10Life Medical Rating Methodology - Enhanced Market Standards (Chinese Article)

Estimated reading time 5 minutes
13 Dec 2021
10Life Medical Rating Methodology - Enhanced Market Standards    |  10Life
Share to Facebook
Share to Twitter
Share to LinkedIn
Share to Whatsapp
Copy URL

13 Dec 2021

Estimated reading time 5 minutes

醫療保險市場競爭激烈,以往屬於中高端醫療保險的產品賣點,也開始變得普及。我們早前文章也曾提及,自願醫保靈活計劃的全數保障產品有增加趨勢。

因應這個轉變,10Life醫療保險評分方法更新了評分因素,期望業界可以精益求精,提升產品保障之餘,並希望令評分方法貼近用家需要。評分因素包括:

  • 醫療保障評分 – 產品對指定傷病個案的保障率
  • 抗醫療通脹–產品是否有對抗醫療通脹的特性
提升乳癌個案保障門檻

先說醫療保障評分。這項評分涉及12個不同程度傷病個案(見下表)的醫療開支。不同的傷病個案牽涉不同醫療項目,如診斷掃描、手術醫生費及手術室費、處方藥物、化療、醫學裝置、出院後康復護理等,開支金額輕重不一。10Life精算師按照醫療產品在每個傷病個案的賠償上限,計算出該產品的預計平均保障率(註1),藉以比較市場上多款醫療保險產品。

同時,我們亦向數間保險公司的理賠部門查詢指定傷病個案的初步估算醫療開支,然後再向香港多名專科醫生覆查上述估算。此外,我們利用公開資料來確保估算合理性,包括私家醫院網站列出的常見手術參考收費、醫院管理局轄下的私家醫療服務項目參考收費,以及香港保險業聯會網站的索償數據(2015年)。

在是次更新中,我們還提高了乳癌個案的醫療開支假設,而其他個案則維持不變。新的乳癌個案中,除了切除手術費用外,還加上重建手術、化療及放射治療開支,再審視有關醫療保險產品的保障率,從而辨別出較佳保障的產品。畢竟乳腺癌屬女性頭五位常見癌症之首(註2),不容忽視。

表:12個不同程度傷病個案

傷病類別 傷病個案及治療
癌症乳癌,乳房切除、重建、化療及放射治療
肺癌,肺葉切除術
肝癌,需接受手術及標靶治療
腸癌,需接受腹腔鏡結腸切除術及化療
受傷 前十字韌帶手術
全膝置換術
血管疾病 通波仔,置入支架
中風
日間血液透析(洗血)
非嚴重疾病 發燒,需住院
割痔瘡手術
腸鏡檢查 (日間治療)

抗醫療通脹的重要性

相對於各個保障細項設限的醫療保險,雖然全數保障產品較易索償,但仍然受限每保單年度賠償上限以及終身賠償上限。香港醫療通脹嚴重,2019年及2020年醫療通脹分別達8.3%及8.1%(見註3),加上香港人口老化,醫療成本持續上升機會很高。

由於普遍保單持有人均會每年續保醫療保險,因此這份保險某程度上屬長期性質,難免多年之後,因醫療通脹令索償金額不幸達到賠償上限,使保障變得不足夠。因此,除了考慮指定傷病個案的預計保障率外,10Life還會考慮產品是否有下列3項抗醫療通脹特性:

  1. 全數保障(產品大部份項目不設細項上限)
  2. 高額每保單年度賠償上限
    • 普選房:大於或等於$5,000,000
    • 半私家房:大於或等於$8,000,000
    • 私家房:大於或等於$20,000,000
  3. 不設終身限額或保證保障不減少(適用於所有自願醫保計劃)
只有少於10%產品可獲5星評級

為了讓消費者易於分辨保障較佳的優質產品,10Life推出5星評級機制。5星評級僅以產品特點、客觀數據為依歸,不受保險公司的佣金、介紹費所影響。當產品的醫療保障評分達9.95或以上,以及具有抗醫療通脹特性,即屬5星級產品。在眾多產品中,只有少於10%的產品可獲5星評級。如想比較5星評級產品,可以運用10Life《保險解碼器》: 

最後必須提醒大家,評分方法涉及假設,並沒有考慮核保過程、理賠嚴謹程度、投保人個人需要等其他因素,僅供一般教育及參考用途,並非銷售建議。

註:

  1. 10Life根據多個常見、涉及不同程度、及醫療服務的傷病個案,於一般情況下的醫療開支,再由10Life精算師對照醫療產品的賠償上限,計算出來的預計平均保障,詳見《大眾醫療保險的評分方法》。上述傷病個案的預計保障率是根據該傷病於一般情況下之預計醫療開支來計算,用作「預計」醫療保險及消費者大概要負擔的醫療開支,僅作參考之用,並未得到有關保險公司之確認。用戶不應視之為實際醫療開支。每個傷病個案的嚴重程度、所需治療、及保險公司的理賠評核等,都未必相同,均影響受保人實際的賠償額。實際賠償額受保單條款約束,保險公司有最終決定權。
  2. 數據來自《2019年香港癌症統計概覽》。香港醫院管理局;2021年10月。
  3. 數字取自怡安《2020 Global Medical Trend Rates》。
  4. 以上資訊由10Life提供,更新至2021年12月9日。

Disclaimer

10Life Product Comparison and 10Life Insurance Ratings are developed by 10Life Financial Limited, an authorised insurance broker with Insurance Authority License Number FB1526. 10Life Product Comparison and 10Life Insurance Ratings are developed for generic customer segments using mathematical calculations based on product information, facts and data, and are not influenced by any partnerships with or fees received from insurance companies.  

Any information on 10Life Platform ("10Life Information"), including but not limited to Product Comparison, Product Ratings, Blog Articles are intended for general education purpose and reference only and should not be constituted as any insurance, financial, investment or other professional advice or solicitation to buy insurance, financial or investment products. 10Life Information does not take into account your individual needs. Reading 10Life Information should not be considered as conducting a suitability assessment. You should only rely on information authorised by insurance companies and/or seek independent advice from licensed intermediaries before purchasing any insurance products or making any insurance decisions. While best effort is used when collecting, validating and updating 10Life Information from various channels, none of 10Life Group and its subsidiaries, affiliates, agents, directors, officers and employees will be responsible for any liability arising from using 10Life Information or for any claims and/or losses caused thereby, and no warranty or guarantee is made on the accuracy, completeness and timeliness of the information.

If you have any questions on 10Life Product Comparison and 10Life Insurance Ratings, please email us at enquiries@10life.com .

Compare VHIS

Instant Chat
Licensed advisors will address all your insurance queries
Please select advisors

Jack, Ng Wai Lap

黃維立

AXA Unit Manager

4.7
3933
606

Nik, Leung Tsz Kei

梁芷萁

10Life Financial Manager, Insurance Specialist

4.9
1173
274

Winnie, Ng Wai King

吳惠琼

FTLife Agency Manager

4.8
1845
308

Even, Shum Miu Chu

岑妙珠

恆泰 高級理財顧問

4.6
1341
250

Philip, Lee Hon Lun

李漢麟

YF Life Branch Manager

4.4
1639
261

Tony, Yeung Chun Fung

楊俊鋒

FWD Life Wealth Planner

4.7
1750
304

Mabel, Siu Sin Wan

蕭善尹

FTLife Wealth Management Director

5
1053
312

Edward, Lam Wing Chuen

林永泉

Convoy Senior Wealth Management Advisor

4.6
1557
263

Noble, Suen Chit Yuen

孫哲遠

AIA Associate Director, Wealth Management and Protection

4.4
1113
249

Liu Lai Ting

廖麗婷

FWD Senior Branch Manager

4.7
1399
208

Have an insurance question? Just ask!

  • Ask a question anytime, anywhere
  • Get response from multiple licensed advisors
  • Simply login with Email
You can choose to direct your question to a specific insurance company before submitting a question.
Please enter all the question field.
Sorry, the question was failed to send.
The question was successfully sent.
ExamplesHow to choose saving insurance?Do I need life insurance?What products cover unknown pre-existing conditions?
Share to Facebook
Share to Twitter
Share to LinkedIn
Share to Whatsapp
Copy URL

Further Readings

「天線得得B」挨跌咗 家居保險可以賠?
Does Home Insurance Cover Property Damage?
24 May 2022
恒生18萬保障爭議未完  索償時間太長?
Unfinished Controversy on Hang Seng Covid Benefit
23 May 2022
個人攰攰地 係咪患咗「長新冠」?
What is Long Covid and What You Need to Know?
23 May 2022
Health
人生咩時候買咩保險?
What Insurance Should You buy in Your Life Journey?
20 May 2022
Wealth
Confirm to leave?

Compare VHIS

Instant Chat
Licensed advisors will address all your insurance queries
Please select advisors

Jack, Ng Wai Lap

黃維立

AXA Unit Manager

4.7
3933
606

Nik, Leung Tsz Kei

梁芷萁

10Life Financial Manager, Insurance Specialist

4.9
1173
274

Winnie, Ng Wai King

吳惠琼

FTLife Agency Manager

4.8
1845
308

Even, Shum Miu Chu

岑妙珠

恆泰 高級理財顧問

4.6
1341
250

Philip, Lee Hon Lun

李漢麟

YF Life Branch Manager

4.4
1639
261

Tony, Yeung Chun Fung

楊俊鋒

FWD Life Wealth Planner

4.7
1750
304

Mabel, Siu Sin Wan

蕭善尹

FTLife Wealth Management Director

5
1053
312

Edward, Lam Wing Chuen

林永泉

Convoy Senior Wealth Management Advisor

4.6
1557
263

Noble, Suen Chit Yuen

孫哲遠

AIA Associate Director, Wealth Management and Protection

4.4
1113
249

Liu Lai Ting

廖麗婷

FWD Senior Branch Manager

4.7
1399
208
×
Ask Questions
No contact information needed. Anonymous questions, instant chat, and get opinions from licensed advisors.
Please sign up or login, instant anonymous questions!
Advisor Replies
Your question has been sent to licensed advisors.
No contact information needed. Anonymous questions, instant chat, and get opinions from licensed advisors.
Please sign up or login, instant anonymous questions!
My Advisors
No record with advisors.
Please sign up or login. No contact information needed, instant contact with advisors!
Instant Chat
Licensed advisors will address all your insurance queries
Please select advisors

Jack, Ng Wai Lap

黃維立

AXA Unit Manager

4.7
3933
606

Nik, Leung Tsz Kei

梁芷萁

10Life Financial Manager, Insurance Specialist

4.9
1173
274

Winnie, Ng Wai King

吳惠琼

FTLife Agency Manager

4.8
1845
308

Even, Shum Miu Chu

岑妙珠

恆泰 高級理財顧問

4.6
1341
250

Philip, Lee Hon Lun

李漢麟

YF Life Branch Manager

4.4
1639
261

Tony, Yeung Chun Fung

楊俊鋒

FWD Life Wealth Planner

4.7
1750
304

Mabel, Siu Sin Wan

蕭善尹

FTLife Wealth Management Director

5
1053
312

Edward, Lam Wing Chuen

林永泉

Convoy Senior Wealth Management Advisor

4.6
1557
263

Noble, Suen Chit Yuen

孫哲遠

AIA Associate Director, Wealth Management and Protection

4.4
1113
249

Liu Lai Ting

廖麗婷

FWD Senior Branch Manager

4.7
1399
208

We use cookies to give you the best possible experience on our website. By continuing to browse this site, you give consent for cookies to be used. For more details please read our Cookie Policy.