Medical Insurance Scoring Methodology

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.

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  
• 2019 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 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). 

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.

Special Feature Score covers different types of additional features and special coverage, including (1) factors relating to medical inflation protection, (2) factors relating to additional coverage, (3) factors relating to hassle-free arrangement, and (4) factors relating to wellness and others.

5.1 Factors relating to medical inflation protection

• No itemised sublimit – i.e. no maximum coverage limits on most individual medical expense categories (subject to the costs being reasonable and customary)
• High Annual Limit 
  • Ward: ≥ HKD 5,000,000
  • Semi-private: ≥ HKD 8,000,000
  • Private: ≥ HKD 20,000,000
• No lifetime limit
• Guaranteed that benefits would not be reduced upon renewal (i.e. all VHIS products)

10Life values whether a medical plan can provide protection against medical inflation, such that medical inflation protection is one of the criteria of 10Life 5-Star Ratings.

10Life definition of “Medical Inflation Protection” is as follows:-

• No itemised sublimit
• High Annual Limit
• No lifetime limit or Guaranteed that benefits would not be reduced upon renewal

5.2 Factors relating to additional coverage

• Hospital cash (private hospital under current room class)
• 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)
• Deductible waiver on designated critical illnesses
• Second claim cash allowance

5.3 Factors relating to hassle-free arrangement

• Cashless arrangement
• Second medical opinion service
• International assistance service

5.4 Factors relating to wellness and others

• Free body check entitlement
• Availability of no-claim bonus
• Availability of e-claim

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.

Updated on 1 Jan, 2024