Preface

The aftermath of the COVID-19 pandemic and shifting regulations in Asia have inflicted a lasting impact on people's mental wellbeing. A recent AON and TELUS Health research indicates that 82% of workers in Asia are at a moderate to high risk of experiencing mental health issues, underscoring the enduring effects of the pandemic on the region's mental health landscape. Notably, 1 in 4 employees in Hong Kong expressed feeling unsettled and nervous.

According to MindHK, less than 30% of individuals experiencing common mental disorders (CMDs), accounting for about 70% of all mental health conditions, seek out any form of mental health support. This discrepancy between the demand for services and their utilization can result in a decline in mental wellbeing, hinder personal and familial functioning, elevate mortality rates, and diminish societal productivity.

“At a time when mental health is more important than ever, we are proud to shed light on what Hong Kong insurers have been doing to address rising mental health risks. Following a step in the right direction, more needs to be done especially in regards to the cover of mental health pre-existing conditions” said Amelie Dionne-Charest, Co-founder of Alea.

Alea has conducted in-depth research on mental health coverage and related insurance initiatives in Hong Kong.

1. Insurance coverage of mental health In Hong Kong: where do we stand?

1.1 Mental health toll – a wake-up call for insurers

The COVID-19 pandemic has caused worldwide anxiety. Its broad-based and multi-dimensional effects were felt emotionally and economically. In Hong Kong, mental health support often falls short due to various cultural, social, and economic factors. This can make it difficult for people to access the help they need, leaving many struggling to take care of their mental wellbeing. However, in 2021 Sun Life reported that spending on mental health insurance claims had increased by about 25%, and the tendency seems to stick. The profound impact of COVID-19 has finally prompted consumers to take action and raised interest for more protection.

This presented an opportune time for insurers to become more proactive on mental health solutions and upgrade coverage options. The increased demand for mental health support has fueled the insurance industry to find innovative ways to help customers get the care they need.

Insurers' capability to underwrite mental health risks is enhanced by advances in the understanding of mental illnesses, consumer behavior, diagnosis criteria, recovery paths and treatments enabled by advanced analytics.

1.2 Insurance coverage

1.2a General exclusions of mental health consultations

Mainstream health insurance plans in Hong Kong seldom provide full coverage for mental health care, but only the most severe aspects of it, i.e. psychiatry. Not to mention such protections often come with caps, sub-limits or special conditions imposed on the beneficiary. Many plans strictly limit the benefit to inpatient care, only accepting hospitalized cases.

Mental health disorders caused by drugs or alcohol addictions are the most common exclusions.

For instance, the Voluntary Health Insurance Scheme (VHIS) launched by the Food and Health Bureau in April 2019 only requires relevant insurance products to cover medical expenses for hospitalization in psychiatric treatment (a minimum of HK$ 30,000 per year). Insurance providers are under no legal obligation to cover other psychiatric-related treatment expenses, let alone daytime outpatient clinics and psychological counseling.

1.2b International Plans

Most international and local comprehensive medical insurance plans provide greater mental health cover under their inpatient and outpatient benefits.

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Glossary

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Psychiatrists are trained doctors who specialize in the treatment and diagnosis of mental illnesses, behavioral and emotional disorders. Treatment approaches by psychiatrists involve medication alongside some degree of psychotherapy. In insurance psychiatry has traditionally been covered under doctor specialist inpatient and outpatient benefits - but unlike other medical specialties - it is common for insurers to cap the extent of the psychiatric cover.

Psychologists and psychotherapists help treat emotional, mental and behavioral disorders. Unlike psychiatrists, they are not medical doctors and cannot prescribe drugs.

While the insurance industry did not cover psychological or psychotherapy treatment in the past, this has changed thankfully. Today most international and comprehensive medical insurance plans cover psychological and psychotherapy treatment under their outpatient benefits. Such insurance cover is dissociated from medical doctor consultations and most often categorised under a separate outpatient benefit section: for example, the "Mental and Nervous Conditions benefit".

Note:

• Psychiatry care is generally under ''Inpatient Coverage'' and "Outpatient Coverage".
• Psychology care is generally under ''Outpatient Coverage'' only.
• Claims are considered for treatment provided by registered and qualified professional.

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1.3 Mental health coverage comparison

1.3a International Insurance Plans

Insurance Provider	Inpatient	Outpatient
Allianz (Care Pro Plan)	Psychiatry and psychotherapy: Fully covered.	Psychiatry and psychotherapy: Fully covered up to 30 visits/year and 18 months waiting period.
April	Hospital treatment of mental and nervous conditions: Fully covered up to 60 days/policy year.	Outpatient mental & nervous conditions (physician or psychologist consultation fees, diagnostic scans and tests, medicines and drugs prescribed by a physician): Fully covered up to US$ 5,000/policy year. Outpatient behavioural & developmental disorders (physician, psychologist and psychotherapist fees, diagnostic scans and tests, medicines and drugs prescribed): Fully covered up to US$ 1,500 per policy year.
AXA (Global Health Plan)	Psychiatric treatment: Fully covered up to 100 days, over membership lifetime.	Psychiatric treatment: Fully covered up to 30 sessions.
Bupa (IHHP)	Psychiatric treatment: Fully covered within annual maximum limit.	Psychologist and psychotherapist: US$ 195 per consultation (combined maximum of 15 consultations within a 30-day period for GP/Specialists and Psychologist/Psychotherapist).
Bupa (Global Health Plan)	Psychiatric treatment, where it is medically necessary to be treated as a daypatient or inpatient to include room & board and all treatment costs: Fully covered for a total of 90 days per lifetime. Any psychiatric treatment overnight in hospital and as a day-patient for 5 days or more will need pre-authorization. Benefit will not be paid unless pre-authorization has been provided.	Consultation fees with psychiatrists, psychologists and psychotherapists: Such consultations must take place in the psychiatrist’s, psychologist’s or psychotherapist’s office. Fully covered up to a combined limit of 60 consultations each policy year.
Cigna (Global Individual Plan)	Mental and Behavioural Health Care as part of inpatient, daypatient or outpatient treatment: Fully covered up to 90 days.	Mental and Behavioural Health Care as part of inpatient, daypatient or outpatient treatment: Fully covered up to 90 days. Mental Health Support Program: Fully covered up to 20 face to face counselling sessions per condition per policy year.
Henner (Care & Health Plan)	Inpatient Psychiatric treatment: Fully covered up to US$ 15,000 per policy year.	Psychiatric treatment, when referred by a physician: Fully covered up to US$ 250 per visit, max 10 visits per policy year. Psychologist treatment, when referred by a physician (referral letter from a Medical Practitioner is required): Fully covered up o US$ 150 per visit, max 10 visits per policy year.
Morgan Price (Elite Plan)	Inpatient Psychiatric treatment: Fully covered up to 30 nights per policy year. Day-patient psychiatric treatment: Fully covered up to 4 separate day admissions in each period of insurance.	Outpatient psychiatric treatment, when referred by a physician: Fully covered up to 30 visits per policy year.
Now Health (WorldCare Plan)	Inpatient Psychiatric treatment: Fully covered up to 30 days per policy year.	Psychiatric & Psychologist treatment: Fully covered up to US$ 7,500, up to 20 sessions per policy year. Referral required for registered psychologist 5th session onwards and no referral required for Pyschiatric visit.

1.3b Local Insurance Plans - Non-VHIS

Insurance Provider	Inpatient	Outpatient
AIA (CEO 5 Plan)	For stay and treatment in a mental or psychiatric hospital, or in the mental or psychiatric unit of a hospital: Fully covered up to HK$ 40,000 and maximum up to 30 days per policy year.	Psychiatric treatment: Fully covered up to HK$ 1,000 per visit and maximum 10 visits per policy year.
AXA (Global Elite II Plan)	Psychiatric treatment: Fully covered up to HK$ 60,000.	Not covered
Blue Cross (Dynasty Plan)	Psychiatric treatment: Fully covered up to HK$ 60,000.	Not covered
Bupa (Care Pro Plan)	Psychiatric treatment: Fully covered up to HK$ 30,000.	Psychiatric treatment: Fully covered up to HK$ 820 per visit (including medication). Psychological counselling (subject to written referral from a Psychiatrist): Fully covered up to HK$ 820 per visit.
Chubb (Assured Medical Series)	Psychiatric treatment: Fully covered up to HK$ 50,000 up to 45 days per policy year.	Not covered
Cigna (Elite 360 Plan)	Psychiatric Treatment: Fully covered up to HK$ 60,000 and maximum up to 30 days per policy year. Mental Wellness Service: Fully covered up to 4 face to face counselling sessions per year with a conselling Psychologist.	Psychiatric & Psychological treatment: Fully covered up to HK$ 800 per visit, maximum up to 5 visits per policy year.
Manulife (ManuMaster Plan)	Psychiatric treatment: Fully covered up to HK$ 66,000 per policy year.	Not covered
Prudential (PRUmyhealth prestige)	Psychiatric treatment: Fully covered up to HK$ 60,000 per policy year, 30 days per year.	Not covered
SunLife (SunHealth Medical Premier Plan)	Psychiatric treatment: Fully covered up to HK$ 40,000 per policy year on necessary treatment on mental, behavioral, psychiatric or psychological disorder during the confinement in hospital, mental or psychiatric hospital.	Not covered

1.3c Local Insurance Plans - VHIS

Insurance Provider	Inpatient	Outpatient
AIA (VHIS Flexi)	Psychiatric treatment: Fully covered up to HK$ 39,600 (in network) & HK$ 36,000 (non-network) per policy year.	Not covered
Blue Cross (Dynasty Plan)	Psychiatric treatment: Fully covered up to HK$ 40,000 per policy year.	Not covered
Bupa (VHIS Hero)	Psychiatric treatment: Fully covered up to annual maximum limit (R&C).	Psychiatric treatment: Fully covered up in network & up to HK$ 1,200 per visit (including medication) in non-network. Psychological counselling treatment: Full coverup in network & up to HK$ 33,000 per policy year in non-network (Subject to written referral from a Psychiatrist).
Bupa (My Flexi)	Psychiatric treatment: Fully covered up to HK$ 30,000 per policy year.	Psychiatric treatment: Fully covered up to HK $550 per visit (including medication), maximum 6 visits per policy year & 1 visit per day.
China Life (VHIS Private Plan)	Psychiatric treatment: Fully covered up to HK$ 30,000 per policy year.	Not covered
China Taiping (VHIS Flexi Plan)	Psychiatric treatment: Fully covered up to HK$ 57,000 per policy year.	Not covered
Chubb (VHIS Flexi Plan)	Psychiatric treatment: Fully covered up to HK$ 90,000 per policy year.	Not covered
FWD (vCANsurance Plan)	Psychiatric treatment: Fully covered up to annual maximum limit.	Not covered
HSBC (VHIS Flexi Plan)	Psychiatric treatment: Fully covered up to HK$ 50,000 per policy year.	Not covered
SunLife (WeHealth Prestige Plan)	Psychiatric treatment: Fully covered up to HK$ 40,000 per policy year.	Not covered

1.4 Summary of findings

• Psychiatry Coverage: Except for Allianz Care and Bupa IHHP, all insurers impose an annual limit – generally between 30 and 90 days – or a cost limit.

• Psychological Coverage: All providers impose a limit of visits per year and/or a cost limit per visit/year.

Local vs international health insurance : Pros and Cons

	PROS	CONS
International private medical insurance	Comprehensive mental and behavioral healthcare coverage	Higher premium
Local private medical insurance	Lower premium	Strict limits on covered benefits

Moving on to extend coverage for services beyond psychiatry

In Asia, insurers continue to fall behind their global counterparts in terms of mental health support, mental health coverage for outpatient treatment and preventative measures.

In order to meet the surging needs for mental health treatments, we are witnessing a new trend in the insurance industry. Insurers are extending coverage beyond psychiatry, to more common conditions with additional coverage for psychological consultations and counseling.

In addition, due to continuing social stigma around mental wellbeing, many people prefer to avoid the sensitivity of making a claim. Insurance providers can do more to support them in this goal.

1.5 Expert Tips

Applying for individual health insurance involves underwriting, a process by which the insurer assesses risk and determines the appropriate cost and extent of cover. Applicants must complete a detailed health questionnaire and the insurer’s underwriting team may decide to counter offer exclusions or loadings on declared medical conditions.

Alea’s advisors have witnessed strict underwriting practices in regards to mental health which most often lead to wide exclusions. Where someone declaring hypertension in their health questionnaire may be offered a 30% loading by the insurer, the mildest mental health declaration can lead to an exclusion with little scope to negotiate cover or a loading.

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Quick Tips:

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Discrimination against pre-existing conditions, especially mental health, is another reason why it is recommended to get solid individual health insurance as early as possible in life and most importantly before any symptoms or diagnosis of any condition.

However, it's important to note that these exclusions typically don't apply to coverage provided by employers, as most companies cover pre-existing conditions as part of their employee benefits packages.

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1.6 Current bottlenecks

Despite recent coverage improvements, mental health care remains underdiscussed, with a coverage gap in the Hong Kong market, as it is still subject to:

1 - Exclusion of pre-existing mental health conditions:

While insurance providers are looking to increase mental health cover, pre-existing mental health conditions constitute a material obstacle. When applicants declare past mental care, this usually leads to exclusion on such future care.

We at Alea have witnessed the strong disconnect between insurers' marketing of their mental health benefits and the actual accessibility to consumers who need it most, the ones who have sought mental health treatment in the past.

2 - Exclusion of self-inflicted harm:

The most extreme cases of mental conditions, which are associated with addiction, self-inflicted harm and suicides, are often under general exclusions listed in the contract.

3 - Caps and sub-limits:

There are caps in mental health items, unlike in most physical conditions, e.g. cancer, diabetes, chronic conditions, etc.

4 - Inadequate coverage:

Most of the time, mental health care for milder conditions takes place in an outpatient setting. Even though outpatient services such as psychologist consultations may be included in the plan, its coverage usually comes with a sub-limit which can be exceeded easily.

The amount allocated might be inadequate to cover a complete series of psychological treatments, which often require multiple sessions, and you may need to pay out-of-pocket for the extra costs.

Alea’s research has found that in Hong Kong, private psychological sessions vary between HK$ 1,500 and HK$ 2,500.

Enhancing workplace wellbeing

Strategies for Employee Support and Mental Health Initiatives

As more employers recognize the importance of mental health in the workplace, offering mental wellbeing solutions for employees has become increasingly prevalent. This shift reflects a growing awareness of the significant impact that mental care has on overall productivity and organizational success.

By providing mental health coverage and support programs, employers not only ensure access to necessary resources and services for their employees but also foster a positive workplace culture and enhance performance. Investing in employee wellbeing is not just a moral imperative but also a strategic decision that yields long-term benefits for both employees and employers.

One of the key advantages for employees is that mental health coverage often includes coverage for pre-existing conditions. This means that individuals with mental health concerns can access the support they need without facing financial barriers or exclusions based on their medical history. This not only promotes inclusivity but also ensures that employees can seek help when they need it most, leading to improved job satisfaction and performance.

In addition to traditional approaches, innovative digital solutions such as apps have emerged, providing convenient and accessible online mental health support. These apps offer a wide range of resources, from therapy sessions to mindfulness exercises, catering to diverse employee needs and preferences.

Appendix: Mental health services in Hong Kong

3.1 Mental health services in the public sector

reatments for mental health issues are provided by the public sectors but the level of service provision falls short of need. People should be aware of waiting times, which can be very long in the public sector. According to a research conducted by Hong Kong Free Press, the waiting time goes from 18, up to 65 weeks for 75% of patients attempting to book an appointment with a psychiatrist from a public hospital.

To access public healthcare, you can visit a general outpatient clinic (GOPC), A&E or family doctor to request a referral (valid for 3 months), with which you can be referred to psychiatric services in the public sector. Here is a list of available public psychiatric day hospitals and public psychiatric outpatient clinics under psychiatry.

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Hospital Authority’s Mental Health Direct Hotline (24-hour)
Tel: 2466 7350

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Clinical psychological services can also be sought from the Social Welfare Department (SWD) with referral from any service unit under the SWD.

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Social Welfare Department Hotline (24-hour)
Tel: 2343 2255

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3.2 Mental health services In the private sector

Private services are available but are much more expensive. Some private hospitals provide inpatient treatment for patients upon referral by a private psychiatrist, such as:

• Gleneagles Hospital Hong Kong — Behavioral Health Clinic: it serves as a psychiatric specialist ward in particular for psychological evaluation, counseling, psychological behavior treatment and medication
• Evangel Hospital
• Hong Kong Baptist Hospital
• Saint Teresa's Hospital

In the usual admission span between 5 and 7 days, the inpatient charge per day is below HK$ 2,200, and the total charge with the inclusion of meals, doctor’s rounds and medications is estimated at below HK$ 30,000.

Click here for a complete list of practitioning psychiatrists in Hong Kong.

You can also find a list of registered clinical psychologists here. Note that currently there is no official regulation for counseling and psychological professions in Hong Kong. Psychologists are under no obligation to be licensed or registered with a professional board or government agency in order to practice.

However, private organizations ​​including the Hong Kong Psychological Society’s Division of Clinical Psychology (DCP), and The Hong Kong Association of Doctors in Clinical Psychology (HKADCP) have been set up to create a framework and regulatory standards. You may refer to their registers for more information.

Conclusion

Lack of accessibility and knowledge

People are generally unfamiliar with the mental care benefits of their insurance policies. Dealing with insurance plans can be challenging, especially when you are already stressed and worried about mental health issues you or a loved one are experiencing. It is best to understand your benefits before you need to use them.

Remaining barriers to care

74% of mental health sufferers do not seek any form of professional help, according to a MindHK study. Financial barriers are one impediment for the public to receive mental health care. People often cite the cost of care and the lack of health insurance coverage as reasons for not seeking mental healthcare. In addition, due to continuing social stigma around mental wellbeing, many people prefer to avoid the sensitivity of making a claim. Employers and insurance providers can do more to support them in this goal.

Gaps in coverage

Insurance coverage tends to prioritize physical health, leaving mental health with limited access to necessary services. This gap creates barriers for individuals seeking mental health treatments. Addressing this inequity is essential to ensure that mental health receives equitable coverage and support comparable to that of physical health conditions.

What’s next?

Emphasis on mental health coverage is increasing among insurers who are working to make treatment for mental illness easier and more accessible. They can step up by redesigning plans to encompass a wider range of mental health services from prevention, detection and treatment to management and recovery.

How Alea can help you save on insurance