1

QUY TC IU KHON
SN PHM B TR BO HIM CHM SC Y T V4
(c ph chun theo cng vn s: 13465 /BTC-QLBH ca B Ti chnh ngy 08/10/2013)



y l Quy tc iu khon ca Sn phm b tr Bo him Chm sc Y t V4 (sau y gi tt l
Quy tc iu khon) dnh cho nhng khch hng c yu cu b sung thm Hp ng Bo him
B tr Bo him Sc khe vo Hp ng Bo him Chnh. Xin vui lng kim tra v c k chc
chn rng Qu khch hng hiu ton b cc ni dung c quy nh trong Quy tc iu khon
ny. Chng ti rt vui lng c gii p mi ni dung ca Quy tc iu khon ny vi Qu khch
hng. Xin lu , vic Qu khch hng k vo Giy yu cu bo him l bng chng xc nhn vic
Qu khch hng hiu r tt c cc ni dung c quy nh trong Quy tc iu khon ny.


Cam kt dch v ca chng ti

Chng ti mong mun c cung cp cc dch v c tiu chun cht lng cao v gii quyt mi
khiu ni pht sinh mt cch trung thc, cng bng v nhanh chng.
2

MC LC
iu 1. CC NH NGHA 3
iu 2. QUY NH CHUNG 8
iu 3. IU KIN C BO HIM 9
iu 4. NHNG THAY I C LIN QUAN N HP NG BO HIM B TR 10
iu 5. CHM DT HP NG BO HIM B TR 11
iu 6. CC TI LIU/THNG TIN CN CUNG CP 12
iu 7. THI GIAN CH 12
iu 8. QUYN LI BO HIM 14
iu 9. IU KHON LOI TR 22
iu 10. PH BO HIM 26
iu 11. TH TC YU CU GII QUYT QUYN LI BO HIM 27

3

iu 1. CC NH NGHA
1.1 m l Cng ty TNHH Bo him Nhn th
Prvoir Vit Nam, c Giy php thnh lp v hot ng s 31 GP/KDBH do B Ti
chnh cp ngy 17/03/2005.
1.2 Hp ng Bo him B tr
ny. Hp ng Bo him B tr c bn km vi mt Hp ng bo him chnh v
bao gm nhng khng gii hn bi Giy yu cu bo him, Giy chng nhn bo
him, Bn cu hi sc khe, Quy tc iu khon ny v cc ti liu sa i b sung
c lin quan khc hoc cc ti liu khc do PRVOIR VIT NAM v Bn mua Bo
him tha thun.
1.3 Hp ng Bo him Chnh
giao kt vi Bn mua Bo him m sn phm bo him b tr ny c bn km v
c ghi nhn trong Giy chng nhn bo him v/hoc Giy chng nhn bo him
sa i.
1.4 Giy yu cu bo him l giy yu cu bao gm tt c cc thng tin c lin quan
n vic yu cu bo him, trong th hin s ng ca Bn mua Bo him/
Ngi c Bo him v cc iu kin v iu khon ca Hp ng Bo him B
tr.
1.5 Giy chng nhn bo him hoc Giy chng nhn bo him sa i
, v l
mt b phn khng tch ri ca Hp ng Bo him B tr. Giy chng nhn bo
him bao gm nhng khng gii hn bi cc thng tin sau y: thng tin c nhn ca
Bn mua Bo him, Ngi c Bo him, Ngy bt u c bo him, Quyn li
bo him, ph bo him, v cc thng tin c lin quan khc
Sau khi c chp nhn bo him, Bn mua Bo him s
cp Giy chng nhn bo him.
1.6 Bn mua Bo him l c nhn hoc t chc c thnh lp hp php ti Vit Nam,
k tn trn Giy yu cu bo him v np ph bo him ca Hp ng Bo him B
tr. Bn mua Bo him c th ng thi l Ngi c Bo him.
1.7 Ngi c Bo him l Ngi c bo him hoc Bn mua Bo him trong
Hp ng Bo him Chnh v p ng c cc iu kin quy nh ti iu 3 di
y.
4

1.8 Tui ca Ngi c Bo him l tui tnh theo sinh nht lin trc Ngy hp
ng c hiu lc.
1.9 Thut ng Ngi th hng c p dng trong trng hp
i tr trc tip cho Bnh
vin, l Ngi c Bo him trong trng hp cn sng
) nhn quyn li bo
him trong trng hp Ngi c Bo him cht.
Vic ch nh Ngi th hng phi c thc hin vo ngy k Giy yu cu bo
him hoc vo bt k thi im no trong thi gian Hp ng Bo him B tr c
hiu lc.
Trong trng hp khng c ch nh Ngi th hng, vic chi tr quyn li bo him
s c thc hin theo th t u tin sau:
(a) V/chng ca Ngi c Bo him, nu khng c ngi ny th chi tr cho:
(b) Con/cc con hp php ca Ngi c Bo him, theo t l chia u. Nu
khng c nhng ngi ny th chi tr cho:
(c) B v m ca Ngi c Bo him, theo t l chia u. Nu khng c nhng
ngi ny th chi tr cho:
(d) Nhng ngi tha k hp php ca Ngi c Bo him theo quy nh ca
php lut v tha k.
1.10 Tai nn l mt s kin hoc mt chui cc s kin khng b gin on c lin quan
n s tc ng bt ng ca mt vt cht hoc mt lc bn ngoi, ngoi mun ch
quan ca Ngi c Bo him, ln c th ca Ngi c Bo him v l nguyn
nhn duy nht v trc tip lm nh hng n sc khe ca Ngi c Bo him,
hoc dn n ci cht ca Ngi c Bo him, hoc dn n vic Ngi c
Bo him phi Nm vin iu tr.
1.11 m au hoc Bnh tt l tnh trng c th c du hiu ca mt bnh l khc vi
tnh trng sc khe bnh thng.
1.12 Bnh c sn hoc Thng tt c sn l bnh hoc thng tt ca Ngi c
Bo him:
(a) tn ti trc ngy giao kt Hp ng Bo him B tr, th hin qua cc du
hiu, hoc triu chng m Ngi c Bo him bit v c bng chng ca
c quan y t c thm quyn; hoc:
(b) phi iu tr hoc kim tra, t vn trong khong thi gian hai nm trc tnh
t ngy giao kt Hp ng Bo him B tr.
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Trong mi trng hp, Bn mua Bo him v Ngi c Bo him vn phi cng
khai ton b tnh trng sc khe v bt k s vic no c lin quan n tnh trng sc
khe ca Ngi c Bo him. Vic cung cp thng tin khng ng, khng r rng
hoc sai lch v tin s Bnh tt ca Ngi c Bo him s dn n vic Hp
ng Bo him B tr v hiu hoc Ngi c Bo him khng nhn c, hoc
nhn c t hn s tin bo him ghi trong Hp ng Bo him B tr. Trong
trng hp ny, cc iu kin v iu khon ca Quy tc iu khon ny v cc quy
nh ca php lut Vit Nam s c p dng i vi Hp ng Bo him B tr.
1.13 Bnh di truyn l bt k bnh no xut hin nhng ngi c cng huyt thng
hay l s chuyn nhng bnh l ca b, m cho con ci thng qua gen ca b, m
v/hoc c truyn t i ny sang i khc, t th h ny sang th h khc trong
nhng ngi c cng huyt thng. Vic xc nh tnh trng Bnh di truyn phi do
Bc s thc hin.
1.14 Bnh bm sinh l bt k bnh no c hnh thnh trn thai nhi trong qu trnh
mang thai ca ngi m di tc ng ca yu t mi trng ln s pht trin ca
thai nhi v c th c c quan y t m t di nhiu tn gi khc nhau nh bnh
bm sinh, d tt bm sinh, khuyt tt bm sinh. Vic xc nh tnh trng Bnh bm
sinh phi do Bc s thc hin.
1.15 Dch v xe cu thng l vic s dng xe cu thng vn chuyn ng b
trong lnh th Vit Nam ca Bnh vin/ C s y t trong trng hp Ngi c Bo
him trong tnh trng m au/Tai nn nguy kch nh hng n tnh mng, buc phi
a n Bnh vin/ C s y t gn nht hoc t Bnh vin ny n Bnh vin khc
theo ch nh ca Bc s hoc yu cu ca Nhn vin y t phc v trn xe cu
thng. Dch v xe cu thng quy nh trong Quy tc iu khon ny khng phi l
dch v vn chuyn bng ng hng khng hoc ng thy.
1.16 iu tr cp cu l vic iu tr khn cp ti Bnh vin, c s y t trong vng 24 gi
k t khi c Tai nn hoc triu chng m au/ Bnh tt c th nguy him n tnh
mng, sc khe ca Ngi c Bo him, cn thit phi iu tr khn cp ti phng
cp cu ca cc Bnh vin/ C s y t, c pht sinh chi ph ging bnh v h s c
du xc nhn cp cu ca Bnh vin/ C s y t.
1.17 Bnh vin hoc C s y t l c s khm v iu tr bnh hp php ti Vit
Nam, c chc nng chm sc, iu tr sc khe cho bnh nhn, c bnh n v h s
bnh n c lu tr theo quy nh ca php lut, v hot ng chnh ca n khng
phi l SPA, nh ngh, nh an dng, phng y t, vin dng lo, ni cai nghin
ru, ni cai nghin ma ty hoc iu tr tm thn, bnh phong, ni phu thut thm
m. Ring i vi Bnh vin, ngoi cc iu kin nu trn cn phi c y kh
nng v phng tin chun on, iu tr, phu thut, c y t phc v, theo di 24/24
gi di s hng dn ca Bc s.
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1.18 Nm vin l vic Ngi c bo him cn thit phi nm ti Bnh vin lin tc t
nht l 24 gi (tr trng hp Quy tc iu khon ny c quy nh khc) iu tr
cho n khi xut vin k c vic sinh hoc iu tr
. Vic Nm vin ca Ngi c Bo him phi din ra lin tc v
khng b gin on trong sut thi gian Nm vin, c bnh n c lp v bin lai
vin ph / giy xut vin ca Bnh vin. n v ngy Nm vin c tnh bng 24 gi
lin tc hoc theo n v ging nm trong Giy xut vin v trong chng t vin ph
chi tit.
1.19 Phng iu tr hoc Phng tiu chun l phng tiu chun ti Bnh vin hoc
phng dch v c gi thp nht ti Bnh vin (ni khng c quy nh v phng tiu
chun) thc hin vic iu tr v chm sc y t.
1.20 iu tr l th tc y t cn thit cha bnh hoc lm gim bnh, nhim trng
hoc chn thng.
1.21 Bc s l bc s lm vic cho Bnh vin/ C s y t, c giy php hnh ngh chn
on, iu tr bnh hoc thc hin phu thut hp php v ang cn hiu lc, c
bng cp chuyn mn ph hp vi ni dung iu tr hoc phu thut, bao gm nhng
khng gii hn vic khm bnh, xt nghim, chn on, iu tr, phu thut, loi tr
nhng bc s chnh l Ngi c Bo him, hay v (chng), ngi thn ca Ngi
c Bo him.
1.22 Phu thut l mt phng php khoa hc iu tr thng tt hoc Bnh tt c
thc hin bi nhng phu thut vin c bng cp thng qua nhng ca m bng tay
vi cc dng c y t hoc thit b y t trong Bnh vin.
1.23 Cy ghp ni tng l vic phu thut cy ghp tim, phi, gan, tuyn ty, thn
hoc ty xng cho Ngi c Bo him tin hnh ti mt Bnh vin bi mt Bc
s.
1.24 iu tr ni tr l vic Ngi c Bo him nhp vin ti mt Bnh vin p ng
cc iu kin quy nh ti iu 1.17, c pht sinh cc chi ph nh Chi ph iu tr
trc khi nhp vin, chi ph Nm vin, chi ph iu tr trong ngy, chi ph phu thut
(bao gm phu thut trong ngy), Chi ph iu tr sau khi xut vin, chi ph chm sc
rng do Tai nn, chi ph Chm sc y t ti nh hoc cc chi ph khc c ghi nhn
trong quy nh v Quyn li iu tr ni tr ca Quy tc iu khon ny(nu c) v
theo cc gii hn quy nh trong Giy chng nhn bo him.
1.25 iu tr ngoi tr l vic iu tr y t ti mt Bnh vin/ C s y t c cp giy php
hot ng hp php v ang cn hiu lc, nhng khng nhp vin iu tr v khng
pht sinh chi ph ging bnh nh iu tr ni tr.
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1.26 Chi ph iu tr trc khi nhp vin l cc chi ph khm, kim tra, siu m, chp
chiu, xt nghim c bn, tin thuc theo ch nh ca Bc s iu tr, lin quan trc
tip n bnh hoc thng tt cn phi nhp vin v cn theo di, c thc hin
trong vng 30 ngy trc khi nhp vin.
1.27 Chi ph iu tr sau khi xut vin l cc chi ph iu tr ngay sau khi xut vin lin
quan trc tip n vic iu tr ni tr trc theo ch nh ca Bc s iu tr ti
Bnh vin nhng ti a khng vt qu 30 ngy k t ngy xut vin. Nhng chi ph
ny bao gm ph khm, kim tra, siu m, chp chiu, xt nghim c bn v tin
thuc theo ch nh ca Bc s iu tr.
1.28 Chm sc y t ti nh l cc dch v chm sc y t do y t c giy php hnh ngh
hp php v ang cn hiu lc, thc hin ti nh ca Ngi c Bo him ngay
sau khi xut vin theo ch nh ca Bc s iu tr ti Bnh vin v lin quan trc tip
n vic iu tr ni tr trc . Tng s ngy Chm sc y t ti nh ti a l 30
ngy trong mt nm.
1.29 Cm t Bt buc v mt y t hoc Cn thit v mt y t tng ng vi cc dch
v v cung ng c coi l ph hp v cn thit v mt y t. Cc dch v v cung
ng ny phi:
(a) Cn thit xc nh r hoc iu tr tnh trng sc kho ca bnh nhn, bnh
tt hoc thng tch;
(b) Phi ph hp vi cc triu chng, chn on hoc iu tr cho bnh nhn;
(c) Phi ph hp vi thc tin y t thng thng c chp nhn v vi cc
tiu chun chuyn mn p dng bi cng ng y t ti thi im chm sc;
(d) Bt buc v cc l do khc ngoi l do tin nghi thoi mi cho bnh nhn hoc
thch ca bnh nhn hoc ca bc s;
(e) C tc dng y t c chng minh v tha nhn;
(f) c thc hin bi cc thit b v vt liu vi s lng v cht lng ph hp
vi mc chm sc cn thit i vi tnh trng sc kho ca bnh nhn;
(g) Ch cung cp trong mt khong thi gian ph hp vi tnh trng sc kho ca
bnh nhn.
Trong nh ngha ny, t ph hp c tnh n s an ton cho bnh nhn v
chi ph iu tr. Lin quan n vic Nm vin, Bt buc v mt y t ng rng
vic chm sc hoc chn on khng th t c mt cch thn trng v hiu
qu thng qua t vn bn ngoi.
1.30 Thuc k theo n ca Bc s l thuc, dc phm c bn v s dng theo
n ca Bc s, khng bao gm thc phm chc nng, m phm, v cc loi vitamin
tr trng hp cc loi vitamin theo ch nh ca Bc s phc v cho vic iu tr, v
chi ph cho cc loi vitamin ny khng ln hn chi ph thuc iu tr.
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1.31 B phn gi l cc vt c lm gi thay th cho cc b phn ca c th bao
gm nhng khng gii hn rng gi, chn tay gi, thy tinh th gi.
1.32 Chi ph sinh l tt c cc chi ph y t lin quan n qu trnh sinh n ca Ngi
c Bo him, bao gm sinh thng hoc sinh m (loi tr m theo yu cu), chi
ph chm sc em b ti Bnh vin ngay sau khi sinh
1.33 Vt l tr liu hn khi phc li tnh
trng th cht bnh thng v/hoc chc nng sau mt Tai nn hoc bnh tt nghim
trng. Qu trnh vt l tr liu phi bt u trong vng 30 ngy sau khi nm vin do Tai
nn hoc bnh tt.
1.34 Bin chng thai sn l chi ph y t lin quan n vic xy thai, ph thai v l do y t
theo ch nh ca Bc s.
1.35 Thi hn Hp ng Bo him B tr l 1 (mt) nm k t Ngy hp ng c hiu
lc. Hp ng Bo him B tr c th c ti tc cho mi thi hn 12 thng tip
theo nu ph bo him c ng y theo tha thun.
1.36 Ngy ti tc bo him l ngy c hiu lc ca Hp ng Bo him B tr tip theo.
1.37 Ngy hp ng c hiu lc l ngy Ngi c Bo him bt u c bo him
theo Hp ng Bo him B tr. Ngy Hp ng c hiu lc l ngy
c ghi r trong Giy chng
nhn bo him hoc trong Giy chng nhn Bo him sa i.
1.38 iu l cc iu, khon, mc tng ng ca Quy tc iu khon ny.
iu 2. QUY NH CHUNG
2.1. Khi tham gia bo him, Bn mua Bo him v ngi mong mun c bo him phi
k khai thng tin y , bao gm
mt bn cc cu hi sc kh
c o lu quyn chp nhn bo him, tu thuc vo vic
Bn Mua Bo Him v ngi mong mun c bo him cung cp cc thng tin theo
yu cu c .
2.2. Bn mua Bo him c th yu cu tham gia bo him b tr vo bt k ngy no k
t ngy Hp ng Bo him Chnh bt u c hiu lc cho n trc ngy chm dt
hiu lc ca Hp ng Bo him Chnh.
9

2.3. Ti mt thi im, mt ngi ch c tham gia vi t cch l Ngi c Bo him
trong 1 (mt) Hp ng Bo him B tr. Trong trng hp mt ngi l Ngi c
Bo him ca 2 (hai) Hp ng Bo him B tr cn hiu lc tr ln th PRVOIR
VIT NAM ch chp nhn bo him cho Ngi c Bo him theo Hp ng Bo
him B tr c hiu lc sm nht trong s cc Hp ng Bo him B tr ca cng
Ngi c Bo him . PRVOIR VIT NAM c chm dt hiu lc tt c (cc)
Hp ng Bo him B tr cn li ngay lp tc m khng phi chi tr quyn li bo
him theo cc Hp ng Bo him B tr ny, trong trng hp , PRVOIR VIT
NAM s hon li cho Bn mua Bo him cc khon ph bo him ng ca (cc)
Hp ng Bo him B tr b chm dt.
2.4. Cc quyn li bo him theo Hp ng Bo him B tr khng c chuyn nhng
cho bn th ba.
2.5. Hp ng Bo him B tr ny khng c chia li, khng c gi tr gii c v
khng c gi tr o hn.
2.6. Tr trng hp c quy nh khc trong Quy tc iu khon ny, cc nh ngha, iu
khon v iu kin ca Hp ng Bo him Chnh s c p dng cho Hp ng
Bo him B tr.
2.7. Nu c s khc nhau gia Quy tc iu khon ny v Hp ng Bo him Chnh th
cc quy nh ca Quy tc iu khon ny s c p dng.
2.8. Lut p dng
(a) Lut php ca nc cng ha x hi ch ngha Vit Nam s c p dng i
vi Hp ng Bo him B tr, v trong bt c trng hp xy ra tranh chp
no gia cc bn.
(b) Khi xy ra bt c tranh chp no c lin quan n Hp ng bo him B tr
ny, bin php gii quyt u tin l thng lng, ha gii. Nu khng t
c s ng thun no trong vng 30 ngy k t ngy pht sinh tranh chp,
mt trong cc bn c quyn ngh mt ta n c thm quyn ti Vit Nam xt
x. Quyt nh ca ta n l quyt nh cui cng v bn thua kin chu ton b
n ph.
iu 3. IU KIN C BO HIM
3.1. Ngi mun c bo him ang (hoc bn mua bo hi
ca .
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3.2. Ngi mun c bo him l cng dn Vit Nam hoc ngi nc ngoi c mt ti
Vit Nam ti thi im yu cu bo him, trong tui t 14 ngy tui n 69 Tui ti
thi im tham gia bo him (nhng khng qu 72 Tui vo thi im ti tc Hp
ng Bo him B tr), p ng c cc yu cu v sc khe c
NAM, k khai thng tin y , chnh xc khi yu cu bo him.
3.3. Ti thi im yu cu bo him, ngi mun c bo him khng trong tnh trng
b bnh tm thn, bnh thn kinh, bnh phong, bnh lao, bnh ung th hoc ang
trong thi gian iu tr bnh hoc thng tt.
iu 4. NHNG THAY I C LIN QUAN N HP NG BO HIM B TR
4.1. Nu Bn mua Bo him k khai nhm ln thng tin khi yu cu bo him nh tui,
ngh nghip, tnh trng sc khe, hoc tr li khng ng cc cu hi c nu trong
Giy yu cu bo him v/hoc Bn cu hi kim tra sc khe, v cc thng tin nhm
ln ny nh hng n quyt nh chp nhn bo him c
n n phng chm dt Hp ng Bo him B tr
ngay lp tc v khng gii quyt quyn li bo him i vi bt k chi ph no pht
sinh. Trong trng h s hon tr li cho Bn mua Bo
him 45% s ph bo him m Bn mua Bo him ng.
4.2. Nu Bn mua Bo him k khai nhm ln thng tin khi yu cu bo him v cc thng
tin ny l c s tnh ph bo him, dn n gim cc ri ro c bo him th Bn
mua Bo him c quyn yu cu PR m ph bo him cho thi
gian cn li ca Hp ng Bo him B tr. Trong trng h
khng chp nhn gim ph bo him th Bn mua Bo him c quyn n phng
nh ch thc hin Hp ng Bo him B tr, nhng phi thng bo bng vn b
c 30 ngy. Trong trng hp ny, Cng ty s: (i) hon
li cho Bn mua Bo him 45% s ph bo him ng cho thi gian cn li ca
Hp ng Bo him B tr nu Bn mua Bo him la chn v thc hin phng
thc ng ph bo him mt ln; hoc (ii) Tip tc bo him cho Ngi c Bo
him cho n ngy n hn ng ph k tip nu Bn mua Bo him la chn v
thc hin phng thc ng ph bo him nh k, ng thi ng y ph bo
him cho k ng ph , Hp ng Bo him B tr s nh ch k t ngy n hn
ng ph k tip.
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4.3. Nu Bn mua Bo him k khai nhm ln thng tin khi yu cu bo him v cc thng
tin ny l c s tnh ph bo him, dn n tng cc ri ro c bo hi
n tnh li ph bo him cho thi gian cn li ca Hp
ng Bo him B tr. Trong trng hp Bn mua Bo him khng chp nhn tng
ph bo hi n n phng nh ch thc hin Hp
ng Bo him B tr v thng bo bng vn bn cho Bn mua Bo him trc 30
ngy. Trong trng hp ny, Cng ty s: (i) hon li cho Bn mua Bo him 45% s
ph bo him ng cho thi gian cn li ca Hp ng Bo him B tr nu Bn
mua Bo him la chn v thc hin phng thc ng ph bo him mt ln;
hoc (ii) Tip tc bo him cho Ngi c Bo him cho n ngy n hn ng
ph k tip nu Bn mua Bo him la chn v thc hin phng thc ng ph
bo him nh k, ng thi ng y ph bo him cho k ng ph , Hp
ng Bo him B tr s nh ch k t ngy n hn ng ph k tip.
4.4. Trong thi gian Hp ng Bo him B tr cn hiu lc, Bn mua Bo him c th
yu cu bng vn bn sa i cc chi tit ca Hp ng
Bo him B tr. s thng bo cho Bn mua Bo him bit vic
thay i c th chp nhn c hay khng v thng bo cc iu kin cn p ng
vic thay i c chp nhn. Nu chp nhn yu cu thay
i v khi tt c cc iu kin c p ng, s xc nhn
vic thay i bng cch gi cho Bn mua Bo him mt bn sa i b sung nu y
cc chi tit c lin quan n vic sa i Hp ng Bo him B tr. Ti liu sa
i b sung ny c coi l mt phn khng th tch ri ca Hp ng Bo him B
tr.
4.5. Ngoi tr cc thng tin quan trng nh hng n quyt nh chp nhn bo him
ca Cng ty quy nh ti iu 4.1 sau khi Hp ng Bo him B tr c hiu lc
lin tc t 24 thng tr ln k t Ngy bt u bo him v Ngi c Bo him
cn sng, Cng ty s khng truy xt cc thng tin khc do Bn mua Bo him k khai
khng chnh xc trong h s bo him.
iu 5. CHM DT HP NG BO HIM B TR
Tr khi c quy nh khc trong quy tc iu khon ny, Hp ng Bo him B tr
v tt c quyn li ca Hp ng Bo him B tr s chm dt vo thi im n
trc ca mt trong nhng thi im sau y:
5.1. Ngy Hp ng Bo him Chnh chm dt hiu lc v bt k l do g;
5.2. Ngy cui cng ca thi hn bo him c ghi nhn trong Giy chng nhn bo
him;
5.3. Ngy ht hn ca k thanh ton ph bo him gn nht m Bn mua Bo him khng
ng y ph bo him;
5.4. Ngy k nim Hp ng Bo him b tr nm Ngi c Bo him 72 Tui;
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5.5. Cc thi im khc theo tha thun gi o him
hoc c quy nh trong Quy tc iu khon ny hoc theo quy nh ca php lut.
Bn mua Bo him c quyn n phng chm dt Hp ng Bo him B tr vo
bt c thi im no, bng cch gi thng bo n cho bn kia trc thi im d
nh chm dt Hp ng Bo him B tr t nht 30 ngy. Trong trng hp Hp
ng Bo him B tr b chm dt trc thi hn theo quy nh ti i
hon li cho Bn mua Bo him 45% s ph bo him
ng cho thi gian cn li ca Hp ng Bo him B tr.
iu 6. CC TI LIU/THNG TIN CN CUNG CP
6.1. Khi giao kt Hp ng Bo him B tr, Bn mua Bo him s
VIETNAM cung cp Quy tc iu khon ny, Giy chng nhn bo him (trong ghi
r, tn, tui, gii tnh v.v. ca Ngi c bo him, ngy Hp ng Bo him B tr
c hiu lc, ngy ht hn Hp ng Bo him B tr), v cc giy t cn thit c lin
quan khc.
6.2. Bn mua Bo him s cung c t c nhng thng tin cn
thit theo yu cu mt cch trung thc. Vo bt k thi i
VIETNAM c quyn kim tra, xc nh tnh chnh xc ca cc thng tin do Bn mua
Bo him cung cp c lin quan n Hp ng Bo him B tr.
iu 7. THI GIAN CH
7.1. Thi gian ch l khong thi gian m mt s quyn li bo him c quy nh trong
Hp ng Bo him B tr cha c hiu lc v Ngi c Bo him khng c
hng cc quyn li bo him ny. Thi gian ch quy nh ti iu 7.3 di y bt
u c tnh t ngy Hp ng Bo him b tr bt u c hiu lc v c p
dng i vi tt c nhng Ngi c bo him, ngoi tr trng hp c quy nh
ti iu 7.2 di y.
7.2. Thi gian ch quy nh trong iu 7.3 di y khng p dng trong trng hp
ngi mun c bo him cung cp cc bng chng chng minh h ang tham gia
mt hp ng bo him chm sc y t tng t trc c thi hn t nht mt nm
v vn ang cn hiu lc hoc o hn khng qu 1 thng trc ngy yu cu
tham gia Hp ng Bo him B tr ny. kim tra cc bng
chng chng minh do ngi mun c bo him cung cp v xc nhn vic khng
p dng thi gian ch theo quy nh ti iu 7.2 ny trn Giy chng nhn bo him.
7.3. Thi gian ch
(a) Tai -mi - hng: Thi gian ch 6 thng, bao gm cc trng hp sau:
- No VA, no si vm hng;
- Ct b xng xon;
13

- Tt c cc phu thut v tai khc tr rch mng nh.
(b) H tim mch: Thi gian ch 1 nm, bao gm cc trng hp sau:
- Bt k hnh thc iu tr tim no;
- Phu thut tim m;
- Chp X-quang mch mu v To hnh mch mu;
- Th thut t ng thng tim phc v cho vic chn on c bo him
sau 3 (ba) thng;
- iu tr Vim tnh mch, ngoi tr iu tr vim tnh mch cp tnh;
- Tr;
- Phu thut ly b cc tnh mch chi di b dn.
(c) H tiu ha: Thi gian ch 1 nm, bao gm cc trng hp sau:
- Thot v;
- Phu thut ct b ti mt;
- Thng lot d dy.
(d) H ni tit: Thi gian ch 1 nm, bao gm cc trng hp sau:
- Phu thut ct b tuyn gip;
- Phu thut ct b tuyn cn gip;
- Tuyn thng thn.
(e) H sinh dc n: Thi gian ch 280 ngy
- Thai sn (sinh thng hoc m ly thai);
- No ph thai (bt buc theo ch nh y t), sy thai, thai ngoi t cung;
- Bt k vic phu thut no lin quan n h thng sinh dc n (Thi gian
ch 1 nm).
H sinh dc n bao gm cc c quan sau y: Tng sinh mn, m h, m o,
c t cung, t cung, thn t cung v bung trng.
(f) H thng sinh dc nam (Thi gian ch 1 nm):
14

Bt k vic phu thut no lin quan n h thng sinh dc nam.
H thng sinh dc Nam bao gm cc c quan sau y: Dng vt, tinh hon,
mo tinh hon, bu, ng dn tinh, thng tinh, ti tinh v tuyn tin lit.
(g) H c: Thi gian ch 1 nm, bao gm cc trng hp sau:
- U nang bao hot dch;
- Tt c cc loi phu thut c hoc xng khng phi do mt tai nn gy
ra (bao gm c ni soi khp v phu thut ct thn t sng);
- Hi chng ng c tay;
- Thay th khp hng v khp gi lin quan n chn thng do tai nn
trc .
(h) Nhn Khoa (Thi gian ch 1 nm):
- Bt k loi phu thut mt no.
(i) H h hp: Thi gian ch 1 nm, bao gm cc trng hp sau:
- Ct b polyp dy thanh;
- Ct amian;
- Bnh lao.
(j) H tit niu (Thi gian ch 1 nm):
- Bt k phu thut no lin quan n h tit niu (bao gm c tn si hoc
phu thut ly si);
- H tit niu bao gm: Thn, niu qun, bng quang v niu o.
(k) Bnh ung th:
- Tt c cc ca phu thut v iu tr lin quan n bnh ung th c bo
him sau 5 nm.
iu 8. QUYN LI BO HIM
8.1. Phm vi ca cc quyn li bo him
Tt c cc quyn li bo him c ch ra trong cc mc di y ch c p dng
cho vic Nm vin, iu tr, v hi chn trong phm vi lnh th Vit Nam.
15

Trong mi trng hp, gii hn trch nhim ca khng vt qu
gii hn s tin chi tr cho tng mc quyn li tng ng c quy nh trong Bng
quyn li bo him.
8.2. Quyn li iu tr ni tr
Chi ph chm sc y t c tr cho Ngi c Bo him sau khi Ngi c Bo
him thc hin quy trnh kim tra y t theo quy nh, v lm th tc nhp vin nh
mt bnh nhn theo ngy hoc bnh nhn ni tr. Chi ph chm sc y t bao gm cc
chi ph hp l lin quan n vic iu tr c lit k di y:
(a) Tin phng v ging bnh
chi tr Chi ph Phng tiu chun v ging pht sinh
khi Ngi c Bo him Nm vin ti mt Bnh vin theo ch nh ca Bc
s. Chi ph ny bao gm: chi ph cho mt phng tiu chun, ba n phc v
ca Bnh vin cho Ngi c Bo him (Bnh nhn) v cc chi ph chm sc
y t cn thit khc do mt y t c bng cp chm sc theo ch nh ca Bc s.
chi tr chi ph Nm vin theo quy nh ca Hp ng Bo
him B tr nhng khng qu 30 ngy trong mt nm Hp ng Bo him B
tr.
(b) Chi ph hi sc tch cc:
Nu trong thi gian Nm vin, Ngi c Bo him cn c hi sc tch
cc do chn thng c th v l do Tai nn hoc Bnh tt,
s chi tr ton b s tin bng vi chi ph thc t m Ngi c Bo him
phi chi tr nhng khng qu 30 ngy trong mt nm.
(c) Cc chi ph pht sinh trong qu trnh Nm vin
s chi tr cho ton b chi ph thc t pht sinh trong qu
trnh Nm vin lin quan n vic iu tr ca Ngi c Bo him bao gm:
- Chi ph hi chn ca Bc s;
- Chi ph mua thuc theo n ca Bc s;
- Chi ph chp MRI, PET, chp X-quang, cc chi ph xt nghim theo ch
nh ca Bc s.
(d) Chi ph iu tr trc v sau khi nhp vin
L cc chi ph c quy nh ti iu 1.26 v iu 1.27 ca Quy tc iu
khon ny vi thi hn ti a l 30 ngy trc khi nhp vin v 30 ngy sau khi
xut vin.
16

(e) Chi ph phu thut (bao gm c phu thut cho bnh nhn khng Nm vin qua
m)
s chi tr cc chi ph phu thut thuc phm vi bo him:
- Chi ph Bc s phu thut;
- Chi ph m;
- Chi ph gy m;
- Chi ph chm sc hi sc.
(f) Chi ph cy ghp ni tng
s chi tr cc chi ph phu thut pht sinh trong qu trnh
Cy ghp ni tng theo nh ngha ti iu 1.23.
(g) Dch v xe cu thng
chi tr ton b cc chi ph cho Dch v xe cu thng
theo nh ngha ti iu 1.15.
ch chi tr chi ph s dng Dch v xe cu thng ti a 3
ln trong mt nm Hp ng bo him.
(h) Chi ph iu tr tn thng rng do Tai nn
chi tr chi ph iu tr tn thng rng do Tai nn c
thc hin trong vng 24 gi k t thi im xy ra Tai nn. Tn thng ny
phi gy nh hng n h thng pht m, rng t nhin.
(i) Chm sc y t ti nh ngay sau khi xut vin
chi tr cc chi ph chm sc y t ti nh cho Ngi
c Bo him vi tng s ngy chm sc y t ti nh ti a c chi tr chi
ph l 30 ngy trong mt nm.
(j) Tr cp Nm vin
chi tr tr cp Nm vin cho Ngi c Bo him
cho thi gian Nm vin thc t. Tng s ngy c chi tr tr cp nm vin ti
a l 30 ngy trong mt nm bo him.
(k) Quyn li thai sn (nu Bn mua la chn quyn li ny trong Quyn li iu tr
ni tr)
chi tr cho Ngi c Bo him cc chi ph, bao
gm:
17

- Chi ph kim tra sc khe khi nhp vin sinh ;
- Chi ph sinh thng (thuc, thng, nm vin ni tr);
- Chi ph m (v l do y t);
- Bin chng thai sn;
- Chm sc tr s sinh sau khi sinh (ti a l 5 ngy k t ngy sinh v ti
a 5 ngy/1 nm).
8.3. Quyn li bo him ty chn
Cc quyn li bo him di y ch c hiu lc nu c Bn mua Bo him la
chn v ph bo him cho cc quyn li ny c ng y .
8.3.1. Quyn li iu tr ngoi tr
s chi tr cho Ngi c Bo him nhng chi ph thc t lin
quan n:
(a) Ph t vn, chi ph mua thuc theo n ca Bc s, chi ph xt nghim, chp X-
quang, phc v cho chn on Bnh tt/thng tt c bo him;
(b) X tr, liu php nhit hoc quang tr liu v cc iu tr tng t khc c ch
nh bi Bc s;
(c) Vt l tr liu theo ch nh ca Bc s ( chi tr ti a 5 USD
mt ngy v tng s 60 ngy mt nm).
8.3.2. Quyn li iu tr nha khoa c bn:
Ngi c Bo him ch c ng k bo him theo quyn li ny nu ng k
Quyn li iu tr ngoi tr. Quyn li iu tr nha khoa c bn bao gm:
(a) Kim tra, hi chn, chun on;
(b) Chp X-quang;
(c) iu tr vim li, vim nu rng;
(d) Trm rng(amalgam, composite);
(e) Loi b rng cht ty, b rng khn (khng bao gm phu thut);
(f) iu tr ty rng;
18

(g) Lm sch rng (quyn li bo him ny c thanh ton mt ln mi nm v
ti a 20 USD mi ln).
8.3.3. Quyn li iu tr nha khoa b sung
Ngi c Bo him khi ng k thm Quyn li iu tr nha khoa c bn (cng vi
Quyn li iu tr ngoi tr) c th yu cu b sung quyn li bo him nha khoa
bng cch ng k Quyn li iu tr nha khoa b sung. Quyn li ny bao gm chi
ph lm rng gi: lm chp rng, hn rng, trm rng, m rng, sa rng, lm cu
rng.
Hn mc ti a ca Quyn li iu tr Nha khoa b sung c tch ring v khng
nm trong hn mc ca Quyn li iu tr Ngoi tr v Quyn li iu tr Nha khoa c
bn.
8.4. Bng quyn li bo him
Sn phm bo him b tr ny cung cp cc gi bo him cho bnh nhn iu tr ni
tr (bao gm c Quyn li thai sn) v bnh nhn iu tr ngoi tr (bao gm c
Quyn li chm sc rng c bn).
Bn mua Bo him c quyn khng chn Quyn li thai sn v / hoc iu tr ngoi
tr v / hoc Quyn li chm sc rng c bn nu nhng quyn li ny khng p
ng c nhu cu ca h. Trong trng h gim ph
bo him tng ng vi s la chn ca Bn mua Bo him.
Di y l Bng quyn li bo him, trong nu r cc gi bo him v hn mc
chi tr c th ca tng gi bo him, tng ng vi tng loi chi ph:
CHNG TRNH BO HIM Y T V4
QUYN LI GII HN BI THNG / NGI/ NM (USD)
LA CHN M1 M2 H1 H2
I. QUYN LI IU TR NI TR
(BO HIM CHNH) HN MC
CHI TR
5000
USD/nm
10000
USD/nm
15000
USD/nm
20000
USD/nm
19

1. Vin ph v cc chi ph y t pht
sinh trong qu trnh Nm vin, bao
gm:
a. Tin phng v ging bnh (bao
gm c ba n ca bnh vin phc
v), chi tr ti a ti 30 ngy/nm.
i vi bnh vin t nhn v bnh
vin quc t, tin phng khng qu
phng tiu chun.
b. Cc chi ph pht sinh trong qu
trnh nm vin chi tr cho cc dch v
v vt t y t cn thit, bao gm:
- Chi ph t vn bc s
- Thuc c k n
- Cc k thut, cc xt nghim chn
on bnh hc: chp cng hng t,
chp ct lp, chp x quang, xt
nghim.

Chi ph thc
t, ti a
250USD/ngy

Chi ph thc
t, ti a
500USD/ngy

Chi ph thc
t, ti a
750USD/ngy

Chi ph thc
t, ti a
1000USD/ngy
2. Phng hi sc tch cc chi tr ti
a ti 30 ngy/nm.
i vi bnh vin t nhn v bnh
vin quc t, tin phng khng qu
phng tiu chun.
Chi tr y Chi tr y Chi tr y Chi tr y
3. iu tr trc nhp vin ti a 30
ngy trc khi nhp vin, ti a 30
ngy/ nm
Chi ph thc
t, ti a 100
USD/nm
Chi ph thc
t, ti a 200
USD/nm
Chi ph thc
t, ti a 300
USD/nm
Chi ph thc
t, ti a 400
USD/nm
4. iu tr sau xut vin ti a 30
ngy sau khi xut vin, ti a 30
ngy/ nm
Chi ph thc
t, ti a 100
USD/nm
Chi ph thc
t, ti a 200
USD/nm
Chi ph thc
t, ti a 300
USD/nm
Chi ph thc
t, ti a 400
USD/nm
5. Chi ph phu thut cho bnh nhn
ni tr hoc bnh nhn khng nm
vin qua m:
- Chi ph cho bc s phu thut
- Chi ph phng m
- Chi ph cho bc s gy m
- Chi ph cho bc s iu tr
Chi tr y Chi tr y Chi tr y Chi tr y
20

6. Cy ghp ni tng
Quyn li ny ch bao gm cc chi
ph phu thut
Chi ph thc
t, ti a
2000
USD/nm
Chi ph thc
t, ti a
5000
USD/nm
Chi ph thc
t, ti a
10000
USD/nm
Chi ph thc
t, ti a
15000
USD/nm
7. Xe cu thng a phng vn
chuyn cp cu n bnh vin
Chi tr y Chi tr y Chi tr y Chi tr y
8. Tn thng rng do Tai nn
Chi ph thc
t, ti a 50
USD/nm
Chi ph thc
t, ti a 100
USD/nm
Chi ph thc
t, ti a 150
USD/nm
Chi ph thc
t, ti a
200 USD/nm
9. Chm sc y t ti nh ngay sau khi
xut vin (ti a 30 ngy/nm)
Chi ph thc
t, ti a 50
USD/nm
Chi ph thc
t, ti a 100
USD/nm
Chi ph thc
t, ti a 150
USD/nm
Chi ph thc
t, ti a 200
USD/nm
10. Tr cp nm vin hng ngy (ti
a 30 ngy/nm)
2 USD/ngy 5 USD/ngy 7 USD/ngy 10 USD/ngy
11. QUYN LI THAI SN (nu Bn
mua la chn quyn li ny trong
Quyn li iu tr ni tr)

a. Kim tra sc khe khi nhp vin
sinh
Khng c Khng c
100% chi ph
ln n 100
USD/nm
100% chi ph
ln n 150
USD/nm
b. Chi ph sinh thng (thuc,
thng, nm vin)
100% chi ph
ln n 2000
USD/nm
100% chi ph
ln n 4000
USD/nm
c. M (v l do y t theo ch nh
ca Bc s)
100% chi ph
ln n 3500
USD/nm
100% chi ph
ln n 5000
USD/nm
d. Bin chng thai sn
Bo him
theo hn mc
t tiu mc
I.1 n I.10
trn
Bo him theo
hn mc t
tiu mc I.1
n I.10 trn
e. Chm sc tr s sinh (trong vng
5 ngy ngay sau sinh, ti a 5 ngy/
nm)
chi tr ti a
ti 30
USD/nm
chi tr ti a
ti30
USD//nm


21

II. QUYN LI BO HIM TY
CHN HN MC CHI TR
250
USD/nm
500
USD/nm
700
USD/nm
1000
USD/nm
1. QUYN LI IU TR NGOI
TR
a. Chi ph t vn, chi ph k n iu
tr, chi ph xt nghim hoc chp X-
quang c s dng trong chn
on Bnh tt/thng tt c bo
him.
b. X tr, liu php nhit hoc quang
tr liu v cc iu tr tng t khc
c ch nh bi Bc s.
c. Vt l tr liu c ch nh bi Bc
s: gii hn 5 USD/ngy v ti a 60
ngy/nm.
Chi tr y Chi try Chi tr y Chi tr y
2. QUYN LI IU TR NHA
KHOA C BN (nu ng k
tham gia Quyn li Mc II.1):
a. Khm /T vn/Chn on.
b. Chp X-quang k thut s.
c. Vim li rng/vim nu rng.
d. Vt liu hn rng/trm rng (hp
kim amalgam, hn hp composite).
e. Loi b rng su, rng khn khng
phi phu thut.
f. iu tr ng chn rng/X l ty
rng.
g. Lm sch rng/ly cao rng (ti a
20 USD/ln, 1 ln/nm).
Chi ph thc
t, ti a
100USD/nm
Chi ph thc
t, ti a 200
USD/nm
Chi ph thc
t, ti a 300
USD/nm
Chi ph thc
t, ti a 400
USD/nm




III. QUYN LI IU TR NHA
KHOA B SUNG HN MC CHI
TR
M1 M2 H1 H2
1. iu tr nha khoa c bn (nu
ng k tham gia Quyn li Mc
II.2).

Chi ph thc
t, ti a 150
USD/nm
Chi ph thc
t, ti a 300
USD/nm
Chi ph thc
t, ti a 500
USD/nm
Chi ph thc
t, ti a 700
USD/nm
22

2. Phc hnh nha khoa (chnh
hnh/lm rng gi): chm sc phc
hnh rng, bao gm lm chp rng,
hn rng, trm rng, phc hi hoc
sa cha cht kt dnh rng gi, cu
rng.

iu 9. IU KHON LOI TR
c quyn khng chi tr cc quyn li bo him ca Hp ng
Bo him B tr (gm c cc quyn li bo him b sung) i vi cc chi ph pht
sinh t hoc ri ro xy ra do cc nguyn nhn sau:
9.1. Bt k chi ph y t no pht sinh sau khi Ngi c Bo him 72 Tui.
9.2. Cc dch v thng c thc hin ti cc phng khm, vn phng ca bc s, cc
trung tm y t, c s iu tr ngoi tr, ngoi tr cc dch v c lit k trong
bng quyn li bo him.
9.3. Vic iu tr cn phi theo ch nh hoc phi c chp thun nhng Ngi c
bo him vn iu tr mc d khng c ch nh hoc khng c chp thun.
9.4. Vic iu tr hoc kim tra khng v mt mc tiu y t c th, hoc khng phi l Bt
buc v mt y t hoc khng c lit k trong phm vi bo him.
9.5. iu tr y t cho bt k Bnh c sn no, tr trng hp Bnh c sn c k
khai v c PRVOIR VIT NAM chp nhn.
9.6. Cc Bnh bm sinh, Bnh di truyn, d tt bm sinh, bao gm c bnh thn kinh, bnh
ri lon thiu tp trung, cc iu tr cho bnh chm pht trin v bnh kh khn trong
pht trin th cht v hc tp, cng nh bin chng t cc bnh ny. Cc d tt bm
sinh l cc d thng, cc d tt v cc khuyt tt xut hin lc sinh.
Ngoi l c bit i vi cc ni dung loi tr trong iu 9.6, cc trng hp sau vn
c bo him:
23

(a) Cc Bnh bm sinh sau y ch c bo him trong cc trng hp m
Ngi c Bo him c cung cp y iu kin v y t khi sinh v tr
s sinh c bo him bi PRVOIR VIT NAM lin tc t khi c 14 (mi
bn) ngy tui theo bo him thai sn: thot v, nang gip li, hp mn v, tro
ngc / hi lu tit niu, tro ngc/ hi lu d dy- thc qun, d tt l tiu
cao, d tt l tiu thp, ln bng quang v ln vng bng di, van niu qun
sau, chng phnh niu qun, gin b thn/ thn nc v khc ni b thn-
niu qun, thot v c honh, hp thc qun, thot v rn v c honh thnh
bng, hp t trng, tc rut, phnh i trng bm sinh (v hch i trng bm
sinh), khng c hu mn, hp ng dn mt, nang ph qun, d dng nang
tuyn, v d tt dnh li (ankyloglossia).
(b) iu tr ni tr i vi Bnh vng da s sinh tm thi cho tr s sinh theo Hp
ng Bo him B tr nu c iu kin v y t, k t khi sinh ra m khng
ph thuc vo thi gian nm vin ca ngi m.
Cc m rng ny khng to ra bt k quyn li hoc li ch no khc i vi tr s
sinh di bt k hnh thc no.
9.7. Chy thn nhn to v phu thut ni ng tnh mch.
9.8. Cc bnh l tm thn, thn kinh, cc ri lon tm l v cc ri lon c lin quan bao
gm rng tc do ri lon tm thn, gim nh tm thn, suy nhc thn kinh v cc
bnh tng t. Th nghim v nh gi v tm l.
9.9. Phu thut thm m, phu thut to hnh hoc cc phu thut c lin quan, tr phu
thut bt buc phi thc hin do chn thng bi tai nn c bo him, vi iu
kin cc phu thut ny c chp thun trc bi PRVOIR VIT NAM hoc t
chc c PRVOIR VIT NAM y quyn gii quyt quyn li bo him, v c
tin hnh trong vng 6 thng k t ngy b Tai nn.
9.10. Vic iu tr hoc xt nghim ti cc trung tm thy tr liu, spa, trung tm lm p,
vin iu dng v cc c s tng t, chm sc ti ging, trong giai on kim
dch, n king c bit v kim sot cn nng, cc chi ph c lin quan ti vic an
dng thm ch l theo yu cu ca vic iu tr ban u.
9.11. Vic iu tr hoc kim tra y t l kt qu ca vic c t gy thng tch, tm cch t
t hoc e da t t, c gy ra cc ri ro, hnh ng bt hp php hoc hnh ng
b cm, s c , bt cn ca bn th ba.
9.12. Vic iu tr hoc kim tra y t pht sinh t hoc lin quan n vic s dng ru, ma
ty hoc cc cht gy nghin.
24

9.13. iu tr hoc kim tra nu (li), tr trng hp c iu kin v c chp
thun trc sau mt tn thng do tai nn c bo him trong vng 06 thng k
t ngy tai nn (loi tr ny khng p dng i vi Quyn li nha khoa c bn v
Quyn li nha khoa b sung).
9.14. iu tr mt lin quan ti cc tt khc x, bao gm cc kim tra v cc thit b cung
cp.
9.15. iu tr lin quan ti lo suy v cc ri lon lin quan ti tui tc.
9.16. Bt k chi ph y t trc tip hay gin tip pht sinh do:
(a) Chin tranh, xm lc, hnh ng ngoi xm, hnh ng khng b hoc ph
hoi hoc cc hnh vi tr a c lin quan, s th ch d c hay khng c
tuyn b chin tranh, ni chin, ni lon, cch mng, nh cng, bo ng trong
nc, ti phm hoc cc hnh vi tri php lut ca Ngi c Bo him.
(b) Phng x i-on ha, nhim phng x do nguyn liu ht nhn hay bt c
ngun cht thi ht nhn no.
(c) Cht phng x, cht c, cht n hoc cc cc cht nguy hi khc t cc thit
b ht nhn.
(d) Xy ra cc hin tng thin nhin nh ng t, l lt, st, bo, dch bnh v.v.
9.17. Bt k chi ph y t trc tip hoc gin tip pht sinh do cc hot ng mo him hoc
th thao, bao gm nhng khng gii hn:
(a) Hot ng trn khng (tr khi l hnh khch trn cc chuyn bay thng mi),
nh: my bay hng nh, my bay mt cnh, khinh kh cu, nhy d, bay ln
trn khng, nhy bungee.
(b) Hot ng th thao ma ng nh: trt tuyt, trt bng, v.v.
(c) Hot ng th thao di nc nh ua thuyn, lt vn/lt sng, bi vi ng
th, ln v.v.
(d) Hot ng ci nga nh: sn bn, nhy nga, chi p-l, ua nga v.v.
(e) Hot ng leo ni nh: thm him khe ni, leo xung vch ni, leo ni v.v.
(f) Tham gia vo bt k mn th thao hay cuc ua no, c hoc khng c
phng tin c gii.
(g) Bt k loi v thut no, bao gm m bc, judo, karate, u vt v.v..
25

(h) Cc hot ng khc c ri ro cao nh cc mn th thao c va chm, bao gm
bng , bng bu dc v.v.
(i) Hot ng v trang thng thng v tnh nguyn nh khng qun, hi qun,
qun i, cnh st, bo v, cha chy v.v.
(j) Cc hnh ng nh cc, c , th thch, thch thc, tri nghim, lp k lc
v.v.
9.18. Chi ph cho tt c cc b phn ca c th c cho i hay c cy ghp, bao gm
c vic cy ghp ty xng, ngoi tr chi ph cho vic phu thut lin quan ti cy
ghp gic mc, nu vic phu thut ny c bo him nhng khng bao gm chi
ph gic mc. Chi ph cho tt c cc loi b phn gi hoc dng c chnh hnh dng
thay th cho mt c quan, chn tay hoc bt k chc nng no ca c th con ngi
bao gm c cc vt liu gi c th phn hy trong c th (loi vt liu mi khng phi
kim loi), nhng ngoi tr:
(a) Cc van tim lin quan ti cc cuc phu thut tim.
(b) Cc b phn gi lin quan ti cc di chng Tai nn (bao gm chn tay gi c
gi tr ti a 5000 USD) xy ra trong thi hn hiu lc ca Hp ng Bo
him B tr hoc thi hn gia hn tng ng. Trong trng hp ny, cc b
phn gi c bo him nu c cung cp cho Ngi c Bo him ngay
sau khi Tai nn v trong thi hn Hp ng Bo him B tr cn hiu lc vi
iu kin Hp ng Bo him B tr khng b gin on k t khi Tai nn.
(c) Gi mch vnh vi gi tr ti a l 3000 USD i vi mt Ngi c bo
him trong mt nm Hp ng Bo him B tr v/hoc trong bt k phm vi
bo him b sung/ko di no.
(d) Gi thot v lin quan ti phu thut thot v, vi iu kin vic Nm vin lin
quan ti tnh trng bnh ny c bo him nh c quy nh trong Quy tc
iu khon ny.
9.19. Tht ng dn trng bao gm tt c quy trnh kim sot, iu tr v xt nghim c lin
quan.
9.20. Cc iu tr hoc xt nghim kim sot sinh , bao gm trit sn v IUD hoc
iu tr him mun bao gm IVF, chng lit dng, chng gin tnh mch tinh,
v.v..No ph thai tr cc trng hp Cn thit v mt y t theo ch nh ca Bc s.
9.21. Bt k vic iu tr hoc kim tra y t no c lin quan ti bnh ly lan qua ng tnh
dc, bao gm bnh si mo g, bnh hoa liu, HIV, AIDS, ARC, v.v., - d mc phi
hoc c tn nh vy.
26

9.22. Tim vac-xin, tim chng, khm sc khe nh k, kim tra tng qut, xt nghim d
ng, th nghim y t, iu tr ngn nga v.v., iu tr hoc kim tra i vi cc d ng
tr trng hp iu tr cp cu do d ng hoc sc phn v.
9.23. iu tr cc bnh ngh nghip v cc iu tr khc c bo him theo cc chnh
sch bi thng cho ngi lao ng. Cc quyn li c bo him cc hp
ng bo him khc.
9.24. Phu thut to hnh vch mi, chnh vch ngn v to hnh mi.
9.25. No ph thai khi khng bt buc v mt y t.
9.26. iu tr bnh Parkinson bao gm c phu thut.
9.27. Kim tra hoc iu tr gic ng lin quan n cc ri lon h hp bao gm ngy v
ngng th khi ng.
9.28. Tt c cc loi kim tra di truyn v th thut bao gm cng ngh di truyn v nhn
bn v tnh di truyn.
9.29. Bt k hnh thc hiu chnh lc hoc tm nhn no.
9.30. Ngi c Bo him nm vin, iu tr ti nhng bnh vin hoc c s y t khng
p ng iu kin quy nh ti iu 1.17 tr trng hp
chp thun trc.
9.31. Ngi c Bo him c min ph Nm vin, iu tr.
9.32. Cc chi ph chi tr cho nhng dch v phi y t nh: in thoi, radio, internet..
iu 10. PH BO HIM
10.1. Ph bo him
(a) Ph bo him cho nm Hp ng Bo him B tr u tin c quy nh trong
Giy chng nhn bo him.
(b) Tr khi c tha thun khc, Ph bo him c th c tnh v c ng nh
k theo thng, qu, 6 thng hoc theo nm trn c s la chn ca Bn mua
Bo him v c ghi nhn trong Giy chng nhn bo him.
(c) n iu chnh t l ph bo him da trn cc tiu
ch nh: Tui ca Ngi c Bo him, t l bi thng v thng bo cho
Bn mua Bo him trc ngy ti tc Hp ng Bo him b tr t nht 15
ngy. T l ph bo him mi s c p dng k t ngy ti tc Hp ng
Bo him b tr.
27

(d) Bn mua Bo him c th y quyn cho ngi khc ng Ph bo him.
10.2. Gia hn ng Ph bo him trong trng hp ng ph bo him nh k.
(a) Qu Ngy n hn ng ph bo him nh k ghi nhn trn Giy chng nhn
Bo him, nu Bn mua Bo him khng ng y ph bo him n hn,
s cho php mt khong thi gian gia hn ng ph bo
him l 60 ngy k t Ngy n hn ng Ph bo him.
(b) Trong thi gian gia hn ng Ph bo him nh k, nu pht sinh S kin Bo
him v c yu cu gii quyt quyn li bo him, c
quyn khu tr phn Ph bo him cn thiu t quyn li bo him trc khi
chi tr.
(c) Sau thi gian gia hn ng Ph bo him nh k nu trn, nu
VIETNAM khng nhn c Ph bo him n hn, Hp ng Bo him B tr
s chm dt hiu lc k Ngy n hn ng Ph bo him nh k.
iu 11. TH TC YU CU GII QUYT QUYN LI BO HIM
Ngi yu cu gii quyt quyn li bo him phi gi mt vn bn thng bo v vic
iu tr i vi Ngi c Bo him ( c in y thng tin theo mu c
) c t chc/c nhn
y quyn, trong vng 60 ngy, k t thi im bt u pht sinh
chi ph i vi Ngi c Bo him cn chi tr bo him.
yu cu gii quyt quyn li bo him, Ngi yu cu gii quyt quyn li bo
him cn gi mt vn bn yu cu gii quyt quyn li bo him c in y
thng tin theo mu c km theo cc ti liu chng minh yu
cu bo him n hoc t chc/c nhn c
VIETNAM y quyn, trong vng 1 nm, k t thi im bt u pht sinh chi ph i
vi Ngi c Bo him cn chi tr bo him. Vic khng tun th thi gian yu cu
gii quyt quyn li bo him c th dn ti vic khng c chi tr quyn li bo
him.
Bn sao, bn chp ca cc loi ho n yu cu chi tr khng
NAM chp nhn tr trng hp Ngi c Bo him chng minh c h s
dng bn gc ca cc ha n yu cu gii quyt quyn li bo him theo cc
hp ng bo him khc. Trong trng hp Ngi c Bo him c gii
quyt quyn li bo him theo cc hp ng bo hi
chi tr phn chnh lch gia chi ph iu tr thc t thuc phm vi bo him ca Hp
ng bo him B tr ny vi tng cc quyn li bo him m Ngi c Bo him
c nhn t cc hp ng bo him khc.
28

Th hng chu trch nhim hon tr i khon tin
qu mc cho Ngi th hng hoc ngi
c Ngi th hng y quyn nu thng tin do nhng ngi ny cung c
lch, gi mo hoc phng i hoc bt k hnh vi sai tri hoc c tnh gian ln no
ca h dn n vi qu mc do da trn cc d liu
khng chnh xc .
11.1. Ti liu chng minh yu cu bo him
(a) Cc chng t lin quan n vic iu tr (nu c): phiu iu tr, phiu xt
nghim, phiu m (trong trng hp phi m), cc ch nh ca Bc s iu tr,
cc chng t lin quan n vic iu tr theo ngyTrng hp khng cung
cp c bn chnh, c th cung cp bn photo c xc nhn ca Bnh vin/C
s y t.
(b) Cc chng t lin quan n vic thanh ton cc chi ph y t: ha n hp
php, bin lai, phiu thu theo quy nh ca php lut v cc chng t chng
minh vic iu tr: n thuc, s khm bnh, giy xut vin. Cc chng t ny
phi l bn gc, c ch k ca Ngi c Bo him v Bc s iu tr.
c quyn gi li cc ti liu, chng t ny.
(c) Trong mi trng hp: Bn sao c cng chng Chng minh th nhn dn
hoc H chiu ca Ngi c Bo him v Ngi th hng.
11.2. Chi tr quyn li bo him
(a) Thanh ton cc chi ph pht sinh trong thi gian iu tr
Nu Ngi c Bo him iu tr ni tr ti Bnh vin nm trong h thng
bo lnh thanh ton vin ph c
NAM s thanh ton trc tip cho Bnh vin cc chi ph thuc phm vi bo him.
Danh sch Bnh vin c bo lnh vin ph cng th tc bo lnh vin ph s
c cung cp cho Bn mua Bo him khi giao kt Hp ng Bo him hoc
c cng b trn trang web http://www.prevoir.com.vn.
Nu Ngi c Bo him iu tr ni tr ti Bnh vin khng nm trong h
thng bo lnh thanh ton vin ph c hoc iu tr
ngoi tr ti cc Bnh vin/ C s y t, Ngi c Bo him t chi tr cc chi
ph pht sinh ti Bnh vin/C s y t. s chi tr cho
Ngi th hng cc chi ph c bo him theo quy nh ti Quy tc iu
khon ny.
(b) Thanh ton cho Ngi Th hng
29

Tr trng hp c tha thun khc vi Ngi th h
NAM s thanh ton cc quyn li bo him cho Ngi th hng bng tin
mt hoc chuyn khon qua ti khon ngn hng ca Ngi th hng.
(c) ng tin thanh ton v t gi
- ng tin thanh ton: hoc
Cc Bn c tha thun khc, vic chi tr quyn li bo him c thc
hin bng tin ng Vit Nam.
- T gi p dng: Mt t gi chung do quy nh s
c p dng quy i cc hn mc chi tr ca cc quyn li bo
him v cc khon ph bo him phi ng t la M sang tin ng
Vit Nam. T gi ny c ghi nhn trn Giy chng nhn bo him v
c p dng trong sut 1 nm ca Thi hn Hp ng Bo him B
tr. Mi trng hp iu chnh t gi ny (nu c) ch c p dng cho
Thi hn Hp ng Bo him B tr k tip nu Hp ng Bo him B
tr c ti tc v phi c ghi nhn trn Giy chng nhn bo him
sa i hoc vn bn thng bo ti tc ca Hp ng Bo him B tr.