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招商信诺寰球至尊高端个人医疗保险(A 款)主险?

产品险种:医疗保险 ?

意外保障
住院
门诊
重大疾病

保额与缴费举例:

保障金额不是固定的,根据投保人年龄、缴费高低的不同,对应获得的保障金额也不同,此处对一些常见情况进行列举供您参考。

投保年龄年缴费缴费期保障项目和金额保障期
25岁26378.00元1年

门诊50.0万

住院2000.0万

孕产生育18.0万

1年

注:具体缴费与保额,可依个人实际情况灵活定制,以上举例仅为参考

  • 保险责任说明条款
  • 相关咨询
  • 包含本产品的计划

8.1 本保险合同承担经专科医生建议并由我方医疗团队所确认,因损伤
或疾病而导致的、属于医疗必要的护理及治疗费用给付责任,以及
特定服务费用给付责任。
This policy covers certain costs of services or supplies which are
recommended by a medical practitioner, and which are medically necessary
for the care and treatment of an injury or sickness, as determined by our
medical team.
8.2 保险条款中所列的费用。这些费用的支付须符合本保险合同的规定
及保险凭证所载的限额及责任免除。
The costs which are covered are set out in the provision. These costs are
subject to the limits and exclusions which are set out in the provision and
your certificate of insurance.
8.3 我方可能给予个别被保险人特别责任免除。特别责任免除详细内容
在保险凭证上明示。
Special exclusions, imposed on an individual basis, may apply. Details of
these special exclusions will be shown on your certificate of insurance.
8.4 任何理赔均须符合既定的免赔额,以及保险条款与保险凭证所载的
给付限额。
Any claim is subject to the applicable deductible and limits of cover set out
in the provision and your certificate of insurance.
8.5 本保险合同将不承担任何发生在保险合同开始前与终止后相关治疗
的费用,即使该治疗在保险合同终止前已经获得了我方的批准。
This policy will not cover any costs relating to treatment received before the
cover starts, or after the cover ends (even if that treatment was approved by
us before the cover ends).
9. 保障选项
Coverage options
9.1 国际医疗保障为被保险人的必选保障,具体责任(参考适用的条
款、规定、限额及责任免除)详见本保险合同中"保障利益表"所
载。
The International Medical Insurance plan is provided to every beneficiary.
The benefits which are available (subject to the applicable terms, conditions,
limits and exclusions) are set out in 'list of benefits' in the provision.
9.2 您方可以为任一被保险人选择下述一个或以上的可选保障,以附加
于国际医疗保障,并交纳相应的附加保险费:
You may (for additional premium) add to the cover provided under the
IGAB1212 寰球至尊A
7
International Medical Insurance plan by choosing one or more from the
following extra coverage options for any beneficiary or beneficiaries:
9.2.1 国际医疗补充保障;
International Medical Insurance Plus;
9.2.2 国际健康与体检保障;
International Health and Wellbeing; and
9.2.3 国际眼科与牙科保障。
International Vision and Dental.
9.3 可选保障的保险责任具体详见本保险合同"保障利益表"所载。
Details of the extra coverage options are set out in 'list of benefits' in the
provision.
9.4 保险期间内不能变更已选定的可选保障。如果您方希望增加或减少
可选保障选项,请于年度续保日前及时通知我方。
Coverage options cannot be changed at your request during the period of
cover. If you want to add or remove coverage options, you should let us
know before the annual renewal date.
9.5 若您方增加新的可选保障选项,请向我方提交一份详细的健康问
卷,我方可能对您方新增的保障选项责任适用新的特殊规定或除外
责任。
If you want to add new coverage options, we may ask for a completed
medical history questionnaire, and we may apply new special restrictions or
exclusions on the new coverage options.
9.6 您方可以根据被保险人的需要来选择以下任一保障区域:
You may choose between two options, which determine where in the world
beneficiaries will be covered.
9.6.1 全球不含美国
Worldwide, excluding USA.
9.6.2 全球含美国
Worldwide, including USA.
------------------------------



招商信诺寰球至尊高端个人医疗保险(A 款)条款阅读指引
The Reading Guide to CIGNA&CMC Individual PrivateMedical Insurance (A) Provision
本阅读指引帮助您理解条款,若与条款冲突,以条款为准。
This guide intends to help you better understand the following policy provision. In the case of any conflicts with the policy provision, the policy provision should always be valid and binding.
........ 您所拥有的重要权益
Highlight of Your Rights
1. 本保险合同的保障人员为国籍国在大中华地区的被保险人,或者国籍国曾经在大中华地区 并且投保时在大中华地区有固定住所的被保险人。
This policy only covers beneficiaries whose country of nationality is in Great China, or beneficiaries who have ever had country of nationality in Great China and have permanent adobe in Great China while application.
若本保险合同不符合您的需求或期望,您可以在收到保险合同并书面签收之日起10 天内联 系我方解除本保险合同。如果尚未发生理赔、付款担保或付款预授权,我方将无息全额退还您方已交纳的全部保险费。粗体词汇的理解请见释义。
If the policy does not meet your needs, or has not been issued in accordance with your intention, you may ask us to cancel it within ten (10) days upon your receipt of your certificate of insurance. If no claims have been made, and no guarantees of payment or prior approvals have been put in place, we will refund any premium which has been paid and without accrued interest. Words and phrases in boldhave the meanings given to them in 'Definitions'.
2. 被保险人可以享受本保险合同提供的保障。
Beneficiaries are covered by the benefits on the policy.
........ 您应特别注意的事项
Matters for attention
1. 请您注意理解各项保险责任的保障内容,相应选择您的保障计划。
Pleasemake sure you know all benefits, and decide your insurance coverage accordingly.
2. 请您留意关于保险金给付限额和条件的条款。
Please pay attention to the provisions about the limits and conditions of cover.
3. 请您留意责任免除条款,尤其是已加下划线的免除或限制我方责任的条款。
Please pay attention to the provisions about exclusions, especially those having been
underlined.
4. 请您留意保险合同中关于保险期间及合同效力终止的条款。
Please pay attention to the provisions about period of cover and policy termination.
5. 请您留意续保的条件,如果您方不愿意续保,请在保单周年日前通知我方。
Please pay attention to the renewal conditions. If you decide not to renew, please informus prior to your policy anniversary.
6. 请您留意一些重要术语的定义,如"常住国"、"日间病房治疗"、"专科医生"、"执业医 生"等。
Please pay attention to the definitions of some key terms, such as "country of habitual
residence", "day case treatment", "specialist", "medical practitioner" and etc.
IGAB1212 寰球至尊A
........ 条款目录
Table of contents
第一章一般条款及规定
Section 1 - General Terms and Conditions
1. 保险双方协议
Insurance agreement
2. 保险合同构成
Policy constitution
3. 保险责任生效
When does the cover begin
4. 保险责��终止
When does the cover end
5. 保险合同续保
How is the policy renewed
6. 被保障人员
Who is covered?
7. 增减被保险人
Add or remove beneficiaries
8. 保障范围
What is covered?
9. 保障选项
Coverage options
10. 保险费及其他费用的交纳
Premium and other charges
11. 免赔额
Deductible
12. 保险合同的终止
Termination of cover
13. 明确说明和如实告知
Truthful and Full Disclosure
14. 未如实告知的处理
False or withheld information
15. 外籍常住者与本国国民
Expatriates and nationals
16. 变更地址与国籍
Changes of address and nationality
17. 联系您方
Contacting you
18. 联系我方
Contacting us
19. 保险合同变更
Changes to this policy
20. 保险合同执行人
Who can enforce this policy?
21. 其他保险
Other insurance
22. 资料保护
Data protection
23. 语言
Language
24. 申诉及争议处理
Complaints & Dispute Settlement
25. 适用的法律法规
Applicable law and jurisdiction
第二章保险责任
Section 2 - Benefits
26. 国际医疗保障
International Medical Benefit
27. 国际医疗补充保障(可选保障)
International Health Insurance Plus
Option
28. 国际健康与体检保障(可选保障)
International Health and Wellbeing Cover
Option
29. 国际眼科与牙科保障(可选保障)
International Vision and Dental Cover
Option
第三章责任免除
Section 3 - Exclusions
30. 通用责任免除
General Exclusions
第四章预先批准
Section 4 - Prior approvals
31. 预先批准清单
List of prior approvals
32. 在美国以外地区治疗的预先批准
Prior approval for treatment outside the
USA
33. 在美国地区治疗的预先批准
Prior approval for treatment in the USA
34. 严格遵从理赔流程
Strict compliance with claim procedure
第五章保险金申请
Section 5 - Claims application
35. 提供信息
Providing information
36. 诉讼时效
Claiming period
37. 美国地区治疗的理赔
Claims for treatment in the United States
38. 中国大陆地区治疗的理赔
Claims for treatment in Mainland China
39. 其他地区治疗的理赔申请
Claims for treatment in other areas
40. 保险金的给付
How we pay claims
41. 其它核定结果
Other decisions
第六章释义
Section 6 - Definitions
42. 术语定义
Defined terms
附件:保险利益表
Appendix: List of benefits
IGAB1212 寰球至尊A
1
招商信诺寰球至尊高端个人医疗保险(A 款)条款
CIGNA&CMC Individual PrivateMedical Insurance (A) Provision
第一章一般条款及规定
Section 1 - General Terms and Conditions
1. 保险双方协议
Insurance
agreement
根据本保险合同载明的各条款、赔付条件、赔付限额、责任免除等条款,
我方将支付在本保险合同保险期间内、所选择保险区域内被保险人发生损
伤、疾病、怀孕及分娩而产生的医疗费用及相关费用,在扣除相应免赔额
后,以相应赔付限额为限。
Subject to the terms, conditions, limits and exclusions set out in this policy, Cigna
shall reimburse medical and related expenses relating to treatment provided within
the selected area of coverage for injury, sickness, and medical conditions relating
to pregnancy and childbirth. The treatment must occur during the period of cover,
in excess of the deductible and up to the limits of cover.
2. 保单合同构成
Policy
constitution
2.1 本保险合同由投保申请、保险凭证、保险条款等其他文件组成,请
注意详细阅读。
This policy consists of your application, your certificate of insurance and
this provision. They constitute the entire contract between us and you. You
should read them carefully.
2.2 如果在你发出申请到保单生效时间前,您方的健康与医疗情况发生
了变化,不同于投保时的健康告知,您方应告知我方。我方将重新
审核您方的投保申请,并可能增加(额外的)特别责任免除,或重
新评估是否承保。
You must let us know of any change in yourmedical condition which occurs
between the date of your application and the start time of your policy.We
will then review your application and may need to apply (additional) special
exclusions or review coverage acceptance.
3. 保险责任生效
When does the cover begin?
3.1 保险责任将于保险凭证首页所载生效时间起生效,该保险凭证将发
送给您方。如果续保的,年度续保日也为每年对应的此日期,如当
月无对应的日期,则以该月的最后一日计算。
The cover will begin on the start time shown on the first certificate of
insurance which we send to you. If the policy is renewed, the annual
renewal date will fall on this date each year.
3.2 如您方选择为其他被保险人购买本保险责任,该被保险人保障的生
效时间为其所在保险凭证首页载明的时间,该保险凭证将发送给您
方。
If you choose to buy cover for any additional beneficiaries, their cover will
begin on the start time shown on the first certificate of insurance on which
they are listed, which we send to you.
3.3 请您务必及时向我方告知在申请日与接受承保条件日之间您方所发
生的任何医疗情况变化,我方将重新审核您方的申请,并可能增加
特别责任免除、或重新评估是否承保。
It is important that you notify us immediately of any change in your medical
condition which occurs between your application and your acceptance of
the policy. We will then review your application and may need to apply
(additional) special exclusions or review coverage acceptance.
4. 保险责任终止
When does the
4.1 本保险合同为一年期保险合同。即:除非本保险合同提前终止或本
保险合同续保,保险责任将在保单终止日终止。
This policy is an annual contract. This means that, unless it is terminated
IGAB1212 寰球至尊A
2
cover end? earlier or renewed, the cover will end on the end day.
4.2 在下列情况下,保险责任自动终止:
Cover will automatically end for any beneficiary if:
4.2.1 被保险人死亡(虽然有些责任在其死亡后仍可获赔偿,如医
疗运送回国及遗体运送回国),对该被保险人的保险责任终
止;或
the beneficiary dies (although any benefits which may be payable
after death, such as repatriation of mortal remains, will still be
paid) ,the insurance liabilities for the corresponding insured will
terminate; or
4.2.2 本保险合同被终止。您方及我方可终止本保险合同的情形请
见第12 条。
the policy is terminated. The circumstances in which you or we can
terminate the policy are explained in provision 12.
4.3 如果投保人死亡,所有被保险人的保障将在投保人已缴保险费所对
应的期间届满时终止。在这样的情况下,我方将尝试联系本保单下
的所有被保险人,允许他们选择其中的一位作为新的投保人、如此
则所有被保险人的保障将延续到保单终止日。如果被保险人确实希
望延续保障,他们必须在30 天内书面确认他们同意延续。如果被保
险人不希望,所有被保险人保障将在投保人已缴保险费所对应的期
间届满时即行终止;我方将不支付保障终止日及以后发生的医疗费
用及服务。
If you die, cover will end for all beneficiaries when the insured period
corresponding the premiums having been paid by you ends. If this happens,
we will try to contact any other beneficiaries who are covered under this
policy, and offer them the opportunity to continue the cover until the end
date, with one of them taking over as policyholder. If the beneficiary does
wish to continue the cover, they must respond, in writing, within 30 days, to
confirm their acceptance. If they do not do so, all cover will end when the
insured period corresponding the premiums having been paid by you ends,
and we will not make any payments in relation to treatment or services
which are received on or after the date on which the cover ends.
4.4 如果在保险终止日前本保险合同提前终止,只要被保险人在终止日
前没有进行理赔、付款担保或预先批准,我方将向您方退还未满期
净保费。
If this policy ends before the normal end date, unearned net premiumwill
be refunded on a pro rata basis, so long as no claims have been made and no
guarantees of payment or prior approvals have been put in place during the
period of cover.
5. 保险合同续保
How is the policy
renewed?
5.1 我方将在本保单终止日前至少一个月前书面询问您是否希望续保当
前保单。我方将同时告知您续保后保费的变化及续保的承保条件。
We will write to you at least one month before the end date and ask you
whether you want to renew the cover you currently have. We will also
inform you of any changes to the premiums or terms and conditions which
would apply on renewal.
5.2 如果您方同意续保,您方无需给予任何反应,您的保障将延续12 个
月。续保所依据的是在续保时我方生效的术语定义、保险条款、保
障利益等。如果我方不同意继续承保,我方将根据后面12.6 条款通
知您方。如果您方不同意续保,您方须在保单终止日前至少7 天通
知我方。
If you choose to renew, you do not need to do anything, and your cover will
IGAB1212 寰球至尊A
3
be renewed automatically for another 12 months. Renewal is subject to the
definitions, benefits and terms of the provision in force at the time of
renewal. If we are unable to renew your cover, we will give you notice as
described in paragraph 12.6. If you do not want to renew your cover, you
must let us know at least seven days before your policy end date.
5.3 如果您方不同意续保,本保险合同将不延续。本保险合同符合条件
的各被保险人可以申请为自己投保。我方将个别审核,分别告知他
们我方是否同意承保及承保条件。
If you do not renew your cover, the policy will not be renewed. Any
beneficiaries who have been covered under the policy can apply for their
own cover. We will consider their applications individually, and inform them
whether, and on what terms, we are willing to offer them such cover.
6. 被保障人员
Who is covered?
6.1 本保险合同的保障人员为国籍国在大中华地区的被保险人,或者国
籍国曾经是在大中华地区并且投保时在大中华地区有固定住所的被
保险人。在本保险合同下被保险人与受益人为同一人。
This policy only cover beneficiaries whose country of nationality is in Great
China, or beneficiaries who have ever had country of nationality in Great
China and have permanent adobe in Great China while application. Under
this policy, beneficiary is the same person as the insured person.
6.2 您方可以酌情同时为其他人员投保;如果这样,您方需要把相应被
保险人添加在投保申请中。经我方审核同意后,该被保险人姓名将
载于保险凭证上,您方将可能承担额外的保险费,我方可能对新增
人员适用特别责任免除。
You may arrange cover for other people at our discretion. In order to do so,
you must include them in your application. If we agree to cover them, we
will include their names on your certificate of insurance. Additional
premium may be payable, and special exclusions may be applied in relation
to them.
6.3 您方可能为他人投保,却不为您本人投保。如果这样,您方将作为
投保人并承担交纳本保险合同保险费及其他所有本保险合同规定的
责任,但不享有保险保障。所有的申请须经医疗核保,我方将向您
方告知我方对保险凭证上列明的被保险人的承保条件。
It is possible for you to take out cover for other people, whilst not taking out
cover for yourself. In this situation, you will be the policyholder, and will be
responsible for payment of premiums and all other obligations under the
policy, but will not be covered. All applications will be subject to medical
underwriting and we will let the policyholder know the terms that will apply
to any beneficiary named on the certificate of insurance.
6.4 投保年龄与年龄误告的处理
Issue age and how to deal with incorrectness of age
6.4.1 被保险人在其最初生效时的年龄上限为70 周岁。并且,如
果在某被保险人最初生效时,已经包含或即将同时包含在同
一保险合同下的所有被保险人的年龄不超过18 周岁,该被
保险人在其最初生效时的年龄下限为出生后30 天。投保申
请上填写的各被保险人的出生日期以其有效身份证件为准。
One beneficiary's oldest age at his initial start time is 70 years old.
Besides, at one beneficiary's initial start time, if all beneficiary(ies)
which have been covered or will be simultaneously covered under
the same policies are less than 18 years old, this beneficiary's
youngest age at his initial start time is 30 days of birth. The birth
date of beneficiary(ies) on your application should be based upon
IGAB1212 寰球至尊A
4
effective identity card.
6.4.2 如您方申报的被保险人年龄不真实,并且其真实年龄不符合
本保险合同约定投保年龄限制的,我们有权解除保险合同,
并向您方退还未满期净保费。我方行使保险合同解除权,该
解除权自我方知道有解除事由之日起超过30 日不行使而消
灭。
If you provide us with an incorrect date of birth and the real age
does not comply with the eligibility requirements of this policy, we

have the right to cancel this policy. In this situation, we shall refund
the unearned net premium. The right to cancel the policy will be
rescinded after 30 days starting from the day we notice this error.
6.4.3 如您���申报的被保险人年龄不真实,致使实付保险费少于应
付保险费的,我们有权更正并要求您方补缴保险费。若已经
发生保险事故,我方有权在给付保险金时按实付保险费和应
付保险费的比例给付。
If you provide an incorrect date of birth, which directly leads to a
lower premium than it should, we have the right to make the
correction and charge the additional payment for premium
difference. In such cases, we will pay benefits on a proportional
basis (according to the difference between the true and incorrect
premium) for any insurance event prior to the date of correction.
6.4.4 如您方申报的被保险人年龄不真实,致使实付保险费多于应
付保险费的,我方会将多收的保险费无息退还给您。
If you provide an incorrect date of birth, which directly leads to
higher premium than it should be, we will refund the difference
without interest.
7. 增减被保险人
Add or remove
beneficiaries
7.1 除非发生重大人生事件,您方仅可在每一保险期间终止时增加或减
少被保险人。例如,您方的保险凭证所载生效时间为1 月1 日,您
方仅能在下一年度的1 月1 日增加或减少被保险人。
Unless there has been a relevant qualifying life event, you may add or
remove a beneficiary only when you are renewing the cover at the end of an
annual period of cover. For example, if the start time shown on your
certificate of insurance is appointed within 1 January, you may only add or
remove a new beneficiary with effect from 1 January the following year.
7.2 如果已发生重大人生事件,您方将可在保险期间中途增加或减少因
受重大人生事件影响的被保险人。如果您方需要增加被保险人,请
务必寄给我方一份载有所增加的被保险人完整信息的申请,我方将
及时通知您方是否接受此投保以及由于接受这一投保而可能需要增
加的额外责任免除、额外保险费等其他条件。新增被保险人的保险
责任将于我方确认同意接受该申请之日起生效,我方将会出具包含
该新增被保险人的保险凭证并发送给您方。
If there has been a relevant qualifying life event, you may add or remove
the other person involved in that qualifying life event as a beneficiary part
way through the period of cover. If you would like to add a new beneficiary
on this basis, you must send us a completed application for that person. We
will then tell you whether we will offer cover to that person and, if so, any
special conditions or exclusions and any additional premium which would
apply. Cover for the new beneficiary will begin from the date on which we
confirm acceptance of the application. We will send you an updated
certificate of insurance to confirm that the new beneficiary has been added.
7.3 若您或您的配偶分娩,您方可要求增加新生儿至已有的保险责任
IGAB1212 寰球至尊A
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中:
If you or your spouse gives birth, you may apply to add the newborn as a
beneficiary to your existing plan:
7.3.1 如在新生儿出生前的10 个月或更长期间内,其父母中至少
有一位已经持续有效地作为我方被保险人,并且我方在该新
生儿出生后7 天内收到该新生儿的投保申请的,该新生儿将
无须经医疗核保,我方不要求新生儿的健康或医疗信息。根
据您的选择,该新生儿的保险责任将于其出生之时或我方确
认收到该申请之日起生效。我方将把更新的保险凭证发送给
您方。
If at least one parent has been covered by the policy for a
continuous period of 10 months or more prior to the newborn's
birth and the application is received by us within 7 days of the
newborn's date of birth, the newborn will not be subject to medical
underwriting, we will not require information regarding the
newborn's health or a medical examination, and according to your
preference, the cover will begin at the newborn's birth or our
confirmation of receiving the application. We will send you an
updated certificate of insurance confirming that the new
beneficiary has been added.
7.3.2 如在新生儿出生前的10 个月或更长期间内,其父母中至少
有一位已经持续有效地作为我方被保险人,并且我方在该新
生儿出生后8-30 天内收到该新生儿的投保申请的,该新生儿
将无须经医疗核保,我方不要求新生儿的健康或医疗信息,
该新生儿的保险责任将于我方确认收到该申请之日起生效。
我方将把更新的保险凭证发送给您方。
If at least one parent has been covered by the policy for a
continuous period of 10 months or more prior to the newborn's
birth and the application is received by us from 8 to 30 days of the
newborn's date of birth, the newborn will not be subject to medical
underwriting, we will not require information regarding the
newborn's health or a medical examination, and cover will begin
when we confirm receipt of the application. We will send you an
updated certificate of insurance confirming that the new
beneficiary has been added.
7.3.3 如在新生儿出生前的10 个月或更长期间内,其父母中至少
有一位已经持续有效地作为我方被保险人,并且我方在该新
生儿在出生30 天后才收到该新生儿的投保申请的,则该新
生儿须经医疗核保。我方将及时通知您方是否同意增加,以
及适用于该被保险人的特别条件及特别责任免除。若您方接
受所列条件,保险责任将于我方确认同意接受该申请之日起
生效。我方将会提供更新的保险凭证以确认新增被保险人并
发送给您方。
If at least one parent has been covered by the policy for a
continuous period of 10 months or more prior to the newborn's
birth and the application is received by usmore than 30 days after
the newborn's date of birth, the newborn will be subject to medical
underwriting. We will then tell you whether we will offer cover to
the newborn and, if so, any special conditions and exclusions which
would apply. If you accept the offered terms, cover will begin when
we confirm acceptance of the application.We will send you an
updated certificate of insurance confirming that the new
IGAB1212 寰球至尊A
6
beneficiary has been added.
7.3.4 如果新生儿的父母中没有一位能满足"在新生儿出生前的10
个月或更长期间内,已经持续有效地作为我方被保险人"的条
件。该新生儿则须经医疗核保。我方将及时通知您方是否同
意增加,以及适用于该被保险人的特别条件及特别责任免
除。若您方接受所列条件,保险责任将于我方确认同意接受
该申请之日起生效。我方将会提供更新的保险凭证以确认新
增被保险人并发送给您方。
If neither parent has been covered by the policy for a period of 10
consecutive months or more prior to the newborn's birth, the
newborn will be subject to medical underwriting. We will then tell
you whether we will offer cover to the newborn and, if so, any
special conditions and exclusions which would apply. If you accept
the offered terms, cover will begin when we confirm acceptanceof
the application. We will send you an updated certificate of
insurance confirming that the new beneficiary has been added.
8. 保障范围
What is covered?
8.1 本保险合同承担经专科医生建议并由我方医疗团队所确认,因损伤
或疾病而导致的、属于医疗必要的护理及治疗费用给付责任,以及
特定服务费用给付责任。
This policy covers certain costs of services or supplies which are
recommended by a medical practitioner, and which are medically necessary
for the care and treatment of an injury or sickness, as determined by our
medical team.
8.2 保险条款中所列的费用。这些费用的支付须符合本保险合同的规定
及保险凭证所载的限额及责任免除。
The costs which are covered are set out in the provision. These costs are
subject to the limits and exclusions which are set out in the provision and
your certificate of insurance.
8.3 我方可能给予个别被保险人特别责任免除。特别责任免除详细内容
在保险凭证上明示。
Special exclusions, imposed on an individual basis, may apply. Details of
these special exclusions will be shown on your certificate of insurance.
8.4 任何理赔均须符合既定的免赔额,以及保险条款与保险凭证所载的
给付限额。
Any claim is subject to the applicable deductible and limits of cover set out
in the provision and your certificate of insurance.
8.5 本保险合同将不承担任何发生在保险合同开始前与终止后相关治疗
的费用,即使该治疗在保险合同终止前已经获得了我方的批准。
This policy will not cover any costs relating to treatment received before the
cover starts, or after the cover ends (even if that treatment was approved by
us before the cover ends).
9. 保障选项
Coverage options
9.1 国际医疗保障为被保险人的必选保障,具体责任(参考适用的条
款、规定、限额及责任免除)详见本保险合同中"保障利益表"所
载。
The International Medical Insurance plan is provided to every beneficiary.
The benefits which are available (subject to the applicable terms, conditions,
limits and exclusions) are set out in 'list of benefits' in the provision.
9.2 您方可以为任一被保险人选择下述一个或以上的可选保障,以附加
于国际医疗保障,并交纳相应的附加保险费:
You may (for additional premium) add to the cover provided under the
IGAB1212 寰球至尊A
7
International Medical Insurance plan by choosing one or more from the
following extra coverage options for any beneficiary or beneficiaries:
9.2.1 国际医疗补充保障;
International Medical Insurance Plus;
9.2.2 国际健康与体检保障;
International Health and Wellbeing; and
9.2.3 国际眼科与牙科保障。
International Vision and Dental.
9.3 可选保障的保险责任具体详见本保险合同"保障利益表"所载。
Details of the extra coverage options are set out in 'list of benefits' in the
provision.
9.4 保险期间内不能变更已选定的可选保障。如果您方希望增加或减少
可选保障选项,请于年度续保日前及时通知我方。
Coverage options cannot be changed at your request during the period of
cover. If you want to add or remove coverage options, you should let us
know before the annual renewal date.
9.5 若您方增加新的可选保障选项,请向我方提交一份详细的健康问
卷,我方可能对您方新增的保障选项责任适用新的特殊规定或除外
责任。
If you want to add new coverage options, we may ask for a completed
medical history questionnaire, and we may apply new special restrictions or
exclusions on the new coverage options.
9.6 您方可以根据被保险人的需要来选择以下任一保障区域:
You may choose between two options, which determine where in the world
beneficiaries will be covered.
9.6.1 全球不含美国
Worldwide, excluding USA.
9.6.2 全球含美国
Worldwide, including USA.
10. 保险费及其他
费用的交纳
Premium and
other charges
10.1 保险费及其他应支付的费用(如税费),及其应支付的时间与方式
均已载明于您方的保险凭证中。
Your certificate of insurance sets out the premium and any other charges
(such as taxes) which are payable, and states when and how they must be
paid.
10.2 支付货币为人民币。
Payments must be made in Chinese Yuan (CNY).
10.3 您方应准时交纳保险凭证详细载明的保险费及任何其他费用。
You are responsible for paying the premium and any other charges as
detailed on your certificate of insurance, and are also responsible for
making sure they are made on time.
10.4 如果您未支付首期保险费,本保险合同自始无效。如果您未如期缴
清到期的续期保险费,自该到期日起60 日内若发生保险事故,我方
仍负保险责任,但在给付保险金时会扣减应缴的续期保险费;超过
该到期日起60 日的24 时仍未缴清的,本保险合同效力终止。
If you do not pay first premium, this policy will be ineffective from all the
beginning. If you do not pay any following premium when it is due, we will
still be responsible for cover of treatment within the 60 days after the due
date. But we will deduct any following premium due when making payment
IGAB1212 寰球至尊A
8
for treatment. If the aforementioned overdue premium remains outstanding
upon the end of the 60th day after the due date, this policy will be
terminated.
10.5 我方将根据每年的医疗费用通胀情况对保险费率进行调整。我方将
在年度续保日前书面通知您方关于下一保险期间内将发生的保险费
及其他费用的变更信息。请注意每年的保险费或/及其他费用均可能
有所不同。
We will adjust the premium rates each year according to medical cost
inflation. We will write to you before the annual renewal date to tell you
about any proposed changes in premium and/or other charges which will
apply during the next period of cover. The premium and/or other charges
may vary from year to year.
11. 免赔额
Deductible
11.1 对国际医疗保障或国际医疗补充保障的支付,如果被保险人的保障
计划中选择了免赔额,我方将对保险期间内有关治疗的每一次理赔
均扣除免赔额,直到累积免赔达到了年度免赔额。
We will reduce the amount which we will pay towards the cost of treatment
in respect of each claim which is made under the International Medical
Insurance or International Medical Insurance Plus option (if applicable) by
the amount of any deductible until the deductible for the period of cover is
reached.
11.2 免赔额将按每一被保险人、每个保险选项及每个保险期间单独计
算。
The deductible applies separately to each beneficiary, each coverage option,
and each period of cover.
11.3 您方有对国际医疗保障及国际医疗补充保障选择免赔���的权利,选
择有免赔额的保险费将低于选择无免赔额的保险费。若您方计划选
择免赔额,请在投保申请中注明。
You can choose to have a deductible on the International Medical Insurance
or International Medical Insurance Plus option. If you do so, your premium
will be lower than it otherwise would be. If you would like to apply a
deductible, you should tell us so in your application.
11.4 住院津贴保险责任、新生儿护理保险责任无免赔额。
No deductible applies to 'Inpatient Cash Benefits' or 'Newborn Care
Benefits'.
11.5 您方应直接负责向医院、诊所或执业医生支付免赔额,具体金额我
方会通知您方。
You will be responsible for paying the amount of any deductible directly to
the hospital, clinic or medical practitioner. We will let you know what this
amount is.
11.6 您方可于年度续保日要求变更免赔额。如果您方希望取消或减少您
方的免赔额,我方有可能要求您方提供健康问卷,并可能附加特别
承保条件或特别责任免除。
You can request a change to the deductibles with effect from your annual
renewal date each year. If you wish to remove or reduce your deductible,
we may require a medical history questionnaire, and we may apply new
special restrictions or exclusions.
12. 保险合同的终

Termination of
cover
12.1 在下面情况下,我方将终止保险合同:
We may terminate this policy if:
12.1.1 在续期保险费或其他应缴的费用(包括税收等)的应缴日期
后60 天内,未及时支付上述费用。如果我方因为此原因解
IGAB1212 寰球至尊A
9
除本保险合同,我方将书面向您方发出通知。本保险合同不
承担任何发生在保险合同开始前与终止后相关治疗的费用,
即使该治疗已经在保险合同终止前获得了我方的批准;或
any premium or other charge (including any relevant tax) is not paid
in full within 60 days of the date on which it is due. We will give you
written notice if we are going to terminate the policy for this
reason. This policy will not cover any costs relating to treatment
received before the cover starts, or after the cover ends (even if
that treatment was approved by us before the cover ends); or
12.1.2 本保险合同所提供的保障违反了相关法律法规;或
it becomes unlawful for us to provide any of the cover available
under this policy; or
12.1.3 被监管机构处罚而不适宜成为被保险人;或
any beneficiary is identified on any sanctions listings of regulator; or
12.1.4 向我方告知的信息存在信息误导,或因不如实告知而影响到
我方对本保险合同所承保风险的评估。
we have been given misleading information or not told something
which we should have been told which would have affected our
assessment of the risks to be insured under this policy.
12.2 犹豫期内解除保险合同
Cancellation during cooling off period
12.2.1 若本保险合同未能满足您方的需求,或达不到您方的预期,
您可以在收到保险合同并书面签收之日起10 天内联系我方
并取消本保险合同。如果在此期间内未发生理赔、付款担保
或未取得预先批准,我方将全额退还您方已交纳的全部保险
费。
If the policy does not meet your needs, or has not been issued in
accordance with your intention, you may ask us to cancel it within
ten (10) days upon your receipt of your certificate of insurance. If
no claims have been made, and no guarantees of payment or prior
approvals have been put in place, we will refund any premium
which has been paid.
12.3 如果您方计划解除本保险合同及所有被保险人的保障,请至少提前7
天书面通知我方。
If you want to terminate this policy and end cover for all beneficiaries, you
may do so at any time by giving us at least seven days' notice in writing.
12.4 如您方要求在保单终止日前解除本保险合同,只要确认在此保险期
间内无理赔、付款担保或预授权审核,我方将向您方退还未满期净
保费。
If this policy ends before the normal end date, unearned net premiumwill
be refunded, so long as no claims have been made and no guarantees of
payment or prior approvals have been put in place during the period of
cover.
12.5 即使某项治疗已经获预先审核同意,如果该项治疗的发生在保险合
同终止或某被保险人离开保单之后,我方不承担该项费用。
If treatment has been authorised, Cigna will not be held responsible for any
treatment costs if the policy ends or a beneficiary leaves the policy before
treatment has taken place.
12.6 如果我方不同意续保本保险合同,我方将在保单到期前至少一个月
书面通知您本保险合同在保单期满后不再续保。
IGAB1212 寰球至尊A
10
We will wherever possible, write to you at least one month before the end
date to give you written notice that the policy will not be renewed with
effect from the end date.
13. 明确说明和如
实告知
Truthful and Full
Disclosure
订立本保险合同时,我方应向投保人明确说明本保险合同的条款内容。对
保险条款中免除责任的条款,我方在订立保险合同时应当在投保申请、保
险凭证或者其他保险凭证上作出足以引起投保人注意的提示,并对该条款
的内容以书面或者口头形式向投保人作出明确说明,未作提示或者明确说
明的,该条款不产生效力。我方可以就投保人、被保险人或家属的有关情
况提出书面询问,投保人应当如实告知。
When concluding the policy, the company shall explicitly describe the contents of
the policy provision and conditions to the policyholder for the insurance. Especially
for the exclusion clauses, the company shall have striking notes in application form,
certificate of Insurance and other documents, as well as make clear explanations to
the applicant in oral or written; otherwise, the exclusion clauses won't be effective.
We may put forward written inquiry about the relevant information of the
policyholder and each beneficiary. The policyholder shall disclose the information
fully and truthfully.
14. 未如实告知的
处理
False or withheld
information
14.1 投保人故意或者因重大过失未履行如实告知义务,足以影响我方决
定是否同意接受投保申请或者提高保险费率的,我方有权解除本保
险合同。
If the policyholder intentionally or due to gross negligence, fails to perform
the duty of truthful and full disclosure, which suffices to influence our
decision as to whether to accept the application or to raise the insurance
premium rate, we have the right to terminate the policy.
14.2 投保人故意不履行如实告知义务的,我方对于本保险合同解除前发
生的保险事故,不负担保险责任的给付,不退还保险费。
If the policyholder fails to perform its obligation of truthful and full
disclosure intentionally, we shall not be liable to pay insurance benefits or
refund the insurance premiums for insured events that occurred before the
termination of the policy.
14.3 投保人因重大过失未履行如实告知义务,对保险事故的发生有严重
影响的,我方对本保险合同解除前发生的保险事故,不负担保险责
任的给付,但退还未满期净保费。
If the policyholder fails to perform the duty of truthful and full disclosure
due to gross negligence, which failure has a material bearing on the
occurrence of an insured event, we have the right to terminate the policy,
and shall not be liable to pay insurance benefits for the insured events that
occurred before the termination of the policy, but shall refund the unearned
net premium.
14.4 我方在保险合同订立时已经知道投保人未如实告知的情况的,不会
解除保险合同;发生保险事故的,我方承担给付保险金的责任。
When concluding the policy, we have aware that the policyholder fails to
perform the duty of truthful and full disclosure, we shall not terminate the
policy; and shall pay insurance benefits for occurred events which are
covered in the benefit coverage.
14.5 上述规定的保险合同解除权,自我方知道有解除事由之日起,超过
三十日不行使而消灭。
The right to terminate the policy as specified in the preceding paragraph
shall be extinguished if it is not exercised within 30 days after the date on
which we learnt of the reason for termination.
15. 本国国民及常 15.1 被保险人须在投保申请时告知其常住地地址,我方将其常住地所在
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11
住国
Nationals and
country of
habitual
residence
的常住国作为保费计算的必要依据之一。
Beneficiaries are required to fill in the application form about the habitual
residence; we will calculate out due premium according to country of
habitual residence as one necessary factor.
15.2 被保险人变更常住国的,根据新常住国法律法规,我方保留要求您
方补充个人信息、变更/终止保障、或改变保费的权利。如果保费有
所增加,我方将提供终止保险合同的选择给您方。如果保险合同在
保单终止日前终止,只要在此期间内未发生任何理赔、付款担保或
未取得预先批准,我方将向您方退还未满期净保费。
We reserve the right to ask you for further information, to vary or end the
cover, or to vary the premium if any beneficiary changes their country of
habitual residence, having regard to the laws and regulations of the new
country of habitual residence. If the premium increases, we will give you the
option to terminate the policy. If the policy is terminated before the end
date, unearned net premiumwill be refunded, so long as no claims have
been made, and no guarantees of payment or prior approvals have been put
in place during the period of cover.
16. 变更地址与国

Changes of
address and
nationality
16.1 我方将按您方投保申请上载明的地址寄送与本保险合同有关的书信
及通知。如果您方及其他被保险人的地址、常住地或常住国发生了
任何变更,请务必通知我方。
We will send any communications and notices in relation to this policy to the
address which you give us in your application. Youmust tell us if you or any
other beneficiary change your address, country of habitual residence, or
nationality.
我方将给您方寄送更新信息后的保险凭证。
We will then send you an updated certificate of insurance.
16.2 ��于您方常住国或国籍国的任何变更请务必及时通知我方。
It is important that you tell us straight away if there is any change in any
beneficiary's country of habitual residence or country of nationality.
16.3 如果您方发生了常住国变更,我方将按照常住国变更后对应的保费
进行调整。
if your country of habitual residence be changed, we will charge or refund
the premium difference accordingly.
16.4 如果您方在一个保险年度内在常住国外的某国家停留超过90 天,我
方将视为您常住国临时变更;由此应该补缴保费的,在理赔前必须
先补缴保费。
If you visit a country other than your country of habitual residence for more
than 90 days, we will regard this as a change to your country of habitual
residence. Any premium shortfall should be made up before any claim
settlements.
16.5 在某些情况下,如果变更常住国将致使原有保障违反当地医疗保健
监管规定,我方有可能需要终止保险责任,具体的规定可能根据不
同国家及/或不同时期而变化。
In some instances, we may need to end the cover if such a change of country
of habitual residence would result in a breach of regulations governing the
provision of healthcare cover to local nationals, residents or citizens. The
details of regulations vary from country to country and may change from
time to time.
17. 联系您方
Contacting you
如果我方需要就本保险合同的有关事宜联系您方,或通知将终止或修改本
保险合同,我方将依据您方保险凭证载明的最新地址寄送书面通知,并视
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为已送达给您方。
If we need to contact you in relation to this policy, or if we need to give you notice
that we are going to amend or terminate this policy, we will write to you at the
address which you gave us in the latest certificate of insurance, and all notices sent
will be considered delivered..
18. 联系我方
Contacting us
18.1 在本规则所述中的某些情况下,如果您需要书面联系我方,请按照
您方持有的成员身份卡上的地址或电子邮箱地址向我方寄送相关资
料:
In some circumstances, which are explained in these rules, youmay need to
contact us in writing. If so, you should write to us or email us at the
addresses on yourmembership ID card.
18.2 如果在其他情况下您需要联系我方,请您发送电子邮件至您方所持
的成员身份卡上的电子邮箱地址,您也可拨打客户服务热线,客户
服务热线电话号码载于您方持有的成员身份卡上。
In any other circumstances, you may email us at the addresses on your
membership ID card or call our Customer Care Team at the phone number
on yourmembership ID card.
19. 保险合同变更
Changes to this
policy
19.1 除我方授权代表以外,任何人均无权更改本保险合同或取消其中的
任意条款,例如:销售代表、经纪人及其他中介方均无权擅自变更
或拓展本保险合同的任何规定。
No person other than an authorized executive officer of us has authority to
change this policy or to waive any of its provisions on our behalf, for
example, sales representatives, brokers and other intermediaries cannot
vary or extend the terms of the policy.
19.2 我方保留依照相关法律法规变更本保险合同的权利,在发生变更时
将书面通知您方。
We reserve the right to change this policy to comply with any changes to
relevant laws and regulations. If this happens, we will write and tell you of
the change.
19.3 我方同时保留变更续保条件的权利,变更将于年度续保日起生效,
我方将至少提前28 天书面通知您方。
We also reserve the right to make changes to the terms of cover on renewal.
We will give you at least 28 days' notice of such changes and the changes
will take effect from the annual renewal date.
19.4 如果有被保险人存在特别责任免除,我方将可能在年度续保日重新
对该被保险人进行评估,以决定我方是否同意去除该特别责任免
除。如果我方可能进行评估以决定是否去除特别责任免除,我方将
在保险凭证上注明此重新评估的日期。如果您方有特别责任免除需
要进行重新评估,您方应该在收到续保通知后、年度续保日前至少
14 天期间通知我方。您方应该提供或告知在保单开始日或最近续保
日后重要风险因素的变化,以便于我方对特别责任免除进行重新评
估并决定相应的保单承保条件变更。如果我方对特别责任免除进行
了变更,我方将就此变更通知您方、并且在适当的情况下将变更后
的保险凭证发送您方。特别责任免除的变更将在相关的年度续保日
后生效。我方不承诺在续保时,特别责任免除一定会去除。
If special exclusion(s) have been applied to any beneficiary there may be
occasions when we can review them at a future annual renewal date, to
consider whether we are willing to remove the exclusion. If this is the case,
we will show the exclusions review date on the certificate of insurance. You
should contact us upon receipt of the renewal notification, and at least 14
days before the annual renewal date if there is an exclusion which is due for
IGAB1212 寰球至尊A
13
review at that date. You should provide information or disclose any changes
affecting risks where such changes have occurred since the policy inception
or last renewal, whichever is the latter, to help us review the exclusion and
any change to this policy. We will then advise you of changes (if any) we
have made to the special exclusion(s) and, where appropriate, issue an
amended certificate of insurance. Amendments to special exclusion(s) will
be effective from the relevant annual renewal date.We do not guarantee
that any special exclusion(s) will be removed on review.
20. 保险合同执行

Who can enforce
this policy?
本保险合同仅对您方与我方具有法律权益,只有您方或我方是本协议的合
同执行人(即使本保险合同赋予其他被保险人进行投诉的权利)。
Only we and you have legal rights in connection with this insurance. This means
that only we or you may enforce the agreement (although we will allow anyone
who is covered under this policy to use our complaints process).
21. 其他保险
Other insurance
如果其他保险公司也为您方提供了保障,我方将与其协商具体的赔付比
例。
If another insurer also provides cover, we will negotiate with them as regards who
pays what proportion of any claim.
22. 资料保护
Data protection
22.1 出于办理本保险合同事务、提供保险保障及其他在第22 条中所述的
目的或原因,我方需要收集及处理您方的个人资料及敏感信息,例
如:姓名、地址、出生日期、电话号码及健康信息等等。您方对我
方出于必要而合理的需求而按第22 条约定的情形收集及处理您方的
个人资料及敏感信息的行为予以认可。
We need to collect and process personal and sensitive data relating to you,
which includes all identifiable information that relates to you for example:
name, address, date of birth, telephone numbers and details of health
information relating to you, for the purposes of administering this policy and
providing the insurance and other purposes stated in provision 22. Pursuant
to the stipulation herein and to the extent reasonably necessary for these
purposes, you consent to us collecting and processing all personal and
sensitive data relating to you.
22.2 我方将会记录来电或去电以控制质量。
Telephone calls to and from usmay be recorded for quality control.
我方将出于履行本保险合同义务、遵守法律法规的规定、服从监管
机构、行业协会的要求等原因而使用或提供上述信息和资料,并有
可能需要与我方授权的第三方分享,在某些情况下需要传输资料到
中国大陆之外的地区。
The abovementioned information and data will be processed or provided by
us for reasons including carrying out our obligations, acting pursuant to laws
and regulations, or following industry regulator's and insurance association's
requests and we may need to share it with third parties authorised by us,
which may mean in certain instances we need to transfer data outside
Mainland China.
以上信息和资料的处理除应符合中国关于信息保护的法律规定外,
还须符合合同中关于机密性及安全性方面的规定。如果您方需要一
份我方持有的您方个人资料复印件,请书面告知我方您的成员编
号。我方可能对提供的信息收取合理的费用。
Such processing is subject to contractual restrictions with regard to
confidentiality and security in addition to the obligations imposed by
applicable data protection laws in China. If you would like a copy of the
information we hold about you, please write to us quoting yourmembership
number. Please note that we may charge a reasonable fee to provide this
IGAB1212 寰球至尊A
14
information.
22.3 为更好地防范与核查欺骗行为,我方有可能需要与其他保险商或机
构分享信息,但该分享仅限于关于欺骗或试图欺骗行为的信息分
享,不会涉及任何被保险人医疗信息的泄露。
To help us detect and prevent fraud, we may need to share information with
other insurers or organisations. If we need to share information for this
reason, we will only share information relating to fraud or attempted fraud,
and will not share information about any beneficiary's medical history.
23. 语言
Language
我方将可能会为您方提供本保险合同文件的中文版本和英文版本并且提供
中文服务及英文服务,但条款及文件均以中文版本为准。
Youmay have asked for all of the policy documents and all communications in
relation to this policy to be provided in Chinese and English. All such documents
and communications will be provided in Chinese and English. But all benefits and
details shall always be subject to Chinese version.
24. 申诉及争议处

Complaints &
Dispute
Settlement
24.1 任何申诉请第一时间寄送我方,具体地址载明于您方持有的成员身
份卡上:
Any complaint should in the first instance be sent to us at the addresses on
yourmembership ID card.
24.2 如果申诉未能解决时,可以从下列两种方式中选择一种争议处理方
式:
If the complaint is not resolved, the parties concerned shall resort to either
of the following two dispute settlement methods:
24.2.1 因履行本保险合同发生的争议,由当事人协商解决,协商不
成的,提交仲裁委员会仲裁;
The relevant disputing parties shall solve the disputes arising from
the performance of this policy through consultation. If the disputes
cannot be solved through consultation, they shall be submitted to
the arbitration committee for arbitration;
24.2.2 因履行本保险合同发生的争议,由当事人协商解决,协商不
成的,依法对本保险合同有管辖权的人民法院提起诉讼。
The relevant disputing parties shall solve the disputes arising from
the performance of this policy through consultation. If the disputes
cannot be solved through consultation, a lawsuit can be submitted
to the People's Court in accordance with legal regulations.
25. 适用的法律法

Applicable law
and jurisdiction
25.1 本保险合同依据中华人民共和国法律制定,并严格遵循该法律。
This policy is governed by, and will be interpreted in accordance with, laws
of the People's Republic of China.
25.2 关于本保险合同的任何争议包括合同的有效性、构成及终止条款,
将由中华人民共和国法庭管辖。
Any disputes about this policy, including disputes about its validity,
formation and termination, will be determined in the courts of People's
Republic of China.
第二章保险责任
Section 2 - Benefits
26. 国际医疗保障
International
Medical Benefit
国际医疗保障为您提供所需要的住院费用、日间病房的手术费用及病房膳
食费等费用的保障。另外,对癌症、妊娠责任和精神心理治疗,保障的范
围包括住院费用、门诊费用及日间病房费用。
International Medical Insurance protects you for as many everyday needs as
IGAB1212 寰球至尊A
15
possible including all inpatient, day-patient surgery and accommodation costs. You
will also have essential cover for cancer, maternity benefit and psychiatric
treatment on an inpatient, outpatient and day-patient basis.
26.1 住院或日间病
房的病房膳食

Accommodatio
n for inpatient
or day-patient
treatment
26.1.1 我方将支付满足下列条件之一的费用:
We will pay for:
(a) 被保险人接受住院或日间病房治疗期间的护理费、病房膳
食费;或
nursing care and accommodation whilst a beneficiary is receiving
inpatient or day-patient treatment; or
(b) 被保险人在接受门诊手术时所支付的手术治疗室收费。
the cost of a treatment room while a beneficiary is undergoing
outpatient surgery, if one is required.
26.1.2 仅在满足下列全部条件时,我方才支付上述费用:
We will only pay these costs if:
(a) 被保险人接受住院治疗或日间病房治疗是出于医疗必要;
it is medically necessary for the beneficiary to be treated on an
inpatient or day-patient basis;
(b) 被保险人住院的时间长度是合理的;
they stay in hospital for a medically appropriate period of time;
(c) 所接受的治疗由专科医生亲自执行或在其有效监控之下;
并且
the treatment which they receive is provided or managed by a
specialist; and
(d) 如果入住单人间,入住标准不超过带独立卫生间(或类似
设施)的标准单人房。
they stay in a standard single room with a private bathroom (or
equivalent).
26.1.3 如果有多规格的单人间病房且被保险人入住超过标准单人间规格
的病房的���我方将按照带独立卫生间(或类似设施)的标准单人
房的规格给付。
If a hospital's fees vary depending on the type of room which the
beneficiary stays in, then the maximum amount which we will pay is the
amount which would have been charged if the beneficiary had stayed in
a standard single room with a private bathroom (or equivalent).
26.1.4 如果主持被保险人治疗的执业医生决定需要延长留院治疗时间并
超出我方的预先批准时长,或者已获我方审核同意的治疗方案将
有所变动,必须尽快向我方寄送由主持治疗的执业医生出具的医
疗报告,并载明下列全部信息:
If the treating medical practitioner decides that the beneficiary needs to
stay in hospital for a longer period than we have approved in advance, or
decides that the treatment which the beneficiary needs is different to
that which we have approved in advance, then that medical practitioner
must provide us with a report, explaining:
(a) 被保险人预期需要留院治疗的时长;
how long the beneficiary will need to stay in hospital;
(b) 被保险人的诊断信息(如果诊断发生了变更);以及
the diagnosis (if this has changed); and
(c) 被保险人已经接受的治疗和需要接受的治疗。
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the treatment which the beneficiary has received, and needs to
receive.
26.2 手术室及麻醉
复苏室费用
Operating
theatre and
recovery room
costs
如果相应的手术费经我方审核可赔付,我方将支付与之相关的手术室及麻
醉复苏室费用。
We will pay any costs and charges relating to the use of an operating theatre or
recovery room, if the treatment being given is covered under this policy.
26.3 药品费及敷料

Medicines,
drugs and
dressings
26.3.1 我方将支付被保险人接受住院治疗或日间病房治疗期间发生的有
处方的药品费及敷料费;
We will pay for medicines, drugs and dressings which are prescribed for
the beneficiary whilst he or she is receiving inpatient or day-patient
treatment.
26.3.2 除非被保险人接受的是癌症治疗,否则,只有被保险人也选择了
国际医疗补充保障,我方才支付被保险人在门诊治疗发生的药品
费及敷料费。
We will only pay for medicines, drugs and dressings which are prescribed
for use at home if the beneficiary has cover under the International
Medical Insurance Plus option (unless they are prescribed as part of
cancer treatment).
26.4 重症监护室
Intensive care
26.4.1 如符合下列全部条件,我方承担被保险人入住重症监护室,重症
治疗室,加护病房或冠心病监护室的费用:
We will pay for a beneficiary to be treated in an intensive care, intensive
therapy, high dependency or coronary care facility if:
(a) 此病房是为被保险人提供恰当治疗的最佳场所;
that facility is the most appropriate place for them to be treated;
(b) 在此病房接受此治疗是所需治疗的必要部分;以及
the care provided by that facility is an essential part of their
treatment; and
(c) 在此病房所接受的治疗是与被保险人病情/伤情相仿者通常
接受的治疗、或相同的治疗。
the care provided by that facility is routinely required by patients
suffering from the same type of illness or injury, or receiving the
same type of treatment.
26.5 父母或监护人
陪护费
Hospital
accommodatio
n for a parent
or guardian
26.5.1 如果被保险人在接受住院治疗时为17 周岁或以下的未成年人,
符合下列全部条件时,我方将承担其父母中的一位或一位法定监
护人在同一医院中的陪同住宿费用:
If a beneficiary who is 17 years old or younger needs inpatient treatment
and has to stay in hospital overnight, we will also pay for hospital
accommodation for a parent or legal guardian, if:
(a) 该医院可以进行陪护;且
accommodation is available in the same hospital; and
(b) 其陪同住宿费用是合理的。
the cost is reasonable.
26.5.2 仅当被保险人接受的是属于本保险合同约定范围内的治疗时,我
方才承担此陪护费用;
We will only pay for hospital accommodation for a parent or legal
guardian if the treatment which the beneficiary is receiving during their
stay in hospital is covered under this policy.
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26.6 手术的外科医
生及麻醉师费

Surgeons' and
anaesthetists'
fees
26.6.1 我方将支付在住院、日间病房或门诊发生的下列费用:
We will pay for inpatient, day-patient or outpatient costs for:
(a) 手术中发生的外科医生及麻醉师费用;及
surgeons' and anaesthetists' surgery fees; and
(b) 手术前或手术后发生的与手术直接相关的治疗(与手术同
一天发生)中的外科医生及麻醉师费用;
surgeons' and anaesthetists' fees in respect of treatment which is
needed immediately before or after surgery (i.e. on the same day
as the surgery).
26.6.2 除非被保险人接受的是癌症治疗;否则,只有被保险人也选择了
国际医疗补充保障,我方才支付被保险人在手术前或手术后的门
诊治疗费用。
We will only pay for outpatient treatments received before or after
surgery if the beneficiary has cover under the International Medical
Insurance Plus option (unless the treatment is given as part of cancer
treatment).
26.7 专科医生诊疗

Specialists'
consultation
fees
26.7.1 如果满足下列条件之一,我方将支付在医院发生的下列专科医生
诊疗费。
We will pay for consultations with a specialist during stays in a hospital
where the beneficiary:
(a) 因住院或日间病房治疗而发生;
is being treated on an inpatient or day-patient basis;
(b) 因手术而发生;或者
is having surgery; or
(c) 因医疗必要而发生的诊疗费。
where the consultation is a medical necessity.
26.8 器官、骨髓及
干细胞移植费

Transplant
services for
organ, bone
marrow and
stem cell
transplants
26.8.1 如果满足下列全部条件,我方将支付与器官移植直接相关的住院
医疗费用:
We will pay for inpatient treatment directly associated with an organ
transplant, for the beneficiary if:
(a) 移植是出于医疗必要;并且
the transplant is medically necessary, and
(b) 器官来源为其家属捐献,或具有已验证的、合法的来源。
the organ to be transplanted has been donated by a member of
the beneficiary's family or come from a verified and legitimate
source.
26.8.2 我方将支付在住院期间发生的移植后抗排异药物费用。
We will pay for anti-rejection medicines following a transplant, when
they are given on an inpatient basis.
26.8.3 如果满足下列全部条件,我方将支付与骨髓及干细胞移植直接相
关的住院医疗费用:
We will pay for inpatient treatment directly associated with a bone
marrow or peripheral stem cell transplant if:
(a) 移植是出于医疗必要;并且
the transplant is medically necessary; and
(b) 骨髓或干细胞来源为其自体骨髓或干细胞,或具有已验证
的、合法的来源。
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the material to be transplanted is the beneficiary's own bone
marrow or stem cells, or bone marrow taken from a verified and
legitimate source.
26.8.4 如果骨髓及干细胞移植是癌症治疗的一部分,则此费用将不作为
移植费用承担,而是按照本保险合同有关癌症治疗部分的条款进
行承担。
We will not pay for bone marrow or peripheral stem cell transplants
under this part of this policy if the transplants form part of cancer
treatment.
关于癌症治疗的内容见本条款相关部分。
The cover which we provide in respect of cancer treatment is explained
in other parts of this policy.
26.8.5 如果有捐献者捐献骨髓或器官给被保险人,我方将承担:
If a person donates bone marrow or an organ to a beneficiary, we will
pay for:
(a) 获取器官或骨髓的手术费用;
the harvesting of the organ or bone marrow;
(b) 医疗必要的组织配型检测费用;
any medically necessary tissue matching tests or procedures;
(c) 捐献者因捐献行为而发生的必要医院收费;及
the donor's hospital costs; and
(d) 捐献者因捐献而发生的并发症治疗费用,但限于捐献进行
后30 天内的治疗费用。
any costs which are incurred if the donor experiences
complications, for a period of 30 days after their procedure;
无论捐献者是否是本保险的被保险人。
whether or not the donor is covered by this policy.
26.8.6 对本保险合同规定范围内的捐献者费用,如果捐献者可以从其他
保险或费用承担者获得赔偿或补偿,我方承担的部分相应减少。
The amount which we will pay towards a donor's medical costs will be
reduced by the amount which is payable to them in relation to those
costs under any other insurance policy or from any other source.
26.8.7 只有被保险人也选择了国际医疗补充保障,我方才支付被保险人
或捐献者所需要在门诊进行的上述治疗费用。
We will not pay for outpatient treatment for either the beneficiary or
donor, unless the beneficiary has cover under the International Medical
Insurance Plus option for the specific outpatient treatment required.
26.8.8 如果某一位被保险人捐献器官、且受捐献者也是本保险合同的被
保险人,我方对捐献者的赔付仅包括摘取器官的手术费用。
If a beneficiary donates an organ, we will only pay for the harvesting of
the organ if the intended recipient is also a beneficiary under this policy.
26.8.9 我方仅支付医疗必要的移植,对其他非医疗必要的移植(如实验
性的移植等)不予承担。"医疗必要"的规定和限制见本保险合同
相关条款,如释义条款。
We will consider all medically necessary transplants. Those transplants
(such as transplants which are considered to be experimental
procedures) are not covered under this policy. This is because of
conditions or limitations to coverage which are explained elsewhere in
IGAB1212 寰球至尊A
19
this policy.
26.8.10 在被保险人接受器官、骨髓或干细胞移植前需要事先通知我方并
获得我方同意。
A beneficiary must contact us and get approval in advance before they
incur any costs relating to organ, bone marrow or stem cell donation or
transplant.
26.9 肾透析
Kidney dialysis
26.9.1 如果在被保险人的常住国内可以进行肾透析治疗,我方将支付被
保险人在日间病房进行的肾透析治疗。
Treatment for kidney dialysis will be covered if such treatment is
available in the beneficiary's country of residence. We will pay for this on
a day-patient basis.
26.9.2 对被保险人到其常住国外的所选择保障区域内进行的肾透析治
疗,我方支付其在日间病房进行的肾透析费用,但不承担其旅行
费用。
We will pay for kidney dialysis treatment outside the beneficiary's
country of habitual residence if the country where that treatment is
provided is within the beneficiary's selected area of coverage. We will
pay for this on a day-patient basis. We will not pay travel costs.
26.10 病理检测、放
射检查及其他
诊断性检查化

Pathology,
radiology and
other
diagnostic tests
26.10.1 我方将支付:
We will pay for:
(a) 病理检测;
pathology tests;
(b) 放射学检查;及
radiology; and
(c) 诊断性检查化验;
diagnostic tests;
但应符合:这些检查化验是医疗必要的、并且是在被保险人进行
住院或日间病房治疗时由专科医生明确要求进行。
where they are medically necessary and are recommended by a
specialist as part of a beneficiary's hospital stay for inpatient or daypatient
treatment.
26.11 住院及日间病
房发生的物理
治疗及补充治

Inpatient and
day-patient
physiotherapy
and
complementary
therapies
26.11.1 我方将支付:
We will pay for:
(a) 专科物理治疗师进行的物理治疗;及
treatment provided by physiotherapist and
(b) 专业补充治疗师(专业针灸师、专业顺势治疗师及专业中
医医生等)进行的专业补充治疗;
complementary therapists (acupuncturists, homeopaths, and
practitioners of Chinese medicine);
但应符合:这些治疗在被保险人进行住院或日间病房治疗期间由
专科医生明确要求进行(但该被保险人不能主要因为接受这些治
疗而进行此住院或日间病房治疗)。
if these therapies are recommended by a specialist as part of the
beneficiary's hospital stay for inpatient or day-patient treatment (but
are not the primary treatment which they are in hospital to receive).
26.12 核磁共振、计
算机断层扫描
及正电子发射
26.12.1 我方将支付:
We will pay for:
IGAB1212 寰球至尊A
20
断层扫描
MRI, CT & PET
scans
(a) 核磁共振;
magnetic resonance imaging (MRI);
(b) 计算机断层扫描;和/或
computed tomography (CT ); and / or
(c) 正电子发射断层扫描;
positron emission tomography (PET );
但应符合:这些检查是在被保险人进行住院、日间病房治疗或门
诊期间由专科医生明确要求进行。
if they are recommended by a specialist as a part of a beneficiary's
inpatient, day-patient or outpatient treatment.
26.13 家庭护理
Home nursing
26.13.1 如果满足下列全部条件,我方将支付被保险人每年最长30 天的
家庭护理费用:
We will pay for a beneficiary to have up to 30 days of home nursing care,
per period of cover, if:
(a) 被保险人进行可获本��险合同赔偿的住院或日间病房治疗
期间由专科医生明确要求进行;
it is recommended by a specialist following inpatient or daypatient
treatment which is covered by this policy;
(b) 在被保险人出院后立即开始;并且
it starts immediately after the beneficiary leaves hospital; and
(c) 进行家庭护理可以实质减少被保险人继续在医院就医的时
间。
it reduces the length of time for which the beneficiary needs to
stay in hospital.
26.13.2 我方将只支付符合下列全部条件的家庭护理:
We will only pay for home nursing if:
(a) 由具有合格资质的专职护士提供;
it is provided in the beneficiary's home by a qualified nurse;
(b) 护理的内容须是医疗必要的护理,且这些护理通常在医院
才能提供的服务。我方不支付非医疗性质的护理或私人服
务。
it comprises medically necessary care that would normally be
provided in a hospital. We will not pay for home nursing which
only provides non-medical care or personal assistance.
26.14 康复治疗
Rehabilitation
treatment
26.14.1 我方将支付在被保险人遭受损伤(如中风或脊髓损伤等)后由专
科医生明确要求进行的医疗必要的康复治疗,包括理疗、职业治
疗及言语治疗等。每一保险期间内,对单一原因导致的康复治
疗,我方最多支付30 天的费用,包括病房膳食费和生活费。
We will pay for rehabilitation treatments (physical, occupational and
speech therapies) which are recommended by a specialist and are
medically necessary after a traumatic event such as a stroke or spinal
injury. This includes up to 30 days accommodation and living costs, per
period of cover, for each separate condition which requires
rehabilitation treatment.
26.14.2 若在整形外科治疗后、或脊髓/神经系统疾病治疗后由专科医生明
确为有医疗必要进行康复治疗,并且经我方预先审核批准后,我
方可以承担超过30 天的康复治疗费用。
If the rehabilitation treatment is required following an orthopaedic,
IGAB1212 寰球至尊A
21
spinal or neurological event, we will, subject to prior approval being
obtained prior to the commencement of any treatment pay for
rehabilitation treatment for more than 30 days, if further treatment is
medically necessary and is recommended by the treating specialist.
26.14.3 对"30 天"限制的计算:
In determining when the 30 day limit has been reached:
(a) 如果被保险人住院进行康复治疗的,每在医院过一个夜晚
计作"一天";并且
we count each overnight stay during which a beneficiary receives
inpatient treatment as one day; and
(b) 如果被保险人在门诊或日间病房部进行康复治疗的,每一
个发生门诊或日间病房治疗的日历日计作"一天"。
we count each day on which a beneficiary receives outpatient and
day-patient treatment as one day.
26.14.4 我方将只支付符合下列全部条件的康复治疗:
We will only pay for rehabilitation treatment if:
(a) 导致康复治疗的疾病本身也在本保险合同可赔偿范围内;
并且
it is needed after, or as a result of, treatment which is covered by
this policy; and
(b) 康复治疗开始的时间在导致康复治疗的疾病治疗结束后30
天内。
it begins within 30 days of the end of that original treatment.
26.14.5 所有的康复治疗必须经我方事先审核同意,且须由治疗的专科医
生向我方出具包含下列全部内容的证明资料:
All rehabilitation treatmentmust be approved by us in advance. We will
only approve rehabilitation treatment if the treating specialist provides
us with a report, explaining:
(a) 被保险人预计在医院停留的时间;
how long the beneficiary will need to stay in hospital;
(b) 诊断;及
the diagnosis; and
(c) 被保险人已经接受的治疗及需要接受的治疗。
the treatment which the beneficiary has received, or needs to
receive.
26.15 临终关怀及姑
息治疗
Hospice and
palliative care
如果被保险人被诊断为终末期状态,且现有医学技术没有有效的治疗手
段,我方将支付在医院进行临终治疗或护理而发生的病房膳食费、护理
费、处方药品费、理疗及心理关怀等。
If a beneficiary is given a terminal diagnosis, and there is no available treatment
which will be effective in aiding recovery, we will pay for hospital or hospice care
and accommodation, nursing care, prescribed medicines, and physical and
psychological care.
26.16 修复体、设备
及装置
Prosthetics,
devices and
appliances
内置修复体、设备及装置
Internal prosthetics devices and appliances
26.16.1 我方将支付为了对被保险人进行治疗、在手术过程中植入被保险
人体内的修复体、设备及装置。
We will pay for internal prosthetic implants, devices or appliances which
IGAB1212 寰球至尊A
22
are put in place during surgery as part of a beneficiary's treatment.
外置修复体、设备及装置
External prosthetics devices and appliances
26.16.2 我方将支付为了对被保险人进行治疗所必不可少的、满足下述条
件的外置修复体、设备及装置。
We will pay for external prosthetics, devices or appliances which are
necessary as part of a beneficiary's treatment (subject to the limitations
explained below).
26.16.3 我方将支付满足下列条件的外置修复体、设备及装置:
We will pay for:
(a) 手术后立即需要的、医疗必要的修复性设备或装置;
a prosthetic device or appliance which is a necessary part of the
treatment immediately following surgery for as long as is required
by medical necessity;
(b) 在病后恢复阶段内短期内需要的、医疗必要的修复性设备
或装置。
a prosthetic device or appliance which is medically necessary and
is part of the recuperation process on a short-termbasis.
26.16.4 对17 周岁及以上的被保险人,每一保险期间我方最多承担一个
外置修复体、设备或装置。
We will pay for one external prosthetic device for beneficiaries aged 17
or over per period of cover.
26.16.5 对16 周岁及以下的被保险人,每一保险期间我方最多承担一个
外置修复体、设备或装置的初装费用、及两次更换费用。
We will pay for an initial external prosthetic device and up to two
replacements for beneficiaries aged 16 or younger per period of cover.
26.17 当地救护车及
空中救援服务
Local
ambulance and
air ambulance
services
26.17.1 如为医疗必要,我方将支付下列运送被保险人的当地救护车费
用:
Where it is medically necessary, we will pay for a local ambulance to
transport a beneficiary:
(a) 从意外或损伤发生地到医院;
from the scene of an accident or injury to a hospital;
(b) 从一医院转送另一医院;或者
from one hospital to another; or
(c) 从其家���到医院。
from their home to a hospital.
26.17.2 只有在当地救护车的使用是为了到医院进行医疗性质的治疗时,
我方才支付其费用。
We will only pay for a local ambulance where its use relates to treatment
which a beneficiary needs to receive in hospital.
26.17.3 如为医疗必要,我方将支付下列运送被保险人的空中救援费用:
Where it is medically necessary, we will pay for an air ambulance to
transport the beneficiary:
(a) 从意外或损伤发生地到医院;或者
from the scene of an accident or injury to a hospital; or
(b) 从一医院转送另一医院。
IGAB1212 寰球至尊A
23
from one hospital to another.
空中救援的使用适用下列条件及限制:
Air ambulance cover is subject to the following conditions and limitations:
26.17.4 某些情况下,空中救援的使用是不可能的、无法操作的或有难以
承担的风险。在这些情况下我方将不予安排或支付空中救援。另
外,空中救援需要适用下列两项条件。因而,即使满足医疗必要
的条件,本保险合同并不保证任何情况下被保险人一定可以得到
空中救援的服务;
In some situations it will be impossible, impractical or unreasonably
dangerous for an air ambulance to operate. In these situations, we will
not arrange or pay for an air ambulance. This policy does not guarantee
that an air ambulance will always be available when requested, even if it
is medically appropriate;
(a) 我方可支付的空中救援最长运送距离是100 公里(160 英
里);并且
we will only pay for an air ambulance to transport a beneficiary
for distances up to 100 miles (160 kilometres); and
(b) 只有在空中救援的使用是为了到医院进行医学治疗时,我
方才支付其费用。
we will only pay for an air ambulance where its use relates to
treatment which a beneficiary needs to receive in hospital.
26.17.5 本保险合同不承担山地救援的服务。
This policy does not provide cover for mountain rescue services.
26.17.6 本保险合同不承担国际紧急救援服务。
This policy does not provide cover for international emergency services.
26.18 住院津贴
Inpatient Cash
Benefit
如果被保险人进行可获本保险合同赔偿的住院治疗,但未就任何病房膳食
费、治疗等医疗费用进行理赔,我方将向被保险人支付住院津贴。
We will make cash payments directly to a beneficiary who has received inpatient
treatment but has not been charged for that treatment or for accommodation, if
the treatment is covered under this policy.
26.19 住院紧急牙科
治疗
Emergency
inpatient dental
treatment
如果被保险人在住院期间由主持治疗的专科医生明确要求因牙科紧急症状
需要在住院期间进行紧急牙科治疗,我方将支付此治疗(但此牙科治疗不
能构成住院的主要治疗,否则住院本身将不成立医疗必要性)。
We will pay for emergency dental treatment which is required by a beneficiary
while they are in hospital as an inpatient, if that emergency inpatient dental
treatment is recommended by the treating medical practitioner because of a
dental emergency (but is not the primary treatment which the beneficiary is in
hospital to receive).
如果住院发生的某次紧急牙科治疗既可以在本保障获偿,也可以在其他保
障中获偿,则按本保障中进行赔偿,而不按其他保障。
This benefit is paid instead of any other dental benefits the beneficiary may be
entitled to in these circumstances.
26.20 精神疾病或异
常治疗
Treatment of
mental health
conditions and
disorders
26.20.1 我方将按照下述条件支付精神疾病或异常的治疗。
Subject to the limits explained below, we will pay for the treatment of
mental health conditions and disorders.
26.20.2 我方仅支付循证治疗及有医疗必要性的治疗。
We will only pay for evidence-based treatment and medically necessary
treatment.
IGAB1212 寰球至尊A
24
26.20.3 任一保险期间内,我方支付下列两项治疗的总和不超过90 天:
We will pay for up to a combined maximum total of 90 days of:
(a) 精神疾病或异常的治疗;及
treatment for mental health conditions and disorders; and
(b) 成瘾性嗜好的治疗;(见下述成瘾性嗜好的条款)
addiction treatment (see additional treatment below);
26.20.4 在任一保险期间内,可支付的住院治疗最多不超过30 天。
in any one period of cover, including up to 30 days of inpatient
treatment.
26.20.5 任意连续五年时间内,我方支付下列两项治疗的总和不超过180
天:
We will pay for up to a combined maximum total of 180 days of:
(a) 精神疾病或异常的治疗;及
treatment for mental health conditions and disorders; and
(b) 成瘾性嗜好的治疗;(见下述成瘾性嗜好的条款)
addiction treatment (see additional treatment below);
例如,在某一保险期间内,某被保险人使用了90 天的精神疾病
或成瘾性治疗,又在随后的保险期间内使用了90 天的精神疾病
或成瘾性治疗,则在再随后的连续3 年时间里我方将不再支付任
何精神疾病或成瘾性治疗。
in any consecutive five year period. For example, if a beneficiary uses 90
days of psychiatric or addiction treatment in one period of cover, and 90
days of psychiatric or addiction treatment in the following period of
cover, we will not pay for any further psychiatric or addiction treatment
for the next three consecutive years of cover.
26.20.6 在确定上述"30 天"、"90 天"、"180 天"的限制时:
In determining when these 30, 90 and 180 day limits have been reached:
(a) 如果被保险人住院进行治疗的,每在医院过一个夜晚计作
"一天";以及
we count each overnight stay during which a beneficiary received
inpatient treatment as one day; and
(b) 如果被保险人在门诊或日间病房进行治疗的,每一个发生
门诊或日间病房治疗的日历日计作"一天"。
we count each day on which a beneficiary receives outpatient
and day-patient treatment as one day.
26.21 成瘾性治疗
Addiction
treatment
26.21.1 我方将支付:
We will pay for:
(a) 成瘾性症状(包括嗜酒)的诊断;及
diagnosis of addictions (including alcoholism); and
(b) 在提供此类专项治疗的遵循循证治疗的专业治疗中心进行
的医疗必要的、并由专科医生所明确要求的一个阶段或一
个疗程的成瘾性治疗。
one course or programme of addiction treatment at a specialist
centre providing evidence-based treatment, if that treatment is
medically necessary and recommended by a medical practitioner.
26.21.2 在正式的门诊成瘾治疗疗程前,我方最多将支付三次断瘾治疗费
用。
IGAB1212 寰球至尊A
25
We pay for up to three attempts at detoxification, following which we
will only pay for further detoxification treatment if the beneficiary
completes a formal outpatient course or programme of addiction
treatment.
26.21.3 我方不承担:
We will not pay for:
(a) 其他对酗酒、成瘾性状态的治疗;或
any other treatment related to alcoholism or addiction; or
(b) 对任何并发症的治疗(包括抑郁,痴呆或肝功能衰竭
等);
treatment of any related condition (such as depression, dementia
or liver failure);
——如果我们有理由认为这些并发症是由酗酒或成瘾直接导致
的。
where we reasonably believe that the condition which requires
treatment was the direct result of alcoholism or addiction.
26.21.4 我方仅支付循证治疗及有医疗必要性的治疗。
We will only pay for evidence-based treatment and medically necessary
treatment.
26.21.5 在任一保险期间内,我方支付的下列两项的共计上限为90 天:
We will pay for up to a combined maximum total of 90 days of:
(a) 成瘾性治疗;及
addiction treatment; and
(b) 精神疾病及异常的治疗;(见前述有关部分)
treatment for mental health conditions and disorders (see
additional treatment above);
包括最多30 天的住院治疗。
in any one period of cover, including up to 30 days of inpatient
treatment.
26.21.6 任意连续五年期间内,我方支付的下列两项的共计上限为180
天:
We will pay for up to a combined maximum total of 180 days of:
(a) 成瘾性治疗;及
addiction treatment; and
(b) 精神疾病及异常的治疗;(见前述有关部分)
treatment for mental health conditions and disorders (see
additional treatment above);
例如,在某一保险期间内,某被保险人使用了90 天的精神疾病
或成瘾性治疗,又在随后的保险期间内使用了90 天的精神疾病
或成瘾性治疗,则在再随后连续3 年时间里我方将不再支付任何
精神疾病或成瘾性治疗。
in any consecutive five year period. For example, if a beneficiary uses 90
days of psychiatric or addiction treatment in one period of cover, and 90
days of psychiatric or addiction treatment in the following period of
cover, we will not pay for any further psychiatric or addiction treatment
for the next three consecutive years of cover.
26.21.7 在确定上述"30 天"、"90 天"、"180 天"的限制时:
IGAB1212 寰球至尊A
26
In determining when these 30, 90 and 180 day limits have been reached:
(a) 如果被保险人住院进行治疗的,每在医院过一个夜晚计作
"一天";以及
we count each overnight stay during which a beneficiary receives
inpatient treatment as one day; and
(b) 如果被保险人在门诊或日间病房进行治疗的,每一个发生
门诊或日间病房治疗的日历日计作"一天"。
we count each day on which a beneficiary receives outpatient
treatment as one day.
26.22 癌症治疗
Cancer
treatment
我方将支付对癌症进行的积极治疗及循证治疗。包括:被保险人在住院、
日间病房或门诊发生的化疗、放疗、肿瘤病理、检查化验及药物等。
We will pay costs for the treatment of cancer if the treatment is considered by us
to be active treatment and evidence-based treatment. This includes
chemotherapy, radiotherapy, oncology, diagnostic tests and drugs, whether the
beneficiary is staying in a hospital overnight or receiving treatment as a daypatient
or outpatient.
26.23 生育及新生儿
护理
Parent and
baby care
常规妊娠
Routine maternity benefit care
26.23.1 如母亲为被保险人,且在生育之前本保险合同连续生效达10 个
月或以上,我方将支付本保险合同连续生效10 个月后被保险人
发生的常规妊娠、常规分娩有关的下列门诊及住院治疗费用,包
括:
We will pay for the following parent and baby care and treatment
incurred after 10 months of start date, on an inpatient or outpatient
basis as appropriate, if the mother has been a beneficiary under this
policy for a continuous period of at least 10 months prior to the birth of
the child:
(a) 正常分娩有关的医院收费、产科医生及助产士费用;及
hospital, obstetricians' and midwives' fees for routine childbirth;
and
(b) 被保险人正常分娩后需要立即进行的产后护理费用。
any fees as a result of post-natal care required by the mother
immediately following routine childbirth.
复杂妊娠
Complicated maternity benefit care
26.23.2 如母亲为被保险人,且在生育之前本保险合同连续生效达10 个
月或以上,我方将支付本保险合同连续生效10 个月后因被保险
人的妊娠、分娩直接导致并发症而发生的门诊及住院治疗费用。
We will pay for inpatient or outpatient treatment incurred after 10
months of start date, relating to complications resulting from pregnancy
or childbirth if the mother has been a beneficiary under this policy for a
continuous period of at least 10 months prior to the birth of the child.
This is limited to conditions which can only arise as a direct result of
pregnancy or childbirth.
26.23.3 复杂妊娠责任不含家中分娩导致并发症的情况。
This part of this policy does not provide cover for home births.
26.23.4 如因医疗必要而须进行剖腹产,我方将按照复杂妊娠承担相应的
医疗费用。如不能证实确有必要进行剖腹产,我方将按常规妊娠
费用承担相应的医疗费用。
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We will pay for a Caesarean section, where it is medically necessary. If
we can not confirm that it was medically necessary, we will only pay up
to the limit of the mother's routine maternity benefit care cover.
26.23.5 本保险合同不予承担任何代孕及与代孕有关治疗的保险责任。无
论代孕者是被保险人,还是被代孕者是被保险人,我方不予支付
其任何妊娠费用。
We will not pay for surrogacy or any related treatment. We will not pay
for maternity benefit care or treatment for a beneficiary acting as a
surrogate, or anyone acting as a surrogate for a beneficiary.
家中分娩
Home births
26.23.6 如母亲为被保险人,且在其生育之前本保险合同连续生效达10
个月或以上,我方将支付本保险合同连续生效10 个月后发生的
与被保险人家中分娩有关的治疗费用,包括助产士或其他专科医
生费用。
We will pay midwives' and specialists' fees incurred after 10 months of
start date, relating to routine home births if the mother has been a
beneficiary for a continuous period of 10 months or more before the
birth.
26.23.7 请注意:家中分娩导致的并发症不包含在上述复杂妊娠责任中,
而是包含在家中分娩责任中进行赔付。即,如为在家中分娩的情
况,我方对任何怀孕或分娩并发症的费用作为家中分娩的费用、
按家中分娩的费用限额进行赔付。
Please note that the complicated maternity benefit cover explained
above does not include cover for home childbirth. This means that any
costs relating to complications which arise in relation to a home
childbirth will only be paid in accordance with the home childbirth limits,
as explained in the list of benefits.
新生儿护理
Newborn care
26.23.8 新生儿成为本合同被保险人后,我方将支付下列费用:
We will pay for:
(a) 累计不超过10 天的新生儿常规护理;以及
up to 10 days routine care for the baby following birth; and
(b) 出生后90 天内所需的所有治疗。此两项费用均在本保障中
承担,不在其他责任中承担。
all treatment required for the baby during the first 90 days after
birth instead of any other benefit;
对于父母亲中至少一位是本保险合同被保险人,且新生儿出生前
10 个月或更长期间内其保险合同连续有效的情形:如果新生儿于
出生30 天内申请加入本保险合同,我方将不要求提供其医疗资
料、并且无须医疗核保加入本保险合同;如果新生儿于出生30
天后申请加入本保险合同,我方将要求进行医疗核保、并要求您
方完成相应的医疗健康问卷、我方有可能适用特别限制条件或特
别责任免除。
If at least one parent has been covered by the policy for a continuous
period of 10 months or more prior to the newborn's birth.We will not
require information about the newborn's health or a medical
examination if an application is received by us to add the newborn to the
policy within 30 days of the newborn's date of birth. If an application is
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received after 30 days of the newborn's date of birth, the newborn will
be subject to medical underwriting and we will require the completion of
a medical health questionnaire whereby we may apply special
restrictions or exclusions.
26.23.9 新生儿成为本合同被保险人后,我方将支付下列费用:
We will pay for:
(a) 累计不超过10 天的新生儿常规护理;以及
up to 10 days routine care for the baby following birth; and
(b) 出生后90 天内所需的所有治疗。此两项费用均在本保障中
承担,不在其他责任中承担。
all treatment required for the baby during the first 90 days after
birth instead of any other benefit;
如果新生儿的父母中没有一位能满足"在新生儿出生前10 月或更
长时间内,已经持续有效地作为我方的被保险人"的条件,而我们
收到该新生儿投保申请的:则须经医疗核保,我方将要求您方完
成其医疗及健康信息问卷。我方将根据医疗核保结果决定是否承
保及承保条件,我方有可能适用特别限制条件或特别责任免除。
If neither parent has been covered by the policy for a continuous period
of 10 months or more prior to the newborn's birth and an application is
received by us to add the newborn to the policy as a beneficiary. The
newborn will be subject to medical underwriting and we will require the
completion of a medical health questionnaire. Cover for the newborn will
be subject to medical underwriting whereby we may apply special
restrictions or exclusions.
26.23.10 所有经不育治疗后出生的儿童(如试管婴儿)、代孕者所生儿童
或领养儿童须在出生满90 天后才可投保本保险合同。
The newborn care benefits explained above are not available for children
who are born following fertility treatment (such as IVF), are born to a
surrogate, or have been adopted. In these circumstances children can
only be covered by the policy when they are 90 days old.
除另有特别说明,为新生儿投保均须填写健康信息问卷并经医疗
核保,我方可能根据其健康情况适用一定的特别限制条件或特别
除外责任。
Cover for the baby will be subject to completion of a medical health
questionnaire whereby we may apply special restrictions or exclusions.
26.24 先天性疾病
Congenital
conditions
26.24.1 如果被保险人18 周岁以前已经明确患有某先天性疾病,我方将
支付与该先天性疾病有关的住院或日间病房治疗费用。
We will pay for treatment on an inpatient or day-patient basis of
congenital conditions which manifest themselves before the
beneficiary's 18th birthday.
26.24.2 若您方同时购买有国际医疗补充保障、国际健康与体检保障或国
际眼科与牙科保障的保障,这些保障下所有因先天性疾病导致的
赔付总和受本责任限额的限制。
If you have cover under the International Medical Insurance Plus,
International Emergency Evacuation, International Health and Wellbeing
or International Vision and Dental options, the stated limits will apply for
cover which is available under those options.
先天性疾病详细清单请联系我方的客户服务团队进行查询。
A full list of the conditions which we define as congenital can be obtained
from our Customer Care Team.
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26.24.3 本保障不适用于所有被保险人均不足18 周岁的保险合同。如果
订立保险合同时所有被保险人的年龄均不足18 周岁,则先天性
疾病不在保险合同保障范围内。
This benefit does not apply for the policies, under which all beneficiary
(ies) are less than 18 years old. If all beneficiary (ies) under one policy are
less than 18 years old when entering into the policy, then congenital
conditions are excluded from the policy.
27. 国际医疗补充
保障(可选保
障)
International
Health Insurance
Plus Option
国际医疗补充保障给予您更全面的关于门诊的保障,包括:门诊诊疗费、
门诊处方药费、门诊敷料费、门诊理疗、门诊整骨治疗、门诊脊椎治疗、
妊娠门诊费用等。
International Medical Insurance Plus covers you more comprehensively for
outpatient care and includes specialist consultations, prescribed outpatient drugs
and dressings, physiotherapy, osteopathy, chiropractic, maternity outpatient visits
and much more.
27.1 执业医生及专
科医生诊疗费
Consultations
with Medical
Practitioners
and Specialists
27.1.1 如被保险人因诊断咨询、安排治疗或接受治疗,至执业医生就
诊,我方将支付该次就诊的挂号费或诊疗费。
We will pay for consultations or meetings with a medical practitioner
which are necessary to diagnose an illness, or to arrange or receive
treatment.
27.1.2 如被保险人经专科医生明确建议需要在门诊进行医疗必要的非手
术治疗,我方将支付在门诊进行的该非手术治疗费,包括病理
学、放射学及放射影像学。
We will pay for non-surgical treatment on an outpatient basis, which is
recommended by a specialist as being medically necessary including, but
not limited to, pathology, radiology and radiography.
27.2 门诊诊断性检
查化验费
Outpatient
diagnostic
testing
如被保险人经执业医生明确建议需要进行检查或化验以诊断或评估其疾病
状况,我方将支付在门诊发生的诊断性检查化验费。
We will pay for any diagnostic test that is carried out on an outpatient basis, if
recommended by a medical practitioner in order to diagnose or assess a
beneficiary's conditions.
27.3 物理治疗
Physiotherapy
treatment
27.3.1 我方将支付医疗必要的、以恢复被保险人日常生活的正常生理功
能为目的的物理治疗。
We will pay for physiotherapy treatment that is medically necessary,
restorative in nature to help you to carry out your normal activities of
daily living.
27.3.2 这些物理治疗必须由拥有治疗所在国恰当专业资格认证的合格物
理治疗师进行。
The treatmentmust be carried out by a properly qualified practitioner
and holds the appropriate license to practice in the country where the
treatment is received.
27.4 正骨治疗及脊
椎治疗
Osteopathy and
Chiropractic
treatment
如果由执业医生建议进行正骨治疗或脊椎治疗、并进行了推荐,在一个保
险期间内我方将支付总计不超过30 次的正骨治疗或脊椎治疗。同时,这些
治疗必须是循证治疗、且医疗必要的,并且主持对被保险人进行治疗的专
科医生也建议进行。这些治疗必须由拥有治疗所在国专业资格认证的合格
治疗师进行。
We will pay for a combined maximum total of 30 consultations in any one period of
cover for osteopathy and chiropractic treatment which is evidence-based
treatment,medically necessary and recommended by a treating specialist, if a
medical practitioner recommends the treatment and provides a referral. The
treatmentmust be carried out by a properly qualified practitioner and holds the
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30
appropriate license to practice in the country where the treatment is received.
27.5 针灸治疗、顺
势治疗及中医
治疗
Acupuncture,
Homeopathy,
and Chinese
medicine
27.5.1 如果被保险人经执业医生明确要求进行针灸治疗、顺势治疗或中
医治疗,在一个保险期间内我方将支付总计不超过20 次的针灸
治疗、顺势治疗或中医治疗。
We will pay for a combined maximum total of 20 consultations with
acupuncturists, homeopaths and practitioners of Chinese medicine for
each beneficiary in any one period of cover, if those treatments are
recommended by a medical practitioner.
27.5.2 这些治疗必须由拥有治疗所在国恰当的专业执业资格的合法注册
护士进行。
We will only pay for these therapies if the practitioner is an appropriately
qualified nurse and entitled to practise in the country where treatment
is given.
27.6 言语复健治疗
Restorative
Speech therapy
27.6.1 我方将支付满足下列全部条件的言语复健治疗:
We will pay for restorative speech therapy if:
(a) 言语复健治疗是紧随着可获本保险合同赔偿的治疗后立即
发生的(如作为被保险人中风后续治疗必要一部分的言语
治疗);
it is required immediately following treatment which is covered
under this policy (for example, as part of a beneficiary's follow-up
care after they have suffered a stroke);
(b) 该治疗经专科医生明确是短期的、且是医疗必要的。
it is confirmed by a specialist to be medically necessary on a
short-termbasis.
27.6.2 我方不予承担不是以恢复原有言语能力为目的的言语治疗,如下
列任一情况:
We will only pay for speech therapy if the aim of that therapy is to
restore impaired speech function. We will not pay for speech therapy
which:
(a) 用于改善发育不完全的言语能力;
aims to improve speech skills which are not fully developed;
(b) 出于教育提高言语能力的目的;
is educational in nature;
(c) 出于维持语言交流能力为目的;
is intended to maintain speech communication;
(d) 为纠正言语障碍(例如口吃);或
aims to improve speech or language disorders (such as
stammering); or

(e) 因学习困难及发育问题引起的,例如阅读障碍,注意力缺
陷多动障碍(ADHD)或自闭症等。
is as a result of learning difficulties, developmental problems (such
as dyslexia), behavioural problems (such as attention-deficit
hyperactivity disorder), or autism.
27.7 药品费及敷料

Drugs and
dressings
我方将支付被保险人在门诊发生的由执业医生开具处方的处方药或敷料
费。
We will pay for prescription drugs and dressings which are prescribed by a medical
practitioner on an outpatient basis.
27.8 耐用医疗设备27.8.1 如果由专科医生明确要求须租赁专用医疗设备以辅助治疗被保险
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31
租赁费
Rental of
durable medical
equipment
人,每一保险期间内我方将支付最多45 天的医疗设备租赁费。
We will pay for the rental of durable medical equipment for up to 45
days per period of cover, if the use of that equipment is recommended
by a specialist in order to support the beneficiary's treatment.
27.8.2 可被支付的耐用医疗设备须满足下列全部条件:
We will only pay for the rental of durable medical equipment which:
(a) 非一次性用品、可多次反复使用;
is not disposable, and is capable of being used more than once;
(b) 以医疗为目的;
serves a medical purpose;
(c) 适于家庭使用;并且
is fit for use in the home; and
(d) 不能用于除治疗疾病或损伤以外的任何其他目的。
is of a type only normally used by a person who is suffering from
the effect of a disease, illness or injury.
27.9 成人疫苗接种
Adult
vaccinations
27.9.1 我方将支付下列疫苗或免疫费用,包括:
We will pay for certain vaccinations and immunisations namely:
(a) 破伤风(每10 年一次);
tetanus (once every 10 years);
(b) 甲肝;
hepatitis A;
(c) 乙肝;
hepatitis B;
(d) 脑膜炎;
meningitis;
(e) 狂犬病;
rabies;
(f) 霍乱;
cholera;
(g) 黄热病;
yellow fever;
(h) 乙型脑炎;
Japanese encephalitis;
(i) 脊髓灰质炎;
polio booster;
(j) 伤寒;以及
typhoid; and
(k) 疟疾(以片剂形式,每日或每周)。
malaria (in tablet form, either daily or weekly).
27.10 牙科意外门诊
治疗
Dental
accidents
27.10.1 如果被保险人因遭受意外事故而导致健康自体牙发生损伤,牙齿
损伤的治疗在意外事故后立即开始、且在意外事故后30 天内完
成的,我方将支付该项牙科意外门诊治疗费用。
If a beneficiary needs dental treatment as a result of injuries which they
have suffered in an accident, we wiII pay for outpatient dental
treatment for any sound natural tooth/teeth or teeth damaged or
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32
affected by the accident, provided the treatment commences
immediately after the accident and is completed within 30 days of the
date of the accident.
27.10.2 为加快理赔过程,须同时提供进行治疗的牙科医生提供的下列全
部信息:
In order to approve this treatment, we will require confirmation from the
beneficiary's treating dentist of:
(a) 意外事故的具体日期;及
the date of the accident; and
(b) 确认所治疗的牙齿为健康自体牙。
the fact that the tooth/teeth which are the subject of the
proposed treatment are sound natural tooth/teeth.
27.10.3 如果某次意外伤害的牙科治疗既可以在本保障获偿,也可以在其
他保障中获偿,则按本保障中进行赔偿,而不按其他保障。(但
如果也可在"住院紧急牙科治疗"中获偿,则优先按"住院紧急牙科
治疗"承担赔偿。)
We will pay for this treatment instead of any other dental treatment the
beneficiarymay be entitled to under this policy, when they need
treatment following accidental damage to a tooth or teeth.
27.10.4 在本项保险责任中,我方将不支付任何对种植牙、冠修复体及义
齿的修补与更换费用。
We will not pay for the repair or provision of dental implants, crowns or
dentures under this part of this policy.
27.11 儿童健康检查
Well child tests
27.11.1 我方将支付在每一适当的年龄间隔内进行的一次儿童发育咨询,
且终身累积不到13 次。具体包括
We will pay for one child development consultation visit at any of the
appropriate age intervals (up to a total of 13 visits for each child),
including
(a) 由执业医生提供的下列咨询服务:
for a medical practitioner to provide below consultations:
(i) 根据健康信息评估健康状况;
evaluating medical history;
(ii) 体格检查,
physical examinations;
仅包含手法检查,或常规器械如耳镜、口镜、听诊器
等进行的常规检查;不包含单独收费的仪器检查、专
科仪器检查、实验室检验。
only including manually, or with routine instruments such
as ear speculum, mouth mirror or stethoscope; excluding
equipment examinations which are separately charged,
equipment examinations which are done by special
laboratories, or laboratorial tests.
(iii) 发育评估;
development assessment;
(iv) 成长发育指导;以及
anticipatory guidance; and
(b) 必要的血常规、尿常规检验。
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appropriate routine blood test and routine urine test.
27.11.2 我方将支付5 周岁及以下儿童的一次性入学健康检查,包括发
育、听力和视力;
We will pay for one school entry health check, to assess growth, hearing
and vision, for each child aged 5 or younger;
27.11.3 我方将支付大于12 周岁的糖尿病患儿的一次糖尿病视网膜病变
筛查。
We will pay for one diabetic retinopathy screening for children over the
age of 12 who have diabetes.
27.12 儿童免疫
Child
immunisations
27.12.1 我方将支付17 周岁及以下儿童的下列免疫费用:
We will pay for the following immunisations for children aged 17 or
younger;
(a) 白百破(白喉、百日咳和破伤风);
DPT (diphtheria, pertussis and tetanus);
(b) MMR(麻疹、腮腺炎和风疹);
MMR (measles,mumps and rubella);
(c) B 型流行感冒嗜血杆菌;
HIB (haemophilus influenza type b);
(d) 脊髓灰质炎;
polio;
(e) 流感;
influenza;
(f) 乙肝;
hepatitis B;
(g) 水痘;
chick pox;
(h) 肺炎;
pneumonia;
(i) 脑膜炎;及
meningitis; and
(j) 人乳头状瘤病毒;
human papilloma virus (HPV).
27.13 每年常规检查
Annual routine
tests
27.13.1 我方将支付15 周岁或以下儿童如下两项费用。
We will pay for the following routine tests for children aged 15 or
younger:
(a) 一次视力检查;及
one eye test; and
(b) 一次听力检查。
one hearing test.
28. 国际健康与体
检保障(可选
保障)
International
Health and
Wellbeing Cover
国际健康与体检保障给予被保险人关于疾病筛查、化验及检查的保障,并
通过在线健康教育、健康风险评估给被保险人提供关于健康评估及生活危
机处理等一系列量身定制的个性化的咨询建议方案,以帮助被保险人按照
他们喜欢的方式维护其健康。
International Health andWellbeing covers the beneficiary for screenings, tests,
examinations, counselling support for a range of life crises and tailored advice and
support through our online health education and health risk assessment, helping
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34
Option the beneficiary to take control and manage their health the way they want.
28.1 成人健康筛查
Adult Screening
28.1.1 每一保险年度内,我方将支付下列由执业医生执行的检查:
During each period of cover we will pay for the following tests to be
carried out by a medical practitioner:
(a) 每年一次帕帕尼科拉乌检查,通常被称为巴氏涂片(检
查);
an annual papanicolaou test (pap smear) for female beneficiaries;
(b) 每年一次针对50 周岁及以上男性被保险人进行的前列腺筛
查,通常称为前列腺特异性抗原(PSA)检查;
an annual prostate examination (prostate specific antigen (PSA)
test) for male beneficiaries aged 50 or over;
(c) 35 周岁到39 周岁无症状女性被保险人,限一次的基准乳腺
X 线摄影检查;
one baseline mammogram for asymptomatic female beneficiaries
aged between 35 and 39;
(d) 40 周岁到49 周岁无症状女性被保险人,每两年一次医疗必
要的乳腺X 线摄影检查;
one mammogram every two years for asymptomatic female
beneficiaries aged between 40 and 49 (or more often, if medically
necessary);
(e) 50 周岁及以上被保险人,每年一次的乳腺X 线摄影检查;
one mammogram per year for female beneficiaries aged 50 or
over;
(f) 55 周岁及以上的被保险人的肠癌筛查,每年一次;
one bowel cancer screening per year for beneficiaries aged 55 or
over;
(g) 每年一次的骨密度扫描;
one bone density scan per period of cover;
(h) 每一保险期间内不超过4 次的营养师咨询,以提供对于某
些诊断疾病需要的饮食建议与要求;以及
up to 4 consultations with a dietician per period of cover, if the
beneficiary requires dietary advice relating to a diagnosed disease
or illness such as diabetes; and
(i) 常规成人体检,其赔付以保障利益表中所列金额为限。
routine adult physical examinations, within the limits set out in
the list of benefits.
28.2 个人关爱服务
Life
management
28.2.1 每天24 小时、每周7 天、每年365 天随时可获得本项服务。
Available 24 hours a day, 7 days a week, 365 days a year.
28.2.2 最多5 次的与专业顾问当面咨询的机会。
Up to 5 face-to-face sessions with a professional counsellor.
28.2.3 服务的内容包括:在工作、生活、个人及家庭事��等方面为被保
险人提供信息或资源的获取、专家咨询等专业支持。
Provides information, resources, and counselling on any work, life,
personal, or family issue that matters to you.
28.2.4 电子咨询平台提供方便的在线咨询。
Convenient online counselling via E-counselling.
28.2.5 不限次的电话咨询服务。
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35
Unlimited telephonic support.
28.2.6 您方还可以用短信发送所需服务,我方将进行电话回访。
SMS texting text the support you need and receive a call back.
28.2.7 危机支援。
Crisis support.
28.3 在线健康教
育、健康风险
评估及健康指

Online health
education,
health
assessments
and web-based
coaching
您方可在线登录到我方提供健康咨询服务的安全网站。
Online access to our health and wellbeing section in our secure customer area.
29. 国际眼科与牙
科保障(可选
保障)
International
Vision and Dental
Cover Option
国际眼科与牙科保障为被保险人提供广泛范围的牙科预防治疗、牙科常规
治疗、牙科重大治疗及牙科正畸治疗等保障。另外,它还提供常规视力维
护的费用,包括验光、视力矫正眼镜、框架眼镜、有处方的太阳镜及隐形
眼镜。
International Vision and Dental gives the beneficiary access to a wide range of
preventative, routine, major and orthodontic treatments. It also pays for the
beneficiary's routine vision care costs, including eye tests, corrective lenses,
eyeglass frames, prescription sunglasses and contact lenses.
29.1 视力

Vision
29.1.1 我方将支付下述费用:
We will pay for:
(a) 每一保险期间一次验光师或眼科医生实施的眼科检查;
one eye examination per period of cover, to be carried out by
either an ophthalmologist or optometrist;
(b) 根据验光师或眼科医生的医嘱所配的眼镜或隐形眼镜;
glasses or contact lenses, when prescribed by an ophthalmologist
or optometrist;
(c) 根据验光师或眼科医生的医嘱所配的眼镜框架;
frames for glasses or lenses which are prescribed by an
ophthalmologist or optometrist; and
(d) 根据验光师或眼科医生的医嘱所配的太阳镜;
sunglasses, when prescribed by an ophthalmologist or
optometrist.
29.1.2 我方将不支付下述费用:
We will not pay for:
(a) 每一保险期间一次以上的眼科检查;
more than one eye examination in any one period of cover;
(b) 太阳镜,除非是医疗必要的且根据验光师或眼科医生的医
嘱所配;
sunglasses, unless medically prescribed, by an ophthalmologist or
optometrist;
(c) 非医疗必要的、或者不是根据验光师或眼科医生的医嘱所
配的眼镜或隐形眼镜;
glasses or lenses which are not medically necessary or not
IGAB1212 寰球至尊A
36
prescribed by an ophthalmologist or optometrist; or
(d) 除上面列明项目外的其他治疗或手术,包括以矫正视力为
目的的手术,如:激光矫正手术、屈光角膜切开手术及屈
光性角膜切削术等。
treatment or surgery, including treatment or surgery which aims
to correct eyesight, such as laser eye surgery, refractive
keratotomy (RK) or photorefractive keratectomy (PRK).
(e) 就视力矫正眼镜进行理赔时,需要向我方提供医嘱或发票
的复印件。
A copy of a prescription or invoice for corrective lenses will need
to be provided to us in support of any claim for frames.
29.2 牙科
Dental
预防性牙科治疗
Preventative dental treatment
29.2.1 我方为国际眼科与牙科保障持续有效达6 个月及以上的被保险人
支付下列牙科预防治疗费用,包括:
We will pay for the following preventative dental treatment
recommended by a dentist after a beneficiary has had International
Visual and Dental cover for at least six months:
(a) 每一保险期间内两次牙科检查;
two dental check-ups per period of cover;
(b) X 光检查包括咬翼片、牙片及口腔全景片;
X-rays, including bitewing, single view, and orthopantomogram
(OPG);
(c) 每一保险期间两次的洁牙及抛光,包括必要情况下局部氟
化剂处理;
scaling and polishing including topical fluoride application when
necessary (two per period of cover);
(d) 每一保险期间一付护齿的费用;
one mouth guard per period of cover;
(e) 每一保险期间一付夜间咬合垫的费用;以及
one night guard per period of cover; and
(f) 窝沟封闭治疗。
Fissure sealant.
常规牙科治疗
Routine dental treatment
29.2.2 我方为国际眼科与牙科保障持续有效达6 个月及以上的被保险人
支付如下牙科常规治疗费用(如果这些治疗是出于维护口腔健康
所必须的并且由牙科医生要求):
We will pay for the following routine dental treatment after a
beneficiary has had International Visual and Dental cover for at least 6
months (if that treatment is necessary for continued oral health and is
recommended by a dentist):
(a) 根管治疗;
root canal treatment;
(b) 拔牙;
extractions;
(c) 牙科手术;
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37
surgical procedures;
(d) 暂时性牙科处理(包括开髓、换药、引流、暂封、暂时充
填等);
occasional treatment;
(e) 麻醉药;以及
anaesthetics; and
(f) 牙周治疗。
periodontal treatment.
重大牙科治疗
Major restorative dental treatment
29.2.3 我方将为国际眼科与牙科保障持续有效达12 个月及以上的被保
险人全额支付牙科修复性治疗费用。
We will pay for the following major restorative dental treatment in full
after a beneficiary has had International Visual and Dental cover for at
least 12 months:
(a) 义齿—丙烯酸树脂/合金复合义齿,金属义齿或金属/丙烯酸
树脂复合义齿;
dentures (acrylic/synthetic, metal and metal/acrylic);
(b) 冠修复体;
crowns;
(c) 嵌体;以及
inlays; and
(d) 种植牙。
placement of dental implants.
若被保险人在其国际眼科与牙科保障持续有效不足12 个月时要
求对其修复性义齿治疗进行理赔,我方将按其实际治疗费用的
50%作为理赔计算中的治疗费用;
If a beneficiary needs major restorative dental treatment before they
have had International Visual and Dental cover for 12 months, we will
pay 50% of the amount which we would pay if they had been covered for
12 months or more.
正畸治疗
Orthodontic treatment
29.2.4 我方将为国际眼科与牙科保障持续有效不少于24 个月且年龄在
18 周岁及以下的被保险人支付牙齿正畸治疗费用。但我方仅支付
满足下列全部条件的正畸治疗:
We will pay for orthodontic treatment for beneficiaries aged 18 or
younger, if they have had International Visual and Dental cover for at
least 24 months. We will only pay for orthodontic treatment if:
(a) 为被保险人主持进行正畸治疗的牙科医生应事先向我方提
供有关正畸治疗的详细资料(包括X 光片及牙科模型的情
况),以及预期的费用;并且
the dentist or orthodontist who is going to provide the treatment
provides us, in advance, with a detailed description of the
proposed treatment (including X-rays and models), and an
estimate of the cost of treatment; and
(b) 事先得到我方审核同意。
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we have approved the treatment in advance.
父母或监护人陪同住院的病房膳食费
Hospital accommodation for a parent or guardian
29.2.5 如果17 周岁或以下的被保险人需要住院进行牙科治疗并且需要
在医院停留过夜:如果满足下面全部条件,我方将支付其父母或
监护人中的一人陪同被保险人住院的病房膳食费用:
If a beneficiary who is 17 years old or younger needs inpatient dental
treatment and has to stay overnight in hospital, we will pay for hospital
accommodation for a parent or legal guardian, if:
(a) 该医院可以进行陪护;且
accommodation is available in the same hospital, and
(b) 其陪同住宿费用是合理的。
the cost is reasonable.
仅当被保险人接受的是属于本保险合同约定范围内的牙科治疗
时,我方才承担此陪护费用;
We will only pay for hospital accommodation for a parent or legal
guardian if the dental treatment which the beneficiary is receiving
during their stay in hospital is covered under this policy.
其他牙科治疗
Other dental treatment
29.2.6 如果被保险人进行了本条款列明外的某牙科治疗,被保险人可以
(在治疗开始前)联系我方查询我方是否同意承担该项治疗。我
方将考虑其要求,审慎决定:
If a beneficiary requires a form of dental treatment which is not
provided for in this provision, they may contact us (before the treatment
is received) to enquire whether we will provide cover for that treatment.
We will consider the request, and will decide, at our discretion:
(a) 我方是否将支付该项治疗;
whether we will pay for the treatment;
(b) 如果同意支付,我方是全部支付还是部分支付;以及
if so, whether we will pay all or part of the cost; and
(c) 该项治疗将作为哪部分的保障利益进行支付(对各部分保
障利益的限额计算将产生影响)。
which of the areas of cover it will come within (for the purposes of
calculating when limits of cover are reached).
29.2.7 预先批准应该在各项治疗开始之前进行。
Prior approval should be obtained before any treatment is received.
一般事项
General conditions
29.2.8 所有保障应受到下列限制:
All cover is subject to:
(a) 保障利益表中所列的对各项保障利益的次数的限制;
the limits shown in the list of benefits as to the number of times
we will pay for a particular treatment;
(b) 保障利益表中所列的对各项保障利益的赔偿最高额度的限
制;以及
the limits shown in the list of benefits as to the maximum
IGAB1212 寰球至尊A
39
amounts we will pay in relation to a particular treatment; and
(c) 本保险条款中所述的各术语、支付条件、限制(包括次数
及额度)及责任免除。
all of the terms, conditions, limits and exclusions set out in this
policy.
牙科责任免除
Dental exclusions
29.2.9 除了后文通用责任免除条款所列的责任免除外,下列责任免除也
适用于牙科治疗。
The following exclusions apply to dental treatment, in addition to those
set out elsewhere in this policy and in your certificate of insurance.
我方将不支付:
We will not pay for:
(a) 单纯的美容性治疗,或其他不是为维持或改善口腔健康而
必须进行的治疗;
Purely cosmetic treatments, or other treatments which are not
necessary for continued or improved oral health.
(b) 被保险人以非法活动为目的(不论是完全还是部分以此为
目的)所需要进行的牙科治疗;
Treatment which is, to any extent, made necessary by a
beneficiary engaging in any illegal activity.
(c) 为了填写理赔申请表或其他日常事务而导致的费用;
Fees or costs which relate to the filling of a claim form, or any
other administrative service.
(d) 已经或者应该由第三方保险公司、个人、组织或公共机构
承担的费用。如果被保险人也在其他保险公司拥有承担相
应费用的保险,我方将按比例承担我方应该适当承担的部
分。如果我方承担的费用中的全部或部分应该由第三方保
险公司、个人、组织或公共机构承担,我方将可能适当地
向他们追讨此全部或部分费用。
Fees or costs which either have been paid, or could be paid, by
another insurance company, person, organisation or public body.
If the beneficiary is also covered by other insurance, we will only
pay a proportion of the cost of treatment, as appropriate. If all or
any of the cost of the treatment could also be met by some other
person, organisation or public body, we may claim back all or any
of the amount we have paid from them, as appropriate.
(e) 因牙具遗失或被盗而进行的更换;
The replacement of any dental appliance which is lost or stolen, or
associated treatment.
(f) 按照被保险人常住国内拥有普通能力技术的牙医的正常合
理的意见:被保险人的牙桥、冠修复体或义齿可以修理并
达到正常可用的状态。但被保险人更换该牙桥、冠修复体
或义齿;
The replacement of a bridge, crown or denture which (in the
reasonable opinion of a dentist of ordinary competence and skill
in the beneficiary's country of habitual residence) is capable of
being repaired and made usable.
(g) 初次安装后不足五年的牙桥、冠修复体及义齿的更换,除
IGAB1212 寰球至尊A
40
非:
The replacement of a bridge, crown or denture within five years
of its original fitting unless:
(i) 保险期间内被保险人因外力伤害导致牙桥、冠修复体
及义齿受损后无法修复达到正常可用的状况;或
it has been damaged beyond repair, whilst in use, as a
result of an dental injury suffered by the beneficiary whilst
they are covered under this policy; or
(ii) 在被保险人必须拔除健康自体牙后,从医疗上必须对
与被拔除牙齿有邻接关系或对合关系的原义齿进行更
换;或
the replacement is necessary because the beneficiary
requires the extraction of a sound natural tooth/teeth; or
(iii) 在对颌牙初次安装半口义齿时,为进行全口牙列的咬
合关系配置,原义齿必须更换。
the replacement is necessary because of the placement of
an original opposing full denture.
(h) 树脂贴面或瓷贴面。
Acrylic or porcelain veneers.
(i) 对上下颌的第一、第二及第三颗磨牙安装冠修复体或假
牙,除非:
Crowns or pontics on, or replacing, the upper and lower first,
second and third molars unless:
(i) 是全瓷、烤瓷或全金属的冠修复体或假牙,如镍铬合
金冠;或
they are constructed of either porcelain; bonded-to-metal
or metal alone (for example, a gold alloy crown); or
(ii) 常规或紧急牙科治疗中所需要的临时冠或假牙。
a temporary crown or pontic is necessary as part of routine
or emergency dental treatment.
(j) 实验性的或不符合通常牙科治疗规范的牙科治疗、操作或
材料;
Treatments, procedures and materials which are experimental or
do not meet generally accepted dental standards.
(k) 直接或间接由下述原因造成的种植牙治疗:
Treatment for dental implants directly or indirectly related to:
(i) 种植融合失败;
failure of the implant to integrate;
(ii) 种植体骨结合部位破裂;
breakdown of osseo-integration;
(iii) 种植体周围炎;
peri-implantitis;
(iv) 更换冠修复体、牙桥及义齿;或
replacement of crowns, bridges or dentures; or
(v) 或任何意外或紧急的牙科治疗,包括任何假体设备。
any accident or emergency treatment including for any
prosthetic device.
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41
(l) 口腔卫生咨询建议,如牙菌斑控制、口腔卫生及饮食等;
Advice relating to plaque control, oral hygiene and diet.
(m) 单纯的服务或商品,包括但不限于漱口水、牙刷及牙膏
等;
Services and supplies, including but not limited to mouthwash,
toothbrush and toothpaste.
(n) 国际眼科与牙科保障不包含在医院进行的应包含在国际医
疗保障及/或国际医疗补充保障(如果被保险人购买了该项
可选责任)内的牙科治疗;另外,如果该牙科治疗是导致
被保险人住院的原因,则该治疗也不包含在国际医疗保障
及/或国际医疗补充保障内;
Medical treatment carried out in hospital by an oral specialist
may be covered under International Medical Insurance plan
and/or International Medical Insurance Plus, if this option has
been bought, except when dental treatment is the reason for you
being in hospital.
(o) 被保险人在19 周岁生日后进行的正畸治疗;
Orthodontic treatment for anyone after their 19th birthday.
(p) 咬合关系取模,精密/半精密附着体;
Bite registration, precision or semi-precision attachments.
(q) 主要出于如下目的的治疗方法、用具及修复物(全口义齿
除外):
Any treatment, procedure, appliance or restoration (except full
dentures) if its main purpose is to:
(i) 改变上下(颌间)距离;或者
change vertical dimensions; or
(ii) 颞下颌关节功能障碍的诊断或治疗;或者
diagnose or treat conditions or dysfunction of the
temporomandibular joint; or
(iii) 牙周病患牙固定;或者
stabilise periodontally involved teeth; or
(iv) 咬合运动障碍解除。
restore occlusion.
第三章责任免除
Section 3 - Exclusions
30. 通用责任免除
General
Exclusions
下述通用责任免除对本保险合同所有保障均适用:
Cover under this policy is subject to the following general exclusions:
30.1 违反法律规定的行为,包括但不限于违反外汇管理的规定、当地的
法律法规、贸易制裁或管制规定。
We will not offer cover or pay claims when it is illegal for us to do so under
applicable laws. Examples include but are not limited to, exchange controls,
local licensing regulations, sanctions or trade embargo.
30.2 即使已经我方批准,我方仍将不对任何因接受医院治疗或由于执业
医生所导致的损失、损害、疾病或损伤承担保险责任。
We cannot be held responsible for any loss, damage, illness and/or injury
that may occur as a result of receiving medical treatment at a hospital or
from a medical practitioner, even when we have approved the treatment as
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being covered.
30.3 如果您方未购买国际医疗补充保障、国际健康与体检保障或国际眼
科与牙科保障,我方将不支付任何与上述保险责任有关的治疗费
用。
If a beneficiary does not have cover under the International Medical
Insurance Plus, International Health and Wellbeing, or International Vision
and Dental options, we will not pay for any of the treatments or other
benefits which are available under those options.
30.4 下述责任免除适用于国际医疗保障及任一可选保障。
The following exclusions apply to the International Medical Insurance plan
and to all of the extra coverage options.
除了我们下面列出的责任免除外,我方将按照被保险人当时所拥有的保障
来支付符合规定条件的治疗费用。
Where, in the exclusions which are set out below, we have stated that we will pay
for treatment in some circumstances, this is subject to the beneficiary having cover
under the appropriate coverage option or options.
30.5 我方将不予支付:
We will not pay for:
30.5.1 人工维持生命,包含仪器辅助呼吸,除非此治疗有使被保险
人复原或恢复到患病前健康状况的合理预期。
Life support treatment (such as mechanical ventilation) unless such
treatment has a reasonable prospect of resulting in the
beneficiary's recovery, or restoring the beneficiary to his or her
previous state of health.
30.5.2 下列治疗:
Treatment for:
(a) 既往症;或
a pre-existing condition; or
(b) 投保前被保险人已经知道(或者应该已经知道)但未
告知的既往症所导致或相关的任何疾病或症状;
any condition or symptoms which result from, or are related
to, a pre-existing condition which the beneficiary knew
about (or should have known about) before the start of their
cover, but which was not disclosed to us.
对任何既往症,只有在投保申请过程中向我方告知并
且我方医疗核保同意接受后,才能在本保险合同中得
到支付。
Pre-existing conditions will only be covered under this policy
if they were disclosed during the application process and our
medical underwriters agreed to provide that cover.
30.5.3 医疗核保所作出的任何特别责任免除中所涉及疾病或症状导
致的治疗。特别责任免除详见您的保险凭证。
Treatment for a condition which is the subject of a special exclusion.
Special exclusions are set out in your certificate of insurance.
30.5.4 非出于医疗必要的入院或住院,包括:
Non medical admissions or stays in hospital which includes:
(a) 可以在日间病房或门诊进行的治疗;
treatment that could take place on a day-patient or
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outpatient basis;
(b) 病后自然恢复过程;
convalescence;
(c) 社会性或家庭性事务导致的入院,如洗衣、穿着及沐
浴等。
social or domestic reasons e.g. washing, dressing and
bathing.
30.5.5 豪华套间、行政套间、贵宾病房等高级病房费用。
Costs of hospital accommodation for a deluxe, executive or VIP
suite.
30.5.6 器官捐献
Donor organs:
(a) 机械性人工器官、或动物器官,除非在等待移植过程
中为短期维持身体机能而临时使用的机械设备;
mechanical or animal organs, except where a mechanical
appliance is temporarily used to maintain bodily function
whilst awaiting transplant;
(b) 通过任何渠道购买捐献器官的费用;或
purchase of a donor organ from any source; or
(c) 针对未来可能出现的疾病而预先保存干细胞的费用。
harvesting and storage of stem cells, when a preventative
measure against possible future disease.
30.5.7 胎儿手术,如在出生前子宫内进行的治疗或手术;除非是由
妊娠并发症引起——在此情况下应该包含在"复杂妊娠"责任
范围内进行赔付。
Foetal surgery, i.e. treatment or surgery undertaken in the womb
before birth, unless this is resulting from complications arising
through maternity and shall be subject to the limits detailed in the
'Complicated Maternity' section of your policy.
30.5.8 足部护理,包括由手足病治疗专家或足科医生进行的。
Foot care by a Chiropodist or Podiatrist.
30.5.9 睡眠异常;除非有证据表明该被保险人经受着严重的呼吸睡
眠综合症(窒息),在这样的情况下我方将支付:
Sleep disorders unless there are indications that the beneficiary is
suffering from severe sleep apnoea. in these circumstances, we will
only pay for:
(a) 一次睡眠情况评估;
one sleep study;
(b) 医学上合理的手术;以及
surgery, if medically appropriate; and
(c) 仪器租借使用费,如其他方法都失败的情况下使用持
续气道正压(CPAP)通气仪器,但仅限于购买了国际
医疗补充保障的被保险人。
the hire of equipment such as a Continuous Positive Airway
Pressure (CPAP) machine because all other methods have
failed to resolve the issue (only if the beneficiary has cover
under the International Medical Insurance Plus option).
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44
30.5.10 下列医生、医院、诊所及机构提供的治疗:
Treatment which is provided by:
(a) 医疗从业人员没有得到治疗所在国有关当局认可为具
有治疗相应疾病、病症或损伤所需要的适当专业知识
和技能的;
a medical practitioner who is not recognised by the relevant
authorities in the country where the treatment is received as
having specialist knowledge of, or expertise in, the
treatment of the disease, illness or injury being treated;
(b) 我方已经以书面形式致函执业医生、治疗师、医院、
诊所及机构通知:我方不再承认其作为我方认可的医
疗服务主体(我方已经作出这样通知的执业医生、治
疗师、医院、诊所及机构的信息可询问我方的信息查
询热线);或者
a medical practitioner, therapist, hospital, clinic, or facility
to whom we have given written notice that we no longer
recognise them as a treatment provider. Details of
individuals, institutions and organisations to whom we have
given such notice may be obtained by calling our general
enquiries number; or
(c) 根据我方的合理意见,没有得到有效认证或授权、或
没有适当的能力进行相应治疗的执业医生、治疗师、
医院、诊所及机构。
a medical practitioner, therapist, hospital, clinic, or facility
which, in our reasonable opinion, is either not properly
qualified or authorised to provide treatment, or is not
competent to provide treatment.
30.5.11 提供治疗的人员与被保险人在同一居所,或为被保险人的家
庭成员;
Treatment which is provided by anyone who lives at the same
address as the beneficiary, or who is a member of the beneficiary's
family.
30.5.12 戒烟及其相关治疗。
Treatment for, or in connection with, smoking cessation.
30.5.13 由于武装冲突或灾难导致的必要治疗,包括但不限于:
Treatment which is necessary as a result of conflict or disaster
including but not limited to:
(a) 核爆炸及化学污染;
nuclear or chemical contamination;
(b) 战争,恐怖主义入侵,叛乱(无论是否已宣战),内
战,骚乱或军事篡位,戒严,暴乱或任何法律下组织
的临时政府;
war, invasion, acts of terrorism, rebellion (whether or not
war is declared), civil war, commotion, military coup or other
usurpation of power, martial law, riot, or the act of any
unlawfully constituted authority;
(c) 当地卫生机构宣布的疫情爆发,并且相应进行的疫情
控制;以及
outbreaks of disease which are declared to be epidemics and
put under the control of the local public health authorities;
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and
(d) 其他武装冲突或灾难,如果被保险人有如下情况:
any other conflict or disaster events if the beneficiary has:
(i) 进入众所周知的武装交战地区(由您国籍国的政
府所宣布,例如由英国外事及公共安全办公室宣
布);或
put him or herself in danger by entering a known area
of conflict (as identified by a Government in your
Country of nationality, for example the British
Foreign and Commonwealth Office);
(ii) 为主动介入冲突者;或
actively participated in the conflict; or
(iii) 表现出明显不顾及个人安危。
displayed a blatant disregard for their own safety.
30.5.14 因被保险人的自杀、自伤及其他故意行为所导致的治疗;
Treatment that arises from, or is in any way connected with
attempted suicide, or any injury or illness that the beneficiary
inflicts upon him or herself.
30.5.15 不是以使原有言语能力复原为目的的言语治疗,包括但不限
于下述任一情况:
Treatment for or in connection with speech therapy that is not
restorative in nature, or if such therapy is:
(a) 用于改善发育不完全的言语能力;
used to improve speech skills that have not fully developed;
(b) 作为家庭监护或家庭教育的;或
can be considered custodial or educational; or
(c) 出于维持语言交流能力为目的。
is intended to maintain speech communication.
30.5.16 发育问题,包括:
Developmental problems including:
(a) 学习困难如阅读障碍;
learning difficulties such as dyslexia;
(b) 行为问题如注意力缺陷或多动症(ADHD);
behavioural problems such as autism or attention deficit
disorder (ADHD);
(c) 身体发育问题如身材矮小。
physical development problems such as short height.
30.5.17 颞下颌关节功能障碍的(TMJ).
Disorders of the temporomandibular joint (TMJ).
30.5.18 治疗肥胖或其并发症,包括但不限减肥课程、减肥指导或药
物减肥。
Treatment for obesity, or which is necessary because of obesity.
This includes, but is not limited to, slimming classes, aids and drugs.
当被保险人符合在如下情况时,我方将支付胃束带或胃旁路
手术:
We will only pay for gastric banding or gastric bypass surgery if a
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46
beneficiary:
(a) 体重指数(BMI)达到40 或以上并被诊断为病态肥
胖,或;
has a body mass index (BMI) of 40 or over and has been
diagnosed as being morbidly obese;
(b) 能够提供文件证明:过去24 个月内已经尝试过其他减
肥方法;
can provide documented evidence of other methods of
weight loss which have been tried over the past 24 months;
(c) 在手术前已经历了心理评估,并确认被保险人适宜进
行这样的手术。
has been through a psychological assessment which has
confirmed that it is appropriate for them to undergo the
procedure.
30.5.19 在自然治疗诊所、水疗养院或温泉疗养院、疗养院或任何非
医院性质的或不被认为是合格的医疗服务提供者的机构提供
的治疗;
Treatment in nature cure clinics, health spas, nursing homes, or
other facilities which are not hospitals or recognised medical
treatment providers.
30.5.20 部分或全部由于家庭事务因素导致在医院居住,或在医院居
住期间实际上并不需要进行治疗,或医院已经成为被保险人
的住所或永久居住的住所。
Charges for residential stays in hospital which are arranged wholly
or partly for domestic reasons or where treatment is not required
or where the hospital has effectively become the place of domicile
or permanent abode.
30.5.21 任何因吸毒或其并发症导致的相关治疗;
Treatment for a related condition resulting from addictive
conditions and disorders.
30.5.22 任何因酗酒、滥用酒精或其他所导致的治疗。
Treatment for a related condition resulting from any kind of
substance or alcohol use or misuse.
30.5.23 妊娠检测,或艾滋病检测;除非有医学上合理的实质症状,
并且由执业医生建议进行;
maternity tests or HIV tests; unless there are physical symptoms
to suggest possible problems and they are suggested by medical
practitioner
"实质症状"是指机体外观或生理检测发生客观改变,并且符
合妊娠或艾滋病的诊断特征;
'physical symptoms' requires that body appearance or
physiological testing has objective changes, and is meeting the
diagnostic characteristics of maternity or HIV infection.
30.5.24 维生素(自用)、益生菌、人参、冬虫夏草、养生方剂等主
要用于养生的费用;
mainly for nourishing, such as vitamins (self-service), probiotics,
ginsengs, Chinese caterpillar fungus, nourishing prescriptions
and etc;
30.5.25 任何与男性或女性有关的生育控制产生的治疗,包括但不限
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47
于:
Treatment needed because of or relating to male or female birth
control, including but not limited to:
(a) 手术避孕,即:
surgical contraception, namely:
(i) 输精管切除术、绝育术或皮下埋置避孕术等;
vasectomy, sterilisation or implants;
(b) 非手术避孕,即:
non surgical contraception, namely:
(i) 避孕药或避孕套;
pills or condoms;
(c) 生育咨询,即:
family planning, namely:
(i) 当面向医生咨询怀孕或避孕治疗;
meeting a doctor to discuss becoming pregnant or
contraception.
30.5.26 与不孕不育(除了为确诊不孕不育而进行的检查)或各种生
育问题相关的治疗、及对这些治疗导致并发症的后续治疗,
包括但不限于:
Treatment relating to infertility (other than investigation to the
point of diagnosis), fertility treatment of any sort, or treatment of
complications arising as a result of such treatment. This includes,
but is not limited to:
(a) 试管婴儿(IVF);
in-vitro fertilisation (IVF);
(b) 卵子输卵管内移植(GIFT);
gamete intra-fallopian transfer (GIFT );
(c) 受精卵输卵管内移植(ZIFT);
zygote intra-fallopian transfer (ZIFT );
(d) 人工受孕(AI);
artificial insemination (AI);
(e) 处方药物治疗;
prescribed drug treatment;
(f) 胚胎转移(从身体的一处转移至另一处);或
embryo transportation (from one physical location to
another); or
(g) 卵子/精子捐赠及其相关费用。
ovum and/or semen donation and related costs.
如果满足下列全部条件,我方将支付确诊不孕不育的检查费
用:
We will pay for investigations into the cause of infertility if:
(a) 主持治疗的专科医生希望明确医学原因;
the specialist wishes to rule out any medical cause;
(b) 被保险人在接受检查前已连续两年投保本保险;且
the beneficiary has been covered under this policy for two
consecutive years before the investigations have
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48
commenced; and
(c) 被保险人在投保时对其不孕不育的问题一无所知,且
没有出现过明显的征兆。
the beneficiary was unaware of the existence of any
infertility problem, and had not suffered any symptoms,
when their cover under this policy commenced.
1.1.2 意图终止怀孕的措施,除非怀孕会危及到被保险人的生命或
精神稳定;
Treatment by way of the intentional termination of pregnancy,
unless the pregnancy endangers a beneficiary's life or mental
stability.
1.1.3 任何与代孕直接有关的治疗。我方不予支付以下情况的妊娠
责任费用:
Treatment directly related to surrogacy. We will not pay maternity
benefits:
(a) 被保险人是代孕者;或者
to a beneficiary who acts as a surrogate; or
(b) 为被保险人代孕的任何人。
to anyone else acting as a surrogate for a beneficiary.
1.1.4 "新生儿护理"责任中,对因采取治疗不孕不育手段出生的新
生儿如试管婴儿、或代孕所生的儿童、或被收养的儿童,这
些儿童须出生满90 天后方可投保本保险合同,且须经过医
疗核保;
'Newborn Care Benefits' for children born as a result of fertility
treatment, such as IVF, or for children born to a surrogate, or who
have been adopted. These children can only join once they are 90
days old, and will be subject to medical underwriting.
1.1.5 新生儿在医院的托管护理,除非其母亲因医疗必要须住院接
受本保险合同规定范围内的治疗;
Nursery care for a newborn in hospital, unless the mother is
required to remain in hospital due to medical necessity for
treatment that is covered by this policy.
1.1.6 被保险人因永久性神经损伤和/或永久植物人状态(PVS)超过
90 天的治疗费用;
Treatment for more than 90 continuous days for a beneficiary who
has suffered permanent neurological damage and/or is in a
persistent vegetative state (PVS).
1.1.7 任何对个性或人格障碍的治疗,包括但不限于:
Treatment for personality and/or character disorders, including but
not limited to:
(a) 情感性人格障碍;
affective personality disorder;
(b) 精神分裂人格(非精神分裂症);或
schizoid personality disorder; or
(c) 表演型人格障碍;
histrionic personality disorder.
1.1.8 预防性治疗:包括但不限于健康筛查、常规体检及疫苗接种
(除非被保险人已投保了包含这些保险责任的可选保障)。
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Preventative treatment, including but not limited to health
screening, routine health checks and vaccinations (unless that
treatment is available under one of the options under which a
beneficiary has cover).
我方将支付如下疾病的预防性手术费用:
We will pay for preventative surgery when a beneficiary:
(a) 有明显家庭遗传史的疾病、或作为某种遗传性肿瘤综
合征的症状之一的疾病(例如卵巢癌);以及
has a significant family history of a disease which is part of a
hereditary cancer syndrome (such as ovarian cancer); and
(b) 已经进行基因检查,并且结果显示患有某种遗传性肿
瘤综合征(请注意我方不支付基因检查的费用);
has undergone genetic testing which has established the
presence of a hereditary cancer syndrome. (Please note that
we will not pay for the genetic testing).
在国际医疗保障下,除癌症治疗外,对先天性疾病和遗传性
疾病的预防性手术计算在先天性疾病的限额内。
Under the International Medical Insurance plan, the limits of cover
for preventative surgery in respect of congenital and hereditary
conditions will apply, other than for cancer .
1.1.9 任何原因引起的性功能障碍的治疗,如阳痿治疗或其他性方
面的问题。
Treatment for sexual dysfunction disorders (such as impotence) or
other sexual problems regardless of the underlying cause.
1.1.10 如果您方投保时未选择全球含美国地区,我方将不会支付在
美国接受治疗的费用。
Treatment in the USA, unless the beneficiary has purchased
Worldwide including USA cover under this policy.
1.1.11 如果我方获知或有理由怀疑下列情况,我方不承担在美国的
治疗:
Treatment in the USA if we know or reasonably suspect that:
(a) 该治疗在保障范围内;并且
the cover was purchased; and
(b) 被保险人旅行到美国;
the beneficiary travelled to the USA;
且该旅行是为了对投保时即存在的既往病症进行治疗(无论
该治疗是否其前往美国的主要或唯一原因)。
for the purpose of receiving treatment for a pre- existing condition
(whether or not treatment was the main or sole purpose of the
visit).
1.1.12 单眼或双眼屈光不正的治疗,包括但不限于:激光治疗、屈
光性角膜切开术及屈光性角膜切削术。如因病情所需,我方
将支付符合条件的视力治疗费用,如白内障或视网膜脱落。
Treatment which is intended to change the refraction of one or
both eyes, including but not limited to laser treatment, refractive
keratotomy and photorefractive keratectomy. We will pay for
treatment to correct or restore eyesight if it is needed as a result of
a disease, illness or injury (such as cataracts or a detached retina).
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1.1.13 在您方所选择保障区域外进行的任何治疗。
Any treatment outside your selected area of coverage.
1.1.14 除非另有说明,治疗期间的任何旅行花费如出租车费、公共
汽车费用、汽油费或停车费。
Travel costs for treatment including any fares such as taxis or buses,
unless otherwise specified, and expenses such as petrol or parking
fees.
1.1.15 任何国际紧急救援服务。
Any expenses for international emergency services.
1.1.16 医疗异地转运、医疗转运回国及第三方陪护等跨国援助费用。
services expenses for emergency evacuation, medical repatriation
and transportation costs for third parties.
1.1.17 任何船运到岸的转运费用。
Any expenses for ship-to-shore evacuations.
1.1.18 变性手术及任何该手术所需的准备及恢复性治疗(例如心理
辅导),包括由该手术引起的并发症。
Sex change operations or any treatment needed to prepare for or
recover from these operations (for example, psychological
counselling) including complications arising out of such treatment.
1.1.19 因参与如下活动导致身体损伤、疾病或残疾而接受的治疗:
Treatment which is necessary because of, or is any way connected
with, any injury or sickness suffered by a beneficiary as a result of:
(a) 参与职业运动项目;
taking part in a sporting activity on a professional basis;
(b) 独自进行水肺潜水运动;或
solo scuba-diving; or
(c) 30 米以上深度的水肺潜水,除非被保险人获得适当的
潜水资格(即:深度潜水资格证或同等资格证书)认
证为可以潜水到此深度。
scuba-diving at a depth of more than 30 metres unless the
beneficiary is appropriately qualified (namely PADI or
equivalent) to scuba-dive at that depth.
1.1.20 根据我方的合理观点认为是实验性的、非规范的、或未被证
实为有效的治疗。这些治疗包括但不限于:
Treatment which (in our reasonable opinion) is experimental, is not
orthodox, or has not been proven to be effective. This includes but
is not limited to:
(a) 临床试验性质的治疗;
treatment which is provided as part of a clinical trial;
(b) 未被治疗发生所在国权威部门批准的治疗;或
treatment which has not been approved by the relevant
public health authority in the country in which it is received;
or
(c) 药品或药物没有获得药品或药物使用地所在国政府许
可或批准。
any drug or medicine which is prescribed for a purpose for
which it has not been licensed or approved in the country in
which it is prescribed.
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1.1.21 除了是医疗必要的并且由疾病、意外伤害或其他手术而导致
的整形、美容或重建手术外,任何形式(包括出于生理原因
导致)的整形、美容或重建手术或改进人的外表的治疗费
用,即使是出于心理原因。这些治疗包括但不限于:
Any form of plastic, cosmetic or reconstructive treatment, the
purpose of which is to alter or improve appearance even for
psychological reasons, unless that treatment is medically necessary
and is a direct result of an illness or an injury suffered by the
beneficiary, or as a result of surgery. This includes but is not limited
to:
(a) 面部提升术(皱纹切除术);
facelifts (rhytidectomy);
(b) 鼻部塑形术(鼻整形术);
nose reshaping (rhinoplasty);
(c) 吸脂术及其他去除脂肪的治疗;
liposuction and other procedures which remove fat tissue;
(d) 植发术;以及
hair transplants; and
(e) 改变乳房形状的手术、乳房增大或缩小手术(癌症治
疗后的乳房重塑术除外)。
surgery to change the shape of, enhance or reduce breasts
(other than breast reconstruction following treatment for
cancer).
在被保险人的保险合同有效期内,我方将支付被保险人在现
有保险期间内因疾病、意外、损伤或外科手术而接受整形、
美容或重建手术的费用。
We will only pay for plastic, cosmetic or reconstructive treatment if
the illness, injury or surgery as a result of which the treatment is
required took place during the beneficiary's current continuous
period of cover and is itself covered under the policy.
1.1.22 各项杂费如报纸、出租车、电话、接待餐费及旅馆住宿费
用。
Incidental costs including newspapers, taxi fares, telephone calls,
guests' meals and hotel accommodation.
1.1.23 填写理赔申请表的费用及其他行政费用。
Costs or fees for filling in a claim form or other administration
charges.
1.1.24 任何其他保险公司、个人、组织或公共机构应支付或已经支
付的费用。如果被保险人已在其他保险中获得了赔偿,我方
仅支付剩余的部分。如果我方所支付的费用应为其他保险公
司、个人、组织、机构所承担,我方将有权要求偿还该笔费
用。
Costs that have been or can be paid by another insurance company,
person, organisation or public programme. If a beneficiary is
covered by other insurance, we may only pay part of the cost of
treatment. If another person, organisation or public programme is
responsible for paying the costs of treatment, we may claim back
any of the costs we have paid.
1.1.25 由于被保险人的违法行为而导致的任何形式治疗或必要治
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疗。
Treatment that is in any way caused by, or necessary because of, a
beneficiary carrying out an illegal act.
第四章预先批准
Section 4 - Prior approvals
2. 预先批准清单
List of prior
approvals
下述所有的治疗均需取得我方的预先批准。若您方未取得我方的预先批
准,将可能对您方的理赔造成延迟,也有可能使我方拒绝向您方给付全部
或部分理赔款项。
Prior approval should be obtained from us for the following treatments: If it is not,
there may be delays in processing claims, or we may decline to pay all or part of the
claim.
2.1 被保险人必须在每次住院前联系我方;
A beneficiary must contact us before each hospitalizations;
如果主持被保险人治疗的执业医生决定需要延长留院治疗时间并超
出我方的预先批准时长,或者已获我方审核同意的治疗方案将有所
变动,必须尽快向我方寄送治疗的专科医生出具的医疗报告,并载
明下列全部信息:
If the treating medical practitioner decides that the beneficiary needs to
stay in hospital for a longer period than we have approved in advance, or
decides that the treatment which the beneficiary needs is different to that
which we have approved in advance, then that medical practitioner must
provide us with a report, explaining:
2.1.1 被保险人预期需要留院治疗的时长;
how long the beneficiary will need to stay in hospital;
2.1.2 被保险人的诊断信息(如果诊断发生了变更);以及
the diagnosis (if this has changed); and
2.1.3 被保险人所接受过的治疗和未来需要接受的治疗。
the treatment which the beneficiary has received, and needs to
receive.
2.2 被保险人必须在每次所有手术(包括器官移植、骨髓移植或外周血
干细胞移植)及操作性治疗前联系我方,包括在门诊、住院或日间
病房发生的;
A beneficiary must contact us before each surgical procedures (including
organ donation, bone marrow or peripheral stem cell procedures) and minor
operating procedures, wherever occurred in in-patient, out-patient or day
patient;
2.3 被保险人必须在每次生育就诊前联系我方,包括住院和门诊;
A beneficiary must contact us before each maternity visits, including
inpatients and outpatients;
2.4 被保险人必须在每次计算机断层扫描(CT)、核磁共振成像(MRI)
或正电子发射断层扫描(PET)前联系我方;
A beneficiary must contact us before each CT scans, MRI scans and PET
scans;
2.5 无论是在门诊、住院或日间病房,被保险人都必须在每次物理治
疗、职业治疗、言语治疗或任何以康复为目的的治疗前通知我方;
A beneficiary must contact us before each physiotherapies, occupational
and speech therapies, or any treatments for rehabilitations, wherever
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53
occurred in in-patient, out-patient or day patient;
因需要物理治疗、职业治疗、言语治疗或任何康复治疗的疾病往往
较为复杂,您方通知我方时必须提交主持该次治疗的专科医生的医
疗报告,该报告须载明:
As conditions requiring physiotherapies, occupational and speech therapies,
or treatments for rehabilitations can be very complex, as part of the prior
approval process we must receive a medical report from the treating
specialist, detailing the following:
2.5.1 被保险人预计在医院停留的时间;
how long the beneficiary will need to stay in hospital;
2.5.2 诊断;及
the diagnosis; and
2.5.3 被保险人已经接受的治疗及需要接受的治疗。
the treatment which the beneficiary has received, or needs to
receive.
每一保险期间内我方承担的对单一疾病的康复治疗以30 天/次治疗
为限;若为整形外科、脊髓或神经系统疾病治疗的需要进行康复治
疗,我方可以承担超过30 天的康复治疗费用,但须事先联系我方并
取得预先批准;
In each period of cover, for each disease, the cover of rehabilitation is up to
30 days/visits. If rehabilitation treatment is needed following orthopaedic,
spinal or neurological events, we may pay for rehabilitation treatment for
more than 30 days. But you should contact us for prior approval.
2.6 被保险人必须在每次精神心理治疗前联系我方;
A beneficiary must contact us before each psychiatric treatment;
2.7 被保险人必须在每次疼痛控制治疗前联系我方,包括住院和门诊;
A beneficiary must contact us before each pain management, including inpatient
and out-patient;
2.8 被保险人必须在每次家庭护理前联系我方;
A beneficiary must contact us before each home nursing;
2.9 被保险人必须在每次姑息治疗、每次长期护理治疗前联系我方;
A beneficiary must contact us before each palliative care or long term care;
2.10 被保险人必须在每次种植牙治疗、每次正畸治疗前联系我方;
A beneficiary must contact us before each dental implant or dental
orthodontic procedure;
某些情况下,若被保险人确实无法预先联系我方取得批准(如发生紧急事
件,或突然生病必须立刻接受治疗),在这样的情况下,如条件允许,您
方应在接受治疗后尽快联系我方,以便我方决定是否应承担后续的治疗费
用。在这种情况下,您方须向我方说明需立即接受治疗的原因,并且我方
有可能请您方举证。若我方确定您方确实无法事先联系我方,即使未经预
先批准,我方仍将承担在本保险合同规定范��内的第一次紧急治疗费用
(包括任何处方药物)。
We appreciate that there will be times when it will not be practical or possible for a
beneficiary to contact us for prior approval (for example, emergencies, or when a
family member is suddenly sick and the priority is to get treatment for them as
soon as possible). In circumstances like these, we simply ask that you or the
affected beneficiary get in touch with us as soon as is reasonably possible after
treatment has been sought, so that we can confirm whether subsequent treatment
will be covered. In this situation, we will ask for an explanation of why the
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54
treatment was needed urgently, and may ask for evidence of this. If we agree that
it was not reasonably possible or practicable to seek prior approval, we will cover
the cost of the initial treatment (including any prescribed medication) which was
urgent, even without prior approval (within the terms of this policy).
尽管紧急治疗不需要经过我方的预先批准,若被保险人在紧急情况下被送
往医院治疗,应该安排医院或其家庭成员在其入院后48 小时内联系我方
(或者在入院48 小时后尽早联系我方),以使我方能确认被保险人合理使
用了相关的保障。
Although emergency treatment does not require our prior approval, if a
beneficiary is taken to hospital in an emergency, he or she should arrange for the
hospital or a family member to contact us within 48 hours of admission (or as soon
as reasonably possible after that). This will allow us to make sure that the
beneficiary is making the best use of the cover.
若被保险人被送往的医院、执业医生或诊所不在我方医疗网络范围内,在
确认不影响医治的情况下,经被保险人同意,我方将安排被保险人转至我
方医疗网络范围内的医院、执业医生或诊所继续接受治疗。
If a beneficiary has been taken to a hospital, medical practitioner or clinic which is
not part of the Cigna network, then we may make arrangements (with the
beneficiary's consent) to move the beneficiary to a Cigna network hospital,
medical practitioner or clinic to continue treatment, once it is medically
appropriate to do so.
3. 在美国以外地
区治疗的预先
批准
Prior approval for
treatment
outside the USA
对于美国以外地区的治疗,若您方已寻求该治疗预先批准,但尚未取得我
方的书面答复,我方将按照预先批准程序应予批准的额度进行支付。若您
方无法证明曾寻求过就该治疗的预先批准,我方将假设:如果您方事先寻
求预先批准,实际发生的治疗费用将减少20%,因而我们将按照80%的治
疗费用进行理赔,赔付金额相应减少。
If prior approval is not obtained for treatment outside the USA, we will pay only the
amount which we would have paid if prior approval had been sought. In the
absence of evidence to the contrary, we will assume that the treatment costs
would have been reduced by 20% if our prior approval had been sought, and the
amount which we will pay will be reduced accordingly.
4. 在美国地区治
疗的预先批准
Prior approval for
treatment in the
USA
4.1 对于美国地区的治疗,若您方已寻求该治疗预先批准,但尚未取得
我方的书面答复,我方将仅支付按照预先批准程序应予批准的额度
进行支付。若您方无法证明曾寻求过关于该治疗的预先批准,我方
将假设:如果您方事先寻求预先批准,实际发生的治疗费用将减少
50%,因而我们将按照50%的治疗费用进行理赔,赔付金额相应减
少。
If prior approval is not obtained for treatment in the USA, we will pay only
the amount which we would have paid if prior approval had been sought. In
the absence of evidence to the contrary, we will assume that the treatment
costs would have been reduced by 50% if our prior approval had been
sought, and the amount which we will pay will be reduced accordingly.
4.2 若已取得我方对预先批准的书面答复,但是被保险人决定接受我方
医疗网络范围以外医院、执业医生或诊所的治疗,我方将按应支付
额度的80%支付。
If prior approval is obtained, but the beneficiary decides to receive
treatment at a hospital, medical practitioner or clinic which is not part of
the CIGNA network, we will reduce any amount which we pay by 20%.
4.3 如果确实由于合理的原因,被保险人无法接受我方医疗网络范围以
内的医院、执业医生或诊所的治疗,我方将按应支付额度的100%支
付,例如:
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There may be occasions when it is not reasonably possible for treatment to
be provided by a CIGNA network hospital, medical practitioner or clinic. In
these cases, we will not apply any reduction to the payments we will make.
Examples include:
4.3.1 距被保险人住所50 公里(或30 英里)以内无我方医疗网络
范围以内的医院、执业医生或诊所;以及
When there is no CIGNA network hospital , medical practitioner or
clinic within 30 miles/50 kilometres of the beneficiary's home
address; and
4.3.2 当地我方医疗网络范围以内的医院、执业医生或诊所无法为
被保险人提供其所需的治疗。
When the treatment the beneficiary needs is not available from a
local CIGNA network hospital, medical practitioner or clinic.
5. 严格遵从理赔
流程
Strict compliance
with claim
procedure
对于每一次的理赔,被保险人必须严格按照本节所述的理赔流程,否则我
方将减少或不予支付理赔款项。
Beneficiariesmust comply strictly with the claims procedures set out in this section
in respect of every claim. If they do not do so, we will reduce benefits or not pay
the claim as specified above.
第五章保险金申请
Section 5 - Claims application
6. 提供信息
Providing
information
您方在要求理赔时有向我方提供与理赔相关的合理信息或证据的责任。
You (or the beneficiary) must provide us with any information or proof that we may
reasonably ask for to support any claim.
7. 诉讼时效
Claiming period
您方向我方请求给付保险金的诉讼时效期间为自您方知道或者应当知道保
险事故发生之日起2 年。
The period of prescription for the lodging of a claim with us for payment of
insurance benefits by the beneficiary shall be two years, counting from the date on
which you learnt or ought to have learnt of the occurrence of the insured event.
8. 美国地区治疗
的理赔
Claims for
treatment in the
United States
8.1 如果被保险人在美国地区接受治疗的医院、执业医生或诊所不属于
我方医疗网络范围之内,我方将按照80%支付相关的医疗费用。我
方医疗网络的医院、执业医生或诊所名单可以查询您方会员卡上的
网址。但被保险人确实无法在我方医疗网络范围内的成员机构接受
治疗的情况除外,如因为地点限制、或需要立即接受紧急治疗。
If a beneficiary receives treatment in the USA from a hospital, medical
practitioner or clinic which is not part of the Cigna network, any payment
we make in respect of this treatment will be reduced by 20%. A list of Cigna
network hospitals, clinics and medical practitioners is available upon
request at the address in yourmembership card. The only exceptions to this
are when it is not reasonably possible to obtain treatment from a member
of the Cigna network, for example because of location, or in the case of
emergency treatment.
8.2 如果被保险人在美国地区接受治疗并要求理赔,如有必要,我方将
要求其接受入院前证明(PAC)和持续留院观察(CSR)的评估。被
保险人将在每次住院时或日间病房治疗时,被送至医疗审核联盟接
受入院前评估。被保险人必须按照以下时间规定与医疗审核联盟商
议:
If a beneficiary makes a claim for treatment in the USA, he or she may be
required to keep to the pre -admission certification (PAC) and continued
stay review (CSR) requirements. The beneficiary will be transferred to
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CareAllies for PAC for each inpatient or day-patient hospital admission in
the USA. The beneficiary must discuss the PAC with CareAllies either:
8.2.1 一般情况下在入院前;或者
before the beneficiary goes into hospital; or
8.2.2 接受紧急治疗时,在入院后的第一个工作日之前。
in the case of emergency treatment, by the end of the first working
day after the date on which the beneficiary goes into hospital.
被保险人必须安排为其进行治疗的执业医生完成入院前证明并转介
至医疗审核联盟。医疗审核联盟将据此核准治疗天数并通知被保险
人。如果被保险人需要住院治疗的时间超过了医疗审核联盟的核准
的天数,则为其治疗的执业医生必须为其建议持续留院观察评估。
对于紧急入院治疗,主持治疗的执业医生应致电客户服务热线,由
客户服务热线安排转介至医疗审核联盟获取入院证明。
The beneficiary must arrange for the medical practitioner who is to carry
out the treatment to complete the PAC, which should then be sent to
CareAllies. CareAllies will advise the beneficiary of the length of the agreed
stay. If the beneficiary needs inpatient treatment for longer than agreed by
CareAllies, then the medical practitioner who is carrying out the treatment
must ask for CSR for the extra days. For emergency inpatient admissions, the
attending medical practitioner should call the Customer Care Team, who will
then transfer him or her to CareAllies for an admission certificate.
美国地区接受治疗的相关理赔申请表格和文档请发送至您方持有的
成员身份卡上的地址,所有的资料注意均须注明保单编号。
Claim forms and documentation relating to treatment received in the USA
should be sent to the address on yourmembership ID card. Please clearly
state the policy number on all documentation.
8.3 如有必要,我方会要求您方额外提供以下资料来核定理赔:
We may need to ask for extra information to help us process a claim, for
example:
8.3.1 医疗报告或关于被保险人状况的其他资料;
Medical reports or other information about the beneficiary's
condition;
8.3.2 任何我方要求提供并予承担费用的独立医疗体检报告;
The results of any independent medical examination that we may
ask and pay for.
8.4 理赔申请表可以通过电邮或传真的形式发送至我方,但在这种情况
下,申请资料原件仍须邮寄给我方。
Claims may be submitted in electronic format (by email or fax) but in that
case the original hard copy document must also be sent to us by post.
9. 中国大陆地区
治疗的理赔
Claims for
treatment in
Mainland China
9.1 完整填写一份正本理赔申请表
complete the claim form
您的招商信诺会员文件包中附有一份理赔申请表,或者您可以致电
我们的客服团队,我们的客服专员会为您提供一份理赔申请表。建
议您就诊时带好理赔申请表,但如果您忘记带了,也没有关系,可
以致电我们的客服团队。
A beneficiary could get the claim forms from his/her CIGNA & CMC member
pack (there is one claim form included in it) or call our Customer Care Team
to get one claim form. You are highly recommended to take one claim form
with you while medical visits. In cases that you forget to take it, you could
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57
call our Customer Care Team.
9.2 随附所有的医疗文件
include all relevant medical documents
例如:医生诊断书,以及/或医疗记录/医疗手册。医疗报告/医疗手
册必须有主持治疗的执业医生的签字以及/或印章(正式的医疗诊断
章)。这些文件的副本是可以接受的。
including: certificate of diagnosis, and/or medical records. The signatures of
treating medical practitioners are necessary in Medical records. Copies of
these documents are also acceptable.
9.3 随附所有的收据和发票原件
include all original receipts and invoices
例如:发票、盖章的医疗费收据等。
including: invoices, sealed medical receipts and so on.
10. 其他地区治疗
的理赔申请
Claims for
treatment in
other areas
10.1 被保险人在向我方要求理赔时,应详细填写理赔申请表的具体内
容。理赔申请表请您在网站下载,并在填写完成后寄送至您方持有
的成员身份卡上的地址:
In order to make a claim, a beneficiary should give us details of the claim on
a CIGNA claim form. You can download this form from website, and please
send to address on yourmembership ID card.
10.2 如有必要,我方会要求您方额外提供以下资料来核定理赔,例如:
We may need to ask for extra information to help us process a claim, for
example:
10.2.1 医疗报告或关于被保险人状况的其他资料;
Medical reports or other information about the beneficiary's
condition;
10.2.2 任何我方要求提供并予承担费用的独立医疗体检报告。
The results of any independent medical examination that we may
ask and pay for.
10.3 理赔申请表可以通过电邮的形式发送给我方,但同时也必须将书面
资料原件寄送我方。
Claims may be submitted in electronic format (by email or fax) but in that
case the original hard copy document must also be sent to us by post.
11. 保险金的给付
How we pay
claims
11.1 在某些情况下,我方可能给予被保险人或医院、执业医生或诊所提
供付款担保。此担保意味着:我方事先同意就某一特定治疗支付部
分或全部费用。
In some circumstances, we may give a beneficiary or a hospital, medical
practitioner or clinic a guarantee of payment. This means that we agree in
advance to pay some or all of the cost of a particular treatment.
如果我方出具付款担保,待治疗结束,在收到相关的申请表和发票
复印件后,我方将按照付款担保向该被保险��或该医院、执业医生
或诊所支付担保的款项。
Where we have given a guarantee of payment, we will pay the beneficiary
or hospital, medical practitioner or clinic the agreed amount on receipt of
an appropriate request and a copy of the relevant invoice, after the
treatment has been provided.
11.2 一些医院、执业医生或诊所愿意直接向我方结算,只要实际的医疗
费用在被保险人的保险责任范围内,在这些医院、执业医生或诊所
向我方寄送原始医疗账单原件后,我方将向其直接支付我方所担保
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的费用。
Some hospitals, medical practitioners or clinics are willing to invoice us
directly. If the treatment is covered, the hospital, medical practitioner or
clinic should send us the original invoice and we will pay them directly.
11.3 如果某医院、执业医生或诊所向被保险人要求结算,在医疗费用还
没有支付的情况下,若要求我方将直接向医院、执业医生或诊所直
接结算,被保险人必须把医疗账单原件发给我方。
If a hospital, medical practitioner or clinic invoices a beneficiary directly,
and the hospital, medical practitioner or clinic has not been paid, the
beneficiary must send the original invoice to us, and we will make any
payment under this policy to that hospital, medical practitioner or clinic
directly.
11.4 如果某医院、执业医生或诊所向被保险人要求结算,在医疗费用已
经支付的情况下,被保险人可以把原始医疗账单和其支付医疗费用
的发票原件发送我方。我方将就其在保险责任范围内的费用赔偿被
保险人。
If the hospital, medical practitioner or clinic invoices to a beneficiary
directly, and the invoice is paid, the beneficiarymay send us the original
invoice and a receipt for the payment which has been made to the hospital,
medical practitioner or clinic.We will then reimburse the beneficiary for
any portion of the cost of the treatment which is covered.
11.5 在各种情况下,我方将仅支付在保险责任范围内的部分。我方将告
知您方我方是否认为某部分费用在保险责任范围内。
In each case, we will only pay the parts of the costs incurred which are
covered. We will let you know if we believe that any part of the cost
incurred is not covered.
11.6 理赔申请表可以通过电邮的形式发送给我方,但同时也必须将书面
资料原件寄送我方。地址在您方持有的成员身份卡上。
Claims may be submitted in electronic format (by email or fax) but in that
case the original hard copy document must also be sent to us by post. Our
contact details may be found on your membership ID card.
12. 其它核定结果
Other decisions
12.1 谎称发生保险事故
Claim for false insurance event
未发生保险事故,被保险人谎称发生了保险事故,向我方提出索赔
申请的,我方有权解除保险合同,并不退还保险费。
If an insured event has not occurred by the beneficiary falsely claims that
such an event has occurred, and lodges a claim with us for the payment of
insurance benefits, we shall have the right to terminate the policy and shall
not return the insurance premium.
12.2 故意制造保险事故
Claim for deliberate caused insurance event
投保人、被保险人故意制造保险事故的,我方有权解除保险合同,
不承担给付保险金的责任也不退还保险费。
If the policyholder or the beneficiary deliberately causes an insured event,
we shall have the right to terminate the policy and shall neither be liable for
the payment of insurance benefits nor return the insurance premium.
12.3 虚假证明
Claim for forged proofs
保险事故发生后,投保人或被保险人以伪造、变造的有关证明、资
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料或者其他证据,编造虚假的事故原因或者夸大损失程度的,我方
对虚报的部分不承担给付保险金的责任。
If the policyholder, the beneficiary fabricates false causes for an insured
event or overstates the extent of the losses, by means of forged or altered
relevant proofs, information or other evidence after the occurrence of such
event, we shall not be liable for payment of insurance benefits for the
portion that is false.
12.4 退回或赔偿处理
Claw back or reimbursement
投保人或被保险人有以上规定行为之一,致使我方支付保险金或者
支出费用的,应当在收到我方相关通知之日起30 日内向我方退回或
者赔偿。
If the policyholder, the beneficiary commits any of the acts specified in the
preceding three paragraphs and causes us to pay insurance benefits or incur
expenses, he or she shall return the insurance proceeds to or compensate us
within 30 days after he or she receives the relevant notice sent by us.
第六章释义
Section 6 - Definitions
13. 术语定义
Defined terms
下列名词或术语按照下面所指明的定义为准。本条款及保障利益表中按照
下列定义的名词或术语将标为粗体字。
The words and phrases set out below have the meanings specified. Where those
words and phrases are used with those meanings, they will appear in bold in these
provisions, including the list of benefits.
带星号的名词或术语定义仅适用于在美国发生的治疗。除非特别指明,下
列术语定义中单数的情况也适用于复数,指男性"他"的也适用于女性
"她";反之亦然。
All definitions that are marked with an asterisk apply to admissions in the USA only.
Unless otherwise provided, the singular includes the plural and the masculine
includes the feminine and vice versa.
13.1 积极治疗
Active
treatment
指为了缩小肿瘤、制止或延缓其扩散而进行的治疗。不包括单纯减轻症状
的治疗。
treatment which is intended to shrink a cancer, stabilise it or slow down the spread
of the disease. This excludes treatment given solely to relieve symptoms.
13.2 急性发作
Acute
指疾病或损伤并需要迅速接受治疗,该治疗的目的是为了迅速恢复被保险
人至遭受疾病或损伤前的状态,或是为了使被保险人完全复原。
a disease, illness or injury that is likely to respond quickly to treatment which aims
to return the beneficiary to the state of health he or she was in immediately before
suffering the disease, illness or injury, or which leads to his or her full recovery.
13.3 年度续保日
Annual renewal
date
指每年与生效时间所对应的日期日期,如当月无对应的日期,则以该月的
最后一日计算。
the anniversary of the start time.
13.4 申请
Application
指投保人的申请(不管是直接邮寄申请表给我方、通过中介机构提出、在
线申请还是通过电话专员提出),以及在保障期内就自己或投保的被保险
人所做的声明。
the policyholder's application (whether they have sent in a form directly to us or
through a broker or applied online or through our telemarketers), and any
declarations that they made during their enrolment for them and any beneficiaries
included in the application.
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13.5 适当的年龄间

Appropriate
age intervals
下列每两个相邻时间点之间的时间间隔:出生,出生后满2 个月,出生后
满4 个月,出生后满6 个月,出生后满9 个月,出生后满12 个月,出生后
满15 个月,出生后满18 个月,2 周岁,3 周岁,4 周岁,5 周岁及6 周
岁。
birth, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months,
2 years, 3 years, 4 years, 5 years and 6 years.
13.6 被保险人
Beneficiaries,
beneficiary
指保险凭证所载的享有本保险合同保障的人员,包括新生儿。
anybody named on your certificate of insurance as being covered under this policy,
including newborn children.
13.7 保险责任
Benefit(s)
指任何载于保障利益表中的保险责任。
any benefit(s) shown in the list of benefits.
13.8 癌症
Cancer
指恶性的肿瘤、组织或细胞,表现为恶性细胞及入侵组织不可控制的生长
与扩散。
a malignant tumour, tissues or cells, characterised by the uncontrolled growth and
spread of malignant cells and invasion of tissue.
13.9 医疗审核联盟
CareAllies
即CareAllies,是对在美国进行的治疗进行审核的一个理赔审核机构。
a claims review organisation used in respect of treatment in the USA.
13.10 保险凭证
Certificate of
insurance
指出具给投保人的证明文件,上面载明有保险合同编号、生效时间、免赔
额的额度(若已选择)——即被保险人理赔时需要自负的费用、被保障人
员的详细名单、及附加的特别责任免除或利益。
the certificate issued to the policyholder. This shows the policy number, start time,
the deductible amount (if one is selected), that a beneficiary would need to pay if
they make a claim, details of who is covered, any special exclusions and benefits
which apply.
13.11 我方、信诺、
保险人
Cigna, we, us,
our, the insurer
指招商信诺人寿保险有限公司。
Cigna-CMC Life Insurance Company.
13.12 诊所
Clinic(s)
指在治疗所在国注册或登记的健康服务机构,主要目的是提供门诊医疗服
务,并且该医疗服务是由执业医生亲自执行或有效监控的。
a health care facility which is registered or licensed in the country in which it is
located, primarily to provide care for outpatients and where care or supervision is
by a medical practitioner.
13.13 补充治疗师
Complementary
therapist
指经过专业培训及资格认证,并经有关当局许可允许在该国进行治疗的针
灸师、顺势疗法医师或中医医师。
an acupuncturist, homeopath or practitioner of Chinese medicine who is
appropriately qualified and entitled to practise in the country where treatment is
given.
13.14 先天性疾病
Congenital
condition
指出生时已存在的任何生理不正常、畸形、疾病或损伤,无论是否做过诊
断。
any abnormality, deformity, disease, illness or injury present at birth, whether
diagnosed or not.
13.15 持续留院观察
Continued stay
review, CSR
指当被保险人发生住院时,医疗审核联盟就该被保险人是否需要继续住院
治疗进行的审核和决定。
a review and decision by CareAllies, during the beneficiary's stay in hospital, on the
suitability of the beneficiary's continued treatment as an inpatient.
13.16 美容
Cosmetic
指基于美学初衷所提供的服务、程序或项目,以及不是为了保持可接受的
健康标准所必须的服务、程序或项目。
services, procedures or items that are supplied primarily for aesthetic purposes and
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which are not necessary in order to maintain an acceptable standard of health.
13.17 常住国
Country of
habitual
residence
指被保险人常住地所在的国家,与您方申请记录一致。
the country where a beneficiary habitually resides, as stated on your application.
13.18 国籍国
Country of
nationality
指被保险人作为其公民、国民的国家或与您方申请记录一致的国家。
any country of which a beneficiary is a citizen, national or subject, as stated on your
application.
13.19 日间病房治疗
Day-patient
treatment
在医院进行护理并使用床位,但并不过夜。在美国的护理中也包含医生在
手术中的外科操作程序。
care involving admission to hospital and using a bed but not staying overnight. In
respect of USA based admissions, this also includes surgical procedures carried out
in the doctor's surgery.
13.20 日间病房病人
Day-patient
指入住医院或日间病房,或使用治疗的其他医疗设施,或需要一段时间的
医疗观察的病人,但并不占用医院病床过夜。
a patient who is admitted to a hospital or day-patient unit or other medical facility
for treatment or because they need a period of medically supervised recovery, but
who does not occupy a bed overnight.
13.21 免赔额
Deductible(s)
指理赔金中被保险人必须自行承担的额度,经选择后在保险凭证上载明。
is the amount of any claim which a beneficiary must pay themselves. This will be
shown in the certificate of insurance if selected.
13.22 紧急牙科
Dental
emergency
指拔牙后止痛药无法遏制的剧痛或面部浮肿或流血不止,同时被保险人的
惯常牙科医生不在非营业时间或不在被保险人当时可及的地域范围之内。
在该情况下的紧急牙科治疗仅以稳定病况及缓解剧痛为目的。
where either severe pain which is not amenable to relief by painkillers or facial
swelling or uncontrollable bleeding after an extraction is being suffered and it is
either outside the business hours of a beneficiary's usual dentist or the beneficiary
is staying at a place which is away from the dental practice he or she usually visits.
The treatment covered in such an instance is to purely stabilise the problem and
relieve severe pain.
13.23 牙齿损伤
Dental injury
指口腔受外部打击而导致健康自然牙的损伤。只有您方选择了国际眼科和
牙科保障,冠修复体、义齿或种植牙的治疗才在保障范围内;并且,需要
根据该保障条款的条件进行承担。
injury to a sound natural tooth caused by extra-oral impact. Treatment for dental
implants, crowns or dentures is not covered unless you have purchased the
International Vision and Dental option and subject to the conditions outlined in the
policy.
13.24 牙科治疗
Dental
treatment
指符合下述全部条件的牙科治疗:
any dental procedure or service which:
13.24.1 为了维持口腔健康;并且
is needed for continued oral health; and
13.24.2 由牙医亲自操作或有效监控,包括辅助人员的操作流程;并且
is carried out or personally controlled by a dentist, including procedures
provided by a hygienist; and
13.24.3 包括于保障利益表中,或尽管未列在保障利益表,但已被我方认
可、符合通常适用的牙科标准、并已被牙科医学界普遍支持的流
程或服务。
is included in the list of benefits, or, though not included in the list of
benefits, is accepted by us as a procedure or service meeting common
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dental standards as upheld by a respectable, responsible and substantial
body of dental opinion, experienced in the particular field of dentistry.
13.25 牙医
Dentist
指为国家、政府或其他监管地区所承认并允许在该地区提供治疗的牙科医
生、牙齿外科医生或牙科执业人员。
a dentist, dental surgeon or dental practitioner who is registered or licensed as
such under the laws of the country, state or other regulated area in which the
treatment is provided.
13.26 断瘾
Detoxification
对戒除吸毒或/及嗜酒时戒断症状的医疗处理,包括采用休息、药物、输液
或调整饮食以稳定身体状态。
treatment for withdrawal symptoms after a beneficiary has been abusing drugs,
alcohol or both. It includes the rest, medication, fluids and changes in diet needed
to stabilise the body.
13.27 诊断检测
Diagnostic tests
指对症状原因的调查研究,如X 光或血液检测等。
investigations such as x-rays or blood tests to find or to help to find the cause of the
beneficiary's symptoms.
13.28 医生
Doctor
指同时符合下列条件的医疗从业人员:拥有适当的医疗学位;在所在的国
家、地区或管辖范围内合法注册并拥有行医执照,可以在医疗发生地提供
医疗服务。
a medical professional who holds an appropriate doctoral degree, is registered and
licensed under the laws of the country, state or regulated area to practice medicine
in the country in which the treatment is provided.
13.29 符合条件的女

Eligible female
指作为投保人或被保险人的女性。
a female policyholder or beneficiary.
13.30 紧急治疗
Emergency
treatment
指为阻止疾病、损伤及症状进一步的迅速恶化而进行的医疗必要治疗,如
不进行该治疗,将会显著地影响健康。
treatment which is medically necessary to prevent the immediate and significant
effects of illnesses, injuries or conditions which, if left untreated, could result in a
significant deterioration in health.
只有在紧急事由发生后24 小时之内由内科医生、执业医生或住院服务机构
提供的紧急医疗,或24 小时之内因此发生的住院才受保障。
Only medical treatment through a physician, medical practitioner and
hospitalisation that commences within 24 hours of the emergency event will be
covered.
13.31 保单终止日
End date
指保险凭证所载的本保险合同保障结束的日期。
the date on which cover under this policy ends, as shown in the certificate of
insurance.
13.32 循证治疗
Evidence-based
treatment
指经过下述机构研究、核查及认可的治疗:
treatment which has been researched, reviewed and recognised by:
13.32.1 美国国家健康及临床优化研究所(the National Institute for Health
and Clinical Excellence);或
the National Institute for Health and Clinical Excellence; or
13.32.2 我方医疗顾问团;或
the CignaMedical Team; or
13.32.3 我方认可的其他机构;
another source recognised by the CignaMedical Team.
13.33 大中华地区指中华人民共和国的全部领土、领海及其领空,包括香港特区、澳门特区
和台湾地区在内。
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Great China all territories, seas and related airspaces of People's Republic of China, including
Hong Kong, Macau and Taiwan.
13.34 付款担保
Guarantee of
payment
指我方对被保险人或治疗方提供关于特定治疗付款担保的协议费用。
a guarantee to pay agreed costs associated with particular treatment which we
may give to a beneficiary or a hospital, clinic or medical practitioner.
13.35 家庭护理
Home nursing
指一位合法注册护士至被保险人家中提供的专业护理服务,包括:
visits from a qualified nurse to the beneficiary's home to give expert nursing
services:
13.35.1 因医疗必要所进行的紧随住院治疗之后的护理;以及
immediately after hospital treatment for as long as is required by
medical necessity; and
13.35.2 因医疗必要而本应在正规医院里所提供的护理。
visits for as long as is required by medical necessity for treatment which
would normally be provided in a hospital.
家庭护理仅限于为被保险人提供治疗的专科医生所要求的范围。
Home nursing is only covered when the specialist who treated the beneficiary has
recommended such services.
13.36 医院
Hospital
指由执业医生或合法注册护士对被保险人进行日常护理、观察、治疗的医
疗机构,并且该医疗机构在所在地的监管机构注册或登记为提供综合医疗
服务或外科医疗服务的合格机构。
any organisation or institution which is registered or licensed as a medical or
surgical hospital in the country in which it is located and where the beneficiary is
under the daily care or supervision of a medical practitioner or qualified nurse.
13.37 最初生效时
Initial start time
指被保险人首次获得国际医疗保障的开始时间。
the first day the beneficiary's cover commenced on the International Medical
Insurance plan.
13.38 损伤
Injury
指机体损伤。
a physical injury.
13.39 住院
Inpatient
指被保险人因医疗原因、被接纳入一家医院并且需要在医院占用正式病床
停留一个夜晚或以上。
a patient who is admitted to hospital and who occupies a bed overnight or longer,
for medical reasons.
13.40 保险
Insurance
指根据本条款及保险凭证上载明的保障内容、赔付条件、赔付限额、责任
免除等条款,我方为被保险人提供的保障。
the coverage which is provided by us to the beneficiaries subject to the terms,
conditions, limits and exclusions set out in these provisions, and your certificate of
insurance.
13.41 重症监护
Intensive care
医院中专门用于提供重症监护治疗的病房,例如重症监护室、重疾监护
室、重症治疗室及重症护理室等。
a specialised department in a hospital that provides intensive care treatment, for
example an intensive care unit, critical care unit, intensive therapy unit, or intensive
treatment unit.
13.42 保障利益表
List of benefits
指载于附件中最新的保障利益表,包括对其的注释。
the latest list of benefits detailed in the provision, including any notes to it.
13.43 妊娠责任
Maternity
benefit
指有关怀孕及分娩方面的责任,包括本保险合同下符合条件的女性被保险
人因此而产生的任何并发症,但不含:
benefits available in relation to all aspects of pregnancy or childbirth, including any
complications, for any eligible female covered under this policy, but excluding:
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13.43.1 有意结束怀孕的治疗,除非怀孕已危及母亲的生理健康或心理稳
定;以及
treatment by way of the intentional termination of pregnancy unless the
pregnancy endangers the life or mental stability of the mother; and
13.43.2 新生儿在医院的托管护理,除非其母亲因医疗必要必须住院接受
本保险合同规定范围内的治疗。
nursery care for a newborn in hospital, unless the mother is required to
remain in hospital due to medical necessity for treatment that is
covered by this policy.
13.44 中国大陆
Mainland China
指中华人民共和国的全部领土、领海及其领空,除香港特区、澳门特区和
台湾地区外。
all territories, seas and related airspaces of People's Republic of China, excluding
Hong Kong, Macau and Taiwan.
13.45 医疗必要
Medically
necessary/
medical
necessity
指经医疗团队同意的、受保障的必要医疗服务及供给,须符合下述全部条
件:
medically necessary covered services and supplies are those determined by the
medical teamto be:
13.45.1 基于诊断或治疗疾病、损伤或相关症状的需求;
required to diagnose or treat an illness, injury, disease or its symptoms;
13.45.2 符合通常医疗标准及医疗实践的规范医疗服务;
orthodox, and in accordance with generally accepted standards of
medical practice;
13.45.3 与疾病的类型、发病频率、波及范围、部位及病程相适应的临床
治疗服务;
clinically appropriate in terms of type, frequency, extent, site and
duration;
13.45.4 非主要出于方便被保险人、内科医生或其他医院、诊所及执业医
生的目的;以及
not primarily for the convenience of the beneficiary, physician or other
hospital, clinic or medical practitioner; and
13.45.5 在合适的最佳设施中所提供的服务与供给。
rendered in the least intensive setting that is appropriate for the delivery
of the services and supplies.
医疗团队会在比较过可选择服务、设施或供给的成本效率后决定什么是最
佳设施。
Where applicable, the medical teammay compare the cost effectiveness of
alternative services, settings or supplies when determining what the least intensive
setting is.
13.46 执业医生
Medical
practitioner
指经国家、政府或其他监管注册或认可的可在该其管辖范围内进行治疗的
执业医生或专业医生,不包括本保险合同保障下的本人或其任何家庭成
员。
a doctor or specialist who is registered or licensed to practice medicine under the
laws of the country, state or other regulated area in which the treatment is
provided, and who is not covered under this policy, or a family member of someone
covered under this policy.
13.47 医疗团队
Medical team
指我方临床小组。
means our clinical team.
13.48 外科操作指载于手术价目表上的所有手术的操作流程。
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Operation(s) any procedure described as an operation in the schedule of surgical procedures.
13.49 口腔健康
Oral health
根据被保险人常住国具有普通能力技术的牙科医生可以接受的口腔健康维
护标准,该标准是关于牙���、牙周及其他口腔支持组织、咀嚼效率等要素
的口腔健康合理标准。
for a patient, a reasonable standard of oral health of the teeth, their supporting
structures and other tissues of the mouth, and of dental efficiency, according to a
standard acceptable to a dentist of ordinary competence and skill in the patient's
country of habitual residence which will safeguard his or her general health.
13.50 规范
Orthodox
对于治疗程序或治疗方式,"规范"应根据:在治疗发生国家内、在疗程开
始或治疗发生当时,与权威的实体主管机构公布的标准或意见相一致的、
由在涉及疾病的专业医疗领域具有丰富经验的执业医生具有并作出的意
见。
when used in relation to a procedure or treatment, 'orthodox' means that the
procedure or treatment in question is medically accepted in the country where it
takes place at the time of the commencement of the procedure or treatment, that
complies with a respectable, responsible and substantial body of medical opinion,
held and expressed by medical practitioners experienced in the particular field of
medicine in question.
13.51 门诊
Outpatient
指病人在医院、诊疗室,或门诊部进行的不是日间病房治疗或住院治疗的
治疗。
a patient who attends a hospital, consulting room, or outpatient clinic for
treatment and is not admitted as a day-patient or an inpatient.
13.52 姑息治疗
Palliative care
指不以使病症完全治愈或实质性好转为目的,仅以缓解痛苦为目的的治
疗。
treatment that does not cure or substantially improve a condition but is given in
order to alleviate symptoms.
13.53 保险期间
Period of cover
指被保险人受到本保险合同保障的期限,由生效时间至保单终止日的连续
12 个月期间、或由生效时间到提交终止日的期间。
the 12 month continuous period during which the beneficiaries are covered under
this policy, being the period from the start time to the end date as noted on the
certificate of insurance or earlier if terminated in accordance with the provisions.
13.54 永久植物人状

Persistent
vegetative state
指一被保险人至少连续90 天处于植物人状态。"植物人状态"是指由于损伤
或疾病使被保险人处于神志丧失的状态,并无法以表情或动作等表现出对
自我或周围环境的感知(此处"对自我或周围环境的感知"是指一种意识反
应或表达,而不是指神经肌肉反射等基础生理反射现象),并且按照医学
上的合理可能性,被保险人应该没有苏醒的可能。
a beneficiary who is in a vegetative state for at least 90 consecutive days. A
persistent vegetative state means a condition caused by injury, disease or illness in
which the beneficiary has suffered a loss of consciousness, with no behavioural
evidence of awareness of self or surroundings in a learned manner, other than
reflex activity of muscles and nerves for low level conditioned response, and from
which to a reasonable degree of medical probability, there can be no recovery.
13.55 保险合同
Policy
指包括保险条款(包括保障利益表及理赔等信息)、您方的保险凭证等内
容的保险合同。
the policy comprising these provisions (which contains the list of benefits and
claiming information) and your certificate of insurance.
13.56 保险合同文件
Policy
documents
指保险合同所包含的文件,包括:保险条款、保险凭��、客户手册、理赔
申请表及您方的保险会员卡。
the documentation relating to the policy, comprising of these provisions, certificate
of insurance, customer guide, the Cigna claim form, and your Cigna ID Card.
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13.57 投保人
Policyholder
是指向我方发出申请,并经我方书面同意按照本保险合同约定负有支付保
险费义务的人。
a person who has made an application to us which has been accepted in writing by
us, and who pays the premium under the policy.
13.58 入院前证明
Pre-admission
certification,
PAC
指医疗审核联盟在病人进入美国医院之前对其住院治疗或日间病房治疗所
做的审核与初始决定。
a review and an initial decision by CareAllies, before admission to a hospital in the
USA, on the suitability of inpatient treatment or day-patient treatment for a
patient.
13.59 既往症
Pre-existing
condition
指被保险人在本保险合同生效前已有的疾病或损伤,并满足下列条件之
一:
any disease, illness or injury, or symptoms linked to such disease, illness or injury
for which:
13.59.1 已经因该疾病或损伤进行过的就诊或治疗;或者
medical advice or treatment has been sought or received; or
13.59.2 在最初生效时前虽然没有进行就诊或治疗,被保险人已经知道或
者应该已经知道。
the beneficiary knew about and did not seek medical advice or
treatment; before the initial start time.
13.60 保险条款
Provision
指包含保障利益表及其他保单重要内容的文件。
contains the list of benefits and forms part of the policy.
13.61 精神心理治疗
Psychiatric
treatment
指对有精神健康问题的被保险人进行的治疗,包括饮食失调。
management and care of a person who is suffering from a mental health condition
including but not limited to eating disorders.
13.62 心理医生
Psychologist
指具备治疗所在国的专业资格认证(并拥有在治疗所在国执业的合法资
格)、在临床心理治疗机构执业的、提供精神和心理问题医疗服务的专业
人员。
is a person who is qualified (and holds the appropriate license to practice in the
country where treatment is received) in clinical psychology and who provides
treatment services to patients with mental and emotional disorders.
13.63 合法注册护士
Qualified nurse
指被治疗所在地的国家、政府或其他监管区域的法律所承认、注册并允许
在该地区提供服务的护士。
a nurse who is registered or licensed as such under the laws of the country, state or
other regulated area in which the treatment is provided.
13.64 重大人生事件
Qualifying life
event
指:
means:
13.64.1 结婚或结为伴侣;
marriage or civil partnership;
13.64.2 与伴侣开始同居;
commencing cohabitation with a partner;
13.64.3 离婚或分居;
divorce or separation;
13.64.4 生育儿女;
birth of a child;
13.64.5 收养孩子;或
legal adoption of a child; or
13.64.6 配偶、伴侣或孩子去世。
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death of a spouse, partner or child.
上述情况我方均要求提供相应证明。
We may require evidence of the above event.
13.65 康复
Rehabilitation
指采用物理治疗、职业治疗和语言治疗等手段,使被保险人恢复到疾病或
损伤急性发作之��的状态。
physical, speech and occupational therapy for the purpose of treatment aimed at
restoring the beneficiary to their previous state of health after an acute event.
13.66 手术价目表
Schedule of
surgical
procedures
指经我方首席医疗官所核准的最新手术价目表。
the current schedule of surgical procedures approved by our chief medical officer.
13.67 所选择保障区

Selected area
of coverage
指下述二者之一:
means either:
13.67.1 全球含美国;或
Worldwide, including USA; or
13.67.2 全球不含美国
Worldwide, excluding USA.
13.68 短期
Short-term
指按照主持治疗的执业医生的评估并经我方医疗主管的认可,与治疗疾病
后被保险人正常复元的合理过程相吻合的时间段。
means a period of time consistent with the recuperation time required for the
treatment and as prescribed by the treating medical practitioner with the approval
of ourmedical director.
13.69 疾病
Sickness
指生理或心理疾病,包括妊娠所导致的或与妊娠有关的疾病。
a physical or mental illness, including illness resulting from or relating to pregnancy.
13.70 健康自体牙
Sound natural
tooth/teeth
指咀嚼、语言等功能完全正常的牙齿、且非种植牙。另外,不得存在下列
任何情况之一:
a tooth that functions normally for chewing and speech purposes and that is not a
dental implant. Such natural tooth/teeth should not have experienced any of the
following:
13.70.1 龋齿或牙科充填;
decay or filling;
13.70.2 伴随牙槽骨丧失的牙龈牙周疾病;
gum disease associated with bone loss;
13.70.3 根管治疗。
root canal treatment.
13.71 专科医生
Specialist
指根据治疗所在地的国家、政府或其他监管区域的法律,合法承认、注册
或登记的医生,并且其所提供的治疗必须在其合法资质的范围内。
a doctor who is recognised, registered or licensed as such under the laws of the
country, state or other regulated area in which the treatment is provided and only
for the treatment which is being recommended.
13.72 配偶
Spouse
指被保险人的法定丈夫或妻子,或我方已接受承保于本保险合同中的未婚
人员或伴侣。
a beneficiary's legal husband or wife, or unmarried or civil partner who we have
accepted for cover under this policy.
13.73 生效时间
Start time
指载于保险凭证中的本保险合同保障开始日期。
the time on which coverage under this policy starts, as shown in the certificate of
insurance.
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13.74 手术
Surgery
对肢体进行开放性切割以治疗疾病、创伤及畸形的医疗专业。
the branch of medicine that treats diseases, injuries, and deformities by operative
methods which involves an incision into the body.
13.75 对症状的
Symptomatic
指不以改变肿瘤生长及进展为目的,仅为了缓解症状的治疗。
treatment that no longer attempts to alter cancer growth or progression but is
given to alleviate symptoms.
13.76 治疗师
Therapist
指国家、政府或其他行政地区所承认并允许在该地区提供治疗的理疗师、
职业治疗师、视力矫正医师或语言治疗师。
a speech therapist, dietician or orthoptist who is suitably qualified and holds the
appropriate license to practice in the country where treatment is received.
13.77 治疗
Treatment
指由执业医生进行的手术或治疗,并且是为了达到"诊断、治愈或实质性缓
解疾病或损伤"的目的所必须进行的。
any surgical or medical treatment controlled by a medical practitioner that are
medically necessary to diagnose, cure or substantially relieve disease, illness or
injury.
13.78 未满期净保费
Unearned net
premium
指对应保险期间尚未经过部分的保险费。
any premium which has been paid in relation to the period after cover has ended.
13.79 美国
USA
指美利坚合众国。
the United States of America.
13.80 全球含美国
Worldwide
including USA
指世界各国及海上。
every country throughout the world and at sea.
13.81 全球不含美国
Worldwide
excluding USA
指除美利坚合众国以外的世界所有地区。
worldwide, with the exception of the USA.
13.82 您、您方、您
方的
You, your
指投保人。
the policyholder.
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附件:保险利益表
Appendix: List of benefits
国际医疗保障
InternationalMedical Insurance
每一保险期间内每一被保险人的国际医疗保障的赔付限额
Annual Benefit – Maximum per beneficiary. This includes claims paid across all
sections of the International Medical Insurance
¥20,000,000
Up to ¥ 20 Million per
period of cover
您所享有的基本医疗保险责任
Your Standard Medical Benefits
赔付限额(可能适用免
赔额)
Benefit Limit (Subject to
Deductable)
综合住院医疗费用,具体包括:
Hospital Charges for:
-住院治疗的护理费及病房膳食费;
. Nursing and accommodation for in-patient treatment;
-日间病房治疗费用;
. Day case treatment;
-手术室及麻醉复苏室费用;
. Operating theatre and recovery room;
-住院或日间病房治疗的处方药及敷料费用;
. Prescribed medicines, drugs and dressings for in-patient or day case treatment;
-门诊手术的治疗室费用。
. Treatment room fees for outpatient surgery.
全额
Paid in Full
重症监护室,包括重症治疗室、加护病房或冠心病监护室
Intensive care: intensive therapy, coronary care and high dependency unit
全额
Paid in full
父母陪同病房费用
Parental Accommodation
本项责任仅适用于未满18 周岁的未成年人。如被保险人须过夜留院治疗,我
方将支付合理的在同一医院的父母陪同住宿费用。
This applies to dependent children under the age of 18. CIGNA will pay for
reasonable costs for a parent staying in the same hospital with the child where the
child is required to stay in the hospital overnight.
全额
Paid in Full
外科医生及麻醉师费用
Surgeons' and Anesthetists' Fees
适用于任何基于住院、日间病房或门诊而施行的手术。
Whether surgery is provided on an in-patient, day case or out-patient basis.
全额
Paid in Full
专科医生诊疗费
Specialists' consultation fees
本项责任适用于在被保险人住院时专科医生的常规巡查,并包括因医疗必要而
须专科医生执行的重症紧急护理。
This benefit is paid in full for regular visits by a specialist during stays in hospital
including intensive care by a specialist for as long as is required by medical
necessity.
全额
Paid in Full
移植治疗
Transplant Services
适用于住院发生的移植治疗。
Where treatment is provided on an in-patient basis.
全额
Paid in Full
病理检测、放射学检查及诊断检测
Pathology, Radiology and diagnostic tests
适用于住院或日间病房期间。
Where treatment is provided on an in-patient or day patient basis.
全额
Paid in Full
物理疗法及补充治疗
Physiotherapy and complementary therapies
适用于住院或日间病房期间。
Where treatment is provided on an in-patient or day patient basis.
全额
Paid in Full
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核磁共振、计算机断层扫描及正电子发射断层扫描
MRI, CT and PET scans
我方将支付在住院、日间病房或门诊发生的这些扫描检查。
We will pay for these scans whether received on an inpatient, day-patient or an
outpatient basis.
全额
Paid in Full
家庭护理费用
Home nursing charges
每一保险期间内以30 天为限。
Paid up to 30 days in any one period of cover.
全额
Paid in Full
康复治疗
Rehabilitation
每一保险期间内以30 天为限。
Paid up to 30 days in any one period of cover.
全额
Paid in Full
临终关怀及姑息治疗
Hospice stay to receive Palliative Care
全额
Paid in Full
内置修复体、设备及装置
Internal prosthetic devices/surgical and medical appliances
我方将支付:
We pay for:
-手术过程中植入体内的假体、设备或医疗用品。
. a prosthetic implant, device or appliance which is inserted during surgery.
全额
Paid in Full
外置修复体、设备及装置
External prosthetic devices/surgical and medical appliances
我方将支付:
We pay for:
-手术后立即需要的、医疗必要的修复性设备或装置。
. a prosthetic device or appliance which is a necessary part of the treatment
immediately following surgery for as long as is required by medical necessity.
-在病后恢复阶段内短期内需要的、医疗必要的修复性设备或装置。
. a prosthetic device or appliance which is medically necessary and is part of the
recuperation process on a short-term basis.
我方为成年人仅支付一次外用假体费用。我方为16 周岁及以下的未成年人支
付初始的假体设备费用及最多两次用于替换的假体设备费用。
For adults, we will pay for one external prosthetic device. For children up to the age
of 16, we will pay for the initial prosthetic device and up to two replacement
devices.
每一假体设备以¥ 20,000
为限
Up to¥ 20,000 for each
prosthetic device
当地救护车及空中救援服务
Local Ambulance and Air Ambulance Services
因医疗必要而须使用当地救护车前往医院进行治疗。
Medically necessary travel by local road ambulance or local air ambulance, such as
a helicopter, when related to covered hospitalization.
全额
Paid in Full
住院津贴
Hospitalization Cash Benefit
我方将在满足下述条件的基础上向您支付每日住院津贴:
We will make a cash payment to the beneficiary when they:
-您所接受的治疗在本合同责任规定范围内;
. received treatment in hospital which is covered under this plan
-住院治疗须过夜;
. stay in hospital overnight
-您未曾报销任何病房膳食费及治疗费。
. have not been charged for your room and board, and treatment costs.
¥ 1,200 元/天,每一保险
期间内以30 天为限
¥ 1,200 per night, up to 30
nights per period of cover
紧急牙科治疗
Emergency dental treatment
因遭受严重意外事故而导致住院接受牙科治疗。
Dental treatment in hospital after a serious accident.
全额
Paid in Full
您所享有的精神疾病医疗责任
Your Psychiatric Care
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精神疾病医疗
Psychiatric Care
我方将支付:
We will pay for:
-精神疾病或异常的治疗。
. treatment of mental health conditions and disorders.
-成瘾性治疗
. addiction treatment.
包括被保险人在住院还是在日间病房或门诊接受治疗。一个保险期间内累积以
90 天为限,包括最多30 天住院。对日间病房治疗和门诊,每就诊日计作"1
天"。
Whether the beneficiary is staying in a hospital overnight or receiving treatment as
a day-patient or outpatient. A combined maximum total of 90 days cover is
available in the period of cover, including up to 30 days of inpatient treatment. For
day-patient and outpatient treatment, each visit will count as one day.
一个连续5 年的期间内总累积限180 天,其中住院最多可以到60 天。
An overall 5 year total limit of 180 days cover will apply, of which a maximum of 60
days can be used for inpatient treatment.
全额
Paid in Full
您所享有的癌症医疗责任
Your Cancer Care
癌症治疗
我方将支付对癌症进行的积极治疗及循证治疗。包括:被保险人在住院、日间
病房或门诊发生的化疗、放疗、肿瘤病理、检查化验及药物等。
We will pay for active and evidence-based treatment received for, or related to
cancer, including chemotherapy, radiotherapy, oncology, diagnostic tests and drugs
whether the beneficiary is staying in a hospital overnight or receiving treatment as
a day-patient or outpatient.
全额
Paid in Full
您所享有的生育与新生儿护理及治疗责任
Your Mother And Baby Care
常规妊娠及分娩保障
Routine Maternity and Childbirth Cover
连续持有本合同10 个月及以上且在此期间内持续有效的女性被保险人可享有
本保障。
Available once the mother has been covered by the policy for 10 months or more.
涵盖门诊及住院治疗费用,包括医院收费,产科医生及助产士费用。
In-patient and out-patient treatment including hospital charges, obstetricians' and
midwives' fees.
每一保险期间以¥ 90,000
为限
Up to ¥ 90,000
per period of cover
复杂妊娠及分娩保障
Complicated Maternity and Childbirth Cover
连续持有本合同10 个月及以上且在此期间内持续有效的女性被保险人可享有
本保障。
Available once the mother has been covered by the policy for 10 months or more.
涵盖门诊及住院治疗费用,包括医院收费,产科医生及助产士费用。
In-patient and out-patient treatment including hospital charges, obstetricians' and
midwives' fees.
本项责任含因医疗必要而发生的剖腹产。如果我方无法确定您的剖腹产确因医
疗必要而发生,我方将按常规妊娠及分娩责任限额进行支付。
Caesarean sections are only covered under this benefit where they are required by
medical necessity. If we are unable to determine that your Caesarean section was
medically necessary, it will be paid from the beneficiary's routine maternity and
childbirth benefit limit.
每一保险期间以¥
180,000 为限
Up to ¥ 180,000
per period of cover
家中分娩
Homebirths
每一保险期间以¥ 7,000
为限
Up to ¥ 7,000 per year of
insurance
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72
新生儿护理
Newborn care
若在新生儿出生前至少10 个月或以上的连续期间内,父母亲中至少一位一直
在本合同保障下,则:
If at least one parent has been covered by the policy for a continuous period of 10
months or more prior to the newborn's birth.
如果新生儿于出生30 天内申请加入本保险合同,我方将不要求提供其医疗资
料、并且无须医疗核保加入本保险合同;如果新生儿于出生30 天后申请加入
本保险合同,我方将要求进行医疗核保、并要求您方完成相应的医疗健康问
卷、我方有可能适用特别限制条件或特别责任免除。
We will not require information about the newborn's health or a medical
examination if an application is received by us to add the newborn to the policy
within 30 days of the newborn's date of birth. If an application is received after30
days of the newborn's date of birth, the newborn will be subject to medical
underwriting and we will require the completion of a medical health questionnaire
whereby we may apply special restrictions or exclusions.
自出生之日起享有最多
90 天以¥1,000,000 为限
的保障,新生儿于出生
之日起30 天内加入本合
同无须经医学核保
Up to ¥ 1 Million,
for treatment within first
90 days following birth No
medical underwriting so
long as child added within
30 days from birth
新生儿护理
Newborn care
如果新生儿的父母中没有一位能满足"在新生儿出生前10 月或更长时间内,已
经持续有效地作为我方被保险人"的条件,而我们收到该新生儿投保申请的:
If neither parent has been covered by the policy for a continuous period of 10
months or more prior to the newborn's birth and an application is received by us to
add the newborn to the policy as a beneficiary.
则须经医疗核保,我方将要求您方完成其医疗及健康信息问卷。我方将根据医
疗核保结果决定是否承保及承保条件,我方有可能适用特别限制条件或特别责
任免除。
The newborn will be subject to medical underwriting and we will require the
completion of a medical health questionnaire. Cover for the newborn will be
subject to medical underwriting whereby we may apply special restrictions or
exclusions.
自出生之日起享有最多
90 天以¥1,000,000 为限
的保障,新生儿加入本
合同须经医学核保
Up to ¥ 1 Million
for treatment within first
90 days following birth
Subject to medical
underwriting
先天性疾病
Congenital conditions
包括对先天性疾病的住院或日间病房治疗费用,且该先天性疾病须在被保险人
18 周岁以前已经证明患有。
Where treatment is provided on an in-patient or day patient basis and the
congenital condition manifested itself before the patient's 18th birthday
本保障不适用于所有被保险人均不足18 周岁的保险合同。如果订立保险合同
时所有被保险人的年龄均不足18 周岁,则先天性疾病不在保险合同保障范围
内。
This benefit does not apply for the policies, under which all beneficiary (ies) are less
than 18 years old. If all beneficiary (ies) under one policy are less than 18 years old
when entering into the policy, then congenital conditions are excluded from the
policy.
以¥ 250,000 为限
Up to ¥ 250,000
您可选择的免赔额
Your deductible options
IGAB1212 寰球至尊A
73
免赔额(多项)
Deductible (various)
免赔额作为理赔的组成部分将不涵盖于您的保险责任当中。
A deductible is a portion of a claim or claims that is not covered by your plan.
例如您为所购买的国际医疗保险选择了¥ 5,000 的免赔额,那么您在任何一个
保险期间内理赔时,我方将在扣除¥ 5,000 的基础上向您支付理赔款项。如果
您已经选择了某免赔额,在每一保险期间内无论发生多少次理赔,作为免赔额
由您方支付的总额为该金额。您选择的免赔额越高,您所应支付的保险费则越
低。免赔额适用于本合同内的所有被保险人。
So, for example if you choose a deductible of ¥ 5,000 for International Medical
Insurance, you'll need to pay the first ¥ 5,000 of a covered claim or covered claims
in any period of cover. If a deductible is chosen, you would only have to pay this
once during any period of cover irrespective of the number of claims. The higher
the deductible you apply, the lower your premium will be. The deductible is payable
by each person covered by the policy.
¥ 0 / ¥ 2,500 / ¥ 5,000 / ¥
10,000 / ¥ 20,000 / ¥
50,000
国际医疗补充保障(可选保障)
InternationalMedical Insurance Plus (Optional)
门诊医疗责任
Out-patient Healthcare Benefits
赔付限额(可能适用免
赔额)
Benefit Limit (Subject to
Deductable)
每一保险期间内每一被保险人所有保险责任赔付限额
Annual Benefit – Maximum per beneficiary
每一保险年度以¥
500,000 为限
Up to ¥ 500,000 per
period of cover
执业医生及专科医生诊疗费
Consultations with Medical Practitioners and Specialists
全额
Paid in Full
诊断性检查化验费
Diagnostic testing
全额
Paid in Full
物理治疗
Physiotherapy
全额
Paid in Full
正骨治疗及脊椎治疗
Osteopathy and chiropractic treatment
每一保险期间内总计不超过30 次。
Up to a combined maximum of 30 visits per period of cover.
全额
Paid in Full
针灸治疗、顺势治疗及中医治疗
Acupuncture, Homeopathy and Chinese Medicine
每一保险期间内总计不超过20 次。
Up to a combined maximum of 20 visits per period of cover.
全额
Paid in Full
言语复健治疗
Restorative Speech Therapy
基于遭受疾病(例如中风)而接受的短期治疗。
Provided on a short-term basis following a condition such as a stroke.
全额
Paid in Full
药品费及敷料费
Drugs and dressings
在门诊发生的由执业医生开具处方的处方药或敷料费。
When prescribed by a medical practitioner on an outpatient basis.
全额
Paid in Full
耐用医疗设备租赁费
Rental of Durable Medical Equipment
每一保险期间内最多45 天的租赁时长。
Up to a maximum of 45 days in the period of cover.
全额
Paid in Full
成人疫苗接种
Adult Vaccinations
全额
Paid in Full
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74
牙科意外门诊治疗
Accidental Dental Treatment
如果被保险人因遭受意外事故而导致健康自体牙发生损伤,牙齿损伤的治疗在
意外事故后立即开始、且在意外事故后30 天内完成的,我方将支付牙科意外
门诊治疗费用。
We will pay for dental treatment required for the damage to the beneficiary's
sound natural tooth/teeth as the result of an accident. Treatment must commence
immediately after the accident and be completed within 30 days of the date of the
accident.
全额
Paid in Full
儿童健康检查
Well Child Tests
为6 周岁及以下的未成年被保险人在适当的年龄间隔内。详情请联系我方咨
询。
Payable for children at appropriate age intervals up to the age of 6. For full details
please contact CIGNA.
全额
Paid in Full
儿童免疫
Child immunizations
为17 周岁及以下未成年被保险人。
Payable for children aged 17 or younger.
全额
Paid in Full
每年常规检查
Annual Routine Tests
15 周岁以下儿童每年一次的视力及一次听力检查。
One eye test and one hearing test for children under the age of 15.
全额
Paid in Full
您可选择的免赔额
Your deductible options
免赔额(多项)
免赔额作为理赔的组成部分将不涵盖于您的保险责任当中。例如您为所购买的
国际医疗补充保险选择了¥ 1,000 的免赔额,那么您在任何一个保险期间内理
赔时,我方将在扣除¥ 1,000 的基础上向您支付理赔款项。如果您已经选择了
某免赔额,在每一保险期间内无论发生多少次理赔,作为免赔额由您方支付的
总额为该金额。您选择的免赔额越高,您所应支付的保险费则越低。免赔额适
用于本合同内的所有被保险人。
A deductible is a portion of a claim or claims that is not covered by your plan. So,
for example if you choose a deductible of ¥ 1,000 for International Medical
Insurance Plus, you'll need to pay the first ¥ 1,000 of a covered claim or covered
claims in any period of cover. If a deductible is chosen, you would only have to pay
this once during any period of cover irrespective of the number of claims. The
higher the deductible you apply, the lower your premium will be. The deductible is
payable by each person covered by the policy.
¥ 0 / ¥ 1,000 / ¥ 6,500
国际健康与体检保障(可选保障)
International Health andWellbeing (Optional)
国际健康与体检责任
International Health and Wellbeing Benefits
赔付限额
Benefit Limit
常规成人体检
Routine Adult Physical Exams
本项责任仅适用于18 周岁以上的被保险人。
This benefit will be paid for, or in connection with, routine physical examinations
for beneficiaries over the age of 18 years old.
每一保险期间以¥ 3,000
为限
Up to ¥ 3,000 per period
of cover
巴氏涂片
Pap Smear
我方将支付每年限一次的巴氏涂片检查费用。
We will pay for an annual Papanicolaou screening.
全额
Paid in Full
前列腺癌症筛查
Prostate Cancer Screening
我方将为50 周岁以上的男性被保险人支付每年限一次的前列腺筛查费用。
We will pay for an annual prostate cancer screening for men aged 50 years or older.
全额
Paid in Full
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75
以乳癌筛查或诊断为目的的乳腺X 线摄影检查
Mammograms for Breast Cancer Screening or Diagnostic Purposes
我方将支付下列费用:
We will pay for:
-35 周岁到39 周岁无症状女性被保险人,限一次的基准乳腺X 线摄影检查;
. one baseline mammogram for asymptomatic women aged 35-39;
-40 周岁到49 周岁无症状女性被保险人,每两年一次医疗必要的乳腺X 线摄
影检查;
. a mammogram for asymptomatic women aged 40-49 every two years or more if
medically necessary;
-50 周岁及以上女性被保险人,每年一次的乳腺X 线摄影检查。
. a mammogram every year for women aged 50 and over.
全额
Paid in Full
肠癌筛查
Bowel cancer screening
我方将为55 周岁及以上的被保险人支付每年一次的肠癌筛查的费用。
We will pay for an annual bowel cancer screening for beneficiaries aged 55 or older.
全额
Paid in Full
骨密度扫描
Bone densitometry
我方将支付每年一次的骨密度扫描。
We will pay for an annual scan to determine the density of the beneficiary's bones.
全额
Paid in Full
营养师咨询
Dietetic consultations
我方将给付每一保险期间内不超过4 次的营养师咨询服务的费用。
We will pay for up to 4 meetings with a dietician per period of cover.
全额
Paid in Full
个人关爱服务
Life Management (customer assistance programme)
-每天24 小时、每周7 天、每年365 天随时可获得本项服务。
. Available 24 hours a day, 7 days a week, 365 days a year.
-最多5 次的与专业顾问当面咨询的机会。
. Up to 5 face-to-face sessions with a professional counsellor.
-服务的内容包括:在工作、生活、个人及家庭事务等方面为被保险人提供信
息或资源的获取、专家咨询等专业支持。
. Provides information, resources, and counselling on any work, life, personal, or
family issue that matters to you.
-电子咨询平台提供方便的在线咨询。
. Convenient online counselling via E-counselling.
- 不限次的电话咨询服务。
. Unlimited telephonic support.
-您方还可以用短信发送所需服务,我方将进行电话回访。
. SMS texting text the support you need and receive a call back.
-危机支援。
. Crisis support.
全额
Paid in Full
在线健康教育、健康风险评估及健康指导
Online health education, health assessment and web-based coaching programs
全额
Paid in Full
国际眼科与牙科保障(可选保障)
International Vision and Dental (Optional)
牙科治疗
Dental Treatment
赔付限额
Benefit Limit
每一保险期间内每一被保险人所有保险责任赔付限额
Annual benefits - Maximum per beneficiary
每一保险期间以¥ 35,000
为限
Up to ¥ 35,000 per period
of cover
预防性牙科治疗
Preventive
适用于持续购买本保障6 个月及以上的被保险人。
Available after the beneficiary has been covered on this option for six months.
全额
Paid in Full
IGAB1212 寰球至尊A
76
常规牙科治疗
Routine
适用于持续购买本保障6 个月及以上的被保险人。
Available after the beneficiary has been covered on this option for 6 months.
全额
Paid in Full
重大牙科治疗
Major Restorative
适用于持续购买本保障12 个月及以上的被保险人。若被保险人在购买后12 个
月内申请理赔,我方将按50%的治疗费用支付。
Available after the beneficiary has been covered on this option for 12 months. If
the beneficiary needs to claim within the first 12 months then this will be covered
with a 50% coinsurance.
全额
Paid in Full
正畸治疗
Orthodontic Treatment
适用于持续购买本保障连续满2 年及以上且年龄在18 周岁及以下的被保险
人。
Available for beneficiaries aged 18 or younger, after they have been covered on this
option for 2 consecutive years.
每一保险期间按50%赔

50% Refund per period of
cover
眼科护理
Vision Care
赔付限额
Benefit Limit
每一保险期间一次验光师或眼科医生实施的眼科检查
One eye examination per period of cover by an Optometrist or an Ophthalmologist
全额
Paid in Full
费用包含:
Expenses for:
-眼镜镜片;
. Spectacle lenses;
-隐形眼镜;
. Contact lenses;
-眼镜镜框;
. Spectacle frames;
-根据医嘱所配墨镜。
. Prescription sunglasses.
每一保险期间以¥ 2,000 为限
Up to ¥ 2,000 per period of cover

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