Chow Tai Fook ''TopCare'' Medical Insurance Plan is a Flexi Plan certified under the Voluntary Health Insurance Scheme, certification number F00037-08-000-03. It entitles the insured to a private room and covers treatment worldwide.
| Age | Annual premium |
|---|---|
| 30 | HK$2,610 |
| 45 | HK$4,213 |
| 60 | HK$7,154 |
| 75 | HK$14,018 |
Female non-smoker, the plan currency, before levy. Age is the only thing that changes down this table; it is the plan's own filed schedule, not a quotation.
| Room | Private |
|---|---|
| Geographical cover | worldwide |
| Annual limit | None |
| Lifetime limit | None |
| Room and board | HK$675 |
| Hospital charges | HK$4,650 |
| Doctor's visits | HK$585 |
| Specialist fees | HK$1,940 |
| Intensive care | HK$1,940 |
| Surgeon's fee | HK$20,650 |
| Anaesthetist | As stated in the schedule |
| Operating theatre | As stated in the schedule |
| Diagnostic imaging | HK$5,165 |
| Non-surgical cancer treatment | HK$20,650 |
| Outpatient before and after | HK$1,295 |
| Psychiatric treatment | HK$10,325 |
Also includes outpatient general, dental, maternity, chinese medicine, home nursing, a companion bed, hospital cash, rehabilitation, hospice care, kidney dialysis, a death benefit.
Read from the certified Terms and Benefits. Each page link opens that page of the filed document. Fields the document does not state are left out.
| Guaranteed renewal to age | 128 p.2 |
|---|---|
| Pre-existing conditions unknown at application | First 30 days of the first Policy Year no coverage; 31st day of the first Policy Year onwards full coverage p.20 |
| Waiting period | 30 days for Pre-existing Condition(s) unknown at application p.20 |
| Cancellation and refund | Full refund within 21-day cooling-off period if no benefit payment. After cooling-off, cancellation by 30 days notice, no refund if benefit paid in Policy Year. p.2 |
| Switching from another plan | Policy Holder can request to switch to another plan with upgrade or downgrade of benefits, subject to re-underwriting for upgrades/additions. p.2 |
| Room class | Standard Private Room p.46 |
| If a higher room is used | If Confined in a higher ward class, coinsurance applies: Ward to Semi-Private 50%; Ward to Standard Private or above 75%; Semi-Private to Standard Private 50%; Semi-Private to Above Standard Private 75%; Standard Private to Above Standard Private 50%. p.41 |
| Geographical cover | Worldwide, except for psychiatric treatment p.20 |
| Psychiatric treatment area | Hong Kong only p.20 |
| Emergency treatment abroad | Covered, as part of worldwide cover p.20 |
| Full cover on core benefits | no p.46 |
| Annual limit | Nil p.49 |
| Lifetime limit | Nil p.49 |
| Deductible options | not stated |
| How the deductible applies | not stated |
| Coinsurance | 15% for major medical benefit; 30% for Prescribed Diagnostic Imaging Tests (Confinement); 20% for Prescribed Diagnostic Imaging Tests (Day Patient) p.46 |
| Pre-admission outpatient | 1 prior outpatient visit or Emergency consultation per Confinement/Day Case Procedure, up to $210 per visit, up to $1,295 per Policy Year p.46 |
| Post-discharge outpatient | 6 follow-up outpatient visits per Confinement/Day Case Procedure (within 90 days after discharge), up to $210 per visit, up to $1,295 per Policy Year p.46 |
| General outpatient | none |
| Psychiatric treatment | USD10,325 per Policy Year p.46 |
| Diagnostic imaging coinsurance | 30% for Confinement, 20% for Day Patient p.46 |
| Non-surgical cancer treatment | USD20,650 per Policy Year (basic); USD20,650 per Benefit Period (Major Cancer top up) p.47 |
| Kidney dialysis | USD19,355 per Policy Year p.47 |
| Day case procedures | Covered as in-patient, plus USD260 cash allowance per Day Case Procedure, once per Policy Year p.47 |
| Home nursing | USD260 per visit, 1 visit per day within 90 days after discharge, 30 visits per Policy Year p.46 |
| Hospice care | USD10,325 per Policy Year p.47 |
| Chinese medicine | Inpatient: same limits as miscellaneous charges and attending doctor's visit fee. Outpatient: 3 follow-up visits (within 90 days after discharge), USD155 per visit, up to USD520 per Policy Year. p.47 |
| Physiotherapy | During Confinement: covered under miscellaneous charges. Post-discharge: covered under pre- and post-Confinement/Day Case Procedure outpatient care. p.21 |
| Congenital conditions | Excluded if manifested or diagnosed before age 8 p.26 |
| Pregnancy complications | Eligible Expenses or actual expenses payable for Covered Pregnancy Complications shall be subject to the respective limits of basic and additional benefits p.47 |
| Emergency dental | Covered within 30 days of Accident, included in Emergency outpatient treatment (Accident) limit of USD3,875 per Policy Year p.47 |
| Hospital cash | USD155 per day, maximum 15 days per Policy Year, for staying in a lower ward class than entitled p.47 |
| Companion bed | Fully Covered, maximum 180 days per Policy Year p.46 |
| Second medical opinion | not stated |
| Direct billing and pre-authorisation | not stated |
| No-claim discount | 16% discount on premium. Reduced to 8% if Specified Benefits claimed, then 0%. Resumes 16% after 3 consecutive no-claim Policy Years. p.38 |
| Exclusions beyond the VHIS standard list | Expenses for treatments not Medically Necessary; Dependence, overdose or influence of drugs, alcohol, narcotics; Prophylactic treatment or preventive care; Purchase of durable medical equipment or appliances; Traditional Chinese medicine treatment (unless covered by additional benefit); Expenses reimbursed by other parties p.26 |
At a constant age of 45, Chow Tai Fook has filed 4 schedule changes on this plan since 2021, an average of +3.7% a year, taking the premium from HK$3,260 to HK$4,213.
| Year | Change |
|---|---|
| 2022 | +8.0% |
| 2023 | +8.0% |
| 2024 | +10.0% |
| 2025 | +0.7% |
| 2026 | no change |
A record of what has been filed, not a forecast of what you will pay.
| Option | Room | Deductible | Annual limit |
|---|---|---|---|
| Benefit Level 4 with SMM (USD) | Private | None | No annual limit |
| Benefit Level 4 with SMM (USD) | Private | None | No annual limit |
| Benefit Level 4 with SMM (USD) | Private | None | No annual limit |
| Benefit Level 4 with SMM (USD) | Private | None | No annual limit |
| Benefit Level 4 with SMM (USD) | Private | None | No annual limit |
| Benefit Level 4 with SMM (USD) | Private | None | No annual limit |
| Benefit Level 4 with SMM (USD) | Private | None | No annual limit |
| Benefit Level 4 with SMM (USD) | Private | None | No annual limit |
Private hospitals publish what they billed for common operations. These pages take those bills and work out what a plan pays of them.
Every procedure with published bills
The certified plan document as filed, on the Health Bureau's VHIS site.