HEALTHCARE INSURANCE – BAO VIET INTERCARE 

HEALTHCARE INSURANCE – BAO VIET INTERCARE is a premium healthcare insurance of Bao Viet Insurance. The product is designed specifically for the group of VIP customers who need healthcare at high-class domestic hospitals in Vietnam such as Viet Phap, Phap Viet (FV), Vinmec … or hospitals in other countries, even global.

• No health examination is required before registration
• Access to the system of modern hospitals in direct billing list.
• Various insurance benefits, suitable for many budget levels and needs
• Direct Billing Service 24/7: Customers do not waste time collecting claim documents and do not have to pay hospital fees. All have been paid by BaoViet.

1. INSURED PERSONS:

– From 15 days old to 69 years old; renew to 75 years old.

– Children under the age of 18 must participate in a contract with Dad or Mom (their program is not higher than their parent’s)

– Being a Vietnamese or a foreigner living or working in Vietnam for at least 6 months.

Notes: Copay Applied for children <4 years old:

• Copay Rate is 70/30: BaoViet pay 70%, Insured pay 30%.
• Apply for private hospital or service department of public hospital. 

2. WAITING PERIOD: (only apply for the first year insurance)

(A waiting period is defined as a time period in which the relevant benefits will not be paid. Bao Viet shall exclude all risks occurring during that time, including but not limited to their related expenses or consequences thereof which arise after the waiting period as specified.)

• In case of medical expenses incurred for treatment of normal illness/ diseases: all benefits shall take effects after 30 days from the effective date of the policy.
• In case of medical expenses incurred for treatment of pre-existing conditions, special diseases, any illness/ diseases hereinafter: all benefits shall take effects after 365 days from the effective date of the policy:

• The following diseases shall not be covered during the first year in any condition: Adenoidectomy, Tonsillectomy, Septoplasty (Deviated nasal septum surgery), vestibular disorders, asthma, middle ear infection (otitis media) surgery, Sinusitis, Degenerative diseases of the vertebral column/joints, Hemorrhoid Surgery, Herniated disc, polyps.
• Special diseases:
  1. 1. Cancer and tumors of any kind
     2. Diseases of heart, liver (hepatitis A, B, C), pancreas, kidney, lung failure
     3. Diseases related to hematopoietic (blood forming) system including pancreatic failure, acute and chronic leukemia.
     4. Growth hormone deficiency
     5. Diabetes mellitus
     6. Parkinson’s disease.
• Pre-existing condition: Any medical conditions of the Insured Person which have been diagnosed; or for which symptoms existed that would cause an ordinary prudent person to seek diagnosis, care or treatment; or for which medical treatment was recommended by a medical practitioner, irrespective of whether treatment was actually received or not.

3. INSURANCE BENEFITS:

BENEFIT SCHEDULE – BAOVIET INTERCARE

Issued with the Decision No. 6608/QĐ-BHBV dated September 21 ^st, 2017 of the Chief Executive Officer – Bao Viet General Insurance Company

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4. INSURANCE PREMIUM

Neccessary Notes about compulsory terms:

Compulsory clause for customers to register: I. CORE PLAN – Inpatient treatment due to illness, disease or accident
Optional clause for customers to register: II. OPTIONAL PLAN (Including Outpatient Treatment, Personal accident, Term life, Dental Care, Maternity)
Premium’s calculation

Total Premium = A + B.

In which clause A is required to buy. Clause B can buy or not, or only buy one of the terms: outpatient, maternity, dental, termlife, personal accident.

For example: Customer Nguyen Van A is 35 years old. He chooses the Classic program. If he buys only the compulsory clause (coreplan), the premium is: 13,300,000 VND.

If he wants to participate in optional plans and choose only outpatient conditions, the premium is: 13,300,000 + 7,700,000 = 21,000,000 vnd

If he wants to add more benefit like dental care, the premium shall be: 13,300,000 + 7,700,000 + 7,900,000 = 28,900,000 vnd

If he wants to choose IP and PA, the premium shall be: 13,300,000 + 1,150,000 = 14,450,000 vnd

Payment term:

All premiums are payable once annually in advance or before the effective date

5. GENERAL EXCLUSION

(Applied to the Insurance Policy and all Endorsements)

The following treatment, items, conditions, activities and their related or consequential expenses are excluded from this Policy:

1. Pre-existing conditions, special diseases as defined and the diseases named in article 02 below shall be excluded in the first year of insurance. This exclusion shall not be applied in the following cases:

+ After Individual and family policies is effective for 12 consecutive months, pre-existing conditions and special diseases shall be covered up to the limit shown in the Benefit Schedule.

2. The following diseases shall not be covered during the first year in any condition: Adenoidectomy, Tonsillectomy, Septoplasty (Deviated nasal septum surgery), vestibular disorders, asthma, middle ear infection (otitis media) surgery, Sinusitis, Degenerative diseases of the vertebral column/joints, Hemorrhoid Surgery, Herniated disc, polyps.

3. Home services or treatments if it is not prescribed by a Physician (except for nursing cost as specified in the Benefit Schedule of this Policy) or treatments received in health hydros, nature cure clinics, spa, sanatorium, or long term care facility or similar establishment. Costs related to treatment at a clinic which fails to comply with definition hereinabove, including but not limited to expenses for medications, tests and/ or treatment indicated by the Physician at such clinic, even though those expenses are incurred in legal clinics, hospitals, drug stores thereafter.

4. Routine medical examinations (in-patient or out-patient), check-ups, cancer screening tests with normai results, medical examination or consultation which are not associated with medical treatment of Illness/ Disease/ Injury, including but not limited to gynaecological examination/ male genital examination, routine laboratory tests, routine check-ups for newborns, immuzination, vaccinations and preventative medicines (excluding vaccinations given after an accident or being bitten or stung by animals or insects). This exclusion is not applied if “Health check-ups” in “Out-patient” Optional plan is applicable.

5. Normal eye tests, cataract, normal hearing test, aging, degradation, any corrective treatment for non-medical/ natural degenerative eyesight and hearing, including the categories listed hereof and/ or in the Endorsement as an integral part of Wording/ Policy such as eyes refraction including myopia, presbyopia and astigmatism, and any corrective surgery for sight and hearing defects;

6. All dental treatment (in-patient and out-patient) except for emergency treatment following an accidental damage to sound, natural teeth. Artificial teeth or denture of any type. This exclusion is not applied if “Dental Care” optional plan is applicable.

7. Any type of treatment for beauty purpose, weight problems (weight increase, decrease, obesity, rickety…), skin pigmentation (hyperpigmentation), treatment for hair loss, cosmetic or plastic surgery and any consequence thereof unless it is re-constructive surgery necessitated by an accident/illness that occurred during the period of insurance stated on the Policy.

8. Psychiatric and behavioral disorders, mental illness/ mental disorders or mental retardation, Attention deficit disorder (ADD),  Autism spectrum disorder (ASD), Alzheimer, sleep disorders, insomania, snoring with unknown causes, asthenia, anxiety disorders (stress) or any of related syndromes/ diseases.

9. Family planning, abortion or any consequence thereof due to psychological or social causes, male/ female infertility, artificial insemination, maternity/ childbirth complications on the insured who already had artificial insemination procedure (of any kind), evaluation and treatment of infertility/fertility problems, sexual dysfunction/impotence, gender dysphoria treatment/sex change, or any related consequence or complication thereof;

10. Pregnancy and Childbirth of any type except complication of pregnancy caused by accidents. This exclusion is not applied if “Maternity care” optional plan is applicable.

11. Any treatment and/ or surgery in connection with birth defects, hereditary illness (including recessive genetic disorders)/ congenital anomalies/ conginental malformations/ conginental disorders, genetic deformities/ diseases, and any related complications or consequence thereof; surgical treatment indicated before the inception date, including the categories listed hereof and/or in the Endorsement as an integral part of Wording/ Policy such as congenital heart disease, Down syndrome, cleft lip and palate, hydrocephalus, anal stricture, phimosis, congenital deviated septum.

12. Costs of providing, maintaining, fitting or replacing any prostheses or medical supportive appliances or devices as defined.

However, devices implanted inside the body such as pacemakers, aerosols, stent or Longo knife for hemorrhoid surgery, etc. are covered up to 70% of the total cost (Bao Viet shall pay 70%, the insured shall pay 30%).

13. Chronic supportive treatment of renal failure, including dialysis (artificial blood filtering). BAOVIET will, however, pay for the cost of renal dialysis incurred:

• immediately pre and post operation.
• in connection with acute secondary failure when dialysis is part of intensive care.

14. Treatment involves ligament reconstructive surgery (this exclusion is not applied after 12 months of continuous cover under this Policy).

15. Any treatment in connection with sexually transmitted diseases such as syphilis, gonorrhea, genital disfunction (sexual malfunction/ sexual disorder),

16. Willful misconduct of the Insured Person or the Beneficiary.

17.

+ Violation of law, regulations and other rules leading to the criminal prosecution by the Insured Person aged 14 or over.

+ Violation of traffic regulations in following cases:

• Illegal racing;
• The Insured drives any kind of transportation whilst being affected by alcohol, wine, beer, or substances or stimulants;
• The Insured drives any kind of transportation whilst having a blood alcohol content higher than 50 mg/100 ml of blood or 0.25 mg/1l of atmosphere;
• The Insured drives automobiles, tractors, trailers, tractor trailers without driver license or with illegal/ unsanctioned license;
• Illegal carriage or failed to comply with any applicable regulations/ standards of transporting dangerous or prohibited goods;
• Entering a road via a no entry sign or going the wrong way on a one-way street;
• In case the Insured drives two-wheeled motorcycles, three- wheeled motorcycles, motorcycles and the like without driver license or with illegal/ unsanctioned license: The Insurer will only reimburse up to 50% of the eligible amount within the coverage;

+ In case of violation of labour laws: The Insurer will only reimburse up to 50% of the eligible amount within the coverage.

18. Accident risk occurs in period of insurance but Consequences of accidents that occur outside the Insured Period applicable for medical expenses.

19. Any risks occurs directly or indirectly caused from the alcohol/ drugs/ stimulants abuse or addiction or abuse/addiction to any substances/ stimulants;

20. The Insured Person’s act of fighting (unless such act can be proved that it is only a defense against an attack), participation in or training for any professional sport activities or any form of professional race or competition.

21. Aviation acitivities other than as a licensed fare-paying passenger. Participation in military demonstration or training, fighting in armed forces.

22. Treatment and expenses directly or indirectly arising from or required as a consequence of: war, riots, invasion, acts of foreign enemy hostilities or warlike operations (whether war be declared or not), civil war, mutiny, civil commotion assuming the proportions of or amounting to a popular uprising, military uprising, insurrection, rebellion, military or usurped power or any act of any person acting on or on behalf of or in connection with any organization actively directed towards the overthrow or to the influencing of any government or ruling body by force, terrorism or violence.

23. Disasters including earthquake, volcanic eruption, tsunami, radioactive contamination, epidemic diseases/public health emergency declared by WHO or local authorities

24. Hormone replacement therapies for the growth period, or the pre-menopausal or menopausal period of women.

25. Treatment directly or indirectly arising from or required as a result of chemical contamination or contamination by radioactivity from any nuclear fission, or from the combustion of nuclear fuel, asbestosis or any related condition.

26. Consultation/Examination/Tests/Treatment or use of drugs without indication or diagnostic conclusions of the participating Physicians/ doctors, or without any diseases/illness; expenses which are not related to diseases/illness within the coverage; herbal medicines of unknown origin; oriental medicine private clinics/facilities. Treatment which is experimental in nature and/ or not scientifically recognized and/or any free treatment received at any hospital.

27. General Out-patient Services other than an emergency Out-patient treatment following an accident. This exclusion is not applied if “Out-patient Treatment” optional plan is applicable.

28. Treatment outside the area of coverage of the plan which is selected and declared on the Policy Schedule.

29. Functional foods, minerals, supplements and organic substances for nutrition or for diet available naturally, cosmetic and pharmaceutical products.

30. Medical expenses and treatment for the person who is not eligible to join into this Policy.

6. CLAIM PROCEDURE

GENERAL GUIDELINES:

a. Proof of Claim (applied for the Core and Optional plans)

When making a claim request, the Insured and/or his/ her legal Beneficiary must submit to Bao Viet Insurance the following documents in English or Vietnamese within 01 year from event of insurance or inform Bao Viet within sixty (60) days from the end date of a referral to treatment period/ Discharge date or Date of Death:

• Claim form (issued by Bao Viet Insurance) filled in and signed  by the Insured or the Claimant who is the Heir/ Beneficiary/ Nonimated receiver named on the  Certificate/  Legally authorized representative of the Insured (except in case where the Insured is the child whose claim forms shall be completed by his/ her legal parents/ guardians). In case of group policy, this form must be signed and stamped by the organization/entity or company acting as the Policyholder unless otherwise agreed.
• In case of accidents:

1. Accidents in daily life: The accident report is required without the local authorities’ confirmation.
2. Labour accidents: The accident report is required with confirmation from the organization/entity or company
3. Traffic accidents (no other parties involved but excluding death case): The accident report is required without the local authorities’ confirmation; a driver license if the accident occurs when the Insured is driving a vehicle with an engine displacement of more than 50cc;

Traffic accidents (other parties involved): The accident report is required by the law, the related reports and documents of police, a driver license if the accident occurs when the Insured is driving a vehicle with an engine displacement of more than 50cc;

• Records of treatment procedure:  medical prescriptions, medical books, hospital discharge notes, treatment records, indication and results of tests, X-ray, CT scan, certificate of operation (in case of operation/ surgery) and other documents related to the medical treatment. If th orginal versions are not available, the copy versions certified by Bao Viet may be accepted. In all circumstances, Bao Viet reserves the right to require originals for checking and/ or reconcilement.  Medical recors/ prescirptions must be stamped by the medical facilities unless otherwise agreed.
• Records of payment procedure: VAT (red) invoices, bills, receipts in forms approved by the Ministry of Finance, General Department of Taxation and enclosed with detailed and breakdown of charges. In respect of these payment records, only the originals are acceptable and shall be considered as the property of Bao Viet Insurance after the claims are reimbursed. The invoices/ bills/ receipts for medication/ treatment expenses must be issued within 30 days since the date of the prescription/ treatment and must indicate the same dosage prescribed by the Physician. Bao Viet shall not accept receipts/ bills (non-VAT invoces) issued for cumulation purposes in each claim case as valid payment proofs;
• In case of Death: Original or certified copy versions  of Declaration of Death and the legal confirmation of the beneficiary or beneficiaries (in case there is no beneficiary nominated by the insured) with authorities’ notarization
• In case of study interruptions: the insured must submit a doctor’s certificate of disability and impossible continuation of the insured’s studies due to an illness or accident, together with valid official receipts/ documents of foreign educational institutions evidencing the payment of the said repeat or non-refundable tuition fees. The amount stated on thesereceipts will be used as the basis for calculating any reimbursement as detailed in the Benefit Schedule. When a family member deceases, the insured must submit the death certificate and relevant documents for claim settlement.
• Others if required by Bao Viet

b. Claim reimbursement and direct billing procedure

• Pay first, claim back:

When visiting the legal hospitals/ clicics which are not in the list of Medical Providers for Direct Billing Services, the Insured must pay all the incurred costs, and then submit the documents to Bao Viet Insurance to claim eligible expenses within the scope of coverage.

• Timebound:

Bao Viet Insurance shall have responsibility in claim processing and settlement within 15 (fifteen) working days from the date of receiving all sufficient and valid documentation and information. In particular:

• The claim receipt notification shall be sent within three (03) working days from the date of receipt of all required documentation and information.
• The requirement for additional documents (if necessary) shall be sent within five (05) working days from the date of receipt of documentation and information.
• The settlement notice shall be sent within ten (10) working days from the date of receipt of all required documentation and information.
• The claim reimbursement shall be transferred (or settled) within fifteen (15) working days from the date of receipt of all required documentation and information.
• The request for returning original claim documents in case of claim rejection must be sent within sixty (60) days after Bao Viet sent the settlement notice.
• Bao Viet Insurance’s examination of documentation and other information relevant to the Insured Person’s claim should be performed within ninety (90) working days from the date of receipt of all required documentation and information.
• Additional documents should be submitted by the Insured within thirty (30) working days from the date of receipt of documentation.

General claim information

All documents and materials required by Bao Viet Insurance to support claim settlement process shall be provided free of charge to Bao Viet before any claim payment is made.

In case medical information/ documentation is insufficient, it shall be the Insured’s responsibility to provide additional information/ documentation which is necessary and reasonable for claim reimbursement and Bao Viet shall not bear the cost of obtaining such information/ documentation.

Claims are only settled to the Insured or his/ her Beneficiary/ Legally authorized representative according to the law.

Direct billing services (applicable for plans which provide direct payment services)

When visiting Clinic/ Hospital which is in the list of Medical Providers for Direct Billing Services, the Insured should follow steps described below:

• Show BaoViet Care Card issued by Bao Viet Insurance and ID card, or Passport or Birth Certificate (in case the Insured is a child aged below 15) in the hospital/ clinic;
• Ensure to check the claim form provided by the Hospital/ Clinic after treatment and sign on that form in order to confirm all information related to the Insured’s treatment, make a deposit to the hospital/ clinic (if required);
• Pay the remaining costs which are not within the scope of coverage or exceed the benefit limits.

Special notes:

• If the Insured is indicated to receive acupuncture or orthopedic care where (s)he is treated by chiropractic, acupuncture, homeopathy, (s)he has to submit the doctor’s indication or referral forms.
• If laboratory tests and X-rays are performed, the Insured has to submit their results.
• In case documentation is insufficient, Baoviet or the policy administration shall have the right to require additional information/ documentation or another claim form to complete claim settlement.

c. Self-insurance/Other Insurance/Thirty party claim

The Policy will not provide the insured benefits other than on a proportional basis if the Insured Person has any other effective Insurance that entitles him/her to the Medical Expenses benefits upon the occurence the insured event.

BAOVIET must be informed without delay of circumstances where a claim against a Third Party can be made. The recipients of benefits shall at the request and at the expenses of BAOVIET, permit and authorize BAOVIET to exercise any rights and remedies for the purpose of enforcing all reasonable and necessary action of obtaining indemnity from other parties whom BAOVIET is entitled or shall become entitled under the subrogation agreement between the Insured and BAOVIET.

EMERGENCY

1. Request for Assistance, Emergency Evacuation

In case of emergency, the Insured Person or his/her representatives as soon as practicable shall call BAOVIET’s Hotline:

In order for BAOVIET to determine the assisting method, the Insured Person shall provide the following information upon contact:

• Name of the Insured Person, No. of the Policy and the expiration day of the insurance period.
• Telephone number and contact address.
• Summary of the actual situation of the Insured Person in need of assistance.
• Name, address, telephone number of the Hospital to which the Insured Person is transferred.
• Name, address, telephone number of the treating Physician and Family Physician (if any).

Medical expert team of the Assistance Company is entitled to directly contact with the Insured Person to understand his or her health situation. If the Insured Person fails to execute that obligation, the Insured Person will not receive medical assistance in any forms unless there are reasonable causes to prove their inability to execute.

2. Life-threatening situation

In a life-threatening situation, the Insured Person or his representative should always try to arrange for emergency transfer to a hospital near the place of incident through the most appropriate means, and notify the Assistant Company and BAOVIET as soon as practicable.

3. Hospitalization prior to notice the emergency Assistance Company

In any case of illness or bodily injury requiring hospitalization, the Insured Person or any person acting on his behalf must inform to BAOVIET/the Assistant Company within 24 hours from the time of admission. Failure to do so may entitle BAOVIET/Assitance Company to invoice the Insured Person for a part of the supplementary cost that has arisen out of the delay.

Related Documents

Application Form InterCare

InterCare Policy Wording

Company Claim Form

Personal Claim Form

Guideline for Claim, include TPA Address

Any question please feel free to contact us : +84 932 156899