Insurance coverage
Ping An shall undertake the following insurance liabilities during the period of insurance:
1、Death 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.
2、Accidental disability insurance:
If the Insured suffers from any accident which results in any disability within 180 days since the occurrence of the accident, 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.
3、Medical 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.
4、Outpatient 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, Ping An shall be liable for 85% of the payment that is beyond accumulative RMB650 Yuan within the same period of insurance, limited to RMB600 Yuan per day and 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 hospitalization and emergency treatment
According to requirements of relevant policies:
Medication duration: 3-day medication of acute disease, 3-day medication of chronic disease, 30-day long-term medication of chronic disease such as hypertension, diabetes, etc.
Times of treatment: limited to fees from at most 3 different hospital departments per day; fees exceeding the limit shall be self-paid.
5、Hospitalization 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 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 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
I、 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 Chinese mainland.
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.
II、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 orthopaedics, diorthosis, face-lift or rehabilitation therapy received by the Insurer;
12. Health check (physical examination), recuperating 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
III Insurance premium
Note: 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 and Ping An Comprehensive Insurance for Group Hospitalization, Outpatient and Emergent Medical Treatment.
If contradiction arises as regards the above contents, elaborations in Chinese shall prevail.
