就医与理赔
来源:    发布时间: 2019-09-05 01:50   96 次浏览   大小:  16px  14px  12px

第一部分

就医前

  1. 生病了,发生意外怎么办?

    What if you sick?

难受?不舒服?意外受伤?需要看病时,先打个电话 400 810 5119 咨询如何看病,如何报销

Feel uncomfortable? If you need to see the doctor, please call us first.

 

就医中

  1. 就医提示

    Where to see a doctor?

    一定要前往大陆境内的公立医院先在医院门诊部治疗,如果遇到特殊情况请拨打400 810 5119热线电话

    Please go to the public hospital of the Mainland China and get the treatment in the outpatient department first, if the situation is getting complicated, please call the hotline.

  2. 挂什么号?

    Notices for Registration

    到医院后只能挂普通号不能选择特需号,外宾号,国际医疗部等买病历本,并且每次看病都要让医生写病历

    When you are in the hospital, please just register in the normal department.

    NO special need or international service for the insured.

    Buy a booklet and ask the doctor to write the medical record for you everytime.

  3. 注意挂号名字

    Notices for Registration

    挂号名字一定要写对可以写护照全名的一个字段,要一个字母一个字母的写清楚,不要连笔

    Please use the accurate name to register.

    You can use one whole part of your English name to register

  4. 挂号费用类型

    Notices for Registration

    1. 费用类型选择“商业保险”或“自费”

      Types of expense, need to choose business insurance or self-paid.

    2. 再到医院相应医生处进行检查治疗

      Go to corresponding department for medical treatment.

 

第二部分

  1. 门诊需要收集哪些材料?

    What kind of materials should collect for outpatient?

    1. 门诊病历(重要), 一定要让医生写门诊病历,每次都要有

      Outpatient medical record.It is imperative for the doctor to write the outpatient medical record every time.

    2. 发票原件需要两章齐全,请收好发票原件,丢失无法理赔

      The original invoice with two stamps.Please collect the original invoices with two seals. In the case of invoice losing, you can’t get reimbursed.

    3. 收好化验单、报告单、处方,最后一起提交理赔。

      Please keep your laboratory test report, examination report and prescription and then submit all of materials for reimbursement.

    4. 意外事故说明--内容包括时间、地点、受伤经过。

      Please write a report to show us clearly where, when and how you get injured. Your clear handwritten signature is required.

  2. 疾病门诊怎么理赔?

    Outpatient policy

    以方案二(800元)为例,

    在一个保险期间内,就诊日费用限额为600元,在日限额的基础上累计超过650元免赔额以后的部分按照85%比例赔付

    Example as plan 2

    Within each insurance period, the daily limit for outpatient is RMB600. For the medical expenses exceeding the starting line of RMB650, The remaining amount of the medical expenses exceeding the deductible RMB650 yuan on the basis of the daily limit will be reimbursed at a percentage of 85%.

     

    以方案二(800元)为例,

    保险期间内,因病在当地公立医院就诊,20182月1日花费900元,5月3日花费4007月15日花费700元(就诊费用均为合理费用)。

    理赔计算公式:{(600+400+600元)-650}*85%=807.50

    Example as plan 2

    If you have paid an insurance fee at RMB 800then you have paid RMB 900 on February 1st2018,paid RMB 400 on May 3rd,and RMB 700 on July 15th all the fees for clinical service are rationaldue to being treated in a local hospital within the insurance period.

    The formula for claim settlement{600+400+600-650}*85%=807.50Unit:RMB Yuan

  3. 住院垫付及住院要求

    Requirement for advanced payment

    病情严重医生建议必须要住院的,须在入院前致电400热线,进行医疗咨询及报案,否则无法垫付及申请理赔。

    If diagnosis confirms that the insured must be hospitalized and need to apply for the advanced paymentplease make sure that you call us before hospitalized.

  4. 住院期间的注意事项

    跟医生说明报销注意事项
    就诊产生自费及部分自费费用时,需个人承担此费用,此类自费不属于当地医保报销的范围,同时保险也不能报销

    注意:只能住普通病房

    Clarify the reimbursement notices with the doctor.
    When you choose selected medicine or treatment which not include in your local Social Insurance category, this part of fee will not be covered by the insurance company. You shall pay for the selective medicine and treatment by yourself.

    Insurance company can only cover insured who treated in general ward.

  5. 住院需要收集哪些材料?

    What kind of materials should collect for hospitalization?

    出院需要医院提供资料
    (1) 发票原件(盖章)

    (2) 费用明细清单原件
    (3) 出院小结或住院病历复印件

    The following materials need to be provided when discharge from hospital
    (1) Stamped original invoices
    (2) Detailed medical expenditure sheet
    (3) Copy of hospital discharge summary or medical record of hospitalization

  6. 其他需要准备的材料

    How to apply for reimbursement

    1. 理赔申请文件----每次提交报销都必须提供

      Application for claim--Necessary materials for claim

    2. 护照复印件

      Passport Copy

    3. 姓名证明----发票病历上的中文名与护照英文名为同一个人的证明

      Name of certification--You are required to provide the name of certification in case of the name in the invoices is different from the passport.

    4. 意外事故说明----内容包括时间、地点、受伤经过。

      Please write a report to show us clearly where, when and how you get injured. Your clear handwritten signature is required.

    5. 银行卡客户信息表----请带护照和银行卡去银行,找工作人员打印一份银行卡信息表,主要用作接收汇款,需要的信息有:户名,账号,开户行信息(这条信息可以给银行的工作人员看一下,他们就会给你相关资料)

      Information letter of Bank Account--Please go to the bank with your passport and bank card, and ask bank staff to print out your bank account information, which will be used to receive money from insurance company. The information includes: Username、account number、bank name(Bank staff will help you once you show this information to them)

  7. 常见免责提示

    Liability Exemption Tips

    1. 民营及私立医院

      Private hospital

    2. 特诊特需病区

      Ward area for special treatment and needs

    3. 外宾病区

      Ward area for foreigners

    4. 特诊特需病房和高干病房

      Ward area for high-ranking officials

    5. 酒后驾驶、无合法有效驾驶证驾驶,或驾驶无有效行驶证的机动车

      Driving under the influence,driving without a legal and valid driving license a motor vehicle without a valid driving license on the part of the Insured

    6. 怀孕、流产、分娩、不孕不育症治疗、人工受精、产前产后检查;节育、堕胎、及以上原因引起的并发症

      Pregnancy,miscarriage or delivery on the part of the Insured,infertility treatment,artificial insemination,prenatal and postnatal check,birth control,abortion and complications caused by above-mentioned causes

    7. 免赔额650元以下部分不予理赔(门急诊责任)

      Deductible:RMB 650,below the deductible,there is no claim (outpatient and emergency medical insurance)

    8. 自费和部分自费项目均不能报销

      The self-paid or partly self-paid items and expenses cannot be reimbursed

    9. 矫形、矫正、整容或康复性治疗

      Expenses of orthopaedics,diorthosis,face-lift or rehabilitation therapy by the Insured

    10. 患先天性疾病、遗传性疾病、既往症(投保前已患疾病或已存在的症状,保险期间非连续的)

      Congenital diseases,hereditary diseases,existing disease (disease or symptoms that already exist prior to the date of insurance)

保险细则以《平安养老保险股份有限公司来华人员综合保险保障计划简介》为准,或参阅www.lxbx.net中的投保指南及理赔指南。

The policy terms and conditions shall be in accordance with Cmprehensive Insurance &Protection Scheme for Foreigners Staying in China of Ping An Annuity Insurance Co.,Ltd.

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