Certain medical procedures or treatments will require a pre-authorization request form to be received by us a minimum of 5 business days prior to the scheduled procedure date, and approval must be received prior to the commencement of the proposed medical treatment.

Pre-authorization approval does not guarantee payment of a claim in full, as additional co-payments and out of pocket expenses may apply.  Failure to comply with pre-authorization procedures will result in an automatic 40% co-payment without any out of pocket limit, if on retroactive review, the care is determined to be a procedure that would have been approved. If, upon retroactive review of medical records, it is determined to be a medical procedure that would not have been approved, the entire claim will be denied.

Services requiring Authorization:

 Ø All Inpatient admissions and/or treatments;
 Ø Any Surgeries requiring general anesthesia (Outpatient or Inpatient);
 Ø Accidental Dental treatment (for emergency dental repair of natural sound teeth damaged
           in an accident);
 Ø Purchase or rental of Durable Medical Equipment, including, but not limited to,
          *Insulin Pumps and supplies;
 Ø Home Health Care;
 Ø Organ Transplants; (Stem Cell Transplants not covered per policy exclusions).
 Ø RSV Immunization/and other medications priced in excess of $1,000. USD per refill.
 Ø All Cancer treatments/therapies;
 Ø Hemodialysis and Peritoneal Dialysis for Renal Failure.
 Ø Substance Abuse treatments/therapies;
 Ø Any condition, including chronic conditions that do not meet the above criteria, but
           are expected to accumulate over $5,000 of medical treatment per policy year

Pre-Authorization ensures that prior to incurring liability for medical treatment, surgeries and other procedures, the member is covered by the policy and will be reimbursed up to the applicable limit by the Company.
Pre-authorization is not required for emergency situations, notification within 48 hours after hospitalization is necessary.

For Pre-authorization, please contact

Please ask your doctor to fill out the pre-authorization form when coming across the above major medical treatment and submit it by fax or email to Shanghai office. We will fax back approval to requesting doctor or provider contact person within 48 hours of receipt of request, if the estimate cost is above $5000 or the medical treatment will be occurred outside China, we will reply you within 5 working days.