Section_CH_Briefing_Final.pptx

SECTION C&H

DESCRIPTION/SPECIFICATION/WORK STATEMENT

Beijing Human Resources Office April 25, 2018

PART I - HEALTH INSURANCE

The medical coverage purchased under this contract is a medical benefit supplemental to coverage provided by the local social security.

Hospitalization 100% reimbursement rate

Outpatient 90%

Annual physical exam 90% with ceiling of RMB 650 per person per year for each employee and for each dependent for annual physical exam.

社保结算以后，社保范围内的住院费用100%报销，门诊90% ；体检员工去医院做体检，之后按90%报销，上限是650人民币，保险公司也可以帮我们制定一个650元的体检套餐，员工可以在这两者之间选择。

CarrollSR (C) -

PART I - HEALTH INSURANCE

Reimbursement for employee eye examinations and treatment, and prescription eyeglasses or contact lenses. With a 60 USD ceiling for two lenses per patient per year, and no reimbursement for frames, nonprescription lenses, or tinting.

参保人员每年可以报销两副镜片，包括隐形眼镜，50%的比例，上限是60美金。镜架不可报销

PART I - HEALTH INSURANCE

Dental Service 50% Dental Care: Dentists’ fees, x-rays, examination and treatment, fillings, extractions, cleaning, fillings, false teeth, crowns and bridges. Orthodontia treatment covered only if treatment begins before age 15, unless required as the result of an accident. Maximum of 4 years of orthodontia treatment per patient.

Dental service is paid at 50% with a ceiling of 1000USD per person per year.

牙科比较特殊，社保范围外的一些项目，比如根管治疗，假牙，齿冠，齿桥等也可以报销，而且整体报销比率是50%，每年每人上限1000美金。除以外上海情况，牙齿矫正必须是15周岁之前的参保人员。

PART I - HEALTH INSURANCE

The insurance company will reimburse covered expenses up to a separate limit of USD 10,000 per employee per contract year, not dependent.

接种疫苗90， 子女预防针是50

PART II GROUP LIFE INSURANCE

Amount of Natural Death Insurance:

The employee’s beneficiary will receive an amount equal to 20 times of the employee’s monthly basic salary in the event the employee dies of natural causes.

Amount of Accidental Death.

The employee's beneficiary will receive an amount equal to 24 times the amount of the employee’s monthly basic salary.

PART II GROUP LIFE INSURANCE

Partial and Total Disability Coverage is NOT required.

Eligible Participants Locally employed employees Employee’s spouse Employee’s dependents must be unmarried, economically dependent upon the employee, and reside with the employee unless away at school.

until the end of the contract year in which he/she reaches age 18, or age 24 if a full time student.

ORE staff, AEA staff and staff spouse and child;

Individually issued as a rider to the primary contract.

中国境内，目前有北京大使馆，广州，上海，沈阳，成都，武汉领馆以及一个深圳办公室。

Medical Insurance Claims and Records The contractor must pick up employees’ medical claims and answer employees’ inquiries regarding their claims at the Embassy and each of the Consulates once per month, during business hours.

The Consulates include Chengdu, Guangzhou, Shanghai, Shenyang and Wuhan.

Medical Insurance Claims and Records-continued

The Contractor should provide a digital claim channel through Internet or smart phone APP for employees to submit small amount claims, up to RMB 1, 000 per invoice, including outpatient and hospitalization;

The Contractor should provide an online real-time platform for employees to check the status of their claims and historical records.

The Contractor should also provide a COR online master account which can check every employee’s claim data.

The Contractor should provide notification to the employees within three days via E-mail, text message or smart phone APP for the below listed situations:

1. Claim approved and paid;

2. Additional material required;

3. Claim denied and reason.

The Contractor should settle the claims no later than two weeks from the date the completed claim is submitted to the Contractor.

The Contractor should maintain medical insurance files for each covered individual.

Report Requirements Monthly Employee Claims Management Report must be received by the COR no later than the 10th day of each month;

Annual Analysis report should be provided one month after the annual contract year ends.

Brochures need to provided according to C.1.7/C.2.7

For details please see Section C and Section H

Thank you for you listening!

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