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  • QUY TC, IU KHON

    SN PHM BO HIM HN HP VI QUYN LI BNH HIM NGHO

    (PH-AN LC) (Km theo Cng vn s 10540 BTC-QLBH ngy 07 thng 08 nm 2012 ca B Ti chnh)

  • Quy tc, iu khon sn phm Bo him hn hp vi quyn li bnh him ngho

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    MC LC

    PHN I. IU KHON CHUNG ...................................................................................... 3 1. GII THCH T NG .................................................................................................... 3 2. HP NG BO HIM ................................................................................................ 6 3. BO HIM TM THI .................................................................................................. 7 4. THI HN CN NHC ................................................................................................. 7 5. NHM LN KHI K KHAI TUI V GII TNH ........................................................ 8 6. IU KHON MIN TRUY XT .................................................................................. 8 7. THA K HP NG BO HIM ............................................................................. 8

    PHN II. CC IU KHON V BO HIM ............................................................... 10 8. QUYN LI BO HIM .............................................................................................. 10 9. TH TC V THI GIAN GII QUYT QUYN LI BO HIM ........................ 12 10. IU KHON LOI TR ........................................................................................... 14 11. QUYN V NGHA V CA BN MUA BO HIM .............................................. 16 12. QUYN V NGHA V CA PRUDENTIAL ........................................................... 20 13. PH BO HIM V NG PH BO HIM .............................................................. 20 14. GIA HN NG PH BO HIM - MT HIU LC HP NG BO HIM -

    TM NG T GI TR HON LI NG PH BO HIM ............................ 20 15. CHM DT HIU LC HP NG ........................................................................ 21 16. GII QUYT TRANH CHP ...................................................................................... 21

    PH LC 22 NHM 1 ........................................................................................................................................ 23 NHM 2 ........................................................................................................................................ 25 NHM 3 ........................................................................................................................................ 26 NHM 4 ........................................................................................................................................ 29 NHM 5 ........................................................................................................................................ 30

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    PHN I. IU KHON CHUNG 1. GII THCH T NG

    Cc t ng s dng trong Quy tc, iu khon sn phm bo him ny (sau y c gi l Quy tc, iu khon) c hiu nh sau:

    1.1. Prudential: l Cng ty Trch nhim Hu hn Bo him Nhn th Prudential Vit Nam, c giy php hot ng s 15 GP/KDBH do B Ti chnh cp ngy 15/11/2004, c ng k li vo ngy 08/09/2011.

    1.2. Bn mua bo him: l t chc c thnh lp v hot ng hp php ti Vit Nam, hoc c nhn t 18 (mi tm) tui tr ln hin ang c tr ti Vit Nam, c nng lc hnh vi dn s y , l ngi k khai v k tn trn H s yu cu bo him v l ngi ng Ph bo him. Bn mua bo him phi c quyn li c th c bo him i vi Ngi c bo him. Theo Quy tc, iu khon ny, Bn mua bo him c quyn li c th c bo him vi nhng ngi sau y:

    Bn thn Bn mua bo him; V, chng, con, cha, m hp php (cha , m , cha nui, m nui, con nui

    ca Bn mua bo him); Anh ch em rut, ngi c quan h nui dng/gim h hp php; Ngi khc, nu Bn mua bo him c quyn li c th bo him theo quy nh

    ca php lut. Trong trng hp Ngi c bo him khng phi l bn thn Bn mua bo him, Bn mua bo him phi c s ng bng vn bn ca Ngi c bo him.

    1.3. Ngi c bo him: l c nhn hin ang c tr ti Vit Nam c Prudential chp nhn bo him theo Quy tc, iu khon ny. Ngi c bo him phi nm trong tui t 18 (mi tm) n 55 (nm mi lm). Ngoi ra, gii hn tui khi kt thc Hp ng bo him l 75 (by mi lm) tui.

    1.4. Ngi th hng: l t chc, c nhn c Bn mua bo him ch nh nhn quyn li bo him theo Quy tc, iu khon ny.

    1.5. Ngy cp Giy chng nhn bo him nhn th: l ngy Prudential pht hnh Giy chng nhn bo him nhn th cho Bn mua bo him v c ghi trn Giy chng nhn bo him nhn th (sau y c gi l Giy chng nhn bo him).

    1.6. Ngy hiu lc hp ng: l ngy Bn mua bo him hon tt H s yu cu bo him v ng y Ph bo him ban u theo quy nh ca Prudential, vi iu kin Bn mua bo him v Ngi c bo him vn cn sng vo thi im H s yu cu bo him c Prudential chp thun, nu khng c quy nh khc. Ngy hiu lc hp ng c ghi trong Giy chng nhn bo him.

    1.7. Nm hp ng: l khong thi gian 1 (mt) nm tnh t Ngy hiu lc hp ng cho n Ngy k nim nm hp ng u tin hoc bt k nm tip theo no tnh t Ngy k nim nm hp ng gn nht cho n Ngy k nim nm hp ng tip theo.

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    1.8. Ngy k nim nm hp ng: l ngy k nim hng nm ca Ngy hiu lc hp ng. 1.9. Ngy kt thc thi hn hp ng: l ngy cui cng ca Thi hn hp ng bo

    him v c ghi trong Giy chng nhn bo him. 1.10. Ph bo him: l khon tin m Bn mua bo him phi ng cho Prudential theo nh

    k cho ton b Hp ng bo him. Ph bo him c ghi trong Giy chng nhn bo him v/ hoc Th xc nhn iu chnh hp ng gn nht, nu c.

    1.11. Tng ph bo him: bao gm Ph bo him ca sn phm ny v (cc) sn phm bo him b tr km theo, nu c.

    1.12. Ph bo him ban u: l Ph bo him ca sn phm bo him ny v (cc) sn phm bo him b tr km theo, nu c, c Bn mua bo him ng cho Prudential cng vi H s yu cu bo him.

    1.13. S tin bo him: l s tin m Prudential chp nhn bo him v c ghi trong Giy chng nhn bo him hoc Th xc nhn iu chnh hp ng gn nht, nu c.

    1.14. Gi tr hon li: l s tin m Bn mua bo him s nhn li, nu c, khi c yu cu chm dt Hp ng bo him trc thi hn. Hp ng bo him c Gi tr hon li trong thi gian hiu lc ca sn phm bo him ny v sau khi Bn mua bo him ng Ph bo him cho 24 (hai mi bn) thng hp ng u tin. Gi tr hon li bao gm gi tr hin ti ca Bo tc, nu c.

    1.15. Khon gim thu nhp u t: l s tin thu nhp t hot ng u t b gim v tm ng t Gi tr hon li hoc do Bn mua bo him cha ng Ph bo him trong thi gian Hp ng bo him tm thi mt hiu lc. Khon gim thu nhp u t c tnh bng phn trm ca s tin tm ng t Gi tr hon li da trn li sut k thut hoc s tin Ph bo him chm ng v thi gian chm ng.

    1.16. Bo tc: l khon li chia (khng m bo) c thng bo cho Bn mua bo him vo mi nm dng lch. Bo tc c thng bo hng nm, nu c, l khon tin m khch hng s ch nhn c ton b khi Prudential chi tr quyn li bo him theo Quy tc, iu khon ny.

    1.17. Li chia cui hp ng: l khon li chia (khng m bo) m khch hng s c chia thm khi nhn quyn li bo him theo Quy tc, iu khon ny. Da vo kt qu kinh doanh ca Prudential, Li chia cui hp ng ca nm trc , nu c, s c xc nh vo mi nm dng lch. Li chia cui hp ng ch c gi tr ti thi im chi tr, khng c tch ly hng nm v khng c rt trc.

    1.18. Bnh him ngho: l mt trong nhng bnh c nh ngha trong Ph lc nh km ca Quy tc, iu khon ny.

    1.19. Nhm bnh him ngho: l nhm bnh bao gm 1 (mt) hoc nhiu Bnh him ngho v c quy nh ti Ph lc ca Quy tc, iu khon ny.

    1.20. Chn on bnh him ngho: l chn on xc nh sau cng ca mt hay nhiu Bnh him ngho c thc hin bi Bc s hoc nhm Bc s chuyn khoa ca bnh vin, vin hoc trung tm y t cp tnh, cp thnh ph hoc cp trung ng hot ng hp php trn lnh th Vit Nam.

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    Kt qu Chn on bnh him ngho phi c Prudential chp nhn da trn nhng kt qu xt nghim y khoa ca Ngi c bo him do Ngi nhn quyn li bo him cung cp. Prudential c quyn yu cu Ngi c bo him tin hnh nhng xt nghim khc nu cn thit. Trong trng hp xy ra tranh chp trn kt qu chn on, Prudential c quyn yu cu Ngi c bo him tin hnh xt nghim y khoa ti mt trung tm xt nghim c lp theo tho thun gia Prudential v Bn mua bo him. Prudential v ngi nhn quyn li bo him phi tun theo kt qu xt nghim sau cng ny. Mi chi ph cho vic tin hnh xt nghim y khoa trong trng hp tranh chp theo yu cu ca Prudential s do Prudential chu trch nhim chi tr.

    1.21. Bnh vin: l mt c s c thnh lp v ng k hp php theo lut php Vit Nam v hot ng Vit Nam nh mt bnh vin hoc trung tm y t cp Qun, Huyn tr ln cp cu, iu tr nhng ngi b bnh cng nh b thng nhp vin lm Bnh nhn ni tr; cc c s ny phi: Hot ng lin tc, cung cp dch v chm sc iu tr 24/24 gi bi cc Bc S v

    cc nhn vin Y t (Y s, Y t) c giy php hnh ngh; v c qun l v iu hnh bi nhng ngi c giy php hnh ngh ca B Y t

    hay S Y t, v Lu tr v cung cp nhng chng t y khoa, chng t k ton ti chnh tun th

    theo cc quy nh ca cc c quan c thm quyn.

    Cho mc ch ca sn phm bo him ny, Bnh vin s khng bao gm: Trung tm y t d phng; Bnh vin/ vin tm thn; Bnh vin/ vin y hc dn tc; Bnh vin/ vin phong; Nh iu dng, trung tm phc hi chc nng, nh lu bnh; Nh bo sanh, nh an dng hay cc c s khc ch yu dnh cho vic cha tr

    cho ngi gi, ngi nghin ru, cht ma ty, cht kch thch. cho d cc c s, trung tm ny hot ng c lp hay trc thuc mt Bnh vin

    1.22. Bc s: l c nhn tt nghip i hc chuyn ngnh Ty Y tr ln v c cp php hnh ngh hp php ti a phng cung cp dch v khm, cha bnh v phu thut. Trong nh ngha ny, Bc s khng bao gm nhng ngi sau y: Bn mua bo him, Ngi c bo him hoc Ngi th hng; (Cc) i tc kinh doanh ca Bn mua bo him hoc Ngi c bo him; i l bo him, ngi tuyn dng, nhn vin ca Bn mua bo him hoc Ngi

    c bo him; Cc thnh vin trong gia nh trc h ca Bn mua bo him hoc Ngi c bo

    him (cha m, v chng, con ci, anh ch em rut).

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    1.23. Thi hn loi tr: l 90 (chn mi) ngy k t ngy sn phm bo him ny c hiu lc hoc t ngy khi phc hiu lc gn nht ca sn phm bo him ny.

    1.24. Tnh trng tn ti trc: ngha l tn thng do Tai nn xy ra hoc bnh