Insure Us: The Basics of Healthcare and Medical Insurance

Nothing is more important than your health – so we don’t want to compromise when it comes to medical care. But going to an international-grade facility in Beijing is costly, as registration and consultation fees alone can amount to over RMB 2,000 depending on the doctor you wish to see. Having healthcare insurance will ease the burden of paying out of pocket. Below is a breakdown of what to expect from healthcare in Beijing.

Clinics

Clinics provide routine services such as checkups, pediatric medicine, and outpatient care. They may also offer dentistry, mental health services, physical rehabilitation, official physical examinations (for visas or other purposes), and vaccinations. In most cases, anything relating to obstetrics and prenatal care require a visit to a hospital with more specialized medical staff and facilities. Although some clinics offer emergency care, patients may need to be transferred to a hospital depending on the seriousness of the case.

Hospitals

Most uninsured expats use local public hospitals, many of which have excellent reputations in their fields. They are much cheaper compared to private hospitals and see a higher number of patients, but the language barrier can be an issue. In addition, they can be a rude awakening for expats who go in expecting a western-style bedside manner and privacy standards. If language isn’t an issue and/or you don’t have medical insurance, you might try visiting a local hospital. Expats often recommend Peking Union Medical College Hospital (founded in 1921) and the China-Japan Friendship Hospital. Both have “VIP” sections with fewer patients and some English-speaking doctors.

At international hospitals, foreign patients will find the process and surroundings familiar and therefore comforting, but bear in mind that the attending doctor will likely still be Chinese – although English-speaking – and that not every international-standard hospital is equipped to handle all scenarios. For example, patients requiring major surgery – particularly emergency surgery – may need to be transferred to a Chinese hospital, both for the operations themselves and for continuing post-surgery treatment.

These cautions aside, international hospitals offer extras such as reminders for checkups and some have more than one location, making them convenient for your home, office, or school. There will also be a greater emphasis on preventative care.

Emergencies

The emergency phone number in Beijing is 120 (999 for English speakers). Keep in mind that ambulances in Beijing have a mixed record for two reasons: (a) getting lost and (b) being perfunctory in their treatment of non-emergency patients. Also, Beijing’s traffic situation isn’t exactly conducive to the quick transfer of patients to medical facilities, and drivers here aren’t yet in the habit of yielding immediately to ambulances.

There’s no simple solution for this. Many taxis will simply refuse to take injured or sick passengers for fear of being held liable for any negative outcomes. Some international hospitals have their own 24-hour emergency call centers with English- and Chinese-speaking operators. However, ambulances are still subject to traffic constraints.

To make matters even more complicated, there’s no Good Samaritan law in China. This may explain why many Chinese are unwilling to get involved in emergency situations. Bystanders who offer help may be held liable even if their actions help resuscitate the injured party. A patient who is given cardiopulmonary resuscitation (CPR) may survive, but non-qualified rescuers have been sued for the broken ribs that can occur in the process. When in doubt, call 120 and report the emergency. However, consider carefully whether there’s a good reason to become directly involved in a situation.

That said, for the sake of one’s own family, friends, and colleagues, most international hospitals and clinics in Beijing offer internationally-recognized CPR and first aid training in English. It’s a good idea to take a course, especially for people who live farther away from a major medical center.

Hospitals require a Guarantee of Payment (GOP) from incoming patients regardless of if it is an emergency or not, and sometimes the insurance company needs to be notified to ensure that the insured gets the medical coverage they require, and the hospital knows that the bill will be settled.

Insurance

In traditional expat remuneration packages, medical insurance can be an attractive benefit. Students are usually covered through their institutions of higher learning, while younger students are included in their parents’ insurance. However, a significant number of expats aren’t covered at all. In a 2014 online survey conducted by insurer NOW Health International, a quarter of the 209 respondents living in United Arab Emirates, China (including Hong Kong), Singapore, and Thailand reported having no medical insurance.

“[They] believed that such cover was unnecessary because they were currently healthy and would not fall ill. However, as costs for medical care in popular expat locations have undergone double-digit inflation in recent years, they risk facing large bills if they are proved over-optimistic,” says the report.

You may be able to buy into a group insurance through your employer. Alternatively you might prefer, or have no choice, but to buy an individual plan.

Groups that are more likely to look at individual plans include entrepreneurs and their families; individuals traveling, studying, or engaging in short-term consulting projects in China; family members who are visiting, studying, or interning in China for several months; and small and medium-sized enterprises employing foreign nationals with medical needs not covered by the state-provided shèbǎo 社保 (social insurance) or yībǎo 医保 (medical insurance) system.

Brokers and Agents

The simplest way to compare medical insurance plans is through a broker. In a nutshell, a broker acts on behalf of the client to find the best insurance plan for their needs. Brokers are usually compensated through commissions taken from the premiums charged to policyholders (i.e. you) by the insurance company, so their services are free for clients. Be sure to seek out an advisor who specializes in medical insurance for expats living in China.

Though both brokers and agents act as a bridge between the client and the insurer, an agent usually represents an insurance company like Cigna, Aon, Allianz, Bupa, IMS, or Aetna. Both agents and brokers must be legally licensed to work in China.

If you currently have medical insurance but are looking to change plans, your current insurer would be the most logical place to start. However, the insurance company may not extend coverage to China, or may limit the list of hospitals you can go to. If you’re set on going to a particular facility, check the hospital’s or clinic’s website for a list of insurers they currently have direct billing relationships with.

FACTORS TO CONSIDER

Annual Limit

An annual limit is the cap on benefits that your insurer will pay in a year, ranging from USD 100,000 to several million per year. If the dollar amount of covered hospitalizations, treatments, and prescriptions exceeds the annual limit, you’ll need to pay all healthcare costs for the rest of the year.

Child Coverage

Medical care for children (including checkups and immunizations) is often included, but confirm this with your insurer. Families with older children who may or may not live at home as dependents may be included, but check if there are any age caps and details of the “global” part of “global insurance coverage” if your kids don’t live in China.

Medical Evacuation

Evacuation would cover transport for essential surgery, medical treatments unavailable here, or a health epidemic. Check whether the plan covers return transportation to Beijing. Insurance for evacuation can be overkill if your primary policy covers most or all possibilities, so make sure it complements rather than overlaps existing coverage. Note that medical evacuation doesn’t necessarily cover treatment in your home country or a third location like Hong Kong.

Annual Rate Increases

Smaller and mid-range insurers with less financial stability usually have more erratic rate increases. Some even increase the premium in response to claims. Larger, more reputable insurers have more gradual increases, both annually and with age.

Discounts

Some insurers offer a family discount, which can be especially cost-effective for large families. No-claims discounts or first-year discounts are sometimes also offered, but keep in mind that a 10 percent first-year discount carries a 10 percent plus age plus annual increase at renewal.

Travel Insurance

International travel goes hand-in-hand with living in Beijing; getting travel insurance is important as a backup on your rider. This is often available as a small package when you have visitors, either through your current insurance plan or through an international hospital or clinic membership. US citizens should note that many global policies don’t cover treatment in the US or only cover it for a limited number of days (usually 30-45).

Maternity Coverage

Couples planning to conceive should note that most insurers require a waiting period of 10-12 months of paid maternity insurance before pregnancy, birth, and/or newborn coverage kick in.

Pre-Existing Conditions

Some insurers will cover certain pre-existing medical conditions, but the trade-off is a higher premium. Coverage for high blood pressure or cholesterol may seem expensive, but keep in mind you’d also be covered for heart attacks.

Outpatient Treatment

Consider how often you or your dependents are likely to visit the doctor in a given year. Policies with high deductibles to minimize the cost of monthly premiums may not be the most cost-effective if you’re only planning to see doctor twice a year.

OTHER

Additional considerations include coverage for children with special needs, deductible and copayment options, dental and visual insurance, coverage for second opinions on major treatments, and emergency protocols (e.g. whether pre-authorization is required).

In addition to health insurance, international hospitals such Beijing United Family Hospital or primary care clinics such as Raffles Medical have memberships that offer patients additional discounts and extra services for an annual fee. These memberships can supplement company-sponsored insurance packages; they can also be appealing for expats who select packages based on low upfront fees, or those who must pay for treatment out-of-pocket.

This article first appeared on our sister website beijingkids.

Photo: wp.com