Insurance Management

When you are diagnosed with kidney disease and need dialysis, you should understand your insurance options. In China, there are two medical insurances in general: the insurance provided by Chinese government; and the commercial insurance.

Medical Insurance Provided by the Chinese Government*

The social medical insurance provided by Chinese government in China includes general medical insurance for urban employees and residents without employment, and special medical insurance under the new rural cooperative medical system for rural area population. The three types of insurance cover all employers, employees and individuals in urban and rural areas, including employees and retirees of all government agencies, public institutions, enterprises, mass organizations and private non-enterprise units. The policy of social medical insurance is established by the national government and implemented by the local governmental authorities, such as the Human Resources and Social Security Bureau, the Public Health Bureau and the Finance Bureau, to protect the health of the population at large. The insurance fund comes from payment by individuals and/or their employers (if any) under certain provisions stipulated in the state policy, and a part of it is pooled by the national government before being adjusted and supplemented. For dialysis services, whether and to what extent the social medical insurance covers the essential treatments should be subject to the relevant local regulations and policies in China. In some provinces, the patient is responsible for a small co-payment.

Commercial Insurance*

Commercial insurance includes expense-reimbursement medical insurance and compensation medical insurance.

Expense-reimbursement medical insurance (general medical insurance) allows for patients' medical expenses in the hospital to be reimbursed by the insurance company. It is generally divided into outpatient medical insurance and hospitalization medical insurance.

Compensation medical insurance (special medical insurance) may be obtained by patients with certain illnesses listed in the contract and clearly diagnosed by a hospital. The insurance company covers the expenses of treatment and care is as agreed in the contract. This kind of insurance is generally divided into single-item illness insurance (such as cancer insurance) and critical-illness insurance (the three versions of which cover patients for 10 types, 20 types and 30 types of critical illnesses).

Insurance companies usually offer a combination of the insurance types described above. The major underwriters include People's Insurance Company of China (PICC), Ping An Insurance (Group) Company of China, Ltd. and others.

Qualification for Special-Disease Reimbursement

End stage renal disease (ESRD) is categorized as a special disease, and hemodialysis treatment can be conducted at outpatient clinics. The qualification of renal disease for the special-disease reimbursement program in China is subject to the relevant local regulations and policies.

1. For city or town residents without regular employment:
   Patients who participate in the social insurance program should apply for ESRD qualification at the city insurance bureau. Patients will need to show their medical records, personal identification cards, and insurance cards. After receiving approval, patients can go to the hemodialysis (HD) outpatient clinic and receive HD treatment. Please follow the same application process for city or town residents with employment.
2. For city or town residents with regular employment:
   1. Application for ESRD patient treatment qualification
      (All applicants for outpatient HD treatment should be evaluated by the specialty office.)
      The specialty office, which is a part of the city insurance bureau, is responsible for the management of patient applications for ESRD qualification. The office has medical teams, which include attending nephrology specialists who follow a disease-identification process to determine ESRD qualification and decide when a patient should come to the insurance bureau to be qualified as an ESRD patient.
   2. The qualification procedure
      1. Provide supporting documents: To apply for ESRD qualification, the applicant will need to provide a personal identification card, insurance card, medical records (original outpatient records and hospital admission records with hospital stamp), diagnosis records, blood-culture records, pathology, x-ray images and diagnosis reports. Any applicant previously qualified as an ESRD patient will need to submit the original ESRD qualification records. Any application lacking the required information will be rejected.
      2. Submit the application: First-time applicants have the option to choose a network outpatient HD clinic. Those who are already receiving HD treatment must apply at their current clinic. Applications will be submitted to the special-disease office in the first 10 days of every month. (Those who reside outside of a city or town should apply by sending their most recent medical records directly to the special-disease office.)
   3. Application response process
      The special-disease office should provide written notice of applicant qualification status to the network outpatient clinics within 10 days after conducting the verification of special-disease qualification. The outpatient clinics should obtain necessary documentation from the special-disease office in three days after receiving the notification. The insurance bureau and the outpatient clinic are responsible for creating the patient visit records and patient demographic database.
   4. Diagnosis verification, if necessary
      Diagnosis verification applies only to patients who have been receiving ESRD benefits for two years and who need to be re-evaluated.
   5. Appeal, if necessary
      A patient who wishes to contest the results of the application can reapply via the network clinic. The network clinic will submit the application to the special-disease office for review.
   6. When you can start to receive HD treatment
      Those who are qualified as ESRD patients can go to an outpatient HD clinic immediately to receive treatment after three days of confirmation. There are a few regional differences in the application process.

*Individual Payment - Urban employees are obliged to join in the basic medical insurance for urban employees; unemployed urban residents and the rural population opt into the basic medical insurance for urban residents and the new rural cooperative medical system, respectively. The payment and treatment covered shall be implemented according to the medical insurance policy of the national government. Commercial insurance is available as supplementary medical insurance, the amount of which is determined by each individual's claims.