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Insurance coverage

Ping An shall undertake the following insurance liabilities during the period of insurance:

1．Death Insurance

Ping An shall pay the stipulated amount of insurance compensation if the Insured dies of any accidental injury or disease (including SARS). Insurance liabilities thus terminate.

2. Disability Insurance

If the Insured suffers from any accidental injury which results in any disability within 180 days since the occurrence of the accidental injury, The sum insured shall be paid by Party B in the amount of agreed insured sum specified in the insurance policy multiply by certain proportion stated in the Disability Degree and Payment Proportion Table of Ping An Life Insurance Corporate Of China, Ltd. (See Annex 1). If the treatment is not finished on the 180th days, disability identification shall be conducted on the basis of the Insured’s physical condition on the 180th day, and the Insurance for Accidental Disability shall be paid in accordance with the Disability Degree and the Payment Proportion Table .

If the same accidental injury results in two or more disabilities listed in the Disability Degree and Payment Proportion Table to the Insured, the Insurer shall pay the sum insuredto the sum of the amount to each corresponding disability. However, however if different disabilities take place to the same arm or leg, only one disability insured amount shall be paid;If the disabilities fall into different disability degrees, the disability insured amountfor the more serious disability shall be paid.

If with the disability resulted from this accidental injury and the previous disability taken together, the Insured could draw the insurance for the more serious disability, the insurance shall be paid in accordance with the standard for the more serious disability, but the disability insurance which has previously been paid (the disabilities took place before buying insurance or the disabilities listed in the Proportion Table between the Degree of Disability and the Payment which were resulted from exceptions shall be treated as being compensated already)shall be deducted.

Party B shall respectively pay the insurance compensation for accidental disability in accordance with the policy, no matter the Insured suffers from accidental injury for once or several times, however the accumulative payment hereto shall not exceed the stipulated sum insured.
The accumulative amount of insurance for accidental disability or death of each insured shall not exceed the insured sum set for the corresponding accidental injury.

If the Insured dies of the same reason within 180 days since the occurrence of accidental injury which results in any disability, Party B shall be liable only for the difference between the stipulated insured amount for accidental death and for accidental disability; if the Insured dies after 180 days, Party B shall pay the stipulated insured amount for accidental death no matter if the death is caused by the same reason., and the insurance liability shall be terminated.

3．Accidental Injury Medical Treatment Insurance Liability

If the Insured receives any medical treatment within 180 days since the occurrence of the accidental injury, the insurer shall be liable for the full amount of the actual and reasonable expenses for medical treatment; however the accumulative payment shall not exceed the stipulated insured sum.

No matter the Insured suffered from accidental injury once or many times, the Insurer shall respectively pay for the Accidental Injury Medical Treatment in accordance with the foresaid provisions, but the accumulative amount of payment shall not exceed the Insured amount, where the accumulative amount of payment amounts to the insured’s Insured sum, the said insurance liability for the said Insured shall be terminated.

4．Hospitalization Medical Treatment Insurance Liability

If the hospitalization is diagnosed to be necessary of the insured due toany accidental injury, or for any disease (including SARS) after the day of insurance policy become effective (Ambulatory Surgery and observation room treatment due to no bed available shall be treated as hospitalization medical treatment), Party B shall be liable for the actual and reasonable expenses for medical treatment including nursing fee (limited to RMB100 Yuan per day for accumulative 30 days), ambulance fee, medical record fee, heating fee, air conditioner fee, bed fee (limited to RMB300 Yuan per day), expenses for docimasia, special examination and treatment, operation, medicine, treatment, laboratory test, radiation and etc., and shall pay 100% of the costs of hospitalization medical treatment.

If hospitalization treatment which is within the scope of insurance liability is necessary to the insured , the outpatient and emergency treatment fee before and after hospitalization arise from the same disease shall be paid in accordance with the payment standard of hospitalization medical treatment.

Insurer shall pay the costs of hospitalization without reference to the number of times within the regulated limits, however insurance liability shall be terminated once the accumulative payments reached the sum insured.

If the Insured suffered from critical illness or chronic disease before buying this insurance, the Insurer shallbe released from its liability to make payments.

Note: 1）All the foregoing medical organizations shall be limited to the public hospitals established within the board of the People’s Republic of China.

2）The scope of medical treatment expenses shall be limited to the items and expenses which can be reimbursed in accordance with the local regulations on social basic medical insurance. However the expenses for the B-class medicine shall be paid by insured.

Liability Exemption

Liability Exemption for Death and Disability

This corporate shall be exempted from the insurance liabilities for the death and disability of the Insured for any of the following circumstances:

1. Any intentional act of the applicant for insurance or the beneficiary;

2. Criminal act, addiction to narcotic, fighting, drunkenness, self-injury or suicide of the insured;

3. Driving while intoxicated or driving without license;

4. Pregnancy, miscarriage or childbirth of the insured;

5. AIDS or other VD of the insured;

6. War, military action, civil rebellion or armed revolt;

7. Nuclear explosion, radiation or pollution;

8. High-risk sports and athletic activities by the professionals;

If any of the foregoing circumstances happens resulting in the death of the Insured, the insurer shall end the insurance liabilities and return the unearned premium after the deduction of the commission charge.

Liability Exemption for Medical Treatment (accidental injury medical treatment and hospitalization medical treatment)

The insurer shall be exempted from the insurance liabilities for any of the following circumstances:

1. Intentional killing or injure the insured by the applicant or the beneficiary;

2. Criminal act or arrest resistance , suicide or intentional self-injury of the insured;

3. Fighting, drunkenness, drug taking, addiction or injection of the insured;

4. Driving while intoxicated or without license or driving motor-driven vehicle without valid driving certificate of the insured;

5. Medical accident occurred during the cosmetic operation or other physician or surgery operations of the insured;

6. The expenses for orthopaedic, cosmetic operation or rehabilitating treatment of the insured;

7. The expenses food and telephone of the insured;

8. Taking, coating or injecting drugs not in conformity with doctor’s advice;

9. War, military act, rebellion or armed revolt;

10. Nuclear explosion, radiation or pollution;

11. Pregnancy, miscarriage or childbirth of the insured

12. Out-patient treatment expenses of common disease.

Notes: Matters not mentioned herein shall be executed in accordance with the provisions of Ping An Group Accidental Injury Insurance, Ping An One-year Fixed Term Life Insurance, Ping An Additional Insurance for Group Accidental Injury Medical Treatment and Ping An Group Hospitalization Medical Treatment Insurance.

(Source: bjchinese.bjedu.cn)