Employee medical insurance premiums are likely to continue to rise in Hong Kong in 2026, according to a new edition of the Hong Kong Employee Medical Insurance Index (EMII).
The report said that the Inpatient Plan Utilisation Index, part of the EMII index, will reach a new high, The average premium is expected to exceed HK$10,000 ($1,285) this year and there is also likely to be a surge in minor day procedures. The EMII was released jointly by the College of Professional and Continuing Education of The Hong Kong Polytechnic University (PolyU CPCE) and corporate employee benefits and MPF consultant GUM.
The EMII, with 2025 second quarter updates, covers data over the past 20 years and reflects the actual utilisation, expenses, and premium trends of group medical insurance. By updating the index every quarter, PolyU CPCE and GUM hope to enhance stakeholders’ awareness of the main drivers of medical expenditure so that medical insurance products can be better designed to mitigate the trend of rising health care expenditure with the view to achieving a win-win situation for all.
The EMII consists of the “Utilisation Index”, “Expense Index” and “Premium Index”, and covers Hong Kong group medical insurance market data from 2006 to the second quarter of 2025. The three sets of indices infer the following:
Utilisation Index: It covers inpatient plans and outpatient plans, reflecting the overall utilisation of medical services and workplace health conditions. The latest data show that the outpatient utilisation index in the second quarter of 2025 increased slightly from 131 in 2024 to 134, indicating that outpatient demand has shifted from the rapid growth after the post-pandemic normalisation last year to a more stable level. In contrast, utilisation of services covered by inpatient plans shows a significant rise from the previous period. The index jumped 13.9% from 273 in 2024 to 311.
GUM CEO Dr Gloria Siu reminds insurers and employers that they need to pay attention to whether minor day procedures will apportion the risk pool that was originally set up for serious illnesses such as cancer, leading to an increase in the cost of serious illness protection and pushing up premiums.
Medical Expense Index: It shows a significant rise in outpatient average expenses but the inpatient plan expense index, reflecting the average bill per claim, appears to have dropped. This is due to the increase in utilisation of minor day procedures, which tend to have lower unit costs.
In the second quarter of 2025, minor day procedures accounted for 82% of the number of inpatient plan cases. The medical expense index in the second quarter of 2025 was 188, down by 6.9% from 202 in 2024, and the average inpatient plan incurred amount per case fell to HK$20,342. The outpatient expense index, however, rose from 284 in 2024 to 319, and the average incurred amount per outpatient visit increased to HK$598.
Director of the Centre for Ageing and Healthcare Management Research Dr Ben Fong said that in order to effectively control outpatient medical expenses, the industry needs to strengthen the service quality and stability of network clinics, so as to encourage more employees to use network outpatient services.
Insurance Premium Index: In the quarter under review, the inpatient plan premium index rose by 6.3% from 411 in 2024 to 437. The main reason is due to the increase in utilisation of inpatient plans, especially minor day procedures. The outpatient premium index increased modestly by 2.6% to 199. The overall premium index rose by 5.0% from 282 in 2024 to 296.
With the current medical inflation level of about 9.73%, assuming that the changes in utilisation and costs this year and next year are similar to those in the first half of 2025, the overall average premium per insured person is expected to increase to around HK$11,078 in 2026.
PolyU CPCE dean and professor Peter Yuen said that if the situation continues, private health insurance, with its current benefit package, could become unaffordable for many employers.