Medical Benefits 醫療保險利益

Voluntary Health Insurance Scheme (VHIS) 自願醫保計劃

The VHIS was launched on 1 April 2019 and is run by the Government, now through the VHIS Office under the Health Bureau. Participation is voluntary for both insurers and consumers. A participating insurer must offer the Standard Plan and may also offer Flexi Plans; together these are called Certified Plans. Insurers set their own premiums: the Government does not fix a uniform price.

The Standard Plan is the minimum requirement. Its main features are guaranteed renewal up to age 100, no re-underwriting on renewal, an annual benefit limit of HK$420,000 per policy year, no lifetime benefit limit and no deductible. Some items have sub-limits, for example HK$80,000 a year for prescribed non-surgical cancer treatments, HK$30,000 a year for psychiatric treatment, and HK$30,000 a year for prescribed diagnostic imaging tests, where the insured also bears 30% coinsurance.

Pre-existing conditions: if the insured did not know of a condition at inception and could not reasonably have been expected to know of it, the Standard Plan reimburses in stages by policy year: 0% in year 1, 25% in year 2, 50% in year 3 and 100% from year 4. Conditions the insured knows about must be declared, and the insurer decides the terms through underwriting.

Flexi Plans must not give less than the Standard Plan but may enhance it, for example with higher limits or wider cover, and they may include a deductible. For tax, a taxpayer who pays Certified Plan premiums for themselves or a specified relative can deduct up to HK$8,000 per insured person per year of assessment under salaries tax or personal assessment, with no cap on the number of insured relatives. Medical policies that are not Certified Plans do not qualify for this deduction.

Guideline on Medical Insurance Business (GL31) 醫療保險業務指引（指引31）

GL31 is issued by the Insurance Authority to authorized insurers carrying on medical insurance business, and sets out the Authority's supervisory expectations for that business. It is a regulatory guideline, not legislation passed by the Legislative Council and not a set of policy terms, but the Authority may take an insurer's failure to follow it into account in its supervision.

Medical policies are usually renewed year after year while medical costs keep rising, so policyholders depend heavily on cover continuing and on premiums being reasonable. It helps to read the guideline from the angle of treating customers fairly: prudent product design and pricing, clear explanation of cover, limits, exclusions and how premiums may be adjusted, and fair underwriting and claims handling.

Do not confuse the two: the VHIS is a voluntary government scheme that sets benefit requirements for Certified Plans, while GL31 is the Insurance Authority's supervisory requirement for authorized insurers. This page gives only the general direction of the guideline, so check the specific requirements against the text published by the Authority.