【Outpatient Insurance Comparison 2026】Product comparison of GP, specialist and Chinese medicine fees and cover disclosed

Many people in Hong Kong do not have company medical insurance, so when they catch a cold or flu they need to pay out of pocket for private clinic consultations, with consultation fees often starting from several hundred dollars. At present, there are many outpatient insurance policies on the market sold separately, helping Hong Kong people reduce healthcare expenses. In addition to general practitioner, specialist and Chinese medicine outpatient cover, some also include X-ray diagnostics and laboratory tests, physiotherapy, bone-setting treatment, and even outpatient surgery and cancer treatment.

The 10Life editorial team has analysed and compared outpatient insurance products available on the market to help everyone choose the right product. These include: Avo, Blue, Zurich.

First, let us briefly compare the basic cover and premiums of each outpatient insurance policy.

First, let us introduce the term “deductible”. As the name suggests, it is the amount of expenses you have to bear yourself. If you purchase medical insurance with a deductible, the policyholder must first pay medical expenses up to the deductible amount, and any amount above the deductible will then be covered by the insurer.

Taking the outpatient insurance shown in Table 1 as an example, the deductible for general outpatient consultations ranges from HK$20 to HK$235. Using some of Hong Kong’s top private medical institutions as a reference, the weekday daytime general consultation fee at Hong Kong Sanatorium & Hospital is HK$400. Suppose you have purchased outpatient insurance with a deductible of HK$220, then for each outpatient visit you can only claim HK$180 from the insurer. Therefore, when choosing outpatient insurance with different deductible levels, the insured should consider the price level of the clinics they usually visit and work out whether the relevant outpatient insurance can cover the consultation fee after deducting the deductible. Policyholders should also pay attention to the relationship between premiums and deductibles. Simply put, the lower the deductible, the higher the premium, and vice versa. Those who are particularly savvy should of course estimate how many times they expect to visit a doctor during the year, in order to determine whether outpatient insurance is worthwhile.

Although outpatient insurance can help reduce outpatient expenses, the relevant medical services are limited to network doctors. Before taking out insurance, consumers should enquire with an insurance adviser or customer service representative about the list of network doctors, and check whether their usual doctor is included.

It is worth noting that among the above products, Blue WeMedi Top Up is not subject to restrictions on medical doctors. As long as the policyholder has successfully made a claim with another insurer, the plan will reimburse the remaining balance of the claimed outpatient expenses, making it particularly suitable for complementing employer-provided medical insurance.

Some outpatient insurance plans (such as Blue and Zurich) include physiotherapy and Chinese bone-setting coverage, so those who exercise regularly may wish to take note. In addition, outpatient plans may also include different coverage features, although the premium may also increase. For example:

• Blue WeMedi Outpatient Plan provides dental services, covering oral examinations and scaling.

As video consultations become increasingly common, many people are choosing to see a doctor online. Among them, only Zurich’s “Care Health Easy” (Prestige Plan) (hereinafter referred to as “Care Health Easy”) mentions claims for video consultations. In addition, some insurers have partnered with medical institutions to launch online doctor consultation services. Policyholders who wish to use teleconsultation services should first check with their insurer whether the product is covered, to avoid any disputes.

As with other types of insurance, outpatient cover also has exclusions. Common examples include treatment arising from congenital defects or illnesses, treatment related to cosmetic procedures, deliberate self-harm, treatment related to pregnancy, miscarriage and abortion, and chronic illnesses. If the policyholder already has a pre-existing condition, it may also fall within the exclusions. In addition to paying attention to the “exclusions”, consumers should also note the “entry age”, “maximum renewal age” and “waiting period”.

Readers often confuse the “outpatient” cover under outpatient insurance with the “pre- and post-hospitalisation outpatient” cover included in hospital medical insurance. In fact, pre- and post-hospitalisation outpatient cover refers to outpatient consultations related to hospitalisation. For example, if Mr Chan consults a specialist 30 days before being admitted for a colonoscopy, the expense may be reimbursed under hospital insurance; however, if Mr Chan visits a general practitioner for a cold during the same period, it would not fall within the scope of hospital insurance, but he may make a claim under outpatient insurance.

For the outpatient consultations within the specified number of days before admission and after discharge covered by top-tier medical insurance and VHIS Flexi plans, please refer to our previous article, or use 10Life’s 《Insurance Decoder》 to compare VHIS and top-tier medical insurance directly.

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With company medical insurance, do I still need to buy outpatient insurance?

It depends on the coverage limit of the company medical insurance, any network doctor restrictions, and the benefit arrangements after leaving the company. If the reimbursement amount for each outpatient visit under the company medical insurance is insufficient, or there is an annual visit limit, you may consider an outpatient top-up plan that can subsidise the shortfall. For example, some products allow you to claim first from your company medical insurance, then reimburse the eligible balance that has not been covered. However, please note that some top-up plans require the policyholder to already hold valid individual or group outpatient medical insurance, and you should also avoid making duplicate claims for the same medical expense.

Is outpatient insurance usable immediately after purchase? Is there a waiting period?

Not necessarily. The effective date, waiting period and exclusions of different outpatient insurance plans vary. Some benefits may be available after the policy takes effect, but some items, treatment for pre-existing conditions or chronic conditions may not be covered, or may be subject to a waiting period. Before purchasing, you should read the policy terms carefully, paying particular attention to the definition of pre-existing conditions, follow-up consultations for chronic illnesses, requirements for network clinics and the claims procedure. If you seek medical treatment after purchase, you should also first confirm whether that service is covered, to avoid having to bear the cost yourself.

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.