Q: Are the doctors' fee and other charges fully covered? What is your criterion?
A: As a general rule, we will cover all of the charges as long as they are Medically Necessary, unless specifically excluded in the Policy. It also depends on which provider you use. We cover fees up to Usual and Customary Fees.
Q: How about the Prescription Drugs benefit?
A: Prescription drugs are a covered benefit under this policy. The usual policy deductible and co-payment does not apply to this benefit. Only a 90-day supply of a prescription can be filled at any one time outside of US pharmacy network.
Prescription drugs are medications which are prescribed by a physician and which would not be available without such prescription. Certain treatments and medications, such as vitamins, herbs, aspirin, and cold remedies, medicines, experimental or Investigative drugs, or supplies even when recommended by a physician, do not qualify as prescription drugs.
Q: How about the Prescription Drugs benefit in China?
A: In Mainland China, the 20% prescription drug co-payment will be waived for generic drugs at local public medical facilities that are using government-regulated drug prices. Expensive brand name drugs should still be either reimbursed up to the generic drug level or at 80% as defined in the policy.
And some OTC which is covered under Chinese Government Health Insurance is also covered. Please refer http://ybj.sh.gov.cn/webquery/listDrug.jsp to check which OTC is covered.
Q: How about the Traditional Chinese Herb benefit in China?
A: In China, Traditional Chinese Herb which is covered under Chinese Government Health Insurance is covered. But there should be definite diagnosis for the disease including traditional medicine diagnosis and western medicine diagnosis as well as. The treatment of herb should be medical necessary. If it is used for adjust subhealth such as fatigue it will not be covered.
Q: What Maternity costs are covered under this group health plan?
A: All (medically necessary) maternity related fees can be covered up to a maximum of US$7,500 and 50% thereafter. This includes, but is not limited to, pre-natal visits, the delivery, complications if any, and post-natal visits. There is a limit of 2 ultrasounds per pregnancy, but we can consider covering addition ones for high-risk pregnancies. The newborn's expenses, such as those routine checkups and immunizations for the first year, go under the baby's Infant Care benefits, provided that you enroll your newborn within the first 14 days after birth.
As a reminder, Pre-authorization is necessary for the delivery and for any special testing such as additional ultrasound or amniocentesis.
Q: If I have some kind of mental condition, will this health plan cover the treatment? Which hospitals can I go to in China?
A: Most mental conditions can be covered under the Mental Illness benefit. The maximum benefit is 180 days / US$25,000 as an inpatient and 20 visits as an outpatient. General psychotherapy and consultations are available at the Psychology department / Mental Illness department of large public hospitals.
Q: Does my health plan cover an annual body checkup?
A: Yes if you have Wellness benefit. However, if you haven't wellness benefit, it does include coverage for certain routine exams, such as mammograms, prostate exams, pap smears, and screenings related to your family medical history.
