Financial Assessment
Enhancement Measures of Means Test Mechanism The enhancement measures of the means test mechanism of the Samaritan Fund and Community Care Fund (CCF) Medical Assistance Programmes were implemented. Please click here for the details of financial assessment of CCF Medical Assistance Programmes. |
(b) Application for Drug Items
(c) Important Points to Note
(d) Means Test Calculator
- All applications are to be assessed on a household basis, taking into account the income and assets of the patient and his / her core family members living under the same roof who have been included in the financial assessment.
- The definition of “household”, first is to determine whether the patient is a dependent member of the household or not. A dependent is defined as a person who is unmarried AND either (i) under 18 years old; or (ii) 18-25 years old receiving full-time education. A patient who does not fulfil the above requirements is classified as a non-dependent patient. The following table lists out the definitions of household and core family member:
Patient Type Household and core family member definitions Dependent patient The patient, his/her parents1/legal guardians, and dependent2 siblings living under the same roof Non-dependent patient If married3 – the patient, his/her spouse, and dependent2 children1 (but not parents/legal guardians or siblings) living under the same roof
If unmarried – the patient would be treated as a single person household (irrespective of whether parents/legal guardians or siblings are living under the same roof)
When there is other family members who are living with the patient’s household and their basic necessity for living is maintained by patient’s household (e.g. the family member is an elderly who is dependent on patient’s household, or adult with no / low income and unable to sustain independent living; or individual unable to take care of oneself by reason of mental or physical condition, etc.), patient / applicant can include these dependent family members into the means test by providing their income and asset information, and they will be taken into account in the calculation of the Median Monthly Domestic Household Income (MMDHI) by Household Size.
MSW will have discretion to adjust the household size based on their professional judgment on a case-by-case basis in light of special familial factors or circumstances that warrant exceptional consideration.
The patient's household income includes but not limited to salary, pension, regular financial contributions from relatives and / or friends not living together, income generated from the assets and / or properties of the patient and his / her core family members living together, other income / compensation received on a regular basis. Financial assistance provided by the HKSAR Government (e.g. Work Incentive Transport Subsidy Scheme, Working Family Allowance Scheme, Allowances under the Social Security Assistance (SSA) scheme such as Normal Disability Allowance, Higher Disability Allowance, Old Age Living Allowance, and Old Age Allowance) and subsidy from the assistance programmes of the Community Care Fund should not be taken into account as household income.
The patient's household assets include savings, investments in stocks and shares, insurance, valuable possessions, properties, lump-sum compensation and other liquidable assets owned by patient and his/her core family members living together. The first flat (self-owned or rented) resided in together by the patient’s household and the tools of trade owned by the patient's household at the time of application are excluded from the calculation.
In assessing the financial condition of the patient, his / her monthly household income must first fulfil the income limit. MSW would make reference to the Median Monthly Domestic Household Income (MMDHI) (Table 1) by Household Size based on the General Household Survey (GHS) conducted regularly by the Census and Statistics Department. The patient’s monthly household income must not exceed the MMDHI corresponding to his / her household size.
Table 1: Median Monthly Domestic Household Income (update on a regular basis)
Household Size Median Monthly Domestic Household Income (HK Dollar)
(3rd Quarter 2019)1 $10,000 2 $20,000 3 $32,000 4 $42,400 5 $57,300 6 or above $62,700
After having passed the income limit, if the patient’s household assets are equal to or less than two times of the estimated cost / deposit (if applicable) of the item concerned, he / she would generally receive full assistance from the SF. If the patient’s household assets are above two times but not more than three times of the estimated cost / deposit (if applicable) of the item concerned, he / she is required to contribute to the item cost based on the sliding scale (Table 2). For patient whose monthly household income is above the MMDHI corresponding to his / her household size, OR the patient's household assets are above three times of the estimated cost / deposit (if applicable) of the item concerned, no SF assistance would be provided normally. However, apart from the above criteria, the SF might consider any special social and financial factors / circumstances faced by the patient on a discretionary basis.
Table 2: Sliding Scale
Household assets with reference to
the cost of the item concernedPercentage of partial contribution to
the cost of the item concernedAbove 2 times to below 2.25 times 55% From 2.25 to below 2.5 times 65% From 2.5 to below 2.75 times 75% From 2.75 to below 3 times 85% Equal to 3 times 90%
Full assistance will be granted to the patient if his / her CSSA* status is valid during application submission and at the time when the medical procedure is performed or when the patient acquires the privately purchased medical items.
* With effect from March 2017, the application procedures, eligibility and important points to note of CSSA recipients for Samaritan Fund are also applicable for Level 0 Voucher Holders of the Pilot Scheme on Residential Care Service Voucher for the Elderly.
1 Legally recognised adoptive parents/children or illegitimate children with proof of parentage are also included
2 A dependent is defined as a person who is unmarried AND either (i) under 18 years old; or (ii) 18-25 years old receiving full-time education
3 Including patient who is separated, divorced, undergoing legal proceedings to divorce or widowed
- Under the financial eligibility criteria which is based on targeted subsidy principle, patient’s household affordability will be determined on the basis of his/her household’s Annual Disposable Financial Resources (ADFR), and the level of patient contributions will be determined based on a sliding scale. All applications are to be assessed on a household basis, taking into account the income, expenditures and capital assets of the patient and his / her core family members living under the same roof who have been included in the financial assessment.
The definition of “household”, first is to determine whether the patient is a dependent member of the household or not. A dependent is defined as a person who is unmarried AND either (i) under 18 years old; or (ii) 18-25 years old receiving full-time education. A patient who does not fulfil the above requirements is classified as a non-dependent patient. The following table lists out the definitions of household and core family member:
Patient Type Household and core family member definitions Dependent patient The patient, his/her parents1/legal guardians, and dependent2 siblings living under the same roof Non-dependent patient If married3 – the patient, his/her spouse, and dependent2 children1 (but not parents/legal guardians or siblings) living under the same roof
If unmarried – the patient would be treated as a single person household (irrespective of whether parents/legal guardians or siblings are living under the same roof)
- When there is other family members who are living with the patient’s household and their basic necessity for living is maintained by patient’s household (e.g. the family member is an elderly who is dependent on patient’s household, or adult with no / low income and unable to sustain independent living; or individual unable to take care of oneself by reason of mental or physical condition, etc.), patient / applicant can include these dependent family members into the means test by providing their income, asset and expenditures information, and they will be taken into account in the calculation of allowable deductions and deductible allowance.
MSW will have discretion to adjust the household size based on their professional judgment on a case-by-case basis in light of special familial factors or circumstances that warrant exceptional consideration.
Annual disposable financial resources are taken as the annual household disposable income plus 50% of patients’ household net assets (i.e. Disposable Capital – Deductible Allowance).
Annual household disposable income is the annual household gross income less allowable deductions during the period.
Household gross income includes but not limited to salary, pension, financial contributions from children, relatives and friends not living together, income generated from the assets and properties of the patient and his/her core family members living together and compensation received. Financial assistance provided by the HKSAR Government (e.g. Work Incentive Transport Subsidy Scheme, Working Family Allowance Scheme, Allowances under the Social Security Assistance (SSA) scheme such as Normal Disability Allowance, Higher Disability Allowance, Old Age Living Allowance, Old Age Allowance) and subsidy from the assistance programmes of the Community Care Fund are excluded from the calculation.
Allowable deductions4 include rental or mortgage payment, rates, Government rents, property management fee of the property occupied by the patient’s household (total deduction of not more than one-half of the household gross income), salary taxes, personal allowances (Table 3) for the patient and his/her core family members living together, child care expenses, provident fund contribution, school fees of children (up to age of 21) who are at secondary level or below (other expenses, such as school activity fees, board & lodging fees, will not be counted as the allowable deductible item) and medical expenses at public hospitals/clinics (other than the drug(s) subsidized by the SF and /or Community Care Fund Medical Assistance Programmes and drug payment under this application) for the last 12 months.Table 3: Personal Allowances (as at 26 February 2019)
Number of Household Member(s)
(including the Patient)Total Personal Allowances
(HK Dollar)1 Person $6,380 2 Persons $11,160 3 Persons $15,890 4 Persons $20,580 5 Persons $27,400 6 Persons $25,710 7 or more Persons $28,670
The figures are adjusted every year in line with the Consumer Price Index A, and every five years in line with the latest Household Expenditure Survey conducted by the Census and Statistics Department.
Disposable capital includes cash owned by the patient and his/her core family members living together at the time of the application and such which have been accrued through past savings from any sources or which have just been acquired, investments in stocks and shares, insurance (refer to investment-linked insurance policies and dividend provided by life insurance policies, but cash value under a life insurance policy should not be counted), valuable possessions, property (for example, land, car park and flat owned in Hong Kong and outside Hong Kong), lump-sum compensation and other realizable assets. The first flat (self-owned or rented) resided in together by the patient’s household and the tools of trade owned by the patient’s household at the time of application are excluded from the calculation.
Deductible Allowance (Table 4) is provided when calculating the total value of disposable capital of patient and his/her core family members living together. The amount of deductible allowance depends on the patient’s household size. If the disposable capital of the patient’s household is below the deductible allowance, the amount of deductible will be capped at the disposable capital of the patient’s household. It is set with reference to the prevailing asset limit in assessing eligibilities for applications for the Waiting List of Public Rental Housing (PRH). The level of allowance will be regularly reviewed with reference to the PRH’s asset limit which is subject to annual review under an established mechanism.
Table 4: Deductible Allowance (as at 1 April 2019)
Number of Household Member(s)
(including the Patient)Allowance to be deducted from Disposable Capital
(HK Dollar)1 Person $257,000 2 Persons $348,000 3 Persons $454,000 4 Persons $530,000 5 Persons $589,000 6 Persons $637,000 7 Persons $680,000 8 Persons $713,000 9 Persons $788,000 10 or more Persons $849,000
The figures are subject to annual review.
Full assistance will be granted to the patient if his / her CSSA* status is valid during application submission and during the treatment period in which the self-financed drug is subsidized by SF.
* With effect from March 2017, the application procedures, eligibility and important points to note of CSSA recipients for Samaritan Fund are also applicable for Level 0 Voucher Holders of the Pilot Scheme on Residential Care Service Voucher for the Elderly.
1 Legally recognised adoptive parents/children or illegitimate children with proof of parentage are also included.
2A dependent is defined as a person who is unmarried AND either (i) under 18 years old; or (ii) 18-25 years old receiving full-time education
3 Including patient who is separated, divorced, undergoing legal proceedings to divorce or widowed
4 The expenditures on patient and his/her core family members living together which are paid by themselves.
Patient's Contribution to Drug Cost
Patient’s contribution is determined by the disposable financial resources and the estimated drug cost that is required to pay, with the latter being determined by multiplying the unit drug cost by the total units of drug consumption. The maximum contribution is capped according to Table 5.
Where the estimated cost of the applied drug is below the maximum contribution payable, patient is required to pay the drug cost and no assistance will be granted. Where the estimated drug cost is above the maximum contribution payable, the Samaritan Fund will pay the outstanding balance.
Under normal circumstances, the patient should settle the patient’s contribution before the utilization of the approved subsidies as far as possible. However, if the patient has special difficulties, he / she could approach the MSW to apply for payment by instalment. The SF might consider the request on a case-by-case basis.
Table 5 : Sliding Scale
(A)
Annual Disposable
Financial Resources
(ADFR) (HK Dollar)(B)
Contribution
Ratio (%)(C)
Maximum
Contribution from Patient
(HK Dollar)
(C) = (A) x (B)(D)
ADFR after deducting
Annual Contribution
(HK Dollar)
(D) = (A) - (C)$0 - 20,000 - $0 $0 - $20,000 $20,001 - 40,000 - $1,000 $19,001 - 39,000 $40,001 - 60,000 # - $2,000 $38,001 - 58,000 $60,001 - 100,000 5 $3,000 - 5,000 $57,001 - 95,000 $100,001 - 140,000 10 $10,000 - 14,000 $90,001 - 126,000 $140,001 - 180,000 15 $21,000 - 27,000 $119,001 - 153,000 $180,001 - 280,000 20 $36,000 - 56,000 $144,001 - 224,000 280,001 - 380,000 20 $56,000 - 76,000 $224,001 - 304,000 $380,001 - 480,000 20 $76,000 - 96,000 $304,001 - 384,000 $480,001 - 580,000 20 $96,000 - 116,000 $384,001 - 464,000 $580,001 - 680,000 20 $116,000 - 136,000 $464,001 - 544,000 $680,001 - 780,000 20 $136,000 - 156,000 $544,001 - 624,000 $780,001 - 880,000 20 $156,000 - 176,000 $624,001 - 704,000 $880,001 - 980,000 20 $176,000 - 196,000 $704,001 - 784,000 $980,001 - 1,080,000 20 $196,000 - 216,000 $784,001 - 864,000 ≥ $1,080,001 20~ as calculated
# Fixed contribution amount is required from patients whose household’s annual disposable financial resources are $60,000 or below, the formula calculating the applicant’s annual contribution in the above table is not applicable.
~ Capped at a flat contribution ratio of 20%.
There is a Means Test Calculator on the SF page of the HA’s website for the patient / applicant to make a preliminary estimation of his / her household financial eligibility for SF however, the result of the self-assessment is for reference only. To be eligible for SF assistance, the patient / applicant must submit a formal application and fulfil all of the above eligibility criteria including passing the financial assessment conducted by MSW. In addition, the applicant can utilize the Means Test Calculator to check his / her eligibility regularly.
- The SF is designed for patients in need. Patients / applicants and household members must provide complete, accurate, up-to-date and true information to the Hospital Authority / Social Welfare Department.
- The SF, if granted, only supports the purchase of essential medical appliance and model which can meet the basic medical needs of the patients.
Under normal circumstances, medical procedure or acquisition of appliance / equipment should only commence or perform after approval is granted. Drug treatment should only commence after approval is granted. SF financial assistance will not cover the cost for medical procedure or appliance / equipment / drug costs paid by patients prior to approval. It should be noted that approval will not be dated back and NO REFUND will be made to patients or applicants for the medical procedure or relevant appliance / equipment / self-financed drugs purchased prior or paid to the approval date.
HA may refuse to consider or reject any application if the declaration and/or the supporting data for assessment are not provided.
Provision of incomplete, inaccurate, not up-to-date or false information by way of declaration or supporting data may result in rejection of the application or the withdrawal of financial assistance (in whole or in part) if approved5 and / or criminal prosecution. Any paid financial assistance prior to withdrawal shall be recoverable by the HA as a debt or otherwise repayable on demand and the Patient / Applicant should undertake to repay to the HA the paid financial assistance.
If the financial status / composition of the patient’s household / CSSA* status of the patient changes after the submission of the application or the provision of declaration, and before the medical procedure or prior to the purchase of relevant appliance / equipment and during the treatment period of the funded self-financed drug, which would affect the patient’s eligibility for financial assistance under the SF,, the patient must notify the HA immediately and provide all relevant information to MSW for financial reassessment6 as appropriate. Information includes but not limited to:
(a) Change of employment status (including being employed, self-employed, change of job / resigning etc.) (b) Change of income (monthly income / bonus / end of year payment / pension, or changes of amount to the aforementioned items etc.) (c) Change of sources of financial resources (e.g. alimony / financial contribution from family and friends / monthly compensation / compensation received on a regular basis, or changes of amount to the aforementioned items etc.) (d) Change of family situation (e.g. change of number of family members living under the same roof, marital status etc.) (e) Change of assets (e.g. receipt of insurance compensation, changes of amount to bank accounts or other investment products etc.) Applicant can also utilize the Means Test Calculator to preview his / her eligibility resulting from the above changes.
The HA may withdraw and/or vary the terms and conditions of any financial assistance (in whole or in part) in the event of any such change. The patient’s failure to notify the HA of his / her change of financial status / household composition / CSSA* status may result in rejection of the application or withdrawal of approved financial assistance (in whole or in part) and / or criminal prosecution. Any paid financial assistance prior to withdrawal shall be recoverable by the HA as a debt or otherwise repayable on demand and the patient / applicant should undertake to repay to the HA the paid financial assistance.
The HA has a Post Approval Checking Mechanism in place, which regularly conducts checks on the approved applications and/ or verifies the patient’s CSSA* status. If there is overpayment of subsidies caused by calculation, assessment or administrative errors, the patient is required to refund the overpaid amount to Hospital Authority immediately and, if necessary, adjust or forfeit the amount that may be payable.
When you provide Personal Data to the HA in relation to your application, please make sure that such data is accurate and complete, failure to provide accurate / complete information may affect your application. Please refer to “Notice to Client” prepared for the SF on collection and transfer of personal data before providing your personal data to the HA.
* With effect from March 2017, the application procedures, eligibility and important points to note of CSSA recipients for Samaritan Fund are also applicable for Level 0 Voucher Holders of the Pilot Scheme on Residential Care Service Voucher for the Elderly.
5 Including applications with Medical Social Worker’s discretionary consideration on the special social and financial factors / circumstances faced by the patient, which may be withdrawn due to provision of incomplete, inaccurate, not up-to-date or false information of patient’s household / applicant.
6 Financial re-assessment will be based on the eligibility criteria adopted under the original application
- The SF, if granted, only supports the purchase of essential medical appliance and model which can meet the basic medical needs of the patients.
- When there is other family members who are living with the patient’s household and their basic necessity for living is maintained by patient’s household (e.g. the family member is an elderly who is dependent on patient’s household, or adult with no / low income and unable to sustain independent living; or individual unable to take care of oneself by reason of mental or physical condition, etc.), patient / applicant can include these dependent family members into the means test by providing their income, asset and expenditures information, and they will be taken into account in the calculation of allowable deductions and deductible allowance.
