Co-insurance & Copayment

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Co-insurance & Copayment

When purchasing insurance, in addition to paying attention to the benefit items and limit in the policy, it is important to also consider whether there is co-insurance and its percentage. So what is co-insurance, and what is the typical percentage for it? Which benefit items in the VHIS include co-insurance? Let's find out!

Co-insurance/ co-pay (similar to deductibles), refers to the portion of medical expenses that the insured is required to pay out of pocket when making a claim. This amount is shared between the insured and the insurance company. Co-insurance can help reduce insurance premiums over the long term.

The difference between co-insurance, co-pay, and deductible

Co-insurance, co-pay, and deductible are all costs that the insured must share with the insurance company and pay out of pocket. The differences between them are as follows:

CoinsuranceCopaysDeductibles
Calculation Methoda percentage of individual medical expenses of a benefit itema fixed amount of individual benefit itemthe amount that the insured must pay out of pocket before the insurance company provides any compensation.

The amount can be calculated on an annual or per-illness/injury basis depending on the plan

Hypothetic Policy TermsCo-insurance: 20%Co-pay: HK$20Deductible: HK$20,000
Example
  1. Medical expenses incurred: HK$120,000
  2. Your co-insurance payment: HK$120,000 x 20% = HK$24,000
  3. The insurance company will compensate the remaining amount of HK$96,000
Regardless of the total amount on the bill, your co-pay is HK$20 and should be paid directly to the medical service provider. The rest will be covered by the insurance company.
  1. Surgical expenses incurred: HK$15,000
  2. Assuming an annual deductible of HK$20,000
  3. The insurance company will not provide compensation for this surgery.
  4. There is HK$5,000 remaining deductible 
  5. If you make another claim in the same policy year, The compensation amount will be reduced by the remaining deductible of HK$5,000 or any other remaining amount, and will be subject to the benefi limit specified in the policy.
  • Note: The above examples are for illustration purposes only and the final compensation amount will be subject to the specific policy terms and benefit limits.

What is the percentage for co-insurance?

The percentage for co-insurance in general ranges from 5% to 30% on the market. The benefit items that may have co-insurance include “Supplementary Major Medical (SMM)”, “Prescribed Diagnostic Imaging Tests”, “Specialist’s fee”, and so on.

Which benefit items in VHIS have co-insurance?

There are two benefit items in VHIS that have co-insurance:

  1. Prescribed Diagnostic Imaging Tests: Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET). The policyholder needs to share 30% of the co-insurance cost.

Assuming Ms. Chan undergoes a lumbar spine CT scan at Hong Kong Gleneagles Hospital, and she is an insured person of Bowtie VHIS, let’s see how it provides coverage for her.

VHIS StandardVHIS Flexi RegularVHIS Flexi Plus
Expenses for the TestHK$8,040
Benefit LimitHK$20k/ yearHK$26k/ yearHK$40/ year
Co-insurance30%
Out-of-pocket feeHK$8,040 x 30% = HK$2,412
Coverage provided by BowtieHK$8,040 x 70% = HK$5,628
Benefit limit left after the claim (= benefit limit for the next similar claim)HK$20k – HK$5,628 = HK$14,372HK$26k – HK$5,628

= HK$20,372

HK$40,000 – HK$5,628 = HK$34,372
Learn moreLearn more

High-end VHIS like Bowtie Pink provides full coverage with deductible options, so they do not have co-insurance.

  1. Supplementary Major Medical (SMM) : this benefit from Bowtie VHIS Flexi requires the insured person to share 20% of the co-insurance cost. SMM refers to the coverage for medical expenses that exceed the benefit limit of eligible benefit items. 

 

Similarly, high-end VHIS such as Bowtie Pink provides full coverage, so they do not have SMM coverage.

Full coverage medical insurance plans are not necessarily expensive, with premiums starting from HK$186^ per month. Apply now!

  • ^Assuming a 30-year man buying Bowtie Pink (Ward) - $80k deductibles plan as example

FAQ about Co-insurance

1. Why do insurance companies set up co-insurance?

“Co-insurance” is a mechanism for the insured person and insurance companies to share costs and risks, with the aim of reducing the occurrence of abusive claims, and ultimately effectively reducing the insurance premium paid by policyholders.

What impact do abusive claims have on insured persons? All premiums paid are included in the fund pool of the insurance plan, from which the insurance company withdraws funds to pay for each claim case. The more abusive claims, the fund pool becomes “tighter”, hence increasing the chance of an overall premium increase.

2. How to reduce co-insurance expenses?

There are three ways to reduce co-insurance expenses:

  1. You can claim from Group Medical Insurance at the same time to reduce co-insurance expenses. 

For example, Ms. Chan is an insured person of Bowtie VHIS Flexi Plan Regular and Group Medical Insurance Pro Gold, and she can claim from both (VHIS first, followed by the group medical insurance).

  1. Alternatively, you can choose to purchase high-end VHIS as they do not have co-insurance. Although the plan has a deductible, an insured person can still use group medical insurance to offset the expense.
  2. If you do not have Group medical insurance, Bowtie insured person can also use “BowtieCash” to pay for reasonable medical expenses that exceed the benefit limit.
  • *The Bowtie Pink Voluntary Health Insurance series fully covers eligible medical expenses such as diagnosis, hospitalisation, surgery, and prescribed non-surgical cancer treatments (except in the United States), and is subject to annual benefit limits and lifetime benefit limits. If the claim involves confinement in a Mainland China Hospital unlisted in / a High-end Mainland China Hospital listed in the "List of Designated Hospitals in Mainland China" / confinement in a room higher than the restricted ward class / a pre-existing condition, the relevant benefit payable may be adjusted.
  • Note:Any content related to Bowtie products in this article is for reference and educational purposes only. Customers should refer to the detailed terms and conditions on the relevant product webpage.
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