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招商信諾寰球至尊高端個人醫療保險(A 款)主險?

產品險種:醫療保險 ?

意外保障
住院
門診
重大疾病

保額與繳費舉例:

保障金額不是固定的,根據投保人年齡、繳費高低的不同,對應獲得的保障金額也不同,此處對一些常見情況進行列舉供您參考。

投保年齡年繳費繳費期保障項目和金額保障期
25歲26378.00元1年

孕產生育18.0萬

門診50.0萬

住院2000.0萬

1年

注:具體繳費與保額,可依個人實際情況靈活定制,以上舉例僅為參考

  • 保險責任說明條款
  • 相關咨詢
  • 包含本產品的計劃

8.1 本保險合同承擔經專科醫生建議并由我方醫療團隊所確認,因損傷
或疾病而導致的、屬于醫療必要的護理及治療費用給付責任,以及
特定服務費用給付責任。
This policy covers certain costs of services or supplies which are
recommended by a medical practitioner, and which are medically necessary
for the care and treatment of an injury or sickness, as determined by our
medical team.
8.2 保險條款中所列的費用。這些費用的支付須符合本保險合同的規定
及保險憑證所載的限額及責任免除。
The costs which are covered are set out in the provision. These costs are
subject to the limits and exclusions which are set out in the provision and
your certificate of insurance.
8.3 我方可能給予個別被保險人特別責任免除。特別責任免除詳細內容
在保險憑證上明示。
Special exclusions, imposed on an individual basis, may apply. Details of
these special exclusions will be shown on your certificate of insurance.
8.4 任何理賠均須符合既定的免賠額,以及保險條款與保險憑證所載的
給付限額。
Any claim is subject to the applicable deductible and limits of cover set out
in the provision and your certificate of insurance.
8.5 本保險合同將不承擔任何發生在保險合同開始前與終止后相關治療
的費用,即使該治療在保險合同終止前已經獲得了我方的批準。
This policy will not cover any costs relating to treatment received before the
cover starts, or after the cover ends (even if that treatment was approved by
us before the cover ends).
9. 保障選項
Coverage options
9.1 國際醫療保障為被保險人的必選保障,具體責任(參考適用的條
款、規定、限額及責任免除)詳見本保險合同中"保障利益表"所
載。
The International Medical Insurance plan is provided to every beneficiary.
The benefits which are available (subject to the applicable terms, conditions,
limits and exclusions) are set out in 'list of benefits' in the provision.
9.2 您方可以為任一被保險人選擇下述一個或以上的可選保障,以附加
于國際醫療保障,并交納相應的附加保險費:
You may (for additional premium) add to the cover provided under the
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International Medical Insurance plan by choosing one or more from the
following extra coverage options for any beneficiary or beneficiaries:
9.2.1 國際醫療補充保障;
International Medical Insurance Plus;
9.2.2 國際健康與體檢保障;
International Health and Wellbeing; and
9.2.3 國際眼科與牙科保障。
International Vision and Dental.
9.3 可選保障的保險責任具體詳見本保險合同"保障利益表"所載。
Details of the extra coverage options are set out in 'list of benefits' in the
provision.
9.4 保險期間內不能變更已選定的可選保障。如果您方希望增加或減少
可選保障選項,請于年度續保日前及時通知我方。
Coverage options cannot be changed at your request during the period of
cover. If you want to add or remove coverage options, you should let us
know before the annual renewal date.
9.5 若您方增加新的可選保障選項,請向我方提交一份詳細的健康問
卷,我方可能對您方新增的保障選項責任適用新的特殊規定或除外
責任。
If you want to add new coverage options, we may ask for a completed
medical history questionnaire, and we may apply new special restrictions or
exclusions on the new coverage options.
9.6 您方可以根據被保險人的需要來選擇以下任一保障區域:
You may choose between two options, which determine where in the world
beneficiaries will be covered.
9.6.1 全球不含美國
Worldwide, excluding USA.
9.6.2 全球含美國
Worldwide, including USA.
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招商信諾寰球至尊高端個人醫療保險(A 款)條款閱讀指引
The Reading Guide to CIGNA&CMC Individual PrivateMedical Insurance (A) Provision
本閱讀指引幫助您理解條款,若與條款沖突,以條款為準。
This guide intends to help you better understand the following policy provision. In the case of any conflicts with the policy provision, the policy provision should always be valid and binding.
........ 您所擁有的重要權益
Highlight of Your Rights
1. 本保險合同的保障人員為國籍國在大中華地區的被保險人,或者國籍國曾經在大中華地區 并且投保時在大中華地區有固定住所的被保險人。
This policy only covers beneficiaries whose country of nationality is in Great China, or beneficiaries who have ever had country of nationality in Great China and have permanent adobe in Great China while application.
若本保險合同不符合您的需求或期望,您可以在收到保險合同并書面簽收之日起10 天內聯 系我方解除本保險合同。如果尚未發生理賠、付款擔保或付款預授權,我方將無息全額退還您方已交納的全部保險費。粗體詞匯的理解請見釋義。
If the policy does not meet your needs, or has not been issued in accordance with your intention, you may ask us to cancel it within ten (10) days upon your receipt of your certificate of insurance. If no claims have been made, and no guarantees of payment or prior approvals have been put in place, we will refund any premium which has been paid and without accrued interest. Words and phrases in boldhave the meanings given to them in 'Definitions'.
2. 被保險人可以享受本保險合同提供的保障。
Beneficiaries are covered by the benefits on the policy.
........ 您應特別注意的事項
Matters for attention
1. 請您注意理解各項保險責任的保障內容,相應選擇您的保障計劃。
Pleasemake sure you know all benefits, and decide your insurance coverage accordingly.
2. 請您留意關于保險金給付限額和條件的條款。
Please pay attention to the provisions about the limits and conditions of cover.
3. 請您留意責任免除條款,尤其是已加下劃線的免除或限制我方責任的條款。
Please pay attention to the provisions about exclusions, especially those having been
underlined.
4. 請您留意保險合同中關于保險期間及合同效力終止的條款。
Please pay attention to the provisions about period of cover and policy termination.
5. 請您留意續保的條件,如果您方不愿意續保,請在保單周年日前通知我方。
Please pay attention to the renewal conditions. If you decide not to renew, please informus prior to your policy anniversary.
6. 請您留意一些重要術語的定義,如"常住國"、"日間病房治療"、"專科醫生"、"執業醫 生"等。
Please pay attention to the definitions of some key terms, such as "country of habitual
residence", "day case treatment", "specialist", "medical practitioner" and etc.
IGAB1212 寰球至尊A
........ 條款目錄
Table of contents
第一章一般條款及規定
Section 1 - General Terms and Conditions
1. 保險雙方協議
Insurance agreement
2. 保險合同構成
Policy constitution
3. 保險責任生效
When does the cover begin
4. 保險責??終止
When does the cover end
5. 保險合同續保
How is the policy renewed
6. 被保障人員
Who is covered?
7. 增減被保險人
Add or remove beneficiaries
8. 保障范圍
What is covered?
9. 保障選項
Coverage options
10. 保險費及其他費用的交納
Premium and other charges
11. 免賠額
Deductible
12. 保險合同的終止
Termination of cover
13. 明確說明和如實告知
Truthful and Full Disclosure
14. 未如實告知的處理
False or withheld information
15. 外籍常住者與本國國民
Expatriates and nationals
16. 變更地址與國籍
Changes of address and nationality
17. 聯系您方
Contacting you
18. 聯系我方
Contacting us
19. 保險合同變更
Changes to this policy
20. 保險合同執行人
Who can enforce this policy?
21. 其他保險
Other insurance
22. 資料保護
Data protection
23. 語言
Language
24. 申訴及爭議處理
Complaints & Dispute Settlement
25. 適用的法律法規
Applicable law and jurisdiction
第二章保險責任
Section 2 - Benefits
26. 國際醫療保障
International Medical Benefit
27. 國際醫療補充保障(可選保障)
International Health Insurance Plus
Option
28. 國際健康與體檢保障(可選保障)
International Health and Wellbeing Cover
Option
29. 國際眼科與牙科保障(可選保障)
International Vision and Dental Cover
Option
第三章責任免除
Section 3 - Exclusions
30. 通用責任免除
General Exclusions
第四章預先批準
Section 4 - Prior approvals
31. 預先批準清單
List of prior approvals
32. 在美國以外地區治療的預先批準
Prior approval for treatment outside the
USA
33. 在美國地區治療的預先批準
Prior approval for treatment in the USA
34. 嚴格遵從理賠流程
Strict compliance with claim procedure
第五章保險金申請
Section 5 - Claims application
35. 提供信息
Providing information
36. 訴訟時效
Claiming period
37. 美國地區治療的理賠
Claims for treatment in the United States
38. 中國大陸地區治療的理賠
Claims for treatment in Mainland China
39. 其他地區治療的理賠申請
Claims for treatment in other areas
40. 保險金的給付
How we pay claims
41. 其它核定結果
Other decisions
第六章釋義
Section 6 - Definitions
42. 術語定義
Defined terms
附件:保險利益表
Appendix: List of benefits
IGAB1212 寰球至尊A
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招商信諾寰球至尊高端個人醫療保險(A 款)條款
CIGNA&CMC Individual PrivateMedical Insurance (A) Provision
第一章一般條款及規定
Section 1 - General Terms and Conditions
1. 保險雙方協議
Insurance
agreement
根據本保險合同載明的各條款、賠付條件、賠付限額、責任免除等條款,
我方將支付在本保險合同保險期間內、所選擇保險區域內被保險人發生損
傷、疾病、懷孕及分娩而產生的醫療費用及相關費用,在扣除相應免賠額
后,以相應賠付限額為限。
Subject to the terms, conditions, limits and exclusions set out in this policy, Cigna
shall reimburse medical and related expenses relating to treatment provided within
the selected area of coverage for injury, sickness, and medical conditions relating
to pregnancy and childbirth. The treatment must occur during the period of cover,
in excess of the deductible and up to the limits of cover.
2. 保單合同構成
Policy
constitution
2.1 本保險合同由投保申請、保險憑證、保險條款等其他文件組成,請
注意詳細閱讀。
This policy consists of your application, your certificate of insurance and
this provision. They constitute the entire contract between us and you. You
should read them carefully.
2.2 如果在你發出申請到保單生效時間前,您方的健康與醫療情況發生
了變化,不同于投保時的健康告知,您方應告知我方。我方將重新
審核您方的投保申請,并可能增加(額外的)特別責任免除,或重
新評估是否承保。
You must let us know of any change in yourmedical condition which occurs
between the date of your application and the start time of your policy.We
will then review your application and may need to apply (additional) special
exclusions or review coverage acceptance.
3. 保險責任生效
When does the cover begin?
3.1 保險責任將于保險憑證首頁所載生效時間起生效,該保險憑證將發
送給您方。如果續保的,年度續保日也為每年對應的此日期,如當
月無對應的日期,則以該月的最后一日計算。
The cover will begin on the start time shown on the first certificate of
insurance which we send to you. If the policy is renewed, the annual
renewal date will fall on this date each year.
3.2 如您方選擇為其他被保險人購買本保險責任,該被保險人保障的生
效時間為其所在保險憑證首頁載明的時間,該保險憑證將發送給您
方。
If you choose to buy cover for any additional beneficiaries, their cover will
begin on the start time shown on the first certificate of insurance on which
they are listed, which we send to you.
3.3 請您務必及時向我方告知在申請日與接受承保條件日之間您方所發
生的任何醫療情況變化,我方將重新審核您方的申請,并可能增加
特別責任免除、或重新評估是否承保。
It is important that you notify us immediately of any change in your medical
condition which occurs between your application and your acceptance of
the policy. We will then review your application and may need to apply
(additional) special exclusions or review coverage acceptance.
4. 保險責任終止
When does the
4.1 本保險合同為一年期保險合同。即:除非本保險合同提前終止或本
保險合同續保,保險責任將在保單終止日終止。
This policy is an annual contract. This means that, unless it is terminated
IGAB1212 寰球至尊A
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cover end? earlier or renewed, the cover will end on the end day.
4.2 在下列情況下,保險責任自動終止:
Cover will automatically end for any beneficiary if:
4.2.1 被保險人死亡(雖然有些責任在其死亡后仍可獲賠償,如醫
療運送回國及遺體運送回國),對該被保險人的保險責任終
止;或
the beneficiary dies (although any benefits which may be payable
after death, such as repatriation of mortal remains, will still be
paid) ,the insurance liabilities for the corresponding insured will
terminate; or
4.2.2 本保險合同被終止。您方及我方可終止本保險合同的情形請
見第12 條。
the policy is terminated. The circumstances in which you or we can
terminate the policy are explained in provision 12.
4.3 如果投保人死亡,所有被保險人的保障將在投保人已繳保險費所對
應的期間屆滿時終止。在這樣的情況下,我方將嘗試聯系本保單下
的所有被保險人,允許他們選擇其中的一位作為新的投保人、如此
則所有被保險人的保障將延續到保單終止日。如果被保險人確實希
望延續保障,他們必須在30 天內書面確認他們同意延續。如果被保
險人不希望,所有被保險人保障將在投保人已繳保險費所對應的期
間屆滿時即行終止;我方將不支付保障終止日及以后發生的醫療費
用及服務。
If you die, cover will end for all beneficiaries when the insured period
corresponding the premiums having been paid by you ends. If this happens,
we will try to contact any other beneficiaries who are covered under this
policy, and offer them the opportunity to continue the cover until the end
date, with one of them taking over as policyholder. If the beneficiary does
wish to continue the cover, they must respond, in writing, within 30 days, to
confirm their acceptance. If they do not do so, all cover will end when the
insured period corresponding the premiums having been paid by you ends,
and we will not make any payments in relation to treatment or services
which are received on or after the date on which the cover ends.
4.4 如果在保險終止日前本保險合同提前終止,只要被保險人在終止日
前沒有進行理賠、付款擔保或預先批準,我方將向您方退還未滿期
凈保費。
If this policy ends before the normal end date, unearned net premiumwill
be refunded on a pro rata basis, so long as no claims have been made and no
guarantees of payment or prior approvals have been put in place during the
period of cover.
5. 保險合同續保
How is the policy
renewed?
5.1 我方將在本保單終止日前至少一個月前書面詢問您是否希望續保當
前保單。我方將同時告知您續保后保費的變化及續保的承保條件。
We will write to you at least one month before the end date and ask you
whether you want to renew the cover you currently have. We will also
inform you of any changes to the premiums or terms and conditions which
would apply on renewal.
5.2 如果您方同意續保,您方無需給予任何反應,您的保障將延續12 個
月。續保所依據的是在續保時我方生效的術語定義、保險條款、保
障利益等。如果我方不同意繼續承保,我方將根據后面12.6 條款通
知您方。如果您方不同意續保,您方須在保單終止日前至少7 天通
知我方。
If you choose to renew, you do not need to do anything, and your cover will
IGAB1212 寰球至尊A
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be renewed automatically for another 12 months. Renewal is subject to the
definitions, benefits and terms of the provision in force at the time of
renewal. If we are unable to renew your cover, we will give you notice as
described in paragraph 12.6. If you do not want to renew your cover, you
must let us know at least seven days before your policy end date.
5.3 如果您方不同意續保,本保險合同將不延續。本保險合同符合條件
的各被保險人可以申請為自己投保。我方將個別審核,分別告知他
們我方是否同意承保及承保條件。
If you do not renew your cover, the policy will not be renewed. Any
beneficiaries who have been covered under the policy can apply for their
own cover. We will consider their applications individually, and inform them
whether, and on what terms, we are willing to offer them such cover.
6. 被保障人員
Who is covered?
6.1 本保險合同的保障人員為國籍國在大中華地區的被保險人,或者國
籍國曾經是在大中華地區并且投保時在大中華地區有固定住所的被
保險人。在本保險合同下被保險人與受益人為同一人。
This policy only cover beneficiaries whose country of nationality is in Great
China, or beneficiaries who have ever had country of nationality in Great
China and have permanent adobe in Great China while application. Under
this policy, beneficiary is the same person as the insured person.
6.2 您方可以酌情同時為其他人員投保;如果這樣,您方需要把相應被
保險人添加在投保申請中。經我方審核同意后,該被保險人姓名將
載于保險憑證上,您方將可能承擔額外的保險費,我方可能對新增
人員適用特別責任免除。
You may arrange cover for other people at our discretion. In order to do so,
you must include them in your application. If we agree to cover them, we
will include their names on your certificate of insurance. Additional
premium may be payable, and special exclusions may be applied in relation
to them.
6.3 您方可能為他人投保,卻不為您本人投保。如果這樣,您方將作為
投保人并承擔交納本保險合同保險費及其他所有本保險合同規定的
責任,但不享有保險保障。所有的申請須經醫療核保,我方將向您
方告知我方對保險憑證上列明的被保險人的承保條件。
It is possible for you to take out cover for other people, whilst not taking out
cover for yourself. In this situation, you will be the policyholder, and will be
responsible for payment of premiums and all other obligations under the
policy, but will not be covered. All applications will be subject to medical
underwriting and we will let the policyholder know the terms that will apply
to any beneficiary named on the certificate of insurance.
6.4 投保年齡與年齡誤告的處理
Issue age and how to deal with incorrectness of age
6.4.1 被保險人在其最初生效時的年齡上限為70 周歲。并且,如
果在某被保險人最初生效時,已經包含或即將同時包含在同
一保險合同下的所有被保險人的年齡不超過18 周歲,該被
保險人在其最初生效時的年齡下限為出生后30 天。投保申
請上填寫的各被保險人的出生日期以其有效身份證件為準。
One beneficiary's oldest age at his initial start time is 70 years old.
Besides, at one beneficiary's initial start time, if all beneficiary(ies)
which have been covered or will be simultaneously covered under
the same policies are less than 18 years old, this beneficiary's
youngest age at his initial start time is 30 days of birth. The birth
date of beneficiary(ies) on your application should be based upon
IGAB1212 寰球至尊A
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effective identity card.
6.4.2 如您方申報的被保險人年齡不真實,并且其真實年齡不符合
本保險合同約定投保年齡限制的,我們有權解除保險合同,
并向您方退還未滿期凈保費。我方行使保險合同解除權,該
解除權自我方知道有解除事由之日起超過30 日不行使而消
滅。
If you provide us with an incorrect date of birth and the real age
does not comply with the eligibility requirements of this policy, we

have the right to cancel this policy. In this situation, we shall refund
the unearned net premium. The right to cancel the policy will be
rescinded after 30 days starting from the day we notice this error.
6.4.3 如您???申報的被保險人年齡不真實,致使實付保險費少于應
付保險費的,我們有權更正并要求您方補繳保險費。若已經
發生保險事故,我方有權在給付保險金時按實付保險費和應
付保險費的比例給付。
If you provide an incorrect date of birth, which directly leads to a
lower premium than it should, we have the right to make the
correction and charge the additional payment for premium
difference. In such cases, we will pay benefits on a proportional
basis (according to the difference between the true and incorrect
premium) for any insurance event prior to the date of correction.
6.4.4 如您方申報的被保險人年齡不真實,致使實付保險費多于應
付保險費的,我方會將多收的保險費無息退還給您。
If you provide an incorrect date of birth, which directly leads to
higher premium than it should be, we will refund the difference
without interest.
7. 增減被保險人
Add or remove
beneficiaries
7.1 除非發生重大人生事件,您方僅可在每一保險期間終止時增加或減
少被保險人。例如,您方的保險憑證所載生效時間為1 月1 日,您
方僅能在下一年度的1 月1 日增加或減少被保險人。
Unless there has been a relevant qualifying life event, you may add or
remove a beneficiary only when you are renewing the cover at the end of an
annual period of cover. For example, if the start time shown on your
certificate of insurance is appointed within 1 January, you may only add or
remove a new beneficiary with effect from 1 January the following year.
7.2 如果已發生重大人生事件,您方將可在保險期間中途增加或減少因
受重大人生事件影響的被保險人。如果您方需要增加被保險人,請
務必寄給我方一份載有所增加的被保險人完整信息的申請,我方將
及時通知您方是否接受此投保以及由于接受這一投保而可能需要增
加的額外責任免除、額外保險費等其他條件。新增被保險人的保險
責任將于我方確認同意接受該申請之日起生效,我方將會出具包含
該新增被保險人的保險憑證并發送給您方。
If there has been a relevant qualifying life event, you may add or remove
the other person involved in that qualifying life event as a beneficiary part
way through the period of cover. If you would like to add a new beneficiary
on this basis, you must send us a completed application for that person. We
will then tell you whether we will offer cover to that person and, if so, any
special conditions or exclusions and any additional premium which would
apply. Cover for the new beneficiary will begin from the date on which we
confirm acceptance of the application. We will send you an updated
certificate of insurance to confirm that the new beneficiary has been added.
7.3 若您或您的配偶分娩,您方可要求增加新生兒至已有的保險責任
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中:
If you or your spouse gives birth, you may apply to add the newborn as a
beneficiary to your existing plan:
7.3.1 如在新生兒出生前的10 個月或更長期間內,其父母中至少
有一位已經持續有效地作為我方被保險人,并且我方在該新
生兒出生后7 天內收到該新生兒的投保申請的,該新生兒將
無須經醫療核保,我方不要求新生兒的健康或醫療信息。根
據您的選擇,該新生兒的保險責任將于其出生之時或我方確
認收到該申請之日起生效。我方將把更新的保險憑證發送給
您方。
If at least one parent has been covered by the policy for a
continuous period of 10 months or more prior to the newborn's
birth and the application is received by us within 7 days of the
newborn's date of birth, the newborn will not be subject to medical
underwriting, we will not require information regarding the
newborn's health or a medical examination, and according to your
preference, the cover will begin at the newborn's birth or our
confirmation of receiving the application. We will send you an
updated certificate of insurance confirming that the new
beneficiary has been added.
7.3.2 如在新生兒出生前的10 個月或更長期間內,其父母中至少
有一位已經持續有效地作為我方被保險人,并且我方在該新
生兒出生后8-30 天內收到該新生兒的投保申請的,該新生兒
將無須經醫療核保,我方不要求新生兒的健康或醫療信息,
該新生兒的保險責任將于我方確認收到該申請之日起生效。
我方將把更新的保險憑證發送給您方。
If at least one parent has been covered by the policy for a
continuous period of 10 months or more prior to the newborn's
birth and the application is received by us from 8 to 30 days of the
newborn's date of birth, the newborn will not be subject to medical
underwriting, we will not require information regarding the
newborn's health or a medical examination, and cover will begin
when we confirm receipt of the application. We will send you an
updated certificate of insurance confirming that the new
beneficiary has been added.
7.3.3 如在新生兒出生前的10 個月或更長期間內,其父母中至少
有一位已經持續有效地作為我方被保險人,并且我方在該新
生兒在出生30 天后才收到該新生兒的投保申請的,則該新
生兒須經醫療核保。我方將及時通知您方是否同意增加,以
及適用于該被保險人的特別條件及特別責任免除。若您方接
受所列條件,保險責任將于我方確認同意接受該申請之日起
生效。我方將會提供更新的保險憑證以確認新增被保險人并
發送給您方。
If at least one parent has been covered by the policy for a
continuous period of 10 months or more prior to the newborn's
birth and the application is received by usmore than 30 days after
the newborn's date of birth, the newborn will be subject to medical
underwriting. We will then tell you whether we will offer cover to
the newborn and, if so, any special conditions and exclusions which
would apply. If you accept the offered terms, cover will begin when
we confirm acceptance of the application.We will send you an
updated certificate of insurance confirming that the new
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6
beneficiary has been added.
7.3.4 如果新生兒的父母中沒有一位能滿足"在新生兒出生前的10
個月或更長期間內,已經持續有效地作為我方被保險人"的條
件。該新生兒則須經醫療核保。我方將及時通知您方是否同
意增加,以及適用于該被保險人的特別條件及特別責任免
除。若您方接受所列條件,保險責任將于我方確認同意接受
該申請之日起生效。我方將會提供更新的保險憑證以確認新
增被保險人并發送給您方。
If neither parent has been covered by the policy for a period of 10
consecutive months or more prior to the newborn's birth, the
newborn will be subject to medical underwriting. We will then tell
you whether we will offer cover to the newborn and, if so, any
special conditions and exclusions which would apply. If you accept
the offered terms, cover will begin when we confirm acceptanceof
the application. We will send you an updated certificate of
insurance confirming that the new beneficiary has been added.
8. 保障范圍
What is covered?
8.1 本保險合同承擔經專科醫生建議并由我方醫療團隊所確認,因損傷
或疾病而導致的、屬于醫療必要的護理及治療費用給付責任,以及
特定服務費用給付責任。
This policy covers certain costs of services or supplies which are
recommended by a medical practitioner, and which are medically necessary
for the care and treatment of an injury or sickness, as determined by our
medical team.
8.2 保險條款中所列的費用。這些費用的支付須符合本保險合同的規定
及保險憑證所載的限額及責任免除。
The costs which are covered are set out in the provision. These costs are
subject to the limits and exclusions which are set out in the provision and
your certificate of insurance.
8.3 我方可能給予個別被保險人特別責任免除。特別責任免除詳細內容
在保險憑證上明示。
Special exclusions, imposed on an individual basis, may apply. Details of
these special exclusions will be shown on your certificate of insurance.
8.4 任何理賠均須符合既定的免賠額,以及保險條款與保險憑證所載的
給付限額。
Any claim is subject to the applicable deductible and limits of cover set out
in the provision and your certificate of insurance.
8.5 本保險合同將不承擔任何發生在保險合同開始前與終止后相關治療
的費用,即使該治療在保險合同終止前已經獲得了我方的批準。
This policy will not cover any costs relating to treatment received before the
cover starts, or after the cover ends (even if that treatment was approved by
us before the cover ends).
9. 保障選項
Coverage options
9.1 國際醫療保障為被保險人的必選保障,具體責任(參考適用的條
款、規定、限額及責任免除)詳見本保險合同中"保障利益表"所
載。
The International Medical Insurance plan is provided to every beneficiary.
The benefits which are available (subject to the applicable terms, conditions,
limits and exclusions) are set out in 'list of benefits' in the provision.
9.2 您方可以為任一被保險人選擇下述一個或以上的可選保障,以附加
于國際醫療保障,并交納相應的附加保險費:
You may (for additional premium) add to the cover provided under the
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7
International Medical Insurance plan by choosing one or more from the
following extra coverage options for any beneficiary or beneficiaries:
9.2.1 國際醫療補充保障;
International Medical Insurance Plus;
9.2.2 國際健康與體檢保障;
International Health and Wellbeing; and
9.2.3 國際眼科與牙科保障。
International Vision and Dental.
9.3 可選保障的保險責任具體詳見本保險合同"保障利益表"所載。
Details of the extra coverage options are set out in 'list of benefits' in the
provision.
9.4 保險期間內不能變更已選定的可選保障。如果您方希望增加或減少
可選保障選項,請于年度續保日前及時通知我方。
Coverage options cannot be changed at your request during the period of
cover. If you want to add or remove coverage options, you should let us
know before the annual renewal date.
9.5 若您方增加新的可選保障選項,請向我方提交一份詳細的健康問
卷,我方可能對您方新增的保障選項責任適用新的特殊規定或除外
責任。
If you want to add new coverage options, we may ask for a completed
medical history questionnaire, and we may apply new special restrictions or
exclusions on the new coverage options.
9.6 您方可以根據被保險人的需要來選擇以下任一保障區域:
You may choose between two options, which determine where in the world
beneficiaries will be covered.
9.6.1 全球不含美國
Worldwide, excluding USA.
9.6.2 全球含美國
Worldwide, including USA.
10. 保險費及其他
費用的交納
Premium and
other charges
10.1 保險費及其他應支付的費用(如稅費),及其應支付的時間與方式
均已載明于您方的保險憑證中。
Your certificate of insurance sets out the premium and any other charges
(such as taxes) which are payable, and states when and how they must be
paid.
10.2 支付貨幣為人民幣。
Payments must be made in Chinese Yuan (CNY).
10.3 您方應準時交納保險憑證詳細載明的保險費及任何其他費用。
You are responsible for paying the premium and any other charges as
detailed on your certificate of insurance, and are also responsible for
making sure they are made on time.
10.4 如果您未支付首期保險費,本保險合同自始無效。如果您未如期繳
清到期的續期保險費,自該到期日起60 日內若發生保險事故,我方
仍負保險責任,但在給付保險金時會扣減應繳的續期保險費;超過
該到期日起60 日的24 時仍未繳清的,本保險合同效力終止。
If you do not pay first premium, this policy will be ineffective from all the
beginning. If you do not pay any following premium when it is due, we will
still be responsible for cover of treatment within the 60 days after the due
date. But we will deduct any following premium due when making payment
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8
for treatment. If the aforementioned overdue premium remains outstanding
upon the end of the 60th day after the due date, this policy will be
terminated.
10.5 我方將根據每年的醫療費用通脹情況對保險費率進行調整。我方將
在年度續保日前書面通知您方關于下一保險期間內將發生的保險費
及其他費用的變更信息。請注意每年的保險費或/及其他費用均可能
有所不同。
We will adjust the premium rates each year according to medical cost
inflation. We will write to you before the annual renewal date to tell you
about any proposed changes in premium and/or other charges which will
apply during the next period of cover. The premium and/or other charges
may vary from year to year.
11. 免賠額
Deductible
11.1 對國際醫療保障或國際醫療補充保障的支付,如果被保險人的保障
計劃中選擇了免賠額,我方將對保險期間內有關治療的每一次理賠
均扣除免賠額,直到累積免賠達到了年度免賠額。
We will reduce the amount which we will pay towards the cost of treatment
in respect of each claim which is made under the International Medical
Insurance or International Medical Insurance Plus option (if applicable) by
the amount of any deductible until the deductible for the period of cover is
reached.
11.2 免賠額將按每一被保險人、每個保險選項及每個保險期間單獨計
算。
The deductible applies separately to each beneficiary, each coverage option,
and each period of cover.
11.3 您方有對國際醫療保障及國際醫療補充保障選擇免賠???的權利,選
擇有免賠額的保險費將低于選擇無免賠額的保險費。若您方計劃選
擇免賠額,請在投保申請中注明。
You can choose to have a deductible on the International Medical Insurance
or International Medical Insurance Plus option. If you do so, your premium
will be lower than it otherwise would be. If you would like to apply a
deductible, you should tell us so in your application.
11.4 住院津貼保險責任、新生兒護理保險責任無免賠額。
No deductible applies to 'Inpatient Cash Benefits' or 'Newborn Care
Benefits'.
11.5 您方應直接負責向醫院、診所或執業醫生支付免賠額,具體金額我
方會通知您方。
You will be responsible for paying the amount of any deductible directly to
the hospital, clinic or medical practitioner. We will let you know what this
amount is.
11.6 您方可于年度續保日要求變更免賠額。如果您方希望取消或減少您
方的免賠額,我方有可能要求您方提供健康問卷,并可能附加特別
承保條件或特別責任免除。
You can request a change to the deductibles with effect from your annual
renewal date each year. If you wish to remove or reduce your deductible,
we may require a medical history questionnaire, and we may apply new
special restrictions or exclusions.
12. 保險合同的終

Termination of
cover
12.1 在下面情況下,我方將終止保險合同:
We may terminate this policy if:
12.1.1 在續期保險費或其他應繳的費用(包括稅收等)的應繳日期
后60 天內,未及時支付上述費用。如果我方因為此原因解
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9
除本保險合同,我方將書面向您方發出通知。本保險合同不
承擔任何發生在保險合同開始前與終止后相關治療的費用,
即使該治療已經在保險合同終止前獲得了我方的批準;或
any premium or other charge (including any relevant tax) is not paid
in full within 60 days of the date on which it is due. We will give you
written notice if we are going to terminate the policy for this
reason. This policy will not cover any costs relating to treatment
received before the cover starts, or after the cover ends (even if
that treatment was approved by us before the cover ends); or
12.1.2 本保險合同所提供的保障違反了相關法律法規;或
it becomes unlawful for us to provide any of the cover available
under this policy; or
12.1.3 被監管機構處罰而不適宜成為被保險人;或
any beneficiary is identified on any sanctions listings of regulator; or
12.1.4 向我方告知的信息存在信息誤導,或因不如實告知而影響到
我方對本保險合同所承保風險的評估。
we have been given misleading information or not told something
which we should have been told which would have affected our
assessment of the risks to be insured under this policy.
12.2 猶豫期內解除保險合同
Cancellation during cooling off period
12.2.1 若本保險合同未能滿足您方的需求,或達不到您方的預期,
您可以在收到保險合同并書面簽收之日起10 天內聯系我方
并取消本保險合同。如果在此期間內未發生理賠、付款擔保
或未取得預先批準,我方將全額退還您方已交納的全部保險
費。
If the policy does not meet your needs, or has not been issued in
accordance with your intention, you may ask us to cancel it within
ten (10) days upon your receipt of your certificate of insurance. If
no claims have been made, and no guarantees of payment or prior
approvals have been put in place, we will refund any premium
which has been paid.
12.3 如果您方計劃解除本保險合同及所有被保險人的保障,請至少提前7
天書面通知我方。
If you want to terminate this policy and end cover for all beneficiaries, you
may do so at any time by giving us at least seven days' notice in writing.
12.4 如您方要求在保單終止日前解除本保險合同,只要確認在此保險期
間內無理賠、付款擔保或預授權審核,我方將向您方退還未滿期凈
保費。
If this policy ends before the normal end date, unearned net premiumwill
be refunded, so long as no claims have been made and no guarantees of
payment or prior approvals have been put in place during the period of
cover.
12.5 即使某項治療已經獲預先審核同意,如果該項治療的發生在保險合
同終止或某被保險人離開保單之后,我方不承擔該項費用。
If treatment has been authorised, Cigna will not be held responsible for any
treatment costs if the policy ends or a beneficiary leaves the policy before
treatment has taken place.
12.6 如果我方不同意續保本保險合同,我方將在保單到期前至少一個月
書面通知您本保險合同在保單期滿后不再續保。
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We will wherever possible, write to you at least one month before the end
date to give you written notice that the policy will not be renewed with
effect from the end date.
13. 明確說明和如
實告知
Truthful and Full
Disclosure
訂立本保險合同時,我方應向投保人明確說明本保險合同的條款內容。對
保險條款中免除責任的條款,我方在訂立保險合同時應當在投保申請、保
險憑證或者其他保險憑證上作出足以引起投保人注意的提示,并對該條款
的內容以書面或者口頭形式向投保人作出明確說明,未作提示或者明確說
明的,該條款不產生效力。我方可以就投保人、被保險人或家屬的有關情
況提出書面詢問,投保人應當如實告知。
When concluding the policy, the company shall explicitly describe the contents of
the policy provision and conditions to the policyholder for the insurance. Especially
for the exclusion clauses, the company shall have striking notes in application form,
certificate of Insurance and other documents, as well as make clear explanations to
the applicant in oral or written; otherwise, the exclusion clauses won't be effective.
We may put forward written inquiry about the relevant information of the
policyholder and each beneficiary. The policyholder shall disclose the information
fully and truthfully.
14. 未如實告知的
處理
False or withheld
information
14.1 投保人故意或者因重大過失未履行如實告知義務,足以影響我方決
定是否同意接受投保申請或者提高保險費率的,我方有權解除本保
險合同。
If the policyholder intentionally or due to gross negligence, fails to perform
the duty of truthful and full disclosure, which suffices to influence our
decision as to whether to accept the application or to raise the insurance
premium rate, we have the right to terminate the policy.
14.2 投保人故意不履行如實告知義務的,我方對于本保險合同解除前發
生的保險事故,不負擔保險責任的給付,不退還保險費。
If the policyholder fails to perform its obligation of truthful and full
disclosure intentionally, we shall not be liable to pay insurance benefits or
refund the insurance premiums for insured events that occurred before the
termination of the policy.
14.3 投保人因重大過失未履行如實告知義務,對保險事故的發生有嚴重
影響的,我方對本保險合同解除前發生的保險事故,不負擔保險責
任的給付,但退還未滿期凈保費。
If the policyholder fails to perform the duty of truthful and full disclosure
due to gross negligence, which failure has a material bearing on the
occurrence of an insured event, we have the right to terminate the policy,
and shall not be liable to pay insurance benefits for the insured events that
occurred before the termination of the policy, but shall refund the unearned
net premium.
14.4 我方在保險合同訂立時已經知道投保人未如實告知的情況的,不會
解除保險合同;發生保險事故的,我方承擔給付保險金的責任。
When concluding the policy, we have aware that the policyholder fails to
perform the duty of truthful and full disclosure, we shall not terminate the
policy; and shall pay insurance benefits for occurred events which are
covered in the benefit coverage.
14.5 上述規定的保險合同解除權,自我方知道有解除事由之日起,超過
三十日不行使而消滅。
The right to terminate the policy as specified in the preceding paragraph
shall be extinguished if it is not exercised within 30 days after the date on
which we learnt of the reason for termination.
15. 本國國民及常 15.1 被保險人須在投保申請時告知其常住地地址,我方將其常住地所在
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住國
Nationals and
country of
habitual
residence
的常住國作為保費計算的必要依據之一。
Beneficiaries are required to fill in the application form about the habitual
residence; we will calculate out due premium according to country of
habitual residence as one necessary factor.
15.2 被保險人變更常住國的,根據新常住國法律法規,我方保留要求您
方補充個人信息、變更/終止保障、或改變保費的權利。如果保費有
所增加,我方將提供終止保險合同的選擇給您方。如果保險合同在
保單終止日前終止,只要在此期間內未發生任何理賠、付款擔保或
未取得預先批準,我方將向您方退還未滿期凈保費。
We reserve the right to ask you for further information, to vary or end the
cover, or to vary the premium if any beneficiary changes their country of
habitual residence, having regard to the laws and regulations of the new
country of habitual residence. If the premium increases, we will give you the
option to terminate the policy. If the policy is terminated before the end
date, unearned net premiumwill be refunded, so long as no claims have
been made, and no guarantees of payment or prior approvals have been put
in place during the period of cover.
16. 變更地址與國

Changes of
address and
nationality
16.1 我方將按您方投保申請上載明的地址寄送與本保險合同有關的書信
及通知。如果您方及其他被保險人的地址、常住地或常住國發生了
任何變更,請務必通知我方。
We will send any communications and notices in relation to this policy to the
address which you give us in your application. Youmust tell us if you or any
other beneficiary change your address, country of habitual residence, or
nationality.
我方將給您方寄送更新信息后的保險憑證。
We will then send you an updated certificate of insurance.
16.2 ??于您方常住國或國籍國的任何變更請務必及時通知我方。
It is important that you tell us straight away if there is any change in any
beneficiary's country of habitual residence or country of nationality.
16.3 如果您方發生了常住國變更,我方將按照常住國變更后對應的保費
進行調整。
if your country of habitual residence be changed, we will charge or refund
the premium difference accordingly.
16.4 如果您方在一個保險年度內在常住國外的某國家停留超過90 天,我
方將視為您常住國臨時變更;由此應該補繳保費的,在理賠前必須
先補繳保費。
If you visit a country other than your country of habitual residence for more
than 90 days, we will regard this as a change to your country of habitual
residence. Any premium shortfall should be made up before any claim
settlements.
16.5 在某些情況下,如果變更常住國將致使原有保障違反當地醫療保健
監管規定,我方有可能需要終止保險責任,具體的規定可能根據不
同國家及/或不同時期而變化。
In some instances, we may need to end the cover if such a change of country
of habitual residence would result in a breach of regulations governing the
provision of healthcare cover to local nationals, residents or citizens. The
details of regulations vary from country to country and may change from
time to time.
17. 聯系您方
Contacting you
如果我方需要就本保險合同的有關事宜聯系您方,或通知將終止或修改本
保險合同,我方將依據您方保險憑證載明的最新地址寄送書面通知,并視
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為已送達給您方。
If we need to contact you in relation to this policy, or if we need to give you notice
that we are going to amend or terminate this policy, we will write to you at the
address which you gave us in the latest certificate of insurance, and all notices sent
will be considered delivered..
18. 聯系我方
Contacting us
18.1 在本規則所述中的某些情況下,如果您需要書面聯系我方,請按照
您方持有的成員身份卡上的地址或電子郵箱地址向我方寄送相關資
料:
In some circumstances, which are explained in these rules, youmay need to
contact us in writing. If so, you should write to us or email us at the
addresses on yourmembership ID card.
18.2 如果在其他情況下您需要聯系我方,請您發送電子郵件至您方所持
的成員身份卡上的電子郵箱地址,您也可撥打客戶服務熱線,客戶
服務熱線電話號碼載于您方持有的成員身份卡上。
In any other circumstances, you may email us at the addresses on your
membership ID card or call our Customer Care Team at the phone number
on yourmembership ID card.
19. 保險合同變更
Changes to this
policy
19.1 除我方授權代表以外,任何人均無權更改本保險合同或取消其中的
任意條款,例如:銷售代表、經紀人及其他中介方均無權擅自變更
或拓展本保險合同的任何規定。
No person other than an authorized executive officer of us has authority to
change this policy or to waive any of its provisions on our behalf, for
example, sales representatives, brokers and other intermediaries cannot
vary or extend the terms of the policy.
19.2 我方保留依照相關法律法規變更本保險合同的權利,在發生變更時
將書面通知您方。
We reserve the right to change this policy to comply with any changes to
relevant laws and regulations. If this happens, we will write and tell you of
the change.
19.3 我方同時保留變更續保條件的權利,變更將于年度續保日起生效,
我方將至少提前28 天書面通知您方。
We also reserve the right to make changes to the terms of cover on renewal.
We will give you at least 28 days' notice of such changes and the changes
will take effect from the annual renewal date.
19.4 如果有被保險人存在特別責任免除,我方將可能在年度續保日重新
對該被保險人進行評估,以決定我方是否同意去除該特別責任免
除。如果我方可能進行評估以決定是否去除特別責任免除,我方將
在保險憑證上注明此重新評估的日期。如果您方有特別責任免除需
要進行重新評估,您方應該在收到續保通知后、年度續保日前至少
14 天期間通知我方。您方應該提供或告知在保單開始日或最近續保
日后重要風險因素的變化,以便于我方對特別責任免除進行重新評
估并決定相應的保單承保條件變更。如果我方對特別責任免除進行
了變更,我方將就此變更通知您方、并且在適當的情況下將變更后
的保險憑證發送您方。特別責任免除的變更將在相關的年度續保日
后生效。我方不承諾在續保時,特別責任免除一定會去除。
If special exclusion(s) have been applied to any beneficiary there may be
occasions when we can review them at a future annual renewal date, to
consider whether we are willing to remove the exclusion. If this is the case,
we will show the exclusions review date on the certificate of insurance. You
should contact us upon receipt of the renewal notification, and at least 14
days before the annual renewal date if there is an exclusion which is due for
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review at that date. You should provide information or disclose any changes
affecting risks where such changes have occurred since the policy inception
or last renewal, whichever is the latter, to help us review the exclusion and
any change to this policy. We will then advise you of changes (if any) we
have made to the special exclusion(s) and, where appropriate, issue an
amended certificate of insurance. Amendments to special exclusion(s) will
be effective from the relevant annual renewal date.We do not guarantee
that any special exclusion(s) will be removed on review.
20. 保險合同執行

Who can enforce
this policy?
本保險合同僅對您方與我方具有法律權益,只有您方或我方是本協議的合
同執行人(即使本保險合同賦予其他被保險人進行投訴的權利)。
Only we and you have legal rights in connection with this insurance. This means
that only we or you may enforce the agreement (although we will allow anyone
who is covered under this policy to use our complaints process).
21. 其他保險
Other insurance
如果其他保險公司也為您方提供了保障,我方將與其協商具體的賠付比
例。
If another insurer also provides cover, we will negotiate with them as regards who
pays what proportion of any claim.
22. 資料保護
Data protection
22.1 出于辦理本保險合同事務、提供保險保障及其他在第22 條中所述的
目的或原因,我方需要收集及處理您方的個人資料及敏感信息,例
如:姓名、地址、出生日期、電話號碼及健康信息等等。您方對我
方出于必要而合理的需求而按第22 條約定的情形收集及處理您方的
個人資料及敏感信息的行為予以認可。
We need to collect and process personal and sensitive data relating to you,
which includes all identifiable information that relates to you for example:
name, address, date of birth, telephone numbers and details of health
information relating to you, for the purposes of administering this policy and
providing the insurance and other purposes stated in provision 22. Pursuant
to the stipulation herein and to the extent reasonably necessary for these
purposes, you consent to us collecting and processing all personal and
sensitive data relating to you.
22.2 我方將會記錄來電或去電以控制質量。
Telephone calls to and from usmay be recorded for quality control.
我方將出于履行本保險合同義務、遵守法律法規的規定、服從監管
機構、行業協會的要求等原因而使用或提供上述信息和資料,并有
可能需要與我方授權的第三方分享,在某些情況下需要傳輸資料到
中國大陸之外的地區。
The abovementioned information and data will be processed or provided by
us for reasons including carrying out our obligations, acting pursuant to laws
and regulations, or following industry regulator's and insurance association's
requests and we may need to share it with third parties authorised by us,
which may mean in certain instances we need to transfer data outside
Mainland China.
以上信息和資料的處理除應符合中國關于信息保護的法律規定外,
還須符合合同中關于機密性及安全性方面的規定。如果您方需要一
份我方持有的您方個人資料復印件,請書面告知我方您的成員編
號。我方可能對提供的信息收取合理的費用。
Such processing is subject to contractual restrictions with regard to
confidentiality and security in addition to the obligations imposed by
applicable data protection laws in China. If you would like a copy of the
information we hold about you, please write to us quoting yourmembership
number. Please note that we may charge a reasonable fee to provide this
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14
information.
22.3 為更好地防范與核查欺騙行為,我方有可能需要與其他保險商或機
構分享信息,但該分享僅限于關于欺騙或試圖欺騙行為的信息分
享,不會涉及任何被保險人醫療信息的泄露。
To help us detect and prevent fraud, we may need to share information with
other insurers or organisations. If we need to share information for this
reason, we will only share information relating to fraud or attempted fraud,
and will not share information about any beneficiary's medical history.
23. 語言
Language
我方將可能會為您方提供本保險合同文件的中文版本和英文版本并且提供
中文服務及英文服務,但條款及文件均以中文版本為準。
Youmay have asked for all of the policy documents and all communications in
relation to this policy to be provided in Chinese and English. All such documents
and communications will be provided in Chinese and English. But all benefits and
details shall always be subject to Chinese version.
24. 申訴及爭議處

Complaints &
Dispute
Settlement
24.1 任何申訴請第一時間寄送我方,具體地址載明于您方持有的成員身
份卡上:
Any complaint should in the first instance be sent to us at the addresses on
yourmembership ID card.
24.2 如果申訴未能解決時,可以從下列兩種方式中選擇一種爭議處理方
式:
If the complaint is not resolved, the parties concerned shall resort to either
of the following two dispute settlement methods:
24.2.1 因履行本保險合同發生的爭議,由當事人協商解決,協商不
成的,提交仲裁委員會仲裁;
The relevant disputing parties shall solve the disputes arising from
the performance of this policy through consultation. If the disputes
cannot be solved through consultation, they shall be submitted to
the arbitration committee for arbitration;
24.2.2 因履行本保險合同發生的爭議,由當事人協商解決,協商不
成的,依法對本保險合同有管轄權的人民法院提起訴訟。
The relevant disputing parties shall solve the disputes arising from
the performance of this policy through consultation. If the disputes
cannot be solved through consultation, a lawsuit can be submitted
to the People's Court in accordance with legal regulations.
25. 適用的法律法

Applicable law
and jurisdiction
25.1 本保險合同依據中華人民共和國法律制定,并嚴格遵循該法律。
This policy is governed by, and will be interpreted in accordance with, laws
of the People's Republic of China.
25.2 關于本保險合同的任何爭議包括合同的有效性、構成及終止條款,
將由中華人民共和國法庭管轄。
Any disputes about this policy, including disputes about its validity,
formation and termination, will be determined in the courts of People's
Republic of China.
第二章保險責任
Section 2 - Benefits
26. 國際醫療保障
International
Medical Benefit
國際醫療保障為您提供所需要的住院費用、日間病房的手術費用及病房膳
食費等費用的保障。另外,對癌癥、妊娠責任和精神心理治療,保障的范
圍包括住院費用、門診費用及日間病房費用。
International Medical Insurance protects you for as many everyday needs as
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possible including all inpatient, day-patient surgery and accommodation costs. You
will also have essential cover for cancer, maternity benefit and psychiatric
treatment on an inpatient, outpatient and day-patient basis.
26.1 住院或日間病
房的病房膳食

Accommodatio
n for inpatient
or day-patient
treatment
26.1.1 我方將支付滿足下列條件之一的費用:
We will pay for:
(a) 被保險人接受住院或日間病房治療期間的護理費、病房膳
食費;或
nursing care and accommodation whilst a beneficiary is receiving
inpatient or day-patient treatment; or
(b) 被保險人在接受門診手術時所支付的手術治療室收費。
the cost of a treatment room while a beneficiary is undergoing
outpatient surgery, if one is required.
26.1.2 僅在滿足下列全部條件時,我方才支付上述費用:
We will only pay these costs if:
(a) 被保險人接受住院治療或日間病房治療是出于醫療必要;
it is medically necessary for the beneficiary to be treated on an
inpatient or day-patient basis;
(b) 被保險人住院的時間長度是合理的;
they stay in hospital for a medically appropriate period of time;
(c) 所接受的治療由專科醫生親自執行或在其有效監控之下;
并且
the treatment which they receive is provided or managed by a
specialist; and
(d) 如果入住單人間,入住標準不超過帶獨立衛生間(或類似
設施)的標準單人房。
they stay in a standard single room with a private bathroom (or
equivalent).
26.1.3 如果有多規格的單人間病房且被保險人入住超過標準單人間規格
的病房的???我方將按照帶獨立衛生間(或類似設施)的標準單人
房的規格給付。
If a hospital's fees vary depending on the type of room which the
beneficiary stays in, then the maximum amount which we will pay is the
amount which would have been charged if the beneficiary had stayed in
a standard single room with a private bathroom (or equivalent).
26.1.4 如果主持被保險人治療的執業醫生決定需要延長留院治療時間并
超出我方的預先批準時長,或者已獲我方審核同意的治療方案將
有所變動,必須盡快向我方寄送由主持治療的執業醫生出具的醫
療報告,并載明下列全部信息:
If the treating medical practitioner decides that the beneficiary needs to
stay in hospital for a longer period than we have approved in advance, or
decides that the treatment which the beneficiary needs is different to
that which we have approved in advance, then that medical practitioner
must provide us with a report, explaining:
(a) 被保險人預期需要留院治療的時長;
how long the beneficiary will need to stay in hospital;
(b) 被保險人的診斷信息(如果診斷發生了變更);以及
the diagnosis (if this has changed); and
(c) 被保險人已經接受的治療和需要接受的治療。
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the treatment which the beneficiary has received, and needs to
receive.
26.2 手術室及麻醉
復蘇室費用
Operating
theatre and
recovery room
costs
如果相應的手術費經我方審核可賠付,我方將支付與之相關的手術室及麻
醉復蘇室費用。
We will pay any costs and charges relating to the use of an operating theatre or
recovery room, if the treatment being given is covered under this policy.
26.3 藥品費及敷料

Medicines,
drugs and
dressings
26.3.1 我方將支付被保險人接受住院治療或日間病房治療期間發生的有
處方的藥品費及敷料費;
We will pay for medicines, drugs and dressings which are prescribed for
the beneficiary whilst he or she is receiving inpatient or day-patient
treatment.
26.3.2 除非被保險人接受的是癌癥治療,否則,只有被保險人也選擇了
國際醫療補充保障,我方才支付被保險人在門診治療發生的藥品
費及敷料費。
We will only pay for medicines, drugs and dressings which are prescribed
for use at home if the beneficiary has cover under the International
Medical Insurance Plus option (unless they are prescribed as part of
cancer treatment).
26.4 重癥監護室
Intensive care
26.4.1 如符合下列全部條件,我方承擔被保險人入住重癥監護室,重癥
治療室,加護病房或冠心病監護室的費用:
We will pay for a beneficiary to be treated in an intensive care, intensive
therapy, high dependency or coronary care facility if:
(a) 此病房是為被保險人提供恰當治療的最佳場所;
that facility is the most appropriate place for them to be treated;
(b) 在此病房接受此治療是所需治療的必要部分;以及
the care provided by that facility is an essential part of their
treatment; and
(c) 在此病房所接受的治療是與被保險人病情/傷情相仿者通常
接受的治療、或相同的治療。
the care provided by that facility is routinely required by patients
suffering from the same type of illness or injury, or receiving the
same type of treatment.
26.5 父母或監護人
陪護費
Hospital
accommodatio
n for a parent
or guardian
26.5.1 如果被保險人在接受住院治療時為17 周歲或以下的未成年人,
符合下列全部條件時,我方將承擔其父母中的一位或一位法定監
護人在同一醫院中的陪同住宿費用:
If a beneficiary who is 17 years old or younger needs inpatient treatment
and has to stay in hospital overnight, we will also pay for hospital
accommodation for a parent or legal guardian, if:
(a) 該醫院可以進行陪護;且
accommodation is available in the same hospital; and
(b) 其陪同住宿費用是合理的。
the cost is reasonable.
26.5.2 僅當被保險人接受的是屬于本保險合同約定范圍內的治療時,我
方才承擔此陪護費用;
We will only pay for hospital accommodation for a parent or legal
guardian if the treatment which the beneficiary is receiving during their
stay in hospital is covered under this policy.
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17
26.6 手術的外科醫
生及麻醉師費

Surgeons' and
anaesthetists'
fees
26.6.1 我方將支付在住院、日間病房或門診發生的下列費用:
We will pay for inpatient, day-patient or outpatient costs for:
(a) 手術中發生的外科醫生及麻醉師費用;及
surgeons' and anaesthetists' surgery fees; and
(b) 手術前或手術后發生的與手術直接相關的治療(與手術同
一天發生)中的外科醫生及麻醉師費用;
surgeons' and anaesthetists' fees in respect of treatment which is
needed immediately before or after surgery (i.e. on the same day
as the surgery).
26.6.2 除非被保險人接受的是癌癥治療;否則,只有被保險人也選擇了
國際醫療補充保障,我方才支付被保險人在手術前或手術后的門
診治療費用。
We will only pay for outpatient treatments received before or after
surgery if the beneficiary has cover under the International Medical
Insurance Plus option (unless the treatment is given as part of cancer
treatment).
26.7 專科醫生診療

Specialists'
consultation
fees
26.7.1 如果滿足下列條件之一,我方將支付在醫院發生的下列專科醫生
診療費。
We will pay for consultations with a specialist during stays in a hospital
where the beneficiary:
(a) 因住院或日間病房治療而發生;
is being treated on an inpatient or day-patient basis;
(b) 因手術而發生;或者
is having surgery; or
(c) 因醫療必要而發生的診療費。
where the consultation is a medical necessity.
26.8 器官、骨髓及
干細胞移植費

Transplant
services for
organ, bone
marrow and
stem cell
transplants
26.8.1 如果滿足下列全部條件,我方將支付與器官移植直接相關的住院
醫療費用:
We will pay for inpatient treatment directly associated with an organ
transplant, for the beneficiary if:
(a) 移植是出于醫療必要;并且
the transplant is medically necessary, and
(b) 器官來源為其家屬捐獻,或具有已驗證的、合法的來源。
the organ to be transplanted has been donated by a member of
the beneficiary's family or come from a verified and legitimate
source.
26.8.2 我方將支付在住院期間發生的移植后抗排異藥物費用。
We will pay for anti-rejection medicines following a transplant, when
they are given on an inpatient basis.
26.8.3 如果滿足下列全部條件,我方將支付與骨髓及干細胞移植直接相
關的住院醫療費用:
We will pay for inpatient treatment directly associated with a bone
marrow or peripheral stem cell transplant if:
(a) 移植是出于醫療必要;并且
the transplant is medically necessary; and
(b) 骨髓或干細胞來源為其自體骨髓或干細胞,或具有已驗證
的、合法的來源。
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the material to be transplanted is the beneficiary's own bone
marrow or stem cells, or bone marrow taken from a verified and
legitimate source.
26.8.4 如果骨髓及干細胞移植是癌癥治療的一部分,則此費用將不作為
移植費用承擔,而是按照本保險合同有關癌癥治療部分的條款進
行承擔。
We will not pay for bone marrow or peripheral stem cell transplants
under this part of this policy if the transplants form part of cancer
treatment.
關于癌癥治療的內容見本條款相關部分。
The cover which we provide in respect of cancer treatment is explained
in other parts of this policy.
26.8.5 如果有捐獻者捐獻骨髓或器官給被保險人,我方將承擔:
If a person donates bone marrow or an organ to a beneficiary, we will
pay for:
(a) 獲取器官或骨髓的手術費用;
the harvesting of the organ or bone marrow;
(b) 醫療必要的組織配型檢測費用;
any medically necessary tissue matching tests or procedures;
(c) 捐獻者因捐獻行為而發生的必要醫院收費;及
the donor's hospital costs; and
(d) 捐獻者因捐獻而發生的并發癥治療費用,但限于捐獻進行
后30 天內的治療費用。
any costs which are incurred if the donor experiences
complications, for a period of 30 days after their procedure;
無論捐獻者是否是本保險的被保險人。
whether or not the donor is covered by this policy.
26.8.6 對本保險合同規定范圍內的捐獻者費用,如果捐獻者可以從其他
保險或費用承擔者獲得賠償或補償,我方承擔的部分相應減少。
The amount which we will pay towards a donor's medical costs will be
reduced by the amount which is payable to them in relation to those
costs under any other insurance policy or from any other source.
26.8.7 只有被保險人也選擇了國際醫療補充保障,我方才支付被保險人
或捐獻者所需要在門診進行的上述治療費用。
We will not pay for outpatient treatment for either the beneficiary or
donor, unless the beneficiary has cover under the International Medical
Insurance Plus option for the specific outpatient treatment required.
26.8.8 如果某一位被保險人捐獻器官、且受捐獻者也是本保險合同的被
保險人,我方對捐獻者的賠付僅包括摘取器官的手術費用。
If a beneficiary donates an organ, we will only pay for the harvesting of
the organ if the intended recipient is also a beneficiary under this policy.
26.8.9 我方僅支付醫療必要的移植,對其他非醫療必要的移植(如實驗
性的移植等)不予承擔。"醫療必要"的規定和限制見本保險合同
相關條款,如釋義條款。
We will consider all medically necessary transplants. Those transplants
(such as transplants which are considered to be experimental
procedures) are not covered under this policy. This is because of
conditions or limitations to coverage which are explained elsewhere in
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this policy.
26.8.10 在被保險人接受器官、骨髓或干細胞移植前需要事先通知我方并
獲得我方同意。
A beneficiary must contact us and get approval in advance before they
incur any costs relating to organ, bone marrow or stem cell donation or
transplant.
26.9 腎透析
Kidney dialysis
26.9.1 如果在被保險人的常住國內可以進行腎透析治療,我方將支付被
保險人在日間病房進行的腎透析治療。
Treatment for kidney dialysis will be covered if such treatment is
available in the beneficiary's country of residence. We will pay for this on
a day-patient basis.
26.9.2 對被保險人到其常住國外的所選擇保障區域內進行的腎透析治
療,我方支付其在日間病房進行的腎透析費用,但不承擔其旅行
費用。
We will pay for kidney dialysis treatment outside the beneficiary's
country of habitual residence if the country where that treatment is
provided is within the beneficiary's selected area of coverage. We will
pay for this on a day-patient basis. We will not pay travel costs.
26.10 病理檢測、放
射檢查及其他
診斷性檢查化

Pathology,
radiology and
other
diagnostic tests
26.10.1 我方將支付:
We will pay for:
(a) 病理檢測;
pathology tests;
(b) 放射學檢查;及
radiology; and
(c) 診斷性檢查化驗;
diagnostic tests;
但應符合:這些檢查化驗是醫療必要的、并且是在被保險人進行
住院或日間病房治療時由專科醫生明確要求進行。
where they are medically necessary and are recommended by a
specialist as part of a beneficiary's hospital stay for inpatient or daypatient
treatment.
26.11 住院及日間病
房發生的物理
治療及補充治

Inpatient and
day-patient
physiotherapy
and
complementary
therapies
26.11.1 我方將支付:
We will pay for:
(a) 專科物理治療師進行的物理治療;及
treatment provided by physiotherapist and
(b) 專業補充治療師(專業針灸師、專業順勢治療師及專業中
醫醫生等)進行的專業補充治療;
complementary therapists (acupuncturists, homeopaths, and
practitioners of Chinese medicine);
但應符合:這些治療在被保險人進行住院或日間病房治療期間由
專科醫生明確要求進行(但該被保險人不能主要因為接受這些治
療而進行此住院或日間病房治療)。
if these therapies are recommended by a specialist as part of the
beneficiary's hospital stay for inpatient or day-patient treatment (but
are not the primary treatment which they are in hospital to receive).
26.12 核磁共振、計
算機斷層掃描
及正電子發射
26.12.1 我方將支付:
We will pay for:
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斷層掃描
MRI, CT & PET
scans
(a) 核磁共振;
magnetic resonance imaging (MRI);
(b) 計算機斷層掃描;和/或
computed tomography (CT ); and / or
(c) 正電子發射斷層掃描;
positron emission tomography (PET );
但應符合:這些檢查是在被保險人進行住院、日間病房治療或門
診期間由專科醫生明確要求進行。
if they are recommended by a specialist as a part of a beneficiary's
inpatient, day-patient or outpatient treatment.
26.13 家庭護理
Home nursing
26.13.1 如果滿足下列全部條件,我方將支付被保險人每年最長30 天的
家庭護理費用:
We will pay for a beneficiary to have up to 30 days of home nursing care,
per period of cover, if:
(a) 被保險人進行可獲本??險合同賠償的住院或日間病房治療
期間由專科醫生明確要求進行;
it is recommended by a specialist following inpatient or daypatient
treatment which is covered by this policy;
(b) 在被保險人出院后立即開始;并且
it starts immediately after the beneficiary leaves hospital; and
(c) 進行家庭護理可以實質減少被保險人繼續在醫院就醫的時
間。
it reduces the length of time for which the beneficiary needs to
stay in hospital.
26.13.2 我方將只支付符合下列全部條件的家庭護理:
We will only pay for home nursing if:
(a) 由具有合格資質的專職護士提供;
it is provided in the beneficiary's home by a qualified nurse;
(b) 護理的內容須是醫療必要的護理,且這些護理通常在醫院
才能提供的服務。我方不支付非醫療性質的護理或私人服
務。
it comprises medically necessary care that would normally be
provided in a hospital. We will not pay for home nursing which
only provides non-medical care or personal assistance.
26.14 康復治療
Rehabilitation
treatment
26.14.1 我方將支付在被保險人遭受損傷(如中風或脊髓損傷等)后由專
科醫生明確要求進行的醫療必要的康復治療,包括理療、職業治
療及言語治療等。每一保險期間內,對單一原因導致的康復治
療,我方最多支付30 天的費用,包括病房膳食費和生活費。
We will pay for rehabilitation treatments (physical, occupational and
speech therapies) which are recommended by a specialist and are
medically necessary after a traumatic event such as a stroke or spinal
injury. This includes up to 30 days accommodation and living costs, per
period of cover, for each separate condition which requires
rehabilitation treatment.
26.14.2 若在整形外科治療后、或脊髓/神經系統疾病治療后由專科醫生明
確為有醫療必要進行康復治療,并且經我方預先審核批準后,我
方可以承擔超過30 天的康復治療費用。
If the rehabilitation treatment is required following an orthopaedic,
IGAB1212 寰球至尊A
21
spinal or neurological event, we will, subject to prior approval being
obtained prior to the commencement of any treatment pay for
rehabilitation treatment for more than 30 days, if further treatment is
medically necessary and is recommended by the treating specialist.
26.14.3 對"30 天"限制的計算:
In determining when the 30 day limit has been reached:
(a) 如果被保險人住院進行康復治療的,每在醫院過一個夜晚
計作"一天";并且
we count each overnight stay during which a beneficiary receives
inpatient treatment as one day; and
(b) 如果被保險人在門診或日間病房部進行康復治療的,每一
個發生門診或日間病房治療的日歷日計作"一天"。
we count each day on which a beneficiary receives outpatient and
day-patient treatment as one day.
26.14.4 我方將只支付符合下列全部條件的康復治療:
We will only pay for rehabilitation treatment if:
(a) 導致康復治療的疾病本身也在本保險合同可賠償范圍內;
并且
it is needed after, or as a result of, treatment which is covered by
this policy; and
(b) 康復治療開始的時間在導致康復治療的疾病治療結束后30
天內。
it begins within 30 days of the end of that original treatment.
26.14.5 所有的康復治療必須經我方事先審核同意,且須由治療的專科醫
生向我方出具包含下列全部內容的證明資料:
All rehabilitation treatmentmust be approved by us in advance. We will
only approve rehabilitation treatment if the treating specialist provides
us with a report, explaining:
(a) 被保險人預計在醫院停留的時間;
how long the beneficiary will need to stay in hospital;
(b) 診斷;及
the diagnosis; and
(c) 被保險人已經接受的治療及需要接受的治療。
the treatment which the beneficiary has received, or needs to
receive.
26.15 臨終關懷及姑
息治療
Hospice and
palliative care
如果被保險人被診斷為終末期狀態,且現有醫學技術沒有有效的治療手
段,我方將支付在醫院進行臨終治療或護理而發生的病房膳食費、護理
費、處方藥品費、理療及心理關懷等。
If a beneficiary is given a terminal diagnosis, and there is no available treatment
which will be effective in aiding recovery, we will pay for hospital or hospice care
and accommodation, nursing care, prescribed medicines, and physical and
psychological care.
26.16 修復體、設備
及裝置
Prosthetics,
devices and
appliances
內置修復體、設備及裝置
Internal prosthetics devices and appliances
26.16.1 我方將支付為了對被保險人進行治療、在手術過程中植入被保險
人體內的修復體、設備及裝置。
We will pay for internal prosthetic implants, devices or appliances which
IGAB1212 寰球至尊A
22
are put in place during surgery as part of a beneficiary's treatment.
外置修復體、設備及裝置
External prosthetics devices and appliances
26.16.2 我方將支付為了對被保險人進行治療所必不可少的、滿足下述條
件的外置修復體、設備及裝置。
We will pay for external prosthetics, devices or appliances which are
necessary as part of a beneficiary's treatment (subject to the limitations
explained below).
26.16.3 我方將支付滿足下列條件的外置修復體、設備及裝置:
We will pay for:
(a) 手術后立即需要的、醫療必要的修復性設備或裝置;
a prosthetic device or appliance which is a necessary part of the
treatment immediately following surgery for as long as is required
by medical necessity;
(b) 在病后恢復階段內短期內需要的、醫療必要的修復性設備
或裝置。
a prosthetic device or appliance which is medically necessary and
is part of the recuperation process on a short-termbasis.
26.16.4 對17 周歲及以上的被保險人,每一保險期間我方最多承擔一個
外置修復體、設備或裝置。
We will pay for one external prosthetic device for beneficiaries aged 17
or over per period of cover.
26.16.5 對16 周歲及以下的被保險人,每一保險期間我方最多承擔一個
外置修復體、設備或裝置的初裝費用、及兩次更換費用。
We will pay for an initial external prosthetic device and up to two
replacements for beneficiaries aged 16 or younger per period of cover.
26.17 當地救護車及
空中救援服務
Local
ambulance and
air ambulance
services
26.17.1 如為醫療必要,我方將支付下列運送被保險人的當地救護車費
用:
Where it is medically necessary, we will pay for a local ambulance to
transport a beneficiary:
(a) 從意外或損傷發生地到醫院;
from the scene of an accident or injury to a hospital;
(b) 從一醫院轉送另一醫院;或者
from one hospital to another; or
(c) 從其家???到醫院。
from their home to a hospital.
26.17.2 只有在當地救護車的使用是為了到醫院進行醫療性質的治療時,
我方才支付其費用。
We will only pay for a local ambulance where its use relates to treatment
which a beneficiary needs to receive in hospital.
26.17.3 如為醫療必要,我方將支付下列運送被保險人的空中救援費用:
Where it is medically necessary, we will pay for an air ambulance to
transport the beneficiary:
(a) 從意外或損傷發生地到醫院;或者
from the scene of an accident or injury to a hospital; or
(b) 從一醫院轉送另一醫院。
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from one hospital to another.
空中救援的使用適用下列條件及限制:
Air ambulance cover is subject to the following conditions and limitations:
26.17.4 某些情況下,空中救援的使用是不可能的、無法操作的或有難以
承擔的風險。在這些情況下我方將不予安排或支付空中救援。另
外,空中救援需要適用下列兩項條件。因而,即使滿足醫療必要
的條件,本保險合同并不保證任何情況下被保險人一定可以得到
空中救援的服務;
In some situations it will be impossible, impractical or unreasonably
dangerous for an air ambulance to operate. In these situations, we will
not arrange or pay for an air ambulance. This policy does not guarantee
that an air ambulance will always be available when requested, even if it
is medically appropriate;
(a) 我方可支付的空中救援最長運送距離是100 公里(160 英
里);并且
we will only pay for an air ambulance to transport a beneficiary
for distances up to 100 miles (160 kilometres); and
(b) 只有在空中救援的使用是為了到醫院進行醫學治療時,我
方才支付其費用。
we will only pay for an air ambulance where its use relates to
treatment which a beneficiary needs to receive in hospital.
26.17.5 本保險合同不承擔山地救援的服務。
This policy does not provide cover for mountain rescue services.
26.17.6 本保險合同不承擔國際緊急救援服務。
This policy does not provide cover for international emergency services.
26.18 住院津貼
Inpatient Cash
Benefit
如果被保險人進行可獲本保險合同賠償的住院治療,但未就任何病房膳食
費、治療等醫療費用進行理賠,我方將向被保險人支付住院津貼。
We will make cash payments directly to a beneficiary who has received inpatient
treatment but has not been charged for that treatment or for accommodation, if
the treatment is covered under this policy.
26.19 住院緊急牙科
治療
Emergency
inpatient dental
treatment
如果被保險人在住院期間由主持治療的專科醫生明確要求因牙科緊急癥狀
需要在住院期間進行緊急牙科治療,我方將支付此治療(但此牙科治療不
能構成住院的主要治療,否則住院本身將不成立醫療必要性)。
We will pay for emergency dental treatment which is required by a beneficiary
while they are in hospital as an inpatient, if that emergency inpatient dental
treatment is recommended by the treating medical practitioner because of a
dental emergency (but is not the primary treatment which the beneficiary is in
hospital to receive).
如果住院發生的某次緊急牙科治療既可以在本保障獲償,也可以在其他保
障中獲償,則按本保障中進行賠償,而不按其他保障。
This benefit is paid instead of any other dental benefits the beneficiary may be
entitled to in these circumstances.
26.20 精神疾病或異
常治療
Treatment of
mental health
conditions and
disorders
26.20.1 我方將按照下述條件支付精神疾病或異常的治療。
Subject to the limits explained below, we will pay for the treatment of
mental health conditions and disorders.
26.20.2 我方僅支付循證治療及有醫療必要性的治療。
We will only pay for evidence-based treatment and medically necessary
treatment.
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24
26.20.3 任一保險期間內,我方支付下列兩項治療的總和不超過90 天:
We will pay for up to a combined maximum total of 90 days of:
(a) 精神疾病或異常的治療;及
treatment for mental health conditions and disorders; and
(b) 成癮性嗜好的治療;(見下述成癮性嗜好的條款)
addiction treatment (see additional treatment below);
26.20.4 在任一保險期間內,可支付的住院治療最多不超過30 天。
in any one period of cover, including up to 30 days of inpatient
treatment.
26.20.5 任意連續五年時間內,我方支付下列兩項治療的總和不超過180
天:
We will pay for up to a combined maximum total of 180 days of:
(a) 精神疾病或異常的治療;及
treatment for mental health conditions and disorders; and
(b) 成癮性嗜好的治療;(見下述成癮性嗜好的條款)
addiction treatment (see additional treatment below);
例如,在某一保險期間內,某被保險人使用了90 天的精神疾病
或成癮性治療,又在隨后的保險期間內使用了90 天的精神疾病
或成癮性治療,則在再隨后的連續3 年時間里我方將不再支付任
何精神疾病或成癮性治療。
in any consecutive five year period. For example, if a beneficiary uses 90
days of psychiatric or addiction treatment in one period of cover, and 90
days of psychiatric or addiction treatment in the following period of
cover, we will not pay for any further psychiatric or addiction treatment
for the next three consecutive years of cover.
26.20.6 在確定上述"30 天"、"90 天"、"180 天"的限制時:
In determining when these 30, 90 and 180 day limits have been reached:
(a) 如果被保險人住院進行治療的,每在醫院過一個夜晚計作
"一天";以及
we count each overnight stay during which a beneficiary received
inpatient treatment as one day; and
(b) 如果被保險人在門診或日間病房進行治療的,每一個發生
門診或日間病房治療的日歷日計作"一天"。
we count each day on which a beneficiary receives outpatient
and day-patient treatment as one day.
26.21 成癮性治療
Addiction
treatment
26.21.1 我方將支付:
We will pay for:
(a) 成癮性癥狀(包括嗜酒)的診斷;及
diagnosis of addictions (including alcoholism); and
(b) 在提供此類專項治療的遵循循證治療的專業治療中心進行
的醫療必要的、并由專科醫生所明確要求的一個階段或一
個療程的成癮性治療。
one course or programme of addiction treatment at a specialist
centre providing evidence-based treatment, if that treatment is
medically necessary and recommended by a medical practitioner.
26.21.2 在正式的門診成癮治療療程前,我方最多將支付三次斷癮治療費
用。
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We pay for up to three attempts at detoxification, following which we
will only pay for further detoxification treatment if the beneficiary
completes a formal outpatient course or programme of addiction
treatment.
26.21.3 我方不承擔:
We will not pay for:
(a) 其他對酗酒、成癮性狀態的治療;或
any other treatment related to alcoholism or addiction; or
(b) 對任何并發癥的治療(包括抑郁,癡呆或肝功能衰竭
等);
treatment of any related condition (such as depression, dementia
or liver failure);
——如果我們有理由認為這些并發癥是由酗酒或成癮直接導致
的。
where we reasonably believe that the condition which requires
treatment was the direct result of alcoholism or addiction.
26.21.4 我方僅支付循證治療及有醫療必要性的治療。
We will only pay for evidence-based treatment and medically necessary
treatment.
26.21.5 在任一保險期間內,我方支付的下列兩項的共計上限為90 天:
We will pay for up to a combined maximum total of 90 days of:
(a) 成癮性治療;及
addiction treatment; and
(b) 精神疾病及異常的治療;(見前述有關部分)
treatment for mental health conditions and disorders (see
additional treatment above);
包括最多30 天的住院治療。
in any one period of cover, including up to 30 days of inpatient
treatment.
26.21.6 任意連續五年期間內,我方支付的下列兩項的共計上限為180
天:
We will pay for up to a combined maximum total of 180 days of:
(a) 成癮性治療;及
addiction treatment; and
(b) 精神疾病及異常的治療;(見前述有關部分)
treatment for mental health conditions and disorders (see
additional treatment above);
例如,在某一保險期間內,某被保險人使用了90 天的精神疾病
或成癮性治療,又在隨后的保險期間內使用了90 天的精神疾病
或成癮性治療,則在再隨后連續3 年時間里我方將不再支付任何
精神疾病或成癮性治療。
in any consecutive five year period. For example, if a beneficiary uses 90
days of psychiatric or addiction treatment in one period of cover, and 90
days of psychiatric or addiction treatment in the following period of
cover, we will not pay for any further psychiatric or addiction treatment
for the next three consecutive years of cover.
26.21.7 在確定上述"30 天"、"90 天"、"180 天"的限制時:
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In determining when these 30, 90 and 180 day limits have been reached:
(a) 如果被保險人住院進行治療的,每在醫院過一個夜晚計作
"一天";以及
we count each overnight stay during which a beneficiary receives
inpatient treatment as one day; and
(b) 如果被保險人在門診或日間病房進行治療的,每一個發生
門診或日間病房治療的日歷日計作"一天"。
we count each day on which a beneficiary receives outpatient
treatment as one day.
26.22 癌癥治療
Cancer
treatment
我方將支付對癌癥進行的積極治療及循證治療。包括:被保險人在住院、
日間病房或門診發生的化療、放療、腫瘤病理、檢查化驗及藥物等。
We will pay costs for the treatment of cancer if the treatment is considered by us
to be active treatment and evidence-based treatment. This includes
chemotherapy, radiotherapy, oncology, diagnostic tests and drugs, whether the
beneficiary is staying in a hospital overnight or receiving treatment as a daypatient
or outpatient.
26.23 生育及新生兒
護理
Parent and
baby care
常規妊娠
Routine maternity benefit care
26.23.1 如母親為被保險人,且在生育之前本保險合同連續生效達10 個
月或以上,我方將支付本保險合同連續生效10 個月后被保險人
發生的常規妊娠、常規分娩有關的下列門診及住院治療費用,包
括:
We will pay for the following parent and baby care and treatment
incurred after 10 months of start date, on an inpatient or outpatient
basis as appropriate, if the mother has been a beneficiary under this
policy for a continuous period of at least 10 months prior to the birth of
the child:
(a) 正常分娩有關的醫院收費、產科醫生及助產士費用;及
hospital, obstetricians' and midwives' fees for routine childbirth;
and
(b) 被保險人正常分娩后需要立即進行的產后護理費用。
any fees as a result of post-natal care required by the mother
immediately following routine childbirth.
復雜妊娠
Complicated maternity benefit care
26.23.2 如母親為被保險人,且在生育之前本保險合同連續生效達10 個
月或以上,我方將支付本保險合同連續生效10 個月后因被保險
人的妊娠、分娩直接導致并發癥而發生的門診及住院治療費用。
We will pay for inpatient or outpatient treatment incurred after 10
months of start date, relating to complications resulting from pregnancy
or childbirth if the mother has been a beneficiary under this policy for a
continuous period of at least 10 months prior to the birth of the child.
This is limited to conditions which can only arise as a direct result of
pregnancy or childbirth.
26.23.3 復雜妊娠責任不含家中分娩導致并發癥的情況。
This part of this policy does not provide cover for home births.
26.23.4 如因醫療必要而須進行剖腹產,我方將按照復雜妊娠承擔相應的
醫療費用。如不能證實確有必要進行剖腹產,我方將按常規妊娠
費用承擔相應的醫療費用。
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We will pay for a Caesarean section, where it is medically necessary. If
we can not confirm that it was medically necessary, we will only pay up
to the limit of the mother's routine maternity benefit care cover.
26.23.5 本保險合同不予承擔任何代孕及與代孕有關治療的保險責任。無
論代孕者是被保險人,還是被代孕者是被保險人,我方不予支付
其任何妊娠費用。
We will not pay for surrogacy or any related treatment. We will not pay
for maternity benefit care or treatment for a beneficiary acting as a
surrogate, or anyone acting as a surrogate for a beneficiary.
家中分娩
Home births
26.23.6 如母親為被保險人,且在其生育之前本保險合同連續生效達10
個月或以上,我方將支付本保險合同連續生效10 個月后發生的
與被保險人家中分娩有關的治療費用,包括助產士或其他專科醫
生費用。
We will pay midwives' and specialists' fees incurred after 10 months of
start date, relating to routine home births if the mother has been a
beneficiary for a continuous period of 10 months or more before the
birth.
26.23.7 請注意:家中分娩導致的并發癥不包含在上述復雜妊娠責任中,
而是包含在家中分娩責任中進行賠付。即,如為在家中分娩的情
況,我方對任何懷孕或分娩并發癥的費用作為家中分娩的費用、
按家中分娩的費用限額進行賠付。
Please note that the complicated maternity benefit cover explained
above does not include cover for home childbirth. This means that any
costs relating to complications which arise in relation to a home
childbirth will only be paid in accordance with the home childbirth limits,
as explained in the list of benefits.
新生兒護理
Newborn care
26.23.8 新生兒成為本合同被保險人后,我方將支付下列費用:
We will pay for:
(a) 累計不超過10 天的新生兒常規護理;以及
up to 10 days routine care for the baby following birth; and
(b) 出生后90 天內所需的所有治療。此兩項費用均在本保障中
承擔,不在其他責任中承擔。
all treatment required for the baby during the first 90 days after
birth instead of any other benefit;
對于父母親中至少一位是本保險合同被保險人,且新生兒出生前
10 個月或更長期間內其保險合同連續有效的情形:如果新生兒于
出生30 天內申請加入本保險合同,我方將不要求提供其醫療資
料、并且無須醫療核保加入本保險合同;如果新生兒于出生30
天后申請加入本保險合同,我方將要求進行醫療核保、并要求您
方完成相應的醫療健康問卷、我方有可能適用特別限制條件或特
別責任免除。
If at least one parent has been covered by the policy for a continuous
period of 10 months or more prior to the newborn's birth.We will not
require information about the newborn's health or a medical
examination if an application is received by us to add the newborn to the
policy within 30 days of the newborn's date of birth. If an application is
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received after 30 days of the newborn's date of birth, the newborn will
be subject to medical underwriting and we will require the completion of
a medical health questionnaire whereby we may apply special
restrictions or exclusions.
26.23.9 新生兒成為本合同被保險人后,我方將支付下列費用:
We will pay for:
(a) 累計不超過10 天的新生兒常規護理;以及
up to 10 days routine care for the baby following birth; and
(b) 出生后90 天內所需的所有治療。此兩項費用均在本保障中
承擔,不在其他責任中承擔。
all treatment required for the baby during the first 90 days after
birth instead of any other benefit;
如果新生兒的父母中沒有一位能滿足"在新生兒出生前10 月或更
長時間內,已經持續有效地作為我方的被保險人"的條件,而我們
收到該新生兒投保申請的:則須經醫療核保,我方將要求您方完
成其醫療及健康信息問卷。我方將根據醫療核保結果決定是否承
保及承保條件,我方有可能適用特別限制條件或特別責任免除。
If neither parent has been covered by the policy for a continuous period
of 10 months or more prior to the newborn's birth and an application is
received by us to add the newborn to the policy as a beneficiary. The
newborn will be subject to medical underwriting and we will require the
completion of a medical health questionnaire. Cover for the newborn will
be subject to medical underwriting whereby we may apply special
restrictions or exclusions.
26.23.10 所有經不育治療后出生的兒童(如試管嬰兒)、代孕者所生兒童
或領養兒童須在出生滿90 天后才可投保本保險合同。
The newborn care benefits explained above are not available for children
who are born following fertility treatment (such as IVF), are born to a
surrogate, or have been adopted. In these circumstances children can
only be covered by the policy when they are 90 days old.
除另有特別說明,為新生兒投保均須填寫健康信息問卷并經醫療
核保,我方可能根據其健康情況適用一定的特別限制條件或特別
除外責任。
Cover for the baby will be subject to completion of a medical health
questionnaire whereby we may apply special restrictions or exclusions.
26.24 先天性疾病
Congenital
conditions
26.24.1 如果被保險人18 周歲以前已經明確患有某先天性疾病,我方將
支付與該先天性疾病有關的住院或日間病房治療費用。
We will pay for treatment on an inpatient or day-patient basis of
congenital conditions which manifest themselves before the
beneficiary's 18th birthday.
26.24.2 若您方同時購買有國際醫療補充保障、國際健康與體檢保障或國
際眼科與牙科保障的保障,這些保障下所有因先天性疾病導致的
賠付總和受本責任限額的限制。
If you have cover under the International Medical Insurance Plus,
International Emergency Evacuation, International Health and Wellbeing
or International Vision and Dental options, the stated limits will apply for
cover which is available under those options.
先天性疾病詳細清單請聯系我方的客戶服務團隊進行查詢。
A full list of the conditions which we define as congenital can be obtained
from our Customer Care Team.
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26.24.3 本保障不適用于所有被保險人均不足18 周歲的保險合同。如果
訂立保險合同時所有被保險人的年齡均不足18 周歲,則先天性
疾病不在保險合同保障范圍內。
This benefit does not apply for the policies, under which all beneficiary
(ies) are less than 18 years old. If all beneficiary (ies) under one policy are
less than 18 years old when entering into the policy, then congenital
conditions are excluded from the policy.
27. 國際醫療補充
保障(可選保
障)
International
Health Insurance
Plus Option
國際醫療補充保障給予您更全面的關于門診的保障,包括:門診診療費、
門診處方藥費、門診敷料費、門診理療、門診整骨治療、門診脊椎治療、
妊娠門診費用等。
International Medical Insurance Plus covers you more comprehensively for
outpatient care and includes specialist consultations, prescribed outpatient drugs
and dressings, physiotherapy, osteopathy, chiropractic, maternity outpatient visits
and much more.
27.1 執業醫生及專
科醫生診療費
Consultations
with Medical
Practitioners
and Specialists
27.1.1 如被保險人因診斷咨詢、安排治療或接受治療,至執業醫生就
診,我方將支付該次就診的掛號費或診療費。
We will pay for consultations or meetings with a medical practitioner
which are necessary to diagnose an illness, or to arrange or receive
treatment.
27.1.2 如被保險人經專科醫生明確建議需要在門診進行醫療必要的非手
術治療,我方將支付在門診進行的該非手術治療費,包括病理
學、放射學及放射影像學。
We will pay for non-surgical treatment on an outpatient basis, which is
recommended by a specialist as being medically necessary including, but
not limited to, pathology, radiology and radiography.
27.2 門診診斷性檢
查化驗費
Outpatient
diagnostic
testing
如被保險人經執業醫生明確建議需要進行檢查或化驗以診斷或評估其疾病
狀況,我方將支付在門診發生的診斷性檢查化驗費。
We will pay for any diagnostic test that is carried out on an outpatient basis, if
recommended by a medical practitioner in order to diagnose or assess a
beneficiary's conditions.
27.3 物理治療
Physiotherapy
treatment
27.3.1 我方將支付醫療必要的、以恢復被保險人日常生活的正常生理功
能為目的的物理治療。
We will pay for physiotherapy treatment that is medically necessary,
restorative in nature to help you to carry out your normal activities of
daily living.
27.3.2 這些物理治療必須由擁有治療所在國恰當專業資格認證的合格物
理治療師進行。
The treatmentmust be carried out by a properly qualified practitioner
and holds the appropriate license to practice in the country where the
treatment is received.
27.4 正骨治療及脊
椎治療
Osteopathy and
Chiropractic
treatment
如果由執業醫生建議進行正骨治療或脊椎治療、并進行了推薦,在一個保
險期間內我方將支付總計不超過30 次的正骨治療或脊椎治療。同時,這些
治療必須是循證治療、且醫療必要的,并且主持對被保險人進行治療的專
科醫生也建議進行。這些治療必須由擁有治療所在國專業資格認證的合格
治療師進行。
We will pay for a combined maximum total of 30 consultations in any one period of
cover for osteopathy and chiropractic treatment which is evidence-based
treatment,medically necessary and recommended by a treating specialist, if a
medical practitioner recommends the treatment and provides a referral. The
treatmentmust be carried out by a properly qualified practitioner and holds the
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appropriate license to practice in the country where the treatment is received.
27.5 針灸治療、順
勢治療及中醫
治療
Acupuncture,
Homeopathy,
and Chinese
medicine
27.5.1 如果被保險人經執業醫生明確要求進行針灸治療、順勢治療或中
醫治療,在一個保險期間內我方將支付總計不超過20 次的針灸
治療、順勢治療或中醫治療。
We will pay for a combined maximum total of 20 consultations with
acupuncturists, homeopaths and practitioners of Chinese medicine for
each beneficiary in any one period of cover, if those treatments are
recommended by a medical practitioner.
27.5.2 這些治療必須由擁有治療所在國恰當的專業執業資格的合法注冊
護士進行。
We will only pay for these therapies if the practitioner is an appropriately
qualified nurse and entitled to practise in the country where treatment
is given.
27.6 言語復健治療
Restorative
Speech therapy
27.6.1 我方將支付滿足下列全部條件的言語復健治療:
We will pay for restorative speech therapy if:
(a) 言語復健治療是緊隨著可獲本保險合同賠償的治療后立即
發生的(如作為被保險人中風后續治療必要一部分的言語
治療);
it is required immediately following treatment which is covered
under this policy (for example, as part of a beneficiary's follow-up
care after they have suffered a stroke);
(b) 該治療經專科醫生明確是短期的、且是醫療必要的。
it is confirmed by a specialist to be medically necessary on a
short-termbasis.
27.6.2 我方不予承擔不是以恢復原有言語能力為目的的言語治療,如下
列任一情況:
We will only pay for speech therapy if the aim of that therapy is to
restore impaired speech function. We will not pay for speech therapy
which:
(a) 用于改善發育不完全的言語能力;
aims to improve speech skills which are not fully developed;
(b) 出于教育提高言語能力的目的;
is educational in nature;
(c) 出于維持語言交流能力為目的;
is intended to maintain speech communication;
(d) 為糾正言語障礙(例如口吃);或
aims to improve speech or language disorders (such as
stammering); or

(e) 因學習困難及發育問題引起的,例如閱讀障礙,注意力缺
陷多動障礙(ADHD)或自閉癥等。
is as a result of learning difficulties, developmental problems (such
as dyslexia), behavioural problems (such as attention-deficit
hyperactivity disorder), or autism.
27.7 藥品費及敷料

Drugs and
dressings
我方將支付被保險人在門診發生的由執業醫生開具處方的處方藥或敷料
費。
We will pay for prescription drugs and dressings which are prescribed by a medical
practitioner on an outpatient basis.
27.8 耐用醫療設備27.8.1 如果由專科醫生明確要求須租賃專用醫療設備以輔助治療被保險
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31
租賃費
Rental of
durable medical
equipment
人,每一保險期間內我方將支付最多45 天的醫療設備租賃費。
We will pay for the rental of durable medical equipment for up to 45
days per period of cover, if the use of that equipment is recommended
by a specialist in order to support the beneficiary's treatment.
27.8.2 可被支付的耐用醫療設備須滿足下列全部條件:
We will only pay for the rental of durable medical equipment which:
(a) 非一次性用品、可多次反復使用;
is not disposable, and is capable of being used more than once;
(b) 以醫療為目的;
serves a medical purpose;
(c) 適于家庭使用;并且
is fit for use in the home; and
(d) 不能用于除治療疾病或損傷以外的任何其他目的。
is of a type only normally used by a person who is suffering from
the effect of a disease, illness or injury.
27.9 成人疫苗接種
Adult
vaccinations
27.9.1 我方將支付下列疫苗或免疫費用,包括:
We will pay for certain vaccinations and immunisations namely:
(a) 破傷風(每10 年一次);
tetanus (once every 10 years);
(b) 甲肝;
hepatitis A;
(c) 乙肝;
hepatitis B;
(d) 腦膜炎;
meningitis;
(e) 狂犬病;
rabies;
(f) 霍亂;
cholera;
(g) 黃熱病;
yellow fever;
(h) 乙型腦炎;
Japanese encephalitis;
(i) 脊髓灰質炎;
polio booster;
(j) 傷寒;以及
typhoid; and
(k) 瘧疾(以片劑形式,每日或每周)。
malaria (in tablet form, either daily or weekly).
27.10 牙科意外門診
治療
Dental
accidents
27.10.1 如果被保險人因遭受意外事故而導致健康自體牙發生損傷,牙齒
損傷的治療在意外事故后立即開始、且在意外事故后30 天內完
成的,我方將支付該項牙科意外門診治療費用。
If a beneficiary needs dental treatment as a result of injuries which they
have suffered in an accident, we wiII pay for outpatient dental
treatment for any sound natural tooth/teeth or teeth damaged or
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affected by the accident, provided the treatment commences
immediately after the accident and is completed within 30 days of the
date of the accident.
27.10.2 為加快理賠過程,須同時提供進行治療的牙科醫生提供的下列全
部信息:
In order to approve this treatment, we will require confirmation from the
beneficiary's treating dentist of:
(a) 意外事故的具體日期;及
the date of the accident; and
(b) 確認所治療的牙齒為健康自體牙。
the fact that the tooth/teeth which are the subject of the
proposed treatment are sound natural tooth/teeth.
27.10.3 如果某次意外傷害的牙科治療既可以在本保障獲償,也可以在其
他保障中獲償,則按本保障中進行賠償,而不按其他保障。(但
如果也可在"住院緊急牙科治療"中獲償,則優先按"住院緊急牙科
治療"承擔賠償。)
We will pay for this treatment instead of any other dental treatment the
beneficiarymay be entitled to under this policy, when they need
treatment following accidental damage to a tooth or teeth.
27.10.4 在本項保險責任中,我方將不支付任何對種植牙、冠修復體及義
齒的修補與更換費用。
We will not pay for the repair or provision of dental implants, crowns or
dentures under this part of this policy.
27.11 兒童健康檢查
Well child tests
27.11.1 我方將支付在每一適當的年齡間隔內進行的一次兒童發育咨詢,
且終身累積不到13 次。具體包括
We will pay for one child development consultation visit at any of the
appropriate age intervals (up to a total of 13 visits for each child),
including
(a) 由執業醫生提供的下列咨詢服務:
for a medical practitioner to provide below consultations:
(i) 根據健康信息評估健康狀況;
evaluating medical history;
(ii) 體格檢查,
physical examinations;
僅包含手法檢查,或常規器械如耳鏡、口鏡、聽診器
等進行的常規檢查;不包含單獨收費的儀器檢查、專
科儀器檢查、實驗室檢驗。
only including manually, or with routine instruments such
as ear speculum, mouth mirror or stethoscope; excluding
equipment examinations which are separately charged,
equipment examinations which are done by special
laboratories, or laboratorial tests.
(iii) 發育評估;
development assessment;
(iv) 成長發育指導;以及
anticipatory guidance; and
(b) 必要的血常規、尿常規檢驗。
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appropriate routine blood test and routine urine test.
27.11.2 我方將支付5 周歲及以下兒童的一次性入學健康檢查,包括發
育、聽力和視力;
We will pay for one school entry health check, to assess growth, hearing
and vision, for each child aged 5 or younger;
27.11.3 我方將支付大于12 周歲的糖尿病患兒的一次糖尿病視網膜病變
篩查。
We will pay for one diabetic retinopathy screening for children over the
age of 12 who have diabetes.
27.12 兒童免疫
Child
immunisations
27.12.1 我方將支付17 周歲及以下兒童的下列免疫費用:
We will pay for the following immunisations for children aged 17 or
younger;
(a) 白百破(白喉、百日咳和破傷風);
DPT (diphtheria, pertussis and tetanus);
(b) MMR(麻疹、腮腺炎和風疹);
MMR (measles,mumps and rubella);
(c) B 型流行感冒嗜血桿菌;
HIB (haemophilus influenza type b);
(d) 脊髓灰質炎;
polio;
(e) 流感;
influenza;
(f) 乙肝;
hepatitis B;
(g) 水痘;
chick pox;
(h) 肺炎;
pneumonia;
(i) 腦膜炎;及
meningitis; and
(j) 人乳頭狀瘤病毒;
human papilloma virus (HPV).
27.13 每年常規檢查
Annual routine
tests
27.13.1 我方將支付15 周歲或以下兒童如下兩項費用。
We will pay for the following routine tests for children aged 15 or
younger:
(a) 一次視力檢查;及
one eye test; and
(b) 一次聽力檢查。
one hearing test.
28. 國際健康與體
檢保障(可選
保障)
International
Health and
Wellbeing Cover
國際健康與體檢保障給予被保險人關于疾病篩查、化驗及檢查的保障,并
通過在線健康教育、健康風險評估給被保險人提供關于健康評估及生活危
機處理等一系列量身定制的個性化的咨詢建議方案,以幫助被保險人按照
他們喜歡的方式維護其健康。
International Health andWellbeing covers the beneficiary for screenings, tests,
examinations, counselling support for a range of life crises and tailored advice and
support through our online health education and health risk assessment, helping
IGAB1212 寰球至尊A
34
Option the beneficiary to take control and manage their health the way they want.
28.1 成人健康篩查
Adult Screening
28.1.1 每一保險年度內,我方將支付下列由執業醫生執行的檢查:
During each period of cover we will pay for the following tests to be
carried out by a medical practitioner:
(a) 每年一次帕帕尼科拉烏檢查,通常被稱為巴氏涂片(檢
查);
an annual papanicolaou test (pap smear) for female beneficiaries;
(b) 每年一次針對50 周歲及以上男性被保險人進行的前列腺篩
查,通常稱為前列腺特異性抗原(PSA)檢查;
an annual prostate examination (prostate specific antigen (PSA)
test) for male beneficiaries aged 50 or over;
(c) 35 周歲到39 周歲無癥狀女性被保險人,限一次的基準乳腺
X 線攝影檢查;
one baseline mammogram for asymptomatic female beneficiaries
aged between 35 and 39;
(d) 40 周歲到49 周歲無癥狀女性被保險人,每兩年一次醫療必
要的乳腺X 線攝影檢查;
one mammogram every two years for asymptomatic female
beneficiaries aged between 40 and 49 (or more often, if medically
necessary);
(e) 50 周歲及以上被保險人,每年一次的乳腺X 線攝影檢查;
one mammogram per year for female beneficiaries aged 50 or
over;
(f) 55 周歲及以上的被保險人的腸癌篩查,每年一次;
one bowel cancer screening per year for beneficiaries aged 55 or
over;
(g) 每年一次的骨密度掃描;
one bone density scan per period of cover;
(h) 每一保險期間內不超過4 次的營養師咨詢,以提供對于某
些診斷疾病需要的飲食建議與要求;以及
up to 4 consultations with a dietician per period of cover, if the
beneficiary requires dietary advice relating to a diagnosed disease
or illness such as diabetes; and
(i) 常規成人體檢,其賠付以保障利益表中所列金額為限。
routine adult physical examinations, within the limits set out in
the list of benefits.
28.2 個人關愛服務
Life
management
28.2.1 每天24 小時、每周7 天、每年365 天隨時可獲得本項服務。
Available 24 hours a day, 7 days a week, 365 days a year.
28.2.2 最多5 次的與專業顧問當面咨詢的機會。
Up to 5 face-to-face sessions with a professional counsellor.
28.2.3 服務的內容包括:在工作、生活、個人及家庭事??等方面為被保
險人提供信息或資源的獲取、專家咨詢等專業支持。
Provides information, resources, and counselling on any work, life,
personal, or family issue that matters to you.
28.2.4 電子咨詢平臺提供方便的在線咨詢。
Convenient online counselling via E-counselling.
28.2.5 不限次的電話咨詢服務。
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35
Unlimited telephonic support.
28.2.6 您方還可以用短信發送所需服務,我方將進行電話回訪。
SMS texting text the support you need and receive a call back.
28.2.7 危機支援。
Crisis support.
28.3 在線健康教
育、健康風險
評估及健康指

Online health
education,
health
assessments
and web-based
coaching
您方可在線登錄到我方提供健康咨詢服務的安全網站。
Online access to our health and wellbeing section in our secure customer area.
29. 國際眼科與牙
科保障(可選
保障)
International
Vision and Dental
Cover Option
國際眼科與牙科保障為被保險人提供廣泛范圍的牙科預防治療、牙科常規
治療、牙科重大治療及牙科正畸治療等保障。另外,它還提供常規視力維
護的費用,包括驗光、視力矯正眼鏡、框架眼鏡、有處方的太陽鏡及隱形
眼鏡。
International Vision and Dental gives the beneficiary access to a wide range of
preventative, routine, major and orthodontic treatments. It also pays for the
beneficiary's routine vision care costs, including eye tests, corrective lenses,
eyeglass frames, prescription sunglasses and contact lenses.
29.1 視力

Vision
29.1.1 我方將支付下述費用:
We will pay for:
(a) 每一保險期間一次驗光師或眼科醫生實施的眼科檢查;
one eye examination per period of cover, to be carried out by
either an ophthalmologist or optometrist;
(b) 根據驗光師或眼科醫生的醫囑所配的眼鏡或隱形眼鏡;
glasses or contact lenses, when prescribed by an ophthalmologist
or optometrist;
(c) 根據驗光師或眼科醫生的醫囑所配的眼鏡框架;
frames for glasses or lenses which are prescribed by an
ophthalmologist or optometrist; and
(d) 根據驗光師或眼科醫生的醫囑所配的太陽鏡;
sunglasses, when prescribed by an ophthalmologist or
optometrist.
29.1.2 我方將不支付下述費用:
We will not pay for:
(a) 每一保險期間一次以上的眼科檢查;
more than one eye examination in any one period of cover;
(b) 太陽鏡,除非是醫療必要的且根據驗光師或眼科醫生的醫
囑所配;
sunglasses, unless medically prescribed, by an ophthalmologist or
optometrist;
(c) 非醫療必要的、或者不是根據驗光師或眼科醫生的醫囑所
配的眼鏡或隱形眼鏡;
glasses or lenses which are not medically necessary or not
IGAB1212 寰球至尊A
36
prescribed by an ophthalmologist or optometrist; or
(d) 除上面列明項目外的其他治療或手術,包括以矯正視力為
目的的手術,如:激光矯正手術、屈光角膜切開手術及屈
光性角膜切削術等。
treatment or surgery, including treatment or surgery which aims
to correct eyesight, such as laser eye surgery, refractive
keratotomy (RK) or photorefractive keratectomy (PRK).
(e) 就視力矯正眼鏡進行理賠時,需要向我方提供醫囑或發票
的復印件。
A copy of a prescription or invoice for corrective lenses will need
to be provided to us in support of any claim for frames.
29.2 牙科
Dental
預防性牙科治療
Preventative dental treatment
29.2.1 我方為國際眼科與牙科保障持續有效達6 個月及以上的被保險人
支付下列牙科預防治療費用,包括:
We will pay for the following preventative dental treatment
recommended by a dentist after a beneficiary has had International
Visual and Dental cover for at least six months:
(a) 每一保險期間內兩次牙科檢查;
two dental check-ups per period of cover;
(b) X 光檢查包括咬翼片、牙片及口腔全景片;
X-rays, including bitewing, single view, and orthopantomogram
(OPG);
(c) 每一保險期間兩次的潔牙及拋光,包括必要情況下局部氟
化劑處理;
scaling and polishing including topical fluoride application when
necessary (two per period of cover);
(d) 每一保險期間一付護齒的費用;
one mouth guard per period of cover;
(e) 每一保險期間一付夜間咬合墊的費用;以及
one night guard per period of cover; and
(f) 窩溝封閉治療。
Fissure sealant.
常規牙科治療
Routine dental treatment
29.2.2 我方為國際眼科與牙科保障持續有效達6 個月及以上的被保險人
支付如下牙科常規治療費用(如果這些治療是出于維護口腔健康
所必須的并且由牙科醫生要求):
We will pay for the following routine dental treatment after a
beneficiary has had International Visual and Dental cover for at least 6
months (if that treatment is necessary for continued oral health and is
recommended by a dentist):
(a) 根管治療;
root canal treatment;
(b) 拔牙;
extractions;
(c) 牙科手術;
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37
surgical procedures;
(d) 暫時性牙科處理(包括開髓、換藥、引流、暫封、暫時充
填等);
occasional treatment;
(e) 麻醉藥;以及
anaesthetics; and
(f) 牙周治療。
periodontal treatment.
重大牙科治療
Major restorative dental treatment
29.2.3 我方將為國際眼科與牙科保障持續有效達12 個月及以上的被保
險人全額支付牙科修復性治療費用。
We will pay for the following major restorative dental treatment in full
after a beneficiary has had International Visual and Dental cover for at
least 12 months:
(a) 義齒—丙烯酸樹脂/合金復合義齒,金屬義齒或金屬/丙烯酸
樹脂復合義齒;
dentures (acrylic/synthetic, metal and metal/acrylic);
(b) 冠修復體;
crowns;
(c) 嵌體;以及
inlays; and
(d) 種植牙。
placement of dental implants.
若被保險人在其國際眼科與牙科保障持續有效不足12 個月時要
求對其修復性義齒治療進行理賠,我方將按其實際治療費用的
50%作為理賠計算中的治療費用;
If a beneficiary needs major restorative dental treatment before they
have had International Visual and Dental cover for 12 months, we will
pay 50% of the amount which we would pay if they had been covered for
12 months or more.
正畸治療
Orthodontic treatment
29.2.4 我方將為國際眼科與牙科保障持續有效不少于24 個月且年齡在
18 周歲及以下的被保險人支付牙齒正畸治療費用。但我方僅支付
滿足下列全部條件的正畸治療:
We will pay for orthodontic treatment for beneficiaries aged 18 or
younger, if they have had International Visual and Dental cover for at
least 24 months. We will only pay for orthodontic treatment if:
(a) 為被保險人主持進行正畸治療的牙科醫生應事先向我方提
供有關正畸治療的詳細資料(包括X 光片及牙科模型的情
況),以及預期的費用;并且
the dentist or orthodontist who is going to provide the treatment
provides us, in advance, with a detailed description of the
proposed treatment (including X-rays and models), and an
estimate of the cost of treatment; and
(b) 事先得到我方審核同意。
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38
we have approved the treatment in advance.
父母或監護人陪同住院的病房膳食費
Hospital accommodation for a parent or guardian
29.2.5 如果17 周歲或以下的被保險人需要住院進行牙科治療并且需要
在醫院停留過夜:如果滿足下面全部條件,我方將支付其父母或
監護人中的一人陪同被保險人住院的病房膳食費用:
If a beneficiary who is 17 years old or younger needs inpatient dental
treatment and has to stay overnight in hospital, we will pay for hospital
accommodation for a parent or legal guardian, if:
(a) 該醫院可以進行陪護;且
accommodation is available in the same hospital, and
(b) 其陪同住宿費用是合理的。
the cost is reasonable.
僅當被保險人接受的是屬于本保險合同約定范圍內的牙科治療
時,我方才承擔此陪護費用;
We will only pay for hospital accommodation for a parent or legal
guardian if the dental treatment which the beneficiary is receiving
during their stay in hospital is covered under this policy.
其他牙科治療
Other dental treatment
29.2.6 如果被保險人進行了本條款列明外的某牙科治療,被保險人可以
(在治療開始前)聯系我方查詢我方是否同意承擔該項治療。我
方將考慮其要求,審慎決定:
If a beneficiary requires a form of dental treatment which is not
provided for in this provision, they may contact us (before the treatment
is received) to enquire whether we will provide cover for that treatment.
We will consider the request, and will decide, at our discretion:
(a) 我方是否將支付該項治療;
whether we will pay for the treatment;
(b) 如果同意支付,我方是全部支付還是部分支付;以及
if so, whether we will pay all or part of the cost; and
(c) 該項治療將作為哪部分的保障利益進行支付(對各部分保
障利益的限額計算將產生影響)。
which of the areas of cover it will come within (for the purposes of
calculating when limits of cover are reached).
29.2.7 預先批準應該在各項治療開始之前進行。
Prior approval should be obtained before any treatment is received.
一般事項
General conditions
29.2.8 所有保障應受到下列限制:
All cover is subject to:
(a) 保障利益表中所列的對各項保障利益的次數的限制;
the limits shown in the list of benefits as to the number of times
we will pay for a particular treatment;
(b) 保障利益表中所列的對各項保障利益的賠償最高額度的限
制;以及
the limits shown in the list of benefits as to the maximum
IGAB1212 寰球至尊A
39
amounts we will pay in relation to a particular treatment; and
(c) 本保險條款中所述的各術語、支付條件、限制(包括次數
及額度)及責任免除。
all of the terms, conditions, limits and exclusions set out in this
policy.
牙科責任免除
Dental exclusions
29.2.9 除了后文通用責任免除條款所列的責任免除外,下列責任免除也
適用于牙科治療。
The following exclusions apply to dental treatment, in addition to those
set out elsewhere in this policy and in your certificate of insurance.
我方將不支付:
We will not pay for:
(a) 單純的美容性治療,或其他不是為維持或改善口腔健康而
必須進行的治療;
Purely cosmetic treatments, or other treatments which are not
necessary for continued or improved oral health.
(b) 被保險人以非法活動為目的(不論是完全還是部分以此為
目的)所需要進行的牙科治療;
Treatment which is, to any extent, made necessary by a
beneficiary engaging in any illegal activity.
(c) 為了填寫理賠申請表或其他日常事務而導致的費用;
Fees or costs which relate to the filling of a claim form, or any
other administrative service.
(d) 已經或者應該由第三方保險公司、個人、組織或公共機構
承擔的費用。如果被保險人也在其他保險公司擁有承擔相
應費用的保險,我方將按比例承擔我方應該適當承擔的部
分。如果我方承擔的費用中的全部或部分應該由第三方保
險公司、個人、組織或公共機構承擔,我方將可能適當地
向他們追討此全部或部分費用。
Fees or costs which either have been paid, or could be paid, by
another insurance company, person, organisation or public body.
If the beneficiary is also covered by other insurance, we will only
pay a proportion of the cost of treatment, as appropriate. If all or
any of the cost of the treatment could also be met by some other
person, organisation or public body, we may claim back all or any
of the amount we have paid from them, as appropriate.
(e) 因牙具遺失或被盜而進行的更換;
The replacement of any dental appliance which is lost or stolen, or
associated treatment.
(f) 按照被保險人常住國內擁有普通能力技術的牙醫的正常合
理的意見:被保險人的牙橋、冠修復體或義齒可以修理并
達到正常可用的狀態。但被保險人更換該牙橋、冠修復體
或義齒;
The replacement of a bridge, crown or denture which (in the
reasonable opinion of a dentist of ordinary competence and skill
in the beneficiary's country of habitual residence) is capable of
being repaired and made usable.
(g) 初次安裝后不足五年的牙橋、冠修復體及義齒的更換,除
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非:
The replacement of a bridge, crown or denture within five years
of its original fitting unless:
(i) 保險期間內被保險人因外力傷害導致牙橋、冠修復體
及義齒受損后無法修復達到正常可用的狀況;或
it has been damaged beyond repair, whilst in use, as a
result of an dental injury suffered by the beneficiary whilst
they are covered under this policy; or
(ii) 在被保險人必須拔除健康自體牙后,從醫療上必須對
與被拔除牙齒有鄰接關系或對合關系的原義齒進行更
換;或
the replacement is necessary because the beneficiary
requires the extraction of a sound natural tooth/teeth; or
(iii) 在對頜牙初次安裝半口義齒時,為進行全口牙列的咬
合關系配置,原義齒必須更換。
the replacement is necessary because of the placement of
an original opposing full denture.
(h) 樹脂貼面或瓷貼面。
Acrylic or porcelain veneers.
(i) 對上下頜的第一、第二及第三顆磨牙安裝冠修復體或假
牙,除非:
Crowns or pontics on, or replacing, the upper and lower first,
second and third molars unless:
(i) 是全瓷、烤瓷或全金屬的冠修復體或假牙,如鎳鉻合
金冠;或
they are constructed of either porcelain; bonded-to-metal
or metal alone (for example, a gold alloy crown); or
(ii) 常規或緊急牙科治療中所需要的臨時冠或假牙。
a temporary crown or pontic is necessary as part of routine
or emergency dental treatment.
(j) 實驗性的或不符合通常牙科治療規范的牙科治療、操作或
材料;
Treatments, procedures and materials which are experimental or
do not meet generally accepted dental standards.
(k) 直接或間接由下述原因造成的種植牙治療:
Treatment for dental implants directly or indirectly related to:
(i) 種植融合失敗;
failure of the implant to integrate;
(ii) 種植體骨結合部位破裂;
breakdown of osseo-integration;
(iii) 種植體周圍炎;
peri-implantitis;
(iv) 更換冠修復體、牙橋及義齒;或
replacement of crowns, bridges or dentures; or
(v) 或任何意外或緊急的牙科治療,包括任何假體設備。
any accident or emergency treatment including for any
prosthetic device.
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41
(l) 口腔衛生咨詢建議,如牙菌斑控制、口腔衛生及飲食等;
Advice relating to plaque control, oral hygiene and diet.
(m) 單純的服務或商品,包括但不限于漱口水、牙刷及牙膏
等;
Services and supplies, including but not limited to mouthwash,
toothbrush and toothpaste.
(n) 國際眼科與牙科保障不包含在醫院進行的應包含在國際醫
療保障及/或國際醫療補充保障(如果被保險人購買了該項
可選責任)內的牙科治療;另外,如果該牙科治療是導致
被保險人住院的原因,則該治療也不包含在國際醫療保障
及/或國際醫療補充保障內;
Medical treatment carried out in hospital by an oral specialist
may be covered under International Medical Insurance plan
and/or International Medical Insurance Plus, if this option has
been bought, except when dental treatment is the reason for you
being in hospital.
(o) 被保險人在19 周歲生日后進行的正畸治療;
Orthodontic treatment for anyone after their 19th birthday.
(p) 咬合關系取模,精密/半精密附著體;
Bite registration, precision or semi-precision attachments.
(q) 主要出于如下目的的治療方法、用具及修復物(全口義齒
除外):
Any treatment, procedure, appliance or restoration (except full
dentures) if its main purpose is to:
(i) 改變上下(頜間)距離;或者
change vertical dimensions; or
(ii) 顳下頜關節功能障礙的診斷或治療;或者
diagnose or treat conditions or dysfunction of the
temporomandibular joint; or
(iii) 牙周病患牙固定;或者
stabilise periodontally involved teeth; or
(iv) 咬合運動障礙解除。
restore occlusion.
第三章責任免除
Section 3 - Exclusions
30. 通用責任免除
General
Exclusions
下述通用責任免除對本保險合同所有保障均適用:
Cover under this policy is subject to the following general exclusions:
30.1 違反法律規定的行為,包括但不限于違反外匯管理的規定、當地的
法律法規、貿易制裁或管制規定。
We will not offer cover or pay claims when it is illegal for us to do so under
applicable laws. Examples include but are not limited to, exchange controls,
local licensing regulations, sanctions or trade embargo.
30.2 即使已經我方批準,我方仍將不對任何因接受醫院治療或由于執業
醫生所導致的損失、損害、疾病或損傷承擔保險責任。
We cannot be held responsible for any loss, damage, illness and/or injury
that may occur as a result of receiving medical treatment at a hospital or
from a medical practitioner, even when we have approved the treatment as
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being covered.
30.3 如果您方未購買國際醫療補充保障、國際健康與體檢保障或國際眼
科與牙科保障,我方將不支付任何與上述保險責任有關的治療費
用。
If a beneficiary does not have cover under the International Medical
Insurance Plus, International Health and Wellbeing, or International Vision
and Dental options, we will not pay for any of the treatments or other
benefits which are available under those options.
30.4 下述責任免除適用于國際醫療保障及任一可選保障。
The following exclusions apply to the International Medical Insurance plan
and to all of the extra coverage options.
除了我們下面列出的責任免除外,我方將按照被保險人當時所擁有的保障
來支付符合規定條件的治療費用。
Where, in the exclusions which are set out below, we have stated that we will pay
for treatment in some circumstances, this is subject to the beneficiary having cover
under the appropriate coverage option or options.
30.5 我方將不予支付:
We will not pay for:
30.5.1 人工維持生命,包含儀器輔助呼吸,除非此治療有使被保險
人復原或恢復到患病前健康狀況的合理預期。
Life support treatment (such as mechanical ventilation) unless such
treatment has a reasonable prospect of resulting in the
beneficiary's recovery, or restoring the beneficiary to his or her
previous state of health.
30.5.2 下列治療:
Treatment for:
(a) 既往癥;或
a pre-existing condition; or
(b) 投保前被保險人已經知道(或者應該已經知道)但未
告知的既往癥所導致或相關的任何疾病或癥狀;
any condition or symptoms which result from, or are related
to, a pre-existing condition which the beneficiary knew
about (or should have known about) before the start of their
cover, but which was not disclosed to us.
對任何既往癥,只有在投保申請過程中向我方告知并
且我方醫療核保同意接受后,才能在本保險合同中得
到支付。
Pre-existing conditions will only be covered under this policy
if they were disclosed during the application process and our
medical underwriters agreed to provide that cover.
30.5.3 醫療核保所作出的任何特別責任免除中所涉及疾病或癥狀導
致的治療。特別責任免除詳見您的保險憑證。
Treatment for a condition which is the subject of a special exclusion.
Special exclusions are set out in your certificate of insurance.
30.5.4 非出于醫療必要的入院或住院,包括:
Non medical admissions or stays in hospital which includes:
(a) 可以在日間病房或門診進行的治療;
treatment that could take place on a day-patient or
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outpatient basis;
(b) 病后自然恢復過程;
convalescence;
(c) 社會性或家庭性事務導致的入院,如洗衣、穿著及沐
浴等。
social or domestic reasons e.g. washing, dressing and
bathing.
30.5.5 豪華套間、行政套間、貴賓病房等高級病房費用。
Costs of hospital accommodation for a deluxe, executive or VIP
suite.
30.5.6 器官捐獻
Donor organs:
(a) 機械性人工器官、或動物器官,除非在等待移植過程
中為短期維持身體機能而臨時使用的機械設備;
mechanical or animal organs, except where a mechanical
appliance is temporarily used to maintain bodily function
whilst awaiting transplant;
(b) 通過任何渠道購買捐獻器官的費用;或
purchase of a donor organ from any source; or
(c) 針對未來可能出現的疾病而預先保存干細胞的費用。
harvesting and storage of stem cells, when a preventative
measure against possible future disease.
30.5.7 胎兒手術,如在出生前子宮內進行的治療或手術;除非是由
妊娠并發癥引起——在此情況下應該包含在"復雜妊娠"責任
范圍內進行賠付。
Foetal surgery, i.e. treatment or surgery undertaken in the womb
before birth, unless this is resulting from complications arising
through maternity and shall be subject to the limits detailed in the
'Complicated Maternity' section of your policy.
30.5.8 足部護理,包括由手足病治療專家或足科醫生進行的。
Foot care by a Chiropodist or Podiatrist.
30.5.9 睡眠異常;除非有證據表明該被保險人經受著嚴重的呼吸睡
眠綜合癥(窒息),在這樣的情況下我方將支付:
Sleep disorders unless there are indications that the beneficiary is
suffering from severe sleep apnoea. in these circumstances, we will
only pay for:
(a) 一次睡眠情況評估;
one sleep study;
(b) 醫學上合理的手術;以及
surgery, if medically appropriate; and
(c) 儀器租借使用費,如其他方法都失敗的情況下使用持
續氣道正壓(CPAP)通氣儀器,但僅限于購買了國際
醫療補充保障的被保險人。
the hire of equipment such as a Continuous Positive Airway
Pressure (CPAP) machine because all other methods have
failed to resolve the issue (only if the beneficiary has cover
under the International Medical Insurance Plus option).
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30.5.10 下列醫生、醫院、診所及機構提供的治療:
Treatment which is provided by:
(a) 醫療從業人員沒有得到治療所在國有關當局認可為具
有治療相應疾病、病癥或損傷所需要的適當專業知識
和技能的;
a medical practitioner who is not recognised by the relevant
authorities in the country where the treatment is received as
having specialist knowledge of, or expertise in, the
treatment of the disease, illness or injury being treated;
(b) 我方已經以書面形式致函執業醫生、治療師、醫院、
診所及機構通知:我方不再承認其作為我方認可的醫
療服務主體(我方已經作出這樣通知的執業醫生、治
療師、醫院、診所及機構的信息可詢問我方的信息查
詢熱線);或者
a medical practitioner, therapist, hospital, clinic, or facility
to whom we have given written notice that we no longer
recognise them as a treatment provider. Details of
individuals, institutions and organisations to whom we have
given such notice may be obtained by calling our general
enquiries number; or
(c) 根據我方的合理意見,沒有得到有效認證或授權、或
沒有適當的能力進行相應治療的執業醫生、治療師、
醫院、診所及機構。
a medical practitioner, therapist, hospital, clinic, or facility
which, in our reasonable opinion, is either not properly
qualified or authorised to provide treatment, or is not
competent to provide treatment.
30.5.11 提供治療的人員與被保險人在同一居所,或為被保險人的家
庭成員;
Treatment which is provided by anyone who lives at the same
address as the beneficiary, or who is a member of the beneficiary's
family.
30.5.12 戒煙及其相關治療。
Treatment for, or in connection with, smoking cessation.
30.5.13 由于武裝沖突或災難導致的必要治療,包括但不限于:
Treatment which is necessary as a result of conflict or disaster
including but not limited to:
(a) 核爆炸及化學污染;
nuclear or chemical contamination;
(b) 戰爭,恐怖主義入侵,叛亂(無論是否已宣戰),內
戰,騷亂或軍事篡位,戒嚴,暴亂或任何法律下組織
的臨時政府;
war, invasion, acts of terrorism, rebellion (whether or not
war is declared), civil war, commotion, military coup or other
usurpation of power, martial law, riot, or the act of any
unlawfully constituted authority;
(c) 當地衛生機構宣布的疫情爆發,并且相應進行的疫情
控制;以及
outbreaks of disease which are declared to be epidemics and
put under the control of the local public health authorities;
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and
(d) 其他武裝沖突或災難,如果被保險人有如下情況:
any other conflict or disaster events if the beneficiary has:
(i) 進入眾所周知的武裝交戰地區(由您國籍國的政
府所宣布,例如由英國外事及公共安全辦公室宣
布);或
put him or herself in danger by entering a known area
of conflict (as identified by a Government in your
Country of nationality, for example the British
Foreign and Commonwealth Office);
(ii) 為主動介入沖突者;或
actively participated in the conflict; or
(iii) 表現出明顯不顧及個人安危。
displayed a blatant disregard for their own safety.
30.5.14 因被保險人的自殺、自傷及其他故意行為所導致的治療;
Treatment that arises from, or is in any way connected with
attempted suicide, or any injury or illness that the beneficiary
inflicts upon him or herself.
30.5.15 不是以使原有言語能力復原為目的的言語治療,包括但不限
于下述任一情況:
Treatment for or in connection with speech therapy that is not
restorative in nature, or if such therapy is:
(a) 用于改善發育不完全的言語能力;
used to improve speech skills that have not fully developed;
(b) 作為家庭監護或家庭教育的;或
can be considered custodial or educational; or
(c) 出于維持語言交流能力為目的。
is intended to maintain speech communication.
30.5.16 發育問題,包括:
Developmental problems including:
(a) 學習困難如閱讀障礙;
learning difficulties such as dyslexia;
(b) 行為問題如注意力缺陷或多動癥(ADHD);
behavioural problems such as autism or attention deficit
disorder (ADHD);
(c) 身體發育問題如身材矮小。
physical development problems such as short height.
30.5.17 顳下頜關節功能障礙的(TMJ).
Disorders of the temporomandibular joint (TMJ).
30.5.18 治療肥胖或其并發癥,包括但不限減肥課程、減肥指導或藥
物減肥。
Treatment for obesity, or which is necessary because of obesity.
This includes, but is not limited to, slimming classes, aids and drugs.
當被保險人符合在如下情況時,我方將支付胃束帶或胃旁路
手術:
We will only pay for gastric banding or gastric bypass surgery if a
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46
beneficiary:
(a) 體重指數(BMI)達到40 或以上并被診斷為病態肥
胖,或;
has a body mass index (BMI) of 40 or over and has been
diagnosed as being morbidly obese;
(b) 能夠提供文件證明:過去24 個月內已經嘗試過其他減
肥方法;
can provide documented evidence of other methods of
weight loss which have been tried over the past 24 months;
(c) 在手術前已經歷了心理評估,并確認被保險人適宜進
行這樣的手術。
has been through a psychological assessment which has
confirmed that it is appropriate for them to undergo the
procedure.
30.5.19 在自然治療診所、水療養院或溫泉療養院、療養院或任何非
醫院性質的或不被認為是合格的醫療服務提供者的機構提供
的治療;
Treatment in nature cure clinics, health spas, nursing homes, or
other facilities which are not hospitals or recognised medical
treatment providers.
30.5.20 部分或全部由于家庭事務因素導致在醫院居住,或在醫院居
住期間實際上并不需要進行治療,或醫院已經成為被保險人
的住所或永久居住的住所。
Charges for residential stays in hospital which are arranged wholly
or partly for domestic reasons or where treatment is not required
or where the hospital has effectively become the place of domicile
or permanent abode.
30.5.21 任何因吸毒或其并發癥導致的相關治療;
Treatment for a related condition resulting from addictive
conditions and disorders.
30.5.22 任何因酗酒、濫用酒精或其他所導致的治療。
Treatment for a related condition resulting from any kind of
substance or alcohol use or misuse.
30.5.23 妊娠檢測,或艾滋病檢測;除非有醫學上合理的實質癥狀,
并且由執業醫生建議進行;
maternity tests or HIV tests; unless there are physical symptoms
to suggest possible problems and they are suggested by medical
practitioner
"實質癥狀"是指機體外觀或生理檢測發生客觀改變,并且符
合妊娠或艾滋病的診斷特征;
'physical symptoms' requires that body appearance or
physiological testing has objective changes, and is meeting the
diagnostic characteristics of maternity or HIV infection.
30.5.24 維生素(自用)、益生菌、人參、冬蟲夏草、養生方劑等主
要用于養生的費用;
mainly for nourishing, such as vitamins (self-service), probiotics,
ginsengs, Chinese caterpillar fungus, nourishing prescriptions
and etc;
30.5.25 任何與男性或女性有關的生育控制產生的治療,包括但不限
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于:
Treatment needed because of or relating to male or female birth
control, including but not limited to:
(a) 手術避孕,即:
surgical contraception, namely:
(i) 輸精管切除術、絕育術或皮下埋置避孕術等;
vasectomy, sterilisation or implants;
(b) 非手術避孕,即:
non surgical contraception, namely:
(i) 避孕藥或避孕套;
pills or condoms;
(c) 生育咨詢,即:
family planning, namely:
(i) 當面向醫生咨詢懷孕或避孕治療;
meeting a doctor to discuss becoming pregnant or
contraception.
30.5.26 與不孕不育(除了為確診不孕不育而進行的檢查)或各種生
育問題相關的治療、及對這些治療導致并發癥的后續治療,
包括但不限于:
Treatment relating to infertility (other than investigation to the
point of diagnosis), fertility treatment of any sort, or treatment of
complications arising as a result of such treatment. This includes,
but is not limited to:
(a) 試管嬰兒(IVF);
in-vitro fertilisation (IVF);
(b) 卵子輸卵管內移植(GIFT);
gamete intra-fallopian transfer (GIFT );
(c) 受精卵輸卵管內移植(ZIFT);
zygote intra-fallopian transfer (ZIFT );
(d) 人工受孕(AI);
artificial insemination (AI);
(e) 處方藥物治療;
prescribed drug treatment;
(f) 胚胎轉移(從身體的一處轉移至另一處);或
embryo transportation (from one physical location to
another); or
(g) 卵子/精子捐贈及其相關費用。
ovum and/or semen donation and related costs.
如果滿足下列全部條件,我方將支付確診不孕不育的檢查費
用:
We will pay for investigations into the cause of infertility if:
(a) 主持治療的專科醫生希望明確醫學原因;
the specialist wishes to rule out any medical cause;
(b) 被保險人在接受檢查前已連續兩年投保本保險;且
the beneficiary has been covered under this policy for two
consecutive years before the investigations have
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48
commenced; and
(c) 被保險人在投保時對其不孕不育的問題一無所知,且
沒有出現過明顯的征兆。
the beneficiary was unaware of the existence of any
infertility problem, and had not suffered any symptoms,
when their cover under this policy commenced.
1.1.2 意圖終止懷孕的措施,除非懷孕會危及到被保險人的生命或
精神穩定;
Treatment by way of the intentional termination of pregnancy,
unless the pregnancy endangers a beneficiary's life or mental
stability.
1.1.3 任何與代孕直接有關的治療。我方不予支付以下情況的妊娠
責任費用:
Treatment directly related to surrogacy. We will not pay maternity
benefits:
(a) 被保險人是代孕者;或者
to a beneficiary who acts as a surrogate; or
(b) 為被保險人代孕的任何人。
to anyone else acting as a surrogate for a beneficiary.
1.1.4 "新生兒護理"責任中,對因采取治療不孕不育手段出生的新
生兒如試管嬰兒、或代孕所生的兒童、或被收養的兒童,這
些兒童須出生滿90 天后方可投保本保險合同,且須經過醫
療核保;
'Newborn Care Benefits' for children born as a result of fertility
treatment, such as IVF, or for children born to a surrogate, or who
have been adopted. These children can only join once they are 90
days old, and will be subject to medical underwriting.
1.1.5 新生兒在醫院的托管護理,除非其母親因醫療必要須住院接
受本保險合同規定范圍內的治療;
Nursery care for a newborn in hospital, unless the mother is
required to remain in hospital due to medical necessity for
treatment that is covered by this policy.
1.1.6 被保險人因永久性神經損傷和/或永久植物人狀態(PVS)超過
90 天的治療費用;
Treatment for more than 90 continuous days for a beneficiary who
has suffered permanent neurological damage and/or is in a
persistent vegetative state (PVS).
1.1.7 任何對個性或人格障礙的治療,包括但不限于:
Treatment for personality and/or character disorders, including but
not limited to:
(a) 情感性人格障礙;
affective personality disorder;
(b) 精神分裂人格(非精神分裂癥);或
schizoid personality disorder; or
(c) 表演型人格障礙;
histrionic personality disorder.
1.1.8 預防性治療:包括但不限于健康篩查、常規體檢及疫苗接種
(除非被保險人已投保了包含這些保險責任的可選保障)。
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Preventative treatment, including but not limited to health
screening, routine health checks and vaccinations (unless that
treatment is available under one of the options under which a
beneficiary has cover).
我方將支付如下疾病的預防性手術費用:
We will pay for preventative surgery when a beneficiary:
(a) 有明顯家庭遺傳史的疾病、或作為某種遺傳性腫瘤綜
合征的癥狀之一的疾病(例如卵巢癌);以及
has a significant family history of a disease which is part of a
hereditary cancer syndrome (such as ovarian cancer); and
(b) 已經進行基因檢查,并且結果顯示患有某種遺傳性腫
瘤綜合征(請注意我方不支付基因檢查的費用);
has undergone genetic testing which has established the
presence of a hereditary cancer syndrome. (Please note that
we will not pay for the genetic testing).
在國際醫療保障下,除癌癥治療外,對先天性疾病和遺傳性
疾病的預防性手術計算在先天性疾病的限額內。
Under the International Medical Insurance plan, the limits of cover
for preventative surgery in respect of congenital and hereditary
conditions will apply, other than for cancer .
1.1.9 任何原因引起的性功能障礙的治療,如陽痿治療或其他性方
面的問題。
Treatment for sexual dysfunction disorders (such as impotence) or
other sexual problems regardless of the underlying cause.
1.1.10 如果您方投保時未選擇全球含美國地區,我方將不會支付在
美國接受治療的費用。
Treatment in the USA, unless the beneficiary has purchased
Worldwide including USA cover under this policy.
1.1.11 如果我方獲知或有理由懷疑下列情況,我方不承擔在美國的
治療:
Treatment in the USA if we know or reasonably suspect that:
(a) 該治療在保障范圍內;并且
the cover was purchased; and
(b) 被保險人旅行到美國;
the beneficiary travelled to the USA;
且該旅行是為了對投保時即存在的既往病癥進行治療(無論
該治療是否其前往美國的主要或唯一原因)。
for the purpose of receiving treatment for a pre- existing condition
(whether or not treatment was the main or sole purpose of the
visit).
1.1.12 單眼或雙眼屈光不正的治療,包括但不限于:激光治療、屈
光性角膜切開術及屈光性角膜切削術。如因病情所需,我方
將支付符合條件的視力治療費用,如白內障或視網膜脫落。
Treatment which is intended to change the refraction of one or
both eyes, including but not limited to laser treatment, refractive
keratotomy and photorefractive keratectomy. We will pay for
treatment to correct or restore eyesight if it is needed as a result of
a disease, illness or injury (such as cataracts or a detached retina).
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1.1.13 在您方所選擇保障區域外進行的任何治療。
Any treatment outside your selected area of coverage.
1.1.14 除非另有說明,治療期間的任何旅行花費如出租車費、公共
汽車費用、汽油費或停車費。
Travel costs for treatment including any fares such as taxis or buses,
unless otherwise specified, and expenses such as petrol or parking
fees.
1.1.15 任何國際緊急救援服務。
Any expenses for international emergency services.
1.1.16 醫療異地轉運、醫療轉運回國及第三方陪護等跨國援助費用。
services expenses for emergency evacuation, medical repatriation
and transportation costs for third parties.
1.1.17 任何船運到岸的轉運費用。
Any expenses for ship-to-shore evacuations.
1.1.18 變性手術及任何該手術所需的準備及恢復性治療(例如心理
輔導),包括由該手術引起的并發癥。
Sex change operations or any treatment needed to prepare for or
recover from these operations (for example, psychological
counselling) including complications arising out of such treatment.
1.1.19 因參與如下活動導致身體損傷、疾病或殘疾而接受的治療:
Treatment which is necessary because of, or is any way connected
with, any injury or sickness suffered by a beneficiary as a result of:
(a) 參與職業運動項目;
taking part in a sporting activity on a professional basis;
(b) 獨自進行水肺潛水運動;或
solo scuba-diving; or
(c) 30 米以上深度的水肺潛水,除非被保險人獲得適當的
潛水資格(即:深度潛水資格證或同等資格證書)認
證為可以潛水到此深度。
scuba-diving at a depth of more than 30 metres unless the
beneficiary is appropriately qualified (namely PADI or
equivalent) to scuba-dive at that depth.
1.1.20 根據我方的合理觀點認為是實驗性的、非規范的、或未被證
實為有效的治療。這些治療包括但不限于:
Treatment which (in our reasonable opinion) is experimental, is not
orthodox, or has not been proven to be effective. This includes but
is not limited to:
(a) 臨床試驗性質的治療;
treatment which is provided as part of a clinical trial;
(b) 未被治療發生所在國權威部門批準的治療;或
treatment which has not been approved by the relevant
public health authority in the country in which it is received;
or
(c) 藥品或藥物沒有獲得藥品或藥物使用地所在國政府許
可或批準。
any drug or medicine which is prescribed for a purpose for
which it has not been licensed or approved in the country in
which it is prescribed.
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1.1.21 除了是醫療必要的并且由疾病、意外傷害或其他手術而導致
的整形、美容或重建手術外,任何形式(包括出于生理原因
導致)的整形、美容或重建手術或改進人的外表的治療費
用,即使是出于心理原因。這些治療包括但不限于:
Any form of plastic, cosmetic or reconstructive treatment, the
purpose of which is to alter or improve appearance even for
psychological reasons, unless that treatment is medically necessary
and is a direct result of an illness or an injury suffered by the
beneficiary, or as a result of surgery. This includes but is not limited
to:
(a) 面部提升術(皺紋切除術);
facelifts (rhytidectomy);
(b) 鼻部塑形術(鼻整形術);
nose reshaping (rhinoplasty);
(c) 吸脂術及其他去除脂肪的治療;
liposuction and other procedures which remove fat tissue;
(d) 植發術;以及
hair transplants; and
(e) 改變乳房形狀的手術、乳房增大或縮小手術(癌癥治
療后的乳房重塑術除外)。
surgery to change the shape of, enhance or reduce breasts
(other than breast reconstruction following treatment for
cancer).
在被保險人的保險合同有效期內,我方將支付被保險人在現
有保險期間內因疾病、意外、損傷或外科手術而接受整形、
美容或重建手術的費用。
We will only pay for plastic, cosmetic or reconstructive treatment if
the illness, injury or surgery as a result of which the treatment is
required took place during the beneficiary's current continuous
period of cover and is itself covered under the policy.
1.1.22 各項雜費如報紙、出租車、電話、接待餐費及旅館住宿費
用。
Incidental costs including newspapers, taxi fares, telephone calls,
guests' meals and hotel accommodation.
1.1.23 填寫理賠申請表的費用及其他行政費用。
Costs or fees for filling in a claim form or other administration
charges.
1.1.24 任何其他保險公司、個人、組織或公共機構應支付或已經支
付的費用。如果被保險人已在其他保險中獲得了賠償,我方
僅支付剩余的部分。如果我方所支付的費用應為其他保險公
司、個人、組織、機構所承擔,我方將有權要求償還該筆費
用。
Costs that have been or can be paid by another insurance company,
person, organisation or public programme. If a beneficiary is
covered by other insurance, we may only pay part of the cost of
treatment. If another person, organisation or public programme is
responsible for paying the costs of treatment, we may claim back
any of the costs we have paid.
1.1.25 由于被保險人的違法行為而導致的任何形式治療或必要治
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療。
Treatment that is in any way caused by, or necessary because of, a
beneficiary carrying out an illegal act.
第四章預先批準
Section 4 - Prior approvals
2. 預先批準清單
List of prior
approvals
下述所有的治療均需取得我方的預先批準。若您方未取得我方的預先批
準,將可能對您方的理賠造成延遲,也有可能使我方拒絕向您方給付全部
或部分理賠款項。
Prior approval should be obtained from us for the following treatments: If it is not,
there may be delays in processing claims, or we may decline to pay all or part of the
claim.
2.1 被保險人必須在每次住院前聯系我方;
A beneficiary must contact us before each hospitalizations;
如果主持被保險人治療的執業醫生決定需要延長留院治療時間并超
出我方的預先批準時長,或者已獲我方審核同意的治療方案將有所
變動,必須盡快向我方寄送治療的專科醫生出具的醫療報告,并載
明下列全部信息:
If the treating medical practitioner decides that the beneficiary needs to
stay in hospital for a longer period than we have approved in advance, or
decides that the treatment which the beneficiary needs is different to that
which we have approved in advance, then that medical practitioner must
provide us with a report, explaining:
2.1.1 被保險人預期需要留院治療的時長;
how long the beneficiary will need to stay in hospital;
2.1.2 被保險人的診斷信息(如果診斷發生了變更);以及
the diagnosis (if this has changed); and
2.1.3 被保險人所接受過的治療和未來需要接受的治療。
the treatment which the beneficiary has received, and needs to
receive.
2.2 被保險人必須在每次所有手術(包括器官移植、骨髓移植或外周血
干細胞移植)及操作性治療前聯系我方,包括在門診、住院或日間
病房發生的;
A beneficiary must contact us before each surgical procedures (including
organ donation, bone marrow or peripheral stem cell procedures) and minor
operating procedures, wherever occurred in in-patient, out-patient or day
patient;
2.3 被保險人必須在每次生育就診前聯系我方,包括住院和門診;
A beneficiary must contact us before each maternity visits, including
inpatients and outpatients;
2.4 被保險人必須在每次計算機斷層掃描(CT)、核磁共振成像(MRI)
或正電子發射斷層掃描(PET)前聯系我方;
A beneficiary must contact us before each CT scans, MRI scans and PET
scans;
2.5 無論是在門診、住院或日間病房,被保險人都必須在每次物理治
療、職業治療、言語治療或任何以康復為目的的治療前通知我方;
A beneficiary must contact us before each physiotherapies, occupational
and speech therapies, or any treatments for rehabilitations, wherever
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occurred in in-patient, out-patient or day patient;
因需要物理治療、職業治療、言語治療或任何康復治療的疾病往往
較為復雜,您方通知我方時必須提交主持該次治療的專科醫生的醫
療報告,該報告須載明:
As conditions requiring physiotherapies, occupational and speech therapies,
or treatments for rehabilitations can be very complex, as part of the prior
approval process we must receive a medical report from the treating
specialist, detailing the following:
2.5.1 被保險人預計在醫院停留的時間;
how long the beneficiary will need to stay in hospital;
2.5.2 診斷;及
the diagnosis; and
2.5.3 被保險人已經接受的治療及需要接受的治療。
the treatment which the beneficiary has received, or needs to
receive.
每一保險期間內我方承擔的對單一疾病的康復治療以30 天/次治療
為限;若為整形外科、脊髓或神經系統疾病治療的需要進行康復治
療,我方可以承擔超過30 天的康復治療費用,但須事先聯系我方并
取得預先批準;
In each period of cover, for each disease, the cover of rehabilitation is up to
30 days/visits. If rehabilitation treatment is needed following orthopaedic,
spinal or neurological events, we may pay for rehabilitation treatment for
more than 30 days. But you should contact us for prior approval.
2.6 被保險人必須在每次精神心理治療前聯系我方;
A beneficiary must contact us before each psychiatric treatment;
2.7 被保險人必須在每次疼痛控制治療前聯系我方,包括住院和門診;
A beneficiary must contact us before each pain management, including inpatient
and out-patient;
2.8 被保險人必須在每次家庭護理前聯系我方;
A beneficiary must contact us before each home nursing;
2.9 被保險人必須在每次姑息治療、每次長期護理治療前聯系我方;
A beneficiary must contact us before each palliative care or long term care;
2.10 被保險人必須在每次種植牙治療、每次正畸治療前聯系我方;
A beneficiary must contact us before each dental implant or dental
orthodontic procedure;
某些情況下,若被保險人確實無法預先聯系我方取得批準(如發生緊急事
件,或突然生病必須立刻接受治療),在這樣的情況下,如條件允許,您
方應在接受治療后盡快聯系我方,以便我方決定是否應承擔后續的治療費
用。在這種情況下,您方須向我方說明需立即接受治療的原因,并且我方
有可能請您方舉證。若我方確定您方確實無法事先聯系我方,即使未經預
先批準,我方仍將承擔在本保險合同規定范??內的第一次緊急治療費用
(包括任何處方藥物)。
We appreciate that there will be times when it will not be practical or possible for a
beneficiary to contact us for prior approval (for example, emergencies, or when a
family member is suddenly sick and the priority is to get treatment for them as
soon as possible). In circumstances like these, we simply ask that you or the
affected beneficiary get in touch with us as soon as is reasonably possible after
treatment has been sought, so that we can confirm whether subsequent treatment
will be covered. In this situation, we will ask for an explanation of why the
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treatment was needed urgently, and may ask for evidence of this. If we agree that
it was not reasonably possible or practicable to seek prior approval, we will cover
the cost of the initial treatment (including any prescribed medication) which was
urgent, even without prior approval (within the terms of this policy).
盡管緊急治療不需要經過我方的預先批準,若被保險人在緊急情況下被送
往醫院治療,應該安排醫院或其家庭成員在其入院后48 小時內聯系我方
(或者在入院48 小時后盡早聯系我方),以使我方能確認被保險人合理使
用了相關的保障。
Although emergency treatment does not require our prior approval, if a
beneficiary is taken to hospital in an emergency, he or she should arrange for the
hospital or a family member to contact us within 48 hours of admission (or as soon
as reasonably possible after that). This will allow us to make sure that the
beneficiary is making the best use of the cover.
若被保險人被送往的醫院、執業醫生或診所不在我方醫療網絡范圍內,在
確認不影響醫治的情況下,經被保險人同意,我方將安排被保險人轉至我
方醫療網絡范圍內的醫院、執業醫生或診所繼續接受治療。
If a beneficiary has been taken to a hospital, medical practitioner or clinic which is
not part of the Cigna network, then we may make arrangements (with the
beneficiary's consent) to move the beneficiary to a Cigna network hospital,
medical practitioner or clinic to continue treatment, once it is medically
appropriate to do so.
3. 在美國以外地
區治療的預先
批準
Prior approval for
treatment
outside the USA
對于美國以外地區的治療,若您方已尋求該治療預先批準,但尚未取得我
方的書面答復,我方將按照預先批準程序應予批準的額度進行支付。若您
方無法證明曾尋求過就該治療的預先批準,我方將假設:如果您方事先尋
求預先批準,實際發生的治療費用將減少20%,因而我們將按照80%的治
療費用進行理賠,賠付金額相應減少。
If prior approval is not obtained for treatment outside the USA, we will pay only the
amount which we would have paid if prior approval had been sought. In the
absence of evidence to the contrary, we will assume that the treatment costs
would have been reduced by 20% if our prior approval had been sought, and the
amount which we will pay will be reduced accordingly.
4. 在美國地區治
療的預先批準
Prior approval for
treatment in the
USA
4.1 對于美國地區的治療,若您方已尋求該治療預先批準,但尚未取得
我方的書面答復,我方將僅支付按照預先批準程序應予批準的額度
進行支付。若您方無法證明曾尋求過關于該治療的預先批準,我方
將假設:如果您方事先尋求預先批準,實際發生的治療費用將減少
50%,因而我們將按照50%的治療費用進行理賠,賠付金額相應減
少。
If prior approval is not obtained for treatment in the USA, we will pay only
the amount which we would have paid if prior approval had been sought. In
the absence of evidence to the contrary, we will assume that the treatment
costs would have been reduced by 50% if our prior approval had been
sought, and the amount which we will pay will be reduced accordingly.
4.2 若已取得我方對預先批準的書面答復,但是被保險人決定接受我方
醫療網絡范圍以外醫院、執業醫生或診所的治療,我方將按應支付
額度的80%支付。
If prior approval is obtained, but the beneficiary decides to receive
treatment at a hospital, medical practitioner or clinic which is not part of
the CIGNA network, we will reduce any amount which we pay by 20%.
4.3 如果確實由于合理的原因,被保險人無法接受我方醫療網絡范圍以
內的醫院、執業醫生或診所的治療,我方將按應支付額度的100%支
付,例如:
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There may be occasions when it is not reasonably possible for treatment to
be provided by a CIGNA network hospital, medical practitioner or clinic. In
these cases, we will not apply any reduction to the payments we will make.
Examples include:
4.3.1 距被保險人住所50 公里(或30 英里)以內無我方醫療網絡
范圍以內的醫院、執業醫生或診所;以及
When there is no CIGNA network hospital , medical practitioner or
clinic within 30 miles/50 kilometres of the beneficiary's home
address; and
4.3.2 當地我方醫療網絡范圍以內的醫院、執業醫生或診所無法為
被保險人提供其所需的治療。
When the treatment the beneficiary needs is not available from a
local CIGNA network hospital, medical practitioner or clinic.
5. 嚴格遵從理賠
流程
Strict compliance
with claim
procedure
對于每一次的理賠,被保險人必須嚴格按照本節所述的理賠流程,否則我
方將減少或不予支付理賠款項。
Beneficiariesmust comply strictly with the claims procedures set out in this section
in respect of every claim. If they do not do so, we will reduce benefits or not pay
the claim as specified above.
第五章保險金申請
Section 5 - Claims application
6. 提供信息
Providing
information
您方在要求理賠時有向我方提供與理賠相關的合理信息或證據的責任。
You (or the beneficiary) must provide us with any information or proof that we may
reasonably ask for to support any claim.
7. 訴訟時效
Claiming period
您方向我方請求給付保險金的訴訟時效期間為自您方知道或者應當知道保
險事故發生之日起2 年。
The period of prescription for the lodging of a claim with us for payment of
insurance benefits by the beneficiary shall be two years, counting from the date on
which you learnt or ought to have learnt of the occurrence of the insured event.
8. 美國地區治療
的理賠
Claims for
treatment in the
United States
8.1 如果被保險人在美國地區接受治療的醫院、執業醫生或診所不屬于
我方醫療網絡范圍之內,我方將按照80%支付相關的醫療費用。我
方醫療網絡的醫院、執業醫生或診所名單可以查詢您方會員卡上的
網址。但被保險人確實無法在我方醫療網絡范圍內的成員機構接受
治療的情況除外,如因為地點限制、或需要立即接受緊急治療。
If a beneficiary receives treatment in the USA from a hospital, medical
practitioner or clinic which is not part of the Cigna network, any payment
we make in respect of this treatment will be reduced by 20%. A list of Cigna
network hospitals, clinics and medical practitioners is available upon
request at the address in yourmembership card. The only exceptions to this
are when it is not reasonably possible to obtain treatment from a member
of the Cigna network, for example because of location, or in the case of
emergency treatment.
8.2 如果被保險人在美國地區接受治療并要求理賠,如有必要,我方將
要求其接受入院前證明(PAC)和持續留院觀察(CSR)的評估。被
保險人將在每次住院時或日間病房治療時,被送至醫療審核聯盟接
受入院前評估。被保險人必須按照以下時間規定與醫療審核聯盟商
議:
If a beneficiary makes a claim for treatment in the USA, he or she may be
required to keep to the pre -admission certification (PAC) and continued
stay review (CSR) requirements. The beneficiary will be transferred to
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CareAllies for PAC for each inpatient or day-patient hospital admission in
the USA. The beneficiary must discuss the PAC with CareAllies either:
8.2.1 一般情況下在入院前;或者
before the beneficiary goes into hospital; or
8.2.2 接受緊急治療時,在入院后的第一個工作日之前。
in the case of emergency treatment, by the end of the first working
day after the date on which the beneficiary goes into hospital.
被保險人必須安排為其進行治療的執業醫生完成入院前證明并轉介
至醫療審核聯盟。醫療審核聯盟將據此核準治療天數并通知被保險
人。如果被保險人需要住院治療的時間超過了醫療審核聯盟的核準
的天數,則為其治療的執業醫生必須為其建議持續留院觀察評估。
對于緊急入院治療,主持治療的執業醫生應致電客戶服務熱線,由
客戶服務熱線安排轉介至醫療審核聯盟獲取入院證明。
The beneficiary must arrange for the medical practitioner who is to carry
out the treatment to complete the PAC, which should then be sent to
CareAllies. CareAllies will advise the beneficiary of the length of the agreed
stay. If the beneficiary needs inpatient treatment for longer than agreed by
CareAllies, then the medical practitioner who is carrying out the treatment
must ask for CSR for the extra days. For emergency inpatient admissions, the
attending medical practitioner should call the Customer Care Team, who will
then transfer him or her to CareAllies for an admission certificate.
美國地區接受治療的相關理賠申請表格和文檔請發送至您方持有的
成員身份卡上的地址,所有的資料注意均須注明保單編號。
Claim forms and documentation relating to treatment received in the USA
should be sent to the address on yourmembership ID card. Please clearly
state the policy number on all documentation.
8.3 如有必要,我方會要求您方額外提供以下資料來核定理賠:
We may need to ask for extra information to help us process a claim, for
example:
8.3.1 醫療報告或關于被保險人狀況的其他資料;
Medical reports or other information about the beneficiary's
condition;
8.3.2 任何我方要求提供并予承擔費用的獨立醫療體檢報告;
The results of any independent medical examination that we may
ask and pay for.
8.4 理賠申請表可以通過電郵或傳真的形式發送至我方,但在這種情況
下,申請資料原件仍須郵寄給我方。
Claims may be submitted in electronic format (by email or fax) but in that
case the original hard copy document must also be sent to us by post.
9. 中國大陸地區
治療的理賠
Claims for
treatment in
Mainland China
9.1 完整填寫一份正本理賠申請表
complete the claim form
您的招商信諾會員文件包中附有一份理賠申請表,或者您可以致電
我們的客服團隊,我們的客服專員會為您提供一份理賠申請表。建
議您就診時帶好理賠申請表,但如果您忘記帶了,也沒有關系,可
以致電我們的客服團隊。
A beneficiary could get the claim forms from his/her CIGNA & CMC member
pack (there is one claim form included in it) or call our Customer Care Team
to get one claim form. You are highly recommended to take one claim form
with you while medical visits. In cases that you forget to take it, you could
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call our Customer Care Team.
9.2 隨附所有的醫療文件
include all relevant medical documents
例如:醫生診斷書,以及/或醫療記錄/醫療手冊。醫療報告/醫療手
冊必須有主持治療的執業醫生的簽字以及/或印章(正式的醫療診斷
章)。這些文件的副本是可以接受的。
including: certificate of diagnosis, and/or medical records. The signatures of
treating medical practitioners are necessary in Medical records. Copies of
these documents are also acceptable.
9.3 隨附所有的收據和發票原件
include all original receipts and invoices
例如:發票、蓋章的醫療費收據等。
including: invoices, sealed medical receipts and so on.
10. 其他地區治療
的理賠申請
Claims for
treatment in
other areas
10.1 被保險人在向我方要求理賠時,應詳細填寫理賠申請表的具體內
容。理賠申請表請您在網站下載,并在填寫完成后寄送至您方持有
的成員身份卡上的地址:
In order to make a claim, a beneficiary should give us details of the claim on
a CIGNA claim form. You can download this form from website, and please
send to address on yourmembership ID card.
10.2 如有必要,我方會要求您方額外提供以下資料來核定理賠,例如:
We may need to ask for extra information to help us process a claim, for
example:
10.2.1 醫療報告或關于被保險人狀況的其他資料;
Medical reports or other information about the beneficiary's
condition;
10.2.2 任何我方要求提供并予承擔費用的獨立醫療體檢報告。
The results of any independent medical examination that we may
ask and pay for.
10.3 理賠申請表可以通過電郵的形式發送給我方,但同時也必須將書面
資料原件寄送我方。
Claims may be submitted in electronic format (by email or fax) but in that
case the original hard copy document must also be sent to us by post.
11. 保險金的給付
How we pay
claims
11.1 在某些情況下,我方可能給予被保險人或醫院、執業醫生或診所提
供付款擔保。此擔保意味著:我方事先同意就某一特定治療支付部
分或全部費用。
In some circumstances, we may give a beneficiary or a hospital, medical
practitioner or clinic a guarantee of payment. This means that we agree in
advance to pay some or all of the cost of a particular treatment.
如果我方出具付款擔保,待治療結束,在收到相關的申請表和發票
復印件后,我方將按照付款擔保向該被保險??或該醫院、執業醫生
或診所支付擔保的款項。
Where we have given a guarantee of payment, we will pay the beneficiary
or hospital, medical practitioner or clinic the agreed amount on receipt of
an appropriate request and a copy of the relevant invoice, after the
treatment has been provided.
11.2 一些醫院、執業醫生或診所愿意直接向我方結算,只要實際的醫療
費用在被保險人的保險責任范圍內,在這些醫院、執業醫生或診所
向我方寄送原始醫療賬單原件后,我方將向其直接支付我方所擔保
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的費用。
Some hospitals, medical practitioners or clinics are willing to invoice us
directly. If the treatment is covered, the hospital, medical practitioner or
clinic should send us the original invoice and we will pay them directly.
11.3 如果某醫院、執業醫生或診所向被保險人要求結算,在醫療費用還
沒有支付的情況下,若要求我方將直接向醫院、執業醫生或診所直
接結算,被保險人必須把醫療賬單原件發給我方。
If a hospital, medical practitioner or clinic invoices a beneficiary directly,
and the hospital, medical practitioner or clinic has not been paid, the
beneficiary must send the original invoice to us, and we will make any
payment under this policy to that hospital, medical practitioner or clinic
directly.
11.4 如果某醫院、執業醫生或診所向被保險人要求結算,在醫療費用已
經支付的情況下,被保險人可以把原始醫療賬單和其支付醫療費用
的發票原件發送我方。我方將就其在保險責任范圍內的費用賠償被
保險人。
If the hospital, medical practitioner or clinic invoices to a beneficiary
directly, and the invoice is paid, the beneficiarymay send us the original
invoice and a receipt for the payment which has been made to the hospital,
medical practitioner or clinic.We will then reimburse the beneficiary for
any portion of the cost of the treatment which is covered.
11.5 在各種情況下,我方將僅支付在保險責任范圍內的部分。我方將告
知您方我方是否認為某部分費用在保險責任范圍內。
In each case, we will only pay the parts of the costs incurred which are
covered. We will let you know if we believe that any part of the cost
incurred is not covered.
11.6 理賠申請表可以通過電郵的形式發送給我方,但同時也必須將書面
資料原件寄送我方。地址在您方持有的成員身份卡上。
Claims may be submitted in electronic format (by email or fax) but in that
case the original hard copy document must also be sent to us by post. Our
contact details may be found on your membership ID card.
12. 其它核定結果
Other decisions
12.1 謊稱發生保險事故
Claim for false insurance event
未發生保險事故,被保險人謊稱發生了保險事故,向我方提出索賠
申請的,我方有權解除保險合同,并不退還保險費。
If an insured event has not occurred by the beneficiary falsely claims that
such an event has occurred, and lodges a claim with us for the payment of
insurance benefits, we shall have the right to terminate the policy and shall
not return the insurance premium.
12.2 故意制造保險事故
Claim for deliberate caused insurance event
投保人、被保險人故意制造保險事故的,我方有權解除保險合同,
不承擔給付保險金的責任也不退還保險費。
If the policyholder or the beneficiary deliberately causes an insured event,
we shall have the right to terminate the policy and shall neither be liable for
the payment of insurance benefits nor return the insurance premium.
12.3 虛假證明
Claim for forged proofs
保險事故發生后,投保人或被保險人以偽造、變造的有關證明、資
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料或者其他證據,編造虛假的事故原因或者夸大損失程度的,我方
對虛報的部分不承擔給付保險金的責任。
If the policyholder, the beneficiary fabricates false causes for an insured
event or overstates the extent of the losses, by means of forged or altered
relevant proofs, information or other evidence after the occurrence of such
event, we shall not be liable for payment of insurance benefits for the
portion that is false.
12.4 退回或賠償處理
Claw back or reimbursement
投保人或被保險人有以上規定行為之一,致使我方支付保險金或者
支出費用的,應當在收到我方相關通知之日起30 日內向我方退回或
者賠償。
If the policyholder, the beneficiary commits any of the acts specified in the
preceding three paragraphs and causes us to pay insurance benefits or incur
expenses, he or she shall return the insurance proceeds to or compensate us
within 30 days after he or she receives the relevant notice sent by us.
第六章釋義
Section 6 - Definitions
13. 術語定義
Defined terms
下列名詞或術語按照下面所指明的定義為準。本條款及保障利益表中按照
下列定義的名詞或術語將標為粗體字。
The words and phrases set out below have the meanings specified. Where those
words and phrases are used with those meanings, they will appear in bold in these
provisions, including the list of benefits.
帶星號的名詞或術語定義僅適用于在美國發生的治療。除非特別指明,下
列術語定義中單數的情況也適用于復數,指男性"他"的也適用于女性
"她";反之亦然。
All definitions that are marked with an asterisk apply to admissions in the USA only.
Unless otherwise provided, the singular includes the plural and the masculine
includes the feminine and vice versa.
13.1 積極治療
Active
treatment
指為了縮小腫瘤、制止或延緩其擴散而進行的治療。不包括單純減輕癥狀
的治療。
treatment which is intended to shrink a cancer, stabilise it or slow down the spread
of the disease. This excludes treatment given solely to relieve symptoms.
13.2 急性發作
Acute
指疾病或損傷并需要迅速接受治療,該治療的目的是為了迅速恢復被保險
人至遭受疾病或損傷前的狀態,或是為了使被保險人完全復原。
a disease, illness or injury that is likely to respond quickly to treatment which aims
to return the beneficiary to the state of health he or she was in immediately before
suffering the disease, illness or injury, or which leads to his or her full recovery.
13.3 年度續保日
Annual renewal
date
指每年與生效時間所對應的日期日期,如當月無對應的日期,則以該月的
最后一日計算。
the anniversary of the start time.
13.4 申請
Application
指投保人的申請(不管是直接郵寄申請表給我方、通過中介機構提出、在
線申請還是通過電話專員提出),以及在保障期內就自己或投保的被保險
人所做的聲明。
the policyholder's application (whether they have sent in a form directly to us or
through a broker or applied online or through our telemarketers), and any
declarations that they made during their enrolment for them and any beneficiaries
included in the application.
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13.5 適當的年齡間

Appropriate
age intervals
下列每兩個相鄰時間點之間的時間間隔:出生,出生后滿2 個月,出生后
滿4 個月,出生后滿6 個月,出生后滿9 個月,出生后滿12 個月,出生后
滿15 個月,出生后滿18 個月,2 周歲,3 周歲,4 周歲,5 周歲及6 周
歲。
birth, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months,
2 years, 3 years, 4 years, 5 years and 6 years.
13.6 被保險人
Beneficiaries,
beneficiary
指保險憑證所載的享有本保險合同保障的人員,包括新生兒。
anybody named on your certificate of insurance as being covered under this policy,
including newborn children.
13.7 保險責任
Benefit(s)
指任何載于保障利益表中的保險責任。
any benefit(s) shown in the list of benefits.
13.8 癌癥
Cancer
指惡性的腫瘤、組織或細胞,表現為惡性細胞及入侵組織不可控制的生長
與擴散。
a malignant tumour, tissues or cells, characterised by the uncontrolled growth and
spread of malignant cells and invasion of tissue.
13.9 醫療審核聯盟
CareAllies
即CareAllies,是對在美國進行的治療進行審核的一個理賠審核機構。
a claims review organisation used in respect of treatment in the USA.
13.10 保險憑證
Certificate of
insurance
指出具給投保人的證明文件,上面載明有保險合同編號、生效時間、免賠
額的額度(若已選擇)——即被保險人理賠時需要自負的費用、被保障人
員的詳細名單、及附加的特別責任免除或利益。
the certificate issued to the policyholder. This shows the policy number, start time,
the deductible amount (if one is selected), that a beneficiary would need to pay if
they make a claim, details of who is covered, any special exclusions and benefits
which apply.
13.11 我方、信諾、
保險人
Cigna, we, us,
our, the insurer
指招商信諾人壽保險有限公司。
Cigna-CMC Life Insurance Company.
13.12 診所
Clinic(s)
指在治療所在國注冊或登記的健康服務機構,主要目的是提供門診醫療服
務,并且該醫療服務是由執業醫生親自執行或有效監控的。
a health care facility which is registered or licensed in the country in which it is
located, primarily to provide care for outpatients and where care or supervision is
by a medical practitioner.
13.13 補充治療師
Complementary
therapist
指經過專業培訓及資格認證,并經有關當局許可允許在該國進行治療的針
灸師、順勢療法醫師或中醫醫師。
an acupuncturist, homeopath or practitioner of Chinese medicine who is
appropriately qualified and entitled to practise in the country where treatment is
given.
13.14 先天性疾病
Congenital
condition
指出生時已存在的任何生理不正常、畸形、疾病或損傷,無論是否做過診
斷。
any abnormality, deformity, disease, illness or injury present at birth, whether
diagnosed or not.
13.15 持續留院觀察
Continued stay
review, CSR
指當被保險人發生住院時,醫療審核聯盟就該被保險人是否需要繼續住院
治療進行的審核和決定。
a review and decision by CareAllies, during the beneficiary's stay in hospital, on the
suitability of the beneficiary's continued treatment as an inpatient.
13.16 美容
Cosmetic
指基于美學初衷所提供的服務、程序或項目,以及不是為了保持可接受的
健康標準所必須的服務、程序或項目。
services, procedures or items that are supplied primarily for aesthetic purposes and
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which are not necessary in order to maintain an acceptable standard of health.
13.17 常住國
Country of
habitual
residence
指被保險人常住地所在的國家,與您方申請記錄一致。
the country where a beneficiary habitually resides, as stated on your application.
13.18 國籍國
Country of
nationality
指被保險人作為其公民、國民的國家或與您方申請記錄一致的國家。
any country of which a beneficiary is a citizen, national or subject, as stated on your
application.
13.19 日間病房治療
Day-patient
treatment
在醫院進行護理并使用床位,但并不過夜。在美國的護理中也包含醫生在
手術中的外科操作程序。
care involving admission to hospital and using a bed but not staying overnight. In
respect of USA based admissions, this also includes surgical procedures carried out
in the doctor's surgery.
13.20 日間病房病人
Day-patient
指入住醫院或日間病房,或使用治療的其他醫療設施,或需要一段時間的
醫療觀察的病人,但并不占用醫院病床過夜。
a patient who is admitted to a hospital or day-patient unit or other medical facility
for treatment or because they need a period of medically supervised recovery, but
who does not occupy a bed overnight.
13.21 免賠額
Deductible(s)
指理賠金中被保險人必須自行承擔的額度,經選擇后在保險憑證上載明。
is the amount of any claim which a beneficiary must pay themselves. This will be
shown in the certificate of insurance if selected.
13.22 緊急牙科
Dental
emergency
指拔牙后止痛藥無法遏制的劇痛或面部浮腫或流血不止,同時被保險人的
慣常牙科醫生不在非營業時間或不在被保險人當時可及的地域范圍之內。
在該情況下的緊急牙科治療僅以穩定病況及緩解劇痛為目的。
where either severe pain which is not amenable to relief by painkillers or facial
swelling or uncontrollable bleeding after an extraction is being suffered and it is
either outside the business hours of a beneficiary's usual dentist or the beneficiary
is staying at a place which is away from the dental practice he or she usually visits.
The treatment covered in such an instance is to purely stabilise the problem and
relieve severe pain.
13.23 牙齒損傷
Dental injury
指口腔受外部打擊而導致健康自然牙的損傷。只有您方選擇了國際眼科和
牙科保障,冠修復體、義齒或種植牙的治療才在保障范圍內;并且,需要
根據該保障條款的條件進行承擔。
injury to a sound natural tooth caused by extra-oral impact. Treatment for dental
implants, crowns or dentures is not covered unless you have purchased the
International Vision and Dental option and subject to the conditions outlined in the
policy.
13.24 牙科治療
Dental
treatment
指符合下述全部條件的牙科治療:
any dental procedure or service which:
13.24.1 為了維持口腔健康;并且
is needed for continued oral health; and
13.24.2 由牙醫親自操作或有效監控,包括輔助人員的操作流程;并且
is carried out or personally controlled by a dentist, including procedures
provided by a hygienist; and
13.24.3 包括于保障利益表中,或盡管未列在保障利益表,但已被我方認
可、符合通常適用的牙科標準、并已被牙科醫學界普遍支持的流
程或服務。
is included in the list of benefits, or, though not included in the list of
benefits, is accepted by us as a procedure or service meeting common
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dental standards as upheld by a respectable, responsible and substantial
body of dental opinion, experienced in the particular field of dentistry.
13.25 牙醫
Dentist
指為國家、政府或其他監管地區所承認并允許在該地區提供治療的牙科醫
生、牙齒外科醫生或牙科執業人員。
a dentist, dental surgeon or dental practitioner who is registered or licensed as
such under the laws of the country, state or other regulated area in which the
treatment is provided.
13.26 斷癮
Detoxification
對戒除吸毒或/及嗜酒時戒斷癥狀的醫療處理,包括采用休息、藥物、輸液
或調整飲食以穩定身體狀態。
treatment for withdrawal symptoms after a beneficiary has been abusing drugs,
alcohol or both. It includes the rest, medication, fluids and changes in diet needed
to stabilise the body.
13.27 診斷檢測
Diagnostic tests
指對癥狀原因的調查研究,如X 光或血液檢測等。
investigations such as x-rays or blood tests to find or to help to find the cause of the
beneficiary's symptoms.
13.28 醫生
Doctor
指同時符合下列條件的醫療從業人員:擁有適當的醫療學位;在所在的國
家、地區或管轄范圍內合法注冊并擁有行醫執照,可以在醫療發生地提供
醫療服務。
a medical professional who holds an appropriate doctoral degree, is registered and
licensed under the laws of the country, state or regulated area to practice medicine
in the country in which the treatment is provided.
13.29 符合條件的女

Eligible female
指作為投保人或被保險人的女性。
a female policyholder or beneficiary.
13.30 緊急治療
Emergency
treatment
指為阻止疾病、損傷及癥狀進一步的迅速惡化而進行的醫療必要治療,如
不進行該治療,將會顯著地影響健康。
treatment which is medically necessary to prevent the immediate and significant
effects of illnesses, injuries or conditions which, if left untreated, could result in a
significant deterioration in health.
只有在緊急事由發生后24 小時之內由內科醫生、執業醫生或住院服務機構
提供的緊急醫療,或24 小時之內因此發生的住院才受保障。
Only medical treatment through a physician, medical practitioner and
hospitalisation that commences within 24 hours of the emergency event will be
covered.
13.31 保單終止日
End date
指保險憑證所載的本保險合同保障結束的日期。
the date on which cover under this policy ends, as shown in the certificate of
insurance.
13.32 循證治療
Evidence-based
treatment
指經過下述機構研究、核查及認可的治療:
treatment which has been researched, reviewed and recognised by:
13.32.1 美國國家健康及臨床優化研究所(the National Institute for Health
and Clinical Excellence);或
the National Institute for Health and Clinical Excellence; or
13.32.2 我方醫療顧問團;或
the CignaMedical Team; or
13.32.3 我方認可的其他機構;
another source recognised by the CignaMedical Team.
13.33 大中華地區指中華人民共和國的全部領土、領海及其領空,包括香港特區、澳門特區
和臺灣地區在內。
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Great China all territories, seas and related airspaces of People's Republic of China, including
Hong Kong, Macau and Taiwan.
13.34 付款擔保
Guarantee of
payment
指我方對被保險人或治療方提供關于特定治療付款擔保的協議費用。
a guarantee to pay agreed costs associated with particular treatment which we
may give to a beneficiary or a hospital, clinic or medical practitioner.
13.35 家庭護理
Home nursing
指一位合法注冊護士至被保險人家中提供的專業護理服務,包括:
visits from a qualified nurse to the beneficiary's home to give expert nursing
services:
13.35.1 因醫療必要所進行的緊隨住院治療之后的護理;以及
immediately after hospital treatment for as long as is required by
medical necessity; and
13.35.2 因醫療必要而本應在正規醫院里所提供的護理。
visits for as long as is required by medical necessity for treatment which
would normally be provided in a hospital.
家庭護理僅限于為被保險人提供治療的專科醫生所要求的范圍。
Home nursing is only covered when the specialist who treated the beneficiary has
recommended such services.
13.36 醫院
Hospital
指由執業醫生或合法注冊護士對被保險人進行日常護理、觀察、治療的醫
療機構,并且該醫療機構在所在地的監管機構注冊或登記為提供綜合醫療
服務或外科醫療服務的合格機構。
any organisation or institution which is registered or licensed as a medical or
surgical hospital in the country in which it is located and where the beneficiary is
under the daily care or supervision of a medical practitioner or qualified nurse.
13.37 最初生效時
Initial start time
指被保險人首次獲得國際醫療保障的開始時間。
the first day the beneficiary's cover commenced on the International Medical
Insurance plan.
13.38 損傷
Injury
指機體損傷。
a physical injury.
13.39 住院
Inpatient
指被保險人因醫療原因、被接納入一家醫院并且需要在醫院占用正式病床
停留一個夜晚或以上。
a patient who is admitted to hospital and who occupies a bed overnight or longer,
for medical reasons.
13.40 保險
Insurance
指根據本條款及保險憑證上載明的保障內容、賠付條件、賠付限額、責任
免除等條款,我方為被保險人提供的保障。
the coverage which is provided by us to the beneficiaries subject to the terms,
conditions, limits and exclusions set out in these provisions, and your certificate of
insurance.
13.41 重癥監護
Intensive care
醫院中專門用于提供重癥監護治療的病房,例如重癥監護室、重疾監護
室、重癥治療室及重癥護理室等。
a specialised department in a hospital that provides intensive care treatment, for
example an intensive care unit, critical care unit, intensive therapy unit, or intensive
treatment unit.
13.42 保障利益表
List of benefits
指載于附件中最新的保障利益表,包括對其的注釋。
the latest list of benefits detailed in the provision, including any notes to it.
13.43 妊娠責任
Maternity
benefit
指有關懷孕及分娩方面的責任,包括本保險合同下符合條件的女性被保險
人因此而產生的任何并發癥,但不含:
benefits available in relation to all aspects of pregnancy or childbirth, including any
complications, for any eligible female covered under this policy, but excluding:
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13.43.1 有意結束懷孕的治療,除非懷孕已危及母親的生理健康或心理穩
定;以及
treatment by way of the intentional termination of pregnancy unless the
pregnancy endangers the life or mental stability of the mother; and
13.43.2 新生兒在醫院的托管護理,除非其母親因醫療必要必須住院接受
本保險合同規定范圍內的治療。
nursery care for a newborn in hospital, unless the mother is required to
remain in hospital due to medical necessity for treatment that is
covered by this policy.
13.44 中國大陸
Mainland China
指中華人民共和國的全部領土、領海及其領空,除香港特區、澳門特區和
臺灣地區外。
all territories, seas and related airspaces of People's Republic of China, excluding
Hong Kong, Macau and Taiwan.
13.45 醫療必要
Medically
necessary/
medical
necessity
指經醫療團隊同意的、受保障的必要醫療服務及供給,須符合下述全部條
件:
medically necessary covered services and supplies are those determined by the
medical teamto be:
13.45.1 基于診斷或治療疾病、損傷或相關癥狀的需求;
required to diagnose or treat an illness, injury, disease or its symptoms;
13.45.2 符合通常醫療標準及醫療實踐的規范醫療服務;
orthodox, and in accordance with generally accepted standards of
medical practice;
13.45.3 與疾病的類型、發病頻率、波及范圍、部位及病程相適應的臨床
治療服務;
clinically appropriate in terms of type, frequency, extent, site and
duration;
13.45.4 非主要出于方便被保險人、內科醫生或其他醫院、診所及執業醫
生的目的;以及
not primarily for the convenience of the beneficiary, physician or other
hospital, clinic or medical practitioner; and
13.45.5 在合適的最佳設施中所提供的服務與供給。
rendered in the least intensive setting that is appropriate for the delivery
of the services and supplies.
醫療團隊會在比較過可選擇服務、設施或供給的成本效率后決定什么是最
佳設施。
Where applicable, the medical teammay compare the cost effectiveness of
alternative services, settings or supplies when determining what the least intensive
setting is.
13.46 執業醫生
Medical
practitioner
指經國家、政府或其他監管注冊或認可的可在該其管轄范圍內進行治療的
執業醫生或專業醫生,不包括本保險合同保障下的本人或其任何家庭成
員。
a doctor or specialist who is registered or licensed to practice medicine under the
laws of the country, state or other regulated area in which the treatment is
provided, and who is not covered under this policy, or a family member of someone
covered under this policy.
13.47 醫療團隊
Medical team
指我方臨床小組。
means our clinical team.
13.48 外科操作指載于手術價目表上的所有手術的操作流程。
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Operation(s) any procedure described as an operation in the schedule of surgical procedures.
13.49 口腔健康
Oral health
根據被保險人常住國具有普通能力技術的牙科醫生可以接受的口腔健康維
護標準,該標準是關于牙???、牙周及其他口腔支持組織、咀嚼效率等要素
的口腔健康合理標準。
for a patient, a reasonable standard of oral health of the teeth, their supporting
structures and other tissues of the mouth, and of dental efficiency, according to a
standard acceptable to a dentist of ordinary competence and skill in the patient's
country of habitual residence which will safeguard his or her general health.
13.50 規范
Orthodox
對于治療程序或治療方式,"規范"應根據:在治療發生國家內、在療程開
始或治療發生當時,與權威的實體主管機構公布的標準或意見相一致的、
由在涉及疾病的專業醫療領域具有豐富經驗的執業醫生具有并作出的意
見。
when used in relation to a procedure or treatment, 'orthodox' means that the
procedure or treatment in question is medically accepted in the country where it
takes place at the time of the commencement of the procedure or treatment, that
complies with a respectable, responsible and substantial body of medical opinion,
held and expressed by medical practitioners experienced in the particular field of
medicine in question.
13.51 門診
Outpatient
指病人在醫院、診療室,或門診部進行的不是日間病房治療或住院治療的
治療。
a patient who attends a hospital, consulting room, or outpatient clinic for
treatment and is not admitted as a day-patient or an inpatient.
13.52 姑息治療
Palliative care
指不以使病癥完全治愈或實質性好轉為目的,僅以緩解痛苦為目的的治
療。
treatment that does not cure or substantially improve a condition but is given in
order to alleviate symptoms.
13.53 保險期間
Period of cover
指被保險人受到本保險合同保障的期限,由生效時間至保單終止日的連續
12 個月期間、或由生效時間到提交終止日的期間。
the 12 month continuous period during which the beneficiaries are covered under
this policy, being the period from the start time to the end date as noted on the
certificate of insurance or earlier if terminated in accordance with the provisions.
13.54 永久植物人狀

Persistent
vegetative state
指一被保險人至少連續90 天處于植物人狀態。"植物人狀態"是指由于損傷
或疾病使被保險人處于神志喪失的狀態,并無法以表情或動作等表現出對
自我或周圍環境的感知(此處"對自我或周圍環境的感知"是指一種意識反
應或表達,而不是指神經肌肉反射等基礎生理反射現象),并且按照醫學
上的合理可能性,被保險人應該沒有蘇醒的可能。
a beneficiary who is in a vegetative state for at least 90 consecutive days. A
persistent vegetative state means a condition caused by injury, disease or illness in
which the beneficiary has suffered a loss of consciousness, with no behavioural
evidence of awareness of self or surroundings in a learned manner, other than
reflex activity of muscles and nerves for low level conditioned response, and from
which to a reasonable degree of medical probability, there can be no recovery.
13.55 保險合同
Policy
指包括保險條款(包括保障利益表及理賠等信息)、您方的保險憑證等內
容的保險合同。
the policy comprising these provisions (which contains the list of benefits and
claiming information) and your certificate of insurance.
13.56 保險合同文件
Policy
documents
指保險合同所包含的文件,包括:保險條款、保險憑??、客戶手冊、理賠
申請表及您方的保險會員卡。
the documentation relating to the policy, comprising of these provisions, certificate
of insurance, customer guide, the Cigna claim form, and your Cigna ID Card.
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13.57 投保人
Policyholder
是指向我方發出申請,并經我方書面同意按照本保險合同約定負有支付保
險費義務的人。
a person who has made an application to us which has been accepted in writing by
us, and who pays the premium under the policy.
13.58 入院前證明
Pre-admission
certification,
PAC
指醫療審核聯盟在病人進入美國醫院之前對其住院治療或日間病房治療所
做的審核與初始決定。
a review and an initial decision by CareAllies, before admission to a hospital in the
USA, on the suitability of inpatient treatment or day-patient treatment for a
patient.
13.59 既往癥
Pre-existing
condition
指被保險人在本保險合同生效前已有的疾病或損傷,并滿足下列條件之
一:
any disease, illness or injury, or symptoms linked to such disease, illness or injury
for which:
13.59.1 已經因該疾病或損傷進行過的就診或治療;或者
medical advice or treatment has been sought or received; or
13.59.2 在最初生效時前雖然沒有進行就診或治療,被保險人已經知道或
者應該已經知道。
the beneficiary knew about and did not seek medical advice or
treatment; before the initial start time.
13.60 保險條款
Provision
指包含保障利益表及其他保單重要內容的文件。
contains the list of benefits and forms part of the policy.
13.61 精神心理治療
Psychiatric
treatment
指對有精神健康問題的被保險人進行的治療,包括飲食失調。
management and care of a person who is suffering from a mental health condition
including but not limited to eating disorders.
13.62 心理醫生
Psychologist
指具備治療所在國的專業資格認證(并擁有在治療所在國執業的合法資
格)、在臨床心理治療機構執業的、提供精神和心理問題醫療服務的專業
人員。
is a person who is qualified (and holds the appropriate license to practice in the
country where treatment is received) in clinical psychology and who provides
treatment services to patients with mental and emotional disorders.
13.63 合法注冊護士
Qualified nurse
指被治療所在地的國家、政府或其他監管區域的法律所承認、注冊并允許
在該地區提供服務的護士。
a nurse who is registered or licensed as such under the laws of the country, state or
other regulated area in which the treatment is provided.
13.64 重大人生事件
Qualifying life
event
指:
means:
13.64.1 結婚或結為伴侶;
marriage or civil partnership;
13.64.2 與伴侶開始同居;
commencing cohabitation with a partner;
13.64.3 離婚或分居;
divorce or separation;
13.64.4 生育兒女;
birth of a child;
13.64.5 收養孩子;或
legal adoption of a child; or
13.64.6 配偶、伴侶或孩子去世。
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death of a spouse, partner or child.
上述情況我方均要求提供相應證明。
We may require evidence of the above event.
13.65 康復
Rehabilitation
指采用物理治療、職業治療和語言治療等手段,使被保險人恢復到疾病或
損傷急性發作之??的狀態。
physical, speech and occupational therapy for the purpose of treatment aimed at
restoring the beneficiary to their previous state of health after an acute event.
13.66 手術價目表
Schedule of
surgical
procedures
指經我方首席醫療官所核準的最新手術價目表。
the current schedule of surgical procedures approved by our chief medical officer.
13.67 所選擇保障區

Selected area
of coverage
指下述二者之一:
means either:
13.67.1 全球含美國;或
Worldwide, including USA; or
13.67.2 全球不含美國
Worldwide, excluding USA.
13.68 短期
Short-term
指按照主持治療的執業醫生的評估并經我方醫療主管的認可,與治療疾病
后被保險人正常復元的合理過程相吻合的時間段。
means a period of time consistent with the recuperation time required for the
treatment and as prescribed by the treating medical practitioner with the approval
of ourmedical director.
13.69 疾病
Sickness
指生理或心理疾病,包括妊娠所導致的或與妊娠有關的疾病。
a physical or mental illness, including illness resulting from or relating to pregnancy.
13.70 健康自體牙
Sound natural
tooth/teeth
指咀嚼、語言等功能完全正常的牙齒、且非種植牙。另外,不得存在下列
任何情況之一:
a tooth that functions normally for chewing and speech purposes and that is not a
dental implant. Such natural tooth/teeth should not have experienced any of the
following:
13.70.1 齲齒或牙科充填;
decay or filling;
13.70.2 伴隨牙槽骨喪失的牙齦牙周疾病;
gum disease associated with bone loss;
13.70.3 根管治療。
root canal treatment.
13.71 專科醫生
Specialist
指根據治療所在地的國家、政府或其他監管區域的法律,合法承認、注冊
或登記的醫生,并且其所提供的治療必須在其合法資質的范圍內。
a doctor who is recognised, registered or licensed as such under the laws of the
country, state or other regulated area in which the treatment is provided and only
for the treatment which is being recommended.
13.72 配偶
Spouse
指被保險人的法定丈夫或妻子,或我方已接受承保于本保險合同中的未婚
人員或伴侶。
a beneficiary's legal husband or wife, or unmarried or civil partner who we have
accepted for cover under this policy.
13.73 生效時間
Start time
指載于保險憑證中的本保險合同保障開始日期。
the time on which coverage under this policy starts, as shown in the certificate of
insurance.
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13.74 手術
Surgery
對肢體進行開放性切割以治療疾病、創傷及畸形的醫療專業。
the branch of medicine that treats diseases, injuries, and deformities by operative
methods which involves an incision into the body.
13.75 對癥狀的
Symptomatic
指不以改變腫瘤生長及進展為目的,僅為了緩解癥狀的治療。
treatment that no longer attempts to alter cancer growth or progression but is
given to alleviate symptoms.
13.76 治療師
Therapist
指國家、政府或其他行政地區所承認并允許在該地區提供治療的理療師、
職業治療師、視力矯正醫師或語言治療師。
a speech therapist, dietician or orthoptist who is suitably qualified and holds the
appropriate license to practice in the country where treatment is received.
13.77 治療
Treatment
指由執業醫生進行的手術或治療,并且是為了達到"診斷、治愈或實質性緩
解疾病或損傷"的目的所必須進行的。
any surgical or medical treatment controlled by a medical practitioner that are
medically necessary to diagnose, cure or substantially relieve disease, illness or
injury.
13.78 未滿期凈保費
Unearned net
premium
指對應保險期間尚未經過部分的保險費。
any premium which has been paid in relation to the period after cover has ended.
13.79 美國
USA
指美利堅合眾國。
the United States of America.
13.80 全球含美國
Worldwide
including USA
指世界各國及海上。
every country throughout the world and at sea.
13.81 全球不含美國
Worldwide
excluding USA
指除美利堅合眾國以外的世界所有地區。
worldwide, with the exception of the USA.
13.82 您、您方、您
方的
You, your
指投保人。
the policyholder.
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附件:保險利益表
Appendix: List of benefits
國際醫療保障
InternationalMedical Insurance
每一保險期間內每一被保險人的國際醫療保障的賠付限額
Annual Benefit – Maximum per beneficiary. This includes claims paid across all
sections of the International Medical Insurance
¥20,000,000
Up to ¥ 20 Million per
period of cover
您所享有的基本醫療保險責任
Your Standard Medical Benefits
賠付限額(可能適用免
賠額)
Benefit Limit (Subject to
Deductable)
綜合住院醫療費用,具體包括:
Hospital Charges for:
-住院治療的護理費及病房膳食費;
. Nursing and accommodation for in-patient treatment;
-日間病房治療費用;
. Day case treatment;
-手術室及麻醉復蘇室費用;
. Operating theatre and recovery room;
-住院或日間病房治療的處方藥及敷料費用;
. Prescribed medicines, drugs and dressings for in-patient or day case treatment;
-門診手術的治療室費用。
. Treatment room fees for outpatient surgery.
全額
Paid in Full
重癥監護室,包括重癥治療室、加護病房或冠心病監護室
Intensive care: intensive therapy, coronary care and high dependency unit
全額
Paid in full
父母陪同病房費用
Parental Accommodation
本項責任僅適用于未滿18 周歲的未成年人。如被保險人須過夜留院治療,我
方將支付合理的在同一醫院的父母陪同住宿費用。
This applies to dependent children under the age of 18. CIGNA will pay for
reasonable costs for a parent staying in the same hospital with the child where the
child is required to stay in the hospital overnight.
全額
Paid in Full
外科醫生及麻醉師費用
Surgeons' and Anesthetists' Fees
適用于任何基于住院、日間病房或門診而施行的手術。
Whether surgery is provided on an in-patient, day case or out-patient basis.
全額
Paid in Full
專科醫生診療費
Specialists' consultation fees
本項責任適用于在被保險人住院時專科醫生的常規巡查,并包括因醫療必要而
須專科醫生執行的重癥緊急護理。
This benefit is paid in full for regular visits by a specialist during stays in hospital
including intensive care by a specialist for as long as is required by medical
necessity.
全額
Paid in Full
移植治療
Transplant Services
適用于住院發生的移植治療。
Where treatment is provided on an in-patient basis.
全額
Paid in Full
病理檢測、放射學檢查及診斷檢測
Pathology, Radiology and diagnostic tests
適用于住院或日間病房期間。
Where treatment is provided on an in-patient or day patient basis.
全額
Paid in Full
物理療法及補充治療
Physiotherapy and complementary therapies
適用于住院或日間病房期間。
Where treatment is provided on an in-patient or day patient basis.
全額
Paid in Full
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核磁共振、計算機斷層掃描及正電子發射斷層掃描
MRI, CT and PET scans
我方將支付在住院、日間病房或門診發生的這些掃描檢查。
We will pay for these scans whether received on an inpatient, day-patient or an
outpatient basis.
全額
Paid in Full
家庭護理費用
Home nursing charges
每一保險期間內以30 天為限。
Paid up to 30 days in any one period of cover.
全額
Paid in Full
康復治療
Rehabilitation
每一保險期間內以30 天為限。
Paid up to 30 days in any one period of cover.
全額
Paid in Full
臨終關懷及姑息治療
Hospice stay to receive Palliative Care
全額
Paid in Full
內置修復體、設備及裝置
Internal prosthetic devices/surgical and medical appliances
我方將支付:
We pay for:
-手術過程中植入體內的假體、設備或醫療用品。
. a prosthetic implant, device or appliance which is inserted during surgery.
全額
Paid in Full
外置修復體、設備及裝置
External prosthetic devices/surgical and medical appliances
我方將支付:
We pay for:
-手術后立即需要的、醫療必要的修復性設備或裝置。
. a prosthetic device or appliance which is a necessary part of the treatment
immediately following surgery for as long as is required by medical necessity.
-在病后恢復階段內短期內需要的、醫療必要的修復性設備或裝置。
. a prosthetic device or appliance which is medically necessary and is part of the
recuperation process on a short-term basis.
我方為成年人僅支付一次外用假體費用。我方為16 周歲及以下的未成年人支
付初始的假體設備費用及最多兩次用于替換的假體設備費用。
For adults, we will pay for one external prosthetic device. For children up to the age
of 16, we will pay for the initial prosthetic device and up to two replacement
devices.
每一假體設備以¥ 20,000
為限
Up to¥ 20,000 for each
prosthetic device
當地救護車及空中救援服務
Local Ambulance and Air Ambulance Services
因醫療必要而須使用當地救護車前往醫院進行治療。
Medically necessary travel by local road ambulance or local air ambulance, such as
a helicopter, when related to covered hospitalization.
全額
Paid in Full
住院津貼
Hospitalization Cash Benefit
我方將在滿足下述條件的基礎上向您支付每日住院津貼:
We will make a cash payment to the beneficiary when they:
-您所接受的治療在本合同責任規定范圍內;
. received treatment in hospital which is covered under this plan
-住院治療須過夜;
. stay in hospital overnight
-您未曾報銷任何病房膳食費及治療費。
. have not been charged for your room and board, and treatment costs.
¥ 1,200 元/天,每一保險
期間內以30 天為限
¥ 1,200 per night, up to 30
nights per period of cover
緊急牙科治療
Emergency dental treatment
因遭受嚴重意外事故而導致住院接受牙科治療。
Dental treatment in hospital after a serious accident.
全額
Paid in Full
您所享有的精神疾病醫療責任
Your Psychiatric Care
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精神疾病醫療
Psychiatric Care
我方將支付:
We will pay for:
-精神疾病或異常的治療。
. treatment of mental health conditions and disorders.
-成癮性治療
. addiction treatment.
包括被保險人在住院還是在日間病房或門診接受治療。一個保險期間內累積以
90 天為限,包括最多30 天住院。對日間病房治療和門診,每就診日計作"1
天"。
Whether the beneficiary is staying in a hospital overnight or receiving treatment as
a day-patient or outpatient. A combined maximum total of 90 days cover is
available in the period of cover, including up to 30 days of inpatient treatment. For
day-patient and outpatient treatment, each visit will count as one day.
一個連續5 年的期間內總累積限180 天,其中住院最多可以到60 天。
An overall 5 year total limit of 180 days cover will apply, of which a maximum of 60
days can be used for inpatient treatment.
全額
Paid in Full
您所享有的癌癥醫療責任
Your Cancer Care
癌癥治療
我方將支付對癌癥進行的積極治療及循證治療。包括:被保險人在住院、日間
病房或門診發生的化療、放療、腫瘤病理、檢查化驗及藥物等。
We will pay for active and evidence-based treatment received for, or related to
cancer, including chemotherapy, radiotherapy, oncology, diagnostic tests and drugs
whether the beneficiary is staying in a hospital overnight or receiving treatment as
a day-patient or outpatient.
全額
Paid in Full
您所享有的生育與新生兒護理及治療責任
Your Mother And Baby Care
常規妊娠及分娩保障
Routine Maternity and Childbirth Cover
連續持有本合同10 個月及以上且在此期間內持續有效的女性被保險人可享有
本保障。
Available once the mother has been covered by the policy for 10 months or more.
涵蓋門診及住院治療費用,包括醫院收費,產科醫生及助產士費用。
In-patient and out-patient treatment including hospital charges, obstetricians' and
midwives' fees.
每一保險期間以¥ 90,000
為限
Up to ¥ 90,000
per period of cover
復雜妊娠及分娩保障
Complicated Maternity and Childbirth Cover
連續持有本合同10 個月及以上且在此期間內持續有效的女性被保險人可享有
本保障。
Available once the mother has been covered by the policy for 10 months or more.
涵蓋門診及住院治療費用,包括醫院收費,產科醫生及助產士費用。
In-patient and out-patient treatment including hospital charges, obstetricians' and
midwives' fees.
本項責任含因醫療必要而發生的剖腹產。如果我方無法確定您的剖腹產確因醫
療必要而發生,我方將按常規妊娠及分娩責任限額進行支付。
Caesarean sections are only covered under this benefit where they are required by
medical necessity. If we are unable to determine that your Caesarean section was
medically necessary, it will be paid from the beneficiary's routine maternity and
childbirth benefit limit.
每一保險期間以¥
180,000 為限
Up to ¥ 180,000
per period of cover
家中分娩
Homebirths
每一保險期間以¥ 7,000
為限
Up to ¥ 7,000 per year of
insurance
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新生兒護理
Newborn care
若在新生兒出生前至少10 個月或以上的連續期間內,父母親中至少一位一直
在本合同保障下,則:
If at least one parent has been covered by the policy for a continuous period of 10
months or more prior to the newborn's birth.
如果新生兒于出生30 天內申請加入本保險合同,我方將不要求提供其醫療資
料、并且無須醫療核保加入本保險合同;如果新生兒于出生30 天后申請加入
本保險合同,我方將要求進行醫療核保、并要求您方完成相應的醫療健康問
卷、我方有可能適用特別限制條件或特別責任免除。
We will not require information about the newborn's health or a medical
examination if an application is received by us to add the newborn to the policy
within 30 days of the newborn's date of birth. If an application is received after30
days of the newborn's date of birth, the newborn will be subject to medical
underwriting and we will require the completion of a medical health questionnaire
whereby we may apply special restrictions or exclusions.
自出生之日起享有最多
90 天以¥1,000,000 為限
的保障,新生兒于出生
之日起30 天內加入本合
同無須經醫學核保
Up to ¥ 1 Million,
for treatment within first
90 days following birth No
medical underwriting so
long as child added within
30 days from birth
新生兒護理
Newborn care
如果新生兒的父母中沒有一位能滿足"在新生兒出生前10 月或更長時間內,已
經持續有效地作為我方被保險人"的條件,而我們收到該新生兒投保申請的:
If neither parent has been covered by the policy for a continuous period of 10
months or more prior to the newborn's birth and an application is received by us to
add the newborn to the policy as a beneficiary.
則須經醫療核保,我方將要求您方完成其醫療及健康信息問卷。我方將根據醫
療核保結果決定是否承保及承保條件,我方有可能適用特別限制條件或特別責
任免除。
The newborn will be subject to medical underwriting and we will require the
completion of a medical health questionnaire. Cover for the newborn will be
subject to medical underwriting whereby we may apply special restrictions or
exclusions.
自出生之日起享有最多
90 天以¥1,000,000 為限
的保障,新生兒加入本
合同須經醫學核保
Up to ¥ 1 Million
for treatment within first
90 days following birth
Subject to medical
underwriting
先天性疾病
Congenital conditions
包括對先天性疾病的住院或日間病房治療費用,且該先天性疾病須在被保險人
18 周歲以前已經證明患有。
Where treatment is provided on an in-patient or day patient basis and the
congenital condition manifested itself before the patient's 18th birthday
本保障不適用于所有被保險人均不足18 周歲的保險合同。如果訂立保險合同
時所有被保險人的年齡均不足18 周歲,則先天性疾病不在保險合同保障范圍
內。
This benefit does not apply for the policies, under which all beneficiary (ies) are less
than 18 years old. If all beneficiary (ies) under one policy are less than 18 years old
when entering into the policy, then congenital conditions are excluded from the
policy.
以¥ 250,000 為限
Up to ¥ 250,000
您可選擇的免賠額
Your deductible options
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免賠額(多項)
Deductible (various)
免賠額作為理賠的組成部分將不涵蓋于您的保險責任當中。
A deductible is a portion of a claim or claims that is not covered by your plan.
例如您為所購買的國際醫療保險選擇了¥ 5,000 的免賠額,那么您在任何一個
保險期間內理賠時,我方將在扣除¥ 5,000 的基礎上向您支付理賠款項。如果
您已經選擇了某免賠額,在每一保險期間內無論發生多少次理賠,作為免賠額
由您方支付的總額為該金額。您選擇的免賠額越高,您所應支付的保險費則越
低。免賠額適用于本合同內的所有被保險人。
So, for example if you choose a deductible of ¥ 5,000 for International Medical
Insurance, you'll need to pay the first ¥ 5,000 of a covered claim or covered claims
in any period of cover. If a deductible is chosen, you would only have to pay this
once during any period of cover irrespective of the number of claims. The higher
the deductible you apply, the lower your premium will be. The deductible is payable
by each person covered by the policy.
¥ 0 / ¥ 2,500 / ¥ 5,000 / ¥
10,000 / ¥ 20,000 / ¥
50,000
國際醫療補充保障(可選保障)
InternationalMedical Insurance Plus (Optional)
門診醫療責任
Out-patient Healthcare Benefits
賠付限額(可能適用免
賠額)
Benefit Limit (Subject to
Deductable)
每一保險期間內每一被保險人所有保險責任賠付限額
Annual Benefit – Maximum per beneficiary
每一保險年度以¥
500,000 為限
Up to ¥ 500,000 per
period of cover
執業醫生及專科醫生診療費
Consultations with Medical Practitioners and Specialists
全額
Paid in Full
診斷性檢查化驗費
Diagnostic testing
全額
Paid in Full
物理治療
Physiotherapy
全額
Paid in Full
正骨治療及脊椎治療
Osteopathy and chiropractic treatment
每一保險期間內總計不超過30 次。
Up to a combined maximum of 30 visits per period of cover.
全額
Paid in Full
針灸治療、順勢治療及中醫治療
Acupuncture, Homeopathy and Chinese Medicine
每一保險期間內總計不超過20 次。
Up to a combined maximum of 20 visits per period of cover.
全額
Paid in Full
言語復健治療
Restorative Speech Therapy
基于遭受疾病(例如中風)而接受的短期治療。
Provided on a short-term basis following a condition such as a stroke.
全額
Paid in Full
藥品費及敷料費
Drugs and dressings
在門診發生的由執業醫生開具處方的處方藥或敷料費。
When prescribed by a medical practitioner on an outpatient basis.
全額
Paid in Full
耐用醫療設備租賃費
Rental of Durable Medical Equipment
每一保險期間內最多45 天的租賃時長。
Up to a maximum of 45 days in the period of cover.
全額
Paid in Full
成人疫苗接種
Adult Vaccinations
全額
Paid in Full
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牙科意外門診治療
Accidental Dental Treatment
如果被保險人因遭受意外事故而導致健康自體牙發生損傷,牙齒損傷的治療在
意外事故后立即開始、且在意外事故后30 天內完成的,我方將支付牙科意外
門診治療費用。
We will pay for dental treatment required for the damage to the beneficiary's
sound natural tooth/teeth as the result of an accident. Treatment must commence
immediately after the accident and be completed within 30 days of the date of the
accident.
全額
Paid in Full
兒童健康檢查
Well Child Tests
為6 周歲及以下的未成年被保險人在適當的年齡間隔內。詳情請聯系我方咨
詢。
Payable for children at appropriate age intervals up to the age of 6. For full details
please contact CIGNA.
全額
Paid in Full
兒童免疫
Child immunizations
為17 周歲及以下未成年被保險人。
Payable for children aged 17 or younger.
全額
Paid in Full
每年常規檢查
Annual Routine Tests
15 周歲以下兒童每年一次的視力及一次聽力檢查。
One eye test and one hearing test for children under the age of 15.
全額
Paid in Full
您可選擇的免賠額
Your deductible options
免賠額(多項)
免賠額作為理賠的組成部分將不涵蓋于您的保險責任當中。例如您為所購買的
國際醫療補充保險選擇了¥ 1,000 的免賠額,那么您在任何一個保險期間內理
賠時,我方將在扣除¥ 1,000 的基礎上向您支付理賠款項。如果您已經選擇了
某免賠額,在每一保險期間內無論發生多少次理賠,作為免賠額由您方支付的
總額為該金額。您選擇的免賠額越高,您所應支付的保險費則越低。免賠額適
用于本合同內的所有被保險人。
A deductible is a portion of a claim or claims that is not covered by your plan. So,
for example if you choose a deductible of ¥ 1,000 for International Medical
Insurance Plus, you'll need to pay the first ¥ 1,000 of a covered claim or covered
claims in any period of cover. If a deductible is chosen, you would only have to pay
this once during any period of cover irrespective of the number of claims. The
higher the deductible you apply, the lower your premium will be. The deductible is
payable by each person covered by the policy.
¥ 0 / ¥ 1,000 / ¥ 6,500
國際健康與體檢保障(可選保障)
International Health andWellbeing (Optional)
國際健康與體檢責任
International Health and Wellbeing Benefits
賠付限額
Benefit Limit
常規成人體檢
Routine Adult Physical Exams
本項責任僅適用于18 周歲以上的被保險人。
This benefit will be paid for, or in connection with, routine physical examinations
for beneficiaries over the age of 18 years old.
每一保險期間以¥ 3,000
為限
Up to ¥ 3,000 per period
of cover
巴氏涂片
Pap Smear
我方將支付每年限一次的巴氏涂片檢查費用。
We will pay for an annual Papanicolaou screening.
全額
Paid in Full
前列腺癌癥篩查
Prostate Cancer Screening
我方將為50 周歲以上的男性被保險人支付每年限一次的前列腺篩查費用。
We will pay for an annual prostate cancer screening for men aged 50 years or older.
全額
Paid in Full
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以乳癌篩查或診斷為目的的乳腺X 線攝影檢查
Mammograms for Breast Cancer Screening or Diagnostic Purposes
我方將支付下列費用:
We will pay for:
-35 周歲到39 周歲無癥狀女性被保險人,限一次的基準乳腺X 線攝影檢查;
. one baseline mammogram for asymptomatic women aged 35-39;
-40 周歲到49 周歲無癥狀女性被保險人,每兩年一次醫療必要的乳腺X 線攝
影檢查;
. a mammogram for asymptomatic women aged 40-49 every two years or more if
medically necessary;
-50 周歲及以上女性被保險人,每年一次的乳腺X 線攝影檢查。
. a mammogram every year for women aged 50 and over.
全額
Paid in Full
腸癌篩查
Bowel cancer screening
我方將為55 周歲及以上的被保險人支付每年一次的腸癌篩查的費用。
We will pay for an annual bowel cancer screening for beneficiaries aged 55 or older.
全額
Paid in Full
骨密度掃描
Bone densitometry
我方將支付每年一次的骨密度掃描。
We will pay for an annual scan to determine the density of the beneficiary's bones.
全額
Paid in Full
營養師咨詢
Dietetic consultations
我方將給付每一保險期間內不超過4 次的營養師咨詢服務的費用。
We will pay for up to 4 meetings with a dietician per period of cover.
全額
Paid in Full
個人關愛服務
Life Management (customer assistance programme)
-每天24 小時、每周7 天、每年365 天隨時可獲得本項服務。
. Available 24 hours a day, 7 days a week, 365 days a year.
-最多5 次的與專業顧問當面咨詢的機會。
. Up to 5 face-to-face sessions with a professional counsellor.
-服務的內容包括:在工作、生活、個人及家庭事務等方面為被保險人提供信
息或資源的獲取、專家咨詢等專業支持。
. Provides information, resources, and counselling on any work, life, personal, or
family issue that matters to you.
-電子咨詢平臺提供方便的在線咨詢。
. Convenient online counselling via E-counselling.
- 不限次的電話咨詢服務。
. Unlimited telephonic support.
-您方還可以用短信發送所需服務,我方將進行電話回訪。
. SMS texting text the support you need and receive a call back.
-危機支援。
. Crisis support.
全額
Paid in Full
在線健康教育、健康風險評估及健康指導
Online health education, health assessment and web-based coaching programs
全額
Paid in Full
國際眼科與牙科保障(可選保障)
International Vision and Dental (Optional)
牙科治療
Dental Treatment
賠付限額
Benefit Limit
每一保險期間內每一被保險人所有保險責任賠付限額
Annual benefits - Maximum per beneficiary
每一保險期間以¥ 35,000
為限
Up to ¥ 35,000 per period
of cover
預防性牙科治療
Preventive
適用于持續購買本保障6 個月及以上的被保險人。
Available after the beneficiary has been covered on this option for six months.
全額
Paid in Full
IGAB1212 寰球至尊A
76
常規牙科治療
Routine
適用于持續購買本保障6 個月及以上的被保險人。
Available after the beneficiary has been covered on this option for 6 months.
全額
Paid in Full
重大牙科治療
Major Restorative
適用于持續購買本保障12 個月及以上的被保險人。若被保險人在購買后12 個
月內申請理賠,我方將按50%的治療費用支付。
Available after the beneficiary has been covered on this option for 12 months. If
the beneficiary needs to claim within the first 12 months then this will be covered
with a 50% coinsurance.
全額
Paid in Full
正畸治療
Orthodontic Treatment
適用于持續購買本保障連續滿2 年及以上且年齡在18 周歲及以下的被保險
人。
Available for beneficiaries aged 18 or younger, after they have been covered on this
option for 2 consecutive years.
每一保險期間按50%賠

50% Refund per period of
cover
眼科護理
Vision Care
賠付限額
Benefit Limit
每一保險期間一次驗光師或眼科醫生實施的眼科檢查
One eye examination per period of cover by an Optometrist or an Ophthalmologist
全額
Paid in Full
費用包含:
Expenses for:
-眼鏡鏡片;
. Spectacle lenses;
-隱形眼鏡;
. Contact lenses;
-眼鏡鏡框;
. Spectacle frames;
-根據醫囑所配墨鏡。
. Prescription sunglasses.
每一保險期間以¥ 2,000 為限
Up to ¥ 2,000 per period of cover

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