澄清保障细节和附加条款
Clarifying Coverage Details and Riders
客户对特定保单表示兴趣，并详细询问保障限额、涵盖或排除的特定医疗状况、等待期以及可用的附加条款或额外选项，以进一步定制保单。
对话轮次
8
预计时长
4 分钟
场景
保险咨询
完整对话内容
以下是该情境的完整英语对话，包含中英文对照和重点解析
👩
Client
第 1 轮
Thanks for explaining the basic policies, Alice. I'm particularly interested in the 'Health Shield' plan. Could you clarify the exact coverage limits for major surgeries?
English
谢谢你解释了基本保单，Alice。我特别对“健康护盾”计划感兴趣。你能否阐明重大手术的具体保障限额是多少？
中文翻译
👨
Insurance Advisor
第 2 轮
Certainly, Emma. For the 'Health Shield' plan, the maximum payout for major surgeries is capped at $500,000 per policy year. This amount covers surgical fees, anesthesia, and hospital care related to the surgery.
English
当然，Emma。对于“健康护盾”计划，重大手术的最高赔付额度为每个保单年度50万美元。这个金额涵盖了手术费、麻醉费以及与手术相关的住院护理费用。
中文翻译
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Client
第 3 轮
That's good to know. And what about specific pre-existing conditions like diabetes or high blood pressure? Are they covered after a certain period, or are they outright excluded?
English
这很好。那像糖尿病或高血压这样的既往病史呢？它们是过了等待期后才受保，还是完全排除在外？
中文翻译
👨
Insurance Advisor
第 4 轮
For pre-existing conditions, there's typically a waiting period of 24 months from the policy's inception. After this period, conditions like diabetes or hypertension might be covered, provided they've been declared at the time of application and approved by our underwriters. Otherwise, they are generally excluded.
English
对于既往病史，通常从保单生效之日起有24个月的等待期。在此之后，糖尿病或高血压等疾病可能会被受保，前提是在申请时已申报并获得我们的核保人批准。否则，它们通常是被排除在外。
中文翻译
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Client
第 5 轮
Okay, that clarifies it. And speaking of waiting periods, what's the standard waiting period for general illnesses before I can claim on the policy?
English
好的，这样就清楚了。说到等待期，一般疾病的等待期是多久才能申请理赔？
中文翻译
👨
Insurance Advisor
第 6 轮
For general illnesses not related to pre-existing conditions, the standard waiting period is 30 days from the policy start date. For specific conditions like certain critical illnesses, it can be up to 90 days, but that's usually specified in the policy document.
English
对于与既往病史无关的一般疾病，标准等待期是从保单开始日期起30天。对于某些特定疾病，比如某些重大疾病，可能长达90天，但这通常会在保单文件中详细说明。
中文翻译
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Client
第 7 轮
Understood. Finally, I'm interested in customizing the policy. Are there any popular riders or add-ons that would enhance the coverage, especially for outpatient specialist visits or international medical emergencies?
English
明白了。最后，我希望能定制保单。是否有受欢迎的附加条款或额外选项可以增强保障，特别是针对门诊专科医生就诊或国际医疗紧急情况的？
中文翻译
👨
Insurance Advisor
第 8 轮
Absolutely, Emma. A common add-on is the 'Outpatient Benefit Rider,' which covers specialist consultations and diagnostic tests. For international coverage, we have the 'Global Emergency Medical Evacuation Rider' that provides transport and treatment if you face a medical emergency overseas. We can certainly explore those options in more detail.
English
当然有，Emma。一个常见的附加选项是“门诊福利附加险”，它涵盖专科医生咨询和诊断测试。对于国际保障，我们有“全球紧急医疗后送附加险”，如果您在海外遇到医疗紧急情况，它提供运输和治疗。我们当然可以更详细地探讨这些选项。
中文翻译
🎯
对话学习完成
结合右侧的词汇和句型解析，加深理解和记忆
重点词汇
coverage
覆盖范围
This means the protection or benefits provided by an insurance policy, like what medical costs it pays for.
中文解释
这意味着保险单提供的保护或福利，例如它支付哪些医疗费用。
limits
限额
Refers to the maximum amount of money an insurance policy will pay out for certain claims, helping to control costs.
中文解释
指保险单为某些索赔支付的最大金额，有助于控制成本。
pre-existing conditions
既往症
Health problems you already have before buying insurance, which may affect coverage or require waiting periods.
中文解释
在购买保险前您已经存在的健康问题，这些问题可能会影响保险覆盖范围或需要等待期。
waiting period
等待期
A set time after starting an insurance policy before you can make claims for certain conditions, to prevent immediate misuse.
中文解释
在开始保险政策后的一段时间，在此期间您不能针对某些情况提出索赔，以防止立即滥用。
riders
附加险
Optional add-ons to an insurance policy that provide extra coverage for specific needs, like additional benefits.
中文解释
保险单的可选附加项目，提供针对特定需求的额外保障，例如额外福利。
payout
赔付
The amount of money an insurance company pays to the policyholder after a valid claim is approved.
中文解释
保险公司批准有效索赔后支付给保单持有人的金额。
underwriters
承保人
Insurance company experts who review and approve applications to decide if coverage is granted.
中文解释
审查并批准申请以决定是否授予保险覆盖的保险公司专家。
claim
索赔
A formal request to an insurance company for payment based on the terms of your policy.
中文解释
根据您的保单条款，向保险公司提出的正式付款请求。
重点句型
"Could you clarify the exact coverage limits for major surgeries?"
"您能澄清主要手术的精确覆盖限额吗？"
重点句型
语法解析
This is a polite question to ask for more details on insurance benefits. Use it when you need precise information. 'Clarify' means to make something clear, and 'exact' emphasizes accuracy.
中文解析
这是一个礼貌的问题，用于询问保险福利的更多细节。当您需要精确信息时使用它。「Clarify」意为使某事清晰，「exact」强调准确性。
"The maximum payout for major surgeries is capped at $500,000 per policy year."
"主要手术的最大赔付额上限为每保单年度500,000美元。"
重点句型
语法解析
This explains a limit on insurance payments. 'Capped at' means limited to a maximum amount. Useful for describing financial boundaries in contracts or policies.
中文解析
这解释了保险支付的限制。'Capped at' 意味着限制在最大金额。有助于描述合同或保单中的财务界限。
"For pre-existing conditions, there's typically a waiting period of 24 months from the policy's inception."
"对于既存疾病，通常从保单生效日起有24个月的等待期。"
重点句型
语法解析
This describes a standard delay in coverage. 'Typically' means usually, and 'inception' means the start. Use this pattern to explain rules with time frames in professional discussions.
中文解析
这描述了标准的覆盖延迟。“Typically”意思是通常，“inception”意思是开始。在专业讨论中使用这种模式来解释有时限的规则。
"After this period, conditions like diabetes or hypertension might be covered, provided they've been declared at the time of application."
"在此期间之后，像糖尿病或高血压这样的情况可能被覆盖，前提是它们在申请时已声明。"
重点句型
语法解析
This shows conditional coverage. 'Provided that' introduces a requirement. It's useful for explaining 'if' situations in agreements, with examples like specific diseases.
中文解析
这显示了条件覆盖。「Provided that」引入了一个要求。它有助于解释协议中的「if」情况，并举例如特定疾病。
"For general illnesses not related to pre-existing conditions, the standard waiting period is 30 days from the policy start date."
"对于与既存疾病无关的一般疾病，标准等待期为保单生效之日起30天。"
重点句型
语法解析
This clarifies exceptions to rules. 'Not related to' specifies differences. Good for breaking down policy details step by step in consultations.
中文解析
这澄清了规则的例外情况。'与...无关'指定了差异。在咨询中逐步分解政策细节很有用。
"Are there any popular riders or add-ons that would enhance the coverage?"
"有任何受欢迎的附加险或附加条款可以增强保障范围吗？"
重点句型
语法解析
This asks about options to improve a policy. 'Enhance' means to improve. Use it when customizing services or products to get suggestions.
中文解析
这是在询问改善保单的选项。“Enhance”意为改善。在定制服务或产品时使用，以获取建议。
"A common add-on is the 'Outpatient Benefit Rider,' which covers specialist consultations and diagnostic tests."
"一个常见的附加选项是“Outpatient Benefit Rider”，它涵盖专科咨询和诊断测试。"
重点句型
语法解析
This introduces an extra feature. The relative clause 'which covers...' explains what it does. Useful for recommending options with brief descriptions.
中文解析
这引入了一个额外功能。关系从句“which covers...”解释了它的作用。用于推荐带有简短描述的选项非常有用。