The same plan can be paid two different ways. The difference decides how much cash you need at the hospital desk, and which hospitals you can use.
What direct settlement actually is
The hospital sends the bill to the insurer and you pay only the excess. It only works inside the insurer's designated hospital network, and the insurer still assesses the claim — direct settlement changes who fronts the money, not whether it is paid.
What reimbursement actually is
You pay the hospital, collect the original invoice, the itemised bill, the diagnosis and discharge records, then claim back. It is simpler to set up and works at more hospitals, but you carry the cost first.
Which to choose
If you use a fixed set of network hospitals and want no out-of-pocket moments, direct settlement fits. If you travel between cities or use public hospitals, reimbursement is more practical.
The document trap
The single most common claim failure is a missing itemised bill. Ask the hospital for the breakdown, not just the total, on the day of discharge.
When neither is enough
Neither structure pays for treatment outside mainland China. For that you need a plan that expressly covers overseas treatment, or you self-fund.