Voluntary Health Insurance Scheme

FAQs

About VHIS

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Q1. What is Voluntary Health Insurance Scheme (VHIS)?

VHIS is a policy initiative implemented by the Health Bureau to regulate indemnity hospital insurance plans offered to individuals by insurance companies. The participation by insurance companies and consumers is voluntary.

Under the VHIS, the participating insurance companies offer certified individual indemnity hospital insurance plans (“Certified Plans”) for consumers to purchase voluntarily.

Q2. What are the objectives of VHIS?

The policy objectives of VHIS are to -

(a) enhance the protection level of hospital insurance products;

(b) provide the public with an additional choice of using private healthcare services through hospital insurance; and

Q3. What is the scope of VHIS?

VHIS covers insurance products which -

(a) provide hospital insurance protection of indemnity nature bought by individuals for themselves and their families

VHIS does not cover insurance products which -

(a) provide non-hospital medical insurance protection e.g. outpatient services; or

(b) provide non-indemnity medical insurance protection e.g. hospital cash, critical illness cash plans; or

Q4. What are the differences between Certified Plans under VHIS and other individual indemnity hospital insurance products?

Certified Plans are officially certified by the Health Bureau to have met a number of standard features to enhance consumer protection, including standardised policy terms and conditions, guaranteed renewal up to the age of 100 years, and more comprehensive benefit coverage. For details, please see Q8.

Q5. How is consumer interest protected under VHIS?

As in the case of all insurance businesses, the insurance companies participating in VHIS and their business practices are subject to the supervision and regulation of the Insurance Authority under the Insurance Ordinance (Chapter 41). In addition, the insurance companies registered as VHIS providers are required to comply with the rules of the scheme, including the product compliance requirements and the code of practice set by the Health Bureau.

Q6. When is VHIS implemented?

VHIS has been fully implemented on 1 April 2019. As from this date -

(a) The participating insurance companies will start offering their Certified Plans and accepting new applications^#.

(b) The insurance policies issued under a Certified Plan effective and with premium paid on or after 1 April 2019 will be eligible for tax deduction under Inland Revenue Ordinance (Cap. 112).

(#) If you have already purchased an individual indemnity hospital insurance policy and your policy will be due for renewal on 1 April 2019 or afterwards, your insurance company (if participating in VHIS) will invite you for renewal into a Certified Plan or offer you a Certified Plan as an option. See also Q33 to Q35.

Protection offered by Certified Plans under VHIS

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Q7. What are Certified Plans?

All Certified Plans, including Standard Plans and Flexi Plans, must meet or exceed the minimum product standard of VHIS.

(a) For the Standard Plans, the terms and benefits are standardised with prescribed minimum, such as minimum benefit coverage and amounts.

(b) For the Flexi Plans, they must provide basic protection equivalent to Standard Plan coverage, plus a flexible top-up protection to suit market needs subject to certain rules set out by the Health Bureau.

Due to variety in product design of Certified Plans available in the market, consumers are advised to check carefully the terms and benefits of insurance plans, understanding their rights and obligations, and making product and premium comparisons.

Q8. How attractive are the Certified Plans?

All Certified Plans must comply with the minimum requirements of providing the following key product features -

(a) Standardised policy terms and conditions with minimum benefit coverage and benefit amounts [The terms and benefits are detailed in the Certified Plan Policy Template].

(b) Guaranteed renewal up to age of 100 years - The guarantee is irrespective of whether or not your health condition has changed after the policy is in force.

(d) Cooling-off period of 21 days － You can enjoy a cooling-off period of 21 days during which you can cancel the policies with full refund of premium.

(e) Premium transparency － You can access the premium schedules of all Certified Plans on the website of the insurance companies concerned and the official VHIS website.

(f) Coverage extended to include -

(i)

Unknown pre-existing conditions - An unknown pre-existing condition refers to a health condition, such as sickness, which has existed but you are unaware of its existence when applying for insurance coverage. According to the terms and conditions, all Certified Plans will provide partial coverage of unknown pre-existing conditions in the second and third year after policy inception, at 25% and 50% respectively. Full coverage i.e. 100% will be provided from the fourth year onwards.

(ii)

Treatment of congenital conditions - Cover investigation and treatment of congenital conditions which have manifested or been diagnosed from the age of 8, subject to the same reimbursement arrangement that applies to unknown pre-existing conditions.

(iii)

Day case procedures - Cover surgical procedures (including endoscopy) not conducted during hospital stay (such as day procedure centres).

(iv)

Prescribed diagnostic imaging tests - Cover Computed Tomography (CT scan), Magnetic Resonance Imaging (MRI scan) and Positron Emission Tomography (PET scan) conducted during hospital stay or in an outpatient setting, subject to 30% coinsurance. For example, if the expense incurred is $5,000, the policy holder has to pay for 30% of the cost, i.e. $1,500, while the insurance company has to pay for 70% of the cost, i.e. $3,500.

(v)

Prescribed non-surgical cancer treatments - Cover radiotherapy, chemotherapy, targeted therapy, immunotherapy and hormonal therapy.

(vi)

Psychiatric inpatient treatments in local hospitals - Cover psychiatric treatments during confinement in Hong Kong.

(*) Some Flexi Plans that meet specified criteria can have lifetime benefit limits. Please see Q9 for details.

Q9. Why are there some Certified Plans with lifetime benefit limits?

In the hospital insurance market, there are some insurance plans that are designed to provide high-end benefits. Such plans adopt lifetime benefit limit to make the premiums more affordable. These plans can cater to the needs of some consumers who need higher coverage, and increase the flexibility of VHIS. To ensure that such plans are regulated, only Flexi Plans that meet the following criteria can have "lifetime benefit limit" -

(a) The annual benefit limit must be at least HK$5 million;

(b) The lifetime benefit limit must be at least HK$20 million or 4 times of annual benefit limit, whichever is higher; and

(c) There must be no itemised dollar limit for at least 10 of the 12 standard benefit items (i.e. the benefit items prescribed under the Standard Plan framework).

As in the case of all Flexi Plans, the policyholders should be provided with the option to switch to the Standard Plan without re-underwriting upon policy renewal. This means that the policyholders of the Flexi Plans with exemption mentioned above can continue to enjoy protection under Standard Plan even if the lifetime benefit limit is reached.

Q10. Is there any restriction on the choice of hospitals and doctors under VHIS?

The basic protection of all Certified Plans (including the Standard Plan in entirety, and the basic protection of Flexi Plans equivalent to Standard Plan) provides free choice of hospitals and doctors. Top-up benefits of Flexi Plans may link with a network of hospitals and doctors.

Q11. Can I still use the public hospital services, and use the insurance to pay for public hospital charges?

Yes to both questions. The purchase of Certified Plans is entirely voluntary and will not affect your rights to use public healthcare services.

Q12. Can I choose hospitals and doctors outside Hong Kong?

Yes. Top-up benefits of Flexi Plans may apply to certain geographical regions. Standard Plan and basic protection of Flexi Plans equivalent to Standard Plan are required to provide global coverage, except for psychiatric treatments that are limited to Hong Kong.

Q13. Is hospital admission necessary for making insurance claims?

Not necessary. All Certified Plans must cover day case procedures (such as endoscopies), prescribed diagnostic imaging tests and prescribed non-surgical cancer treatments for which overnight hospital stay is not necessary. If the attending doctor considers hospitalisation medically necessary, the care received will also be covered.

Q14. Is dental treatment covered under VHIS ?

Standard Plan only covers dental treatments related to emergency treatment and surgery during confinement arising from an accident. Other inpatient and outpatient dental coverage may be provided as top-up protection of Flexi Plans. Please consult your insurance company on the exact coverage of each Certified Plan.

Q15. Are treatments of COVID-19 infection covered by VHIS?

As in the case of all medically necessary treatments, eligible expenses on the treatments of COVID-19 infection (including expenses incurred for hospitalisation, day case procedures and prescribed diagnostic imaging tests in Hong Kong and elsewhere in the world) must be covered as part of the basic protection offered by all VHIS Certified Plans. The basic protection refers to the terms and benefits of Standard Plan or that part of Flexi Plans equivalent to the terms and benefits of Standard Plan.

Q16. What about treatments due to adverse reactions to COVID-19 vaccinations?

The treatments likewise fall within the scope of basic protection offered by all VHIS Certified Plans. See Q.15 for details.

Q17. What is the meaning of an unknown pre-existing condition and how is it covered under VHIS?

An unknown pre-existing condition refers to a health condition, such as sickness, which has existed but you are unaware of its existence when applying for insurance coverage.

According to the terms and conditions, all Certified Plans will provide partial coverage of unknown pre-existing conditions in the second and third year after policy inception, at 25% and 50% respectively. Full coverage i.e. 100% will be provided from the fourth year onwards.

Choice of insurance companies

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Q18. How many insurance companies will participate in VHIS?

We have published the list of participating insurance companies on the official VHIS website, and will update the list regularly.

Q19. How can I know if an insurance company participates in VHIS?

Upon successful registration as a VHIS provider, the insurance companies are required to disclose their registration status to consumers at least through their company websites. You may also check the list of participating insurance companies through the official VHIS website.

Choice of insurance plans

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Q20. Is there only one choice of Certified Plan?

No. In addition to Standard Plan that all the participating insurance companies must offer, they are allowed and encouraged to offer Flexi Plans that provide top-up protection, such as higher benefit amount and wider benefit coverage.

Q21. What is the difference between Standard Plan and Flexi Plans?

Standard Plan benchmarks the minimum complying requirements of VHIS. As the policy terms and benefits of Standard Plan are standardised, the Standard Plans offered by different insurance companies will be virtually the same (except for very limited minor allowable variations).

Flexi Plans offer basic protection equivalent to Standard Plan coverage, plus a flexible top-up protection such as higher benefit amounts and wider benefit coverage, which vary from plan to plan and company to company.

Q22. How many Certified Plans are available for application?

As of 30 September 2024, there were 93 Certified Plans available in the market (including Standard Plan and Flexi Plans) which altogether offered 488 products . For details, please visit the official VHIS website.

Q23. Are there hospital insurance products other than Certified Plans available for my choice?

VHIS is a voluntary scheme for both insurance companies and consumers. Insurance companies are allowed to offer non-VHIS hospital insurance plans alongside Certified Plans. Consumers have the freedom to choose which insurance plans best suits their needs.

Premiums

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Q24. Are the premiums of Certified Plans regulated by the Health Bureau?

The Health Bureau does not regulate the premiums of Certified Plans. However, the participating insurance companies have to publish the premium schedules of their Certified Plans that facilitate comparison and the premium schedule of all Certified Plans of insurance companies can be accessed on the official VHIS website.

Q25. Do the premiums vary by age and gender?

Yes, in general.

Q26. Can the insurance companies adjust the premiums when renewing my policy?

Yes, but the rate of adjustment in your case must equally apply to other customers within the same age-gender group of your insurance plan. This restriction can prevent the insurance companies from treating you unfairly.

Buying a Certified Plan

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Q27. When and from where can I buy a Certified Plan?

You can search for participating insurance companies and Certified Plans on the official VHIS website.

If you do not have any individual indemnity hospital insurance cover now or your insurance company has not joined VHIS, you are encouraged to consider purchasing a Certified Plan.

Q28. Is there any age limit for subscription?

The participating insurance companies are required to consider applications from Hong Kong residents aged between 15 days and 80 years.

Q29. Can I subscribe a Certified Plan if I am not a Hong Kong resident?

Yes, but the insured person must be a Hong Kong resident for the purpose of tax deduction. According to the rules of VHIS, the participating insurance companies are required to consider applications for Certified Plans in relation to insured persons being Hong Kong residents aged between 15 days and 80 years. However, it is at the discretion of the companies whether to consider applications in relation to insured persons being non-Hong Kong residents according to their business practices.

Q30. Is there guaranteed acceptance of application for a Certified Plan?

The participating insurance companies may decline an application after a fair and reasonable underwriting process in accordance with the principles set out in the Code of Practice under VHIS.

Q31. Is premium loading or exclusion of particular illnesses allowed?

Yes, provided that there are pre-existing health conditions or other health risks such as smoking habit, family medical history and occupational hazard.

Q32. The insurance company accepts my application for VHIS coverage on the condition that certain specified illnesses are subject to a lower class of benefit coverage. Is it permitted?

The said situation is permitted for Flexi Plans when the product design encompasses a higher benefit layer by default and a lower benefit layer for the known pre-existing conditions of the insured person, and all the benefits are subject to the minimum protection as benchmarked by the Standard Plan.

Q33. Will my insurance policy issued under a Certified Plan not be renewed?

No, unless important information (such as pre-existing health conditions) required in the process of application is not provided accurately and completely.

Q34. If I already have an individual indemnity hospital insurance coverage, how can I switch to a Certified Plan?

If your insurance company has participated in VHIS, it must offer its existing policyholders of individual indemnity hospital insurance an opportunity to switch to Certified Plans. The timing of the migration may depend on the renewal cycle of your existing insurance policy or other arrangements that your insurance company may offer. You may wish to approach your insurance company or agent/broker.

Q35. If my insurance company has participated in VHIS, when will it arrange migration for me?

Please check with your insurance company direct.

Most insurance companies have arranged or are planning to arrange migration for existing customers as soon as possible. In any event, the offer of migration must be made within 10 years starting from the full implementation of VHIS on 1 April 2019.

Q36. What is the migration arrangement?

The migration arrangement may take one of the following forms -

(a) Direct renewal from your existing plan into a Certified Plan (i.e., Same plan with VHIS features incorporated) at your next policy renewal; or

(b) Beside your existing plan, you are given an option to change to a Certified Plan (Different plan with VHIS features incorporated). In this case, you may be subject to re-underwriting and required to disclose your latest health conditions. If your enrolment is rejected or you refuse to accept the reunderwriting result, you may still stay insured with your existing plan.

Q37. Can the insurance company pick and choose which customer to migrate and which does not?

No, the insurance companies are required to offer migration for all their existing individual indemnity hospital insurance policyholders. Insurance companies are also required to treat policyholders fairly in the migration process.

Q38. Can I reconsider my decision after purchasing a Certified Plan?

Upon successful application, you may reconsider your decision of the purchase of a Certified Plan. You have the right to cancel it with full premium refund during the cooling-off period (at least 21 days) provided that no claim has been made.

Tax deduction

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Q39. How can an insurance policy qualify for claiming tax deduction under VHIS?

In order to be eligible for claiming tax deduction under VHIS, an insurance policy must meet all the following criteria -

(a) The policy provides coverage of a Certified Plan under VHIS;

(b) The policyholder is a personal income taxpayer or his/her spouse;

(c) The insured person is the policyholder or the policyholder's “specified relatives” as defined under the Inland Revenue Ordinance (Cap. 112); and

(d) The insured person is a Hong Kong resident^*.

(*) Including Hong Kong Identity Card holders, and people aged under 11 who are not Hong Kong Identity Card holders but their parents are Hong Kong Identity Card holders when they were born or adopted. For detailed definitions, please refer to Inland Revenue Ordinance Cap. 112.

Q40. Who can claim tax deduction for the premium paid for an eligible VHIS policy?

Any taxpayer who or whose spouse is the policyholder of an eligible insurance policy.

Q41. What is the definition of “specified relatives”?

A specified relative of a policyholder refers to the policyholder's -

(a) Spouse;

(b) Children^* aged less than 18 / aged 18 to less than 25 receiving full-time education / aged 18 or above but incapacitated for work by reason of physical or mental disability;

(c) Brothers or sisters^* aged less than 18 / aged 18 to less than 25 receiving full-time education / aged 18 or above but incapacitated for work by reason of physical or mental disability; or

(d) Parents or grandparents^* aged less than 55 but eligible to claim an allowance under the Government's Disability Allowance Scheme / aged 55 or above.

(*) Step and adopted relationship also apply. For detailed definitions, please refer to Inland Revenue Ordinance Cap. 112.

Q42. Is there any limit on the amount of premium of eligible policies that can claim tax deduction?

Yes, the premium that a taxpayer can claim tax deduction is up to $8,000 per insured person in each assessment year. See the following example that two taxpayers purchase VHIS policies for themselves respectively -

Policyholder Insured person Annual Premium Paid Eligible premium amount (capped at $8,000 per insured person) Assumed tax rate Amount of tax saved

Taxpayer A Taxpayer A $5,000 $5,000 17% $850

Taxpayer B Taxpayer B $12,000 $8,000 17% $1,360

Q43. Is there any limit on the number of eligible policies for which I can claim tax deduction?

No. See the following example that a taxpayer purchases VHIS policies for himself and his specified relatives -

Policyholder Insured person Annual Premium Paid Eligible premium amount (capped at $8,000 per insured person) Amount of tax saved (assuming tax rate is 17%)

Taxpayer Taxpayer $5,000 $5,000 $850

Taxpayer Spouse $7,000 $7,000 $1,190

Taxpayer Mother $9,000 $8,000 $1,360

Taxpayer Son $3,000 $3,000 $510

Taxpayer Grandmother $12,000 $8,000 $1,360

Total --- $36,000 $31,000 $5,270

Q44. How much is the amount of tax deduction that I can enjoy?

The amount of tax deduction will depend on the number of VHIS policies claimed, the amount of premiums, and the tax rates that apply in your case. See the following example -

Policyholder Insured person Annual Premium Paid Eligible premium amount (capped at $8,000 per insured person) Assumed tax rate Amount of tax saved

Taxpayer A Taxpayer A $9,000 $8,000 17% (highest marginal tax rate) $1,360

Taxpayer B Taxpayer B $7,000 $7,000 15% (Standard tax rate) $1,050

Taxpayer B Taxpayer B's Daughter $4,000 $4,000 15% (Standard tax rate) $600

Taxpayer C Taxpayer C's spouse $6,500 $6,500 10% $650

Q45. If an insurance policy covers a Certified Plan as well as a life insurance plan, will the total premium of this policy be eligible for tax deduction?

No, only the premium paid in relation to the Certified Plan is eligible for tax deduction.

Q46. If a personal income taxpayer is already subject to the standard tax rate of 15%, can he/she save taxes by claiming tax deduction for qualifying premium of VHIS policies?

Yes. The net assessable income can be reduced by the amount of the qualifying premium before the standard tax rate applies. The tax savings are equivalent to the multiple of the qualifying premium and 15% in this case.

Q47. When is the tax deduction under VHIS effective?

The tax deduction has been effective in the assessment year starting from 1 April 2019. This means that the policies issued under Certified Plan that are effective and with premium paid on or after 1 April 2019 are eligible for the tax deduction.

Q48. If I have any questions about tax deduction under VHIS, what should I do?

You may browse the FAQs page maintained by the Inland Revenue Department (IRD), or contact the IRD.

Standardised Underwriting Questionnaire

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Q49. What is the Standardised Underwriting Questionnaire (“SUQ”)? How would it be applicable to VHIS?

The SUQ is defined under the Best Practice on Standardising Underwriting Questionnaire for Individual Indemnity Hospital Insurance Plans (“Best Practice on SUQ”) issued by the Hong Kong Federation of Insurers (“HKFI”). The Best Practice on SUQ aims to lay down guiding principles and design a standardised template (i.e. the SUQ) with a view to defining the scope of health-related information that consumers are required to disclose when applying for individual indemnity hospital insurance coverage.

All VHIS Providers are required to adhere to such Best Practice on SUQ and adopt the SUQ when handling applications for VHIS Certified Plan coverage signed by the applicant on or after 1 January 2022.

Q50. When is the Standardised Underwriting Questionnaire (“SUQ”) adopted under VHIS?

All VHIS Providers are required to adhere to the Best Practice on SUQ and adopt the SUQ when handling applications for VHIS Certified Plan coverage signed by the applicant on or after 1 January 2022.

Q51. How can the Standardised Underwriting Questionnaire (“SUQ”) enhance consumer protection?

The SUQ clearly sets out the scope of health-related information that consumers are required to disclose when applying for individual indemnity hospital insurance coverage, and adopts simplified wording and a standardised format for easier comprehension by consumers, thereby strengthening consumer protection and increasing market transparency.

Q52. In addition to the Standardised Underwriting Questionnaire (“SUQ”), will the insurance company ask me to provide additional information or undergo medical examination?

Based on the information provided in the SUQ, the insurance company may have follow-up questions related to the conditions reported, which may include requiring you to provide further information or undergo a medical examination for underwriting purpose.

Q53. What should I pay attention to when filling out the Standardised Underwriting Questionnaire (“SUQ”)?

Regardless of the format of the questionnaire, based on the insurance principle of utmost good faith, anyone who wants to purchase insurance is required to be honest and provide the insurance company with all pertinent facts and circumstances to the best of his/her knowledge and belief, so that the insurance company could be fully informed of all the risks involved. Once this principle is violated, the insurance company may have the contractual right to repudiate the policy.

Q54. I have suffered from a certain disease, but the insurance company did not ask about such disease in their questionnaire. Do I still need to declare it?

The Standardised Underwriting Questionnaire (“SUQ”) has defined the scope of health-related information that consumers are required to disclose and covers the areas of risk assessment from insurance company. If an insurance company does not ask a certain standardised question from SUQ during application, it means that the company has waived using that health-related information for underwriting purpose. Thus, the applicant does not need to disclose any information if not being asked.

Q55. I suffered from a disease before the disclosure timeframe in the Standardised Underwriting Questionnaire (“SUQ”), do I need to disclose information related to the disease?

(a) Scenario 1 : You had fully recovered from the relevant disease before the disclosure timeframe (e.g. past 5 years) and no further treatment or follow up is required throughout the disclosure timeframe

No. For example, the required disclosure timeframe in the standardised question is 5 years for a certain disease. If an applicant had such a disease 7 years ago and was fully recovered 6 years ago with no further treatment or follow up required until the time of application, there is no need to disclose such information. Even if the insurance company obtains some health information from other sources that is beyond the scope or required disclosure timeframe set in the SUQ, the insurance company should not use such information for underwriting application for VHIS Certified Plan coverage.

(b) Scenario 2 : You did not fully recover from the relevant disease at the start of the disclosure timeframe

Yes. For example, the required disclosure timeframe in a standardised question is 5 years for a certain disease. If an applicant had such a disease 7 years ago, but did not fully recover from it at the start of the disclosure timeframe, all information (e.g. treatment and follow up details etc.) related to the disease during the disclosure timeframe should be disclosed as requested in the questionnaire, regardless of whether the applicant has fully recovered at the time of application.

Q56. If I have already applied for VHIS Certified Plan coverage and am awaiting the application result, can I request my insurance company to re-underwrite my application by using the Standardised Underwriting Questionnaire (“SUQ”)?

Starting from 1 January 2022, you may request your insurance company to use the SUQ to re-underwrite your application if the insurance company has not yet issued the new VHIS policy to you. Yet, if you applied for VHIS Certified Plan coverage and signed the application form before 1 January 2022, and your insurance company has already issued the new VHIS policy to you, the insurance company has the right to refuse re-underwriting using the SUQ.

VHIS

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