Does medical insurance provide only outpatient coverage?
Is the coverage provided by group medical insurance
benefits enough?
What is the hospitalisation coverage?
Taking out a medical insurance policy allows insured
persons to shift responsibility for some of the medical expenses they incur as a
result of an accident or illness to the insurer. This eases the financial pressure
of using private medical services and avoids relying solely on the public healthcare
system. In general, medical insurance works on a reimbursement basis to cover the
actual medical expenses, subject to a cap.
Common types of coverage
Hospitalisation coverage
Outpatient coverage
Hospital cash benefits
Hospitalisation coverage
- Mainly expenses in relation to hospitalisation, including room and board, doctor’s visit fees, surgery fees and miscellaneous charges. There is normally a maximum limit for each medical benefit item.
- Some plans may offer supplementary major medical benefits that allow the insured person to claim a prescribed percentage of the relevant expenses in excess of the maximum payable benefits.
- There is normally a choice of class.
Outpatient coverage
- Mainly outpatient medical expenses resulting from consultations with general practitioners, basic medication, laboratory examinations, etc. Some outpatient benefits may also include consultations with Chinese medicine practitioners, physiotherapists, Chinese bonesetters, and specialists, as well as related medication expenses.
- There is normally a yearly and daily limit on the benefit amount and number of visits.
Hospital cash benefits
Common classifications
Mode of application
An employer takes out a policy for its employees
Maximum benefit limit
Generally, there is a maximum limit for each medical benefit
item.
Reminders
- The protection is terminated immediately if you quit your job (e.g. due to resignation or retirement). However, if your group medical insurer offers portable protection, you may choose to continue the protection by paying the premium even if you change employers or retire.
- Some group medical insurance plans offer top-up options, which allow policyholders to buy an additional individual policy with deductible options. Policyholders can then enjoy higher coverage for a relatively low premium.
Mode of application
An individual takes out a policy with an insurer.
Maximum benefit limit
- Some traditional plans set a maximum limit for each medical benefit item, while some offer “full cover benefits”.
- The lifetime benefit limit for some high-end plans may be up to tens of millions of dollars, but the higher the benefit limit, the higher the premium.
Reminders
- These plans normally have a deductible. Policyholders can choose from among different deductible options – the higher the deductible, the lower the premium.
- Medical insurance works on a reimbursement basis. The claimable amount cannot exceed the actual medical expenses incurred. Insured persons cannot claim more than the amount paid even if they are covered. Consider your protection needs and assess your financial situation to choose the plan that best suits your needs.
- Compare different medical insurance plans, in terms of coverage level, benefit limits, mode of compensation, premium level and deductible options, and pay attention to the excluded items and waiting period.
- Generally, a younger, healthier, non-smoking policy holder who is not a heavy drinker will have a lower premium.
- Disclose your health condition and medical history actively and honestly, so that the insurer can reasonably assess the risk based on the disclosed information, or the insurer may reject a claim or even declare your policy invalid on the ground of non-disclosure of material facts.
- “Medically necessary” and “reasonable and customary charges” are two common principles insurers follow when handling claims. Make sure you understand the definitions of these two clauses in your desired policy and consider whether the policy meet your expectations to avoid a claim dispute in the future.
Objective
This is a policy initiative implemented by the Health Bureau to regulate indemnity hospital insurance plans offered to individuals by participating insurers.
Nature
Voluntary participation by insurers and individuals.
Coverage
Health Bureau-certified indemnity hospital insurance plans offered by participating insurers, including the Standard Plan and the Flexi Plan.
Difference from other
medical insurance plans
- Premiums paid for a VHIS policy are eligible for a tax deduction under the Inland Revenue Ordinance (Cap. 112).
- All certified plans must meet or exceed the VHIS minimum product standards, including standardised policy terms and conditions, guaranteed renewal up to the age of 100, prescribed level of coverage (e.g. unknown pre-existing conditions, congenital conditions and psychiatric inpatient treatment), etc.
- All product and premium information on VHIS certified plans, including policy terms and conditions, and premium schedules, are accessible on the VHIS website.
For details, please visit the VHIS website。
