How difficult it is to make a critical illness insurance claim and how to pay for critical illness i

Critical illness insurance claims can be paid if they meet the conditions agreed in the contract, and the number of claims made by insurance companies every day is huge. In 2019, the claims ratio of most insurance companies was above 97%, and the claim ratio of Beijing Life Insurance reached 100%. Even the insurance companies with the lowest claims rates have reached the point where "difficult to settle claims" is not worthy of the name.

Many users think that it is difficult to make a claim for critical illness insurance because they did not have a clear understanding when buying insurance, and they only found that there was a difference between them and their own phenomenon when they went out of the insurance later, so they should have a detailed understanding of the insurance terms before applying for insurance, especially the payment standard of critical illness insurance, because some diseases are not paid immediately after diagnosis, and they need to reach a certain disease state or perform relevant surgery before they can be paid.

In the critical illness insurance contract, there are indeed several situations in which there are no compensations. Let's take a look at the details.

1. No compensation within the scope of the exemption clause.

In addition to the insurance instructions and insurance liability, the critical illness insurance clause also has an exemption clause and other contents, and if the insured is out of the scope of the exemption clause, the insurance company will not make a claim, such as illegal and criminal acts, force majeure events caused by the insurance.

2. The disease is not contracted out.

Critical illness insurance refers to the protection of the serious illness agreed in the contract, if the serious illness suffered by the insured is not covered by the contract, the insurance company will not make a claim. Secondly, appendicitis and mild kidney stones cannot be regarded as serious diseases. The Code for the Use of Disease Definitions in Critical Illness Insurance, jointly formulated by the Insurance Association of China and the Chinese Medical Doctor Association, also has unified and clear provisions on the diseases that should be insured by critical illness insurance products.

Therefore, when applying for insurance products, it is important to be clear about the content of the protection.

3. Failure to meet the claim standard.

Many people have the impression that critical illness insurance is "paid immediately upon diagnosis", which cannot be said to be completely wrong, but it is not comprehensive. In addition to the most common malignant tumors (such as cancer), there are two other conditions: the agreed surgery such as major organ transplantation and coronary artery bypass surgery can only be paid; If the agreed state of illness such as the sequelae of stroke is reached, it can only be paid, and it is not paid immediately after diagnosis, so if the critical illness does not meet the claim standard, the insurance company will not make a claim.

4. Accidents during the waiting period.

The waiting period for critical illness insurance is generally 90 or 180 days. The main purpose of setting up a waiting period is to prevent moral hazard and insurance fraud. If the waiting period for the critical illness insurance is 90 days, then if you get a critical illness within 90 days after the policy is purchased, the critical illness insurance will not be covered.

During the waiting period, the insurance company will generally agree to refund the premium paid and the insurance contract will be terminated; There are also some critical illness insurance conditions that are relaxed, and this time the insurance will not be compensated, but the contract will continue to be valid.

5. Failure to tell the truth.

Before buying critical illness insurance, you should inform your health details, and the insurance company will use the health notice to weigh the risk of underwriting and decide whether to underwrite or not. Some people deliberately conceal their illness knowing that they are suffering from certain diseases and are at risk of serious illness. In this case, even if the insurance is successfully purchased, the insurance company will not make a claim after the later accident.

Test your anti-risk index, experts will interpret it for you for free!

Most of the insurance companies' claims settlement rates are 97%-99%, and in critical illness insurance, the 28 high-incidence critical illnesses stipulated by the China Banking and Insurance Regulatory Commission account for 8-9% of critical illness claims. In addition, critical illness insurance claims are also affected by factors such as health notices, waiting periods, and whether the accident is reported in a timely manner, which may seem complicated, but in fact, as long as the process agreed in the contract is followed, it is generally not difficult to settle claims. Senior sister would like to remind everyone that once we have successfully applied for insurance within the insurance period, we must notify the insurance company within the time limit specified in the contract and submit the required information as required, otherwise the insurance company can not make a claim.

Secondly, pay attention to health advice. When we apply for critical illness insurance, the insurance company will ask us for the relevant health condition. For the insurance company's requirements, we must tell the truth, and the insurance company does not ask for us, we can not answer.

If we conceal the truthfulness of the insurance company's requirements, even if the insurance is successful, we may be denied or terminated if we are found to be subsequent. Regarding health notice, friends who don't understand can take a look at this article again: Is the health notice of the insurance company making it difficult for us?

In addition, the waiting period is also a setting that is closely related to critical illness insurance claims. Generally speaking, the waiting period for critical illness insurance is 90 180 days, and the insurance company can not pay the claim if the insurance is due to non-unexpected reasons during the waiting period; However, if the insurance is due to unexpected reasons during the waiting period, some products can directly claim the claim and ignore the waiting period. The waiting period is set by the insurance company to prevent deliberate insurance fraud, otherwise if it is used by so many well-intentioned people, the insurance company may already be difficult to insure, let alone have the strength to settle claims.

There are three types of compensation for critical illness insurance: the first type is compensation upon diagnosis: it means that as long as you have been examined by a qualified medical institution, have typical clinical manifestations, and have a clear diagnosis that meets the definition of the disease, you can get the compensation.

The second type is the agreed condition payment, which usually has more complex criteria, first of all, the diagnosis must meet the definition of the disease, and the status of additional regulations. The third type is the agreed surgical benefit. These conditions are generally associated with vital human organs and require some kind of surgery**.

Which insurance company is better for critical illness insurance.

Claims for critical illness insurance are usually not difficult, and the conditions for claiming critical illness insurance will be specified in detail in the terms of the contract, and as long as the claim criteria are met, the insurance company will settle the claim in accordance with the provisions of the contract. If you are worried, you can also take a look at this critical illness insurance claim strategy compiled by the senior sister: how to make a claim after the claim case occurs.

Critical illness insurance claims require the insured to report the accident in a timely manner after the accident, and submit the claim information in accordance with the regulations of the insurance company. If it is a simple case, it will be reviewed immediately, and if it is a complex case, it will be approved within 30 days at the latest. If approved, the insurance company will issue a claim notice to the insured, and the claim will be paid within 10 days.

If the insurance company refuses to make a claim, it may be because the insured person has not truthfully disclosed his or her health condition, has not complied with the provisions of the contract, or has not prepared the claim documents, etc. If you want to know how to get the claim payment quickly and well, you can take a look at the claim information that needs to be submitted: What are the claim materials?

Details determine the success or failure of a claim!

Under the strict supervision of the China Banking and Insurance Regulatory Commission, as long as it meets the claim standards, then the insurance company will not dare not make a claim, so you don't have to worry too much about the problem of claims. You must know that the most important thing for a high-quality critical illness insurance is comprehensive protection, and most of the excellent critical illness insurance on the market at present covers mild, moderate and critical illness protection, and these three basic protections must be available at the same time. In addition, if the product has a second claim for malignant tumors, a second claim for cardiovascular and cerebrovascular diseases, and a total disability benefit for death, it is better to have other practical benefits.

Xueba talks about insurance, focusing on insurance evaluation! When it comes to how difficult it is to make a critical illness insurance claim, then you must have overlooked the following points:What are the general claim information? Details determine the success or failure of a claim!

In fact, many people have misunderstandings about critical illness insurance claims, but critical illness claims are not"Compensation will be paid upon diagnosis".It's so simple, there are many people who only pay attention to what critical illnesses are included in critical illness insurance, but many times ignore the claim conditions for critical illness, resulting in information errors at the time of purchase and hitting a wall when making claims, so how to define the claim standard of critical illness insurance, I mentioned it in this article I wrote before:What is included in [Insurance Claims] and how to define the disability criteria for claims, you all need these

Among the 25 types of critical illnesses prescribed by the CIRC, only 3 are critical illnesses that are immediately compensated upon diagnosis. In fact, the immediate claim is only one of the conditions for critical illness insurance claims, and in general, critical illness insurance claims are divided into the following situations:

1. Compensation will be paid upon diagnosisIn fact, among the 25 types of critical illnesses, compensation is paid immediately upon diagnosisThere are only three of them2. Perform a certain type of surgery:Diseases such as benign brain tumors (craniotomy), major organ transplants or hematopoietic stem cell transplants, heart valve surgery, and aortic surgery must be performed in order to be paid.

3. Reach a certain state:After acute myocardial infarction, sequelae of stroke, deafness in both ears, deep coma and other diseases are diagnosed, it is still necessary to reach a certain state before the claim can be made.

In fact, there are relevant detailed descriptions in the insurance contract for the claim conditions of these critical illnesses, and the insurance company will not refuse to pay if the claim conditions are basically met, so we also need to keep our eyes open when choosing critical illness insurance, try to avoid those products with harsh payment conditions, and choose products that are more worth buyingWhat kind of insurance can cover critical illnesses? What critical illness insurance is worth buying?

It is very necessary to buy critical illness insurance, critical illness insurance claims are only relatively strict, and many people are not clear, here the senior sister will send you a claim encyclopedia of claims, how to make a claim.

As long as you suffer from a critical illness, you can get a claim from the insurance company with a diagnosis certificate.

This step is very important, and the general rejection of claims is also a problem in this link, such as incomplete claim application materials, not meeting the requirements, etc. Regarding the issue of claim materials, let's take a look at this summary, and in terms of preparing claim materials, you can also take a look at this article for reference. What are the general claim information?

Details determine the success or failure of a claim!

Case closing: For those who meet the insurance liability, the insurance company will close the case and make the payment. For those that do not fall under the insurance liability, the case shall be closed and a written notice shall be issued within a certain period of time and the reasons shall be explained.

The importance of critical illness insurance will not be diminished because of the "difficulty in making claims", but the "difficulty in making claims" is precisely because it is very important, and it will be more strict in the review, which is also a manifestation of responsibility to other policyholders in the same risk capital pool. Hope to adopt.

In case of a critical illness, it will bring huge medical expenses to the family, and there will also be loss of income such as ** expenses, family debts, and living expenses. Critical illness insurance, which can be paid in advance, can hedge these risks, and its sum insured can not only be used to treat diseases, but also to make up for the loss of family income.

It is difficult for people to eat whole grains and grains, and you can feel that the current incidence of cancer is also very high. If you suffer from a critical illness, not only do you need to have multiple times**, but you may not be able to work for several years and need a long-term recovery, and these are all costly. Although medical insurance can be reimbursed, it only reimburses the hospitalization part of the disease, and the loss of income is also a large part of the critical illness, and only critical illness insurance can play a role in making up for the loss of income.

The principle of critical illness insurance is very simple, that is, the insurance company will give a large sum of money for the illness that meets the contract. This money can be used freely for medical treatment, physical therapy abroad, recovery of the body, purchase of health products, etc. Critical illness insurance is essentially "loss of income insurance" and has been unanimously welcomed in many countries since its invention.

Because critical illness insurance combines financial, legal, and medical content, the product is too complex, and ordinary people simply do not have the ability to distinguish between good and bad, the reason why everyone thinks that critical illness insurance claims are difficult is because we simply think that critical illness insurance is to pay for illness, which is not to understand the claim logic of critical illness insurance, and now we will analyze how to settle for critical illness insurance

Critical illness insurance claims can only be paid in accordance with the contract, so how is the critical illness insurance contract agreed? Deep Blue Jun analyzes the top 25 critical illnesses that cover most of the claims, which can be basically divided into 3 categories:

Immediate compensation upon diagnosis: 3 types

Some kind of surgery is required to pay: 5 types

Reach a certain status to pay: 17

Please click Enter a description.

Therefore, critical illness insurance is not exactly a compensation upon diagnosis, and there are some diseases that require specific surgery, and some that need to reach a certain status. In fact, buying insurance is buying a contract, and these details are written in the contract, but ordinary people are too lazy to read or can't understand it.

Critical illness insurance claims can be paid if they meet the conditions agreed in the contract, and the number of claims cases of insurance companies is huge every day, and most insurance companies have a claim settlement rate of more than 97%. "Difficult to settle claims" is not worthy of the name. Many users think that it is difficult to make a claim for critical illness insurance because they did not have a clear understanding when buying insurance, and they only found that there was a difference between them and their own phenomenon when they went out of the insurance later, so they should have a detailed understanding of the insurance terms before applying for insurance, especially the payment standard of critical illness insurance, because some diseases are not paid immediately after diagnosis, and they need to reach a certain disease state or perform relevant surgery before they can be paid.

Extended Material: Claims.

1.Claim settlement is a concrete embodiment of the insurance company's execution of the insurance contract, the fulfillment of the insurance obligations, and the assumption of insurance liability. On the one hand, only when the claims settlement work is done well can the insured be compensated for their losses, the functions of insurance can be brought into play, the smooth operation of social reproduction and the normal stability of people's lives can be guaranteed, and the credibility of the insurance company can be improved. On the other hand, through insurance claims, the quality of underwriting business can be tested, and the weak links in disaster prevention and loss prevention can be exposed, so that the company can further grasp the law of disaster accidents, summarize and learn lessons and lessons, and further improve and enhance the company's operation and management.

2.There are two ways for the company to settle claims to the policyholder according to the insurance contract after the accident: compensation and payment.

3.Compensation corresponds to property insurance, which refers to the compensation made by the insurance company for the loss of the insured on the basis of the insured amount according to the damage of the insured property at the time of the accident. Insurance compensation is compensatory in nature, i.e. it compensates only for the part of the actual loss, at most equal to the value of the damaged property, and never more than its value.

4.Life insurance is based on people's life or body as the subject of insurance, because people's life and body cannot be measured by money, therefore, the damage to life or body caused by life insurance cannot be compensated with money. Therefore, in the event of an accident, the insurance company can only pay the insurance money to the insured or beneficiary within the amount agreed in the policy.

That is, life insurance pays the insurance money in the form of benefits.