Insurance
I. Eligibility for Insurance
Foreign students studying in China, students from Hong Kong, Macao and Taiwan, as well as overseas Chinese students, who are in good health and aged between 8 and 69 years, are eligible to participate in this insurance coverage.
II. Coverage
(I) Insurance Liabilities
During the effective date of the insurance, the insurance company provides the following coverage and services:
1. Death Insurance Liability
Where the insured dies due to an accident or an illness, the insurance company will pay the agreed insurance amount, and the insurance liability will terminate.
2. Accidental Dismemberment Insurance Liability
Where the insured suffers an accident and experiences dismemberment within 180 days of the accident, the insurance company will assess the disability severity according to the Life Insurance and Disability Assessment Standards Code (JR/T0083-2013) (issued by the former China Insurance Regulatory Commission under Document B.J.F. [2014] No. 6). The insurance company will pay dismemberment insurance benefits based on the disability assessment results, using the percentage specified by the standards for each disability category, multiplied by the insured amount. Where the treatment has not concluded within 180 days, the disability assessment will be conducted based on the insured person's condition on the 180th day, and the dismemberment insurance benefits will be paid accordingly. Where the current accident-related dismemberment of the insured, combined with a previous disability, qualifies for a higher level of dismemberment compensation, the insurance company will pay the dismemberment insurance benefits based on the more severe category of disability. However, any previously paid dismemberment benefits (due to pre-existing conditions or exclusions specified in the Life Insurance and Disability Assessment Standards Code (JR/T0083-2013), issued by the former China Insurance Regulatory Commission under Document B.J.F. [2014] No. 6) will be deducted from the payment. The cumulative payment for accidental death and dismemberment (AD&D), and illness-related death for each of the insured is limited to the insured amount, and once the total payout reaches the insured amount, the coverage for that person terminates.
3. Liability for Accident-Related Medical Expenses
If the insured requires medical treatment due to an accident within 180 days of the accident, the insurance company will reimburse 100% of the actual, reasonable, and necessary medical expenses incurred as accidental medical benefits.
Examples of accidents include injuries caused by cat or dog bites, falls while walking, or injuries sustained during sports activities.
The reimbursement formula is as follows: Total reasonable expenses X 100% = Reimbursement amount (Reasonable expenses do not include self-paid portions not covered by the local basic medical insurance system.)
Regardless of whether the insured experiences one or multiple accidents, the insurance company will pay the accidental medical benefits as described above, with the cumulative payments not exceeding the accidental medical coverage amount of the insured. Once the total payout reaches the insured amount, the coverage for that person terminates.
4. Liability of Inpatient Medical Insurance
Where the insured is hospitalized due to an accident or illness, and hospitalization is deemed necessary by the hospital, the insurance company will reimburse 100% of the actual, reasonable, and necessary medical expenses incurred during hospitalization. These expenses include caregiver expenses (up to RMB 200 per day, for a maximum of 60 days), medical record establishment expenses, energy expenses (heating and air conditioning expenses), bed expenses, physical examination and lab testing expenses, special examination and treatment expenses, surgery expenses, medication expenses, treatment expenses, radiology expenses, and other reasonable medical expenses.
Emergency medical expenses incurred during urgent care are also covered under liability of impatient medical insurance. The insurance company will pay 100% of the reasonable and necessary treatment expenses for emergency care provided by the hospital.
The reimbursement formula is as follows: Total reasonable inpatient expenses X 100% = Reimbursement amount (Reasonable expenses do not include self-paid portions as specified by the local basic medical insurance system.)
Regardless of the number of hospitalizations or emergency treatments, the insurance company will pay the insurance benefits within the stipulated limit. Once the cumulative payment reaches the insured amount, the coverage for this particular insurance liability terminates.
5. Outpatient and Emergency Medical Insurance Liability
Where the insured undergoes outpatient or emergency treatment due to illness, the insurance company will cover the reasonable and necessary medical expenses. For each insurance period, the daily limit for outpatient or emergency treatment is RMB 600 (i.e., where the daily medical expenses exceed the limit, only RMB 600 will be covered; where the expenses are below the limit, the actual amount will be covered). For the portion exceeding the deductible of RMB 650 (which is cumulative over the insurance period), 85% of the excess will be reimbursed, up to a maximum insurance amount of RMB 20,000. Once the cumulative reimbursement reaches the insured amount, the coverage for this insurance liability terminates.
Daily Limit: The maximum allowable medical expenses per day.
Deductible: The deductible for this insurance is set at RMB 650 (deducted once per insurance period), and expenses below the deductible are not covered. Outpatient and emergency medical expenses include Outpatient and emergency medical expenses include general outpatient visit expenses, emergency visit expenses, outpatient surgery expenses, emergency observation expenses, as well as pre- and post-hospitalization outpatient expenses related to the same illness as the hospitalization. All of these fall under the scope of outpatient and emergency medical liability.
For example, treatment expenses for conditions such as abdominal pain, fever, fainting, upper respiratory infections, and others, in outpatient or emergency settings, are included in the abovementioned scope.
The reimbursement formula is as follows: (Total reasonable daily expenses within the RMB 600 daily limit - RMB 650) X 85% = reimbursement amount (Reasonable expenses do not include self-paid portions as specified by the local basic medical insurance system.)
Note:
1. All abovementioned medical insurance liabilities are limited to public hospitals within mainland China. Where the insured receives treatment in a foreign guest ward, a VIP ward, a private room, an A-class ward, a single room, or a special diagnostic or special care ward in public hospitals, or similar ward with higher standards, none of the medical expenses will be reimbursed by the insurance company.
2. For all the abovementioned medical expenses, where a third party has paid part or all of the expenses, the insurance company will only compensate the remaining portion as well as only reasonable expenses that fall within the scope of local basic medical insurance coverage. However, items such as bed expenses, caregiver expenses, and outpatient/emergency daily limits specified in the insurance liabilities will still be subject to their respective limits. Where the third party compensation is subject to a proportional limit, the insurance company will deduct the amount already paid based on the limited amount and compensate the remaining portion. Where there is no proportional limit, the insurance company will deduct the standard amount based on the limit as per local basic medical insurance standards and pay the remaining amount, up to the insured amount.
3. All medical expenses under the medical insurance liability are limited to items that can be reimbursed by the local basic medical insurance system. Self-paid or partially self-paid items as per the medical insurance policy are not eligible for reimbursement.
4. For new or non-consecutive insurance policyholders, there is a waiting period (observation period) of 30 days starting from the effective date of the insurance. Any illnesses or subsequent treatments occurring during the waiting period will not be reimbursed. However, continuous policyholders or those receiving treatment due to accidents are exempt from the waiting period.
(2) Exclusion of Liabilities
1. Accidental Death and Dismemberment (AD&D) Liability
The insurance company shall not be liable for the payment of insurance benefits for the insured’s AD&D resulting from any of the following circumstances:
(1) Intentional killing or intentional injury of the insured by the policyholder or beneficiary;
(2) The insured's intentional self-injury, suicide, intentional crime, or resistance to lawful criminal enforcement measures;
(3) The insured engaging in fights, excessive alcohol consumption, or actively taking or injecting drugs;
(4) The insured driving a motor vehicle under the influence of alcohol, without a valid driver's license, or driving an unregistered motor vehicle;
(5) Wars, military conflicts, riots, or armed rebellion;
(6) Nuclear explosion, nuclear radiation, or nuclear contamination;
(7) Injuries caused by the insured’s pregnancy, miscarriage, or childbirth;
(8) Medical accidents resulting from the insured’s cosmetic surgery or other internal or external surgeries;
(9) The insured failing to follow medical advice and self-medicating; however, this exclusion does not apply to the use of over-the-counter drugs used according to the instructions;
(10) Any loss or expense arising from the insured contracting AIDS (Acquired Immune Deficiency Syndrome) or becoming infected with the HIV virus (HIV positive)；
(11) The insured's death or disability occurring outside mainland China;
(12) The insured engaging in high-risk activities such as diving, skydiving, rock climbing, bungee jumping, piloting gliders or hang gliders, exploration, wrestling, martial arts competitions, stunt performances, horse racing, or motor racing;
(13) Providing false information during the insurance application, or non-students applying as students;
(14) Accidents occurring to the insured during their academic period.
In the event of the insured's death under any of the above circumstances, the insurance company's liability for the insured shall terminate.
1. AD&D Liability
The insurance company shall not be liable for the payment of insurance benefits for the insured’s AD&D resulting from any of the following circumstances:
(1) Intentional killing or intentional injury of the insured by the policyholder or beneficiary;
(2) The insured's intentional self-injury, suicide, intentional crime, or resistance to lawful criminal enforcement measures;
(3) The insured engaging in fights, excessive alcohol consumption, or actively taking or injecting drugs;
(4) The insured driving a motor vehicle under the influence of alcohol, without a valid driver's license, or driving an unregistered motor vehicle;
(5) Wars, military conflicts, riots, or armed rebellion;
(6) Nuclear explosion, nuclear radiation, or nuclear contamination;
(7) Injuries caused by the insured’s pregnancy, miscarriage, or childbirth;
(8) Medical accidents resulting from the insured’s cosmetic surgery or other internal or external surgeries;
(9) The insured failing to follow medical advice and self-medicating; however, this exclusion does not apply to the use of over-the-counter drugs used according to the instructions;
(10) Any loss or expense arising from the insured contracting AIDS (Acquired Immune Deficiency Syndrome) or becoming infected with the HIV virus (HIV positive)；
(11) The insured's death or disability occurring outside mainland China;
(12) The insured engaging in high-risk activities such as diving, skydiving, rock climbing, bungee jumping, piloting gliders or hang gliders, exploration, wrestling, martial arts competitions, stunt performances, horse racing, or motor racing;
(13) Providing false information during the insurance application, or non-students applying as students;
(14) Accidents occurring to the insured during their part-time employment.
In the event of the insured's death under any of the above circumstances, the insurance company's liability for the insured shall terminate.
2. Medical Insurance Liability (Liability for Accident-Related Medical Expenses, Liability of Inpatient Medical Insurance, and Outpatient and Emergency Medical Insurance Liability)
The insurance company shall not be liable for the payment of insurance benefits for the insured’s medical expenses resulting from any of the following circumstances:
(1) Intentional killing or intentional injury of the insured by the policyholder or beneficiary;
(2) The insured's intentional self-injury, suicide, intentional crime, or resistance to lawful criminal enforcement measures;
(3) The insured engaging in fights, excessive consumption of alcohol or being intoxicated, or actively taking or injecting narcotic drugs;
(4) The insured driving a motor vehicle under the influence of alcohol, without a valid driver's license, or driving an unregistered motor vehicle;
(5) Wars, military conflicts, riots, or armed rebellion;
(6) Nuclear explosion, nuclear radiation, or nuclear contamination;
(7) The insured suffering from congenital diseases, hereditary diseases, or pre-existing conditions (illnesses or symptoms that existed before the insurance policy took effect or during non-consecutive insurance periods);
(8) Any loss or expense arising from the insured contracting AIDS (Acquired Immune Deficiency Syndrome) or becoming infected with the HIV virus (HIV positive), having or sexually transmitted disease;
(9) Medical expenses arising from the insured's pregnancy, miscarriage, childbirth, infertility treatment, artificial insemination, prenatal and postnatal check-ups; contraception (including sterilization), abortion, and any complications arising from the above;
(10) Medical accidents resulting from cosmetic surgery or other internal or external surgeries undergone by the insured;
(11) Medical expenses incurred by the insured for dental care such as teeth cleaning, dental implants, dentures, crowns, porcelain teeth, as well as expenses related to oral restoration, orthodontics, oral health care, and cosmetic dental procedures. (However, reasonable medical expenses incurred for the treatment of cavities, pulpitis, cracked teeth, dental fillings, root canal treatment, tooth extraction, impacted tooth treatment, and periodontal diseases such as periodontitis, gingivitis, and periapical inflammation, excluding teeth cleaning, are covered under the insurance liability.)
(12) Expenses incurred by the insured for orthopedic treatments, corrective procedures, cosmetic surgery, or rehabilitative therapy;
(13) Expenses incurred by the insured for medical examinations, disease screenings, and similar procedures; expenses for preventive care, wellness programs, recuperation, rest, or special nursing care; expenses for vaccinations, reflexology, fitness massages, and similar services;
(14) The insured failing to follow medical advice and self-administering medications, topical applications, or injections;
(15) Medical expenses incurred outside mainland China, or medical expenses incurred in private hospitals within mainland China; expenses incurred from pharmacies or medical equipment companies;
(16) Expenses resulting from accidents and subsequent treatments occurring outside mainland China;
(17) Expenses incurred by the insured for telephone charges, transportation fees, meal costs, and similar expenses;
(18) The insured engaging in high-risk sports or competitive activities involving professional participation, such as diving, skydiving, paragliding, roller skating, skiing, ice skating, bungee jumping, rock climbing, wrestling, judo, taekwondo, martial arts, karate, fencing, and other high-risk activities;
(19) Providing false information during the insurance application, or non-students applying as students;
(20) Expenses incurred by the insured for experimental treatments or procedures conducted in hospitals for the purpose of medical research;
(21) Expenses incurred by the insured for hospitalization without meeting the hospital's admission criteria, including voluntary hospitalization or occupying a hospital bed without medical necessity; such expenses are not reimbursable;
(22) Expenses occurring to the insured during their part-time employment.
(3) Premium Rate
Note: The insurance is implemented in accordance with the Guoren P&C Additional Accidental Injury Insurance (2022 Edition) Clauses (C00014232322022062811611), Guoren P&C Additional Accidental Medical Insurance Clauses (C00014232522021042044092), Guoren P&C Hospitalization Medical Expenses Insurance (Clause D) Clauses (C00014232512021062817971), Guoren P&C Additional Outpatient and Emergency Medical Expenses Insurance Clauses (C00014232522021061799611), Guoren P&C Additional Hospitalization Allowance Medical Insurance Clauses (C00014232522021051468622), Guoren P&C Additional Disease Death and Total Disability Insurance Clauses (C00014232622020102617952), and other clauses.
Settlement of claims
Before seeking medical treatment, make sure to call 4008105119 for a pre-consultation.
(1) Claims Procedures
After an insurance accident occurs, the standard procedures for claims settlement are as follows:
The first step is to consult and report the case. If you need medical treatment due to physical discomfort, call 4008105119 before the treatment. The doctor will conduct a health consultation, medical guidance and inform you of the claims matters.
The second step is to apply for hospitalization advance payment. If the doctor confirms that further hospitalization is required after consultation and outpatient treatment, you can apply for hospitalization advance payment. After communication and confirmation by the advance payment company, where you meet the conditions for hospitalization advance payment, the advance payment will be made in accordance with the advance payment procedures.
Note: For those who do not report the case or consult by calling 4008105119, or are directly admitted to the hospital for treatment without outpatient diagnosis and treatment (including those who ask the outpatient doctor for consent for hospitalization even though their condition is not severe enough to be hospitalized), the insurance company shall not be liable for the advance payment of hospitalization expenses. Individuals who pay medical expenses on their own without applying through the above reporting procedures
shall not be eligible for compensation.
(2) Documents Required for Claims Settlement:
1. AD&D
A A copy of an identity certificate of the insured;
B. When the insured is disabled, they need to provide a disability assessment certificate (the assessment report shall be issued by a designated appraisal institution);
C. Death certificate of the insured;
D. Accident certificate (for example, where a traffic accident occurs, a road traffic accident responsibility determination certificate or criminal identification certificate issued by the public security organ is required; where a fall from a height or drowning occurs, the public security organ or relevant department must issue qualitative materials indicating that the accident is an accident or suicide; where an accident is caused by drinking, a quantitative report on the alcohol content must be issued);
E. Certification of the relationship between the insured and the beneficiary and copies of the family members’ identity documents.
2. Accidental Medical Insurance
A. A copy of an identity certificate of the insured;
B. Proof of the circumstances of the accident (where a traffic accident occurs, a road traffic accident responsibility determination letter issued by the public security organ is required);
C. Original outpatient receipts, expense lists, medical records (corresponding to each outpatient visit) and copies of examination and laboratory test reports.
3. Inpatient Medical Insurance
A. A copy of an identity certificate of the insured;
B. Proof of the circumstances of the accident (where a traffic accident occurs, a road traffic accident responsibility determination letter issued by the public security organ is required);
C. Hospital diagnosis certificate, original hospitalization receipt, original hospitalization detailed list, discharge summary or copy of hospitalization medical record.
4. Outpatient and Emergency Medical Insurance
A. A copy of an identity certificate of the insured;
B. Original receipt of expenses;
C. Medical records of each visit (the date of the medical record must correspond to the date of the invoice), detailed expense information, and copies of examination and laboratory test reports. If the deductible of RMB 650 has been reached, you must submit original invoices below RMB 650, as well as medical records, detailed expense statements, and copies of examination and test reports.
5. Application for Caregiver Fees Reimbursement
The original invoice for caregiver expenses shall be issued by the hospital or the caregiver company during hospitalization.
Explanation for the application of the above medical expense reimbursement:
(1) For every claim application, the application materials must include the insured’s bank account information in mainland China, along with accurate account details, including the account holder’s name, account number, and bank branch information. This can be provided through a copy of the passbook or a bank customer information form with the above details. (For more details, please call 4008105119.)
(2) If the insured receives treatment for the same incident at two or more hospitals, a diagnosis certificate, medical record copies, and other relevant documents must be provided for each treatment.
Claim materials mailing address: Room 1012, 10th Floor, Ping An Building, No. 23 Jinrong Street, Xicheng District, Beijing (Postal Code: 100033)
Recipient: Project Team for Foreigners Coming to China
Tel.: 4008105119
This plan is a combination of insurance products.
For the latest updates on the insurance plan, please visit the international student insurance website: www.1xbx.net
This brochure is for informational purposes only. Guoren Property & Casualty Insurance Co., Ltd. retains the final right to interpret the above content.
In case of disputes, the Chinese interpretation shall prevail.
international student insurance website:
https://www.lxbx.net/insurance?id=aEFLaGtNR3VkbVFqdHc9PQ%253D%253D