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医疗保险
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平安养老保险股份有限公司来华人员综合保险保障计划简介
 

投保条件

留学生:来华留学生、港澳台学生及华侨学生(华侨身份可由相关单位出具证明),凡身体健康、年龄在6-69周岁可参加本保险。

保险责任

在保险期间内(从本次保险生效到截止的期限内),本公司承担下列保险责任:

1、身故保险责任

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

2、意外残疾保险责任

被保险人因遭受意外事故,并自事故发生之日起180日内因该事故造成本附加合同所附《人身保险伤残评定标准》所列伤残项目的,本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,本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日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》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保险金累计给付以该被保险人的保险金额为限,累计给付金额达到其保险金额时,对该被保险人的保险责任终止。

每一被保险人的意外残疾、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。

3、意外伤害医疗保险责任:

被保险人因遭受意外事故,并自事故发生之日起一百八十日内进行治疗,保险人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。被保险人不论一次或多次发生意外伤害保险事故,保险人均按上述规定分别给付“意外伤害医疗保险金”,但累计给付金额以不超过该被保险人的保险金额为限,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。

4、门急诊医疗保险责任:

被保险人因疾病进行门诊、急诊治疗所发生的合理医疗费用,每个保险期间内,就诊日费用限额为600元,累计超过起付线2000元以上的部分保险人按照85%的比例赔付,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,该被保险人的保险责任终止。

普通门诊、急诊、门诊手术、急诊留观、急诊抢救所产生的相关费用,由公立医院或卫生防疫部门提供证明的传染病因隔离期间所产生的相关费用、及因与住院同一病因产生的院前、院后门所产生的费用等均归属于门急诊医疗责任范围内。

按照相关政策要求:

药量:急性病3天,慢性病7天; 日限额:为每日的最高费用限额。

起付线:本险种设置2000元为起付线,起付线以下部分不予赔付。

5、住院医疗保险责任:

被保险人因意外事故或于保单生效日后因疾病(含SARS),经医院诊断必须住院治疗,本公司就其实际支出的护工费(限额100元/天,累计30天)、建病历费、取暖费、空调费、床位费(限额300元/天)、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”。

被保险人不论一次或多次住院治疗,本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,该项保险责任终止。

被保险人在本次投保前发生重大疾病或慢性病的,保险人不承担给付保险金的责任。

注:

1)以上所有医疗责任所涉及的医疗机构仅限于中华人民共和国大陆境内的公立医院,但不包括公立医院的分院、外宾病区、VIP病区、包房、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发生的医疗费用。

2)以上所有医疗责任所发生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,自费和部分自负项目均不能报销。

3)首次投保或非连续投保的被保险人自投保之日起30日为等待期(观察期),如等待期内出现住院或疾病门诊情况,本公司不负担赔偿责任。连续投保或被保险人遭受意外事故进行治疗的无等待期。

4)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,我司仅负责补偿剩余部分且与当地社会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,我司只赔付剩余金额,如无赔付比例,受限部分按照当地社会医疗保险的标准,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。

责任免除

一、身故及残疾责任免除

因下列情形之一导致被保险人身故、伤残的,本公司不承担给付保险金的责任:

(一)投保人、受益人对被保险人的故意杀害、故意伤害;

(二)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;

(三)被保险人殴斗、醉酒,主动服用、吸食或注射毒品;

(四)被保险人酒后驾驶、无合法有效驾驶证驾驶,或驾驶无有效行驶证的机动车;

(五)战争、军事冲突、暴乱或武装叛乱;

(六)核爆炸、核辐射或核污染;

(七)被保险人怀孕、流产、分娩;

(八)被保险人因整容手术或其他内、外科手术导致医疗事故;

(九)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;

(十)被保险人患爱滋病(AIDS)或感染爱滋病毒(HIV呈阳性)期间;

(十一)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;

(十二)被保险人在中国大陆地区以外身故的;

(十三)提供虚假投保信息的,外籍专家及外教以学生身份投保的;

(十四)留学生在勤工俭学期间发生的事故。

发生上述情形之一,被保险人身故的,本公司对该被保险人保险责任终止。

二、医疗责任(意外伤害医疗、门急诊医疗、住院医疗)责任免除

因下列情形之一造成被保险人医疗费用支出的,本公司不承担给付保险金的责任:

(一)投保人、受益人对被保险人的故意杀害、故意伤害;

(二)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;

(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、无合法有效驾驶证驾驶,或驾驶无有效行驶证的机动车;

(五)战争、军事冲突、暴乱或武装叛乱;

(六)核爆炸、核辐射或核污染;

(七)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);

(八)被保险人患艾滋病或感染艾滋病病毒、性病;

(九)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、堕胎,及以上原因引起的并发症;

(十)被保险人因整容手术或其它内、外科手术导致医疗事故;

(十一)被保险人因矫形、矫正、整容或康复性治疗等所支出的费用;

(十二)被保险人健康健查(体检)、疗养、静养或特别护理;

(十三)被保险人未遵医嘱,私自服用、涂用、注射药物;

(十四)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;

(十五)被保险人支出电话费、交通费等;

(十六)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;

(十七)提供虚假投保信息的,外籍专家及外教以学生身份投保的;

(十八)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;

(十九)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的费用不予报销;

(二十)非紧急情况下就医,未提前报案通过就医指导途径就医的相关费用;

(二十一)留学生在勤工俭学期间产生的相关费用。

保险费

保障责任

保险金额

(元)RMB

6—69岁

(留学生)

18—45岁

(外籍专家及外教)

46—69岁

(外籍专家及外教)

保险费

(元/人·半年)

保险费

(元/人·年)

保险费

(元/人·半年)

保险费

(元/人·年)

保险费

(元/人·半年)

保险费

(元/人·年)

身故责任+意外残疾

100000

300

600

600

900

900

1500

意外伤害医疗

20000

门、急诊疾病医疗(日费用限额600元;起付线2000元以上的部分85%赔付)

20000

住院医疗保险

400000

注:未尽事宜以《平安团体意外伤害保险》、《平安一年期团体定期寿险》、《平安附加意外伤害团体医疗保险》、《平安住院门诊急诊综合团体医疗保险》等条款执行。

Comprehensive Insurance & Protection Scheme for Foreigners Staying in China of Ping An Annuity Insurance Company, Ltd.

To participate in conditions:

International students: international students in China, students from Hongkong and Macao and overseas Chinese students (identity need to be proved by relative authority) in healthy condition from 6 to 69 are eligible to this policy.

Insurance coverage

Ping An shall undertake the following insurance liabilities during the period of insurance (Insurance period( from the valid date of policy to the end of the insurance period)

1Death insurance:

Ping An shall pay the stipulated amount of insurance compensation if the Insured dies of any accident or disease (including SARS). Insurance liabilities thus terminate.

2Accidental disability insurance:

If the Insured suffers from any accident which results in any disability within 180 days since the occurrence of the accident, according to the policy Ping An shall pay the insurance money, whose amount shall be calculated based on the multiplication of the sum insured and the proportion that is specified in the “Proportion Table of Disability Degree and Payment” of Ping An Annuity Insurance Company, Ltd. If medical treatment is still not over on the 180th day, disability evaluation shall be made on the basis of the Insured’s physical condition on that day and the “Insurance of Accidental Disability” shall be paid in accordance with the “Proportion Table of Disability Degree and Payment”.

If the same accident causes the Insured to suffer two or more disabilities as are specified in the “Proportion Table of Disability Degree and Payment”, the Insurer shall pay the total insured amount of the relevant disabilities. However, if different disabilities befall the same upper limb or lower limb, only the insured amount of one disability shall be paid; if disabilities are of different degrees, the insured amount of the disability that is more serious shall be paid.

If, with the disability resulted from this accident and the previous disability combined, the Insured can claim the insurance for the more serious disability, the insurance shall be paid in accordance with the standard for the more serious disability, but the disability insurance which has been paid previously (disabilities that have taken place before purchase of insurance, or disabilities that are caused by liability exemption and are listed in the “Proportion Table of Disability Degree and Payment” shall be deemed as having been compensated already) shall be deducted therefrom.

The accumulative amount of insurance for death or accident of each insured shall not exceed the insured sum of the insured’s total insurance for the death or accident.

3Medical Insurance for Accidental Injury:

If the Insured receives medical treatment within 180 days since the occurrence of the accident, the Insurer shall be liable for the payment of the full amount of the actual and reasonable expenses for the medical treatment, but the accumulative amount of payment shall not exceed the agreed sum insured. Whether an accidental injury happens to the Insured for once or several times, the Insurer shall pay the respective “medical insurance for accidental injury” in accordance with the foresaid provisions, but the accumulative amount of payment shall not exceed the Insured’s sum insured. When the accumulative amount of payment reaches the Insured’s sum insured, the said insurance liability for the said Insured shall be terminated.

4Outpatient and Emergency Medical Insurance:

If the Insured receive outpatient or emergency medical treatment because of illness and incur actual and reasonable expenses for medical treatment, Within the insurance time , the daily limitation for outpatients is RMB600. If beyond the starting-line,RMB2000,in the insurance time , the insured can enjoy 85% of reimbursement an accumulative amount of RMB20000 Yuan. The insurance liability shall be terminated once the accumulative amount of payment reaches the sum insured.

The fees of general outpatient treatment, emergency treatment, outpatient surgery, hospitalization for observation, emergency rescue, isolation due to infectious diseases that is certified by the public hospital or department of public health and epidemic prevention, and outpatient and emergency treatment before and after hospitalization that arise from the same cause of disease are also deemed as outpatient and emergency treatment

According to requirements of relevant policies:

Medication duration: 3-day medication of acute disease,

7-day medication of chronic disease

Daily limit: The top claim limit of available medical cost

Daily limit: The top claim limit of available medical cost

Starting-line to pay the limitation: RMB 2000. Below the starting-line,there is no claim.

5Hospitalization and Medical Insurance:

If diagnosis confirms that the Insured must be hospitalized for treatment because of the accident or the illness (including SARS) that befalls him/her after the insurance policy comes into force, Ping An shall be liable for the full payment of the “hospitalization and medical insurance” with regard to the actual and reasonable expenses for medical treatment, including fees for nursing (limited to RMB100 Yuan per day for accumulative 30 days), medical record, heating, air-conditioning, bed (limited to RMB300 Yuan per day), examination, special examination and treatment, operation, medicine, treatment, laboratory test, radiation, etc.

Whether the Insured is hospitalized for once or several times, the Insurer shall pay the costs of hospitalization within the prescribed limit, but the insurance liability shall be terminated once the accumulative amount of payment reaches the sum insured.

If the Insured suffers from a major disease or a chronic disease before the purchase of this insurance, the Insurer shall not bear the liability of payment.

Note:

1) Medical organizations which are involved in all the foregoing medical liabilities are limited to the public hospitals established within the border of the Chinese mainland; the medical expenses incurred in sub-branch of public hospitals, ward area for foreigners, ward area for special treatment and needs, ward for special treatment and needs, ward for high-ranking officials, or similar ward area or ward VIP ward single room. shall be excluded from the insurance.

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

3) The first 30 days of the first application for insurance or non-continuous coverage is waiting period (observation period). Where the issued is hospitalized or outpatient during the waiting period, the Issuer bears no liability. The treatment for continuous insured or the Insured suffered from an accident is not subject to any waiting period.

4) If any third party has partially or fully paid any above-mentioned medical treatment fees, Ping An shall be liable only for the rest amount of reasonable fees that are in accordance with the payment scope of the local social medical insurance. But the fees for nursing, bed and other fees within the insurance coverage are also limited. If the third party has a specified proportion for payment, then Ping An shall be liable only for the payment within its proportion deducting the already paid amount. If the third party has no specified proportion for payment, then Ping An shall be liable for the rest, not exceeding the insured sum, of the limited amount in accordance with the regulations of the local social medical insurance and with a deduction of the standard amount of this item.

Liability Exemption

一、 Liability Exemption for Death and Disability

Ping An shall be exempted from the insurance liabilities for death and 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, intentional crime, resistance to criminal compulsory measures taken according to law, suicide or arrest resistance on the part of the Insured;

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

4. Driving under the influence, driving 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, miscarriage or delivery 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 AIDS virus (HIV-positive);

11. 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.

12. The Issued passes away outside the mainland China.

13. Providing false insurance information, or international experts and teachers taking out an insurance policy as a student

14. Accidents occurring after the expiration of the last insurance duration and before the start of the next insurance duration with failure to renew the insurance by rule of the Insured part.

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

二、Liability Exemption for Medical Liability (Medical Treatment of Accidental Injury, Outpatient, Emergency and Hospitalization)

Ping An 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 law on the part of the Insured;

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

4. Driving under the influence, driving 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. Congenital diseases, hereditary diseases, existing disease (disease or symptoms that already exist prior to the date of insurance);

8. 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, abortion and complications caused by above-mentioned causes;

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

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

12. Health check (physical examination), healing, convalesce or special care

13. Taking, application or injection of medicine without the permission of doctor on the part of the Insurer;

14. Medical expenses incurred outside the Chinese mainland or in private hospitals of the Chinese mainland;

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

16. 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.

17. Providing false insurance information, or the international experts and teachers taking out an insurance policy as a student.

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

19. 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.

20. Fees incurred after the expiration of the last insurance duration and before the start of the next insurance duration with failure to renew the insurance by rule of the Insured part.

21. Fees incurred without reporting the case in advance or through the guidance channels of medical treatment under non-emergent circumstances

Insurance premium

Insurance Liabilities

RMB

Insurance Amount (Yuan) RMB

Age 6-69

(International Student)

Age 18-45

(International Expert and Teacher)

Age 46-69

(International Expert and Teacher)

Insurance Premium (Yuan per half a year per person)

Insurance Premium (Yuan per year per person)

Insurance Premium (Yuan per half a year per person)

Insurance Premium (Yuan per year per person)

Insurance Premium (Yuan per half a year per person)

Insurance Premium (Yuan per year per person)

Liability for Death + Accidental Disability

100000

300

600

600

900

900

1500

Medical Treatment for Accidental Injury

20000

Medical Treatment for Outpatient and EmergencyWith the daily limit of RMB600,beyond the start to pay limit of RMB2000, the insured can enjoy 85% of reimbursement

20000

Hospitalization Medical Treatment

400000

Note: Matters not mentioned herein shall be executed according to “Ping An Additional Disability Guarantee Group Accident Insurance (2013) (Clause D)”, “Ping An One-year Group Term Life Insurance”, “Ping An Additional Accidental Injury Group Medical Insurance”, “Ping An Inpatient, Outpatient and Emergency Comprehensive Group Medical Insurance” and “Ping An Inpatient Group Medical Insurance”.

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