Given the regulatory restrictions on “auto renewal” in Mainland medical insurance, is there any impact to Hong Kong?(Updated Jul 2021)(Chinese Article)

Estimated reading time 6 minutes

10Life Team

22 Jul 2021
Given the regulatory restrictions on “auto renewal” in Mainland medical insurance, is there any impact to Hong Kong?
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10Life Team

22 Jul 2021

Estimated reading time 6 minutes

近月,內地推出新政策,規管短期健康保險產品使用「自動續保」、「承諾續保」等字眼,結果令不少短期健康保險紛紛下架。針對續保,中港兩地不少保險產品,均會用到類近的字眼,讓客戶以為可以得到長期保障。事實上,所謂「自動續保」、「承諾續保」、或者香港醫療保險常表述的「保證續保」,有沒有鮮為人知的魔鬼細節?對於打算長期投保醫療保險的讀者,如何避免突然被拒保?那麼內地的新政策對香港有沒有值得借鏡的地方?今天10Life就跟大家探討一下。

內地短期健康保險不可使用「自動續保」等字眼

內地的短期健康保險的保障年期一般是在1年或以下。過往,內地部分保險公司取巧以「自動續保」、「承諾續保」作招徠,令人將短期健康保險誤當作長期產品;但是,於續保時,受保人仍可能再被要求出示健康報告,又或者,當產品賠償金額一旦超過預期,保險公司便停售產品,令受保人無法續保。

為免誤導消費者,於今年1月中,中國銀保監會發佈《關於規範短期健康保險業務有關問題的通知》(下稱《通知》,見註1),要求內地的保險公司不得在短期健康保險產品條款、宣傳材料中使用「自動續保」、「承諾續保」等表述,甚至加上「不保證續保」條款(見註2)。而不符合《通知》要求的產品更須於2021年5月1日前停止銷售。另外,保險公司被要求披露短期健康保險的綜合賠付率指標,讓客戶衡量產品會否長期銷售。

香港的醫療保險常見「保證續保」 消費者可以安心嗎?

香港的醫療保險一般的保障期為一年,亦常標榜「保證續保」,讓受保人可續保至指定年齡,期間,受保人當然需依時繳交保費,即使曾作出索償亦無須再核保。

但是,「保證續保」依然未必適用於停售的產品。若保險公司因計錯風險、醫療保險索償超出預期以致虧蝕等原因,仍有權將產品下架,拒絕受保人續保。屆時,若客戶身體狀況有異、或曾經索償,想重新投保亦未必容易,可能被加上不保事項或額外附加保費。此外,「保證續保」亦未必等於保障內容相同,當產品盈利不足時,保險公司依然可於保單週年日之前發出通知,調整、修訂或變更保單的保障內容,令消費者權益受損。

相對於一般醫保,「保證續保至100歲」的自願醫保顯然較有規範。除非保險公司不再獲《保險業條例》授權承保、或終止與政府註冊為自願醫保的產品提供者、或者受保人書面通知不續保(註3),否則,保單皆可自動續保,保險公司於續保時不能任意刪減或調低其自願醫保的保障或保額(詳見早前文章﹚。與一般醫保比較,自願醫保條款對消費者較有利(見下表1)。

圖1:比較自願醫保與非自願醫保之續保條款

醫保計劃 續保條款細節
自願醫保1

(a)除本公司不再獲《保險業條例》授權承保本條款及保障,或終止與政府註冊為自願醫保的產品提供者,或保單持有人按照第二部分第3節所述,於【輸入一個不多於30日的日數】_____日前以書面通知本公司決定不續保本條款及保障的情況外,將按以下安排續保:本條款及保障將按不差於續保時由政府公布最新版本的標準計劃條款及保障(當中第一部分第7節、第六部分第1(b)及第5節和政府不時批准的其他豁免事項則除外)自動續保

 按以上(a)-(c) 段所述的續保情況下,任何其他對條款及保障的修訂應適用於所有同一 類別保單,並且不可與以上(a),(b)或(c)段(按情況而定)相違背及導致與續保前比較時,出現適用於本條款及保障的賠償限額被減少或共同保險或自付費增加的情況出現。

非自願醫保2

在符合此保單內所述之條款和條件的情況下,您擁有保證續保的權利,並可於每個保單週年日預先繳交於當時適用的全年保費以辦理續保,惟屆時此計劃須仍然可供續保。我們保留訂定續保條款及條件的權利。

註:
1. 節錄自食物及衞生局公布的《自願醫保計劃認可產品保單範本(2020年7月修訂)》第4部份第 1節。
2. 節錄自某保險公司的非自願醫保計劃條款。
3. 粗體及斜體部分為10Life所加。
4. 以上資訊由10Life提供,更新至 2021年6月9日,僅供參考,絕非銷售提議。

我們曾向保險業監管局查詢,會否借鏡內地《通知》措施,規管醫療保險使用「保證續保」。保險業監管局回覆指,「保證續保」一般指在保單生效後,投保人無須每年重新提出申請,而不論其健康狀況有否改變,保險公司均不會重新核保。

對於如何確保「保證續保」產品的保障內容不會於續保時減少,保險業監管局回應,根據《醫療保險業務指引》《指引31》,若保險公司在醫療保單續保期間,對保單的特點和條款及細則作出重大修訂,保險公司應在保單續保日或該修訂生效日之前,預留充裕時間向投保人作書面通知。

雖然現在香港的醫療保險仍可使用「保證續保」等用眼,但消費者仍要留意當中的限制,例如產品停售時的安排。早幾年,不少內地人都投保香港的醫療保險,但也不要忽略兩地法規上的差異。

註:

  1. 按此參閱《關於規範短期健康保險業務有關問題的通知》。
  2. 不保證續保條款中至少可接受包含以下內容:本產品保險期間為一年(或不超過一年)。保險期間屆滿,投保人需要重新向保險公司申請投保本產品,並經保險人同意,交納保險費,獲得新的保險合同。
  3. 詳情請參閱食物及衞生局公布的《自願醫保計劃認可產品保單範本(2020年7月修訂)》第4部份第1節。
  4. 以上資訊由10Life提供,更新至2021年7月23日,僅供參考,絕非銷售提議。  

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.

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Jack, Ng Wai Lap

黃維立

AXA Unit Manager

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Nik, Leung Tsz Kei

梁芷萁

10Life Financial Manager, Insurance Specialist

4.8
1173
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Winnie, Ng Wai King

吳惠琼

FTLife Agency Manager

4.8
1849
309

Even, Shum Miu Chu

岑妙珠

恆泰 高級理財顧問

4.6
1345
250

Philip, Lee Hon Lun

李漢麟

YF Life Branch Manager

4.4
1644
262

Tony, Yeung Chun Fung

楊俊鋒

FWD Life Wealth Planner

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308

Mabel, Siu Sin Wan

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FTLife Wealth Management Director

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Edward, Lam Wing Chuen

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Convoy Senior Wealth Management Advisor

4.6
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263

Noble, Suen Chit Yuen

孫哲遠

AIA Associate Director, Wealth Management and Protection

4.4
1114
249

Liu Lai Ting

廖麗婷

FWD Senior Branch Manager

4.8
1408
211

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