The first step is reconciliation and negotiation.

You can call China PICC 24-hour customer service hotline 025-955 18, and our customer service staff will provide you with claim guidance services.

Step 2: Claim application

1, online application:

Self-help claim through "Nanjing Ninghuibao" WeChat WeChat official account, "Nanjing Smart Medical" WeChat WeChat official account or "My Nanjing" App, or call China PICC 24-hour customer service hotline 025-955 18 to report the case.

Matters needing attention in online claim:

(1) The uploaded photos or pictures of claims data must be clear and complete;

(2) The signature of WeChat application and other materials must be the signature of the insured (or guardian);

(3) Please keep the original claim data for subsequent insurance companies to collect and check;

Note: If the insurer claims for the uploaded electronic materials, the claim amount is less than 6,543,800 yuan after deducting the 20,000 deductible (the invoice is required to be written "used for PICC claim" and signed before taking photos), if the insured claims for more than 6,543,800 yuan after deducting the 20,000 deductible, it is required to send the materials to the insurance company.

(4) If you apply for compensation from the deceased insured, only offline applications are supported. Please bring your family members' identity certificates, relationship certificates and entrustment materials to the settlement service outlets of China People's Property Insurance Co., Ltd. Nanjing Branch (see the end of the article for details).

2. Offline applications:

The insured can carry the relevant information of claim settlement to the claim settlement service outlets designated by China PICC Nanjing Branch.

Step 3: Complete the claim.

According to the audit results, the claims will be paid to the beneficiary account of medical insurance.

Second, the claim materials

(1) Claim Form

(2) Electronic certificate of insurance policy

(3) The front and back of the insured's identity document (if the insured is a minor, the legal guardian's identity document and relationship certificate shall be presented at the same time).

(4) Medical information (including but not limited to invoices, medical records, discharge summary, detailed list of hospitalization expenses, filming reports and films). Before taking photos, the invoices should be written in black ink and signed.

(5) If other third parties pay in advance, the original and a copy of the original settlement bill of other third parties shall be provided.

(6) Payee's bank account information: including bank, account name and account number.

(7) In case of death, provide death certificate, cremation certificate, household registration cancellation certificate, beneficiary's identity certificate, relationship certificate and other materials entrusted by the beneficiary;

(eight) other materials that the insurance company considers relevant to the confirmation of the nature and cause of the insured accident.

Note: (1) If you entrust others to apply on your behalf, in addition to the above-mentioned certificates and materials, you must also provide the power of attorney of the beneficiary of the relevant insurance interest, the valid identity certificate of the trustee and other relevant documents; (2) When the insurance money is the insured's inheritance, it must also provide relevant rights documents that can prove the legal inheritance right; (3) If the beneficiary or heir is a minor or a person without capacity for civil conduct, his legal guardian shall apply for receiving insurance benefits on his behalf, and his legal guardian must also provide proof that the beneficiary or heir is a minor or a person without capacity for civil conduct and that the guardian has legal custody; (4) If the insured transfers the social medical insurance relationship to other cities due to work or other reasons, it shall provide valid proof that the insured was the insured of Nanjing basic medical insurance when purchasing this product, such as the payment record of Nanjing basic medical insurance or the certificate issued by the unit (or medical insurance bureau).

If the above certificates and materials are incomplete, the insurance company will promptly notify the insured to supplement the relevant certificates and materials.

Third, the progress of claim investigation.

If you need to check the claim progress or have any objection to the claim, you can log in to the official account of "Nanjing Ninghuibao" WeChat, "My Nanjing" APP, and "Nanjing Smart Medical" WeChat WeChat, or call the 24-hour customer service hotline of China PICC at 025-955 18 to check the claim progress or give feedback.

Fourth, matters needing attention

(1) Claim limit

1. After receiving the request of the insured or beneficiary for compensation or payment of insurance benefits, the insurance company shall make timely verification;

2. If the situation is complicated, it shall be verified within 30 days unless otherwise agreed in the contract.

(2) Time for claim settlement

1. For the insured, the obligation to compensate or pay insurance money shall be fulfilled within ten days after reaching an agreement with the insured or beneficiary.

2. If the insurance company cannot determine the amount of compensation or payment of insurance benefits within 60 days from the date of receiving the request for compensation or payment of insurance benefits and relevant certificates and materials, it shall pay the amount that can be determined according to the existing certificates and materials; After the insurance company finally determines the amount of compensation or payment of insurance benefits, it shall pay the corresponding difference.

(3) Time for refusing to reply

For those who do not belong to the insurance liability, a notice of refusing to pay compensation or paying insurance money shall be issued to the insured or beneficiary within three days from the date of approval, and the reasons shall be explained.

Verb (abbreviation for verb) special agreement

(1) pre-existing disease protocol

If the insured has suffered from six listed major diseases (see the agreement on previous diseases in the details of the protection plan) before the product takes effect, or has appeared the pre-illness symptoms of the listed diseases, and medical expenses have occurred due to the disease or its complications during the insurance period, the reimbursement ratio of the first product is 50%, and the reimbursement ratio of the second product is 20%; However, the medical expenses agreed by other products can still be settled according to the original payment ratio.

(2) social medical insurance use agreement

1) If the insured enjoys medical insurance benefits in Nanjing, but does not use the basic medical insurance in Nanjing for reimbursement, this product will not bear the corresponding insurance liability.

2) The insured participates in Nanjing basic medical insurance for the first time, or interrupts or defaults on Nanjing medical insurance during the warranty period of this product. This product only bears the insurance liability during the effective period of Nanjing medical insurance benefits, and does not bear the insurance liability for the expenses incurred during the invalid or invalid period of medical insurance benefits.

(3) Off-site reimbursement agreement

1) The medical expenses incurred by residents (residents) in the designated medical insurance hospitals for filing are the same as those in this city.

2) Other unregistered insured persons who seek medical treatment in different places directly in designated hospitals for medical insurance in different places shall be reimbursed by Nanjing Social Medical Insurance in advance, and the rest shall be settled according to the insurance liability stipulated in the product after reimbursement by social medical insurance; If there are other third parties, other third parties will pay first. After Nanjing Social Security Medical Insurance is reimbursed, the rest will be settled according to the insurance liability agreed by the product.