1. Warranty clause:
(1) General medical insurance, including inpatient medical treatment, specific outpatient medical treatment, emergency medical treatment 30 days before hospitalization and outpatient surgical treatment, with a coverage of 2 million;
(2) 120 kinds of medical insurance premium for serious illness, including hospitalization for serious illness, specific outpatient medical treatment for serious illness, emergency medical treatment for 30 days after hospitalization for serious illness, and surgical treatment for serious illness, with the insured amount of 2 million;
(3) proton heavy ion medical insurance premium: the insured amount is 4 million, and the bed fee is limited to 1500/ day;
(4) Out-of-hospital cancer-specific drug genetic testing fee insurance premium: the insured amount is 4 million;
(5) Medical insurance premium for specific drugs for malignant tumors outside the hospital: the insured amount is 4 million;
(6) Insurance premium for urgently needed drugs for specific diseases outside the hospital: the insured amount is 20,000;
(7) Calculation method of insurance premium: (medical expenses within the scope of insurance responsibility undertaken by the insured-deductible) * reimbursement ratio. Under normal circumstances, the reimbursement rate is 100%, but if the insured person is basic medical insurance or medical treatment at public expense, the reimbursement rate is 60%;
(8) Deductible: General medical insurance premium and critical illness medical insurance premium * * * enjoy the deductible of 654.38+00000 yuan, and other insurance liabilities are zero.
2. Exemption clause:
The insurance company shall not be liable for the payment of insurance benefits if the insured has an insurance accident or medical expenses due to one of the following circumstances:
(1) The insured intentionally kills or intentionally hurts the insured;
(2) The insured intentionally commits suicide, self-injures, intentionally commits a crime or resists criminal compulsory measures taken according to law;
(3) The insured fights, gets drunk, takes the initiative to take or inject drugs;
(4) The insured is drunk driving, driving without a valid driver's license or driving a vehicle without a valid driver's license;
(5) Nuclear explosion, nuclear radiation and pollution, war, military conflict, terrorist attack, riot or armed rebellion;
(6) Treatment of mental and behavioral disorders and various medical consultations and health predictions, such as health consultation, sleep consultation, sexual consultation and psychological consultation;
(7) Various medical appraisals, including but not limited to medical accident appraisal, mental illness appraisal, pregnant woman fetus sex appraisal, injury appraisal, paternity appraisal and gene appraisal;
(8) Hereditary diseases and congenital malformations, deformations or chromosomal abnormalities other than specific diseases;
(9) Except for previous diseases and diseases specially agreed in insurance contracts;
(10) Diseases during the period when the insured is infected with HIV or suffers from AIDS, except AIDS caused by specific reasons in the list of specific diseases;
(1 1) The insured is infected with Treponema pallidum and Neisseria gonorrhoeae;
(12) Physical examination, recuperation, gastric volume reduction surgery (including but not limited to adjustable band surgery, sleeve gastrectomy, gastric bypass surgery, gastric water sac surgery, gastrointestinal bypass surgery), vision correction surgery, strabismus correction surgery, cosmetic surgery caused by accidents, and various cosmetic plastic surgery projects, including but not limited to skin pigmentation, acne treatment, rosacea treatment, and benign skin injury. Treatment and removal of varicose veins, spider veins and other scars except keloids on the distal elbow joint and face of upper limbs. Tattoo removal, skin discoloration treatment or surgery. Laser beauty, wrinkle removal, eye bags removal, double eyelid opening, alopecia areata, gray hair, hair loss, hair removal, rhinoplasty, breast augmentation and various plastic and physiological defects. Including but not limited to flat feet and various non-functional cosmetic, plastic and plastic surgery expenses. Various bodybuilding treatment items, such as nutrition, weight loss, weight gain and height increase;
(13) infertility treatment, artificial insemination, pregnancy, delivery (including dystocia), abortion, birth control (including sterilization), prenatal and postpartum examination and complications caused by the above reasons;
(14) Circumcision, balloon dilatation and treatment of sexual dysfunction;
(15) oral medicine (dentistry) health care and oral medicine (dentistry) disease treatment except oral tumor treatment;
(16) The insured receives medical treatment for accidental injury in high-risk activities meeting one or more of the following standards:
Engaged in the occupation in the Special Occupation Category Table attached to this main insurance contract:
Activities must involve surface or underwater movements in natural waters with a water depth of more than 2 meters, including but not limited to various types and levels of diving, swimming and diving in natural waters (including artificial lakes or reservoirs);
Activities will inevitably involve high-altitude sports above the ground 10 meter, including but not limited to skydiving, bungee jumping, non-commercial aircraft flight, glider or paraglider, wing-mounted flight, rock climbing, etc.
Deliberately entering an environment that is generally considered to be life-threatening or entering a natural area that has not been artificially developed, including but not limited to various exploration and space activities except commercial flights;
Various fighting or similar military activities, such as wrestling, martial arts competitions, paintball shooting and other simulated gun battles;
Various stunts;
Running sports other than walking and running, such as horse racing, car racing, racing ice and snow sports, etc.
(17) Inpatients who pretend to be hospitalized, fail to go to the hospital on time for medical treatment, fail to meet the admission criteria, hang up their beds in the hospital or refuse to leave the hospital (all medical expenses incurred since the date of hospital discharge);
(18) The insured receives experimental treatment (medical behavior without scientific or medical approval).
The insurance company shall not be liable for the related medical expenses under any of the following circumstances:
(1) Any medicine that is not treated by doctor's advice or purchased without doctor's prescription;
(2) Although there is a doctor's suggestion, the relevant treatment and examination are not carried out in the hospital, or the hospital does not charge related fees;
(3) treatment without the approval of the local competent department, or drugs or drugs without the approval or approval of the local government.
(4) Expenses incurred from not purchasing drugs or medical devices in the drug list specified in this main insurance contract according to the procedures agreed in this main insurance contract;
(5) Expenses incurred by departments with rehabilitation treatment as the main function, such as hospital rehabilitation department and rehabilitation center;
(six) the drug costs involved in Chinese herbal medicines and various wine preparations brewed by them;
(7) although there is a doctor's prescription, but the dose is more than 30 days;
(8) All medical expenses arising from gene therapy and cellular immunotherapy not explicitly agreed in this main insurance contract;
(nine) the purchase, installation and replacement of artificial organs other than heart valves, intraocular lenses and artificial joints;
(10) Purchase, lease and replacement expenses of all non-disposable medical devices and over-the-counter medical devices such as all kinds of corrective and protective medical devices for personal use, all kinds of rehabilitation medical devices, prostheses, artificial limbs, wheelchairs, massage health care and therapeutic supplies.