Claim report
(1) online application
You can follow and log in to the official account of "Jiangsu Medical Bao Hui 1" WeChat, click Service Center-Claims Service in the menu bar at the bottom, and fill in and upload the information according to the prompts.
(2) Offline service
If you cannot apply online due to special circumstances, you can call "Jiangsu Medical Bao Hui 1" unified customer service telephone number 400065 1066 to consult the offline service path.
Claim materials
The materials required to apply for "Bao Hui 1No. of Suyi" include (subject to the tips on the application page):
(1) the identity certificate of the insured, and the minor can provide the household registration book (birth certificate);
(2) medical records such as inpatient medical records, outpatient medical records and drug prescriptions;
(3) Medical invoice, expense list and basic medical insurance statement (if submitted online, the original invoice shall be marked with a black signature pen "Claim has been applied to China Life Insurance Jiangsu Branch" and signed, and the electronic invoice is exempt from visa);
(4) Hospital diagnosis certificate, inspection report, etc. ;
(5) The bank account number of the insured or his guardian or beneficiary (legal heir);
(6) If the third party pays in advance, it is required to provide the original statement of the third party and the corresponding medical records, copies of invoices, expense lists, prescriptions, copies of basic medical insurance statements and other claims materials;
(7) Other materials that the insurance company considers necessary to confirm the nature of the insured accident.
Please take good care of the original data for subsequent insurance companies to collect and check. )
Claim process
(1) The applicant pays attention to and logs into the official account of "Jiangsu Medical Bao Hui 1" WeChat, clicks on the service center-claims service in the menu bar at the bottom, and fills in and uploads the materials according to the prompts.
(2) If the insurance company finds that the information is missing or needs to send paper information, it will notify the applicant and will continue to process it after it is completed.
(3) The insurance company conducts claim review according to the complete information. If a decision is made to settle claims, the insurance premium shall be paid to the account of the relevant obligee; If it is decided not to pay compensation, a notice of decision will be issued.
(4) Applicants can check the progress and results in the official account of "Jiangsu Medical Bao Hui 1" WeChat.
(If there is any adjustment to the claim method during the insurance period, it will be updated in time to inform everyone. )
Important tips for claims settlement
(1) If the insured is a minor, the identity certificate and relationship certificate of the guardian shall be provided at the same time;
(2) If the insured dies, the death certificate (such as medical death certificate, cremation certificate or burial certificate, cancellation certificate, etc.). ) should also be provided. When the insurance money is taken as the insured's inheritance, it is also necessary to provide relevant rights documents that can prove the legal inheritance right;
(3) If the insured entrusts others to apply for claim settlement, it is required to sign a power of attorney, which shall be signed by a person qualified for claim settlement, and indicate the scope or matters of authorization, and provide the identity documents of the entrusting parties;
(4) According to the anti-money laundering regulations of the People's Bank of China, you need to fill in the anti-money laundering information registration form when applying for compensation.
Frequently asked questions about claim settlement
1, how long will it take to settle the claim?
After the claim materials are submitted completely, the insurance company will timely examine and approve the application cases with clear nature and within the scope of insurance liability. If the situation is complicated, it will be approved within 30 days.
2. How long is the validity period of filing a claim?
The period of validity for submitting a claim is 2 years from the date of knowing the insured accident.
3. In which hospitals can I get claims?
Designated medical institutions with national secondary and above basic medical insurance (excluding special needs, international medical department, foreign guests' wards, etc.). ), and designated medical institutions can make inquiries through official website and local medical security administrative departments.
4. What are the expenses of psychotherapy?
Responsibility 1 includes the part paid by individuals within the scope of medical insurance payment in designated hospitals and retail pharmacies. Responsibility 2 is limited to the part paid by individuals outside the scope of medical insurance payment in designated hospitals. The scope of special diseases (or projects) shall be implemented in accordance with the relevant provisions of the basic medical insurance. Among them, if the special protection of the insured place contains special provisions, the diseases or items corresponding to the special provisions are not included in the compensation scope of this product.
5. Must the claim for "Jiangsu Medical Bao HuiNo. 1" be submitted after medical insurance reimbursement?
Yes, if the insured enjoys the basic medical insurance benefits in Jiangsu, but is not reimbursed by the basic medical insurance, he shall submit the claim application of "Su Yi Bao Hui 1" after the basic medical insurance reimbursement.
6. The medical insurance is invalid. Can Jiangsu Medical Bao Hui 1 still pay for it?
"Jiangsu Medical Bao Hui 1" bears the insurance liability of the insured during the effective period of Jiangsu basic medical insurance benefits, and does not bear the insurance liability of the expenses incurred during the invalid or invalid period of Jiangsu basic medical insurance benefits.
7. Can hospitalization be reimbursed before the effective date of the guarantee?
If you go to the hospital for the same medical treatment (referring to one-time settlement) before or during the waiting period of 2022 10/,and are discharged during and after the insurance period, this product will not bear the insurance liability.
8. Can I be reimbursed if I don't leave the hospital after the guarantee?
If the patient is admitted to hospital after the waiting period (referring to one-time settlement) after the same medical treatment, and the treatment is not finished after 65438+February 3, 20221,this product will normally bear the insurance liability, and the longest time will not exceed 180 days. For the insured who has been insured continuously, if the admission time and discharge time span two policy years, for the medical expenses of the same medical treatment, this product will make liability claims according to the policy of the year of admission date.
9. Can medical treatment in different places be reimbursed?
The insured person's medical treatment in different places (including overseas medical treatment) meets the requirements of the Measures for the Administration of Basic Medical Insurance and Health Administrative Departments in the Insured Places, and goes through the referral and filing procedures according to the regulations, and enjoys the protection benefits of this product normally. If the referral and filing procedures are not handled according to the regulations, 50% of the guarantee treatment of this product will be implemented (except for emergency, the emergency medical certificate and emergency expense settlement certificate shall prevail).