Standard Plan VS Flexi Plan

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Standard Plan VS Flexi Plan

The Voluntary Health Insurance Scheme (VHIS) has been launched for over 3 years. There are two recognized types of plans - the Standard Plan and the Flexi Plan. What are the differences between these two plans in terms of coverage and premiums? To help everyone better understand these two plans and make smarter choices, Bowtie will explain them in a simple way!

How many Standard and Flexi Plans are available on the market?

According to the Health Bureau, the VHIS sets the framework and rules for insurance companies to offer two types of insurance products: the Standard and the Flexi Plan.

As of Jun 30, 2023, there are 88 recognized Standard Plans and Flexi Plans offered by different insurance companies on the market, providing 409 products for customers.

The names of the plans are not fixed and can be changed by insurance companies for promotional purposes. For example, Bowtie’s Standard Plan is named “Bowtie VHIS Standard“, while its Flexi Plan includes “Bowtie VHIS Flexi Regular/ Plus” and “Bowtie Pink (Ward/ Semi-Private /Private)”.

Before looking into the detailed differences between the two plans, you could understand the Flexi Plan as an upgraded version of the Standard Plan.

Before learning the difference, you may treat Flexi plan as an upgrade of Standard Plan

What are the differences in coverage?

In order to get the recognition of the Health Bureau, all Standard plans must follow the stated-out terms, and provide 10 minimum coverage.

And The Flexi Plans must at least provide what Standard plans provide, while insurance companies can provide additional coverage to meet market demands as long as they comply with the rules set by the Health Bureau.

Requirements set by the Health Bureau. All plans must fulfill below requirements:
  1. Guaranteed renewal until the policyholder is 100 years old
  2. No lifetime benefit limit should be added
  3. Terms and conditions should be clearly stated to reduce disputes
  4. Must provide premiums rate by age
  5. Must provide a reasonable preliminary estimate of compensation
  6. Cover inpatient and day case procedure 
  7. Cover unknown pre-existing conditions
  8. Coverage for Prescribed diagnostic imaging tests, Psychiatric inpatient treatments in local hospitals, and Prescribed non-surgical cancer treatments
  9. Must not ask the policyholders to share the medical expenses, except for diagnostic imaging tests
  10. The benefit limit for compensation items must be in line with the market, e.g., the maximum compensation for minor surgeries is HK$5,000

Benefit Items and Limits of the Standard Plan

All the VHIS Standard Plans should use the “policy template” provided by the Health Bureau, and provide the following coverage: 

Standard Plan
Benefit Item1Benefit Limits
Room and boardHK$750 per day

Maximum 180 days per policy year

MiscellaneousHK$14,000 per policy year
Attending doctor’s visit feeHK$750 per day

Maximum 180 days per policy year

Specialist’s fee2HK$4,300 per policy year
Intensive CareHK$3,500 per day

Maximum 25 days per policy year

Surgeon’s feeClassification of surgical procedures according to the surgical fee schedule

  • Complex HK$50,000/ session
  • Major HK$25,000/ session
  • Intermediate HK$12,500/ session
  • Minor HK$5,000/ session
Anaesthetist’s fee35% of Fees for Surgeons
Operating theatre charges35% of Fees for Surgeons
Prescribed Diagnostic Imaging Tests2,3HK$20,000 per policy year

Co-insurance of 30%

Prescribed non-surgical cancer treatment4HK$80,000 per policy year
Pre- and post-Confinement/Day Case Procedure outpatient care2HK$580 per visit

HK$3,000 per policy year

1 prior and 3 follow-up outpatient visits

Psychiatric treatmentsHK$30,000 per policy year
Other
Annual benefit limit for the above itemsHK$420,000
Lifetime benefit limit for the above itemsNone

Additional Benefit Items for the Standard Plan

addition to the above items, including:

  • Compassionate Death Benefit
  • Medical negligence benefit
  • Hospital Cash Benefit
  • Total and permanent incapacity income benefit
  • Accidental Death Benefit
  • Additional Death Benefit for Organ Donors
  • Second Claim Cash Allowance Benefit

For example, “Bowtie VHIS Standard” provides an additional coverage item of “Total and permanent incapacity income benefit” for the insured person.

  • 1 Qualified expenses for the same item cannot be reimbursed under more than one benefit item as listed above.
  • 2The company reserves the right to request supporting documentation for any written advice, such as referral letters or statements provided by the attending doctor or registered doctor in the claim application form.
  • 3 Diagnostic imaging tests only include CT Scan, MRI Scan, PET Scan, PET–CT combination, PET–MRI combination.
  • 4 Treatment only includes: Radiotherapy, chemotherapy, targeted therapy, immunotherapy, hormonal therapy.
  • 5 This percentage applies to the actual reimbursed amount for fees for surgeons or the benefit limit for fees for surgeons based on the classification of surgical procedures, whichever is lower.

Benefit Items and Limits of the Flexi Plan

The Health Bureau requires that the Flexi Plan provide the same basic coverage as the Standard Plan, but may offer additional coverage. Therefore, the benefit items and limits of each Flexi Plan can vary greatly.

For example, “Bowtie VHIS Flexible Regular/ Plus” do not only provides higher benefit limits for each benefit items than the “Standard Plan”, but also offers additional benefit items, including:

  • Accident and Emergency Outpatient Treatments
  • Outpatient kidney dialysis
  • Post-Confinement Daily Home Nursing
  • Rehabilitative care
  • Hospital Companion Bed
  • Hospice and Palliative Care Benefit
  • Day Case Procedure cash benefit
  • Special bonus
  • Medical negligence benefit
  • Total and permanent incapacity income benefit

Bowtie Pink” (which is a high-end VHIS) provides higher benefit limits than the Flexi Plan Regular/ Plus.

Compare Bowtie VHIS Plans

Premium Comparison

From the website of the Health Bureau, you can refer to the premiums of the “Standard Plan” and “Flexi Plan” of different insurance companies.

Premiums for the Standard Plan

Although the coverage provided by the “Standard Plan” is generally the same, the premiums may still differ because the Health Bureau does not regulate the pricing of VHIS.

If you are interested in buying a Standard Plan, you can simply choose the cheapest one. It is worth noting that insurance companies have the right to adjust premiums upon renewal, either by increasing or decreasing them, so consumers should be aware of this.

Standard Premiums Comparison of Non-smoker Male*
AgeBowtie Average Annual Premiums of all plans on the market^
10HK$1,020HK$1,697
20HK$1,116HK$1,812
30HK$1,476HK$2,224
40HK$2,052HK$3,006
50HK$3,216HK$4,615
60HK$5,268HK$7,946
Standard Premiums Comparison of Non-smoker Female*
AgeBowtie Average Annual Premiums of all plans on the market^
10HK$1,008HK$1,673
20HK$1,308HK$1,983
30HK$1,872HK$1,983
40HK$2,520HK$3,755
50HK$3,828HK$5,393
60HK$5,064HK$7,400
  • Note: The above prices are the standard premiums for non-smoking individuals of the VHIS Standard at that age, updated as of February 14, 2023, for reference only. For accurate quotes and product details, please consult each insurance company.
  • *The annual premium does not include, but is not limited to, premium levies collected by the Insurance Authority, premium differences that may arise from different payment methods (such as credit cards, cash), premium discounts, premium differences between smokers and non-smokers, and additional premiums due to higher health risks of the insured.
  • ^ Excludes premiums for policy riders.

Premiums for the Flexi Plan

As for the “Flex Plan”/”High-end VHIS”, the coverage of different plans can vary greatly, it is difficult to price them directly. You can visit the Health Bureau’s website and search for all “Flexi Plans” and check their premiums one by one.

Some companies (such as Bowtie) have premium calculators on their websites. You only need to select/input your gender, age, and smoking habits to find out the standard premium of the plan. 

Of course, the actual premium is also affected by the health condition of the insured. It is worth calculating the difference in premiums between buying a Standard Plan and a Flexi Plan.

High-end medical plan must be super expensive? Not really! If you buy it with deductibles smartly, it could be as cheap as Flexi plan!

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