平安人寿来华人员综合保险保障计划简介

Brief Introduction of Ping An Life Insurance’s Overall Insurance & Benefit Plan for People Coming to China

保险责任

Insurance Liabilities

一、在保险责任有效期内，本公司承担下列保险责任：

1. This company shall undertake the following insurance liabilities during the period of insurance:

1、身故保险责任：被保险人因意外伤害事故或疾病(含SARS)死亡，本公司按约定保险金额给付保险金，保险责任终止。

1． Loss of Life Insurance

This company shall pay the stipulated amount of insurance compensation if the Insured dies of any accidental injury or disease (including SARS).

2、残疾保险责任：被保险人因遭受意外伤害事故，并自遭受意外伤害之日起一百八十日内导致残疾，本公司按照《平安意外残疾附加责任条款》所附“残疾程度与给付比例表”的规定比例乘以约定保险金额给付保险金。

2． Disability Insurance

If the Insured suffers from any accidental injury which results in any disability within 180 days since the occurrence of the accidental injury, this company shall be liable for the agreed amount of insurance multiplying the proportion stipulated in the Proportion Table between the Degree of Disability and the Payment attached to Ping An’s Additional Liability Clause for Accidental Disability.

被保险人不论一次或多次发生意外伤害保险事故，本公司均按规定分别给付意外残疾保险金，但累计给付金额以不超过约定保险金额为限。

This company shall respectively pay the insurance compensation for accidental disability in accordance with the stipulations no matter the Insured suffers from accidental injury for once or several times, however the accumulative payment hereto shall not exceed the stipulated amount of insurance.

被保险人自意外伤害事故发生并导致残疾之日起一百八十日内由于同一原因死亡，本公司只给付约定保险金额与意外残疾保险金的差额；超过一百八十日死亡，不论是否同一原因所致，本公司按约定保险金额给付保险金，保险责任终止。

If the Insured dies of the same reason within 180 days since the occurrence of accidental injury which results in any disability, this company shall be liable only for the difference between the stipulated amount of insurance and the insurance compensation for accidental disability; if the Insured dies after 180 days, this company shall pay the stipulated amount of insurance no matter the death is caused by the same reason.

3、意外伤害医疗保险责任：

3． Accidental Injury Medical Treatment Insurance

被保险人因遭受意外伤害事故，并自事故发生之日起一百八十日内进行治疗，本公司就其实际支出的合理医疗费用按100%给付意外伤害医疗保险金，累计给付金额以约定的保险金额为限。

If the Insured receives any medical treatment within 180 days since the occurrence of the accidental injury, this company shall be liable for the actual and reasonable expenses for medical treatment; however the accumulative payment shall not exceed the stipulated amount of insurance.

4、住院医疗保险责任：

4． Hospitalization Medical Insurance

被保险人因意外伤害事故或因疾病(含SARS)，经医院诊断必须住院治疗，本公司就其实际支出的护理费（限额100元/天）、床位费（限额100元/天）、手术费、药费、治疗费、化验费、放射费、检查费等合理医疗费用，按100%给付“住院医疗保险金”，累计给付金额以约定的保险金额为限。

If the Insured must be hospitalized through diagnosis for any accidental injury or disease (including SARS), this company shall be liable for the actual and reasonable expenses for medical treatment including nursing fee (limited to RMB100 Yuan per day), bed fee (limited to RMB100 Yuan per day), expenses for operation, medicine, treatment, laboratory test, radiation and examination, however the accumulative payment shall not exceed the stipulated

5、团体高额医疗费用保险责任：

5．Group Major Medical Expenses Insurance

被保险人因疾病(含SARS)或意外伤害住院治疗而导致的在保险期间发生的合理且必要的医疗费用以及在保险期间内发生并延续至保险合同到期日后一个月内的合理且必要的住院医疗费用（包括床位费（限额100元/天）、药费治疗费、护理费、护工费（限额100元/天）、检查检验费、特殊检查治疗费、救护车费和手术费），在累计超过起付线（人民币6万元）时，本公司对起付线以上至封顶线（人民币40万元）的部分按100%给付住院医疗保险金。

As for the reasonable and necessary expenses for the medical treatment hereto occurred during the period of insurance as well as the expenses for hospitalization medical expenses (including the bed fee (limited to RMB100 Yuan per day), expenses for medicine, nursing fee (limited to RMB100 Yuan per day), treatment, laboratory test and examination, special examination and treatment, ambulance and operation) which is occurred during the period of insurance and extended into one month after the expiration of the insurance agreement, if the Insured is hospitalized for any disease (including SARS) or accidental injury, this company shall be liable for the amount of insurance compensation exceeding RMB60,000 Yuan but limited to RMB400,000 Yuan.

注：1）以上所有医疗机构仅限于中华人民共和国大陆境内的公立医院。

2）医疗费用范围只限于符合当地社会基本医疗保险规定报销范围的项目和费用，但承担乙类药品的自负费用。

Note: 1）All the foregoing medical organizations shall be limited to the public hospitals established within the board of the People’s Republic of China;

2）The scope of medical treatment expenses shall be limited to the items and expenses which can be reimbursed in accordance with the local regulations on social basic medical insurance. However the expenses for the B-class medicine shall be paid by themselves.

责任免除

Liability Exemption

身故及残疾责任免除

Liability Exemption for Loss of Life and Disability

因下列情形之一，造成被保险人身故、残疾的，本公司不负给付保险金责任：

This company shall be exempted from the insurance liabilities for the loss of life and disability of the Insured for any of the following circumstances:

一、投保人或受益人的故意行为；

二、被保险人犯罪、吸毒、殴斗、酒醉、自残或自杀；

三、被保险人酒后驾驶或无照驾驶；

四、被保险人怀孕、流产或分娩；

五、被保险人患有爱滋病或其它性病。

六、战争、军事行动、内乱或武装叛乱；

七、核爆炸、核辐射或核污染；

八、专业人员参与的高风险运动及高危竞技类活动。

发生上述情形，被保险人身故的，本公司对该被保险人保险责任终止，并在扣除手续费后退还该被保险人的未满期保险费。

• any intentional act of the applicant for insurance or the beneficiary;
• criminal act, addiction to narcotic, fighting, drunkenness, self-injury or suicide of the insured;
• driving while intoxicated or driving without license of the insured;
• pregnancy, miscarriage or childbirth of the insured;
• AIDS or other VD of the insured;
• War, military action, civil rebellion or armed revolt;
• Nuclear explosion, radiation or pollution;
• High-risk sports and athletic activities by the professionals;

If any of the foregoing circumstances happens resulting in the death of the Insured, this company shall end the insurance liabilities and return the immature insurance premium after the deduction of the commission.

医疗责任（意外伤害医疗、住院医疗、高额医疗费用）免除

Liability Exemption for Medical Treatment (accidental injury medical treatment, hospitalization medical treatment and major medical expenses)

因下列情形之一造成被保险人支出的医疗费用，本公司不负给付保险金责任：

This company shall be exempted from the insurance liabilities for any of the following circumstances:

一、投保人、受益人对被保险人故意杀害、伤害；

二、被保险人故意犯罪或拒捕、自杀或故意自伤；

三、被保险人殴斗、醉酒，服用、吸食或注射毒品；

四、被保险人酒后驾驶、无照驾驶及驾驶无有效行驶证的机动交通工具；

五、被保险人因整容手术或其他内、外科手术导致医疗事故；

六、被保险人因矫形、整容或康复性治疗等所支出的费用；

七、被保险人支出的挂号费、膳食费、陪住费、取暖费、交通费等；

八、当地社会基本医疗保险或公费医疗管理部门规定的自费项目和药品；

九、被保险人未遵医嘱，私自服用、涂用、注射药物；

十、战争、军事行动、暴乱或武装叛乱；

十一、核爆炸、核辐射或核污染。

十二、首次投保前的既往症、精神疾病、艾滋病、性病、先天性或遗传性疾病及其并发症；

十三、在中国大陆地区以外发生的医疗费用。

十四、被保险人怀孕、流产或分娩；

十五、普通疾病门诊医疗费用。

• intentional killing or injure the insured by the applicant or the beneficiary;
• criminal act or arrest resistance , suicide or intentional self-injury of the insured;
• fighting, drunkenness, drug taking, addiction or injection of the insured;
• driving while intoxicated or without license or driving motor-driven vehicle without valid driving certificate of the insured;
• medical accident occurred during the cosmetic operation or other physician or surgery operations of the insured;
• the expenses for orthopaedic, cosmetic operation or rehabilitating treatment of the insured;
• registration fee, expenses for board, accompanying accommodation, heating and traffic of the insured;
• items and drugs at private expense stipulated by the local departments in charge of the social basic medical insurance or medical treatment on public expense;
• taking, coating or injecting drugs not in conformity with doctor’s advice;
• war, military act, rebellion or armed revolt;
• nuclear explosion, radiation or pollution;
• previous disease, mental disease, AIDS, VD, congenital or hereditary disease and the complications before the first application for insurance;
• medical treatment expenses occurred out of the board of the People’s Republic of China;
• pregnancy, miscarriage or childbirth of the insured;
• out-patient treatment expenses of common disease.

保险费

Insurance Premium

注：未尽事宜以《平安团体一年定期保险条款》、《平安附加残疾保障团体意外伤害保险条款》、《平安团体附加意外伤害医疗保险条款》、《平安团体住院医疗条款》、《平安团体高额医疗费用保险（B）款》的规定为准。

Note: other matters that are not stipulated in this plan shall be governed by the Ping An’s Regular 1-Year Group Insurance Clause, Ping An’s Additional Liability Clause for Disablity Benifit and Group Accacidental Injury , Ping An’s Insurance Clause for Additional Accidental Injury Medical Treatment, Ping An’s Clause for Group Hopistalization Medical Treatmentand the Clause (B) for Group Major Medical Expenses Insurance.

平安人寿来华人员保险理赔指南

A Guide for People Coming to China to Insurance Claim against Ping An Life Insurance

尊敬的客户：

您如果想了解中国平安人寿保险股份有限公司来华人员综合保险理赔服务事项,请您仔细阅读如下内容。

Dear Valued Customer:

Respectful clients of Ping An Insurance Company:

If you would like to know services for settlement of claims of comprehensive insurance for people coming to China, please read this guide carefully.

1、理赔程序

⑴　保险事故发生后，理赔的规范程序:

直接向协议约定的中国平安人寿保险股份有限公司所属分公司团险理赔部报案；

⑵　理赔咨询电话：

协议约定的中国平安人寿保险股份有限公司所属分支机构电话或通过平安人寿北京分公司客户服务咨询及理赔报案电话010-66213388-69013直接查询被保险人所在地的平安人寿分管机构电话及详细地址；

1. Procedure of settling claims:

• Claim settling procedure against the occurrence of insured incidents:

Submit your claim to Group Insurance Division with affiliated companies under China Ping An Life Insurance Co., Ltd. as stipulated in the agreement.

• Claim & consulting hotlines:

Please call the local branches under China Ping An Life Insurance Co., Ltd. or dial the service and claim consulting number: 010-66213388-69013 of Beijing Branch to inquire the numbers and specific address of the local branches as agreed in the contract directly.

2、理赔应备文件：

① 团体一年定期寿险

A 被保险人护照复印件；

B 被保险人伤残时需提供伤残鉴定证明（由司法或劳动部门出具）；

C 被保险人死亡需提供死亡证明；

D 如发生交通事故，需出具公安交通部门的事故证明；

E 被保险人死亡时提供受益人身份证明复印件；

F 死亡赔付需提供受益人亲笔签字认可的保险分配方案的文件；

G 被保险人保险卡复印件；

2. Documents to be presented for settlement of claims:

①Group term life insurance of one year

A. Copy of passport of the insured;

B. Disability assay certificate in case the insured is disabled (provided by judicial or labor department);

C. Death certificate of the insured;

D. Proof of accident provided by the communications department of the police in case an traffic accident occurs;

E. Copy of the beneficiary’s identity proof in case the insured is dead;

F. Insurance distribution scheme signed and ratified by the beneficiary in death compensation;

G. Copy of the insurance card of the insured.

②团体意外伤害附加医疗

A 被保险人护照复印件；

B 意外事故经过及证明（若是交通事故则需出具公安交通部门事故证明）；

C医院诊断证明、病历本以及门诊收据、药费处方、超声波、CT、X光片、核磁等辅助检查报告单；

D 被保险人保险卡复印件；

②Annexed medical treatment to group accidental injury

A. Copy of passport of the insured;

B. Process of the accident and its proof (A proof of accident provided by the communications department of the police has to be presented in case a traffic accident occurs);

C. Diagnoses certificate and the medical records and medical examination receipt, diagnoses with medical charge, assist examination record of ultrasonic, CT, X-ray, nuclear and magnetic etc.

D. Copy of the insurance card of the insured.

③团体住院医疗

A 被保险人护照复印件；

B 意外事故经过及证明；

C 医院诊断证明以及住院收据住院明细文件原件；

D 被保险人保险卡复印件；

③Group medical treatment in hospital

A. Copy of passport of the insured;

B. Process of the accident and its proof;

C. Original copy of diagnoses certificate and receipt and detailed documents for hospitalization;

D. Copy of the insurance card of the insured

④每次赔案文件中须附上被保险人或学校指定的银行帐号,并本人签字或学校盖章。

④Account number of the insured or the school in designated bank and the signature or school’s seal is to be annexed to each of the claim settling documents.

注意事项：Notes:

1、若一次保险事故分别在两家（含）以上医院就诊，须出具相应医院诊断证明书、病历本等相关文件。

2、就诊医院为公立二级（含）以上医疗机构。

3、保险公司理赔完成后将加盖本公司公章的医药费分割单同赔款一同寄至申请人，以报销余下部分医药费。

4、护工费申请要求：

（1）被保险人个人申请所需材料：医院出具的护工费收据；

（2）被保险人所在单位申请所需材料：医院出具的护工费收据或单位开具的证明和护工本人的签字并加盖申请单位公章；

5、材料寄送地址：中国平安人寿当地分管机构规定的地址。

Notes:

1. Where in one insured incident, the insured has to be treated in two or more hospitals, diagnoses certificate from those aforesaid hospitals and the medical records and other documents in respect thereof shall be presented.

2. The insured shall get treatment in hospitals which are public medical institutions and at least in second rank.

3. After the insurance company settles a claim, dividable medical charge bill sealed by the insurance company and the indemnity will be sent to the applicant so as to compensate the remaining medical charge.

4. Application of Nursing Fee:

(1) Materials the insured is required to submit: Receipt of nursing fee issued by the hospital;

(2) Materials required from the applicant’s working unit: Receipt of nursing fee issued by the hospital or letter of identification with nurse’s signature and official seal of the unit of applicant;

5. Materials sent to: the appointed local branches subordinated to China Ping An Life Insurance.