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外教A住院理赔文件

来源:本站 最后更新:2019-10-24 11:11:44 作者:佚名 浏览:964次

住院理赔(只用于理赔)

Hospitalization Treatment (Claim Only

 

医院Hospital

1. 就医时请选择公立医院普通科室普通病房

私立、合资医院、特需、国际门急诊、外宾病房、VIP病房、医疗整形美容科、康复科、干部病房、包间、单间、包床、挂床等情况不能理赔报销

 

 2. Please go to Public Hospital, General Department,General Ward.

Private and joint-venture hospitals, special needs, international outpatient and emergency department, foreign guests' wards, VIP wards, medical plastic surgery and cosmetic department, rehabilitation department, cadre wards, private rooms, single rooms, packaged bed and hanging beds 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.  

 

住院医疗保险责任:

 

  1. 保险责任:

  被保险人因遭受意外事故或疾病,经医院诊断必须住院治疗的,本公司就其实际支出的合理且必要的护工费(限额200元/天,最多累计30天)、建病历费、取暖费、空调费、床位费、检查检验费、特殊检查治疗费、手术费、药费、治疗费、化验费、放射费等合理医疗费用,按100%的比例向被保险人给付“住院医疗保险金”。在一个保期内,被保险人不论一次或多次住院治疗,本公司均根据理赔规则向其给付保险金,每次给付的住院医疗保险金累计相加达到400,000元时,该项保险责任终止。 即:因受伤或生病后,经医院诊断必须住院治疗,可申请网络医院住院垫付或自付后申请报销。

 

  2. 报销公式

合理住院费用*100%=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)。

 

  3. 注意事项:

  1. 以上所有医疗保险责任所涉及的医疗机构仅限于在中华人民共和国大陆境内的公立医院。但是,若被保险人是在公立医院的分院、外宾病区、VIP 病区、包房、A 等病房、单间、特诊特需病区、特诊特需病房和高干病房等同类病区或病房接受的治疗,则其所有的医疗费用本公司均不予报销。
  2. 以上所有医疗保险责任所涉及的医疗费用只限于当地社会基本医疗保险可报销项目内的费用,自费和部分自费项目本公司均不予报销。
  3. 首次投保或非连续投保的被保险人,自投保之日起30日内为等待期(观察期),如等待期内发生住院或疾病门诊的医疗费用,本公司不承担理赔责任。连续投保或被保险人遭受意外事故进行治疗的无等待期。
  4. 以上所有医疗费用,若其它第三方支付了部分或全部费用,我司仅就剩余的、且在当地社会基本医疗保险可报销项目范围内的合理费用予以赔付;但保险责任中所涉及的床位费、护工费、门急诊日限额等限额部分同样受限,如第三方有赔付比例的受限部分按照受限金额为基础扣除已赔付金额,我司只赔付剩余金额,如无赔付比例,受限部分按照当地社会医疗保险的标准, 以受限金额为基础扣除此项目的标准金额,赔付剩余金额,并以保险金额为限。
  5. 被保险人在本次投保前发生重大疾病或慢性病的,保险人不承担给付保险金的责任。

 

Introduction to claims settlement rules: 

 

   1. Hospitalization

  If diagnosis confirms that the Insured must be hospitalized for treatment because of suffering from the accident or the illness, Ping An shall pay 100% of the “hospitalization and medical insurance” to the insured with regard to the actual and reasonable expenses for medical treatment, including reasonable and necessary fees for nursing (limited to RMB200 Yuan per day and accumulate up to 30 days), medical record, heating, air-conditioning, bed, examination, special examination and treatment, operation, medicine, treatment, laboratory test, radiation, etc. During one valid insurance period, whether the Insured is hospitalized for once or several times, the Insurer shall pay the insurance payment as per compensation rule, but the insurance liability shall be terminated once the accumulative amount of payment reaches the limitation of RMB 400,000.   In another word: if diagnosis confirms that the insured must be hospitalized for treatment because of suffering from the injury or illness, the insured may apply online for advanced payment by the hospital or at his own expense of medical expense for hospitalization and reimburse later.

 

    2. Reimbursement equation

Reimbursement equation: reasonable hospitalization expenditure * 100%=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)

 

     3.  Note:

  1. Medical organizations which are involved in all the foregoing medical insurance liabilities are limited to the public hospitals established within the border of Mainland China; However, for the insured who are treated in sub-branch of public hospitals, ward area for foreigners, ward area for VIPs, private room, Class A ward, separate ward room, ward area for special treatment and needs, ward for special treatment and needs, ward for high-ranking officials, or similar ward area, shall be excluded from the insurance, then all medical expenses incurred by such shall not be covered by the insurer.
  2. Medical treatment expenses generated by all the foregoing medical insurance liabilities are limited to the items and expenses that can be reimbursed in accordance with the local regulations of social basic medical insurance, the self-paid or partly self-paid items and expenses cannot be reimbursed by the insurer.
  3. For the insured who apply for the insurance for the first time or the insured who is not continuously insured, the first 30 days since the purchase of the insurance is the waiting period (observation period). Where the insured is hospitalized or treated in outpatient during the waiting period and related medical cost occurs, the insurer bears no liability of compensation. The treatment for the insured of continuously insured or the Insured suffered from an accident is not subject to any waiting period.
  4. If any third party has partially or fully paid any above-mentioned medical treatment fees, Ping An shall be liable for the remaining amount of reasonable fees that are within the reimbursable payment scope of the local social basic medical insurance. But the limited portion of the fees for the bed, nursing, outpatient and emergency treatment within the daily limitation is also limited; if the third party has a specified proportion for payment of the limited sum, Ping An shall be liable only for the remaining amount after deducting the already paid amount from the limited sum. If the third party has no specified proportion for payment, then Ping An shall be liable for the remaining amount, but not exceeding the insured sum, after deducting the standard amount of this item from the limited sum which takes the regulations of the local social medical insurance as the standard.
  5. If the Insured suffers from a major disease or a chronic disease before the purchase of this insurance, the Insurer shall not bear the liability of payment.

 

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. 被保险人护照复印件
  3. 发票原件,费用明细原件
  4. 出院小结或住院病历复印件
  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。)
  7. 意外伤害证明(如果因意外伤害住院,需提供意外伤害证明(学生本人签字或留学生办公室盖章,意外证明中要写清受伤过程(包括什么时间、在哪里、因为什么导致受伤、伤到哪里); 如因交通事故受伤,还需提供交通事故认定书原件(盖红章);如果因疾病住院,则不用提供此证明)
  8. 护工费申请(如果申请护工费,需提供住院期间医院或护工服务公司出具的护工费发票原件。)

 

List of materials required for claim :

  1. Reimbursement Application Form (Insureds handwritten signature & school stamp are required.)
  2. Copy of your passport
  3. All original invoices and detailed expenditure sheet
  4. Copy of hospital discharge summary or medical record of hospitalization.
  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. )  
  7. Accident Report (If you got hurt because of accident, please write a report to show us clearly where, when and how you get injured. Your clear handwritten signature is required. If you receive inpatient treatment because of disease, accident report is not needed. If you have a traffic accident, you also have to write if you call the police and get any compensation from the third party. If you call the police, we also need the certification from the police.)   
  8. Application for nursing fee ( If you need to apply for nursing fee, then the Original invoices issued by hospital or by Nursing Service Company is required.)

 

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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