3、理赔须知 Claim Notice

您在医院就诊完毕后需先向医院支付费用，然后收集完整的理赔资料进行申请，最后我们会向您

支付保障内规定的费用，完成理赔。

You need to pay the hospital first and our staff will settle with you after receiving all

required materials.

事后理赔材料及说明

资料名称

备注

需填写完整，申请人签名处需您（指被保险人本人，下同）亲笔签名（若您为未成年人，需您的

法定监护人亲笔签名）

理赔申请书

身份证明复印件您的身份证明复印件（二代身份证正反面、户口本、护照等）；

(住院或金额大于

1 万元的非住院若您为中国籍未成年人的，申请理赔金额大于 1 万元，须提供您的以及您的监护人的身份证明复

理赔案件)

印件、以及与监护人的关系证明 (户口本、出生证等)；

门诊资料名称

住院资料名称

住院病历（可根据需要）、出院小结或疾病诊断证明原件

（备注：疾病诊断证明书须加盖医院印章）

门诊资料复印件

医疗费用发票原件（显示本人姓名，并加盖医院收费章）

医疗费用结算清单，医疗费用明细清单

病理、血液、X 线及 CT 报告

被保险人所能提供的与确认保险事故的性质、原因等有关的其它证明和资料

Table of materials for pay and claim

Material

Notes

The insurance applicant must fill out this form and sign it with his/her name. The

insured is referred to as the “applicant” in this form. If the insured is a minor,

his/her legal guardian's signature is required.

Claim Application

Form

Copies of Identity

Certificates

A copy of the insured’s identity certificates (ID card, household register, passport,

etc);

（inpatient

treatment or

outpatient

If the insured is a minor, copies of the identity certificates of the minor and their

legal guardian, as well as documents or certificates proving the relationship

between them (household register; birth certificate, etc) must be provided.

treatment costing

more than

22 / 42

平安健康保险股份有限公司 Ping An Health Insurance Co., Ltd.