Recently, this newspaper found that the COVID-19 insurance products which were previously launched by many insurance companies and can be applied for compensation after diagnosis were snapped up or taken off the shelves, while the COVID-19-related insurance products currently on sale are mostly critical illness protection.
In addition, the paper interviewed a number of insurance institutions and learned that those who have previously purchased COVID-19 insurance products and are within the insurance period can claim compensation at present, but they all need confirmation certificates issued by medical institutions, and the results of antigen self-test are generally not recognized by insurance companies.
At present, asymptomatic mild diseases are generally treated in isolation at home, and the insured may face difficulties in obtaining evidence when making claims. Some lawyers suggested that the change of circumstances clause in the Civil Code can be applied at this time, and the terms of the contract can be changed, that is, patients should be allowed to obtain other evidence that can prove that they are infected.
COVID-19 insurance is still on sale.
The existing COVID-19-related insurance covers serious and major diseases.
The article points out that some insurance products sold in COVID-19 before, such as COVID-19 Epidemic Prevention Insurance of Didi Insurance, COVID-19 Epidemic Prevention Insurance of Huatai Insurance, COVID-19 Epidemic Prevention Insurance of Zijin Insurance and Taiping Property Insurance, etc. , all sold out or off the shelf.
COVID-19 insurance, which is still on sale at present, mainly covers serious diseases and major diseases. The paper search found that there is an insurance product named "Yi 'an Bao Xinfang" underwritten by China People's Insurance Company on the insurance agency platform of Ant. However, unlike many previous COVID-19 insurances, this product only pays the seriously ill and seriously ill people-COVID-19's hospitalization allowance for serious/serious illness, with the insured amount of 6,543,800 yuan; Hospitalization allowance for infectious diseases 100 yuan/day.
The customer service staff of the insurance company told the paper that if the insured reaches the severe or critical type after the expiration of the waiting period of 15 days, according to the novel coronavirus diagnosis and treatment plan effective at the time of diagnosis, and must be hospitalized in the hospital recognized by the company or the designated infectious disease medical institution designated by the local health administrative department, the company will pay the medical insurance premium for the severe hospitalization allowance for specific infectious diseases according to the basic insurance amount agreed in the contract, and this contract will be terminated at the same time.
At the same time, the document pointed out that some insurance companies have expanded their existing products, adding heavy and critical insurance liabilities in COVID-19.
China Life official website information shows that as early as February 2020, China Life extended its existing 3 1 long-term critical illness insurance products, covering COVID-19's confirmed insurance liability. The staff of China Life told this newspaper on February 61that at present, the coverage of insurance liability in COVID-19 has reached 5 1. China Life said that new and old customers who have purchased the above insurance products do not need to pay extra fees. If COVID-19 is diagnosed by the hospital for the first time during the extended liability period, and the clinical classification is severe or critical, the Company can pay COVID-19 insurance premium at 25% of the basic insurance amount under the contract when the insured is diagnosed. Each policy is limited to one payment of extended liability, and the maximum payment amount is RMB 6,543,800+0,000. The insurance liability of the original insurance contract remains unchanged. Those who are diagnosed with Omicron and clinically classified as critical diseases are also within the extended liability scope of the above insurance products.
Similar to China Life Insurance, Ping An Life Insurance Company of China, China has also expanded the COVID-19-related liabilities of 85 long-term illness insurances currently listed. If the customer is diagnosed as having COVID-19 for the first time by the hospital during the extended liability period, and the clinical classification is severe or critical, the company will pay an additional 20% of the basic insurance amount of sickness insurance in the insurance contract, and the insurance liability of the original insurance contract will remain unchanged.
In addition, according to Beijing Pratt & Whitney Health Insurance Project Team, Beijing Pratt & Whitney Health Insurance recently presented COVID-19's guarantee responsibility to the insured. According to the protection scheme, if the insured is diagnosed as a major or critical infectious disease in COVID-19 by People's Republic of China (PRC) * * * and domestic public hospitals or designated hospitals designated by the Health and Health Committee, the insurer will pay 20,000 yuan in one lump sum, and the insurance liability for the insured will be terminated.
The newspaper noted that on February 9, 65438, Beijing Banking Insurance Supervision Branch issued the Notice on Strengthening Financial Support for Work Related to Resumption of Work, requiring insurance companies to speed up the research and development of insurance products related to infectious diseases in COVID-19. Accelerate the design and development of COVID-19 infectious disease-related liability insurance which is affordable and widely applicable to people, so as to protect the risks of serious illness, critical illness and death caused by COVID-19. At the same time, improve the protection level of the insured of Jingpuhui Health Insurance, support insurance institutions to expand the product insurance liability without raising the rate, and improve the protection ability against the serious, dangerous and death risks caused by COVID-19.
An insurance agency said that COVID-19 insurance has been sold out.
How to settle claims after the previous COVID-19 insurance products were removed from the shelves?
If the relevant COVID-19 insurance products are removed from the shelves, can the insured who bought insurance before apply for compensation if they are diagnosed? Can the antigen self-test "two bars" be used as the basis for diagnosis? 12 16, the reporter consulted a number of insurance institutions as the insured.
Shuidibao's customer service staff told this newspaper that Shuidibao COVID-19 Insurance needs to submit an inspection report issued by a public hospital above Grade II to apply for claims. "The report needs to indicate the clinical classification of COVID-19, whether it is light or heavy or critical, and the proportion of compensation in different degrees is different." At the same time, it is necessary to upload the report documents of all the examinations done by the hospital for patients. The customer service staff said that the antigen self-test positive result does not count.
The customer service staff of Huatai Insurance said that if people who bought the company's COVID-19 insurance before were diagnosed, they needed to submit a positive certificate of COVID-19's diagnosis, and "the severity should be normal or above". The lung images issued by public hospitals above Grade II can show the relevant pathological reports and cases of pneumonia. Huatai insurance personnel also said, "If it is only the result of antigen self-inspection, it may affect the subsequent claims."
The customer service staff of Zijin Insurance also gave a similar reply. She said that those who bought Zijin Insurance and COVID-19 Insurance need to report to the insurance company first after the diagnosis. It is necessary to provide the certificate of suspected or confirmed infection of legal infectious diseases issued by disease prevention and control institutions or medical institutions, and the certificate of centralized isolation treatment issued by disease prevention and control institutions or medical institutions, and it is necessary to indicate what isolation treatment measures have been taken. "You also need a discharge summary. If there is no discharge summary, you can submit the diagnosis certificate and inspection report on the first page of the case. "
Taiping Insurance also launched a "worry-free" COVID-19 insurance product, which agreed to get a subsidy of 20,000 yuan after diagnosis, and the hospitalization isolation allowance was 200 yuan every day. On 12 16, the customer service staff of Taiping Insurance said that the materials needed for claim settlement would be informed by the claimant. As of press time, the reporter has not received the contact of the claimant.
At the the State Council Joint Prevention and Control Conference on February 8, 65438, Wang Guiqiang, director of the Department of Infectious Diseases of the First Hospital of Peking University, said that most people infected with COVID-19 could be treated at home, and only a few people with serious basic diseases might need to go to medical institutions for treatment. That is to say, if the infected people in COVID-19 don't go to a medical institution, they won't get the medical information and can't apply for compensation.
Ding Jinkun, a lawyer of Shanghai Dabang Law Firm, believes that under the current situation, insurance companies should appropriately relax the conditions for claims. He said that the insured patient has an insurance contract relationship with the insurance company. Under normal circumstances, proof of COVID-19 infection should be provided according to the contract, so as to obtain the claim. However, after the adjustment of prevention and control policies, patients with minor illnesses are generally treated at home, and it is difficult to obtain evidence. If the original contract is continued, the result will be unfair to the patient. At this time, the situation change clause in the civil code can be applied and the contract terms can be changed, that is, the patient can be allowed to obtain compensation under the condition of obtaining other evidence that can prove that he is infected.
Article 498 of the Civil Code stipulates: "If there is any dispute about the understanding of standard terms, it shall be interpreted according to the usual understanding. If there are more than two interpretations of the standard terms, an interpretation that is unfavorable to the party providing the standard terms shall be made. If the format clause is inconsistent with the non-format clause, the non-format clause shall be adopted. "
Xu Hao, a lawyer of Beijing Shi Jing Law Firm, said in an interview with the reporter of Beiqing Daily that insurance companies cannot unilaterally raise the threshold for claims and increase the difficulty for policyholders. For example, it is required to provide nucleic acid positive special inspection report and chest CT report. It goes beyond the usual understanding and raises the threshold of claim.
Related reports:
COVID-19's insurance is positive, but it doesn't pay? China Life responded.
12 15, a news about "China Life Insurance COVID-19 Insurance was exposed on the Internet but failed to claim compensation" attracted many concerns. Some netizens said, "I bought China Life, and now it's Yang, and the insurance company refuses to pay."
12 16 according to the report of China bancassurance, China life insurance co., ltd. investigated and verified this matter at the first time, and the customer insured many products such as critical illness insurance and medical insurance in the company, some of which expanded COVID-19's liability. At present, the company has not received the claim information submitted by customers or their families.
China Life said that it has contacted customers' families to further strengthen communication with customers. In the future, according to the relevant information and contracts submitted by customers, the corresponding claims procedures and services will be quickly started.
China Life said that since the outbreak of the COVID-19 epidemic in 2020, the company has actively responded to the call of the state, fulfilled the responsibility of central enterprises, and has extended the heavy and dangerous insurance responsibility of new crown pneumonia to more than 50 insurance products. For new and old customers who have purchased the above insurance products, there is no need to pay extra fees. If COVID-19 is diagnosed by the hospital for the first time during the extended liability period, and the clinical classification is serious or dangerous, the Company can pay COVID-19 insurance premium at 25% of the basic insurance amount under the contract at that time when the insured is diagnosed. Each policy is limited to one-time payment of extended liability, and the maximum amount is RMB 6,543,800+0,000. The insurance liability of the original insurance contract remains unchanged.
China Life said that the insured was diagnosed as Omicron for the first time, and the clinical classification was severe and critical, which belongs to the extended liability scope of the above insurance products.
Since the outbreak of New Crown Pneumonia, many insurance companies have expanded the insurance liability of related insurance products, but the major insurance liability is COVID-19. However, it is worth noting that the so-called "COVID-19 Insurance" in the market is mostly the extended liability of medical insurance, critical illness insurance, accident insurance and other products, or related additional risks.
Recently, with the adjustment of epidemic prevention and control policies, many insurance products related to COVID-19 epidemic have been removed from the shelves. However, because of this, the claims related to "COVID-19 Insurance" are increasing day by day.