Applicable object

Employees who participate 這玩in the SIBCO Comprehen還她sive Benefit Coverage為亮 as a group and choose medical cov中個erage, and the participa從銀ting organization has paid for信電 it.

coverage

1. Outpatient, emergency and ho慢了spitalization expenses incurred b坐做y the applicable object within th睡到e provisions;

2. Suitable for ----- 理制full-time healthy emp低木loyees under the age of 60 who 兒人do not suffer from any of the fol鐘自lowing diseases

For: Malignant tumors, heart d鐵醫isease (heart dysfunction g拿廠rade II or above), myocardial in跳來farction, leukemia, hypertens冷什ion (grade II or above), cirrhosis 內老of the liver, chronic 海看obstructive bronchial disease, cere師從brovascular disease, chronic kid年好ney disease, diabetes m知看ellitus, aplastic anemia, congenital di是農sease, mental illness, epilepsy, spec行林ific infectious diseas著商es, AIDS, venereal diseases, interver科謝tebral disc herniation or b聽是eing hospitalized for illness,章女 and Take full or half vacation

Scope of medical trea資不tment

In mainland China.

Visit a designated ho外近spital

Municipal, district and county level (房上including) public hospit拍樹als within the scope of medical i車也nsurance (but not including the 日房foreign guest ward, special diag去相nosis ward, special need 醫器ward and high-level ward an月離d other similar wards商跳 or wards of these hospitals)不老. Emergency or rescue can go to any pub姐服lic hospital designated by the medic但大al insurance for treatment, but t音麗he local secondary (including商河) medical insurance 劇如designated public hospital 能紙for treatment.

Note: The following hospital空國s are not designated hospita妹開ls

Shanghai Navy 411 Hospital

Shanghai Pudong Yangsi Hospital

Shanghai Hongkou District Quyang Hosp錢員ital

Shanghai Hongkou District mat和匠ernal and Child Health Ho是光spital

Shanghai Pudong Anda Hospital

Shanghai Hongkang Hospital

Beijing Military Region G舊購eneral Hospital

Beijing 309 PLA Hospital (now the視女 Second Affiliated Hosp匠從ital of PLA General Hosp冷門ital)

Beijing Armed Police Cor下土ps Hospital

Armed Police Beijing是歌 Corps second hospital

Beijing Private Hospit商看al Chinese Medicine Hall體兵 (i.e. Hong Medicine H知畫all)

Yangqiao Hospital, Beijing Hospital of 內司Traditional Chinese Me匠工dicine

Beijing Air Force Hospital

Beijing Naval General 花鄉Hospital

Tianjin PLA 464 Hospital

Tianjin People's Li兵還beration Army 254 Hospital

Payment standard for 站路outpatient, emergency and inp裡新atient medical expen拿身ses

1. Outpatient and emergency m這南edical expenses: With空現in the effective period of the pro看紙tection liability, the outpatient有輛 and emergency medical expens跳南es incurred by the appli章紙cable subjects due to diseases s媽請hall be paid 100% by the 嗎嗎individual's own報煙 part within the scop上跳e of Shanghai Medical ins開通urance.

2. Hospitalization: Within th內看e validity period of the insuranc來跳e liability, the appli理村cable object of parti睡秒cipating in Shanghai medical in為愛surance and the cardholder友爸 for medical treatment will be grante對會d 100% of the self-fina們唱nced portion within 劇這the scope of Shanghai Municipal M物海edical insurance; The appli腦土cable subjects who do not participat放自e in Shanghai medical insurance 人朋shall pay the standard sta森懂rting payment amount within拍現 the scope of Shanghai medical森刀 insurance and 15% ab著謝ove the starting payment 海票standard for their own part according t討草o the scope of Shanghai medical i舊筆nsurance;

*** In each insurance year, t術學he total payment of outpatient, e讀舞mergency and inpatient medical exp頻吧enses is capped at 50,000 yuan;

17 diseases are excluded from the綠嗎 outpatient, emergency and i短費npatient medical expe黑那nses.

3. Maternity medical ex藍新penses for female employees:

1) For the medical exp很多enses incurred by the female insured 們這under the conditions of national famil購內y planning laws and r大們egulations and within t海生he scope of insurance, th姐年e Company shall compe術南nsate the expenses at 100% ratio. 現坐For those who do not p男得articipate in Shanghai Medical insuran也河ce, 15% of the cost o到煙f childbirth hospitalization in老影 line with family planning s弟從hall be paid in accordance with the pr光窗ovisions of Shanghai 頻美medical insurance.

2) Within each insurance year, t說市he following expenses fo離會r each female insured shall no短月t exceed RMB 5000 yuan.

- Fees for prenatal examinatio兒還ns for pregnant wome學作n;

- the cost of delivery (excluding 子自the cost of the baby);

- Medical expenses incurred by 煙文married persons for abortion (within 個嗎the scope of family pl裡亮anning) or for terminating pregna公內ncy;

- The cost of getting the ring, takin理離g the ring, penetrating the ring and l煙身igation of the married pers說民on;

- Expenses for abortion protecti冷用on and safety;

-- Maternity bed fee: The compensat還體ion limit is RMB100 per pe去們rson per day.

3) Explanation of ma訊有ternity costs:

The Company shall, upon receipt of 煙商such medical expense clai妹計m application, immediately pay the視草 medical insurance mone藍錢y according to the agreed time if離靜 the information is complete and紙遠 there is no doubt about it; Claims fo姐討r medical expenses incurred by a 近什married person as a result of aborti微書ons or operations to termin草對ate a pregnancy after each occurrence人內; The maternity expenses shall b時習e uniformly claimed from the Company af著白ter delivery;

-- The cost of childbirth (excluding 西厭the cost of the baby) shall be pai雪水d by the Company according to t海公he insurance liability, and the mater村船nity medical expenses su拍中bsidy of RMB 3,000 pro秒自vided by Shanghai Social ins微書urance shall not be deducte商音d;

- If the period during 草員which the pregnancy and 去見perinatal examination fee is incurred b有什y the female insured spans two insu章們rance years, the Company shall compens鄉那ate the accumulated maternity exp老冷enses of the female i村從nsured according to the子理 welfare standard of the畫不 insurance year in which the chi湖鄉ld is delivered.

Instructions for filing a claim

1. Claim application頻報 procedures:

1) When Chinese employees appl慢事y for claims, they can s窗兒end complete materials required for c件兵laims to the customer service De快風partment of our company.

2) The required materials are:

◇ Fill in the Employee Claim Appli高他cation Form;

◇ Copy of medical record co自吃ver, copy of medical history (報畫medical history must clearly recor少少d the date of treatment討物, condition, drug name, dosag你物e form, dosage, taking訊這 method, and stamped wit地爸h doctor's seal o算事r full name);

◇ Original medical fee receipt (有煙hospital certificate, handwritten音農 receipt or copy of receipt is in美房valid), the fee items兵器 and fee date on the receipt must be co輛近nsistent with the medical rec綠票ord;

◇ Photocopy of laboratory t河音est and inspection rep裡兒ort.

◇ Copy of discharge summary (hosp理區italization);

◇ A copy of the list of e黃離xpenses during hospitalization (hospit視快alization);

2. Claim Settlement Instructions:

1) Cardholder medical tre化空atment: Those who participate in 件人social insurance payment,火謝 emergency and hospitalization冷商 must hold the social (medic姐看al) insurance card and medical records 電木manual in accordance with the medical i冷兒nsurance regulations, and those w光音ho do not use medical 空公insurance will not be pai懂著d. If the new employees 志城seek medical treatment, the medical 謝報insurance information has not been 制農opened during the medical treatmen他醫t can only claim the pers笑吧onal self-financing 關就part of the Shanghai 了這medical insurance scope; Those who d舊北o not participate in Shanghai medical理場 insurance can only claim the樂著 self-financed part of Shanghai 做短medical insurance cove體媽rage;

2) If the medical receipt is los你靜t, no claim can be made,多紙 and the copy of the hos土會pital certificate or receipt理一 is invalid;

3) According to the principle of ins也謝urance compensation, the 暗事compensation shall not excee兵村d the actual loss of the compens鐘土ation. If the multi-party in日雨surance can only pay the i體銀nsufficient part, the company will no朋冷t pay the medical expe雪頻nses already paid in other 西風companies.

4) Outpatient and emergency medic小醫ine amount: emergency three是秒 days, outpatient seven 男放days, chronic disease 14 days, 一城more than the prescrib南畫ed amount of medicine costs will not 空草be reimbursed.

5) All kinds of laboratory tests業北 and disease examinations, 司間the inspection report should be a那黃ttached when applying for compensation;喝錯

6) Prescription medicine: the hospi林做tal prescription can only湖腦 be obtained in the hospital pres船船cription, prescription 快腦or purchase of drugs, will not be 吧廠reimbursed.

7) Claim validity:

◇ The commencement date is t司多he date on which the Compan都雪y receives the premium pa紅風id by your unit;

◇ The expiration date shall be cal姐子culated from the date of termi秒在nation or termination of the empl生上oyment relationship of現爸 the Chinese employee by th草鐘e insured entity as agreed in拍嗎 the contract signed between 間數you and the company;

◇ The cost of the insurance森玩 plan is moderate

7) Claim validity:

◇ The commencement date is the村上 date on which the Company receive綠錯s the premium paid by your unit;

◇ The expiration date shall be calcula土答ted from the date of termination 員如or termination of the可麗 employment relationshi的票p of the Chinese employee by the insur低時ed entity as agreed in the 花湖contract signed between 議男you and the company;

◇ The insurance plan fee 看我shall be paid by the insured unit of 雪醫the Chinese employee to the c做山ompany on a monthly basis. If the在話 insured unit fails 還媽to pay the fee for more than 60 day朋月s, the insurance plan shall be t花要erminated.

Our company has a 30-day exemp兒花tion period, during 訊妹which the relevant expenses will 子算not be reimbursed.

8) Time limit for claim不坐 application: under norma請舞l circumstances, claim s吃訊hould be applied within 60 days工鄉 from the second day of med舞電ical treatment expenses, and spe動車cial circumstances can be也妹 extended appropriately.

Out-of-town treatment claims

1) If you fall ill du又去ring the business trip音北, you should receive emergency treatme樹生nt at the local county (dis跳美trict) level or coun好我ty (district) level or abo相都ve public general hospital (with 輛了emergency seal), and bring a算年ll the information to the nea行林rest medical insurance center wit紅喝hin one month after the文如 end of treatment to m唱笑ake up the settlemen有用t procedures. With the original stateme務西nt issued by the medical ins都站urance center and a copy of the me放東dical receipt (other materials a藍章nd claims required materi東現als) to our company to s開歌ettle claims;

2) If you work in the field for a場區 long time (more than 1 m空劇onth), you need to subm中議it the written proof of the hiring com服這pany (and stamp the offici雨黑al seal), and go to the district a說事nd county medical in年商surance for the transfer of medical視會 relations. The expen議間ses incurred for outpatient treatment森些 in a public general hospital at or a睡如bove the workplace sh拍雪all be settled at the nearest 吧看medical insurance center according 街制to the regulations of Shanghai 但這Medical Insurance (within 3 mo為北nths from the date of receipt i要到ssued by the medical institution), an藍水d shall be settled by our compa得藍ny with the original statement and新呢 a copy of the medical receipt issued b睡舊y the medical insurance center (other 制呢materials and materials required 通近for claim settlement);

Scope of no claim

1. Seek treatment in hospi河我tals that are not covered by medical視些 insurance and regulated by 舊妹our company;

2. For those who have participated她我 in Shanghai social insur吧紅ance payment, the soc男麗ial (medical) insurance card an費風d medical treatment re房數cord manual have not been us靜店ed in outpatient, emergency and道報 hospitalization;

3. Self-funded projects;

4. Dispensing medicines on behalf of pa輛煙tients without medical his門線tory;

5. Medical treatment t遠姐hat is not paid for

1) Service items

◇ Consultation fee, 上近out-patient fee, spec海離ial outpatient fee;

◇ Urgent fees for exa做市mination and treatment, specia老區l medical service fees (inclu場綠ding nurses, escorts, follow-up照舊 visits, home visits, full mother-chi什她ld service, special surge河兒ry surcharge, high quality 輛通and premium fees);

◇ Medical records, various b紅要illing costs.

2) Non-disease treatment progra算自ms

◇ A variety of beauty, bodybuilding 兒算projects and some non-f我暗unctional cosmetic surgery, orth資麗opaedic surgery, etc. (such as: treatm紙為ent of freckles, acne (麗鐘pimples, pimples), f花的acial pigmentation (melasma), mole銀大s, white hair, hair tran身子splant, ear piercing, facial m現了ask, dental implants, mouth defo少這rmity, snoring, flat feet, scar repai訊城r;

◇ Various cosmetic, orthopedic (exc務水ept poliomyelitis sequela) and phy議算siological defect treatment (suc化為h as: armpit deodorization, 民子cleft lip repair, stuttering, orth動會otropia, and multiple 放會fingers (toes), circumcision, &到遠quot;Q" leg "X" 朋鐵leg and other surgical items);

◇ A variety of weigh人爸t loss, weight gain, increase, s民在moking cessation and other projects;

Diagnosis of human body in來哥formation, computer selection of th火自e best pregnancy period, fetal sex日內 and fetal development 兵船examination (except perinatal 男木examination of female insured pers城我ons) and other diagnosis厭麗 and treatment items農些

◇ A variety of health examinations,制資 vaccinations;

A variety of preventive health care di街章agnosis and treatment items (such 生開as preventive appendectomy, preve用照ntive tonsillectomy, etc.);

◇ Various medical consultati分場on (including psycholog去刀ical consultation, health consul們公tation, diet consultati美家on), medical appraisa山外l (judicial appraisal, industrial inju說通ry appraisal, labor ap快坐praisal, medical appraisal, pater爸近nity appraisal), various predi放銀ctions (stroke predictio輛得n, health prediction, disease predi上間ction) health guidan分錢ce and other projects.

3) Diagnosis and treatment 開亮items and medical materials

The use of positron tomog為對raphy device, electron beam, ce習來ll knife, ophthalmic excimer lase呢拍r therapy equipment and ot熱筆her large medical equipment f到個or examination and treatment project她計s;

Glasses, dentures (including post c森草rown, set crown, mounting dentures), 商業prosthetic eyes, pro子了sthetic limbs, hearing AIDS and othe花唱r rehabilitation equipment, a var了中iety of self-use health care, mass山厭age, monitoring, insp通現ection and treatment physiot和友herapy equipment;

◇ Implantable automatic mul去現tirate defibrillator (子可ICD);

◇ The price is limited to disposa資個ble medical materials t他生hat cannot be charged separa器下tely according to the departmen遠就t.

4) Treatment items

Organ source or tissue source for t上區ransplantation of vario商件us organs or tissues (ex日少cept skin transplantation 匠動of burn patients);

Transplantation of o紅歌rgans or tissues other than kidney, h亮西eart valve, cornea, skin, blood vess為劇els, bone and bone marrow, and rela店錢ted operations to ob話舊tain organ and tissue就事 sources;

◇ Herniated disc

Myopia orthopedics, myop看鐘ia (refractive error) examination a吧就nd treatment;

Qigong therapy, music therapy, he通近alth nutrition therapy, magne民農tic therapy and other頻畫 auxiliary treatment items;

◇ Blood therapy, cosmetic teeth cl美日eaning, dental prostheses, dental impl員醫ants, dental orthodontics, dent輛紅al plaque treatment, porcel不藍ain teeth and other projec好北ts;

◇ All kinds of venereal disea站少ses, specific infectious diseases爸道, AIDS, mental illness, schizophrenia,通厭 sex reassignment surgery, human experi白是mentation, artificial repro北廠duction, contraception an窗開d sterilization treatment costs, vario兒黃us infertility (sterility), s一男exual dysfunction, tubal exa舞為mination;

◇ Various painless examination (gastros長城copy, colonoscopy, tracheoscopy, etc.呢草) anesthesia fees, painless abortion an暗這esthesia fees;

◇ Use a variety of protein p放藍reparations (drugs con光用taining α-2β components舞小, genetically modified seeds, sunwh人會ite energy, etc.);

5) Others

◇ A variety of scientific research, 要懂teaching, clinical v城到alidation of diagnosis a海劇nd treatment projects;

◇ All expenses incurred i月志n violation of family電森 planning;

All expenses arising from fighting, alc鄉答oholism, drug addiction有西, self-injury, self-harm, suici會子de, sexually transmitted d相制iseases, pet bites, traffic ac懂鐵cidents, medical accidents 下章and other liability incide又筆nts;

◇ Medical expenses incu購火rred when going abroad 吃對or to Hong Kong, Macao or Taiwan 站長for family visits, meetings風光, investigation, further stu男光dy or lectures;

The inpatient who should be discha從通rged but refuses to be dis村林charged shall be ide化銀ntified by the medical technical app做火raisal team to confirm that the inpa自嗎tient treatment has been 子答established, and the一男 diagnosis and treatment items and all跳河 expenses incurred f唱土rom the second day after the identif務喝ication and confirmation; Th服劇e medical treatment items and all是日 expenses incurred by the insured pe姐醫rsonnel who are hospitalized in 很報name or do not meet t議多he admission standards;

◇ Medical expenses incur知對red for health care and unauth喝嗎orized rehabilitation.

6. Scope of items for non-reimbu知分rsed medical services facilities綠體

Referral transportation, first aid fare通鄉, outpatient medicine decocti身如ng fee, traditional Chin照業ese medicine processing fee, meal議內 fee, disposable items such工頻 as sheets, diapers, garbage民都 bags and other special但中 life service fees.

7. Taking, applying or i愛很njecting drugs without following medica弟市l advice;

8. Treatment and rehabilitation 嗎公of uncured diseases and p事訊re-existing disabilities b們木efore insurance;

9. Engaged in diving, water skiing劇從, rafting, skiing, sky少話diving, rock climbin身還g, adventure activit現媽ies, martial arts competition, wrestlin你靜g competition, stunt show外著, horse racing, racing a海身nd other high-risk sports;

10. War, military action, insurrecti這明on or armed rebellion;事校

11. Nuclear explosio看友n, radiation or contamination;

12. Other non-claims訊頻 or expenses incurred dur友樂ing the period of exemption specifie跳火d in this Manual

Relevant definition

Emergency conditions refer 哥員to the following conditions tha算舊t require an emergenc得土y stamp on the medical rec好他ord:

◇ High fever (38.5 degrees for adul電快ts, 39 degrees for childr視對en);

Acute abdominal pain, 道睡severe vomiting, severe diarrh服鐘ea;

◇ Shock of various caus計鄉es;

◇ Coma;

◇ Seizures;

Severe wheezing and dyspnea;南微

◇ Acute chest pain, acute he路志art failure, severe arrhythmia;錯黑

Hypertensive crisis, hypertensive en冷為cephalopathy, cerebrovascular acciden我南t;

◇ Acute bleeding due to various reasons老車;

◇ Acute urinary effusion報年, urinary asthenia, hematomia亮工, renal colic;

All kinds of acute poison車相ing (food or drug poi上機soning). Various accidents (el工討ectrocution, drowning, hanging, 笑話throat cutting);

Traumatic brain injury, f農如racture, dislocation,和外 laceration, burn, scalding or other a歌地cute trauma;

◇ All kinds of poisonous animals,可報 insect bites, acute all秒頻ergic diseases;

Foreign bodies in the five features都關, respiratory tract and esophagus, 體北acute eye pain, red or swollen光校 eyes, sudden visual impairment他年 and eye trauma;

◇ Diseases of infants within two高道 months;

◇ Other critical and serious pa歌裡tients should be given emerg紅跳ency treatment.

Chronic diseases:

◇ Chronic obstructive Pulmo中明nary disease (Bronchiectasis)日南

◇ Chronic pancreatit書土is

◇ Tuberculosis

◇ Chronic atrophic gastritis

◇ High blood pressure (Stage 2報腦 and above)

◇ Chronic glomerulonephri綠黃tis

◇ Coronary heart disease

Rheumatic heart disease

◇ Chronic pulmonary heart但紅 disease

◇ Chronic cardiac insufficiency

◇ Necrosis of the femoral head

Cerebrovascular accident (cerebral he看在morrhage, cerebral thrombosis, 吃玩cerebral infarction, cerebral atrophy 車子and sequelae)

◇ Systemic lupus erythematosus

◇ Chronic viral activ通影e hepatitis

◇ Cirrhosis of the liver

◇ Aplastic anemia

◇ Chronic renal insufficiency (includin遠來g uremia)

◇ Diabetes

◇ Parkinson's dise信樂ase

◇ Epilepsy

◇ Malignant tumors (including out光快patient radiotherapy and chemother照店apy)

◇ Leprosy

◇ Rejection therapy after organ t紅歌ransplantation

◇ Severe burns (two degre長媽es deep, 20% area or more)