FAQ: Insurance Questions 101

General question

What is health insurance?

Health insurance is used to reimburse, partially or fully, your medical expenses. Depending on the cover chosen, health insurance can reimburse you:

  • Your consultations and medical care;
  • Your medication (upon presentation of a medical prescription);
  • Your hospital costs;
  • Your maternity expenses (monitoring of pregnancy, childbirth, etc.);
  • Your optical and ophthalmological care;
  • Your dental care and prostheses;
  • Your costs related to an evacuation or repatriation.

What is an onshore health insurance plan onshore plan versus an offshore plan?

Your insurance contract has been arranged or effected wholly or partly with a foreign insurer that is not authorized by the Insurance Authority to conduct insurance business in Hong Kong. Such foreign insurers are not subject to the provisions of the Insurance Companies Ordinance (Cap. 41), which establishes a system of prudential supervision of authorized insurers in Hong Kong.

Do I have to pay for Alea services?

No, you pay absolutely nothing for our services. If you take out an insurance policy with us (or transfer your current policy for Alea advice and service), we are paid by a brokerage commission received from the insurer. We offer free advice and quotes to find the best health insurance for you at the best price. The price we indicate is the same or even cheaper than if you buy your insurance directly from an insurer.

What services does Alea offer?

  • An audit of your current insurance policy, if applicable.
  • Help in defining your budget and your needs.
  • Market research of the products that best suit your budget and your needs.
  • The selection of the best insurers and products for you.
  • The preparation of a clear analysis and explanations on premiums and benefits.
  • Help and follow-up during your membership procedure and during the renewal process.

Do I need health insurance?

Yes, because an accident or illness can happen at any time. It is important to be insured to pay your medical bills, because in Asia they can be very high. For example, in the private sector in Hong Kong, surgery following an arm fracture costs HK$ 250,000 (€29,000) and cancer treatment costs between HK$ 1,000,000 and HK$ 2,000,000 (€116,000 up to €200,000).

What is the difference between travel insurance and international health insurance?

They are completely different products. Travel insurance is generally temporary and does not cover pre-existing medical conditions. It is cheaper and also covers the risks associated with the trip (cancellation of flights, loss of luggage, etc.). International health insurance provides longer term protection, specifically for your medical expenses. The guarantees are therefore more extensive and renewal usually guaranteed. Contact us at hello@alea.care for more information.

Do I really need health insurance? Where I live, the public sector is inexpensive or even free.

It is important to know the pros and cons of your local health sector. Is the quality of care sufficient? Are there any waiting times that could compromise your treatment? For example, Hong Kong has an excellent public sector but waiting times are very long (including in the case of cancer treatment - even in advanced stages, since it is impossible to start immediate treatment with certainty). This is why it is common to take out health insurance in order to have the option of going into private sector, where there are very short waiting times but the prices are very high.

Can anyone signed up to health insurance?

In general, the minimum age to subscribe is 18 and the maximum age is between 60 and 75 depending on the product. There are so-called “expatriate” products which require that your nationality be different from your country of residence. There are also specific international products, like in Hong Kong, where nationality has no impact on your eligibility.

Can my family members be covered?

Yes. An additional contribution is required by the insurer to cover your family members. Your partner can be covered on your insurance whether you are married or not. Children are covered under their parents' policy until the age of 18, and can be covered longer if they study full time (up to 20 or 26 depending on the product). Please note: some products require that all family members have the same levels of guarantees, while other products are flexible and allow people under the same contract to have different guarantees. Contact us at hello@alea.care for more information.

What is sufficient international health coverage? Do I have to choose all the guarantees?

The minimum coverage to be taken is hospitalization in the event of an accident or serious illness as the costs can be very high. To this hospitalization cover, you can add standard medicine (consultations, prescriptions, radiology, etc.) according to your needs. Depending on the scope of the standard medicine guarantee, this can include complementary medicines (osteopath, homeopath, etc.) as well as health checks. Other guarantees that you can choose as an option are maternity as well as dental and optics. Although your needs may change over time, it is important to note that any increase in warranty (“upgrade”) requires a new medical questionnaire and that may subject you to exclusions or surcharges due to medical conditions. However, any reduction in your guarantees (“downgrade”) is only a simple formality and does not require a new medical questionnaire.

What are the benefits of international health insurance?

This insurance covers you all over the world, and can guarantee the payment of your hospital bills all over the world. So you don't have to pay out of pocket large amounts of money for your health care. You have the freedom to choose your healthcare provider and can keep this coverage if you move; for example if you move from Hong Kong to Singapore.

Why take health insurance when you are already covered through your work

I have health insurance through my business. Do I need to take additional coverage?

It depends on the extent of the coverage your business provides and your needs. In Hong Kong, where the employer does not have the legal obligation to provide health insurance to their employees, you can observe a huge disparity between companies in terms of coverage. It is common to offer different guarantees depending on the level of management of employees. It is also very common to offer capped guarantees in order to limit the consumption of guarantees and therefore the costs of renewal. Thus, many employees take out additional insurance to be sure (1) of being reimbursed 100% of the costs in the event of an accident or serious illness; (2) to benefit from renewable coverage for life regardless of the hazards of work. Contact us at hello@alea.care for more information.

How to comprehend the guarantees via my employer health insurance and know what I am covered for?

It is essential to understand the extent of the guarantees provided by the employer.mIn Hong Kong, local insurance companies impose ceilings which are easily reached in the private sector. Please note: you may have to pay for any excess out of pocket and you may realize too late that your work coverage is not sufficient. Here are some questions to ask your HR:

  • The detailed table of guarantees
  • If the members of your family are covered (spouse and child/ren). This is not always the case in Hong Kong.
  • If pre-existing medical conditions are covered. This is not always the case in Hong Kong.
  • If congenital conditions are covered. Often excluded in Hong Kong.
  • If you can take out a higher level of guarantee through the company and if so, what are the costs and when is it due?
  • If you have to consult in a particular network to be reimbursed at 100%. This is often the case in Hong Kong.
  • If the insurer can issue a payment guarantee for hospital costs. This is not always the case in Hong Kong.
  • Is there is portability of the product - that is, can you convert your work coverage to individual health insurance.

Finally, you can contact our Alea team at hello@alea.care for a free audit of your company's health insurance coverage.

If I lose or quit my job, can I keep my health coverage?

It is rare and an overload is often applied. In most cases in Hong Kong, when you leave your job, you lose the employer-provided medical coverage. If you or a family member is sick and in need of care at this time, this can be complicated. Indeed, few insurers accept the pre-existing conditions and you could face exclusions, surcharges or even rejection of the file. Hence the importance of individual insurance that can protect you for life without the hazards of work. In some rare cases, the employer provides employees with coverage portability (also called “guarantee of conversion”). In this case, you have the possibility within a given period (between 30 and 60 days on average) of converting your job guarantees into individual guarantees without any new medical questionnaire. This is particularly attractive when you have pre-existing conditions. Please note, insurers often apply a surcharge for this conversion.

The costs of international health insurance

What is the price of health insurance?

Your contribution is based on four elements: your age, your place of residence, the level of guarantees and the state of your health. Premiums in Hong Kong are high because they reflect the high costs of the private health sector, the second most expensive in the world after the United States. For a free quote and expert advice, contact us.

What is a deductible and co-insurance?

These are great mechanisms for reducing the amount of your premiums (contributions).This is the part of your medical expenses that you have agreed to pay yourself: a deductible is a fixed amount and co-insurance a fixed %. When you request a reimbursement or payment, all costs higher than this deductible will be reimbursed by your insurer. Deductibles generally apply per person per year and sometimes per family.

Why do contributions increase every year?

Contributions increase each year due to medical inflation, your increasing age and product performance. Unfortunately, there is no way for your broker to minimize or control these increases which are otherwise unregulated.

How much is medical inflation on average?

This is a universal issue that worries a lot of people. According to a Mercer's 2019 report, global medical inflation is around 9.6%. In Hong Kong, annual medical inflation is 8-10%.

Is it financially advantageous to subscribe as a family or individually?

It depends entirely on the insurer and the product. Some insurers offer discounts (-5% as a couple and -7.5% or -10% depending on the number of children) and others offer attractive ‘family contributions’ regardless of the number of children. Bupa Global, for example, suggests that children be covered free of charge from birth until the age of 10. Ask us for advice at hello@alea.care, we will be happy to advise you!

Why it is useful to be advised by an expert

What is an intermediary?

The insurance intermediary is responsible for presenting and explaining the insurers' products, by proposing formulas adapted to each person's needs. Their role is thus to inform and advise you in your efforts. They can also carry out preparatory work for the conclusion of a contract.

How do I know if I receive good advice?

The advice must be adapted to your situation, whether you are an individual or a business. Thanks to their expertise, the intermediary can answer all your questions and allow you to better understand the guarantees that suit you.

Is it more expensive to go through a broker?

No. You get advice, services and additional expertise with no extra charge. In fact, your contribution is exactly the same whether you subscribe directly (with an insurer) or through a broker. The broker's commission is automatically included in your premium and cannot be subtracted by the insurer. In Hong Kong and Asia, brokers receive an average commission of 15% of the annual premium on health insurance.

What are the advantages of subscribing through a broker?

The broker saves you time and money. The main role of the broker is an advisory role: she works for you, to find you the best possible insurance at the best price. The broker matches your needs to an insurance policy. Her expertise allows you to give you tailored and independent advice on health insurance products, while monitoring your situation. Her knowledge of the products and their prices allows you to make choices according to your needs and your budget, in order to optimize the broker also allows you to save time and money. Finally, using a broker does not entail any additional costs when subscribing, or increased subscription.

Discrimination of pre-existing conditions

Do I need to provide the results of a health checkup to purchase health insurance?

Unlike some life insurance products, there is no mandatory medical check-up. However, you will need to complete a medical questionnaire when applying for membership. This questionnaire must be completed in good faith and in full transparency. If there is a medical history, the insurer will come back with questions and perhaps a counter offer proposing: exclusions, surcharges or even rejection of the file.

Refunds

I'm going to have surgery or a big treatment. How can I get my insurer to pay the hospital directly?

I'm going to have surgery or a big treatment. How can I get my insurer to pay the hospital directly?
It is essential to contact your insurer in order to (1) validate the medical procedure and the costs, thus allowing the insurance to set up (2) a payment guarantee (direct payment by the insurer of the costs with the hospital).In an emergency, you must call your insurer's hotline. If the procedure is planned in advance, it is advisable to contact your insurer several working days in advance to avoid any problems!

How do I request my refunds?

This varies depending on the product and the nature of the medical expense:

  • you can pay first and then request reimbursement later. You will need to submit a copy of your detailed invoices via email, an app or an online customer account. Some insurers require originals by mail;
  • your insurer already has a direct care agreement with the practice or the health establishment and you will have nothing to pay (apart from a deductible, co-insurance or any service not covered by your policy);
  • you are planning hospitalization and you can request a payment guarantee before admission so that the insurer pays the hospital directly;
  • in the case of emergency hospitalization, most insurers will pay directly provided that they are informed within the time limit stipulated in your policy, generally within 48 hours of admission.

How long do refunds take?

From experience, about two weeks. This presupposes that the request is legitimate and that all supporting documents have been provided to the insurer.

At the time of renewal, will the offer be based on my refunds during the year?

In principle, no. The renewal offer will be based on your age, medical inflation and product performance. However, there are products in Hong Kong that offer no claims discounts in the range of 5 to 15% if you have made no claims during the year.

Can I request a refund immediately after subscribing?

Yes, but beware: the first claims just after subscribing are closely studied by insurers in order to detect fraud and pre-existing undeclared conditions.

Changes and renewals

I want to change insurer. Is it possible?

Yes, you can change your insurer at the time of renewal. But be careful if you have preexisting conditions or have ongoing treatment. Normally, the change of insurer involves a new medical questionnaire which exposes you to exclusions or surcharges. The solution? So-called “CPME” contracts, which allow you to request a transfer of conditions without a new medical questionnaire. Contact us at hello@alea.care for more information.

Can I change the level of coverage during the contract?

Normally no. Health insurance contracts are for one year and changes can only be made upon renewal. There are, however, more flexible insurers but any change must be justified.

Can I cancel my health insurance contract during the year?

The majority of products cannot be canceled during the year. That said, there are some very high-end products that allow you to be canceled during the year and get pro rata refund of your premium. Contact us at hello@alea.care for more information.

I am pregnant. Can I still take out maternity insurance?

The answer is no, for the overwhelming majority of products. If you are already pregnant, you cannot take maternity coverage because a waiting period is always imposed. This waiting period varies on the market between 10 and 24 months, the average being 12 months. There is an exception, however: rare products agree to cover women who are already pregnant for complications related to childbirth only. This can be excellent financial protection. In Hong Kong, medical complications related to childbirth can easily exceed HK $ 250,000 (€ 29,000) in a private hospital.