第一部分综合医疗服务.doc

“留学中国”医疗保险计划及投保确认书“Studying in China” Expatriates Insurance Plan & Application Letter保障对象 / About the insured: 常驻大陆地区的境外人士(留学生)且未满60足岁均可参加本保险计划。Foreign residents under 60 years old living in Mainland China 保障特点 / Benefits advantage: （1）专业完善 - 保障完善的专属境外人士(留学生)（含港澳台）保险计划Elite choice Designed specially for foreign residents living in Mainland China (including Hong Kong, Taiwan, Macau citizen). （2）综合保障 - 结合人寿险、意外险、医疗险为一体的超值保障Comprehensive coverage Included in one insurance plan: Life, Accidental, and Medical benefits. （3）轻松就医 - 由医疗服务公司为您提供24小时家庭医生咨询，门急诊及住院引导就医服务（注1）Medical guide 24 hours medical service hotline providing experts guides for emergency treatment and choosing hospitals. (See Note. 1)（4）代垫费用 - 于网络医院或特约医疗机构就医时，由医疗机构代垫医疗费用Direct billing Direct billing available in network hospitals. （5）免费体检 - 一年一次免费身体检查（注2）Free medical check-up One free medical check-up offered per year (Note. 2)（6）全球保障 - 境外就诊亦可获得理赔Global cover Medical bills incurred outside Mainland China can also be claimed. （7）全球救援 - 全球紧急急难援助Global Assistance worldwide emergency assistance provided.（8）手续简便 - 参加本保险，无须健康检查Simplified policy application procedure no pre medical check-up required for policy application 1保障内容 / Benefits Schdedule: 保障专案 / Benefits 保障金额 / Benefit Amount / Limit (RMB)1.1 疾病身故或全残保险金Disease Death / Total Disability 30万元RMB 300 K2.1 意外身故保险金（除特定交通工具意外）Accidental Death（ Excluding specific traffic accidents ）60万元RMB 600 K2.2 意外残疾保险金（除特定交通工具意外）Accidental Disability（ Excluding specific traffic accidents ）30万元RMB 300 K3.1 特定交通工具意外身故保险金Accidental Death in specific traffic accidents飞机-100万元陆上公共交通工具或轮船-80万元Flight RMB 1000 Kboats or other common carriers RMB 800 K3.2 特定交通工具意外残疾保险金Accidental Disability in specific traffic accidents飞机-70万元陆上公共交通工具或轮船-50万元Flight RMB 700 Kboats or other common carriers RMB 500 K4. 重大疾病保险金（29种疾病）Critical Illness（29 Types）10万元RMB 100K5. 门急诊医疗保险金In-patient reimbursement每次限额800元每年限额1万元Limit per visit: RMB 800Limit per year: RMB 10K给付比例90%Reimbursement rate 90%6. 住院医疗保险金Out-patient reimbursement每年限额5万元Limit per year: RMB 50 K给付比例100%Reimbursement rate 100%会员费 / 每人 / 每年 （含医疗咨询服务费）Premium / Person / Year 4000元RMB 4000保障须知 / Policy Application Notice: 1.本保险计划保险期限为1年，第二年可办理续保；参加本保险计划最高投保年龄60周岁，续保可放宽投保年龄至65周岁；The effective period of the Policy is one year, renewal possible; The insured should be under 60y old. For renewal, the age can be extended to 65y old. 2.本会员保险费采用每年交付的方式；Premium payable annually. 3.本保险计划身故保险金以法定继承人为受益人；残疾保险金、医疗保险金及重大疾病保险金的受益人为被保险人本人；The beneficiary of death benefits for the Policy is legal beneficiary. The beneficiary of Accidental Disability, In-patient, Out-patient and Critical Illness benefits is the insured him/her self. 24.如现被保险人现在或过去患有恶性肿瘤、心脏病、中慢性肾功能衰竭、白血病、肝硬化、高血压II期及以上、糖尿病II期及以上、癫痫病、精神病、中风、再生障碍性贫血、帕金森氏病、血友病、红斑狼疮及结缔组织疾病、艾滋病等病症须提供个人健康告知声明书。If previously having any serious illness, the Policy applicant needs to provide DOH (Declaration of Health) *以上未尽事宜以保险合同条款为准。For more details, please refer to the Policy provisions. 申请人签字 / Insured Signature: 要保单位盖章 / Policyholder: 投保数据（务必填写完整且真实的数据，以确保投保利益，如有变更，请及时办理）Policy Application Documents (Please fill correctly all information requested. If there is any change, please inform the insurance company instantly) 姓名Insured Name出生日期Date of Birth性别Sex证件种类ID. Type证件号码ID. No.国内居住地Location in PRC China地址Insured Address电话Tel: 开户银行： 银行账号： （供理赔转帐）Bank Name： Bank Account： （For claim purpose）日期： 年 月 日Date： D MM YYYY保障说明 / The Policy Notice: 1.疾病身故保险金 / Disease Death Benefit：保险生效日起30天后被保险人发生疾病身故或疾病全残的，保险公司依照保险合同约定给付保险金。during the effective period of the Policy, if death or total disability occurs to the insured due to disease 30 days after the effective date of the Policy, the sum Assured will be given to the Insured or the Beneficiary. 2.意外身故保险金 / Accidental Death Benefit：保险有效期间内，被保险人因遭受意外伤害（除特定交通工具意外），自意外事故发生之日起180日内身故，保险公司给付意外伤害身故保险金。during the effective period of the Policy, if death occurs to the Insured within 180 days since the accidental injury occurs, the Sum Assured as Death benefit will be given to the Beneficiary.3.意外残疾保险金 / Accidental Disability Benefit：保险有效期间内，被保险人因遭受意外伤害（除特定交通工具意外）事故，自意外伤害发生之日起180日内导致残疾，比照残疾给付等级，保险公司给付意外伤害残疾保险金。during the effective period of the Policy, the Insured becomes disabled within 180 days since the accidental injury occurs to the insured, the Company will pay the benefit according to the “disable degree & benefit payment table”.4.特定交通工具意外伤害保险金 / Accidental Death in specific traffic accidents：3保险有效期间内，被保险人以乘客身份搭乘飞机、陆上交通工具或轮船时,遭受意外伤害，自意外事故发生之日起180日内身故，保险公司给付特定交通工具意外身故保险金。during the effective period of the Policy, if death occurs to the Insured within 180 days since the accidental injury occurs to the insured who is taking (Note. 4) a flight, boats or other common carriers (Note. 5) as a passenger (Note. 3), the Sum Assured as Death benefit will be given to the Beneficiary.5.特定交通工具意外残疾保险金 / Accidental Disability in specific traffic accidents：保险有效期间内，被保险人以乘客身份搭乘飞机、陆上交通工具或轮船时遭受意外伤害，自意外伤害发生之日起180日内导致残疾，比照残疾给付等级，保险公司给付特定交通工具意外残疾保险金。during the effective period of the Policy, The Insured becomes disabled within 180 days since the accidental injury occurs to the insured taking a flight, boats or other common carriers as a passenger, the Company will pay the benefit if the disablements are listed in “disable degree & benefit payment table”.6.重大疾病保险金 / Critical Illness Benefit:：保险生效日起，30天后被保险人经医院明确诊断初次患有本合同所定义的重大疾病，且生存28天以上者，保险公司将给付重大疾病保险金。during the effective period of the Policy, the insured who survive after 28 days from being first time diagnosed as suffering from a critical illness (type1 to type 29) listed in the rider, will be paid the sum assured as the living benefit. And the policy terminates.7.门急诊（含境外门诊或急诊） / Out-patient reimbursement (Including hospital visits outside mainland China) (1) 保障地区范围：全球保障。Cover area: worldwide (2) 保险有效期间内，被保险人因意外、疾病进行门诊或急诊治疗时，实际发生的合理且必要的门诊或急诊的医疗费用（包括药品费、诊疗费、牙科治疗费、检查费和材料费等）按约定的给付比例进行赔付，每次门诊或急诊最高给付限额为人民币800元。其中牙科治疗费年累计最高给付1500元。The insurance company will pay the outpatient medical expenses by signed payable ratio to the insured who is treated due to accidental injury or disease occurred during the effective period of the Policy. The outpatient expense paid by the insured must be necessary and reasonable. Reimbursement limit per visit is RMB 800. The reimbursement limit per year for dental treatment is RMB 1500.8.住院医疗 / In-patient reimbursement (Including hospital visits outside mainland China) ：(1)保障地区范围 / Cover area：全球保障 / worldwide (2)保险生效日起30日后，被保险人在中国大陆境内因疾病或意外伤害进行住院治疗时，实际发生的合理且必要的住院医疗费用（包括床位费、药品费、治疗费、检查费、材料费等）按约定进行赔付。In mainland China, company will pay the in-patient medical expenses by signed payable ratio to the insured who is treated due to accidental injury or disease occurred during the effective period of the Policy and 30 days after the effective date of the Policy. The in-patient expense paid by insured must be necessary and reasonable. 4(3)保险生效日起30日后，被保险人在台湾地区因疾病或意外伤害进行住院治疗时，实际发生的合理且必要的住院医疗费用（包括床位费、药品费、治疗费、检查费、材料费等），在台湾全民健保赔付后的自付额部分按约定进行赔付。In Taiwan area, while the rider is in force, company will pay the in-patient medical expenses by signed payable ratio to the insured who is treated due to accidental injury or disease occurred during the effective period of the Policy and 30 days after the effective date of the Policy. The in-patient expense paid by insured must be necessary and reasonable and be complementary to the reimbursement of Taiwan peoples social medical insurance plan. (4)保险生效日起30日后，被保险人在中国境外及港澳地区因疾病或意外伤害进行住院治疗时，实际发生的合理且必要的住院医疗费用（包括床位费、药品费、治疗费、检查费、材料费等）按中国境内三级甲等医院医疗费用标准计算并按约定的给付比例进行赔付。In Hong Kong, Macau and other parts of the world, company will pay the in-patient medical expenses by signed payable ratio and by reference to PRC China hospital grade III charge level to the insured who is treated due to accidental injury or disease occurred during the effective period of the Policy and 30 days after the effective date of the Policy. 9.关于医院 / About hospitals：(1)被保险人在电话报案后，可在国内任何网络医院或社保定点医院就诊，包括所有网络医院、特与医疗机构及国营医院的外宾部、特需部、特诊病房（不含重症监护病房）和高干病房等同类部门或病房。In-patient and out patient acceptable for all network hospitals and Chinese social security admitted hospitals, including the foreign room area, and other VIP rooms. (2)如在中国境外及港澳地区因意外伤害或急性疾病住院治疗，可在当地医院就诊。For emergency treatment in case of accident or of sudden breaking out sickness outside mainland China, the local hospitals are also acceptable. (3)如在台湾地区住院治疗，可在当地全民健保局特约医疗机构就诊。In Taiwan, all hospitals admitted by Taiwan peoples social medical insurance plan are acceptable. (4)大陆境内指定医院、中国境外及港澳地区的当地医院是指在符合当地医疗法规且经核准颁发开业执照并设有病房之全球的公立、私立及财团法人医疗。但不包括专供修养、戒毒、戒酒、护理、养老等非以直接治疗疾病为目的之医疗机构。台湾地区医院是指当地全民健保特约医院。All hospitals defined above should be public hospitals or of similar status, which have local legal license and In-patient rooms. Acceptable hospitals exclude those such as health resort, sanatorium, convalescent hospitals, drug & alcohol abandon center, retirement aged person center, etc whose main purpose are not of traditional medical cure and treatment. 10.注解 / Note：（1）注（1）：若需接受门诊、急诊、住院治疗，可与医疗服务公司联系，由医疗服务公司为您安排医院、推荐医师、控制并提高您的治疗质量。In case of need to get access to hospitals, the insured can call up the service hot