Insurance FAQ

What documents do clients need to bring when applying for hospitalization?

· Medical insurance payment application form, filled out and signed by the insured

· Detailed diagnosis certificate issued by the hospital designated by the insurance company (including the full name of the diagnosis, brief medical history, and treatment process), detailed list of hospitalization expenses;

· Inpatient outpatient clinic, emergency diagnosis certificate, discharge summary

· Insured ID

· Original insurance policy

· Power of Attorney

What materials do customers need to bring when they have an accidental medical treatment?

· Medical insurance payment application form, filled out and signed by the insured

· Accident proof documents

· Diagnosis certificate issued by the county-level (inclusive) and above hospitals of the health department. Detailed diagnosis certificate (including the full name of the diagnosis, simple medical history, and treatment process)

· Detailed table of treatment costs

· Original receipts for treatment expenses (Original receipts for medicines should be prescribed)

· Outpatient, emergency diagnosis certificate insured identity certificate

· Original insurance policy

· Last payment receipt

· Power of Attorney

What kind of materials need to be prepared when a customer suffers from a serious illness

· Critical Illness Benefit Payment Application Form, to be filled out and signed by the insured

· Diagnosis certificate, operation certificate, pathological examination results, electrocardiogram, and other relevant documents required by the insurance company to identify the insured suffering from major diseases, etc. issued by the hospital designated by the insurance company

· The assured's identity document

· Original insurance policy

· Last payment receipt

· Power of Attorney

What materials do I need to prepare for a claim application in the event of a customer's death?

· Application form for payment of death insurance benefits, this application form should be filled out and signed by the beneficiary

· If there are more than 2 beneficiaries, the beneficiaries should jointly sign

· If the beneficiary is under the age of 18, it should be signed by the legal guardian of the beneficiary

· If no beneficiary is designated, it shall be signed by the legal heirs

· If the beneficiary dies before the insured and no beneficiary is designated, the legal heir of the insured shall jointly sign and issue a death certificate of the beneficiary; if the beneficiary dies after the insured, the beneficiary shall The heirs jointly sign, and legally a death certificate of the beneficiary must be issued.

· Insurance policy, claim application form, power of attorney, identity certificate of the beneficiary (providing a notarial certificate of inheritance rights if necessary), original household registration cancellation, original cremation certificate, hospital death notice, medical diagnosis certificate, pathological report, and corresponding examination report. Accidental death: Accident certificates, traffic accident certificates, work-related injury certificates, police station certificates, witness certificates, etc. are also required.

What kind of accident is an accidental injury accident?

According to the definition of the insurance contract, an accident that causes personal injury due to sudden, external, unintended, and non-disease reasons is an accidental injury accident.

What kind of reports will the insurance company not file for claims?

1. The person involved in the accident is not the insured named in the insurance policy.

2. The insurance contract has expired.

3. Other cases that do not meet the filing conditions.

What are the requirements for the status of an applicant for insurance benefits?

1. Applicants for survival insurance, disability insurance, disability security, and medical (expenses, allowances) insurance must be the insured or the insured's trustee.

2. The applicant for the death insurance must be the beneficiary himself or the beneficiary's trustee. If there is no designated beneficiary or the beneficiary dies before the insured or at the same time, the insured's heir has the right to claim the insurance.

Can the insured be reimbursed by the insurance company after an accident?

Not all accident insurance companies will cover claims. After the customer reports the case, the insurance company or the salesperson will inform the customer whether the accident occurred within the scope of insurance liability. Customers can also reconfirm by reading the insurance terms, consulting with an agent, or calling the insurance company's hotline. The insurance company only compensates the insured for the loss caused by the accident within the scope of responsibility. For the exclusions in the insurance clause, such as suicide within two years, crime, and the intentional behavior of the insured and the insured, the insurance company does not provide. Assure.

What documents do the insured need to provide when filing a claim with the insurance company?

To prevent someone from making unfounded or exaggerated claims, the insurance company will require the insured to provide evidence of loss and explain the detailed circumstances within a specified time. Regardless of the type of insurance, the beneficiary must prepare the original insurance policy, the originals of the insured's and the beneficiary's identity documents (identity card, household registration officer's certificate, and soldier's certificate), and the invoice of the latest premium paid. For claim settlement procedures, a power of attorney must also be filled out.

If the insured's claim involves medical expenses, and the insured has social medical insurance, what is the basis for the insurance company's claim?

If the insured has basic medical insurance and the social security has already reimbursed part of it, the insurance company must present the medical expense reimbursement split form issued by the social security to the insurance company in advance and indicate the total medical expenses spent and the expenses paid by the social security, together with Copies of the original documents should be handed over to the insurance company, and the insurance company will make claims within the remaining amount of medical expenses based on the above materials.

What is the time limit for a life insurance claim?

A life insurance claim must be filed within the claim statute of limitations. If the time limit is exceeded, the insured or the beneficiary does not file a claim with the insurer, does not provide the necessary documents, and does not receive insurance money, which is regarded as a waiver of rights. Different types of insurance have different periods. The limitation period for claims of life insurance is generally 5 years; the limitation period for claims of other insurances is generally 2 years.

What exactly does a life insurance claims adjuster do?

There are generally two types of life insurance claims adjusters, auditors, and investigators, or both. Auditors generally review the materials submitted by customers when they claim, put forward claims opinions, make claims decisions, and calculate the number of claims. Investigators use various methods to find out the true image of an insurance accident, defend the authenticity, and provide a basis for making a claim conclusion.

If I get sick during the observation period, will the insurance company pay compensation?

In some medical insurance contracts with compensation for medical expenses, to prevent the insured from deliberately applying for insurance with illness, and to reduce the risk of the insurance company, one of the provisions is that the insurance liability starts from the end of the waiting period (observation period) if The insurance accident occurs during the waiting period (observation period), and the insurance company is not liable for compensation.

If the claim is not covered by the insurance coverage, will the insurance company pay the claim?

It is also more common to claim the insurance company because of not knowing the insurance liability of the policy in hand, but it is finally rejected. Every insurance has its specific insurance responsibilities. Insurance is not a panacea, and it is not "all-in-one insurance". As a rational consumer, the responsible attitude towards oneself is to know beforehand the insurance that oneself (the family member) has bought and which insurance accidents can be liable for. In addition, consumers need to be reminded that before buying insurance, they must look carefully at the scope of insurance claims, and know what can and cannot be compensated after an accident.

If the insured does not tell the truth, will the insurance company refuse to pay?

Integrity is the most basic principle of insurance. This principle is specific to life insurance, which requires the insured to fulfill the obligations of truthful notification and declaration. That is to say, in the process of contracting the insurance, the insured shall truthfully answer the questions raised by the insurer about the subject matter of insurance or the situation of the insured. If the insured violates the principle of good faith, deliberately conceals the facts, and fails to fulfill the obligation of truthful disclosure, in the event of an insured accident, the insurer may not bear the insurance liability and may not refund the insurance premium.

The "Insurance Law" also has similar provisions. Article 17, paragraph 2 of the "Insurance Law" stipulates: "The insured intentionally conceals the facts, fails to perform the obligation of truthful disclosure, or fails to perform the obligation of truthful disclosure due to negligence, which is sufficient to affect the insurer's decision on whether to agree to underwrite or not. If the premium rate is increased, the insurer has the right to rescind the insurance contract."

In the event of force majeure factors such as natural disasters, will the insurance company pay for it?

Different life insurances have different exemption clauses, which need to be judged according to the contract terms of the purchased life insurance. Generally speaking, insurance will not pay for some force majeure factors such as natural disasters and wars. In addition, there are some special Professionals and high-risk groups, such as firefighters, who are also not compensated, which is the exemption clause in the insurance contract.

What should I do if an insured accident occurs during the grace period?

The grace period only provides a grace period for customers to pay premiums, but from the perspective of the insurance period, it already belongs to the insurance liability for the next year, so the insurance company will deduct the premiums payable by the insured in the next year from the insurance payment. If the insurance money paid is not enough to cover the insurance premium, the insurance premium should be paid first and then the claim insurance money should be paid.