I’ve lived in China for over 10 years and have worked in medical insurance in China since 2012.
The contents of this guide are what I would tell my best friend if we were sitting and having a coffee or a drink, and he asked me for the best advice about what he should do for his medical insurance.
This is the definitive guide.
What Is Medical Insurance?
China Medical insurance is an insurance policy which can cover you for the cost of medical treatment in China. In simplistic terms, this means if you go to the doctor or hospital you can ask the insurance company to reimburse you for the money you spent. Only treatment which is covered under your health insurance plan can be reimbursed. Different plans provide different levels of cover, which we will discuss this in more detail below.
There are different types or levels of medical insurance in China.
The lowest level of medical insurance is a top-up to the employer-provided social medical insurance. This is usually only available for companies to purchase for their staff and only covers costs at some public hospitals.
Then there are expatriate and international level medical insurance plans. These are designed to make expats feel safe in foreign countries giving them access to English speaking doctors, international facilities and coverage levels that won’t run out when you need them most. The last thing you want in a medical emergency is to hear that your plan doesn’t cover that or that the limit is too low for that treatment.
Can I Just Use Travel Insurance?
Some people come to China with a travel insurance plan. However, most people don’t know the difference between travel insurance and medical insurance. Travel insurance is fine for short trips if you’re just visiting. But as soon as you get a resident permit and are here long-term, or you’re already in China when buying travel insurance, then the travel insurance policy probably isn’t valid anymore and you actually have no cover at all. Don’t fall into this trap, travel insurance is for travelling, not to cover medical expenses where you reside.
It’s also worth bearing in mind that, many travel insurance plans have a cancellation clause in the case of any insured event happening, meaning they may agree to insure you to the end of the policy year but won’t insure you after that. But now you have a pre-existing condition and no insurance.
Do I Even Need Medical Insurance in China?
Some people have social medical insurance through their employer, some people have AD&D (accidental death and dismemberment cover) or a critical illness plan. If this is similar to your situation, read more and find out why you still need medical insurance in China.
So now we know what medical insurance is and I hope everyone reading this knows why this is an essential protection every expat needs. Now for the tricky part, how do you get the right cover at the right price.
Step 1: What Is The Right Price?
Choosing a budget for your insurance can be stressful and difficult. Some people think a couple of hundred US$ or a few thousand RMB should be enough, it isn’t! Any insurance costing that little won’t provide the minimum level of cover required and only gives a false sense of security which doesn’t exist.
Whatever the number is it should be affordable and sustainable, which means you should try to spend less than 15% of your annual salary on the insurance plan. Ideally you should be between 5% and 12%.
People who earn more, usually can spend a lower percentage on their insurance and get good cover, whilst people earning less usually pay a higher percentage. However older people earn more but their insurance is more expensive.
If you have a family, like me, you should expect to pay a higher percentage, possibly up to 20% of your annual salary. Ultimately this is worth it to ensure your kids are protected and can get the healthcare they need.
I’m an expert, and my family’s insurance costs me a lot, but I sleep easily knowing no matter what life throws at us, we can see the best doctors and don’t need to worry about the cost.
“Hope for the best, plan for the worst.” Lee Child
Before deciding an ideal budget, also factor in that the price of insurance increases over time as you get older and because of inflation.
Step 2: Figure Out What Benefit Coverage You Want
First of all, you need to decide what kind of protection or health insurance you are looking for and what kind of benefits are important to you. If you are already familiar with the basic structure of health insurance plans, our Guide to The Most Popular Expat Health Insurance Plans in China might be able to help you figure this out. If you’ve never purchased this type of insurance before then I recommend you read on.
Different stages in your life will require different levels of protection. For instance, if you are young, single and just starting out in your career, you may just want an inpatient / hospitalization only plan covering major medical issues. You probably won’t need – or may not be able to afford – the sort of comprehensive insurance policy that someone with a family may want. A family policy may including outpatient, regular wellness check-ups, vaccinations and perhaps even dental coverage.
To help you choose which benefits suit your situation you need to know the basic structure of a health insurance plan, which is basically the same for every insurance company.
Inpatient / Hospitalization Plans
Medical insurance plans start with a ‘Core Plan’. This covers inpatient treatment (hospitalization), daycare treatment, cancer treatment, emergency medical evacuation and mortal remains repatriation – should someone pass away. In more simple terms a ‘Core Plan’ covers the most expensive medical events you are likely to face and is the minimum cover any expat should have in China.
There are always high costs when it comes to inpatient treatment. These typically include private room fees, surgical costs, doctors fees, anesthesiologist costs, medication, nursing costs, etc. The average costs for an inpatient stay in hospital is between CNY 50,000 to CNY 500,000 depending on whether you go to a public hospital or an international hospital and the complexity of the treatment.
The approximate cost of an inpatient health insurance plan is between CNY 500/month and CNY 1,600/month depending on age, area of cover and coverage limits.
The second most important part of a health insurance plan is deciding whether or not you need an outpatient plan. Outpatient treatment is when you go to see a doctor or specialist but you do not need to stay in hospital overnight. In simpler terms, it covers the costs of regular doctors visits for relatively minor ailments and issues.
Your common cold, the flu, cuts or grazes, allergies or broken bones are usually all treated on an outpatient basis. Outpatient plans generally cover the costs of:
- Doctors consultation
- Specialist consultation
- Medication and prescriptions
- Examinations and tests (X-rays, scans, blood tests)
- Various therapies: physical therapy, occupational therapy, acupuncture, etc.
- Psychiatric care
- Durable medical equipment: crutches, wheelchairs, nebulizers
Out-patient plans cannot be purchased without inpatient coverage. The coverage limits can range from a limited CNY 10,000 up to the millions.
More than 90% of all medical treatment is outpatient treatment. Whilst less expensive than inpatient treatment, outpatient can also be expensive. An outpatient visit costing between CNY 700 and CNY 4,000 depending on which clinic you visit and what treatment you’re receiving. MRI scans and CT scans in international clinics generally cost over CNY 6,000 and can go as high as CNY 12,000.
The approximate cost of a health insurance plan including Outpatient: an additional 60% – 150% of the in-patient premium.
Dental coverage varies widely depending on the insurer, and the treatments are rarely fully covered. The coverage will be limited up to a particular amount and will incur co-payments.A copayment is usually a percentage of the total cost which you must pay yourself. Most dental plans include preventative procedures such as cleaning and polishing, as well as simple routine treatments such as inlays, plus major treatments such as bridges. Dental prostheses or orthodontics, on the other hand, are not always covered. Emergency dental care is often covered within an inpatient plan or outpatient plan.
The approximate cost of a dental plan on top of a regular health insurance plan is between CNY 250/month and CNY 1,000/month depending on age, area of cover and cover limits.
Wellness Check-ups & Vaccinations
Wellness check-ups differ from regular treatment as they are preventative in nature. Meaning you do not need to have symptoms present, or a health issue, to get a check-up done. Check-ups at clinics typically come in packages and include, a physical body examination, blood tests, x-rays, Electrocardiogram (EKG) and cancer screenings. At an international facility this would cost between CNY 2,500 and CNY 8,000. In a local Chinese facility this could cost as little as CNY 500, but the reports are all in China and a doctor will not consult with you on the results, you need to figure out what it all means yourself.
Whether or not this is included in your insurance, this is a great way to detect underlying health risks early and prevent future illness.
Most medical insurance companies include vaccination cover within the wellness check-up benefit, one or two insurers cover vaccinations in their outpatient plans. If you have young kids then a wellness plan or choosing a plan which covers vaccinations within outpatient can be a cost-effective way of getting expensive imported vac plan, the vaccine schedule for China, US, UK and Australia have some important differences.
The approximate cost of a check-up plan on top of a regular health insurance plan is between CNY 250/month and CNY 500/month depending on age, area of cover and cover limits.
Maternity Insurance Plan / Pregnancy Insurance Plan
A maternity insurance plan includes cover for medical costs arising from pregnancy and childbirth. For a detailed look at maternity insurance and the cost of giving birth in China check out our Guide to China Maternity Insurance & Having a Baby in China.
Maternity benefits will cover the cost of prenatal and postpartum healthcare for expectant mothers, as well as the delivery of the baby. The costs of maternity care in China are relatively high; especially at private clinics, and it is important for any young woman or family to ensure the welfare of the newborn child. If a child is born without any Insurance, and there are unforeseen medical conditions, the baby would not be covered at all for the condition after birth. Neonatal intensive care can cost thousands of US$ a day and some of the highest medical bills we’ve seen have arisen from this. One important thing to note is all maternity plans have a 12 month waiting period, meaning if you want your future pregnancy to be covered you need to purchase maternity insurance before you start making or adding to your family.
The approximate cost of maternity cover on top of a regular health insurance plan is between CNY 1,200/month and CNY 1,500/month depending on age, area of cover and cover limits.
Ophthalmology / Optical Cover
Optical cover within health insurance plans doesn’t refer to eye injuries and or eye diseases. This is covered within the inpatient and outpatient plan. Optical cover refers to cover for the cost of eyeglasses and contact lenses for people with short or long sightedness. This isn’t a common benefit, so insurers which have it, it is usually covered within the wellness and check-up plan, some insurance companies have it in their outpatient plan, but most don’t cover it at all. I don’t think this is essential cover, but it is a ‘nice to have’ if it comes included on the package you choose.
Area of Cover
The area of cover defines the geographical area where the insured person can seek medical treatment covered under the insurance. In China there are usually four areas of cover available: Mainland China; Greater China (including Hong Kong, Macau and Taiwan); Worldwide excluding the US; and Worldwide including the US. Some plans may also have an option for Asia but this isn’t very popular. Most insurance plans provide a limited level of cover outside the area of cover. This usually only covers life-threatening emergencies and has a limit on the amount and the number of days spent outside the area of cover. This is important to know as if you work and live in China, but only travel once in a while to other areas than a Mainland China or Greater China insurance plan may work perfectly for you and is usually 5 to 15% cheaper than a Worldwide Excluding the US plan. Worldwide plans usually cost twice as much as Worldwide Exc. US plan. This is mainly due to the high cost of medical treatment in the US.
Step 3: Choose What Services You Need From Your Medical Insurance
At this stage, you’ve decided on a rough budget, and on what benefits you would prefer to have or need to have. Lastly you need to figure out whether or not you have any particular insurance service requirements and what you expect from your insurance company in terms of performance.
Basic Services All China Insurance Provides
- Direct billing (cashless outpatient treatment using an insurance card) at an extensive China hospital network
- Direct Settlement (cashless inpatient treatment with guarantee letter)
- Help booking doctor appointments
- 24/7 Chinese-English helpline
Direct billing is a term for outpatient treatments where your bill will be directly paid by the insurer to the clinic or hospital. Most hospitals in China – especially private ones- have contracts with many insurers so that they pay directly for treatments and doctor’s visits. Different insurers will offer direct billing for different services.
Direct settlement is the process where you apply for a treatment guarantee letter from your insurance company, and then the insurance company directly settles any bills with the medical provider. This works as official approval from your insurer for a specific treatment. Which treatments require a guarantee letter depends on your insurance company but most international or private clinics are aware. In general they include any inpatient treatment, outpatient surgery, MRI or CT scans or other more serious or expensive treatment items.
Issuing a guarantee letter can take up to five working days and it depends on submitting all the required documents from the doctor. Make sure you receive your guarantee letter and that your treatment is covered before you go to the hospital for more serious treatments.
In an emergency you can apply for the guarantee letter 48 hours or as soon as possible after receiving emergency treatment.
Capabilities & Services Offered By Better Insurance Providers
- Portability to other countries (meaning you can take your plan with you when you move outside of China)
- Good direct billing outside of Mainland China
- Large overseas hospital network
- International concierge service to assist with getting treatment outside of China
If you need good service and cover outside of Mainland China, choosing an insurance company with better overseas capabilities is very important. Or, if you’re a long-term expat and working in another country in the future is a possibility, then portability is a must.
Imagine, you have an insurance plan in China for 5 years, during this time you get cancer or have an accident which is covered under your plan, however when you move to another country you’re forced to leave your insurance and can’t buy new insurance plan because of your pre-ex or existing illness, this is a nightmare scenario which can be avoided by ensuring you have portability. However if you’re a more short-term expat then having portability might not be worth the extra cost of a better insurance company.
These are examples of ensuring your insurance company and plan matches you and your families long-term and short-term insurance requirements. It’s great to pay less, as long as it isn’t at the expense of yourself.
Step 4: Choose The Right Insurance Plan
Why You Should Use An Insurance Broker
Now you have a budget in mind, know which benefits you want in your plan and what service capabilities you need from your insurance company. However it’s tricky to match your requirements and circumstance to the right plan. Speak to one of our consultants who can help you navigate these choices or get a no-obligation medical insurance comparison here.
Using an insurance broker doesn’t affect the price of any insurance plan but adds great value as you have an expert advisor and advocate working on your side. Our services are completely free to you.
Now it’s time to review the personalized medical insurance comparison we sent to you. Check which plans meet your budget and match your benefits coverage requirement – if you’ve spoken to one of our consultants then the comparison will already match your budget and coverage requirements.
Lastly you need to choose which of the qualified options is best for you. This will depend on what your preferred mix of medical insurer affordability vs service vs brand is.
Insurance Companies In China
Below is a list of health insurance companies who have plans and services specifically designed for expats in China.
- ICBC AXA
- AXA Tianping
- Now Health
- Ping An Health
More health insurance providers are available, however the above are the most popular, reputable and trustworthy insurance companies available.
What Might Not Be Covered In Your Insurance Plan
This is the period of time during which you are not able to claim certain benefits under your insurance policy. While insurance companies cover the risk from the moment the insurance policy starts, to ensure that no condition that existed prior to the start date will be covered, waiting periods are set for certain benefits. This mainly applies to dental (up to 6 months) or maternity (up to 12 months), but some insurers even have implemented waiting periods of up to 30 days for inpatient or outpatient benefits.
To find out if your plan has any waiting periods, ask your broker or check the table of benefits on the insurance product you’re looking at to see which items have waiting periods.
A deductible is an amount deducted from your claimable amount. In simpler terms, this is the amount you have to pay yourself each policy year before any costs will be covered by the insurance. Deductibles are usually a fixed amount per year per insured person. Sometimes you can get ‘per visit deductibles’, which is a set amount per visit you must pay yourself.
This is very similar to a deductible, even seasoned insurance professionals sometimes don’t know the difference. An excess is an amount you must pay before the insurance actually starts. Unlike a deductible, it isn’t deducted from your claimable amount. In practice in 99% of scenarios, an excess is the same as a deductible. The only time there is a difference in reimbursement amount is when a benefit limit is exceeded, in which instance a plan with an excess will pay out slightly more in total than an equivalent deductible.
Most medical insurance plans only use deductibles and not excesses. Unlike car insurance which usually uses excesses as opposed to deductibles.
Co-Payment or Co-pay
This is a percentage of the medical bill the patient has to pay, which is not reclaimable. Co-pays may be applicable for both inpatient and outpatient treatments, and also for dental and maternity treatments
Hospital Access and High-cost Providers
Private individual medical insurance in China usually covers all hospitals within your area of coverage – public as well as private. A unique concept to China and Hong Kong, however, is ‘high-cost providers’. Certain facilities in the Greater China region are classed as luxury facilities with treatment costs beyond average and even comparable with costs in the US. These luxury clinics and hospitals are either excluded, covered with a co-pay, or fully covered. To include such facilities fully the insurance premium can be up to 30% more expensive than without.
Generally following hospitals / clinics are considered High Cost at insurers in China:
- United Family Hospitals and Clinics (Beijing, Shanghai, and other cities if any)
- ParkwayHealth Clinics (Shanghai)
- Shanghai East International Medical Center
- Beijing International Medical Center
- International SOS Clinics (Beijing, Tianjin, Nanjing, Shenzhen)
- Hong Kong Adventist Hospital
- Matilda International Hospital (Hong Kong)
- Hong Kong Sanatorium & Hospital
All insurers have a list of medical treatments or conditions which aren’t covered in their plans. Common general exclusions you might find are alcoholism, self-inflicted injuries, dangerous sports, professional sports competitions, cosmetic surgery, injury or illness caused by participating in a criminal act, treatment resulting from war or terrorism.
The specifics vary from insurer to insurer so before buying make sure you have a good read through of the policy wording for anything which may affect you.
Some insurers have a very short / generous exclusions list, such as Bupa, Allianz and Now Health. Most other insurers have quite a long and extensive list.
Pre-Existing Conditions & Underwriting
Pre-existing conditions refer to all medical treatment, illness, injury or symptoms which presented itself or was undertaken before purchasing a medical insurance policy, regardless of whether that particular medical issue is not now present or is fully cured. Although insurance companies definitions are actually slightly different between each other.
When you apply for medical insurance you complete a medical history questionnaire which aims to identify any relevant pre-existing conditions. An underwriter (a person who evaluates risk in an insurance company) looks at the questionnaire and based on that will decide whether to exclude all conditions listed from cover, provide cover for listed conditions or decline the application if they feel the risk is too large. This process is known as Full Medical Underwriting or FMU, read below for more details.
Most pre-existing conditions won’t be covered at all. Some more minor issues such as asthma or acne may be included but with a slight increase in the cost (known as a loading). Unfortunately some pre-existing conditions result in an automatic decline of the application, such as diabetes type-1.
For people with serious pre-existing conditions, there is another form of underwriting know as Moratorium Underwriting which may allow them to get some cover without having their application rejected. It’s complicated so if you want to know more, speak to one of our expert consultants who have extensive knowledge on which options are available for those with serious pre-existing conditions.
Beware of insurance providers that accept you and don’t ask you to fill out a medical questionnaire. Read more in the Alert, Before You Buy, Check You Don’t Fall For These Traps! section below.
Chronic conditions are illnesses or injuries for which ongoing medical treatment is likely required and a full cure is not always possible, such as diabetes, back-pain, high-blood pressure, cholesterol, etc.
Some insurers have limitations on chronic condition coverage or have lifetime limits, we always suggest to avoid plans which restrict chronic conditions coverage too much as this can turn into an insurance and financial nightmare.
Sexually Transmitted Diseases
Most insurers exclude coverage of Sexually Transmitted Diseases (STDs), however Allianz does provide cover if it isn’t a pre-existing condition. Some insurers may provide cover if it was not your fault, for example if it is the result of a blood transfusion – but the burden of proof may be on you.
Additionally, there is usually a limit on expenses that are covered relating to HIV, plus a minimum waiting period of 24-48 months for HIV treatment.
Coverage for professional sporting events, combat-focused sports and other very high-risk sporting activities such as paragliding is normally never covered under health insurance. If you take part in any form of professional competition or what could be considered to be a dangerous sport, then you should check the exclusions section of your insurance policy.
Some insurance companies exclude specific sports; others are broader in their description. If you are at serious risk of a sports injury, you probably want to get something in writing from the insurance company stating if you’re going to be covered or not. Amateur sports, however, are usually no problem and most companies cover normal amateur sporting activities.
Alert, Before You Buy, Check You Don’t Fall For These Traps!
If It Looks Too Good To Be True
We’ve seen plans come across our desk which charge half the amount of the market standard and, on the surface appear to have great coverage. But if you look a little closer things look really bad: no cover for cancer, lifetime limit on Chronic conditions, the right to not renew your plan if they feel you are abusing it. This is like signing a blank cheque to an insurance company and praying they don’t screw you over.
No Medical Questionnaire
Some medical insurance companies well brag about their easy application process with no questions. Sounds like a dream come true, particularly for people who have pre-existing conditions. However, the small print always states that pre-existing conditions are not covered, but you didn’t fill out a medical questionnaire, so who decides what’s pre-existing or not? The insurance company, who – guess what – has an interest in not paying your claims. The onus will be on you to prove a condition arose under the plan which can be very tricky for many conditions. This is why choosing a full medical underwriting option is almost always best.
We’ve seen potential clients who bought such a plan and come back to us a year later saying they couldn’t get any claims paid and feel like its all just a scam. A trustworthy consultant ensuring you’re protected is free but priceless.
Where Is The Insurer Regulated?
A good insurance company for expats in China should be regulated in China to ensure you have adequate protection and recourse. We’ve come across insurance companies whose head office is located in the third world or in small Carribean tax havens like St. Kits – not naming any names but you know who you are – with no oversight and a weak regulator. This means the insurer/cowboy/conman can basically do whatever they want and there’s nothing you can do about it. Having a reputable regulated insurance plan is an absolute must.
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