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China expat health insurance ideas ?

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Does anyone know of a good expat health insurance plan that i can look into? the one i have currently is ridiculously pathetic (i didn't know any better back then when i first signed up...), it only covers local hospitals. for minor colds and stuff, going to the expat wings in the local hospitals is okay. however, for anything more than that, the level of medical knowledge and treatment is just not acceptable (not to mention english). i know there are insurance brokers that i can talk to, but i'd like to get first-hand opinion on fellow expats who have different insurance plans, good or bad, so i know which ones to look into and stay away from....thanks a bunch!!

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With regards to medical insurance for expatriates there are a number of points that you need to take into consideration:

Apart from the expensive costs of international facilities here in Shanghai it should cover you on your other travels for business or pleasure around the world - and therefore cover should be of a premium.

If you and your family are fit and healthy go for something that has very good inpatient cover and also for special investigations and lab tests, surgery, ICU etc.

For outpatients most expats are fairly healthy and we do not use outpatient services more than two or three times a year (we self medicate more than they do in China). So you can choose an insurance that has very limited outpatient cover and pay out of pocket for these but ensure you have really really good cover for longterm inpatient care in case of surgery or catastrophic event that will keep you there for a long time. Check on cover for chronic medications - drugs can be a major expense.

Some insurances are very smart, they want to restrict payouts but want your premiums, obviously that is how they make money, so they may give you a ridiculous cover for outpatient care and a limited amount for inpatient care as they know that is where the claims are going to be high, so go over the cover very closely.

They will insure you for a couple of million USD for cancer etc, and really the risk for most healthy people is low for that and we would most likely relocate home for that anyway.

Common things happen commonly - so for us if we are fit and healthy it is likely to be accidental in nature, the odd heart attack, stroke, diabetes if you are NOT THAT healthy and exercise etc.

Finally check to see that there is medical evacuation cover as you may want to go somewhere where you are getting a better level of care and this can be very expensive, ensure that the medical assistance company responsible for evacuation/repatriation (to home country for major illness like cancer) and linked to your insurance is one that has a good reputation here in Asia as well - they don't all match up.

If you want a good expat package you are going to pay for it, so do a risk benefit analysis and go for the things that are likely to happen and take the risk - sh...t happens but the percentage is likely to be low.

I would recommend you look at ones like BUPA and CIGNA these are the ones used by the largest MNC's. If you want to go for something that is not in this price category Royal Sun Alliance and there are also others, like GMCI/Aetna/Goodhealth/William Russell/Allianz/AIG etc. But be very careful of some of the fine print of all these insurances as some will not readily pay up when it comes to saving costs at the risk of potentially not doing the best for the patient - like "the healthcare in China is the same as other places in the world, so why would you want to go elsewhere" and b/s like that.

Make sure you ask your broker all the questions - so be knowledgeable and question everything, remember they also make money out of it so they may try to sell you something that is not suitable for you and I have advised many people not to take the packages they have been offered based on all the facts above.

It really is going to depend on your personal needs, family, current health status travel etc. and whether you will be covered under your home country healthcare system should something major go wrong.

Don't get roped into something not suitable for the most important needs you will require - there should be no compromise to your health and you should expect only the best so pay for it and sleep well at night!

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I have health insurance with BUPA, but there are many other international insurers that offer similar packages. It pays off to shop around and compare what's on the market.

 

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I have used the Aetna. Everything was covered as it claimed to be. The deductible wasn't met that year because I wasn't ill very often. I believe I saw the doctor twice in China and saw two doctors in the US. However, the claims process was easy (receipts had to be furnished to count towards the deductible). As for the specific of that plan, I don't really remember. It was all-inclusive, covered most types of doctors visits throughout the world and had a US limitation of 30 days in the hospital. Major medical, visits, emergency evacuation and repatriation were all part of the plan. Specialists were included. There were network and non-network doctors (really only applied for the US). Cost was roughly USD3000 for the year.

Aetna is a very large insurer. I had no qualms about selecting their coverage.

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My husband & I have medical insurance through his company group plan. The outpatient medical coverage is 12,000 RMB maximum per year (for both of us) and paid out at 80% of the cost of a visit/treatment.

Recently I had to go to see a general practitioner here in Shanghai and had a very small procedure done at the doctor's clinic. This procedure would have cost approx. 1500-2000 RMB in my home country (New Zealand). I know this because I spoke to a person in NZ who works in the medical area. Here in Shanghai it cost 5,000RMB.

My questions are:

1. Is an 80% refund on out-patient visits normal or is 100% more usual?

2. Is the level the company is offering at 12,000 RMB (for two adults) realistic? I am heavily doubting it is after my initial "outing" into Shanghai medical costs.

Would really appreciate your comments on this as I have no idea - this is all so new to us.

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try to get an overview from a broker (eg china expat health - contact details should be easy to google/ if not let me know and i give you an email addr). you can describe whats important for you and they give you several alternatives.

 

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I am having nightsweats about health insurance. All of sudden prices are become very inflated. I am tired of dealing with brokers with powerpoint presentations.

I am quite healthy and do not eat meats that have been previously visited by bluebottles.

Anyone know of any decent companies that sell affordable products without brokerages?

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It's really nice if the carrier can directly reimburse the providers you plan on using here. The usual expat healthcare providers include Shanghai United Hospital, Parkway Health, and some others.

One of the main criteria I used in selecting a plan is whether it will provide for ongoing treatment in the U.S. 365 days / year if necessary. There aren't many plans out there that do that. They're expensive too.

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I'd use Blue Cross / Blue Shield. Most of the time it's on a reimbursement basis, but it's still better than many alternatives.

A lot of plans here will not cover even your basic imported medicines and certainly not any of that Chinese traditional medicine that doctors like to slip in unnoticed.

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I have used the Aetna planned through AmCham. Everything was covered as it claimed to be. The deductible wasn't met that year because I wasn't ill very often. I believe I saw the doctor twice in China and saw two doctors in the US. However, the claims process was easy (receipts had to be furnished to count towards the deductable). As for the speficis of that plan, I don't really remember. It was all-inclusive, covered most types of doctors visits throughout the world and had a US limitation of 30 days in the hospital. Major medical, visits, emergency evacuation and repatriation were all part of the plan. Specialists were included. There were network and non-network doctors (really only applied for the US). Cost was roughtly USD3000 for the year.

Aetna is a very large insurer. I had no qualms about selecting their coverage.

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I would like to make some additional important comments that you need to look at when buying medical insurance, and I am not an insurance broker so I don't have to favour any particular company at all:

Independent insurance brokers make their revenue on what they sell you, so may put forward one insurance over another to make more money depending on commissions etc. So not always in your interest but in theirs. Read the fine print and make sure you know what you are getting for your money as stated above.

Often the low risk items will provide huge amounts of coverage and the high risk items coverage have low thresholds to avoid expensive claims. Healthcare here and in some of the centers of medical excellence is very expensive, sometimes exceeding costs in the US and other international centers.

As far as the evacuation cover goes, it is not just about the coverage, you can be insured for ten million $$ but if you don't have someone to get you out of China when you need it, then you are stuck here, and I certainly do not agree with the comments on Beijing and Shanghai necessarily being acceptable - they are not if you come from a country with superb healthcare (sometimes just acceptably good).

So when you choose your insurance make sure that they are affiliated to a medical assistance company for evacuation that has a presence in China or who is able to do an evacuation out of China properly in an acceptable time frame, and that you don't end up staying here because the insurance tells you this is an ''acceptable international standard" only because they don't have the means to get you out, and because they don't want to spend the money; remember they are insurances, so they make money on premiums and not on spending money on their clients, so they will obviously do all they can to keep costs down, with what could sometimes be construed as 'acceptable healthcare' based on personal perceptions.

For the record, I don't make money out of moving or referring patients to any healthcare provider or insurance/assistance company, I am a salaried employee and have the interest of my clients at heart to ensure they get the best possible care - I can write a book about some very unfavourable outcomes due to poor/inappropriate health insurance cover or the total lack thereof in China as well as other parts of Asia.

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@Paullie

Your implication however that health insurance companies prejudice the health of their clients to save a dollar is a general statement that can't be applied across the board. There are good and bad insurance companies and practices in every country as there are good and bad examples of medical facilites and assistance companies but I for one know that we would never risk the health of our clients by suggesting sub-par treatment.

We are a for profit company and we therefore have an obligation to ensure that every dollar spent is spent in the most efficient manner to ensure the best possible outcome for the client. We also have to consider our other policy holders and ensure that the premiums we charge each year are within their expectations and not inflated by unnecesssary treatments that provide no benefit other than to inflate the bill.

With reference to medical treatment in China, everyone has anecdotal evidence of medical treatment going wrong in every part of the world but I have factual evidence that in my three years in this business in Shanghai we have only been involved in three cases of alledged medical malpractice and ironically all three cases were at Western orientated facilities.

Far from suggesting Chinese medical facilities are perfect, I am simply stating that they are not as bad as many scaremongers would have you think and evacuation is of course, no walk in the park. For a case to require air evacuation it is by implication extremely serious and will certainly not be improved by any additional delay in arriving at a medical facility and the additional trauma suffered through air travel and the logistics involved.

If good quality and effective treatment is available locally it should always be considered first to maximise the chances of a complete recovery for the patient. Certain conditions such as transplants would automatically qualify for evacuation but other conditions should rely on the opinions of those qualified to make them such as the local attending physician, physicians working with the assistance company and those intending to receive the client in the offshore location. Efforts have to be focused on achieving the best overall outcome for the client.

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Hello,

I am looking to buy medical insurance with maturnity coverage without waiting period. I have found a few plans that require 12-month waiting period.

I would greatly appreciate if someone can recommend a plan without waiting period.

Thank you in advance for your help.

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@victoria

For an individual medical plan almost all insurance companies will require a waiting period for maternity as they wish to avoid clients paying for one years insurance, having a baby and then not renewing their policy - it becomes a very expensive exercise.

We have a 12 month waiting period but our restriction is on paying the bills so provided the pregnancy occurs after the 4th month of the policy and lasts the normal duration we will cover the delivery provided the client has renewed the policy.

I'm sorry I couldn't be more helpful.

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Great information, however there needs to be more clarification about actual coverage and allowances.

I once had an international medical insurance policy from the States.
Became injured on a remote jobsite ouside a third tier city.

This required xrays, bloodwork and stitches at the local hospital, paid cash.
Never received a reimbursement check.

So, will all hospitals/clinics here in China accept and provide treatment without payment?

Is it required to first get approval/pay bill - then submit any fapiaos to the respective insurance firms?

It would be helpful to all here if you could attach a PDF file or provide a company website which shows what is covered and/or the limits of standard procedures/fees.

What are the pre-existing condition terms, catastrophic coverage or disease restrictions?

Kindly identify the specific coverage if there are different plans, annual costs, deductables, co-pays, etc.

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Obviously I can only speak on behalf of my company so provided you except that all company terms and conditions can be different I'm happy to provide you with the benefit of my experience here.

NO is the answer to your first question. Many hospitals outside of the Tier 1 cities and indeed, many public hospitals within Tier 1 cities will not except direct billing arrangements for the simple reason they don't need to. They don't need the extra customers and they don't want the extra work of providing credit to insurance companies that are often offshore and may or may not pay for the treatment provided - cash is king. A number of insurance companies and third party networks have had some success in penetrating the Chinese hospital system but the coverage is by no means complete. In our case, for outpatient treatment, we have the client pay and claim but for an inpatient case where the hospital will not except credit, we have a network of agents nationwide that run along to the hospital hauling a bag of cash! I have no idea why you weren't reimbursed by your original insurer.

With reference to pre-authorisation, in our case this is only necessary if the member needs to be admitted into the hospital. In the case of an emergency the hospital will have an additional 12 hours to contact us to ensure that treatment isn't delayed whilst trying to obtain pre-authorisation. Outside of our outpatient cashless network all outpatient treatment is pay and claim.

With reference to pre-existing conditions, again, all the companies are different. In our case, for individual plans, we impose a 2 year waiting period for all conditions that occurred in the 2 years before the plan started. We are not considering coughs, colds and other common ailments but we focus on those clients that have serious ongoing conditions that purchase insurance with the full intention of making claims significantly above their premium contribution. These clients prejudice our results and also impact the other members who through subsequent premium increases are subsiding their treatment. Once 2 clear years have passed without treatment those conditions considered pre-existing are once again covered.

With reference to available plans and premiums etc., I don't want to turn this post into a sales pitch for our product as I believe that by providing honest opinions we are already marketing our services however if you do want more information about out products either contact me on my email.

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Attention, I am going to make some salient points about medical care in Shanghai. Let me give some perspective. I have lived in greater China for 17 years, the last 10 in Shanghai. I work in the legal profession and I am an expat. Primarily I practice corporate law however on too many occasions I am approached to assist expats who have had unsatisfactory experiences with medical treatment in Shanghai from the foreign medical clinics.

It is disconcerting to me that these complaints are varied and all too common.

Let me point out some facts about the foreign clinics in Shanghai.

a. Staffed by foreign medical practitioners who have either failed in their home jurisdiction or been held too incompetent to practice medicine in their home jurisdiction. However, they are cheap for the international clinics to employ as they are desperate for employment and because they are cheap to employ, they maximise the profits of the international clinics which are run essentially for profit.

b. I have been approached in respect of misdiagnoses of heart conditions, paediatric issues, dermatological conditions etc etc.

c. Those local Chinese medical practitioners that are hired by the foreign clinics are usually the incompetent ones that the local Chinese hospitals are happy to be rid off. I have personally heard on several occasion of paediatricians, anti hesiologists who were dismissed as incompetent by the local leading hospitals, Ruijin, Huashan etc, ending up working for the clinics and foreign inpatient clinics, who are not concerned about incompetence provided the price is right.

d. It is a travesty that these clinics's abilities are limited to treating mundane problems such as coughs and colds but have little or no competence with medical complications that go behind this. Meanwhile, one pays RM B 2000-4000 at such clinics to be referred to a Chinese medical specialist who five minutes before is treating a local patient for the same condition and charging 200 RMB for the same consultation. By and large, one is therefore paying RMB 3000 for an English interpreter to receive the identical treatment.

The purpose of this post is to advise you that by and large the more competent treatment is to be found in the Shanghai hospitals. For those, who still remain sceptical, ask yourself, when you are next seeing the dermatologist, cardiologist, paediatrician, gynaecologist, ask yourself this, is it better to see the specialist who sees the medical conditions and problems 50 times a day as opposed to the foreign medical practitioner who in his career, and in his or her short time in China, has much less exposure to the medical condition or problem which confronts him or her.

All the above is sad but true.

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@Dextrum Not too long ago i had gallstones, and was rushed to Hua Shan Hospital. It was weekend, and late at night, and for this reason, i could only get help at the Chinese department.

It was, as to be expected, packed and after a long wait i got to see a doctor, who was not patient at all and told me to do MRI and blood exam.

They told me to wait one hour for the result, which i reply i couldn't because i was experiencing acute pain. He said there was nothing he could do. I then decided to transfer myself to Parkway, which i knew was going to be much more expensive, but when you feel your life is in danger, money is the last thing you think about.

As i was rushing out of Hua Shan, i got my blood report, which i brought with me to Parkway.

When i got there, the doctors reviewed the blood exam from Hua Shan Hospital, which said i was perfectly fine. I knew i wasn't, because i was in serious pain. Later reports stated "patient pain, grade 10/10". Gallstones are no joke.

Anyways, they told me i was having gallstones, and since this is can be a very annoying and painful chronic condition, i was suggested to remove my gallbladder, which is a very common surgery.

I was treated very well, and the doctors seemed to be professional.

The point i am trying to make is, i have had bad experiences in Chinese hospitals before, and only go to International Hospitals when is something serious, since my insurance policy has a big deductible. Chinese hospitals sometimes may have better doctors, i can't argue with that because i dont know. However, they are often crowded, many of these doctors have no manners and they often prescribe you expensive medicines because they get commission on it.

Sad but true.

If you have a good insurance that covers any hospital, i recommend Parkway "worldlink" and United Family. I might need to do some research, but i heard bad things about Ruijin Hospital and Hua Shan is a big No No for a lot of people.

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Health insurance companies are profit-making entities which exist to help reduce the fear people may have at not being able to pay generally POTENTIAL medical bills that are out of one's budget.

Agreed, it would be terrible to be in an accident or have a serious illness and incur high fees for the needed treatment (without adequate insurance) but if we are playing the odds, having such an accident is extremely unlikely, although it is possible.

I work for someone who holds a US passport who purchases an insurance plan for his foreign employees which is so pathetic I opted out straightaway as I did the math and saw how pointless it was to pay the premium. The problem with that plan without naming names is that if you have any serious illness or emergency it would not cover you! For example, cancer would not be covered if you got it. This boss, unfortunately, receives kickbacks from the insurance company so he pushes this onto the employees.

I agree with the idea that the foreign clinics are charging an arm and a leg for services which may be provided by medical staff that has been rejected in their home countries or here in China. I would definitely prefer to be seen by a doctor who exercises his/her area of expertise say 50 times a day vs a few times in a month or year! A girlfriend and I recently had health exams at a local regional hospital. I paid cash for everything up front and while the whole endeavour was quite different from what would happen in my home country, I felt it was overall a more thorough exam at about 10% of the price overseas. This is not, however, why we buy insurance.

We need insurance for major events, should they occur.

I seriously do not understand the thinking of insurance companies, usually making women pay a year premium before covering maternity. If a woman is happy with the company she will stay with it, and guess what - that baby and that baby's family is very likely to be buying insurance one day as well. I guess insurance companies don't value future investors enough to cover women who are pregnant or would like to have babies soon - which should not be such a major expense as it is a NORMAL part of human health and life and NOT an illness. In fact I believe it should be factored in to ALL insurance schemes as it is a NORMAL thing and not a pre-existing condition, not a disease and wow - could even make money in the future for the insurance company. Hmmmm just food for thought.

Best of luck to us all and may we not have to rush to an emergency room in the middle of the night!

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