An excess is the fixed cash amount you pay towards a claim. You must choose one when you first apply for your health plan. You pay the excess for each medical condition, per period of cover.
Example: the excess in action
Mrs Smith breaks her arm in November and visits her doctor in January for a severe cold. When she purchased her plan, Mrs Smith chose a US$50 per claim excess. Since her two medical conditions are unrelated, Mrs Smith pays the excess for each condition.
Mrs Smith’s excess is ‘per claim’, so she doesn’t pay the excess again when we has follow-up consultations for her fractured arm. But if the programme of follow-up treatment spans the renewal date of Mrs Smith’s health plan, she would need to pay the US$50 excess again upon renewal.
You can choose from two excess types: –
• ‘Per claim’ excess – This is the amount you pay each time you make a new claim for a new medical condition.
• ‘Per annum’ excess – This is the total amount you’ll be out-of-pocket in a single period of cover. For example, if you choose a US$500 per annum excess, we will not pay the first US$500 of expenses you incur during your period of cover.
How to choose an excess
The right excess for you depends on your needs. We see the excess as a partnership between you and us: it helps us reduce our spending on medical treatment, and we pass on savings to your premium. As a rule of thumb, a higher excess means a lower premium.
Here are a couple of considerations that members typically make when choosing an excess: –
• ‘Catastrophe’ – Some members might choose an extremely high excess (e.g. US$5,000 per annum). Such an excess means their health plan serves as protection only against the most serious & expensive catastrophic health issues, such as cancer. These members probably won’t receive benefit for primary care & low-cost treatments, because these costs are unlikely to exceed US$5,000. As such, a ‘catastrophe’ excess is typically taken with a Bronze plan, which doesn’t have much cover for out-patient care anyway.
• ‘Maximum cover’ – For members wanting assurance that all their healthcare costs will be paid in full, the nil excess might be best. Since these members won’t be helping us to reduce our spending on medical treatment, there will be no savings for us to pass onto their premiums.
• ‘Balance’ – Most members opt for somewhere in the middle. They choose an excess that gives an acceptable fixed amount they’ll pay for each medical condition, in exchange for a reasonable saving on their premium.
|HK$400 / US$50 per claim||x||✔||✔|
|HK$800 / US$100 per claim||x||✔||✔|
|HK$2,000 / US$250 per annum||✔||✔||✔|
|HK$4,000 / US$500 per annum||✔||✔||✔|
|HK$6,000 / US$800 per claim||✔||✔||✔|
|HK$8,000 / US$1,000 per annum||✔||✔||✔|
|HK$12,500 / US$1,600 per claim||✔||✔||✔|
|HK$20,000 / US$2,500 per annum||✔||✔||✔|
|HK$40,000 / US$5,000 per annum||✔||✔||✔|
|HK$80,000 / US$10,000 per annum||✔||✔||✔|