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國任財產保險股份有限公司來華人員綜合醫療保險保障計劃簡介

2023-02-19 

投保條件

來華留學生、港澳臺學生及華僑學生凡身體健康、年齡在8周歲-69周歲可參加本保險。

保障內容

(一)保險責任

在保險有效期間內,保險公司承擔下列保險責任及服務項目:

1、身故責任:

被保險人因意外事故或疾病身故,保險公司按約定保險金額給付保險金,保險責任終止。


2、意外傷殘責任:

被保險人因遭受意外事故,并自事故發生之日起180日內因該事故造成《人身保險傷殘評定標準及代碼》(JR/T00832013)(原中國保險監督管理委員會發布,保監發〔20146號)所列傷殘項目的,保險公司依照該標準規定的評定原則對傷殘項目進行評定,除另有約定外,保險公司按評定結果所對應該標準規定的給付比例乘以保險金額給付意外傷殘保險金。如治療仍未結束的,按事故發生之日起第180的身體情況進行傷殘鑒定,并據此給付意外傷殘保險金。

被保險人該次意外事故導致的傷殘合并前次傷殘可領較嚴重項目意外傷殘保險金的,按較嚴重項目標準給付,但前次已給付的意外傷殘保險金(投保前已有或因責任免除事項所致《人身保險傷殘評定標準及代碼》(JR/T00832013)(原中國保險監督管理委員會發布,保監發〔20146號)所列傷殘的,視為已給付意外傷殘保險金)應予以扣除。

每一被保險人的意外傷殘、意外身故、疾病身故保險金的累計給付金額以其對應的保險金額為限,累計給付金額達到其保險金額時,對該被保險人的該項保險責任終止。

3意外醫療責任:

被保險人因遭受意外事故,并自事故發生之日起180日內進行治療,保險公司就其實際支出的合理且必要的醫療費用按100%給付意外醫療保險金。

意外事故發生如:貓狗抓咬傷、走路磕摔傷、體育活動時摔傷等等造成的事故。

賠付公式:合理費用合計*100%=賠付金額(合理費用合計不含當地社會基本醫療保險規定的自費及部分自費費用)

被保險人不論一次或多次發生意外事故,保險公司均按上述規定分別給付“意外醫療保險金”,但累計給付金額以不超過該被保險人的意外醫療保險金額為限,累計給付金額達到其意外醫療保險金額時,對該被保險人的該項保險責任終止。


4、住院醫療責任:

被保險人因意外事故或因疾病,經醫院診斷必須住院治療的,保險公司就其實際支出合理且必要的護工費(限額200/天,累計60天)、建病歷費、取暖費、空調費、床位費、檢查檢驗費、特殊檢查治療費、手術費、藥費、治療費、化驗費、放射費等合理醫療費用,按100%給付“住院醫療保險金”。

急診搶救所產生的相關費用,歸屬住院醫療責任下,對被保險人在醫院進行了急診搶救的合理且必要的治療費用,按照100%給付保險金。

賠付公式:合理住院費用合計*100%=賠付金額(合理費用合計不含當地社會基本醫療保險規定的自費及部分自費費用)。

被保險人不論一次或多次住院或急診搶救的治療,保險公司均在規定限額內給付保險金,分項累計給付金額達到其保險金額時,對該被保險人該項保險責任終止。

5、門急診醫療責任:

被保險人因疾病進行門診、急診治療所發生的合理且必要的醫療費用,每個保險期間內,就診日費用限額為600元(即:若當日醫療費用超日限額的只能按600元計算,當日醫療費用未超600限額的按實際發生金額計算)在日限額的基礎上累計超過650元免賠額以上的部分按照85%比例賠付累計給付以保險金額20000元為限。當累計給付金額達到其保險金額時,該被保險人的該項保險責任終止。

日限額:為每日就診的最高費用限額。

免賠額:本險種設置650元為免賠額(一個保險期間內累計扣一次650元),免賠額以下部分不予賠付。

門急診醫療費用包括:普通門診、急診、門診手術、急診留觀所產生的相關費用、及因與住院同一病因產生的院前、院后門診所產生的費用等均歸屬于門急診醫療責任范圍內。

即:如因腹痛、發熱、暈倒、上呼吸道感染等等在門診或急診進行治療的;

賠付公式:(每天在日限額600元以內的合理費用相加-650)*85%=賠付金額(合理費用合計不含當地基本醫療保險規定的自費及部分自費費用)


注:1.以上所有醫療保險責任所涉及的醫療機構僅限于在中華人民共和國大陸境內的公立醫院。若被保險人在公立醫院的外賓病區、VIP病區、包房、A等病房、單間、特診特需病區、特診特需病房和高干病房等同類病區或病房接受的治療,則其所有的醫療費用保險公司均不予報銷。

2.以上所有醫療費用,若其它第三方支付了部分或全部費用時,保險公司僅負責補償剩余部分且與當地基本醫療保險支付范圍相符的合理費用,但保險責任中所涉及的床位費、護工費、門急診日限額等限額部分同樣受限,如第三方有賠付比例的受限部分按照受限金額為基礎扣除已賠付金額,保險公司只賠付剩余金額,如無賠付比例,受限部分按照當地基本醫療保險的標準, 以受限金額為基礎扣除此項目的標準金額,賠付剩余金額,并以保險金額為限。

 3.以上所有醫療保險責任所涉及的醫療費用只限于當地社會基本醫療保險可報銷的項目內的費用,醫保規定的自費或部分自費項目均不在報銷范圍內。

 4.首次投保或非連續投保的被保險人,自保險生效之日起30日內為等待期(觀察期),等待期內發生的疾病及后續治療,均不予報銷。連續投保或被保險人遭受的意外事故進行的治療則無等待期。

(二)責任免除

1、身故及意外傷殘責任

因下列情形之一,造成被保險人身故、意外傷殘的,保險公司不承擔給付保險金責任:

1)投保人、受益人對被保險人的故意殺害、故意傷害;

2)被保險人故意自傷、自殺、故意犯罪或者抗拒依法采取的刑事強制措施;

3)被保險人毆斗、醉酒,主動吸食或注射毒品;  

4)被保險人酒后駕駛機動車、無合法有效駕駛證駕駛機動車,或駕駛無有效行駛證的機動車;

5)戰爭、軍事沖突、暴亂或武裝叛亂;

6)核爆炸、核輻射或核污染;

7)被保險人妊娠、流產、分娩導致的傷害;

8)被保險人因整容手術或其他內、外科手術導致醫療事故;

9)被保險人未遵醫囑,私自使用藥物,但按使用說明的規定使用非處方藥不在此限;

10)被保險人患艾滋病(AIDS)或感染艾滋病病毒(HIV呈陽性)期間;

11)被保險人在中國大陸地區以外身故或造成傷殘的;

12)被保險人從事潛水、跳傘、攀巖、蹦極、駕駛滑翔機或滑翔傘、探險、摔跤、武術比賽、特技表演、賽馬、賽車等高風險運動;

13)提供虛假投保信息的,非學生身份以學生身份投保的;

14)被保險在勤工助學期間發生的事故。

發生上述情形,被保險人身故的,保險公司對該被保險人保險責任終止

2、醫療責任(意外醫療、住院醫療及門急診醫療)

因下列情形之一,造成被保險人支出的醫療費用,保險公司不承擔給付保險金責任:

1)投保人、受益人故意殺害或故意傷害被保險人;

2)被保險人故意自傷、故意犯罪或者抗拒依法采取的刑事強制措施;

3)被保險人毆斗、醉酒或受酒精影響,服用、吸食或注射毒品;

4)被保險人酒后駕駛機動車、無合法有效駕駛證駕駛機動車,或駕駛無有效行駛證的機動車;

5)戰爭、軍事沖突、暴亂或武裝叛亂;

6)核爆炸、核輻射或核污染;

7)被保險人患先天性疾病、遺傳性疾病、既往癥(投保前已患疾病或已存在的癥狀,保險期間非連續的);

8)被保險人患艾滋病或感染艾滋病病毒、性病;

9)被保險人懷孕、流產、分娩、不孕不育癥治療、人工受精、產前產后檢查;節育(含絕育)、墮胎,及以上原因引起的并發癥;

10)被保險人因整容手術或其它內、外科手術導致醫療事故;

11)被保險人因牙護理,如洗牙、牙移植、義齒、鑲牙、烤瓷牙等發生的醫療費用,以及口腔修復、口腔正畸、口腔保健及美容所發生的費用;(被保險人因齲齒、牙髓病、牙隱裂所引起的補牙、治牙神經、拔牙、阻生齒治療以及牙周組織疾病,如牙周炎、牙齦炎、根周炎(潔牙治療除外),所發生的合理醫療費用,屬于保險人保險責任范圍);

12)被保險人因矯形、矯正、整容或康復性治療等所支出的費用;

13)被保險人如體檢、疾病普查等項目;各種預防、保健性、療養、靜養或特別護理的診療項目;如各種疫苗預防接種、足部反射推拿療法、健身按摩等項目;

14)被保險人未遵醫囑,私自服用、涂用、注射藥物;

15)在中國大陸地區以外發生及中國大陸境內私立醫院發生的醫療費用及藥店、醫療器材公司所支出的費用;

16)被保險人在中國大陸地區以外發生的意外事故及后續治療;

17)被保險人支出的電話費、交通費、餐費等;

18)專業人員參與的高風險運動及高危競技類活動,如被保險人從事潛水、跳傘、滑翔傘、滾軸輪滑、滑雪滑冰、蹦極、攀巖、摔跤、柔道、跆拳道、武術、空手道、擊劍等高風險運動;

19)提供虛假投保信息的,非留學生身份以留學生身份投保的;

20)被保險人在醫院進行試驗性治療,且以醫學實驗為目的所產生的相關費用;

21)嚴格按照就診醫院的入院標準就醫,未達到入院指標、但被保險人按自己意愿住院或掛床住院的費用不予報銷;

22)被保險人在勤工助學期間產生的相關費用。

(三)保險費率

保障責任

保險金額

(元)RMB

8周歲—69周歲

保險費

(元/人·半年)

保險費

(元/人·年)

身故責任+意外傷殘

100000

400

800

意外醫療

20000

住院醫療

400000

門、急診疾病醫療

(日限額600元,起付線650元以上的部分報銷比例85%

20000

注:《國任財產保險股份有限公司附加意外傷害保險(2022版)條款》(C00014232322022062811611號)、《國任財產保險股份有限公司附加意外醫療保險條款》(C00014232522021042044092號)、《國任財產保險股份有限公司住院醫療費用保險(D款)條款》(C00014232512021062817971號)、《國任財產保險股份有限公司附加門急診醫療費用保險條款》(C00014232522021061799611號)、《國任財產保險股份有限公司附加住院津貼醫療保險條款》(C00014232522021051468622號)、《國任財產保險股份有限公司附加疾病身故及全殘保險條款》(C00014232622020102617952號)等條款執行。

理賠

就醫前務必撥打電話 4008105119 進行詢診

(一)理賠程序

保險事故發生后,理賠的規范程序:

第一步咨詢報案:因身體不適需就醫的,須在就診前致電4008105119,由救援醫生進行健康詢診、就醫指導及理賠注意事項告知。

第二步申請住院墊付:如經過詢診且門診治療后醫生確診需進一步住院治療的可申請住院墊付,經墊付公司溝通確認后符合住院墊付條件的,按照墊付程序進行墊付。

須知:凡未經4008105119電話報案、詢診的,或未經門診診治而直接入院治療的(包括病情未達到住院程度卻要求門診醫生同意住院治療的),墊付公司不負責住院費用墊付。對于未經上述報案程序申請的,個人自行墊支醫療費用的,將無法獲得賠付。

(二)理賠應備文件:

1、身故+意外傷殘

A 被保險人身份證明復印件;

B 被保險人傷殘時需提供傷殘鑒定證明(由指定鑒定機構出具鑒定報告);

C 被保險人死亡證明;

D 意外事故證明(如發生交通事故需公安部門出具的道路交通事故責任認定書或刑事鑒定證明書,高墜、溺水等須公安機關或相關部門出具事故屬意外或自殺的定性材料,飲酒導致事故須出具酒精含量定量報告);

E 被保險人與受益人關系證明及家屬的身份證明復印件。

2、意外醫療保險

A 被保險人身份證明復印件;

B 意外事故證明(如發生交通事故需公安部門出具的道路交通事故責任認定書等);

C 門診收據原件、費用清單、病歷(相對應每次就診的門診病歷)及檢查、化驗報告單復印件。

3、住院醫療保險

A 被保險人身份證明復印件;

B 意外事故經過證明(如發生交通事故需公安部門出具的道路交通事故責任認定書等);

C 醫院診斷證明、住院收據原件、住院明細清單原件、出院小結或住院病歷復印件。

4、門急診醫療保險

A 被保險人身份證明復印件;

B 收費收據原件;

C 相對應每次就診病歷(病歷日期須與發票日期相對應),費用明細,檢查、化驗報告單復印件。

如果已滿650元免賠額,須提交650元以下的發票原件、病歷、費用明細、檢查化驗報告單復印件。

5、護工費申請

住院期間醫院或護工公司出具的護工費發票原件。

以上醫療費用申請項說明:

1)每次申請理賠,申請材料中必須附上被保險人中國大陸境內的銀行賬號及該賬號的準確賬戶信息,包括賬戶名、賬號和開戶行信息,可通過存折復印件或銀行客戶信息表載明以上信息。(詳情請撥打4008105119進行咨詢)

2)若一次保險事故分別在兩家(包含兩家)以上醫院就診,須出具每次就診的診斷證明書、病歷復印件等相關文件。

理賠材料寄送地址:北京市西城區金融街 23 號平安大廈 10 1012 (郵編 100033)

收件人:來華項目組

電  話:4008105119

本方案為保險產品組合

最新保險簡介更新內容,請及時登錄留學保險網 www.lxbx.net 網站查閱。

本頁供了解產品內容,以上內容的最終解釋權歸屬國任財產保險股份有限公司所有

若有爭議,以中文解釋為準。


To participate in conditions:

International students studying in China, students from Hongkong, Macao and Taiwan, as well as overseas Chinese students in healthy condition, from 8 years old to 69 years old, are eligible to this policy.

Insurance Liabilities:

Guoren shall undertake the following insurance liabilities during the valid period of insurance:

1. Death insurance:

Guoren shall pay the stipulated amount of insurance compensation if the Insured dies of an accident or disease. Insurance liabilities thus terminate.

2. Accidental disability insurance:

If the Insured suffers from an accident which results in any disability listed in the Standards and Codes for Personal Insurance Disability Assessment (JR/T0083-2013) (issued by former China Insurance Regulatory Commission, BJF [2014] No. 6) within 180 days since the occurrence of the accident, Guoren shall assess the injury and disability according to the assessment principles stipulated by this Criteria, unless otherwise stipulated, Guoren shall pay the accidental disability insurance money, whose amount shall be calculated based on the multiplication of the proportion stipulated in this Criteria, which is corresponding to the assessment result, by the sum insured, which is corresponding to insurers responsibilities. If medical treatment is still not over on the 180th day, disability evaluation shall be made on the basis of the Insureds physical condition on that day and the Insurance of Accidental Disability shall be paid in accordance with the evaluation results.

If with the disability resulted from this accident and the previous disability combined as a more serious disability which could receive accidental disability insurance benefits for more serious items, the insurance shall be paid in accordance with the standard for the more serious disability, but the insurance of accidental disability which has been paid previously (disabilities listed in the Standards and Codes for Personal Insurance Disability Assessment (JR/T0083-2013) (issued by former China Insurance Regulatory Commission, BJF [2014] No. 6) have taken place before purchase of insurance or caused by events under Liability Exemption, shall be deemed as having been compensated already) shall be deducted therefrom.

The accumulative payment amount of accidental disability insurance, and death due to any accidental injury or disease shall not exceed the corresponding insured sum of the Insured. If the accumulative amount of payment exceeds the insured sum of the Insured, then the insurance liabilities to the insured thus terminate.

3. Accidental Medical Insurance:

If the Insured, who suffers from the accidental incident, receives medical treatment within 180 days since the occurrence of the accident, the Insurer shall be liable for the full amount of the reasonable and necessary expenses actually paid by the Insured for the medical treatment.

For example, the accidents such as scratches or bites by cats and dogs, falling down when walking, injured while playing sports.

Reimbursement equation: reasonable expenditure * 100%=reimbursable amount (the total amount of reasonable expenditures shall exclude the self-paid or partly self-paid items and expenses stipulated by the local regulations of the basic medical insurance).

Whether an accident happens to the Insured for once or several times, the Insurer shall pay the "accidental medical insurance" respectively in accordance with the aforesaid provisions, but the accumulative amount of payment shall not exceed the insured sum of the accidental medical insurance of the Insured. When the accumulative amount of payment reaches the insured sum of the accidental medical insurance of the Insured, the said insurance liability for the said Insured shall be terminated.

4. Hospitalization and Medical Insurance:

If diagnosis confirms that the Insured must be hospitalized for treatment because of suffering from the accident or the illness, Guoren shall pay 100% of the hospitalization and medical insurance to the insured with regard to the actual and reasonable expenses for medical treatment, including reasonable and necessary fees for nursing (limited to RMB200 Yuan per day and accumulate up to 60 days), medical record, heating, air-conditioning, bed, examination, special examination and treatment, operation, medicine, treatment, laboratory test, radiation, etc.

Relevant expenses arising from emergency rescue, under the responsibility of inpatient medical treatment, the Insured shall be paid 100% of the insurance premium for the reasonable and necessary treatment expenses of undergoing emergency rescue in the hospital.

Reimbursement equation: reasonable hospitalization expenditure * 100%=reimbursable amount (the total amount of reasonable expenditures shall exclude the self-paid or partly self-paid items and expenses stipulated by the local regulations of the basic medical insurance).

Whether the Insured is hospitalized for once or several times, the Insurer shall pay the insurance payment in the ruled limitation, when the cumulative amount of sub-item payment reaches its insurance amount, the insurance liability shall be terminated.

5. Outpatient and Emergency Medical Insurance:

The reasonable and necessary expenses incurred by the Insured for receiving outpatient or emergency medical treatment because of illness, within each insurance period, the daily limit for outpatient is RMB600, (that means, if medical expense exceeding RMB 600 per day, shall be calculated as RMB600; if the medical expense not exceeding RMB600 per day, shall be calculated by the actual amount). Once the medical expenses exceeding the starting line of RMB650, the remaining amount of the medical expenses exceeding the deductible RMB650 yuan on the basis of the daily limit rules will be reimbursed at a percentage of 85%, and the accumulative payment shall not exceed the limit of RMB20000. The insurance liability shall be terminated once the accumulative amount of payment reaches the sum insured.

Daily limit: The top claim limit of available medical cost.

Deductible: RMB 650 yuan (A total of RMB650 yuan is deducted accumulatively for one time during an insurance period). Below the starting line, there is no compensation.

The related expenses incurred from general outpatient treatment, emergency treatment, outpatient surgery, hospitalization for observation, and expense or cost of outpatient and emergency treatment before and after hospitalization that arise from the same cause of disease are also deemed as outpatient and emergency treatment.

For example, being treated in the outpatient or emergency for abdominal pain, fever, faint, and upper respiratory tract infection etc.

Reimbursement equation: (the expense of each day within the daily limit RMB600 yuan add up-650 yuan) * 85%=reimbursable amount (the total amount of reasonable expenditures shall exclude the self-paid or partly self-paid items and expenses stipulated by the local regulations of the basic medical insurance)

Note:

1) Medical organizations which are involved in all the foregoing medical insurance liabilities are limited to the public hospitals established within the border of Mainland China; However, for the insured who are treated in the ward area for foreigners, ward area for VIPs, private room, Class A ward, separate ward room, ward area for special treatment and needs, ward for special treatment and needs, ward for high-ranking officials, or similar ward area of the public hospitals, shall be excluded from the insurance, then all medical expenses incurred by such shall not be covered by the insurer.

2) If any third party has partially or fully paid any above-mentioned medical treatment fees, Guoren shall be liable for the remaining amount of reasonable fees that are within the reimbursable payment scope of the local basic medical insurance. But the limited portion of the fees for the bed, nursing, outpatient and emergency treatment within the daily limitation is also limited; if the third party has a specified proportion for payment of the limited sum, Guoren shall be liable only for the remaining amount after deducting the already paid amount from the limited sum. If the third party has no specified proportion for payment, then Guoren shall be liable for the remaining amount, but not exceeding the insured sum, after deducting the standard amount of this item from the limited sum which takes the regulations of the local basic medical insurance as the standard.

3) Medical treatment expenses generated by all the foregoing medical insurance liabilities are limited to the items and expenses that can be reimbursed in accordance with the local regulations of basic medical insurance, the self-paid or partly self-paid items and expenses cannot be reimbursed by the insurer.

4) For the insured who apply for the insurance for the first time or the insured who is not renewal of insurance, the first 30 days from the effective date of the insurance is the waiting period (observation period). Where the insured is hospitalized or treated in outpatient during the waiting period and related medical cost occurs, the insurer bears no liability of compensation. Insurance renewal or the treatment for the Insured suffered from an accident is not subject to any waiting period.

Liability Exemption

I. Liability Exemption for Death and Accidental Disability Insurance

Guoren shall be exempted from the insurance liabilities for death and accidental disability caused by any of the following circumstances on the part of the Insured:

1. Deliberate killing or injury conducted by the policy-holder or beneficiary to the Insured;

2. Deliberate self-harm, suicide, intentional crime, resistance to criminal compulsory measures taken according to the law on the part of the Insured;

3. Fighting, drunkenness, sucking or injection of drugs on the part of the Insured;

4. Driving a motor vehicle under the influence, driving a motor vehicle without a legal and valid driving license or driving a motor vehicle without a valid driving license on the part of the Insured;

5. War, military conflict, riot or armed rebellion;

6. Nuclear explosion, nuclear radiation or nuclear pollution;

7. Pregnancy, abortion, delivery and related complication on the part of the Insured;

8. Medical accident occurring to the Insured because of cosmetic surgery or other surgical operations;

9. Taking of medicine (excluding OTC medicine taken according to instructions) without permission of doctor on the part of the Insured;

10. During the period when the Insured suffers from AIDS or is infected with the AIDS virus (HIV-positive);

11. The Insured passes away or becomes disability because of an accident outside mainland China.

12. The Insured engages in high-risk activities such as diving, parachuting, mountain climbing, bungee jumping, paragliding, expedition, wrestling, martial art, stunt performance, horse racing, car racing, etc.

13. Providing false insurance information, or non-oversea students insured as an overseas student.

14. Those accidents that occur during the time when the Insured do their part-time job;

If the Insured is caused dead in any of the foregoing circumstances, Guoren shall terminate the insurance liability of the Insured.

II. Liability Exemption for Medical Insurance Liability (Accidental Medical Treatment, Outpatient, Emergency and Hospitalization)

Guoren shall be exempted from the insurance liabilities for medical expenses caused by any of the following circumstances on the part of the Insured:

1. Deliberate killing or injury conducted by the policy-holder or beneficiary to the Insured;

2. Deliberate self-harm, intentional crime or resistance to criminal compulsory measures taken according to the law on the part of the Insured;

3. Fighting, drunkenness or affected by alcohol, and active taking, sucking or injection of drugs on the part of the Insured;

4. Driving a motor vehicle under the influence, driving a motor vehicle without a legal and valid driving license or driving a motor vehicle without a valid driving license on the part of the Insured;

5. War, military conflict, riot or armed rebellion;

6. Nuclear explosion, nuclear radiation or nuclear pollution;

7. The insured suffers from congenital diseases, hereditary diseases, existing disease (disease or symptoms that already exist prior to the date of insurance and non-continuous within the insurance period);

8. The insured suffers from AIDS or HIV infection, sexually transmitted diseases;

9. Pregnancy, miscarriage or delivery on the part of the Insured, infertility treatment, artificial insemination, prenatal and postnatal check, birth control (including sterilization), abortion and complications caused by above-mentioned causes;

10. Medical accident occurring to the Insured because of cosmetic surgery or other surgical operations;

11. The medical expenses incurred by the Insured for dental care, such as washing teeth, dentures, dental implants, false filling, porcelain teeth, etc., as well as expenses incurred in oral restoration, orthodontics, oral health care and beauty; the reasonable medical expenses of the Insurer's dental fillings, tooth nerve treatment, tooth pulling, tooth impaction treatment and periodontal diseases (such as, periodontitis, gingivitis, periapical inflammation, except for teeth cleaning) due to dental caries, dental pulp disease and cracked teeth are within the insurance liability of the Insurer;

12. Expenses of orthopedics, correct procedure, plastic surgery or rehabilitation therapy received by the Insurer;

13. Items such as physical examination and disease screening for the Insured; various medical treatment items for prevention, health care, recuperation, rest and special care: such as various vaccines vaccination, foot reflexology massage therapy, fitness massage and other items;

14. Taking, application or injection of medicine without the permission of doctor on the part of the Insured;

15. Medical expenses incurred outside Mainland China or in private hospitals within Mainland China, and expenses incurred in drug stores and companies of medical apparatus and instruments;

16. Accidents that occur outside Mainland China and the follow-up treatments as a consequent on the part of the Insured;

17. Charge of telephone, transportation, meals, etc. on the part of the Insured;

18. Sports and athletic activities of high risk only professionals participate. (The Insured engages in high-risk activities such as diving, parachuting, paragliding, roller skating, skiing, skating, bungee jumping, rock climbing, wrestling, judo, taekwondo, martial art, karate, fencing, etc.

19. Providing false insurance information, or non-overseas students insured as an overseas student.

20. Experimental treatment and costs incurred for medical experiment purpose.

21. The insurant should turn to medical treatment in strict accordance with the hospital admissions standards. If not, the insurer does not reimburse the cost of hospitalization.

22. Relevant expenses incurred by the Insured during the time when they do their part-time work.

Insurance premium

Insurance Liabilities

Insurance Amount (Yuan) RMB

Age 869

Insurance Premium (Yuan per half a year per person)

Insurance Premium (Yuan per year per person)

Liability for Death + Accidental Disability

100000

400

800

Accidental Medical Treatment

20000

Hospitalization Medical Treatment

400000

Medical Treatment for Outpatient and   Emergency

(With a   daily limit of 600 yuan; the medical   expenses exceeding 650 yuan can apply for a claim, that excess portion will   be reimbursed at a proportion of 85%)

20000

Note: Matters not mentioned herein shall be executed according to 《國任財產保險股份有限公司附加意外傷害保險(2022版)條款》(C00014232322022062811611號)、《國任財產保險股份有限公司附加意外醫療保險條款》(C00014232522021042044092號)、《國任財產保險股份有限公司住院醫療費用保險(D款)條款》(C00014232512021062817971號)、《國任財產保險股份有限公司附加門急診醫療費用保險條款》(C00014232522021061799611號)、《國任財產保險股份有限公司附加住院津貼醫療保險條款》(C00014232522021051468622號)、《國任財產保險股份有限公司附加疾病身故及全殘保險條款》(C00014232622020102617952號)

If any dispute arises concerning the contents mentioned above, the Chinese interpretation shall prevail.


Claims:

Please be sure to call 4008105119 firstly to make a diagnosis inquiry before you go to see a doctor.

(1) Procedures for insurance claims:

Standard procedures of insurance claims after the occurrence of insurance accident:

STEP 1: Please call directly 4008105119 for medical consultation due to disease or accident. The rescuing doctor will provide consultation, diagnose, and medical guidance and instructions on the insurance claim.

STEP 2: After consulting the doctor and getting outpatient treatment, if the doctor confirms that further hospitalization is required, the insured can apply for advanced payment of medical expense for hospitalization to the rescue company. After communication and confirmation between the rescue company and hospital, it will be decided whether the advanced payment procedures shall be started.

Note: If the insured is directly hospitalized without being inquired, recorded by the doctor of the rescue company as well as not being treated by the outpatient (including those whose conditions do not meet the requirements of hospitalization but require the outpatient doctor to agree with hospitalization), or without advanced consultation by calling 4008105119, the rescue company will not be responsible for advanced payment of medical expense for hospitalization. If payment for medical expenses is made without the above procedures, the insured will not be able to get compensation.

(2) Document to be presented for settlement of claims:

1) Death or accidental disability

ACopy of ID of the Insured

BDisability certificate when the Insured is disabled (an evaluation report shall be issued by the assigned evaluation body)

CDeath certificate of the Insured

DCertificate of accident in case of an accident (in case of traffic accident, the traffic unit should issue a liability confirmation of traffic accident; in case of falling from the height and drowning, the public security organs or relevant departments shall issue the materials determining whether it is accidental or suicidal; in case of alcohol-induced accident, a quantitative report on the alcohol concentration shall be issued.)

E. Copies of certificates of the relationship between the Insured and all the beneficiaries, and copies of identification proofs of the beneficiaries


2) Accidental medical treatment

ACopies of ID of the Insured

BProcess and certificate of accident (in case of a traffic accident, the traffic unit should issue a liability confirmation of traffic accident, which is needed.)

COriginal of receipt, detailed expenditure sheet, medical record and copies of examination report and laboratory test report.


3) Hospitalization

ACopies of ID of the Insured

B. Certificate of the accident in case of an accident (in case of the traffic accident, the traffic unit should issue a liability confirmation of traffic accident)

C. Certificate of diagnosis, original receipt, expenditure sheet for hospitalization, copy of hospital discharge summary or medical record of hospitalization


4) Medical treatment for outpatient and emergency

ACopies of ID of the Insured

BOriginal of receipt

CMedical record, detailed expenditure sheet and copies of examination report and laboratory test report of each respective treatment (The date of the medical record and the date of invoice shall be corresponding with each other).


If the fees reach the deductible of RMB650 Yuan, then the original invoice, medical record, detailed expenditure sheet and copy of examination report and laboratory test report of treatment that costs below RMB650 Yuan are also required to be presented.

5) Application for nursing fee

Original Invoices of nursing fee issued by the hospital or by a nursing service company.


Special instructions to above:

(1) The Insureds bank account opened in mainland China and accurate information of this account, including account number, name, opening bank information, which can be obtained from a copy of deposit book and bank customer table, it must be attached to the claim settling documents for each request for compensation (For more details, please call 4008105119 ).

(2) Where the insured treated in two or more hospitals (including two hospitals) respectively for one insured incident, relevant documents such as diagnosis certificate and medical record from relevant hospitals of each treatment shall be presented.


Materials for claims settlement sent to 北京市西城區金融街23號平安大廈10層(郵編100033

Addressee: 來華項目組

Please Dial: 4008105119

This program is an insurance product mix

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This material is for your information; the final right of interpretation of the above content belongs to Guoren Property & Casualty Insurance Company, Ltd.

Chinese explanation prevails in case of contradiction arising out of the aforementioned contents.




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