保险业务——理赔须知
来源:    发布时间: 2017-11-29 03:54   330 次浏览   大小:  16px  14px  12px

就医前务必拨打电话4008105119转1进行寻诊
尊敬的客户:
您如果想了解平安养老保险股份有限公司来华人员综合保险理赔服务事项,请您仔细阅读如下内容。
(一)理赔程序:
保险事故发生后,理赔的规范程序:
1.因疾病或意外事故需就诊,需直接致电4008105119转1键,由救援医生进行健康询诊、就医指导及理赔注意事项说明。如经过询诊且门诊治疗后医生确诊需进一步住院治疗的可向救援公司申请住院垫付,救援公司与医院沟通确认后决定是否启动住院垫付程序。凡未经救援公司医生询诊备案且未经门诊诊治而直接入院治疗的(包括病情未达到住院程度却要求门诊医生同意住院治疗的),救援公司不负责住院费用垫付。对于未按照上述程序申请的,个人自行垫支医疗费用的将无法获得赔付。
2.重大事故可通过以下联系方式报案
理赔咨询、报案电话:4008105119转1键
凡是未经400电话报案或者未按照要求规范程序执行的,将无法获得赔付。
(二)理赔应备文件:
1).身故或意外伤残
A被保险人护照复印件及签证页复印件
B被保险人伤残时需提供伤残鉴定证明(由指定鉴定机构出具鉴定报告)
C被保险人死亡证明
D被保险人与所有受益人关系证明及受益人身份证明复印件。
E如意外事故须提供意外事故证明及相关部门的定性材料(如:交通事故须出具交通部门的交通事故责任认定书,高坠、溺水等须公安机关或相关部门出具事故属意外或自杀的定性材料,饮酒导致事故须出具酒精含量定量报告)
2).意外伤害医疗
A被保险人护照复印件及签证页复印件
B意外事故经过及证明(如是交通事故须出具交通部门的交通事故责任认定书等)
C收费收据原件
D相对应每次就诊病历(病例日期须与发票日期一一对应),费用明细,检查、化验报告单复印件
3).门急诊医疗
A被保险人护照复印件及签证页复印件
B收费收据原件
C相对应每次就诊病历(病例日期须与发票日期一一对应),费用明细,检查、化验报告单复印件
如果已满2000元起付线,须提交2000元以下的发票原件、病历、费用明细、检查化验报告单的复印件。
4).住院医疗
A被保险人护照复印件及签证页复印件
B 如意外事故须提供意外事故证明(如是交通事故出具交通部门的交通事故责任认定书等)
C住院收据原件、费用明细原件
D出院小结或住院病历复印件
以上2)—4)项特别说明:
(1)每次申请理赔,申请材料中必须附上被保险人中国大陆境内的银行账号及该账号的准确账户信息,包括账户名、账号和开户行信息,可通过存折复印件或银行客户信息表载明以上信息。(详情请拨打4008105119转1进行咨询)
(2)若一次保险事故分别在两家(包含两家)以上医院就诊,须出具每次就诊的诊断证明书、病历复印件等相关文件。
(3)就诊医院必须是中华人民共和国大陆境内的公立医院,申请理赔费用应属于当地社会基本医疗保险规定可报销的范围之内的费用。
5).护工费申请
住院期间医院或护工服务公司出具的护工费发票原件。
理赔材料寄送地址:北京市朝阳区东三环中路55号双子座B座303室(邮编100022)
收件人:来华项目理赔部
电 话:4008105119转1键

 

Do be sure to firstly call 4008105119 EXT 1 to make a diagnosis inquiry before you go to see a doctor.
Dear customers:
If you want to learn about the services of settlement of claim of comprehensive insurance for people coming to China of Ping An Endowment Insurance Co., Ltd., please read this guide carefully.
(1)Procedures for insurance claims:
Standard procedures of insurance claims after occurrence of insurance accident:
1. Please call directly 4008105119 EXT 1 for medical consultation due to disease or accident. The rescue doctor will consult, diagnose, and provide medical guidance and precautions for insurance claim. After consulting diagnosis and outpatient treatment, if the doctor confirms that further hospitalization is required, the insured can apply for advanced payment of medical expense for hospitalization to the rescue company. After communication and confirmation of the rescue company and hospital, it will be decided whether the advanced payment procedures shall be started. If the insured is directly hospitalized without consulting, diagnosis and recording of doctor of the rescue company and outpatient treatment (including those whose conditions do not meet the requirements of hospitalization but require the outpatient doctor to agree with hospitalization), the rescue company will not be responsible for advanced payment of medical expense for hospitalization. If advanced payment for medical expenses is made without the above procedures, the insured will not be able to get compensation.
2. Major accident can be reported with the following contact information
Telephone number for claim consultation and reporting: 4008105119 EXT 1. You cannot get compensated without reporting through the 400 call or following the standard procedures.
(2)Document to be presented for settlement of claims:
1).One-year term life insurance
A Copy of passport and visa page of the Insured
B Disability certificate when the Insured is disabled (an evaluation report shall be issued by the assigned evaluation body)
C Death certificate of the Insured
D Certificate of relationship between the Insured and all the beneficiaries, and copy of identification proof of the beneficiaries
E Certificate of accident, in case of an accident (in case of traffic accident, the traffic unit should issue a liability confirmation of traffic accident)
2).Medical treatment for accidental injuries
A Copy of passport and visa page of the Insured
B Course and certificate of accident (in case of traffic accident, the traffic unit should issue a liability confirmation of traffic accident, which is needed.)
C Original of receipt
D Medical record, detailed expenditure sheet and copy of examination report and laboratory test report of each respective treatment (date of examination and date of invoice shall be corresponding).
3).Medical treatment for outpatient and emergency
A Copy of passport and visa page of the Insured
B Original of receipt
C Medical record, detailed expenditure sheet and copy of examination report and laboratory test report of each respective treatment (date of examination and date of invoice shall be corresponding).
If the fees have exceeded the minimum payment line of RMB2000 Yuan, then the medical record, detailed expenditure sheet and copy of examination report and laboratory test report of treatment that costs below 2000 Yuan are also required to be presented.
4).Hospitalization
A Copy of passport and visa page of the Insured
B Certificate of accident, in case of an accident (in case of traffic accident, the traffic unit should issue a liability confirmation of traffic accident)
C Original of receipt and detailed expenditure sheet for hospitalization
D Copy of hospital discharge summary or medical record of hospitalization
Special instructions to item 2) to item 4) above:
(1) Besides, the Insured’s bank account opened in the mainland of China and accurate information (account No. name, opening bank information), which can be obtained from copy of deposit book and bank costumer table, in relation to the account must be attached to the claim settling documents for each request for compensation; (For details, please call 4008105119 EXT 1 )
(2). Where in one insured incident, the Insured has to be treated in two or more hospitals (including two hospital), relevant documents such as diagnosis certificate and medical record from relevant hospitals shall be presented.
(3). Hospitals for treatment shall be limited to the public hospitals within the territory of the Chinese mainland, and requested items and expenses that can be reimbursed should in accordance with the scope of local regulations of social basic medical insurance.
5). Application for nursing fee
Original Invoices of nursing fee issued by hospital or by nursing service company
Materials for claims of settlement sent to: 北京市朝阳区东三环中路55号双子座B座303室(邮编100022)
Addressee:来华项目理赔部
Please Dial : 4008105119 to 1

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