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外教B疾病理赔文件

来源:本站 最后更新:2019-10-24 10:59:46 作者:佚名 浏览:796次

疾病门急诊理赔

Disease Outpatient & Emergency Department

 

医院Hospital :

1. 就医时请选择公立医院。

私立、合资医院、等情况不能理赔报销

 

 2. Please go to Public Hospital, Normal Department.

  Private and joint-venture hospital are not eligible for reimbursement. 

 

发票、病历Invoice & Medical Record:

1. 每次就诊时,请收集有效发票原件并务必提醒医生书写详细的就诊记录/病历。

      收费发票日期与门急诊病历所记载的就诊日期一致,且发票和病历上姓名与护照姓名中某个字段一致,不一致时到医院收费处变更或找留办老师开具《姓名证明》,发票为中文名的,《保险理赔申请书》上须标注中文名。 

 

 2. Every time you go to hospital, please collect every valid original invoices and ask doctor to write medical records for you. 

The billing invoice date is consistent with the medical treatment date recorded in the outpatient and emergency medical records, and the name on the invoice and medical records is consistent with a field in the name of the passport. In case of any inconsistency, please change the name at the charge office of the hospital or ask the teacher who holds the office to issue the name certificate. If the invoice is in Chinese name, the Chinese name shall be marked on the application form for insurance claims.  

 

疾病门诊理赔规则介绍:

 

   1. 日限额1000RMB

被保险人因疾病在门诊、急诊进行治疗所发生的合理且必要的医疗费用,在一个保险期间内,就诊日费用限额为1000元(即:若当日医疗费用超日限额的只能按 1000 元计算,当日医疗费用未超1000元限额的按实际发生金额计算):日限额为每日就诊的最高费用限额。

 

   2. 免赔额800RMB & 学生自付比例15%: :

   在日限额的基础上累计超过800元免赔额以上的部分按照 85%比例赔付,累计给付保险金额以20000元为限。当累计给付金额达到其保险金额时,对被保险人的该项保险责任终止。 免赔额是本险种设置800元为免赔额(一个保险期间内累计扣一次 800 元),免赔额以下部分不予赔付。

 

  3. 门急诊医疗费用包括

    普通门诊、急诊、门诊手术、急诊留观、急诊抢救所产生的相关费用;由公 立医院或卫生防疫部门提供证明的传染病因隔离期间所产生的相关费用;因与住院同一病因而产生的院 前、院后的门诊费用等均归属于门急诊医疗责任范围内。 即:如因发烧、突然腹痛、晕倒、身体某处炎症等等在门诊或急诊进行治疗的;

 

  4. 报销公式

(每天在日限额 1000 元以内的费用相加- 800 元)*85%=可报销费用(合理费用合计不含当地社会基本医疗保险规定的自费及部分自费费用)。

例如7月1日,您的花费是800元;7月2日,您的花费是1000元;7月3日您的花费是200元;

      计算公式:{(1000+1000+200)- 800} * 85%= 425    (注具体赔付多少需提交理赔文件进行审核后出结果。注保存起付线一下疾病门诊的全部医疗文件,超过起付线后可申请理赔,理赔时须一并提交。)

 

Introduction to claims settlement rules 

  1. Daily Limitation 1000RMB:

   The reasonable and necessary expenses incurred by the Insured for receiving outpatient or emergency medical treatment because of illness, within each insurance period, the daily limit for outpatient is RMB1000, (that said, for the medical expense of the day exceeding RMB 1000 shall be calculated as RMB1000, for the medical expense of the day not exceeding RMB1000 shall be calculated by the actual amount)Notes: Daily limit:The top calculated limit of available medical cost.

 

  2. Deductible 800RMB & Coinsurance 15%:

   For the medical expenses exceeding the starting line of RMB800, The remaining amount of the medical expenses exceeding the deductible RMB800 yuan on the basis of the daily limit will be reimbursed at a percentage of 85%, and the accumulative payment shall not exceed the limit of RMB20000. The insurance liability shall be terminated once the accumulative amount of payment reaches the sum insured.Notes: Deductible : RMB 800 yuan (A total of RMB800 yuan is deducted accumulatively for one time during an insurance period). Below the starting line, there is no compensation.

 

      3. Medical expenses of outpatient and emergency treatment:

   The related expenses incurred from general outpatient treatment, emergency treatment, outpatient surgery, hospitalization for observation, emergency rescue, isolation due to infectious diseases that is certified by the public hospital or department of public health and epidemic prevention, and expense or cost of outpatient and emergency treatment before and after hospitalization that arise from the same cause of disease are also deemed as outpatient and emergency treatment. For example, being treated in the outpatient or emergency for fever, sudden abdominal pain, faint, and inflammation etc.

 

     4.  Reimbursement equation:

 (the expense of each day within the daily limit RMB1000 yuan add up - 800 yuan) * 85%=reimbursable amount (the total amount of reasonable expenditures shall exclude the self-paid or partly self-paid items and expenses stipulated by the local regulations of the social basic medical insurance).    

For instance, you spent 1200RMB in July 1st, 1000RMB in July 2nd, 200RMB in July 3rd, then these expenses would be calculated as follows:

                                                     Calculation equation:{(1000+1000+200)- 800} * 85%= 1190     (Note: The exact number of reimbursement result also depends on the materials you submitted.)

 

申请理赔所需提交资料清单:

  1. 理赔/垫付申请及委托书(需学生手写签字、院校盖章)
  2. 护照首页复印件
  3. 所有有效发票原件
  4. 所有病历(需提供每天就医病历)
  5. 银行账户信息(请携带护照和银行卡去银行打印客户信息表,该表内容需包括,准确的户名、卡号、银行名称)
  6. 联系方式(请写明您的联系电话和邮箱地址,并建议提供留学办公室或负责老师的联系电话。)

 

List of materials required for claim :

  1. Reimbursement Application Form (Insured’s handwritten signature & school stamp are required.)
  2. Copy of your passport
  3. All valid original invoices.
  4. All the medical records  (Provide daily medical records.)
  5. Bank account information (You are required to go to the bank with your passport and debit card, ask the staff there to print the account information for you. The information should include: account name, account number and sub-branch name.)
  6. Contact Information (Please write your contact number and e-mail address on a piece of paper. You are also suggested to provide contact information of the International Students Office or phone number of your teacher.)  

理赔资料快递地址Postal address

收件人Recipient:来华项目组,

地址Address:北京市西城区金融街23号平安大厦9层,

电话Tel:400-810-5119                  

 

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