BEFORE YOU APPLY · UNDERWRITING
Health underwriting — eight questions answered
On this page
- What is health underwriting? What will the insurer ask?
- I have a pre-existing condition or take medication. Can I still apply?
- Does an exclusion mean my whole policy is useless?
- How is loading calculated?
- What happens if I do not disclose my medical history at application?
- Does being declined or non-standard accepted affect my future applications?
- I have a long-term condition such as high blood pressure or diabetes. What must I declare, and what could happen?
- I have a health history and want to switch plans. What should I watch out for?
Before you take out a Voluntary Health Insurance Scheme (VHIS) policy, the insurer assesses your individual risk through “health underwriting”. Here are the eight most common questions, answered: what underwriting actually is, whether you can apply with a pre-existing condition, how exclusions affect you, how loading is calculated, what happens if you do not disclose your medical history, whether being declined affects future applications, what to declare for long-term conditions such as high blood pressure or diabetes, and what to watch when switching plans with a health history.
What is health underwriting? What will the insurer ask?
Health underwriting is the process by which an insurer assesses your individual health status and risk after receiving your application. The insurer reviews the information you provide and decides on one of four outcomes:
- Standard acceptance — standard premium, full cover;
- Loading (non-standard acceptance) — you pay extra premium because of certain health risks;
- Specified exclusion — certain conditions will not be covered, but everything else is;
- Decline — the application is not accepted.
Since 1 January 2022, every application for a VHIS Certified Plan must use the Standardised Underwriting Questionnaire (SUQ) set by the Hong Kong Federation of Insurers (FAQ Q49). It covers:
- height, weight, smoking and drinking habits;
- whether you have ever been diagnosed with certain listed conditions (for example cancer, heart disease, high blood pressure, diabetes, mental health conditions) — in the SUQ template this question asks “ever”, not just recent years;
- hospital stays, surgery, tests, regular follow-ups and prescription medicine taken for more than a month within a recent period (the template sets this at no more than 5 years);
- family history — whether a natural parent or sibling was diagnosed with listed conditions such as cancer, coronary heart disease, diabetes or stroke at or before age 60;
- hazardous sports or activities (for example diving, mountaineering).
You do not need to disclose health information the questionnaire does not ask about (FAQ Q54). If your answers mention a condition, the insurer may ask follow-up questions, request more information or a medical examination before deciding (FAQ Q52).
I have a pre-existing condition or take medication. Can I still apply?
Yes, you can apply. A pre-existing condition does not mean automatic decline. The insurer looks at the nature and severity of the condition, how well it is controlled and how long ago it happened. The outcome may be one of the following:
Outcome 1
Standard acceptance
The insurer finds no extra risk and accepts you at the standard premium with full cover. Also, if you had fully recovered from a condition before the questionnaire’s disclosure period began, and needed no treatment or follow-up during that period, you do not need to disclose it (FAQ Q55).
Outcome 2
Loading (non-standard acceptance)
The insurer considers that a pre-existing condition or another health risk (such as smoking or family history) increases the risk. It may still accept you but charge a premium loading on top of the standard premium (FAQ Q31). All other benefits stay the same. See Q4 for how loading works.
Outcome 3
Specified exclusion
Example: after a past slipped disc, the insurer may add an exclusion for lumbar-spine conditions. Everything else stays covered. See Q3 for how to read exclusions.
An insurer may also decline, but only after a fair and reasonable underwriting process in line with the VHIS Code of Practice (FAQ Q30). Which situations lead to a loading, an exclusion or a decline is decided by each insurer under its own underwriting criteria; this site cannot tell you in advance.
Worth knowing: once the policy is in force, the insurer cannot raise your loading rate or add exclusions because your health changes (Standard Plan terms, Part 4 Section 2). So your health at application shapes your policy terms for good.
Does an exclusion mean my whole policy is useless?
No. An exclusion removes one specific body part or condition; it does not switch off the whole policy. Everything else remains covered.
An example:
Ming previously had knee surgery. The insurer adds an exclusion: “Left knee joint disorders and complications permanently excluded”.
What that means:
- Future left-knee pain or surgery → not covered;
- A hospital stay for flu, an appendix operation, a heart problem or cancer → covered under the policy terms as usual;
- A right-knee problem (if the wording only excludes the left knee) → covered as usual.
So exclusions are targeted and bounded. When reading the terms:
- The more precise the wording (e.g. “left knee anterior cruciate ligament”), the narrower — and better for you;
- Broad wording (e.g. “all bone, joint and muscle disorders of the lower limbs”) deserves caution; it can reach a long way.
When you receive the underwriting result, go through every exclusion with your agent or broker before signing. If your condition later improves, you can ask for re-underwriting at renewal to remove an exclusion (see Q7).
How is loading calculated?
A loading (“Premium Loading” in the policy terms) is the extra premium the insurer charges on top of the standard premium for your additional risk. It can be set as a percentage of the standard premium or as a fixed amount (Standard Plan terms, Part 4 Section 2 and Part 8 Definitions). The insurer sets the rate based on its underwriting assessment; we have not found any official published range, so this page does not quote a “typical” one.
The arithmetic, using made-up numbers (for illustration only, not a quote for any plan):
Suppose a plan’s standard annual premium is HK$10,000:
- 25% loading → HK$12,500 a year: HK$2,500 extra a year, HK$12,500 extra over 5 years;
- 50% loading → HK$15,000 a year: HK$5,000 extra a year, HK$25,000 extra over 5 years;
- 100% loading → HK$20,000 a year: HK$10,000 extra a year, HK$50,000 extra over 5 years.
Key point: loading is not a first-year charge; it applies at every renewal. If the loading is a percentage, it rises automatically whenever the standard premium rises with age or at renewal (Standard Plan terms, Part 4 Section 2), so the real extra cost may be higher than the simple sums above. Before deciding, ask your agent for a 10-year total-premium comparison based on the actual quote.
At renewal the insurer may adjust premiums, but the rate of adjustment must be the same for other customers in your plan’s age-gender group (FAQ Q26). In other words, the insurer cannot raise your premium alone because you made a claim.
What happens if I do not disclose my medical history at application?
The consequences can be serious. Under the principle of utmost good faith you must answer the questionnaire honestly and completely; otherwise the insurer may have the contractual right to repudiate the policy (FAQ Q53).
The three most common consequences:
Claim refused
If, at claim time, the insurer finds a condition you knew about and were asked about but did not disclose, it can refuse to provide cover (Standard Plan terms, Part 6 Section 4). You would pay that bill yourself.
Policy declared void
The insurer can declare the policy void, demand repayment of benefits already paid and refund premiums under the policy terms (Standard Plan terms, Part 6 Section 4). The burden of proof rests with the insurer.
Other insurance applications may be affected
The VHIS questionnaire does not ask about your past applications (see Q6), but it only applies to individual indemnity hospital insurance. Application forms for other products such as life or critical illness cover are not bound by it and may ask whether you have ever been declined or had a policy cancelled.
The rule is simple: if asked, answer truthfully; if unsure, check with your agent or the insurer. Full disclosure may still lead to a loading, an exclusion or a decline — but that is better than a refused claim or a void policy later.
Items people most often think “don’t count”:
- Regular prescription medicine (including blood-pressure, diabetes, sleeping and antidepressant medication);
- Tests within the disclosure period — the SUQ lists “normal result” as an answer you still need to report;
- Anything marked “abnormal” on a past health check (even if the doctor said “watch and follow up”);
- Consultations for mental health conditions.
Does being declined or non-standard accepted affect my future applications?
Two scenarios: applying to a different insurer, and applying to the same insurer again.
Scenario 1
Applying to a different insurer
The SUQ does not ask about your application history with other insurers, and it sets the maximum scope of information an insurer may use for underwriting (Best Practice, General Guidance point 3). So a loading, exclusion or decline at Insurer A is not something Insurer B will ask about; B underwrites independently from your answers. The underlying health condition, however, must still be disclosed if the questionnaire asks about it.
Scenario 2
Applying to the same insurer again
The same insurer is also limited to the SUQ questions. But where a question does ask about a condition, the insurer may use information it holds from other sources (such as past applications or claim records) to check that your answer is accurate (Best Practice, General Guidance point 3). So if the questionnaire asks, declare it.
If the first insurer’s terms disappoint, you can apply to a second or third — the earlier underwriting result itself does not follow you to another insurer.
I have a long-term condition such as high blood pressure or diabetes. What must I declare, and what could happen?
The SUQ asks directly about long-term conditions such as high blood pressure, diabetes and high cholesterol. The questions to watch:
- Whether you have ever been diagnosed with listed conditions — including high blood pressure, diabetes or impaired glucose tolerance, high cholesterol or hyperlipidaemia, heart disease and kidney disease. This asks “ever”, not just recent years;
- Whether, in the recent period (no more than 5 years), a doctor has advised you to take prescription medicine regularly for more than a month — such as blood-pressure or diabetes medication;
- Whether you have had regular follow-ups for any condition in that period;
- Whether you have had tests (blood, urine, ECG and so on), and whether the results were normal, abnormal or still pending.
A “yes” leads to follow-up questions: when symptoms first appeared, treatments or tests done, present condition (e.g. still on medication, next follow-up date), date of last consultation, and the treating doctor. The insurer may also ask for more information or a medical examination (FAQ Q52).
Possible outcomes: standard acceptance, a loading, a specified exclusion, or a decline. VHIS allows insurers to apply a loading or exclusion for pre-existing conditions (FAQ Q31) and to decline after a fair and reasonable underwriting process (FAQ Q30). Different insurers can reach different decisions on the same condition; details such as how well it is controlled, any complications and the medication you take may all matter. This site cannot and does not predict any individual’s underwriting outcome — only the insurer decides, once it has your full application.
I have a health history and want to switch plans. What should I watch out for?
Switching means applying for a new policy, and the new insurer underwrites you on your health today. With a health history, these points matter most:
1. Do not cancel your current policy until the new one is in force
The new application may come back with a loading, an exclusion or a decline (FAQ Q30, Q31). Wait until the new policy is approved and in force and you are happy with its terms before cancelling the old one, so you are never left without cover. The government VHIS website also notes that when switching to another Certified Plan with the same insurer, if your application is rejected or you do not accept the re-underwriting result, you can stay insured under your existing plan (FAQ Q36).
2. Conditions that arose under your current policy are “pre-existing” to a new one
Under your current VHIS policy, the insurer cannot raise your loading rate or add exclusions because your health changes (Standard Plan terms, Part 4 Section 2). A new insurer, though, assesses any condition you know about as pre-existing and may apply a loading or exclusion for it (Standard Plan terms, Part 6 Section 4). A condition your current policy covers normally may not be covered the same way after switching.
3. The waiting period for unknown conditions restarts
Pre-existing conditions you were not and would not reasonably have been aware of follow the new policy’s policy years: no cover in year 1, 25% in year 2, 50% in year 3 and full cover from year 4 (Standard Plan terms, Part 6 Section 4; FAQ Q17).
4. The new policy has a cooling-off period
Once accepted, you can cancel the new policy with a full premium refund within the cooling-off period (at least 21 days), provided no claim has been made (FAQ Q38). Another reason to keep the old policy in place until then.
If you are moving to a plan with better benefits with the same insurer, re-underwriting is limited to the upgraded or additional benefits (Standard Plan terms, Part 4 Section 4(b)).
What you cannot know in advance: the terms a new insurer will offer you. You only find out once underwriting is complete and you have the result in writing. Compare benefits, premiums and exclusions of the old and new policies before deciding to switch.