How about critical illness insurance compensation, how about critical illness insurance compensation

The definition of illness in critical illness insurance contracts is generally formulated with reference to the diagnostic criteria recommended by international or domestic authorities, but sometimes it may be more stringent than the clinical diagnostic criteria. For example, the general critical illness insurance clause requires that "acute myocardial infarction" must have an abnormal increase in cardiac enzymes as the basis for diagnosis. For example, a person related to a life insurance company said that a customer did not seek medical attention in time after the onset of the disease, and although he was diagnosed with "acute myocardial infarction", he missed the best time to check the cardiac enzymes, which brought trouble to the claim.

However, the insurance company may be able to make accommodation payments under special circumstances. However, if the customer can understand the definition of various diseases in the contract in advance, he will be more cautious when making a purchase decision, and he will encounter less trouble when making a claim. A person in the medical profession pointed out that the definition of disease indicated by the insurance company is different from the medical clinical definition, and the exclusion scope is extremely general, while the insurable disease is indicated in great detail, which is basically the most serious symptom of the disease.

Taking malignant tumors as an example, there are only four types of tumors that are not covered in the regulations, but in fact, these four types cover a wide range. He advises customers to pay special attention to which illness insurance companies can and which do not when buying critical illness insurance. Otherwise, if something happens, the beneficiary of the policy will not receive any compensation.

Many contracts also stipulate the time of diagnosis and compensation. The person pointed out that if the terms of the contract do not specify in detail how many days after the diagnosis is paid (generally speaking, how many days after the procedures and documents are complete), then in principle, the compensation will be paid after diagnosis. Some stipulate that compensation will be paid within 30 days after diagnosis, etc.

In fact, health insurance has an observation period. The observation period is from the effective date of the policy, and if you suffer from a critical illness within a certain period of time, the insurance company will not pay or partially pay the claim. For example, if someone buys critical illness insurance today, and the observation period of this critical illness insurance is 90 days, then if someone unfortunately has a critical illness at the age of two months, the insurance company will not pay for it, or only a small part of it.

Generally speaking, the observation period for critical illnesses is generally 90 days to one year, and the terms and conditions of each insurance company are different. In addition, if you do not fulfill the notification at the time of insurance application, it will also cause great trouble when making a claim. After all, many critical illnesses are closely related to certain common diseases and need to be informed by customers at the time of application.

There have been customers who have claimed critical illness insurance due to liver cancer. During the claims investigation, it was found that the customer had a history of chronic hepatitis B before taking out the insurance, which was not communicated by the customer due to the customer's negligence at that time. In the end, the customer was not reimbursed.

Therefore, when applying for critical illness insurance, actively informing the insurance company of past medical history will effectively prevent the occurrence of future claims conflicts. Trap 5: You can repay the principal without getting sick"Buying insurance should follow the basic capital protection, and the more profits the better, the principle of not suffering losses.

There are many policyholders who have such an idea and regard the purchase of insurance as a business that will make a profit without losing money, which is also misled by the false propaganda of some people.

Some people find it difficult to get a critical illness insurance claim, but in fact, critical illness insurance claims are very simple, and the process is roughly divided into 4 steps:

1. Go to the hospital first for diagnosis.

It should be noted that not all critical illness insurance is paid immediately upon diagnosis, and some critical illnesses require that they must reach an agreed status or undergo an agreed surgery before they can be claimed.

2. Apply to the insurance company for compensation.

After discovering that the insured person has suffered from a critical illness specified in the insurance contract, the insured or his/her family should promptly contact the insurance company to report the accident, inform them of the insurance situation, and ask what claim materials need to be prepared.

3. Prepare the claim information for submission.

According to the requirements of the insurance company, prepare the required claim proof materials, and submit them in a timely manner after collection. The materials that need to be provided for critical illness insurance generally include: outpatient medical records, diagnosis certificates, hospitalization certificates, discharge certificates, etc.

4. Wait for the result of the claim.

After submitting the relevant claim information, the insurance company will review and determine whether the claim conditions are met, and if the claim conditions are met, the compensation will be credited to your account, and you only need to wait for the claim result during this period.

If you want to know the details that need to be paid attention to in the claim, you can take a look at this article: What are the general claims materials and what are the details to pay attention to?

Depending on the number of claims, critical illness insurance can be divided into single claims and multiple claims.

What is Multi-Claim Critical Illness Insurance? It means that the insured suffers from a critical illness for the first time, and the insurance contract will not be terminated after the insurance company pays the insurance money as required; If the Insured suffers from a critical illness again, they will continue to receive benefits as long as they meet the conditions until the agreed number of benefits is exhausted.

Is it good or bad to pay out multiple times? Click on the link below, and the senior sister will tell you!

Is the critical illness insurance worth paying multiple claims? It turns out that we were all deceived!

Multiple claims for critical illness can be divided into two types, one is multiple claims in groups, and the other is multiple claims without groups. Both types have intervals, and the interval between multiple claims in groups is generally shorter, and the interval between non-groups is generally longer.

Although the content of critical illness insurance is relatively complex, as long as you understand the relevant process and required materials, the claim process will not be very troublesome, and as long as it meets the claim criteria and does not trigger the exemption clause, the insurance company will make corresponding compensation, so you can rest assured.

In the past, the state did not have unified regulations on the coverage and claim standards of critical illness insurance, and each insurance company formulated its own insurance terms and explained the claim standards, which caused many disputes. To this end, the Insurance Association of China and the Chinese Medical Doctor Association, in combination with the development of critical illness insurance in China and the progress of modern medicine, and drawing on international experience, jointly formulated the definition of critical illness insurance on August 1, 2007, and uniformly stipulated the scope and standards of insurance companies' claims for 25 major diseases, so as to protect the rights and interests of consumers.

However, consumers should also know that critical illness insurance will only pay out when the disease reaches the specified level, such as carcinoma in situ in the early stage of cancer, many companies will not compensate, so carefully check the definition of disease in the insurance terms.

In addition, the amount of critical illness insurance claims is the amount insured by the customer, not the actual amount spent at the time of the visit, and the consumer can be compensated if they are insured by multiple insurance companies.

Critical illness is a payout type, and the diagnosis payment does not mean that it can be paid as soon as it is diagnosed. Like cancer, you can pay as soon as you are diagnosed; Some of the other diseases need to reach a certain state or perform some kind of surgery to pay for them.

85% will be reimbursed for less than 10,000 yuan, 90% will be reimbursed for less than 40,000-80,000 yuan, and 95% will be reimbursed for more than 80,000 The maximum payment limit is RMB 150,000 per medical year.

2.Critical illness medical treatment can be divided into two types in terms of insurance forms. One is the social security of serious illness medical care, which is a special medical insurance established to ensure the medical needs of urban employees for major diseases, which is used to pay for the medical expenses of the insured persons who participate in the basic medical insurance for urban employees and exceed the maximum payment limit of the basic medical insurance during the year.

The other is commercial insurance for serious illness medical treatment, which is agreed by the insurance company in accordance with the terms of the insurance.

3.The reimbursement of the actual medical expenses within the scope of the serious illness medical insurance, the invoices that need to be actually incurred for the medical expenses, are divided into ordinary outpatient and emergency expenses reimbursement and hospitalization expense reimbursement, as well as large-amount medical co-ordination, with a certain limit; The expenses covered by the critical illness medical insurance of commercial insurance are paid in advance, that is, as long as the hospital is diagnosed with a serious illness in the policy, it will be paid in full immediately according to the contract.

Extended Materials: a. Critical illness insurance does not cover the following areas:

1.Seeking medical treatment in non-designated hospitals without approval (except for emergency rescue);

2.Suffering from occupational diseases, work-related injuries or work-related injuries**;

3.Injuries caused by traffic accidents;

4.Causing harm due to one's own violation of the law;

5.Food poisoning caused by a liability accident;

6.Caused by suicide;

7.Injuries caused by medical malpractice;

8.According to the provisions of the state and the city, the medical expenses shall be borne by themselves.

Two. The coverage of critical illness insurance can be divided into three main aspects:

1.The six major illnesses that must be covered by the insurance company are malignant tumors, coronary artery bypass grafting (or coronary artery bypass grafting), sequelae of stroke, major organ transplantation or hematopoietic stem cell transplantation, acute myocardial infarction, end-stage renal disease (or chronic renal failure uremia stage);

2.In addition to the 6 illnesses specified above, the insurance company can choose which diseases can be covered by critical illnesses, such as severe brain injury, loss of multiple limbs, blindness, deep coma, loss of speech ability, etc.;

3.The insurance company can increase the coverage of the diseases at its own discretion, provided that it does not contradict medical principles and common sense.

It seems that there are 32 types of major diseases with the largest number of types. The compensation standard is implemented in accordance with the terms of the insurance company's critical illness insurance contract. If you buy this product, there will definitely be a standard table of critical illnesses in the insurance contract.

It's basically on the back pages of the insurance contract.

Critical illness insurance can generally be paid out in the following ways:

1.Report the case within three days of hospitalization. After the insured has an insured accident, it is also necessary to notify the insurance company in time and report the case to the insurance company;

2.According to the requirements of the insurance company, prepare the information required to apply for a claim, generally need to prepare a disease diagnosis certificate, or a hospital diagnosis report, a disease identification report, etc., and the specific information required needs to be determined according to the disease suffered by the insured;

3.Submit the claim information to the insurance company for review, and if the review is passed, the insurance company will transfer the claim money to the bank account designated by the insured.

If it is a death claim, then it is generally necessary to prepare a cremation certificate, a certificate of household registration cancellation by the public security organ and a medical death certificate issued by the hospital (some insurance companies usually only need two of them in order to simplify the claim procedure), and the insurance company will transfer the claim money to the bank account designated by the death beneficiary after approval.

Summary. Hello dear. The amount of critical illness coverage depends on the amount of coverage you choose and the type of illness you have.

Because the payment of critical illness insurance is closely related to the amount of insurance selected by the user and the type of illness that occurs. The sum insured is the basis, and according to the different severity of the disease, it will be paid according to the proportion of the sum insured, mainly in the following three situations: 1. Critical illness:

Pay 100 sum insured, for example, if the sum insured is 500,000, 500,000 will be paid. 2. Moderate disease: 50 -60 sum insured, for example, if the sum insured is 500,000, 250,000-300,000 will be compensated.

3. Mild illness: 20 -45 insured amount, such as 500,000 insured amount, 100,000 yuan. If it is a critical illness and meets the claim requirements, the sum insured will be paid directly, and if the occurrence is death or total disability, the premise is that the critical illness insurance purchased has this responsibility, and some provisions are based on the paid premium, then the premium will be paid; If there is a specified amount of compensation, then the amount of compensation will be paid; If there is a provision that the highest premium paid, cash value or sum insured will be compensated, then the highest of the three at that time will be compensated.

It should be noted that generally speaking, if you pay for a critical illness first, and then the corresponding mild or moderate illness, you will not be able to receive compensation, and if you pay for a mild or moderate illness first, the critical illness sum insured will not be affected.

How much does the insurance cover for critical illness.

Hello dear. The amount of critical illness coverage depends on the amount of coverage you choose and the type of illness you have. Because the payment of critical illness insurance is closely related to the amount of insurance selected by the user and the type of illness that occurs.

The sum insured is the basis, according to the different severity of the disease, according to the proportion of the sum insured, there are mainly the following three situations: 1. Critical illness: pay 100 sum insured, such as 500,000 insured, 500,000 yuan.

2. Moderate disease: 50 -60 sum insured, for example, if the sum insured is 500,000, 250,000-300,000 will be compensated. 3. Mild symptoms:

Pay 20 -45 sum insured, for example, if the sum insured is 500,000, 100,000 will be compensated. If it is a critical illness and meets the claim requirements, the sum insured will be paid directly, and if the occurrence is death or total disability, the premise is that the critical illness insurance purchased has this responsibility, and some provisions are based on the paid premium, then the premium will be paid; If there is a specified amount of compensation, then the amount of compensation will be paid; If there is a provision that the highest premium paid, cash value or sum insured will be compensated, then the highest of the three at that time will be compensated. It should be noted that generally speaking, if you pay for a critical illness first, and then the corresponding mild or moderate illness, you will not be able to receive compensation, and if you pay for a mild or moderate illness first, the critical illness sum insured will not be affected.

I paid Ping An Insurance, 6,700 yuan per year for critical illness.

Suddenly, a sudden illness. Dead.

How should this be compensated?

Hello dear. Critical illness insurance does not cover death liability. The amount of compensation is related to your payment base, number of years, etc., and the amount of solid compensation is determined after calculation according to the contract<>