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Understanding Medical Insurance

Protection of policy holders' interests

Medical insurance products in general

Under the Insurance Ordinance, the Insurance Authority (IA) has no statutory power to approve medical insurance products. However, all insurers and intermediaries carrying on medical insurance business in or from Hong Kong have to be authorised or licensed by the IA. To protect the interests of policy holders, the IA reviews the relevant documents and conducts on-site inspection to ensure that the insurers and licensed intermediaries adopt proper standards of conduct and engage in sound and prudent business practices.

Issued by the IA, the Guideline on Medical Insurance Business (GL 31) took effect in September 2020. It applies to all medical insurance business, including both individual and group medical insurance business. GL31 provides guidance on the standards and practices which are expected to be met in order to ensure fair treatment of customers across all aspects of medical insurance business, including selling, handling claims, after-sales, and the handling of complaints. 

Voluntary Health Insurance Scheme (VHIS)

As is the case for all insurers operating a medical insurance business, insurers participating in VHIS and their business practices are subject to the supervision of the IA under the Insurance Ordinance. Under the VHIS in particular, insurers providing certified plans 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. For details, please visit the VHIS website.

Lodging a complaint

Insurers should provide policy holders with information on channels and procedures for making complaints. If you are dissatisfied with the way in which your insurer has handled your application or claim, or with its claims decision, you can lodge a complaint through any of the channels provided by your insurer.

For claims-related complaints on individual insurance contracts of a monetary nature with a dispute value not exceeding HK$1,200,000, lodge your complaint with the Insurance Complaints Bureau.

If your complaints relate to the sale of VHIS products, you should approach the VHIS office under the Health Bureau.

To find out the different ways to lodge a complaint based on your own situation, please visit the IA website.