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The Government-recognised Voluntary Health Insurance Scheme (also known as VHIS) was launched in April 2019, and the tax deduction benefit has attracted many consumers. However, insurance is ultimately a tool for risk transfer. How much it pays out when you are hospitalised, and whether it can truly allow you to feel at ease staying in a private hospital for treatment, are matters that should not be overlooked. For different situations, from minor conditions such as haemorrhoids surgery and colonoscopy to more serious illnesses such as cancer and angioplasty, what exactly is the coverage ratio of the VHIS Standard Plan (hereinafter referred to as the “Standard Plan”)?

The VHIS Standard Plan mainly covers minor conditions; the difference between products lies in the premium

According to the Food and Health Bureau’s requirements, the VHIS Standard Plan has uniform benefit amounts and policy wording definitions across a number of major benefit items. As such, the coverage differences between products are not significant, but their premiums do differ. 10Life consulted multiple specialist doctors on 12 common illness and injury cases of varying severity and medical services involved, to understand the medical services and expenses these cases entail. Based on this, 10Life’s actuaries calculated the VHIS “estimated coverage ratio” and the insured person’s estimated out-of-pocket amount. This article has selected several illness and injury cases to illustrate the VHIS Standard Plan’s estimated coverage ratio for minor and major conditions, assuming the insured person stays in a general ward (see Note 2).

Illness/injury case	Estimated medical expenses General ward (see Note 3) $	Estimated compensation (paid by insurer) $	Estimated out-of-pocket amount (paid by insured person) $	Estimated coverage ratio %
Colonoscopy (day procedure)	$18,100	$14,160	$3,940	78.2%
Fever, requiring hospitalisation	$21,600	$19,660	$1,940	91.0%
Haemorrhoids surgery	$45,600	$36,410	$9,190	79.8%
Angioplasty, with stent insertion	$217,813	$53,070	$164,743	24.4%
Breast cancer, requiring surgery only	$170,536	$83,238	$87,298	48.8%
Liver cancer, requiring surgery and targeted therapy	$482,700	$199,550	$283,150	41.3%

From the table above, the VHIS Standard Plan offers fairly good coverage for less severe cases, such as hospitalisation for fever without surgery, with an estimated coverage ratio of over 90%, and the insured person would only need to pay less than HK$2,000 out of pocket. As for some non-emergency surgical cases, such as haemorrhoids surgery and colonoscopy, the Standard Plan’s estimated coverage ratio is close to 80%, and the insured person would need to pay less than HK$10,000 out of pocket.

However, for more complex cancer cases, such as breast cancer requiring surgery, the VHIS Standard Plan’s estimated coverage ratio is less than 50%, and the insured person’s out-of-pocket amount is close to HK$90,000. If liver cancer involves surgery and non-surgical cancer treatment, such as costly targeted therapy, the estimated coverage is even lower, at around 41%, and the insured person’s out-of-pocket amount is correspondingly higher, exceeding HK$280,000. Another common hospital procedure, angioplasty and stent insertion due to coronary heart disease, has a very low coverage ratio under the Standard Plan, at only around 24%, meaning the insured person may need to pay about HK$160,000.

To strengthen coverage for major illnesses, consumers should pay attention to the VHIS Flexi Plans

The VHIS Standard Plan provides acceptable coverage for minor cases, but consumers should still be prepared to pay a small portion of medical expenses themselves. For major illnesses, the coverage gap under the Standard Plan is very evident. In fact, the VHIS Standard Plan is positioned as the most basic government-recognised hospitalisation medical protection. If you want better VHIS coverage, you should take note of the VHIS Flexi Plans.

However, regardless of product structure and benefit amount, the Flexi Plans offered by each company vary greatly. Some provide itemised benefit limits, while others advertise “full coverage” (see Note 4). Consumers therefore need to compare carefully. For more details, please refer to 10Life’s Insurance Decoder Comparison, which includes estimated coverage, product analysis, and premiums by age and gender for more illness and injury cases, and covers more than 100 medical insurance products from insurers such as AIA, AXA Hong Kong and Macau, Bupa, Cigna Healthcare, FWD, Manulife, Prudential and others:

[Compare VHIS (general ward) including Flexi Plans and Standard Plan]

[Compare VHIS (semi-private room) including Flexi Plans and Standard Plan]

[Compare VHIS (private room) including Flexi Plans and Standard Plan]

This article aims to analyse the estimated coverage ratio of the VHIS Standard Plan, but when choosing medical insurance, you should also understand your personal needs, the coverage of any group medical insurance (if applicable), and your own health condition, so as to choose suitable medical insurance.

Further reading:

‘“Full Coverage” VHIS (Semi-private room plan): make good use of the deductible for lower premiums’

‘A practical VHIS plan for the general public: comprehensive protection for both major and minor illnesses — how should you choose?’

‘Defend against “astronomical medical bills”! Compare VHIS semi-private room plans’

‘VHIS guide! Is the tax deduction attractive? If you already have medical insurance, should you switch? What are the rights and benefits during transfer?’

Notes:

The above information is provided by 10Life for reference only and does not constitute a sales recommendation.
10Life calculated the estimated coverage ratio based on 12 common illness and injury cases. For details, please refer to The Scoring Method for Mass-market Medical Insurance.
The estimated medical expenses above are calculated based on the costs of the relevant illness or injury under normal circumstances, and are used to estimate the expected compensation from the medical insurance and the consumer’s estimated out-of-pocket amount. They are for reference only and should not be regarded as actual medical expenses. The severity of each illness or injury case, the treatment required, and the insurer’s claims assessment may differ, all of which affect the insured person’s actual compensation amount. For details, please refer to The Scoring Method for Mass-market Medical Insurance.
“Full coverage” means the insurer will pay the full amount of eligible medical expenses after deducting the deductible, if any, subject to annual benefit limits, lifetime benefit limits, and other relevant conditions. Claims must satisfy the criteria of “medical necessity”, and the charges must also be “reasonable and customary”.

This English version of this article has been generated by machine translation powered by AI. It is provided solely for reference purposes. In the event of any discrepancy or inconsistency between this translation and the original Chinese version, the Chinese version shall prevail.

Last updated: 10 Aug 2026

10Life Editorial Team

Our team of professional content researchers focussing on insurance

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10Life Editorial Team

Our team of professional content researchers focussing on insurance

About Author

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10Life Product Comparison and 10Life Insurance Ratings are developed by 10Life Financial Limited, an authorised insurance broker company licensed with the Insurance Authority under 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. None of the 10Life Information is intended, nor should they be considered or relied upon, as regulated advice, insurance, financial, investment or professional advice, recommendation, approval, endorsement, invitation or solicitation in respect of any 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, and is not sufficient to form the basis of any decisions to purchase any insurance products. You should rely on information authorised by insurance companies, carry out your own research and/or seek independent advice from licensed intermediaries before purchasing any insurance products or making any insurance decisions. While reasonable 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, claim or loss arising from or associated with you using 10Life Information. No warranty, representation or guarantee is given by 10Life Group and its subsidiaries 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

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Estimated protection level of the Voluntary Health Insurance Standard Plan (Updated June 2020)

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