Financial Consumer Protection Class
Today, our guest is Liu Shuwen, Senior Director of Health Services, Business Support Department, Hubei Branch, Taikang Life Insurance Hubei BranchCommercial Medical Insurance Claims Servicerelated topics.
As a consumer, after buying insurance, the most concerned is to settle claims, in ordinary life, our insurance consumers will still have some questions about insurance claims, especially claims services. Can you tell us about the way to apply for a claim, especially in terms of claim timeliness, claims service and information security, and what efforts Taikang has made?
Liu Shuwen: First of all, I would like to thank consumers very much for choosing Taikang Insurance, so that Taikang can officially provide you with longevity, health and wealth solutions, so that you can enjoy high-quality and thoughtful life cycle services. Regarding the claim issue, please don't worry, Taikang has thought of it for you. We all know that the essence of insurance is protection, and the core of protection is claims, and the competition in the insurance market depends on the service.
Taikang has always been committed to creating the ultimate claims service: in 2009, it established the "Carnation" claim service brand, and the first Carnation visit service in the industry;In 2013, it launched mobile phone claims, and in 2021, it will create a service system of "one simple, two warm and three fast";Based on the pain points of customers, the Carnation claims service system will be upgraded again in 2023!It can be said that Taikang's claims service has been improving, iterating and upgrading.
It turns out that Taikang has so many claims-related services, can you give us a detailed introduction?
Liu Shuwen: Okay. Our Taikang Carnation claims service adheres to the tenet of "keeping promises and caring for a lifetime", which runs through the pre-claim - claim settlement - post-claim settlement for consumers. The claim process usually refers to the following steps: after the customer has an accident, the claim report is submitted, the claim application is submitted, the insurance company reviews the claim, and finally the case is closed and paid.
The "one simple" in the service system just mentioned is to make it no longer difficult to report and apply for claims, and 4In the 0 era, it is easier to apply for claims, and consumers can make a claim with one click through their mobile phones, and they can realize real-time tracking from reporting, application, to closing payment, and the entire application process is transparent and traceable.
There are also many options for application, and customers can apply for medical, critical illness, death, disability, waiver and other claims through Taikang Life's official WeChat and Thai Life APP. Taikang ** people can also submit applications for customers through Taikang Tai Marketing APP, assist in initiating claims, assist in preparing claim materials, assist in reminding the progress of claims, and remind the payment of claims to the account.
It turns out that the claim application can be so convenient, and when it comes to application, what information do we usually need to provide?
Liu Shuwen: If there is an accident, it is recommended to report to the insurance company as soon as possible, Taikang's way to report the case is 95522 special line**, Taikang life app, Thai marketing app, Taikang life official WeChat. After receiving the report, Taikang will provide special claim settlement services in a timely manner, and there will be professionals to explain the information required for the claim.
Under normal circumstances, the following information is required for all claim applications: claim application, valid identity document, applicant's bank account, other supplementary information related to the claim, proof of the relationship between the beneficiary and the insured in the case of death, and proof of the relationship between the applicant, the policyholder, the insured and the beneficiary. Here is a detailed introduction to the information required for medical insurance and critical illness insurance.
In addition to the basic information, the medical insurance for hospitalization expenses needs to provide a diagnosis certificate, discharge summary, invoice and expense list, and the hospitalization allowance can provide a diagnosis certificate and a discharge summary.
In addition to basic information, critical illnesses also need to provide a diagnosis certificate, discharge summary, pathology report or other examination reports.
If you have any questions about claims, you can call Taikang customer service at 95522**. You can also enter the official WeChat account of Taikang Life, and the intelligent robot will wait for the whole process to answer the claim problem anytime and anywhere.
I heard that there is a visitation service during the hospitalization, can you tell us more about it?
Liu Shuwen: The visitation service is the "warmth" of our service system, as the name suggests, it is to make the claim no longer cold, this carnation inpatient visit service is a humanized service provided by Taikang to inpatient customers. The customer reports the case within 3 days of hospitalization, and the service staff will send you warm condolences with a letter of condolence and a visitation gift under the guidance of the service requirements of the "four unifications": unified standards, unified processes, unified tools, and unified management. During the visit, our Taikang staff will patiently explain the claim process for you, assist in preparing the claim materials for claims, etc.
I feel that Taikang's claims are really more reassuring and convenient, and are there any other special claims services?
Liu Shuwen: In the claim settlement, our customers can enjoy more services. The "fast" in the system means that the claim is being settled, so that the claim is not slow. In order to create a fast claim settlement service, Taikang Life keeps up with the pace of the times, relies on customer innovation, and solves the urgent need for customer reimbursement through three services: "allowance credit claim, health insurance direct payment, and critical illness first compensation".
Zero manual intervention in the whole process, intelligent "credit claim" mode, refreshing the new speed of claim settlement. The service won the Best Insurance Intelligent Service Innovation Award at the 8th China Insurance Industry International Summit "Golden Flash Award" and the Gold Medal Case of Annual Service Innovation by China Banking and Insurance News.
Taikang's health insurance service opens up the last mile of claims, establishes a medical insurance cooperation system with domestic preferred medical institutions, and realizes one-stop claims settlement for commercial insurance customers such as direct claims and quick claims through direct connection of the system. The customer was discharged from the hospital in the health insurance hospital, realizing the one-stop settlement of commercial insurance and medical insurance.
It should be noted that customers can only enjoy the service of direct compensation or quick compensation if they stay in a hospital that has signed a cooperation agreement with our company. You can check the list of hospitals on Taikang's official website, official WeChat and Tai Life APP. In order to solve the pain points of customers suffering from critical illnesses, Taikang relaunched the critical illness compensation service in 2017, and delivered the claims to customers as soon as possible, so that customers in pain do not worry about the cost and feel at ease.
If a customer who has been insured for 3 years and meets the critical illness criteria in the terms and conditions report to us within 3 days after suffering from a critical illness, the claims service staff will visit the patient as soon as possible after receiving the report and assist the patient in preparing the claim informationThrough the exclusive channel for customers to submit information to apply for critical illness claims, after the approval of the customer can receive critical illness claims during the hospitalization, critical illness compensation to solve the urgent need, demonstrating human care, this service also won the "User Experience Case of the Year Award" of China Financial Publishing House.
Can these services be guaranteed in place?
On December 26, 2022, the China Banking and Insurance Regulatory Commission issued the Administrative Measures for the Protection of Consumer Rights and Interests of Banking and Insurance Institutions, which will come into effect on March 1, 2023.
With the support of digital technologies such as big data and artificial intelligence, we have realized the whole process of policy service online. The science and technology innovation center and operation center fully protect the security and privacy of customer information in accordance with regulatory requirements, and strictly protect the right to customer information security. After receiving the request for compensation or payment of insurance money from the insured or beneficiary, the company shall deal with it in a timely manner in accordance with laws, regulations and contractual agreements, and shall not delay the settlement of claims or unreasonably refuse to make claims, so as to fully protect the consumer's right to claim compensation in accordance with the law.
Taikang Life Insurance has always adhered to the feelings of family and country, bravely assumed social responsibility, and actively funded Taikang Yicai public welfare**. The promise will continue forever, let insurance shine with the brilliance of humanity, and let the journey of life shine. With good business and technology empowerment, Taikang is committed to providing customers with a full range of protection services, making claims more convenient, warmer and faster, and making insurance more secure, convenient and affordable.
Produced by |Wuhan Emergency Broadcasting.
Audit |Zhang Tao.
Editor-in-charge |Zhang Feng, Wang Gang.
Edit |Yuan Yuan.