The Hong Kong Federation of Insurers (HKFI) welcomes the observations made by the Insurance Claims Complaints Panel regarding the wording of the medically necessary provisions set out in medical insurance policy.

Most of the medical insurance policies for hospitalization contain the medically necessary clause.  Though the exact policy wordings may vary from one plan to another, they share the same objective of explaining clearly in advance the conditions under which claims are paid.  Insurers will continue, as in the past, to pay claims for medically necessary expenses incurred for treatment performed in hospitals in accordance with the relevant policy terms.

"The HKFI highly appreciates the important role played by the Insurance Claims Complaints Panel as an independent arbitrator in helping to resolve amicably insurance claim disputes," said Mr Peter C H Tam, Chief Executive of the HKFI.  "We will continue to work with the Panel to raise consumers’ awareness and understanding of such policy terms.  In reviewing the way forward, the Medical Insurance Association will also study the need for, and the feasibility of, providing recommended wordings for insurers’ reference."

According to the statistics of the Medical Insurance Association, the gross medical insurance claims paid out in 2007 amounted to HK$5,496 million.