VHIS Full Coverage plans getting better with Annual Limits reaching record highs (Chinese Article)

Estimated reading time 6 minutes

10Life Team

17 Aug 2020
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10Life Team

17 Aug 2020

Estimated reading time 6 minutes

政府去年推出自願醫保,為標準計劃設定劃一的條款,增加市場透明度。但自願醫保標準計劃只是醫保的最低要求,讓受保人享扣稅優惠,保障只是一般;在此基礎上,保險公司爭相推出保障較佳的靈活計劃,所以,真正的戰場在於靈活計劃。今年,陸續有「全數保障」(見註2)的靈活計劃上市。常言道,有競爭才有進步,保險公司可謂越戰越強,新出的自願醫保計劃的保障,尤其是年度賠償上限都屢創新高,並且就著自願醫保的特色,再進一步優化。本文將比較友邦AIA、滙豐保險HSBC Life、安盛AXA、保柏Bupa及宏利Manulife「全數保障」的自願醫保靈活計劃。

自願醫保年度賠償上限最高達港幣4千萬
傳統醫療保險為每個項目設賠償上限,受保人索償時殊多掣肘。但是,俗稱「全包」的「全數保障」自願醫保,基本上全數支付多個保障項目的醫療費用,主要受每保單年度賠償上限、及終身賠償上限所限。當中,年度賠償上限尤其重要,試想想,當大家不幸罹患重病時,可能短時間內需要大額的醫藥費,加上醫療通脹壓力,嶄新的醫療技術及藥物往往是天價,所以,消費者要考慮「全數保障」計劃的年度賠償上限是否足夠。

即使是同一產品,其年度賠償上限會因應受保地區及病房級別而有所不同。現時「全數保障」的自願醫保中,私家房計劃最高者滙豐保險的年度賠償上限有港幣4千萬(全球受保),對高端的行政人員具有吸引力。至於深受中產客歡迎的半私家房計劃,滙豐保險及保柏的年度賠償上限均高達港幣2千5百萬(受保地區為亞洲)。而針對大眾的普通房計劃,滙豐保險及安盛的年度賠償上限同是港幣5百萬(受保地區為大中華/亞洲)。從圖表1看,今年新出的產品不斷突破年度賠償上限。

[圖表1]
比較「全數保障」的自願醫保計劃﹕保單年度賠償上限

先揀定受保地區及病房級別 

當大家投保「全數保障」的自願醫保計劃時,要先選擇受保地區(如全球、亞洲、大中華)、病房級別(如私家房、半私家房、普通房)、自付費等選項。消費者要留意,產品未必提供所有的選項,根據圖表2,滙豐保險所提供的選項最廣,涵蓋高端的全球私家房,及平民的大中華普通房計劃,以及不同程度的自付費。

[圖表2]
比較「全數保障」的自願醫保的產品選項 (受保地區、病房級別、自付費)

優化自願醫保的特色﹕訂明非手術癌症治療、投保前未知已存在疾病

無疑「全數保障」為醫保訂立一個相高的標準。要突圍而出,保險公司在設計產品時,嘗試在自願醫保的框架下,提升保障。自願醫保一大特色,為訂明非手術癌症治療設最低要求。所謂非手術癌症治療,即化療、標靶藥物,後者開支更是無底深淵。但是,標準計劃的賠償上限只得每年度港幣8萬;參閱圖表3,友邦及宏利的「全數保障」自願醫保計劃,已分別將賠償上限定為港幣200萬及250萬;而滙豐保險、安盛及保柏就全額支付有關非手術癌症治療開支。

自願醫保規定保險公司需保障 投保前未知已存在疾病,最低要求是,第2年賠25%賠償額、第3年賠50%賠償額,第4年才賠足100%賠償額。保險公司再加大保障,例如,滙豐保險及安盛,在保單生效後,便可賠足賠償額,無須等4年。

另外,對於普通房的定義,不少保險公司都將此定義為多於2張病床的房間,但現時有私家醫院的普通房只有2張病床,如港怡醫院。如果受保人投保普通房計劃,患病打算入住普通房,但醫院只能安排2張病床的普通房,到索償時會否引起爭議?所以,滙豐保險將普通房定義為「醫院列為普通房的房間」,這個寫法較為寬鬆。

[圖表3]
比自較醫保標準計劃更高的保障

善用自付費 保費可調低

「全數保障」的醫療保險,配上高的年度及終身賠償上限,令受保人在索償時更安心。10Life分析醫療保險的保障時,亦計算出下列「全數保障」自願醫保的預計醫療保障率(參閱圖表4見註2 )均超過99.6%,代表產品於12個包括癌症、通波仔及血液透析等大家關注的傷病個案中,平均的預計保障率都相當高,接近賠足。

一般而言,「全數保障」的醫保的保費都不太便宜,為減低保費,大家可選擇設自付費的計劃,受保人需先負擔部分醫療開支。若有公司的團體醫保,自付費可由團體醫保來承擔,尤其是高級的行政人員及專業人士,可因應團體醫保的保障,選擇自付費較高的醫保。

市場上多數保險公司都提供受保於亞洲、入住半私家房的計劃,我們以此類別的計劃來比較保費。參閱圖表4,對於40歲非吸煙人士的受保人,0自付費計劃的每年保費約港幣13,300至15,800元;若選擇自付費越高,保費便越低,舉例,自付費高於港幣5萬的計劃,保費可低於港幣5,000,下列自願醫保中,滙豐保險及保柏有此選項。

[圖表4]
比較「全數保障」的自願醫保計劃 (半私家房,受保地區為亞洲)﹕預計保障率及保費

有消費者擔心,若選擇高自付費的產品時,將來他們退休再無團體醫保抵償自付費部分。其實,本文提及之產品皆容許客戶於指定年齡(通常臨近退休)有一次調低、取消自付費選項的機會,而無須再次核保,這為客戶提供一定程度的彈性,大家可向保險公司或顧問了解有關細節。

最後提醒大家,投保前要了解產品是否符合自身需要,及負擔能力,大家可瀏覽10Life的《產品解碼比較》,比較市場上多個自願醫保產品,分析它們的主要保障內容,再作適當的選擇。


註﹕

  1. 以上資訊由10Life提供,僅供參考,並不是銷售提議。以上資料更新至 2020年8月17日。
  2. 「全數保障」的是指,保險公司會全額支付,扣除自付費(如有)後的合資格醫療費用及其他費用,但受每年保障限額、終身保障限額、及其他相關條件所限。有關索償需符合「醫療所需」、費用亦要「合理及慣常」。
  3. 上述預計醫療保障是根據12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精算師對照醫療保險產品的賠償上限,計算出來的預計平均保障,詳見《大眾醫療保險的評分方法》。 

Disclaimer

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.

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Nik, Leung Tsz Kei

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10Life Financial Manager of Business Development

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