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Securing health insurance plans for your family

Pacific Prime China looks at five steps you can take to secure the best family health insurance plan.

Posted on Sep 18, 2015 by Rob McBroom

When moving to China, or even moving within China, one of the most important things expats need to consider, especially if they have families, is health insurance. While some expats will get coverage through their company, this coverage may not cover the whole family, which means you are going to need to find a plan yourself. The thing is, as with all other forms of insurance, the number of family oriented plans available can be overwhelming.

To make the process of finding the best plan easier, we have come up with five steps to follow.

Step 1: Establish a base criteria

Before you begin looking for plans, it would be a good idea to figure out exactly what you want to get out of any plan you purchase. In order to do this, you can ask yourself questions like:

  • How many people will be covered by this plan? When it comes to family plans, many insurers offer different coverage options. For example, with some plans you pay for coverage of the first child only - additional children will be covered automatically.

  • How much do I spend on health care now? Many plans do have coverage limits, so if you know approximately how much you currently spend on health care you can look for plans with limits above this amount. If you end up with a plan with lower limits than what you spend annually, you are likely going to have to pay for the difference out of pocket.

  • Do I want a plan with guaranteed lifetime renewal? This is an option available with some family insurance plans where, for as long as you are paying premiums, the insurer will base coverage on age alone, disregarding any ongoing medical conditions that arise while you have the plan.

  • When do I want to pay premiums? The good thing about many health insurance plans is that they do often offer different payment schedules. For example, you can select whether to pay premiums annually, semi-annually, or maybe even quarterly. Selecting one over the other could see you save money in the long run.

  • Are there any pre-existing conditions? If you or anyone who will be covered by the plan has an ongoing or existing medical condition, some insurance companies won't cover it. Others will cover these conditions but will attach a moratorium (period of time that must pass before claims are allowed) or a loading (amount you must pay on top of the premium to get coverage for the condition).

Step 2: Identify a few different plans and review their benefits

Once you have identified what you are looking for in a plan, and what you want to get out of it, the next step is to look at a few different plans. The first thing to look at when considering plans is the benefits. The list of benefits offered is usually a fairly large table - called a benefits table - or a list of items that can be, at first glance, confusing. When it comes to family plans however, the best will usually offer some form of annual checkup along with other useful family-oriented benefits like optical checkups, dental, maternity/pre-pregnancy checkups, and more. These benefits will usually become available after you renew your plan.  

While the benefits you find desireable will be different from everyone else, we usually see people asking for the following benefits when selecting a family health insurance plan in China:

  • Maternity or newborn coverage

  • Worldwide, or regional (Asia) coverage

  • Emergency evacuation coverage

  • Inpatient and outpatient coverage

  • Vaccinations and other preventive medicine

  • Alternative medicine such as Traditional Chinese Medicine

  • Pre-existing or chronic condition coverage

Step 3: Look at the specifics or fine print of a plan

Once you look at the benefits of a number of plans, the next step is to narrow down your choice to a few select plans. From there you will want to look closely at the terms and conditions of the plan. This is usually a lengthy document, but it is important that you read and understand it. The main reason for this is because this is where you will find plan specifics listed.

Some important specifics to be on the lookout for include:

  • If pre-existing conditions are covered, or if there are any waiting periods or limits attached to coverage of these conditions.

  • When you pay your premiums

  • When coverage starts

  • If the plan covers genetic disorders/heritable diseases or congenital diseases.

  • If there is any deductible or excess and whether it is on a per-use basis or not.

With the last point - excess and deductible - you can usually select the amount. If you go with a higher deductible, for example, your premium will usually be lower. The downside with this is that you will need to pay that amount before coverage kicks in. If the deductible is on a per-use (or per-covered incident) basis, this means you will need to pay that amount each time you see a doctor before coverage will kick in.   

Step 4: Find out what is covered if you have to go to the hospital

While we can all hope that we won't have to go to the hospital for medical care, with a family (especially a relatively young family) you can be pretty sure that you will be going to the hospital at least once a year. When it comes to seeking care, it should be known that many plans on the market do have caps or limits on how much the health insurance plan will cover. If you are in, say, Shanghai and buy a local plan with lower limits, you may not have full coverage at the international hospitals which are favored by many expats. Therefore it would be a good idea to know what these caps and limits are.

Also, be sure to know how the provider you are considering defines inpatient and outpatient care. Some providers view a hospital stay of less than 24 hours to be outpatient - even if you are admitted by staff - while others will only require that you be admitted in order to claim inpatient cover. This can be important if you decide to only purchase a health insurance plan with inpatient coverage.

For families there are a number of important hospital-related coverage elements that could be useful. Here are six of the most popular that our clients considering family plans have requested:

  1. Room and bed - Most of the hospitals in China, especially those targeting expats, will have different levels of room and bed for hospital stays. Some plans will only cover a ward bed, while others will cover a private, semi-private or even suite room. Be sure to also check if the plan covers a secondary bed for a family member if, say, your child is sick and you want to be close by.

  2. Intensive care - This is usually covered in family plans, but care in the ICU is almost always expensive and could see you reach your claim limit quicker than expected.

  3. Private nursing - A luxury for many, but if you have a sick child, being cared for by the same group of people can go a long way in comforting them and easing a frightening stay at the hospital.

  4. Specialist fees - Some plans may not provide coverage for certain specialists, or will attach a separate limit on how often you can see one and how much you can claim.

  5. Dialysis and cancer treatment - Many plans will cover this as long as it is not a pre-existing condition, while others will have a set time period in which you must pay premiums before you can claim for treatments like these.  

  6. Direct billing - This is especially important for plans in China, as many hospitals will not start treatment until you have paid. By having a plan that supports direct billing you will get treatment quicker

Step five: Select a plan with a strong support network

Finally, every insurance provider in China has a preferred network of health care facilities that have agreed to accept payment from the provider. Obviously, a provider with a stronger network - more connections and facilities - that also accepts direct billing is preferable. This also gives you greater choice in where you receive medical care.

Beyond that, look for a provider who offers plan support tools like online portals, 24-hour hotlines, etc. This will make it easier for you to not only submit claims, but also renew plans and even reach your provider should you need to talk with them. An alternative to this is to work with Pacific Prime. We can not only help you to find the best family health insurance plan on the market, but we also offer a highly knowledgeable support team who can help with everything from claims to even suggesting where to receive medical care. Contact us today to see how we can help.  

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