Most important health insurance terms and definitions for expats in China
While shopping around for the right health insurance, you may encounter certain terms and jargon that can have an opposite meaning of what you think it is. Many insurance companies try to keep things as simple as possible for clients, but even then there is a great number of terminology that regular client have never heard of before. In this article we have prepared a list of most common definitions you will see when buying your health policy. We will not dig into medical terms, but rather only cover important day to day definitions. Below is in alphabetical order.
A-D
Accident – sudden and unexpected event that resulted in an injury
Acute – suddent onset of symptoms. Acute conditions often cattegorized as something that may quickly respond to a medical treatment
Area of cover – geographic area within which your policy is valid. Often you may still get emergency cover for short trips outside of this area
Benefits – cover details that is included into your insurance policy
Benefits schedule – more commonly refered as Table of Benefits (TOB) is comprehsive file outlining all the details and beenfits of your insurance plan
Claim – a process through which you seek reimbursement on the expenses that you paid earlier
Claim reimbursement – upon successfull review of the claims material, insurance company will reimburse you the eligible expenses in accoradce with the benefits schedule and terms of your plan
Certificate of insurance – commonly known as COI, is a certificate issue to a policyholder stating validity of insurance contract with the details that may include: policy holder and dependent(s) information, valid period of cover, level of cover together with details, special endorsements or exclusions (if any)
Co-insurance – is a pre determined percentage of medical expenses that you need to cover out of pocket
Daypatient, inpatient and outpatient – if you are a daypatient, you will be admitted to a hospital for a medical treatment but will not spend overnight. Inpatient on the other hand means you are also admitted to the hospital and will eventually have to spend a night in the ward. Outpatient refers to clinical doctor visits in a consultation room when there is no admission into a hospital.
Deductibles – some insurance providers use the word excess, is a fixed amount that will be on you to cover out of pocket, before insurance plan covers anything. More on ths in our deductibles and what they mean article
Dependents – spouses and/or unmarried children of age 18 and below. Often insurance companies can still let you enroll children up until age 23-25, with proof that they are on full time studies
E-O
Emergency – sudden and unforseem event that leads to medical assisatnce. Often insurance companies define emergency treatment as the that that starts within 24 hours from the emergency event
Emergency treatment outside of area of cover – treatment that can occur during short trips outside your designated area of cover. Keep in mind some restrictions may apply sucv as only trips of up to 30 days can be subject for reimbursement so it is best to check terms of your particular insurance plan
Evacuation and Repatriation – in case medical treatment is not available locally, insurance company can help to evacuate you either to a place of residency within China, or even to your own country of nationality for further medical treatment. Repatriation are benefits which are payble for the local burial costs or repatriating mortal remains of insured person to their home country
Insured person – anybody listed on the Certificate of Insurance as an insured person on the policy
Lifetime limit – total sum which is subject for reimbursement per insured person’s lifetime. This is an aggregate limit throughout your life you can claim. Most of the limits for China health insurance however are renewed on annual basis, at the anniversary of your policy
Medically necessary – medical treatment that is essential to address the injury and symptoms. Treatment shall be performed by a qialified medical practitioner, in consent with both given diagnosis and local medical practices
Outpatient direct billing – list of medical facilities in which your insurance provider supports cashless direct billing procedures
Outpatient surgery – surgery procedures that are performed in a daycare unit without need of hospitalization
P-Z
Plan start date – anniversary of your health insurance policy. In other words, renewal date
Pre-authorization – a procedure a hospital needs to perform in order to pre-authorize certain medical treatments to let you enjoy direct billing. Mopst companies will require pre-authorization for any inpatient treatment, outpatient treatments if those exceed RMB 10,000, outpatient advanced imagings (CT, PET and MRI), prescribed medications if a single refill exceeds RMB 8,000.
Pre-existing conditions – medical conditions that showed symptomps prior to the date you first joined insurance policy. There is a great many plans that allow coverage of existint illnesses, more on this in our article
Preventative care – often referred to as wellness benefits. This is a treatment you can receive without showing actual symptoms and on preventative basis such as annual medical check up or vaccinations
Waiting period – a specified period of time during which you cannot claim certain benefits. Most companies will apply 3-6 months waiting period on some major dental care, maternity related benefits and sometimes on mental health or other psychiatry related treatments
If you need help finding the right health insurance to cover your needs, get in touch.
FAQ
Do different insurance companies have different terms?
While most basic terms and conditions are identical for all companies, it is common that there is some differences too. In particular waiting periods may vary, coverage for pre-existing medical conditions and deductibles/copayments.
If I start a treatment as a daycare patient, can it be later referred as inpatient?
Yes, it can. However, it will require hospitalization procedures and thus pre-authorization request from a hospital to insurance company.