保险理赔流程 Insurance Claim Process

1. 索赔手续：被保险人申请医疗费赔偿时，先填写《保险理赔申请书》一份并加盖公章，然后将资料交至保险公司服务人员。

2. 理赔时限：保险公司收取理赔资料后，在15个工作日内完成理赔，并将理赔款项直接打入被保险人个人帐户，或被保险人直接到柜面领取

3. 索赔时须提供的单据：

住院或意外门诊保险金的申请

由被保险人作为申请人，填写保险金给付申请书，并凭下列资料向保险人申请给付保险金：

（1）保险单或其他保险凭证及保险金申请书；

（2）被保险人身份证明；

（3）本补充约定指定或者认可的医疗机构出具的医疗费用原始收据、电脑打印的费用明细清单、意外门急诊病历复印件、出院小结；

（4）被保险人所能提供的与确认保险事故的性质、原因、伤害程度等有关的其他证明和资料；

注：不受理外配药发票及到药房自行购买的药费发票；

索赔时效:

被保险人申请住院或意外门急诊医疗赔偿时，应在三个月内提出索赔，否则，可能会带来的不利法律后果由被保险人自行承担。

索赔时须注意事项：

病历上注明病情、检查、治疗、用药及剂量；病历上的记录与收据上的收费的项目相符；病历上的诊病日期须与收据上的日期一致。

------------------------------------------------------------------------------------------------------

1.Claims procedures: when the applicant lodges a claim foe medical treatment, he/she shall fill in Insurance Claims Application with the seal and then give the relative materials to the service commissioner of insurance company.

2.Claims effectiveness: After taking the claims application, insurance company should finish claims within 15 working days and transfer the indemnity into the individual account of the insurer, or the insured can draw the benefits from the counter directly.

3.Forms Required in Claims

The out-patient or in-patient insurance application

The insured fills in the benefits claims application as the applicant and applies to the insurer for insurance with the following materials:

(1) Insurance policy or the other insurance documents;

(2) ID certificate of beneficiary;

(3) Duplicated documentation of the case history, diagnosis certificate, brief summary of leaving hospital, prescription and the original certificate of medical expenses issued by the hospital;

(4) Any other certificates and documents can be provided to prove the nature and cause of the insurance accident;

Remarks: the medicine invoice bought in drug store or in the other hospital shall not be included.

Validity of claims

The insured should apply for in-patient or out-patient and emergency medical benefits within 3 months. Any legal consequences otherwise are borne by the insured.

Notes in Claims

The information about case condition, inspection, treatment, medicine and dosage should be identified in the case history; the charged project in the receipt should be the same as the record in the case history; the date receiving treatment in the case history should be the same as that in the receipt.