One of the primary concerns for international visitors choosing medical tourism in China is “What expenses does international insurance cover?” The scope of coverage for international medical tourism insurance in China varies depending on the type of policy (international commercial insurance, domestic specialty insurance, travel agency customized insurance) and is influenced by factors such as the type of treatment, hospital accreditation, and insurance policy terms. Below is a detailed guide for international visitors covering three key dimensions: coverage scope of mainstream insurance products, reimbursement procedures, and important considerations.
I、Analysis of Coverage Scope for Mainstream International Insurance
(1) International Commercial Insurance: Global Coverage with Direct Payment Convenience
Definition: Specialized medical tourism insurance offered by globally renowned insurers (e.g., Aetna, Allianz, MSH), covering medical services in China and other countries.
1. Core Coverage Scope
• Medical Expenses:
• Diagnostic fees (CT, MRI, PET-CT, etc.), treatment fees (surgery, radiotherapy, chemotherapy), medication and medical device fees (including imported drugs and specially approved medical devices);
• Rehabilitation fees (physical therapy, traditional Chinese medicine therapy), long-term care fees (e.g., post-operative home care).
• Medication and Medical Device Coverage:
• Covers internationally approved anti-cancer drugs (e.g., PD-1 inhibitors), targeted therapies, and high-end medical devices (e.g., cardiac stents);
• China-approved special-use drugs and medical devices (e.g., 289 off-market items at Hainan Boao Lecheng), subject to policy confirmation of “special-use drugs/devices” coverage.
• Emergency Assistance:
• Emergency medical evacuation (e.g., transfer from China to Singapore/Japan for treatment), emergency medical repatriation (due to deteriorating condition);
• 24/7 international medical assistance hotline (e.g., Allianz's “Global Emergency Assistance Service”).
2. Additional Service Coverage
• Multilingual support: Some policies include translation services (e.g., Aetna covers English, Chinese, Japanese, Korean, etc.);
• Accommodation & transportation: Premium plans may cover hotel stays during treatment (e.g., ¥500–1,500/night) and airport-to-hospital shuttle services;
• Legal Assistance: Covers legal expenses (e.g., attorney fees, litigation costs) arising from medical disputes.
3. Exclusions and Limitations
• Pre-existing Conditions: Diseases diagnosed prior to enrollment (e.g., advanced cancer) are typically excluded;
• High-Risk Activities: Injuries resulting from exploration or extreme sports are excluded;
• Non-Designated Hospitals: Coverage applies only to partner hospitals (e.g., Ruijin Hospital Shanghai, Boao Lvcheng Hainan). Non-partner hospitals require out-of-pocket payment.
Case Study: American patient Linda purchased Aetna International Medical Insurance and received CAR-T therapy at Ruijin Hospital Shanghai. Of the ¥800,000 treatment cost, the insurance covered 70% (¥560,000) directly, with Linda paying ¥200,000 out-of-pocket (including non-covered specialty drugs and medical devices).
(2) Insurance with Chinese Characteristics: Policy Support, Strongly Targeted
Definition: Comprehensive “medical + travel” insurance products launched by domestic Chinese insurers, designed to align with China's medical tourism features (e.g., licensed pharmaceuticals and medical devices, traditional Chinese medicine treatments).
1. Hainan “Lecheng Special Medication Insurance”
• Core Coverage:
• 70% of licensed pharmaceutical and medical device costs (e.g., PD-1 inhibitors, CAR-T cell therapy drugs);
• Hospital meal allowance (50-100 RMB/day), transportation subsidy (200-500 RMB/trip).
• Restrictions: Treatment must occur exclusively at Boao Lecheng in Hainan, with pre-approval of treatment plans required from the insurer.
2. Shanghai “Pudong International Medical Insurance”
• Core Coverage:
• Hospitalization and outpatient expenses in international/specialty departments (including TCM therapy, premium health checkups);
• Imported drug and medical device costs (requires FDA/CE certification).
• Restrictions: Excludes routine outpatient care (e.g., colds/fevers), limited to high-end treatment programs.
3. Coverage Features
• Policy Advantage: Designed for China's unique “designated medical treatment” policy, alleviating out-of-pocket burdens for high-cost drugs/devices;
• Geographic Restriction: Limited to designated medical tourism destinations (e.g., Boao, Hainan; Pudong, Shanghai);
• Lower Premiums: Annual premiums range from approximately ¥3,000–8,000 (only 1/3–1/2 of international commercial insurance).
Case Study: Malaysian patient Nina purchased Hainan's “Lecheng Special Medication Insurance” and received CAR-T therapy at Shanghai Ruijin Hospital. Of the RMB 480,000 in special medical device costs, insurance reimbursed 70% (RMB 336,000), with personal out-of-pocket expenses totaling RMB 144,000.
(3) Travel Agency/Platform Customized Insurance: Contextual Coverage with High Cost-Effectiveness
Definition: “Medical + Travel” bundled insurance launched by medical tourism intermediaries (e.g., Ctrip Medical, Hopu Ark) in partnership with insurers, covering the entire process including treatment, accommodation, and transportation.
1. Core Coverage Scope
• Treatment Costs: Hospitalization, surgery, and drug/device expenses at partner hospitals (must be listed in the intermediary's approved hospital directory);
• Travel expenses: Trip cancellation/change losses (e.g., hotel refunds due to visa delays), attraction tickets;
• Accident Protection: Accidental death/disability during travel (coverage approx. RMB 500,000–1,000,000).
2. Additional Services
• Customized Itineraries: Includes “treatment + tourism” packages (e.g., “3-day treatment + 2-day Sanya beach tour”);
• Tour Guide Services: Arranges Chinese/English-speaking guides to assist with medical appointments and tourism.
3. Limitations
• Hospital Restrictions: Coverage limited to partner institutions (e.g., Shanghai United Family Hospital, Beijing United Family Hospital);
• Low Coverage Limits: Medical expense reimbursement typically capped at 80% (international commercial insurance offers 100% direct payment);
• Hidden Clauses: Some policies impose “treatment outcome” requirements (e.g., no payout if expected results are not achieved).
Case Study: Thai tourist Ahmed purchased a “cosmetic surgery + vacation” customized plan through Ctrip Medical, covering breast augmentation surgery (¥80,000) + 5-day island tour (¥30,000) for a total premium of ¥6,000. The insurance reimbursed 90% of surgical costs (¥72,000) and 80% of travel expenses (¥24,000).
II、International Insurance Reimbursement Process: Materials and Steps
Regardless of the insurance chosen, the core of the reimbursement process lies in the completeness of materials and the alignment with insurance terms. Below is the standardized procedure:
(1) Step One: Confirm Insurance Coverage (Before Purchase)
• Review policy terms: Focus on “Coverage Scope,” “Exclusions,” and “Network Hospital List” (e.g., whether target hospitals like Hainan Boao Lecheng or Shanghai Ruijin Hospital are included).
• Pre-authorization: Obtain insurer approval for treatment plans before care begins (if supported by your international commercial policy) to avoid claim denials due to non-compliant plans.
(2) Step 2: Collect Claim Documentation (Post-Treatment)
Prepare basic + specialized materials as follows:
Basic Materials: Passport/Visa, Policy Number, ID Copy (Passport must be valid for at least 6 months)
Medical Expense Proof: Hospital Invoice (stamped), Fee Schedule (must specify “Medical Tourism” or “International Patient”)
Diagnosis and Treatment Documentation: Medical records (including diagnostic reports, surgical records), test reports (e.g., PET-CT scans). Medical records must be translated into English (some insurers require notarization).
Insurance-Related Proof: Insurance contract, claim notification receipt, claim application form. Submit electronic copies via the insurer's official website/app.
(3) Step Three: Submit Materials and Await Review (1-4 weeks)
• Online submission: Upload documents via the insurer's official website/app (some support electronic signatures);
• Offline submission: Mail to the insurer's designated address (retain mailing proof);
• Review focus: Verify document authenticity and confirm expenses fall within coverage scope (e.g., whether specialty drugs/devices are listed in the insurance schedule).
(4) Step Four: Claim payment disbursement (upon approval)
• Direct Payment Service: Some policies (e.g., international commercial insurance) offer “direct payment,” where the insurer settles fees directly with the hospital, eliminating personal out-of-pocket expenses;
• Reimbursement Transfer: After approval, compensation is transferred to the patient's designated account (bank card/Alipay/WeChat), typically within 3-7 business days.
III、Precautions: Common Pitfalls to Avoid Reimbursement Failure
(1) Pitfall 1: Misleading “Full Coverage” Claims
Issue: Some intermediaries claim “insurance covers all costs,” but actual exclusions exclude “high-risk treatments” and “pre-existing conditions.”
Solution: Before purchasing, carefully review the Policy Terms, focusing on:
• Exclusion clauses (e.g., whether late-stage cancer or mental illness is excluded);
• Coverage for specific treatments (e.g., CAR-T therapy, traditional Chinese medicine physiotherapy);
• Trigger conditions for emergency evacuation (e.g., accident occurring within a specified radius).
(2) Pitfall 2: Hidden Restrictions in “Low-Cost Plans”
Issue: Some travel agencies offer “999 RMB global medical insurance” with limitations on hospital tiers (public hospitals only) and treatment types (inpatient care only).
Countermeasures: Verify these details:
• List of partner hospitals (does it include target hospitals like Hainan Boao Lecheng?);
• Treatment type restrictions (does it cover outpatient care, health checkups, rehabilitation?);
• Claims process (is prior notification required? What documents must be submitted?).
(3) Trap 3: Hidden Barriers to Claims Settlement
Issue: Some insurers require “detailed medical records submitted before treatment,” but translating overseas medical records for international tourists is time-consuming, causing claim delays.
Solution: Choose insurance supporting “pre-authorization” (e.g., international commercial insurance). Have the treatment plan reviewed by the insurer before treatment to avoid claim denials due to medical record issues.
Summary: The “Three-Step Decision Method” for International Insurance Reimbursement
1. Define Needs: Identify treatment type (cancer/cosmetic surgery/health checkups), budget (high/medium/low), and risk preference (low deductible/high payout);
2. Match Policy Type:
• High budget/global access: Choose international commercial insurance (e.g., Aetna);
• Policy benefits/specialized drugs/devices: Opt for domestic specialty coverage (e.g., Lucheng Specialty Drug Insurance);
• Scenario-based protection (treatment + travel): Select travel agency customized insurance;
3. Verify policy terms: Focus on exclusion clauses, network hospitals, and claims processes to avoid misleading “all-inclusive” marketing claims.
Critical Reminder: Before purchasing, always verify policy details through the insurer's official website or authorized agents. Retain all payment receipts and policy documents to ensure smooth claims processing. Securing international insurance reimbursement for medical tourism in China is fundamentally an art of balancing risk and cost. The right coverage makes your journey more secure and worry-free.