- o p t i o n 4 - g o l d e n h e a l t h i n s u r a n c e p r o g...

INSURANCE HANDBOOKGOLDEN HEALTH INSURANCE PROGRAM

- OPTION 4 -

VIETJET AVIATION JOINT STOCK COMPANY

INSURANCE HANDBOOK - GOLDEN HEALTH - OPTION 4

1

TABLE OF CONTENT

I GENERAL INFORMATION ………………………………………………………… 2

II BENEFIT TABLE ………………………………………………………… 3

III DEFINITION ………………………………………………………… 6

IV WAITING PERIOD ………………………………………………………… 7

V EXTENSION CLAUSES ………………………………………………………… 8

VI MAIN EXCLUSIONS ………………………………………………………… 10

VII DIRECT BILLING AND CLAIM

PROCEDURE

………………………………………………………… 11

7.1 DIRECT BILLING PROCEDURE ………………………………………………………… 11

7.2 CLAIM BACK PROCEDURE ………………………………………………………… 13

7.3 CLAIM DOCUMENT ………………………………………………………… 14

7.4 MEDICAL SAMPLE ………………………………………………………… 15

VII CONTACTS FOR SUPPORT ………………………………………………………… 27


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I. GENERAL INFORMATION

Policy’s Holder : VIETJET AVIATION JOINT STOCK COMPANY AND/OR

COMPANIES/PARTNERS SUPPLYING HUMAN

RESOURCES FOR VIETJET AND/OR VIETJET’S MEMBER

COMPANIES

Eligibility of the Insured person : Employees

Period of insurance : From 01/08/2019 to 31/07/2020 (both day inclusive)

Insurer : BaoViet Insurance Corporation - Binh Duong Branch

Consultant : GiNET Vietnam


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II. BENEFIT TABLE

I PERSONAL ACCIDENT INSURANCE

1 ACCIDENT VND 2.000.000.000/year

AREA OF COVERAGE WORLDWIDE

1.1 Dealth or permanent total disablement due to accident 100% sum insured

1.2 Partial permanent disablement due to accident A percentage of Capital Sum

as per Scale of Compensation

2 MEDICAL TREATMENT FOLLOWING ACCIDENT VND 200.000.000/ year

AREA OF COVERAGE VIETNAM

2.1 Hospital miscellaneous charges Paid up to limit

2.2 Daily allowance per night when the Insured is paid from and above 70% total expenses by compulsory medical insurance (maximum 60 days/year)

VND 200.000/day

2.3 Expenses for transportation in emergency case (excluding by air and IPA, and limit for taxi: VND 500.000/person/year)

Paid up to limit

2.4 Educational support: VND 5,000,000/child, maximum 2 children under 18 years old whose mother/father is VietJet Air’s employee and die due to accident under coverage

VND 5.000.000

II HEALTH INSURANCE (EXCLUDING MATERNITY BENEFIT)

1 DEATH/ PERMANENT TOTAL DISABLEMENT FOLLOWING ILLNESS/ SICKNESS/ DISEASE (EXCLUDING MATERNITY BENEFIT)

VND 200.000.000/ year

AREA OF COVERAGE ASIA

Dealth/ Permanent total disablement due to sickness/illness/ disease (excluding maternity)

Paid up to limit

2 IN PATIENT TREATMENT FOLLOWING ILLNESS/ SICKNESS/DISEASE (EXCLUDING MATERNITY BENEFIT)

VND 200.000.000/ year


2.1 Hospitalization charges (including daycare treatment) VND 200.000.000/year

2.1.1 Daily accommodation charges (standard single room)

VND 10.000.000 /day

Maximum 60 days/year

2.1.2 Diagnostics Test charges

2.1.3 Drugs during treatment

2.1.4 Blood, dressings, plasma


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2.1.5 Other charges during inpatient treatment

2.1.6 Intensive care unit charges; Emergency ward

2.2 Surgical charges (including Inpatient/ Day-patient/ Minor surgery) VND 200.000.000/year

Surgical charges including but not limit: - Surgeon and anesthetist charges - Operating theatre charges - Medical supplies - In-hospital specialist consultation; - Rehabilitation after surgery - Organ transplant charges (excluding organ procurement costs as well as the costs incurred by the donor) - Re-surgical charges

Paid up to limit

2.3 Pre - hospitalization treatment (only 1 examination/test before the hospital admission)

VND 10.000.000/year

2.4 Post - hospitalization treatment (the nearest time within 30 days after discharge)

VND 10.000.000/year

2.5 Home nursing care after discharge (immediately following the date of charge and maximum 15 days/year)

VND 10.000.000/year

2.6 Rehabilitation VND 20.000.000/year

2.7 Daily allowance (Insured choose 1 allowance)

2.7.1 Daily allowance per night (maximum 60days/year) VND 200.000/day

2.7.2 Daily allowance per night when the Insured is paid from and above 70% total expenses by compulsory medical insurance (maximum 60 days/year)

VND 400.000/day

2.8 Local emergency transportation by all the transport, including taxi (max VND 500,000/year) and excluding airplane and IPA service

Paid up to limit

2.9 Burial Allowance (Death during hospitalization) VND 2.000.000/year

3 OUT PATIENT TREATMENT FOLLOWING SICKNESS/ILLNESS/DISEASE (EXCLUDING MATERNITY BENEFIT)

VND 10.000.000/year


3.1

- General Practitioners and Specialist fees, - Prescribed medicines, - Laboratory tests, X-ray tests, - Diagnostic and treatment prescribed by a physician within scope of coverage, including the first examination for physiotherapy

VND 2.000.000 / visit

Limit of visit/year Not limited


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3.2

Dental treatment - Diagnostic, x-rays - Gingivitis, pyorrhoea - Normal filling (amalgam or composite, fuji) - Root canal treatment - Removal of decayed teeth - Extractions of diseased teeth (including surgery and minor surgery, max VND 500,000/ year)

VND2.000.000/year

3.3 Physiotherapy, radiotherapy, heat therapy or phototherapy, other similar therapies prescribed by a physician (maximum 60 days/ year)

VND 100.000/day

Note: Dental treatment is limited at the following medical establishment:

- Dental departments at all legal hospitals in Vietnam.

- HCMC and Hanoi: besides Dental departments at legal hospitals, Bao Viet only accept treatment at

the clinics/ dental clinics in the Direct Billing System signed with Bao Viet Insurance.

- Other cities/ provinces: besides Dental departments at legal hospitals, the insurer shall extend to

cover treatments at legally licensed clinics/ dental clinics and being able to issue legal invoices in

accordance with Ministry of Finance’s regulation.

Bao Viet will not cover for treatments at Happy dental clinic (26 Ham Nghi, Da Nang), Dai Nam dental

clinic (328 Ong Ich Khiem, Thanh Khe District, Da Nang). For full details of black-list please see the website

(http://www.Bao Viet.com.vn/insurance)

http://www.baoviet.com.vn/insurance


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III. DEFINITION

Eligible medical expenses: refer to the expenses incurred for medically necessary treatments

provided to an insured for illness, disease and injury by accidents.

Hospitalization: refers to the necessity for a patient to stay at least 24 hours in the hospital for medical

treatment, shown in the Admission or Discharge Form or in the detail medical record and bills.

Day-patient: An insured Person who is admitted to the Hospital, incurring expenses for bed but does

not stay overnight

Room and board: refers to the costs, limited to a standard private room rate (excluding VIP room),

and associated charges, including admittance to the intensive care unit, and charges for nursing by a

qualified nurse

Physician: refers to a legally licensed medical practitioner recognized by the law of the country where

treatment is provided and who, in rendering such treatment, is practicing within the scope of his

licensing and training but excluding a Physician who is the Insured Person himself, or the spouse or lineal

relative of the Insured Person. A physician may be recognized as a Consultant or a Specialist.

Accident: Any sudden and unforeseen event, caused by an external, violent and visible means during

the period of insurance, and a directly cause resulting in Bodily Injury to the Insured and occurs beyond the

Insured’s control.

Out-patient: An insured person who receives treatment at a recognized licensed medical facility

(registered at Provincial or City Health Department and Taxation Bureau) but is not admitted to a hospital

bed as an In-patient or Day-patient

Ambulance service means the ambulance car service provided by any legal Hospital or Clinic in the

event of a Medical Emergency or serious accident/illness or diseases to evacuate the Insured to the

nearest Hospital/Clinic or from a Hospital/Clinic to another

In-patient: An insured Person who is admitted to a bed in a Hospital or Clinic which incurs expenses

including pre-hospitalization expenses, hospitalization expenses, day-patient expenses, surgical

expenses

Pre-hospitalization expenses refer to the examinations such as X-ray, scan and laboratory tests,

ordered by a Physician and resulting directly from a condition for which hospitalization is required and

performed during 30 days before hospitalization

Post-hospitalization treatment: refer to medical treatment received immediately discharge from

Hospital for a continuous period not exceeding 30 days, such treatment being provided or ordered by a

physician and resulting directly from the condition for which hospitalization is required

Home nursing: refer to services of a legally licensed nurse in the Insured’s Person abode

immediately following a covered in-patient stay in the hospital (the minimum number of hospitalization days

is from 7 days). This sevice must be prescribed by a physician for medical due to specific reasons of

medical vision


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IV. WAITING PERIOD

Waiting period

1. Accident Waived

2. Normal illness, sickness, disease Waived

3. Special Diseases, Pre-existing conditions, diseases excluded in the first year (excluding ligament surgery)

Waived

4. Death/Permanent Disablement due to normal illness, disease Waived

5. Death/Permanent Disablement due to Special Diseases, Pre-existing conditions

365 days

Pre-existing Diseases/ Injury

Illness or injury which exists before applying for insurance and due to such medical condition, the Insured

Person:

a) has been under treatment within three (03) previous years

b) has recognised or has been aware or should reasonably be aware of symptoms of such illness/ injury

before the date of applying for the insurance, regardless of whether a consultation/ treatment is received or

not

For example: tonsillectomy, VA curettage, disc herniation, spine spine, vestibular disorder…

Special Diseases

Refers to cancer and tumor of all types, hypertension, cardio-vascular diseases, stomach ulcers, chronic

inflame of bone joints, intestine ulcers, liver inflammation, inflammation of inside uterus, haemorrhoids,

different kinds of stones in the urinary and biliary systems, cataract, sinusitis, Parkinson, diabetes, disease

relating to recreating blood system such as blood purification, blood transfusion, hemodialysis.

Normal Diseases

They are acute diseases which have no long-term incubation period, newly arising and treating completely, no

repeating many times as chronic disease

For example: dengue fever, urticaria, allergic rhinitis, appendicitis, fever….


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IV. EXTENSION CLAUSES

EXTENSION CLAUSE FOR RISKS WITH HUGE CONSEQUENCES

Toxic Poisoning through eating and drinking Maximum overall compensation limit (accumulation loss):

VND2.100.000.000/each and every occurrence and in the aggregate Toxic Poisoning due to inhalation of toxic gases, compound

Diseases due to swine flu, bird flu, influenza A (H1N1), H5N1 (maximum accumulative VND 2.1 billion VND / contract), exclusion of disease notified by the health authorities (coverage for medical expenses )

Applied

Exposure & Disappearance Clause Applied

Hijacking Clause Applied

Army forces activities Applied

Motor Cycling Extension Applied

Occupational disease clause Pay to benefit “Medical expenses due to

accident”

EXTENSIONS CLAUSES FOR DIAGNOSTICS

Homeopath and traditional Chinese medicine practitioner; Applied

Medical materials in outpatient treatment include but not limit:Natri clorid, Sterima, Humer, Marinmer, Xisat.

VND 500.000/year

Longo knife for hemorrhoid surgery Applied

Extension for stent, coronary arteries, cathenter in heart surgery and net in inguinal hernia surgery

Applied

Vitamins and minerals supporting the treatment of diseases

max 20% of total description value for complemantory medecines and full covered

if they are main medecine for treatment. Maximum 500,000 VND/person/year

Extension for medical supplies for treatment of illnesses including but not limited to: metal splint, disc, vis

Limit to 1,500,000 VND/ person/year

Extension forbiochemical and metabolic abnormalitiesincluding but not limited for treatment of increasing lipid level in blood serum, high liver enzyme, hypocalcemia or similar conditions

Applied


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EXTENSION CLAUSES FOR CLAIM PROCEDURE

Cancellation of insurance policy within 60 days from the effective date

Applied

Waiver of medical detailed and breakdown lists at public hospitals (applicable for inpatient and outpatient)

Apply for inpatient records of under VND 2,000,000 and outpatient visits of under

VND 500,000

Extension for all types of service rooms in international departments, voluntary departments, on-demand care departments at standard public hospitals (excluding deluxe and VIP room)

Applied

Daily hospital expenses include standard meal (as part of medical expenses) and other reasonable expenses during treatment

Applied

Accepting VAT invoice of medecines issued within 30 days from the date of prescription

Applied

Accepting prescriptions of up to 60 days as indicated by doctor but it must be not longer than insurance period and in the list of chronic diseases

Appied for Chronic diseases

Company stamp and signature of management on claim form Applied

ADDITIONAL SERVICES

Claim handling and settlement within 15 working days since receiving valid and sufficent claim document. Payment within 07 working days since receiving notification.

Applied

Quarter claim report Applied


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VI. MAIN EXCLUSIONS

Wilful misconduct of the Insured Person or the legal Beneficiary

Grave violation of law, regulation and other rule of the local authority or other social bodies and serious

violation of traffic regulations

The use of and under the influence of alcohol, beer or other similar stimulants by the Insured Person,

when it is proven that it has been the direct cause of the accident

Medical treatment or use of medicaments or medicines without applying prescription or indication of the

physician.

Syphilis, gonorrhea, tuberculosis, malaria, HIV-AIDS

Birth defects, Congenital Anomalies, genetic deformities or diseases

Routine healthchecks, Hospitalization for the purpose of clinical test or medical expertise which in manner

that has no relationship to the treatment of illness or injury including gynecology/andrology, routine tests,

routine check up for new born babies. Vaccinations and prevention medicines

Treatment or operation at the request of the Insured Person which is in anyway not the normal

therapeutics

Any type of treatment for Beauty purpose, cosmetic or plastic surgery

Products classified as vitamins or minerals or organic substances, nutritional or dietary supplements,

including cosmetic products

Test or treatment directly or indirectly arising from or required in connection with: male and female birth

control

Treatment for mental, psychological problems, sleep disorder, stress and other related diseases

Treatment for weight loss or weight problems

Participating in air transport activities (except in the capacity of an air passenger), military demonstration

or training, fighting in armed forces

And please refer other exclusions in the Insurance Wording


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VII. DIRECT BILLING AND CLAIM PROCEDURE

7.1 DIRECT BILLING CARD

Insurance card is issued to each employee for inpatient treatment/ surgery following by

diseases/sickness/illness at the hospital/ clinic in Bao Viet’s direct billing network.

Note: Excluding establishments, pharmacies in the Black List of Bao Viet. The Black list is attached in

the Policy, please kindly consult carefully to avoid rejection of compensation

DIRECT BILLING PROCEDURE

2

Deposit (if any)

Some hospitals (Vinmec, Viet Phap,

etc.) may require a deposit in advance

depending on the severity of the case in

order to prove financial

3

Considere direct-billing

At the time of discharge, after

completing the medical procedures,

Bao Viet and the hospital will

consider and approve the direct

billing for customers

1

Present the Insurance card

The Insured or his representative

must present the insurance card

and ID card/passport to the Direct

billing department of hospital

4

Sign the claim form

Before hospital discharge, Insured or

his representative recheck all charges

when signing the claim form & any

medical treatment documents, invoices

that the staff of the hospital/ clinic guide

and pay medical expense which is not

under direct billing (if any) 5

Case of refusal of direct billing

In case of refusal of direct billing, the

insured will pay to the hospital charges

and claim with the insurance company

later


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Note 1: The insured person / representative should carefully check all charges during the treatment

process, compare with the amount of the Direct billing Division and the payment of fees paid by Bao

Viet Insurance before signing the insurance vouchers

Note 2:

- Customers can call the Hotline Guarantee Department of Bao Viet (after the card) for direct

instructions in emergency case and for emergency medical transportation services.

- Customers can call GiNET directly for instructions on collecting documents or direct billing procedure.

Note 3: During the holidays, Bao Viet may not handle direct billing due to insufficient information or the

Direct billing Division of hospital does not work. In that case, please kindly pay in advance and claim

later.

Note 4: Hospital guarantee does not apply to:

- Treatment of accidents; Emergency treatment

- Allowance

- Expenses for examination and testing before admission and re-examination after discharge (*)

(*) The claim back will be resolved after Baoviet received the guarantee medical papers from the

hospital.

- Dental treatment

Note 5: In case of Bao Viet can not haldle direct billing lack of information or need to evaluate and

confirm further information, please kindly pay in advance and claim later.


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7.2 CLAIM BACK PROCEDURE

Note 1: Please kindly declare exaclty and sufficiently information in Claim form

Note 2: In order to check online claim document, please kindly send photos of medical papers via email:

Title mail: VietJet Air – Claim document – Name of Insured

To: [email protected]

Cc: [email protected] - Ms Mai, SDT 0904990910

hienpt@ ginet-vn.com - Ms Hiền, SDT 0979494095

Note 3:

Please kindly send the hard copy of claim document to GiNET as following address:

Hà Nội Hồ Chí Minh

GiNET Việt Nam - Phòng 3, Tầng 11, Tòa nhà Harec,

Số 4A Láng Hạ, Ba Đình, Hà Nội

Mr Hùng Chiến: Tel: +84 247 1080 668 (ext: 106) -

SĐT: 0838 830 038

GiNET Việt Nam - Tầng 8, Tòa nhà Platinum, Số

145 Điện Biên Phủ, Phường Đa Kao, Quận 1, Hồ

Chí Minh

Ms Thuyết: Tel: +84 28 7108 0668 (ext: 203)

mailto:[email protected]



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Note 4: The Insured Person is entitled to claim compensation for Bao Viet Insurance within 6 months from

the date of receiving the notice of Bao Viet Insurance and any claim can not exceed 03 years from The

date of the event that resulted in the complain

Note 5: Deadline of making a claim request is within 180 working days form the end date of treatment

period or date of death.

7.3 CLAIM DOCUMENT

Document for inpatient treatment

1 Claim Form

2 Hospital discharge form

3 List of hospitalization expenses (including room charge)

4 Minor surgery/ surgery certificate (in case of minor surgery / surgery)

5 Prescriptions, indications and results of examination, testing

6 VAT invoice/ Particular invoice

Document for out patient treatment

1 Claim Form

2 Examination form /medical examination book (clarify doctor's diagnosis and conclusions)

3 Prescription

4 VAT invoice/ electronic invoice

5 Retail invoice with the seal of the pharmacy/ hospital in case of under 200,000 VND

Document for medical treatment due to accident

Beside the documents as above instruction (inpatient and out patient), in case of accident Insured need have:

1 Accident report

2 Minutes for handling accidents and other documents of the police (if any)

3 Minutes of injury assessment (if any)

4 Photo of driving license (in case of driving from 50cc)

5 Death certificate (death case)

Note: - Medical documents need to have a sign of the hospital/ medical establishment.

- Insured fill information in Claim form with company stamp and signature of management.


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7.4 MEDICAL SAMPLE

a. Hospitalization discharge

b. Surgical certificate


16

c. Detailed list of hospital fees


17

d. Treatment book/ record

Diagnostic

Hospital/ Department

stamp


18

e. Medical Report


19

f. Prescription


20

g. Indicated Paper of tests


21

h. Test results


22


23

i. Physical therapy appointment form and physical therapy schedule table


24

j. Receipt


25

k. VAT invoice

VAT traditional invoice


26

Red invoice converted from electronic invoice


27

VII. CONTACTS FOR SUPPORT

Note: This documents is not insurance policy and for reference only.

Item Address

Address for sending

claim papers

1. Hanoi

GiNET Vietnam - Room 3, 11st Floor, Harec Building, No. 4A Lang Ha, Ba Dinh, Hanoi

Mr. Hùng Chiến: [email protected]

Tel: +84 247 1080 668 (ext: 106) - Phone: 0838 830 038

2. Ho Chi Minh

GiNET Vietnam - 8th Floor, Platium Building, No 145 Dien Bien Phu, Da Kao, District 1,

HCM

Mr Thuyết: [email protected]

Tel: +84 28 7108 0668 (ext: 203)

BaoViet’s hotline BAOVIET Insurance Corporation

Hotline 24/7: 0904 832 888/ 0906 633 757

GiNET’s hotline

Hotline in Vietnamese:

Ms Quỳnh Mai [email protected]

Tel: +84 247 1080 668 (ext: 103) - SĐT 0904 99 0910

Ms Phan Hiền [email protected]

Tel: +84 28 7108 0668 (ext:205) - SĐT 0979 494 095

Hotline in English:

Ms Quỳnh Mai [email protected]

Tel: +84 247 1080 668 (ext: 103) - SĐT 0904 990 910

Ms Bích Thảo [email protected]

Tel: +84 247 1080 668 (ext: 105) - SĐT 0396 694 364






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