【Medical Insurance】Do you need to buy it? Learn about the types and benefits of Hong Kong medical insurance

Is buying insurance useful? My company already provides medical insurance — do I still need to buy a personal medical insurance plan? What does personal medical insurance cover? Who needs medical coverage the most? For answers to common questions about medical insurance, the common types of medical insurance in Hong Kong, and the benefits and necessity of purchasing personal medical insurance, read on below to learn about each in turn.

Medical insurance is a type of insurance product designed to protect against medical expenses, primarily covering costs arising from hospitalization, surgeries and other medical services. Most medical insurance reimburses on a cash-basis — that is, the insurer pays back expenses according to a percentage or a limit. The insured only needs to pay premiums regularly and can receive support for medical expenses when ill, reducing financial pressure and allowing them to undergo treatment with peace of mind.

The coverage of medical insurance varies by product type and policy terms. However, most plans typically cover the following categories of medical expenses:

1. Hospitalization expenses

Covers basic expenses during hospitalization, including:

• Ward charges (e.g., general ward, semi-private room, or private room)
• Daily meal charges
• Intensive Care Unit (ICU) charges
• Doctor ward visit fees
• Diagnostic tests and scans (e.g., X-ray, CT, MRI)
• Medications and treatment costs incurred during hospitalization

2. Surgical and anesthesia-related fees

Costs for surgical procedures, anesthetist fees, and operating theater charges, etc.

3. Treatment for specific illnesses

Some medical insurance plans offer additional coverage for certain illnesses, such as non-surgical cancer treatments (e.g., chemotherapy, targeted therapy, immunotherapy) or renal dialysis (hemodialysis), etc.

4. Day surgery coverage

Nowadays many minor procedures, such as cataract surgery or endoscopic examinations, can be completed in day clinics without an overnight stay. Some medical insurance plans also cover these types of day surgeries.

5. Post-discharge rehabilitation care

Some policies cover rehabilitation treatments for a period after discharge, such as physiotherapy, traditional Chinese medicine treatment, or chiropractic services, to help patients recover faster.

6. Psychiatric inpatient treatment

Some medical insurance covers inpatient treatment for psychiatric patients; for example, the Voluntary Health Insurance Scheme standard plans provide at least HK$30,000 per policy year for psychiatric inpatient treatment compensation.

7. Other additional coverages

Some flexible or high-end plans offer extra benefits, such as home nursing services, organ donation-related expenses, etc.

Although medical insurance provides broad coverage, there are also exclusions. The following are common exclusions:

• Diseases or medical histories known or existing before the policy was taken out, including congenital conditions or deformities. (However, the Voluntary Health Insurance Scheme’s coverage includes congenital conditions diagnosed at age 8 or later.)
• Injuries caused by war, terrorist attacks, radiation, or other hazardous activities
• Medical expenses related to illegal acts, self-harm, or substance abuse
• Accidents or injuries arising from professional or competitive sports
• Cosmetic or non-essential elective treatments, such as plastic surgery
• Routine health checks, dental or eye examinations (unless otherwise stated in the policy)
• Expenses related to childbirth, contraception, or assisted reproductive treatments
• Prostheses or artificial devices, such as dentures, artificial eyes, prosthetic limbs, etc.
• Non-approved or experimental treatments, transportation costs, and other non-eligible expenses

Coverage, claim limits, and exclusions vary among different medical insurance plans. It is recommended to read the terms carefully before buying a policy and choose suitable coverage based on your needs.

Voluntary Health Insurance Scheme

The Voluntary Health Insurance Scheme (VHIS) is government-recognised medical insurance. Plans are divided into "Standard Plans" and "Flexible Plans". Coverage includes hospitalization, surgery, psychiatric inpatient treatment, congenital conditions, and non-surgical cancer treatment. Policies are guaranteed renewable up to age 100, have no lifetime benefit limit, and policyholders are eligible for tax deductions. You can learn about the coverage on the VHIS official website.

Traditional Hospital and Surgical Reimbursement Insurance

Primarily covers compensation for hospital and surgical expenses, including hospital fees, ward meals, surgical fees, operating theatre fees, anaesthetist fees, and intensive care unit (ICU) expenses. Claims are paid on a reimbursement basis and there are itemised or annual benefit limits.

Hospitalization and Surgical Cash Insurance 

Does not reimburse medical expenses; instead it pays a fixed cash benefit based on the number of hospitalisation days or the grade of surgery, with no receipts required. The cash can be used freely and is suitable for insured persons whose income stops when they are unable to work.

Outpatient Insurance

Primarily covers medical expenses incurred at clinics, including general practice, specialist consultations, Chinese medicine, and physiotherapy. It does not cover medical expenses incurred during hospitalization. Some policies have limits on the number of visits or benefit amounts, and pre-existing conditions are not covered.

Employer Group Medical Insurance

Group coverage provided by employers, usually covering hospitalization, outpatient care, dental, etc. Coverage is limited and typically ceases upon termination of employment. The scope of coverage varies by company policy.

Cancer Medical Insurance

Cancer insurance is specifically for cancer treatment and includes chemotherapy, targeted therapy, and immunotherapy. Some policies also provide a lump-sum cash benefit (for example, HK$100,000) to cover treatment costs or loss of income.

Receive treatment faster

In Hong Kong, waiting times at public hospitals are long, and patients often have to wait a long time to receive treatment. If you fall ill, having medical insurance allows you to choose private hospitals, where you can receive diagnosis and treatment more quickly, helping you recover sooner and reducing the risk of your condition worsening.

Alleviate financial pressure

Private hospitals in Hong Kong are expensive; hospitalization, surgery, medications and diagnostic tests can easily cost tens of thousands of Hong Kong dollars. With medical insurance, you can be reimbursed on an actual-expenses basis, easing sudden financial strain. Moreover, with even public hospitals adjusting their fees, medical expenses are rising, making medical protection even more important.

Receive treatment in a more comfortable environment

With medical insurance, the insured can not only have priority access to private hospitals for treatment but also be admitted to semi-private or private rooms, enjoying a quieter and more private recovery environment. In addition, some policies cover post-discharge rehabilitation care, facilitating rest and helping speed up recovery.

Protect your family and loved ones

Medical insurance not only provides protection for yourself when you get sick, but can also reduce the financial burden on your family. If you unfortunately become ill, your family will not have to worry about large medical bills, reducing their concerns.

Enjoy tax deduction benefits

Purchasing a Voluntary Health Insurance Scheme (VHIS) plan is eligible for tax deductions. Taxpayers can insure themselves, their spouse or eligible relatives; the maximum deductible premium per insured person is HK$8,000.

Medical risks do not discriminate by age or status — anyone can become ill. So whether you are a child, a young person just entering the workforce, a family member with dependents, or a retired senior, you should consider purchasing medical insurance. If you unfortunately fall ill, medical insurance can provide coverage for hospital and surgical expenses, easing sudden financial pressure.

Many people assume they don't need additional coverage because their company already provides medical insurance. In reality, company medical plans generally offer basic coverage and limited payout limits, and they will lapse once you leave your job or retire, creating a protection gap. If you want more comprehensive and long-term medical protection, it is recommended to purchase individual medical insurance as a Top UP to fill the coverage gap and to ensure you still have some medical protection after retirement.

Health insurance premiums are generally calculated based on age and health status: the younger and healthier you are, the lower the premiums and the higher the chance of approval. Conversely, if you wait until you are older to consider purchasing a policy, you may need a medical examination and face higher premiums, exclusions for certain conditions, or even the risk of being denied coverage. Therefore, the earlier you plan, the better—you can save on premiums and gain protection sooner.

There are many types of medical insurance on the market, and each insurer has different strengths — how should you choose? As an insurance comparison platform in Hong Kong, 10Life has introduced a ratings system designed by actuaries that compares major insurance products comprehensively and fairly across coverage, premiums, and product features, helping you pick the plan that suits you best. Check out 10Life's medical insurance comparison now to learn more.

Further reading
【Which VHIS is Best 2025】 Comparing "5-star" plans — which one is the pick for middle-class families?
What is a VHIS plan? Learn the difference between VHIS plans and medical insurance
【High-end Medical Insurance Comparison】Top-tier plans — 3 key points to pick the right insurance
 

Last updated: 16 May 2025

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.