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Pearl Plan
  • Benefits up to RMB1million
  • Coverage area: Mainland China, excluding Hong Kong, Macao and Taiwan
  • Access to quality health care: easy access to top private hospitals, VIP and international departments in the best public hospitals
  • Advanced treatment and important drugs: covering expensive advanced treatment and imported drugs
  • Direct billing service which is popular in Europe and the United States: treatment fee is directly paid by Cigna & CMB to the network hospital
  • World-class service experience: worldwide 7*24 hour support; Chinese and English bilingual service; online health assessment, wellness information, crisis support, appointment, accompaniment and foreign/local expert second opinion services are offered.

Overview

Insurance Benefit: RMB 1,000,000 per insurance period
Maximum per main insured person / insured dependant per insurance period

Coinsurance:
The percentage of changes for covered expenses that the main insured person or insured dependant will be required to pay under the plan after satisfying the required deductible.

1、Subject to a 20% coinsurance in some items under “Outpatient Healthcare Benefits” (See list below for details)
2、There will be no reimbursement for Pearl plan if seeking services at hospitals or clinics in the Non- Covered Provider List below.

Coverage Area: Mainland China, excluding Hong Kong, Macao and Taiwan

In-Patient/Day Case

Hospital Charges for: 100% Refund, up to RMB 1,200 per day

  • Nursing and accommodation for in-patient treatment, up to RMB 1,200 per day
  • Day case treatment

Surgical Appliance and/or Medical Appliance; Prescribed medicines, drugs and dressings for in-patient or day case treatment: 100% Refund, up to RMB 50,000 per insurance period
This benefit will be paid in respect of:

  • an artificial limb, prosthesis or device which is inserted during surgery;
  • an artificial prosthesis or device which is necessary part of the treatment immediately following surgery for as long as is required by medical necessity;
  • a prosthesis or appliance which is medically necessary and is part of the recuperation process on a short-term basis.

Parental Accommodation: 100% Refund; up to RMB 10,000 per insurance period
This applies to insured dependant under the age of 18. Cigna & CMB will pay for reasonable costs for a parent staying in the same hospital with the insured dependant.

Operating theatre and recovery room; Surgeons and Anaesthetists Fees; Surgical Procedures: 100% Refund, up to RMB 80,000 per insurance period

Specialist Physicians Fees; Physiotherapy: 100% Refund, up to RMB 50,000 per insurance period
This benefit is paid in full for regular visits by a specialist physician during stays in hospital including intensive care by a specialist physician for as long as is required by medical necessity

Radiotherapy, Chemotherapy: 100% Refund, up to RMB 100,000 per insurance period

Radiology, Pathology: 100% Refund, up to RMB 50,000 per insurance period

Private Ambulance: 100% Refund
This benefit is payable for transport to or from a hospital when ordered for medical reasons

Out-Patient

Consultations with Medical Practitioners and Specialists; Prescribed Medicines, Drugs and Dressings; Physiotherapy, Acupuncture, Chiropody, Osteopathy, Homeopathy; Hormone Replacement Therapy; Annual Routine Test (One eye test and hearing test for insured dependant under the age of 15); Travel Vaccinations (This benefit will be payable for vaccinations related to travel); Chinese Herbal Medicine : up to RMB 30,000 per insurance period (20% coinsurance for Prescribed Medicines, Drugs and Dressings at non-public hospital; RMB 500 per day for consultations)

Pathology, Radiography: 100% Refund, up to RMB 10,000 per insurance period

Non-surgical and Minor Surgical Procedures and Treatment: 100% Refund, up to RMB 10,000 per insurance period

Emergency Dental Treatment: 100% Refund, up to RMB 5,000 per insurance period
This benefit will be payable for treatment received during the emergency visit immediately after accidental damage to natural teeth

Cigna & CMB Care+

Health and Well-being assessment:

  • Personal health profile report
  • Online Health Library (Buy-up Benefit)
  • Targeted Risk Assessments (Buy-up Benefit)
  • Online Health Improvement Programs (Buy-up Benefit)

International Employee Assistance Program (IEAP):
You are supported worldwide 24 hours a day and 365 days a year no matter what difficulties you face.

  • Crisis intervention (Topics include, but are not limited to: relationships, stress, emotional support, anxiety, depression, bullying and harassment, life transitions, relocations and substance abuse, etc)
  • 5 session counselling
  • Community resource referrals
  • EAP work life referrals to professionals, including child care, legal services, elder care and financial services (Buy-up Benefit)

Expert Second Opinion:
The Cleveland Clinic has been one of America’s most respected medical referral institutions for more than 85 years. It will provide comprehensive expert online medical second opinions to you and covered family members, should someone receive a life-threatening or life-altering diagnosis. Each opinion is provided by a Cleveland Clinic doctor who specializes in the condition and provides a review of the diagnosis and prescribed medical treatment. Support from the Cleveland Clinic, in addition to the second opinion, includes a telephone consultation and secure email communication with a nurse.

Cigna & CMB Assist

  • Appointment services are available for all public hospitals in our network. In addition, we will work with our customers to secure appointments at select out of network public facilities.
  • Accompaniment services are available for the following treatments in select public facilities across our network.
  • All inpatient stays (including maternity deliveries);
  • All day surgeries;
  • Lab testing and radiological examination (such as PET-CT, MRI, CT) with amount above RMB3, 000.
  • Local Expert Second Opinion – A complement to our Global Second Opinion Service

In addition to provide global 2nd Opinion service via E-Cleveland Clinic, the worldwide leading provider, we offer local 2nd Opinion services through top tier public medical facilities in China.

Optional Maternity Benefits

Inpatient and Outpatient Maternity Cover:
This benefit is payable to female main insured person or insured dependant covered under the plan. It includes childbirth, pre-natal and post-natal exams and pre-natal vitamins.
Option One: 100% Refund up to RMB 30,000 per insurance period; Limit applies to routine and complicated maternity

Optional Wellness Benefits

Routine Physical Exams; Pap Smear; Prostate Cancer Screening; Mammograms for Breast Cancer Screening or Diagnostic Purposes
Option One: Payable up to RMB 1,000 pre insurance period

Routine Physical Exams
This benefit will be paid for, or in connection with, routine physical examinations for main insured person or insured dependant.
Option One: Payable up to RMB 1,500 per insurance period

Pap Smear
Cigna & CMB will pay charges for an annual Papanicolaou screening
Option One: 100% Refund

Prostate Cancer Screening
Cigna & CMB will pay charges for an annual prostate cancer screening for male main insured person or insured dependant over 50 years old.
Option One: 100% Refund

Mammograms for Breast Cancer Screening or Diagnostic Purposes
This benefit will be paid in respect of:

  • one baseline mammogram for asymptomatic women aged 35-39;
  • a mammogram for asymptomatic women aged 40-49 every two years or more if medically necessary;
  • a mammogram every year for women aged 50 and over

Option One: 100% Refund

Immunization
This benefit will be payable for insured dependant up to age 18.
Option One: Payable up to RMB 1,000 per insurance period

Optional Dental Benefits

Maximum Benefit per insurance period for Class One, Two and Three
Option One: RMB 2,000 per insurance period

Deductible
Option One: none

Class One
Investigative and Preventative Treatment
Benefits include: X-rays, Scale and Polish
Option One: 80% refund

Class Two
Basic restorative treatment, Periodontal treatment and treatment of dental injury.
Benefits include: Root canal treatment, extractions, surgical procedures, occasional treatment, anaesthetics, periodontal treatment
Option One: 50% refund

Class Three
Major Restorative and Orthodontic treatment
Benefits include: Dentures – acrylic/synthetic, metal and metal/acrylic; Crowns, inlays, mouth-guard or occlusal splint
Option One: 50% refund

Orthodontic Treatment for insured dependant under the age of 18
Option One: none

Notes:

  • Examination and Scale & Polish will both be limited to 2 visits per year.
  • Full Case Assessment will be limited to one visit per year.
  • X-rays will be limited to four Bitewings and six Intra Oral per year and OPG every 3 years.
  • Prolonged Periodontal Treatment limit of one course per year
  • The above limitation shall be recalculated according to the underwriting rules of Cigna & CMB and further stated in the contract in the event of the insurance period less than one year.

Non-Covered Provider List

There will be no reimbursement for Pearl plan if insured persons seek services at the hospitals or clinics listed below:

  • United Family Hospitals and Clinics (Beijing, Shanghai, Guangzhou, Wuxi and other cities if any)
  • Parkway Health Medical Centers (Shanghai, Chengdu)
  • SinoUnited Health Medical Center (Shanghai)
  • St. Michael Hospital
  • Shanghai East International Medical Center
  • Worldpath Clinic International (Shanghai)
  • International S.O.S Clinics (Beijing, Tianjin, Nanjing, Shekou and other cities if any)
  • Beijing International Medical Centre (IMC)
  • OASIS International Hospital (Beijing)
  • Institute for Western Surgery (Guangzhou and other cities if any)

*The above list is subject to change

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