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国任财产保险股份有限公司来华人员综合医疗保险保障计划简介

2023-02-19

投保条件

来华留学生、港澳台学生及华侨学生凡身体健康、年龄在8周岁-69周岁可参加本保险。

保障内容

(一)保险责任

在保险有效期间内,保险公司承担下列保险责任及服务项目:

1、身故责任:

被保险人因意外事故或疾病身故,保险公司按约定保险金额给付保险金,保险责任终止。


2、意外伤残责任:

被保险人因遭受意外事故,并自事故发生之日起180日内因该事故造成《人身保险伤残评定标准及代码》(JR/T00832013)(原中国保险监督管理委员会发布,保监发〔20146号)所列伤残项目的,保险公司依照该标准规定的评定原则对伤残项目进行评定,除另有约定外,保险公司按评定结果所对应该标准规定的给付比例乘以保险金额给付意外伤残保险金。如治疗仍未结束的,按事故发生之日起第180的身体情况进行伤残鉴定,并据此给付意外伤残保险金。

被保险人该次意外事故导致的伤残合并前次伤残可领较严重项目意外伤残保险金的,按较严重项目标准给付,但前次已给付的意外伤残保险金(投保前已有或因责任免除事项所致《人身保险伤残评定标准及代码》(JR/T00832013)(原中国保险监督管理委员会发布,保监发〔20146号)所列伤残的,视为已给付意外伤残保险金)应予以扣除。

每一被保险人的意外伤残、意外身故、疾病身故保险金的累计给付金额以其对应的保险金额为限,累计给付金额达到其保险金额时,对该被保险人的该项保险责任终止。

3意外医疗责任:

被保险人因遭受意外事故,并自事故发生之日起180日内进行治疗,保险公司就其实际支出的合理且必要的医疗费用按100%给付意外医疗保险金。

意外事故发生如:猫狗抓咬伤、走路磕摔伤、体育活动时摔伤等等造成的事故。

赔付公式:合理费用合计*100%=赔付金额(合理费用合计不含当地社会基本医疗保险规定的自费及部分自费费用)

被保险人不论一次或多次发生意外事故,保险公司均按上述规定分别给付“意外医疗保险金”,但累计给付金额以不超过该被保险人的意外医疗保险金额为限,累计给付金额达到其意外医疗保险金额时,对该被保险人的该项保险责任终止。


4、住院医疗责任:

被保险人因意外事故或因疾病,经医院诊断必须住院治疗的,保险公司就其实际支出合理且必要的护工费(限额200/天,累计60天)、建病历费、取暖费、空调费、床位费、检查检验费、特殊检查治疗费、手术费、药费、治疗费、化验费、放射费等合理医疗费用,按100%给付“住院医疗保险金”。

急诊抢救所产生的相关费用,归属住院医疗责任下,对被保险人在医院进行了急诊抢救的合理且必要的治疗费用,按照100%给付保险金。

赔付公式:合理住院费用合计*100%=赔付金额(合理费用合计不含当地社会基本医疗保险规定的自费及部分自费费用)。

被保险人不论一次或多次住院或急诊抢救的治疗,保险公司均在规定限额内给付保险金,分项累计给付金额达到其保险金额时,对该被保险人该项保险责任终止。

5、门急诊医疗责任:

被保险人因疾病进行门诊、急诊治疗所发生的合理且必要的医疗费用,每个保险期间内,就诊日费用限额为600元(即:若当日医疗费用超日限额的只能按600元计算,当日医疗费用未超600限额的按实际发生金额计算)在日限额的基础上累计超过650元免赔额以上的部分按照85%比例赔付累计给付以保险金额20000元为限。当累计给付金额达到其保险金额时,该被保险人的该项保险责任终止。

日限额:为每日就诊的最高费用限额。

免赔额:本险种设置650元为免赔额(一个保险期间内累计扣一次650元),免赔额以下部分不予赔付。

门急诊医疗费用包括:普通门诊、急诊、门诊手术、急诊留观所产生的相关费用、及因与住院同一病因产生的院前、院后门诊所产生的费用等均归属于门急诊医疗责任范围内。

即:如因腹痛、发热、晕倒、上呼吸道感染等等在门诊或急诊进行治疗的;

赔付公式:(每天在日限额600元以内的合理费用相加-650)*85%=赔付金额(合理费用合计不含当地基本医疗保险规定的自费及部分自费费用)


注:1.以上所有医疗保险责任所涉及的医疗机构仅限于在中华人民共和国大陆境内的公立医院。若被保险人在公立医院的外宾病区、VIP病区、包房、A等病房、单间、特诊特需病区、特诊特需病房和高干病房等同类病区或病房接受的治疗,则其所有的医疗费用保险公司均不予报销。

2.以上所有医疗费用,若其它第三方支付了部分或全部费用时,保险公司仅负责补偿剩余部分且与当地基本医疗保险支付范围相符的合理费用,但保险责任中所涉及的床位费、护工费、门急诊日限额等限额部分同样受限,如第三方有赔付比例的受限部分按照受限金额为基础扣除已赔付金额,保险公司只赔付剩余金额,如无赔付比例,受限部分按照当地基本医疗保险的标准,以受限金额为基础扣除此项目的标准金额,赔付剩余金额,并以保险金额为限。

3.以上所有医疗保险责任所涉及的医疗费用只限于当地社会基本医疗保险可报销的项目内的费用,医保规定的自费或部分自费项目均不在报销范围内。

4.首次投保或非连续投保的被保险人,自保险生效之日起30日内为等待期(观察期),等待期内发生的疾病及后续治疗,均不予报销。连续投保或被保险人遭受的意外事故进行的治疗则无等待期。

(二)责任免除

1、身故及意外伤残责任

因下列情形之一,造成被保险人身故、意外伤残的,保险公司不承担给付保险金责任:

1)投保人、受益人对被保险人的故意杀害、故意伤害;

2)被保险人故意自伤、自杀、故意犯罪或者抗拒依法采取的刑事强制措施;

3)被保险人殴斗、醉酒,主动吸食或注射毒品;

4)被保险人酒后驾驶机动车、无合法有效驾驶证驾驶机动车,或驾驶无有效行驶证的机动车;

5)战争、军事冲突、暴乱或武装叛乱;

6)核爆炸、核辐射或核污染;

7)被保险人妊娠、流产、分娩导致的伤害;

8)被保险人因整容手术或其他内、外科手术导致医疗事故;

9)被保险人未遵医嘱,私自使用药物,但按使用说明的规定使用非处方药不在此限;

10)被保险人患艾滋病(AIDS)或感染艾滋病病毒(HIV呈阳性)期间;

11)被保险人在中国大陆地区以外身故或造成伤残的;

12)被保险人从事潜水、跳伞、攀岩、蹦极、驾驶滑翔机或滑翔伞、探险、摔跤、武术比赛、特技表演、赛马、赛车等高风险运动;

13)提供虚假投保信息的,非学生身份以学生身份投保的;

14)被保险在勤工助学期间发生的事故。

发生上述情形,被保险人身故的,保险公司对该被保险人保险责任终止

2、医疗责任(意外医疗、住院医疗及门急诊医疗)

因下列情形之一,造成被保险人支出的医疗费用,保险公司不承担给付保险金责任:

1)投保人、受益人故意杀害或故意伤害被保险人;

2)被保险人故意自伤、故意犯罪或者抗拒依法采取的刑事强制措施;

3)被保险人殴斗、醉酒或受酒精影响,服用、吸食或注射毒品;

4)被保险人酒后驾驶机动车、无合法有效驾驶证驾驶机动车,或驾驶无有效行驶证的机动车;

5)战争、军事冲突、暴乱或武装叛乱;

6)核爆炸、核辐射或核污染;

7)被保险人患先天性疾病、遗传性疾病、既往症(投保前已患疾病或已存在的症状,保险期间非连续的);

8)被保险人患艾滋病或感染艾滋病病毒、性病;

9)被保险人怀孕、流产、分娩、不孕不育症治疗、人工受精、产前产后检查;节育(含绝育)、堕胎,及以上原因引起的并发症;

10)被保险人因整容手术或其它内、外科手术导致医疗事故;

11)被保险人因牙护理,如洗牙、牙移植、义齿、镶牙、烤瓷牙等发生的医疗费用,以及口腔修复、口腔正畸、口腔保健及美容所发生的费用;(被保险人因龋齿、牙髓病、牙隐裂所引起的补牙、治牙神经、拔牙、阻生齿治疗以及牙周组织疾病,如牙周炎、牙龈炎、根周炎(洁牙治疗除外),所发生的合理医疗费用,属于保险人保险责任范围);

12)被保险人因矫形、矫正、整容或康复性治疗等所支出的费用;

13)被保险人如体检、疾病普查等项目;各种预防、保健性、疗养、静养或特别护理的诊疗项目;如各种疫苗预防接种、足部反射推拿疗法、健身按摩等项目;

14)被保险人未遵医嘱,私自服用、涂用、注射药物;

15)在中国大陆地区以外发生及中国大陆境内私立医院发生的医疗费用及药店、医疗器材公司所支出的费用;

16)被保险人在中国大陆地区以外发生的意外事故及后续治疗;

17)被保险人支出的电话费、交通费、餐费等;

18)专业人员参与的高风险运动及高危竞技类活动,如被保险人从事潜水、跳伞、滑翔伞、滚轴轮滑、滑雪滑冰、蹦极、攀岩、摔跤、柔道、跆拳道、武术、空手道、击剑等高风险运动;

19)提供虚假投保信息的,非留学生身份以留学生身份投保的;

20)被保险人在医院进行试验性治疗,且以医学实验为目的所产生的相关费用;

21)严格按照就诊医院的入院标准就医,未达到入院指标、但被保险人按自己意愿住院或挂床住院的费用不予报销;

22)被保险人在勤工助学期间产生的相关费用。

(三)保险费率

保障责任

保险金额

(元)RMB

8周岁—69周岁

保险费

(元/人·半年)

保险费

(元/人·年)

身故责任+意外伤残

100000

400

800

意外医疗

20000

住院医疗

400000

门、急诊疾病医疗

(日限额600元,起付线650元以上的部分报销比例85%

20000

注:《国任财产保险股份有限公司附加意外伤害保险(2022版)条款》(C00014232322022062811611号)、《国任财产保险股份有限公司附加意外医疗保险条款》(C00014232522021042044092号)、《国任财产保险股份有限公司住院医疗费用保险(D款)条款》(C00014232512021062817971号)、《国任财产保险股份有限公司附加门急诊医疗费用保险条款》(C00014232522021061799611号)、《国任财产保险股份有限公司附加住院津贴医疗保险条款》(C00014232522021051468622号)、《国任财产保险股份有限公司附加疾病身故及全残保险条款》(C00014232622020102617952号)等条款执行。

理赔

就医前务必拨打电话4008105119进行询诊

(一)理赔程序

保险事故发生后,理赔的规范程序:

第一步咨询报案:因身体不适需就医的,须在就诊前致电4008105119,由救援医生进行健康询诊、就医指导及理赔注意事项告知。

第二步申请住院垫付:如经过询诊且门诊治疗后医生确诊需进一步住院治疗的可申请住院垫付,经垫付公司沟通确认后符合住院垫付条件的,按照垫付程序进行垫付。

须知:凡未经4008105119电话报案、询诊的,或未经门诊诊治而直接入院治疗的(包括病情未达到住院程度却要求门诊医生同意住院治疗的),垫付公司不负责住院费用垫付。对于未经上述报案程序申请的,个人自行垫支医疗费用的,将无法获得赔付。

(二)理赔应备文件:

1、身故+意外伤残

A被保险人身份证明复印件;

B被保险人伤残时需提供伤残鉴定证明(由指定鉴定机构出具鉴定报告);

C被保险人死亡证明;

D意外事故证明(如发生交通事故需公安部门出具的道路交通事故责任认定书或刑事鉴定证明书,高坠、溺水等须公安机关或相关部门出具事故属意外或自杀的定性材料,饮酒导致事故须出具酒精含量定量报告);

E被保险人与受益人关系证明及家属的身份证明复印件。

2、意外医疗保险

A被保险人身份证明复印件;

B意外事故证明(如发生交通事故需公安部门出具的道路交通事故责任认定书等);

C门诊收据原件、费用清单、病历(相对应每次就诊的门诊病历)及检查、化验报告单复印件。

3、住院医疗保险

A被保险人身份证明复印件;

B意外事故经过证明(如发生交通事故需公安部门出具的道路交通事故责任认定书等);

C医院诊断证明、住院收据原件、住院明细清单原件、出院小结或住院病历复印件。

4、门急诊医疗保险

A被保险人身份证明复印件;

B收费收据原件;

C相对应每次就诊病历(病历日期须与发票日期相对应),费用明细,检查、化验报告单复印件。

如果已满650元免赔额,须提交650元以下的发票原件、病历、费用明细、检查化验报告单复印件。

5、护工费申请

住院期间医院或护工公司出具的护工费发票原件。

以上医疗费用申请项说明:

1)每次申请理赔,申请材料中必须附上被保险人中国大陆境内的银行账号及该账号的准确账户信息,包括账户名、账号和开户行信息,可通过存折复印件或银行客户信息表载明以上信息。(详情请拨打4008105119进行咨询)

2)若一次保险事故分别在两家(包含两家)以上医院就诊,须出具每次就诊的诊断证明书、病历复印件等相关文件。

理赔材料寄送地址:北京市西城区金融街23号平安大厦101012(邮编100033)

收件人:来华项目组

电 话:4008105119

本方案为保险产品组合

最新保险简介更新内容,请及时登录留学保险网www.lxbx.net网站查阅。

本页供了解产品内容,以上内容的最终解释权归属国任财产保险股份有限公司所有

若有争议,以中文解释为准。


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 whichresults in any disability listed in theStandards and Codes for Personal Insurance Disability Assessment (JR/T0083-2013) (issued by formerChina 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 overon the 180thday,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 theStandards 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 treatmentwithin 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 thehospitalization and medical insuranceto the insured with regard to the actual and reasonable expenses for medical treatment, including reasonable and necessary fees for nursing (limited toRMB200 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 isRMB600, (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 ruleswill 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 aninsurance period). Below the starting line, there is no compensation.

The related expenses incurred fromgeneral outpatient treatment, emergency treatment, outpatientsurgery, hospitalization for observation, and expense or cost of outpatient andemergency treatmentbefore and after hospitalization that arise from the same cause of diseaseare 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 andthe 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《国任财产保险股份有限公司附加意外伤害保险(2022版)条款》(C00014232322022062811611号)、《国任财产保险股份有限公司附加意外医疗保险条款》(C00014232522021042044092号)、《国任财产保险股份有限公司住院医疗费用保险(D款)条款》(C00014232512021062817971号)、《国任财产保险股份有限公司附加门急诊医疗费用保险条款》(C00014232522021061799611号)、《国任财产保险股份有限公司附加住院津贴医疗保险条款》(C00014232522021051468622号)、《国任财产保险股份有限公司附加疾病身故及全残保险条款》(C00014232622020102617952号)

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北京市西城区金融街23号平安大厦10层(邮编100033

Addressee:来华项目组

Please Dial:4008105119

This program is an insurance product mix

Please log in www.lxbx.net for latest insurance introduction.

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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