Is the health insurance claims process complicated?

First; If you accidentally get out of danger, the first thing to do is to stay calm, see if your danger is serious, and then call 120 yourself immediately or ask the people around you to help you call 120. On the way to the hospital, you should immediately contact your insurance broker, explain your general situation to him, and after arriving at the hospital, you should tell the doctor that you have purchased health insurance, so that the doctor will combine your situation when writing your medical records.

Second; Report to the insurance company by yourself or with the company of the insurance broker, and consult the information that needs to be prepared in the process of claims.

Third; Prepare relevant documents, which generally include: hospital medical records, invoices, receipts, personal ID cards, bank cards, etc. Each insurance company has a different decision on what to do.

Fourth; Give the information you have prepared to your insurance broker, and if there is no person in charge, you can call the insurance customer service to consult and submit the information. The next is to wait for the insurance company's compensation, if your own insurance situation is in line with the content of the insurance contract, you can generally make a claim. Insurance claims have always been the most concerned and worrying issue when buying insurance, but basically we can easily solve the claim problem by doing these four steps.

Health insurance claims depend on the specific insurance contract, different companies have different requirements for health insurance claims, most health insurance products can be claimed in advance, provide diagnosis and laboratory reports, medical records, insurance policies, ID cards, bank cards, etc., you can go to the insurance company to apply for claims.

In general, health insurance claims for critical illnesses are a one-time payment, and minor illnesses are paid on a pro-rata basis. What to note when making health insurance claims:

To apply for a claim, you must report the claim to the insurance company in a timely manner after the occurrence of the insured event. The insurance company will make an assessment in a timely manner after receiving the application for insurance payment and the proof and information agreed in the contract, and in case of complex circumstances, the verification will be made within 30 days.

2.Pay attention to the deductible, commercial medical insurance, all stipulate a deductible. If your medical expenses are less than the deductible, you will not be reimbursed.

3.Read the terms of the insurance policy carefully to understand what is covered and what is not.

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It's never hard to make an insurance claim. The difficulty is that you can't provide the claim materials required by the insurance company and still have to ask the insurance company to make a claim, or you don't buy the corresponding insurance but ask the insurance company to make a claim.

The first is like if you go to the bank to withdraw money, you don't have a bank card or no ID card, the bank counter can't handle it for you, this is a national regulation, and the bank can't withdraw money from you in violation of the regulations.

The second is like buying an electric appliance, you didn't buy a refrigerator, you only bought a TV, you have to use the TV as a refrigerator, you can't use it, you can't blame the TV for being fake!

Most people only hear that insurance claims are difficult, but they don't understand why it's hard to make claims.

In general, you will need to provide the following when making a claim

Insurance contract and proof of the most recent payment, claim application, beneficiary's ID card or heir's identity certificate and relationship certificate

The identity certificate of the insured, if the person entrusts another person, the "Power of Attorney for Claim" and the identity certificate of the client and the trustee and other basic information shall be issued.

When applying for a life insurance death claim, you must also provide: a medical death diagnosis certificate issued by a public medical institution at or above the county level designated or recognized by the company

Certificate of cancellation of household registration issued by the public security department

The forensic doctor's autopsy report and the cremation certificate issued by the funeral department (this point can be appropriately relaxed for rural areas that have not implemented cremation and funeral management).

Depending on the circumstances of the case, the insured party may be required to provide the original inpatient medical records (photocopy) or outpatient medical records.

When applying for short-term insurance death claim, it is necessary to provide: a diagnosis certificate issued by a public medical institution designated or recognized by the company, a certificate of cancellation of household registration issued by the public security and judicial departments, a post-mortem examination report or judgment, and a cremation certificate issued by the funeral department.

In case of death from disease, inpatient medical records (photocopy) or outpatient medical records must also be provided; In the case of accidental death, proof of accidental injury is also required: the traffic accident shall have the "Road Traffic Accident Liability Determination" issued by the traffic police department, the work-related death certificate issued by the labor department for the work-related death, and the case certificate issued by the public security criminal investigation department for criminal cases.

When applying for a medical expense insurance claim, you must provide: medical records issued by a medical institution designated or approved by the company.

Discharge summary, disease diagnosis certificate, original receipt of medical expenses (inpatients should provide a detailed settlement list of inpatients), and transfer certificate.

In the case of medical expenses due to accidental injury, it is also necessary to provide proof of the accident, such as the identification certificate of the industrial accident issued by the labor department, the road traffic accident liability determination certificate or criminal case certificate issued by the public security department, and the poisoning accident certificate issued by the health and epidemic prevention department.

When applying for a critical illness claim, you need to provide: the diagnosis certificate issued by the insured in a medical institution designated or recognized by the company, pathology report, electrocardiogram report, coronary angiography report, CT report and other examination reports related to the disease.

There are many types of health insurance, and different types of insurance have different payment methods, so you can check the terms of the product to understand its specific payment methods. The following senior sister will take two very common health insurances - critical illness insurance and million medical insurance as examples to explain their payment methods.

Critical illness insurance is basically a payment insurance, after the insurance, if the insured is diagnosed with the disease agreed in the contract during the protection period, and meets the claim conditions, the insurance company will pay the corresponding insurance money in accordance with the contract, the use of this insurance money is not restricted, it can be used to pay medical expenses, can also be used as Gao Hong's follow-up expenses, family living expenses and so on.

In addition to protecting critical illnesses, many excellent critical illness insurance will also provide other protection, you may wish to find out what a good critical illness insurance looks like: a good critical illness Qi Zheng book insurance looks like this! You've been lied to for so many years.

Most of the million medical insurance is reimbursement insurance, during the protection period, if the insured is sick and hospitalized, how much of the reasonable medical expenses incurred meet the claim conditions of the million medical insurance, then the product will be reimbursed according to the agreed proportion.

It is necessary to note that the million medical insurance basically has a deductible, generally 10,000 yuan, which means that the insurer and the insured agree in advance that the loss is within the specified amount, and the insured bears the loss by himself, and the insurer is not responsible for the amount of compensation. If you want to buy million medical insurance, then about the deductible, it is recommended that you know more: what is the deductible?

Is the less deductible the better?

It can be seen from the payment method of critical illness insurance and million medical insurance that the functions of these two types of health insurance are very different and play in different places, so if the economic conditions allow, the senior sister suggests that it is best to configure these two types of insurance, so that the personal security system is more perfect, and the economic risk of disease can be transferred more effectively. Regarding the difference between critical illness insurance and million medical insurance, if you still want to know more, you can check this article again: after reading these contents of medical insurance, you will know why you should buy critical illness insurance.

Health insurance is divided into sickness insurance, medical insurance, income protection insurance, etc.

Deductibles vary from company to company and need to be determined on a contract-by-contract basis. It is divided into absolute deductible and relative deductible. Absolute deductible means that a certain amount will not be compensated at once, and it will only be compensated if it is exceeded.

Relative deductibles are generally given as percentages, and how much percent is paid for the deductibles. Sometimes the two are also used together.

Extended reading: [Insurance] How to buy, which one is better, teach you to avoid these insurance"pits"

There are two types of critical illness, one is critical illness insurance, which is critical illness insurance with early payment.

You look at your own policy, which one it is. If it is the former, it is to wait until you are discharged from the hospital to lose money, but you also have to report the case when the doctor diagnoses it. The latter is to pay the sum insured immediately after reporting the crime.

Claim settlement is to accompany as much as the sum insured when buying insurance.

Extended reading: [Insurance] How to buy, which one is better, teach you to avoid these insurance"pits"

After all, the claim method of each health insurance product is not necessarily the same, and there will always be some differences, so how to make a claim for health insurance should be analyzed according to the specific situation.

If you have a little bit of insurance knowledge, you can take a look at this article by Senior Sister:

Ultra-complete! Everything you need to know about insurance is here

Next, the senior sister will introduce to you what things should be paid attention to when making health insurance claims! Don't talk nonsense, go straight to the dry goods!

Taking critical illness insurance as an example, we must first be clear about one thing, critical illness insurance does not pay corresponding compensation as long as the critical illness agreed in the contract is diagnosed, and some critical illnesses will only be paid by the insurance company if they reach a specific state.

Among the 28 types of critical illnesses stipulated by the China Banking and Insurance Regulatory Commission, only malignant tumors - severe, multiple limb loss, and severe burns will be diagnosed and compensated!

In addition, if the insured suffers from a critical illness that is not covered by the policy, the insurance company will not pay out even if it is diagnosed.

Therefore, you must carefully read the policy terms before you want to apply for a critical illness insurance claim!

The correct procedure for handling claims disputes

Secondly, after the insured is out of insurance, we can mainly report the case through the official customer service of the insurance company** claim**, the official website of the insurance company or the official WeChat of the insurance company*** and other channels.

The specific claim materials include the claim application, the insurance contract number, the legal and valid identity certificate of the insured, the legal valid identity certificate of the applicant and the relationship certificate, etc.

What are the general claim information? Details determine the success or failure of a claim! Hope.

Generally speaking, if you buy three health insurance policies from the same insurance company, as long as you meet the insurance company's payment conditions, then all three health insurance plans will provide claims to the insured. It is important to note that three different critical illness policies can be paid at the same time.

However, medical expenses that have already been reimbursed under one medical insurance cannot be reimbursed for three different medical insurance plans.

In addition, the insured does not have to worry that critical illness insurance and medical insurance will affect the outcome of the claim with each other, because the two types of insurance will not conflict with each other in the claim. If you don't know this, you can check out the following articleWhat is the difference between critical illness insurance, medical insurance, accident insurance, and life insurance?

Will it be washed away when making a claim?

Seeing this, we can find that whether the same company buys three health insurances, or the three companies each buy one health insurance, the insurance company can get protection. Therefore, it doesn't matter where you buy insurance, what kind of health insurance you buy is the most important thing we should pay attention to!

1. Comprehensive protection

A high-quality critical illness insurance will not only provide the insured with protection for mild, moderate and severe illness, but also set up additional benefits for cancer and critical illness. Compared with those products that are short of two pounds and pounds, critical illness insurance with comprehensive protection is more worthy of our choice. The most popular critical illness insurance on the market right now is Versailles Plus, if you want to know more about this product, you can click on the link below:

Versailles Plus Critical Illness Insurance is back, an in-depth review must be seen before buying!

The sum insured should be sufficient

Buying critical illness insurance is actually buying the sum insured, and only if the sum insured is sufficient, then the insured can get strong protection when the accident occurs. Therefore, the senior sister suggests that if the policyholder's premium budget is relatively sufficient, the insurance amount should be as high as possible!

In addition to these two points, there are many other aspects that we need to consider when purchasing critical illness insurance. If you don't want to step on the pit when you buy critical illness insurance, you can take a look at this article that Senior Sister once wrote:Which is the best critical illness insurance, how to buy it cost-effectively, and teach you to avoid these pitfalls of insuranceHope.

To avoid the difficulty of making a claim when making an insurance claim, you need to pay attention to the following points:

1. Understand the insurance claim process. The description of the claim process in the company's insurance terms can be understood by reading the insurance terms, and of course, the customer service counter of the insurance company or **** can consult the claim process in detail. When applying for a claim, you can ask the insurance claims adjuster about the specific steps and progress of the insurance claim.

2. Take a proper view of insurance. Establish a correct sense of insurance, correctly view the protection function of insurance, treat insurance claims realistically, and better protect your own interests. When entering into a contract, the principle of good faith is emphasized, all material facts are provided to the insurance company, and the agreement and commitment of the contract are abided by.

3. Pay attention to the problems in the insurance process. Customers should pay attention to choosing a strong insurance company when applying for insurance, so that they can be guaranteed in terms of customer service; Choose an insurer who has been in the business for a long time and has no bad records, and choose the insurance product correctly according to your personal situation; Pay attention to carefully read the terms and conditions of the insurance you have insured, and pay special attention to the understanding of the terms of insurance liability, truthful notification and claim application, etc., so as to avoid disputes in the future.

4. Matters to be paid attention to by customers in the claim process. Once the accident occurs, the customer should report to the insurance company in time, and collect the relevant documents as soon as possible with the assistance of the business personnel and go through the relevant procedures. In the process of handling a claim case, keep in touch with the claims adjuster frequently, and if the customer needs to provide relevant information, the customer should provide timely feedback.

Extended reading: [Insurance] How to buy, which one is better, teach you to avoid these insurance"pits"