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
发布时间:2020-04-07 13:58:13
发布时间:2020-04-07 13:58:13
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
Brief Introduction to Ping An Annuity Insurance Company, Ltd..
Comprehensive Insurance & Protection Scheme for Foreigners staying in China
保险责任
Insurance coverage
在保险责任有效期内,本公司承担下列保险责任:
Ping An 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.Death Insurance: Ping An shall pay the stipulated amount of insurance compensation if the
Insured dies of any accidental injury or disease (including SARS). Insurance liabilities thus
terminate.
2、残疾保险责任:被保险人因遭受意外伤害保险事故,并自遭受意外伤害之日起一百
八十日内导致残疾,乙方按照平安养老保险股份有限公司“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。如第一百八十日治疗仍未结束,则按第一百八十日的
身体情况进行残疾鉴定,并据“残疾程度与给付比例表”给付“意外残疾保险金”。
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, The sum insured shall be
paid by Party B in the amount of agreed insured sum specified in the insurance policy multiply by
certain proportion stated in the Disability Degree and Payment Proportion Table of Ping An
Annuity Insurance Company, Ltd.. If the treatment is not finished on the 180th days, disability
identification shall be conducted on the basis of the Insured’s physical condition on the 180th day,
and the Insurance for Accidental Disability shall be paid in accordance with the Disability Degree
and the Payment Proportion Table .
被保险人因同一意外伤害事故造成“残疾程度与给付比例表”所列残疾程度两项以上者,
保险人给付各对应项残疾保险金之和。但不同残疾项目属于同一手或同一足时,仅给付一
项残疾保险金;若残疾项目所属残疾等级不同时,给付较严重项目的残疾保险金。
If the same accidental injury results in two or more disabilities listed in the Disability Degree
and Payment Proportion Table to the Insured, the Insurer shall pay the sum insured to the sum of
the amount to each corresponding disability. However, however if different disabilities take place
to the same arm or leg, only one disability insured amount shall be paid;If the disabilities fall into
different disability degrees, the disability insured amount for the more serious disability shall be
paid.
该次意外伤害事故导致的残疾合并前次残疾可领较严重项目残疾保险金者,按较严重
项目标准给付,但前次已给付的残疾保险金(投保前已患或因责任免除事项所致“残疾程度
与给付比例表”所列的残疾视为已给付残疾保险金)应予以扣除。
If with the disability resulted from this accidental injury and the previous disability taken
together, the Insured could draw 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 previously been paid (the disabilities took place before buying insurance or the
disabilities listed in the Proportion Table between the Degree of Disability and the Payment which
were resulted from exceptions shall be treated as being compensated already)shall be deducted.
被保险人不论一次或多次发生意外伤害保险事故,乙方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。
Party B shall respectively pay the insurance compensation for accidental disability in
accordance with the policy, no matter the Insured suffers from accidental injury for once or
several times, however the accumulative payment hereto shall not exceed the stipulated sum
insured.
每一被保险人的意外残疾、意外身故保险金的累计给付金额以其对应的意外伤害保险
金额为限。
The accumulative amount of insurance for accidental disability or death of each insured shall
not exceed the insured sum set for the corresponding accidental injury.
被保险人自意外伤害保险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,
乙方只给付约定意外身故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,乙方按约定意外身故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, Party B shall be liable only for the difference between the
stipulated insured amount for accidental death and for accidental disability; if the Insured dies
after 180 days, Party B shall pay the stipulated insured amount for accidental death no matter if
the death is caused by the same reason., and the insurance liability shall be terminated.
3、意外伤害医疗保险责任:
3.Accidental Injury Medical Treatment Insurance Liability
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。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。
If the Insured receives any medical treatment within 180 days since the occurrence of the
accidental injury, the insurer shall be liable for the full amount of the actual and reasonable
expenses for medical treatment; however the accumulative payment shall not exceed the stipulated
insured sum.No matter the Insured suffered from accidental injury once or many times, the Insurer
shall respectively pay for the Accidental Injury Medical Treatment in accordance with the foresaid
provisions, but the accumulative amount of payment shall not exceed the Insured amount, where
the accumulative amount of payment amounts to the insured’s Insured sum, the said insurance
liability for the said Insured shall be terminated.
4、住院医疗保险责任:
4. Hospitalization Medical Treatment Insurance Liability
被保险人因意外伤害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(门诊手术及医院无床位原因的观察室治疗视同住院医疗),乙方就其实际支出的护工费
(限额100元/天,累计30天)、救护车费、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”。
If the hospitalization is diagnosed to be necessary of the insured due to any accidental injury,
or for any disease (including SARS) after the day of insurance policy become effective
(Ambulatory Surgery andobservation room treatment due to no bed available shall be treated as
hospitalization medical treatment), Party B shall be liable for the actual and reasonable expenses
for medical treatment including nursing fee (limited to RMB100 Yuan per day for accumulative
30 days), ambulance fee, medical record fee, heating fee, air conditioner fee, bed fee (limited to
RMB300 Yuan per day), expenses for docimasia, special examination and treatment, operation,
medicine, treatment, laboratory test, radiation and etc., and shall pay 100% of the costs of
hospitalization medical treatment.
被保险人发生保险责任范围内的住院治疗,其因同一病因发生的院前、院后门急诊医
疗费用可以按住院医疗费用赔付标准予以赔付。
If hospitalization treatment which is within the scope of insurance liability is necessary to the
insured , the outpatient and emergency treatment fee before and after hospitalization arise from the
same disease shall be paid in accordance with the payment standard of hospitalization medical
treatment.
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。
Insurer shall pay the costs of hospitalization without reference to the number of times within
the regulated limits, however insurance liability shall be terminated once the accumulative
payments reached the sum insured.
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。
If the Insured suffered from critical illness or chronic disease before buying this insurance,
the Insurer shall be released from its liability to make payments.
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
insured.
责任免除
Liability Exemption
身故及残疾责任免除
Liability Exemption for Death 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 corporate shall be exempted from the insurance liabilities for the death 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。
1. any intentional act of the applicant for insurance or the beneficiary;
2. criminal act, addiction to narcotic, fighting, drunkenness, self-injury or suicide of the
insured;
3. driving while intoxicated or driving without license;
4. pregnancy, miscarriage or childbirth of the insured;
5. AIDS or other VD of the insured;
6. War, military action, civil rebellion or armed revolt;
7. Nuclear explosion, radiation or pollution;
8. High-risk sports and athletic activities by the professionals;
If any of the foregoing circumstances happens resulting in the death of the Insured, the
insurer shall end the insurance liabilities and return the unearned premium after the deduction of
the commission charge.
医疗责任(意外伤害医疗、住院医疗)免除
Liability Exemption for Medical Treatment (accidental injury medical treatment and
hospitalization medical treatment)
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:
The insurer 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;
保障责任 | 保险金 额 (元) RMB | 6—69岁 (留学生) | 6—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 | 400 | 600 | 600 | 1000 |
意外伤害医疗 | 20000 | ||||||
住院医疗保险 | 400000 | ||||||
七、被保险人支出膳食费、电话费等;
八、被保险人未遵医嘱,私自服用、涂用、注射药物;
九、战争、军事行动、暴乱或武装叛乱;
十、核爆炸、核辐射或核污染。
十一、在中国大陆地区以外发生的医疗费用。
十二、被保险人怀孕、流产或分娩;
十三、普通疾病门诊医疗费用。
1. intentional killing or injure the insured by the applicant or the beneficiary;
2. criminal act or arrest resistance , suicide or intentional self-injury of the insured;
3. fighting, drunkenness, drug taking, addiction or injection of the insured;
4. driving while intoxicated or without license or driving motor-driven vehicle without valid
driving certificate of the insured;
5. medical accident occurred during the cosmetic operation or other physician or surgery
operations of the insured;
6. the expenses for orthopaedic, cosmetic operation or rehabilitating treatment of the insured;
7. the expenses food and telephone of the insured;
8. taking, coating or injecting drugs not in conformity with doctor’s advice;
9. war, military act, rebellion or armed revolt;
10. nuclear explosion, radiation or pollution;
11. the medical expenses occurred from out of the board of the People’s Republic of China;
12. pregnancy, miscarriage or childbirth of the insured;
13. out-patient treatment expenses of common disease.
保险费
Insurance Premium
意外伤害团体医疗保险(A 款)》、《平安住院团体医疗保险》条款执行。
Age: 6—69
(Foreign student)
Age: 6—45
(Foreign expert and
Outside teaches
Age: 46—69
(Foreign expert and
Outside teaches)
Insurance Liabilities Insurance
amount(yu
an)RMB
Insurance Premium (Yuan per half-of- year for each) | Insurance Premium (Yuan per year for each) | Insurance Premium (Yuan per half-of- year for each) | Insurance Premium (Yuan per year for each) | Insurance Premium (Yuan per half-of- year for each) | Insurance Premium (Yuan per year for each) | ||
Liability for Death +Accidental Disability | 100000 | 300 | 600 | 400 | 600 | 600 | 1000 |
Medical Treatment for Accidental Injury | 20000 | ||||||
Hospitalization Medical Treatment Insurance | 400000 | ||||||
Notes: Matters not mentioned herein shall be executed in accordance with the provisions of Ping
An Group Accidental Injury Insurance, Ping An Group One-year Fixed Term Life Insurance, Ping
An Additional Insurance for Group Accidental Injury Medical Treatment (Tape A), Ping An
Group Hospitalization Medical Treatment Insurance.
以上内容若有争议,以中文的解释为准