MSH China Advanced Individual Health Plan Proposal

Size: px
Start display at page:

Download "MSH China Advanced Individual Health Plan Proposal"

Transcription

1 MSH China Advanced Individual Health Plan Proposal Prepared by: MSH China March,

2 Table of Contents Page SectionⅠ Company Introduction 3 SectionⅡ Plan Introduction 4 Ⅰ Geographic Coverage 4 Ⅱ Benefit Schedule 4 Ⅲ Exclusions 8 Section ⅢPlan Administration 9 Ⅰ Eligibility 9 Ⅱ Enrollment Guidelines 9 Ⅲ Service Highlights 9 Section ⅣQuotation 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 14years 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 theiso27001 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 in2013. MSH CHINA istheno.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 Section II. 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 up to 500,000 is covered 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 ;Emergency coverage up to 500,000 is covered outside of Mainland China, Taiwan, Macao and Hong Kong. Emergency coverage outside of Mainland China, Taiwan, Macao and Hong Kong 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. *Provider Co payment in high cost providers 0% for Worldwide Plan/ International (Plus) See Note 2 for a reference list of Provider Co payment. Plan No coverage for Greater China (Plus) Inpatient and Day care Treatment 4

5 *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 Hospice Care Covered up to 45 days 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 For Worldwide Plan: Fully Covered For Other Plans: Covered up to 80,000 Doctor s Fees, Specialist s Fees Prescription Drugs Laboratory Tests, X rays, Diagnostic Tests and Procedures Therapy Including Physiotherapy, chiropractic therapy, vocational therapy, speech and occupational therapy Covered up to 40,000 for Worldwide Plan/ International (Plus) Plan 800 per visit, up to 20 visits for Greater China (Plus) Plan Acupuncture and Homeopathy Covered up to 4,000 Traditional Chinese Medicine Consultation fee, diagnosticfee, Traditional Chinese Medicines prescribed by a registered traditional Chinese physician Chinese Public Hospitals: Other Providers: 300 per visit, up to 20 visits 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 Durable Medical Equipment Hospice Care Covered up to 40,000 5

6 Special Conditions Pre existing Conditions Any Illness or Injury, physical or mental condition, for which an Insured Person received any diagnosis, medical advice or treatment, or had taken any prescribed drug, or where distinct symptoms were evident prior to the effective date A 2 year moratorium term will be applied. Covered after 24 months continuous cover if there is no morbidity, symptom, related examination or medical treatment during the 24 months Chronic Conditions Covered up to 200,000; For Chronic Maintenance and palliative treatment for chronic medical conditions Conditions immediately happened (normally within 180 days) after the policy start date, it will be subject to pre existing investigation Chronic Conditions Stabilization of acute exacerbations of chronic conditions Major Organ Failure or Transplant Covered up to 2,000,000 Congenital Conditions / Birth Anomalies Covered up to 60,000 Mental Health Inpatient: Covered up to 50,000 Outpatient: Covered up to 20 visits Rehabilitation Treatment for Alcohol and Drug Abuse: Not covered Emergency Evacuation Ground Ambulance Emergency Medical Evacuation Economy class air tickets for an accompanying person, 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 For an accompanying person in case of emergency medical evacuation Covered up to 12 nights and 800 per night Repatriation of Mortal Remains / Local Burial Covered up to 160,000 Preventive Care Pap Smear and Mammogram for Female Once per policy year Pap Smear and Mammogram for dependent daughters are not covered Prostate Exam for Male Once per policy year Prostate Exam for dependent sons is not covered Screenings Recommended by a Physician Due to Family Medical History Covered up to 2,000 Wellness Routine Exams, Annual Full Body Check up, Immunizations Optional Benefit Covered up to 3,200, no waiting period Emergency Dental Emergency treatment necessary to restore or replace sound natural teeth Covered up to 40,000 damaged in an accident Damage to teeth caused by chewing foods does not qualify 6

7 Dental Treatment Include Class I, Class II and Class III Services Optional Benefit Covered up to 4,000or 8,000 if selected, no waiting period Class I Preventive Treatment 100% covered Routine examination, cleanings (twice a year), dental health instruction, fluoride treatment, scale and polish (Prophylaxis) Class II Basic Treatment 80% covered Amalgam or composite fillings, simple extractions, periodontal scaling and root planting Class III Major Treatment 50% covered Root fillings, crowns and inlays, bridges, wisdom teeth extractions, and orthodontic treatment Maternity Benefits, 12 month Waiting Period Optional Benefit Maternity Prenatal care, normal delivery or medically necessary C section and postnatal Covered up to 68,000 per pregnancy for Worldwide Plan/ International (Plus) Plan care Maternity Benefits for Dependent daughters are not covered Covered up to 40,000 per pregnancy for Greater China (Plus) Plan Complications of Pregnancy Infant Care for the first 14 days without notification; after enrollment Routine Exams for Infant within age of 12 months Covered up to 6 visits If Maternity Benefit is selected and waiting period is passed Immunizations for Infant within age of 12 months If Maternity Benefit is selected and waiting period is passed Diphtheria, hepatitis B, measles, mumps, pertussis, polio, rubella, tetanus, varicella, haemophilus influenza B, hepatitis A Additional Options Outpatient Cap Covered up to 30,000 Policy Co payment a) 20% for Outpatient only b)20% for Inpatient with 60,000 out of pocket maximum only c) 20% for Outpatient and 20% for Inpatient with 60,000 out of pocket maximum Provider Co payment For International (Plus) Plan & Worldwide Plan Only d)20% for Outpatient e)20% for Inpatient with 60,000 out of pocket maximum f) 20% for Outpatient and 20% for Inpatient with 60,000 out of pocket maximum Individual Annual Deductibles Optional 800, 1,600, 2,000, 4,000, 8,000 or 16,000 7

8 Note 1 For Worldwide Plan, there would be a special co payment. If the treatment is taken out of U.S. Network, the following co payment would be applied. 0% when no Network provider is located within a 30 mile radius 20% when Network provider is available within a 30 mile radius For outpatient Prescription Drugs, the following co payment would be applied: Within U.S. Network: Formulary Drug Guide co payment Outside of U.S. Network: Formulary Drug Guide co payment +20% additional co payment Note 2 A reference list in which Provider Co payment will be applied includes: United Family Hospitals and Clinics (Beijing, Shanghai, and other cities if any) ParkwayHealth Clinics / Gleneagles International Medical & Surgical Center SinoUnited Health Medical Center (Shanghai) Shanghai Global HealthCare Shanghai East International Medical Center Hong Kong International Medical Clinic (Beijing) OASIS International Hospital(Beijing) International SOS Clinics (Beijing, Tianjin, Nanjing, Shenzhen) Adventist Hospital (Hong Kong) Matilda International Hospital (Hong Kong) Sanatorium Hospital (Hong Kong) No coverage in above medical providers for Greater China (Plus) members. 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. Any pre existing condition, for which an Insured Person received diagnosis, medical advice or treatment, or had taken any prescribed drug, or where distinct symptoms were evident prior to the effective date 8

9 Additional Items ante natal classes and circumcisions Exceptional Risks professional sports Charges in excess of Usual and Customary Fees Coverage in above medical facilities (see Note 2 on Page 7 8) for Greater China (Plus) members 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 from 60 days and up to 21 years old (24 if full time student) 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; for family status change please notify us within 30 days. Newborn infants should be enrolled within 30 days after birth if the baby delivery is covered by the plan; Otherwise the newborn baby will be subject to medical underwriting and can be added from 60 days Service Highlights Wide and Most In depth Medical Network Global medical network of more than 860,000 hospitals and clinics across 150 countries in 6 continents Most in depth local network in Greater China for 1,500 hospitals and Clinics in over 38 major cities Most convenient and efficiency direct billing service for all Outpatient and Inpatient treatment items because of over 10 years network partnership and advanced IT system On site MSH representatives in top local hospitals to ensure VIP experience for MSH members Note: Direct billing service would be available if a valid credit / debit card guarantee letter can be signed. Thoughtful Customer Service and Communication System Bi lingual 24/7/365 Call Center capable of worldwide emergency assistance and local bilingual claim, pre authorization support, hospital or specialties referral service within network anytime and anywhere Designated account manager teams in Shanghai, Beijing, Guangzhou, Wuhan, Shenzhen, Chengdu, Dalian and Suzhou to ensure implementation of health plan and the communication with the insured members. Bi lingual global online service to track claim status, benefit details, updated direct billing provider list and to automatically generate a claim form with personal information. Practical Value Added Services Case Management and medical escort service if member requires major medical treatment Hospital and specialties referral and appointment assistance services Free Mobile APP to help members locate nearby network provider(s), track claim records & status, and check pre authorization status if any, etc. ISO Rewards First international health insurance service provider to be accredited the ISO9001 quality system certification and ISO27001 Information Security Certification. 9

10 Section IV. Quotation (Valid from April 1 st, 2014 to March 31 st, 2015) Currency: RMB 2014 Individual Annual Premium Rates, 0% Provider Co payment, NO Maternity Benefits Coverage Type Greater China 11,225 9,354 11,665 12,961 14,154 16,994 19,342 23,083 27,581 34,253 45,092 63, ,233 Greater China Plus 12,304 10,427 12,880 14,309 15,544 18,446 20,844 24,694 29,344 36,244 47,358 65, ,695 International 18,025 15,021 18,732 20,923 22,485 27,165 31,221 37,464 45,070 55,974 73, , ,149 International Plus 18,511 15,687 19,378 22,369 23,916 28,538 32,573 38,754 46,359 57,255 74, , ,945 Worldwide 24,079 21,499 26,557 29,658 31,880 38,499 44,267 53,115 63,920 79, , , ,513 No coverage in the listed medical providers (see Note 2 on Page 8) for Greater China (Plus) members. Optional Maternity Benefits & Outpatient Cap, Discount is applied for ALL Family Members Optional Benefits Discount Optional Maternity +25% Optional Outpatient Cap to 30,000 5% You can choose 1 option benefit of below 3 items, Discount is applied for ALL Family Members (1) Policy Co payment Discount a) 20% for Outpatient 18% b)20% for Inpatient with 60,000 out of pocket maximum 12% c) 20% for Outpatient and 20% for Inpatient with 60,000 out of pocket maximum 30% (2) Provider Co payment (for International (Plus) Plan & Worldwide Plan only) Discount d) 20% for Outpatient 15% e)20% for Inpatient with 60,000 out of pocket maximum 10% f) 20% for Outpatient and 20% for Inpatient with 60,000 out of pocket maximum 25% (3) Annual Deductible 800 1,600 2,000 4,000 8,000 16,000 Greater China (Plus) Plan 7% 13% 16% 28% 42% 58% International (Plus) Plan/ Worldwide Plan 4% 9% 10% 17% 25% 35% Optional Wellness & Routine Dental Benefits, ONLY available for ALL Family Members Coverage Adult Dependent Child 3,200 Wellness Benefit 2,662 1,996 4,000 Dental Benefit 2,189 1,642 8,000 Dental Benefit 4,243 3,182 Note: 1) Children aged 0 17 can only be enrolled as dependents. 2) Maternity Benefit is only available for two adults enrolled together (couple or whole family). 3) This quotation is only applicable to members who are living in Mainland China, Hong Kong, Macao and Taiwan for most of the time during the policy year. 4) Lump sum annual payment is required. 10

11 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 or sugary 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

12 Appendix B: Direct Billing Hospitals List China (As of Jan. 1 st, 2014) Please click 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 FudanUniversity,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 ShuGuang 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 ShuGuang 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

13 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 TiantanPuhua 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 YafeiDenta 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 MeigeerDendal 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

14 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 NongkenSanya 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 check. Asia Please click check. Other Regions Please click of world.html to check. 14

Benefits at a Glance. Vectrus Systems Corporation Policy Number: 04804A. OAP Global Plan

Benefits at a Glance. Vectrus Systems Corporation Policy Number: 04804A. OAP Global Plan Benefits at a Glance Vectrus Systems Corporation Policy Number: 04804A OAP Global Plan Vectrus Systems Corporation Long Benefits at a Glance Policy # 04804A Effective Date January 1, 2016 Vectrus Systems

More information

RSNA EMPLOYEE BENEFIT TRUST PLAN II S2502 NON GRANDFATHERED PLAN BENEFIT SHEET

RSNA EMPLOYEE BENEFIT TRUST PLAN II S2502 NON GRANDFATHERED PLAN BENEFIT SHEET BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Standard COB Dependents Children birth to age 26 Filing Limit 1 year from date of service Mailing Address & PPO Company. Remit claims to:

More information

Amherst Central School District First Choice Health Plan. Non-First Choice Providers and Out-of-Network Providers

Amherst Central School District First Choice Health Plan. Non-First Choice Providers and Out-of-Network Providers Health: Hospital Services provided by First Choice Preferred Provider Network Medical Services Radiology, Ultrasounds 20% after $500 individual or Laboratory Testing 20% after $500 individual or MRI and

More information

Choice PPO Retired Employees Health Program Non-Medicare Eligible Retired Members

Choice PPO Retired Employees Health Program Non-Medicare Eligible Retired Members Choice PPO Retired Employees Health Program Non-Medicare Eligible Retired Members DEDUCTIBLE (per calendar year) Annual in-network deductible must be paid first for the following services: Imaging, hospital

More information

1199SEIU Greater New York Benefit Fund OVERVIEW OF YOUR BENEFITS

1199SEIU Greater New York Benefit Fund OVERVIEW OF YOUR BENEFITS 1199SEIU Greater New York Benefit Fund OVERVIEW OF YOUR BENEFITS I HOSPITAL CARE This benefit is for the hospital s charge for the use of its facility only. Coverage for services rendered by doctors, labs,

More information

SUMMARY OF P-5-5 BENEFITS AND SCHEDULE OF COPAYMENTS

SUMMARY OF P-5-5 BENEFITS AND SCHEDULE OF COPAYMENTS SUMMARY OF P-5-5 BENEFITS AND SCHEDULE OF COPAYMENTS THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND IS A SUMMARY ONLY. THE EVIDENCE OF COVERAGE AND PLAN CONTRACT SHOULD BE

More information

Schedule of Benefits

Schedule of Benefits Schedule of Benefits ANTHEM Small Business Health Options Program (SHOP) This is a brief schedule of benefits. Refer to your Anthem Certificate of Coverage (Booklet) for complete details on benefits, conditions,

More information

OVERVIEW OF YOUR BENEFITS

OVERVIEW OF YOUR BENEFITS OVERVIEW OF YOUR BENEFITS IMPORTANT PHONE NUMBERS Member Services Department (646) 473-9200 For answers to questions about your benefits or to be referred to another Benefit Fund department. Program for

More information

Your Out-of-Pocket Type of Service

Your Out-of-Pocket Type of Service Calendar Year Deductible (CYD) 1 $3,000 single/ 3x family Out-of-Pocket Maximum - Deductibles and copays all accrue towards the out-of-pocket $6,200 single/ 2x family maximum. With respect to family plans,

More information

Your Out-of-Pocket Type of Service

Your Out-of-Pocket Type of Service Calendar Year Deductible (CYD) 1 $0 single/ 3x family Out-of-Pocket Maximum - Deductibles, coinsurance and copays all accrue toward the outof-pocket maximum. With respect to family plans, an individual

More information

MERCY MEDICAL CENTER - DUBUQUE TRADITIONAL PPO PLAN $10/20%/40% RX PROVIDED BY PREFERRED HEALTH CHOICES EFFECTIVE JANUARY 1, 2015

MERCY MEDICAL CENTER - DUBUQUE TRADITIONAL PPO PLAN $10/20%/40% RX PROVIDED BY PREFERRED HEALTH CHOICES EFFECTIVE JANUARY 1, 2015 MERCY MEDICAL CENTER - DUBUQUE TRADITIONAL PPO PLAN $10/20%/40% RX PROVIDED BY PREFERRED HEALTH CHOICES EFFECTIVE JANUARY 1, 2015 DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS facilities and Aligned

More information

BCBSM provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims.

BCBSM provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims. Michigan Catholic Conference Group Number: 71755 Package Code(s): 010 Section Code(s): 1000, 2000 PPO - PPO1, Hearing, Vision ( Exam only) Effective Date: 01/01/2018 Benefits-at-a-glance This is intended

More information

CONRAD INDUSTRIES, INC. S2489 NON GRANDFATHERED PLAN BENEFIT SHEET

CONRAD INDUSTRIES, INC. S2489 NON GRANDFATHERED PLAN BENEFIT SHEET BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Standard COB Dependents Children to age 26 Filing Limit 12 months from date of service Mailing Address & PPO Company. PPO Co.: PPO CIGNA

More information

SUMMARY OF BENEFITS. Hamilton County Department of Education Network Copay Plan. Connecticut General Life Insurance Co.

SUMMARY OF BENEFITS. Hamilton County Department of Education Network Copay Plan. Connecticut General Life Insurance Co. SUMMARY OF BENEFITS Connecticut General Life Insurance Co. Hamilton County Department of Education Annual deductibles and maximums Lifetime maximum Pre-Existing Condition Limitation (PCL) Coinsurance All

More information

The MITRE Corporation Plan

The MITRE Corporation Plan Benefit Type Plan Year Type Calendar Year Annual Medical Out of (for certain services) Employee Employee + 1 Family Annual Prescription Drug Out of Employee Employee + 1 Family Copayments: One copay per

More information

Summary of Benefits Prominence Preferred Health Insurance Small Group Health Plan

Summary of Benefits Prominence Preferred Health Insurance Small Group Health Plan Calendar Year Deductible (CYD) 2 $1,000 Single / $3,000 Family $3,000 Single / $9,000 Family Coinsurance - Member responsibility 20% coinsurance 50% coinsurance Out-of-Pocket Maximum 3 - Deductibles, coinsurance

More information

TRADITIONAL PPO PLAN FT. LAUDERDALE $10/20%/40% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC.

TRADITIONAL PPO PLAN FT. LAUDERDALE $10/20%/40% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC. TRADITIONAL PPO PLAN FT. LAUDERDALE $10/20%/40% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned Deductible

More information

NY EPO OA 1-09 v Page 1

NY EPO OA 1-09 v Page 1 PLAN FEATURES Deductible (per calendar year) Member Coinsurance (applies to all expenses unless otherwise stated) Maximum Out-of-Pocket Limit (per calendar year) Lifetime Maximum (per member lifetime)

More information

Blue Shield of California

Blue Shield of California An independent member of the Blue Shield Association City of San Jose Custom ASO PPO 100 90/70 Active Employees Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage

More information

HEALTH SAVINGS PPO PLAN (WITH HSA) FT. LAUDERDALE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JUNE 1, 2017 AETNA INC.

HEALTH SAVINGS PPO PLAN (WITH HSA) FT. LAUDERDALE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JUNE 1, 2017 AETNA INC. HEALTH SAVINGS PPO PLAN (WITH HSA) FT. LAUDERDALE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JUNE 1, 2017 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned Deductible

More information

Irvine Unified School District ASO PPO /50

Irvine Unified School District ASO PPO /50 An Independent member of the Blue Shield Association Irvine Unified School District ASO PPO 500 90/50 Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage Matrix) THIS

More information

HEALTH SAVINGS PPO PLAN (WITH HSA) - BOISE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE June 1, 2017 AETNA INC. CPOS II

HEALTH SAVINGS PPO PLAN (WITH HSA) - BOISE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE June 1, 2017 AETNA INC. CPOS II HEALTH SAVINGS PPO PLAN (WITH HSA) - BOISE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE June 1, 2017 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned Deductible -

More information

WILLIS KNIGHTON MEDICAL CENTER S2763 NON GRANDFATHERED PLAN BENEFIT SHEET

WILLIS KNIGHTON MEDICAL CENTER S2763 NON GRANDFATHERED PLAN BENEFIT SHEET BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Customized COB Dependents Children birth to 26 Filing Limit 12 months For employees that work in a WKHS location within the primary HealthPlus

More information

Medical Plans Benefit Guide

Medical Plans Benefit Guide Medical Plans Benefit Guide Employers with 1-50 employees 1.1.01 Provider network built for value and quality... Wellness rewards...3 Medical Travel Support and Air or Surface Transportation... Support

More information

Kaiser Permanente Group Plan 301 Benefit and Payment Chart

Kaiser Permanente Group Plan 301 Benefit and Payment Chart 301 Kaiser Permanente Group Plan 301 Benefit and Payment Chart 10119 CITY AND COUNTY OF SAN FRANCISCO About this chart This benefit and payment chart: Is a summary of covered services and other benefits.

More information

ESSENTIAL ASSIST PPO PLAN (WITH HRA) $10/25%/50% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC.

ESSENTIAL ASSIST PPO PLAN (WITH HRA) $10/25%/50% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC. ESSENTIAL ASSIST PPO PLAN (WITH HRA) $10/25%/50% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned

More information

Skilled nursing facility visits

Skilled nursing facility visits Modified Premier HMO 20 Non Union This Summary of Benefits is a brief overview of your plan's benefits only. For more detailed information about the benefits in your plan, please refer to your Certificate

More information

Blue Cross Premier Bronze

Blue Cross Premier Bronze An individual PPO health plan from Blue Cross Blue Shield of Michigan. You will have a broad choice of doctors and hospitals within BCBSM s unsurpassed statewide PPO network including nationwide coverage.

More information

Telemedicine services $0 copay Not applicable Primary care provider (PCP) CYD/Coinsurance CYD/Coinsurance CYD/Coinsurance CYD/Coinsurance

Telemedicine services $0 copay Not applicable Primary care provider (PCP) CYD/Coinsurance CYD/Coinsurance CYD/Coinsurance CYD/Coinsurance Calendar Year Deductible (CYD) 2 Plan includes an embedded individual deductible provision. An embedded deductible combines individual and family deductibles in $4,000 Single / $8,000 Family $12,000 Single

More information

ST. MARY S HEALTHCARE SYSTEM, INC. Case # GA6476 BlueChoice HMO Benefit Summary Effective: January 1, 2018

ST. MARY S HEALTHCARE SYSTEM, INC. Case # GA6476 BlueChoice HMO Benefit Summary Effective: January 1, 2018 ST. MARY S HEALTHCARE SYSTEM, INC. Case # GA6476 BlueChoice HMO Benefit Summary Effective: January 1, 2018 All benefits are subject to the calendar year deductible, except those with in-network copayments,

More information

2018 CareOregon Advantage Plus (HMO-POS SNP) Summary of Benefits

2018 CareOregon Advantage Plus (HMO-POS SNP) Summary of Benefits 2018 CareOregon Advantage Plus (HMO-POS SNP) Summary of Benefits For Oregon counties: Clackamas, Clatsop, Columbia, Jackson, Josephine, Multnomah, Tillamook, Washington and Yamhill H5859_1099_CO_1018 CMS

More information

Services Covered by Molina Healthcare

Services Covered by Molina Healthcare Services Covered by Molina Healthcare As a Molina Healthcare member, you will continue to receive all medically-necessary Medicaid-covered services at no cost to you. The following list of covered services

More information

PLAN DESIGN AND BENEFITS - PA POS 4.2 with $5/$15/$30 RX PARTICIPATING PROVIDERS

PLAN DESIGN AND BENEFITS - PA POS 4.2 with $5/$15/$30 RX PARTICIPATING PROVIDERS PLAN FEATURES Deductible (per calendar year) PHYSICIAN SERVICES Primary Care Physician Visits Specialist Office Visits Maternity OB Visits Allergy Treatment Allergy Testing PREVENTIVE CARE Routine Adult

More information

CITY OF SLIDELL S2630 NON-GRANDFATHERED BENEFIT SHEET

CITY OF SLIDELL S2630 NON-GRANDFATHERED BENEFIT SHEET CITY OF SLIDELL S2630 BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Standard COB Dependents Children birth to 26 No later than 365 days after the Filing Limit date expenses are incurred

More information

GIC Employees/Retirees without Medicare

GIC Employees/Retirees without Medicare GIC Active Employees & Retirees without Medicare 7/1/18 GIC Employees/Retirees without Medicare HMO Summary of Benefits Chart This chart provides a summary of key services offered by your Health New England

More information

Schedule of Benefits-EPO

Schedule of Benefits-EPO Schedule of Benefits-EPO [Plan Information] [Health Plan:] [Ambetter Balanced Care 3 (2018)-Standard Silver On Exchange Plan] [Primary Member:] [John Doe] [Member ID:] [01213456] [Date of Birth:] [08/12/62]

More information

$10 copay. $10 copay. $10 copay $5 copay $10 copay $5 copay. $10 copay. No charge. No charge. No charge

$10 copay. $10 copay. $10 copay $5 copay $10 copay $5 copay. $10 copay. No charge. No charge. No charge PLAN FEATURES * ** Deductible (per calendar ) Member Coinsurance Copay Maximum (per calendar ) Lifetime Maximum Unlimited Primary Care Physician Selection Required Upon enrollment to a Vitalidad Plus plan,

More information

GLOBAL HEALTH ADVANTAGE 2 to 20

GLOBAL HEALTH ADVANTAGE 2 to 20 GLOBAL HEALTH ADVANTAGE 2 to 20 Benefits Proposal Prepared specially for Marathon Petroleum Effective Date: 01/01/2018 112336 8/17 Offered by: Cigna Health and Life Insurance Company, Connecticut General

More information

2016 Medical Plan Comparison Chart

2016 Medical Plan Comparison Chart 2016 Medical Plan Comparison Chart WellStar Health System is committed to helping you control healthcare costs while providing more choices and personal control over your healthcare coverage through the

More information

MyHPN Solutions HMO Gold 7

MyHPN Solutions HMO Gold 7 MyHPN Solutions HMO Gold 7 HIOS ID: 95865NV0030074 Attachment A Benefit Schedule Calendar Year Deductible (CYD): $3,000 of EME per Member and $6,000 of EME per family. The Calendar Year Out of Pocket Maximum

More information

Opportunities in China Healthcare Sector

Opportunities in China Healthcare Sector Opportunities in China Healthcare Sector Position paper - web edition, January 2013 Executive summary China represents one of the most rapidly growing healthcare markets in the world and all major drivers

More information

Super Blue Plus 2000 WVHTC High Option-B (Non-Grandfathered) $200 Deductible

Super Blue Plus 2000 WVHTC High Option-B (Non-Grandfathered) $200 Deductible BENEFIT HIGHLIGHTS 1 Super Blue Plus 2000 WVHTC High Option-B (Non-Grandfathered) $200 Group Effective Date December 1, 2017 Benefit Period (used for and Coinsurance limits) January 1 through December

More information

CALIFORNIA Small Group HMO Aetna Health of California, Inc. Plan Effective Date: 04/01/2007. Aetna Value Network* HMO $30/$40

CALIFORNIA Small Group HMO Aetna Health of California, Inc. Plan Effective Date: 04/01/2007. Aetna Value Network* HMO $30/$40 PLAN FEATURES Deductible (per calendar year) Member Coinsurance Lifetime Maximum Primary Care Physician Selection Referral Requirement PHYSICIAN SERVICES CALIFORNIA Small Group HMO Primary Care Physician

More information

Cigna Summary of Benefits Open Access Plus Copay Plan (OAP10)

Cigna Summary of Benefits Open Access Plus Copay Plan (OAP10) Cigna Care Network (CCN) Cigna Summary of Benefits Open Access Plus Copay Plan (OAP10) Cigna Care Network (CCN) Your employer has selected a Cigna Care Network (CCN) plan. When you need specialty care,

More information

Summary of Benefits. January 1, 2018 December 31, Providence Medicare Dual Plus (HMO SNP)

Summary of Benefits. January 1, 2018 December 31, Providence Medicare Dual Plus (HMO SNP) Summary of Benefits January 1, 2018 December 31, 2018 Providence Medicare Dual Plus (HMO SNP) This plan is available in Clackamas, Multnomah and Washington counties in Oregon for members who are eligible

More information

Kaiser Permanente (No. and So. California) 2018 Union

Kaiser Permanente (No. and So. California) 2018 Union Kaiser Permanente (No. and So. California) General Information Lifetime Maximum Benefit Annual Maximum Benefit Coinsurance Percentage Precertification Requirements Precertification Penalty Health Savings

More information

Aetna Health of California, Inc.

Aetna Health of California, Inc. Easily locate PrimeCare participating providers at www.aetna.com/docfind/primecare PLAN FEATURES Deductible (per calendar year) Member Coinsurance Lifetime Maximum Primary Care Physician Selection Referral

More information

Summary of Benefits Platinum Full PPO 0/10 OffEx

Summary of Benefits Platinum Full PPO 0/10 OffEx Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits Platinum Full PPO 0/10 OffEx Group Plan PPO Benefit Plan This Summary of Benefits shows the amount

More information

Summary of Benefits Prominence HealthFirst Small Group Health Plan

Summary of Benefits Prominence HealthFirst Small Group Health Plan POS Triple Choice 3000 Summary of Benefits Calendar Year Deductible (CYD) $3,000 Single / $9,000 Family $7,000 Single / $21,000 Family $21,000 Single / $63,000 Family Coinsurance 40% coinsurance 50% coinsurance

More information

Blue Shield Gold 80 HMO 0/30 + Child Dental INF

Blue Shield Gold 80 HMO 0/30 + Child Dental INF Blue Shield Gold 80 HMO 0/30 + Child Dental INF Benefit Summary (For groups 1 to 100) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2017 THIS MATRIX

More information

SENIOR MED, LLC EMPLOYEE BENEFIT PLAN MEDICAL BENEFITS SCHEDULE LOW PLAN Effective April 1, 2014

SENIOR MED, LLC EMPLOYEE BENEFIT PLAN MEDICAL BENEFITS SCHEDULE LOW PLAN Effective April 1, 2014 LOW PLAN MAXIMUM BENEFIT AMOUNT: Aggregate Annual Limit NETWORK PROVIDERS NOTE: Benefits are only covered at Network Providers. No coverage is available at NON-NETWORK Providers, except where indicated

More information

Gold Access+ HMO 500/35 OffEx

Gold Access+ HMO 500/35 OffEx An Independent Member of the Blue Shield Association Gold Access+ HMO 500/35 OffEx Benefit Summary (For groups 1 to 100) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective

More information

Services Covered by Molina Healthcare

Services Covered by Molina Healthcare Services Covered by Molina Healthcare Because you are covered by Medicaid, you pay nothing for covered services. As a Molina Healthcare member, you will continue to receive all medically necessary Medicaid-covered

More information

CA Group Business 2-50 Employees

CA Group Business 2-50 Employees PLAN FEATURES Network Primary Care Physician Selection Deductible (per calendar year) Member Coinsurance Copay Maximum (per calendar year) Lifetime Maximum Referral Requirement PHYSICIAN SERVICES Primary

More information

Regence Engage Plan Highlights For Groups of /1/2016

Regence Engage Plan Highlights For Groups of /1/2016 Plan Features Provider choice: Members have direct access to their choice of providers. Category 1 are Preferred; Category 2 are Participating; and Category 3 are Non-contracted providers. Simplicity:

More information

Summary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx]

Summary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx] Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx] Group Plan HMO Benefit

More information

HOME BANK - S2395 NON-GRANDFATHERED CONSUMER DRIVEN HEALTH PLAN BENEFIT SHEET

HOME BANK - S2395 NON-GRANDFATHERED CONSUMER DRIVEN HEALTH PLAN BENEFIT SHEET CONSUMER DRIVEN HEALTH PLAN BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Standard COB Dependents Children birth to 26 180 days from incurred Filing Limit date, except when 180 days would

More information

Platinum Trio ACO HMO 0/20 OffEx

Platinum Trio ACO HMO 0/20 OffEx Platinum Trio ACO HMO 0/20 OffEx Benefit Summary (For groups 1 to 100) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2017 THIS MATRIX IS INTENDED TO

More information

PROFESSIONAL SERVICES. 1199SEIU VIP Premier (HMO) Medicare INPATIENT HOSPITAL SERVICES. 1199SEIU VIP Premier (HMO) Medicare

PROFESSIONAL SERVICES. 1199SEIU VIP Premier (HMO) Medicare INPATIENT HOSPITAL SERVICES. 1199SEIU VIP Premier (HMO) Medicare PROFESSIONAL SERVICES PCP office visits Specialist office visits Annual physical exam/preventive care Physical, speech & occupational therapy Flu and pneumonia vaccinations Diagnostic services including

More information

High Deductible Health Plan (HDHP)

High Deductible Health Plan (HDHP) High Deductible Health Plan (HDHP) BeneFIts Summary Effective July 1, 2012 or October 1, 2012 Benefit Highlights How The Plan Works...1 Summary Of Benefits...4 Special Programs...7 Approval Of Care At

More information

Summary of Benefits Platinum Trio HMO 0/25 OffEx

Summary of Benefits Platinum Trio HMO 0/25 OffEx Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits Platinum Trio HMO 0/25 OffEx Group Plan HMO Benefit Plan This Summary of Benefits shows the amount

More information

Schedule of Benefits - HMO Group - MEDFORD AREA SCHOOL DISTRICT Benefit Year: January 1st through December 31st Effective Date: 01/01/2016

Schedule of Benefits - HMO Group - MEDFORD AREA SCHOOL DISTRICT Benefit Year: January 1st through December 31st Effective Date: 01/01/2016 Security Health Plan certifies that you and any covered dependents have coverage as described in your Certificate and Schedule of Benefits as of the effective date shown on the letter you received with

More information

Schedule of Benefits - Point of Service MOSINEE SCHOOL DISTRICT Benefit Year: January 1st Through December 31st Effective Date: 07/01/2016

Schedule of Benefits - Point of Service MOSINEE SCHOOL DISTRICT Benefit Year: January 1st Through December 31st Effective Date: 07/01/2016 Security Health Plan certifies that you and any covered dependents have coverage as described in your Certificate and Schedule of Benefits as of the effective date shown on the letter you received with

More information

This plan is pending regulatory approval.

This plan is pending regulatory approval. Bronze Full PPO 3000 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective October 1, 2015 THIS MATRIX IS INTENDED TO BE USED

More information

FLEX RETIREE MAP (Over 65 Flex Retirees) 2018 Benefits PROFESSIONAL SERVICES. Visit to a physician, physician assistant or nurse practitioner at a PPG

FLEX RETIREE MAP (Over 65 Flex Retirees) 2018 Benefits PROFESSIONAL SERVICES. Visit to a physician, physician assistant or nurse practitioner at a PPG PROFESSIONAL SERVICES Visit to a physician, physician assistant or nurse practitioner at a PPG Periodic health evaluations/preventive services - Applies when the only service(s) provided is a Medicare

More information

Kaiser Foundation Health Plan, Inc. A NONPROFIT HEALTH PLAN - HAWAII REGION

Kaiser Foundation Health Plan, Inc. A NONPROFIT HEALTH PLAN - HAWAII REGION Kaiser Foundation Health Plan, Inc. A NONPROFIT HEALTH PLAN - HAWAII REGION 2019 Summary of Important Changes for Contract Renewals for the Kaiser Permanente Group Plan (These changes are subject to regulatory

More information

Schedule of Benefits - Indemnity Group - MEDFORD AREA SCHOOL DISTRICT Benefit Year: January 1st through December 31st Effective Date: 01/01/2016

Schedule of Benefits - Indemnity Group - MEDFORD AREA SCHOOL DISTRICT Benefit Year: January 1st through December 31st Effective Date: 01/01/2016 Security Health Plan certifies that you and any covered dependents have coverage as described in your Certificate and Schedule of Benefits as of the effective date shown on the letter you received with

More information

Blue Shield $0 Cost-Share HMO AI-AN

Blue Shield $0 Cost-Share HMO AI-AN Blue Shield $0 Cost-Share HMO AI-AN This plan is only available to eligible Native Americans 1 Uniform Health Plan Benefits and Coverage Matrix Blue Shield of California Effective January 1, 2017 THIS

More information

FCPS BENEFITS COMPARISON FOR PLAN YEAR 2018 Active Employees and Retirees Under 65

FCPS BENEFITS COMPARISON FOR PLAN YEAR 2018 Active Employees and Retirees Under 65 BENEFIT Medical Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Unlimited Individual Annual Deductible $250 $500 $250 $500 None Family Annual Deductible $500 $1,000 $500 $1,000 None Medical Plan

More information

Benefits are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY

Benefits are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY PLAN FEATURES Annual Deductible The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Hearing aid reimbursement does not apply to the out-of-pocket

More information

Blue Shield Gold 80 HMO

Blue Shield Gold 80 HMO Blue Shield Gold 80 HMO Uniform Health Plan Benefits and Coverage Matrix Blue Shield of California Effective January 1, 2017 THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND

More information

Congressional Regional Plan BlueChoice HMO Referral Gold 80 Non-Integrated Deductible

Congressional Regional Plan BlueChoice HMO Referral Gold 80 Non-Integrated Deductible Congressional Regional Plan BlueChoice HMO Referral Gold 80 Non-Integrated Deductible Summary of Benefits Services In-Network You Pay 1 FIRSTHELP 24/7 NURSE ADVICE LINE Free advice from a registered nurse.

More information

Member s Responsibility: Deductible, Copays, Coinsurance and Maximums

Member s Responsibility: Deductible, Copays, Coinsurance and Maximums Benefits-at-a-Glance for GradCare 2018 This is intended as an easy-to-read summary. It is not a contract. Refer to the Your Benefits chapter in the Certificate for an official description of benefits.

More information

BENEFIT PLAN. What Your Plan Covers and How Benefits are Paid. Appendix A. Prepared Exclusively for The Dow Chemical Company

BENEFIT PLAN. What Your Plan Covers and How Benefits are Paid. Appendix A. Prepared Exclusively for The Dow Chemical Company Appendix A BENEFIT PLAN Prepared Exclusively for The Dow Chemical Company What Your Plan Covers and How Benefits are Paid Traditional Choice (Over Age 65 Retirees - Comprehensive Medical MAP Plus Option

More information

EXCLUSIVE CARE SUMMARY OF COVERED BENEFITS Select Medicare Eligible Supplement Plan

EXCLUSIVE CARE SUMMARY OF COVERED BENEFITS Select Medicare Eligible Supplement Plan 2018 EXCLUSIVE CARE SUMMARY OF COVERED BENEFITS Select Medicare Eligible Supplement Plan Summary Table of Benefits Select Medicare Supplement Plan PLAN REIMBURSEMENT METHOD DEDUCTIBLE - Individual Medicare

More information

SUMMARY OF BENEFITS. Cigna Health and Life Insurance Co. For Employees of - Digital Risk, LLC Open Access Plus Plan

SUMMARY OF BENEFITS. Cigna Health and Life Insurance Co. For Employees of - Digital Risk, LLC Open Access Plus Plan SUMMARY OF BENEFITS Cigna Health and Life Insurance Co. For Employees of - Digital Risk, LLC Open Access Plus Plan Notice of Grandfathered Plan Status This plan is being treated as a "grandfathered health

More information

$25 copay per visit annual deductible applies. $30 copay per visit annual deductible applies

$25 copay per visit annual deductible applies. $30 copay per visit annual deductible applies Minnesota Public Employees Insurance Program (PEIP) Advantage Health Plan 2018-2019 Benefits Schedule Benefit Provision Cost Level 1 You Pay Cost Level 2 You Pay Cost Level 3 You Pay Cost Level 4 You Pay

More information

HEALTH PLAN BENEFITS AND COVERAGE MATRIX

HEALTH PLAN BENEFITS AND COVERAGE MATRIX HEALTH PLAN BENEFITS AND COVERAGE MATRIX THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND IS A SUMMARY ONLY. THE EVIDENCE OF COVERAGE AND PLAN CONTRACT SHOULD BE CONSULTED FOR

More information

Single/Family $2,500/$5,000 $5,000/$10,000. Single/Family $6,000/$12,000 $10,000/None. Single/Family $5,000/$10,000 $6,250/$12,500

Single/Family $2,500/$5,000 $5,000/$10,000. Single/Family $6,000/$12,000 $10,000/None. Single/Family $5,000/$10,000 $6,250/$12,500 Plan Information Provider networks: Members have direct access to their choice of providers. Member cost-sharing is lowest for In-Network providers. If a member chooses an Out-of-Network provider, the

More information

SECTION II YOUR HEALTH BENEFITS

SECTION II YOUR HEALTH BENEFITS 54 SECTION II YOUR HEALTH BENEFITS A. Participating Providers Member Choice Panel Providers B. Using Your Benefits Wisely 1199SEIU Care Review Ambulatory/Outpatient Surgery Pre-Certification Managed Care

More information

Essential Health Benefits Addendum. Office of the Insurance Commissioner Washington State

Essential Health Benefits Addendum. Office of the Insurance Commissioner Washington State Essential Health Benefits Addendum Office of the Insurance Commissioner Washington State 1 Details, details Classification of Services Classification of a service may affect the scope of the available

More information

Platinum Local Access+ HMO $25 OffEx

Platinum Local Access+ HMO $25 OffEx Platinum Local Access+ HMO $25 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2015 THIS MATRIX IS INTENDED

More information

January 1, 2015 December 31, Maintenance Organization (HMO) offered by HEALTHNOW NEW YORK INC. with a Medicare contract)

January 1, 2015 December 31, Maintenance Organization (HMO) offered by HEALTHNOW NEW YORK INC. with a Medicare contract) BLUECROSS BLUESHIELD SENIOR BLUE 601 (HMO), BLUECROSS BLUESHIELD SENIOR BLUE HMO SELECT (HMO) AND BLUECROSS BLUESHIELD SENIOR BLUE HMO 651 PARTD (HMO) (a Medicare Advantage Health Maintenance Organization

More information

UNM Medical Plan. summary of benefits. Effective: July 1, 2012

UNM Medical Plan. summary of benefits. Effective: July 1, 2012 UNM Medical Plan summary of benefits Effective: July 1, 2012 Offered by The Regents of the University of New Mexico Administered by Lovelace Insurance Company administered by ANNUAL PLAN YEAR DEDUCTIBLE

More information

Optional PREFERRED CARE. Covered 100%; deductible waived. Covered 100%; deductible waived 30% after deductible

Optional PREFERRED CARE. Covered 100%; deductible waived. Covered 100%; deductible waived 30% after deductible PLAN FEATURES NON- Deductible (per calendar year) $500 Individual $750 Individual $1,500 Family $2,250 Family All covered expenses, excluding prescription drugs, accumulate toward both the preferred and

More information

BlueChoice HMO HSA/HRA Silver 2000 Integrated Deductible

BlueChoice HMO HSA/HRA Silver 2000 Integrated Deductible BlueChoice HMO HSA/HRA Silver 2000 Integrated Deductible Summary of Benefits Services In-Network You Pay 1 FIRSTHELP 24/7 NURSE ADVICE LINE Free advice from a registered nurse. Visit www.carefirst.com/needcare

More information

Doing Business in China Xylina Wu

Doing Business in China Xylina Wu Doing Business in China Xylina Wu Director of Business Development, Greater China May 7, 2010 Presentation Outline China Overview China Business Environment Business Models MA-China: MOITI s Services 2

More information

Health Reimbursement Account and Health Savings Account

Health Reimbursement Account and Health Savings Account Plan Design & Benefits 1 EFFECTIVE JANUARY 1, 2011 Health Reimbursement Account and Health Savings Account Employee: $1,000 Employee + spouse: $1,500 Employee + children: $1,500 Family: $2,000 Non- Employee:

More information

Stanislaus County Medical Benefits EPO Option. In-Network Benefits (Stanislaus County Partners in Out-of-Network Benefits

Stanislaus County Medical Benefits EPO Option. In-Network Benefits (Stanislaus County Partners in Out-of-Network Benefits Stanislaus County Medical EPO Option The following summary of benefits is a brief outline of the maximum amounts or special limits that may apply to benefits payable under the Plan. For a detailed description

More information

Schedule of Benefits HDHP WITH HSA MASSACHUSETTS

Schedule of Benefits HDHP WITH HSA MASSACHUSETTS Schedule of Benefits HDHP WITH HSA MASSACHUSETTS ID: MD0000017710_A9 X This Schedule of Benefits states any Benefit Limits and amounts you must pay for Covered Benefits. However, it is only a summary of

More information

FREEDOM BLUE PPO R CO 307 9/06. Freedom Blue PPO SM Summary of Benefits and Other Value Added Services

FREEDOM BLUE PPO R CO 307 9/06. Freedom Blue PPO SM Summary of Benefits and Other Value Added Services FREEDOM BLUE PPO R9943 2007 CO 307 9/06 Freedom Blue PPO SM Summary of Benefits and Other Value Added Services Introduction to Summary of Benefits for Freedom Blue January 1, 2007 - December 31, 2007 California

More information

Freedom Blue PPO SM Summary of Benefits

Freedom Blue PPO SM Summary of Benefits Freedom Blue PPO SM Summary of Benefits R9943-206-CO-308 10/05 Introduction to the Summary of Benefits for Freedom Blue PPO Plan January 1, 2006 - December 31, 2006 California YOU HAVE CHOICES IN YOUR

More information

Blue Cross provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims.

Blue Cross provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims. HOPE COLLEGE - HOURLY ORANGE 007013084/0011/0012/0013/0014/0015/0016/0017 Simply Blue PPO HSA ASC Effective Date: On or after July 2018 Benefits-at-a-glance This is intended as an easy-to-read summary

More information

Gold Access+ HMO $30 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix)

Gold Access+ HMO $30 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Gold Access+ HMO $30 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2015 THIS MATRIX IS INTENDED TO BE USED

More information

Covered Services List

Covered Services List CAREPLUS Covered Services List For CeltiCare Health with MassHealth CarePlus Coverage This is a list of all covered services and benefits for MassHealth CarePlus enrolled in CeltiCare Health. The list

More information

Single/Family $2,500/$5,000 $5,000/$10,000. Single/Family $6,000/$12,000 $10,000/None. Single/Family $5,000/$10,000 $6,250/$12,500

Single/Family $2,500/$5,000 $5,000/$10,000. Single/Family $6,000/$12,000 $10,000/None. Single/Family $5,000/$10,000 $6,250/$12,500 Plan Information Provider networks: Members have direct access to their choice of providers. Member cost-sharing is lowest for In-Network providers. If a member chooses an Out-of- Network provider, the

More information

Chinese Hypertension League called to celebrate WHD2016

Chinese Hypertension League called to celebrate WHD2016 Chinese Hypertension League called to celebrate WHD2016 May 17 th 2016 was World Hypertension Day (WHD2016). The theme of WHD2016 is know your blood pressure with the goal of increasing high blood pressure

More information

2017 Summary of Benefits

2017 Summary of Benefits H5209 004_DSB9 23 16 File & Use 10/14/2016 DHS Approved 10 7 2016 This is a summary of drug and health services covered by Care Wisconsin Medicare Dual Advantage Plan (HMO SNP) January 1, 2017 to December

More information

CLASSIC BLUE SECURE/BLUE CROSS BLUE SHIELD COMPLEMENTARY Monroe County Benefit Summary/Comparison (Over 65 Retirees)

CLASSIC BLUE SECURE/BLUE CROSS BLUE SHIELD COMPLEMENTARY Monroe County Benefit Summary/Comparison (Over 65 Retirees) WHO IS COVERED Enrollment Requirement Members must be enrolled in both Medicare Parts A and B Members must be enrolled in both Medicare Parts A and B Type of Tier Single only Single only Dependent/Student

More information

PREFERRED CARE. combination of family members; however no single individual within the family will be subject to more than the individual

PREFERRED CARE. combination of family members; however no single individual within the family will be subject to more than the individual PLAN FEATURES Deductible (per plan year) $500 Individual $1,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. The family Deductible is a cumulative Deductible

More information