Comprehensive Insurance& Protection Scheme for Foreigners Staying in China of
Ping An Annuity InsuranceCompany, Ltd.
Insurance coverage
Ping An shall undertake the following insurance liabilities during the periodof insurance:
1、Death insurance:
Ping An shall paythe stipulated amount of insurance compensation if the Insured dies of anyaccident or disease (including SARS). Insurance liabilities thus terminate.
2、Accidentaldisability insurance:
If the Insured suffers from any accidentwhich results in any disability within 180 days since the occurrence of theaccident, Ping An shall pay the insurance money, whose amount shall becalculated based on the multiplication of the sum insured and the proportion thatis specified in the “Proportion Table of Disability Degree and Payment” of PingAn Annuity Insurance Company, Ltd. If medical treatment is still not over onthe 180th day, disability evaluation shall be made on the basis ofthe Insured’s physical condition on that day and the “Insurance of AccidentalDisability” shall be paid in accordance with the “Proportion Table ofDisability Degree and Payment”.
If the same accident causes the Insured tosuffer two or more disabilities as are specified in the “Proportion Table ofDisability Degree and Payment”, the Insurer shall pay the total insured amountof the relevant disabilities. However, if different disabilities befall thesame upper limb or lower limb, only the insured amount of one disability shallbe paid; if disabilities are of different degrees, the insured amount of thedisability that is more serious shall be paid.
If, with the disability resulted from thisaccident and the previous disability combined, the Insured can claim theinsurance for the more serious disability, the insurance shall be paid inaccordance with the standard for the more serious disability, but thedisability insurance which has been paid previously (disabilities thathave taken place before purchase of insurance, or disabilities that are causedby liability exemption and are listed in the “Proportion Table of DisabilityDegree and Payment” shall be deemed as having been compensated already) shallbe deducted therefrom.
Theaccumulative amount of insurance for death or accident of each insured shallnot exceed the insured sum of the insured’s total insurance for the death oraccident.
3、Medical Insurance for Accidental Injury:
If the Insured receives medical treatmentwithin 180 days since the occurrence of the accident, the Insurer shall beliable for the payment of the full amount of the actual and reasonable expensesfor the medical treatment, but the accumulative amount of payment shall notexceed the agreed sum insured. Whether an accidental injury happens to theInsured for once or several times, the Insurer shall pay the respective“medical insurance for accidental injury” in accordance with the foresaidprovisions, but the accumulative amount of payment shall not exceed theInsured’s sum insured. When the accumulative amount of payment reaches theInsured’s sum insured, the said insurance liability for the said Insured shallbe terminated.
4、Outpatient and EmergencyMedical Insurance:
If the Insured receive outpatient or emergencymedical treatment because of illness and incur actual and reasonable expenses formedical treatment, Ping An shall be liable for 85% of the payment that isbeyond accumulative RMB650 Yuan within the same period of insurance, limited toRMB600 Yuan per day and an accumulative amount of RMB20000 Yuan. The insuranceliability shall be terminated once the accumulative amount of payment reachesthe sum insured.
The fees of general outpatient treatment,emergency treatment, outpatientsurgery, hospitalization for observation, emergency rescue, isolation due toinfectious diseases that is certified by the public hospital or department ofpublic health and epidemic prevention, and outpatient and emergency treatment before and afterhospitalization that arise from the same cause of disease are also deemed as hospitalizationand emergency treatment
According torequirements of relevant policies:
Medicationduration: 3-day medication of acute disease, 3-day medication of chronicdisease, 30-day long-term medication of chronic disease such as hypertension,diabetes, etc.
Timesof treatment: limited to fees from at most 3 different hospital departments perday; fees exceeding the limit shall be self-paid.
5、Hospitalizationand Medical Insurance:
If diagnosis confirms that the Insured mustbe hospitalized for treatment because of the accident or the illness (includingSARS) that befalls him/her after the insurance policy comes into force, Ping Anshall 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 30days), medical record, heating, air-conditioning, bed (limited to RMB300 Yuanper day), examination, special examination and treatment, operation, medicine,treatment, laboratory test, radiation, etc.
Whether the Insured is hospitalized foronce or several times, the Insurer shall pay the costs of hospitalizationwithin the prescribed limit, but the insurance liability shall be terminatedonce the accumulative amount of payment reaches the sum insured.
If the Insured suffers from a major diseaseor a chronic disease before the purchase of this insurance, the Insurer shallnot bear the liability of payment.
Note:
1) Medicalorganizations which are involved in all the foregoing medical liabilities arelimited to the public hospitals established within the border of the Chinesemainland; the medical expenses incurred in sub-branch of public hospitals, wardarea for foreigners, ward area for special treatment and needs, ward forspecial treatment and needs, ward for high-ranking officials, or similar wardarea or ward shall be excluded from the insurance.
2) Medicaltreatment expenses generated by all the foregoing medical liabilities arelimited to the items and expenses that can be reimbursed in accordance with thelocal regulations of social basic medical insurance, the self-paid or partlyself-paid items and expenses cannot be reimbursed.
3) The first 30days of the first application for insurance or non-continuous coverage iswaiting period (observation period). Where the issued is hospitalized duringthe waiting period, the Issuer bears no liability. The treatment for continuousinsured or the Insured suffered from an accident is not subject to any waitingperiod.
4) If any thirdparty 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 inaccordance with the payment scope of the local social medical insurance. Butthe fees for nursing, bed and other fees within the insurance coverage are alsolimited. If the third party has a specified proportion for payment, then PingAn shall be liable only for the payment within its proportion deducting thealready paid amount. If the third party has no specified proportion forpayment, then Ping An shall be liable for the rest, not exceeding the insuredsum, of the limited amount in accordance with the regulations of the localsocial medical insurance and with a deduction of the standard amount of thisitem.
Liability Exemption
一、LiabilityExemption for Death and Disability
Ping An shall be exempted from the insuranceliabilities for death and disability caused by any of the followingcircumstances on the part of the Insured:
1.Deliberate killing orinjury conducted by the policy-holder or beneficiary to the Insured;
2.Deliberate self-harm,intentional crime, resistance to criminal compulsory measures taken accordingto law, suicide or arrest resistance on the part of the Insured;
3.Fighting, drunkennessand active taking, sucking or injection of drugs on the part of the Insured;
4.Driving under theinfluence, driving without a legal and valid driving license or driving a motorvehicle 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, miscarriageor delivery on the part of the Insured;
8.Medical accident occurringto the Insured because of cosmetic surgery or other surgical operations;
9.Taking of medicine(excluding OTC medicine taken according to instructions) without permission ofdoctor on the part of the Insured;
10.During the period whenthe Insured suffers from AIDS or is infected with AIDS virus (HIV-positive);
11.Sports and athleticactivities of high risk only professionals participate.(The Insuredengages in high risk activities such as diving,parachuting, paragliding, roller skating, skiing,skating, bungee jumping, rock climbing, wrestling, judo, taekwondo, martialart, karate, fencing, etc.
12.The Issued passes away outside the mainland China.
13.Providing false insurance information, or international experts andteachers taking out an insurance policy as a student
14.Accidents occurring after the expiration of the last insuranceduration and before the start of the next insurance duration with failure torenew the insurance by rule of the Insured part.
Ifthe Insured is caused dead in any of the foregoing circumstances, Ping An shallterminate the insurance liability of the Insured.
二、LiabilityExemption for Medical Liability (Medical Treatment of Accidental Injury,Outpatient, Emergency and Hospitalization)
Ping An shall be exempted from the insuranceliabilities for medical expenses caused by any of the following circumstanceson the part of the Insured:
1.Deliberate killing orinjury conducted by the policy-holder or beneficiary to the Insured;
2.Deliberate self-harm,intentional crime or resistance to criminal compulsory measures taken accordingto law on the part of the Insured;
3.Fighting, drunkennessand active taking, sucking or injection of drugs on the part of the Insured;
4.Driving under theinfluence, driving without a legal and valid driving license or driving a motorvehicle 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 orsymptoms that already exist prior to the date of insurance);
8.AIDS or HIV infection, sexually transmitted diseases;
9.Pregnancy, miscarriageor delivery on the part of the Insured, infertility treatment, artificialinsemination, prenatal and postnatal check, birth control, abortion andcomplications caused by above-mentioned causes;
10.Medical accidentoccurring to the Insured because of cosmetic surgery or other surgicaloperations;
11.Expenses oforthopaedics, diorthosis, face-lift or rehabilitation therapy received by theInsurer;
12.Health check (physicalexamination), recuperatinghealing, convalesce or special care
13.Taking, application orinjection of medicine without the permission of doctor on the part of the Insurer;
14.Medical expensesincurred outside the Chinese mainland or in private hospitals of the Chinesemainland;
15.Charge of telephone,transportation, etc. on the part of the Insured;
16.Sports and athleticactivities of high risk only professionals participate.(The Insured engages inhigh risk activities such as diving,parachuting, paragliding, roller skating, skiing,skating, bungee jumping, rock climbing, wrestling, judo, taekwondo, martialart, karate, fencing, etc.
17.Providing falseinsurance information, or the international experts and teachers taking out aninsurance policy as a student.
18.Experimental treatmentand costs incurred for medical experiment purpose.
19.The insurant shouldturn to medical treatment in strict accordance with the hospital admissionsstandards. If not, the insurer does not reimburse the cost of hospitalization.
20.Fees incurred after theexpiration of the last insurance duration and before the start of the nextinsurance duration with failure to renew the insurance by rule of the Insuredpart.
21.Fees incurred withoutreporting the case in advance or through the guidance channels of medicaltreatment under non-emergent circumstances
三、Insurance premium
 Insurance Liabilities
|
RMB Insurance Amount (Yuan) RMB |
Age 6-69 (International Student) |
Insurance Premium (Yuan per half a year per person) |
Insurance Premium (Yuan per year per person) |
Liability for Death + Accidental Disability |
100000 |
400 |
800 |
Medical Treatment for Outpatient and Emergency |
20000 |
Medical Treatment for Accidental Injury (Starting line is RMB650. 85% of the excessive part beyond the starting line will be paid. The daily limit is RMB600. ) |
20000 |
Hospitalization Medical Treatment |
400000 |
Note: Matters not mentioned herein shall be executed in accordance withthe provisions of Ping An Group Accidental Injury Insurance, Ping An Group One-year Fixed Term LifeInsurance, Ping AnAdditional Insurance for Group Accidental Injury Medical Treatment and PingAn Comprehensive Insurance for Group Hospitalization, Outpatient and Emergent MedicalTreatment.
If contradiction arises as regards theabove contents, elaborations in Chinese shall prevail.
Dear customers:
If you want to learn about theservices of settlement of claim of comprehensive insurance for people coming toChina of Ping An Endowment Insurance Co., Ltd., please read this guidecarefully.
（1）Procedures forinsurance claims:
Standardprocedures of insurance claims after occurrence of insurance accident:
1. Please call4008105119 EXT 1 for medical consultation due to disease or accident. The rescuedoctor will consult, diagnose, and provide medical guidance and precautions forinsurance claim. After consulting diagnosis and outpatient treatment, if the doctorconfirms that further hospitalization is required, the insured can apply for advancedpayment of medical expense for hospitalization to the rescue company. Aftercommunication and confirmation of the rescue company and hospital, it will bedecided whether the advanced payment procedures shall be started. If theinsured is directly hospitalized without consulting, diagnosis and recording ofdoctor of the rescue company and outpatient treatment (including those whose conditionsdo not meet the requirements of hospitalization but require the outpatientdoctor to agree with hospitalization), the rescue company will not be responsiblefor advanced payment of medical expense for hospitalization. If advancedpayment for medical expenses is made without the above procedures, the insured willnot be able to get compensation.
2. Majoraccident can be reported with the following contact information
Telephonenumber for claim consultation and reporting: 4008105119 EXT 1. You can call 010-67185217in the areas without telephone number beginning with 400.
You cannot getcompensated without reporting through the 400 call or following the standardprocedures.
（2）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 (anevaluation report shall be issued by the assigned evaluation body)
C Death certificate of the Insured
D Certificate of relationship between the Insured and all thebeneficiaries, and copy of identification proof of the beneficiaries
E Certificate of accident, in case of an accident (in case oftraffic accident, the traffic unit should issue a liability confirmation oftraffic 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 ofexamination report and laboratory test report of each respective treatment
F Copy of valid insurance certificate
3).Medical treatment for outpatient and emergency
A Copy of passport and visa page of the Insured
B Original of receipt
C Medical record, detailed expenditure sheet and copy ofexamination report and laboratory test report of each respective treatment
D Copy of valid insurance certificate
If the fees have exceeded the minimum payment line of RMB650 Yuan, thenthe medical record, detailed expenditure sheet and copy of examination reportand laboratory test report of treatment that costs below 650 Yuan are alsorequired to be presented.
4).Hospitalization
A Copy of passport and visa page of the Insured
B Certificate of accident, in case of an accident (in case oftraffic accident, the traffic unit should issue a liability confirmation oftraffic accident)
C Original of receipt and detailed expenditure sheet forhospitalization
D Copy of hospital discharge summary or medical record ofhospitalization
E Copy of valid insurance certificate
Besides, the Insured’s bank account with signature or school-assignedbank 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 twoor more hospitals, relevant documents such as diagnosis certificate and medicalrecord from relevant hospitals shall be presented.
(2). Hospitals for treatment are limited to the public hospitals withinthe territory of the Chinesemainland, and items and expenses that can be reimbursed should in accordancewith the scope of local regulations of social basic medical insurance.
5). Application for nursing fee
A Original Invoices of nursing fee issued by hospital or by nursingservice company
B The application for nursing fee issued by the nursing unit shallbe signed by the Insured him/herself and stamped with the official seal of theunit.
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（杜新平）, Song Qingfeng（宋庆锋）, Zhang Chunxia（张春侠）
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Chinese explanation prevails in case ofcontradiction arising out of the aforementioned contents.
