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来华留学保险常见Q&A

时间:2017/5/25 9:49:00 来源: 作者:Admin 点击:623

理赔问题

Issues on claims settlement

 

 

Q1:我从老师那边获得了一张红色的保险卡,有什么作用?

Q1:I received a red card for insurance from my teacher. What is it for?

 

A1:服务卡的作用为提示和联系,不具备直接支付功能。

A1:The function of the service card is for reminding and contact and it does not have the function of direct payment.

 

 

本卡的作用在于提醒学生记得服务卡号,以及服务卡上的救助电话(最好把电话号码及服务卡号保存到手机里防止服务卡遗失),在就医前或需紧急就医时可拨打服务卡上的电话,报你的护照号或服务卡号进行咨询,我们将24小时为您服务,直到你毕业时都可以连续使用这张卡片(无须更换)。

The purpose of this card is to remind the students to remember their service card number as well as the telephone number on the service card (it would be best if the telephone number and the service card number are saved in your cell phone so as to avoid loss of service card).You could dial the telephone number on the service card before going to see a doctor or in urgent need of visiting a doctor. You should show your passport number or the service card number for consultancy and we will provide service to you 24 hours a day. You can continuously use this card until your graduation (it is of no need for you to change it).

 

 Q2:我在哪里可以了解到更详细的保险说明?

 Q2:Where can I understand more detailed insurance instruction?

 

 

A2:如果你想了解你所购买的保险的具体信息,例如保险责任范围,保险理赔资料,资料邮寄地址等,你可以登录网址www.lxbx.net了解的相关保险内容信息,有10种语言的详细说明。

A2:If you would like to know the specific information on the insurance you have purchased, such as the scope of the insurance duty, the materials for insurance claim settlement, or the address for posting the materials, you could log on the website www.lxbx.net to know more about the information related to the content of the insurance having been explained in ten languages in detail.

 

Q3:我们买的保险哪种情况不能赔付?

Q3:Under which kind of condition is the claim of the insurance we bought unable to be settled?

 

 

A3:请登录www.lxbx.net --> 点击【投保指南】,可查看其中的责任免除说明,凡在免除责任范围内发生的事故,保险责任中明确标注不能报销的范围,均不能赔付。

A3:Please log on www.lxbx.net --> click【Instruction for Buying Insurance】so as to check the instruction for duty exemption in it. No accident incurred within the scope for exemption of duties could be claimed if the scope is specified to be unable to be reimbursed within the insurance duty.

 

 

另外,还有一些特殊费用不能报销的情况有:如配眼镜、餐费、打车费、药店购买任何东西、器材公司购买的东西。

In addition, there are also some conditions when special fees could not be reimbursed, including getting the right lenses for one's eyeglasses, fees for having food in restaurants, taxi fees, buying anything in drug stores, and the things bought in instrument companies.  

 

Q4:你们所列的疾病门诊包括哪些类型?

Q4:Among the diseases listed by you, what are the types for out-patients?

 

 

A4:普通门诊、急诊、门诊手术、急诊留观、急诊抢救等所产生的相关费用,由公立医院或卫生防疫部门提供证明的传染病因隔离期间所产生的相关费用、及因与住院同一病因产生的院前、院后费用等均归属于门急诊医疗责任范围内。

A4:The fees related to the following types are all within the scope for outpatient service or emergency treatment: common outpatient service, emergency treatment, outpatient operation, observed patient under emergency treatment, first aid in emergency treatment, those incurred by contagion in isolation period and having been proved by public hospitals or medical departments, and those incurred due to the same reason for being hospitalized before and after having been hospitalized.  

 

简单判别方法为:发票为门诊发票。

A simple method for determination: The invoice is for outpatient service.

 

Q5:疾病门诊为什么要扣我的650元或2000元的起付线,“起付线”是什么意思?

Q5:Why does the outpatient service charge me a beginning amount of RMB 650 or 2000? What does “the beginning amount” mean?

 

Q5:扣除起付线,也称免赔额,是保险公司根据规定对被保人门诊医疗责任理赔费用的计算起点,起付线及以下的门诊费用由被保险人自己支付。

A5:The beginning amount having been charged is also called as an amount having been exempted, and it is the beginning point for the fees having been claimed for the outpatient clinical duties to the insuree by the insurance company, but the amount for and below the beginning one should be paid by the insurees themselves.

 

Q6:如果我在公立医院住院,想住包房、外宾部、高干病房、特需病房、套房等,也可以进行理赔吗?

Q6:If I wish to be hospitalized in a public hospital, including living in a single room, Department of Foreign Patients, Wards for High Officials, Wards for Patients in Special Needs, and suites, etc., could the fees also be claimed?

 

Q6:不可以。仅限医保范围内的普通病房。

A6:No. The fees to be claimed are only limited within the scope for medical insurance.

 

 Q7:如果我多次住院,保险公司也理赔吗?

Q7:If I have been hospitalized for many times, could the fees be claimed from the insurance company?

 

A7:在同一个保期内,被保险人不论一次或多次住院治疗,本公司均在规定限额内给付保险金,分项累计给付金额达到其保险金额时(40万元人民币),该项保险责任终止。

A7:No matter how many times (one or more) the insuree has been claimed within the same insured periods, the company will also

 

 Q8我看的疾病门诊费用,为什么没有100%给我报销,怎么计算的?

Q8:Why is not all the fees for my outpatient service reimbursed? How had it been calculated?

 

A8:疾病门诊报销是要扣除起付线和超600元日限额以上的费用的,具体规定请参考留学生保险简介-à保险责任-à第4点。

A8:It needs to deduct the beginning amount and the fees exceeding the daily limit of RMB 600. For specific regulation, please refer to Introduction of Insurance for Overseas Students -àInsurance Duties-àArticle 4.

 

示例如下:

Examples are shown as below:

 

a.例如你交的是800元或400元的保费:在保险期间内因病在当地的公立医院就诊,2016年2月1日花费900元,5月3日花费400元,7月15日花费700元(就诊费用均为合理费用)。

a. If you have paid an insurance fee at RMB 800 or RMB 400, then you have paid RMB 900 on February 1st, 2016, paid RMB 400 on May 3rd, and RMB 700 on July 15th (all the fees for clinical service are rational) due to being treated in a local public hospital within the insurance period.

 理赔计算公式:{(600元+400元+600元)-650元}*85%=807.50元

The formula for claim settlement: {(600 +400 +600)-650}*85%=807.50 (Unit: RMB Yuan)

 

 

b.如果您交的600元或300元的保费:在保险期间内因病在当地的公立医院就诊,2016年2月1日花费900元,5月3日花费400元,7月15日花费700元,8月1日花费1200元(就诊费用均为合理费用)。

b. If you have paid an insurance fee at RMB 600 or RMB 300, then you have paid RMB 900 on February 1st, 2016, paid RMB 400 on May 3rd, RMB 700 on July 15th, and RMB 1200 Yuan on August 1st (all the fees for clinical service are rational) due to being treated in a local public hospital within the insurance period.

 

 

理赔计算公式:{(600元+400元+600元+600元)-2000元}*85%=170元

The formula for claim settlement: {(600 +400 +600 +600)-2000}*85%=170 (Unit: RMB Yuan)

 

 

Q9.我看完病要申请报销,怎么办理?

Q9What should I do for application for being reimbursed after receiving medical service?

 

 

A9.根据实际就诊情况分类属于门诊还是住院,再按如下的要求准备理赔资料;

A9:First the type of the medical service should be confirmed to be outpatient one or having been hospitalized according to real conditions, and then materials for claim settlement should be prepared according to the following requirements:

 

门急诊材料(在医院门诊看病的材料):

Materials for outpatient service and emergency treatment (materials for visiting doctors in outpatient service):

 

1.门急诊收费收据(发票)原件(发票姓名使用护照姓名中一个完整字段即可;如理赔申请书/委托书签中文名的可以写中文名;公立医院-国税发票-盖医院及财务章、地税收据不能报销);

1. The original receipts (invoices) for fees paid for outpatient service and emergency treatment (it would be enough to use a complete field from the name in the passport for the invoice; Chinese name could be for the Application/Entrustment in need of Chinese signature; but the public hospital – invoice for national tax – having official seals of the hospital and financial seals, and receipts for local fees should not be reimbursed);

2.每次门急诊就诊记录/病历(每次看病记得跟医生说明写门诊病历,每次就诊发票日期与病历日期一一对应);

2. The record/case history for visiting a doctor in each outpatient service and emergency treatment (every time you should remember to remind the doctor to record your outpatient service and the date in an invoice for each visit should be corresponding to the one on case history);

 

3.检查单、化验单复印件或其他补充材料;

3. Examination List, Copy for Chemical Examination, or other supplementary materials;

 

以上1-3是在医院看病时必须获取的资料,所以你去医院时,记得记得留存这些材料,如果已看完病,没有其中一项资料时,需要你再去医院再补一下这些资料,发票丢失不报!)

The above 1-3 are the materials having to be obtained when visiting doctors in hospital; so if you go to a hospital, you should remember to save these materials; and if you have finished being diagnosed and there is some item having been omitted, you need to go to the hospital to supplement these materials again, but no reimbursement would be realized if the invoice has been lost!.  

 

 

4.意外事故证明(必须提供这个资料,写明什么时间因为什么发生了此意外事故,需要找你的学校帮助盖章。如果涉及交通事故需要交通事故责任认定书;如果涉及刑事案件,出具公安部门相关证明。)

4. Certificate for accidents (Materials must be supplied for this, stating when and why these accidents had, and you need to go to your school to get help for sealing. If it involves with traffic accident, then Traffic Accidents Report should be provided; and if it falls into a criminal case, the related certificate should be provided by public security departments.)

 

 

5.留学生本人的护照及签证页复印件(有效期内);

5. The copies for the passport and the visa page of the overseas students in person (within valid periods);

 

 

6.留学生本人中国境内的银行卡信息表(此文件获取条件1.当时在银行办理银行卡的回执复印件;2.拿护照和银行卡去银行找工作人员打印银行卡信息表。需要有准确账号、户名和开户分支行信息。)

6. Information Form for the bank card within the territory of China of the overseas student in person (Conditions for obtaining this document: 1. The copy for the receipt of obtaining the account card from the bank; 2. Take your passport and bank card to the bank to find working staffs to print bank card information form. Correct account number, account name, and information on branch of the opening bank ).

 

 

7.理赔申请书/委托书(本人签字+留办盖章),可网上下载模版(出链接);

7. Application for claim/Entrustment (personal signature+seal from the office for overseas students), the formulate for which could be downloaded from our website (show the link);

 

 

 

住院材料(在医院住院的材料需提供):

Materials for hospitalization (the materials for hospitalization should be provided);

 

1.住院收据(发票)原件(发票名字需与护照某字段一致、理赔申请书/委托书签中文名的可以写中文名、公立医院-国税发票-盖医院及财务章、地税收据不能报销)

1. The original receipts (invoices) for hospitalization (the name on the invoice should be consistent with a field from the name in the passport; Chinese name could be for the Application/Entrustment in need of Chinese signature; but the public hospital – invoice for national tax – having official seals of the hospital and financial seals, and receipts for local fees should not be reimbursed);

 

 

2.总住院费用清单(总明细);

2. List for Total Hospitalization Fees (Total Details);

 

 

3.出院小结或住院病历复印件(出院时记得找医生提供);

3. Brief Summary for Hospitalization; Copy for Hospitalization Case (remember to request the doctor to provide for you);

 

以上1-3是在医院看病时必须获取的资料,所以你去医院时,记得记得留存这些材料,发票丢失不报)

The above 1-3 are the materials having to be obtained when visiting doctors in hospital; so if you go to a hospital, you should remember to save these materials; but no reimbursement would be realized if the invoice has been lost!). 

 

 

4.意外事故证明(必须提供这个资料,写明什么时间因为什么发生了此意外事故,需要找你的学校帮助盖章。如果涉及交通事故需要交通事故责任认定书;如果涉及刑事案件,出具派出所相关证明。)

4. Certificate for accidents (Materials must be supplied for this, stating when and why these accidents had, and you need to go to your school to get help for sealing. If it involves with traffic accident, then Traffic Accidents Report should be provided; and if it falls into a criminal case, the related certificate should be provided by public security departments.)

 

 

5.留学生本人的护照及签证页复印件(有效期内);

5. The copies for the passport and the visa page of the overseas students in person (within valid periods);

 

 

 

6.留学生本人中国境内的银行卡信息表(此文件获取条件1.当时在银行办理银行卡的回执复印件;2.拿护照和银行卡去银行找工作人员打印银行卡信息表。需要有准确账号、户名和开户分支行信息。)

6. Information Form for the bank card within the territory of China of the overseas student in person (Conditions for obtaining this document: 1. The copy for the receipt of obtaining the account card from the bank; 2. Take your passport and bank card to the bank to find working staffs to print bank card information form. Correct account number, account name, and information on branch of the opening bank ).

 

 

 

7.理赔申请书/委托书(本人签字+留办盖章),可网上下载模版(出链接);

7. Application for claim/Entrustment (personal signature+seal from the office for overseas students), the formulate for which could be downloaded from our website (show the link);

 

 

 

准备完资料以后,请快递到如下地址,(如下具体地址不用翻译)

The prepared materials should be sent to the following address with courier:

 

 

北京市朝阳区东三环中路55号双子座B303

收件人:来华项目理赔部

电话: 40081051191

邮编: 100022

 

 

 

收到资料后,我们会尽快处理,大概两概星期左右会通知您结果。

We will deal with the materials as soon as we received them, and we will notify you of the result in about two weeks.

 

 

Ø  祝您就医顺利!早日康复!

Wish you have a successful medical visit and early recovery!

 

Q10:我要去医院看牙,能报销吗?

Q10Could I be reimbursed if I go to see a dentist in hospital?

 

A10 公立医院普通科室,正常治疗费用(除自费费用),按保险要求报销,如果期间产生镶牙、种牙等费用就不能报销。

A10The normal fees for treatment (except for those should be paid by oneself) received in ordinary department in public hospital could be reimbursed according to the corresponding requirements on insurance, but the fees for insert artificial teeth or implantation of teeth within the period should not be refunded.

 

 

提示:同样每次看病都需要提供每次(每次)的门诊病历。切记。

Reminder: Identically, you should provide case history record for every time of your visiting medical institutions. Please do remember this.

 

 

Q11:女性的怀孕、妊娠、流产能报销吗?

Q11Could it be reimbursed for females due to pregnancy, gestation, or abortion?

 

 

 

A12:不能报销。怀孕、妊娠、流产等是属于保险的除外责任。

A11No. Pregnancy, gestation, or abortion is the exclusions for insurance.

 

 

Q12:我看病的时候忘记让医生写病历了,怎么到医院补门急诊病历?

Q12How could I supplement the case record for outpatient service or emergency treatment if I forget to have a doctor to do so?

 

 

A12:请您本人持护照原件及该次看病医院给您出具的发票原件及其他相关医疗文件,到您看病的这家医院的门急诊所在科室,找医生给您补该次看病的门急诊病历,注意此门急诊病历所记载的就诊日期一定要与发票的日期一致;如果到医院后遇到困难,也可以到导医台需求帮助;

A12:Please bring your original passport as well as the original invoice and other related medical documents issued to you by the hospital you go to for that time to the department for the outpatient service or emergency treatment we received in that hospital and find the doctor to write up the records for you. Please be noted that the date for receiving medical service recorded in this case history for outpatient service or emergency treatment must be identical to the one on the corresponding invoice; and you could also go to the Guiding Desk to ask for help whenever you have difficulties after having arrived a hospital.

 

 

 

Q13:医生让住院,想申请住院医疗费用垫付,我该如何办理?

Q13What should I do if I wish to apply for the medical fees to be prepaid because the doctor wishes to hospitalize me?

 

 

A13.就诊前请一定先拔打4008105119-1电话进行入院前的咨询。

A13:You must first dial 4008105119-1 to consultation for pre-hospitalization before visiting a doctor.

 

注意条件:

Conditions to be noted:

 

 

1.       如果要申请垫付,必须在网络医院,如果你不知道哪家是网络医院,请登录www.lxbx.net查询。

1. If you apply to be prepaid by us, you must go to a hospital in our network. If you can not confirm which hospital is in our network, please log on www.lxbx.net for reference.

 

2.       住院一定是在医院的普通科室医保能报销的普通床位。不能报销和垫付在医院的这些情况:特需、VIP、医疗整形美容科、康复科、干部病房、包房、挂床等期间产生的所有医疗费用。

2. Hospitalization must be conducted on ordinary bed able to be reimbursed by ordinary department medical insurance in a hospital. The following conditions in a hospital could not be reimbursed or prepaid: all the fees incurred due to special needs, VIP, Department for Medical Plastic Surgery, Recovery Department, Ward for Officials, Single Room, and false hospitalization.

 

3.       一定要达到住院条件才可以住院,自己申请或未达到住院标准住院的,医疗费用不予报销;

3. Hospitalization is not permitted unless conditions for it have been met. The medical fees will not be reimbursed if they are only applied by the patients themselves or hospitalization is conducted without conditions having been satisfied.

 

 

4.       住院时一定和医生说明,所有的医疗费用须使用当地医保范围内的项目,如果产生自费和部分自费的费用,不在保险责任内,须本人自行承担。

4. Upon hospitalization, the patient has to specify to the doctor that all the fees for medical treatment must be incurred to the items within the local medical insurance. The fees incurred to be paid by oneself partly or completely are not within the scope of insurance, which must be borne by the person himself.

 

5.       你所在医院看的病,必须附合报销条件(详细保险责任说明及除外责任见网上上的详细介绍)。

5. The disease for which you go to a hospital must meet the conditions for reimbursement (Refer to the detailed instruction on internet for detailed explanation to insurance duties and exclusions).

 

6.       垫付注意事项:

6. Issues to be noted for prepaid:

l  住院姓名与护照姓名中某个完整字段一致,发现不一致时请马上到医院住/出院处变更,以免影响垫付及后期理赔,以中文姓名办入院的,保单、《保险理赔申请书》上须标注有此中文名;

l  The name for hospitalization must be consistent to a certain field of the name on you passport. If you find there is inconsistency, you should go to the Department of Hospitalization/Discharging for changing so as not to affect our prepayment or later claim settlement. If you are hospitalized with your Chinese name, then this name must also be marked in the insurance policy or Application for Insurance Claim Settlement;

 

l  如果您办理完住院手续到科室后,一定尽快通知4008105119-1,以便落实垫付服务;

l  You must notify 4008105119-1 as soon as possible after you finish all the procedures for being hospitalized and arrive at the department so as to receive our service of prepayment for you;

 

l  如果为您垫付了医疗费用,出院时是需要您将出院小结、诊断证明、费用总清单及发票原件提交给我们。

l  If we have prepaid the medical fees for you, you need to submit you Brief Summary for Discharging, Certificate for Diagnosis, List for Total Fees, and the original invoice to us upon your being discharged from the hospital.

 

投保问题

Question on application for insurance

Q1:我想买来华留学生保险,能告诉我怎么购买吗?

Q1: I wish to buy insurance for overseas students to China, so would you please tell me what I should do to buy them?

 

A1:需要通过你的学校办理,可以让你的老师跟我们联系。

A1:You need to finish procedures through your school and let your teachers to contact us.

 

Q2:我想给我的家属也买这个保险可以吗?

Q2: Can I also buy this kind of insurance for my family members?

 

A2:不可以

A2:No.

 

你可以电话到*******,可以购买其他的保险产品,但跟你的保险内容是有差别的。

You can telephone *******, so you can buy other insurance products, but they are different from the one for you in content.

 

Q3:我在网上购买你们的保险,操作时出现问题,怎么办?

Q3: If problem arises when I buy your insurance on the internet, then what should I do?

 

A3:请拔打4008105119-4,工作人员会通过系统给你查询问题及办法。这个电话只限工作日的工作时间会有人接通。

A3: Please dial 4008105119-4, so our staffs could check the questions and solutions for you through our system. This telephone number is available on working days when it will be received by our staffs.

 

 

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