It's not fun contemplating the worst case scenario, but if you don't, you risk ending up Worst Case Creek without a paddle. Those are the moments where you'd really wished you'd made arrangements with someone to bring you a paddle, or perhaps covered the cost of a consultation about healthy preventative paddle maintenance.
Pushing this analogy a bit. Look, you need insurance. It's just the responsible thing to do. Especially when you're an expat. Apart from the obvious,
1. As a foreigner, you're more likely to need to go somewhere the doctors speak English, and that means you're going to probably have to pay for the privilege.
2. There are longterm health concerns associated with living in China, and getting a plan now, before you need it is way, way easier than trying to get it back home, when you do.
We've already written a very, very in-depth article about health insurance in China. This is mostly an addendum to that, explaining how you might actually go about actually getting a plan.
Basically, you've got two options.
Option 1: Go Straight To An Insurance Company
You'll have to deal with them eventually anyway. Your first port of call will probably be their website. Most have nice-looking websites with information that applies worldwide. Others have a confusing network of all-Chinese domains for their local branches, and phone numbers that don't work.
Whatever the case, don't rely on the website for anything more than a contact person anyway. Insurance packages are priced according to your beautiful, unique self. You will have to fill in varying degrees of massive health declarations before your get your final quote. Forms upon which it is an actual crime to lie. It's best to get your information (and your price) directly from an actual human being so you can clarify everything before you sign anything or pay anyone an rmb.
If they have the option, submit a request for a quote on their website and odds are good a sales person will get back to you in a day or two at the most by phone call or email. If they don't have that option, you can try a technique that we journalistic types refer to as "call every number listed on the website and demand to speak to a sales person."
In my experience, insurance salespeople are happy to sit and answer as many questions as you've got. A couple of big insurers in China are:
- Aetna, an American Fortune 100 company, partnered with state-owned China Life — one of the largest providers in the country despite a flood of competitors joining the market after the 90s — and Huatai Insurance.
- Allianz, German company (now called Allianz Jingdong in China), one of the largest insurance providers in the world, and reportedly has one of the best claims processes in the business.
- Bupa, a British healthcare provider that partners with Shanghai-based company Alltrust Insurance. They run their own integrated medical center down in Guangzhou, but most Shanghai clinics are in their network.
- Cigna, probably one of the biggest insurers worldwide, popular with corporate clients. They parter with China Merchant Bank. Their website includes a very good quote calculator, and they run a special medical advice hotline for their clients.
- MSH China, a French insurer popular with high-level executives with families. We hear they have good maternity coverage, too.
- Ping An Health, the biggest health insurance provider in China, which also runs the country's biggest healthcare platform, Good Doctor.
These are some big international names, but there are tons of other providers, many offering more specialized products. One example we reached out to was StartupCare, partnered with Ping An Health, which focus on startups and SMEs. They don't charge premiums according to age, and they let companies swap out beneficiaries in the plan as employees come and go.
Going directly to the insurance company will give you the most in-depth information about their products, and they can adjust the plans to fit your needs more easily.
Don't just go to one, though. Get quotes from as many insurers as you can, so you can compare the prices, benefits and options from each. That can be a lot of work, which is why your second option might be to...
Option 2: Go To A Broker
Brokers can sell you insurance from many different companies, and it wont cost you anything because they take their fee from the insurance providers. That gives them a wide perspective, and they can do the difficult work of comparing the various packages for you. In the best case scenarios, they can even help out if there's a dispute with your insurer. They come in many shapes and sizes, and their quality varies dramatically. We tried two.
- Pacific Prime is a well-established broker offering plans from over 30 insurers worldwide. Their Hong Kong-based China branch has offices here in Shanghai, and they're quick to contact you and answer questions in-depth.
- China Expat Health, as the name suggests, has a more local focus. It's a division of Beijing-based Evertrust International, and in addition to the basic package info, will inform you if insurance providers have things like Chinese language service or an app for submitting claims or finding hospitals.
A lot of terminology gets thrown around in health insurance. Is it because health insurance is complicated, or is it meant to bamboozle you out of your money? Of course not. Here are some terms you might hear:
Premium - the price you pay for your insurance, either in monthly, quarterly, semi-annual or annual installments. Premiums are based on a lot of factors, but primarily your age and gender. The premiums advertised on websites or in brochures are not the final rate: your premium will change based on the medical declaration you make when purchasing the plan, and your premium will rise as you get older, especially around the age of 55.
Deductible - an annual limit of how much you have to pay towards a medical bill before the insurer starts to pay. If you have an annual deductible of 300 dollars, and you get a medical bill of 800 dollars, you have to pay 300 dollars first before your insurance company steps in to pay the remaining 500 dollars. The higher your deductible, the lower your premium.
Copay/Coinsurance - even after you meet your deductible, you might have a copay/coinsurance. It's usually expressed as a percentage, though sometimes as a fixed rate. The most common one is 80/20, where you pay 20% of the cost, whatever it is, and the insurer pays 80%. Generally, the higher your copay/coinsurance, the lower your premiums.
Out-Of-Pocket Maximum - this is the maximum you have to pay per year, in any form, before the insurance will step in to cover 100% of the cost (up to your plan's annual maximum). That's including your deductible and your coinsurance.
Direct Billing - when the cost of your treatment is handled directly by the hospital and the insurance provider. You don't have to pay and then apply for reimbursement from your insurer, it just gets done. If you are treated somewhere that doesn't have a direct billing agreement with your insurer, you might have to provide a guarantee of payment, basically basically a letter from your insurer saying that they agree to pay for whatever you've applied for. Depending on the treatment, this guarantee might be ready in two-five days or within the hour.
High Cost/Expensive Provider (HCP/EP) - a classification used by insurance providers to indicate the tippy-top of the healthcare provider pyramid, or at least the ones that cost the most. In Shanghai Shanghai United Family and Parkway are classified as High-Cost Providers by every insurance company we checked. Getting access to these HCP clinics will greatly increase your premiums. Curiously, Jiahui's new state of the art facility was not an HCP. Wonderful!
Selecting Your Insurance Package
There are many, many plans available (God there are so many) with names like Ultra Extended Diamond Plus World Cover Family Super Care Plan, but you can put them into three basic categories. We're calling them Disaster, Standard and Expat+.
This is the bare minimum you should have. It covers inpatient, basically anything that requires a stay in the hospital. Accidents, sudden and severe illnesses, surgery, etc. Most of the time, this will cover the cost of your accommodation, cost of your service, and potentially rehabilitation. The higher the premium, the more you get; longer stays, better accommodation, higher maximum cost of services, longer rehabilitation coverage.
These packages typically add basic outpatient, covering the cost of any illnesses or conditions that aren't serious enough to get you hospitalized. The range and flexibility here is broad. Options include dental, eye-care, the cost of prescription drugs, and "wellness" or "preventative" care, for example annual GP check-ups and screening for underlying conditions. The more options you add on, the higher your premiums: typically, wellness is a fairly cheap add-on, coming to a couple hundred rmb extra per month, whereas dental can add several thousand rmb.
The Cadillac of insurance packages. The executive suite. The secret VIP room at the KTV. This highest tier of insurance will usually have zero deductibles, sky-high annual limits, no copay, and get you access to the High-Cost/Expensive Provider with all kinds of bonuses, like nutritionists, physiotherapy, even cosmetic surgery. If you have one of these, it was almost definitely provided by the gigantic multinational corporation that brought you over here.
A Particular Case Study
I contacted a bunch of insurers and brokers and got an idea of ranges, but premiums depend heavily on your individual situation. So I'm not going to name the packages, but here's an idea of how much a couple things will cost if you're say, a 30 year old European male.
If money was no object — well not "no" object but a diminished object — I'd get a worldwide plan with zero copays (or 80/20 at HCPs) that covered inpatient, outpatient, my prescription asthma medication and eye care (my eyesight is crap). I'd be able to get one/two checkups per year and 75% coverage on dental, because the way I live is going to have consequences down the line. That'd cost me around 24,000rmb per year.
In reality, I'm still just young enough to not need all that. But as my health becomes more of a concern, I'd look to get something with zero deductibles zero deductibles, worldwide inpatient/outpatient coverage with a coinsurance at HCP in case of serious emergencies, and some limited wellness stuff I think I might need in the next few years, like physiotherapy because I sit all day in a charge. This would cost me around 20,000rmb.
If I just wanted to get my mom off my back, I'd get a country-specific package that covered emergency inpatient care (excluding at HCP) with a deductible juuust high enough to not ruin me financially, say 15,000rmb. For that, I could get the price down to around 5,000rmb per year, and live safe in the knowledge that at least I won't die if I get hit by a bus.
Some Important Questions To Keep In Mind
What additional options do you want it to add?
Do you want to include dental? Eye care? Are you going to need maternity coverage? Do you need specialist care? Do you spend a lot on prescription drugs? Options can dramatically affect the cost of your insurance plan. Make sure you have some idea of what you want before you start comparing packages or you'll be drowning. Adding options later on could also be more expensive than having it included in the package to begin with.
Will you be the only beneficiary?
Grandma on your ass? You planning to have a family? If so, ask for a quote of what the plan might look like with a child or two. Your insurance plans should be long-term investments that you put a lot of thought into. Do not impulse buy health insurance without thinking about how it might need to evolve.
Is it transferable?
Very important. Some plans only cover your nationality and your country of residence. Much cheaper that way, but if you plan to move, you need to know if your plan is transferable to another country. Worldwide insurance is a good option for young people, as we don't always know where we'll end up. Assuming there's even a world left!
How does it play with my national insurance?
Some of you might be lucky enough to live in countries with a national insurance system. If you plan to take advantage of that, consider how your two insurance plans could cover the gaps in each other. Does your country have any standing agreements with your insurance provider?
How often do I pay?
Depends on your budget. Some plans can only be paid annually, some give you the option to pay monthly, quarterly or semi-annually. You can sometimes get discounts if you choose less regular payment options: for example, CIGNA gives you a 10% discount if you pay annually rather than monthly.
Can I pay in rmb?
If you're going for worldwide health insurance, the answer is probably "no." Most need to be paid for in Euros, US Dollars or British Pounds.
If I have to make a claim, how long does it take to get reimbursed?
This matters. If you have to wait two weeks to get your 6,000rmb medical bill reimbursed, that'll hurt a lot more than if it only takes 3 working days.
If you have an undiagnosed pre-existing condition, how will your insurer respond?
This is a very big deal. Pre-existing conditions are almost never covered by your insurance. So what happens when it turns out you have one? Your insurer's definition matters. For example, one insurance provider defines it as any "medical conditions or any related conditions for which one or more symptoms have been displayed... which you or your dependents could reasonably have been assumed to have known, will be deemed to be pre-existing."
Yikes. "Reasonably have been assumed to have known" leaves a lot of leeway for rejecting you or rescinding your coverage.
What is your geographical coverage?
Insurance providers in China typically give some combination of these four options: Mainland China, Mainland China including HK/TW/MC, worldwide excluding the US, and worldwide including the US. Getting coverage that includes the US will raise your premiums by several thousand rmb.
Check to see if your plan includes Medical Evacuation if you find yourself somewhere that can't treat your condition. And, again, worst case scenario, if it all goes to pot, see if they'll help put your mortal remains to rest.
Okay, I've Thought About It, So How Do I Get Insurance Again?
We've sorted through the numbers and website URLs that work and don't work, so follow the links below to get in touch with a human being. Personally, I preferred speaking to the brokers for their broader perspective and relative impartiality. Plus it's freeeeeee.
- Pacific Prime - Tel: 2426 6400 / pacificprime.cn
- China Expat Health - Tel: 5100 1960 / chinaexpathealth.com
However, if you prefer to get the package information from the insurance providers directly, more power to you.
- Aetna - Tel: 400 881 1269 / www.aetnainternational.com
- Allianz - Tel: 400 800 2020 / www.allianz.cn
- Bupa - Tel: 010 5854 1666/ www.bupa.com.cn
- Cigna - Tel: 6187 1288 / www.cignacmb.com
- MSH China - Tel: 6187 0330 / www.mshasia.com
- Ping An Health - Tel: 400 886 6338 / www.pingan.com
- StartupCare - Tel: 6153 5075 / www.startupcare.cn
Looking to get health insurance? Check out our health directory for even more insurance providers and brokers.