Can foreigners purchase health insurance in China?

I'm Mark, an American who's worked as an engineer at a tech company in Shanghai for five years. When I first arrived in China, “Is medical care expensive?” and “What should I do if I get sick?” were my biggest concerns. Now, not only have I gotten used to booking appointments through Alipay, but I've also genuinely benefited from China's healthcare system. Today, I'll share my perspective on the ins and outs of foreigners purchasing health insurance in China.

I. Can Foreigners Enroll in China's Medical Insurance? The Answer is: Yes!

Five years ago, when I started my job, HR handed me an employee benefits brochure. Among the “five insurances and one housing fund,” medical insurance was listed. I wondered, “Can foreign employees enroll too?” Later, I learned China had long been gradually opening its basic medical insurance to foreign nationals. According to the 2016 “Notice on Issues Concerning Foreigners Employed in China Participating in Social Insurance” and local implementation rules, foreigners legally employed in China, holding permanent residence permits, or meeting local requirements can enroll in either employee medical insurance or resident medical insurance.

Simply put, eligibility hinges on two factors: first, having legal residency status in China (e.g., work visa, permanent residence permit); second, possessing valid employment or residency documentation. For foreign white-collar workers like me employed by a company, the employer handles the Employee Medical Insurance enrollment. Retired foreigners residing long-term in China, parents accompanying their children for schooling, or individuals like my colleague's international student girlfriend can enroll in the Urban and Rural Residents' Medical Insurance.

II. Two Main Options: Employee Medical Insurance vs. Resident Medical Insurance – Which Suits You Better?

1. Employee Medical Insurance: The “Standard Option” for Employed Foreigners

For foreigners employed by companies like mine, employee medical insurance is jointly funded by the employer and the individual (the personal contribution is approximately 2% of salary, while the company contributes about 8%), identical to local employees. The primary benefit is “medical expense reimbursement”—outpatient visits, hospitalization, medications, and diagnostic tests are all covered proportionally. In Shanghai, the reimbursement rate for hospitalization under employee medical insurance can reach up to 92% (after exceeding the deductible threshold). Last year, I underwent a minor surgery costing 12,000 yuan. Insurance covered over 9,000 yuan, leaving me to pay just over 2,000 yuan—far more affordable than the out-of-pocket costs of commercial insurance in the U.S.

Application Process: Your company's HR department will handle this for you. Required documents include your passport, Foreign Work Permit, and a copy of your Residence Permit. You'll need to fill out a few social insurance registration forms. Coverage typically takes effect the month you start employment, with no lengthy waiting period (though some cities may require continuous contributions for 6 months before inpatient coverage kicks in—check local policies).

2. Resident Medical Insurance: The “Safety Net Option” for Non-Working Foreigners

Retired foreigners settling in China (like my in-laws with permanent residency), unemployed international students, or freelancers can enroll in the Urban and Rural Residents' Medical Insurance. Taking Shanghai as an example, the 2023 individual contribution for resident medical insurance is 720 yuan annually (cheaper for students and children at 390 yuan), with additional government subsidies. While reimbursement rates are slightly lower than employee medical insurance (around 70%-80% for hospitalization), it offers low premiums and broad coverage, including treatment for colds, fevers, and chronic disease medications.

Application Process: Individuals must register in person at their local community affairs service center. Required documents include a passport, a residence permit, and proof of residence (e.g., a rental contract or a property deed). When my in-laws first arrived, community staff kindly guided them through the application process in English, completing everything within half an hour—a thoughtful touch.

III. Is it really convenient to see a doctor after enrolling in insurance?

When I first enrolled, I also worried about whether I'd have to go to designated hospitals or if reimbursement would be a hassle. In practice, most top-tier hospitals have implemented the “Medicare Electronic Voucher.” After linking your Medicare card to Alipay or WeChat, you can scan the code to register and pay. The system automatically calculates the reimbursed portion, so you only pay the out-of-pocket amount. Last year, when I accompanied my daughter for vaccinations at the community health center, I used my personal Medicare account to pay directly—it felt completely seamless, no “foreigner treatment” at all.

Of course, there are minor details to note: some imported drugs or high-end tests may not be covered and require out-of-pocket payment. For out-of-area medical care, pre-registering on the “National Medical Insurance Service Platform” app enables direct settlement. Last year, during a business trip to Hangzhou, I suddenly developed gastroenteritis and used my Shanghai medical insurance card at a local hospital for reimbursement.

IV. Why recommend foreigners enroll in medical insurance? It’s not just about saving money—it’s about belonging

For me, medical insurance isn't just a tool for “reimbursing medical expenses”; it's a sense of security that helps me “put down roots in China.” I used to think “getting sick abroad is the most troublesome thing,” but now with insurance, even if I rush to the ER with a fever in the middle of the night, I don't have to worry about facing a sky-high bill first. More importantly, after enrolling, I clearly feel that I've been integrated into the local social security network—not as an “outsider,” but as part of “us.”

Tips for Foreign Friends

1. Enroll early: For employee medical insurance, enroll through your company upon joining. For resident medical insurance, note the annual enrollment period (e.g., November-December in Shanghai). Missing it may affect next year's coverage.

2. Check local policies: Policies vary slightly by city. For instance, Shenzhen allows foreigners with work visas to enroll directly, while Beijing has residency permit duration requirements. Call the 12333 social security hotline or check your local human resources bureau website for confirmation.

3. Supplement with commercial insurance: If you seek more comprehensive coverage (like dental or maternity), consider adding commercial health insurance. But always prioritize basic medical insurance—it’s your essential safety net.

Nowadays, I keep my electronic medical insurance certificate on my phone and carry my physical Social Security card in my bag. Even when gym salespeople pitch “premium medical insurance,” I smile and say, “No thanks—my Chinese medical insurance is more than enough.” For foreigners in China, enrolling in insurance isn't just a right—it's a solid sense of security. (Mark, Engineer at a Shanghai Tech Company)

Document dated 2025-11-12 10:05 Modify