Insurance Services

投保告知
Insured to inform

保险责任:
The insurance liability:
保险责任

The insurance liability

保险金额

The insured amount

备注

note

意外伤害身故及残疾

Accidental injury death and disability

30万元

RMB300000

残疾赔付比例1--10级

Disability compensation ratio 1- 10

意外伤害医疗

Accidental injury medicine

0.5万元

RMB5000

100%赔付

100% pay

特别说明:不包含公共自行车保险责任。

Special instructions: No liability for public bicycle insurance is included

释义:乘坐民航客机或商业营运的火车、轮船、汽车期间:指自被保险人进入客运民航班机的舱门、商业营运的火车车厢、轮船甲板或汽车车厢时起,至抵达目的地走出舱门、车厢或甲板时止的期间。

Paraphrase: The period of train, ship or car in civil aviation passenger aircraft or commercial operation: the period from the time of the insured entering the door of a passenger civil aviation flight, the time of the train, ship deck or car carriage in commercial operation, to the time of departure from the door, carriage or deck at the destination.


请确保本人已查看中国平安财产保险股份有限公司《平安交通工具意外伤害保险条款》,阅知保险责任、保险金额和责任免除内容,并知悉理解本保险只承担乘坐民航客机或商业营运的火车、轮船、汽车期间(指自被保险人进入客运民航班机的舱门、商业营运的火车车厢、轮船甲板或汽车车厢时起,至抵达目的地走出舱门、车厢或甲板时止的)期间发生的意外事故,并同意授权西安城市一卡通有限责任公司为本人购买此份保险。
Please make sure: I have to see China's ping an property insurance co., LTD. "safe transportation accident injury insurance clause", passed the insurance liability, insurance amount, and the content of liability exemption, and knowledge to understand this insurance only cover to take civil aircraft or during the business operation of the train, ship, automobile (refers to the insurant into passenger airliner doors, commercial operation of the train, ship or car deck carriage, to reach the destination out of doors, car or stop when deck) during the accident, and I agree to authorize xian city smart card co., LTD. Buy the insurance for himself.



中国平安财产保险股份有限公司理赔须知
China Ping An Property Insurance co. LTD Claims instructions

理赔报案电话:95511--9(365天*24小时)
Claim report phone: 95511--9 (365 days *24 hours)
服务专线:王亚军 电话:029-88861477 18991280889
Service hotline: Wang Ya Jun Tel: 029-88861477 18991280889

填写《意外险理赔申请书》,只要能提供正规的印有国家财税章的二级(含)以上公立医院的医疗费用发票均可。
Fill in the application form for claims settlement of casualty insurance, as long as you can provide a formal medical expense invoice of a public hospital with the national financial and tax seal of level 2 (including) above.
首诊日不限医院(包括私人诊所),只要能提供正规的印有国家财税章的医疗费用结算收据或发票均可,第二日须转入任何一家二级(含)以上公立医院进行复诊或治疗。
The first consultation day (including private clinics) can be transferred to any public hospital of level two (including) or more to be retreated or treated on second days, as long as it can provide a regular medical expense account receipt or invoice with a state financial and tax seal.

门诊理赔所需资料:
Information required for outpatient claims:
1.门诊病历
Outpatient medical records
2.门诊发票
Outpatient invoice
3.门诊费用清单
List of outpatient expenses
4.身份证正反面复印件、银行卡复印件(注明开户行)
Photocopy of the front and back of the ID card and a copy of the bank card

住院理赔所需资料:
The information required for inpatient claims:
1.住院病历(包括病历首页、长期医嘱、临时医嘱、出院记录)
Hospitalization medical records (including home page of medical records,
long-term medical advice, temporary medical advice, discharge records)
2.住院费用总账单
Total bill of hospitalization expenses
3.住院费结算发票
Inpatient fee settlement invoice
4.身份证正反面复印件、 银行卡复印件(注明开户行)
Photocopy of the front and back of the ID card and a copy of the bank card
5.城镇职工医保挂账结算审核表(在医院医保窗口打印)
Medical insurance checklist for urban workers (printed in hospital medical
insurance window)
6.二次结算证明
Two settlement proof
备注:如果没有城镇职工医保的5、6项可省略。
Remarks: if there are no 5 or 6 items of medical insurance for urban workers, they can be omitted.




中国平安财产保险股份有限公司
平安交通工具意外伤害保险条款
注册号为:C00001732312018040804211

总则

第一条 本保险合同由保险条款、投保单、保险单、保险凭证以及批单等组成。凡涉及本保险合同的约定,均应采用书面形式。

第二条 本保险合同的被保险人应为身体健康、能正常工作或正常生活的自然人。

第三条 本保险合同的投保人应为具有完全民事行为能力的被保险人本人、对被保险人有保险利益的其他人。

第四条 本保险合同的受益人包括:

(一)身故保险金受益人

订立本保险合同时,被保险人或投保人可指定一人或数人为身故保险金受益人。身故保险金受益人为数人时,应确定其受益顺序和受益份额;未确定受益份额的,各身故保险金受益人按照相等份额享有受益权。投保人指定受益人时须经被保险人同意。

被保险人死亡后,有下列情形之一的,保险金作为被保险人的遗产,由保险人依照《中华人民共和国继承法》的规定履行给付保险金的义务:

1.没有指定受益人,或者受益人指定不明无法确定的;

2.受益人先于被保险人死亡,没有其他受益人的;

3.受益人依法丧失受益权或者放弃受益权,没有其他受益人的。

受益人与被保险人在同一事件中死亡,且不能确定死亡先后顺序的,推定受益人死亡在先。

被保险人或投保人可以变更身故保险金受益人,但需书面通知保险人,由保险人在本保险合同上批注。对因身故保险金受益人变更发生的法律纠纷,保险人不承担任何责任

投保人指定或变更身故保险金受益人的,应经被保险人书面同意。被保险人为无民事行为能力人或限制民事行为能力人的,应由其监护人指定或变更身故保险金受益人。

(二)伤残或医疗保险金受益人

除另有约定外,本保险合同的伤残或医疗保险金的受益人为被保险人本人。

 

保险责任

第五条 在保险期间内,被保险人以乘客身份乘坐民航客机或商业营运的火车、轮船、汽车期间因遭受意外伤害事故导致身故、伤残或医疗费用支出的,保险人依照下列约定承担全部或部分责任,具体承担的责任和对应的保险金以保险单载明的为准,且身故保险金和伤残保险金累计给付不超过各项意外伤害保险金额,医疗保险金为保险单载明的意外伤害对应的医疗责任(如有多项意外责任则为累计意外医疗),且累计给付不超过意外伤害医疗保险金额

(一)身故保险责任

在保险期间内,被保险人以乘客身份乘坐民航客机或商业营运的火车、轮船、汽车期间因遭受意外伤害事故,并自事故发生之日起180日内因该事故身故的,保险人按飞机意外伤害保险金额火车意外伤害保险金额轮船意外伤害保险金额汽车意外伤害保险金额分别给付身故保险金,对被保险人的保险责任终止。

被保险人因遭受意外伤害事故且自该事故发生日起下落不明,后经人民法院宣告死亡的,保险人按飞机意外伤害保险金额火车意外伤害保险金额轮船意外伤害保险金额汽车意外伤害保险金额分别给付身故保险金。但若被保险人被宣告死亡后生还的,保险金受领人应于知道或应当知道被保险人生还后30日内退还保险人给付的身故保险金。

被保险人身故前保险人已给付第(二)款约定的伤残保险金的,身故保险金应扣除已给付的伤残保险金。

(二)伤残保险责任

在保险期间内,被保险人以乘客身份乘坐民航客机或商业营运的火车、轮船、汽车期间因遭受意外伤害事故,并自该事故发生之日起180日内因该事故造成《人身保险伤残评定标准及代码》(标准编号为JR/T0083—2013,下简称《伤残评定标准》)所列伤残之一的,保险人按该《伤残评定标准》所列给付比例乘以飞机意外伤害保险金额火车意外伤害保险金额轮船意外伤害保险金额汽车意外伤害保险金额分别给付伤残保险金。如第180日治疗仍未结束的,按当日的身体情况进行伤残鉴定,并据此给付伤残保险金。

1.当同一保险事故造成两处或两处以上伤残时,应首先对各处伤残程度分别进行评定,如果几处伤残等级不同,以最重的伤残等级作为最终的评定结论;如果两处或两处以上伤残等级相同,伤残等级在原评定基础上最多晋升一级,最高晋升至第一级。同一部位和性质的伤残,不应采用《伤残评定标准》条文两条以上或者同一条文两次以上进行评定。

2.被保险人如在本次意外伤害事故之前已有伤残,保险人按合并后的伤残程度在《伤残评定标准》中所对应的给付比例给付伤残保险金,但应扣除原有伤残程度在《伤残评定标准》所对应的伤残保险金。

在保险期间内,前述第(一)、(二)款下的保险金累计给付金额以保险单载明的意外伤害保险金额为限。

(三)医疗保险责任

在保险期间内,被保险人在以乘客身份乘坐民航客机或商业营运的火车、轮船、汽车期间遭受意外伤害事故,并因此在符合本合同释义的医院(以下简称释义医院)进行治疗,保险人就其事故发生之日起180内实际支出的按照当地社会医疗保险主管部门规定可报销的、必要、合理的医疗费用超过人民币100元部分按80%的比例给付医疗保险金

被保险人不论一次或多次以乘客身份乘坐民航客机或商业营运的火车、轮船、汽车遭受意外伤害保险事故,保险人均按上述规定分别给付医疗保险金,但累计给付金额以本保险合同约定的意外伤害医疗保险金额为限,累计给付金额达到意外伤害医疗保险金额时,对被保险人的意外伤害医疗保险责任终止。

被保险人如果已从其他途径获得补偿,则保险人只承担合理医疗费用剩余部分的保险责任。

 

责任免除

第六条 因下列原因造成被保险人身故、伤残或医疗费用支出的,保险人不承担给付保险金责任:

(一)投保人的故意行为;

(二)被保险人自致伤害或自杀,但被保险人自杀时为无民事行为能力人的除外;

(三)因被保险人挑衅或故意行为而导致的打斗、被袭击或被谋杀;

(四)被保险人妊娠、流产、分娩、疾病、药物过敏、中暑、猝死;

(五)被保险人未遵医嘱,私自服用、涂用、注射药物;

(六)核爆炸、核辐射或核污染;

(七)被保险人犯罪或拒捕;

(八)被保险人从事高风险运动或参加职业或半职业体育运动;

(九)被保险人严重违反承运人关于安全乘坐的规定。

第七条 被保险人在下列期间遭受伤害导致身故、伤残或医疗费用支出的,保险人也不承担给付保险金责任:

(一)战争、军事行动、暴动或武装叛乱期间;

(二)被保险人醉酒或受毒品、管制药物的影响期间;

(三)被保险人非以乘客的身份置身于任何交通工具;

(四)被保险人乘坐非商业营运的火车、轮船或汽车期间。

第八条 下列费用,保险人不负给付保险金责任:

(一)保险单签发地社会医疗保险或其他公费医疗管理部门规定的自费项目和药品费用;

(二)因椎间盘膨出和突出造成被保险人支出的医疗费用;

(三)营养费、康复费、辅助器具费、整容费、美容费、修复手术费、牙齿整形费、牙齿修复费、镶牙费、护理费、交通费、伙食费、误工费、丧葬费。

 

保险金额和保险费

第九条 保险金额是保险人承担给付保险金责任的最高限额。

本保险合同的保险金额分为飞机意外伤害保险金额火车意外伤害保险金额轮船意外伤害保险金额汽车意外伤害保险金额意外伤害医疗保险金额由投保人、保险人双方约定,并在保险单中载明。

投保人应该按照合同约定向保险人交纳保险费。

 

保险期间

第十条 本保险合同保险期间由保险人和投保人协商确定,以保险单载明的起讫时间为准。

 

保险人义务

第十一条 本保险合同成立后,保险人应当及时向投保人签发保险单或其他保险凭证。

第十二条 保险人按照第二十条的约定,认为被保险人提供的有关索赔的证明和资料不完整的,应当及时一次性通知投保人、被保险人补充提供。

第十三条 保险人收到被保险人的给付保险金的请求后,应当及时作出是否属于保险责任的核定;情形复杂的,保险人将在确定是否属于保险责任的基本材料收集齐全后,尽快做出核定。

保险人应当将核定结果通知被保险人;对属于保险责任的,在与被保险人达成给付保险金的协议后十日内,履行给付保险金义务。保险合同对给付保险金的期限有约定的,保险人应当按照约定履行给付保险金的义务。保险人依照前款约定作出核定后,对不属于保险责任的,应当自作出核定之日起三日内向被保险人发出拒绝给付保险金通知书,并说明理由

第十四条 保险人自收到给付保险金的请求和有关证明、资料之日起六十日内,对其给付的数额不能确定的,应当根据已有证明和资料可以确定的数额先予支付;保险人最终确定给付的数额后,应当支付相应的差额。

第十五条 投保人符合保险法规定的退还保险费相关要求的,保险人应当按照保险法相关规定退还未满期净保费。

 

投保人、被保险人义务

第十六条 除另有约定外,投保人应当在保险合同成立时交清保险费。

第十七条 订立保险合同,保险人就被保险人的有关情况提出询问的,投保人应当如实告知。

投保人故意或者因重大过失未履行前款规定的义务,足以影响保险人决定是否同意承保或者提高保险费率的,保险人有权解除本保险合同

前款规定的合同解除权,自保险人知道有解除事由之日起,超过三十日不行使而消灭。自合同成立之日起超过二年的,保险人不得解除合同;发生保险事故的,保险人应当承担给付保险金责任。

投保人故意不履行如实告知义务的,保险人对于合同解除前发生的保险事故,不承担给付保险金责任,并不退还保险费。

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,不承担给付保险金责任,但应当退还保险费。

保险人在合同订立时已经知道投保人未如实告知的情况的,保险人不得解除合同;发生保险事故的,保险人应当承担给付保险金责任。

第十八条 投保人住所或通讯地址变更时,应及时以书面形式通知保险人。投保人未通知的,保险人按本保险合同所载的最后住所或通讯地址发送的有关通知,均视为已发送给投保人。

第十九条 投保人、被保险人或者保险金受益人知道保险事故发生后,应当及时通知保险人。否则,投保人、被保险人或受益人应承担由于通知迟延致使保险人增加的勘查、检验等项费用。故意或者因重大过失未及时通知,致使保险事故的性质、原因、损失程度等难以确定的,保险人对无法确定的部分,不承担给付保险金责任,但保险人通过其他途径已经及时知道或者应当及时知道保险事故发生的除外。

保险事故发生后,被保险人需要治疗的,应在释义医院就诊,若因急诊未在释义医院就诊的,应在三日内通知保险人,并根据病情及时转入释义医院。若确需转入非释义医院就诊的,应向保险人提出书面申请,保险人在接到申请后三日内给予答复,对于保险人同意在非释义医院就诊的,对这期间发生的住院医疗费用按本条款规定给付保险金。上述约定,不包括因不可抗力而导致的迟延。

 

保险金申请与给付

第二十条 保险金申请人向保险人申请给付保险金时,应提交以下材料。保险金申请人因特殊原因不能提供以下材料的,应提供其他合法有效的材料。保险金申请人未能提供有关材料,导致保险人无法核实该申请的真实性的,保险人对无法核实部分不承担给付保险金的责任。

(一)身故保险金申请

1.保险金给付申请书;

2.保险单原件;

3.保险金申请人的身份证明;

4.公安部门或医疗机构出具的被保险人死亡证明书。若被保险人为宣告死亡,保险金申请人应提供人民法院出具的宣告死亡证明文件;

5.被保险人的户籍注销证明;

6.由承运人出具的意外事故证明;

7保险金申请人所能提供的与确认保险事故的性质、原因、损失程度等有关的其他证明和资料;

8若保险金申请人委托他人申请的,还应提供授权委托书原件、委托人和受托人的身份证明等相关证明文件。

(二)伤残保险金申请

1.保险金给付申请书;

2.保险单原件;

3.被保险人身份证明;

4.二级以上(含二级)或保险人认可的医疗机构或司法鉴定机构出具的伤残鉴定诊断书;

5.由承运人出具的意外事故证明;

6.保险金申请人所能提供的与确认保险事故的性质、原因、损失程度等有关的其他证明和资料;

7.若保险金申请人委托他人申请的,还应提供授权委托书原件、委托人和受托人的身份证明等相关证明文件。

(三)医疗保险金申请

1.保险金给付申请书;

2.保险单原件;

3.被保险人身份证明;

4.释义医院出具的医疗证明和医疗费用原始凭证;

5由承运人出具的意外事故证明;

6.保险金申请人所能提供的与确认保险事故的性质、原因、损失程度等有关的其他证明和资料;

7.若保险金申请人委托他人申请的,还应提供授权委托书原件、委托人和受托人的身份证明等相关证明文件。

第二十一条 保险金申请人向保险人请求给付保险金的诉讼时效期间为二年,自其知道或者应当知道保险事故发生之日起计算。

 

争议处理和法律适用

第二十二条 因履行本保险合同发生的争议,由当事人协商解决。协商不成的,提交保险单载明的仲裁机构仲裁;保险单未载明仲裁机构或者争议发生后未达成仲裁协议的,依法向人民法院起诉。

第二十三条 与本保险合同有关的以及履行本保险合同产生的一切争议处理适用中华人民共和国法律(不包括港澳台地区法律)。

 

其他事项

第二十四条 

本合同涉及的外币与人民币的汇率,以结算当日中华人民共和国中国人民银行公布的外汇汇率为准。不涉及境外的,以人民币进行赔付。

第二十五条  投保人和保险人可以协商变更合同内容。

变更保险合同的,应当由保险人在保险单或者其他保险凭证上批注或附贴批单,或者投保人和保险人订立变更的书面协议。

第二十六条  在本保险合同成立后,投保人可以书面形式通知保险人解除合同,但保险人已根据本保险合同约定给付保险金的除外。

投保人解除本保险合同时,应提供下列证明文件和资料:

(一)保险合同解除申请书;

(二)保险单原件;

(三)保险费交付凭证;

(四)投保人身份证明。

投保人要求解除本保险合同,自保险人接到保险合同解除申请书之时起,本保险合同的效力终止。保险人收到上述证明文件和资料之日起30日内退还保险单的未满期净保费。

 

释义

第二十七条

保险人】指与投保人签订本保险合同的中国平安财产保险股份有限公司。

【意外伤害】指以外来的、突发的、非本意的和非疾病的客观事件为直接且单独的原因致使身体受到的伤害。

【人身保险伤残评定标准及代码】 《人身保险伤残评定标准及代码》(JR/T 0083—2013)是由中国保险监督管理委员会发布(保监发[2014]6号)并经国家标准化委员会备案的中华人民共和国金融行业标准。

【乘坐民航客机或商业营运的火车、轮船、汽车期间】指自被保险人进入客运民航班机的舱门、商业营运的火车车厢、轮船甲板或汽车车厢时起,至抵达目的地走出舱门、车厢或甲板时止的期间。

【火车】包括铁路列车、地铁、轻轨。

【商业营运】指经相关政府部门登记许可的以客运为目的的运输经营活动。

【未满期净保费】未满期净保费=保险费×[1-(保险单已经过天数/保险期间天数)135%)。经过天数不足一天的按一天计算。

【不可抗力】指不能预见、不能避免并不能克服的客观情况。

【保险金申请人】指受益人或被保险人的继承人或依法享有保险金请求权的其他自然人。

【医院】指保险人与投保人约定的定点医院,未约定定点医院的,则指经中华人民共和国卫生部门评审确定的二级或二级以上的公立医院,但不包括主要作为诊所、康复、护理、休养、静养、戒酒、戒毒等或类似的医疗机构。该医院必须具有符合国家有关医院管理规则设置标准的医疗设备,且全天二十四小时有合格医师及护士驻院提供医疗及护理服务。

【高风险运动】指比一般常规性的运动风险等级更高、更容易发生人身伤害的运动,在进行此类运动前需有充分的心理准备和行动上的准备,必须具备一般人不具备的相关知识和技能或者必须在接受专业人士提供的培训或训练之后方能掌握。被保险人进行此类运动时须具备相关防护措施或设施,以避免发生损失或减轻损失,包括但不限于潜水,滑水,滑雪,滑冰,驾驶或乘坐滑翔翼、滑翔伞,跳伞,攀岩运动,探险活动,武术比赛,摔跤比赛,柔道,空手道,跆拳道,马术,拳击,特技表演,驾驶卡丁车,赛马,赛车,各种车辆表演,蹦极。

【辅助器具费】指购买、安装或修理假肢、矫形器、假眼、假牙和配置轮椅等辅助器具的费用。





Ping An Property & Casualty Insurance Company of China, Ltd.
Ping An Traffic Group Accident Insurance Clause


General Provisions

Article 1               The insurance contract incorporates insurance clauses, insurance applications, insurance policies and endorsements. Any agreement related to the insurance contract shall be in written form.

Article 2        The Insured of this insurance contract shall be a natural person who is in healthy condition and is capable of regular work and life may become the Insured under this insurance contract.

Article 3        The Applicant of this contract shall be the Insured himself/herself with full capacity for civil conduct or any other person who has an insurable interest to the Insured.

Article 4        The beneficiary of this contract shall include:

1. Beneficiary of death benefit

The Insured or Applicant may designate one or more persons as the beneficiaries of the death benefit when entering into the contract. If there is more than one beneficiary, the Insured or Applicant shall determine their sequence and proportion of the benefits; in the absence of such determination, all the beneficiaries should share the benefits on an equal basis. The Applicant shall ask for the Insured’s consent when determining the beneficiary.

In the case of one of the following conditions after the Insured’s death, the benefits shall be handled as the Insured’s legacy and the Insurer shall fulfill the obligation of payment according to the Law of Succession of the People’s Republic of China.

(1) There is no designated beneficiary or the designation of the beneficiary is not clear enough to determine;

(2) The beneficiary died before the Insured and there is no other beneficiary;

(3) The beneficiary forfeits the right of succession according to laws or waives such right and there is no other beneficiary

If the beneficiary and the Insured dies in the same accident and it is impossible to determine the sequence of the deaths, it is assumed that the beneficiary dies first.

If the Applicant takes out personal insurance policies on workers with whom it/he/she has an employment relationship, it/he/she may not designate anyone other than the Insured or their close relatives as beneficiaries.

The Insured or the Applicant may change the beneficiary of the death benefit by giving a written notice to the Insurer, and the Insurer shall endorse on this contract. The Insurer shall not be liable for any legal dispute arising out of the change of the beneficiary of the death benefit.

2. Beneficiary of Disability Benefit or Medical Expense Benefit

Unless otherwise agreed, the beneficiary of the disability benefit or medical expense benefit under this insurance contract shall be the Insured himself/herself.

 

Scope of Cover

Article 5         During the period of insurance, if the Insured suffers death, disability or payment of medical expenses due to an accident when taking civil aircraft or commercially-operated train, ship and car as a passenger, the Insurer shall pay the benefits according to the following agreements, provided the amount of death benefit and disability benefit shall not exceed the accident insured amount and the amount of medical expense benefit shall not exceed the accident medical expense insured amount.

1. Liability for death benefit

During the period of insurance, if the Insured dies from an accident within 180 days after the occurrence of such accident occurring during the course of taking a civil airplane, a commercially operated train, ship or bus as a passenger, the Insurer shall pay the death benefit according to the Airplane Accident Sum Insured, Train Accident Sum Insured, Ship Accident Sum Insured or Bus Accident Sum Insured and the Insurer’s liability for such Insured shall be terminated.

If the Insured suffers an accident and disappears since the accident date and is then declared dead by the People’s Court, the Insurer shall pay the death benefit according to the Accident Sum Insured specified in the policy. However, in case that the Insured is confirmed alive after the declaration of death, the payee of the benefits shall refund the death benefits to the Insurer within 30 days after he/she knows or should know the fact that the Insured is alive.

In case the Insurer has paid for the injury or disability benefit described in paragraph (2) before the Insured’s death, such amount already paid shall be deducted from death benefit.

2. Liability for disability benefit

During the period of insurance, if the Insured is injured in an accident occurring during the course of taking a civil airplane, a commercially operated train, ship or bus as a passenger, and suffers disability of any grade in the attached in the attached “Assessment Standards of Injury and Disability for Personal Insurance (standard code JR/T0083-2013, hereinafter referred to as “Assessment Standards of Injury and Disability”) within 180 days due to the occurrence of such accident, the Insurer shall pay the disability benefit by multiplying the agreed Airplane Accident Sum Insured, Train Accident Sum Insured, Ship Accident Sum Insured or Bus Accident Sum Insured by the corresponding percentage in the Table of Indemnity.  If the treatment still continues after 180 days, the Insurer will pay the injury and disability benefit according to the Insured's physical condition examination on the 180th day.

(1) In case that two or more parts of the Insured in are injured or disabled due to the same insured event, the grades of injury and disability for each part shall be assessed separately first, if the grades of injury and disability is different, the most severe grade of injury and disability shall be the final assessment; if the grades of injury and disability for such parts are the same, one grade will be increased on the basis of the original assessment grade at the most, the first grade is the top grade that can be increased to.  In case of injury and disability on the same part and with the same nature, no more than two articles of the Assessment Standards of Injury and Disability shall be applied or the same article of which shall not be applied for more than two times. 

(2) In case that the Insured is injured and disabled before this accident, the Insurer shall pay the disability benefit according to the corresponding indemnity percentage of the combined injury and disability in Assessment Standards of Injury and Disability, but the indemnity for the original disability according to the Assessment Standards of Injury and Disability shall be deducted.

3. Liability for medical expense benefit

During the period of insurance, if the Insured is injured in an accident occurring during the course of taking a civil airplane, a commercially operated train, ship or bus as a passenger, and accepts medical treatment in hospital that is eligible for the definition of hospital in article 26 (hereinafter referred to as “definition hospital”), the Insurer will pay 80% of the sum in excess of RMB100 of the actual, necessary and reasonable medical expenses incurred within 180 days after the accident to the Insured and reimbursable in accordance with the regulations of the local social medical insurance administrative departments as medical expense benefit.

No matter how many accidents having occurred to Insured during the course of taking a civil airplane, a commercially operated train, ship or bus as a passenger, the Insurer will pay Medical Expense Benefit respectively, and the aggregate payment shall not exceed the Accident Medical Sum Insured specified in the Policy. When the payment reaches the Accident Medical Sum Insured, the Insurer’s liability for such Insured shall be terminated.

If the Insured’s medical expense has been reimbursed by other sources, the Insurer will only pay the remaining part.

 

Exclusions

Article 6        The Insurer will not pay benefit if any of the following cause results in the Insured’s death, injury and disability or payment of medical expenses:

1. Intentional act of the Applicant;

2. The Insured’s committing self-hurt or suicide, except that the Insured is a person without capacity for civil conduct when committing suicide;

3. Fighting, being attacked or murdered caused by the insured’s provocation or intentional act;

4. The Insured’s pregnancy, miscarriage, childbirth, disease, drug allergies, heat stroke, sudden death;

5. The insured’s receipt of cosmetic surgery and other medical operation or surgery;

6. The Insured’ taking, using, injecting drug without doctor's advice;

7. Nuclear radiation, nuclear explosion or nuclear pollution;

8. Terrorist attack;

9. The Insured commits crime or resists arrests;

10. The Insured engages in high risk sports or participate in professional or semi-professional sports;

11. During the time when the Insured is taking a non-commercially­-operated train, ship, or bus;

12. The Insured acts against relevant regulations on safety stipulated by the carrier.

Article 7         If the Insured suffers death, injury and disability or occurs medical expenses during the following period, the Insurer shall not be liable to pay benefits:

1. War, military actions, riots or armed rebellion;

2. When the Insured is drunken or under the influence of drugs or controlled substance;

3. The Insured takes any public vehicles not as a passenger.

Article 8   The Insurer shall not pay benefit for the following expenses:

1. The items and medicines at the Insured’s own expense as stipulated by social medical insurance or other public medical management authority where the policy is issued;

2. Medical expense caused by the Insured’s disc bulging or disc protrusion;

3. Nutrition fees, rehabilitation fees, assistive devices expense, face-lifting fees, cosmetic fees, repairing fees, tooth cosmetic fees, tooth repairing fees, prosthodontics fees, attendance expenses, traffic expenses, accommodation fee, loss of income, funeral expenses.

Should the Insured die because of the occurrence of any situation of the above Article 6 and 7, the Insurer’s liability to the Insured hereunder shall be terminated, and the Insurer shall return to the Applicant the unearned net premium calculated on daily pro-rata basis.

 

Sum Insured and Premium

Article 9        The Sum Insured is the maximum amount that shall be paid by the Insurer.

The insured amount of this insurance contract, including Airplane Accident Insured Amount, Train Accident Insured Amount, Ship Accident Insured Amount, Bus Accident Insured Amount, and Accidental Medical Expense Insured Amount, shall be agreed by the Applicant and the Insurer and set forth in the policy.

The Applicant shall pay the premium to the Insurer according to the contract.

 

Period of Insurance

Article 10       The period of insurance of this insurance contract shall be determined by the Insurer and the Insurance Applicant, the time of commencement and termination being subject to the stipulation in the policy.

 

Obligations of the Insurer

Article 11       The Insurer shall issue the policy or other insurance certificates in a timely manner after the establishment of the insurance contract.

Article 12       According to Article 19, if the Insurer deems the evidence or materials provided by the Insured incomplete, the Insurer shall timely request the Applicant and/or Insured to supplement all additional documents once for all.

Article 13        The Insurer shall, in a timely manner after the receipt of a claim for payment of the insurance benefits from the Insured, ascertain and determine whether the claim is within the liability of the Insurer; for a complicated case, the Insurer shall make decision as quickly as possible after the complete information of the claim is collected.

The Insurer shall notify the Insured of the decision and fulfill the obligation of payment within ten (10) days after reaching the agreement with the Insured if the event falls within the cover of the policy. If the time limit for indemnity is specifically stipulated in the insurance contact, the Insurer shall make payment within such time limit. If the event is not covered in this policy, the Insurer shall issue the Insured a rejection letter and explain reasons within three (3) days from date of making decision according to the preceding paragraph.

Article 14       The Insurer shall pay in advance the amount determined by the proof or documents on hand if the payment amount cannot be finally determined within sixty (60) days from such reception of the Insurer. The Insurer shall pay the remaining amount to the Insured after the final amount is adjusted.

 

Obligations of the Insurance Applicant and the Insured

Article 15       Unless otherwise specified, the Applicant shall pay premium upon entering into the insurance contract.

Article 16       When entering an insurance contract, the Applicant shall make true representations if the Insurer makes inquiries on the subject-matter insured or the Insured.

If the Applicant fails to comply with the obligations of making honest representation aforementioned due to willful act and/or gross negligence, which may affect the Insurer’s decision as to whether he accepts the risk or raises the premium rate, the Insurer has the right to cancel the insurance contract.

The Insurer’s right to terminate an insurance contract aforementioned is void if not exercised by the Insurer within thirty days after acknowledgement of any events triggering termination of this policy. This right is also void after two years of the establishment of an insurance contract and the Insurer shall be liable for indemnity in respect of an insured event.

If the Applicant willfully fails to comply with the obligations of making honest representations, the Insurer shall not be liable for any loss of or damage to the Item Insured prior to the cancellation of the policy, and premium shall not be refunded.

If the Applicant fails to comply with the obligations of making true statement due to gross negligence, the Insurer shall not be liable for any loss of or damage to the Item Insured prior to the cancellation of the policy, but the premium shall be refunded.

The Insurer shall not terminate the insurance contract where he has already known when contracting that the Insured fails to give representations in truth. The Insurer shall still be liable for indemnity in respect of an insured event.

Article 17       The Applicant shall give the Insurer timely notice of any change of his/her residence or mail address. If the Applicant fails to notify the Insurer, any related notification sent by the Insurer as per the final residence or mail address specified in the Policy shall be deemed as having been delivered to the Applicant.

Article 18       The Applicant and/or the Insured shall notify the Insurer immediately upon acknowledgement of any occurrence of the insured event. Otherwise, the Applicant, the Insured or the benefit beneficiary shall bear the increased expenses for the Insurer’s investigation and survey caused by delayed notification. If the Applicant and/or the Insured fail to notify the Insurer in time due to his/her willful act or gross negligence, which makes the Insurer can not make sure the nature, cause and extent of the loss, the Insurer shall not indemnify the Insured in respect of the uncertain part, except that the Insurer has known the occurrence timely by other means or should have known the occurrence timely.

Upon occurrence of the insured event, the Insured shall be treated in the defined hospital if necessary; in case the Insured is not treated in the defined hospital due to emergency, the Insured shall notify the Company within three days and be transferred to the defined hospital in time according to the conditions. In case the Insured shall be transferred to the undefined hospital, the Insured shall make a written request to the Insurer; the Insurer shall make its determination within three days after receipt of the request; the Insurer shall pay benefit for medical expenses occurred during treatment in accordance with this insurance contract if the Insurer approves the Insured's request.

The above agreement does not include the delay caused by force majeure.

 

Claim and Payment of Insurance Benefit

Article 19       The benefits applicant shall submit the following certificates and documentary materials when making claims under the policy. If the benefits applicant fails to provide the following materials for special reasons, he/she shall provide other legal and valid materials. In the event that the Insurer is unable to verify the authenticity of the claim due to the benefits applicant’s failure to provide related materials, the Insurer shall not be liable to pay for the uncertain part.

1. Claim for death benefit

(1) Benefit application form;

(2) Original policy;

(3) The identification certificate of the benefits applicant;

(4) The death certificate of the Insured issued by the public security department or medical institution. If the Insured is declared dead, the benefits applicant shall present the certificate of declaration of death issued by the people's court;

(5) Certificate of deregistration of the Insured’s registered permanent residence;

(6) Accident certificate issued by the carrier;

(7) Any other evidences and materials provided by you and the Insured to identify the nature and cause of the insured accident and the extent of loss;

(8) If the benefits applicant entrusts other person to claim, he/she shall provide the original authorization letter, identification certificate of the trustor and the trustee, as well as other related certificates.

2. Claim for injury and disability benefit

(1) Benefit application form;

(2) Original policy;

(3) Identity document of the Insured;

(4) Medical certificate for injury and disability identification issued by medical institute of second-level or above or recognized by the Insurer or the judicial identification institute;

(5) Accident certificate issued by the carrier;

(6) Any other evidences and materials provided by you and the Insured to identify the nature and cause of the insured accident and the extent of loss;

(7) If the benefits applicant entrusts other person to claim, he/she shall provide the original authorization letter, identification certificate of the trustor and the trustee, as well as other related certificates.

3. Claim for medical expense benefit

(1) Benefit application form;

(2) Original policy;

(3) Identity document of the Insured;

(4) The medical certificate and original medical bills issued by the defined hospital;

(5) Accident certificate issued by the carrier;

(6) Any other evidences and materials provided by you and the Insured to identify the nature and cause of the insured accident and the extent of loss;

(7) If the benefits applicant entrusts other person to claim, he/she shall provide the original authorization letter, identification certificate of the trustor and the trustee, as well as other related certificates.

Article 20       The right of the Insured to claim for indemnity shall lapse if the Insured fails to exercise such right within two years from the date the Insured is or should be aware of the occurrence of the insured event.

 

Dispute Settlement and Law Application

Article 21       Disputes arising from the execution and performance of the policy shall be settled through negotiation between the parties hereto. Should no settlement be reached, the case in dispute shall be submitted to the arbitration institution specified in the policy; where no arbitration institution is specified in the policy and no arbitration agreement is reached after disputes, either party hereinto may bring litigation to the people’s court of P. R. China.

Article 22       Any dispute with regard to the policy should apply the laws of P. R. China (excluding the laws of Hong Kong, Macao and Taiwan area).

 

Other Provisions

Article 23           If the Insured is hospitalized outside P. R. C., the Insurer’s payment will be calculated as per domestic standards where the Policy is issued,

In case of the conversion between the foreign currency and RMB, the Insurer’s payment shall be calculated at the exchange rate announced by the People’s Bank of China at the date of processing the payment.

Article 24       The Insurance Applicant and the Insurer may amend the contents of the insurance contract subject to mutual agreement.

Should there be any amendments to the insurance contract, the Insurer shall endorse the original policy or any other insurance certificates, or issue an endorsement slip attached to the insurance contract or insurance certificates, or conclude a written agreement of amendment with the Insurance Applicant.

Article 25       The Insurance Applicant may notify the Insurer in writing to terminate the insurance contract after the establishment of the insurance contract, except that the Insurer has paid insurance benefit according to the insurance contract.

When the Applicant requests cancellation of the policy, he/she shall submit the following documents and materials:

1. Application for cancellation of insurance contract;

2. Original policy;

3. Payment receipt of premium;

4. Identity document of the Insurance Applicant;

Where the Applicant requests cancellation of the insurance contract, the effectiveness of insurance contract shall be cancelled upon the Insurer’s reception of the cancellation application. The Company shall refund the unearned net premium under the policy within 30 days after receipt of the above evidences and materials.

 

Definitions

Article 26

[Insurer] refers to Ping An Property & Casualty Insurance Company of China who signs the insurance contract with the Applicant.

[Accidental injury] refers to any bodily injury directly and solely caused by any extraneous, sudden, unintentional and non-disease objective event.

[Disability Assessment Standard and Code for Life Insurance] Disability Assessment Standard and Code for Life Insurance (JR/T 0083 - 2013) is a financial industry standard issued by the China Insurance Regulatory Commission (CIRC [2014] No. 6) and filed to the National Standardization Committee of the People's Republic of China.

[Limbs] refers to the four limbs of human body, namely left upper limb, right upper limb, left lower limb and right lower limb.

[Without Valid Driver’s License]: refers to one of the following circumstances of the insured:

(1) Without driver’s license or the driver’s license has expired;

(2) The vehicle driven by the insured does not match the model indicated in the driver’s license;

(3) Driving buses, public passenger vehicle or motor vehicle that carries dangerous cargo such as explosive substances, flammable and explosive chemical materials, highly toxic articles or radioactive substances in the course of internship, driving the motor vehicle to haul trailer during the internship period;

(4)Holding driver’s license that has not been legally reviewed, and driving motor vehicle when the driver’s license is withheld, detained, revoked or cancelled;

(5) Operating variety of special-purpose mechanical vehicles or special vehicles without valid operation permits issued by the relevant departments of the State, driving the public passenger vehicle without valid certificate issued by the relevant departments of the State;

(6) Driving under the circumstances that prohibited by the laws and regulations or according to the relevant provisions of the traffic department of the Public Security Organ.

[Without valid vehicle license]: refers to one of the following circumstances:

(1) The vehicle’s registration has been legally cancelled;

(2) Without vehicle license, license plate, or temporary license plate or temporary movement permit issued by the traffic department of the Public Security Organ;

(3) Vehicle has not passed motor vehicle safety technical inspection in the specified inspection period.

[Unearned net premium] Unearned Net premium= premium * (1-passed days/total policy period days) * (1-35%). One day applies if the passing period is less than 24 hours.

[Benefits applicant] refers to the beneficiary or the legal heirs of the insured, or other natural person who is entitled to claim for insurance benefit.

[Force majeure] refers to the objective situation that cannot be foreseen, avoided or overcome.

[During the course of taking a commercially operated train, ship or bus] refers to the period from the time when the Insured steps into the carriage of a commercially operated train, deck of a commercially operated ship or the carriage of a commercially operated bus, to the time when the Insured steps out of the carriage of a commercially operated train, deck of a commercially operated ship or the carriage of a commercially operated bus.

[Train] includes railway train, subway and light rail.

[Commercially operated] refers to the condition the operator is legally licensed and registered to operate a passenger conveyance.

[Hospital] refers to the designated hospital by the Insurer and the Applicant. In case of no designated hospital, refers to the public hospital of second-level II or above evaluated by the Health Department of P. R. China but excluding asylum and medical institute mainly for non-direct treatment, such as convalescence, rest cure, abstinence of drugs, abstinence, attendance, nursing and etc.. Such hospital must have medical appliances in accordance with national standards in related hospital management regulations and qualified doctors and nurses providing medical and attending service 24-h a day.

[High-risk sports]: refers to a sport activity with a higher risk grade than normal activities, where the possibility to incur bodily injury is bigger. Before doing such sport, the person shall make full preparation both psychologically and physically, grasp relevant knowledge and technique that a normal person doesn’t grasp, and accept training or exercise guided by a professional. In the process of such sport, the insured should be equipped with relevant protective measures and facilities to avoid being hurt, including but not limited to diving, skiing, skating, driving or taking hang gliding or paraglider, parachute jumping, rock climbing, exploration, martial art competition, rassling competition, judo, karate, kickboxing, equestrianism, boxing, stunt performance, go-kart driving, horse racing, car racing, various car performance, bungee jumping.

[Assistive devices cost] refers to the cost for purchase, installation or repair of artificial limb, orthopedic instruments, ocular prosthesis, artificial tooth and wheelchair and other assistive devices.