Applicable object

Employees who participate土如 in the SIBCO Comprehensi好弟ve Benefit Coverage as 數見a group and choose medica照刀l coverage, and the particip要會ating organization has p劇商aid for it.

coverage

1. Outpatient, emergency and hosp哥電italization expenses incurred by t雪視he applicable object within the pr林關ovisions;

2. Suitable for ----- full-time hea妹兒lthy employees under 舊暗the age of 60 who do not suffer 場店from any of the follow船但ing diseases

For: Malignant tumors, heart dis信湖ease (heart dysfunction grade II or 刀市above), myocardial infarction, le離歌ukemia, hypertension (grade II or above到現), cirrhosis of the liver, chr人會onic obstructive bronc森學hial disease, cerebrovascular di亮習sease, chronic kidney disease嗎章, diabetes mellitus, aplast秒話ic anemia, congenital disease, m家美ental illness, epileps南國y, specific infectious diseases, 下美AIDS, venereal diseases, int路風ervertebral disc hernia員電tion or being hospit理吃alized for illness, and Take full or議冷 half vacation

Scope of medical treatment

In mainland China.

Visit a designated hospital

Municipal, district and c術得ounty level (including)靜姐 public hospitals within the少街 scope of medical in但文surance (but not including the forei日女gn guest ward, special diagnosis war些雪d, special need ward and high-lev都時el ward and other similar wa能事rds or wards of these hospita筆醫ls). Emergency or rescue can g上銀o to any public hospital designate懂長d by the medical insura校區nce for treatment, but the local se著道condary (including) medical insuran議去ce designated public hospital 這兵for treatment.

Note: The following hospitals are 美商not designated hospitals

Shanghai Navy 411 Hospital

Shanghai Pudong Yangsi Hospital

Shanghai Hongkou Distr科離ict Quyang Hospital

Shanghai Hongkou District maternal an美會d Child Health Hospital

Shanghai Pudong Anda Hospital

Shanghai Hongkang Hospital

Beijing Military Region General Hospita慢司l

Beijing 309 PLA Hospita近線l (now the Second Af中一filiated Hospital of PLA 道湖General Hospital)

Beijing Armed Police Corps Hospital

Armed Police Beijing Corps s商湖econd hospital

Beijing Private Hospital Chinese業月 Medicine Hall (i.e. Hong Medicine北湖 Hall)

Yangqiao Hospital, Beijing Hospi是路tal of Traditional Chines事下e Medicine

Beijing Air Force Hospit區坐al

Beijing Naval General Hospital

Tianjin PLA 464 Hospital

Tianjin People's 說事Liberation Army 254 Hospi文能tal

Payment standard for outpatient, emer就車gency and inpatient medical e業報xpenses

1. Outpatient and emergency medical ex好答penses: Within the effective period 術睡of the protection liability, the o中店utpatient and emergency medic關個al expenses incurred 可腦by the applicable subjects due刀見 to diseases shall be paid 10訊議0% by the individual'歌飛s own part within the scope o木內f Shanghai Medical insurance.

2. Hospitalization: Within the validity如遠 period of the insuran身公ce liability, the applicabl男民e object of participati如藍ng in Shanghai medical insurance and照女 the cardholder for medical treatment木內 will be granted 100% of the就熱 self-financed portion志哥 within the scope of Shanghai Mun放算icipal Medical insurance; The ap不雨plicable subjects who do n短動ot participate in Shang照農hai medical insurance shall近日 pay the standard startin我暗g payment amount wit話微hin the scope of Shanghai medical ins術章urance and 15% above the starting pa錯司yment standard for their own part accor遠短ding to the scope of S東時hanghai medical insurance拍輛;

*** In each insurance year, the to美熱tal payment of outpatient, emergency 麗喝and inpatient medical expenses i做愛s capped at 50,000 yuan;

17 diseases are excluded from the out章醫patient, emergency and inpa區有tient medical expenses.

3. Maternity medical expenses 服呢for female employees:

1) For the medical expenses incurre紙個d by the female insured un好作der the conditions of小雨 national family plann校都ing laws and regulations and within 民你the scope of insurance, the Com讀黃pany shall compensate 化長the expenses at 100% ratio. For thos票農e who do not participate in Shanghai M廠女edical insurance, 15% of the cost 還子of childbirth hospitalization in li金雜ne with family planning 車腦shall be paid in accordance with們飛 the provisions of Shanghai medica裡風l insurance.

2) Within each insurance ye匠習ar, the following expenses的草 for each female insured shall拿多 not exceed RMB 5000 yuan.

- Fees for prenatal examinations fo新不r pregnant women;

- the cost of delivery (ex去高cluding the cost of the baby);

- Medical expenses incurre票在d by married persons for a綠關bortion (within the scope of fam麗白ily planning) or for terminating pregna水地ncy;

- The cost of getting 為船the ring, taking the 服話ring, penetrating the ring and l離好igation of the married p妹城erson;

- Expenses for abortion pr制報otection and safety;

-- Maternity bed fee: The 雨子compensation limit is R習市MB100 per person per day.

3) Explanation of ma用女ternity costs:

The Company shall, upon re報輛ceipt of such medical e唱通xpense claim application, immedi村鐘ately pay the medical insuranc妹花e money according to th報藍e agreed time if the inf林森ormation is complete and there 女麗is no doubt about it; Claims fo又金r medical expenses incur店線red by a married person as a result of刀友 abortions or operat計我ions to terminate a pregnancy after ea玩購ch occurrence; The maternity expe事爸nses shall be uniformly claimed f計影rom the Company after delivery;

-- The cost of childbirth (個少excluding the cost of the baby) shall小開 be paid by the Company外就 according to the insurance li做也ability, and the maternity medical低大 expenses subsidy of RMB 3,000 provide月長d by Shanghai Social insurance sha子從ll not be deducted;

- If the period during which the pre你習gnancy and perinatal examination f兒們ee is incurred by the f人低emale insured spans two insurance y朋舊ears, the Company shall compensate 店讀the accumulated maternity expenses of t作鐵he female insured according to the對日 welfare standard of t我個he insurance year in which the到公 child is delivered.

Instructions for filing a claim

1. Claim application procedures:筆雨

1) When Chinese empl店車oyees apply for claims, they can send 靜男complete materials required for clai舊在ms to the customer servi見西ce Department of our company.

2) The required mater音紙ials are:

◇ Fill in the Employe這請e Claim Application Form;遠在

◇ Copy of medical record cover, c下票opy of medical history 船和(medical history must clearly recor木我d the date of treatment, condition, 視可drug name, dosage form, dosage, takin村窗g method, and stamped with 們男doctor's seal or f國謝ull name);

◇ Original medical f月女ee receipt (hospital certificate, h黑司andwritten receipt or copy of receip裡綠t is invalid), the fee items and fee城個 date on the receipt mus會小t be consistent with the m弟到edical record;

◇ Photocopy of laboratory test and去請 inspection report.

◇ Copy of discharge summary (務音hospitalization);

◇ A copy of the list of expenses d嗎吃uring hospitalization (水到hospitalization);

2. Claim Settlement Inst事花ructions:

1) Cardholder medica你計l treatment: Those who participat為美e in social insurance payment, em有間ergency and hospitalizat煙校ion must hold the social (medica鄉你l) insurance card and medical這老 records manual in accordance with北嗎 the medical insurance regulatio也月ns, and those who do空金 not use medical insurance will 道資not be paid. If the new emplo讀快yees seek medical treatment, the m得房edical insurance inf好學ormation has not been opened during 風醫the medical treatment can on城離ly claim the personal self說不-financing part of the Shanghai medic請雪al insurance scope; Those who do看和 not participate in Shanghai med森說ical insurance can only claim t舊金he self-financed part of Shanghai med照線ical insurance coverage;

2) If the medical receipt is lost,算樂 no claim can be made, and the copy of說靜 the hospital certificate or他請 receipt is invalid;

3) According to the pri如訊nciple of insurance comp民會ensation, the compensatio計海n shall not exceed the actual東的 loss of the compensatio電員n. If the multi-party insuran明頻ce can only pay the in們船sufficient part, the company will 村服not pay the medical exp微好enses already paid in other 靜現companies.

4) Outpatient and emergency medicine 些會amount: emergency three days, o現舞utpatient seven days, 月城chronic disease 14 days, mo小算re than the prescribed amount of me哥店dicine costs will not紅費 be reimbursed.

5) All kinds of labora爸小tory tests and disease examinations, t爸錢he inspection report should b市自e attached when applying場低 for compensation;

6) Prescription medicine: the 你做hospital prescription can only be妹體 obtained in the hospital prescriptio我山n, prescription or purchase行煙 of drugs, will not be reimbursed.錢學

7) Claim validity:

◇ The commencement date is信子 the date on which the Company r分雜eceives the premium 街通paid by your unit;

◇ The expiration date 很的shall be calculated f短爸rom the date of termination o煙工r termination of the empl歌行oyment relationship of the Chin錢吃ese employee by the insured ent喝舊ity as agreed in the海為 contract signed bet說視ween you and the company;

◇ The cost of the ins窗玩urance plan is moderate

7) Claim validity:

◇ The commencement date is th書人e date on which the Company receives訊要 the premium paid by your u體秒nit;

◇ The expiration date shall be ca離金lculated from the date of termination現訊 or termination of the employmen老間t relationship of the Ch樹師inese employee by the insured en妹朋tity as agreed in the 人美contract signed between you 購照and the company;

◇ The insurance plan fee shall be paid水兒 by the insured unit of the 國和Chinese employee to the c個習ompany on a monthly basis. I音讀f the insured unit fa計視ils to pay the fee for more 醫們than 60 days, the insurance p樹老lan shall be termina影員ted.

Our company has a 30-day exemption pe什子riod, during which the relevant ex對低penses will not be reimbursed.

8) Time limit for clai拍姐m application: under norma這購l circumstances, claim shou弟睡ld be applied within 60 days from the愛得 second day of medical t個票reatment expenses, and special circ個北umstances can be extended a但司ppropriately.

Out-of-town treatment claims

1) If you fall ill during the business線河 trip, you should receive emergenc低師y treatment at the local知上 county (district) level or cou少紅nty (district) level or above pu鐘資blic general hospital (with市影 emergency seal), and bring all作畫 the information to 西都the nearest medical insurance center w票空ithin one month after th光票e end of treatment to make up the settl請山ement procedures. With the original 好用statement issued by the me紙妹dical insurance center and a c在短opy of the medical receipt (othe算東r materials and claim分河s required materials) to our compan老中y to settle claims;

2) If you work in the field for a 湖錯long time (more than 1 month), you ne白得ed to submit the written proof of t器國he hiring company (a鐵車nd stamp the official seal), and廠數 go to the district and county medic聽錯al insurance for the 司老transfer of medical r船弟elations. The expenses incur錯爸red for outpatient treatment in a pub就弟lic general hospital at or ab學日ove the workplace shall會間 be settled at the nearest medical ins懂醫urance center according to t我遠he regulations of Shanghai Medical站林 Insurance (within 3 months from 化但the date of receipt issued by the 愛女medical institution), and shall be s慢花ettled by our company w姐哥ith the original sta南章tement and a copy of the medical rece船服ipt issued by the medical insurance c門影enter (other materials and mat熱為erials required for claim settlem刀請ent);

Scope of no claim

1. Seek treatment in 木數hospitals that are not covered by med司河ical insurance and regul遠醫ated by our company;

2. For those who have partic靜舊ipated in Shanghai social insuran愛志ce payment, the social (medical) insu店生rance card and medica媽算l treatment record manual東路 have not been used in outpa醫體tient, emergency and hospitaliza在又tion;

3. Self-funded projec答近ts;

4. Dispensing medicines on吃很 behalf of patients without medica店分l history;

5. Medical treatment th能地at is not paid for

1) Service items

◇ Consultation fee, out-pati現購ent fee, special out著湖patient fee;

◇ Urgent fees for examination and t線內reatment, special medical 地快service fees (including nurses, escort朋這s, follow-up visits, home visi上冷ts, full mother-child service, spe紙算cial surgery surcharge, high quali場醫ty and premium fees);

◇ Medical records, vari黑秒ous billing costs.

2) Non-disease treatment pr件草ograms

◇ A variety of beauty, bodybuilding p請她rojects and some non-北術functional cosmetic surgery, orthopa得內edic surgery, etc. (such as: treatme開都nt of freckles, acne (廠市pimples, pimples), facial pigmenta就雜tion (melasma), moles, whi海服te hair, hair transpla拿房nt, ear piercing, facial mask, dental 錢門implants, mouth deformity,我遠 snoring, flat feet, 靜從scar repair;

◇ Various cosmetic, 子還orthopedic (except poliomyeli熱舞tis sequela) and physiological defect 訊短treatment (such as: armpit deodorizat睡聽ion, cleft lip repair, stutte我什ring, orthotropia, and multiple fin男他gers (toes), circumcision, 相男"Q" leg "X" leg窗腦 and other surgical ite綠放ms);

◇ A variety of weight loss, weig少光ht gain, increase, smoking cessation an從多d other projects;

Diagnosis of human body in白雪formation, computer selection of 長都the best pregnancy period, fetal玩開 sex and fetal development ex看場amination (except perinat北能al examination of female insured工通 persons) and other diagnosis and 兒文treatment items

◇ A variety of health exa司電minations, vaccinations;

A variety of preventive heal門女th care diagnosis and 術市treatment items (such as prevent說制ive appendectomy, preventive tonsil水舊lectomy, etc.);

◇ Various medical consultat都民ion (including psychologic吧嗎al consultation, health consult媽木ation, diet consultatio個吧n), medical appraisal (judicial ap相做praisal, industrial injury apprai我化sal, labor appraisal, medical apprai服近sal, paternity appraisal), v銀飛arious predictions (stroke pre煙為diction, health prediction草城, disease prediction) health guid土業ance and other projects.

3) Diagnosis and treatment 報好items and medical materials

The use of positron tomog公外raphy device, electron beam, cell kni窗視fe, ophthalmic excimer laser ther音舊apy equipment and other金近 large medical equipment for examin雜呢ation and treatment projects;

Glasses, dentures (including post吃很 crown, set crown, mounting dentu歌兒res), prosthetic eyes, pr跳冷osthetic limbs, hearing AIDS an那民d other rehabilitation equipment, a 湖讀variety of self-use 窗女health care, massage, monito章妹ring, inspection and treatment phys那關iotherapy equipment;

◇ Implantable automatic mul們有tirate defibrillator (ICD);

◇ The price is limited to 要藍disposable medical materials that c她數annot be charged separately 我著according to the dep農木artment.

4) Treatment items

Organ source or tissue sour東訊ce for transplantation of村算 various organs or tissues (exce湖樹pt skin transplantation of burn p日他atients);

Transplantation of organs or不路 tissues other than kidney,算學 heart valve, cornea, skin, bloo玩人d vessels, bone and bone marrow, and 化媽related operations to obtai去公n organ and tissue sources;

◇ Herniated disc

Myopia orthopedics, myopia (refractive 理綠error) examination and treatm議答ent;

Qigong therapy, music 來高therapy, health nutr老費ition therapy, magnetic therapy and ot商暗her auxiliary treatment item爸鐵s;

◇ Blood therapy, cosmetic teeth 要數cleaning, dental prosthese鐘廠s, dental implants, dental orthodontics拍和, dental plaque treatment, por道都celain teeth and other projects;

◇ All kinds of venereal diseases, spe火對cific infectious diseases, AIDS, me區他ntal illness, schizo理鐵phrenia, sex reassignment surgery,什快 human experimentation, artificia來廠l reproduction, contracept綠場ion and sterilization treatm南生ent costs, various infertility (steri飛舞lity), sexual dysfuncti頻信on, tubal examination;

◇ Various painless examination生章 (gastroscopy, colonoscopy, tracheosco謝好py, etc.) anesthesia fees, painless ab我林ortion anesthesia fees;

◇ Use a variety of p技舞rotein preparations (drugs containing 司器α-2β components, genetically modified s喝事eeds, sunwhite energy, etc.坐醫);

5) Others

◇ A variety of scientific res時內earch, teaching, cli的藍nical validation of diagnosis a白醫nd treatment projects;制錯

◇ All expenses incurred in viola能去tion of family planning;

All expenses arising from fightin化關g, alcoholism, drug addict船好ion, self-injury, self-h頻嗎arm, suicide, sexually tran聽農smitted diseases, pet放車 bites, traffic accidents, m新男edical accidents and other l房土iability incidents;

◇ Medical expenses incurred廠件 when going abroad o綠一r to Hong Kong, Macao or Taiwan for f森高amily visits, meetings, inves睡錢tigation, further study or lectur體時es;

The inpatient who should be disch花用arged but refuses to那拿 be discharged shall be id友刀entified by the medical te訊舊chnical appraisal team to confirm 要鐘that the inpatient treatment ha近購s been established, and th費姐e diagnosis and treatment items and a小友ll expenses incurred from the 一了second day after the identification醫姐 and confirmation; The近制 medical treatment items a短紅nd all expenses incurred by the in舞如sured personnel who are hospitalized 靜輛in name or do not meet物報 the admission standards;匠近

◇ Medical expenses incurred f紅歌or health care and unauthorized rehabi場林litation.

6. Scope of items for non-reimburse秒做d medical services facilities市答

Referral transportation, first北我 aid fare, outpatient m秒來edicine decocting fee, tradi算他tional Chinese medicine processing fe如師e, meal fee, disposable items學雨 such as sheets, diapers, garbage b兵醫ags and other special lif內車e service fees.

7. Taking, applying or injec電下ting drugs without following medi腦雜cal advice;

8. Treatment and rehabil話喝itation of uncured d草銀iseases and pre-existing disabi到這lities before insurance;

9. Engaged in diving, water skiin西樹g, rafting, skiing, sk對少ydiving, rock climbing, advent呢少ure activities, martia坐路l arts competition, wrestling competi下地tion, stunt show, horse racing, racing 新麗and other high-risk sports;廠飛

10. War, military acti事西on, insurrection or ar謝街med rebellion;

11. Nuclear explosion, radiati知秒on or contamination;

12. Other non-claims or expenses incur件可red during the period of空笑 exemption specified in this Ma南家nual

Relevant definition

Emergency conditions refer to the follo在街wing conditions that require an emer妹雪gency stamp on the medical record:

◇ High fever (38.5 degrees for adults,子們 39 degrees for child金綠ren);

Acute abdominal pain, 紙金severe vomiting, severe diarrhea;

◇ Shock of various cause草樹s;

◇ Coma;

◇ Seizures;

Severe wheezing and dysp空舊nea;

◇ Acute chest pain, acute heart failure爸到, severe arrhythmia;

Hypertensive crisis, hypertensi子如ve encephalopathy, cere票視brovascular accident;

◇ Acute bleeding due to妹友 various reasons;

◇ Acute urinary effusion, 費子urinary asthenia, hem生木atomia, renal colic;

All kinds of acute poisoning (food or 國拍drug poisoning). Various 光樹accidents (electrocution, drowning, ha子開nging, throat cutting);

Traumatic brain injury, fractu劇廠re, dislocation, lac看放eration, burn, scaldi妹內ng or other acute trauma;

◇ All kinds of poisonous animals討樂, insect bites, acute器習 allergic diseases;

Foreign bodies in the five features,兒些 respiratory tract and esophag玩東us, acute eye pain, red or swollen e長醫yes, sudden visual impairment and ey術文e trauma;

◇ Diseases of infants wi區紅thin two months;

◇ Other critical and serious pat刀厭ients should be given emergen湖暗cy treatment.

Chronic diseases:

◇ Chronic obstructive Pulmonary disea綠綠se (Bronchiectasis)

◇ Chronic pancreatitis

◇ Tuberculosis

◇ Chronic atrophic gastritis

◇ High blood pressure (Stage 2下影 and above)

◇ Chronic glomerulonephritis什文

◇ Coronary heart disease

Rheumatic heart diseas草男e

◇ Chronic pulmonary heart disease

◇ Chronic cardiac insuffi日很ciency

◇ Necrosis of the femoral head

Cerebrovascular accident (c器嗎erebral hemorrhage, c金遠erebral thrombosis, cerebral infarct習做ion, cerebral atrophy and s算跳equelae)

◇ Systemic lupus erythematosus

◇ Chronic viral active hepat秒花itis

◇ Cirrhosis of the liv西鐵er

◇ Aplastic anemia

◇ Chronic renal insuff制民iciency (including uremi坐問a)

◇ Diabetes

◇ Parkinson's disease

◇ Epilepsy

◇ Malignant tumors (高場including outpatient radi能理otherapy and chemoth市線erapy)

◇ Leprosy

◇ Rejection therapy after org兒們an transplantation

◇ Severe burns (two degrees de小林ep, 20% area or more)