加载中…海外旅行意外事故和医疗保险条款(英文版）
(2018-01-09 20:19:19) | 分类： 金融借贷担保融资保险证劵 |
General Clause 一般性条款
I. The composition of insurance contract 保险合同的构成
II. The Insured 被保险人
III.
IV. Insurance Benefit Type Select 保险收益类型的选择
V. General Exclusion 一般性免责
VI.
VII. Honest Disclosure 善意披露信息
VIII.
IX.
X. Termination of contract 合同终止
XI.
XII. Definition 定义
XIII.
Insurance Liability Clause 保险责任条款
Ⅰ．Accident Death and Dismemberment Insurance 意外死亡和短肢保险
Ⅱ．Medical Reimbursement 医疗赔偿
Ⅲ．Emergency Assistance Service Insurance 紧急援助服务保险
General Clause 一般性条款
I. The composition of insurance contract 保险合同的构成
The
II. The Insured 被保险人
Resident in China, healthy, aged from 1 to 75, join in overseas travel group organized by travel agency, or carrying individual tour visa go aboard can be the insured.
Resident of the China who carrying working permission, studying visa or compassionate visa go aboard to working, studying or visiting can be the insured.
III.
The effective period of the policy shall be in accordance with the period as specified in the policy. The policy takes effect from the zero hour of the effective date that is specified in the policy after the policy holder pays the premium as agreed. The insurer shall bear corresponding insurance liabilities after the policy takes effect.
IV. Insurance Benefit Type Select 保险收益类型的选择
The insurer provide three type of benefit to insured:
(1) Global;
(2) Global (exclusion U.S. and Canada);
(3) Asia area (exclusion Japan).
V. General Exclusion 一般性免责
The insurer shall not be liable for any event caused in following cases:
1．Exploration or other highly risk activities (If the activities have been registered with civil service is exclusion, which include shikar, skiing, drifting, bungee jumping, parachute jump, gliding, horse racing, car racing.);
2．The fraud acts of the Policyholder, the Insured or the Beneficiary;
3．The intentional acts of the Policyholder, the Insured or the Beneficiary;
4．The insured suicide,
self-inflicted injury, fighting, committing crimes, arrest
resistance, and during the period the
5．Driving without a license, or driving a vehicle without a valid certificate;
6．Costs of accident or illness caused by mental illness or unconsciousness, if this is a result of the consumption of alcohol, drugs, intoxicants or sedatives, sleeping tablets or other narcotic substances;
7．Phrenitis or anoia;
8．Miscarriage（but it caused by accidental injure is exclusion）, childbearing, abortion, medical treatment accident, and accident caused by acceptance or self diagnosis and treatment;
9．Any expense related to the medical treatment or health care which is not recognized by local government;
10．Any expense related to cosmetic surgery;
11．Any expense for obtaining transplanting organs or the donation for transplanting organs;
12．Any psychiatric or psychological treatment;
13．Routine or long-term dialysis for chronic or advanced stage of renal failure;
14．Sexually transmited disease, pregnancy, inherited or congenital disease;
15．Chemical contamination, terrorism or heresy activity;
16．War, military action, civil war, armed rebellion;
17．Nuclear explosion, nuclear radiation or nuclear pollution;
18．Injured, died or diseased direct or indirect caused of asbestos;
19．Any expense caused by strike, SRCC or nuclear energy.
VI.
1．The sum insured shall be mutually agreed upon and fixed by the policy holder and the insurer, and shall be specified in the policy.
2．The premium is based on the sum insured and premium rate, and specified in the policy, The insured shall pay the total premium the Company at one time.
VII. Honest Disclosure 善意披露信息
During the process of establishment of the policy, the insurer shall explain to the policy holder the insurance content, especially the exclusion content, and raise questions concerning the policy holder and the insured. The policy holder and the insured are obligated to make honest disclosure.
If the policy holder does not fulfill the obligation of the honest disclosure intentionally, the insurer shall not bear the liability for the insured accident happened before the termination of the policy and shall not refund the premium paid.
If the policy holder does not fulfill the obligation of the honest disclosure due to negligence, which has a serious influence on the occurrence of the insured event, the insurer shall not bear the liability for the insured accident happened before the termination of the policy, but shall refund the premium after deducting the administration fee.
VIII.
The policy holder or the insured shall contact with assistant organization urgent call-center when insurance event happened; otherwise, the policy holder or the insured shall bear the additional expenses of investigation, test or other expenses that are incurred as a result of the delay. If the delay causes the inability of validating the nature, the reason, the degree of damage of the insured event, the insurer shall not be liable for the liabilities that cannot be validated, except if the delay is caused by irresistible force.
IX.
1．The insured or applicant shall submit the necessary documents and materials to the insured required by the liability terms and conditions when applying for payment of benefits.
2．After receiving the application of the benefit and the other relative documents and materials from the applicant, the insurer shall make payment of those benefits that are within the scope of insurance within 10 days from the date that the claim decision has been made. The applicant shall be notified in time of those liabilities confirmed not within the scope of insurance.
3．If the insured survived after declare of death, the beneficiary must returned to the company in the 30 days when he knows it.
X. Termination of contract 合同终止
The insured may apply for termination of the policy in writing if no insured event has not taken place during the period of Insurance. The policy shall terminate on the day the insurer receives the written application.
The insured shall not accept the termination application of the policy if an insured accident has taken place.
1．Application of terminate policy
2．The insurance policy
3．The identification certificate of the policy holder;
4．Covering warrant of insurance premium
5．Other documents and materials is required by the insurer.
When insurer received the application of termination the policy terminated immediately. For annual travel policy, if the date insured apply for termination exceeding 10 days after policy effect, the insurer shall refund the unearned premium for the remaining period after the administration fee is deducted, or refund the sum of premium.
XI.
The dispute arising from the execution of the policy shall be settled by both parties through consultations. If no settlement to the disputes can be reached by both parties, the disputes shall be resolved through arbitration, or shall be submitted to the People’s Court that has jurisdiction over the disputes at the locality where the policy is issued.
The
Company: referred The
Insured: The party who stands to benefit from an insurance policy
Accidental injury: An accident occurs if: a) the insured person involuntarily sustains injury to their health by virtue of a sudden event acting on their body from outside; b) a joint is twisted or sprained, or muscles, tendons, ligaments or joint capsules are strained or torn as a result of increased exertion.
Sudden and acute disease: Shall mean the disease, which has never been treated and diagnosed before the contract took effect, which occurs during the travel and needs immediate medical treatment to avoid harm to the health.
Drug abuse: it means that taking, inportation or injection of the narcotiocs or any other under public surveillanced drugs.
China: Shall mean the Republic of China, but not including Hong Kong SAR, Taiwan & Macau SAR.
Irresistible force: Shall mean an objective situation that is unforeseeable, unavoidable and can not be controlled
All disputes arisen from the contract shall be regulated and explained by Chinese laws.
Insurance Liability Clause 保险责任条款
Ⅰ．Accident Death and Dismemberment Insurance 意外死亡和短肢保险
1．Liability
(1) Accidental Disability Benefit and Accidental Burn Benefit
If the insured suffers an accidental injury, and the insured hence acquires one of the disability features listed in the table 1 “Disability Features and Payment Ratio Table” or list in the “burn feature and the payment ratio table” within 180 days after the accident occurs, the insurer shall pay the accidental disability benefit according to the Sum insured, multiplied by the corresponding payment ratio listed in the table.
If the accident causes more than one disability features listed in the table 1 or table 2 to the insured, the insurer shall pay the sum of the corresponding accidental disability benefit; however, if the different disability is on the same limb of the body, the insurer shall only pay disability benefit of one item which is the more serious degree.
(2) Accidental or Acute Disease Death Benefit
If the insured suffers an accidental injury or sudden and acute disease and dies within 180 days after the accident occurs, the insurer shall pay the accidental death benefit specified in the policy.
During the insured period, the sum of the accidental death benefit, accidental disability benefit, accidental burn benefit shall be limited to the sum insured specified in the policy.
2．Claim Application and Payment
The insured or applicant shall submit the necessary documents and materials to the insured required by the liability terms and conditions when applying for payment of benefits. Include the following materials: Accident proof issued by the relevant local authorities where the accident happens; Aeger, case history, disability appraisal of the insured issued by relevant hospital; Evidence of cancellation of residence registration of the insured; Other proofs and materials for purpose of confirming the nature and the reasons of the insured event as required by the insurer.
1．Liability
During the insured period the insurer will reimburse the acute medical expense due to an accidental injury or sickness. If the expense can totally or partly reimbursed from commercial health insurance, social health insurance or other avenue, the company just reimburse the residual reasonable medical expense which deducted the expense has been payment.
During the insured period, the sum of the medical reimbursement shall be limited to the sum insured specified in the policy.
The insurer will pay the costs of medical treatment required abroad, which is performed or ordered by doctors. This includes in particular the costs of
a) in-patient treatment in hospitals including operations;
b) out-patient treatment;
c) drugs, medicines and bandages;
d) Aids (e. g. aids for walking, rental of a wheelchair), if they are required for the first time on account of an accident or an illness on the insured trip up to the total of RMB 2000,-- for each insured event.
Any costs are reimbursed only if the insurer’s Emergency Call Centre is contacted immediately after each insured event and treatment is arranged or approved by the Emergency Call Centre.
2．Obligations of the Insured
In the event of a Bodily Injury or sudden Illness resulting in the hospitalization of the Insured Person prior to notify IPA, the Insured Person or his/her representative, where possible, shall contact any of IPA within three days of the occurrence of such emergency or any complication directly relating to such emergency. In the absence of such notice, IPA may hold the Insured Person responsible.
In case of an Emergency, and prior to taking personal action where reasonable, the Insured Person or his representative shall collect call IPA's Alarm Centre whose contact number is listed below:
3．Local Treatment
If medical return transport is not realisable by the end of the insured trip because it is not possible to move the insured person, the insurer will pay the costs of medical treatment up until the day when it is possible to move the insured person, but for no longer than the maximum of 45 days from the occurrence of the insured event.
4．Repatriated Treatment
If the insured person is repatriated to the People’s Republic of China and medical treatment is still necessary the medical expenses incurred in the People’s Republic of China for the same disease/injury/illness contracted abroad at the usual customary level up to 30 days are covered.
5．Franchise
The insured will paid the franchise which specified in policy.
6．Exclusions
The following are not insured
a)
b)
c)
d)
e)
f)
g)
h)
I
)
7．Claim Application and Payment
The insured shall submit the necessary documents and materials to the insured required by the liability terms and conditions when applying for payment of benefits. Include the following materials: Accident proof issued by the relevant local authorities where the accident happens; Aeger, prescription, case history and treatment expense receipt issued by relevant hospital; Other proofs and materials for purpose of confirming the nature and the reasons of the insured event as required by the insurer.
Ⅲ．Emergency Assistance Service Insurance 紧急援助服务保险
1．Liability
（1）Medical consultation service
When medical advice is needed, the Insured Person may telephone IPA’s Alarm center for medical advice and evaluation from the attending physician. However, it shall be stressed that telephone conversation cannot establish a diagnosis and shall be considered as an advice only. If medically necessary, the Insured Person shall be referred to another physician or to a medical specialist for personal assessment and IPA will assist the Insured Person in making the medical appointment.
All physician's fees and related charges shall be borne entirely and directly by the Insured Person without any reimbursement from IPA.
（2）Medical Evacuation (The maximum limit up to RMB200,000)
Transfer the Insured Person to the nearest hospitals by road ambulance. IPA shall not be responsible for any rescue actions.
Should the Insured Person suffer from Bodily Injury or Illness such that IPA’s medical team recommends hospitalization in a or another medical facility where the Insured Person can be suitably treated, IPA will arrange and pay for the transfer of the Insured Person into one of the nearest hospital.
If necessary, on medical grounds, IPA will arrange and pay for the transfer of the Insured Person with necessary medical super¬vision.
If the
transfer should be done by air, IPA will arrange and pay for the
scheduled commercial flight to a hospital more appropriately
equipped for the particular Bodily Injury or Illness. If
the
The decisions of the means of transfers will be determined by IPA’s medical team.
The Insured Person should contact IPA within 24 hours after his/her hospitalization unless he/she is unconscious, being coma or inaccessible to IPA due to lack of communication tools. Otherwise, IPA will not bear the costs of the transfer.
（3）Repatriation After Treatment (The maximum limit up to RMB50,000)
When after local treatment, the medical condition of the Insured Person will not prevent his medically supervised repatriation as a Regular Passenger, according to the medical opinion of IPA Alarm Centre doctor, IPA will organise and pay for the repatriation of the Insured Person to China by scheduled airline flight (on economy class basis).
If the Insured Person is medically stable, IPA will repatriate him/her to his/her specified place among Beijing, Shanghai Guangzhou and Shenzhen. If there is no specification made by the Insured Person, IPA will repatriate him/her to the international airport among those four cities. IPA’s responsibility is completed. Upon the Insured Person’s request, IPA can also deliver him/her to the Place of Residence from those four cities at Insured Person’s costs.
IPA can despatch the Insured Person to his/her specified hospital among those four cities if following up treatment is necessary after return to China. If there is no specification made by the Insured Person, IPA will arrange him/her to IPA’s selected hospital among those four cities. IPA’s responsibility is completed.
IPA will try to use the Insured Person’s original ticket to repatriate him/her to China. If his/her original ticket is not valid for the purpose, IPA will arrange another ticket (on economy class basis) for the Insured Person provided that the Insured Person shall surrender any unused portion of his/her ticket to IPA.
（4）Repatriation of Mortal Remains/Ashes (The maximum limit up to RMB20,000)
The repatriation of the Insured Person’s body or ashes to the international airport among Beijing, Shanghai, Guangzhou or Shenzhen.
Upon the request of the Insured Person’s heirs or representative, IPA will bear the funeral fee of the local burial of the Insured Person and the transportation cost of the ashes to China.
Under any circumstance, IPA will not bear the cost of coffin.
（5）Travel Information
The Insured Person may contact IPA to obtain the following information and services before starting or during his journey.
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（6）Deposit Guaranteeing of Hospital Admission
In case of hospital admission for emergency treatment duly approved by IPA’s Alarm Centre doctor and the Insured Person is without means of payment of the required hospital admission deposit, IPA will on behalf of the Insured Person guarantee or provide such payment up to USD625.00. The guaranteed deposit of this benefit should be reimbursed by the Company to IPA within one month without any interest from the date IPA renders this service.
Prior to issue the guarantee to the hospital, IPA will request the Insured Person to give the valid financial guarantee to IPA to secure IPA’s financial risk.
（7）Compassionate Visit
In the event of the Insured Person is traveling alone outside China and has suffered from Bodily Injury or Illness resulting in hospital confinement for more than 10 (ten) consecutive days, IPA will arrange and pay for the cost of a return scheduled airline ticket (on economy class basis) or any reasonable transportation means (on economy class basis) for a Close Relative of the Insured Person to travel from the Place of Residence of the Insured Person to the Insured Person’s bedside, including the cost of an ordinary room accommodation in any reasonable hotel up to USD100.00 per day for a maximum period of 5 (five) consecutive days, but excluding the cost of drinks, meals and other room services.
（8）Return of Unattended Dependent Child(ren) to Country of Residence
If any of the Insured Person’s traveling dependent child(ren) under 16 years of age is left unattended by reason of the Insured Person's Bodily Injury or Illness resulting in hospital confinement outside China, IPA will organize and pay for the cost of a scheduled airline ticket (on economy fare basis) for such child(ren) to return to China. If necessary, IPA will also hire and pay for a qualified attendant to accompany any such dependent child(ren) for return journey.
（9）Urgent Message Transmission
IPA will transmit the urgent message to the Insured Person’s Close Relative if the Insured Person suffers the Bodily Injury or Illness outside China.
（10）Essential Medication/Medical Equipment
Upon request from a local attending physician IPA will, while possible and legally permissible, dispatch any essential medicine and/or medical equipment required for the Insured Person which is not locally available.The Insured Person shall bear the cost of the items dispatched and the relevant transportation costs, unless these items are required for emergency according to the opinion of IPA’s medical team.
（11）Unexpected Return to China (The maximum limit up to RMB2,000)
In the event of the death of the Insured Person’s Close Relative in his/her Place of Residence while the Insured Person is traveling overseas (excluding the case of immigration) necessitating an unexpected return to China, IPA will arrange and pay for the cost of a scheduled return airline ticket (on economy class basis) for the return of the Insured Person to China. This service is applicable after 180 days of the effective date of the Policy (not applicable to the renewed Policy) but excluding the death of the Insured Person’s Close Relative caused by the accident or sudden illness.
2．The Insured Person should provide the following information
(1) His/her name, the number of his/her policy, date of birth;
(2) The name of the place and the telephone number where IPA can reach the Insured Person or his/her representative and,
(3) A brief description of the accident and the nature of help required.
3．Exclusion
IPA shall not be required to provide the assistance services in any form or manner to the Insured Person or his/her representative with respect to Bodily Injury or sudden Illness of the Insured Person caused by following reasons:
（1）The Bodily Injury or sudden Illness caused in China;
（2）Pre-existing Illness or disabilities prior to the commencement of the trip during which the illness manifests, regardless the Beneficiary is aware of the illness or not;
Pre-existing conditions: IPA shall not provide the assistance services in respect of any of the following illness: hemorrhoids; thyroidectomy; diabetes mellitus; tumours; gastric or duodenal ulcer; cholecystitis; organ transplant; endometriosis; cervical diseases; pregnancy; abortion or miscarriage (except for emergency treatment arising from an accident); cosmetic treatment; oral surgery or dental treatment (except for emergency treatment arising from an accident); systemic lupus erythematosus ; psoriasis.
（3）IPA and the Company shall not be responsible for any delay resulting from the visa application procedure during a repatriation of the Insured to a nearby country;
（4）IPA and the Company shall not be responsible for any of the following circumstances, which caused the Bodily Injury, or sudden Illness of the Insured Person:
①Any repatriation which is not approved by IPA’s authorized doctor before the action is taken;
②Routine physical check-up, rehabilitative treatment, psychological treatment, mental treatment, alcohol or drug-use prevention treatment, prophylactic treatments or vaccinations;
③Resulting from any action made against the doctor’s advice during the trip;
④the policyholder is
engaged or taking part in racing of any kind other than on foot,
rallies and competitions, professional or organized sports,
mountaineering any kind of
⑤Any expenses related to the accidents incurred by professional activities in constructional field, meals, oil field or any field work in oil or chemical operation site;
⑥Any expense related to search and rescue;
⑦Any illness or injury which in the opinion of IPA’smedical doctor can be treated after returning to PRC;
⑧Any expenses resulting from consumption of drugs, anesthetic which is not approved by IPA’s authorized doctor;
（5）Countries and Regions that are not included in the policy
The Company shall not bear liabilities for the accidents which occur in the following countries and regions:
1) Europe: Balkan area, Bosnia Herzegovina
2) Asia: North Korea, Afghanistan, Iraq, Israel, Palestine, Jordan, Syria, Cocos Islands, east Timor.
3) Africa: All of the countries except for S. Africa, Egypt, Morocco, Tunisia, Ivory coast.
4) Pacific Rim: American Samoa, Bouver Islands, Christmas Islands, French Southern Territories, Heard and Mac Donald, Kiribati, Marshall Islands, Micronesia, Nauru, Niue, Palau, Pitcairn, Solomon Islands, South Georgia and South Sandwich, Tokelau, Tonga, Tuvalu, US Minor outlying islands, Vanuatu Wallis and Futuna.
NOTE: 1. Blindness includes lack or removal of eyeball, or inability to differentiate darkness and lightness and only recognize the person waving in front, or actual the best corrected vision is 0.02 lower than International Standard Visual Chart, or less 5 degree in radius of view. This diagnostic statement shall be issued by qualified ophthalmic doctor.
2. Functional loss of joint refers to permanent and total stiffness, paralysis or inability to move joints consciously.
3. Functional loss of chewing and swallowing refers to the structural impediment or dysfunction caused by reasons other than teeth, and leads to inability to chew and swallow and the inability to ingest or swallow anything other than liquid food.
4. The daily life activity for maintaining life depends on others’ assistant refers to inability to perform activities on his/her own and needs others’ assistant such as food ingestion, defecation and urination, putting on and taking off clothes, standing and living, walking, bathing, etc.
5.3 major joints in the arm refer to shoulder joint, elbow joint and wrist joint. 3 major joints in the leg refer to coax, knee joint, and anklebone.
6. Loss of finger refers to total cut of part above the lower knuckle, as for the thumb, this refers to the knuckle.
7. Loss of sense of hearing refers to lingual frequency average hearing loss exceeds 90 dB, lingual frequency are 500, 1000, and 2000 Hz.
8. Functional loss of finger refers to cut of the upper knuckle, or anchylosis or inability to move consciously from the lower knuckle.
9. Loss of toes refers to total removal from toe joint.
10. Loss of lingual function refers to loss of the language function of 3 of the major lingual functions, which are labial, radula, tegmenoris, or total removal of vocal cords, or aphasia caused by injury to speech center in the brain. This shall be diagnosed and certified by a qualified E.N.T. doctor. This does not include aphasia caused by psychological obstacle.
11. Notable loss of both eyelids refers to eyelids’ inability to cover cornea when closed.
12. Loss of part of the nose with significant smell disturbance refers to loss of whole or 1/2 of the nose cartilage and both nostrils close which makes breathe difficult and can not be corrected and cured, or loss of smelling capability in both sides.
Permanent and total loss mentioned above refers to the total functional loss after 180-day treatment since the accident. Cases like eyeball removal, which are evidently irrecoverable, are not included.
NOTES：THIS ENGLISH VERSION OF THE INSURANCE CONTRACE IS JUST A TRANSLATED VERSION FROM THE CHINESE VERSION OF THE CONTRACT .THE FINAL EXPLANATION FOR THIS CONTRACT SHOULD FOLLOW THE POLICY IN CHINESE.
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