Workplace schemes, partial schemes and tax-funded care

Most of the region ties health cover to the job. Employees in Japan join Employees’ Health Insurance through work, South Korea enrols workplace staff in its National Health Insurance, and China places employed people in employee basic medical insurance as one of its five social insurances. Taiwan’s single-payer National Health Insurance, compulsory national health insurance in Vietnam, Indonesia’s JKN, PhilHealth in the Philippines and Thailand’s Social Security Fund all collect contributions through payroll as well.

A second group has statutory schemes that reach only part of the workforce. India’s Employees’ State Insurance covers employees below a monthly wage ceiling at establishments with ten or more employees. Pakistan relies on provincial employees’ social security institutions funded by employers. Malaysia’s statutory employment contributions carry no general health insurance, and foreign nationals pay full fees at public facilities.

The rest fund care through tax or status. Australia’s Medicare and New Zealand’s public system are paid for through taxes, with access set by residence and visa. Hong Kong has no contributory health insurance; identity card holders count as Eligible Persons for subsidised public hospital charges. In Singapore, MediShield Life covers citizens and permanent residents automatically, while foreigners on work passes sit outside the CPF system.

What a local employer has to arrange

In the payroll systems, the employer enrols and pays. Japanese employers file enrolment with the Japan Pension Service within five days of the start date, Korean employers split the health contribution evenly with the employee, and Chinese contribution rates are set city by city rather than nationally. Vietnamese employers pay the larger share of the health contribution for a foreign worker on a contract of at least a year, and Indonesian employers pay most of the JKN contribution and must enrol foreign workers employed for more than six months.

Some duties sit beside health insurance. Singapore requires employers to buy and maintain medical insurance meeting the Ministry of Manpower’s minimum for Work Permit and S Pass holders, but not for Employment Pass holders. Hong Kong employers must carry employees’ compensation insurance for work injuries, with no general medical insurance requirement. Malaysian employers register foreign workers with the social security organisation’s employment injury scheme, and migrant workers there also need SPIKPA, a hospitalisation and surgical scheme the health ministry requires.

Top-up in most places, main cover in a few

Wherever enrolment is compulsory, an international plan can only add to it. That covers Japan, South Korea, China, Taiwan, Thailand and the Philippines, Vietnam for qualifying foreign workers, Indonesia after six months of work, India below the ESI ceiling, Pakistan’s provincial social security, and Singapore citizens and permanent residents. What a top-up adds depends on the plan the insurer offers.

A few cases leave room for a global plan to be the main private cover. Hong Kong has no statutory scheme for it to replace, Singapore sets no medical insurance mandate for Employment Pass holders, and Indian employees above the ESI ceiling fall outside the statutory scheme.

Australia adds a tax angle. An international plan does not spare a higher earner the Medicare Levy Surcharge, because the exemption needs hospital cover from a registered Australian health insurer, and the tax office says an unregistered overseas policy earns no private health insurance rebate. In New Zealand, private or international cover becomes the main protection for someone not eligible for public care, for example on a shorter work visa.

Who may sell cover in the region

Singapore bars carrying on insurance business without a Monetary Authority licence, Taiwan reserves insurance business to licensed insurance enterprises, Pakistan requires registration with its securities commission, and China’s Insurance Law limits commercial insurance business to insurers set up under that law. In the Philippines, procuring or delivering a policy from an unauthorised insurer that covers Philippine risks is a penal offence. Law-firm guides describe Japan as generally requiring a licensed branch for a foreign insurer, Thailand as barring solicitation for foreign insurers, and Indonesia as allowing a foreign insurer to cover a local client only on strict reverse solicitation.

Others set conditions rather than bans. Vietnam permits cross-border insurance only under its treaty commitments, and a 2023 decree limits buyers to foreign-invested organisations and foreigners working in the country, with sales through a broker holding a Vietnamese licence. Hong Kong requires authorisation to carry on insurance business in or from the territory. India requires insurers to register with its insurance regulator, and New Zealand’s Reserve Bank licenses insurers carrying on business in the country.

Whether a given international plan can be offered to someone living in a particular country is for the insurer to confirm.

Hiring routes and EOR limits

Often a US company without a local entity hires through an employer of record that becomes the legal employer and handles enrolment, the route EOR providers describe for Japan, South Korea, Hong Kong, the Philippines, India and Pakistan. Work permits narrow the choice elsewhere. Singapore’s manpower ministry says an EOR may not apply for a work pass for a foreigner based in Singapore who works for an overseas company, so an EOR there mostly suits citizens and permanent residents. Malaysia needs an entity registered with its expatriate services division to sponsor an Employment Pass, Indonesia generally needs a registered local company to hire a foreign worker, and in Thailand a Thai employer sponsors the work permit, which consultancy guides tie to capital and local headcount tests.

China is the most cautious case. Law-firm analysis warns that hiring without a Chinese company, branch or representative office risks an illegal-office finding, and that global employment outsourcing resembles labour dispatch, which Chinese law limits to temporary, supporting or substitute roles. Australia and New Zealand sit at the other end: a foreign company can register as an employer for Australian withholding, and a non-resident employer with a sufficient presence registers with New Zealand’s Inland Revenue, or the employee files PAYE as an IR56 worker.

Our guide to health coverage for EOR employees and contractors abroad compares these routes in general terms.

Family cover and tax treatment

Japan’s Employees’ Health Insurance can cover financially dependent relatives living in Japan, and benefits guides say group medical plans in India often extend to a spouse, children and parents. In Australia, avoiding the Medicare Levy Surcharge takes registered hospital cover for the employee, a spouse and all dependants.

Tax treatment ranges widely. Singapore’s tax authority leaves group medical insurance for the employee, spouse and children untaxed when it is offered to all staff, but taxes an employer-paid personal policy. Australia and New Zealand charge the employer fringe benefits tax when it pays health premiums. Hong Kong tax advisers say premiums under the employer’s own contract are generally not taxable to the employee, while reimbursing a personal policy is. Philippine fringe benefit tax rules have treated group health premiums for employees as exempt, though the point has been disputed. Tax guidance reports South Korea treating employer-paid group insurance premiums as non-taxable welfare benefits, and China lets employees deduct qualifying tax-advantaged health products up to an annual cap.

Rules like these change often, so ask a local adviser or tax professional to confirm the treatment for your plan.

Country guides for Asia-Pacific

Each guide covers that country’s public system, employer contributions, private cover and hiring routes:

For Canada and other regions, start from the international health insurance overview, or browse the employee benefits hub.

Asking for an introduction for an Asia-Pacific team

Use the quote form on this page to tell us where in the region your people live, how many work in each place, whether they are employed through your entity or an EOR, which work pass or visa applies where it matters, and whether family members need cover. We can then introduce you to a benefits partner focused on international and remote-team health coverage; from there, the insurer and the partner work out who is eligible, the plan options and the price.

Hiring abroad can change your US business policies too. Our page on insurance changes for remote teams covers employment practices liability and cyber; we request those lines from insurers, and the insurer decides.

A few useful answers

Common questions

Can an international plan be the main health cover for an employee in Asia-Pacific?

In a few situations it can be the main private cover: in Hong Kong, for an Employment Pass holder in Singapore, or for an Indian employee above the ESI wage ceiling. Whether a given plan can be offered there is for the insurer to confirm. Where enrolment is compulsory, as in Japan, South Korea, China, Taiwan, Thailand and the Philippines, it adds to the statutory scheme.

Why does a global plan not help with Australia’s Medicare Levy Surcharge?

The exemption needs an appropriate level of hospital cover from an insurer registered in Australia. Cover from international insurers that are not registered there is listed among the policies that give no exemption.

Can an employer of record sponsor a work pass in Singapore?

Not for a foreigner who would be based in Singapore while working for an overseas company, according to the Ministry of Manpower. An EOR there mainly suits citizens and permanent residents, and a foreign hire on a work pass generally needs your own Singapore entity.

Which Asia-Pacific countries restrict foreign insurers?

Most of them, in different ways. Singapore, Taiwan, China, the Philippines, Japan, Thailand, Indonesia and Vietnam limit cover sold without local authorisation, and Australia withholds tax benefits from unregistered overseas policies. The insurer confirms whether its plan can be offered where your employee lives.

Who enrols a remote employee in the local scheme?

The legal employer: your own local entity, or an employer of record that employs the person for you. A genuine contractor usually arranges their own cover, for example through National Health Insurance in Japan or as a self-earning PhilHealth member in the Philippines.

International Health Insurance for Remote Employees in Asia-Pacific