VCLI ".;/

CONG T NHAN THO VIETCOMBANK-CARDIF

QUY TAC DIE U KHOAN

BAO HIEM BO TRH HO TRq CHI PHI Y TE DO TAI NAN

(Dmyc clap thufin theo cong TC-QLBH ngetyiothcingiCieun 2016 cfia Bo Tai chink)

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MIJC LUC

DIEU I QUY DINH CHUNG 3

DIEU 2 MOT SO KHAI NIEM 3

DIEU 3 QUYEN LOI BAO HIEM 7

DIEU 4 CAC QUY DINH LORI TRti TRACH NHIEM BAO HIEM 9 DIEU 5 PHI BAO HIEM

10 DIEU 6 THAY DOI NGHE NGHIEP

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DIEU 7 CHAM DOT HIEU LUC CIDA SAN PHAM 11

DIEU 8 GIAI QUYET QUYEN LOT BAO HIEM 12

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Dieu 1 Quy dinh chung

San pham Bao hiem be trg 1-1.6 trg chi phi y to do tai nan cung cap cac quyen Igi ho trg chi phi y to khi khach hang phai trai qua nam vien, dieu tri tai khoa chain soc dac biet hoac phau thuat de dieu tri chin thuung do tai

Quy the dieu khoan nay bao gem nhung thoa thuan be sung giaa chfing toi - CONG TY TNHH BAO HIEM NHAN THQ VIETCOMBANK-CARDIF va Ben mua bao hiem khi Ben mua bao hiem yeu cau dugc bao hiem be trg cac quyen 19i bao hiem cu the vao Hop deng bao hiem da ky ket.

San pham bao hiem be trg nay se dugc ap dung nhang Quy the dieu khoan cua san pham bao hiem chinh a ky k6t. Tuy nhien, neu c6 nhang khac biet giaa Quy the dieu khoan San pham bao hiem be trg nay vii Quy the dieu khoan San pham bao hiem chinh lien quan den quy dinh cua san pham bao hiem be trg nay thi quy dinh trong Quy the dieu khoan San pham bao hiem be trg nay se dugc tru tien ap dung.

Cac quy dinh chung ve tha tic bao hiem, tha tic giai quyet quyen lgi bao hiem va giai guy& tranh chap dugc ap dung Wong to nhu da neu trong Quy the diet' khoan San pham bao hiem chinh da ket. ky

Dieu 2 Mot se khai niem

2.1 "Cling ty": la Cong ty TNHH Bao hiem Nhan th9 Vietcombank-Cardif c6 gig), phep

thanh lap va hoat Ong se 55GP/KDBH do Be Tai chinh cap ngay 23 thing 10 'tam 2008 tai Ha Nei va dugc sira dei thy tong thei diem.

2.2 "Hvp dong bao hiem": la H9p deng bao hiem ma san pham bao hiem be trg nay di kern.

2.3 "Giay chirng nhan bao hiem" la van ban do Cong ty phat hanh. Giay chimg nhan bao

hiem dugc dinh kern va eau thanh met plan khong tach rai caa H9p deng bao hiem ma san plain bao hiem be trg nay di kern va cac ban sira dei, be sung dm Gay chung nhan bao hiem, neu co.

2.4 "Ben mua bao ham": cung la Ben mua bao hiem caa san pham bao hiem chinh ma san

plant bao hiem be trg nay dinh kern.

2.5 "NguiYi duvc bao hiem": la ca nhan c6 de tuei tir 18 (muoi tam) den 60 (sau tuei tinh theo sinh nhat vim qua vao Ngay hieu lrc cua san pham va dugc Cong ty chap nhan bao hiem theo Quy the dieu khoan san pham bao hiem be trg nay.

Nguei dugc bao hiem caa san plant bao hiem be trg nay la Ngueri dugc bao hiem cua san pham bao hiem chinh hoac c6 the la ngtrei khac neu c6 quyen lgi c6 the dugc bao hiem vOi Ben mua bao hiem.

2.6 "Tuei toi da ket thtic gia han bao hiem": la Wei tei da cua Ngtred dugc bao hiem ma

Cong ty khong tiep tic gia hart Thai han bao hiem. Tuei tei da nay se phi thuee vao thefi han &mg phi dm san pham bao hiem chinh, tuei tei da dugc bao hiem cua Ngtroi dugc bao hiem san pham be trg nay, tu6si cua Ngtrei dugc bat) hiem san pham chinh va/hoac Ben mua bao hiem (neu co) va theo quy dinh cua Cong ty tai tirng thai diem. Mei tei da ket thdc gia hart bao hiem dugc quy dinh trong Giay chimg nhan bao hiem hoac (cac) thea thuan sira doi, be) sung khac (neu co).

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2.7 "Thoi han bao hitm": thai han bap hiem cua san pham bao hiem 13,6 trg nay la 1 (m0t) nam va dugc gia han hang nam cho clan Ngay gia han nam ngay sau khi NguOj dugc bao hiem dat Tu6i toi da kat thitc gia han bao hiem nau Ben mua bao hiem va COng ty deu khong thong bao ve viac chain dirt hiau ltrc cua san pham bao hiem b6 trg nay; vai diau kin Ben mua bao hiem nOp du va dimg han cac phi bao hiem clan han trong thai gian gia han dOng phi va chip nhan cac diau khoan va diau kien cua san pham bao hiem b6 trg nay.

Trong truong hgp Cong ty quy& dinh khong tip tpc gia han Thai han bao hiem cua san pham bao hiem b6 trg nay, Cong ty se thong bao bang van ban cho Ben mua bao hiem it nhat 60 (sau muai) ngay truerc Ngay gia han nam cita san pham bao hiem b6 trg nay.

2.8 "Thiri han dong phi": thoi han &mg phi dia san pham bao hiem b6 trg nay bang Thai han bao hiem, la 1 (m0t) nam va dugc gia han hang nam twang img theo Thai han bao hiem cua san pham bao hiem b6 trg nay.

2.9 "Phi bao hiem": la s6 tin Ben mua bao hiem se thanh toan cho Cong ty de tham gia san pham bao hiem b6 trg nay vao ngay clan han nOp phi.

2.10 "St tin bao hitm": la so tin tong ty chap thuan bao hiem cho NgtreYi dugc bao hi8m di vai san pham bao hiem b6 trg nay. S6 tin bao hiem cua san pham bao hiem b6 trg nay dugc the hian trong Gidy chimg nh4n bao hiem hoac (cac) them thuan sira doi, b6 sung khac (nau co).

2.11 "Ngay hieu Itre efia san phalli": la ngay ma Cong ty guy& dinh chap nhan bao hiem san pham bao hiem b6 trg nay va ngay nay dugc ghi trong Giay chirng nhan bao hiem hoac (cac) th6a thuan sira doi, b6 sung c6 lien quan khac (nen co).

2.12 NO)/ khoi piny hi0 Ikre: la ngay san pham bac, hiem b6 trg nay &pc Cong ty chap nhan khoi phiric hiau 1Lrc ding vai viac khoi phut hiau ltrc cua san pham bao hiem chinh theo quy dinh tai Quy the dieu khoan cua san pham bao hiem chinh da k3r, ket.

2.13 "Ngay gia han Wane: la ngay lap lai hang nam cua Ngay hiau luc cua san pham bao hiem b6 trg nay nL khong c6 ben nao thong bao ve viac chain dirt hiau luc cua san pham bao hiem b6 trg nay. Neu nam khOng c6 ngay nay, ngay cu6i thong ttrang ling se la Ngay gia han nam.

2.14 "Nam licrp &trig": la khoang thai gian 1 (met) nam tinh tir Ngay hiau hie cua san pham cho clan Ngay gia han nam dau tien hoac bat kSr nam tip theo nao tinh tir Ngay gia han nam gan nhat cho den Ngay gia han nam tip theo.

2.15 "13fith vi0": la mot co so kham china banh &rye thanh lap va dang ky hop phap theo phap luat Viet Nam va hoat dOng o Viet Nam. Ca s6 d6 phai la banh vian, vian y to hoac trung tam y to cap pan huyen to len, da cap dm, diau tri nhang ngtrOd bi banh cling nhtr bi thuang nhap vin de DiL tri not tra.

Cac Ca sO• nay phai:

Hoat dung lien tut, cung cap dich vu cham soc dial" tri 24/24 gia bOi cac Bac si va cac nhan vien Y to (Y sy, Y td...) co giay phap hanh ngha; va

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- DUVC quan 1ST va clieu hanh boi nhiing ngtrai c6 giay phdp hanh nghe cita BO Y to hay Sa Y t6; va

- Luu trcr va cung cap nhfing chimg tir y khoa, chUng tir ke toan tai chinh theo dung quy dinh cua cac co quan c6 tham quyen.

Cho rntic dich cua san pham bao hiem nay, Benh vien se kb:Mg bao gem:

Trung tarn y to du phong;

Benh vien / vien tam than;

Benh vien / vien y hoc dan toe;

Benh vier) / vien phong;

Nha dieu chrang, trung tam phtic he)i chirc nang, nha ltru benh;

- Nha an duOng hay cac co so. khac chit y6u danh cho vice china tri cho ngtroi gia ngtrai nghien rugu, chat ma tiny, chat kich

,

cho du cac co so, trung tam y to nay hoat dOng dee lap hay tArc thuOc met Benh vien.

2.16 "Bac sy": la ngtrai co bang cap chuyen men y khoa dugc co quan c6 thArn quyen cap

phep hoac thisnhan dugc thuc hanh nghe y hop phap trong pham vi giAy phdp theo quy Binh cua phap luat. Trong dinh nghia nay, Bac si khong bao gem bac sy dong y, y hoc co truyen, vat 13,̀

tri lieu, chan (loan hinh anh, cham dru, va nhtitng ngueri sau day:

Ben mua bao hiem, Ngtrai dugc bao hiem hoac NgtrOi thtt farOng;

D6i tac kink doanh cua Ben mua bao hiem hoac Ngtred dugc bao hiem;

bao hiem;

Cac thanh vien trong gia dinh -aye he dia. Ben mua bao hiem hoac Ngtrari dugc bao hiem (cha me, vg ch6ng, con cai, anh chi em runt).

2.17 "Chan thuong": la cac ton thuong co the dm Ngued dugc bao hiem hi gay ra do Tai nan

va khong lien quan den nguyen nhan nap khac trong thai gian san pham bao hiem be trg nay dang c6 hieu luc.

2.18 "Tai n#n": la met hoac met chit& sit kien lien tic, khach quan, xay ra do tac dOng cua met luc, met vat bat ng6 tir ben ngoai len co the Nguari dugc bao hiem. Cac sit kie

chd& sit kien neu tren chi throe xem la Tai nan neu hoi du cac dieu kien sau:

n hoac a.

Xay ra do ngoai sit tien lieu, kiem soat cung nhtr y mu6n cua Ngtroi &roc bao hiem; b. Phai la nguyen nhan true tiep, duy nhat gay ra Chan

' thuong cho Ngtreri dugc bao hiem;

c. Khong phai la nhang ton thucmg than the do: dau 6m; benh tat; nhigm cac logi vi khuan hoac

nge dOc; sir dtmg trai phdp cac loci thu6c hoac chat gay nghien bat ky.

2.19 "Di&I tri not trti": la viOc Nguai duce bao him Nam vin it nhat qua met dem tai BOnh viOn khi bi Chan thuong de dirge diau tri y to do Sir can thiet va mat y khoa theo chi dinh dm Bac sy va phai co ten trong danh sach bOnh nhan not trit cita BOnh viOn. Vic Dieu tri not trU phai duot bat dau trong thai gian san pham bao him b6 try nay dang c6 hileu Itrc.

Trong truemg hop can thiet, viOc Nam vin Dieu tri not trit phai duce Bac sy do COng ty chi dinh xac nhan la can thiet phai Dieu tri not tit.

2.20 "Nam vii?n": la viOc Ngtrai dugc bao him phai nhap vin de diau tri y to doi voi Chan thuong tai met BOnh vin nhu la met bOnh nhan not tra theo yeu eau dm Bac sy.

2.21 "Sty can thiet vt met y khoa": la sir diau tri y khoa dap Ung nhfing diau kin sau: a. Theo thing chan down va diau tri cho Chan thuong do; va b. Theo dung chi dan y khoa cUa Y hoc hiOn dai; va c. Phu hop voi tieu chuan ve hanh ngha y chive, s6 ngay nam vin la h9p 13% va phu hpp

voi thOng le dieu tri cho Chan thuong lien quan.

2.22 "Ngay nam viOn": la met ngay ma Ngtrod &rye bao him nam Blau tri not tit tai BOnh vin qua 12 (mtrai hai) gia dem, va phai nop vin phi, tin phong cho met ngay theo quy dinh cna BOnh viOn.

2.23 "Khoa cap cum": la khoa hoc phong c6 chirc nang chan doan ban (tau N/A lam cac thu

thuat cap cau de on dinh tinh tang banh nhan truac khi chuyen bOnh nhan flap tuc diau tri not tru tai cac khoa khac.

2.24 "Khoa chain soc dec biOt": la met khoa hoc met be phan cua BOnh viOn, khong phai la

khoa/phOng hau phau hoec khoa/phong cap ciru, va phai dap (mg tat ca cac diau kin sau: - DUVC thanh lap de cung cap chtrong trinh cham soc va diau tri dee biOt; va

Danh rieng cho cac bOnh nhan trong diau kin ngay kich dOi hOi sir theo dOi va kiam tra y to lien tic ctia Bac sy; va

- Dtrac trang bi cac thiet 1)1, thu6c, phtrang tin cap dm khac de co the can thiOp ngay khi can thiet.

2.25 "Phan diner: la met phuang pita]) y khoa de diau tri do nhang you eau can thiet va hop ly va met y khoa cho Chan thuong; ducyc chi dinh va thut hiOn bai Bac sy co giay

he hanh ngha trong phong plan thuet, va &rot thtrc hiOn trong ph6ng phau thuet cua BOnh vin c6 chuyen mon phu hop cho met trong cac loci pilau thuet sau day:

Phau thuet ma nap so a lay kh6i mau ti not so do chan thuong so nao 'tang (khong bao g6m but mau ti th6ng qua 16 khoan kap s9).

PhAu thuat cat b6 ph6i toan phan (met ben hoc Ca hai ben ph6i; loci trix phau thuet cat thity ph6i).

Pilau thuat cat bO then toan phan (met ben hoc ca hai ben then).

Pilau thuet cat 1)6 lath toan phan.

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Phau thuat cat cut chi tren mot ben, tir 'chop ce tay tra len.

Pilau thuat cat cut it nhat 4 ngon tay cua mot ban tay, trong do phai co ngon tay cai hoac ngon tay tro; mom cot phai sat khop ban - ngon.

- Phau thuat cat cut chi dual met ben, cut den khOp c6 chan tra len.

Phau thuat cat cut ban chan mot ben, bao gem tat ca cac ng6n chan a tai hoac gan khOp ban chan - ngOn chan.

- Phau thuat thay khop hang toan

Phau thuat thay khop g6i toan

Phau thuat cat bo nhan cau.

Phau thuat vi phau n6i ban tay dirt rai.

Viec phau thuat theo dinh nghia nay khong bao g6m cac Phau thuat not tren dirge thuc hien tai Khoa cap ciru cua Benh vien; hoac trong luc Nguai dugc bao .hiem khong nam vien Dieu tri n0i

Trong nhung truang hop sau chi xem nhu mot Phau thuat dugc thgc hien:

- Hai hay nhieu ran m6 dugc thuc hien trong cling mot tien trinh Phan thuat; hoac

- M6t phau thuat dugc thuc hien vai nhieu buoy. 2.26 "Thai gian can nhic":

san phdm bao hiem b6 trg nay se ap dung thai gian can nhac theo quy dinh tai Quy tac dieu khoan cua san pham bao hiem chinh da ky ket.

Dieu 3 Quytn loi bao hiC4in

Trong thai gian san pham bao hiem be trg nay co hieu lirc, neu Nguai dugc bao hien] phai Nam vien Dieu tri not tru tai Benh vien de dieu tri Chan thuang do Tai nan, Cong ty se thanh toan (cac) quyen lqi bao hiem vai chi tiet nhu sau:

3.1 4uyen

Cong ty se thanh toan S6 tien bao hiem cho rntii Ngay nam vien Dieu tri not trit do Chan thuang do Tai nan, vai dieu kien la Nguai dugc bao hiem phai nam vien Dieu tri nOi tra do Chin thuang it nhdt la 3 (ba) ngay.

Quyen lcyi Ho trg vien phi dugc chi tra t6i da la:

30 (ba muai) Ngay nam vien Dieu tri n6i tru do Chan thuang cho mot six kien gay Chan thuang; va

Khong vugt qua 3 (ba) Quyen lgi HO trg vien phi trong I (m0t) Nam hap ang va (cac) str kien gay Chin thuang phai hoan toan khac nhau.

3.2u 10•Qyifi phi(me Net

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Ong ty se thanh toan met Ian so tien H8 tra vien phi dac biet ttrang throng yeti 5 (nam) Mil Se tien bao hiem aim san pham bao hi& be tra nay neu Ngubi dugc bao hiem phai nam vien Dieu tri not tit do Chan throng trong cac tnremg hap sau:

Ngtrevi duce bao hiem la hanh khach c6 mua ye dang di tren cac phtrang tien giao thong cong cong tren be hoac ten khong, theo lich trinh thubng xuyen va tren nhung tuye'n &rang Binh san nhu xe buSrt, xe dien, xe lira (tau Ma) hoac cac chuyen bay dan dung, ngoai trir xe taxi hay bat cir phuang tien thue nao dtrac sir dung nhu phuang tien di lai ca nhan; hoac

No/6i dugc bao hiem dang a trong thang may cong cong (khong bao g6m thang may hoat dOng trong ham mo hay tai cong trinh )(ay Ong); hoac

Do Nu qua trirc tip cua hoa hoar' tai cac t6a nha cong cong, chi bao gem nha hat, rap chieu phim, hei trubng, khach sari, trubng hoc, benh vien va cac trung tam the thao.

Quyen Igi H8 try. vien phi dac biet dugc chi tra toi da la:

1 (met) ran H8 try vien phi dac biet trong 1 (met) Nam h9p gong; va

- Kitting vugt qua 3 (ba) Ian H8 try vien phi dac biet trong suet th&i gian tham gia san ph& bao hi& be try nay.

Quyen Igi H8 try vien phi dac biet se chArn dirt khi Cong ty da thanh toan du 3 (ba) ran H8 tra vien phi dac biet.

3.3 Quyen lai H8 tra cham sOc dac biet:

Cong ty se thanh toan s6 tien He) try cham soc dac biet tucmg duang 3 (ba) fan Se tien bao hi& ciia san pham bao hiem be try nay cho m6i Ngay nam vien Dieu tri not trii do Chan thuong tai Khoa cham sOc dac biet neu Ngued dtrac bao hiem phai dieu tri tai Khoa cham soc dac biet nhu quy dinh tai Dieu 2.24.

Khi thanh toan quyen lyi H8 try cham soc dac biet, Using ty se khong thanh toan s6 Ngay nam vien cua quyen lyi H8 try vien phi Wing vai tiled diem Ngubi dirge bao hiem nam dieu tri tai Khoa cham soc dac biet.

Quyen lyi HO try cham sOc dac biet dtrgc chi tra t6i da la:

45 (ben mtroi lam) ngay nam vien tai Khoa chain sOc dac biet cong den trong 1 (met) Nam hap long; va

Khong vuyt qua 3 (ba) Mn H8 try chain soc dac biet trong suet thbi gian tham gia san pham bao hi& be try nay.

Quyen lyi H8 try cham soc dac biet se cham dirt khi Cong ty da thanh toan du 3 (ba) ran H8 try cham sOc dac biet.

3.4 Quyen lai H8 tra Phau thuat:

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Ong ty thanh toan met ran s6 tien 118 trg Phau thuat twang &rang I/6i 5 (narn) Ian Se tien bao hiem cua san pham bao hiem be trg nay khi Ngtroi duce bao hiem phai trai qua Pilau thuat theo quy djnh tai Dieu 2.25

Quyen lgi He; trg Pau thuat dugc chi tra t6i da la:

1 (met) Ian Ho trg phau thuat trong 1 (met) Nam hop deng; va

Khong virgt qua 3 (ba) Ian Ho trg Phau thuat trong suet thai gian tham gia san pham bao hiem be trg nay.

Quyen Igi HO' trg ph`au thuat se chain dirt khi Cong ty da thanh toan du 3 (ba) Ian HI; trg phAu thuat.

Dieu 4 Cac guy dinh 100 trir trach nhi;em bao hiem

Cong ty khong chi tra quyen Igi bao hiem theo quy djnh tai Dieu 3 cila Quy tac dieu khoan san pham bao hiem be trg nay neu Ngu6i dugc bao hiem phai Nam vien Dieu tri Wei till hay trai qua PhAti thuat do cac nguyen nhan sau day:

a. Chan thuong (bao gem cac hau qua va su tai Oat cua benh tat hoac tai nan) hoac cac dieu tri y to da." phat sinh truce Ngay hieu lye cua san pham hoac ngay khOi phut hieu lire sau ding cua san pham bao hiem be trg nay (neu co); hoac

b. Tu tir hoac Ar gay ten thuang co the cho du trong tinh trang tinh than binh thuOng hay mat tri; hoc

c. Hanh Ong coy hoac c6 tinh toan cua Ngtrori dugc bao hiem, Ben mua bao hiem hoac Ngtx6i thp huong; hoac

d. Nhiem HIV, bi AIDS (hei chimg suy giam mien dich mac phai) ho4c cac benh co lien quan den HIV/AIDS; hoac

e. Chan thuang trong luc Ngtr6i dugc bao hiem dang bi anh huong do sir dung rugu bia ma trong mau hoac hai tha co neng de con vugt qua mire quy dinh cua phap lust; hoac

f. Chan timing trong lac Nguoi dugc bao hiem dang bi anh huang do sir dung ma My, cac chat kich thich, cac chat gay nghien hoac thuec khong dugc chi dinh; hoac

Cac thir nghiem hay dieu tri lien quan den vo sinh, thai san, sinh say thai, pha thai hoac bat 14 nguyen nhan nao co lien quan den thai san, viec triet san hoac kiem tra viec triet san; hoac

h. Chien tranh (co tuyen be hay kh6ng tuyen be) hoac cac hog Ong gay chien, bao gem hanh Ong xam lugc, hanh Ong dm nu& thii dich, not chien, nei loan each mang, khai nghia, dao chinh quan sir, khung be hoac ti6m quy&I; hoac

Dieu tri nhiem bite xa ion Mc hoac nhiem phong xa tir nhi'en lieu hat nhan hoac tir chat thai hat nhan tir sir dot chay nhien lieu hat nhan; hoSc

j. Phong xa, chat dec hai, chat ne hoac tinh chat nguy hiem khac cila bat kS, sir tap hgp hat nhan a no nao hoac thanh phan hat nhan dm no; hoac

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g.

k. Tham gia vao cac ho4t cl(mg in4o hi6m nfra tip xilc, van hanh cac vat lieu chay no hoac va khi; hoac

I. Tham gia dank nhau, au da, pham t6i hoac chong lai viac bit gill cua ca quan CO thim quell; hoac

m. Chin thuang trong khi Ngtroi dirge bao hiem tham gia the thao chuyen nghiap (bao gem ca viac luyan tap cho mon the thao dO), cac mon the thao duai nuac, hoac cac mon the thao dei hoi den viac sir dung may (thiet bi) bay, xe ca giad hoac six tham gia ctla mot loci dOng vat nao d6; hoac

n. Dieu tri y to co lien quan den banh dau lung va cac triau chimg co lien quan; hoac o. Dieu tri y t6 co lien quan den cac r6i loan thin kinh, cac r6i loan tam thin, lo au, cac van

de ve tam thin, cac r6i loan nhan each, hoac bit ky triau chimg nao co nguen g6c tir yin de tam ly thin kinh va cac hau qua dm chfing; hoac

P. Phau thuat theo yeu ciu kh6ng lien quan den chin doan dm Bac sy; va chin down kh8ng lien quan den thuong tich hoac Om dau hoac khong theo su can thiet ve mat y te; hoac PI& thuat thim my; hoac

Bit kY qua trinh dieu tri nao duce thuc hian beri No.(6i khong co giAy phep hanh nghe y t6 dtryt clang 4; ho4c

r. DiL tri, chin doan y t6 ducyc thuc h*1 a nuac ngoai khi Nguai dugc bao hi6m a nuac ngoai; hoac

s. Chi phi y to va chi phi di nuac ngoai cua Ngu6i /rye bao hiem de ducre nh4n cac lieu tri hoac chin doan y

Di.tu 5 Phi bao hgm

5.1 Phi bao hiem va dinh ky dOng phi bao hiem cua san phim bao hiem b6 try nay di/ye ghi trong Gidy chung nhan bao hiem hoac (cac) thoa thuan sira d6i, b6 sung khac (neu co).

5.2 Phi bao hiem dugc (long khi den han, ngay ca trong Itie Nguori dtryc bao hiem Nam vian tai Banh vian a Dieu tri not to hay phai PhAu thuat theo Quy tic dieu khoan san phim bao hiem b6 try nay.

5.3 Khi tham gia kem vii san phim bao hiem chinh c6 gia tri hoan lai, trtrong hop Hap d6ng bao hiem thuc hian to dOng tam ling tir gia tri hoan 1ai a dOng phi, san phim bao hiem b6 try nay cling se duyc to Ong tarn ling tir gia tri hoan lai de dOng phi bao hiem can vii san phim bao hiem chinh theo quy dinh tai Quy tae dieu khoan cua san phim bao hiem chinh da ky ket.

5.4 Truing hap san phim bao hiem b6 try nay bi mat hiau luc do Ben mua bao hiem khong n6p du phi sau th8ri gian gia han (long phi, Ben mua bao hiem c6 the yeu eau khoi phtic hieu Itrc san phim bao hiem b6 try cling A/6i san phim bao hiem chinh. Viec chip nhan khoi phtic hiau luc san phirn bao hiem b6 try toy thulOc vao quy6t dinh thim dinh

cua Ong ty.

q.

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5.5 C6ng ty c6 the thay mi Phi bao hiem cua san pham bao hiem 136 tra nay vao bat kSi Ngay gia hart nam nao trong tucmg lai vai su chap thulan dm BO Tai Chinh va mire Phi bao hiem mai. Cong ty se thong bao int.& it nhat 60 (sau muai) ngay cho Ben mua bao hiem bang van ban tnxot khi viac thay d6i Phi bao hiem bat du co hiau Igc. Phi bao hiem mai ding se dugc ap dung d6i yeti cac Hop d6ng bao hiem co yeu cau khoi phpc hiau lgc.

Truong hop Ben mua bao hiem khong chap nhL viac thay d'cii phi bao hiem mOri, Ben mua bao hiem co the yeu cL chain dirt hiau Igc san pham bao hiem b6 try nay.

Dieu 6 Thay nghe nghib

Phi bao hiem cua san pham bao hiem b6 try nay co the thay doi tiny thuOc vao ngha nghiap cita Ngtrai duce bac, hiem. Neu ngha nghiap cua Ngtrai dugc bao hiem co su thay d6i, Ben mua bao hiem phai thong bao ngay bang van ban cho C8ng ty trong yang 30 (ba muai) ngay ke tir ngay Nguai dugc bao hiem co su thay d6i ve ngha nghiap. Neu khong, Cong ty c6 the khong thanh toan khi phat sinh yeu cAu tra tin bao hiem.

Neu c6 su thay d6i va ngha nghiap, Cong ty c6 the se quy& dinh lai Phi bao hiem phai (long ct6i voi san pham bao hiem b6 try nay va d6ng thai se thong bao lai cho Ben mua bao hiem. Vic tang hay giam phi bao hiem nett c6 se dugc ap dung ka tir ngay thay d6i ngha nghiap. Neu ngha nghiap mai cita Ngtrai doge bao hiem la ngha nghiap khong the bao hiem, hoc khong the chap nhan bao hiem dtrgc theo fieu chuan bao hiem cua C8ng ty, Cong ty se cham dirt hiau Arc cita san pham bao hiem b6 trg nay ka tir ngay Nguari dugc bao hiem thay d6i ngha nghiap va hoan lai phi bao hiem da clang cho khoang thai gian chtra dugc bao hiem (nett co), khong co lai phat sinh.

Dieu 7 Chac m chirt hqu cula san pilau'

San pham bao hiem b6 try nay se cham dirt khi mot trong cac su kin sau xay ra: a. Nguoi duce bao hiem tir vong; hoc

b. Hap d6ng san pham bao hiem chinh cham dirt hiau Arc; hoc c. San pham bao hiem b6 try nay kat thud Thai han bao hiem va COng ty khong tip tic gia

han Thai han bao hiem; holac d.

Ben mua bao hiem khong nOp du phi sau thai gian gia han dOng phi theo quy dinh cua hop d6ng san pham bao hiem chinh; ho'ac e. Ben mua bao hiem yeu cL chain dirt san pham bao hiem b6 try nay; hoac f.

Vao Ngay gia han nam ngay sau khi Ngtrai doge bao hiem dat Tu6i t6i da kat thitc gia han bao hiem; ho4c

H9p d6ng bao hiem san pliant bao hiem chinh da ks,' kat duce duy tri vo'i SO tin bao hiem giam; hok

h. Do Ngtrai clime bao hiem thay d6i ngha nghiap va khong ducyc Cong ty chap nkan tip tuc bao hiem nhu quy dinh tai Dieu 6; hoc

i. Bat kS, Quyan lgi bao hiem ctia san pham 1)6 try Ha' try /long phi (T* bo thu phi) cho H9p diing bao hiem dugc guyat dinh chi tra, trir truang hyp san pham 136 try nay thuOc pham

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g.

vi dugc mien &rig phi da ky ket khi tham gia san pham bo trg Ht; trg dOng phi (Tix bO thu phi). Trong trueyng hap nay, san phim bo trg nay se chim dirt hieu Itrc vao ngay den han &rig phi ngay sau khi C6ng ty guy& dinh chi tra guy& Igi bao hiem 116 trg Ho trg dOng phi (ter bO thu phi) cho Hop ang bao hiem; hoc

j. Nhitng nguyen nhan khac dugc quy climb tai cac Dieu ho4c Khoan khde trong Hop ang bao hiem; ho4c

k. Cac trueng hop khac theo quy dinh cua phap

Dieu 8 Gial quyet quyen Iqi bao hien' 8.1 Nguoi nhjn quy6'n Ici bao hiem

C8ng ty se chi tra quyen Igi bao hiem san pham be tip nay cho Nguai dugc bao hiem.

8.2 De yeu cau giai quy& quyen 19i bao hiem, bang chi phi cita minh, Ngtroi nhan quyen lgi bao hiem phai:

- Thong bao ngay bang van ban cho Cong ty trong yang 90 (chin muoi) ngay ke tir ngay xuAt vien. Viec khong nep cac chi ng tir trong khoang thoi gian not tren see khong gay phtrang hai den quyen yeu cau 136i thuang neu có 15, do hop 1e. Cac yeu cau thanh toan quyen lgi nOp muon qua 12 (mu6i hai) thang ke tir ngay xuit vien se khong dirge Ong ty chip nhan.

Bang chi phi ciia minh, cung cap cac thong tin va gigy to hO so can thiet theo yeu eau cita Cong ty

• Giay yeu cau giai quy& quyen lgi bao hiem (theo mau Cong ty cung cap) duce dien day du, trung thgc va chinh xac; va

• Ban g6c holac ban sao h9p 1e gidy nhap vien, ra vien, chuyen vien, hOa don vien phi; va

• Ho so benh an va giiy chimg nh4n phau thudt trong twang hop dieu tri tai Khoa chdm soc d;dc biet ho:ac Phau thuat; va

• Bang chimg ve tai non xay ra nhu Bien ban tai non giao thong, bien ban kham nghiem hien trtrOng, bao cao ket loan dieu tra hoc gi lay xac nhan tai Tian ciia co quan có tham quyen.

8.3 Cong ty se giai quyet quyen lgi bao hiem trong vong 30 (ba muoi) ngay ke tir ngay nhan day du cac chimg tir theo yeu cau.

8.4 De phuc vu cho vice giai quye't quye'n lei bao hiem trong nht-mg truOng h9p can thiet va 1191315,, COng ty co the:

Yeu cau NgtrOl dirge bao hiem thuc hien cac giam dinh y khoa vai chuyen gia y to do Cong ty chi dinh a xac dinh sir can thiet phai nam vien dieu tri nOi

Yeu eau giant dinh phap y trong truang hop tir vong neu can thiet va dugc phap ludt cho phop.

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Cong ty se chi tra chi phi cho viec giam dinh/xac nil:an y to bo sung nay. C6ng ty c6 quyen khong chi tra quyen lgi bao hiem ne'u Ben mua bao hiem va/hoac Nguad dirge No hiem va/ho4c Nguai yeu cau giai guy& quyen lcd bao hi6m khong hop tac veri cac caz yeu cau not ten.