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Finding the optimal family health insurance plan

When you have a family, simply having insurance coverage for yourself is not enough. The thing is, some company-sponsored insurance plans may not extend coverage to your whole family – leaving you to find coverage yourself. If you are looking for family health insurance you will quickly find that there are so many options available that it can be simply overwhelming finding the best plan for your family.

To help make the process less stressful, we asked our family health insurance experts at Pacific Prime Hong Kong for their advice on finding the most suitable plan. Here are their top five suggestions.

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Ask yourself five questions to determine the base criteria for your selection

By first having a good idea of what you need from your family health insurance, you can then begin to narrow down your selection. In order to do this, it would be a good idea to ask yourself:

  • How many people will this plan cover? This may seem like a bit of a simple question – the answer is obviously as many people as there are in your direct family. The thing is, health insurance providers usually have different coverage options for families. For example, there are plans out there where you only have to pay for your first child, with coverage being extended to your other children at no additional cost. By knowing how many people you will need to cover with the plan, you can start to explore the plans that are optimal for that number of people..
  • What is your average expected budget on health care? If you know roughly how much money you spend each year at the doctor’s office, you will have an easier time looking for plans. This is because many health insurance plans have coverage limits, meaning that providers will only cover costs up to a certain amount. If you have a limit lower than your annual average spend on health care, you will see yourself paying out of pocket.
  • Do I want a plan with lifetime renewal? Lifetime renewal is an option available with some family insurance plans. Basically, this is a way insurers look at the plan. As long as you continue to pay your premiums for the selected plan, the insurer will base premiums on age alone, regardless of any conditions that arise while you are covered or claims made.  
  • How often do I want to pay my premium? Raising children is expensive and there may be months where money is tighter than usual. Because of this, you should consider when or how often you want to be paying premiums. Many plans offer monthly or annual payments and selecting one over the other could result in you saving money.  
  • Does anyone who will be covered have pre-existing conditions? Insurers will usually ask if anyone who will be covered under the same plan, has any existing medical conditions. If they do, insurers may add a moratorium onto the plan, which means any medical expenses related to these conditions will not be claimable for a set amount of time – usually 12 months or more, depending on the condition.

Look at a plan’s benefits

Once you have a rough idea of your base selection criteria, it’s time to start looking at different plans. One of the first things to look into is the benefits on offer. This list will usually be quite long, but the best family medical plans will offer yearly health checks and even some free wellness benefits, which become available after your first renewal. These can often include optical checkups, vaccinations, dental polishing, and even pre-pregnancy checkups.

In our experience, most families looking for a family health insurance plan in Hong Kong will look for plans that include the following benefits:

  • Worldwide coverage
  • Maternity and newborn coverage
  • Inpatient coverage
  • Outpatient coverage
  • Preventive medicine and vaccinations
  • TCM (Traditional Chinese Medicine) and alternative medicine
  • Dental Coverage
  • Pre-existing and chronic condition coverage
  • Emergency evacuation

Be crystal clear about the plan specifics/fine print

If you have ever signed up for health insurance before, you are probably well aware that all plans come with a lengthy document explaining what is and isn’t covered, and the limitations of the plan. Some of the most important specifics to take note of are:

  • Whether the plan covers pre-existing conditions or not.
  • If the plan does cover pre-existing conditions, whether there is a moratorium or wait period before you can claim expenses.
  • If the plan covers congenital (especially important if you plan to have a baby in the near future) or heritable diseases (especially important if your family has a history of certain diseases).
  • What deductible is on your plan. This is an important figure to know, as it allows you to budget for care. For example, if you have a HKD1,000 deductible, you will need to pay that much before insurance will kick in. It is far easier to budget for this ahead of time.
  • If there is any excess on the plan. Like the deductible, if your plan has an excess limit, you will need to pay anything over this amount. For example, if the excess limit is HKD 3,000 and your hospital bill is HKD 4,000 you will need to pay the difference – or excess – of HKD 1,000.

The good thing about the last two points – excess and deductible – is that you can usually pick how much you would like. Generally speaking, plans with deductibles or excesses will have lower premiums than those without.

Know what is covered when you need to go to the hospital

While one can hope that they will never have to submit a claim for medical care, the fact of the matter is that you, or someone in your family, will likely need to see a doctor at least once a year. When it comes to medical care you should be sure to know the caps or limits on both outpatient and inpatient benefits. It would also be beneficial to know how your insurance provider defines inpatient vs outpatient care, as many require you to spend a set amount of time in the hospital, or to be admitted by a doctor, before they will deem treatment as inpatient.

If you decide on a plan that offers inpatient only coverage, some medical issues like a cast, sutures, radiotherapy, and even day surgeries (all of which require you to go to the hospital) may not be covered.

Of our clients who have purchased family health insurance in the past, here are eight of the most important coverage elements they have requested for when they do need to stay in the hospital for an inpatient procedure:

  1. Room and board – One of the most requested elements for family plans not only includes a bed for the person who is receiving treatment, but also a secondary bed for a family member to sleep on.
  2. Intensive Care – While intensive care is usually covered, it can be expensive so extra coverage for this may be necessary.
  3. Private nursing – Certainly a luxury, but having a dedicated nurse can go a long way in making your children more comfortable at the hospital should they receive care.
  4. Surgical coverage – This includes things like surgeon, anaesthetist, operating theater, and attendant fees, but it is still a good idea to ensure how much your plan will cover. Almost all plans will cover this, but different plans will have different limits so it would be a good idea to know how much is covered.   
  5. Specialist fees for both inpatient and outpatient care – Some plans will limit the amount you can claim for these, while others may not necessarily cover them.
  6. Cancer treatment and kidney dialysis – most plans will cover this, but will attach a limit to the amount that can be claimed.
  7. Coverage for accidents – Almost every plan will cover this. The difference is whether they will offer evacuation to another location for better care e.g., from mainland China to Hong Kong. This is a useful element to have if you plan on traveling with your family.  
  8. Direct billing – The last thing you want when you have a child or loved one in the hospital is to have to deal with paying or claiming treatment. That is why many insurers have set networks of hospitals and clinics that will bill the insurer directly (direct billing). If your plan offers this, it would be a good idea to know which facilities support it.

Look for a plan with strong support and a wide network  

What we mean by this is that the best family health insurance plans out there offer a wealth of support to their clients. This comes in the form of online portals where you have easy access to plan information, and even support lines where you can call for guidance on not only where to go for medical treatment, but how to start the claims process.

When it comes to the network, this is a group of health care providers that have agreed to work with your insurance company to offer direct billing, or to accept payment from your insurer. An insurance provider that has a large network translates into the fact that you will be able to seek care for a wider choice of facilities. Direct billing is also an important feature as it allows the healthcare facility to bill the insurance company directly, meaning that you won’t have to pay for care and then submit a claim for repayment.

Selecting your health insurance plan will take time and can be somewhat overwhelming, even if you follow our suggestions above. What we recommend is talking with the experts at Pacific Prime Hong Kong. Not only can we find you an ideal plan, but our support teams can also make sure that when you do need medical care, the claims process is as smooth as possible. Contact our experts today to learn more about how we can help.

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Jess Lindeman

Content Strategist at Pacific Prime Hong Kong
Jessica Lindeman is a Content Strategist at Pacific Prime. She comes to work every day living and breathing the motto of "simplifying insurance", and injects her unbridled enthusiasm for health and insurance related topics into every article and piece of content she creates for Pacific Prime.

When she's not typing away on her keyboard, she's reading poetry, fueling her insatiable wanderlust, getting her coffee fix, and perpetually browsing animal Instagram accounts.
Jess Lindeman