Insurers' policies criticised for exclusions and poor benefits Doctors have criticised some medical insurance plans as unrealistic, saying they offer too few benefits and contain too many exclusions. In some cases, doctors say, policies are limited to people under the age of 65 and exclude some congenital disorders and mental-health problems. The Medical Association is negotiating with the Federation of Insurers to remove some barriers in the hope of providing patients with better protection and encouraging more people to take out medical insurance. It is also drawing up a standard basic medical insurance plan, which it hopes all insurers will be able to provide. It is expected tax incentives to encourage people to take out medical insurance will be part of the government's consultation on health care reform later this year. Doctors said some plans offered so few benefits that patients who had planned to book into private hospitals for surgery ended up having to go back to the public sector. Fewer than 3 million people in the city are covered by medical insurance policies. Nearly half are employees whose companies pay for the insurance. Total expenditure on health care services is about HK$60 billion a year, of which only 7 per cent to 8 per cent is paid by insurers. The South China Morning Post surveyed a number of medical insurance plans provided by the five main insurers - AIA, HSBC, Manulife, AXA and Bupa. Most exclude mental-health problems and set an age limit of about 60 to 65 years. Some even offer special benefits to policyholders if they stay in public wards. One policy even offers up to HK$750 in cash per day if the patient stays in a public ward, where charges are often as low as HK$100 per day. Although such benefits may lure patients to use public services to 'earn' the extra money, the burden is increased on the public health-care sector. Meanwhile, an AXA package that sells on the basis that holders can enjoy cover for as little as HK$1.20 a day only offers HK$300 a day for a hospital stay, which would hardly cover the daily room charge in a private hospital. Chan Man-kam, a council member of the Medical Association, said it was common for patients to overlook the contents of their insurance plans before they fell sick. He said some plans only allowed patients to claim HK$500 per day for a hospital stay, which barely covered the lowest room charges in private hospitals. 'On top of the room charges, the patients also need to pay for different services, such as laboratory tests and meals. Such insurance plans are nearly meaningless to patients if they can't enjoy the private hospital services.' He said exclusions based on age, or the fact that policyholders may be recovering from previous illnesses, were unreasonable and suggested that insurers could charge higher premiums rather than rejecting them outright. He said medical insurance coverage often excluded psychiatric and hereditary illnesses, which could affect a person's earning power. For example, he said, many insurance plans excluded hereditary illnesses such as polycystic kidney disease which could still affect a person's ability to earn, while most patients had seizures only in their 20s. He suggested that as long as a person did not have the disease in a health check before the insurance policy came into effect, the insurers should accept the application and protect their clients. Peter Tam Chung-ho, executive director of the Federation of Insurers, admitted that some insurance plans might not offer attractive benefits. He said the root of the problem was that the number of people taking out medical insurance in Hong Kong was small and the pool of policyholders sharing the risk was not yet big enough. Premiums could be lower and coverage greater if more people took out medical insurance. For example, if every one of the 3 million working population paid HK$3,000 per year in medical insurance, the risk pooling would be nearly HK$10 billion per year, which would spread the insurers' risk. 'We recognise that there can be greater development of medical insurance and we would like to co-operate with doctors to better meet the needs of patients,' Mr Tam said. Last year, the Consumer Council received 81 complaints about medical insurers, 14 more than in 2005, and 32 complaints between January and May of this year.