You can insure the basic part separately, or you can add optional parts to the basic part, but you can't insure the optional parts separately. When insuring an optional part, you must insure two responsibilities of the part at the same time, and you can't just choose one of them.
During the validity period of this additional insurance contract, we undertake the following insurance responsibilities:
Waiting period
When applying for this insurance for the first time or intermittently, the insured falls ill within 30 days from the effective date of this additional insurance contract, resulting in hospitalization (see 7.2), and we are not responsible for paying the insurance money. These 30 days are called waiting period.
There is no waiting period for renewal of insurance or hospitalization due to accidental injury (see 7.3).
If an insurance accident occurs after the waiting period, we will pay the insurance premium as follows:
base component
Hospitalization fee insurance:
The insured must be hospitalized due to a disease or accidental injury diagnosed by the hospital (see 7.4). We will pay 80% of the reasonable and necessary medical expenses (see 7.6) actually paid by the insured for each hospitalization (see 7.5) within the agreed scope (the same as the compensation scope stipulated in the social medical insurance of the branch where the policy is issued). See the attached table for each hospitalization limit.
In each policy year, we are only responsible for the medical expenses incurred within 0/80 days of hospitalization of the insured.
Optional part
(1) Non-organ transplant operation cost insurance
The insured is hospitalized for non-organ transplantation due to illness or accidental injury (see 7. 15). We will pay 80% of the reasonable and necessary surgical expenses (see 7. 16) actually paid by the insured for each operation within the agreed scope (the same as the compensation scope stipulated in the social medical insurance of the branch where the policy is issued). See the attached table for the limit of insurance premium paid for each operation.
(2) organ transplant operation cost insurance.
When the insured is hospitalized for organ transplantation due to illness or accidental injury (see 7. 17), we will pay the insurance money within the agreed scope (the same as the compensation scope stipulated in the social medical insurance of the branch where the policy is issued) according to 80% of the reasonable and necessary operation expenses actually paid by the insured. See the attached table for the limit of insurance payment for each operation.
If the insured needs intermittent operation for the same reason, and the interval between operation dates is less than 90 days, it is regarded as the same operation.
Continuation of responsibility
We are still responsible for the payment of insurance benefits for hospitalization that occurs after the waiting period and before the expiration of this additional insurance contract and continues within 30 days after the expiration of this additional insurance contract.
Compensation principle
If the insured has obtained compensation from other channels (including social medical insurance institutions, free medical care, rural cooperative medical insurance, work units, any commercial insurance institutions including our company, etc.). ), we will pay the balance of various expenses within the payment limit of various insurance benefits and according to the agreed scope of various expenses in this additional insurance contract, and the balance of all expenses paid shall not exceed 80% of all expenses within the agreed scope of this additional insurance contract. Table of payment limits for corresponding items in each hospitalization of comprehensive diseases
(per serving)
Unit: RMB yuan
Project payment limit
The basic medical expenses are 3000 yuan.
(Outpatient expenses shall not exceed 300)
Optional partial non-organ transplant operation cost 1500.
Organ transplant operation cost 10000. The product features low cost and can be reimbursed many times a year!