Ping An Health Group Comprehensive Health Insurance Nanjing International School 01 AUG 2014
Table of Content 1. Special stipulations... 2 2. Pre-authorization... 2 3. Benefit Schedules... 3 4. How is the annual deductible, 20% special hospital co-pay and CNY 10,000 out of pocket (OOP) limit calculated... 9 5. Special Hospitals (Luxury Hospitals)... 10 6. Recognized hospitals in the benefit schedules... 12 7. Major Exclusions... 12 8. Introduction to Global Emergency Assistance... 15 1
1. Special stipulations Waiting period: No waiting period. Pre-existing conditions: pre-existing conditions are all covered. For non-inpatient post-treatment claims exceeding CNY 10, 000 and inpatient post-treatment claims, copies of individual identification shall be provided. The amount that has already been paid by the third party will not be reimbursed by Ping An Health. 2. Pre-authorization Below is a complete list for services requiring pre-authorization. If you need to receive the following medical items, please contact our 24 hour hotline 400-8833-663 option 2 or our service email health@pingan.com.cn in advance to apply for pre-authorization: 1. All in-patient and surgery treatment(including out-patient surgery) 2. First Special Out-patient Treatment 3. Exams and therapy priced in excess of RMB 5,000 4. Purchase or rental of insulin pumps and associated devices 5. Use of Albumin 6. Hospice care 7.Emergency coverage outside coverage area For emergency situations, pre-authorization is not required. But please notify us within 48 hours after the occurrence of emergency. Members that fail to obtain pre-authorization prior to 1-6 services listed above or fail to notify us in 48 hours in emergency situation, you may be held liable for paying a 40% co-payment of the entire cost of the procedure, with no out-of-pocket limit. Members that fail to obtain pre-authorization the 7th service listed above or fail to notify us in 48 hours in emergency situation, you are liable for paying 100% of the entire cost. Please provide the following information when you call the hotline: a. Your policy number, ID card number and name b. Details of the hospitalization, including but not limited to: Name of the hospital Date of admission Length of stay Reason for admission (medical condition) Relative medical record We will reply you within one or two working days. The pre-authorization is valid for 30 days. 2
3. Benefit Schedules 2.1 Policy Period:00:00 hours, August 1st 2014 24:00 hours, July 31st 2015 2.2 Benefit Plan Currency: CNY 保 障 项 目 Benefit items 保 单 年 度 总 限 额 Overall limit for a policy year 保 障 区 域 范 围 Geographic coverage 自 付 限 额 封 顶 ( 包 括 免 赔 额 和 特 定 医 院 ) Out of pocket maximum (applies to excess/deductible and Special/Luxury Hospital & clinics co-pay) 年 度 免 赔 额 Annual Deductible 中 草 药 保 单 年 限 额 Chinese Herbal medicine Annual Limit 住 院 医 疗 保 险 金 责 任 Inpatient benefit 住 院 医 疗 保 险 金 保 单 年 度 总 限 额 Overall limit for inpatient benefits for a policy year 赔 付 比 例 Benefit ratio 床 位 费, 膳 食 费, 护 理 费 日 限 额 ( 最 多 365 日 / 分 项 保 额 Amount insured by item CNY 12,000,000 全 球 除 美 Worldwide Exc. US CNY 10,000 per policy year 6,000 元 每 个 人 每 保 险 年 度 CNY 6,000 Per Individual Per Policy Year 18,000 每 个 家 庭 每 保 险 年 度 CNY 18,000 Per Family Per Policy Year 年 限 额 12,000 元 Up to CNY 12,000 per policy year 同 保 单 年 度 总 限 额 The same as the overall limit for a policy year 100% 同 住 院 医 疗 保 单 年 度 总 限 额 保 障 责 任 的 其 他 约 定 Other stipulations on coverage 在 美 国 范 围 设 置 门 诊 治 疗 限 额 1 万 以 及 体 检 责 任 ( 仅 提 供 给 美 国 国 籍 人 员 ) United States Outpatient Treatment RMB 10,000 and Routine Physical Examination benefit (only provided to US nationals) 因 被 保 险 人 前 往 特 定 医 院 就 诊, 导 致 的 累 计 自 付 限 额 为 1 万, 自 付 限 额 超 1 万 后 特 定 医 院 按 100% 赔 付 ( 免 赔 额 不 计 入 自 付 限 额 ) If an insured visits some special/luxury hospitals & clinics, the accumulative co-pay maximum will be CNY 10,000; for the part exceeding CNY 10,000 at the special/luxury hospital, it will be 100% covered (the deductible will not apply to the co-pay maximum) 不 适 用 于 体 检 责 任 Not applied to preventative wellness benefit 3
保 单 年 度 ) Daily policy limits for hospital bed fee, food and nursing care charges (up to 365 days/policy year) 检 查 检 验 费, 治 疗 费 保 险 金 额 Policy limits for examination, laboratory test and treatment fees (including doctors fee) 医 生 费 保 险 金 额 Policy limit for doctors fee 药 品 费 ( 含 中 草 药 ) 保 险 金 额 Policy limit for medicine expenses (including Traditional Chinese herbal medicine) 手 术 费 保 险 金 额 Policy limit for operation charges 加 床 费 日 限 额 Daily policy limit for companion bed fee 重 症 监 护 室 床 位 费 日 限 额 Daily policy limit for ICU bed fees 住 院 无 理 赔 日 额 补 贴 ( 最 多 30 日 / 保 单 年 度 ) Daily policy limit for hospitalization allowance for zero claim (up to 30 days/ policy year) 精 神 疾 病 治 疗 费 保 险 金 额 最 多 90 日 / 保 单 年 度 ) Policy limit for treatment of mental illnesses (up to 90 days/policy year) 家 庭 护 理 保 险 金 额 ( 最 多 100 日 / 保 单 年 度 ) Policy limit for family care (up to 100 days/ policy year) 日 间 治 疗 / 留 观 费 Day care treatment 临 终 关 怀 医 疗 费 保 险 金 额 ( 最 多 45 日 / 保 单 年 度 ) Policy limit for hospice care expenses (up to 45 days/ policy year) 救 护 车 费 用 Ambulance charge 门 诊 医 疗 保 险 金 Outpatient benefit 门 诊 医 疗 保 单 年 度 总 限 额 Overall limit for outpatient treatment for a policy year 赔 付 比 例 Benefit ratio 次 免 赔 额 Deductible per visit 门 诊 手 术 费 保 和 MRI CT PET 扫 描 险 金 额 The same as the overall limit for inpatient benefits for a policy year 同 住 院 医 疗 保 单 年 度 总 限 额 The same as the overall limit for inpatient benefits for a policy year 同 住 院 医 疗 保 单 年 度 总 限 额 The same as the overall limit for inpatient benefits for a policy year 同 住 院 医 疗 保 单 年 度 总 限 额 The same as the overall limit for inpatient benefits for a policy year 同 住 院 医 疗 保 单 年 度 总 限 额 The same as the overall limit for inpatient benefits for a policy year 同 住 院 医 疗 保 单 年 度 总 限 额 The same as the overall limit for inpatient benefits for a policy year 同 住 院 医 疗 保 单 年 度 总 限 额 The same as the overall limit for inpatient benefits for a policy year 不 在 保 障 范 围 内 Not covered 不 在 保 障 范 围 内 Not covered 不 在 保 障 范 围 内 Not covered 同 住 院 医 疗 保 单 年 度 总 限 额 The same as the overall limit for inpatient benefits for a policy year 同 住 院 医 疗 保 单 年 度 总 限 额 The same as the overall limit for inpatient benefits for a policy year 同 住 院 医 疗 保 单 年 度 总 限 额 The same as the overall limit for inpatient benefits for a policy year 同 保 单 年 度 总 限 额 The same as the overall limit for a policy year 100% 0 同 门 诊 医 疗 保 单 年 度 总 限 额 4
Outpatient operation fee, MRI, CT, PET Scan Annual Limit 药 品 费 保 险 金 额 Policy limit for medicine expenses 挂 号 费 / 医 生 诊 疗 费, 检 查 费, 治 疗 费 Policy limit for registration fee/doctor consultation fee, examination fee, treatment fee 糖 尿 病 治 疗 用 品 费 ( 胰 岛 素 泵 及 相 关 用 品 ) 保 险 金 额 Policy limit for diabetes treatment article purchase or rental expenses annual limit (Inc. insulin pumps, etc.) 物 理 治 疗 及 其 他 特 殊 疗 法 次 限 额 ( 最 多 10 次 / 保 单 年 度 ) Policy limit for physiotherapy and other alternative therapies per visit (up to 10 visits/policy year) 精 神 疾 病 治 疗 次 限 额 ( 最 多 20 次 / 保 单 年 度 ) Policy limit for psychiatric treatment (up to 20 visits/policy year) 意 外 牙 科 治 疗 保 险 金 额 Policy limit for accidental dental treatment 激 素 替 代 治 疗 保 险 金 额 Policy limit for hormone replacement therapy 婴 儿 免 疫 和 检 查 费 保 险 金 额 Policy limits for neonate immunization and examination expenses 救 护 车 费 用 The same as the overall limit for outpatient treatment for a policy year 年 限 额 60,000 元 Up to CNY 60,000 per policy year 年 限 额 60,000 元 Up to CNY 60,000 per policy year 年 限 额 60,000 元 Up to CNY 60,000 per policy year 年 限 额 12,000 元 Up to CNY 12,000 per policy year 年 限 额 60,000 元 Up to CNY 60,000 per policy year 不 在 保 障 范 围 内 Not covered 不 在 保 障 范 围 内 Not covered 不 在 保 障 范 围 内 Not covered 年 限 额 60,000 元 Ambulance charge Up to CNY 60,000 per policy year 特 殊 门 诊 医 疗 保 险 金 Benefit for special outpatient treatment 赔 付 比 例 100% Benefit ratio 特 殊 门 诊 医 疗 保 险 金 保 单 年 度 限 额 Overall limit for special outpatient treatment for a policy year 女 性 生 育 保 险 金 Maternity benefit 赔 付 比 例 Benefit ratio 女 性 生 育 保 单 年 度 总 限 额 Overall limit for maternity benefit for a policy year 1. 新 生 婴 儿 出 生 后 14 日 内 护 理 费 免 疫 费 和 治 疗 费 ; 新 生 婴 儿 护 理 费 指 住 院 期 间 根 据 医 嘱 所 示 的 护 理 等 级 确 定 的 费 用 2. 产 前 检 查 产 前 处 方 补 充 维 生 素 和 钙 剂 自 然 分 娩 医 学 必 要 的 手 术 分 娩 流 产 产 后 检 查 孕 产 期 并 发 症 治 疗 费 用 ; 每 一 保 单 年 度 因 流 产 给 付 的 女 性 生 育 保 险 金 仅 限 一 次 同 保 单 年 度 总 限 额 The same as the overall limit for a policy year 100% 年 限 额 60,000 元 Up to CNY 60,000 per policy year 总 限 额 为 60,000 Overall annual limit for the sub-limits CNY 60,000 门 诊 肾 透 析 门 诊 恶 性 肿 瘤 电 疗 化 疗 或 放 疗 Outpatient renal dialysis and outpatient cancer treatment (electrotherapy, chemotherapy or radiotherapy) 5
3. 每 次 妊 娠 期 内 两 次 B 超 检 查 费, 对 于 高 危 或 伴 有 并 发 症 的 妊 娠, 亦 包 括 两 次 以 上 的 B 超 检 查 费, 但 须 医 生 提 供 该 项 检 查 的 医 学 必 要 性 证 明 ; 被 保 险 人 不 论 一 次 或 多 次 接 受 孕 产 期 检 查 治 疗 的, 累 计 给 付 金 额 以 不 超 过 女 性 生 育 保 险 金 的 最 高 给 付 金 额 为 限 1. Newborn infant care, treatment and immunization expenses (up to 14 days following birth); Newborn infant care expenses refer to the care expenses of a standard determined by a doctor for a newborn infant during his/her hospitalization. 2. Pre-natal examinations, prescribed pre-natal vitamins and minerals, natural childbirth, delivery by caesarean section with medical necessity, miscarriage, post-natal examination, pregnancy and pregnancy complications treatment expenses; We will only pay maternity benefits for miscarriage once per policy year. 3. Two type-b ultrasonic examinations per pregnancy. Where the female Insured is in high risk or has pregnancy complications, two or more type-b ultrasonic examinations can be covered, but the Insured must provide a doctor s certificate to prove the examinations are out of medical necessity. Regardless of the number of times the female Insured receives examinations and treatments for pregnancy and childbirth, the accumulated compensation amount may not exceed the maternity benefit limits. 紧 急 医 疗 保 险 金 Emergency Medical Treatment Outside the Coverage Area 赔 付 比 例 Benefit ratio 紧 急 医 疗 保 单 年 度 总 限 额 Overall limit for emergency treatment benefit 100% 同 保 单 年 度 总 限 额 The same as the overall limit for a for a policy year policy year 全 球 紧 急 救 援 ( 具 体 内 容 详 见 第 七 部 分 ) Worldwide emergency assistance (For details, please refer to part 7.) 赔 付 比 例 Benefit ratio 紧 急 医 疗 转 送, 直 系 亲 属 探 病 及 住 宿, 随 行 未 成 年 子 女 回 国 或 居 住 地, 医 疗 转 送 回 国 或 居 住 地, 紧 急 回 国 或 居 住 地 料 理 直 系 亲 属 后 事, 直 系 亲 属 前 往 处 理 后 事, 遗 体 安 排 Emergency assistance, medical evacuation escort, transportation and accommodation 100% 具 体 服 务 内 容 以 救 援 机 构 实 际 提 供 为 准 Subject to the specific services provided by the assistance agency. 6
expenses incurred after medical evacuation escort, mortal remains transportation and burial, etc. 健 康 关 爱 健 康 管 理 服 务 Health Care Health Management Service 健 康 体 检 和 疫 苗 Health Check-up and Vaccinations 宫 颈 涂 片 ( 每 年 一 次 ) Female Pap Smear (Once per year) 乳 房 X 光 片 检 查 ( 每 年 一 次 ) Female Mammogram (Once per year) 前 列 腺 癌 检 查 ( 每 年 一 次 ) Male Prostate Cancer Screening (Once per year) 疫 苗 接 种 Vaccinations 其 他 特 殊 保 障 Other special benefits 耐 用 医 疗 设 备 Durable Medical Equipment 矫 形 手 术 : 意 外 伤 害 或 患 疾 病 需 要 接 受 矫 形 改 造 手 术 恢 复 肢 体 功 能 或 容 貌, 对 意 外 伤 害 或 疾 病 发 生 12 个 月 内 的 矫 形 改 造 手 术 的 治 疗 费 用 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. 针 对 新 生 婴 儿 ( 要 求 在 30 天 内 投 保 ), 如 果 其 在 出 生 后 6 个 月 内 诊 断 出 先 天 性 遗 传 性 疾 病, 对 于 相 关 疾 病 的 治 疗 和 检 查 费 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 18 岁 以 下 子 女 先 天 性 疾 病 治 疗 和 检 查 费 Congenital condition treatment and examination for minors under 18 years of age 妊 娠 并 发 症 治 疗 : 妊 娠 并 发 症 治 疗 的 医 疗 费 用 Pregnancy Complications: Expenses for complications arising from pregnancy 癌 症 治 疗 Cancer Treatment 艾 滋 病 /HIV 治 疗 年 限 额 ( 非 既 往 症 ) AIDS/HIV Treatment (Non pre-existing) 年 限 额 3,000 元 Up to CNY 3,000 per policy year 涵 盖 在 住 院 和 门 诊 责 任 中 Subjected to Inpatient & Outpatient limits 同 保 单 年 度 总 限 额 The same as the overall limit for a policy year 年 限 额 200,000 元 Up to CNY 200,000 per policy year 年 限 额 30,000 元 Up to CNY 30,000 per policy year 同 保 单 年 度 总 限 额 The same as the overall limit for a policy year 同 保 单 年 度 总 限 额 The same as the overall limit for a policy year 年 限 额 600,000 元 Up to CNY 600,000 per policy year 100% 赔 付, 涵 盖 美 国 发 生 的 体 检 疫 苗 费 用 100% Covered, includes US coverage 不 限 于 女 性 生 育 限 额 Not restricted to maternity limits 不 限 于 门 诊 限 额 Not restricted to outpatient limits 7
特 定 ( 昂 贵 ) 医 院 & 诊 所 Special/Luxury Hospitals & Clinics 赔 付 比 例 Reimbursement Ratio 特 定 ( 昂 贵 ) 医 院 列 表 请 详 见 第 4 部 分 80% For special/luxury hospitals & clinics list, please refer to part 4 for details. 在 特 定 医 院 进 行 门 诊 住 院 体 检 或 生 育 治 疗, 均 需 自 付 20% 的 医 疗 费 用 南 京 国 际 SOS 赔 付 比 例 为 100% Nanjing International SOS Hospital Coverage 100% 20% copayment will be subject for outpatient, inpatient, wellness or maternity visits in the special/luxury hospitals & clinics listed. 提 供 健 行 天 下 健 康 管 理 服 务 Vitality health management service 备 注 Notes 牙 科 保 健 和 治 疗 眼 科 视 力 检 查 和 配 镜 不 在 保 障 方 案 中 Dental benefit (Preventative care and treatment), Ophthalmology benefit (Vision check and glasses or contact lenses) are not covered in the policy 住 院 提 供 直 接 结 算 服 务 门 诊 女 性 生 育 和 体 检 无 直 接 结 算 服 务 Direct billing is available for inpatient treatment only. For outpatient, maternity and wellness visit, please pay first and claim back later. 8
4. How is the annual deductible, 20% special hospital co-pay and CNY 10,000 out of pocket (OOP) limit calculated Examples: Each member is subject to CNY 6,000 annual deductibles and the out-of-pocket maximum for the 20% co-payment for visits in special/luxury hospital & clinic is CNY 10,000 per policy year. 1. Mr. Smith went to Huashan Hospital in for medical treatment. The treatment cost CNY 4,500 and was covered under the insurance. However this is subject to a CNY 6,000 deductible so there is no reimbursement. And the remaining deductible is CNY 1,500= CNY 6,000 CNY 4,500 after this visit. 2. Mr. Smith at a later date seek treatment at a special hospital or clinic. The cost was CNY 2,500. Since the hospital visited is classified as a special/luxury hospital, only 80% of the covered treatment, i.e. CNY 2,000 (= CNY 2,500*80%) will be approved. And after deducting the remaining deductible (i.e. CNY 1,500), the reimbursement will be CNY 500 (= CNY 2,000 - CNY 1,500). The remaining annual deductible after this claim is CNY 0. The remaining out-of-pocket maximum for 20% co-payment in special/luxury hospital is CNY 9,500 = CNY 10,000 - CNY 2,500*20%. 3. Later in the year Mr. Smith again seek treatment at a special hospital or clinic. The treatment cost CNY 80,000. As the treatment happened in a special hospital, only 80% of the covered treatment is eligible for reimbursement, resulting in a co-payment of CNY 16,000= CNY 80,000*80%. However, since Mr. Smith has to pay the 20% co-payment for visits in special/luxury hospital, but only up to CNY 9,500 co-payment after last claim, the reimbursement for this time is CNY 80,000 - CNY 9,500 remaining co-payment for special/luxury hospital= CNY 70,500 Note: The above examples are based on treatment that is covered under the insurance, and we suppose all the costs happen are approved by the insurance. For family with more than 3 members, each member is subject to CNY 6,000 annual deductible, and at the same time, the annual deductible for the whole family will be up to CNY 18,000. 9
5. Special hospitals/clinics Please be kindly noted that 20% co-payment will be applied if you choose to visit the hospitals below. The accumulative co-payment will be up to a maximum of CNY 10,000, and after that the medical bills for covered treatment 100% covered according the limits stated in the benefit schedule. 城 市 City 北 京 Beijing 北 京 Beijing 北 京 Beijing 北 京 Beijing 北 京 Beijing 北 京 Beijing 北 京 Beijing 北 京 Beijing 北 京 Beijing 医 院 Provider 北 京 国 际 医 疗 中 心 Beijing International Medical Center 北 京 天 坛 普 华 医 院 Beijing St. Michael hospital 北 京 普 华 国 际 门 诊 部 Beijing St. Michael International Clinic 北 京 和 睦 家 医 院 Beijing United Family Hospital and Clinics 北 京 和 睦 家 建 国 门 保 健 中 心 Beijing United Family Health & Wellness Center - Jianguomen 北 京 和 睦 家 亮 马 诊 所 United Family Liangma Clinic 北 京 和 睦 家 顺 义 诊 所 Beijing United Family Clinic - Shunyi 国 际 SOS 北 京 诊 所 Beijing International SOS Clinic 北 京 百 汇 诊 所 ParkwayHealth Beijing Clinic 戴 是 凯 医 学 康 复 门 诊 部 -portman 分 店 Sinounited Health ( Center) 戴 是 凯 医 学 康 复 门 诊 部 - 金 桥 分 店 Sinounited Health(Jinqiao) 天 坛 普 华 医 院 St. Michael Hospital 东 方 国 际 医 院 East International Medical Center 百 汇 瑞 虹 医 疗 中 心 Manderine City Medical Center 百 汇 华 鹰 医 疗 中 心 Tomorrow Square International Medical & Surgical Center 百 汇 新 瑞 医 疗 中 心 Parkway Specialty and Inpatient Center 百 汇 瑞 祥 医 疗 中 心 Parkway Hong Qiao Medical Center 百 汇 瑞 浦 医 疗 中 心 Parkway Jinqiao Medical and Dental Center 百 汇 瑞 新 医 疗 中 心 Parkway Centre Medical & Dental Centers 百 汇 金 浦 医 疗 中 心 ParkwayHealth Jin Mao Tower Medical Center 市 闵 行 区 和 美 家 诊 所 10
广 州 Guangzhou 广 州 Guangzhou 广 州 Guangzhou 成 都 Chengdu 杭 州 Hangzhou 天 津 Tianjin 深 圳 Shenzhen 深 圳 Shenzhen 香 港 Hong Kong 香 港 Hong Kong 香 港 Hong Kong 香 港 Hong Kong 新 加 坡 Singapore 新 加 坡 Singapore 新 加 坡 Singapore 新 加 坡 Singapore 新 加 坡 Singapore 新 加 坡 Singapore United Family Clinics - Minhang 和 睦 家 医 院 United Family Hospital and Clinics 国 际 医 院 ( 原 华 山 国 际 医 疗 中 心 浦 东 门 诊 部 A/B) 区 ) International Hospital(Huashan Worldwide Medical Center (Pudong Branch)) Klinoerth Therapy Clinic 香 格 里 拉 大 酒 店 诊 所 Shangri-la Clinic 沃 德 医 疗 中 心 WorldPath Clinic International 广 州 和 睦 家 诊 所 Guagnzhou United Family Clinic 广 州 加 美 医 疗 中 心 Guangzhou CanAm International Medical Center 西 部 外 科 研 究 所 Institute for Western Surgery China 百 汇 成 都 医 疗 中 心 Parkway Chengdu Medical Center 杭 州 北 美 医 疗 中 心 国 际 SOS 天 津 诊 所 Tianjin International SOS Clinic 国 际 SOS 蛇 口 诊 所 Shekou International SOS Clinic 深 圳 加 美 医 疗 中 心 Shenzhen CanAm Medical Center 香 港 港 安 医 院 Adventist Hospital 香 港 明 德 医 院 Matilda Hospital 香 港 养 和 医 院 Sanatorium Hospital ParkwayHealth Central Hong Kong Medical Center 百 汇 香 港 医 疗 中 心 Raffles Hospital 莱 福 士 医 院 Thomson Medical Centre 汤 姆 森 医 疗 中 心 Gleneagles Hospital 鹰 阁 医 院 Mount Elizabeth Hospital 伊 丽 莎 白 医 院 Mount Elizabeth Novena Hospital 伊 丽 莎 白 诺 维 娜 医 院 Parkway East Hospital (formerly East Shore Hospital) 东 岸 医 院 11
6. Recognized hospitals in the benefit schedules Worldwide medical institutions legally registered with the local authorities in accordance with law. Hospitals exclude convalescent care facilities, nursing homes, rehabilitation centers, alcohol or drug rehabilitation centers, psychiatric hospitals, hospitals without qualified medical staff or equipment, affiliated grade 2 or grade 3 hospitals or wards. 7. Major 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 orthopedics: 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 cheloid, tattoo removal, and skin discoloration; laser orthopedics, 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 orthopedics or biological defects: flatfoot, snoring and various non-functional orthopedics 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; 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; 12
2. Medical expenses resulting from diseases when the Insured suffers from sexual transmitted disease, AIDS or infected 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 hydro, 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; 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 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; 13
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
8. Introduction to Global 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 to the 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, and whether 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 an insured 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. 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 15
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 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 Sending minor children back to their homelands or countries of permanent residence Visits by and accommodation of immediate relatives Hotel accommodation during recuperation Return to homelands or country of permanent residence in emergency Immediate relatives' accommodation and funeral affairs handled by them 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 USD1,000,000 for each time per time A single-trip economy class ticket for the minor child A round-trip economy class airline ticket; accommodation fee of up to USD250 per day and USD1,000 per event Up to USD250 per day and up to USD1,000 per case A single-trip economy class ticket A round-trip economy class ticket, boarding fee which is up to USD250 per day and USD1k per case 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 Up to RMB6,500,000 per time permanent residence, repatriation of remains to country of permanent residence 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 Hotel accommodation during recuperation Accommodation fee up to RMB3,000 Emergency return to country of permanent residence A single-trip economy class ticket Immediate relatives' accommodation and funeral affairs A round-trip economy class ticket, accommodation fee of 16
handled by them Transportation fee for escorts in emergency 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. RMB3000 or below Transport fee incurred by one immediate relative or appointed agent of the customer under emergent medical escort is up to RMB10,000. 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: Arrangement of and payment for repatriation of mortal remains to the country of nationality Up to USD100,000 per time 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: Arrangement and payment for mortal remains repatriation to the place of residence Up to RMB600,000 per time 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 (a dependent, parent, step-parent, parent-in-law, grandparent, grandchild, brother, sister, brother-in-law, sister-in-law, son-in law, daughter-in-law or guardian.), 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. 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 guide service 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 the insured'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 information can 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 17
(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 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. 18
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. * 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 insured to recuperate locally after being discharged from the 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 services via 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. 19
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 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 services 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 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 20
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 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. 21
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 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. 9. Arrangement of and payment for mortal remains repatriation to the place of residence 22
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 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 23
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 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. 24
6.2. For the above exclusions, the emergency assistance company will not provide medical assistance 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. 25