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 for initial enrollment; or extend to 75 years old if renewal.

– Not suffer from mental illness.

– Not suffer from cancer (applicable for the person joining in first year).

– Not suffer from more than 80% permanent disabilities (applicable for the person joining in the first year).

– Not under inpatient treatment(s) of any special disease as defined (applicable for the person joining in the first year).

– Vietnamese or Foreigner residing legally within the territory of Vietnam and not travel away Vietnam for more than consecutive 180 days.

If the insured person is not eligible to join into this insurance policy, the Insurer has the right to cancel the insurance coverage for that insured person and all benefits are forfeited.

All the dependents of any employee could be only enrolled and updated into the insurance policy with benefits equivalent to or lower than those of the employee (including main benefit and optional benefits) and must be approved by Bao Viet Insurance.

Newborn children from 15 days of age from the date of birth or the date of hospital discharge, whichever is later, shall be eligible for insurance. The insured person must submit an insurance application form along with a certificate of good health and must be approved by Bao Viet Insurance.

Children under the age of 18 are required to enroll concurrently with a parent.

Applies additionally to group insurance policy:

Eligibility of Insured person in group insurance policy including

a. Employees of the Policyholder.

b. Dependents of the Employees.

– Dependents of the existing employees must be enrolled in the program once at the

effective date.

– Mid-term declaration is only applicable for:

• Dependents of new staff joining after effective date;

• Newly-married wife or husband;

• Newborn baby when being eligible to join into the policy;33

• Dependant(s) of employees who passed the probationary period/promoted during

the insurance period attaining to join according to company policy.

– The dependents (if applicable) will be deleted automatically from the employees’ leaving

date.

– All the dependents of any employee could be only enrolled and updated into the Policy

with benefits equivalent to or lower than those of the employee.

– The Policyholder is responsible for providing the list of employees and dependents as per

the above eligibility. Failure to do so will lead to the claim(s) decline and cancellation with

specific cases.

2. Effective date / Waiting period

Insurance benefits are subject to the waiting periods as follows:

2.1 For Individual insurance policy:

a. Personal accident:

Effective immediately from the policy effective date.

b. Term life

– First 90 days in case of normal illness/diseases, dental care.

– First 365 days in case of pre-existing conditions, special diseases, maternity, diseases/

conditions listed under general exclusion 39 of the insurance wording.

– First 180 days for children to 6 years old for: bronchitis, bronchiolitis, all types of

pneumonia.

c. Inpatient treatment:

– First 30 days in case of normal illness/diseases

– First 365 days in case of pre-existing conditions, special diseases, maternity, diseases/

conditions listed under general exclusion 39 of the insurance wording.

– First 180 days for children to 6 years old for: bronchitis, bronchiolitis, all types of

pneumonia.

d. Outpatient treatment:

– First 30 days in case of normal illness/diseases

– First 365 days in case of pre-existing conditions, special diseases, maternity, diseases/

conditions listed under general exclusion 39 of the insurance wording.

– First 180 days for children to 6 years old for: bronchitis, bronchiolitis, all types of

pneumonia.

e. Maternity

– First 90 days in case of complications of maternity.

– First 635 days in case of childbirth.37

f. Dental care

– First 30 days

2.2. For group insurance policy:

2.2.1. Group less than 20 employees:

a. Personal accident

Effective immediately from the policy effective date.

b. Term life

– First 90 days in case of normal illness/diseases, dental care.

– First 365 days in case of pre-existing conditions, special diseases, maternity, diseases/

conditions listed under general exclusion 39 of the insurance wording.

– First 180 days for children to 6 years old for: bronchitis, bronchiolitis, all types of

pneumonia.

c. Inpatient treatment, Daily allowance due to loss of income

– First 30 days in case of normal illness/diseases.

– First 365 days in case of pre-existing conditions, special diseases, maternity, diseases/

conditions listed under general exclusion 39 of the insurance wording.

– First 180 days for children to 6 years old for: bronchitis, bronchiolitis, all types of

pneumonia.

d. Outpatient treatment

– First 30 days in case of normal illness/diseases.

– First 365 days in case of pre-existing conditions, special diseases, maternity, diseases/

conditions listed under general exclusion 39 of the insurance wording.

– First 180 days for children to 6 years old for: bronchitis, bronchiolitis, all types of

pneumonia.

e. Maternity

– First 90 days in case of complications of maternity

– First 365 days in case of childbirth

f. Dental care

– First 30 days

2.2.2. Group from and above 20 employees:

a. Personal accident

Effective immediately from the policy effective date.

b. Term life

– First 90 days in case of normal illness/diseases, dental care.

– First 365 days in case of pre-existing conditions, special diseases, maternity, diseases/

conditions listed under general exclusion 39 of the insurance wording.

– First 180 days for children to 6 years old for: bronchitis, bronchiolitis, all types of

pneumonia.

c. Inpatient treatment, Daily allowance due to loss of income

– Not applicable in case of normal illness/diseases.

– Not applicable in case of pre-existing conditions, special diseases, maternity, diseases/

conditions listed under general exclusion 39 of the insurance wording.

d. Outpatient treatment

– Not applicable in case of normal illness/diseases.

– Not applicable in case of pre-existing conditions, special diseases, maternity, diseases/

conditions listed under general exclusion 39 of the insurance wording.

e. Maternity

Claim settlement on pro-rata basis:

– First 90 days in case of complications of maternity

– First 365 days in case of childbirth

f. Dental care

– Not applicable.

3. INSURANCE BENEFITS – BAOVIET INTERCARE

4.PREMIUM TABLE – BAO VIET INTERCARE

5. 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

6. Payment term:

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

7. GENERAL EXCLUSION

(Applied to the Insurance Policy and all Endorsements)

The following exclusions apply to all insurance benefits, including optional benefits.

The Insurer shall not be liable for any risks, below listed items and related medical expenses or their complications/ consequences:

1. Any expenses in excess of medically necessary, customary and reasonable expenses and not prescribed by physician.

2. Pre-existing conditions, special diseases as defined shall be excluded in the first year of insurance.

3. Wilful misconduct of the insured person or the legal beneficiary.

4. The insured person aged 14 or over violate laws leading to the criminal prosecution, violation of regulation of local authorities or of social associations. The insured person violates labour regulation according to labour laws.

5. The insured person drives any kind of transportation while having blood alcohol content exceeds 50 milligrams/100 milliliters of blood or 0.25 milligrams/1 liter of breath; or violating other provisions of the Law on Road Traffic Order and Safety (and its amendments, supplements, or replacements, if any).

6. The insured person being under the influence of stimulants, narcotics, addiction- cessation drugs, medicines that are not prescribed by a physician, alcohol, beer, or any other alcoholic substances, where such influence is the cause of the accident.

7. Consequences arising from the use of illegal drugs, alcoholic substances, or addiction treatment.

8. Costs of acquisition of organs for transplant, including but not limited to, expenses for organ donation, receiving, purchase, transportation, or preservation of organs. However, medical expenses incur for the surgical transplantation of an organ into the body of the insured person shall be covered.

9. Any intentional unlawful act or brawl committed by the insured person, unless such act is confirmed by a competent authority as being performed in the act of saving a life, protecting property, or in self-defense.

10. Costs for dental examinations and treatments, including both inpatient and outpatient treatment, except the emergency accidental dental treatment benefit and in case the insured person enrolls the optional “Dental Care” benefit.

11. Engaging in aviation activities (unless as a fare-paying passenger on a commercial flight), participating in military training courses, or engaging in combat operations by armed forces.

12. Disaster risks such as earthquakes, volcanoes, tsunamis; radioactive contamination; epidemics of infectious diseases group A&B/pandemics/public health emergency officially declared by WHO or the local authorities.

13. Risks arising from or related to war, civil war, strikes, terrorism, riots, civil commotions, armed insurrection disturbing public order, rebellions, or actions of any leader of an organization aiming to overthrow, threaten government, or control by force.

14. Engaging in training for or participating in professional sports activities, or engaging in hazardous sports activities, unless otherwise agreed in the insurance policy.

15. Examination and treatment of sexually transmitted diseases such as: chancroid, granuloma inguinale, gonorrhea, syphilis, genital herpes, genetal warts, genital HPV, pubic lice (genital crabs), chlamydia, trichomonas, trichomonas, lymphogranuloma venereum, molluscum contagiosum for insured person above 10 years old, acquired immunodeficiency syndrome (AIDS), HIV-related conditions and diseases, other sexually transmitted diseases; and any complications/consequences related to the above diseases/ syndromes/ conditions.

16. Congenital diseases, birth defects, congenital anomalies, genetic deformities or diseases, hereditary medical conditions with symptoms occur at birth.

17. Treatment of chronic renal failure, dialysis methods (artificial blood filtration). However, Bao Viet Insurance will pay for dialysis costs arising:

a. Immediately pre and post surgical operation.

b. Related to secondary acute kidney injury when the insured person has to be treated in the intensive care unit.

18. Routine health check-ups, periodic examinations; general health check-ups; cancer screenings; medical assessments or medical consultations unrelated to the treatment of disease/illness or injury, including gynecological/andrological examinations; examination/treatment for growth hormone deficiency/disorder, pre-menopause or menopause in women; routine examinations for newborns; all forms of immunizations, vaccines, and preventive medicines (except for vaccinations administered after an accident or animal/insect bite); and pregnancy check-ups (unless otherwise agreed in the insurance policy).

19. Degenerative cataracts; strabismus (squint); Routine vision/hearing tests; Aging, degeneration, or treatment for natural/non-pathological deterioration of hearing or vision, including but not limited to: refractive errors including myopia (nearsightedness), hyperopia (farsightedness), and astigmatism, and any treatment/surgical operation for their correction. However, dry eyes, accommodative29 asthenopia, and accommodative disorders are covered, with a total limit per visit equal to 5% of the sum insured of outpatient treatment benefit, and not exceeding the outpatient treatment benefit sum insured.

20. Treatment and surgical operation carried out as requested by the insured person which are not associated with common treatment or operation as regulated by the health industry.

21. Examinations and laboratory tests/diagnostic imaging without a physician’s disease diagnosis, or the physician conclude that there is no diagnosed disease (this does not apply to the first follow-up examination after inpatient discharge as prescribed by a physician); and medical expenses unrelated to the event within scope of coverage.

22. Cosmetic treatment, cosmetic surgery, plastic surgery, complications arising from cosmetic treatment/cosmetic surgery/plastic surgery; and orthodontics (this exclusion does not apply to reconstructive surgery performed to restore the function of an injured organ/body part incur during the insurance period).

23. Treatment for hyperpigmentation (melasma), acne/pimples, and hair loss treatment are specifically excluded for the outpatient treatment benefit. However, if the insured person is required to have inpatient treatment for these diseases/illnesses, the treatment shall be covered under the inpatient treatment benefit.

24. Costs of buying, providing, maintaining, fixing or replacing: prosthesis, medical supportive appliances/devices/equipments used for treatment as defined (unless otherwise agreed in the insurance policy).

25. Funtional foods, minerals, organic substances augmenting nutritional intake or serving dietary regimens available naturally, cosmeceutical products, and vitamins (unless such vitamins are prescribed accompanied by treatment drug and total expenses for these vitamin/minerals shall not exceed 20% the total expenses of treatment drug).

26. Family planning; examination and treatment for infertility/subfertility; treatment for impotence; sexual dysfunction or physiological treatment; artificial insemination (including all types of artificial insemination), treatment of complications of maternity/childbirth on people got pregnant by artificial insemination; treatment for gender issues; or any consequences or complications of the aforementioned treatments.

27. Body weight control (weight gain or weight loss treatment), malnutrition, rickets, obesity.

28. Mental and behavioral disorders, mental illnesses, psychoneuroses, psychological conditions, somatoform disorders, mental retardation, attention deficit disorders, autism spectrum disorders, sleep disorders, insomnia, snoring without specific cause, neurasthenia and physical debility without pathological cause, stress syndrome or related conditions arising therefrom.

29. Treatment at a private clinic and dental clinic, which is unlicensed or is not able to provide payment documents/invoices in accordance with legal regulations, unless otherwise specified in the policy schedule or any endorsement.

30. In the event that the Policyholder/insured person declares or provides dishonest or incomplete information regarding their medical condition/injury, the Insurer reserves the right to reduce its liability in full or in part for the claim under the insurance policy.

31. All costs incurred in related to persons who is ineligible to be insured under this insurance policy.

32. Risks or medical treatment occur outside the geographical coverage area; Accidents occur outside of the insurance period; medical expenses occur outside of the insurance period which are the consequences of accidents occur during the insurance period.

33. Home examination/treatment services; remote medical examination and treatment services from hospitals/clinics; examination and treatment at hospitals/clinics that do not comply with the definition of hospitals/clinics in the insurance wording, including the indication from physician of such hospitals/clinics for prescription/tests/treatment at legal hospitals/clinics/pharmacies (unless otherwise agreed in the insurance policy).

34. Experimental treatment, treatment that is not scientifically recognized. Medical expenses derived from free treatment service at any medical facility, preventive examination/treatment.

35. Treatment due to the attending physician’s fault.

36. Use of medicine without a prescription; medical treatment and/or use of medicine not in accordance with a physician’s prescription; or medicines not legally permitted for circulation in Vietnam.31

37. Treatment and surgical operation for disease/illness/injury by stem cell transplantation methods, such as: costs for extraction, processing, transplantation of stem cells, maintenance treatment after stem cell transplantation, and consequences of this treatment method. Stem cell transplantation is only covered for inpatient treatment costs at public hospitals, unless otherwise agreed in the insurance policy.

38. Medical expenses incurred or prescibed by medical facility where insurance benefits are not covered updated on the Insurer’s website and/ or regulated in the insurance policy, in case of any difference, the provisions in the insurance policy will prevail.

39. The following illnesses/conditions will not be covered during the first year of insurance regardless of whether the illnesses/conditions occur before or after the insurance policy takes effect

a) Diseases of the respiratory system: Adenoiditis need curettage, nasopharyngeal papillomas, tonsillitis requiring tonsillectomy, sinusitis, nasal septum deviation requiring a surgery, asthma.

b) Diseases of the ear: Otitis media requiring a surgery, removal of turbinate bones/nasal conchae.

c) Diseases of the cardiovascular disease: Phlebitis and Thrombophlebitis/ Venous thrombosis, varicose veins, tunnel syndrome, lymphatic disease/lymph node disease, hemorrhoids.

d) All types of Metabolic disorders

e) Disease of the musculoskeletal system: Chronic arthritis, chronic polyarthritis, spondylosis, spondylarthrosis, degenerative joint disease, herniated disc, bone density and structure disorder, gout.

f) Diseases of the digestive system: Peptic ulcer, duodenal ulcer, colonic ulcer, và ulcerative colitis

g) Other illnesses/ diseases:  Gallstones, cysts, warts, polyps, vestibular disorders, /examination/treatment related to ligament tears/ruptures/reconstruction and meniscus.

40. Medical expenses for people who are not the insured person (such as room/board

expenses for relatives, other expenses for relatives of the insured person).

8. Claim settlement procedure and direct billing

8.1. In case of pay first then submit claim later:

In cases the Insured person is not eligible to use direct billing services, or clinic/hospital which is not in the list of direct billing network, the insured person must pay all medical expenses first, and then submit the claim to the Insurer for reimbursement of medical expenses within scope of insurance coverage.

a. Claim payment timeline:

The Insurer is responsible for processing and settling the claim within the claim payment timeline in the insurance policy; in case there is no relevant regulatory in the insurance policy, the Insurer shall be responsible for claim handling and settlement, claim notification to the insured person/his legal heir/his legal beneficiary/his legally authorized representative within fifteen (15) working days from the date of receipt of all valid and sufficient claim documents.

b. General information of claim settlement:45

– All documents (including original invoices, certificates, X-ray films, etc.) required by the Insurer to support the claim settlement process, including medical reports and any information related to the insured person’s medical history must be provided free of charge to the Insurer, prior to any insurance payment being made. In cases medical information is missing or documents must be clarified, the insured person is responsible for providing the additional information, and the Insurer is not obligated to cover the costs associated with acquiring this additional information.

– Insurance benefits shall be paid to the insured person/his legal heir/his legal beneficiary/his legally authorized representative in accordance to applicable laws. In cases the insured person has not nominated his legal beneficiary, or this legal beneficiary has passed away or gone missing, the Insurer shall pay the claim amount to the legal heir(s) in accordance to the inheritance laws.

– The employee may act on his/her dependent’s behalf to make a claim and receive claim reimbursement unless it is a death claim which shall be subject to applicable inheritance laws.

8.2. In case of direct billing (applicable for insurance policy with direct billing service)

Unless otherwise stipulated in the insurance policy, when visiting clinic/hospital which is in the list of direct billing network system, the insured person should follow steps described below:

– To show Baoviet direct billing insurance card issued by the Insurer and ID card/Passport/Residence card/Birth Certificate (in case the insured person is a child) to the hospital/clinic.

– To 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 person’s treatment, make a deposit to the hospital/ clinic (if required).

– To pay the remaining costs which are not within the scope of coverage or exceed the benefit limits.

9. Emergency case

9.1. Request for emergency medical assistance and evacuation

In an emergency, the Insured Person or their representative must immediately call the hotline of Bao Viet Insurance or the Assistance Company designated by Bao Viet. To enable Bao Viet Insurance to determine the appropriate assistance measures, the Insured Person must provide the following information when contacting the hotline:

•  Full name of the Insured Person, insurance policy number, and policy expiry date;
•  Contact phone number and current location;
•  A brief description of the Insured Person’s actual medical condition requiring assistance;
•  Name, address, and phone number of the hospital where the Insured Person has been admitted;
•  Name, address, and phone number of the attending physician and family doctor (if any).

The medical team of the Assistance Company is authorized to contact the Insured Person to assess their health condition. If the Insured Person fails to fulfill this responsibility, they will not be entitled to any form of medical assistance, unless there is a valid reason proving that they were unable to do so.

9.2. Life-Threatening Situation

In the event that the Insured Person’s life is in critical danger, the Insured Person or their representative must make every effort to arrange emergency transportation to a nearby hospital using an appropriate means of transport and must notify the Assistance Company and Bao Viet as soon as possible.

9.3. Hospitalization Prior to Notification to the Assistance Company

In the event that the Insured Person suffers an illness or bodily injury requiring hospitalization, the Insured Person or their representative must notify Bao Viet Insurance and/or the Assistance Company designated by Bao Viet within 24 hours from the time of admission. Failure to notify within the specified timeframe may result in Bao Viet Insurance and/or the designated Assistance Company requiring the Insured Person to bear a portion of any unreasonable excess costs arising from the delayed notification.

10. Time limit for appealing claim

The insured person has the right to appeal against any claim settlement within six (06) months from the date of receipt of Insurer’s notification and the duration for any appeal must not exceed three (03) years from the date the entitled person knows or should know that his/her legitimate rights and interests have been violated.

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