What Is a Caregiver Contract?
Detailed terms:
Chinese People's Health Insurance Co., Ltd. often worry-free daily care personal care insurance clauses (filed with the China Insurance Regulatory Commission in August 2009)
1 Scope of the insured 1.1 Scope of the insured Individuals who are 18 years of age to 55 years of age at the time of application and are in good health can participate in this insurance as the insured.
2 Insurance liability and exemption 2.1 The insured amount shall be mutually agreed upon between the insured and the company, and shall be stated in the insurance policy with the consent of the insured.
2.2 Insurance liability The insurance period of this contract is divided into 4 types: 3 years, 5 years, 8 years, and 10 years. During the validity of this contract, the company assumes the following insurance liabilities:
Nursing insurance benefits are due to accidental injury from the effective date of the insurance contract, or 180 days after the effective date of the insurance contract, due to reasons other than accidental injuries, the insured person is completely disabled. The company pays the nursing insurance benefits at the insurance amount. The validity of the contract is terminated.
For the reason of accidental injury from the effective date of the insurance contract, or 180 days after the effective date of the insurance contract, for reasons other than accidental injury, the insured is not fully disabled but loses his daily life ability and continues to the end of the observation period. The payment of nursing insurance premiums based on the insured amount shall terminate the validity of this contract.
The payment of the above-mentioned care insurance benefits is limited to the amount of insurance and must not be repeated.
The death benefit is due to the death of the insured for reasons other than accidental injury 180 days after the effective date of the insurance contract. The company shall pay the death benefit according to the insurance amount, and the validity of this contract shall be terminated.
If the insured does not have an insured event during the insurance period and is still alive when the insurance period expires, the company will return the insurance premium paid without interest and the validity of this contract shall terminate.
Within 180 days from the effective date of the insurance contract, if the insured is totally disabled, incapacitated or dies due to reasons other than accidental injury, the company will not be responsible for the payment of insurance benefits, but the interest-free return has been paid Insurance contract, the validity of this contract is terminated.
2.3 Liability Exemption Insured accidents caused by one of the following situations, the company does not bear the responsibility of paying insurance premiums:
1) Intentional killing and intentional injury of the insured by the policyholder;
2) The insured intentionally injured himself, committed a crime or resisted the criminal compulsory measures adopted in accordance with the law;
3) The insured commits suicide within 2 years from the date of the establishment of this contract, except that the insured was a person without civil capacity at the time of the suicide;
4) The insured is engaged in high-risk professional activities such as diving, water skiing, rafting, skydiving, rock climbing, bungee jumping, driving a glider, adventure, wrestling competition, boxing competition, martial arts competition, stunt performance, horse racing, and racing;
5) war, military conflict, riot or armed rebellion;
6) Nuclear explosion, nuclear radiation or nuclear pollution;
7) The insured suffers from hereditary diseases, congenital malformations, deformities or chromosomal abnormalities.
The Company shall not be liable for the payment of insurance premiums for insured accidents occurring within the following periods:
1) Drunk, actively taking or injecting drugs;
2) Drunk driving, driving without a valid and valid driving license, or driving a motor vehicle without a valid driving license;
3) HIV or AIDS.
If the insured person dies due to the above circumstances, the validity of this contract shall be terminated and the Company shall return the cash value of this contract to the policyholder. However, if the insured dies due to the intentional killing or intentional injury of the insured by the insured, the company will return the cash value of this contract to the beneficiary.
3 Contract Effectiveness 3.1 Contract Formation and Effectiveness The insurance applicant submits an insurance application, the company agrees to underwrite the insurance, this contract is established, and the contract establishment date is stated in the insurance policy.
Unless otherwise agreed, this contract will take effect from 00:00 the next day after the contract is established, the company collects insurance premiums and issues an insurance policy, and the company will assume the insurance obligations agreed in this contract from the effective date stated on the insurance policy .
3.2 Hesitation period There is a 10-day hesitation period from the date on which the policyholder signs the insurance policy. If the insured applies to the company to cancel the contract in writing within this period, the contract will not be effective, and the company will not bear any insurance liability.
If the policyholder cancels the contract within the hesitation period, the company will refund the insurance premium paid by the policyholder without interest.
3.3 Procedures and risks for termination of contract If the policyholder applies for termination of this contract after the hesitation period, it shall complete the application for termination of contract and provide the following information to the company:
1) Insurance contract;
2) A valid ID of the applicant.
The validity of this contract shall cease when the Company receives the application for termination of contract. The company will return the cash value of this contract to the policyholder within 30 days of receiving the application for termination of contract.
Cancellation of the contract after the hesitation period will result in some losses.
4 Insurance premium 4.1 Insurance premium The insurance premium will be determined according to the guarantee content agreed between the policyholder and the company, and the policyholder shall pay the insurance fee to the company at one time.
5 Application and payment of insurance premium 5.1 Notification of insurance accident to the policyholder, the insured or the beneficiary, the company shall be notified within 10 days after knowing that the insurance accident has occurred.
If the insured, the insured or the beneficiary intentionally or due to serious negligence fails to notify in time, which makes it difficult to determine the nature, cause and degree of loss of the insured accident, the company shall not be liable for the payment of insurance premiums for the parts that cannot be determined, However, except that the company has known or should know in time through other channels that the insured accident occurred or did not notify in time but does not affect the determination of the nature, cause and degree of loss of the insured accident.
5.2 Beneficiaries The insured or insured may designate one or more persons as beneficiaries of the death insurance.
When there are multiple beneficiaries of the death insurance benefit, the insured or the insured can determine the benefit order and benefit share; if no benefit share is determined in the same benefit order, each beneficiary enjoys the benefit right in equal shares; if the benefit order is not determined, each Beneficiaries enjoy beneficiary rights in the same order.
If the insured is a person without or with limited capacity for civil conduct, his guardian may designate a beneficiary.
The insured or insured may change the beneficiary of the death insurance and notify the company in writing. After receiving the written notice of change of the beneficiary, the company endorses or attaches an endorsement note to the insurance policy or other insurance certificates.
When designating and changing the beneficiary of the death benefit, the insured must obtain the written consent of the insured.
After the death of the insured, under any of the following circumstances, the insurance money shall be regarded as the estate of the insured, and the company shall perform the obligation to pay the insurance money in accordance with the provisions of the Inheritance Law of the People's Republic of China:
1) No beneficiary is designated, or the designation of the beneficiary is unknown and cannot be determined;
2) the beneficiary dies before the insured, and there is no other beneficiary;
3) The beneficiary loses the beneficiary right or waives the beneficiary right according to law, and there is no other beneficiary.
If the beneficiary and the insured dies in the same event and the order of death cannot be determined, the beneficiary is presumed to have died first.
If the beneficiary intentionally causes the death, disability, or illness of the insured, or attempts to kill the insured intentionally, the beneficiary loses the right to benefit.
Unless otherwise stipulated in the contract, the beneficiary of the nursing insurance benefit is the insured himself.
5.3 Insurance application materials The applicant should provide the following materials, and the company has the right to keep the original or photocopy of the application materials:
Nursing insurance benefits 1) valid ID of the insured;
2) Diagnosis certificate issued by the chief physician of the corresponding department of the hospital;
3) Appraisal certificate of the physical disability of the insured issued by the hospital or other legal appraisal agency;
4) Other proofs and information related to confirming the nature and cause of the insured accident.
Death insurance 1) valid ID of applicant and beneficiary;
2) Certificate of cancellation of household registration of the insured;
3) The death certificate of the insured issued by the medical institution, public security department or other relevant institutions recognized by the national health administrative department;
4) Other proofs and information related to confirming the nature and cause of the insured accident.
When insurance money is used as the insured's estate, relevant rights documents that can prove the legal inheritance right must be provided.
If the above certifications and materials are incomplete, the company will promptly notify the applicant once to provide relevant certifications and materials.
5.4 Payment of insurance benefits The company will make an approval within 5 days after receiving the application for insurance benefits and the proof and materials agreed in the contract; if the circumstances are complex, the approval will be made within 30 days. For those who are insured, the company fulfills the obligation to pay the insurance within 10 days after reaching an agreement with the beneficiary on the payment of insurance.
If the company fails to perform its obligations under the preceding paragraph in a timely manner, it shall compensate the beneficiary for the losses incurred in addition to the insurance payment.
For those that are not covered by insurance, the company will issue a notice of refusal to pay the insurance benefit to the beneficiary and explain the reason within 3 days from the date of approval.
Within 60 days from the date when the company receives the application for insurance benefits payment and relevant certificates and information, if the amount of insurance benefits cannot be determined, the company can pay the amount in advance based on the available certificates and information; the company finally determines the payment After the amount of insurance money, the corresponding difference will be paid.
5.5 The limitation period of litigation limitation beneficiary's request for payment of insurance premiums from the company is 2 years, calculated from the date when it knows or should know that the insured accident occurred.
6 Other matters 6.1 When clearly entering into this contract with truthful notification, the company shall explain the contents of this contract to the policyholder.
The Company shall make inquiries about the relevant situation of the insured and the insured, and the insured shall truthfully inform.
The company has the right to terminate this contract if the policyholder intentionally or due to gross negligence fails to fulfill the obligation of truthful notification as stipulated in the preceding paragraph, which will affect the company's decision whether to agree to underwrite or increase the insurance premium rate.
If the policyholder deliberately fails to perform the obligation of truthful notification, the company will not be liable for insurance premiums and will not refund insurance premiums for insured accidents that occur before the termination of this contract.
If the insured fails to fulfill the obligation of truthful notification due to gross negligence, which has a serious impact on the occurrence of the insured accident, the company shall not be liable for the payment of insurance premiums for the insured accident that occurred before the termination of this contract, but shall refund the insurance premium.
The company shall not be able to rescind the contract if the company has known the facts that the policyholder has not truthfully notified when the contract was concluded; in the event of an insured event, the company shall bear the responsibility for the payment of insurance premiums.
6.2 Restrictions on the right of the company to terminate the contract The right to terminate the contract as stipulated in the preceding article shall expire on the day when the company knows that there is a reason for termination. The company shall not terminate the contract for more than 2 years from the date of the establishment of the contract; in the event of an insured event, the company shall bear the liability to pay insurance benefits.
6.3 Change of contract content The policyholder and the company can negotiate to change the contract content. Changes to this contract shall be endorsed or affixed to the insurance policy or other insurance certificates by the company, or a written agreement for the change shall be entered into between the policyholder and the company.
6.4 Change of Address When the insured's residential address or correspondence address changes during the validity of this contract, the company shall be notified in a timely manner.
If the company is not notified, the company will send the relevant notice according to the last residential address or correspondence address specified in this contract, and it will be deemed to have been delivered to the policyholder.
6.5 Age Determination and Mishandling The age of the insured is calculated as the age of the insured, in which the age of insurance is based on the age of the effective date of this contract. When applying for this insurance, the insured should indicate the true age of the insured on the insurance policy. If an error occurs, the company will deal with it according to the following rules:
1) If the age of the insured declared by the insured is not true, and its true age does not meet the insurance age limit stipulated in this contract, the company has the right to terminate the contract, and shall not be liable for insurance premiums for insured accidents that occur before the contract is terminated . Upon termination of this contract, the company will return the cash value of this contract to the policyholder. The Company's exercise of the right to rescind the contract shall be governed by the provisions of Article 6.2 of this Article, Restrictions on the Right to Rescind the Contract of the Company.
2) If the age of the insured declared by the insured is not real, and the actual premium paid by the insured is less than the payable premium, the company has the right to correct and require the insured to pay the insurance premium. If an insured event has occurred, the insurance premium shall be paid in proportion to the actual premium paid and the premium payable.
3) If the age of the insured declared by the insured is not real, which causes the insured to actually pay more insurance premiums than the insurance premiums payable, the company will return the overcharged insurance premiums to the insured without interest.
6.6 Dispute settlement contract The dispute settlement method shall be selected by the parties in the contract from the following two methods:
1) The disputes arising from the performance of this contract shall be settled by the parties through negotiation. If the negotiation fails, they shall be submitted to __________ Arbitration Commission for arbitration;
2) Any disputes arising from the performance of this contract shall be settled by the parties through negotiation. If the negotiation fails, the people's court shall sue according to law.
6.7 It is particularly reminded that the supplementary insurance contract of this contract is the "China People's Health Insurance Co., Ltd.'s additional accident-free personal accident insurance".
As a part of this contract, the insurance premium and cash value of the supplementary insurance contract will be separately incorporated into the insurance premium and cash value of this contract and cannot be decomposed.
The validity of this contract is also subject to the validity of the supplementary insurance contract. If the validity of the supplementary insurance contract is terminated, the validity of this contract will be terminated. If the validity of the contract is terminated due to an insured event in the supplementary insurance contract, the company will not refund the insurance premium or cash value of this contract.
Explanation of terms 1 year old is calculated based on the date of birth recorded in the legal identity document.
2 Unintentional injury The body is harmed by being subject to external, sudden, unintended, non-illness objective events.
3 Total disability refers to one of the following situations:
1) Binocular permanent blindness;
2) The two upper limbs are above the wrist joint or the two lower limbs are above the ankle joint;
3) One arm is above the wrist and the other is above the ankle.
4) Permanent total blindness in one eye and loss of one upper extremity or wrist joint;
5) Permanent complete blindness in one eye and loss of ankles above the lower limbs;
6) Permanent and complete loss of joint function;
7) permanent and complete loss of chewing and swallowing functions;
8) The central nervous system functions or the chest and abdominal organs are extremely impaired, and they cannot engage in any work for life. All other people's assistance is needed to support life.
Blindness includes the absence or removal of the eyeballs, or the inability to distinguish between light and dark, or only the manual in front of the eyes. The best corrected visual acuity is lower than the international standard vision chart 0.02, or the field of view radius is less than 5 degrees. Diagnosis of proof.
Loss of joint function means that the joint is permanently stiff or paralyzed, or that the joint cannot move with consciousness.
Loss of chewing and swallowing function refers to a state in which organic or functional disorders are caused by reasons other than teeth, so that chewing and swallowing movements cannot be performed, and the state cannot be ingested or swallowed except for liquid food.
In order to maintain the daily life activities necessary for all, assistance from others means food intake, the beginning and end of the bowel movements, dressing and undressing, living, walking, bathing, etc., you cannot do it yourself and need help from others.
The so-called permanent completeness refers to the fact that after 180 days of treatment from the date of accidental injury or the diagnosis of the disease, the function is still completely lost, but it is not limited to cases such as eye removal that are obviously unrecoverable.
4 Loss of daily life ability The insured was diagnosed by the hospital and determined to have lost the ability to independently complete three or more of the six "daily activities".
5 Daily activities refer to the following six activities:
1) Dressing: You can dress and undress yourself;
2) Move: from one room to another;
3) Action: Get in or out of bed or wheelchair yourself;
4) Go to the toilet: use your own control to urinate and urinate;
5) Eat: Take food from prepared bowls or dishes and put it in your mouth;
6) Take a bath: Take a shower or bath yourself.
6 Observation period A period of 180 consecutive days from the date on which the insured was diagnosed to be incapacitated.
7 Hereditary diseases refer to diseases caused by mutations or aberrations in the genetic material (chromosomes and genes) of germ cells or fertilized eggs. They usually have the characteristic of vertical transmission from parent to offspring.
8 Congenital malformation, deformity or chromosomal abnormality means the deformity, deformity or chromosomal abnormality that the insured person has at birth. Congenital malformations, deformities and chromosomal abnormalities are determined in accordance with the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10).
9 Drugs refer to opium, heroin, methamphetamine (methamphetamine), morphine, marijuana, cocaine, and other narcotic drugs and psychotropic substances that can cause people to become addicted, as prescribed by the state, but do not include prescriptions issued by doctors And prescribed medicines used for treating diseases but containing narcotics.
10 Drunk driving means that the alcohol content per 100 milliliters of blood of the driver of the vehicle at the time of the accident has reached or exceeded a certain standard after testing or identification. The traffic management department of the public security organ is deemed to be driving after drinking according to the provisions of the Road Traffic Safety Law. Or drunk.
11 Driving without a valid and valid driving license refers to one of the following situations:
1) Driving without a driver's license in accordance with the law;
2) Driving while the driver's license is detained according to law;
3) Driving a vehicle that does not conform to the driving license type;
4) Driving with a driver's license that has not been verified or has expired;
5) When learning to drive with a learning driver's license, there is no coach to guide you, or you do not learn to drive according to the specified time and route;
6) Other situations identified by the public security traffic management department without a valid driver's license.
12 No valid driving permit refers to one of the following situations:
1) The motor vehicle is deregistered according to law;
2) Failure to carry out or pass motor vehicle safety technical inspections according to law.
13 HIV infection or AIDS HIV refers to the human immunodeficiency virus, the English abbreviation is HIV. AIDS refers to the acquired immunodeficiency syndrome caused by the human immunodeficiency virus, and the English abbreviation is AIDS.
If HIV or its antibody is detected positive in human blood or other samples without clinical symptoms or signs, it is infected with HIV; if there are obvious clinical symptoms or signs at the same time, it is AIDS.
14 Cash value refers to the value of the insurance policy, which is usually reflected in the part of the amount refunded by the company based on actuarial principles when the contract is terminated.
15Hospitals refer to medical institutions of Grade A or Grade II or higher in the hospital classification of the Ministry of Health established by law, but do not include nursing homes, nursing homes, rehabilitation centers, alcohol or drug treatment centers, mental and psychological treatment centers and A united hospital or unit ward of a secondary or tertiary hospital with corresponding medical personnel or equipment.
Carefree Daily Care Personal Care Insurance
Right!
- Chinese name
- Carefree Daily Care Personal Care Insurance
- the company
- Chinese People's Health Insurance Co., Ltd.
- Record
- China Insurance Regulatory Commission
- Time
- August 2009
- Detailed terms:
Chinese People's Health Insurance Co., Ltd. often worry-free daily care personal care insurance clauses (filed with the China Insurance Regulatory Commission in August 2009)
1 Scope of the insured 1.1 Scope of the insured Individuals who are 18 years of age to 55 years of age at the time of application and are in good health can participate in this insurance as the insured.
2 Insurance liability and exemption 2.1 The insured amount shall be mutually agreed upon between the insured and the company, and shall be stated in the insurance policy with the consent of the insured.
2.2 Insurance liability The insurance period of this contract is divided into 4 types: 3 years, 5 years, 8 years, and 10 years. During the validity of this contract, the company assumes the following insurance liabilities:
Nursing insurance benefits are due to accidental injury from the effective date of the insurance contract, or 180 days after the effective date of the insurance contract, due to reasons other than accidental injuries, the insured person is fully disabled. The validity of the contract is terminated.
For the reason of accidental injury from the effective date of the insurance contract, or 180 days after the effective date of the insurance contract, for reasons other than accidental injury, the insured is not fully disabled but loses his daily life ability and continues to the end of the observation period The payment of nursing insurance premiums based on the insured amount shall terminate the validity of this contract.
The payment of the above-mentioned care insurance benefits is limited to the amount of insurance and must not be repeated.
The death benefit is due to the death of the insured for reasons other than accidental injury 180 days after the effective date of the insurance contract. The company shall pay the death benefit according to the insurance amount, and the validity of this contract shall be terminated.
If the insured does not have an insured event during the insurance period and is still alive when the insurance period expires, the company will return the insurance premium paid without interest and the validity of this contract shall terminate.
Within 180 days from the effective date of the insurance contract, if the insured is totally disabled, incapacitated or dies due to reasons other than accidental injury, the company will not be responsible for the payment of insurance benefits, but the interest-free return has been paid Insurance contract, the validity of this contract is terminated.
2.3 Liability Exemption Insured accidents caused by one of the following situations, the company does not bear the responsibility of paying insurance premiums:
1) Intentional killing and intentional injury of the insured by the policyholder;
2) The insured intentionally injured himself, committed a crime or resisted the criminal compulsory measures adopted in accordance with the law;
3) The insured commits suicide within 2 years from the date of the establishment of this contract, except that the insured was a person without civil capacity at the time of the suicide;
4) The insured person engages in high-risk professional activities such as diving, water skiing, rafting, skydiving, rock climbing, bungee jumping, driving a glider, adventure, wrestling competition, boxing competitions, martial arts competitions, stunt performances, horse racing, and racing;
5) war, military conflict, riot or armed rebellion;
6) Nuclear explosion, nuclear radiation or nuclear pollution;
7) The insured suffers from hereditary diseases, congenital malformations, deformities or chromosomal abnormalities.
The Company shall not be liable for the payment of insurance premiums for insured accidents occurring within the following periods:
1) Drunk, actively taking or injecting drugs;
2) Drunk driving, driving without a valid and valid driving license, or driving a motor vehicle without a valid driving license;
3) HIV or AIDS.
If the insured person dies due to the above circumstances, the validity of this contract shall be terminated and the Company shall return the cash value of this contract to the policyholder. However, if the insured dies due to the intentional killing or intentional injury of the insured by the insured, the company will return the cash value of this contract to the beneficiary.
3 Contract Effectiveness 3.1 Contract Formation and Effectiveness The insurance applicant submits an insurance application, the company agrees to underwrite the insurance, this contract is established, and the contract establishment date is stated in the insurance policy.
Unless otherwise agreed, this contract will take effect from 00:00 the next day after the contract is established, the company collects insurance premiums and issues an insurance policy, and the company will assume the insurance obligations agreed in this contract from the effective date stated on the insurance policy .
3.2 Hesitation period There is a 10-day hesitation period from the date on which the policyholder signs the insurance policy. If the insured applies to the company to cancel the contract in writing within this period, the contract will not be effective, and the company will not bear any insurance liability.
If the policyholder cancels the contract within the hesitation period, the company will refund the insurance premium paid by the policyholder without interest.
3.3 Procedures and risks for termination of contract If the policyholder applies for termination of this contract after the hesitation period, it shall complete the application for termination of contract and provide the following information to the company:
1) Insurance contract;
2) A valid ID of the applicant.
The validity of this contract shall cease when the Company receives the application for termination of contract. The company will return the cash value of this contract to the policyholder within 30 days of receiving the application for termination of contract.
Cancellation of the contract after the policyholder's hesitation period will suffer a certain loss.
4 Insurance premium 4.1 Insurance premium The insurance premium will be determined according to the guarantee content agreed between the policyholder and the company, and the policyholder shall pay the insurance fee to the company at one time.
5 Application and payment of insurance premium 5.1 Notification of insured accident to the policyholder, the insured or the beneficiary shall notify the company within 10 days after knowing that the insured accident has occurred.
If the insured, the insured or the beneficiary intentionally or due to serious negligence fails to notify in time, which makes it difficult to determine the nature, cause, and degree of loss of the insured accident, the company shall not be liable for the insurance benefits for the unidentifiable parts However, except that the company has known or should know in time through other channels that the insured accident occurred or did not notify in time but does not affect the determination of the nature, cause and degree of loss of the insured accident.
5.2 Beneficiaries The insured or insured may designate one or more persons as beneficiaries of the death insurance.
When there are multiple beneficiaries of the death insurance benefit, the insured or the insured can determine the benefit order and benefit share; if no benefit share is determined in the same benefit order, each beneficiary enjoys the benefit right in equal shares; if the benefit order is not determined, each Beneficiaries enjoy beneficiary rights in the same order.
If the insured is a person without or with limited capacity for civil conduct, his guardian may designate a beneficiary.
The insured or insured may change the beneficiary of the death insurance and notify the company in writing. After receiving the written notice of change of the beneficiary, the company endorses or attaches an endorsement note to the insurance policy or other insurance certificates.
When designating and changing the beneficiary of the death benefit, the insured must obtain the written consent of the insured.
After the death of the insured, under any of the following circumstances, the insurance money shall be regarded as the estate of the insured, and the company shall perform the obligation to pay the insurance money in accordance with the provisions of the Inheritance Law of the People's Republic of China:
1) No beneficiary is designated, or the designation of the beneficiary is unknown and cannot be determined;
2) the beneficiary dies before the insured, and there is no other beneficiary;
3) The beneficiary loses the beneficiary right or waives the beneficiary right according to law, and there is no other beneficiary.
If the beneficiary and the insured dies in the same event and the order of death cannot be determined, the beneficiary is presumed to have died first.
If the beneficiary intentionally causes the death, disability, or illness of the insured, or attempts to kill the insured intentionally, the beneficiary loses the right to benefit.
Unless otherwise stipulated in the contract, the beneficiary of the nursing insurance benefit is the insured himself.
5.3 Insurance application materials The applicant should provide the following materials, and the company has the right to keep the original or photocopy of the application materials:
Nursing insurance benefits 1) valid ID of the insured;
2) Diagnosis certificate issued by the chief physician of the corresponding department of the hospital;
3) Appraisal certificate of the physical disability of the insured issued by the hospital or other legal appraisal agency;
4) Other proofs and information related to confirming the nature and cause of the insured accident.
Death insurance 1) valid ID of applicant and beneficiary;
2) Certificate of cancellation of household registration of the insured;
3) The death certificate of the insured issued by the medical institution, public security department or other relevant institutions recognized by the national health administrative department;
4) Other proofs and information related to confirming the nature and cause of the insured accident.
When insurance money is used as the insured's estate, relevant rights documents that can prove the legal inheritance right must be provided.
If the above certifications and materials are incomplete, the company will promptly notify the applicant once to provide relevant certifications and materials.
5.4 Payment of insurance benefits The company will make an approval within 5 days after receiving the application for insurance benefits and the proof and materials agreed in the contract; if the circumstances are complex, the approval will be made within 30 days. For those who are insured, the company fulfills the obligation to pay the insurance within 10 days after reaching an agreement with the beneficiary on the payment of insurance.
If the company fails to perform its obligations under the preceding paragraph in a timely manner, it shall compensate the beneficiary for the losses incurred in addition to the insurance payment.
For those that are not covered by insurance, the company will issue a notice of refusal to pay the insurance benefit to the beneficiary and explain the reason within 3 days from the date of approval.
Within 60 days from the date when the company receives the application for insurance benefits payment and related certificates and materials, if the amount of insurance benefits cannot be determined, it shall be paid in advance based on the available certificates and information; the company finally determines the payment After the amount of insurance money, the corresponding difference will be paid.
5.5 The limitation period of litigation limitation beneficiary's request for payment of insurance premiums from the company is 2 years, calculated from the date when it knows or should know that the insured accident occurred.
6 Other matters 6.1 When clearly entering into this contract with truthful notification, the company shall explain the contents of this contract to the policyholder.
The Company shall make inquiries about the relevant situation of the insured and the insured, and the insured shall truthfully inform.
The company has the right to terminate this contract if the policyholder intentionally or due to gross negligence fails to fulfill the obligation of truthful notification as stipulated in the preceding paragraph, which will affect the company's decision whether to agree to underwrite or increase the insurance premium rate.
If the policyholder deliberately fails to perform the obligation of truthful notification, the company will not be liable for insurance premiums and will not refund insurance premiums for insured accidents that occur before the termination of this contract.
If the insured fails to fulfill the obligation of truthful notification due to gross negligence, which has a serious impact on the occurrence of the insured accident, the company shall not be liable for the payment of insurance premiums for the insured accident that occurred before the termination of this contract, but shall refund the insurance premium.
The company shall not be able to rescind the contract if the company has known the facts that the policyholder has not truthfully notified when the contract was concluded; in the event of an insured event, the company shall bear the responsibility for the payment of insurance premiums.
6.2 Restrictions on the right of the company to terminate the contract The right to terminate the contract as stipulated in the preceding article shall expire on the day when the company knows that there is a reason for termination. The company shall not terminate the contract for more than 2 years from the date of the establishment of the contract; in the event of an insured event, the company shall bear the liability to pay insurance benefits.
6.3 Change of contract content The policyholder and the company can negotiate to change the contract content. Changes to this contract shall be endorsed or affixed to the insurance policy or other insurance certificates by the company, or a written agreement for the change shall be entered into between the policyholder and the company.
6.4 Change of Address When the insured's residential address or correspondence address changes during the validity of this contract, the company shall be notified in a timely manner.
If the company is not notified, the company will send the relevant notice according to the last residential address or correspondence address specified in this contract, and it will be deemed to have been delivered to the policyholder.
6.5 Age Determination and Mishandling The age of the insured is calculated as the age of the insured, in which the age of insurance is based on the age of the effective date of this contract. When applying for this insurance, the insured should indicate the true age of the insured on the insurance policy. If an error occurs, the company will deal with it according to the following rules:
1) If the age of the insured declared by the insured is not true, and its true age does not meet the insurance age limit stipulated in this contract, the company has the right to terminate the contract, and shall not be liable for insurance premiums for insured accidents that occur before the contract is terminated . Upon termination of this contract, the company will return the cash value of this contract to the policyholder. The Company's exercise of the right to rescind the contract shall be governed by the provisions of Article 6.2 of this Article, Restrictions on the Right to Rescind the Contract of the Company.
2) If the age of the insured declared by the insured is not real, and the actual premium paid by the insured is less than the payable premium, the company has the right to correct and require the insured to pay the insurance premium. If an insured event has occurred, the insurance premium shall be paid in proportion to the actual premium paid and the premium payable.
3) If the age of the insured declared by the insured is not real, which causes the insured to actually pay more insurance premiums than the insurance premiums payable, the company will return the overcharged insurance premiums to the insured without interest.
6.6 Dispute settlement contract The dispute settlement method shall be selected by the parties in the contract from the following two methods:
1) The disputes arising from the performance of this contract shall be settled by the parties through negotiation. If the negotiation fails, they shall be submitted to __________ Arbitration Commission for arbitration;
2) Any disputes arising from the performance of this contract shall be settled by the parties through negotiation. If the negotiation fails, the people's court shall sue according to law.
6.7 It is particularly reminded that the supplementary insurance contract of this contract is the "China People's Health Insurance Co., Ltd.'s additional accident-free personal accident insurance".
As a part of this contract, the insurance premium and cash value of the supplementary insurance contract will be separately incorporated into the insurance premium and cash value of this contract and cannot be decomposed.
The validity of this contract is also subject to the validity of the supplementary insurance contract. If the validity of the supplementary insurance contract is terminated, the validity of this contract will be terminated. If the validity of the contract is terminated due to an insured event in the supplementary insurance contract, the company will not refund the insurance premium or cash value of this contract.
Explanation of terms 1 year old is calculated based on the date of birth recorded in the legal identity document.
2 Unintentional injury The body is harmed by being subject to external, sudden, unintended, non-illness objective events.
3 Total disability refers to one of the following situations:
1) Binocular permanent blindness;
2) The two upper limbs are above the wrist joint or the two lower limbs are above the ankle joint;
3) One arm is above the wrist and the other is above the ankle.
4) Permanent complete blindness in one eye and loss of one upper limb above the wrist joint;
5) Permanent complete blindness in one eye and loss of ankles above the lower limbs;
6) Permanent and complete loss of joint function;
7) permanent and complete loss of chewing and swallowing functions;
8) The central nervous system functions or the chest and abdominal organs are extremely impaired, and they cannot engage in any work for life. All other people's assistance is needed to support life.
Blindness includes the absence or removal of the eyeballs, or the inability to distinguish between light and dark, or only the manual in front of the eyes. The best corrected visual acuity is lower than the international standard vision chart 0.02, or the field of view radius is less than 5 degrees. Diagnosis of proof.
Loss of joint function means that the joint is permanently stiff or paralyzed, or that the joint cannot move with consciousness.
Loss of chewing and swallowing function refers to a state in which organic or functional disorders are caused by reasons other than teeth, so that chewing and swallowing movements cannot be performed, and the state cannot be ingested or swallowed except for liquid food.
In order to maintain the daily life activities necessary for all, assistance from others means food intake, the beginning and end of the bowel movements, dressing and undressing, living, walking, bathing, etc., you cannot do it yourself and need help from others.
The so-called permanent completeness refers to the fact that after 180 days of treatment from the date of accidental injury or the diagnosis of the disease, the function is still completely lost, but it is not limited to cases such as eye removal that are obviously unrecoverable.
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8ICD-10
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13HIVAIDS
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