VHIS Surgery List
How to read the VHIS Surgical Procedures?
To help policyholders understand their coverage easily and clearly, the VHIS Surgical Procedures is categorized by different body systems and organs/surgeries. The coverage amount is then determined based on the complexity of the surgery.
The voluntary health insurance surgery table is divided into 13 body systems and 40 organs/surgeries, as detailed in the following table:
Organs include:
- Esophagus, stomach, and duodenum
- Small intestine, ileum, and colon
- Bile duct
- Liver
- Pancreas
- Abdomen
Organs include:
- Neurosurgery
- Spine surgery
Organs include:
- Heart
- Blood vessels
Organs include:
- Adrenal glands
- Pineal gland
- Pituitary gland
- Thyroid gland
Organs include:
- Ear
- Nose, mouth, and pharynx
- Respiratory system
Organs include:
Eye
Organs include:
- Cervix
- Fallopian tubes and ovaries^
- Uterus
- Vagina
- External genitalia and introitus
Organs include:
- Lymph nodes
- Spleen
Organs include:
- Prostate gland
- Penis
- Testes^
- Vas deferens
Organs include:
- Bones
- Joints
- Muscles and tendons
- Fractures and dislocations
- Spine
- Other
Organs include:
- Skin
- Breasts
Organs include:
- Kidneys
- Bladder, ureters, and urethra
Organs include:
- Dental
- ^Unless otherwise specified, this category applies to one or both sides (fallopian tubes and ovaries/testes).
VHIS sets benefit amounts based on the complexity of the surgery
After categorizing surgeries/procedures by body system, organ, and surgery/procedure, the surgery table is further divided into four categories based on the complexity of the surgery/procedure to determine the coverage amount.
For example, Bowtie VHIS plans provide different benefit limit for different surgeries.
The Benefit amount for surgeon fees (per session)
| Flexi Regular | Flexi Plus | Bowtie Pink (High-end VHIS) | |
| Minor | HK$6,000 / session | HK$9,000/session | Full Coverage* |
| Intermediate | HK$15,000/ session | HK$22,500/session | |
| Major | HK$30,000/ session | HK$45,000/session | |
| Complex | HK$60,000/ session | HK$90,000/session |
- *The Bowtie Pink Voluntary Health Insurance series fully covers eligible medical expenses such as diagnosis, hospitalisation, surgery, and prescribed non-surgical cancer treatments (except in the United States), and is subject to annual benefit limits and lifetime benefit limits. If the claim involves confinement in a Mainland China Hospital unlisted in / a High-end Mainland China Hospital listed in the "List of Designated Hospitals in Mainland China" / confinement in a room higher than the restricted ward class / a pre-existing condition, the relevant benefit payable may be adjusted.
Does the complexity of surgery affect other benefit amounts?
The complexity of surgery also affects the coverage amount for the operating room and anesthesiologist fees. The more complex the surgery, the higher the coverage amount.
Below are the benefit amounts for different VHI plans offered by Bowtie as a reference.The Benefit amount for operating theater and anesthesiologist fees (per operation)
| Flexi Regular | Flexi Plus | Bowtie Pink (High-end VHIS) | |
| Minor | HK$2,100 / session | HK$3,200/session | Full Coverage* |
| Intermediate | HK$5,300 / session | HK$7,900/session | |
| Major | HK$10,500 / session | HK$15,800/session | |
| Complex | HK$21,000 / session | HK$31,500/session |
Are the Surgical Procedures and benefit amount the same across all VHIS plans?
The surgical procedures and benefit amounts for all VHIS Standard plans are the same, and the benefit amounts represent the minimum benefit amount for all approved Flexi Plans.
In other words, all insurance companies must provide coverage amounts that are the same or greater than those of the “standard plan”.
Most commonly claimed surgeries
The three most commonly claimed surgeries received by Bowtie are as follows, for reference.
| Surgery | Total Claimed Amount | Total Reimbursed Amount | Average Claimed Amount | Average Reimbursed Amount | Average Claim Rate |
| Cryotherapy, Electrocautery, or Laser Treatment for Skin Warts | Approximately HK$257,000 | Approximately HK$ 240,000 | HK$ 5,262 | HK$ 4,986 | Approximately 95% |
| Gastroscopy (with or without biopsy and/or polypectomy) | Approximately HK$ 126,000 | Approximately HK$ 118,000 | HK$ 4,061 | HK$ 3,836 | Approximately 94% |
| Colonoscopy (with or without biopsy and/or polypectomy) | Approximately HK$ 98,000 | Approximately HK$ 84,000 | HK$ 5,790 | HK$ 4,964 | Approximately 86% |
- Note: The above data is for 2020.
