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Health

Outpatient Medical Insurance Comparison 2022

2022-08-12 15min read
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10Life Editorial Team
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Many people in Hong Kong do not have company medical insurance and have to pay at least a few hundred dollars when they visit a private clinic even for cold and flu. To help reduce the medical expenses of the public, some insurance companies now offer standalone outpatient medical insurance plans. Apart from general practitioners, specialist and Chinese medicine consultation, some plans also cover X-ray diagnosis, laboratory tests, physiotherapy, Chinese bone setting, and even outpatient surgery and cancer treatment.

Some readers asked whether it would be worthwhile to get outpatient insurance if you have chronic disease such as diabetes requiring regular clinic visits. Unfortunately, exclusions on pre-existing conditions would likely be imposed by the insurer at insurance application. However, if you are generally in good health, you may benefit from this comparison of outpatient medical insurance products of 8 insurance companies, including AIA (note 1), Blue, Blue Cross, Cigna, HK Life, Prudential, YF Life, and Zurich.

Let’s start with a brief comparison of the basic benefits and price of each outpatient insurance product.

Table 1: Comparison of Outpatient Insurance (Medical Network, Outpatient for General Practice, Specialty, Traditional Chinese Medicine)

Assuming that the insured is a non-smoker aged 6, 35 and 55, and comparing with the highest level plan of the following products

 

Product Plan
Medical Network
Outpatient for General Practice
Outpatient for Specialty
Outpatient for Traditional Chinese Medicine
Annual Premium for 6 year-old
Annual Premium for 35 year-old
Annual Premium for 55 year-old
Medical Network
Not mentioned
Outpatient for General Practice
Max no. of visits per year: 302
Co-payment per visit: $20
Outpatient for Specialty
Max no. of visits per year: 102
Co-payment per visit: $40
Outpatient for Traditional Chinese Medicine
Max no. of visits per year: 10
Co-payment per visit: $20
Annual Premium for 6 year-old
$4,448
(Ward)3
Annual Premium for 35 year-old
$4,672 (Male)
$4,968 (Female)
(Ward)3
Annual Premium for 55 year-old
$6,624 (Male)
$7,384 (Female)
(Ward)3
Medical Network
800+ destinated doctors
Outpatient for General Practice
Unlimited visits
Co-payment per visit: $210
Outpatient for Specialty
Unlimited visits
Co-payment per visit: $500
Outpatient for Traditional Chinese Medicine
Unlimited visits
Co-payment per visit: $190
Annual Premium for 6 year-old
$388
$120
Annual Premium for 35 year-old
$388
$120
Annual Premium for 55 year-old
$388
$120
Medical Network
360+ destinated doctors
Outpatient for General Practice
Unlimited visits
Co-payment per visit: $30
Outpatient for Specialty
Unlimited visits
Co-payment per visit: $80
Outpatient for Traditional Chinese Medicine
Max no. of visits per year: 10
Co-payment per visit: $30
Annual Premium for 6 year-old
$3,288
Annual Premium for 35 year-old
$3,288
Annual Premium for 55 year-old
$3,288
Product Plan
Cigna
DIY Health Plan
Medical Network
Not mentioned
Outpatient for General Practice
Max no. of visits per year: 50
Co-payment per visit: $50
Outpatient for Specialty
Max no. of visits per year: 10
Co-payment per visit: $100
Outpatient for Traditional Chinese Medicine
Max no. of visits per year: 10
Co-payment per visit: $50
Annual Premium for 6 year-old
$3,5904
Annual Premium for 35 year-old
$3,2604
Annual Premium for 55 year-old
$3,2604
Medical Network
Not mentioned
Outpatient for General Practice
Unlimited visits
Co-payment per visit: $20
Outpatient for Specialty
Unlimited visits
Co-payment per visit: $50
Outpatient for Traditional Chinese Medicine
Max no. of visits per year: 125
Co-payment per visit: $30
Annual Premium for 6 year-old
$5,544
Annual Premium for 35 year-old
$4,608
Annual Premium for 55 year-old
$4,608
Medical Network
500+ destinated doctors
Outpatient for General Practice
Unlimited visits
Co-payment per visit: $30
Outpatient for Specialty
Max no. of visits per year: 15
Co-payment per visit: $60
Outpatient for Traditional Chinese Medicine
Max no. of visits per year: 10
Co-payment per visit: $30
(optional coverage)
Annual Premium for 6 year-old
$2,080
Annual Premium for 35 year-old
$2,080
Annual Premium for 55 year-old
$2,080
Medical Network
Western and Chinese medical
practitioners and clinics: 550+
Outpatient for General Practice
Unlimited visits
Co-payment per visit: $40
Outpatient for Specialty
Unlimited visits
Co-payment per visit: $80
Outpatient for Traditional Chinese Medicine
Max no. of visits per year: 20
Co-payment per visit: $50
Annual Premium for 6 year-old
$3,4006
Annual Premium for 35 year-old
$3,4006
Annual Premium for 55 year-old
$3,4006
Medical Network
500+ destinated doctors
Outpatient for General Practice
Unlimited visits
No co-payment
Outpatient for Specialty
Unlimited visits
No co-payment
Outpatient for Traditional Chinese Medicine
Unlimited visits
No co-payment
Annual Premium for 6 year-old
$7,212
Annual Premium for 35 year-old
$7,212
Annual Premium for 55 year-old
$7,212
Medical Network
460+ destinated doctors7
Outpatient for General Practice
Unlimited visits
No co-payment
Outpatient for Specialty
Max no. of visits per year: 10
No co-payment
Outpatient for Traditional Chinese Medicine
Max no. of visits per year: 10
No co-payment
Annual Premium for 6 year-old
$3,672
Annual Premium for 35 year-old
$3,672
Annual Premium for 55 year-old
$3,672
Note:
1. Although AIA Health Journey Guardian provides outpatient coverage, it is not purely outpatient insurance. It also provides hospitalization coverage for cancer treatment, etc. Its premium will increase with age.
2. AIA Health Journey Guardian: general practitioner consultation, specialist consultation, Chinese medicine consultation, acupuncture, bonesetter, physiotherapy coverage up to a total of 30 visits/sessions per policy year.
3.AIA Health Journey Guardian: semi-private and private room options are also available.
4. Cigna DIY Health Plan: include general outpatient coverage. Outpatient surgical benefit premiums are $1,980 (for a 6-year-old non-smoking boy or girl), $2,380 (for a 35-year-old non-smoking man or woman); Additional Outpatient Benefit premiums are $3,000 (for a 6-year-old boy), $2,780 (for a 35-year-old non-smoking man or woman).
5. HKLife We-Care Outpatient Plan (Golden): 15% discount on additional visits for a total of 12 visits per policy year for Chinese medicine and acupuncture treatments.
6. YF Life Out-Patient Insurance Plan (Plan 2): children under the age of 6 must be insured with at least one parent member between the ages of 18 and 65.
7. Zurich ClinicGo (Platinum): 300+ general practitioners, 150+ specialists, 10+ physiotherapy centers, Chinese medicine centers and dental care centers.

Co-payment Enables Lower Price

According to the price list of Hong Kong Sanatorium & Hospital, the cost of outpatient service can range from HK$320 for a general consultation to over HK$1000 for a specialist consultation. If one is covered by outpatient insurance, the out-of-pocket cost would be less than HK$100 for general or specialist consultation, under most of products shown in Table 1 above.
 
Policyholders should be aware of the relationship between premium and co-payment - the lower the co-payment, the higher the premium, and vice versa. Using a 35-year-old non-smoker as example, Zurich’s HealthMultiple Medical Insurance Plan covers unlimited number of general, specialist and Chinese medicine consultations with zero co-payment, with an annual premium of HK$7,212. A savvy consumer would calculate the expected number of doctor visits in a year to check if the outpatient insurance is cost effective.

Network Doctor Restrictions

While outpatient insurance can help reduce the cost of outpatient visits, it is important to note that related medical services are often restricted to the network doctors of the insurance company. Before purchase, consumers are recommended to check the network doctor list with their advisor or insurance company to see if their preferred doctors are on the list.

 

In terms of price, the premium rates of outpatient insurance are usually the same for adults aged between 35 and 55 but may be higher for children as in the case of Cigna and Hong Kong Life. On the other hand, AIA’s Health Journey Guardian covers cancer treatment and rehabilitation benefits, thus the premium also increases with age.

 

After the basic benefits, let’s compare the additional benefits of the different outpatient insurance products in the table below.

Table 2: Comparison of Outpatient Insurance Coverage

Compare the highest level plans of the following products

 

Product Plan
X-ray & Laboratory examination
Physiotherapy
Chinese Medicine Bone-Setting
Other Coverage
X-ray & Laboratory examination
$2,000 per policy year
Physiotherapy
20 visits2
Co-payment per session: $40
Chinese Medicine Bone-Setting
10 sessions2,3
Co-payment per session: $20
Other Coverage
Cancer benefits, rehabilitation benefits

Acupuncture: 10 sessions2,3
Co-payment per session: $20

Vaccination: $200
X-ray & Laboratory examination
Not mentioned
Physiotherapy
Unlimited visits
Co-payment per session: $330
Chinese Medicine Bone-Setting
Unlimited visits
Co-payment per session: $270
Other Coverage
Compassionate death benefit: $1,000
Acupuncture treatment: unlimited visit, $300 co-payment per visit
Chiropractor treatment: unlimited visit, $480 co-payment per visit
Dental examination, scaling and polishing: unlimited visit, $198 up co-payment per visit
X-ray & Laboratory examination
$5,000 per policy year
Physiotherapy
10 visits
Co-payment per session: $60
Chinese Medicine Bone-Setting
Not mentioned
Other Coverage
Clinical procedures:
20% co-payment, $4,000 limit per year
Product Plan
Cigna
DIY Health Plan
X-ray & Laboratory examination
Not included
Physiotherapy
12 visits
Co-payment per session: $150
Chinese Medicine Bone-Setting
Full cover with maximum 10 visits
(add-on benefits)4,5
Other Coverage
Day-patient or clinical surgery4: $15,000 per disability
$100,000 per policy year

Add-on "supplementary outpatient benefit"4,5 : acupuncture, Chinese bone-setting, chiropractor consultation, occupational therapy, dietetic guidance, speech therapy
X-ray & Laboratory examination
$2,000 per policy year
Physiotherapy
Not mentioned6
Chinese Medicine Bone-Setting
Not mentioned6
Other Coverage
Death benefit: $1,000

Acupuncture: 12vists each year, $50 co-payment per visit7
X-ray & Laboratory examination
$2,000 per policy year
Physiotherapy
Not mentioned
Chinese Medicine Bone-Setting
Not mentioned
Other Coverage
Minor operations performed in clinic: $2000 each year

Eye test: 1 visit, no co-payment (optional coverage)
X-ray & Laboratory examination
Co-payment 20% per visit
$4,500 per policy year
Physiotherapy
Not mentioned
Chinese Medicine Bone-Setting
Not mentioned
Other Coverage
Special investigation and advance imaging examination
Co-payment: 20%
$2,500 per year
X-ray & Laboratory examination
$1,000 per policy year
Physiotherapy
15 visits
No co-payment
Chinese Medicine Bone-Setting
Unlimited visits
No co-payment
Other Coverage
Free body check annually
X-ray & Laboratory examination
$2,000 per policy year
Physiotherapy
10 visits
No co-payment
Chinese Medicine Bone-Setting
10 visits
No co-payment
Other Coverage
Not mentioned
Note:
1. Although AIA Health Journey Guardian provides outpatient coverage, it is not purely outpatient insurance. It also provides hospitalization coverage for cancer treatment, etc. Its premium will increase with age.
2. AIA Health Journey Guardian: general practitioner consultation, specialist consultation, Chinese medicine consultation, acupuncture, bonesetter, physiotherapy coverage up to a total of 30 visits/sessions per policy year.
3. AIA Health Journey Guardian: acupuncture and bonesetter for a total of 10 visits per policy year.
4. Cigna DIY Health Plan: basic outpatient benefit does not include outpatient surgical benefit and supplementary outpatient benefit, which are subject to a separate premium.
5. Cigna DIY Health Plan: acupuncture, bonesetter, chiropractic, occupational therapy, nutritional counselling, speech therapy, for a total of 10 visits per policy year.
6. HKLife We-Care Outpatient Plan (Golden): “Preventive Healthcare Program” with a special offer of 15% discount.
7. HKLife We-Care Outpatient Plan (Golden): A total of 12 Chinese medicine and acupuncture treatments per policy year, 15% discount on additional visits.

Additional Benefits

Additional coverages are offered by some insurance companies. A sporty person may consider products that cover physiotherapy and bone setting. Usually, additional coverage would lead to a higher price.
 
Consumers should pay attention to the covered benefits and choose the most suitable based on their personal needs. For example, Zurich’s HealthMultiple Outpatient Medical Plan offers a free medical check-up annually.
 
On the other hand, Blue Cross, Cigna and Prudential offer additional coverage for clinical surgery (subject to recommendations of network doctors). Common clinical procedures include colonoscopy, hemorrhoid removal and many more. Cigna offers the highest benefit among all products, covering HK$15,000 per condition with a maximum of HK$100,000 per policy year.
 
In addition, AIA provides coverage for cancer. Take wardroom as an example, AIA covers as much as HK$200,000 annually, with HK$600,000 lifetime limit, including full coverage for cancer treatment with a daily hospital cash benefit of HK$400 (up to 90 days).

Figure 3: Outpatient Insurance Comparison (Premium, Issue Age, Maximum Cover Age, Waiting Period)

Compare the highest level plans of the following products

 

Product Plan
Issue Age
Maximum Cover Age (year)
Waiting Period
Issue Age
15 days to age 80
Maximum Cover Age (year)
Lifelong
Waiting Period
Not mentioned
Issue Age
15 days to age 80
Maximum Cover Age (year)
85
Waiting Period
Not mentioned
Issue Age
15 days to age 60
Maximum Cover Age (year)
65
Waiting Period
Not mentioned
Product Plan
Cigna
DIY Health Plan
Issue Age
15 days to age 60
Maximum Cover Age (year)
75
Waiting Period
Not mentioned
Issue Age
30 days to age 71
Maximum Cover Age (year)
71
Waiting Period
1 month
Issue Age
15 days to age 60
Maximum Cover Age (year)
65
Waiting Period
14 days
Issue Age
15 days to 66 years2
Maximum Cover Age (year)
66
Waiting Period
Not applied
Issue Age
15 days to age 64
Maximum Cover Age (year)
75
Waiting Period
14 days
Issue Age
15 days to age 64
Maximum Cover Age (year)
75
Waiting Period
Not applied
Note:
1. Although AIA Health Journey Guardian provides outpatient coverage, it is not purely outpatient insurance. It also provides hospitalization coverage for cancer treatment, etc. Its premium will increase with age.
2. YF Life Out-Patient Insurance Plan (Plan 2): children under the age of 6 must be insured with at least one parent member between the ages of 18 and 65.

Telehealth service

Telehealth is becoming increasingly popular nowadays. Among the 9 products, only Zurich ClinicGo (Platinum Plan) mentions the coverage of video consultation. As for other products, please check with their insurance companies beforehand to avoid unnecessary dispute.

Like other insurance, outpatient insurance also has exclusions and limitations. Common exclusions include treatment for congenital defects or diseases, cosmetic-related treatment, intentional self-inflicted injury, treatment for pregnancy, miscarriage, abortion, and chronic diseases. Waiting period is usually 14 days from the date of enrollment, except for YF Life and Zurich ClinicGo which do not have any waiting period.
 

Outpatient Insurance vs. Pre/Post-Confinement Medical Consultation (Inpatient Insurance)

Some readers confuse the difference between “outpatient” and “pre/post-confinement”. “Pre/ post-confinement” refers to medical services before/ after hospital procedures. For example, if Mr. Chan is admitted to the hospital for a colonoscopy 30 days prior to the surgery, he will be covered by the inpatient insurance, while if Mr. Chan goes to the general clinic for the flu during the same period, he will not be covered by the inpatient insurance, but by the outpatient insurance instead.
 
For more details on the pre-hospitalization and post-discharge outpatient visits covered by the voluntary health insurance scheme (VHIS) and high-end medical insurance, please refer to our earlier article or use our Decoder to compare VHIS and high-end medical insurance.
 
Note:
  1. Although AIA Health Journey Guardian provides outpatient coverage, it is not purely outpatient insurance. It also provides hospitalization coverage for cancer treatment, etc. Its premium will increase with age.
  2. The above information is updated as of 12 Aug 2022.
10Life Editorial Team

Our team of professional content researchers focussing on insurance

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10Life Editorial Team

Our team of professional content researchers focussing on insurance

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

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