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Get the most out of your company sponsored health insurance

Pacific Prime China shares six tips on how you can get the most out of your company sponsored health insurance.

Posted on Jul 06, 2016 by Rob McBroom

One of the increasingly popular ways businesses attract and maintain employees is the group health insurance plan. Here in China, many companies offer expats a wide variety of health insurance policies, from plans that cover just basic care to those that cover you and the whole family worldwide. Regardless of the plan, your company offers you, there are a number of things you can do to ensure that you get the most out of it. Here are six.


1. Be aware what is covered by your plan

This is arguably the most important thing you should consider when you setting out to maximize what you get out of your company's health insurance plan. Because there are so many different plans available on the market it would be a good idea to be aware of exactly what is covered by your plan.

Take the time to read the documentation provided by your company's provider and if offered, attend meetings or sessions with the insurer. During these sessions, you will usually learn more about what is covered, how to claim, etc.

In regards to knowing what is covered, pay attention to the wording in the plan details as this is where you will find exactly what is covered when it comes to inpatient, outpatient, maternity, dental, optical, etc. and any associated limits related to this coverage. Beyond that, you will also see if there are any exclusions e.g., pre-existing conditions and waiting limits e.g., 1 year for maternity claims.

This is especially important as many businesses are starting to reduce coverage in certain areas. For example, we have seen a number of businesses reducing maternity coverage limits or increasing the waiting period that must pass before you can submit a claim. On the other hand, we are also seeing businesses and insurers implementing wellness related benefits such as expat support, or yearly health checkups. Knowing that you have access to these could be a big help in ensuring you are getting the best out of your plan.  


2. Be aware of how to use your plan

Once you know what is covered, it is important to know exactly how to use your plan. It should be explained to you when you start a new plan how to submit claims and when to use your cover. One thing to pay close attention to is whether the plan supports direct billing or you will need to submit a claim for reimbursement.

This is especially important in China where most hospitals will require you to pay upfront before care is administered. If you know that your company's plan works on direct billing, then you can just show up at a hospital in your network and present your insurance card. The hospital will then bill the insurer, allowing you to receive care faster. On the other hand, if your plan is reimbursement oriented then you will need to budget for care.

It is important to note here that many group insurance plans sold in China will usually offer direct billing. But, as care is becoming more expensive some companies are starting to implement restrictions on where you can use direct billing in order to reduce or maintain premiums. For example, we have seen cases where a company will limit direct billing to certain hospitals within the provider's network. If you want to receive care from a luxury international hospital you will need to submit a claim for pre-approval from the insurer before you visit.


3. Be a part of the plan purchase/renewal process

Both the renewal process an process of implementing a new health insurance plan can often take months, and while it is not always possible to be part of the process, it could be beneficial to work with your HR team and see if you can provide input on the plan.

This could be important in helping to ensure that should the company be thinking about changing coverage you can provide insight into what you and your fellow employees are using the plan for, or would like to see covered.

A number of companies do take into account feedback from their employees if your's doesn't try sending an email to HR with your feedback and see if they can help.


4. Determine the best source of coverage for your dependents

Some group insurance plans cover dependents, while others will only offer coverage to yourself as an employee. If you are going to be moving to China with your family, or will be moving jobs, it would be a good idea to check with your employer whether your family will be covered through your plan or not.

If the answer is yes, look at what is covered and whether there are any major points/limits you should be aware of. For example, some plans will cover a spouse but won't offer a dependant maternity coverage. If you believe that the coverage won't be enough, or dependants aren't covered, it would be a good idea to secure a separate plan or talk with a broker like Pacific Prime.


5. Evaluate your plan's network

As we noted above, there is a growing trend when it comes to group health insurance of both providers and companies implementing plan networks with a collection of hospitals/clinics that will accept payment from the insurer.

While some plans, especially those from international providers, offer a comprehensive network, others may have a more limited one. This could really dictate where you receive care and the overall quality of care you receive.

Also, by knowing where your health plan is accepted in China you can plan out things such as quickest routes should there be a medical emergency, and appointments well in advance. This also ensures that you won't have to pay up-front and submit a claim for reimbursement.

If you feel that the network is not comprehensive enough for your needs, you can talk with your HR team to see if there are other options, or talk with a broker like Pacific Prime who can help you uncover an individual plan that provides the cover you need.


6. Don't focus solely on price

One important thing to remember when not only looking at a potential plan for dependents not covered, extra coverage, but also at the different health care venues in China is that price should not be the sole driver.

For example, some hospitals in China charge patients at higher rates than others yet offer no better quality of care. The same can be said for insurance coverage. Instead of focusing solely on price, try to take into account what is covered, the quality of the plan and care given, and more.

If you are looking for more tips on how to get the most out of your insurance please visit our website. Pacific Prime can also help you secure a plan that covers any gaps missed by your health insurance plan. Click here to learn more.


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