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个人税收优惠型健康保险产品指引框架(保监会2017版)

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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.1//EN" "http://www.w3.org/TR/xhtml11/DTD/xhtml11.dtd"><html xmlns="http://www.w3.org/1999/xhtml"><head><meta http-equiv="Content-Type" content="application/xhtml+xml; charset=utf-8" /><title></title><style type="text/css">body{ font-family:'Times New Roman'; font-size:1em; } p {padding:0;margin-top:5pt;margin-right:0;margin-bottom:5pt;margin-left:0;} ul, ol{ margin-top: 0; margin-bottom: 0; } .Normal{page-break-inside:auto;page-break-after:auto;page-break-before:auto;margin-left:0.0pt;text-indent:0.0pt;border-top-style: none;border-left-style: none;border-right-style: none;border-bottom-style: none;font-size:11.0pt;font-family:SimSun;mso-fareast-font-family:宋体;mso-bidi-font-family:Arial;lang:EN-US;mso-fareast-language:EN-US;mso-ansi-language:AR-SA;} .Heading-1{page-break-inside:avoid;page-break-after:avoid;page-break-before:auto;margin-left:0.0pt;text-indent:0.0pt;border-top-style: none;border-left-style: none;border-right-style: 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none;border-left-style: none;border-right-style: none;border-bottom-style: none;color:#4F81BD;font-size:11.0pt;font-family:SimSun;mso-fareast-font-family:宋体;mso-bidi-font-family:'Times New Roman';font-weight:bold;} .Heading-2-Char{color:#4F81BD;font-size:13.0pt;font-family:SimSun;mso-fareast-font-family:宋体;mso-bidi-font-family:'Times New Roman';font-weight:bold;} .Heading-3-Char{color:#4F81BD;font-size:11.0pt;font-family:SimSun;mso-fareast-font-family:宋体;mso-bidi-font-family:'Times New Roman';font-weight:bold;} </style></head><body style="pagewidth:612.0pt;pageheight:792.0pt;"><div class="Section0"><div style="min-height:72pt" /> <p class="Heading-1" style="text-align:center;line-height:1.0;"><span style="color:#000000;font-size:18.0pt;font-family:SimSun;mso-fareast-font-family:宋体;mso-bidi-font-family:SimSun;font-weight:bold;">个人税收优惠型健康保险产品指引框架</span></p> <p class="Heading-3" style="line-height:1.0;"><span style="color:#000000;font-size:13.0pt;font-family:SimSun;mso-fareast-font-family:宋体;mso-bidi-font-family:SimSun;font-weight:bold;">一、基本信息</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">1.保障范围</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">个人税收优惠型健康保险产品采取万能险方式,包含医疗保险和个人账户积累两项责任。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">2.被保险人范围</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">凡16周岁以上的、未满法定退休年龄者,身体健康且适用商业健康保险税收优惠政策的纳税人(健康人群),或者投保时根据其健康状况确定为既往症(见名词释义6)且投保时连续纳税满一年的适用商业健康保险税收优惠政策的纳税人(既往症人群),均可作为保险合同的被保险人。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">3.被保险人投保年龄</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">16周岁以上,且未满法定退休年龄。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">4.保险期间</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">医疗保险:一年期,可保证续保至法定退休年龄。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">个人账户累积:长期。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">5.等待期</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">本产品无等待期。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">6.交费方式</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">年交、月交。</span></p> <p class="Heading-3" style="line-height:1.0;"><span style="color:#000000;font-size:13.0pt;font-family:SimSun;mso-fareast-font-family:宋体;mso-bidi-font-family:SimSun;font-weight:bold;">二、保险责任</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">根据目标人群的不同,保险公司可将个人税收优惠型健康保险产品设计为三种类型。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">1.产品形态一</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(1)目标人群:已参加公费医疗或基本医疗保险,且经过公费医疗或基本医疗保险报销后对个人负担的医疗费用有保障需求的人群。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(2)最低保障范围:被保险人医保所属地基本医疗保险基金支付范围内自付的费用及基本医疗保险基金支付范围外的部分费用,保险公司应当通过列举法或者排除法明确给予给付的费用范围。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(3)保险责任:</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">1)住院医疗费用保险金</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">被保险人在基本医疗保险协议管理医疗机构(不含特需和国际医疗部,下同)住院治疗的,对于其住院发生的医疗必需且合理的保险合同约定的住院医疗费用,在该保单年度余额内,按照附表中的约定给付医疗保险金。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">住院费用包括住院期间实际发生的药品费、住院手术费、床位费和其他费用之和。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">2)住院前后门诊费用保险金</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">被保险人在基本医疗保险协议管理医疗机构治疗的,对于因与该次住院相同原因在该次住院前7日(含住院当日)以及出院后30日内(含出院当日)发生的医疗必需且合理的门诊治疗费,在该保单年度余额内,按照附表中的约定给付医疗保险金。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">合同约定的门诊治疗费用包括医生诊断、处方、药品、检查、护理、医疗用品等在医疗机构内发生的费用,以当地卫生或有关政府部门核准的收费标准为限。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">3)特定门诊治疗费用保险金</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">被保险人在基本医疗保险协议管理医疗机构以门诊方式接受恶性肿瘤放射治疗、恶性肿瘤静脉注射化学治疗、血液透析、腹膜透析、肾移植术后抗排异治疗或肝硬化治疗的,对其每次门诊实际发生的医疗必需且合理的特定门诊治疗费用,在该保单年度余额内,按照附表中的约定给付保险金。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">4)慢性病门诊治疗费用保险金</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">被保险人在基本医疗保险协议管理医疗机构进行高血压病、糖尿病、冠心病门诊治疗的,对其每次门诊实际发生的医疗必需且合理的门诊治疗费用,在该保单年度余额内,按照附表中的约定给付保险金。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">若被保险人在其医保所属地以外的医疗机构就医,且已从公费医疗或基本医疗保险获得费用补偿,则保险公司承担的费用范围为被保险人已发生的责任范围内的医疗费用的80%。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">每一保单年度内,保险公司对被保险人累计给付的各项医疗保险金金额以附表对应责任的保险金额为限。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">若单个保单年度各单项医疗保险金累计给付金额达到约定金额时,该保单年度该项保险责任终止。同时,若单个保单年度内各项医疗保险金累计给付金额之和达到附表约定的单个保单年度内医疗费用保险金额时,该保单年度各项医疗保险金责任均终止。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">若保证续保期间内各项医疗保险金责任累计赔付金额之和达到附表中约定的保证续保期间内累计医疗费用赔付限额时,则保证续保期间内的各项医疗保险金责任均终止。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">2.产品形态二</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(1)目标人群:已参加公费医疗或基本医疗保险,且经过公费医疗或基本医疗保险报销后对个人负担的大额医疗费用有保障需求的人群。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(2)最低保障范围:被保险人医保所属地基本医疗保险基金支付范围内自付的费用及基本医疗保险基金支付范围外的部分费用,保险公司应当通过列举法或者排除法明确给予给付的费用范围。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(3)保险责任:</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">1)住院医疗费用保险金:同产品形态一。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">2)住院前后门诊费用保险金:同产品形态一。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">3)特定门诊治疗费用保险金:同产品形态一。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">3.产品形态三</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(1)目标人群:未参加公费医疗或基本医疗保险,或虽已参加公费医疗或基本医疗保险,但投保前声明自愿放弃公费医疗或基本医疗保险补偿的人群。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(2)最低保障范围:纳入被保险人投保所属地基本医疗保险基金支付范围内的费用。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(3)保险责任:同产品形态一的保险责任。</span></p> <p class="Heading-3" style="line-height:1.0;"><span style="color:#000000;font-size:13.0pt;font-family:SimSun;mso-fareast-font-family:宋体;mso-bidi-font-family:SimSun;font-weight:bold;">三、责任免除</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">因下列情形之一导致被保险人发生医疗费用的,保险公司不承担给付保险金的责任,保险合同在约定的保险期间内继续有效:</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">1.被保险人在香港特别行政区、澳门特别行政区、台湾地区或中国境外的诊疗;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">2.患先天性畸形、变形和染色体异常(以世界卫生组织颁布的《疾病和有关健康问题的国际统计分类(ICD-10)》为准);</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">3.投保人对被保险人的故意杀害、故意伤害;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">4.被保险人故意犯罪或抗拒依法采取的刑事强制措施;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">5.被保险人自杀或故意自伤,但被保险人自杀或故意自伤时为无民事行为能力人的除外;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">6.被保险人斗殴、醉酒,主动吸食或注射毒品;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">7.被保险人未遵医嘱,私自服用、涂用或注射药物(但按使用说明的规定使用非处方药不在此限);</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">8.被保险人酒后驾驶、无合法有效驾驶证驾驶或驾驶无有效行驶证的机动车;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">9.被保险人参加潜水、跳伞或其他空中运动、登山、攀岩或攀爬建筑物、探险、武术比赛、摔跤比赛、特技表演、赛马、赛车等高风险运动;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">10.被保险人的戒酒或戒毒治疗、心理治疗、视力矫正手术、变性手术、整容整形或矫形手术;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">11.疗养、康复治疗、包皮环切、非医学必需的激素治疗、脱发治疗、美容、减肥、丰胸或者缩胸手术、睡眠有关的研究或者治疗、戒烟、矫形、视力矫正手术、非意外事故所致的整容手术;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">12.使用假体装置、各种矫正器(包括义肢、义眼,及非急救中使用的颈托、夹板)、轮椅及各种电动助行器械、助听器;常规视力检查、配制眼镜或隐形眼镜、视力治疗或视力训练;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">13.因医疗事故导致的医疗费用;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">14.被保险人的精神和行为障碍(以世界卫生组织颁布的《疾病和有关健康问题的国际统计分类(ICD-10)》为准);</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">15.战争、军事冲突、暴乱或武装叛乱、核爆炸、核辐射或核污染、恐怖主义行为;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">16.被保险人作为捐赠人而进行的器官或组织摘除,器官供体寻找、获取以及从供体切除、储藏、运送器官;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">17.未经科学或者医学认可的试验性或者研究性治疗及其产生的后果所产生的费用;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">18.质子重离子治疗费用;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">19.法律规定的其他情形。</span></p> <p class="Heading-3" style="line-height:1.0;"><span style="color:#000000;font-size:13.0pt;font-family:SimSun;mso-fareast-font-family:宋体;mso-bidi-font-family:SimSun;font-weight:bold;">四、经营管理</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">1.产品开发原则</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">本产品指引为个人税收优惠型健康保险基本保障要求,各保险公司在开发产品时可以在此基础上适当放宽医疗保险的承保条件、责任范围或提高保障水平。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">保险公司开发产品时,若产品条款有与本产品指引及配套的示范条款不一致的地方,需在上报产品时提供相应说明,指明具体不一致的地方及原因。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">2.保证续保约定</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">可保证续保至法定退休年龄。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">在保证续保期间内,保险公司不得因被保险人的健康状况而拒绝投保人续保。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">3.补偿原则</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">首次投保及续保时,投保人均需向保险公司提供有无参加公费医疗或基本医疗保险的证明;已参加补充医疗保险的被保险人在投保时应提供已参加补充医疗保险的证明及补充医疗保险的保险责任明细。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">在给付保险金时,若被保险人已从公费医疗、基本医疗保险和补充医疗保险获得补偿,保险公司将按其实际发生的医疗费用扣除被保险人从其他任何获得的补偿金额后的余额给付保险金,即包括本产品在内的各种途径所给付的所有补偿或赔偿金额之和不得超过被保险人实际发生的医疗费用。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">对于产品形态一、二,若被保险人已参加公费医疗或基本医疗保险,但未从公费医疗或基本医疗保险获得费用补偿,则保险公司承担的费用范围为被保险人已发生的责任范围内的医疗费用的50%。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">4.既往症人群的管理</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">对于既往症人群,在投保前以及承担保险责任时需遵循如下原则:</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(1)对于既往症人群,要求投保时必须已连续缴纳个人所得税满1年;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(2)既往症人群在续保时通过核保,被认定为已恢复健康的,可按照健康人群承保,但其保证续保期间内累计医疗费用保险金额需扣除该被保险人在保证续保期间内累计已赔付的金额。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">5.投保管理</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">若投保人以个人名义投保,需向保险公司提供可以证明其符合纳税人资格的相关材料。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">若投保人所在团体组织第一次组织办理投保相关事宜后的一年内投保人未选择投保,该投保人投保时保险公司可对该投保人采取个人核保的方式,审核通过后方可投保。若该投保人为投保团体组织新入职员工且已通过投保团体入职体检,则不受上述限制。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">6.保单权益转移及退保</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">对于保单权益转移,保险公司不设置犹豫期,但允许保险公司对该保单进行核保。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">对于处在宽限期或者中止状态的保单,不允许保单权益转移。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">被保险人可以退保,但应补缴已减免的税额。退保后的被保险人再次投保时,保险公司可以对其进行个人核保。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">7.不实告知</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">如果被保险人故意不履行如实告知义务,对于保险合同解除前发生的保险事故,保险公司不承担给付保险金的责任,并不退还保险费,保险责任终止。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">如果被保险人因重大过失未履行如实告知义务,对保险事故的发生有严重影响的,对于保险合同解除前发生的保险事故,保险公司不承担给付保险金的责任,但应当向投保人退还保险费,保险责任终止。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">保险公司有权通过中国商业健康保险信息平台,对被保险人的个人信息进行查询。如发现被保险人或被保险人所在团体组织存在不如实告知的情况,保险公司可以在保险有效期内的续保保单年度对被保险人或其所在团体组织设定相应的投保限制条件。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">8.理赔管理</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">保险公司应对理赔进行详细审核,确保被保险人发生的医疗费用是医疗必需且合理的。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">9.费率浮动机制</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">保险公司可在基准费率的基础上,按照被保险人所在地区的不同根据相关规定进行费率浮动。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">保险公司可以根据团体组织中被保险人整体风险状况按相关规定进行费率下浮,但不得对费率进行上浮。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">10.差额返还机制</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">本产品以会计年度为基础,在下一会计年度计算简单赔付率。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">某一会计年度的简单赔付率=(发生在该会计年度保单有效期内的全部赔款+该会计年度的额外费用)/(在该会计年度经过有效的保单的全部经过保费)</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">全部赔款包括已决赔款和未决赔款;额外费用是用于提供给被保险人的增值服务费用(例如健康管理费用);经过保费的计算以天为基础,一年按365天计算(闰年按366天计算)。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">保险公司需在下一会计年度的3月31日前,根据《个人税收优惠型健康保险业务管理暂行办法》将差额部分返还到被保险人的个人账户。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">返还方式由各保险公司根据自身情况自行制定。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">11.医疗行为管控</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(1)对于产品形态一、二:对于医疗必需的国产普通型材料,保险公司承担的费用范围参照附表。对于基本医疗保险基金支付范围外的医疗必需的进口材料,保险公司承担的费用补偿比例为该材料费用的30%。若该进口材料无法用类似国产普通型材料替代的,被保险人需向保险公司申请,保险公司按照国产普通型材料费用相同的方式给予赔付。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(2)保险公司可以严格按照有关政策规定,在医疗机构的合作下,做好对医疗行为的管控;保险公司要通过适当的手段,避免过度医疗等不合理的就医行为。</span></p> <p class="Heading-3" style="line-height:1.0;"><span style="color:#000000;font-size:13.0pt;font-family:SimSun;mso-fareast-font-family:宋体;mso-bidi-font-family:SimSun;font-weight:bold;">五、名词释义</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">1.基本医疗保险</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">指城镇职工基本医疗保险、城镇居民基本医疗保险、新型农村合作医疗、医疗救助等基本医疗保险保障项目,以及城乡居民大病保险等保障项目。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">2.补充医疗保险</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">补充医疗保险是相对于公费医疗和基本医疗保险而言的,指团体组织的、用于补偿公费医疗或基本医疗保险以外的住院医疗费用型保险产品。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">3.法定退休年龄</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">指国家法定退休年龄,被保险人实际办理退休时的年龄小于法定退休年龄的,以实际退休年龄为准。退休年龄应为周岁年龄,周岁年龄以法定有效身份证件中记载的出生日期为计算基础。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">4.适用商业健康保险税收优惠政策的纳税人</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">指符合商业健康保险税收优惠政策适用范围规定的纳税人,如取得工作薪金所得、连续劳务报酬所得的个人,以及取得个体工商户生产经营所得、对企事业单位的承包承租经营所得的个体工商户业主、个人独资企业投资者、合伙企业合伙人和承包承租经营者等。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">5.有效身份证件</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">指由政府主管部门规定的证明其身份的证件,如:居民身份证、按规定可使用的有效护照、警官证、户口簿等证件。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">中国内地纳税人提出投保申请时,必须提供二代的18位中华人民共和国居民身份证及信息;中国港澳居民提出投保申请时,必须提供港澳居民来往内地通行证及信息;中国台湾居民提出投保申请时,必须提供台湾居民来往大陆通行证及信息;外籍人员提出投保申请时,必须提供本国护照及信息。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">若无法提供以上身份证件类型的,被保险人须向保险公司提供能够证明其身份的合理唯一的其他有效身份证件。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">6.既往症</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">指在保单生效之前被保险人已患有的且已知晓的比较严重的疾病或症状。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">7.纳税</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">是指税收中的纳税人的执行过程,即根据国家各种税法的规定,按照一定的比率,把集体或个人收入的一部分缴纳给国家,且缴纳的金额需大于零。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">8.住院</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">指被保险人确因临床需要入住医疗机构之正式病房进行治疗,并正式办理入出院手续,不包括入住门诊观察室、家庭病床、挂床住院及以及休养、疗养、身体检查和健康护理等非治疗性行为导致的住院。其中挂床住院指被保险人非治疗需要,一次离开医疗机构12小时以上,视为自动离开医疗机构,保险公司仅对离开日及以前属于保险责任范围内的住院治疗承担保险金给付责任。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">在保险期间内,年度累计住院天数以180天为限。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">9.药品费</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">药品费是指根据医生处方使用的具有国家药品监督管理部门核发的药品批准文号或者进口药品注册证书、医药产品注册证书的国产或进口药品,包括西药、中成药和中草药。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">10.住院手术费</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">指当地卫生行政部门规定的手术项目的费用,包括手术费、麻醉费、手术监测费、手术材料费、术中用药费、手术设备费等;若因器官移植而发生的手术费用,不包括器官本身的费用和获取器官过程中的费用。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">11.床位费</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">指被保险人在住院期间发生的医疗机构床位的费用,不包括陪人床、观察病房床位和家庭病床的费用。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">12.其他费用</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">指被保险人在住院期间发生的除药品费、手术费及床位费及膳食费以外的以下费用:</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(1)化验费、检查费;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(2)输氧费;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(3)病室治疗费、诊疗费、冷暖气费用、医生诊查费、护理费;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(4)本地救护车费;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(5)注射费;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(6)物理治疗费;</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(7)包扎科、普通外科夹板及石膏整形费用</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(8)材料费:指在住院以及门急诊就医期间医生或者护士在为被保险人进行的各种治疗中所使用的医疗器材和医用材料。</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">13.门诊</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">指被保险人确因临床需要,正式办理挂号手续,并确实在医疗机构的门诊部接受治疗的行为过程,但不包括休养、疗养、身体检查和健康护理等非治疗性行为。</span></p> <p class="Normal" style="line-height:1.0;font-size: 12pt;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">&#xa0;</span></p> <p class="Heading-2" style="text-align:center;line-height:1.0;"><span style="color:#000000;font-size:14.0pt;font-family:SimSun;mso-fareast-font-family:宋体;mso-bidi-font-family:SimSun;font-weight:bold;">附表一:保险金额表及保险金给付比例表</span></p> <p class="Heading-3" style="line-height:1.0;"><span style="color:#000000;font-size:13.0pt;font-family:SimSun;mso-fareast-font-family:宋体;mso-bidi-font-family:SimSun;font-weight:bold;">1、保险金额表:</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">产品形态一和产品形态三                               单位:人民币元</span></p> <table cellspacing="0" style="border-collapse: collapse; width: 468pt; "><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">投保人群</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">医疗保险责任</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">首次投保时未罹患既往症的</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">首次投保时已经罹患既往症的</span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">一、单个保单年度内医疗费用保险金额</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">200,000</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">40,000</span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(一)住院及前后门诊医疗费用保险金</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">200,000</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">40,000</span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">其中:单一材料费用</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">30,000</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">5,000</span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(二)特定门诊治疗费用保险金</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">20,000</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">5,000</span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(三)慢性病门诊治疗费用保险金</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">3,000</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">1,000</span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">二、保证续保期间内累计医疗费用赔付限额</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">800,000</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">150,000</span></p> </td></tr></table><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">产品形态二                                           单位:人民币元</span></p> <table cellspacing="0" style="border-collapse: collapse; width: 468pt; "><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">投保人群</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">医疗保险责任</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">首次投保时未罹患既往症的</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">首次投保时已经罹患既往症的</span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">一、单个保单年度内医疗费用保险金额</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">200,000</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">40,000</span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(一)住院及前后门诊医疗费用保险金</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">200,000</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">40,000</span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">其中:单一材料费用</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">30,000</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">5,000</span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(二)特定门诊治疗费用保险金</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">20,000</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">5,000</span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">二、保证续保期间内累计医疗费用赔付限额</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">800,000</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">150,000</span></p> </td></tr></table><p class="Heading-3" style="line-height:1.0;"><span style="color:#000000;font-size:13.0pt;font-family:SimSun;mso-fareast-font-family:宋体;mso-bidi-font-family:SimSun;font-weight:bold;">2、保险金给付比例表(仅适用于产品形态一和产品形态二,不适用产品形态三):</span></p> <table cellspacing="0" style="border-collapse: collapse; width: 468pt; "><tr style="height: 16.0px"><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">保险金给付比例表</span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">费用范围</span></p> <p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">医疗保险责任</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">基本医疗保险基金支付范围内的费用</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">基本医疗保险基金支付范围外的费用</span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(一)住院及前后门诊医疗费用保险金</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">100%</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">80%</span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(二)特定门诊治疗费用保险金</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">100%</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">80%</span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">(三)慢性病门诊治疗费用保险金(不适用于产品形态二)</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">100%</span></p> </td><td style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.0px;border-left-style:solid;border-left-color:#000000;border-left-width:1.0px;border-right-style:solid;border-right-color:#000000;border-right-width:1.0px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0.75pt;padding-right:0.75pt;padding-top:0.75pt;padding-bottom:0.75pt;"><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">80%</span></p> </td></tr></table><p class="Normal" style="line-height:1.0;"><span style="color:#000000;font-size:12.0pt;font-family:SimSun;mso-bidi-font-family:SimSun;">注:若保险公司实际赔付的金额低于合同约定范围内被保险人医疗费用的90%,保险公司应向被保险人自动补齐相关差额。</span></p> </div></body></html>

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