[SMM] What is Additional Medical Coverage? Examples and Pitfalls Fully Disclosed

Many medical insurance plans with "itemised limits," including some Voluntary Health Insurance Schemes (VHIS), offer additional medical coverage or Supplementary Major Medical (SMM) benefits. When specific medical expenses (such as surgical fees) exceed the basic compensation limit, SMM will cover the remaining costs. This is particularly useful for medical insurance plans with "itemised limits," though it is important to pay attention to the terms and conditions.

Generally, SMM is indicated in the insurance product name and is specifically highlighted in promotional brochures or policy terms. This coverage is only activated when expenses exceed the original medical insurance compensation limit, with annual compensation limits ranging from HKD 100,000 to HKD 220,000.

For example, consider a VHIS Flexi Plan where the SMM covers 80% of excess medical expenses, with a compensation limit of HKD 100,000. If an insured person unfortunately falls ill and is hospitalised for surgery, incurring medical expenses of HKD 74,000, while the compensation limit per the itemised benefit schedule is HKD 52,000, the remaining uncompensated amount is HKD 22,000.

For this remaining uncompensated amount (HKD 22,000), SMM will cover 80% of it (HKD 17,600), increasing the coverage ratio from just 70% to 94%. The insured person will need to bear the remaining cost (HKD 4,400).

Policyholders should note the coverage items under SMM. Some products' SMM may not include "non-surgical cancer treatments," such as chemotherapy, targeted therapy, or radiotherapy expenses. Taking targeted therapy as an example, the treatment costs can easily amount to hundreds of thousands of Hong Kong dollars, potentially exceeding the sub-limit of the policy, and SMM might not be able to provide assistance.

Before purchasing insurance, consumers should carefully read the policy terms and conditions and pay attention to the product features. Taking the Manulife Guardian Life Medical Protection Plan/Supplementary Benefit as an example, the SMM for this semi-private room plan has a compensation limit of HKD 160,000 per injury or illness. Once the insured reaches the age of 75, a lifetime compensation limit of HKD 1,300,000 will be applied, effectively reducing the coverage.

There are numerous medical insurance products available in the market, and it is advisable to compare options before purchasing. Readers can easily use 10Life's 《Insurance Decoder》 to compare products based on SMM amounts and coverage items, including ward and meal expenses, surgeon fees, prescribed diagnostic imaging tests, and prescribed non-surgical cancer treatments, which is very convenient. However, if you are looking to purchase a high-end medical insurance plan with "full reimbursement," as there are no "itemised limits," SMM is not provided. Note: This article was last updated on 28th 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.