VHIS Surgery List

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VHIS Surgery List

The VHIS surgical schedule contains numerous complex surgical terms. How to read them? Are the surgical schedule and coverage amounts standardized? How does the complexity of different surgeries affect the claim for surgeons, operating theartres, and anesthesiologists? The Bowtie team is here to break it down for you.

How to read the VHIS Surgical Procedures?

To help policyholders understand their coverage easily and clearly, the VHIS Surgical Procedures is categorized by different body systems and organs/surgeries. The coverage amount is then determined based on the complexity of the surgery.

The voluntary health insurance surgery table is divided into 13 body systems and 40 organs/surgeries, as detailed in the following table:

Abdominal and digestive system

Organs include:

  • Esophagus, stomach, and duodenum
  • Small intestine, ileum, and colon
  • Bile duct
  • Liver
  • Pancreas
  • Abdomen
Brain and central nervous system

Organs include:

  • Neurosurgery
  • Spine surgery
Cardiovascular system

Organs include:

  • Heart
  • Blood vessels
Endocrine system

Organs include:

  • Adrenal glands
  • Pineal gland
  • Pituitary gland
  • Thyroid gland
Ear, nose, and throat/respiratory system

Organs include:

  • Ear
  • Nose, mouth, and pharynx
  • Respiratory system
Eye

Organs include:

Eye

Female reproductive system

Organs include:

  • Cervix
  • Fallopian tubes and ovaries^
  • Uterus
  • Vagina
  • External genitalia and introitus
Blood and lymphatic system

Organs include:

  • Lymph nodes
  • Spleen
Male reproductive system

Organs include:

  • Prostate gland
  • Penis
  • Testes^
  • Vas deferens
Musculoskeletal system

Organs include:

  • Bones
  • Joints
  • Muscles and tendons
  • Fractures and dislocations
  • Spine
  • Other
Skin and breasts

Organs include:

  • Skin
  • Breasts
Urinary system

Organs include:

  • Kidneys
  • Bladder, ureters, and urethra
Dental

Organs include:

  • Dental
  • ^Unless otherwise specified, this category applies to one or both sides (fallopian tubes and ovaries/testes).

VHIS sets benefit amounts based on the complexity of the surgery

After categorizing surgeries/procedures by body system, organ, and surgery/procedure, the surgery table is further divided into four categories based on the complexity of the surgery/procedure to determine the coverage amount. 

For example, Bowtie VHIS plans provide different benefit limit for different surgeries.

The Benefit amount for surgeon fees (per session)

Flexi Regular Flexi PlusBowtie Pink (High-end VHIS)
MinorHK$6,000 / sessionHK$9,000/sessionFull Coverage*
IntermediateHK$15,000/ sessionHK$22,500/session
Major HK$30,000/ sessionHK$45,000/session
ComplexHK$60,000/ sessionHK$90,000/session
  • *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.

Does the complexity of surgery affect other benefit amounts?

The complexity of surgery also affects the coverage amount for the operating room and anesthesiologist fees. The more complex the surgery, the higher the coverage amount. 

Below are the benefit amounts for different VHI plans offered by Bowtie as a reference.The Benefit amount for operating theater and anesthesiologist fees (per operation)

Flexi Regular Flexi PlusBowtie Pink (High-end VHIS)
MinorHK$2,100 / sessionHK$3,200/sessionFull Coverage*
IntermediateHK$5,300 / sessionHK$7,900/session
Major HK$10,500 / sessionHK$15,800/session
ComplexHK$21,000 / sessionHK$31,500/session

Are the Surgical Procedures and benefit amount the same across all VHIS plans?

The surgical procedures and benefit amounts for all VHIS Standard plans are the same, and the benefit amounts represent the minimum benefit amount for all approved Flexi Plans. 

In other words, all insurance companies must provide coverage amounts that are the same or greater than those of the “standard plan”.

Most commonly claimed surgeries

The three most commonly claimed surgeries received by Bowtie are as follows, for reference.

SurgeryTotal Claimed AmountTotal Reimbursed AmountAverage Claimed AmountAverage Reimbursed AmountAverage Claim Rate
Cryotherapy, Electrocautery, or Laser Treatment for Skin WartsApproximately HK$257,000Approximately HK$ 240,000HK$ 5,262 HK$ 4,986 Approximately 95%
Gastroscopy (with or without biopsy and/or polypectomy) Approximately HK$ 126,000Approximately HK$ 118,000 HK$ 4,061HK$ 3,836 Approximately 94%
Colonoscopy (with or without biopsy and/or polypectomy) Approximately HK$ 98,000Approximately HK$ 84,000HK$ 5,790 HK$ 4,964Approximately 86%
  • Note: The above data is for 2020.
For just HKD 257 per month^, you can have a VHIS policy that provides full coverage. Get a quote now.

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