Post on 27-Oct-2020
INSURANCE HANDBOOKGOLDEN HEALTH INSURANCE PROGRAM
- OPTION 4 -
VIETJET AVIATION JOINT STOCK COMPANY
INSURANCE HANDBOOK - GOLDEN HEALTH - OPTION 4
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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
INSURANCE HANDBOOK - GOLDEN HEALTH - OPTION 4
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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
INSURANCE HANDBOOK - GOLDEN HEALTH - OPTION 4
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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
AREA OF COVERAGE VIETNAM
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
AREA OF COVERAGE VIETNAM
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)
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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: cskh1@ginet-vn.com
Cc: maiptq@ginet-vn.com - 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)
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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
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c. Detailed list of hospital fees
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d. Treatment book/ record
Diagnostic
Hospital/ Department
stamp
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e. Medical Report
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f. Prescription
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g. Indicated Paper of tests
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h. Test results
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i. Physical therapy appointment form and physical therapy schedule table
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j. Receipt
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k. VAT invoice
VAT traditional invoice
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Red invoice converted from electronic invoice
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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: chiendh@ginet-vn.com
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: cssk1@ginet-vn.com
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 maiptq@ginet-vn.com
Tel: +84 247 1080 668 (ext: 103) - SĐT 0904 99 0910
Ms Phan Hiền hienpt@ginet-vn.com
Tel: +84 28 7108 0668 (ext:205) - SĐT 0979 494 095
Hotline in English:
Ms Quỳnh Mai maiptq@ginet-vn.com
Tel: +84 247 1080 668 (ext: 103) - SĐT 0904 990 910
Ms Bích Thảo thaovtb@ginet-vn.com
Tel: +84 247 1080 668 (ext: 105) - SĐT 0396 694 364