The Hidden Benefits of VHIS Beyond Tax Deductions

Estimated reading time 7 minutes

10Life Team

25 Jul 2021
The Hidden Benefits of VHIS Beyond Tax Deductions
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10Life Team

25 Jul 2021

Estimated reading time 7 minutes

自願醫保計劃(Voluntary Health Insurance Scheme,VHIS)大受市場歡迎,首兩年已經賣出超過79萬張保單(見註1)。自願醫保對消費者的有利之處,多數人都知悉扣稅優惠(見註2),又或者是自願醫保標準計劃設有統一條款及基本保障,例如保證續保至100歲、保障投保前未知的已有疾病等等。然而,自願醫保的優點並不止於此,有些條款不為消費者注意,但在精算的角度而言,對消費者卻相當「值錢」,也為保險公司帶來一定成本壓力。今天,10Life就跟大家探討這些鮮為人知的好處,以及美之不足的地方。

利1:自願醫保條款暗藏玄機 保證續保倍安心

自願醫保保單條款雖然複雜,但部份細節確實保障消費者,就如保證續保,乍聽之下,看似沒甚麼特別,因為香港市場上不少傳統的醫療保險也標明保證續保。不過,自願醫保的續保的條款(註3)卻明確定明﹕

若本公司於續保時將會或已終止與政府註冊為自願醫保的產品提供者,但仍獲《保險業條例》 授權承保本條款及保障,將按以下安排續保: 本條款及保障將按不差於no less favourable than本公司終止與政府註冊為自願醫保的產品提供者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(見註4

以及

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) (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(reducing the benefit limits)或共同保險或自付費增加的情況出現(見註5

與一般醫保的保證續保比較,上述自願醫保條款凸顯出兩個優勢:

一、他日縱使保險公司因銷情欠佳、計錯風險、或者虧蝕等任何原因而要將產品下架,保險公司仍有責任向早前已購買自願醫保的客戶續保。相反,就算一般醫療保險標榜保證續保至指定歲數,但只要產品下架,客戶便無法續保;屆時,如果客戶年老或身體狀況已不如以前,想購買另一份醫保亦可能會遇上拒保或額外加保費的情況。

二、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。換句話說,若保險公司之早推出的高保額或特點而導致成本大增,將來保險公司亦不能將有關項目變差。反之,於一般醫療保險,當某保障項目導致賠償超出預期時,保險公司有權於續保時改動此保障項目。

利2:自願醫保價格透明 加價無所遁形

漢堡包加價,傳媒自會報導,大家亦很易察覺,但是醫療保險呢?不少人知道年紀越大,醫療保險的保費越貴,但是大家其實無法透過「現時」的保費表預視將來,因為「現時」的保費未反映醫療通脹,而保險公司往往以醫療通脹為由來加價。

先談自願醫保,保險公司須將自願醫保的保費刊載於其網站內。另外,只要大家前往自願醫保的官方網站,登入「消費者資訊專區」內的「識別認可產品」專頁,再選擇標準計劃名單或靈活計劃名單,便可翻查過去計劃的保費,加多加少,立即知道。相反,對於一般醫療保險,保險公司悄悄加價而難被察覺,因為消費者難以透過公開途徑得識,更遑論計算其加幅。

利3:自願醫保核保問卷條款 冀減少索償爭議

過往,保險公司以受保人於投保時未披露重要事實而拒賠。但是,普通消費者難以分辨何為必須披露的重要事實(material fact)。

自願醫保的的條款(見註6)提到,保單持有人及受保人均有責任回覆核保問卷的問題,披露重要事實,可是,若核保問卷未有相關問題,保險公司將豁免保單持有人及受保人披露有關資料的責任。換言之,若保險公司設定的問題本身含糊,未能引導保單持有人及受保人披露重要事實,這是保險公司的責任,而非保單持有人及受保人。

至於一般醫療保險,不論核保問卷字眼是否模糊不清,向保險公司披露重要事實,仍是保單持有人及受保人的責任。

利4自願醫保由食衛局把關 釐清條款灰色地帶

2020年10Life發現,自願醫保中的「訂明非手術癌症治療」的保障適用於「住院期間,或在為日症病人提供醫療服務的設備下」的合資格費用,對於家中口服標靶藥是否受保存在不同的詮釋空間。其後10Life向食物及衛生局了解有關條款的含義。據了解,食物及衛生局曾就事件向多間保險公司查詢,並事後向保險公司發出通知,指有關治療只要是由註冊醫生按醫療需要處方,便可以獲得保障。事件反映,食衛局為自願醫保把關,釐清條款,減少日後索償可能出現的爭議。

除了本談及的條款,自願醫保亦於索償爭議的關鍵條款——醫療必需(medically necessary)及合理及慣常(reasonable and customary)——加以保障消費者。由於篇幅關係,我們將於將來再探討,大家不容錯過。

最後,我們亦想談及兩個自願醫保弊端。

弊1:自願醫保產品預計平均保障差異大

10Life精算師以多個傷病個案(包括癌症、心臟病、中風等),計算自願醫保的預期保障率。不過,我們發現標準計劃預計平均保障僅得53.1%。另一方面,市場上卻有少部靈活計劃其預計保障率超過99.5%。所以,投保之前,宜貨比三家,了解產品的特性。

弊2:自願醫保不等於最佳保障

誠如於「利1」提到,就算索償超出預期,自願醫保保障不能任意刪減。所以,保險公司可能在設計自願醫保產品時,選擇提供相對保守的保障,尤其針對「全數賠償」的計劃,部分保險公司的自願醫保的年度保障額,低於其傳統醫保產品。

為了讓消費者易於掌握自願醫保產品的保障,10Life精算師以多個傷病個案(包括癌症、心臟病、中風等),計算自願醫保的預期保障率,歡迎大家瀏覽10Life《產品解碼器》逐一比較。


  1. 截至2021年3月31日,自願醫保保單的數目已達791,000張。
  2. 納稅人可為自己、或受養人的自願醫保保費,申請免稅額,而扣稅額上限為每份保單$8000元。當大家計算實際節省的稅款時,就要將保費與邊際稅率相乘,每份保單能實際節省的稅款,最多為$1,360。詳情請參閱〈扣稅吸引嗎?已有醫保轉不轉會?轉移時權益係點?〉。
  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. 引述自《自願醫保計劃認可產品保單範本(2020年7月修訂)》第4部份續保條款第1(b)節,粗體及英語部份為筆者所加。
  5. 引述自《自願醫保計劃認可產品保單範本(2020年7月修訂)》第4部份續保條款第1節,粗體及英語部份為筆者所加。
  6. 《自願醫保計劃認可產品保單範本(2020年7月修訂)》條款及細則中保單第8條原文節錄:「每位保單持有人及 受 保 人均有責任回覆問題,並披露問題所要求的重要事實。本公司同意,若在投保申請文件内未 有包括任何相關問題,將被視為本公司豁免保單持有人及受保人披露有關所需資料的責任。」
  7. 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.

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

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Jack, Ng Wai Lap

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AXA Unit Manager

4.6
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610

Nik, Leung Tsz Kei

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10Life Financial Manager, Insurance Specialist

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Winnie, Ng Wai King

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FTLife Agency Manager

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Even, Shum Miu Chu

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AIA Associate Director, Wealth Management and Protection

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Jack, Ng Wai Lap

黃維立

AXA Unit Manager

4.6
3978
610

Nik, Leung Tsz Kei

梁芷萁

10Life Financial Manager, Insurance Specialist

4.8
1173
274

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

4.7
1763
308

Mabel, Siu Sin Wan

蕭善尹

FTLife Wealth Management Director

5
1058
313

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
1114
249

Liu Lai Ting

廖麗婷

FWD Senior Branch Manager

4.8
1408
211

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