Group's health insurance has unique skills to settle a claim

Group's health insurance has unique skills to settle a claim
Increasingly many enterprises and institutions insure staff group's health insurance, as the important employee welfare measure. However, because group's health insurance is usually insured by the unit, a lot of people do not care about the guarantee range of health insurance of the group, claims settlement procedure very much, the material that this offers after resulting in threatening is insufficient or wrong, and then influence settles a claim.
Everything should know yourself as well as the enemy. The assured need to understand the insurance rights and interests enjoyed by oneself at first, could obtain guarantee better. After it insure health insurance group, it information understood will need mainly to insurance responsibility staff, it last amount, not last time limit, except responsibility, and declare material,etc. that the need offered while settling a claim specifically, the information can generally be known from manuals of staff that the insurance company provide for enterprise. Once threaten, the customer can consult to company Human Resource Department first, or dial the hot-line of the insurance company, carry on again relevantly and settle a claim.
Some enterprises may insure for health to several different insurance companies at the same time, this may involve the question of using the hospitalization cost receipt many times in claims settlement, the customer must mark out on the application form of the claim to also need to claim from other insurance companies, and while offering the receipt original paper of the hospitalization cost, enclose copies. If just compensate the hospitalization cost partly, and compensate the proportion and lower than 50% actually, will offer customer expenses to cut apart single and returning the receipt original paper of the hospitalization costly, when the time comes, the customer can cut apart singly according to the expenses and the hospitalization cost receipt original paper is claimed from other safety units again.
Because group's health insurance is suitable for compensating the principle more, if the insurance company has already paid the hospitalization cost fully or compensated the proportion higher than 50% actually, will no longer return the expense receipt.
The expert points out, group's health insurance customer may not understand the procedure about ensuring and settling a claim fully at ordinary times, having ignored some details, the procedure fee setbacks of claims settlement that and these details will often make. For this reason, must remind group's health insurance customers: In order to settle a claim smoothly, the customer must look out for the corresponding " liability exemption " which ensure the project The item, should notice to the following details at the same time:
( 1) Only if the expenses going to a doctor in person are unable to be settled a claim, so, don't let others take the place of and examine. Remind it for a while here too, should check and declare the name on the claims settlement invoice and keep the same with me carefully, if is inconsistent, will basically suffer claims rejected. Cause such a reason and have: Some hospitals may type the patient's name by mistake while opening the invoice, or one's own name, with already inconsistent while insuringing, so, the customer must try hard to be careful in these links, if change the name, ones that must offer the organization rename as identification or depopulation,etc., you had better tell the insurance company does a good job of and upgrades the matters through Human Resource Department of one's own company in time.
( 2) Understand which are the hospital appointed in group's health insurance that the company purchases, must go to these hospitals to go to a doctor, if in the appointed ranges, generally all refuse to settle a claim.
( 3) Under having very appointed prerequisite, the expenses that organization purchases medicine beyond the hospital dispensary will not be got and compensated (the expenses substantially as to the fixed pharmacy of the social insurance to purchase medicine by oneselfing) . If really because there is not this kind of medicines in the hospital dispensary, need to go to the outside to buy, need to be affixed and mix the chapter outside by departments such as the outpatient Office of the hospital,etc..
( 4) There is no disease to write a prescription simply: Some staff let the doctor prescribe some medicines correlated to condition no while seeing the doctor, in order to using or health care while preparing against the disease. Medicines and relevant expenses drawn like this will not be got and compensated.
( 5) There should be medical history of keeping the same with invoice in the material offered, it is incomplete to only offer the invoice, not have medical history or medical history, also will influence and settle a claim.
( 6) There is no disease to check and treat as the customary regular physical examination, the insurance company will not submit an expense account and settle a claim. So, the medical check that only carries on when the customer has symptom, the part which accords with range of submitting an expense account could be settled a claim normally. (Tang YuanChun)
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