Provider directory for Mainland China 中国大陆医疗网络指南 The Provider Directory is intended for reference only and subject to changes. For most updated facility information, please visit www.aetnainternational.com. 本医院目录仅供参考且可能发生变化，请登陆www.aetnainternational.com 以了解最新的医疗机构信息。 This Provider Directory is for Aetna International Members only. Any unauthorized circulation of this directory is prohibited. 本医院目录仅供Aetna International会员使用，禁止任何未经授权的转载与引用。 46.01.303.0-CH (9/14) 直接结算指南 在直接结算网络内就诊时，请遵守以下程序： 12. 不孕不育/计划生育 • 在接受医疗服务之前，请向医院/诊所出示您的会员卡及身份证 13. 产伤/先天性异常/遗传性畸形或疾病 明 14. 性传播疾病 • 会诊治疗结束后，请在治疗收据/索赔申请表上签字以示确认 1 5 . 精 神 病 治 疗 • 免赔额、共同保险以及任何理赔范围以外的项目须与医院/诊 16. 自残损伤，酒精/物质（毒品）依赖，睡眠窒息或其他睡眠异 所结算完毕后方可离开 常 • 如需急诊治疗，请立即前往医院或指定医疗机构就医。如急诊 17. 康复治疗 后需住院治疗，我们将在下一工作日为您启动直接结算。 18. 根据诊所所在城市和地区的具体情况，超过合理和惯常范围 • 然而，如果您在急诊后出院，那么您将预付所有产生的费用，并 的费用 向Aetna递交索赔表申请赔付 19. 提供医疗文件或完成要求表格所需费用 以下项目不能直接结算，会员需要在就医时支付。其中属 20. 救护车服务的使用（除非得到我们的事先同意）。遇到紧急 于保障利益范围的费用，会员可以向保险公司提交理赔 情况，请及时拨打会员卡后的紧急求助电话 申请，以获得补偿。如您需要了解所拥有的保障利益，请 21. 任何总费用超过500美元的检查或治疗需事前获得我们的同 致电会员卡背后的客户服务热线查询。 意。 1. 牙科治疗（除非在本公司指定的牙科诊所） 2. 生育/妊娠 3. 饮食补充剂，维他命，矿物质和营养素的费用 4. 接种疫苗，常规检查和旅行建议 5. 物理治疗必须由经治医生或专家推荐。如对任一疾病，需有 超过6次以上的物理治疗，您的注册治疗师必须在理赔申请 表上注明理由以便我们考虑承担保险责任。 6. 任何“替代疗法”，包括但不限于，脊椎指压疗法，整骨疗法， 顺势疗法与针灸疗法；及单独的传统中医中药治疗 7 . 电 话，传 真 或 复 印 费 用 8. 任何在登记日前已经存在的医学疾病，包括相关的，次要的 或有关联的疾病 9 . 超过持卡人保险卡到期日之后的任何治疗，该日期显示于保 险卡上 10. 慢性疾病，指目前已知医学手段无法根本治愈的病情，包括 但 不 限 于 高 血 压，糖 尿 病，高 胆 固 醇 血 症，血 脂 代 谢 异 常 等 11. 屈光不正/视力缺陷矫正手术 The Provider Directory is intended for reference only and subject to changes. For most updated facility information, please visit www.aetnainternational.com. 本医院目录仅供参考且可能发生变化，请登陆www.aetnainternational.com 以了解最新的医疗机构信息。 This Provider Directory is for Aetna International Members only. Any unauthorized circulation of this directory is prohibited. 本医院目录仅供Aetna International会员使用，禁止任何未经授权的转载与引用。 2 Guidelines to the direct settlement network When visiting the medical providers within the 9. Any Treatment received after the 12-month period from network, please follow the procedures listed the “valid from” date, or after “expiration date” (as shown below: on the DSN card). • Present your DSN card and proof of identification to the 10. Chronic conditions - i.e., conditions that cannot by cured receptionist prior to the consultation. by proven methods of conventional medicine (including but not limited to hypertension, diabetes, • Sign the Treatment voucher / claim form to acknowledge hypercholesterolemia and lipid disorders). receipt of the Treatment following the consultation. • Settle any Co-insurance or non-covered items (please see 11. Treatment for refractive errors and sight defects. below list) with the clinic prior to leaving. 12. Infertility and birth control. • For Emergency Treatment please proceed immediately to a 13. Birth injuries, Congenital Anomalies, genetic deformities hospital or designated medical facility. or diseases, Hereditary Medical Conditions. • If, as a result of the emergency, you are admitted to a 14. Sexually transmitted diseases. hospital, a Direct Settlement will be initiated on your behalf the following business day. However, if you are discharged 15. Treatment for psychiatric complaints/ conditions. following your emergency visit, you will be responsible for all 16. Self inflicted injuries/ alcohol or substance abuse/ sleep charges up-front and will need to submit a claim to Aetna for apnoea or other sleep disorders. reimbursement. 17. Rehabilitation programme. The following items do not have direct settlement. 18. Costs which are above Reasonable and Customary charges Member needs to pay at point of service. Member with respect to the city / area of your clinic. can submit claim for reimbursement for the costs 19. Cost of providing medical documentation or completing a as per your benefit coverage. Contact your Aetna claim form. International Member service center through the 20. Use of ambulance services (unless pre-approved by us). number on your member ID card if you hope to Please be reminded to call the emergency number at the know your Aetna coverage. back of your card in case of emergency. 1. Dental costs (Unless the service rendered at our 21. Any visit or course of Treatment where the combined cost designated Dental Clinic). exceeds US$ 500.00 must be pre-approved. 2. Maternity/pregnancy costs. 3. Dietary supplements, vitamins, minerals, dietician charges. 4. Vaccinations, routine check-ups, travel advices. 5. Physiotherapy must be referred by a medical practitioner or specialist. If more than six physiotherapy sessions are needed for any medical condition, your therapist must provide the reasons in the Claim form so we can consider cover. 6. Alternative Treatments (including but not limited to Chiropractic Treatment, Osteopathy, Homeopathy & Acupuncture) and Traditional Chinese Medicines. 7. Telephone, fax or copying charges. 8. Pre-existing Conditions, i.e., any Medical Conditions which existed before the Date of Entry, including related, secondary or associated complaints. The Provider Directory is intended for reference only and subject to changes. For most updated facility information, please visit www.aetnainternational.com. 本医院目录仅供参考且可能发生变化，请登陆www.aetnainternational.com 以了解最新的医疗机构信息。 This Provider Directory is for Aetna International Members only. Any unauthorized circulation of this directory is prohibited. 本医院目录仅供Aetna International会员使用，禁止任何未经授权的转载与引用。 3 会员卡 会员卡类型 会员卡识别及说明 1. 卡色: 红色 2. 持有该会员卡的会员可以到中国大陆以及其他所选保障区域内的 所有网络医院就医。 Starr UltraCare Individual Regional Healthcare Plan Insurance Plan Excess USD: 0 Member ID: 123456 Direct Billing John Doe USA Elective Policy Number: XXXXXXXXXX Expiration Date: 31 Dec 2015 Member Since: 01 Jan 2013 Membership Card Card Types Card Identification and Remarks 1. Card color: Red 2. Members will have access to all network hospitals and providers in both mainland China and selected area of coverage. Starr UltraCare Individual Regional Healthcare Plan Insurance Plan Excess USD: 0 Member ID: 123456 Direct Billing John Doe USA Elective Policy Number: XXXXXXXXXX Expiration Date: 31 Dec 2015 Member Since: 01 Jan 2013 The Provider Directory is intended for reference only and subject to changes. For most updated facility information, please visit www.aetnainternational.com. 本医院目录仅供参考且可能发生变化，请登陆www.aetnainternational.com 以了解最新的医疗机构信息。 This Provider Directory is for Aetna International Members only. Any unauthorized circulation of this directory is prohibited. 本医院目录仅供Aetna International会员使用，禁止任何未经授权的转载与引用。 4 优先医院：如果您在”优先医院”列表中的医院就诊,您将不需要支付共付比例。 Primary Hospital: Should insured seek out-patient treatment at hospitals/clinics that are listed as Primary Hospital, Zero Co-Insurance is applied on treament. 昂贵医院：如果您在”昂贵医院”列表中的医院就诊,您将需要支付20%的共付比例。但是如果您选择了零 共付比例计划，您将不需要支付共付比例。 Secondary Hospital : Should insured seek out-patient treatment at hospitals/clinics that are listed as Secondary Hospital, 20% Co-Insurance is applied on treament. This Co- insurance can be reduced to nil-copay if you select Nil co-insurance optional benefit. The Provider Directory is intended for reference only and subject to changes. For most updated facility information, please visit www.aetnainternational.com. 本医院目录仅供参考且可能发生变化，请登陆www.aetnainternational.com 以了解最新的医疗机构信息。 This Provider Directory is for Aetna International Members only. Any unauthorized circulation of this directory is prohibited. 本医院目录仅供Aetna International会员使用，禁止任何未经授权的转载与引用。 5 中国大陆 Mainland China 直接结算网络 Contracted facilities with direct settlement 名称 地址 电话 类别 注意事项 Provider Name Address Telephone Category Note 北京 Beijing 北京庇利积臣门诊部 北京市朝阳区日坛东路七号 86 10 8562 9998 优先医院 Bayley & Jackson Medical No.7 Ritan East Road, Chaoyang District, Primary Center Beijing 北京美中宜和妇儿医院 (丽都院 北京市朝阳区芳园西路9-9号 86 4001000016 优先医院 区) No. 9-9, Fangyuan West Road, Chaoyang Primary Beijing AmCare Women’s & District, Beijing Children’s Hospital at LIDU 北京美中宜和妇儿医院 (亚运村 北京市朝阳区安慧北里逸园5号 No.5, Yiyuan, 86 4001000016 优先医院 院区) An Hui Bei Li, Chaoyang District, Beijing Primary Beijing AmCare Women’s & Children’s Hospital at YYC 北京玛丽妇婴医院 和平里北街5号，朝阳区，北京 86 10 6421 6666 优先医院 Beijing Mary Hospital Women & Executive Floor, No.5 Hepingli Bei Ave, Primary Children Chaoyang District, Beijing 北京二十一世纪医院 朝阳区亮马桥路甲40号，二十一世纪大厦1 86 10 8444 6168 优先医院 Beijing 21st Century Hospital 层，2层 Primary 21st Century Plaza 1F-2F, Liangma Qiao Road No.40, Chaoyang District, Beijing 北京英智眼科医院 北京市朝阳区潘家园南里12号潘家园大厦1、4 86 10 6771 5558 优先医院 Beijing Intech Eye Hospital 、5层 Primary 1st, 4th, 5th Floor, Panjiayuan Plaza No.12 District, Panjiayuan Nanli, Chaoyang District Beijing 北京中日友好医院 北京市朝阳区樱花园东街2号 86 10 8420 5566 优先医院 *仅供100%保障范围的客户 Beijing China-Japan Friendship 2 East Yinghua street Primary *only for plans with 100% Hospital Chaoyang District, Beijing coverage 北京新世纪荣和门诊部 北京市顺义区天竺镇丽苑街荣和商业中心19号 86 10 6456 2599 优先医院 Beijing New Century Harmony 楼K01 Primary Clinic K01 NO19 Building, Harmony Business Center Li Yuan Street, Shun Yi Tian Zhu District, Beijing 北京新世纪国际儿童医院 北京市西城区南礼士路56号 86 10 6802 5588 优先医院 Beijing New Century No. 56 Nan Lishi Road Xicheng District, Beijing Primary International Children’s Hospital 北京新世纪妇儿医院 北京市朝阳区望京北路51号院 86 10 5178 3366 优先医院 Beijing New Century Women’s No.51 Wangjing North Road, Chaoyang Distrct, Primary and Children’s Hospital Beijing, PRC 北京新世界耀东诊所 北京市崇文门外大街3号新世界中心写字楼（北 86.10.6708.5075 优先医院 Beijing New World Eaton 办公楼）B座五层 Primary Medical Centre Level 5, Beijing New World Shopping Mall(5/F, B Tower Office Building), No. 3 Chong Wen Men Wai Street, Beijing 北京仁泰门诊部 北京市朝阳区建国路89号华贸中心16号商务楼 86 10 6958 1887 优先医院 Beijing Orient Care Clinic 102室 Primary #102 NO.16