{l*l utx - biznet
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DANH MUc cAc Lo4I BENH xEM xET NHAN nAo nmvt
/,)ll"/,,{l*l
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TT DANH MUC BENH
CIIAP NTIAN BAO HIEM
rilcudrsAomilr
CEAP NHAN BENHc6 s,i,x
LOAIrnil
BENHc6's.i.x
TY LEoOxc
cnr rnAxAmrniJ z( 30/70)
NHANnAo
mimnIr,olr rnil'NAMDAU
utxI B€nh hG thin kinh
Viem hC than kinh truns uong (ndo) x
Parki son
Tho6i h6a kh6c cira hC then kinh x
Mdt tri nhd, hdn m€, bai ndo, li0t
Bdnh hG hd h5p
Suv ph6i, trin khi phtii, suv h6 h6p mirl tinh x
vlem Dnol x
Vi€m xoang xVi€m amidan, vi€m VA, vi€m ph0 quan,Vi€m mii hqng
3 B6!h h€ tuin hoinTim x
Huyiit rip
Tins do luc ddne mach vdnh vo cinMach m6u nio/ dOt quy (xuat huyet neo, xocrins d6ns mach)
t nap Knop cap
Nhdi mdu co tim x
4 BGnh h0 ti6u h6a
Vi€m da dirv XVi€m ean (A. B. C) X
Xo gan X
MAt, tuy, da diyTe tane. dai trine
5 B6nh h6 ti6t ni6u
Sdi then. sdi dudns tiiit nieu XSuv th6n. teo thdn. s6i than cd 2 bdn
Viem duans ti6t ni€u. vi€m bins quane X
Chav th6n nhAn lao x
Sdi bun, soi tui m6t nhd X
Vi€m tuv6n tiAn li€J X
Vi€m co quan sinh duc nam./nfr xTi6u <ludng chi s6 tr€n l6 d nhfrng nguditren )u ruol X
XTiiiu duong chi sii dudi 16 d nhtng nguoitr€n 50 tuoiTiiiu tluong chi s6 du6i l6 d nhiing ngudidudi 50 tu6i
6 AGnh h0 nOi ti6tR6i loan tuv6n ei6p. culng gi6p, suy gi6p x
Ri5i loan chuy6n h6a X
Md m6u X
7 Kh6i U
U lanh tinh cdc loai (U md. U nhD ndu rldpnau lnu4t mlloai trir chi phi ndm clAu)
U xo tu cune (sd'n tuoi ti€n man kinh)
U xo tri cunq (dudi 40 tudi) x
U nang budng trimg x
u ac. u xo Uen er
U thuons than ftii (cit hoac chua c6t)
Polip nhd hon I cm
Polip l6n hon I cm (ld phii m6 n6i soi)
8 B6nh vii m6u
Thiiiu m6u
R6i loan dOne m6u x
Ghep tiy9 B€nh ciia da vi cric md li6n k6t
Lupus ban al6 x
Xo cfne bi toe,Jl thin x
Teo co
Loan dudng co x
Vdv niin, md dav di rrng X
l0 BGnh v6 ctr urons kh6'oThorii h6a xuong, tho6i h6a cQt s6ng, d6tsOns
Tho6t vi dia d6m X
Gout XVi€m kh6p/da khop
ll B€nh hG taiViem tai gita, tai hong XR6i loan tidn dinh, h6i chirng ch6ng mit XDitic X
t2 BGnh hG nrach
ViCm tinh mach
tfl oo z-5 X
NG C(
+ofAO\
g
C6c bpnh l6y qua dudng tinh duc, giang mai,
Lw !: Bdng ndy chi mang tinh chiit tham khao diji voi cdc c6ng ty thdnh vi6n'
..,
,ill;.r'v1r\7
BAOIIIET {$ InsuranceBAo Hr{M BAo vrer
GAY YEU CAU ENO HIENI
"BAo uFr AN GlA"GYCBH ney b mot bO phan kh6ng tach rdi cua Hqp (rdng bio hi6m. Dd nghi ttOc kl cic yeu clu duoi diy vi tfi6n 6ly drl th6ng tin GYCBH
THoNG TrN vE r.rcudt vEu cAu eAo H|EM (NYGBH)
Ho vd ten: sii cMND/ H0 chi6u:
Ngey thAng nAm sinh:
Dign lho?i di al9n9: Email:
THONG TrN vE l,touot ougc eAo HIEM (NDBH)
s6TT
H9 ten NOBH Gi(''itinh
Ngay sinh s6 cMND, H9 chi6u
$6 CMND te en = 'so CMND ctabAne'.'con thtt nAY")
Quan he v(' NYCBH
2
3
4
5
aUYEN LgI VA PHi BAO HIEM
ouYtN Lgr & PHi BAo HIEM
TRU(Ghi tCn chvang tlnh - TEem < 1 I tu^i tham gia ctngb6/ne phei than gia chtronghnh thep hon hoAc hNng
Phi bao hi6m [1]
-Nbekhc6 (Ap dung v6iNDBH > 1 tu6i)
. Thal sen (Ap dung vdi\IDBH E no gi6i trcng d0tuA [r 1 8 &n 45 ve than
A PHI BAo HgM F=r+2+3+4+5+51
KE KHAI T|NH TRANG SI?C KHOE1. Trcng 03 nem qua, ben hoac bet ki thdnh vien neo tong gia 61nh d5 tirng phei c/'6u t4, hen vicn, hay ph6u thuat tong n benh
vien, vi,n diAu du6ng, phdng khin hoAc c.,c tA chlc y tA khec khOng? HoAc & trong linh tang cin phei diu ttitong benh viCn trcng
vdng 12 th4ng tui?
oCo
E Kh6ng
Ziirg OS ,e, q"", ta, nob *t Xl thanh vien neo tong gia dinh de ntc holc ditu ti nQt hay nhi6u trong cec chvng benh sau:
vien he thAn kinh trung uvng hed; Pa*inson; lhobi h6a kh6c cla he then kinh; n't lri nhit, h'n nt, bai neo, bai let; suy phOi, trin
khi phdi, suy h6 h'p nen tuh; n?ch neu neo, d,t luy. SuAt huy6l neo,/ xo cvng d,ng .nach); nh6i n,u co tin; xo gan; suy then Eo
than, s6i than ce 2 ben; chay thAn nhen ho; u ec, u xo ien Iet: u thwng th1n tri @et hoAc chva cit); ghep $y; Lupus ban &; lao
cac loai; phong: ung thu clc toei: suy tiy; bach cAu; c,c benh hy qua dvdng sinh dVc, giang nai, Eu, h1i ch(jng suy gien ni6n dich;
benh ben sinh, di ttuy6n, di deng v6 gm; Down?
N6u bet ki ceu h6i neo d t6n duqc te bt te c6, xin h6y neu chi ti6t (ha ve Gn Ngtrdi dvsc beo hi6m, En benh, thoi dtCn
chin &e; benh. pmrong phap d,du ti, tinh tqng hen hi cd sd deu n)
oC6
s Kh6ng
i quy^t bdi thutng theo nAl Hqp ddng beo hin y t6
twnig tv; iodc t! bdo vie,/c6ng V beo hi6n khec tn.chdi ieo hidn/ ttr chdi Hi tuc Hqp 6i)ng beo hiAn y 6 tLrong t\4 holc duqc chSp
nhan nhung vii dieu kien 6p dvng cec di6u khoen bA sung dAc biet?
Nlu cau te bi h c6, xin h6y n6u chi ti6t (c6ng ty beo hjen, ir ch,i/chtp nh:ln beo hi'n v6i &eu khoen b6 sung dac biet, lt do .)
---:
o Khong
-:
'ON6 T
) HIEI'JMEt
cHI oINH NHAN TIEN BAO HI
H9 va ten: s6 CMND/ H0 chieu:
D!; chi: ................... Quan hg voi NoBH . . '
CAM
r iAnntng tAi can aoan rdng hi€n tei rcilchtng 6i nc)jn l.oen khde n h; kh?/ng b! b1nh than kinh, En thAn, phong; kh'ng tong thdi gian &du h benh nt' thuwlg
kh6ng bi thwng Qt vlnh iEn tit 5096 tu l6n.
2. r,ilchtng t6i x6c nhiJn dns cac thans M neu tr''ln ta dAy dt va xec atw theo sv hau bi{t cao nhAt cua toitchi)ns toi vd sE t\^ns beo nolP !:"-Y!]6!Al.li l.!d6i nao c6 lEn quan. T'i/chtng t6i 66ng i leng CiAy yau c,u beo hi6n ney cnng vAi vigc d6ng dAy dn p bao hian sO En co s0 cho Hqp d^ng bAo hEn gitta tavcht:tng
ve Beo vct ve chip nhln cec dAu tien beo han quy dinh hi Hap d&E beo htdn
3. ffuilchttng bi nlxa nhln rjJng, truttg hw toi/ch(tng $i khong thw hien 6Ay dn Gch nhiem khai bao naithong tin Beo vel c6 1r.an quven giAn tech nhiem nAt Fh
ho& roan bo dtt voi khieu nai HQp 66ng ney. Neu vtec kh6ng khai beo nh,lm r|,vc dlch twc lqt beo hiafi, Beo va c6 quy,n hty/vo hieu h6a Hap &ng beo hi6n ngay
ngAy bll diu cn hieu lvc.
'yfiu ceu ko *hai dey aJ w ca cAc n'i dung trcng nAu GYTBH
beo
Phan danh cho c6n b0 khai th6c Bao Viet:Ngey... theng ... nen .....
Chep nhan beo higm tr Ti, ch6i nhAn bao hiem cl
QUY TAC BAO HIEM,.BAo VIET AN GIA,'
(Ban hhnh theo Quy6t dinh tri6n khai s6 4542 ngiv 1 3 th6ng 1 0 nim 201 6
cua Ttlng Ciam d6c- T6ng C6ng ty Biro hi6m Bao Vi€t;
D6y td euy tdc Bdo hi6n Bdo Vi€t An Gia ddnh cho nhOng kh6ch hdng cd nhdn c6 yqu cdu tham gia bdo
hi6m. Xin'vui tdng ki6m tra vi! d7c ki'dO chdc chdn rdng Qu'! kh^ch hdng dd hi€u toitn bQ cdc nQi dung
duq c quy dlnh tring euy Ec ndy. Xin luu :i, vi6c Qui kh6ch hdng ki vdo Gi6y y6u cdu bdo hi€m ld bdng
chung x6c nh6n viQc Qu!, khdch hdng dd hi€u rb tdt cd cdc nQi dung duEc quy dinh trong Quy tec ni)y
MUC LUC
Phin l: Quy dinh chung
Phin ll: Didu khoin bAo hi6m chinh
Phin llt: Didu khoin bjro hi6m b6 sung
Phin lV: G6c di6m loqi tr& chung
Phin V: Thi tuc y6u ciu biii thudng vi bio linh vi6n phi
Phin Vl: Php lgc bjrng ti le thuong tit vinh vi6n do tai n3n
PHAN I: QUY DINH CHUNG
DINH NGHIA
1. C6ng ty Bio hi6m
Ld Bio hi6m Bao ViCt rtuqc thanh lAp va hoat dong theo phap luat ViCl Nam. Bdo hi6m Bao Viet co cac quyen vd nghia
vu duqc nCu trong Hqp ddng bao hi6m ve bi rang buQc bdi c6c di6u khodn crla Hqp tt6ng bdo hi6m.
2. Ngudi duqc bAo hi6m
Ld cd nhSn c6 tinh mang hoac tinh trang srlc kh6e duoc bao hi6m theo Hop d6ng b6o hiCm/Gi5y chrlng nhin bdo hi6m.
Nguoi dugc bio hi6m da hoan thanh viCc ke khai trong GiSy y6u c6u bio hidm vd hieu l\rc bao hi6m de dugc xac nhan
3. Nguoi y6u ciu bio hi6m
La ngudi dai dien nhu b6/me cho nhirng nguoi phu thuoc Ie con dudi 18 tu6i hoac vg/chong, con cia ngudi duqc bdo
hi6miron 18 tu6i dong ra ydu c6u vd kf i6t Hqp Odng bio hi6m v6i Beo hiam Bao Viet va dong phi bio hi6m.
4. Nguoi phv thuoc
Ld con cia Nguoi you c5u bio hi6m/ Ngudi duqc bdo hi6m theo tuat phap c6 d6 tudi t* 15 ngey tu6i dcn 18 tu6i hoac
24 tu6i n6u da;g theo hgc cac kh6a hqc dei han va chua kct h6n, kA t0 ngdy cd hiCu luc b6o hi6m hoAc ngay tai tuc bao
hiCm tiCp theo. ;at ca nhtng ngudi phu thuQc phii c6 tdn trong Danh siich y6u cdu dugc bdo hi6m.
5. Ngudi thg hudng
Le c6 nhan, hoic nh6m ce nhdn duEc ngudi ydu cAu bdo hi6m / ngudi duoc bio hi6m chi dinh nhan toan b0 hoac mot
ona" J" q"Vi" in' Uao hidm c;a Hqp d|ng bjo hi6m ndy. Ngudi thu hudng duqc ghi tcn trong GiSv v6u c6u bdo hi6m'
biay yeu cA, tra ti6n beo hiSm va trong GiAy chrlng nhdn b6o hi6m /H.gp ddng bio hiam. Trudng hgp khdng c6 chi dinh
ng|'roi tnu hrrOng gao hi6m Bao Viet sc giai quy6t theo cec quy djnh ve Thira ke crla B0 Luat Dan srr'
6. Tu6i duqc bio hi6m
La tu6i cia Nguoi ttugc beo hi6m vAo ngdy co hieu lqc cr:ra Hop d6ng bdo hi6m tinh theo lAn sinh nhat li6n truoc ngAy
Hep ddng c6 hi9u l!rc.
7. Hgp ddng bio hi6m
LdhEpd6ngduqck!'kotgioaBdohi6mBioVictvaNgu.oiy6ucAubdohi6m/Ngudidugcbeohi6m,theodoNgudiv6u c6u bdo hi6m/ NgLpoi dugc bao hi6m phdi d6ng phibao'hi6m, Bdo hi6m Bdo Vi€t cung c5p dich vq bio hi6m nhu'u"""lieiiu*,r""n ou'v re" uao niar. Gi5y ydu cdu iAo ni6mlQuy t6c oao hi6rn/Giey chr?ng nhQn bdo hidm /phu luc hqp
ddng ld mOt b0 ph?n kh6ng tech rdi cria Hqp ddng bio hi6m
8. Bing quy6n lEi bio hidm
Bing quydn lqi b6o hi6m cung c6p c6c th6ng tin iom t5t vA quy':n loi bdo hi6m' Bing quydn lqi bio hi6m duqc cap cUng
ve tj oO pnan knong tach rdi cia Hqp ddng bio hi6m.
9. T6ng hqn Mrlc Quydn lgi bao hiam/S6 ticn bao hiam
L?r hqn mr?c quydn lgi bio hi5m cia B3o hi6m BioVietd6ivoi Ngudi duqc bdo hi6m trong su6tthdi hanbaohi6m Han
;;;;;;;;;il oinrr trong ciiy chi'ns nhan bao hiam hoic Bdns quy6n lqi bio hi6m dinh kdm Quy t5c nev
10. Gi6i h?n phv
La gi6i han bdi thuong t6i da cho m6i h4ng mqc dugc quy dinh chi tiet tong Bang quydn lgi bdo hi6m Trong mqi
tr"i"g hqp, ia"g "a
tidi udi tnuong cac gidi han phu chi ti6t khong vuqt qua T6ng hsn moc quy6n lqi b6o hi6m'
11. Ngey hiCu lyc bio hi6m
Bio hi6m c6 hieu luc tD ooh:0.1 sSng ngay bat dau bao hi6m lan dAu ti6n hoac ngey tai tuc c0a Hqp ddng bio hi6m vd
duqc kct thic vao 23h:59 ngay nitia"ia" hi6m duqc ghi tr6n GiSy chung nhin bdo hidm hoac Hqp d6n9 bio hi6m.
ftigu tuc Udo hi6m chi dugc co'i ta liCn tuc trong trudng hqp Ngtldi y6u cdu bdo hi6m/Ngudi tlugc bio hi6m th\rc hign
t6i tgc Hgp ddng vdo ngay hoac truoc ngdy hCt han hiQu lr,rc cia Hqp d6ng c0
12. Thdi hln bio hi6m
Thdi han bao hiAm dugc quy dinh cv th6 trong Hqp d6ng bdo hi6m hoic Gi6y ch[png nhan bao hi6m. Thdi han bao hiSm
la mot (01) ndm, khOng chap nhan cec trudng hqp tham gia ngSn han ho{c b6 sung quy6n lqi gioa ki.
'13. Thdi gian chd
La thdi gian md cac quydn lqi bio hi6m c6 IiCn quan khong atuqc chi tre bdo hi6m bao g6m ci nhong tnrdng hEp thdi
diem phet sinh rui ro nam trong thdi gian chd nhung chi phi ph6t sinh hoac hau qua cia alqt diau tri nii ro ndy l4i k6o ddi
qu6 thdi gian chd quy djnh.
14. Pham vi l6nh th6
euy tic bdo hi6m ndy cung c6p bdo hi6m trong trudng hEp bi tai nan/6m dau vii nhong chi phi y te li6n quan ph6t sinh
tro;g lenh th6 ViCt Nam ngoai tru c6 nhung quy dlnh khec trong Gidy chung nhan bao hicm hoic phu luc
15. Tai nan
La bat ky sU kien bat ngd hay khong ludng truoc, gdy ra b&i m6t lltc tu ben ngoei, menh ve c6 th6 nhin thdy duqc xiy
.-a tronginoi nan odo hi6m, ti nguycn nnan truc ticp din d€n thuong tat than th6 hoac ch6t cho Ngudi dusc b6o hi6m
vii xdy ra ngodi sqr ki6m sodt cia Nguoi duqc bdo hi6m.
16. Thuong Qt th6n thd
Thuong tat than thd gay ra truc tiep bdi tai nan trong thdi han bdo hi6m d5n d6n Ngucri duoc bdo hi6m br thuong tat.
17. Thuong tat bO phan vinh vian
La cac thuong tat duqc liet kC kong bang ti le thuong tat hodc cac t6n thuong than th6 do tai nan gay ra ldm cho
Ngudi duqc bio hi6m vintrvi6n matii m6t phin khd ndng tao d6ng do hiu qud crla vigc bi c5t, mat hoAc mat khe ndng
si dung hoic tiQt m6t phAn co th6 mir voi di€u kiqn y h'c hiqn tai khOng co kha ndng khic phqc vd k6o dei trong vdng
52 tuan lien tuc.
18. Thucrng tAuten t4t toan bQ vinh vi6n
La thuong tautan tat lam cho Ngudi duEc bao hi6m b! can trd hoan toan khi tham gia vao c6ng vicc cia ngudi do hav bi
mat noanlodn khi ndng tao dQng trong b6t ky loai lao dong nao, k6o dai 104 tuen liCn tvc vd khdng hy vQng vao su tien
tri6n crla thuong tavtan tat d6.
19. 6m dau, benh tat
La tinh trang co thA co d6u hieu crla mot benh li kh6c voi tinh trang suc khde binh thudng duqc biCu hiCn bing cAc
trieu ch0ng hay hoi ch{fng c6 chin do5n cria B6c s!.
20. BCnh/thuong t?t c6 sin
La benh hoac thuong tat co tu trudc ngdy b6t dau dugc nhan bao hiam theo hep ddng bdo hi6m vd Id benh/thuong Et
mA Ngudi duqc bao hiCm:
a. DA phai djCu id trong vong 03 nam gan day.
b. La bet c0 tinh trang suc kh6e da dugc chan do6n: trigu chong bgnh/thuong tat da xay rai xuet hicn tru6c ngay
kghqp.l6ngmdNgudidugcbiohi6mdabi6tho6cythr}cduqcchoduNgudidugcbaohicmc6thucsukh6m, arieu tri hay kh6ng.
21. BCnh dic biet
Theo Quy tic bio hi6m ndy, nhong bCnh sau day dugc hi6u ld b€nh d6c biet:
(
)
1. B0nh hO th6n kinh:
2. BCnh hC h0 hap:
3. BCnh hC tuan hoan:
C6c benh viCm hC than kinh trung uong (ndo), teo hC th6ng anh hudng l6n h0
thAn kinh trung uong (benh Huntington, mat aidu vin oong di truyen, teo co cot
s6ng ve hoi chong liCn quan), r6i loan van dong ngoai thep (Parkison, r6i loan
truong h,rc ccr, r6i loan van dong va ngo4i th6p khac), Alzheimer, hoi ch0ng
Apalic/m5t tri nho, dong kinh, hOn mC, cac benh bai nao va hoi chfng liet kh6c'
BCnh suy ph6i, tran khi ph6i.
Bgnh tim, €ng/cao huyiSt 6p, tdng ap luc dong mach v6 cen, cec benh mach
m6u nao/dot quy va cac hau qua/di ch0ng cia benh ndy.
4. BCnh he ti6u h6a:
5. BCnh hC tiet nigu:
6. Benh hC noiti6t:
7. Bcnh khOi U:
8. Benh cia m6u:
ViCm gan A,B,C, xo gan, suy gan,sdi mat,
Benh cia ciu thdn, 6ng thin, s6i than va nieu quan,s6i duong ti6t nieu dudi,suy than
R6i loan tuy6n gi6p, at6i thao dudng va noi ti6t tuyen tuy, tuy6n thuqng than,
hOn mC, r6i loan cdc tuy6n noiti6t kh6c.
Kh6i U/buou lenh tinh cac lo?i.
R6i loan dong mau, r6i loqn chfc ndng ct]a bach ciu da trung tinh, bgnh liCn
quan m6 ludi bach huyet va hC ttr6ng luoi m6 bao, gh6p t!y.
9. Benh crla da vd mO li6n ket: Benh Lupus ban d6, xo cung bi toan then, xo c0ng rii r6c, xo crlng bi6u bi ti6n
trjan/cOt bcn teo co, loan dudng co va bicn chung crla c6c benh nay,
Penphygus, vdy ncn, mc day di ong m6n (c6 didu tri beng khang nguycn cianudc ngoai).
22. BCnh nghii nghi6p
BCnh nghd nghicp la bcnh phat sinh do ttidu kicn lao dong c6 hai crla ngh6 nghicp t6c dong d6i v6i ngudi lao dong.
Danh muc c6c toai benh nghd nghicp do B0 Y t6 vd Bo Lao dong - Thucrng binh va xa h6i ban hdnh. .
23. BQnh di truydn
Le bat ky bgnh nao xu5t hiqn d nhong ngudi c6 cirng huyet th6ng hay sq chuy6n nh0ng bCnh li cia b0, me cho con c6i
th6ng qua gen cira b6, m9 vdihoic dugc truyCn tir ddi nay sang ddi khac, tU thc he nay sang thii hc khac trong nhtng
ngudi co cing huy6t th6ng. Viec xec dinh benh di truyCn phai do b6c sy thuc hien
24. BCnh bAm sinh
Ld bat ky benh neo atuqc hinh thanh tr6n thai nhi trong qu6 trinh mang thai c|]a ngudi m9 dudi tac dong cia yiiu t6 m6i
tr"Jng f6" su ph6t tri€n cia thai nhi vd c6 th6 dugc Io quan y 16 m6 ta dudi nhidu t6n goi khec nhau nhu'b€nh b6m
.rr,, oi ta, bam sinh, khuyct tat bam sinh vir bat tnudng cia Nhi6m sic th6'. vicc xac dinh tinh trang bcnh bam sinh
phei do bac sY thuc hiCn.
25. Dich vqr van chuyan c6P c6u
Ld viec sO dung xe cuu thuong hodc phuong tien v?n chuy6n kh6c (kh6ng phei ld dich vg vin chuy€n bing dudng
heng kh6ng) trong tructng hqp Ngudi Ouqc U-do ni6m trong tinh trqng 6m dau/tai nan nguy kich anh hudng d6n tinh
mang ouoc ptrii oua ngudi bcnh den benh vign/ph6ng kh6m gln nhat ho6c t.| benh vien niry dcn bcnh vien khac.
26. Didu tri ciP cuu
Le viec diau tri khdn cap taj co sd y ti5 trong vdng 24h sau khi cd tai nAn hoAc trieu ch0ng 6m dau/benh tat c6 th6 nguy
hi6m d6n tinh mqng, suc khde cin ti,i6t pf'ai OiC, trl khdn cdp tqi phdng c5p cuu v?r hd so c6 dau xdc nhan cAp crlu crlta
co sd y t€.
Trlrdng hEp didu tri tai phdng cap cou chi vi li do ngoai gid phqc vq crla phdng kh6m/bcnh vicn thi dLrqc coi la dicu tri
ngoai tr0.
27. BCnh vi+n
Le mot co sd kham va diCu tri benh hqp phap dugc nhd nudc cOng nhan v':
- C6 khi ndng vir phuong tiCn chin tlodn bQnh, didu tri vd phSu thuit'
- C6 diCu kign thuan lqi cho vigc dj6u tri n6i tru, ngoai tru vd c6 hC th6ng theo d6i strc kho6 hang ngay cho c6c
benh nhan di6u tri noitrU, ngoqi tru.
-Kh6ngphai|dnoid6anduOngphqchdisockhdehoac|amotnoidacbietchicomucdichduynhat|aphqcvucho ngudi gia, duong tao hoal gitp oo cai nghicn rugu, thu6c phign, ma tui hoac d6 d16u tri r6i loan tam than,
diau tri benh phong hoac Ia ncti diau tri su6i kho6ng, x6ng hoi' massage'
28. Benh vien c6ng laP
Benh vien cong lap la t6 ch0c do Co quan nha nuoc co thAm quy6n thenh lap va quin lf theo quy dinh cia phep luat,
J tu cacn pnjp nnan, con ddu, tii kho6n va t6 ch6c bO may ke toan theo quy dinh cia phap luat va kc toAn d6 tnuc
hien nhiem vu cung iip dich vu c6ng hoac phuc vu quan ly nhar nuctc trong cec fnh vuc chuycn m6n kham chDa bcnh. ,
l'
29. Phdng kham
Ld co sd y t5 cung c6p dAy ttil cac co sd vat chat, trang thi6t bi y t6 phuc vu cho cOng t6c chen doan/kham va didu tri
bCnh nhan theo quy rtjnh. Phdng kh6m phai c6 GiSy ph6p hoqt ttQng kinh doanh hEp ph6p va chong chi hdnh nghd ciatirng ca nhan trong phdng khdm.
Li6n quan d6n cdc ch0ng tir h6a ddn/bien lai/phi5u thu chi phi didu td phat sinh t?i phdng kh6m hqp ph5p phiitudn thrl
theo quy dinh cia Ba Tai chinh/T6ng cuc thuc.
30. HC th6ng bao lanh vien phi
Ld he th6ng cec co sd y td c6 kf kCt thda thuan cung c6p dich vu bAo lanh vdi Bdo hi6m Bao ViCt. Ngudi dL?qc beo
hi6m khi kh6m ve djeu tri tai nhung co sd niry sA ttugc Bao hi6m Bao Viet bio l6nh thanh to6n cAc chi phi phdt sinh
thu6c pham vj bio hi6m va theo han mic quy dlnh trong Hop ddng/Gi5y ching nhan bdo hi6m. Ngudi duqc bdo hidm
phai tu chi tra cho nhong chi phi vud qua N4Oc trech nhiCm da tham gia trong Quy t6c bdo hi6m tai thd' diCm diitu tri.
31. Nim viQn
La viec benh nh6n phdi luu tru tai benh vien it nhat la 24 gio dC didu tri. Trong trudng hEp benh vien kh6ng c6p dugc
GiAy nhip vien hodc xuSt vien, h6 so y t€ hoac h6a don thanh todn th6 hlCn rd thdl gian diCu tri sc dugc coi nhu chong
tU t-nay tne. Don vi ngiry nam viCn duqc tinh b;ng 24h va theo don vi giudng nlm trong Giay ralxuat vien hoAc trong
cnrlng tir vien pni cni ti6t. ViQc dicu tri noi tr0 chi dugc chap nhan khi benh nhan dugc thuc hien dicu tri tai mot benh
vien nhu dinh nghia, khdng phdi ld phdng kham hay co sd dieu trl ngoai tnl.
32. Ti6n phdng va giuong
Cec chi phitidn giudng nAm dicu tri trong mot phdng don va cdc khoan chi phi liCn quan khAc phuc vU cho Ngudi dugc
bdo hi6m didu tri(khdng chi tra chi phi p-nOng Uao1,-bao gdm ci phdng chim soc dAc biet va cec chi phi chdm s6c y tit
can thiet khac do mot y te c6 beng cep chem s6c.
33. Chi phi y tC hEP liC6c chi phi y t6 phat sinh can thiCt hqp ly va chi liCn quan diin viec didu tri y t6 crla Nguoi duqc.bao hidm trong trudng
hqp 6m Oau, UCni' tqt, tai nan, bi6n chong thai s6n theo chi dinh cia bac sy thuoc pham vi bio hi6m'
34. Chi phi diAu tri truoc khi nh{p viQn
LA cac chi phi kh6m, ki6m tra, si6u am, chup chi6u, x61 nghiem co bin vi tidn thu6c theo chi dinh cia bac sy, lien quan
truc ti6p o6n bQnh/thuong tQt can phdi nhip viQn vd cdn theo doi, chi dugc chSp nhin mot lin gan nhat duqc thltc hicn
trong vdng 30 ngey truoc khi nhap vien.
35. Chi phi diiju tri sau khi xuat vien
Ld cac chi phi y tC ph6t sinh theo chi dinh cia b6c s! ngay khi Ngudi ductc bao hi6m xuat vien va c6 li6n quan tryc ti6p
d6n dot didu tri n6i tr1 truoc d6. Cdc chi phi ndy bao gdm chi phi kham, xet nghiQm, ch6n do6n hinh anh' vat tu y td vA
thu6c phat sinh trong vdng 30 ngay ke tir ngay Ngucri duqc bdo hi6m xuAt viqn'
36. Trq c6p bCnh vien c6ng
Ld khoin ti6n trq c5p trong trudng hgp Ngudi duqc bao hi6m ndm vien didu tri noi tro do 6m benh, tai nan tai cac benh
vien c0n9 lap.
37. Di6u tri Y ti5
Le viec phau thuat, di6u tri hoic ch0a tri theo chi dinh cria bdc s! v6i mvc dich duy nh6t le choa tri hoic lem giam nhe
tinh tr?ng benh tavthuong tat.
38. oiiru tri phuc h6i chfc nang
La phuong ph6p di€u tri nhlm mqc dich khoi phuc lai tinh trang binh thudng va/hay choc ndng sau t6n thuong cAp tinh
nodc Oo uEnn t6 tu khi ngudi bCnh dtuqc bac si chi dinh chuy6n sang d16u tri l3i chuyon khoa phuc h6i chttc neng'
39. PhAu thuit
La mot phuong phdp khoa hqc d6 diCu tri thuong tat hoac benh Ft duqc thltc hien bdi nhong phau thuat vion c6 bang
;;;;il;;;ffi;s l";a bang t"v 'oi cac dung cu y t5 hoic b:ns thict bi y tc trons bCnh viCn bao sdm nhons danh
muc liet kC dudi day valhoac ca" Oann mUc d,,q" ligt ke trong Sl}a ddi b6 sung nhu la mot bq phan dinh kem cia Quy
t6ciHqp Odng Udo hi6m nhu m6 phanh, m6 nqi soi, m6 bing tia laser' Phau thuat bao gom 02 loai:
,l
- Pheu thuat noi tr0: la hinh thr?c benh nhan sau ph5u thuat can phai luu tni tai benh vien it nhat 24h.
- Pheu thuat ngoaitro: la hinh thrlc benh nhan sau phAu thuat chi luu tru tai bCnh viCn dudi 24h.
40. C5y gh6p nQi teng
LA viec phSu thu6t d5 cAy gh6p c6c co quan nhu tim, ph6i, gan, tuy5n tUy, th6n, bao g6m ca tiy xuong cho Ngudi ttuqc
bdo hi6m ti6n hanh tai mot benh viCn bdi mot bac sy c6 bing c6p duqc ph6p thuc hien loai phau thuat nay. Cac chi phi
mua co quan cay gh6p vA todn bO cac chi phi phat sinh cho ngudi hi6n b0 phin co th6 khong duqc bao hi6m theo Ouy
tic bio hidm ndy.
41. Bac sY
Ld ngudi duqc cap giSy phep hdnh nghd hqp phap, duoc luat phap nuoc sd tai c6ng nhan ve bdc sy d6 dang aliCu tri,
hdnh ngh6 trong ph?m vi Giey phep duqc c6p vd trong ph?m vi chuyCn ngirnh ddo tao crla minh, loai trir nhirng b6c sy
cfrinfr ti Ngudi-Ouoc bdo hi6m, hay vq (ch6ng), b6 me, b6 m9 vo/chdng hodc con cia Ngudi duEc bao hi6m. Mqt bac
sy co th6 la mot b6c sy chuyCn khoa hay c6 v6n y td
42. Thutlc kC theo Don cia b6c s!
La nhong thu6c, duEc phdm dugc b6n vd si dqng theo Don cira B6c sy, theo quy dinh cia phap luat va khong bao
g6m thgJ phAm chpc nang, duqc my phdm, my ph6m, khoAng ch6t, ch6 phAm kh6ng ndm trong danh mV€ thu6c di6u tr!
ii" eO V i6, tt,u6" t6, vitamin. fry nnien, Bao ViCt s6 xem x6t bdi thudng thu6c b6' vitamin tai'i da 20% t6ng chi phi cga
ca toa thu6c khi th6a mAn cac dieu kiCn sau:
- Cdc loai thu6c b6 vi vitamin nay dugc su chi dlnh cia Bec sy di6u tti
- H6 trq cho viec diCu tri bCnh/tai n?n
- Trong toathu6cphai c6thu6cdiautri di kem
43. Cac b9 phanithiiit b! y tC h6 trq oidu tri.
Ld c6c b0 phan/thiet bi/dung cu Y tC
- ouqc dat/c6yltrdng vio bat cri mot bo phan nio crla co th6 d6 h6 trg cho chrlc neng hoat dong cia b0 phan
d6,baog6mnhirngdanhmuc|ietkeduoidAyv2r/hoicc-Scdanhmuct'uqc|ictk6trongsiad6ibdsungnhulam6.tbOphandinhkdmc&aQuytiaHqpddngb6ohi5mnhustent'vantim'bdngnong'diadgm'nep'vis'ch6t treo, mey tao nhip tim.
- C6 tinh chat dac thn, chi si dqng ri6ng cho tung loai hinh diAu tri hodc phau thuat, si dung mot lan va khOng
khau hao, bao g6m nhong danh muc liet ko duqi day valhoac cac danh muc duqc liet kA trong Siia d6i b6
sung nhu fa mOt oO pnanilnh kdm cia Ouy tec/Hqp d6ng bdo hi6m nhu dao cit svn' luoi bao' dao cit gan
sieu"am, dao c6t tri theo phuong pn6p Longo, rg tAn s6i trong ph5u thu?t l5y sdi'
- BCn ngoai co th6 c6 t6c dqng h6 trq chrlc n6ng vin dong hodc cdc choc ndng kh6c crla co th6 bao q6m nhong
danh muc liCt kC dudi day v;/hoAc cac danh m'c duqc li6t kd trong S&a d6i b6 sung nhu la mqt b0 phan dinh
rrJ,n "0"
OrV tidnqp tr6ng b6o hi6m nhu nang, nep, xe lan, thi6t bi trg thinh, kinh thu6c, mey h6 trq tim.
- C6c dung cu chinh hinh mang tinh chet tham my khac'
/t4. B0 phan gia:
La cec bO phan/thiet bi/ch6t ligu duqc lam gia dA thay thC cho cac bO phan cia co th6 bao gdm nh0ng danh muc liet kC
duoi d6y vd/ho{c cac danh muc ouqc ti6ixe trong soa o6i t6 sung nhu la mot b6 phan dinh kem crla Quv tec/Hgp
OOng o60 ni6m nhu ring gii, ch6n tay gid, th|]y tinh th6 gii'
45. Biiin ch&ng thai san
La tjnh trang b5t thudng crja bdo thai, bi6n ch&ng do nguyCn nhan.tai nan ho|c b6nh ly phat sinh trong qu6 trinh mang
tn"i",l" NsiJio""" ua"o tri5m lnhung thong tier;quan-d6n viec didu tri v6 sinh' sinh non, sinh nd) phai dicu tri theo chi
dinh cia bec sY.
46. vat lY tri liCu
Ldphuongphapphdngvachoabcnhbdngcachsfdung.c6ctacnhanvat|itltnhicnhaynhant?onhu:nudc'kh6ngkhi, nhigt dO, khi hau, dO cao, dien, tia X, t; cLPc tim, tia h'jng ngoai' si6u dm' c5c chet dong vi phong xa' xoa b6p' th6
!
J-1
duc - th6 thao, di bO, du6ng sinh... Quy t6c bao hiAm nay kh6ng bio hi6m c6c chi phi nham muc dich thu gian,
massage, spa, sl}a deng di.
47. Vat tu ti6u hao, vat tu thay thii th6ng thudng
La vat tu duqc sir dung mOt lan ho4c nhi6u lAn nhim muc dich h6 trq cho di6u hi vd kh6m choa b0nh, kh6ng l5p dAt
vinh vi5n trong co tha, ngoai tra, cac trudng hqp cac vat tu nay tu tiCu trong co thA hoac l€ ra co thd l5y ra kh6i co th6
ma kh6ng dnh hudng d6n chr?c ndng hoat dong cria co th5 nhung do co th6 khong atao thai non kh6ng c5n thi6t phii
l6y ra.
48. Oidu tri ngoei triLa viCc diau tri y t6 tai mot co sd y tdibcnh viCn/phdng khem nhu dinh nghia nhung khong nhap vien dicu td n6i iri.
Cac truong hqp diCu tri trong ngdy, ph5u ihu?Vtieu phau/noi soi chdn dodn benh trong ngAy duoc gidi quyilt theo quyen
lqi diou tri ngoai tr0.
49. Lin kh6m/didu tri
Le mqt tan ngudi benh duqc bac sy them kh6m lam sdng, thrtc hien c6c x6t nghiem, chan doan hjnh anh hav cdc th0
thuat them dd kh6c va /hoac sl], dung thuiic dj6u tri theo chi dinh cia bec sy tai ctrng mot c(, sd y te hop phap nh;m muc
dich chan doen benh/thuong tat va dicu tri.
- Trudng hop nhidu bec sy chuyan khoa cirng hoi chAn trudc mot ngudi benh theo quy ch6 benh vien thi chi
dugc tinh ld mot lan kham idieu tri
- Trudng h9p nguoi benh kh6m mot chuyCn khoa nhidu ldn trong ngay thi chi tinh ld m6t l5n khdm/d16u tr!
- Trudng hqp nguoi b€nh phdi kh5m nhicu chuyen khoa khec di co chi dinh c0a bec si trong cirng mOt ccv sd y
t6, trong mot ngay thl van chi tinh la mot lan kham/diCu tri
50. Odng chi tra
D6ng chi tra td s6 tian theo I le ma COng ty b6o hi6m, Ngudi duqc bdo hi6m cing chi tre khiphat sinh chi phi thuoc
pia'i "iUa"
ni6m cri" Ouy tj" Uio tridm.-O6ng chi trd duqc tinh theo t! lQ phdn trdm (%) tr6n t6ng s6 tiCn chi phi phat
iin't, tnuO" phqm vi bio hibm ho6c tr6n c6c muc gidi han phu crla quy6n tqi ngoqi tr. (hoAc n.i tr[r) ti]y theo muc neo
thAp fron thi dugc ep dung. Gioi han chi phi duq;bao hi6m sau khi d6ng chi tra t6i da beng gioi han cia mqc quyen lgi
trong Bang quygn lqi bao hi6m.
II. DOI TUqNG THAM GIA BAO HIEM
:
Dieu kien duqc tham gia bdo hirim theo quy tic bao hiCm nay:
1. Ngudi dugc bio hiam ta mai cong dan vict Nam hodc ngudi nudc ngoai cu tni tai vict Nam tir mudi l;m (15)
ngay tu6i atCn seu muoi l6m 105);ailgi tnji Oi6m U6i Adu niQu lqc cga Quy tic bio hi6m. Ngudi duoc bdo hi6m
cii auqc tnam gia d6n sdu .ooi tar 1OS1 tu6t vdi didu ki€n dA tham gia li6n tuc truoc do ti-f n;m seu muoi (60)
IUOI.
2. Trudng hqp tre em dudi muoi tam (18) tu6i chi tluqc nhQn bdo hiBm vdi di6u kien phai tham gia b6o hi6m cirng
hqp ddng vdi 86 va/hoac ve i'oi" eOlre da tham gia it nh6t mqt loai hinh Bio hiam Srlc kh6e, chi phi y t6 cdn
trigu iuc iai eao hi6m Blo Viet. Cnuong trinn bio hi6m cia ngudi phu thuqc chi tluqc ap dung m6c tuong dudng
hoec thep hon chuong trinh cia Ngudi duqc bao hiCm'
3. D6i tuqng trC em tir 15 ngary tu6i dCn 3 tu6i, quy6n loi chi phi y t6 noi tni va ngoai trrl 6p dung theo ti l0 d6ng chi
tra duqc quy dnh trong Bdng QuyAn lqi bdo hi6m dinh kdm'
4. O6i tugng tr6 em tu 15 ngay tu6i d6n1 tudi chi du.o..c tham gia voi di6u kiQn: cung €p Gi6y Y6u c5u bdo hi6m
trong uni;trang srlc khde t6t va khi tr6 d:i xu6t vign, iham gia carng b6/me nhu,da dA clp d tr6n, chi duoc tham gia
chuong trinh Bach Kim/ Kim cuong, phi bao hiam bdng 150% phi cda do tu6i 1-3 theo chuong trinh tham gia
tu'ong ung.
III, KT KET/HOY BO HgP OONG BAO HIEM VA TAI TUC HgP DONG BAO HIEM
't.
3.
Khi c6 yOu cau tham gia bAo hidm, Ngudi yeu cdu bio hi6m/ Ngudi duqc bao hi6m phei k6 khai trung thqc ddy
drl noi dung tren ci6y ydu cAu bio hi6m. Gi6y y6u c6u bdo hiem la mot bO phan kh6ng tech roi cua Hqp ddng bdo
hi6m. Vigc kC khai trung thuc ve chinh xac ld didu kien ti6n quy6t quyCt Oinh trdch nhiem crla Bdo hi6m Bdo Vi€t
voi Ngudi dugc bio hi6m.
TrCn co sd Gi6y y6u cAu bio hiam, 86o hi6m Bio ViCt sA cap cho m6i Ngudi duqc beo hi6m mot GiSy chrlng
nh?n bAo hi6m. Gi6y chung nhan bio hi6m dugc coi la bing ch&ng giao k6t Hqp ddng b6o hi6m.
Trudng hqp mot trong hai b€n mu6n hui b6 Hqp d6ng bdo hi6m phei thdng b6o bing vdn ban cho bCn kia biCt
truoc 30 ngay kC tt ngay dinh hui b6.
- NCu Ngudi y6u c6u bio hi6m /Ngudi duqc bao hi6m y€u cdu hu!' b6 Hqp ddng, Bdo hi6m Bdo ViQt sE hoirn
trd 80"/" phi bdo hi6m crla thdi gian con tqi voi dia:u kiCn trong thdi gian hieu luc coa Hqp ddng bdo hi6m chua
c6 khi6u nai dditri tien bio hi6m ndo xdy ra.
- N6u Bio hi6m Bdo Viet ydu cau hu! b6 Hqp d6ng, Bio hi6m Bdo ViCt sC hoan tra toan bO phi bdo hi6m cria
thdi gian cdn lai cho dU c6 khiiiu nai doi tra ti6n bdo hi6m hay chua'
- N6u Ngudi dugc bao hi6m hoic dai dien Ngudi duoc bdo hi6m co b6t ky khiiiu nai nao thd hien gian lan hay
tn6ngirung th\_rc hoac n6u c6 hdnh vi gian d6i hoAc co muu k6 trvc lqi bdo hiOm vO bat kl phuong dien neo
nnanifSy 6"en bio hi6m thi Hqp d6ng Ud-o ni6m se b! htiy bd ngay lap t1i,c va Ngudi duoc b6o hidm s6 mAt toin
lO orvc" oi oj" ni6m , odng thoi -Ngudi
y6u clu b6o hi€m/ Ngudi atuqc bdo hi6m phdi hoan tra t5t c6 Gi6v
ch1ng'nhan bao hi6m vd thalao friOir cno Bao hi6m Beo ViCt. Bao hi6m Bao ViCt hoan lai 70% phi bio hi6m
crla thoi gian cdn lai voi didu ki6n chua co b6i thudng nao duqc chi tra trudc do '
Trong trudng hqp Hqp ddng bao hiam tai tqc lien tuc, hieu luc bao hi6m s€ chAm dit vao ngay het han dau tien
sau igdy sinn nh6t tho seu muoi lem (65) c|]a Ngudi duqc bao hicm
Cu6i thdi han beo hi6m cen cu lich sr) bOi thuong coa Nguoi dugc bdo hi6m, Bao hiam Bao Viet c6 quydn tu ch6i
t6i tuc hqp d6ng hoic di6u chinh €c od, ilQn, g;i nan phu c6c quy6n lgi b6o hi6m trong Hqp d6ng bdo hi6m
v. BAO HIEM TRUNG VA BAO HIEM KHAC
V. PHi BAO HIEM VA SO TIEN BAO HIEM
u. KET THUC OUYEN Lq| BAO HIEM
lt'
)Trongtrudnghqpchiphiytclicnquantoicingthuongtat,bcnhtatdugcbiohiCmtheoquytScndyc6theddibdiinroin iJ"f*"n *i hinhlao hi6m khac, g6o hi6m BdoVi€l chi thanh toan khoin ti6n vud que mi'c duqc b6i thudng
theo c6c Quy tac kh,rc do hoac theo ti lc gira s6 ticn bio hi6m cria Quy tac bio hi6m ndy voi t6n9 gidi h?n trach nhiem
cia t5t ca Quy tic bao hiAm khac.
Phi bao hi6m quy dinh trong Bi€u phi dinh kdm Quy t6c bio hi6m n2ry' phi bio hi6m phq thuQc vao chuong trinh bao
hi6m, dq tu6i cia Ngudi duqc bao hi6m khi tham gia/t6i tuc bao hiCm'
Thay d6i quy6n lgi: ci6i han trach nhiQm cria c6c quydn lqi khOng th6 thay at6i trong su6t thdi han Hqp dOng bio hi6m'
*'ii|,n o"ilil"' iay chi co rh6 duqc thay d6i vdo ngiy t6i tuc cia Hqp ddng b6o hi6m. Trudng hqp tai tuc voi 56 tian
bao hi6m cao hon ho6c tham gia them qryan tqi Od *ng "o
voi nam trudc phai dugc su ch5p thuAn crira 96o hi6m Bdo
Vie, "a
,1,li-"1'C"fr tCcn vd s6ii6n b6o hi6m c0n9 nhu quy6n lqi tham gia them mc/i se kh6ng duqc coi la tai tuc li6n tUc
v2r duqc 6p dung thdi gian chd theo quy d!nh.
T6t ce cac quy6n lqi bio hi6m theo Hgp d6ng bio hi6m ndy s6 ch6m-dut hlcu luc veo 23h:59 gid d6m cia ngay cu6i
;;;J;;';" Lio ni6m noac vao ngay "-h6r
dur hi€u irrc bio hi6m do ch. hqp d6ns bdo hi6m you cau tiv theo
thdi di.im nao dOn tru6c bao g6m ca nh-Ong rii ro phat sinh trong thcti h?n bao hi6m nhung hQu quA xiy ra nqoai thdi
han bao hi6m.
VII. TRUONG HqP DAC BIFT
Trong trudng hqp Ngudi tluqc bio hi6m tham gia cac tan thi d6u hoic c6c c oc dua chuyon nghiQp nhu itua xe, dua
ngua, da b6ng, quydn anh, leo nUi, luol ven, luctt s6ng hoac tham gia vao cac hoat dong kham pha kh6ng gian, khem
pna cac vtrng d5t moi, cac khem ph6 khoa hqc, hoAc cac hoat dQng khec nhu sin bin, thirm hi6m t€n n0i, Nam/B5c
CVc, ltrc lugng tham hi6m khi xdy ra tai nan, Bao hi6m Bao ViCt se kh6ng bio hi6m trir trudng hqp dA tluqc ch6p nhan
bing vdn bin cria Beo hi6m Bao ViCt ve phi b6o hi6m b6 sung tl6 d6 dugc thanh toan
vilr.NGHIA VU CoA NGUOI DUEC BAO HIEM
1. NgLrdi tham gia bao hi6m kC khai trung thuc diy d0 cAc noi dung trong Gi5y ydu cdu bdo hidm cira Bdo hi6m 86o
vicr.
2. Ngudi duoc bao hi6m phdi cung c6p trung thuc c6c th6ng tin v?r chung cu vi! rii ro duqc bio hi6m ve mai chi phi
li€n quan d6n vigc cung c5p h6 scr khdng thuoc kach nhiem ct]a Bao hi6m Bao Viet'
3. Uy quydn cho Bio hi6m Bao ViCt thay mat Ngudi dugc beo hi€m d6n bdnh viQn sao luu hd sd phuc vu c6ng tac
bdithuong.
4. Ngudi duqc bdo hi6m c6 nghia vu thong b6o cho Bao hi6m Bao Viet trong trudng hqp sau:
- B5t ki'thay d6i ndo vi: dia chi, nghe nghiQp hay cdng viQc dang l)m'
- B6t ki tinh tr?ng thuong tat, 6m dau, khi6m khuy6t hay khuy6t tat co th6 ph6t sinh cho di tru6c khi tham gia
bdo hi6m hay sau khi tham gia bao hidm.
- Bat ki loai hlnh bdo hiem khec dang c6 hieu lvc crla Nguoi duoc bdo hi6m'
Trudng hgp Ngudi tham gia bao hi6m, Ngudi duqc b6o hi6m hoic Ngudi thu hudng quy6n lqi bdo hi6m kh6ng trung
thuc ve/hoac kh6ng tuan th6 d6ng cac qri oinn trong Quy t6c bdo hi6m niy, Bao hi6m Bao Viet tLr ch6i chi ka tiAn bao
hiCm.
IX. THCYI HAN KHIEU NAI VA TRA TIEN BAO HIEM
1. Thoi han kh6ch hrAng ndp hd so y€u cau baii thudng trong vong 60 ngay kA t'r ngay di6u tri cu6i ctrng cia moi dqt
diau tri hoac ngay NDBH ti| vong vd kh6ng qu6 01 nim k6 ti.r ngdy x6y ra s|,| kien bao hi6m Qu' thdi h?n ken'
eio viet "O
qr'iven tt'"r't6l mQt phan hoac ioan bQ y6u ciu bdi thuing c!1a khAch hang Thoi gian xay ra s\r kign
b5t khe khang hodc tfo ngai khech quan kh6c kh6ng tinh vao thoi h?n yeu cau lra tidn bao hiam hoic bdi thuong'
BAohi6mBdoVi€tcotr6chnhiemgiaiquyiitvachitr6tidnbdohi6mtrongvdngmudi|.m(15)ngdylamviccketungiry nhin du<rc hd so yeu ceu b6i thudng day drl, hqp lg
Ngudi duoc b3o hi6m co quy6n khi6u n4i vii viQc trd ti6n b6o hi6m crla Bdo hidm Bao viet trong vdng s6u (06)
tnZng 16 ti ngay nhan duqc th6ng bdo crla Bdo hi6m Bio Vict va b5t c0 khi6u nai/khi6u kion ndo cgng kh6ng
duqc vuqt que ba (03) nam kA tu ngay ph6t sinh tranh chap'
Mgi tranh chSp ph6t sinh til Quy t5c beo hi6m n.ry md kh6ng th6 gi6i quy5t bing thuong lugng s6 dugc gidi quv6t
A toa an cla ViCt Nam va theo luat phap Vigt Nam'
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X. KEMTRA
Bio hiAm Bdo Vi€t c6 quyAn th6ng qua c6c chuyen vien y t6 ki6m tra tinh trang soc kh6e cia Ngudi duqc bao hi6m vao
bet ky loc nao khi can thi6t trong su6t thdi gian khi6u nai hoac irong thdi han bdo hi6m. Ngoai ra, Beo hidm Bao MCt c6
quy6n you cAu kh6m nghiem t0 thi trong trudng hqp chet n5u viCc khem nghiCm nay kh6ng trai voi phap luat.
XI. LUAT CHI PHOIVA GAI QUYET TRANH CHAP
BAt ky mau thuSn ! ki6n vi: chuy6n m6n y ti! ndo li6n quan diin phuong ph6p di6u tri tai nqn hoic 6m atau dugc giai
quy6t ndi hai (02) chuyCn gia y te do c6c bCn chi dinh bdng vdn bin. Chi phi phdt sinh phuc vu cOng tec giai quy5t b6i
thudng s6 do ben thue chiu tr6ch nhi6m. Ndu f kion c0a hai chuyon gia y te tr6n kh6ng th6ng nhat thi sC duqc giei
quyet tnOng qua mOt (01) trgng tdi do hai chuyen gia y te chi dinh bing vdn bdn ngay tu ban dau. Trudng hqp cac ben
kh6ng thA gidi quyCt beng thuong lugng s6 duqc gidi quy6t d tda 6n coa MCt Nam va theo luat phap Viet Nam (m9i chi
phi li6n quan d6n en phi sC do toa 6n quyCt dinh)
PHAN II: DIEU KHOAN BAO HIEM CHINH
DIEU TRI NgITRO DO OM DAU, BENH TAT, TAI NAN
1. Quydn lcri biio hi6m
- Bio hi6m cho trudng hqp 6m dau, benh Et, tai nan bao gdm ci bi6n chrlng ihai sdn xdy ra trong thdi han bao
hi6mkhi€nNgudidugcbiohidmphiinimviQndieutr!noitrovahoacphauthuatnoitr|jtaibenhvicn'
- E6ituqng tr6 em tir 15 ngdy tu6i dan 3 tu6i, quy6n lqi ndy dp dr'rng theo t lC dong chi tre duqc quy dinh trong
Bing quydn lEi b6o hi6m dinh kdm.
a. Trudng hqP nim viQn
Trudng hgp Ngudi duqc bio hi6m phii nim viQn thuoc piam vi bao hi6m, Bao hiam Bao vieJ s6 thanh to5n c6c chi phi
oicu tri tien phdng vd giudng, ti6n in theo ti6u chuAn di6u tri ngi tr0 cia bQnh viCn (neu c6), chi phi x6t nghiem' hoac
"i" pi"r"n inlo "hin
ooa-n hinh 6nh nhu X-quang, MRt, CT, pET, sieu am, nQi soi (c6c x6t nghiQm nlv phdi do bdc
sy chi dinh te bien ph6p can thicr dt;anh gi6 tinh tr;ng benh ve phai la m6t phan cia chi phi didu.tri ndm vien), thu6c
iiu" uiiru,6n *"1 o xy, nuyct tnann, qudn- ao oCnn viqn ve c6c chi pni v te lie" q*l kh:" :1,""916i
da-khons qua si6i
;.; ;;; ;;; tai ngav d16u ii quv djnh trons Bdng quvdn lei hoAc Giav chlrns nhan brio hi6m T6ng so nsav dcu tri
duoc x6t trd ti6n b6o hi6m khong qua 6o ngallnam-va ttng s5 tiatn khong vugt qua s6 ti6n bio hi6m quy dlnh cOa quy6n
lqi di6u tri noi tr0.
b. Trudng hop Phau thuat
TrudnghgpNgudidugcbaohi6mphaiphauthuatphainSmviOndidutrinOitrothuocphamvibio.hi6m,BSohi6mBioViCt s6 thanh to6n toAn bO cac chi ptri t'Oi"nAn, gay me, h6i s0c, chi phi phau thuat bao gdm ci ph5u thuat c5v gh6p noi
;fiiil;; bao hi6m cho chi phi mua cac bO ph,-an nOi tang vd chiphi hi6n n6i tang). Gidi han s6 ticn chi tra cho trudns
hqp phau thuat kh.ng vuqt muc giOihn t6iia Oo f.rguoi duqc bAo hi6m lpa chqn khi tham gia bao hiAm va duqc ghi
"u itr'6 trong GiSy
"hrlng nhan bdo hi6m hodc Hqp ddng bdo hi6m'
Trudng hqp phau thuat ngoaitr0 khdng duEc chi ra trong quyen lqi nay'
c. G5c quydn lqi bao hi6m khec (giii hgn quydn tEi 'ruoc
liCt kA chi ti5t trong Bing Quydn lgi bio hi6m)
- Chi ohi dieu iri trudc khi nhap vign ph6t sinh trong vdng 30 ngay trudc khi nh?p viin
- Chi phi dieu tri sau khixuat vien trong vdng 30 ngay sau khi xuat viCn
- Dich vu xe cou thuong' xe cdp cou bdng cludng b0
- Ph\rc h6i chuc neng.
- Trg c5p benh vien c6ng.
- Trq cap maitang phitrong trudng hqp tl} vong tai bCnh vien
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10
2. Hieu lpc bao hiom
Bao hi6m c6 hieu l!"pc sau thdi gian chd dudi day ka tr:r ngay b6t dau thoi han bio hi6m quy itinh tren Giay chong nhan
b3o hi6m:
- 30 ngdy tt6i vdi kudng hgp 6m dau, benh tat (bao gdm ca thoi gian ph6t benh cho d6n khi k6t th0c dqt dicu
trininh theo thdi di6m c6 benh, kh6ng tinh theo thdi di6m di6u tri).
- 90 ngay d6i v6i biiSn chrirng thai sin nhu dinh nghia k6 lir ngdy tham gia b6o hi6m.
- 365 ngay d6i vdi benh co sen va c6c benh duqc liet kc tai Di6m loai tri chung s6 36 cl]a Quy t5c bio hi6m
- 365 ngey ddivoi bCnh ddc biCJ theo dlnh nghia.
- 180 ngey d6i vditre em dCn 6 tu6i : bQnh vi€m phil qudn, ti6u phe qudn, vidm ph6icac loai.
PHAN III: DIEU KHOAN BAO HIEM BO SUNG
Cdc quy6n lgi b6 sung sau day s6 duqc cdp cirng vdi Quy t5c va la mot b9 phan khong th6 tach rdi Quy t5c b6o hi6m
nay.
C6c quydn lqi b6 sung ndy chi dugc 6p dung trong trudng hqp dusc ghi 16 rdng ld dusc bdo hi6m trong Bang t6m t'tf,qp aOng bdo hi6m hoic Gi5y chfng nhan bao hi6m va dugc gjai quyet b6i tfruong cen c0 vao c6c dinh nghia, cec
di6m loaitru ougc quy dlnh trong ph6n Quy6n lqi chinh cr)a Quy t5c nriy n6u khdng c6 quy dlnh neo kh6c'
DIEU KHOAN BO SUNG 1: DIEU TR! NGOAI TRO DO 6M gNU, BENH TAT, TAI NAN
1. Quyiin lgi bio hi6m
Bio hi6m 86o Viqt s6 thanh toan cho Ngudi duqc bdo hi6m tham gia Di6u kho6n bd sung ney c6cchi phi y tC phat sinh
di6u tri ngoai tr6 do 6m ttau, bqnh tit, tai nan bao gdm ca bi6n chong thai san trong thdi hqn bio hi6m bao g6m:
. Chi phi kh6m, c6c x6t nghiem, chan doan hinh anh, thi thuat them dd, vat tu y t6 tiCu hao th6ng thuong theo zchidinh cia bec si.
. Chi phithu6c theo kC don coa bec si. .
. Chi phi phau thuat ngo?i trr!, nQi soi chdn do6n nhudinh nghia cia Quy tac'
. Vat ry tri ligu, ti lieu hQc buc xa, lieu phep 6nh sang do bac sy chi dinh' )
Gi6i han trach nhigm theo cac quyen tqidugc quy dinh cu th6 trong Bang QuyCn lqyciey ching nhan bao hi6m va/hoAc \Hqp tt6ng bio hi6m dinh kem.
D6i tugng tre em ti} 15 ngdy tu6i o6n 3 tudi, quydn lqi nay 6p dung theo ti lo d6ng chi tra dugc quy dinh trong Bang
Quydn tqi bdo hi6m dinh kCm.
2. HiQu lpc brio hi6m
Bio hi6m cd hiQu tpc sau thoi gian cho du6i day ke ti, ngay bet dau thdi han bao hi6m quy dinh tr6n Giay chung nhan
bdo hi6m:
- 30 ngay at6i voi truong nqp 6m dau, bCnh tat (bao g6m ci thdi gian phat bCnh cho dcn khi k6t th0c dqt dicu
tri/tin; iheo thdi dicm co bcnh, kh6ng tinh theo thdi diem dieu tri)'
- 90 ngey d6ivdi bi6n chrlng thai san nhu tlinh nghia k6 tt ngay tham gia bao hi6m'
. 365 ngey d6i voi b€nh c6 san vir c6c bcnh duqc |ict k6 tai Di6m loai trt? chung s6 36 cOa Quy t5c bio hi6m.
- 365 ngay d6ivdi bCnh dac biet lheo dinh nghia'
- 180 ngay d6i vdi tre em d6n 6 tu6i : bCnh viCm ph6 qu6n, ti6u ph6 qudn, vi6m ph6i cac loai
DrEu KHoAN BO suNG z: BAo HIEM TAI NAN cA NHAN
t. Quyiin lqi bio hi6m11
Bio hidm cho lrudng hqp ch6t, thuong 6t ban bQ vinh viSn hoac thuong tat bO phan vinh vi6n do tai nan xay ra trong
thdi han bio hi6m.
. Trudng hqp Ngudi duqc bao hiem ch6t hoac thudng tat toan bO vinh vi6n do tai nan thuoc pham vi bdo hi6m,
86o hi6m 86o Vi€r tre toan bO s6 ticn b6o hi6m tr6n Gi6y chong nhan bio hi6m hoic Hqp trdng bio hi6m.
. Truong hqp Ngudi dugc bao hiem bi thudng tat bO phan vlnh vi6n do tai nan thuoc pham vi bao hi6m, Bdo
hiem Bao ViCt lra theo Phu lrJc I - Beng I l€ tri ti6n thuong t€t tai Quy tic b6o hi6m ndy.
. Trudng hgp Ngudi duqc bao hi6m bi tai nqn dan d6n thuong tat b9 phan vTnh vi6n da duqc tre tidn bdo hi6m,
trong vdng 365 ngay kA tu ngay xay ra tai nan Ngudi duqc bdo hi6m bi ch6t do hiu qui cia chinh tai nan tt6,
Bdo hi6m Bao Vigt s6 tra phAn ch6nh l6ch gi0a s6 ti6n bdo hi6m ghi trong Hop d6ng hoic GiSy chrlng nhQn
bao hiam voi sO tiAn dd kd truoc d6.
2. Hilu lr,rc bio hidm
86o hi6m c6 hieu luc ngay khi bet dAu thdi han b6o hi6m quy dinh tren Gi5y ch0ng nhin bio hi6m'
DIEU KHOAN BO SUNG g: BAO HIEM SINH MANG
1. Phem vi bao hi6m
Bdo hi6m trudng hop ch5t hoic ten tat toan bo vinh vi6n do nguyen nhan khdng phai la tai n4n xdy ra trong thdi han
bao hi6m tri.p nhung di6m loaikir quy dinh tai PhAn lV cria Quy tic bio hi6m ndy'
2. HiCu lt?c bio hi6m
Bao hidm c6 hiCu luc sau chin muoi (90) ngay k6 tir ngdy d6ng phi bdo hi6m ct6i vdi bCnh thOng thudng. C5c hgp tl6ng
bdo hi6m t5i tuc liCn tuc mac nhiCn c6 nier'rtrrc ngay sau khi Nguoi yeu cau bio hi6m/ ngudi duqc bao hi6m dong phi
cho ki' ticp theo.
D6i v6i trudng hqp chOt do bqnh di|c biCt, bQnh c6 s5n, benh liet kC s6 36 trong Di6m lo?i tri] chung cia Quy tac ndy'
bi6n ch6ng th;i ;n, Ouy tac bao h;Am chi co hiQu lqc d6i voi Ngudi duqc bio hi6m tham gia theo Quv t5c bdo hi6m
nay lien tuc sau mot nem (01) trd lCn.
3. Quyan lqi bio hi6m
Trudng hqp Ngudi duqc bdo hi6m ch6t hoac tain €t toen bo vinh vi6n thuoc pham vi bio hi6m, Bao hi6m Bao vict tr6 l
toan b9 s6 tien bdo hi6m ghitr6n Gi5y chrlng nhan bao hi6m hoAc Hqp d6ng b6o hi6m l
.!'
DIEU KHOAN BO SUNG A: EAO HIEM NHA KHOA
-
;,
Bdo hi6m Bio Vi€t se thanh to6n cho Ngudi duoc b6o hi6mchi phi y t6 di6u hi rdng benh ly bao gdm:
. Khiim vd ch5n doan bOnh
. L5y cao ring
. Trem rang beng cac chat lieu th6ng thudng
. Nhd rang benh lY
. Liy u v6i rdng (lay voi rang sau dudi nudu)
. Phau thuat c6t ch6p rang
. ChOa tiy rdng
. Di6u tfl viom nuou, vi6m nha chu
DiAu fi rdng dupc gioi han tAi cAc co sd kh'm chira bCnh nhLr sau:
- TAi Thdnh ph6 H6 Chi Minh ve Hd NOi: 86o hi6m diiu td rdng tqi.t* ce c6c b1nh vien( theo dinh nghia trong Quiy
t6c) . Ri6ng tai cec phdng Nha/ phdng khem chi ch6p nh4n b6o.hi6m voi dieu kien c6c phdng Nha/ phdng kban nay
de'co Th6; thuan hqp tAicung c p dlch vu thanh toan clli phi yt6v6i BAohi6n BAoviCt
- Tai c6c nnh/ Thanh ph6 khec: md rQng bdo hidm viQc di6u td rang tai c^c phong Nha/ phdng khAm co gi6y phop
dang ki hanh nghA hqp PhaP.
' Lu|i: Beo Viet kh'ng thanh toan cho dicu n rdng tai Phong nha Hanh Ph(tc (Happy), 26 HAm Nghi' Dd Ndng' Nha
khoa iiCt Phap, 24 Trdn Duy Hung, He NAi ; Nha ihoa ozi Nam - 328 Ong lch Khiem' Thanh Khe' Ea NAng e
DIEU KHOAN BO SUNG 5: BAo HIEM THAI SAN
Ngudi duqc bdo hidm c6 dO tudi tir18d6n45tu6i
Ngudi duqc bao hi6m phdi tham gia Di6u khodn chinh, tuong duong chuong hinh Bach Kim hoic chuong trinhKim Cuong.
o6i vdi bi5n ching thai san: Ngoai viec dugc hudng theo quy6n lgi bdo hi6m b6 sung nay, Ngudi atugc bao
hilm se dugc hudng thdm quy6n lqi t6i da thuQc ph?m vi bio hi6m theo diAu khoan chinh vA di6u khoan didu tri
ngoai tro voi dieu kien cung cap d6y dri hd so chrlng tir v6 y t6 vA h6a aton theo qui ttlnh.
Dorr v!: vND
Thai san BACH KIM KIM CUONG
GiOi hen trech nhiqm toi da cho
mot thoi han bao hiAm21.000.000 3'1.500.000
Phi bio hi6m / nguoi / nim 4.800.000 5.500.000
'1. Quyirn lqi bio hi6m
a. Bi6n ch0ng thai san ve sinh kh6
Bao hi6m Bao ViCt se chj tre c,c chi phi y tO phat sinh do c6c bi6n chung trong qua trinh mang thai, hoac trong qua trinh
sinh nd cdn d6n cac thi thuat sin khoa, chi phi chim s6c m9 trucrc vd sau khi sinh tai benh vien. Thi thu?t sinh m6 chi
duoc bao hi6m n6u do bac si chi dinh ld can thict cho ca sinh d6, khong bao g6m vi$c sinh m6 theo ydu cau (hoac phai
m6 lai do viec yeu cAu m6 trudc d6). Bi6n ch(fng thai san va sinh kh6 bao gdm vd kh6ng gi6i han trong c6c trudng hqp
sau:
. Siy thai ho;c thai nhi chat trong til cungl
. lvlang thai trung nuoc;
. Thai ngoali t& cung;
. Bang huyct sau khi sinh;
. S6t nhau thai trong tt) cung sau khi sinh;
o Phd thai do diAu tri bao g6m c6c iruong hqp pha thai do cac
hoAc phai phe thai dA bao vC tinh mang cia nguoi me;
. DQa sinh non
. Sinh kh6
. Bi6n chong cia cac nguyCn nhan tron
benh ly di truydrv oi tat b,m sinh cua thai nhi
I
b. Sinh thudng
Bao hiem Bao ViOt se chi ta c6c chi phi y t6 phat sinh cho viec Sinh thudng bao gdm ve kh6ng gidi han trong cac chi
phi: ctd d6, vign phi tdng hqp, bac si chry6n ino", chem s6c me tru6c va sau khi sinh tai bgnh viCn, chi phi may them
my dudng rach.
2. HiQu h.rc bio hi6m:
- O6i vdi sinh nd: Quvdn lqi bao hiAm nay duqc chitre voi di6u ki6n sau 635 ngey k6 tir ngdy hqp d6ng b6o hi6m c6
hiCu lvc-E6i voi bi6nchongthai sen: Sau 90 ngdy kA tu ngey hqpd6ng beo hiCm c6 hieu llrc
Lu,u y; cec chi phi sinh m6 kqn goi phat sinh t?i c6c bcnh vicn phu san He noi, phu san TW va b6nh vjcn cong( ndu phat
sinh tuong lrt) dugc thanh toen toan bO bao g6m ca truong hqp khOng b6c tach duoc bAng ke chi tjCt tu cec bCnh vien
ney.
13
PHAN M: cAc DIEM LOAI TRU CHUNG
(Ap dgng cho Di€u khoan chinh va tet ca cac Diau khoan b6 sung)
Bio hi6m Bio Viet khong chiu trach nhiem chi tri ti€n bao hiam d6i vdi cac rii ro xdy ra do cac nguyCn nhan sau:
1- Hanh along cO i cia Ngudi duEc bio hi6m hoic Nguoithtra kC hqp phap.
2. Ngudi duqc b6o hi6m tir 14 tu6i tra l6n vi pham phap luAt phai thu 6n hinh su va/ hoac vi pham Luat an toan giao
th6ng;vi pham noi quy cia co quan theo Luat lao dong.
3. Ngudi duqc b6o hi6m didu khi6n phuong tien giao thdng khi c6 ndng dO c6n trong m6u vudt qud m|}c quy dinh
crla Luit an toan giao thOng va Ngudi dugc bdo hi6m bi dnh hudng bdi ruEu, bia hoAc cac chat kich thich, cdc
chAt gey nghien khec ld nguyon nh6n d5n d6n tai nan hoic 0m bcnh.
4. CAc hanh dong dAnh nhau cia Ngudi atugc bao hi6m, tri khi chung minh duEc hanh dong danh nhau d6 chi voi
muc dich tu ve.
5. Hau qua cia tai nqn xdy ra ngoirithdi han bdo hi6m 6p dung ri6ng ddr vor Chi phi y t6
6. Didu tri y te hoac s0 dung thu6c khOng c6 don thu6c vd sq chi d5n crla bac sy; cac loqi thu6c dong y kh6ng 16
ngudn g6c, cac phdng kh5m, chdn trl d6ng y tu nhan.
7. Tham gia vao c6c hoqt dQng h2rng kh6ng (hi,t khi voi tu c6ch la hanh khach), tham gia cec cuQc di6n tip huin
luyCn quan su, tham gia chi6n d6u c|]a luc lugng vi trang.
9.
10.
11.
12.
13.
17.
14.
15.
'16.
Nhiing rii ro mang tinh chSt tham hqa nhu dQng dat, noi lla, song th6n, nhi6m ph6ng xq, dlch b€nh theo c6ng b6
cia co quan c6 thim quyiln (bao gdm SARS, H5N1, Ebola).
Chi6n tranh, nQi chi€n, dinh cOng, khing b6, bao dong, d5n bi6n, phi6n to?n, c6c hoat dong dan su hoac hanh
dong cia bet ki,ngudi cdm dlu crla t6 chrlc ndo nhdm lat d6, de doa chinh quy6n, ki6m soat beng v0 l!rc.
Tham gia tap luyen hoic tham gia thi dAu cAc mon th6 thao chuyen nghiep, bet ky hoat dong dua neo
Benh lao cdc loai, benh s6t ret, benh ngha nghiep, benh phong.
Benh ung thu.
Nhong ngudi dang didu tri thuong tat hoac benh tat, ngudi b! thuong tau lin tat vinh vi6n trCn 50% tai thdi di6m
tham gia hoac thdi di6m hqp ddng bao hi6m b5t ddu c6 hieu l!rc.
cec bcnh suy tiy, b4ch cau, dii:u tri lqc m6u, chay than nhan tao vd hfu qui hay bi6n ch{rng crla cac benh nay.
Licu ph6p thay thit hooc-m6n trong thdi ki' sinh trudng hoic tiCn m6n kinh hay man kinh d phu nO'
DiCu tri cec benh lay lan qua ductng tinh duc nhu benh giang mai, benh lau, r6i loan chic n'ng sinh duc hay dicu
tri sinh li, 6m dau li€n quan ddn cdc b€nh thuOc hoi chung suy gidm midn dich (HlV) bao gdm cac hoi chong lion
quan OCn ntOS vA/hodc bet c0 biCn chung hoac bi6n ddi ndo, hoac benh lay truydn qua dudng tinh duc hay bet
cu hoi chung licn quan den AIDS hoac c6c benh liCn quan dcn AIDS khac'
DiCu tri va/hoAc ph6u thuat cho c6c benh b6m sinh, bCnh di truyCn/di taukhuyat tat bam sinh, benh d! dang ve gen
vA mQi birln chong, hau qud ticn quan d6n nhong bcnh ney, nhong chi dinh phau thgat c6 ti| trudc ngdy b:t aAu
U6o fridm; bao g6li nhOng danh muc liqt ke dudi day va/ hoac cac danh mqc dugc liqt kO trong Spa d6i b6 sung
nhu ta mqt UO inan Oinn lem crla Quy rlcr'Hgp ttdng bdo hi6m nhu bCnh tim bam sinh, b6nh Down, hd m6i, hd
ham 6ch, tich nu6c trong nao, hep hau m6n' hep bao quy diu, veo vach ngan bam sinh'
KiAm tra soc khde dlnh ky (noi tr0 hay ngoai tni); ki6m tra sfc kh6e t6ng qu6t, tim so6t ung thu kCt qua binh
thudng, gi6m dinh y khoa noa" ru u5n y t6-rn6ng li€n quan d6n dicu tri om dau hodc thuong tat, bao g6m ci ki6m
tra phu khoa/nam khoa; X6t nghiem Olnn ry, fnam dinh ky cho tre mdi sinh, tat ca cac hinh th&c ti6m ch0ng vdc-
xin va thuiic phdng ngL?a (trir trudng hqp tiCm v6c-xin sau khi bitai nan hay soc vat, c6n tdng c'n)'
Kidm tra thi luc, atuc thiy tinh thd, thinh giac thong thudng, lao h6a, tho€ri h6a, diAu tri suy bii-in tU nhiCn/khong
phai vi ti do bCnh Ig cia cho viec suy giam thinh thi lvc, bao gdm nhong danh muc liet ke duoi day va/hoac cec
danh mqc khac duqc tigt kC trong Sir"-O6i b6 sung nhu la mot bO phan dinh kdm cia Quy tdc/Hqp ddng bio hi6m
nhu cac tat kh0c xa nhu can thi, viSn thi ve loan thi vi bAt ky phau thuat atA phuc hdi hieu chinh nao doi voi cac
khuy6t tat thoei hoa thinh gi6c va thi gi6c.
I
t
18.
19.
14
20.
21-
24.
25.
30.
27.
BCnh kh6 m6t, mdi mat di6u ti6t euqc bio hi6m vdi gi6i han 5% STBH didu khoan ngoai tru/an kham va khong
vuqt qu6 STBH didu khoin didu tri ngqi tru.
Sinh de (bao gdm ce cac trudng hqp bicn chong hau qua phei sinh dd, sinh non). Mot s6 hau qua sau khi sinh
nhu benh s6t, nhi6m khu6n, hQu s6n, rong huy6t, cdng sara, tit soa, 6p xe vt, dau ddu, chan tay te mdi, dau nhoc
lung, r6i lo4n dudng tiet nieu. Oi6u khoan ney chi dugc bao hiem tD trudng hqp co tham gia dldu khoin b6 sung
s6 5 - bao hi6m thai sen
C6c chi phi di6u tri li6n quan tl6n ring bao gdm ci diSu tri nOi tru var ngoai tnl tril trudng hqp c6 tham gia di6u
khoin b6 sung s6 4 - Bao hi6m Nha khoa
DiAu tri hoac pheu thuat theo yeu cdu cria Ngudi duqc bdo hi6m md khdng phii dicu tri theo cach thong thuong;
Kham va x6t nghigm kh6ng co ki;t luan chin dodn bQnh hoec k6t luan kh6ng c6 bQnh cAn di6u tri crla bdc si.
Ri€ng di6u khoin toai tru di€u tri hoic phau thuat theo ydu c6u c0a Nguoi duqc bio hiCm sC khdng ip dung d6i
voi cac chi phi phat sinh tai ' phdng kh6m dich vu, dieu trj tr,] nguyen/ theo yeu cau thuoc bcnh vicn cong.
C6c hinh thoc tham m9, ph5u thuqt th5m my, chinh hinh.
C6c diCu tri teng s5c t6 (n5m da), d16u tri mvn trung ca, didu tri ch0ng rung t6c bi loai tru rieng d6i vdi di6u kien
ngoqi tr0. Truong hqp Ngudi duoc bdo hi6m bi nhong benh ndy phai dj6u tri n6i trrl thi v5n dugc giai quyet rheo
quyen lqi dieu tri noitr[ do 6m dau, benh tat.
Chi phi d6 cung cap, bao duong, s0a choa hay thay thii bO phan/ thi6t bi h6 trq dieu tr! hay b0 phan gie nhu dinh
nghTa.
C6c chi phi li6n quan diln phau thuat, dieu lri benh/thuong tat bdng phuong phdp cay ti6 bdo g6c bao g6m nhong
danh muc tiet kC dudi day ve/ hoac cac danh mpc khac duoc liet ke trong S&a d6i b6 sung nhu la mot b0 phan
dinh kdm cia Quy tec/Hqp ddng bao hiCm nhu chi phi chi6t xu6t, x0 lf, cay te bao g6c, didu tri duy tri sau khi cay
te beo vd hau qud coa phuong ph6p ttidu tri ney. Rieng trudng hqp ndy chi bdo hi6m chi phi ngay nlm vign noi
tru tai c6c bCnh viCn c6ng.
c6c chet bd sung hoac thay thd phr,rc vu cho vi?c dn ki6ng c6 s5n trong tu nhi6n va c6 th6 dugc mua md kh6ng
cen chi dinh, bao g6m nhong danh mqc liCt kC tai day va/hodc c6c danh muc kh6c luong tU nhu vay nhu c6c loai
vitamin, thu6c b6, khoeng "t'6t
ua "6"
ch5t hou co thr,rc phAm chrlc ning), thu6c teng cudng mi6n dich cq the,
c6c loqi chC phAm y t6.
Thuc hien cac bien phap kc ho?ch h6a gia dinh, hau qud cl]la ph5 thai do nguyCn nhen tam li hay xe hoi' di'u tri
v6 sinh nam/nt. thu tinh nhan tao, di6u tri bat luc/lict duqng, hoac thay d6i gidi tinh va bat ky hau qui hay bi6n
chung nao ti.P nhi|ng dieu tritrCn.
Didu tri kiAm soat trong luong co thd (t6ng hoic giam can); suy dinh duong' cdi xuong' b6o phi
OiCu tri benh roi toan tam than va hanh vi, benh tam thAniloan thAn kinh hodc benh cham phet tri6n' bCnh r6i loan
thi6u tap trung, benh tu ki. Didu tri r6i loSn giSc ngri, mat ngri, ngri ngey kh6ng 16 nguyen nhan' suy nhuoc va hoi
chung cdng theng (stress) hoAc cec benh c6liCn quan tu hoi ch0ng d6
32. Di6u tri tai phdng kh6m kh6ng ding theo dinh nghia va bao gtrm cd viQc chi dlnh cria b6c sy phdng kh6m ney d6i
voi mua rhu6c hay xdt nghiCm, di6; tri tai phdng kham, benh vien, nha thu6c hop phap'
33. Kh5m vd di6u tri kh6ng theo quy trinh cia benh vien, phdng kham vd co sd y t6
34. B€nh c6 s5n nhu dinh nghia trong Quy t5c nay chi dugc bdo hi6m ttr nim tho hai tham gia li6n tuc'
35. Benh dac biet nhu dinh nghTa trong Quy t5c nay chi duqc bao hi6m tU ndm thu hai tham gia li6n tvc'
36. Cec bCnh sau day s6 khong dugc bAo hi6m trong ndm ddu ti6n cho di xay ra truoc hay sau khi hqp dong bao
hi6m c6 higu luc, bao gOm:
28.
J
1. Bgnh he h6 h6p:
2. Benh hC tai:
3. BCnh he m?ch:
VlCm V.A can phai nao, viem xoang, veo vech ngen, benh hen/suycn
RiCng bgnh vi6m phi! qu6n, tiAu ph€ quin' viem ph6i cdc loqi 6p dvng thdi gian chd
06 th6ng cho d6i tuong trC em d6n 06 tudi
Vi6m taigi0a cin phii phdu thu?t, siivdm hgng' c6t b6 xuong xoen'
Viem tinh mach va viCm tac/nghen tinh mach, giSn tinh mach chi dudi, hoi chrlng 6ng
37.
c6 tay, mach/hach bach huy6t, tri.
4. Benh r6i lqn chuy5nh6a cec loai
5. Blnh hC co, xuong, Vi6m khdp/da khop man tinh, bCnh thoai hoa cot s6ng, th6n at6t s6ng, thoet v! dia
khdp dCm, r6i loan mat d0 va cau trlc xuong, benh gout.
6. BCnh he tieu h6a Benh loet da day, t6 trang.
7. BCnh khec S6i, nang, mun com, n6t ruoi cdc loai, r6i loan tien dinh.
C6c di6u tri ti6n quan d6n t6i tao day ching, rdch sun chCm khong dugc bdo hi6m trong ndm dau vd dugc bao
hi6m nim thri hai liCn tuc vdi diCu kien bdi thudng trdn co sd ddng chi tri 70/30. Ngudi duqc b6o hi6m chiu 30%
chi phi theo dinh nghia ddng chi tra.
C6c chi phi vd d16u tri cho d6ituqng kh6ng di tti6u kiCn tham gia bao hi€m.
Vi6c didu tri thr] nghi€m, didu tri khOng dLrgc khoa h9c cong nhan va cec dich vu di6u tri mi6n phi t?i b6t ky bCnh
viCn nao.
PHAN V: THO TUC YEU CAU TRA TIEN BAO HIEM VA BAO LANH
1. HOSgYCUCAUTRATIEN BAOHIEM
38.
39.
Khi y6u ciu 86o hi6m Bdo Vi€t trd ti6n bdo hi6m, Ngudi duqc bdo hi6m vd/hoac Ngudi thira k6 hqp phap phai thdng
b6oigrli cdc chrlng t0 sau day cho Bdo hi5m Bio Vi€t trong vdng sau muoi (60) ngay ke tir ngay dilu tri cu6i cing cria
moJ iqt oidu tri noac tir vong ve khong qua 01 ndm k6 tir ngdy xdy ra su kien bio hi6m:
a. Gi5y y6u cau trd tidn bdo hi6m (theo mau crla Bdo hi6m 86o ViQt) phdi do chinh Ngudi dugc bao hi6m hodc
NguOl yeu cau bdi thudng te ngudi thira k6/ngudi thv hudng/ ngudi dugc chi tlinh tr6n GCNBH /ngudi dugc iyquydn nqp pnap cna NDBH ke khai vd ki tCn (tru trudng hgp tr6 em do b6 m9/ ngudi gi6m h6 hqp phap kc khai )
b. Cec chfng ti, lien quan dCn viCc dAu tri: bdn g6c hoic bin sao don thui'c, s6 tnem benn, giSy ra viQn, phi6u djdu
tri, phi6u chi dlnh xet nghiem, k6t qua x6t nghiCm hoac phiCu chvp li6n quan' phi6u m6ltrong trudng hop phai m6)'
Trong moilrudng hqp, gao ni6t Bao ViCt co quyan y6u c6u cung c5p bin chinh d6 d6i chi6u'
c. C5c chrlng til, tiOn quan dCn viec thanh toan chi phi y ti-i: h6a don tai chinh, biCn lai, phi6u thu theo quy dlnh ctla B0- i"i Cfri"f.,, fang c.rc Thu6 v) bdng ke chi tiet kdm theo. Cdc gi6y td tr6n phdi ld b6n g6c vd s6 thuQc s& h1u cia
Bdo hi6m Bio Vigt sau khi khi6u n-ai Oa Ouec giii quyet. H6a don mua thu6c/diOu tri ph6i dugc xu5t trong vdng 30.ngay
k6 ti? ngay k6 don t raJaia, tri va tir6 iien s5 tuqng thu6c d6ng theo don thu.6c b-5c s! d16u tri. Bio hi6m
BloViet kh6ng chip nhan cec phi6u thu/bicn lai ban le cong gop cho m6i h6 so ydu ciu bdi thudng'
D6i vdi truong hqp Tai nan:
Tai nan sinh hoat, tai nan lao dong: Ban tLrdng trinh t6m tdt vd tai nqn, kh6ng y6u c6u xirc nhan cia co quan chinh
quyen dia phuong
Tai nan giao lhOng kh6ng phal sinh ben tho ba tru trudng hqp ti vong: Ben tuong trinh tom tet v' tai nan' khdng
y6u clu -xac
nf,inlia cc, quan chinh quydn dia ptruong; Gi6y phep l6i xe trong truong hqp Ngudi dugc beo hi6m
bitai nan trong khi ttiau khian xe co gidi tr6n 50cc
Tai nan giao th6ng co phat sinh bCn ihr? ba: Ban luong tinh tai nan theo qui dlnh cia phAp luat; h6 so giai quyot tai
nan "0ut qrun long an; GiSy phep tei xe kudng hqp Ngudi dugc beo hi6m bi tai nan trong khi di6u khi6n xe co
giqi tr6n 50cc
Truong hgp ti vong: ban g6c ho{c bdn sao c6 c6ng chr}ng ; GiSy chung tl}i Gi6y xdc nhQn quyCn thua k6 hqp
ph6p (irudng hEp Ngudi duqc bdo hi6m kh6ng chi dinh ngudi dugc thv hudng)
C6c chong ttr y tC kh6c c6 li6n quan phqc vu gidi quyCt bdi thudng theo ydu ciu crla Bdo hi6m Bio Vi€t'
I
16
2. THU TUc TRA TIEN BAO HIEM VA BAO LANH
a. Trudng hqp l?ng tidn trudc, baji thudng sau:
Trudng hgp Ngudi ttLrgc bdo hi5m kh6m vi di6u tri tai cac co s6 y t6 trqp phep khdng thuOc he th6ng bao lenh thanh
todn cria chuong trinh, Ngudi ttuqc bio hi6m phai thanh toen mqi chi phi afi6u tri, sau at6 gt}i hd so cho Brio hi6m Brio
V|CJ dA thanh toan phAn chi phi thuoc pham vi bdo hi5m.
b. Thdi han b6ithudng
86o hi6m BAo ViCt co tr6ch nhiem giai quyOt va chi tra tiCn beo hi6m trong thoi han t6i da'15 (mudi lim) ngay lem viec
k6 t* ngay nhan dugc hd so y6u c.iu b6i thudng day di vd hgp 10, cu th6 nhu sau:
. Thdi gian gr}i thdng b6o nhan hd so trong vdng ba (03) ngey lam viCc k6 tn ngay nhan day di h6 so.
. Thdi gian g&ith6ng bdo b6 sung hd so trong vdng ndm (05) ngiiy ldm viQc k6 tir ngdy nhfn diy di hd so.
. Thoi gian giri th6ng bao bdi thudng trong vdng mudi (10) ngay lam viCc k6 tU ngay nhan d6y dri h6 so.
. Thdi gian chuy6n khodn trong vdng mudi lam (15) ngay lam viCc kd ttr ngdy nhQn dAy drl h6 scr.
. Thdi gian you cAu hodn trd hd so lrong trusng hctp bi ti/ ch6i bdi thuong la t6i da sau muoi (60) ngey ka tingdy Bio hidm Bao ViCt giri thdng bao.
. Thdi gian da Bao hiem Bao Vigt xdc minh hd so t6i da chin muoi (90) ngdy lam viec kC tir ngey nhan ddy dri hd
so.
. Thdi han de kh6ch hdng b6 sung hd so trong vdng ba muoi (30) ngey ldm viec k6 tD ngdy nhQn h6 so
c. ThOng tin chung vd chi tra bdo hiim
T5t ca cac ch0ng tir vd tai ti€u md Bio hi6m Bao Vigt yOu cau h6 trq cho viec chi trd bdo hi6m s6 dugc cung c5p mi6n
phi cho Bdo hi6m Beo ViCt truoc khi bdt ki'viec chi tr6 bao hi6m nao duoc hodn tat
Trudng hqp thiCu th6ng tin y t6/chung i0 y ta, Ngudi duqc beo hi6m phdi co trech nhiem bd sung c6c thOng tin/chong
ti1, y t6;en thiCt ve nqJ ty p;uc vu c6ng tec giai quyet udi thuong cho Bdo hi6m Bao ViCt ve Bao hiem Beo Viet khOng
phii chiu chi phi cho viCc c6 thCm thong tin d6 \Ti6n b6o hi6m s6 duoc chi kd cho Ngudi ttuqc bao hi6m holc Nguoi thu hudng/Ngudi duqc 0y quy6n hqp phap theo
.:
d0ng quy dlnh crla Phdp luat. t
d. Trudng hgp bao lanh (5p dung cho chuctng trinh c6 dich vU bao lanh)
Trudng hqp Ngudi duqc bao hi6m khSm vri didu tr! tai cac bCnh viCn, phdng kham trong hQ th6ng bio lAnh thanh toen i
c0a chuong trlnh, Ngudi dugc bao hi6m c3n thpc hien nhing budc sau: /
. Xuat trinh th6 Baovietcare ve chung minh nhan dan hoac hQ chi6u, 9i5y khai sinh (n6u le tre em) cho benh 't
vien, phdng kh6m.
. Ki6m tra gi5y y6u c5u b6i thudng ma benh vien, phdng kh6m cung cap sau khi didu tri va ky ton dC xec nhan
viCc Oidu iri iga lgudi duEc bio hi5m, dat cac theo quy dinh crla b€nh vign/phdng kham (neu co).
. Thanh to6n cec chi phi trong bcnh vicn rtrong thuoc pham vi bao hi6m hoac vuqt qu6 moc trdch nhiem bao
hi6m.
't7
pHU LUC | : BANG Tr LF TRA TIEN THUONG TAT
(Ap dqng cho quydn lgi Bio hi6m Tai nqn c6 nh6n)
Quydn lqiI _ CHET-
Ti lQ tri ti6n
100vo
1. MAt hoec m! hodn toan 2 mit---------- --------100%
2. R6i loan tem than hoen toan kh6ng th6 choa duqc 100%
1000/03. Hdng toAn b0 ch0c ndng nhai va noi
4. Mat hoic liCt hoan toan 2 tay (tu vai hoic khulu xu6ng)
Hoic 2 chin (tir h6ng ho{c ddu g6i xu6ng)----- ----------- 100%
S. N45t ca hai bdn tay hoac hai bdn chan hoic met mot canh tay hoac mot ban chan hoac mii mot cdnh tay vd mot cSng
chan hoac mot ban tay vd mQt cing chan hoec mot ban tay va mot ban chan 1000/0
6. Met hoan toan khe neng lao dong ma kh0n9 th6 lem bat c0 vicc gi (toAn b0 bi tC liet, bi thuong dan dCn tinh trang
n6m liCt giuong hodc den den ten tat toen bO vinh vi6n)
7. Cet toan bO mot bon pn6ivd mot pnin pn6i ben kia
ItI - THUONG TAT Bq PHAN VJNH VIEN
GHI TREN
8. Met mot cenh tay tu vai xu6ng (th6o khop
II - THUONG TAT TOAN BQ VINH UEN
'llOYo
100%
9. Cet cut canh tay ttr du6ivai xuOng
7 5-85o/o
70-80./.
65-75Y"
60-70%
40-500/.
35-45o/o
30-35%
35-4D%
10. Cet cut mot canh tay tir khuiu xu6ng (th6o khdp khuiu)
1 1. M5t tran mot ban tay hoac toan b0 cd 5 ng6n tay
12. NISI at6ng thdi ca b6n ng6n tay ctla mot ban
t
3I
13. MAt ddng thdi ci ngon c6i vir ng6n trd
14. N46t 3 ng6n: 3-4- 5
15. Met ng6n cei ve 2 ng6n
16. N4at ng6n cai va mot ng6n khac --30-35%
17. M5t ng6n trd va hai ng6n kh6c
18. Met ng6n trd ve mot ngon gioa
19. M5t han ng6n cai vd itAt
Nl6t trqn ng6n ciri--- --- 2o-25o/o
MAt ca d6t
N4at nriva d6t ngoai-
20. iilat ngon tr6 va dOt
Mat ngon tr6
1O-15o/"
07-10%
20-250/0
1B-22%
10-12'/o
08-10%
18
N45r hai d6t 2 ve
Mat d6r 2
21. M5t trgn ngon gioa ho{c ngon nh5n
(bao 96m ca d6t ban)
M5t trgn ng6n gioa hoic ng6n nhin
MAt hai d6t 2 va 3
M6t d6t 2
22. Mat ca ngon !t vd d6t ban
1a-22%
15-18%
08-12o/o
04-070/o
15-20%
'to-15%
08-10%
04-070/o
30-40%
25-35y.
20-30%
Mat ca ng6n Ut
N46t hai d6t
Mat dot 2
23. Cing khop ba
24. Ctlng khop khu9u tay
25. Crlng kh6p c6
26. Gay Ey can lech hoac m6t xudng ldm chi ng5n tren 3cm va ch0c nang quay s5p ngira hqn chii hoac tao thanh khdp
gla
cHt DLrol
27. Mat mot chan tir h6ng xu6ng (thao khop khong m6t ttiri)
28. Cat cut mOt dtri
75-85o/o
1/3 gioa hoec duOi
29. Cit cut m6t chan tD g6i xu6ng (th6o khdp g6i)
30. Theo khop c6 chan hoac mat m6t ban
31. Met xuong scn
70-80%
55-75%
60-70%
55-65%
35-40%
35-45%
35-45%
20-30%
10-15%
15-20%
45-55./.
32. Mat xuong g6t
33. Met doan xuong chay, m6c gay khop gie cing chan
34. NIet doan xLrong mac
\
j
I35. M5t met ca chan: Met ca ngoai
M5t c6 trong
36. NIat ca 5 ngon chan
37. M5t 4 ng6n chan bao g6m ca ng6n
38. Mat b6n ng6n tn) ng6n c6i
39. M6tbang6n3-4-5
40.Matbang6n1-2-3
35-45%
25-3oo/o
30-35%
20-25%
15-20%
10-15%
o8-12%
45-55%
41. Met mot ng6n cdi vd ng6n
42. Mat mot ng6n
43. Mat mot ngon ngodi ng6n
44. N4et mot d6t n96n c6i
45. Cung khop hOng
47. Met phan ldn xuong banh che ve gi6i han nhiau khi ning du6i cing chan trCn dii
48. Gey chan can lCch hoac m6l xuong lam ngin chi'19
it ntr6t 5 cm
tuJoenScm
49. LiCt hoan toan day than kinh h6ng khoeo
50. LiCt hoan toan day than kinh h6ng khoeo
cQT S6NG
ngodi
40450/0
35-40yo
3545%
2r35V.
35-40%
45-60%
35-45%
15-20%
25-35%
08-10%
70-80%
51. cet b6 cung sau cia mOt d6t s6ng
cuaz-Jootsongtro
SO NAO
52. Khuy6t xuong s9 (chua
LdNG NGUC
53. cet b6 I -2 xuong sudn
co bi6u hien than kinh, tam than) gay ra dau dAu k6o ddi
54. CAt b6 tir 3 xuong sudn kA l6n
55. cit bd doan m6i xuong sudn
5tj. ual loan DQ mgt oen pnol
57. C5t nhidu thny ph6i d 2 bcn, DTS giem trcn 50% ---- 65-75o/a
56. Uat nnteu rnuy pnor q 50-60%
59. c6t mot thny ph6i
BUNG
60. Cat toan b0 da ddy
61. CAt do?n da day
62. CAt gan hCt ruot non (cdn lai dudi 1 m)--- --75-85%
63. Cdt doan ruot non
64. CAt toan b9 dai trang-
65. Cat doan d?i trdng
66. Cat b6 gan ph6i Quy tdc
67. C;t bd gan trai Quy tdc thudn
68. c6t phen thny gan, tiy vi tri, s6 lugng vd kilt qui phau thuat
69. Cat b6 tni mar
70. cet b6 la lech
71 . Cat b6 rtu6i tuy, lech
75-85%
50-60%
70-80%
60-70%
40-60%
45-55%
40-50%
60-70%
50-60%
7o-ao%
3040%
27-35%
7O-40'/o
55-65%
20
CO OUAN TI€T NIEU, SINH DUC
72. C6i b6 mot than, than cdn lai binh thudng
73. Cet bd mot than, than con lai bi thuc/ng hoic benh ll74. Cet mot phan than trai hoac phai
i/5. Ual m9t Pnan Oang
76. M5t duong vat vd 2 tinh hoin d ngudi:
Dudi 55 tu6i chua co
uuor 55 tuot oa co con
TrCn 55 tu6i
77. Cit b6 da con vd buiing tn?ng d nguoi:
Drldi 45 tu6i chua c6 con
Duoi 45 tu6i de c6 con
Tron 45
/d. ual vu 0 nu:
Dudi 45 tu6i: mot
Tren 45 tu6i: mot ben
MAT
79. Mat hodc mi hoan toan m6t mat
Khdng lep duqc m;t
L5p duqc mdt gia
80. N4et hoSc mir hoan toan m6t m:t nhung trudc khi xdy ra tai nan ney da mdt hoec mrl mol mj1 15;----TAI - MUI - HONG
81. Oi6c 2 tai, hodn toan khong phuc h6i atuoc
Neng (n6i to hoec th6t vao tai ngudi nghe)
VUa (n6i to 1-2m v5n c6 khd nSng nghe)---Nhe (n6i to 2-4m ven co khe neng nghe)
82. DiCc mot tai, hoen toen kh6ng phuc hdi duqc
Vira
rG colAO FiI
AAO V
Nhe
83. M5t vdnh tai hai ben
84. M5t vdnh tai mot bon 0-25./.
8-40%85. lvat m0i, bi6n dang m[i
MAT
86. Mat toan b0 xuong ham kCn va mot phdn xuong ham du6i trlr cdnh cao tro xu6ng
Khdc b6n
Cirng bCn 70-80%
87. Mat toen b0 xuong hem tren hoAc dudi
88. Mat mot phan xuong ham tren hoAc mot phan xuong hdm dudi tu 1/3 ddn 112 bi m5t t0 canh cao trd xui5ng--- 35-45%
89. Mat rang: tren 6 cai khdng lip dugc rdng gid
Til5-73040%
15-25Vo
75-85%90. M6t 3/4 luoj, cdn g6c tudi
91 . M'l2l3ludi tir d5u tuoi------------- ______ 50-60%
92. N46t 1/3 ludi anh budng dCn ph6t
't0-15y.
21
93. Mat mot phan nhd luoi (dudi 't13) dnh hudng d6n ph6t dm
Nguy6n t5c x6t tri tiAn bio hi6m
Viec xet gidi quyet tra tiSn theo Bang nay sC cin cO trCn cAc chfng tD diAu ki cia kh6ch hang cung c5p cho C6ng tybio hi6m vd cac quy dinh duoi day:
1) M6t hen ch0c neng crla t.Ing b0 phan hoec h6ng vTnh vi6n chi duqc coi nhu m6t tirng b0 phan d6 hodc m5t chi.
2) Nhong trudng hgp thuong tat khdng liet k6 trong Bang se duqc bdi thudng theo ti lC trCn co sd so senh tinhnghiem trqng c0a n6 vdi nhi/ng trudng hEp kh6c c6 trong Bdng.
3) V6t thuong didu tri binh thudng, vitt thuong kh6ng bi nhi5m trong sc duoc tri ti€n bdo hi6m tuong ong voi mucthSp nhet cia thang ti le trd tidn bao hi6m quy dinh cho trudng hgp n;y.
4) VCt thuong dieu trj ph&c tap, va,t thuong bi nhi6m trong hoAcsau khi didu tri cdnd6 lai di chungthi tirytheo m&cdOneng, nhe duqc tre cao dan cho tdi moc t6i da c0a thang ti ll trd tien brio hi6m quy dinh cho trudng hqp nay.
5) Trudng hgp da v6t thuong duqc tri tlCn bao hi6m cho tilng vilt thuong nhung t6ng s6 tidn tra cho Ngudi duqc beo
hi6m kh6ng vuqt qud siir tien bdo hidm. Trudng hgp da v6t thuong a c0ng mot chi, t6ng s6 tidn trd cho cac v6t
thuong khong dugc vLrqt que ty le mat chi d6.
6) Nhong trudng hEp phai m6 lai, dap can xuong lam lai duqc tre thCm 50% moc t6i thi6u cia thang ti lC tra cho
trudng hEp do nhung t6ng s6 ti6n chi tra kh6ng vuqt qua s6 tidn bdo hi€m.