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1. Scoring Methodology at a Glance
Medical insurance mainly covers hospitalisation expenses, and the policy is usually renewed on an annual basis. Some medical insurance products have maximum coverage limits on certain medical expense categories, while some offer “full coverage” on individual medial expense categories (subject to the costs being reasonable and customary) with an overall annual and a life time limit.
Many consumers worry that in an unfortunate event of requiring hospitalisation at a private hospital, how much of the hospital bill their medical insurance can cover, and how much they would need to pay out of pocket. Due to the complicated structure of medical insurance products, including inner benefit limits and/or exclusions on various medical expense items, an average consumer may not be able to estimate the amount of coverage.
In order to compare the coverage of different medical insurance products, 10Life selected a number of common hospitalisation cases with different severity levels and required medical services, and consulted with a number of medical specialists on the estimated medical expenses under general circumstances. Using these assumptions, our actuaries calculated the estimated average coverage of each mass market medical insurance product to arrive at the product comparison and scores. The coverage is based on non-network doctor usage as the doctors available for each insurance panel can differ significantly.
10Life compares the medical insurance products in the market based on two main factors:
- 10Life Medical Coverage Score – based on the coverage ratios on selected hospitalisation cases with different severity levels
- Medical Inflation Protection – product features that help protect against medical inflation
Other factors such as underwriting process, ease of claims, and your individual needs, have not been considered.
2. Assumptions
Insured is non-smoker, hospitalisation in Hong Kong private hospitals.
Note: The premium table shows the current prices at different ages, i.e adult or child, which do not represent prices in the future, which may increase significantly due to medical inflation.
3. 10Life 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
| Category | Case Details |
| Cancer | Breast Cancer with Mastectomy, Reconstruction, Chemotherapy & Radiotherapy Lung Cancer with Lobectomy Liver Cancer with Surgery and Targeted Therapy Colon Cancer with Surgery and Chemotherapy |
| Injuries | 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) |
| Cases | Estimated Medical Cost (HKD) | ||
| Ward Room | Semi-private Room | Private Room | |
| Breast Cancer with Mastectomy, Reconstruction, Hemotherapy & Radiotherapy | 799,978 | 949,037 | 1,240,755 |
| Lung Cancer with Lobectomy of Lungs | 275,158 | 417,737 | 691,695 |
| Colon Cancer with Surgery & Chemotherapy | 348,984 | 470,076 | 697,860 |
| Liver Cancer Requiring Surgery & Targeted Therapy | 482,700 | 600,650 | 830,150 |
| Common Injury - Anterior Cruciate Ligament Surgery | 106,900 | 158,650 | 259,750 |
| Severe Injury - Total Knee Replacement | 196,200 | 294,700 | 486,900 |
| Heart Disease - Angioplasty | 217,813 | 326,120 | 541,133 |
| Stroke | 95,600 | 123,100 | 174,100 |
| Kidney Dialysis – Day Case | 316,000 | 316,000 | 316,000 |
| URTI - Fever Requiting Hospitalisation | 21,600 | 33,100 | 53,700 |
| Hemorrhoid Surgery | 45,600 | 68,600 | 113,000 |
| Colonoscopy -Day Case | 18,100 | 26,350 | 42,850 |
Note: 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
4.
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 criteria are met.
- 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)
- High Annual Limit
- Ward: ≥ $5,000,000
- Semi-private: ≥ $8,000,000
- Private: ≥ $20,000,000
- 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 ($80,000 or above per life) |
| Pregnancy Complications Coverage ($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 Ratings
| Room Type | 10Life Medical Coverage Score | Medical Inflation Protection |
| Ward | ≥ 9.95 | ✓ |
| Semi-Private | ≥ 9.95 | ✓ |
| Private | ≥ 9.95 | ✓ |
