Objectives. 12 Minimum Requirements Note 2. [Page 1]

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1 [Page 1] Objectives The Voluntary Health Insurance Scheme (VHIS) aims to provide better protection to those who are able and willing to buy health insurance Note 1 and use private healthcare services through regulating and improving the quality of hospital health insurance, so that the public sector can focus on providing services in its target areas, thereby enhancing the long-term sustainability of the dual-track healthcare system of Hong Kong. The VHIS is not intended as a total solution to the problems of our healthcare system, but one of the measures for taking forward healthcare reform. 12 Minimum Requirements Note 2 (A) Improving accessibility to and continuity of health insurance 1. Guaranteed renewal - No re-underwriting upon policy renewal 2. No lifetime benefit limit - No lifetime limit on cumulative claims amount 3. Coverage of pre-existing conditions - Subject to a three-year waiting period, during which only partial reimbursement will be provided 4. Guaranteed acceptance with premium loading cap - Guaranteed acceptance with a premium loading cap of 200% of standard premium, will be offered to the following persons : all ages within the first year of implementation of the VHIS; and those aged 40 or below starting from the second year of implementation of the VHIS 5. Portable insurance policy - Changing insurers without re-underwriting if no claims made for a certain period of time (say three years) immediately before transfer of policies (B) Enhancing quality of insurance protection 6. Coverage of hospitalisation and prescribed ambulatory procedures - Benefit coverage includes prescribed ambulatory procedures and treatments in addition to those performed in in-patient setting 7. Coverage of prescribed advanced diagnostic imaging tests and non-surgical cancer treatments - Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and Positron Emission Tomography (PET) scans, as well as chemotherapy and radiotherapy, etc.

2 8. Minimum benefit limits - Prescribed levels for benefit limits to provide basic protection to the public 9. Cost-sharing restrictions - No co-payment of policyholders, except the 30% co-insurance paid for prescribed advanced diagnostic imaging tests - Co-payment subject to an annual cap of $30,000 (C) Promoting transparency and certainty 10. Budget certainty - No-gap / known gap arrangement for at least one procedure / test: policyholders can enjoy no-gap (no out-of-pocket payment) or known-gap (a pre-determined amount of out-of-pocket payment) if the procedure concerned is on the list Note 3 specified by the insurer - Informed Financial Consent : i.e. written quotation, providing information on estimated doctor fees, hospital charges and out-of-pocket expenses to be paid after deducting estimated insurance reimbursement amount 11. Standardised policy terms and conditions - Minimise disputes over interpretation of terms and conditions 12. Premium transparency - Publish age-banded premium schedules We welcome your views on the VHIS. Please send us your views on or before 16 March 2015 through the contact below. Address : Healthcare Planning and Development Office, Food and Health Bureau, 19/F, East Wing, Central Government Offices, 2 Tim Mei Avenue, Tamar, Hong Kong Fax : (852) [email protected] Website : Note 1: Refers to indemnity hospital insurance. Note 2: Applicability of the Minimum Requirements differs between different insurance plans. Please refer to the Consultation Document for details. Note 3: Doctor and hospital/ institution providing services would be specified by insurer

3 [Page 2] Product Design Standard Plan - A health insurance Note 1 plan that meets (but not exceeding) all 12 Minimum Requirements, offering basic protection - Insurers must offer to all consumers who want to take out health insurance Flexi Plan - A health insurance plan that provides enhanced benefits to Standard Plan (e.g. higher benefit limits) - Comply with Minimum Requirements Top-up Plan - A plan (e.g. savings plans, critical illness plans, income protection plans) that provides benefits other than those in the nature of health insurance - Not required to comply with Minimum Requirements Group Health Insurance Insurers must offer Conversion Option to employers who take out group health insurance. The option allows employees to switch to an individual Standard Plan without re-underwriting upon retirement or leaving employment Employees may procure at their own cost Voluntary Supplements offered by insurers. The group policy, enhanced by the Voluntary Supplement, should provide insurance protection at a level comparable to the protection of an individual Standard Plan Group health insurance will not be subject to the Minimum Requirements, but employees have the right to know whether their group plan is compliant with the Minimum Requirements Financial Incentives Policyholders can claim tax deduction in respect of : - premiums paid for Standard Plans and Flexi Plans by policyholders (and their dependants) Note 2 ; and - premiums paid by employees for Voluntary Supplements Migration Within the first year of implementation of the VHIS, if existing health insurance policyholders choose to migrate to the VHIS, their- - benefits in existing policies will not be re-underwritten; and - case-based exclusion in existing policies can be removed (may be re-underwritten and need to pay premium loading) If an insurer continues to administer the policy concerned, policyholder may choose to keep the existing policy (non-compliant policies not entitled to tax deduction)

4 High Risk Pool Provide Standard Plan coverage to high-risk individuals who are willing to use private healthcare services Premium loading is capped at 200% of standard premium to ensure that premiums are set at a reasonable level Regulatory Framework Set up a regulatory agency under the Food and Health Bureau to supervise the implementation and operation of the VHIS Implement, enforce and regularly review the Minimum Requirements having regard to market situation Coordinate with other regulatory and professional institutions/bodies in respect of matters related to the VHIS Consumer education on the VHIS Set up a mechanism to handle claims disputes Other Supporting Policies Review healthcare manpower planning - A Steering Committee has been set up; two universities in Hong Kong were commissioned to conduct strategic review on healthcare manpower planning and professional development Facilitate private healthcare service development - The Wong Chuk Hang site was awarded for construction of a new private hospital (providing about 500 hospital beds) - A number of existing private hospitals are undergoing redevelopment/expansion ( about 900 additional hospital beds) - Consider granting loan to assist the construction of non-profit-making private hospitals Review the regulation of private healthcare facilities - Covering price transparency, clinical governance, complaint management, regulation of facilities where high-risk medical procedures are conducted, etc., in order to enhance protection for patients and consumers Long-term Implications for the Healthcare System Better positioning of public and private healthcare services, such that the public system can focus on serving people in need - Some procedures will be shifted from the public sector to the private market ( in 2016 and in 2040) More cost-effective delivery of healthcare services - Patients can claim for reimbursement for prescribed ambulatory procedures without being hospitalised, thus better utilising healthcare resources - Enhancing transparency of healthcare services to facilitate market competition

5 Note 1: Refers to indemnity hospital health insurance Note 2: Top-up plans are not subject to Minimum Requirements and hence the corresponding portion of premium is not eligible for tax deduction For more information, please visit the website below: