Individual Health Plan Proposal

Transcription

1 Individual Health Plan Proposal

2 Table of Contents Page Section Ⅰ Company Introduction 3 Section Ⅱ Plan Introduction 4 Ⅰ Geographic Coverage 4 Ⅱ Benefit Schedule 4 Ⅲ Exclusions 8 Section Ⅲ Plan Administration 9 Ⅰ Eligibility 9 Ⅱ Enrollment Guidelines 9 Ⅲ Service Highlights 9 Section Ⅳ Quotation 10 Appendix A Claim Procedures 11 Appendix B Direct Billing Hospitals List 12 2

3 SectionⅠ Company Introduction MSH INTERNATIONAL Founded in 1974, MSH INTERNATIONAL is a world leader in the design and management of international healthcare solutions. With four regional headquarters in Paris, Calgary, Dubai and Shanghai, MSH INTERNATIONAL provides 24/7, round-the-clock assistance in 35 languages for its 2,000 corporate clients and 300,000 insured members across 194 countries. MSH is majority owned by the House of Rothschild, a major player in the financial industry in Europe for more than two centuries. History in China MSH CHINA setup China s first international health insurance service center in 2001 to provide high-end health insurance to expatriates and local executives. During our 14 years of service provision, we have created many Firsts-in-China milestones and continue to be a trusted brand in the local business communities. To continuously improve and provide quality service to our members, we became the first international health insurance service provider to be accredited with the ISO9001 quality system certification and the ISO27001 Information Security Certification in 2011 and 2013 respectively. SERVICE is at the heart of our corporate DNA and a lifestyle we practice. MSH CHINA was selected by our esteemed colleagues in the ASIA Insurance Industry, as Asia s Best SERVICE PROVIDER of the Year in MSH CHINA is the No.1 leading service provider for high-end health insurance in China, serving more than 1,000 multinationals and local corporations in China, many of which are Fortune 500 companies. Our success stems from our passion for excellence, innovative products, professional services and corporate social responsibility. Our Offering for Clients We provide a wide range of high-quality individual plans and tailor-made international healthcare programs for corporate groups: Group and Individual Health Group and Individual Life Group and Individual Accidental Death & Dismemberment Group Long Term Disability Our Core Competitive Advantages As the leading service provider in China, MSH is strongly supported by an integrated service delivery model linking our outstanding local operational capabilities to our global resources. By doing so, members can access our direct billing hospital network throughout the world; 24/7 medical help, customer service and emergency assistance around the world; fast and efficient local administrative services, seamless procedures and consistent quality service worldwide. We are also able to provide: Flexibility in customization of benefit provision and geographic coverage Efficient claim processing and reimbursement option in 150 currencies Access for Member to obtain online information tracking and inquiry Through our 14 years of hard work, we have won the trust and respect from our clients, network providers as well as the China Government. As a Service Provider, we are dedicated to establishing a professional service team and cultivating a warm local community with the best quality health care services for our members in China. 3

4 SectionⅡ Plan Introduction Geographic Coverage Worldwide Plan No geographic restrictions and full coverage up to usual and customary charges in any country in the world. International Plan Full coverage up to usual and customary charges in all countries/areas except the U.S and Canada. International Plus Plan Full coverage up to usual and customary charges in all countries/areas except U.S and Canada; Emergency coverage is provided in the U.S. and Canada. Emergency coverage in the U.S. and Canada must be approved by our emergency assistance Company. Greater China Plan Full coverage up to usual and customary charges in Mainland China, Taiwan, Macao, and Hong Kong. Greater China Plus Plan Full coverage up to usual and customary charges in Mainland China, Taiwan, Macao, and Hong Kong. Other areas are deemed restricted areas, where only Emergency coverage is provided. And Emergency coverage must be approved by our emergency assistance Company. Benefit Schedule Currency: RMB Policy Period: One Year The same Benefit Schedule will be applied to all plans unless indicated otherwise. Overall Limits Annual Maximum 16,000,000 for Worldwide Plan/International (Plus) Plan 8,000,000 for Greater China (Plus) Plan Lifetime Maximum No limit Deductible and Co-payment Individual Annual Deductibles 0 Family Annual Deductible 0 3 times of Individual Annual Deductible *Policy Co-payment 0% For Worldwide Plan, there would be some co-payment outside of U.S. Network. See Note 1 for details. Routine Dental Co-payment See Dental Care *Provider Co-payment in Luxury Facilities 0% for Worldwide Plan See Note 2 for a complete list of Provider Co-payment. 20% for International (Plus) Plan 40% for Greater China (Plus) Plan 4

5 Inpatient and Day-care Treatment *Pre-authorization is required for in-patient treatment. See Note 3 for a complete treatment list for pre-authorization. Intensive Care Unit and Theatre Costs Operating and Emergency Room Accommodations Standard private room in Mainland China and semi-private room outside Companion Bed For a parent accompanying a hospitalized insured child under 18 years of age and for a baby aged under 16 weeks accompanying a hospitalized female insured person Doctor s Fees, Surgeon s Fees, Anesthesiologist s Fees Nursing Fees and Ancillary Fees Therapy and Treatment Including Radiotherapy, chemotherapy, consultations, pathology and radiology X-rays, Diagnostic Tests and Procedures MRI, PET, CT Scans and Oncology Tests Drugs and Dressings Reconstructive Surgery Following an accident or following surgery for an eligible medical condition Durable Medical Equipment Extended Care / Inpatient Rehabilitation Covered up to 90 days Skilled nursing and related services on an inpatient basis for patients who require medical or nursing care for a covered illness Outpatient Treatment Doctor s Fees, Specialist s Fees Prescription Drugs Laboratory Tests, X-rays, Diagnostic Tests and Procedures Therapy for Worldwide Plan and Including Physiotherapy, chiropractic therapy, vocational therapy, speech and occupational therapy International (Plus) Plan 1,000 per visit, up to 20 visits for Greater China (Plus) Plan Acupuncture and Homeopathy Covered up to 4,000 Traditional Chinese Treatment Public Hospitals: Consultation fee, diagnostic fee, Traditional Chinese Medicines Other Providers: 300 per visit, up to 20 visits prescribed by a registered traditional Chinese physician Sleep Testing and Treatment For suspected conditions of Narcolepsy or Obstructive Sleep Apnea Outpatient Surgical Operations Emergency Room Home Nursing Covered up to 100 days Underwriting Conditions 5

6 Pre-existing Conditions Subject to underwriter s approval and a waiting Any Illness or Injury, physical or mental condition, for which an Insured period may be applied to approved pre-existing Person received any diagnosis, medical advice or treatment, or had taken conditions any prescribed drug, or where distinct symptoms were evident prior to the effective date Chronic Conditions if not pre-existing conditions Hypertension, Diabetes etc. Catastrophic Illnesses if not pre-existing conditions Cancer, stroke, heart disease, major organ failure or transplant, AIDS/HIV etc. Maternity Benefits 12 months waiting period Maternity Covered up to 68,000 per pregnancy for Prenatal care, normal delivery or medically necessary C-section, and Worldwide Plan and International (Plus) Plan postnatal care. Covered up to 40,000 per pregnancy for Maternity Benefits for Dependent daughters are not covered Greater China (Plus) Plan Complications of Pregnancy Infant Care for the first 14 days without notification after enrollment Routine Exams for enrolled Infant within the age of 12 months without Covered up to 6 visits waiting period Immunizations for enrolled Infant within the age of 12 months without waiting period Diphtheria, hepatitis B, measles, mumps, pertussis, polio, rubella, tetanus, varicella, haemophilus influenza B, hepatitis A Congenital Conditions Congenital Conditions / Birth Anomalies Covered up to 60,000 Emergency Evacuation Ground Ambulance Emergency Medical Evacuation Economy-class air tickets for an accompanying, in the case of initial transportation to the location of the insured person Economy-class air tickets to return to the place of residence for the insured person and the accompanying person Hotel Fees Covered up to 12 nights and 800 per night For an accompanying person in case of emergency medical evacuation Repatriation of Mortal Remains / Local Burial Covered up to 160,000 Mental Health Mental Health Inpatient Covered up to 50,000 Mental Health Outpatient Covered up to 20 visits Hospice Care Hospice Care Covered up to 45 days for inpatient and 40,000 for outpatient Preventive Care 6