1. Hospitalization medical insurance: hospitalization in general wards of medical institutions designated by insurance companies. For the reasonable and necessary hospitalization expenses incurred by the insured (referring to the drug expenses and other hospitalization expenses agreed in this contract), the insurance company is limited to the basic insurance amount. After deducting the agreed deductible, the medical insurance premium for illness hospitalization shall be calculated and paid according to the following formula: (1) If the insured has obtained medical expenses compensation from public medical care or social medical insurance at the time of insurance, the medical insurance premium for illness hospitalization = the sum of reasonable and necessary hospitalization expenses incurred by the insured-the sum of medical expenses compensation from public medical care and social medical insurance. (2) If the insured fails to get the medical expenses compensation of free medical care or social medical insurance when applying for insurance money, the hospitalization insurance premium for illness = the sum of reasonable and necessary hospitalization expenses incurred by the insured *60%.
One or more cumulative medical insurance premiums paid for hospitalization due to illness are limited to the basic insurance amount.
2. Accidental hospitalization medical insurance premium: If the insured suffers accidental injury and is hospitalized in the general ward of the medical institution designated by the insurance company, the reasonable and necessary hospitalization medical expenses incurred by the insured (referring to the hospitalization medical expenses such as the medicine fee agreed in the contract) shall be limited to 2 times of the basic insurance amount in the contract. After deducting the agreed deductible, the accidental hospitalization medical insurance premium shall be calculated and paid according to the following formula: (1) If the insured has been compensated for the medical expenses of public medical care or social medical insurance at the time of insurance, the accidental hospitalization medical insurance premium = the sum of reasonable and necessary hospitalization medical expenses incurred by the insured-the sum of medical expenses compensation obtained by the insured from public medical care and social medical insurance. (2) If the insured fails to obtain medical expenses compensation from public medical care or social medical insurance when applying for insurance money, the accidental hospitalization insurance money = the sum of reasonable and necessary hospitalization medical expenses incurred by the insured *60%.
Accidental hospitalization medical insurance premium paid in one or more times shall be limited to 2 times of the basic insurance amount of this contract.
3. Medical insurance premium for major diseases: If the insured is diagnosed with major diseases agreed in this contract for the first time due to accidental injuries (regardless of one or more kinds of insurance premiums, the same below), or after the disease observation period, he is diagnosed with major diseases agreed in this contract for the first time due to reasons other than accidental injuries, and is hospitalized in the general ward of a medical institution designated by the insurance company or treated in a specialized clinic for malignant tumors of a designated medical institution (excluding specialized clinics), For the reasonable and necessary medical expenses incurred by the insured due to serious diseases, the insurance company shall be limited to 3 times of the basic insurance amount, and after deducting the agreed deductible, the medical insurance premium for serious diseases shall be calculated and paid according to the following formula: (1) At the time of insurance, the insured has been compensated for the medical expenses of public medical care or social medical insurance. Medical insurance premium for major diseases = sum of reasonable and necessary medical expenses for major diseases of the insured-sum of medical expenses compensation obtained by the insured from public medical care and social medical insurance-sum of medical expenses compensation obtained by the insured from public medical care and social medical insurance. (2) If the insured fails to obtain medical expenses compensation from public medical care or social medical insurance when applying for insurance benefits, the medical insurance premium for major diseases = the sum of reasonable and necessary medical expenses for major diseases incurred by the insured *60%. The accumulated medical insurance premium for one or more major diseases is limited to 3 times of the basic insurance amount.
In any case, for the same insurance accident, the hospitalization insurance premium for illness, the hospitalization insurance premium for accident and the medical insurance premium for major illness cannot have both, that is to say, if one insurance premium is paid, the other insurance premiums will not be paid.