Is Maxing Out Health Insurance Coverage Always Better?

If you’re thinking about getting health insurance, the first thing that probably comes to mind is the coverage limit. You might be asking yourself, ‘Is this enough?’ or ‘Should I go for a higher amount?’

Before comparing the total coverage amounts of policies, it’s smart to first understand what health insurance actually covers. After all, a higher annual or lifetime limit doesn’t always mean you’ll get 100% reimbursement. In fact, plans with bigger coverage often come with steeper premiums, so your ability to handle those costs long-term should be the top priority.

Right now, most health insurance plans on the market reimburse eligible medical expenses on a real basis. Take VHIS Flexible Plan products as an example—their coverage typically includes:

For general medical insurance that has Sub-limits , policyholders must clearly understand the content, coverage amounts, and limitations (such as the number of claims) of each coverage item, as well as whether the medical insurance plan includes Supplementary Major Medical (SMM) , so they can select a plan that fits their needs and achieve a higher claim payout rate when it’s time to make a claim.

As mentioned earlier, beyond the annual and lifetime limits, standard medical insurance policies often set independent sub-limits for each coverage item , such as the Bowtie VHIS Standard , Bowtie VHIS Flexi Regular , and Bowtie VHIS Flexi Plus .

However, some market plans don’t have sub-limits, offer full reimbursement, include deductibles (excess fees) , and have higher annual and lifetime limits—these are generally known as high-end medical insurance.

For example, with Bowtie, Bowtie Pink is our high-end medical insurance product. The following table outlines the differences in coverage for our various medical insurance plans:

High-end medical insurance often comes with coverage exceeding tens of millions, making it seem incredibly comprehensive. So, is opting for high-end medical insurance always the smartest move? Not necessarily. In fact, choosing medical insurance is a lot like picking out clothes—the key is finding something that fits you just right, which is what Bowtie always emphasizes— Just Fit concept.

Of course, if cost weren’t a factor, everyone would want the highest level of coverage. But in reality, the more protection you get, the higher the premiums you’ll pay. Achieving that top-tier coverage with high-end medical insurance means shelling out more for your premiums.

Keep in mind that medical coverage is essential for everyone from newborns to seniors in their 70s or 80s, and the risk of illness or injury tends to rise with age. So, it’s wise not to chase the highest coverage blindly. Instead, base your choice on your financial situation and pick a plan with premiums you can comfortably afford long-term. This way, you avoid the risk of having to cancel or lapse your policy due to money troubles, which could leave you or your family in a coverage gap.

Some might think it’s no big deal to go without coverage temporarily and just get a new policy when finances improve, but watch out—down the line, insurers might reject you based on your medical history or health changes. Even if you’re lucky enough to get approved, you could face extra premiums (Loading) or end up with exclusions in your policy.

Plus, high-end medical insurance often includes deductibles, so it’s smart to pair it with other existing policies, like group plans from your employer. If you don’t have any medical insurance at all, going for a non-high-end VHIS Flexi Plan could be a savvy and budget-friendly option. Take Bowtie’s VHIS Flexi Plan series, for example—it boasts an actual claims payout rate of up to 90% (as of November 2022), with basic monthly premiums starting at just HK$218 for a 30-year-old non-smoking male.

So, how much medical coverage is actually enough? And how do you figure out what you need? You can use this simple formula as a guide:

Personal Required Coverage (Basic Medical Expense Estimate)

＝ Diagnostic Tests (Specified Diagnostic Imaging)

＋ Hospitalization Costs (Room and Board + Attending Doctor Fees + Specialist Fees + In-Hospital Miscellaneous Fees)

＋ Surgery Costs (Surgeon Fees + Anesthetist Fees + Operating Room Fees)

If you’re unsure about the market rates for these medical expenses, check out the current fees at major private hospitals in Hong Kong here , along with Bowtie’s real claim data below:

Moreover, Bowtie has also launched Personalized Insurance Recommendation Tool , making it easy for you to get an actuary’s opinion before purchasing insurance.

1. If you’re unsure how to select the coverage amount or different medical insurance plans, simply choose ‘Start Analysis’ in the leftmost box.

2. Select ‘Medical Insurance – How to Choose the Right Plan’ , then answer a few simple questions as prompted.

3. Next, select your ‘Gender’ , ‘Age’ , and ‘Smoking Habits’ , and the system will provide overall medical protection recommendations.

4. The system will also explain the reasons behind the recommendations