MEDICAL MARKET DEVELOPMENT AND OUTLOOK: VHIS AND BEYOND

Transcription

1 MEDICAL MARKET DEVELOPMENT AND OUTLOOK: VHIS AND BEYOND ASHK Healthcare Seminar Sustainable Healthcare Protection Elaine Chan October 13, 2017

2 Total no. of insured memberships Medical Insurance Market penetration Individual market has a penetration rate of 44.4% and corporate market 32.1% only 6,000,000 5,000,000 4,000,000 3,499,841 3,701,441 4,002,696 4,201,289 4,372,322 4,675,091 5,008,240 5,145,220 Ind Cash Ind RMed Group Total 3,000,000 2,000,000 1,000,000 2,121,889 1,906,482 1,791,899 1,851,664 1,565,395 1,642,787 1,499,476 1,549,715 1,657,126 1,704,548 1,780,061 1,741, , , , , , ,259 2,482,350 2,226,502 1,854,755 1,895, , ,736 - Source: HKFI Medical Insurance Business Statistic

3 Average Premium in HKD 3 Medical Insurance Market Growth Average premium per member grew YOY by 5.0% and 5.7% in the past 7 years for reimbursement medical Individual and Group respectively 5,000 4,500 4,000 3,500 3,000 2,500 3,168 3,330 3,061 3,198 2,883 2,942 3,519 3,333 3,173 3,919 3,468 3,293 4,091 3,816 3,460 4,413 4,531 3,886 4,055 3,566 3,676 4,679 4,303 3,956 Ind Cash Ind RMed Group 2,000 1,500 1,000 1, , ,052 1,032 1,130 1,045 Ind Rmed & Group Average Source: HKFI Medical Insurance Business Statistic

4 Health Protection Scheme (HPS) Voluntary Health Insurance Scheme (VHIS)

5 168. The Government plans to implement the Voluntary Health Insurance Scheme in 2018 and will amend tax legislation to offer tax incentives for members of the public who procure such health insurance products. To harness the potential of new technology for better public health policies and clinical outcomes, we will set up a steering committee to lead the study on strategies for developing genomic medicine in Hong Kong.

6 VHIS 10 minimum requirements 1 Guaranteed renewal 6 Minimum benefit limits 2 No lifetime benefit Limit 7 Cost-sharing restrictions Coverage of pre-existing conditions Coverage of hospitalization and prescribed ambulatory Coverage of prescribed advanced diagnostic imaging tests and non-surgical cancer 8 Budget certainty 9 Standardized policy terms and conditions 10 Premium transparency

7 Implementation Framework The VHIS is confined to individual hospital insurance there are two types of VHIS compliant products, namely the Standard Plan and Flexi Plan With tax incentive VHIS compliant products 1. Meeting 10 minimum requirements 2. Insurance company can voluntary opt to join Individual Hospital Indemnity Standard Plan Flexi Plans Group Medical Indemnity Without tax incentive Critical Illness Outpatient Hospital Cash Plans

8 Implementation Framework

9 Implementation Framework A new Guidance Note by IIA Provide guidelines on various aspects of individual Hospital Insurance business according to the principle of fair treatment 保監局的新指引 of consumers Recommend insurers to comply with VHIS practice guidelines Practice Guidelines by FHB Define compliant products and other scheme requirements and guidelines 食物及衛生局的執行指引 Insurance Claims Complaint Bureau

10 The Timeline Where are we VHIS Policy Direction Implementation Framework Implementation Details Scheme Roll-out (within 2018) Consultations on the implementation details, development of VHIS practice guidelines and related arrangements, e.g. : Standard policy terms and conditions Guidelines on exclusion of pre-existing conditions Indicative standard premium schedule of VHIS Standard Plan Other details e.g. the review mechanism for regular update, or service guidelines etc Approve legislative amendment to effect individual tax deduction

11 Opportunity and Implication Opportunity Implication Attract of new customers Regulatory restriction Migrate and upgrade existing products Migration complexity Create baseline coverage of Group Medical Alignment of provisions among other products

12 Preparation Products Segment Distribution & Backend Basic Plan Minimum Benefits Standard provision e.g. guarantee renewal Basic Plan Minimum Benefits Standard provision e.g. guarantee renewal Top Up Add on coverage e.g. SMM Flexible provisions Bundle Plan (Basic + Top Up) Higher benefit level including high end medical Flexible and better provision e.g. no copay Existing Book of 3.1m population 1. Options of migration with or without underwriting 2. Cater for various customer need e.g. lower / higher level, multiple policies Opportunity of 4.2m Non-insured population 1. Segmentation 2. Eligible and non eligible group 3. Extend to group medical 1. Distribution Strategy 2. Operation flow 3. Pre-notification 4. Claim control 5. Other policies alignment Tax Incentive

13 And BEYOND..

14 Product Trend in last 30 years 90 s 00 s 10 s Customer needs And more Product Pay & Claim Defined benefits Full cover Cashless Network TPA Disease Oriented Technology SMO Wellness Ongoing Gaps Increasing demand of medical coverage Increase medical cost Operation efficiency Customer demand by all means How to be unique? Disruptive product? Develop own solution? 14

15 1 VOC Voice of Customer I don t understand how the medical insurance be read I just paid for medical premium but never claim How should I buy medical insurance Why claim submission is so complicated I already have my medical insurance 10+ years ago

16 Going Forward and Evolution A Wellness program aim to provide preventive, educational solutions to members Operation Efficiency and one stop customer journey. Claim submission, biometric reading, medical advice, live chat etc Simple with cost containment element Single lump sum, Cover the uncover, network with incentive etc Collateral features to engage your customer for both pre and post care Check up, rehabilitation, alternative medicine etc

17 Formula NEVER Change A Wellness program aim to provide preventive, educational solutions to members Operational efficiency High volume claim transactions with increasing administration cost Need to explore innovative way to ease these administrative burden Cost Control Fraud / Abuse claim control is another key issue Network management and product structure are another way to go for cost containment Penetration Still pay for high above the line cost?? Digital marketing with TM support Penetration with viral effect 17

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