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.

So how can foreigners cover existing illness in China with health insurance?

Approximately 47% 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 day to day 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.

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Summary on expat health insurance in China and all you need to know about it

1. Find the right level of insurance you need.
2. Make sure it gives you access to the right medical facilities.
3. Deductibles, copayments or excess. Do you need them?
4. Compare the insurance plans in terms of benefits included, services provided as well s prices.

We are a China based insurance broker with main aim to help foreigners and international Chinese to source, purchase and utilize health insurance plans in the country.

Types of expat medical insurance plans in China

Most medical insurance plans can be broken down into the following three categories:

Category 1: Core Benefits (inpatient only coverage) – this category covers only hospitalizations (overnight stays and longer), ambulatory care, evacuations. As well as other serious conditions and emergencies that will require you to spend at least one night in a hospital.

Category 2: Core Benefits + Outpatient Benefits – this category includes core coverage plus coverage for clinic doctor visits, prescription drugs. Certain scans like MRI’s, X-rays, day surgery, physiotherapy, chiropractic care, and other same-day doctor visits.

Category 3: Core Benefits + Outpatient Benefits + Premium (Optional) Benefits – this category includes all of the above + optional extras such as dental care (routine, complex and orthodontics). Preventative care is annual wellness check ups and vision care (glasses, eye checks). Last part is maternity (natural birth, C-sections, and complications of pregnancy).

As a summary

Inpatient Benefits = Hospitalization

Outpatient = Clinic doctor visits

Premium/Optional Benefits = Dental, vision, and maternity

Each insurance company has different terms and conditions. Generally, here are the benefits offered for each category to use as a guide for health insurance in China.

Inpatient Benefits: These benefits are for overnight hospital stays whether one day or several days and includes coverage for invasive surgeries. Things such as serious accidents or chronic medical conditions are also part of it. Inpatient coverage is a crucial component of any policy because the financial risk to you is very high.

Outpatient Benefits: These benefits cover visits outside of the hospital such as a doctor’s appointment, prescription drugs, physiotherapy, and minor day case surgeries. Example of day case surgery is a small surgery for a broken arm. Outpatient services don’t cost as much as inpatient, but with enough visits, they can break the bank. Which is why many expats in China carry outpatient benefits too.

Premium/Optional Benefits: These benefits are optional and are considered upgrades to inpatient or outpatient coverage. The benefits may include dental, vision, or wellness treatment and are a nice add-on. This will give you peace of mind whenever you need medical attention.

Maternity coverage is probably the most valuable of the premium benefits since many of the international maternity facilities like United Family Hospitals, Sino American, Parkway, OASIS will be charging around of RMB 80-90,000 for a routine birth. Cost are more than RMB 100,000 for C-section delivery. The coverage may also help with any complications at birth. It’s important to note that you must purchase maternity cover BEFORE you become pregnant. There is always a waiting period before maternity benefits begin, which is 6-12 months.

Most expats in China (more than 77%) prefer a minimum level of health insurance cover at Category 2. Those include outpatient clinical doctor visits benefits. We’ve found that a smaller percentage (only 23%) of expats in China prefer Category 1 or hospitalization major medical insurance.

There is always a higher chance you will need to visit a doctor and get prescription drugs for a quick outpatient visit such as for a cough, cold, or skin rash rather than undergo inpatient surgery where you’ll be hospitalized for a few days or weeks.

Many people don’t realize that concerns such as a broken arm or leg are outpatient care in 95% of the cases. You visit the hospital, get an X-ray, get treated and go home. Only about 5% of cases have to spend the night in the hospital. This is why most expats select Category 2 benefits at a minimum.

If I buy health insurance, which hospitals and clinics can I go to?  Can I go to the expensive private hospitals?

Yes, you can go to ALL of them, but there are exceptions. You can have your plan adjusted to exclude certain higher cost medical facilities. If you exclude them, you may lower your premium because the insurance company won’t have to pay out the higher fees for the benefits at these facilities.

Another consideration when buying medical insurance in China is whether or not you want access to high-cost providers. As mentioned above, if you choose to limit access to certain hospitals and clinics which cost more you can drastically reduce your insurance premiums. But how popular is this option?

At China Access Health, we understand the importance of having access to the best facilities in China. We will review your policy with you and discuss your options for various medical facilities helping you choose the plan that provides the benefits you need at the prices you budgeted in mind.

The best three expatriate medical insurance plans in China are from

1. Allianz Care
2. Now Health
3. Aetna

These are the three most popular choices among the clients we work with.

Over 60% of foreigners we meet choose one of those three insurance companies. There are exceptions, particularly if you want maternity coverage, need coverage for pre-existing medical conditions, or need worldwide coverage, which includes the United States. If we include MSH along with the other three companies, the percentage of our clients using the four firms would be close to 75%. Get in touch with us to learn more about China expat health insurance.

Dispute Resolution

Even with the best insurer, sometimes things go wrong. But if you are with the right insurer and broker, any issues or errors can usually be resolved very quickly and avoided in the future. The ability to resolve problems when they arise is possibly the most important thing we look at when advising on insurance plans for our clients. You want your long-term insurance partner to be accommodating and understanding, not belligerent and inflexible.

As an example, ICBC AXA and GBG are exceptional at resolving issues or disputes. Their attitude towards our clients and us has been very positive and cooperative. This is partly owing to our close relationship with their senior management.

Hotline Quality

The first port of call for most people when interacting with their insurance company is either calling the 24/7 hotline or emailing their service team. You might need to check if a particular treatment or clinic is covered under your plan or follow up a claim. Either way, the hotline is essential. A good hotline will understand what you want, provide helpful information, and resolve your query fast. If a hotline doesn’t function correctly, simple tasks can become unnecessarily complex.

Bupa has the highest quality hotline, and this applies worldwide. Even if you are in a foreign country and need help in the middle of the night, Bupa’s concierge service will connect you with local network contacts to guide you through any issues.

Direct Billing

Direct billing refers to cashless services at network hospitals and clinics. Put another way, it is when you get treatment at a medical provider within the insurance company’s network, and you don’t have to pay anything — they simply bill the insurer.

This is one of the most critical services an insurer can give, and it comes standard with most insurance plans in China. It means you can avoid applying for those pesky claims reimbursements which involve a lot of paperwork. Just make sure you and your family bring your medical cards when getting medical care, to ensure that the direct billing takes place.

When examining if an insurance company’s direct billing services are good or not, there are two criteria:

1. Is the hospital network large and does it include the hospitals or clinics you’ll use?
2. Are there any coverage benefits which are not included in their direct billing services, such as dental or annual wellness check-ups? This is important as many insurance providers have different direct billing lists for different types of treatment. While you will find that some companies have over 45 medical facilities in Beijing for outpatient cashless services, in many cases their lists for dental care will be much less extensive. If a clinic accepts direct billing for outpatient care, that doesn’t often mean that they’ll accept the same for dental care, even if their dental department is right next door.

Making a Claim

If you find yourself outside of the insurance company’s hospital network, or direct billing isn’t provided for that type of treatment, you must pay first and then make a claim for reimbursement. Making a claim is everyone’s least favorite part of using medical insurance. Some companies pay their claims fast and proactively help you make a successful claim, while others can take weeks to process a claim only to come back and tell you that you’re missing some information, or they reject the claim without clearly explaining why.

Allianz has by far the fastest claim turnaround time of any insurance company on the market – over 95% of claims are paid within 48 business hours.

Most insurance companies support online submission of claims. Allianz, MSH, Aetna, and Now Health have online portals where claims can be submitted. However, ICBC AXA, PingAn, AXA TianPing, and GBG only have this function through their WeChat official accounts. Some companies like Allianz, Now Health, and MSH even have apps for both IOS and Android.

Overseas Service Standards

Another thing to consider is whether or not you will need to use insurance or have coverage for when you are outside of China, for example on holiday, business travel, or back in your home country.

Different insurers have vastly different service standards when using insurance overseas. A good example would be ICBC AXA. They provide a solid service proposition in China; however, using their insurance outside of China can be difficult. In contrast, higher-cost insurers who are more international, such as Allianz and Bupa, provide great service both within and outside of China.

Let’s look at these service elements in more detail.

Strength of the insurer’s overseas hospital network

No matter where you and your family are in the world, your insurance company should be able to arrange a direct settlement with a hospital in the event you need inpatient treatment or need to be hospitalized.

Some insurers will even be able to offer direct billing for outpatient treatment in many countries throughout the world. This isn’t the case for all insurance companies, so if you do not want to be responsible or large amounts of out-of-pocket expenses, ensure your insurance plan work well overseas.

Can You claim documents written in other languages?

You may not think about needing coverage in other countries, but if you travel, it’s an important aspect when looking at health insurance in China.

Imagine this: You go on holiday to France, and while there you trip and break your arm. You go to the emergency room, get treated, and pay for the treatment. However, when submitting your claim to the insurance company, instead of processing it as normal, they ask you to arrange for it to be translated before they’ll examine the claim. In addition to being a huge annoyance, this will also cost you money.

The moral of the story is: If you spend significant time outside of China, particularly as a family, ensure your insurance plan will work well overseas.

Ability to Advise You When Seeking Treatment Overseas

Bupa has an international concierge service designed to help you when you travel. One of our clients, while travelling in Vienna, had a pregnancy-related emergency in the middle of the night. They called the Bupa concierge hotline for emergency assistance, who transferred them to their European call center, who directed them to the appropriate maternity hospital and even managed to arrange direct payment for the treatment on short notice. Wow! Very few insurance companies have this high level of service.

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How much does expat health insurance in China cost?

Average costs for a China expatriate health insurance covering both in&outpatient benefits will be RMB 37,219 per year*. Around a third of this will be contributed by each of inpatient and outpatient raider, while the rest distributed between dental and preventative parts. Obviously, if your insurance plan has deductibles or copayments premium will be lower.

• the above is average costs for a plan covering Worldwide excluding USA for a 40 years old person

Keep reading to find out what are the most common practices to lower the costs of a private health insurance plan. Some of them won’t require out of pocket expenses so you can still enjoy full cover up to the limits of your policy. 

Premium range in the country is devastating, as an expat living in China you can get a health insurance plan with low limits for less than RMB 2,100, while more premium insurance companies like Bupa can easily charge you over RMB 100,000. Lower premium always refers to less coverage, in many cases copayments from your side as well as a large list of exclusions*.

There are other factors that determine the costs as well. Your age, access to foreign and international doctors throughout the country, deductibles (if any), and in rare occasions the city where you live in China. In addition to these factors, pre existing medical conditions are also reviewed on a case by case basis, and may or may not be covered under the plan depending on the insurance company and their standards of underwriting. Let’s dive into the details. 

*No matter how expensive your policy is, every insurance company has its own exclusion list, things they won’t cover under any circumstances. While most things are common among all companies, some for instance will not cover sleep treatments related to apnea, or durable medical equipment such as crunches or wheelchairs. Always refer to the policy wording for the exact list of exclusions.

Inpatient – Core cover

The base package for any medical insurance plan is inpatient cover, sometimes referred to as core benefits. The core plan is designed to cover the cost of an emergency or planned stay in a hospital where a person is hospitalized and spends at least one night. For example planned medically necessary surgery, or a large accident or medical emergency which requires hospitalization. The average cost for a 40 years old person looking to get this type of health insurance plan in China is around RMB 13,287 per annum. 

About half of insurance companies in China offer deductibles* only for inpatient care, which helps to reduce the costs of the core plan by 30.5-50.9%. In our experience, the most suitable option is to have a deductible of around RMB 10,000-15,000 which will save you roughly 23.8-31.2%* Any deductible above this amount will not reduce the premium by the same percentage, meaning there is diminishing returns on paying more out of pocket relative to the lower premium you pay for the plan

*Deductibles, sometimes also referred as excess, is a fixed amount that the policyholder must pay out of pocket first, before the insurance company begins covering any bills. For example, a RMB 10,000 deductible means the policyholder must pay 10,000 RMB out of pocket before the insurance company begins covering treatment. The deductible is set per year, meaning that each year the deductible will return to the selected amount.

Outpatient Benefits

Outpatient is the second kind of package for a medical insurance plan. Adding outpatient benefits such as clinical doctor visits, prescriptions and therapies will increase the costs by RMB 13,432 for a 40 years old person. For example coughs and colds, minor scrapes, broken limbs, orthopaedic consultations and literally anything that doesn’t require a person to spend a night in the hospital (be hospitalized).

Outpatient is where insurance companies reimburse the most. A person can be insured for 5 years and never be admitted to a hospital (inpatient care) and thus not have a single inpatient bill under the plan, but can easily have 3-4  outpatient doctor visits each year. This is related to lower back pain, skin rash, or a simple cold during the winter season. 

Most expats in China, over 76.5% based on our research, have a medical plan that covers both in&outpatient benefits. 

Having deductibles for outpatient care is much less of an attractive solution in our experience. People who tend to visit doctors more than 2-3 times throughout the year in the vast majority of cases prefer plans that are fully covering this part. The discount on adding deductibles to the outpatient part of a package can be anywhere from 1.1%-4.25%, which pales in comparison to the cost of a single outpatient visit.

Dental

Not all companies offer a dental package, and it cannot be purchased separately. As a foreigner in China you have the option to add dental coverage to your plan. A dental plan that covers RMB 6,000 in benefits will increase your premium by approximately RMB 3,000 to 3,500. This is enough for an annual teeth cleaning and maybe one or two other visits if you live in a Tier 1 city in China. For kids, the premium surcharge on dental benefits is often lower. Several insurance companies also do not provide preventative dental benefits for minors. Please get in touch to learn more about health insurance in China for foreigners and which companies offer dental benefits.

For those looking to cover braces, implants and orthodontic treatment, there are only a few companies that offer high enough limits to cover these kinds of treatment. Allianz, Now Health and Bupa each provide more than RMB 15,000 dental benefits per year. Adding a dental package to their plan will increase the premium by approximately RMB 6,000-7,000

Wellness

Wellness covers annual medical checkups, vaccines or tests which are not medically necessary. To make it simple, wellness covers preventative tests and treatment, which are otherwise not covered under any plan. For example if you need a COVID test for travel, or a flu shot during winter season for your kids. 

Most insurance companies in China view wellness benefits as a strict liability which is why costs to cover Wellness are quite high. Some companies will allow you to add RMB 3,000 of Wellness coverage to their plan, but will charge RMB 2,600-2,700 for this benefit. Some companies like Aenta and ICBC AXA will add wellness into their plans at no extra costs to be more competitive on price. Please speak with us here so we can share with you the companies that offer the best wellness packages.

How can plans be tailored to reduce the costs? 

Some policies will allow you to remove dental and wellness benefits to lower the price of the plan. You can also restrict coverage at luxury hospitals (often referred as high cost providers) and clinics, or reduce the geographic area of cover of your plan (for example, changing the area of cover from Worldwide Excluding US to Mainland China). Quite often plans covering China only can still cover you overseas for emergency & inpatient situations, very similar to travel insurance. 

• excluding high cost providers (luxury hospitals and clinic) from cover typically reduces premium by 22.5-31.9%
• reducing the area of coverage to China only compared to Worldwide excluding the US in most cases will save you 5-8% of the premium. However, certain companies such as ICBC AXA and Aetna will provide a greater discount of around 18-20%

Does it matter where I live in China? 

Only a few companies factor in the primary city of residence into the cost of your plan. Recently there has been a launch of a few plans offering around 10% discount for members who live outside of Tier 1 cities (Shanghai, Beijing, Guangzhou and Shenzhen). That usually means that 80% or more of the medical expenses under the plan should come from places other than Tier 1 cities. If you live in Ningbo but travel to Shanghai for your medical care, this kind of discount is not an option.

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International hospitals for expats in China.

Looking for the best English speaking doctors in China? You are at the right place.

Foreigners and Expats in China can choose from four different types of medical facilities. Public hospitals, also known as government-run. Those are the most widely available and affordable option. Surprisingly, at VIP and International wards you will experience somewhat basic level of English service. However, at this article we are going to check what are the international level privately owned medical facilities. We will cover some of the largest cities in the country. If you have good China expat health insurance plan then most likely you can even get direct billing (cashless services) in those. 

*list does not reflect all international and private run hospitals. Although, the most popular ones in our experience. Based on our research, 81% of foreigner do get treatments in one of the following options.

**below list does not constitute to a medical advice. But rather our reflection of the market on what clinics and hospitals are popular among foreigners in China

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