Waiving of Medical Charges (For Eligible persons)
Introduction
It has always been the Government’s fundamental philosophy that no one will be denied adequate medical care due to lack of means. To ensure that this principle will continue to be upheld after the fee revamp in April 2003, the Hospital Authority (HA) has put in place a medical fee waiver mechanism to provide assistance to needy patients.
Target group
The recipients of Comprehensive Social Security Assistance (CSSA), Level 0 Voucher Holders of the Residential Care Service Voucher (RCSV) Scheme for the Elderly1 and Old Age Living Allowance (OALA) recipients aged 75 or above (including those recipients under the Guangdong Scheme and Fujian Scheme)2 under Social Welfare Department (SWD) will be waived from payment of public medical fees upon presentation of identity proof and claim their waiver eligibility status each time they register for consultation and their waiver status could be confirmed through online eligibility checking.
Other than the above recipients of social security schemes, to assist the three vulnerable groups in the community, i.e., the low income group, chronically ill patients and elderly patients who have little income or assets, the medical fee waiver mechanism is in place to provide them with effective protection from undue financial burden. The following guiding principles were taken into account when the waiver mechanism was enhanced in 2003: (1) Public funds should be channeled to the vulnerable groups and to services which carry major financial risks; (2) There should be a set of objective and transparent criteria to assess a patient’s eligibility for exemption from payment of public medical fees. At present, both financial and non-financial factors should be considered; and (3) The enhanced mechanism should facilitate accessibility to services, while maintaining low administrative and operating cost of the existing mechanism.
Patients who could not afford medical expense at the public sector can apply for a medical fee waiver at the Medical Social Services Units of public hospitals and clinics or the Integrated Family Service Centres, the Family and Child Protective Services Units and other designated service units of SWD (the service units of SWD). Medical Social Workers or Social Workers of the service units of SWD (MSWs / SWs) would assess the application with due consideration given to the financial, social and medical condition of applicants on a household basis.
1 With effect from March 2017, Level 0 Voucher Holders of the Pilot Scheme on Residential Care Service Voucher (RCSV) Scheme for the Elderly are also waived from payment of public medical fees. After the regularization of the RCSV scheme on 1 April 2023, the medical fee waiving arrangement also applies to Level 0 Voucher Holders of the RCSV Scheme for the Elderly.
2 Starting from 15 Jul 2017, the medical fee waiver for public medical fees has been extended to cover OALA recipients meeting the eligibility criteria and from 1 Jun 2018, the medical fee waiving arrangement is also applicable to Higher OALA recipients aged 75 or above. After the merger of Normal OALA and Higher OALA on 1 Sep 2022, the medical fee waiving is also applicable to OALA recipients aged 75 or above (including Guangdong Scheme and Fujian Scheme).
Financial consideration
Patients who meet both of the following two financial criteria are eligible to apply for a medical fee waiver under the enhanced mechanism (patients who do not meet these criteria could provide other non-financial factors for the consideration of MSWs/SWs:| (a) | The patient's monthly household3 income does not exceed 75% of the Median Monthly Domestic Household Income (MMDHI) applicable to the patient's household size, and |
| (b) | The value of the patient's household3 asset is within a certain limit applicable to their household size. It should be noted that the first flat (self-owned or rented) resided in together by the patient's household will not be counted towards this asset limit, and households with elderly members will enjoy a Old Age Living Allowance (OALA) asset limit than those without (taking into account the fact that most elderly citizens will no longer earn any income and have to depend on personal savings). |
3Household includes patient and his/her core family members living under the same roof, i.e. patient’s parents, children, spouse and dependent siblings – siblings aged below 18, aged between 18-25 receiving full-time education or disabled adult siblings (i.e. receiving disability allowance under the Social Security Allowance scheme or standard rates for 100% disabled or requiring constant attendance under the CSSA scheme).
| 1 | $10,400 | $7,800 | $5,200 |
| 2 | $22,300 | $16,725 | $11,150 |
| 3 | $36,600 | $27,450 | $18,300 |
| 4 | $50,000 | $37,500 | $25,000 |
| 5 | $62,100 | $46,575 | $31,050 |
| 6 or above | $63,700 | $47,775 | $31,850 |
| Source: General Household Survey, Census and Statistics
Department, HKSAR Government (The above figures were updated in November 2024) |
|||
| Household Size | Asset Limit (with no elderly member) | Asset Limit(with 1 elderly member) | Asset Limit(with 2 elderly members) |
|---|---|---|---|
| 1 | $41,500 | $209,500 | - |
| 2 | $85,000 | $253,000 | $421,000 |
| 3 | $127,500 | $295,500 | $463,500 |
| 4 | $170,000 | $338,000 | $506,000 |
| 5 | $212,500 | $380,500 | $548,500 |
| Note: The asset limit is raised by $168,000 for each elderly member (i.e. age = or >65) in the patient's family. | |||
Patients whose monthly household income do not exceed 50% of the MMDHI applicable to their household size and pass the asset limit test will be considered for full waiving of medical fees at public hospitals/clinics.
There
is a Means Test Calculator on the Medical Fee Waiving page
of the HA’s website for the patient / applicant to make a preliminary estimation of his / her household financial
eligibility for Medical Fee Waiving; however, the result of the self-assessment is for reference only. To be
eligible for Medical Fee Waiving, the patient / applicant must submit a formal application and fulfil all of the
above eligibility criteria including passing the financial assessment conducted by MSWs/SWs. In addition, the
applicant can utilize
the Means Test Calculator to check his / her eligibility regularly.
Non-financial consideration
MSWs/SWs would also consider the following non-financial factors, apart from the financial factors of household income and asset:| (a) | The patient's clinical condition as defined by the patient's frequency of use of different public medical services, and severity of illness; |
| (b) | Whether the patient is a disabled person, single parent with dependent children, or from other vulnerable groups; |
| (c) | Whether a medical fee waiver could provide incentive and support to solve the patient's family problems; |
| (d) | Whether a patient has any special expenses that make it difficult to pay for his/her medical fees at public hospitals/clinics; or |
| (e) | Other justifiable social factors. |
MSWs/SWs would consider the above factors to ensure elderly or chronic patients who are frequent users of public medical services could obtain a medical fee waiver if needed. This list is not exhaustive and the MSWs/SWs will exercise discretion to grant waivers, where appropriate, to a patient with special difficulties (even if he/she fails to meet the financial criteria) on a case-by-case basis. The waiving mechanism and guidelines will be regularly reviewed to ensure needy patients of adequate medical care.
Validity period of waiving
A medical fee waiver granted by the MSWs/SWs after assessment will either be one-off or valid for a period of time. The MSWs/SWs have the discretion to decide the exact period based on a patient's actual needs and conditions (the longest period being twelve months). For convenience of patients, the MSWs/SWs may in advance grant medical fee waiver to a chronically ill patient who frequently needs Specialist Out-patient (SOP) service, which the waiver will be valid for a defined period of time for the SOP service he/she needs. To make the system more user-friendly, the waiver issued by MSWs/SWs is not only applicable to the institution he/ she is admitted, attends or obtains the waiver, but is also applicable to other public institutions (i.e. the HA or the Department of Health) that provide the same service, including in-patient service, out-patient services and community services etc.Application for a fee waiver
Patients who have financial difficulties in paying medical expenses could apply for medical fee waiving. Applicants can bring along original and copy of relevant documents as follows and approach MSWs/SWs during office hours for assessment:(a) Identity documents of patient / applicant / all family members living under the same roof who have been included in financial assessment
- Hong Kong Identity Card / Passport / Travel document or other identity documents
- Tenancy agreement of public housing unit
- Employed persons:
Bank passbooks, bank statements, salary statement, documents issued by employers for proving their income, Mandatory Provident Fund (MPF) Scheme pay records, tax return statement or the notice of assessment, and other documentary proof of income (e.g. bonus / allowance / commission / part-time income / lump sum gratuity / monthly pension, etc.) for the past 6 months (at least) - Self-employed / business operators:
Profit & Loss Account, Tax return statement, income declaration, other proof of income - Unemployed persons:
Documentary proof of unemployment (e.g. termination letter, notification by an employer of an employee who is about to cease to be employed, medical proof, proof of looking for jobs, etc.) - Other income:
Contribution (e.g. family / living expenses / fees paid for family member given by relative(s) and friend(s) not residing with the family), alimony, Rental income of property / land / carpark / vehicle / vessel, the payout provided under the annuity scheme, etc.
- Bank passbooks, bank statements, bank record of active / inactive / closed accounts for the past 6 months (at least) relating to all the individual and joint accounts3 including saving deposit, time deposit, club deposits, foreign currency deposit, investment, shares and securities services, current account, integrated account, Jockey Club betting account, etc.;
- Documentary proof of self-employed / business operators, e.g. Business Registration Certificate, balance sheet, company account statements, etc.;
- Documentary proof of annuity scheme / insurance policies with investment or saving element (e.g. investment-linked insurance policies, life insurance and annuity scheme), such as monthly statement or annual report;
- Documentary evidence of stock, shares, warrants, funds, bonds and other investments owned;
- Documents proof of the ownership of the properties / land / parking spaces, e.g. Demand Notes for Rates, Demand Notes for Government Rent, mortgage repayment schedule, etc.;
- Screenshot of e-wallet transaction for the past 6 months and balance (e.g. PayMe / Alipay HK / We Chat Pay)
- Asset held in trust of others / Asset entrusted to others / Other assets (e.g. cheques in transit)
- Documents of mortgage payments, rental receipts, debit notes, bills of medical expenses, etc.
- Core family members include patient’s parents, spouse, children and dependent siblings (i.e. siblings aged
below18, aged between 18-25 receiving full-time education or disabled adult siblings).
- MSWs/SWs will base on the financial condition of at least past 6 months of patient and core family members
living together for assessing the eligibility of medical fee waiver. According to individual case merit, the
MSWs/SWs may request for other documents, and/or information on financial condition for more than past 6 months,
make enquiries on transactions shown in bank statements (such as purpose of individual withdrawal / deposit
transaction) and the details of income / expenditure record etc., or contact the patient / his / her family
member(s) / related parties for clarification, provision of additional documentary proof / explanation and
verification of information when necessary in order to assess and calculate the financial condition of patient’s
household.
- During the application process, MSWs/SWs will request patient / applicant to re-submit all up-to-date information if the supporting document(s) provided is not up-to-date, or the information submitted are required to be updated.
- If the applicant authorized by patient for handling the application could not present original copy of identity document(s) of the patient / core family members living together, MSWs/SWs may consider to accept the copy of identity document(s) for application purpose (except individual case which requested the original copy of identity document(s) of the patient for verification of identity with other Department during the waiver application).
- The Medical Fee Waiving Mechanism provides a safety net for those needy patients. The patient / applicant and household member(s) must provide complete, accurate, up-to-date and true information to the HA/ SWD for assessment. The HA established the Post Approval Checking Mechanism that will periodically conduct checks on approved medical fee waiver applications to confirm accuracy of information provided.
- Provision of incomplete, inaccurate, not up-to-date or false information (including the supporting data) by way of application or declaration may result in rejection of the application or withdrawal of waiving of medical fees (in whole or in part) if approved4 and/or criminal prosecution. In such circumstances, any medical fees waived prior to withdrawal shall be recoverable by the HA as a debt repayable on demand.
- If patient / applicant disagrees with the application result, he / she may lodge an appeal within four weeks after the notification of the application result by HA / SWD. Related enquiries can be made to the office which handles his / her application or the Patient Relations Officer of the concerned hospital.
4In general, the balance in the joint account is equally divided among the account holders, unless documentary proof is provided on the division of assets.
5Including the MSWs/SWs’ discretionary consideration on the special social and financial factors / circumstances which was based on the declaration or supporting data provided by patient household / applicant at the time of application, maybe withdrawn due to provision of incomplete, inaccurate, not up-to-date or false information of patient’s household / applicant.
Enquiries
- Medical Social Services Units of public hospitals and clinics
- Integrated Family Service Centres of Social Welfare Department (SWD)
- Family and Child Protective Services Units (FCPSUs) and other designated service units of SWD (applicable for cases being followed up by FCPSUs and other designated service units)
Post Approval Checking Mechanism
In the application of medical fee waiving, applicants are required to provide complete, accurate, true and up-to-date information to MSWs/SWs for assessment and verification. In order to maintain integrity of the medical fee assistance systems and avoid these systems from being abused, the HA established Investigation Section (Fee Assistance Application) in March 2007 (renamed as Medical Fee Assistance Section in 2008) for the purposes of:- preventing and detecting the occurrence of fraud and abuse of medical fee waiving and Samaritan Fund
- taking appropriate action against suspect who commits deception relating offence
- in-depth investigation on suspected fraud cases of medical fee assistances
- regular checks of approved cases selected on random basis
- checking of cases with high risk factors for fraud and abuse
- data matching within HA, with Government Department, bank, employer and other parties
Medical fee assistance demands your honesty
Medical Fee Waiving, Samaritan Fund and Community Care Fund (Medical Assistance Programmes) are provided only for
needy patients. The Checking Units of the Hospital Authority conduct checks on approved applications regularly. The
patient/ applicant and household member(s) must provide complete, accurate, true and up-to-date information and has
to report to the Hospital Authority/ Social Welfare Department any changes in the particulars in the application
within the validity period of the financial assistance. Don't break the law
Acquiring Medical Fee Waiving by deception is a Criminal Offence. In addition to the consequence of being ineligible for the Medical Fee Waiving, the patient/ applicant/ patient's household member(s) shall be liable on conviction upon indictment to imprisonment of 10 years under the Theft Ordinance (Chapter 210 of the Laws of Hong Kong).Information Pamphlet
(Click to view) |
(Click to view) |
Video
Waiving of Medical Charges
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| Video 1: Knowing More about Medical Fee Assistance | Video 2: Medical Fee Assistance – What you need to know about the post-approval checking process |
| Duration : 04:04min | Duration : 04:15min |
HA Go – ‘Medical Fee Assistance’ Mobile Application Introduction (HA Go > Home > Features > Payment-related > Pay HA)
Hospital Authority
November 2024
(with MMDHI figures updated in November 2024)