This insurance contract (hereinafter referred to as "this contract") consists of insurance policy and other insurance documents, attached clauses, insurance application, insurance documents related to this contract, statements, comments, attached approval forms and other written documents. ▲ top
Article 2 Insurance coverage
1. Applicant: Anyone who has an insurable interest in the insured can be an applicant.
2. Insured: Anyone who has reached 16 years old (including 16 years old, the same below) to 65 years old, is healthy and can work or work normally, is regarded as the insured of this insurance.
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Article 3 Insurance liability
During the insurance period of this contract, the insurer shall bear the following insurance payment responsibilities:
I. accidental injury, death or disability
(1) If the insured dies within 180 days from the date of accidental injury, the insurer shall pay the death insurance money according to the accidental injury insurance amount specified in the insurance policy.
(2) If the insured is disabled due to accidental injury within 180 days from the date of accidental injury, the insurer shall pay disability insurance money according to the amount of accidental injury insurance specified in the insurance policy and the proportion of compensation corresponding to physical disability. If the treatment has not been completed after 180 days from the date of the accident, the disability appraisal shall be carried out according to the physical condition on the 180th day, and the disability insurance money shall be paid accordingly.
If the insured causes multiple physical disabilities due to the same accident, the insurer shall pay the sum of the corresponding disability insurance benefits. However, when different disability items belong to the same hand or foot, only one disability insurance premium will be paid; If the proportion of different disability items belonging to the same hand or foot is different, the insurer only pays a higher proportion of disability insurance money.
If the disability caused by this accidental injury is combined with the previous disability, a higher proportion of disability insurance money can be paid, but the paid disability insurance money (the disability listed in the Disability Degree and Payment Proportion Table before insurance or due to exemption from liability) should be deducted.
(3) If the insured suffers burns due to accidental injury, the insurer shall pay the burn insurance money according to the amount of accidental injury insurance contained in the insurance policy and the proportion corresponding to burns in the Table of Payment Proportion of Accidental Burn Insurance Money attached to this clause. When the insured causes multiple burns due to the same accidental injury, the insurer shall pay the sum of the corresponding burn insurance benefits.
Accidental disability and burn insurance don't offset each other.
(4) The insurer's liability to the insured for paying the above-mentioned insurance money is limited to the accidental injury insurance amount specified in the insurance policy. When the one-time or accumulated insurance premium reaches the accidental injury insurance amount, the insurer's insurance liability to the insured is terminated.
Second, the accidental injury medical expenses
If the medical expenses incurred by the insured in a medical institution designated or recognized by the insurer due to accidental injury can be reimbursed according to the provisions of the social medical insurance department of the government where this insurance policy is issued, the insurer shall be responsible;
(1) The insurer is not responsible for the medical expenses within 100 yuan (including 100 yuan) in the accident, and compensates the medical expenses above 100 yuan in the accident according to 80% of the accidental injury medical insurance amount.
(2) If the insured's treatment has not ended at the expiration of the insurance period, the insurer will continue to bear the insurance liability for medical expenses incurred due to accidental injury, death or disability until the 180th day from the date of accidental injury, but the insurance liability will be terminated when the accumulated payment reaches the amount of medical insurance for accidental injury.
(3) During the insurance period, regardless of one or more accidental injuries of the insured, the insurer shall pay the medical insurance premium for accidental injuries according to the regulations, but when the accumulated payment amount reaches the medical insurance premium for accidental injuries, the insurer's insurance liability to the insured shall be terminated.
(4) When an insured accident occurs, if the insured has other effective policies for medical expenses insurance, the insurer shall bear the responsibility for paying medical expenses according to the ratio of the effective accidental injury medical insurance amount in this contract to the effective accidental injury medical insurance amount in all contracts.
Three. Accidental first-degree disability allowance
If the insured suffers an accidental injury, and the accidental injury is one of the direct causes of the first-class disability listed in the Table of Disability Degree and Payment Proportion attached to this contract within 180 days from the date of the accidental injury, the insurer shall pay the disability subsidy from the date of identification and confirmation. Disability allowance is paid once a month, and the payment amount is112 of the accident insurance amount, * * * paid12 months. If the insured dies during the period of receiving disability allowance, the insurance payment responsibility shall be terminated.
This disability allowance cannot be offset with other insurance benefits.
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Article 4 Exemption from liability
In case of death, disability or medical expenses of the insured due to one of the following circumstances, the insurer shall not be liable for paying insurance benefits:
1. The applicant or beneficiary intentionally kills or hurts the insured;
2. The insured violates the law, intentionally commits a crime or resists arrest;
3. The insured fights, gets drunk, commits suicide, intentionally injures himself, takes drugs or injects drugs;
4. The insured is influenced by alcohol, drugs and controlled drugs;
Five, the insured drunk driving, driving without a valid driver's license and driving a motor vehicle or motor vehicle without a valid driver's license;
Six, the insured pregnancy (including ectopic pregnancy), abortion, childbirth (including caesarean section, abortion and induced labor);
7. The insured is insane or insane;
Eight, the insured medical accidents caused by examination, cosmetic surgery, surgical treatment, drug treatment;
Nine, the insured did not follow the doctor's advice, taking, smearing or injecting drugs without authorization;
Ten, the insured engaged in diving, water skiing, gliding, skydiving, rock climbing, hunting, adventure, martial arts, wrestling, stunts, horse racing, racing, bungee jumping and other high-risk sports and activities;
Xi. During the period when the insured suffers from AIDS or is infected with HIV (HIV positive);
12. War, military action, riots, terrorist activities or armed rebellion;
Thirteen, nuclear explosion, nuclear radiation or nuclear pollution;
14. Treatment not caused by accidental injury;
Fifteen, for orthopedics, cosmetic surgery, beauty, psychological counseling, organ transplantation, or repair, installation and purchase of disabled appliances (such as wheelchairs, artificial limbs, hearing AIDS, artificial eyes, glasses, etc.). );
Sixteen, the insured physical examination, recuperation, rehabilitation treatment;
17. Transportation, accommodation, living allowance, lost time and nursing expenses paid by the insured.
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Article 5 Period of insurance
Unless otherwise agreed, the insurance period is one year. From 0: 00 the day after the insurer agrees to underwrite, the insurance premium will be collected and the insurance policy will be issued until 24: 00 the agreed termination date.
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Article 6 Insurance amount and insurance premium
The amount of accidental injury insurance and accidental injury medical insurance in this contract shall be agreed upon by the applicant and the insurer and specified in this contract. Once the above insurance amount is determined, it shall not be changed halfway.
The insurance premium of this contract shall be charged at the corresponding rate in the attached occupational classification table. The applicant shall pay all the insurance premiums in one lump sum before the contract is established.
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Rule 7: Tell the truth.
When concluding this contract, the insurer shall clearly explain the terms of this contract to the applicant, especially the exemption clause, and have the right to make written inquiries to the applicant and the insured, and the applicant and the insured shall truthfully inform them.
If the applicant and the insured intentionally fail to perform the obligation of telling the truth, the insurer has the right to terminate this contract; The insurer shall not be responsible for paying the insurance premium or returning the insurance premium for the insured accident that occurred before the termination of this contract.
If the applicant and the insured fail to fulfill the obligation of truthful disclosure due to negligence, which is enough to affect the insurer's decision on whether to agree to underwrite or increase the insurance premium rate, the insurer has the right to terminate this contract; If it has a serious impact on the occurrence of the insured accident, the insurer shall not be responsible for paying the insurance premium for the insured accident that occurred before the termination of this contract, but shall return the unexpired insurance premium.
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Article 8 designation and change of beneficiaries
1. The insured or the insured may designate one or more persons as beneficiaries of death insurance benefits. When there are several beneficiaries, the order or share of benefits shall be determined. If the beneficiary is not specified, the insurance money shall be regarded as the insured's inheritance, and the insurer shall fulfill the obligation to pay the insurance money to the legal heir of the insured.
2. When the insured or the applicant changes the beneficiary of death insurance money, it shall notify the insurer in writing, and the insurer shall endorse the insurance policy. The applicant shall obtain the written consent of the insured when designating and changing the beneficiary of the death insurance.
3. The beneficiary dies before the insured, or the beneficiary waives (loses) the beneficial right according to law:
(1) If no other beneficiary is specified in the insurance contract, it shall be handled as if no beneficiary is specified;
(2) If other beneficiaries are listed in the insurance contract, the insurance premium shall be paid in the following ways:
1. order, the insurer shall pay the insurance money to the beneficiary whose benefit order is the first among other beneficiaries;
2. If equal or proportional benefits are adopted, the insurer shall pay insurance benefits to other beneficiaries according to the share of benefits agreed in the insurance contract; The insurance benefits under the name of the deceased beneficiary or the beneficiary who gave up (lost) the beneficial right according to law shall be regarded as the insured's heritage, and the insurer shall perform the obligation of paying the insurance benefits to the insured's heirs in accordance with the provisions of this contract.
Four, the insured and the beneficiary died in the same accident, it is impossible to determine the order of their deaths, it is presumed that the beneficiary died before the insured.
Five, the beneficiary of accidental disability and accidental first-class disability insurance money is the insured himself, and the insurer does not accept other designations or changes.
Six, the beneficiary of accidental injury medical expenses insurance is the actual medical expenses.
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Article 9 Notice of Insurance Accident
The applicant, the insured or the beneficiary shall notify the insurer within five days from the date when he knows or should know the occurrence of the insured accident. Otherwise, the applicant, the insured or the beneficiary shall bear the increased exploration and inspection expenses due to the delay in notification. Except for the delay caused by force majeure.
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Article 10 Application for insurance money
I. Application for accidental death insurance money
As the insured, the beneficiary shall fill in the application for payment of insurance benefits and apply to the insurer for payment of insurance benefits with the following documents and materials:
1, insurance policy or other insurance certificate;
2. Insurance premium receipt;
3. The beneficiary's household registration certificate and identity certificate;
4. The death certificate of the insured and the cancellation certificate of the insured's household registration issued by the public security department and the medical institution designated or recognized by the insurer;
5. If the insured declares death, the beneficiary shall provide the certificate of death declaration issued by the people's court;
6. Other certificates and materials that can be provided by the beneficiary to confirm the nature and cause of the insured accident.
Two, accidental disability, accidental disability insurance and accidental injury medical expenses insurance application.
The insured or the payer of accidental injury medical expenses shall fill in the application for payment of insurance benefits as the insured, and apply to the insurer for payment of corresponding insurance benefits with the following documents and materials:
1, insurance policy or other insurance certificate;
2. Insurance premium receipt;
3. The household registration certificate and identity certificate of the insured;
4. Disability certificate issued by the medical institution designated or recognized by the insurer;
5. Other certificates and materials that the insured can provide to confirm the nature, cause and degree of injury of the insured accident;
6. Medical diagnosis certificates, medical records, original documents, medical expense settlement lists and prescriptions with pathological examination, laboratory examination and other medical device inspection reports issued by medical institutions designated or recognized by the insurer.
Three, entrust others to handle insurance benefits, but also must provide a power of attorney and the trustee's relevant identification and other materials.
Four, the insurer shall, after receiving the application for payment of insurance benefits from the applicant and the above-mentioned relevant certificates and materials, perform the obligation of payment of insurance benefits within ten days after reaching an agreement with the applicant on the amount of insurance benefits. For those who do not belong to the insurance liability, a notice of refusal to pay the insurance premium shall be issued to the applicant.
Five, the insurer from the date of receipt of the applicant's application for payment of insurance benefits and the above-mentioned relevant certificates and materials within 60 days, the insurance liability and the amount of insurance benefits can not be determined, according to the existing certificates and materials, according to the minimum amount that can be determined in advance, the insurer finally determines the amount of insurance benefits to pay the corresponding difference.
6. If the insured returns after being declared dead, the beneficiary shall return the insurance money paid by the insurer within 30 days after knowing or should know that the insured is still alive.
Seven, the beneficiary or the insured's right to request payment of insurance money from the insurer has not been exercised for two years since he knew or should have known that the insured accident occurred.
Eleventh occupation or type of work change notification obligation
When the insured changes his occupation or type of work, the applicant or the insured shall notify the insurer in writing within ten days.
When the insured changes his occupation or type of work to reduce his risk according to the insurer's occupational classification, the insurer shall refund the corresponding insurance premium according to the difference from the date of receiving the notice; When the degree of danger increases, the insurer shall increase the corresponding insurance premium according to the difference from the date of receiving the notice. In the event of an uninformed insurance accident after the increase of risk, the insurer shall calculate the payment of insurance benefits according to the ratio of its original premium to the premium receivable; However, if it falls within the scope of the insurer's refusal to pay compensation, the insurer is not responsible for paying the insurance money.
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Article 12 Change of address
If the domicile or mailing address of the applicant changes, it shall promptly notify the insurer in writing. If the applicant fails to notify in writing, the insurer will send the relevant notice according to the last residence or mailing address specified in this contract.
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Article 13 Changes of Contract Contents
During the validity of this contract, the relevant contents of this contract may be changed through consultation between the applicant and the insurer. Where this contract is changed, the insurer shall endorse or attach a consent to the original insurance policy or other insurance documents, or the applicant and the insurer shall sign a written agreement on the change.
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Article 14 Handling of the Insured's Termination of the Contract
After the establishment of this contract, the applicant may terminate this contract by written notice.
1. When the applicant requests to terminate the contract, he shall provide the following certificates and materials:
1, insurance policy or other insurance certificate;
2. Insurance premium receipt;
3. Application for termination of the contract.
2. If the applicant requests to terminate the contract, the insurance liability of this contract shall be terminated from the date when the insurer receives the application for termination of the contract. The insurer shall refund the unexpired insurance premium within 30 days from the date of receiving the above certificates and materials.
Three, has received the insurance money, shall not require the termination of the contract.
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Article 15 Dispute settlement
The contract dispute settlement method shall be selected by the parties from the following two ways when the contract is agreed:
1. Any dispute arising from the performance of this contract shall be settled by both parties through consultation; If negotiation fails, it shall be submitted to the place where the policy is issued or to the nearest arbitration commission for arbitration;
2. Disputes arising from the performance of this contract shall be settled by both parties through consultation. If negotiation fails, a lawsuit shall be brought to the people's court where the policy is issued according to law.
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Article 16 Interpretation
Insurer: China Pacific Property Insurance Company Limited.
Accidental injury: refers to the injury to the body caused by external, sudden, unintentional and non-disease objective events.
Force majeure: refers to unforeseeable, unavoidable and insurmountable objective circumstances.
Payment proportion: refers to the insurance payment proportion specified in the Table of Disability Degree and Insurance Payment Proportion attached to this insurance clause.
Diving: refers to the underwater movement in rivers, lakes, oceans, reservoirs, canals and other waters with the help of auxiliary breathing equipment.
Rock climbing: refers to climbing cliffs, building external walls, artificial cliffs, ice cliffs, icebergs and other sports.
Wushu: refers to the antagonistic competition between two or more people in judo, karate, taekwondo, Sanda, boxing and other boxing methods and various instruments.
Adventure: refers to the act of deliberately putting yourself in certain natural conditions, such as drifting in rivers, hiking through deserts or inaccessible virgin forests, knowing that there is a danger of losing your life or hurting your body.
Special effects: refers to engaging in equestrian, acrobatics, animal training and other special skills.
AIDS: refers to acquired immunodeficiency syndrome.
HIV: refers to the acquired immunodeficiency syndrome virus.
The definition of acquired immunodeficiency syndrome should be based on the definition formulated by the World Health Organization. If the acquired immune deficiency syndrome virus or its antibody is found in blood samples, it can be considered as infected with AIDS or AIDS virus.
Unexpired insurance premium: "insurance premium ×[ 1- (days after the policy expires /365)]×( 1- 10%)". If the number of days is less than one day, it shall be counted as one day.
Controlled drugs: refer to drugs that are classified as special management according to the Drug Administration Law of People's Republic of China (PRC) and relevant laws and regulations, including narcotic drugs, psychotropic drugs, toxic drugs and radioactive drugs.
Insurance amount: the maximum amount that the insurer promises to pay insurance money.