AXA-Minmetals InterGlobal China Executive Medical Plan Proposal 金盛福满安康医疗保险产品说明书 HCPP11001FMU 一 Table of Benefits 保险责任 Section 1 第 1 部分 Overall limits 总保额 Under the terms and conditions of the plan, we will pay reasonable costs up to an overall 1.1 maximum, for you in each plan year (unless a lifetime limit is shown). 8,925,000 在一个保险年度内, 对于每一个被保险人发生的医疗状况, 我们将根据保险计划的条款和条件支付合理的费用, 最 高不超过某一限额 / 每被保险人 ( 除有终身限额的特殊约定外 ) Section 2 第 2 部分 2.1 2.2 2.3 2.4 2.5 2.6 In-patient and daycare treatment (see section 13 for co-insurances) 住院治疗和日间护理治疗费 ( 共保额请参见第 13 部分 ) Accidents and emergencies 意外和紧急事件费用 Hospital accommodation 住院膳宿费用 Intensive care, theatre costs, nursing fees, medical expenses and other charges, surgeons', consultants', anaesthetists' and medical practitioners' fees, prescribed drugs, MRI, PET and CT scans, X- rays, pathology, diagnostic tests and procedures and physiotherapy by a registered physiotherapist 重症监护和手术费用, 护理费用, 医疗和辅助费用, 外科医生 顾问 麻醉师 执业医师费用, 处方医药, 核磁共振 正电子电子扫描法 X 线断层计算机电子扫描,X 光 病理 诊断试验和程序和注册理疗学家施行的物理疗法 Reconstructive surgery following an accident or following surgery for an eligible medical condition 意外发生后进行的重建手术或为符合条件的医疗状况进行的手术之后的重建手术 Prostheses: artificial body parts surgically implanted to form permanent parts of your body 假肢 : 作为被保险人身体永久部分的人造肢体 Parent accommodation (for an insured parent with an insured child under 18 years of age in hospital) 被保险人在 18 周岁以下, 其父或母同时属于承保对象时, 父或母在医院所发生的膳宿费用 2.7 Accidental damage to natural teeth 自然牙意外损伤 Section 3 第 3 部分 3.1 3.2 3.3 Out-patient treatment (see section 13 for co-insurances) 门诊费用 ( 共保额请参见第 13 部分 ) Consultations to include medical practitioners' fees, prescribed drugs and dressings, X-rays, pathology, diagnostic tests and procedures 会诊费用, 包括执业医师费用, 处方医药和敷料费用,X 光 病理 诊断试验和程序 Psychiatric treatment and psychotherapy available after you have had 12 months continuous cover under the plan 在等待期届满后的精神治疗和心理治疗 ( 等待期为在保险计划连续生效 12 个月后 ) Complementary medicine and treatment by a therapist, when referred by a medical practitioner, consultant or specialist. This benefit covers osteopathic, chiropractic, homeopathic and acupuncture treatment only* 由执业医师 专科医师或顾问引荐转诊的治疗专家的补充医药和治疗费用 ; 此项保险利益包括整骨疗法 脊椎指压疗法 顺势疗法及针灸治疗 * 3.4 Traditional Chinese medicine* 中医治疗 * 3.5 Physiotherapy by a registered physiotherapist, when referred by a medical practitioner, consultant or specialist* 由执业医师 专科医师或顾问引荐转诊的注册理疗学家施行的物理疗法 * 3.6 MRI, PET and CT scans 核磁共振, 正电子电子扫描法,X 线断层计算机电子扫描 3.7 Out-patient surgical operations 门诊病人手术治疗 Paid up to 59,500 *Complementary medicine and treatment, traditional Chinese medicine and physiotherapy limited to11,900 最高保障为 59,500 * 其中第 3.3 3.4 和 3.5 部分保障之和最高为 11,900 Section 4 第 4 部分 4.1 4.2 4.3 4.4 Section 5 第 5 部分 5.1 5.2 Cancer care (see section 13 for co-insurances) 癌症护理 ( 共保额请参见第 13 部分 ) Treatment aimed to cure cancer, including bone marrow transplants 以治愈癌症为目的的治疗, 包括骨髓移植 Stabilising acute episodes of a cancer which is diagnosed as a chronic medical condition 稳定癌症急性发作的治疗 Consultations, tests, drugs and dressings to maintain the symptoms of a cancer which is diagnosed as a chronic medical condition 为维持癌症状态的门诊费, 测试费, 药费和敷料费 Palliative and hospice care when cancer is diagnosed as a terminal medical condition 在确诊为晚期癌症后对于延缓病症的治标治疗和住院护理费用 Chronic medical conditions (see section 13 for co-insurances) 慢性疾病 ( 共保额请参见第 13 部分 ) Stabilising acute episodes of chronic medical conditions 稳定慢性疾病的急性恶化 Consultations, tests, drugs and dressings to maintain the symptoms of a chronic medical condition 为维持慢性疾病状态的会诊 检查 处方药和敷料费 Covered in the benefit limit shown in section 5.2 最高保障计入第 5.2 部分 Covered in the benefit limit shown in section 6.1 最高保障计入第 6.1 部分 Covered in the benefit limits shown in sections 2 and 3 最高保障计入第 2 3 部分 Paid up to a lifetime limit of 595,000 终身最高保障为 595,000 5.3 Please note: If a chronic medical condition becomes terminal, cover under the chronic medical conditions benefit will end. We can only cover terminal medical conditions under the terminal illness benefit 注意 : 慢性疾病一旦被确诊为晚期疾病, 此部分保险利益将终止 晚期疾病只能在 晚期疾病 ( 第 6 部分 ) 项下获得保障 1
Section 6 第 6 部分 6.1 Section 7 第 7 部分 7.1 Section 8 第 8 部分 8.1 Terminal illness (see section 13 for co-insurances) 晚期疾病 ( 共保额请参见第 13 部分 ) Palliative and hospice care for a terminal medical condition 在确诊为晚期疾病后对于延缓病症的治标治疗和住院护理费用 HIV or AIDS (see section 13 for co-insurances) 感染艾滋病病毒或患艾滋病 ( 共保额请参见第 13 部分 ) Treatment for HIV or AIDS and related medical conditions- available after you have had 4 years continuous cover from the date that the benefit was first introduced on your plan 在等待期届满后的感染艾滋病病毒或患艾滋病的相关治疗 ( 等待期为在保险计划连续生效 48 个月后 ) Emergency local ambulance 紧急事件当地救护车 Costs of appropriate ambulance transport needed because of an emergency or medical necessity to the nearest available and appropriate local hospital 由于紧急事件或医疗必须而需要运送到最近的 合适的当地医院所需要的救护车运输费用 Paid up to a lifetime limit of 595,000 终身最高保障为 595,000 Paid up to a lifetime limit of 595,000 终身最高保障为 595,000 Section 9 第 9 部分 9.1 Section 10 第 10 部分 10.1 Organ transplants (see section 13 for co-insurances) 器官移植 ( 共保额请参见第 13 部分 ) Transplants of kidney, liver, heart, lung or heart and lung and any related treatment that you need as a result of a covered medical condition 被保险人受保障的医疗状况范围内需要进行的, 包括肾 肝 心脏 肺 或心肺器官移植所发生的费用及相关治疗费用 Evacuation and repatriation 紧急运送和遣返 The costs to transport you to the nearest centre where appropriate medical facilities are available. We will only pay this benefit, including treatment received, if you suffer from a medical condition; (a) that means you need to be placed on a critical list, or (b) for which, in our opinion, appropriate treatment is not available locally 将被保险人运往最近的拥有足够的医疗设施的治疗中心的运送费用 我们是否给付包括治疗费在内的此项保险利益, 取决于被保险人遭受的医疗状况 : (a) 被保险人病情危重, 有必要紧急运送 ; 或 (b) 从我们角度来看, 被保险人在进行治疗的国家不能得到足够的治疗 Paid up to 2,975,000 最高保障为 2,975,000 10.2 10.3 Economy class return ticket following your evacuation, to the country where you live 紧急医疗运送后返回居住国的回程经济舱飞机票费用 Costs of your dependants, a close family member or business colleague having to accompany you for a medical evacuation. This benefit will only become available under the conditions detailed in clause (a) of benefit section 10.1 above and must be pre-authorised by us. We will provide cover for the following: return economy flight overnight accommodation to include breakfast return taxi from the airport to the hotel return taxi from the hotel to the hospital once a day 陪同人员包括被抚养人 近亲属 联系密切的商业伙伴因医疗运送所发生的如下费用 ( 此项利益仅对第 10.1(a) 部分有效, 并需要得到我们的事先授权 ): 往返机票 一晚住宿包含一早餐 从机场到宾馆的往返出租车费 从宾馆到医院的往返出租车费, 每天一次 Paid up to 595,000 最高保障为 595,000 Section 11 第 11 部分 11.1 Section 12 第 12 部分 12.1 Section 13 第 13 部分 Mortal remains 遗体遣送 If you die outside of your home country, we will pay the costs of preparing and transporting your body, mortal remains or ashes to your home country, or we will pay the costs of preparing your body or mortal remains for local burial or cremation 若被保险人在海外死亡的情况下, 从死亡地准备及空运遗体或骨灰至祖国的费用, 或在死亡地准备并就地埋葬或火葬遗体的费用 Emergency medical treatment outside area of cover (see section 13 for co-insurances) 在保障区域之外的紧急医疗费用 ( 共保额请参见第 13 部分 ) Emergency medical treatment outside of your area of cover 在保障区域地域范围之外的紧急医疗费用 Co-insurances (In-patient, daycare and out-patient medical treatment co-insurance on sections 2,3,4,5,6,7,9 and 12.) 共保额 ( 指每个保险年度, 您或被保险人就承保范围内的索赔需要按比例支付的 保险公司不予承担的费用部分 ) Paid up to 178,500 最高保障为 178,500 Paid up to 360,500 最高保障为 360,500 Co-insurances 共保额比例 Should insured seek treatment at hospitals/clinics that are listed on Network A, Zero Co- 13.1 Insurance is applied on treatment. 0% 如果被保险人在 医院列表 A 中的医院或诊所就诊, 您或被保险人不需要支付任何共保额 Should insured seek treatment at hospitals/clinics that are listed on Network B, 30% Co- 13.2 Insurance is applied on treatment. 如果被保险人在 医院列表 B 中的医院或诊所就诊, 您或被保险人需要支付 30% 的共保额, 相应的我们将根据 30% 最高赔付限额, 承担每次合理理赔总额 70% 的费用 No cover at hospitals/clinics that are listed on Excluded Hospitals 13.3 100% 如果被保险人在 除外医院列表 中的医院或诊所就诊, 我们将不接受任何理赔 If you choose to receive your treatment at hospitals/clinics that not in our hospital list, 30% Co- 13.4 Insurance is applied on treatment. 30% 如果被保险人就诊的医院或诊所不在我们的医院列表中, 被保险人将需要支付 30% 的共保额 2
二 Benefit Exclusions 保险利益除外 Although we cover most medical conditions, your plan does not cover claims for, arising from or connected with the following benefit exclusions unless shown on your table of benefits, in any written plan endorsement, or agreed by us in writing: 尽管我们承保大多数医疗状况, 但由下列保险利益除外情况所引起的费用不属于保险计划承保范围, 除非在您的保险利益表或任何书面批注中注明, 或经我们书面同意 以 下情况为我们的除外责任 : BE1 Any Condition or symptoms in existence or which you or any other person covered under the plan were aware or prior to your join date, but did not declare on your application form. 投保前的既存医疗状况, 但并未在投保申请表上陈述 Pre-existing - any medical condition or related medical condition which has one or more of the following characteristics 既存医疗状况指任何具有以下情况的医疗状况或相关的医疗状况 : was foreseeable; 可以预见 ; clearly showed itself; 自然显现 ; you had signs or symptoms of; 被保险人有其体征或症状 ; you asked advice about; 被保险人为其寻求医疗建议 ; you received treatment for; 被保险人为其寻求医疗建议 ; to the best of your knowledge, you were aware you had. 被保险人知道或已经意识到其存在 BE2 You exceeding a limit shown on your table of benefits. 超过您保险计划的保险利益限额, 该限额已经详细的列在您的保险利益表上 BE3 Any benefit not available on your plan. 您保险计划所不承保的范围 BE4 You not completing a waiting period shown on your table of benefits. 您保险计划在等待期内产生的任何治疗和就诊, 该等待期已经详细的列在您的保险利益表上 BE5 Pregnancy, childbirth and postnatal costs whether complicated or not. 怀孕 分娩和产后的费用, 无论是正常的还是带有并发症 BE6 Travel costs for journeys from the country where you live, specifically made for the purpose of getting medical treatment, unless we have pre-authorized this. 从居住国出发以治疗疾病为目的旅行费用, 除非根据紧急运送或遣返保障经过我们事先授权 BE7 Non-emergency transportation. 非紧急事件运送 BE8 Burial, cremation or moving your body or mortal remains if you die in your home country. 被保险人在其祖国死亡而发生的丧葬 火化或运输费用 BE9 Any journey, activity, action or pursuit carried out against the advice of a medical practitioner, specialist or consultant, registered nurse or therapist. 违背执业医师 专科医师 / 顾问 注册护士或治疗专家的建议进行的任何旅行 活动或行为 BE10 Treatment by a medical practitioner, specialist or consultant who is in any way related to you. 接受与被保险人本人或与被保险人有任何亲属 同事关系的执业医师 专科医师或专科顾问的治疗 BE11 Alcohol, drug or any other intoxicating substance abuse, any addictive condition of any kind and any medical condition arising directly or indirectly from any such abuse or addiction. 酒精 药物或任何其他致瘾性物质的滥用或任何成瘾状况和由此直接或间接引起的任何医疗状况 BE12 A medical condition due to you being under the influence of alcohol, drugs or any other intoxicating substance. 被保险人在酒精 药物或其他致瘾性物质影响下造成的医疗状况 BE13 Male to female or female to male gender reassignment. 从女性到男性或男性到女性的性别转变 BE14 Tests and treatment because of sexually transmitted diseases. 性传播疾病的检查和治疗 BE15 Experimental or unproven treatment, unless we have pre-authorised us. 试验性或未证实的治疗, 除非我们给予事先授权 BE16 Bone-marrow transplants, the costs of finding and obtaining an organ, treatment as a result of the removing an organ from a donor, treatment for removing an organ from you to transplant it into another person and any resulting complications. 骨髓移植 器官获取或寻找的费用, 为了移植目的而进行的对捐赠人或被保险人进行的器官摘除及与此相关的并发症的治疗 BE17 Cryopreservation, implantation or re-implantation of living cells or living tissue, whether autologous or provided by a donor. 活细胞或活体组织的冷冻保存 移植或再移植, 无论是自体移植还是捐赠移植 BE18 Foetal treatment. 胎儿治疗 BE19 Terminating a pregnancy. 终止妊娠 BE20 Congenital abnormalities or birth defects. 先天畸形或先天缺陷 BE21 Suicide, attempted suicide or any deliberate, self-inflicted medical conditions. 自杀 试图自杀和 / 或任何有意 自己造成的医疗状况 BE22 Putting yourself in needless danger, except in an attempt to save human life. 故意暴露在不必要的危险中, 除非是为拯救他人生命为目的 BE23 Medical conditions suffered by military, naval or air force personnel due to you taking part in any military, naval or air force operation or exercise. 陆军 海军或空军人员由于参加军队 海军或空军军事行动或训练造成的医疗状况 3
BE24 Including but not limited to taking part in war, riots, revolution or any similar event, strikes, lock-outs, civic commotion, terrorism, military or usurped power or any illegal or criminal act. 参与战争 暴乱 罢工 封锁 骚乱 叛乱 革命 起义 恐怖主义 军事或武力篡夺 或任何非法 / 犯罪行为, 包括其引起的入狱 BE25 Weapons of mass destruction (nuclear, biological or chemical) whether this involves an explosion or not. 大规模杀伤性武器 ( 包括核 生物或化学武器 ) 的泄漏, 无论是否造成破坏性后果 BE26 Contamination from chemical, biological and nuclear materials, including waste products from the combustion of nuclear fuel. 核 生物或化学物质的污染, 包括核燃料燃烧造成的废物 BE27 Medical conditions due you taking part in professional sports or using a weapon or firearm. 参加职业运动造成的医疗状况或使用武器 枪支引起的医疗状况 BE28 Sleep apnoea, sleep-related breathing disorders, snoring, or insomnia. 睡眠呼吸暂停, 睡眠相关的呼吸异常 鼾症 或失眠 BE29 Learning difficulties or disorders, developmental disorders and speech or voice problems. 学习困难和 / 或失常, 成长问题和语言和 / 或发声问题 BE30 Cosmetic, reconstructive, or remedial treatment, whether or not for psychological reasons, and any complications, unless they are needed as the direct result of a covered medical condition. 无论是否由心理原因造成的美容 整形或修复治疗及引起的并发症, 除非因加入日期后发生的在承保范围内的医疗状况造成的直接后果而必须进行该类治疗 BE31 Removing fat from any part of the body, breast reduction or breast enlargement. 身体任何部位的脂肪去除, 隆乳或缩乳 BE32 Treatment in a quarantine, isolation ward or unit, nursing home, hydro spa, spa, health farm or similar establishment. 在隔离治疗 水疗 疗养中心或类似设施进行的治疗 BE33 Preventative services for sight and hearing examinations. 预防性听力及视力检查 BE34 Myopia, hypermetropia, astigmatism, natural or non-medical degenerative sight disorders, non-medical or natural degenerative hearing disorders, aids to help with your eye sight and hearing, contact lens solutions, eye drops, sunglasses and prescription sunglasses. 近视 远视 散光 自然的 / 非医疗的退化性视力缺陷 自然的 / 非医疗的退化性听力缺陷 视力和听力的辅助性治疗, 隐形眼睛配镜 眼药水或滴眼液治疗费用 BE35 Ear or body piercing and tattooing, and any treatment needed as a result of any of these. 耳朵或身体穿刺和纹身以及由此引起的治疗 BE36 Services for dental examinations and treatment, including but not limited to scraping, scaling, cleaning, polishing, removable bridges, dentures, false teeth, dental implants or orthodontic treatment. 牙科相关检查和治疗费用 BE37 Compulsive or addictive eating disorders or being homesick. 强制性或成瘾性的进食紊乱或思乡症 BE38 Obesity, special diet and weight control. 肥胖症, 特殊饮食, 体重控制 BE39 Children's food, baby supplies, vitamin, mineral or organic supplements, products that can be obtained without a doctor's prescription, including, but not limited to, mouthwash, toothpaste, antiseptic lozenges or sprays, shampoo or sunscreen. 幼儿饮食 婴儿供应品 维生素 矿物质或有机物补充, 以及没有医生处方所购买的物品 ( 例如, 漱口水 牙膏 止咳糖或杀菌喷雾 洗发水或防晒霜等 ) BE40 Supplying, maintaining or fitting any external prostheses, appliance or device, and renting or buying crutches, wheelchairs or other equipment, medical or otherwise. We will pay for a spinal support, knee brace or air cast boot if it is part of a surgical operation or part of the treatment for a covered medical condition. 外部义肢或用具的供应 保养或装置, 拐杖 轮椅或其他设备的租赁或购买, 无论是否属于治疗性质 BE41 Costs for the completing claim forms or other documentation. 填写医疗理赔申请表产生的收费或费用 BE42 Any consequential loss. 任何间接损失 BE43 Treatment after your end date unless your cover has been renewed, the premium is paid and the treatment is eligible. 保险计划满期日或被保险人的保险利益满期日 ( 以较早发生者为准 ) 之后的治疗, 除非保险计划或被保险人的保险利益得到续保并支付续保保费, 而且治疗属于承保范围 BE44 Any treatment relating to a hospital admission at the time of your start date, which you did not tell us about and we have not accepted. 任何被保险人于生效日当日入院接受的治疗, 而该治疗未向我们告知并被我们接受 BE45 Any treatment relating to a planned hospital admission that you were aware of at your start date, which you did not tell us about and we have not accepted. 任何与被保险人于生效日当日已经作出的入院计划有关的治疗, 而该入院计划未向我们告知并被我们接受 BE46 Medication, drugs and dressings which are not recognised by the pharmaceutical regulator in a given country or are available without prescription from a medical practitioner, specialist or consultant, registered nurse or therapist. 任何不被国家药品管理部门认可的药物治疗, 药物和敷料或非经执业医师 专科医师 / 顾问 注册护士或治疗专家开处方或指示的药物处理, 药物和敷料 BE47 Treatment as a result of proven medical negligence or malpractice. 任何由于已证实的医疗事故而需要的治疗 BE48 Infertility tests and treatment, contraception, sterilisation or fertilisation, treatment for sexual problems (including impotence, whatever the cause), assisted reproduction (for example IVF treatment) or surrogacy. 任何不孕 避孕 不育或多孕 性疾病的治疗 ( 包括任何原因造成的阳痿 ), 辅助怀孕 ( 例如, 人工授精治疗 ) 治疗以及任何由此引起的怀孕 ( 包括代孕 ) BE49 Any treatment needed for a newborn child as a result of a pregnancy following assisted conception. For example, a premature newborn child requiring admittance into a Special Care Unit or other Pediatric Intensive Care Unit. 通过人工受孕出生的新生儿所接受的任何治疗 例如, 早产新生儿需到特殊护理病房或重症监护病房接受治疗 BE50 Any co-insurance which applies to your plan. 任何适用于您保险计划的共保额 BE51 Treatment in our excluded hospital list. 任何在 除外医院列表 中的医院就诊而产生的费用 BE52 Routine health check, including but not limited to cancer screening, cardiovascular examinations, neurological examinations, vital sign tests (e.g. blood pressure, cholesterol checks). 常规体检, 包括但不仅限于癌症普查, 心血管系统检查, 神经系统检查, 重要指标测试 ( 如 : 血压, 胆固醇 ) 4
三 Policy period and Renewing your plan 保险期间及续保 The Period of the policy is 1 year. With our agreement, the planholder may renew the plan each year. Renewal of the plan is not guaranteed. The planholder must tell us all material facts about himself/herself and all dependants before the renewal date (please read general condition If the planholder wants to renew the plan, they must tell us in writing by letter, fax or email before the renewal date. 本保险产品保险期间为 1 年 您可以每年续保保险计划, 我们有权决定是否接受续保 本保险计划不保证续保 每次续保时, 您都有义务向我们如实告知任何有关投保所要求提供的重要情况 We may change the definitions, benefits, general conditions, benefit conditions and benefit exclusions that apply to the plan. These will be sent to the planholder together with the renewal quotation at least four weeks prior to your renewal date. The planholder must pay the renewal premium on or before the renewal date. 每次续保都应在保费到期日或之前交纳续保保费, 并遵守续保当时有效的定义 一般条款 保险利益条件和保险利益除外条款 我们会在本保险计划的到期日至少四周之前向您签发续保条款和如何续保本保险计划的通知 Renewal premiums depend on the age of the planholder and all dependants, the country you live in, increases in medical inflation, the number of the dependants. 每次续保保费将以您及您的被抚养人在新的保险年度开始当时的年龄 居住地 医疗费用通货膨胀 被抚养人的数目为基础计算 Cover will no longer be eligible at the next renewal date if any child under the plan 如果在续保日, 在保险计划下的子女满足以下任一情况, 他们将不再有资格在您的保险计划下获得保障 : marries; 成婚 ; reaches the age of 18, and leaves full-time education; 满 18 周岁并且停止在全日制学校学习 ; reached the age of 25. 满 25 周岁 With our agreement, they can apply to have their own plan by completing an individual application form. As long as there is no break in their insurance cover, their date of joining will stay the same. Their application will be governed by the definitions, benefit conditions and benefit exclusions in force at the time they move to their own plan. 如保险计划下的子女满足以上任一情况, 他们可以填写保险计划的投保单并拥有他们自己的保险计划 在他们的前后保险计划没有间断的前提下, 新的保险计划的加入日期仍以他们加入您的保险计划的加入日期为准 投保申请将遵守转换当时的有效定义 保险利益 条款和条件 四 Claims procedures 理赔方式 1. How to make a claim under your plan for in-patient or daycare treatment. You must obtain pre-authorisation for any in-patient or daycare treatment you require. 如何在住院或日间护理情况下申请理赔 : 被保险人必须在安排住院或日间护理前得到我们的预先授权 a. See your medical practitioner in the usual way. 和往常一样去就诊 b. If your medical practitioner refers you for a specialist consultation for treatment requiring a stay in a hospital or clinic as an in-patient, or for daycare treatment, you must call the International Helpline (IGAssistance) immediately on the telephone number shown on your membership card. 如果被保险人的医生或专科医生安排被保险人住院或日间护理, 您或被保险人需要通过您会员卡上的电话号码和我们的国际救援中心取得联络 c. The International Helpline is open 24 hours a day, 365 days a year. (When calling the International Helpline please give) 我们的国际救援服务中心是 24 小时,365 天运转机构 当您或被保险人取得联系后, 您或被保险人需要提供给服务中心人员以下信息 : Your membership number; 被保险人的会员卡号 ; Your attending medical practitioner's name; 被保险人的就诊医生的名字 ; Name and telephone number of the hospital/clinic. 就诊医院或诊所的名称和电话 d.the International Helpline will then contact your medical practitioner and the hospital or clinic concerned, to ensure arrangements are in place for your treatment. 救援服务中心的人员会在之后和被保险人的医生及有关医院或诊所取得联络, 安排住院事宜 e.the International Helpline will get back to you, confirm authorisation and the arrangements that have been put in place for your treatment. Unless a Coinsurance applies to your plan, you will not be required to pay for any treatment as all eligible costs will be met directly with the medical practitioner, consultant, hospital or clinic concerned. You will not need to complete any medical claim forms. 救援服务中心的人员然后会及时给您或被保险人回复, 确认有关授权事项及住院手续等事宜是否已经妥善安排 如果医院或诊所接受我们的费用担保, 被保险人一般都不需要向医院支付任何费用 任何在承保范围内的住院费用, 我们会直接向医院支付 被保险人不需要填写理赔申请单 IMPORTANT 请注意 : If you to receive your treatment under our Network B list, we will only offer the guarantee for 70% of the fees. 30% should be paid by you and cannot be reimbursed. 若被保险人至 医院列表 B 中的医院就诊, 我们对共保额部分不提供费用担保 ; If the hospital or clinic will not accept our guarantee, you may need to pay the fees first and then submit them back to us for reimbursement. (The reimbursement procedure is shown below) 如果医院或诊所不接受我们的费用担保, 您需要先与医院进行结算, 再向我们申请理赔 ( 申请流程参见门诊项下的申请理赔流程 ) f. Receive your treatment at the hospital or clinic. 在医院或诊所接受治疗 2. How to make a claim under your plan for emergency evacuations: 如何在紧急援助遣送项下申请理赔 : We will only provide benefit for evacuation costs if your medical condition is considered an emergency, or if our International Helpline considers there are no adequate medical facilities in your location. This will be based on medical necessity and approved by us. We will only evacuate you within your area of cover which is detailed on your Certificate of Insurance. 只有在紧急情况下或者在我们认为该地区内没有任何完善的医疗设施的情况下, 我们才会安排紧急援助遣送 紧急援助遣送必须是医疗必需的, 并得到我们的认可, 且在您保障区域范围内 In a medical emergency, you or your representative must contact the International Helpline on the telephone numbers shown on your membership card. 在任何紧急情况下, 您和您的代表人必须通过会员卡上的电话号码和我们的国际援救中心取得联络 Please note: in accordance with BC6, if a local situation makes it impossible, unreasonably dangerous or impractical to enter a specific area or country we may be unable to arrange an emergency evacuation. 请注意 : 依照 BC6, 如果当地局势使我们无法进入该地区或国家 或进入该地区或国家有极大危险我们可能无法安排紧急撤离 5
3. How to make a claim under your plan for out-patient treatment: 如何在门诊项下申请理赔 : If you need any help or advice, please contact our claims team. You do not need to contact the International Helpline for pre-authorization. 如果您或被保险人在周一到周五 9:00-17:30 之间需要帮助, 请拨打我们健康险理赔部门电话联系 此项理赔无需和国际救援中心联系 3.1 Procedure under reimbursement: 在非免现金直付网络中的医院门诊就诊的理赔流程 : a.see your medical practitioner, therapist, specialist or consultant in the usual way. 和往常一样去就诊 ; b.pay your bill for the treatment you have received. 对就诊项目产生的任何费用进行付款 ; c.make sure you obtain an original itemised invoice and original receipt as you will need to send this to us with your completed medical claim form (see step f). Please ensure that one medical claim form is completed per medical condition. 请确认被保险人得到所有账目明细原件和发票原件 ( 请参见 f.), 并确保一张理赔申请单适用于一种病症 ; d.complete a medical claim form. You can get a medical claim form at www.axa-minmetals.com.cn/medical 请填写完整理赔申请单 ( 理赔申请单可从 www.axa-minmetals.com.cn/medical 下载 ); e.you must ask your medical practitioner or dentist to complete Medical Information. Please note: treatment received from a therapist, specialist or consultant must always be on referral from your medical practitioner. 请确保被保险人的医生在 医疗信息或齿科治疗 部分签字 请注意 : 由理疗师 专科医师或顾问进行的治疗必须通过被保险人的执业医师引荐 ; f. Send your claim to the claims team. You must send the following items to make sure that we can process your claim 请将完整的理赔申请寄到健康险理赔部门 ( 地址请参见理赔申请单 ) 理赔资料包括: The original itemised bill; 就诊账目明细原件 ; The original receipt; 正式发票原件 ; The fully completed medical claim form. 完整的理赔申请单 Please return the above items as soon as possible from the first date of treatment. 请在就诊后尽快将理赔申请寄给我们 If we deem that the above items and materials are incomplete, we shall notify you in a timely manner and at one time of all items and materials to be supplemented. 如提供的以上证明和资料不完整, 我们将及时一次性通知申请人补充有关证明和资料 3.2 Procedure under Direct Billing 在免现金直付网络中的医院门诊就诊的理赔流程 : If you have applied for the direct billing benefit, you may be entitled to a direct billing claims facility. We will provide you with a list of hospitals that will accept you on a direct billing arrangement. An up-to-date list may be found on our website at www.axa-minmetals.com.cn/medical. 如果被保险人申请了免现金直付服务, 我们会给被保险人提供一张免现金直付网络医院列表 ( 该列表将可在我们的网站上 www.axa-minmetals.com.cn/medical 下载并被实时更新 ) 被保险人可至该网络医院列表上的医院就诊并享受门诊免现金直付服务 a.visit one of the hospitals on the list; 去我们免现金直付网络医院列表所列的医院就诊 ; b.show the membership card; 出示被保险人的会员卡 ; c.receive the treatment; 接受治疗 ; d.pay any co-insurance applicable to the plan. This Co-insurance will be shown on the membership card. For Network A facilities no co-pay will apply for outpatient treatment. 支付任何适用的共保额 IMPORTANT 重要提示 : Any visit, consultation or treatment at any excluded provider listed under our Excluded list will not be covered.(including in the emergency situation, Please referral to the definition of Emergency ) 如果被保险人选择 除外医院列表 的医院或诊所接受治疗, 我们将不接受任何理赔 ( 包括在紧急事件中, 被保险人主动或被动去 除外医院列表 " 名列中任何一家医院或诊所进行治疗, 我们均不接受任何理赔 请被保险人仔细阅读本合同对 紧急事件 的定义 ) If you choose to receive your treatment under our Network B list, you will have access for 70% of the total medical cost, 30% of total medical cost will be paid by you and cannot be reimbursed. 如果被保险人在 医院列表 B 中的医院或诊所就诊, 适用 30% 的共保额比例, 被保险人就承保范围内的合理理赔将需要自行支付 30% 的费用 ; 相应的我们将根据保险利益表上最高赔付限额, 承担每次合理理赔总额 70% 的费用 If you choose to receive your treatment at hospitals/clinics that not in our hospital list, 30% Co-Insurance is applied on treatment. 如果被保险人就诊的医院或诊所不在我们的医院列表中, 被保险人将需要支付 30% 的共保额 You can download the hospital list from www.axa-minmetals.com.cn/medical. The hospital list is subject to change at all times due to expansion and updating. Please always refer to the list on our website for the most recent information. 我们的医院列表可在我们的网站上 www.axa-minmetals.com.cn/medical 下载 我们将保留对以上医院列表随时进行更新的权利, 请您及被保险人务必在就诊前登陆我们的网站进行查阅 五 Declaration 声明 I have read and understood the proposal, especially for the benefit, exclusions, renewing the plan, claim procedures, policy period, etc. 本人已认真阅读并理解本产品说明书的全部内容, 特别是金盛福满安康医疗保险的保险责任 责任免除 投保人的权利和义务 续保 理赔程序及理赔文件要求 保险期间等内容 Customer signature 投保人签名 : Date 签名日期 : Broker/Agent/Sales advisor 销售人员签名 : Date 签名日期 : The proposal shall be written in Chinese. The English language version is the translation of Chinese language version and only for reference. 本产品说明书以中文书就, 英文版仅为中文版的翻译文本, 仅供参考 www.axa-minmetals.com.cn 全国客户服务热线 : 4006-70-5577(working hours from 9:00am to 5:30pm) 金盛人寿保险有限公司中国 上海浦东陆家嘴环路 166 号未来资产大厦 19 楼邮编 :200120 电话 : (8621) 5879 2288 传真 : (8621) 5879 2299 邮箱 : interglobal@axa-minmetals.com.cn 6