Insurance terms of travel accident insurance

Article 1 This insurance contract consists of insurance clauses, application form, insurance policy, insurance certificate and endorsement. All agreements involving this insurance contract shall be in writing.

Article 2 The insured under this insurance contract should be a traveler under 80 years old, in good health, and able to work or live normally.

Article 3 The insured person of this insurance contract shall be the insured person with full capacity for civil conduct and other persons who have insurable interests in the insured person. Article 4 The beneficiaries of this insurance contract include:

(1) When the beneficiary of the death insurance proceeds enters into this insurance contract, the insured or the policy holder may designate one or more persons to be the beneficiary of the death insurance proceeds. people. When there are several beneficiaries of the death insurance benefit, their beneficiary order and beneficiary shares should be determined; if the beneficiary share is not determined, each beneficiary of the death insurance benefit shall enjoy the beneficiary rights in equal shares. The policyholder must obtain the consent of the insured when designating a beneficiary. After the death of the insured, if one of the following circumstances occurs, the insurance money will be regarded as the inheritance of the insured, and the insurer will perform the obligation to pay the insurance money in accordance with the provisions of the "Succession Law of the People's Republic of China":

1． No beneficiary is designated, or the beneficiary is unclear and cannot be determined;

2. The beneficiary dies before the insured and there is no other beneficiary;

3. The beneficiary loses the beneficiary rights or gives up the beneficiary rights in accordance with the law and there is no other beneficiary. If the beneficiary and the insured die in the same event and the order of death cannot be determined, the beneficiary is presumed to have died first. The insured or policy holder may change the beneficiary of the death insurance benefit, but must notify the insurer in writing, and the insurer shall make an endorsement on this insurance contract. The insurer does not bear any responsibility for legal disputes arising from changes in beneficiary of death insurance benefits. If the policyholder designates or changes the beneficiary of the death insurance benefit, the insured must obtain written consent. If the insured is a person without capacity for civil conduct or a person with limited capacity for civil conduct, his or her guardian shall designate or change the beneficiary of the death insurance benefit.

(2) Beneficiary of disability insurance and medical insurance benefits Unless otherwise agreed, the beneficiary of disability insurance and medical insurance benefits in this insurance contract shall be the insured person himself. Article 5 During the insurance period, if the insured suffers an accidental injury during travel, resulting in death, disability or medical expenses, the insurer will pay the insurance money in accordance with the following agreement.

(1) Death insurance liability During the insurance period, if the insured suffers an accidental injury during travel and dies as a result of the accident within 180 days from the date of the accident, the insurer shall The injury insurance amount pays the death insurance benefit and the insurance liability to the insured terminates. If the insured suffers an accidental injury and his whereabouts are unknown since the date of the accident, and is later declared dead by the people's court, the insurer will pay the death insurance benefit based on the accidental injury insurance amount. However, if the insured survives after being declared dead, the recipient of the insurance benefits shall return the death insurance benefit paid by the insurer within 30 days after he knows or should know that the insured survives. If the insurer has paid the disability insurance benefits specified in paragraph (2) before the death of the insured, the death insurance benefit shall be deducted from the paid insurance benefits.

(2) Disability Insurance Liability During the insurance period, the insured suffers an accidental injury during travel, and the "Personal Injury" attached to this insurance contract is caused by the accident within 180 days from the date of the accident. If one of the disabilities is listed in the Table of Insurance Disability Degrees and Insurance Benefit Ratios (referred to as the "Benefits Table"), the insurer will pay the disability insurance benefits based on the benefit ratio listed in the table multiplied by the accidental injury insurance amount. If the treatment has not ended on the 180th day, a disability assessment will be conducted based on the physical condition on that day, and disability insurance will be paid accordingly. 1． When the insured suffers from more than one disability due to the same accidental injury, the insurer will pay the sum of the various disability insurance benefits, but the total payment shall not exceed the accidental injury insurance amount. When different disability items belong to the same limb, only the disability insurance benefit for the one with the highest benefit ratio will be paid. 2． If the insured was disabled before the accident, the insurer will pay the disability insurance benefit according to the benefit ratio corresponding to the combined degree of disability in the "Benefit Schedule", but the original disability degree shall be deducted from the benefit ratio in the "Benefit Schedule". 》The corresponding disability insurance benefit. The insured's cumulative death insurance and disability insurance benefits are limited to the amount of his or her accidental injury insurance. (3) Medical insurance liability During the insurance period, if the insured suffers an accidental injury during travel and is treated in a hospital that complies with the interpretation of Article 27 of this clause (hereinafter referred to as the "interpretation hospital"), the insurer will be covered The insurance company will pay medical insurance benefits for the part of the necessary and reasonable medical expenses that are reimbursable in accordance with the regulations of the local social medical insurance authority and exceeds RMB 100 within 180 days from the date of the accident. Regardless of whether the insured suffers one or more accidental injuries, the insurer will pay the medical insurance benefits separately according to the above provisions, but the cumulative payment amount is limited to the insured’s accidental injury medical insurance amount, and the cumulative payment amount reaches the accidental injury medical insurance amount. , the insurance liability to the insured terminates. If the insured has received compensation from other sources, the insurer will only bear insurance liability for the remainder of the reasonable medical expenses.

Liability Exemption Article 6 If the insured’s death, disability or medical expenses are incurred due to the following reasons, the insurer shall not be liable for insurance benefits:

(1) Insured Person Intentional act;

(2) The insured causes self-injury or suicide, except that the insured is a person without capacity for civil conduct at the time of suicide;

(3) Due to being injured Fighting, assault or murder caused by provocation or intentional behavior of the insured;

(4) Pregnancy, miscarriage, childbirth, disease, drug allergy, heat stroke and sudden death of the insured;

< p>(5) The insured person undergoes plastic surgery and other internal and surgical operations;

(6) The insured person fails to follow the doctor’s advice and takes, applies or injects drugs privately;

(7) Nuclear explosion, nuclear radiation or nuclear pollution;

(8) Terrorist attack;

(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 suffers injury resulting in death, disability or medical expenses during the following periods, the insurer will not be liable for insurance benefits: (1) War, military action, riot or armed During the period of rebellion;

(2) During the period when the insured is drunk or under the influence of drugs or controlled substances;

(3) The insured drives under the influence of alcohol, or drives or drives without a valid driver's license Period of motor vehicle without valid driving license.

Article 8: The insurer is not responsible for paying insurance premiums for the following expenses:

(1) Self-pay items stipulated by the social medical insurance or other public medical management departments in the place where the insurance policy is issued and Drug expenses;

(2) Medical expenses incurred by the insured due to disc bulge and herniation;

(3) Nutrition expenses, rehabilitation expenses, assistive device expenses, and plastic surgery expenses , cosmetology fees, restorative surgery fees, dental plastic surgery fees, dental restoration fees, denture fees, nursing fees, transportation expenses, food expenses, lost work expenses, and funeral expenses.

If the above-mentioned circumstances in Articles 6 and 7 occur and the insured dies, the insurer shall terminate its insurance liability for the insured and refund the unexpired net premium to the policy holder on a daily basis. Article 11 After this insurance contract is established, the insurer shall issue an insurance policy or other insurance certificate to the policy holder in a timely manner.

Article 12 If the insurer, in accordance with the provisions of Article 20, believes that the proof and information related to the claim provided by the insured are incomplete, it shall promptly notify the policy holder and the insured to provide supplementary information in a timely manner. .

Article 13 After receiving the insured’s request for payment of insurance benefits, the insurer shall promptly make a determination as to whether it is covered by insurance liability; in complex circumstances, the insurer will determine whether it is covered by insurance liability. After the basic materials are collected, the approval will be made as soon as possible. The insurer shall notify the insured of the verification results; for insurance liability, it shall perform its obligation to pay insurance benefits within ten days after reaching an agreement with the insured to pay insurance benefits. If the insurance contract stipulates the time limit for payment of insurance benefits, the insurer shall perform its obligation to pay insurance benefits in accordance with the agreement. After the insurer makes an assessment in accordance with the provisions of the preceding paragraph, if the insurance liability is not covered by the insurance, it shall issue a notice of refusal to pay insurance benefits to the insured within three days from the date of assessment and explain the reasons.

Article 14 If the insurer cannot determine the amount of insurance payment within sixty days from the date of receipt of the request for payment of insurance benefits and relevant certificates and materials, it shall determine the amount based on existing certificates and materials. The determined amount shall be paid first; after the insurer finally determines the amount of payment, it shall pay the corresponding difference. Obligations of the policy holder and the insured Article 15 Unless otherwise agreed, the policy holder shall pay the insurance premium when the insurance contract is established.

Article 16 When entering into an insurance contract, if the insurer inquires about the relevant situation of the insured, the policy holder shall truthfully inform the insured. If the policyholder fails to perform the obligations stipulated in the preceding paragraph intentionally or due to gross negligence, which is enough to influence the insurer's decision whether to agree to underwrite the policy or to increase the insurance rate, the insurer has the right to terminate this insurance contract. The right to terminate the contract stipulated in the preceding paragraph shall be extinguished if it is not exercised for more than thirty days from the date when the insurer becomes aware of the reasons for termination. If it exceeds two years from the date of establishment of the contract, the insurer shall not terminate the contract; if an insured accident occurs, the insurer shall bear the responsibility for paying insurance benefits. If the policyholder intentionally fails to fulfill the obligation of truthful disclosure, the insurer will not be liable for insurance benefits and will not refund the insurance premium for the insured event that occurred before the contract was terminated. If the policyholder fails to fulfill the obligation to truthfully report due to gross negligence, which has a serious impact on the occurrence of the insured event, the insurer shall not be liable for insurance benefits for the insured event that occurred before the contract was terminated, but shall refund the insurance premium. If the insurer is aware of the situation that the policy holder has not truthfully informed when the contract is concluded, the insurer shall not terminate the contract; if an insured accident occurs, the insurer shall bear the liability for paying insurance premiums.

Article 17 When the insured’s residence or mailing address changes, the insurer shall be notified in writing in a timely manner. If the policy holder fails to notify, the relevant notice sent by the insurer to the last residence or mailing address stated in this insurance contract shall be deemed to have been sent to the policy holder.

Article 18 The policyholder, the insured or the beneficiary of the insurance money shall promptly notify the insurer after learning that an insured accident has occurred.

If the failure to notify in a timely manner intentionally or due to gross negligence makes it difficult to determine the nature, cause, extent of loss, etc. of the insured accident, the insurer shall not be liable for paying insurance premiums for the undetermined portion, but the insurer has timely known or should have known through other channels Exceptions are made if the occurrence of the insured accident is promptly known. The above agreement does not include delays caused by force majeure.

Article 19 After an insured accident occurs, if the insured needs treatment, he should go to Shiyi Hospital for treatment. If he does not go to Shiyi Hospital for emergency reasons, he should notify the insurer within three days and arrange treatment according to his condition. Transferred to Shiyi Hospital in time. If you really need to transfer to a non-interpretation hospital for treatment, you should submit a written application to the insurance company. The insurance company will respond within three days after receiving the application. If the insurance company agrees to treat you in a non-interpretation hospital, you will be responsible for the hospitalization medical expenses incurred during this period. Insurance benefits shall be paid according to the provisions of this insurance contract. Insurance Benefit Application and Payment

Article 20 When applying for insurance benefits from the insurer, the insurance claimant shall submit the following materials. If the insurance applicant is unable to provide the following materials due to special reasons, he should provide other legal and valid materials. If the applicant for insurance benefits fails to provide relevant materials, resulting in the insurer being unable to verify the authenticity of the application, the insurer shall not be responsible for paying insurance benefits for the portion that cannot be verified.

(1) Application for death insurance benefits

1. Insurance benefit payment application form;

2. Original insurance policy;

3. Proof of identity of the insurance applicant;

4. Death certificate of the insured person issued by the public security department or medical institution. If the insured is declared dead artificially, the applicant for insurance benefits should provide the death declaration certificate issued by the people's court;

5. Proof of household registration cancellation of the insured;

6. The insured must submit copies of the insured's travel transportation tickets (such as air tickets, bus tickets, etc.), hotel accommodation tickets, tour group fee documents and other travel documents and provide the originals for inspection;

7. Other certificates and information that the insurance applicant can provide to confirm the nature, cause, extent of loss, etc. of the insured accident;

8. If the insurance applicant entrusts another person to apply, he should also provide the original power of attorney, identity certificates of the trustor and trustee and other relevant supporting documents.

(2) Application for disability insurance funds

1. Insurance benefit payment application form;

2. Original insurance policy;

3. Proof of identity of the insured;

4. Disability appraisal diagnosis certificate issued by Class II or above (including Class II) or a medical institution or judicial appraisal institution recognized by the insurer;

5. The insured must submit copies of the insured's travel transportation tickets (such as air tickets, bus tickets, etc.), hotel accommodation tickets, tour group fee documents and other travel documents and provide the originals for inspection;

6. Other certificates and information that the insurance applicant can provide to confirm the nature, cause, extent of loss, etc. of the insured accident;

7. If the insurance applicant entrusts another person to apply, he should also provide the original power of attorney, identity certificates of the trustor and trustee and other relevant supporting documents.

(3) Application for medical insurance benefits

1. Insurance benefit payment application form;

2. Original insurance policy;

3. Proof of identity of the insured;

4. Interpret the medical certificate and original voucher for medical expenses issued by the hospital;

5. The insured must submit copies of the insured's travel transportation tickets (such as air tickets, bus tickets, etc.), hotel accommodation tickets, tour group fee documents and other travel documents and provide the originals for inspection;

6. Other certificates and information that the insurance applicant can provide to confirm the nature, cause, extent of injury, etc. of the insured accident;

7. If the insurance applicant entrusts another person to apply, he should also provide the original power of attorney, identity certificates of the trustor and trustee and other relevant supporting documents.

Article 21 The statute of limitations for an insurance claimant to request payment of insurance benefits from the insurer is two years, calculated from the date the applicant knew or should have known that the insured accident occurred. Dispute handling and application of law

Article 22 Disputes arising from the performance of this insurance contract shall be resolved by negotiation between the parties. If the negotiation fails, the dispute 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 the dispute occurs, the case shall be filed in the People's Court in accordance with the law.

Article 23 All disputes related to this insurance contract and arising from the performance of this insurance contract shall be governed by the laws of the People's Republic of China (excluding the laws of Hong Kong, Macao and Taiwan). Article 24 If the insured seeks medical treatment abroad, the medical expenses included in the insurance liability shall be converted according to the average level of the same treatment in the place where the insured's domestic insurance policy is issued. The exchange rate between foreign currency and RMB involved in this insurance contract shall be based on the foreign exchange rate announced by the People's Bank of China and the People's Bank of China on the settlement date.

Article 25 The policy holder and the insurer may negotiate to change the contents of the contract. To change an insurance contract, the insurer shall annotate or attach an endorsement to the insurance policy or other insurance certificate, or the policy holder and the insurer shall enter into a written agreement on the change.

Article 26 After the insurance contract is established, the policy holder may notify the insurer in writing to terminate the contract, except where the insurer has already paid insurance premiums in accordance with the insurance contract.

When the policyholder terminates this insurance contract, he or she shall provide the following supporting documents and information:

(1) Application for termination of insurance contract;

(2) Insurance Original copy of the insurance policy;

(3) Insurance premium delivery certificate;

(4) Proof of identity of the policy holder. If the policyholder requests to terminate this insurance contract, the validity of this insurance contract will terminate from the moment the insurer receives the application for termination of the insurance contract. The insurer shall refund the unexpired net premium of the insurance policy within 30 days from the date of receipt of the above supporting documents and information. Interpretation

Article 27

Travel refers to behavior that requires leaving the insured's location for travel, business negotiations, family visits, etc.

The chronological age is calculated based on the date of birth recorded in the legal identity document.

Insurer refers to Ping An Property & Casualty Insurance Co., Ltd. of China, which signed this insurance contract with the policy holder.

Accidental injuries refer to injuries to the body caused by external, sudden, unintentional and non-disease objective events as a direct and independent cause.

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

Hospital refers to the designated hospital agreed between the insurer and the policy holder. If no designated hospital is agreed upon, it refers to a public hospital of Grade II or above that has been reviewed and determined by the People's Government of the People's Republic of China and the State Health Department. But it does not include medical institutions that are mainly used as clinics, rehabilitation, nursing, rest, retreat, alcohol treatment, drug treatment, etc. or similar medical institutions. The hospital must have medical equipment that meets the standards set by the relevant national hospital management rules, and have qualified doctors and nurses on site 24 hours a day to provide medical and nursing services.

The insured without a valid driver's license has one of the following circumstances:

(1) No driver's license or the driver's license has expired;

(2) ) The motor vehicle being driven does not match the permitted driving type stated on the driving license;

(3) During the internship period, driving a public car, a commercial bus, or carrying explosives, flammable and explosive chemicals , motor vehicles carrying dangerous goods such as highly toxic or radioactive materials, and motor vehicle tractor-trailers driven during the internship period;

(4) Holding a driver's license that has not been verified as required, and holding a driver's license that is temporarily withheld, detained, revoked, Driving a motor vehicle while the driver's license is cancelled;

(5) Personnel who use various special-purpose mechanical vehicles and special vehicles do not have valid operating licenses issued by relevant national departments, and drivers who drive commercial passenger vehicles do not have valid operating licenses issued by relevant national departments. A valid qualification certificate issued;

(6) Driving under other circumstances where driving a motor vehicle is not allowed in accordance with laws, regulations or relevant regulations of the traffic management department of the public security organ.

No valid driving license refers to one of the following situations:

(1) The motor vehicle has been deregistered in accordance with the law;

(2) There is no traffic management by the public security organ Motor vehicles with driving licenses, license plates, or temporary license plates or temporary mobility permits issued by the department

(3) Motor vehicles that fail to undergo motor vehicle safety technical inspection within the prescribed inspection period or fail to pass the inspection tool.

High-risk sports refer to sports that have a higher risk level than regular sports and are more likely to cause personal injury. Before engaging in such sports, you need to be fully mentally prepared and physically prepared. You 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 when engaging in such sports to avoid losses or mitigate losses, including but not limited to diving, water skiing, skiing, ice skating, driving or riding hang gliding, paragliding, parachuting, and rock climbing. , adventure activities, martial arts competitions, wrestling competitions, judo, karate, taekwondo, equestrian, boxing, stunts, kart driving, horse racing, racing, various vehicle performances, bungee jumping.

Assistive device fees refer to the cost of purchasing, installing or repairing prosthetic limbs, orthotics, artificial eyes, dentures and wheelchairs and other assistive devices. Net premium for the unexpired period Net premium for the unexpired period = insurance premium × [1 - (number of days the insurance policy has elapsed/number of days during the insurance period)] × (1 - 25%). If the number of days passed is less than one day, it will be calculated as one day.

Force majeure refers to objective circumstances that cannot be foreseen, avoided and overcome.

The applicant for insurance benefits refers to the beneficiary or the heir of the insured or other natural person who has the right to claim insurance benefits according to law.