Article 2 The insured under this insurance contract shall be a traveler who is under 80 years old, is in good health and can work or lead a normal life.
Article 3 The insured under this insurance contract shall be the insured himself with full capacity for civil conduct and other persons with insurable interests to the insured. Article 4 The beneficiaries of this insurance contract include:
(1) Beneficiaries of death insurance benefits When concluding this insurance contract, the insured or the applicant may designate one or more persons as beneficiaries of death insurance benefits. When there are several beneficiaries of the death insurance, the order and share of the beneficiaries shall be determined; If the share of benefits is not determined, all beneficiaries of death insurance benefits shall enjoy the same share of welfare rights. The applicant must obtain the consent of the insured when designating the beneficiary. After the death of the insured, in any of the following circumstances, the insurance money shall be regarded as the heritage of the insured, and the insurer shall perform the obligation to pay the insurance money in accordance with the provisions of the Inheritance Law of People's Republic of China (PRC):
1. No beneficiary is specified, or the beneficiary designation is unclear and uncertain;
2. The beneficiary dies before the insured, and there are no other beneficiaries;
3. The beneficiary loses or waives the beneficial right according to law, and there are no other beneficiaries. If the beneficiary and the insured die in the same event and the order of death cannot be determined, it is presumed that the beneficiary died first. The insured or the applicant can change the beneficiary of the death insurance, but it needs to notify the insurer in writing, and the insurer will make comments on this insurance contract. The insurer shall not bear any responsibility for legal disputes caused by changing the beneficiary of death insurance. If the applicant designates or changes the beneficiary of death insurance, it shall obtain the written consent of the insured. If the insured is a person without or with limited capacity for civil conduct, his guardian shall designate or change the beneficiary of the death insurance money.
(II) Beneficiaries of disability insurance and medical insurance Unless otherwise agreed, the beneficiaries of disability insurance and medical insurance under this insurance contract are the insured himself. Article 5 During the insurance period, if the insured suffers death, disability or medical expenses due to accidental injury during travel, the insurer shall pay the insurance money according to the following agreement.
(I) Liability for Death Insurance During the insurance period, if the insured suffers an accidental injury accident while traveling, and dies due to the accidental injury accident within 180 days from the date of the accident, the insurer shall pay the death insurance premium according to the amount of the accidental injury insurance, and the insurance liability for the insured shall be terminated. If the insured suffers an accidental injury accident and his whereabouts are unknown from the date of the accident, and he is later declared dead by the people's court, the insurer shall pay death insurance money according to the amount of accidental injury insurance. However, if the insured returns after being declared dead, the beneficiary of the insurance money shall return the death insurance money paid by the insurer within 30 days from the date when he knew or should have known that the insured was still alive. Before the death of the insured, if the insurer has paid the disability insurance benefits agreed in paragraph (2), the death insurance benefits shall be deducted from the paid insurance benefits.
(II) Liability for Disability Insurance During the insurance period, if the insured suffers an accidental injury accident during the travel period, and one of the disabilities listed in the Table of Disability Degree and Insurance Payment Proportion (hereinafter referred to as the Compensation Table) attached to this insurance contract is caused within 180 days from the date of the accident, the insurer shall pay the disability insurance money by multiplying the payment ratio listed in the table by the accidental injury insurance amount. 180 If the treatment is still not finished on the same day, disability appraisal will be conducted according to the physical condition of that day, and disability insurance money will be paid accordingly. 1. When the insured is disabled for more than one time due to the same accidental injury accident, the insurer shall pay the sum of various disability insurance benefits, but the total payment shall not exceed the amount of accidental injury insurance. When different disability items belong to the same limb, only the disability insurance with the highest proportion will be paid. 2. If the insured has been disabled before the accident, the insurer shall pay the disability insurance money according to the proportion of the combined disability degree in the payment table, but the disability insurance money corresponding to the original disability degree in the payment table shall be deducted. The cumulative payment of death insurance and disability insurance of the insured is limited to the amount of accidental injury insurance. (III) Liability for Medical Insurance During the insurance period, if the insured suffers an accidental injury accident while traveling, he will be treated in a hospital that meets the definition in Article 27 of this Article (hereinafter referred to as "Interpretation Hospital"), and the expenses actually spent by the insurer for the insured exceeding 65,438+000 yuan within 65,438+080 days from the date of the accident can be reimbursed according to the regulations of the local social medical insurance authorities. No matter the insured suffers one or more accidental injuries, the insurer shall pay the medical insurance premium according to the above provisions, but the cumulative payment amount shall be limited to the insured's accidental injury medical insurance amount. When the accumulated compensation amount reaches the insured's accidental injury medical insurance amount, the insurance liability to the insured is terminated. If the insured has obtained compensation through other means, the insurer shall only bear the insurance liability for the remaining reasonable medical expenses.
Article 6 The insurer shall not be liable for the payment of insurance benefits in case of death, disability or medical expenses of the insured due to the following reasons:
(a) the intentional act of the applicant;
(2) The insured causes self-mutilation or suicide, unless the insured is a person without civil capacity at the time of suicide;
(3) Fighting, being attacked or being murdered due to the provocation or intentional behavior of the insured;
(4) Pregnancy, abortion, childbirth, illness, drug allergy, heatstroke and sudden death of the insured;
(5) The insured receives cosmetic surgery and other internal and surgical operations;
(six) the insured did not follow the doctor's advice and took, smeared or injected drugs without authorization;
(7) Nuclear explosion, nuclear radiation or nuclear pollution;
(8) terrorist attacks;
(9) The insured commits a crime or resists arrest;
(10) The insured engages in high-risk sports or participates in professional or semi-professional sports.
Article 7 If the insured dies, suffers from disability or suffers from medical expenses during the following periods: (1) During the period of war, military action, riot or armed rebellion;
(2) The insured is under the influence of drunkenness, drugs or controlled drugs;
(3) During drunk driving, the insured drives or drives a motor vehicle without a valid driver's license.
Article 8 The insurer shall not be liable to pay the insurance money for the following expenses:
(1) Self-funded items and drug expenses stipulated by social medical insurance or other publicly-funded medical management departments in the place where the policy is issued;
(2) Medical expenses incurred by the insured due to disc herniation;
(3) Nutrition expenses, rehabilitation expenses, assistive devices expenses, cosmetic expenses, beauty expenses, repair surgery expenses, dental plastic surgery expenses, tooth restoration expenses, dental implant expenses, nursing expenses, transportation expenses, meals expenses, lost time expenses and funeral expenses.
If the insured dies under the circumstances mentioned in Articles 6 and 7 above, the insurer shall terminate the insurance liability to the insured and return the unexpired net insurance premium to the insured on a daily basis. Article 11 After the establishment of this insurance contract, the insurer shall issue an insurance policy or other insurance certificates to the applicant in time.
Article 12 According to the provisions of Article 20, if the insurer thinks that the certificates and materials related to the claim provided by the insured are incomplete, it shall promptly notify the applicant and the insured to supplement them.
Article 13 After receiving the request of the insured to pay the insurance money, the insurer shall promptly verify whether it belongs to the insurance liability; If the situation is complicated, the insurer will check it as soon as possible after collecting all the basic information to determine whether it belongs to the insurance liability. The insurer shall notify the insured of the verification result; For the insured, the obligation to pay insurance money shall be fulfilled within ten days after reaching an agreement with the insured. If there is an agreement on the payment period of insurance benefits in the insurance contract, the insurer shall perform the obligation to pay insurance benefits in accordance with the agreement. After verification as agreed in the preceding paragraph, the insurer shall, within three days from the date of verification, issue a notice of refusal to pay insurance benefits to the insured, and explain the reasons.
Article 14 If the insurer cannot determine the amount of insurance benefits within 60 days from the date of receiving the request for insurance benefits and relevant certificates and materials, it shall pay the amount that can be determined according to the existing certificates and materials in advance; After the insurer finally determines the amount of compensation, it shall pay the corresponding difference. Obligations of the applicant and the insured Article 15 Unless otherwise agreed, the applicant shall pay the insurance premium when the insurance contract is concluded.
Article 16 When concluding an insurance contract, the insurer asks about the insured, and the applicant shall truthfully inform him. If the applicant fails to perform the obligations stipulated in the preceding paragraph intentionally or due to gross negligence, which is enough to affect the insurer's decision to agree to underwrite or increase the insurance premium rate, the insurer has the right to terminate this insurance contract. If the right to terminate the contract stipulated in the preceding paragraph is not exercised for more than 30 days from the date when the insurer knows the reason for termination, it shall be extinguished. If more than two years have passed since the establishment of the contract, the insurer shall not terminate the contract; In the event of an insured accident, the insurer shall be responsible for paying the insurance premium. If the applicant intentionally fails to fulfill the obligation of telling the truth, the insurer shall not be liable for paying the insurance premium or returning the insurance premium for the insurance accident that occurred before the termination of the contract. If the insured fails to fulfill the obligation of telling the truth due to gross negligence, which has a serious impact on the occurrence of the insured accident, the insurer shall not be liable for paying the insurance premium for the insured accident that occurred before the termination of the contract, but shall refund the insurance premium. When concluding a contract, the insurer knows that the applicant has not truthfully informed it, and may not terminate the contract; In the event of an insured accident, the insurer shall be responsible for paying the insurance premium.
Article 17 When the domicile or mailing address of the applicant changes, it shall promptly notify the insurer in writing. If the applicant fails to notify, the relevant notice issued by the insurer according to the last residence or mailing address specified in this insurance contract shall be deemed to have been served on the applicant.
Article 18 The applicant, the insured or the beneficiary shall notify the insurer in time after knowing the occurrence of the insured accident. If it is difficult to determine the nature, cause and loss degree of the insured accident due to intentional or gross negligence, the insurer shall not be liable for paying the insurance premium for the uncertain part, except that the insurer has known or should have known the occurrence of the insured accident in time through other means. The above agreement does not include delays caused by force majeure.
Article 19 If the insured needs medical treatment after an insurance accident, he shall go to the Interpretation Hospital for medical treatment. If you fail to go to the interpretation hospital for emergency treatment in time, you should inform the insurer within three days and transfer to the interpretation hospital in time according to your illness. If it is really necessary to transfer to a non-explanatory hospital, a written application shall be submitted to the insurer, and the insurer shall give a reply within three days after receiving the application. If the insurer agrees to see a doctor in a non-interpreter hospital, the hospitalization expenses incurred during this period shall be paid in accordance with the provisions of this insurance contract. Insurance application and payment
Article 20 An applicant shall submit the following materials when applying to the insurer for payment of insurance benefits. If the applicant cannot provide the following materials due to special reasons, he shall provide other legal and effective materials. If the applicant fails to provide relevant materials, which makes it impossible for the insurer to verify the authenticity of his application, the insurer shall not be liable for paying the insurance money for the part that cannot be verified.
(1) Application for death insurance benefits
1. Insurance claim application;
2. Original insurance policy;
3. The identity certificate of the insured;
4. The death certificate of the insured issued by the public security department or medical institution. If the insured is declared dead, the applicant shall provide a death certificate issued by the people's court;
5. Certificate of cancellation of the insured's household registration;
6. The insured's travel documents such as travel tickets (such as air tickets and boat tickets). ), hotel accommodation tickets, tour group fee documents must be submitted in copies and originals for inspection;
7. Other certificates and materials that the insured can provide to confirm the nature, cause and loss degree of the insured accident;
8. If the applicant entrusts others to apply, it shall also provide the original power of attorney, the identity certificates of the principal and the trustee and other relevant supporting documents.
(2) Application for disability insurance money
1. Insurance claim application;
2. Original insurance policy;
3. The identity certificate of the insured;
4. The disability identification and diagnosis certificate issued by the medical institution or judicial authentication institution recognized by the insurer and above (including Grade II);
5. The insured's travel documents such as travel tickets (such as air tickets and boat tickets). ), hotel accommodation tickets, tour group fee documents must be submitted in copies and originals for inspection;
6. Other certificates and materials that the insured can provide to confirm the nature, cause and loss degree of the insured accident;
7. If the applicant entrusts others to apply, it shall also provide the original power of attorney, the identity certificates of the principal and the trustee and other relevant supporting documents.
(3) Medical insurance application
1. Insurance claim application;
2. Original insurance policy;
3. The identity certificate of the insured;
4. Explain the medical certificate issued by the hospital and the original certificate of medical expenses;
5. The insured's travel documents such as travel tickets (such as air tickets and boat tickets). ), hotel accommodation tickets, tour group fee documents must be submitted in copies and originals for inspection;
6. Other certificates and materials that can be provided by the insured to confirm the nature, cause and degree of injury of the insured accident;
7. If the applicant entrusts others to apply, it shall also provide the original power of attorney, the identity certificates of the principal and the trustee and other relevant supporting documents.
Article 21 The limitation of action for the applicant to ask the insurer to pay the insurance money is two years, counting from the day when he knows or should know that the insured accident has occurred. Dispute settlement and application of law
Article 22 Any dispute arising from the performance of this insurance contract shall be settled by both parties through consultation. If negotiation fails, it shall be submitted to the arbitration institution specified in the insurance policy for arbitration; If the arbitration institution is not specified in the insurance policy or an arbitration agreement is not reached after a dispute arises, a lawsuit shall be brought to the people's court according to law.
Article 23 All disputes arising from the performance of this insurance contract shall be governed by the laws of People's Republic of China (PRC) (excluding the laws of Hong Kong, Macao and Taiwan). Article 24 If the insured goes abroad for medical treatment, the medical expenses in the insurance liability shall be converted according to the average level of equal treatment in the place where the insurance policy is issued in China. The exchange rate between foreign currency and RMB involved in this insurance contract shall be based on the foreign exchange quotations published by the People's Bank of People's Republic of China (PRC) and China on the settlement date.
Article 25 The applicant and the insurer may change the contents of the contract through consultation. Where an insurance contract is changed, the insurer shall endorse the insurance policy or other insurance documents or attach an endorsement, or the applicant and the insurer shall conclude a written agreement on the change.
Article 26 After the establishment of this insurance contract, the applicant may notify the insurer in writing to terminate the contract, except that the insurer has paid the insurance benefits in accordance with the provisions of this insurance contract.
The applicant shall provide the following supporting documents and materials when dissolving this insurance contract:
(1) An application for termination of the insurance contract;
(2) The original insurance policy;
(3) Insurance premium delivery certificate;
(4) the identity certificate of the applicant. The applicant requests to terminate this insurance contract, and the validity of this insurance contract shall be terminated when the insurer receives the application for termination of the insurance contract. The insurer shall refund the unexpired net insurance premium of the insurance policy within 30 days from the date of receiving the above-mentioned supporting documents and materials. translate freely
Article 27
Travel refers to leaving the insured's place for travel, business negotiation and visiting relatives.
The age of majority is calculated according to the date of birth recorded in legal identity documents.
The insurer refers to China Ping 'an Property Insurance Co., Ltd. which signed this insurance contract with the applicant.
Accidental injury refers to physical injury caused by external, sudden, unintentional and non-disease objective events as direct and separate reasons.
Limb refers to the four limbs of human body, that is, left upper limb, right upper limb, left lower limb and right lower limb.
Hospital refers to the designated hospital agreed by the insurer and the insured. If there is no designated hospital, it refers to the public hospitals at or above the second level determined by People's Republic of China (PRC) and the national health department, but it does not include medical institutions mainly used for diagnosis and treatment, rehabilitation, nursing, rest, rest, alcohol withdrawal and drug rehabilitation. Hospitals must have medical equipment that meets the standards stipulated in the relevant national hospital management rules, and qualified doctors and nurses are stationed in the hospital for 24 hours to provide medical and nursing services.
The insured without a valid driver's license is under any of the following circumstances:
(1) No driver's license or the validity period of the driver's license has expired;
(two) driving a motor vehicle does not meet the driving license;
(3) Driving a bus, operating a bus or a motor vehicle carrying explosives, inflammable and explosive chemicals, toxic or radioactive substances during the internship period, and towing a trailer by a motor vehicle driven during the internship period;
(four) holding a driver's license that has not been verified according to the regulations, and driving a motor vehicle during the period when the driver's license is temporarily detained, detained, revoked or cancelled;
(five) the personnel who use all kinds of special mechanical vehicles and special vehicles do not have valid operation certificates issued by relevant state departments, and the drivers who drive commercial buses do not have valid qualification certificates issued by relevant state departments;
(6) Other circumstances in which a motor vehicle may not be driven in accordance with laws and regulations or the relevant provisions of the traffic administrative department of the public security organ.
No valid driver's license refers to any of the following circumstances:
(1) Motor vehicles are deregistered according to law;
(2) A motor vehicle without a driving license, license plate, temporary license plate or temporary mobile license plate issued by the traffic administrative department of the public security organ.
(3) Motor vehicles that fail to carry out the safety technical inspection of motor vehicles within the specified inspection period or fail to pass the inspection.
High-risk sports refer to sports with higher risk level and more prone to personal injury than general regular sports. Before carrying out such sports, we need to be fully prepared psychologically and for action, and we must have relevant knowledge and skills that ordinary people do not have or can only be mastered after receiving training or training provided by professionals. The insured must have relevant protective measures or facilities to avoid or mitigate losses, including but not limited to diving, water skiing, skiing, skating, driving or riding hang gliding, paragliding, skydiving, rock climbing, adventure activities, martial arts competitions, wrestling competitions, judo, karate, taekwondo, equestrian, boxing, stunts, go-karting, horse racing, racing and so on.
The cost of assistive devices refers to the cost of purchasing, installing or repairing prosthetic limbs, orthotics, artificial eyes, dentures and wheelchairs. Unexpired net premium Unexpired net premium = insurance premium × [1- (days after policy/days during insurance period) ]× (1-25%). If the number of days is less than one day, it shall be counted as one day.
Force majeure refers to an objective situation that cannot be foreseen, avoided and overcome.
The applicant for insurance benefits refers to the beneficiary or heir of the insured, or other natural persons who have the right to claim insurance benefits according to law.