 |
American International Assurance (AIA,AIG) Beijing branch. www.aia.com.cn
|
| Address |
The Exchange Beijing, No.118 Jian Guo Lu Yi, Chaoyang District, Beijing. 100022 |
| Agent |
Xu Feng (Ricky) |
Agent code: 110043766 |
| Tel |
86-13911460247 |
|
The translation of this contract into English is for your information only. The official and binding contract is the Chinese version.
HOSPITAL REIMBURSEMENT RIDER
1. The Rider
This Rider is attached to the Basic Policy and forms a part of the insurance contract, and shall not be effective unless it is included in the application or endorsement for the Basic Policy and approved by the Company. If the provisions of the Basic Policy and the Rider are in conflict, the provision of this Rider shall prevail.
This Rider will not be in effect unless it is stated in the application form or policy endorsement for the Basic Policy.
If the Insured's age is below 6-month-old, this Rider shall not be effective. The name of this Rider is known as Hospital Reimbursement Rider, or abbreviated as HR.
2. Benefit
If, as a result of injury or sickness which occurs while this Rider is in force, the Insured shall be in a hospital as a resident patient, a hospital reimbursement reasonably and customarily charged by the hospital will be paid in an amount equal to the sum actually charged for the hospital confinement expenses, provided further that the maximum amount shall not exceed the hospital reimbursement amount stated in the application with respect to such Insured for any one injury or sickness. Successive hospital confinement, due to the same cause, shall be considered as resulting from one injury or sickness unless the hospital confinement is separated by at least 90 days from the immediately .preceding hospital confinement. If part of or all of the medical expenses for an injury or sickness can be reimbursed by the Government, any other welfare plan or medical expense insurance plan, the Company will only be liable to the excess of the amount paid or recoverable from such other sources.
3. Exclusions and Limitations
This Rider shall not cover any hospital confinement caused by any one of the following occurrences:
(1) violation of the law or resistance to arrest, or imprisonment;
(2) sunstroke, refraction error, mental disease or being under the influence of alcohol drug or restricted medicine;
(3) pregnancy, miscarriage, childbirth, contraception, and infertility and ligation;
(4) cosmetic or plastic surgery or any derive surgery or congenital anomalies or congenital disease;
(5) dental care or surgery unless necessitated by an accident;
(6) general check-up, convalescence, custodial or rest care;
(7) treatment or surgery for tonsils, adenoids, hernia or a disease peculiar to the female generative organs unless the Insured has been continuously covered under this Rider for a period of 120 days immediately preceding such treatment or surgery;
(8) In case of(l)or (2) or (3) or (6) or (9) or from (11) to (17) in EXCLUSION AND LIMITATION of the Basic Policy.
4. Proof of Hospitalization
After being discharged from the Hospital, originals- of official statement of accounts and receipts of the Hospital, affirmative proof of hospital confinement and any other forms as the Company prescribes must be furnished to it as soon as possible at the expense of the Insured after the termination of the period for which claim is made.
5. Hospital Confinement Expense Receipt
Upon the reimbursement of the accidental hospital confinement expenses, the Company will request the Insured to submit the relative hospital historic information and the originals of hospital confinement expense receipts. If, as required by written application, the Company may give the originals of such receipts back to the claimant after sealing on them the amount already been paid. In case that 100% of the actual hospital confinement expenses has already been reimbursed under the Rider, the originals of hospital confinement expense receipts will not be given back to the claimant.
6. Termination
This Rider shall automatically be terminated on the earliest of the following:
(1) the Basic Policy is terminated;
(2) the Rider expires and the Company refuses to renew it;
(3) the Rider is canceled by the Policyowner.
Notes:
In case of (2), this Rider shall automatically be terminated on 24:00 of the expired date.
7. Definition
(1) Sickness: shall mean sickness or disease contracted and whose sign and symptom commenced after the Insured has been covered under this Rider for not less than 30 days, after the effective date or date of reinstatement, if any, of this Rider, and excludes conditions for which the Insured received or was recommended by a Physician to receive medical treatment, diagnosis, consultation or prescription preceding the effective date or date of reinstatement of this Rider.
(2) Hospital: shall mean an institution providers organized facilities for diagnosis and major surgical facilities, and is being rated grade two or above as a general or specialist hospital, but excluding observation wards, united wards or rehabilitation wards;
(3) Hospital Confinement Expense: shall mean the following expenses charged when the Insured is in a hospital as a resident patient
• Expenses for medicine prescribed by doctor and consumed in the hospital. The prescriptions must be in accordance with "The Medical Reimbursement Coverage of Beijing Free Medical Services and Labor Medical Insurance" or its counterpart in the place of the residence.
• Assaying fees. Check-up fees
• Oxygen therapy fees
• Room treatment fees, diagnosis & treatment fees, air conditioner fees, doctor consultation fees
(do not include x-ray treatment, radiotherapy, and isotopes treatment fees)
• Ambulance fees
• Injection fees
• Physical therapy fees
• Splint & gesso plastics fees occurring in the bind-up department and surgical department, material fees (do not include rectification devices, appliance & instrument Tees).
SURGICAL BENEFIT RIDER
1. The Rider
This Rider is attached to the Basic Policy and forms a part of the insurance contract, and shall not be effective unless it is included in the application or endorsement for the Basic Policy and approved by the Company. If the provisions of the Basic Policy and the Rider are in conflict, the provision of this Rider shall prevail.
This Rider will not be in effect unless it is stated in the application form or policy endorsement for the Basic Policy.
If the Insured's age is below 6-month-old, this Rider shall not be effective. The name of this Rider is known as Surgical Benefit Rider, or abbreviated as SB.
2. Benefit
If, as a result of injury or sickness which occurs while this Rider is in force, the Insured shall need a surgery, a surgical benefit reasonably and customarily charged by the Physician will be paid in an amount equal to the sum actually charged for the surgery performed in a hospital by a physician, provided further that the maximum amount shall not exceed the surgical benefit amount stated in the application with respect to such Insured for any one injury or sickness. Successive surgeries, due to the same cause, shall be considered as resulting from one injury or sickness unless the surgery is separated by at least 90 days from the immediately preceding surgery. If part of or all of the surgical expenses for an injury or sickness can be reimbursed by the Government, any other welfare plan or medical expense insurance plan. the Company will only be liable to the excess of the amount paid or recoverable from such other sources.
3. Exclusions and Limitations
This Rider shall not cover any surgery caused by any one of the following occurrences:
(1) violation of the law or resistance to arrest, or imprisonment;
(2) sunstroke, refraction error, mental disease or being under the influence of alcohol drug or restricted medicine;
(3) pregnancy, miscarriage, childbirth, contraception, and infertility and ligation;
(4) cosmetic or plastic surgery or any derive surgery or congenital anomalies or congenital disease;
(5) dental care or surgery unless necessitated by an accident;
(6) general check-up, convalescence, custodial or rest care;
(7) treatment or surgery for tonsils, adenoids, hernia or a disease peculiar to the female generative organs unless the Insured has been continuously covered under this Rider for a period of 120 days immediately preceding such treatment or surgery;
(8) In case of(l) or (2) or (3) or (6) or (9) or from (11) to (17) in EXCLUSION AND LIMITATION of the Basic Policy. 4. Surgical Expense Receipt
Upon the reimbursement of the surgical expenses, the Company will request the Insured to submit -the relative hospital historic information and the originals of surgical expense receipts of the hospital. If, as required by written application, the Company may give the originals of such receipts back to the claimant after sealing on them the amount already been paid. In case that 100% of the actual surgical expenses has already been reimbursed under the Rider, the originals of surgical expense receipts will not be given back to the claimant.
5. Termination
This Rider shall automatically be terminated on the earliest of the following:
(1) the Basic Policy is terminated;
(2) the Rider expires and the Company refuses to renew it;
(3) the Rider is canceled by the Policyowner.
Notes:
In case of (2), this Rider shall automatically be terminated on 24:00 of the expired date.
6. Definition
(1) Sickness; shall mean sickness or disease contracted and whose sign and symptom commenced after the Insured has been covered under this Rider for not less than 30 days, after the effective date or date of reinstatement, if any, of this Rider, and excludes conditions for which the Insured received or was recommended by a Physician to receive medical treatment, diagnosis, consultation or prescription preceding the effective date or date of reinstatement of this Rider.
(2) Hospital: shall mean an institution providers organized facilities for diagnosis and major surgical facilities, and is being rated grade two or above as a general or specialist hospital, but excluding observation wards, united wards or rehabilitation wards;
(3) Surgical fee: shall mean the operating room and facilities charges, anesthetist's fee and the surgical fee actually charged by a Physician to perform the surgery in the Hospital.
|
