First release: Wenwen Dabao Beier
An insurance self-media that can contact the public account owner
Hello everyone, I am Wenwen Dabao Beier, an insurance blogger responsible for every customer's claims.
01
3 The epidemic has been repeated over the past few years. In order to prevent and control the epidemic, "isolation" has become a very normal thing.
In order to avoid the loss of income from being isolated, many friends have begun to buy isolation insurance for themselves. Because you can get hundreds of dollars in quarantine for one day, this wool looks easy to get. What is the real claim situation of
isolation insurance? Is isolation insurance used by everyone to "flee" or is it used by insurance companies to "cut leeks"? The young lady in the claim case,
, initially had the mentality of "buying just in case" and took out an insured isolation insurance product -
The premium is only 43 yuan a year, and the compensation for 200 yuan a day is quarantined. Although it is incredible, the premium itself is not expensive. Just buy it and buy it to feel at ease. Who would have thought that
actually used it!
In September, due to the repeated epidemic situation in the area, the community where the young lady lives was divided into medium- and high-risk areas, and was required by the community to manage statically at home.
Aiwuyou Isolation Insurance wants to obtain a claim for isolation allowance, it must be one of the following two situations:
① I have been diagnosed with new crown or a close contact
② In a medium- and high-risk area (including residence/work/pass/destination)
As long as it is forced centralized isolation or home isolation caused by the above situation, it meets the claims conditions.
In fact, the community where the young lady lives is divided into medium- and high-risk areas, which does meet the claims conditions. However, when I went to the community to issue a certificate, I encountered some problems -
The community is unwilling to write "quarantine", but only wants to write "static management":
After communicating with the young lady, the young lady said that there is really no way. The community is only willing to issue a certificate like this and is unwilling to write an quarantine.
In order to avoid disputes in "static management" and "home isolation", I wrote her a situation description, asking her to upload the claims information as well:
At the same time, the official WeChat official account was attached to the "Risk Level Adjustment in Some Areas Notice, proving that I am indeed in the medium and high-risk area:
Then, the young lady uploaded the claims materials online:
However, because it was the National Day holiday after uploading, it was delayed for a week on claims.
After all, it is legal holidays . It is normal for an insurance company to not go to work, so please understand this.
plus the repeated epidemics in various places, there are many people applying for claims, and the review and work pressure of the claims teachers are also relatively high, so this claim settlement took about two weeks to complete:
But in general, the whole process was relatively smooth.
02
Can insurance be compensated as long as it is quarantined? The claim for
is difficult and simple.
compensation conditions are two:
1. Work, routes, residence and other places are judged as medium and high-risk areas and are required to be quarantined.
2, confirmed or close contact, was required to be forced to isolate.
When the claims are met, such as close contacts and medium-risk areas, insurance claims are really not difficult. The "quarantine" in
quarantine insurance has conditions. For example, if you are quarantined due to the return policy, you cannot compensate in this situation. There are also the following situations where you cannot compensate. The following 10 cases where
cannot be compensated (including but not limited to) are summarized through many claims cases:
①If the insurance does not meet the requirements: has been confirmed or suspected to be positive, or has been notified of isolation and other similar situations.
②Close connection: Close connections are close contacts of close contacts and are not within the scope of the isolation allowance insurance.
③People accompanying for compulsory isolation: People from low-risk areas or non-contact contacts, accompanying people who are compulsory isolation for isolation, will not be compensated for isolation allowance. For example, parents accompany babies who are forced to isolate.
④Home health testing: For example, if someone in the community is confirmed, the entire community (non-medium and high-risk areas) is required to have a home health testing.
"Home Health Test" requires isolation to be "not going out unless necessary". This situation does not meet the requirements of "mandatory isolation" and cannot meet the compensation conditions.
⑤ Being quarantined during the waiting period: quarantine insurance generally has a two-day waiting period. If you are quarantined within these two days, you cannot compensate.
⑥ Actively go/pass medium and high-risk areas: If it is an act of actively going, it will definitely not meet the claims conditions.
knows that you will be isolated when you go, and you can avoid this situation, but you still take the initiative to go and be isolated when you take the initiative to pay.
⑦ Quarantine caused by returning from abroad: Returning from abroad is 100% quarantined. Insurance covers uncertain risks, and this certain risks are not within the scope of protection.
⑧ Quarantine caused by returning home: In order to prevent and control the epidemic, many places require forced isolation for returning home. They cannot be compensated for being isolated due to policies, but if there is a confirmed diagnosis in the car you go back, you are close contacts and you can meet the compensation conditions.
⑨Cannot provide quarantine proof: Isolation proof is the most important claim material for isolation allowance insurance. If it does not exist, it means that the information is incomplete. The insurance company will not start the review, but will notify supplementary materials.
⑩ cannot prove that the area you are in is a "medium- and high-risk area": has many disputes in claims for isolation insurance, mainly because of this reason.
As the prevention and control upgrades, many areas not only need to be blocked in medium and high-risk areas, but nearby areas will also be adjusted to "control areas" to implement closed management.
insurance company also agreed that the definition of "medium and high-risk areas" is based on the announcement of relevant departments:
There are also clear agreements in the contract for this:
In this case, it is difficult to judge whether to pay, because the region is indeed not in line with the definition of medium and high-risk areas.
Seeing so many situations that cannot be compensated, many friends who have been quarantined for more than ten days due to community control and isolation are very unhappy.
But these situations of not paying are generally reasonable. For example, taking the initiative to go to medium and high-risk areas without paying can prevent some people from using irregular means to obtain claims, which is also fair to most of us.
So what we need to do is to actively prepare the claims materials and make them well-founded, so that we can get the claims better, faster and smoother.
I hope the epidemic will be eliminated as soon as possible:)
