Is your doctor covered by your insurance plan?
Spend even a short amount of time looking for health insurance in Hong Kong and you will quickly find that there is a mind-boggling number of plans available. While to many, this choice is a good thing – you can find a plan that fits your needs perfectly – it can also be overwhelming if you’re not familiar with health insurance. A common issue that comes up when looking for a plan without thoroughly understanding the policy is that you may find your doctor or facility of choice is not covered.
In Hong Kong, there are a large range of medical facilities available. You can find facilities that charge 100 HKD for a visit, or some that charge over 1,000 HKD for a simple consultation. As such, not every insurance plan will cover all of the facilities in your area. In fact, insurance companies usually offer coverage based on health care networks – a group of medical facilities that essentially agree to accept payment from the insurance company. These networks, and actually finding where your plan is accepted in Hong Kong, can be confusing. So, to help, we have written this article which looks at the three most common groups of networks.
Group 1: Public and low cost facilities
As the name suggests, plans that support these networks provide coverage only for low cost providers and public facilities. These plans are often designed to be very cost effective with lower premiums and, subsequently, lower limits and benefits. This means that if you purchase one of these plans you will only have access to lower cost facilities because the limits will only really cover the costs at these facilities
While some insurers do not cover treatment outside of your network, others will. This really depends on the insurer you choose. In fact, many will give you the flexibility to still visit doctors and hospitals outside of the network, but they will only provide coverage up to the average cost of facilities that are within your list.
So if you do purchase a budget plan, and they tell you that your doctor or hospital is covered, you still need to be careful and check the limit that they will cover up to. The plan won’t be very useful if it only covers a small amount of what your desired doctor actually charges.
Group 2: Mid to high cost facilities
These are plans that offer higher limits and a larger health care network, but may still impose coverage limits, copays, or deductibles on your treatment cost. Essentially, these plans have been designed to allow you greater flexibility in selecting your hospital, but the cost will be shared.
A copay or deductible is a part of the treatment cost that you will pay out of pocket. This amount will be agreed to before the start of the policy, and is a good way to help manage the cost of your plan while allowing you to better set and manage risk. In this way, you can still get care from the doctor or hospital that you want when you need it, without paying a high annual insurance premium.
The main downside with this type of network is that it may still limit access to the most expensive facilities in your area, especially those who are extremely specialized or serve only a small niche market. Other plans will allow you to access these facilities, but the coverage limits will be lower, which means you will be paying more if you visit them.
Group 3: Unlimited Network
Plans with unlimited networks are typically offered by international insurers, and will have high or no limits. Yes, the premiums for these plans are typically more expensive, but they do let you rest easy knowing that you can have access to the very best care that the world has to offer, because you’re not limited to treatment in public or lower tier private hospitals in Hong Kong. In fact, because these plans are international in nature, they will usually cover medical treatment anywhere in the world.
Because of their international nature, these plans are also most suitable for expats and High Net Worth individuals because they provide coverage in facilities and locations that will feel most comfortable to them – e.g., an expat’s home country. Another benefit for expats is that these type of plans allow for treatment immediately, without waiting months to re-enroll in the public healthcare system if they move to a new city or country.
How do I find out if my doctor/medical facility of choice is covered?
Regardless of the insurance plan you select or the provider you work with, there is a chance that your doctor or medical facility of choice may not be covered. There are three common ways this can be found out:
1. Look at the documentation included with the plan
All plans come with documents that explain not only what is covered, but also where you can receive medical attention. For example, if you buy a plan through Pacific Prime, we send you a Quick User Guide with information on your plan, including where you are covered.
Other plans, especially local ones, will also come with a booklet or a link to a website that lists all locations, clinics, and hospitals where your plan is accepted. When you sign up for a new plan, it is a good idea to store this information in a secure location so you have access to it when you need it.
2. Contact your main doctor and ask
If you have had your plan for a longer period of time, or are unsure whether your doctor or clinic of choice will accept your insurance plan, it could be a good idea to contact the office directly. They will likely be able to tell you right away if they are part of your provider’s network.
3. Talk to Pacific Prime
Living in Hong Kong, English may or may not be spoken to a level where you can communicate effectively with the receptionist at the clinic or hospital you have selected, so calling and asking may leave you with more questions than you started with in regards to coverage. What we recommend is contacting one of our knowledgeable health insurance professionals. Because we work closely with virtually every health insurance provider in Hong Kong, we can provide you with the details you need, and even recommend a solution if one is necessary.
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