3. Regulation 10 of the principal Regulations is amended —(a) | by deleting paragraph (8); | (b) | by deleting paragraphs (10) and (11) and substituting the following paragraphs:“(10) Subject to paragraphs (1)(c), (2) and (5)(c), where in any policy year, an insured person has received at an approved hospital any medical treatment (excluding any medical treatment specified in paragraph (13)) as an in-patient or as day surgical treatment, and the insured person was admitted for such medical treatment on or after 1st July 2005, he shall be entitled to claim from the Board, in respect of such medical treatment, an amount ascertained in accordance with one of the following formulae:(a) | if the total of the relevant amounts for all such medical treatments received in the policy year is less than or equal to $3,000, the formula is — | | | is the total of the relevant amounts for all such medical treatments received in the policy year; |
| | | | is the insured person’s contribution specified in item (1) in Part II of the Fourth Schedule; and |
| | | | is the total claim paid in the policy year; |
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| (b) | if the total of the relevant amounts for all such medical treatments received in the policy year is more than $3,000 but less than or equal to $5,000, the formula is — | | | | + [(A – $3,000) x 0.85] – C, |
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| | | is the total of the relevant amounts for all such medical treatments received in the policy year; |
| | | | is the insured person’s contribution specified in item (1) in Part II of the Fourth Schedule; and |
| | | | is the total claim paid in the policy year; or |
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| (c) | if the total of the relevant amounts for all such medical treatments received in the policy year is more than $5,000, the formula is — | [($3,000 – B) x 0.8] + ($2,000 x 0.85) |
| | | + [(A – $5,000) x 0.9] – C, |
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| | | is the total of the relevant amounts for all such medical treatments received in the policy year; |
| | | | is the insured person’s contribution specified in item (1) in Part II of the Fourth Schedule; and |
| | | | is the total claim paid in the policy year. |
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(11) Subject to paragraphs (1) to (7), where in any policy year, an insured person has received any insured out-patient medical treatment, he shall be entitled to claim from the Board, in respect of such medical treatment, the lower of the following amounts:(a) | 80% of the total of the charges incurred for such medical treatment pro-rated against the applicable pro-rating factor; or | (b) | the total of the assured amounts for such medical treatment.”; |
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| (c) | by deleting paragraph (13) and substituting the following paragraph:“(13) Subject to paragraphs (1) to (7), where in any policy year, an insured person has received in an approved hospital any treatment of neoplasms by chemotherapy or radiotherapy treatment for cancer (as specified in item 7 of Part I, II, III or IV of the Third Schedule) as an in-patient or as day surgical treatment, he shall be entitled to claim from the Board, in respect of such medical treatment, the lower of the following amounts:(a) | 80% of the total of the charges incurred for such medical treatment pro-rated against the applicable pro-rating factor; or | (b) | the total of the assured amounts for such medical treatment.”; |
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| (d) | by deleting the words “the claim limits provided in paragraphs (1), (2), (5), (8) and (10)” in paragraph (14) and substituting the words “paragraphs (1), (2), (5) and (10)”; and | (e) | by inserting, immediately after paragraph (14), the following paragraph:“(15) In paragraph (10), “relevant amount”, in relation to any medical treatment, means the lower of the following amounts:(a) | the total of the charges incurred for such medical treatment pro-rated against the applicable pro-rating factor; or | (b) | the total of the assured amounts for such medical treatment.”. |
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