西 安 市 碑 林 区 人 民 法 院西 安 市 碑 林 区 人 民 法 院民 事 判 决 书（2021）陕0103民初335号     原告：王小莉，女，1993年9月19日出生，汉族，无业，住西安市新城区。委托诉讼代理人：刘晏，陕西润海律师事务所律师。委托诉讼代理人：杨小娟，陕西润海律师事务所律师。被告：泰康养老保险股份有限公司陕西分公司，住所地：陕西省西安市高新区。负责人：胡成国，总经理。委托诉讼代理人：胡俊峰，男，该公司员工，住西安市碑林区。原告王小莉与被告泰康养老保险股份有限公司陕西分公司保险合同纠纷一案。西安市中级人民法院于2020年9月4日作出（2020）陕01民终8807号民事裁定书，撤销西安市碑林区法院（2019）陕0103民初7549号民事判决书，发回我院重审。2021年1月8日立案后，依法另行组成合议庭，公开开庭进行了审理。原、被告委托诉讼代理人到庭参加了诉讼，本案现已审理终结。 王小莉向本院提出诉讼请求：1、被告支付原告保险赔偿金100000元，并承担从2018年5月9日至实际给付之日的逾期利息；2、被告按照保险合同的约定履行义务，及豁免原告从2018年至2042年应缴纳的保险费；3、被告承担本案全部诉讼费用。事实与理由：2017年9月18日，原告为自己在被告公司购买了泰康健康终身重大疾病保险，双方约定只要在被保险人患有重大疾病或轻型疾症就可以理赔。重大疾病的保险金额为500000元，轻症的保险金为100000元，保险费为每年6150元，缴纳费期限为27年。合同签订后，原告按照约定向被告缴纳了首期保费，被告向原告出具了保险合同，保险合同成立并生效。2018年4月19日，原告被西安市交大一附院诊断为PRL腺瘤，并在该医院就诊。该病症属于双方合同约定的轻症疾病，2018年5月9日原告向被告提出理赔申请，被告未在30日内作出拒付赔付的回复，侵犯了原告的合法权益，诉至法院。 被告泰康养老保险股份有限公司陕西分公司(以下简称泰康保险陕西分公司)答辩，其公司不应承担100000元的责任，不应豁免从2018年至2042年应缴纳的保险费及不应承担诉讼费。投保人签署保险合同时，已知悉保险的起算时间及权利，知悉保险条款内容，应遵守相应的保险责任；原告被诊断为PRL腺瘤，构成脑垂体瘤，但未实际接受手术或者放射治疗，故不符合双方签订的保险合同，原告的请求不能成立，应予以驳回。经审理查明：2017年9月18日，王小莉为自己在被告公司购买了泰康健康有约终身重大疾病保险，双方在保险条款中进行了约定。其中第10条为轻症疾病定义，10.2条“脑垂体瘤、脑囊肿、脑动脉瘤及脑血管瘤”条款中经头颅断层扫描、核磁共振检查或者其他影像学检查被确诊为下列病变，并实际接受了手术或者放射治疗。重大疾病的保险金额为500000元，轻症的保险金为100000元，保险费为每年6150元，缴纳费期限为27年。合同签订后，王小莉按照约定向泰康保险陕西分公司缴纳了首期保费，泰康保险陕西分公司出具了保险合同，保险合同成立并生效。2018年4月19日王小莉被西安市交大一附院诊断为PRL腺瘤，并在该医院就诊，但并未实施手术或放射治疗。2018年5月9日，王小莉向泰康保险陕西分公司提出理赔申请，遭拒绝。以上事实，有庭审笔录、保险单及保险条款、王小莉门诊病历等证据在卷佐证。审理中，泰康保险陕西分公司同意赔偿王小莉100000元的保险赔偿金，涉案保险合同终止。但原告不同意，双方未达成调解协议。                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         本院认为，原、被告签订的保险合同，系当事人真实、自愿意思表示，内容不违反法律法规的强制性规定，合法有效，本院依法予以确认。原告虽被诊断为PRL腺瘤，但并没有实施手术或放射治疗，不符合合同第十条约定的脑垂体瘤、脑囊肿、脑动脉瘤及脑血管瘤的定义，故现要求被告支付保险赔偿金100000，故本院不予支持。同理，因不符合轻症疾病的定义，故不能豁免原告从2018年至2042年应缴纳的保险费。综上所述，依据《中华人民共和国民法典》第五百零九条之规定，判决如下：一、驳回原告王小莉要求被告泰康养老保险股份有限公司陕西分公司支付原告保险赔偿金100000元，并承担从2018年5月9日至实际给付之日的逾期利息的诉讼请求；二、驳回原告王小莉要求被告泰康养老保险股份有限公司陕西分公司按照保险合同的约定履行义务，及豁免从2018年至 2042年应缴纳的保险费的诉讼请求。案件受理费2300元，由原告王小莉负担（此款原告已预交）。如不服本判决，可在判决书送达之日起十五日内，向本院递交上诉状，并按对方当事人的人数提出副本，上诉于陕西省西安市中级人民法院。      审  判  长      刘  彧人民陪审员      李  秦人民陪审员      王海燕     二О二一年七月二日  书  记  员      冯亚楠   1