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Home : Policy Terms & Conditions

1. Our Contract With You

1.1 These terms and conditions need to be read together with the schedule, the namelist, the benefits schedule we have most recently sent to the policyholder, and any endorsement(s). All of these documents, together with the statements made in your application and any documents enclosed with or referred to in your application; make up this contract of insurance.
1.2 This contract uses defined terms which appear in Italics. Defined terms have the same meaning wherever they appear. The meaning given to a defined term can be found in the definitions section at the end of these terms and conditions.
1.3 Please examine the contract carefully to make sure you have the cover you want. If you have any questions about the contract, please speak with the person who arranged this contract for you.

2. What Is Covered?

2.1 Once the premium has been paid and subject to the waiting period set out in clause 6, we will cover you for expenses up to the amount of cover.
2.2 All expenses will be paid excess of any deductible that applies and after we have applied any coinsurance percentage.
2.3 If three or more members of your family are injured in the same accident whilst covered under this contract, we will pay expenses excess of only one deductible, which shall be the largest of the deductibles which would have otherwise applied.
2.4 Each and every payment of expenses will erode the amount of cover corresponding to the category of benefit in the benefits schedule to which it is most closely related. Once an amount of cover has been exhausted, it will not be reinstated and we will have no further liability under this contract for expenses relating to the exhausted amount of cover.
2.5 All expenses we pay during the period of insurance will be added together. If the total of expenses we pay during the period of insurance reaches USD2million, we will have no further liability under this contract.
2.6 expenses will be paid to you or your legal representatives, whose receipt discharges our liability for those expenses. We may, in our absolute discretion, pay expenses to a provider of services, but we will not do so where we have been told in writing by you or your legal representative not to pay expenses to them.

3. Where Are You Covered?

3.1 The geographical area stated on the schedule.

4. Who Is Covered?

4.1 you and your dependant(s).

5. Period Of Cover, Premium Payment And Automatic Renewal

5.1 The minimum initial period of insurance is 12 months.
5.2 Once the minimum initial period of insurance has ended, cover will be renewed automatically for further periods of 12 months unless:
5.2.1 we have offered you new or additional terms of cover; or
5.2.2 we have withdrawn the product upon which this contract is based and offered replacement cover providing similar benefits; or
5.2.3 we have not received the premium due upon each renewal within 15 days of the renewal date.
5.3 Cover (except for a child born during the period of insurance) will start at 00:00am on the first day and end at 11:59pm on the last day of the period of insurance.

6. Waiting Periods

6.1 Cover under the Maternity Benefits section of the benefits schedule will take effect once you have renewed cover after the initial minimum period of insurance has come to an end.

7. Children Born Or Adopted During The Period Of Insurance

7.1 A child born after the initial minimum period of insurance has come to an end, to a mother who has renewed cover with us, will be covered regardless of any pre-existing or congenital condition, but only if the premium of the child is paid within 15 days of birth or adoption and only after we have been given the child's name, gender, and date of birth. The cover available for the child will match the benefits available to the mother or parent at the time of the child's birth.
7.2 An Application Form II (Medical Questionnaire) must be completed for any child;
7.2.1 Born during the minimum initial period of insurance to a mother we cover under this contract; or
7.2.2 Born on behalf of mother we cover under this contract; or
7.2.3 Adopted by a parent we cover under this contract; or
7.2.4 Born following assisted conception. If we agree to provide cover for any child which falls under the section 7.2, the cover available will match the benefits available to the mother or parent at the time of the child's birth or adoption, but will exclude cover for disabilities which start within 15 days of birth or for special care or treatment for a congenital condition or premature birth.

8. Cancellation

8.1 The minimum period of insurance is 12 months and cannot be cancelled.

9. Failure To Disclose Material Facts

9.1 If the application for cover, including any document submitted with the application, contains false statements made with actual intent to deceive or which induce us to provide cover to you, this contract shall be void in its entirety.

10. Reasonable Precautions And Material Changes (Condition Precedent)

10.1 you must take all reasonable precautions to prevent and minimize illness or injury.
10.2 you must give us immediate written notice of:
10.2.1 A change in your usual country of residence (a change in your usual country of residence occurs whenever you are away from your usual country of residence for a continuous period of more than 180 days); or
10.2.2 Any change in your name or address
10.3 Upon receiving written notice from you, we shall have the right to alter the terms and conditions to those we consider are appropriate to the changes you have told us about.
10.4 Failure to give the required notice under this clause will result in us having no liability under this contract for expenses.

11. Notification, Proof Of Claim And Cooperation

11.1 Any claim for expenses must be presented to us on a properly completed claim form (a form which can be used for claiming expenses can be found on our website www.pallasglobalhealth.com), attaching original documents (photocopies and scanned copies are not acceptable), within 90 days of a service having been provided, or the first day of confinement, whichever is earlier.
11.2 Where it is not reasonably possible to present all the required documents to us within this period, they must be presented to us within 365 days of either the service having been provided, or the first day of confinement, whichever is earlier.
11.3 On receipt of a properly completed claim form, we may ask for further documents and information. We may also ask you to undergo a medical examination at our expense. We may also exercise our right to require a post mortem examination, where this is not forbidden by law.
11.4 You and your representatives must fully cooperate with us and our appointed agents in connection with any claim for expenses presented to us. Your cooperation may include, but is not limited to, providing any document we reasonably need to obtain information relevant to your claim, from any source, including a doctor or hospital.
11.5 We are entitled to obtain any medical records, reports, statements or other information about your state of health and to contact any hospital, physician or other medical practitioner who is or has been treating you for physical or mental illness or injury.

12. Settlement Of Claims (Condition Precedent)

12.1 you must not negotiate, settle, compromise, release or otherwise discharge any claim you may have against someone and which has given rise to an illness or injury, without our prior written agreement. Failure to obtain our prior written agreement will result in us having no liability under this contract for expenses.

13. Settlement of Claims against Third Parties

13.1 we may take proceedings in your name, but at our expense, to recover any amount we pay under this contract.

14. Successor Insured

14.1 If the policyholder should die during the period of insurance then (in the following order of priority), your surviving spouse or de facto partner, or other adult dependant covered by this contract, will automatically become the policyholder.

15. Right Of Recovery

15.1 If we pay, or authorize payment of, expenses and later find that you were not entitled to that payment for any reason, we reserve the right to claim the payment back from you.

16. Other Insurance Or Indemnity

16.1 If, during the period of insurance, other medical or accident insurance or another source of indemnity covers you for expenses relating to an illness or injury which are also covered by this contract, you must seek recovery from such protection and such recovery will be reduced from the payment made under this policy.

17. Changes To The Contract

17.1 Any changes to this contract will appear in one or more endorsements and will take effect only when an endorsement has been signed by our authorized signatory.

18. Governing Law And Jurisdiction

18.1 This contract is governed by, and is to be interpreted according to, the laws of the Hong Kong Special Administrative Region.

19. Arbitration And Time Limits

19.1 you agree that:
19.1.1 Any dispute or difference arising out of, or in connection with, this contract must first be referred to mediation at the Hong Kong International Arbitration Centre (HKIAC) and in accordance with the HKIAC’s mediation rules. If the mediation is abandoned by the mediator or otherwise ends without the dispute or difference being resolved, the dispute or difference must be referred to, and resolved by, arbitration at the HKIAC and in accordance with the HKIAC’s domestic arbitration rules.
19.1.2 If the dispute or difference arising out of or in connection with this contract requires medical knowledge (including, but not limited to, questions relating to the amount of cover for any medical service or an operation not listed in the benefits schedule) the mediator or arbitrator may, in our reasonable discretion, be a registered medical practitioner or a consultant specialist, surgeon, or physician.
19.1.3 If we refuse to pay any expenses and a dispute or difference arising from that refusal is not referred to mediation and, if necessary, arbitration, within 12 months from the date of refusal, any claim against us arising from that dispute or difference will be barred.

20. Absolute Ownership

20.1 Unless an endorsement states otherwise, we are entitled to treat the policyholder as the absolute owner of this contract and we are not bound to recognise any other claim to, or interest in, this contract.

21. Exclusions

This contract does not cover:

21.1 A pre-existing condition or related, associated or consequential illness or injury which is not disclosed to us before the period of insurance and which we have not agreed in writing to cover under this contract.
21.2 Treatment, care or a test which is not medically necessary or which is covered by insurance or a source of indemnity (collectible or otherwise) other than this contract.
21.3 Vitamins, nutritional supplements, vaccinations, chelation therapy, hydro colon therapy, counseling, custodial or maintenance care, rest cures, and services or treatment at home or while a bed patient at any facility that is not a hospital.
21.4 Dental work, other than (a) dental work shown on the benefits schedule as covered by this contract, or (b) expenses incurred for the prompt repair of an injury to teeth which, before the injury, were sound and natural.
21.5 cosmetic treatment.
21.6 Obesity surgery or treatment
21.7 reconstructive surgery except for reconstructive surgery arising from an illness or injury covered under this contract.
21.8 Treatment, care or a test related in any way to:
21.8.1 assisted conception, contraception including sterilization, fertility, sexual dysfunction, induced abortion;
21.8.2 Pregnancy or childbirth where Maternity Benefits cover is not available (complications of pregnancy are excepted from this exclusion);
21.8.3 An illness arising from Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV) except when contracted during a treatment covered by this contract;
21.8.4 Venereal disease;
21.8.5 An irreversible vegetative state present after acute brain injury or degenerative/metabolic disorder.
21.9 physician prescribed rest or bed rest during pregnancy.
21.10 illness, injury or pregnancy arising from any form of assisted conception.
21.11 Prostheses, corrective devices, medical appliances other than standard surgical implants shown on the benefits schedule as covered by this contract.
21.12 The cost of purchasing an organ for transplantation.
21.13 Treatment by a psychologist or any treatment, care or test related in any way to self-inflicted injury, suicide or attempted suicide, deliberate exposure to exceptional danger except in an effort to save human life, abuse of alcohol, drugs and/or medicines, sleep disorders, learning difficulties, behavioral or developmental disorders.
21.14 Experimental or pioneering medical and surgery techniques except with our prior written approval.
21.15 Services which have not been recommended and prescribed by your attending physician or specialist other than a second opinion before surgery.
21.16 Refractive defects of the eye.
21.17 Medical certificates.
21.18 Treatment by naturopaths or homoeopaths and naturopathic or homoeopathic medications and other alternative methods of treatment unless shown on the benefits schedule as covered by this contract.
21.19 Treatment performed by or at an enterprise owned by you or your parents.
21.20

illness or injury suffered (a) while serving as a member of a police or military unit of any country or international authority, (b) during war, civil war, invasion, insurrection, revolution, use of military power or usurpation of government or military power, (c) while engaged in any illegal act, (d) while an inmate of a prison, jail or any correctional facility including halfway houses or similar facilities, (e) while a patient of any mental institution, or (f) as a result of exposure to ionizing radiation or radioactive contamination of any kind.

21.21 hospital inpatient treatment for convalescence, rehabilitation, supervision or conditions which in the opinion of our medical adviser can be properly treated as an outpatient.
21.22 hospice or palliative treatment.
21.23 Treatment at an institution such as a convalescent or nursing home devoted to providing medical, nursing, or custodial or maintenance care for an individual over a prolonged period, such as during the course of a chronic disease or the rehabilitation phase after an acute illness.
21.24 Travel expenses incurred to obtain medical treatment other than in the course of an emergency medical evacuation we have approved in advance, or which has been approved by our appointed 24-hour emergency medical assistance center.
21.25 expenses:
21.25.1 Which are not reasonable and customary;
21.25.2 Arising under legislation which seeks to increase the cost of medical treatment and services actually received above charge levels which would be considered reasonable and customary in the absence of such legislation;
21.25.3 Which are in any respect false or fraudulent;
21.25.4 Incurred outside the period of insurance or in any period for which the appropriate premium has not been paid;
21.25.5 Incurred during the period of insurance for drugs and/or medical services consumed or provided once the period of insurance has ended and cover has not been renewed.
21.26 you in any jurisdiction which prohibits us from providing insurance cover to you under this contract.

Definitions

amount of cover
The amount(s) on the benefits schedule showing the maximum amount of expenses we will pay under this contract.

assisted conception
The use of medical technology to bring a human sperm and an egg, or eggs, close together, thereby increasing the chance of ovulation or the number of eggs during ovulation. This includes but is not limited to Intra-uterine insemination (IUI), In vitro fertilization (IVF), Intracytoplasmic sperm injection (ICSI) or the use of any form of treatment to induce ovulation.

benefits schedule
The schedule(s) showing each of the benefits available under this contract and the amount of cover available for those benefits.

co-insurance percentage
The share of expenses for which you are liable, shown on the benefits schedule.

complications of pregnancy
Ectopic pregnancy, medically prescribed abortion, post-caesarian infection, infection contracted while in hospital for pregnancy, acute nephritis, nephrosis, cardiac decompensation, missed abortion, puerperal infection, eclampsia, toxemia, or similar conditions.

confinement
A continuous period of not less than 18 hours as a registered bed patient in a hospital.

congenital condition
A physical or mental abnormality existing at the time of birth.

cosmetic treatment
Cutting, thermal destruction or chemical treatment of tissue performed to reshape normal structures of the body.

custodial or maintenance care
Care provided mainly:
a) For personal needs, comfort or convenience for which specialized medical training or skills are not necessary; or
b) To maintain, rather than improve, a physical or mental function, or to provide a protected environment.

deductible
An amount shown on the namelist corresponding to a benefit available under this contract. We are entitled to deduct this amount from any payment of expenses.

dentist
A properly qualified practitioner other than a relative of any Insured Person by blood or marriage, who is licensed by the competent authorities of the country in which treatment is provided to render dental treatment, and who in rendering such treatment is practicing within the scope of his or her licensing and training.

dependant(s)
a) your spouse or your de facto partner under the law of your country of residence;
b) Each of your unmarried children, stepchildren or adopted children who are under 19 years of age for all or part of the period of insurance or, if a full-time student and primarily dependant on you for support and maintenance whilst a full-time student, under 23 years of age for all or part of the period of insurance.

emergency
A sudden change in your health which requires urgent medical or surgical intervention to avoid permanent damage to your life or health.

expenses
Amounts you incur during the period of insurance for a medically necessary service and which fall within the categories of benefits shown on the benefits schedule.

home country
The country of the numbered passport listed against your name on your application for cover. For any dependant who has no passport, the home country of their spouse or parent.

hospice or palliative treatment
A centralized program of physical, psychological, social and spiritual care to the dying, prescribed by an attending physician and provided by an institution licensed by the competent medical authorities of the country in which care is provided and which, in
providing care, is practicing within the scope of its license.

hospital
An institution licensed by the competent medical authorities of the country in which it is located to provide care and treatment of sick and injured persons as bed patients and which:
a) Has full diagnostic, therapeutic and surgical procedures; and
b) Provides 24 hour a day nursing services by registered graduate nurses; and is supervised by a staff of physicians; and
c) Is not primarily a clinic, a nursing, rest, or convalescent home, a mental institution, a home for the aged, or a place for alcoholics or drug addicts.

illness
A physical condition, including symptoms, sequelae, or complications, marked by a pathological deviation from the normal healthy state during the period of insurance.

injury or injured
Physical damage arising wholly and exclusively from an unintended event occurring at a fixed place and time, and caused wholly and exclusively by violent, external and visible means.

medical check up
Tests that are undertaken without any clinical signs or symptoms being present.

medically necessary
a) A therapeutic service required to prevent permanent damage to life or health where you have an illness or injury; or
b) A diagnostic service to determine whether therapeutic services are necessary, where you have active symptoms, the cause of which are unknown, but which are suggestive of an illness or injury.

medicines and drugs
Medicines and drugs for which a physician’s prescription is required for purchase and which have been dispensed by a physician’s office or by a licensed pharmacist after having been prescribed by a physician for treatment of a illness or injury.

mental and nervous condition
A psychiatric, psychological, affective, mental, or behavioral disorder, irrespective of whether a physiologic cause is known or suspected. It includes any condition listed in the ICD-10 Classification of Mental and Behavioral Disorders.

namelist
The document identifying the member(s) covered under this contract, deductible(s), selected module(s) of the benefits schedule and the annual premium.

oral hygienist
A properly qualified employee of a Dentist who is licensed, if required, by the competent medical authorities of the country in which treatment is provided to render services such as cleaning and anaesthesia, and who is rendering such treatment at the direction of, and under the direct supervision of, a licensed Dentist.

organ transplantation costs
Any fee or expense in any way related to the transplantation of a kidney, heart, liver, lung or bone marrow from one human to another.

parental accommodation
A fee for an additional bed in the same room for a parent or legal guardian staying with a dependant child who is admitted as an inpatient in a hospital for the treatment of an illness or injury.

period of insurance
The period starting at 00:00am on the first day shown on the schedule and ending at 11:59pm on the last day shown on the schedule. Both times are the local times of the usual country of residence of the policyholder (or primary place of business if the policyholder is a business or a sole proprietor).

physician
A qualified medical practitioner other than someone related to you by blood or marriage, who is licensed by the competent medical authorities of the country in which treatment is provided, and who in rendering such treatment is practicing within the scope of his or her licensing and training.

policyholder
The natural person named in the schedule as the policyholder.

post hospitalization benefits
expenses incurred following confinement for medical services provided or ordered by a physician as a direct consequence of the illness or injury which led to confinement.

pre-existing condition
Any illness or injury:
a) Which existed before the period of insurance and which presented signs or symptoms of which you were aware or should reasonably have been aware; or
b) For which you have sought or received treatment, medication, advice or diagnosis in the two years before the period of insurance; or
c) Which you knew to exist before the period of insurance and whether or not you sought or received treatment, medication, advice, or diagnosis for it.

pre-hospitalization benefits
expenses incurred up to 30 days before confinement for medical services provided or ordered by a physician as a direct consequence of the illness or injury which led to confinement.

reasonable and customary
An amount unrelated to an ability to pay or the availability or adequacy of insurance or other indemnity, which is comparable to that charged by others of similar professional standing in the same locality, for a person of similar sex and age, for a similar illness or injury.

reconstructive surgery
Cutting or thermal destruction of tissue performed to improve the function or appearance of abnormal structures of the body caused by a congenital condition, developmental abnormality, trauma, infection, tumor or disease.

rehabilitation treatment
Treatment beginning immediately after medical treatment for an acute illness or injury upon referral by an attending specialist that is intended to restore normal form/near to normal form and/or function to the body.

schedule
The document naming the policyholder.

usual country of residence
The country in which the policyholder spends the greatest amount of time during the period of insurance.

war
war, whether declared or not, or any warlike activities, including use of military force by any sovereign nation to achieve economic, geographic, nationalistic, political, racial, religious or other ends.

we, us (and our)
Liberty International Insurance Limited (Hong Kong).

you (and your)
The policyholder and his or her dependants.