XLS《UserGuide》

DirectSettlementNetworkUserGuide 直付网络使用指南 Inordertoprovideourinsuredmembershipwithaccesstothebestpossiblemedicalcareandservice,AZCNhasdevelopedanetworkofmedicalpractices,whereinsuredmembershavinganAZCNInternationalPlanmembershipcardmayreceivemedicaltreatmentwhichwillbesettledbyusdirectlywiththehospital/clinic/medicalcentre.

为了给我们的客户提供最好的就医体验,AZCN提供了直付医疗网络.当会员在直付网络内就诊时出示AZCN保险卡,会员就可以享受直付服务,网络内的医疗机构会直接和保险公司结算. Whenvisitinganyofthemedicalfacilitieswithinthisnetwork,pleasefollowtheprocessesoutlinedbelow: 在直付网络内就医时,请遵循如下流程: 1.FollowtheguidelinesinyourEmployeeBenefitsMemberPack.Forexample,ifyouareseekinginpatienttreatment,youshouldobtaintheGuaranteeofPaymentdocumentfromAZCNinadvancebyfollowingthetreatmentguaranteeprocess. 1.请确保您的保险承保范围包括您所需的治疗,您的保单利益表将列明您所享有的保单利益.例如,当您需要住院治疗,您需要事先递交《医疗担保申请书》并获取担保函. 2.PresentyourAZCNmembershipcardandproofofidentificationtothereceptionistpriortothemedicalappointment. 2.就医时请向医疗机构出示您的安联健康险会员卡和身份证明. 3.SigntheClaimFormtoacknowledgereceiptofthetreatmentfollowingtheconsultation. 3.在就医结束后请在理赔申请书上签字确认已接受的医疗服务. 4.Settleanyexclusions,co-payments,ordeductible/excesspaymentswiththemedicalfacilitypriortoleaving. Forexample,ifyourpolicywithushasa10%co-paymentforaspecificinpatienttreatment,youshouldsettle10%ofthetotalbillpriortoleavingthemedicalfacility.Insuchacase,ifyourtotalbillisRMB3000,wewillpayRMB2700directtothemedicalfacilityandyouwillpayRMB300followingyourtreatmentandpriortoleavingthemedicalfacility. 4.在您离开前您需要向医疗机构支付保单内约定的不在保险范围内的费用、免赔额或共付额.例如:您的保单对于住院治疗约定有10%的自付比例,您需要在离开医院前支付帐单金额的10%.在此情况下,如果您的帐单总金额是3000元人民币,我们会跟医疗机构直接结算2700元人民币,您需要在治疗结束后向医院支付300元RMB. IMPORTANTNOTES 注意事项 i)Thedirectsettlementnetworkshouldnottobeusedtoobtainanytreatment,whichfallsoutsidethescopeofyourpolicy. 不能在直付医疗网络内获取保单利益之外的治疗. ii)ThedirectsettlementnetworkisdependentuponthelevelofcoverthatyouhavepurchasedfromAllianzChinaGeneral. 直付医疗网络的具体使用规则由您在安联财产险购买的保单福利计划决定. iii)AllianzChinaGeneralwillnotprovidecoverforanymembershipfeesthatmaybedemandedbyanymedicalprovider. 安联财产险将不会支付任何医疗机构提出的会员费等费用. iv)IfyouuseaHospitaloutsideofourNetwork,pleaseasktheHospitaltocontactusdirectlyandwewillarrangedirectsettlement. 如果您在直付网络外就医,请通知医院联系我们,我们会尝试安排直付服务. v)WealsohaveaccesstoanextensivenetworkofprovidersthroughourthirdpartyadministratorsintheUSA.MemberswithWorldwideCovercancontactthetoll-freenumberasindicatedonthereverseofthemembershipcardformoreinformation. 我们通过第三方服务机构提供在美国的直付网络.承保地域为全球的会员可以拨打会员卡背面的免费电话获取该方面的信息. vi)Pleasekindlynotethatsomeofthepublichospitalrequirespreapprovalaheadoftheconsultation,insuchcasesyouneedtocontactus2~3daysaheadofyourappointmentinorderthatwecangettheapprovalinplacebeforethevisit. 有部分中国境内公立医院在就诊前需要得到确认,在此情况下您在这些医院就诊时需要提前2~3天通知我们,以确保医院能够提供直付服务. 安联财产保险(中国)有限公司是本保险单的保险人并提供中国大陆境内的保单服务.安联财产保险(中国)有限公司注册于中国并受中国保险监督管理委员会监管.注册地址:广东省广州市天河区珠江西路5号广州国际金融中心主塔写字楼第34层01-