|
ISSI China
条款一 定义
以下定义适用于本保单，无论运用在保单、保单清单、保单批单中，都具有相同定义。
1.1 意外事故是指直接并立即造成被保险人伤害，可能导致死亡或其它人身伤害的一种突发的外来事件，其前提条件是对伤害的性质、地点或死亡原因在医学上能够明确认定且成立。意外事故定义如下：
a. 直接并完全由于投保的意外事故造成的人身伤害；
b. 因合法自卫，或者为救助或尝试救助遇险的人员或货 物受到的伤害；
c. 急剧且无意识地吞咽下固态、液态和/或气态的物体造成的人身伤害；
d. 由于突然用力造成的错位、扭伤、肌肉拉伤或破裂；
e. 由于极端的天气状况造成的身体不适；
f. 溺水；
g. 由于投保的意外事故造成的狂犬病或破伤风；
h. 因交通意外导致被保险人心力衰竭，心肌梗塞或心脏动脉破裂，从而导致被保险人死亡。
1.2 友邦旅行协助（AIG Travel Assist）是指代表公司提供保单中所述的紧急援助服务的机构。
1.3 汽车是指陆地行驶的机动车、拖车或半拖车。本条款不包含重型机车或农场用拖拉机或农场设备，也不包含其他设计用途主要不应用于公共道路或高速公路，并且不作为机动车登记的设备。
1.4 保单受益人是指在保单中注明的受益人，如果保单未注明， 则受益人是：
n 如果被保险人死亡，受益人为国家法定继承人；
n 对于其他一切情况，受益人为被保险人本身。
1.5 公司是指中国的太平保险有限公司。
1.6 妊娠并发症是指病情的诊断不同于妊娠，但该病情是由妊娠影响或者导致的，例如：急性肾炎、肾病变、心脏代偿失调、流产和严重程度相近的相似内科和外科病情。具体包括如下：已终止的异位妊娠，胎儿不可能存活分娩的情况下的妊娠终止，产褥期感染，子痫和毒血症。但不包括IVF诱导妊娠，剖宫产，假临产，偶尔疱疹，妊娠期间医师建议的休假，妊娠清晨不适以及妊娠期内出现的类似痛苦症状。
1.7. 先天缺陷是指出生时或在出生后六个月内发展形成的身体或精神不正常状况。
1.8. 整形手术是指为了改进形体外观而对身体正常结构进行重塑的治疗。
1.9. 医疗服务日期是指提供一项医疗服务的日期。
1.10. 保单生效日是指本保单项下被保险人受保险保障的生效之日。
1.11. 急诊是指个人健康突然转变需要紧急内科或外科治疗，以免生命或健康遭受永久性损害。
1.12. 本国是指被保险人拥有该国护照并且该被保险人希望返回的国家。
1.13. 医院是指拥有完善的组织、并且为住院的患者或受伤人士提供照料和治疗的注册机构：
A. 该机构具有完善的诊疗体系和手术设施；
B. 提供全天24小时的注册护士护理服务；
C. 由医生管理；
D. 并非护理院、疗养院、康复院、看守所、老人院、精神或行为异常治疗机构或戒毒或戒酒治疗所；即便上述机构与医院位处同一地址。
1.14. 其他国是指被保险人居留学习的国家。
1.15. 疾病是指在正常健康状态下发生病理变异的身体状况，并不是一种外部伤害。
1.16. 伤害是指完全地、唯一地因受保险保障的意外事故造成的身体损害。
1.17. 被保险人是指保单清单中注明的所有适用于本保单保障的人士，并且他们的保障应该得到公司或者服务管理机构书面认可。
1.18. 保险期间是指与保单注明期限一致的保单有效期限，即保险期限始于被保险人离开本国前往指定国，至保单注明的终止日为止，或者终止于被保险人回到本国之日止。
此保险保障在被保险人按照约定支付保费后且在保单所注明的生效日期零时始生效。保险人在保单生效之后应承担相应的保险责任。
1.19. 医疗顾问是指为公司、友邦旅行援助或服务管理机构提供意见的医师。
1.20. 医疗急症是指出乎意料发生的伤害或疾病，由于病情急剧变化，显现出足够的重要性（包括剧痛），以至一个拥有普通健康和药物知识的谨慎的外行人，都能够合理地得出以下结论：如果不立即提供医疗救治，则：（1） 个人（或者孕妇，妇女或她尚未出生的婴孩）健康将受到严重损害；（2）身体机能将受到严重损害；（3）任何身体器官或者部位严重的功能丧失。医疗急症不包括选择性或常规性治疗。
1.21. 医疗必需是指被保险人患有受保险保障的某种疾病或受到受保险保障的伤害时，由主治医师提出的诊断服务或治疗服务。
1.22. 服务管理机构是指代表公司提供本保单项下管理服务的机构。
1.23. 药物是指需要凭医生处方才能购买，由医生为治疗受保险保障的某种疾病或伤害所开立的处方且通过医生办公室或注册药剂师发放的药品。
1.24. 精神和行为失常是指精神性、心理性、感情性的精神和行为失常，不管这种失常的生理原因是已知原因或者可能性原因，其包括世界卫生组织国际疾病分类中的精神和行为失常的任何状况。
1.25. 临终照料是指主治医师通过处方开立的服务，由一个专门注册的机构为临终人士提供的一种集中型、支持型的、有形的、或心理性的、或社会性和精神性的照料服务。
1.26. 父母住宿是指父母或者法定监护人在同一病房增加床位住宿的费用。
1.27. 医生是指毕业于任一在世界卫生组织医学院目录上的、有完整组织的医学院的医疗工作者，他们在提供医疗服务的国家获得法定医疗机构注册认证，并且在他们注册和毕业的学科范围内行医。
1.28. 投保人是指从公司领取保单并且保单清单上列明该人姓名的人。
1.29. 既往病是指发生在本保单保障生效日之前的疾病或者相关病情的感染或恶化，以及因此向注册医生的咨询，为此开出的治疗方案或药物。
1.30. 出院后治疗是指由受保险保障的疾病或伤害造成的住院治疗完成后，出院时由主治医师提供或指示提供的后继医疗服务。
1.31. 住院前治疗是指由受保险保障的疾病或伤害直接造成的、发生在住院前30天内由医生提供或指示提供的医疗服务。
1.32. 合理并合乎惯例的费用是指不管有没有购买保险，受保险保障的医疗费用不得超过因为相似疾病或伤害，在相同地区的相近的健康保健服务提供者的普通收费标准。对于非常规性的服务或者药物供应，服务管理机构将考查其复杂程度，所要求的专业技术和其他相关因素，从而判断哪种程度的收费是合理并合乎惯例的。
1.33. 再造手术是指在身体的异常结构上进行以改进功能或者改进正常外貌为目的的治疗，无论是否由先天缺陷，或者变异性的异常、伤害或疾病引起的。
1.34. 注册护士是指通过专业训练毕业的、通过国家认证考试并且进行注册护理服务的护士。
1.35. 法律代理人是指注册律师或者相类似的专业人员，在本保单条件下经授权而成为被保险人的代理人。
1.36. 健康天然牙齿是指没有龋齿，补牙不得超过两个平面，没有因牙骨缺失而造成的牙龈疾病，没有牙根牙管手术，并非再造牙，并且咀嚼和语言功能均属正常的牙齿。
1.37. 标准单人间是指在医院价格最低的单人病房。
1.38. 学生是指取得中国政府签发的中国护照，并且在任何一个欧洲国家留学并居留不超过三年的被保险人，其在东道国大学或者其他学术机构注册成为学生或学者。
1.39. 性病是指通过性接触传播的疾病，或者包括下列无论是否由性交感染所致的疾病：梅毒、淋病、人乳头状瘤病毒、生殖器疱疹、腹股沟内肉芽瘤、软性下疳、毛滴虫、虱子及衣原体病毒引起的疾病。
1.40. 战争是指由任何武装部队引发的行为，或者一个国家蓄意实施的武装行动，包括内战，革命或者侵略。
条款二 通用条款
2.1 被保险人
本保单的被保险人应为拥有中华人民共和国居留权并且在一个欧洲国家留学的学生。该学生必须同时具有中国政府和留学东道国的签证。
该学生必须取得签证签发的东道国认可的大学或者其他教育机构的入学登记通知。被保险人的投保年龄不得超过40周岁。
本保单保险有效期的生效日为以下日期当中任何一个最先达致的日期为准：
A. 保单生效日；
B. 保费已支付的在申请表上注明的（若有注明）日期；
C. 被保险人离开其本国出发到欧洲的日期，前提条件是预定到达欧洲的时间距离他们离开本国的时间不得超过48小时。
D. 保单申请表上注明的（若有注明）日期，并且已经缴纳保费。
如实告知：
每个被保险人应当完成一份问卷调查表并且提交给保险公司。保险公司将按照他们的要求来定义部分或全部除外保障条款，或者在取消除外条款的情况下增加保费。
2.2 保障地区
本保单仅在被保险人身处欧洲或中华人民共和国境内时提供保障。
2.3保单或保险责任的终止
本保单项下公司对被保险人的保险责任在以下情况下终止（以先发生者为准）：
n 保单有效期最后一天的午夜十二点；
n 保费支付期限的最后一天；
n 被保险人不再适用于本保单的日期；
n 被保险人永久性离开欧洲返回中国的日期（不包括最长四周的短期离境旅游）；
n 被保险人参加军事服务的日期；
n 保险人依据本保单支付的保险金已经达到约定的保险金额；
n 被保险人40周岁生日之后本保单下一年度的续期日；
n 被保险人取得本国或留学东道国社会保险，且该社会保险与本保单相关保险责任重合时，本保单的相应保险责任终止；
n 投保人因重大过失未履行如实告知义务，对保险事故的发生有严重影响的，保险人对于合同解除前发生的保险事故，不承担赔偿或者给付保险金的责任，但应当[温福东1] 退还保险费。
2.4保费缴纳
保费应该在保单清单中注明的保费到期日前缴纳。
如果保单持有人在收到保费缴交通知单后30天内没有缴纳或者拒绝缴纳首期保费，在约定缴费日之后发生的任何事故，公司不予承担赔付责任，并不负任何违约责任。
如果保单持有人拒绝支付续期保费，在约定缴费日之后发生的任何事情公司不予承担赔付责任。
如果保单持有人未能及时缴付续期保费，公司将在到期日后给保单持有人寄出书面缴费通知书，该通知书寄出后15日保费仍未缴付，发生任何事故，公司不予承担赔付责任。保单持有人有义务支付保费。
保险保障中断期间该保单项下发生的任何事故公司不给予保险保障。
2.5保单终止后的保费退还
如果保单持有人决定在合同未到期日之前终止保单，公司在扣除25%的手续费之后退回未到期保费，该手续费最低不低于25欧元。
保险人未到期之前终止保单，或者因保费变更或保单条款对被保险人产生不利影响而由投保人在保单未到期之前要求终止保单，未到期保费将全额退还。
由于投保人、被保险人故意不履行如实告知义务导致未到期保单终止的，保费将不予退还。
2.6风险改变
任何条件或情况的改变有可能造成危险程度增加的，投保人和被保险人应当立即通知保险公司。包括但不限于本国或东道国的变更。
如果此种变化并非被保险人健康状况改变，但这种变化会引起危险程度增加，公司有权在一个月内解除保险合同并取消保险保障或者增加保费及提高保险条件，此行为可以追溯到风险增加之时。
投保人在收到保险条件修改通知60日之内，有权通过取消保单来拒绝被修改的保费和保险条款。
2.7费率或保险条件变更
费率可以在每年1月1日进行调整。
公司有权对相似保险保障在同一级别基础上对费率和/或保险条件做出改变。
如果该保单属于此类产品，公司有权于每年1月1日对保单费率和/或保险条件做出相应调整。公司应该在调整生效日之前至少两个月书面通知保单持有人。除非保单持有人在收到变更通知一个月内取消保单，否则将会被认定为接受变更。在取消保单的情况下，本保险终止于当年的12月31日24时。
如果变更是指保费下降或保费不变情况下保险保障的扩展，保单持有人无权取消保单。
2.8战争情况下取消保单
如果战争的风险显而易见或者战争即将发生，公司和保单持有人可以因此而取消任何保险保障。
2.9索偿通知
投保人、被保险人或者受益人应当遵照“索赔程序”下的各项程序，当知道本保单保障的事故发生时应当通知公司。
2.10索偿举证
投保人、被保险人或者受益人应当提供证明索赔的所有合理和必要的文件，费用自理。如果公司认为必要，他们应当配合进行健康或者其他检查或查询。
2.11合理代管
保单持有人、被保险人或者受益人应当采取所有合理步骤来避免和最大限度减低费用、损失或损害，并且尽最大努力追回本保单保障丢失或被窃的财物。
2.12.义务和协定
保单持有人、被保险人应当遵守保单规定的义务和约定。如果保单持有人和被保险人未能遵守义务和约定，公司可以扣除由此而造成的相关损失。
2.13. 付款利息
保险公司不支付任何到期款项的利息。
2.14. 重复保险和代位追偿
如果本保单承保的责任、损失或损害同时受社会医疗保险或者其他任何保险保单保障，本保单仅承保受社会医疗保险和其他保单保障超出的部分。本保单赔付的金额和社会医疗保险和其他保单保障赔付金额的总和，不得超过本保单清单中注明的最高赔付额。
保单持有人、被保险人或受益人应当将其他保险保障告知公司，并且一旦公司有要求，应向公司提供包括保险利益和保险清单在内的保单副本。
2.15. 转让
除非取得公司书面同意，本保单不得转让。
2.16. 时效限制条款
有权利取得赔偿的人士向保险人索赔的诉讼时效为两年，自其在知道或应当知道保险事故发生之日计算。
2.17. 地址
公司应该向公司所知的投保人的最新地址或者向本保单保险经纪发出有效通知。
2.18. 个人资料登记
为本保单运用或修改提供的个人资料由公司处理，目的是为了完成或者履行保险合同和/或提供财务服务和处理由此产生的关系，包括避免和打击欺诈以及以发展公司客户群为目的的行为活动。这种个人资料的处理工作，受保险公司个人资料处理的法规管制。此法规规定个人信息处理各方的权利和义务，全套法规的文字文本可以从太平信息中心取得。
2.19. 司法管辖和诉讼
本保单是保单持有人和公司之间的保险合同。本保单按照中华人民共和国的法律解释、阐述，并且接受中华人民共和国法院专属的司法管辖。
纠纷处理
合同纠纷由合同各方按照以下方式之一解决：
1) 本合同履行过程中产生的任何纠纷应当由各方面协商解决，如果经协商无法解决，应递交双方协商指定的仲裁机构仲裁。
2) 本合同履行过程中产生的任何纠纷应当由各方面协商解决，如果经协商无法解决, 各方可以向中华人民共和国的人民法院提起法律诉讼。
2.20. 免责事则
承保人对以下任何一种情况不负有赔偿责任：
n 探险或者其他高风险行为（包括各种冬季运动、水下运动、滑水、漂流、蹦极跳、跳伞、滑翔，赛马、赛车。）;
n 被保险人自杀、自己造成的伤害、斗殴、犯罪、拘捕和被保险人被采取刑事强制措施期间；
n 无牌照驾驶，或者无有效证件驾驶车辆；
n 因为服用酒精，药物，麻醉品或镇静剂，安眠药物或其他麻醉性药剂，导致精神疾病或失去意识而造成意外或疾病的费用；
n 精神病或者智力缺失；
n 流产（除非由于意外造成），怀孕和妊娠终止；
n 任何不为当地政府认可的医疗治疗或健康保健费用；
n 任何美容整形手术的费用；
n 任何因取得器官移植或捐献移植器官产生的费用；
n 为治疗慢性或高度肾衰竭进行的定期或长期的肾透析；
n 化学污染，恐怖袭击或异端主义活动；
n 核爆炸，核放射或核污染；
n 职业体育活动或者设有奖项的体育竞技运动；
n 战争，军事行动，内战或者武装暴动；
n 直接或间接由石棉导致的伤害、死亡或者疾病；
n 罢工，或劫机造成的任何费用。
条款三 医疗费用保障
3.1. 赔付程序
联络方式：
医疗服务管理机构
比利时，安特卫普B-2140，69号邮箱
24小时/ 365天电话：+32-3-217 68 77
传真：+32-3 235 83 51
网址：（密码将和新用户欢迎文件一起交给用户）
非急症住院或门诊外科手术需要服务管理机构的提前证明。服务管理机构保证将费用送交医院。
被保险人必须先行向医疗服务提供者支付费用。在医疗服务提供之日起九十天内必须向服务管理机构提交书面索赔要求。
索赔表格可以通过联络24热线小时电话取得或者可以上网下载。必须填妥表格，并且连同原始文件、发票和收据一起递交给服务管理机构（复印件或扫描件将不予受理）
如果被保险人能够通过社会保险或其他商业保险索赔，被保险人应该首先向该机构提起索赔要求。然后被保险人应当把该机构的理赔确认书的原件以及提交的文件、发票和收据的复印件一起递交给服务管理机构。服务管理机构将扣除这些机构已经或者可能支付的赔款金额。
3.2. 医疗费用保险金
本保单应提供以下保险保障：
n 在保单或保单清单注明限制范围之内的医疗费用；
n 被保险人产生的真实的、合理的、惯例性的费用；
n 以下列明的各项医疗服务的费用；
a与被保险人受保险保障的伤害或疾病直接相关的医疗费用；
b由主治医师处方开立或证明为治疗必须的费用；
c普遍接受的，或者是科学上被认可的医疗服务，并且治疗日期在保险保障期限内。但任何实验性或创新性的治疗手段除外。
在每个365天的保障期限中，治疗费用最高偿付额为每人每年20万欧元。处方药物费用最高每人每年500欧元。牙医费用每人每年340欧元。
本保障受伤或疾病免赔额为50欧元。
以下情况视为受保险保障的医疗服务：
a. 住院和门诊手术
n 在标准单人病房的住院费用以及普通护理费用。
n 手术室费用；重症护理；医学造影；诊断和实验；处方药物；血液和血浆；手术器械；租用的医疗救助设备。
n 治疗师费用，包括麻醉师、外科医生、专家、放射科专家、物理治疗师和病理学家。
n 入院前和出院后治疗师的费用。
n 公司将支付从入院之日起最长365天的医疗费用。
n 保险公司按最低档次的治疗方案赔偿医疗费。
b. 门诊给付金
n 家庭医生费用。
n 医生和专家咨询费用。
n 无处方不能购买的处方药物。
n 医学造影，诊断和实验，手术器械。
n 医疗援助。
n 非实验性预防性的护理和检查。
n 补充药物。
n 针灸治疗最高给付金为每年500欧元，其前提是需要提供一份主治医师或专家的介绍证书。
n 脊椎按摩或精神疗法等指定的其他治疗法必须提交全科医生或者专家签发的转荐证明，每365天保险期最高赔付为750欧元。
c. 本地救护车
n 本地医疗急救运送费用
d. 私人医生费用给付
n 医院和护理院住院费
n 注册护士家庭护理费用，每个保险年度最长60天
n 临终关怀
e. 生育和新生儿不是本保险保障范围，但如果是意外造成的流产治疗受保险保障。
f. 精神和行为失常受益金：
n 上述a和b 项下的费用是由精神和行为失常造成的
g. 紧急牙科治疗
n a 和b项下由意外造成的健康天然牙的损伤相关的紧急牙科治疗费用。
n 12 个月保险期内最高保障为340欧元。
h. 紧急视力治疗
n a 和b 项下由意外造成的一只眼睛的损伤相关的紧急视力治疗费用。
i. 性病
n a 和b 项下由意外造成的相关医疗费用，每364天最高为100欧元。
3.3. 医疗服务提供者转荐
服务管理机构将依据要求转院被保险人到合适的医院。以上信息可以通过联络24小时热线电话或者上网查询获得。
服务管理机构将尽职选择医疗服务提供者，本保险公司或服务管理机构不直接提供医疗服务，对医疗服务提供者的服务不负责任。
3.4. 回国治疗
如果被保险人在国外所患的相同疾病或所受的伤害，返回中华人民共和国后仍然需要进行继续治疗，直至被保险人能够对其医疗费用另行保险，其间正常医疗费用受保险保障，最长时间为从回国之日起10天。
3.5. 除外条款
除本保单条款2中医疗费用普通除外责任外，还包括以下除外责任：
n 被保险的服务在医疗费用保险金部分未明确列明；
n 医疗费用、服务或治疗在受损失之后超过365天发生；
n 维他命和矿物质（除非是由主治医师处方开立或者经证明为治疗明显的维他命或矿物质缺乏症状的药物），营养和节食补充品，婴儿食品；
n 整容手术；
n 再造手术；
n 为缓解由于衰老，青春期或者其他自然心理原因造成的症状；
n 针对睡眠失调的门诊治疗；
n 被保险人旅行前就知道的，已由医师安排好的医疗方案或其他治疗方法。
n 出于医疗治疗为目的的旅行；
n 既往病，先天畸形，不正常变异或者染色体异变；
n 心脏起搏器的购买和修理，义肢和辅助视力；
n 减肥治疗或者体重问题；
n 世界卫生组织《国际疾病分类》中列明的F10 至F19, F45, F52, F55, F59 或F99项所指的精神和行为失常；
n 被保险人没有听从医师治疗建议而引起的费用
n 实验性或者创新性技术
n 如演说治疗法，工作治疗法，职业病治疗，产前和产后检查，运动按摩；
n 矫形治疗法，排毒治疗法，隐形疗法，电脱发治疗，浴疗造影疗法或者其他预防性或替代性治疗；
n 无需医生处方可以获得的产品；
n 租借或者购买设备器械产生的成本费用；
n 任何性问题，包括（无论任何原因造成的）阳痿，变性或性别再造；
n HIV和艾滋病；
n 治疗中心，洗浴中心，温泉，健康疗养和康复中心，即便这种治疗是在治疗师处方开立的；
n 生殖，IVF诱导怀孕的综合症或者疾病，阳痿或不举，避孕，节育，选择性剖宫产，或者并非医疗必需的终止妊娠；
n 牙科或者视力治疗，以上所提到的紧急牙科受益金和紧急视力受益金除外；
n 电池，电力，维护费用，设备或者医疗援助替换品（包括助听和助视力设备）；
n 转送，运输或旅行费用（除援助受益金包括的本地急救运送费用）。
条款四 意外伤害保险保障
4.1定义
4.1.1累积赔偿限额是指针对同一意外事故或其产生的一系列事故引起的意外险保单所列的总计赔偿最高限额。
4.1.2暂缓期间是指临时性暂时性失能情况下初期不应赔偿保险金的期间。
4.1.3听力丧失是指听力功能永久性、全部丧失。
4.1.4肢体丧失是指大腿及其以下肢体、身体各关节、手、臂、趾出现永久性断开或功能的永久性、完全丧失；
4.1.5视力丧失是指双眼或单眼视力的永久性、全部丧失；或经矫正并在Snellen标准测定后视力达到或低于3/60。
4.1.6语言功能丧失是指说话功能的全部永久性丧失。
4.1.7截瘫是指完全永久性丧失其下肢、直肠和膀胱的功能。
4.1.8永久性残疾是指保单所列指的身体任何肢体、器官功能部分或全部的永久性残疾。
4.1.9四肢麻痹是指两上肢的上臂和两大腿以下的全部永久性麻痹。
4.1.10暂时性残疾是指导致被保险人正常工作和正常收入中断的意外身体伤害。
4.2保险责任
4.2.1意外身故保险责任
在保险期限内，被保险人因遭受意外伤害事故，且自事故发生之日起2年内因同一原因不幸身故，或被保险人因意外事故失踪，且在其事故后180天后，并可合理合法地确信被保险人已经造意外身故，本保险人按本保险单中约定的意外伤害保险金额给付“意外身故保险金”，同时本合同对被保险人的保险责任终止。
但若本公司在给付“意外身故保险金”前，已向被保险人给付本合同项下的“意外伤残保险金”，则本公司将从“意外身故保险金”中扣除已给付的“意外伤残保险金”。
被保险人失踪后重新生还，应将原赔款返还给本保险人。
本保险责任项下最高限额为10000欧元。对于驾驶或乘坐排气量达到或超过50cc以上的摩托车而遭受的意外伤害身故，其限额为5000欧元。
4.2.2意外残疾保险责任
被保险人在保险期间内遭受意外伤害事故，本保险人按该伤残程度所对应的比例乘以本合同保险单中约定的保险金额给付“意外伤残保险金”。
伤残等级一旦经合理合法地确定后，将不予提高或降低，伤残等级的确定应不超过保险事故发生后两年。
当被保险人被确定伤残等级后非因被保险事故而身故，本保险人应按身故前确定的伤残等级标准和本合同约定的保险金给付标准予以赔偿。
伤残等级的确定及其给付标准，详见下表：
表一：伤残给付比例表
等级 | 项目 | 伤 残 程 度 | 给付 比例 |
第一级 | 一 二 三 四 五 六 七 八
| 双目永久完全失明的（注1） 两上肢腕关节以上或两下肢踝关节以上缺失的 一上肢腕关节以上及一下肢踝关节以上缺失的 一目永久完全失明及一上肢腕关节以上缺失的 一目永久完全失明及一下肢踝关节以上缺失的 四肢关节机能永久完全丧失的（注2） 咀嚼、吞咽机能永久完全丧失的（注3） 中枢神经系统机能或胸、腹部脏器机能极度障碍，终身不能从事任何工作，为维持生命必要的日常生活活动，全需他人扶助的（注4） | 100% |
第二级 | 九
十 | 两上肢、或两下肢、或一上肢及一下肢，各有三大关节中的两个关节以上机能永久完全丧失的（注5） 十手指缺失的（注6） | 75% |
第三级 | 十一 十二 十三 十四 十五 | 一上肢腕关节以上缺失或一上肢的三大关节全部机能永久完全丧失的 一下肢踝关节以上缺失或一下肢的三大关节全部机能永久完全丧失的 双耳听觉机能永久完全丧失的（注7） 十手指机能永久完全丧失的（注8） 十足趾缺失的（注9） | 50% |
第四级 | 十六 十七 十八 十九 二十 二一 二二 | 一目永久完全失明的 一上肢三大关节中，有二关节之机能永久完全丧失的 一下肢三大关节中，有二关节之机能永久完全丧失的 一手含拇指及食指，有四手指以上缺失的 一下肢永久缩短5公分以上的 语言机能永久完全丧失的（注10） 十足趾机能永久完全丧失的 | 30% |
第五级 | 二三 二四 二五 二六 二七 二八 二九 | 一上肢三大关节中，有一关节之机能永久完全丧失的 一下肢三大关节中，有一关节之机能永久完全丧失的 两手拇指缺失的 一足五趾缺失的 两眼眼睑显著缺失的（注11） 一耳听觉机能永久全丧失的 鼻部缺损且嗅觉机能遗存显著障碍的（注12） | 20% |
第六级 | 三十 三一 三二 | 一手拇指及食指缺失，或含拇指或食指有三个或三个以上手指缺失的 一手含拇指或食指有三个或三个以上手指机能永久完全丧失的 一足五趾机能永久完全丧失的 | 15% |
第七级 | 三三 三四 | 一手拇指或食指缺失，或中指、无名指和小指中有二个或二个以上手指缺失的 一手拇指及食指机能永久完全丧失的 | 10% |
注：（1）失明包括眼球缺失或摘除、或不能辨别明暗、或仅能辨别眼前手动者，最佳矫正视力低于国际标准视力表0.02，或视野半径小于5度，并由有资格的眼科医师出具医疗诊断证明。
（2）关节机能的丧失系指关节永久完全僵硬、或麻痹、或关节不能随意识活动。
（3）咀嚼、吞咽机能的丧失系指由于牙齿以外的原因引起器质障碍或机能障碍，以致不能作咀嚼、吞咽运动，除流质食物外不能摄取或吞咽的状态。
（4）为维持生命必要之日常生活活动，全需他人扶助系指食物摄取、大小便始末、穿脱衣服、起居、步行、入浴等，皆不能自已为之，需要他人帮助。
（5）上肢三大关节系指肩关节、肘关节和腕关节；下肢三大关节系指髋关节、膝关节和踝关节。
（6）手指缺失系指近位指节间关节（拇指则为指阶间关节）以上完全切断。
（7）听觉机能的丧失系指语言频率平均听力损失大于90分贝，语言频率为500、1000、2000赫兹。
（8）手指机能的丧失系指远位指节间关节切断，或自近位指节间关节僵硬或关节不能随意识活动。
（9）足趾缺失系指自趾关节以上完全切断。
（10）语言机能的丧失系指构成语言的口唇音、齿舌音、口盖音和喉头音的四种语言机能中，有三种以上不能构声、或声带全部切除，或因大脑语言中枢受伤害而患失语症，并须有资格的五官科（耳、鼻、喉）医师出具医疗诊断证明，但不包括任何心理障碍引致的失语。
（11）两眼眼睑显著缺损系指闭眼时眼睑不能完全覆盖角膜。
（12）鼻部缺损且嗅觉机能遗存显著障碍系指鼻软骨全部或二分之一缺损及两侧鼻孔闭塞，鼻呼吸困难，不能矫治或两侧嗅觉丧失。
永久完全系指自事故发生之日起经过一百八十天后，身体机能仍然完全丧失，但眼球摘除等明显无法复原之情况，不在此限。
表二：III度烧烫伤与给付比例表
身体部位 | 等级 | 伤 残 程 度 （III度烧烫伤面积占全身皮肤面积百分比） | 给付比例 |
头部 | 第一级 | 2%（含）但少于5% | 50% |
第二级 | 5%（含）但少于8% | 75% | |
第三级 | 8%或8%以上 | 100% | |
躯干及四肢(不含头部) | 第一级 | 10%（含）但少于15% | 50% |
第二级 | 15%（含）但少于20% | 75% | |
第三级 | 20%或20%以上 | 100% |
本保险责任项下最高限额为75000欧元。
4.2.3个人随身物品
如果被保险人遭受意外事故而紧急住院，本保险人将赔偿因意外事故导致被保险人的随身物品遭受盗窃或损毁的损失，其最高赔偿限额为1000欧元。
4.2.4安全带条款
被保险人因道路交通事故导致死亡，并经确认事故发生时未系好安全带，则其保险金应扣除2500欧元。
4.2.5施救者条款
意外事故发生时，第三方因在积极施救过程中，导致该第三方在事故发生后2年内身故或伤残，本保险人将支付该第三方最高5000欧元保险金，且该保险金在赔偿给被保险人的相关保险金以外另计。
4.2.6整形手术条款
被保险人由于被保险事故导致的在事故发生后2年内的经整形外科医生要求的科学合理的畸形矫正、整容，其相关门诊医药治疗、敷料和其它必要诊治护理成本，本保险人将给以每次保险事故5000欧元的最高限额予以补偿。如果上述费用部分或全部在本保险的其它保障中或其它方获得补偿，本条款将不予生效。
4.3理赔流程
4.3.1投保人或被保险人通知义务
A)被保险人身故的情况下：
1.受益人、保单持有人（投保人）等应尽可能在事故发生后48小时通知保险人，并提供事故细节内容；
2.应提供保险人指定的医生或授权人启动和履行调查事故的机会；
3.如果必要情况下，应允许实施尸体解剖。
B)被保险人伤残的情况下：
1.应尽可能并最长在90天内通知保险人；
2.尽可能寻求治疗以达成治愈效果；
3.由于本保险人要求前往接受指定的医生或机构接受检查，其费用由本保险人承担。
投保人未按上述4.1.1或4.1.2条款要求履行义务，则本保险人在赔偿时将扣除因此造成的损失，并在发现有欺诈行为时有权利取消相关赔偿责任。
4.3.2履行义务条款
投保人或被保险人应遵守本保险约定的相关义务，否则，本保险人赔偿时将扣除因未履约造成的损失。
4.3.3损失范围
投保人或被保险人在合理的范围内意识到事故的发生或即将发生，并采取必要措施阻止事故发生或减少损失，包括财物被盗抢，则本保险人将赔偿因采取上述措施而导致的相关额外费用。
4.4特别除外责任
除本条款二中所列的一般除外责任外，下列除外同样适用：
n 由于故意行为或实施犯罪；
n 服役期间；
n 被保险人已处于疾病状态下，或被保险人曾经受意外，处于瘫痪、呆滞症、失明、耳聋、精神错乱、癫痫症、糖尿病、痛风等或其它残疾状态；
n 开展危险活动；
n 使用或乘坐任何飞行器，除非作为客运飞机的乘客；
n 使用或乘坐有特别危险的在海洋中行驶的船舶；任何竞技体育运动、骑车兜风运动、橄榄球运动、降落伞运动、滑翔运动、马术马场竞技；
n 参加任何机动车辆的速度、指标等测试活动；任何冬季运动，包括冰球运动；还有带有呼吸器的水下活动。
条款五 个人责任保险保障
5.1保险责任
5.1.1由于被保险人过失行为造成其他人的意外身故或财产损失（包括财产使用价值的降低），须由被保险人承担的民事赔偿费用，由本保险人在赔偿限额范围内赔偿。
5.1.2由于被保险人下列过失行为造成其他人意外伤害或患疾病，在保险事故发生后1年内应支付的合理的、常规费用，其中包括必要的医疗费、手术和牙科费用、prosthetic装置、救护车费用、住院和专业护理费、丧葬费。
1）被保险人自身活动引起的；
2）被保险人拥有或照看的动物引起的。
5.2抗辩处理及其附属费用
本保险人将根据保单约定的限额承担被保险人个人责任诉讼情况下相关法律抗辩及其附属费用。
5.3赔偿限额
本保险全年累积赔偿限额为1,250,000欧元。
5.4理赔事宜
相关保险责任事故发生后，被保险人或其代表人应尽快通知保单指定的服务管理机构。
5.5特别除外条款
除本条款二中所列的一般除外责任外，下列除外同样适用：
n 被保险人的任何商业活动行为导致的第三方的损失，除非与被保险人实际控制、租用、或拥有的个人房屋有关的个人行为。
n 任何交通工具在拥有过程中、修理、操作、使用、装卸活动，其中包括：
a) 离开被保险人个人房屋的汽车；
b) 被保险人拥有或租用的总长达到或超过8米，或外船舷功率超过18千瓦，或内船舷功率超过36千瓦的船只，且该船只离开被保险人所述房屋；
c) 任何飞行器；
■ 被保险人故意行为；
■ 任何经被保险人确认的合同行为造成的责任，除与被保险人房屋相关的特指书面合同；
■ 被保险人正用于身体锻炼的实际控制、照看或租用的他人财产；
■ 对于第三者的身体伤害、疾病或死亡情况：
a) 任何由于雇佣关系造成的责任，且若其损伤可通过劳工赔偿法律部分或全部获偿；
b) 任何在本保单项下的被保险人；
c) 常住被雇佣者；
■ 下列原因造成的人身伤害和财产损失：
a) 战争；
b) 被保险人所患传染性疾病；
c) 性骚扰、肉体惩罚、身体或精神虐待；
d) 酒精滥用、药物过失、镇静剂使用、非法毒品或制剂；
■被保险人自身财产损失。
条款六 行李和家居用品保险保障
6.1定义
6.1.1行李：
a.被保险人在到达目的地后或保险期间内收到的，已属于被保险人本人的物品；
b.被保险人在保险期间内新获得的行李物品，最高限额为250欧元。
6.1.2旅行所携文件、证明
包括护照、门票、驾驶证、登记材料、证明信件、绿卡、签证、信用卡、身份证件等。
6.1.3家居物品
保险期间内，被保险人在国外居所中存在的有被保险人正式声明或确属于被保险人的所有物品或动产。
6.2保险责任
该保险责任每次事故免赔额为50欧元。
6.2.1旅行文件、证明
最高补偿限额为150欧元。
6.2.2行李和家居用品
行李最高赔偿限额为1500欧元；家居用品最高赔偿限额为5000欧元。同时，遵守以下特别保障：
■冲浪板及自行车（包括附件）：250.00欧元；
■汽车、自行车和摩托车所用工具：150.00欧元；
■假牙：250.00欧元；
■新购置衣物及洗浴用品：75.00欧元；
■影音及电脑设备：500.00欧元；
■珠宝：150.00欧元；
■手表：150.00欧元；
■眼镜、太阳镜和隐形眼镜：150.00欧元；
■电子通讯设备（移动电话）：150.00欧元；
■其它家居用品：因无痕迹的盗抢所致损失免赔额：125.00欧元/次。
6.3特别除外条款
除本条款二中所列的一般除外责任外，下列除外同样适用：
■船、飞行器、摩托车、露营车以及其他车辆：
船（不包括冲浪板），飞机（包括滑翔机），机车（包括机动自行车），露营车及其他交通工具（不包括自行车）及其他零部件附属配件。
■磨损、自身失误以及天气因素：
由于损耗、自身失误、自然及天气因素造成的损失，但不包括交通事故及害虫造成的损失。抓痕、凹裂及小斑点
■影音刻录设备
损坏只包括刻录设备、录像机及声音设备的损坏。除此之外的没有权利获得补偿。
■正常护理和养护
被保险人未尽到预防损失、偷盗及行李家居物品的损坏进行正常的护理及小心养护责任。
正常护理及小心养护是指使录像机、电脑、照片、电影、有声及通讯设备、珠宝、手表及其他价值高的物品应锁在合适的地方，而不是无人管理的状态。对于其他物品，如果它们在车里，仅可在如下情况下获得补偿：
a、物品用安全带锁住，外面看不见
b、物品在车里的时候，在没有合适的安全带锁住的情况下被较好的放置以免遭窃。
根据上述a和b所提及的，被保险人会被要求提供物品被合理安全放置的证明。
■ 下列行李和家居用品：
a. 现金、有任何价值的纸张材料、手稿、画、图；
b. 收藏品（例如：集邮册、币册）；
c. 工具（除本条款特别说明的工具）
d. 贸易品或样品；
e. 动物。
■ 被保险人或相关利益方未尽如实告知、配合调查等义务。
6.4理赔事宜
本保险赔偿基于补偿的基本原则，索赔物品须按如下表述折旧后赔偿：
已使用或拥有1至2年的物品：折旧率10%
已使用或拥有2至3年的物品：折旧率20%
已使用或拥有3至4年的物品：折旧率30%
已使用或拥有4以上的物品：每年折旧率10%
条款七 援助和额外费用
7.1本保险由AIG Travel Assist的高效医疗救援、护理团队提供专业、高效合理的救助和治疗服务。
被保险人需要救助服务时，应向服务管理机构及时提供如下准确信息：
a) 被保险人姓名、联系电话、所在地址；
b) 保单持有人（投保人）姓名、保单号；
c) 事故经过和现状。
7.2 AIG Travel Assist将通过电话用英语提供医疗建议、安排。
7.3 AIG Travel Assist将帮助并指引被保险人获得两种单独的医疗处理建议。
7.4紧急救助服务
被保险人将获得如下紧急救助服务：
（1） 紧急医疗转运
（2） 重要应急药物递送
（3） 意外身故情况的紧急处理（遗体及私人物品遣送回国）
（4） 翻译服务
（5） 法律建议
7.5额外费用责任
7.5.1由于疾病或意外发生的慰问探访费用
由于疾病或意外发生的慰问探访费用最高赔偿限额为7000欧元。
7.5.2旅行意外身故后的遣返费用
旅行过程中由于疾病或意外导致身故，提供最高赔偿限额为7000欧元的遗体遣返费用。
7.5.3长途通讯费用
因急需紧急救助，致电AIG Travel Assist所产生的每次事故最高限额150欧元。
7.5.4中国境外的旅行援助服务（如旅行票证补办服务的，费用由被保险人承担等）。
7.6特别除外条款
除本条款二中所列的一般除外责任外，下列除外同样适用：
■ 所有慰问、转运、救助费用须以民用航空的经济舱为标准，除非得到AIG Travel Assist的专业许可。
■ 未得到AIG Travel Assist事先许可、组织的服务；
■ 旅行的目的就是为得到医疗救治和建议，除非得到AIG Travel Assist的批准；
■ 被保险人不遵照医生的指引擅自旅行；
■ 属本保险其它医疗保障条款约定的责任，或正处于等待期中。
条款八 法律援助
8.1定义
8.1.1费用
法律援助费用必须是由外部法务机构提供的必要的法律援助费用，且应为不可从第三方再次获得的援助。
8.1.2生效地区范围
a.欧洲及环地中海国家（除利比亚、阿尔巴尼亚、格陵兰岛、黎巴嫩、叙利亚）；
b.美国、加拿大、澳大利亚、新西兰、印度尼西亚、南非和泰国；其它地区的相关费用须经保险人同意并在被保险人回到原居住国（地）前发生的。其当地律师费用最高限额为5000欧元。
8.2保险责任
被保险人所获的法律援助费用包括：
a) 被保险人个人的利益或权利处于直接的法律传唤状态下；
b) 每次报告的关于法律援助费用不超过5000欧元；
c) 被报告事件的利害关键点：第三方致被保险人人身伤害应负的法定责任；基于原居住地法律被保险人以个人名义被诉情况下的法律辩护事宜，以及被保险人过失违反当地法律或致第三方损害情况下提供法律援助。
8.2.1预付费用
为获得足够的担保，本保险人将提供最高7000欧元的预付担保费用。
8.3理赔事宜
■被保险人希望获得法律援助时，须提前通知服务管理机构，并尽可能听从该机构指引，参考外部法律机构的意见；
■如果申请案件被受理，保险人将及时转移处置权给受理的法律援助机构；
■如果案件处理有必要聘请律师，则本保险人将指定相关律师或法务专家；
■未经本保险人事先建议或同意而发生的费用由被保险人本人承担；
■自保险人通知被保险人其案件进一步处理已没有胜诉的可能时，本保险将不再承担被保险人就此案件发生的费用。
8.4法律援助申请后的争议处理
当本保险人和被保险人就法律援助事宜存在不同意见并引发争议时，被保险人在得到保险人的相关建议后，有一次自聘律师的权利；但此行为应尽快实施，并在保险人通知被保险人相关案件处理问题后1个月内实施。如果该律师同意本保险人的观点，被保险人则仅能自行承担继续法律程序的费用。
8.5特别除外
除本条款二中所列的一般除外责任外，下列除外同样适用：
■ 在本保险生效前，被保险人本可以预计到的法律援助需要；
■ 法律援助费用低于250欧元；
■ 被保险人故意、过失或疏忽的行为。
太平ISSI出境留学人员意外伤害综合保险费率规章 | |||||
货币单位：欧元 | |||||
保险项目（category） | 保障内容（coverage） | ||||
医疗费用保障 | 总赔偿限额 （欧元/人/年） | 特约限额（欧元/人/年） | 免赔额 （欧元） | ||
医疗费用：200，000.00 | 处方药：500.00 | 受伤和疾病免赔额为50/保单/年 | |||
牙医费：340.00 | |||||
针灸治疗费：500.00 | |||||
脊椎按摩或精神疗法等指定的其他治疗法（最多12种）：750.00 | |||||
意外事故保障 | 死亡 | 10000.00 | 摩托车（排气量≥50cc）意外身故： 5，000.00 | 被保险人在意外交通发生时未系安全带而身故赔偿限额减少2，500 | |
永久伤残 | 75000.00 | 第三方因救助被保险人受伤导致身故或永久伤残：5，000.00 | |||
急救时个人物品遗失、被盗或损坏 | 1000.00 | ﹊ | |||
个人责任保障 | 1250000.00 | ﹊ | -- | ||
行李及家具物品保障 （含折旧） | 行李 | 1500.00 | 保险期间内重新置办的行李最高额不超过250欧元。 | 50.00/每次 | |
家具物品 | 5000.00 | 1.冲浪板及自行车（包括附件）：250.00；2.汽车、自行车和摩托车所用工具：150.00；3.假牙：250.00；4.新购置衣物及洗浴用品：75.00；5.影音及电脑设备：500.00；6.珠宝：150.00；7.手表：150.00；8.眼镜、太阳镜和隐形眼镜：150.00；9.电子通讯设备（移动电话）：150.00 | 因无痕迹的盗抢所致损失免陪额：125.00/次，其他家具物品免赔50.00/每次 | ||
旅行文件 | 150.00 | ﹊ | 50.00/每次 | ||
援助和额外 费用保障 | 额外费用 | 通讯费限额： 150/次意外 | -- | ﹊ | |
亲属探访额外费用： 7，000.00 | |||||
紧急援助 | 获相关 服务 | 指定项目 | -- | ||
法律援助保障 | 国外当地律师咨询或仲裁费 | 5000.00 | ﹊ | 250.00 | |
替被保险人支付的担保费或预付款 | 7000.00 | 250.00 | |||
上述保险方案保险费为470欧元，锁定为RMB4700.00元/份，限购份数为一份，保费上下浮动范围为30%。
Taiping ISSI (International Study Student Insurance)
Policy wording 2009/01
Article 1 - Definitions
Article 2 - General Conditions
Article 3 - Medical Expense
Article 4 - Accident
Article 5 - Personal Liability
Article 6 - Baggage and Household
Article 7 - Assistance and Exceptional Costs
Article 8 - Legal Aid
Article 1 - Definitions
The following definitions apply to the Policy, and have the same meaning wherever they are used in the policy, policy schedule or endorsements.
1.1 Accident means a sudden, violent external event which results directly and immediately in Injury to the Insured Person, and which may or may not result in death, provided that the nature and location of the Injury or the cause of death can be medically established.
Accident shall also be taken to mean:
a. Health disorders that are directly and solely due to an insured Accident;
b. Injury resulting from lawful self-defense, or rescue or attempted rescue of endangered persons or goods;
c. Acute and unintentional ingestion of solid, liquid and/or gaseous substances that are injurious to a person’s health.
d. Dislocations, sprains , muscle strains or ruptures caused by a sudden exertion;
e. Disorders due as a result of extreme weather conditions;
f. Drowning;
g. Rabies or tetanus as the result of an insured Accident;
h. Death of the Insured Person as a result of a traffic Accident, due to cardiac arrest, myocardial infarct or cardiac artery rupture of the Insured Person.
1.2 AIG Travel Assist means the organization that provides the emergency assistance services described in this policy on behalf of the Company.
1.3 Automobile means a land motor vehicle, trailer or semi-trailer. The term does not refer to crawler or farm-type tractors or farm equipment nor to any other equipment which is designed for use primarily away from public streets or highways and which is not subject to motor vehicle registration.
1.4 Beneficiary means the person who is designated as such in the policy; in the absence thereof:
§ In the event of death: the spouse of the Insured Person; in the absence of a spouse, the legal heirs with the exclusion of the state;
§ In case of an under age Insured Person: the insured parent(s);
§ In all other cases: the Insured Person.
1.5 Benefit Period means the period between the Effective Date of the cover and the termination of the benefit for the concerned Insured Person.
1.6 Company means Tai Ping Insurance Co. Ltd in China.
1.7 Complementary Medicine means consultation services and medication provided by a physiotherapist, chiropractor, acupuncturist, bonesetter, osteopath, homoeopath or Chinese medicine practitioner, who is fully trained, who is licensed by the competent medical authorities of the country in which treatment is provided, and who is practicing within the scope of his or her licensing and graduation.
1.8 Complications of Pregnancy are conditions whose diagnoses are distinct from pregnancy but are adversely affected or caused by pregnancy, such as: acute nephritis, nephrosis, cardiac decompensation, missed abortion, and similar medical and surgical conditions of comparable severity. They include ectopic pregnancy which is ended, spontaneous ending of pregnancy at a time when a viable birth is not possible, puerperal infection, eclampsia, and toxemia. They do not include complications or Illness from IVF induced pregnancy, caesarean section, false labor, occasional spotting, Physician prescribed rest during pregnancy, morning sickness, and similar conditions associated with the management of a difficult pregnancy but which are not medically distinct conditions.
1.9 Congenital Condition means a physical or mental abnormality existing at time of birth or manifesting itself within six months of birth.
1.10 Cosmetic Surgery means any treatment performed to reshape normal structures of the body in order to improve the physical appearance.
1.11 Date of Service means the date on which a medical service is rendered.
1.12 Effective Date means the date on which the period of cover commences for the Insured Person under this policy.
1.13 Emergency means a sudden change in a person’s health that requires urgent medical or surgical intervention to avoid permanent damage to life or health.
1.14 Home Country means the country of which the Insured Person holds a passport and to which the Insured Person would want to be repatriated.
1.15 Hospital means an establishment duly constituted and registered as a facility for the care and treatment of sick or injured persons as bed patients and which:
a. has organized diagnostic and surgical facilities,
b. provides 24 hour a day nursing services by Registered Nurses,
c. is supervised by a staff of Physicians, and
d. is not a nursing home, rest home, convalescence home, place for custodial care, home for the aged, institution for Mental or Behavioral Disorders, sanatorium, or a place for the treatment of alcoholics or drug addicts; even if located at the same place.
1.16 Host Country means the country in which the Insured Person is staying for study.
1.17 Illness means a physical condition marked by a pathological deviation from the normal healthy state, and which is not an Injury.
1.18 Injury means physical damage arising wholly and exclusively from a covered Accident.
1.19 Insured Person means every person designated as such in the policy schedule, who has applied for cover by this policy and for whom coverage has been confirmed in writing by the Company or the Medical Plan Administrator.
1.20 Insured period means the effective period of the policy shall be in accordance with the period as specified in the policy, that the insured shall leave his permanent home or actual address to go abroad, and shall end on the end date named on the policy sheet or as much earlier as the insured shall return to his actual address.
The cover shall commence from the zero hour of the effective date that is specified in the policy after the policy holder pays the premium as agreed. The insurer shall bear corresponding insurance liabilities after the policy takes effect.
1.21 Legal Expenses means
§ The fees, expenses and other costs that can reasonably be charged by the Representative in connection with a cause for action, including the reasonable expenses of experts and of the Company incurred in this connection.
§ The legal costs incurred by or on behalf of the Insured Person and the extra-judicial costs after settlement out of court.
§ The fees, expenses and other costs that can reasonably be charged by the Representative for appeal proceedings, provided that prior written permission from the Company has been obtained for such proceedings and provided that they are connected with the cause of action referred under the first bullet point of this definition.
1.22 Medical Consultant means a Physician advising the Company, AIG Travel Assist or the Medical Plan Administrator.
1.23 Medical Emergency means the unexpected onset of an Injury or Sickness which manifests itself by acute symptom of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in: (1) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; (2) serious impairment to bodily functions; or (3) serious dysfunction of any bodily organ or part. A Medical Emergency does not include elective or routine care.
1.24 Medically Necessary means for therapeutic services that the Insured Person has a covered Illness or Injury and that the services are requested by the attending Physician to prevent permanent damage to life or health.
For diagnostic services, Medically Necessary means that the Insured Person has active symptoms of unknown cause and suggestive of a covered Illness or Injury, and that the services are requested by the attending Physician to determine whether therapeutic services are required.
1.25 Medical Plan Administrator means the organization that provides the medical administration services described in this policy on behalf of the Company.
1.26 Medicines and Drugs are those for which a Physician’s prescription is required for purchase, which have been prescribed by a Physician for treatment of a covered Illness or Injury, and which have been dispensed by a Physician’s office or by a licensed pharmacist.
1.27 Mental and Behavioral Disorder means a psychiatric, psychological, affective, mental or behavioral disorder, irrespective of whether a physiologic cause is known or suspected. It includes any condition listed as Mental and Behavioral Disorder in the International Classification of Diseases of the World Health Organization.
1.28 Palliative Care means the services prescribed by the attending Physician, of an institution duly constituted and registered to provide a centralized program of palliative and supportive services to dying persons in the form of physical, psychological, social and spiritual care.
1.29 Parental Accommodation means costs for an added bed in the same room for a parent or legal guardian.
1.30 Physician means a medical practitioner graduated from a recognized medical school listed in the Directory of Medical Schools of the World Health Organization, who is licensed by the competent medical authorities of the country in which treatment is provided, and who is practicing within the scope of his licensing and graduation.
1.31 Plan Administrator means the organization that provides the claim administration services described in this policy on behalf of the Company.
1.32 Policyholder means the person who has taken out this insurance with the Company and who is named as such in the policy schedule.
1.33 Pre-existing Conditions Limitation means a Sickness or related condition which was contracted or which manifested itself, or for which a licensed Physician was consulted; or for which treatment or medication was prescribed prior to the Effective date of the Insured person’s coverage under this Policy.
1.34 Post-hospitalization Services means medical services immediately following a covered stay in a Hospital, and that are provided by or ordered by the attending Physician as a direct consequence of the covered Illness or Injury that necessitated such hospitalization.
1.35 Pre-hospitalization Services means medical services incurred within 30 days prior to and directly related to a covered stay in a Hospital which are provided by or ordered by a Physician.
1.36 Reasonable and Customary Expenses mean insured medical expenses that do not exceed the general level of fees for comparable services by similar healthcare providers in the same region for a similar Illness or Injury, irrespective of availability of insurance. In case of an unusual nature of service or supply, the Medical Plan Administrator will determine to what extent the charge is reasonable and customary, taking into account the complexity involved, the degree of professional skills required and other pertinent factors.
1.37 Reconstructive Surgery means any treatment performed on abnormal structures of the body, whether caused by Congenital Conditions, developmental abnormalities, Injury or Illness, in order to improve function or approximate a normal appearance.
1.38 Registered Nurse is a graduate trained nurse who has passed a state registration examination and has been licensed to practice nursing.
1.39 Representative means a licensed attorney or similar professional who has been authorized to act on behalf of the Insured Person in accordance with the conditions of this insurance policy.
1.40 Sound natural tooth means a tooth with no decay, no filling on more than two surfaces, no gum disease associated with bone loss, no root canal therapy, that is not a dental implant and functions normally in chewing and speech.
1.41 Standard Private Room is the lowest rated room with a single bed in that Hospital.
1.42 Student is the Insured person with a Chinese passport that is granted by the Chinese Government and has is residence for a maximum of three years in one of the countries in Europe for study and is registered as a student or scholar at a university or other scholar institutions that are located in the hosted country.
1.43 Venereal Disease means an Illness which has been transmitted by sexual contact, or any of the following Illnesses whether sexually transmitted or not: syphilis, gonorrhea, venereal warts including genital HPV (human papillomavirus), genital herpes, granuloma inguinale, chancroid, trichomona, pubic lice (phthirus pubis) infestation, and Chlamydia.
1.44 War means any activity arising out of military force or an attempt to participate in military force by a nation, and will include civil war, revolution and invasion.
Article 2 - General Conditions
2.1 Eligibility
The policy is open to a student with residence in People’s Republic of China and studying in one of the European countries. Therefore the student requires a passport from the Chinese Government and a visa from the in coming European host country.
The student also needs to be registered at a acknowledge university or other scholar institutions in the host country they have received visa from. The age limit for enrolment of an Insured Person is 40 years.
The Effective Date of the cover of this individual insurance will become effective on the later of:
A) The Policy effective date;
B) The date indicated on the Enrollment Form (if applicable) for which premium has been paid;
C) The date the Insured Person departs his or her Home Country to travel to Europe, provided that the scheduled arrival in Europe is no more than 48 hours later than departure from the Home Country; or
D) The date the Enrollment Form (if applicable) and premium are received by the program Administrator
The medical formalities are:
A medical questionnaire has to be completed by each Insured Person and has to be submitted to the Company. The Company can at his discretion define partial or total exclusion of cover or propose an additional premium to waive exclusions.
2.2 Area of Cover
The policy covers the Insured Person within Europe and People’s Republic of China.
2.3 Termination of policy and or Benefits
The benefits for the Insured Person under this Policy terminate on the earliest of the following moments:
§ At midnight on the last day of the Policy Period;
§ The last date for which premium has been paid;
§ The date the Insured Person ceases to be eligible for the Insurance;
§ The date the Insured Person departs Europe for China permanently (not for a temporary visit for a period of at most four weeks);
§ The date the Insured Person enters military service;
§ The moment the concerned benefit of this policy have been exhausted;
§ On the next annual policy renewal date following the 40th birthday of the Insured Person;
§ The moment the Insured become or could have become covered by the National Health Service of their Home Country or by the National Health Service of the host Country;
§ Termination by written notice of the insurer within two months if the insurer has discovered that the policyholder did not comply with his duty of disclosure when taking out the insurance and that policyholder acted with the deliberate intent of misleading the insurer or that the insurer would not have conclude the policy he had known the true state of affairs. The insurance ends on the date mentioned in the notice letter. The Insurer is entitled to recover claims compensation that has been paid under this policy from the Insured.
2.4 Payment of Premiums
The premium is due on the premium due date as stated in the policy schedule.
If the Policyholder has not paid or refuses to pay the initial premium within 30 days of receipt of the request for payment, no cover is provided for any event occurring after the request date, without the Company being required to serve any notice of default.
If the Policyholder refuses to pay the renewal premium, no cover is provided for events occurring after such premium request date.
If the Policyholder does not pay the renewal premium on time, no cover is provided for events occurring as from the 15th day of the date on which the Company sent the Policyholder a written demand for payment after the due date and payment had not been made. The Policyholder shall remain obliged to pay the premium.
No cover is provided under this policy for events that took place during the period in which the cover was interrupted.
2.5 Premium refund after termination
If the policyholder decides to terminate the contract prematurely the unearned premium is refunded after deduction of 25% costs and insofar as the payment is not less than € 25.00. In all cases the minimum premium is 9/12 from the annual premium for each individual policy.
In case of a premature termination by the insurer or – after a change of the premium and/or the terms and conditions to the detriment of the policyholder – by the policyholder, unearned premiums will fully be refunded.
In case of premature termination due to deliberate intent to mislead the insurer, no premiums will be refunded.
2.6 Change of Risk
The Policyholder and Insured Person shall inform the Company immediately of any change in circumstances or conditions that may increase the risk. This includes but is not limited to change of Home Country, or change of Host Country.
If such change is not a change in the health state of the Insured Person and the change involves an increased risk, the Company has the right during one month to cancel the insurance cover or to increase the premium and the conditions of insurance, and this retroactively as from the moment of the aggravation of the risk.
The Policyholder shall have the right to refuse the amended premium and conditions of insurance by cancelling the policy within 60 days of the date on which the Policyholder was informed of the amendment.
2.7 Change of Premium Rates and/or Conditions
The premium may be adjusted at January 1st of each year.
The Company shall have the right to change the premium and/or conditions of certain insurance covers on a class basis for all similar covers.
If this policy belongs to such a group of products, the Company shall have the right to change the premium and/or conditions of this policy accordingly with effect from January 1st of each year. The Company shall inform the Policyholder in writing at least 2 months before the effective date of the change. The Policyholder is deemed to have accepted this unless the Policyholder cancels the agreement within one month of the notification of the change. In the latter case, the insurance shall end at midnight of December 31st.
The Policyholder shall not have the right to cancel the policy if the change involves a reduction of the premium or an extension of the cover without premium increase.
2.8 Cancellation in the Event of War
The Company and the Policyholder may cancel any cover for War if such risk is manifested or if this is about to happen, subject to 7 days’ notice.
2.9 Notification of Claim
The Policyholder, Insured Person or Beneficiary shall respect the procedures mentioned under the title “Claims Procedure” of the concerned benefit, or in general notify the Company, as soon as he is aware of the potential occurrence of a risk covered by this insurance policy.
2.10 Proof of Claims
The Policyholder, Insured Person or Beneficiary shall provide at their own expense all reasonable and necessary documents to substantiate the claim. They shall cooperate in medical or other examinations or enquiries related to the claim if the Company deems this necessary.
2.11 Reasonable Care
The Policyholder, Insured Persons and Beneficiaries must take all reasonable steps to avoid and/or minimize expenses, loss or damage and must also make every effort to recover any property covered by this policy which has been lost or stolen.
2.12 Obligations and Stipulations
The Policyholder and the Insured Persons shall comply with the obligations and stipulations set out in the policy. If the Policyholder or the Insured Person fails to do so, the Company may deduct any consequential loss it has incurred.
2.13 Fraud
The Policyholder, Insured Person or Beneficiary will lose any benefit in case of fraud, deliberate dishonesty or deliberate hiding of information, they must pay back any benefit that the Company has already paid, and shall compensate the Company for the loss or damage incurred because of this situation. If this happens, the Company will not refund any premium and has the right to immediately cancel the policy.
2.14 Interest on Payments
The Company shall not pay interest on any due payments.
2.15 Other Insurance and Subrogation
If the liability, loss or damage that is covered under this policy is also covered by a National Health Service or under any other insurance policy, whether or not of an earlier date, or would have been covered under these had this insurance not been taken out, this insurance shall only provide cover in excess of what would have been covered by the National Health Service and such other insurance policy. The amounts paid under this insurance shall not exceed, when combined with the amounts paid by the National Health Service and under such other insurance policy, the maximum limits as mentioned on the policy schedule.
The Policyholder, Insured Person or Beneficiary shall inform the Company of such cover and provide the Company, at request, with a copy of the policy including the benefit schedules.
In the event of Injury, loss or damage involving the actions or negligence of a third party, the Policyholder, Insured Person or Beneficiary shall use their best endeavors to claim from such third party for the full amount of the loss. The Policyholder, Insured Person and Beneficiary shall not negotiate, settle, compromise, release, or otherwise discharge any claim against such a party without the Company’s express written consent. The Company has full rights of subrogation and may take proceedings in the Insured Person’s name, but at the Company’s expense, to recover for the Company’s benefit the amount of any payment made under the policy including but not limited to the cost of such proceedings.
2.16 Transfer
The policy cannot be transferred unless otherwise agreed upon in writing with the Company.
2.17 Term of Limitation
A claim against the Company to make a payment shall lapse by the passage of three years after the start of the day following the day on which the person entitled to payment became aware of the payment being due and payable.
The period of limitation is interrupted by a written notification whereby a claim to payment is made.
A new period of limitation shall commence with the start of the day following the day on which the Company either acknowledges the claim or announces by registered letter that it has rejected the claim, unambiguously stating that in the event of rejection the claim shall lapse by the passage of six months.
2.18 Address
The Company can give valid notice to the Policyholder at his last address known by the Company or at the address of the broker for this policy.
2.19 Registration of personal data
Personal data provided upon application or amendment of an insurance policy are processed by the company for the purpose of concluding and performing insurance agreements and/or financial services and managing ensuing relationships, including the prevention and combating of fraud and the performance of activities aimed at increasing its client base. Such processing of personal data is governed by the code of conduct applicable to Personal Data Processing for Insurance Companies. This code of conduct sets out the rights and obligations of parties with regard to data processing. The complete text of this code of conduct can be obtained from the information centre of the Tai Ping.
2.20 Governing law and complaints
This policy is a contract of insurance between the Policyholder and the Company. It will be governed by and construed and interpreted in accordance with the law applying in the country where the Policyholder has its home address and will be subject to the exclusive jurisdiction of the Courts of that country.
Contractual disputes shall be resolved in one of the following methods determined by
the parties in the contract:
(1) Any disputes arising from performance of this Contract shall be solved by negotiation between the parties, failing which the disputes shall be submitted to arbitration committee for arbitration;
(2) Any disputes arising from performance of this Contract shall be solved by negotiation between the parties, failing which the parties may bring up litigation proceedings in people’s court.
2.21 General Exclusions
The insurer shall not be liable for any event caused in following cases:
§ The fraud acts of the Policyholder, the Insured or the Beneficiary;
§ The intentional acts of the Policyholder, the Insured or the Beneficiary;
§ Exploration or other highly risk activities (if the activities have been registered with civil service is exclusion, which include winter sports, under water sports, skiing, drifting, bungee jumping, parachute jump, gliding, horse racing, car racing);
§ The insured suicide, self-inflicted injury, fighting, committing crimes, arrest resistance,
and during the period the insured under arrest , put in prison by judicial departments;
§ Driving without a license, or driving a vehicle without a valid certificate;
§ Costs of accident or illness caused by mental illness or unconsciousness, if this is a result
of the consumption of alcohol, drugs, intoxicants or sedatives, sleeping tablets or other
narcotic substances;
§ Phrenitis or anoia;
§ Miscarriage (except if caused by an accident), childbearing and abortion;
§ Any expense related to the medical treatment or health care which is not recognized by
local government;
§ Any expense related to cosmetic surgery;
§ Any expense for obtaining transplanting organs or the donation for transplanting organs;
§ Routine or long-term dialysis for chronic or advanced stage of renal failure;
§ Chemical contamination, terrorism or heresy activity;
§ Nuclear explosion, nuclear radiation or nuclear pollution;
§ Professional Sports and sporting activities with rewards;
§ War, Military Action, Civil war and armed rebellion;
§ Injured, died or diseased or indirect caused of asbestos;
§ Any expense caused by strike, SRCC and Hijacking.
Article 3 - Medical Expense
Contact information:
The Medical Plan Administrator
for Tai Ping Insurance Company Ltd
P.O. Box 69
B-2140 ANTWERP
BELGIUM
24/365 telephone number: +32-3-217 67 77
Fax: +32 3 235 83 51
Email: myclaim@issi-china.com
Website: (ID will be communicated to the Insured Person with the Welcome Package)
Non-Emergency Hospitalization and outpatient surgery need pre-certification from the Medical Plan Administrator. The Medical Plan Administrator will guarantee the medical expenses to the Hospital.
The Insured Person must pay other expenses to the provider and submit a claim for reimbursement in writing to the Medical Plan Administrator within 90 days of the Date of Service.
Claim forms can be obtained by contacting the 24/365 telephone number or can be found on the website. The claim form must be completed and sent to the Medical Plan Administrator together with the original documentation, invoices and receipts (photocopies or scans are not accepted).
In case the Insured Person can claim from the National Health Service or any other insurance policy, he should first request reimbursement from that organization. The Insured Person shall afterwards forward the original settlement confirmation from that organization with photocopy of the submitted documentation, invoices and receipts to the Medical Plan Administrator. The Medical Plan Administrator shall deduct the amounts that are or could have been received from that organization.
This Policy shall provide cover:
§ within the limitations stated in the policy and the policy schedule;
§ for the actual, Reasonable and Customary Expenses incurred by the Insured Person;
§ for the services listed below;
§ that directly relate to a covered Injury or Illness suffered by the Insured Person;
§ that are prescribed and certified Medically Necessary by the attending Physician;
§ that are general accepted and scientifically recognized medical services, excluding any experimental or
pioneering services; and
§ that have a Date of Service during the Benefit Period.
The compensation for Medial Expense is limited to € 200,000 per person per year for each insured period of 365
days. Prescription medications are limited to a maximum of € 500 per person per year. Dental expense is limited
to € 340 per person per year.
A deductible of € 50 per person per policy per year for Injury or Sickness is applicable on this cover.
Insured services in case of:
a. Hospitalization & Outpatient Surgery: | |
§ Hospital accommodation costs including general nursing in a Standard Private Room. § Expenses related to theatre fees; intensive care; medical imaging; diagnostic and laboratory tests; prescribed medicines and drugs, blood and plasma; surgical appliances; rental of medical aids; surgical appliances. § Fees of Physicians, including anesthetist, surgeon, specialist, radiologist, physiotherapist and pathologist fees. § Fees of Physicians for Pre-and Post-Hospitalization Services. § The company will pay the costs of medical treatment up until the 365th day after the day on which day on which this admission shall have commenced. § Reimbursement shall take place on the basis of the lowest class. | |
b. Outpatient Benefit: | |
§ Fees of a family Physician. § Fees of Physicians and specialist consultations. § Prescribed Medicines and Drugs that cannot be purchased without prescription. § Medical imaging, diagnostic and laboratory tests, and surgical appliances. § Medical aids. § Non-experimental preventive care and examinations. § Complementary Medicine. § Acupuncture is maximized by € 500 per period of 12 months, after submission of a referral certificate issued by the general physician or specialist. § Reimbursement shall be made in accordance with the rates for Physio-, Mensendieck-, Chiropractic- or Cesar therapists as set down by Central Health Charges Board for a maximum of 12 treatments/ applications per period of 12 months, after submission of a referral certificate issued by the general physician or specialist and limited to € 750 for each insured period of 365 days. | |
c. Local Ambulance: | |
§ Local Emergency medical transport. | |
d. Private Nursing Benefit: | |
§ Inpatient in hospital or nursing home. § Home nursing costs by a Registered Nurse, up to 60 days per policy year. § Palliative Care. | |
e. Maternity and Childbirth Benefit: Not covered. Treatment miscarriage is covered if caused by an accident | |
f. Mental and Behavioral Disorders Benefit: | |
§ Expenses covered under the points “a” to “d” above that are related to the treatments of mental and behavioral disorders. § The inpatient treatment is limited to mental and behavioral disorders that begin more than 10 months after the Effective Date of the cover, unless the Company because of a Preceding Policy waived the waiting period. § The outpatient treatment is limited to mental and behavioral disorders that begin more than 18 months after the Effective Date of the cover, unless the Company because of a Preceding Policy waived the waiting period. § Reimbursement shall be made for a maximum of 9 treatments per period of 12 months, after submission of a referral certificate issued by the general physician or specialist. Further treatment shall exclusively qualify for reimbursement if prior consent has been granted for it by the insurer. | |
g. Emergency Dental Benefit: | |
§ Expenses covered under the points “a” to “b” above that are related to emergency dental treatment required for Accidental damage to sound natural teeth. § Maximum cover is € 340 per insured period of 12 months | |
h. Emergency Vision Benefit: | |
§ Expenses covered under the points “a” to “b” above that are related to emergency vision treatment required for Accidental damage to an eye. | |
§ Expenses covered under the points “a” to “b” above that are related to venereal diseases is covered up to a maximum of € 100 per treatment per insured period of 364 days. | |
The Medical Plan Administrator can refer the Insured Person, upon request, to a suitable Hospital. The information can be obtained by contacting the 24/365 telephone number or can be found on the website.
While the Medical Plan Administrator exercise care and diligence in selecting the Medical Service Providers, the Company or the Medical Plan Administrator cannot guarantee and is not responsible for the service obtained from the Medical Service Providers.
If the insured is repatriated to the People’s Republic of China and medical treatment is still
necessary the medical expenses incurred in the People’s republic of China for the same
disease/injury/illness contracted abroad at the usual customary level, until the moment when
the insured is able to insure himself against medical expenses, but for a maximum period of
10 days, counting from the date of return.
In addition on the general exclusions described under article 2 of this policy wording for the cover of Medical Expense the following exclusions are applicable:
§ Any insured services not explicitly listed under the Medical Expense benefit section;
§ Medical expenses, services, or treatments incurred in excess of 365 days from the date of loss;
§ Vitamins and minerals (except if prescribed and certified Medically Necessary by the attending Physician to
treat significant vitamin or mineral deficiency syndromes), nutritional and dietary supplements, baby food;
§ Cosmetic Surgery;
§ Reconstructive Surgery, unless the treatment is Medically Necessary and carried out as part of the original
treatment of the Congenital Conditions, developmental abnormalities, Injury or Illness;
§ Relieving symptoms caused by ageing, puberty or other natural physiological cause;
§ Outpatient treatment of sleep disorders;
§ Medical treatment and other measures ordered by a physician where the insured person was aware when
starting the trip that, if the trip took place as planned, the treatment would have to be given for medical reasons (e.g. dialysis);
§ Medical treatment which was the reason for going on the trip;
§ Treatment of pre-existing illness, congenital malformation, deformation or chromosome
Abnormality;
§ Purchase and repair of heart pacemakers, prostheses and aids to assists sight;
§ Treatment of weight loss or weight problems;
§ Mental and Behavioral Disorders listed as F10 till F19, F45, F52, F55, F59 or F99 in the International
Classification of Diseases of the World Health Organization;
§ Expenses incurred where an Insured Person has not followed the medical advice of the Physician;
§ Experimental or pioneering techniques;
§ Physiotherapeutic treatments as Speech therapy, Ergo therapy, Occupational therapy, Antenatal and Postnatal
exercises and Sport massage;
§ Ortho manual therapy, podo therapy, chiropractic treatment, camouflage therapy, electrical epilation, acne
treatment, balneao photo therapy or any other preventive and/or alternative treatment;
§ Products that can be obtained without a Physician’s prescription;
§ Costs related to the rental of purchase of apparatuses or devices;
§ Any sexual problem including impotence (whatever the cause), sex change or gender Reassignment;
§ HIV and AIDS;
§ Cure centre, bath centre, spa, health resort and recovery centre, even if the stay is medically prescribed;
§ Fertility, complications or Illness from IVF induced pregnancy, impotence or erectile dysfunction,
contraception, sterilization, elective cesarean, or termination of pregnancy that is not medically necessary;
§ Dental and vision treatment, except the Emergency Dental Benefit and the Emergency Vision Benefit as
mentioned above;
§ Batteries, electricity, maintenance expenses and recharging of appliances or medical aids (Including hearing
and visual aids);
§ Transfer, transport or travel expenses (except those for local Emergency medical transport of
insured under the Assistance benefit).
Article 4 - Accident
4.1.1 Accumulation Limit means the total maximum amount the Company will pay in the aggregate under this and any other accident insurance policy issued by the Company for Injuries suffered by all Insured Persons in the same Accident or series of Accidents contributed to, caused by or consequent upon the same original cause, event or circumstance.
4.1.2 Deferment Period means the initial period of Temporary Disablement during which the benefit on the policy schedule is not payable
4.1.3 Loss of Hearing means total and permanent loss of hearing.
4.1.4 Loss of Limb means:
In the case of a leg or lower limb:
a. loss by permanent physical severance at or above the ankle, or
b. permanent and total loss of use of a complete foot or leg.
In the case of an arm or upper limb:
a. loss by permanent physical severance of the four fingers at or above the meta
carpo phalange joints (where the fingers join the palm of the hand), or
b. permanent and total loss of use of a complete arm or hand.
4.1.5 Loss of Sight means permanent and total loss of sight in both eyes, or in one eye if the degree of sight remaining after correction is 3/60 or less on the Snellen Scale.
4.1.6 Loss of Speech means total and permanent loss of speech.
4.1.7 Paraplegia means the permanent and total paralysis of the two lower limbs, bladder and rectum.
4.1.8 Permanent Disablement means permanent total or partial loss or disablement of any limb or organ (or a part thereof).
4.1.9 Quadriplegia means the permanent and total paralysis of the two upper limbs and two lower limbs.
4.1.10 Temporary Disablement means an Injury that prevents the Insured Person from carrying out all parts of his usual and paid professional occupation.
If the Insured Person had an insured Accident during the Benefit Period and dies within two years as a direct and sole consequence of that Accident, the sum insured stated in the policy schedule is paid out.
The payment is made as soon as the investigation by the Company into the Accident, the cause of death and the connection between the two has been completed. All sums already paid out on to this insurance policy for Permanent Disablement as a result of the same Accident are deducted from this payment.
If an Insured Person is missing and after a period of 18 months it can reasonably be assumed that the Insured Person has died as the result of Injury, the sum insured stated on the policy schedule is paid out. In that case, the Beneficiary is required to sign an agreement stating that if it transpires later that the Insured Person has not died, any benefits received are repaid to the Company.
The sum insured for the Insured is limited to € 10,000. For accidents which occur while driving or riding as a passenger on a motorcycle with a cylinder capacity of 50cc or more, the payment upon decease shall be limited to € 5,000. A deductible for this cover is not applicable.
In the event of Permanent Disablement as a result of an insured Accident during the Benefit Period, the Company shall pay out the percentages of the sum insured applicable to Permanent Disablement as set out below.
The degree of Permanent Disablement is assessed as soon as it has reasonably been concluded that the condition of the Insured Person is not likely to improve or deteriorate, but not later than two years after the Accident.
In the event that the Insured Person dies before the percentage has been determined, the Company is not obliged to pay any Permanent Disablement benefit. However, if the Insured Person dies more than 6 months after the Accident but not as a result of the Accident, the Company shall pay the amount that it would reasonably have expected to pay out for Permanent Disablement had the Insured Person not died.
In order to determine the percentage of disablement, the following disablement scale is used:
TABLE 1 Schedule of Benefits for Dismemberment
Degree | Item | Degree of Dismemberment | Percentage of Sum Insured
|
Level 1 | 1 | Permanent Total Loss of sight of both eyes (note 1) | 100 |
2 | Loss of both upper limbs at or above the wrist or of both limbs at or above the ankle | ||
3 | Loss of one upper limb at or above the wrist and of one lower limb at or above ankle | ||
4 | Permanent Total Loss of sight of one eye and of one upper limb at or above the wrist | ||
5 | Permanent Total Loss of one eye and of one lower limb at or above the ankle | ||
6 | Permanent Total Loss of function of joints of all the limbs (note 2) | ||
7 | Permanent Total Loss of function of chew and swallow (note 3) | ||
8 | Severe damage to the function of the central nervous system or the internal organs such as the abdomen and thorax, resulting in the permanent loss of the ability to engage in any job occupation and independently perform daily activities that are essential to the maintenance of life (note 4) | ||
Level 2 | 9
| Permanent Total Loss of function of two or more of the three great-joints of both upper limbs or of both lower limbs or of both an upper limb and a lower limb (note 5) | 75 |
10 | Total Loss of all fingers (note 6) | ||
Level 3 | 11 | Permanent Total Loss of one upper limb at or above the wrist or of function of three great-joints of an upper limb | 50 |
12 | Permanent Total Loss of one lower limb at or above the ankle or function of three great-joints of a lower limb | ||
13 | Permanent Total Loss of hearing in both ears (note 7) | ||
14 | Permanent Total Loss of function of joints of all fingers (note 8) | ||
15 | Loss of all toes (note 9)
| ||
Level 4 | 16 | Permanent Total Loss of sight of one eye | 30 |
17 | Permanent Total Loss of function of two great-joints of the three great-joints of an upper limb | ||
18 | Permanent Total Loss of function of two great-joints of the three great-joints of a lower limb | ||
19 | Loss of four or more fingers (including a thumb and a forefinger) of one hand | ||
20 | Permanent Shortening of Leg by at least 5 cm | ||
21 | Permanent Total Loss of Speech (note 10) | ||
22 | Permanent Total Loss of function of all toes | ||
Level 5 | 23 | Permanent Total Loss of function of one great-joint of the three great-joints of an upper limb | 20 |
24 | Permanent Total Loss of function of one-great joint of the three great-joints of a lower limb | ||
25 | Loss of both thumbs of both hands | ||
26 | Total loss of five toes of one foot | ||
27 | Obvious defect of two eyelids (note 11) | ||
28 | Permanent Total Loss of hearing in one ear | ||
29 | Defect of nasal part and severe dysosmia (note 12) | ||
Level 6 | 30
| Loss of forefinger and thumb of one hand, or of more than three fingers including thumb or forefinger | 15 |
31
| Permanent Total Loss of function of three or more fingers of one hand including thumb or forefinger | ||
32 | Permanent Total Loss of function of five toes of one foot | ||
Level 7 | 33 | Loss of a thumb or a forefinger of one hand, or two or more fingers of middle-finger, ring-finger or little finger | 10 |
34 | Permanent Total Loss of function of a thumb and a forefinger of one hand |
Notes:
1. Loss of sight of eye(s) shall include removal or loss of eyeball(s), or anopia, or only the ability for light sensation, or visual acuity after correction of lower than 0.02 of the international standard eyesight chart, or a visual field narrower than 5 degrees. Medical evidence must be provided by a qualified ophthalmologist appointed by the Company.
2. Loss of function of joint(s) shall mean permanent total stiffness, or paralysis of the joints, or that the joints may not be able to move willfully.
3. Loss of function to chew and swallow shall mean the organic or functional disturbance of such functions as chewing and swallowing by any means other than dental causes, and which renders the Insured Person incapable of eating or swallowing anything other than fluid diet.
4. Inability to perform independently the daily activities that are essential to life shall mean complete and continuous inability of the Insured Person to perform such activities independently as eating, going to the toilet, dressing, walking, bathing, etc., and must rely on the assistance of others.
5. The three great-joints of upper limb include shoulder joint, elbow joint, and wrist joint; three great-joints of lower limb include hip joint, knee joint, and ankle joint.
6. Total loss of finger shall mean complete severance through or above the proximal phalangeal joints (interphalageal joints of thumb).
7. Total loss of hearing shall mean the average frequency hearing loss is above 90 dB where speech frequencies are at 500, 1,000, 2,000 Hz.
8. Total loss of function of joints of fingers shall mean complete severance through the distal phalangeal joints, or stiffness of proximal phalangeal joints or moving disturbance of the phalangeal joints.
9. Total loss of toes shall mean complete severance through or above the metatarsophalangeal joints.
10. Total loss of speech shall mean the loss of articulating ability of any three of the four sounds which contribute to the speech (from the labial sounds, alveolar sounds, palatal sounds, and the velar sounds) or total loss of vocal cord or damage of speech center in brain resulting in aphasia. However, all psychiatric related causes are excluded. Medical evidence must be supplied by a qualified otorhinolaryngology specialist.
11. Obvious defect of two eyelids shall mean eyelids incapable of covering corneas completely when the Insured Person closes his/her eyes.
12. Defect of nasal part and severe dysosmia shall mean the irrecoverable defect of total or one half nasal cartilage and nasal atresia, nasal dyspnea or anosmia of both sides.
Permanent total loss shall mean bodily injury beyond hope of improvement at the expiry of at least one hundred eighty (180) days medical treatment from the date of Accident, but exclude the irrecoverable status such as removing the eyeball.
TABLE 2 Schedule of Benefits for Third Degree Burns
Body Part | Percentage of Damaged Area to Total Body Surface Area | Maximum Percentage of Sum Insured
|
Head | 2% or more but less than 5% | 50% |
5% or more but less than 8% | 75% | |
8% or more | 100% | |
Body (excluded head surface area) | 10% or more but less than 15% | 50% |
15% or more but less than 20% | 75% | |
20% or more | 100% |
The sum insured for the Insured is limited to € 75,000. A deductible for this cover is not applicable.
4.2.3 Personal Belongings
If an insured Accident results in immediate hospitalization, the Company shall pay for damage to and the cost
of lost, damaged or stolen personal belongings as a direct result of the Accident, up to a maximum of € 1,000.
4.2.4 Seatbelt
If the Insured Person dies as a result of a road traffic Accident and it has been established that the Insured was
not wearing a seatbelt at the time, the benefit to be paid will be decreased by € 2,500.
4.2.5 Life Saver
If a third party (not an Insured Person or the Policyholder) sustains Injury while trying to save the life of an
Insured Person which subsequently results in the death or Permanent Disablement of this third party within
two years of the event, the Company shall pay this third party on the basis of an insured sum of € 5,000. This
benefit is paid in addition to any benefit paid to the Insured Person.
4.2.6 Plastic surgery
Plastic surgery, in order to treat malformation, disfigurement or defacement occurred as a result of an accident,
shall only be compensated if, according to the opinion of a plastic surgeon, there is fair chance of
improvement or recovery there from. The costs connected with the operation or treatment in an outpatient’s
department, the medicine prescribed, dressings and other remedies and the costs of nursing in the hospital shall
be compensated provided that this treatment takes place within two years after the accident. The compensation
shall amount to no more than € 5,000 per accident and will be given on top of the maximum amount for
permanent disability. If the above-mentioned costs are wholly or partially covered by insurance, or if a liable
third party has been under an obligation to compensate those costs, there shall be no claim regarding this cover.
4.3 Claims process
Contact information:
The Plan Administrator
for Tai Ping Insurance Company Ltd
P.O. Box 69
B-2140 ANTWERP
BELGIUM
24/365 telephone number: +32-3-217 67 77
Fax: +32 3 235 83 51
Email: myclaim@issi-china.com
Website: (ID will be communicated to the Insured Person with the Welcome Package)
4.3.1 Notification
The policyholder, the insured person and/or the person(s) entitled to payment is/are obliged:
A) In the event of death:
1. to notify the company of the accident as soon as possible and always within 48 hours after the accident, providing all the details required by the company;
2. to give the physician and/or authorized person/persons designated by the company every opportunity to launch any investigation into the cause of death they may deem necessary;
3. if requested, to allow an autopsy.
B) In the event of permanent disablement:
1. to notify the company of the accident as soon as possible but always within 90 days of the accident;
2. to seek medical treatment as soon as possible and to continue such treatment;
3. when asked to do so by the company, to have themselves examined by a physician designated by the company or to have themselves admitted to a hospital or any other institution designated by the company for observation. The costs associated with this shall be borne by the company.
If the notifications referred to in articles 4.1.1 and 4.1.2 are not made within the periods specified:
- the company may deduct any loss it incurs as a result of this from the claim;
- the company shall have the right to conclude that the right to claim has lapsed if as a result of late notification any reasonable interest of the company has been injured;
- the right to payment shall lapse if the policyholder or the person entitled to payment deliberately fails to fulfill his obligation to report with the intention to deceive the company, unless such deception does not justify the lapse of the right to payment.
4.3.2. Obligations and conditions
The policyholder and the insured persons shall comply with the obligations and conditions set out in the policy. If the policyholder or the insured person fails to do so, the company may deduct any loss it incurs as a result of this from the claim.
4.3.3 Fraud
If the policyholder and/or the person entitled to payment fail(s) to comply with an obligation specified with the intention to mislead the company or does not provide the company with all the information and documents that the latter requires to assess its obligation to pay, the right to payment shall lapse, unless such deception does not justify the lapsing of the right to payment. The person(s) (policyholder and/or the person entitled to payment) who has/have perpetrated such deception, shall also compensate the company for the loss or damage incurred as a result of this situation. The company may also deduct such damage from a payment if it concerns the person entitled to payment.
4.3.4 Limitation of loss
The policyholder and the insured persons shall as soon as one of them is aware or should be aware of an accident or the fact that this is about to happen, insofar as he has the opportunity to do so and within reasonable limitations, take all measures that may help prevent or reduce the loss or damage, including attempts to recover possessions that have been lost or stolen. The company shall reimburse the costs associated with the above-mentioned measures and the damage to any goods deployed to that effect.
4.4 Specific Exclusions
In addition on the general exclusions described under article 2 of this policy wording for the cover of accident
the following exclusions are applicable:
§ by or as a result of having deliberately committed a crime or having participated in a crime;
§ military service;
§ as a result or, or made possible by, a diseased or unhealthy condition which the insured already exhibited at
the time of the accident, or through paralysis or growing stiff, blindness, deafness, insanity, epilepsy,
vertigo, diabetes, gout/cramp or any physical disability;
§ dangerous activities
§ when making use of aircraft of any nature whatsoever, unless s a passenger of an airplane which has been
admitted for public passenger transport;
§ when making use of vessels outside the inland waters, unless it involves no particular special dangers;
as well as during practice in any way whatsoever of the following sports: all fighting sports, cycling, rugby,
parachuting, hang-gliding and horse racing competitions;
§ participation in or preparations for speed, record and reliability testing of motorized vehicles;
all sorts of winter sports, including ice hockey, as well as underwater sports in which is made of an
aqualung.
Article 5 - Personal Liability
5.1.1 The Company will indemnify the Insured Person for sums which the Insured Person shall become legally obligated to pay due to Injury or Illness sustained by any person, including death at any time resulting there from, and as a loss due to damage to or destruction of property, including the loss of use thereof.
i. The Company will also cover the Insured Persons liability to pay Reasonable and Customary Expenses incurred within one year from the date of Accident for necessary medical, surgical and dental services, including prosthetic devices, and necessary ambulance, hospital, professional nursing and funeral services, to or for each person who sustains Injury or Illness caused accidentally:
1) Is caused by the activities of an Insured Person;
2) Is caused by an animal owned by or in the care of the Insured Person.
With respect to such insurance as is afforded by this policy for liability coverage, the Company shall:
5.2.1 Defend any suit against the Insured Person alleging such Injury, Illness, damage or destruction and seeking losses on account thereof, even if such suit is groundless, false or fraudulent; but the Company may make such investigation, negotiation and settlement of any claim or suit as it deems expedient;
5.2.2 With the respect to liability of the Insured Person to indemnify the sums which the Insured Person shall become legally obligated to pay as damages to the sustained person, the Company shall pay the following supplementary payments:
a) Premiums on bonds to release attachments for amounts not in excess of the applicable limit of the policy coverage, premiums on appeal bonds required in any such defended suit, but without any obligation to apply for or furnish any such bonds;
b) Expenses incurred by the Company, costs taxed against the Insured Person in any such suit and interest accruing after entry of judgment until the Company has paid or tendered or deposited in court such part of such judgment as does not exceed the limit of the Company’s liability thereon;
c) Expenses incurred by the Insured Person in the event of an Accident causing Injury or Illness, for such immediate medical and surgical relief to others as shall be imperative at the time of the Accident; or
d) All reasonable expenses, other than loss of earnings, incurred at the Company’s request. And the amounts so incurred, except settlements of claims and suits, are payable by the Company in addition to the applicable limit of liability of this policy.
5.3.1 The sum insured is limited to € 1,250,000 for all losses, including losses for care and loss of services, as the result of any one occurrence during the insured period of 365 days.
A deductible for this cover is not applicable.
5.3.2 The term Insured Person is used severally and not collectively, but the inclusion herein of more than one Insured Person shall not operate to increase the limits of the Company’s liability. The Company’s total liability under Third Party Liability for all losses resulting from any one occurrence shall not be more than the sum insured stated on the policy schedule. This limit is the same regardless of the number of Insured Persons, claims made or persons injured. All Injuries and property damage resulting from continuous or repeated exposure to substantially the same general harmful conditions shall be considered to be the result of one occurrence.
5.3.3 The Company’s total liability for all medical expenses payable for Injuries to one person as the result of one Accident will not be more than the sum insured stated on the policy schedule.
Contact information:
The Plan Administrator
for Tai Ping Insurance Company Ltd
P.O. Box 69
B-2140 ANTWERP
BELGIUM
24/365 telephone number: +32-3-217 67 77
Fax: +32 3 235 83 51
Email: myclaim@issi-china.com
Website: (ID will be communicated to the Insured Person with the Welcome Package)
5.4.1 When an occurrence takes place, written notice thereof shall be given by or on behalf of the Insured Person as
soon as practicable to the Plan Administrator.
Such notice shall contain the identity of the policy and Insured Person, reasonably available information on the time, place, and circumstances of the Accident or occurrence and names and addresses of any claimants and witnesses. At the request of the Plan Administrator, the Insured Person shall help the Plan Administrator to make settlement, enforce any right of contribution or indemnity against any person or organization who may be liable to an Insured Person, with the conduct of suits and attend hearings and trials and to secure and give evidence and obtain the attendance of witnesses.
5.4.2 If claim is made or suit is brought against the Insured Person, the Insured Person shall immediately forward to the Plan Administrator every demand, notice, summons or other process received by the Insured Person or his representative. The proceeding should be instituted within the prescriptive period settled by the legislation of the local law or within one year from the date of loss if any other legislation is applicable to the policy.
5.4.3 The Insured Person shall cooperate with the Plan Administrator or Company, and upon the Company’s request, shall attend hearings and trials and shall assist in effecting settlements, securing and giving evidence obtaining the attendance of witnesses and in the conduct of suits. The Insured Person shall not, except at his own cost, voluntarily make any payment, assume any obligation or incur any expense other than for such immediate medical and surgical relief to others as shall be imperative at the time of the Accident.
5.4.4 No action shall be taken against the Company unless, as a condition precedent thereto, the Insured Person shall have fully complied with all the terms of this policy, nor until the amount of the Insured Persons obligation to pay shall have been finally determined either by judgment against the Insured Person after actual trial or by written agreement of the Insured Person, the claimant and the Company. Any person or organization or the legal representative thereof who has secured such judgment or written agreement shall thereafter be entitled to recover under this policy to the extent of the insurance afforded by this policy. Nothing contained in this policy shall give any person or organization any right to join the Company as a co-defendant in any action against the Insured Person to determine the Insured Person’s liability. Bankruptcy or insolvency of the Insured Person or of the Insured Person’s estate shall not relieve the Company of any of its obligations hereunder.
In addition on of the general exclusions described under article 2 of this policy wording for the cover of personal liability the following exclusions are applicable:
§ To any business activities of an Insured Person, other than those which are ordinarily incidental to non-
business pursuits; nor to claims arising from the rendering, or omission of rendering, of any professional
services; nor to any act or omission in connection with Insured Premises other than as defined above, which
are owned, rented or controlled by an Insured Person;
To the ownership, maintenance, operation, use, loading or unloading of:
a) Automobiles while they are away from the Insured Premises;
b) watercraft, 8 meters or more in overall length, or with outboard motors with more than
18 Kilowatt or inboard motors with more than 36 Kilowatt, when owned by or rented
to an Insured Person and while located away from the Insured Premises; and
c) Aircraft.
§ To Injury, Illness, damage or destruction caused intentionally by or at the direction of the Insured Person;
§ To liability assumed by the Insured Person under any contract or agreement, except liability of others
assumed under a written contract specifically relating to the Insured Premises;
§ Under article 5.1.1, to damage to or destruction of property used by, rented to or in the care, custody or
control of the Insured Person or the property on which the Insured Person is exercising physical control;
However liability for damage is insured for and in connection with goods which an insured has, other than
in those cases as set under this article through up to an amount of € 10,000 for each event; for and in
connection with goods which belong to the trainee position address which an insured has at his/her
disposal whilst conducting trainee activities, up to an amount of € 10,000 for each event. Property / real
estate sill remains fully excluded form coverage.
§ Under article 5.1.2, to Injury, Illness or death of:
a) Any person, when arising out of or in the course of employment, if benefits are wholly or
partially payable or required to be provided under a Worker’s Compensation Law;
b) Any Insured Person otherwise covered under this policy; or
c) Any person, other than a Residence Employee, if such person is regularly residing on the
Insured Premises, or is on the Insured Premises because of a business conducted thereon, or
is injured by an accident arising out of such business.
§ To Injury, Illness, damage or destruction directly or indirectly arising from, occasioned by, or in consequence
of:
a) War;
b) The transmission of a communicable disease by an Insured Person;
c) Sexual molestation, corporal punishment or physical or mental abuse; or
d) Excessive consumption of alcohol, misuse of medication, or use of narcotics, illegal drugs
or agents;
- Property damage to property owned by the Insured Person.
Article 6 - Baggage and Household
6.1 Definitions
6.1.1. Baggage
a. the objects which an insured has taken for his/her own use, or which have been sent on in advance or
after the insured’s arrival to the destination, or within the duration of validity of the insurance;
b. the objects acquired within the duration of validity of the insurance, up to a maximum amount of
€ 250.00.
6.1.2. Travel documents
Travel documents are deemed to include: passports, travel tickets, driving licenses, registration papers, registration plates, carnets/vignettes, green cards, visas, identity papers and tourist cards/tourist travel documents.
6.1.3. Household goods
Household goods include all goods and chattels belonging to or which are the responsibility of the insured which normally speaking are referred to as household goods and which, during the validity of the insurance, were present at the address of the insured abroad.
6.2 Cover
For each claim of this cover a deductible of € 50 is applicable.
Travel documents shall be compensated for up to a maximum amount of € 150.00.
Baggage, up to a maximum amount of € 1,500.00 and household goods up to a maximum amount of € 5,000.00, bearing the following in mind:
Windsurfing boards and bicycles are insured up to a maximum amount of € 250.00 per object, including accessories;
Car, bicycle and motor bike tools, snow chains, car sound and broadcasting equipment (fixed and mounted or not) solely with a battery connection, music cassettes, compact disks, as well as spare parts (including V-connectors, sparking plugs, jump start cables, rotor, contact points and light bulbs) are insured up to a maximum amount of € 150.00;
False teeth are insured if the costs incurred for replacement or repair may not be defrayed pursuant to the chapter on health and dental care costs, up to a maximum amount of € 250.00;
Insurance cover is also granted up to a maximum amount of € 75.00 for compensation for the costs of having to purchase replacement clothing and toilet articles due to the delayed arrival of baggage;
Photographic, film, video, sound and computer equipment, including accessories, are insured up to a maximum amount of € 500.00;
Jewelry is insured up to a maximum amount of € 150.00. Jewelry includes objects made to be worn on or around the body and which consist wholly or partly of (precious) metal, stone, mineral, ivory, coral or suchlike substances as well as pearls, with the exception of watches;
Watches, including straps and chains are insured up to a maximum amount of € 150.00;
Spectacles, sun-glasses (including lenses) and contact lenses are insured up to a maximum amount of € 150.00;
(Mobile) telecommunications equipment is insured up to a maximum amount of € 150.00;
For the remaining household goods, cover is given against the following threats and dangers: fire and explosion (also that resulting from own fault), strike by lightning, induction and power surge after lightning has struck, aircraft, storm, precipitation, water, steam and oil, theft or attempted theft after breaking and/or entering, robbery and extortion, traffic accident, burning, singeing, smelting, charring, scorching, smoke and soot, as well as damage caused by glass splinters when windows break. Damage caused by theft or attempted theft without any signs of breaking and/or entering, will be subject to a deductible of € 125.00 per event.
6.3. Specific exclusions
In addition on the general exclusions described under article 2 of this policy wording for the cover of Baggage and Household Goods the following exclusions are applicable:
§ Boats (with the exception of windsurfing boards), aircraft (including gliders and gliding
equipment), vehicles (including mopeds), campers and other vehicles (with the exception of bicycles),
as well as the accessories to the aforementioned, spare parts and further appurtenances (including tents);
§ Damage due to wear and tear, own fault, natural decay and slow working influences of the weather,
attachment or forfeiture, other than due to a traffic accident, as well as damage caused by moths or
other vermin;
§ Damage consisting of damages such as scratches, dents, stains, and other unsightly markings, unless
the damaged object has become unsuitable as a result of this for the use for which said object was
intended;
§ Damage solely consisting of damages to recording devices, video and sound heads of audio and
video equipment.
Moreover, there is no right to receive compensation in connection with:
if the insured did not adhere to and comply with the normal care and caution which may be expected of him/her, in preventing loss, theft or damages being sustained by baggage and household goods.
Normal care and caution shall be deemed not to have been taken when video, computer, photographic, film, sound and telecommunication equipment, jewelry, watches, fur and other valuable objects are left unsupervised other than in a properly locked area (not including a vehicle). For other articles, if they are left in a vehicle, compensation shall solely be paid if:
a. those goods were in a properly locked boot and were also not visible from the outside;
b. all measures were taken to prevent the damage in question when these goods were in a vehicle
which does not have a proper boot which can be locked.
In connection with that determined in sub-sections a. and b. the insured may be required to show that in all reasonableness no safer measures could have been taken.
§ The following shall not be deemed to be baggage and household goods:
a. money, papers of value of whatever nature, manuscripts, drawings and drafts (for travel
documents refer to 6.1.2);
b. collections (such as postage stamps and coin collections, etc.);
c. tools (with the exception of the car, bicycle, motor bike tools referred to below);
d. trade goods and samples;
e. animals.
§ Supplementary obligations on the part of the insured or interested party
Aside from the general obligations, the insured or an interested party is also bound:
a. when damage is sustained by baggage and household goods, to inform the insurer and permit the insurer to investigate the matter prior to repairs being made;
b. in the case of theft or loss of insured goods, to file a police report locally and moreover the persons such as railway station chiefs, the staff of airlines, train conductors, ship’s captains, hotel management, etc. must also be requested to determine that damage has actually been incurred;
c. to prove possession, the value and the age of the insured object or objects;
d. if the damage arose during transit of the insured objects by train, boat, aircraft, or other means of transport, to check the baggage upon receipt to ensure it is in good condition and/or to note its/their loss. Should something be missing and/or not in good condition, then the insured is also bound to file a complaint with the transport company and to demand that the transport company make an official written report of the complaint. This original report shall be required to be submitted to the insurance company with any claim for damages.
6.4 Damages
Contact information:
The Medical Plan Administrator
for Tai Ping Insurance Company Ltd
P.O. Box 69
B-2140 ANTWERP
BELGIUM
24/365 telephone number: +32-3-217 67 77
Fax: +32 3 235 83 51
Email: myclaim@issi-china.com
Website: (ID will be communicated to the Insured Person with the Welcome Package)
The foundations for calculating compensation to be paid for damages sustained which are connected with travel documents shall be the amount due for obtaining the documents in question once again.
The foundations for calculating the compensation for damages for baggage and household goods are:
a. for articles which are no older than one year old, their new value;
b. for articles which are older than one year old, their present value based on the following depreciation table:
Older than 1 year, but younger than 2 year : 10% depreciation;
Older than 2 years, but younger than 3 years : 20% depreciation;
Older than 3 years, but younger than 4 years : 30% depreciation;
After 4 years for each year 10%
New value shall be deemed to be the amount needed to acquire new articles of the same sort and quality; while present value shall be deemed to be the new value less the amount of depreciation of value due to age or wear and tear.
Objects which cannot be replaced by new ones of the same kind and quality shall be made subject to the assumption of their market value, which shall be deemed to be the market price upon the sale by the insured of the articles in question in the condition these articles were in, immediately before damages were sustained.
If damages or lost objects could, in all reasonableness, be repaired and/or replaced, the insured will
contact the Plan Administrator with phone number as described on the insurance card.
Article 7 - Assistance and Exceptional Costs
Contact information:
The Plan Administrator
for Tai Ping Insurance Company Ltd
P.O. Box 69
B-2140 ANTWERP
BELGIUM
24/365 telephone number: +32-3-217 67 77
Fax: +32 3 235 83 51
Email: myclaim@issi-china.com
Website: (ID will be communicated to the Insured Person with the Welcome Package)
Medical Staff:
AIG Travel Assist has a team of highly qualified medical advisers and nurses who are available to provide advice regarding the most appropriate assistance and treatment.
When assistance is required, the following information must always be provided to the Plan Administrator:
a. Concerning the Insured Person:
§ The name of the Insured Person,
§ The telephone number on which the Insured Person can be contacted
§ The address where the Insured Person is staying.
b. Concerning the Policyholder:
§ The name of the Policyholder,
§ The policy number.
c. The nature of the incident.
AIG Travel Assist will arrange for the provision of medical advice from an English speaking Registered Nurse to the Insured Person over the phone.
AIG Travel Assist will help and guide the Insured Person in order to obtain 2 independent reviews of his medical file relating to an insured Illness or Injury. Those second opinions intend to assist the Insured Person and the attending Physician to decide upon the diagnosis and/or treatment protocols.
The Insured Person is provided with the following assistance services:
1. Emergency Medical Evacuation
AIG Travel Assist shall organize and pay for, in accordance with the advice of its Medical Consultants, in case of an insured Injury or Illness that needs the emergency medical evacuation of the Insured Person to a more suitable and better-equipped local Hospital. Depending on the seriousness of the circumstances, the person is transported by air ambulance, a scheduled flight, an ambulance or any other means of transport, and if necessary under the supervision of a medical team that has the necessary medical equipment at its disposal. The Medical Consultants of AIG Travel Assist shall decide, if necessary in consultation with the local Physician in attendance, if evacuation is needed, with which mode of transport and to what hospital.
In case the Insured Person was evacuated outside his Home or Host Country, AIG Travel Assist shall organize and pay for the return the Insured Person to his Home or Host Country.
2. Delivery of Essential Medication
At the request of the Insured Person and in case of an emergency, AIG Travel Assist shall assist in finding and sending essential medication or medical equipment if these are not available locally. AIG Travel Assist shall pay for the shipping cost.
In non-emergency cases, AIG Travel Assist can provide the same service but at the cost of the Insured Person.
3. Assistance in case of Death
If the Insured Person dies, AIG Travel Assist shall organize and pay for transportation of the mortal remains or the ashes, including the cost of the coffin needed for transport, and for transportation of the personal belongings of the Insured Person to his Home Country.
AIG Travel Assist shall also organize and pay for the flight to the Home Country of the insured Dependants.
4. Interpreter Referral
At the request of the Insured Person, AIG Travel Assist refers him to an interpreter.
5. Legal Referral
At the request of the Insured Person, the Plan Administrator refers to external legal firm.
7.5. Exceptional Costs Cover
7.5.1. Costs incurred due to illness or accident – Compassionate Visit
Up to a maximum of € 7,000 per insured period of 365 days the travel costs incurred with the permission of
AIG Travel Assist for a necessary return trip, as well as the costs of accommodation of at most two family
members in the 1st or 2 nd degree and/or of the persons with whom the insured lived as a family, for
assistance and support to an insured who is seriously ill or whose life is in danger.
7.5.2. Costs of returning from the trip due to death
If the insured must return from the trip due to the fact that family members in the 1st or 2nd degree who are not traveling with the insured have died, or that their lives are in danger, the extra traveling and accommodation expenses incurred by the insured in question to the place to which he/she has been called back, up to a maximum of the costs of travel and accommodation in order to reach the place of residence. In addition, the extra travel and accommodation expenses incurred to return to the original destination are insured, provided they are incurred during the validity of the insurance.
Insured costs are limited to a maximum of € 7,000 per insured period of 365 days and return trip must be approved by AIG Travel Assist up front.
7.5.3. Telecommunication costs
If there is entitlement to compensation for damages, to payment or to the provision of assistance, the
necessary telecommunication costs incurred, to the extent that they were incurred in order to contact AIG
Travel Assist. The telecommunication costs are limited to a maximum of € 150 per incident.
7.5.4. Travel aids outside China
In the event of unexpected and serious difficulties abroad as a result of the loss or theft of travel documents, AIG Traven Assist will assist the insured with word and deed at embassies, consulates and other official bodies. If necessary and where possible, AIG Travel Assist shall act as an interpreter. If necessary, AIG Travel Assist shall arrange a replacement travel ticket for the insured. The costs of this ticket, if any, shall be charged to the insured.
In addition on the general exclusions described under article 2 of this policy wording for the cover of
Assistance and Exceptional Costs the following exclusions and limitations are applicable:
The benefit in case of flights is limited to public transport in economy class, unless the Medical Consultants of
AIG Travel Assist decide otherwise.
The Company shall not pay any benefit:
§ For services that were not organized or approved in advance by AIG Travel Assist.
§ If the purpose of the trip is to obtain medical treatment or medical advice, unless in the course
of an approved Emergency Medical Evacuation.
§ If the Insured Person is traveling against the advice of a Physician.
§ For services that are excluded in the Medical Cost cover and exclusions on all other coverage’s as
described in this policy wording or have their Date of Service during
a waiting period mentioned under the Medical Expense cover.
Article 8 - Legal Aid
8.1. Definitions
8.1.1. Costs
Costs which are necessary for legal aid or which will be incurred by an external law firm, to the extent that they are not recoverable from a third party, that is;
a. the costs in relation to examination and treatment;
b. the costs in relation to the enlistment of lawyers, court bailiffs, witnesses and experts. In
the United States and Canada the lawyer’s fee is not charged to the insurer if the lawyer
handles the case on the basis of “no cure, no pay”. In this case the fee shall be deemed to
be included in the compensation for damages;
c. the costs of accommodation to be incurred by the insured in consultation with
appointed external law firm and the travel expenses to be incurred in accordance with
fares for public transport (train, second class);
8.1.2. Territorial scope of the validity
Cover of the costs of legal aid shall apply during a stay abroad in:
a. Europe and the countries surrounding the Mediterranean Sea (including the Canary
Islands) with the exception of Libya, Albania, Greenland, Lebanon and Syria;
b. the United States, Canada, Australia, New Zealand, Indonesia, South Africa and
Thailand; In relation to questions in all other countries the insurer shall take for its
account, before the insured returns to his/her own permanent home and habitual place of
residence, the costs to be incurred in consultation with the insurer for advice or mediation
by a local lawyer up to a maximum of € 5,000.
8.2. Cover
The insured is entitled to the provision of legal aid and the reimbursement of costs to the extent that:
a. the rights or interests of the insured as a private person are directly at issue, with the
exception of damages sustained as a result of possessing, keeping or using a means of
transport;
b. the costs do not exceed the amount of € 5,000 per question reported;
c. the question reported concerns: - the recovery of material and immaterial damages
sustained by the insured as a consequence of a physical injury sustained by him for which
a third party is liable on the grounds of a statutory provision; - the legal defense of the
insured in the event that the insured is sued at law as a private individual for his liability
under civil law, under the legislation of the country where he presently is, for damages
incurred to third parties or after involuntary infringement of local laws.
8.2.1. Advances
In return for an adequate guarantee, the insurer shall provide advances up to a maximum of € 7,000 for:
a. payment of the costs of the proceedings and of enforcement due from the insured and the
other party, with the exception of the sureties, to the extent that a final and conclusive
court ruling has determined that they must be borne by the insured;
b. the release of the insured in the event that he has been placed in pretrial detention
following a traffic accident.
Such an advance or a surety shall be deemed to be a loan by the insurer to the insured, who shall repay this loan in its entirety as soon as the surety has been repaid to him in the event of a decision to drop charges, acquittal or otherwise within 15 days after the day on which the competent court has handed down a ruling.
Repayment to the insurer shall follow in any case no later than 60 days after the advance has taken place or the security deposit has been made.
8.3. Claims Procedure
Contact information:
The Plan Administrator
for Tai Ping Insurance Company Ltd
P.O. Box 69
B-2140 ANTWERP
BELGIUM
24/365 telephone number: +32-3-217 67 77
Fax: +32 3 235 83 51
Email: myclaim@issi-china.com
Website: (ID will be communicated to the Insured Person with the Welcome Package)
§ If the insured wishes to invoke the legal aid, he shall notify the Plan Administrator
and he will refer to external law firm of this as soon as possible;
§ If the case is covered, then the insurer transfers the further handling to the
organization which carries out the legal aid;
§ If the enlistment of a lawyer is necessary for the handling of the case, then the
choice of the lawyer and/or the expert shall be appointed by the insurer;
§ The costs shall be for the account of the insured if they have been incurred without
prior consultation with the Insurer; if they are related to the enlistment of a lawyer or an expert which took place without prior consultation with the Insurer; to the extent that the costs are the consequence of omissions or errors on the part of the insured in relation to the handling of the case.
§ Starting from the moment that the insurer informs the insured that further
handling of the case does not have a reasonable chance of success; the insured can
no longer lay any claim to cover, with the exception of the rules on the settlement
of disputes.
8.4. Rules on the settlement of disputes if legal aid applies
In the event of a difference of opinion between the insured and Insurer as to the expected result or the manner of handling of the case, after consultation with insurer and for the account of the insurer, the insured shall have one opportunity to place the case before a lawyer of his choice who is an expert in the discipline in question; this must take place as soon as possible, but in any case within one month after the insurer has informed the insured of its opinion or manner of handling the case and he/she has disputed it.
If this lawyer shares the standpoint of the insurer, then the insured may only continue the proceedings for his own account. Should the results show the insured to be entirely or partly right, then the costs will be reimbursed after all, up to the maximum of the insured amount. If the case is already being handled by a lawyer and the insured loses confidence in him, then the insured shall have one opportunity to transfer the case to a different lawyer for the account of the insurer, if the insurer, in fairness, can share the standpoint of the insured.
8.5. Further exclusions
In addition on the general exclusions described under article 2 of this policy wording for the cover
of Legal Aid the following exclusions are applicable:
§ if, upon the commencement date of the insurance, he/she could reasonably have foreseen the need for legal aid;
§ if the amount is € 250 or less;
§ in the event of conditional intention, recklessness or default on the part of the insured.
[温福东1]原：可以