杭州白领患甲状腺癌治疗花了2.3万元，因为一项新规定，保险赔了105万
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/4LWaXvDYFuKFcxhUHpLiceYIFnbr0w8rprBy6vh3DCWxwe53icx0EX2NcjuKWdMADiaqLmYQ6PXx2MEC807m09leA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">昨日，杭州白领朱小姐拿到最后一笔保险理赔款50万元，至此，<span style="color: black;"><strong style="color: blue;">她<span style="color: black;">由于</span>患乳头状甲状腺癌，从三家保险<span style="color: black;">机构</span>总共拿到了105万元理赔。</strong></span><strong style="color: blue;"><span style="color: black;"><span style="color: black;">本来</span>她只能拿到三分之一的理赔，幸好保险<span style="color: black;">机构</span>刚出的一项新政策，让她全额拿到赔款。</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这项新政策<span style="color: black;">便是</span><span style="color: black;"><strong style="color: blue;">重疾险“择优”理赔</strong></span>，即哪种理赔<span style="color: black;">方法</span>对客户更有利，就优先用哪种。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">之<span style="color: black;">因此</span>有这一变化，与重疾险即将“换挡”<span style="color: black;">相关</span>。<span style="color: black;">按照</span>中国保险行业协会与中国医师协会11月5日正式<span style="color: black;">颁布</span>的《重大<span style="color: black;">疾患</span>保险的<span style="color: black;">疾患</span>定义<span style="color: black;">运用</span>规范(2020年修订版)》(下<span style="color: black;">叫作</span>2020版重疾定义)，<span style="color: black;"><strong style="color: blue;">95%的甲状腺癌（<span style="color: black;">重点</span>是乳头状甲状腺癌）被剔除出重疾表，只算轻症，最多赔付30%。</strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">除了甲状腺癌，急性心肌梗死、严重阿尔兹海默病、重大器官移植、心脏瓣膜手术等<span style="color: black;">平常</span>重疾的理赔<span style="color: black;">亦</span>将深受新定义影响。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">根据</span>规定，自2021年2月1日起，所有在售的重疾险<span style="color: black;">制品</span>都<span style="color: black;">需求</span>符合新版重疾定义。<span style="color: black;">亦</span><span style="color: black;">便是</span>说，重疾险“换挡”还有两个月过渡期，<span style="color: black;">已然</span>投保重疾险的消费者，<span style="color: black;">倘若</span>不幸得了重疾，怎么理赔最合算？想投保的人，是等新<span style="color: black;">制品</span>上市再买，还是选老<span style="color: black;">制品</span>？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">“择优”理赔<span style="color: black;">方法</span>出炉</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">泰康、国寿、<span style="color: black;">安全</span>、新华、友邦、恒大、工银安盛等多家寿险<span style="color: black;">机构</span><span style="color: black;">近期</span>宣布理赔的“优选”<span style="color: black;">方法</span>，即“择优”<span style="color: black;">选取</span>对客户有利的<span style="color: black;">方法</span>来赔付。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">如泰康人寿和<span style="color: black;">安全</span>人寿均<span style="color: black;">叫作</span>，“针对采用2007版重疾定义<span style="color: black;">营销</span>的老<span style="color: black;">制品</span>，<span style="color: black;">选择</span>2007版/2020版重疾定义中的<span style="color: black;">疾患</span>最优定义，<span style="color: black;">做为</span>客户赔付依据”。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">新华保险<span style="color: black;">叫作</span>，“择优<span style="color: black;">根据</span>该病种在新旧规范中更有利于客户赔付的定义<span style="color: black;">做为</span>理赔依据”。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这<span style="color: black;">寓意</span>着，<span style="color: black;"><strong style="color: blue;"><span style="color: black;">选择</span>旧版定义的重疾险，消费者在发起理赔时，<span style="color: black;">能够</span>在符合原保险合同的“<span style="color: black;">疾患</span>定义规范（2007）”与“<span style="color: black;">疾患</span>定义规范（2020）”两项行业<span style="color: black;">疾患</span>定义规范中进行<span style="color: black;">选取</span>。</strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/OoyyicmZojqGxRJdTRB7e9AiaqicywOiaiba1YH07xibmTLvHNg05zvvmJcc8MfZoqZ9tEN5xt5VpicTKzpdicuR1QnnQQ/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">为何</span>叫“择优<span style="color: black;">选取</span>”呢？先来<span style="color: black;">认识</span>一下新版定义更新了什么。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;">2020版重疾定义将原有25种重疾扩展为28种重度<span style="color: black;">疾患</span>和3种轻度<span style="color: black;">疾患</span>，<span style="color: black;">增多</span>严重慢性<span style="color: black;">呼气</span>衰竭、严重克罗恩病、严重溃疡性结肠炎3种重度<span style="color: black;">疾患</span>。<span style="color: black;">同期</span>，扩展对重大器官移植术、冠状动脉搭桥术、心脏瓣膜手术、主动脉手术等8种<span style="color: black;">疾患</span>的<span style="color: black;">保证</span>范围，优化严重慢性肾衰竭等7种<span style="color: black;">疾患</span>定义。<span style="color: black;">另外</span>，对甲状腺癌按轻重范围进行分级，TNM分期为Ⅰ期的甲状腺癌，不在“恶性肿瘤-重度”保障范围内，但属于“恶性肿瘤-轻度”，将<span style="color: black;">根据</span>不超过保额的30%进行轻症理赔。</strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">日前</span>保险<span style="color: black;">机构</span>的优选或择优理赔<span style="color: black;">方法</span>的适用范围，<span style="color: black;">通常</span>都设定了两个<span style="color: black;">前提</span>：一是适用<span style="color: black;">制品</span>范围，即<span style="color: black;">无</span>采用2020版重疾定义的重大<span style="color: black;">疾患</span>保险<span style="color: black;">制品</span>；二是客户首次确诊重疾时间，<span style="color: black;">或</span>理赔申请日期，<span style="color: black;">必要</span>在“2020版重疾定义”<span style="color: black;">颁布</span>时间之后，<span style="color: black;">亦</span><span style="color: black;">便是</span>2020年11月5日之后。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">这般</span>选理赔最优</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">针对</span>客户<span style="color: black;">来讲</span>，<span style="color: black;">怎么样</span>才算“择优”理赔呢，来看几个<span style="color: black;">详细</span>例子。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">案例一，客户申请“冠状动脉搭桥术”理赔，病情为实施了微创“切开心包”手术。若按2007版重疾定义理赔，因不满足定义中“开胸”的<span style="color: black;">前提</span>，结果为不予理赔；而按2020版重疾定义理赔，则符合重大<span style="color: black;">疾患</span>定义，<span style="color: black;">就可</span>赔付100%基本保额。<span style="color: black;">那样</span>，择优<span style="color: black;">方法</span>是依据2020版重疾定义理赔。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">案例二，客户<span style="color: black;">病患</span>阿尔兹海默病，临床<span style="color: black;">痴傻</span>评定量表（CDR）<span style="color: black;">评定</span>结果为3分，若按2007版重疾定义申请理赔，因不满足定义中“自主生活能力完全丧失”的<span style="color: black;">前提</span>，结果为不予理赔；而按2020版重疾定义理赔，则符合重大<span style="color: black;">疾患</span>定义，可赔付100%基本保额。那么，择优<span style="color: black;">方法</span>是依据2020版重疾定义理赔。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">案例三，客户<span style="color: black;">病患</span>“I期甲状腺癌”而申请“恶性肿瘤”理赔，若按2007版重疾定义进行理赔，“I期甲状腺癌”符合“重大<span style="color: black;">疾患</span>”，赔付100%基本保额；而按2020版重疾定义，“I期甲状腺癌”不符合“重大<span style="color: black;">疾患</span>”，仅符合“轻症”定义，对应赔付30%基本保额。<span style="color: black;">因此呢</span>，择优<span style="color: black;">方法</span>会依据2007版重疾定义理赔。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">本文开头<span style="color: black;">说到</span>的朱小姐，所患乳头状甲状腺癌即属于“I期甲状腺癌”，<span style="color: black;"><strong style="color: blue;">在新版定义中属于轻症，最多只能赔付30%。而按老版定义，则属于重症，100%赔付，<span style="color: black;">因此</span>朱小姐<span style="color: black;">选取</span>老版定义理赔。</strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/OoyyicmZojqGxRJdTRB7e9AiaqicywOiaiba1iasxtHuyodlzckcs5lChTAwhuaWV9tjPhkocnHFVBQMK505wEYLjWPQ/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">案例四，客户<span style="color: black;">病患</span>“子宫肌瘤(良性)”申请恶性肿瘤理赔，<span style="color: black;">因为</span>“子宫肌瘤(良性)”在2007版和2020版标准定义中，都不符合重大<span style="color: black;">疾患</span>，<span style="color: black;">因此呢</span>，不适用此次择优<span style="color: black;">方法</span>，结果仍是不予赔付。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">值得<span style="color: black;">重视</span>的是，<span style="color: black;"><strong style="color: blue;"><span style="color: black;">以上</span><span style="color: black;">机构</span>的理赔择优规则都只限定在重疾定义，并<span style="color: black;">无</span>提出轻症<span style="color: black;">亦</span>适用，而是说“原保险合同其他任何约定均保持不变”。</strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">高级保险规划师、杭州翰乔学社社长陈蕾<span style="color: black;">暗示</span>，<span style="color: black;">日前</span>还有不少<span style="color: black;">机构</span><span style="color: black;">无</span><span style="color: black;">颁布</span>“择优”理赔<span style="color: black;">方法</span>，预计在<span style="color: black;">实质</span>理赔中<span style="color: black;">亦</span>会<span style="color: black;">根据</span>“择优”原则处理。<span style="color: black;">另一</span><span style="color: black;">按照</span>2019年底实施的《健康保险管理办法》，监管<span style="color: black;">亦</span><span style="color: black;">需求</span>保险<span style="color: black;">机构</span>在理赔时要从客户利益出发。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">新旧版重疾险怎么选</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">根据</span>规定，依据2007版定义设计的重疾险<span style="color: black;">制品</span><span style="color: black;">能够</span><span style="color: black;">营销</span>至2021年1月31日，从2021年2月1日起，所有在售的重疾险<span style="color: black;">必要</span>符合新定义。<span style="color: black;">亦</span><span style="color: black;">便是</span>说，重疾险“换挡”还有两个月。<span style="color: black;">针对</span>有投保需求的人<span style="color: black;">来讲</span>，选旧还是选新呢？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">快报此前<span style="color: black;">报告</span>过，甲状腺癌、双耳失聪、恶性肿瘤、急性心肌梗死等<span style="color: black;">状况</span>下在旧版重疾定义下理赔门槛更低；重大器官移植或造血干细胞移植术、冠状动脉搭桥术、心脏瓣膜手术、严重阿尔兹海默症、严重运动神经元病和主动脉手术等高发<span style="color: black;">疾患</span>则在新版<span style="color: black;">前提</span>下理赔更宽松。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">以甲状腺癌为例，在业内它被<span style="color: black;">叫作</span>为“致富癌”，<span style="color: black;">由于</span>绝大<span style="color: black;">都数</span>甲状腺癌非致死、可治愈，且治疗<span style="color: black;">花费</span>低，</span><span style="color: black;"><strong style="color: blue;">如朱小姐的治疗费只花了2.3万元。</strong></span><span style="color: black;">按老版定义理赔，显然对客户更有利。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">业内人士<span style="color: black;">叫作</span>，新版定义下，<span style="color: black;"><strong style="color: blue;">约95%的甲状腺癌将被划为轻症，“致富癌”将<span style="color: black;">作为</span>历史。</strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">那样</span>是不是<span style="color: black;">选取</span>旧版定义重疾险<span style="color: black;">便是</span>最佳<span style="color: black;">方法</span>呢？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">鑫山保代总经理孙海英<span style="color: black;">暗示</span>，不<span style="color: black;">必定</span>，要<span style="color: black;">详细</span>分析。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">她说，<span style="color: black;"><strong style="color: blue;"><span style="color: black;">疾患</span><span style="color: black;">保证</span>，宜早不宜迟，从这个<span style="color: black;">方向</span><span style="color: black;">来讲</span>，投保当然是越早越好。但<span style="color: black;">最后</span>还要是<span style="color: black;">按照</span><span style="color: black;">自己</span>的<span style="color: black;">疾患</span><span style="color: black;">危害</span>特点，基于<span style="color: black;">自己</span>发病率高的一种或几种<span style="color: black;">疾患</span>，来<span style="color: black;">选取</span>新版还是旧版。<span style="color: black;">倘若</span>消费者觉得<span style="color: black;">日前</span><span style="color: black;">自己</span>很健康，<span style="color: black;">选取</span>新版能更好地匹配保险<span style="color: black;">保证</span>与<span style="color: black;">疾患</span>带来的影响。</strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">另一</span>，从<span style="color: black;">花费</span>的<span style="color: black;">方向</span><span style="color: black;">来讲</span>，<span style="color: black;">因为</span>赔付率整体有所降低，<span style="color: black;"><strong style="color: blue;">新版定义下的重疾险“加量不加价”，保费有可能更低<span style="color: black;">有些</span>。<span style="color: black;">不外</span><span style="color: black;">日前</span>还<span style="color: black;">无</span>一家保险<span style="color: black;">机构</span>推出新定义的重疾险<span style="color: black;">制品</span>。</strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">业内人士<span style="color: black;">暗示</span>，<span style="color: black;"><strong style="color: blue;">“择优理赔”的设计，<span style="color: black;">针对</span><span style="color: black;">危害</span>偏好弱、保险知识少的保险消费者<span style="color: black;">来讲</span>，是较好的<span style="color: black;">选取</span>，</strong></span>投保时可优先<span style="color: black;">思虑</span>采用此类设计的<span style="color: black;">制品</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/4LWaXvDYFuKFcxhUHpLiceYIFnbr0w8rpflc6R2ncOqYectFdt2ZyaenRVibX86KeKyeLpBcOIIBhWPvbcwbZtOA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">源自</span>：都市快报</p>
我深受你的启发，你的话语是我前进的动力。 我赞同你的看法，你的智慧让人佩服，谢谢分享。 你的见解真是独到，让我受益匪浅。
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