Lecheng Global Special Drug Insurance: Coverage, Cost & Claims Q&A

In my work with international patients at Lecheng, there is one question I hear more often than any other: “If I come here for treatment, how do I pay for it?” It is a fair question. The drugs and devices available in Lecheng are often the most advanced in the world — and they come with prices that reflect their novelty. For many families, the science is not the barrier. The cost is.

That is why the Lecheng Global Special Drug Insurance exists. It is not a conventional insurance product. It was designed specifically for a problem that conventional insurance was never built to solve: how to give ordinary people access to medicines that are approved abroad but not yet available in China. I have watched this program evolve over six years. I have seen patients who would otherwise have been priced out of treatment receive drugs that changed the trajectory of their disease. And I have seen the confusion that persists among patients and families who are not sure whether this insurance applies to them.

So let me answer the questions I hear most often, honestly and in plain language.

It is a supplementary medical insurance product developed under the guidance of the Lecheng Pilot Zone Administration, with support from the National Financial Regulatory Administration Hainan Bureau and the Hainan Medical Security Bureau. It was first launched in 2020 and is the first health insurance product in China to cover drugs that are already on the market abroad but not yet approved domestically. In practical terms, it reimburses the cost of specific drugs and medical devices that are legally available within the Lecheng Pilot Zone but are not covered by China’s basic medical insurance system.

The 2026 edition offers two plans. Plan A costs 49 yuan per year and covers up to 120 specific drugs — 50 domestic and 70 clinically urgently needed imported drugs — with a maximum benefit of 2 million yuan and zero deductible. Plan B costs 99 yuan and adds coverage for 14 imported licensed medical devices and inpatient medical expenses, with a maximum benefit of up to 3 million yuan. Together, the two plans cover up to 149 innovative drugs and devices, spanning oncology, hematology, rare diseases, immune disorders, and transplant-related conditions.

What I find most meaningful is the rare disease coverage. Among the 120 drugs in the base plan, 28 are rare disease medications — including 25 imported rare disease drugs. For families dealing with conditions like inborn errors of bile acid synthesis or inherited retinal dystrophy, this insurance can mean the difference between accessing a life-changing therapy and going without.

This is where the 2026 version represents a genuine step forward. Eligibility now extends to Hainan household registration holders, Hainan ID card holders, Hainan basic medical insurance participants and their immediate family members, “new citizens” who have held a valid Hainan residence permit for at least one year, and — for the first time — foreign nationals residing in China. The product also introduced cross-border payment channels and bilingual enrollment pages, making it genuinely accessible to the international patient community.

Critically, enrollment is not conditioned on health status. There is no age limit, no occupational restriction, and no health screening requirement. Patients with pre-existing conditions can enroll. This is not typical for commercial insurance, and it reflects the program’s public-health orientation rather than a purely commercial logic.

This is the question that requires the most careful answer, because the rules are nuanced. Enrollment is open to everyone, including those with pre-existing conditions. But reimbursement for pre-existing conditions follows different rules than reimbursement for newly diagnosed conditions.

For newly diagnosed conditions after enrollment, reimbursement rates range from 30% to 100%, depending on the specific drug and its listed terms. For pre-existing conditions, the reimbursement rate is 0% to 30% — meaning some drugs are not covered at all for pre-existing conditions, while others are covered at a reduced rate. The exact terms are specified in the drug list that accompanies each policy. As a general principle, a condition that existed before enrollment and is listed as a “pre-existing condition” in the policy terms will not receive the same level of reimbursement as a condition first diagnosed after enrollment.

I always tell patients: read the drug list carefully. The reimbursement terms are not uniform across all drugs. Some are covered at 100% for new diagnoses and 30% for pre-existing conditions. Others are covered at 60% for new diagnoses and not at all for pre-existing conditions. The details matter.

The insurance is tied to a network of designated medical institutions within the Lecheng Pilot Zone. The 2026 edition recognized nine institutions as “Lecheng Global Special Drug Insurance Designated Medical Service Institutions,” including Ruijin Hospital Hainan Hospital, West China Lecheng Hospital, Shulan (Boao) Hospital, Boao Super Hospital, Boao Evergrande International Hospital, and several others. These institutions have dedicated service channels and health management support for insured patients.

For patients who require treatment at one of these hospitals, the insurance covers the cost of the specified drugs and devices according to the policy terms. It is worth noting that the insurance does not cover all medical expenses at these hospitals — it is specifically designed to address the cost of the listed special drugs and devices.

The process begins with a confirmed diagnosis and a prescription from a qualified physician at a designated Lecheng institution. Once the prescription is issued, the patient or their representative submits a claim through the insurance company’s designated channels — typically the insurer’s customer service hotline or mobile app. The insurer then reviews the eligibility of the drug and the patient’s condition against the policy terms.

For drugs that are approved for reimbursement, the insurer may arrange for direct payment or reimbursement, depending on the specific product and arrangement. In some cases, the patient may need to pay upfront and submit receipts for reimbursement. The service manual for one of the participating insurers outlines a structured process: the patient contacts the insurer, the insurer confirms eligibility, the patient receives treatment at a designated hospital, and the insurer settles the eligible costs. Response times are typically within one to two business days during working hours.

One practical note: the insurance operates on a reimbursement model for most products, meaning patients may need to have the financial capacity to pay for treatment initially, with reimbursement following afterward. This is an important consideration for families planning their finances.

Yes. As of the 2026 launch, the Lecheng Global Special Drug Insurance has helped 841 cancer patients receive claims, with total payouts reaching 32.95 million yuan. The annual comprehensive payout ratio is approximately 60%. Beyond the numbers, the program has expanded its reach through cooperation with more than 60 medical insurance coordination regions across China, covering over 117 million people. What began as a Hainan-specific product has become a national pathway for patients seeking innovative therapies.

The program has also evolved beyond drug coverage. Lecheng has partnered with insurance institutions to introduce specialized medical insurance for boron neutron capture therapy (BNCT) and frontier biotechnologies, extending coverage from special drugs to cutting-edge diagnostic and treatment technologies. This reflects a broader vision: insurance should not just pay for pills, but for access to the full spectrum of innovative medicine.

China’s basic medical insurance is designed to cover essential healthcare for the general population. It does not cover imported drugs that have not yet received NMPA approval, and it does not cover many of the innovative therapies available in Lecheng. If you or a family member has a condition for which a clinically urgently needed drug or device is available in Lecheng but not covered by national insurance, this supplementary insurance fills that gap. It is not a replacement for basic insurance — it is a complement to it.