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ISSIChina太平财产保险有限公司太平ISSI留学生综合保险(涉外版)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.
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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.
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2友邦旅行协助(AIGTravelAssist)是指代表公司提供保单中所述的紧急援助服务的机构.
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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.
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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:如果被保险人死亡,受益人为国家法定继承人;对于其他一切情况,受益人为被保险人本身.
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5公司是指中国的太平保险有限公司.
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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.
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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.
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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.
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医疗服务日期是指提供一项医疗服务的日期.
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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.
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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.
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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.
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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.
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其他国是指被保险人居留学习的国家.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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标准单人间是指在医院价格最低的单人病房.
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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.
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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.
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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.
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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.
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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.
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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):保单有效期最后一天的午夜十二点;保费支付期限的最后一天;被保险人不再适用于本保单的日期;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);被保险人参加军事服务的日期;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;被保险人40周岁生日之后本保单下一年度的续期日;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;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,但应当退还保险费.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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付款利息保险公司不支付任何到期款项的利息.
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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.
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转让除非取得公司书面同意,本保单不得转让.
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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.
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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.
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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.
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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.
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20.
免责事则承保人对以下任何一种情况不负有赔偿责任: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.
);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;无牌照驾驶,或者无有效证件驾驶车辆;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;精神病或者智力缺失;流产(除非由于意外造成),怀孕和妊娠终止;任何不为当地政府认可的医疗治疗或健康保健费用;任何美容整形手术的费用;任何因取得器官移植或捐献移植器官产生的费用;为治疗慢性或高度肾衰竭进行的定期或长期的肾透析;化学污染,恐怖袭击或异端主义活动;核爆炸,核放射或核污染;职业体育活动或者设有奖项的体育竞技运动;战争,军事行动,内战或者武装暴动;直接或间接由石棉导致的伤害、死亡或者疾病;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:+32-3-2176877传真:+32-32358351电邮:myclaim@issi-china.
com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:在保单或保单清单注明限制范围之内的医疗费用;被保险人产生的真实的、合理的、惯例性的费用;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.
住院和门诊手术在标准单人病房的住院费用以及普通护理费用.
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.
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.
入院前和出院后治疗师的费用.
公司将支付从入院之日起最长365天的医疗费用.
保险公司按最低档次的治疗方案赔偿医疗费.
b.
门诊给付金家庭医生费用.
医生和专家咨询费用.
无处方不能购买的处方药物.
医学造影,诊断和实验,手术器械.
医疗援助.
非实验性预防性的护理和检查.
补充药物.
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.
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.
本地救护车本地医疗急救运送费用d.
私人医生费用给付医院和护理院住院费注册护士家庭护理费用,每个保险年度最长60天临终关怀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: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.
12个月保险期内最高保障为340欧元.
h.
紧急视力治疗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:被保险的服务在医疗费用保险金部分未明确列明;医疗费用、服务或治疗在受损失之后超过365天发生;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;整容手术;再造手术;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;针对睡眠失调的门诊治疗;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.
出于医疗治疗为目的的旅行;既往病,先天畸形,不正常变异或者染色体异变;心脏起搏器的购买和修理,义肢和辅助视力;减肥治疗或者体重问题;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;被保险人没有听从医师治疗建议而引起的费用实验性或者创新性技术如演说治疗法,工作治疗法,职业病治疗,产前和产后检查,运动按摩;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;无需医生处方可以获得的产品;租借或者购买设备器械产生的成本费用;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;HIV和艾滋病;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;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;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;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);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%第三三一手拇指或食指缺失,或中指、无名指和小指中有二个或二个以上手指缺失的10%七级三四一手拇指及食指机能永久完全丧失的注:(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:由于故意行为或实施犯罪;服役期间;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;开展危险活动;使用或乘坐任何飞行器,除非作为客运飞机的乘客;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;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: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.
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):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AIGTravelAssist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.
2AIGTravelAssist将通过电话用英语提供医疗建议、安排.
7.
3AIGTravelAssist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AIGTravelAssist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AIGTravelAssist的专业许可.
未得到AIGTravelAssist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AIGTravelAssist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.
001.
冲浪板及自行车(包括):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.
00250.
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%.
TaipingISSI(InternationalStudyStudentInsurance)Policywording2009/01Article1-DefinitionsArticle2-GeneralConditionsArticle3-MedicalExpenseArticle4-AccidentArticle5-PersonalLiabilityArticle6-BaggageandHouseholdArticle7-AssistanceandExceptionalCostsArticle8-LegalAidArticle1-DefinitionsThefollowingdefinitionsapplytothePolicy,andhavethesamemeaningwherevertheyareusedinthepolicy,policyscheduleorendorsements.
1.
1Accidentmeansasudden,violentexternaleventwhichresultsdirectlyandimmediatelyinInjurytotheInsuredPerson,andwhichmayormaynotresultindeath,providedthatthenatureandlocationoftheInjuryorthecauseofdeathcanbemedicallyestablished.
Accidentshallalsobetakentomean:a.
HealthdisordersthataredirectlyandsolelyduetoaninsuredAccident;b.
Injuryresultingfromlawfulself-defense,orrescueorattemptedrescueofendangeredpersonsorgoods;c.
Acuteandunintentionalingestionofsolid,liquidand/orgaseoussubstancesthatareinjurioustoaperson'shealth.
d.
Dislocations,sprains,musclestrainsorrupturescausedbyasuddenexertion;e.
Disordersdueasaresultofextremeweatherconditions;f.
Drowning;g.
RabiesortetanusastheresultofaninsuredAccident;h.
DeathoftheInsuredPersonasaresultofatrafficAccident,duetocardiacarrest,myocardialinfarctorcardiacarteryruptureoftheInsuredPerson.
1.
2AIGTravelAssistmeanstheorganizationthatprovidestheemergencyassistanceservicesdescribedinthispolicyonbehalfoftheCompany.
1.
3Automobilemeansalandmotorvehicle,trailerorsemi-trailer.
Thetermdoesnotrefertocrawlerorfarm-typetractorsorfarmequipmentnortoanyotherequipmentwhichisdesignedforuseprimarilyawayfrompublicstreetsorhighwaysandwhichisnotsubjecttomotorvehicleregistration.
1.
4Beneficiarymeansthepersonwhoisdesignatedassuchinthepolicy;intheabsencethereof:Intheeventofdeath:thespouseoftheInsuredPerson;intheabsenceofaspouse,thelegalheirswiththeexclusionofthestate;IncaseofanunderageInsuredPerson:theinsuredparent(s);Inallothercases:theInsuredPerson.
1.
5BenefitPeriodmeanstheperiodbetweentheEffectiveDateofthecoverandtheterminationofthebenefitfortheconcernedInsuredPerson.
1.
6CompanymeansTaiPingInsuranceCo.
LtdinChina.
1.
7ComplementaryMedicinemeansconsultationservicesandmedicationprovidedbyaphysiotherapist,chiropractor,acupuncturist,bonesetter,osteopath,homoeopathorChinesemedicinepractitioner,whoisfullytrained,whoislicensedbythecompetentmedicalauthoritiesofthecountryinwhichtreatmentisprovided,andwhoispracticingwithinthescopeofhisorherlicensingandgraduation.
1.
8ComplicationsofPregnancyareconditionswhosediagnosesaredistinctfrompregnancybutareadverselyaffectedorcausedbypregnancy,suchas:acutenephritis,nephrosis,cardiacdecompensation,missedabortion,andsimilarmedicalandsurgicalconditionsofcomparableseverity.
Theyincludeectopicpregnancywhichisended,spontaneousendingofpregnancyatatimewhenaviablebirthisnotpossible,puerperalinfection,eclampsia,andtoxemia.
TheydonotincludecomplicationsorIllnessfromIVFinducedpregnancy,caesareansection,falselabor,occasionalspotting,Physicianprescribedrestduringpregnancy,morningsickness,andsimilarconditionsassociatedwiththemanagementofadifficultpregnancybutwhicharenotmedicallydistinctconditions.
1.
9CongenitalConditionmeansaphysicalormentalabnormalityexistingattimeofbirthormanifestingitselfwithinsixmonthsofbirth.
1.
10CosmeticSurgerymeansanytreatmentperformedtoreshapenormalstructuresofthebodyinordertoimprovethephysicalappearance.
1.
11DateofServicemeansthedateonwhichamedicalserviceisrendered.
1.
12EffectiveDatemeansthedateonwhichtheperiodofcovercommencesfortheInsuredPersonunderthispolicy.
1.
13Emergencymeansasuddenchangeinaperson'shealththatrequiresurgentmedicalorsurgicalinterventiontoavoidpermanentdamagetolifeorhealth.
1.
14HomeCountrymeansthecountryofwhichtheInsuredPersonholdsapassportandtowhichtheInsuredPersonwouldwanttoberepatriated.
1.
15Hospitalmeansanestablishmentdulyconstitutedandregisteredasafacilityforthecareandtreatmentofsickorinjuredpersonsasbedpatientsandwhich:a.
hasorganizeddiagnosticandsurgicalfacilities,b.
provides24houradaynursingservicesbyRegisteredNurses,c.
issupervisedbyastaffofPhysicians,andd.
isnotanursinghome,resthome,convalescencehome,placeforcustodialcare,homefortheaged,institutionforMentalorBehavioralDisorders,sanatorium,oraplaceforthetreatmentofalcoholicsordrugaddicts;eveniflocatedatthesameplace.
1.
16HostCountrymeansthecountryinwhichtheInsuredPersonisstayingforstudy.
1.
17Illnessmeansaphysicalconditionmarkedbyapathologicaldeviationfromthenormalhealthystate,andwhichisnotanInjury.
1.
18InjurymeansphysicaldamagearisingwhollyandexclusivelyfromacoveredAccident.
1.
19InsuredPersonmeanseverypersondesignatedassuchinthepolicyschedule,whohasappliedforcoverbythispolicyandforwhomcoveragehasbeenconfirmedinwritingbytheCompanyortheMedicalPlanAdministrator.
1.
20Insuredperiodmeanstheeffectiveperiodofthepolicyshallbeinaccordancewiththeperiodasspecifiedinthepolicy,thattheinsuredshallleavehispermanenthomeoractualaddresstogoabroad,andshallendontheenddatenamedonthepolicysheetorasmuchearlierastheinsuredshallreturntohisactualaddress.
Thecovershallcommencefromthezerohouroftheeffectivedatethatisspecifiedinthepolicyafterthepolicyholderpaysthepremiumasagreed.
Theinsurershallbearcorrespondinginsuranceliabilitiesafterthepolicytakeseffect.
1.
21LegalExpensesmeansThefees,expensesandothercoststhatcanreasonablybechargedbytheRepresentativeinconnectionwithacauseforaction,includingthereasonableexpensesofexpertsandoftheCompanyincurredinthisconnection.
ThelegalcostsincurredbyoronbehalfoftheInsuredPersonandtheextra-judicialcostsaftersettlementoutofcourt.
Thefees,expensesandothercoststhatcanreasonablybechargedbytheRepresentativeforappealproceedings,providedthatpriorwrittenpermissionfromtheCompanyhasbeenobtainedforsuchproceedingsandprovidedthattheyareconnectedwiththecauseofactionreferredunderthefirstbulletpointofthisdefinition.
1.
22MedicalConsultantmeansaPhysicianadvisingtheCompany,AIGTravelAssistortheMedicalPlanAdministrator.
1.
23MedicalEmergencymeanstheunexpectedonsetofanInjuryorSicknesswhichmanifestsitselfbyacutesymptomofsufficientseverity(includingseverepain)suchthataprudentlayperson,whopossessesanaverageknowledgeofhealthandmedicine,couldreasonablyexpecttheabsenceofimmediatemedicalattentiontoresultin:(1)placingthehealthoftheindividual(or,withrespecttoapregnantwoman,thehealthofthewomanorherunbornchild)inseriousjeopardy;(2)seriousimpairmenttobodilyfunctions;or(3)seriousdysfunctionofanybodilyorganorpart.
AMedicalEmergencydoesnotincludeelectiveorroutinecare.
1.
24MedicallyNecessarymeansfortherapeuticservicesthattheInsuredPersonhasacoveredIllnessorInjuryandthattheservicesarerequestedbytheattendingPhysiciantopreventpermanentdamagetolifeorhealth.
Fordiagnosticservices,MedicallyNecessarymeansthattheInsuredPersonhasactivesymptomsofunknowncauseandsuggestiveofacoveredIllnessorInjury,andthattheservicesarerequestedbytheattendingPhysiciantodeterminewhethertherapeuticservicesarerequired.
1.
25MedicalPlanAdministratormeanstheorganizationthatprovidesthemedicaladministrationservicesdescribedinthispolicyonbehalfoftheCompany.
1.
26MedicinesandDrugsarethoseforwhichaPhysician'sprescriptionisrequiredforpurchase,whichhavebeenprescribedbyaPhysicianfortreatmentofacoveredIllnessorInjury,andwhichhavebeendispensedbyaPhysician'sofficeorbyalicensedpharmacist.
1.
27MentalandBehavioralDisordermeansapsychiatric,psychological,affective,mentalorbehavioraldisorder,irrespectiveofwhetheraphysiologiccauseisknownorsuspected.
ItincludesanyconditionlistedasMentalandBehavioralDisorderintheInternationalClassificationofDiseasesoftheWorldHealthOrganization.
1.
28PalliativeCaremeanstheservicesprescribedbytheattendingPhysician,ofaninstitutiondulyconstitutedandregisteredtoprovideacentralizedprogramofpalliativeandsupportiveservicestodyingpersonsintheformofphysical,psychological,socialandspiritualcare.
1.
29ParentalAccommodationmeanscostsforanaddedbedinthesameroomforaparentorlegalguardian.
1.
30PhysicianmeansamedicalpractitionergraduatedfromarecognizedmedicalschoollistedintheDirectoryofMedicalSchoolsoftheWorldHealthOrganization,whoislicensedbythecompetentmedicalauthoritiesofthecountryinwhichtreatmentisprovided,andwhoispracticingwithinthescopeofhislicensingandgraduation.
1.
31PlanAdministratormeanstheorganizationthatprovidestheclaimadministrationservicesdescribedinthispolicyonbehalfoftheCompany.
1.
32PolicyholdermeansthepersonwhohastakenoutthisinsurancewiththeCompanyandwhoisnamedassuchinthepolicyschedule.
1.
33Pre-existingConditionsLimitationmeansaSicknessorrelatedconditionwhichwascontractedorwhichmanifesteditself,orforwhichalicensedPhysicianwasconsulted;orforwhichtreatmentormedicationwasprescribedpriortotheEffectivedateoftheInsuredperson'scoverageunderthisPolicy.
1.
34Post-hospitalizationServicesmeansmedicalservicesimmediatelyfollowingacoveredstayinaHospital,andthatareprovidedbyororderedbytheattendingPhysicianasadirectconsequenceofthecoveredIllnessorInjurythatnecessitatedsuchhospitalization.
1.
35Pre-hospitalizationServicesmeansmedicalservicesincurredwithin30dayspriortoanddirectlyrelatedtoacoveredstayinaHospitalwhichareprovidedbyororderedbyaPhysician.
1.
36ReasonableandCustomaryExpensesmeaninsuredmedicalexpensesthatdonotexceedthegeneralleveloffeesforcomparableservicesbysimilarhealthcareprovidersinthesameregionforasimilarIllnessorInjury,irrespectiveofavailabilityofinsurance.
Incaseofanunusualnatureofserviceorsupply,theMedicalPlanAdministratorwilldeterminetowhatextentthechargeisreasonableandcustomary,takingintoaccountthecomplexityinvolved,thedegreeofprofessionalskillsrequiredandotherpertinentfactors.
1.
37ReconstructiveSurgerymeansanytreatmentperformedonabnormalstructuresofthebody,whethercausedbyCongenitalConditions,developmentalabnormalities,InjuryorIllness,inordertoimprovefunctionorapproximateanormalappearance.
1.
38RegisteredNurseisagraduatetrainednursewhohaspassedastateregistrationexaminationandhasbeenlicensedtopracticenursing.
1.
39RepresentativemeansalicensedattorneyorsimilarprofessionalwhohasbeenauthorizedtoactonbehalfoftheInsuredPersoninaccordancewiththeconditionsofthisinsurancepolicy.
1.
40Soundnaturaltoothmeansatoothwithnodecay,nofillingonmorethantwosurfaces,nogumdiseaseassociatedwithboneloss,norootcanaltherapy,thatisnotadentalimplantandfunctionsnormallyinchewingandspeech.
1.
41StandardPrivateRoomisthelowestratedroomwithasinglebedinthatHospital.
1.
42StudentistheInsuredpersonwithaChinesepassportthatisgrantedbytheChineseGovernmentandhasisresidenceforamaximumofthreeyearsinoneofthecountriesinEuropeforstudyandisregisteredasastudentorscholaratauniversityorotherscholarinstitutionsthatarelocatedinthehostedcountry.
1.
43VenerealDiseasemeansanIllnesswhichhasbeentransmittedbysexualcontact,oranyofthefollowingIllnesseswhethersexuallytransmittedornot:syphilis,gonorrhea,venerealwartsincludinggenitalHPV(humanpapillomavirus),genitalherpes,granulomainguinale,chancroid,trichomona,pubiclice(phthiruspubis)infestation,andChlamydia.
1.
44Warmeansanyactivityarisingoutofmilitaryforceoranattempttoparticipateinmilitaryforcebyanation,andwillincludecivilwar,revolutionandinvasion.
Article2-GeneralConditions2.
1EligibilityThepolicyisopentoastudentwithresidenceinPeople'sRepublicofChinaandstudyinginoneoftheEuropeancountries.
ThereforethestudentrequiresapassportfromtheChineseGovernmentandavisafromtheincomingEuropeanhostcountry.
Thestudentalsoneedstoberegisteredataacknowledgeuniversityorotherscholarinstitutionsinthehostcountrytheyhavereceivedvisafrom.
TheagelimitforenrolmentofanInsuredPersonis40years.
TheEffectiveDateofthecoverofthisindividualinsurancewillbecomeeffectiveonthelaterof:A)ThePolicyeffectivedate;B)ThedateindicatedontheEnrollmentForm(ifapplicable)forwhichpremiumhasbeenpaid;C)ThedatetheInsuredPersondepartshisorherHomeCountrytotraveltoEurope,providedthatthescheduledarrivalinEuropeisnomorethan48hourslaterthandeparturefromtheHomeCountry;orD)ThedatetheEnrollmentForm(ifapplicable)andpremiumarereceivedbytheprogramAdministratorThemedicalformalitiesare:AmedicalquestionnairehastobecompletedbyeachInsuredPersonandhastobesubmittedtotheCompany.
TheCompanycanathisdiscretiondefinepartialortotalexclusionofcoverorproposeanadditionalpremiumtowaiveexclusions.
2.
2AreaofCoverThepolicycoverstheInsuredPersonwithinEuropeandPeople'sRepublicofChina.
2.
3TerminationofpolicyandorBenefitsThebenefitsfortheInsuredPersonunderthisPolicyterminateontheearliestofthefollowingmoments:AtmidnightonthelastdayofthePolicyPeriod;Thelastdateforwhichpremiumhasbeenpaid;ThedatetheInsuredPersonceasestobeeligiblefortheInsurance;ThedatetheInsuredPersondepartsEuropeforChinapermanently(notforatemporaryvisitforaperiodofatmostfourweeks);ThedatetheInsuredPersonentersmilitaryservice;Themomenttheconcernedbenefitofthispolicyhavebeenexhausted;Onthenextannualpolicyrenewaldatefollowingthe40thbirthdayoftheInsuredPerson;ThemomenttheInsuredbecomeorcouldhavebecomecoveredbytheNationalHealthServiceoftheirHomeCountryorbytheNationalHealthServiceofthehostCountry;Terminationbywrittennoticeoftheinsurerwithintwomonthsiftheinsurerhasdiscoveredthatthepolicyholderdidnotcomplywithhisdutyofdisclosurewhentakingouttheinsuranceandthatpolicyholderactedwiththedeliberateintentofmisleadingtheinsurerorthattheinsurerwouldnothaveconcludethepolicyhehadknownthetruestateofaffairs.
Theinsuranceendsonthedatementionedinthenoticeletter.
TheInsurerisentitledtorecoverclaimscompensationthathasbeenpaidunderthispolicyfromtheInsured.
2.
4PaymentofPremiumsThepremiumisdueonthepremiumduedateasstatedinthepolicyschedule.
IfthePolicyholderhasnotpaidorrefusestopaytheinitialpremiumwithin30daysofreceiptoftherequestforpayment,nocoverisprovidedforanyeventoccurringaftertherequestdate,withouttheCompanybeingrequiredtoserveanynoticeofdefault.
IfthePolicyholderrefusestopaytherenewalpremium,nocoverisprovidedforeventsoccurringaftersuchpremiumrequestdate.
IfthePolicyholderdoesnotpaytherenewalpremiumontime,nocoverisprovidedforeventsoccurringasfromthe15thdayofthedateonwhichtheCompanysentthePolicyholderawrittendemandforpaymentaftertheduedateandpaymenthadnotbeenmade.
ThePolicyholdershallremainobligedtopaythepremium.
Nocoverisprovidedunderthispolicyforeventsthattookplaceduringtheperiodinwhichthecoverwasinterrupted.
2.
5PremiumrefundafterterminationIfthepolicyholderdecidestoterminatethecontractprematurelytheunearnedpremiumisrefundedafterdeductionof25%costsandinsofarasthepaymentisnotlessthan25.
00.
Inallcasestheminimumpremiumis9/12fromtheannualpremiumforeachindividualpolicy.
Incaseofaprematureterminationbytheinsureror–afterachangeofthepremiumand/orthetermsandconditionstothedetrimentofthepolicyholder–bythepolicyholder,unearnedpremiumswillfullyberefunded.
Incaseofprematureterminationduetodeliberateintenttomisleadtheinsurer,nopremiumswillberefunded.
2.
6ChangeofRiskThePolicyholderandInsuredPersonshallinformtheCompanyimmediatelyofanychangeincircumstancesorconditionsthatmayincreasetherisk.
ThisincludesbutisnotlimitedtochangeofHomeCountry,orchangeofHostCountry.
IfsuchchangeisnotachangeinthehealthstateoftheInsuredPersonandthechangeinvolvesanincreasedrisk,theCompanyhastherightduringonemonthtocanceltheinsurancecoverortoincreasethepremiumandtheconditionsofinsurance,andthisretroactivelyasfromthemomentoftheaggravationoftherisk.
ThePolicyholdershallhavetherighttorefusetheamendedpremiumandconditionsofinsurancebycancellingthepolicywithin60daysofthedateonwhichthePolicyholderwasinformedoftheamendment.
2.
7ChangeofPremiumRatesand/orConditionsThepremiummaybeadjustedatJanuary1stofeachyear.
TheCompanyshallhavetherighttochangethepremiumand/orconditionsofcertaininsurancecoversonaclassbasisforallsimilarcovers.
Ifthispolicybelongstosuchagroupofproducts,theCompanyshallhavetherighttochangethepremiumand/orconditionsofthispolicyaccordinglywitheffectfromJanuary1stofeachyear.
TheCompanyshallinformthePolicyholderinwritingatleast2monthsbeforetheeffectivedateofthechange.
ThePolicyholderisdeemedtohaveacceptedthisunlessthePolicyholdercancelstheagreementwithinonemonthofthenotificationofthechange.
Inthelattercase,theinsuranceshallendatmidnightofDecember31st.
ThePolicyholdershallnothavetherighttocancelthepolicyifthechangeinvolvesareductionofthepremiumoranextensionofthecoverwithoutpremiumincrease.
2.
8CancellationintheEventofWarTheCompanyandthePolicyholdermaycancelanycoverforWarifsuchriskismanifestedorifthisisabouttohappen,subjectto7days'notice.
2.
9NotificationofClaimThePolicyholder,InsuredPersonorBeneficiaryshallrespecttheproceduresmentionedunderthetitle"ClaimsProcedure"oftheconcernedbenefit,oringeneralnotifytheCompany,assoonasheisawareofthepotentialoccurrenceofariskcoveredbythisinsurancepolicy.
2.
10ProofofClaimsThePolicyholder,InsuredPersonorBeneficiaryshallprovideattheirownexpenseallreasonableandnecessarydocumentstosubstantiatetheclaim.
TheyshallcooperateinmedicalorotherexaminationsorenquiriesrelatedtotheclaimiftheCompanydeemsthisnecessary.
2.
11ReasonableCareThePolicyholder,InsuredPersonsandBeneficiariesmusttakeallreasonablestepstoavoidand/orminimizeexpenses,lossordamageandmustalsomakeeveryefforttorecoveranypropertycoveredbythispolicywhichhasbeenlostorstolen.
2.
12ObligationsandStipulationsThePolicyholderandtheInsuredPersonsshallcomplywiththeobligationsandstipulationssetoutinthepolicy.
IfthePolicyholderortheInsuredPersonfailstodoso,theCompanymaydeductanyconsequentiallossithasincurred.
2.
13FraudThePolicyholder,InsuredPersonorBeneficiarywillloseanybenefitincaseoffraud,deliberatedishonestyordeliberatehidingofinformation,theymustpaybackanybenefitthattheCompanyhasalreadypaid,andshallcompensatetheCompanyforthelossordamageincurredbecauseofthissituation.
Ifthishappens,theCompanywillnotrefundanypremiumandhastherighttoimmediatelycancelthepolicy.
2.
14InterestonPaymentsTheCompanyshallnotpayinterestonanyduepayments.
2.
15OtherInsuranceandSubrogationIftheliability,lossordamagethatiscoveredunderthispolicyisalsocoveredbyaNationalHealthServiceorunderanyotherinsurancepolicy,whetherornotofanearlierdate,orwouldhavebeencoveredunderthesehadthisinsurancenotbeentakenout,thisinsuranceshallonlyprovidecoverinexcessofwhatwouldhavebeencoveredbytheNationalHealthServiceandsuchotherinsurancepolicy.
Theamountspaidunderthisinsuranceshallnotexceed,whencombinedwiththeamountspaidbytheNationalHealthServiceandundersuchotherinsurancepolicy,themaximumlimitsasmentionedonthepolicyschedule.
ThePolicyholder,InsuredPersonorBeneficiaryshallinformtheCompanyofsuchcoverandprovidetheCompany,atrequest,withacopyofthepolicyincludingthebenefitschedules.
IntheeventofInjury,lossordamageinvolvingtheactionsornegligenceofathirdparty,thePolicyholder,InsuredPersonorBeneficiaryshallusetheirbestendeavorstoclaimfromsuchthirdpartyforthefullamountoftheloss.
ThePolicyholder,InsuredPersonandBeneficiaryshallnotnegotiate,settle,compromise,release,orotherwisedischargeanyclaimagainstsuchapartywithouttheCompany'sexpresswrittenconsent.
TheCompanyhasfullrightsofsubrogationandmaytakeproceedingsintheInsuredPerson'sname,butattheCompany'sexpense,torecoverfortheCompany'sbenefittheamountofanypaymentmadeunderthepolicyincludingbutnotlimitedtothecostofsuchproceedings.
2.
16TransferThepolicycannotbetransferredunlessotherwiseagreeduponinwritingwiththeCompany.
2.
17TermofLimitationAclaimagainsttheCompanytomakeapaymentshalllapsebythepassageofthreeyearsafterthestartofthedayfollowingthedayonwhichthepersonentitledtopaymentbecameawareofthepaymentbeingdueandpayable.
Theperiodoflimitationisinterruptedbyawrittennotificationwherebyaclaimtopaymentismade.
AnewperiodoflimitationshallcommencewiththestartofthedayfollowingthedayonwhichtheCompanyeitheracknowledgestheclaimorannouncesbyregisteredletterthatithasrejectedtheclaim,unambiguouslystatingthatintheeventofrejectiontheclaimshalllapsebythepassageofsixmonths.
2.
18AddressTheCompanycangivevalidnoticetothePolicyholderathislastaddressknownbytheCompanyorattheaddressofthebrokerforthispolicy.
2.
19RegistrationofpersonaldataPersonaldataprovideduponapplicationoramendmentofaninsurancepolicyareprocessedbythecompanyforthepurposeofconcludingandperforminginsuranceagreementsand/orfinancialservicesandmanagingensuingrelationships,includingthepreventionandcombatingoffraudandtheperformanceofactivitiesaimedatincreasingitsclientbase.
SuchprocessingofpersonaldataisgovernedbythecodeofconductapplicabletoPersonalDataProcessingforInsuranceCompanies.
Thiscodeofconductsetsouttherightsandobligationsofpartieswithregardtodataprocessing.
ThecompletetextofthiscodeofconductcanbeobtainedfromtheinformationcentreoftheTaiPing.
2.
20GoverninglawandcomplaintsThispolicyisacontractofinsurancebetweenthePolicyholderandtheCompany.
ItwillbegovernedbyandconstruedandinterpretedinaccordancewiththelawapplyinginthecountrywherethePolicyholderhasitshomeaddressandwillbesubjecttotheexclusivejurisdictionoftheCourtsofthatcountry.
SettlementofDisputeContractualdisputesshallberesolvedinoneofthefollowingmethodsdeterminedbythepartiesinthecontract:(1)AnydisputesarisingfromperformanceofthisContractshallbesolvedbynegotiationbetweentheparties,failingwhichthedisputesshallbesubmittedtoarbitrationcommitteeforarbitration;(2)AnydisputesarisingfromperformanceofthisContractshallbesolvedbynegotiationbetweentheparties,failingwhichthepartiesmaybringuplitigationproceedingsinpeople'scourt.
2.
21GeneralExclusionsTheinsurershallnotbeliableforanyeventcausedinfollowingcases:ThefraudactsofthePolicyholder,theInsuredortheBeneficiary;TheintentionalactsofthePolicyholder,theInsuredortheBeneficiary;Explorationorotherhighlyriskactivities(iftheactivitieshavebeenregisteredwithcivilserviceisexclusion,whichincludewintersports,underwatersports,skiing,drifting,bungeejumping,parachutejump,gliding,horseracing,carracing);Theinsuredsuicide,self-inflictedinjury,fighting,committingcrimes,arrestresistance,andduringtheperiodtheinsuredunderarrest,putinprisonbyjudicialdepartments;Drivingwithoutalicense,ordrivingavehiclewithoutavalidcertificate;Costsofaccidentorillnesscausedbymentalillnessorunconsciousness,ifthisisaresultoftheconsumptionofalcohol,drugs,intoxicantsorsedatives,sleepingtabletsorothernarcoticsubstances;Phrenitisoranoia;Miscarriage(exceptifcausedbyanaccident),childbearingandabortion;Anyexpenserelatedtothemedicaltreatmentorhealthcarewhichisnotrecognizedbylocalgovernment;Anyexpenserelatedtocosmeticsurgery;Anyexpenseforobtainingtransplantingorgansorthedonationfortransplantingorgans;Routineorlong-termdialysisforchronicoradvancedstageofrenalfailure;Chemicalcontamination,terrorismorheresyactivity;Nuclearexplosion,nuclearradiationornuclearpollution;ProfessionalSportsandsportingactivitieswithrewards;War,MilitaryAction,Civilwarandarmedrebellion;Injured,diedordiseasedorindirectcausedofasbestos;Anyexpensecausedbystrike,SRCCandHijacking.
Article3-MedicalExpense3.
1ClaimsProcedureContactinformation:TheMedicalPlanAdministratorforTaiPingInsuranceCompanyLtdP.
O.
Box69B-2140ANTWERPBELGIUM24/365telephonenumber:+32-3-2176777Fax:+3232358351Email:myclaim@issi-china.
comWebsite:(IDwillbecommunicatedtotheInsuredPersonwiththeWelcomePackage)Non-EmergencyHospitalizationandoutpatientsurgeryneedpre-certificationfromtheMedicalPlanAdministrator.
TheMedicalPlanAdministratorwillguaranteethemedicalexpensestotheHospital.
TheInsuredPersonmustpayotherexpensestotheproviderandsubmitaclaimforreimbursementinwritingtotheMedicalPlanAdministratorwithin90daysoftheDateofService.
Claimformscanbeobtainedbycontactingthe24/365telephonenumberorcanbefoundonthewebsite.
TheclaimformmustbecompletedandsenttotheMedicalPlanAdministratortogetherwiththeoriginaldocumentation,invoicesandreceipts(photocopiesorscansarenotaccepted).
IncasetheInsuredPersoncanclaimfromtheNationalHealthServiceoranyotherinsurancepolicy,heshouldfirstrequestreimbursementfromthatorganization.
TheInsuredPersonshallafterwardsforwardtheoriginalsettlementconfirmationfromthatorganizationwithphotocopyofthesubmitteddocumentation,invoicesandreceiptstotheMedicalPlanAdministrator.
TheMedicalPlanAdministratorshalldeducttheamountsthatareorcouldhavebeenreceivedfromthatorganization.
3.
2MedicalExpenseBenefitsThisPolicyshallprovidecover:withinthelimitationsstatedinthepolicyandthepolicyschedule;fortheactual,ReasonableandCustomaryExpensesincurredbytheInsuredPerson;fortheserviceslistedbelow;thatdirectlyrelatetoacoveredInjuryorIllnesssufferedbytheInsuredPerson;thatareprescribedandcertifiedMedicallyNecessarybytheattendingPhysician;thataregeneralacceptedandscientificallyrecognizedmedicalservices,excludinganyexperimentalorpioneeringservices;andthathaveaDateofServiceduringtheBenefitPeriod.
ThecompensationforMedialExpenseislimitedto200,000perpersonperyearforeachinsuredperiodof365days.
Prescriptionmedicationsarelimitedtoamaximumof500perpersonperyear.
Dentalexpenseislimitedto340perpersonperyear.
Adeductibleof50perpersonperpolicyperyearforInjuryorSicknessisapplicableonthiscover.
Insuredservicesincaseof:a.
Hospitalization&OutpatientSurgery:HospitalaccommodationcostsincludinggeneralnursinginaStandardPrivateRoom.
Expensesrelatedtotheatrefees;intensivecare;medicalimaging;diagnosticandtests;prescribedmedicinesanddrugs,bloodandplasma;surgicalappliances;medicalaids;surgicalappliances.
FeesofPhysicians,includinganesthetist,surgeon,specialist,radiologist,physiotherappathologistfees.
FeesofPhysiciansforPre-andPost-HospitalizationServices.
Thecompanywillpaythecostsofmedicaltreatmentupuntilthe365thdayafterthedaydayonwhichthisadmissionshallhavecommenced.
Reimbursementshalltakeplaceonthebasisofthelowestclass.
b.
OutpatientBenefit:FeesofafamilyPhysician.
FeesofPhysiciansandspecialistconsultations.
PrescribedMedicinesandDrugsthatcannotbepurchasedwithoutprescription.
Medicalimaging,diagnosticandlaboratorytests,andsurgicalappliances.
Medicalaids.
Non-experimentalpreventivecareandexaminations.
ComplementaryMedicine.
Acupunctureismaximizedby500perperiodof12months,aftersubmissionofarefecertificateissuedbythegeneralphysicianorspecialist.
ReimbursementshallbemadeinaccordancewiththeratesforPhysio-,Mensendieck-Chiropractic-orCesartherapistsassetdownbyCentralHealthChargesBoardformaximumof12treatments/applicationsperperiodof12months,aftersubmissionreferralcertificateissuedbythegeneralphysicianorspecialistandlimitedtoeachinsuredperiodof365days.
c.
LocalAmbulance:LocalEmergencymedicaltransport.
d.
PrivateNursingBenefit:Inpatientinhospitalornursinghome.
HomenursingcostsbyaRegisteredNurse,upto60daysperpolicyyear.
PalliativeCare.
e.
MaternityandChildbirthBenefit:Notcovered.
Treatmentmiscarriageiscoveredifcauaccidentf.
MentalandBehavioralDisordersBenefit:Expensescoveredunderthepoints"a"to"d"abovethatarerelatedtothetreatmentsoandbehavioraldisorders.
TheinpatienttreatmentislimitedtomentalandbehavioraldisordersthatbeginmorethmonthsaftertheEffectiveDateofthecover,unlesstheCompanybecauseofaPrecedwaivedthewaitingperiod.
TheoutpatienttreatmentislimitedtomentalandbehavioraldisordersthatbeginmoretmonthsaftertheEffectiveDateofthecover,unlesstheCompanybecauseofaPolicywaivedthewaitingperiod.
Reimbursementshallbemadeforamaximumof9treatmentsperperiodof12monthssubmissionofareferralcertificateissuedbythegeneralphysicianorspecialistreatmentshallexclusivelyqualifyforreimbursementifpriorconsenthasbeengrantedforinsurer.
g.
EmergencyDentalBenefit:Expensescoveredunderthepoints"a"to"b"abovethatarerelatedtoemergencydenttreatmentrequiredforAccidentaldamagetosoundnaturalteeth.
Maximumcoveris340perinsuredperiodof12monthsh.
EmergencyVisionBenefit:Expensescoveredunderthepoints"a"to"b"abovethatarerelatedtoemergencyvisiotreatmentrequiredforAccidentaldamagetoaneye.
i.
VenerealDiseases:Expensescoveredunderthepoints"a"to"b"abovethatarerelatedtovenerealdiseasiscovereduptoamaximumof100pertreatmentperinsuredperiodof364days.
3.
3MedicalServiceProviderReferralTheMedicalPlanAdministratorcanrefertheInsuredPerson,uponrequest,toasuitableHospital.
Theinformationcanbeobtainedbycontactingthe24/365telephonenumberorcanbefoundonthewebsite.
WhiletheMedicalPlanAdministratorexercisecareanddiligenceinselectingtheMedicalServiceProviders,theCompanyortheMedicalPlanAdministratorcannotguaranteeandisnotresponsiblefortheserviceobtainedfromtheMedicalServiceProviders.
3.
4RepatriatedTreatmentIftheinsuredisrepatriatedtothePeople'sRepublicofChinaandmedicaltreatmentisstillnecessarythemedicalexpensesincurredinthePeople'srepublicofChinaforthesamedisease/injury/illnesscontractedabroadattheusualcustomarylevel,untilthemomentwhentheinsuredisabletoinsurehimselfagainstmedicalexpenses,butforamaximumperiodof10days,countingfromthedateofreturn.
3.
5ExclusionsInadditiononthegeneralexclusionsdescribedunderarticle2ofthispolicywordingforthecoverofMedicalExpensethefollowingexclusionsareapplicable:AnyinsuredservicesnotexplicitlylistedundertheMedicalExpensebenefitsection;Medicalexpenses,services,ortreatmentsincurredinexcessof365daysfromthedateofloss;Vitaminsandminerals(exceptifprescribedandcertifiedMedicallyNecessarybytheattendingPhysiciantotreatsignificantvitaminormineraldeficiencysyndromes),nutritionalanddietarysupplements,babyfood;CosmeticSurgery;ReconstructiveSurgery,unlessthetreatmentisMedicallyNecessaryandcarriedoutaspartoftheoriginaltreatmentoftheCongenitalConditions,developmentalabnormalities,InjuryorIllness;Relievingsymptomscausedbyageing,pubertyorothernaturalphysiologicalcause;Outpatienttreatmentofsleepdisorders;Medicaltreatmentandothermeasuresorderedbyaphysicianwheretheinsuredpersonwasawarewhenstartingthetripthat,ifthetriptookplaceasplanned,thetreatmentwouldhavetobegivenformedicalreasons(e.
g.
dialysis);Medicaltreatmentwhichwasthereasonforgoingonthetrip;Treatmentofpre-existingillness,congenitalmalformation,deformationorchromosomeAbnormality;Purchaseandrepairofheartpacemakers,prosthesesandaidstoassistssight;Treatmentofweightlossorweightproblems;MentalandBehavioralDisorderslistedasF10tillF19,F45,F52,F55,F59orF99intheInternationalClassificationofDiseasesoftheWorldHealthOrganization;ExpensesincurredwhereanInsuredPersonhasnotfollowedthemedicaladviceofthePhysician;Experimentalorpioneeringtechniques;PhysiotherapeutictreatmentsasSpeechtherapy,Ergotherapy,Occupationaltherapy,AntenatalandPostnatalexercisesandSportmassage;Orthomanualtherapy,podotherapy,chiropractictreatment,camouflagetherapy,electricalepilation,acnetreatment,balneaophototherapyoranyotherpreventiveand/oralternativetreatment;ProductsthatcanbeobtainedwithoutaPhysician'sprescription;Costsrelatedtotherentalofpurchaseofapparatusesordevices;Anysexualproblemincludingimpotence(whateverthecause),sexchangeorgenderReassignment;HIVandAIDS;Curecentre,bathcentre,spa,healthresortandrecoverycentre,evenifthestayismedicallyprescribed;Fertility,complicationsorIllnessfromIVFinducedpregnancy,impotenceorerectiledysfunction,contraception,sterilization,electivecesarean,orterminationofpregnancythatisnotmedicallynecessary;Dentalandvisiontreatment,excepttheEmergencyDentalBenefitandtheEmergencyVisionBenefitasmentionedabove;Batteries,electricity,maintenanceexpensesandrechargingofappliancesormedicalaids(Includinghearingandvisualaids);Transfer,transportortravelexpenses(exceptthoseforlocalEmergencymedicaltransportofinsuredundertheAssistancebenefit).
Article4-Accident4.
1.
Definitions4.
1.
1AccumulationLimitmeansthetotalmaximumamounttheCompanywillpayintheaggregateunderthisandanyotheraccidentinsurancepolicyissuedbytheCompanyforInjuriessufferedbyallInsuredPersonsinthesameAccidentorseriesofAccidentscontributedto,causedbyorconsequentuponthesameoriginalcause,eventorcircumstance.
4.
1.
2DefermentPeriodmeanstheinitialperiodofTemporaryDisablementduringwhichthebenefitonthepolicyscheduleisnotpayable4.
1.
3LossofHearingmeanstotalandpermanentlossofhearing.
4.
1.
4LossofLimbmeans:Inthecaseofalegorlowerlimb:a.
lossbypermanentphysicalseveranceatorabovetheankle,orb.
permanentandtotallossofuseofacompletefootorleg.
Inthecaseofanarmorupperlimb:a.
lossbypermanentphysicalseveranceofthefourfingersatorabovethemetacarpophalangejoints(wherethefingersjointhepalmofthehand),orb.
permanentandtotallossofuseofacompletearmorhand.
4.
1.
5LossofSightmeanspermanentandtotallossofsightinbotheyes,orinoneeyeifthedegreeofsightremainingaftercorrectionis3/60orlessontheSnellenScale.
4.
1.
6LossofSpeechmeanstotalandpermanentlossofspeech.
4.
1.
7Paraplegiameansthepermanentandtotalparalysisofthetwolowerlimbs,bladderandrectum.
4.
1.
8PermanentDisablementmeanspermanenttotalorpartiallossordisablementofanylimbororgan(orapartthereof).
4.
1.
9Quadriplegiameansthepermanentandtotalparalysisofthetwoupperlimbsandtwolowerlimbs.
4.
1.
10TemporaryDisablementmeansanInjurythatpreventstheInsuredPersonfromcarryingoutallpartsofhisusualandpaidprofessionaloccupation.
4.
2Cover4.
2.
1DeathIftheInsuredPersonhadaninsuredAccidentduringtheBenefitPeriodanddieswithintwoyearsasadirectandsoleconsequenceofthatAccident,thesuminsuredstatedinthepolicyscheduleispaidout.
ThepaymentismadeassoonastheinvestigationbytheCompanyintotheAccident,thecauseofdeathandtheconnectionbetweenthetwohasbeencompleted.
AllsumsalreadypaidoutontothisinsurancepolicyforPermanentDisablementasaresultofthesameAccidentaredeductedfromthispayment.
IfanInsuredPersonismissingandafteraperiodof18monthsitcanreasonablybeassumedthattheInsuredPersonhasdiedastheresultofInjury,thesuminsuredstatedonthepolicyscheduleispaidout.
Inthatcase,theBeneficiaryisrequiredtosignanagreementstatingthatifittranspireslaterthattheInsuredPersonhasnotdied,anybenefitsreceivedarerepaidtotheCompany.
ThesuminsuredfortheInsuredislimitedto10,000.
Foraccidentswhichoccurwhiledrivingorridingasapassengeronamotorcyclewithacylindercapacityof50ccormore,thepaymentupondeceaseshallbelimitedto5,000.
Adeductibleforthiscoverisnotapplicable.
4.
2.
2PermanentDisablementIntheeventofPermanentDisablementasaresultofaninsuredAccidentduringtheBenefitPeriod,theCompanyshallpayoutthepercentagesofthesuminsuredapplicabletoPermanentDisablementassetoutbelow.
ThedegreeofPermanentDisablementisassessedassoonasithasreasonablybeenconcludedthattheconditionoftheInsuredPersonisnotlikelytoimproveordeteriorate,butnotlaterthantwoyearsaftertheAccident.
IntheeventthattheInsuredPersondiesbeforethepercentagehasbeendetermined,theCompanyisnotobligedtopayanyPermanentDisablementbenefit.
However,iftheInsuredPersondiesmorethan6monthsaftertheAccidentbutnotasaresultoftheAccident,theCompanyshallpaytheamountthatitwouldreasonablyhaveexpectedtopayoutforPermanentDisablementhadtheInsuredPersonnotdied.
Inordertodeterminethepercentageofdisablement,thefollowingdisablementscaleisused:TABLE1ScheduleofBenefitsforDismembermentDegreeItemDegreeofDismembermentPercentageofSumInsuredLevel11PermanentTotalLossofsightofbotheyes(note1)1002Lossofbothupperlimbsatorabovethewristorofbothlimbsatorabovetheankle3Lossofoneupperlimbatorabovethewristandofonelowerlimbatoraboveankle4PermanentTotalLossofsightofoneeyeandofoneupperlimbatorabovethewrist5PermanentTotalLossofoneeyeandofonelowerlimbatorabovetheankle6PermanentTotalLossoffunctionofjointsofallthelimbs(note2)7PermanentTotalLossoffunctionofchewandswallow(note3)8Severedamagetothefunctionofthecentralnervoussystemortheinternalorganssuchastheabdomenandthorax,resultinginthepermanentlossoftheabilitytoengageinanyjoboccupationandindependentlyperformdailyactivitiesthatareessentialtothemaintenanceoflife(note4)Level29PermanentTotalLossoffunctionoftwoormoreofthethreegreat-jointsofbothupperlimbsorofbothlowerlimbsorofbothanupperlimbandalowerlimb(note5)7510TotalLossofallfingers(note6)Level311PermanentTotalLossofoneupperlimbatorabovethewristoroffunctionofthreegreat-jointsofanupperlimb5012PermanentTotalLossofonelowerlimbatorabovetheankleorfunctionofthreegreat-jointsofalowerlimb13PermanentTotalLossofhearinginbothears(note7)14PermanentTotalLossoffunctionofjointsofallfingers(note8)15Lossofalltoes(note9)Level416PermanentTotalLossofsightofoneeye3017PermanentTotalLossoffunctionoftwogreat-jointsofthethreegreat-jointsofanupperlimb18PermanentTotalLossoffunctionoftwogreat-jointsofthethreegreat-jointsofalowerlimb19Lossoffourormorefingers(includingathumbandaforefinger)ofonehand20PermanentShorteningofLegbyatleast5cm21PermanentTotalLossofSpeech(note10)22PermanentTotalLossoffunctionofalltoesLevel523PermanentTotalLossoffunctionofonegreat-jointofthethreegreat-jointsofanupperlimb2024PermanentTotalLossoffunctionofone-greatjointofthethreegreat-jointsofalowerlimb25Lossofboththumbsofbothhands26Totallossoffivetoesofonefoot27Obviousdefectoftwoeyelids(note11)28PermanentTotalLossofhearinginoneear29Defectofnasalpartandseveredysosmia(note12)Level630Lossofforefingerandthumbofonehand,orofmorethanthreefingersincludingthumborforefinger1531PermanentTotalLossoffunctionofthreeormorefingersofonehandincludingthumborforefinger32PermanentTotalLossoffunctionoffivetoesofonefootLevel733Lossofathumboraforefingerofonehand,ortwoormorefingersofmiddle-finger,ring-fingerorlittlefinger1034PermanentTotalLossoffunctionofathumbandaforefingerofonehandNotes:1.
Lossofsightofeye(s)shallincluderemovalorlossofeyeball(s),oranopia,oronlytheabilityforlightsensation,orvisualacuityaftercorrectionoflowerthan0.
02oftheinternationalstandardeyesightchart,oravisualfieldnarrowerthan5degrees.
MedicalevidencemustbeprovidedbyaqualifiedophthalmologistappointedbytheCompany.
2.
Lossoffunctionofjoint(s)shallmeanpermanenttotalstiffness,orparalysisofthejoints,orthatthejointsmaynotbeabletomovewillfully.
3.
Lossoffunctiontochewandswallowshallmeantheorganicorfunctionaldisturbanceofsuchfunctionsaschewingandswallowingbyanymeansotherthandentalcauses,andwhichrenderstheInsuredPersonincapableofeatingorswallowinganythingotherthanfluiddiet.
4.
InabilitytoperformindependentlythedailyactivitiesthatareessentialtolifeshallmeancompleteandcontinuousinabilityoftheInsuredPersontoperformsuchactivitiesindependentlyaseating,goingtothetoilet,dressing,walking,bathing,etc.
,andmustrelyontheassistanceofothers.
5.
Thethreegreat-jointsofupperlimbincludeshoulderjoint,elbowjoint,andwristjoint;threegreat-jointsoflowerlimbincludehipjoint,kneejoint,andanklejoint.
6.
Totallossoffingershallmeancompleteseverancethroughorabovetheproximalphalangealjoints(interphalagealjointsofthumb).
7.
Totallossofhearingshallmeantheaveragefrequencyhearinglossisabove90dBwherespeechfrequenciesareat500,1,000,2,000Hz.
8.
Totallossoffunctionofjointsoffingersshallmeancompleteseverancethroughthedistalphalangealjoints,orstiffnessofproximalphalangealjointsormovingdisturbanceofthephalangealjoints.
9.
Totallossoftoesshallmeancompleteseverancethroughorabovethemetatarsophalangealjoints.
10.
Totallossofspeechshallmeanthelossofarticulatingabilityofanythreeofthefoursoundswhichcontributetothespeech(fromthelabialsounds,alveolarsounds,palatalsounds,andthevelarsounds)ortotallossofvocalcordordamageofspeechcenterinbrainresultinginaphasia.
However,allpsychiatricrelatedcausesareexcluded.
Medicalevidencemustbesuppliedbyaqualifiedotorhinolaryngologyspecialist.
11.
ObviousdefectoftwoeyelidsshallmeaneyelidsincapableofcoveringcorneascompletelywhentheInsuredPersoncloseshis/hereyes.
12.
Defectofnasalpartandseveredysosmiashallmeantheirrecoverabledefectoftotaloronehalfnasalcartilageandnasalatresia,nasaldyspneaoranosmiaofbothsides.
Permanenttotallossshallmeanbodilyinjurybeyondhopeofimprovementattheexpiryofatleastonehundredeighty(180)daysmedicaltreatmentfromthedateofAccident,butexcludetheirrecoverablestatussuchasremovingtheeyeball.
TABLE2ScheduleofBenefitsforThirdDegreeBurnsBodyPartPercentageofDamagedAreatoTotalBodySurfaceAreaMaximumPercentageofSumInsuredHead2%ormorebutlessthan5%50%5%ormorebutlessthan8%75%8%ormore100%Body(excludedheadsurfacearea)10%ormorebutlessthan15%50%15%ormorebutlessthan20%75%20%ormore100%ThesuminsuredfortheInsuredislimitedto75,000.
Adeductibleforthiscoverisnotapplicable.
4.
2.
3PersonalBelongingsIfaninsuredAccidentresultsinimmediatehospitalization,theCompanyshallpayfordamagetoandthecostoflost,damagedorstolenpersonalbelongingsasadirectresultoftheAccident,uptoamaximumof1,000.
4.
2.
4SeatbeltIftheInsuredPersondiesasaresultofaroadtrafficAccidentandithasbeenestablishedthattheInsuredwasnotwearingaseatbeltatthetime,thebenefittobepaidwillbedecreasedby2,500.
4.
2.
5LifeSaverIfathirdparty(notanInsuredPersonorthePolicyholder)sustainsInjurywhiletryingtosavethelifeofanInsuredPersonwhichsubsequentlyresultsinthedeathorPermanentDisablementofthisthirdpartywithintwoyearsoftheevent,theCompanyshallpaythisthirdpartyonthebasisofaninsuredsumof5,000.
ThisbenefitispaidinadditiontoanybenefitpaidtotheInsuredPerson.
4.
2.
6PlasticsurgeryPlasticsurgery,inordertotreatmalformation,disfigurementordefacementoccurredasaresultofanaccident,shallonlybecompensatedif,accordingtotheopinionofaplasticsurgeon,thereisfairchanceofimprovementorrecoverytherefrom.
Thecostsconnectedwiththeoperationortreatmentinanoutpatient'sdepartment,themedicineprescribed,dressingsandotherremediesandthecostsofnursinginthehospitalshallbecompensatedprovidedthatthistreatmenttakesplacewithintwoyearsaftertheaccident.
Thecompensationshallamounttonomorethan5,000peraccidentandwillbegivenontopofthemaximumamountforpermanentdisability.
Iftheabove-mentionedcostsarewhollyorpartiallycoveredbyinsurance,orifaliablethirdpartyhasbeenunderanobligationtocompensatethosecosts,thereshallbenoclaimregardingthiscover.
4.
3ClaimsprocessClaimsProcedureContactinformation:ThePlanAdministratorforTaiPingInsuranceCompanyLtdP.
O.
Box69B-2140ANTWERPBELGIUM24/365telephonenumber:+32-3-2176777Fax:+3232358351Email:myclaim@issi-china.
comWebsite:(IDwillbecommunicatedtotheInsuredPersonwiththeWelcomePackage)4.
3.
1NotificationThepolicyholder,theinsuredpersonand/ortheperson(s)entitledtopaymentis/areobliged:A)Intheeventofdeath:1.
tonotifythecompanyoftheaccidentassoonaspossibleandalwayswithin48hoursaftertheaccident,providingallthedetailsrequiredbythecompany;2.
togivethephysicianand/orauthorizedperson/personsdesignatedbythecompanyeveryopportunitytolaunchanyinvestigationintothecauseofdeaththeymaydeemnecessary;3.
ifrequested,toallowanautopsy.
B)Intheeventofpermanentdisablement:1.
tonotifythecompanyoftheaccidentassoonaspossiblebutalwayswithin90daysoftheaccident;2.
toseekmedicaltreatmentassoonaspossibleandtocontinuesuchtreatment;3.
whenaskedtodosobythecompany,tohavethemselvesexaminedbyaphysiciandesignatedbythecompanyortohavethemselvesadmittedtoahospitaloranyotherinstitutiondesignatedbythecompanyforobservation.
Thecostsassociatedwiththisshallbebornebythecompany.
Ifthenotificationsreferredtoinarticles4.
1.
1and4.
1.
2arenotmadewithintheperiodsspecified:-thecompanymaydeductanylossitincursasaresultofthisfromtheclaim;-thecompanyshallhavetherighttoconcludethattherighttoclaimhaslapsedifasaresultoflatenotificationanyreasonableinterestofthecompanyhasbeeninjured;-therighttopaymentshalllapseifthepolicyholderorthepersonentitledtopaymentdeliberatelyfailstofulfillhisobligationtoreportwiththeintentiontodeceivethecompany,unlesssuchdeceptiondoesnotjustifythelapseoftherighttopayment.
4.
3.
2.
ObligationsandconditionsThepolicyholderandtheinsuredpersonsshallcomplywiththeobligationsandconditionssetoutinthepolicy.
Ifthepolicyholderortheinsuredpersonfailstodoso,thecompanymaydeductanylossitincursasaresultofthisfromtheclaim.
4.
3.
3FraudIfthepolicyholderand/orthepersonentitledtopaymentfail(s)tocomplywithanobligationspecifiedwiththeintentiontomisleadthecompanyordoesnotprovidethecompanywithalltheinformationanddocumentsthatthelatterrequirestoassessitsobligationtopay,therighttopaymentshalllapse,unlesssuchdeceptiondoesnotjustifythelapsingoftherighttopayment.
Theperson(s)(policyholderand/orthepersonentitledtopayment)whohas/haveperpetratedsuchdeception,shallalsocompensatethecompanyforthelossordamageincurredasaresultofthissituation.
Thecompanymayalsodeductsuchdamagefromapaymentifitconcernsthepersonentitledtopayment.
4.
3.
4LimitationoflossThepolicyholderandtheinsuredpersonsshallassoonasoneofthemisawareorshouldbeawareofanaccidentorthefactthatthisisabouttohappen,insofarashehastheopportunitytodosoandwithinreasonablelimitations,takeallmeasuresthatmayhelppreventorreducethelossordamage,includingattemptstorecoverpossessionsthathavebeenlostorstolen.
Thecompanyshallreimbursethecostsassociatedwiththeabove-mentionedmeasuresandthedamagetoanygoodsdeployedtothateffect.
4.
4SpecificExclusionsInadditiononthegeneralexclusionsdescribedunderarticle2ofthispolicywordingforthecoverofaccidentthefollowingexclusionsareapplicable:byorasaresultofhavingdeliberatelycommittedacrimeorhavingparticipatedinacrime;militaryservice;asaresultor,ormadepossibleby,adiseasedorunhealthyconditionwhichtheinsuredalreadyexhibitedatthetimeoftheaccident,orthroughparalysisorgrowingstiff,blindness,deafness,insanity,epilepsy,vertigo,diabetes,gout/cramporanyphysicaldisability;dangerousactivitieswhenmakinguseofaircraftofanynaturewhatsoever,unlesssapassengerofanairplanewhichhasbeenadmittedforpublicpassengertransport;whenmakinguseofvesselsoutsidetheinlandwaters,unlessitinvolvesnoparticularspecialdangers;aswellasduringpracticeinanywaywhatsoeverofthefollowingsports:allfightingsports,cycling,rugby,parachuting,hang-glidingandhorseracingcompetitions;participationinorpreparationsforspeed,recordandreliabilitytestingofmotorizedvehicles;allsortsofwintersports,includingicehockey,aswellasunderwatersportsinwhichismadeofanaqualung.
Article5-PersonalLiability5.
1Cover5.
1.
1TheCompanywillindemnifytheInsuredPersonforsumswhichtheInsuredPersonshallbecomelegallyobligatedtopayduetoInjuryorIllnesssustainedbyanyperson,includingdeathatanytimeresultingtherefrom,andasalossduetodamagetoordestructionofproperty,includingthelossofusethereof.
i.
TheCompanywillalsocovertheInsuredPersonsliabilitytopayReasonableandCustomaryExpensesincurredwithinoneyearfromthedateofAccidentfornecessarymedical,surgicalanddentalservices,includingprostheticdevices,andnecessaryambulance,hospital,professionalnursingandfuneralservices,toorforeachpersonwhosustainsInjuryorIllnesscausedaccidentally:1)IscausedbytheactivitiesofanInsuredPerson;2)IscausedbyananimalownedbyorinthecareoftheInsuredPerson.
5.
2DefenseSettlementandSupplementaryPaymentsWithrespecttosuchinsuranceasisaffordedbythispolicyforliabilitycoverage,theCompanyshall:5.
2.
1DefendanysuitagainsttheInsuredPersonallegingsuchInjury,Illness,damageordestructionandseekinglossesonaccountthereof,evenifsuchsuitisgroundless,falseorfraudulent;buttheCompanymaymakesuchinvestigation,negotiationandsettlementofanyclaimorsuitasitdeemsexpedient;5.
2.
2WiththerespecttoliabilityoftheInsuredPersontoindemnifythesumswhichtheInsuredPersonshallbecomelegallyobligatedtopayasdamagestothesustainedperson,theCompanyshallpaythefollowingsupplementarypayments:a)Premiumsonbondstoreleaseattachmentsforamountsnotinexcessoftheapplicablelimitofthepolicycoverage,premiumsonappealbondsrequiredinanysuchdefendedsuit,butwithoutanyobligationtoapplyfororfurnishanysuchbonds;b)ExpensesincurredbytheCompany,coststaxedagainsttheInsuredPersoninanysuchsuitandinterestaccruingafterentryofjudgmentuntiltheCompanyhaspaidortenderedordepositedincourtsuchpartofsuchjudgmentasdoesnotexceedthelimitoftheCompany'sliabilitythereon;c)ExpensesincurredbytheInsuredPersonintheeventofanAccidentcausingInjuryorIllness,forsuchimmediatemedicalandsurgicalrelieftoothersasshallbeimperativeatthetimeoftheAccident;ord)Allreasonableexpenses,otherthanlossofearnings,incurredattheCompany'srequest.
Andtheamountssoincurred,exceptsettlementsofclaimsandsuits,arepayablebytheCompanyinadditiontotheapplicablelimitofliabilityofthispolicy.
5.
3LimitsofLiability5.
3.
1Thesuminsuredislimitedto1,250,000foralllosses,includinglossesforcareandlossofservices,astheresultofanyoneoccurrenceduringtheinsuredperiodof365days.
Adeductibleforthiscoverisnotapplicable.
5.
3.
2ThetermInsuredPersonisusedseverallyandnotcollectively,buttheinclusionhereinofmorethanoneInsuredPersonshallnotoperatetoincreasethelimitsoftheCompany'sliability.
TheCompany'stotalliabilityunderThirdPartyLiabilityforalllossesresultingfromanyoneoccurrenceshallnotbemorethanthesuminsuredstatedonthepolicyschedule.
ThislimitisthesameregardlessofthenumberofInsuredPersons,claimsmadeorpersonsinjured.
AllInjuriesandpropertydamageresultingfromcontinuousorrepeatedexposuretosubstantiallythesamegeneralharmfulconditionsshallbeconsideredtobetheresultofoneoccurrence.
5.
3.
3TheCompany'stotalliabilityforallmedicalexpensespayableforInjuriestoonepersonastheresultofoneAccidentwillnotbemorethanthesuminsuredstatedonthepolicyschedule.
5.
4ClaimsProcedureClaimsProcedureContactinformation:ThePlanAdministratorforTaiPingInsuranceCompanyLtdP.
O.
Box69B-2140ANTWERPBELGIUM24/365telephonenumber:+32-3-2176777Fax:+3232358351Email:myclaim@issi-china.
comWebsite:(IDwillbecommunicatedtotheInsuredPersonwiththeWelcomePackage)5.
4.
1Whenanoccurrencetakesplace,writtennoticethereofshallbegivenbyoronbehalfoftheInsuredPersonassoonaspracticabletothePlanAdministrator.
SuchnoticeshallcontaintheidentityofthepolicyandInsuredPerson,reasonablyavailableinformationonthetime,place,andcircumstancesoftheAccidentoroccurrenceandnamesandaddressesofanyclaimantsandwitnesses.
AttherequestofthePlanAdministrator,theInsuredPersonshallhelpthePlanAdministratortomakesettlement,enforceanyrightofcontributionorindemnityagainstanypersonororganizationwhomaybeliabletoanInsuredPerson,withtheconductofsuitsandattendhearingsandtrialsandtosecureandgiveevidenceandobtaintheattendanceofwitnesses.
5.
4.
2IfclaimismadeorsuitisbroughtagainsttheInsuredPerson,theInsuredPersonshallimmediatelyforwardtothePlanAdministratoreverydemand,notice,summonsorotherprocessreceivedbytheInsuredPersonorhisrepresentative.
Theproceedingshouldbeinstitutedwithintheprescriptiveperiodsettledbythelegislationofthelocallaworwithinoneyearfromthedateoflossifanyotherlegislationisapplicabletothepolicy.
5.
4.
3TheInsuredPersonshallcooperatewiththePlanAdministratororCompany,andupontheCompany'srequest,shallattendhearingsandtrialsandshallassistineffectingsettlements,securingandgivingevidenceobtainingtheattendanceofwitnessesandintheconductofsuits.
TheInsuredPersonshallnot,exceptathisowncost,voluntarilymakeanypayment,assumeanyobligationorincuranyexpenseotherthanforsuchimmediatemedicalandsurgicalrelieftoothersasshallbeimperativeatthetimeoftheAccident.
5.
4.
4NoactionshallbetakenagainsttheCompanyunless,asaconditionprecedentthereto,theInsuredPersonshallhavefullycompliedwithallthetermsofthispolicy,noruntiltheamountoftheInsuredPersonsobligationtopayshallhavebeenfinallydeterminedeitherbyjudgmentagainsttheInsuredPersonafteractualtrialorbywrittenagreementoftheInsuredPerson,theclaimantandtheCompany.
Anypersonororganizationorthelegalrepresentativethereofwhohassecuredsuchjudgmentorwrittenagreementshallthereafterbeentitledtorecoverunderthispolicytotheextentoftheinsuranceaffordedbythispolicy.
NothingcontainedinthispolicyshallgiveanypersonororganizationanyrighttojointheCompanyasaco-defendantinanyactionagainsttheInsuredPersontodeterminetheInsuredPerson'sliability.
BankruptcyorinsolvencyoftheInsuredPersonoroftheInsuredPerson'sestateshallnotrelievetheCompanyofanyofitsobligationshereunder.
5.
6.
SpecificExclusionsInadditiononofthegeneralexclusionsdescribedunderarticle2ofthispolicywordingforthecoverofpersonalliabilitythefollowingexclusionsareapplicable:ToanybusinessactivitiesofanInsuredPerson,otherthanthosewhichareordinarilyincidentaltonon-businesspursuits;nortoclaimsarisingfromtherendering,oromissionofrendering,ofanyprofessionalservices;nortoanyactoromissioninconnectionwithInsuredPremisesotherthanasdefinedabove,whichareowned,rentedorcontrolledbyanInsuredPerson;Totheownership,maintenance,operation,use,loadingorunloadingof:a)AutomobileswhiletheyareawayfromtheInsuredPremises;b)watercraft,8metersormoreinoveralllength,orwithoutboardmotorswithmorethan18Kilowattorinboardmotorswithmorethan36Kilowatt,whenownedbyorrentedtoanInsuredPersonandwhilelocatedawayfromtheInsuredPremises;andc)Aircraft.
ToInjury,Illness,damageordestructioncausedintentionallybyoratthedirectionoftheInsuredPerson;ToliabilityassumedbytheInsuredPersonunderanycontractoragreement,exceptliabilityofothersassumedunderawrittencontractspecificallyrelatingtotheInsuredPremises;Underarticle5.
1.
1,todamagetoordestructionofpropertyusedby,rentedtoorinthecare,custodyorcontroloftheInsuredPersonorthepropertyonwhichtheInsuredPersonisexercisingphysicalcontrol;Howeverliabilityfordamageisinsuredforandinconnectionwithgoodswhichaninsuredhas,otherthaninthosecasesassetunderthisarticlethroughuptoanamountof10,000foreachevent;forandinconnectionwithgoodswhichbelongtothetraineepositionaddresswhichaninsuredhasathis/herdisposalwhilstconductingtraineeactivities,uptoanamountof10,000foreachevent.
Property/realestatesillremainsfullyexcludedformcoverage.
Underarticle5.
1.
2,toInjury,Illnessordeathof:a)Anyperson,whenarisingoutoforinthecourseofemployment,ifbenefitsarewhollyorpartiallypayableorrequiredtobeprovidedunderaWorker'sCompensationLaw;b)AnyInsuredPersonotherwisecoveredunderthispolicy;orc)Anyperson,otherthanaResidenceEmployee,ifsuchpersonisregularlyresidingontheInsuredPremises,orisontheInsuredPremisesbecauseofabusinessconductedthereon,orisinjuredbyanaccidentarisingoutofsuchbusiness.
ToInjury,Illness,damageordestructiondirectlyorindirectlyarisingfrom,occasionedby,orinconsequenceof:a)War;b)ThetransmissionofacommunicablediseasebyanInsuredPerson;c)Sexualmolestation,corporalpunishmentorphysicalormentalabuse;ord)Excessiveconsumptionofalcohol,misuseofmedication,oruseofnarcotics,illegaldrugsoragents;-PropertydamagetopropertyownedbytheInsuredPerson.
Article6-BaggageandHousehold6.
1Definitions6.
1.
1.
Baggagea.
theobjectswhichaninsuredhastakenforhis/herownuse,orwhichhavebeensentoninadvanceoraftertheinsured'sarrivaltothedestination,orwithinthedurationofvalidityoftheinsurance;b.
theobjectsacquiredwithinthedurationofvalidityoftheinsurance,uptoamaximumamountof250.
00.
6.
1.
2.
TraveldocumentsTraveldocumentsaredeemedtoinclude:passports,traveltickets,drivinglicenses,registrationpapers,registrationplates,carnets/vignettes,greencards,visas,identitypapersandtouristcards/touristtraveldocuments.
6.
1.
3.
HouseholdgoodsHouseholdgoodsincludeallgoodsandchattelsbelongingtoorwhicharetheresponsibilityoftheinsuredwhichnormallyspeakingarereferredtoashouseholdgoodsandwhich,duringthevalidityoftheinsurance,werepresentattheaddressoftheinsuredabroad.
6.
2CoverForeachclaimofthiscoveradeductibleof50isapplicable.
6.
2.
1TraveldocumentsTraveldocumentsshallbecompensatedforuptoamaximumamountof150.
00.
6.
2.
2BaggageandhouseholdgoodsBaggage,uptoamaximumamountof1,500.
00andhouseholdgoodsuptoamaximumamountof5,000.
00,bearingthefollowinginmind:WindsurfingboardsandbicyclesWindsurfingboardsandbicyclesareinsureduptoamaximumamountof250.
00perobject,includingaccessories;Toolsforacar,bicycleandmotorbikeCar,bicycleandmotorbiketools,snowchains,carsoundandbroadcastingequipment(fixedandmountedornot)solelywithabatteryconnection,musiccassettes,compactdisks,aswellasspareparts(includingV-connectors,sparkingplugs,jumpstartcables,rotor,contactpointsandlightbulbs)areinsureduptoamaximumamountof150.
00;FalseteethFalseteethareinsuredifthecostsincurredforreplacementorrepairmaynotbedefrayedpursuanttothechapteronhealthanddentalcarecosts,uptoamaximumamountof250.
00;ReplacementclothingandtoiletarticlesInsurancecoverisalsogranteduptoamaximumamountof75.
00forcompensationforthecostsofhavingtopurchasereplacementclothingandtoiletarticlesduetothedelayedarrivalofbaggage;Photographic,film,video,soundandcomputerequipmentPhotographic,film,video,soundandcomputerequipment,includingaccessories,areinsureduptoamaximumamountof500.
00;JewelryJewelryisinsureduptoamaximumamountof150.
00.
Jewelryincludesobjectsmadetobewornonoraroundthebodyandwhichconsistwhollyorpartlyof(precious)metal,stone,mineral,ivory,coralorsuchlikesubstancesaswellaspearls,withtheexceptionofwatches;WatchesWatches,includingstrapsandchainsareinsureduptoamaximumamountof150.
00;SpectaclesandcontactlensesSpectacles,sun-glasses(includinglenses)andcontactlensesareinsureduptoamaximumamountof150.
00;Telecommunicationsequipment(Mobile)telecommunicationsequipmentisinsureduptoamaximumamountof150.
00;OtherhouseholdgoodsFortheremaininghouseholdgoods,coverisgivenagainstthefollowingthreatsanddangers:fireandexplosion(alsothatresultingfromownfault),strikebylightning,inductionandpowersurgeafterlightninghasstruck,aircraft,storm,precipitation,water,steamandoil,theftorattemptedtheftafterbreakingand/orentering,robberyandextortion,trafficaccident,burning,singeing,smelting,charring,scorching,smokeandsoot,aswellasdamagecausedbyglasssplinterswhenwindowsbreak.
Damagecausedbytheftorattemptedtheftwithoutanysignsofbreakingand/orentering,willbesubjecttoadeductibleof125.
00perevent.
6.
3.
SpecificexclusionsInadditiononthegeneralexclusionsdescribedunderarticle2ofthispolicywordingforthecoverofBaggageandHouseholdGoodsthefollowingexclusionsareapplicable:Boats(withtheexceptionofwindsurfingboards),aircraft(includingglidersandglidingequipment),vehicles(includingmopeds),campersandothervehicles(withtheexceptionofbicycles),aswellastheaccessoriestotheaforementioned,sparepartsandfurtherappurtenances(includingtents);Damageduetowearandtear,ownfault,naturaldecayandslowworkinginfluencesoftheweather,attachmentorforfeiture,otherthanduetoatrafficaccident,aswellasdamagecausedbymothsorothervermin;Damageconsistingofdamagessuchasscratches,dents,stains,andotherunsightlymarkings,unlessthedamagedobjecthasbecomeunsuitableasaresultofthisfortheuseforwhichsaidobjectwasintended;Damagesolelyconsistingofdamagestorecordingdevices,videoandsoundheadsofaudioandvideoequipment.
Moreover,thereisnorighttoreceivecompensationinconnectionwith:Normalcareandcautioniftheinsureddidnotadheretoandcomplywiththenormalcareandcautionwhichmaybeexpectedofhim/her,inpreventingloss,theftordamagesbeingsustainedbybaggageandhouseholdgoods.
Normalcareandcautionshallbedeemednottohavebeentakenwhenvideo,computer,photographic,film,soundandtelecommunicationequipment,jewelry,watches,furandothervaluableobjectsareleftunsupervisedotherthaninaproperlylockedarea(notincludingavehicle).
Forotherarticles,iftheyareleftinavehicle,compensationshallsolelybepaidif:a.
thosegoodswereinaproperlylockedbootandwerealsonotvisiblefromtheoutside;b.
allmeasuresweretakentopreventthedamageinquestionwhenthesegoodswereinavehiclewhichdoesnothaveaproperbootwhichcanbelocked.
Inconnectionwiththatdeterminedinsub-sectionsa.
andb.
theinsuredmayberequiredtoshowthatinallreasonablenessnosafermeasurescouldhavebeentaken.
Thefollowingshallnotbedeemedtobebaggageandhouseholdgoods:a.
money,papersofvalueofwhatevernature,manuscripts,drawingsanddrafts(fortraveldocumentsreferto6.
1.
2);b.
collections(suchaspostagestampsandcoincollections,etc.
);c.
tools(withtheexceptionofthecar,bicycle,motorbiketoolsreferredtobelow);d.
tradegoodsandsamples;e.
animals.
SupplementaryobligationsonthepartoftheinsuredorinterestedpartyAsidefromthegeneralobligations,theinsuredoraninterestedpartyisalsobound:a.
whendamageissustainedbybaggageandhouseholdgoods,toinformtheinsurerandpermittheinsurertoinvestigatethematterpriortorepairsbeingmade;b.
inthecaseoftheftorlossofinsuredgoods,tofileapolicereportlocallyandmoreoverthepersonssuchasrailwaystationchiefs,thestaffofairlines,trainconductors,ship'scaptains,hotelmanagement,etc.
mustalsoberequestedtodeterminethatdamagehasactuallybeenincurred;c.
toprovepossession,thevalueandtheageoftheinsuredobjectorobjects;d.
ifthedamagearoseduringtransitoftheinsuredobjectsbytrain,boat,aircraft,orothermeansoftransport,tocheckthebaggageuponreceipttoensureitisingoodconditionand/ortonoteits/theirloss.
Shouldsomethingbemissingand/ornotingoodcondition,thentheinsuredisalsoboundtofileacomplaintwiththetransportcompanyandtodemandthatthetransportcompanymakeanofficialwrittenreportofthecomplaint.
Thisoriginalreportshallberequiredtobesubmittedtotheinsurancecompanywithanyclaimfordamages.
6.
4DamagesClaimsProcedureContactinformation:TheMedicalPlanAdministratorforTaiPingInsuranceCompanyLtdP.
O.
Box69B-2140ANTWERPBELGIUM24/365telephonenumber:+32-3-2176777Fax:+3232358351Email:myclaim@issi-china.
comWebsite:(IDwillbecommunicatedtotheInsuredPersonwiththeWelcomePackage)6.
4.
1ThefoundationsforcompensationfordamagesThefoundationsforcalculatingcompensationtobepaidfordamagessustainedwhichareconnectedwithtraveldocumentsshallbetheamountdueforobtainingthedocumentsinquestiononceagain.
Thefoundationsforcalculatingthecompensationfordamagesforbaggageandhouseholdgoodsare:a.
forarticleswhicharenoolderthanoneyearold,theirnewvalue;b.
forarticleswhichareolderthanoneyearold,theirpresentvaluebasedonthefollowingdepreciationtable:Olderthan1year,butyoungerthan2year:10%depreciation;Olderthan2years,butyoungerthan3years:20%depreciation;Olderthan3years,butyoungerthan4years:30%depreciation;After4yearsforeachyear10%Newvalueshallbedeemedtobetheamountneededtoacquirenewarticlesofthesamesortandquality;whilepresentvalueshallbedeemedtobethenewvaluelesstheamountofdepreciationofvalueduetoageorwearandtear.
Objectswhichcannotbereplacedbynewonesofthesamekindandqualityshallbemadesubjecttotheassumptionoftheirmarketvalue,whichshallbedeemedtobethemarketpriceuponthesalebytheinsuredofthearticlesinquestionintheconditionthesearticleswerein,immediatelybeforedamagesweresustained.
6.
4.
2RepairorreplacementIfdamagesorlostobjectscould,inallreasonableness,berepairedand/orreplaced,theinsuredwillcontactthePlanAdministratorwithphonenumberasdescribedontheinsurancecard.
Article7-AssistanceandExceptionalCosts7.
1.
ClaimsProcedure[Tobedecided]ClaimsProcedureContactinformation:ThePlanAdministratorforTaiPingInsuranceCompanyLtdP.
O.
Box69B-2140ANTWERPBELGIUM24/365telephonenumber:+32-3-2176777Fax:+3232358351Email:myclaim@issi-china.
comWebsite:(IDwillbecommunicatedtotheInsuredPersonwiththeWelcomePackage)MedicalStaff:AIGTravelAssisthasateamofhighlyqualifiedmedicaladvisersandnurseswhoareavailabletoprovideadviceregardingthemostappropriateassistanceandtreatment.
Whenassistanceisrequired,thefollowinginformationmustalwaysbeprovidedtothePlanAdministrator:a.
ConcerningtheInsuredPerson:ThenameoftheInsuredPerson,ThetelephonenumberonwhichtheInsuredPersoncanbecontactedTheaddresswheretheInsuredPersonisstaying.
b.
ConcerningthePolicyholder:ThenameofthePolicyholder,Thepolicynumber.
c.
Thenatureoftheincident.
7.
2.
MedicalAdviceoverPhoneAIGTravelAssistwillarrangefortheprovisionofmedicaladvicefromanEnglishspeakingRegisteredNursetotheInsuredPersonoverthephone.
7.
3.
SecondOpinionBenefitAIGTravelAssistwillhelpandguidetheInsuredPersoninordertoobtain2independentreviewsofhismedicalfilerelatingtoaninsuredIllnessorInjury.
ThosesecondopinionsintendtoassisttheInsuredPersonandtheattendingPhysiciantodecideuponthediagnosisand/ortreatmentprotocols.
7.
4.
AssistanceBenefitsTheInsuredPersonisprovidedwiththefollowingassistanceservices:1.
EmergencyMedicalEvacuationAIGTravelAssistshallorganizeandpayfor,inaccordancewiththeadviceofitsMedicalConsultants,incaseofaninsuredInjuryorIllnessthatneedstheemergencymedicalevacuationoftheInsuredPersontoamoresuitableandbetter-equippedlocalHospital.
Dependingontheseriousnessofthecircumstances,thepersonistransportedbyairambulance,ascheduledflight,anambulanceoranyothermeansoftransport,andifnecessaryunderthesupervisionofamedicalteamthathasthenecessarymedicalequipmentatitsdisposal.
TheMedicalConsultantsofAIGTravelAssistshalldecide,ifnecessaryinconsultationwiththelocalPhysicianinattendance,ifevacuationisneeded,withwhichmodeoftransportandtowhathospital.
IncasetheInsuredPersonwasevacuatedoutsidehisHomeorHostCountry,AIGTravelAssistshallorganizeandpayforthereturntheInsuredPersontohisHomeorHostCountry.
2.
DeliveryofEssentialMedicationAttherequestoftheInsuredPersonandincaseofanemergency,AIGTravelAssistshallassistinfindingandsendingessentialmedicationormedicalequipmentifthesearenotavailablelocally.
AIGTravelAssistshallpayfortheshippingcost.
Innon-emergencycases,AIGTravelAssistcanprovidethesameservicebutatthecostoftheInsuredPerson.
3.
AssistanceincaseofDeathIftheInsuredPersondies,AIGTravelAssistshallorganizeandpayfortransportationofthemortalremainsortheashes,includingthecostofthecoffinneededfortransport,andfortransportationofthepersonalbelongingsoftheInsuredPersontohisHomeCountry.
AIGTravelAssistshallalsoorganizeandpayfortheflighttotheHomeCountryoftheinsuredDependants.
4.
InterpreterReferralAttherequestoftheInsuredPerson,AIGTravelAssistrefershimtoaninterpreter.
5.
LegalReferralAttherequestoftheInsuredPerson,thePlanAdministratorreferstoexternallegalfirm.
7.
5.
ExceptionalCostsCover7.
5.
1.
Costsincurredduetoillnessoraccident–CompassionateVisitUptoamaximumof7,000perinsuredperiodof365daysthetravelcostsincurredwiththepermissionofAIGTravelAssistforanecessaryreturntrip,aswellasthecostsofaccommodationofatmosttwofamilymembersinthe1stor2nddegreeand/orofthepersonswithwhomtheinsuredlivedasafamily,forassistanceandsupporttoaninsuredwhoisseriouslyillorwhoselifeisindanger.
7.
5.
2.
CostsofreturningfromthetripduetodeathIftheinsuredmustreturnfromthetripduetothefactthatfamilymembersinthe1stor2nddegreewhoarenottravelingwiththeinsuredhavedied,orthattheirlivesareindanger,theextratravelingandaccommodationexpensesincurredbytheinsuredinquestiontotheplacetowhichhe/shehasbeencalledback,uptoamaximumofthecostsoftravelandaccommodationinordertoreachtheplaceofresidence.
Inaddition,theextratravelandaccommodationexpensesincurredtoreturntotheoriginaldestinationareinsured,providedtheyareincurredduringthevalidityoftheinsurance.
Insuredcostsarelimitedtoamaximumof7,000perinsuredperiodof365daysandreturntripmustbeapprovedbyAIGTravelAssistupfront.
7.
5.
3.
TelecommunicationcostsIfthereisentitlementtocompensationfordamages,topaymentortotheprovisionofassistance,thenecessarytelecommunicationcostsincurred,totheextentthattheywereincurredinordertocontactAIGTravelAssist.
Thetelecommunicationcostsarelimitedtoamaximumof150perincident.
7.
5.
4.
TravelaidsoutsideChinaIntheeventofunexpectedandseriousdifficultiesabroadasaresultofthelossortheftoftraveldocuments,AIGTravenAssistwillassisttheinsuredwithwordanddeedatembassies,consulatesandotherofficialbodies.
Ifnecessaryandwherepossible,AIGTravelAssistshallactasaninterpreter.
Ifnecessary,AIGTravelAssistshallarrangeareplacementtravelticketfortheinsured.
Thecostsofthisticket,ifany,shallbechargedtotheinsured.
7.
6.
Limitations&ExclusionsInadditiononthegeneralexclusionsdescribedunderarticle2ofthispolicywordingforthecoverofAssistanceandExceptionalCoststhefollowingexclusionsandlimitationsareapplicable:Thebenefitincaseofflightsislimitedtopublictransportineconomyclass,unlesstheMedicalConsultantsofAIGTravelAssistdecideotherwise.
TheCompanyshallnotpayanybenefit:ForservicesthatwerenotorganizedorapprovedinadvancebyAIGTravelAssist.
Ifthepurposeofthetripistoobtainmedicaltreatmentormedicaladvice,unlessinthecourseofanapprovedEmergencyMedicalEvacuation.
IftheInsuredPersonistravelingagainsttheadviceofaPhysician.
ForservicesthatareexcludedintheMedicalCostcoverandexclusionsonallothercoverage'sasdescribedinthispolicywordingorhavetheirDateofServiceduringawaitingperiodmentionedundertheMedicalExpensecover.
Article8-LegalAid8.
1.
Definitions8.
1.
1.
CostsCostswhicharenecessaryforlegalaidorwhichwillbeincurredbyanexternallawfirm,totheextentthattheyarenotrecoverablefromathirdparty,thatis;a.
thecostsinrelationtoexaminationandtreatment;b.
thecostsinrelationtotheenlistmentoflawyers,courtbailiffs,witnessesandexperts.
IntheUnitedStatesandCanadathelawyer'sfeeisnotchargedtotheinsurerifthelawyerhandlesthecaseonthebasisof"nocure,nopay".
Inthiscasethefeeshallbedeemedtobeincludedinthecompensationfordamages;c.
thecostsofaccommodationtobeincurredbytheinsuredinconsultationwithappointedexternallawfirmandthetravelexpensestobeincurredinaccordancewithfaresforpublictransport(train,secondclass);8.
1.
2.
TerritorialscopeofthevalidityCoverofthecostsoflegalaidshallapplyduringastayabroadin:a.
EuropeandthecountriessurroundingtheMediterraneanSea(includingtheCanaryIslands)withtheexceptionofLibya,Albania,Greenland,LebanonandSyria;b.
theUnitedStates,Canada,Australia,NewZealand,Indonesia,SouthAfricaandThailand;Inrelationtoquestionsinallothercountriestheinsurershalltakeforitsaccount,beforetheinsuredreturnstohis/herownpermanenthomeandhabitualplaceofresidence,thecoststobeincurredinconsultationwiththeinsurerforadviceormediationbyalocallawyeruptoamaximumof5,000.
8.
2.
CoverTheinsuredisentitledtotheprovisionoflegalaidandthereimbursementofcoststotheextentthat:a.
therightsorinterestsoftheinsuredasaprivatepersonaredirectlyatissue,withtheexceptionofdamagessustainedasaresultofpossessing,keepingorusingameansoftransport;b.
thecostsdonotexceedtheamountof5,000perquestionreported;c.
thequestionreportedconcerns:-therecoveryofmaterialandimmaterialdamagessustainedbytheinsuredasaconsequenceofaphysicalinjurysustainedbyhimforwhichathirdpartyisliableonthegroundsofastatutoryprovision;-thelegaldefenseoftheinsuredintheeventthattheinsuredissuedatlawasaprivateindividualforhisliabilityundercivillaw,underthelegislationofthecountrywherehepresentlyis,fordamagesincurredtothirdpartiesorafterinvoluntaryinfringementoflocallaws.
8.
2.
1.
AdvancesInreturnforanadequateguarantee,theinsurershallprovideadvancesuptoamaximumof7,000for:a.
paymentofthecostsoftheproceedingsandofenforcementduefromtheinsuredandtheotherparty,withtheexceptionofthesureties,totheextentthatafinalandconclusivecourtrulinghasdeterminedthattheymustbebornebytheinsured;b.
thereleaseoftheinsuredintheeventthathehasbeenplacedinpretrialdetentionfollowingatrafficaccident.
Suchanadvanceorasuretyshallbedeemedtobealoanbytheinsurertotheinsured,whoshallrepaythisloaninitsentiretyassoonasthesuretyhasbeenrepaidtohimintheeventofadecisiontodropcharges,acquittalorotherwisewithin15daysafterthedayonwhichthecompetentcourthashandeddownaruling.
Repaymenttotheinsurershallfollowinanycasenolaterthan60daysaftertheadvancehastakenplaceorthesecuritydeposithasbeenmade.
8.
3.
ClaimsProcedureContactinformation:ThePlanAdministratorforTaiPingInsuranceCompanyLtdP.
O.
Box69B-2140ANTWERPBELGIUM24/365telephonenumber:+32-3-2176777Fax:+3232358351Email:myclaim@issi-china.
comWebsite:(IDwillbecommunicatedtotheInsuredPersonwiththeWelcomePackage)Iftheinsuredwishestoinvokethelegalaid,heshallnotifythePlanAdministratorandhewillrefertoexternallawfirmofthisassoonaspossible;Ifthecaseiscovered,thentheinsurertransfersthefurtherhandlingtotheorganizationwhichcarriesoutthelegalaid;Iftheenlistmentofalawyerisnecessaryforthehandlingofthecase,thenthechoiceofthelawyerand/ortheexpertshallbeappointedbytheinsurer;ThecostsshallbefortheaccountoftheinsurediftheyhavebeenincurredwithoutpriorconsultationwiththeInsurer;iftheyarerelatedtotheenlistmentofalawyeroranexpertwhichtookplacewithoutpriorconsultationwiththeInsurer;totheextentthatthecostsaretheconsequenceofomissionsorerrorsonthepartoftheinsuredinrelationtothehandlingofthecase.
Startingfromthemomentthattheinsurerinformstheinsuredthatfurtherhandlingofthecasedoesnothaveareasonablechanceofsuccess;theinsuredcannolongerlayanyclaimtocover,withtheexceptionoftherulesonthesettlementofdisputes.
8.
4.
RulesonthesettlementofdisputesiflegalaidappliesIntheeventofadifferenceofopinionbetweentheinsuredandInsurerastotheexpectedresultorthemannerofhandlingofthecase,afterconsultationwithinsurerandfortheaccountoftheinsurer,theinsuredshallhaveoneopportunitytoplacethecasebeforealawyerofhischoicewhoisanexpertinthedisciplineinquestion;thismusttakeplaceassoonaspossible,butinanycasewithinonemonthaftertheinsurerhasinformedtheinsuredofitsopinionormannerofhandlingthecaseandhe/shehasdisputedit.
Ifthislawyersharesthestandpointoftheinsurer,thentheinsuredmayonlycontinuetheproceedingsforhisownaccount.
Shouldtheresultsshowtheinsuredtobeentirelyorpartlyright,thenthecostswillbereimbursedafterall,uptothemaximumoftheinsuredamount.
Ifthecaseisalreadybeinghandledbyalawyerandtheinsuredlosesconfidenceinhim,thentheinsuredshallhaveoneopportunitytotransferthecasetoadifferentlawyerfortheaccountoftheinsurer,iftheinsurer,infairness,cansharethestandpointoftheinsured.
8.
5.
FurtherexclusionsInadditiononthegeneralexclusionsdescribedunderarticle2ofthispolicywordingforthecoverofLegalAidthefollowingexclusionsareapplicable:if,uponthecommencementdateoftheinsurance,he/shecouldreasonablyhaveforeseentheneedforlegalaid;iftheamountis250orless;intheeventofconditionalintention,recklessnessordefaultonthepartoftheinsured.