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××人寿保险公司附加意外伤害医疗保险条款(参考文本)

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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; } ul, ol{ margin-top: 0; margin-bottom: 0; } .Normal{page-break-inside:auto;page-break-after:auto;page-break-before:auto;margin-top:0.0pt;margin-bottom:0.0pt;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:12.0pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';} .Default-Paragraph-Font{font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';} .Table-Normal{} .Table-Grid{} </style></head><body style="pagewidth:595.3pt;pageheight:841.9pt;"><div class="Section0"><div style="min-height:72pt" /> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;font-size: 12pt;"><span style="color:#000000;font-size:12.0pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';">&#xa0;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;font-size: 12pt;"><span style="color:#000000;font-size:12.0pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';">&#xa0;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;font-size: 12pt;"><span style="color:#000000;font-size:12.0pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';">&#xa0;</span></p> <p class="Normal" style="text-align:center;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">×</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">×</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">人寿保险公司</span></p> <p class="Normal" style="text-align:center;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">附加意外伤害医疗保险条款</span></p> <p class="Normal" style="text-align:center;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">(参考文本)</span></p> <p class="Normal" style="text-align:center;line-height:22.0pt;margin-right:0.0pt;direction: ltr;font-size: 12.5pt;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">&#xa0;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">  第一</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">条</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">&nbsp;&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> 附加合同说明</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  附加意外伤害医疗保险合同(以下简称本附加合同)附加于主保险合同(以下简称主合同)投保。凡本附加合同条款未做规定的内容,主合同条款适用本附加合同。如主合同系款与本附加合同条款互有抵触时,则以本附加合同条款规定为准。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">  第二</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">条</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">&nbsp;&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> 附加合同构成</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  本附加合同由保险单及所附条款、声明、批注、批单,以及与本附加合同有关的投保单、复效申请书、健康声明和其他书面协议共同构成。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">  第三</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">条</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">&nbsp;&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> 保险责任开始</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  本附加合同如与主合同同时投保,主合同保险责任开始条款适用本附加合同。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  投保人也可以在主合同有效期间内的年生效对应日前申请投保本附加保险。除另有约定外,本附加合同保险责任开始的日期即为主合同当时的年生效对应日。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">  第四</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">条</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">&nbsp;&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> 保险责任</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  在本附加合同有效期间内,被保险人因遭受意外伤害在本公司指定或认可的医院治疗,或在就近医院抢救(被保险人病情稳定后须转入本公司指定或认可的医院治疗),本公司对被保险人自意外伤害事故发生之日起九十日内所支出的医疗费用,按如下规定给付医疗保险金:</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  一、门诊治疗。本公司对被保险人实际支出的五十元以上部分的医疗费用按75%给付医疗保险金,但在每一保险年度内此项给付限额为本附加合同保险金额的20%,并且门诊次数不得超过十五次。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  二、住院治疗。本公司对被保险人实际支出的医疗费用按85%给付医疗保险金,但在每一保险年度内此项给付限额为本附加合同保险金额的80%。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  三、当被保险人治疗跨二个保险年度时,本公司以意外伤害事故发生日当年度本附加合同的保险金额为限给付医疗保险金。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  四、被保险人因他人责任造成伤害而引起的医疗费用中依法应由他人承担的部分,本公司不负给付医疗保险金的责任。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">  第五</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">条</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">&nbsp;&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> 责任免除</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  因下列原因导致被保险人支出的医疗费用,本公司不负给付保险金的责任:</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  一、投保人、被保险人的故意行为:</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  二、被保险人故意犯罪或拒捕;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  三、被保险人殴斗、醉酒、自杀、故意自伤身体及服用、吸食、注射毒品;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  四、被保险人酒后驾驶、无有效驾驶执照驾驶,或驾驶无有效行驶证的机动交通工具;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  五、被保险人患病、流产、分娩;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  六、被保险人因整容手术或其他内、外科手术导致医疗事故;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  七、被保险人未遵医嘱,私自服用、涂用、注射药物;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  八、被保险人从事潜水、跳伞、攀岩、探险、武术、摔跤、特技、赛马、赛车等高风险运动期间;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  九、被保险人感染艾滋病病毒(HIV呈阳性)或患艾滋病(AIDS)期间;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  十、战争、军事行动、暴乱或武装叛乱;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  十一、核爆炸、核辐射或核污染。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">  第六</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">条</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">&nbsp;&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> 保险期间与续保</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  本附加合同保险期间为一年。若在保险期间届满日的十日前,投保人未以书面作不续保的通知,则本附加合同视为续保。续保开始日期为原附加合同届满日后主合同的年生效对应日。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  本公司保留终止本附加合同续保的权利。本公司如终止本附加合同的续保,须在本附加合同期满前三十日内以书面形式通知投保人。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">  第七</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">条</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">&nbsp;&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> 续保保险费的计算</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  本附加合同续保时,续保保险费按续保当时被保险人职业的费率计算。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  本公司有权于每一保险年度未调整本附加合同的续保保险费率,但须在本附加合同期满前三十日内以书面形式通知投保人。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">  第八</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">条</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">&nbsp;&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> 保险费(含续保保险费)的交付、宽限期间及合同效力终止</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  主合同交费方式为期交的,本附加合同的交费方式及交费日期与主合同相同。主合同交费方式为趸交的,本附加合同的交费方式为年交,交费日期为主合同的生效日或年生效对应日。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  投保人如未按上述规定日期交付保险费的,自次日起六十日为宽限期间,在宽限期间内发生保险事故,本公司仍负保险责任,但应从给付的保险金中扣除欠交的保险费;逾宽限期间仍未交付保险费的,本附加合同效力自宽限期间届满的次日起终止。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  本附加合同效力终止后所发生的保险事故及其后遗症,本公司不负保险责任。</span></p> </div></body></html>

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