What are an insurer’s options when taking on a new client with a pre-existing condition?
When looking for health insurance in China, the insurer 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.
Get in touch so we can try to help you get those covered