Table of Content

Medical Insurance Scoring Methodology

Medical Insurance Scoring Methodology
Evaluation by professional actuaries to help you identify medical products with best coverage
Iris Lun
10Life Co-founder and Chief Actuary
1. Overview

Average Coverage of Common Medical Cases

Based on the medical expenses of 12 common medical scenarios against the policy provisions.

Medical Inflation Protection

Whether the product can protect against medical inflation due to future increase in medical costs.

Additional Features

Comparing additional features that can improve the overall coverage for the customer.

2. Assumptions

A non-smoking insured hospitalised in a private hospital in Hong Kong due to specified injury or sickness

Note: Medical insurance premium may differ between male and female.
Insurance premium information is based on current premium tables.  Current premium rates at different ages do not represent future premiums, which may rise significantly due to inflation.


5 Stars VHIS 2022
Medical 5-Star Criteria
  • Medical Coverage Score of 9.95 or above
  • Medical plan with Medical Inflation Protection

3. Average Coverage of Common Medical Cases

To estimate the medical cost compositions of the different hospitalisation cases, 10Life researched into public information available, including the following sources: 

  • Reference fees and charges listed on the Hong Kong private hospital websites
  • Reference fees and charges from the Hong Kong Hospital Authority Private Service  
  • 2015 HKFI claims statistics 


Case Details


  • Breast Cancer with Mastectomy, Reconstruction, Chemotherapy & Radiotherapy
  • Lung Cancer with Lobectomy
  • Liver Cancer with Surgery and Targeted Therapy
  • Colon Cancer with Surgery and Chemotherapy


  • Anterior Cruciate Ligament Surgery
  • Total Knee Replacement

Vascular Diseases

  • Angioplasty and Stent Placement
  • Stroke
  • Kidney Dialysis

Common Cases

  • Fever Requiring Hospitalisation
  • Hemorrhoid Surgery
  • Colonoscopy (Day Case)

To improve on the accuracy of our estimates, 10Life reached out to the claims department of several major medical insurers to obtain initial estimates of the 12 different cases. We then consulted with medical specialists in Hong Kong to verify the estimates. We also cross referenced the resulting overall costs to the public information where available to ensure reasonableness. Note that these estimates are based on normal circumstances of hospitalization in private hospitals (i.e. assuming no complications other than the listed conditions).

For products with deductibles, the estimated coverage ratios are calculated without considering the deductible amount. As consumers choose a certain deductible in exchange for lower premium, they should be conscious of the resulting expected out-of-pocket shortfall amount. 10Life focusses on comparing coverage based on unexpected events, and the deductible itself does not impact the coverage limits within the product. Therefore, products with deductibles are treated as if they had no deductibles, i.e. the out-of-pocket expenses stated do not include the deductible amount.

The relevant medical expense categories and the relative proportions vary under the 12 cases studied. Using these estimated costs on each case, 10Life actuaries then refer to the benefit limits on each expense category to calculate the estimated coverage amount (to be paid by the insurer) and out of pocket expenses (to be paid by the policyholder). 

Table 1: Estimated Medical Cost of Selected Hospitalisation Cases


Estimated Medical Cost (HKD)

Ward Room

Semi-private Room

Private Room

Breast Cancer with Mastectomy, Reconstruction, Hemotherapy & Radiotherapy




Lung Cancer with Lobectomy of Lungs




Colon Cancer with Surgery & Chemotherapy




Liver Cancer Requiring Surgery & Targeted Therapy




Common Injury - Anterior Cruciate Ligament Surgery




Severe Injury - Total Knee Replacement




Heart Disease - Angioplasty








Kidney Dialysis – Day Case




URTI - Fever Requiting Hospitalisation




Hemorrhoid Surgery




Colonoscopy -Day Case





1. It should be noted that coverage ratios are based on estimated medical expenses under normal circumstances for illustrating how a policyholder and the insurer would share the incurred medical expenses, and should not be regarded as the actual medical cost. The actual claim payment amount of each case may vary by the actual severity and medical procedures used, as well as the insurer’s claim assessments. 
2. The above information is updated as of 03-12-2021.

The Estimated Coverage Ratio of each of the 12 medical cases is calculated as follows:

Estimated Coverage Ratio = (Estimated Coverage Amount / Estimated Medical Expense Incurred) × 100%

To reflect the relativity of the various cost amounts among the 12 cases, a weighted average based on the estimated medical expense incurred for each case is calculated: 

Weighted Average Coverage Ratio = SUM of [Estimated Coverage Ratio × weight of case]

where weight of each case = Estimated Medical Expense Incurred / (SUM of [Estimated Medical Expense Incurred])

10Life Medical Coverage Score (Out of 10) = Weighted Average Coverage Ratio / 100% × 10

It should be noted that estimated average coverage are based on estimated medical expenses under normal circumstances for illustrating how a policyholder and the insurer would share the incurred medical expenses, and should not be regarded as the actual medical cost. The actual claim payment amount of each case may vary by the actual severity and medical procedures used, as well as the insurer’s claim assessment.

4. Medical Inflation Protection

In addition to the coverage ratios for the selected medical cases, 10Life has compared other features in the products that have not been reflected in the 12 medical cases. 10Life considers a product to be providing protection against medical inflation if the below 3 criteria are met.

  1. Full coverage (no inner limit) – i.e. no maximum coverage limits on most individual medical expense categories (subject to the costs being reasonable and customary)
  2. High Annual Limit 
    • Ward: ≥ HKD 5,000,000
    • Semi-private: ≥ HKD 8,000,000
    • Private: ≥ HKD 20,000,000
  3. One or both of the following 2 conditions:
    • No lifetime limit
    • Guaranteed that benefits would not be reduced at renewal (i.e. all VHIS products) 

5. Number of Additional Features

In addition to the coverage ratios in the selected medical cases and medical inflation protection, a list of distinguishable additional features that can improve the overall coverage for the customer have been selected as follows. 

List of Additional Features
Second Medical Opinion Service
International Assistance Service
Hospital Cash (private hospital under current room class)
Long-term Post Hospitalisation Outpatient Cover (180 days or above covering no less than 6 visits)
Hospice/Palliative Care Coverage (HKD 80,000 or above per life)
Pregnancy Complications Coverage (HKD 100,000 or above per policy year, or covers no less than 80% of the expense)
Short Waiting Period
VHIS Plan: ≤30 days for unknown pre-existing conditions
Non-VHIS Plan: ≤30 days for general waiting period 
Waiver on Deductible (for certain critical cases)  

6. 10Life Medical Insurance 5-Star Rating

5-Star Ratings for medical insurance is based on 10Life Medical Coverage Score and Medical Inflation Protection. 5-Star Ratings are categorised by hospital room levels (Ward Room, Semi-Private Room or Private Room)

To earn a 5-Star Rating, the product must meet the criteria below.

Room Type10Life Medical Coverage ScoreMedical Inflation Protection
Ward≥ 9.95
Semi-Private≥ 9.95
Private≥ 9.95


Updated on 13 Jan, 2022


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