DOMESTIC HELPER INSURANCE:
DEFINITION, COVERAGE, BENEFITS, COST,  CLAIMS

What are the Legal Requirements for Helper Insurance in Hong Kong?

Under Hong Kong law, the requirements for domestic helper insurance are governed primarily by the Employees' Compensation Ordinance (Cap. 282) and the Standard Employment Contract.

Here are the specific legal obligations:

1. Mandatory Employees' Compensation (EC) Insurance

• The Law: Under the Employees' Compensation Ordinance, every employer must take out an insurance policy to cover their liability for injuries or death of employees resulting from accidents arising out of and in the course of employment.

• Minimum Coverage: The policy must provide a minimum cover of HK$100 million per event.

• Timing: The insurance must be effective from the very first day of the helper's employment.

2. Contractual Obligation for "Free Medical Treatment"

• The Contract: While the Ordinance only mandates EC insurance, the Standard Employment Contract (Clause 9) legally requires the employer to provide free medical treatment to the helper.

• Scope: This includes consultation fees, maintenance in hospitals, and dental treatment (for emergencies).

• Implication: Although purchasing a "Comprehensive" medical insurance policy covers general sickness (like the flu or toothaches) is not strictly mandated by statute, employers are personally liable for these costs. Therefore, most employers purchase a comprehensive plan to offset this unlimited financial liability.

3. Penalties for Non-Compliance

• Failure to secure a valid Employees' Compensation insurance policy is a criminal offense.

• Maximum Fine: HK$100,000.

• Imprisonment: Up to 2 years.

• You are also liable to pay for any compensation dictated by the Employees' Compensation Assessment Board.

What are the Standard Medical Benefits and Minimum Coverage for Helper Insurance?

There is no legal "minimum coverage amount" for medical benefits (unlike the HK$100M requirement for liability). However, market standards have evolved to meet the typical costs of healthcare in Hong Kong. Here is what you can expect from a Standard Comprehensive Policy:

1. Hospitalization & Surgical (Inpatient)

• Purpose: Covers serious illnesses or accidents requiring an overnight stay.

• Standard Limit: HK$25,000 to HK$30,000 per year.

• What it covers: Room & board (usually general ward in public hospitals), surgery fees, anesthetist fees, and operating theater charges.

• Important Note: This limit is sufficient for public hospitals (where costs are heavily subsidized for residents with a visa). It is generally insufficient for private hospital care.

2. Clinical / Outpatient (GP Visits)

• Purpose: Covers day-to-day sickness like flu, fever, or infections.

• Standard Limit: HK$3,000 to HK$4,000 per year.

• Per-Visit Sub-limit: Most policies cap the payout at roughly HK$150 to HK$250 per visit.

• Co-payment: Some cheaper plans require you (or the helper) to pay a portion (e.g., HK$50) per visit, while premium plans offer "cashless" cards for network doctors.

3. Dental Expenses

• Purpose: Covers emergency dental work.

• Standard Limit: HK$1,500 to HK$2,500 per year.

• Scope: Strictly for emergency treatment (e.g., abscesses, extractions, pain relief).

• Exclusion: Cosmetic procedures like scaling, polishing, and braces are almost always excluded.

4. Other Standard Benefits

• Bonesetter / Chinese Medicine: Often capped at HK$100 - HK$150 per visit with a yearly limit of HK$1,000 - HK$2,000.

• Cancer & Heart Disease: Basic plans may exclude these or treat them under the general "Hospitalization" limit. Premium plans may offer a specific lump sum rider.

Summary: The "Minimum" you should look for is a plan that covers full public hospital costs. A limit of HK$30,000/year is usually safe for public sector treatment.

Are there Exclusions such as Pre-existing Conditions or Waiting Periods for Helper Insurance?

Yes, like all insurance, domestic helper policies have strict exclusions to keep premiums affordable.

1. Pre-existing Conditions

• The Rule: Almost all standard helper insurance policies exclude pre-existing medical conditions.

• Definition: Any illness or injury the helper had (or showed symptoms of) before the policy start date.

• Example: If your helper has a history of high blood pressure or diabetes before you hire her, the insurance will not pay for any treatment or medication related to those conditions.

• Exception: Some insurers may cover pre-existing conditions after the helper has been insured with them continuously for 12 months, but this is rare in basic plans.

2. Waiting Periods

• The Rule: You cannot claim immediately for certain benefits.

• Standard Medical: Usually has a 14 to 30-day waiting period for sickness (e.g., flu). Accidents are covered immediately.

• Special Conditions: Serious conditions like cancer, heart disease, or tumors often have a longer waiting period, typically 90 to 180 days.

• Dental: Often has a 3 to 6-month waiting period to prevent people from buying insurance just to fix a tooth immediately.

3. Other Common Exclusions

• Pregnancy & Maternity: Routine check-ups and childbirth are almost never covered. Employers are liable for maternity leave pay, but the medical costs fall on the helper (who is eligible for subsidized public care).

• Suicide & Self-Harm: Injuries resulting from attempted suicide or intentional self-harm are excluded.

• Drug & Alcohol Abuse: Accidents or illnesses caused by intoxication or drug use are not covered.

• Sexually Transmitted Diseases (STDs): HIV/AIDS and other STDs are typically excluded.

• Cosmetic Surgery: Any surgery not medically necessary (plastic surgery) is excluded.