6 questions to ask about your current employee health insurance plan

When it comes to employee benefits, perks like free office massages might do a lot for employee morale, but nothing beats a robust employee health insurance plan for keeping staff happy. In fact, a 2016 Glassdoor study found that the majority of employees and job candidates want health insurance benefits over pay rises.

But, when handed their employee benefits booklet, most workers find it hard to discern whether their corporate health insurance coverage is enough for their needs. This is where reading the policy’s fine print is crucial. Not only will it help you understand what benefits you are entitled to, it will also illuminate the coverage areas that may be lacking and help you avoid any nasty surprises.

In our recent post on top-up insurance, our expert team looked at the importance of top-up plans in making up for the coverage gaps in corporate health insurance policies. To further help you decide whether your current employee health insurance is enough for your needs, this article discusses some of the most important questions to consider:

Is my doctor covered?

In terms of employer-provided health insurance, one of the most popular cost-containment measures implemented by employers in China is limiting cover to a specific network of hospitals and clinics. Please note that you will usually need to pay more for out-of-network care. Additionally, some plans won’t cover care at out-of-network facilities at all, while others will only cover a very small amount or percentage. If it’s important for you to keep seeing the same doctor, it would be a good idea to ask your company’s HR whether your doctor is covered by your health plan. If they’re not sure, check with the insurer or a reputed broker like Pacific Prime China.

What’s the coverage limit?

Another common gap in basic employee health insurance plans is overall low coverage limits for hospitalization and surgery. A limit is the maximum amount your insurance policy will pay for covered services, which means that you will need to pay all the costs that exceed your plan’s limit out of pocket (unless you have a separate or top-up medical policy that can take care of these costs).

A policy’s coverage limit is a key element that should by no means be overlooked, as a large medical bill can easily exceed low insurance limits. This is especially true for those who only/usually seek care at private clinics and hospitals, where costs tend to be much higher than their public counterparts (e.g. a private emergency surgical procedure costs around RMB 50,000).

Does the plan cover pre-existing conditions?

Historically, it was common for group health insurance plans to cover pre-existing conditions, which are any illnesses, ailments, or injuries the policyholder already has or had. However, amidst rising healthcare and health insurance costs, an increasing number of corporate plans are excluding these conditions.

If you have a condition that requires ongoing medical treatment (e.g. diabetes), it’s important to ask or check your policy’s exclusions section to find out whether your plan will cover you for this type of care.

Are there any preventative care and/or maternity benefits?

Another common coverage area that many employees in China find lacking is the exclusion of added benefits like preventative care (e.g. health checkup) and maternity cover. These types of care can be very expensive in China (e.g. a maternity c-section package costs up to RMB 98,000), which is why it’s imperative for you to know whether they’re covered by your plan. This is especially important if you require such healthcare services on a regular basis or in the foreseeable future.

Is care outside of China covered?

Does your plan only cover you in China, or can you rely on it internationally? This is another factor to consider, especially if you’re a globally mobile expat or frequent traveller. If your current employee health insurance only covers you in China and you’re looking for a solution that features wider geographical coverage, we would recommend finding a plan that at least includes both China and Hong Kong cover; this is because Hong Kong has some of the very best hospitals in Asia.

Do I need top-up insurance?

If, after studying your current employee health insurance, you find that there are a number of coverage deficiencies that you want to supplement, a top-up insurance plan might be the best option for you. Designed to fill the coverage gaps and deficiencies in company-sponsored health plans, top-up insurance can take over where your current plan’s benefits end, and also offer additional benefits that are not currently provided (e.g. maternity).

There are, of course, many other considerations you will need to make when deciding whether top-up insurance is right for you. For instance, there’s also the option of purchasing an entirely separate medical insurance plan, in which case there will not be any control over your plan by your employer, so you’ll be able to continue your benefits regardless of your employment status. While this option has its perks, coverage elements may overlap with your current employee plan, and it can often be costlier than arranging a top-up insurance solution.

Don’t just stop at health insurance

When reviewing your employee benefits, don’t just stop at health insurance. Your employer may also offer a wider range of protection solutions like home and contents, Accidental Death & Dismemberment, as well as liability and income protection insurance.

If the above mentioned benefits are something that you feel is important for you to have, but are not currently offered by your employer, be sure to talk to a trusted broker like Pacific Prime China, who will ensure that you get the most optimal solutions at the best possible price.

Download our Beijing and Shanghai Top-Up Guides today

If you are looking to learn more about supplementing your employee health insurance, downloading our recently released Beijing and/or Shanghai Top-Up Guide(s) is a great way to start. Get your free copy of our latest guides by clicking the links below:

• Beijing Top-Up Guide 2017-2018
• Shanghai Top-Up Guide 2017-2018

If you have any more questions about your employee health insurance, top-up insurance, or any other insurance related matter, be sure to contact our expert team today. With almost two decades of experience matching expats and professionals with the most optimal insurance solutions in China, our team are more than happy to offer their impartial advice, as well as give you a free quote and plan comparison.

Disclaimer: Pacific Prime China solely represents, operates and manages locally regulated insurance products and services in the territory of PR China. Any references to Pacific Prime Global Company or Group, the international services, insurance products or otherwise stated written or verbally, is for introduction purposes about our overseas network only as each entity is fully independent.