Microsoft Word - Product Provisions - CI Additional _Final_.doc

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1 危疾附加利益保障 ( 額外賠償 ) CRITICAL ILLNESS RIDER (ADDITIONAL) (R13) 1. 生效 生效本附加利益保障之上述編號須載明於承保表或之後有效之批單上並於承保表或之後有效之批單上所規定的保費被繳付後, 本附加利益保障才開始並持續生效 除有效之保單批單上另行註明外, 本附加利益保障於保單簽發日期當日起生效 基本條款除非另有訂明, 本保單之一般保單條款適用於本附加利益保障, 如本附加利益保障之條款與一般保單條款出現任何矛盾, 則以前者為準 本附加利益保障不設有貸款價值和不能作廢選擇, 及本保單之不得異議條款不適用於本附加利益保障上 本附加利益保障不會獲分配本公司之盈餘 2. 基本 1. IN FORCE This Rider only becomes effective if the above form number appears in the Policy Specifications or any subsequent endorsement validly made to this Policy and remains in force only when all premiums due for this Rider as stated in the Policy Specifications or any subsequent endorsement have been paid. The effective date of this Rider will be the same as the Policy Issue Date unless stated otherwise in any endorsement validly made to this Rider. 2. BASIC PROVISIONS The General Policy Provisions contained in this Policy shall apply to this Rider unless stated otherwise. In the event of any conflict between the provisions of this Rider and the General Policy Provisions, the former shall prevail. This Rider has no loan value or non-forfeiture options and the incontestability provision of this Policy is inapplicable to this Rider. There is no distribution of surplus by the Company in respect of this Rider. 3. 釋義 釋義除非文義另有所指, 本部份所載定義適用於本附加利益保障出現的下列字詞 意外事件指於本附加利益保障有效期間發生無法預見和意料之外的暴力 偶發 外在及可見事件, 並在不牽涉任何其他因素下, 構成身體受傷的唯一和直接原因 診斷指醫生 ( 包括如心臟病專科醫生 腎病專科醫生 神經科專科醫生及眼科專科醫生 ) 對病況作出的鑑定及測定, 由決定性的醫學檢查結果所證明, 其包括但不限於臨床 放射 組織及化驗的證據 該證據須為本公司接受及參考本附加利益保障列出的特定嚴重疾病或非嚴重疾病之定義 若就診斷的合適性或正確性發生爭論或意見不同時, 本公司有權在該醫學界選擇一位獨立的公認專家對受保人或達致此診斷之證據作出審查 該專家之判斷將對受保人及本公司具約束力 3. DEFINITIONS Unless the context otherwise requires, the definitions in this section apply to the following words and phrases whenever they appear in this Rider. Accident Diagnosis 嚴重疾病 指列明於保障給付條款內第 4.1 條的任何一種疾病 Major Illness 嚴重疾病賠償 指根據保障給付條款內第 4.4 條所給付之賠償 Major Illness 非嚴重疾病指列明於保障給付條款內第 4.2 條的任何一種疾病 非嚴重疾病賠償指根據保障給付條款內第 4.3 條所給付之賠償 醫生 指任何具有正式資格 已正式註冊並且在法律上獲准在其執業地方提供西醫內科或外科醫療服務的醫生, 但如果該醫生本身為保單權益人 / 受保人, 或是保單權益人 / 受保人的配偶, 或是透過血緣或婚姻關係而與保單權益人 / 受保人有關的任何其他人, 則該醫生不被包括在本定義之內 Benefit Minor Illness Minor Illness Benefit Physician means an unforeseen and unexpected event of violent, accidental, external and visible nature which occurs while this Rider is in force and which shall, independent of any other cause, be the sole and direct cause of bodily injury. means identification and determination of the medical condition by a Physician (including specialist such as cardiologist, nephrologist, neurologist and ophthalmologist) supported by confirmatory investigations including, but not limited to, clinical, radiological, histological and laboratory evidence. Such evidence shall be acceptable to the Company and shall refer to the definition of the particular Major Illness or Minor Illness as set out in this Rider. In the event of any disputes or disagreement regarding the appropriateness or correctness of the Diagnosis, the Company shall have the right to call for an examination, of either the Insured or of the evidence used in arriving at such Diagnosis, by an independent acknowledged expert in the field of medicine concerned selected by the Company and the opinion of such expert as to such Diagnosis shall be binding on both the Insured and the Company. means any of the illnesses specified under Clause 4.1 under the Payment of Benefit Provisions. means the benefit payable pursuant to Clause 4.4 under the Payment of Benefit Provisions. means any of the illnesses specified under Clause 4.2 under the Payment of Benefit Provisions. means the benefit payable pursuant to Clause 4.3 under the Payment of Benefit Provisions. means any registered medical practitioner duly qualified and registered and legally authorized in the geographical area of his practice to render western medical or surgical services but excludes a Physician who is the Policy Owner/Insured, the spouse of the Policy Owner/Insured or any other person related to the Policy Owner/Insured whether by blood or marriage. NB/Provn/P052/Sept 2012/S - Product Specific Provisions (CI Additional Rider) 1

2 已存在醫療狀況指任何以下狀況或疾病 : (i) 以前曾存在或一直存在 ; 或 (ii) 直接致病因素以前存在或一直存在 ; 或 (iii) 受保人知悉該狀況 疾病 病徵之病狀 ; 或 (iv) 任何化驗室的測試或調查顯示可能有該狀況或疾病的存在而有關狀況在本附加利益保障生效日期或加簽批單日期或本附加利益保障最後復效生效日 ( 以較遲者為準 ) 前發生 4. 保障給付條款 4.1 嚴重疾病之定義 Pre-existing Condition 保障給付條款 4. PAYMENT OF BENEFIT PROVISIONS 嚴重疾病之定義 4.1 DEFINITION OF MAJOR ILLNESS 每項嚴重疾病均有其訂定之定義並詳述於下列之有關標題下, 而任何就嚴重疾病的診斷證明必須符合該定義及該嚴重疾病標題下列出的所有及每一項條件及要求, 方可就該嚴重疾病提出索償 以下嚴重疾病之六組分類僅供參考用途, 並不影響本條文之解釋 癌症癌症癌症指惡性腫瘤, 其特徵為惡性細胞漸進地不受控制地生長及擴散, 侵潤及破壞正常及周邊組織 癌症必須由組織病理學報告證實腫瘤呈陽性 基於上述定義, 下列腫瘤情況並不屬保障範圍 : (i) 組織病理學中以下的腫瘤分類 : - 癌前病變 ( 如 : 血小板增生症 真性紅細胞增多症 原位癌包括子宮頸上皮內贅瘤 CIN-1 CIN-2 及 CIN-3); - 交界性腫瘤 ; 或 - 低惡性腫瘤 (ii) 白血病但沒有造成造血骨髓內白血病細胞廣泛擴散的情況, 及 RAI 級別 I 或 Binet 級別 A-I 以下的慢性淋巴性白血病 ; 組別 1: 癌症 Group 1: Cancer 1.a) 癌症 1.a) Cancer (iii) 所有皮膚癌, 除非能夠證實腫瘤已經擴散或是利用 Breslow 組織學檢驗方法證明最高厚度超過 1.5mm 的惡性黑色素瘤 ; 及 (iv) 非致命的癌症, 如 : - TNM 組織學分期在 T1 (a) 或 T1(b) ( 或其他分級方法中同等或更低分級 ) 的前列腺癌 ; - 微小甲狀腺乳頭狀癌 ; 及 - 膀胱乳頭狀癌, 組織學上被界定為 TaN0M0 或更低的分級 組別 2: 與心臟相關的疾病 2.a) 心肌病多種病因導致心室功能受損, 引致永久及不可逆轉的損害, 其程度至少為美國紐約心臟病學會心臟功能分級的第 4 級 必須由心臟專科醫生診斷, 並且有適當的檢查報告, 報告中應包括心臟超聲波證明 means any condition or illness: (i) which existed or was existing; or (ii) where its direct cause existed or was existing; or (iii) in respect of which the Insured had knowledge, signs or symptoms of the condition or illness; or (iv) where any laboratory test or investigation showed the likely presence of the condition or illness prior to the effective date of this Rider or the date of endorsement or the effective date of last reinstatement of this Rider whichever is later. Each Major Illness has its meaning given under the relevant heading below. Any Diagnosis of a Major Illness for the purpose of claiming the Major Illness Benefit must fall within the relevant definition and meet with each and every condition and requirement set out under the heading of the relevant Major Illness. The classification of Major Illness into six groups is for reference purpose only and shall not affect the interpretation thereof. Cancer means the presence of a malignant tumour that is characterised by progressive, uncontrolled growth, spread of malignant cells with invasion and destruction of normal and surrounding tissue. Cancer must be positively diagnosed with histopathological confirmation. Based on above definition, the following tumours are not covered: 與心臟相關的疾病 Group 2: Heart related illnesses 心肌病 2.a) Cardiomyopathy 2.b) 冠狀動脈手術經正中胸骨切開進行的冠狀動脈搭橋手術, 以矯正一條或以上之冠狀動脈狹窄或阻塞, 手術須經心臟專科醫生建議而實施 鎖孔手術 血管成形術 激光治療或其他經動脈穿刺進行的手術除外 NB/Provn/P052/Sept 2012/S - Product Specific Provisions (CI Additional Rider) 2 (i) (ii) (iii) (iv) All growths which are histopathologically classified as any of the following: - pre-malignant (for example: essential thrombocythaemia, polycythaemia rubra vera, tumours showing the malignant changes of carcinoma-in-situ including cervical intraepithelial neoplasia CIN-1, CIN-2 and CIN-3); - having either borderline malignancy; or - having low malignant potential. Leukaemia if there is no generalized dissemination of leukaemia cells in the blood-forming bone marrow and chronic lymphocytic leukaemia less than RAI Stage I or Binet Stage A-I; All skin cancers, unless there is evidence of metastases or the tumour is a malignant melanoma of greater than 1.5mm maximum thickness as determined by histological examination using the Breslow method; and Non life-threatening cancers, such as: - prostate cancers which are histologically described as TNM Classification T1 (a) or T1(b), or are of another equivalent or lesser classification; - papillary micro-carcinoma of the thyroid; and - papillary cancer of the bladder histologically described as TaN0M0 or of a lesser classification. Impaired ventricular function of variable aetiology, resulting in permanent and irreversible physical impairments to the degree of at least Functional Class 4 of the New York Heart Association Functional Classification of Cardiac Impairment. The Diagnosis must be confirmed by a consultant cardiologist and supported by the appropriate test results including echocardiography. 2.b) Coronary Artery Disease Surgery The undergoing of surgery requiring median sternotomy on the advice of a consultant cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts. 'Keyhole', angioplasty, laser treatment or other intra-arterial procedures are excluded from this definition.

3 2.c) 急性心肌梗塞由於供血不足引致部分心肌壞死 急性心肌梗塞須得到明確診斷且符合以下所有條件 : (i) 典型胸痛症狀 ; (ii) 心電圖變化提示新近心肌梗塞 ; (iii) 典型心臟酵素提升或肌鈣蛋白達到以下水準或更高 : - Troponin T > 1.0 ng/ml - AccuTnI> 0.5 ng/ml 或其他 Troponin I 的檢驗方法同等的閾值 急性心肌梗塞 2.c) Heart Attack 2.d) 心瓣手術經正中胸骨切開進行手術, 以置換或修補一個或多個心瓣, 手術須經心臟專科醫生建議而實施 心瓣擴張術除外 心瓣手術 2.d) Heart Valve Surgery 2.e) 原發性肺動脈高壓原發性肺動脈高壓指由於肺結構 肺功能或循環障礙引起的肺動脈壓力病理性增高, 造成右心室擴大 受保人所患的肺動脈高壓必須已經造成永久性和不可逆轉的體力活動能力受限, 心臟功能損害達到美國紐約心臟病學會心功能分級 4 級或以上 必須證明肺動脈壓在至少六個月內超過 30mmHg Unequivocal Diagnosis of the death of a portion of the heart muscle arising from inadequate blood supply to the relevant area. All of the following criteria must be satisfied: (i) Typical central chest pain suggestive of heart attack; (ii) New ECG changes indicative of a recent myocardial infarction; (iii) The characteristic rise of cardiac enzymes or Troponins recorded at the following levels or higher: - Troponin T > 1.0 ng/ml - AccuTnI > 0.5 ng/ml or equivalent threshold with other Troponin I methods. The undergoing of surgery requiring median sternotomy on the advice of a consultant cardiologist to replace or repair one or more heart valves. Valvotomy is excluded. 原發性肺動脈高壓 2.e) Primary Pulmonary Arterial Hypertension 2.f) 主動脈手術主動脈手術指經胸廓切開或剖腹進行修補或矯正主動脈瘤或主動脈阻塞 縮窄或創傷性破裂的情況 本定義內的主動脈指胸主動脈和腹主動脈, 不包括其分支 利用微創手術或動脈穿刺技術進行的手術除外 主動脈手術 2.f) Surgery to Aorta 組別 3: 與神經系統相關的疾病 3.a) 亞爾茲默氏病亞爾茲默氏病指受保人患有亞爾茲默氏病或者其他癡呆 亞爾茲默氏病是一種進行性腦變性疾病, 表現為彌漫性大腦皮質萎縮並具有特徵性組織病理學改變 癡呆是一種器質性精神疾患, 表現為全面的智力喪失, 包括記憶力 判斷力 抽象思維能力障礙和人格改變 患有亞爾茲默氏病或者其他癡呆的受保人必須滿足下列所有條件 : (i) 不可逆轉的永久性腦功能衰竭 ; (ii) 標準測試顯示由亞爾茲默氏病或其他癡呆導致明顯的認知功能損害 ; 及 (iii) 受保人必須處於持續的看護狀態之下, 以避免傷害他人或其自身 Primary Pulmonary Arterial Hypertension is the pathological increase of pulmonary pressure due to structural, functional or circulatory disturbances of the lung leading to right ventricular enlargement. The disease must result in permanent irreversible physical impairment to the degree of at least Class 4 of the New York Heart Association Functional Classification of Cardiac Impairment. There must be proof that pulmonary pressure has remained above 30mm Hg for a period of at least six months. Surgery to Aorta means the undergoing of surgery via thoracotomy or laparotomy to repair or correct an aortic aneurysm, an obstruction of the aorta, a coarctation of the aorta or a traumatic rupture of the aorta. For the purpose of this definition aorta shall mean the thoracic and abdominal aorta but not its branches. Surgery performed using only minimally invasive or intra arterial techniques are excluded. 與神經系統相關的疾病 Group 3: Nervous System related illnesses 亞爾茲默氏病 3.a) Alzheimer's Disease 3.b) 植物人指腦皮質廣泛壞死, 惟腦幹仍保持完整 有關診斷必須獲神經科專科醫生證明, 且此狀態須已持續最少一個月 植物人 3.b) Apallic Syndrome 3.c) 細菌性腦 ( 脊 ) 膜炎細菌感染導致覆蓋腦或脊髓的腦脊膜炎症, 並造成永久性神經功能損害 必須由神經科專科醫生證明永久性神經功能損害已持續至少 30 天 膜炎 3.c) Bacterial Meningitis Alzheimer s Disease means the Insured has Alzheimer s Disease or other Dementia. Alzheimer s Disease is a progressive degenerative disease of the brain characterised by diffuse atrophy throughout the cerebral cortex with distinctive histopathologic changes. Dementia is an organic mental disorder characterised by a general loss of intellectual abilities involving impairment of memory, judgment and abstract thinking as well as changes in the personality. All of the following conditions must be fulfilled and be caused by Alzheimer s Disease or other Dementia: (i) Permanent irreversible failure of brain function; (ii) Standardised tests must prove a significant cognitive impairment due to Alzheimer s Disease or Dementia; and (iii) The Insured must require continuous supervision to prevent the Insured from harming others or him/herself. Universal necrosis of the brain cortex, with the brainstem remaining intact. Diagnosis must be confirmed by a neurologist and condition must be documented for at least one month. Bacterial Meningitis is an inflammation of the membranes covering the brain or spinal cord caused by bacteria. Permanent neurological deficit lasting for a minimum period of 30 days has to be confirmed by a consultant neurologist. NB/Provn/P052/Sept 2012/S - Product Specific Provisions (CI Additional Rider) 3

4 3.d) 良性腦腫瘤良性腦腫瘤指危及生命的腦部良性腫瘤, 引起顱內壓增高的特徵性臨床表現, 例如 : 視神經乳頭水腫 精神症狀 癲癇及感覺障礙 腦腫瘤的存在必須由影像學 ( 如 : 頭顱 CT 或 MRI) 檢查證實 該瘤必須已導致最少連續六個月的嚴重及永久性神經功能損害 基於上述定義, 下列各項情況並不屬保障範圍 : (i) 腦部的囊腫 ; (ii) 肉芽腫 ; (iii) 腦血管畸形 ; (iv) 血腫 ; 及 (v) 腦垂體腫瘤以及脊髓腫瘤 良性腦腫瘤 3.d) Benign Brain Tumour 3.e) 昏迷完全喪失知覺, 對所有外界的刺激或內部需求完全沒有反應, 且須符合下列所有條件 : (i) 需要使用生命維持系統至少連續 96 小時以上 ; 及 (ii) 造成永久性神經功能損害, 出現持續的臨床症狀 昏迷 3.e) Coma 3.f) 腦炎指大腦半球 腦幹及小腦的炎症 須由神經病專科醫生證實已導致嚴重併發症且持續最少六個星期, 其中應包括永久性神經功能損害 腦炎 3.f) Encephalitis 3.g) 嚴重頭部創傷意外造成的頭部創傷造成永久性神經功能損害, 導致受保人在沒有協助的情況下, 永久性失去進行日常活動六項中最少三項的能力 神經功能損害必須得到神經科專科醫生證實 Benign Brain Tumour means a life-threatening, non-cancerous tumour in the brain giving rise to characteristic symptoms of increased intracranial pressure such as papilloedema, mental symptoms, seizures and sensory impairment. The presence of the underlying tumour must be confirmed by imaging studies such as CT scan or MRI. The tumour must result in significant permanent neurological deficit persisting for at least six (6) consecutive months. Based on above definition, the following are not covered: (i) Cysts; (ii) Granulomas; (iii) Vascular malformations; (iv) Haematomas; and (v) Tumours of the pituitary gland or spinal cord. 嚴重頭部創傷 3.g) Major Head Trauma 3.h) 運動神經元病運動神經元病的特徵為皮質脊髓束和前角細胞或延髓傳出神經元進行性變性 運動神經元病包括脊髓性肌萎縮 進行性球麻痹 肌萎縮性側索硬化症和原發性側索硬化症 本定義僅對運動神經元病造成永久性神經功能損害, 并導致受保人在沒有協助的情況下, 永久性失去進行日常活動六項中最少三項的能力 運動神經元病 3.h) Motor Neurone Disease 3.i) 多發性硬化症是一種神經性腦組織的脫髓鞘疾病 必須由神經科專科醫生證實為臨床定義的多發性硬化症 診斷必須符合下列所有條件 : (i) 檢查必須明確診斷為多發性硬化症 (ii) 連續六個月以上反復發作神經損害 ; 及 (iii) 必須有清楚記錄的病歷顯示以上病徵或神經性損害的惡化及緩解的情況 由於系統性紅斑狼瘡等其他原因引起的神經性損害除外 多發性硬化症 3.i) Multiple Sclerosis 3.j) 肌營養不良症肌營養不良症是一組遺傳性肌肉變性病變, 臨床特徵為與神經系統無關的肌肉無力和肌肉萎縮 病情必須導致受保人在沒有協助的情況下, 永久性失去進行日常活動六項中最少三項的能力 肌營養不良症 3.j) Muscular Dystrophy A state of unconsciousness with no reaction to external stimuli or internal needs which: (i) Requires the use of life support systems for a continuous period of at least 96 hours; and (ii) Results in permanent neurological deficit with persisting clinical symptoms. Encephalitis is an inflammation of the brain (cerebral hemisphere, brainstem or cerebellum). The disease must result in significant complications lasting at least 6 weeks, which include permanent neurological deficit. The resultant significant permanent neurological deficit must be confirmed by a consultant neurologist. Accidental head injury caused by an external physical force resulting in permanent neurological deficit giving rise to the inability of the Insured to perform without assistance 3 of the 6 Activities of Daily Living as certified by a neurologist. Motor Neurone Disease is characterised by progressive degeneration of corticospinal tracts of anterior horn cells or bulbar efferent neurones. Motor Neurone Disease includes spinal muscular atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis and primary lateral sclerosis. In respect of this definition, claims shall only be admitted if Motor Neurone Disease causes permanent neurological deficit resulting in the irreversible inability of the Insured perform at least 3 of the 6 Activities of Daily Living without the assistance of another person. A disease due to demyelination of neurological brain tissue. A consultant neurologist must make a Diagnosis of clinically definite Multiple Sclerosis. The Diagnosis must be supported by all of the following: (i) Investigations which unequivocally confirm the Diagnosis to be Multiple Sclerosis; (ii) Multiple neurological deficits which occurred over a continuous period of at least 6 months; and (iii) Well documented history of exacerbations and remissions of said symptoms or neurological deficits. Other causes of neurological damage such as Systemic Lupus Erythematosus are excluded. Muscular Dystrophies are a group of genetic degenerative myopathies characterised by weakness and atrophy of muscle without involvement of the nervous system. The condition must cause permanent and irreversible inability of the Insured to perform at least 3 of the 6 Activities of Daily Living without the assistance of another person. NB/Provn/P052/Sept 2012/S - Product Specific Provisions (CI Additional Rider) 4

5 3.k) 壞死性筋膜炎壞死性筋膜炎的診斷須滿足下列全部條件 : (i) 符合壞死性筋膜炎的常規臨床診斷標準 ; (ii) 確認能夠導致壞死性筋膜炎的致病菌 ; 及 (iii) 肌肉及其他軟組織被大面積破壞, 導致受影響部位的身體機能永久完全喪失 壞死性筋膜炎 3.k) Necrotising Fasciitis 3.l) 癱瘓指由於腦或脊髓的疾病或意外導致兩個或以上的肢體功能永久完全喪失, 包括四肢癱瘓 下身癱瘓 兩側癱瘓 偏癱及全身癱瘓 定義中的肢體指完整的上肢或下肢 四肢癱瘓指上兩肢及下兩肢功能永久完全喪失 下身癱瘓指下兩肢功能永久完全喪失 兩側癱瘓指身體兩側功能永久完全喪失 偏癱指左或右半身功能永久完全喪失 全身癱瘓指上兩肢 下兩肢及頭部活動功能永久完全喪失 癱瘓 3.l) Paralysis 3.m) 柏金遜症柏金遜症是一種緩慢進行性中樞神經系統變性疾病, 是由於腦實質某區域神經元變性引起腦內部分區域多巴胺水準下降而導致的 柏金遜症必須被明確診斷, 並且符合下列所有條件 : (i) 症狀無法用藥物控制 ; (ii) 呈進行性損害徵兆 ; 及 (iii) 病情必須導致受保人出現神經功能損害, 在沒有協助的情況下, 永久性失去進行日常活動六項中最少三項的能力 柏金遜症 3.m) Parkinson's Disease 3.n) 脊髓灰質炎由於脊髓灰質炎病毒的感染而導致癱瘓, 出現運動功能障礙或呼吸功能損害 本定義所指的脊髓灰質炎須造成神經功能損害並導致肢體永久性癱瘓方可符合理賠條件 脊髓灰質炎 3.n) Poliomyelitis 3.o) 中風腦血管事故包括腦組織梗塞 腦出血 蛛網膜下腔出血 腦栓塞及腦血栓 診斷必須由以下各項支持 : (i) 由神經科專科醫生證明永久性神經功能損害, 由事故發生後持續至少六個星期 ; 及 (ii) MRI 或 CT 報告或其他可靠的影像技術證明此為新發生的中風事故 基於上述定義, 下列情況並不屬保障範圍 : (i) 短暫性腦缺血發作 ; (ii) 意外或傷害 感染 血管炎及炎症性疾病引起的腦部損害 ; (iii) 引起眼或視神經障礙的血管疾病 ; 及 (iv) 前庭系統的缺血性異常 中風 3.o) Stroke The occurrence of Necrotising Fasciitis where all of the following conditions are met: (i) (ii) (iii) The usual clinical criteria of Necrotising Fasciitis are met; The bacteria identified is a known cause of Necrotising Fasciitis; and There is widespread destruction of muscle and other soft tissues that results in a total and permanent loss of function of the affected body part. Paralysis means the permanent and total loss of function of two or more limbs as a result of injury to, or disease of the spinal cord, including Quadriplegia, Paraplegia, Diplegia, Hemiplegia or Tetraplegia. Limb is defined as the complete arm or the complete leg. Quadriplegia means the permanent and total loss of function of both arms and both legs. Paraplegia means the permanent and total loss of function of both legs. Diplegia means the permanent and total loss of function of both sides of the body. Hemiplegia means the permanent and total loss of function of one side of the body. Tetraplegia means the permanent and total loss of function of both arms and both legs and loss of head movement. Parkinson s Disease is a slowly progressive degenerative disease of the central nervous system with degeneration of neurones in a region of the brain that causes a reduction of dopamine levels in parts of the brain. The disease must be unequivocally diagnosed and the following conditions must be fulfilled: (i) The disease cannot be controlled with medication; (ii) The disease shows signs of progressive impairment; and (iii) The disease must cause neurological deficit resulting in the permanent and irreversible inability of the Insured to perform at least 3 of the 6 Activities of Daily Living without the assistance of another person. Unequivocal Diagnosis of infection with the poliovirus leading to paralytic disease as evidenced by impaired motor function or respiratory weakness. In respect of this definition, claims shall only be admitted if Poliomyelitis causes neurological deficit resulting in paralysis in limbs that is permanent. A cerebrovascular incident including infarction of brain tissue, cerebral and subarachnoid haemorrhage, cerebral embolism and cerebral thrombosis. This Diagnosis must be supported by all of the following conditions: (i) Evidence of permanent neurological deficit confirmed by a neurologist at least 6 weeks after the event; and (ii) Findings on MRI, CT, or other reliable imaging techniques consistent with the Diagnosis of a new stroke. Based on above definition, the following are not covered: (i) Transient Ischaemic Attacks; (ii) Brain damage due to an accident or injury, infection, vasculitis, and inflammatory disease; (iii) Vascular disease affecting the eye or optic nerve; and (iv) Ischaemic disorders of the vestibular system. NB/Provn/P052/Sept 2012/S - Product Specific Provisions (CI Additional Rider) 5

6 組別 4: 與主要器官相關的疾病 4.a) 慢性肝病末期肝衰竭, 伴有黃疸增加 普遍醫學觀點認為病人已沒有好轉的可能, 並且已經出現腹水或肝性腦病 與主要器官相關的疾病 Group 4: Major Organs related illnesses 慢性肝病 4.a) Chronic Liver Disease 4.b) 末期肺病末期肺病, 須滿足以下所有條件 : (i) 證明受保人需要接受永久性的吸氧治療, 每天至少 8 小時以上 ; 及 (ii) 第一秒最大呼氣量 測試 (FEV1 ) 結果少於一公升 末期肺病 4.b) End Stage Lung Disease 4.c) 暴發性肝炎因為肝炎病毒感染造成部分或大部分的肝壞死導致急驟性肝臟衰竭 暴發性肝炎的診斷必須符合下列所有條件 : (i) 嚴重黃疸或黃疸逐漸加深 ; (ii) 肝性腦病 ; (iii) 肝臟超聲波或其他影像測試顯示肝臟急速萎縮 ; 及 (iv) 肝功能逐漸退化 暴發性肝炎 4.c) Fulminant Hepatitis 4.d) 腎衰竭末期腎衰竭指全部腎臟出現慢性不可逆轉的功能喪失, 導致受保人需長期接受定期的腎臟透析 需由腎臟病專科醫生確認腎功能衰竭程度以及透析的必要性 腎衰竭 4.d) Kidney Failure 4.e) 重要器官移植重要器官移植指人與人之間, 受保人作為受體進行的完整器官移植, 包括腎臟 肝臟 心臟 肺 胰腺或用於治療造血功能損害或造血系統惡性腫瘤的造血幹細胞移植 本定義內的肝臟移植不得少於一葉, 肺移植不得少於兩葉, 造血幹細胞可包括骨髓幹細胞 外周血幹細胞或臍帶血幹細胞 除以上列明的情況外, 其他任何器官移植 部分器官移植 組織或細胞移植均除外 End stage liver failure with increasing jaundice that in general medical opinion will not improve in future and resulting in either ascites or encephalopathy. End stage lung disease. All of the following must be fulfilled: (i) (ii) Proof of necessary and permanent oxygen therapy for at least 8hrs/day; and FEV1 test results of less than 1 litre. A sub-massive to massive necrosis of the liver caused by a Hepatitis virus, leading precipitously to liver failure. 重要器官移植 4.e) Major Organ Transplantation 4.f) 腎髓質囊腫病是一種遺傳疾病, 其特徵為腎髓質內的囊腫導致受保人漸進地失去腎功能 診斷必須由影像檢查證明多個髓質囊腫的存在, 且伴有皮質萎縮 腎髓質囊腫病 4.f) Medullary Cystic Disease All of the following criteria must be satisfied: (i) Severe jaundice or deepening jaundice; (ii) Encephalopathy; (iii) A rapidly decreasing liver size evidenced by a liver ultrasonic examination or other imaging examinations; and (iv) Progressive deteriorating liver function tests. End stage renal failure which presents chronic irreversible failure of all kidney(s) in functioning and requires regular long-term dialysis. The conditions of the renal functions and the necessity of continuous dialysis must be certified by a nephrologist. Major Organ Transplantation means the human to human complete organ transplant from a donor to the Insured of one or more of the following organs: kidney, liver, heart, lung, pancreas or the transplantation of hemopoietic stem cells as a result of hemopoietic function damage or malignant tumour of the blood forming system. In respect of this Policy, liver means at least one lobe of the liver, lung means at least two lobes of a lung, hemopoietic stem cells include bone marrow stem cells, peripheral blood stem cells and umbilical blood stem cells. Except for the organ mentioned above, the transplantation of any other organs, parts of organs, tissues or cells is excluded. A hereditary kidney disorder characterised by gradual and progressive loss of kidney function because of cysts in the kidney medulla. Diagnosis must be supported by imaging evidence of multiple medullary cysts with cortical atrophy. 組別 5: 構成嚴重傷殘的疾病 5.a) 失明臨床證明因為疾病或意外導致雙目視力不可逆轉的下降 雙目矯正後視力必須低於 6/60 或 20/200( 如根據 Snellen 測試類別標準 ) 或雙目視野均小於或等於 20 如一般的醫療建議認為儀器或植入手術可以恢復完全或部分視力, 本公司不予理賠 構成嚴重傷殘的疾病 Group 5: Disability related illnesses 失明 5.a) Blindness Clinically proven irreversible reduction of sight in both eyes as a result of sickness or accident. The corrected visual acuity must be less than 6/60 or 20/200 using e.g. Snellen test types, or visual field restriction to 20 or less in both eyes. No benefit will be payable if in general medical opinion a device, or implant could result in the partial or total restoration of sight. NB/Provn/P052/Sept 2012/S - Product Specific Provisions (CI Additional Rider) 6

7 5.b) 失聰失聰指因疾病或意外導致雙耳不能治療的喪失聽覺, 聽閾超過 90 分貝 如一般的醫療意見認為助聽器 儀器或植入裝置可以恢復部分或全部的聽覺, 本公司不予理賠 失聰 5.b) Loss of Hearing 5.c) 不能獨立生活不能獨立生活指由於疾病或意外傷害導致受保人在沒有協助的情況下, 完全喪失進行日常活動六項中最少三項的能力 受保人的情況必須已經持續最少 6 個月, 而且屬永久性 Loss of Hearing means irrecoverable loss of hearing in both ears, with an auditory threshold of more than 90 decibels, as a result of sickness or injury. No benefits will be payable if in general medical opinion a hearing aid, device, or implant could result in the partial or total restoration of hearing. 不能獨立生活 5.c) Loss of Independent Existence 5.d) 斷肢指由於疾病或意外導致兩個或以上的肢體自腕關節或踝關節以上完全斷離 斷肢 5.d) Loss of Limbs 5.e) 喪失語言能力喪失語言能力指因疾病或意外導致完全不可恢復的語言能力喪失超過連續十二個月 如一般的醫療意見認為任何的輔助 儀器 治療或植入裝置可以恢復部分或全部的語言能力, 本公司不予理賠 喪失語言能力 5.e) Loss of Speech 5.f) 完全及永久傷殘如果在診斷時, 受保人年齡在 18 至 64 週歲 ( 包括此兩個歲數 ), 且擁有獲取收入的職業, 完全及永久傷殘是指受保人因疾病或身體傷害而完全喪失從事任何職業或工作以獲取收入的能力, 並且得到本公司指定醫生的確認 如果在診斷時, 受保人年齡在 65 週歲, 或沒有從事獲取收入的職業, 完全及永久傷殘之定義為 : 由於疾病或意外原因導致受保人在沒有協助的情況下, 無能力進行日常活動六項中其中三項, 並且得到本公司指定醫生的確認 如果受保人達到完全傷殘但未滿連續 6 個月, 則不能視為永久性傷殘 由於精神原因導致的傷殘除外 Loss of Independent Existence means a condition as a result of a disease, illness or injury whereby the Insured has been totally unable to perform without assistance 3 of the 6 Activities of Daily Living for a period of at least 6 months. The Insured's condition must be permanent. Complete severance of two or more limbs above the wrist or ankle through accident or disease. Loss of Speech means the complete and irrecoverable loss of speech as a result of sickness or injury. The loss of the ability to speak must be established for a continuous period of 12 months. No benefits will be payable if in general medical opinion any aid, device, treatment or implant could result in the partial or total restoration of speech. 完全及永久傷殘 5.f) Total and Permanent Disability 組別 6: 其他嚴重疾病 6.a) 再生障礙性貧血是指因不可逆轉的骨髓功能衰竭導致的貧血 中性粒細胞減少和血小板減少 再生障礙性貧血診斷必須得到骨髓活組織檢查診斷證實 血全象檢查必須滿足以下其中兩個條件 : (i) 中性粒細胞絕對計數 500/mm3; (ii) 網織紅細胞絕對計數 20,000/mm3; 及 (iii) 血小板計數 20,000/mm3 其他嚴重疾病 Group 6: Other Major Illnesses 再生障礙性貧血 6.a) Aplastic Anaemia 6.b) 因輸血感染人類免疫力缺乏病毒受保人感染人類免疫力缺乏病毒 (HIV), 並符合下列所有條件 : (i) 感染由於輸血引起, 且導致感染的輸血日期在附加利益保障生效日期之後 ; (ii) 提供輸血的單位承認責任或者法院終審庭裁定此醫療責任, 而且不准上訴 ; 及 (iii) 受保人並非血友病患者 ; 此項醫療責任須已通過正常途徑進行上報並按正常程式進行了調查取證 如果醫學上出現能夠治癒愛滋病或 HIV 的方法, 或者出現能夠 Where, at the time of the Diagnosis, the Insured is between ages of 18 and 64 (both ages inclusive) and has a gainful occupation for wage or profit. Total and Permanent Disability is defined as a state of inability caused by disease or bodily injury as wholly prevents the Insured from engaging in any occupation or from performing any work for remuneration or profit, as certified by the Company s appointed doctor. Where, at the time of the Diagnosis, the Insured is aged 65, or has no gainful occupation for wage or profit, Total and Permanent Disability is defined as the inability of the Insured as a result of injury or disease to perform, without assistance, at least 3 of the 6 Activities of Daily Living, as certified by the Company s appointed doctor. Total disability shall not be presumed permanent unless there is evidence that the Insured has been continuously and totally disabled for not less than six months. All psychiatric related causes are excluded. Irreversible bone marrow failure resulting in anaemia, neutropenia and thrombocytopenia. The Diagnosis must be based on a bone marrow biopsy. Two out of the following three values should be present: (i) Absolute neutrophil count of 500 per cubic millimetre or less; (ii) Absolute reticulocyte count of 20,000 per cubic millimetre or less; and (iii) Platelet count of 20,000 per cubic millimetre or less. 因輸血感染人類免疫力缺乏病毒 (HIV) 6.b) HIV due to Blood Transfusion The Insured being infected by Human Immunodeficiency Virus (HIV) provided that: (i) The infection is due to a blood transfusion received after the effective date of this Rider; (ii) The institution which provided the transfusion admits liability or there is a final court verdict that cannot be appealed indicating such liability; and (iii) The infected Insured is not a haemophiliac. The incident must have been reported to appropriate authorities and have been investigated in accordance with the established procedures. NB/Provn/P052/Sept 2012/S - Product Specific Provisions (CI Additional Rider) 7

8 預防愛滋病的方法, 本保障將不再適用 由於其他方式導致的感染, 包括經性行為或靜脈注射藥物導致的感染均除外 我們有權取得受保人任何的血液樣本, 並且保留使用該血液樣本進行獨立測試的權利 This benefit will not apply in the event that any medical cure is found for AIDS or the effects of the HIV virus or a medical treatment is developed that results in the prevention of the occurrence of AIDS. Infection in any other manner, including infection as a result of sexual activity or intravenous drug use is excluded. We must have open access to all blood samples and reserve the right to obtain independent testing of such blood samples. 6.c) 嚴重燒傷嚴重燒傷指因為熱力 化學物質或電力導致皮膚第三度燒傷或全層燒傷達身體表面面積最少 20%, 燒傷面積根據九分法或體表面積表 (Lund and Browder Body Surface Chart) 來量度 嚴重燒傷 6.c) Major Burns 6.d) 因職業感染人類免疫力缺乏病毒受保人由於下列原因感染人類免疫力缺乏病毒 (HIV): (i) 受保人在其常規職業工作過程中受傷 ; 或 (ii) 職業需要處理血液或者其他體液有效的理賠必須符合下列所有條件 : (i) 感染必須是在受保人正在從事的職業工作時發生, 該職業必須是以下列表內的一種 ; (ii) 受保人必須提供在發生相關事故後五天內接受 HIV 病毒或 HIV 抗體測試呈陰性的報告 ; (iii) HIV 病毒或 HIV 抗體必須在事故發生後 12 個月內被證實 保障只限以下職業 : - 醫生及牙科醫生 ; - 護士 ; - 實驗室工作人員 - 醫院內輔助人員 - 醫療或牙科助理 ; - 救護員 - 助產士 - 消防員 ; - 警察 ; - 懲教主任 如果醫學上出現能夠治癒愛滋病或 HIV 的方法, 或者出現能夠預防愛滋病的方法, 本保障將不再適用 因職業感染人類免疫力缺乏病毒 (HIV) 6.d) Occupationally Acquired HIV 6.e) 嚴重類風濕關節炎因嚴重類風濕關節炎, 而導致廣泛性的關節受損及有以下三個或以上關節嚴重畸形 : (i) 手關節 (ii) 腕關節 (iii) 肘關節 ; (iv) 頸椎關節 ; (v) 膝關節 ; (vi) 踝關節 診斷須符合下列所有條件 : (i) 晨起的關節僵硬 ; (ii) 對稱性關節炎 ; (iii) 類風濕結節 ; (iv) 類風濕因子滴度增高 ; 及 (v) 放射檢查證明病情嚴重 類風濕關節炎的嚴重程度必須導致受保人在沒有協助的情況下, 失去進行日常活動六項中最少三項的能力, 且已持續最少三個月 我們保留權利要求由我們指定之類風濕病專家通過獨立醫學檢查確定診斷及殘疾程度 Major Burns means tissue injury caused by thermal, chemical or electrical agents causing third degree or full thickness burns to at least 20% of the body surface area as measured by The Rule of Nines or the Lund and Browder Body Surface Chart. Infection with the Human Immunodeficiency Virus (HIV) where the virus is acquired as the result of: (i) An injury occurring during the course of the Insured's normal occupation; or (ii) Occupational handling of blood or other body fluids The following conditions must be fulfilled for a valid claim: (i) The infection must have incurred while the Insured worked in his/her profession and the profession must be on the list below. (ii) The Insured must provide the negative result of a test for HIV-virus or antibodies to HIV virus that was made within 5 days after the reported incident. (iii) HIV virus or HIV antibodies must be proven within 12 months after the incident. The list is restricted to the following professions: - Doctors and dentists; - Nurses; - Laboratory personnel; - Ancillary hospital workers; - Medical and dental assistants; - Ambulance personnel; - Midwives; - Fire brigade; - Policemen/-women; - Prison officers. 嚴重類風濕關節炎 6.e) Severe Rheumatoid Arthritis This benefit will not apply in the event that any medical cure is found for AIDS or the effects of the HIV virus or a medical treatment is developed that results in the prevention of the occurrence of AIDS. Widespread joint destruction as a result of Severe Rheumatoid Arthritis with major clinical deformity of three or more of the following joint areas: (i) hands; (ii) wrists; (iii) elbows; (iv) cervical spine; (v) knees; (vi) ankles. The Diagnosis must be supported by all the following: (i) Morning stiffness; (ii) Symmetric arthritis; (iii) Presence of rheumatoid nodules; (iv) Elevated titres of rheumatoid factors; and (v) Radiographic evidence of severe involvement. The severity of the disease shall be such that there will be at least 3 of the 6 Activities of Daily Living which the Insured will, for a continuous period of at least 3 months, have been unable to perform without the assistance of another person. At our discretion, confirmation of the Diagnosis and the degree of disability may be required through an independent medical examination by a specialist rheumatologist appointed by us. NB/Provn/P052/Sept 2012/S - Product Specific Provisions (CI Additional Rider) 8

9 6.f) 末期疾病受保人患上之疾病經明確診斷後, 預期其壽命不超過 12 個月 診斷必須有專科醫生進行, 並且由公司指定醫生證實 末期疾病 6.f) Terminal Illness The conclusive Diagnosis of an illness that is expected to result in the death of the Insured within 12 months. This Diagnosis must be supported by a specialist and confirmed by the Company s appointed doctor. 嚴重疾病定義所用之詞語 Terms used in the definition of Major Illness 在這保障給付條款第 4.1 項所指的 : As used in this Clause 4.1 of Payment of Benefit Provisions: - 日常活動 指 :- Activities of Daily Living means:- (i) 洗澡 - 沐浴或淋浴 ( 包括自行出入浴缸或沖淋房 ) 或以任何其他方式清洗身體的能力 ; (ii) 更衣 - 穿衣 脫衣 扣緊或解開任何衣服以及包括任何矯正架, 義肢或其他外科器具 ( 如適用 ) 的能力 ; (iii) 移動 - 自床上移動至座椅或輪椅, 或自座椅或輪椅移動至床上的能力 ; (iv) 步行 - 室內從房間到房間之間平地行走能力 ; (v) 如廁 - 自行使用廁所和控制大小便, 能夠保持滿意的個人衛生能力 ; (vi) 進食 - 在食物已經準備好的情況下, 自己進食的能力 (i) Washing - The ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash satisfactorily by other means. (ii) Dressing - The ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs or other surgical appliances. (iii) Transferring - The ability to move from a bed to an upright chair or wheelchair and vice versa. (iv) Mobility - The ability to move indoors from room to room on level surfaces. (v) Toileting - The ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a satisfactory level of personal hygiene. (vi) Feeding - The ability to feed oneself once food has been prepared and made available. 永久性神經功能損害 指 :- permanent neurological deficit means:- 臨床檢查證明受保人出現神經系統功能失調症狀, 並且預期症狀將持續終身 受保的症狀包括癱瘓 發音困難 失語 吞咽困難 視覺受損 步行困難 協調失當 手震 癲癇 昏睡 癡呆 精神錯亂及昏迷 以下情況除外 : (i) 腦素描可看到之腦部異常, 或從其他素描檢查中可看到之異常而沒有明確相關的臨床症狀 ; (ii) 神經性症狀但無病徵異常, 如快速的反射動作, 但無其他症狀 ; (iii) 源自心理或精神科的症狀 4.2 非嚴重疾病定義每項非嚴重疾病均有其訂定之定義並詳述於下列之有關標題下, 而任何就非嚴重疾病的診斷證明必須符合該定義及該非嚴重疾病標題下列出的所有及每一項條件及要求, 方可就該非嚴重疾病索償 所有有關原位癌或早期癌症的診斷必須由組織病理學報告證實, 臨床診斷不符合本保障的標準 Symptoms of dysfunction in the nervous system that are present on clinical examination and expected to last throughout the Insured person's life. Symptoms that are covered include paralysis, dysarthria, aphasia, dysphagia, visual impairment, difficulty in walking, lack of coordination, tremor, seizures, lethargy, dementia, delirium and coma. The following are not covered: (i) An abnormality seen on brain or other scans without definite related clinical symptoms; (ii) Neurological signs occurring without symptomatic abnormality, e.g. brisk reflexes without other symptoms; (iii) Symptoms of psychological or psychiatric origin. 非嚴重疾病定義 4.2 DEFINITION OF MINOR ILLNESS 治療冠心病的小型介入手術由心臟科專家證明受保人有醫療需要, 實際進行氣囊血管成形術 鎖孔手術 激光治療或利用其他技術矯正一條或以上冠狀動脈嚴重閉塞最少 70% 的情況 Each Minor Illness has its meaning given under the relevant heading below. Any Diagnosis of a Minor Illness for the purpose of claiming the Minor Illness Benefit must fulfill the meaning together with each and every condition and requirement set out under the heading of that Minor Illness. All Diagnosis of Carcinoma-in-situ or Early Stage Cancer must always be supported by a histopathological report. Clinical diagnosis does not meet this standard. 治療冠心病的小型介入手術 Minor Interventions for Coronary Artery Disease The actual undergoing of balloon angioplasty, key-hole, laser relief or other techniques to correct significant stenosis of at least 70% of one or more coronary arteries as considered medically necessary by a consultant cardiologist 乳房原位癌 Carcinoma-in-situ of the Breast 乳房原位癌指癌細胞自發地增生, 但尚未侵潤正常乳房組織 子宮頸原位癌指癌細胞自發地增生, 但尚未侵潤正常子宮頸組織 原位癌的診斷必須通過子宮頸圓錐切除活檢或通過陰道鏡進行子宮頸活組織檢, 取得固定組織, 進行顯微鏡檢查且診斷結果呈陽性 子宮頸上皮內贅瘤 (CIN) 分級中的 CIN 1 CIN 2 及 CIN 3( 重度不典型增生但無原位癌 ) 除外 yet resulted in the invasion of normal breast tissue. 子宮頸原位癌 Carcinoma in situ of the Cervix Uteri A focal autonomous new growth of carcinomatous cells, which has not yet resulted in the invasion of normal tissue of the Cervix Uteri. Carcinoma-in-situ must always be positively diagnosed upon the basis of a microscopic examination of fixed tissue from a cone biopsy or colposcopy with cervical biopsy. Cervical Intraepithelial Neoplasia (CIN) classification including CIN-1, CIN-2 and CIN-3 (severe dysplasia without Carcinoma in situ) are specifically excluded. NB/Provn/P052/Sept 2012/S - Product Specific Provisions (CI Additional Rider) 9

10 4.2.4 子宮原位癌 Carcinoma in situ of the Uterus 子宮原位癌指癌細胞自發地增生, 但尚未侵潤正常子宮組織 腫瘤必須根據 TNM 組織學分期方法被界定為 TisN0M0 或根據 FIGO 方法被界定為 FIGO 輸卵管原位癌指癌細胞自發地增生, 但尚未侵潤正常輸卵管組織 本保障只限於輸卵管黏膜內的腫瘤 腫瘤必須根據 TNM 分期方法被界定為 TisN0M0 或根據 FIGO 方法被界定為 FIGO 0 yet resulted in the invasion of normal tissue of the uterus. This tumour should be classified as TisN0M0 according to the TNM Classification or FIGO 0 according to the method of The Federation Internationale de Gynecologie et d'obstetrique. 輸卵管原位癌 Carcinoma in situ of the Fallopian Tube yet resulted in the invasion of normal fallopian tube tissue. This tumour should be limited to the tubal mucosa and classified as TisN0M0 according to the TNM staging method or FIGO 0 according to the method of The Federation Internationale de Gynecologie et d'obstetrique 陰道原位癌 Carcinoma in situ of the Vagina 陰道原位癌指癌細胞自發地增生, 但尚未侵潤正常陰道組織 腫瘤必須根據 TNM 分期方法被界定為 TisN0M0 或根據 FIGO 方法被界定為 FIGO 0 yet resulted in the invasion of normal vagina tissue. This tumour should be classified as TisN0M0 according to the TNM staging method or FIGO 0 according to the method of The Federation Internationale de Gynecologie et d Obstetrique 睪丸原位癌 Carcinoma in situ of the Testes 睪丸原位癌指癌細胞自發地增生, 但尚未侵潤正常睪丸組織 此保障只包括睾丸生殖細胞腫瘤 其他的睾丸腫瘤包括性索間質腫瘤 (Leydig 細胞 ), 支持細胞 (Sertoli 細胞 ) 腫瘤及並非直接生長在睾丸組織內的腫瘤 ( 附屬器官腫瘤 ) 一概不包括在此保障範圍內 yet resulted in the invasion of normal tissue of the testes. This benefit covers only germ cell tumours of the testes. Other testicular tumours including sex cord-stromal tumours (Leydig), Sertoli tumours and tumours not arising directly from the testicular tissue (adnexal) are all excluded 早期卵巢癌 Early Stage Cancer of the Ovary 早期卵巢癌指癌細胞自發地增生, 但尚未侵潤正常卵巢組織 腫瘤包膜必須完整, 卵巢表面無腫瘤 腫瘤必須根據 TNM 組織學分期方法被界定為 T1aN0M0 或根據 FIGO 方法被界定為 FIGO 1A 早期前列腺癌指癌細胞自發地增生, 但尚未侵潤正常前列腺組織 腫瘤必須根據 TNM 組織學分期方法被界定為 T1(a) 或 T1(b) yet resulted in the invasion of normal ovary tissue. This tumour should be capsule intact, with no tumour on the ovarian surface, classified as T1aN0M0 according to the TNM Classification or FIGO 1A according to the method of The Federation Internationale de Gynecologie et d'obstetrique. 早期前列腺癌 Early Stage Cancer of the Prostate yet resulted in the invasion of normal prostate tissue. This tumour should be classified as T1(a) or T1(b) according to the TNM Classification. NB/Provn/P052/Sept 2012/S - Product Specific Provisions (CI Additional Rider) 10

11 4.3 非嚴重疾病賠償在符合本附加利益保障的條款及條件下, 若受保人經醫生診斷患上非嚴重疾病在本公司接獲有關索償的合理證明後並經本公司批核後, 本公司將向保單權益人支付一筆相等於保單資訊表所指明本附加利益保障投保額的百份比的賠償金額, 減除任何未繳的應付保費, 只要 : (i) 在非嚴重疾病診斷日本附加利益保障仍然生效 ; 及 (ii) 在任何情況下, 這賠償金額以保單資訊表所指明非嚴重疾病的最高賠償金額為上限, 而該上限須扣除本公司簽發以受保人生命投保的所有保單下就任何非嚴重疾病作出或須作出的所有賠償 在不損害上文的概括性的原則下, 倘就一項非嚴重疾病已作出或須作出賠償, 而該項非嚴重疾病於這些其他保單下並不屬於 " 非嚴重疾病 " 之定義, 則無須就該賠償給付作出扣除 本公司支付非嚴重疾病賠償後 : (i) 本附加利益保障的投保額須即時減去非嚴重疾病賠償金額 ; (ii) 承保表所載本附加利益保障應付保費在下一保費到期日將相應減少 ; 及 (iii) 非嚴重疾病賠償將自動終止 4.4 嚴重疾病賠償 嚴重疾病賠償在符合本附加利益保障的條款及條件下, 若受保人經醫生診斷患上嚴重疾病, 而在嚴重疾病診斷日本附加利益保障仍然生效, 本公司在接獲有關索償的合理證明並經本公司批核後, 本公司將向保單權益人支付一筆金額相等於 : (i) 索償時之本附加利益保障投保額 ; 減除 (ii) 任何未繳的應付保費 本公司支付嚴重疾病賠償後, 本附加利益保障將自動終止 解除責任 解除責任由保單權益人所簽署的嚴重疾病賠償的收據, 或由本附加利益保障下有權領取此等賠償的任何人士簽署的收據 ; 或本公司支付嚴重疾病賠償已被存入或兌現之證明, 即解除本公司於本附加利益保障下之進一步責任 4.5 賠償的限制無論受保人患上多少次非嚴重疾病 非嚴重疾病復發或不時接受治療, 本附加利益保障在受保人在生期間不會支付超過於保單資訊表上所列明的非嚴重疾病賠償次數 無論受保人患上多少次嚴重疾病 嚴重疾病復發或不時接受治療, 本附加利益保障在受保人在生期間不會支付超過於保單資訊表上所列明的嚴重疾病賠償次數 4.3 MINOR ILLNESS BENEFIT Subject to the terms and conditions of this Rider, if the Insured is diagnosed by a Physician to be suffering from a Minor Illness, upon receipt of due proof and subject to the approval of the Company, the Company will pay a lump sum benefit equivalent to the percentage of the Sum Insured of this Rider as shown in the Policy Information Sheet less any outstanding premiums to the Policy Owner provided that: (i) (ii) this Rider was in force at the date of Diagnosis of the Minor Illness; and in any case, lump sum benefit cannot exceed the maximum amount of Minor Illness Benefit as shown in the Policy Information Sheet less all other benefit amounts in respect of any Minor Illness paid or payable under all policies issued by the Company on the life of the Insured. Without prejudice to the generality of the foregoing, no deductions shall be made in respect of benefit amounts paid or payable under such other policies in connection with a minor illness if such minor illness does not fall within the definition of "Minor Illness". After payment of the Minor Illness Benefit by the Company: - (i) the Sum Insured of this Rider shall be reduced immediately by the amount of the Minor Illness Benefit paid; (ii) the premium payable for this Rider as set out in the Policy Specifications shall be reduced accordingly on its next due date; and (iii) Minor Illness Benefit shall be automatically terminated. 4.4 MAJOR ILLNESS BENEFIT Major Illness benefit Subject to the terms and conditions of this Rider, if the Insured is diagnosed by a Physician to be suffering from a Major Illness, upon receipt of due proof and subject to the approval of the Company and provided that this Rider is in force at the date of Diagnosis of the Major Illness, the Company will pay to the Policy Owner a lump sum benefit equivalent to: (i) the Sum Insured of this Rider at the time of claim; less (ii) any outstanding premiums. After payment of the Major Illness Benefit by the Company, this Rider shall be automatically terminated Discharge The receipt of the Major Illness Benefit under this Rider by the Policy Owner or by any person entitled to receive such benefit, or evidence that the Company's payment for the Major Illness Benefit has been deposited or cashed will discharge the Company from further liability under this Rider. 4.5 BENEFIT RESTRICTIONS The Minor Illness Benefit under this Rider shall not be paid more than the number of Minor Illness Benefit as shown in the Policy Information Sheet during the Insured s lifetime regardless of the number of occurrences of Minor Illness, recurrence of Minor Illness or frequency of treatment. The Major Illness Benefit under this Rider shall not be paid more than the number of Major Illness Benefit as shown in the Policy Information Sheet during the Insured s lifetime regardless of the number of occurrences of Major Illness, recurrence of Major Illness or frequency of treatment. NB/Provn/P052/Sept 2012/S - Product Specific Provisions (CI Additional Rider) 11

12 4.6 除外事項 (a) 因以下任何一項而直接或間接引起 與其有關 導致或產生 ( 全部或部份 ) 的嚴重疾病或非嚴重疾病, 將不在本附加利益保障非嚴重疾病賠償和嚴重疾病賠償的受保範圍內 : (i) 任何已存在醫療狀況 ; (ii) 先天畸形或異常 不育或絕育 ; (iii) 服用非由醫生處方的藥物 濫用酒精或服用毒品 ; (iv) 屬於人類免疫力缺乏病毒 (HIV) 的疾病或人類免疫力缺乏病毒 (HIV) 感染及 / 或其有關之疾病包括愛滋病及 / 或因愛滋病引發之任何突變 衍生或變異, 本附加利益保障之保障給付條款內第 4.1 條所指因輸血感染人類免疫力缺乏病毒 (HIV) 或因職業感染人類免疫力缺乏病毒 (HIV) 的除外 ; (v) 核分裂 核熔合 核燃料或燃燒核燃料或核子武器物料後的核廢料的放射性所產生的電離輻射或污染 ; (vi) 戰爭或戰鬥 ( 不論宣佈或不宣佈之戰爭 ) 人民集體騷動 叛變 革命 暴動 罷工 恐怖份子或類似戰爭的行動 ; (vii) 參與任何軍事或維持和平活動 ; (viii) 任何人士為自己或代表任何團體或組織或與任何團體或組織有關, 以恐佈主義 綁架或企圖綁架 攻擊 毆打或其他暴力手段去强行影響任何團體 法團或政府 ; (ix) 任何蓄意自致之行為 ; (x) 扺觸或企圖扺觸法律 拒捕或參與任何爭執或毆鬥 ; 或 (xi) 職業運動 任何比賽 借助呼吸器具水中活動 空中活動 ( 包括高空彈繩跳 懸掛式滑翔 熱氣球飛行 跳傘及特技跳傘 ) 但作為機員或購票乘客乘搭具有正式牌照商業固定航班的載客飛機則除外 或任何危險活動或運動, 除非得到特別批單同意的除外 (b) 在本附加利益保障中, 對於附加利益保障生效日期或加簽批單日期或最後附加利益保障復效的生效日 ( 以較遲者為準 ) 起計首 90 日內患上的首次出現或顯現有關病徵或狀況或任何首次確診的任何非嚴重疾病或嚴重疾病, 將不獲任何非嚴重疾病賠償和嚴重疾病賠償 本第 4.6(b) 項不適用於由意外事件直接導致嚴重疾病或非嚴重疾病 4.7 身故賠償 身故賠償倘受保人在本附加利益保障生效期間身故, 在符合本附加利益保障的條款及條件下, 並於切實可行範圍內盡快向本公司遞交為其滿意的書面索償申請後, 本公司將依一般保單條款內第 1.12 條之規定, 向受益人支付索償時本附加利益保障之投保額 本公司支付本第 4.7 條的身故賠償後, 本附加利益保障將自動終止 解除責任 解除責任由保單權益人所簽署本第 4.7 條的身故賠償的收據, 或由本附加利益保障下有權領取此等賠償的任何人士簽署的收據 ; 或本公司支付該身故賠償已被存入或兌現之證明, 即解除本公司於本附加利益保障下之進一步責任 4.6 EXCLUSIONS (a) (b) Neither Minor Illness Benefit nor Major Illness Benefit is payable under this Rider for any Minor Illness or Major Illness resulting (directly or indirectly) from, or related to, or caused by or contributed (in whole or in part) by any of the following: (i) Any Pre-existing Condition; (ii) Congenital deformities or anomalies, infertility or sterilization; (iii) Drug-taking other than under the direction of a Physician, abuse of alcohol or the taking of poison; (iv) Disease of or infection with any Human Immunodeficiency Virus (HIV) and/or any HIV-related illness including AIDS and/or any mutations, derivations or variations thereof, except HIV due to Blood Transfusion or Occupationally Acquired HIV as defined under Clause 4.1 under the Payment of Benefit Provisions of this Rider; (v) Nuclear fission, nuclear fusion, ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuels or nuclear weapons material; (vi) War or hostilities (whether war be declared or not), civil commotion, rebellion, revolution, riot, strikes, terrorist or warlike activities; (vii) Participation in any armed force or peace keeping activities; (viii) An act of any person acting on their own or on behalf of or in connection with any group or organisation to influence by force any group, corporation or government by terrorism, kidnapping or attempted kidnapping, attack, assault, or any other violent means; (ix) An intentional self-inflicted act; (x) Violation or attempted violation of the law or resistance to arrest or participation in any brawl or affray; or (xi) Professional sports, racing of any kind, underwater activities involving the use of breathing apparatus, aerial flights (including bungee-jumping, hang-gliding, ballooning, parachuting and sky-diving) other than as a crew member or as a fare-paying passenger on a licensed carrying commercial aircraft operating in a regular scheduled route or any hazardous activities or sports unless agreed by special endorsement. Neither Major Illness Benefit nor Minor Illness Benefit is payable under this Rider for any Major Illness or Minor Illness, the symptoms or conditions of which or the diagnosis of which first appeared or occurred within ninety (90) days immediately following the effective date of this Rider or the date of endorsement or the effective date of last reinstatement, whichever is later. This Clause 4.6(b) shall not apply to any Major Illness or Minor Illness caused by an Accident. 4.7 DEATH BENEFIT Death Benefit If the Insured dies while this Rider is in force, subject to the terms and conditions of this Rider and upon submission of a written proof of claim satisfactory to the Company as soon as practicable, the Company shall pay the Beneficiary in accordance with Clause 1.12 under the General Policy Provisions the Sum Insured of this Rider at the time of claim. After payment of the death benefit under this Clause 4.7 by the Company, this Rider shall be automatically terminated Discharge The receipt of the death benefit under this Clause 4.7 by the Policy Owner or by any person entitled to receive such benefit, or evidence that the Company's payment for the death benefit has been deposited or cashed will discharge the Company from further liability under this Rider. NB/Provn/P052/Sept 2012/S - Product Specific Provisions (CI Additional Rider) 12

13 4.8 索償通知及證明 5. 終止生效 受保人必須於本附加利益保障有效期間, 並在獲悉患上非嚴重疾病或嚴重疾病當日起計 90 日內提出索償 除非證明無法在此期間內提出索償, 並已在合理的情況下儘早提出索償, 否則, 本公司無須對逾期作出的非嚴重疾病或嚴重疾病索償 ( 視乎情況而定 ) 負責 在本公司接獲索償通知後六個月內, 保單權益人必須呈交索償證明文件, 包括所需資料 文件及由本公司接納的醫生簽署的醫療證明及報告, 有關支出由保單權益人負責 本公司保留權利就有關非嚴重疾病或嚴重疾病之索償 ( 視乎情況而定 ), 要求受保人進行檢查或其他合理及有關檢驗以確定其存在 5.1 在下列任何一種情況最早發生時, 本附加利益保障將自動終止, 並可同時停止支付保費 : (i) 如在繳費到期日後超過三十一 (31) 日仍未繳足本附加利益保障之保費 ; 或 (ii) 如本附加利益保障及 / 或基本計劃期滿 到期 退保 終止 轉為展期保險或減額繳清保險 ; 或 (iii) 於受保人年滿六十五歲或之後之首個保單週年日 ; 或 (iv) 本公司作出嚴重疾病賠償 ; 或 (v) 本公司作出上述身故賠償 6. 續保 5.2 保單權益人有權於下一個到期繳付保費日期前以書面通知本公司終止本附加利益保障, 惟本公司需在下一個到期繳付保費日前收妥該通知方可終止本附加利益保障 續保除本附加利益保障的條款及條件另有規定外, 保單權益人享有保證權利, 可於每個保單週年日, 按續保時受保人的年齡及本公司當時所定的保費率, 依時繳付保費而延續生效十二個月 本公司有權於任何一個保單週年日前 30 日以書面通知保單權益人調整保費 在不限制本條文的應用下, 如受保人有任何失實陳述 未有披露或欺詐行為, 本公司有權終止本附加利益保障或修訂本附加利益保障的條款及條件 不續保本附加利益保障將不會影響保單權益人於本附加利益保障到期前所產生的權利 若本公司或本公司的代理人在本附加利益保障終止後收到或接受任何保費, 將不會對本公司構成任何責任 ( 退回該保費除外 ) 7. 轉換 轉換於受保人生存期間及本附加利益保障有效期內, 保單權益人可於本附加利益保障期滿日前任何一個保費到期日, 在無需提供受保人可保證明下而將本附加利益保障全部或部份保額轉換為本公司認可之終身壽險計劃, 惟此權益只適用至受保人年滿六十五歲後之首個保單週年日止, 且保額不得少於轉換日時本公司所定之最低保額要求 新的計劃將於轉換日開始生效 新的保費將根據轉換日時受保人之年齡及本公司當時之保費率而定 若本附加利益保障有額外加費, 新計劃之額外保費將以一致之方法計算及收取 若本附加利益保障之保費正被豁免, 新轉計劃之保費將根據新轉計劃之條款給付, 而不會獲得豁免 4.8 NOTICE AND PROOF OF CLAIM 5. TERMINATION A claim must be made whilst this Rider is in force and within ninety (90) days of the Insured becoming aware that he is suffering from a Minor Illness or Major Illness. If the claim is not made within that period, the Company will not be liable to pay the Minor Illness Benefit or Major Illness Benefit (as the case may be) unless it is shown that it was not reasonably possible to make such a claim, and that the claim was made as soon as was reasonably possible. Written proof of loss, such as the necessary information, documents, medical evidence and reports signed by a Physician approved by the Company, which it requires the Policy Owner to provide at his expense, must be received by the Company within six months after it receives the written notice of claim. The Company reserves the right to require the Insured to undergo an examination or other reasonable and appropriate tests to confirm the occurrence of the Minor Illness or Major Illness (as the case may be). 5.1 This Rider shall be automatically terminated and the premiums shall cease to be payable upon the first occurrence of any of the followings: (i) (ii) (iii) (iv) (v) if any premium for this Rider remains unpaid after the end of thirty-one (31)-day period from the due date for payment of the premium; or if this Rider and/or the Basic Plan matures, expires, is surrendered, terminated, converted to extended term insurance or reduced paid-up insurance; or on the Policy Anniversary on or immediately following the Insured's sixty-fifth (65 th ) birthday; or the Company s payment of the Major Illness Benefit; or the Company s payment of the aforementioned death benefit. 5.2 The Policy Owner may terminate this Rider before the next premium due date by notice in writing to the Company provided that such notice is duly received by the Company before the next premium due date in order to terminate this Rider. 6. RENEWABILITY Subject to all the terms and conditions of this Rider, the Policy Owner has a guaranteed right to renew this Rider on each Policy Anniversary for a further twelve (12) months period by continued payment of premium. The Company reserves the right to vary the premium of this Rider upon no less than 30 days written notice to the Policy Owner prior to any Policy Anniversary. Without limiting the application of this clause, if there is any misrepresentation, non-disclosure or fraud on the part of the Insured, the Company shall have the right to terminate this Rider, or to revise the terms and conditions of this Rider. Non-renewal will not affect the Policy Owner s rights arising before the termination of this Rider. The payment to or acceptance by the Company or the Company s agent of any premium subsequent to the termination of this Rider will not create any liability on the Company s part except that of a refund of any such premium. 7. CONVERSION During the lifetime of the Insured and while this Rider is in force, the Policy Owner may convert all or part of the amount of coverage under this Rider to a whole life plan as defined by the Company without further evidence of insurability, but the coverage must not be less than the minimum issue limit set by the Company at the date of conversion, on any premium due date prior to the expiry date but not later than the Policy Anniversary on or immediately following the Insured s sixty-fifth (65 th ) birthday. The new plan will be issued as at the date of conversion. The premium charged on the new plan shall be determined in accordance with the Company's prevailing rates for the Insured's Age on the date of conversion. If this Rider is issued with an extra premium, an extra premium computed on a consistent basis shall be charged on the new plan. If premiums under this Rider are being waived, premiums payable under the converted plan will not be waived and will be payable in accordance with the provisions of the converted plan. NB/Provn/P052/Sept 2012/S - Product Specific Provisions (CI Additional Rider) 13