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ISMI

update date : 2022-08-01

National Cheng Kung University Terms of Group Insurance Contract for Students

Approved at the fourth University Council Meeting of the 1999 academic year on June 21, 2000
Approved at the 189th University Council Meeting on March 14, 2018
Approved at the 191th University Council Meeting on June 27, 2018

【Constitution of the Insurance Contract】
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.
                                                              

【Definitions】
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.
 

【Coverage】
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.
 

【Premium】
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.
 

【Policy Period】
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.
 
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.
 
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.
 
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.
 

【Payout of death benefit】
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)
 

【Payout of disability benefit】
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.
 

【Payout of benefits for severe burns】
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.
 

【Payout of healthcare benefit】
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.
 

【Duration of insurance benefit validity】                                                         
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.
 

【Insurance benefit limit】
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.
 

【Insurance exclusions】
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.
 
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.
 

【Disappearance of the insured】
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.
 

【Application for insurance benefits】
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.
 

【Extinctive prescription】
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.
 

【Endorsement】
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.
 

【Court of jurisdiction】
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. )

 

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