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Picking the benefits you need on your health insurance plan

Pacific Prime looks at how how expats in Hong Kong can find the best benefits for their health insurance plans by asking 5 simple questions.

Posted on May 22, 2015 by Rob McBroom

Both the demand for, and cost of, health care in Hong Kong have been steadily rising and will continue to do so for the foreseeable future. Because of this, insurance premiums are also rising at a fairly steady pace. Luckily, there is a wealth of insurance options available in the city. In fact, one of the top comments received by the staff at Pacific Prime is about struggling through the sheer number of different plans and benefits available. This can make it hard to really zero in on the best medical insurance plan, but our insurance experts have come up with 5 questions you can ask yourself to help you decide what benefits you need on your health insurance plan.

1. What type of plan am I looking for?

There are three main types of health insurance policy in Hong Kong that the vast majority of people select from:

  • Local
  • International
  • Group

Local policies are insurance plans developed for the local market and are usually designed with limited benefits in place. Often, they won’t grant access to many private facilities. They are created to provide coverage for those wishing to use public hospitals and normally have more exclusions, benefit sublimits, and coverage gaps.

On the other hand, International or global health insurance policies are generally developed for expats and people who want to have access to any facility of their choice, in several locations. This is also more suitable for people with busy schedules because public facilities can have longer wait times. Global plans usually offer ample coverage that is perfect for those preferring to make use of private hospitals or clinics. Beyond that, they also offer expanded coverage, higher limits, and a wider coverage area when compared with local plans.

Group policies are either local or international policies that are designed for businesses to offer to their employees. Many group insurance plans or employee health plans are designed for 10 or more employees, so be sure to read the plan information before selecting any plans.

2. What general coverage elements will I need?

The good thing about many of the plans currently available in the market, whether they are local or international, is that they can be very flexible and customized to fit the coverage that clients need.

The first and most basic level of coverage is for inpatient procedures. This is, as the name suggests, for inpatient procedures only. Essentially, if you are in an emergency and are hospitalized, these plans will cover the costs of the hospitalization including doctor visits and any surgery. Inpatient benefits are defined as treatment that you received once you’ve been admitted into the hospital. This can be a week long stay or even as short as 3 - 4 hours. Usually when assigned a bed space, you are considered inpatient.

The second type is inpatient and outpatient coverage. This type of coverage takes the benefits offered with inpatient coverage and adds outpatient options as well. Outpatient care is often defined as care that does not require hospitalization. This includes everything from a visit to a doctor's’ clinic to diagnostic tests that can take a few hours. For the vast majority of expats, this is adequate coverage.

3. What supplementary coverage is essential to me?

As we noted above, almost every insurer offers plans based on the two main coverage elements. In order to differentiate plans and attract customers, insurers add supplementary coverage elements that are either included in the plan, or can be added on. Because there are so many different plans out there it can often be hard to narrow down the selection to a manageable number. One of the best ways to do this is to define what supplementary  elements you would like included on your plan.

This includes elements like maternity, dental, prescription drug coverage, medical evacuation, travel insurance, coverage in the US, yearly health check, coverage for dependents like children, etc. The list really is limitless but if you take the time to define coverage elements that are essential to you, actually finding the best plan will become much easier.

4. Where will I potentially need medical care?

With this question there are three factors you should consider. The first is if you will be travelling on a regular basis, either for work or for pleasure. If you do travel, there is a higher risk that you will need to seek medical care outside of Hong Kong. If you have a local plan, there is a good chance that the medical bills will not be covered simply because local plans usually are only valid for medical care in Hong Kong.

The second factor to consider is whether you would feel comfortable seeking medical treatment for very serious health issues in Hong Kong. Although Hong Kong does offer high quality health care, some people would feel much more comfortable getting treatment for serious issues or long term treatment in their own home country surrounded by family or in a country where they feel they are getting the best care possible.

The third factor focuses on care here in Hong Kong. If you are new to the city and have not picked up much cantonese, public hospitals can be intimidating. The same goes for if you want access to the best doctors and the best care available. While the public system is adequate for many, it is overburdened with long wait times and service can be impersonal because the staff have to care for a larger number of patients.

What most people don’t know is that actually since the cost of private healthcare is so expensive in Hong Kong, if you want to purchase a plan that covers private facilities, most likely, this plan will also automatically cover you internationally. So even if you don’t think you’d need treatment outside of Hong Kong, you should still look into an international healthcare plan if you want to access Hong Kong’s private hospitals and clinics.

5. What is my budget?

Finally, the last question to ask is what your budget is and how you want to spend it. Many plans offer the ability to balance premiums and deductible to a point that meets your current budget.

The key here is to ask yourself what you are willing to spend to buy the plan (the premium) and whether this is realistically enough to get the benefits that you need. If you find that your budget is not enough to get every benefit that you wanted, then you need to understand the risks that you are exposing yourself to if you were to remove certain benefits. Although there may be a benefit that you’d really want such as an annual health check, this is not as important as something such as maternity care. If you don’t have an annual health check benefit, the cost out of pocket is still manageable and won’t break the bank, but if you don’t have maternity coverage, and you find yourself in need of it, that’s when the sudden cost can be financially debilitating.

Another thing to consider is what you are willing to pay at the time of care, before the insurance company will consider a claim (the deductible). If you are ok with a higher deductible, your premium will usually be lower because you are agreeing to take on more of the risk yourself.

This is really a balancing act because it can be hard to guess your financial health when you eventually do need to pay for health care.

Looking for a new plan?

If you are looking for a new plan, it can be a lot of work and research to uncover the benefits you will need throughout the life of the plan. One of your best options is to work with the experts at Pacific Prime. For fifteen years we have taken the time to get to know the needs of people, and can recommend plans that answer all the questions above and more. Contact our Hong Kong-based experts today to learn more about how we can help.

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