Sun Alliance Insurance (China) Limited
Additional Travel Medical Expenses Reimbursement Insurance Policy Wording
(The English translation is for reference only. In case of any discrepancies, the Chinese version shall prevail.)
General Provisions
Article 1
This Additional Contract is attached to the Main Contract with the Insurer’s consent. The generalprovisions of the Main Contractare also applied to this Additional Contract. If any provision contained in this Additional Contract is inconsistent with or in contravention of any provision in the Main Contract, the Additional Contract shall prevail.
If the Additional Contract and the Main Contract are applied for at the same time, the effective date of the Additional Contract will be the same as Main Contract.
If this Additional Contract is applied for during the period of insurance of the Main Contract, this Additional Contract will be effective once Insured pays the due premium and Insurer agrees to accept it.
This Additional Contract will terminate automatically under the following conditions: 1) The Main Contract terminates; 2) The Applicant notifies the Insurer to terminate this Additional Contract in writing.
Coverage
Article 2
If the Insured sustains an Accident or sickness on his/her insured Trip during the Period of Insurance and receives necessary treatment within ninety (90) days from the date of the Accident or sickness, the insurer shall reimburse the Insured for the Necessary and Reasonable Medical Expenses actually occurred by the Insured up to the limit as specified in the policy schedule under this Additional Contract.
Items covered include charges for:
1Medical, surgical, X-ray, Hospital or nursing treatment given or prescribed by a Medical Practitioner in his professional capacity; and
2Ambulance costs; and
3Dental fees necessarily incurred as the result of Accidental Injury to sound natural teeth; and
4If the Insured sustains an Accident or sickness outside of the territory and the aforesaid Medical Expenses incurred Within the Territory, the insurer shall reimburse the Insured for the Necessary and Reasonable Medical Expenses actually occurred by the Insured, up to fifteen (15) percent of the limit specifiedto such Insured under the Additional Contract;
5If the Insured sustains sickness during an insured domestic trip, the insurer shall reimburse medical expense up to “Limit of Sickness Medical Reimbursement for Domestic Travel”specified to such insured in the policy schedule under this Additional Contract.
Exclusions
Article 3
The General Exclusions in the Main Contract are also suitable for this Additional Contract. If the Main Contract has any conflict with the Exclusions of this Ad0ditional Contract, the Additional Contract shall prevail.
Insurer will not pay for:
1)Dental treatments or surgeries, denture fault, dental restoration planting or Correction of defect of vision unless necessitated by an Accident,or correction of defect of vision or optometry test for the preparation of correction of defect of vision, or treatment of refractive errors which is not necessitated by an Accident; refraction error;
2)Expenses recoverable from any medical or Hospital benefit fund；
3)General health check-ups, convalescence, custodial, rest care, rehabilitation, or psychological treatment;
4)The journey is to obtain medication treatment or is against the recommendation by a Qualified Medical Practitioner;
5)Spine disease or disorder;
6)Cosmetic or plastic surgeries or any elective surgeries;
7)Pre-Existing Medical Condition; or Pre-Existing Physical Condition, which had not been declared to and accepted in writing by the Insurer.
InsuranceBenefit Application and Payment
Article4
The insurance benefitapplicant, when applying for payment of insurance benefit, shall submit the followingmaterials. If the insurance benefitapplicant is unable to provide the following materials due to any special reason, he shall provide other legal and effective materials. If the insurance benefit applicant fails to provide the relevant materials, making the Insurer unable to verify the authenticity of the application, the Insurer shall not be liable for payment of the insurance benefit to the extent of the portion that is unable to be verified.
1A fully completed claim form
2The identification certificate of the insured
3Travel document
4Medical report and medical expense receipts
5The identification certificate of the benefit applicant
6Any other evidence or materials in relation to the ascertainment of the nature and cause of the insured accident, the extent of loss and etc. as far as the insurance benefit applicant can provide;
7The original letter of authorization, the identification certificates of the entrusting party and the entrusted party, and any other relevant certificates if the insurance benefit applicant entrusts others to apply for the insurance benefit.
Definitions
- Pre-existing Sickness shall mean 1) Insured has suffered from the tonsils, glandular swelling, hernia or female genital diseases, which cause an ordinarily prudent person to seek diagnosis, care, or treatment preceding the effective date of the Policy; 2) or a condition for which medical advice or treatment(excluding the tonsils, glandular swelling, hernia or female genital diseases) was recommended by a physician or received from a physician within 12 months preceding the effective date of the Policy.
- Outside the Territoryshall mean countries and regions rather than the mainland China, including Taiwan province, Hong Kong and Macao Special Administrative Regions.
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