＊실손의료보험 청구서류 표준화＊

<실손의료보험금 청구서류 표준화․통일화된 서류내용> <TABLE style="BORDER-RIGHT: medium none; BORDER-TOP: medium none; BORDER-LEFT: medium none; BORDER-BOTTOM: medium none; BORDER-COLLAPSE: collapse" cellSpacing=0 cellPadding=0 border=1> <TBODY> <TR> <TD style="BORDER-RIGHT: #000000 0.4pt solid; PADDING-RIGHT: 5.1pt; BORDER-TOP: #000000 0.4pt solid; PADDING-LEFT: 5.1pt; PADDING-BOTTOM: 1.4pt; BORDER-LEFT: #000000 0.4pt solid; PADDING-TOP: 1.4pt; BORDER-BOTTOM: #000000 0.4pt solid" vAlign=center width=104 bgColor=#d6d6d6 height=36> 구분</TD> <TD style="BORDER-RIGHT: #000000 0.4pt solid; PADDING-RIGHT: 5.1pt; BORDER-TOP: #000000 0.4pt solid; PADDING-LEFT: 5.1pt; PADDING-BOTTOM: 1.4pt; BORDER-LEFT: #000000 0.4pt solid; PADDING-TOP: 1.4pt; BORDER-BOTTOM: #000000 0.4pt solid" vAlign=center width=240 bgColor=#d6d6d6 height=36> 현행</TD> <TD style="BORDER-RIGHT: #000000 0.4pt solid; PADDING-RIGHT: 5.1pt; BORDER-TOP: #000000 0.4pt solid; PADDING-LEFT: 5.1pt; PADDING-BOTTOM: 1.4pt; BORDER-LEFT: #000000 0.4pt solid; PADDING-TOP: 1.4pt; BORDER-BOTTOM: #000000 0.4pt solid" vAlign=center width=240 bgColor=#d6d6d6 height=36> 변경</TD></TR> <TR> <TD style="BORDER-RIGHT: #000000 0.4pt solid; PADDING-RIGHT: 5.1pt; BORDER-TOP: #000000 0.4pt solid; PADDING-LEFT: 5.1pt; PADDING-BOTTOM: 1.4pt; BORDER-LEFT: #000000 0.4pt solid; PADDING-TOP: 1.4pt; BORDER-BOTTOM: #000000 0.4pt solid" vAlign=center width=104 height=94> 공통</TD> <TD style="BORDER-RIGHT: #000000 0.4pt solid; PADDING-RIGHT: 5.1pt; BORDER-TOP: #000000 0.4pt solid; PADDING-LEFT: 5.1pt; PADDING-BOTTOM: 1.4pt; BORDER-LEFT: #000000 0.4pt solid; PADDING-TOP: 1.4pt; BORDER-BOTTOM: #000000 0.4pt solid" vAlign=center width=240 height=94> ․청구서(양식), 신분증,  통장사본</TD> <TD style="BORDER-RIGHT: #000000 0.4pt solid; PADDING-RIGHT: 5.1pt; BORDER-TOP: #000000 0.4pt solid; PADDING-LEFT: 5.1pt; PADDING-BOTTOM: 1.4pt; BORDER-LEFT: #000000 0.4pt solid; PADDING-TOP: 1.4pt; BORDER-BOTTOM: #000000 0.4pt solid" vAlign=center width=240 height=94> 좌동</TD></TR> <TR> <TD style="BORDER-RIGHT: #000000 0.4pt solid; PADDING-RIGHT: 5.1pt; BORDER-TOP: #000000 0.4pt solid; PADDING-LEFT: 5.1pt; PADDING-BOTTOM: 1.4pt; BORDER-LEFT: #000000 0.4pt solid; PADDING-TOP: 1.4pt; BORDER-BOTTOM: #000000 0.4pt solid" vAlign=center width=104 height=280> 통원</TD> <TD style="BORDER-RIGHT: #000000 0.4pt solid; PADDING-RIGHT: 5.1pt; BORDER-TOP: #000000 0.4pt solid; PADDING-LEFT: 5.1pt; PADDING-BOTTOM: 1.4pt; BORDER-LEFT: #000000 0.4pt solid; PADDING-TOP: 1.4pt; BORDER-BOTTOM: #000000 0.4pt solid" vAlign=center width=240 height=280> ․진단서/통원확인서 중 택일, 진료비세부내역서       ․진료비계산서(영수증)      </TD> <TD style="BORDER-RIGHT: #000000 0.4pt solid; PADDING-RIGHT: 5.1pt; BORDER-TOP: #000000 0.4pt solid; PADDING-LEFT: 5.1pt; PADDING-BOTTOM: 1.4pt; BORDER-LEFT: #000000 0.4pt solid; PADDING-TOP: 1.4pt; BORDER-BOTTOM: #000000 0.4pt solid" vAlign=center width=240 height=280> ․병명확인 가능한 서류   (진단서, 병명있는 통원확인서, 병명있는 진료확인서, 소견서, 병명 기재된 차트 중 택일) ․계산서영수증   (일자별 진료비계산서 또는 납입확인서와 세부내역서)</TD></TR> <TR> <TD style="BORDER-RIGHT: #000000 0.4pt solid; PADDING-RIGHT: 5.1pt; BORDER-TOP: #000000 0.4pt solid; PADDING-LEFT: 5.1pt; PADDING-BOTTOM: 1.4pt; BORDER-LEFT: #000000 0.4pt solid; PADDING-TOP: 1.4pt; BORDER-BOTTOM: #000000 0.4pt solid" vAlign=center width=104 height=158> 입원</TD> <TD style="BORDER-RIGHT: #000000 0.4pt solid; PADDING-RIGHT: 5.1pt; BORDER-TOP: #000000 0.4pt solid; PADDING-LEFT: 5.1pt; PADDING-BOTTOM: 1.4pt; BORDER-LEFT: #000000 0.4pt solid; PADDING-TOP: 1.4pt; BORDER-BOTTOM: #000000 0.4pt solid" vAlign=center width=240 height=158> ․진단서/입퇴원확인서 중택일, 수술확인서, 진료비세부내역서 ․진료비계산서(영수증)</TD> <TD style="BORDER-RIGHT: #000000 0.4pt solid; PADDING-RIGHT: 5.1pt; BORDER-TOP: #000000 0.4pt solid; PADDING-LEFT: 5.1pt; PADDING-BOTTOM: 1.4pt; BORDER-LEFT: #000000 0.4pt solid; PADDING-TOP: 1.4pt; BORDER-BOTTOM: #000000 0.4pt solid" vAlign=center width=240 height=158> ․진단서(20만원 미만시 병명 있는 입·퇴원확인서 등으로 대체가능) ․진료비세부내역서 ․진료비계산서(영수증)</TD></TR> <TR> <TD style="BORDER-RIGHT: #000000 0.4pt solid; PADDING-RIGHT: 5.1pt; BORDER-TOP: #000000 0.4pt solid; PADDING-LEFT: 5.1pt; PADDING-BOTTOM: 1.4pt; BORDER-LEFT: #000000 0.4pt solid; PADDING-TOP: 1.4pt; BORDER-BOTTOM: #000000 0.4pt solid" vAlign=center width=104 height=144> 처방</TD> <TD style="BORDER-RIGHT: #000000 0.4pt solid; PADDING-RIGHT: 5.1pt; BORDER-TOP: #000000 0.4pt solid; PADDING-LEFT: 5.1pt; PADDING-BOTTOM: 1.4pt; BORDER-LEFT: #000000 0.4pt solid; PADDING-TOP: 1.4pt; BORDER-BOTTOM: #000000 0.4pt solid" vAlign=center width=240 height=144> ․처방전, 영수증</TD> <TD style="BORDER-RIGHT: #000000 0.4pt solid; PADDING-RIGHT: 5.1pt; BORDER-TOP: #000000 0.4pt solid; PADDING-LEFT: 5.1pt; PADDING-BOTTOM: 1.4pt; BORDER-LEFT: #000000 0.4pt solid; PADDING-TOP: 1.4pt; BORDER-BOTTOM: #000000 0.4pt solid" vAlign=center width=240 height=144> ․처방전과 일자별 약제비 계산서(영수증)    * 카드 결재영수증은 증빙서류가 아님</TD></TR></TBODY></TABLE>       ※ 단, 추가조사 등 필요시 별도의 추가서류를 요청할 수 있음.