VHIS basic rules: minimum requirements, waiting period, stopping premiums, renewal and migration
VHIS is individual indemnity hospital insurance regulated by the Health Bureau; certified plans must offer ‘guaranteed renewal’ up to age 100, have no lifetime benefit limit, and have a cooling-off period of at least 21 days. Pre-existing conditions unknown when you take out the policy are not covered in the first year, are paid at 25% and 50% in the second and third years, and in full from the fourth year; the premium grace period is not less than 30 days, and the policy terminates if premiums remain unpaid.
What is VHIS, and whom is it for?
It is individual hospital insurance regulated by the Government: the Voluntary Health Insurance Scheme is implemented by the Health Bureau and regulates insurers' individual indemnity hospital insurance products; participation by insurers and consumers is voluntary, and participating insurers offer approved products (certified plans).
The scheme's policy objectives are to raise the level of protection of hospital insurance products, to give the public one more choice of using private healthcare services through hospital insurance, and, in the long run, possibly to reduce the pressure on public hospitals (Health Bureau VHIS FAQs).
People who currently have no individual indemnity hospital insurance cover, or whose insurer has not joined the Voluntary Health Insurance Scheme, are encouraged by the Health Bureau to consider buying a certified plan (VHIS FAQs).
The Voluntary Health Insurance Scheme covers only individual indemnity hospital insurance bought for yourself and your family; it does not cover non-hospital medical insurance such as outpatient cover, non-indemnity insurance such as hospital cash and critical illness cash, or group insurance bought by employers for employees.
What are the minimum requirements for certified plans?
All certified plans must meet the same set of minimum requirements, including standard policy terms and conditions, minimum benefit coverage and benefit limits; ‘guaranteed renewal’ up to age 100, not changed by changes in health after the policy takes effect; no lifetime benefit limit (except some Flexi Plans meeting specified requirements); a cooling-off period of at least 21 days; and premium tables that must be published (Health Bureau VHIS FAQs).
Certified plans cover unknown pre-existing conditions at the time of application, congenital conditions that manifest or are diagnosed at age 8 or later, day surgery, prescribed diagnostic imaging tests (30% co-insurance borne by the policy holder), prescribed non-surgical cancer treatments, and psychiatric inpatient treatment in hospitals in Hong Kong (Health Bureau VHIS FAQs).
The basic cover of certified plans must allow free choice of hospital and doctor and provide worldwide cover (psychiatric treatment in Hong Kong only); the enhanced benefits of Flexi Plans may apply only to certain hospital and doctor networks (Health Bureau VHIS FAQs).
| Standard Plan | Flexi Plan | |
|---|---|---|
| Terms and benefits | Uniform, equivalent to the minimum compliance requirements of the Voluntary Health Insurance Scheme | Provides basic cover equivalent to the Standard Plan, plus enhanced benefits (for example higher benefit limits or wider coverage) |
| Between insurers | Largely the same, apart from very few permitted minor changes | Varies by product and insurer |
Can cover take effect immediately?
The policy takes effect from the policy effective date once the premium is paid, but unknown pre-existing conditions have a waiting period: pre-existing conditions that the insured was not aware of, and could not reasonably have been aware of, when applying are not covered in the first policy year, are paid at 25% in the second policy year and 50% in the third policy year, and in full from the fourth policy year (Health Bureau VHIS policy template, version of 1 July 2022).
If a customer has already been diagnosed with an illness or has other health risk factors (for example smoking, family history or occupational disease risk) when applying, the insurer may charge an extra premium or add exclusions for specific conditions; before rejecting an application, it must go through a fair and reasonable underwriting process (Health Bureau VHIS FAQs).
Can I stop paying VHIS premiums?
You can stop paying, but the policy will terminate: the insurer must give a premium grace period of not less than 30 days, counted from the due date of each premium; the policy remains in force during the grace period, but no claims are paid until the premium is received (Health Bureau VHIS policy template, version of 1 July 2022).
If the premium is still unpaid when the grace period ends, the policy terminates from the premium due date, and premiums already paid are generally not refunded (Health Bureau VHIS policy template, version of 1 July 2022).
If you have not made a claim after taking out the policy, you can cancel it within the cooling-off period (at least 21 days) and get back the full premium paid (Health Bureau VHIS FAQs).
Will premiums and cover change on renewal?
The cover continues, but premiums can be adjusted: a certified plan policy will not be refused renewal unless the required information was not provided accurately and fully when applying; the insurer can adjust the premium on renewal, but the adjustment must be the same as for other customers in the same age/sex group within the same product (Health Bureau VHIS FAQs).
The Health Bureau does not regulate the premiums of certified plans, but insurers must publish their premium tables; premiums generally vary by age and sex (VHIS FAQs).
Flexi Plan policy holders can choose to switch to the Standard Plan on renewal without re-underwriting; if the insurer offers a Flexi Plan for renewal and the policy holder declines, the insurer should offer the Standard Plan as a renewal option (Health Bureau VHIS FAQs and Code of Practice, version of 1 July 2022).
Who can take out a policy? Can an old policy be migrated?
Participating insurers must consider applications from Hong Kong residents aged from 15 days to 80 years; non-Hong Kong residents can also take out a policy, but the insured must be a Hong Kong resident for a tax deduction to be claimed (Health Bureau VHIS FAQs).
Participating insurers must give all existing individual indemnity hospital insurance policy holders one opportunity to migrate to a certified plan, and migration must be arranged within ten years of the scheme's full launch on 1 April 2019; migrating to another product may require re-underwriting, and if you are rejected or do not accept the outcome, you can still renew your original policy (Health Bureau VHIS FAQs).
When comparing products, you can read the terms and benefits closely and ask the insurer about the coverage, out-of-pocket costs and premiums; for the tax arrangements, see VHIS tax deduction; for using insurance for admission, see Medical insurance pre-approval; for specialist outpatient cover, see Using medical insurance for a private specialist.
Frequently asked questions
Who is VHIS suitable for?
People who currently have no individual indemnity hospital insurance cover, or whose insurer has not joined the Voluntary Health Insurance Scheme, are encouraged by the Health Bureau to consider buying a certified plan; the scheme's objectives include giving the public one more choice of using private healthcare services through hospital insurance (VHIS FAQs).
Does VHIS cover outpatient care?
The Voluntary Health Insurance Scheme does not cover non-hospital medical insurance such as outpatient cover; certified plans do include cover that does not need an overnight stay, such as day surgery, prescribed diagnostic imaging tests and prescribed non-surgical cancer treatments (Health Bureau VHIS FAQs).
What is the age limit for VHIS?
Participating insurers must consider applications from Hong Kong residents aged from 15 days to 80 years, and certified plans offer ‘guaranteed renewal’ up to age 100 (Health Bureau VHIS FAQs).