Bupa Hero VHIS Plan (Advance) (F00040)

General Terms:

• I declare that I am in Hong Kong at the time of making this online application.
• I confirm and declare that neither of myself nor any proposed insured persons held any Bupa medical insurance applied via Hang Seng Bank or Bupa Hero VHIS Plan.
• I acknowledge that any premium refund made under this Policy shall be payable to the Policy Holder only.
• I confirm that the credit card used to make payment under this Policy is held by myself. (Applicable to applications that have provided Hang Seng Credit Card details for premium payment)
• I acknowledge that Bupa reserves the right to request a copy of identification card of myself and/or any Additional Insured Person(s) for verification purposes at any point during the policy period.
• I understand that if I or any Additional Insured Person(s) have an existing medical insurance policy, it is my responsibility to determine the suitability and desirability of continuing the existing medical insurance policy in conjunction with a new medical insurance policy under the Scheme, should my or any Additional Insured Person(s)’s application be accepted by Bupa

Coverage and Pre-existing Conditions:

• I agree to be bound by the terms and conditions of the Policy of this Scheme, which will be provided to me if this Application is approved.
• I acknowledge that the Policy shall be renewed automatically on a yearly basis unless it is not renewed by giving notice to Bupa or according to the terms of the Policy. I further authorise Bupa to deduct the premium payments from my designated bank account / credit card (where applicable) upon renewal. If I want to cancel the Policy in future, I will need to inform Bupa in writing at least 30 days before the renewal date.
  
• I acknowledge that benefit is not payable to me or any Additional Insured Person(s) under the Scheme for any costs of treatment arising from any existing illnesses, injuries or other conditions which has been treated or diagnosed or manifested with signs and symptoms that should be reasonably aware before the Policy Effective Date of the Scheme (or, if applicable, the date as referred in the Endorsement Letter if switching from an existing Bupa Health Insurance Scheme).
• The statements and information provided in the Health Declaration of this Application are true and complete and all information disclosed on behalf of the Additional Insured Person(s) has been verified by me as true and correct. I acknowledge that the knowledge of the Additional Insured Person(s) is imputed to my knowledge.
• I acknowledge that Bupa may verify the answers in the Health Declaration of this Application with Additional Insured Person(s) and where there is any discrepancy between:
  (a) the content of the telephone calls between Additional Insured Person(s) and Bupa; and
  (b) the information provided in the Health Declaration,
  the information on the Health Declaration will be deemed as true, accurate and complete declarations made by all Additional Insured Person(s).
• If any information collected during the telephone calls between the Additional Insured Person(s) and Bupa has changed or is not reflected accurately in the Health Declaration, I shall advise Bupa of such change or inaccuracy before submitting this Application. I understand that I am required to notify Bupa immediately if the health condition of any Insured Person(s) has changed at any time after the submission of this Application and before the Policy Effective Date of the Scheme.
• In the event the Pre-existing Conditions have been disclosed during application and accepted by Bupa, Bupa may apply a Premium Loading to cover that specific condition(s) and the percentage of Premium Loading shall be notified to me in writing.  Bupa may apply Case-based Exclusion(s) due to a Pre-existing Condition or any other factor that may affect the insurability of the proposed Insured Person(s). 
  
• I acknowledge that the place of residence of the proposed Insured Person(s) is in Hong Kong. I understand that I am required to notify Bupa immediately in writing if any proposed Insured Person(s) has changed his/her place of residence.
•  I acknowledge that Bupa may terminate the cover for the proposed Insured Person(s) with immediate effect if the law of the country in which the proposed Insured Person(s) is located, or the proposed Insured Person(s)’ Place of Residence or nationality, including but not limited to USA and Japan, or any other law which applies to Bupa or the Policy, prohibits the provision of healthcare cover by Bupa to local nationals, residents or citizens. I further declare that the proposed Insured Person(s) is not US permanent residents. I understand that I am obliged to immediately notify Bupa in writing if the proposed Insured Person(s) becomes a permanent resident of USA during the Policy Year. For the above purpose, ‘permanent resident’ shall mean a person residing in a country who is a citizen of or who is permitted under applicable laws to live and work, on a permanent basis, in that country.
• I understand that failure to provide Bupa with full, complete and accurate information in the Application may result in Bupa having the right to treat my policy as if it has not existed or refusing to pay all or part of a claim. I agree that the answers given in this Application and the Health Declaration shall be the basis of the Policy between me/Additional Insured Person(s) and Bupa.     

Personal Data and Information Disclosure:

• I consent, and I have obtained consent from all Additional Insured Person(s), to:
  • Hang Seng Bank Limited disclosing the personal data provided in this Application to Bupa; and
  • Bupa using and disclosing the personal data provided in this Application and other personal data it collects about me and the Additional Insured Person(s),
    for the purposes set out in and in accordance with the Personal Information Collection Statement of this Application.
• Further, I have obtained consent from all Additional Insured Person(s) to me providing Bupa, and to Bupa providing me, with health and medical information and other personal data regarding the Additional Insured Person(s) during the Application and the continuance of the Policy, including renewal.
• I acknowledge that Bupa reserves the right to ask for submission of more details of health status or medical reports relating to myself and any Additional Insured Person(s) listed in this Application, at my own cost.
• I authorise any medical practitioner, hospital, clinic, by whom or where I / the Additional Insured Person(s) have been observed or treated or any insurance company or organisation that has any records or health information concerning me and / or the Additional Insured Person(s) for any reason, to give full particulars thereof including prior medical history to Bupa.
• I acknowledge that Bupa has discretion to appoint Registered Medical Practitioners, Hospitals, Qualified Nurses, cancer centres, day-case centres, diabetic centres, wellness centres and other service providers to provide health and care services, credit facilities for eligible medical expenses and to do all things and acts incidental to such appointment for me or the Additional Insured Person(s). I acknowledge and agree that such appointment shall be made on such terms and conditions as Bupa shall think fit at its absolute discretion. Bupa shall not be liable for any claim whatsoever which may be made by me or any Additional Insured Person(s) against any such service provider appointed by Bupa. I acknowledge and agree to reimburse Bupa in full for any ineligible medical expenses and Deductible (if applicable) under this Scheme within 14 days of receipt of a written notice from Bupa.

Eligibility for Tax Deduction:

• I acknowledge that the premium paid under this Scheme shall not be automatically entitled to tax deduction even this Application is approved by Bupa. I understand that I am required to fulfil the conditions and assessment criteria imposed by the Inland Revenue Department and any applicable laws (which may amend from time to time), which include but not limited to allowable relationship for dependant, age/disability/full-time education requirement, date and amount of qualifying premium paid, in order to enjoy any tax deduction.
• Policies purchased for grandchild, domestic partner (i.e. civil partner, or the person with whom the Policy Holder lives in a continuous, committed, exclusive relationship during which period neither the Policy Holder or that person were or are married to or partnered with any other person) and domestic partner’s child/parents are not eligible for tax deductions.

Cancellation Rights and Refund of Premium(s) within Cooling-off Period:

• I understand that I have the right to cancel the policy and obtain a refund of any premium(s) and levy paid by giving a written notice to Bupa (Asia) Limited. I understand that to exercise this right, the notice of cancellation must be signed by me and received directly by Bupa (Asia) Limited at 6/F, Tower 2, The Quayside, 77 Hoi Bun Road, Kwun Tong, Kowloon, Hong Kong within the cooling-off period. I understand that the cooling-off period is the period of 21 days immediately following either the day of delivery of the policy or the cooling-off notice to me or my nominated representative (whichever is the earlier). I understand that the cooling-off notice is a notice that will be sent to me or my nominated representative by Bupa (Asia) Limited to notify me of the cooling-off period around the time the policy is delivered.

Personal Information Collection Statement: