Standard Plan VS Flexi Plan
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.
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.
- Guaranteed renewal until the policyholder is 100 years old
- No lifetime benefit limit should be added
- Terms and conditions should be clearly stated to reduce disputes
- Must provide premiums rate by age
- Must provide a reasonable preliminary estimate of compensation
- Cover inpatient and day case procedure
- Cover unknown pre-existing conditions
- Coverage for Prescribed diagnostic imaging tests, Psychiatric inpatient treatments in local hospitals, and Prescribed non-surgical cancer treatments
- Must not ask the policyholders to share the medical expenses, except for diagnostic imaging tests
- 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 Item1 | Benefit Limits |
| Room and board | HK$750 per day Maximum 180 days per policy year |
| Miscellaneous | HK$14,000 per policy year |
| Attending doctor’s visit fee | HK$750 per day Maximum 180 days per policy year |
| Specialist’s fee2 | HK$4,300 per policy year |
| Intensive Care | HK$3,500 per day Maximum 25 days per policy year |
| Surgeon’s fee | Classification of surgical procedures according to the surgical fee schedule
|
| Anaesthetist’s fee | 35% of Fees for Surgeons |
| Operating theatre charges | 35% of Fees for Surgeons |
| Prescribed Diagnostic Imaging Tests2,3 | HK$20,000 per policy year Co-insurance of 30% |
| Prescribed non-surgical cancer treatment4 | HK$80,000 per policy year |
| Pre- and post-Confinement/Day Case Procedure outpatient care2 | HK$580 per visit HK$3,000 per policy year 1 prior and 3 follow-up outpatient visits |
| Psychiatric treatments | HK$30,000 per policy year |
| Other | |
| Annual benefit limit for the above items | HK$420,000 |
| Lifetime benefit limit for the above items | None |
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.
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.
| Age | Bowtie | Average Annual Premiums of all plans on the market^ |
| 10 | HK$1,020 | HK$1,697 |
| 20 | HK$1,116 | HK$1,812 |
| 30 | HK$1,476 | HK$2,224 |
| 40 | HK$2,052 | HK$3,006 |
| 50 | HK$3,216 | HK$4,615 |
| 60 | HK$5,268 | HK$7,946 |
| Age | Bowtie | Average Annual Premiums of all plans on the market^ |
| 10 | HK$1,008 | HK$1,673 |
| 20 | HK$1,308 | HK$1,983 |
| 30 | HK$1,872 | HK$1,983 |
| 40 | HK$2,520 | HK$3,755 |
| 50 | HK$3,828 | HK$5,393 |
| 60 | HK$5,064 | HK$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.
