VHIS Medical Insurance Coverage & Benefits
According to the rules set by the Health Bureau, the terms and coverage of the “Standard Plan” are standardized with a few minimum requirements, while the “Flexi Plan” can provide additional coverage on top of the basic protection of the “Standard Plan” to meet market demands.
Benefit Amount of Different Plans
According to the Health Bureau, the annual benefit amount for all Voluntary Health Insurance Scheme (VHIS) must be HK$420,000 or above.
From room type, coverage amount limits to additional coverage, the table below briefly introduces you to the general differences of different VHIS plans.
We are using Bowtie’s VHIS plans as example:
| Ward Level | Annual/ Lifetime Benefit Limit | Annual Supplementary Major Medical (SMM)* | |
| Standard Plan | Standard Ward | HK$420,000 | Not applicable |
| Flexi Plan（Regular） | HK$600,000 | HK$120,000 | |
| Bowtie Pink (Ward) | Annual – HK$8,000,000 Lifetime – HK$40,000,000 | Not applicable (as it is a full-covered plan) | |
| Flexi Plan（Plus） | Semi-Private | HK$100,000 | HK$220,000 |
| Bowtie Pink (Semi Private) | Annual – HK$10,000,000 Lifetime – HK$50,000,000 | Not applicable (as it is a full-covered plan) | |
| Bowtie Pink (Private) | Private | Annual – HK$20,000,000 Lifetime – HK$80,000,000 | Not applicable (as it is a full-covered plan) |
- *with 20% Co-Insurance
As you can see, Bowtie VHIS Standard meets the required coverage amount, while VHIS Flexi Plan provides higher benefits with additional Supplementary Major Medical (SMM).
Bowtie Pink is a high-end plan that provides a higher annual of HK$10 millions and a lifetime benefit limit of HK$50 millions. It also provides full-covered protection to most of the benefit items, including surgeon’s fees, intensive care, specified diagnostic imaging tests, and specified non-surgical cancer treatments. Bowtie Pink can certainly cater the needs of various people with different budgets.
What is “Supplementary Major Medical” (SMM)?
SMM refers to the additional medical coverage that compensates for medical expenses beyond the eligible coverage limit of the basic protection items.
The 12 Required Basic Benefit Items
Regardless of providing a “Standard Plan” or “Flexi Plan”, insurance companies have to follow the requirements set by the Health bureau and provide at least 12 basic benefit items to the VHIS customers.
Beyond the basic protection, they also have the choice to provide additional protection:
| VHIS Coverage & Benefits | |
| Basic Protection | Additional Protection |
|
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Additional Benefit Items
Not limited to adding extra benefit items, VHIS Flexi Plan also supports the expansion of benefit limits for individual items, annual benefit limits, and geographical restrictions for protection, etc.
Using Bowtie VHIS Flexi as an example, apart from the 12 basic benefit items, we offer 11 additional coverages. Meanwhile, Bowtie Pink provides a even higher benefit limit with full-covered protection for some of the following items:
| Flexi Plan | Bowtie Pink ( Ward/ Semi-Private / Private) | |
| Supplementary Major Medical（SMM） | HK$120,000 / HK$220,000（per year）* | Not applicable (as it is a full coverage plan) |
| Accidental Emergency Outpatient Treatments | HK$8,000（per year） | Full coverage4 |
| Post-confinement / Day case procedure daily home nursing^3 | HK$500 / HK$800（per day）^ | HK$1,300 / HK$1,600 / HK$2,000（per day）^ |
| Rehabilitative care^3 | HK$750 / HK$1,500（per day）# | HK2,200 / HK2,500 / HK$3,000（per day）# |
| Outpatient kidney dialysis^3 | HK$50,000 / HK$100,000（per year） | Full coverage4 |
| Hospital companion bed | HK$350 / HK$800（per day） | Full coverage4 |
| Hospice and palliative care benefit^3 | HK$20,000 / HK$40,000 （per year） | HK$100,000 / HK$100,000 / HK$120,000（per year） |
| Day case procedure cash benefit | HK$800 / HK$1,300 （per surgical procedure） | HK$1300（per surgical procedure） |
| Special bonus | HK$400 / HK$600（per day）1 | HK$600（per day）1 |
| Medical negligence benefit | HK$1,000,000 | HK$1,000,000 |
| Total and permanent incapacity income benefi* | HK$500 / HK$800（per week）2 | HK$800（per week）2 |
- *20% of co-insurance.
- ^Hospitalization benefits limited to 180 days after discharge.
- #Annual maximum coverage limit of HK$10,000/HK$20,000/HK$34,000/HK$40,000 only applies if the patient is discharged within 90 days.
- 1Maximum of 90 days per year
- 2Total of 52 weeks of compensation
- 3We may require written proof of referral, such as a transfer letter or a statement from the attending or registered doctor, when you submit a claim.
- 4The 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. For details, please refer to Section 1(b), 1(c) of the Supplement No. 1 and Section 6.4 of the Terms and Conditions.
