Health Insurance

Ultimate Guide to Outpatient Insurance: Mind the Claim Restriction!

Outpatient insurance is a popular choice for children, students, and retired persons without group medical insurance. It helps to cover outpatient medical fees even for common cold and flu. If you are considering outpatient insurance, here is everything you need to know before purchasing.
Author Bowtie Team
Date 2021-06-21
Updated on 2021-06-21
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What is outpatient insurance? Coverage may exclude Chinese medicine?No underwriting necessary but not everyone is acceptedOut-of-pocket feesBe Aware of the Medical network and annual claim limitPremiums for outpatient insurance are usually higher than hospital insuranceVHIS covers some outpatient medical expenses

What is outpatient insurance? Coverage may exclude Chinese medicine?

Each insurance company defines outpatient insurance differently and the protection coverage can vary by a lot. Most outpatient insurances basically cover the consultation expenses of General Practitioners and Specialists with some extending coverage to include Chinese medicine practitioners, Physiotherapists, Chiropractors, and bone-setting. Some insurance plans even cover prescribed western medicine, x-rays, and laboratory tests, occupational and speech therapy, or day-case surgery expenses.

No underwriting necessary but not everyone is accepted

Age limit
Youngest accepted age 15 days to 18 years of age
Oldest accepted age 50 to 64 years of age
Renewal age 65 to 75 years of age / Lifetime

Outpatient insurances on the market don’t require underwriting and policyholders or insured persons are not required to declare their health conditions to be enrolled. However, age limits apply to outpatient insurance from as young as 15 days up to 64 years of age. Also, It does not guarantee lifetime renewal and renewal approval is case by case.

Out-of-pocket fees

Main medical services Out-of-pocket fees*
General Practitioner $0 – 50
Specialist $0 – 100
Physiotherapist $0 – 150
Chinese medicine practitioner $0 – 50
Bone-setting $0 – 50

Having outpatient insurance doesn’t mean you could enjoy free doctors’ consultation with a “medical card”. Some lower-end outpatient medical plans require policyholders to pay for part of the expenses such as registration fees or a fixed copayment fee. Thus, the western or Chinese prescribed medicine may be restricted to a limited number of days up to 5 days only, to prevent abuse. 

  • *Depends on the insurance company or plan level

Be Aware of the Medical network and annual claim limit

Most outpatient insurances cover the treatment expenses from within the medical network only and the size of the networks can vary from around 200 up to 2,000 medical services providers.

Some insurers limit the number of doctor’s visits per year such as a total of up to 20 to 40 claims across all benefit items. In some cases, limitations on benefit items are different. For example, most plans do not have a limit on the number of doctor’s visits for General Practitioners but the maximum number of visits for Chinese medicine practitioners is up to 10 only.

Premiums for outpatient insurance are usually higher than hospital insurance

Age Annual Premium
15 days to 5 years of age Outpatient insurance*: $2,676 – $8,016

Bowtie VHIS^: $1,476 – $2,040

6 to 60 years of age  Outpatient insurance*: $2,080 – $7,212

Bowtie VHIS^: $1,344 – $5,388

As outlined in the above table, premiums for outpatient insurance are not cheap. For a HK$0 deductible outpatient insurance plan, the annual premiums can cost up to HK$7,000. Compared to the annual premium for Bowtie VHIS Standard plan with an annual benefit limit of HK$420,000 for a 25-year-old non-smoking male that is only HK$1,332, it’s nearly HK$5,000 difference.

If you don’t have any medical insurance, it is recommended to start with hospital insurance. This is because hospitalization and surgery fees can cost a lot and hospital insurance or VHIS can lessen the financial burden from medical expenses.

  • *Depends on the insurance company or plan level
  • ^Bowtie VHIS Standard

VHIS covers some outpatient medical expenses

VHIS covers not only hospital and surgery fees but also some outpatient medical expenses such as ‘Day Case Procedure outpatient care’ and ‘Pre- and Post-Confinement outpatient care’. Bowtie Flexi (Regular) even covers “Accident Emergency outpatient treatments” and the premium for a 25-year-old non-smoking male is only HK$2,196.

Must premiums of outpatient insurance start from a few thousand per year? If you’re interested to find out if Bowtie will offer more affordable outpatient insurance plans in the future, leave us your contact details to receive our latest updates! 

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