Understanding Medical Insurance in China

China is still in the process of developing an adequate national health system, and therefore it is important for expatriates living here to cover the risks. While the majority of expatriates purchase medical insurance to cover any unexpected events, it is important to understand what the risks of living in China are, and what medical insurance covers as well as the way the insurer manages your policy.

The majority of insurers will ask many medical history questions. Many are unlikely to accept cover for recurring injuries from your past and some insurers will have a moratorium on existing health issues – meaning they will not cover anything that existed for a certain period prior to being covered, which is usually two years.

Lastly there are some insurers, which will cover pre-existing medical conditions once you have been covered with them for a certain period of time. It is therefore important to ascertain how the insurer underwrites your policy and you should ask questions to ensure you will be covered.

When assessing what insurance to buy, it is always important to compare insurer products. In China there are approximately 15 insurers with high-level medical insurance plans and each will have at least three or four different options. However, deciding on a policy and an insurer can be a daunting process without a good broker. It is also important to understand the different terms that are used, as many products will look identical – even though they are not.

In-Patient

 

The core component and foundation to any insurance package is its in-patient coverage. This is when a patient needs to stay in a hospital bed for more than 12 hours or overnight. There are always major costs that are associated with in-patient care. In catastrophic incidents, it’s important to realize potential costs, which could run into the hundreds of thousands of RMB, such as full local stabilization and evacuation either to a centre of excellence in China or back to Home Country.

 

Out-Patient

 

This is the term used for any treatment where an overnight stay is not necessary and the patient walks into a facility and then leaves after a simple consultation or treatment. 85 percent of all claims associated with the industry fall into the Out-Patient bracket. Therefore it is extremely important to find an insurance product that covers all your needs in this area. This is often a key component of any insurance package especially if you have children who will be large utilizers of out patient care.

Maternity

 

This is the term used for any costs resulting in pregnancy and child birth. The costs of maternity in China are relatively high, and it is important for any young female or family to ensure that the welfare for the newborn child is covered.

If a child is born without any insurance, and there are unforeseen medical conditions, the baby would not be covered at all for any conditions diagnosed after the birth.

 

Dental

 

Coverage for dental treatment is never fully covered under an insurance policy and the coverage will be up to a maximum amount. It usually has co-payments associated with it. Some insurers cover preventative coverage such as cleaning and polishing but many will exclude it.

 

Wellness

 

This is the term for an annual Medical Check Up specifically to see if there are any underlying problems that have not yet surfaced. This is something that is highly recommended as anything caught early can be treated efficiently and cost effectively. Looking after your wellbeing is always critical. With a Wellness Package, insurance companies will cover you for an annual check-up looking at a range of issues e.g. mammograms, pap smears, prostate cancer checks, diabetes tests etc.

 

 

Other Important Terms

Co Pay – This is a percentage that would be paid personally and not reclaimable.

Deductible – An amount that for every policy year you would pay before any costs would be covered by the insurance.

Excess – An amount per treatment that would not be covered by the insurance.

High Cost Facilities – A unique term applying only to China and Hong Kong where certain facilities are classed as charging US-treatment costs so are excluded from full coverage.

China Licensed Products – These are insurance products that have been approved by the China Regulators for sale in China and are denominated in RMB. They include local taxes and are approved for all China residents both foreigners and Chinese.

Offshore Products – These are insurance products that are non-approved in China and are developed for international residents in non-regulated countries such as Hong Kong. They carry no China taxes and should not be sold to China residents.

Family and Individual Medical Insurance – KEY things to consider:

• International Medical Insurance with country restrictions such as China Only Policies, Asia Only Policies or Worldwide excluding USA and Canada

• International Medical Insurance policy without hospital restrictions. Many hospitals now in China are classed as high costs and have non or Co Pay added.

• Full In Patient and Out Patient coverage

• Full In Patient with Sub Limits on Out Patient coverage

• Hospitalization Only Plan

• Dental Option

• Maternity Option

• Continuation from a current Insurance Plan ■

 

*Chris Hughes is a shareholder and Business Development Director for Panoramic Insurance Brokerage (Beijing) Co Ltd (PIBB), the leading Independent Insurance Brokerage in China, specialising in Medical and Employee Benefits. Chris has worked on international projects for over 19 years in more than 40 countries. He has been based in China since 2000.