(中英對照)保險單

合眾團體附加意外傷害醫(yī)療保險(2013修訂)條款ProvisionsforAdditionalAccidentalInjuryMedicalInsurance(2013Revision)ofUnion

Life(合保發(fā)〔2013〕483號，2013年12月經(jīng)保監(jiān)會核準備案)(UnionLifeIssuance[2013]No.483,whichisapprovedbyCIRCinDec.2013)在本條款中，本公司指合眾人壽保險股份有限公司Inthisprovision,thecompanyreferstoUnionLifeInsuranceCo.,Ltd.1.投保人與本公司的合同1.Contractsignedbetweenthepolicyholderandthecompany1.1投保范圍ScopeofInsurance凡在本附加保險合同(以下簡稱“本附加合同”)訂立時對被保險人具有保險利益或經(jīng)被保險人書面同意的機關(guān)、企業(yè)、事業(yè)單位和社會團體均可作為投保人。WhensigningthisAdditionalInsuranceContract(hereinafterreferredtoas“AdditionalContract”),policyholdercanbetheonewholinkswiththeinsuredintermsofinsuranceinterestorgovernmentunits,enterprises,publicinstitutionsandsocialorganizationswhicharepermittedbytheinsuredinwritten.凡符合本公司承保條件的人均叫作為被保險人。Allthosecomplyingwiththeinsuranceconditionscanbeconsideredastheinsured.1.2合同構(gòu)成ContractFormation本附加保險合同需由主保險合同(以下簡稱“主合同”)投保人提出申請,經(jīng)本公司同意而訂立。ThisAdditionalContractshallbesignedoncebeingappliedbytheinsuredsetintheMasterInsuranceContract(hereinafterreferredtoas“MasterContract”)andbeingagreedbythecompany.主合同所附條款、投保書、合法有效的聲明、批注、附貼批單、其他書面協(xié)議，凡與本附加合同相關(guān)者，都是本附加合同的構(gòu)成部分。若主合冋與本附加合同的條款互有沖突，則以本附加合同的條款為準。ThisAdditionalContractincludesallprovisionssetintheMasterContract,proposalform,legalandvaliddeclaration,notes,approvalordersattachedtothisAdditionalContract,otherwrittenagreementsandpartiesrelatedtothisAdditionalContract.IfthereisaconflictbetweenthisAdditionalContractandMasterContract,AdditionalContractshallbeprevailed.1.3投保人解除合同的手續(xù)及風(fēng)險FormalitiesandRisksofTerminatingtheContractbyPolicyHolder如投保人申請解除本附加合同，請?zhí)顚懡獬贤暾垥⑾蚬咎峁┤缦沦Y料：IfthepolicyholderappliestoterminatethisAdditionalContract,itisnecessarytofilltheapplicationformforcontractterminationandsubmitdocumentslistedherebelow:(1)保險合同:InsuranceContract(2)保險費收據(jù)。Insurancefeereceipts自本公司收到解除合同申請書時起，本附加合同終止，本公司自收到解除合同申請書之日起30日內(nèi)向投保人退還保險單的現(xiàn)金價值(見釋義6.1).ThisAdditionalContractwillbeterminatedfromthedaywhenthecompanyreceivestheapplicationofterminatingcontract.Thenthecompanyshallrefundthecashvalue(refertoexplanation6.1)oftheinsurancepolicytothepolicyholderwithin30daysuponreceivingtheapplication.2.本公司提供的保障2.GuaranteesProvidedbytheCompany2.1保險金額本附加合同被保險人的保險金額由投保人與本公司約定并在保險單中載明。2.1InsuredAmount.TheinsuredamountfortheinsuredinthisAdditionalContractshallbeagreedbythepolicyholderandthecompany,whichshallbeclearlydescribedintheinsurancepolicy.2.2保險期間本附加合同的保險期間同主合同。2.2InsurancePeriod.TheinsuranceperiodofthisAdditionalContractisthesameasthatoftheMasterContract.2.3保險責(zé)任在本附加合同保險期間內(nèi)，本公司承擔(dān)下列保險貴任:InsuredLiability.Duringtheinsuranceperiod,thefollowingliabilitiesaretobeundertakenbythecompany:若在理賠時，被保險人己從社會基本醫(yī)療保險、公費醫(yī)療或其他途徑(包括：工作單位以及包含本公司在內(nèi)的任何商業(yè)保險機構(gòu)費用補償型產(chǎn)品等)獲得補償，本公司將在扣除前述補償后，按剩余的部分給付意外傷害醫(yī)療保險金。Atthetimeofclaim,iftheinsuredhasobtainedcompensationfromsocialbasicmedicalinsurance,freemedicalserviceorothers(including:compensationprovidedbyhisorhercompanyorthecompanyorothercommercialinsuranceorganizations),thecompanywillpaytheinsurancebenefitforaccidentalinjurytotheinsuredafterdeductingthecompensationaforementioned,whosecalculationisbasedonthebalanceofmedicalexpense.若在理賠時，被保險人未從社會基本醫(yī)療保險、公費醫(yī)療和其他途徑(包括：工作單位以及包含本公司在內(nèi)的任何商業(yè)保險機構(gòu)費用補償型產(chǎn)品等)獲得補償，本公司將在扣除100元免賠額后，按剩余的部分給付意外傷害醫(yī)療保險金。Atthetimeofclaim,iftheinsureddoesnotobtaincompensationfromsocialbasicmedicalinsurance,freemedicalserviceorothers(including:compensationprovidedbyhisorhercompanyorthecompanyorothercommercialinsuranceorganizations),thecompanywillpaytheinsurancebenefitforaccidentalinjurytotheinsuredafterdeductingthedeductible(RMB100Yuan),whosecalculationisbasedonthebalanceofmedicalexpense.2.4保險責(zé)任的免除ExemptionofInsuranceLiabilities被保險人因以下情形之一發(fā)生醫(yī)療費用的，本公司不承擔(dān)給付保險金的責(zé)任：Ifthereisoneofthefollowingsituationsthattheinsuredpaysmedicalexpense,thecompanywillnotundertaketheresponsibilitytopayinsurancebenefittotheinsured:1投保人對被保險人的故意殺害、故意傷害；(1)Thepolicyholderkillsorinjurestheinsuredonpurpose;被保險人故意犯罪或者抗拒依法采取的刑事強制措施；(2)Theinsuredhasacrimeonpurposeortheinsuredresiststothecriminalcompulsorymeasureswhicharelegal;被保險人主動吸食或注射毒品(見釋義6.4);（3）Theinsuredactivelytakesdrugsorinjectsdrugs（refertoexplanation6.4）;被保險人酒后駕駛（見釋義6.5），無合法有效駕駛證駕駛（見釋義6.6）或駕駛無有效行駛證（見釋義6.7）的機動車；Theinsureddrivesaftertakingwine(refertoexplanation6.5),ortheinsureddoesnothavealegalandvalidlicense(refertoexplanation6.6)ortheinsureddrivesamotorvehiclewithouthavingavaliddrivinglicense(refertoexplanation6.