Service guide

为更好的保障来华人员在遭受意外或疾病困扰时的经济利益，您参加了在平安养老保险股份有限公司江苏分公司承保的人身保险和意外医疗保险，以下是关于保险内容的介绍及服务指南。

For guranteeing the economic benefits for the foreigner who came to china when suffering from disease, you join in the insurance plan of life insurance and accidental medical insurance, the insurance contents and service guide shall be shown as following:

一、 保险期间 insurance term

具体以您参保后，签发的保险单上载明的时间为准

Please refer to the time listed in the policy issued by our company after your application.

二、 参保资格 qualification

所有身体健康、能正常工作和生活的16-60周岁来华人士。(0-17周岁收费标准为100%，61-70周岁收费标准为150％，71-75周岁收费标准为200%)  

The insured is the visitor from abroad aging from 16 to 60 who is healthy and capable of normal work and normal living (charged by the rate of 100% for the insured who is aging from 0 to 17 years old, by the rate of 150% upon the basic premiums for those who are aging from 61 to 70, and by the rate of 200% upon the basic premiums for those who are aging from 71 to 75 years old.).

三、 参保手续application

由各单位统一办理参保手续。The institution shall handle with application procedure respectively.

四、 受益人 beneficiary

医疗保险金的受益人为参保人本人，身故保险金的受益人为参保人员的法定继承人。The beneficiary of medical benefits shall be the applicant, and the beneficiary of death benefits shall be the heritor in law of the applicant.

五、 服务热线 service hotline

平安养老保险股份有限公司江苏分公司服务专员（王碧云）热线：025—84677283；13809045696

Service commissioner of Ping An Annuity Insurance Company, LTD, Jiangsu Branch

(Biyun Wang)

Service tel: 025—84677283；13809045696

六、就诊指定医院 designated hospital

1）指定医院为当地社会基本医疗保险部门定点的区县级以上公立医院。意外急诊首诊可以到非指定的区县级以上的公立医院就诊治疗；The designated hospitals are those public hospitals over district (county) designated by the local medical insurance department. If needing an accidental and emergency treatment, the non-designated public hospital can be chosen.

2）所指定医院的分院、外宾病区、特诊病区、特诊病房和高干病房等同类病区或病房不在指定的范围内；The branch of designated hospital, foreigner hospitalization area, special treatment area, special treatment room and joint venture and exclusive investment room (hospital) are not in the regulated scope;

七、用药范围：Medicine

为了切实保证来华人员获得最充足的保障，本方案医疗药品报销范围按以下相关规定执行：《南京市基本医疗保险药品目录》for the complete guarantee, the medical scope of the insurance plan shall refer to the regulation of Medicine List of Basic Medical Insurance in Nanjing.

八、意外门急诊范围包括：The scope of accidental out-patient and emergency treatment shall be as following:

1）因意外原因造成的休克、昏迷。Shock, coma caused by accident;

2）因意外原因所致急性出血。 Emergency bleeding caused by accident;

3）脑外伤、骨折、脱位、撕裂、烧伤、烫伤或其他急性外伤。Brain trauma, fracture, dislocation, avulsion, burn or other acute trauma;

九、索赔 claims

1、索赔手续：被保险人申请医疗费赔偿时，先填写《保险理赔申请书》一份并加盖公章，然后将资料交至保险公司服务人员。Claims procedure: when the insured applies with medical expenses claims, he/she should fill in insurance claims application with the seal, and then give the relative materials to the service commissioner of insurance company.

2、理赔时限：保险公司收取理赔资料后，在15个工作日内完成理赔，并将理赔款项直接打入被保险人个人帐户，或被保险人直接到柜面领取Claims effectiveness: after taking the claims application, insurance company should finish claims within 15 working days and transfer the indemnity into the individual account of the insurer, or the insured can draw the benefits to the counter directly.

3、索赔时须提供的单据：The materials when claiming

住院或意外门诊保险金的申请the out-patient or in-patient benefits application

由被保险人作为申请人，填写保险金给付申请书，并凭下列资料向保险人申请给付保险金：the insured fills in the benefits claims application as the applicant and applies with the benfits with the following materials:

1）、保险单或其他保险凭证及保险金申请书；Insurance policy or the other insurance documents;

2）、被保险人身份证明；ID certificate of beneficiary;

3）、本补充约定指定或者认可的医疗机构出具的医疗费用原始收据、电脑打印的费用明细清单、意外门急诊病历复印件、出院小结；Duplicated documentation of the case history, diagnosis certificate, brief summary of leaving hospital, prescription and the original certificate of medical expenses issued by the hospital;

4）、被保险人所能提供的与确认保险事故的性质、原因、伤害程度等有关的其他证明和资料；Any other certificates and documents can be provided to prove the nature and cause of the insurance accident;

注：不受理外配药发票及到药房自行购买的药费发票；Remarks: the medicine invoice bought in drug store or in the other hospital shall not be included in.

十、索赔时效: Time limit of claims

1、被保险人申请住院或意外门急诊医疗赔偿时，应在三个月内提出索赔，否则，可能会带来的不利法律后果由被保险人自行承担。The insured should apply with in-patient or out-patient and emergency medical benefits within 3 months, or possible result in low shall be undertaken by the insured.

十一、索赔时须注意事项：Notes when claims

1、病历上注明病情、检查、治疗、用药及剂量；病历上的记录与收据上的收费的项目相符；病历上的诊病日期须与收据上的日期一致。The information about case condition, inspection, treatment, medicine and dosage should be identified in the case history; the charged project in the receipt should be the same as the record in the case history; the date receiving treatment in the case history should be the same as that in the receipt.

16-75周岁人员保障内容简表

注：18周岁以下未成年人累计意外险保额以10万元为限。

本服务手册不作保险凭证，保险责任以签发的保单为准，且统一出保单和发票。

Insurance contents table

Remarks: the accumulative accidental insurance sum for the minor whose age is under 18 years old can not exceed RMB100000.

the service manual shall not be referred as insurance certificate, the issured policy shall prevail. We shall issue the policy and invoice.