Self-Funded Outpatient vs. Full-Insured Outpatient
Cost Comparison

See exactly how much your company can save by switching from a traditional full-insured plan to MixCare's FlexHealth self-funded model. Adjust the inputs to match your team.

HK$6,020
Annual saving vs current
12.3%
Cost reduction
HK$13,370
Saving vs next-yr renewal

👥 Company Profile

Company Name
Number of Members
No existing insurance plan
Skip premium comparison — show FlexHealth cost only
Current Premium per Head / Year (Outpatient Only) HKD
Actual Paid Claims — Total Group (Current Year) HKD
Total outpatient claims paid by insurer for the entire group this policy year (not per head). Leave 0 if unknown.
IBNR Reserve (%) 10%
0% 15% 30%
Incurred But Not Reported reserve — estimated claims submitted but not yet processed. Typically 8–15%.
Annual Medical Inflation
Disabled — medical inflation not applied to projected renewal cost.

🏥 Health Usage

visits / member / year
📊 Average HK member outpatient usage is 8.15 visits/year

⚖️ Panel vs Non-Panel

Panel Visits (MixCare Network) 35%
0% Panel 100% Panel
Panel (cashless): 35% Non-Panel (pay & claim): 65%

🪙 Wellness Credit

Enable to add a Wellness Credit flexible spending wallet for wellness redemptions (optical, dental, vaccines, check-ups).

🎯 Outpatient Budget Cap

Enable to set a maximum outpatient reimbursement per member per year, capping total employer exposure.
Employer Subsidy per Visit (non-panel) (HKD)
% employee pays per non-panel bill
Employee pays this % of each out-of-network bill directly. Employer reimburses the remainder. 0% = fully employer-funded.
MixCare Network Rates (HKD/visit)
Panel Copayment per Visit (HKD)
Member copay at MixCare network clinics. Set to $0 for zero-copay cashless experience.
Annual Management Fee / Member / Year HKD
Pay & Claim Fee (% of non-panel claims) %
Applied to total non-panel claim cost. Covers processing & reimbursement admin.
Total Saving vs Current
HK$6,020
12.3% reduction
Saving per Member
HK$430
per year
Total Saving vs Renewal
HK$13,370
23.7% reduction

📊 Cost Comparison

📌 Year 1 insured = projected renewal (current premium adjusted for incurred claims + IBNR). Years 2–3 compound at your annual medical inflation rate (default 8% if not set). FlexHealth is flat — driven only by actual claims usage.

📋 Detailed Breakdown

Cost Item Full-Insured FlexHealth Difference

💰 FlexHealth Cost Breakdown

🧑‍⚕️ Member Experience per Visit

Visit Type Channel Rate Employer Pays Member Copay

✨ Values of MixCare Self-funded Solution

🚀

Ready to explore self-funded outpatient?

Book a free 20-minute consultation to review your group's claims data and see a customised FlexHealth proposal.

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⚠️ Disclaimer

This calculator is provided by MixCare Health for illustrative purposes only and does not constitute financial, insurance, or legal advice. Actual costs may vary based on your group's claims experience, plan design, and provider network agreements.

Employers should consult with a licensed insurance broker or financial advisor before making any changes to their employee benefits programme. Past claims data and loss ratios are not indicative of future results.