To participate in conditions:
International students in China, students from Hongkong, Macao and Taiwan, as well as overseas Chinese students (identities are needed to be proved by relative authority) in healthy condition, able to participate in study normally and from 8 to 69, are eligible to this policy.
Insurance Liabilities:
Ping An shall undertake the following insurance liabilities during the valid period of insurance (Insurance period (from the valid date of the policy to the expiry date of the insurance period))
Ping An shall pay the stipulated amount of insurance compensation if the Insured dies of an accident or disease. Insurance liabilities thus terminate.
If the Insured suffers from an accident which results in any disability listed in the Standards and Codes for Personal Insurance Disability Assessment (JR/T0083-2013) (issued by former China Insurance Regulatory Commission, BJF [2014] No. 6) within 180 days since the occurrence of the accident, Ping An shall assess the injury and disability according to the assessment principles stipulated by this Criteria, unless otherwise stipulated, Ping An shall pay the accidental disability insurance money, whose amount shall be calculated based on the multiplication of the proportion stipulated in this Criteria, which is corresponding to the assessment result, by the sum insured, which is corresponding to insurer’s responsibilities. 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 evaluation results.
If with the disability resulted from this accident and the previous disability combined as a more serious disability according to the Injury and Disability Assessment Criteria for Personal Insurances, the insurance shall be paid in accordance with the standard for the more serious disability, but the insurance of accidental disability which has been paid previously (disabilities listed in the Standards and Codes for Personal Insurance Disability Assessment (JR/T0083-2013) (issued by former China Insurance Regulatory Commission, BJF [2014] No. 6) have taken place before purchase of insurance or caused by events under Liability Exemption, shall be deemed as having been compensated already) shall be deducted therefrom.
The accumulative payment amount of accidental disability insurance, and death due to any accidental injury or disease shall not exceed the corresponding insured sum of the Insured. If the accumulative amount of payment exceeds the insured sum of the Insured, then the insurance liabilities to the insured thus terminate.
Note: Standards and Codes for Personal Insurance Disability Assessment (JR/T0083-2013) (issued by former China Insurance Regulatory Commission, BJF [2014] No. 6 is accessible from the website of Insurance Association of China.
If the Insured, who suffers from the accidental incident, receives medical treatment within 180 days since the occurrence of the accident, the Insurer shall be liable for the full amount of the reasonable and necessary expenses actually paid by the Insured for the medical treatment, but the accumulative amount of payment shall not exceed RMB 20,000. Whether an accident happens to the Insured for once or several times, the Insurer shall pay the "accidental medical insurance" respectively in accordance with the aforesaid provisions, but the accumulative amount of payment shall not exceed the insured sum of the accidental medical insurance of the Insured. When the accumulative amount of payment reaches the insured sum of the accidental medical insurance of the Insured, the said insurance liability for the said Insured shall be terminated.
For example, the accidents such as bruises of bumps, burns, sprained ankle, accidental cut- wound when cutting vegetables, scratches and bites by cats and dogs.
Reimbursement equation: total amount of reasonable expenditure * 100%=reimbursable amount (the total amount of reasonable expenditures shall exclude the self-paid or partly self-paid items and expenses stipulated by the local regulations of the social basic medical insurance)
The reasonable and necessary expenses incurred by the Insured for receiving outpatient or emergency medical treatment because of illness, within each insurance period, the daily limit for outpatient is RMB600, (that said, for the medical expense of the day exceeding RMB 600 shall be calculated as RMB600, for the medical expense of the day not exceeding RMB600 shall be calculated by the actual amount). For the medical expenses exceeding the starting line of RMB650, The remaining amount of the medical expenses exceeding the deductible RMB650 yuan on the basis of the daily limit will be reimbursed at a percentage of 85%, and the accumulative payment shall not exceed the limit of RMB20000. The insurance liability shall be terminated once the accumulative amount of payment reaches the sum insured.
Medical expenses of outpatient and emergency treatment: The related expenses incurred from 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 expense or cost of outpatient and emergency treatment before and after hospitalization that arise from the same cause of disease are also deemed as outpatient and emergency treatment.
For example, being treated in the outpatient or emergency for fever, sudden abdominal pain, faint, and inflammation etc.
Reimbursement equation: (the expense of each day within the daily limit RMB600 yuan add up-650 yuan) * 85%=reimbursable amount (the total amount of reasonable expenditures shall exclude the self-paid or partly self-paid items and expenses stipulated by the local regulations of the social basic medical insurance)
Definitions:
Daily limit: The top claim limit of available medical cost
Deductible: RMB 650 yuan (A total of RMB650 yuan is deducted accumulatively for one time during an insurance period). Below the starting line, there is no compensation.
If diagnosis confirms that the Insured must be hospitalized for treatment because of suffering from the accident or the illness, Ping An shall pay 100% of the “hospitalization and medical insurance” to the insured with regard to the actual and reasonable expenses for medical treatment, including reasonable and necessary fees for nursing (limited to RMB200 Yuan per day and accumulate up to 60 days), medical record, heating, air-conditioning, bed, examination, special examination and treatment, operation, medicine, treatment, laboratory test, radiation, etc.
During one valid insurance period, whether the Insured is hospitalized for once or several times, the Insurer shall pay the insurance payment as per compensation rule, but the insurance liability shall be terminated once the accumulative amount of payment reaches the limitation of RMB 400,000.
In another word: if diagnosis confirms that the insured must be hospitalized for treatment because of suffering from the injury or illness, the insured may apply online for advanced payment by the hospital or at his own expense of medical expense for hospitalization and reimburse later.
Reimbursement equation: reasonable hospitalization expenditure * 100%=reimbursable amount (the total amount of reasonable expenditures shall exclude the self-paid or partly self-paid items and expenses stipulated by the local regulations of the social basic medical insurance)
Note:
1) Medical organizations which are involved in all the foregoing medical insurance liabilities are limited to the public hospitals established within the border of Mainland China; However, for the insured who are treated in the ward area for foreigners, ward area for VIPs, private room, Class A ward, separate ward room, ward area for special treatment and needs, ward for special treatment and needs, ward for high-ranking officials, or similar ward area of the public hospitals,, shall be excluded from the insurance, then all medical expenses incurred by such shall not be covered by the insurer.
2) Medical treatment expenses generated by all the foregoing medical insurance 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 by the insurer.
3) For the insured who apply for the insurance for the first time or the insured who is not continuously insured, the first 30 days from the effective date of the insurance is the waiting period (observation period). Where the insured is hospitalized or treated in outpatient during the waiting period and related medical cost occurs, the insurer bears no liability of compensation. The treatment for the insured of continuously 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 for the remaining amount of reasonable fees that are within the reimbursable payment scope of the local social basic medical insurance. But the limited portion of the fees for the bed, nursing, outpatient and emergency treatment within the daily limitation is also limited; if the third party has a specified proportion for payment of the limited sum, Ping An shall be liable only for the remaining amount after deducting the already paid amount from the limited sum. If the third party has no specified proportion for payment, then Ping An shall be liable for the remaining amount, but not exceeding the insured sum, after deducting the standard amount of this item from the limited sum which takes the regulations of the local social medical insurance as the standard.
5) 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.
Liability Exemption
I. Liability Exemption for Death and Accidental Disability Insurance
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:
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 Insurance Liability (Accidental Medical Treatment, 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:
Insurance premium
Insurance Liabilities |
Insurance Amount (Yuan) RMB |
Age 8—69 |
|
Insurance Premium (Yuan per half a year per person) |
Insurance Premium (Yuan per year per person) |
||
Liability for Death + Accidental Disability |
100000 |
400 |
800 |
Accidental Medical Treatment |
20000 |
||
Medical Treatment for Outpatient and Emergency (With a daily limit of 600 yuan; the medical expenses exceeding 650 yuan can apply for a claim, that excess portion will be reimbursed at a proportion of 85%) |
20000 |
||
Hospitalization Medical Treatment |
400000 |
Note: Matters not mentioned herein shall be executed according to “Ping An Additional Disability Guarantee Group Accident Insurance (2013) (Clause D)”, “Ping An One-year Group Term Life Insurance”, “Ping An Additional Accidental Injury Group Medical Insurance”, “Ping An Inpatient, Outpatient and Emergency Comprehensive Group Medical Insurance”, “Ping An Inpatient Group Medical Insurance” and “Ping An Inpatient Reassuring Group Medical Insurance (Clause A)”.
If any dispute arises concerning the contents mentioned above, the Chinese interpretation shall prevail.
Do be sure to firstly call 4008105119 to make a diagnosis inquiry before you go to see a doctor.
Dear customers:
If you want to learn about the services of the settlement of a claim of comprehensive insurance for people coming to China of Ping An Endowment Insurance Co., Ltd., please read this guide carefully.
(1) Procedures for insurance claims:
Standard procedures of insurance claims after the occurrence of insurance accident:
Telephone for consultation and report: 4008105119
Please call directly 4008105119 for medical consultation due to disease or accident. The rescuing doctor will provide consultation, diagnose, and medical guidance and instructions on the insurance claim. After consulting the doctor and getting outpatient treatment, if the doctor confirms that further hospitalization is required, the insured can apply for advanced payment of medical expense for hospitalization to the rescue company. After communication and confirmation between the rescue company and hospital, it will be decided whether the advanced payment procedures shall be started. If the insured is directly hospitalized without being inquired, recorded by the doctor of the rescue company as well as not being treated by the outpatient (including those whose conditions do not meet the requirements of hospitalization but require the outpatient doctor to agree with hospitalization), the rescue company will not be responsible for advanced payment of medical expense for hospitalization. If advanced payment for medical expenses is made without the above procedures, the insured will not be able to get compensation.
(2) Document to be presented for settlement of claims:
1) Death or accidental disability
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. Copies of certificates of the relationship between the Insured and all the beneficiaries, and copies of identification proofs 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; in case of falling from the height and drowning, the public security organs or relevant departments shall issue the materials determining whether it is accidental or suicidal; in case of alcohol-induced accident, a quantitative report on the alcohol concentration shall be issued.)
2) Accidental medical treatment
A.Copies of passport and visa page of the Insured
B.Process and certificate of accident (in case of a traffic accident, the traffic unit should issue a liability confirmation of traffic accident, which is needed.)
C.Original of receipt
D.Medical record, detailed expenditure sheet and copies of examination report and laboratory test report of each respective treatment (The date of the medical record and the date of invoice shall be corresponding with each other).
3) Medical treatment for outpatient and emergency
A.Copies of passport and visa page of the Insured
B.Original of receipt
C.Medical record, detailed expenditure sheet and copies of examination report and laboratory test report of each respective treatment (The date of the medical record and the date of invoice shall be corresponding with each other).
If the fees reach the deductible of RMB650 Yuan, then the original invoice, medical record, detailed expenditure sheet and copy of examination report and laboratory test report of treatment that costs below 650 Yuan are also required to be presented.
4) Hospitalization
A.Copies of passport and visa page of the Insured
B. Certificate of the accident in case of an accident (in case of the 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
Special instructions to item 2) to item 4) above:
5) Application for nursing fee
Original Invoices of nursing fee issued by the hospital or by a nursing service company
Materials for claims settlement sent to 北京市西城区金融街23号平安大厦9层(邮编100033)
Addressee:来华项目组
Please Dial:400-810-5119
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This material is for your information; the final right of interpretation of the above content belongs to Ping An Annuity Insurance Company, Ltd.
Chinese explanation prevails in case of contradiction arising out of the aforementioned contents.