No compensation shall be paid in the following cases:
1. If it should be borne by a third party, or it should be paid from work injury insurance or maternity insurance, the insurance company will not be liable for compensation.
2. If the deductible set by the guarantee liability is not exceeded, the insurance company will not pay.
3. The insured meets the requirements for applying for charitable relief drugs, but the application for relief projects fails because the insured fails to submit relevant applications or the application materials are incomplete due to personal reasons; The insured passes the aid audit, but fails to receive the aid drugs due to the insured's reasons, which shall be deemed as the insured's voluntary waiver of the applicable insurance rights and interests under this contract.
4. During the insurance period, the insured stops paying the local basic medical care, and the insurance company will not pay for the medical expenses that have occurred before the start date of insurance liability (0: 00 on June 65438+10: 00 on October 65438).
5. Non-disease treatment items, such as various health check-ups, premarital check-ups, travel check-ups, occupational check-ups, exit check-ups and other expenses, as well as various infertility (pregnancy) and sexual dysfunction diagnosis and treatment items, will not be paid by insurance companies.
6. Other cases that will not be reimbursed, such as all kinds of expenses incurred in beauty, plastic surgery, non-functional orthopedics, weight loss, freckle removal, mole removal, skin care, tooth implantation, tooth cleaning, glasses, artificial eyes, artificial limbs, hearing AIDS, etc.
Payment method:
1, "one-stop" settlement
If the insured incurred medical expenses that met the reimbursement requirements during 2002 11-March1,the insurance company will cooperate with the Medical Insurance Bureau to transfer the expenses that should be reimbursed by the insurance company to the insured's bank account through the medical insurance information system after the payment period. After the medical insurance settlement information system is upgraded, the expenses of Xihu Yilianbao within the responsibility of designated medical institutions can also be settled by one-stop credit card.
2, sporadic reimbursement settlement
Medical expenses incurred by the insured do not meet the one-stop settlement conditions, and sporadic reimbursement can be implemented. The insured can bring relevant materials to the service outlets of the insurance company for reimbursement.