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Insurance 101: Family Health And Maternity Coverage In Hong Kong

family health and maternity insurance hong kong
ExpertsPost Category - ExpertsExpertsPregnancyPost Category - PregnancyPregnancy - Post Category - Doctors & HospitalsDoctors & Hospitals

How to protect your family’s health and wealth.

Choosing the right insurance plan for your family can be an intimidating decision. Most people have no idea about how insurance works; they find it more complicated than reading ancient texts! To help change that, we’ve created a handy guide to help you get started and understand your family health and maternity insurance options in Hong Kong a tad better. Here’s to saving you from financial strain and surprise health bills! Welcome to adulting 101…

A quick rundown of what we are covering here:

Why You Need Insurance
Is Employer-Sponsored Health Insurance Enough?
Understanding Insurance Terms
Questions To Ask Before Choosing An Insurance Policy
Where To Get Family Insurance
Pre-Existing Health Conditions: The Hot Debate
Other Basics About Insurance Coverage
Health Insurance for Pregnant Women
Understanding Maternity Insurance Terms
Top Maternity Insurance Providers in Hong Kong

Editor’s note: This article is to offer information only and is in no way meant to be taken as financial, investment or medical advice. Please read all offer documents carefully before making your insurance decision. 

Read more: Where To Get Women’s And Family Health Checks In Hong Kong

why you need insurance in hk

Why You Need Insurance

Hong Kong has a robust public healthcare system that takes care of its residents in emergencies; but when it comes to a health issue that does not require a trip to the ER, your wellbeing is better handled by private practitioners. A newborn struggling with eczema, a child’s earache, throbbing dental pain – these scenarios are not emergencies for a public hospital but need immediate tending to. Without solid medical insurance, the ballooning costs of private medical care can quickly cause a huge financial strain.

You might be fit as a fiddle and wade through decades without so much as an appointment with a doctor. Most years for the majority of people are like that. But diseases happen and emergencies strike. Like with everything else in life, it’s impossible to predict when an incident could bury you in spiralling medical costs. Therefore, as soon as you are independent and responsible for yourself (and your family), invest in a plan which gives you robust coverage.

We understand that it’s annoying to pay dollops of premium without a single healthcare bill when you’re single, young and healthy. That’s what I thought as well until 2013. That year, I sustained a gym injury. It took four months of intensive physiotherapy sessions to heal. I also landed myself with typhoid, pink eye and then, I also found myself pregnant. All I can say is thank heavens for insurance and decent maternity cover! So even if you are young, disease-free and in top shape, it’s impossible to predict your medical needs. The trade-off of paying premiums and having no medical costs in return is still worth it.

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Read more: Where To Buy Your Family’s Vitamins And Supplements In Hong Kong

employer sponsored insurance in hk

Is Employer-Sponsored Health Insurance Enough?

Most full-time working employees get fairly decent medical coverage for themselves, their kids and their spouse. Since this insurance is built into your contract, there’s usually no option of rejecting or changing it (unless you negotiate hard!) and you don’t put in the same due diligence you otherwise would have in case shopping for brand new coverage. Unfortunately, there are times when employer-sponsored health insurance is simply not enough and comes with problematic loopholes.

Take a weekend to study the fine print and weigh it against how much (predictable) medical aid you’ll need in the coming year. You can’t foresee broken bones, but are babies and elective surgery on the horizon? Find out your limit for hospitalisation and out-patient care. Are fertility procedures covered, and is your plan equipped with enough physiotherapy sessions if a gym injury were to happen?

If the plan leaves you and the family with a considerable amount of financial exposure, go for a safety net. Top up the employer’s insurance with another coverage.

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Read more: 5 Ways To Financially Prepare To Be A Parent In Hong Kong

planning insurance

Understanding Insurance Terms

Sassy Mama number peach 1Premium: The fixed amount you pay either monthly, quarterly or annually for your coverage. Whether you use healthcare services or not, premiums have to be paid to the insurance company. It’s illegal for an insurer to increase the premium amount in the midst of a contract. If you’re on a company-sponsored healthcare plan, the fee is either paid by the employer in full or split with the worker. Point to note: higher premiums don’t always mean foolproof coverage.

Sassy Mama number peach 2Coverage: Insurance coverage is the amount of risk or liability that is covered and varies according to the insurance provider. You’d want a plan that covers a little more than the basics, and one that gives you the best value for your investment.

Sassy Mama number peach 3Deductible: The pre-determined amount you agree to pay while you are covered by insurance. It means that for every medical bill, you pay your part first and then the insurer takes over the outstanding healthcare expenses. For example, if you’re visiting a panel doctor and the standard consultation fees is roughly $400, you pay $25 out of your pocket and the insurer takes care of the rest. This kind of arrangement is more predictable, transparent and usually more beneficial for high-ticket procedures, say an MRI or a biopsy, than if you had to pay a percentage (coinsurance).

Sassy Mama number peach 4Coinsurance: Another cost-sharing tool between you and the insurance company. Unlike a deductible, coinsurance or copayment is a pre-determined percentage an insured must pay against a claim – the amount will vary from bill to bill. If a policy offers coinsurance, the monthly premium will be lower.

In Hong Kong, coinsurance generally varies between 10% to 30%. This works in your favour if you can only afford the lowest monthly premium and hardly ever seek medical aid. And also if you are okay with spending a bigger amount from your wallet if something major comes up.

Sassy Mama number peach 5Customer Service: Medical emergencies don’t always happen within office hours; you will want to sign up for a company and a plan where 24X7 customer service is on the offer. If not on phone then at least on live chat.

Sassy Mama number peach 6Waiting Period: Most policies have a specified time before the coverage kicks in. It could be nine months for maternity or a couple of years for cancer. Getting insurance in an early stage of life helps you cross over the waiting period by the time lifestyle diseases typically strike (let’s hope they never do!).

Sassy Mama number peach 7Family Discounts: Getting individual policies for each family member can be quite costly. Thankfully, many insurers offer discounted packages if you want your whole family covered. And of course, you do!

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Read more: Useful Over-The-Counter Medicines, At-Home Remedies And Natural Cures

understanding insurance terms

Questions To Ask Before Choosing An Insurance Policy

Issues crop up when people assume they would be covered for treatment in full but it’s not included in their plan, or it comes with a shockingly low cap. The devil is in the detail, mamas! Pay close attention to the fine print and ask the right questions before involving your wallet. There are no bad questions when it comes to medical insurance, so for the love of your health and money, make sure you consider these:

  • What doctors do you or your family typically visit and are they covered in the plan you choose? It could be the top paediatrician in the city, the lactation consultant you can’t do without, a skin specialist or an oncologist for mum. If you have a specialist you can’t live without, ensure they’re under the plan you’re buying.
  • Understand the coverage capping in case of hospitalisations. Most plans do not give an unlimited stay in a private room at a top hospital even if an emergency surgery popped up. Know your benefits beforehand and do the math – is the premium you’re paying weighing up against the treatments covered?
  • If you’re hospitalised, who makes the payment? Is it from your wallet, to be claimed later, or a cashless transaction?
  • Does the insurer have network hospitals in your area of residence?
  • Do pre-existing health conditions matter and how much do they affect the premium rates?
  • Does your coverage include vaccinations, opticians, (glasses, lenses and eye exams), dentists and maternity benefits? Many children these days are getting glasses young and dental services in Hong Kong are expensive – it always helps to be insured for these aspects.
  • Does the plan cover annual health scans? Does it include a basic heart and body check-up, or comes with a more in-depth one (including mams, paps, body density, vitamins and hormonal testing)?

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Read more: Women’s Health: Critical Checks For Your 30s, 40s and 50s

where to get family health insurance

Where To Get Family Insurance

These are some of the major family health insurance providers:

AIA

This is a trusted international insurance provider. It offers several innovative insurance plans which don’t come with the cheapest premiums but with comprehensive coverage. In a first of sorts, some AIA plans cover every illness and injury, even diseases that haven’t been discovered yet!

AIA, 2232 8888, [email protected], www.aia.com.hk

AXA

A global leader in insurance with offices in 57 countries, AXA covers a wide range of illnesses and treatment plans. Their critical illness protection plan provides financial cover against cancer, heart attack, stroke, fatty liver, diabetes and gout. No wonder they enjoy the trust of over 1.5 million customers in Hong Kong and Macau to financially protect them.

AXA Group, 2519 1166, www.axa.com.hk

BUPA

BUPA offers family-focused, comprehensive insurance plans and it’s ideal for senior citizens. BUPA has been serving Hong Kong since 1976.

BUPA, 2517 5338, www.bupa.com.hk

HSBC

This financial conglomerate has several flexible medical insurance plans eligible for tax deductions and cashless access to an array of private practitioners.

HSBC, 2233 3130, www.hsbc.com.hk/insurance

Manulife

The company offers broad cashless coverage at one of the most competitive market rates in Hong Kong.

Manulife, 2108 1188, [email protected], www.manulife.com.hk

William Russell

A popular name amongst the expatriate community in Hong Kong, William Russell prides itself on its claims handling service. The company appoints one advisor who will be your point-person for the entire claims process. Bye-bye anonymous customer service call centre!

William Russell3702 6161[email protected], www.william-russell.com.hk

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Read more: Where To Donate Blood In Hong Kong

pre exisiting medical conditions for insurance

Pre-Existing Health Conditions: The Hot Debate

Like in many countries, Hong Kong insurance providers also discriminate against pre-existing medical conditions. It could be anything from high cholesterol to cancer.

When applying for insurance, the company gives you a comprehensive medical questionnaire in which you have to share a detailed medical history for the last five years or a decade (some providers want complete disclosure since birth!). At the time of claim, if the company feels you have been dishonest about a pre-existing ailment, they might decline your claim and null your contract.

That doesn’t mean you can’t get insured once you have a chronic condition. It’s complicated but still possible to avail a tailored cover. Speak to an insurance broker who can guide you on the next best insurance solution.

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Read more: Diabetes: What You Need To Know About Prevention And Management

hospitals and insurance

Other Basics About Insurance Coverage

In-patient cover is always part of medical insurance coverage. It covers your overnight stays in the hospital, including all the treatments.

Outpatient cover compensates you for visits to your doctor, medical check-ups, or short treatments that won’t require you to stay overnight in the hospital. This is best for when you need to have your children vaccinated, undergo medical examinations or for doctor follow-ups.

Other coverage options you might want your policy to include are:

  • Private room cover (an add-on to your in-patient coverage)
  • Optical/vision coverage (for those who might need glasses)
  • Coverage for pre-existing conditions such as asthma, arthritis, even obesity
  • Dental cover (consultations, treatments and emergency dental procedures)

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Read more: Children’s Vaccinations In Hong Kong: When And Where To Get Them

maternity insurance in hk

Health Insurance For Pregnant Women

The approximate cost of giving birth in Hong Kong (for a straightforward, no-complications delivery) in a private setup is upwards of $80,000! While many women may choose to opt for delivery at a public hospital, if you prefer the frills and the support of a five-star private hospital, it makes sense to get insured at the earliest.

Now, basic maternity insurance coverage usually has the following inclusions:

  • Prenatal care: This includes consultations, check-ups and treatments during pregnancy
  • Post-natal care (for you): This includes hospitalisation, new-born care, check-ups, treatments and more

Aside from basic coverage on doctor visits, ultrasounds, labour and delivery, a good health insurance plan should also take into account possibilities of complications. With maternity insurance, you can also get covered for the costs of the following:

  • Treatment for congenital birth defects and other complications
  • Delivery with complications
  • Caesarean section
  • Delivery requiring emergency surgery
  • Congenital defects treatment
  • Extended complimentary coverage for new-borns

One thing to note is that a lot of maternity insurance plans will not include coverage for IVF treatments, or pregnancies and subsequent deliveries of babies conceived via IVF. So always make sure to check this before purchasing.

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Read more: Preparing For Birth In A Public Hospital In Hong Kong

newborn and maternity insurance

Understanding Maternity Insurance Terms

Waiting Period: When you apply for maternity coverage on your health insurance, there’s a so-called waiting period, which specifies how long you need to wait before you can be entitled to any maternity-related insurance benefits.

So, to make the most out of your insurance plan, apply for maternity coverage before you conceive, or just as you’re planning to have a child. Because of this waiting period, you can’t make a claim if the plan was purchased after the conception of the child.

Until Conception: An Until Conception mandate on your insurance plan means that you’d need to wait 12 months after purchasing the plan before you can conceive, in order to enjoy full coverage on the costs of pregnancy.

Start of the Plan: If your policy indicates a Start of the Plan waiting period on your maternity coverage, it means you can conceive any time after the purchase of the policy but won’t be able to make a claim within a specific period of time. The usual minimum for Start of the Plan waiting periods is 10 months from the date of purchase.

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Read more: How To Choose Your Obstetrician In Hong Kong

maternity insurance providers in hk

Top Maternity Insurance Providers in Hong Kong

When applying for an insurance plan with maternity coverage, you have two options: local or international insurance. Local insurance provides maternity coverage should you avail of accredited medical facilities within the borders of Hong Kong. On the other hand, an international medical insurance plan gives you coverage when you avail of the services of a doctor or a hospital anywhere in the world. These usually cost more, for obvious reasons.

The following Hong Kong insurance providers offer excellent maternity insurance coverage:

Premiums vary according to your insurance coverage, the provider and a number of other factors. There aren’t maternity insurance only plans in Hong Kong; maternity coverage is usually an add-on to a general health insurance plan. We suggest you get an insurance quote online (there are many options such as Money Hero or CCW Global) to give you a better idea of how much you have to set aside for these insurance plans.

You’re All Set!

Or do you have any more questions? Don’t worry – that’s totally natural! After all, family and maternity insurance is complicated territory. Consult an insurance broker and navigate plans and policies with them – they’re updated on the latest industry trends and offer sound advice. Browse through online tools for comparing policies and don’t forget to contact your HR department if you’re covered through your job.

Read more: COVID-19 And Children In Hong Kong: Doctor Q & A

Editor’s note: This article was originally published in September 2016 and has been updated by Nikita Mishra in June 2021. 

Main image courtesy of Gustavo Fring via Pexels, image 1 courtesy of Emma Simpson via Unsplash, image 2 courtesy of Sora Shimazaki via Pexels, image 3 courtesy of Christin Hume via Unsplash, image 4 courtesy of Mikhail Nilov via Pexels, image 5 courtesy of Jonathan Borba via Unsplash, image 6 courtesy of National Cancer Institute via Unsplash, image 7 courtesy of Pixabay via Pexels, image 8 courtesy of Amina Filkins via Pexels, image 9 courtesy of Solen Feyissa via Unsplash, image 10 courtesy of MART PRODUCTION via Pexels.

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