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December 2021

How can I cover for pre-existing medical conditions in China?

How can I cover for pre-existing medical conditions in China? 150 150 China Access Team

Pre-existing conditions and how insurance companies can cover them

One of the most confusing parts of expat health insurance in China is the section about pre-existing conditions. Most people are unsure what pre-existing conditions are or insurance companies wouldn’t cover them. We know how confusing it can be, but we break it down for you in this guide to help you understand health insurance for foreigners in China.

What are pre-existing conditions?

A pre-existing condition is a condition you’ve been treated for previously or a condition that already showed symptoms. It can be considered a pre-existing condition even if you did not know that you had it before you applied for the health insurance. Examples include an injury such as a torn ligament or an illness, such as an ongoing respiratory problem. Hereditary conditions such as diabetes can also be considered pre-existing. For most insurers, these conditions are a serious concern because insurance companies do not want to offer insurance for conditions they know exist and will create medical bills.

It can be frustrating for expats in China when you’re told a condition you’ve had coverage for over the years isn’t covered by a new plan. This doesn’t mean it’s impossible or even difficult to get health insurance with a pre-existing condition. There are plenty of options for health insurance for expats in China, you just have to work with an experienced and compassionate broker to find the right options.

What are my options?

Approximately 45% of the expats in China who need medical insurance have a pre-existing condition. This varies from minor conditions that have little to no impact on your daily life, to serious conditions such as type 2 diabetes or a serious heart problem.

There has been a large increase in the number of people with pre-existing conditions who need health insurance in China. Today’s lifestyle and diet choices have led to more serious health conditions in millions of people. There has also been a lot of progress in medical treatments, giving people with chronic health conditions longer lifespans, but larger medical bills.

The good news is, though, there is also an increasing number of options for medical insurance for expats in China, even those with pre-existing conditions.

We are here to help clients and their families with pre-existing conditions get covered. How? Through our experience, knowledge, and ability to go the extra mile, we help expats in China get the coverage they need.

What are an insurer’s options when taking on a new client with a pre-existing condition?

When looking for expat health insurance in China, an insurance company will first look at the client’s medical records. Depending on what they see, they may require check-ups to accurately assess your condition*. Once they have results, providers have a few options:

*usually the one done in the past 12 months. On rare occasions insurance companies request one done in the past 6 months.

  • You could be given full health coverage including any pre-existing. This means no exclusions* on your policy or any premium loading. This only applies to several major international insurance providers and for clients with minor pre-existing conditions.

*Exclusions refer to disclosed medical conditions not covered under the plan.

  • You could be given health coverage that includes the pre-existing conditions but with premium loading* applied. Again, most international companies will offer this if there is clear proof the condition is well-managed over the last one or two years.

*Premium loading refers to a certain percentage by which standard rates for insurance plans increase. Often this applies to minor chronic conditions with some companies too, for example back pain or asthma, several companies can agree to cover it for 10-15% loading. 

  • You could be given coverage for the pre-existing conditions, but the insurer may apply a moratorium period. This means the insurer agrees to review the conditions in 24 months. In that time, if you can provide clear proof that the condition is fully cured and no medical attention was required, the insurance company will re-assess your policy. They might provide coverage for the pre-existing condition, however, there is usually a 24-month waiting period.

*No cover available until moratorium period is gone. 

  • The insurance company could provide you with limited health coverage. Currently, this only applies to two companies on an individual and family basis. Those two are well known to provide coverage for non-catastrophic pre-existing conditions. Usually, during the first year, this includes coverage between RMB 3,000 and RMB 10,000. On each renewal, the limit increases 50%. Starting with the fourth year, the insurance company may agree to cover pre-existing conditions in full if they are managed well. In our experience, those two companies cover most situations. Examples include chronic back pain from sitting in office chairs to serious mental health conditions.

Remember, if you have an exclusion plan on your health insurance in China, any related conditions will be excluded too. For example, if you have a previous asthma diagnosis, any connected conditions won’t be covered.

The last option became one of the most popular in our experience as those companies cover most day to day chronic conditions. RMB 8,000 will not be enough should a person have complications after hip replacement, but will serve just fine for most people doing refills of their anxiety medications, occasional physiotherapy sessions on lower back, or even simple consultations + 90 days refill for diabetes medications.

One common question we hear from expats in China is, “Can I get coverage for more than RMB 10,000? I am afraid that if there is a complication during the first or second year, the RMB 6,000 might not be enough to cover it.” The answer: It’s possible, but it depends on how well the condition was managed. Insurance companies will review your medical records regarding the condition or require a check-up to assess the situation. We also push them to make the best decision for you.

As you age, it’s likely you’ll suffer from chronic health conditions as well as those tied to your lifestyle. It’s important to have health insurance in China BEFORE any conditions develop. If you wait until you experience a condition, you may lose your chance at full coverage.

Many of the top health insurers have various standards of coverage for some of the more serious conditions such as diabetes, heart attacks, and certain forms of cancer. Each case is assessed individually, and the amount of coverage offered varies from person to person. Insurance companies evaluate how long it’s been since your condition required treatment, along with your overall health and lifestyle to determine your likelihood of future claims.

Contact us to learn more about China Expat Health insurance plans so we can try to help you get those covered