医疗保险 Medical Insurance


  发布时间: 2017-03-22   信息员:   

医疗保险

为了保证在华留学生的健康安全,根据教育部国际合作与交流司规定,自2008/2009学年度起,凡来华学习时间超过六个月的留学生必须在注册时购买中国平安保险公司提供的外国留学生团体综合保险,个人人身保险的保险单不能作为办理入学注册和在华居留许可的文件。目前我校指定中国平安养老保险有限公司为来华留学人员提供《来华人员综合保险保障计划》服务。一经参保,学生凭护照号和姓名即可申请保险理赔等相关服务。

1) 享受综合医疗保险的中国政府奖学金生、福建省政府奖学金生、福建农林大学奖学金生,如因意外伤害或疾病发生门诊或住院费用,可通过学校向保险公司提出理赔申请。(自费学生:在每学年缴交学费的同时缴纳相关投保费用,因拖欠投保费用而造成的一切后果由个人承担。

2) 门诊费用报销程序

学生需在中国大陆境内的公立医院门诊就医,如果所有费用累计超过650,学生可凭病历发票等材料在保险有效期内到海外学院留学生管理办公室进行审核,海外学院协助办理报销手续。保险公司按照当地社会医疗保险部门规定可报销的、必要的、合理的医疗费用超过人民币650元以上的部分按85%的比例给付门诊医疗保险金,且每次门诊费用日限额600。具体请见《平安养老保险股份有限公司来华人员综合保险保障计划与理赔指南简介》(网页链接为 http://www.lxbx.net/admissions.html)。

3) 住院医疗报销程序

学生可视情况选择申请保险公司垫付或者自行付清医疗费用后申请报销:

a) 申请保险公司垫付

可申请垫付的医院仅限于福州省立医院、福州市第一医院、福建医科大学附属第一医院、福州医科大学附属协和医院、南京军区福州总医院、福建中医学院附属人民医院等。如果需要向保险公司申请垫付,请提前联系海外学院留学生管理办公室。

b) 申请理赔

学生在向中国平安保险公司报备的前提下,若已自行付清医疗费用,可在治疗结束后申请报销住院费用,需携带所有的相关医疗文件前往海外学院留学生管理办公室,具体请见附录《平安养老保险股份有限公司来华人员综合保险保障计划与理赔指南简介》(网页链接为 http://www.lxbx.net/admissions.html

 

附:平安来华人员保险理赔说明:


(一)理赔程序:

保险事故发生后,理赔的规范程序:

1.因疾病或意外事故需就诊,需直接致电40081051191,由救援医生进行健康询诊、就医指导及理赔注意事项说明。如经过询诊且门诊治疗后医生确诊需进一步住院治疗的可向救援公司申请住院垫付,救援公司与医院沟通确认后决定是否启动住院垫付程序。凡未经救援公司医生询诊备案且未经门诊诊治而直接入院治疗的(包括病情未达到住院程度却要求门诊医生同意住院治疗的),救援公司不负责住院费用垫付。对于未按照上述程序申请的,个人自行垫支医疗费用的将无法获得赔付。

2.重大事故可通过以下联系方式报案

理赔咨询、报案电话:40081051191

凡是未经400电话报案或者未按照要求规范程序执行的,将无法获得赔付。

(二)理赔应备文件:

1).身故或意外伤残

A被保险人护照复印件及签证页复印件

B被保险人伤残时需提供伤残鉴定证明(由指定鉴定机构出具鉴定报告)

C被保险人死亡证明

D被保险人与所有受益人关系证明及受益人身份证明复印件。

E如意外事故须提供意外事故证明及相关部门的定性材料(如:交通事故须出具交通部门的交通事故责任认定书,高坠、溺水等须公安机关或相关部门出具事故属意外或自杀的定性材料,饮酒导致事故须出具酒精含量定量报告)

2).意外伤害医疗

A被保险人护照复印件及签证页复印件

B意外事故经过及证明(如是交通事故须出具交通部门的交通事故责任认定书等)

C收费收据原件

D相对应每次就诊病历(病例日期须与发票日期一一对应),费用明细,检查、化验报告单复印件

3).门急诊医疗

A被保险人护照复印件及签证页复印件

B收费收据原件

C相对应每次就诊病历(病例日期须与发票日期一一对应),费用明细,检查、化验报告单复印件

如果已满650元起付线,须提交650元以下的发票原件、病历、费用明细、检查化验报告单的复印件。

4).住院医疗

A被保险人护照复印件及签证页复印件

B 如意外事故须提供意外事故证明(如是交通事故出具交通部门的交通事故责任认定书等)

C住院收据原件、费用明细原件

D出院小结或住院病历复印件

以上24)项特别说明:

1)每次申请理赔,申请材料中必须附上被保险人中国大陆境内的银行账号及该账号的准确账户信息,包括账户名、账号和开户行信息,可通过存折复印件或银行客户信息表载明以上信息。(详情请拨打40081051191进行咨询)

2)若一次保险事故分别在两家(包含两家)以上医院就诊,须出具每次就诊的诊断证明书、病历复印件等相关文件。

3)就诊医院必须是中华人民共和国大陆境内的公立医院,申请理赔费用应属于当地社会基本医疗保险规定可报销的范围之内的费用。

5).护工费申请

住院期间医院或护工服务公司出具的护工费发票原件。

理赔材料寄送地址:北京市朝阳区东三环中路55号双子座B303室(邮编100022

收件人:来华项目理赔部

:40081051191

备注:

1. 所有学生镶牙、补牙、配眼镜、分娩、人工流产、矫正生理缺陷、购买营养滋补品,以及治疗来华前已患有的一般性慢性疾病,其费用全部自理。

2. 海外学生因违反校纪、法律而造成的伤亡事故所支付的有关费用,由肇事者自理。


Medical Insurance

In order to ensure their health and safety and in line with relevant Chinese government and Fujian Agriculture and Forestry University regulations, since 2008/2009 Academic Year, overseas students who wish to study in China for over 6 months are required to purchase comprehensive group insurance scheme for foreign students provided by Ping An Insurance (Group) Company of China. Insurance only for individuals purchased home or abroad cannot be a substitute. After the purchase, students can file an insurance claim with their passport number and name.

1)  Chinese Government Scholarship students, Fujian Government Scholarship Students, Fujian Agriculture and Forestry University Scholarship Students who enjoy comprehensive medical insurance scheme purchased by CSC or FAFU can apply for reimbursement if they need to go to the doctor for outpatient or inpatient treatment.( Self-supporting students: Students should pay the insurance fee together with tuition fee at the beginning of every academic year. Students should be held responsible for results arising from arrears of insurance fee.)

2) Reimbursement for out-patient medical expense

The insurance scheme only covers medical treatment in public hospitals within mainland China. The starting line is 650RMB. If the total expense exceeds 650RMB, students can apply for reimbursement by bringing all the relevant medical documents to OEC, which will be forwarded to the insurance company. The insurance company will reimburse 85% of the reasonable expenses that is beyond 650 RMB with a daily limit of 600 RMB.

For more details, please refer to “Comprehensive Insurance & Protection Scheme for Foreigners Staying in China of Ping An Annuity Insurance Company, Ltd.”( The URL is  http://www.lxbx.net/admissions.html).

3) Reimbursement for in-patient medical expense

Students can apply for prepayment or pay for the medical treatment first and apply for reimbursement later.

a) Apply for prepayment

Prepayment service is only limited to Fujian Provincial Hospital, The First Hospital of Fuzhou ,The First Affiliated Hospital of Fujian Medical University, Fujian Medical University Union Hospital, Fuzhou General Hospital of Nanjing Military Command, People Affiliated Hospital of Fujian Traditional Chinese Medicine.etc. Please contact OEC in advance if you need to apply for prepayment service.

b) Apply for reimbursement

If students have already paid all the medical fees after they inform Ping An Insurance (Group) Company of China , they can bring all the relevant medical materials to OEC and OEC will assist you to apply for reimbursement. For more details, please refer to “Comprehensive Insurance & Protection Scheme for Foreigners Staying in China of Ping An Annuity Insurance Company, Ltd.”( The URL is http://www.lxbx.net/admissions.html).

  

Attaching: Insurance Claims

1Procedures for insurance claims:

Standard procedures of insurance claims after occurrence of insurance accident:

1. Please call directly 4008105119 EXT 1 for medical consultation due to disease or accident. The rescue doctor will consult, diagnose, and provide medical guidance and precautions for insurance claim. After consulting diagnosis and outpatient treatment, if the doctor confirms that further hospitalization is required, the insured can apply for advanced payment of medical expense for hospitalization to the rescue company. After communication and confirmation of the rescue company and hospital, it will be decided whether the advanced payment procedures shall be started. If the insured is directly hospitalized without consulting, diagnosis and recording of doctor of the rescue company and outpatient treatment (including those whose conditions do not meet the requirements of hospitalization but require the outpatient doctor to agree with hospitalization), the rescue company will not be responsible for advanced payment of medical expense for hospitalization. If advanced payment for medical expenses is made without the above procedures, the insured willnot be able to get compensation.

2. Major accident can be reported with the following contact information

Telephone number for claim consultation and reporting: 4008105119 EXT 1. You cannot get compensated without reporting through the 400 call or following the standard procedures.

2Document to be presented for settlement of claims:

1).One-year term life insurance

ACopy of passport and visa page of the Insured

BDisability certificate when the Insured is disabled (an evaluation report shall be issued by the assigned evaluation body)

CDeath certificate of the Insured

DCertificate of relationship between the Insured and all the beneficiaries, and copy of identification proof of the beneficiaries

ECertificate of accident, in case of an accident (in case of traffic accident, the traffic unit should issue a liability confirmation of traffic accident)

2).Medical treatment for accidental injuries

ACopy of passport and visa page of the Insured

BCourse and certificate of accident (in case of traffic accident, the traffic unit should issue a liability confirmation of traffic accident, which is needed.)

COriginal of receipt

DMedical record, detailed expenditure sheet and copy of examination report and laboratory test report of each respective treatment(date of examination and date of invoice shall be corresponding).

3).Medical treatment for outpatient and emergency

ACopy of passport and visa page of the Insured

BOriginal of receipt

CMedical record, detailed expenditure sheet and copy of examination report and laboratory test report of each respective treatment(date of examination and date of invoice shall be corresponding).

If the fees have exceeded the minimum payment line of RMB650Yuan, then the medical record, detailed expenditure sheet and copy of examination report and laboratory test report of treatment that costs below 650Yuan are also required to be presented.

4).Hospitalization

ACopy of passport and visa page of the Insured

BCertificate of accident, in case of an accident (in case of traffic accident, the traffic unit should issue a liability confirmation of traffic accident)

COriginal of receipt and detailed expenditure sheet for hospitalization

DCopy of hospital discharge summary or medical record of hospitalization

Special instructions to item 2) to item 4) above:

(1) Besides, the Insured’s bank account opened in the mainland of China and accurate information (account No. name, opening bank information), which can be obtained from copy of deposit book and bank costumer table, in relation to the account must be attached to the claim settling documents for each request for compensation; (For details, please call 4008105119 EXT 1 )

(2). Where in one insured incident, the Insured has to be treated in two or more hospitals(including two hospital), relevant documents such as diagnosis certificate and medical record from relevant hospitals shall be presented.

(3). Hospitals for treatment shall be limited to the public hospitals within the territory of the Chinese mainland, and requested items and expenses that can be reimbursed should in accordance with the scope oflocal regulations of social basic medical insurance.

5). Application for nursing fee

Original Invoices of nursing fee issued by hospital or by nursing service company

Materials for claims of settlement sent to:北京市朝阳区东三环中路55号双子座B303室(邮编100022

Addressee:来华项目理赔部

Please Dial:4008105119 to 1

Please log in www.lxbx.netfor latest insurance introduction.

This material is for your information, the final right of interpretation of above content belongs to Ping An Annuity Insurance Company, Ltd.

Chinese explanation prevails in case of contradiction arising out of the aforementioned contents.

Note:

1. Overseas students must themselves pay for: dentures, fillings, eyeglasses, childbirth, abortion, plastic surgery, purchase of nutritional supplements, and treatment of common chronic diseases predating arrival in China.

2. Costs of injuries or casualties in accidents arising from overseas students disobeying to school discipline or law are paid entirely by the responsible party.

  

  

  

  


  


 

 

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