nanjing international school 2015-2016 high-end …...- 4 - city provider address shenzhen 国际sos...
TRANSCRIPT
Nanjing International School
2015-2016
High-end Medical Benefit Handbook
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Contents
1. INTRODUCTION ............................................................................................................................ 2
1.1 GREETINGS .................................................................................................................................... 2
1.2 PING AN HEALTH ......................................................................................................................... 2
2. IMPORTANT NOTES ...................................................................................................................... 3
2.1 PRE-AUTHORIZATION ................................................................................................................... 3
2.2 LUXURY HOSPITALS: ...................................................................................................................... 3
2.3 DIRECT BILLING ............................................................................................................................ 4
3. BENEFIT ............................................................................................................................................. 5
3.1 TABLE OF BENEFIT ......................................................................................................................... 5
3.2 EXCLUSIONS ................................................................................................................................ 10
4. SERVICE GUIDE ............................................................................................................................ 14
4.1 HOW TO USE DIRECT BILLING SERVICE ................................................................................... 14
4.2 HOW TO SUBMIT AFTER VISIT CLAIM APPLICATION .............................................................. 14
4.3 HOW TO ARRANGE SURGERY IN THAILAND ............................................................................. 15
4.4 WORLDWIDE EMERGENCY ASSISTANCE ................................................................................... 16
APPENDIX ........................................................................................................................................... 17
APPENDIX 1: SELECTION OF NETWORK HOSPITALS....................................................................... 17
APPENDIX 2: WORLDWIDE EMERGENCY ASSISTANCE ................................................................... 25
APPENDIX 3: THAILAND HOSPITALS LIST........................................................................................ 40
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1. Introduction
1.1 Greetings
Greetings members! In the year 2015/2016, eligible members are covered in an international health
insurance plan provided by Ping An Health Insurance Company. Please read this guide book carefully
before receiving treatment. We wish you good physical and mental health for the future.
1.2 Ping An Health
Ping An Health Insurance Company of China, Ltd. (Ping An Health) is a wholly owned subsidiary of
second largest financial and insurance groups in China, the Ping An Insurance (Group) Company of
China, Ltd. Specializing in health insurance provisions, Ping An Health has combined local and overseas
expertise of members with rich professional experience to its management and service team.
Ping An has developed a wide Direct Settlement Network in either mainland China or overseas,
supporting its members comprehensive medical-care. Also, Ping An Health aimed at building a
long-term scheme of health management in China for customers by providing high-quality health
services in the beginning.
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2. Important Notes
Ping An Health 24-Hour Hotline: 400 8833 663*2 (English service)
Account Manager (Ping An Health)
Rita ZHANG
Contact No: +86-21-2066 0471
Mailbox: [email protected]
One World Cover
Mailbox: [email protected]
2.1 Pre-authorization
Members that fail to obtain pre-authorization prior to all services listed below (except for
emergency medical evacuation) treatment may be held liable for paying a 40% co-payment of the
entire cost of the procedure, with no out-of-pocket limit. For emergency situations, please notify
us within 48 hours after the occurrence of emergency.
If you need to receive the following medical treatment, please contact our 24 hour hotline
400-8833-663 in advance to apply for pre-authorization:
Flight to Thailand (see details in the table of benefit)
All in-patient and surgery treatment（including out-patient surgery）
Exams and therapy priced in excess of RMB 5,000
Purchase or rental of insulin pumps and associated devices
First Special Out-patient Treatment (see details in the table of benefit)
Emergency Medical Treatment Outside the Coverage Area (see details in the table of benefit)
Please provide the following information when you call the hotline:
Your sub-policy number (printed on the insurance card), passport number and name
Details of the hospitalization
We’ll reply within one or two working days.
2.2 Luxury hospitals:
Only 80% of expenses will be reimbursed if you go to Luxury Hospitals on the list below!
We will update the list on a regular base, for the most up-to-date specified hospital list please contact
400 8833 663*2 (English service)
City Provider Address
Beijing 北京国际医疗中心
Beijing International Medical Center
北京市朝阳区亮马桥路 50 号北京燕沙中心办
公楼 S111
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City Provider Address
S111 Lufthansa Center, 50 Liangmaqiao Road,
Chaoyang District
Beijing 北京国际医疗中心
Beijing International Medical Center
北京市朝阳区亮马桥路 50 号北京燕沙中心办
公楼 S111
S111 Lufthansa Center, 50 Liangmaqiao Road,
Chaoyang District
Beijing 北京天坛普华医院
Beijing St. Michael hospital
北京市天坛南里 12 号
No.12 TianTan _Nanli Beijing
Beijing
北京普华国际门诊部
Beijing St. Michael International
Clinic
北京市朝阳区武胜北路 54 号
54 N. Wusheng Road, Chaoyang District
Beijing
北京和睦家医院
Beijing United Family Hospital and
Clinics
北京朝阳区将台路 2 号
2 Jiangtai Road, Chaoyang District
Beijing
北京和睦家建国门保健中心
Beijing United Family Health &
Wellness Center - Jianguomen
北京朝阳区建国门外大街 21 号北京国际俱乐
部饭店公寓楼地下一层
B1/F, 21 Jianguomenwai Avenue,
The St. Regis Residence, St. Regis Hotel Beijing
Beijing 北京和睦家亮马诊所
United Family Liangma Clinic
北京市朝阳区东方东路 19 号 1 号楼会所 27
号
No.16,The Grand Summit Beijing, Section
B,Liangmaqiao Diplomatic Residence
Compound , No.19Dongfangdong Road Beijing,
Beijing 北京和睦家顺义诊所
Beijing United Family Clinic - Shunyi
北京顺义天竺开发区荣祥广场 818 号
Pinnacle Plaza, Unit #818, Tian Zhu Real Estate
Zone, Shunyi
Beijing 国际 SOS 北京诊所
Beijing International SOS Clinic
北京朝阳区三里屯西五街5号北信京谊大厦 C
座
Suite 105, Wing 1, Kunsha Building No 16
Xinyuanli,Chaoyang District,Beijing
Beijing 北京百汇诊所
ParkwayHealth Beijing Clinic
北京朝阳区朝外大街甲 6 号万通中心 1 层
1F-2F, Vantone Center No.Jia 6, Chaowai Street,
Chao Yang Street, Beijing
Beijing 北京明德医院
OASIS INTERNATIONAL HOSPITAL
北京市朝阳区酒仙桥北路 9 号
No. 9 Jiuxianqiao Bei Lu Chaoyang District,
Beijing 100015 China
Beijing 北京泰济堂中医医院 北京市海淀区彰化路 138 号西荣阁大厦 A 座
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City Provider Address
Beijing Taijitang Traditional Chinese
Medicine Hospital
底商 102A
Room 102A XiRongGe bottom No.138 of
Changhua Road, Hai Dian District, Beijing
Shanghai
上海戴是凯医学康复门诊部-金桥
分店
Sinounited Health(Jinqiao)
红枫路 300 弄 16 号
No.16,Lane 300 Hongfeng Rd.Pudong,Shanghai
Shanghai 上海天坛普华医院
Shanghai St. Michael Hospital
上海长宁区红宝石路 388 号
388 Hongbaoshi Road, Changning District
Shanghai
上海东方国际医院
Shanghai East International Medical
Center
上海市浦东南路 551 号(东方医院门诊大楼后
门)1 楼/12 楼
1/F&12/F, 551 South Pudong Road. Pudong
District, Shanghai (North door of Shanghai East
Hospital Outpatient Building)
Shanghai 百汇瑞虹医疗中心
Manderine City Medical Center
上海市虹许路 788 号 30 座底楼
G/F, No. 30, Lane 788, HongXu Road
Shanghai
百汇华鹰医疗中心
Tomorrow Square International
Medical & Surgical Center
上海南京西路 389 号明天广场 4 楼
4/F, Tomorrow Square, 389 West Nanjing Road
Shanghai
百汇新瑞医疗中心
Parkway Specialty and Inpatient
Center
上海市淡水路 170 号 2/3 楼
2-3/F, 170 Danshui Road
Shanghai 百汇瑞祥医疗中心
Parkway Hong Qiao Medical Center
上海市虹桥路 2258 号
2258 Hongqiao Road
Shanghai
百汇瑞浦医疗中心
Parkway Jinqiao Medical and Dental
Center
上海浦东新区金桥红枫路 51 号
51 Hongfeng Road, Jinqiao, Pudong District
Shanghai
百汇瑞新医疗中心
Parkway Shanghai Centre Medical &
Dental Centers
上海南京西路 1376 号商城西峰店 203/204 室
203-4 West Retail Plaza, 1376 West Nanjing
Road
Shanghai
百汇金浦医疗中心
ParkwayHealth Jin Mao Tower
Medical Center
上海浦东世纪大道 88 号金茂大厦裙房金茂时
尚生活中心一层
J-LIFE, Podium Building, 88 Century Avenue,
Pudong New Area
Shanghai
上海市闵行区和美家诊所
Shanghai United Family Clinics -
Minhang
上海市闵行区华漕镇金丰路 555 弄上海网球
俱乐部内
Shanghai Racquet Club, Ground Floor
Clubhouse, Lane 555,
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City Provider Address
Jinfeng Lu Huacao Town, Minhang District,
Shanghai
Shanghai
上海和睦家医院
Shanghai United Family Hospital and
Clinics
上海市长宁区仙霞路 1139 号
1139 Xianxia Road, Changning District, Shanghai
Shanghai
上海国际医院（原华山国际医疗中
心浦东门诊部 A/B)区）
Shanghai International Hospital
（Huashan Worldwide Medical
Center (Pudong Branch)）
金桥红枫路 525 号 1 楼 A/B 区
Area A/B, 1/F, 525 Hongfeng Road
Shanghai
上海沃德医疗中心
Shanghai WorldPath Clinic
International
上海市世纪大道 777 号 C 座
Suite C, 777 Century Avenue, Shanghai
Shanghai 上海臻景医疗
Optimum Health Care
上海市兴国路 78 号兴国宾馆 5 号楼
Bd 5, Radisson Plaza Xing Guo Hotel, 78
Xingguo Road, Shanghai
Shanghai 上海世道中医门诊部
Shanghai Shidao TCM Clinic
上海市古美路 475 号
No 475，Gumei Road，Shanghai
Guangzhou 广州和睦家诊所
Guagnzhou United Family Clinic
广州大道中 301 号人保大厦附楼首层 1/F,
Annex Building, PICC Buidling, 301 Guangzhou
Ave Middle
Guangzhou
广州加美医疗中心
Guangzhou CanAm International
Medical Center
广州市环市东路 368 号花园酒店花园大厦 5
楼
5/F Garden Tower, Garden Hotel 368 Huanshi
Dong Lu
Guangzhou 西部外科研究所
Institute for Western Surgery China
广州海珠区同福中路 396 号
396 Middle Tongfu Road, Haizhu District,
Guangzhou
Chengdu 百汇成都医疗中心
Parkway Chengdu Medical Center
万象北路 18 号成都市第一人民医院内
Chengdu No. 1 People's Hospital,
18 Wan Xiang North Road
Tianjin 国际 SOS 天津诊所
Tianjin International SOS Clinic
天津河西区紫金山路喜来登饭店
1F Sheraton Hotel Apartment Building, Zi Ji
Shan Road,He Xi District,Tianjin
Tianjin
天津和睦家医院
Tianjin United Family Hospital and
Clinics (TJU)
天津市河西区潭江道天潇园 22 号
22 Tanjiang Road, Hexi District, Tianjin
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City Provider Address
Shenzhen 国际 SOS 蛇口诊所
Shekou International SOS Clinic
深圳蛇口南海大道南 9 号招商国旅大厦 1 楼
Ground Floor, CMIT Building No.9 Nanhai
Road South,Shekou, Shenzhen
Shenzhen 深圳加美医疗中心
Shenzhen CanAm Medical Center
深圳市南山区蛇口南海大道 1033 号泰格国际
公寓 E0119
E0119, 1033 Nanhai Avenue, Shekou, Nanshan
District, Shenzhen
Shenzhen
香港大学深圳医院国际医疗中心
The University of Hong Kong-
Shenzhen Hospital International
Medical Center
深圳市福田区海园一路 1 号
1 Haiyuan 1st Road, Futian District, Shenzhen
Hong Kong 香港港安医院
Adventist Hospital
香港司徒拔道 40 号
40 Stubbs Road,HK
Hong Kong 香港明德医院
Matilda Hospital
香港山顶加列山道 41 号
41 Mount Kellett Road,The Peak, HK
Hong Kong 香港养和医院
Sanatorium Hospital
香港跑马地山村道二号
2 Village Road, Happy Valley, HK
Singapore Thomson Medical Centre
汤姆森医疗中心 339 Thomson Road, Singapore
Singapore Gleneagles Hospital
鹰阁医院 6A Napier Road, Singapore 258500
Singapore Mount Elizabeth Hospital
伊丽莎白医院 3 Mt.Elizabeth Singapore 228510
Singapore Mount Elizabeth Novena Hospital
伊丽莎白诺维娜医院
38 Irrawaddy Road, Suite 08-56, Singapore
329563
Singapore
Parkway East Hospital (formerly East
Shore Hospital)
东岸医院
321 Joo Chiat Place Singapore 427990
2.3 Direct billing
The direct billing service is provided to inpatient treatment within our network hospital. (See network
hospital list in Appendix 1) The direct billing services will NOT be provided for out-patient treatment,
medical exclusions, female maternity, health check, vision, dental, and vaccination services. If the
mentioned items are covered in your benefits scheme, please submit the expenses for afterwards
claim.
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3. Benefit
3.1 Table of Benefit
Policy Period: One Year (1 August 2015 – 31 July 2015) Currency: RMB
Core benefits
Overall limit for a policy year RMB 12,000,000
Geographic area where cover
applies Worldwide Exc. US
United States Outpatient Treatment RMB
10,000 and Routine Physical Examination
benefit (only provided to US nationals)
Out of pocket maximum
(applies to excess/deductible
and Specified Hospital co-pay)
RMB10,000
If an insured visits some luxury hospital,
the accumulative co-pay maximum will be
10,000; for the part exceeding 10,000 at
the specified hospital, it will be 100%
covered (the deductible will not apply to
the co-pay maximum)
Annual Deductible*
*based on your family’s Vitality status
as at 1 July 2015.
6,000 Per Individual
18,000 Per Family
Not applied to health check up
5,000 Per Individual
15,000 Per Family
4,000 Per Individual
12,000 Per Family
3,000 Per Individual
9,000 Per Family
Inpatient treatment benefits
Overall limit for inpatient benefits for a policy year RMB 12,000,000
Reimbursement ratio of inpatient claims 100%
Daily policy limits for hospital bed fee, food and nursing
care charges (up to 365 days/policy year) RMB 12,000,000
Policy limits for examination, laboratory test and
treatment fees (including doctors’ fee) RMB 12,000,000
Policy limit for doctors’ fee RMB 12,000,000
Policy limit for medicine expenses(including Traditional
Chinese herbal medicine) RMB 12,000,000
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Policy limit for operation charges RMB 12,000,000
Surgery (excluding organ transplant surgery) RMB 12,000,000
Daily policy limit for companion bed fee RMB 12,000,000
Daily policy limit for hospitalization allowance for zero
claim (up to 30 days/ policy year) Not covered
Policy limit for treatment of mental illnesses (up to 90
days/policy year) Not covered
Policy limit for family care (up to 100 days/ policy year) Not covered
Day care treatment RMB 12,000,000
Policy limit for hospice care expenses (up to 45 days/
policy year) RMB 12,000,000
Ambulance charge RMB 12,000,000
Outpatient treatment benefits
Annual limit RMB 12,000,000
Reimbursement ratio of outpatient claims 100%
Deductible per visit 0
Outpatient operation fee, MRI, CT, PET Scan Annual Limit RMB 12,000,000
Policy limit for medicine expenses RMB 60,000
Overall annual
limit for the
sub-limits RMB
60,000
Policy limit for registration fee/doctor consultation fee,
examination fee, treatment fee RMB 60,000
Policy limit for diabetes treatment article purchase or
rental expenses annual limit (inc. insulin pumps, etc.) RMB 60,000
Policy limit for physiotherapy and other alternative
therapies per visit (up to 10 visits/policy year) RMB 12,000
Policy limit for psychiatric treatment (up to 20 visits/policy
year) RMB 60,000
Policy limit for accidental dental treatment Not covered
Policy limit for hormone replacement therapy Not covered
Policy limits for neonate immunization and examination
expenses Not covered
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Ambulance charge RMB 60,000
Special outpatient treatment benefits
Definition: Regardless of the number of times the Insured undergoes outpatient renal dialysis and
outpatient cancer treatment (electrotherapy, chemotherapy or radiotherapy) in a hospital, we will cover
the reasonable and necessary special outpatient treatment expenses at the corresponding benefit
ratios within the annual special outpatient treatment benefit limits.
Benefit ratio 100%
Overall limit for special outpatient treatment for a policy
year: RMB 12,000,000
Emergency treatment outside of the geographic coverage
Definition:
Emergency treatment outside of the geographic coverage area applies to the following list of accidental
injuries or sudden acute diseases:
Hyperpyrexia (38.5 degrees Celsius or higher in case of an adult, and 39 degrees Celsius or higher
in case of a child);
Acute abdominalgia, violent vomiting, and severe diarrhea;
Severe shock due to various causes;
Comas;
Epilepsy;
Severe wheezing and dyspnea (shortness of breath);
Acute chest pain, acute heart failure, and serious cardiac arrhythmias;
Hypertensive crisis, hypertensive encephalopathy, and cerebrovascular accidents (stroke);
Acute bleeding due to various causes;
Acute bleeding and haematocele of urinary tract, enuresis, and nephric colic;
Acute poisoning (e.g. food/drug poisoning), and various critical accidents (e.g. electric shock,
drowning);
Traumatic brain injuries, fractures, dislocations, tearing, burns, scalding or other acute external
injuries;
Various bites inflicted by poisonous animals or insects, or acute anaphylactic diseases;
Foreign bodies in the five sensory organs, respiratory tract or esophagus; acute ophthalmalgia,
pink-eye, swelling of eye; sudden visual disorder and ocular injury; and Other emergency
treatments for patients with acute or critical illnesses.
Reimbursement ratio of hospital claims 100%
Annual limit RMB 12,000,000
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Worldwide travel emergency evacuation
Includes emergency medical evacuation, accommodation
for compassionate visits and repatriation to the country of
residence
Included
Repatriation of mortal remains or ashes for local
cremation or burial
Services as detailed under emergency
assistance (See appendix 2)
Maternity benefits
Reimbursement ratio of claims 100%
Pre-natal and post-natal examinations, pre-natal vitamins
and calcium tonic;
Hospital expenses on delivery or abortion (We will only
pay maternity benefits for miscarriage once per policy
year.);
Type-B ultrasonic examination (up to two visits each policy
year);
Newborn infant care, treatment and vaccinations (within
14 days)
RMB 60,000
Dental benefits
Annual limit Not Covered
Preventive dental treatment Not Covered
Basic dental treatment: includes amalgams or composite
fillings, simple extractions, periodontal scaling and root
planning
Not Covered
Major dental treatment: Not Covered
Health Check-up
Health Check-up and Vaccinations
RMB 3,000;
100% Covered, includes US coverage
Female Pap Smear (Once per year)
Female Mammogram (Once per year)
Male Prostate Cancer Screening (Once per year)
Vaccinations
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Preventive Dental Care Not Covered
Vision benefits
Routine eye examination (once each year) Not covered
Contact lenses Not covered
Frames and lenses Not covered
Other special medical benefits
Chinese Herbal medicine Annual Limit RMB 12,000
Durable Medical Equipment Subjected to Inpatient & Outpatient limits
Reconstructive Surgery: Where reconstructive surgery is
needed as a result of an accident or disease in order to
restore function or shape/appearance, the surgery must
be carried out within 12 months of the accident or
disease.
RMB 12,000,000
Congenital condition treatment, and examination that is
diagnosed within 6 months of birth for new born infants
that are enrolled onto the plan within 30 days of birth
RMB 200,000
Congenital condition treatment and examination for
minors under 18 years of age
RMB 30,000
Pregnancy Complications: Expenses for complications
arising from pregnancy
RMB 12,000,000
Not restricted to maternity limits
Cancer Treatment RMB 12,000,000
Not restricted to outpatient limits
AIDS/HIV Treatment (Non pre-existing) RMB 600,000
Flights to Thailand RMB 6,000
Only eligible for inpatient treatment
received within Ping An Health’s
Thailand network. (See appendix 3 for
Thailand network list.) Inpatient
treatment preauthorization is also
required.
Restricted to one economy class return
flight under the name of the client
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receiving the inpatient treatment per
policy year up to a maximum amount of
RMB 6,000
Flights for accompanying family
members are not covered
Flights must arrive in Thailand within a
two-day period prior to admission and
leave Thailand within a two-day period
following discharge from hospital
3.2 Exclusions
The Company shall not be responsible for medical expenses or Worldwide Emergency Assistance
service arising from following situation:
(I) Treatment Not on Purpose of Cure Disease
1. All kinds of cosmetic orthopaedics: skin pigmentation, acne without cyst or abscess, redness
acne; treatment and removal of benign skin changes (freckles, age pigment, moles, warts)
without pathological cell changes (size, shape or color have changed recently); treatment of
superficial varicose veins, spider veins, scars other than keloid, tattoo removal, and skin
discoloration; laser orthopaedics, wrinkle removal, eye pockets removal, opening of double
fold, white hair, baldness, hair loss, hair planting, hair removal, rhinoplasty and breast
augmentation;
2. All kinds of surgery for orthopaedics or biological defects: flatfood, snoring and various
non-functional orthopaedics and orthopedic surgery;
3. Body-building treatment: nutrition, weight loss, weight increase and adding height;
4. Health check-up items which are not listed in the Contract;
5. All kinds of preventive healthcare: massage, automatic massage bed, medicated steam,
medicated bathing, physical fitness, various vaccinations (unless specified in the Contract),
preventive injections and disease survey;
6. All kinds of medical advisory and healthy forecast: health counseling, family counseling,
marriage counseling, sex counseling and pre-marriage counseling;
7. All kinds of medical identification: Medical Accident, mental disorders, fetal gender, wounds,
paternity test and genetic genes.
(II) Reproductive Treatment
1. Artificially assisted reproduction, male and female birth control;
2. Vasectomies or tubal ligation and other sterilization techniques;
3. Treatment of sexual dysfunction;
4. Abortion, except for emergency; Cost of abortion and its consequences if performed for
psychological or social reasons, and elective cesarean delivery;
5. Examining and treatment of infertility;
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6. Reversal of previous sterilization;
7. Transsexual surgery;
8. Medications taken for sexual dysfunction;
9. Pre-natal training;
10. Freeze-storage, cultivation, and re-cultivation of any active cells related to birth control or
maternity.
(III) Organ transplantation items
1. Transplant surgery on organs or tissues except kidney, liver, heart, lung and hematopoietic
stem cells;
2. Examination and treatment costs of donors;
3. Searching, buying, transporting and storage of source of organs or tissues;
4. Any expenses relating to donation of one’s own tissues and organs.
(IV) Dental Medical Treatment
1. Expenses of dental medical treatment which are not covered by the insurance policy. Such as
costs arising from teeth treatment on cosmetic purpose which are not medically necessary,
teeth whitening, tooth transplantation, inlays, orthopedic treatment, veneer and precious
metal materials used in any dental treatment;
2. Regarding Accident Dental benefit, treatment on the teeth which have been treated before or
with crack, and treatment on injury caused by chewing food (even if due to foreign body).
(V) Treatment items
1. Artificial organ materials, installation and replacement except for heart valve, artificial lens and
artificial joints;
2. Medical expenses resulting from diseases when the Insured suffers from sexual transmitted
disease, AIDS or inflected by HIV;
3. Elective Surgery and procedures treatment and/or surgery that is not medically necessary as
defined by a qualified, licensed medical practitioner; including Laser eye surgery to correct
vision;
4. Received in health hydros, nature cure clinics or similar establishments, or private beds
registered as a “nursing home” attached to such establishments;
5. Milieu therapy for rest and/or observation; services or treatment in any long term care facility,
spa, hydro clinic, rehabilitation institution, sanatorium or home for the aged that is not a
hospital as defined in this policy;
6. Circumcision.
(VI) Emergency Treatment
1. Treatment related to the condition that existed prior to arrival in the restricted area;
2. Treatment that could have been postponed until return from Restricted Area;
3. Treatment that has been planned in advance;
4. Treatment arising from circumstances that could have been reasonably anticipated by the
Insured;
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5. Complications or delivery that arising from pregnancy.
The above exclusions only apply to the Emergency Treatment while the exclusions of the
emergency treatment are not limited to above exclusions.
(VII) Service Facilities and Medical Materials
1. Expenses occurred due to use of telephone, electric stove, and coal gas and insulated cabinet;
2. Expenses of processing Mortal Remains and freezing (liabilities specified in the Contract is not
excluded);
3. Accompanied nursing and Companion-bed (liabilities specified in the Contract is not excluded),
nursing staff, washing and costs which are not arising from diagnosis and treatment (such as
wash basin, sanitary plastic and toilet tissue);
4. Assistant equipment for recovering treatment: orthopedic devices, hearing aids, glasses
(unless specified in the Contract), artificial eyes and artificial limbs;
5. Self-using facilities for massage, healthcare and treatment: Neck collar, waist band, stomach
care mat, kidney elevator, scrotal support, uterus support、hernia truss, knee cap bandage,
steel helm, orthopedic shoe, orthopedic devices, medicated strip, medicated pillow, crutch,
wheelchair, massage machines, various facilities for magnetic therapy and appliance of testing
and treatment for home using;
6. Customizing any vehicle, bathroom facility or residential facility;
7. Cost of all over the counter medical devices;
8. Prosthesis and corrective devices which are not medically required intra-operatively or
equivalent appliances; except prosthesis or durable medical equipment used as an integral
part of treatment prescribed by a physician.
(VIII) Expenses of Drugs
1. Self-purchased drugs
Self-purchased Drugs refers to the drugs purchased by the insured from pharmacies,
supermarkets, pharmacies affiliated to the hospitals on his/her own, without the prescription
from qualified Physicians;
2. All the OTC drugs;
3. Vitamins (except for those which is specified in the Contract), minerals, herbal paste and other
nutritional and healthcare drugs;
4. Drugs prescribed by Physician but in excess of 90 days supply.
(IX) Special medical expenses
1. Charges in excess of the usual and customary for any covered procedure;
2. The transportation expenses incurred when seeking medical treatment, but local ambulance
and emergency medical evacuation specified in the Contract is not excluded;
3. Claims and costs for medical treatment occurring after the expiration date of the policy,
including any portion of a covered prescription to be used after the expiration of the policy
(except for those specified in the Contract).
(X) Miscellaneous
- 13 -
1. Pre-existing conditions and diseases specified in the Contract;
2. For alcoholism, solvent abuse, drug abuse or addictive conditions of any kind and treatment of
any illness or injury arising directly or indirectly from any such abuse or addiction;
3. Treatment resulting from self-inflicted injury and attempted suicide, or fighting, drunk, drug
abuse or commit a crime;
4. The Insured participates in diving, parachute, rock climbing, bungee jumping, air glider,
exploration activities, martial art competition, wrestling competition, acrobat performance,
stunts, horse racing, motor racing, or any other high-risk sports;
5. Congenital malformations, deformations, or chromosomal abnormalities, (classification under
ICD-10 announced by WHO);
6. Medical expenses that result from occupational disease and Medical Accident;
7. Medical expenses of traffic accident which incurred as a result of the Insured drives under the
influence of alcohol; or without a valid driving license; or the vehicle does not have a valid
license;
8. Nuclear explosion, nuclear radiation, nuclear pollution or chemical pollution; war, military
action, riots or armed rebellion;
9. Insured who is hospitalized under false name, failed to meet the admission criteria, Registered
But Not Physically Staying In Hospital, or remaining hospitalized while should discharge (all
the medical expenses from the date of discharge which is determined by the hospital);
10. Any experimental treatments, i.e. treatments not recognized by scientific community or
medical community
- 14 -
4. Service Guide
4.1 How to Use Direct Billing Service
Direct billing service is available only for inpatient treatment within our network hospitals. (See
appendix 1)
Make the appointment with our network hospitals yourself, or call helpline 400-8833-663*2 to
make the appointment for you;
Call 400-8833-663*2 for pre-authorization;
Show your passport and insurance card for direct billing within our network
Confirm the expenses, sign and leave
Please remember:
The direct billing services will NOT be provided for medical exclusions, female maternity,
health check, vision, dental, and vaccination services. If the mentioned items are covered in
your benefits scheme, please submit the claim materials for afterwards claim (See 4.2).
Treatment in all the legally licensed hospitals outside of our network also will be accepted but it
need you to pay first and collect the materials back to claim
Take passport and insurance card when going for treatment within our network providers so that
the hospital could confirm your identity and provide direct billing service; For your children’s
appointment in mainland China, direct billing can be provided based on showing both the
insured and his guardian’s copy of passport
When receiving treatment the hospital will base on your coverage limits or coverage ratio you
may be asked to pay for corresponding amounts owed buy some of the hospital. You may have to
wait while these checks are carried out, thank you for your cooperation.
For self-payment carried out when receiving treatment you do not need to separately apply for
claim reimbursement, you just need leave the claim form, medical diagnosis, expense list and
receipt at the hospital for claim reimbursement.
During our review of the claims, if we find that the hospital charges are not equal to the actual
medical expenses payable by you, we will notify the hospital to refund the overcharged payment
to you or collect the underpayment from you.
Hospitals are not representatives of Ping An Health, their interpretation of your coverage may be
incorrect, the claim result provided by Ping An Health will prevail.
Please refer to appendix 1 for Network Provider list
4.2 How to Submit After Visit Claim Application
For outpatient treatment, maternity, health check-up and any treatment outside of our network,
you should pay out-of-pocket and send claim materials to us afterwards.
- 15 -
Materials you have to provide:
Claim application form (Please don’t forget to sign at “Applicant Signature”);
Original official medical invoices, i.e. ‘FAPIAO’ ;
Copy of Valid Identification used for enrollment (First Claim);
Copy of relevant medical document (Diagnosis written by doctor, medical report);
Copy of out-patient visit record or physician’s diagnosis;
Copy of expense List of inpatient treatment;
Copy of discharge summary of inpatient treatment;
Copy of billing summary related to the above medical documentation
Please provide the claim materials to the address:
Receiver 张璐 RITA ZHANG Tel: +(86)21 2066 0471
9F, 8-2 Gate, No.8 ChangShu Rd, Jingan District, Shanghai, 200040
中国上海静安区常熟路 8 号 8-2 门 9 楼平安健康 200040
Notes:
All the medical documents, bills and invoices should be matched and under the name of the
applicant.
For claims of prescription drugs in the pharmacy, diagnosis and prescription from doctor are
needed
Time Standard:
If the facts are clear and documents are well prepared, we will close the case within 10 working
days since we receive the complete materials, with transferring the money within 3 working days
after closing the case into your bank account.
In case of special claims, we will settle the claim within 60 days
4.3 How to arrange surgery in Thailand
If you choose to take surgery or other inpatient treatment in Thailand, the airfare is also covered in
the insurance plan. Please kindly follow the procedures as below:
Make the appointment with our network hospitals in Thailand (See Appendix 3 for Thailand
network list) , or call 400-8833-663*2 to make the appointment for you;
Call 400-8833-663*2 for pre-authorization;
For direct billing service, our calling center may require your previous medical report;
Book your flights (Flights must arrive in Thailand within a two-day period prior to admission and
leave Thailand within a two-day period following discharge from hospital)
Please kindly note:
Restricted to one economy class return flight under the name of the client receiving the inpatient
- 16 -
treatment per policy year up to a maximum amount of RMB 6,000
Flight to Thailand is only eligible for inpatient treatment received within Ping An Health’s
Thailand network (See Appendix 3 for Thailand network list).
Inpatient treatment preauthorization is required.
Flights for accompanying family members are not covered
Flights must arrive in Thailand within a two-day period prior to admission and leave Thailand
within a two-day period following discharge from hospital
The airfare is not eligible for Direct Billing. You can pay out-of-pocket and apply for claim
afterwards.
4.4 Worldwide Emergency Assistance
Our Worldwide Emergency Assistance provides you with peace-of-mind while you are traveling around
the world (100km outside of your residence for periods not exceeding 90 consecutive days per trip). A
24-hour hotline 400-8833-663 is available for emergency assistance in cases of serious injuries or
illnesses. Please refer to appendix 2 for detailed service issues.
- 17 -
Appendix
Appendix 1: Selection of Network Hospitals
City Provider Address Specialities & Notes
Shanghai
▲上海交通大学医学院附
属瑞金医院特需中心（3A）
Rui Jin Hospital Affiliated to
Shanghai Jiao Tong
University School of
Medicine,VIP Dept
上海市黄浦区瑞金二路 197
号瑞金医院 9 号楼 2 楼/38 号
楼 2 楼
2/F,Buiding 9/Buiding 38,197
Ruijin Er Road，Luwan
District，Shanghai
内分泌科、血液科、肾脏科、
麻醉科、普通外科、消化科
EC/HEM/NEP/ANS/GS/GAS
Shanghai
▲复旦大学附属华山医院
国际医疗中心(3A)
Huashan Worldwide Medical
Center, Affiliated to Fudan
University
上海静安区乌鲁木齐中路 12
号门诊楼 8 楼
8/F Clinic Building,12 Middle
Wulumuqi Road，Jing'ai
District
神经内外科、皮肤科、肾内
科、泌尿科、内分科;
日语服务;
24 小时急诊，其中 10pm-8am
在综合楼 15 楼;
NEU/NEUS/DERM/NEP/UR/EC
;
Japanese service;
24-hour EMER. 10pm-8am at
15/F, Multifunction Bd.
Shanghai
▲上海瑞东医院（瑞金医院
浦东分院）国际医疗部(J)
Shanghai Ruidong Hospital
(Ruijin Hospital Pudong
Branch) - International
Department
上海市浦东新区锦绣东路
120 号 2 楼
2/F, 120 East Jinxiu Road,
Pudong District, Shanghai
日语服务;Japanese service
内科、外科、妇科、儿科、
中医科;IM/GS/OB/PAE/TCM
24 小时急诊; 24-hour EMER.
Shanghai
▲复旦大学附属华东医院
特需医疗部(3A)
Huadong Hospital, VIP
Medical Center
上海市延安西路 221 号 5 号
楼 2 楼
2/F,Buiding 5,221 West Yanan
Road
消化科、口腔科;
日语、韩语
GAS/DEN;
English、Japanese、Korean
Shanghai
▲上海交通大学附属第一
人民医院国际医疗保健中
心(3A)
No.1 People's Hospital
International Medical Care
Center, affiliated to
Shanghai Jiao Tong
University
上海虹口区九龙路 585 号国
际医疗保健中心 1 楼
1st floor of International
Medical Center,585 Jiulong
Road,Hongkou District
眼科 Vision、泌尿外科、妇科、
麻醉科;
有日语服务;
OPH/UR Surgery/GYN/ANS;
Japanese service available
- 18 -
City Provider Address Specialities & Notes
Shanghai
▲上海交通大学附属第一
人民医院南院国际医疗保
健中心(3A)
No.1 People's Hospital
International Medical Care
Center (Songjiang
Branch) ,affiliated to
Shanghai Jiao Tong
University
上海市新松江路 650 号 1 楼
1/F，650 Xinsongjiang
Road,Songjiang District
眼科 Vision、泌尿外科、妇科、
麻醉科;
有日语服务;
OPH/UR Surgery/GYN/ANS;
Japanese service available
Shanghai
▲上海交通大学附属仁济
医院浦东分院高级专家门
诊(3A)
Renji Hospital (Pudong
Branch), VIP Dept.,affiliated
to Shanghai Jiao Tong
University
上海浦东新区北园路 33 号健
保楼 3 楼
3/F,Jianbao Building,33
Beiyuan Road, Pudong District
消化科、神经外科 、泌尿科;
基础英语;
GAS/NEUS/UR;
Basic English
Shanghai
▲上海同济大学附属同济
医院特需门诊(3A)
Shanghai Tongji Hospital, VIP
Medical Center
上海普陀区新村路 389 号门
诊 3 楼
3/F Outpatient Building,Tongji
Hospital,389 Xinchun
Road,Putuo District
心血管内科、骨科(足踝)、妇
产科;
基础英语;
Cardiovasular
medicne/ORP(ankle)/OB/GYN
;
Basic English
Shanghai
▲上海中医药大学附属曙
光医院浦东分院特需中心
(3A)
Shuguang Hospital (Pudong
Branch), VIP Clinic, affiliated
to Shanghai Shanghai
University of T.C.M
上海浦东新区张衡路 528 号
贵宾楼 1 楼
1/F VIP Building, Shuguang
hospital,528 Zhangheng
Road,Pudong District
中医内科、中医外科;
基础英语;
TM;
Basic English
Shanghai
▲上海儿童医学中心特诊
部(3A)
Shanghai Children's Medical
Center, Special Service Clinic
上海市东方路 1678号门诊大
楼 3 楼
3/F,Clinic Building,1678
Dongfang Road,Pudong
District
小儿心血管内外科、儿科;
Infant Cardiology/PAE
- 19 -
City Provider Address Specialities & Notes
Shanghai
▲上海第一妇婴保健院南
院 VIP 贵宾门诊 Shanghai
No.1 Maternity and Infant
Health Hospital (South
Branch)
上海市浦东新区耀华路 391
号门诊 5 楼（近打浦路隧道
浦东出口）5F, 391 Yaohua
Road , Pudong District
计划生育、围产保健、妇科;
英日陪诊;
Birth control/Perinatal
health-care/GYN; Visit guide
in English and Japanese
Shanghai
▲上海第一妇婴保健院东
院特需门诊 Shanghai
No.1 Maternity and Infant
Health Hospital (East
Branch)
上海市浦东新区高科西路
2699 号门诊 4 楼
4F，Outpatient
Department,No 2699，GAO Ke
Xi Road,Pudong
District,Shanghai
计划生育、围产保健、妇科;
英日陪诊;
Birth control/Perinatal
health-care/GYN; Visit guide
in English and Japanese
Shanghai
▲上海第一妇婴保健院西
院 VIP 贵宾门诊 Shanghai
No.1 Maternity and Infant
Health Hospital (Pudong
Branch)
上海市静安区长乐路 560 号
No 560，Chang Le Road，
Jingan District,Shanghai
计划生育、围产保健、妇科;
英日陪诊;
Birth control/Perinatal
health-care/GYN; Visit guide
in English and Japanese
Shanghai
▲复旦大学附属儿科医院
特需医疗中心(3A)
Children's Hospital of Fudan
University - International
Clinic Center
上海市闵行区万源路 399 号
3 号楼第一诊疗部
No.1 Clinic Area, Building 3,
399 Wan Yuan Road, Minhang
District, Shanghai
儿科，内科不提供预约
Paediatrics, no appointment
available for IM
24 小时急诊，其中 16:30-次
日 8:00 在万源路 399 号 1 号
楼 6 楼 11 病房内，咨询电话：
021-64931121
Shanghai
▲上海交通大学附属上海
市儿童医院特诊部(3A)
Children's Hospital of
Shanghai - Special Medical
Center
上海市北京西路 1400 弄 24
号 2 号楼一楼
1st Floor,Building 2,No
24,Lane 1400, West Beijing
Road, Shanghai
儿科 PAE
Shanghai
(▲)上海逸仙医院-中山医
院外宾部
Shanghai Yixian Hospital
上海市徐汇区医学院路 111
号门诊 A 楼 10 号门 6 楼
6 Floor,Outpatient Building
A,No 111, Yixueyuan
Road,Xuhui District,Shanghai
拨打平安热线预约；客户预
约需要提供姓名、平安保险
卡号及电话。
非指定专家预约需提前 7 个
工作日，指定专家预约需前
天 10 个工作日。
- 20 -
City Provider Address Specialities & Notes
Shanghai
▲上海浦东新区浦南医院
国际医疗中(2A)
Shanghai Punan Hospital,
International Medical Center
(VIP Department)
上海浦东新区临沂路 219 号
17 楼
17/F, 219 Linyi Road, Pudong
District
普外科、神经外科、妇产科、
中医科、针灸科、骨科、心
内科;
日语服务;
GS/NEUS/OB/GYN/TM/ACU/O
RP/CAR
Japanese service
Shanghai
▲上海美华丁香门诊部(P)
American-Sino Ob/Gyn
Service
上海华山路 800弄 6号群楼 3
楼
3/F, Podium Building 6, Lane
800, Huashan Road
特色科室：妇产科/儿科；
Ob/Gyn/PAE
服务语种：英语；English
医院设置：儿科只有门诊。
妇产科有门诊及住院部。
直接结算：儿科提供门诊直
接结算，妇科提供门诊、住
院直接结算，产科生育不提
供直接结算。
Shanghai ▲上海禾新医院(F)
Shanghai Landseed Hospital
徐汇区钦江路 102 号 2 楼（近
虹漕路）
2/F, 102 QinJiang Road
特色科室：全科；GP
服务语种：英语/日语；
English/Japanese
背景：台资医院
Shanghai
▲上海爱尔眼科医院国际
部(F)
Shanghai Aier Eye Hospital，
International department
虹桥路 1286 号 2 楼国际部
（近宋园路）
2/F International Department,
1286 Hongqiao Rd.,
Changning District, Shanghai
特色科室：眼科 Vision;OPH
服务语种：韩语;Korean
Shanghai
▲上海同仁医院特需门诊
(2A，原上海长宁中心医院)
Shanghai Changning District
Central Hospital, Special
Medical Service Center
长宁区仙霞路 1111号新门诊
大楼（3 号楼）4 楼
4/F, Clinic Building, 1111
Xianxia Road,Changning
District
妇产科、眼科 Vision;
有英语、日语、韩语服务;
GYN/DEN;
English, Japanese, Korean
service available
Shanghai
▲上海圣安儿科门诊部(F)
Sunshine Children's Clinic,
Shanghai
上海市闵行区伊犁南路 85 号
85 South Yili Road, Minhang
District, Shanghai
特色科室：儿科；PAE
服务语种：英语/日语；
English/Japanese
Shanghai
▲上海圣恩儿科门诊部(F)
Sunshine Children's Clinic,
Shanghai
上海市徐汇区永嘉路 718 弄
1 号 No 1，
Lane 718， Yong Jia Road，
Xuhui District，Shanghai
特色科室：儿科；PAE
服务语种：英语/日语；
English/Japanese
- 21 -
City Provider Address Specialities & Notes
Shanghai
▲上海圣欣门诊部(F)
Sunshine Children's Clinic,
Shanghai
上海市浦东新区长柳路 58 号
101 室 Room
101，No 58，Changliu Road，
Pudong，Shanghai
特色科室：儿科；PAE
服务语种：英语/日语；
English/Japanese
Shanghai ▲上海全康医疗中心(F)
Global Healthcare Center
上海市静安区南京西路 1788
号国际中心 303 室（近华山
路）
3/F,No.1788 West
Nanjing,Jingan
District,Shanghai
特色科室：全科/皮肤科/心脏
内科；GP/DERM/CAR
服务语种：英语/日语/法语
（仅限全科和妇产科）；
English/Japanese/French
Shanghai
▲上海众康医疗中心(F)
Shanghai Zhongkang
medical center
上海市浦东新区世纪大道
100 号环球金融中心 212 室
212 World Financial Center,
100 Century Avenue,Pudong
District，Shanghai
全科;GP
Shanghai
上海市闵行区中医医院特
需门诊(2A)
Shanghai Minhang Hospital
of Traditional Chinese
Medicine - Korean Clinic
(former Shanghai Rhine
Hospital)
合川路 3071 号急诊楼 2 楼
2/F emergency building,
3071 Hechuan Road,Minhang
District
特色科室：骨科（脊椎及关
节疾病）/肛肠科/手外科；
ORP/Anorectal/Hand surgery
服务语种：韩语；Korean
Shanghai
▲上海诺美尔眼耳鼻喉科
医院(F)
Shanghai Nobel Eye and ENT
Hospital
上海市新闸路 371 号
371 Xinzha Road
日语服务; Japanese service
五官科专科医院;ENT
Shanghai
▲上海交通大学附属第六
人民医院国际医疗部(3A)
Shanghai Sixth People's
Hospital, International
Medical Center, Affiliated to
Shanghai Jiaotong University
上海徐汇区宜山路 600 号门
诊 13 楼
13/F Clinic Building,800
Yishan Road,Xuhui District
骨科、内分泌科、耳鼻、喉
科;
Othopaedics/EC/ENT;
服务语种：英语
Shanghai 上海樱华门诊部(P)
Shanghai Sakura Clinic
延安西路 2558 号综合康复楼
B 座 4 楼（近水城南路）
4/F, Seat B, 2558 West Yan'an
Road
特色科室：内科/耳鼻喉科/
妇科/儿科;IM//ENT/Gyn/PAE
服务语种：日语;Japanese
- 22 -
City Provider Address Specialities & Notes
Shanghai
上海樱园门诊部(P)
Shanghai Sakura Clinic -
Shanghai Garden
虹桥路 2489 弄 200 号上海花
园广场管理中心 2 楼（近延
安西路）
2/F, No.200, Lane 2489,
Hongqiao Road
日语服务; Japanese service
Shanghai
▲上海中医药大学附属曙
光医院浦西分院名中医诊
疗中心(3A)
Shuguang Hospital (Puxi
Branch), VIP Clinic, affiliated
to Shanghai University of
T.C.M
上海黄浦区普安路 185 号
185 Puan Road,Luwan District
门诊：曙光大厦 1 楼
中医内科、中医外科;
基础英语;
TM;
Basic English
Shanghai
▲上海同济大学附属东方
医院特需部(3A)
East Hospital of Shanghai
Tongji University，VIP
Medical Center
浦东新区即墨路 150 号（东
方医院门诊大楼，门诊地址：
3 楼，住院部地址：12 楼右
侧）
3/F&12/F, 150 Jimo
Road,Pudong District，
Shanghai
口腔科、急危重病科、急症
创伤外科、妇产科、心血管
内科、骨科
DEN/OB/GYN/ORP/24-hour
EMER
Shanghai 上海瑞林诊所(P)
Shanghai Green clinic
仙霞路 88 号太阳广场东塔 1
楼（近娄山关路）1/F East Sun
Plaza, 88 Xianxia Road
全科;GP
日语;Japanese
Shanghai ▲上海景康门诊部(F)
Shanghai Jingkang Clinic
上海黄浦区打浦路 398 号 1
楼
1/F, 398 Dapu Road,Luwan
District, Shanghai
全科;GP
Shanghai
▲上海瑞和门诊部-莱佛士
医疗中心(F)
Shanghai Raffles Medicle
Center
上海虹梅路 1801 号凯科国际
大厦二楼 2/F,Keiko
International Building,
1801 Hongmei Road, Shanghai
特色科室：皮肤科/儿科/妇科
/口腔科;DERM/PAE/GYN/DEN
服务语种：英语/日
语;English/Japanese
Shanghai ▲美国医学中心(F)
American Medical Center
上海市田林路 888 弄 1 号楼
东
EAST BUILDING NO1.LANE888
TIANLING ROAD
骨科,物理治疗
Othopaedics，Physiotherapy
- 23 -
City Provider Address Specialities & Notes
Shanghai
▲上海德西门诊部有限公
司(F)
DeltaWest Clinic
上海市长宁区延安西路 2558
号 8 幢 B 栋 4 层西 5 层 5F,
4F(W), Suite B Block 8, No.
2588, West YAN AN Road
Changning District Shangahi
特色科室：全科/心脏康复
科；GP/cardial rehabilitation
服务语种：英语；English
Shanghai
▲上海博爱医院国际医疗
服务中心(P)
Shanghai Humanity Hospital
上海市淮海中路 1590 号 7 楼
7/F, No.1590 Middle Huaihai
Road,Xuhui District
特色科室：儿科/妇科/内分泌
科/肛肠科/肿瘤科；
PAE/GYN//EC/Anorectal/ONC
服务语种：英语；English
Shanghai
▲上海百瑞肿瘤中心（F）
Shanghai ProMed Cancer
Centers
上海市淡水路 170 号
170 Danshui Road
放射科
RAD
Shanghai
▲上海康威门诊部（F）
Shanghai Neuglow Medical
Center
上海市浦东滨江大道 2525 弄
25 号 C 栋别墅
Building C,No.25,Lane
2525,Reverier
Avenue ,Pudong
District,Shanghai
内科、妇科、中医科、皮
肤;IM/GYN/TCM/DERM/
服务语种：英语/日
语;English/Japanese
Shanghai
▲上海威瑞门诊部（F）
Shanghai Healthway Medical
Center
上海市浦东碧云路 1228 号
No.1228 Biyun Road,Pudong
District,Shanghai
全科、妇科、中医
科;GP/GYN/TM
服务语种：英语/日
语;English/Japanese
Nanjing
南京市鼓楼医院著名专家
会诊中心(3A)
Nanjing Drum Tower
Hospital - Specialist Center
鼓楼区中山路 321 号，门诊 4
楼 7、8 号挂号窗口
4th Floor, No 321, Zhongshan
Road, Gulou District, Nanjing
骨科、妇科、免疫、生殖中
心
ORP,GYN,IMM,RSD
Nanjing 南京市第一医院（3A）
Nanjing No 1 Hospital
长乐路 68 号 1 号楼 3 楼
3F,Building 1,No 68,Changle
Rd
心内科，CAR
Nanjing ▲环球医生南京诊所(F)
Global Doctor——Nanjing
南京市建邺区莫愁湖东路 6
号左邻风度花园
6 East Mochouhu Road, Jianye
District, Nanjing (Next to
Fengdu Garden)
全科;GP
- 24 -
City Provider Address Specialities & Notes
Nanjing 南京明基医院国际部(J)
Nanjing BenQ Hospital
江苏省南京市建邺区河西大
街 71 号
71 Hexi Street, Jianye district,
Nanjing
／
Notes：
Exceptional conditions are listed in note column. The letter following hospital name indicates the
nature of hospital. (F: Foreign invested; P: Private owned; J: Joint venture; 2A: Public, Tier 2, Level
A; 3B: Public, Tier 3, Level B; 3A: Public, Tier 3, Level A.)
We will update the list on a regular base, you can visit Ping An official website, consult your
service manager or contact our hotline to get the latest information and other area hospitals.
- 25 -
Appendix 2: Worldwide Emergency Assistance
Article 1: Definitions
1.1 "Terrorist actions" refer to actions taken by any individuals or groups for themselves or on
behalf of any organizations and governments due to political, religious, political ideology and
ethnic reasons, to impose influence on governments and to scare the public or some people,
including but not limited to use or threat of use of force and violence.
1.2 "An authorized person" refers to the person appointed by Ping An Health Insurance Company
of China, Ltd. in writing to perform this Agreement on behalf of Ping An Health Insurance
Company of China, Ltd. and the Insured.
1.3 "Compulsory inclusion" refers to the assistance service provided by International SOS
automatically where the service items are not optional.
1.4 "A home country" refers to the country of nationality.
1.5 "The country of permanent residence" and "the domestic land" refer to the territory of the PRC
(excluding Taiwan, Hong Kong SAR and Macao SAR).
1.6 "A domicile" refers to the city of residence within the territory of the PRC (excluding Taiwan,
Hong Kong SAR and Macao SAR) as finally confirmed by the insured and confirmed by Ping An
Health Insurance Company of China, Ltd., and it refers to the city where the policy held by the
Insured is issued by Ping An Health Insurance Company of China, Ltd. by default.
1.7 "Maximum compensation amount for assistance service" refers tothe maximum expenses that
should be borne by International SOS for assistance services provided for an insured during any
incident according to the Agreement.
1.8 "Services" refer to the medical and travel assistance services provided by International SOS as
specified in Article 5 of the Agreement.
1.9 "Severe medical conditions" refer to the conditions which must be treated as an emergency in
order to avoid the death of the insured or direct or long-term severe damage to the insured's
health according to International SOS doctors’ advices. When judging whether patients are in
severe medical conditions, International SOS's doctors will take account of the location of
insureds, the natures of medical emergencies, andwhether it is possible to provide medical
service and equipment at the location of incidence.
1.10 "Pre-existing conditions" refer to any medical conditions for which insureds receive inpatient
treatment within the 12 months before the effective date of this service plan, or any medical
conditions for which insureds receive diagnosis or treatment (including prescription medicines)
in legal medical facilities within 6 months before the effective date of this service plan. This
stipulation is not applicable to those who have already been aninsured of International SOS
since the last year.
1.11 "Immediate relatives" refer to the spouse, parents (mother-in-law and father-in-law), children
and their spouses, grandparents, maternal grandparents, grand children (maternal
grandchildren) and their spouses, great grandparents and maternal great grandparents.
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1.12 "Third-party service providers" refer to any member in International SOS's service provider
network. They are standalone service providers recommended by International SOS to
customers, including but not limited to hospitals, clinics, etc. Such service providers are not
employed or controlled by International SOS, but just one of the members who join in
International SOS's third-party service provider network.
Article 2: Qualifications
2.1 Unless otherwise stated by International SOS in writing, the upper age limit for the services
listed in 5.4.1 and 5.4.2 is 70.
2.2 The International SOS services are provided on the basis of the “compulsory inclusion” as
defined in 1.3.
2.3 An insured is eligible for service item 11 "arrangement of and payment for repatriation of
mortal remains to the country of nationality" as listed in II "international medical
assistance service" under 5.4.1 "international medical and travel assistance service", when
he/she travels outside his/her country of nationality for a trip of no more than 365
consecutive days. An insured is eligible for service item 9 "arrangement and payment for
mortal remains repatriation to the place of residence" as listed under 5.4.2 "domestic
medical assistance service", when he/she travels more than 100km away from his/her
residence within the territory of the People's Republic of China for a trip of no more than
365 consecutive days.
2.4 The insureds who travel outside their countries of nationality or countries of residence (the
insureds are neither in their countries of nationality nor countries of residence) for no more
than 90 consecutive days are entitled to all the international medical and travel assistance
services specified in 5.4.1; the insureds who travel 100 kilometers away from their residences
for no more than 90 consecutive days are entitled to all the domestic medical assistance
services specified in 5.4.2.
Article 3: Geographic coverage of assistance services
3.1 International SOS shall provide services outside the territory of the PRC (including Taiwan, Hong
Kong SAR and Macao SAR) according to 5.4.1 hereof; International SOS shall provide services
within the territory of the PRC (excluding Taiwan, Hong Kong SAR and Macao SAR) according to
5.4.2 hereof. International SOS undertakes to do its best to provide services, but relevant local
and/or global services shall be subject to the local and international acts. Where International
SOS-related cases may not be processed unless relevant parties' authorizations are obtained,
whether the authorizations can be obtained is not under International SOS's control.
3.2 International SOS shall do its best to provide services, but it may not be required to provide
services for insureds in areas with war risks and areas where services cannot be performed for
political reasons or force majeure. Based on the above reasons, International SOS will reserve
- 27 -
the right for not providing any service for any insured.
Article 4: Limit on assistance services
4.1 International medical assistance (applicable to services set out in 5.4.1)
On any accident, limit on assistance services are as follows:
Emergency medical transfer, medical transfer to
homelands or country of permanent residence,
repatriation of remains to homelands or country
of permanent residence
Up to USD1,000,000 for each time per time
Sending minor children back to their homelands
or countries of permanent residence
A single-trip economy class ticket for the minor
child
Visits by and accommodation of immediate
relatives
A round-trip economy class airline ticket;
accommodation fee of up to USD250 per day and
USD1,000 per event
Hotel accommodation during recuperation Up to USD250 per day and up to USD1,000 per
case
Return to homelands or country of permanent
residence in emergency
A single-trip economy class ticket
Immediate relatives' accommodation and funeral
affairs handled by them
A round-trip economy class ticket , boarding fee
which is up to USD250 per day and USD1k per
case
Benefit limit on the assistance services provided
to any insured under any accident except for the
above-mentioned emergency medical transfer,
medical evacuation to place of residence and
repatriation of mortal remains to place of
residence.
Up to USD10,000
4.2 Domestic medical assistance (applicable to services set out in 5.4.2)
On any accident, limit on assistance services are as follows:
Emergency medical transfer, medical transfer to
country of permanent residence, repatriation of
remains to country of permanent residence
Up to RMB6,500,000 per time
Sending minor children to country of permanent
residence
A single-trip economy class ticket for the minor
child
Visits by and accommodation of immediate
relatives
A round-trip economy class ticket;
accommodation fee up to RMB3000
- 28 -
Hotel accommodation during recuperation Accommodation feeup to RMB3,000
Emergency return to country of permanent
residence
A single-trip economy class ticket
Immediate relatives' accommodation and funeral
affairs handled by them
A round-trip economy class ticket,
accommodation fee of RMB3000 or below
Transportation fee for escorts in emergency Transport fee incurred by one immediate relative
or appointed agent of the customer under
emergent medical escort is up to RMB10,000.
Benefit limit for the assistance services provided
to any insured under any accident except for the
above-mentioned emergency medical transfer,
medical evacuation to place of residence and
repatriation of mortal remains to place of
residence.
Up to RMB65,000
4.3 Arrangement of and payment for repatriation of mortal remains to the country of
nationality/the place of residence
For service item 11 "arrangement of and payment for repatriation of mortal remains to the country
of nationality" as listed in II "international medical assistance service" under 5.4.1 "international
medical and travel assistance service", the limit of the assistance service for any insured in any
accident is as follows:
For service item 9 "arrangement and payment for mortal remains repatriation to the place of
residence" as listed under 5.4.2 "domestic medical assistance service", the limit of the assistance
service for any insured in any accident is as follows:
4.4 Compassionate emergency visit
Costs you have to pay for an economy class return ticket from a country within your area
of cover to visit a close family member, if their medical condition results in them being placed on a
critical list, or their death. You are limited to one return journey in each plan year.
Arrangement of and payment for repatriation
of mortal remains to the country of nationality Up to USD100,000 per time
Arrangement and payment for mortal remains
repatriation to the place of residence Up to RMB600,000 per time
- 29 -
Article 5: Description of services
5.1 International SOS shall maintain the verified latest information of the service providers at any
moment. International SOS shall regularly review and update the information related to
name, address, specialty, working time and proficiency in language. International SOS shall
guideservice providers to report the newly acquired relevant information as soon as they
receive it, including the service quality, new address and telephone number list and updates.
For theinsured's inquiries, the insured will get the latest information about the service
providers and their services.
5.2 Ping An shall provide 7*24 services in Mandarin and English to the insured via its emergency
center in Beijing.
5.3 Where the informationcan be provided immediately, International SOS shall provide the
insured with appropriate services by phone. Under all other circumstances, International SOS
will try its best to provide services in the quickest way.
5.4 International SOS shall provide the following services to all the qualified insureds as
stipulated in Agreement who call International SOS as per the agreement:
5.4.1 International medical and travel assistance services
(I)International Travel Assistance Service
1. Travel consultancy
Before and during a trip, the insured can contact International SOS to obtain the
following information:
Passport and visa requirements
Local requirements on and demand for vaccination
Weather
Local languages
Exchange rate
2. Information about embassies and consulates
International SOS can provide the telephone numbers and addresses of embassies and
consulates of China in destination countries as well as the telephone numbers and
addresses of embassies and consulates of the destination countries in China.
3. Assistance in finding delayed or lost luggage
In the event that the insured's luggage is delayed or lost during his/her commercial flights,
International SOS can introduce relevant organizations, such as airline companies and the
customs, to the insured to help them find their luggage.
4. Assistance in the event of passport loss
In the event that the insured's important identity certificates, such as a passport and
traveling certificate, are lost or stolen during overseas travel, International SOS can
provide the insured with the information about procedures for re-issuance of the
- 30 -
certificates and introduce appropriate departments or organizations to the insured for
re-issuance. The expenses incurred shall be borne by the insured.
5. Rearranging travel plan
In the event that the insured fails to continue his/her trip according to the original travel
plan due to emergencies, International SOS can assist the insured in rearranging the
flights, hotels and travel plans. The expenses incurred shall be borne by the insured.
6. Emergent interpreting services via telephone/introducing local interpreting services
In case of emergencies during the overseas travel, the insured can call International SOS
to access a brief emergent interpreting service via telephone for free. International SOS
can also introduce a local interpreter to the insured by providing the interpreter's
address, phone number and working hours, but the expenses for hiring the interpreter
shall be borne by the insured.
7. Emergent legal assistance
When required by the insured, International SOS can introduce local law firms to the
insured and even assist in bailing. The expenses incurred shall be borne by the insured.
8. Urgent message and document delivery
In the event that emergent injuries and diseases happen to the insured or his/her
relatives, the insured or the relatives can request International SOS to notify his/her
relatives or the insured him/herself of the emergencies as soon as possible. As required
by the insured, International SOS will facilitate the delivery of urgent documents to the
insured's relatives, friends or colleagues. The expenses incurred shall be borne by the
insured.
9. Assistance in arranging hotel accommodation
In the event that the insured needs the company of his/her relatives or friends when
hospitalized overseas, International SOS can arrange the accommodation in local hotel
for the relatives or friends.
The above-mentioned services are based on assistance or referral, so International SOS will not bear
any third-party expenses. All third-party expenses shall be paid by the insured.
(II)International medical assistance service
The following services are accessible only when accidents or sudden diseases happen to the
insured in countries other than home country or country of residence.
1. Medical consultancy by phone
When the insured gets ill or encounters a medical emergency during the overseas trip (in
countries other than home country or country of residence), he/she can call
International SOS to obtain the medical consultancy service from International SOS's
doctors.
- 31 -
* The nature of the medical consultancy service provided through the hotline is only
provision of consultancy opinion whose aim cannot be interpreted as a request for the
insured to carry out or abandon any medical action. However, International SOS shall
perform the duty of care and stick to professional code of ethics.
* This service should not be regarded as phone diagnosis, 120 or 911 services.
2. Medical institution recommendation
Upon the request of the insured and on the basis of his/her health conditions,
International SOS may recommend local medical institutions that can meet treatment
requirements and are certified by International SOS and/or have partnership with
International SOS. Information provided include names, address, telephone number,
expertise, working hours and other information about doctors, hospitals, clinics, dentists,
etc.
3. Assistance in and arrangement for hospitalization
According to the insured's physical health condition, International SOS can assist the
patient in seeing doctors at local medical facilities (doctors, hospitals, clinics, dentists, etc)
that meet treatment requirements and are certified by International SOS and/or have
partnership with International SOS. In case the insured is seriously ill, International SOS
will assist in arranging the in-patient treatment for the insured.
4. Hospital admission deposit guarantee and/or advance payment and track, observation
and monitoring of the treatment during the hospital stay
Where the insured needs to receive inpatient treatments due to some disease or
accident when traveling in country other than home country or country of residence,
upon the requirement of the insured, International SOS will guarantee the relevant
medical expenses incurred by the insured during the hospital stay. The premise for
International SOS to provide the finance guarantee for the insured is that: International
SOS obtains the adequate assurance for the financial payment from the credit card of the
insured or the relatives of the insured in advance. International SOS will not bear the tax
generated by the issuance of service invoice for such service and the tax shall be borne
by the insured.
Under the premise that International SOS provides hospital admission deposit guarantee
for the insured, and the confidentiality and authorization conditions are met,
International SOS’ doctor, where possible, will contact the attending doctor of the
insured, track and supervise the treatment provided for the insured during the hospital
stay. Where possible, International SOS will try its best to assist the insured in obtaining
the medical report, discharge summary, bills, receipts and other documents so as to
facilitate the claim of the insured.
5. Hotel accommodation during recuperation
If the insured's attending doctor and a doctor of International SOS both agree that it’s
medically necessary for the insuredto recuperate locally after being discharged from the
- 32 -
hospital, International SOS will arrange the insured's accommodation in a local ordinary
hotel for recuperation immediately after discharge. International SOS will pay for room
fee for at most 4 consecutive days (USD250 or less per day).
6. Medical translation services
International SOS can provide the insured with medical translation servicesvia phone.
7. Arrangement and payment for emergent return to home country or country of
residence
In case of the death of the insured's direct relatives, if the insured is traveling abroad
(emigrants excluded) and needs to return to home country or country of residence
urgently, International SOS can arrange for the insured’s return and will pay for one
economy class single-trip ticket.
8. Arrangement and payment for emergency medical transfer
When it is medically necessary and as long as International SOS can help, International
SOS can arrange for the delivery of medicine, drugs and medical supplies that are
necessary for the insured's nursing and treatment and that are unavailable at the place
where the insured stays. The delivery of medicine, drugs or medical supplies should
comply with the local laws and regulations, and the expenses of these products and
delivery fees shall be undertaken by the insured.
9. Arrangement and payment for emergency medical transfer
When the insured is traveling abroad, in the event that he/she is badly ill and
International SOS doctors judge that local hospitals cannot provide proper treatment,
International SOS shall arrange necessary communication and transportation tools as
well as medical escort to transfer the insured to the nearest hospital that can provide
proper medical treatment and health care services. The hospital is not limited to
domestic ones. International SOS is to pay necessary transport expenses related to the
emergent medical transfer and supplementary expenses incurred during the process of
services.
Since SOS is responsible for expenses related to medical transfer, International SOS shall
have the right to make following judgments and decisions:
1. Whether the insured's conditions are so critical that emergent medical transfer is
required.
2. SOS also reserves the right to decide the transfer destination and transfer method
according to all the evaluated fact and condition known by then, including but not
limited to whether sufficient and necessary treatment can be provided by the medical
facility at the initial treatment place or whether the treatment can be postponed till the
insured returns to home country.
International SOS's judgments or decisions should be agreed by the insured or the
insured's family members, or implemented when the insured or the insured's family
- 33 -
members understand risks.
10. Arranging and paying for emergency medical transfer to home country or country of
residence
After the insured receives International SOS's emergent medical transfer, admission and
initial treatment service outside the home country or country of residence, and when
doctors of International SOS judge that medical transfer back to home country or the
country of residence is medically appropriate, International SOS will arrange and pay for
flight or other proper transportation to send the insured to home country or country of
residence for treatment. International SOS will provide proper communication and
language translation support, mobile medical equipment, wheelchair, stretcher and
other supplementary devices, and/or professional nursing staff.
11. Arrange and pay for mortal remains transportation to home country or country of
residence
When the insured travels outside of his/her home country or country of residence and
dies from an accident or a sudden acute disease, International SOS will, as required by
the insured or his/her direct relatives to arrange and pay for the returning of mortal
remains or bone ashes to home country or country of residence, or funeral in places
where the insured dies. Coffins or bone ash boxes must meet the requirements of
international air transportation. The subsidies mentioned above do not include
graveyard, rituals, flowers, farewell ceremonies, and other unnecessary items.
12. Arrange and pay for the visit and accommodation of direct relatives
If the insured is hospitalized for over seven continuous days when traveling outside the
home country or country of residence alone and needs his/her direct relatives to visit,
International SOS can arrange one round-trip ticket of economy class for one direct
relative of the insured between home country or country of residence and the hospital
where the insured is hospitalized, and arrange and pay for the accommodation.
International SOS will pay up to 250 US dollars for the visiting direct relatives’
accommodation per day and the total payment for each case cannot exceed 1,000 US
dollars. The expenses exclude foods, drinks, communication and other service fees.
* International SOS does not promise that the direct relative can acquire the visiting
country's visa, and the expenses for visa and other related expenses other than the
above mentioned expenses are to be undertaken by the insured.
13. Arrange and pay for minor children's transportation to home country or country of
residence
In the event that the insured’s accompanying child/children under 16 years old (16
included) is/are not taken care of due to any accidental injury, acute illness, emergent
- 34 -
medical transfer or death of the insured, International SOS will arrange and buy a
single-trip economy-class ticket of the nearest trip for the child/children to return to the
home country or country of residence. The original ticket should be given to
International SOS for further handling. Where necessary, International SOS will arrange
for escort to accompany the child/children and pay for the expense.
14. Arrangement and payment for transportation of a direct relative to handle post-death
affairs
If the insured dies outside the home country or country of residence due to accidental
injury or acute illness, International SOS will arrange one round-trip economy-class flight
ticket from the home country or country of residence to the place where the insured dies
for one of the insured's direct relatives or designated agent to handle funeral affairs.
International SOS will also arrange and pay up to 250 US dollars for local accommodation
per day and up to 1000 US dollars for each event. The expenses exclude foods, drinks,
communication and other service fees.
15. Emergent oral message delivery
In case of insured’s emergency or injures/illness, International SOS can inform the
insured's relatives and/or the employer as soon as possible in according to the
requirement.
Notes:
（i）The above service 2-3 and 8 are based on assistance of arrangement and recommendation,
International SOS will not pay for any third-party expense. All the third-party expense and
relevant service expense will be paid by the insured.
（ii） As for service item 4, International SOS will not undertake any hospitalization expenses and
expenses for the third party, all in-hospital expenses and expenses for the third party will be
undertaken by the insured.
（iii）The above service items 5, 7 and 9-14 are subject to limits defined in No.5 clause in this
Agreement as well as exclusions in No.8 clause.
（iv）If the above service item 9 and 10 involving International SOS' negligence during the transfer,
Section 18.1 in the Agreement shall be followed.
5.4.2. Domestic medical assistance
1. Medical consultancy by phone
When an insured gets ill or encounters a medical emergency during a domestic trip,
he/she can call International SOS to obtain medical consultancy from International SOS's
doctors.
* The nature of this service provided through the hotline is only consultancy provision
which cannot be explained as a request for the insured’s adoption or abandonment of any
medical practice. However, International SOS shall be prudent and stick to professional
- 35 -
ethics when the medical consultancy is provided.
* This service should not be regarded as phone consultation, or 120 or 911 services.
2. Introduction to and recommendation of medical facilities
Where an insured feels bad or falls ill during a domestic travel, International SOS may,
according to the insured's requirements and health conditions, introduce and recommend
local medical facilities (hospitals, clinics, dentists, etc., including their names, addresses,
telephones, specialties and working hours) that best meet medical treatment
requirements, and have been reviewed and recognized by and/or have cooperative
relations with International SOS.
3. Assistance in and arrangement for hospitalization
International SOS can assist patients in seeing doctors at the local medical facilities
(hospitals, clinics, dentists, etc., including their names, addresses, telephones, specialties
and working hours) that best meet medical treatment requirements, and have been
reviewed and recognized by and/or have cooperative relations with International SOS. If
the insured is seriously ill, International SOS will assist in arranging in-patient treatment
for the insured.
4. Guarantee and/or advances of inpatient medical expenses, and tracking and monitor
of treatment progress during a hospital stay
Where an insured needs to receive inpatient treatment due to diseases or accidents when
traveling in his/her home country, upon the requirement of the insured, International SOS
will guarantee the relevant medical expenses incurred by the insured during
hospitalization. International SOS provides the financial guarantee for the insured under
the premise that: International SOS needs to obtain adequate guarantees for payment
from the credit card or the family member(s) of the insured in advance. International SOS
will not bear the tax incurred due to issuance of the invoice for such a service, and the tax
shall be borne by the insured.
When International SOS guarantees inpatient expenses for the insured,International SOS
doctors, without prejudice to non-disclosure and authorization requirements, will contact
the attending doctor of the insured, and track and monitor the inpatient treatment where
possible. Besides, International SOS, where possible, will try its best to assist the insured in
obtaining the medical report, the discharge summary, bills, receipts, etc. so as to make it
convenient for the insured to lodge claims.
5. Post-discharge recuperation and accommodation
Where the insured's attending doctor and the doctor of International SOS agree that
- 36 -
the insured needs to recuperate locally after discharge when it is medically necessary,
International SOS will arrange for the patient to live in a standard local hotel for
recuperation after discharge and will bear the accommodation expense of up to RMB
3,000 in total.
6. Urgent return to the place of residence for post-death affairs of direct relatives
Where an insured is informed of the death of an direct relative when he/she is outside of
his/her country of residence and needs to return immediately, International SOS will
arrange the repatriation and will cover the airfare of a single-journey economy-class flight
or necessary expenses for other means of transportation.
7. Arrangement of and payment for emergency medical evacuation
If an insured is severely ill when traveling in the home country, and a doctor of International
SOS judges that the current hospital cannot provide proper treatment, International SOS
will make arrangements to transfer the insured, by air, land or water, to the nearest
domestic hospital that can provide proper medical services. International SOS should pay
necessary transportation expenses related to the medical transfer and the supplementary
expenses incurred due to arrangement of this service.
Since International SOS is responsible for paying expenses related to medical transfer,
International SOS has the right to make judgments and decisions on the following:
1. Whether the insured's disease is so critical that emergent medical transfer is required.
2. The transfer destination and the transfer method based on all the evaluated known facts,
including but not limited to whether the medical facility at the initial treatment place can
provide sufficient and necessary treatment, and whether the treatment can be postponed
until the insured returns to the home country.
However, the preconditions for International SOS's judgments or decisions are that the
insured or the insured's family members agree to them, or the risks have been made known
to the insured or the insured's family members.
8. Arrangement of and payment for medical transfer to the place of residence
After an insured receives emergency medical assistance and is hospitalized for preliminary
treatment, International SOS will arrange a regular flight or other appropriate means of
transportation to transfer the insured to his/her place of residence for further treatment if
International SOS’ doctor judges that the transfer is medically necessary. International SOS
will provide proper communications support, mobile medical apparatuses, wheelchairs,
stretchers and other auxiliary equipment, and/or professional nurses. International SOS
shall pay necessary traffic expenses related to the medical transfer and accessorial charges
usually incurred during this service arranged by International SOS.
- 37 -
9. Arrangement of and payment for mortal remains repatriation to the place of residence
Where an insured dies from an accident or a sudden disease during his/her domestic travel,
International SOS will, as expected by the insured or his/her direct relatives, arrange and
pay for mortal remains repatriation to his/her place of residence or a burial at the place
where the insured died. Specifications of coffins/bone ash boxes must be in line with air
transport standards. The above-mentioned benefits do not include graveyard purchase, a
religious ritual, flowers, a farewell ceremony, or any other unnecessary benefits.
10. Arrangement of and payment for the visit and accommodation of direct relatives
If the insured is hospitalized for seven consecutive days or above during his/her
unaccompanied domestic travel and needs his/her direct relatives' visits, International SOS
can arrange and pay for a round-trip economy-class air ticket for such a direct relative’s
travel between the relative’s domicile to the hospital where the insured is hospitalized, and
also arrange and pay for the relative’s accommodation in the area where the hospital is
located. The upper limit for accommodation expense per accident is RMB3,000 excluding
expenses incurred due to food, drinks, communications and other services.
11. Arrangement of and payment for minor children's return to the place of residence
In the event that a minor children under or at the age of 16 who are traveling together with
adult insureds and left unattended due to accidental injury, acute disease, emergent
medical transfer or death of the adult insureds, International SOS will help the minor
children go back to their place of residence and cover corresponding transportation fees.
Where necessary, International SOS will arrange escort to accompany the customer back to
the country and pay for the expense.
12. Arrangement of and payment for transportation of a direct relative to handle
post-death affairs
In the event that an insured died from an accidental injury or acute illness during a
domestic trip, International SOS will arrange and pay for one round-trip economy-class
flight ticket for one direct relative or appointed agent of the customer to travel from his/her
place of residence to the place of accident to handle post-death affairs. International SOS
will also arrange and pay for lodging in local places. The limit for lodging expense per event
is RMB 3000. The expenses exclude foods, drinks, communication and other service fees.
13. Transport expenses for escorts under emergencies
International SOS will arrange and cover the transport expenses of escorting by one direct
relative or appointed agent of the customer for emergency medical service, subject to a
maximum limit of RMB10,000. Where International SOS has already borne the round-trip
air ticket, train ticket or ship ticket for the relative's visit to the customer, the expenses
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under this item will not be covered.
14. Emergent oral message delivery
In case of emergency or injures/illness on an insured, International SOS can inform his/her
relative and/or employer of the condition as soon as possible as requested.
Notes:
(i) International SOS selects third-party service providers prudently, but it cannot
guarantee the service quality from the third-party service providers.
(ii) The above service items 2 and 3 are just assistance of arrangement and introduction,
International SOS will not pay any third-party expenses. All third-party expenses shall be
borne by the insured.
(iii) For service item 4, International SOS will not undertake any inpatient medical expenses
or third-party expenses, and all such expenses shall be undertaken by the insured.
(iv) Limits for assistance service in the above service items 5 to 13 are subject to the limits
for assistance service stipulated in Article 5 hereof, and the exclusions in Article 8 hereof
shall be met.
(v) Service item 7 and service item 8 mentioned above shall be subject to Article 18.1
hereof if International SOS commits a negligent act(s) during the transportation.
6. Exclusions
6.1 Unless International SOS has given prior written approval and PAH or the user has paid relevant
expenses, the expenses incurred due to the following treatments, items, conditions, activities and
other expenses relevant to or indirectly related to them belong to exclusions.
(1) Any assistance expenses arising from the customer's pre-existing conditions;
(2) Any assistance expenses not included in the service plan of International SOS, expenses without
prior written approval of International SOS, and/or expenses arising from emergency medical
assistances that are not arranged by International SOS; This exclusion does not apply to cases where
customers cannot notify in advance or effectively contact International SOS for the emergency medical
transfer in remote and backward regions and where delay of such transfers may be life-threatening or
have other adverse effect.
(3) Any emergency assistance events occurred in the user's country of nationality or residence
(applying to 5.2.1 under this Agreement), or emergency assistance events occurred in the user's place
of residence (applying to 5.2.2 under this Agreement)
(4) Any assistance expenses incurred due to the fact that the user leaves their country of nationality or
country of residence for travel overseas (applicable to 5.2.1 under this Agreement) or leaves the
domestic place of residence (applicable to 5.2.2 under this Agreement) for travel regardless of the
doctor's advices; assistance expenses arising from travels aiming at gaining access to medical
treatments or travels aiming at further rehabilitation or rest for previous accidental injuries, diseases
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or pre-existing conditions.
(5) Any assistance expenses for customers without severe medical conditions, and/or can be properly
treated in local places or can wait until the return to their country of nationality or residence
(applicable to 5.2.1 under this Agreement) or to domestic place of residence (applicable to 5.2.2 under
this Agreement) to receive treatments as advised by International SOS doctors;
(6) Any assistance expenses incurred when a user insists on having assistance while he/she can behave
like a normal traveler and does not need medical escort in accordance with International SOS doctors'
opinions;
(7) Any expenses arising from any treatment related to childbirth, miscarriage or pregnancy. This is not
applicable to any abnormal pregnancy or pregnancy complications occurring within the first 24 weeks
of pregnancy and severe enough to endanger the mother's and/or the fetus's lives
(8) Any assistance expenses arising from the accidents and injuries of users for participation in caving,
mountaineering, rope-or-guide-based rock climbing, potholing, skydiving, parachuting, bungee,
ballooning, gliding, deep-sea dive wearing the protective helmet equipped with the air hose, martial
arts, rallying, and various contests other than racing, and any competitive sports organized by
professional teams or initiators;
(9) Any assistance expenses arising from emotion disorders, intellectual or mental diseases;
(10) Any assistance expenses arising from self-inflicted injury, suicide, drug addiction or abuse, alcohol
abuse and sexually transmitted diseases;
(11) Any assistance expenses arising from acquired immunodeficiency syndrome (AIDS) or
AIDS-related diseases;
(12) Any assistance expenses incurred by the user for riding flights other than regular commercial
flights or aircrafts specially permitted to rent and traveled on approved route as a passenger;
(13) Any assistance expenses arising from users' engagement in or attempts to engage in any illegal
activity;
(14) Any assistance expenses arising from medical treatments and/or advices that are provided by an
unregistered medical service provider and not in line with the national standards;
(15) Any assistance expenses arising from customers' enrollment in any active duty army or the police
of any country; any assistance expenses arising from customers' voluntary participation in wars
(whether declared to other countries or not), invasions, operations involving enemy states,
confrontations, civil wars, insurrections, riots, revolutions or uprisings;
(16) Any assistance expenses arising from use or threat of nuclear weapons/equipments, chemical
weapons, or biological weapons, including but not limited to in terrorist activities or wars;
(17) Any assistance expenses arising from work or activities on vessels, offshore drilling platforms or
other similar offshore facilities;
(18) The user aged above 70 when asking for assistance services;
(19) Any assistance expenses directly arising from nuclear reaction or radiation.
6.2. For the above exclusions, the emergency assistance company will not provide medical assistance
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services unless receiving extra financing or repayment guarantee offered by Ping An or the user. Such
medical assistance services will be charged according to the service contents.
Appendix 3: Thailand hospitals list
1 Bangkok Hospital 2 SoiSoonvijai 7,New PetchburiRoad,Bangkok 13310
Thailand
2 Bangkok Hospital Chantaburi 25/14 ThaluangRoad,Watmai, Mueang,Chanthaburi 22000
Thailand
3 Bangkok Hospital Chiang Mai 88/8 Moo 6, TumbolNong Pa Khrang,AmpherMuang Chiang Mai,
Chiang Mai,Thailand 50000
4 Bangkok Hospital Hat Yai 75 Soi 15, PetchakasemRoad,Hatyai, Songkhla 90110,Thailand
5 Bangkok Hospital HuaHin 888 PhetchakasemRoad,HuaHin 77110,Thailand
6 Bangkok Hospital Pakchong 5/1 MitraparpRoad,APakchong ,Nakhonratchasima
30130,Thailand
7 Bangkok Hospital Pattaya 301 Moo 6, Sukhumvit Road (km 143),Naklua,
Banglamung,Chonburi 20150,Thailand
8 Bangkok Hospital Phuket 2/1 HongyokUtisRoad,Muang, Phuket 83000 Thailand
9 Bangkok Hospital Prapadaeng
288 Moo 1, Suksawat Road,
Pakklongbangplakod,Prasamutjadee,Samutprakarn
10290,Thailand
10 Bangkok Hospital Ratchasima
(Korat)
1308/9 MitrapapRoad,NaiMuang, NakhonRatchasima
30000,Thailand
11 Bangkok Hospital Rayong 8 Moo 2, SoiSaengchanNeramit,Nernpra, Rayong 21000,Thailand
12 Bangkok Hospital Samui 57 Moo 3, ThaweeratPhakdeeRoad,Bophut, KohSamui,Suratthani
84320,Thailand
13 Bangkok Hospital Trat/Koh
Chang Clinic
376 moo 2 SukhumwitRoad,Wangkrajae, Muangtrat, Trat.
23000,Thailand
14 Bangkok Hospital Udon 111 ThongyaiRoad,Markkaeng, Muangdistrict,Udonthani province
41000,Thailand
17 Bumrungrad International
Hospital
33 Sukhumvit Road 3,Wattana,Bangkok 10110,Thailand
+66-2-6671234；+66-2-6671508(中文 Chinese)