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News report

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Insurance age

1 year

Insurance period

Short-term universal medical insurance products mainly provide medical reimbursement for hospitalization and outpatient service, and can also provide reimbursement for outpatient treatment such as radiotherapy, intravenous chemotherapy, hemodialysis and chronic diseases.

product description

insured liability

During the insurance period of this contract, the Company undertakes the following insurance responsibilities:

First, the medical expenses insurance liability

(1) Insurance premium for hospitalization expenses

If the insured is hospitalized in a medical institution managed by the basic medical insurance agreement (excluding special needs and the International Medical Department, the same below), after deducting the part that has been compensated or paid by local public medical care and basic medical insurance, the company will pay the insurance premium for hospitalization medical expenses according to the compensation ratio listed in the insurance payment ratio table. Among them, hospitalization medical expenses refer to the actual medical expenses, hospitalization surgery expenses, bed fees and other expenses incurred by the insured during hospitalization.

(2) Insurance premium for outpatient treatment expenses before and after hospitalization

If the insured is hospitalized in a medical institution managed by the basic medical insurance agreement, and the outpatient treatment expenses actually incurred and paid by the insured in the same medical institution for the same reason as hospitalization within seven days before hospitalization (including hospitalization day) and thirty days after discharge (including discharge day) are within the scope of medical expenses insurance benefits under this contract, after deducting the part that has been compensated or paid by local free medical care, basic medical insurance, etc., the company will pay the premium according to the Insurance Payment Proportion Table (Annex/)

(3) Insurance premium for specific outpatient treatment expenses

If the insured receives radiotherapy for malignant tumor, intravenous chemotherapy for malignant tumor, hemodialysis, peritoneal dialysis, anti-rejection treatment after renal transplantation or outpatient treatment for liver cirrhosis in medical institutions managed by the basic medical insurance agreement, the specific outpatient treatment expenses actually incurred and paid for each outpatient treatment are in line with the scope of medical expenses insurance treatment under this contract. After deducting the part that has been compensated or paid by local free medical care and basic medical insurance, the company will pay the insurance premium for specific outpatient treatment expenses according to the proportion listed in the Insurance Payment Proportion Table (Annex 1) for the balance during the insurance period of this contract.

During the insurance period of this contract, the company's one-time or cumulative compensation for the insured's specific outpatient treatment expenses is limited to the insured amount of the specific outpatient treatment expenses during the insurance period.

(4) outpatient chronic disease treatment insurance premium

If the insured carries out outpatient treatment of chronic diseases in medical institutions managed by the basic medical insurance agreement, after deducting the part that has been compensated or paid by local public medical care and basic medical insurance, the company will pay the outpatient treatment expenses of chronic diseases according to the payment ratio listed in the payment ratio table.

range

Description of support project

If the hospitalization expenses insurance premium is hospitalized in a medical institution managed by the basic medical insurance agreement (excluding special needs and the International Medical Department, the same below), the hospitalization expenses actually incurred and paid for each hospitalization shall be paid according to the payment proportion listed in the Insurance Payment Proportion Table after deducting the part that has been compensated or paid by local public medical care and basic medical insurance.

If the insurance premium of outpatient medical expenses before and after hospitalization is hospitalized in a medical institution managed by the basic medical insurance agreement, and the outpatient medical expenses actually incurred and paid in the same medical institution as hospitalization within seven days before hospitalization (including hospitalization day) and thirty days after discharge (including discharge day) for the same reason as hospitalization are within the scope of medical expenses insurance in this contract, after deducting the part that has been compensated or paid by local free medical care and basic medical insurance, the insurance premium of outpatient medical expenses before and after hospitalization shall be paid according to the proportion listed in the insurance payment proportion table.

If the medical institution managed by the basic medical insurance agreement receives malignant tumor radiotherapy, malignant tumor intravenous chemotherapy, hemodialysis, peritoneal dialysis, anti-rejection treatment after renal transplantation or outpatient treatment of liver cirrhosis in the form of outpatient service, the specific outpatient treatment expenses actually incurred and paid for each outpatient service are in line with the scope of medical expenses insurance under this contract. After deducting the part that has been compensated or paid by local free medical care and basic medical insurance, the remaining amount during the contract insurance period will be paid to the specific outpatient treatment expenses according to the payment ratio listed in the insurance payment ratio table.

Outpatient treatment insurance premium for chronic diseases If outpatient treatment for chronic diseases is carried out in a medical institution managed by the basic medical insurance agreement, the outpatient treatment insurance premium for chronic diseases actually incurred and paid for each outpatient treatment in accordance with the scope of medical expenses insurance under this contract, after deducting the part that has been compensated or paid by local public medical care, basic medical insurance and other means, shall pay the balance according to the payment proportion listed in the insurance payment proportion table within the contract insurance period.

exonerate

For the medical expenses incurred by the insured due to one of the following circumstances, the Company shall not be liable for the payment of insurance benefits, and this contract shall remain valid during the agreed insurance period:

1. The insured seeks medical treatment in Hong Kong Special Administrative Region, Macao Special Administrative Region, Taiwan Province Province or outside China;

2. Congenital malformation, deformation or chromosomal abnormality;

3. The insured intentionally commits a crime or resists criminal compulsory measures taken according to law;

4. The insured commits suicide or intentionally injures himself, unless he is a person without civil capacity when committing suicide or intentionally injures himself;

Five, the insured drunk driving, driving without a valid driver's license or driving a motor vehicle without a valid driver's license;

6. The insured fights, gets drunk, takes the initiative to take or inject drugs;

Seven, the insured did not follow the doctor's advice, privately taking, smearing or injecting drugs (except for the use of over-the-counter drugs according to the instructions for use);

8. The insured participates in diving, skydiving or other high-risk sports such as air movement, mountain climbing, rock climbing or stair climbing, adventure, martial arts competition, wrestling competition, stunt show, horse racing and car racing;

Nine, the insured receives alcohol or drug treatment, psychotherapy, vision correction surgery, sex change surgery, plastic surgery or orthopedic surgery;

Ten, recuperation, rehabilitation treatment, circumcision, non-medical hormone therapy, alopecia treatment, beauty, weight loss, breast enhancement or breast reduction surgery, sleep-related research or treatment, smoking cessation, orthopedics, cosmetic surgery caused by non-accidents;

Eleven, the use of prosthetic devices, various orthoses (including artificial limbs, artificial eyes, and neck braces and splints used in non-emergency situations), wheelchairs and various electric walkers and hearing AIDS; Routine vision examination, preparation of glasses or contact lenses, vision therapy or vision training;

Twelve, medical expenses caused by medical accidents;

Thirteen. Mental and behavioral disorders of the insured;

14. Organ or tissue removal as a donor, search and acquisition of organ donors, and organ removal, storage and transportation of donors;

Fifteen, experiments or research treatments without scientific or medical approval and their consequences;

Sixteen, the use of proton heavy ion therapy;

17. War, military conflict, terrorist acts, riots or armed rebellion;

Eighteen, nuclear explosion, nuclear radiation or nuclear pollution;

19. Other circumstances stipulated by law.

Detailed regulations

China Life Personal Tax Preferential Health Insurance (Universal) Clause A (Version 2016) Click to view it.

What is not guaranteed?

The insured shall not pay compensation for insurance accidents caused by the insured's intentional homicide, intentional crime, suicide, medical treatment in Hong Kong, Macao and Taiwan or overseas, participation in high-risk sports, alcohol or drug treatment, recuperation, rehabilitation, use of prosthetic devices, mental and behavioral disorders, use of proton heavy ion therapy, non-compliance with medical advice, drug abuse, drunkenness, driving without a license, war riots, nuclear explosions and other reasons.

For details, please refer to the "Exemption" section in the following terms:

China Life Personal Tax Preferential Health Insurance (Universal) Article 1 (20 16 Edition)

Who can guarantee that?

Has reached 16 years old.

number; amount; how many; how much

Due to gender, age and other differences, the premiums paid are not the same. If you need to know the specific cost, you can consult the insurance agent certified by Wobao. Looking for the best quotation scheme.

Protect what?

How much is the guarantee?

Hospitalization medical expenses (reasonable expenses actually paid-reimbursement for public expenses and basic medical care-reimbursement for other channels) × agreed reimbursement ratio.

Outpatient treatment expenses before and after hospitalization (reasonable expenses actually paid-reimbursement for public expenses and basic medical care-reimbursement for other channels) × agreed reimbursement ratio.

Specific outpatient treatment expenses (reasonable expenses actually paid-reimbursement for public expenses and basic medical care-reimbursement for other channels) × agreed reimbursement ratio.

Outpatient treatment expenses for chronic diseases

(Reasonable expenses actually paid-reimbursement for public expenses and basic medical care-reimbursement for other channels) × agreed reimbursement ratio

(Treatment of hypertension, diabetes or coronary heart disease can be reimbursed)