China Health Insurance Plans for Expats in China



Navigating the health insurance maze is hard enough, and having to do it in China can add an additional layer of frustration and difficulty. James D, Senior Consultant at China Expat Helth, answers some of the most common questions and concerns when it comes to finding the right coverage for your family during your time in China.

Why is health insurance coverage in China important?

Health insurance is one of the major concerns for expatriates moving to or living in China. First, you need to know that in China, hospitals (public or private) and ambulances won’t usually treat you if you don’t have insurance, or if you’re not able to pay for the treatments upfront.

Usually not eligible for any social scheme in China and/or willing to go to an international hospital, expatriates need to subscribe to private medical insurance to cover medical costs that can occur.

What should people look for in an China insurance provider?

Benefits: What is covered in my plan? What is not covered? Where am I covered? Which hospitals can I access? The answers depend on the level of coverage you’re looking for. The more comprehen- sive the benefits, the more expensive the premium will be.

Service: How efficient is my insurer when an issue arises? We recommend you contact a broker who has experience working with most of the insurers so they can help guide you to the one that best suits your family’s needs. Note: the premium offered by a broker should be the exact same as the one offered by the insurer.

Stability of the Insurer: If an insurer looks too good to be true, get more information from an impartial source. Some insurers will offer excessively attractive rates to enroll a maximum of clients. When claims arise they might not be able to honor the rates they initially promised and you might have a renewal offer with a 100 percent increase.

What are the main types of health insurance?

It’s difficult to identify a main type of health insurance as different pro- files (i.e. age, nationality, single, family, etc.) will have different requirements, and have different sensibilities and knowledge about medical insurance they want and/or need.

What is normally covered and what isn’t?

The level of coverage depends on the type of plan you choose. Generally speaking, insurers cover the risk of an event to occur. Therefore, they should cover you if you declare symptoms that did not exist be- fore joining the plan. Insurers can also choose not to offer coverage for conditions that happened before joining the plan (pre-existing conditions), but this depends on the insurer.

How much does China health insurance cost?

There are many factors to take into consideration when it comes to the cost of insurance, such as age, level of coverage, family status, etc. It’s best to receive quotes from different insurance companies in order to compare what’s available on the market.

What if people move to China with their own health insurance plan? Would it cover them in China?

Some people move to China with their own health insurance and it’s perfectly fine. Just make sure that the benefits and sub-limits are high enough to offer good coverage in China. Also, it’s crucial to make sure your insurer has the experience to offer a Guarantee of Payment to the hospitals in case of hospitalization. Otherwise, you will need to pay out-of-pocket and then claim the money back.

Finally, it’s most important to know how long your insurer will allow you to renew your plan while your primary country of residence is China. There are cases where people are no longer eligible to keep their plan from home because they have been living in China for more than two years. This would end continuation of coverage and can be tragic for people who develop medical conditions while abroad.

Private Medical Insurance for China Expats

Though local hospitals are cheap in China, international hospitals are expensive. This means a good healthcare plan is essential. Local hospitals often require you to queue and lack English speaking doctors; they may be fine for minor ailments, but in the case of serious illness or injury, the last thing anyone needs is a long waiting list and a culture barrier.

Health insurance plans with companies such as Cigna and Aetna give you a card you can carry on your person. You can then show the card when you go to hospital and your treatment should be taken care of; each insurance plan has a set of terms and conditions that details which kinds of healthcare are covered, and which hospitals/clinics the card can be used at. High end plans should cover treatment at all international hospitals in Shanghai, including expensive hospitals such as the Shanghai United Family hospital.

Another point to check on your insurance policy is the benefits cover. Ensure that there is adequate outpatient cover, and that the area of cover includes China and any other countries you may be spending time in. Most policies come with a maximum pay out of eight million US dollars for inpatient treatment, which should be enough to cover all contingencies. A good plan should also pay for emergency evacuation. You might need to be evacuated if you fall ill in a remote area, or if you become sick in Shanghai and need to be repatriated.

If you have additional family members to insure, or your work doesn’t offer health insurance, you can arrange health insurance yourself. Buying insurance independently, you are free to adjust the policy according to your personal needs. You can approach insurance companies independently or use a broker. A good broker will give you a range of options as they work with several insurance companies and understand the market. Reputable brokers also help with any claim disputes that may arise.

Check that your broker is legally licensed to sell insurance in China. Also be careful to buy a legal plan: some reputable international companies sell insurance in China although they are not registered to trade in China. These health insurance policies may work, but if there is a dispute you will have no options to resolve it. Make sure your insurance provider and your broker are both legally registered.

The price of your insurance will be determined by whether you take options such as dental insurance, as well as by your age and any pre-existing conditions. For a thirty-year old, a general plan will cost 15,000 RMB to 25,000 RMB annually.For a fifty year old, a plan with the same cover might cost 40,000 RMB a year.

With health insurance being both expensive and essential, it can be tough if you’re on a budget. One option for those in excellent health is accident insurance.This kind of insurance doesn’t cover anything except accidents, but can cost as little as 1,000 RMB a year. If you choose this kind of insurance, be aware that a range of conditions that can happen to young, healthy people, from food poisoning to malaria, won’t be covered. If you choose to travel to remote areas or nearby countries on accidental insurance, consider supplementing it with travel insurance.

For short term visitors to China, a sound travel insurance plan might be a good option. It’s often better to buy travel insurance before leaving home, as some companies won’t offer travel insurance if you have already left your home country.

What You Must-know About China Health Insurance

As an expatriate living abroad, it’s both more important and more difficult to understand the details of your health insurance. Here are six points to consider when shopping for coverage.

Buy it before you need it

At the very least you need a health insurance policy that includes inpatient services and emergency evacuation. Outpatient services aren’t that expensive to pay out-of-pocket but add a lot to your premium. 

Emergency evacuation coverage is key

You never know where you’ll be when you need it. So make sure you have adequate emergency evacuation cover. And by adequate it means the overall limit should be sufficient to provide evacuation to the nearest center of medical excellence.

Know your healthcare options and preferences

You need to consider your healthcare options when deciding how much and what kind of coverage you need. Will you use western, local or overseas facilities? For example, are you just going to use western clinics and want to evacuate offshore if you have a serious emergency? Will you use a mix of local and western facilities? Or will you head for those nearby countries that have top international hospitals but at much lower cost such as Thailand, Singapore and the Philippines?

Place your coverage locally

If you’re not covered under your company’s global policy, then it’s best to place your coverage locally through one of the legally registered local insurance providers (e.g. AXA-Minmetals, Goodhealth, Ping An, GBG/TieCare). Placing your coverage locally has several advantages. First of all, you have local staff that speak the language, can help you navigate the local system and can negotiate with local hospitals and doctors. Secondly, in cases where direct billing isn’t an option then a good local provider will send agents directly to your clinic to pay the claims directly (for inpatient cases). And finally, with an offshore product, you won’t have any consumer protection. In China the China Health Insurance Regulatory Commission (CIRC) regulates and maintains the legal and stable operation of the insurance industry. But if your provider isn’t here, they can’t help you.

The devil is in the detail. Read your policy

Does it extend overseas? What does it cover? Where doesn’t it cover? For example, we  offer worldwide coverage and then worldwide coverage excluding the U.S. The latter decreases your premium, but won’t cover your medical expenses if you want to go to the U.S. for treatment (with the exception of a small amount of emergency coverage). Sometimes people will bring domestic plans from Hong Kong and find out too late that these plans don’t actually cover everything they need. For example, there’s a higher probability of evacuation from mainland China and their Hong Kong-based policy won’t necessarily cover that. 

Insurance and the local healthcare system

Some local hospitals will handle direct billing (your insurance company will have a list), but most don’t. They have plenty of local paying business, so they don’t have a need to cater to foreigners. Even if you don’t use a local hospital it’s a good idea to find a Chinese doctor who speaks English. They’ll be able to navigate the local system and services for you should you need something a western clinic can’t provide.



12 COMMENTS

  1. I’m moving to Shanghai in the New Year and am trying to sort out my medical insurance. I’ve seen a fairly reasonable plan that is affordable and covers me to a decent level.

    The only issue is that not all hospitals in Shanghai are covered. It says that the following places are excluded:

    ParkwayHealth Clinics / Gleneagles International Medical & Surgical Center (Shanghai)
    SinoUnited Health Medical Center (Shanghai)
    United Family Hospitals and Clinics (Beijing, Shanghai, and other cities if any)
    Klinoerth Therapy Clinic (Shanghai)
    Shanghai East International Medical Center

    Are these all the English speaking hospitals in Shanghai? I don’t mind not being able to use the very flash private hospitals – I currently live in Hong Kong and happily use the public system and before that relied on the NHS in the UK. All I need is a hospital where English is spoken so I can communicate and where I can get a decent standard of care in an emergency.

    Are the only places that fit my criteria the ones listed above or are there other options I can use?

    Any thought/ideas would be welcome. Thanks in advance for any help!

  2. The excluded clinics are all high-end, English-speaking establishments that charge like wounded bulls. I know someone in the insurance industry here and they say that one or two of the establishments on that list are rated amongst the most expensive private clinics in the world. (And this is a big multinational insurer with access to international data.)

    There are other places you can go for good English-speaking service. On the whole I’d say you can get away with it. However, do check to see whether your plan covers you for repatriation to other countries for expert care. Some insurers operate through a third party which acts as a triage system. If they think it’s better for you to be flown out to (say) HK, they will pay for it.

    However, I suspect that such plans are probably more intended for travellers than residents.

  3. Don’t buy that insurance policy as it doesn’t cover most expat places here.

    I work in another hospital and that is my competition but I still suggest not to buy a policy that excludes most places as you might like one of the doctors in one of those places and wont be able to use his/her services.

  4. I recently became sick and spent 2 weeks in the hospital because of the mononucleosis. I went in the foreign section of Huashan hospital and I think they are good, but my insurance (a kind of French social security for expats = CFE) has no contracts with hospitals in China, so I had to pay 30000 RMB from my pocket (I will be reimbursed in one month).

    The problem is that it can be much more expansive if I need surgery so I’m looking for an insurance which does direct billing in Shanghai (and in France). I asked the accountant to give me the list of insurance companies which have contract with them.

    Is anyone having some experience with direct billing insurance for expats in China ?

    Which insurance you think would fit to a single young man (it can be an insurance not listed above)? I heard BUPA or CIGNA are very good, but they don’t appear in the list…

    Thanks.

    PS: I would like to advice you to NOT go to Changzheng hospital near People Square, I went there 4 days before going to Huashan and they were not very hygienic and they were wrong: they gave me antibiotics whereas I had a virus infection…

  5. I am hoping some of you can share some advice about my current situation. The last time I was in Shanghai back in 2016 my company took care of my health insurance for me, and being young and dumb I didn’t really take it upon myself to understand what my situation was.

    This time around, I would like to be better prepared. I asked my new company if they could simply pay me my healthcare premium monthly, and I would go out and buy my own insurance (and cover whatever additional costs myself).

    Their reply is that they would prefer to insure me using the company plan, and that I should purchase whatever additional coverage I want on my own.

    I can’t see this being cost effective. In fact I’d rather skimp on my China coverage since services are cheap there and I wouldn’t even stick around if something really major happened (if I could help it in such a case) and have a robust US coverage. I also have no faith in collecting from a Chinese insurance company in the case of a real accident.

    Are my requests unreasonable? What are your suggested solutions? Do I have any misconceptions?

    • I think many companies will not allow you to “skimp” on health insurance because they are obligated to cover you.

      And cover in China does not mean it has to be a Chinese insurance company.

      Having said that, my company uses a Chinese company and the service has been fine.

      A colleague had no problems getting treatment at Parkway Health and the bill was settled directly by the company – he did not even need to pay first and claim back.

    • I’m guessing the Company may also be able to deduct some of the costs of the premiums from their corporate taxes as business expenses. If paid to you directly, they are treated as wages and may be subject to withholding taxes. You’d also be subject to income taxes on the amount.

  6. Also….If you get sick and your company doesn’t have your insurance details, then it will be tough for anyone to sort out coverage and treatment for you.

    Chinese hospitals don’t have a “treat first, bill later” approach to healthcare. You need to prove you are good for the money before they start treatment in most serious cases. It is rather tricky to return home and fish out your insurance docs when you are unconscious on the floor of the hospital.

    Yes, there are “foreign hospitals” here that will treat first, but they are merely a group of GPs who refer to the Chinese hospital for anything specialized, like surgery. They can’t do anything for you if you have bleeding on the brain from a traffic accident for example.

    This is completely forgetting the group discount that your company gets from its insurer. This can be up to 20-40% depending on the size of the group. You won’t get that yourself.

    I’ve heard Chinese insurers pay out. Secondly I’ve heard foreign based ones that don’t on occasion, and in China there isn’t much legal redress on offer in that scenario.

    Talk to a health insurance broker if you must, but chances are your company arranged insurance will be better and cheaper than what you’ll find yourself. And with the added bonus your HR department will help sort you out of any problems arise, heaven forbid.

  7. I am relocating from UK to Shanghai later this year and require a budget health insurance plan that will cover my current condition of type 2 diabetes.

    Will any local Chinese health insurance companies cover me for a china only insurance ? I do not need international as I will only be traveling between the UK and China for work.

  8. I am also looking for health insurance that can cover my pre-existing conditions, I have the following pre-existing medical conditions but I should underline that I am in good health otherwise. I have a mostly well balanced vegetarian diet and I exercise regularly:

    1. Sleep apnoea (I sleep with a CPAP machine)

    2. High blood pressure and high cholesterol treated by medication

    3. Diet and exercise controlled Type 2 diabetes (no medication)

    4. Enlarge prostrate (my last PSA was 6.8) I am waiting to do an MRI scan to make sure all is well. I have no signs of any problem otherwise.

    5. A few small patches of Psoriasis.

    6. I had a heart attack Dec 2010 and had one stent inserted. I am on blood thinning and heart stabilisation medication. I am otherwise in good health and exercise regularly.

    I take the following medicaition:

    Atorvastin – 20 mg
    Bisoprolol – 2.5 mg
    Clopidogrel – 75 mg
    Candesartan – 2 mg

    My weight is: 166 lbs. My BMI is 24.9. My height is: 5ft 8.5 inches.

  9. I have had a claim denied by Cigna that I believe is covered under my policy. Both psychiatric care and consultations with medical practitioners and specialists are listed in the policy booklet at “paid in full.” However, Cigna says the claim has been denied because they state it is INDIVIDUAL PSYCHOTHERAPY and not covered.

    Also, they have denied two other claims stating that they did not receive an invoice/receipt, but I sent in all fapiaos from received!

  10. I recently became sick and spent 2 weeks in the hospital because of the mononucleosis. I went in the foreign section of Huashan hospital and I think they are good, but my insurance (a kind of French social security for expats = CFE) has no contracts with hospitals in China, so I had to pay 30000 RMB from my pocket (I will be reimbursed in one month).

    The problem is that it can be much more expansive if I need surgery so I’m looking for an insurance which does direct billing in Shanghai (and in France). I asked the accountant to give me the list of insurance companies which have contract with them.

    Is anyone having some experience with direct billing insurance for expats in China ?

    Which insurance you think would fit to a single young man? I heard BUPA or CIGNA.

    Thanks.

    PS: I would like to advice you to NOT go to Changzheng hospital near People Square, I went there 4 days before going to Huashan and they were not very hygienic and they were wrong: they gave me antibiotics whereas I had a virus infection…

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