中国人寿来华留学生综合保险保障方案

Introduction for Foreign Students Comprehensive Insurance Schemes From China Life

一、方案(Insurance Plan)

二、保险责任(Insurance liability)

1、意外、疾病身故保险责任

Death Insurance liability caused by accidents, illnesses

被保险人因意外伤害身故或在本合同约定的等待期后因疾病身故，本公司按保险单载明的保险金额给付保险金，对该被保险人的保险责任终止。

InsuredDeath which caused by accident injure or disease after the waiting period of this contract , the company will pay insurance amount stated in this insurance contract according to the policy, therefore the insurance liability of the insured shall be terminated.

2、意外伤残保险责任

Accidental disability insurance responsibility

（1）被保险人遭受意外伤害，并自该意外伤害发生之日起一百八十日内因该意外伤害导致身体伤残的，本公司根据《人身保险伤残评定标准（行业标准）》的规定，按本附加合同约定的保险金额乘以该处伤残的伤残等级所对应的保险金给付比例给付伤残保险金。

The insured suffers accident harmand by which caused physical disability within one hundred and eighty days from the date since the accident happened , the company will pay disability insurance fees according to according to the regulation of the personal insurance disable assess standardand the attached contract of insurance amount multiplied by insurance amount paying proportion refer to disability grade.

当同一保险事故导致两处或两处以上伤残时，本公司仅按其中一处的伤残等级给付伤残保险金：如果各处的伤残等级不完全相同且最重的伤残等级所对应的伤残只有一处，本公司按最重的伤残等级所对应的保险金给付比例给付伤残保险金；如果各处的伤残等级完全相同或最重的伤残等级所对应的伤残有两处或两处以上，本公司将该伤残等级在原基础上晋升一级（但最高晋升至第一级），并按晋升后的伤残等级所对应的保险金给付比例给付伤残保险金。同一部位和性质的伤残，不能采用《标准》条文两条以上或者同一条文两次以上进行评定。

For two or more disabilities by the same insurance accident, the company will only pay insurance fees according to one disability grade. If disability grade for every injure is not completely same and if the heaviest disability grade is only one place, the company will pay insurance fees according to the insurance amount paying proportion refer to the heaviest disability grade; if disability grade for every injure is completely same and there are two or more disabilities refer to the heaviest disability grade, the company will upgrade disability grade by one level (the highest upgrade will be the first grade), and will pay insurance fees according to the paying proportion of the upgraded disability grade. For same part and nature disability, it is not able to be assessed by using two or more provisions or more than twice for same provisions according to standard articles.

（2）本公司给付的保险金以保险金额为限，一次或累计给付的保险金达到本附加合同约定的保险金额时，对该被保险人的保险责任终止。

The insurance compensation paying by our company will be limited to insurance amount, which are paid by one time or accumulation reaching to the agreed amount subject to this additional contract, the insurance responsibility for the insured will be terminated.

3、意外门诊、意外住院保险责任

Accidental Outpatient service and accidental hospitalization insurance responsibility

在本附加合同保险期间内，被保险人遭受意外伤害，并因该意外伤害在二级以上（含二级）医院或本公司认可的其他医疗机构诊疗，对被保险人每次意外伤害事故所发生并实际支出的医疗费用，按本附加合同约定给付比例给付医疗保险金。

During the period of this additional insurance contract, the insured suffers an accident harm, and of which accepts the medical treatment in the second class or above level hospital or other medical institution recognized by the company, the company will pay medical compensation for every medical treatment expenses caused by accident injure and of which is real paid according to the agreed proportion stated in this contract.

保险期间届满被保险人治疗仍未结束的，除另有约定外，本公司继续承担给付医疗保险金责任的期限，门诊治疗以保险期间届满的次日起十五日为限，住院治疗以保险期间届满的次日起九十日为限。

The insured’s medical treatment extends to the expiration of the insurance, unless otherwise stated, the company continues to be liable to assume medical insurance time limit. Outpatient service treatment will be subject to 15 days from the date following the insurance contract expiration, the hospitalization treatment will be limited to 90 days from the day following the insurance contract expired.

本公司给付的医疗保险金以本附加合同约定的保险金额为限，一次或累计给付的医疗保险金达到本附加合同约定的保险金额时，对该被保险人的保险责任终止。

The medical compensation will be limited according to the stated insurance amount subject to this additional insurance contract, the insurance responsibility will be terminated when the medical expense compensation to the insured reaching to the agreed medical insurance amount by one time or more times accumulative payment.

4、疾病住院、疾病门诊保险责任

Insured liability of hospitalized disease and disease clinic

（1）普通门（急）诊医疗费用补偿责任

Expense compensation responsibility of Ordinary outpatient (urgent) medical treatment

被保险人在二级（含二级）及以上医疗机构一次或多次诊疗支出的普通门（急）诊医疗费用，按本附加合同约定的比例给付普通门（急）诊医疗保险金，就诊日费用限额为600元，在日限额的基础上累计超过0元（起付线）以上的部分保险人按照100%的比例赔付，累计给付以保险金额20000元为限。对被保险人一次或累计给付的普通门（急）诊医疗保险金达到普通门（急）诊医疗保险金额时，该项保险责任终止。

The insured paid medical expenses one or more times due to ordinary outpatient (urgent) medical treatment in the secondary or higher grade medical institution ( including secondary medical institution), the company will pay medical compensation due to ordinary outpatient (urgent) medical treatment according the agreed proportion of this additional contract. Daily medical expense is limited to RMB600, the insurance company will pay by 100% for exceeding RMB 0( starting line) by accumulation on the day sum limit basis, total accumulative payment will be limited to RMB20000.The insurance responsibility will be terminated when the medical expense compensation to the insured reaching the insurance limit amount by one timeor more times accumulative payment.

相关政策要求/ Relevant policy requirements

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

Dosage: acute disease 3 days,chronic diseases 7 days; Daily sum Limit: the maximum cost for daily.

起付线：本险种设置0元为起付线，起付线以下部分不予赔付。

Starting line: RMB0 as payment starting line for this insurance, less than this amount will not be paid.

（2）住院医疗费用补偿责任

Expense compensation responsibility for hospital medical treatment

被保险人在二级（含二级）及以上医疗机构一次或多次诊疗支出的住院医疗费用（检查检验费、检查治疗费、手术费、药费、化验费、放射费等合理医疗费用），按本附加合同约定的比例给付住院医疗保险金。对被保险人一次或累计给付的住院医疗保险金达到住院保险金额时，该项保险责任终止。

The insured paid hospital medical expenses one or more times in the secondary or higher grade medical institution ( including secondary medical institution), hereby the hospital medical expenses refer to reasonable medical treatment expenses which including examination and inspection fees, examination and treatment fees, operation fees, medicine fees, test fees, emission fees, etc, the company will pay medical compensation according to the agreed proportion stated in the insurance contract. The insurance responsibility will be terminated when the medical expense compensation to the insured reaching the hospitalization insurance amount by one time or more times accumulative payment.

注/Remark:

（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、单间、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所有医疗费用。

All medical institutions involved in this medical liability is limited to the public hospitals which located in the mainland of the People's Republic of China, but does not include below medical expenses which caused by the medical treatment of the branch of public hospitals, foreign guests’ ward, VIP ward, compartment, private rooms, single rooms, special clinicspecial ward, special hospital wards and senior officials inpatient ward and so on ward of similar.

（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。

Above all medical costs incurred in this medical liability is only limited to the program and medical treatment expenses conforming to the stipulations of the local socialprimary medical treatment insurance ,self-expense and part of the self-expense projects cannot be reimbursed.

5.遗体遣返

Repatriation Benefits

若被保险人在中国境内因遭受意外伤害或疾病导致身故，本公司承担保险责任（相关赔偿保险金按照该被保险人的遗愿或其家属的愿望按下列方式之一使用，但累计承担的费用以保险金额为限）。

（1）安排在事发当地的火化、安葬。

若被保险人遗愿或者其家属选择在事发地火化，使用理赔保险金承担其遗体在事发地的火化费用，但不承担其它如宗教仪式或非必要的手续的开支。如选择就地安葬的，使用理赔保险金承担约定限额内的就地安葬相关的费用（上限不超过1万元）。

（2）安排运送遗体或骨灰返回国内。

安排用正常航班把被保险人遗体或骨灰从事发地运至被保险人或会员离其居住地最近的国际机场。使用理赔保险金承担当地国际航空运输标准的棺木费用(以约定承担限额为限)、相关手续费及正常的航空运输费，但不承担其它如宗教仪式或非必要的手续的开支。

注：结合根据被保险人或会员遗愿或其直系亲属的委托，根据实际情况区分必要开支和非必要开支。遗体/骨灰送返、丧葬安排费用包含：尸体防腐、保存、火化、运输及骨灰盒等材料和服务费用。

If the insured person dies due to accidental injury or illness in China, the Company shall be liable for insurance (the relevant indemnity insurance money shall be used in accordance with the wishes of the insured or the wishes of his family members in one of the following ways, but the accumulated expenses shall be limited to the amount insured).

(1) Arrangement for cremation and burial in the area where the incident occurred.

If the insured's will or his family members choose to cremate at the place of the accident, the claim insurance money shall be used to bear the cost of cremation of his body at the place of the accident, but not other expenses such as religious ceremonies or unnecessary formalities. For those who choose to bury in situ, the compensation insurance fund shall be used to bear the expenses related to burial in situ within the agreed limit (the upper limit shall not exceed 10,000 yuan).

(2) Arrange for the transport of remains or ashes back to China.

Arrange regular flights to transport the body or ashes of the insured from their place of origin to the International Airport nearest to their place of residence. The claim insurance fund shall be used to cover the coffin expenses of the local international air transport standards (to the limit of the agreed amount), related handling fees and normal air transport fees, but not other expenses such as religious ceremonies or unnecessary formalities.

Note: According to the wishes of the insured or members or the entrustment of their immediate relatives, the necessary expenditure and unnecessary expenditure can be distinguished according to the actual situation. Costs for the return of remains/ashes and funeral arrangements include materials and services such as preservation, preservation, cremation, transportation and ashes boxes.

三、责任免除(Exemption from liability)

因下列情形之一，导致被保险人身故、伤残、发生医疗费用的，本公司不承担给付保险金的责任：

The company won’t assume insurance compensation liability due to below reasons ：

1、保险单中特别约定的不承担保险责任的疾病；

Diseases specially mentioned not subject to insurance responsibility

2、被保险人在本附加合同生效前的未愈疾病；

Unrecovered disease which happened before the validity of this additional insurance contract

3、投保人对被保险人的故意杀害、故意伤害；

The intentionally kill or injure to the insured from the insurant

4、被保险人故意犯罪或抗拒依法采取的刑事强制措施；被保险人自杀或故意自伤，但被保险人自杀或故意自伤时为无民事行为能力人的除外；

The insured intentional commits a crime or resists the criminal compulsory measures in accordance with the law; the insured intentionally commits suicide, or deliberately self-injury, but except for below situation if the insured who belong to persons without capacity of civil conduct while the insured commits suicide, or deliberately self-injure.

5、被保险人斗殴、醉酒，服用、吸食或注射毒品；

The insured fights, drunk, taking, or injecting drugs;

6、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交通工具；

The insured is drunk driving or driving without a valid driver's license or driving without a valid registration of motor vehicles;

7、战争、军事冲突、暴乱或武装叛乱；

War, military conflicts, riot or armed rebellion

8、核爆炸、核辐射或核污染；

Nuclear explosion, nuclear radiation or nuclear pollution;

9、被保险人患艾滋病或感染艾滋病病毒、性病

The insured suffers from AIDS or infected with HIV or other sexually transmitted diseases

10、被保险人的遗传性疾病，先天性畸形、变形或染色体异常、既往症（投保前已患疾病或已存在的症状，保险期间非连续性的）；

The insured has genetic diseases, congenital anomaly, deformation or chromosomal abnormalities, anamnesis (suffers from disease or the existing symptomsprior to the insurance, discontinuity during the period of insurance);

11、被保险人洗牙、牙齿美白、正畸、烤瓷牙、种植牙或镶牙等牙齿保健和修复；

The insured is doing teeth care and teeth repair including teeth cleaning, teeth whitening, teethorthodontic, porcelain teeth, dental implant and denture fitted, etc;

12、被保险人的视力矫正手术或变性手术；

The corrective surgery ortranssexual operation of the insured

13、被保险人因整容手术或其它内、外科手术导致医疗事故；

Medical accidents caused by plastic surgery or other internal or surgery operation of the insured

14、被保险人产前产后检查、妊娠（含宫外孕）、流产（含人工流产）、分娩（含剖腹产）、避孕、绝育手术、治疗不孕不育症、人工受精以及上述原因引起的并发症；

The insured has some disease complications causing by prenatal postpartum examination, pregnancy (including ectopic pregnancy), miscarriage(abortion), accouchement (including cesarean section), contraception, sterilization,medical treatment for infertility, artificial insemination and etc.

15、被保险人健康检查（体检）、疗养、静养或特别护理；

The insured does health check (physical examination), rehabilitation, rest-treatment or special care;

16、被保险人未遵医嘱、私自服用、涂用、注射药物；

The insured is not following doctor’s advice, or self taking, smearing or injecting medicine;

17、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及药店所支出的费用；

The insured’s medical expenses are occurred in the private hospital or drugstores which happened within the mainland of China or outside of the mainland of China

18、被保险人参加潜水、跳伞、攀岩、探险、武术比赛、摔跤比赛、特技表演、赛马、赛车等高风险运动；

The insured takes part in below activities, such as diving, sky diving, rock climbing, adventure and martial arts game, wrestling, stunt, riskier movement, horse racing, car racing and etc.

19、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；

The expense is occurred due to the insured taking trial treatment in the hospital and for the purpose of medical experiments

20、被保险人在中国台湾、香港、澳门地区或中国境外治疗；

The insured is taken medical treatment in Taiwan, Hong Kong, Macao or outside China

21、被保险人在中国大陆以外地区意外身故的；

The insured’s accidental death in outside mainland China region;

22、被保险人因整容手术及其它内、外科手术导致医疗事故；

The insured’s medical accident caused by plastic surgery, or the other medical or surgery operations .

四、青岛定点医疗机构/Designated medical institutions

四、理赔材料准备/Claim material preparation

五、理赔流程/Claim flow