Own a medical plan without a clue what it covers?!

Own a medical plan without a clue what it covers?!

Hong Kong’s exorbitant medical expenditures is nothing new. A lot of Hongkongers purchase insurance for their families and themselves in case that need arises. However, medical insurance and critical illness insurance are different products, and medical insurance can be further classified into individual indemnity hospital insurance plans and company group medical insurance plans. The recent talk of the town, Voluntary Health Insurance Scheme (VHIS), should be listed into the individual indemnity hospital insurance category. Hong Kong is in no shortage of insurance options. However, how many consumers truly understand their own medical needs, and which type of medical insurance suits them the most?

The differences between Critical Illness Insurance and Medical Insurance

Before understanding the differences between these two types of insurance, let’s clear things up. Critical illness insurance usually pays the claims amount in a lump sum to the insured person after he/she suffers from a designated critical illness and is unable to work. The reimbursement can help support the insured person in covering medical and household expenses, as well as child tuition fees. On the other hand, medical insurance reimburses the insured person with his/her actual medical expenses.

Between critical illness and medical insurances, they can be further divided into “general critical illness insurance” or “cancer critical illness insurance”, and “cancer medical insurance” or “general medical insurance”. Although all of them claim to cover cancer, the reimbursement calculation basis and definition of cancer between these four types of insurance are different. To avoid a claim being denied, let’s clarify their differences before making a purchase:

comparison of cancer critical illness insurance and cancer medical insurance

*The above information is referenced from a comparison of cancer critical illness insurance and cancer medical insurance made by the consumer council in January 2017

“Maximum Benefit Payable” is not “Actual Benefit Payable”

Ms. Chan has become a property owner, business owner and a mother in the last four years. With increased responsibility, a comprehensive medical insurance plan has never been more important. With a good plan in hand, if Ms. Chan does unfortunately fall ill and lose the ability to generate income, or when faced with a huge medical bill, she can still handle it with ease. Ms. Chan notices that the terms and conditions in medical insurance plans are complicated, and is especially worried about the actual benefit paid by the product turning out to be significantly lower than the maximum benefit payable.

In truth, some medical insurances emphasise the maximum benefit payable whilst the actual benefit payable depends on different variables and will sometimes only reimburse part of the medical expenses:


Source: 10Life
*All the above illnesses and conditions must match medical prerequisites. 

Get reimbursed fully and stay worry-free

VHIS adopts the product structure of conventional medical insurances, reimbursing for a range of medical expenses, such as room and board, specialist’s fee, surgeon’s fee, attending doctor’s visit fee, miscellaneous charges and much more. Since each item has its own inside limit, there are often situation where the limits in certain items are exceeded, while some others are not fully utilised, leading to a reimbursement of under 100%. Two plan options are offered under VHIS. “Standard Plan” sets out the minimum requirements for medical insurance products, whilst “Flexi Plan” allows benefit limit upgrades in certain benefit items, or addition of supplementary medical benefits. However, claims are calculated based on relevant items, thus the insured person may only receive partial reimbursement.

The market also offers non-VHIS products which reimburse according to benefit items listed, but specifically offer “full cover”. As long as the treatments for disability fulfil the criteria of “being medically necessary and incurring reasonable and customary expenses”, the insured person can submit a claim within the benefit limit and potentially be reimbursed in full. These products are similar to high-end medical insurances with offers of full reimbursements. However, they have an annual limit or benefit limit per disability and have a more affordable premium than high-end medical insurances.

Take FWD’s CANsurance Full Medical Plan as an example, the waiting period of hospitalization is 30 days, benefit schedule is itemised, and benefit limit is set in a per disability basis. Expenditures from hospitalisation, surgery, private nursing in hospital, pre- and post-hospitalisation/day case procedure out-patient care and home-nursing within the specified period and limit on number of visits are all reimbursed in full for actual expenses; plain and simple, and worry-free. The plan offers up to hundreds of thousands in benefit limits per disability, depending on the plan level, at a reasonable premium. The typical cancer treatments, including chemotherapy, radiotherapy, and kidney dialysis, can all be reimbursed in full. Also, the per disability benefit limit will be doubled for claims related to a covered cancer, which well caters to Ms. Chan’s concerns and needs.

Medical insurances are complicated products and should be studied thoroughly before purchase. It is always better to ask when you have uncertainties. Many people thought that they possessed sufficient understanding on the insurance plan and its coverage at application, but only read the terms and conditions of the claim when filing a claim few years later and were surprised to discover the great deviation of the actual benefits provided from what they expected. This abruptly disturbs one’s life plans with a huge medical bill and is best avoided. 


The above information is a brief summary of product features. For detailed product information, please read the product brochure and policy terms and conditions. The information in this website is for reference purpose only and should not be considered as an offer or solicitation for any of the products or investments mentioned herein. FWD expressly disclaims all liability for the use or interpretation by others of information contained in this website (including third-party responsibility). You are advised to seek independent advice from appropriate professionals if you have any enquiries with related information.

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