Applicable object

Employees who participate in the SIBCO Comprehensive Benefit Coverage as a gro←up and choose medical coverage, and the participating organization has paγid for it.

coverage

1. Outpatient, emergency and hospitalization expenses incurred by the applicable ob☆ject within the provisions;

2. Suitable for ----- full-time healthy employees under the age of 60 who ₹do not suffer from any of the following diseases

For: Malignant tumors, heart disease (heart dysfunction grade I"I or above), myocardial infarction, leukemia, hypertension (grade II or abov e), cirrhosis of the liver, chronic obstructive bronchial disease, ←cerebrovascular disease, chronic kidney disease, diabetes mellitus, aplastic anemia, conge nital disease, mental illness, epilepsy, specific infectious di§seases, AIDS, venereal diseases, intervertebral diφsc herniation or being hospitalized for illness, and Take full or half vaca→tion

Scope of medical treatment

In mainland China.

Visit a designated hospital

Municipal, district and county level (including) public hospitals within the scope of medical insur∏ance (but not including the foreign guest ward, special diagnosis ward, special need• ward and high-level ward and other similar wards or wards of these hospitals). ×Emergency or rescue can go to any public hospital designated by t∑he medical insurance for treatment, but the local secondary (including) medical insuranc÷e designated public hospital for treatment.

Note: The following hospitals are not designated hospital∑s

Shanghai Navy 411 Hospital

Shanghai Pudong Yangsi Hospital

Shanghai Hongkou District Quyang Hospital

Shanghai Hongkou District maternal and Child Health Hospital

Shanghai Pudong Anda Hospital

Shanghai Hongkang Hospital

Beijing Military Region General Hospital

Beijing 309 PLA Hospital (now the Second Affiliated Hospital of PLA General Hospital)α

Beijing Armed Police Corps Hospital

Armed Police Beijing Corps second hospital

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

Yangqiao Hospital, Beijing Hospital of Traditional Chinese Med icine

Beijing Air Force Hospital

Beijing Naval General Hospital

Tianjin PLA 464 Hospital

Tianjin People's Liberation Army 254 Hospital

Payment standard for outpatient, emergency and inpatient medical expenses

1. Outpatient and emergency medical expenses: Within the effective period of the protection lia©bility, the outpatient and emergency medical expenses incurred by the a'pplicable subjects due to diseases shall be paid 100% by the individual's own part within tλhe scope of Shanghai Medical insurance.

2. Hospitalization: Within the validity period of the insurance li₽ability, the applicable object of participating in Shan∑ghai medical insurance and the cardholder for medical treatm‍ent will be granted 100% of the self-financed portionσ within the scope of Shanghai Municipal Medical insu‍rance; The applicable subjects who do not participate in Shanghai medical insura nce shall pay the standard starting payment amount within the sc✔ope of Shanghai medical insurance and 15% above the starting♠ payment standard for their own part according to the scopeΩ of Shanghai medical insurance;

*** In each insurance year, the total payment of outpatient, emerg≥ency and inpatient medical expenses is capped at 50,000 yuan;

17 diseases are excluded from the outpatient, emergency  and inpatient medical expenses.

3. Maternity medical expenses for female employees:

1) For the medical expenses incurred by the female insured under the conditions of natio≤nal family planning laws and regulations and within the scope of insurance, the Compa∑ny shall compensate the expenses at 100% ratio. For those who do not participate in ×Shanghai Medical insurance, 15% of the cost of childbirth hospitalization in line ✔with family planning shall be paid in accordance with the provisions' of Shanghai medical insurance.

2) Within each insurance year, the following expenses for each female insured shall not exce₩ed RMB 5000 yuan.

- Fees for prenatal examinations for pregnant women;

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

- Medical expenses incurred by married persons for abortion (within the scope of family planning)¥ or for terminating pregnancy;

- The cost of getting the ring, taking the ring, penetrating the ring and ligation of the marri ed person;

- Expenses for abortion protection and safety;

-- Maternity bed fee: The compensation limit is RMB100 pe​r person per day.

3) Explanation of maternity costs:

The Company shall, upon receipt of such medical expense claim applicatio‌n, immediately pay the medical insurance money according to the agreed time if the informati‍on is complete and there is no doubt about it; Claims for medical expenses incurred by a marrie®d person as a result of abortions or operations to terminate a pregnancy after each occurrence;≈ The maternity expenses shall be uniformly claimed from the Company after deli™very;

-- The cost of childbirth (excluding the cost of the baby) shall be paid by the• Company according to the insurance liability, and the maternity medical expe₽nses subsidy of RMB 3,000 provided by Shanghai Social insurance shall not b™e deducted;

- If the period during which the pregnancy and perinatal examinati×on fee is incurred by the female insured spans two insurance years•, the Company shall compensate the accumulated maternity≥ expenses of the female insured according to the welfare standard of the insurance year i✔n which the child is delivered.

Instructions for filing a claim

1. Claim application procedures:

1) When Chinese employees apply for claims, they can send complete materials required for ∞claims to the customer service Department of our company.

2) The required materials are:

◇ Fill in the Employee Claim Application Form;

◇ Copy of medical record cover, copy of medical history (me∏dical history must clearly record the date of treatment, condition, drug naλme, dosage form, dosage, taking method, and stamped with doctδor's seal or full name);

◇ Original medical fee receipt (hospital certificate, handwritten receipt or copy of receipt← is invalid), the fee items and fee date on the receipt must be÷ consistent with the medical record;

◇ Photocopy of laboratory test and inspection report.

◇ Copy of discharge summary (hospitalization);

◇ A copy of the list of expenses during hospitalization (hospitalization);

2. Claim Settlement Instructions:

1) Cardholder medical treatment: Those who participate in social insurance pay¥ment, emergency and hospitalization must hold the social (medical) insurance card and medical reεcords manual in accordance with the medical insurance regulations, and those who do not use med‍ical insurance will not be paid. If the new employees see$k medical treatment, the medical insurance information has not been opened< during the medical treatment can only claim the personal self-financing partφ of the Shanghai medical insurance scope; Those who do not participate in Shanghaiδ medical insurance can only claim the self-financed part of Shanghai medical i•nsurance coverage;

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

3) According to the principle of insurance compensation, the compensation shall not exceed the actu¥al loss of the compensation. If the multi-party insurance can only pay the insu∏fficient part, the company will not pay the medical expenses already paid in other companies.

4) Outpatient and emergency medicine amount: emergency three days, outpat∑ient seven days, chronic disease 14 days, more than the prescribed amount of medicine costs 'will not be reimbursed.

5) All kinds of laboratory tests and disease examinations, the inspection report shoul•d be attached when applying for compensation;

6) Prescription medicine: the hospital prescription can only be obtained  in the hospital prescription, prescription or purchase of d₹rugs, will not be reimbursed.

7) Claim validity:

◇ The commencement date is the date on which the Company receives the premium paid by your unit;₽

◇ The expiration date shall be calculated from the date of t‍ermination or termination of the employment relationship of  the Chinese employee by the insured entity as agreed in the contract signed betwe en you and the company;

◇ The cost of the insurance plan is moderate

7) Claim validity:

◇ The commencement date is the date on which the Company receives the premium paid  by your unit;

◇ The expiration date shall be calculated from the date of termination or termination of the emplo₽yment relationship of the Chinese employee by the insured entδity as agreed in the contract signed between you and the company;

◇ The insurance plan fee shall be paid by the insured unit of the Chinese employee to the± company on a monthly basis. If the insured unit fails to pay the fee for more than 6‌0 days, the insurance plan shall be terminated.

Our company has a 30-day exemption period, during which the relevant expen‌ses will not be reimbursed.

8) Time limit for claim application: under normal circumstances, claim should b e applied within 60 days from the second day of medical treatment expenses£, and special circumstances can be extended appropriately.

Out-of-town treatment claims

1) If you fall ill during the business trip, you should receive emergency treatment± at the local county (district) level or county (district) level or abλove public general hospital (with emergency seal), a₩nd bring all the information to the nearest medical insurance center €within one month after the end of treatment to make up the settβlement procedures. With the original statement issued by λthe medical insurance center and a copy of the medical receipt (oth≥er materials and claims required materials) to our company‍ to settle claims;

2) If you work in the field for a long time (more t÷han 1 month), you need to submit the written proof ☆of the hiring company (and stamp the official seal), and go to the district and county medica l insurance for the transfer of medical relations. The e♣xpenses incurred for outpatient treatment in a public general hospital at or above the wor✘kplace shall be settled at the nearest medical insurance center according to the regulatio"ns of Shanghai Medical Insurance (within 3 months ¥from the date of receipt issued by the medical institution), and s≠hall be settled by our company with the original statement and ≤a copy of the medical receipt issued by the medical insurance center (other mat∑erials and materials required for claim settlement);

Scope of no claim

1. Seek treatment in hospitals that are not covered by medical insu♣rance and regulated by our company;

2. For those who have participated in Shanghai social ins♦urance payment, the social (medical) insurance card and m×edical treatment record manual have not been used in outεpatient, emergency and hospitalization;

3. Self-funded projects;

4. Dispensing medicines on behalf of patients without med÷ical history;

5. Medical treatment that is not paid for

1) Service items

◇ Consultation fee, out-patient fee, special outpatient fee;

◇ Urgent fees for examination and treatment, special medical‍ service fees (including nurses, escorts, follow-up visits, home visits, full mother-child ​service, special surgery surcharge, high quality and premium fees);

◇ Medical records, various billing costs.

2) Non-disease treatment programs

◇ A variety of beauty, bodybuilding projects and some non-funct£ional cosmetic surgery, orthopaedic surgery, etc. (such as: treatment of freckles, acne (pi$mples, pimples), facial pigmentation (melasma), moles&, white hair, hair transplant, ear piercing, facial mask, dental implants, mouαth deformity, snoring, flat feet, scar repair;

◇ Various cosmetic, orthopedic (except poliomyelitis sequela) and physiological defect treatm®ent (such as: armpit deodorization, cleft lip repair,÷ stuttering, orthotropia, and multiple fingers (toes), circumcision, "Q" le g "X" leg and other surgical items);

◇ A variety of weight loss, weight gain, increase, smoking cessation and ot↔her projects;

Diagnosis of human body information, computer selection of the best pregnancy peδriod, fetal sex and fetal development examination (except perinatal examination of female in✘sured persons) and other diagnosis and treatment items

◇ A variety of health examinations, vaccinations;

A variety of preventive health care diagnosis and treatment items (such as preventive appβendectomy, preventive tonsillectomy, etc.);

◇ Various medical consultation (including psychological consultaπtion, health consultation, diet consultation), medical appraisal (judicial appraisal, industriaΩl injury appraisal, labor appraisal, medical appraisal, paternity ap•praisal), various predictions (stroke prediction, health prediction, disease prediction) heal→th guidance and other projects.

3) Diagnosis and treatment items and medical materials

The use of positron tomography device, electron beam,δ cell knife, ophthalmic excimer laser therapy equipment and other large medical e←quipment for examination and treatment projects;

Glasses, dentures (including post crown, set crown, mounting dentures), prostheπtic eyes, prosthetic limbs, hearing AIDS and other rehabilitation equipment, a variet&y of self-use health care, massage, monitoring, inspect♥ion and treatment physiotherapy equipment;

◇ Implantable automatic multirate defibrillator (ICD);

◇ The price is limited to disposable medical materials that cannot be charged s£eparately according to the department.

4) Treatment items

Organ source or tissue source for transplantation of various organs or ≠tissues (except skin transplantation of burn patients);

Transplantation of organs or tissues other than kidney, heart valve, cornea, ski‍n, blood vessels, bone and bone marrow, and related operations t o obtain organ and tissue sources;

◇ Herniated disc

Myopia orthopedics, myopia (refractive error) examination and treatment;

Qigong therapy, music therapy, health nutrition therapy, magneαtic therapy and other auxiliary treatment items;

◇ Blood therapy, cosmetic teeth cleaning, dental prostheses, dental implants, dental orthod→ontics, dental plaque treatment, porcelain teeth and other projects;

◇ All kinds of venereal diseases, specific infectious diseases, AIDS,← mental illness, schizophrenia, sex reassignment surgery, human expe♥rimentation, artificial reproduction, contraception and s©terilization treatment costs, various infertility (sterility), s→exual dysfunction, tubal examination;

◇ Various painless examination (gastroscopy, colonoscopy, tracheoscopy, etc.) anesthesia →fees, painless abortion anesthesia fees;

◇ Use a variety of protein preparations (drugs containing α-2β components, genetically modified se≠eds, sunwhite energy, etc.);

5) Others

◇ A variety of scientific research, teaching, clinical validation of ↓diagnosis and treatment projects;

◇ All expenses incurred in violation of family planning;

All expenses arising from fighting, alcoholism, drug addiction, self-injury, self-harm, suicide≤, sexually transmitted diseases, pet bites, traffic accidents, medical accidents and othe÷r liability incidents;

◇ Medical expenses incurred when going abroad or to Hong K§ong, Macao or Taiwan for family visits, meetings, investigation, further study or∞ lectures;

The inpatient who should be discharged but refuses to be discharged shall be identified‍ by the medical technical appraisal team to confirm that the inpatie↑nt treatment has been established, and the diagnosis and treatment items and all expenses incurr♦ed from the second day after the identification and confirmation; The medical treatment items and a&ll expenses incurred by the insured personnel who are hospitalized i¥n name or do not meet the admission standards;

◇ Medical expenses incurred for health care and unauthorized rehabilitation.

6. Scope of items for non-reimbursed medical services facilities

Referral transportation, first aid fare, outpatient medicine decocting fee↕, traditional Chinese medicine processing fee, meal fee, disposable items such as sheets, ÷diapers, garbage bags and other special life service fee↓s.

7. Taking, applying or injecting drugs without following medical →advice;

8. Treatment and rehabilitation of uncured diseases and pre-existing disaδbilities before insurance;

9. Engaged in diving, water skiing, rafting, skiing, skydiving, rock climbing, adventure a☆ctivities, martial arts competition, wrestling competition, stunt show, horse♦ racing, racing and other high-risk sports;

10. War, military action, insurrection or armed rebellion;

11. Nuclear explosion, radiation or contamination;

12. Other non-claims or expenses incurred during t>he period of exemption specified in this Manual

Relevant definition

Emergency conditions refer to the following conditions that requir≥e an emergency stamp on the medical record:

◇ High fever (38.5 degrees for adults, 39 degrees for children);

Acute abdominal pain, severe vomiting, severe diarrhea;

◇ Shock of various causes;

◇ Coma;

◇ Seizures;

Severe wheezing and dyspnea;

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

Hypertensive crisis, hypertensive encephalopathy, cerebrovasculaεr accident;

◇ Acute bleeding due to various reasons;

◇ Acute urinary effusion, urinary asthenia, hemato♥mia, renal colic;

All kinds of acute poisoning (food or drug poisoning). Various accidents (electrocut™ion, drowning, hanging, throat cutting);

Traumatic brain injury, fracture, dislocation, laceration, burn, scalding or other acute traum✘a;

◇ All kinds of poisonous animals, insect bites, acute aller'gic diseases;

Foreign bodies in the five features, respiratory tract and esophagus,₹ acute eye pain, red or swollen eyes, sudden visual impairment and eye traumγa;

◇ Diseases of infants within two months;

◇ Other critical and serious patients should be given emergency treεatment.

Chronic diseases:

◇ Chronic obstructive Pulmonary disease (Bronchiectasis)

◇ Chronic pancreatitis

◇ Tuberculosis

◇ Chronic atrophic gastritis

◇ High blood pressure (Stage 2 and above)

◇ Chronic glomerulonephritis

◇ Coronary heart disease

Rheumatic heart disease

◇ Chronic pulmonary heart disease

◇ Chronic cardiac insufficiency

◇ Necrosis of the femoral head

Cerebrovascular accident (cerebral hemorrhage, cerebral thrombo♠sis, cerebral infarction, cerebral atrophy and sequelae)

◇ Systemic lupus erythematosus

◇ Chronic viral active hepatitis

◇ Cirrhosis of the liver

◇ Aplastic anemia

◇ Chronic renal insufficiency (including uremia)

◇ Diabetes

◇ Parkinson's disease

◇ Epilepsy

◇ Malignant tumors (including outpatient radiotherapy and chemotherapy♠)

◇ Leprosy

◇ Rejection therapy after organ transplantation

◇ Severe burns (two degrees deep, 20% area or more)