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<Prudent Strategies in Taking Out Medical Insurance> pdf (Chinese Version only)

Frequently Asked Questions

Why do you have to take out medical insurance?

The function of medical insurance is to reduce the policyholder’s financial burden to pay for the medical expense in case of sickness or injury resulting from accident.  There is no saving element in medical insurance and no  investment return.

How to claim for the difference in medical expenses which exceed the policy coverage?

Generally, two situations will happen:

1. Most employers provide group medical insurance for their employees.  They will be given healthcare cards for doctor consultation to get the level of medical cover according to the terms agreed between their employers and insurers.  However, the cover provided under group medical insurance may be insufficient.  Employees have to pay for the difference if their medical expenses exceed the reimbursement limit in the group medical policy.  As such, Some employees will take out an additional individual medical insurance.  In the event of any claim exceeds the maximum limit of one of the policies, the difference can be recovered from the other policy.  This will minimize the medical expenses borne by the employee.
2. If a policyholder takes out more than one medical policy and the cover of one policy is insufficient to pay for the actual medical expense incurred, he can claim the balance from the other policy.  He must request the original receipt from the first insurer who will, after the claim process is completed, state at the back of the receipt the claim amount paid by its company.  The policyholder can base on the returned receipt to claim for the balance from the second insurer.

What to watch out for after receipt of the policy?

Though a policy has a lot of fine prints, certain terminologies may have  meaning different from how they are normally used.  Immediately upon receipt of the policy, a policyholder should carefully study its terms and conditions, including the scope of coverage and the excluded items in order to protect his insured interest and avoid unnecessary misunderstanding.

More policies mean more compensation?

The principle of medical insurance policy is to indemnify a policyholder for the actual amount incurred.  Regardless of how many policies a policyholder has taken out, indemnity will be made according to the actual total amount incurred.  Since there is usually an indemnity limit in each policy, a policyholder can claim the balance from the other policy if the protection amount in one policy is not sufficient to cover the actual expenses.  As such, a policyholder should assess his actual needs to decide whether he needs another or more medical policies.

What can a policyholder do if he is dissatisfied with the compensation amount?

A policyholder can lodge a complaint with either one of the following mechanisms:

• appeal to the insurer concerned to request for review of the decision on indemnity amount;
• Insurance Claims Complaint Bureau – only deals with individual insurance policies of residents in Hong Kong, with total claim amount not to exceed HK$800,000 and the complaint is filed within six months from the date of receipt of the result on the indemnity;
• Small Claims Tribunal mainly handles claims under HK$50,000 lodged by consumers; and
• Other legal means – engaging a lawyer to bring your case to court.