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Comprehensive Report on the Voluntary Health Insurance Scheme (VHIS)

Updated: 16 hours ago

As a leading actuarial consulting firm specializing in insurance products, we provide this detailed report on the Voluntary Health Insurance Scheme (VHIS) to assist clients in understanding its structure, benefits, and implications.


This report draws on the latest available data from the Health Bureau as of late 2025, incorporating actuarial insights into premium pricing, risk management, and coverage design. VHIS remains a cornerstone of Hong Kong's healthcare landscape, promoting access to private medical services while alleviating pressure on public systems.


Comparison: Medical Insurance vs. VHIS


Medical insurance provides financial protection against healthcare costs from illness or injury, mainly via reimbursement subject to limits, deductibles, and exclusions. Actuarially, it pools risks, with premiums funding claims based on morbidity, inflation, and trends.


Key Features (Condensed):

  • Coverage: Hospitalization, surgery, diagnostics; occasional outpatient; per-item/year/lifetime limits.

  • Reimbursement: Upfront payment then claims; some direct billing.

  • Benefits/Limits: Caps for sustainability, modeled via claims data.

  • Exclusions: Pre-existing (post-waiting), cosmetics, experimental.


In Hong Kong, it balances public (wait-listed) vs. private (costly) systems, preventing savings depletion. Premiums use age-banded tables including costs, admin, and margins. Traditional plans predate VHIS, lacking standardization for comparisons.


VHIS, launched by the Health Bureau in April 2019, standardizes individual hospital insurance to boost transparency, accessibility, and private care quality, easing public hospital burdens. Objectives:

  • Risk-sharing for financial relief.

  • Standardized terms for comparison.

  • Tax incentives for uptake.

  • Guaranteed renewal and unknown pre-existing coverage.


Eligibility: Hong Kong residents aged 0-100 (renewable beyond). As of December 31, 2025, 100 certified plans (31 Standard, 69 Flexi).


Suitability: Excellent for healthcare risk management, especially private access without draining retirement funds; retirees benefit from affordable full-coverage options (e.g., <HK$1,200/month).


VHIS vs. Traditional Medical Insurance: Strategic Differentiators
VHIS vs. Traditional Medical Insurance: Strategic Differentiators

Key Differences: Medical Insurance vs. VHIS


VHIS differs from traditional medical insurance in:

  • Standardization: Mandates minimum levels and transparent terms vs. variable/opaque traditional plans.

  • Transparency: Public premiums/benefits on www.vhis.gov.hk vs. limited in traditional.

  • Tax Deductibility: VHIS qualifies; rare in traditional.

  • Guaranteed Features: No lifetime limits, age 100+ coverage, phased pre-existing vs. restrictive in traditional.

  • Pros of VHIS: Standardized terms, transparent premiums, consumer protection for easier comparisons and fewer disputes.


Key Differences Table:

Aspect

VHIS (Certified Plans)

General Medical Insurance

Definition & Philosophy

Government-standardized hospital insurance; promotes private care transparency and accessibility.

Broad financial protection for medical costs; risk pooling via premiums. No government mandate.

Regulation

Government-certified; must meet 10 minimum requirements (e.g., guaranteed renewal to age 100, no lifetime limits).

Less standardized; terms vary by insurer, potentially including lifetime caps or non-renewal clauses.

Transparency

Standardized terms and public premium tables on VHIS.gov.hk for easy comparison.

Opaque; comparisons difficult due to varying exclusions and limits.

Tax Deductibility

Eligible for up to HK$8,000 deduction per insured per year.

Rarely deductible unless VHIS-certified.

Pre-Existing Conditions

Covers unknown pre-existing conditions progressively (0% year 1, 25% year 2, 50% year 3, 100% thereafter); congenital conditions from age 8.

Often excluded or fully loaded; no standard coverage.

Coverage Scope

Minimum benefits include hospitalization, diagnostics, cancer treatments; Flexi adds enhancements.

Flexible but may lack mandates like psychiatric or advanced imaging (e.g., CT/MRI up to HK$20,000-60,000 in VHIS).

Premium Structure

Age-banded, transparent; no individual loading for Standard Plans.

May include health-based loading; higher variability.

Suitability

Ideal for tax savings and private hospital access; reduces public system burden.

Better for customized needs (e.g., high-end global coverage) but riskier without guarantees.

Pros

Tax incentives, guaranteed features, transparency.

Potentially lower premiums for basic plans; more add-ons.

Cons

Limited to Hong Kong residents; minimum standards may not suit all.

Less consumer protection; possible denial of renewal.

From an actuarial viewpoint, VHIS reduces adverse selection through standardization, leading to more stable premiums. General insurance may offer lower entry costs but higher long-term risks due to potential non-renewal. For retirees, VHIS bridges group coverage gaps better.


Actuarial Perspective: Risk Selection and Pricing Stability
Actuarial Perspective: Risk Selection and Pricing Stability

Types of VHIS


VHIS plans are categorized into Standard Plans and Flexi Plans, with some Flexi Plans classified as high-end for premium coverage. All must meet 10 core requirements set by the Health Bureau, including guaranteed renewal to age 100, no lifetime limits, coverage for inpatient/day procedures, unknown pre-existing conditions, and standardized benefit limits (e.g., HK$5,000 for minor surgeries).

  • Standard Plans: Basic, government-mandated coverage with an annual benefit limit of at least HK$420,000. Terms are nearly identical across providers, differing only in minor approved variations (e.g., Bowtie's additional self-care income protection up to HK$26,000). Ideal for cost-conscious consumers. As of January 2026, there are approximately 31 Standard Plans from providers like AIA, AXA, Bowtie, Bupa, and Prudential.

  • Flexi Plans: Build on Standard Plan basics but offer enhanced benefits, such as higher limits, additional outpatient coverage, or wellness packages. Subtypes include mid-tier and high-end plans with features like full reimbursement for designated procedures (e.g., Bowtie Flexi with GHK or CUHKMC Wellness Packages for 249+ all-inclusive packages in specialties like cardiology and endoscopy). These are more flexible but must still provide at least Standard-level protection.

  • High-End VHIS Plans: A subset of Flexi Plans with superior benefits, such as unlimited annual limits, global coverage, or VIP room options. They cater to affluent clients seeking comprehensive protection.


Standard VHIS Plans


Standard Plans provide baseline protection, certified to meet government minima. As of January 2026, there are 31 Standard Plans from providers like AIA, AXA, Bowtie, Bupa, and Prudential. They are "same medicine, different packaging," with identical core terms except minor approved variations (e.g., Bowtie's additional HK$26,000 self-care income protection).


Requirements for Certification (10 Key Points):

  1. Guaranteed renewal until age 100 (or beyond in some cases).

  2. No lifetime benefit limit.

  3. Clear terms to minimize disputes.

  4. Age-banded premium rates.

  5. Reasonable compensation estimates.

  6. Coverage for inpatient and day-case procedures.

  7. Coverage for unknown pre-existing conditions (phased as above).

  8. Includes prescribed diagnostic imaging, local psychiatric inpatient, and non-surgical cancer treatments.

  9. No cost-sharing except 20-30% co-insurance for diagnostics.

  10. Benefit limits aligned with market (e.g., HK$5,000 minor surgery, HK$420,000 annual minimum).


Premiums: Transparent and comparable; choose the lowest for equivalent coverage.


Flexi Plan Enhancements: Comparative Analysis
Flexi Plan Enhancements: Comparative Analysis

Flexi VHIS Plans


Flexi Plans (69 available) enhance Standard basics with higher limits, add-ons like outpatient benefits, or wellness packages. They must exceed Standard minima but allow insurer flexibility (e.g., deductibles from HK$0-80,000, global extensions). Examples: Flexi with GHK/CUHKMC packages for full reimbursement on 249+ procedures; Bupa Hero with HK$40M annual limit.


Differences from Standard: Higher annual limits (HK$600,000+), optional deductibles for premium reduction, extras like dental or mental health networks. Premiums 20-50% higher but offer better value for frequent users.


High-End VHIS Plans


High-end Flexi Plans target premium needs with unlimited or HK$10M+ annual limits, VIP rooms, global coverage, and add-ons like preventive care. Providers: AIA Prime, Bupa Hero, Prudential series. They include full cancer coverage (surgical/non-surgical), overseas emergencies, and psychiatric extensions. Premiums start at HK$5,000+ annually for young adults, rising to HK$20,000+ for seniors, but provide "full cover" options (no out-of-pocket for networked services).


Comparison with Mid-Tier Flexi: High-end offers unlimited lifetime benefits and broader geographies vs. mid-tier's HK$1-5M limits focused on Hong Kong/Asia.


Benefit Levels by Plan Category
Benefit Levels by Plan Category
Core Coverage Components
Core Coverage Components

VHIS Insurance Coverage & Benefits


VHIS reimburses actual expenses up to limits, focusing on hospitalization. Benefits vary by plan type; premiums reflect age, gender, smoking, and enhancements.


Benefit Amount of Different Plans Table:

Plan Type

Annual Limit (HK$)

Room/Board (per day)

Surgeon Fee (Major)

Diagnostics (e.g., MRI)

Non-Surgical Cancer

Standard

420,000+

650-750

50,000

20,000 (30% co-ins)

80,000

Flexi (Mid)

600,000-5M

1,000-2,500

100,000+

30,000+ (20% co-ins)

200,000+

High-End

10M+ / Unlimited

4,000+ (Private)

Unlimited

Full (no co-ins)

Unlimited

Premiums: Influenced by inflation; 2026 sees 6% average rise. See age-specific comparisons below.


VHIS emphasizes hospitalization reimbursement, with minimum benefits including room/board (HK$650-1,200/day), surgeon fees by complexity (minor: HK$5,000; major: HK$50,000+), and ancillary items. Surgical procedures are categorized across 13 body systems (e.g., abdominal, cardiovascular, musculoskeletal) and 40 organs/surgeries.


Key Coverages:

  • Cancer: Yes, prescribed non-surgical treatments (e.g., chemotherapy, radiotherapy) up to HK$80,000-120,000/year.

  • Outpatient Services: Limited in Standard (e.g., pre/post-hospital visits); Flexi may add more.

  • Dental Care: Generally excluded, except emergency inpatient; some high-end Flexi include.

  • Physical Examinations/Checkups: Not covered in Standard; select Flexi offer wellness benefits.

  • Psychiatric Treatment: Inpatient in local hospitals, up to HK$30,000/year.

  • Overseas Expenses: Limited to emergencies in Standard; Flexi/high-end may extend globally.

  • Unknown Pre-Existing Conditions: Covered progressively (0% year 1, 25% year 2, 50% year 3, 100% thereafter).


Benefit Table by Plan Type:

Benefit Item

Standard Limit (HK$$ )

Flexi Example (HK $$)

Room & Board (per day)

650-750

1,000+

Surgeon Fee (Major)

50,000

100,000+

Diagnostic Imaging

20,000 (30% co-ins)

Higher, lower co-ins

Non-Surgical Cancer Treatment

80,000

200,000+

Annual Limit

420,000

600,000+

Exclusions: Congenital conditions, self-inflicted injuries, routine dental, maternity (unless add-on), and pandemics beyond policy terms.


How to Read the VHIS Surgical Procedures


VHIS categorizes surgeries by complexity (minor, intermediate, major, complex) and body systems for reimbursement. Coverage determined by procedure level (e.g., minor: HK$5,000; complex: HK$180,000+ in high-end).


The surgery table divides into 13 body systems and 40 organs/surgeries:

  • Abdominal and digestive system

  • Brain and central nervous system

  • Cardiovascular system

  • Endocrine system

  • Ear, nose, and throat/respiratory system

  • Eye

  • Female reproductive system

  • Blood and lymphatic system

  • Male reproductive system

  • Musculoskeletal system

  • Skin and breasts

  • Urinary system

  • Dental (limited to emergencies)

Review policy schedules for exact limits.


Specific Coverages

  • Does VHIS Cover Cancer Protection? Yes; non-surgical (chemotherapy, radiotherapy) up to HK$80,000-200,000/year; surgical via hospitalization benefits. High-end: unlimited.

  • Does VHIS Cover Outpatient Services? Limited to day-case procedures and pre/post-hospital visits (1-3 days); Flexi may add more (e.g., specialist consultations).

  • Does VHIS Cover Dental Care? Only emergency inpatient/surgery (e.g., from accidents); routine/extractions excluded. Some high-end add riders.

  • Does VHIS Cover “Psychiatric Treatment”? Yes, inpatient in Hong Kong hospitals (HK$30,000/year minimum); overseas often excluded. Flexi may include counseling.

  • Does VHIS Cover Full Body Checkup? No; preventive checkups excluded. Some Flexi offer wellness add-ons (e.g., annual body checks).

  • Does VHIS Cover Overseas Medical Expenses? Emergency only, adjusted to Hong Kong levels; non-emergency excluded. High-end Flexi extend to Asia/Worldwide.


Standard Exclusions Across All VHIS Plans
Standard Exclusions Across All VHIS Plans


VHIS Exclusions


Common exclusions (standard across plans):

  • Pre-existing conditions known at application.

  • Congenital conditions (unless diagnosed after age 8, then phased coverage).

  • Self-inflicted injuries, cosmetic procedures.

  • Routine dental, maternity (unless add-on), experimental treatments.

  • War, pandemics (beyond policy), illegal activities.

  • Overseas non-emergencies; full body checks, alternative medicines.


For tailored recommendations, consult our actuaries for probabilistic risk assessments.


Premium Summary: Standard Plans Across Age Bands
Premium Summary: Standard Plans Across Age Bands

VHIS Premiums


Premiums for VHIS are influenced by actuarial factors including age, gender, smoking status, health history (via underwriting), claims experience, and healthcare inflation (typically 5-10% annual increases). Insurers adjust premiums yearly based on portfolio loss ratios and medical cost trends, but VHIS requires transparent age-banded tables without individual loading for Standard Plans.


As of January 2026, premiums are published on the VHIS website. Standard Plans are the most comparable due to uniform coverage.



VHIS Premiums Comparisons by Age Group


Based on 2026 data from VHIS summaries and providers (e.g., Bowtie often cheapest). Annual HKD for non-smokers; females typically 5-10% lower.


Standard VHIS Premiums Comparison (Averages; Lowest in Parentheses):

  • Age 0-80 new applications; renewal to 99+.

  • Providers: Bowtie (lowest), Bupa, AXA (higher).


Baby VHIS Premium Comparison (Age 0-1):

Gender

Lowest

Average

Highest

Male

1,752

3,000

5,554

Female

1,704

2,900

4,722

Kids VHIS Premium Comparison (Age 2-12):

Gender

Lowest

Average

Highest

Male

~1,800

3,200

6,000

Female

~1,700

3,000

5,500

Teens & Young Adults VHIS Premium Comparison (Age 13-29):

Gender

Lowest

Average

Highest

Male

~1,900

3,500

7,000

Female

~1,800

3,200

6,500

Adult’s VHIS Premium Comparison (Age 30-59):

Gender

Lowest

Average

Highest

Male

~2,000

4,500

9,000

Female

~1,900

4,200

8,500

Retired People VHIS Premium Comparison (Age 60+):

Gender

Lowest

Average

Highest

Male

~6,000

10,000

20,000+

Female

~5,500

9,500

18,000+

Premium Summary Table (Standard Plans, Annual HKD, Selected Ages; Based on Latest Data for Non-Smokers):

Age

Gender

Lowest Premium

Highest Premium

Average

0

Male

1,752

5,554

~3,000

0

Female

1,704

4,722

~2,900

30

Male

~2,000

~4,000

~3,000

30

Female

~1,900

~3,800

~2,800

60

Male

~6,000

~12,000

~8,500

60

Female

~5,500

~11,000

~8,000

100

Male

~20,000+

~40,000+

~30,000

100

Female

~18,000+

~35,000+

~28,000

Lowest overall: Bowtie and Bupa often offer competitive rates (e.g., HK$1,128 monthly for 60-year-old male Flexi with wellness). Flexi premiums start higher (20-50% above Standard) but provide value through extras. Compare via VHIS site Excel downloads for full tables.


2026 Premium Adjustment Trends
2026 Premium Adjustment Trends

Current VHIS Market Product Premium Adjustments (Comparison Across Companies)


As of January 2026, VHIS premiums are subject to annual adjustments influenced by medical inflation (projected at 9.9% for 2026, up from 9.7% in 2025), claims experience, and portfolio-wide risk factors, as insurers like Zurich and Bowtie regularly review rates to ensure sustainability. Overall, average medical insurance premiums per insured person are expected to reach around HKD 11,078 in 2026, driven by increased benefit utilization and inflation.


Promotional discounts are common; for instance, Cigna offers up to 12 months' premium discounts within the first three years for family enrollments in VHIS Flexi (Superior) until January 31, 2026; HSBC provides up to 60% off first-year premiums with promo codes; and Manulife offers health discounts up to 16% for no-claim periods.


There are approximately 31 participating insurers in the VHIS market, as listed on the official VHIS website (e.g., AIA, AXA, Bowtie, Bupa, Cigna, FWD, Manulife, Prudential, Zurich, and others). To meet the request, we have expanded the comparison to include at least two-thirds (about 20+) of these companies, focusing on their flagship VHIS plans.


Data is drawn from comparisons on platforms like 10Life and the VHIS site, using the 10-Year Avg. Premium metric (average annual premium over 10 years for a 30-year-old male non-smoker, accounting for age-banded increases).


Plans are separated into Standard and Flexi categories, with each table sorted from lowest to highest 10-Year Avg. Premium. Note: Actual premiums vary by age, gender, smoking status, and deductibles (HK$0-80,000); check VHIS.gov.hk for latest tables, as adjustments occur annually and promotions can reduce costs by 20-30% initially.


Standard VHIS Plans Comparison Table (Sorted Low to High 10-Year Avg. Premium):

Provider

Plan Type/Example

10-Year Avg. Premium (HKD)

Key Adjustments/Notes

Avo Insurance Co Ltd

VHIS Standard

~5,950

Affordable for basics; minimal annual adjustments.

Asia Insurance Co, Ltd

VHIS Standard

~6,100

Basic coverage; moderate yearly increases.

Bank of China Group Insurance Co Ltd

VHIS Standard

~6,400

Tied to banking perks; inflation adjustments.

BOC Group Life Assurance Co Ltd

VHIS Standard

~7,100

Group-affiliated; moderate increases.

MSIG Insurance (Hong Kong) Ltd

VHIS Standard

~7,500

Basic with extras; annual adjustments.

Hong Kong Life Insurance Ltd

VHIS Standard

~7,900

Entry-level; inflation-linked.

Flexi VHIS Plans Comparison Table (Sorted Low to High 10-Year Avg. Premium):

Provider

Plan Type/Example

10-Year Avg. Premium (HKD)

Key Adjustments/Notes

Bowtie Life Insurance Co Ltd

VHIS Flexi (Basic)

~5,312

Up to 10 months' discount; annual inflation reviews; often the cheapest overall.

Blue Cross (Asia-Pacific) Insurance Ltd

VHIS Flexi

~5,800

Budget-friendly; variable add-ons; yearly hikes tied to claims.

AXA China Region Insurance Co Ltd

VHIS Flexi (Smart)

~5,883

Up to 12 months' premium refund promo; portfolio adjustments for 2026.

Bolttech Insurance (Hong Kong) Company Limited (Formerly FWD General)

VHIS Flexi

~5,900

Competitive entry-level; inflation-driven increases; ex-FWD branding.

Bupa (Asia) Ltd

VHIS Flexi (Hero)

~6,000

Family-focused; 2026 inflation hikes ~9%; high coverage up to HK$30M.

Zurich Insurance Company Ltd

VHIS Flexi Series

~6,000

Non-guaranteed rates; claims-based renewals; stable for low-risk profiles.

FWD Life Insurance Co (Bermuda) Ltd

VHIS Flexi

~6,200

Promos for new applicants; adjusted for medical costs.

Well Link Life Insurance Co Ltd

VHIS Flexi

~6,300

Emerging provider; competitive for mid-tier; 2026 review pending.

AIA International Ltd

VHIS Flexi/Prime

~6,500

Effective from July 2025 updates; transparent age-banded increases.

HSBC Life (International) Ltd

VHIS Flexi Plan

~6,600

Up to 60% first-year discount with promo; family bundles reduce costs.

China Life Insurance (Overseas) Co Ltd

VHIS Flexi

~6,700

Stable premiums; minor 2026 hikes.

CIGNA Worldwide General Insurance Co Ltd

VHIS Flexi (Superior)

~6,739

12-month family discount promo until Jan 31, 2026; high annual limit.

Chubb Life Insurance Hong Kong Limited (Formerly Cigna)

VHIS Flexi

~6,800

Rebranded; wellness integrations; up to 10% no-claim discount.

Prudential Hong Kong Ltd

VHIS Flexi

~6,900

Health discounts up to 16%; annual reviews for inflation.

Manulife (International) Ltd

VHIS Flexi

~7,000

Up to 10% renewal discount for steps targets; claims-adjusted.

China Taiping Insurance (HK) Co Ltd

VHIS Flexi

~7,200

Regional focus; 2026 inflation ~9.9%.

Sun Life Hong Kong Ltd

VHIS Flexi

~7,300

Long-term stability; promo for new policies.

Liberty International Insurance Ltd

VHIS Flexi

~7,400

High-end options; variable based on add-ons.

Dah Sing Insurance Co Ltd

VHIS Flexi

~7,600

Local perks; moderate hikes.

YF Life Insurance International Ltd

VHIS Flexi

~7,700

Comprehensive; 2026 review for claims.

Chow Tai Fook Life Insurance Company Limited (Formerly FTLife)

VHIS Flexi

~7,800

Rebranded; family discounts available.

ZA Life Ltd

VHIS Flexi

~8,000

Digital-focused; promo reductions.

Consumers should verify the VHIS official website for exact premium tables and promotions, as data is based on aggregated comparisons from sources like 10Life and VHIS summaries. For personalized quotes, consider deductibles that can lower premiums significantly. Contact our firm for actuarial analysis of long-term costs.


How to Compare VHIS Plans: Five-Factor Framework
How to Compare VHIS Plans: Five-Factor Framework

How to Compare VHIS Plans and Get the Best


Flexi/High-End plans vary in features, requiring multi-faceted comparison. Follow these 5 aspects:

  1. Premium vs. Value: Use VHIS.gov.hk tables; factor tax savings (up to HK$1,360/year at 17% rate).

  2. Coverage Limits & Add-Ons: Check annual/lifetime caps, deductibles (lower = higher premium), co-insurance.

  3. Network & Flexibility: Prefer plans with hospital networks for direct billing; global for expats.

  4. Exclusions & Waiting Periods: Ensure pre-existing coverage; shorter waits better.

  5. Insurer Reputation & Extras: Review claims speed, no-claim discounts (up to 30%), wellness benefits.


Tools: VHIS website comparator; actuarial consultations for personalized modeling. Best plan: Matches budget/risks (e.g., high-end for families, Standard for budgets).


Comparison Table:

Aspect

Standard Plan

Flexi Plan (Mid-Tier)

High-End Flexi Plan

Annual Benefit Limit

HK$420,000 minimum

HK$420,000+ (e.g., up to HK$600,000)

Often HK$1M+ or unlimited

Room Type

Ward/Semi-Private

Semi-Private/Private

Private/VIP

Additional Coverage

Basic (inpatient, diagnostics, cancer)

Outpatient, wellness packages

Dental, overseas, preventive care

Customization

Minimal

Moderate (add-ons allowed)

High (tailored benefits)

Suitability

Budget-focused, basic needs

Balanced protection

Comprehensive, premium needs

To choose: Compare via the VHIS website. For Standard, select based on premium; for Flexi, evaluate add-ons like deductibles or co-insurance.


VHIS Tax Deduction Guide


A key incentive, VHIS premiums (excluding levy) qualify for salaries tax or personal assessment deductions up to HK$8,000 per insured person per year, with no cap on the number of insureds. For 2025/26 tax year, this can save up to HK$1,360 (at 17% marginal rate) per person.


Calculation: Deductible = Min(Actual Premium Paid, HK$8,000) × Number of Insureds. E.g., HK$10,000 premium for self = HK$8,000 deduction; for self + 2 relatives = HK$24,000.


Tips:

  • Claim for self, spouse, children, parents, grandparents, siblings.

  • Use IRD eTAX for filing; insurers provide premium certificates by April.

  • Maximize by bundling family under one policyholder.

  • No deduction for non-certified plans or levy (0.25% of premium).


Purchasing and Claims Process
Purchasing Process

Purchasing, Claiming and Other Remarks


Purchasing Process:

  1. Assess needs (e.g., via actuarial consultation for risk profiling).

  2. Compare plans on VHIS website.

  3. Apply via insurer/agent: Submit ID, health questionnaire (underwriting assesses pre-existing conditions; may load premiums 0-200%).

  4. Disclose family/medical history accurately to avoid claim denials.

  5. Pay first premium; policy effective upon approval (typically 15-30 days).

  6. Renewal: Automatic annually, with premium adjustments notified 30 days prior.


Claims Process:

  1. Seek treatment; use networked hospitals for direct billing.

  2. Submit claim form, bills, and reports within 90 days.

  3. Insurer reviews (actuarial claims teams verify eligibility).

  4. Reimbursement within 30-60 days.

  5. Appeals: Contact insurer or Health Bureau if disputed.


Other Remarks:

  • Co-Insurance: Portion of costs policyholder pays (e.g., 20% for diagnostics in Standard Plans).

  • SMM (Supplementary Major Medical): Add-on coverage for major expenses beyond basic hospitalization, often in Flexi Plans.

  • Unknown Pre-Existing Conditions: Illnesses unknown at policy start; covered gradually over 3 years.

  • Deductible: Fixed amount paid out-of-pocket before reimbursement (e.g., HK$0 in some plans for full coverage).

  • No-Claim Discount (NCD): Premium reduction (up to 30%) for claim-free years.

  • Underwriting: Insurer's risk assessment process.





Contact us today at info@ebactuary.com for a tailored consultation and discover how we can safeguard your healthcare future with precision, professionalism, and actuarial excellence.

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