国任财产保险股份有限公司来华人员综合保险保障计划简介

投保条件

留学生：来华留学生、港澳台学生及华侨学生（华侨身份可由相关单位出具证明），凡身体健康、年龄在8-69周岁可参加本保险。

保险责任

在保险期间内（从本次保险生效到截止的期限内），本公司承担下列保险责任：

1、身故保险责任：

被保险人因意外事故或疾病身故，保险公司按约定保险金额给付保险金，保险责任终止。

2、意外残疾保险责任：

被保险人因遭受意外事故，并自事故发生之日起180日内因该事故造成本附加合同所附《人身保险伤残评定标准》所列伤残项目的，本公司依照该标准规定的评定原则对伤残项目进行评定，除另有约定外，本公司按评定结果所对应该标准规定的给付比例乘以保险金额给付意外伤残保险金。如治疗仍未结束的，按事故发生之日起第180日的身体情况进行伤残鉴定，并据此给付意外伤残保险金。

被保险人该次意外事故导致的伤残合并前次伤残可领较严重项目意外伤残保险金的，按较严重项目标准给付，但前次已给付的意外伤残保险金（投保前已有或因责任免除事项所致《人身保险伤残评定标准》所列伤残的，视为已给付意外伤残保险金）应予以扣除。

每一被保险人的意外伤残保险金累计给付以该被保险人的保险金额为限，累计给付金额达到其保险金额时，对该被保险人的保险责任终止。

3、意外医疗保险责任：

被保险人因遭受意外事故，并自事故发生之日起180日内进行治疗，保险人就其实际支出的合理医疗费用按100%给付意外伤害医疗保险金。被保险人不论一次或多次发生意外伤害保险事故，保险人均按上述规定分别给付“意外伤害医疗保险金”，但累计给付金额以不超过该被保险人的保险金额为限，累计给付金额达到其保险金额时，对该被保险人的该项保险责任终止。

4、住院医疗保险责任：

被保险人因意外事故或于保单生效日后因疾病，经医院诊断必须住院治疗,本公司就其实际支出的护工费（限额200元/天，累计60天）、建病历费、取暖费、空调费、床位费（限额300元/天）、检查检验费、特殊检查治疗费、手术费、药费、伙食费、治疗费、化验费、放射费、护理费、病历复印费等合理医疗费用，按100%给付“住院医疗保险金”。

急诊抢救所产生的相关费用，归属住院医疗责任下，对被保险人在医院进行了急诊抢救的合理且必要的治疗费用，按照100%给付保险金。

被保险人不论一次或多次住院治疗，本公司均在规定限额内给付保险金，分项累计给付金额达到其保险金额时，该项保险责任终止。

5、门急诊医疗保险责任：

被保险人因疾病进行门诊、急诊治疗所发生的合理医疗费用，每个保险期间内，就诊日限额为600元，累计超过起付线650元以上的部分保险人按照85%的比例赔付,累计给付以保险金额20000元为限。当累计给付金额达到其保险金额时，该被保险人的保险责任终止。

普通门诊、急诊、门诊手术、急诊留观、急诊抢救所产生的相关费用，由公立医院或卫生防疫部门提供证明的传染病因隔离期间所产生的相关费用、及因与住院同一病因产生的院前、院后门所产生的费用等均归属于门急诊医疗责任范围内。

6、遗体遣送服务项目：

被保险人在保险期间内不论因何种原因身故的，保险公司将根据被保险人所在单位的合理要求委托联华国际保险经纪（北京）有限公司 或救援机构承担遗体遣送相关工作及费用，全部费用总额不能超过200000元人民币，具体金额以发生的相关费用的正式发票金额为准。

注：申请遗体遣送服务项目时，只能由学校申请此项目，无须出具与家属的关系证明及身份证明，且无须家属签字确认。

注：

1）以上所有医疗责任所涉及的医疗机构仅限于中华人民共和国大陆境内的公立医院，但不包括公立医院的分院、外宾病区、VIP病区、包房、特诊特需病区、特诊特需病房和高干病房等同类病区或病房发生的医疗费用。

2）以上所有医疗费用，若其它第三方支付了部分或全部费用时，我司仅负责补偿剩余部分且与当地社会医疗保险支付范围相符的合理费用，但保险责任中所涉及的床位费、护工费等限额部分同样受限，如第三方有赔付比例的受限部分按照受限金额为基础扣除已赔付金额,保险公司只赔付剩余金额,如无赔付比例,受限部分按照当地社会医疗保险的标准,以受限金额为基础扣除此项目的标准金额,赔付剩余金额,并以保险金额为限。

责任免除

一、身故及残疾责任免除

因下列情形之一导致被保险人身故、伤残的，本公司不承担给付保险金的责任：

（一）投保人、受益人对被保险人的故意杀害、故意伤害；

（二）被保险人故意自伤、自杀、故意犯罪或者抗拒依法采取的刑事强制措施；

（三）被保险人殴斗、醉酒，主动服用、吸食或注射毒品；

（四）被保险人酒后驾驶、无合法有效驾驶证驾驶，或驾驶无有效行驶证的机动车；

（五）战争、军事冲突、暴乱或武装叛乱；

（六）核爆炸、核辐射或核污染；

（七）被保险人怀孕、流产、分娩；

（八）被保险人因整容手术或其他内、外科手术导致医疗事故；

（九）被保险人未遵医嘱，私自使用药物，但按使用说明的规定使用非处方药不在此限；

（十）被保险人患爱滋病（AIDS）或感染爱滋病毒（HIV呈阳性）期间；

（十一）被保险人从事潜水、跳伞、攀岩、蹦极、驾驶滑翔机或滑翔伞、探险、摔跤、武术比赛、特技表演、赛马、赛车等高风险运动。

发生上述情形之一，被保险人身故的，本公司对该被保险人保险责任终止。

二、医疗责任（意外伤害医疗、门急诊医疗、住院医疗）责任免除

因下列情形之一造成被保险人医疗费用支出的，本公司不承担给付保险金的责任：

（一）投保人、受益人对被保险人的故意杀害、故意伤害；

（二）被保险人故意自伤、故意犯罪或者抗拒依法采取的刑事强制措施；

（三）被保险人殴斗、醉酒，服用、吸食或注射毒品；

（四）被保险人酒后驾驶、无合法有效驾驶证驾驶，或驾驶无有效行驶证的机动车；

（五）战争、军事冲突、暴乱或武装叛乱；

（六）核爆炸、核辐射或核污染；

（七）被保险人患艾滋病或感染艾滋病病毒、性病；

（八）被保险人怀孕、流产、分娩、不孕不育症治疗、人工受精、产前产后检查；节育、堕胎，及以上原因引起的并发症；

（九）被保险人因整容手术或其它内、外科手术导致医疗事故；

（十）被保险人因矫形、矫正、整容或康复性治疗等所支出的费用；

（十一）被保险人未遵医嘱，私自服用、涂用、注射药物；

（十二）在中国大陆地区以外发生及中国大陆境内私立医院发生的医疗费用；

（十三）被保险人支出电话费、交通费等；

（十四）既往症；

既往症认定依据：（1）因投保前已明确诊断的疾病就诊的；

（2）垫付机构核实确认为投保前已有疾病就诊的；

既往症包括的疾病如下：恶性肿瘤、心脏病、再生障碍性贫血、心肌梗塞、白血病、结核病、血管畸型、慢性肝病、血管瘤等。

（十五）被保险人或学校申请自行承担的相关自费费用。

保险费

Comprehensive Medical Insurance & Protection Scheme for Foreigners Staying in China of Guoren Annuity Insurance Co., Ltd.

To participate in conditions:

International students: international students in China in healthy condition from 8 to 69 are eligible to this policy.

Insurance coverage:

Insurance shall undertake the following insurance liabilities during the valid period of insurance （Insurance period （from the valid date of policy to the expiry date of the insurance period））

1. Death insurance:

Insurance shall pay the stipulated amount of insurance compensation if the Insured dies of any accident or disease. Insurance liabilities thus terminate.

2. Accidental disability insurance:

If the Insured suffers from any accident which results in any disability listed in the Injury and Disability Assessment Criteria for Personal Insurances within 180 days since the occurrence of the accident, according to the policy Guoren shall pay the insurance money, whose amount shall be calculated based on the multiplication of the sum insured, which is corresponding to insurer’s responsibilities, and the proportion that is specified in the “Proportion Table of Disability Degree and Payment” of Guoren 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 （Guoren） 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 and as a result of 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.

Note: “Proportion Table of Disability Degree and Payment” is accessible from the website of INSURANCE ASSOCIATON OF CHINA.

3. Medical Insurance for Accidental Treatment:

If the Insured receive medical treatment within 180 days since the occurrence of the accident, the Insurer shall be liable for the payment of the full amount of the reasonable and necessary expenses actually paid by the Insured for the medical treatment. 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 because of suffering from the accident or the illness, Insurance 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 reasonable and necessary fees for nursing （limited to RMB200 Yuan per day for limitation of accumulative 60 days）, medical record, heating, air-conditioning, bed (limited to RMB 300 yuan per day), examination, special examination and treatment, operation, medicine, treatment, laboratory test, radiation, etc to the insured as 100% proportion.

The relevant expenses incurred in emergency rescue belong to the hospitalization medical responsibility, and the reasonable and necessary treatment expenses for the insured who underwent emergency rescue in the hospital shall be paid 100% of the cost.

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.

5. Outpatient and Emergency Medical Insurance:

If the Insured receive outpatient or emergency medical treatment because of illness and actually incur reasonable and necessary expenses for medical treatment, within the insurance time, the daily limit for outpatients is RMB600. On the precondition of not exceeding the daily limit, should the daily medical cost is less than RMB600; the actual cost shall be used for calculation. if the daily medical expenses and cost is more than RMB600, the Insurer only cover RMB600 per day.For medical expenses exceeding the starting line of RMB650, their remaining amount after deducting RMB650 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.

Insurance Responsibilities of emergency medical treatment and general outpatient treatment include: The fees of 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.

6. Body Removal Services:

If the insured person dies for any reason during the insurance period, the Insurance will entrust Lianhua International Insurance Brokerage (Beijing) Co., Ltd. or rescue agencies to take on the work and expenses related to the removal of the body according to the reasonable requirements from the insured person's unit. The total amount of all expenses shall not exceed RMB200000, and the specific amount shall be subject to the official invoice.

Note: When applying for the body removal service, only the school can apply for this project, and there is no need to provide proof of relationship and identity with the family, and there is no need for the family to sign and confirm.

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 the Chinese mainland.

2）If any third party has partially or fully paid any above-mentioned medical treatment fees, Guoren shall be liable for the amount of reasonable fees that are in accordance with the payment scope. But the fees for nursing, bed, outpatient and emergence treatment daily limitation fee and other fees within the insurance coverage are also limited. If the third party has a specified proportion for payment, then Guoren shall be liable only for the payment within its proportion deducting the already paid amount. If the third party has no specified proportion for payment, then Guoren shall be liable for the rest, not exceeding the insured sum, of the limited amount in accordance with the regulations of the local social medical insurance and with a deduction of the standard amount of this item.

Liability Exemption

I. Liability Exemption for Death and Disability Insurance

Guoren 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, abortion, miscarriage, delivery （including caesarean birth） , birth control, treatment of infertility, contraceptive sterilization, artificial impregnation and related complication 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. （The Insured engages in high risk activities such as diving, parachuting, paragliding, roller skating, skiing, skating, bungee jumping, rock climbing, wrestling, judo, taekwondo, martial art, karate, fencing, etc.）

If the Insured is caused dead in any of the foregoing circumstances, Guoren shall terminate the insurance liability of the Insured.

II. Liability Exemption for Medical Insurance Liability （Medical Treatment of Accidental Injury, Outpatient, Emergency and Hospitalization）

Guoren 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. AIDS or HIV infection, sexually transmitted diseases;

8. Pregnancy, miscarriage or delivery on the part of the Insured, infertility treatment, artificial insemination, prenatal and postnatal check, birth control, abortion and complications caused by above-mentioned causes;

9. Medical accident occurring to the Insured because of cosmetic surgery or other surgical operations;

10. Expenses of orthopedics, correct procedure, plastic surgery or rehabilitation therapy received by the Insurer;

11. Taking, application or injection of medicine without the permission of doctor on the part of the Insurer;

12. Medical expenses incurred outside the Chinese mainland or in private hospitals of the Chinese mainland, and expenses incurred in drug stores;

13. Charge of telephone, transportation, etc. on the part of the Insured;

14. Past diseases;

Basis for determining past diseases: (1) seeking medical treatment for a disease that has been clearly diagnosed before the insurance application;

(2) The advance payment institution verifies and confirms that there has been a medical treatment for a disease before the insurance application;

Past diseases include: malignant tumor, heart disease, aplastic anemia, myocardial infarction, leukemia, tuberculosis, vascular malformation, chronic liver disease, hemangioma, etc.

15. The insured or the school applies for self payment.

Insurance Liability and Amount