Outpatient Medical Insurance Comparison 2025

Many people in Hong Kong do not have company group medical insurance, therefore when they visit a private clinic even for cold and flu, they need to pay for themselves. To help reduce the medical expenses, some insurance companies now offer standalone outpatient medical insurance plans. Apart from general practitioners, specialist and Chinese medicine consultation, some outpatient insurance plans also cover X-ray diagnosis, laboratory tests, physiotherapy, Chinese bone setting, and even outpatient surgery and cancer treatment. 

The 10Life editorial team analyzed and compared 9 outpatient insurances on the market, including AIA (note 1), Blue, Blue Cross, BOCG, Cigna, Prudential, and Zurich, in order to assist readers in choosing the suitable product.

Let’s start with a brief comparison of the basic benefits and price of each outpatient insurance product. 

Let's introduce the term "co-payment," which is the cost that one needs to bear themselves. If you purchase medical insurance that includes a co-payment, the policyholder needs to first pay the designated co-payment amount for medical expenses, and the insurance company will cover the portion that exceeds the co-payment.

In Table 1, the co-payment for Outpatient for General Practice ranges from $20 to $220. Using the fees at one of Hong Kong's top private medical facilities as a reference, the standard consultation fee at Hong Kong Sanatorium & Hospital is $400. Assuming you have purchased outpatient insurance with a co-payment of $220, you can only claim back $180 from the insurance company. When choosing outpatient insurance with different co-payment amounts, the insured should consider the usual consultation fees at clinics and calculate whether the insurance can cover the consultation fees after deducting the co-payment. Policyholders should also pay attention to the relationship between premiums and co-payments; the lower the co-payment, the higher the premium, and vice versa. A savvy consumer would calculate the expected number of doctor visits in a year to check if the outpatient insurance is cost effective. 

While outpatient insurance can help reduce the cost of outpatient visits, it is important to note that related medical services are often restricted to the network doctors of the insurance company. Before purchase, consumers are recommended to check the network doctor list with their advisor or insurance company to see if their preferred doctors are on the list.

In Table 1, both Blue WeMedi Top Up and BOCG Outpatient Insurance are not limited by network doctors. As long as the policyholder has successfully claimed from another insurance company, these plans will compensate for the remaining outpatient expenses that have already been claimed, making it a good companion with company medical insurances.

Blue WeMedi Outpatient Protector provides dental services, covering oral examinations and teeth cleaning.

On the other hand, Blue Cross, Cigna and Prudential offer additional coverage for clinical surgery (subject to recommendations of network doctors). Common clinical procedures include colonoscopy, hemorrhoid removal and many more. Cigna offers the highest benefit among all products, covering HK$15,000 per condition with a maximum of HK$100,000 per policy year.

In addition, AIA provides coverage for cancer. Take wardroom as an example, AIA covers as much as HK$200,000 annually, with HK$600,000 lifetime limit, including full coverage for cancer treatment with a daily hospital cash benefit of HK$400 (up to 90 days). 

Like other insurance, outpatient insurance also has exclusions and limitations. Common exclusions include treatment for congenital defects or diseases, cosmetic-related treatment, intentional self-inflicted injury, treatment for pregnancy, miscarriage, abortion, and chronic diseases.

1. Although AIA Health Journey Guardian provides outpatient coverage, it is not purely outpatient insurance. It also provides hospitalization coverage for cancer treatment, etc. Its premium will increase with age.
2. The above information is updated as of 22 Jan 2025.