Terms of Use of Means Test Calculator

As a prospective applicant for Samaritan Fund^ / Community Care Fund* Medical Assistance Programmes (the Fund), you can use this Means Test Calculator (the Calculator) to make a preliminary estimation of your household financial eligibility for the Fund.
To be eligible for financial assistance, the patient must be an Hospital Authority (HA) patient and fulfil all of the clinical requirement, residence requirement and financial requirement. The patient must pass a household-based financial assessment conducted by Medical Social Worker (MSW). The patient can approach the Medical Social Services Units during office hours to enquire about the application details.
The Calculator can only compute your household financial eligibility based on the financial figures that you have entered. The result of the assessment is for reference only and does not guarantee that you will be granted the Fund. For formal application for the Fund, applicant must bring along the originals as well as a copy for each of the relevant supporting documents. MSW may request other documents or contact applicant’s family members for verification of information when necessary.
Before you start, you are advised to visit “Samaritan Fund” and “Community Care Fund Medical Assistance Programmes” of the HA’s website and read the related patient information leaflets.
All the information entered in the Calculator will not be submitted to the HA. You may immediately print or save the data inputted in the Calculator in your computer device as reference.
The currency used in the Calculator is Hong Kong dollars. Please disregard the decimal point and enter the value as integer dollars.
The HA accepts no responsibility for the accuracy of the self-assessment of your household financial resources provided by the Calculator, and any loss or misrepresentation incurred by its use.
^ Including specific ultra-expensive drug which Eculizumab for Paroxysmal Nocturnal Haemoglobinuria (PNH)
* Applicable to First Phase Programme and "Subsidy for Eligible Patients to Purchase Ultra expensive Drugs (Including Those for Treating Uncommon Disorders)"

I have read, understood and agreed to be bound by the above terms of use.

General
Information
Monthly
Household
Gross Income $ 0
Total
Household
Asset $ 0
Monthly
Allowable
Deduction $ 0
Preliminary
Assessment
Result

The type of assistance required is?	Drug Item For details of self-financed drugs supported by the Samaritan Fund and Community Care Fund Medical Assistance Programmes, please visit “Samaritan Fund” and “Community Care Fund Medical Assistance Programmes” of the HA’s website. Non-drug Item For details of non-drug items supported by the Samaritan Fund and Community Care Fund Medical Assistance Programmes, please visit “Samaritan Fund” and “Community Care Fund Medical Assistance Programmes” of the HA’s website.	Reset All Print Preview
Estimated item cost: *
[For recurrent applicants] Have you ever applied the Drug item(s) (supported by Samaritan Fund / Community Care Fund Medical Assistance Programmes) which has/ have been approved in previous 18 months?: * Yes No
Application for Implantable Medical Devices for Interventional Procedures?: * Yes No

Information for Samaritan Fund^ / Community Care Fund* Medical Assistance Programmes Application

Information for Samaritan Fund Medical Assistance Programmes Application

Eligibility:
1.	Clinical Requirement:
	Drug items (supported by Samaritan Fund^ / Community Care Fund* Medical Assistance Programmes): The patient’s clinical indications and commencement of treatment must be supported by a designated Hospital Authority doctor as stipulated under the prevailing clinical guidelines. Non-drug items (supported by Samaritan Fund): The patient's clinical indications and need for the item must be supported by a medical doctor or an allied health professional in the Hospital Authority in accordance with the prevailing clinical guidelines.
2.	Residence Requirement:
	The patient must be an eligible person within the meaning of the latest relevant government gazette published under the Hospital Authority Ordinance.
3.	Financial Requirement:
	The patient must pass a household-based financial assessment conducted by Medical Social Worker (MSW).
Application Procedure:
The patient can approach the Medical Social Services Units (MSSU) during office hours to enquire about the application details. To process the application, the patient must bring along the originals as well as a copy for each of the relevant supporting documents. Comprehensive Social Security Assistance Scheme (CSSA) Recipient / Level 0 Voucher Holders of the Pilot Scheme on Residential Care Service Voucher for the Elderly is also required to put up a formal application via the MSSU but without need of financial assessment.

Financial Assessment:

Drug items (supported by Samaritan Fund^ / Community Care Fund* Medical Assistance Programmes): All applications are to be assessed on a household basis, taking into account the income, expenditures and assets of the patient and all family members living under the same roof who have been included in financial assessment. Patient’s contribution is determined by the disposable financial resources and the estimated drug cost that is required to pay. The maximum contribution is capped according to the established sliding scale. 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 respective fund will pay the outstanding balance.

^ Including specific ultra-expensive drug which Eculizumab for Paroxysmal Nocturnal Haemoglobinuria (PNH)

* Applicable to First Phase Programme and "Subsidy for Eligible Patients to Purchase Ultra expensive Drugs (Including Those for Treating Uncommon Disorders)"

Financial Assessment:

Non-drug items (supported by Samaritan Fund): All applications are to be assessed on a household basis, taking into account the income and assets of the patient and all family members living under the same roof who have been included in financial assessment. 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) 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. After having passed the income limit, if the patient’s household assets are equal to or less than two times of the cost of the item concerned, he / she would generally receive full assistance from the Samaritan Fund. If the patient’s household assets are above two times but not more than three times of the cost of the item concerned, he / she is required to contribute to the item cost based on the sliding scale. 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 cost of the item concerned, no Samaritan Fund assistance would normally be made. However, apart from the above criteria, the Samaritan Fund might consider any special social and financial factors / circumstances faced by the patient on a discretionary basis.

Household size (including patient): 1 To add household member		Reset All Print Preview

Please input the average monthly income of the patient and all household members living under the same roof in the past 6 months. All of the patient's and his / her household members' incomes received inside and outside Hong Kong in the past 6 months should be included for calculating the average monthly income. Normal Disability Allowance, Higher Disability Allowance, Old Age Living Allowance, and Old Age Allowance should not be taken into account as household income.		* Mandatory field

	Patient	Household member *	Subtotal
Salary Include income from full-time / part-time employment, self-employment / business
Allowance / Commission Include housing, education, travel, meal and shift allowances etc, and commissions such as tip and profit
Bonus / Year End Payment Include bonus / year end payment such as remuneration and gratuity in the past 6 months
Benefits-in-kind Include housing, education, travel, meal benefits etc
Pension Monthly retirement income
Rental Income Include rents from apartments, shops, commercial buildings, factories, carparks and land etc
Regular Financial Contributions from Children, Relatives and Friends who are not Living Together with Patient Include money or contribution of housing / water / electricity or other living expenses
Others Include alimony, subsidy, compensation received on a regular basis and payout provided under the annuity scheme etc
Subtotal

# Currency used is Hong Kong dollars. Please disregard the decimal point and enter the value as integer dollars.

Total


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Household size (including patient): 1	Reset All Print Preview

Please input the total assets of the patient and all household members living under the same roof. All assets under their names regardless of being individually or jointly held, in Hong Kong or outside Hong Kong For jointly-owned assets by patient and household members → one entry of the total value of the asset would be enough to avoid double counting in the calculation. For assets that are jointly owned with non-household members → only the value of the share of patient/household members should be included in the calculation.

	Patient	Household member 1	Subtotal
Cash Include Hong Kong and foreign currencies
Deposits & Savings Include all savings (Hong Kong and foreign currencies), time deposit, current, club deposit, integrated account, investment and securities account, Jockey Club betting account and others
Investment Items Include stocks, shares, warrants, funds, bonds, other investments
Insurance / Annuity Scheme Policy value and other disposable value provided by investment-linked insurance policies; cash value, dividend and other disposable value provided by life insurance / annuity scheme Policy value and other disposable value provided by investment-linked insurance policies; dividend and other disposable value provided by life insurance policies / annuity scheme
Non-owner Occupied Property Include non-owner occupied apartments, shops, commercial buildings, factories
Carpark Include carpark that is vacant, rented or self-occupied
Land Include land that is vacant, rented or self-occupied
Other Realizable Assets Vehicle, Gold, Jewellery, Assets held in trust by others , E-wallet and other valuable possession (excluding tools of trade)
Subtotal

# Currency used is Hong Kong dollars. Please disregard the decimal point and enter the value as integer dollars.

Total


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Household size (including patient): 1	Reset All Print Preview

Please input the monthly allowable deductions of the patient and all household members living under the same roof. The monthly average of allowable deductions should be used for calculation, which include expenditures from the property occupied by the patient’s household (i.e. rental or mortgage payment, rates, Government rents, property management fee, the total deduction of these items are capped at one-half of the household gross income), 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) for the past 6 months and personal allowances for the patient and his/her core family members living together. The salary taxes 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) of the last 12 months are also included.

Total Expenditures from Property Occupied by the Patient's Household The sum of expenditures from property occupied by the patient’s household (including rent / mortgage payment, rates / government rent, management fee) is capped at 50% of the monthly household gross income
Rent / Mortgage Payment
Rates / Government Rent
Management Fee
Subtotal

Salary Taxes for last 12 months
Provident Fund / Mandatory Provident Fund Contribution
Child Care Expenses
School fee of dependent children (up to age of 25) who are receiving full-time tertiary education programmes (in Hong Kong) or below For the school fees in tertiary education programmes (in Hong Kong), the net amount would be counted after deducted the Tuition fee grant amount under Tertiary Student Finance Scheme - Publicly-funded Programmes (TSFS) or Financial Assistance Scheme for Post-secondary Students (FASP) (if applicable) from the course fees. Other expenses, such as school activity fees, board & lodging fees, will not be counted as the allowable deductible item
Average Medical Expenditures at the Public Hospitals / Clinics for the Last 12 Months Other than the self-paid drug payment under this application, except for recurrent applicant with approved drug application in previous 18 months
Maintenance paid Payment has been order by Court and actually made for the maintenance of a spouse living separate and apart or a former spouse or a child, whichever is lower
Personal Allowances The Personal Allowance is 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. Based on the household size that you have entered, the Means Test Calculator will automatically determine the personal allowances for the patient’s household. For details, please visit “Samaritan Fund” and “Community Care Fund Medical Assistance Programmes” of the HA’s website and read the related patient information leaflets.
Subtotal

Total

# Currency used is Hong Kong dollars. Please disregard the decimal point and enter the value as integer dollars.

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Based on the information that you have entered, the preliminary assessment result is as follows :
Estimated Patient Contribution:	$	Annual Disposable Financial Resources x Contribution Ratio Since the estimated item cost is below the maximum contribution, patient is required to pay the total drug cost For "Subsidy for Eligible Patients to Purchase Ultra-expensive Drugs (Including Those for Treating Uncommon Disorders)" the maximum contribution from patient capped at a flat contribution ratio of 20% or $1 million (whichever is the lower)
Estimated Subsidy:	$	Since there is no entry of estimated item cost, the amount of subsidy cannot be estimated


Assessment information is as follows:

Estimated Item Cost:

Monthly Household Gross Income:

Monthly Allowable Deduction:

Total Household Asset:

Deductible Allowance:

Annual Disposable Financial Resources:

Monthly Household Gross Income

Monthly Allowable Deduction

Total Household Asset (i.e. Disposable Capital)

Deductible Allowance

Annual Disposable Financial Resources

‒ $

) X

% X

12 +

‒ $

)

X 50%

= $

( $0)

Annual Disposable Financial Resources	Contribution Ratio Patient’s contribution is determined by the disposable financial resources and the estimated drug cost that is required to pay. The maximum contribution is capped according to the established sliding scale. 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 Fund will pay the outstanding balance. For details of the sliding scale, please visit “Samaritan Fund” and “Community Care Fund Medical Assistance Programmes” of the HA’s website and read the related patient information leaflets.		Maximum Contribution For "Subsidy for Eligible Patients to Purchase Ultra-expensive Drugs (Including Those for Treating Uncommon Disorders)" the maximum contribution from patient capped at a flat contribution ratio of 20% or $1 million (whichever is the lower)
$	X	= $
Maximum Contribution 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 contribution is not applicable.		= $

Estimated Item Cost:

Monthly Household Gross Income:

"Monthly Household Gross Income" is below {0} "Median Monthly Domestic Household Income" "Monthly Household Gross Income" is equal to {0} "Median Monthly Domestic Household Income" "Monthly Household Gross Income" is above {0} "Median Monthly Domestic Household Income"

Total Household Asset:

Estimated Patient Contribution:
Estimated Item Cost		Contribution Ratio In assessing the financial condition of the patient, his / her monthly household income must first fulfil the income limit. Medial Social Worker would make reference to the Median Monthly Domestic Household Income (MMDHI) 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. After having passed the income limit, if the patient’s household assets are equal to or less than two times of the cost of the item concerned, he / she would generally receive full assistance from the Samaritan Fund. If the patient’s household assets are above two times but not more than three times of the cost of the item concerned, he / she is required to contribute to the item cost based on the sliding scale. 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 cost of the item concerned, no Samaritan Fund assistance would normally be made. However, apart from the above criteria, the Samaritan Fund might consider any special social and financial factors / circumstances faced by the patient on a discretionary basis. For details of the sliding scale, please visit “Samaritan Fund” of the HA’s website and read the related patient information leaflets.
$	X	% =	$

Disclaimer

To be eligible for the Samaritan Fund / Community Care Fund Medical Assistance Programmes (the Fund), the patient must be an Hospital Authority (HA) patient and fulfil all of the clinical requirement, residence requirement and financial requirement. The patient must pass a household-based financial assessment conducted by Medical Social Worker (MSW). The patient can approach the Medical Social Services Units during office hours, visit “Samaritan Fund” / “Community Care Fund Medical Assistance Programmes” of the HA’s website and read the related patient information leaflets for application details.

The Means Test Calculator (the Calculator) can only compute your household financial eligibility based on the financial figures that you have entered. The result of the assessment is for reference only and does not guarantee that you will be granted the Fund. For formal application for the Fund, applicant must bring along the originals as well as a copy for each of the relevant supporting documents. MSW may request other documents or contact applicant’s family members for verification of information when necessary.

All the information entered in the Calculator will not be submitted to the HA. You may immediately print or save the data inputted in the Calculator in your computer device as reference. The currency used in the Calculator is Hong Kong dollars.

The HA accepts no responsibility for the accuracy of the self-assessment of your household financial resources provided by the Calculator, and any loss or misrepresentation incurred by its use.

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Terms of Use of Means Test Calculator

Information for Samaritan Fund^ / Community Care Fund* Medical Assistance Programmes Application

Information for Samaritan Fund Medical Assistance Programmes Application

Based on the information that you have entered, the preliminary assessment result is as follows in Progress… :

Assessment information is as follows:

Disclaimer

Based on the information that you have entered, the preliminary assessment result is as follows :