The Consumer Council has put forward 14 recommendations for the consideration of the regulatory authorities and the private health insurance (PHI) industry, to foster a sustainable and beneficial market for Hong Kong consumers.

The recommendations are:

1. Standardise definitions of key policy terms
2. Improve the design of application forms to ask specific questions
3. Enhance transparency on change of policy terms, benefit and premium
4. Provide sample policy contracts on a publicly accessible platform
5. Provide clear explanations in writing and in plain language
6. Provide market and complaint statistics of PHI policies
7. Improve transparency of sources of reference for “Reasonable and Customary” charges
8. Provide pre-authorisation services for non-emergent services
9. Enhance intermediary training and improve administrative process
10. Strengthen consumer education
11. Extend entry age limit
12. Offer opt-out option for enhancements of non-core benefits
13. Provide coverage for unknown pre-existing conditions
14. No re-underwriting / enhance transparency on re-underwriting policy and conditions.

The way forward

The Consumer Council says that the 14 recommendations are the result of a rigorous study it has conducted on the key concerns of consumers, current offerings in the market, regulatory practices from selected jurisdictions and the opinions of stakeholders on the viability and practicality of the recommendations.

From the study findings, the Council considers that it should be a priority for stakeholders to join hands and take a progressive approach by imposing clear regulatory guidance to the PHI industry.

Consumers also play a very important part in this regard. They should enrich their knowledge of PHI, understand what protection they are looking for and which PHI products are suitable for their needs and must not hesitate to ask for clarification when there is doubt regarding benefits coverage and significance of key policy terms and conditions. Consumers are always encouraged to make a responsible and well-considered purchasing decision, says the Council.