Terms and Conditions

I. Outpatient:

  • In-network coverage only

(Primary care provider:City international Hospital  - Code: 79505 (health care facility codes) / emergency medical condition / doctor referral letter )

II. Inpatient:

  • Applied to in and out-network coverage

III. Benefits:

  • In-Network coverage : insurance pays 100% - 95% - 80% (depending on the coverage amount)
  • Out-Network coverage: insurance pays 60% - 57% - 48%  (depending on the coverage amount)

IV. Rights:

Participants will be entitled to health insurance benefits in accordance with the applicable regulations in state agencies. The difference in services such as examination, testing, medical treatment, surgical treatment, ect ... people with health insurance cards must pay themselves to the hospital.

Services not covered by insurance, the patient will pay for the hospital fee as prescribed.

* Note: Prescription coverage:

  • Prescription medicines listed in the insurance plan, the patient only have to pay a copayment  with an additional 10 % charge of drug management fee.
  • Prescription medicines unlisted in the insurance plan, the patient will be charged as prescribed .

* Note:

  • Preventive health services, such as testings, pregnancy tests, screenings, vaccinations, and counseling will not be covered.
  • For your visit, remember to bring your insurance card and proof of identification (ID card, driver's license, student ID, Passport, etc.).