Scoring Methodology of High-end Medical Insurance

Scoring Methodology of High-end Medical Insurance (Private Room)


1. Scoring Methodology at a Glance

Medical insurance mainly covers hospitalisation expenses, and the policy is renewed on an annual basis. People who prefer the best in class medical services in private hospitals can opt for private room plans. Some of these plans have maximum coverage limits on certain medical expense categories, while others offer “full coverage” on individual medical expense categories (subject to the costs being reasonable and customary) with an overall annual limit. . Some plans also offer a choice of geographical locations of hospitals covered, usually classified as Global, Global excluding US, and Asia Only.

10Life compares the medical insurance products (private room) in the market based on two main factors:

  • Medical Coverage Score – based on coverage ratios on selected hospitalisation cases
  • Auxiliary Benefit Score – based on additional benefits beyond the selected hospitalisation cases

Other factors such as underwriting process, ease of claims, and your individual needs, have not been considered.

2. Assumptions

Insured is either aged 35-44 adult or aged 0-12 child, non-smoker, hospitalisation in a private room of a Hong Kong private hospital.

Note: The premium table shows the current prices at different ages, which do not represent prices in the future, which may increase significantly due to medical inflation.  

3. Medical Coverage Score

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
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 hospitalistaion in a private room (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 scored 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). 



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. Auxiliary Benefit Score

In addition to the benefits compared in the selected medical cases, 10Life has compared other benefits in the plans and selected a list of distinguishable auxiliary benefits that can improve the overall coverage for the customer.

Included Auxiliary Benefits
High Annual Limit
No Lifetime Limit
Hospital Cash Benefits
Long Term Post Hospitalisation Outpatient Benefits
Second Medical Opinion Services
International Assistance Services
VHIS Certification
Special Cancer Treatment (immunotherapy, hormonotherapy, proton therapy and gamma knife)

5. Overall Medical Score (Private Room)
10Life Ratings for private medical insurance plan is based on estimated average coverage and auxiliary score. The score weighting in presented in the following table.

10Life Overall Medical Score (Private Room)
100%
Medical Coverage Score
80%
Auxiliary Benefits Score
20%

10Life Medical Star Rating (Private Room)
10Life Overall Medical Score (Private Room)
☆☆☆☆☆
≥9.0
☆☆☆☆
≥7.5
☆☆☆
≥6.4
N/A
<6.4

10Life strives to offer an unbiased scoring methodology to compare insurance products through data analyses and mathematical calculations, based on public information from insurers. 10Life scores are for reference only, and do not constitute any insurance sales advice. As everyone has different insurance needs and affordability levels, you should seek independent advice from licensed insurance advisors before purchasing any insurance products. 10Life may review the scoring methodology from time to time to improve the product comparisons. If you have any questions or suggestions on the methodology, please email us at enquiries@10Life.com.

Updated on 23 Mar, 2020 
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