Scoring Methodology of High-end Medical Insurance

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:

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

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.  

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

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). 

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)

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