from time to time without prior notice. The approval of the Cashless Arrangement Service is subject to the terms and conditions of MAI and the acceptance of the “Letter of Guarantee” by the hospitals. If the hospital expenses incurred have exceeded the eligible claim amount, the shortfall has to be borne by the policyowner or insured person.

6. The Second Medical Opinion Service and 24-hour Worldwide Emergency Assistance Service is provided by Inter Partner Assistance Hong Kong Ltd. and Aspire Lifestyles (HK) Limited respectively. MetLife Limited shall not be liable for any matters in respect of the services provided and reserves the right to revise the details of the services or withdraw the services by giving no less than 1 month’s prior written notice.

7. Written recommendation from a registered attending physician is required.8. Written recommendation from a registered specialist in psychiatry is required.9. Specified items include pace maker, stents for Percutaneous Transluminal Coronary Angioplasty, intraocular lens, artificial

cardiac valve, metallic or artificial joints for joint replacement, prosthetic ligaments for replacement or implantation between bones, prosthetic intervertebral disc; and prosthetic device implanted during surgery and/or replacement of any other body organ or part inside the insured person’s body which is Medically Necessary.

IV. Extended Benefits

a.Cancer Treatment Benefit7

(includes chemotherapy, target therapy, radiotherapy, hormonal therapy, immunotherapy, proton therapy and specifically approved medication3)

Full cover

b. Kidney Dialysis Benefit7 Full cover

c. Organ and Bone Marrow Transplant Benefit Full cover

d. Accidental Out-patient Treatment Benefit Full cover (within 24 hours after accident)

e. Accidental Dental Treatment Benefit Full cover (within 2 weeks after accident)

f. HIV / AIDS Treatment Benefit $100,000 per life (once per lifetime)

g. Reconstructive Surgery Benefit7 $25,000 per life (within 12 months from the date of accident or date of mastectomy)

h. Hospice and Palliative Care Benefit7 $25,000 per life (once per lifetime)

i. Pregnancy Complications Benefit7 Full cover

Other Services

a. Cashless Arrangement Service5

b. Second Medical Opinion Service6

c. 24-hour Worldwide Emergency Assistance6

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Page 7: MetLife Health-on-the-Peak Optional Rider Medical Benefit€¦ · cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy,

Key Product RiskGeneral Exclusions

The Optional Rider will not cover conditions that result from any of the following events:(i) Pre-existing Condition;(ii) intentionally self-inflicted injury, or attempted suicide, while sane or insane;(iii) any treatment as a result of nuclear contamination or as a result of the insured person’s participation in war (whether it is

declared or not), invasion, act of foreign enemies, hostilities, strike, riot and/or civil commotion, civil war, rebellion, revolution, insurrection, terrorist acts, military or usurped power;

(iv) any act of the insured person contrary to the law of the country or territory in which the act is committed;(v) any congenital anomaly or inherited disorder or developmental disorders which has manifested or was diagnosed before the

insured person attains age 16;(vi) pregnancy (including child birth, miscarriage, or abortion), surrogacy or foetal surgery and complication resulting therefrom or

relating thereto, unless such occurrence is covered by Pregnancy Complications Benefit, birth control, infertility treatment or assisted reproduction;

(vii) any elective surgery or treatment, cosmetic surgery or treatment, plastic or reconstructive surgery or treatment, unless such surgery or treatment is covered by Reconstructive Surgery Benefit;

(viii) dental care and treatment unless such occurrence is covered by Accidental Dental Treatment Benefit;(ix) scuba diving or engaging in or taking part in any kind of race other than on foot, mountaineering involving the use of ropes or

guides by the insured person;(x) the insured person being under the influence of alcohol or drugs unless, in the case of drug consumption, it is proved that such

drug was taken in accordance with proper medical prescription or treatment;(xi) the insured person being in a state of insanity or psychiatric or psychological disturbance or any mental or nervous disease or

disorder unless such occurrence is covered by Psychiatric Treatment Benefit;(xii) sexual problem or sex changes, any sexually transmitted disease which is classified as a venereal disease in the International

Classification of Diseases (ICD) and testing for sexually transmitted diseases, infection with Human Immunodeficiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS) and/or any mutations, derivations or variations, AIDS Related Complex (ARC) and complications resulting therefrom or relating thereto unless such occurrence is covered by HIV / AIDS Treatment Benefit;

(xiii) routine preventive health checks and vaccinations;(xiv) prostheses, orthotic devices, corrective devices and medical appliances not required for a surgical operation (unless such

medical appliances and medical devices are covered by medical devices of the Surgical Benefits);(xv) experimental drugs and treatment which have not been approved by the government, relevant authorities and recognized

medical association in the locality (unless such drug is a specifically approved medication);(xvi) consumption of any of the following traditional Chinese medicines: (i) agaricus blazei murill, (ii) antelope horn powder, (iii)

antler, (iv) cordyceps, (v) cubilose, (vi) donkey-hide gelatin, (vii) ganoderma, (viii) all kinds of ginseng, (ix) hippocampus, (x) moschus, (xi) pearl powder and (xii) placenta hominis;

(xvii) the organ transplantation cost incurred in connection with identifying and procuring a replacement organ or organ donation as the donor, all associated transportation costs and administrative costs;

(xviii) treatment of sleep disorders including insomnia, snoring or sleep apnoea (except for the treatment of sleep apnoea which is life threatening as confirmed by the attending physician and approved by MetLife Limited in advance);

(xix) treatment of obesity (including morbid obesity), weight control program or bariatric surgery (except when bariatric surgery is Medically Necessary as confirmed by the attending physician and approved by MetLife Limited in advance);

(xx) bank charges, expenses incurred for the provision of medical and hospital bills, certificates, documentation, information or other evidence as required by MetLife Limited;

(xxi) any confinement or stay, surgery, medical treatment, services and/or supplies for which compensation or reimbursement is payable under any law, medical program, or insurance policy provided by any governments, companies or other insurance providers; and

(xxii) any confinement or stay, surgery, medical treatment, investigation, services and/or supplies which are not Medically Necessary; or any charges which exceed the Reasonable and Customary charges.

Product Limitations1. Your Optional Rider will terminate when the aggregate benefits paid (except Life Benefit) under all insurance policies (including

this Optional Rider), whether in force or not, covering the insured person that are subject to respective lifetime limits and issued by the MetLife Limited have reached the lifetime limit which corresponds to your chosen Plan Level.

2. Cover for specific items will take effect from the following dates:

ItemsCoverage Effective Date

(after the effective date or the latest reinstatement date of the Optional Rider, whichever is later)

Accidental Injury Immediately

Sickness 30 days

Pregnancy Complications 300 days

Organ and Bone Marrow Transplant 1 year

HIV / AIDS Treatment 5 years

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Page 8: MetLife Health-on-the-Peak Optional Rider Medical Benefit€¦ · cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy,

3. MetLife Limited shall reimburse Reasonable and Customary charges for the actual expenses incurred for Medically Necessary Confinement or stay, surgery, medical treatment, services and/or supplies up to the relevant maximum benefit limits as shown in the Benefit Schedule.

Reasonable and Customary means the level of charges for confinement or stay, surgery, medical treatment, services and/or supplies received by the insured person that are Medically Necessary, which does not exceed the usual level of charges for such confinement or stay, surgery, medical treatment, services and/or supplies in the locality where the charges are incurred. Please refer to the Policy Provisions for the definition of Medically Necessary.

Confinement means an admission of the insured person to a hospital or mental or psychiatric hospital that is recommended by a physician for medical service and as an in-patient as a result of a Medically Necessary condition in relation to a covered injury or covered sickness for a period of no less than 6 consecutive hours. No minimum period is required for confinement in connection with any emergency treatment in a hospital, as a result of an emergency for the performance of a surgical procedure or other medical service in a hospital, or where a confinement commences and ends on 2 different dates. Confinement shall be evidenced by a daily room charge invoiced by the hospital or mental or psychiatric hospital and the insured person must stay in the hospital or mental or psychiatric hospital continuously for the entire period of confinement.

4. If the insured person is confined in a room of a class above the room type which corresponds to the chosen Plan Level on any days of a confinement, the below adjustment factor shall be multiplied to any amount that can be claimed under the Confinement Benefits and Surgical Benefits for such confinement:

Room Type of the ConfinementRoom Type Corresponding to Chosen Plan Level

Standard Semi-Private Room Standard Private Room

Standard Semi-Private Room Not applicable Not applicable

Standard Private Room 50% Not applicable

Any room with amenities upgraded beyond a Standard Private Room 25% 25%

Please refer to the Policy Provisions for the definition of Standard Semi-Private Room and Standard Private Room.

5. If the insured person changes his or her principal location of residence to a Designated Country, where such Designated Country is within the Geographical Coverage Area which corresponds to the chosen Plan Level, commencing from the date of such change, in respect of any confinement or stay, surgery, medical treatment, services and/or supplies for the covered injury and covered sickness which takes place in such Designated Country being the principal location of residence, any amount that can be claimed under Medical Reimbursement Benefits therein shall be reduced to 75% of the Medical Reimbursement Benefits payable. Designated Country refers to any country below or a country covered in any below region:i. Western Europe (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Monaco,

Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, United Kingdom and Vatican City); ii. Australia;iii. New Zealand; andiv. Canada.

6. If both product limitations no. 4 and 5 are applicable, any amount that can be claimed under Confinement Benefits and Surgical Benefits shall be multiplied by both 75% and the adjustment factor while any amount that can be claimed under Pre- and Post-Hospitalization Benefits and Extended Benefits shall be reduced to 75% of the amount payable.

7. If your chosen Plan Level is Global Plan, any amount that can be claimed under Medical Reimbursement Benefits shall be reduced to 50% of the amount payable if:i. the insured person’s principal location of residence is the United States of America at the time of any confinement or stay,

surgery, medical treatment, services and/or supplies received by the insured person in the United States of America; and/orii. the confinement, stay, surgery, medical treatment, services and/or supplies received by the insured person in the United

States of America are not pre-approved by MetLife Limited unless such confinement, surgery, medical treatment, services and/or supplies are incurred solely for emergency purpose due to an accident.

8. If both product limitations no. 4 and 7 are applicable, any amount that can be claimed under Confinement Benefits and Surgical Benefits shall be multiplied by both 50% and the adjustment factor while any amount that can be claimed under Pre- and Post-Hospitalization Benefits and Extended Benefits shall be reduced to 50% of the amount payable.

9. If the chosen Plan Level is the Multinational Plan or Oriental Plan, no benefits are payable under the Medical Reimbursement Benefits for any confinement or stay, surgery, medical treatment, services and/or supplies in a country outside the Geographical Coverage Area of the chosen Plan Level unless such country is not the principal location of residence of the insured person and the confinement, surgery, medical treatment, services and/or supplies that are incurred solely for emergency purposes due to an accident within 30 days of entry to such country.

10. Pre-existing Condition means any injury or sickness:

(i) which existed or was existing;

(ii) where its cause existed or was existing;

(iii) where the insured person had knowledge of the injury or sickness, signs or symptoms of the sickness;

(iv) where any laboratory test or investigation showed the presence of the injury or sickness; or

(v) which the insured person suffered or was suffering from; prior to the effective date (if the Optional Rider has not been reinstated) or the effective date of reinstatement (if the Optional

Rider has been reinstated), whichever is later.

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Page 9: MetLife Health-on-the-Peak Optional Rider Medical Benefit€¦ · cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy,

11. Requirement for obtaining pre-approval:

(i) Bariatric surgery or treatment of sleep apnoea must be confirmed as Medically Necessary by the attending physician and approved by MetLife Limited in advance.

(ii) Specifically approved medication must be recommended in writing by a registered specialist in the relevant field and approved by MetLife Limited in advance before the relevant application is filed with the Department of Health in Hong Kong.

(iii) (Only applicable to Global Plan) The confinement, stay, surgery, medical treatment, services and/or supplies received by the insured person in the United States of America needs to be pre-approved by MetLife Limited unless such confinement or surgery are incurred solely for emergency purpose caused by an accident, otherwise, any amount that can be claimed under Medical Reimbursement Benefits shall be reduced to 50% of the amount payable.

Premium Adjustment and Benefit Revision Premium shall be determined by reference to the last birthday of the insured person upon renewal on each policy anniversary date. The premium rate is non-guaranteed and may be increased. MetLife Limited reserves the right to adjust the rate of premium from time to time by giving you not less than 1 month’s prior written notice.

MetLife Limited has the absolute discretion and right to revise the benefit structure (including but not limited to annual deductible, day case surgery annual deductible and benefit limits), benefits, restrictions, terms and conditions and premium rates under the Optional Rider on each renewal by giving not less than 1 month’s prior written notice to the policyowner. Any revision and adjustment will apply to your Optional Rider automatically on renewal.

Any revision and adjustment to the premium and/or benefit will reflect the past experience and long-term assumptions of a number of factors in respect of the relevant policies including but not limited to (a) medical cost inflation; (b) expected changes in medical trends and practices; (c) operating expenses; (d) policy persistency; (e) cost of claim; and (f) performance of the investment of the assets.

Non-payment of PremiumYou should pay premium(s) on time and according to the selected premium payment schedule while the Optional Rider is in force. If you do not pay the premium within 60 days of the premium due date, the Optional Rider will be terminated and the insured person will lose the coverage.

Renewal and Changes to Plan LevelIf the Optional Rider continues to be available for renewal and all premiums have been paid, the renewal of your Optional Rider is guaranteed without further production of health evidence required on each policy anniversary date before the insured person's age exceeds age 99, subject to the premium rate, benefit structure and terms and conditions that apply at the time of renewal.

If MetLife Limited decides to no longer offer the Optional Rider to all policyowners who are already enrolled, MetLife Limited will endeavor to enroll the insured person in another medical plan or rider available at that time.

If the chosen Plan Level is the Global Plan, MetLife Limited has absolute discretion to revise the Plan Level of your Optional Rider from Global Plan to Multinational Plan at any time if the principal location of residence of the insured person has changed to the United States of America.

Existence and Duration of Right of CancellationWhile the Optional Rider is in force, you may surrender or terminate the Optional Rider at any time by sending a written request to us.

Implication on Pre-existing Conditions and Other Implications When Switching from One Policy to AnotherIf you want to switch to another medical policy from your existing medical plan, there would likely be changes in the premium rate, coverage, exclusions, as well as terms and conditions which you are subject to. In particular, you should pay attention to whether the new plan covers the Pre-existing Conditions.

Claims ProcedureIf you wish to make a claim, you must notify us within 30 days of the date of the event which may give rise to claim, and send us the completed prescribed claim forms and written proofs in support of the claim within 90 days from the date of such event. You can get the prescribed claim form by calling our Customer Service Hotline (852) 8102 1332 or by downloading from our website at http://www.metlife.com.hk.

Full DisclosureYou should make full and frank disclosure of all material facts, including without limitation health conditions, in response to the questions asked when applying for the Optional Rider. Non-disclosure may render the Optional Rider voidable at the sole and absolute discretion of MetLife Limited and the benefits provided under the Optional Rider may become immediately repayable to MetLife Limited and MetLife Limited reserves the right to recover from the policyowner any costs related to the Optional Rider.

Double InsuranceIf you are covered by more than one indemnity hospital insurance plan, you should be aware that any actual amounts reimbursed by other insurance policies will be deducted from the benefit payable under this Optional Rider. Such amounts will count towards the annual deductible and/or the day case surgery annual deductible (if applicable) if (i) you submit the relevant documents such as receipts and claims settlement letter issued by the other insurance providers to MetLife Limited and (ii) the relevant claim would have been payable under this Optional Rider.

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Page 10: MetLife Health-on-the-Peak Optional Rider Medical Benefit€¦ · cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy,

Credit RiskThe Optional Rider is underwritten by MetLife Limited. The benefits payable under your Optional Rider are subject to the credit risk of MetLife Limited. If MetLife Limited is unable to satisfy the financial obligations of the Optional Rider, insured person may lose the coverage and you may lose the premium paid.

Foreign Exchange RiskYou should be aware that any transaction which is denominated in a currency other than that of your home currency is subject to foreign exchange risks.

Inflation RiskThe benefits under the Optional Rider may not be sufficient for the increasing protection needs in the future as the future cost of living may be higher than now due to the effects of inflation.

Important Notes● MetLife Limited reserves the right to accept or reject any application for MetLife Health-on-the-Peak Medical Benefit.● MetLife Health-on-the-Peak Medical Benefit is an optional rider with no savings element. All premiums pay for the insurance and

related costs. ● MetLife Limited is the insurance underwriter of MetLife Health-on-the-Peak Medical Benefit, and is solely responsible for all

content, approvals, coverage and benefit payment. MetLife Limited is a wholly-owned subsidiary of MetLife, Inc. in Hong Kong and operates under the "MetLife" brand. MetLife Limited is a company incorporated and registered as a private company limited by shares under the applicable laws in Hong Kong.

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MetLife Limited Customer Service Centre: Level 57, Hopewell Centre, 183 Queen’s Road East, Wan Chai, Hong KongTel: (852) 2199 1000 Fax: (852) 8101 3977 www.metlife.com.hk(This leaflet is for distribution in Hong Kong only.)

Insurance Companyof the Year

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9

Page 11: MetLife Health-on-the-Peak Optional Rider Medical Benefit€¦ · cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy,

年繳保費表 (美元 )- 全球計劃 Annual Premium Table (USD)-Global Plan

年齡 Age (上次生日年齡 )

(Age last birthday)

每年自付額(美元)Annual Deductible (USD)

$0(門診手術之每年自付額:$0)

(Day Case Surgery Annual Deductible: $0)

$1,250(門診手術之每年自付額:$313)

(Day Case SurgeryAnnual Deductible: $313)

$5,000(門診手術之每年自付額:$313)

(Day Case SurgeryAnnual Deductible: $313)

男性 Male 女性 Female 男性 Male 女性 Female 男性 Male 女性 Female

0-4 2,305 2,257 1,844 1,805 1,083 1,060

5-17 1,844 1,805 1,475 1,444 867 848

18 1,867 1,833 1,494 1,467 877 862

19 1,892 1,862 1,514 1,489 889 874

20 1,915 1,900 1,532 1,520 900 894

21 1,944 1,949 1,555 1,559 914 917

22 2,005 2,010 1,604 1,608 943 945

23 2,069 2,074 1,655 1,659 973 975

24 2,132 2,135 1,705 1,709 1,002 1,004

25 2,204 2,199 1,763 1,759 1,035 1,033

26 2,278 2,262 1,822 1,809 1,070 1,064

27 2,353 2,325 1,883 1,860 1,105 1,093

28 2,408 2,387 1,925 1,909 1,132 1,122

29 2,464 2,450 1,972 1,962 1,158 1,152

30 2,478 2,529 1,983 2,024 1,164 1,189

31 2,522 2,632 2,018 2,105 1,185 1,237

32 2,569 2,733 2,055 2,187 1,208 1,285

33 2,622 2,840 2,098 2,273 1,233 1,335

34 2,659 2,945 2,128 2,357 1,250 1,385

35 2,699 3,037 2,159 2,429 1,268 1,427

36 2,758 3,132 2,207 2,505 1,295 1,472

37 2,815 3,230 2,253 2,584 1,323 1,519

38 2,877 3,330 2,302 2,665 1,353 1,565

39 2,935 3,432 2,348 2,745 1,380 1,613

40 3,007 3,538 2,405 2,830 1,413 1,663

41 3,089 3,677 2,470 2,942 1,452 1,728

42 3,175 3,834 2,540 3,068 1,493 1,803

43 3,282 3,989 2,625 3,192 1,543 1,874

44 3,408 4,148 2,727 3,318 1,602 1,949

45 3,585 4,305 2,868 3,444 1,685 2,024

46 3,773 4,462 3,018 3,569 1,774 2,098

47 3,980 4,620 3,184 3,697 1,870 2,172

48 4,200 4,778 3,360 3,823 1,974 2,247

49 4,435 4,937 3,548 3,949 2,084 2,320

50 4,725 5,093 3,780 4,074 2,222 2,394

A1

Page 12: MetLife Health-on-the-Peak Optional Rider Medical Benefit€¦ · cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy,

年齡 Age (上次生日年齡 )

(Age last birthday)

每年自付額(美元)Annual Deductible (USD)

$0(門診手術之每年自付額:$0)

(Day Case Surgery Annual Deductible: $0)

$1,250(門診手術之每年自付額:$313)

(Day Case SurgeryAnnual Deductible: $313)

$5,000(門診手術之每年自付額:$313)

(Day Case SurgeryAnnual Deductible: $313)

男性 Male 女性 Female 男性 Male 女性 Female 男性 Male 女性 Female

51 5,067 5,288 4,053 4,230 2,382 2,487

52 5,475 5,487 4,380 4,389 2,573 2,579

53 5,933 5,684 4,747 4,547 2,788 2,672

54 6,483 5,880 5,187 4,704 3,047 2,764

55 7,034 6,145 5,627 4,917 3,307 2,889

56 7,623 6,458 6,098 5,167 3,584 3,035

57 8,234 6,853 6,587 5,483 3,869 3,222

58 8,865 7,324 7,092 5,859 4,167 3,443

59 9,514 7,878 7,612 6,303 4,472 3,703

60 10,304 8,507 8,243 6,805 4,844 3,998

61 11,287 9,335 9,029 7,469 5,305 4,388

62 12,547 10,357 10,037 8,285 5,898 4,867

63 14,120 11,539 11,295 9,232 6,637 5,424

64 15,697 12,720 12,557 10,177 7,378 5,979

65 17,272 13,903 13,817 11,123 8,118 6,534

66* 18,749 14,717 14,999 11,774 8,813 6,918

67* 20,323 15,519 16,258 12,415 9,552 7,294

68* 21,898 16,319 17,518 13,054 10,292 7,670

69* 23,474 17,047 18,779 13,638 11,033 8,012

70* 24,222 17,849 19,377 14,279 11,384 8,390

71* 24,970 18,504 19,977 14,803 11,737 8,697

72* 25,718 19,162 20,574 15,329 12,087 9,007

73* 26,464 19,817 21,172 15,853 12,439 9,314

74* 27,214 20,473 21,770 16,378 12,790 9,623

75* 27,962 21,127 22,369 16,902 13,143 9,929

76* 29,355 22,367 23,485 17,894 13,798 10,512

77* 30,943 23,532 24,754 18,825 14,543 11,060

78* 32,459 24,698 25,967 19,759 15,255 11,608

79* 33,974 25,934 27,179 20,747 15,968 12,189

80* 35,490 27,099 28,393 21,680 16,680 12,737

81* 36,079 27,959 28,864 22,368 16,958 13,142

82* 36,643 28,869 29,314 23,095 17,222 13,569

83* 37,045 29,673 29,637 23,738 17,412 13,947

84* 37,353 30,458 29,882 24,367 17,557 14,315

85-99* 37,624 31,502 30,100 25,202 17,684 14,805

* 只供續保* For renewal only.

年繳保費表 (美元 )- 全球計劃 Annual Premium Table (USD)-Global Plan

A2

Page 13: MetLife Health-on-the-Peak Optional Rider Medical Benefit€¦ · cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy,

年繳保費表 (美元 )- 環宇計劃 Annual Premium Table (USD)-Multinational Plan

年齡 Age (上次生日年齡 )

(Age last birthday)

每年自付額(美元)Annual Deductible (USD)

$0(門診手術之每年自付額:$0)

(Day Case Surgery Annual Deductible: $0)

$1,250(門診手術之每年自付額:$313)

(Day Case SurgeryAnnual Deductible: $313)

$5,000(門診手術之每年自付額:$313)

(Day Case SurgeryAnnual Deductible: $313)

男性 Male 女性 Female 男性 Male 女性 Female 男性 Male 女性 Female

0-4 1,537 1,504 1,229 1,204 723 708

5-17 1,229 1,203 983 963 578 567

18 1,244 1,223 995 978 585 575

19 1,260 1,240 1,008 993 593 583

20 1,277 1,267 1,022 1,014 600 597

21 1,295 1,300 1,038 1,040 609 610

22 1,338 1,340 1,070 1,073 629 630

23 1,380 1,383 1,104 1,105 649 650

24 1,420 1,424 1,137 1,139 668 670

25 1,469 1,467 1,175 1,174 690 689

26 1,518 1,507 1,214 1,205 713 709

27 1,569 1,549 1,255 1,239 738 729

28 1,604 1,592 1,284 1,274 754 749

29 1,643 1,633 1,314 1,307 772 768

30 1,652 1,687 1,320 1,349 777 793

31 1,680 1,755 1,344 1,405 790 824

32 1,713 1,822 1,370 1,458 805 857

33 1,748 1,893 1,398 1,515 822 890

34 1,774 1,964 1,419 1,572 834 923

35 1,800 2,024 1,440 1,620 845 952

36 1,838 2,089 1,470 1,672 864 982

37 1,878 2,153 1,502 1,723 883 1,013

38 1,918 2,220 1,534 1,777 902 1,044

39 1,958 2,287 1,567 1,830 920 1,075

40 2,004 2,358 1,604 1,887 943 1,108

41 2,059 2,450 1,648 1,962 968 1,152

42 2,118 2,555 1,694 2,045 995 1,202

43 2,188 2,659 1,752 2,128 1,028 1,250

44 2,272 2,765 1,817 2,213 1,068 1,300

45 2,390 2,870 1,913 2,298 1,124 1,349

46 2,515 2,974 2,013 2,380 1,183 1,398

47 2,653 3,079 2,123 2,464 1,248 1,448

48 2,800 3,185 2,239 2,549 1,317 1,498

49 2,958 3,290 2,365 2,633 1,390 1,547

50 3,150 3,394 2,520 2,715 1,480 1,595

B1

Page 14: MetLife Health-on-the-Peak Optional Rider Medical Benefit€¦ · cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy,

年齡 Age (上次生日年齡 )

(Age last birthday)

每年自付額(美元)Annual Deductible (USD)

$0(門診手術之每年自付額:$0)

(Day Case Surgery Annual Deductible: $0)

$1,250(門診手術之每年自付額:$313)

(Day Case SurgeryAnnual Deductible: $313)

$5,000(門診手術之每年自付額:$313)

(Day Case SurgeryAnnual Deductible: $313)

男性 Male 女性 Female 男性 Male 女性 Female 男性 Male 女性 Female

51 3,378 3,525 2,702 2,820 1,587 1,657

52 3,650 3,657 2,920 2,925 1,715 1,718

53 3,955 3,788 3,164 3,030 1,859 1,780

54 4,322 3,920 3,458 3,138 2,030 1,843

55 4,690 4,097 3,752 3,278 2,204 1,925

56 5,083 4,305 4,067 3,444 2,389 2,024

57 5,489 4,568 4,392 3,654 2,580 2,148

58 5,909 4,883 4,728 3,907 2,778 2,294

59 6,343 5,252 5,074 4,202 2,982 2,468

60 6,869 5,672 5,494 4,538 3,229 2,667

61 7,524 6,223 6,019 4,979 3,537 2,924

62 8,364 6,904 6,692 5,523 3,932 3,245

63 9,414 7,693 7,532 6,154 4,425 3,617

64 10,465 8,479 8,372 6,783 4,918 3,985

65 11,515 9,268 9,212 7,414 5,412 4,357

66* 12,499 9,812 9,999 7,849 5,875 4,612

67* 13,548 10,347 10,839 8,277 6,368 4,863

68* 14,598 10,879 11,679 8,704 6,860 5,114

69* 15,649 11,364 12,519 9,090 7,355 5,340

70* 16,147 11,899 12,918 9,520 7,589 5,593

71* 16,647 12,335 13,317 9,868 7,824 5,798

72* 17,145 12,775 13,717 10,219 8,059 6,005

73* 17,643 13,210 14,115 10,569 8,293 6,210

74* 18,143 13,648 14,514 10,918 8,528 6,414

75* 18,640 14,085 14,913 11,268 8,762 6,620

76* 19,572 14,912 15,657 11,929 9,198 7,009

77* 20,629 15,689 16,504 12,550 9,695 7,374

78* 21,639 16,464 17,313 13,172 10,170 7,739

79* 22,650 17,290 18,120 13,832 10,647 8,127

80* 23,660 18,065 18,929 14,453 11,122 8,490

81* 24,053 18,639 19,243 14,912 11,305 8,760

82* 24,429 19,245 19,544 15,397 11,482 9,047

83* 24,698 19,783 19,759 15,827 11,608 9,298

84* 24,903 20,305 19,922 16,244 11,704 9,544

85-99* 25,083 21,002 20,065 16,802 11,789 9,870

* 只供續保* For renewal only.

年繳保費表 (美元 )- 環宇計劃 Annual Premium Table (USD)-Multinational Plan

B2

Page 15: MetLife Health-on-the-Peak Optional Rider Medical Benefit€¦ · cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy,

年繳保費表 (美元 )- 環亞計劃Annual Premium Table (USD)-Oriental Plan

年齡 Age (上次生日年齡 )

(Age last birthday)

每年自付額(美元)Annual Deductible (USD)

$0(門診手術之每年自付額:$0)

(Day Case Surgery Annual Deductible: $0)

$1,250(門診手術之每年自付額:$313)

(Day Case SurgeryAnnual Deductible: $313)

$5,000(門診手術之每年自付額:$313)

(Day Case SurgeryAnnual Deductible: $313)

男性 Male 女性 Female 男性 Male 女性 Female 男性 Male 女性 Female

0-4 999 978 799 783 470 460

5-17 798 782 638 625 375 368

18 809 794 648 635 382 373

19 819 807 655 645 385 379

20 832 823 664 659 392 388

21 842 845 674 677 395 398

22 869 870 697 697 409 410

23 897 898 717 718 422 422

24 924 925 739 740 435 435

25 954 953 764 763 449 448

26 987 980 789 785 464 462

27 1,020 1,007 817 807 479 473

28 1,043 1,034 834 828 490 487

29 1,068 1,062 854 849 502 499

30 1,074 1,097 859 877 504 515

31 1,094 1,140 874 913 515 535

32 1,113 1,184 890 948 524 557

33 1,137 1,230 910 985 534 578

34 1,153 1,277 922 1,022 543 600

35 1,170 1,315 937 1,053 550 619

36 1,195 1,358 955 1,085 562 638

37 1,222 1,399 977 1,120 574 658

38 1,245 1,443 997 1,154 585 679

39 1,272 1,488 1,018 1,189 598 700

40 1,303 1,532 1,043 1,227 612 719

41 1,339 1,593 1,072 1,274 629 749

42 1,375 1,662 1,100 1,330 648 782

43 1,423 1,729 1,138 1,384 668 813

44 1,475 1,799 1,180 1,439 693 845

45 1,554 1,865 1,243 1,493 730 877

46 1,634 1,934 1,308 1,547 768 909

47 1,724 2,002 1,379 1,602 810 942

48 1,819 2,070 1,455 1,657 855 973

49 1,922 2,138 1,538 1,710 903 1,005

50 2,048 2,207 1,638 1,765 963 1,038

C1

Page 16: MetLife Health-on-the-Peak Optional Rider Medical Benefit€¦ · cancer treatments like chemotherapy and radiotherapy but also advanced cancer treatments including target therapy,

年齡 Age (上次生日年齡 )

(Age last birthday)

每年自付額(美元)Annual Deductible (USD)

$0(門診手術之每年自付額:$0)

(Day Case Surgery Annual Deductible: $0)

$1,250(門診手術之每年自付額:$313)

(Day Case SurgeryAnnual Deductible: $313)

$5,000(門診手術之每年自付額:$313)

(Day Case SurgeryAnnual Deductible: $313)

男性 Male 女性 Female 男性 Male 女性 Female 男性 Male 女性 Female

51 2,195 2,292 1,757 1,834 1,032 1,078

52 2,372 2,378 1,898 1,902 1,114 1,118

53 2,570 2,464 2,055 1,972 1,208 1,158

54 2,809 2,549 2,248 2,040 1,320 1,199

55 3,048 2,662 2,439 2,129 1,433 1,252

56 3,304 2,799 2,644 2,239 1,553 1,315

57 3,568 2,970 2,854 2,377 1,677 1,397

58 3,840 3,174 3,073 2,539 1,805 1,492

59 4,123 3,413 3,299 2,730 1,938 1,604

60 4,464 3,685 3,572 2,948 2,098 1,733

61 4,890 4,045 3,913 3,237 2,299 1,902

62 5,437 4,488 4,350 3,590 2,555 2,109

63 6,119 4,999 4,897 3,999 2,877 2,350

64 6,802 5,512 5,442 4,409 3,198 2,592

65 7,484 6,023 5,988 4,819 3,518 2,832

66* 8,125 6,378 6,500 5,102 3,818 2,998

67* 8,808 6,725 7,045 5,380 4,140 3,160

68* 9,488 7,072 7,590 5,658 4,460 3,324

69* 10,173 7,387 8,138 5,909 4,782 3,472

70* 10,497 7,735 8,398 6,188 4,934 3,637

71* 10,822 8,018 8,658 6,414 5,087 3,769

72* 11,145 8,303 8,917 6,643 5,239 3,903

73* 11,468 8,588 9,175 6,870 5,389 4,037

74* 11,793 8,870 9,434 7,095 5,543 4,169

75* 12,117 9,155 9,693 7,324 5,695 4,303

76* 12,722 9,692 10,178 7,753 5,979 4,555

77* 13,409 10,197 10,728 8,158 6,303 4,793

78* 14,065 10,703 11,253 8,562 6,612 5,030

79* 14,723 11,238 11,779 8,992 6,920 5,282

80* 15,379 11,742 12,304 9,394 7,228 5,519

81* 15,635 12,117 12,509 9,693 7,349 5,695

82* 15,879 12,512 12,703 10,009 7,463 5,880

83* 16,054 12,859 12,843 10,288 7,545 6,044

84* 16,187 13,199 12,949 10,559 7,608 6,203

85-99* 16,303 13,652 13,043 10,922 7,663 6,415

* 只供續保* For renewal only.

年繳保費表 (美元 )- 環亞計劃Annual Premium Table (USD)-Oriental Plan

C2