健康傷害險

依據保險契約之約定，一般均為自得請求之日起兩年內，如果經過兩年仍未申請保險理賠，則請求權將消滅。

According to insurance contract terms, claims must typically be filed within two years from the date of eligibility; the right to claim expires if not filed within this period.

不可，理賠所需文件之診斷書必須為正本，如有投保其他家保險公司，請向醫療院所申請多份正本診斷書，或依醫院規定核發之副本診斷書，診斷書開立費用可在實支實付型商品的保險額度內給付。

No, original medical certificates are required for claims. If you have multiple insurance policies, request multiple original certificates from the medical institution. Certificate issuance fees can be covered under actual expense reimbursement policies.

國術館或接骨所非法定的醫療院所，傳統接骨師父也未領有醫師執照，不符契約規定之合法醫療院所及醫師之要求，因此於國術館、接骨所之治療費用，將無法獲得保險公司理賠。

Traditional bone-setting clinics or martial arts halls are not legally recognized medical institutions, and traditional bone-setters do not hold medical licenses. Treatment costs from these facilities cannot be claimed as they do not meet the contract requirements for legal medical institutions and licensed physicians.

依照保險契約之約定，「意外傷害事故」是指非由疾病所引起之外來突發事故。

According to insurance contract terms, "accidental injury" refers to a sudden external incident not caused by illness.

如為傷害醫療保險金、失能保險金，其給付對象為被保險人本人。

如為身故保險金，則其給付對象為保單約定之受益人。

For accident medical benefits and disability benefits, the beneficiary is the insured person.

For death benefits, the beneficiary is the designated beneficiary specified in the policy.

被保險人於保險契約有效期間內，遭受保險契約約定之意外傷害事故時，要保人、被保險人或受益人應於知悉意外事故發生後十日內將事故狀況及被保險人的傷害程度，通知保險公司。並於通知後儘速準備所需文件，向保險公司申請給付保險金。

保險公司應於收齊文件後十五日內支付保險金。逾期應按年利一分加計利息給付。如逾期支付賠款之原因可歸責於被保險人或受益人者，保險公司得不負擔利息。

When the insured suffers an accidental injury during the valid period of the insurance contract, the policyholder, insured, or beneficiary must notify the insurance company of the accident circumstances and extent of injury within 10 days of becoming aware of the incident. Required documents should be prepared and submitted promptly afterward.

The insurance company must pay the claim within 15 days of receiving complete documentation. Late payments will incur 1% annual interest. If the delay is attributable to the insured or beneficiary, the insurance company may not be liable for interest payments.

被保險人於其保險期間內因保險契約條款所約定之意外傷害事故失蹤者，於戶籍資料所載失蹤之日起滿一年仍未尋獲時，或要保人、受益人能提出證明文件足以認為該被保險人極可能因發生保險契約所約定之意外傷害事故而死亡者，保險公司將依保險契約之約定給付身故保險金。 但如日後發現該被保險人生還時，受益人應將已領取之身故保險金歸還保險公司。

If the insured person goes missing due to an accident covered by the insurance policy and remains unfound for one year from the date of disappearance as recorded in household registration, or if the policyholder or beneficiary can provide evidence suggesting the insured likely died from a covered accident, the insurance company will pay death benefits as specified in the policy.
However, if the insured person is later found alive, the beneficiary must return the death benefits to the insurance company.

1. 要、被保險人的故意行為。

2. 被保險人的「犯罪行為」。

3. 被保險人飲酒後駕（騎）車，其吐氣或血液所含酒精成份超過道路交通法令規定標準者。

4. 戰爭（不論宣戰與否）、內亂及其他類似的武裝變亂。但契約另有約定者不在此限。

5. 因原子或核子能裝置所引起的爆炸、灼熱、輻射或污染。但契約另有約定者不在此限。

6. 被保險人從事角力、摔跤、柔道、空手道、跆拳道、馬術、拳擊、特技表演等競賽或表演，契約另有約定者除外。

7. 被保險人從事汽車、機車及自由車等競賽或表演，契約另有約定者除外。

1. Intentional acts by the policyholder or insured.
2. Criminal acts by the insured.
3. Driving under the influence where breath or blood alcohol content exceeds legal limits.
4. War (declared or undeclared), civil unrest, and similar armed conflicts, unless otherwise specified in the contract.
5. Explosion, heat, radiation, or contamination from atomic or nuclear devices, unless otherwise specified in the contract.
6. Participation in wrestling, judo, karate, taekwondo, equestrian, boxing, stunts, or similar competitions/performances, unless otherwise specified.
7. Participation in car, motorcycle, or bicycle racing or performances, unless otherwise specified.