Do I need individual medical insurance when I'm already covered by group medical insurance?

Do I need individual medical insurance when I'm already covered by group medical insurance?

Many employees wonder if they still need individual medical insurance as their employer has already provided group medical insurance. In particular, younger employees are usually relatively healthy with only occasional ailments such as the common cold and flu. They often focus on out-patient insurance and think that the coverage provided by their employer is sufficient. They usually have a skimping mentality when it comes to in-patient insurance. However, individual medical insurance actually offers more extensive coverage compared to group medical insurance. The two can be complementary and offer more comprehensive coverage together.

Group medical insurance offers both out- and in-patient coverage, while individual medical insurance provides further protection

Group medical insurance provides a basic safety net that offers both out-patient and in-patient protection. According to statistics from the Hong Kong Federation of Insurers in 2018, the average claim for standard hospital ward under a group medical insurance policy is HK$41,802 with the reimbursement rate at about 75% (see Remark 1). In other words, patients will need to pay the remaining 25% of the medical expenses out of their own pockets. Since these are just average figures, the reimbursement rate may be even lower for in-patient cases with higher expenses such as cancer treatments and angioplasty.

 

Lower individual medical insurance premiums with deductibles

There are two types of individual medical insurance plans on the market: those without deductibles and those with deductibles. A deductible is the amount you pay out of pocket before your insurance will cover the remaining eligible amount up to the benefit limit set out in the policy.

So, what are the benefits of medical insurance with a deductible? Simply put, customers can lower their premiums by choosing an individual medical plan with deductibles. Generally speaking, the higher the deductible, the lower the premium. If you're already covered by your company's group medical insurance, then you can offset your deductible with the reimbursement received from your group medical insurance plan. You may then submit another individual medical insurance claim to enhance your overall protection. Here's two of our Bupa plans with deductibles:

• Bupa HealthPlus: A relatively affordable plan that fully reimburses hospital expenses at semi-private room level (see Remark 2) up to HK$3 million per year (see Remark 3). In addition, you can claim up to HK$740,000 per year for cancer treatment and kidney dialysis expenses. With three deductible options (HK$0/HK$12,000/HK$40,000) available, this plan covers diagnosis, in-patient care and follow-up out-patient visits after surgery or cancer treatment, etc.
• Bupa Hero VHIS: This plan offers comprehensive medical protection with full cover for eligible expenses (see Remark 4) up to HK$40 million per year and no lifetime benefit limit. Prescribed non-surgical cancer treatments are covered in full. With four deductible options (HK$0/ HK$12,000/ HK$40,000/ HK$80,000) available, this plan will help you significantly lower your premiums. This is a VHIS plan that is eligible for tax deduction.

 

Greater flexibility with optional benefits

Last but not least, some medical insurance plans offer greater flexibility with different coverage options. Customers can choose to add various benefits based on their needs to expand their coverage (see Remark 5). For example with Bupa Hero VHIS, customers can include the Supplementary Critical Illness Benefit, which provides coverage for up to 98% of all serious critical illnesses (see Remark 6), such as cancer, heart attack and stroke with a lifetime benefit amount up to HK$3,300,000 in aggregate (see Remark 7). In addition, the plan also provides Clinical, Maternity, as well as Dental and Optical Benefit as optional benefits that can be enjoyed across Asia, Australia and New Zealand or worldwide (excluding the United States).

Read more:
How can I use a deductible to lower my medical insurance expenses?

Remarks:
¹ Source: Medical Claims Statistics 2018. Hong Kong Federation of Insurers.

² Bupa HealthPlus: You need to follow the required procedures to enjoy full cover or cashless service. Please refer to the notes in the Schedule of Benefits and Contract for more details.

³ Bupa HealthPlus: The annual maximum cover for members aged 65 or above and for treatment received in the USA is different. Please refer to the Schedule of Benefits for details.

⁴ Bupa Hero VHIS: Please refer to the Summary of Benefits for the items eligible for full cover. Full cover is only applicable to covered expenses and subject to the annual benefit limit, deductible and restricted ward class set out in the Summary of Benefits.

⁵ Bupa Hero VHIS: Optional benefits are not part of the VHIS certified plan. The premiums paid are not eligible for claiming tax deduction and any family discount.

⁶ Bupa Hero VHIS: The 85 critical illnesses covered under the critical illness basic benefits and optional Extended Major Critical Illness Benefit of the Supplementary Critical Illness Benefit include 98% of designated critical illnesses in 10Life's Scoring Methodology of Term Critical Illness Insurance. Exclusions and waiting periods apply. Please refer to the contract for the terms and excluded conditions.
⁷ Bupa Hero VHIS: Waiting periods apply between payment of benefit items. Additional Cancer Benefit is also subject to active cancer treatment requirements. Please refer to the Important Information section of the Supplementary Critical Illness Benefit brochure for details.

 

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