中国人寿来华留学生综合保险保障方案
IntroductionforForeignStudentsComprehensiveInsuranceSchemesFromChinaLife
一、方案(InsurancePlan)
保险责任Insuranceresponsibility
保险金额（元）InsuranceAmount(Yuan)
保险费
(元/人/年)
Premium(Yuan/person/year)
疾病、意外身故
AccidengtaldeathorDiseasedeath
100000
800元/人
RMB800/person
意外伤残
Accidentaldisability
意外门诊
（免赔额0元，100%比例报销）
Outpatientservice(deductibleinsuranceRMB0,compensationratio:100%)
50000
意外住院
Hospitalizationcausedbyaccidents(deductibleinsuranceRMB0,compensationratio:100%)
疾病住院
Diseasehospitalization(deductibleinsuranceRMB0,compensationratio:100%)
200000
疾病门诊（免赔额0元，赔付比例100%，日费用限额600元）
Diseaseoutpatientservice(accumulativelydeductibleinsuranceRMB0,compensationratio:100%,dailyexpenselimitRMB600)
20000
遗体遣返RepatriationBenefits
120000
二、保险责任(Insuranceliability)
1、意外、疾病身故保险责任
DeathInsuranceliabilitycausedbyaccidents,illnesses
被保险人因意外伤害身故或在本合同约定的等待期后因疾病身故，本公司按保险单载明的保险金额给付保险金，对该被保险人的保险责任终止。
InsuredDeathwhichcausedbyaccidentinjureordiseaseafterthewaitingperiodofthiscontract,thecompanywillpayinsuranceamountstatedinthisinsurancecontractaccordingtothepolicy,thereforetheinsuranceliabilityoftheinsuredshallbeterminated.
2、意外伤残保险责任
Accidentaldisabilityinsuranceresponsibility
（1）被保险人遭受意外伤害，并自该意外伤害发生之日起一百八十日内因该意外伤害导致身体伤残的，本公司根据《人身保险伤残评定标准（行业标准）》的规定，按本附加合同约定的保险金额乘以该处伤残的伤残等级所对应的保险金给付比例给付伤残保险金。
Theinsuredsuffersaccidentharmandbywhichcausedphysicaldisabilitywithinonehundredandeightydaysfromthedatesincetheaccidenthappened,thecompanywillpaydisabilityinsurancefeesaccordingtoaccordingtotheregulationofthepersonalinsurancedisableassessstandardandtheattachedcontractofinsuranceamountmultipliedbyinsuranceamountpayingproportionrefertodisabilitygrade.
当同一保险事故导致两处或两处以上伤残时，本公司仅按其中一处的伤残等级给付伤残保险金：如果各处的伤残等级不完全相同且最重的伤残等级所对应的伤残只有一处，本公司按最重的伤残等级所对应的保险金给付比例给付伤残保险金；如果各处的伤残等级完全相同或最重的伤残等级所对应的伤残有两处或两处以上，本公司将该伤残等级在原基础上晋升一级（但最高晋升至第一级），并按晋升后的伤残等级所对应的保险金给付比例给付伤残保险金。同一部位和性质的伤残，不能采用《标准》条文两条以上或者同一条文两次以上进行评定。
Fortwoormoredisabilitiesbythesameinsuranceaccident,thecompanywillonlypayinsurancefeesaccordingtoonedisabilitygrade.Ifdisabilitygradeforeveryinjureisnotcompletelysameandiftheheaviestdisabilitygradeisonlyoneplace,thecompanywillpayinsurancefeesaccordingtotheinsuranceamountpayingproportionrefertotheheaviestdisabilitygrade;ifdisabilitygradeforeveryinjureiscompletelysameandtherearetwoormoredisabilitiesrefertotheheaviestdisabilitygrade,thecompanywillupgradedisabilitygradebyonelevel(thehighestupgradewillbethefirstgrade),andwillpayinsurancefeesaccordingtothepayingproportionoftheupgradeddisabilitygrade.Forsamepartandnaturedisability,itisnotabletobeassessedbyusingtwoormoreprovisionsormorethantwiceforsameprovisionsaccordingtostandardarticles.
（2）本公司给付的保险金以保险金额为限，一次或累计给付的保险金达到本附加合同约定的保险金额时，对该被保险人的保险责任终止。
Theinsurancecompensationpayingbyourcompanywillbelimitedtoinsuranceamount,whicharepaidbyonetimeoraccumulationreachingtotheagreedamountsubjecttothisadditionalcontract,theinsuranceresponsibilityfortheinsuredwillbeterminated.
3、意外门诊、意外住院保险责任
AccidentalOutpatientserviceandaccidentalhospitalizationinsuranceresponsibility
在本附加合同保险期间内，被保险人遭受意外伤害，并因该意外伤害在二级以上（含二级）医院或本公司认可的其他医疗机构诊疗，对被保险人每次意外伤害事故所发生并实际支出的医疗费用，按本附加合同约定给付比例给付医疗保险金。
Duringtheperiodofthisadditionalinsurancecontract,theinsuredsuffersanaccidentharm,andofwhichacceptsthemedicaltreatmentinthesecondclassorabovelevelhospitalorothermedicalinstitutionrecognizedbythecompany,thecompanywillpaymedicalcompensationforeverymedicaltreatmentexpensescausedbyaccidentinjureandofwhichisrealpaidaccordingtotheagreedproportionstatedinthiscontract.
保险期间届满被保险人治疗仍未结束的，除另有约定外，本公司继续承担给付医疗保险金责任的期限，门诊治疗以保险期间届满的次日起十五日为限，住院治疗以保险期间届满的次日起九十日为限。
Theinsured’smedicaltreatmentextendstotheexpirationoftheinsurance,unlessotherwisestated,thecompanycontinuestobeliabletoassumemedicalinsurancetimelimit.Outpatientservicetreatmentwillbesubjectto15daysfromthedatefollowingtheinsurancecontractexpiration,thehospitalizationtreatmentwillbelimitedto90daysfromthedayfollowingtheinsurancecontractexpired.
本公司给付的医疗保险金以本附加合同约定的保险金额为限，一次或累计给付的医疗保险金达到本附加合同约定的保险金额时，对该被保险人的保险责任终止。
Themedicalcompensationwillbelimitedaccordingtothestatedinsuranceamountsubjecttothisadditionalinsurancecontract,theinsuranceresponsibilitywillbeterminatedwhenthemedicalexpensecompensationtotheinsuredreachingtotheagreedmedicalinsuranceamountbyonetimeormoretimesaccumulativepayment.
4、疾病住院、疾病门诊保险责任
Insuredliabilityofhospitalizeddiseaseanddiseaseclinic
（1）普通门（急）诊医疗费用补偿责任
ExpensecompensationresponsibilityofOrdinaryoutpatient(urgent)medicaltreatment
被保险人在二级（含二级）及以上医疗机构一次或多次诊疗支出的普通门（急）诊医疗费用，按本附加合同约定的比例给付普通门（急）诊医疗保险金，就诊日费用限额为600元，在日限额的基础上累计超过0元（起付线）以上的部分保险人按照100%的比例赔付，累计给付以保险金额20000元为限。对被保险人一次或累计给付的普通门（急）诊医疗保险金达到普通门（急）诊医疗保险金额时，该项保险责任终止。
Theinsuredpaidmedicalexpensesoneormoretimesduetoordinaryoutpatient(urgent)medicaltreatmentinthesecondaryorhighergrademedicalinstitution(includingsecondarymedicalinstitution),thecompanywillpaymedicalcompensationduetoordinaryoutpatient(urgent)medicaltreatmentaccordingtheagreedproportionofthisadditionalcontract.DailymedicalexpenseislimitedtoRMB600,theinsurancecompanywillpayby100%forexceedingRMB0(startingline)byaccumulationonthedaysumlimitbasis,totalaccumulativepaymentwillbelimitedtoRMB20000.Theinsuranceresponsibilitywillbeterminatedwhenthemedicalexpensecompensationtotheinsuredreachingtheinsurancelimitamountbyonetimeormoretimesaccumulativepayment.
药量：急性病3天，慢性病7天；日限额：为每日的最高费用限额
Dosage:acutedisease3days,chronicdiseases7days;DailysumLimit:themaximumcostfordaily.
起付线：本险种设置0元为起付线，起付线以下部分不予赔付。
Startingline:RMB0aspaymentstartinglineforthisinsurance,lessthanthisamountwillnotbepaid.
（2）住院医疗费用补偿责任
Expensecompensationresponsibilityforhospitalmedicaltreatment
被保险人在二级（含二级）及以上医疗机构一次或多次诊疗支出的住院医疗费用（检查检验费、检查治疗费、手术费、药费、化验费、放射费等合理医疗费用），按本附加合同约定的比例给付住院医疗保险金。对被保险人一次或累计给付的住院医疗保险金达到住院保险金额时，该项保险责任终止。
Theinsuredpaidhospitalmedicalexpensesoneormoretimesinthesecondaryorhighergrademedicalinstitution(includingsecondarymedicalinstitution),herebythehospitalmedicalexpensesrefertoreasonablemedicaltreatmentexpenseswhichincludingexaminationandinspectionfees,examinationandtreatmentfees,operationfees,medicinefees,testfees,emissionfees,etc,thecompanywillpaymedicalcompensationaccordingtotheagreedproportionstatedintheinsurancecontract.Theinsuranceresponsibilitywillbeterminatedwhenthemedicalexpensecompensationtotheinsuredreachingthehospitalizationinsuranceamountbyonetimeormoretimesaccumulativepayment.
注/Remark:
（1）以上所有医疗责任所涉及的医疗机构仅限于中华人民共和国大陆境内的公立医院，但不包括公立医院的分院、外宾病区、VIP病区、包房、单间、特诊特需病区、特诊特需病房和高干病房等同类病区或病房发生的所有医疗费用。
（2）以上所有医疗责任所发生医疗费用范围只限于符合当地社会基本医疗保险规定报销范围的项目和费用,自费和部分自负项目均不能报销。
Aboveallmedicalcostsincurredinthismedicalliabilityisonlylimitedtotheprogramandmedicaltreatmentexpensesconformingtothestipulationsofthelocalsocialprimarymedicaltreatmentinsurance,self-expenseandpartoftheself-expenseprojectscannotbereimbursed.
5.遗体遣返
RepatriationBenefits
（1）安排在事发当地的火化、安葬。
（2）安排运送遗体或骨灰返回国内。
注：结合根据被保险人或会员遗愿或其直系亲属的委托，根据实际情况区分必要开支和非必要开支。遗体/骨灰送返、丧葬安排费用包含：尸体防腐、保存、火化、运输及骨灰盒等材料和服务费用。
IftheinsuredpersondiesduetoaccidentalinjuryorillnessinChina,theCompanyshallbeliableforinsurance(therelevantindemnityinsurancemoneyshallbeusedinaccordancewiththewishesoftheinsuredorthewishesofhisfamilymembersinoneofthefollowingways,buttheaccumulatedexpensesshallbelimitedtotheamountinsured).
(1)Arrangementforcremationandburialintheareawheretheincidentoccurred.
(2)ArrangeforthetransportofremainsorashesbacktoChina.
ArrangeregularflightstotransportthebodyorashesoftheinsuredfromtheirplaceoforigintotheInternationalAirportnearesttotheirplaceofresidence.Theclaiminsurancefundshallbeusedtocoverthecoffinexpensesofthelocalinternationalairtransportstandards(tothelimitoftheagreedamount),relatedhandlingfeesandnormalairtransportfees,butnototherexpensessuchasreligiousceremoniesorunnecessaryformalities.
Note:Accordingtothewishesoftheinsuredormembersortheentrustmentoftheirimmediaterelatives,thenecessaryexpenditureandunnecessaryexpenditurecanbedistinguishedaccordingtotheactualsituation.Costsforthereturnofremains/ashesandfuneralarrangementsincludematerialsandservicessuchaspreservation,preservation,cremation,transportationandashesboxes.
三、责任免除(Exemptionfromliability)
因下列情形之一，导致被保险人身故、伤残、发生医疗费用的，本公司不承担给付保险金的责任：
Thecompanywon’tassumeinsurancecompensationliabilityduetobelowreasons：
1、保险单中特别约定的不承担保险责任的疾病；
Diseasesspeciallymentionednotsubjecttoinsuranceresponsibility
2、被保险人在本附加合同生效前的未愈疾病；
Unrecovereddiseasewhichhappenedbeforethevalidityofthisadditionalinsurancecontract
3、投保人对被保险人的故意杀害、故意伤害；
Theintentionallykillorinjuretotheinsuredfromtheinsurant
4、被保险人故意犯罪或抗拒依法采取的刑事强制措施；被保险人自杀或故意自伤，但被保险人自杀或故意自伤时为无民事行为能力人的除外；
Theinsuredintentionalcommitsacrimeorresiststhecriminalcompulsorymeasuresinaccordancewiththelaw;theinsuredintentionallycommitssuicide,ordeliberatelyself-injury,butexceptforbelowsituationiftheinsuredwhobelongtopersonswithoutcapacityofcivilconductwhiletheinsuredcommitssuicide,ordeliberatelyself-injure.
5、被保险人斗殴、醉酒，服用、吸食或注射毒品；
Theinsuredfights,drunk,taking,orinjectingdrugs;
6、被保险人酒后驾驶、无合法有效驾驶证驾驶或驾驶无有效行驶证的机动交通工具；
7、战争、军事冲突、暴乱或武装叛乱；
War,militaryconflicts,riotorarmedrebellion
8、核爆炸、核辐射或核污染；
Nuclearexplosion,nuclearradiationornuclearpollution;
9、被保险人患艾滋病或感染艾滋病病毒、性病
TheinsuredsuffersfromAIDSorinfectedwithHIVorothersexuallytransmitteddiseases
10、被保险人的遗传性疾病，先天性畸形、变形或染色体异常、既往症（投保前已患疾病或已存在的症状，保险期间非连续性的）；
Theinsuredhasgeneticdiseases,congenitalanomaly,deformationorchromosomalabnormalities,anamnesis(suffersfromdiseaseortheexistingsymptomspriortotheinsurance,discontinuityduringtheperiodofinsurance);
11、被保险人洗牙、牙齿美白、正畸、烤瓷牙、种植牙或镶牙等牙齿保健和修复；
Theinsuredisdoingteethcareandteethrepairincludingteethcleaning,teethwhitening,teethorthodontic,porcelainteeth,dentalimplantanddenturefitted,etc;
12、被保险人的视力矫正手术或变性手术；
Thecorrectivesurgeryortranssexualoperationoftheinsured
13、被保险人因整容手术或其它内、外科手术导致医疗事故；
Medicalaccidentscausedbyplasticsurgeryorotherinternalorsurgeryoperationoftheinsured
14、被保险人产前产后检查、妊娠（含宫外孕）、流产（含人工流产）、分娩（含剖腹产）、避孕、绝育手术、治疗不孕不育症、人工受精以及上述原因引起的并发症；
Theinsuredhassomediseasecomplicationscausingbyprenatalpostpartumexamination,pregnancy(includingectopicpregnancy),miscarriage(abortion),accouchement(includingcesareansection),contraception,sterilization,medicaltreatmentforinfertility,artificialinseminationandetc.
15、被保险人健康检查（体检）、疗养、静养或特别护理；
Theinsureddoeshealthcheck(physicalexamination),rehabilitation,rest-treatmentorspecialcare;
16、被保险人未遵医嘱、私自服用、涂用、注射药物；
Theinsuredisnotfollowingdoctor’sadvice,orselftaking,smearingorinjectingmedicine;
17、在中国大陆地区以外发生及中国大陆境内私立医院发生的医疗费用及药店所支出的费用；
Theinsured’smedicalexpensesareoccurredintheprivatehospitalordrugstoreswhichhappenedwithinthemainlandofChinaoroutsideofthemainlandofChina
18、被保险人参加潜水、跳伞、攀岩、探险、武术比赛、摔跤比赛、特技表演、赛马、赛车等高风险运动；
Theinsuredtakespartinbelowactivities,suchasdiving,skydiving,rockclimbing,adventureandmartialartsgame,wrestling,stunt,riskiermovement,horseracing,carracingandetc.
Theexpenseisoccurredduetotheinsuredtakingtrialtreatmentinthehospitalandforthepurposeofmedicalexperiments
20、被保险人在中国台湾、香港、澳门地区或中国境外治疗；
TheinsuredistakenmedicaltreatmentinTaiwan,HongKong,MacaooroutsideChina
21、被保险人在中国大陆以外地区意外身故的；
Theinsured’saccidentaldeathinoutsidemainlandChinaregion;
22、被保险人因整容手术及其它内、外科手术导致医疗事故；
Theinsured’smedicalaccidentcausedbyplasticsurgery,ortheothermedicalorsurgeryoperations.
四、青岛定点医疗机构/Designatedmedicalinstitutions
医院名称
Hospital
地址
Address
Contactnumber
是否有国际门诊
internationalclinic
青岛大学医学院附属医院（东部院区）
AffiliatedHospitalofQingdaoUniversityMedicalCollege（EasterncourtDistrict）
青岛市崂山区海尔路59号
NO.59HaierRoad,LaoshanDistrict,Qingdao
0532-82911877
/
青岛大学医学院附属医院（西部院区）
AffiliatedHospitalofQingdaoUniversityMedicalCollege(WesterncourtDistrict)
青岛市市南区江苏路16号
NO.16JiangsuRoad，ShinanDistrict，Qingdao
0532-82911847
YES
青岛市市立医院（东部院区）
QingdaoMunicipalHospital（EasterncourtDistrict）
青岛市市南区东海路57号
NO.57EastSeaRoad，ShinanDistrict，Qingdao
0532-85937690
青岛市市立医院（西部院区）
QingdaoMunicipalHospital(WesterncourtDistrict)
青岛市市北区胶州路1号
NO.1JiaozhouRoad，ShibeiDistrict，Qingdao
0532-82789328
中国人民解放军四〇一医院
青岛市市南区闽江路22号
NO.22MinjiangRoad，ShinanDistrict，Qingdao
0532-83970702
青岛市海慈医疗集团
QingdaoHaicimedicalgroup
青岛市市北区人民路4号
NO.4RenminRoad，ShibeiDistrict，Qingdao
0532-83777856
青岛市中心医院
QingdaoCentralHospital
青岛市市北区四流南路127号
NO.127FourstreamRoad，ShibeiDistrict，Qingdao
0532-84855192
青岛市第八人民医院
青岛市李沧区峰山路84号
NO.84FengshanRoad，LicangDistrict，Qingdao
0532-86740173
青岛市胸科医院
QingdaoChestHospital
青岛市市北区重庆中路896号
NO.896middleChongqingRoad，ShibeiDistrict，Qingdao
0532-84816258
齐鲁医院（青岛院区）
QiluHospital(Qingdaohospitalarea)
青岛市市北区合肥路758号
NO.758HefeiRoad，ShibeiDistrict，Qingdao
0532-96599
青岛市传染病医院
Qingdaoinfectiousdiseasehospital
青岛市市北区抚顺路9号
NO.9FushunRoad，ShibeiDistrict，Qingdao
0532-81636699
青岛城阳古镇正骨医院
TheancienttownofChengyangQingdaoorthopedicshospital
青岛市城阳区银河路518号
NO.518YinheRoad,ChengyangDistrict,Qingdao
0532-87786926
青岛市肿瘤医院
QingdaoTumorHospital
青岛市市北区开平路19号
NO.19KaipingRoad，ShibeiDistrict,Qingdao
0532-84962329
青岛市阜外心血管病医院（康复中心除外）
QingdaoFuwaiHospitalofCardiovascularDisease(exceptrehabilitationcenter)
青岛市市北区南京路201号
NO.201NanjingRoad，ShibeiDistrict,Qingdao
0532-82989797
青岛市开泰耳鼻喉专科医院（只限耳鼻喉科）
QingdaoKaitaiENTspecialisthospital(DepartmentofENTonly)
青岛市崂山区香港东路77号
NO.77eastHongKongRoad，LaoshanDistrict,Qingdao
0532-88708086
四、理赔材料准备/Claimmaterialpreparation
基本单证/Basicdocuments
1.被保险人身份证明（护照）复印件
2、被保险人在校学生证明
3、账户所有人和账号清晰的银行卡复印件
Theaccountownerandtheaccountclearbankcardcopy
4、理赔申请书
Applicationforsettlementofclaims
根据申请项目，需提供的单证
Materialsarerequiredaccordingtotheapplication
意外身故
Accidentaldeath
1.公安部门或有出具资格的医疗机构出具的死亡证明或验尸报告(原件或复印件)
2.如被保险人为宣告死亡，受益人须提供人民法院出具的宣告死亡证明文件(原件或复印件)
3.有关部门出具的意外事故证明原件或复印件
Theoriginalorcopyoftheaccidentcertificateissuedbytherelevantdepartment
4.被保险人户籍注销证明（外籍人员可不提供）
5.受益人身份证明（护照）
6.受益人与被保险人关系证明（大使馆出具）
Proofofrelationshipbetweenthebeneficiaryandthe
insured(issuedbytheembassy)
疾病身故
diseasedeath
1.病历（门诊、住院）原件（发生就诊时需提供）
2.医学死亡证明
Medicaldeathcertificate
3.户籍注销证明（外籍人员可不提供）
Certificateofhouseholdregistrationcancellation(foreignpersonneldonotprovide)
4.受益人身份证明（护照）
5.受益人与被保险人关系证明（大使馆出具）
Proofofrelationshipbetweenthebeneficiaryandtheinsured(issuedbytheembassy)
6.受益人银行卡复印件
意外伤害残疾
Accidentalinjuryleadstodisability
1.二级（含）以上公立医疗机构或司法机关出具的残疾或烧伤鉴定诊断书Certificateofdiagnosisanddiagnosisofdisabilityorburnsissuedbypublicmedicalinstitutionsorjudicialorgansatorabovesecondarylevel
2.病历原件
Originalmedicalrecord
3.有关部门出具的意外事故证明原件
Theoriginaloftheaccidentcertificateissuedbytherelevantdepartment
4.申请人的法定身份证明
Legalidentificationoftheapplicant
意外、疾病住院
Hospitalizationduetoanaccidentorillness
1.住院病案（出院15天后回病案室打印）
Hospitalization(after15daysafterdischarge)
2.住院收费专用票据原件
Originalbillofspecialbillsforinpatientfees
3.住院费用明细清单
Adetailedlistofhospitalizationexpenses
4.出院小结
Dischargesummary
5.各项检查化验报告单原件
Theoriginaloftheinspectionreport
意外、疾病门诊
Outpatienttreatmentduetoaccidentordisease
1.门诊病历（与发票日期对应）
Outpatientmedicalrecord(correspondingtotheinvoicedate)
2.门诊收费专用票据原件
Theoriginaloftheoutpatientfeespecialbill
3.费用明细清单（若发票上有可不提供）
Listofexpenses(ifthereisnoprovisionontheinvoice)
4.各项检查化验报告单原件
Theoriginalofthetestreport
理赔时限
Settlementtimelimit
1.治疗结束后20天内提交理赔材料
Settlementclaimsshouldbesubmittedwithin20daysaftertheendoftreatment
2.资料齐全后，我公司将在15个工作日内予以赔付
Aftercompleteinformation,ourcompanywillpayin15workingdays