综合健康意外保险服务手册

宁波诺丁汉大学

University of Nottingham Ningbo China

Comprehensive Medical

and Accident Insurance Handbook

04

01

06

22

02

11

03

14

Profile of China Pacific

Insurance (Group) Co., Ltd

Risks Covered

4.1 Amount covered by accidental

injury insurance

4.2 Additional Group Medical Care

Insurance for Accidental Injury

4.3 Group Outpatient or Emergency

Medical Care Insurance

4.4 Group Inpatient Medical Care

Insurance

Definition of Emergency Care

Contact Us

Documents for Insurance Claims

Insurance Scheme Overview

Exclusions

3.1 Insurance Program

6.1 Insurance Benefits for

Accidental Injury

6.2 Additional Group Medical Care

Insurance for Accidental Injury

6.3 Group Outpatient or

Emergency Medical Care Insurance

6.4 Group Inpatient Medical Care

Insurance

3.2 Special Provisions

Ⅰ

Ⅳ

Appendix1/2

Ⅱ

V

Ⅲ

VI

01

06

06

07

08

10

22

02

11

03

14

03

14

15

16

19

04

Application for Accident Health

Insurance Claims

23

CONTENTS

P.01 Insurance (Group) Co., Ltd Profile of China Pacific

Profile of China Pacific

Insurance(Group) Co., Ltd

Comprehensive Medical and Accident Insurance Handbook

China Pacific Insurance (Group) Co., Ltd. (hereinafter referred to as “CPIC” or “the

Company”) is an insurance group established based on the former China Pacific

Insurance Corporation, which was founded on 13 May 1991. Headquartered in

Shanghai, CPIC is a leading integrated insurance group with its A and H shares

listed on the Shanghai and Hong Kong stock exchanges, respectively.

CPIC has been dedicated to expanding its lines of insurance business by obtaining

the full range of licenses that exist in the insurance industry chain. It offers life and

property insurance products, asset management, on-line services, endowment

insurance, health insurance, and crop insurance through its specialized

subsidiaries. CPIC has established nationwide marketing network and diversified

service platforms, allowing itself to provide a broad range of risk prevention

solutions, investment, as well as wealth management and asset management

services.

CPIC adheres to its mission of “Becoming a Responsible Insurance Company” and

its core corporate value of “Integrity, Steadiness, and the Pursuit of Excellence”

by incorporating its corporate social responsibility into its business model and

creating value for its customers, shareholders, employees, industry, society, and

the environment and other stakeholders. CPIC has been widely recognized and

was granted the “Outstanding Enterprise Award” for the List of Corporate Social

Responsibilities of Enterprises in China for six consecutive years.

综合健康意外保险服务手册

Comprehensive Medical and Accident Insurance Handbook

P.02 Contact Us Ⅱ

Ⅱ /Contact Us

24-hour hotline:

1010 8686

The hotline service is available 24/7. You may dial the hotline by land or mobile phone

nationwide. Leave a message for us anytime during off-hours or when you have any

questions, and we will reply within one business day.

Consult or report through exclusive email: nottingham@cpic.com.cn

Short Message Notice: Following the closing of an insurance claim, you may receive

a short message as a notice of closing the claim so that you will stay informed of the

result of the claim.

综合健康意外保险服务手册

P.03 Insurance Scheme Overvie

(Currency: CNY)

Ⅲ

Ⅲ /Insurance Scheme Overview

3.1 Insurance Program

Insurance Products Description Amount Covered Risks Covered

Group Accident

Insurance

Accidental death

or disability 200,000 Accidental death or disability

Additional Group

Medical Care

Insurance for

Accidental Injury

(Type B)

Accidental

outpatient

(emergency) care

and accidental

inpatient care

50,000

Within the scope of social

medical insurance,

100% compensation for

outpatient and hospitalization.

Extend to Class B

Group Medical Care

Insurance (Type B)

Outpatient

(emergency) care

caused by disease

20,000

Within the scope of social

medical insurance,

100% compensation for

outpatient care;

Outpatient annual deductible:

RMB 500.00;

No outpatient deductible at

UNNC Clinic, but limited to

daily limitation in amount of

RMB 100

Inpatient care 400,000

Within the scope of social

medical insurance,

100% compensation for

hospitalization.

Extend to Class B

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

Insurance Scheme Overvie Ⅲ

P.04

3.2 Special Provisions

For the general pre-existing conditions that is declared and approved, the insurance

could cover the related expenses. The pre-exisitng major diseases as below and any

condition arising therefrom or associated therewith. malignant tumors, heart disease

(Class II heart failure and above), myocardial infarction, leukemia, aplastic anemia,

cirrhosis, hypertension (class II or above), chronic kidney disease, chronic obstructive

pulmonary disease, cerebrovascular disease, diabetes, congenital diseases, mental

diseases, epilepsy, specific infectious diseases, AIDS, and sexually transmitted

diseases are not covered.

The designated hospitals means the ordinary departments of public hospitals of

Class II and above based in mainland China. Any public hospital nearby is acceptable

in case of emergency care, and the insured shall be transferred to the designated

hospital if he or she reaches a stable condition after the emergency care. The

University of Nottingham Ningbo (UNNC) Clinic and ZheJiang University Mingzhou

Hospital are the designated hospitals.

However, if the Insured is under treatment at a branch hospital of public hospitals,

inpatient area for foreigners, inpatient care area for VIPs, private ward, Class A ward,

separate ward, ward or inpatient area for special treatment and needs, ward for highranking officials, or similar ward or inpatient care, then any and all medical expenses

arising out of such treatment shall not be reimbursed.

Pre-existing Medical Conditions:

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

P.05

Any medical expenses shall be limited to coverage of local social medical insurance,

any full or partial out-of-pocket items shall be not covered.

If a third party has partially or fully paid any above-mentioned medical expenses, a

claim against only the remaining amount of reasonable expenses that are within the

reimbursable limit by the local social medical insurance shall be accepted by CPIC.

However, a limited portion of the expenses for a ward bed, nursing, outpatient and

emergency treatment mentioned in the risks covered shall also be limited; if a third

party has deducted the claimed amount based on its claim settlement ratio for the

limited proportion, CPIC shall pay only the remaining amount after such a deduction.

If the third party gives no claim settlement ratio, then the limited proportion shall be

subject to the standard under the local social medical insurance. Based on the limited

proportion, a standard amount shall be deducted from the item and the remaining

amount shall be covered but subject to the amount covered.

The medical liabilities arising during the period of engaging in a work-study program

(not internship) shall not be covered.

Additional Group Medical Care Insurance for Accidental Injury: Extend the liability

for dental treatment due to an accidental injury.

Note: Matters not mentioned herein shall be subject to the stipulated terms of the

insurance policy. In case of any dispute arises out of the contents mentioned above,

the interpretation in Chinese shall prevail.

Comprehensive Medical and Accident Insurance Handbook Insurance Scheme Overvie

Ⅲ综合健康意外保险服务手册

P.06 Risks Covered Ⅳ

Ⅳ /Risks Covered

4.1 Amount covered by accidental injury insurance

In the event of an accidental injury incident that directly leads to the death of the

Insured within 180 days following the occurrence thereof, CPIC shall pay the amount

covered by the accidental death insurance of the Insured and CPIC’s insurance

liabilities for the said Insured shall be terminated.

In the event of an accidental injury incident which directly leads to any injury/

disability of the Insured within 180 days following the occurrence thereof and such

injury/disability is included in the list of injuries and disabilities provided in the

Assessment Criteria and Codes for Injuries and Disability in Personal Insurance

(promulgated by China Insurance Regulatory Commission, CIRC [2014] No. 6, coded:

JR/T 0083-2013), CPIC shall assess the injury/disability pursuant to the said Criteria

and pay an amount which is equal to the benefit percentage stipulated in the said

Criteria multiplied by the amount covered of the Insured. In case the treatment has

not been completed within 180 days following the occurrence of the accidental

injury incident, such injury/disability assessment shall be performed on the 180th day

following the occurrence of the said incident and the accidental disability benefit

shall be disbursed based on the assessment result.

Under any circumstances, CPIC’s liabilities for the Insured shall be terminated when

the cumulative amount of any benefit(s) reaches the amount covered for the Insured.

Note: Assessment Criteria and Codes for Injuries and Disability in Personal Insurance

are available at the website of Insurance Association of China.

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

P.07

In case the Insured receives outpatient (emergency) care at a designated medical

institution as a result of an accidental injury, CPIC shall disburse the insured for

outpatient (emergency) care expenses which are calculated using the following

formula; however, the disbursement amount shall be limited to the amount covered

for the Insured:

In case the Insured receives inpatient care at a designated medical institution as a

result of an accidental injury, CPIC shall disburse the inpatient care expenses which

are calculated using the following formula; however, the disbursement amount shall

be limited to the amount covered for the insured:

Amount covered for outpatient (emergency) care = (Aggregate of four medical

expenses of the insured i.e. expenses of treatment, examination, surgery, and

medicine which are in line with the rating regulations and not exceeding the limit

prescribed by the medical insurance policies by the local government of the place

where the insurance policy is issued) × 100%.

Amount covered for inpatient care = (Aggregate of five medical expenses of the

Insured i.e. expenses of treatment, examination, surgery, medicine, and ward bed

which are in line with the rating regulations and not exceeding the limit prescribed

by the medical insurance policies by the local government of the place where the

insurance policy is issued) × 100%.

4.2 Additional Group Medical Care

Insurance for Accidental Injury

Comprehensive Medical and Accident Insurance Handbook Risks Covered

Ⅳ综合健康意外保险服务手册

4.3 Group Outpatient or Emergency

Medical Care Insurance

P.08

In no event should the aggregate outpatient (emergency) care benefit and inpatient

care benefit disbursed by CPIC once or more than once cumulatively during the

insurance period to the same insured exceed the amount covered for the insured. The

insurance liabilities of CPIC to the Insured shall be terminated when such aggregate

benefits reach the amount covered for the insured.

In case the Insured receives outpatient (emergency) medical care at a designated

medical institution as a result of an illness which occurs after observation period,

CPIC shall disburse the outpatient (emergency) care expenses which are calculated

using the following formula and not exceeding the maximum expenses per outpatient

(emergency) care and the amount covered for the Insured:

Amount covered for outpatient (emergency) care = (Aggregate of four medical

expenses of the Insured i.e. costs of treatment, examination, surgery and medicine

which are in line with the rating regulations and not exceeding the limit prescribed by

the basic medical insurance policies by the local government of the place where the

insurance policy is issued – Annual Deductible).

Example: Accidental injuries such as bruises of bumps, burns, sprained ankles,

accidental cut-wound when cutting vegetables, scratches, and bites by cats and

dogs. Reimbursement equation: total amount of reasonable expenses × 100% =

reimbursable amount (the total amount of reasonable expenses shall exclude the selfpaid or partly self-paid expenses according to the local social medical insurance).

Comprehensive Medical and Accident Insurance Handbook Risks Covered Ⅳ综合健康意外保险服务手册

P.09

The foregoing maximum benefit per outpatient (emergency) care, deductible, and

disbursement ratio shall be determined by the Policyholder and CPIC at the time

when the person was insured.

The foregoing deductible and disbursement ratio shall be determined by the

Policyholder and CPIC at the time when the person was insured.

In no event should the aggregate outpatient (emergency) care benefit and inpatient

care benefit disbursed by CPIC once or more than once cumulatively during the

insurance period to the insured exceed the amount covered for the Insured. The

insurance liability of CPIC to the Insured shall be terminated when such aggregate

benefits reach the amount covered for the insured.

Example: If the Insured is under treatment of outpatient or emergency for fever,

sudden abdominal pain, faint, and inflammation etc.

Reimbursement equation: (total expance - 500 annual limit) × 100% = reimbursable

amount (the reasonable expensese shall exclude the self-paid expenses stipulated by

the local regulations of the social basic medical insurance) .

Annual Deductible：Deductible shall mean to the amount of expenses that an

insured person has to pay out of pocket before reimbursement begins.

Comprehensive Medical and Accident Insurance Handbook Risks Covered

Ⅳ综合健康意外保险服务手册

P.10

4.4 Group Inpatient Medical Care Insurance

In case the Insured receives inpatient care at a designated medical institution as a

result of an illness or accidental injury which occurs after the observation period,

CPIC shall disburse the Insured for inpatient care expenses that are calculated using

the following formula and not exceeding the amount covered for the Insured:

The foregoing deductible and disbursement ratio shall be determined by the

policyholder and CPIC at the time when the person was insured.

In no event should the aggregate inpatient care benefit disbursed by CPIC once or

more than once cumulatively during the insurance period for the insured exceed

the amount covered for the Insured. The insurance liabilities of CPIC to the Insured

shall be terminated when such aggregate benefits reach the amount covered for the

Insured.

Amount covered for inpatient care = (Aggregate of five medical expenses of the

insured person i.e. costs of treatment, examination, surgery, medicine, and ward bed

which are in line with the rating regulations and not exceeding the limit prescribed by

the basic medical insurance policies by the local government of the place where the

insurance policy is issued – Deductible) × Disbursement Ratio.

Comprehensive Medical and Accident Insurance Handbook Risks Covered

Ⅳ综合健康意外保险服务手册

P.11 Documents for Insurance Claims

V

V /Documents for

Insurance Claims

Risks covered Document Accidental

Death

Accidental

Injury or

Disability

Outpatient

(emergency)

Medical Treatment

Inpatient

Treatment

Original insurance claim form √ √ √ √

Valid ID certificate of the Insured √ √ √ √

Valid ID certificate of the

beneficiary √

Certificate of relationship with the

beneficiary √

Death certificate √

Injury or disability certificate √

Original medical expense invoice √ √

Original medical expense

settlement statement and the

breakdown statement

√ √

Outpatient (emergency) record √ √ √

Discharge Summary √ √

Surgery certificate, pathological

and microscopic examination

report, and electrocardiography

report

△ △

Accident certificate (in case

of a traffic accident, a liability

confirmation of traffic accident

from a traffic authority is required)

√ √ △ △

Original authorization for transfer

of claimed amount and copy of a

bankcard

√ √ √ √

The following documents should be submitted in accordance with Chapter II

Contact Us -- How to submit your insurance claims.

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

Documents for Insurance Claims V

P.12

Note:Exam/Test reports refer to the results of the necessary pathological, blood,

imaging, and other scientific exams/tests.

“ △” marked in the table means the relevant document would be required if available.

If the holder of the beneficiary account is not the Insured, an authorization letter for

transfer of the claimed amount should be provided.

Legal beneficiary: After the death of the Insured, under any of the following

circumstances, CPIC shall fulfill its obligation to pay the insurance claim (as the

Insured's heritage) in accordance with the provisions of the Inheritance Law of the

People's Republic of China:

No beneficiary is designated or such designation is ambiguous and unidentifiable;

Death of the beneficiary(ies) occurs before death of the Insured and no any other

beneficiary exists;

The right of the beneficiary(ies) is forfeited by law or waived and no any other

beneficiary exists.

In the event that the Insured and the beneficiary(ies) died from the same incident

and the sequence of their deaths cannot be determined, the beneficiary(ies) shall be

presumed dead before the Insured.

In case the beneficiary (ies) deliberately caused death or injury/disability of the

Insured, or attempts to murder the Insured, the right of such beneficiary (ies) shall be

forfeited.

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

P.13

According to the policy clauses, your right to claim any benefits against CPIC may

be invalidated if such rights have not been exercised within two years after you are

aware of the occurrence of the incident.

In addition to the above mentioned materials, the claimant may provide other

materials available that would be used to testify as to the cause of the incident,

including the diagnosis & treatment documents and other evidence that is related

to the insurance claim, such as the verdict of traffic accident liability, letter of

authorization, accident evidence, relationship certificate, etc.

Comprehensive Medical and Accident Insurance Handbook Documents for Insurance Claims

V综合健康意外保险服务手册

P.14Exclusions

VI

VI /Exclusions

6.1 Insurance Benefits for Accidental Injury

If the Insured dies, is injured, or suffers a burn injury under any of the following

circumstances, the insurance company shall not be liable to pay any insurance

benefits for the accidental injury:

The policyholder kills or injures the Insured intentionally;

The Insured deliberately commits any crime or resists any lawful criminal

enforcement measures;

The Insured commits suicide, except that the Insured is a person with no capacity for

civil conduct at the time when he/she commits suicide;

The Insured is drunk, fights, or voluntarily takes or injects drugs;

The Insured drives under the influence of alcohol, without a valid driver license, or

drives a motor vehicle with no valid road-worthiness certificate;

The Insured is injured due to pregnancy (including cesarean), miscarriage, or

childbirth (including cesarean delivery);

The Insured is injured due to medical accident or drug allergy;

Any accidents occur with respect to the Insured due to mental disorder;

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

P.15

The Insured takes medicine without following a doctor’s advice, except for over-thecounter (OTC) medicine taken in accordance with the instructions.

The insurance company shall not be liable to pay the insurance benefits

with respect to the following expenses or if the Insured receives outpatient

(emergency) medical care under any of the following circumstances:

The Insured takes part in high risk activities such as diving, parachuting, rock

climbing, piloting a glider or a paraglider, exploring, wrestling, martial art competition

or stunt run, horse racing, or auto racing;

The excluded items specified in Benefits for Accidental Injury;

Medical treatments received in respect of non-accidental injuries;

Orthopedic & reconstructive surgery, cosmetic/plastic therapy, organ transplantation

or organ repairs, installation and purchase of disability equipment (for instance,

wheelchair, artificial limbs, hearing aids, artificial eyes, glasses, or artificial teeth, and

etc.);

Nuclear explosion, nuclear radiation, or nuclear contamination.

War, military conflict, riot, or armed rebellion;

6.2 Additional Group Medical Care

Insurance for Accidental Injury

Comprehensive Medical and Accident Insurance Handbook Exclusions

VI综合健康意外保险服务手册

P.16

6.3 Group Outpatient or Emergency

Medical Care Insurance

General health examination, recuperation, rehabilitation treatment, physiotherapy,

and psychological counseling or therapy;

The medical expenses incurred by the Insured at any medical institutions not

designated by the insurance companies;

The portion of the medical expenses incurred by the Insured, which has been

reimbursed by any third parties according to laws.

Medical treatment caused by accidental injuries;

The policyholder's intentional act;

Diseases or injuries caused by the Insured, except that the Insured is a person with no

capacity for civil conduct at the time when he/she commits suicide;

Disability, unreported pre-existing symptoms, and illnesses not specifically covered

by the insurance policy before the Insured is insured;

The insurance company shall not be liable to pay insurance benefits with respect

to the following expenses or if the Insured receives outpatient (emergency)

medical care under any of the following circumstances:

Comprehensive Medical and Accident Insurance Handbook Exclusions

VI综合健康意外保险服务手册

P.17

The Insured deliberately commits any crime or resists any lawful criminal

enforcement measures;

A fight, attack, or murder caused by an Insured’s provocation or deliberate act;

The Insured takes, injects, or uses medicine without following a doctor’s advice;

The expenses with respect to orthopedic & reconstructive surgery, cosmetic/

plastic therapy or organ repairs, installation and purchase of disability

equipment (for instance, wheelchair, artificial limbs, hearing aids, artificial

eyes, artificial teeth ,glasses, or artificial teeth, and etc.);

The Insured’s pregnancy, abortion, abortion, childbirth (including caesarean

section), contraception, birth control sterilization, treatment of infertility,

artificial insemination, or the complications caused by the aforementioned

cases;

The Insured conducts general health checkups, convalescence, rehabilitation,

psychological counseling or treatment, or conducts medical activities for the

purpose of donating body organs;

The Insured engages in high-risk sports and activities such as diving, skydiving,

skiing, water skiing, hang gliding, hunting, rock climbing, adventuring, martial

arts, wrestling, stunts, horse racing, racing, bungee jumping;

The Insured’s congenital malformations, deformations, and chromosomal

abnormalities (subject to the International Statistical Classification of

Diseases and Related Health Problems (ICD-10) issued by the World Health

Organization);

Comprehensive Medical and Accident Insurance Handbook Exclusions

VI综合健康意外保险服务手册

P.18

The Insured suffers from STDs, mental and behavioral disorders (subject to the

International Statistical Classification of Diseases and Related Health Problems (ICD10) issued by the World Health Organization);

The Insured‘s cosmetic surgery, cosmetology, orthopedic, surgical plastic surgery,

transsexual surgery, preventive surgery (e.g. preventive appendectomy);

Any explosion, burn, pollution or radiation caused by biological, chemical, atomic

energy, atomic or nuclear energy installations;

The insurer shall not be liable for the payment of insurance benefits if the Insured

suffers injury or suffers from illness resulting in treatment or expenses during the

following periods:

Ⅰ）During the period of mental disorder or insanity of the Insured;

Ⅱ）During war, military operations, riots, or armed rebellions;

Ⅲ）During the period in which the Insured is drunk or affected by drugs or controlled

drugs;

Ⅳ）During any event of drunk driving by the Insured, driving without a valid driver's

license, or driving a motor vehicle without a valid driving license.

The Insured suffers from disc herniation (including disc bulging, disc herniation,

intervertebral disc prolapse, free disc, etc.), and endemic disease;

The Insured suffers from occupational diseases;

Terrorist attacks;

Comprehensive Medical and Accident Insurance Handbook Exclusions

VI综合健康意外保险服务手册

P.19

The insurance company shall not be liable to pay the insurance benefits with

respect to the following expenses or if the Insured receives inpatient medical

care under any of the following circumstances:

6.4 Group Inpatient Medical Care

Insurance

The policyholder's intentional act;

Diseases or injuries caused by the Insured, except that the Insured is a person

with no capacity for civil conduct at the time when he/she commits suicide;

Disability, unreported pre-existing symptoms, and illnesses not specifically

covered by the insurance policy before the Insured is insured;

The Insured deliberately commits any crime or resists any lawful criminal

enforcement measures;

The expenses with respect to orthopedic & reconstructive surgery, cosmetic/

plastic therapy or organ repairs, installation and purchase of disability

equipment (for instance, wheelchair, artificial limbs, hearing aids, artificial

eyes, artificial teeth ,glasses or artificial teeth, and etc.);

The Insured takes, injects, or uses medicine without following a doctor’s

advice;

A fight, attack, or murder caused by an Insured’s provocation or deliberate

act;

Comprehensive Medical and Accident Insurance Handbook Exclusions

VI综合健康意外保险服务手册

P.20

The Insured’s pregnancy, abortion, abortion, childbirth (including caesarean

section), contraception, birth control sterilization, treatment of infertility, artificial

insemination, or the complications caused by the aforementioned circumstances;

The Insured conducts general health checkups, convalescence, rehabilitation,

psychological counseling or treatment, or conducts medical activities for the purpose

of donating body organs;

The Insured engages in high-risk sports and activities such as diving, skydiving,

skiing, water skiing, hang gliding, hunting, rock climbing, adventuring, martial arts,

wrestling, stunts, horse racing, racing, bungee jumping;

Congenital malformations, deformations, and chromosomal abnormalities in the

Insured (subject to the International Statistical Classification of Diseases and Related

Health Problems (ICD-10) issued by the World Health Organization);

The Insured suffers from occupational diseases;

The Insured is with STDs, mental, and behavioral disorders (subject to the

International Statistical Classification of Diseases and Related Health Problems (ICD10) issued by the World Health Organization);

The Insured suffers from disc herniation (including disc bulging, disc herniation,

intervertebral disc prolapse, free disc, etc.), and endemic disease;

The Insured‘s cosmetic surgery, cosmetology, orthopedic, surgical plastic surgery,

transsexual surgery, preventive surgery (e.g. preventive appendectomy);

Comprehensive Medical and Accident Insurance Handbook Exclusions

VI综合健康意外保险服务手册

P.21

Terrorist attacks;

Any explosion, burn, pollution, or radiation caused by biological, chemical, atomic

energy, atomic or nuclear energy installations;

The insurer shall not be liable for the payment of insurance benefits if the Insured

suffers injury or suffers from illness resulting in treatment or expenses during the

following periods:

Ⅰ）During the period of mental disorder or insanity of the Insured;

Ⅱ）During war, military operations, riots, or armed rebellions;

Ⅲ）During the period in which the Insured is drunk or affected by drugs or controlled

drugs;

Ⅳ）During the time when the Insured had been drunk driving, driving without a valid

driver's license or driving a motor vehicle without a valid driving license.

Comprehensive Medical and Accident Insurance Handbook Exclusions

VI综合健康意外保险服务手册

P.22 Appendix 1 /Definition of

Emergency Care

Emergency Care

Appendix 1. Definition of

Emergency care is deemed in case of the following situations:

The high fever (above 38.5 degree Celsius);

Acute stomach pain, severe vomiting, serious diarrhea;

Severe wheezing, dyspnea;

Shock, coma; epileptic seizure due to various reasons;

Acute chest pain, acute heart failure, serious heart arrhythmia;

Hypertension crisis, hypertension brain, cerebrovascular;

Acute bleeding for various reasons, acute urinary bleeding, anuretic, blood block,

renal colic;

Acute poisoning for various reasons (such as food or medicine poisoning);

Traumatic brain injury, fracture, dislocation, avulsion, burning, or other acute injury;

In case of any dispute over the contents above, the interpretation in Chinese shall

prevail.

Bites of various poisonous animals, insect bite, acute allergic disease;

The disease of a baby at zero to two-month.

The five sense organs and the respiration, blockage of the esophagus, acute eye pain,

red or swollen eyes, eyesight obstacle and injury;

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

P.23

Policy Numbe * Insured * Mobile Phone

Gender □ Male □ Female Date of Birth Nationality

* Document Type

□ ID □ Passport

* ID /Passport

Number

Terms of

Validity of ID/

Passport

*Mailing Address Zip Code

E-mail

* Cause of Claim: □ Accident □ Disease □ Other

* Application Type: □ Death □ Disability □ Medical Expenses □ Other

Application

Number * Applicant Application

Method

Application

Time * Accident Date * Name of

Hospital

* Accident description (Please specify the time/location/cause/course of event/result etc.):

Note: The above fields with "*" are compulsory.

□ Apply by the Insured (No need to fill in the applicant information)

□ Non - Insured person applies ( applicant must fill in " *" information below )

* Applicant Type

□ Guardian □ Other * Applicant * Mobile Phone

* Document Type

□ ID □ Passport

* ID /Passport

Number

Terms of

Validity of ID/

Passport

* Bank Account Information (Compulsory):

Name of Payee: Payee's Account No.

Bank information: Bank Name Branch

Sub-branch

Bank Location Province City

Ningbo Branch of China Pacific Property Insurance Co., Ltd

Application for Accident Health Insurance Claims

Health Insurance Claims

Appendix 2. Application for Accident Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

Health Insurance Claims

Appendix 2. Application for Accident

P.24 Additional information:

1. I hereby declare that the above statements are true and there are no false statements or major omissions.

2. I hereby authorize any medical institutions, insurance companies or other institutions, as well as any

person who is familiar with the health status of the insured, to truthfully provide the information about the

health status of the insured to your company. Photocopies of such authorizations are also valid.

3. Statement of transfer authorization: I hereby agree that your company can transfer the compensation

to the bank account provided in this Application. I declare that the above bank account is indeed the

Applicant's own account or the trustee's account, and the bank name, account name and account number

of the bank account are authentic and valid. I agree to assume legal and economic responsibilities arising

from the failure of transfer due to wrong provision of bank account details.

4. According to the regulations of the Insurance Supervision Department, insurance claim paid in cash is not

allowed to be collected by insurance agencies, insurance agencies’ employees and insurance salesmen. I

am aware of the above matters.

* Signature of Applicant:

* Date of Application： 年 月 日

Original Copy

□ Claims form 份 份

□ ID Of the patient 份 份

□ Medical record or

discharge summary 份 份

Original Copy

□ Number of receipts

or Itemized expense

list

份 份

□ Bank card or

deposit book 份 份

□ Others 份 份

Customer Service Hotline:

1010 8686

In case of any dispute over the above contents, the Chinese terms and conditions

shall prevail.

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

目 录

25

29

40

26

32

27

34

太平洋保险集团介绍

保险责任

4.1 意外伤害保险金

4.2 附加团体意外伤害医疗保险

4.3 团体门急诊医疗保险

4.4 团体住院医疗保险

对急诊的定义

联系我们

理赔申请资料

保险保障内容说明

除外责任

3.1 保险计划

6.1 意外伤害保险金

6.2 附加团体意外伤害医疗保险

6.3 团体门急诊医疗保险

6.4 团体住院医疗保险

3.2 特别约定

附表 1/2

25

29

29

39

30

31

40

26

32

27

34

27

34

35

35

37

28

意外健康险理赔申请书 41

Ⅰ

Ⅳ

Ⅱ

V

Ⅲ

VI

P.25太平洋保险集团介绍

太平洋保险集团介绍

中国太平洋保险（集团）股份有限公司（以下简称“太平洋保险”、“公司”）是

在 1991 年 5 月 13 日成立的中国太平洋保险公司的基础上组建而成的保险集

团公司，总部设在上海，是国内领先的“A+H”股上市综合性保险集团。

太平洋保险不断完善保险产业链全牌照布局，旗下拥有寿险、产险、资产管理、

在线服务、养老保险、健康保险、农业保险等专业子公司，建立了覆盖全国

的营销网络和多元化服务平台，提供全方位风险保障解决方案、投资理财和

资产管理服务。

太平洋保险以“做一家负责任的保险公司”为使命，以“诚信天下，稳健一生，

追求卓越”为企业核心价值观，将企业社会责任全面融入公司的商业模式中，

为客户、股东、员工、行业、社会、环境等利益相关方创造共享价值，受到

广泛赞誉，连续六年获中国企业社会责任榜“杰出企业奖”。

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

联系我们

P.26

Ⅱ

Ⅱ / 联系我们

全国统一服务热线：

1010 8686

本热线的服务时间为 24 小时全天候，全国范围内固定电话或手机均可拨打。非

人工服务时间或遇到疑难问题您可进行留言，我们会在一个工作日回复您。

通过专属邮箱咨询或报案 : nottingham@cpic.com.cn

短信通知：在理赔结案以后，您将收到结案通知短信，让您及时知晓理赔结果。

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

P.27 Ⅲ / 保险保障内容说明

( 货币单位 : 人民币 )

Ⅲ保险保障内容说明

3.1 保险计划

保险险种 保险内容 保险金额 保障范围

团体意外伤害保险 意外身故或伤残 200,000 意外身故或伤残

附加团体意外伤害

医疗保险（B 款）

意外门急诊 +

意外住院 50,000

赔付医保范围内金额，无免

赔额，赔付比例 100%。扩

展乙类。

团体疾病医疗保险

（B 款）

疾病门急诊 20,000

赔付医保范围内金额，拓展

门诊丙类药品费。

门诊年免赔额 500 元，赔付

比例 100%。

校医务室门诊免赔额 0 元，

日赔付限额 100 元。

住院 400,000 赔付医保范围内金额，赔付

比例 100%， 扩展乙类。

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

Ⅲ保险保障内容说明

P.28

3.2 特别约定

所有医疗保险责任所涉及的医疗费用只限于当地社会基本医疗保险可报销项目

内的费用，自费和部分自费项目本公司均不予报销。

不承担在勤工助学（非实习）期间产生的医疗保险责任。

所有医疗费用，若其它第三方支付了部分或全部费用，我司仅就剩余的、且在

当地社会基本医疗保险可报销项目范围内的合理费用予以赔付；但保险责任中

所涉及的床位费、护工费、门急诊日限额等限额部分同样受限，如第三方有赔

付比例的受限部分按照受限金额为基础扣除已赔付金额 , 我司只赔付剩余金额 ,

如无赔付比例 , 受限部分按照当地社会医疗保险的标准 , 以受限金额为基础扣除

此项目的标准金额 , 赔付剩余金额 , 并以保险金额为限。

就诊医院范围：中国大陆公立二级及二级以上医保定点医院普通部，急诊可至

就近任意公立医院，病情稳定后需转至约定医院治疗，开放宁波诺丁汉大学校

医院、浙江大学明州医院为约定医院。

但是，若被保险人是在公立医院的分院、外宾病区、VIP 病区、包房、A 等病房、

单间、特诊特需病区、特诊特需病房和高干病房等同类病区或病房接受的治疗，

则其所有的医疗费用本公司均不予报销。

既往症：承担被保险人投保前因一般既往症引起的医疗责任，不承担投保前严

重既往症及其并发症引起的医疗责任严重既往症是指：恶性肿瘤、心脏病（心

功能不全 II 级以上）、心肌梗塞、白血病、再生障碍性贫血、肝硬化、高血压

病（II 级及以上）、慢性肾脏性疾病、慢性阻塞性支气管疾病、脑血管疾病、糖

尿病、先天性疾病、精神病、癫痫、特定传染病、艾滋病、性传播疾病。

附加团体意外伤害医疗保险：扩展承担因意外伤害导致的牙科治疗责任。

注：未尽事宜以保险条款为准。 本手册内容若有争议，以中文的解释为准。

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

P.29

Ⅳ

若被保险人遭受意外伤害事故，并因本次意外伤害直接导致被保险人在该意外

伤害事故发生之日起 180 日内身故，本公司按该被保险人对应的保险金额给付

意外身故保险金，本公司对该被保险人的保险责任终止。

若被保险人遭受意外伤害，在本公司指定的医疗机构进行门（急）诊治疗，本

公司以该被保险人对应的保险金额为限，按以下公式计算并给付门（急）诊医

疗保险金：

门（急）诊医疗保险金 =（被保险人实际支出的保单签发地政府基本医疗保险

管理规定范围内符合费用标准的治疗费、检查费、手术费、药品费等四项医疗

费用的金额总和）×100%。

若被保险人遭受意外伤害事故，并因本次意外伤害直接导致被保险人在该意外

伤害事故发生之日起 180 日内发生《人身保险伤残评定标准及代码》（中国保

险监督管理委员会发布，保监发 [2014]6 号，标准编号 JR/T 0083 － 2013）中

所列的伤残条目，本公司依照该标准规定的评定原则进行评定，并按评定结果

所对应该标准规定的给付比例乘以该被保险人对应的保险金额给付意外残疾保

险金。如自意外伤害事故发生之日起 180 日治疗仍未结束的，则按事故发生之

日起第 180 日的身体情况进行伤残鉴定，并据此给付意外残疾保险金。

在任何情况下，当任何一项或数项保险金给付额累计达到该被保险人对应的保

险金额时，本公司对该被保险人的全部保险责任终止。

注：《人身保险伤残评定标准及代码》可登陆中国保险行业协会网站查看。

保险责任

Ⅳ / 保险责任

4.1 意外伤害保险金

4.2 附加团体意外伤害医疗保险

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

Ⅳ

P.30

若被保险人遭受意外伤害，在本公司指定的医疗机构进行住院治疗，本公司以

该被保险人对应的保险金额为限，按以下公式计算并给付住院医疗保险金：

在任何情况下，本公司在保险期间内对同一被保险人一次或多次累计给付的门

（急）诊医疗保险金和住院医疗保险金以该被保险人对应的保险金额为限。当

一次或累计给付的门（急）诊医疗保险金和住院医疗保险金达到该被保险人对

应的保险金额时，本公司对该被保险人的保险责任即时终止。

例如：如因磕伤、烧烫伤、崴脚、切菜不小心切着手、猫狗抓咬伤等造成意外

伤害事故的；

报销公式：合理费用合计 × 100%= 可报销金额（合理费用合计不含当地社会基

本医疗保险规定的自费及部分自费费用）。

住院医疗保险金 =（被保险人实际支出的保单签发地政府基本医疗保险管理规

定范围内符合费用标准的治疗费、检查费、手术费、药品费、床位费等五项医

疗费用的金额总和）×100%。

保险责任

若被保险人在疾病观察期后因患疾病，在本公司指定的医疗机构进行门（急）

诊治疗，本公司以每次门（急）诊给付最高限额及该被保险人对应的保险金额

为限，按以下公式计算并给付门（急）诊医疗保险金：

门（急）诊医疗保险金 =（被保险人实际支出的保单签发地政府基本医疗保险

管理规定范围内符合费用标准的治疗费、检查费、手术费、药品费等四项医疗

费用的金额总和 - 年度免赔额）。

4.2 团体门急诊医疗保险

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

P.31

若被保险人在疾病观察期后因意外或疾病，在本公司指定的医疗机构进行住院治

疗，本公司以该被保险人对应的保险金额为限，按以下公式计算并给付住院医疗

保险金：

在任何情况下，本公司在保险期间内对同一被保险人一次或多次累计给付的住

院医疗保险金以该被保险人对应的保险金额为限。当一次或累计给付的住院医

疗保险金达到该被保险人对应的保险金额时，本公司对该被保险人的保险责任

即时终止。

上述免赔额、给付比例由投保人和本公司在投保时约定。

住院医疗保险金 =（被保险人实际支出的保单签发地政府基本医疗保险管理规定

范围内符合费用标准的治疗费、检查费、手术费、药品费、床位费等五项医疗费

用的金额总和 - 免赔额）× 给付比例。

上述每次门（急）诊给付最高限额、免赔额、给付比例由投保人和本公司在投保时约定。

在任何情况下，本公司在保险期间内对同一被保险人一次或多次累计给付的门

（急）诊医疗保险金以该被保险人对应的保险金额为限。当一次或累计给付的

门（急）诊医疗保险金达到该被保险人对应的保险金额时，本公司对该被保险

人的保险责任即时终止。

年免赔额：免赔额是指被保险人在偿付开始前必须自付的费用数额。

例如：如因发烧、突然腹痛、晕倒、身体某处炎症等等在门诊或急诊进行治疗的；

报销公式：（费用总和 -500 元年度免赔额 ) × 100%= 可报销费用（合理费用

合计不含当地社会基本医疗保险规定的自费费用）。

上述免赔额、给付比例由投保人和本公司在投保时约定。

4.4 团体住院医疗保险

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

Ⅳ保险责任

V

P.32理赔申请资料

V / 理赔申请资料

险种单证名称 意外身故 意外伤残 门急诊医疗 住院医疗

理赔申请书原件 √ √ √ √

被保险人有效身份证明 √ √ √ √

受益人有效身份证明 √

受益人关系证明 √

死亡证明 √

伤残鉴定书 √

医疗费用收据原件 √ √

医疗费用结算单原件及明细清单 √ √

门急诊病历 √ √ √

出院小结 √ √

手术证明文件及相关病理显微镜检查报

告、心电图等相关检查检验报告 △ △

意外事故证明 （如是交通事故须出具交

通部门的交通事故责任认定书等） √ √ △ △

保险金转账授权书原件、银行卡复印件 √ √ √ √

以下理赔资料按第 II 章联系方式中的“理赔方式”提交。

注 :

检查检验报告时指诊断疾病必要的病理检查、血液检查、影像学检查及其他科学

方法的检查、检验结果。

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

P.33

上表“△”指如有相应材料，则需提供。

如收款账户账户名不是被保险人本人，则需提供保险金转账授权书。

法定受益人 : 被保险人身故后，有下列情形之一的，保险金作为被保险人的遗产，由本公

司依照《中华人民共和国继承法》的规定履行给付保险金的义务：

根据保险条款规定，您向本公司申请给付保险金的权利，自您知道或应当知道保险事故发

生之日起两年不行使而失效。

除上述材料外，申请人应当提供其所能提供的与证明事故原因相关的其他资料，包括申请

人能够提供的与本项保险金申请有关的诊疗资料和其他证明，如道路交通事故责任认定

书、授权委托书、事故证明、关系证明等。

- 没有指定受益人，或者受益人指定不明无法确定的；

- 受益人先于被保险人身故，没有其他受益人的；

- 受益人依法丧失受益权或者放弃受益权，没有其他受益人的。

受益人与被保险人在同一事件中身故，且不能确定身故先后顺序的，推定受益人身故在先。

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

V理赔申请资料

P.34

VI

VI / 除外责任

6.1 意外伤害保险金

因下列情形之一，导致被保险人身故、残疾或烧伤的，保险公司不承担给付保险金

的责任：

投保人对被保险人的故意杀害、故意伤害；

被保险人故意犯罪或者抗拒依法采取的刑事强制措施；

被保险人自杀，但被保险人自杀时为无民事行为能力人的除外；

被保险人醉酒，斗殴，主动吸食或注射毒品；

被保险人酒后驾驶，无合法有效驾驶证驾驶，或驾驶无有效行驶证的机动车；

被保险人因妊娠（含宫外孕）、流产、分娩（含剖宫产）导致的伤害；

被保险人因医疗事故、药物过敏导致的伤害；

被保险人因精神疾患导致的意外；

被保险人未遵医嘱，私自使用药物，但按使用说明的规定使用非处方药除外；

战争、军事冲突、暴乱或武装叛乱；

核爆炸、核辐射或核污染。

被保险人参加潜水、跳伞、攀岩、驾驶滑翔机或滑翔伞、探险、摔跤、武术比

赛特技表演、赛马、赛车等高风险活动；

除外责任Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

P.35

对下列费用，或因下列情形之一导致被保险人发生门（急）诊或住院治疗的，

保险公司不负给付保险金的责任：

对下列费用，或因下列情形之一导致被保险人发生门（急）诊治疗的，保险公

司不负给付保险金的责任：

意外伤害保险金列明的“责任免除”事项；

非因意外伤害事故而发生的治疗；

矫形、整容、美容、器官移植，或修复、安装及购买残疾用具（如轮椅、假肢、

助听器、假眼、配镜、假牙等）；

被保险人支出的医疗费用中依法已由第三者赔偿的部分。

意外伤害导致的医疗费用；

投保人的故意行为；

被保险人自致的疾病或伤害，但被保险人自杀时为无民事行为能力人的除外；

被保险人在非保险公司指定医疗机构发生的医疗费用；

一般健康体检、疗养、康复治疗、物理治疗、心理咨询或治疗；

6.2 附加团体意外伤害医疗保险

6.3 团体门急诊医疗保险

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

VI除外责任

P.36

被保险人投保前已有的残疾、未告知的既往症以及保险单特别约定除外的疾病；

被保险人违法、犯罪或者抗拒依法采取的刑事强制措施；

因被保险人挑衅或故意行为而导致的打斗、被袭击或被谋杀；

被保险人未遵医嘱，私自服用、涂用、注射药物；

被保险人用于矫形、整容、美容，或修复、安装、购买残疾用具（如轮椅、假肢、

助听器、配镜、假眼、假牙等）的费用；

被保险人怀孕、流产、堕胎、分娩（含剖腹产）、避孕、节育绝育手术、治疗

不孕不育症、人工受孕，或由前述情形导致的并发症；

被保险人进行一般健康检查、疗养、康复治疗、心理咨询或治疗，或进行以捐

献身体器官为目的的医疗行为；

被保险人进行潜水、跳伞、滑雪、滑水、滑翔、狩猎、攀岩、探险、武术、摔跤、

特技、赛马、赛车、蹦极等高风险运动和活动；

被保险人先天性畸形、变形和染色体异常（以世界卫生组织颁布的《疾病和有

关健康问题的国际统计分类（ICD － 10）》为准）；

被保险人患性病、精神和行为障碍（以世界卫生组织颁布的《疾病和有关健康

问题的国际统计分类（ICD － 10）》为准）;

被保险人患椎间盘突出症（包括椎间盘膨出、椎间盘突出、椎间盘脱出、游离

型椎间盘等类型）、地方病；

被保险人患职业病；

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

VI除外责任

P.37

对下列费用，或因下列情形之一导致被保险人发生门（急）诊治疗的，保险公

司不负给付保险金的责任：

投保人的故意行为；

被保险人自致的疾病或伤害，但被保险人自杀时为无民事行为能力人的除外；

被保险人投保前已有的残疾、未告知的既往症以及保险单特别约定除外的疾病；

被保险人违法、犯罪或者抗拒依法采取的刑事强制措施；

因被保险人挑衅或故意行为而导致的打斗、被袭击或被谋杀；

被保险人进行整容、美容、矫形、外科整形手术、变性手术、预防性手术（如

预防性阑尾切除）；

恐怖袭击；

任何生物、化学、原子能武器，原子能或核能装置所造成的爆炸、灼伤、污染

或辐射 ;

被保险人在下列期间遭受伤害或罹患疾病导致发生治疗或支出费用的，保险人

也不承担给付保险金责任：

Ⅰ）被保险人精神失常或精神错乱期间；

Ⅱ）战争、军事行动、暴动或武装叛乱期间；

Ⅲ）被保险人醉酒或受毒品、管制药物的影响期间；

Ⅳ）被保险人酒后驾车、无有效驾驶证驾驶或驾驶无有效行驶证的机动车期间。

6.4 团体住院医疗保险

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

VI除外责任

P.38

被保险人未遵医嘱，私自服用、涂用、注射药物；

被保险人用于矫形、整容、美容，或修复、安装、购买残疾用具（如轮椅、假肢、

助听器、配镜、假眼、假牙等）的费用；

被保险人进行一般健康检查、疗养、康复治疗、心理咨询或治疗，或进行以捐

献身体器官为目的的医疗行为；

被保险人进行潜水、跳伞、滑雪、滑水、滑翔、狩猎、攀岩、探险、武术、摔跤、

特技、赛马、赛车、蹦极等高风险运动和活动；

被保险人先天性畸形、变形和染色体异常（以世界卫生组织颁布的《疾病和有

关健康问题的国际统计分类（ICD － 10）》为准）；

被保险人患性病、精神和行为障碍（以世界卫生组织颁布的《疾病和有关健康

问题的国际统计分类（ICD － 10）》为准）;

被保险人患职业病；

被保险人患椎间盘突出症（包括椎间盘膨出、椎间盘突出、椎间盘脱出、游离

型椎间盘等类型）、地方病；

被保险人进行整容、美容、矫形、外科整形手术、变性手术、预防性手术（如

预防性阑尾切除）；

恐怖袭击 ;

被保险人怀孕、流产、堕胎、分娩（含剖腹产）、避孕、节育绝育手术、治疗

不孕不育症、人工受孕，或由前述情形导致的并发症；

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

VI除外责任

P.39

任何生物、化学、原子能武器，原子能或核能装置所造成的爆炸、灼伤、污染

或辐射 ;

被保险人在下列期间遭受伤害或罹患疾病导致发生治疗或支出费用的，保险人

也不承担给付保险金责任：

Ⅰ）被保险人精神失常或精神错乱期间；

Ⅱ）战争、军事行动、暴动或武装叛乱期间；

Ⅲ）被保险人醉酒或受毒品、管制药物的影响期间；

Ⅳ）被保险人酒后驾车、无有效驾驶证驾驶或驾驶无有效行驶证的机动车期间。

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

VI除外责任

P.40附表对急诊的定义1

附表 1/ 对急诊的定义

急诊是指发生下述情形的就医：

高热（38.5 度以上）；

急性腹痛、剧烈呕吐、严重腹泻；

严重喘息、呼吸困难；

各种原因的休克；昏迷；癫痫发作；

急性胸痛、急性心力衰竭、严重心律失常；

高血压危象、高血压脑病、脑血管意外；

各种原因所致急性出血；急性泌尿道出积血、尿闭、血闭、肾绞痛；

各种急性中毒（如食物或药物中毒）；

脑外伤、骨折、脱位、撕裂、灼伤、或其它急性外伤；

以上内容若有争议，以中文条款解释为准。

各种有毒动物、昆虫咬伤、急性过敏性疾病；

两个月以内婴儿疾患。

五官及呼吸道、食道异物、急性眼痛、红、肿，突然视力障碍者以及眼外伤；

Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

P.41

保单号码 * 被保险人 * 联系电话

性别 □男 □女 出生日期 国 籍

* 证件类型

□身份证 □护照 * 证件号码 证件有效期

* 通讯地址 邮 编

电子邮箱

* 出险原因 : □意外 □疾病 □其他

* 申请类型 : □ 死亡 □伤残 □医疗费用 □其他

报案号 * 报案人 报案方式

报案时间 * 出险时间 * 就诊医院

* 事故描述（请写明时间 / 地点 / 发生原因 / 经过 / 结果等详情）：

注：上述内容带“*”信息必填

□ 被保险人申请（无需填写申请人信息）

□ 非被保险人申请（必须填写申请人带“*”信息）

* 申请人类型

□监护人 □其他 * 申请人 * 联系电话

* 证件类型

□身份证 □护照 * 证件号码 证件有效期

* 账户信息（必填）：

银行账户名 : 银行账号

银行信息 : 银行 分行 支行

银行所在省市 省 市

中国太平洋财产保险股份有限公司宁波分公司

意外健康险理赔申请书

附表意外健康险理赔申请书

2Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

补充说明 P.42

1、本人声明以上陈述均为事实，并无虚假及重大遗漏。

2、本人授权任何医疗机构、保险公司或其它机构、以及一切熟悉被保险人身体健康状况之人士，均可以将被保

险人身体健康状况之资料向贵公司如实提供。本授权之影印件亦属有效。

3、转账授权声明：本人同意贵公司将理赔金转入“理赔申请书”所提供的银行账户中。本人声明上述银行账户

确为申请人本人或受托人的账户，开户行名称、户名和账号均真实有效，本人同意承担因银行账户提供错误而导

致转账失败而产生的法律、经济责任。

4、根据保险监管部门规定，以现金方式给付的保险金不得由保险代理机构、保险代理业务人员和保险营销员代领，

上述事宜本人已知晓。

* 索赔申请人签名 :

* 申请日期： 年 月 日

原件 复印件

□ 理赔申请表 份 份

□ 患者身份证明 份 份

□ 病历、出院小结 份 份

Original Copy

□ 医疗费结算明细清

单或 收据数量 份 份

□ 银行卡或存折 份 份

□ 其他 份 份

客户服务专线 :

1010 8686

以上内容若有争议，以中文条款解释为准

附表意外健康险理赔申请书

2Comprehensive Medical and Accident Insurance Handbook综合健康意外保险服务手册

中国太平洋财产保险股份有限公司

宁波分公司

邮箱：nottingham@cpic.com.cn