Medical Insurance Claim Procedures & Tips for Foreign Nationals Receiving Treatment in China

Scenario 1: Post-Treatment Claim for International Commercial Medical Insurance

This applies to foreign nationals with global or high-end commercial medical insurance purchased overseas who pay medical expenses in full out of pocket in China and then file for reimbursement. This is the core need for 90% of short-term medical tourists in China.

Prerequisites for a Valid Claim

1. The medical institution is an approved hospitalas defined in the insurance policy (most international insurers accept China’s Class 3A public hospitals, including their international medical departments; private hospitals and wellness facilities must be confirmed in advance).
2. The treatment, medication, and supplies are covered under the policyand not excluded.
3. The claim is submitted within the validity periodwith complete, compliant, and authentic documents.

Standard Claim Process

Step 1: Confirm Claim Rules Before Treatment

Contact your insurer (global hotline, broker, official app) to confirm 5 key points:

1. Coverage: Eligibility of planned surgery, treatment, exams, and medication; deductible, co-insurance, and annual/single-claim limits.
2. Hospital requirements: Whether the target hospital is approved and if treatment at the international department is mandatory.
3. Pre-notification: Most high-end plans require advance notificationfor surgery or hospitalization; failure to notify may reduce payout or result in rejection.
4. Document requirements: Official claim checklist, including rules for medical records, invoices, and translations.
5. Time limit: Deadline to submit the claim after treatment.

Step 2: Collect and Keep All Required Documents

Obtain bilingual (Chinese-English) documents stamped by the hospital—these are most widely accepted by international insurers.

1. Basic Documents (all cases)

• Copy of valid passport and Chinese visa/entry stamp
• Insurance policy, insurance card, or electronic certificate
• Completed and signed claim form (insurer’s official template)
• Bank details: bank name, account name, account number, SWIFT code

2. Outpatient Additional Documents

• Stamped bilingual outpatient medical record & diagnosis certificate
• Examination reports and prescriptions
• Registration and payment receipts
• Original official medical invoice stamped with financial supervision seal(slips and POS receipts are NOT acceptable)

3. Inpatient/Surgery Additional Documents

• Stamped bilingual discharge summary and inpatient diagnosis certificate
• Operation record, anesthesia record, pathology report (if applicable)
• Detailed itemized inpatient bill
• Original official inpatient invoice
• Copies of full inpatient medical records (stamped by medical records office) if required

4. Special Cases

• Emergency treatment: emergency certificate explaining the reason
• Accident injury: written accident statement
• Pre-existing conditions: previous overseas medical records to support medical necessity

Important: Scan and keep copies of all originals. Most insurers require original invoices; copies are generally not accepted.

Step 3: Submit the Claim On Time

1. Time limit: Usually 30–90 daysafter treatment (per policy). Late submission may lead to rejection.
2. Submission channels:

• Via insurance broker (most recommended)
• Online via insurer app, website, or email
• By tracked international mail

Step 4: Insurer Review & Additional Documents

• Standard review: 5–15 working days; up to 30 days for complex/large claims.
• Cooperate promptly if additional information or documents are requested.

Step 5: Claim Result & Payment

1. Approved: Claim notification issued; payment transferred to your designated account.

• Cross-border transfer: 3–10 working days(depending on the receiving bank).

2. Partial or full rejection: Rejection letter with reasons provided; you may appeal per policy terms.

Scenario 2: Reimbursement under China Basic Medical Insurance

This only applies to legally employed or long-term resident foreigners who participate in China’s basic medical insurance. They enjoy the same benefits as Chinese citizens.

1. Direct Settlement (Most Convenient)

Present your social insurance card or electronic medical insurance certificate at designated hospitals. The insurance portion is settled directly; you only pay the personal share.

2. Manual Reimbursement (After Full Payment)

For non-local treatment without registration, emergency care at non-designated hospitals, or system failures:

1. Prepare documents: passport, residence permit, social insurance card, original invoices, detailed bills, diagnosis/discharge summary, local bank card.
2. Submit: local medical insurance office or official app/mini-program.
3. Review & payment: Usually 10–20 working days. Funds are transferred to your linked Chinese bank account.

Important Notes & Common Pitfalls

For International Commercial Insurance

1. Use direct billingif available to avoid large upfront payments and claim disputes.
2. Original stamped official invoices are mandatory. Receipts and printouts are invalid.
3. No falsificationof records or invoices—this constitutes insurance fraud.
4. Excluded services(cosmetic surgery, non-medical wellness, experimental treatment, etc.) are not covered.
5. Use hospital-issued bilingual stamped documents; confirm translation requirements if using third-party translators.

For China Basic Medical Insurance

1. Treatment must be at designated medical institutions(except emergencies).
2. Register for cross-provincial treatment in advance; otherwise, reimbursement rates may be reduced or denied.
3. Only drugs, supplies, and services in the national medical insurance catalogare covered.
4. Cards/certificates are non-transferable; fraudulent use may result in penalties or criminal liability.