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A Letter to the Shanghai Retired Insurance Participants Living or Undergoing Medical Treatment Outside of Shanghai
(02.21.2008)

Dear Retirees,

In accordance with the Shanghai Municipal Procedures of Basic Medical Insurance for Urban Employees promulgated by the Shanghai Municipal Government, the details related to the Basic Medical Insurance for urban employees in Shanghai in the 2003 Medical Insurance Year have been determined and are listed as follows:

I. Individual Medical Accounts in the new Medical Insurance Year:

1. The 2003 Medical Insurance Year will begin on April 1, 2003 and end on March 31, 2004. After that, each Medical Insurance Year shall begin on April 1 of that year and end on March 31 of the following year.

2. In the 2003 Medical Insurance Year, the individual medical account mailed to you was calculated on a 12-month basis. If you are older than 75 (i.e. you were born before December 31, 1927), the Individual medical account mailed to you will contain RMB 876.30; if you are younger than 74 (i.e. you were born after January 1, 1928), the Individual Medical Account mailed to you will contain RMB 778.90. In addition, it also contains the reissued balance and interest of the Individual Medical Account in the 2002 Medical Insurance Year, the exact amount of which is included in the memo section of the remittance sheet.

3. The Shanghai Municipal Medical Insurance Affairs Center will mail you the above amount on or around April 10, 2003, via the Shanghai municipal post office. Please check your mail carefully. If the Individual Medical Account mailed to you doesn't arrive by July, you should call the Social Services Department of the Shanghai Municipal Medical Insurance Affairs Center or the district/county Medical Insurance Affairs Center to make an inquiry (refer to the telephone number at the end of the letter).

II. Reimbursement of Clinical and Emergency Treatment Expenses:

1. The Individual Medical Account mailed to you is used to pay the clinical and emergency treatment expenses occurring from April 1, 2003 to March 31, 2004 (altogether 12 months).

2. If you used up the account mailed to you for clinical and emergency treatment expenses within 12 months, you will have to pay any additional clinical and emergency treatment expenses at your own cost, according to your retirement time and the proper standards. The specific standard of expenses at your own cost is:

If you retired before December 31, 2000, you shall pay RMB 308.00 for clinical or emergency treatment expenses after using up the account mailed to you.

For the part of the medical expenses beyond RMB 308.00, you can get 90% of it reimbursed if the expenses are incurred in a village hospital; get 85% of it reimbursed if the expenses are incurred in a county hospital; and get 80% of it reimbursed if the expenses are incurred in a provincial hospital.

If you retired after January 1, 2001, you shall pay RMB 771.00 for clinical or emergency treatment expenses after using up the account mailed to you. For the part of the medical expense beyond RMB 771.00, you can get 85% of it reimbursed if the expenses are incurred in a village hospital; get 80% of it reimbursed if the expenses are incurred in a county hospital; and get 75% of it reimbursed if the expenses are incurred in a provincial hospital.

3. Within 12 months, if you do not use up the account mailed to you or the total amount including the use-up of this account, if it is still below the standard that you have to pay for clinical and emergency treatment expenses at your own cost, you do not need to get the medical expenses reimbursed.

III. Reimbursement of Hospitalization (including emergency treatment) Expenses

During the Period from April 1, 2003 to March 31, 2004:

If you incur expenses during the hospitalization treatment, you must pay the hospitalization expenses below the deductable at your own cost.

If you retired before December 31, 2000, you have to pay RMB 771.00 for hospitalization at your own cost; if you retired after January 1, 2001, you have to pay RMB 1,234.00 for hospitalization at your own cost. If the hospitalization expenses at your own cost go beyond the above amounts, you can get 92% of the difference reimbursed; if the accumulative hospitalization expenses (excluding the part at your own cost) exceed RMB 61,680.00, you can get 80% of the difference reimbursed.

IV. Reimbursement Procedures of Medical Expenses:

1. From the 2003 Medical Insurance Year onwards, the retired employees living out of Shanghai shall get their medical expenses reimbursed in their district/county Medical Insurance Center. You may choose one, and only one of the district/county Medical Insurance Centers in Shanghai as the dedicated location to handle the procedures of medical expense reimbursements.

2. When you choose the dedicated district/county Medical Insurance Center for reimbursements, you must handle all the medical expense reimbursements and medical service related transfers in the 2003 Medical Insurance Year in the dedicated center, and you cannot receive services in any other district/county Medical Insurance Center. If you do not choose a district/county Medical Insurance Center, the one that your original work organization was affiliated with shall be your dedicated location for getting medical expense reimbursements.

3. When applying for medical expense reimbursements, you must bring all documented records of your original medical expense receipt(s), clinical records, leaving-hospital summary and medical expense details, your ID card (duplicate copy), and your social security card or Medical Insurance Card. If you entrust another person to handle your reimbursement(s), the trustee must bring his/her ID card as well.

4. If you have medical expenses that occurred in 2002 and still require reimbursement, you must handle the procedures of reimbursement in your chosen district/county Medical Insurance Center before June 30, 2003. The district/county Medical Insurance Center will not handle your reimbursement application after this date.

5. From the 2003 Medical Insurance Year onwards (except for the clinical and emergency treatment expense receipts paid with the Individual Medical Account and the receipts within the standard amount paid at an individual’s private cost after the full pay-out from the Individual Medical Account) all other medical expenses requiring reimbursement shall be reimbursed within 3 months after the date of producing the medical expense receipts, and these will not be reimbursed after the deadline.

If you have any questions regarding the Medical Insurance policies and the related medical expense reimbursement and registration procedures in Shanghai, you should consult the district/county Medical Insurance Center that your original work organization is affiliated with, or the center you have chosen by mail or telephone, or you may contact the Shanghai Municipal Medical Insurance Bureau by calling +86 21 6215 7519.

Thank you for your support and understanding of the Medical Insurance developments in Shanghai.

Shanghai Municipal Medical Insurance Bureau

March 28, 2003


How can insurance participants apply for and use their Medical Services Record after entering the 2003 Medical Insurance Year?

Q: If an insurance participant began using his/her Medical Services Record before April 1, 2003, can they continue using it after April 1, 2003?

A: If an insurance participant began using his/her Medical Services Record before April 1, 2003, they can continue using it after April 1, 2003. It means he/she can continue to use it from the time that the clinical and emergency treatment expenses were paid with the Individual Medical Account.

Q: If an insurance participant applied for but did not use his/her Medical Services Record before April 1, 2003, when shall he/she use it after April 1, 2003?

A: If an insurance participant applied for but did not use his/her Medical Services Record before April 1, 2003, when their clinical and emergency treatment expenses are paid with the Local Supplemental Fund after April 1, 2003, their hospital shall issue a Notification of Applying for and Using the Medical Insurance Medical Services Record that requests the participant to bring and use his/her Medical Services Record for their next severe illness, clinical or emergency treatment. Otherwise, the medical expenses will not be paid for with Medical Insurance.

Q: If an insurance participant never applied for a Medical Services Record, how can he/she apply for and begin to use it?

A: From April 1, 2003 onwards, when the clinical and emergency treatment expenses begin to be paid from the Local Supplemental Fund, the hospital shall issue a Notification of Applying for and Using the Medical Insurance Medical Services Record. The participant shall bring this Notification/Application and his/her Social Security Card (or Medical Insurance Card) to apply for their Medical Services Record in a nearby district/county Medical Insurance Center. He/she shall take their Medical Services Record to their next severe illness, clinical or emergency treatment. Otherwise, the medical expenses will not be paid for with Medical Insurance.

Q: Can the Medical Services Record work alone in the case that an insurance participant undergoes medical services?

A: In the case of severe illness, clinical or emergency treatment, the Medical Services Record must work in conjunction with the Social Security Card (or Medical Insurance Card). However, this is unnecessary if a participant undergoes treatment for mental illness in an asylum, or if they undergo treatment for a contagious hepatitis virus, treatment in a contagious enteritis in an epidemic (hepatitis) department, or treatment in an enteritis clinical department in a hospital.

Shanghai Municipal Medical Insurance Bureau

March 28, 2003