Health insurance in Hong Kong is not standardized and can be confusing. Most people neglect to look in-depth into their policies or to ask experts before they sign.

What is health insurance?

Simply put, medical insurance or health insurance covers your medical expenses, which often include costs of hospitalization, surgery, doctor consultation, body checkup, medications, and other health-related services.

Although health insurance is not required by law in Hong Kong (unlike countries like the United States and Switzerland), more and more people get private health insurance in Hong Kong to cover the ever-increasing local healthcare costs. In fact, the private healthcare sector is the second most expensive in the world after the United States [1] and medical inflation is about 8 to 10% per year. There is no limit to what health providers can charge and price differences vary greatly depending on the doctor, hospital and location.

If you wish to avoid public sector waiting times and benefit from insurance reimbursements for private medical fees, it is recommended to have private medical insurance.

➜ EXPERT TIP: Did you know that you can check real-time public sector waiting time? Click here to access them.

In Hong Kong, you can have medical coverage through work, for your family, individually or supplement your work insurance with an individual plan that is better suited for your needs and unique situation (i.e. top-up insurance).

Whatever your situation or the coverage you may already have, here are 5 things you should know about medical coverage in Hong Kong.

1. Your family may not automatically be covered by your work health insurance

If you are covered through work/group medical insurance, check if your spouse and children are covered. It's not always the case. If you have individual coverage and you want to cover your spouse and children, premiums will be adjusted accordingly.

Some insurance plans offer special "family" rates whereas others have an ‘individual’ rate per person, based on age. It is best to check with an advisor as Hong Kong insurance plans are not standardized.

➜ EXPERT TIP: your children can be included under your policy even as adults, provided they study full-time (terms & conditions such as maximum age vary).

2. The standard categories of health coverage: what’s basic and what’s nice to have

Inpatient

Basic benefit that must always be subscribed and which covers hospitalizations, surgeries, cancers, etc.

➜ EXPERT TIP: health insurance policies from employers often have very restrictive sub-limits — that discourage members to seek medical services in private hospitals.

Outpatient

Benefit which often comes with inpatient and is used to reimburse GP and doctor Specialist consultations.

➜ EXPERT TIP: there may be limits to your reimbursements for consultations and prescribed medications.

Dental

Usually an optional benefit as dental care is very expensive in Hong Kong.

➜ EXPERT TIP: dental care is always capped and may be subject to a waiting period.

Optical

Optional benefit for eye examinations, glasses and lenses. Given the high rate of myopia in Hong Kong, this benefit is rarely provided by employers and local basic products.

➜ EXPERT TIP: note that optical care is not the same as ophthalmologist care which is reimbursed under doctor Specialist consultations.

Maternity

Maternity coverage is most often an expensive and optional benefit. To know all about Maternity Insurance, check out our dedicated article.

➜ EXPERT TIP: for individual plans, maternity coverage is always subject to a waiting period (9 months minimum and 12 months on average).

Other benefits categories include evacuation, repatriation, checkups, and vaccination. All these benefits and their associated costs must be carefully explained to you and assessed according to your personal situation.

3. Where you are geographically covered (or not) by your medical insurance

The most common geographical areas of coverage are: Worldwide, Worldwide excluding the United States, and Asia only. The most commonly requested area of coverage by expats for instance, is Worldwide except USA — thus typically covering their home country i.e. UK, Canada, France, etc. if they are not US citizens.

➜ EXPERT TIP: international coverage is very attractive for international/mobile individuals and families. If you want to do an annual health checkup in Bangkok, or prefer undergoing chemotherapy in the UK? You are covered.

4. Standard exclusions: pre-existing conditions

This is a hot topic! In terms of individual health insurance, both "international" and "local Hong Kong" insurance providers discriminate against "known" pre-existing conditions. The list is long and may include conditions as diverse as asthma, eczema, diabetes, back pain, cancer history, chronic migraines, psoriasis, hypertension, and HPV. As for the compliant VHIS plans that were launched in 2019, they are even more restrictive as they also limit coverage of "unknown" pre-existing conditions.

➜ EXPERT TIP: how to be covered for my or my family’s pre-existing conditions? Employee medical benefits usually cover pre-existing conditions but you usually lose such coverage when leaving your job. The best time to get purchase private health insurance is when you are young and healthy. That way, you lock in coverage for life and are covered for unknown or future conditions.

5. Mechanisms to lower premiums: deductibles & coinsurance

Some insurance plans provide the option of adding a deductible (also known as excess) to lower premiums. There are different types of deductibles:

a) annual deductibles per person or family;

b) deductibles per condition.

You may also have the option of choosing co-insurance options to lower premiums. With a coinsurance of 20% for example, you must pay 20% of the medical bill.

➜ EXPERT TIP: to maximize your coverage and reimbursements, you can purchase individual insurance with a high deductible that is paid by the proof of reimbursement from your employee medical benefits. That way, you maximize coverage and reduce out-of-pocket expenses.

Footnotes: [1] https://www.healthymatters.com.hk/8-things-you-should-know-about-healthcare-in-hong-kong/