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【Voluntary Health Insurance】Does it cover oral targeted drugs taken at home? Calls for Health Bureau to revise terms to avoid disputes.
As tax season approaches, many consumers take out VHIS policies to seize the tax deduction opportunity. VHIS products are certified by the Government, providing consumers with greater peace of mind. One of the selling points of VHIS is that the minimum annual benefit for “Prescribed Non-surgical Cancer Treatments” is HK$80,000, covering treatments such as chemotherapy and targeted therapy. 10Life has discovered a potential claims loophole in the definition of “Prescribed Non-surgical Cancer Treatments”. The benefit applies to eligible expenses incurred “during hospitalisation, or under the facilities provided for medical services to day patients”. As for oral targeted therapy taken at home, whether it is covered remains questionable.
Insurers may interpret the policy terms differently
Targeted therapy attacks cancer cells at specific targets. It is more targeted than chemotherapy and reduces damage to other organs. Common forms of targeted therapy include intravenous injection, subcutaneous injection and oral medication (such as tablets or capsules). For many oral targeted drugs, patients can take them at home under a doctor’s prescription. However, based on the VHIS definition, it appears unclear whether oral targeted drugs taken at home are covered. The following is the definition of “Prescribed Non-surgical Cancer Treatments” under the VHIS Standard Plan:
This benefit will reimburse eligible expenses charged for Prescribed Non-surgical Cancer Treatments received by the Insured Person during hospitalisation, or under the facilities provided for medical services to day patients, including specialist outpatient consultation fees incurred during the course of treatment for carrying out the treatment plan, monitoring the prognosis and monitoring the progression of the disease.
According to market sources, some insurers interpret the wording of the policy literally and do not cover oral targeted drugs taken at home. To gain a better understanding, 10Life emailed the major insurers in Hong Kong in December last year to enquire about the scope of their coverage. Some insurers did not respond. However, some insurers clearly stated that their VHIS products cover targeted drugs taken at home, showing that certain insurers still interpret the policy terms in a reasonable and humane manner.
The VHIS products of the following insurers cover targeted drugs taken at home (in alphabetical order)
- AXA Hong Kong and Macau
- Bupa Bupa
- Chubb Chubb Life
- China Life China Life（海外）
- Cigna 信諾
- FWD FWD
- Manulife Manulife
- Sun Life金融
Response from the Food and Health Bureau: Such treatments are covered as long as they are prescribed by a registered doctor based on medical necessity
Based on a literal interpretation, oral targeted drugs taken at home do not appear to constitute eligible expenses incurred “under the facilities provided for medical services”. But does this interpretation reflect the original intention of the policy terms? We also approached the Food and Health Bureau to clarify the meaning of the relevant terms and received the following written response: “The coverage of all VHIS-recognised products must include ‘Prescribed Non-surgical Cancer Treatments’, which encompass radiotherapy, chemotherapy, targeted therapy, immunotherapy and hormone therapy for cancer treatment. Such treatments are covered as long as they are prescribed by a registered doctor based on medical necessity.” It can therefore be inferred that oral targeted drugs taken at home and prescribed by a registered doctor based on medical necessity should be covered. However, given the current wording of the definition, insurers may reject claims. We therefore recommend that the Food and Health Bureau revise the wording of the policy terms, so that the good intentions of VHIS can be properly implemented and any doubts can be dispelled.
Some non-VHIS medical insurance products provide clearer wording
In fact, apart from VHIS, other medical insurance products in the market also cover targeted therapy, with clearer definitions. For example, AIA’s “AIA Asia Pacific Elite Medical Plan 2” clearly stipulates that oral targeted drugs prescribed by a doctor and taken at home are also covered. This is worth referencing. We hope that the Food and Health Bureau will revise the wording of the VHIS policy terms in the future to avoid inconsistent interpretations by insurers.
AIA’s “AIA Asia Pacific Elite Medical Plan 2” definition of “Chemotherapy, Radiotherapy and Targeted Therapy Expenses Benefit”:
We will reimburse the actual reasonable and customary expenses incurred:
1) for any chemotherapy, radiotherapy or targeted therapy specified and medically necessary by the Insured Person’s attending registered medical practitioner, whether the Insured Person receives such treatment as an inpatient or an outpatient, due to a Covered Illness or Covered Injury; and
2) any targeted therapy or chemotherapy drugs specified and medically necessary by the Insured Person’s attending registered medical practitioner due to a Covered Illness or Covered Injury, for the Insured Person to use or take at home。
Basic VHIS cancer coverage is insufficient; consumers should compare products before taking out a policy
Targeted therapy is expensive. According to an earlier media report, a liver cancer patient taking the new-generation liver cancer targeted drug Lenvatinib spent more than HK$20,000 per month, amounting to nearly HK$300,000 in ten months. The basic annual benefit of only HK$80,000 for “Prescribed Non-surgical Cancer Treatments” under VHIS is clearly insufficient to cover targeted drugs. Only a small number of VHIS Flexi Plans in the market provide additional coverage for targeted therapy.
Therefore, although VHIS is certified by the Government, consumers should still understand and compare the coverage and terms of different products before taking out a policy. You can visit 10Life’s《Product Decoder》, where our actuaries have calculated coverage scores for various illness cases, including cancer, heart disease and stroke.
If you have any questions about the terms and coverage of VHIS, medical insurance or critical illness insurance, or wish to plan your medical protection according to your personal needs, you can “ask a question anonymously” on the 10Life website and receive immediate responses from multiple licensed advisers.
References:
- 《Ming Pao Health Net》18 February 2019: 《Does chemotherapy harm the body? Are targeted and immunotherapies better? The three major cancer treatments each have their strengths 》
- Health and Drug Education Health Topics of the Drug Office of the Department of Health of the Hong Kong Special Administrative Region, 《Targeted Therapy Drugs 》
- 《HK01》 2019-10-03《Liver cancer silently strikes: non-smoking, non-drinking woman in her sixties suffers abdominal pain for nearly six months before scans reveal late-stage disease》
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.
10Life Editorial Team
Our team of professional content researchers focussing on insurance
10Life Editorial Team
Our team of professional content researchers focussing on insurance
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