무배당 프로미라이프

아이(I)러브(LOVE)건강보험2004

2p

무배당 프로미라이프 아이(I)러브(LOVE)건강보험2004

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자주 발생하는 민원 예시 ·········································································· 16

신용정보 제공·활용에 대한 고객 권리 안내문 ········································ 18

가입자 유의사항 ························································································· 20

주요내용 요약서 ························································································· 22

보험금 청구시 준비하셔야 할 서류 ·························································· 24

프로미라이프 용어사전 ·············································································· 30

프로미라이프 지식백과 ·············································································· 33

A형 : 일반형C형 : 해지환급금 미지급형ⅠD형 : 해지환급금 미지급형ⅡE형 : 해지환급금 미지급형Ⅲ

보통약관

제 1관 목적 및 용어의 정의 ···································································· 36

1. 목적 ··································································································· 36 2. 용어의 정의 ························································································ 36

제 2관 보험금의 지급 ·············································································· 37 3. 보험금의 지급사유 ·············································································· 37 4. 보험금 지급에 관한 세부규정 ······························································ 37 5. 보험금을 지급하지 않는 사유 ······························································ 38 6. 보험금 지급사유의 통지 ······································································ 38 7. 보험금의 청구 ···················································································· 38 8. 보험금의 지급절차 ·············································································· 38 9. 적립환급금의 지급 ·············································································· 39 9-1. 적립환급금의 지급시기 지정 및 변경(A형만 적용) ························· 40 9-2. (태아기간 적립환급금 지급)(A형만 적용) ······································ 40 10. 보험금 받는 방법의 변경 ···································································· 40 11. 주소변경통지 ······················································································ 41 12. 보험수익자의 지정 ·············································································· 41 13. 대표자의 지정 ···················································································· 41

제 3관 계약자의 계약 전 알릴 의무 등 ·················································· 41 14. 계약 전 알릴 의무 ·············································································· 41 15. 계약 후 알릴 의무 ·············································································· 42 16. 알릴 의무 위반의 효과 ······································································· 43 17. 사기에 의한 계약 ··············································································· 43

제 4관 보험계약의 성립과 유지 ······························································ 43 18. 보험계약의 성립 ················································································· 43 19. 청약의 철회 ······················································································· 44 20. 약관교부 및 설명의무 등 ···································································· 45

목차

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21. 계약의 무효 ······················································································· 46 22. 계약내용의 변경 등 ············································································ 46 23. 보험나이 등 ······················································································· 47 24. 계약의 소멸 ······················································································· 47

제 5관 보험료의 납입 ··············································································· 48

25. 제1회 보험료 및 회사의 보장개시 ······················································· 48 26. 제2회 이후 보험료의 납입 ·································································· 49 26-1. (보험료 납입면제) (고급형 限 : A형-6종, A형-7종, C형-9종, D형-10종, E형-12종) ········· 49

26-1-1. (“9대질병”의 정의 및 진단확정) ···································· 4926-1-2. (“9대질병” 진단에 관한 납입면제 세부규정) ·················· 50

27. 보험료의 자동대출납입 ······································································· 51 28. 보험료의 납입이 연체되는 경우 납입최고(독촉)와 계약의 해지 ············· 51 29. 보험료의 납입을 연체하여 해지된 계약의 부활(효력회복) ····················· 52 30. 강제집행 등으로 인한 해지계약의 특별부활(효력회복) ·························· 52

제 6관 계약의 해지 및 해지환급금 등 ··················································· 53 31. 계약자의 임의해지 및 피보험자의 서면동의 철회 ································· 53 32. 중대사유로 인한 해지 ········································································· 53 33. 회사의 파산선고와 해지 ······································································ 53 34. 해지환급금 ························································································· 54 35. 공시이율의 적용 및 공시 ···································································· 57 36. 중도인출금 ························································································· 57 37. 보험계약대출 ······················································································ 57 38. 배당금의 지급 ···················································································· 57

제 7관 분쟁조정 등 ·················································································· 57 39. 분쟁의 조정 ······················································································· 57 40. 관할법원 ···························································································· 57 41. 소멸시효 ···························································································· 57 42. 약관의 해석 ······················································································· 58 43. 회사가 제작한 보험안내자료 등의 효력 ··············································· 58 44. 회사의 손해배상책임 ··········································································· 58 45. 개인정보보호 ······················································································ 58

46. 준거법 ······························································································· 58 47. 예금보험에 의한 지급보장 ·································································· 58

특별약관

제 1장 상해관련 특별약관 1. 상해후유장해(20~100%) 특별약관 ······················································· 60 2. 상해50%이상후유장해생활자금(1회한)(매년10년간지급) 특별약관 ·········· 61 3. 상해80%이상후유장해(1회한) 특별약관 ················································ 62 4. 상해사망(비갱신형/갱신형) 특별약관 ······················································ 63 5. 교통상해후유장해 (3~100%) 특별약관 ················································· 63 5-1. 운전자 교통상해후유장해 (3~100%) 특별약관 ······························· 63 5-2. 비운전자 교통상해후유장해 (3~100%) 특별약관 ···························· 65 6. 교통상해50%이상후유장해 생활자금(1회한)(매년10년간지급) 특별약관 ···· 67 6-1. 운전자 교통상해50%이상후유장해 생활자금(1회한)(매년10년간지급) 특별약관 ························································································ 67 6-2. 비운전자 교통상해50%이상후유장해 생활자금(1회한)(매년10년간지급) 특별약관 ························································································ 69 7. 교통상해80%이상후유장해(1회한) 특별약관 ·········································· 71 7-1. 운전자 교통상해80%이상후유장해(1회한) 특별약관 ························ 71 7-2. 비운전자 교통상해80%이상후유장해(1회한) 특별약관 ····················· 72 8. 자전거탑승중 상해80%이상후유장해(1회한) 특별약관 ···························· 74 9. 팔 및 손가락 후유장해(3~100%) 특별약관 ·········································· 75 10. 상해수술비(동일사고당 1회지급)(비갱신형/갱신형) 특별약관 ··················· 76 11. 상해입원일당(1일이상 180일한도)(비갱신형/갱신형) 특별약관 ················ 78 12. 상해중환자실입원일당(1일이상180일한도) 특별약관 ······························· 78 13. 골절진단비(치아포함) 특별약관 ····························································· 80 14. 5대골절진단비 특별약관 ······································································· 80 15. 성장판손상유발 자동차사고 특수골절진단비 특별약관 ···························· 80 16. 화상진단비 특별약관 ············································································ 81 17. 골절수술비(동일사고당 1회지급) 특별약관 ············································· 82 18. 화상수술비(동일사고당 1회지급) 특별약관 ············································· 83 19. 중대한 화상 및 부식진단비 특별약관 ···················································· 84 20. 중대한 특정상해수술비(1회지급) 특별약관 ············································· 84

무배당 프로미라이프 아이(I)러브(LOVE)건강보험2004

5

21. 뇌·내장손상수술비(1회지급) 특별약관 ···················································· 85 22. 상해흉터복원수술비 특별약관 ······························································· 86 23. 탈구염좌및과긴장수술비(동일사고당 1회지급) 특별약관 ························· 88 24. 자동차부상치료비 특별약관 ··································································· 88 24-1. 운전자 자동차부상치료비 특별약관 ··············································· 88 24-2. 비운전자 자동차부상치료비 특별약관 ············································ 90 25. 자동차사고 치아보철지원금 특별약관 ···················································· 91 26. 스쿨존 교통사고보험금(비갱신형/갱신형) 특별약관 ································· 92 27. 일상생활 폭력상해보험금(연간1회한)(비갱신형/갱신형) 특별약관 ·········· 93 28. 강력범죄피해보험금 특별약관 ······························································ 94 29. 척추골절진단비(비갱신형/갱신형) 특별약관 ············································ 95 30. 골절진단비(치아제외) 특별약관 ····························································· 96 31. 상해입원일당(1일이상10일한도)(비갱신형/갱신형) 특별약관 ··················· 96 32. 가족동승 자동차부상치료비Ⅰ(자가용운전자용, 최대5인)

(비갱신형/갱신형) 특별약관 ·································································· 97 33. 가족동승 자동차부상치료비Ⅱ(1-11급, 자가용운전자용, 최대5인)

(비갱신형/갱신형) 특별약관 ·································································· 99 34. 상해1~5종수술비Ⅱ(동일사고당 1회지급)(비갱신형/갱신형) 특별약관 ···· 101 35. 상해입원·통원수술비(동일질병당1회지급)(비갱신형/갱신형) 특별약관 ···· 103

제 2장 질병관련 특별약관 1. 질병50%이상후유장해(1회한) 특별약관 ·············································· 106 2. 질병80%이상후유장해(1회한) 특별약관 ·············································· 106 3. 질병사망(비갱신형/갱신형) 특별약관 ···················································· 107 4. 질병수술비(동일질병당 1회지급)(비갱신형/갱신형) 특별약관 ················· 108 5. 질병입원일당(1일이상 180일한도)(비갱신형/갱신형) 특별약관 ·············· 110 6. 질병중환자실입원일당(1일이상180일한도) 특별약관 ····························· 111 7. 암진단비Ⅱ(유사암 제외)(비갱신형/갱신형) 특별약관 ···························· 113 8. 암진단비Ⅱ(유사암 제외)(예약) 특별약관 ·············································· 114 9. 유사암진단비Ⅱ(비갱신형/갱신형) 특별약관 ·········································· 115 10. 유사암진단비Ⅱ(예약) 특별약관 ··························································· 116 11. 계속받는암진단비(유사암,대장점막내암,전립선암 제외)(비갱신형/갱신형) 특별약관 ···························································································· 118 12. 11대특정암진단비(비갱신형/갱신형) 특별약관 ······································ 123 13. 고액치료비암진단비(비갱신형/갱신형) 특별약관 ··································· 124 14. 자녀7대암진단비(비갱신형/갱신형) 특별약관 ········································ 125

15. 소아백혈병진단비(비갱신형/갱신형) 특별약관 ······································· 126 16. 항암방사선․약물치료비 특별약관 ·························································· 127 17. 암직접치료입원일당(요양병원제외)(4일이상120일한도) 특별약관 ·········· 129 18. 암입원일당(요양병원)(4일이상90일한도) 특별약관 ······························· 131 19. 암직접치료입원일당(요양병원제외)(1일이상180일한도) 특별약관 ·········· 134 20. 암입원일당(요양병원)(1일이상90일한도) 특별약관 ······························· 136 21. 뇌졸중진단비(비갱신형/갱신형) 특별약관 ············································· 139 22. 뇌졸중진단비(태아가입)(비갱신형/갱신형) 특별약관 ······························ 140 23. 뇌졸중진단비(예약) 특별약관 ······························································ 141 24. 뇌출혈진단비(비갱신형/갱신형) 특별약관 ············································· 142 25. 뇌출혈진단비(태아가입)(비갱신형/갱신형) 특별약관 ······························ 143 26. 뇌출혈진단비(예약) 특별약관 ······························································ 144 27. 뇌혈관질환진단비(비갱신형/갱신형) 특별약관 ······································· 145 28. 뇌혈관질환진단비(태아가입)(비갱신형/갱신형) 특별약관 ······················· 146 29. 뇌혈관질환진단비(예약) 특별약관 ························································ 147 30. 뇌혈관질환입원일당(4일이상120일한도) 특별약관 ································ 148 31. 뇌혈관질환수술비(비갱신형/갱신형) 특별약관 ······································· 150 32. 급성심근경색증진단비(비갱신형/갱신형) 특별약관 ································ 151 33. 급성심근경색증진단비(예약) 특별약관 ················································· 152 34. 허혈심장질환진단비(비갱신형/갱신형) 특별약관 ··································· 153 35. 허혈심장질환진단비(예약) 특별약관 ····················································· 153 36. 허혈심장질환입원일당(4일이상120일한도) 특별약관 ···························· 154 37. 허혈심장질환수술비(비갱신형/갱신형) 특별약관 ··································· 156 38. 양성뇌종양진단비(비갱신형/갱신형) 특별약관 ······································· 157 39. 말기신부전증진단비 특별약관 ····························································· 158 40. ADHD진단비 특별약관 ······································································· 158 41. 아토피진단비(중증) 특별약관 ······························································ 159 42. 중대한 재생불량성빈혈진단비 특별약관 ··············································· 160 43. 중증세균성수막염진단비(비갱신형/갱신형) 특별약관 ····························· 161 44. 어린이 개흉심장수술비(1회지급)(비갱신형/갱신형) 특별약관 ················ 162 45. 중대한 가와사키진단비(비갱신형/갱신형) 특별약관 ······························· 162 46. 1형 당뇨병진단비(비갱신형/갱신형) 특별약관 ······································ 163 47. 중대한 류마티스 열 진단비(비갱신형/갱신형) 특별약관 ························ 164 48. 치핵수술비(비갱신형/갱신형) 특별약관 ················································ 165 49. 희귀난치성질환수술비(비갱신형/갱신형) 특별약관 ································ 166 50. 어린이생활질환수술비(비갱신형/갱신형) 특별약관 ································ 167

6

51. 어린이생활질환입원일당(4일이상120일한도)(비갱신형/갱신형) 특별약관 ···· 168 52. 자녀10대질환수술비(비갱신형/갱신형) 특별약관 ··································· 169 53. 자녀10대질환입원일당(4일이상120일한도)(비갱신형/갱신형) 특별약관 ··· 171 54. 컴퓨터질환수술비 특별약관 ································································· 172 55. 질병으로 인한 3대시각질환수술비 특별약관 ········································ 173 56. 호흡기관련질병수술비 특별약관 ·························································· 174 57. 당뇨병수술비(비갱신형/갱신형) 특별약관 ············································· 175 58. 조혈모세포이식수술비(1회지급) 특별약관 ············································ 176 59. 충수염(맹장염)수술비(1회지급) 특별약관 ············································· 177 60. 특정법정감염병치료비(비갱신형/갱신형) 특별약관 ································ 178 61. 식중독입원일당(4일이상120일한도) 특별약관 ······································ 179 62. 선천이상수술비(비갱신형/갱신형) 특별약관 ·········································· 180 63. 선천이상수술비(혀유착증 및 모반증 제외)(비갱신형/갱신형) 특별약관 ··· 181 64. 선천이상입원일당(1일이상120일한도)(비갱신형/갱신형) 특별약관 ········· 182 65. 신생아입원일당(4일이상120일한도)(전기납) 특별약관 ·························· 183 66. 유치보존치료비(갱신형) 특별약관 ························································ 185 67. 결핵진단비 특별약관 ·········································································· 187 68. 약제내성결핵(슈퍼결핵 포함)진단비 특별약관 ······································ 188 69. 심장질환수술비 특별약관 ···································································· 189 70. 성조숙증진단비(갱신형) 특별약관 ························································ 190 71. 모야모야병 개두수술비 특별약관 ························································· 191 72. 사시수술비(비갱신형/갱신형) 특별약관 ················································ 191 73. 척추측만증수술비(비갱신형/갱신형) 특별약관 ······································· 193 74. 이비인후과질환수술비(비갱신형/갱신형) 특별약관 ································ 194 75. 질병후유장해(3~100%)(비갱신형/갱신형) 특별약관 ···························· 196 76. 주요한방외래치료비(연간 20회 한도, 1일1회 제한)(갱신형) 특별약관 ····· 197 77. 유치치수치료비(갱신형) 특별약관 ························································ 201 78. 치주질환치료비(갱신형) 특별약관 ························································ 203 79. 특정치석제거(스케일링)치료비(갱신형) 특별약관 ·································· 206

80. 5대난치성질환진단비 특별약관 ··························································· 20781. 갑상선암진단비 특별약관 ···································································· 20882. 갑상선암(초기제외)진단비 특별약관 ····················································· 209

83. 질병입원일당(1일이상10일한도)(비갱신형/갱신형) 특별약관 ················· 210 84. 5대기관수술비(1회한,관혈/비관혈)(갱신형) 특별약관 ···························· 211 85. 암수술비(유사암 제외) 특별약관 ·························································· 213 86. 암수술비(유사암 제외)(1회지급) 특별약관 ············································ 214

87. 유사암수술비 특별약관 ······································································· 216 88. 주요뇌혈관질환진단비(비갱신형/갱신형) 특별약관 ································ 217 89. 주요뇌혈관질환진단비(태아가입)(비갱신형/갱신형) 특별약관 ················· 218 90. 주요뇌혈관질환진단비(예약) 특별약관 ················································· 219 91. 주요허혈심장질환진단비(비갱신형/갱신형) 특별약관 ····························· 220 92. 주요허혈심장질환진단비(예약) 특별약관 ·············································· 221 93. 3대질병진단비 특별약관 ····································································· 222 94. 계속받는3대질병진단비 특별약관 ···························································· 224 95. 질병후유장해(20~100%)(비갱신형/갱신형) 특별약관 ·························· 229 96. 질병1~5종수술비Ⅱ(동일질병당 1회지급)(비갱신형/갱신형) 특별약관 ····· 231 97. 77대질병수술비(비갱신형/갱신형) 특별약관 ·········································· 233 98. 계속받는항암방사선·약물치료비(급여,연간1회한) 특별약관 ···················· 235 99. 뇌전증진단비 특별약관 ······································································· 237 100. 심근병증진단비 특별약관 ·································································· 237 101. 위·십이지장,대장 양성신생물(폴립포함)진단비(연간1회한) 특별약관 ···· 238 102. 특정5대기관 양성신생물(폴립포함)수술비(급여,연간1회한) 특별약관 ··· 239 103. 갑상선기능항진증치료비 특별약관 ····················································· 240 104. 전립선비대증진단비 특별약관 ··························································· 242 105. 대상포진진단비 특별약관 ·································································· 242 106. 대상포진눈병진단비 특별약관 ··························································· 243 107. 녹내장진단비 특별약관 ····································································· 243 108. 특정망막질환진단비 특별약관 ··························································· 244 109. 통풍진단비 특별약관 ········································································ 244 110. 요로결석진단비 특별약관 ·································································· 245 111. 질병입원·통원수술비(동일질병당1회지급)(비갱신형/갱신형) 특별약관 ··· 246 112. 암진단비Ⅱ(유사암 제외)(10년후2배체증) 특별약관 ···························· 248 113. 유사암진단비Ⅱ(10년후2배체증) 특별약관 ········································· 249 114. 뇌졸중진단비(10년후2배체증) 특별약관 ············································ 250 115. 뇌졸중진단비(10년후2배체증)(태아가입) 특별약관 ····························· 251 116. 급성심근경색증진단비(10년후2배체증) 특별약관 ································ 252

제 3장 질병 및 상해관련 특별약관 1. 뇌성마비진단비(비갱신형/갱신형) 특별약관 ·········································· 256 2. 뇌성마비진단자금(매월3년간지급)(비갱신형/갱신형) 특별약관 ··············· 257 3. 5대장기이식수술비(1회지급) 특별약관 ················································· 258 4. 각막이식수술비(1회지급) 특별약관 ······················································ 259

무배당 프로미라이프 아이(I)러브(LOVE)건강보험2004

7

5. 깁스치료비(상해 및 질병) 특별약관 ····················································· 259 6. 추간판탈출증수술비(갱신형) 특별약관 ·················································· 260 7. 시력치료비(갱신형) 특별약관 ······························································· 261 8. 시력교정비(갱신형) 특별약관 ······························································· 262 9. 부정교합치료비(갱신형) 특별약관 ························································ 263 10. 영구치보존치료비(갱신형) 특별약관 ····················································· 264 11. 영구치보철치료비(갱신형) 특별약관 ····················································· 266 12. 영구치상실보험금(갱신형) 특별약관 ····················································· 269 13. 응급실내원보험금(비갱신형/갱신형) 특별약관 ······································· 270 14. 보험료납입지원Ⅱ(3대질병진단, 80%이상후유장해시)(태아가입) 특별약관 ···························································································· 272 15. 보험료납입지원Ⅱ(3대질병진단, 80%이상후유장해시) 특별약관 ··········· 274 16. 영구치치수치료비(갱신형) 특별약관 ····················································· 277 17. X-Ray 및 파노라마 치아촬영비(갱신형) 특별약관 ································ 279 18. 등급별 골절 및 특정외상진단비Ⅰ(1~6급, 연간1회한) 특별약관 ··········· 281 19. 등급별 골절 및 특정외상진단비Ⅱ(1~6급, 연간1회한) 특별약관 ··········· 283 20. 등급별 골절 및 특정외상수술비Ⅰ(1~6급, 연간1회한)

(동일사고당1회지급) 특별약관 ···························································· 286 21. 등급별 골절 및 특정외상수술비Ⅱ(1~6급, 연간1회한)

(동일사고당1회지급) 특별약관 ···························································· 288 22. 상해․질병80%이상후유장해(1회한) 특별약관 ······································· 291 23. 신깁스치료비(상해 및 질병) 특별약관 ················································· 291 24. 응급실내원보험금(연간 12회한)(비갱신형/갱신형) 특별약관 ·················· 293 25. 보험료납입면제대상보장(11대사유) 특별약관 ······································· 295

제 4장 비용손해관련 특별약관 1. 유괴납치피해일당(비갱신형/갱신형) 특별약관 ······································· 300 2. 의료사고법률비용(실손)(갱신형) 특별약관 ············································ 300 3. 자동차사고 벌금Ⅱ(실손) 특별약관 ······················································ 302 4. 자동차사고 벌금(대물,실손) 특별약관 ·················································· 304 5. 자동차사고 변호사선임비용Ⅲ(실손) 특별약관 ······································· 305 6. 교통사고처리지원금Ⅳ(실손) 특별약관 ·················································· 306 6-1. 자가용운전자 교통사고처리지원금Ⅳ(실손) 특별약관 ······················ 306 6-2. 영업용운전자 교통사고처리지원금Ⅳ(실손) 특별약관 ······················ 309 7. 면허정지일당Ⅱ(영업용) 특별약관 ························································ 311 8. 면허취소보험금(영업용) 특별약관 ························································ 313

9. 자동차사고성형수술비(동일사고당 1회지급) 특별약관 ··························· 314 10. 자전거벌금(실손) 특별약관 ································································· 315 11. 자전거사고처리지원금(타인사망시)(실손) 특별약관 ······························· 316 12. 화재벌금(실손) 특별약관 ····································································· 317 13. 가족화재벌금(실손) 특별약관 ······························································ 318

제 5장 배상책임관련 특별약관 1. 가족일상생활배상책임II(실손)(갱신형) 특별약관 ···································· 322 제 6장 산모관련 특별약관 1. 엄마 상해사망(일시납/전기납) 특별약관 ··············································· 330 2. 모성사망(일시납/전기납) 특별약관 ······················································· 330 3. 임신·출산질환치료비(일시납) 특별약관 ················································· 331 4. 유산치료비(일시납) 특별약관 ······························································· 333 5. 출산위험담보(일시납/전기납) 특별약관 ················································· 335 6. 저체중아입원일당(일시납/전기납) 특별약관 ·········································· 336 7. 극소저체중아입원일당(일시납/전기납) 특별약관 ···································· 337 8. 임신중독증(자간포함)진단비(일시납) 특별약관 ······································ 337 9. 태반조기박리진단비(일시납/전기납) 특별약관 ······································· 338 10. 여성산과관련 자궁적출수술비(일시납/전기납) 특별약관 ························ 339 11. 다운증후군양육자금(매년10년간지급)(일시납/전기납) 특별약관 ············· 340

제 7장 부양자관련 특별약관 1. 부양자 상해사망 특별약관 ·································································· 344 2. 부양자 상해80%이상후유장해(1회한) 특별약관 ··································· 344 3. 부양자 질병사망 특별약관 ·································································· 346 4. 부양자 질병80%이상후유장해(1회한) 특별약관 ··································· 346 5. 부양자 보험료납입지원Ⅱ(3대질병진단, 80%이상후유장해시) 특별약관 ···· 347

제8장 무배당 프로미라이프 간병인지원입원일당(1일이상180일한도)(자녀형) (갱신형) 특별약관

1. 간병인지원 상해입원일당(1일이상180일한도)(자녀형)(갱신형) ························· 3612. 상해입원일당(1일이상180일한도)(자녀형)(갱신형)(전환용) ···························· 3633. 간병인지원 질병입원일당(1일이상180일한도)(자녀형)(갱신형) ························· 3644. 질병입원일당(1일이상180일한도)(자녀형)(갱신형)(전환용) ···························· 367

8

제9장 무배당 프로미라이프 가족일상생활배상책임Ⅱ(실손)(자녀형)(갱신형) 특별약관1. 가족일상생활배상책임Ⅱ(실손)(자녀형)(갱신형) ·············································· 369

제도성 특별약관

1. 이륜자동차 운전중 상해 부담보 특별약관 ············································ 390 2. 보험료 자동납입 특별약관 ·································································· 390 3. 선지급 서비스 특별약관 ······································································ 391 4. 특정 신체부위․질병 보장제한부 인수 특별약관 ····································· 392 5. 출생 전 자녀가입 특별약관 ································································· 393 6. 피보험자추가 특별약관 ······································································· 396 7. 지정대리청구서비스 특별약관 ······························································ 396 8. 계약전환 특별약관(A형계약 전용) ······················································· 397 9. 전자서명 특별약관 ·············································································· 397 10. 특별조건부(표준하체 인수) 특별약관 ··················································· 398 11. 갱신형 계약 자동갱신(A형계약 전용) 특별약관 ···································· 399 12. 장애인전용보험전환 특별약관 ····························································· 400

B형 : 계약전환용

보통약관 ···································································································· 403

특별약관

제 1장 상해관련 특별약관 1. 상해80%이상후유장해(1회한) 특별약관 ·············································· 420 2. 상해사망 특별약관 ·············································································· 420 3. 상해입원일당(1일이상180일한도) 특별약관 ·········································· 421 4. 골절진단비(치아포함) 특별약관 ··························································· 422 5. 화상진단비 특별약관 ··········································································· 422 6. 골절수술비(동일사고당 1회지급) 특별약관 ··········································· 422 7. 화상수술비(동일사고당 1회지급) 특별약관 ··········································· 423 8. 골절진단비(치아제외) 특별약관 ··························································· 424

제 2장 질병관련 특별약관 1. 암진단비Ⅱ(유사암 제외) 특별약관 ······················································ 426 2. 유사암진단비Ⅱ 특별약관 ···································································· 426 3. 암수술비(유사암 제외) 특별약관 ·························································· 427 4. 암수술비(유사암 제외)(1회지급) 특별약관 ············································ 429 5. 유사암수술비 특별약관 ······································································· 430 6. 암직접치료입원일당(요양병원제외)(4일이상120일한도) 특별약관 ·········· 431 7. 암입원일당(요양병원)(4일이상90일한도) 특별약관 ································ 434 8. 질병입원일당(1일이상180일한도) 특별약관 ·········································· 436 9. 뇌졸중진단비 특별약관 ······································································· 437 10. 급성심근경색증진단비 특별약관 ························································· 438

제 3장 질병 및 상해관련 특별약관 1. 등급별 골절 및 특정외상진단비Ⅰ(1~6급, 연간1회한) 특별약관 ··········· 440 2. 등급별 골절 및 특정외상진단비Ⅱ(1~6급, 연간1회한) 특별약관 ··········· 442 3. 등급별 골절 및 특정외상수술비Ⅰ(1~6급, 연간1회한)

(동일사고당1회지급) 특별약관 ···························································· 445 4. 등급별 골절 및 특정외상수술비Ⅱ(1~6급, 연간1회한)

(동일사고당1회지급) 특별약관 ···························································· 447

무배당 프로미라이프 아이(I)러브(LOVE)건강보험2004

9

제 4장 비용손해관련 특별약관 1. 자동차사고 벌금Ⅱ(실손) 특별약관 ······················································ 452 2. 자동차사고 벌금(대물,실손) 특별약관 ·················································· 454 3. 자동차사고 변호사선임비용Ⅲ(실손) 특별약관 ······································· 455 4. 교통사고처리지원금Ⅳ(실손) 특별약관 ·················································· 456 4-1. 자가용운전자 교통사고처리지원금Ⅳ(실손) 특별약관 ······················ 456 4-2. 영업용운전자 교통사고처리지원금Ⅳ(실손) 특별약관 ······················ 459 5. 면허정지일당Ⅱ(영업용) 특별약관 ························································ 461 6. 면허취소보험금(영업용) 특별약관 ························································ 462 7. 자동차사고성형수술비(동일사고당 1회지급) 특별약관 ··························· 463 8. 자전거벌금(실손) 특별약관 ·································································· 465 9. 자전거사고처리지원금(타인사망시)(실손) 특별약관 ······························· 466

제도성 특별약관

1. 이륜자동차 운전중 상해 부담보 특별약관 ············································ 470 2. 보험료 자동납입 특별약관 ·································································· 470 3. 선지급 서비스 특별약관 ······································································ 471 4. 특정 신체부위․질병 보장제한부 인수 특별약관 ····································· 472 5. 지정대리청구서비스 특별약관 ······························································ 473 6. 전자서명 특별약관 ·············································································· 474 7. 특별조건부(표준하체 인수) 특별약관 ··················································· 475 8. 장애인전용보험전환 특별약관 ······························································ 476

【별표1】 장해 분류표 ··················································································· 479【별표2】 골절(치아파절제외) 분류표 ····························································· 495【별표3】 화상 분류표 ··················································································· 496【별표4】 5대골절 분류표 ·············································································· 496【별표5】 골절 분류표 ··················································································· 497【별표6】 중대한 특정상해 분류표 ································································· 497【별표7】 자동차사고 부상등급표 ··································································· 498【별표8】 자녀10대질환 분류표 ····································································· 506【별표9】 자녀7대암 분류표 ·········································································· 507【별표10-1】 악성신생물(암) 분류표(기타피부암 및 갑상선암 제외) ················ 508【별표10-2】 기타피부암 및 갑상선암 분류표 ················································· 509【별표10-3】 전립선암 분류표 ······································································· 509【별표11】 제자리신생물 분류표 ···································································· 510【별표12】 행동양식 불명 또는 미상의 신생물 분류표 ···································· 510【별표13】 1형 당뇨병 분류표 ······································································· 511【별표14】 충수염(맹장염) 분류표 ·································································· 511【별표15】 피부질환 분류표 ·········································································· 512【별표16】 호흡기관련질병 분류표 ································································· 512【별표17】 시청각질환 분류표 ······································································· 513【별표18】 법정감염병 중 대상이 되는 특정법정감염병 분류표 ······················· 513 【별표18.1】 감염병환자를 진단할 수 있는 기관 ······································· 514 【별표18.2】 감염병환자 진단기준 ···························································· 514【별표19】 식중독 분류표 ·············································································· 515【별표20】 선천성기형, 변형 및 염색체이상 분류표 ········································ 516【별표21】 뇌졸중 분류표 ·············································································· 516【별표22】 뇌출혈 분류표 ·············································································· 517【별표23】 급성심근경색증 분류표 ································································· 517【별표24】 11대특정암 분류표 ······································································ 518【별표25】 고액치료비암 분류표 ···································································· 519【별표26】 주산기질환 분류표 ······································································· 520【별표27】 여성산과(임신, 출산 및 산후)관련 특정질병 분류표 ······················· 520【별표28】 장해의 대상 분류표 ····································································· 521【별표29】 심한 장해의 대상 분류표 ····························································· 522【별표30】 임신·출산관련질환 분류표 ····························································· 522【별표31】 유산 분류표 ················································································· 523【별표32】 뇌·내장손상 분류표 ······································································ 523

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【별표33】 당뇨병 분류표 ·············································································· 525【별표34】 선천성기형, 변형 및 염색체이상(혀유착증 및 모반증 제외) 분류표 ······ 525【별표35】 추간판탈출증 분류표 ···································································· 526【별표36】 교통사고처리특례법 제3조 제2항 단서 ········································· 526【별표37】 탈구,관절 및 인접근육의 염좌 및 과긴장 분류표 ··························· 527【별표38】 탈구,관절 및 인접근육의 염좌 및 과긴장(치아탈구제외) 분류표 ······ 528【별표39】 어린이생활질환 분류표 ································································· 529【별표40】 희귀난치성질환 분류표 ································································· 532【별표41】 소아백혈병 대상질병 분류표 ························································· 534【별표42】 다운증후군 분류표 ······································································· 535【별표43】 뇌혈관질환 분류표 ······································································· 535【별표44】 허혈심장질환 분류표 ···································································· 536【별표45】 자동차사고 특수골절 분류표 ························································· 536【별표46】 결핵 분류표 ················································································· 537【별표47】 약제내성결핵(슈퍼결핵 포함) 분류표 ············································· 537【별표48】 심장질환 분류표 ·········································································· 538【별표49】 성조숙증 분류표 ·········································································· 538【별표50】 치핵 및 항문주위정맥의 혈전증 분류표 ········································· 539【별표51】 응급의료에 관한 시행규칙 제2조(응급환자) 분류표 ······················· 539【별표52】 질병으로 인한 3대시각질환 분류표 ··············································· 540【별표53】 누적외상성질환(VDT증후군) 분류표 ·············································· 541【별표54】 활동성 및 주의력 장애 분류표 ····················································· 541【별표55】 아토피성 피부염 분류표 ······························································· 542【별표56】 모야모야병 분류표 ······································································· 542【별표57】 임신중독증(자간포함) 분류표 ························································ 543【별표58】 태반조기박리 분류표 ···································································· 543【별표59】 자궁적출수술 분류표 ···································································· 544【별표61】 척추골절 분류표 ··········································································· 544【별표62】 주요이비인후과질환 분류표 ··························································· 545【별표63】 치주질환(잇몸질환)치료 진료행위코드 분류표 ································ 545【별표64】 치석제거(스케일링)치료 진료행위코드 분류표 ································ 546【별표65】 X-ray촬영 및 파노라마촬영 진료행위코드 분류표 ·························· 546【별표66】 사시 분류표 ················································································· 546【별표67】 척추측만증 분류표 ········································································ 547【별표68】 골절 및 특정외상 분류표 ······························································ 547【별표69】 골절 및 특정외상 등급분류기준표 ················································· 548

【별표70】 특정부위·질병 분류표 ··································································· 549【별표71】 5대난치성질환 분류표 ·································································· 551【별표72】 갑상선암 분류표 ·········································································· 551【별표73】 5대기관질병 분류표 ····································································· 552【별표74】 주요뇌혈관질환 분류표 ································································· 553【별표75】 주요허혈심장질환 분류표 ······························································ 553【별표76】 뇌졸중Ⅱ 분류표 ·········································································· 554【별표77】 보험금을 지급할 때의 적립이율 계산 ·········································· 554【별표78】 1~5종수술Ⅱ 분류표 ···································································· 555【별표79】 77대질병 분류표 ········································································· 559【별표80】 뇌전증 분류표 ·············································································· 564【별표81】 심근병증 분류표 ·········································································· 565【별표82】 위, 십이지장 또는 대장의 양성신생물(폴립포함) 분류표 ················ 565【별표83】 5대기관 양성신생물(폴립포함) 분류표 ··········································· 566【별표84】 5대기관 양성신생물(폴립포함) 수술(급여) 대상 수가코드 ··············· 566【별표85】 전립선비대증 분류표 ···································································· 567【별표86】 대상포진 분류표 ·········································································· 568【별표87】 대상포진눈병 분류표 ···································································· 568【별표88】 녹내장 분류표 ·············································································· 569【별표89】 특정망막질환 분류표 ···································································· 569【별표90】 통풍 분류표 ················································································· 570【별표91】 요로결석 분류표 ·········································································· 570

참고. 약관에서 인용한 법규 ··································································· 571

무배당 프로미라이프 아이(I)러브(LOVE)건강보험2004

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가나다順 색인 (A, C, D, E형)

(ㄱ) 가족동승 자동차부상치료비Ⅰ(자가용운전자용, 최대5인) ··························· 97 가족동승 자동차부상치료비Ⅱ(1-11급, 자가용운전자용, 최대5인) ·············· 99 가족일상생활배상책임II(실손)(갱신형) 특별약관 ······································· 322 가족일상생활배상책임Ⅱ(실손)(자녀형)(갱신형) ········································ 369 가족화재벌금(실손) 특별약관. ································································ 318 각막이식수술비(1회지급) 특별약관 ························································· 259 간병인지원 상해입원일당(1일이상180일한도)(자녀형)(갱신형) ················· 361 간병인지원 질병입원일당(1일이상180일한도)(자녀형)(갱신형) ················· 364 갑상선기능항진증치료비 특별약관 ·························································· 240 갑상선암(초기제외)진단비 특별약관 ························································ 209 갑상선암진단비 특별약관 ······································································· 208 강력범죄피해보험금 특별약관 ·································································· 94 갱신형 계약 자동갱신(A형계약 전용) 특별약관 ······································ 399 결핵진단비 특별약관 ············································································· 187 계속받는3대질병진단비 특별약관 ··························································· 224 계속받는암진단비(유사암,대장점막내암,전립선암 제외)(비갱신형/갱신형) ··· 118 계속받는항암방사선·약물치료비(급여,연간1회한) 특별약관 ······················· 235 계약전환 특별약관(A형계약 전용) ·························································· 397 고액치료비암진단비(비갱신형/갱신형) 특별약관 ······································ 124 골절수술비(동일사고당 1회지급) 특별약관 ··············································· 82 골절진단비(치아제외) 특별약관 ································································ 96 골절진단비(치아포함) 특별약관 ································································ 80 교통사고처리지원금Ⅳ(실손) 특별약관 ···················································· 306 교통상해50%이상후유장해생활자금(1회한)(매년10년간지급) 특별약관 ······ 67 교통상해80%이상후유장해(1회한) 특별약관 ············································· 71 교통상해후유장해 (3~100%) 특별약관 ··················································· 63 극소저체중아입원일당(일시납/전기납) 특별약관 ······································ 337 급성심근경색증진단비(10년후2배체증) 특별약관 ····································· 252 급성심근경색증진단비(비갱신형/갱신형) 특별약관 ··································· 151 급성심근경색증진단비(예약) 특별약관 ···················································· 152 깁스치료비(상해 및 질병) 특별약관 ······················································· 259

(ㄴ) 녹내장진단비 특별약관 ·········································································· 243 뇌·내장손상수술비(1회지급) 특별약관 ······················································· 85 뇌성마비진단비(비갱신형/갱신형) 특별약관 ············································· 256 뇌성마비진단자금(매월3년간지급)(비갱신형/갱신형) 특별약관 ·················· 257 뇌전증진단비 특별약관 ·········································································· 237 뇌졸중진단비(10년후2배체증) 특별약관 ················································· 250 뇌졸중진단비(10년후2배체증)(태아가입) 특별약관 ·································· 251 뇌졸중진단비(비갱신형/갱신형) 특별약관 ················································ 139 뇌졸중진단비(예약) 특별약관 ································································· 141 뇌졸중진단비(태아가입)(비갱신형/갱신형) 특별약관 ································· 140 뇌출혈진단비(비갱신형/갱신형) 특별약관 ················································ 142 뇌출혈진단비(예약) 특별약관 ································································· 144 뇌출혈진단비(태아가입)(비갱신형/갱신형) 특별약관 ································· 143 뇌혈관질환수술비(비갱신형/갱신형) 특별약관 ·········································· 150 뇌혈관질환입원일당(4일이상120일한도) 특별약관 ··································· 148 뇌혈관질환진단비(비갱신형/갱신형) 특별약관 ·········································· 145 뇌혈관질환진단비(예약) 특별약관 ··························································· 147 뇌혈관질환진단비(태아가입)(비갱신형/갱신형) 특별약관 ·························· 146

(ㄷ) 다운증후군양육자금(매년10년간지급)(일시납/전기납) 특별약관 ················ 340 당뇨병수술비(비갱신형/갱신형) 특별약관 ················································ 175 대상포진눈병진단비 특별약관 ································································ 243 대상포진진단비 특별약관 ······································································· 242 등급별 골절 및 특정외상수술비Ⅰ(1~6급, 연간1회한) ···························· 286 등급별 골절 및 특정외상수술비Ⅱ(1~6급, 연간1회한) ···························· 288 등급별 골절 및 특정외상진단비Ⅰ(1~6급, 연간1회한) 특별약관 ·············· 281 등급별 골절 및 특정외상진단비Ⅱ(1~6급, 연간1회한) 특별약관 ·············· 283

(ㅁ) 말기신부전증진단비 특별약관 ································································ 158 면허정지일당Ⅱ(영업용) 특별약관 ··························································· 311 면허취소보험금(영업용) 특별약관 ··························································· 313 모성사망(일시납/전기납) 특별약관 ························································· 330 모야모야병 개두수술비 특별약관 ··························································· 191

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(ㅂ) 보험료 자동납입 특별약관 ····································································· 390 보험료납입면제대상보장(11대사유) 특별약관 ·········································· 295 보험료납입지원Ⅱ(3대질병진단, 80%이상후유장해시) 특별약관 ·············· 274 보험료납입지원Ⅱ(3대질병진단, 80%이상후유장해시)(태아가입) ·············· 272 부양자 보험료납입지원Ⅱ(3대질병진단,80%이상후유장해시)특별약관 ······ 347 부양자 상해80%이상후유장해(1회한) 특별약관 ······································ 344 부양자 상해사망 특별약관 ····································································· 344 부양자 질병80%이상후유장해(1회한) 특별약관 ······································ 346 부양자 질병사망 특별약관 ····································································· 346 부정교합치료비(갱신형) 특별약관 ··························································· 263 비운전자 교통상해50%이상후유장해생활자금(1회한)(매년10년간지급) ······ 69 비운전자 교통상해80%이상후유장해(1회한) 특별약관 ······························ 72 비운전자 교통상해후유장해 (3~100%) 특별약관 ····································· 65 비운전자 자동차부상치료비 특별약관 ······················································· 90

(ㅅ) 사시수술비(비갱신형/갱신형) 특별약관 ··················································· 191 상해·질병80%이상후유장해(1회한) 특별약관 ·········································· 291 상해1~5종수술비Ⅱ(동일사고당 1회지급)(비갱신형/갱신형) 특별약관 ······· 101 상해50%이상후유장해생활자금(1회한)(매년10년간지급) 특별약관 ············· 61 상해80%이상후유장해(1회한) 특별약관 ··················································· 62 상해사망(비갱신형/갱신형) 특별약관 ························································ 63 상해수술비(동일사고당 1회지급)(비갱신형/갱신형) 특별약관 ····················· 76 상해입원·통원수술비(동일질병당1회지급)(비갱신형/갱신형) 특별약관 ······· 103 상해입원일당(1일이상 180일한도)(비갱신형/갱신형) 특별약관 ·················· 78 상해입원일당(1일이상180일한도)(자녀형)(갱신형)(전환용) ······················· 363 상해입원일당(1일이상 10일한도)(비갱신형/갱신형) 특별약관 ····················· 96 상해중환자실입원일당(1일이상180일한도) 특별약관 ································· 78 상해후유장해(20~100%) 특별약관 ························································· 60 상해흉터복원수술비 특별약관 ·································································· 86 선지급 서비스 특별약관 ········································································ 391 선천이상수술비(비갱신형/갱신형) 특별약관 ············································· 180 선천이상수술비(혀유착증 및 모반증 제외)(비갱신형/갱신형) 특별약관 ····· 181 선천이상입원일당(1일이상120일한도)(비갱신형/갱신형) 특별약관 ············ 182 성장판손상유발 자동차사고 특수골절진단비 특별약관 ······························· 80

성조숙증진단비(갱신형) 특별약관 ··························································· 190 소아백혈병진단비(비갱신형/갱신형) 특별약관 ·········································· 126 스쿨존 교통사고보험금(비갱신형/갱신형) 특별약관 ··································· 92 시력교정비(갱신형) 특별약관 ································································· 262 시력치료비(갱신형) 특별약관 ································································· 261 식중독입원일당(4일이상120일한도) 특별약관 ········································· 179 신깁스치료비(상해 및 질병) 특별약관 ···················································· 291 신생