Exclusions (See Policy Wording for details)

Transcription

1 Shanghai Global HealthCare Shanghai East International Medical Center OASIS International Hospital(Beijing) International SOS Clinics (Beijing, Tianjin, Nanjing, Shenzhen) Hong Kong Adventist Hospital Matilda International Hospital (Hong Kong) Hong Kong Sanatorium & Hospital For all members, the Insurer will not accept claims for treatment received at the following providers, or from physicians affiliated with such providers: Asia Medical Specialists/Sportsphysicians (Sportsperformance Ltd.). Note 3 - A complete list for services requiring Pre-authorization: Hospitalization, including baby deliveries Outpatient surgery/chemotherapy and radiation treatment/renal failure treatment Purchase or rental of Durable Medical Equipment (DME); including but not limited to insulin pumps and supplies. Emergency Medical Evacuation Emergency Dental Treatment (immediate pain relief is not required for pre-authorization) Medications or Immunizations priced in excess of 8,000 per refill Members that fail to obtain pre-authorization prior to all services listed above (except for emergency medical evacuation) treatment may be held liable for paying a 40% co-payment of the entire cost of the procedure, with no out-of-pocket limit. For emergency situations, Pre-authorization is not required. Please notify us within 48 hours after the occurrence of emergency. Emergency medical evacuation performed without Pre-Authorization will be subject to an Insured Person co-payment liability of 100%, with no out-of-pocket limit. Exclusions (See Policy Wording for details) Treatment as a result of Self-Inflicted Injury Cosmetic/Elective Treatments - laser eye surgery, weight reduction, etc. Reproductive Treatments - birth control, infertility, most abortions, sexual dysfunction, Viagra, etc. Corrective Devices - orthopedic shoes, braces, etc. Pre-existing conditions for adopted children for the 1st year from official adoption Additional Items - ante-natal classes and circumcisions Exceptional Risks - professional sports Charges in excess of Usual and Customary Fees 8

2 Section Ⅲ Plan Administration Eligibility Maximum age for enrollment: 70, renewal up to age 75 Eligible dependents can be the spouse of the eligible employee and children up to 21 years old (24 if full-time student) Employees and eligible dependents must reside within Mainland China, Hong Kong, Macao and Taiwan at least 70% of the policy year Enrollment Guidelines Eligible Dependents must be on the same plan as the employee and be added at the same time as the employee, except family status change If there is any insurance coverage change of the family members in the middle of the policy year (such as new marriage, newborn baby), please notice us within 30 days after the status change; otherwise medical underwriting will be needed Service Highlights As part of MSH INTERNATIONAL, we share the global medical network of more than 750,000 hospitals and clinics across 150 countries in 6 continents. Our network expands along with our clients' business and we have established the most in-depth local network in Greater China. From 2002, we established China s first direct billing network with top ranking local hospitals in China which have increased to 1,100 hospitals and clinics in over 38 major cities, to help members enjoy the most convenient direct billing services(please refer to Appendix A: Claim Procedures). We assign dedicated Account Managers to ensure implementation of health plan and the communication with the insured members. We have service teams in Shanghai, Beijing, Guangzhou, Wuhan, Shenzhen, Chengdu, Dalian and Suzhou. Our 24/7/365 Call Center for worldwide emergency assistance and local bilingual claim, pre-authorization support, hospital or specialties referral service within network anytime and anywhere; appointment services are also available for all public hospitals within our network. We adjudicate better claims control through our professional medical case management team. Our global online service is able to track claim status, benefit details, updatedthedirect billing provider list and to automatically generate a claim form with personal information. Our MSH hospital representatives in major hospitals ensure VIP service provision. Provide medical escort service if member requires major medical treatment. To continuously improve for our members benefit, we became the first international health insurance service provider to be accredited the ISO9001 quality system certification and ISO27001 Information Security Certification. 9

3 Appendix A : Claim Procedures a. If seeking treatment within our Direct Billing Hospitals Network, please bring: Insurance Card Photo ID / Passport b. If seeking treatment out of our Direct Billing Hospitals Network, please bring: Claim form c. If the doctor is not willing to complete Part B of the Claim Form out of the Network, it can be replaced by the photocopy of the diagnosis.. In Direct Billing Hospitals Network Out of Direct Billing Hospitals Network Please present your Photo ID with your Insurance Card and request a claim form Please bring our Claim Form with you to the hospital Please complete and sign Part A of the claim form The doctor should complete Part B of the claim form Please sign the invoice or Part B of the claim form to confirm expenses and leave the complete documents with the hospital The hospital will bill us directly Please file the necessary documents including: 1. Complete Claim Form 2. Original Taxed Invoices 3. Prescriptions (if any) 4. Medical Reports (Inpatient treatment) 5. Copy of your valid picture ID card / Passport and insurance card Complete Claims must be received by our Claim Center within 180 days 11

4 Appendix B: Direct Billing Hospitals List China (As of Jan. 1 st, 2014) Please click to check. --- Shanghai --- Changning Alpha Dental Clinic Jing Xian Dental Clinic ParkwayHealth - Hongqiao Medical Center Shanghai Aier Eye Hospital Shanghai Changning District Central Hospital, International Outpatient Department Shanghai g.dental Clinic Shanghai United Family Hospital St. Michael Hospital Sun-Tec Medical Center Tokushinkai Dental Clinic - Hong Qiao Yuanhua Health Check-up Center Hongkou Shanghai First People s Hospital International Medical Care Center Shanghai Quyang Hospital - VIP Department Huangpu ParkwayHealth - Shanghai Gleneagles International Medical & Surgical Center Shanghai Greenway Dental SinoUnited Health Portman Clinic Yi Dental Clinic Jingan American-Sino Ob/Gyn/Pediatrics Services Children s Hospital of Shanghai - VIP Department Huadong Hospital affiliated to Fudan University,VIP Department Huashan Worldwide Medical Center Rich Healthcare Management Center - Jing An Branch Shanghai Arrail Dental Plaza 66 Clinic Shanghai Centre Medical and Dental Center Shanghai Global HealthCare Puxi Center Tokushinkai Dental Clinic Shanghai - (Jing An) Luwan New Vision Eye Clinic - International Patient Services ParkwayHealth - Specialty and Inpatient Center Shanghai ARRAIL Dental Clinic - Xintiandi Clinic Ruijin Hospital Exclusive Medical Care Center Shanghai Shu Guang Hospital VIP Department Shanghai St. John s Oral Medicine Center St. John's Health Clinic Minhang Children s Hospital of Fudan University - International Clinic Center Shanghai Minhang Central Hospital - VIP Department Shanghai United Family Minhang Clinic Sunshine Children s Clinic Pudong Parkway Community Pharmacy ParkwayHealth - JinQiao Medical and Dental Center ParkwayHealth - Shanghai JinMao Tower Medical Center Renji Hospital of Shanghai Jiaotong University, Pudong Branch - VIP Department Rich Health Management Center Rich Healthcare Management Center - Zhang Jiang Branch Shanghai ARRAIL Dental Clinic - Time Square Clinic Shanghai ARRAIL Dental Clinic Zhengda Clinic Shanghai Children s Medical Center (Special Service Clinic) Shanghai D & D Dental Clinic Shanghai East Hospital - VIP Department Shanghai East International Medical Center Shanghai First Maternity and Infant Health Hospital, Pudong Branch Shanghai Global HealthCare Pudong Center Shanghai Healthway Medical Center (Jinqiao) Shanghai Huajian Health Check-up Center Shanghai IMD Dental Clinic Shanghai Punan Hospital, International Medical Center Shanghai Ruidong Hospital Shanghai Ruidong Hospital International Medical Center Shanghai Shu Guang Hospital VIP Department (Eastern Branch) SinoUnited Health Jinqiao Clinic The Community Health Service Center of Nicheng Tokushinkai Dental Clinic - Jin Qiao Tokushinkai Dental Clinic - Lian Yang Putuo Shanghai ARRAIL Dental Clinic - Putuo Parkside Plaza Clinic Tongji Hospital of Tongji University - VIP Department Songjiang Shanghai First People's Hospital, Songjiang Branch Xuhui Klinoerth Therapy Clinic Longhua Hospital Shanghai University of TCM - VIP Clinic Raffles Medical Center Rich Healthcare Management Center - Cao He Jing Branch Shanghai 6th Hospital-International medical center Shanghai ARRAIL Dental Clinic - Xu Jia Hui Clinic Shanghai Humanity Hospital - International Medical Center Shanghai Landseed Hospital International Medical Center Shanghai Sixth People s Hospital - VIP Department Shanghai St.Reiss Medical Center The International Peace Maternity & Child Health Hospital of the China Welfare Institute - VIP Department Yi Xian Hospital Foreigners Wing of Zhongshan Hospital Affiliated to Fudan University 12

5 ----- Beijing ---- Chaoyang A&S Dental - CBD Clinic A&S Dental - IVY Clinic AMCARE Women s & Children s Hospital Bayley and Jackson Beijing Medical Center Beijing Aier-Intech Eye Hospital Beijing American-Sino Ob/Gyn Hospital Beijing ARRAIL Dental Clinic - CITIC Clinic Beijing ARRAIL Dental Clinic - Exchange Clinic Beijing ARRAIL Dental Clinic - Somerset Clinic Beijing Arrail Dental Clinic-CBD Clinic Beijing Arrlink Dental Clinic - Central-P Clinic Beijing Ditan Hospital Beijing IDC Dental Clinic BeiJing Jing Xin Chinese Traditional Medicine Clinic Beijing New Century Women's and Children's Hospital Beijing SDM Dental - China World Trade Center Clinic Beijing SDM Dental - SDM Clinic Beijing SDM Dental - Sunshine Plaza Clinic Beijing SDM Dental-World Trade Clinic Beijing United Family Health & Wellness Center - Jianguomen Beijing United Family Hospital Nova Vision Eye Clinic China-Japan Friendship Hospital - International Department Hong Kong International Medical Clinic, Beijing International Medical Center - Beijing Puhua Outpatient Clinic Vista Clinic Chongwen Beijing Tiantan Puhua Hospital The New World Eaton Medical Center Dongcheng Beijing MJ Health Screening Center Cui Yue-Li Traditional Medicine Research Center, Ping Xin Tang Clinic De Heng Clinic Peking Union Medical College Hospital, International Medical Services The Military General Hospital of Beijing PLA - VIP Department Fengtai Bo Ai Tang Traditional Medicine Hospital-South Railway Station Haidian A&S Dental - XZM Clinic A&S Dental - ZGC Clinic Beijing ARRAIL Dental - Raycom Clinic Beijing Bo Ai Tang Traditional Medicine Clinic Beijing SDM Dental - Yuan Da Clinic Shunyi Beijing New Century Harmony Pediatric Clinic Beijing SDM Dental - Euro Plaza Clinic Beijing United Family - Shunyi Clinic Xicheng Beijing Children s Hospital, Special Consultation Clinic Beijing Friendship Hospital National Center for Cardiovascular Disease, China; Fuwai Hospital CAMS & PUMC New Century International Children s Hospital ---- Other Cities ---- Chengdu Chengdu Yafei Denta Global Doctor Chengdu Clinic No.3 People s Hospital of Chengdu - VIP Department ParkwayHealth Chengdu Medical Center Sichuan Provincial People s Hospital - VIP Department Sichuan University West China Hospital, Golden Card Hospital Chongqing Affiliated Yongchuan Hospital of Chongqing Medical University Chongqing Meigeer Dendal Global Doctor - Chongqing Clinic The First Affiliated Hospital of Chongqing Medical University- Jin Shan Hospital Dalian Affiliated Zhongshan Hospital of Dalian University - VIP Department Dalian Municipal Friendship Hospital - VIP Department Dalian Perfect Dental Clinic Dalian Smile Dental Clinic The First Affiliated Hospital of Dalian Medical University - VIP Department The First Affiliated Hospital of Dalian Medical University, The Third Branch - VIP Department The Second Affiliated Hospital of Dalian Medical University - VIP Department Dongguan Global Doctor - Dongguan Clinic Guangzhou All Smile - Dr. Lu International Dental Clinic Clifford Hospital - VIP Center Eur Am International Medical Center Global Doctor Prime Healthcare Guangdong General Hospital, Concord Medical Center Guangzhou - Pearl River Hospital of Southern Medical University (Yiqiao Building) Guangzhou ARRAIL Dental Clinic - Gaode Clinic Guangzhou Can Am International Medical Center Nanfang Hospital of Southern Medical University Huiqiao Building New Omega Medical Center - Canadian Immigration Medical Examination Centre Hangzhou Sir Run Run Shaw Hospital International Service Clinic VIP Department of Zhejiang Provincial People's Hospital Huizhou The 3rd People s Hospital of Huizhou Jinan Shandong Provincial Qianfoshan Hospital Kunshan Jen Ching Memorial Hospital 13

6 The First People s Hospital of Kunshan - Green Card Department Nanjing Global Doctor Nanjing Clinic Jiangsu Province People s Hospital - VIP Department Nanjing BenQ Hospital, International Medical Center Ningbo NingBo Department Zone Center Hospital-Foreigners Medical Clinic (FMC) Qingdao Bellaire Medical Center Qingdao Municipal Hospital (East) - International Clinic Sanya Hainan Province Nongken Sanya Hospital VIP Outpatient Center Shenyang Global Doctor Shenyang Clinic Liaoning Jin Qiu Hospital - VIP Department Shengjing Hospital affiliated to China Medical University-Medical Service Center for Foreign Nationals/VIP Department Shenzhen Peking University Shenzhen Hospital Priority Clinical Center Shenzhen ARRAIL Dental - Noble Clinic Shenzhen ARRAIL Dental Clinic - Di Wang Clinic Shenzhen ARRAIL Dental Clinic - Heng Yu Clinic Shenzhen Can Am International Medical Center Shenzhen Far-East Women & Children Hospital Shenzhen Nanshan Hospital Special Health-Care Center Suzhou Gentle Medical Clinic Singhealth Medical Clinic Suzhou Kowloon Hospital of Shanghai Jiao Tong University VIP Medical Center & Foreign Patient Clinic The Second Affiliated Hospital of Soochow University Tokushinkai Dental Clinic - Suzhou Industrial Park Tokushinkai Dental Clinic - Suzhou New District Tianjin Deji Hospital First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Guo Yi Tang - VIP Department TEDA International Cardiovascular Hospital - VIP Department Tianjin Aichi International Dental Center Tianjin First Central Hospital, International Medical Center Tianjin Huada Hospital System - Huatai Hospital Tianjin Huada Hospital System - Western Hospital Tianjin Liang Chi Dental Center Tianjin Teda Hospital - VIP Department Tianjin United Family Hospital Wuhan General Hospital of Guangzhou Military Area in Wuhan TCM Hospital of Hubei Province VIP Department Tongji Hospital Tongji Medical College of Huazhong University of Science & Technology, Department of Wuhan Optic Valley Medical Center/Optic Valley Hospital Zhongnan Hospital of Wuhan University - VIP Department Wuxi Phoenix Hospital of Wuxi New District Hospital Xi an Xi an Gaoxin Hospital Xiamen The City Medical Consultancy VIP Department of Xiamen Chang Gung Hospital Xiamen ARRAIL Dental Clinic - International Clinic Xiamen Maternity and Child Health Care Hospital - VIP Maternity & Gynecology Center Zhangjiagang Zhangjiagang Central Hospital VIP Outpatient Department Zhuhai The Fifth Affiliated Hospital of Sun Yat-Sen University - VIP Medical Service Center Hongkong Hong Kong Raffles Medical Central Hong Kong Raffles Medical Hong Kong International Airport Hong Kong Raffles Medical Taikoo Place Human Health Medical Centre Quality Healthcare Medical Services Limited (QHMS) UMP Medical Center UMP Medical Center (Central) Macau Quality Healthcare Medical Services Limited (QHMS) Macau Taiwan Taiwan Adventist Hospital, International Healthcare Center St. Martin De Porres Hospital, International Medical Healthcare Service Center Chang Gung Memorial Hospital (Taipei), International Service Center Chang Gung Memorial Hospital (Linkou), International Service Center Chang Gung Memorial Hospital (Taoyuan), International Service Center Chang Gung Memorial Hospital (Kaohsiung), International Service Center Taiwan Landseed Hospital, International Service Center Note: This is a complete direct billing providers list for your reference. The exact list may vary for different plans you finally select. North America Please click to check. Asia Please click to check. Other Regions Please click to check. 14