Not only Full Coverage? Exploring the superior features of High End Medical (Updated Oct 2021) (Chinese Article)

Estimated reading time 8 minutes

10Life Team

12 Nov 2021
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10Life Team

12 Nov 2021

Estimated reading time 8 minutes

高端醫療保險是不少行政人員、高端客戶的選擇。此類產品保額高,再加上保障項目多以「全數保障」(見註1)賠償,使受保人對醫療保險的賠償更有把握。然而,除此以外,高端醫療保險還有甚麼不容忽視的超然特點,令保障進一步昇華?10Life分析了市場上多個高端醫療保險計劃(標準私家房),發掘高端醫療保險非一般的延伸保障。本文將比較AIA友邦、AXA安盛、HSBC Life滙豐保險、Bupa保柏、Cigna信諾、Manulife宏利、Prudential英國保誠、及Sun Life永明金融的高端醫療保險計劃。
 
有產品年度賠償上限達3,000萬或以上  兼不設終身賠償上限
 
傳統醫療保險為每個項目設賠償上限,受保人難以掌握醫療保險的保障,索償時擔心賠唔足。然而,高端醫療保險一般都「全數保障」多個項目,主要受每保單年度賠償上限、及終身賠償上限所限;只要受保人提出合資格的索償,符合「醫療所需」及費用「合理及慣常」,理應得到全數賠償。10Life根據12個常見傷病個案,包括癌症、通波仔等多個消費者關注的個案,向多名專科醫生了解醫療開支,再由10Life精算師計算出醫療保險的預計醫療保障率(見註2),詳見下列比較﹕ 
 
圖表1

從圖表1所見,上述高端醫療保險於12個傷病的預計醫療保障率都十分高,介乎99.9%至100%。當中,AIA友邦至尊醫療5保柏Bupa Hero非凡自願醫保計劃(尊尚)Cigna信諾尊尚醫療保Manulife宏利晉領醫療保障Prudential英國保誠「摯為您」優悅醫療保險、及Sun Life永明金融永明滿心醫療保的預計保障率均達100%,即使是癌症(涉及標靶治療)、通波仔、全膝置換術、血液透析等昂貴的醫療服務,這些高端醫保亦理應「全數保障」。
 
順帶一提,自推出10Life醫療保險評分以來,我們看到保險公司的產品推陳出新,其預計醫療保障率越來越高。為了貼近消費者需要,我們即將進一步提升評分標準,冀望業界可再精益求精,為普羅大眾提供保障更完備的醫療保險。大家記得密切留意!
 
所謂一闊三大,當大家入住私家房,其他手術費、雜費等各醫療開支亦隨之提高(相比起半私家或普通房)。所以,投保「全數保障」的高端醫療保險(私家房)時,消費者都會關心產品的年度及終身賠償上限是否夠高,以應付醫療通脹及持續治療所衍生的沉重醫療負擔。上述私家房計劃的保單年度賠償上限起碼有港幣3千萬,包括保柏Bupa Hero非凡自願醫保計劃(尊尚)Cigna信諾尊尚醫療保,以及HSBC Life滙豐自願醫保靈活計劃,而這些產品皆不設終身賠償上限。
 
高端保障昇華 住院現金可達每日2000元
 
無疑「全數保障」的高端醫療保險的保障很高,哪麼,保險公司怎樣令產品突圍而出呢?當然,為保險產品包裝成多特點並非難事,但這些特點能否在受保人患病時發揮作用,才是重點。10Life嘗試分析高端醫療保險延伸保障的用處。
 
圖表2 


市場上不少高端醫療保險都會提供住院現金,但多數適用於「降級」的情況,意思是,雖然受保人投保高端醫保的私家房計劃,但若選擇入住較低級別的的病房(如半私家房、大房、甚至是入住公立醫院),保險公司便會給予受保人次級病房住院現金,按入院日數計算。這樣,保險公司自然有得益,因為當受保人入住較低級別的的病房時,整體醫療費用及索償金額亦會減低。
 
不過,Cigna信諾尊尚醫療保的住院現金,就算受保人入住私家房,亦可賠償每日港幣2,000;另外,該產品亦提供強制隔離現金,每日港幣2,000,當受保人懷疑或確診傳染病,需於醫院的隔離病房、政府指定的隔離地點、或在家強制隔離,便可索償。如果受保人因新冠肺炎而需強制隔離及住院,可同時索償住院現金及強制隔離現金。
 
一般而言,醫療保險的住院現金可視之為入院期間收入減少的補償。當然,對於行政人員、高端客戶,多數不是日薪收入,但是,當他們住院期間,如果家人需要人照顧,這些住院現金可彌補受保人臨時聘請鐘點工人、保母的開支。

 
涵蓋住院後門診費用 若與癌症相關,有產品保障期長達365日
 
不少高端醫保的客戶都關心患重病、或慢性疾病時的持續治療,所以,住院前後門診保障是另一要點。再看圖表2,雖然高端醫保的住院前後門診是「全數保障」,但受入院後日數或/及門診次數所限。保柏Bupa Hero非凡自願醫保計劃(尊尚)賠償入院後90日內之門診費用,不限次數。而Cigna信諾尊尚醫療保更全數保障入院後180日內60次之門診費用,如果有關住院或手術與癌症有關,可進一步延長至 365 日內。對於癌症或慢性疾病,若醫保能保障出院後的相關門診時間越長、次數越多,自然對受保人較有利。
 
另外,應對癌症向來是醫療保險的重點。醫學界一直積極研發治療癌症的嶄新醫療技術及儀器,例如質子治療、伽馬刀等,它們的費用高昂。引述傳媒早前報道,養和質子治療中心將於2022投入服務,院內設置全港首個質子治療系統,預料質子治療的價用高昂;曾有患者赴德國接受質子治療,幾個星期的治療索價百萬港元(見註3,4)。
 
高端醫療保險對於特殊癌症治療保障如何呢?上述產品的保單條款中明確表明會保障質子治療、伽馬刀、數碼導航刀、免疫治療、激素治療,只有AIA友邦至尊醫療5AXA 安盛智尊守慧醫療保障Cigna信諾尊尚醫療保Prudential英國保誠「摯為您」優悅醫療保險、以及Sun Life永明金融永明滿心醫療保
 
自政府推出自願醫保計劃,標準計劃的條款劃一,投保人可享有扣稅優惠,不少市民都感興趣。在上述高端醫療保險中有3款產品獲自願醫保認證,包括AXA安盛智尊守慧醫療保障保柏Bupa Hero 非凡自願醫保計劃,以及HSBC Life滙豐自願醫保靈活計劃

 
揀選受保地區及設自付費的計劃 保費大不同
 
如果患病時,期望在哪裡醫治呢?當大家選擇高端醫療保險時,就要選擇受保地區,這大致分為亞洲、全球(美國除外)、及全球;有些產品可能只提供部分受保地區作選項。當中,受保地區涵蓋美國的全球醫保計劃最貴。如果大家只需要在香港醫病,揀選受保地區為亞洲、全球(美國除外)比起全球的計劃,前兩者保費顯著較平。
 
圖表3

對於已有公司團體醫保的消費者,可因應團體醫保的保障,選擇設自付費的計劃,保費可顯著調低。於圖表3中,假設受保人為35歲非吸煙人士,我們分別按不同的受保地區、自付費(分為港幣0自付費、及港幣10,000-25,000自付費),顯示相應的10年平均保費。另有,高端醫保計劃所設的自付費選項很不同,大家可先設定自付費的範圍,再比較保費。
 

最後提醒大家,投保前要認清個人需要、負擔能力,再了解高端醫療保險產品。10Life網站的《產品解碼器》內有更多高端醫療保險計劃的分析,用戶可按性別、受保地區、自付費、保費範圍來篩選產品,深入比較。
 
註﹕
  1. 「全數保障」適用於住院及手術保障等多個保障項目,意思是全額支付合資格費用及其他費用於扣除餘下的自付費(如有)後的實際金額,並受每年保障限額、終身保障限額及其他條件所規限。
  2. 預計醫療保障是根據12個多個常見、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《高端醫療保險的評分方法》。
  3. 詳見香港經濟日報報導〈養和東區醫療中心全方位3合1診斷及治療建成抗癌新樞紐〉。
  4. 詳見香港經濟日報報導〈前列腺癌治療方法多 百萬質子治療將引入本港  〉。
  5. 以上資訊由10Life提供,更新至2021年10月25日,僅供參考,並不是銷售提議。

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Jack, Ng Wai Lap

黃維立

AXA Unit Manager

4.7
4004
611

Nik, Leung Tsz Kei

梁芷萁

10Life Financial Manager, Insurance Specialist

4.8
1173
274

Arthur, Law Wing Kai

羅永楷

10Life Financial Manager of Business Development

5
245
80

Winnie, Ng Wai King

吳惠琼

FTLife Agency Manager

4.8
1852
309

Even, Shum Miu Chu

岑妙珠

恆泰 高級理財顧問

4.6
1348
250

Philip, Lee Hon Lun

李漢麟

YF Life Branch Manager

4.4
1646
263

Tony, Yeung Chun Fung

楊俊鋒

FWD Life Wealth Planner

4.7
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309

Mabel, Siu Sin Wan

蕭善尹

FTLife Wealth Management Director

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Edward, Lam Wing Chuen

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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
1116
249

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