Three routes to a payment

Direct settlement

Where the hospital is on the insurer's designated list and the plan allows it. You present the identity document and the direct-pay card; the hospital bills the insurer. The insurer still processes the claim file — direct settlement changes who fronts the money, not whether the claim is assessed.

Self-pay then claim

You pay the hospital and claim afterwards. Expect to assemble the claim form, identity documents, the original invoice and its itemised breakdown, the diagnosis and discharge record, and the examination or pathology reports.

Advance payment

Some insurers offer an advance against a large inpatient case before the full file is complete. It is case-by-case and must be requested, not assumed.

Deadlines

  • The insurer must respond to a complete claim notification within the statutory timeframe — generally 30 days where the case is complex, and payment within 10 days of agreement.
  • The limitation period for life insurance claims is three years from the date the insured died or the policy matured; for non-life insurance it is two years from the date the insured knew or should have known of the event.
  • Missing the deadline is not a formality. Report the event as soon as it happens and keep the file.

Claims from overseas

  • Documents issued outside mainland China are commonly required in Chinese, sometimes with notarisation. There is no single national rule on translation and notarisation — the insurer decides per case, so ask before you incur the cost.
  • Medical records from a foreign hospital should be translated in full, including the diagnosis, the procedure and the itemised charges.
  • For a claim that happened abroad, check whether the plan covers overseas treatment at all before incurring the cost.