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 accidental injury 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 accidental injury, 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. Hospitalization and Medical Insurance:
If diagnosis confirms that the Insured must be hospitalized for treatment (outpatient surgery, emergency treatment, hospitalization for observation, and isolation due to infectious diseases that is certified by the public hospital or department of public health and epidemic prevention are also deemed as hospitalization) because of the accidental injury he/she receives or because of 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), ambulance, medical record, heating, air-conditioning, bed (limited to RMB300 Yuan per day), examination, special examination and treatment, operation, medicine, treatment, laboratory test, radiation, etc.
If hospitalization treatment that is within the scope of insurance liability is necessary for the Insured, the fees of outpatient treatment and emergency treatment before and after hospitalization that arise from the same cause of disease shall be paid in accordance with the standard of hospitalization medical treatment.
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) All the foregoing medical organizations 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) The scope of medical treatment expenses is limited to the items and expenses that can be reimbursed in accordance with the local regulations of social basic medical insurance, but the expenses for B-class medicine shall be covered by the insured him/herself.
Liability Exemption
1. 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.
12) Providing false insurance information, or international experts and teachers taking out an insurance policy as a student.
If the Insured is caused dead in any of the foregoing circumstances, Ping An shall terminate the insurance liability of the Insured.
2. Liability Exemption for Medical Liability (Medical Treatment of Accidental Injury 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) 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) Expenses of orthopaedics, face-lift or rehabilitation therapy received by the Insurer;
10) Taking, application or injection of medicine without the permission of doctor on the part of the Insurer;
11) Medical expenses incurred outside the Chinese mainland or in private hospitals of the Chinese mainland;
12) Charge of telephone, transportation, etc. on the part of the Insured;
13) Clinical expenses for disease treatment on the part of the Insured;
14) Clinical expenses in advance of hospitalization before the insured period starts on the part of the Insured that insures for the first time
15) Providing false insurance information, or the international experts and teachers taking out an insurance policy as a student.
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 Group Hospitalization Medical Treatment Insurance.
If contradiction arises as regards the above contents, elaborations in Chinese shall prevail.
Dear customers:
If you want to learn about the services of settlement of claim of comprehensive insurance for people coming to China of Ping An Endowment Insurance Co., Ltd., please read this guide carefully.
Procedure of claim settlement:
Hotline for consultation: 010-59731677，010-59731688，Fax: 01066217668
In case of danger, please dial the 24-hour hotline for consultation of claim settlement and rescue: 4008105119
Document to be presented for settlement of claims:
1． One-year term life insurance
A Copy of passport and visa page of the Insured
B Disability certificate when the Insured is disabled (an evaluation report shall be issued by the assigned evaluation body)
C Death certificate of the Insured
D Certificate of relationship between the Insured and all the beneficiaries, and copy of identification proof of the beneficiaries
E Certificate of accident, in case of an accident (in case of traffic accident, the traffic unit should issue a liability confirmation of traffic accident)
F Copy of valid insurance certificate
2． Medical treatment for accidental injuries
A Copy of passport and visa page of the Insured
B Course and certificate of accident (in case of traffic accident, the traffic unit should issue a liability confirmation of traffic accident)
C Original of receipt
D Medical record, detailed expenditure sheet and copy of examination report and laboratory test report of each respective treatment
F Copy of valid insurance certificate
3． Hospitalization
A Copy of passport and visa page of the Insured
B Certificate of accident, in case of an accident (in case of traffic accident, the traffic unit should issue a liability confirmation of traffic accident)
C Original of receipt and detailed expenditure sheet for hospitalization
D Copy of hospital discharge summary or medical record of hospitalization
E For compensation of outpatient service before and after hospitalization, original of outpatient service receipts, copy of medical record of outpatient service, detailed expenditure sheet, examination report and laboratory test report shall be provided.
F Copy of valid insurance certificate
Besides, the Insured’s bank account with signature or school-assigned bank account with school stamp must be annexed to the claim settling documents.
Points for attention:
1) Where in one insured incident, the insured has to be treated in two or more hospitals; relevant documents such as diagnosis certificate and medical record from relevant hospitals shall be presented.
2) Hospitals for treatment are limited to the public hospitals within the territory of the Chinese mainland, with the scope of public health services.
4． Application for nursing fee
A Receipt of nursing fee issued by hospital or by nursing service company
B The application for nursing fee issued by the nursing unit shall be signed by the Insured him/herself and stamped with the official seal of the unit.
Materials for claims of settlement sent to:
Project Group for Foreigners
Floor 9 of Ping An Building
No. 23 Financial Street, Xicheng District
Beijing 100033 China
Addressee: Du Xinping, Song Qingfeng Zhang Chunxia
If contradiction arises as regards the above contents, elaborations in Chinese shall prevail.
-----Ping An Annuity Insurance Company, Ltd.
