360ttb - 天天保健康险 - 高端医疗险试算 --旅游保险|旅行险|车险|健康保险|家财险|企业财产保险|货运险|养老保险|老人意外保险|人寿保险|责任险

受理地：	省/市市找不到我所在的城市？
户籍所在地：
被保人出生日期：	周岁
生效时间：
到期时间：	365 天

美亚外籍人士医疗保险 GlobalHealth Advantage Plans

保费金额
实付金额

保险项目 Bisic of Benifits

优越100 Advantage 100

优越200 Advantage 200

优越300 Advantage 300

优越400 Advantage 400

优越500 Advantage 500

全球保障 Worldwide Coverage 北美除外 North American Exclusion Coverage

免赔额 Annual Deductible
(请选择免赔额来获取报价)

无
US$500或人民币3,200元 US$1,000美元或人民币6,400元
US$2,000美元或人民币12,800元 US$5,000美元或人民币32,000元

最高保险金额
Total Annual Benefit Limit up to>

每一病症US$250,000或人民币1,600,000元

每保险年度US$250,000或人民1,600,000元

每保险年度US$3,000,000或人民币19,200,000元

住院与门诊手术费用补偿
Hospitalisation & Out-patient Surgery
膳宿费（包括一般护理费）；
Room and board including generalnursing care

赔偿限额
Hospitalisation &Out-patient Surgery sub-limits:
每天250美元或人民币1,600元
$250/ ￥1,600 per day

赔偿限额
Hospitalisation &Out-patient Surgery sub-limits:
每天300美元或人民币1,920元
$300/ ￥1,920 per day

全额赔付 Fully Covered

父母陪宿费用（在同一病房内加床）；
Parental Accommodation (added bed, same room)

无 No Cover

全额赔付 Fully Covered

手术室费、重症监护护理费、X光透视费、CT扫描费、核磁共振费、B超费、化验费、药物或药品费用、血液与血浆费用、外科器材费、轮椅租金、拐杖和助步架费用以及普通手术植入物费用；
Theatre fees; intensive care; X-rays; CT Scans; MRI Scans; Ultrasounds; laboratory tests; Medicines and Drugs; blood and plasma; medical appliances; rental of wheel chairs, crutches and walkers; standard surgical implants

全额赔付 Fully Covered

外科医生诊断费，包括手术前咨询、手术后及外科医生门诊随访咨询；
Surgeon’s Fees including pre– and post– surgical services

每一病症15,000美元或人民币96,000元
$15,000/￥96,000 per Disability

每年20,000美元或人民币128,000元
$20,000/￥128,000 per Policy Year

麻醉费； Anaesthetist Fees

外科医生诊断费的30%
30% of Surgeon’s Fees

医生费用，包括内科、专科、放射科、理疗科和病理科医生费用。
Professional Fees including physician, specialist, radiologist, physiotherapist and pathologist

全额赔付 Fully Covered

入院前治疗补偿 Pre-hospitalisation
若被保险人因承保病症住院，则保险公司赔付在其入院之日前30 天内发生的医疗服务费用，但所有治疗均须由医生提供且与住院病症直接相关。
Medical services incurred within 30 days prior to a covered Confinement in a Hospital which are provided by or ordered by a Physician as a direct consequence of the covered Disability which necessitated such Confinement

入院之日前30天内的医疗服务费用，每一病症1,000美元或人民币6,400元
Up to $1,000/ ￥6,400 per Disability incurred within 30 days prior to a covered confinement

入院之日前30天内的医疗服务费用，每一病症1,000美元或人民币6,400元
Up to $1,000/￥6,400 per Disability incurred within 30 days prior to a covered confinement

全额赔付 Fully Covered

出院后治疗补偿 Post-hospitalisation
若被保险人因承保病症住院，则保险公司全额赔付自其出院之日起90 天内发生的医疗服务费用。
Normal follow-up treatment for up to 90 days following hospitalisation
医生及专家门诊的诊疗费用； Physicians and specialists office visits
主治医生证明有必要进行的理疗师、脊椎整形医师、针灸师的治疗费用； Physiotherapist, chiropractor and acupuncturist when certified necessary by an attending Physician
药物或药品费用；X摄片、化验费用；手术器具费用。 Medicines and Drugs; dressings; X-rays; diagnostic laboratory tests; surgical appliances

全额赔付 Fully Covered

肿瘤 Oncology
化疗和放射疗法费用 Chemotherapy and radiotherapy

全额赔付 Fully Covered

肾脏透析 Renal Dialysis
肾脏透析费用 Kidney Dialysis

终生15,000美元或人民币96,000元 $15,000/￥96,000 lifetime benefit

全额赔付 Fully Covered

妊娠并发症 Complications of Pregnancy
因妊娠并发症而发生的必要住院费用，包括新生儿费用。 In-patient treatment necessary as a direct result of Complications of Pregnancy including Newborn Accommodation

适用住院与门诊手术费用补偿项下的赔偿限额
Hospitalisation & Out-patient Surgery sub-limits apply

适用住院与门诊手术费用补偿项下的赔偿限额
Hospitalisation & Out-patient Surgery sub-limitsapply

全额赔付 Fully Covered

艾滋病 / 人体免疫缺损病毒（HIV）保障 AIDS/ HIV
在保险合同首个生效日期起持续续保五（5）年后出现与人体免疫缺损病毒（HIV）有关的疾病
Coverage will apply when signs or symptoms are present for the first time after five years continuous coverage under the plan and any renewal thereof

终生25,000美元或人民币160,000元
$25,000/￥160,000 lifetime benefit

终生100,000美元或人民币640,000元
$100,000/￥640,000 lifetime benefit

私人护理费用补偿 Private Nursing
住院期间所发生的私人护理费用) In Hospital when certified medically necessary by an attending Physician

全额赔付 Fully Covered

在出院后或医院手术后即由注册护士提供家庭护理的费用
Home Nursing by a registered nurse immediately following hospitalisation or surgery in a Hospital

无 No Cover

全额赔付，每一病症的最多赔付日数以28周为限。
Fully Covered up to 28 weeks per Disability

全额赔付，每一病症的最多赔付日数以28周为限。Fully Covered up to 28 weeks per Disability

精神或神经功能紊乱医疗费用补偿用 Mental or Nervous Disorders
Inpatient treatment in a Hospital

无 No Cover

每年5,000美元或人民币32,000元; $5,000/￥32,000 per Policy Year $10,000/ ￥64,000 lifetime benefit

住院治疗费用 Inpatient treatment in a Hospital

无 No Cover

终生10,000美元或人民币64,000元
$5,000/￥32,000 per Policy Year $10,000/￥64,000 lifetime benefit

器官移植费用补偿 Organ Transplant
心脏、肝脏、肾脏、骨髓、角膜、肺移植费用 Transplant of heart, liver, kidney, bone marrow, cornea or lung to a limit of

每一病症250,000美元或人民币1,600,000元
$250,000/ ￥1,600,000 per Disability

每一病症250,000美元或人民币1,600,000元每一病症750,000美元或人民
$250,000/ ￥1,600,000 per Disability

每一病症750,000美元或人民币4,800,000元
$750,000/ ￥4,800,000 per Disability

收容/临终关怀保障
Hospice/ Palliative Care

无 No Cover

终生10,000美元或人民币64,000元
$10,000/￥64,000 lifetime benefit

急症费用补偿 (详情请参阅急症服务计划)
Emergency Benefits (see Emergency Service Program for full details)
全球紧急救援服务，包括急救援助与运送。
Worldwide emergency assistance including evacuation and repatriation
当地医院的救护车费用；
Local Ambulance to Hospital
急诊室治疗的费用
Emergency room treatment
健全与天生的牙齿在遭受意外事故后14 天内发生必要的治疗费用
Dental treatment for up to 14 days following Accidental damage to sound natural teeth

全额赔付 Fully Covered

遗体送返费用
Repatriation of Mortal Remains

15,000美元或人民币96,000元
$15,000/ ￥96,000

慢性病 Chronic Conditions
因慢性病需要入住医院进行治疗的费用。
Treatment for a Chronic Condition received while an admitted patient in a Hospital

适用住院与门诊手术费用补偿项下的赔偿限额
Hospitalisation & Out-patient Surgery sub-limits apply

全额赔付 Fully Covered

与慢性病相关的医生与专科医生诊疗以及处方药物费用
General Practitioner and specialist consultations; prescribed Medicines and drugs;：

无 No Cover

若选择门诊医疗，则有此保障
Included in optional out-patient

无 No Cover

全额赔付 Fully Covered

门诊费用补偿
Out-patient
医生与专科医生门诊；
Physicians and specialists consultations
经主治医生推介的理疗医生；
处方药物、敷料、X光透视、诊断检验与外科器材。
Prescribed medicines; dressings; X-rays; diagnostic laboratory tests and surgical appliances

无 No Cover

可选择每年5,000美元或人民币32,000元
Optional $5,000/￥32,000 per Policy Year

无 No Cover

全额赔付 Fully Covered

补充医疗费用补偿
Complementary Medicine
理疗师（无需主治医生推介）、脊椎指压治疗师、整骨医生、同种疗法医师、足病医师、语言治疗师或营养医师；
Physiotherapist without certification from an attending Physician; chiropractor; osteopath; homeopath; podiatrist; speech therapist; dietician
针灸、正骨以及中医，每次诊疗费用以50美元或人民币320元为限
Acupuncturist; bone setter and Chinese medicine practitioner not exceeding $50 per visit

无 No Cover

每年500美元或人民币3,200元
$500/￥3,200 per Policy Year

生育保障 (无免赔额)
Maternity (deductible does not apply)
妊娠发生的产前与产后服务、流产、堕胎、分娩费用（包括一切医院与医生费用）及最多七天的婴儿室护理费用
Pre-natal and post-natal services; miscarriage; therapeutic abortion; costs of delivery including all Hospital and professional fees and up to seven days of nursery care

无 No Cover

每次怀孕10,000美元或人民币64,000元
$10,000/ ￥64,000 per pregnancy

Dental
齿科保障

齿科 Dental
常规牙科治疗包括检查，洁牙，普通复合充填补牙术，镶牙（金牙除外），拔牙，密封
Routine Dental Treatment (Examinations; tooth cleaning; normal composite fillings; inlay (excluding gold inlays); onlay (excluding gold onlays); extractions; sealant)

每年700美元或人民币4,480元
$700/￥4,480 per Policy Year

重大牙科修复术
拔除阻生牙、掩埋牙或未萌牙；牙根移除；牙根管治疗；牙瘤剔除；根尖切除术；牙桥托安装或修复（金牙桥托除外）；牙全冠安装或修复(金牙全冠除外)；假牙安装或修复。
Major Restorative Dental Work (Removal of impacted, buried or unerupted teeth; removal of roots; root canal treatment; removal of solid odontomes; apicectomy; new or repair of bridge work (excluding gold bridge work); new or repair of crowns (excluding all gold crowns); new or repair of upper and lower dentures)

每年1,500美元或人民币9,600元
$1,500/￥9,600 per Policy Year

人身意外伤害以及每日住院津贴附加保障

经典计划

优越计划

卓越计划

未成年人计划

成年人计划

未成年人计划

成年人计划

未成年人计划

成年人计划

意外身故、残疾及烧伤保障
Accidental Death, Burns and Dismemberment

15,000美元或人民币96,000元

75,000美元或人民币480,000元

15,000美元或人民币96,000元

150,000美元或人民币960,000元

15,000美元或人民币96,000元

300,000美元或人民币1,920,000元

每日住院津贴 (每一保险年度总赔偿日数以90天为限)
Hospital Income (Up to 90 days per Policy Year)

无

45美元或人民币288元

无

80美元或人民币512元

无

80美元或人民币512元

1. This Policy does not cover any medical expenses incurred in or arising from any accident or illness occurred in Cuba, Burma，Iran and Sudan.

2. In order to protect your own interests, before applying for the Policy, please read carefully the terms and conditions of this Policy, especially the exclusions. The policy wording is available from our salespersons or on our website: http://www.chartisinsurance.com.cn/. Please call 8009880898 or contact our salespersons to enquire the terms and conditions of this Policy. Please make sure that you fully understand the explanations of our salespersons. With no enquiry, you are deemed to have fully understood the terms and conditions of this Policy.

3. This Application Form and Quotation (if any), policy wording, Schedule, any endorsement attached hereto or marked thereon (if any) and any other written agreement shall form integrated parts of this Policy.

"卓越"环球个人医疗保险

保费金额￥
实付金额￥

保险项目 Bisic of Benifits	中国计划(除香港,澳门,台湾) China Plan(Ex. HK, TaiWan, Macau)		国际计划(除美国) International Plan(Ex. USA)		全球计划 WorldwidePlan
年度总赔偿限额-保障1-7部分 Annual Limit for Part 1-7	8,000,000		12,000,000		18,000,000
男Male 女Female	经典Classic	精英Elite	经典Classic	精英Elite	精英Elite
住院保障 Part 1: Hospitalization Benefit
自付比率 Co-Payment	无 Nil	无 Nil	无 Nil	无 Nil	无 Nil
住院病房费用（每一病症无赔偿天数限制） Daily Room & Board Limit Per Day	标准私人病房 StandardPrivate Room	标准私人病房 StandardPrivate Room	标准私人病房 StandardPrivate Room	标准私人病房 StandardPrivate Room	标准私人病房 StandardPrivate Room
重症监护室 Intensive Care Unit	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage
医院杂项费用（处方药物、住院检查检验费用、看护/护理费用、手术室费用） Hospital Miscellaneous Expenses (Prescription drugs, inpatientdiagnostic procedures, Nursing, Operating theatre charges)
住院物理治疗、救护车费用、手术费用、麻醉费用、住院主诊医生费用 Inpatient Physiotherapy, Ambulance Service, Surgeon's Fee,Anesthetist's Fee, Inpatient Physician's Visit
家庭看护（每一病症最高赔偿期为90天） Home Nursing (Max 90 days per disability)
陪房费用(近亲属) Immediate Family Accommodation
入院前或日间手术前医生求诊费用（住院前90天内） Pre-hospitalization or Pre-day Surgery Specialist Consultation (Upto 90 days before admission)
入院前或日间手术前检查检验费用（住院前90天内） Pre-hospitalization or Pre-day Surgery Diagnostic Services (Up to90 days before admission)
离院后或日间手术后治疗(离院后90天内) Post-hospitalization or Post-day Surgery Treatment: Within 90 daysimmediately following the date of the last discharge from hospital
精神病治疗(初次投保时，自生效日起等待期为12个月；每一保险年度最高赔付天数为30天；累计保险年度下，终身最高赔付天数不超过100天。) Inpatient Psychiatric Treatment: Up to 30 days per policy yearafter 12 months continuous cover under the plan; Lifetime limit of100 days	非保障范围 Not Covered	非保障范围 Not Covered	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage
第二部分: 器官移植 Part 2: Major Organ Transplant	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage
第三部分: 义肢/人造假肢(手术植入) Part 3: Artificial Prosthesis (Surgical Implants)	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage
第四部分:癌症治疗及非住院洗肾 Part 4: Outpatient Kidney Dialysis and Cancer Treatment
年度最高赔偿限额 Benefit Limit Per Year	500,000	500,000	650,000	650,000	800,000
终生最高赔偿限额 Lifetime Limit	1,500,000	1,500,000	2,000,000	2,000,000	2,500,000
第五部分:意外牙科紧急医疗 Part 5: Outpatient Emergency Dental Treatment (Due to accidentsonly)	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage
第六部分:意外门诊紧急医疗 Part 6: Outpatient Emergency Treatment (Due to accidents only)	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage
第七部分: 可否使用列表中的昂贵医疗机构 Part 7: Usage of High Cost Provider	非保障范围 Not Covered	全额赔付 Full Coverage	非保障范围 Not Covered	全额赔付 Full Coverage	全额赔付 Full Coverage
第八部分:24小时紧急支援服务 Part 8: Emergency Assistance Service and Benefits	不设限额 Unlimited	不设限额 Unlimited	不设限额 Unlimited	不设限额 Unlimited	不设限额 Unlimited

门诊保障 Outpatient Cover
年度总赔偿限额(同一病症每天仅限求诊一次) Annual Limit (Limit to 1 visit per day per disability)	30,000	30,000	60,000	60,000	120,000
自付比率 Co-Payment	无 Nil	无 Nil	无 Nil	无 Nil	无 Nil
免赔额/次 Deductible/visit	无 Nil	无 Nil	无 Nil	无 Nil	无 Nil
普通门诊费用、专科门诊费用、处方药物 Clinical Consultation, Specialist Consultation, Prescription Drugs& Medicine	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage
物理治疗及脊骨治疗（每年最多10次） Physiotherapy & Chiropractic Treatment** (Max 10 visits per year)
X光检验及其他检查检验费用 X-Ray and Laboratory Fees
中医,跌打及针灸治疗（每年最多10次） Chinese Herbalist,Bonesetter,and Acupuncturist (Max 10 visits peryear)
常规体检、健康检查和接种疫苗 Routine physical examinations,health screening & health check-ups,and vaccinations 年度最高赔偿限额 Benefit Limit Per Year	3,000	3,000	4,000	4,000	5,000
可否使用列表中的昂贵医疗机构 Usage of High Cost Provider	非保障范围 Not Covered	全额赔付 Full Coverage	非保障范围 Not Covered	全额赔付 Full Coverage	全额赔付 Full Coverage

牙科保障（在选择住院以及门诊的基础上附加） Dental Cover（Optional based on IP+OP）
年度总赔偿限额 Annual Limit	5,000	5,000	8,000	8,000	10,000
自付比率 Co-Payment	25%	25%	25%	25%	25%
自然牙齿或牙龈、牙周疾病的治疗，包括充填、补牙、拔牙（智齿除外）、X光、根面平整、根管治疗 Nature dental treatment including fillings,build-ups,extractions(except wisdom teeth),X-ray,root planning, root canal treatment and periodontal treatment	保障 Covered	保障 Covered	保障 Covered	保障 Covered	保障 Covered
洗牙及口腔检查（每年最多2次）每次治疗限额 Preventive & Oral Examination (Max 2 visits per year) Max limit per visit	500	500	800	800	1,000
镶牙费用每颗牙齿最高限额 Dentures Max limit per tooth	2,500	2,500	2,500	2,500	2,500
可否使用列表中的昂贵医疗机构# Usage of High Cost Provider#	非保障范围 Not Covered	非保障范围 Not Covered	非保障范围 Not Covered	非保障范围 Not Covered	非保障范围 Not Covered

生育保障（在选择住院以及门诊的基础上附加） Maternity Cover (Optional based on IP+OP
年度总赔偿限额 Annual Limit	30,000	30,000	60,000	60,000	90,000
等待期 Waiting Period	12个月 12 months	12个月 12 months	12个月 12 months	12个月 12 months	12个月 12 months
自付比率 Co-Payment	无 Nil	无 Nil	无 Nil	无 Nil	无 Nil
顺产,剖腹产,堕胎, 流产,产前并发症和分娩时并发症, 15 天内有医疗必要的婴儿费用 Normal Delivery, Cesarean,Abortion, Miscarriage,Complications arising during the antenatal period and childbirth, Medically necessary costs for new born bady for 15 days upon birth	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage	全额赔付 Full Coverage
可否使用列表中的昂贵医疗机构 Usage of High Cost Provider#	非保障范围 Not Covered	全额赔付 Full Coverage	非保障范围 Not Covered	全额赔付 Full Coverage	全额赔付 Full Coverage

1. 所有费用必须合理且必需。 All expenses must be reasonable, necessary and customary.

2. 门诊直接付费和住院医疗费用担保服务需签妥同意书方可生效,且对于计算错误或不被理赔的金额,您有义务配合进行相关理赔金额的调整。CashlessPayment and inpatient guarantee letter can be provided subject to indemnification.

3. 全额赔付及各项保险金均受限于各险种的年度总赔偿限额。 Full coverage and all benefits payable shall be always subject to Annual Limit.

4. ** 需由主治医生推荐或配方 recommended or referred by the attending physician

5. ##包括所有手术室费用、麻醉师费用、手术费用及医院杂项费用等进行肾脏、心脏、肝脏、肺或骨髓移植手术的全部合理且必需的医疗费用。Include all expenses of operating theatre & materials, anesthetists, surgeon and hospital service relating to the transplantation ofheart\kidney\liver\lung or bone marrow.

6. # 最新昂贵医疗机构名单 List of high cost providers:
(1). 和睦家医院United Family Hospital;
(2). 国际(SOS)救援中心诊所SOS International Clinics;
(3). 上海东方国际医疗中心Shanghai EastInternational Medical Center;
(4). 上海康联医院Shanghai Kanglian Hospital;
(5). 百汇医疗集团旗下中国所有的医疗机构All the medical centers belong to Parkway Health Medical Centers in China;
(6). 港安医院Adventist Hospital;
(7). 香港明德医院Matilda Hospital;
(8). 香港养和医院Sanatorium Hospital若有变动,昂贵医疗机构名单将及时更新在本公司网站www.axa-ins.com.cn。This list will be updated timely if have changes and the latest list isavailable at www.axa-ins.com.cn.

7.对于中国精英计划/国际精英计划/全球计划,在中国大陆及香港地区, 选择去普通医院就诊时（即不在”最新昂贵医疗机构名单”之列的医院）,门诊的免赔额仍为50元。For China Elite Plan/International Elite Plan/Worldwide Plan, outpatient deductible RMB 50 will be applied for those local generalhospitals which are not included in the“List of high cost providers”in China mainland and HK.

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