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Limitations of TCM coverage in employee benefits

Whether you are an employer or an employee in China, you likely will have at least a passing familiarity with Traditional Chinese Medicine (TCM). Even if you are an expat in China, it really should come as no surprise that having access to TCM is important to Chinese people. Depending on where you are, and which office we’re talking about, in many cases the majority of the staff will even prefer to seek treatment for health issues from a TCM practitioner, rather than be treated in a medical facility that practices Western medicine.

With this in mind, one would assume that benefits provided by employers in China would provide comprehensive coverage for all things TCM. Is this really the reality of the situation, though? Here, Pacific Prime China looks at the topic of traditional Chinese medicine as it relates to employee benefits.

Traditional Chinese Medicine coverage

People who are just arriving in China from countries abroad may be surprised to find just how ubiquitous TCM is in the country. Even more, they would likely find it interesting that most insurance plans in the country have some amount of coverage for TCM, even group health insurance plans. As such, if a new arrival receives their health insurance through their employer, it may be the first time they’ve had insurance coverage for TCM, which may lead them to explore jus what kind of treatments they are eligible to receive.

Not all TCM treatments are covered by a health insurance policy with TCM benefits. There are particular medicines and techniques that are not covered, as insurers have found some aspects of TCM to be of dubious medical benefit. Commonly excluded TCM items include, but are not limited to:

  • Hairy antler
  • Monkey bezoars
  • Canis familiaris
  • Seamaster
  • Pipe fish
  • Agate
  • Hawksbill
  • Chine caterpillar fungus
  • Horse bezoars
  • Bezoars
  • Cora
  • Moschus
  • Cornu Saigae
  • Tataricae apex powder
  • Cornu Rhinocerotis
  • Bird’s nest
  • Ginseng
  • Animals and their organs (placenta, penis, tail, tendon, bone, etc.)
  • Colla Corii Asini
  • Deer-horn glue
  • Turtle shell glue
  • Turtle angle glue
  • Guilu erxian glue
  • Tortoise plastron glue
  • Safflower
  • Sun-cured ginseng
  • Antelope horn powder
  • And wine made with any of the above items

Many of the items above may seem exotic, and strange to someone from outside China, but they can all certainly be used in TCM. To be sure, within Chinese medicine there a whole host of other herbs, and medicines that may seem equally as odd, yet will be covered by an insurance plan in China. For more information on common forms of TCM that are practiced in China, you can check out a recent blog post we wrote on the topic.

The public/private difference

One of the most important things to remember when it comes to health insurance, and TCM in China is that there is a big difference between the cost of it in public, and private medical facilities. To see this exemplified, all one really needs do is check the wording of their insurance policy documentation. This is because, in most cases, there will be separate coverage provisions for TCM treatment received in each type of facility.

Due to significantly lower price tag for TCM treatment in public hospitals in China, it is not unusual for insurance companies to give preferential coverage terms for care received in public facilities. Let’s look at two examples of real world health insurance plan benefits to see how this can look.

Example 1

The traditional Chinese medicine benefit on a popular plan provides coverage in both public, and private hospitals, but the maximum annual benefits allowed on the plan total RMB 5,000.

Example 2

A health insurance plan with TCM coverage allows for unlimited appointments, and claims for TCM services received at public healthcare facilities, but will only provide up to RMB 800 per appointment at any private facility, with 10 of such appointments covered each year.

As you can see, while some plans may not differentiate between public and private hospitals, these types of plans may comes with lower annual maximums with which to receive TCM care. On the other hand, plans that have no such maximums on TCM received in public hospitals may then set stricter caps on care received at public hospitals.

What to do about poor TCM coverage

Above, you can see some of the areas where TCM coverage can be limited as it applies to group health insurance provided to you by an employer. With this knowledge, you can check your own China health insurance plan documents to see if you can identify any shortcomings of your own TCM coverage. If your TCM benefits are not to the level you would like to see, the question then becomes, “What can I do to improve my TCM benefits?”

Unfortunately in this case, the answer for the most part is: “Nothing.” This is because, unlike other types of health insurance coverage, a rider or top-up insurance plan for traditional Chinese medicine is not something that insurance companies normally offer to clients. In reality, many insurers only provide TCM coverage due to the large and ubiquitous demand for it in China. Absent that, Chinese medical insurance plans would likely feature the same benefits that are found in the west.

Thus, if you find that your company insurance offering does not provide the level of TCM benefits you want, your only real choice to secure improved benefits is to buy your own separate private health insurance plan. While this may seem like an extravagance, it’s not uncommon to find that plans with more inadequate TCM benefits may also have other benefits that are lacking too. In this case, you will want to find the best possible insurance solution for your needs, which will combine the benefit levels you want with a value you can afford.

To find this, it’s best to team up with an insurance broker, like the knowledgeable insurance advisers at Pacific Prime China. They can compare plans from numerous insurers here in China, and abroad to locate one that has all the TCM and benefits you want, while still fitting your budget. To find your today, just contact us! Our agents are standing by to answer all your questions, as well as provide you with a free plan comparison and price quote.

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