GPA - Policy Wording VNE

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  • Bao him tai nan con ngi theo nhom Quy tc bao him 12/2014

    1

    BO HIM TAI NN CON NGI DNH CHO NHM QUY TC BO HIM

    MC LC

    PHN I INH NGHIA 2

    PHN II - QUYN LI BO HIM 5

    QUYN LI 1 - T VONG V THNG TT VNH VIN DO TAI NN 5

    QUYN LI 2 QU GIAO DUC TRE EM 6

    QUYN LI 3 TR CP TANG L 6

    QUYN LI 4 - THANH TON CHI PH Y T DO TAI NN 6

    QUYN LI 5 BI THNG HNG TUN CHO THNG TT TON B TM THI 7

    QUYN LI 6 BO HIM TRONG TRNG HP BI KHUNG B 7

    PHN III CC IU KHON LOI TR CHUNG 7

    PHN IV CC QUY INH CHUNG 8

    PHN V CC IU KIN CHUNG 9

  • Bao him tai nan con ngi theo nhom Quy tc bao him 12/2014

    2

    BO HIM TAI NN CON NGI DNH CHO NHM

    Hp ng bo him ny c ban hnh bi Cng ty TNHH Bo him AIG Vit Nam (sau y gi tt l Cng ty) v bao gm cc iu khon sau y. Trn c s vic ng ph bo him v tun theo cc nh ngha, cc gii han v cc quy nh chung y, c b sung sau ny hoc c km theo, Cng ty ng bo him cho cc c nhn c nu tai Bn tm tt hp ng bo him (sau y gi l Ngi c bo him) v cam kt bi thng cho tn tht nm trong pham vi bo him c quy nh y. Tt c cc thi han bo him s bt u v kt thc lc 00:01 sng, gi chun tai ni m Hp ng bo him c cp.

    PHN I INH NGHIA Tai nn hoc do tai nn c ngha l s kin bt ng, khng lng trc v cu th, tc ng t bn ngoi n c th tai mt thi im v ni chn xc nh c. Hi chng suy gim h thng min dch - AIDS c ngha l cc trng hp c xc nh theo bi T chc y t th gii bao gm Nhim trng c hi, Ung th c tnh, HIV, bnh no (tm thn phn lit), hi chng tn ph HIV hoc bt k bnh tt hoc m au c xt nghim huyt thanh dng tnh vi HIV. Hot ng thng ngy c ngha l tm ra, mc qun o, n ung, i v sinh, di chuyn v dch chuyn.

    Tm ra c ngha l kh nng tm ra bn, vi sen hoc cc phng tin khc.

    Mc qun o c ngha l kh nng mc, ci, tht cht v m tt c cc loai qun o, dy eo, chi gi, nu c hoc cc thit b phu tr phu thut hoc y t khc.

    n ung c ngha l kh nng t n sau khi thc n c chun b v lm sn.

    i v sinh c ngha l kh nng s dung nh v sinh hoc cc phng tin khc i ai tin v tiu tin cho n vic s dung qun o lt hoc cc thit b phu tr phu thut nu c.

    Di chuyn c ngha l kh nng di chuyn trong nh gia cc phng trong cng mt mt bng.

    Dch chuyn c ngha l kh nng dch chuyn t ging vo gh hoc xe ln v ngc lai. Hnh ng khng b c ngha l bt k vic thc t s dung hoc mang tnh cht e da s dung vu lc hoc bao lc dn ti hoc gy ra thit hai, thng tch, nguy him hoc ngng tr, hoc vic thc hin mt hnh ng nguy him n tnh mang hoc ti sn, n bt c c nhn no, ti sn hoc chnh phu no, vi muc ch c nu ro hoc khng c nu ro nhm theo ui li ch kinh t, sc tc, chu ngha dn tc, chnh tr, chung tc hoc tn gio, cho d nhng li ch ny c c tuyn b hay khng. Cc hnh vi cp hoc pham ti khc c thc hin chu yu vi li ch c nhn v cc hnh ng xy ra chu yu t nhng mi quan h c nhn gia (nhng) ngi thc hin hnh vi v (nhng) nan nhn s khng c xem l mt Hnh ng Khung b. Hnh ng Khung b cung s bao gm bt k hnh ng no c xc nhn hoc cng nhn bi c quan c thm quyn l mt hnh ng khung b. Thng tch thn th c ngha l thng tt i vi c th Ngi c bo him hon ton do nguyn nhn tai nan v c lp vi bt k nguyn nhn no khc v khng phi l hu qu cua m au hay bnh tt. Bc s ng y c ngha l mt bc s hnh ngh dc phm, chm cu v nn khp xng c cp giy php cha bnh theo php lut. Bc s ng y hnh ngh y khng c l Ngi c bo him, i tc kinh doanh hoc ngi lao ng hoc ngi s dung lao ng cua Ngi c bo him, ai l cua Ngi c bo him hoc mt ngi c quan h h hng vi Ngi c bo him.

  • Bao him tai nan con ngi theo nhom Quy tc bao him 12/2014

    3

    Thng tt c ngha l mi hoc bt k trng hp Thng tt Ton b Vnh vin hoc Thng tt Ton b Tam thi m c nguyn nhn duy nht trc tip do Thng tt, c lp vi tt c cc nguyn nhn khc v pht sinh trong vng 365 ngy k t ngy xy ra Tai nan dn n Thng tch . Ngy hiu lc c ngha l ngy bt u hoc ngy khi phuc bo him nh c nu tai Bn tm tt hp ng bo him hoc Sa i b sung i vi Ngi c bo him. Bnh vin c ngha l c s c giy php theo quy nh cua php lut; hoat ng chu yu vi muc ch chm sc v iu tr nhng ngi b m au hoc thng tch; lun lun c mt hoc nhiu hn mt bc s; cung cp dch vu cha bnh 24 gi v c t nht mt y t chuyn nghip c ng k thc hin nhim vu vo mi lc; c cc thit b chun on v phu thut, hoc c c s hoc iu kin vt cht i vi bnh vin trn c s thu xp trc v tr trng hp bt thng, khng phi l phng khm, nh iu dng hoc nh an dng cho ngi c tui hoc mt c s hoat ng vi t cch l mt trung tm iu tr ma ty hoc ru bia. Nm vin ngha l vic nhp vin vo mt bnh vin nh mt bnh nhn ni tr qua m theo ch nh cua Bc s v phi tr tin phng v tin ging cho bnh vin cho thi gian iu tr . Thu nhp c ngha l thu nhp gp trung binh hng tun (trc thu) trong 12 thng trc khi b thng tt, bao gm c tin lng hoc tin cng, tin hoa hng v cc khon thng thng xuyn, nhng khng bao gm tin tr lm thm. Ngi c bo him l bt k ngi no c xc nh trn Hp ng bo him l Ngi c bo him. Quyn li bo him c p dung cho n khi kt thuc thi han bo him hoc ngy m Ngi c bo him chm dt cng vic lm hoc s lin i i vi chu hp ng bo him, tu vo thi im no xy ra u tin. Phng chm sc c bit (ICU) c ngha l loai phng chuyn kim sot lin tuc v cht ch cc chc nng sng cn c bn cua c th cua bnh nhn trong cc iu kin y t him ngho i hi mc phuc vu cao cua cc y t v c u cc c s vt cht lm bnh nhn c th tnh lai. Mt ngn tay hoc ngn chn c ngha l t ri t khp ngn tay hoc ngn chn tr ln. Mt thnh lc c ngha l mt vnh vin v khng th phuc hi thnh lc khi: Nu a dB Mt thch lc mc 500 Hertz Nu b dB Mt thch lc mc 1000 Hertz Nu c dB Mt thch lc mc 2000 Hertz Nu d dB Mt thch lc mc 4000 Hertz 1/6 cua (a+2b+d) l trn 80dB. Mt chi c ngha l mt t ri hon ton mt tay t c tay hoc hoc mt chn t mt c chn tr ln. Mt th lc c ngha l mt th lc ton b, v khng th phuc hi. Mt kh nng ni c ngha l mt kh nng pht m cua bt k ba trong bn m hinh thnh ging ni bao gm m mi, m ngac, m vm mm v m lin quan n rng v mi hoc mt ton b dy thanh qun hoc tn thng trung tm thn kinh ngn ng no dn n chng mt ngn ng. Mt chc nng c ngha l thng tt chc nng ton b v iu tr nh l mt hon ton cc chi hoc b phn nu. U c tnh bao gm nhng khng gii han bi u/bu th Kaposi, ung th h thn kinh trung ng v/hoc cc u c tnh khc hin nay c cho l hoc s c cho l nguyn nhn trc tip gy t vong, bnh, hay tn tt khi c Hi chng suy gim min dch (AIDS). Chi ph y t c ngha l cc chi ph pht sinh trong vng 365 ngy k t ngy b thng tt v do Ngi c bo him tr cho mt Bc s hoc mt Bc s ng y, Bnh vin v/hoc dch vu cu thng cho vic iu tr y t, phu thut, chup X-quang, nm vin hoc cha tr bao gm cc chi ph dng y t v xe cu thng phi thu v bao gm chi ph iu tr nha khoa nu vic iu tr l cn thit phuc hi rng tht v lnh ln do tai nan gy ra. Tt c cc iu tr bao gm iu tr bi bc s chuyn khoa phi c ch nh bi mt bc s hnh ngh hp php thi chi ph mi c thanh ton theo Hp ng bo him v

  • Bao him tai nan con ngi theo nhom Quy tc bao him 12/2014

    4

    s khng vt mc thng thng phi tr cho cc iu tr, dch vu y t hoc dng y t tng t ni m chi ph pht sinh v nu khng c vic bo him ny. Nhim trng c hi bao gm nhng khng gii han vim phi (Pneumocystis Carinii), vim rut non mn tnh, nhim nm v/hoc vi rt ly lan. Vnh vin c ngha l ko di sut 365 ngy lin tuc k t ngy xy ra tai nan v tai thi im cui giai oan ny vn khng c hy vng phuc hi. Thng tt ton b vnh vin c ngha l thng tt duy nht v trc tip lm mt kh nng v ngn cn Ngi c bo him ton b v vnh vin tham gia c bn cc hoat ng kinh doanh hoc ngh nghip (mi hinh thc) hoc thc hin t 3 hoat ng thng ngy tr ln nu nh khng c hoat ng kinh doanh hoc ngh nghip. Bc s c ngha l mt bc s hnh ngh u kh nng c cp giy php theo php lut cha bnh trong pham vi giy php v c o tao cua minh. Bc s iu tr y khng c l Ngi c bo him, i tc kinh doanh hoc ngi lao ng hoc ngi s dung lao ng cua Ngi c bo him, ai l cua Ngi c bo him hoc mt ngi c quan h h hng vi Ngi c bo him. Ch hp ng bo him c ngha l cng ty c tn trong Bn tm tt hp ng bo him. Bn tm tt hp ng bo him c ngha l Bn tm tt cp cho Chu hp ng bo him v l mt phn khng th tch ri cua Hp ng bo him. iu kin tn ti trc c ngha l bt c m au, bnh tt hoc tinh trang no khc cua Ngi c bo him m, trc ngy hiu lc cua Hp ng, (a) biu l, tr nn xu i, tr nn cp tnh hoc th hin triu chng lm cho mt ngi binh thng phi tim n s chn on, chm sc hoc iu tr; (b) i hi Ngi c bo him phi ung thuc hoc dc phm; hoc (c) c iu tr bi mt Bc s hoc c Bc s a ra hng iu tr. m au hoc bnh tt c ngha l iu kin th cht c biu hin bi s thay i mang tnh bnh l so vi iu kin sc khoe binh thng. Thng tt ton b tm thi c ngha l thng tt ton b lm mt kh nng v ngn cn Ngi c bo him tham gia vo mt phn hoat ng kinh doanh hoc ngh nghip (mi hinh thc) cho mt giai oan lin tuc v khng b gin oan.

  • Bao him tai nan con ngi theo nhom Quy tc bao him 12/2014

    5

    PHN II - QUYN LI BO HIM Trong khi Hp ng bo him ny c hiu lc, nu Ngi c bo him gp phi Thng tch thn th trc tip do Tai nan v c lp vi tt c cc nguyn nhn khc thi Cng ty s, trn c s nhn c v chp thun cc bng chng v tun theo cc quy nh, iu kin v gii han c quy nh y hoc cc sa i b sung v sau, tr s tin bi thng v cc tn tht lin quan trong thi han cua Hp ng bo him nhng ch i vi khon tin hoc quyn li c nu trong Hp ng bo him vi mc ti a quy nh tai Hp ng bo him. QUYN LI 1 - T VONG V THNG TT VINH VIN DO TAI NN Hp ng bo him s bi thng cho Ngi oc bo him i vi cc tn tht di y theo ty l cua s tin bo him hoc s tin c quy nh, cho thng tt c nh ngha, dn n: S kin tn tht Bi thng %

    s tin bo him 1. T vong do tai nan 100%

    2. Thng tt ton b vnh vin 100%

    3. Mt hoc mt chc nng ton b vnh vin cua hai chi 100%

    4. Mt hoc mt chc nng ton b vnh vin cua mt chi 100%

    5. Mt th lc ton b vnh vin c hai mt 100%

    6. Mt th lc ton b vnh vin mt mt 50%

    7. Mt hoc mt chc nng ton b vnh vin cua mt chi v mt th lc mt mt 100%

    8. Mt kh nng ni v thnh lc 100%

    9. Mt tr hon ton khng cha c 100%

    10.Mt thnh lc ton b vnh vin

    a) c hai tai 75%

    b) mt tai 25%

    11.Mt kh nng ni 50%

    12.Mt hon ton thuy tinh th mt mt 50%

    13.Mt hoc mt hon ton kh nng s dung cua 4 ngn tay v ngn ci cua

    a) tay phi 70%

    b) tay tri 50%

    14.Mt hoc mt hon ton kh nng s dung cua 4 ngn tay cua

    a) tay phi 40%