FAQ: Insurance Questions 101

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.

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.

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.

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.

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.

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.

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%.

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!

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.

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.

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.

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.

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.

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!

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.

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

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.

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

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.

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.

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.

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.