【SMM】What is supplementary medical cover? Examples and pitfalls fully disclosed.

Many medical insurance plans with sub-limits, including some Voluntary Health Insurance Scheme (VHIS) plans, offer Supplementary Major Medical (SMM) cover. When specified medical expenses (such as surgical fees) exceed the basic benefit limits, SMM will cover the remaining costs. This is particularly useful for medical insurance plans with sub-limits, although the policy terms and conditions should also be noted.

Generally speaking, SMM is indicated in the name of the insurance product, and the relevant cover will also be specifically stated in the promotional leaflet or policy terms. The cover will only be activated when expenses exceed the original medical insurance benefit limits. The annual benefit limits range from HK$100,000 to HK$220,000.

Taking a VHIS Flexi Plan as an example, assume that the plan’s SMM covers 80% of excess medical expenses, with a benefit limit of HK$100,000. If the policyholder is unfortunately taken ill and admitted to hospital for surgery, incurring medical expenses of HK$74,000, while the benefit limit under the benefit schedule is HK$52,000, the remaining unreimbursed amount would be HK$22,000.

For the remaining unreimbursed amount of HK$22,000, the SMM benefit would cover 80% of it (HK$17,600), increasing the coverage rate from just 70% to 94%, while the policyholder would need to bear the remaining expense of HK$4,400.

Policyholders should take note of the coverage provided under SMM. Some products’ SMM may not cover “non-surgical cancer treatments”, such as chemotherapy, targeted drugs and radiotherapy. Taking targeted drugs as an example, treatment costs can easily amount to hundreds of thousands of Hong Kong dollars, exceeding the sub-limit of the policy, while SMM may not be of help.

Before purchasing insurance, consumers should read the policy terms carefully and take note of the product features. Taking the ManulifeManuGuard medical protection plan/additional protection as an example, the SMM of the semi-private room plan has a maximum benefit of HK$160,000 for each illness or injury. Once the insured reaches the age of 75, a lifetime maximum benefit of HK$1,300,000 will apply, effectively reducing the coverage.

There are many medical insurance products on the market, so it is advisable to compare different options before taking out a policy. Readers can easily compare the SMM amounts and coverage items of different products through 10Life’s Insurance Decoder, including room and board, surgeons’ fees, prescribed diagnostic imaging tests and prescribed non-surgical cancer treatments. It is highly convenient. However, if you wish to purchase high-end medical insurance that provides “full reimbursement”, no SMM is provided because there are no sub-limits. Note: This article was last updated on 28 July 2022.

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.