Health Insurance Claims

When you choose CCW Global as your Hong Kong health insurance broker you are able to receive comprehensive support and assistance for all aspects of your policy, including the claims process.

The purpose of a Hong Kong health insurance plan is to cover you against the costs of healthcare treatment which you may receive, both in Hong Kong and around the world. In many cases in order for the policy to cover your healthcare expenses you will need to submit a claim for reimbursement, and this consequently means that the claims procedure of a plan is one of the most important aspects to consider when selecting a medical insurance policy in Hong Kong.

You need to be sure that your insurance provider will be able to speedily settle any and all outstanding claims on your plan.

CCW chooses to work only with Hong Kong Health Insurance Companies which have demonstrated exceptional claims procedures, ensuring that our clients will always receive reimbursement and settlement of their claims in a quick and efficient manner.

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Outpatient Claims in Hong Kong

Outpatient Healthcare claims will normally be settled by the policyholder at the treating medical facility. You will typically pay the healthcare provider after receiving treatment and then submit a claim for reimbursement to the insurance company.

Once the outpatient claim has been received, and approved as eligible under the policy, the insurance company will then reimburse you the full cost of treatment minus any applicable deductibles.

However, many Hong Kong health insurance companies have extensive Direct Settlement networks which streamline the process of receiving, and paying for, outpatient medical treatment in Hong Kong. A direct settlement network is usually a group of healthcare provider with which the insurance company has payment agreements.

If you are receiving medical treatment with a healthcare provider included in your HK medical insurance plan’s direct settlement network all you need to do is provide your policy details to the receptionist and the insurer will liaise directly with the facility to arrange payment of the treatment costs. You will still be responsible for paying your deductible to the healthcare provider, but all remaining expenses will be settled directly.

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Inpatient Claims in Hong Kong

Inpatient Healthcare will normally be the most expensive medical treatment you receive during the course of your lifetime. Because of the costs associated with inpatient medical care are extremely high paying for your treatment and receiving reimbursement from the insurance company may not be the most feasible option.

Many inpatient treatments will be scheduled in advance of your entering hospital. If you have a scheduled treatment then you will need to complete a Treatment Guarantee Form and submit this to the insurance company. The insurer will then contact the hospital to arrange direct payment, minus your deductibles, even if the hospital is outside of the insurers direct settlement network.

However, in an emergency situation where there no advance warning that you will be going to hospital completing a treatment guarantee form may not be possible. Should you suffer an accident or illness which requires immediate hospitalization then either you, or someone you are close to, should contact your insurance company as soon as possible after the incident. The insurer will then contact the hospital to ensure prompt payment of your bills.

In some, extremely rare, cases it may not be possible for the insurer to contact the hospital and arrange payment in an emergency situation. In this instance you would need to settle the bill personally and then submit a claim to the insurance company for reimbursement.


Why Claims are Rejected

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Incomplete Claims Documentation

The biggest impediment in the Hong Kong health insurance claims process is incomplete documentation and claims paperwork.

To ensure that your claim is processed quickly it is imperative that you provide all the documentation requested by the insurance company. This includes a claims form, doctors’ signatures and statements, treatment receipts and all other supporting documentation.

When submitting your claims documentation it is a good idea to make copies of all the paperwork you will be providing to the insurance company. This will help you ensure that even if something gets lost in the post you will still be able to provide the requisite details to the insurer.

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Pre-Existing Medical Conditions

The second major obstacle to a successful claim in Hong Kong is in relation to a pre-existing medical condition. Unless otherwise specified by your HK medical insurance policy, pre-existing conditions will typically be excluded from coverage and will not be eligible for reimbursement under the plan.

Claims for pre-existing conditions will normally be denied outright unless coverage has been offered.

Additionally, claims made for coverage benefits where there is a waiting period will only be approved and reimbursed only if the treatment was received after the waiting period has expired. For example, if you are trying to make a claim under your Hong Kong Maternity Insurance plan and the pregnancy benefit has a 10 month waiting period, it is only treatment which has been received after 10 months which can be claimed for under the policy.

Keeping with the maternity example, it is important to note that you cannot receive treatment at 9 months and then submit a claim at 10 months, after the waiting period has expired. It is only treatment which has been received after the expiry of the waiting period which is eligible for reimbursement under a Hong Kong medical insurance plan.

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Claims Support and Free Health Insurance Quotes

If you would like to learn more about the claims support and assistance offered by CCW to our customers in Hong Kong please Contact Us Today. Our expert Hong Kong Insurance Brokers will be happy to answer any questions you may have about the HK medical insurance claims process.

If you would like to receive a free, customized quotation comparison for a range of comprehensive Hong Kong health insurance policies you can request that by completing the short form here. A CCW advisor will contact you shortly with your comparison overview.

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