Integrated Medical Scheme

You and your spouse/dependent children's eligibility for the Integrated Scheme are determined according to the terms of your employment with the University. Dependent children are covered from the 15th day after birth to the age of 20 and spouse is covered up to the age of 64.

For enrollment into the Integrated Scheme, please contact the Human Resources Office (HRO) at 3411-7979/3411-5081 or email at hro@hkbu.edu.hk.

a. Outpatient (Western medicine) Benefits
b. Outpatient (Chinese medicine) Benefits (at University appointed Chinese Medicine Clinics only)
c. Hospitalisation Benefits
d. Dental Benefits
e. Maternity Benefits
f. Preventive Care (for staff only aged 35 and above)

You may refer to HRO's website for more details on the Integrated Scheme:
https://hro.hkbu.edu.hk/content/dam/hro-assets/our-hr/policies-and-procedures/06-benefits/medical-and-dental-benefits/15-ims-regulations-en.pdf

The e-Medical Claims System (the System) aims to streamline and automate the reimbursement of outpatient claims processing. The System was launched on 1 July 2021 and provides an electronic portal for eligible members of the Integrated Medical Scheme to submit and track their outpatient medical claims through a web-based system or the HKBU mobile app. Please note that e-Medical Claims System does not process claim submission under in-patient/hospitalisation claims.

Eligible staff can submit an e-Claim via web-based e-Medical Claims System (on BUniPort) or HKBU mobile app;

• Click “New e-Claims” on home page;
• Select “Claimant” and “Medical Category”;
• Input “Consultation/Treatment Date”;
• Input “Name of Doctor/Clinic (Optional)”;
• Input/select “Diagnosis”;
• Select “Nature of Claim” for either new claim or second claim;
• Input the “Receipt Amounts”;
• Upload the required supporting receipt/invoice and/or referral letter;
• Review the e-Claim; and
• Review and check the “Declaration and Authorisation” box before you click “Submit”

Please contact the HRO for submission process.

“Pre-existing conditions” are injuries or sickness arising prior to effective date of membership in the Integrated Scheme and which presented signs or symptoms of which the Integrated Scheme member was aware or should reasonably have been aware of diagnoses that are classified as “Pre-existing conditions” are not covered under the Integrated Scheme for the first 6 months from the effective date of membership.

Please refer to the list of “Pre-existing Conditions” from HRO’s website for more details: https://hro.hkbu.edu.hk/content/dam/hro-assets/our-hr/policies-and-procedures/06-benefits/medical-and-dental-benefits/18-ims-pre-existing-conditions.pdf The list may not be exhaustive and is subject to the University’s consultant’s advice.

Please refer below for the list of "General Exclusions" at HRO’s website for more details: https://hro.hkbu.edu.hk/content/dam/hro-assets/our-hr/policies-and-procedures/06-benefits/medical-and-dental-benefits/17-ims-general-exclusions-en.pdf

Outpatient medical & dental claims should be submitted within one month after the date of consultation/treatment. Hospitalisation claims should be submitted within one month from the date of discharge from hospital. Late submission will be denied.

Please refer to HKBU's BUniPort > Profile > My Benefit > Medical > Hospitalisation Insurance Policy Number &/ Medical Benefits Summary. Alternatively, you may contact the University’s underwriter, BUPA, at 2517-5388.

Please click here for FAQ about e-Claims on following topics:
- General questions about e-Claims System and its scope
- Questions about data input for e-Claims System
- Action required for returned or rejected e-Claims
- User Guides for the e-Claims System

• For enquiries or assistance regarding in-patient (hospitalisation) claims, you may contact the University’s underwriter, BUPA, at 2517-5388.
• For enquiries or assistance regarding e-Claims, please provide the e-Claim number by contacting the FO 24-hour enquiry hotline (unmanned): 3411 2299 or email to fomedical@hkbu.edu.hk. Please note this hotline number is unmanned and it only provides pre-recorded information on various topics concerning staff’s payroll and benefits. To leave a message for FO after calling the enquiry hotline, please press 1 > 0 for Cantonese version OR press 2 > 0 for English version OR press 3 > 0 for Putonghua version. Please leave your name, question, e-Claim number and contact details when being prompted to leave a message. You may also write to FO’s email at fomedical@hkbu.edu.hk. Our FO colleagues will revert to you within the next two working days.

You can visit the following doctors/medical professionals of your own choice under the outpatient (western) benefits:
(a) General/Specialist registered under The Medical Council of Hong Kong.
http://www.mchk.org.hk
(b) Registered physiotherapists and chiropractors referred by registered western medical practitioners.

No. Only physiotherapy and chiropractic treatment with a valid referral letter are claimable under the Integrated Scheme.

A valid referral letter issued from a registered medical practitioner is required for the following medical treatments:-
(a) Physiotherapy/Chiropractic treatments, X-ray/laboratory tests (6 months validity period from the date of issue).
(b) Purchase of prescribed long-term medications (6 months validity period from the date of issue).

You have to pay a co-payment of 15% while the University reimburses 85% of each medical bill, including those incurred for physiotherapy and chiropractic treatments referred by registered medical practitioners, subject to an annual overall reimbursement limit of $13,000 for each Integrated Scheme member. Within this limit, there is a sub-limit of $6,000 for reimbursement of X-ray/laboratory tests (including all radiology items) and prescribed long-term medications.

Medication prescribed by a registered medical practitioner for 30 days or more which is purchased from the clinic or a licensed pharmacy (Rx) is defined as long-term medication. The reimbursable amount is governed by an annual sub-limit of $6,000.

Yes. The Claimant needs to attach the relevant prescription letter as well as stating the past purchases (i.e. the first and second purchases/claims) on the receipts of the current claim in order to enable an easy verification by the Finance Office.

The maximum reimbursement limit for outpatient benefits is $13,000 for each Integrated Scheme member. Within this limit, there is a sub-limit of $6,000 for X-ray / laboratory tests (including all radiology items) and long-term medication (please refer to Question 17 and Question 18).

With the launch of the e-Medical Claims System, the frequency of reimbursement is enhanced to a weekly basis. The entitled reimbursement will be deposited directly to staff’s salary account. Under normal circumstances, an e-Claim submission with sufficient supporting documents would be reimbursed within 15 working days.

A referral letter issued from a registered western medical practitioner is required for X-ray to be taken in chiropractor’s clinic. Medication prescribed or medical supplies by chiropractor are not covered by the Integrated Scheme.

Yes. Please request the attending western doctor to complete the “Hospitalisation & Surgical Claim Form”, and attach the invoices, official receipts together with the claim form and send to the University’s underwriter directly.

No. Expenses incurred for surgery/operation (excluding X-ray/laboratory test and physiotherapy treatment) in the clinic/out-patient setting, regardless of minor or intermediate surgery/operation, are covered under hospitalisation benefits. Please request the attending western doctor to complete the “Hospitalisation & Surgical Claim Form”, and attach the invoices, official receipts together with the claim form and send to the University’s underwriter directly.

There are two steps involved. First, you claim the advanced diagnostic scanning charge (i.e. MRI/CT Scan) via the in-patient/hospitalisation coverage (i.e. either your personal medical insurer(s) or/and the University’s underwriter as refer to Question 23) and request the insurer to return the certified true copies of the official receipts to you. Second, you then submit an e-Claim on the consultation fee via the e-Medical Claims System with the returned certified true copies of medical receipts, payment advices issued by other insurer(s).

An administration fee of HK$50/application will be charged for each application. Please inform the Finance Office which e-Claims that require certification by detailing your e-Claims details (including the e-Claim Number, Claim Amount and Date of Consultation) and send your request to Finance Office via email to fomedical@hkbu.edu.hk attached with the relevant bank-in slip as evidence of payment.

Staff member aged 35 and above may claim reimbursement for undertaking annual physical (including eye) check-up or gynaecological check-up. Only staff members are eligible for Preventive Care benefit.

No referral letter is required. You can join the health check package offered by any medical or laboratory centre without a referral letter.

The benefit entitlement is $1,000 per annum (with effective from 1 July 2021) per Staff member aged 35 or above. Spouse and dependent children are NOT eligible for this benefit. From the financial year of 2015/16, flexibility will be provided to combine 2 year’s benefit limit to be used in alternate years. Any unused balance (subject to the annual entitlement of $1,000) can be carried forward to the next Integrated Scheme year. Advanced entitlement is not allowed.
Illustration:

Please submit an e-Claim uploaded with relevant supporting documents via the e-Medical Claims System.

Staff claiming for Maternity Benefits should have completed 40 weeks of continuous service in the University prior to the expected date of her or his spouse’s commencement of maternity leave.

The reimbursement amount is calculated according to the labour conditions and the staff’s terms of service. Please see [Table]. Staff is advised to keep the receipts for ante-/post-natal check-ups and hospital bill for delivery and claim for reimbursement of the expenses so incurred in one lot and submit an e-Claim via the e-Medical Claims System within one month after the maternity case has been concluded. If the staff member concerned is taking maternity leave, claim for reimbursement should be submitted within one month after her resumption of duty.

Dental Service Centre Limited (DSC).

No. Only the fee incurred at the University’s appointed dental service provider is claimable.

Please see [List] for the addresses and opening hours of dental clinics.

Advance booking is required. Bookings are made either by phone or online. Please see [List] for the phone numbers of dental clinics. The emergency hotline is: 6632-3280 (0800-2200)..

No claim procedure is required for Primary Dental Care as it is free of charge. For Secondary Dental Care, Integrated Scheme member should pay the service in FULL. He/She can submit a new e-Claim via the e-Medical Claims System within one month after the treatment date by uploading the Secondary Dental Care Form, which is to be filled in by the attending dentist and accompanied with an official receipt.

Primary Dental Care is free of charge.

As for Secondary Dental Care, Member should pay in FULL at the designated dental clinics and the University will reimburse a maximum of 50% of the quoted reference price list or 50% of the actual amount charged, whichever is lower [click here for details]. The reimbursed amount is subject to an annual cap of $3,800 per Member.

Illustration for Claiming the treatment of Crown:
The quoted reference price for Crown per tooth (Non-precious alloy) is $2,500, therefore, the maximum amount reimbursed would be 50% of it i.e. $1,250

No. The University only covers those Primary and Secondary Dental Care listed in the HRO’s website

Yes, only limited to Secondary Dental Care treatment and reimbursement will be done according to Question 6.

No. The Integrated Scheme only covers Chinese medicine services rendered at any of the HKBU Chinese Medicine clinics and their locations are listed in the link: - [Name and Location of Appointed Chinese Medicine Clinics].

You have to pay a nominal fee of $30 per visit for the first 15 visits and $50 per visit for the 16th to 20th visits per financial year (i.e. 1 July to the next 30 June) upon presentation of valid staff/affiliate ID. For any expenses exceed the benefit limit will be borne by claimants, no reimbursement will be made by the University.

Yes, but limited to referral issued by the Chinese Medicine Practitioners of the University appointed Chinese Medicine Clinics. All medical lab test (except for Advanced Diagnostic Scanning) referred by HKBU’s Chinese Medicine Practitioners are claimable under the Scheme. For Advanced Diagnostic Scanning such as Computed Tomography Scan and Magnetic Resonance Imaging, it must be referred by a registered western medical practitioner.

Hospitalisation under the Integrated Scheme will be covered according to a schedule of benefits for [Group I], [Group II] & [Group III], if recommended by a Registered Medical Practitioner, and such hospitalisation shall mean confinement in Hospital where the Member is registered as a bed patient, except that no confinement in Hospital is required if surgical procedure is performed at Doctor’s clinic. One pre-hospitalisation consultation and all necessary post-hospitalisation follow up consultations within 6 weeks from the date of discharge are also covered within hospitalisation benefits subject to the limit of Physician’s Hospital Visit Fees.

There is one optional voluntary plan - the Sapphire Plan for each three different levels of benefits [Group I] [Group II] [Group III] for staff to choose from. Colleagues are given options to join the voluntary plan, with enrollment on a family basis, starting from 1 July every year by completing the “Voluntary Plan Enrolment Form” and return to the Human Resources Office for enrollment. The premium for the voluntary plan will be borne by Integrated Scheme member and deducted from Staff members’ payroll.

Member has to obtain an official receipt with detailed breakdown of charges and a letter of discharge / statement with full details from hospitals as follows: -

• Patient details
• Period of hospitalisation or date of day ward charges or date of clinical operation performed
• Diagnosis
• Operation performed (if applicable, with full description of the procedure(s) involved)
• Name(s) of all the attending/surgical doctors; and
• Completed Hospitalisation & Surgical Claim Form (“Hospitalisation Claim Form”) by both the Integrated Scheme member and the attending doctor.

The original receipt (including the deposit receipt) issued by the clinic/hospital and copy of referral letter (if applicable) should be attached to the “Hospitalisation & Surgical Claim Form” and to be sent directly to the University’s underwriter at the address indicated in the Claim Form at BUPA (Asia) Ltd – Claims Dept., 6/F, Tower 2, The Quayside, 77 Hoi Bun Road, Kwun Tong, Kowloon, or via the Finance Office. The Finance Office shall forward all hospitalisation claims to the University’s underwriter every Monday morning for reimbursement process.

You may go to HKBU's BUniPort > Profile > My Benefit > Medical > Medical Benefits Summary & Corporate Membership Number > Schedule of Hospitalisation Benefits or contact the University’s underwriter hotline at 2517-5388 for assistance.

Please contact the University’s underwriter’s Hotline at 2517-5388 directly (24-hour) or login to the University’s underwriter‘s website at “https://www.bupa.com.hk/en/customer-care/” for enquiry. For member login, please note the Group/Corporate Policy number is 01589500. Please input the Corporate Policy number, your name, date of birth, and assign your own login ID name and password for registration.

Please put a “√” in the box for request of certified true copy for other insurance claim on page one of the Hospitalisation Claim Form provided by the University’s underwriter.

Please refer to slide 26 to 28 of the presentation slides of Integrated Medical Scheme for illustration of SMM at here.