一、保险责任约定Insurance liability agreement
保险责任大类 Category of insurance liability | 保险责任项目Insurance liability items | 保险责任简要描述Brief description of insurance liability | 保险金额（万元）Insurance amount (ten thousand yuan) | |||
寿险保险责任 Life insurance liability | 疾病身故保障Disease death protection | 见保险责任描述description of insurance liability | 20 | |||
意外伤害保险责任 Accidental injury insurance liability | 意外身故保障 Accidental death protection | 见保险责任描述 See description of insurance liability | 20 | 意外身故与意外残疾保障共用保险金额 Sharing insurance amount for accidental death and accidental disability protection | ||
意外伤残保障Accidental disability protection | 见保险责任描述description of insurance liability | |||||
交通意外身故保障 Traffic accident death protection | 民航 Civil aviation | 见保险责任描述 description of insurance liability | 30 | 交通意外身故保障与交通意外伤残保障共用保险金额 Traffic accident death protection and traffic accident disability protection share insurance amount | ||
列车、轮船 Train, ship | 20 | |||||
营运性汽车 Operational vehicle | 10 | |||||
交通意外伤残保障 Operational vehicle | 民航 Civil aviation | 见保险责任描述 description of insurance liability | 30 | |||
列车、轮船 Train, ship | 20 | |||||
营运性汽车 Operational vehicle | 10 | |||||
意外医疗保障 Accident medical insurance | 合理医疗费用（不包括全自费，但包括个人首先自付部分），100%赔付 Reasonable medical expenses (excluding full self-payment, but including personal self-payment first), 100% compensation | 4 | ||||
健康保险责任 Health insurance liability | 费用型 Expense type | 疾病住院医疗 Inpatient treatment of diseases | 合理医疗费用（不包括全自费，但包括个人首先自付部分），100%赔付 Reasonable medical expenses (excluding full self-payment, but including personal self-payment first), 100% compensation | 5 | ||
门急诊医疗 Outpatient and emergency medical treatment | 合理医疗费用（不包括全自费，但包括个人首先自付部分），80%赔付，次限额500元。 Reasonable medical expenses (excluding full self-payment, but including personal self-payment first), 100% compensation | 0.5 | ||||
津贴型 Allowance type | 意外住院现金补贴 Cash allowance for accidental hospitalization | 按100元/天给付，最多给付180天 Pay according to 100 yuan/day, with a maximum payment of 180 days | 1.8 | |||
重大疾病 Major disease | 33种重大疾病 33 major diseases | 10 | ||||
上述保险责任适用于《平安一年期团体定期寿险条款（2014版）》、《平安附加团体意外伤害保险（2020版）（A款）条款》、《平安交通团体意外伤害保险(2013版)》、《平安附加意外伤害团体医疗保险条款》、《平安附加意外伤害住院现金补贴团体医疗保险条款》、《平安附加门诊急诊团体医疗保险条款》、《平安团体重大疾病保险（2021版)（A款）》、《平安住院团体医疗保险条款》。以上条款仅承担上述协议约定保险责任，不承担条款中所列其他保险责任。 The above insurance liability applies to "Ping an One-year Group Term Life Insurance Clauses (2014 Edition，)Ping an Additional Group Accident Insurance (2020 Edition) (Section A) , Ping an Traffic Group Accident Insurance (2013 Edition), Ping an Additional Accident Group Medical Insurance Clause, Ping an Additional Accident Hospitalization Cash Subsidy Group Medical Insurance Clause, Ping an Additional Outpatient Emergency Group Medical Insurance Clause, Ping an Group Critical Illness Insurance (2021 Edition) (Section A), Ping an Hospitalization Group Medical Insurance Clause. The above clauses only bear the insurance liabilities agreed in the above agreement, and do not bear other insurance liabilities listed in the clauses. | ||||||
方案二Scheme 2
保险责任大类 Category of insurance liability | 保险责任项目 Insurance liability items | 保险责任简要描述 description of insurance liability | 保险金额（万元） Insurance amount (ten thousand yuan) | |||
寿险保险责任 Life insurance liability | 疾病身故保障 Disease death protection | 见保险责任描述 description of insurance liability | 20 | |||
意外伤害保险责任 Accidental injury insurance liability | 意外身故保障 Accidental death protection | 见保险责任描述 description of insurance liability | 20 | 意外身故保障与意外残疾保障共用保险金额 Sharing insurance amount for accidental death and accidental disability protection | ||
意外伤残保障 Accidental disability protection | 见保险责任描述 description of insurance liability | |||||
交通意外身故保障 Traffic accident death protection | 民航 Civil aviation | 见保险责任描述 description of insurance liability | 30 | 交通意外身故保障与交通意外伤残保障共用保险金额 Traffic accident death protection and traffic accident disability protection share insurance amount | ||
列车、轮船 Train, ship | 20 | |||||
营运性汽车 Operational vehicle | 10 | |||||
交通意外伤残保障 Traffic accident disability protection | 民航 Civil aviation | 见保险责任描述 description of insurance liability | 30 | |||
列车、轮船 Train, ship | 20 | |||||
营运性汽车 Operational vehicle | 10 | |||||
意外医疗保障 Accident medical insurance | 合理医疗费用（不包括全自费，但包括个人首先自付部分），100%赔付 Reasonable medical expenses (excluding full self-payment, but including personal self-payment first), 100% compensation | 4 | ||||
健康保险责任 Health insurance liability | 费用型 Expense type | 疾病住院医疗 Inpatient treatment of diseases | 合理医疗费用（不包括全自费，但包括个人首先自付部分），100%赔付 Reasonable medical expenses (excluding full self-payment, but including personal self-payment first), 100% compensation | 5 | ||
津贴型 | 意外住院现金补贴 | 按100元/天给付，最多给付180天 Pay according to 100 yuan/day, with a maximum payment of 180 days | 1.8 | |||
上述保险责任适用于《平安一年期团体定期寿险条款（2014版）》、《平安附加团体意外伤害保险（2020版）（A款）条款》《平安交通团体意外伤害保险(2013版)》、《平安附加意外伤害团体医疗保险条款》、《平安附加意外伤害住院现金补贴团体医疗保险条款》、《平安住院团体医疗保险条款》。以上条款仅承担上述协议约定保险责任，不承担条款中所列其他保险责任。 The above insurance liability applies to Ping an One-year Group Term Life Insurance Clause (2014 Edition), Ping an Additional Group Accident Insurance (2020 Edition) (Section A) Clause, Ping an Traffic Group Accident Insurance (2013 Edition), Ping an Additional Accident Group Medical Insurance Clause, Ping an Additional Accident Hospitalization Cash Subsidy Group Medical Insurance Clause and Ping an Hospitalization Group Medical Insurance Clause. The above clauses only bear the insurance liabilities agreed in the above agreement, and do not bear other insurance liabilities listed in the clauses. | ||||||
二、保险费
年人均保费为人民币600元/年、500元/10个月、300元/6个月，200元/4个月。
II. Insurance Premium
The annual per capita premium is RMB 600 yuan/year, 500 yuan/10 months, 300 yuan/6 months and 200 yuan/4 months.
三、指定医院
指定医院为当地基本医疗保险部门定点的二级（含二级）以上公立医院及保险人认可定点医院。但不包括不能出具电脑打印发票和费用明细清单的医院，也不包括作为诊所、康复、护理、休养、精养、戒酒、戒毒等或类似的医疗机构。该医院必须具有符合国家有关医院管理规则设置标准的医疗设备，且全天二十四小时有合格医师及护士驻院提供医疗及护理服务。若指定医院有不合理收费行为或者违反当地社会医疗主管部门的有关规定，保险人将取消该医院的指定医院资格并通知投保人。
1.急诊可以到非指定医院就诊治疗，但复诊时须到指定医院就诊治疗若因指定医院条件限制而需转至非指定医院治疗时，必须经原治病医院会诊，出具转院证明并经保险人同意；
2.所有指定医院的分院、便民（简易）门诊、家庭病房、挂床住院、外宾病区、特诊（特需）病区、特诊（特需）病房和合资、独资医院等同类病区或病房不在规定的范围内。
III．Designated hospitals
Designated hospitals are public hospitals above Grade II (including Grade II) designated by local basic medical insurance departments and designated hospitals recognized by insurers. However, it does not include hospitals that cannot issue computer-printed invoices and detailed lists of expenses, nor does it include medical institutions that serve as clinics, rehabilitation, nursing, rest, intensive care, abstinence from alcohol, drug addiction, etc. or similar medical institutions. The hospital must have medical equipment that meets the standards set by the relevant national hospital management rules, and have qualified doctors and nurses stationed in the hospital 24 hours a day to provide medical and nursing services. If the designated hospital has unreasonable charging behavior or violates the relevant regulations of the local social medical department, the insurer will cancel the designated hospital qualification of the hospital and notify the insured.
1. The emergency department can go to a non-designated hospital for treatment, but it must go to a designated hospital for treatment when returning to the hospital. If it needs to be transferred to a non-designated hospital for treatment due to the conditions of the designated hospital, it must be consulted by the original treating hospital, and the transfer certificate must be issued and approved by the insurer;
2. All designated hospital branches, convenience (simple) outpatient clinics, family wards, hanging bed hospitalization, foreign guest wards, special diagnosis (special needs) wards, special diagnosis (special needs) wards, joint venture and wholly-owned hospitals and other similar wards or wards are not within the prescribed scope.
四、理赔服务
1. 线上理赔
（1）下载平安好福利APP查询保障、自助理赔
IV. Claims Service
Online claims
(1) Download Ping an Good Welfare APP to inquire about protection and self-service claims
（2）进入自助理赔页面，核实个人信息、拍照上传医疗材料影像
(2) Enter the self-service claims page, verify personal information, take photos and upload medical materials images
（3）提交申请成功，可在理赔记录中查看实时理赔进度
(3) If the application is submitted successfully, you can view the real-time claim progress in the claim record
线下理赔 Offline claims
申请书Application | 治疗费发票 Invoice of treatment fee | 费用清单 Cost list | 门诊病历 Outpatient medical record | 住院病历 Inpatient medical record | |
门急诊医疗 Outpatient and emergency medical treatment | √ | √ | √/▲ | √/▲ | |
住院医疗Inpatient care | √ | √ | √/▲ | √/▲ |
备注：√ 表示需提供相应资料原件 ▲表示需提供相应资料复印件
说明：
1、申请书和治疗费发票为必须提供材料。
2、必须提供就诊人员护照首页复印件及银行卡复印件。
3、理赔咨询电话95511-6或咨询专属服务人员18052266667（陆老师）。
Remarks: √ indicates that the original of the corresponding data should be provided ▲ indicates that a copy of the corresponding data should be provided
Description:
1. The application form and the invoice of treatment fee are the materials that must be provided.
2. A copy of the first page of the passport and a copy of the bank card must be provided.
3. Claims consultation telephone number 95511-6 or exclusive service personnel 18052266667 (Teacher Lu).
