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I have read and agree to the Terms and Condition


Terms and Condition

本人声明和授权:

I hereby declare and authorize:

1. 我授权医生、医院 / 诊所或其他医疗机构提供我(或被保险人——我的家庭成员的)诊断和/或药物治疗的信息和/或医疗记录,及

1. That I authorize the medical practitioner, Hospital / Clinic or any other medical institution to give the information and / or medical record, according to the diagnosis and / or medication treatment which is/has been given to me or my family member who being as the insured, and

2. 我授权保险人及其指定的第三方管理公司基于理赔流程需要从医生、医院 / 诊所或其他医疗机构获得我(或被保险人——我的家庭成员)的所有医疗信息。

2. That I authorize insurer and its designated third party administrators; to gather further information / medical records from the Hospital and or other parties related to the diagnosis and or health services provided to me or my family member which may be required to process the claim in accordance with existing policy and term conditions.

3. 本索赔申请表上的信息均为真是有效, 我同意此授权书及时生效。

3. That all information on this Medical Claim Form is written truthfully and I hereby agree that this Letter of Authority to be used promptly.

4. 本声明的复印件与原件同属有效。

4. That copy of this Declaration is as valid and has power in accordance with the original document.

5. 我同意若我或我的家庭成员实际发生的医疗费用不属于保单保障范围时,保险人无须承担相应的赔偿责任;我同意即使保险人已经承担部分费用,若我或我的家庭成员随后的求诊费、检查检验费或其他医疗服务费用不是合理且惯常的,保险人无须承担后续治疗费用或类似的治疗费用。

5. That the approval (where applicable) of this claim does not discharge my obligations to fulfill the terms and conditions under the policy which I and/or family member is/are insured, and also, insurer is not obliged to pay the ongoing costs of continuing, or similar, treatment, even where insurer has previously paid for this type of, or similar treatment, if it is subsequently noted that this claim is not an eligible treatment.

6. 我授权保险人及其指定的第三方管理公司向我的父母披露医疗、理赔信息。

6. That I authorize insurer and its designated third party administrators; to disclose my medical and claims information to my parents.

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