How can SMEs in Hong Kong choose group medical insurance tailored to their budget and employees’ needs?

For a Hong Kong SME, the best group medical insurance plan is not necessarily the one with the highest limits. It should protect employees against medical expenses, provide practical access to healthcare services, and remain affordable at renewal. SME employers should start by considering inpatient and surgical coverage as the core benefit, then decide whether optional benefits, such as outpatient, supplementary major medical (SMM) and dental benefits are necessary for their employees based on their needs and budget. 

To manage costs, employers may consider different reimbursement percentage levels, such as 80% or 100% reimbursement. In addition, when comparing plans, employers should evaluate factors such as network provider access, claims administration and renewal arrangements, rather than focusing solely on the initial premium.

Before comparing proposals, SMEs should prepare a clear set of requirements outlining their workforce profile, benefit objectives and budget. This helps insurers provide quotations based on consistent assumptions, allowing employers to make meaningful like-for-like comparisons.

• Eligible population: The number of permanent full-time employees to be covered, their work locations, and whether dependent coverage for spouses and/or children is required. Dependent coverage cannot be offered on a selective basis. If spouse and child coverage is included, it should be provided consistently to the spouses and children of all eligible employees within the same employee category.
• Workforce profile: Factors such as company business nature, age distribution, job title, job nature, length of service, travel requirements can help estimate healthcare needs and expected plan utilisation. These factors may influence plan design and budgeting, but benefit eligibility and coverage levels should be based on the company's documented HR policies and applied consistently across employees in the same category.
• Budget: The total annual budget, target cost per employee and a sustainable budget range for future renewal.
• Benefits objective: Whether the primary goal is to provide protection again major medical expenses, support employees’ day-to-day healthcare needs, strengthen recruitment and retention efforts, or achieve a combination of these objectives.
• Administration: Assign designated personnel to manage enrolment, employee additions and deletions, employee general enquiries, claims related questions and policy renewal.

Under the current MSIG SME Group Medical Insurance eligibility rules, a scheme may start with minimum two employees. All eligible permanent full-time employees must enrol. Employees must be under age 65 upon initial enrolment and may renew up to age 69, subject to the policy terms and conditions.

For groups with four employees or fewer, individual health declarations are required. For groups with five or more employees, individual health declarations are not required. These requirements may affect both enrolment and onboarding timeline, so employers should confirm the number of employees before requesting a quotation or submitting an application.

When designing a company medical insurance plan, employers should consider their employees' healthcare needs, the company's budget and HR policy. Different benefit levels may be offered to different employee groups based on objective criteria such as job grade, employee category or length of service.

Hospitalisation can result in the largest medical expenses for employee, so inpatient and surgical benefits are typically the foundation of a group medical insurance scheme. When comparing plans, employers should review key benefits such as the entitled room class, room and board limit, hospital miscellaneous expenses, surgical benefits, anaesthetist and operating theatre fees, specialist consultations, intensive care benefits and other benefit sub-limits. A plan with high overall maximum benefit may still leave employees with a significant out-of-pocket expense if specific benefit limits are inadequate.

MSIG offers six Hospitalisation and Surgical Plans. Employees enrolled in Plans 1 to 3 are entitled to accommodation in a general ward, Plan 4 provides coverage for a semi-private room, while Plans 5 and 6 include coverage for a standard private room. Eligible inpatient expenses are reimbursed at 100% of the covered costs, subject to the applicable benefit limits.

For SMEs with tighter budgets, a general ward plan can provide essential protection against major hospital expenses at a more affordable cost. Companies that wish to offer employees greater provider choice and access to private healthcare facilities may consider semi-private or standard private-room plans. MSIG also allows different hospitalisation plans for employee groups defined under the employer's documented HR policy, such as job grade, employee category or length of service, subject to the applicable eligibility requirements. To ensure fairness and consistency, employees within the same category should be enrolled in the same benefit plan.

Outpatient benefits are among the most commonly used employee medical benefits . Depending on the plan selected, outpatient coverage usually include general practitioner consultations, specialist consultations, Chinese medicine, physiotherapy or chiropractic treatment, diagnostic tests, prescribed medicines, routine health screenings and vaccinations.

When evaluating outpatient benefits, employers should consider several key factors beyond the headline coverage limits. In particular, it is important to understand:

• The number of visits allowed per year for each type of service;
• The applicable per-visit, per-item, or annual benefit limits;
• Whether referrals are required for specialist consultations or specific treatments; and
• Whether employees can access services through a network provider using an electronic medical card, or if they are required to pay upfront and submit a reimbursement claim afterward.

A clear understanding of these features will help ensure that the selected outpatient plan meets employees' healthcare needs while providing a convenient claims experience.

MSIG’s optional outpatient benefit allows employers to choose either 100% or 80% reimbursement, subject to the applicable benefit limits. Employees can access eligible consultations at network clinics using MSIG’s e-Medical Card, allowing direct settlement of covered expenses without upfront payment. For services such as acupuncture, Tui Na, and chiropractic treatment, employees need to pay and claim in accordance with the policy terms and conditions. 

When introducing the plan, employers should explain which services are available through the medical network and which require reimbursement claims. This helps employees understand how to use their benefits and avoid unexpected out-of-pocket expenses.

For employees facing complex medical conditions, major surgeries, or prolonged hospital stays, medical expenses may exceed the limits provided under the basic Hospitalisation and Surgical Plan. To enhance financial protection, MSIG’s Optional Supplementary Major Medical (SMM) Benefit provides an additional layer of coverage by reimbursing eligible medical expenses that exceed the basic inpatient benefit limits, subject to the policy terms and conditions. This extra safeguard helps reduce employees’ out-of-pocket costs and provides greater peace of mind when substantial medical treatment is required.

With the current MSIG SME Group Medical Insurance plan, the SMM benefit is linked with the selected hospital plan level. Once the applicable benefit limits under the basic hospital plan have been exhausted, the SMM Benefit reimburses 80% of eligible over-limit expenses, after applying a deductible of HK$1,000 per disability per policy year, up to the maximum SMM limit of the selected plan. By extending protection beyond the basic inpatient limits, the SMM Benefit can significantly reduce the financial burden associated with unexpected high-cost hospital treatments, allowing employees to focus on their recovery with greater confidence.

Dental benefits can enhance the overall value of a company medical insurance by supporting employees’ routine oral healthcare needs. When comparing dental plans, employers should consider factors such as the annual benefit limit, reimbursement percentage, dental service scope, network arrangements and treatment-specific limits. MSIG allows employers to select any of six dental levels independently of the hospital plan and to choose 100% or 80% reimbursement, subject to the benefit limits.

In addition to dental coverage, employers may consider optional benefits such as Personal Accident Insurance for employees. These benefits can provide broader protection and enhance the overall employee benefits package. When considering optional cover, employers should clearly understand the associated costs.

The reimbursement percentage determines how eligible expenses are shared, but it is always subject to the benefit limits, number of visit, annual limits and exclusions specified under the policy.

For example, if an eligible outpatient bill is HK$500 and the applicable plan limit is HK$500, an employee under a 100% reimbursement plan may be reimbursed the full eligible amount. Under an 80% reimbursement plan, the insurer may reimburse HK$400 and the employee pays the remaining HK$100. However, If the plan’s applicable limit is only HK$350, reimbursement will be capped at that limit regardless of the reimbursement percentage. The actual reimbursement amount is subject to the policy terms and benefit schedule.

An 80% reimbursement option may help reduce premium costs while encouraging employees to share a portion of their healthcare expenses. A 100% reimbursement option generally provides a simpler and more comprehensive employee benefit, reducing out-of-pocket expenses for routine medical care.

When comparing options, employers should consider both the premium savings and the employee experience. Requesting quotations for both reimbursement levels can help determine whether the cost savings justify the additional out-of-pocket expenses that employees may incur. In some cases, an 80% reimbursement arrangement may offer a good balance between cost control and employee benefits, while a 100% reimbursement arrangement may be preferred where providing more comprehensive healthcare support is a priority.

When evaluating a group medical insurance plan, employers should consider the healthcare network and digital services available to employees, as these can significantly enhance convenience and improve the overall member experience.

MSIG's SME Group Medical Insurance provides access to a network of medical providers and a range of cashless healthcare services. For eligible outpatient consultations at network clinics, employees can use the MSIG e-Medical Card for direct billing without the need to pay upfront and submit a claim afterwards. For eligible hospital treatments, employees may also benefit from Guarantee of Payment (GOP) arrangements at designated hospitals, subject to pre-authorisation and policy terms and conditions.

Employees can manage their medical benefits through MediGo, MSIG's digital health platform, which allows them to:

• View their benefit;
• Access to the electronic medical card;
• Online claim submission;
• Check claim status and claims history;
• Access the latest and full network doctor list;
• Access designated healthcare programmes and services; and
• Submit enquiries through the online platform.

In addition, MSIG offers dedicated programmes for selected medical treatments, including day-case endoscopy services and specified viral wart and skin lesion treatments through designated providers, subject to the applicable terms, eligibility requirements and pre-authorisation procedures.

By combining provider network access, cashless services and digital claim management, employers can help employees access healthcare more conveniently while reducing the administrative burden associated with medical claims.

When selecting a group medical insurance plan, employers should consider not only the initial premium but also how the plan operates at renewal. For SME group medical insurance schemes, premiums are typically reviewed periodically and may be adjusted to reflect factors such as medical inflation, healthcare cost trends and product experience.

Under MSIG's SME Group Medical Insurance, premiums are payable annually in advance. Renewal premiums may be revised from time to time on a portfolio basis. Employees and their spouses may remain insured up to age 69, subject to the policy terms and conditions.
Before each renewal, employers should:

• Review whether the current plan continues to meet the needs of their employees;
• Confirm the latest employee census and dependent information;
• Assess whether the selected benefit level remains appropriate for the company's budget; and
• Consider available plan options if a different level of coverage is preferred.

As medical costs generally increase over time, employers should take potential premium adjustments into account when planning their employee benefits budget. A sustainable medical insurance programme should balance employee healthcare needs with the company's long-term affordability.

For employees who wish to enhance their medical protection beyond the coverage provided by their MSIG Group Medical Insurance plan, the MSIG Employee Top Up Medical Insurance offers an additional layer of hospitalisation coverage. Available exclusively to eligible members of an MSIG Group Medical Insurance policy, the top-up plan operates independently with its own benefits, deductibles, enrolment requirements, and renewal terms. As it is a voluntary plan purchased and maintained by the employee, it should be communicated separately from the employer-sponsored SME medical plan. Presenting both solutions side by side enables employees to clearly differentiate between their company-provided coverage and optional personal protection.

Before committing to a group medical insurance policy, SMEs should clarify the following:

• Are all permanent full-time employees required to join, and how are new joiners and leavers handled?
• Which room level and hospital sub-limits apply to each employee group?
• Does outpatient or dental reimburse 80% or 100%, and what visit or annual limits still apply?
• Which services use an e-medical card, which require reimbursement and when is referral or pre-authorisation necessary?
• How are pre-existing conditions, waiting periods and continuity treated?
• What exclusions and room-level adjustments could create a large employee shortfall?
• How will premiums and plan terms be reviewed at renewal?

1. Is group medical insurance compulsory for Hong Kong SMEs?

   No. Group medical insurance is generally a voluntary employee benefit and is separate from the statutory Employees' Compensation Insurance that employers in Hong Kong are required to maintain. While it is not a legal requirement, many SMEs offer group medical insurance as part of their employee benefits package to support staff wellbeing, enhance employee retention and remain competitive in attracting talent. When considering employee benefits, employers should ensure they comply with all applicable legal and regulatory requirements and seek professional advice where appropriate.

2. How many employees are needed for MSIG SME Group Medical Insurance?

   The current requirement is a minimum of two employees. All eligible permanent full-time employees must enrol. A group with four employees or fewer requires individual health declarations. For a company with five or more employees, no individual health declaration is required, subject to the product terms.

3. Should a small company buy outpatient or supplementary major medical first?

   The answer depends on the company's priorities, workforce needs and budget. Outpatient coverage supports employees' day-to-day healthcare needs by providing benefits for services such as general practitioner consultations, specialist visits and other outpatient treatments. It is often one of the most frequently used employee benefits and can provide immediate value to employees.

   Supplementary Major Medical (SMM) coverage, on the other hand, is designed to provide additional financial protection when hospital bills exceed the limits of the core Hospitalisation and Surgical Plan. It can help reduce employees' out-of-pocket expenses in the event of serious illnesses, major surgeries or costly hospital treatments.

   When deciding between the two, employers should consider whether their primary objective is to provide employees with convenient access to routine healthcare services or to enhance protection against high-cost medical events. Some companies may prioritise outpatient benefits because of their frequent usage, while others may prefer SMM coverage to strengthen protection against large and unexpected medical expenses.

4. Does 100% reimbursement mean every medical bill is fully paid?

   No. The reimbursement percentage applies only to covered expenses that are medically necessary and reasonable and customary, and remains subject to the terms and conditions of the policy, including benefit limits, deductibles, visit limits, room entitlement adjustments, referral and network requirements, and applicable exclusions. Please refer to the benefit schedule and policy wording for complete details.

5. Can an SME offer different plans to different employees?

   MSIG allows plan groups based on an employer’s HR policy, such as grade, class or length of service, subject to headcount limits. Employees with the same eligibility and grading should be enrolled in to the same plan. The company should document objective criteria and communicate them consistently.

6. What happens to company medical insurance when an employee leaves?

   Employer-sponsored group medical insurance coverage is generally linked to employment and is subject to the policy's termination provisions. Employers should clearly communicate the coverage termination date and any applicable claim submission requirements to departing employees.

   Eligible existing MSIG Group Medical Insurance members may consider applying for MSIG Employee Top Up Medical Insurance to continue their medical protection after leaving the company. Applicants should carefully review the plan's eligibility requirements, enrolment period, benefits, exclusions and policy terms before applying.

   Employees who wish to apply for MSIG Employee Top Up Medical Insurance should submit their application within 30 days before the termination date of their group medical insurance coverage, subject to the applicable plan terms and conditions.

The most effective group medical insurance solution for a Hong Kong SME is not necessarily the one with the highest benefit limits. Rather, it should provide meaningful healthcare protection for employees, be easy for employees and HR to understand, and remain affordable over the long term.

By starting with hospitalisation and surgical coverage and then adding optional benefits such as Supplementary Major Medical (SMM), outpatient and dental coverage, employers can tailor their medical benefits programme to meet the needs of their workforce and budget. Employers should also consider factors such as reimbursement arrangements, provider network access, claims procedures and renewal affordability when evaluating different plans.

A well-designed and clearly communicated medical insurance programme can help employees better understand and utilise their benefits, while reducing administrative challenges for HR and supporting effective cost management for the business.

MSIG SME Group Medical Insurance offers a flexible solution with six Hospitalisation and Surgical Plan levels, optional Supplementary Major Medical (SMM) coverage, outpatient, dental and personal accident benefits. In addition, MSIG also offer provider network access, cashless healthcare services and digital administration through online platform (MediGo). Employers should obtain a quotation based on their employee census and review the coverage, premiums, benefit limits and policy terms and conditions carefully before making a purchase decision.