If your company already offers a health insurance plan, do you still need to buy VHIS?


Most office workers in Hong Kong enjoy their company-provided medical insurance. However, ever since the government started offering the Voluntary Health Insurance Scheme (VHIS), more and more people have become interested in buying a plan for themselves. You might question, if you already have group health insurance from work, is there a need to buy a VHIS plan? Today at Kwiksure, our expert insurance advisors will break down the differences between group and individual health insurance.

Corporate health insurance has limited cover

Different companies offer different health benefits. A number of businesses offer the same group health plan for all employees. Still, others provide differing levels of health benefits depending on the employee's job title or their position in the company hierarchy. 

Unfortunately, most SMEs (small and medium enterprises) in Hong Kong have limited resources. What's more, securing employee health insurance is not a legal requirement. Therefore, most plans merely provide the most basic outpatient and inpatient coverage. For example, when you catch a cold, you may visit your general physician for a low price or even for free. However, this comes attached with numerous terms and conditions. For instance, the compensation amount is limited per year, per claim filed, and there's a cap on the number of times you're allowed to file for claims. Also, your insurance company may only cover in-network doctors, specialists must hold a valid referral letter, and so on. 

What if you are seriously ill and need to be admitted to a hospital? Here, private hospitals charge around $750 to $1,200 per day for a large room. However, your corporate health benefits may be limited to around $400 to $600 only. What's more, most companies place limitations on each coverage item. In other words, there is a compensation limit set for each item. This may include room expenses, surgical expenses, miscellaneous expenses, and more (see the table below). In the end, employees still have to pay out-of-pocket.

An example of basic inpatient benefits

Main coverage items

Coverage limitations

Room stay and meals

$650 to $800 per day

Miscellaneous expenses

$10,000 to $15,000 per year

Surgery fees

$10,000 (minor surgery) to $45,000 (complex surgery) per injury/illness

Outpatient fees

$4,000 to $5,000 (limited by the compensation amount per visit and the number of visits)

You may lose all medical benefits if you're fired, in between jobs, or just recently began your retirement. Planning to buy a health plan after you've retired? The premium will be a lot higher. Besides, your insurance company might just reject your application based on your pre-existing conditions. Some group medical insurance policies let you switch to individual health insurance when you retire without having to reinstate your health insurance. However, there is no guarantee that you won't change jobs or that you can retire smoothly. Therefore, it is the best and safest option to secure an individual health insurance plan as soon as possible. 

Choose a VHIS plan with deductibles

Already enrolled in an employee health insurance plan? Consider buying a VHIS plan with deductibles. Also known as "excess", deductibles are the amount you're required to pay your insurer when filing for claims before your insurer covers the rest of your medical expenses according to the terms and conditions of your plan. 

For instance, if you purchase a health plan with a $5,000 deductible, and your total inpatient costs amount to $40,000, then you need to first pay $5,000. Then, your insurance company will pay for the leftover amount, which is $40,000 - $5,000 = $35,000.

You might ask, "why do I still have to pay out-of-pocket to file for a claim? Isn't that ridiculous?". In fact, deductible and your premium are interlinked. Generally, an insurance policy with a deductible is usually cheaper but provides a higher coverage cost/insured amount. This is because the policyholder is willing to be responsible for part of the loss. Also, they tend to want to avoid accidents, so that's why the higher the deductible is, the lower the premium.

To sum up, an insurance policy with deductibles is more suitable for those who already have other forms of protection (ex. corporate group health insurance) and still wants a plan with an even higher coverage amount. 

After purchasing both the corporate health plan and your individual health insurance, when you file for claims, you can use the group plan compensation to make up for your individual insurance's deductible. This gives you complete compensation. 

What you need to know when filing for claims for the group and individual health insurance

Planning to file for claims with your company's health plan and VHIS? Read on for two important tips!

Gather all of your claims documents to save time

First of all, the claim-filing process has a time limit. Usually, within 30 days of treatment or discharge, you must submit a claim form and other supporting documents. Since you're compensated by different insurance companies, remember to set aside enough time to avoid delays. Collect several claim forms and submit them to your attending doctor at once, together with the hospital receipt and diagnostic report. When filing your claim for the first time, remember to request a verified copy of the documents from your first insurer. This is so that you can claim from your second insurance company as soon as possible. Before your admission into the hospital, you can even inform the insurance consultant and let him follow up for you.

Lower your deductible when your group health insurance expires

Again, when you leave your job, you may lose the group medical insurance coverage. At that time, it's better to reduce the deductible for your medical insurance. Some health insurance policies allow you to change the deductible without having to re-underwrite. This is to avoid the impact of having to underwrite in the future when your physical condition deteriorates. You should pay attention to whether the VHIS plan provides relevant options before you even apply for cover. 

More useful insurance information

The sooner you purchase VHIS, the earlier you can enjoy your tax deductions. If you want the low-down for tax deduction, you can refer to our previous article VHIS Tax Deduction Strategy in 2020.

In addition to VHIS, Kwiksure also provides car insurance (third-party and comprehensive), motorcycle insurance, domestic helper insurance and other products. You can use our online quotation system to get a free quote. Want to chat with us? Contact our experienced insurance advisors for impartial advice that will help you to find the best insurance solution for your budget!