Medical insurance is a compulsory benefit for all employees in China. Employers are responsible for the enrollment of their employees in the state-run mandatory medical insurance program.
Ways of acquiring medical insurance
Medical insurance in China is typically acquired through two main channels: social insurance and commercial insurance. Social insurance offers fundamental life protections, allowing qualifying workers to access five essential benefits by establishing employment relationships or adhering to prescribed social security contributions. These benefits encompass medical insurance, unemployment insurance, pension insurance, work-related injury insurance, and maternity insurance.
On the other hand, commercial insurance caters to flexible workers and is operated by insurance companies with profit as their primary goal. In commercial insurance, the relationship between the insurer and the insured is a voluntary civil agreement, giving citizens the freedom to decide whether to enroll or not, without any legal obligation. The fundamental aim of commercial insurance is to generate economic profits, and the insurance premiums are borne by the policyholders.
In certain cases, employers in our country voluntarily choose to provide both social insurance and commercial insurance for their employees, aiming to offer a more comprehensive coverage.
How to enroll in insurance?
To enroll employees in social insurance:
Open a corporate social insurance account within the jurisdiction of the company.
Transfer the existing social insurance relationships of employees within the company to this account.
Obtain a detailed payment statement from the social insurance bureau during the initial month of payment. This statement includes employee names, ID numbers, and payment bases.
Complete the procedures for entrusting local banks with social insurance payment deductions (this is done at the bank where the company holds an account).
Going forward, only submit forms to the social insurance office for adding or removing insured individuals.
The specific documentation required for opening a corporate social insurance account and procedures for adding employees to social insurance can vary based on location and policy changes. It’s important to adhere to the social insurance regulations specified in the jurisdiction where the company operates.
How to inquire about personal accounts and check your balance?
Open WeChat and tap on “Me” at the bottom. Pay attention to the “Services” section at the top. Tap on it and scroll up to find “City Services” at the bottom.
Once you open it, pay attention to “Social Insurance” at the bottom. Open it, and here you’ll need to apply for your electronic social insurance card.
Click on “Electronic Social Insurance Card” and follow the instructions to apply. I’ve already applied. There’s an option for “Personal Social Insurance Account Balance Inquiry” below!
Click on it to see my medical insurance information, including “personal account details, balance payments, transaction records, expense details, and usage history.” You can explore and query based on your needs.
Alipay
Open Alipay and notice the “More” section at the bottom.
Open it and then select “Citizen Service Center.” After opening it, look for “Social Insurance” at the bottom. Open it, and similarly, you’ll need to link your electronic social insurance card here.
There’s an option for “Medical Insurance Balance Inquiry.” Open it and then access “Medical Insurance Balance Inquiry” below. Pay attention to the instructions below to guide you on how to check your medical insurance balance. Check the “I have read and agree” box and tap “No need for identification verification.”
Once you’ve successfully completed the facial recognition as per the page’s instructions, notice the available features: records of medical insurance usage, deposit details, and insurance status. You can use any of these features based on your requirements!
Call 12333
The third method is to dial 12333. 12333 is the hotline for labor resources and social security services. By calling, you can follow the voice prompts to check your social insurance card balance.
Counter
The fourth method is to visit a counter. Look for the bank branch listed on your social insurance card. Take your card to the corresponding counter and ask the staff to help you with the inquiry.
Medical insurance reimbursement
The reimbursement process involves the use of a Social Insurance Card, which can be electronic. However, it requires physical pairing with a Chinese bank. This card can be used as a general bank card, can withdraw money and save money, but the insurance can not be taken out, can only be used for medical reimbursement.The reimbursement scope includes coverage range, reimbursement ratios affected by factors like age, city, hospital, and other variables. Major medical diseases are often specified in a designated list.
Eight Major Serious Illness Medical Insurance Protections:
Uremia
Childhood Leukemia
Congenital Diseases in Children
Breast Cancer
Cervical Cancer
Severe Mental Illness
Drug-Resistant Tuberculosis
Opportunistic Infections in AIDS
Twelve Disease Categories Covered by Serious Illness Medical Insurance:
Lung Cancer
Esophageal Cancer
Stomach Cancer
Colon Cancer
Rectal Cancer
Chronic Myeloid Leukemia
Acute Myocardial Infarction
Cerebral Infarction
Hemophilia
Type 1 Diabetes
Hyperthyroidism
Cleft Lip and Palate
Reimbursement Rates for Serious Illness Medical Insurance:
Reimbursement at 85% for expenses below ¥40,000
Reimbursement at 90% for expenses between ¥40,000 and ¥80,000
Reimbursement at 95% for expenses above ¥80,000
Payment Ratios for Serious Illness Medical Insurance:
For Employee Medical Insurance:
60% payment for expenses between ¥20,000 and ¥40,000
65% payment for expenses between ¥40,000 and ¥60,000
70% payment for expenses between ¥60,000 and ¥80,000
75% payment for expenses between ¥80,000 and ¥100,000
80% payment for expenses above ¥100,000
For Resident Medical Insurance:
50% payment for expenses between ¥20,000 and ¥40,000
55% payment for expenses between ¥40,000 and ¥60,000
60% payment for expenses between ¥60,000 and ¥80,000
65% payment for expenses between ¥80,000 and ¥100,000
70% payment for expenses above ¥100,000
Non-Reimbursable Situations for Serious Illness Medical Insurance:
Treatment in non-designated hospitals without approval (excluding emergency rescue)
Occupational diseases, work-related injuries, or recurrence of work-related injuries
Injuries caused by traffic accidents
Injuries caused by the insured person’s illegal actions
Food poisoning caused by responsibility accidents
Treatment due to suicide
Injuries caused by medical accidents
Medical expenses that should be self-funded according to national and local regulations.
How to transfer medical insurance across provinces
Residents moving from one province/territory to another continue to be covered by their “home” province/territory during any minimum waiting period, not to exceed three months, imposed by the new province/territory of residence. After the waiting period, the new province/territory of residence assumes your health care coverage.
It is your responsibility to inform your provincial/territorial plan that you are leaving and where you are moving, and to register with the health insurance plan of your new province or territory.
Supplementary medical insurance (commercial insurance)
Supplemental health insurance is a type of insurance that helps pay for treatments and services that standard health insurance plans may not cover.
Some supplemental health insurance plans cover specific services, such as cancer treatments. Others may help reduce the financial burden of a major illness or accident by providing a lump-sum of money that you can use for medical treatments or household expenses. Unlike health insurance, which often pays your healthcare provider, it pays you directly.
It’s important to note that depending on the type of plan you choose, your supplemental health insurance coverage functions differently than your primary health insurance plan. For instance, some plans pay a set amount of money for certain treatments. Others cover a percentage of your costs, which may reduce the amount you owe on a medical bill.
Supplemental health insurance plans provide payments that can help cover a wide variety of treatments and services, making it essential to find the right plan before enrolling. Let’s take a closer look at some of the most common types of supplemental health insurance.
Types of supplemental health insurance
Below, we break down several different types of supplemental medical insurance:
Factors to pay attention to when choosing an insurance:
(1) Hospitals
You have to check whether the hospital you intend to go to cooperates with the insurance company, or your insurance will not work.
(2) Coverage
You need to verify the coverage of the insurance, such as vaccinations, chiropractic treatment, Chinese medicine treatment, etc. Also, high-cost provider coverage is worthy of high attention. You have to check with the insurance company whether the coverage of the hospital you want to go is classified as a high-cost hospital or not. If so, you have to pay an extra premium and are excluded from being covered by the health insurance.
(3) Pre-existing Conditions
You have to affirm whether your pre-existing conditions are covered.
(4) Waiting time
Waiting time refers to the time you have to wait until your insurance takes effect. You have to pay for yourself to get treated during waiting time.
(5) Deductibles
You have to know how much you need to pay before your insurance pays for you.
(6) Direct Billing
You have to check whether the hospital you want to go to has a direct billing agreement with your insurer so that the insurance company can pay directly for treatment and doctor visits.
(7) Pre-authorization
If you buy high-end medical insurance, you are required to get a pre-authorization letter from the insurance company before you receive the service of hospitalization, large-scale imaging examinations (CT/MRI/CT-PET), outpatient treatment for major diseases, such as radiotherapy, kidney dialysis, etc. The insurance company will have a quick review of your application before you enjoy direct payment claims. Clients who do not make a reasonable pre-authorization request as required may face difficulties in reimbursement. In case of an emergency situation, you can notify the insurance company within 48 hours afterwards.
Where to buy insurance in China:
(1) Online
You can search insurance companies on the Internet to know about different kinds of insurance and their details. But it requires a lot of time and energy.
(2) Offline
A. Insurance agents
On behalf of his working insurance company, an insurance agent only sells their own insurance products.
B. Insurance brokers
An insurance broker stands for the interests of the client, so he provides various types of insurance, including life, medical, and commercial insurance, from different insurance companies. He introduces the details of each insurance so that you can make the best choice. If you have any questions about the insurance, you can ask the broker for help. He will serve you wholeheartedly at any time.
Insurance company options:
(1) Ping An
As one of the largest domestic insurance companies in China, Ping An provides high-quality health insurance service for foreigners in China. Its wide direct billing network is not only established in Mainland China, but also overseas. For example, direct billing is available in United Health Care Globe (UHCG) and Active Care Management (ACM). You can call its bilingual hotline for insurance products and claim information.
(2) Mobility Saint Honoré (MSH international)
MSH International is a global leader in the design and management of international health insurance. With four regional headquarters in Paris, (France), Toronto (Canada), Dubai (Middle East) and Shanghai (China), MSH international provides multilingual services for 24 hours everyday. Customized insurance products and competitive maternity insurance are offered.
(3) Allianz
Allianz is the largest insurance company in Europe, it has a branch in China. Its inpatient-only insurance plans in China are a major feature and its insurance products are of competitive price. Its direct-billing network is wide, covering many countries in the world. A wide range of pre-existing conditions is another feature.
(4) Bupa China
Bupa is committed to offering high-end health insurance plans and international customer service for global clients. It establishes a branch in Beijing, China. With a strong direct billing network, it cooperates with many medical institutions worldwide. Companies planning to buy group insurance for employees can choose Bupa. If the insured employees of a company exceed 10 people or more, pre-existing conditions can be covered in the insurance.
Contact Hrone.com for help with insurance in China. Whether you’re a Chinese resident or an expatriate, comprehensive healthcare coverage is a must. China’s healthcare landscape is continually evolving, and being well-prepared ensures you receive the best care while minimizing financial stress.
Frequently Asked Questions
What should I do if I am sick and hospitalized without medical insurance? Sue your employer
Being sick and hospitalized without medical insurance can be incredibly challenging. While it’s tough, suing your employer might not be the most straightforward or immediate solution. There are other steps you can take to address this situation:
Seek Medical Assistance: Your health is the priority. While hospitalized, focus on receiving the necessary medical care and treatment. Hospitals often have financial assistance programs or can help negotiate payment plans.
Explore Financial Aid: Inquire about financial aid options provided by the hospital or local government agencies. Some hospitals have charity care programs or sliding-scale fees based on income.
Negotiate Bills: Hospitals can be flexible with payment plans or reduce bills, especially for those without insurance. Engage with the hospital’s billing department to discuss your situation and negotiate a feasible payment arrangement.
Research Community Resources: Look for community health clinics or nonprofits that offer medical services on a sliding-scale or at reduced costs. They might provide assistance or guidance on managing medical bills.
Consider Legal Advice: While suing an employer might seem like an option, legal action can be lengthy and complex. Consulting with a lawyer or seeking legal aid could provide insights into potential options or alternatives.
What expenses are not reimbursed by medical insurance? Wheelchair, esthetics
Medical insurance coverage often varies depending on the policy and provider. While many insurance plans cover a wide range of medical expenses, there are certain items or services that might not be fully reimbursed or covered:
Wheelchair Costs: Insurance coverage for wheelchairs can vary. Basic wheelchairs might be covered partially or fully, while specialized or advanced models, such as electric or custom-fitted wheelchairs, might not be fully reimbursed. Sometimes, insurance plans have specific criteria for coverage, such as medical necessity or specific types of wheelchairs.
Esthetic Procedures: Cosmetic or esthetic procedures, typically performed for non-medical reasons, are often not covered by medical insurance. These include treatments like cosmetic surgeries, Botox injections for cosmetic purposes, and other elective aesthetic procedures aimed at enhancing appearance rather than addressing medical conditions.
Registration Fees: Generally, registration fees at hospitals or medical facilities are not covered by insurance. These fees often cover administrative costs and are typically the patient’s responsibility to pay out of pocket.
Orthodontic Treatment: Dental insurance plans typically classify orthodontic procedures as elective or cosmetic, rather than medically necessary. As a result, expenses related to orthodontic programs, including braces, aligners, retainers, and associated appointments, are often not covered or reimbursed by standard medical insurance.
What should I do if my workplace changes?
Understand Your Options: With a job change, your healthcare coverage might change too. Evaluate the new employer’s health insurance plans and benefits, considering factors like coverage, deductibles, and networks.
Special Enrollment Period: If you lose coverage due to a job change, you might qualify for a special enrollment period in the Health Insurance Marketplace. This allows you to sign up for a new plan outside the annual enrollment period.
Transfer Accounts: Some accounts, like Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs), can often be transferred or used in different locations. Ensure you understand the portability options for these accounts.
Inform Providers: If changing healthcare plans, inform your healthcare providers about the change in coverage and update your information with them.