法規內容

下載法規原始檔

 

國立成功大學學生團體保險契約條款
National Cheng Kung University Terms of Group Insurance Contract for Students

89.6.21八十八學年度第四次校務會議通過  
Approved at the fourth University Council Meeting of the 1999 academic year on June 21, 2000

107.3.14第一百八十九次行政會議通過
Approved at the 189th University Council Meeting on March 14, 2018

107.6.27第一百九十一次行政會議通過 
Approved at the 191th University Council Meeting on June 27, 2018

【保險契約的構成】   

【Constitution of the Insurance Contract】

第 一 條:本保險單條款、附著的要保書、被保險人名冊、批註及其他約定書,均為本保險契約(以下簡稱本契約)的構成部分。

本契約的解釋,應探求契約當事人的真意,不得拘泥於所用的文字;如有疑義時,以作有利於被保險人的解釋為準。

Article 1.  These policy provisions and the attached proposal, endorsements, and other agreements are all constituent parts of this insurance contract ("this contract").

Interpretation of this contract shall seek the true intent of the parties involved, and may not adhere blindly to the language employed. Where there is doubt, the interpretation favoring the insured shall be adopted.

 

【名詞定義】                                                                 

【Definitions】

第 二 條:本契約所稱名詞定義如下:

一、「要保人」係指國立成功大學。

二、「被保險人」係指具成功大學學籍之在學舊生及入學錄取榜單之新生。

三、「醫院」係指依醫療法規定,領有開業執照並具有住院診療設備之公、私立醫院,但不包括專供休養、戒毒、戒酒、護理、復健、養老等類似之醫療處所。

四、「癌症」係指一種疾病,其特徵係由人體內惡性細胞不能控制的生長和擴張,對身體組織構成侵害,或白血球過多症所造成的惡性腫瘤,而按行政院衛生署最新公佈之「國際疾病傷害及死因分類標準」歸屬為惡性腫瘤者。

五、「受益人」係指被保險人本人或戶籍資料所載之監護人或其家長。

Article 2.  The terms in the Contract are defined as follows:

1.        “Proposer” refers to National Cheng Kung University

2.        “Insured” refers to individuals possessing student status at the National Cheng Kung University or on the admission list.

3.        “Hospital” includes any public or private hospital with a license to operate and owning hospitality equipment in accordance with the Medical Care Act, excluding medical institutions established for purposes such as recuperation, drug rehabilitation, alcohol abstinence, care, physical rehabilitation, and care of older adults.

4.        “Cancer” refers to a group of diseases characterized by malignant tumor and involving uncontrollable growth and spreading of malignant cells in the human body, causing invasion of tissue or leukocytosis. The “cancer” in the Contract shall also be listed as malignant tumor in accordance with the most recent edition of the International Statistical Classification of Diseases and Related Health Problems published by the Ministry of Health and Welfare[Jane1] , Executive Yuan.

5.        “Beneficiary” refers to the insured or to the guardian or parent of the insured as stated on household registration data.

 

【保險範圍】

【Coverage】

第 三 條:被保險人在本契約有效期間內,因疾病或遭遇意外傷害事故,以致身故、殘廢或需要住院治療時,保險公司依照本契約的約定給付保險金。

前項所稱意外傷害事故,指非由疾病引起之外來突發事故。

Article 3.  In accordance with the Contract, the insurance company shall pay a claim to the insured for death, disability, or hospital admission caused by occurrence of a disease or injury by accident during the policy period.

The term "injury by accident" as used in the preceding paragraph refers to physical harm caused by unforeseen external events other than illness.

 

【保險費】 

【Premium】

第 四 條:本保險保險費分二次繳納,於每一學期註冊後三十天內彙總交付保險公司。

要保人應交之保險費經註冊後三十天未交付者,自催告到達之翌日起三十天為寬限期間,逾寬限期間未交付者,保險公司得暫行拒絕給付,如被保險人已將保險費繳付於要保人,而要保人未向保險公司交付者,因保險公司暫行拒絕給付而生之損害,應由要保人負責賠償。在寬限期間內發生保險事故,保險公司於給付保險金內扣除該被保險人欠繳之保險費。

Article 4.  The insurance policy premium shall be paid in two installments. The premium collected by the school shall be paid to the insurance company within 30 days after the registration date per semester.

Proposer failing to pay the premium within the said 30-day period shall pay the premium within 30 days (i.e., the grace period) after the date of the payment reminder receipt. After this grace period, should the proposer fail to pay the premium, the insurance company may temporarily refuse to pay for claims. Where the insured has paid the premium to the proposer, yet the proposer has yet to pay the premium to the insurance company, the proposer shall indemnify the insured for damage caused by temporary refusal by the insurance company to pay claims. Should any incidents covered by the Contract occur during the grace period, the insurance company may deduct the unpaid amount from a claim paid to the proposer.

 

【保險期間】

【Policy Period】

第 五 條:本契約的保險期間,自民國110年8月1日上午零時起,至民國111年7月31日下午十二時止。

凡參加本保險之學生,註冊繳納保險費在8月1日以後,保險效力仍溯至8月1日起生效(新生如在8月1日至註冊前發生事故而身故,仍應受理理賠。);應屆畢業生在7月31日以前畢業者,保險效力仍至7月31日終止,延至7月31日以後畢業者,由要保人將學生姓名、學號等資料通知保險公司備查,並於繳納保險費後,其保險效力至畢業之日終止。

Article 5.  The policy period of the Contract commences at 12 am, August 1, 2021 and terminates at 12 pm, July 31, 2022.

Policies of students enrolled in this insurance who registered after August 1 still come into effect on August 1. For example, a claim can still be filed for the death of the insured between August 1 and the registration date. Policies remain effective until July 31 for students to graduate prior to July 31. For students to graduate after July 31, the proposer shall submit the names and student identification numbers of said students to the insurance company to be filed for future reference. After the premium is paid, the effectiveness of said students’ policies will be prolonged to the date of graduation.

 

第 六 條:被保險人每學期應繳納之保險費,依公開招標決標價為準,由教育部補助五十元整,其餘由被保險人本人或法定代理人或家長於每學期註冊時繳納。

Article 6.  The premium per semester is calculated based on the open bid price per year. After an amount subsidized by the Ministry of Education is deducted (i.e., NT$50), the insured or their legal representative or parent shall pay the remaining premium during registration per semester.

 

第 七 條:有學籍的學生休學時,應繼續交付保險費參加本保險,並由要保人將休學學生姓名、學號等資料,通知保險公司備查。

Article 7.  Where a student is suspended from school with their student status retained, they shall continue to pay the premium. A list of suspended students and their student identification numbers shall be filed for the reference of the insurance company.

 

第 八 條:已參加本保險的學生中途喪失學籍者,要保人應將喪失學籍的時日通知保險公司,保險公司應依所剩餘之月數退還未到期的保險費。保險公司的保險責任至喪失的月終之日下午十二時為止。

Article 8.  The proposer shall report to the insurance company the respective dates for any students who lose their student statuses during the policy period. The insurance company shall then return paid premiums calculated based on the number of months remaining. Insurance liabilities of the insurance company terminate at 12 pm on the last date of the month when the Contract expires.

 

【身故保險金的給付】

【Payout of death benefit】

第 九 條:被保險人在保險期間內,因疾病或遭遇意外傷害事故,以致身故者,保險公司給付身故保險金新台幣壹佰萬元。

被保險人因參加校外教學活動或校內、外全校性正式的運動比賽或經校方核准登記之社團活動而遭遇意外傷害事故以致身故,並經要保人提出書面證明者,前項身故保險金提高為新台幣貳佰萬元。

(本條文另有註記於附表一)

Article 9.  Where the insured dies of a disease or an accident, the insurance company is obliged to pay a death benefit worth NT$1,000,000 to the beneficiary.

Where accidental death of the insured occurs during their engagement in school field trips, official intramural or extramural sport competitions, or student club activities approved by the university, the death benefit will increase to NT$2,000,000 upon submission of a written certificate by the proposer.

(Notes of this Article is attached in Table 1)

 

【殘廢保險金的給付】

【Payout of disability benefit】

第 十 條:被保險人在保險期間內,因疾病或遭遇意外傷害事故,致成附表二所列殘廢程度之一者,保險公司按附表一所列給付金額,給付殘廢保險金。

被保險人因同一事故致成附表二所列二項以上殘廢程度時,保險公司給付各該項殘廢保險金之和,但最高以保險金額為限。但不同殘廢項目屬於同一手或同一足時,僅給付一項殘廢保險金;若殘廢項目所屬殘廢等級不同時,給付較嚴重項目的殘廢保險金。

合併前次致成的殘廢可領附表二所列較嚴重項目的殘廢保險金者,以該較嚴重的殘廢保險金給付,但其已給付的殘廢保險金,應扣除之。

被保險人於訂立本契約前或因第十五、十六規定之除外責任所致附表二所列之殘廢,於本契約有效期間內再受傷害,致殘廢程度加重時,如其殘廢為非同一目、同一手、同一足者,適用本條第二項、第三項的規定;如其殘廢係加重於同一手或同一足者,對已前殘廢部份視同已給付殘廢保險金,應由加重後的殘廢保險金內扣除之。但加重後的殘廢程度屬同一等級不同項目之殘廢時,不再給付殘廢保險金。

被保險人在保險期間內,因疾病或遭遇外來突發的意外傷害致成附表二所列第一、二、三級者,除給付殘廢保險金外,並分期給付生活補助津貼。

Article 10.           Where the insured is subject to any disease- or accident-related disability with a level listed in Table 2 attached, the insurance company will pay a disability benefit in accordance with the corresponding amount stated in Table 1.

Where more than two disabilities caused by a single accident occur and their severity corresponds to the levels listed in Table 2, the insurance company shall pay the sum of each corresponding benefit, yet the maximum sum shall not exceed the insured amount. However, should different disabilities affect the same arm or leg, only one corresponding benefit is paid. Should said disabilities exhibit different severity levels, the benefit for the more severe disability shall be paid.

When a disability integrating with prior disabilities satisfies the benefit for the more severe disability listed in Table 2, the benefit for the more severe disability shall be paid to the insured, excluding the amount of already paid disability benefits.

Regarding deterioration of any disability in Table 2 caused prior to the establishment of the Contract or caused by insurance exclusions specified in Articles 15 and 16, benefits are paid as follows. Where a disability affects a different eye, arm, or leg, Articles 2 and 3 shall be followed; where deterioration of disability affects the same arm or leg, the benefits corresponding to the existing disabilities shall be deducted from the total benefits calculated after deterioration is considered. However, no benefit is paid where the injury causes a different disability of the same level as the existing disabilities.

In addition to disability benefits, living subsidies are separately granted to the insured subject to disease- or accident-related disabilities of Levels I, II, and III, as stated in Table 2.

 

【重大燒燙傷保險金的給付】

【Payout of benefits for severe burns】

第十一條:被保險人在保險期間內,因遭遇意外傷害事故以致發生重大燒燙傷者(附表三依全民健保重大燒燙傷定義),保險公司給付重大燒燙傷保險金新台幣貳拾伍萬元。

Article 11.           Where the insured is subject to accidental major burns (fulfilling severe burns defined by the National Health Insurance as attached in Table 3) during the policy period, the insurance company will pay a benefit of NT$250,000.

 

【醫療保險金的給付】

【Payout of healthcare benefit】

第十二條:被保險人在保險期間內,因疾病或遭遇意外傷害事故在醫院治療者,保險公司按下列金額給付醫療保險金,但對已參加公、勞、農、僑保等社會保險或其眷屬保險者,其醫療給付應扣除健保已給付之部份。

一、傷害及疾病住院治療:每一事故按下列標準計算:

(一)一般住院醫療日額給付保險金:保險公司按其實際住院日數每日給付新台幣伍佰元,但每次住院給付日數最高以六十日為限。

被保險人於本契約期間內,因同一疾病或傷害或其引起之併發症,必須住院治療兩次以上時,如每次出院日期與再入院日期間隔未超過十四日者,視為同一次住院。

(二)加護病房日額給付保險金:保險公司按其實際住院日數每日給付新台幣壹仟元,但每次住院給付日數最高以十四日為限。

(三)燒燙傷住院日額給付保險金:被保險人於本契約有效期間內,遭受附表三之燒燙傷時,保險公司按其實際住院日數每日給付新台幣壹仟伍佰元,但每次住院給付日數最高以六十日為限。

(四)一般手術:被保險人在保險期間內,因疾病或遭遇意外傷害事故,經醫院診斷必須實施手術者,保險公司每次手術最高給付新台幣陸仟元,實際費用不到新台幣陸仟元者,按實支金額給付。

(五)重大手術:被保人在保險期間內,因疾病或遭遇意外傷害事故,經醫院診斷必須實施附表四所列重大手術項目之一者,保險公司每次手術最高給付新台幣參萬元,實際費用不到新台幣參萬元者,按實支金額給付。

(六)醫藥及X光檢驗等費用:最高以新台幣肆仟元為限,實際費用不到新台幣肆仟元者,按實支金額給付。

二、意外傷害門診給付:

(一)門診保險金:

被保險人在保險期間內,因遭遇意外傷害事故,經醫院診斷必須實施治療者,保險公司每次最高給付新台幣伍仟元,實際費用不到新台幣伍仟元者,按實支金額給付。

(二)校內集體食物中毒慰問金:

被保險人因食用學生餐廳食物或參加本契約第九條第二項所列活動所致集體中毒(含疑似)事故,經醫院或診所治療者,保險公司給付每人慰問金新台幣壹仟元。

(三)骨折未住院醫療費用:被保險人在保險期間內,因遭遇意外傷害事故而致骨折,但未住院治療且經檢附X光片證明者,保險公司每次事故給付骨折未住院醫療保險金新台幣陸仟元。

Article 12.           Where the insured receives medical treatment in a hospital for injuries caused by a disease or accident, the insurance company will pay a healthcare benefit as follows. However, the amount covered by social insurance for civil servants, laborers, farmers, or overseas compatriot (either as the insured or the family of the insured) shall be deducted.

1.        Coverage for each injury and disease treatment in hospitals is calculated as follows.

(1)     Daily benefit for general hospital stays:  The insurance company pays a benefit worth NT$500 per day according to the actual duration, in day(s), of their hospital stay; the number of benefit days is a maximum of 60 per hospital stay.

During the policy period, where the insured requires hospital stays on two or more occasions due to the disease or injury in question or to complication(s) from the same disease or injury, hospital stays of less than 14 days apart shall be considered a single hospital stay.

(2)     Daily benefit for intensive care unit stays: The insurance company pays a benefit worth NT$1,000 per day according to the actual duration, in day(s), of the stay; the maximum number of benefit days is 14 per stay.

(3)     Daily benefit for hospital stays due to burns: The insurance company pays a benefit worth NT$1,500 per day to the insured subject for a burn described in Table 3 according to the actual day(s) of hospital stay; the maximum number of benefit days is 60 per stay.

(4)     General surgery: Where a hospital diagnoses an operation to treat a disease or injuries from an accident by which the insured subject is affected during the policy period, the insurance company pays a benefit worth a maximum of NT$6,000 per operation. For operations with a cost lower than said amount, a benefit with an amount equivalent to the actual cost is granted.

(5)     Major surgery: Where any of the major operations listed in Table 4 (attached) is diagnosed by a hospital for treating a disease or injuries from an accident affecting the insured subject during the policy period, the insurance company pays a benefit worth a maximum of NT$30,000 per operation. For operations costing less than the said amount, a benefit with an amount equivalent to the actual cost is granted.

(6)     Coverage for medications and X-ray tests: The insurance company pays a benefit worth a maximum of NT$4,000. For medications or tests costing less than said amount, a benefit equivalent to the actual cost is granted.

2.        Outpatient benefits for accident injury:

(1)     Outpatient benefits:

An insured subject receiving injuries from an accident during the policy period receives a benefit worth a maximum of NT$5,000 from the insurance company per treatment diagnosed by a hospital. For treatments costing less than said amount, a benefit equivalent to the actual cost is granted.

(2)     Benefit for group intramural food poisoning:

Where the insured receives treatment at a hospital or clinic due to (suspected) group poisoning at school cafeterias or activities specified in Paragraph 2 of Article 9 of the Contract, the insurance company pays a benefit worth NT$1,000 per victim.

(3)     Medical treatment for fractures without hospital stays: The insurance company pays a benefit worth NT$6,000 to the insured subject for fracture(s) caused by an accident during the policy period, upon submission of an X-ray slide and without requirement for hospitalization.

 

【保險給付的期限】

【Duration of insurance benefit validity】                                                         

第十三條:被保險人在保險期間內發生疾病或外來突發的意外傷害,而保險期滿後身故、殘廢或繼續治療的,祇要身故或確定殘廢或繼續治療的日期,在發生疾病或傷害之日起一百八十天以內者,保險公司依第九、十、十一、十二條規定仍負給付責任,但超過一百八十天者,保險公司不負給付責任。

Article 13.           Regarding the insured subject who, as a result of a disease or accident, died, became disabled, or continued to receive treatment after the policy period expires, upon confirmation of the death date, disability date, and date of treatment continuation, the insurance company will pay a benefit within 180 days after the date of disease occurrence or injury in accordance with Articles 9–12; the insurance is not liable for matters reported after said deadline, and these are not covered.

 

【保險給付的限額】 

【Insurance benefit limit】

第十四條:保險公司對本契約的每一被保險人身故、殘廢及重大燒燙傷保險金(但不包含生活補助津貼)之給付,於每一保險期間內,合計最高以新台幣壹佰萬元為限。(符合本契約第九條第二項規定之身故保險金提高為新台幣貳佰萬元)

依本契約第十三條在保險期滿後的給付,仍歸屬於疾病或傷害發生的年度。

Article 14.           The maximum benefit for death, disability, and severe burns affecting the insured to be paid by the insurance company per policy period (excluding living subsidies) is NT$1,000,000 (amount increased to NT$2,000,000 for benefits fulfilling conditions specified in Paragraph 2 of Article 9 in the Contract).

The time of benefit payout after the expiration of the policy period for the circumstances specified in Article 13 is still considered equivalent to the year when the disease or accident concerned occurred.

 

【除外責任】

【Insurance exclusions】

第十五條:被保險人直接因下列事由致身故、殘廢、傷害或疾病者,保險公司不負給付保險金的責任:

一、被保險人或受益人的故意行為。

二、被保險人的犯罪行為。

三、被保險人非因保險事故所施行的外科手術、整形美容或天生畸形整復。

Article 15.           For death, disability, injury, or disease resulting from the following causes, the insurance company bears no liability for settlement of claims:

1.        intentional acts performed by the insured or beneficiary,

2.        criminal acts performed by the insured,

3.        surgery, aesthetic plastic surgery, or born deformity surgery that is not required because of the insured accident concerned.

 

第十六條:被保險人具有下列情事之一者,保險公司不負給付保險金的責任:

一、精神病、癩病或麻醉藥、迷幻藥品嗜好症。

二、法定傳染病。

三、懷孕、流產或分娩,但遭受強暴脅迫致流產或分娩及剖腹生產手術或子宮外孕手術不在此限。

四、牙科鑲補或裝設義齒、義肢、義眼、眼鏡(包括檢查、驗光)或其他附屬品者。

五、非以治療為目的之健康檢查、療養或特別護理。

六、掛號、診斷證件、運送傷患、病房陪護或指定醫師等費用。

Article 16.           For the following conditions or coverage, the insurance company bears no liability for settlement of claims:

1.        mental illness, leprosy, or addiction to narcotic drugs or psychedelic drugs

2.        statutory contagious disease

3.        pregnancy, miscarriage, or delivery (cases subject to miscarriage, delivery, caesarean section, or ectopic surgery due to rape are not subject to this restriction)

4.        dental implant(s), dental, limb, or eye protheses, eye glasses (including eye tests and relevant examinations), or other accessories

5.        health examinations, care, special care for non-treatment purposes, and

6.        expenses for hospital appointment(s), diagnosis document issuance, patient transport, or physician designation.

 

【失蹤處理】

【Disappearance of the insured】

第十七條:被保險人因第二條所約定的事故失蹤或下落不明,於戶籍登記簿登記失蹤之日起滿一年仍未尋獲者,或有被保險人極有身故可能之證明者,保險公司可以先行墊付身故保險金。以後如發現生還時,受益人應於發現後一個月內,將該項墊付的身故保險金全數返還保險公司。

Article 17.           Where the insured disappears or is unaccounted for following the incidents specified in Article 2 and remains missing for 1 year following the date of disappearance registration on the household registration book, or if sufficient evidence indicates that the insured is highly likely to be dead, the insurance company may pay the death benefit in advance. Should the insured be found alive, the beneficiary shall return the death benefit in full amount to the insurance company a month after discovery.

 

【保險金的申請】

【Application for insurance benefits】

第十八條:受益人申請保險金時,要檢送下列文件:

一、保險金申請書。

二、請求身故保險金者,另檢具相驗屍體證明書或死亡診斷書及受益人的戶籍謄本。

三、請求失蹤之身故保險金者,另檢送失蹤證明文件。

四、請求殘廢保險金者,另檢送殘廢診斷書。

五、請求醫療保險金者,另檢送診斷書及醫療費用收據。

六、受益人的身分證明;但受益人申請各項醫療保險金時,保險公司有權對被保險人的身體予以檢驗。

Article 18.           The insured shall file a claim by submitting the following supporting documents:

1.     claim application form

2.     autopsy report or death certificate and beneficiary’s household registration transcript for death benefit claims

3.     proof of the insured’s disappearance for death claims based on declared death in absentia

4.     disability diagnosis report for disability claims

5.     diagnosis report and receipt for medical treatment required for healthcare claims

6.     beneficiary’s certificate of identity; when the beneficiary claims for any healthcare benefit, the insurance company reserves the right to request physical examinations of the insured.

 

【時效】

【Extinctive prescription】

第十九條:由本契約所生的權利,自得為請求之日起,經過兩年不行使而消滅。

Article 19.           Any right arising out of the Contract shall be extinguished if not exercised within two years from the day when it becomes possible to exercise the right.

 

【批註】

【Endorsement】

第 廿 條:本契約內容的變更,或記載事項的增刪,非經要保人與保險公司雙方面書面同意且批註於保險單者,不發生效力。

Article 20.           Any amendment to the content of the Contract or addition or deletion of contract particulars must be made upon written consent of both the proposer and insurance company to be effective.

 

【管轄法院】

【Court of jurisdiction】

第廿一條:本契約涉訟時,約定以臺南地方法院為管轄法院。

Article 21.           Any litigation arising from the Contract shall be filed only in the Taiwan Tainan District Court as the jurisdiction court.

 

 

( These regulations were translated from the original Chinese. In the event of any discrepancies between the two versions, the Chinese always takes precedence. )