| 保险福利 | 珍珠计划 |
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Insurance Benefit – Maximum per insured member / dependant
per insurance period.
保险福利－每一保险期间每个被保险人或家属被保险人的
最高保险金额。
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RMB 1,000,000 per insurance period
人民币1,000,000元每个保险期间
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Coinsurance
共付比例
Coinsurance is the percentage of charges for covered expenses
that the insured member/dependant will be required to pay
under the plan after satisfying the required deductible.
共付比例是指被保险人或家属被保险人在达到免赔限额之
后，根据保单还需支付的费用比例。
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1. Subject to a 20% coinsurance in some items under “Outpatient
Healthcare Benefits” (See list below for details)
在“门诊医疗保险福利”下的部分项目有20%的共付比例，
详见以下明细。
2. There will be no reimbursement for Pearl plan if seeking services
at hospitals or clinics in the Non-covered Provider List below.
在珍珠计划下，如被保险人或家属被保险人选择于后面“除外
医院列表”列出的医院或诊所就诊，被保险人或家属被保险人
将承担100%的费用
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Coverage Area
保障地区
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Mainland China
中国大陆
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| 住院 / 日间留院治疗保险福利（核心） | |
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Hospital Charges for:
下列医院收费项目：
Nursing and accommodation for in-patient treatment
住院治疗的护理和住宿；
Day case treatment
日间留院治疗；
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100% Refund
Up to RMB 1,200 per day of insurance
100%赔付，每个保险日不超过人民币1,200元
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Prescribed medicines, drugs and dressings for in-patient ordaycasetreatment
住院或日间留院治疗的处方药、药物和包扎。
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100% Refund
Up to RMB 50,000 per insurance period
100%赔付，每个保险期间不超过人民币50,000元
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Surgical Appliance and/or Medical Appliance
外科器具及 / 或医疗器械
This benefit will be paid in respect of:
针对以下情况：
an artificial limb, prosthesis or device which is inserted duringsurgery;
手术中置入的假肢、假体或设备；
an artificial prosthesis or device which is necessary part of thetreatment immediately following surgery for as long as isrequired by medical necessity;
因医疗所需，作为术后治疗必需部分的人工装置或辅助
设施。时间长短视医疗需要而定；
a prosthesis or appliance which is medically necessary and ispart of the recuperation process on a short-term basis.
因医疗所需，用于短期康复过程的辅助设施或器械。
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Parental Accommodation
家长留宿
This applies to insured children under the age of 18. CIGNA &CMC will pay for reasonable costs for a parent staying in the samehospital with the insured child
适用于18岁以下的家属被保险人。招商信诺将支付一名家
长与该家属被保险人同住一家医院合理的费用。
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100% Refund
Up to RMB 10,000 per insurance period
100%赔付，每个保险期间不超过人民币10,000元
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Operating theatre and recovery room
手术室与康复室
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100% Refund
Up to RMB 80,000 per insurance period
100%赔付，每个保险期间不超过人民币80,000元
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Surgeons’ and Anesthetists’ Fees
外科医生和麻醉师费用
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Surgical Procedures
外科手术
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Specialist Physician’s Fees
专科医生费用
This benefit is paid in full for regular visits by a specialist physicianduring stays in hospital including intensive care by a specialistphysician for as long as is required by medical necessity
此项保险福利适用于留院期间专科医生的常规出诊（包括
重症监护），时间长短视医疗需要而定
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100% Refund
Up to RMB 50,000 per insurance period
100%赔付，每个保险期间不超过人民币50,000元
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Physiotherapy
物理治疗
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Radiotherapy, Chemotherapy
放射治疗、化疗
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100% Refund
Up to RMB 100,000 per insurance period
100%赔付，每个保险期间不超过人民币100,000元
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Radiology, Pathology
放射检查，病理检查
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100% Refund
Up to RMB 50,000 per insurance period
100%赔付，每个保险期间不超过人民币50,000元
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Private Ambulance
私人救护车
This benefit is payable for transport to or from a hospital whenordered for medical reasons
此项保险福利适用于支付出于医疗原因而产生的往来医院
的交通费用。
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100% Refund
100%赔付
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| 门诊医疗保险福利 | |
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Consultations with Medical Practitioners and Specialists
普通及专家门诊
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Up to RMB 30,000 per insurance period
(20% coinsurance for Prescribed Medicines, Drugs and
Dressings at non-public hospital;
RMB 500 per day for consultations)
每个保险期间不超过人民币30,000元
（对于非公立医院处方药、药品和敷料，需支付
20%的共付比例;
每天普通及专家门诊费不超过人民币500元）
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Prescribed Medicines, Drugs and Dressings
处方药、药品和敷料
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Physiotherapy,Acupuncture,Chiropody,Osteopathy,Homeopathy
物理治疗、针灸、手足治疗、整骨疗法、顺势疗法
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Hormone Replacement Therapy
荷尔蒙替代治疗
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Annual Routine Test
每年常规检查
One eye test and hearing test for insured children under the age of 15
15岁以下的家属被保险人可享受一次视力检查和听力检查。
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Travel Vaccinations
旅行预防接种
This benefit will be payable for vaccinations related to travel
用于支付与旅行相关的预防接种费用。
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Chinese Herbal Medicine
中草药
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Pathology, Radiography
病理检查、影像检查
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100% Refund
Up to RMB 10,000 per insurance period
100%赔付，每个保险期间不超过人民币10,000元
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Non-surgical and Minor Surgical Procedures and Treatment
非手术性和小型外科手术及相关治疗
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100% Refund
Up to RMB 10,000 per insurance period
100%赔付，每个保险期间不超过人民币10,000元
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Emergency Dental Treatment
紧急牙科治疗
This benefit will be payable for treatment received during theemergency visit immediately after accidental damage to natural teeth
用于支付在天然牙齿意外受损后紧急治疗期间的支付费用。
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100% Refund
Up to RMB 5,000 per insurance period
100%赔付,每个保险期间不超过人民5000元
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| 可选保险福利 | |
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Optional Maternity Benefits
可选妊娠及生育保险福利
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Option 1
计划1
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Inpatient and Outpatient Maternity Cover
住院和门诊生育保险
This benefit is payable to eligible females covered under the plan.It includeshildbirth,pre-natal and post-natal exams and pre-natal vitamins
所有经保单承保的符合条件的女性均享有此项保险福利，包括分娩、产前和产后检查、产前维生素等费用。
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100% Refund
Up to RMB 30,000 per insurance period
Limit applies to routine and complicated maternity
100%赔付
每个保险期间不超过人民币30,000元的常规分娩或生育并发症的生育保险赔付
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Optional Wellness Benefits
可选保健保险福利
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Option 1
计划一
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Routine Physical Exams
常规检查
This benefit will be paid for, or in connection with, routine physical examinationsfor insured members/dependants
用于支付或部分承担被保险人/家属被保险人的常规体检费用
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Payable up to RMB 1,000 per insurance period
每个保险期间不超过人民币1,000元
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Pap Smear
巴式涂片
CIGNA&CMC will pay charges for an annual Papanicolaou screening
招商信诺将支付每年一次的巴式涂片检查费用
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Prostate Cancer Screening
前列腺癌检查
CIGNA&CMC will pay charges for an annual prostate cancer screening foreligible males over 50 years old
招商信诺为符合条件的50岁以上男性支付每年一次的前列腺癌检查费用
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Mammograms for Breast Cancer Screening or
Diagnostic Purposes
乳腺拍片或诊断检查
This benefit will be paid in respect of:
针对以下情况：
one baseline mammogram for asymptomatic women aged 35-39;
35-39岁无症状女性一次性基本拍片检查；
a mammogram for asymptomatic women aged 40-49 every two years ormore if medically necessary;
40-49岁无症状女性每两年或更频繁的(若医学上有必要)乳腺检查；
a mammogram every year for women aged 50 and over
50岁及以上女性每年一次乳腺癌拍片检查
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Immunization
儿童疫苗
This benefit will be payable for insured dependent children up to age 18.
面向18岁及以下的家属被保险人。
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Payable up to RMB 1,000 per insurance period
每个保险期间不超过人民币1,000元
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Optional Dental Benefits
可选牙科保险福利
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Maximum Benefit per insurance period for Class One, Two and Three
一类、二类和三类保险期间内的最高保险金额
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RMB 2,000 per insurance period
人民币2,000元每个保险期间
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Deductible
免赔额
Individual
个人
Family
家庭
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None
无
None
无
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Class One
一类
Investigative and Preventative Treatment Benefits include:
检查和预防性治疗包括：
X-rays, Scale and Polish
X光、去垢和磨光
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80% Refund
80%赔付
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Class Two
二类
Basic restorative treatment, Periodontal treatment and treatment of dentalinjury.Benefits include:
基本恢复性治疗、牙周治疗及牙齿受损治疗。包括：
Root canal treatment, extractions, surgical procedures, occasionaltreatment, anaesthetics, periodontal treatment
根管治疗、拔牙、手术处理、偶发治疗、麻醉和牙周治疗
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50% Refund
50%赔付
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Class Three
三类
Major Restorative and Orthodontic treatmentBenefits include:
重大恢复性和矫正性治疗包括：
Dentures – acrylic/synthetic, metal and metal/acrylic
假牙-丙烯酸酯/人造牙，金属牙及金属/丙烯酸酯牙
Crowns, inlays, mouth-guard or occlusal splint
齿冠、嵌体、防护牙托或咬合夹板
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50% Refund
50%赔付
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Orthodontic Treatment for insured dependent children under the age of 18
针对18岁以下的家属被保险人的牙齿整形治疗
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None
无
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