全球医疗投保单.doc

Instructions 填写说明 You are responsible for completing this application and are solely responsible for its accuracy and completeness. 您有责任如实完整填写本投保单 All questions must be answered in full; all signatures or chop and dates must be included where noted; otherwise the application may be returned to you, resulting in a delay in processing and possibly a delay in the effective date of coverage. 所有问题都需完整填写，并请在所有提示必要处签字，盖章并签署日期。否则，该投保单会退还给您并可能延误保单生效日期。 Type or print clearly using blue or black ink. 请输入打印该投保单或使用蓝色或黑色水笔清晰填写。 Applicant’s Name: 申请人姓名 Section 1: Insurance Policy Selection: Please complete this section to tell us what insurance you are interested / applying for. 1区：保障选择: 请选择您希望申请的保障福利。 Enrollment Type:加减保类型 New Enrollment 新加保 Add Spouse, 增加附属被保险配偶Date of Marriage:结婚日期 Add Child 增加附属被保险子女 Other 其他： Currency of Premium and Benefits: CNY (￥) 保费及保障货币：人民币(￥) ; Method of Payment: Annual 付费方式：年付 This policy has 24-month waiting period for pre-existing conditions. Pre-existing Conditions means any illness or injury, physical or mental condition, for which an insured person received any diagnosis, medical advice or treatment, or had taken any prescribed drug, or where distinct symptoms were evident prior to the effective date. After a period of 24 months continuous insurance under the plan, approved pre-existing medical conditions will be covered. Non-disclosed conditions in this application are not covered. 本保单对于既往症适用24个月等待期。既往症是指在保险人对其保险责任生效前被保险人已就此接受诊断、医学咨询或治疗， 或服用药物，或显现症状的任何疾病或损伤或精神疾病。 经保险公司核保通过的既往症在被保险人加入保险计划连续24个月后纳入保险责任范围。 Applicant Signature 对在此投保单健康问卷中被保险人未列明的既往症，保险公司不承担保险责任。 投保申请人签名 ________________ Requested Medical Insurance Coverage 申请人申请的保险责任 Geographic Coverage: 地域保障类型： Worldwide (No Area Exclusions) 全球保障 （无除外地区） International (No Coverage in U.S. or Canada) 国际保障 （不包含美国，加拿大） International Plus (Emergency Coverage in U.S. or Canada) 国际增强保障（