Does VHIS cover traditional chinese medicine treatment? 4 key tips before claiming
Does VHIS Coverage Include Traditional Chinese Medicine Treatments?
All “Standard Plans” Do Not Provide Coverage
Those who have some knowledge of voluntary health insurance likely know that the Bowtie VHIS Standard offered by different insurance companies has largely the same coverage, essentially serving as the industry’s unified minimum standard. Under this minimum standard, Traditional Chinese Medicine (TCM) treatments are not covered . But why is that?
As reported by local media in 2021, Mr. Li Chi-chung , the then Director of the Voluntary Health Insurance Scheme at the Food and Health Bureau, explained during a Legislative Council meeting on health affairs that services like TCM outpatient consultations and acupuncture are not considered core services. The scheme primarily covers inpatient medical services to alleviate pressure on the public healthcare system. This explanation partly clarifies why expenses related to traditional TCM treatments are excluded from the “Standard Plan” coverage.
For “Standard Plan” policies, traditional TCM treatments include, but are not limited to:
- Herbal medicine treatment
- Injury treatment (e.g., for sprains or fractures)
- Acupuncture
- Acupressure
- Tuina massage
- Alternative therapies, such as hypnotherapy, qigong, massage therapy, aromatherapy, naturopathy, hydrotherapy, homeopathy, and similar treatments
Some “Flexi Plans” Offer Coverage
Although the Bowtie VHIS Standard does not cover TCM treatments, the growing popularity of TCM in Hong Kong is undeniable. To meet market demands, some insurance companies have added extra coverage for TCM treatments to their “Standard Plan” basics. For instance, they include TCM outpatient services, acupuncture, and orthopedic treatments in their Bowtie VHIS Flexi products.
However, even if you choose a “Flexi Plan” that includes TCM coverage, it’s essential to thoroughly understand the policy’s terms for TCM before purchasing to avoid disputes during claims. Below, we’ve outlined some common considerations for TCM insurance claims.
4 Key Considerations for TCM Insurance Claims
Must Be Provided by a Registered TCM Practitioner
Regardless of whether it’s a VHIS product, most medical insurance policies only accept prescriptions and receipts issued by registered TCM practitioners as valid claim documents. TCM treatments in Hong Kong vary widely, including common services like outpatient consultations, acupuncture, and injury treatment, as well as tuina, cupping, scraping, bone-setting, spinal adjustment, and massage—these may not all be provided by registered practitioners.
If you want to successfully claim for TCM treatment costs, remember to verify that the practitioner is registered. Besides checking the registration number and practice certificate displayed at the clinic, you can also use the Registered TCM Practitioners List on the Chinese Medicine Council of Hong Kong’s website to confirm the provider’s qualifications.
Understand the Coverage Scope
In addition to the practitioner’s qualifications, your claim must align with the policy’s specified coverage for TCM treatments. As mentioned, TCM treatments come in many forms and items; for example, even for a sprain from an accident, options could include injury treatment, acupuncture, internal and external herbal medicines, or various alternative therapies. Therefore, it’s crucial to clearly understand the claimable items listed in your policy.
Keep in mind that even if the treatment type meets policy requirements, the purpose of the treatment matters. For instance, is TCM outpatient consultation for preventive or regulatory purposes, or for treating common colds and flu, covered under your policy? You must review the policy details before making a claim.
Understand Coverage Limits and Restrictions
Policies that cover TCM treatments typically specify limits and restrictions, which may include but are not limited to:
- Annual maximum claim amount for TCM consultations
- Annual limit on the number of sessions for various TCM treatments (e.g., outpatient or orthopedic)
- Maximum claim amount per TCM consultation
- Daily maximum number of TCM consultation sessions
- Specific time periods or number of sessions for TCM consultations before or after surgery or hospitalization
To successfully claim TCM treatment expenses, always ensure you do not exceed the specified limits or violate any restrictions.
Properly Retain Receipts and Herbal Prescription Forms
The herbal prescription forms and receipts issued by registered TCM practitioners are key documents for determining the success of a claim. Therefore, if you plan to claim, you must obtain them from the practitioner or clinic after your consultation.
- The herbal prescription form should clearly list the medications prescribed, including their names, usage, and dosage
- The receipt should detail the diagnosis results and fee breakdown for that consultation
- Both the prescription form and receipt should include the practitioner’s name, registration number, clinic stamp, and signature or stamp
After obtaining these documents, patients should keep them safe for submission to the insurance company during the claims process.
Bowtie Cancer Protection Provides Traditional Chinese Medicine Treatment Coverage
Although currently Bowtie voluntary medical insurance products do not cover the medical expenses for Traditional Chinese Medicine treatment, Bowtie Cancer Protection provides coverage for cancer-related Traditional Chinese Medicine treatments (including herbal medicine and acupuncture), with the following coverage limits:
- Limit: 45 sessions ~
- Maximum compensation per session: $750
- Once per day
Bowtie Cancer Protection covers all levels of malignant cancer and carcinoma in situ ^ , from diagnosis, monitoring checks, surgery, treatment to medication expenses * (including targeted drugs and immunotherapy), with broad coverage and no deductible required * .
If unfortunately diagnosed with cancer for the first time, the $1 million cancer treatment coverage amount will be immediately activated. This $1 million cancer treatment coverage amount will be reset every 3 years after the first activation to cover cancer recurrence or other cancer diagnoses, until the lifetime coverage limit is reached.
The product offers three lifetime coverage limit options: $1 million, $2 million, or $3 million, allowing comprehensive coverage for cancer recovery monitoring (up to 5 years after active treatment), recurrence, and other cancer diagnoses.
- ~The limit is shared with coverage for nutritionist consultations, physiotherapy, occupational therapy, speech therapy, psychological counseling, and medications.
- ^Bowtie Cancer Protection covers all levels of malignant cancer and carcinoma in situ, but does not include precancerous conditions, CIN I or CIN II cervical abnormalities, or all cancers associated with HIV infection.
- *Applies to standard semi-private rooms or lower levels; if the insured chooses a standard private room or higher level during hospitalization, we will only reimburse a specified percentage of the related hospitalization expenses.
