CONG HOA
xA HOI
CHU NGHiA VI~T NAM
DQc l,p - T.., do - H~lDh phuc
TPHCM,ngay 29 thong 03 ndm 2022
S6: ..... ./ ..... '/TB-MIC ...
THONG BAo TRA.TIEN BAo HIEM
(S6 H6 sa b6i thuong: 20220329030871)
I
Kinh giri: NGUYEN NHAN QUYET
Tong Cong ty C6 phdn Baa hidm Qudn a6i aa xem xet H6 sa b6i thuong cua
Qui' khach hang. Can Clf vaa Gidy yeu cdu tra tiJn baa hiem, Giay chung nhdn baa
hiem, H(1p a6ng baa hiem, Quy tAc baa hiem, Chung toi thong baa vJ viec giai quyit
b6i thuong cua Quj khdch. hang nhu sau:
Nguoi duQ'c bao hi~m: NGUYEN NHAN QUYET
Dia chi: l d duong tan hoa 2 p hiep phu q9 tp hcm-PHUONG HIEP PHUQUAN 9-TP HO CHI MINH-VIET NAM
Tham gia bao hiem thea HDBH s6: 20210809051189
Can cir vao h6 sa b6i thuong s6 20220329030871
Da duoc duyet ngay:29 thang 03 nam 2022
TAng
sa ti~n b6i thirong:
5.000.000 VND
(Bang chii: Nam trieu d6ng)
TruOng hO]) Chuy~n khoan:
Theo yeu du cua Nguoi duoc bao hiem, chung t6i
se chuyen
s6 ti€n tren vao:
Chu tai khoan: NGUYEN NHAN QUYET
TK s6: 7480123457777
Tai: Ngan hang Ngan hang TMCP Quan dQi
NQi dung thanh toan: Tni ti€n bao hi~m cho NGUYEN NHAN QUYET vao
vi~n ngay 18/03/2022 t~i B~nh vi~n QUA.N DAN Y MIEN DONG
CIIlI j: S6 tiJn b6i thuirng lren se alt(1Cthanh {aan b{mg tiJn mqf haqc c/7uyJn
khoan vaa Tili khacm thea yell cdu cua Nguej'i am)'c baa hiim. Sau 15 ngay nhrjn aU9'C
thong baa llay. niu ivflC khong nhf/m aZI'(1c
p/uin h6i Iqi tli' Nglrai aU9'Cbaa hiim thi cai
nhu S~f ki¢n baa hiim tren ail atr9'Cgilli quyit xang, khong con thiic mdc khidu nqi gi.
Tran trQng kinh chao.!.
NO';nhijn:
- Nhu tren;
- Luu: Phong ....
BM/QT/Gf)BT/CN,OI,IO
TONG CONG TY CP
BAo HIEM
QUAN DOl
~S
III
CONG HOA
xA HOI
CHU NGHiA VI~T NAM
Dqc I~p - TV do - H,nh phuc
..., ngay 29 thang 03 ndm 2022
TO TRINH GIM QVYET QUYEN
H8
SO'
tor BAo
HIEM
sue KHOE
b8i thuong: true ti~p/bao Ianh vi~n phi
(118 so' s8:20220329030871)
I - Thong tin v~ hop d8ng bao hi~m: •
H9 ten nguoi tham gia bao hiem: NGUYEN NHAN QUYET
S6 chirng minh thu: 241114343
Ngay sinh: 02/1011991
Email: congty.phuongnamjsc@gmail.com
Thuoc don vi: CT CP KT XD VAN TAI PHUONG NAM
Hop d6ng bao hi~mlGi~y chimg nhan bao hiem s6: 20210809051189
Thai han BH: Til 18:00 gio, ngay 09/08/2021 d~n 18:00 gio, ngay 09/08/2022
Ngay dong phi: 09/08/2021
Il-Thdng tin v~ sv ki~n bao hi~m:
Ngay vao vien: 18/03/2022
Ngay ra vien:
B~nh vien dieu tri: Benh vien QUAN DAN Y MIEN DONG
Nguyen nhan: Tro dp thu nhap
Hau qua: Tro c~p thu nhap
S6 tien yeu c~u: 5.000.000 VND
H8 so g8m co:
- Giay yeu c~u tnt tien bao hiem;
- Chung nr di~u tri do co quan y t~ dp: Giay xet nghiem PCR
- Chung minh nhan dan.
- Bien ban xac nhan cua co quan v~ viec di~u tri Sars - COy 2.
BMlQT/GDBT/CN.15
1/2
III - Danh gia b8 so cua b8i thuong vien:
- Can err vao nguyen nhan nhap vien, chirng nr y t€. K~t luan: Truong hop tren thuoc
pharn vi hop d6ng bao hi€m.
- Gi§y
to- kham chua
- Ngay yeu
benh d§y du hop 1~.
du tra tien bao hiem
theo thai han quy dinh,
IY - Tinh toan b8i thmmg:
QUYENLQI
DUC}CCHI TRA
-- Tro c§p thu nhap
GIm~
CmTRA.
(VND)
so TIEN
pIlAT SINH
(VND)
5.000.000
5.000.000
S6TIEN
CHTTRA.
(VND)
5.000.000
V- Lich sU'b8i thuong:
S6 v~: 0 v~
S6 ti~n: 0 VND
Ten toi la: Nguyen Pham Thanh Thao voi ill each la b6i thuong vien cua MIC cam ket
s6 tien:
5.000.000 VND.
dll kiem tra tinh chinh xac va hop 1~cac chirng nr tren, de nghi lanh dao duyet
S6 tien tren
duoc chi tra cho nguoi diroc bao hi€m.l.
LANH D~O DON VI
BMlQT/GBBTICN.IS
PT. PHONG NGm~p Vl)
BOI THUONG VIEN
2/2
CONG HOA
xA HOI
CHU NGHiA VI~T NAM
DQc l,p - Tt.r do - H~nh phuc
S6: ..... .1..... .lTB-MIC ...
TPHCM,ngay 29 thang 03 ndm 2022
/lit.
,
?::..
x
?
THONG BAO TRA TIEN BAO HIEM
(S6 H6 sa b6i thuong: 20220329031317)
Kinh giri: Vo Kim Tuyen
Tong Cong ty C6 phdn Baa hiem Qudn a9i aii xem xet H6 sa b6i thuong cua
Quy khach hang. Can CtC vaa Gidy yeu cdu tra tiJn baa hiem, Gidy chung nhdn baa
hiem, H(Jp a6ng baa hiem, Quy tac baa hiem, Chung toi thong baa vJ viec giai quytt
b6i thutrng cua Quf khach hang nhu sau:
NglfOi dlfgC bao hi~m: Vo Kim Tuyen
Dia chi: S6 12 dirong s6 26, phuong Tang Nhon Phil a, Thanh ph6 Thu Dire
Tham gia bolohiem theo HDBH s6: 20210901029536
Can cir vao
h6 sa
b6i thirong s6 20220329031317
Da duoc duyet ngay: 29 thang 03 nam 2022
Tang
sa ti~n bBi thirong:
5.000.000 VND
(Bang chit: Nam trieu d6ng)
Trlf(rng bQ]) Cbuy~n khoan:
Theo yeu cAu cua Ngiroi duoc bolohiem, chung tei se chuyen s6 ti€n tren vao:
Chii tai khoan: Vo Kim Tuy~n
TK
sa: 0301008487063
T~i: Ngan bang AB BANK
NQi dung thaob toaD: Tra ti€n bolo hiSm cho Vo Kim Tuyen vao vi~n ngay
10103/2022 4li B~nh vi~n QUAN DAN Y MIEN DONG
Chit y: S6 NJn b6i thlrang {ren se aU(Jc thanh roan b6ng tiJn m(jl hacic chuyin
khacm vaa Tai khaan thea yeu cdu cua Ngu()'i aU(Jcbaa hi~m. Sou 15 ng(~vnh¢n aU:9'c
thong bao nay, niu ]vf]C kh6ng nhgn aU(Jcphim h6i It;lit£,Ngu()'i aU(Jcbaa hi~m {hi cai
nhu Sll ki¢n baa hi~m tren dil aU(Jcgiai quyit :xang, khong con tMic mbc khiJu nt;ligi.
Tran trQng kinh chao.!.
Not nh~n:
TONG CONG TY CP
BAo
HrEM
QUAN DOl
- Nhu tren;
- Luu: Phong ....
BMlQT/GDBT/CN.Ol.lO
III
CONG HOA
xA HOI CHi) NGHiA VI~T NAM
DQc l,p - TI}'do - H~nh phuc
..., ngay 29 thong 03 niim 2022
TO TRiNH GW QUYET QUYEN LQI BAo HIEM
sire KHOE
HB SO' bBithuimg: true ti~p/bao lanh vi~n phi
(HA so s&:20220329031317)
I - Thong tin v~ hQ1>dAng bao hi~m:
He) ten ngiroi tham gia bao hiern: Vo Kim Tuyen
S6 chirng minh thu:
241716515
Ngay sinh: 24/03/1998
Email:
ThuQc don vi: CONG TY TNHH GLOBAL FISHERIES EXCHANGE VIeT NAM
Hop d6ng bao hiem/Giay chimg nhan bao hiem s6: 20210901029536
Thai han BH: Til 16:18 gio, ngay 30108/2021 d~n 16:18 gio, ngay 30108/2022
Ngay dong phi: 0110912021
Il-Thdng tin v~ sl}' ki~n bao hi~m:
Ngay vao vien: 10103/2022
Ngay ra vien:
B~nh vien di~u tri: B~nh vien QUAN nAN Y MIEN DONG
Nguyen nhan: TrQ'cftp thu nhap
Hau qua: TrQ'cftp thu nhap
S6 tien yeu cau:
5.000.000 VND
HA so' gAm co:
- Gifty yeu c~u tra tien bao hiem;
- Chung ill di~u tri do co quan y t~ cftp: Giay xet nghiem PCR
- Chung minh nhan dan.
- Bien ban xac nhan cua ca quan v~ viec di~u tri Sars - COy 2.
BMlQT/GDBT/CN.15
1/2
III - Danh gia h6 so cua b6i thuong vien:
- Can cir vao nguyen nhan nhap vien, chirng ill y t€. K€t luan: Truong hop tren thuoc
pharn vi hop d6ng bao hiern.
- Giay to kham chua benh d~y du hop I~.
- Ngay yeu c~u tra ti~n bao hiem thea thai han quy dinh.
IV - Tinh toan b6i thuong:
QUYENLQI
DUQ'C CHI TRA
GIm~N
CHITRA
(VND)
SOTIEN
pIlAT SINH
5.000.000
-- TrQ'cip thu nhap
(VND)
5.000.000
so TIEN
CHITRA
(VND)
5.000.000
V- Lich sir b6i thirong:
S6 V1;-l: 0 V1;-l
S6 tiJn: 0 VND
Ten tei Iii: Nguyen Pham Thanh Thao voi tu each Iii b6i thuong vien cua MIC cam k€t
da kiem tra tinh chinh xac va hop I~ cac chirng ill tren, d~ nghi lanh dao duyet s6 tien:
5.000.000 VND.
S6 tien tren diroc chi tra cho nguoi
LANH D~O DON VI
BMlQT/GDBTICN.15
duoc bao hiem.,',
PT. PHONG NGHIl:P VV
SOl THUONG V[EN
2/2
,
'\
CQNG HOA
xA HQI
CHU NGHiA VJl:T NAM
D{}cI,p - T,! do - H~nh phuc
TPHCM,ngay 29 thang 03 ndm 2022
S5: ..... .1..... .lTB-MIC ...
THONG BAo TRA. TIEN BAo HIEM
(S5 H6 sa b6i thuong: 20220329032852)
Kinh giri: NGUYEN MINH TRI
Tlmg Cong ty C6 phdn Bdo hiJm Qudn il(Ji illi xem xet H6 sa b6i thuong cua
Quy khach hang. Can cu vaa Giay yeu cdu tra tiJn baa hiem, Gidy chung nhdn baa
hiem, H9]J il6ng bao hiJm, Quy tdc bao hiem, Chung toi thong baa vJ viec giai quyh
b6i thuong cua Quj khach hang nhu sau:
NgU'oodU'Q'cbao hi~m: NGUYEN MINH TRI
Via chi: S5 2Bis Nguyen Thi Minh Khai, Phuong Va Kao, Quan 1, TPHCM
Tham gia bao hiem theo HDBH s5: 20210826048915
Can cu vao h6 sa b6i thuong s5 20220329032852
Va duoc duyet ngay:29 thang 03 nam 2022
T6ng
sa ti~n b8i thuong:
5.000.000 VND
(Bling chii: Nam trieu d6ng)
TrU'<rng hClPChuy~n khoan:
Theo yeu cdu cua Nguoi diroc bao hiem, chung toi se chuyen s5 ti€n tren vao:
Chii tai khoan: NGUYEN MINH TRI
TK
sa: 1100119489006
T~i: Ngan hang Ngan hang TMCP Quan d{}i
N{}idung thanh toan: Tra ti€n bao hiSm cho NGUYEN MINH TRI vao vi~n
ngay 17/03/2022 t~i B~nh vi~n MEDICAL DrAG CENTER
Cllu j: s6 tiJn b6i thu(mg h'en se aU(Jc thanh roan bling ti~n mqt haqc chuyin
khaan vao Tili khoan thea yeu cdu cua Nguai aU(Jcbao hiJm. Sau J 5 ngay nh4n alf9'c
fhong baa nay, niu MlC khong nh(in aU'(J'c
phan h6i lr;1i fir Ngw]'i thr9'c bao hiJm thi coi
nhu Sll ki¢n baa hiJm trerz ali au'9'Cgiai quyh xong. khong con thdc mbc khiJu n(li gi.
Tran tn;mg kinh chao./.
TONG CONG TY CP
Nu; nh(in:
- Nhutren;
- LUll: Phong ....
BMlQT/GDBT/CN.O
1.10
BAo HIEM
QUAN DQI
c--s
III
.
CONG HOA
xA HOI.
CHU NGHiA VIET
. NAM
DQc I~p - TV do - H~nh phuc
..., ngay 29 thang 03 nam 2022
TO TRiNH GIAJ QUYET QUYEN LQI BAo IDEM sue KHOE
HA so bAi thuong: true ti~p/bao lanh vi~n phi
(HA so
s8:20220329032852)
I - Thong tin v~ hQ'PdAng bao hi~m:
HQ ten nguoi tham gia bao hiem: NGUYEN MINH TRI
s6 chirng minh
thu: 079096012509
Ngay sinh: 12/0111996
Email:
Thuoc dan vi: CONG TY CO pHAN SAN XUAT THlJdNG
DljNG MINH THANH
MAl DrCH V1)
xA y
Hop d6ng bao hiern/Giay chirng nhan bao hiem s6: 20210826048915
Thai han BH: Til 17:30 gio, ngay 26/08/2021 d~n 17:30 gio, ngay 26/08/2022
Ngay dong phi: 26/08/2021
Il-Thong tin v~ sv ki~n bao hi~m:
Ngay vao vien: 17/03/2022
Ngay ra vien:
Benh vien di~u tri: MEDICAL DIAG CENTER
Nguyen nhan: TrQ'c~p thu nhap
Hau qua: TrQ'c~p thu nhap
86 ti~n yeu d.u:
5.000.000 VND
;;.
A
H o SO' gom co:
r
- Giay yeu c~u tra tien bao hiern;
- Chung nr di~u tri do co quan y t~ dp: Gi~y xet nghiem PCR
- Chung minh nhan dan.
- Bien ban xac nh~ cua co quan v€ viec di€u tri Sars -
BMlQT/GflBT/CN.lS
COy
2.
1/2
III - Danh gia h8 so ella b8i thuong vien:
- Can cir van nguyen nhan nhap vien, chirng ill y t~. K~t luan: Truong hop tren thuoc
pharn vi hop d6ng bao hiem.
- GiAyto' kham chua benh d~y du hop l~.
- Ngay yeu du tra tien bao hi~m thea thai han quy dinh.
IV - Tinh roan b8i thirong:
QUYENLQI
DUQC CHI TM
GI61~
CHITM
(VND)
5.000.000
-- Tro cdp thu nhap
SO TIEN
SOTIEN
PHATSINH
(VND)
CHITM
(VND)
5.000.000
5.000.000
V- Ljch sir b8i thirong:
s6 v~: 0 v~
S6 tiin: 0 VNf)
Ten toi la: Nguyen Pham Thanh Thao voi til each la b6i thuong vien cua MIC cam k~t
da kiem tra tinh chinh xac va hop I~ cac chirng ill tren,
nghi lanh dao duyet s6 tien:
5.000.000 VND.
de
S6 tien tren diroc chi tra cho nguoi
LANH D~O DON VI
BMlQT/GDBTICN.lS
duoc bao hiem.'.
PT. PHONG NGHI~P VV
BOI THUONG VIEN
2/2
CONG HOA
xA HOI
CHU NGHiA VI~T NAM
DQc l~p - TV do - H,nh phuc
S6: ..... .1. .... .lTB-MIC ...
TPHCM,ngay 29 thang 03 nam 2022
THONG BAo TRA. TIEN BAo IDEM
(S6 H6 sa b6i thuong: 20220329033102)
Kinh giri: NGUYEN TAN TAl
Tlmg Cong ty C6 phdn Bdo hidm Qulin a6i ail xem xet H6 sa b6i thuong cua
QuY khdch hang. Can cu VaG Gidy yeu cdu tra tiJn btio hiem, Gidy chicng nhdn bao
hiem, H(Jp a6ng bao hiem, Quy tlic bao hiem, Chung toi thong bao vJ viec giai quyit
b6i thuong cua QuY khdch hang nhu sau:
NguOi dUQ'c bao hiim: NGUYEN TAN TAl
Dia chi: S6 2Bis Nguyen Thi Minh Khai, Phuong Da Kao, Quan 1, TPHCM
Tham gia bao hiem thea HDBH s6: 20210826048911
Can cir VaGh6 sa b6i thirong s6 20220329033102
Da: diroc duyet ngay: 29 thang 03 nam 2022
TAng
s6 ti~n
b8i thuong: 5.000.000 VND
(Bang chii: Nam trieu d6ng)
Tnrirng hup Chuyin khoan:
Theo yeu cdu cua Ngiroi duoc bao hiem, chung t6i se chuyen s6 ti€n tren VaG:
Chu tai khoan: NGUYEN TAN TAl
TK
s6: 1100116385005
Tai: Ngin hang Ngan hang TMCP Quan dQi
NQi dung thanh toan: Tra ti€n bao hi~m cho NGUYEN TAN TAl VaGvi~n
ngay 16/03/2022 t~i B~nh vi~n TTXN Y KHOA :MEDLAB
Chti y: S6 fiJn b6i {huang {ren se aU9'c {hanh {oem bdng tiJn mqt hoqc chuyi.n
khoan VaGTizi khoim thea yeu cdu cLLaNgu()'i aU(Jcbao hiim. Sau 15 ngay nhi)n azwc
{hong bao nay, niu MIC khong nhi)n aU(J'cphan h6i 19i tir Ngu()'i aU9'c bao hiim thi coi
nhu SI,{ ki¢n bao hiim tren ail auo'c g;ai quyJt :Kong,khong con thlic mac khiiu ngi gi.
Tran trQng kinh chao.!.
Nui nh~n:
TONG CONG TY CP
BAo HIEM
QUAN D(n
- Nhutren,'
- Luu: Phong ....
BMlQTIGDBT/CN.OI.IO
111
CQNG HOA
xA HQI cnu NGHiA
VI¥T NAM
DQc l~p - T\I' do - H~nh phuc
"'J
ngay 29 thdng 03 nam 2022
TO TRiNH GIM QUYET QUYEN L<}I BAo HIEM sue
HB
SO'
KHOE
bBi thirong: tr1}'ctiSp/bao lanh vi~n phi
(IIa
SO' s6:202203290331
02)
I - Thong tin v~ hQ1>dang bao hi~m:
H9 ten ngiroi tham gia baa hiem: NGUYEN TAN TAl
S6 chimg minh thu: 024252469
Ngay sinh: 08/0211986
Email:
Thuoc don vi: CONG TY CO pRAN SAN XUAT THlJdNG
DljNG MINH THANH
MAl DJCH V1)
xA y
Hop d6ng baa hi€m/Gi~y chirng nhan baa hiem s6: 20210826048911
Thai han BH: Til 17:30 gio, ngay 26/08/2021 d~n 17:30 gio, ngay 26/08/2022
Ngay dong phi: 26/08/2021
Il-Thdng tin v~ s\l' ki~n bao hi~m:
Ngay vao vien: 16/03/2022
Ngay ra vien:
Benh vien di~u tri: TTXN Y KHOA MEDLAB
Nguyen nhan: Tro c~p thu nhap
Hau qua: Tro c~p thu nhap
S6 ti~n yeu du: 5.000.000 VND
Ha
SO' gam
co:
- Gi~y yeu cAutra tien baa hiem;
- Chirng ill di~u tri do co quan y t~ c~p: Gi~y xet nghiem PCR
- Chung minh nhan dan.
- Bien ban xac nhan cua co quan v~ viec di~u tri Sars - Cov 2.
BMlQT/GDBT/CN.15
1/2
III - Danh gia h6 so cua b6i thuimg vien:
- Can cir vao nguyen nhan nhap vien, clnrng ill y t€. K€t luan: Tnrong hQ"Ptren thuoc
pham vi hQ"Pd6ng bao hiem.
- Gic1yto kham chua benh d~y du hQ"Pl~.
- Ngay yeu c§u tra ti6n bao hiem thea thai han quy dinh.
IV - Tinh toan b6i thueng:
QUYENLQ'I
GI61~
DU<}C cm TRA
CIDTRA
(VND)
-- Tro cc1pthu nh~p
so TIEN
PHAT SINH
(VND)
5.000.000
5.000.000
SOTIEN
CHITRA.
(VND)
5.000.000
V- Lich Stf b6i thuong:
ss v~:
s6 tiJn:
0 v~
0 VNE)
Ten t6i la: Nguyen Pham Thanh Thao voi tu each la b6i thirong vien cua MIC cam k€t
da:kiem tra tinh chinh xac va hQ"Pl~ cac chirng ill tren, d6 nghi lanh dao duyet s6 tien:
5.000.000 VND.
S6 ti6n tren
duoc chi tra cho nguoi dtroc bao hiem.,'.
LANH D~O
BMlQTIGDBT/CN.15
DON
VI
PT. PHONG NGm~p VV
BOI THUONG VlEN
2/2
.
CONG HOA
xA HOI
.
.
CHiT NGHiA VIET NAM
DQc I~p - TV do - H~nh phuc
TPHCM,ngay 29 thdng 03 nam 2022
sf>: ..... ./. .... .lTB-MIC ...
THONG BAo TRA TIEN BAo HIEM
(sf> H6 sa b6i thuong: 20220329033317)
Kinh giri: LE TRUNG NGOC
Tdng Cong ty cd phdn Baa hidm Qudn a(5i ail xem xet H6 SO' b6i thuong cua
Qui' khach hang. Can Cll-vaa Gidy yeu cdu tra tiJn baa hiem, Gidy chung nhdn baa
hiem, H9'P a6ng baa hiem, Quy tac baa hiem, Chung toi thong baa vJ viec giai quyet
b6i thuong cua Qui' khach hang nhu sau:
NguOO dUQ"c bao hi~m: LE TRUNG NGOC
Dia chi: sf>2Bis Nguyen Thi Minh Khai, Phuong Da Kao, Quan 1, TPHCM
Tham gia bao hiem thea IIDBH s6: 20210826048900
Can cir vao h6 sa b6i thuong sf>20220329033317
D§ duoc duyet ngay:29 thang 03 narn 2022
TAng
sA ti~n
b8i thirong: 5.000.000 VND
(Bang chii: Nam trieu d6ng)
TrucYng h9]) Chuy~n khoan:
Theo yeu cfru cua Ngiroi diroc bao hiem, chung toi se chuyen sf>ti~n tren vao:
Chil tai khoan: LE TRUNG NGOC
TK sa: 1100116387008
Tal: Ngin hang Ngin hang TMCP Quin dQi
NQi dung thanh toan: Tra tien bao hi~m cho LE TRUNG NGOC vao vi~n
ngay 07103/2022 t~i B~nh vi~n TTKS BJ?,NHTA.T TPHCM HCDC
Cllit j: sd tiJn b6i thlrimg Iren se au9'c thanh (aim biing tiJn mijl ha(lc chuy~n
khacm vaa Taj khocm lhea yeu cdu clLaNgui)"i au9'c baa hiim. Sau 15 nga.v nh4n auo'c
thong bClonay, niu MIC khong n174naU(J"c
phim h6i lc;litt'r Nguo'i alro'c baa hidm thi cai
nhu S7l ki¢l1 baa hidm tren ail GU9'Cgiai quyit xong, khong can thlie mae khiJu n(l1gi.
Tran tr9ng kinh chao.!.
Nu; nh(in:
TONG CONG TY CP
- Nhu tren;
- Luu: Phong ....
~
BMlQT/GDBT/CN.01.l0
~
BAo HIEM
QUAN D(H
':2
III
CONG HOA
xA HOI CHU NGHiA VI~T NAM
DQcI,p - TI! do - H~mhphuc
..., ngay 29 thang 03 ndm 2022
TO'TRINH GIM QVYET QUYEN LQI BAo IDEM
sue KHOE
HB so bBi thuong: true ti~p/bao lanh vi~n phi
(lIa so' s6:20220329033317)
I - Thong tin v~ hop dang bao hi~m:
~-------------------------------------------------------~
H9 ten nguoi tham gia bao hiem: LE TRUNG NGOC
S6 chirng minh thir: 020955712
Ngay sinh: 02/05/1970
Email:
Thuoc dan vi: CONG TY CO pHAN sAN XUAT THUONG
DljNG MINH THANH
MAl
DICH V1)
xA Y
Hop d6ng bao hiem/Giay chimg nhan bao hiem s6: 20210826048900
Thai han BH: re
17:30 gio, ngay 26/08/2021 d~n 17:30 gio, ngay 26/08/2022
Ngay dong phi: 26/08/2021
Il-Thdng tin v~ Sl! kifn bao hi~m:
Ngay vao vien: 07/03/2022
Ngay ra vien:
Benh vien di€u tri: TTKS BBNH TAT TPHCM HCDC
Nguyen nhan: Tro c~p thu nhap
Hau qua: Tro c~p thu nhap
S6 ti€n yeu c§u: 5.000.000 VND
H6 so gam co:
- Gic1yyeu c§u tra ti~n bao hiern;
- Chung nr di€u tri do co quan y t~ c~p: Gi~y xet nghiem PCR
- Chirng minh nhan dan.
- Bien ban xac nhan cua co quan v€ viec di€u tri Sars - COy 2.
BMJQT/GDBT/CN.15
1/2
III - Danh gia h6 so etia b6i thtrimg vien:
- Can cu van nguyen nhan nhap vien, chung ill y t~. K~t luan: Truong hQ'Ptren thuoc
pham vi hop d6ng bao hiem.
- Gifry to kham chua benh d§y du hQ'Pl~.
- Ngay yeu c§u tra tien bao hiem thea thai han quy dinh.
IV - Tinh toan b6i thirong:
QUYENLQ'I
GI(lI~
DU<}C CHI TRA.
-- Tro cfrp thu nh~p
CHITRA.
(VND)
SOTIEN
pHATSINH
(VND)
5.000.000
SOTIEN
CHITRA.
(VNI»
5.000.000
5.000.000
V- Lich sif b6i thueng:
s6 v~:
0 v~
ss tiJn: 0 VND
Ten toi la: Nguyen Pham Thanh Thao voi tu each la b6i thuong vien cua MIC cam k~t
dffkiem tra tinh chinh xac va hop l~ cac clnrng ill tren, d~ nghi lanh dao duyet 56 tien:
5.000.000 VND.
S6 tien tren
duoc chi tra cho ngiroi duoc bao hiem.,',
LANH D~O DON
vr
PT. PHONG NGHI¥P
VV
nOI THUONG VIEN
~
BMlQT/GDBT/CN.15
Jrrin fJltryttl ~/w~h~!tM
2/2
,
CONG HOA xA H(H CHl) NGHiA VI~T NAM
t~r'_MIC
DQc I~p - TV do - H~nh phuc
86: ..... ./. ..... rrB-MIC ...
TPHCM,ngay 29 thang 03 ndm 2022
THONG BAo TRA. TIEN BAo IDEM
(86 H6 sa b6i thuong: 20220329033472)
Kinh gtri: HOANG THI MINH XUAN
Tong Cong ty C6 phdn Bao hiim Qudn deji da xem xi! H6 sa b6i thuong cua
Quy khach hang. Can ctr vao Gidy yeu cdu tra tiJn btio hiem, Giciy chung nhdn baa
hiem, Hop d6ng baa hiem, Quy tac bao hiem, Chung toi thong baa vJ viec gidi quyet
b6i thuong cua Quy khach hang nhu sau:
Nglfiri dtrgc bao hi~m: HOANG THI MINH XUAN
Dja chi: 86 2Bis Nguyen
Thi Minh
Khai, Phuong Da Kao, Quan 1, TPHCM
Tham gia bao hiem theo HDBH s6: 20210826048897
Can ClI vao h6 sa b6i thuong s6 20220329033472
D§ duoc duyet ngay:29 thang 03 nam 2022
Tang s8 ti~n bAi th trim g: 5.000.000
VNf)
(Bang chit: Nam trieu d6ng)
Trtrimg hQ]) Chuy~n khoan:
Theo yeu cAucua Ngiroi duoc bao hiem, chung toi se chuyen s6 tien tren vao:
Chi) tai khoan: HOANG TID MINH XUAN
T](s8: 1100116394004
Tai: Ngan hang Ngan hang TMCP Quan dQi
NQi dung thanh toan: Ira ti€n bao hi~m cho HOANG THI MINH XUAN vao
vi9n ngay 13/03/2022 ~i B~nh vi~n MEDICAL DIAG CENTER
CIIIJy: s6 ";~n b6i {huang fren se dU(J'cthanh toan bang tiin mijt ha(1c chuyin
khoan vao Tat khoan thea .veu cdu cua Nguo'i du(yc bao hiim, Sau 15 ngay nhl)n azr(J'c
thong bao nay, niu MlC khong nl1l)ndU(J'cphan h6i l(,1iftc NgU'o'idu(J'Cbao hidm thi cai
nhu s~' ki~n baa hiJm tren da au'(J'cgidi quyJt xang, kh6ng con thcic m6c khiiu n(,1;gi.
Iriin tn;mg kinh chao.!.
Nui nh~n:
- Nhzr tren;
- Lzm: Phong ....
BMlQT/G:E>BT/CN.01.l 0
TONG CONG TY CP
cr
BAo
IDEM
QUAN D(H
S
111
CQNG HOA
t~r"MIC
xA HQI CHiT NGHiA VI~T NAM
DQc I~p - TV do - H~nh phuc
•••
J
ngay 29 thdng 03 ndm 2022
TO TRINH GIA.I QUYET QUYEN LQI BAo IDEM sue KHOE
HB so bBithlfimg: true ti~p/bao linh vi~n phi
(Ha sO's6:20220329033472)
I - Thong tin v~ hQ'Pdang bao hi~m:
H9 ten nguoi tham gia bao hiem: HOANG THI MINH XUAN
sf> chirng minh thu: 022828449
Ngay sinh: 26/10/1976
Email:
Thu9C dan vi: CONG TY CO pHAN
DlJNG MINH THANH
sAN XUAT THVONG ~I
DJCH
vu Xi\.y
Hop d6ng bao hi~mlGi.iy chirng nhan bao hiem sf>:20210826048897
Thai han BH: Til 17:30 gio, ngay 26/08/2021 d~n 17:30 gio, ngay 26/08/2022
Ngay dong phi: 26/08/2021
IT-Thong tin v~ sv ki~n bao hi~m:
Ngay ra vien:
Ngay vao vien: 13/03/2022
B~nh vien dieu tri: "MEDICALDrAG CENTER
Nguyen nhan: Tro c§p thu nhap
Hau qua: Tro c§p thu nhap
sf> tien yeu c~u: 5.000.000
VND
Ha so gam co:
- Gi§y yeu c~u tra tien bao hiem;
- Chung til dieu tri do co quan y t~ c§p: Gi§y xet nghiem PCR
- Chung minh nhan dan.
- Bien ban xac nhan cua co quan ve viec dieu tri Sars - COy2.
BMlQT/GDBT/CN.15
1/2
III - Danh gia h6 so ella b6i thirong vien:
- Can ctr vao nguyen nhan nhap vien, chirng ill y teo Ket luan: Truong hop tren thuoc
pham vi hop d6ng bao hiern.
- Giay to kham chua benh dfty dii hop l~.
- Ngay yeu c§u tra ti~n bao hiem thee thai han quy dinh.
IV - Tinh toan b8i thuong:
QUYENLQI
GI61~
DUQC CHI TRA
-- Tro c~p thu nhap
CHITRA
(VND)
SOTIEN
pIlAT SINH
(VND)
5.000.000
5.000.000
SOTIEN
CHITRA
(VND)
5.000.000
V- Ljch sir b6i thirong:
S6 v¥: 0 v¥
S6 tien: 0 VND
Ten t6i la: Nguyen Pham Thanh Thao voi tu each la b6i thirong vien cua MIC cam ket
da:kiem tra tinh chinh xac va hop l~ cac clnrng ill tren, d~ nghi lanh dao duyet s6 tien:
5.000.000 VND.
se ti~n tren duoc
chi tra cho nguoi diroc bao hiem.z,
LANH D~O DON
vr
PT. PHONG NGm~p
VV
BOI THUONG VlEN
BMJQTIGDBTICN.15
1\
'1
1')1
CQNG HOA
Q)
xA HQI CHiT NGHiA VI~T NAM
DQcI~p - TV do - H,nh phuc
TPHCM,ngay 29 thdng 03 ndm 2022
S6: ..... .1..... .ITB-MIC ...
THONG BAo TRA.TIEN BAo HIEM
(S6 H6 sa b6i thuong: 20220329038875)
Kinh giri: Pham Thi Kim Oanh
T6ng Cong ty C6 phdn Baa hiim Qudn ai)i ail xem xet H6 so b6i thuong cua
QuY khach hang. Can cu vaa Gidy yeu cdu tra tien baa hiem, Gidy chung nhdn baa
hiem, H9]J a6ng baa hiem, Quy tdc baa hiem, Chung toi thong baa vJ viec giai quyit
b6i thuong cua Quy khacn hang nhu sau:
NguOi duQ'c bao hi~m: Pham Thi Kim Oanh
Dia chi: 1295B Nguyen Thi Dinh, Cat Uii, Quan 2, H6 Chi Minh
Tham gia bao hiem thea HDBH s6: 20210826041665
Can cu vao h6 sa b6i thuong s6 20220329038875
Da duoc duyet ngay: 29 thang 03 nam 2022
TAng sa ti~n b8i thmrng: 5.000.000 VND
(Bang chii: Narn trieu d6ng)
Truimg hap Chuy~n khoan:
Theo yeu c~u cua Ngiroi diroc bao hiem, chung toi se chuyen sf>ti~n tren vao:
Chu tai khoan: Pham Th] Kim Oanh
TJ(sa:2540104546007
Tai: Ngan hang Ngan hang TMCP Quan dQi
NQi dung thanh tmln: Tra ti~n bao hi~m cho PhC:lmThi Kim Oanh vao vi~n
ngay 11103/2022 t~i B~nh vi~n
LE VAN
THlNH
Cit';' y: 86 tiJn b6i thlrang {ren se t/u(Jc thanh taan bang liJn mijt haijc chuyin
khaan vaa Tc'z;khaim thea yeu cdu ella Nguai au'(Jcbaa hiJm. Sau 15 ngay n/uj,n aU9'c
thong baa nay, niu MlC khong nhqn t/u(Jcphim h6i It;lit£rNguo'; al-r(Jcbaa hiJm fhi eai
nhu Sl,{ ki¢n baa hidm tren ail oU(JCgiai quyh xang. khong con thde mbc khiJu n(li gi.
Tn1n tr<;mgkinh chflO.I.
NO'inhljn:
TONG CONG TY CP
- Nhutren;
- Luu:
Phong ....
BMlQT/GDBT/CN,01.10
BAo HIEM QUAN DQI
~i_
~
~
111
CONG HOA
t~r'_MIC
xA HOI
CHU NGHiA VI~T NAM
DQc I,p - Tl}'do - H~nh phuc
•••
J
ngay 29 thang 03 nam 2022
TO TRiNH GW QUYETQUYEN LQI BAo IDEM sire KHOE
HB so' bBi thuong: trl}'c ti~p/bao lanh vi~n phi
(liB SO's6:20220329038875)
I - Thong tin vi hQ'P dBng bao hi~m:
HQ ten nguoi tham gia bao hiem: Pham Thi Kim Oanh
sf>chirng minh thu: 031751003
Ngay sinh: 1111111993
Email:
ThuQc don vi: CONG TY TNIDI MTV
:xAY DljNG
CONG TRINH TAN CANG
Hop d6ng bao hi~mJGifry chirng nhan bao hiem sf>:20210826041665
Thai han BH: Til' 16:11 gio, ngay 25/08/2021 d~n 16:11 gio, ngay 25/08/2022
Ngay dong phi: 26/08/2021
Il-Thong tin vi Sl}'ki~n bao hi~m:
Ngay vao vien: 1110312022
Benh vien di€u tri: BV
Ngay ra vien:
LE VAN THJNH
Nguyen nhan: Tro dp thu nhap
Hau qua: Tro cfrp thu nhap
sf>tien yeu celu: 5.000.000 VND
HB SO'gBm co:
- GifrYyeu celutra ti€n bao hiem;
- Chung til' di€u tri do co quan y t~ cap: Giay xet nghiem PCR
- Chung minh nhan dan.
- Bien ban xac nhan cua co quan v€ viec di€u tri Sars - COy 2.
BMlQT/GDBTICN.15
1/2
III - Danh gia h6 so ella b6i thmrng vien:
- Can cir VaGnguyen nhan nhap vien, clnrng ill y t~. K~t luan: Truong hQP tren thuoc
pham vi hQP d6ng bao hiem,
- Giay
ta kham chua benh diy
du hQP 1~.
- N gay yeu du tra tien bao hiem thea thai han quy dinh.
IV - Tinh toan b6i thueng:
QUYENLQI
DUQC CHI TRA
-- TrQ'cAp thu nhap
GIm~
CHITRA
(VND)
SOTIEN
PHAT SINH
(VND)
5.000.000
5.000.000
SOTIEN
CHITRA
(VND)
5.000.000
V- Ljch sir b6i thuoug:
S6 V1;J: 0 V1;J
S6 tien: 0 VND
Ten t6i la: Nguyen Pham Thanh Thao voi ur each la b6i thirong vien cua MIC cam k~t
dfl kiem tra tinh chinh xac va hQP 1~cac chimg ill tren, de nghi lanh dao duyet s6 tien:
5.000.000 VNB.
S6 tien tren
duoc chi tra cho ngiroi duoc bao hiem.,',
LANH D~O DON vr
BMlQTIGDBTICN.1S
PT. PHONG NGHI¥P Vl)
DOl THUONG VIEN
2/2
t~r"MIC
CONG HOA
xA HOI CHiT
NGHiA VI~T NAM
DQc I~p - TV do - H~nh phuc
TPHCM,ngay 29 thdng 03 ndm 2022
sf>: ..... .1..... .lTB-MIC ...
THONG BAo TRA TIEN BAo IDEM
(sf> H6 sa b6i thirong: 20220329039147)
Kinh gui: Phung Thi Ha
T6ng Cong ty C6 phdn Bao hidm Qudn a9i aa xem xet H6 sa b6i thuong cua
Quy khach hang. Can cu vao Gidy yeu cdu tra tiJn bao hiem, Gidy chtmg nhdn bao
hiem, H9P dong bao hiem, Quy tac bao hiem, Chung toi thong bao vJ viec giai quyit
b6i thuong cua Quf; khdch hang nhu sau:
Nguoi dUQ'cbao hi~m: Phung Thi Ha
Dia chi: 1295B Nguyen Thi Dinh, Cat Lai, Quan 2, H6 Chi Minh
Tham gia baa hiem thea HDBH
s6: 20210826041604
Can cu vao h6 sa b6i thuong sf>20220329039147
Dil duoc duyet ngay:29 thang 03 nam 2022
Tang sa ti~n bai thuong: 5.000.000 VND
(Bang chii: Nam trieu d6ng)
Truirng hoopChuy~n khoan:
Thea yeu cftu cua Ngiroi diroc baa hiem, chung t6i se chuyen sf>tien tren vao:
Chii tai khoan: Phung Thi Ha
T](sa: 1510101552006
T~i: Ngan hang Ngan hitng TMCP Quan dQi
NQi dung thanh tmin: Tra ti~n baa hi~m cha Phung Thi Ha vao vi~n ngay
08/03/2022 t~i B~nh vi~n VI.¬ NSOT RET - KST - CT TPHCM
Chit y: s6 tiJn b6i thuimg tren se aU9'c thanh toan bang tiJn mijt hoijc chuydn
khoan vao Tili khoan theo yeu cdu cua Nguo'i aU(Jcbao hikm, Sau 15 ng([.vnhi).nOU(),c
thong bao nay, niu .MIC khong n174naU9'cphan h6i lqi tif Ng'uo'i GLWC bao hidm thi coi
nhu Sll ki¢n bao hidm tren da dU(JcgMi quyh xong. khong can thac mbc khiiu nqi gi,
Tnln tr9ng kinh chao.!,
NO'; nh{in:
- Nhutren;
- Luu: Phong ,...
BMlQT/GDBTICN.Ol.lO
TONG CONG TV CP
BAo HIEM
QUA.N DOl
st=~111
CONG HOA
xA
HOI CHU NGHlA VI:E:TNAM
DQcI~p - T'1 do - Ha;loh phuc
"'J
ngay 29 thdng 03 nam 2022
TO TRiNH GIM QUYET QUYEN LQI BAo IDEM
HB
SO'
sue KHOE
bBi thuong: true ti~p/bao Ianh vi~o phi
(lIa so s6:20220329039147)
I - Thong tin v~ hop dang bao hi~m:
HQten nguoi tham gia bao hiem: Phung Thi Ha
S6 chirng minh thu: 025818858
Ngay sinh: 19/0811982
Email:
ThuQc dan vi: CONG TY TNHH MTV
xA Y Dl)'NG
CONG TRiNH TAN CANG
HQ'Pd6ng bao hi€mlGic1Ychirng nhan bao hi€m s6: 20210826041604
Thai han BH: Til' 16:11 gio, ngay 25/08/2021 d~n 16:11 gio, ngay 25/08/2022
Ngay dong phi: 26/08/2021
II-Thong tin v~ s'1 kifn bao bj~m:
Ngay vao vien: 08/03/2022
Ngay ra vien:
Benh vien diSu tri: VIEN SOT RET - KST - CT TPHCM
Nguyen nhan: Tro dp thu nhap
Hau qua: Tro d.p thu nhap
S6 tien yeu c~u: 5.000.000 VND
Ha so gam co:
- Gic1Yyeu c~u tra tiSn bao hiem;
- Chung ill diSu tri do co quan y t~ c~p: Gic1yxet nghiem PCR
- Chung minh nhan dan.
- Bien ban xac nhan cua co quan v€ viec diSu tri Sars - COy 2.
BMlQT/GDBT/CN.15
1/2
III -Danh gia h6 so cua b6i thirong vien:
- Can cir VaG nguyen nhan nhap vien, chirng nr y t€. K~t luan: Truong hop tren thuoc
pham vi hop d6ng bao hiem,
- Gi~y to kham chua benh d§y du hop l~.
- Ngay yeu c§u tra tien bao hiem thea thai han quy dinh.
IV - Tinh toan b6i thuong:
QUYENLQI
GIm~N
DUQ'C CHI TRA
CHITRA.
(VND)
SOTIEN
PHAT SINH
(VND)
5.000.000
-- Tro c~p thu nhap
5.000.000
SOTIEN
CHITRA.
(VND)
5.000.000
V- Ljch sfr b6i thirong:
s6 v~: 01 v~
s6 tiJn: 2.400. 000
VND
Ten toi la: Nguyen Pharn Thanh Thao voi tu each la b6i thuong vien cua MIC cam k~t
da kiem tra tinh chinh xac va hop l~ cac clnrng tir tren, d~ nghi lanh dao duyet s6 tien:
5.000.000 VNB.
S6 tien tren
duoc chi tra cho nguoi duoc bao hiem.,',
LANH D~O DON
BMlQT IG£>BTICN.15
Vl
PT. PHONG NGlII¥P
vu
BOI THUONG VIEN
2/2
CONG HOA
xA HOI
CHU NGHiA VI~T NAM
DQc I~p - TV do - H~nh phuc
se. ..... .1...... /TB-MIC ...
TPHCM,ngay 29 thong 03 ndm 2022
THONG BAo TRA.TIEN BAo HIEM
rse H6 sa b6i thuong:
20220329039289)
Kinh giri: Le Van Hai
cs
Tdng Cong ty
phdn Bao hidm Qudn aC;i aa xem xet H6 sa b6i thuang cua
Quf khach hang. Can cu vao Gidy yeu cau tra tiJn bao hiem, Gidy chung nhdn bao
hiem, H9'P a6ng bao hiem, Quy tfic bdo hiem, Chung toi thong bao vJ viec giai quyet
b6i thuong cua Quf khdch hang nhu sau:
NgU'OidU'Q'cbao hi~m: Le Van Hai
Dia chi: 1295B Nguyen Thi D!nh, Cat Lai, Quan 2, H6 Chi Minh
Tham gia bao hiem theo HDBH s6: 20210826041687
Can cir vao h6 sa b6i thuong s6 20220329039289
Da duoc duyet ngay:29 thang 03 nam 2022
Tang
sA ti~n
b6i thuoug: 5.000.000 VND
(Bang chit: Nam trieu d6ng)
TrU'()'DghoopChuy~n khoan:
Theo yeu du cua Nguoi duoc bao hiem, chung t6i se chuy~n s6 ti~n tren vao:
Chii tai khoan:
TK
Le Van
Hai
sA: 0961971315
T~i: Ngan hang Ngan hang TMCP Quan dQi
NQi dung thanh toan: Tra ti~n bao hi~m cho Le Van Hai vao vi~n ngay
17/03/2022 4li B~nh vi~n DK DONG NAI
CIIIJ y: 86 fiJn b6i rhuimg Iren se dU9'Cthanh loan biing liJn mijl ho(lc chuyin
khoan vao Tai khoan theo yeu cau cua Ngu()'i du9'c bao hiim. Sau 15 nga}' n174nazwc
thong bao nay; n€u A-llC khong nh(m dU9'Cphan h6i fe;zifll:Nguai au9'c boo hidm thi coi
nhu S¥' ki¢n boo hiim tren aa aU9'cgiai quyJr xong, khong con thbc /nbc khiiu nqi gi.
Tran tr9ng kinh chao.!.
Nui nh9n:
TONG CONG TY CP
BAo HI EM QUAN
DOl
- Nhu tren;
- Lz.ru:Phong ....
BM!QTIGDBT/CN.Ol.IO
-~
III
CONG HOA xA HOI
t~r"MIC
cnu NGHiA
VI~T NAM
DQc I~p - TV do - H~nh phuc
..., ngay 29 thang 03 ndm 2022
TO'TRiNH GIAI QUYET QUYEN L<}I BAo HIEM
sue KHOE
H8 SO' b8i thuoug: true ti~p/bao lanh vi~n phi
(Ha so' s8:20220329039289)
I - Thong tin v~ hop dang bao hi~m:
HQten nguoi tham gia bao hiern: Le Van Hai
s6 clnrng minh thu:
0272806653
Ngay sinh: 0110811985
Email:
ThuQc dan vi: CONG TY TNHH MTV
xAY DljNG
CONG TRiNH TAN CANG
HQ'Pd6ng bao hi~mJGi~y chirng nhan bao hiem s6: 20210826041687
Thai han BH: Tir 16: 1] gio, ngay 25/08/2021 d€n 16:11 gio, ngay 25/08/2022
Ngay dong phi: 26/08/2021
Il-Thfing tin v~ S\f ki~n bao hi~m:
Ngay vao vien: 17/03/2022
Ngay ra vien:
B~nh vien di~u tri: B~nh vien DK DONG NAI
Nguyen nhan: Tro c~p thu nhap
Hau qua: Tro c~p thu nhap
s6 ti~n yeu cau:
Ha
SO' gam
5.000.000 VND
co:
- Gi~y yeu c~u tra ti~n bao hiem;
- Chung nr di~u tri do co quan y t€ dp: Gi~y xet nghiem PCR
- Chung minh nhan dan.
- Bien ban xac nhan cua co quan v~ viec di~u tri Sars - COy 2.
BMlQT/GDBT/CN.15
1/2
III - Danh gia h8 so cua b8i thuong vien:
- Can cir van nguyen nhan nhap vien, chung tir y t€. K€t luan: Tnrong hop tren thuoc
pham vi hop d6ng bao hiem,
- Giay to kham chua benh d~ydu hop I~.
- Ngay yeu c~u tra ti~n bao hiem thee thai han guy dinh.
IV - Tinh toan b8i thueng:
QUYENLQl
DUQC CHI TRA
GI61~
CHITRA
(VND)
-- Tro c§p thu nhap
SOTIEN
PHAT SINH
(VND)
5.000.000
5.000.000
SOTIEN
CHITRA
(VND)
5.000.000
V- Ljch sir b8i thirong:
s6 v~: 0 v¥
s6 tiJn: 0 VND
Ten t6i la: Nguyen Pham Thanh Thao voi ill each la b6i thuong vien cua MIC cam k~t
da kiem tra tinh chinh xac va hop 1~cac chirng ill tren, d~ nghi lanh dao duyet s6 tien:
5.000.000 VND.
S6 tien tren duoc chi tra cho ngiroi
LANH D~O DON vt
BMlQTIGDBT/CN.15
duoc bao hiem.,'.
PT. PHONG NGmtp
VlJ
DOl THUONG VIEN
2/2
CQNG HOA
xA HQI
CHU NGHiA VItT NAM
DQc I~p - T\f do - H~lDh phuc
TPHCM,ngay 29 thang 03 ndm 2022
S6: ..... ./. .... .ITB-MlC ...
"
r
",,).
::t
?
THONG BAO TRA TIEN BAO IDEM
(S6 H6 sa b6i thirong: 20220329042436)
Kinh giri: Nguyen Van Quyen
T6ng Cong ty C6 phdn Bao hidm Qudn il()i dii xem xet H6 sa b6i thuong cua
Quy khacli hang. Can cu VaG Gidy yeu cdu tra tiJn bao hiem, Gidy chung nhdn bao
hiem, H9]J d6ng bao hiem, Quy tdc baa hiem, Chung toi thong bao vJ viec giai quyet
b6i thuang cua Quy khach hang nhu sau:
Nguoi dlfQ'Cbao hi~m: Nguyen Van Quyen
Dja chi: 1295B Nguyen Thi Dinh, Cat Lai, Quan 2, H6 Chi Minh
Tham gia bao hiem thea HDBH s6: 20210826041621
Can cir vao h6 sa b6i thirong s6 20220329042436
Dit duoc duyet ngay: 29 thang 03 nam 2022
T6ng
sa tiin
bBi thirong: 5.000.000 VND
(Bang chii: Narn trieu d6ng)
Trlf()'Dg hO'p Chuy~n khoan:
Theo yeu c~u cua Ngiroi duoc bao hi€m, chung toi se chuy€n s6 ti~n tren vao:
Chu Hli khoan: Nguy~n Van Quy~n
TK sA: 0971381587
T:;ai:Ngan hang Ngan hang TMCP Quan dQi
NQi dung thanh toan: Tra ti~n bao hi€m cho Nguy~n Van Quy~n vao vi~n
ngay 07103/2022 t~i B~nh vi~n PXN GENMEDIC VN
ell II j: s6 tiJn b6i thlfimg h'en se ilu9'c thanh toan bang tiJn
ho(lc chuyin
khoan VaG Tiz;khoan theo yeu cdu cua Ngu(Yi au9'c bao hiim. Sau 15 ngay nh¢n aU9'c
thong bao nay, ndu MIC khong nh(jn aU9'cphon /uji lr,zifir Ngu()"iau9'c baa hiim thi co;
nhu S7,/" ki¢n bao hiim tren dii du9'c giai quyJr xong. khong con thac mac khiiu n(l; gi.
mijl
Tran tr<;mgkinh chao'!'
Nui nllQn:
TONG CONG TY CP
BAo HIEM
QUAN DQI
- Nhtr tren;
- Luu: Phong ....
BMlQT/GDBTICN.O 1.1 0
III
CONG HOA
xA HOI CHiT NGHiA VI~T NAM
DQc I,p - TI}'do - H~nh phuc
•••
J
ngay 29 thang 03 niim 2022
TO TRiNH GW QUYET QUYEN LQI BAo mEM sue KHOE
Ha
SO'
bai thirong: true ti~p/bao lanh vi~n phi
(Ha so s8:20220329042436)
I - Thong tin v~ hqp dang bao hi~m:
H9 ten nguoi tham gia bao hiern: Nguyen Van Quyen
S5 chimg
minh thu: 030071000124
Ngay sinh: 23110/1971
Email:
ThuQc dan vi: CONG TY TNHH MTV
xA Y DljNG
CONG TRiNH TAN CANG
Hop d6ng bao hi~m1Gi§y chimg nhan bao hi~m s5: 20210826041621
Thai han BH: Til 16: 11 gio, ngay 25/08/2021 d~n 16: 11 gio, ngay 25/08/2022
Ngay dong phi: 26/08/2021
Il-Thong tin v~ S,! ki~n bao hi~m:
Ngay vao vien: 07/03/2022
Ngay ra vien:
B~nh vien di~u tri: PXN GENMEDIC VN
Nguyen nhan: Tro c~p thu nhap
Hau qua: Tro c~p thu nhap
S5 ti~n yeu c~u: 5.000.000
VNI>
Ha so' gam co:
- Gi§y yeu c~u tra ti~n bao hiern;
- Chung til di~u tri do co quan y t~ c~p: Giay xet nghiem PCR
- Chung minh nhan dan.
- Bien ban xac nhan cua co quan v~ viec di~u tri Sars - COy 2.
BMlQT/GDBT/CN.15
1/2
III - Danh gia h6 so cua b6i thuong vien:
- Can cir vao nguyen nhan nhap vien, chirng nr y t~. K~t luan: Tnrong hop tren thuoc
pham vi hQ'Pd6ng bao hiern.
- Gifty to' kham chua benh dfiy du hQ'PI~.
- Ngay yeu cftu tra ti€n bao hiern thea thai han quy dinh.
IV - Tinh toan b6i thuong:
QUYENLQI
DUQCCHITRA.
-- TrQ'cftp thu nhap
GImH~N
CHITRA.
(VND)
SOTIEN
,
PHAT SINH
(VND)
5.000.000
5.000.000
so TIEN
CHITRA.
(VND)
5.000.000
V- Ljch sir b6i thuong:
s6 Vlj: 0 Vlj
s6 tiJn: 0 VND
Ten toi la: Nguyen Pham Thanh Thao voi ill each la b6i thirong vien cua MIC cam k€t
da: kiern tra tinh chinh xac va hQ'PI~ cac chirng til tren, d€ nghi 1300 dao duyet s6 tien:
5.000.000 VND.
S6 tien tren
duoc chi tra cho ngiroi diroc bao hi€m.!.
LANH D~O DON VI
BMlQT/GDBTICN.15
PT. PHONG NGHI_eP \TV
HOI THUONG VlEN
2/2
@
b1
CONG HOA
xA
HQI CHU NGHiA VI¥T NAM
DQc I~p - TV do - H~nh phuc
S6:
./
ITB-MIC .
TPHCM,ngay 29 thdng 03 ndm 2022
THONG BAo TRA. TIEN BAo IDEM
(S6 H6 sa b6i thuong: 20220329044398)
Kinh giri: Phung Xuan f)~i
T6ng Cong ty C6 phdn Bdo hdm Qudn doi da xem xet H6 sa b6i thuong cua
Quy khach hang. Can cu viw Gidy yeu cdu tra ti~n bao hiem, Gidy chung nhdn bao
hiem, H9'P dong bao hiem, Quy tilc bao hiem, Chung toi thong bao v~ viec giai quyet
b6i thuong cua Quf; khdch hang nhu sau:
NglrOi dlrgc bao hi~m: Phung Xuan Dai
Dia chi: 1295B Nguyen Thi Dinb, Cat Lai, Quan 2, H6 Chi Minh
Tham gia bao hiem theo HDBH s6: 20210826041650
Can cir vao h6 sa b6i thuong s6 20220329044398
Da duoc duyet ngay:29 thang 03 nam 2022
TAng s&ti~n b8i thuong: 1.200.000 VND
(Bang chic: Mot trieu hai tram ngan d6ng)
TrlrO'ng hap Chuy~n khoan:
Theo yeu c~u cua Ngiroi ducc bao hiem, chung toi se chuyen s6 ti~n tren vao:
Chii tai khoan: Phung Xuan D~i
Tl(s&: 1050104204008
T~i: Ngan hang Ngan hang TMCP Quan dQi
NQi dung thanh toan: Tra ti~n bao hiem cho Phung Xuan D~i vao vi¢n ngay
02/03/2022 ~i B¢nh vi¢n LE VAN THINH
Cltu y: S6 l;~n b6i lhlt'(Yngtren se aU(J'cthanh toan bang tiJn m(lt ho(zc chuyin
khoan vao Tc'zikhoim theo yeu cdu cua NguiJi au(J'cbcio hiJm. Sau 15 nga}' nl1(1naU(J'c
thong bao nay, n~u Mle khong nh(1ndu9'c ph an h6i lq.i ti'r Ng;uo'iau9'c bao hiJm thi coi
nhu Sl,t' ki¢n biw hiJm tren da au9'c gfOi quyh xong, khong con th6c m6c khiiu n(li gi.
Tran tr9ng kinh chao.!.
Nui nh(in:
TONG CONG TY CP
BAo HIEM
QUAN DQI
- Nhu tren;
- Luu: Phong ....
BMlQT/GDBT/CN.Ol.lO
~111
I. "," MIC
\~
~'I
CONG HOA
xA HOI CHU NGHiA VI~T NAM
DQc l~p - Tl! do - H~nh phuc
•••
J
ngay 29 thang 03 nam 2022
TO TRINH GIM QVYET QUYEN L<}I BAo HIEM
sue KHOE
H6 so b6i thufmg: true ti~p/bao lanh vi~n phi
(1:16 so' s8:20220329044398)
I - Thong tin v~ hop d6ng bao hi~m:
Ho ten ngiroi tham gia bao hiem: Phung Xuan Dai
S6 chirng minb thu: 112258229
Ngay sinh: 13/1111962
Email:
Thu9c dan vi: CONG TY TNHH MTV
xA Y DVNG
CONG TRiNH TAN CANG
Hop d6ng bao hiBmlGiclYchirng nhan bao hiem s6: 20210826041650
Thai han BH: Tu 16:11 gio, ngay 25/08/2021 d€n 16:11 gio, ngay 25/08/2022
Ngay dong phi: 26/0812021
II-Thong tin v~ Sl! ki~n bao hi~m:
Ngay vao vien: 02/03/2022
Ngay ra vien: 08/03/2022
B~nh vien di~u tri: B~nh vien
LE VAN
THlNH
Nguyen nhan: Tro cclp nam vien do 6m dau, benh ~t
H~u qua: G.AY KiN MAT
cA TRONG
CHAN
TRAI
S6 tien yeu du: 1.200.000 VNf)
H6 SO' g6m co:
- GiclYyeu c~u tra ti~n bao hiem;
- Chung tir di~u tri do co quan y t€ dp: Giay ra vien, Gicly clnrng nhan ph~u thuat,
Bang ke chi phi;
- Bien ban tai nan
- Chung minh nhan dan.
- Bien ban Xclc nh~n nght vi~c t~m thai cua co quan.
BMJQT/GDBTICN.15
1/2
III - Danh gia bc3so ella bc3ithuong vien:
- Can cir vao nguyen nhan nhap vien, chirng ill y t~. K~t luan: Truong hop tren thuoc
pham vi hop d6ng bao hiem.
- Gifiy to kham chua benh d~y du hop l~.
- Ngay yeu c~u tra tien bao hiem thea thai han guy dinh.
IV - Tinh toan bc3ithuoug:
QUYENLQI
DUQC CHI TRA.
- Tro cftp trong thai gian
di~u tri do 6m dau, benh
t~t, tai nan (khong ap
dung cho thai san, sinh
ncr)
-- Tro cap/ngay
-- S6 ngay tro cfip
so TIEN
PIlAT SINH
(VND)
GIOI~
CHITRA.
(VND)
so TIEN
CHITRA.
(VND)
17.000.000
1.200.000
1.200.000
200.000
200.000
200.000
60
6
6
V- Ljch sir bc3ithueng:
S6 v~: 0 v~
S6 tiJn: 0 VND
Ten toi la: Nguyen Pham Thanh Thao voi nr each la b6i thirong vien cua MIC cam k~t
da kiem tra tinh chinh xac va hop l~ cac chirng ill tren, de nghi lanh dao duyet s6 tien:
1.200.000VND
S6 tien tren dugc chi tni cho nguai dugc bao hi~m./.
LANH D~O DON VJ
BM!QT/GDBTICN.1S
PT. PHONG NGHI~P Vl)
BOI THUONG VI EN
2/2
t~r"MIC
CONG HOA
xA HOI
CHU NGHiA VI:E:TNAM
DQc I,p - TV do - H~nh phuc
TPHCM,ngay 29 thang 03 ndm 2022
S6: ..... ./. .... .lTB-MIC ...
THONG BAo TRA TIEN BAo HIEM
(S6 H6 sa b6i thirong: 20220329044017)
Kinh giri: Ngo Kim Anh
T6ng Cong ty C6 phdn BO.ohiem Qudn a¢i ali xem xet H6 sa b6i thuong cua
Quy khach hang. Can cU vao Gidy yeu cdu tra tien bao hiem, Gidy chimg nhdn bao
hiem, H(YJJa6ng bao hiem, Quy tdc bao hiem, Chung toi thong bao vJ viec giai quyet
b6i thuong cua Quy khacli hang nhu sau:
NgU'OidU'(}'cbao hi~m: Ngo Kim Anh
Dia chi: 1295B Nguyen Thi Dinh, Cat Lii, Quan 2, H6 Chi Minh
Tham gia bao hiern thea HDBH s6: 20210826041693
Can ClI VaGh6 sa b6i thuong s6 20220329044017
Da: diroc duyet ngay: 29 thang 03 nam 2022
Tang sa ti~n bBi thuong: 600.000 VND
(Biing chit: Sau tram ngan d6ng)
TrU'irng hO]) Chuy~n khoan:
Theo yeu c~u cua Nguoi duoc bao hiem, chung toi se chuyen s6 tien tren vao:
Chii tai khoan: Ngo Kim Anh
TJ(sa: 1050104227008
T~i: Ngan hilDg Ngan hang TMCP Quan dQi
NQi dung thanh toan: Tra ti~n bao hi~m cho Ngo Kim Anh VaGvi~n ngay
08/02/2022 t~i B~nh vi~n DA KHOA DONG NAl
Chit y: s6 tiJn b6i thlrimg tren se aU9'c thanh toan being tiJn m(Jl ho¢c chuyin
khoGn voo Tai khoGn theo yeu cdu cua NguiJi au9'c bao hiim. Sau 15 nga.v n174nalc9'c
thong bao nay, niu MIe khong nh(m au9'c phim h6i 19i tt'rNguo'i au9'c bao hiim thi co;
nhu Sll ki¢n bao hidm tren ali aU"(1c
gMi quyh xong. kh6ng con thdc mac k17iiun(l; gi.
Tran tr9ng kinh chao./.
Nui nh~n:
TONG CONG TY CP BAo HIEM QUAN DOl
- Nhu tren;
- Luu: Phong ....
~
BMlQT/GDBT/CN.Ol.IO
111
CONG HOA
t~r--MIC
xA HOI
CHU NGHiA VI¥T NAM
DQc I~p - TI! do - H~nh phuc
..., ngay 29 thdng 03 nam 2022
TO'TRiNH GIM QUYET QUYEN L<}I BAo HIEM sire
KHOE
H& SO' b&i thueng: trtrc ti~p/bao lanh Vi~Dphi
(Ha
SO' s8:202203290440
17)
I - Thong tin v~ hQ'Pdang bao hi~m:
H<.>ten nguoi tham gia bao hicm: Ng6 Kim Anh
S6 clnrng minh thir: 271528333
Ngay sinh: 12/0511983
Email:
Thuoc don vi: CONG TY TNHH MTV
xA Y Dl)NG
CONG TRiNH TAN CANG
Hop d6ng bao hiem/Giay chirng nhan bao hiem s6: 20210826041693
Thai han BH: Til 16:11 gio, ngay 25/08/2021 d~n 16:11 gio, ngay 25/08/2022
Ngay dong phi: 26/08/2021
II-Thong tin v~ Sl!ki~n bao hi~m:
Ngay vao vien: 08/02/2022
Ngay ra vien: 1110212022
B¢nb vien di€u tri: B¢nh vien DA KHOA DONG NAl
r-o c~p nam vien do 6m dauz benh ~t
Hau qua: SOl NmU QUAN TRAl
( chl 60 ~
Nguyen nhan:
(
)
S6 tien yeu cAu: 600.000 VND
Ha
SO' gam
co:
- Gi~y yeu cAu tra ti€n bao hiem;
- Chung til di~u tri do
CCY
quan y t~ c~p: Gi~y ra vien, Bien lai thu tien;
- Chirng minh nhan dan.
- Bien ban xac nhan nghi viec tam thai cua
BMJQT/GDBT/CN.15
CCY
quan.
1/2
III - Danh gia h8 so cua b8i thirong vien:
- Can err van nguyen nhan nhap vien, chimg til y t~. K~t luan: Truong hop tren thuoc
pharn vi hop d6ng bao hiern.
- Gi~y
ta kham
chua benh d§y du hop 1~.
- Ngay yeu c§u tra tien bao hiem thea thai han quy dinh.
IV - Tinh toan b8i thiroug:
QUYENLQl
DUQCCHITRA.
- Tro c~p trong thai gian
di~u tri do f>mdau, benh
t~t, tai nan (kh6ng ap
dung cho thai san, sinh
no)
-- Trq cap/ngay
-- sf>ngay tro c~p
SOTIEN
PHATSINH
(VND)
Glm~N
CHITRA.
(VND)
SOTIEN
CIDTRA.
(VND)
17.000.000
600.000
600.000
200.000
200.000
200.000
60
3
3
V- Ljch sir b8i thuoug:
s6 v~: 0 v~
s6 tiJn: 0 VND
Ten t6i la: Nguyen Pham Thanh Thao voi tu each la b6i thuong vien cua MIC cam k~t
da kiem tra tinh chinh xac va hop l~ cac chirng tir tren, d~ nghi lanh dao duyet sf>tien:
600.000 VND.
sf>ti~n tren diroc chi tra cho nguai duqc bao hi~m./.
LANH D~O DON VI
BMlQT/GDBTICN.15
PT. PHONG NGffi1j:P
\TV
BOI THUONG V[EN
2/2
TfJ
CQNG HOA
xA
HOI CHiT NGHiA VItT NAM
DQc I~p - TV do - H~nh phuc
S5: ...... I ..... .lTB-MIC ...
TPHCM,ngay 29 thong 03 ndm 2022
THONG
BAo TRA TIEN BAO IDEM
(S6 H6 sa b6i thuong: 20220329071475)
Kinh giri: Nguyen Thi PhuQ11g
T6ng Cong ty C6 phdn Bao hiem Qulin a9i ali xem xi! H6 sa b6i thuong cua
Quf; khacn hang. Can cu VaG Gidy yeu cdu tra tiJn bao hiem, Gidy chung nhdn bao
hiem, H9'P a6ng bao hiem, Quy tdc bao hiem, Chung toi thong bao vJ viec giai quyet
b6i thuong cua Quy khacn hang nhu sau:
Nguoi <lugc bao hi~m: Nguyen Thi PhuQ11g
Dia chi:
nruA THIEN HUE
Tham gia bao hi~m thea HDBH s6: 20220228089823
Can cir van h6 sa b6i thuong s5 20220329071475
Dii duoc duyet ngay: 29 thang 03 nam 2022
Tang
sA ti~n
bBi thmmg: 5.000.000 VND
(Bang chit: Nam trieu d6ng)
Trm'rng hO'p Chuy~n khoan:
Theo yeu c~u cua Nguoi duoc bao hiem, chung toi se chuyen s6 ti~n tren van:
Chu tai khoan: Nguy~n Thj PhU'Q'Dg
T](sa:
7030105481006
T~i: Ngan hang MB
NQi dung thanh toan: Ira ti~n bao hi~m cho Nguy€n
QuAN Y 175
Thi PhuQ11gvan vi~n
ngay 01/03/2022 t~i B~nh vi~n
Cltu f: S6 tiJn b6i thl(ang tren se aU9'c thanh toan bang tidn mgt hogc chuyin
khoan VaGTai khoan thea yeu cdu cua Ngu()'i ctu9'c bao hidm. Sau 15 nga.v nhgn Olf9'c
thong baa nay, ndu MIC khong nhgn thf9'Cphan h6i lqi Hr Ng;u(}iaU9'cbaa hidm thi cai
nhu S1:l' ki?n baa hidm trim dO.GU9'Cgioi quyh xong. khong con thac mac khiiu nqi gi.
Iran tr9ng kinh chao.!.
Nu; nh9n:
- Nhutren;
- Luu: Phong ....
BMlQT/GDBT/CN.01.10
TONG CONG TY CP
BAo
HIEM
QUAN D(H
cr_-~
----
111
CONG HOA
xA HOI
CHi) NGHiA VI:¢T NAM
Dqc I~p - T" do - H~nh phuc
..., ngay 29 thong 03 ndm 2022
TO TRINH GIM QVYET QUYEN LQI BAo HIEM
H8
SO'
sue KHOE
b8i thuong: true ti~p/bao lanh vi~o phi
(Ha so s6:20220329071475)
I - Thong tin v~ hQ'p dang bao hi~m:
HQten ngiroi tham gia bao hiern: Nguyen Thi Phuong
S6 chimg
minh thu: 191875626
Ngay sinh: 28/0211995
Email: quantri.vndaiphong@gmail.com
ThuQc dan vi: CONG TY TNllli VN DAr PHONG
Hop dong bao hi~m1Gi§'ychirng nhan bao hiem s6: 20220228089823
(~ ~~ )
Thai han BH: Tir 00:00 gio, ngay 28/02/2022 d~n 00:00 gio, ngay 28/08/2022
Ngay d6ng phi: 18/03/2022
If-Thong tin v~ SI! ki~n bao hi~m:
Ngay vao vien: 01/03/2022
Ngay ra vien:
B~nh vien dieu tri: B~nh vien
QuAN Y
175
Nguyen nhan: TrQ'c§.pthu nhap
Hau qua: TrQ'c§.pthu nhap
S6 tien yeu du: 5.000.000
VND
Ha so gam co:
- Gi§.y yeu c~u tra tien bao hiem;
- Chung tIT dieu tri do co quan y t~ c§.p:Gi§.y xet nghiem PCR
- Chung minh nhan dan.
- Bien ban xac nhan cua co quan ve viec dieu tri Sars - COy 2
BMlQT/G£>BTICN.lS
1/2
TIl - Danh gia ha so cua bai tlnrong vien:
- Can cir vao nguyen nhan nhap vien, chung nr y t€. K€t luan: Truong hop tren thuoc
pharn vi hop d6ng bao hiern.
- Gi§y to kham chua benh d§y du hop l~.
- Ngay yeu du tra tien bao hiem thea thai han quy dinh,
IV - Tinh toan bai thtrimg:
QUYENLQI
IlUQCCHITRA
GI61~
CHITRA
SOTIEN
pIlAT SINH
(VN1l)
-- Tro C§p thu nhap
SO TIEN
CHITRA.
(VN1l)
5.000.000
(VN1l)
5.000.000
5.000.000
V- Ljch suobai thuoug:
ss v~:
a v~
s6 tiJn: a VND
Ten toi la: Nguyen Pharn Thanh Thao voi tu each la b6i thirong vien cua MIe cam k~t
dfl ki~m tra tinh chinh xac va hop l~ cac chimg nr tren, d€ nghi lanh dao duyet sf>tien:
5.000.000 VND.
sf> tien
tren duoc chi tra cho ngiroi duoc bao hiern.,'.
LANH Il~O IlON vt
PT. PHONG NGHI~P
VV
BOI THUONG V[EN
~
j(fyin
BMJQTIGDBTICN.15
Pl.
~/1fJJnl~k!:.
2/2
CONG HOA
xA HOI CHiT
NGHiA VI:t:T NAM
DQc I,p - TI! do - H~nh phuc
S6: ..... .1. .... .lTB-MIC ...
TPHCM,ngay 29 thang 03 ndm 2022
THONG BAo TRA TIEN BAo IDEM
(S6 H6 sa b6i thirong: 20220329071861)
Kinh gui: Nguyen Thi Hoang Loan
Tdng C6ng ty cd phdn Baa hidm Qudn a9i ali xem xet H6 sa b6i thuong cua
Quf; khacn hang. Can cu vaa Gidy yeu cdu tra tien baa hiem, Gidy chicng nhdn baa
hiem, Hop iJ6ng baa hiem, Quy tac baa hiem, Chung t6i th6ng baa vJ viec giai quyet
b6i thuang cua Quy khdcn hang nhu sau:
NglfOi dtrQ'c bao hi~m: Nguyen Thi Hoang Loan
Dia chi: HOC MON
Tham gia bao hiem thea HDBH s6: 20220228089833
Can cir vao h6 sa b6i thuong s6 20220329071861
Da duoc duyet ngay:29 thang 03 narn 2022
Tang
sa ti~n b6i thuong:
5.000.000 VND
(Bang chii: Nam trieu d6ng)
TrlfiYng h9J>Chuy~n khoan:
Theo yeu cAu cua Nguoi duoc bao hiem, chung t6i se chuyen s6 tien tren vao:
Chu tai khoan: Nguy~n Th] Hoang Loan
TK
sa: 2050103999008
T~i: Ngan hang MB - PGD LE D~ nANH
NQi dung thanh tmin: Tni ti~n bao hi€m cho Nguy~n Thi Hoang Loan vao vi~n
ngay 03/03/2022 t~i B~nh vi~n QUAN Y 175
Cluj i': S6 tiJn b6i thl/'{Jngtren se aU9'c thanh taan bJng tiJn mij.l ho(lc chuyin
khaan vaa Tai khaan thea yeu cdu cua Nguai aur;rcbaa hiim. Sau 15 ngay nhijn ill,WC
thong baa nay, niu MlC kh6ng nhijn ilur;rcphiin h6i lC:litz}Ngucyi iJu(Jcbaa hiJm thz coi
nhu Sl,f ki¢n bao hiJm trel?ali iJuy),Cgiiti quyit xong, khong con thac mite khiiu n(li gi.
Tnln tr9ng kinh chao.!.
Nui nlt(in:
TONG CONG TY CP
BAo
HIEM
QUAN DOl
- Nhu tren;
- Lu-u: Phong ....
BMlQT/GDBT/CN.OI.IO
111
t~r~MIC
CONG HOA
xA HOI
CHi; NGHiA VI:¢T NAM
DQc l~p - T1}'do - H:;tnh phuc
..., ngay 29 thdng 03 niim 2022
TO TRINH GIAI QUYET QUYEN LQI BAo HIEM
88
SO'
sue KHOE
b8i thuong: true ti~p/bao lanh vi~n phi
(lIA so s8:20220329071861)
I - Thong tin vi hQ'P dAng bao hi~m:
HQten nguoi tham gia bao hiem: Nguyen Thi Hoang Loan
S6 chirng minh thu:
272328257
Ngay sinh: 18/03/1993
Email: quantri.vndaiphong@gmail.com
Thu9c dan vi: CONG TY TNHH VN
DN
PHONG
Hop d6ng bao hi~m/Gi§'y clnrng nhan bao hiern s6: 20220228089833 (~. ~
)
Thai han BH: Til 00:00 gio, ngay 28/02/2022 dSn 00:00 gio, ngay 28/08/2022
Ngay dong phi: 18/03/2022
Il-Thfmg tin vi S1}'ki~n bao hi~m:
Ngay vao vien: 03/03/2022
Ngay ra vien:
B~nh vien dieu tri: B~nh vien QUAN Y 175
Nguyen nhan: TrQ'c§.pthu nhap
Hau qua: TrQ'c§.pthu nhap
S6 ti€n yeu
c~u: 5.000.000 VND
HA so gAm co:
- Gi§.yyeu c~u tra tien bao hiem;
- Chung nr di€u tri do co quan y tS c§.p:Gi§.y xet nghiem PCR
- Chung minh nhan dan.
- Bien ban xac nhan cua co quan v€ viec di€u tri Sars -
BMlQT/GDBT/CN.15
COy
2
I12
III - Danh gia hA so cua bAi thuong vien:
- Can cir vao nguyen nhan nhap vien, chirng tir y teo Ket luan: Truong hop tren thuoc
pham vi hop d6ng bao hiem.
- Gi~y to' kham chua benh d§y du hop l~.
- N gay yeu c§u tra ti€n bao hiem theo thai han quy dinh.
IV - Tinh toan bBi thuong:
QUYENLQI
DU<}C CHI TRA.
GImH~N
CHITRA
SO TIEN
pIlAT SINH
(VND)
-- Tr<;Y c§p thu nhap
5.000.000
(VND)
5.000.000
SOTIEN
CHITRA
(VND)
5.000.000
V- Ljch sir bAi thmmg:
s6 v~: 0 v~
s6 ti~n: 0 VND
Ten tei la: Nguyen Pham Thanh Thao voi nr each 13b6i thirong vien cua MIC cam ket
da kiem tra tinh chinh xac va hop l~ cac chirng tir tren, d€ nghi lanh dao duyet 56 ti€n:
5.000.000 VND.
S6 tien tren duoc
chi tra cho ngiroi duoc bao hiem.,'.
LANH D~O DON VI
BMlQT/GDBT/CN.15
PT. PHONG NGHIep Vl)
BOI THUONG VIEN
2/2
CONG HOA
xA HOI
CHU NGHiA VI¥T NAM
DQc l~p - TV do - H~nh phuc
TPHCM .ngay 29 thang 03 nam 2022
S6: ..... ./. .... .ITB-MIC ...
THONG BAo TRA TIEN BAo IDEM
(S6 H6 sa b6i thuong: 20220329067008)
Kinh giri: Ung Thi Thuy Di~m
Timg Cong ty C6 phdn Bao hiem Qudn il9i ild xem xet H6 SO' b6i thuong cua
Quy khach hang. Can etc V{lOGidy yeu cdu tra tiJn bao hiem, Gidy chung nhdn bao
hiem, H9'P il6ng bao hiem, Quy tac bao hiem, Chung toi thong bao vJ viec giai quyet
b6i thuang cua Quy khach hang nhu sau:
Ngtro; dlrgc bao hi~m: U'ng Thi Thuy Diem
Dia chi: TAN
pHD
Tham gia bao hiem thea HDBH s6: 20220228089935/3
Can cll vao h6 So' b6i thuong s6 20220329067008
Da dircc duyet ngay:29 thang 03 nam 2022
TAng s3 ti~n b6i thuong: 5.000.000 VND
(Bling chii: Nam trieu d6ng)
Trlr()'Dg hop Chuy~n khoan:
Theo yeu du cua Nguoi duoc bao hiem, chung toi se chuyen s6 ti~n tren vao:
Chii tai khoan: CONG TY TNHH VN D";'I PHONG
TJ(s3: 7031100287003
T~i: Ngan hang MB - PGD
LE D";'I HANH
NQi dung thanh toan: Tra ti~n bao hi€m cho Vng Thi Thuy Di~m vao vi~n
ngay 20103/2022 t~i B~nh vi~n MEDICAL DIAG CENTER
Clui y: s6 NJn b6i fh[((Yngfren se tlu9'c thanh foan b6ng tiJn mijt hoijc chuy~n
khoGn VaGTai k170anthea yeu c6u cua Ngu(J'i au9'c bew hiJm. Sau 15 ngay n179nozf9'c
fhong baa nay, niu MlC khong nh4n au()'cphim h6i l(li fIrNgU[J'iaz(9'c bao hiint thi cai
nhu S1l ki¢l1 bao hiim tl'en ad au9'c giaz' quyh xong. kh6ng con th6c m6c khz'Jun(l; gi.
Tran trQng kinh chao.!.
Nu; nh~n:
- Nhu tren;
- Luu: Phong ....
BMlQTIGDBTICN.O 1.1 0
TONG CONG TY CP
BAo
HI EM QUAN DOl
cl-=:S
---
)/!
CQNG HOA
xA HQI
CHi) NGHiA VI~T NAM
DQc I~p - Tl! do - H~nh phuc
"'J
ngay 29 thdng 03 nom 2022
TO TRINH GW QUYET QUYEN LQI BAo IDEM
sue KHOE
HB SO' bBi thuong: true ti~p/bao Hinh vi~n phi
(H6
sO's6:20220329067008)
I - Thong tin v~ hep dAng bao hi~m:
HQ ten nguoi tham gia bao hiern: If ng Thi Thuy Diem
S6 chirng minh thir: 051190000900
Ngay sinh: 09/10/1990
Email: quantri.vndaiphong@gmail.com
ThuQc dan vi: CONG TY TNHH VN f.)A,IPHONG
Hop d6ng bao hi~m/Gi~y chirng nhan bao hiern s6: 20220228089935/3
Thai han BH:
ro 00:00
gio, ngay 28/02/2022 d~n 00:00 gio, ngay 28/08/2022
Ngay dong phi: 0110312022
Il-Thdng tin v~ Sl!ki~n bao hi~m:
Ngay vao vien: 20103/2022
Ngay ra vien:
B~nh vien di€u tri: l\.1EDICAL DIAG CENTER
Nguyen nhan: TrQ'c~p thu nhap
Hau qua: TrQ'c~p thu nh~p
S6 ti€n yeu du: 5.000.000 VNf.)
H6 so g6m co:
- Gi~y yeu c§u tra ti€n bao hiem;
- Chung illdi€u tri do co quan y t~ cap: Gi~y xet nghiem PCR
- Chung minh nhan dan.
- Bien ban xac nhan cua co quan v€ viec di€u tri Sars - COy 2
BMlQT/G£>BT/CN.lS
112
III - Danh gia hA so cua bAi thireng vien:
- Can cir vao nguyen nhan nhap vien, chimg til y t~. K~t luan: Truong hop tren thuoc
pharn vi hop d6ng bao hiem.
- Giay to kham chua benh dfiy du hop I~.
- Ngay yeu
cAu tra ti~n bao hiem thea
thai han quy dinh.
IV - Tinh toan bAi thuong:
QUYENLQI
DUQCCHITRA.
Glm~
CHITRA.
(VND)
-- TrQ' cftp thu nhap
SOTIEN
PIlAT SINH
(VND)
5.000.000
5.000.000
SOTIEN
CHITRA.
(VND)
5.000.000
V- Ljch sir bAi thmmg:
S6 v¥: 0 v¥
S6 tiJn: 0 VNtJ
Ten toi la: Nguyen Pham Thanh Thao voi nr each la b6i thuong vien cua MIC cam k~t
da kiem tra tinh chinh xac va hop l~ cac chirng til tren, d~ nghi lanh dao duyet s6 tien:
5.000.000 VND.
S6 tien tren
diroc chi tra cho nguoi diroc bao hi~m./.
LANH D~O DON V1
PT. PHONG NGH~P V1J
DOl THUONG V[EN
~
19uyin ~Acpnr;{w,nA~kl{.
BMJQT/GDBTICN.I5
2/2
CQNG HOA
t~r"MIC
sf>: ..... .1.....
xA HQI
CHU NGHiA VlE:T NAM
f>Qcl~p - T1}'do - H~nh phuc
TPHCM,ngay 29 (hang 03 ndm 2022
.lTB-MIC ...
THONG
BAo TRA. TIEN BAo HIEM
(sf> H6 sa
b6i thuong: 20220329070475)
Kinh giri: Quach Thi Khanh Ly
Tong Cong ty C6 phdn BO.ohiim Quem a6i ail xem xet H6 sa b6i thuong cua
QuY khacn hang. Can eu VaG Gidy yeu cdu tra ti~n bao hiem, Gidy chung nhdn bao
hiem, H9'P a6ng bao hiem, Quy tlic bao hiem, Chung toi thong bao v~ viec giai quyet
b6i thuong cua Quy khach hang nhu sau:
NguOi dUQ'c bao hi~m: Quach Thi Khanh Ly
Dta chi: QUAN 12
Tham gia bao hiem then HDBH
s6: 20220228089863/2
Can cir van h6 sa b6i thtrong sf>20220329070475
Dil duoc duyet ngay:29 thang 03 nam 2022
TAng sAti~n b8i thuong: 5.000.000 VND
(Bling chii: Nam trieu d6ng)
TruOng hap Chuy~n khoan:
Theo yeu du cua Ngiroi duoc bao hiem, chung toi se chuyen
s6 ti€n tren
van:
Chii tai khoan: Quach Th] Khanh Ly
TKsA: 0700175822070
Tai; Ngan hang MB
NQi dung thanh toan: Tra ti~n bao hi~m cho Quach Thi Khanh Ly van vi~n
ngay 14/03/2022 t';li B~nh vi~n QUAN Y 175
Cit" j: S6 ti~n b6i thuang tren se aU(lCthanh toem bang ti~n mgt hogc chuydn
khocm VaGTai khocm theo yeu edu cua Nguai au9'c bO.ohidm. Sau 15 l1gay nh(m azr(J'c
thong bao nay, niu MIC klu5ng nh4n aU'9'cphcm h6i lqi tt'rNguo'i au9'c bao hiim thi cof
nhu S7,l' kff_-f1
bao hidm trhi dil aU9'cgiai quyh xong. khong con thac mac kllliu n(lf gi.
Tran tr<;mgkinh chao.!.
Nui lih{in:
- Nhu: tren;
- Lu:u: Phong ,..,
BM/QTIGDBTICN.OI.IO
III
CONG HOA
xA HOI
CHU NGHiA VI~T NAM
DQc I~p - TI}' do - H~nh phuc
"'J
ngay 29 thang 03 ndm 2022
TO TRiNH GIM QUYET QUYEN LQI BAo HIEM sire KHOE
HB SO' bBi thuong: true ti~p/bao lanh vi~n phi
(IIA SO' s8:20220329070475)
I - Thong tin v~ hop dAng bao hi~m:
HQ ten nguoi tham gia bao hiem: Quach Thi Khanh Ly
sf; chirng minh thir: 034193005655
Ngay sinh: 02/06/1993
Email: quantri.vndaiphong@gmai1.com
ThuQc don vi: CONG TY TNHH VN D.AI PHONG
Hop d6ng bao hi€mJGi§y chirng nhan bao hiem sf;: 20220228089863/2
Thai han BH: Til 00:00 gio, ngay 28/02/2022 den 00:00 gio, ngay 28/08/2022
Ngay dong phi: 01/0312022
If-Thong tin v~ Sl}' ki~n bao hi~m:
Ngay vao vien: 14/03/2022
Ngay ra vien:
B¢nh vien di~u tri: B¢nh vien QUAN Y 175
Nguyen nhan: Tro dp thu nhap
Hau qua: Tro c~p thu nhap
sf; tien yeu cAu: 5.000.000 VND
HA SO' gAm co:
- Giay yeu c§u tra tien bao hiem;
- Chung illdieu tri do co quan y t€ dp: Gi§y xet nghiem peR
- Chung minh nhan dan.
- Bien ban xac nhan cua co quan v~ viec di~u tri Sars - COy 2
BMlQT/GDBTICN.1S
1/2
ill - Danh gia hB so ella bBi thuong vien:
- Can cir vao nguyen nhan nhap vien, chirng illy t€. K€t luan: Truong hQ'Ptren thuoc
pham vi hQ'Pd6ng baa hiem.
- Gi§y to' kham chua benh d§y du hQ'Pl~.
- Ngay yeu cftu tra tien baa hiem thea thai han quy dinh.
IV - Tinh toan bBi thuoug:
QUYEN LQI
DUQC CHI TRA.
Glm~
CHITRA.
(VND)
-- TrQ'cip thu nhap
SOTIEN
pIlAT SINH
(VND)
5.000.000
5.000.000
SOTIEN
CHI TRA.
(VND)
5.000.000
V- Lich Stf bBi thuong:
ss v~:
0 v~
s6 tiJn: 0 VNfJ
Ten t6i la: Nguyen Pham Thanh Thao voi nr each la b6i thuong vien cua MIC cam k€t
da kiem tra tinh chinh xac va hQ'Pl~ cac chimg ill tren, d€ nghi lanh dao duyet s6 titn:
5.000.000 VND.
S6 tien trcn
ducc chi tra cho nguoi duoc baa hiem.',
LANH D~O DON VI
BMlQT/GDBT/CN.15
PT. PHONG NGmtp
vu
nOI TRUONG VIEN
2/2
,IJ @
xA HOI
CONG HOA
CHU NGHiA VI~T NAM
DQc I~p - TV do - H~nh phuc
S6: ..... .1..... .lTB-MIC ...
TPHCM, ngay 29 thang 03 ndm 2022
THONG BAo TRA.TIEN BAo HIEM
(S6 H6 sa b6i thirong: 20220329070811)
Kinh gui: Nguyen Thanh
Y Tr§m
Tong Cong ty Cb phdn BO.ohidm Qudn a{5i ail xem xet H6 sa b6i thuong cua
QuY khach hang. Can ctr VaG Gidy yeu cdu tra ai« bao hiem, Gidy chung nhdn bao
hiem, H9P a6ng bao hiem, Quy tdc bao hiem, Chung toi thong bdo v~ viec giai quyet
b6i thuong cua QuY khach hang nhu sau:
Nglfiri dlfQ'Cbao hi~m: Nguyen Thanh
Y Trk
Dia chi: BiNH TAN
Tham gia bao hiem thee HUBH
Can cir vao h6
sa b6i thuong
s6: 20220228089881/3
s6 20220329070811
Da duoc duyet ngay: 29 thang 03 nam 2022
TBng
sA ti~n
bBi thiroug: 5.000.000 VND
(Bling chit: Nam trieu d6ng)
Trlfirng hoopChuy~n khoan:
Theo yeu c§u cua Ngiroi duoc bao hiem, chung toi
Ch1i tai khoan: Nguy~n Thanh
TK
sA:
se chuyen s6 tien tren vao:
Y Trim
6688855566888
T~i: Ngan hang MD
NQi dung thanh toan: TnTtti€n bao hiem cho Nguy~n Thanh
ngay 21103/2022 t;;ti B~nh vi~n TTYT HOA HAo
Y Trk
vao vi~n
tlllrimg tren se dU9'C thanh toiln bling tiJn mgt ho(ic chuyin
khoim VaG Tai klwcm thea yeu cdu cua Nguai au9'c bao hdm. Sau J 5 nga,v nhgn aU9'C
thong bao nay, niu MlC kh6ng nhgn au9'c phon h6i 19i tt'rNgU'(Jial-Wc baa Idim thi coi
nhu Sl:/' ki¢n bao hzim a'en ail au(},cgiai quyh xong, kh6ng con thAc !nbc khidu n(li gi.
CIIlJ y:
s6 r;~11 b6i
Tdin tr<;mgkinh chao.!.
Nui nh~n:
TONG CONG TY CP
BAo
HIEM
QUAN D(n
- Nhutren,'
- Luu: Phong ....
BMlQT/GDBT/CN.OI.10
III
CONG HOA xA HOI CHU NGHiA VI~T NAM
t~r'_MIC
DQcl~p - Til do - H~nh phuc
"'} ngay 29 thdng 03 ndm 2022
TO TRiNH GIAI QUYET QUYEN LQI BAo HIEM sue KHOE
H& so bBi thuong: true ti~p/bao lanh vi~n phi
;l.
,
(Ho so so:20220329070811 )
I - Thong tin v~ hQ1>dAng bao hi~m:
H9 ten nguoi tham gia bao hiem: Nguyen Thanh
S6 chirng minh thu:
Y Trfun
272228625
Ngay sinh: 12/06/1993
Email: quantri.vndaiphong@gmail.com
Thu9c don vi: CONG TY TNHH VN D~_I PHONG
Hop d6ng bao hiem/Giay chirng nhan bao hiem s6: 20220228089881/3
Thai han BH: Tir 00:00 gio, ngay 28/02/2022 d~n 00:00 gio, ngay 28/08/2022
Ngay dong phi: 01/0312022
If-Thong tin v~ S\f ki~n bao hi~m:
Ngay vao vien: 21103/2022
Ngay ra vien:
B~nh vien di~u tri: TTYT HOA
BAo
Nguyen nhan: Tro cap thu nhap
Hau qua: TrQ'c~p thu nh~p
S6 ti~n yeu cau: 5.000.000
VND
HA so gAm co:
- Giay yeu c~u tra tien bao hiem;
- Chung nr di~u tri do
C(J
quan y t~ dp: Gi~y xet nghiem PCR
- Chirng minh nhan dan.
- Bien ban xac nhan cua
8M1QT/GDBT/CN.lS
C(J
quan v€ viec dieu tri Sars - COy 2
112
III - Danh gia hB so ciia bBi thuong vien:
- Can cu vao nguyen nhan nhap vien, chimg ill y te. K~t luan: Tnrong hop tren thuoc
pham vi hop d6ng bao hiern.
- Gi~y to kham chua benh dfty du hQ'P1~.
- Ngay yeu cAutra ti€n bao hiem thea thai han quy dinh,
IV - Tinh toan bBi thuong:
QUYENLQI
DUQC CHI TRA
-- Tro c~p thu nhap
GIOI~N
CHITRA
(VND)
SOTIEN
pIlAT SINH
(VND)
5.000.000
5.000.000
SOTIEN
CHITRA
(VND)
5.000.000
V- Ljch suobBi thuong:
S6 vzz . 0 v¥
S6 ti~n: 0 VNE)
Ten toi la: Nguyen Pharn Thanh Thao voi tu each la b6i thuong vien cua MIe cam k~t
da:kiem tra tinh chinh xac va hop l~ cac clnrng ill tren, d~ nghi lanh dao duyet s6 tien:
5.000.000 VND.
S6 ti~n tren duoc chi tra cho nguoi duoc bao hiem.,',
LANH D';_O DON V1
BMlQTIGDBT/CN.15
PT. PHONG NGHIlP
VV
BOI THUONG VIEN
2/2
ftV
1 k)
CONG HOA
xA HOI
CHU NbmA
VI:eT NAM
DQc I~p - TV do - H~nh phuc
TPHCM,ngay 29 thang 03 ndm 2022
S6: ..... .1..... .lTB-MIC ...
THONG BAo TRA.TIEN BAo IDEM
(S6 H6 sa b6i thuong: 20220329072088)
Kinh gui: Nguyen Thi Thu Hien
Tong Cong ty C6 phdn Bao hiim Qudn t19i dii xem xet H6 sa b6i thuong cua
Quy khach hang. Can cu VaG Gidy yeu c6.u tra tiJn bao hiem, GiCY chung nhdn baa
hiem, H(YJJd6ng bao hiem, Quy tlic bao hiem, Chung toi thong baa vJ viec giai quyit
b6i thuong cua Quy khdch hang nhu sau:
Nglloi dllQ"Cbao hi~m: Nguyen Thi Thu Hien
Uia chi:
GO V Ap
Tham gia bao hi~m thea HUBH s6: 20220228089814
Can ClI vao h6 sa b6i thuong s6 20220329072088
Ua diroc duyet ngay:29 thang 03 nam 2022
TAng
sa ti~n b6i thuong: 5.000.000 VNU
(Bang chi1::Nam trieu d6ng)
Tnro'ng hQ]) Chuy~n khoan:
Theo yeu C§u cua Ngiroi duoc bao hiern, chung toi se chuyen s6 tien tren vao:
Chii tai khoan: Nguy~n Thj Thu Hi~n
TK
sa: 7030105503007
T~i: Ngan hang MB - CN
LE D~I
HANH
NQi dung thanh toan: Tra ti~n bao hi~m cho NguySn Thi Thu Hi~n vao vi~n
ngay 28/02/2022 t~i B~nh vi~n QuAN Y 175
CllIJ y: 86 tiJn b6i thuang tren se chr9'cthanh toem bang tiJn m¢t ho¢c chuy~n
khoGn VaG Tezi khoGn thea _veucdu cua Ngu()'i du(yc bew hidm. 8au 15 nga,v nh4n t/u.'9'c
thong bao nay, niu MfC kh6ng nh4n t/u(ycphan fu5i lqi ti'r Ngu()"ial(,(),cbao hidm thi coi
nhu S1", ki¢n bao hiJm tren aii t/u(yc giai quyh xong. khong con thlic mac khiiu n(li gi,
Tran tr9ng kinh chao.!.
NlIi nhQn:
TONG CONG TY CP
BAo
HIEM
QUAN DOl
- Nhu tren;
- LU'U: Phong ....
BMlQT/GDBT/CN.Ol.lO
III
CONG HOA
xA HOI cnu NGHiA
VI~T NAM
DQc l~p - T\f do - H~nb phuc
"'1
ngay 29 thang 03 ndm 2022
TO TRINH GIAI QUYET QUYEN LQI BAO IDEM
sue KHOE
H& SO' b&i thufrng: true ti~p/bao lanh vi~n phi
(H& so s8:20220329072088)
I - Thdng tin v~ hQ1>d&ng bao hi~m:
HQ ten ngiroi tham gia bao hiem: Nguyen Thi Thu Hi~n
S6 clnmg minh thu: 285430838
Ngay sinh: 27/06/1995
Email: quantri.vndaiphong@gmail.com
ThuQc dan vi: CONG TY TNHH VN BAI PHONG
Hop d6ng bao hi~m/Gi§'y chirng nhan bao hi~m s6: 20220228089814
Thai han BH: Til 00:00 gio, ngay 28/02/2022 d~n 00:00 gio, ngay 28/08/2022
Ngay dong phi: ~8'J03/2022
Il-Thong tin v~ S\f ki~n bao hi~m:
Ngay vao vien: 28/02/2022
Ngay ra vien:
Benh vien di~u tri: Benh vien QUAN Y 175
Nguyen nhan: TrQ'cip thu nhap
Hau qua: TrQ'cip thu nhap
S6 tien yeu c~u: 5.000.000 VNB
H& SO' g&m co:
- Giiy yeu c~u tra ti~n bao hiem;
- Chung til di~u tri do co quan y t~ dp: Gi§y xet nghiem PCR
- Chung minh nhan dan.
- Bien ban xac nhan cua co quan v~ viec di~u tri Sars - COy 2
BMlQT/GDBT/CN.lS
1/2
III - Danh gia h8 so ciia b8i thU'img vien:
- Can cir vao nguyen nhan nhap vien, chimg ill y t€. K€t luan: Tnrong hop tren thuoc
pham vi hQ1Jd6ng baa hiem.
- Giay
ta kham
chua benh d~ydu hQ1J1~.
- Ngay yeu du tra tien baa hiem thea thai han quy dinh,
IV - Tinh toan b8i thtrimg:
QUYEN L<}I
DUQCCRITRA.
-- TrQ'c~p thu nhap
GIm~N
CIDTRA.
(VND)
SOTIEN
PRAT SINH
(VND)
5.000.000
5.000.000
so TIEN
CRITRA.
(VND)
5.000.000
V- Ljch sir b8i thuong:
S6 v¥: 0 v¥
S6 tiJn: 0 VND
Ten toi la: Nguyen Pharn Thanh Thao voi tu each la b6i thuong vien cua MIC cam k€t
da: kiern tra tinh chinh xac va hQ1J1~cac chirng ill tren, d~ nghi lanh dao duyet s6 tien:
5.000.000 VND.
S6 tien tren duoc
chi tra cho ngiroi diroc baa hiem.z.
LANH D~O DON VI
BMlQTIG£>BT/CN.15
PT. PRONG NG~P
VV
BOI TRUONG VIEN
2/2
lu
,
CONG HOA
xA HOI CHiT
GHiA VI~T NAM
DQc l~p - TV do - H~nh phuc
TPHCM,ngay 29 thdng 03 nam 2022
S6: ..... ./. .... .ITB-MIC ...
THONG BAo TRA TIEN BAO HIEM
(S6 H6 sa b6i thuong: 20220329071150)
Kinh giri: Nguyen Thi Tirong Vy
T6ng Cong ty c6 phdn Bao hiim Qudn a6i aa xem xet H6 sa b6i thuong cua
Quy khach hang. Can Cll'VaGGidy yeu cdu trd tiJn bao hiem, Gidy chung nhdn bao
hiem, H9P a6ng bao hiem, Quy tac bao hiem, Chung toi thong bao vJ viec giai quyet
b6i (huang cua Quy khdch hang nhu sau:
Nglf01 dlfQ'Cbao hi~m: Nguyen Thi Tuong Vy
Dia chi: HOC MON
Tham gia bao hiem thea HDBH s6: 20220228089837/2
Can cir vao h6 sa b6i thuong s6 20220329071150
Da duoc duyet ngay: 29 thang 03 nam 2022
Tang
sA ti~n
b8i thuong: 5.000.000 VND
(Bdng chii: Nam trieu d6ng)
TrU'CrnghO'p Chuy~n khoan:
Theo yeu c§u cua Ngiroi duoc bao hiem, chung tei se chuy~n s6 ti~n tren vao:
Chli tai khoan: Nguy~n Thj TU'irng Vy
TK
sA:
7030105642007
T~i: Ngan hang MB
NQi dung thanh toan: Tra ti~n bao hi~m cho Nguy~n Thi Tuang Vy vao vi~n
ngay 12/03/2022 t~i B~nh vi~n MEDICAL DIAG CENTER
Cltit y: S6 tiJn b6i thuong Iren se aU9'c thanh toan bang tiJn mgl ho(lc chuyin
khocm VaG Tai khoan theo yeu cdu cua Nguai au9'c bew hiJm. Sau 15 nga,v nh4n dU9'C
thong bao nay, niu MIC khong nh4n au9'c phd}] h6i lqi til' Nguoi du9'c bao hidm thi coi
nhu Sl! ki¢n bao hiJm trhz ail aU9'cgiai quyh xong. kh6ng can thac mdc khiiu nqi gi.
Tnln tn;mg kinh chao.!.
Nui nltQn:
- Nhutren,'
- Luu: Phong ....
BM/QT/GDBT/CN.Ol.lO
TONG CONG TY CP
BAo
HIEM
QUAN DOl
--III
CQNG HOA
xA HQI
CHU NGHiA VI~T NAM
Dqc I~p - T\f do - H~nh phuc
..., ngay 29 thdng 03 nom 2022
TO TRINH GW QUYET QUYEN LQI BAo HIEM
H6
SO'
sue KHOE
b6i thmrng: trl}'cti~p/bao lanh vi~n phi
(118 sO's6:20220329071150)
I - Thong tin v~ hQ11d8ng bao hi~m:
HQ ten nguoi tham gia bao hiem: Nguyen Thi TUOng Vy
S6 chirng minh thu:
025820588
Ngay sinh: 16/03/1998
Email: quantri.vndaiphong@gmail.com
Thuoc don vi: CONG TY TNllli VN VA-I PHONG
Hop d6ng bao hi~m1Gi§y clnrng nhan bao hiem s6: 2022022808983712
Thai han BH: ro 00:00 gio, ngay 28/02/2022 dSn 00:00 gio, ngay 28/08/2022
Ngay dong phi: 01/03/2022
If-Thong tin v~ s\f ki~n bao hi~m:
Ngay vao vien: 12/03/2022
Ngay ra vien:
B¢nh vien di€u tri: MEDICAL DIAG CENTER
Nguyen nhan: TrQ'd.p thu nhap
Hau qua: TrQ'd.p thu nhap
S6 ti€n yeu c§u: 5.000.000
VND
H8 SO'g8m co:
- GiAy yeu c§u tra tien bao hiem;
- Chung tir di€u tri do co quan y tS cAp:Gi§y xet nghiem PCR
- Chirng minh nhan dan.
- Bien ban xac nhan cua co quan v€ viec di€u tri Sars - COy 2
BMlQTIGDBT/CN.15
1/2
III - Danh gia b8 so cua b8i thuong vien:
- Can cir vao nguyen nhan nhap vien, chirng ill y t~. K~t luan: Truong hop tren thuoc
pham vi hop d6ng baa hi€m.
- Gifty to kham chua benh dAydu hop l~.
- Ngay yeu cAutra tien baa hiem thea thoi han guy dinh.
IV - Tinh toan b8i tlnroug:
QUYENLQI
GI61H4N
DUQC CHI TRA.
-- TrQ'cftp thu nhap
CIDTRA.
(VND)
SOTIEN
pIlAT SINH
(VND)
5.000.000
5.000.000
SOTIEN
CHITRA.
(VND)
5.000.000
V- Ljch sir b8i thuong:
S6 Vl,L" 0 V1:l .
S6 tiJn: 0 VND
Ten toi la: Nguyen Pham Thanh Thao voi ill each lii b6i thuong vien cua MIC cam k~t
dffkiem tra tinh chinh xac va hop l~ cac clnrng ill tren, d~ nghi lanh dao duyet s6 ti~n:
5.000.000 VND.
S6 tien tren duoc
chi tra cho nguoi duoc baa hiem.,'.
LANH D~O DON VI
BMlQT/GDBTICN.15
PT. PHONG NGHU:P V1)
BC)! THUONG VIEN
2/2
"-,
1tJ l'l.D)
/'
.
CONG HOA xA HOI
. CHU
DQc I~p - TV
S6: ..... .1..... .lTB-MIC ...
NGlIiA VIET
.
do - H~nh
NAM
phuc
TPHCM,ngay 29 thdng 03 ndm 2022
BAo TRA TIEN BAO HIEM
THONG
(S6 H6 sa b6i thuong: 20220329072735)
Kinh giri: Le Thi Minh Hang
Tong Cong ty C6 phdn Bao hidm Qudn a(>i ali xem xet H6 sa b6i thuong cua
Ql!Y khach hang. Can Clf VaG Gidy yeu cdu tra tiJn bao hiem, Gidy chung nhdn bao
hiem, Hap a6ng bdo hiem, Quy tdc bao hiem, Chung toi thong bao vJ viec giai quyet
b6i thuong cua Qui' khacli hang nhu sau:
NguOi dllQ'C bao hi~m: Le Thi Minh Hang
Dia chi: BINH DJNH
Tham gia bao hiem thea HDBH s6: 20220228089942/2
Can ClI van h6 sa b6i thuong s6 20220329072735
Dil duoc duyet ngay: 29 thang 03 nam 2022
TAng
sa ti~n b&i thuong:
5.000.000 VND
(Brmg chic: Nam trieu d6ng)
TruOng hop Chuy~n khoan:
Theo yeu c§u cua Ngiroi diroc bao hiem, chung t6i se chuyen s6 ti~n tren vao:
Chii tai khoan:
TK
Le Thi
Minh H~ng
sa: 162461689
T~i: Ngan hang ACB
NQi dung thanh toan: Tra ti~n baG hi~m cho Le Thi Minh H~ng viw vi~n ngay
15/03/2022 t?i B~nh vi~n MEDICAL DIAG CENTER
Cluj y: 86 tiJn b6i thlfong fren se GU9'Cthanh toim bimg ti~n mijt ho(lc chuyin
khoan VaG TaTkhoGn theo yeu c6u cila Nguo'i GU()'cbew hiim. 8au J 5 nga.v nl14n aU9'c
thong bao nily, niu Mle khong nJl{~nGU()'cphon h6i 19i tt'r Nguo'i au9'c bao hidm thi coi
nhu Sl,f ki¢n bao hiim tren ali tiu,(),cgiai quyJr xong, khong con {hac mbc khidu n(li gi.
Tran trQng kinh chao.!.
TONG CONG TV CP BAo HIEM QUAN I)()I
d=>_
Noi nh(in:
- Nhu tren;
- Luu: Phong ....
BMlQT/GDBT/CN.O
1.10
1/1
CONG HOA
t~r"MIC
xA HOI
CHU NGHiA VI~T NAM
f}QcI~p - T,! do - H~nh phuc
"'J
ngay 29 thang 03 ndm 2022
TO TRiNH GW QUYETQUYENLQI BAo HIEM sue KHOE
DB SO' bBi thuong: true ti~p/bao lanh vi~n phi
(HA so' s6:20220329072735)
I - Thong tin v~ hQ'P dAng bao hi~m:
H<;>ten ngiroi tham gia bao hiem: Le Thi Minh Hfug
sf> clnrng minh thu:
215071697
Ngay sinh: 12/1011987
Email: quantri.vndaiphong@gmail.com
Thuoc dan vi: CONG TY TNHH VN DAl PHONG
Hop d6ng bao hiem/Giay chirng nhan bao hiem sf>:20220228089942/2
Thai han BH: TtT 00:00 gio, ngay 28/02/2022 dSn 00:00 gio, ngay 28/0812022
Ngay dong phi: 01/03/2022
11-Thong tin v~ s,! ki~n bao bi~m:
Ngay vao vien: 15/03/2022
Ngay ra vien:
Benh vien di€u tri: MEDICAL DIAG CENTER
Nguyen nhan: Tro cc1pthu nhap
Hau qua: Tro Cc1pthu nhap
sf> tien yeu du: 5.000.000
VND
H8 so' gAm co:
- Gic1Yyeu c§u tra tien bao hiem;
- Chung til di€u tri do co quan y t€ cap: Gic1Yxet nghiem PCR
- Chung minh nhan dan.
- Bien ban xac nhan cua co quan v€ viec di€u tri Sars - COy 2
BMlQT/GDBT/CN.15
112
ill -Danh gia h6 so ciia b6i thuong vien:
- Can cir vito nguyen nhan nhap vien, chirng tir y t~. K~t luan: Tnrong hop tren thuoc
pham vi hop d6ng bao hi~m.
- Giay to kham chua benh d~ydu hop l~.
- Ngay yeu c~u tra ti~n bao hiem thea thai han quy dinh.
IV - Tinh roan b6i thuong:
QUYENLQI
DU<}C CHI TRA.
-- Tro d.p thu nhap
GImH~N
CmTRA.
(VND)
SOTIEN
pIlAT SINH
(VND)
5.000.000
5.000.000
SOTIEN
CmTRA.
(VND)
5.000.000
V- Ljch sir b6i thirong:
S6 v~: 0 v~
S6 tiJn: 0 VNfJ
Ten toi lit: Nguyen Pham Thanh Thao voi ill each lit b6i thirong vien cua MIC cam k~t
da kiem tra tinh chinh xac va hop l~ cac chimg til tren, d~ nghi lanh dao duyet s6 tien:
5.000.000 VND.
se ti~n tren duoc chi tra cho ngiroi duoc bao hiem.z.
LANH D~O DON VI
BMlQT/GDBTICN.15
PT. PHONG NGm:¢p vu
BOI THUONG VIEN
2/2
)~!."'MIC
I
Bao Hiem Quan OQi
"
"
r
?
'l.
?
;t
THONG BAO TRA TIEN BAO HIEM
(SO H6 so' b6itludJ'ng: 13579/22IBT-CN/049-GDBT)
Kinh gui Quy khach hang: Vo ie Thcw Nguyen.
T6ng Cong ty C6 phdn Baa hdm Qudn ari aa xem xet H6 so b6i (huang cua Quy khach hang.
Can cu viw Gidy yeu criu tra ti§n bao hiem, Gi6y chung nhdn baa hiem, H(lJJa6ng baa hi€m, Quy
tac baa hiem, Chung toi thong baa vd viec giai quye: b6i thuong cua Quy khach hang nhu sau:
NguOi dmlc bao hi~m: Vo Le Thiio Nguyen.
Dia chi: Tring 6, Taa nha C. T Plaza Tan San Nhdt, 60A Truong San, Phuong 2, Quc;inTan Binh,
TP H6 Chi Minh.
Tham gia bao hi~m thea HDBH s6: 10692/21/HD-CN/049-KDBH02.
Can ClI vao h6 sa b6i thuong s6 13579/22/BT-CN/049-GDBT.
Dff duoc duyet : ngay 23 thang 03 nam 2022
Tang
sA ti~n
bBi thuong: 2,126,500 d6ng.
(Bang chii: Hat trieu mot tram hai muoi sau ngan nam tram a6ng).
TruOng hO'p tra ti~n b~ng ti~n mat.:..
Trong thai h(;ln bay (07) ngay k~ tu khi nMn dUQ'cthong bao nay, nguai dUQ'cbao hi~m (ho~c
Nguai thua k~ hQ'pphap) tr\fc ti~p ho~c Clfnguai d~n lInh ti~n t(;li:ITDVKH PHiA NAM
Khi d~n nh~ ti~n, d~ nghi Quy khach mang thea: Gi~y chUng minh nhan dan, truang hQ'Pnha
nguai khac nh~n h<)phai co Gi~y uy quy'~n hQ'P phap.
TruOng h9]J Chuy~n khofm:
Theo yeu
du clla Nguai
dUQ'cbao hiSm, chung toi
se chuy~n s6 ti~n tren
vao:
+ Chu tai kho~ln: v6 Li; THAo NGUYEN.
+ TK sA:
02124035401.
+ T~i: Ngan hang TP BANK.
+ Nqi dung thanh toan: Tra ti~n bao hi~m eho Va Le Thaa Nguyen, vao vi~n ngay 25/02/2022 va
ngay 02/03/2022 t(;liB~nh vi~n NHA KHOA KIM - BV fJK Quac
TE VINMEC.
Cllil y: s6 tiJn b6i thu:cmg /ren se c1u'9'cthanh loan bfing tiJn m(it ha(ic chuy€n khaan vew Tid
khaim thea yeu c6u cl~a NgU'()'idu:()'cbcia hidm. Sau 15 ngclY nh4n aU9'c thong bao nay, ndu MIC
khong nhc;inaU'9'cphan h6i l(:ti tir Ngu(]'i thwc baa hi€m thi cai nhu S(l ki?n bew hi€m tren aa au:9'c
giai quy6t xang, khong con th6c mac khi6u n(li gi.
Tran tr9ng kinh chao .I.
Ngay 23 thang 03 nam 2022
TONG CONG TV CO PHAN BAo HIEM QUAN DOl
Nai nhan:
- Nhu tren;
- Luu Phong TCKT
- Luu Phong ....
BMlQT/CN/02.11
o
J~!."MIC
~I
Bao Hii~mQuan f>Qi
TO TRINH nOI THU'ONG
(liB so' s5: 13S79/22/BT-CN/049-GDUT)
I.Tom t~t hB so' b8i thuirng:
HQ ten ngiroi tham gia bao hiem: va Le Tluio Nguyen.
Thuoc dan vi: CONG TY TNHH CODE88.
Dia Chi
: Tang 6, Toa nha C T Plaza Tan San Nhrit, 60A Truong San, Phuong 2, Qudn Tan
Binh, TP H6 Chi Minh.
f)i~n thoai : 0773604517
Tham gia loai hinh bao hiem: Bao hidm Sio: Khoe Nhom va Tai Nan Nhom.
HQ'Pd6ng bao hiern s6: 10692121IHD-CNI049-KDBH02,
Thai han BH: Tit 1410512021 din 1310512022.
Mire trach nhiem bao hiem: Chit thuong tdt toan b¢ va b¢ phdn vinh viln do tai nan: 80,000,000;
Nlim vi?n do 6m dau, benh tat/nom: 120,000,000; Phdu thudt do 6m dau benh tat/nom:
40,000,000; Phau thudt lien quan ain cdy ghep n¢i tang do 6m dau, b¢nh te,it:40,000,000; Di§u
tri truce khi nhdp vien/ndm: 2,000,000; Di§u tri sau khi xurit vien: 2,000,000; Y ta cham soc tai
nha/nam: 2,000,000; trc crip n6m vi¢nlngay: 70,000; Djch v¥ xe cUu thuang trong 19nh th6 Vi?t
Nam 109i trit bling auang hang kh6ng: 40,000,000; Tr9' crip mai tang phi: 2,300,000; DKBS 01 Di§u trf ngo(li tru do 6m dau, b?nh t4tlnarn: 7,000,000; s6 ti~nlldn kham: 2,100,000; Ve,itIf; tri
li¢ultdn: 70,000; s6 Idn v(it If; trj liqulnarn: 4,200,000; DKBS 02 - Quy~n 19'i nha khoalnam:
2,100,000; s6 ti~nlldn kham: 2,100,000,' DKBS 03 - Quy~n 19'i thai sanlnam: 40,000,000; Sinh
Thuimg: 40,000,000,' Sinh m6: 40,000,000; min chung thai san: 10,000,000; DKBS 04 - Tit
vong, thuang {(it vinh viln do tai n(lnlv¥: 80,000,000; tir vongl thuang tgt toan b¢ vinh viln:
80,000,000; DKBS O.
Ngay dong phi: 17/05/2021.
Ngay vao vi~n: 2510212022 vel 0210312022.
B~nh vi~n di~u tri: NHA KHOA KIM - BV DK Quac TE VINMEC
Nguyen nhan: DIEU TRJ sAu NGA R17 27, piroc H6I c6 R16, VTEMAM DAD.
H~u qua: DIEU TRJ sAu NGA R17 27, PHOC H6I c6 R16, VLEMAM DAD.
].
].
.
H o SO' gom co:
- Gi§.y yeu du t1'ati~n bao hi~m;
- ChUng tir di~u tri do ca quan y t~ c§.p:IjOA DON, PHIEU fJIEU TRJ RANG, TOA THU6c;
II. Banh gia h8 so·cua biH thU'O'ngvien:
- Can cu vaG nguyen nhan nh~p vi~n, chUng y t~. K~t lu~: THUOC P HAM VI BH
- Gi§.y khal11chua b~nh d~y dll hQ'Pl~.
- Ngay yeu cAu tra ti~n bao hi~m thea thai h~n quy dinh.
III. Tinh toan b6i thU'O'ng:
tu
ta
Gio'i h~n B6i thU'(mg
Quy~n Ic;)'idU'Q'cchi tra
Chi phi ngol;li t1't1 7tr/ nam
(2td/ l~ kham)
__c_
_
Chi phi dieu tri rang 2t1'1/
nam
TAng c(>ng
Ty l~
(TT,PT,
TCNV)
I
I
sA ti~n
So
ngay
di~u tri_._-
b].·
01
BM/QT/CN/02.16
sinh
B~ xu§t b6i
thU'ong
thU'O'ng
826,500
826,500
826,500
1,300,000
1,300,000
1,300,000
t=
-
2,126,500
IV. Lich sfr tAn th§t:
s6 v¥: O.
sA ti~n phat
86 ti~n: 0 d6ng.
2,126,500
t~!."'MIC
I
Bao Hiem Quin 091
_ Ten toi la: Ngtty!" Pham Thanh Tluio voi tLT each la b6i thirong vien ella MIC cam k~t da kiem
tra tinh chinh xac va hop 1~cac chirng tir tren, d~ ngh] lanh dao duyet s6 ti~n nhir sau:
Bang s6: 2,126,500 d6ng.
BAng chir: Hai trieu mot tram hai muoi sau ngan nam tram d6ng. .
S6 tien tren duoc chi tra cho nguoi duoc bao hiem,
Ngay 23 (hang 03 nam 2022.
BOI THUONG VrEN
PT. PHONG NGHI:¢P \TV
LANH D~O DON VI
Nguy~n Pham Thanh Thao
BM/QT/CN/02.16
)~!.'_MIC
I
~&-
,Bao Hlem Quin £lQI
THONG BAO TRA TIEN BAo HIEM
(sa H8
SO'
b8i thuang: 13741122IBT-CNI029-GDBT)
Kinh gtri Quy khach hang:
Le Quang
Tilting.
T6ng Cong ty C6 phdn Bao hidm Qudn a(Ji ali xem xet H6 sa b6i thuong cua Quy khdch hang.
Can cu veLD Gidy yeu cdu tra tiJn bao hiem, Gidy chung nhdn bao hiem, H9]J a6ng bao hiem, Quy
tdc baa hidm, Chung toi thong bao vJ viec giai quyh b6i thuong cua Quy khach hang nhu sau:
NguOi oUQ'c bao hi~m:
Le
Quang Thdng.
£>iachi: 219 D(;d1(JBinh Duong, P. Vinh Phu, Thi xii Thutin An, Tinh Binh Duong.
Tham gia bao hiem thee HDBH s6: 6407121IHD-CNI029-PHH.
Can cu vao h6 sa b6i thirong s6 13741122IBT-CNI029-GDBT.
Dff duoc duyet .ngay 23 thang 03 nam 2022
TAng
sa ti~n b6i thuong: 440,695 d6ng,
(Bang chii: B6n tram b6n muai ngan sau tram chin muai lam a6ng).
S6 ti~n yeu d.u: 498,995d
S6 ti~n ill ch6i: 58,300d chi phi test Covid 19 khong thuQc ph~
vi BH
TruOng hop tra ti~n b~ng ti~n mat:
Trong thai h~ bay (07) ngay k~ ill khi nh~n duqc thong bao nay, nguai duqc bao hi~m (ho~c
Nguai thua k~ hqp phap) tNc ti~p ho~c cu nguai d~n linh ti~n t~: IT DKVH PI-liA NAM
Khi d~n nh~n ti~n, d~ nghi Quy khach mang thea: Gi~y chUng minh nhan dan, truemg hqp nha
nguai khac nh~ hQ phai co Gi~y uy quy~n hqp phap,
Trtrong hop Chuy~n khoan:
Theo yeu cfiu cua Nguai duQ'c bao hi~m~ chung toi se chuy~n s6 ti~n tren vao:
+ Chii tai khoan: LE QUANG THANG.
+ TK
sa: 613704060429192.
+ T~i: Ngan h~lDg VIB.
+ NQi dung thanh toan: Tnl ti~n bao hi~m cho Le Quang Thang, vao vi~n ngay 0910312022 tc;ti
B~nh vi~n BV NHAN DAN GIA DJNH.
thuang (ren se ilu(J'c thanh toan bang tiJn m(lt ho(lc chuy€n khoan vew Tai
khoan theo yeu cdu cua Nguai ilzC(J'cbao hi€m. Sau 15 ngay nh4n aU(J'cthong bao nay, ndu MIC
kh6ng nh(m aU(fc phan h6i h;d til: NgU'ai aU(Jcbao hidm thi coi nhu SI! ki~n bao hi€m tren ilil ilu(Jc
Chit y:
s6 Li€n b6i
giai quyit xong, kh6ng con thac
mac khiiu
ngi gi.
Tran trQng kinh chao .I,
Ngay 23 (hang 03 nam 2022
Nai nhan:
- Nhu (ren;
- Luu Phong TCKT.
- Luu Phong ....
BMlQT/CN/02.11
TONG CONG TY CO
pRAN BAo HIEM
QUAN DOl
t~!."MIC
, I
BaaHlem Quin D91
TO' TRINfI BOI THlfONG
(116 so' sa: 13741122/BT-CN/029-GDBT)
I. Tom tit h& SO' bBi thuong:
HQ ten ngiroi tham gia bao hiem: Le Quang Thang.
Thuoc don vi: CONG TYTNHHTHUONG~I
D1CHVUTAN HI$P PHAT
Dia Chi
: 219 Dai Binh Duong, P. V'inhPhu, Thl xli Thu(mAn, Tinh Binh Duong.
Di~n thoai : 0976425383
Tham gia loai hinh baa hiem: Bao hiem Sue Khoe Nhom va Tai Nan Nhom.
HQ'Pd6ng baa hiern sf>: 6407121IHD-CNI029-PHH
Thai han BH: Tir01104/2021tJin 3110312022.
Mire trach nhiern baa hiern: Chit thuong t(it toan b9 va b9 phdn vinn viln do tai nan:
to
293,321,009; Nlim vien do 6m dau, benh tdt/nam: 40,000,000; Phdu thudt do 6m dau benh
tat/niim: 40,000,000; Phdu thudt lien quan tJin cdy ghep n9i tang do 6m dau, benh tdt:
40,000,000; Di~u tri truoc khi nhdp vien/niim: 3,000,000; Di€u tri sau khi xuat vien: 3,000,000; Y
ta cham soc tai nha/nam: 2,000,000; tro cdp nlim vien/ngay: 60,000; Dich. v¥ xe cUu (huang
trong lanh th6 Vi?t Nam IO(,litrir bling tJucJnghang khong: 40,000,000; Tr(l cdp mai tang phi:
2,000,000; DKBS 01 - Di€u trj ngo(,litru do 6m tJau,b?nh t(itlnam: 6,300,000; s6 ti~nlldn kham:
2,000,000; s6 Ian khamlnam: 60; V(itIj trj li¢ulian: 105,000; s6 ian v(it ij Ir; li?ulnam: 60.
Ngay dong phi: 20/04/2021.
Ngay vaa vi~n: 0910312022.
.
B~nh vi~n diSu tri: BV NHAN DAN GIA D/NH
Nguyen nhan: VIEM PHE QuAN.
H~u qua: VIEM PHE QuAN.
A
l
,
Ho SO' gom co:
- GiAy yeu du tra ti~n baa hi6m;
- Chung ill ai~u tri da co quan y t~ cAp: HOA DON, TOA THUDC;
II.Danh ghi h& so' cua bBi thU'(mg yien:
- Can elI vao nguyen nhan nh~p vi~n, chUng tir y t~. K~t lu~n: THUOC PH~M VI BH
s6 ti€nyeu c6u: 498,995tJ
s6 ti€n b6i thucJng:440,695tJ
s6 ti€n til' cluji: 58,300tJchiphi
test Covid 19 khong thw5cph(,lmvi BH
- GiAy ta kham chua b~nh d~y au hQ'Pl~.
- Ngay yeu du tra ti~n baa hi~m thea thai h~ guy dinh.
III. Tinh toan bBi thU'(yog:
GiOi h~n BBi thU'Ong
Quy~n IQ'idU'Q'cchi tnt
Chi phi ngo~i tnl 6tr3/ mlm
(2tr/ l~ kham)
T5r1~
(TT,PT,
TCNV)
S6
Sa ti~n
ngay
di~u tri
bl.·
01
I
440,695
IV. Lich sU' tAn th~t:
BM/QT/CN/02.16
phat
sinh
D~ xuit bBi
thU'Ong
thU'Ong
TAng cQng
s6 v~: o.
s6 ti~n
s6 ti€n: 0 tJ6ng.
498,995
440,695
498,995
440,695
t~~"'MIC
I
Bao Hiem Quin D91
Ten toi la: Nguyin Pluun Thanh Tluio voi nr each la b6i thirong vi en cua MIC cam k~t
qa kiem
tra tinh chinh xac va hop 1~cac clnrng nr tren, 08 nghi lanh dao duyet s6 tien nhir sau:
Bang s6: 440,695 d6ng.
Bang chit: B6n tram b6n mum ngan sau tram chin rmroi lam d6ng.
S6 tien tren duoc chi tra cho ngiroi diroc bao hiern.
Ngay 23 thdng 03 nam 2022.
LANH D~O DON VI
PT. PHONG NGHI¥P
VV
BC)I TIiUONG VIEN
Nguy~n Pham Thanh Thao
BM/QT/CN/02.16
r:
~!;J
J)s G-
_/
THONG BAo TRA TIEN BAo HutM
(Sa H6
SO'
b6i tlucong: 13610122IBT-CNI029-GDBT)
Kinh giri Quy khach hang: Ngllyin Th] Diim Thtsy,
T6ng Cong ty C;6phdn, Baa hi1m Qudn .d(ji uti xem xet H6 sa b6i thutmg cua Quy khach. hang.
C~n dt' va~ Gidy yeu cdu Ira lien baa hiem, Gidy chung nhdn bao hi€m, H9'P d6ng baa hiem, Quy
tac bao hiem, Chung toi thong bao v~ viec giai quyet b6i thuong cua Quy khacn hang nhu sau:
Nguo'i dU'Q'cbao hi~m: Ngllyin Thj
Dia chi: 219 Dr;d
to Binh Duong,
tni« Tlzuy.
P. VTnh
rn« Thj xCiThu(ln An, Tinh Binh Duong.
Tham gia bao hi~m thee HBBH s6: 64071211HD-CNI029-PHH.
Can cu vao h6 sa b6i thuong s6 13610122IBT-CNI029-GDBT.
Dll duoc duyet : ngay 23 thang 03 nam 2022
TAng
s6 ti~n
bai thuo'ng: 11,969 d6ng.
(Bang chic: Muoi mot ngan chin tram sau muoi chin d6ng).
S6 tien yeu cAu: 216,369d
S6 ti~n tu ch6i: 204,400d do khach
hang khong b6 sung dlIQ'Cchung til
Tru'o'ng h9]) tra ti~n b~ng ti~n mat:
Trong thai h!,illbay (07) ngay k~ ttr khi nh~ duQ'c thong bao nay, ngum duQ'c bao hiSm (ho~c
NglIO'jthua k~ hqp phap) tn.l'Cti~p ho~c cu nguai d~n lInh ti~n t~i: IT DVKH PHiA NAM
Khi d~n nh~n ti€n, d€ nghi Quy khach mang thee: Gi~y chung minh nhan dan, trlIang hqp nha
nguaj khac nh~n h<)phai
Gi~y uy quy~n hqp phap.
co
TrU'o'ng h91> Chuy~n khoan:
Theo yeu cdU cua NglIai duQ'cbao hi~m; chung toi se chuy~n
s6 ti€n tren
vao:
+ Chu tai khoan: NGUYEN TH! DIEM THUY.
+ TK
s6: 6137040604240
19.
+ T~i: Ngan himg VIR BiNH DUONG.
+ NQi dung thanh tmin: Tra ti~n bao hi~m cho Nguyin Thi Diim Thuy, vao vi~n ngay
2410212022 t?i B~nh vi~n TTYT TP THUJ,N AN.
Chu J~:s6 ti~n b6i {huang {ren Sf duO'c thanh loan bang ti~n m(lt ho(lc chuyin khoim vao Tai
khoan theo yeu c6u Clla Ngu(}i (11l'1;Jc
bao hidm. Sau 15 ngay nh(in au9'c thong bao nay. ndu MIC
kh6ng nh(in aU'O'cpha12 h6i 19i tic NgU07 auO'c bao hidm thi coi nhu SI! ki?n bao hidm tren dCidu9'c
gicli quydt xong, khong con {hcicmejc khidu n9i gi.
Tran trQng kin11 chao .I,
Ngay 23 thang 03 nam 2022
Nai nhan:
- Nhu tf"en;
- Luu Phong TCKT.
-Luu Phong ....
BM1QT/CN/02.11
TONG CONG TV CO PHAN BAo IDEM QUAN B(n
,~
MIC
""'1
'
'
fIIII'....
,
Bao Hiem Quan DQI
TO'TRiNH B()I TIIUONG
(H6 so' sa: 13610/22IBT-CN/029-GDBT)
I. Tom t~t h6 SO' b6i thuong:
HQ ten ngiroi tham gia baa hiern: Nguyin Til! Diim Tltuy.
Thu¢c dan vi: CONG TY TNHH THUONG MAl DICH
TAN HIEP PHAT
Dja Chi
: 219 Dc;riZ(JSinh Duong, P. Vinh
Th/ xii Thudn An, Tinh Binh DUO'ng.
Dien thoai : 0907681900
.
Tham gia loai hinh baa hi~m: Bao hiem Suc Khoe Nhom va Tai Nan Nhom.
Hop d6ng baa hi~m s6: 6407121IHD-CNI029-PHH
.
Thai han BH: Til:01/04/2021 din 3110312022.
Mire trach nhiern baa hi~m: Chat (huang tgt toan b(J va b(J phdn .vinh viln do tai nan:
293,321,009; Nam vien do 6m dau, b?nh tdt/nam: 40,000,000; PhJu thudt do 6m dau benh
tdt/ruim: 40,000,000; Ph6u thug! lien quan din cay ghep n(Ji tang do .6m dau, benh ~gt:
40,000,000; Ditu tri trutrc khi nhdp vien/nam: 3,000,000,' DiJu tri sau khi xudt vien: 3,000,000; Y
ta cham soc tai nha/nam: 2,000,000; tro cdp nam vien/ngay: 60,000; Dich v¥ xe CUu thuang
trong lanh Ih6 Vi?t Nam loc;ritnf bang duang hcmg kh6ng: 40,000,000; Trc; cdp mai tang phi:
2,000,000; DKBS 01 - Di~u trj ngoc;ritru do 6m dau, b?nh tgtlnam: 6,300,000; s6 tiJnll6n kham:
2,000,000,' s6 Zdn khamlnam: 60,' Vt;'itIi' trj li?ulldn: 105,000; s6 idn vgt If tri li?ulnam: 60.
Ngay d6ng phi: 20/04/2021.
Ngay vaa vi~n: 2410212022.
Benh vien dieu tri: TTYT TP THUAN AN
N~uyen'nhan: N1UEEMC TRUNG DUONG HO HAp TREN cAp (J NHIEU NOI VA VI TRi
KHONG pRAN LO/lI, V1'£MXOANG MAN TiNH
H~u qua: NHIEEMC TRUNG DUONG HO HAp TREN cAp (J NHIEU NOI VA VI TRi KHONG
rs«
vu
PHAN LOAI, VIEM XOANG MAN TiNH
:l.
:l.
,
H o so' gom co:
- Gi§y yeu cAu tra tien baa hi~m;
_ Chll11gtu dieu tri do cO'quan y t~ dp: HOA DON, TOA THUDC;
II. Danb ghi b8 sO'cua b6i thU'ong vien:
_ Can clI VaGnguyen nhan nh~p vi~n, chUng ill y t~. K~t lu~: THUOC PH/lM VI BH
s6 tiJnyeu cdu: 216,369d
s6 tiJn b6i thuang: 11, 969d
s6 tiJn til:ch6i: 204,400d do kh6ch
himg kh6ng bc5sung du9'c chung tir
- Gi~y to' kham chua b~nh dAy du hQ'p1~.
_Ngay yeu c~u
tien baa hi~m thea thai h~n quy dinh.
III. Tinh toan b6i thU'{)'Dg:
tra
Gi6'i h~n B6i tbU'o-ng
Ie
hi trii
I
Chi phi nga~i tru 6tr 3/n~m-r(2trll~n kham)
I
Tang cQng
Ty
(TT,PT,
TCNV)
-
_[
sa
ngay
di~u tri
S6tiIn
b:l.·
01
sa ti~n phat
sinh
f):l.
e xua,(t b:l.·
01
thU'Ong
thU'on_g
11,969
216,369
11,969
216,369
11,969
IV. Lich su' tAn thAt:
s6 vu: o.
s6 tiJn: 0 d6ng.
Ten toi lii: Nguyln Ph{1m Thanh Thiio vai tu cach la b6i thuang vien eua MIC cam k~t da ki~m
tra tinh chinh xac va hQ'pl~ cac chung tir tren, de ngh~ lanh d~a duy~t s6 tien nhu sau:
BM/QT/CN/02.16
)~!."'MIC
I
Bao Hlem Quan D91
Bing s6: 11,969 d5ng.
Bang chir: Muoi mQt ngan chin tram sau rmroi chin d6ng.
S6 tien tren duoc chi tra cho nguoi duoc bao hiern.
LANI! D~O DON Vl
~
Pt. PHONGNGm~p Vl)
Ngay 23 thdng 03 nam 2022.
BOI TIlU'ONG VIEN
..
Nguy~n Pham Thanh Thao
BM/QT/CN/02.16
J)%-
t~!."MIC
I
,Bao
(~?9
Hiihn Quan 091
r;;_)
CJ
THONG BAo TRA TIEN BAO HIEM
(sJ H6 SO' b6itlllrimg:
J3636122IBT-CNI029-GDBT)
Kinh giri Quy khach hang: Trim Phuirc Minh.
Tong Cong ty C6 phdn Bao hiim Qudn tl9i tlii xem xet H6 SO' b6i (huang cua Quy khach hang.
Can cu VCLO Gidy yeu cdu tra li€n bao hi€m, Gidy chung nhdn bao hiem, H(Jp tl6ng bao hiem, Quy
tc'icbao hiem, Chung toi thong bao v~ vi?c giai quyit b6i thuang cua Quy khdch hang nhu sau:
Nguo'i dU'Q'c bao hj~m: Trim Phu'o'c Mi!lh.
Dia chi: 219 Dr;zi19Binh DU(Jng, P. Vinh Phu, Thi xii Thudn An, Tinh Binh DU(Jng.
Tham gia bao hiem thea HBBH s6: 6407/21/HD-CN/029-PHH.
Can cir van h6 sa b6i thirong s6 13636/22IBT-CNI029-GDBT.
Dff duoc duyet : ngay 23 thang 03 nam 2022
TAng
sB ti~n
b6i thuong: 919,705 d6ng.
(Bang chic: Chin tram muoi chin ngan bay tram Ie nam tl6ng).
S6 tien yeu d.u: 934,705d
S6 tien
ch6i: 15,000d phi hanh chinh khong thuQc ph~m vi BH
tu
Tru'o'ng I1(Yp tra ti~n b~ng ti~n mat:
Trang thai h~l1 bay (07) ngay k€ ttr khi nh?n duQ'c thong bao nay, nguai dUQ'cbao hi€m (ho~c
Nguai thira k~ hqp phap) tfllc ti~p ho~c cll' nguai d~n linh ti~n~: IT DVKH PHiA NAM
Khi dSn nh~n ti~n, d~ nghi Quy khach mang thea: Gifly chUng minh nhan dan, truang hQ'p nha
nguai khac nh?n hQ phai co Gi§.y uy quy~n hqp phap.
Truo'ng hQ]J Chuy~n khoan:
Theo yeu d.u cua Nguai duQ'c bao hi€m, chung toi se chuy~n s6 ti~n tren VilO:
+ Chii Hli khoan: TRAN PllUO'C MINH.
+ TK
sB:
613704060427515.
+ T~i: Ngan himg VIR.
+ NQi dung thanh toan: Tra ti~n bao hi€m cho Trdn Phuac Minh, van vi~n ngay 03/03/2022 t~i
B~nh vi~n BV COLUMBIA ASIA BiNH DUONG.
CIl", )J: s6 tidn b6i thuang tren sl! tlu(Jc thanh toan b&ng ti€n m(lt ho(lc chuydn khoan VaG Titi
khoim thea yeu c6u cLlaNguai ilu(Jc bao hi€m. Sau 15 ngay nh4n tlu(Jc thong bao nay, n€u MIC
khong nh(in tht'9'Cphiin h6i [(Ii tit' Ngw)'i tlu{Jc bao hidm Ihi coi nhu S1l ki?11bao hiim tren tla tlu(Jc
gidi quydt xong, kh6ng con thitc mac khidu nr;zigi.
Tran trQng kinh chao .I.
Ngay 23 thang 03 nam 2022
NO'inhan:
- Nhu tren;
- Luu Phong TCKT.
- Luu Phong ....
BMlQTICN/02.11
TONG CONG TV CO PHAN BAo mEM QUAN D(H
-
~
.
)~!."'MIC
I,
Bao Hiem Quan DQi
TO TRINH nOI THU(JNG
(Hi) so' s6: 13636/22/BT-CN/029-GDBT)
I. Torn t~t hB so' bBi thunng:
HQ ten ngtroi tham gia bao hi~m: Trim PhU'O'c Minh.
Thuoc dan vi: CONG TYTNHHTHU'ONG U1I D!CH vUTAN HIEp PHAT
Dia Chi
: 219 Dai Binh Duong, P. V'i'nhPhu, Th; xa Thudn An, Tinh Binh Duong.
Dien thoai : 0909298974
Tham gia loai hinh bao hiern: Bao hidm Sue Khoe Nhom va Tai Nan Nhom.
HQ'pd6ng bao hiem s6: 6407/21/HD-CN/029-PHH
Thm han BH: Tit 01/04/2021 din 31/03/2022.
Mire trach nhiem bao hiern: Chit thuong 1(it toan b(j va b(j phdn vinh vien do tai nan:
293,321,009; Niim vien do 6m dau, benh tat/nom: 40,000,000; Phdu thudt do 6m dau benh
tdt/ndm: 40,000,000; Phdu thudt lien quan din cdy ghep noi tang do 6m dau, b?nh tdt:
40,000, 000; f)i~u tri truce khi nhdp vien/nam: 3,000, 000; Di~u tri sau khi xudt vien: 3,000,000; Y
ta cham soc tai nha/nam: 2,000,000; tro cap niim vien/ngay: 60,000; Dicb v¥ xe cuu thuang
trong Ir;znhth6 Vi?l Nam lor;zitrit biing duirng hang khong: 40,000,000; Tr(l cap mat tang phi:
2,000,000; DKBS 01 - Di~u trj ngor;zitru do 6m dau, b?nh t4t/nam: 6,300,000; S6 ti€nlldn kham:
2,000,000,' S61an kham/nam: 60; V4t If tri Ii?ulldn: 105,000; s6 tdn v4t If trl li?ulnam: 60.
Ngay d6ng phi: 20/04/2021.
Ngay vao vi~n: 03/03/2022.
B~nh vi~n dieu trj: BV COLUMBIA ASIA BiNH DUONG.
Nguyen nhan: DUONG TiNH SARS COV 2.
H~u qua: DUONG TiNH SARS COV 2.
to
HB
sO' gAm co:
tra
- Gi~y yeu c~u
ti~n bao hi~m;
_ Ch{mg tu di~u tri do co quan y t~ cAp: HOA DON, TOA THU6c,
KQ XET NGHIEM, BANG
KE
CP;
II. Danh gh\ hB sO' cua bBi thu'(mg vien:
_ Can cu vao nguyen nhan nh~p vi~n, chUng ill y tS. K~t lu~: THUOC PH4M VI BH
s6 ti~n yeu
cdu: 934, 705d
S6 ti~n b6i thuirng: 919, 705d
.
s6 ti~n tit ch6i: 15,OOOdphi hanh chinh khong thu(jc phr;zmvi BH
- GifrY kham chua b~nh d~y du hQ'pl~.
- Ngay yeu du tra tien bao hi~m thee thm h~n quy dinh.
to
III. Tinh toan bBi thU'<rng:
____ ----------------~----------------------.----------.----------~
Gi6'i h~n BBi thU'<rn.y-g--,------1
D~ xu~t bAi
s6 ti~n phat
I Ty l~
s6
s6 ti~n
thu'<rng
sinh
(TT,PT,
ngay
bBi
-+-1.::::C:.:_NV~r)~d~i:.::~~u-=-tr:--;i_+_-:t~h:.::U':..:::<rn-::IJ:2---g_+_--------_+----------I~
Quy~n lQ'i dU'Q'cchi tnt
1--
.__ .
Chi phi ngo~i tn16tr3/ nam
919,705
(2trl l~n kham)
TAng. cQng
____
IV.Lich
s6 vu: o.
suo tfin
934,705
919,705
934,705
919,705
th~t:
.
s6 tiJn:
0 d6ng.
Ten toi la: Nguyin Ph{lnt Thanh Thao v6i tu cach la b6i thuang vien cua MIC cam k€t dil ki~m
tra tinh chinh xac va hQ'pl~ cac chung ill tren, de nghi lanh d~o duy~t s6 ti~n nhu sau:
B~g sf>:919,705 d6ng.
BM/QT/CN/02.16
J~!."'MIC
I,
,
Oao Hiem Quan DQi
Bang chit: Chin tram rmroi chin ngan bay tram Ie nam d6ng.
sf, ti~n tren duoc chi tra cho ngiroi duoc bao hiern,
LANH D~O DON vt
PT. PRONG NGIUf,P
vv
Ngay 23 thang 03 nam 2022.
BOI THl10NG VIEN
Nguy~n Pham Thanh Thao
BM/QT/CN/02.16
J) ~C-r ({)I
c: ')
(!JJ
THONG BAo TRA TlEN BAo HIEM
(SO Hfl so' b6i thuimg: 14562122IBT-CNI029-GDBT)
Kinh giri Quy khach hang: Trim
va Bao Nhi.
q6
Tong Cong ty
phdn, Baa hiem Qudn /19i ali, xem xet H6 SD' b6t thuong cua Quy khach hang.
Cfin cu vaq Gidy yeu cdu tra tien bao_hiem, Gidy c~un!f nhdn baa hiem, H9P a6ng baa hiim, Quy
tac bao hiem, Chung tai thong baa ve ·vi?c giat quyet boi thuong cua Quy khdch hang nhu sau:
NgU'OidU'Q'cbao hi~m: Trim
va Bao Nlti.
Dia chi: 219 Dr,zi19 Binh Duong, P. Vinh Phu, Tht xli tnoa« An, Tinh Binh Duong.
Tham gia bao hiem thea HDBH s6: 6407/21/HD-CN/029-PHH.
Can cu vao h6 sa b6i thuong s6 14562/22/BT-CN/029-GDBT.
D§ duoc duyet .ngay 28 thang 03 narn 2022
TAng
sa ti~n bBi thuong:
709,180 d6ng.
(Bang chii: Bay tram Ie chin ngan mot tram tam muoi a6ng).
S6 ti~n yeu cAu: 877,840d
S6 tien ill choi: 168,660d,
gorn: 15,000 phi harth chinh + 153,660d nuoc suc mi~ng povidone
(khong thuQc ph~m vi BH)
TrU'img hQ]) tra ti~n b~ng ti~n mat:
Trong thai h~ bay (07) ngay k~ tir khi nh~ dUQ'cthong bao nay, ngum duQ'c bao hi€m (ho~c
Nguai thira kS hQ'Pphap) nvc tiep ho~c cli nguai den linh ti~n tl;li: IT DVKH PHiA NAM
Khi den nh~ ti~n, d~ nghi Quy khach mang thea: Gi~y chUng minh nhan dan, tru<'mg hQ'P nha
nguai khac nh~ hQ phru c6 Gi~y uy quy~n hgp phap.
TrU'Ong h9'P Chuy~n khoan:
Theo yeu du cua Nguai duQ'cbao hi€m, chung toi se chuy~n s6 ti~n tren vao:
+ Chii tai khoan: TR.AN PHU(JC MINH.
+ TK
sa: 613704060427515.
+ T~i:
Ngan hang VIB.
+ NQi dung thanh toan: Tra ti~n bao hi€m cho Trdn Va Bao Nhi, vao vi~n ngay 02/03/2022 t~i
B~nh vi~n BV COLUMBIA ASIA BiNH DUONG.
Cltu y: S6 ti€n bai thuang tren se au9'C thanh toan bang ti€n m¢t hoij.c chuyin khocm VaG Tai
khacin thea yeu cdu ctia Ngu()'i aurIc bao hiim. Sau 15 ngay nh~n ilu(),c thang bao nay, niu MIC
khang n~q.n au()'cphim h6i l(1i.'!(Nf5!cai4u()'c baa hiim thi coi nhu S1,t ki?n bao hiim {ren aa au(!c
gidi quyet xong, khang con thac mac khieu nr,zigi.
Tnln tr9ng kinh chao .I.
Ngay 28 thcmg 03 nam 2022
Nai nhan:
- Nhu tren;
- Luu Phong TCKT.
- Luu Phong ....
BMlQT/CN/02.11
TONG CONG TY CO
~-
pRAN BAo
------=-
IDEM QUAN DQI
t~!:"MIC
I,
Bao Hiem Quin 091
TO TRINI-I DOl THVONG
(lIB so' sa:
14562/22IBT-CN/029-GOBT)
I.Tom t~t h8 so b8i thujmg:
HQ ten nguoi tham gia bao hiem: Tran va Biio Nhi.
Thuoc don vi: CONG TYTNHH THUONG NMI D!CH vUTAN HI£,P PHAT
Dia Chi
: 219 Dai If) Binh Duong, P. Vtnh Phu, Thi XQ Thudn An, Tinh Binh Duong.
Di~n thoai :
Tham gia loai hinh bao hiem: Bao hiem Sue Khoe Nhom vii Tai Nan Nhom.
Hop d6ng bao hiem s6: 6407121IHD-CNI029-PHH
.
Thai han BH: Tu 01/04/2021 din 3110312022.
Mire trach nhiern bao hiem: Chit thuong t4t toan bf) va bf) phdn vinh vien do tai nan:
293,321,009; Nlim vien do 6m dau, benh tdt/niim: 40,000,000; Phdu thudt do 6m dau benh
tdt/ndm: 40,000,000; Phdu thudt lien quan din cay ghep noi tang do 6m dau, b?nh tat:
40,000,000; Di€u tri truce khi nhdp vi?rilniim: 3,000,000; Di€u tri sau khi xuat vien: 3,000,000; Y
ta cham soc tai nha/nam: 2,000,000; tro cap nlim vien/ngay: 60,000; Dicn v~ xe cUu thuang
trong Ir;znhth6 Vi?t Nam lor;zitrit bling du&ng himg khong: 40,000,000; TrC)'cap mai tang phi:
2,000,000; DKBS 01 - Di€u tri ngo(,Zitru do 6m dau, b?nh t4tlniim: 6,300,000; s6 tiin/ian kham:
2,000,000; s6 Ian kham/niim: 60; V4t Iy trl li?ulian: 105,000; s6 Ian v4t Ii' trj li?ulniim: 60.
Ngay dong phi: 23/04/2021.
Ngay VaGvi~n: 0210312022.
B~nh vi~n di€u tri: BV COLUMBIA ASIA BiNH DUONG.
Nguyen nhan: NHIEM COVID 19.
H~u qua: NHIEM COVID 19.
l.
l.
Ho sO'gom co:
- GiAy yeu c~u tra ti€n bao hi€m;
_ Chung tir di€u tri do co quan y t~ cAp: HOA DON, TOA THU6c, KQ XET NGHI£,M;
II. Danh gia h8 sO'clla b8i thU'Ong vien:
_ Can ClI vao nguyen nhan nh~p vi~n, chUng til y t~. K~t lu~: THUOC PH4M VI BH
S6 ti€n yeu du: 877,840d
S6 ti€n b6i thu&ng: 709,180d
S6 ti€n tit ch6i: 168,660d, g6m:
15,000 phi hanh chinh + 153,660d nuClc suc mi?ng povidone
(khong thuf)c ph(,Zmvi BH)
- GiAy kMm chua b~nh d~y du hQ'p1~.
- N gay yeu du tra ti€n bao hi€m thea thai h~ quy dinh.
III. Tinh toan b8i thU'Ong:
ta
Quy~n IQ'idU'Q'cchi tra
Chi phi ngo~i tru 6tr3/ nam
(2tr/ lk kham)
Gioi h~n B8i thU'Ong
Sat~n
sa
Ty l~
bl.·
01
ngay
(TT,PT,
thU'Ong
TCNV) di~u tri
709,180
TAng cQng
s6 ti~n phat
sinh
I)l.e xua,(tbl.·
01
thU'Ong
877,840
709,180
877,840
709,180
IV. Lich sfr tAn th§t:
s6 vu: o.
s6 ti€n: d6ng.
.
Ten
la: Ngllyin PIl{lnl Thanh Thiio v6i tu each la b6i thuang vien cua MIC cam k~t da ki€m
tra tinh chlnh xac va hQ'pl~ cae chUng til tren, dS nghi lanh d~o duy~t s6 ti€n nhu sau:
B~ng s6: 709,180 d6ng.
toi
BM/QT/CN/02.16
°
t~!:-MIC
I,
Bao Hlem Quin 091
Bang chir: Bay tram le chin ngan mQt tram tam rmroi d6ng.
se ti~n tren duoc chi tra eho nguoi duoc bao hi~rn.
LANH D~O DON VI
BM/QT/CN/02.16
PT. PHONG NGH:Q:P VV
Ngay 28 (hang 03 nam 2022.
BOI TmJONG VIEN
)~~'_MIC
I
,880 Hiem Quin 091
A
,
?
~
'?
2
THONG BAO TR.A TIEN BAO HIEM
(s6 Hb so' b6i thuirng: 14566/22/BT-CN/029-GDRT)
Kinh giri Quy khach hang: Trim
va Bao
Trl.
T6ng Cong ty c6 phdn Bao hiem Qulin a6i ali xem xet H6 S(J b6i thuong cua Quy khach hang.
Gin cu VaGGidy yeu cdu tra tidn bao hiem, Gidy chung nhdn bao hiim, H(lJJa6ng bao hiem, Quy
tdc baa hiem, Chung toi thong bao vd vi?c giai quye: b6i thuong cua Quy khach hang nhu sau:
NgU'OidU'Q'c bao hi~m: Trait
va Bao
Tri.
Dia chi: 219 Dai 19 Binh DU(Jng, P. Vinn Phu, Thi xli Thudn An, Tinh Binh Duong,
Tham gia bao hiem thee HDBH s6: 6407121IHD-CNI029-PHH.
Can cu vao h6 sa b6i thirong s6 14566122IBT-CNI029-GDBT.
Dil duoc duyet .ngay 28 thang 03 nam 2022
Tang
sa ti~n bAi thuong:
952,162 d6ng:
(Bdng chii: Chin tram nam muoi hai ngan m6t tram sau mU(Jihai a6ng).
S6 ti8n yeu cfru: 967, 162d
S6 ti8n ttl ch6i:15,000d phi hanh chinh khong thuQc ph~
vi BH
TrU'img hQ]J tra ti~n b~ng ti~n mat:
Trong thai hl;ln bay (07) ngay k~ tir khi nh~ duQ'c thong bao nay, ngum duQ'c bao hi€m (ho?c
Nguai thua k~ hQ'Pphap) tn,rc ti~p ho?c cu nguai d~n linh ti8n tl;li:ITDVKH PHiA NAM
Khi d~n nh~ ti8n, d8 nghi Quy khach mang thee: Gi~y chUng minh nhan dan, truOng hQ'Pnha
nguai khac nh~ hQ phiti co Gi~y uy quy8n hQ'Pphap.
TrU'img hop Chuy~n khoan:
Theo yeu cAu cua Nguaj duQ'c bao hi€m, chung toi se chuy~n s6 tiSn tren vao:
+ Chii tai khoan: TR.4N PHU(JC MINH.
+ TK
sa: 613704060427515.
+ T~i: Ngan hang VIR.
+ NQi dung thanh toan: Tra tiSn bao hi~m cho Trdn
va Bao
Tri, vao vi~ri ngay 2610212022 tl;li
B~nh vi~n BV COLUMBIA ASIA BiNH DUONG.
Clllt j: S6 tidn b6i thucmg {ren se du9'c thanh toem bang tiJn mijt hoijc chuy€n khoan VaG Tai
khoan thea yeu cdu cua NgU'ai aU'9'cbao hiJm. Sau 15 ngay nh4n au9'c thong bao nay, niu MIC
khong nh4n aU'9'cphan h6i !(li til NgU'ai du9'c bao hiim Ihi coi nhu s~rki?n bao hiim tren ali au9'c
gicii quyJt xong, khong con thdc mdc khiiu nr;dgi.
Tnln trQng kinh chao ./.
Ngay 28 thang 03 nam 2022
NO'inhan:
- Nhu tren;
- Luu Phong TCKT
- Luu Phong ....
BMlQTICN/02.11
~,
T9NG CONG TY CO pIIAN
~
BAo IDEM QUAN
:_-::::,
DQI
t..!~"'MIC
'i
,
Bao Hlem Quin 091
TO TRiNH DOl THU'ONG
(H6 so sa: 14566/22IBT-CN/029-GDBT)
I. Tom t~t h6 so b6i thuong:
HQ ten ngiroi tham gia bao hiern: Tran Va Biio Trl.
Thuoc don vi: CONG TY TNHH THUaNG Ad4I D!CH
TAN HIep PHAT.
Dia Chi
: 219 Dai /6 Binh Duong, P. Vinh Phil, Tht xii Thu9n An, Tinh Binh Duong.
Dien thoai :
Tham gia loai hinh bao hiem: Bao hiim Sue Khoe Nhom va Tai Nan Nhom.
HQ'Pd6ng bao hiem s6: 6407121IHD-CNI029-PHH
Thai han BH: Tit 0110412021 din 3110312022.
Mire trach nhiern bao hiem: Chit thuong t9t toan b6 va b6 phdn . vinh vien do tai nan:
293,321,009; N6m vien do 6m dau, benh tat/nam: 40,000,000; PhJu thudt do 6m dau benh
tat/nam: 40, 000, 000; PhJu thudt lien quan din cciy ghep noi tang do dm dau, b?nh tdt:
40,000, 000,' DiJu tri truce khi nhdp vien/nam: 3, 000, 000; ou« tri sau khi xucil vien: 3, 000, 000; Y
ta cham soc tai nha/nam: 2, 000, 000; tro ccip n6m vien/ngay: 60, 000; Dich v~ xe cUu IhuO'ng
trong h;mh Ih6 Vi?t Nam /o(Ji trit b6ng duimg hang khong: 40, 000, 000; Trr; cdp mai tang phi:
2,000,000; DKBS 01 - DiJu trj ngo(Ji tril do 6m dau, b?nh t9tlnam: 6,300,000; s6 tiJnlldn kham:
2,000,000; S61dn khamlnam: 60; V91 Iy Ir! li?ulldn: 105, 000; S61dn v9t ly Irj li?ulnam: 60.
vu
Ngay d6ng phi: 2310412021.
Ngay vao vi~n: 2610212022.
B~nh vi~n di~u tri: BV COLUMBIA ASIA BiNH DUONG.
Nguyen nhan: NHIEMCOVID 19.
H~u qua: NHIEM COVID 19.
" co:
,
Ho" sO' gom
- GiAy yeu c~u tra ti~n bao hi€m;
_ ChUng ill di~u tri do co quan y t~ dp: HOA DON, TOA THU6c, KQ XET NGHIeM;
II.Danh gia h6 SO' cua b6i thU'b'ng vien:
_ Can cu va.o nguyen nhan nh~p Vi~li,chung til y t~. Ket l~n: THUOC PlUM
s6 tiJn yeu cdu: 967, 162d
s6 tiJn b6i thuong: 952, 162d
s6 tiJn tit ch6i: 15,OOOd phi hanh
VI Bli
chfnh kh6ng thu6c ph(Jm vi BH
to
- Gi~y kham chua b~nh d~y dti hQ'Pl~.
- Ngay yeu c~u tra ti~n bao hi€m thea thai hc;tnquy dinh.
III. Tinh toan b6i thU'(rng:
GiOi h~n B6i thu'(rng
Quy~n lQ'idmlC chi tra
Chi phi ngo~i trU 6tr3/ nam
(2tr/ lk kham)
Ty I~
(TT,PT,
TCNV)
sa
sa ti~n
sA ti~n phat
ngay
di~u tri
b'"01
thU'(mg
sinh
952,162
TBng cqng
IV. Lich sir tBn th§t:
s6 v~: o.
BM/QT/CN/02.16
s6 tiJn: a d6ng.
D~ xu§t b6i
thU'(rng
967,162
952,162
967,162
952,162
)~~"MIC
,I
Bao Hlfm Quin 091
Ten toi la: Nguyin Pham Thanh Tluio voi ttl each Ia b5i thirong vien cua MIC cam k€t d§ ki8m
tra tinh chinh xac va hop l~ cac chirng tiJ tren, d~ nghi lanh dao dlJ.y~ts5 ti€n nhir sau:
Bang s5: 952,162 d6ng.
Bang chtr: Chin tram nam rmroi hai ngan mot tram sau rmroi hai d6ng.
85 ti€n tren duoc chi tra cho ngiroi diroc-bao hiem.
Ngay 28 thang 03 nam 2022.
LAND D~O DON
VI
PT. PRONG NGm~p
VV
BOI THtJONG vrEN
Nguy~nPh~m Thanh Thao
BM/QT/CN/02.16
J) S& (6),\
)~~"'MIC'
I
)
.~
8ao Hiem Qulin 091
THONGBAo TRATIEN BAo HIEML~ ,
(Sa IIa
SO'
baitltU'ung: 14567122/BT-CNI029-GDRT)
Kinh giri Quy khach hang: Va Tit! Kim Loan.
T6ng Cong ty C6 phdn Baa hiim Quem a9i ali xem xet H6 S(J b6i thuang cua Quy khdch hang.
Can etc vao Gidy yeu cdu tra ti€n bao hiim, Giciy chung nhdn bao hiim, H(JJJa6ng bao hiim, Quy
tac bao hiem, Chung toi thong bao v€ viic giai quyet b6i thuong cua Quy khacb hang nhu sau:
NgU'b'i dU'Q'c bao hi~m: Va Tit! Kim Loan.
Dia chi: 219 D(,li 19Binh DU(Jng, P. Vinh'
n« Thj xii Thu(in An, Tinh Binh Duong.
Tham gia bao hiem theo HDBH s5: 6407121IHD-CNI029-PHH.
Can ClI vao h6 sa b6i thirong s6 14567122IBT-CNI029-GDBT.
Dil duoc duyet .ngay 28 thang 03 nam 2022
TAng
sa ti~n bAi thuimg: 666,553 d6ng.
(Brmg chit: Sau tram sau muoi sau ngan nam tram ndm muai ba a6ng).
S6 tiSn yeu cau: 681,553d
S5 tiSn til ch6i: IS,OOOdphi hanh chinh khong thuQc phl;lIl1vi BH
TrU'ong hQ'P tra ti~n b~ng ti~n ma,t:
Trong thm h~ bay (07) ngay k~ til khi nh~ duQ'c thong bao nay, ngum duQ'c bao hi~m (ho~c
Nguoi thila k~ hgp phap) trvc ti~p ho~c ell nguoi d~n linh tiSn t~i: IT DVKH PHiA NAM
Khi d~n nh~ tiSn, d€ nghi Quy khach mang thee: Gicly chUng minh nhan dan, truOng hgp nho
nguoi khac nh~ h(>phcii co Gi~y uy quySn hgp phap.
TrU'Ong hoopChuySn khmln:
Theo yeu c~u cua Nguoi dUQ'cbao hi~m, chung toi se chuy~n s6 ti€n tren vao:
+ Chii tai khoan:
+ TK
TMN PHU(JC MINH.
sa: 613704060427515.
+ T~i: Ngan hang VIR.
+ NQi dung thanh toan: Tra tiSn bao hi~m cho Va Tht Kim Loan, vao vi~n ngay 0410312022 t~i
B~nh vi~n BV COLUMBIA ASIA BiNH DUONG.
CluJ y: S6 ti€n b6i thuang !ren se aur;c thanh toan bang ti€n mi;it hoi;ic chuyin khoan vito Tid
khoan theo yeu cdu cua Ngum tJur;c bao hdm. Sau 15 ngay nh(in aur;c thong bao nay, niu MIC
khong nh(in aur;c phan h6i l(li tir NguiYi aur;c bao hdm thi coi nhu s~t'ki?n bao hidm tren ali aur;c
giai quyit xong, khong can thac mac khiiu n(,ligi.
Tran trQng kinh chao .I.
Ngay 28 thang 03 nam 2022
Nai nhM:
- Nhu tren;
- Luu Phang TCKT
- Luu Phang ....
BMlQT/CN/02.11
TONG CONG TV
CO PHAN BAo HIEM QuAN I>()I
t~!.",MIC
,I
Bao Hlem Qulin 091
TO' TRiNH BOI THUONG
(lIB
SO'
s8: 14S67/22/BT-CN/029-GDBT)
I. Tom tit h3 SO' b3i thuong:
HQ ten ngiroi tham gia bao hiem:
Th] Kim Loan.
ThuQc don vi: CONG TY TNHH TWaNG MAl D!CH Vl) TAN
PHAr .
Dia Chl
: 219 Dr;zi19Binh Duong, P. Vinh Phu, Thi xCiThugn An, Tinh Blnh Duong.
va
ntt»
Dien thoai : 098760129
Thrun gia loai hinh bao hiem: Baa hiem Sue Khoe Nhom va Tai Nan Nhom.
HQ'Pd6ng bao hiern sf>:64071211HD-CNI029-PHH
ThO; han BH: Tu 01104/2021ain 3110312022.
Mire trach nhiern bao hiem: Chit thuong tgt toan b9 va b9 phdn vinh viin do tai nan:
293,321,009; Nam vien do 6m dau, b?nh tdt/ruim: 40,000,000; Phdu thudt do 6m dau benh
tdt/ndm: 40,000,000; Phdu thudt lien quan ain cJy ghep n9i tang do 6m dau, b?nh tat:
40,000,000; ou« tri truce khi nhdp vien/nam: 3,000,000; DiJu tri sau khi xuJt vien: 3,000,000; Y
ta cham soc tai nha/nam: 2,000,000; tro cdp nam vien/ngay: 60,000; Dich v~ xe cUu thuang
trong ll;mhth6 Vi?t Nam lor;zitru bdng'aucJng hang khong: 40,000,000; Tr(Jcdp mai tang phi:
2,000,000; DKBS 01 - DiJu trf ngor;zitru do 6m aau, b?nh tgtlniim: 6,300,000; s6 tiJnlZdnkham:
2,000,000; S6Zdn khamlniim: 60; Vgt Zytrf li?uIldn: 105,000; S61dn vgt Iy trj li?u/niim: 60.
Ngay dong phi: 23/04/2021.
Ngay vao vi~n: 0410312022
B~nh vi~n diSu tri: BV COLUMBIA ASIA BiNH DUONG.
Nguyen nhan: NHIEM COVID 19.
H~u qua: NHIEMCOVID 19.
).
).
,
Ho SO' gom co:
- Gi~y yeu c~u tn1tiSn bao hiSm;
- Chung tlr diSu tri do cO'quan y t~ dp: HOA DON, TOA THU6c, KQ xET NGHltM;
II.Danh ghl hA SO' ciia b3i thU'Ong vien:
_ Can cu VIlO nguyen nhan nh~p vi~n, chUng tlr y t~. K~t lu~n: THUOC PH~M VI BH
s6 tiJnyeu cdu: 681,553a
s6 tiJn b6i thucmg: 666,553a
s6 tiJn tit ch6i: 15,OOOaphi hanh chinh khong thu9c phr;zmvi BH
- Gi~y to' kham chua b~nh d~y du hQ'Pl~.
- Ngay yeu cftu tra ti€n bao hiSm thea thai h?U quy dinh.
III. Tinh toan b3i thU'O'ng:
.Gi6'i h~n B3i thU'O'ng
Quy~n IQ'idu'q'c chi tra
Chi phi ngo?i tru 6tr3/ nam
(2tr/ l~ kham)
f--
Ty I~
sa
sa ti~n
(TT,PT,
TCNV)
ngay
b).·
01
di~u tri
thU'O'ng
666,553
Tang cQllg
IV. Lich sir tAn th~t:
86 v~: 1.
BM/QT/CN/02,16
s6 tiJn:
°
a6ng.
s,(·).
o hen
p h'ta
sinh
»).e xua,(tb).·01
thU'Ong
681,553
666,553
681,553
666,553
'~~MIC
~ .,
-','
I
,
Bio Hiem Quin 09i
Ten toi la; Nguytn Pham Tltanlt Thiio voi tu each la b6i thuong vien cua MIC cam k~t dff kiem
tra tinh chinh xac va hop l~ cac chirng ttl tren, d~ nghi lanh dao duyet s5 tien nhu sau:
B~ng s6: 666,553 d6ng.
Bang chfr: Sau tram sau rmroi sau ngan nam tram nam rmroi ba d6ng.
S6 ti~n tren duoc chi tra cho ngiroi diroc bao hiem.
Ngay 28 thang 03 nam 2022.
LAND D~O DON VI
PT. PHONG NGHIE:P VV
BOI THlfONG VIEN
Nguy~n Ph~m Thanh Tbao
BM/QT/CN/02.16
~) >G (0")0)
,~ MIC
I. ,...
"~I •
~
' Hlem Quin 091
Bao
A
•
••
•
a
THONG BAO TR.A TIEN BAO HIEM
(!}
(Sa H8 sa b8i thuimg: 14551122IBT-CNI029-GDBT)
Kinh giri Quy khach hang: Le Th] Thanh.
Tong Cong ty C6 phdn Bao hiim Qudn d9i dil xem xi! H6 S(J b6i thuong cua Quy khach hang.
C,cmcil' va~ Gidy yeu cdu tra ti€n ba~ hiim, Gidy c~Un~ nhdn bao hiim, Hop d6ng bao hiim, Quy
tac bao hiem, Chung toi thong bao ve viec giai quyet boi thuong cua Quy khdch. hang nhu sau:
NguOi dUQ'c bao hi~m:
u Tlti
Tlta~1h.
Dja chi: 219 Dai 19 Binh Duong, P. Vinh Phu, Thi xii Thudn An, Tinh Binh Duong.
Tham gia bao hiem thee HDBH s6: 6407121IHD-CNI029-PHH.
Can cir vao h6 sa b6i thirong s6 14551122IBT-CNI029-GDBT.
Da duoc duyet .ngay 28 thang 03 nam 2022
TAng
s8 ti~n bAi thU'Ong: 1,134,940
d6ng.
(Bttng chu: M9t tri¢u m9t tram ba mU(Jib6n ngan chin tram b6n mU(Jid6ng).
S6 tiSn yeu du: 1,394,940d
S6 tiSn ill ch6i: 260,000d, g6m: 100,000d tiSn khAm kho Q' va m~t m6i - r6i loc;mdc;mgC(J thS +
160,000d ch\lp X quang - do di~n tim (lo:;li tril thee mvc 2.3.8 cua hQ'Pd6ng BH va quy tlic BH,
kiSm tra cho k~t qua binh thuemg, khong thu9C ph:;lffivi BH)
Tru'ong hop tra ti~n b~ng ti~n mat:
Trong thai hc;mbay (07) ngay kS til khi nh~n duqc thong bao nay, nguai duqc bao hi~m (ho~c
Nguai thira k~ hqp phap) trvc ti~p ho~c cu ngum d~n linh tiSn t:;li: IT DVKH PHiA NAM
Khi d~n nh~n tiSn, dS nghj Quy khach mang thee: Gi§.y chUng minh nhan dan, truemg hQ'Pnha
ngum khac nh~n hQ phai co Gi§.y uy quySn hqp phap.
TruOng hop Chuy~n khoan:
Theo yeu du cua Nguai duqc bao hiSm, chUng toi se chuySn s6 tiSn tren vao:
+ Chti tai khoan: LE THI THANH.
+ TK s8: 613704060429059.
+ T~i: Ngan hang VIR niNH DcfaNG.
+ NQi dung thanh tmin: Tra tiSn bao hiSm cho Le Thi Thanh, vao vi~n ngay 0210312022 t:;liB~nh
vi~n BV NHAN DAN 115.
b6i thuang 'ren se du(),c thanh toim bttng ti€n m(lf ho{lc chuyin khaan VaG Tal
khoan thea yeu cdu cila Nguai dur;rcbao hiim. Sau 15 ngity nh(in ilu(),c thong bao nay, niu MIC
khong nh(in du(),cphan h6i lC;Zi
fit Nguai du(),c bao hiim thi col nhu s~rki?n baa hiim tren illi QUr;rC
giai quydt xang, kh6ng can fhftc mac khi6u nc;zigi.
CluJ y:
s6 ti€n
Tran tr9ng kinh chao ./.
Ngay 28 thang 03 nam 2022
Nai nhan:
- Nhu (ren;
- Luu Phang TCKT.
- Luu Phang ....
BMJQT/CN/02.11
TONG CONG TY CO pHAN BAo HIEM QUANDOl
cr--_ :!:2
-
,
~~!."'MIC
"'-
Bao Hlem Quin 091
TO TRINH BOI THU'(JNG
(lIB so' sA: 14SS1I22/BT-CN/029-GDBT)
I. Tom tit b8 so b8i thirong:
HQ ten ngiroi tharn gia bao hiem: Le Thi Thanh.
ThuQc don vi: CONG TYTNHHTHTiONG NMI D!CH vUTAN HIEp PHAT.
Dia Chi
: 219 Dai 16 Binh Duong, P. Vinh Phil, Thi xii Thudn An, Tinh Binh Duong.
Dien thoai : 0907660561
Tharn gia loai hinh bao hiem: Baa hiim Suc Khoe Nhom va Tai Nan Nhom.
HQ'Pd6ng bao hiern s6: 6407/21/HD-CN/029-PHH
Thai han BH: Ttl 01104/2021 din 31103/2022.
Mire trach nhiern bao hiern: Chit thuang tat toan b6 va b6 phdn vinh vien do tai nan:
293,321,009; N6m vien do 6m dau, b?nh tat/nom: 40,000,000; Phdu thudt do 6m dau benh
tdt/niim: 40,000,000; Phdu thudt lien quan din cay ghep n6i tang do 6m dau, benh t~l:
40,000,000; DiJu tri truoc khi nhdp vien/nam: 3,000,000; DiJu tri sau khi xudt vien: 3,000,000; Y
ta cham soc tai nha/nam: 2,000,000; tra cap n6m vten/ngay: 60,000; Dicn v¥ xe CUu thuong
trong lanh th6 Viet Nam loai tric bang duong hang khong: 40,000,000; Tr(1 cap mai tang phi:
2,000,000; DKBS 01 - DiJu tri ngor;zitril do 6m dau, b¢nh t~t/nam: 6,300,000; s6 tiJnlZdn kham:
2,000,000; s6 Idn khdm/nam: 60; V~t Iy tri li?ulldn: 105,000; s6 Idn v~t Iy tri li?ulnam: 60.
Ngay dong phi: 23/04/2021.
Ngay vao vi~n: 02/03/2022.
B~nh vi~n di~u tri: BV NHAN DAN 115.
Nguyen nban: VLEM D~ DAY TATRANG, KHO 0 VA MeT MDI, ROI LO~N D~NG
THE.
H?u qua: VTEM D~ DAY TA TRANG, KHO 0 VA MeT MOL RaI LO~N D~NG
THE.
A
A
,
Ho sO'gom co:
- Gigy yeu cAu tra ti~n bao hi~m;
- Chung ill di~u tri do co quan y t~ d.p: HOA DON, TOA THuaC, KQ NOI SOl - DIeN TIM - X
QUANG;
II. Ihinb gia b8 sO'cua b8i tbU'Ong vien:
- Clin Cll vao nguyen nhan nh?P vi~n, chUng til y t~. K~t lU?n: THUOC PH~M VI BH
s6 tiJnyeu cdu: 1,394,940d
s6 tiJn b6i thuang: 1,134,940d
s6 tiJn tit ch6i: 260,000d, g6m: 100, OOOdtiJn khdm kho (1 va m?l moi - r6i lor;zndr;mg C(J thi +
160,OOOdch¥P X quang - do di?n tim (lor;zitru theo m¥c 2.3.8 cua h(J]Jd6ng BH va quy tac BN,
kiim tra cho kit qua binh thuang, kh6ng' thu6c phr;zmvi BH)
- Gigy kham chua b~nh d~y dli hQ'Pl~.
- N gay yeu c~u tra ti~n bao hi~m theo thai hl;lllquy dinh.
III. Tinb toan b8i tbu'ong:
co
co
ta
Quy~n lQ'idU'Q'cchi tra
Chi phi ngol;li tm 6tr3/ nam
(2tr/ lk kham)
GiOi b~n B8i thU'Ong
sa-tfrnsa
Ty I~
bA•
01
(IT,PT,
ngay
thU'Ong
TCNV) di~u tri
s'<Olen
fA
p h'at
sinh
1,134,940
TAng cQng
1,394,940
1,134,940
1,394,940
1,134,940
IV. Lich su' tAn thit:
s6 v¥:
4.
BM/QT/CN/02.16
s6 ti€n: 2,584,903
xuit b8i
thU'Ong
f)~
d6ng.
t~!:-MIC
,I
Bao Hlem Quin 091
Ten toi I,\: Nguyin Pham Thanh 11,(;0 voi ttl' each la b6i thirong vien ella MIC cam k€t da kiem
tra tinh chinh xac va hop I~ cac clurng tiT. tren, d~ nghi lanh dao duyet s6 tien nlur sau:
Bang s6: 1,134,940 d6ng.
Bang chtr: MQt trieu mot tram ba rmroi b6n ngan chin tram b6n rmroi d6ng.
S6 ti~n tren duoc chi tra cho ngiroi duoc bao hiem.
Ngay 28 thdng 03 nam 2022.
BOI TIWONG VIEN
PT. PHONG NGmtP vu
Nguy~n Pham Thanh Thao
BMjQTjCNj02.16
".J'!.
... MIC
""1
<
830 Hiem
Quan f)Qi
THONG BAo TRA TI1~NBAo HI EM
(Sa H6
SO'
b6i thuong: J36J3/22IBT-CN/029-GDRT)
Kinh giri Quy khach hang: Truong Th]
cam Huang,
T6ng Cong ty C6 phdn Bao hdm Quan tJ6i tJa xem xet H6 SO' b6i thuang cua Quy khdch hang.
Can de VelO Gidy yeu cdu tra Ii€n baa hidm, Gidy chung nhdn bao hiem, H(7p tJ6ng bao hiem, Quy
tilc bao hiem, Chung t6i thong bao v€ viec giat quydt b6i thuang cua Quy khach hang nhu sau:
F
Ngutri oU'C?,c bao hi~m: Truong Th]
cam Huang.
Dia chi: 219 D(1i 19 Binh Duong, P. Vinh Phu, Thi xii Thudn An, Tinh Binh Duong.
Tham gia bao hiern thea HDBH s6: 640712JIHD-CNI029-PHH.
Can err VaGh6 so b6i thirong s6 J36J3122IBT-CNI029-GDBT.
Dll diroc duyet .ngay 23 thing 03 nam 2022
Tang
sa ti~n bc3ithuirng:
2,000,000 dong,
(Bc7ngchit: Hat trieu d6ng).
S6 tien yeu du:
S6 tien ill choi:
2,876,563d
876,563d do virot hc,mmile chi phi ngo~i tru 2,OOO,000/1~n kham
Tru'O'ng ho'p tra ti~n b~ng ti~n mat:
Trong thai hc,mbay (07) ngay k~ tll' khi nh~ duQ'c thong bao nay, nguoi dugc bao hi~m (ho~c
Nguoj thua k~ hgp phap) trvc ti~p ho~c cli nguai d~n linh ti~n t~i: IT l)VKH PHiA NAM
Khi d~n nh~ ti~n, d~ nghi Quy khach mang thea: Gi§y chung minh nhan dan, truOng hgp nha
nguo·j khac nh?n h9 phai co Gi§y uy quy€n hQ'pphap.
Trtl'O'ng hoopChuySn khoan:
Theo yeu du cua Nguai dUQ'cbao hi~m, chung toi
se chuy~n s6 ti~n tren VaG:
+ Cbii Uti khoan: TRUONG TH! CAM HUONG.
+ TK
+ T~i:
sa: 613704060422460.
Ngan hang VIR BiNH DUONG.
+ NQi dung thanh toan: Tra ti€n bao hi~m cho Truong Thi Cdm Huang, VaGvi~n ngay
0210312022 t~i B~nh vi~n BV DA KHOA TAM ANH TPHCM.
b6i thuong tren se dU(7c thanh toim b{mg ti€n m(ll hot;ic chuydn khoim VelO Tid
khoim thea yeu c6u c~ia Nguo'i ,1zwc bao hidm. Sau 15 ngiry nh(m GU(7Cth6ng bao nay, n€u lvllC
kh6ng nh¢il1C1LWCph6n h6i lc;zi tIl: Nguo'i tJU()'cb60 hidm thi coi nhu Sl! ki~n bao hi€m tren tJ{JGU(7C
gi6i quydt xong, kh6ng can Ihcic mc1ckhidu n9i gi.
Clul JJ:
s6 tidn
Tran tr9ng kinh chao .I.
Ngay 23 {hang 03 nam 2022
Nai nhan:
- Nhu tren;
- Luu Phong TCKT.
- Luu Phong ....
BMlQT/CN/02.11
TONG CONG TY CO PHAN BAO HIEM QUAN DOl
-
d:~
~~~'_MIC
••
Bao Hlem Quan D91
TO' TRINH BOI THlfQ'NG
(lI8 so' s6: 13613/22IBT-CN/029-GDBT)
I.Tom t~t h3 so b3i thuirng:
HQ ten nguoi tham gia bao hiern: Truong Th]
cam HU'O'I'lg.
ThuQc don vi: CONG TY TNHH THUONG M-1.IDrCH VU TAN Hiep PHA T.
Dia Chi
: 219 Dt;li19 Binh Duong, P. Vinh Phu, Tht xii Thudn An, Tinh Binh Duong.
Dien thoai : 0775678752
Tham gia loai hinh bao hiem: Bao hidm Sue Khoe Nh6m va Tai Nan Nhom.
Hop d6ng bao hi€m s6: 6407121IHD-CNI029-PHH
Thai hanBH: Tit 01104/2021 din 3110312022.
Mire trach nhiem bao hi~m: Chit thuong t9t toan b9 va b9 phdn vinh vien do tai nan:
293,321,009; Nam vien do 6m dau, b~nh tdt/nam: 40,000,000; Ph&u thudt do 6m dau benh
tdt/ndm: 40,000,000,' PhJu thudt lien quan din cay ghep n9i tang do 6m dau, b?l1h tat:
40,000,000,' ou« tri truce khi nhdp vien/nam: 3,000,000; Di€u tri sau khi xudt vien: 3,000,000; Y
fa cham soc tai nha/nam: 2,000,000; tra cap niim vien/ngay: 60,000; Dich v"'" xe cUu thuang
trong It;lnhth6 Vi?! Nam lot;li (rit biing duimg hang kh6ng: 40,000,000;· Tr(y cdp mat tang phi:
2,000,000,' DKBS 01 - Di€u trj ngot;li Iru do Om dau, b?nh 19t1nam: 6,300,000; s6 ti~nlltin kham:
2,000,000,' S6ltin khamlnam: 60; V9t Zf tr! li?ulltin: 105,000; s6 ldn v(it Zf trt li~ulnam: 60.
Ngay d6ng phi: 20/04/2021.
Ngay vao vi~n: 0210312022.
B~nhvi~n di~u tri: BV DA KHOA TAM ANH TPHCM
Nguyen nhan: TRAG NGUOC DJ DAY THljC QuAN, VLEM THljC QuAN, VTEM SUNG
HUY]};TTHAN HANG VJ, HP+.
H~ll qua: TRAO NGUOC D-1.DAY THljC QuAN, VIEAI THljC QuAN, VIEM SUNG HUytT
THAN HANG VI, HP+.
A
A
,
H050' gom co:
- Gi§y yell c~u tra ti~n bao hi~m;
- Ch(mg tu di~u tri do C(J quan y t€ cAp: HOA DON, TOA THUDC, KQ NOI SOl - DltN TIM,
PHIEU THU - IT NGO-1.! TRU,'
II.Danh ghi h3 SO' cua b6i thU'ong vien:
- Can cu vao nguyen nhan nh~p vi~n, chUng tir y t€. K€t lu~n: THUOC PH-1.M VI BH
SO tidn yeu ctiu: 2,876,563d
s6 ti~n b6i lhuong: 2,000, OOOd
s6 ti€n tit ch6i: 876, 563d do vu(Yt hr;inmuc chi phi ngor;zitru 2,000,0001 Ztinkham
- Gi~y kham chua b~nh d~y du hqp l~.
- Ngay yeu du tra ti~n bao hi€m thee thai h~ quy dinh.
III. Tinh toan b6i thU'ong:
ta
Gio'i h~n B6i thU'Ong
Quy~n lQi dU'(}'cchi tra
Ty I~
(IT,PT,.
TCNV)
Chi phi ngo?i tru 6tr3/ l1am
(2trl l~ kham)
I
T6ng cQng
i
-
'-._---
-
So
S6
ngay
di~u tri
ti~n
b],'
01
BM/QT/CN/02.16
sinh
D~ xufit b6i
thU'Ong
thU'On~
2,000,000
2,876,563
2,000,000
2,876,563
2,000,000
----t--
IV. Lich suot5n th§t:
SO v""': O.
sa ti~n phat
s6 ti~n: 0 d6ng.
t~!."MIC
I'
Bao Hlem Quan D9i
Ten toi la: Nguyin Pham Thanh Thiio voi tu each la bai thuong vien cua MIC cam k~t da kiem
de
tra tlnh chinh xac va hQ1Jl~ cac chirng tlT tren,
nghi lanh dao duyet 86 ti~n nhir sau:
Bfu1g 86: 2,000,000 dang.
Bang chtr: Hai trieu dang.
S6 ti€n tren duoc chi tra cho ngiroi diroc bao hiem.
Ngay 23 thdng 03 nam 2022.
LANI-If)~O DON VJ
PT. PHONG NGIIJ.:¢P VV
BOI TmfONG VIEN
Nguy~n Pham Thanh Thao
BM/QT/CN/02.16
j ([;,
(fJ? --:.)
J~!."MIC
I "'
(iv
Bao Hiem Quan OQi
THONG BAo TRA TIEN BAo HIEM
(S61I6 so' b6i thuirng: J3624122IBT-CNI029-Gl)BT)
Kinh giri Quy khach hang: Pham Tit! Nguyit.
Tdng Cong ty cd phdn Baa hdm Qudn a6i ao. xem xet H6 so b6i (huang cua Quy khdch hang.
Can cu' vao Gidy yeu cdu tra tidn baa hiem, Gidy chung nhdn baa hiem, Hop a6ng baa hiem, Quy
ttic baa hiem, Chung toi thong bao v~ viec giai quyet b6i thuang cua Quy khach hang nhu sau:
NgU'(ri dU'Q'cbao hi~m: Pltqm Tit! lVguYit.
Dia chi: 219 Dai l6 Binh DUO'ng,P. Vinh Phu, Thi xo. Thudn An, Tinh Binh DUO'ng.
Tham gia bao hiem thea HDBH s6: 6407121IHD-CNI029-PHH.
Can cir VaGh6 sa b6i thuong s6 13624122IBT-CNI029-GDBT.
Da diroc duyet : ngay 23 thang 03 nam 2022
TAng
s6 ti~n
b6i thuo'ng: 700,000 d6ng:
(BAng chic: Bay tram ngan a6ng).
Tru'ong hop
tra ti~n b~ng
ti~n mat:
Trong thai han bay (07) ngay k~ ill khi nh~ duQ'c thong bao nay, nguai duQ'c bao hi~m (ho~c
Nguai thll'a k~ hQ'pphap) tn,rc ti~p ho~c Cll'nguai d€n lInh ti~n tiili:IT DVKH PHiA NAM
Khi d~n nh~ ti~n, d~ nghi Quy khach mang thea: Gigy chUng minh nhan dan, truang hQ'P nha
nguai khac nh~ h9 phai co Gilly uy quy~n hQ'pphap.
TrU'o'ng hoopChuy~n khm\n:
Theo yeu du eua Nguaj dUQ'cbao hi~m, chUng toi se chuy~n s6 ti~n tren VaG:
+ Chii tiii khoan: TRCfONG NHCfTUAN.
+ TK s6: 000052464.
+ T~i: Ngan himg VIB BiNH DCfO'NG.
+ NQi dung thanh toan: Tra ti~n bao hi~m eho Ph(lm Thj Nguy?t, VaGvi~n ngay 20/0212022 tiili
B~nh vi~n NHA KHOA KIM.
Chi/. y: 86 tidn b6i {huang {ren se au9'c thanh toan bang tidn m(.tt ho(.tc chuyin khoan VaG Tai
khoim thea yeu c6u cLla Nguifi dzwc bao hiim. 8au. 15 ngay nh{in au(Yc thong bao nay, niu MIC
khong nh{i1'lthc9'C phon h6i l<lilit· Nguo'i du()'c bdo hiim thi coi nhu S'I! ki?n bao hidm !ren aa du9'c
gidi quyit xong, khong con rh6c m6c khiiu n(li gi.
Tri'm tr9ng kinh chao .I.
Ngay 23 thang 03 nam 2022
NO'inhan:
- Nhu tren,'
- Luu Phong TCKr
- Luu Phong ....
BMlQT/CN/02.11
TONG CONG TY CO PHAN BAo HIEM QUAN DQI
-
S-
)~!."MIC
, I
BaoHlem Quin D9i
TO TRINH BOI TIIUONG
(H6 SO' s6: 13624/22IBT
-CN/029-GDBT)
I. Tom t~t h8 so bAi thuong:
HQ ten nguoi tham gia bao hi6m: Pluun Th] Nguyft.
ThuQc dun vi: CONG TY TNHH THUONG U1.1 D!CH
TAN Hlep PHAT.
Dia Chi
: 219 Dai 19 Binh Duong, P. VTnhPM, Thi xii Thudn An, Tinh Binh Duong.
vu
Dien thoai : 0368589759
Tharn gia loai hlnh baa hiem: Baa hiem Sire Khoe Nhom va Tai Nan Nhom.
HQ'pd6ng bao hiem s6: 6407121IHD-CNI029-PHH
Thai han BH:
01104/2021 tMn 3110312022.
Mire trach nhiem baa hiern: Chit thuong tat loan b(J va b9 phdn vinh viin do tat nan: 293,321,009; Ndm
vien do 6m dau, benh tdt/ndm: 40,000,000; Phdu thudt do 6m dau benh tdt/ndm: 40,.000,000; Phdu thudt
lien quan d€n cdy ghep n(Ji tang do 6m dau, benh tdt: 40,000,000; Di€u tri truce khi nhdp vien/nam:
3,000,000; Di€u tri sau khi xudt vien: 3,000,000; Y ta cham soc tai nha/nam: 2,000,000; tra cap ndm
vi?nlngay: 60,000; Pich v~ xe CLI"U thu-cmg trong lqnh th6 Vi~t Nam /oqi trir bdn, duang hang khOng:
40,000,000; TrQ'dip mal tang phi: 2,000,000; DKBS 01 - Dieu tri ngot:;litru do am dau, b¢nh t(itlnam:
6,300,000; s6 tiJnlldn kham: 2,000,000; s6 ldn khGmlnam: 60; V(it ly tr; li?ulldn: 105,000; s6 ltin v(it /y
tri li¢ulnam: 60.
Ngay dong phi: 20/04/2021.
Ngay vao vi~n: 2010212022.
B~nh vi~n di~u tri: NHA KHOA KJM
Nguyen nhan: VIEM NU6v => CAD VOl RANG, sAu MON CO RANG 37.
H?u qua: VIEM NUOU => CAD VOl RANG, sAu MON
RANG 37.
.l.
;:.
,
Ho so·gom co:
ro
Co
- Gi§y yeu cdu tni ti~n bao hi~m;
- Chung tu di~u tri do CO" quan y t~ c§p: HOA DON, PHltU DT RANG;
II.Danh gia h8 sO'eua bAi thU'(mg vien:
- Can cu vao nguyen I1Mn nh~p vi~n, ch(mg tu y t8. K~t lu?n: THUOC PH4M VI BH
- Gi§y to kham chil'a b~nh dAy du hqp I~.
- Ngay yeu cAu tra tiSn bao hi~m thea thai h?n quy dinh.
III. Tinh toan b6i thU'(mg:
-
,----
~
Quy~n lQi dllQ'C chi tra
_L
Chi phi di€u tri rang 2tl"I nal~
(c~ovoi rang 500,0001 nal!0__
TAng cQllg
-------
-
Gio'i hl;\11B6i thllO'ng
Ty I~
(TT,PT,T
CNV)
sa ngay
sa ti~n b6i
di~u trj
thu·cmg
700,000
I
I
IV. Lich sir tAn thAt:
s6 V"(J: 0.
s6 ti€n:
°
S.(·J.
o tlen p h'at
sinh
D~ xuAt b6i
thllO'ng
700,000
700,000
700,000
700,000
d6ng.
Ten toi Iii: Nguyin P/u,1m Thanll Thao v6i· tu cach la b6i thuang vien eua MIC cam k8t da kiSm tra tinh
chinh xac ,va hQ''pI~ cac eh(r~1gtll' tren, d€ nghi lanh d~o duy~t s6 ti€n nhu sau:
Bang so: 700,000 dong.
B~ng chil': Bay tram ngan d6ng.
S6 ti€n tren duqc chi tra cho nguc)'i dU'Q·cbao hi~m.
Ngay 23 thang 03 nam 2022.
LANH D~O DON Vl
PT. PHONG NGlI.I¥P Vl)
BOI THlJONG VIEN
~
Nguy~n Phl;\m Thanh Thao
BM/QT/CN/02.16
)~~"MIC
I
Bao Hlem Quan OQi
THONG BAo TRA TIEN BAo HIEM
(SO HJ so bJi thuirng: J3628/22IBT-CN/029-GDBTJ
Kinh gjri Quy khach hang: Truong Plutm Nlur Ngoc.
T6ng Cong ty C6 phdn Bao hiem Qudn art aii xem xet H6 S(J b6i (huang cua Quy khach hang.
Can cu vao Gidy yeu cdu tra ti€n bao hiem, Gidy chung nhdn bao hi€m, H9P a6ng bao hiem, Quy
uic bao hiem, Chung toi thong bao v€ viec giai quy€t b6i thuong cua Quy khacb hang nhu sau:
Nguo'i dU'Q'cbao hi~rn: Truong Pltam Nhu Ng(Jc.
Dia chi: 219 Dr;zi 19 Binh DU(Jng, P. Vinh
n« Thj xii Thu(m An,Tinh
Binh DU(Jng,
Tham gia bao hi~m thea HDBH s6: 64071211HD-CNI029-PHH.
Can cir VaGh6 so b6i thuong s6 13628127IBT-CNI029-GDBT.
Da duoc duyet : ngay 23 thang 03 nam 2022
TAng
s8 ti~n
b8i tlnrong: 800,000 d6ng.
(Bang chic: Tam tram ngan a6ng).
'
hO'p t'ra t'.)..
len b!ang t·.)..
len rna-t :
TfU'O'ng
Trong thai h~n bay (07) ngay k~ tu khi nh~ duQ'c thong bao nay, nguai duQ'c bao hi~m (ho?c
NgmJi thua k~ hQ'ppbap) tl"\l'C ti~p ho~c cli nguai d~n linh ti~n t~i: TT DVKH PHiA NAM
Khi d~n nh~ ti€n, d~ nght Quy khach mang theo: Gi~y chung minh nhan dan, truang hQ'Pnha
nguai khac nh~n he)phai co GifrYuy quy€n hQ'pphap.
TrU'()'ng hop Chuy~n khoan:
Thea yeu cku cua Nguai duQ'c bao hi~m, ch(mg toi
+ Chii Hli khoan:
se chuy~n s6 ti~n tren
vao:
TRlfONG NHlfTUAN.
+ TK s8: 000052464,
+ T~i: Ngan hang VIB BiNH DlfONG.
+ NQi dung thanh toan: Tra ti~n bao hi~m cho Truong Phr;zmNhu NgQc, Vao vi~n ngay
2010212022 t~i B~nh vi~n NHA KHOA KIM.
bdi thU'(mg {ren se au9'c thanh toan bJng ti€n m(lt ho¢c chuy€n khoan VaG Tat
khoiln thea yeu c6u ala NgwJ'i ,1zl'Q'c bao hiJm. Sau 15 ngay nh(ln au9'c thong baa nay, ndu M1C
khong nh(i.naU'9'cphon h6i h,li tir Nguai aU9'cbao hi€m thi coi nhu s~r ki?l1 baa hi€m tren aii au9'c
giai quy€t xang, khong con rhit.cmac khidu nr;zigi.
Cllti y:
S6 ti€n
Tran trQng kinh chao .I.
Ngay 23 (hang 03 nam 2022
NO'inhan:
- Nhu tren;
- Luu Phong TCKT
- Luu Phong ....
8MlQT/CN/02.11
T9NG CONG TY CO PHAN BAo HIEM QUAN DQI
C~
)~!."MIC
I
Bao Hlem Quan D9i
TO TRINH nOI THUO'NG
(H3 SO' s6: 13628/22/BT -CN/029-GDBT)
I. Tom tit h8 so' b8i thuong:
HQ ten ngiroi tham gia bao hi~m: Truong Plutm Nhtr Ngoc.
ThuQc dan vi: CONG TY TNHH TWaNG MAl D!CH VV TAN
PHAT.
Dia Chi
: 219 Dai 1(JSinh Duong, P. VTnhPhil, Thi xii Thudn An, Tinh Binh Duong.
Dien thoai : 036858975~
"
Tham gia loai hinh bao hiem: Baa hiem Sire Khoe Nhom va Tai Nan Nhom.
HQ'P d6ng bao hi€m s6: 6407121IHD-CNI029-PHH
Tho-i han BH: Tu:0110412021 din 3110312022.
Mire trach nhiern bao hiem: Chit thuong tdt toan bi) va b(Jphdn vinli viin do tai nail: 293,321,009; N&m
vien do 6m dau, benh tdt/ndm: 40,000,000,' PhJu thudt do 6m dau benh tdt/ndm: 40,000,000; PhJu thudt
lien quan din cdy ghep n(Ji tang do 6m dau, benh tdt: 40,000,000; DiJu tri trutrc khi nhdp vien/ruim:
3,000,000; DiJu tri sau khi xucit vien: 3, 000, 000; Y ta cham soc tat nha/nam: 2,000,000; tra cdp n&m
nu»
vien/ngay: 60,000; Pich v~ xe CLt·U thuung trang It:;mhth6 Vi~t Nam /oC;Zitrir b&n~ duemg hemg khOng:
40,000,000; Tr9' dip mai tang phi: 2,000,000; DKBS 01 - Dieu tri ngoc;zitru do om dau, benh tgtlnam:
6,300,000; s6 tiinlldn kham: 2,000,000; s6 ian khtimlnam: 60; Vgt If tri lieu/Ian: 105,000; s6 tdn vgt If
tri lieulnam: 60.
Ngay dong phi: 2010412021.
Ngay van vi~n: 2010212022.
B~nh vi~n di~u tri: NHA KHOA KIM
Nguyen nhan: RANG SUA 55 84 85 74 Bf SAU => TRAM
H~u qua: RANG SUA 558485 74 Bf SAU => TRAM
" co:
,
Ho" so' gom
- Gi~y yeu cAu tra ti~n bao hi~m;
- Cht'mg ill di~u tfi do co' quan y t~ c§p: HOA DON, PHIEU DT RANG;
II.flanh gia h8 so' cua b3i thU'imgvien:
- Can Cll' VilO nguyen nhan nh~p vi~n, chung tu y t~. K~t lu~n: THUOC PH~M VI BH
- GiAy to khalTI chu'a b~nh dAy du hqp I~.
- Ngay yeu cAu tni. ti€n bao hi€m thco thai h~n quy dinh.
III. Tlnh toan b8i thU'(rng:
------1
. Gi6i h~1l BBi thtr(yog
Quy~n 19i dtr9'C chi tra
1-----..-----------
Chi phi di~u tri rang
1-=2:2'
O::..:O:_::_O,~O~OO:..:..../
_:::na:::_m:_:__ .
.:I.
Tong c9ng
-,
Ty Ie
TT,PT,T
CNV)
sA ti~n
sA ngay
b6i
thu'crng
di~u trj
800,000
-
800,000
800,000
800,000
800,000
1
A
-
D~ xuit bBi
thtrcYng
-
--J-
'--------
S.(
f" p h'at
olen
sinh
-
--
IV. Ljch sir tAn th§t:
S6 V~I: O.
So tien: 0 d6ng.
Ten t6i la: Nguyill PluJltl Thallh Tluio v6'i ttr cach la b6i tluro-ng vien cua MIC cam k~t da kiSm tra tinh
chinh xac va hQ'p 1~ cac chlrng tll' tren, d~ nghi lanh d~o duy~t s6 ti€n nhu sau:
B~ng s6: 800,000 d6ng.
BAng chG': Tam tram ngan d6ng.
S6 ti€n tren oUQ'c chi tr8. cho ngm'yi du'Q'c bao hi~m.
Ngay 23 thang 03 nom 2022.
BOI
THlfONG vrEN
PT.
PHONG
NGIII¥P
Vl,J
LANH D~O DON V1
BM/QT/CN/02.16
t~~"'MIC
I,
Bao Hiem Quan Oi,ii
"
,
?:1
?
;c
THONG BAO TRA TIEN BAO HIEM
(Sa1I6 so'
uu thuirng:
1363JI22IBT-CNI029-GDBT)
Kinh giri Quy khach hang: Truong Pham Arlin" Long.
T6ng C6ng ty C6 phdn Bdo hiem Qudn ari aii xem xet H6 so b6i (huang cua Quy khdch hang.
Can Cl~' VCIO Gidy yeu cdu tra tidn bao hiem, Gidy chung nhdn bao hi~m, H(Jp a6ng bao hi~m, Quy
tlic bao hiem, Chung t6i th6ng bdo v€ vi?c giai quyet b6i thuang cua Quy khdch hang nhu sau:
Nguoi dUQ'c bao hi~m: Truong Pluim Minh Long,
Dja chi: 219 IJC;Zi
to Binh Duong, P. Vinh Pha,
Thi xii Thudn An, Tinh Binh Duong.
Tham gia bao hi~m thea HDBH s6: 640~/21/HD-CN/029-PHH.
Can cir vao h6 sa b6i thuong s6 13631/22/BT-CN/029-GDBT.
Da diroc duyet .ngay 23 thang 03 nam 2022
TAng
sa ti~n b6i thuong: 800,000 d6ng.
(Bang chic: Tam tram ngan a6ng).
Tru'o'llg hQ]J tra ti~n b~ng ti~n mat:
Trong thai h~n bay (07) ngay k~ ill khi nh?n duQ'c thong bao nay, nguai duQ'c bao hi~m (ho~c
Nguai thua k~h9'P phap) tn,rc ti~p ho~c Clr nguai d~n linh ti~n t(;li:IT DVKH PHiA NAM
d§n nh?n ti~n, dS nghj Quy khach mang thea: Gi~y chung minh nhan dan, truOng hQ'Pnha
nguai khac nh?n hQ pMi co Gi~y uy quySn hQ'pphap.
K.hj
Tru(rng hQ]J Chuy~n khoan:
Theo yeu cfiu cua Nguai duQ'cbao hi~m,. chung toi
se chuy~n s6 tiSn tren
vao:
+ Chu tili khoan: TRUONG NHUTUAN.
+ TK
sa: 000052464.
+ T~i: Ngan hfmg VIB BiNH DCfONG.
+ NQi dung tlumh toan: Ira tiSn bao hi~m cho Trucrng Pht;lmMinh Long, vao vi~n ngay
20/02/2022 t~i B~nh vi~n NHA KHOA KIM.
Cha )1: 86 tidn b6i thuOng lren sf! aU'(Jcthanh toan b6ng tidn m(j.t hoi;ic chuy~n khoan VilO Tai
khocin thea yeu c6u aia Nguai d~f(Jcbao hi~m. Sau 15 ngay nh(m aU(Jc Ih6ng bao nay, niu MIC
kh6ng 12h(inaU'9'cphdn h6i lc;ziILlNgu()'i aU9'Cbao hi~m thi coi nhu s(J' ki?n bao hiim tren aii aU(lC
giai quydt xong, kh6ng can thiic m{7ckhidu nc;zigi.
Tran tn;mg kinh chao .I.
Ngay 23 thang 03 nam 2022
NO'i nhan:
- Nhu !ren,'
- Luu Phong TCKT.
- Luu Phong ....
BMlQTICN/02.11
TONG CONG TY CO PHAN BAo HIEM QUAN DOl
t~!.'_MIC
I
,
Bao Hlem Quan 091
TO TRINH
nOI THU'O'NG
(Hc3 so' sa: 13631122fBT-CN/029-GDBT)
I. Tom t~t bA so bAithuong:
H9 ten ngiroi tham gia bao hi~m: Truong Pluim Minh Long.
Thuoc dan vi: CONG TY TNHH THUONG MA.l D!CH VU TAN Hl$P PHAr.
Dja Chi
: 219 DQi It} Binh Duong, P. Vinh Phil, Thi xii Thudn An, Tinh Binh Duong.
Dien thoai : 0368589759
Tham gia loai hinh baa hi~m: BaD hiem Sue Khoe Nhom va Tai NQn Nhom.
HQ'pd6ng bao hiem 56: 6407121IHD-CNI029-PHH
Thai han BH: Tic01/04/2021 din 3110312022.
Mire trach nhiern bao hiern: Chit thuong tdt toan bt} va bt} phdn vinh viin do tai nan: 293,321,009; Nlim
vien do 6m dau, benh tdt/nam: 40,000,000,' PhJu thudt do 6111
dau benh tdt/ndm: 40,000,000; PhJu thudt
lien quan din cay ghep n6i tang do 6m dau, benh tdt: 40,000,000; Didu tri truce khi nhdp vien/ndm:
3,000,000; DiJu tri sau khi xudt vien: 3,000,000,' Y lei cham soc tai nha/nam: 2,000,000; tra cap nlim
vien/ngay: 60,000,' Dich v¥ xe cuu thuong trong lanh th6 Vi~t Nam IO(lilric blinf: aucmg himg khOng:
40,000,000; Tr(),cap mai tang phi: 2,000,000; DKBS 01 - Dieu tri ngo(li tru do am aau, b?nh trjtlnam:
6,300,000,' S6 tiJnll6n kham: 2,000,000; S61dn khamlnam: 60; Vrjtly tri li?ulZdn:105.000.' S6ldn vrjt ly
Iri li¢ulnam: 60.
Ngay d6ng phi: 20/04/2021.
Ngay vaa vi~n: 2010212022.
Benh vien di8u tri: NHA KHOA KIM
Nguyen 'nhan: RiNG SUA 54 647484 B! SAU.
H~u qua: RANG SUA 54 647484 Bl SAu.
A
A
,
Ho sO'gom co:
- GiAy yeu cAu tra tj~n baa hi~m;
- Chlrng tu di~ll tri do cO'quan y t~ cAp: HOA DON, PHIEU DT RANG;
Il.Danh gia h8 so' cua bAithU'(mgvien:
- Can Clrvaa nguyen nhan nh~p vi~n, chlrng ttr y t~. K~t lu~n: THUOC PH4M VI BH
- GiAy to kham chu'a b~nh d§y chi hQ'p I~,
- Ngay yeu du tra ti~n baa hi~m thea thai lwn quy dinh.
III. Tinh toaD b8i thU'ong:
.
Gi6'i h~n B8i thu'()'Dg
Quy~n
Jc;ri oU'Q'c chi tnl
Chi phi di~u tri ral1g-'-~
2,000,000/ niim
Ty· It,;
s6 ngay
(TT,PT,T
CNY)
Ili~u tri
s6 ti~n
bai
thU'img
-I
s6 ti~n
800,000
pbat
sinh
+-
I>~xu it b&i
thuo-ng
~-----------800,000
800,000
800,000
800,000
~~~~~=-----------+-----~------~--------+-----------+--------TAng cQng
IV. Ljcb sir tAn th§t:
°
S6 v¥: O.
S6 tidn: a6ng,
Ten tei la: Nguyin Ph(lm Thanh 1'l1iiov6'i tu' cach la b6i thuang vien cua MIC cam k~t dii ki~m tra tfnh
chinh xac va hQ'p I~ cac cht:rng tLrtren, d~ nghi lanh d<:loduy~t s6 ti8n nhu 5au: .
Bing s6: 800,000 d6ng.
Bing ch(i: Tam tram ngan d6ng.
S6 ti8n tren dUQ'cchi tra cho nguo'i duQ'c bao hj~m,
Ngay 23 thang 03 niim 2022.
BOI TB1fO'NG VIEN
PT. PRONG NG~P
VV
LANH I>~O DON Vl
~
BM/QT/CN/02.16
..
~
Nguy~n Ph~m Thanh Thao
t~!:·MIC
I,
Bao Hlem Quiin DQi
THONG BAo TRA TI1~NnAo HIEM
(S8 H6 so b6itlluimg: J36J6/22/JJT-CN/029-GDBT)
Kinh gui Quy khach hang: Truong Nlur Tuiin.
T6ng Cong Iy C6 phdn Baa hiem Qulin d6i dli xem xet H6 so b6i thuong cua Quy khdcn hang.
Can CLl'vao Gidy yeu cdu Ira !i§n baa hiem, Gidy chung nhdn baa hiim, H9'P d6ng baa hiim, Quy
tdc baa hiem, Chung tot thong baa v§ viec giai quyet b6i thutmg cua Quy khach hang nhu sau:
Nguo'i dU'Q'cbao hi~m: Truong Nitti' Tuiin.
Via chi: 219 £J(Ji19Binh Duong, P. Vinn Phil, Th/ xli Thudn An,Tinh Binh Duong.
Tham gia bao hiem thee HDBH s6: 6407/21/HD-CN/029-PHH.
Can cir vao h6 sa b6i thuong s6 J36J6/22/BT-CN/029-GDBT.
Va duoc duyet : ngay 23 thang 03 nam 2022
T6ng
sA ti~n
biH thuong: 400,000 d6ng.
(Bang chic: B6n tram ngan tl6ng).
TrU'irng hQ]J tra ti~n b~ng ti~n mat:
Trong thai h<;U1
bay (07) ngay k€ tir khi nhan duoc thong bao nay, nguoi diroc bao hi~m (ho~c
Nguai thlra k~ hQ'Pphap) tn,rc ti~p ho~c eu nguai d~n linh tien tl,li:IT DVKH PHiA NAM
Khi d~nnh~ tien, de nghi Quy khach mang thee: GiAy chung minh nhan dan, truOng h91>nha
nguai khac nh~n h(> phai c6 Gi~y uy quyen hQ'pphap.
TrU'irng hO'p Chuy~n khoan:
Theo yeu d.u cua Nguai duQ'c bao hi~m, chung toi
se ehuy~n s6 tiS!l tren
vao:
+ Chii tiii khoan: TRUONG NHUTUAN.
+ TK sa: 000052464.
+ Tl,ii: Ngan himg VIB BiNI-I DUONG.
+ NQi dung thanh toan: Tni tien bac hi~m eho TruO'ng Nhu Tulin, vao vi~n ngay 20/02/2022 tl,li
B~nh vi~n NHA KHOA KIM.
Chu )1: s6 ti§n b6i (huong tren sCIdu9'c thanh taan bang tt€n m(it ho(lc chuyin khoim vao Tai
khacin thea yeu c6u cLla Nguili aLl'9'cbaa hiim. Sau 15 ngay rzhrJndu9'c thong baa nay, niu MJC
kh6ng nh4n aLWcphon h6i l(Ji HI' Nguo'i tiU(Jf.: bao hidm Ihi coi nhu S1:f ki?l1 baa hidm tren dti dU(Jc
giai quyh xang, khong con thc7cmac khidu n(Jigi.
Trfu1tr9ng kinh chao .I.
Ngay 23 thang 03 nam 2022
Nai nhan:
TONG CONG TY CO pHAN
- Nhu tren;
- LUll Phong TCKT.
- LUll Phong ....
BMlQT/CN/02.11
BAo
HIEM
QUAN DOl
t~~"'MIC
.
•
Bao Hlem Quan 091
TO TRINH
nOI THUONG
(Hfi SO' s6: 13616/22/BT-CN/029-GDBT)
I. Tom t~t hA so' b5i thuo'ng:
HQ ten nguoi tham gia bao hiem: Truong NIue Tutin.
Thuoc don vi: CONG TY TNHR TRUONG MA.ID[CH Vl) TAN HI$P PHAT
Dia Chi
: 219 Dai 1(5Binh Duong, P. Vinh Phil, Thi xii Thudn An.Tinh Binh Duong.
Di~n thoai : 0368589759
Tharn gia loai hinh bao hi~m: Bao hiim Sue Khoe Nh6m va Tai Nan Nhom.
HQ'p d6ng bao hi€m s6: 6407121IHD-CNI029-PHH
Tho'i han BH: TL'r 01/04/2021 din 3110312022.
Mire trach nhiern bao hi~m: Chit thuong trJttoan b(5va b(Jphdn vinh viln do tai nan: 293,321,009; Nlim
vien do 6m dau, benh tdt/ruim: 40,000,000; Phciu thudt do 6m dau benh tdt/nam: 40,000,000; Phciu thudt
lien quan din cdy ghep noi tang do 6m dau, benh tdi: 40,000,000; DiJu tri trutrc khi nhdp vien/nam:
3,000,000; Diiu tri sau khi xudt vien: 3,000,000; Y ta cham soc tai nha/nam: 2,000,000; tra clip nlim
vi?nlngay: 60,000; Djch v+' xe CLI"U thuang trong Iqnh tM Vi?t Nam loqi tru bling du-tYnghang khOng:
40,000,000; Tr9' cdp mai tang phi: 2,000,000; DKBS 01 - Di€u tri ngoqi tru do 6m dau, b?nh t(ltlnam:
6,300,000; S6 tlin/lim kheim: 2,000,000; S6 Ian kheimlnam: 60; VrJtIj tri li?uJlan: 105,000; S6 Ian v(lt lj
tr; li?ulnam: 60.
Ngay dong phi: 20/04/2021.
Ngay vao vi~n: 2010212022.
B~nh vj~n di~lI tri: NHA KHOA KIM
Nguyen nhan: LiYCAO RANG.
H~u qua: LiY CAO RANG.
).
). ,
Ho so' gom co:
- Gi§y yeu cAli tni ti8n bao hi€m;
- Chu'ng ttl' di8u tri do co quan y t€ dp: HOA DON, PHIEU DIEU TR/ RANG;
II.Dauh gi:i hA so' ella b6i thu'()'Ugvien:
- Can cu vao nguyen nhan nh~p vi~n, chung tlr y t~. KSt lu~n: THUOC PH4M VI BH
- GiAy to- kham chi1a b~nh dAy du hQ'p I~.
- Ngay yell cAu tn't ti~1l bao hi~m thea tho'i h~l guy dinh.
ill. Tinh toan b6i thU'(mg:
-~-
r--
Gi6'i h~n BAi thu()'Og
Quy~n lQi dtrQ'c chi tra
T5t1~
(TT,PT,T
S61lgay
ai~u trj
CNV)
Chi phi dieu tri rang 2t1'l nam
(cao
. v6j rang 500,0001 nam) ~
TAng cQng
I
1
--,_
-
--
S.(·;I.
o hen ph'at
s6 ti~n b6i
sinh
D~ xu~t bBi
thU'()'Og
thu'ong
400,000
I
400,000
400,000
400,009
400,000
1
IV. Ljch sil tBn tb~t:
S6 V~l.' o.
S6 tidn: 0 d6ng.
Ten t6i la: Nguyln Plu}112 Thanh Thao vO'j tu cach la b6i thu6'ng vien eua MJC cam k€t da kiSm tra til1.h
ehinh xac va hQ'p I~ cac chung ttl' tren, d~ nghi lanh d?o duy~t s6 ti8n nhu sau:
Bings6:40~OOOd6ng.
Bing chu-: B6n tram ngan dfmg.
S6 ti8n tren duQ'c chi tra cho ngU'o'jduQ'c bao hi~m.
Ngay 23 thang 03 nam 2022.
LANH D~O DON VJ
PT. PHONG NGmtP Vl)
BOr Tm10NG
Ng~hao
BM/QT/CN/02.16
VIEN
~~!.'_MIC
I
ait\, Hiem Quan OQi
A
,
?),.
?
:z:
THONG BAO TRA TIEN SAO HIEM
(sa H6 so b6i thuirng:
13704122/BT-CNI029-GDBT)
Kinh giri Quy khach hang: Nguyill Mill" Thiing,
T6ng C6ng ty C6 phdn Bao hiem Qudn il6i il[i xem xet H6 S(J b6i thuang cua Quy khdch hang.
Can de veLO Gidy yeu c6u tra ti€n bao hiim, Gidy chung nhdn bao hiim, H9P il6ng bao hiem, Quy
tac bao hiim, Chung t6i th6ng bdo v€ viec giai quyit b6i thuong cua Quy khdch hang nhu sau:
Nguoi dU'Q'c bao hi~m: Nguyill Minb Tlltillg.
Dia chi: 219 Dai 16Binh DU(Jng, P. Vinh Phu, Thi x[i Thu(jn An, Tinh Binh Duong.
Tham gia bao hiem thea HDBH s6: 6407121IHD-CNI029-PHH.
Can ClI vao h6 sa b6i thuong s6 13704122IBT-CNI029-GDBT.
Da duoc duyet : ngay 23 thang 03 nam 2022
TAng s8 ti~n b6i thuirng: 1,496,250 d6ng.
(Bimg chit: M6t trieu b6n tram chin muai sau ngan hai tram nam mU(Jiil6ng).
'
h o'P t'ra t·len
A b~
ang t'Alen rna~t:
T rU'O'ng
Trang thai h<;Ul
bay (07) ngay kS tu khi nh~n duqc thong baa nay, nguai duqc bao hiSm (ha~c
NguCrithua k~ hqp phap) tn,rcti~p ha~c Clr nguai d~n lInh ti~n t:;ti:IT DVKH PHiA NAM
Khj d€n nh~ ti8n, d8 nghi Quy khach mang theo: Gifty chUng minh nhan dan, truerng hqp nha
nguai khac nh~n ho phai c6 Giclyuy quy~n hqp phip.
Tru'o'ng hO'pChuy~n khoan:
Thea yeu du cua Nguai duqc baa hi~m, chung toi se chuy~n s6 ti~n tren vaa:
+ Chu tai
khoan:
+ TK s8:
000053087.
NGUYEN MINH THANG.
+ T~i: Ngan hang VIB BiNH DUONG:
+ NQi dung thanh toan: Tra ti8n baa hi~m cha Nguyin Minh Thang, vaa vi~n ngay 1210312022
t:;tiB~nh vi~n PHONG KHAM Y HOC CO TRUYEN sAl GON.
Chtt J': s6 ti€n b6i thuong {ren sf! ilu(lC thanh toan b6ng ti€n m¢t ho(ic chuyin khoan veLO Ted
khoim thea yeu cdu cua Nguo·j t/u(lC bao hiim. Sau 15 ngay nh¢in ilu(lc th6ng bao nay, niu MIC
kh6ng nh(jn thwc phim h6i lr;zitt'rNguoi dU(1c bdo hiJm thi coi nhu s~ ki?n bao hiJm tren il[iilu(lc
gilli quydt xong, kh6ng con thac mAc khiiu nr;zigi.
Tran tr<;mgkinh chao .I.
Ngay 23 thcmg 03 nam 2022
Nai nhan:
- Nhu tren;
- Luu Phong TCKT
- Luu Phong ....
BMlQTICN/02.11
TONG CONG TY CO PH AN BAo HIEM QUAN DOl
~~!."MIC
,I
Bao Blem Quin OQi
TO TRiNH BOI TIIUONG
(H6 so' s6: 13704/22/BT-CN/029-GDBT)
I.16m t~t hB so bBi thuong:
H9 ten ngiroi tham gia bao hiem: Ngllyin Minl: Thling,
ThllOc don vi: CONG TY TNHH TRUONG M1-I DjCH vt) TAN HI£,P PHAr
Di2, Chi
: 219 Dai 1(JBinh DUO'ng,P. Vinh Phil, Thi xii Thudn An, Tinh Binh DU07lg.
Di~n thoai : 0332959570
TIHm gia loai hinh bao hiem: Bao hidm Suc'Khoe Nhom va Tai Nan Nhom.
HQP d6ng bao hiern 56: 6407121IHD-CNI029-PHH
ThO'i han BH: Tt'r0110412021 din 3110312022,
Mire trach nhiern bao hi~m: Chit thuong tgt toan b(J va b(Jphdn vinh viin do tai nan: 293,321,009; NJm
vien do 6m dau, benb tdt/ndm: 40,000,000; Phdu thudt do 6m dau benh tdt/nam: 40,000,000; Phdu thud:
lien quan din cay ghep n(Ji tang do 6m dau, benh tgt: 40,000,000; ou« tri 'tnrac khi nhdp vien/nam:
3,000,000; DiJu tri sau khi xudt vien: 3,000,000; Y ta cham soc tai nha/nam: 2,000,000; tro cap nJm
vien/ngay: 60,000; Dich v~ xe cuu thuong trong 19nh th6 Vi?t Nam IOf;litru bi'mg dU<7nghang khOng:
40,000,000; Tr9' cap mai tang phi: 2,000,000; DKBS 01 - DiJu tri ngot;zi tru do 6m dau, b?nh t(itlnam:
6,300,000; S6 ti§n/lCtn kharn: 2,000,000; S616n khamlnam: 60; Vgt ly tri li?ulZ6n: 105,000; S616n v(it ly
tr i li?u/nam: 60,
Ngay d6ng phi: 2010412021.
Ngay vao vi~n: 12/03/2022.
B~nh Yi~n dicSutri: PHONG KHAM Y HOC CO TRUYEN SAl GON.
1\guyen nhan: HOI CHUNG DNG CO TAY.
H~u qua: HOICH(J'NG DNG CO TAY.
).
). ,
I [o SO' gom co:
- Gi~y yeu cAu tra ti~D bao hi~m;
- Ch(mg tl'rdi8u tri do co quan y t~ cAp: HOA DON, TDA THUDC, BANG K.E THUDC;
JI.I>anh gia h3 sO'cua b8i thu'ong vien:
- Can CLt vao nguyen nhan nhap vi~n, chung tl'r y t~. K~t luan: THUOC PH4,M VI BH
. Gifry ta kbam chua b~nh d~y elu hQ'p I~.
..Ngay yeu cAu tra ti~n bao hi~111thea thai h~n quy dinh.
HI. Tinh to an bBi thU'<rng:
' Gi6i h~n Bai thlfb'ng
Quy~n iQ'idU'Q'cchi tra
Chi phi ngo~i tr6 6tr31 nam
(2trl I~nkham)
Ty I~
(TT,PT,T
CNV)
s6 ngay
s6 ti~n b6i
di~u trj
thu'img
1,496,250
Tang cQog
s6 ti~n
pilat
sinh
D~xuAt b8i
thlfO'ng
1,496,250
1,496,250
1,496,250
1,496,250
IV.qch Stf tAn th§t:
S6 V~I: O.
S6 tiJn:
0 d6ng.
Ten toi la: Ngllyln Pltam Thanh Thiio vo-i tu cach 1ftb6i thuang yien cua MIC cam k~t dli ki~m tra tinh
chinh xac ,va hQ''pI~cac' chun& tl'rtren, d~ nghi lanh d?o duy~t s6 ti8n nhu sau:
Bang so: 1,496,250 dong.
B~ng chfr: Mot tri~u b6n tram chin muoi sau ngan hai tram nam muoi d6ng.
S6 ti~n tren duQ'c chi tni cho ngu'o'i duQ'c bao hi~m.
Ngay 23 thang 03 nam 2022,
BOI THUONG VIEN
PT. PHONG NGHIE:P VV
LANH D~O DON VI
Nguy~n Ph~m Thanh Thao
BM/QT /CN/02, 16
)~!."'MIC
I,
Bao Hiem Quan £lQi
THONG BAo TRA TIEN BAo IDEM
(sa Ha so' bai thuang:
J370JI22IBT-CNI029-GDBT)
Kinh giri Quy khach hang: Nguyin Minh. Thiing,
T6ng Cong ty C6 phdn Baa hiem Qudn, d(,Hali xem xet H6 sa b6i thuong cua Quy khach hang.
Can Ctf VaGGiayyeu cdu tra tiJn bao hiem, Gidy chung nhdn bao hiim, H(lJJd6ng baa hiem, Quy
tilc bao hiim, Chung toi thong baa vJ vi?c giai quyit b6i thuong cua Quy khdch hang nhu sau:
Nguo'i dU'Q'c bao hi~m: Nguyin Minh Tltdng.
Dia chi: 219 [)9i 19Binh Duong, P. Vinh
n« Thi xCiThugn An, Tinh Binh Duong.
Tham gia baa hi€m thea HUBH s6: 6407121IHD-CNI029-PHH.
Can cu vao h6 sa b6i thuong s6 13701122IBT-CNI029-GDBT.
Da duoc duyet : ngay 23 thang 03 nam 2022
TAng
s8 ti~n
b6i thuung: 1,601,250 d6ng.
(Bang chit: M9t trieu sau tram Ie mot ngan hai tram nam muai d6ng).
TrU'o'ng hO'p tra ti~n b~ng ti~n mat:
Trang tho-i hlp1 bay (07) ngay k~ tu khi nh~ duQ'c thong baa nay, nguo-i duQ'c baa hi~m (ha~c
Nguo-i thira k€ hqp phap) tIVc tiSp ha~c cu ngum d€n linh ti~n t~i: IT DVKH PHiA NAM
Khi d€n nh~n ti~n, d€ nghi Quy khach rnang thea: Gi~y chUng minh nhan d~, truo-ng hqp nhonguo-i khac nh~n h(>phai c6 Gi~y uy quy~n hqp phap.
Truong hO'p Chuy~n khoan:
Thea yeu c~u cua Nguai dLrQ'cbaa hi~m, chung toi
se chuy€n s6 ti~n tren VaG:
+ Chii tili khoan: NGUYEN MINH THANG.
+ TK s8: 000053087.
+ T~i: Ngan hang VIB BiNH DUONG.
+ NQi dung thanh toan: Tra ti€n baa hi~m cha Nguyin Minh Thilng, vaa vi~n ngay 0710312022
t~i B~nhvi~n PHONG KHAM Y HOC
CO TRUYEN SAl GON.
S6 tidn b6i
thuang tren se au()'cthanh toim biing ti~n m(jt hoi;icchuyin khoan VaGTai
khodn theo yeu c6.uc~laNgu&i ou()'cbao hiJm. Sau 15 ngay nh(m c/u(),cthong bao nay, niu MIC
khong nh(in aU(Jc phan h6i 19i tir Ngu(J'iau()'cbao hiim thi coi nhu S,! ki?n baa hiim (ren aCiau()'c
giai quyit xang, khong con tht1cmt.1ckhiiu n9i gi.
Chu JJ:
Tran tf9ng kinh chaa .I.
Ngay 23 thang 03 nam 2022
NO'i nhan:
- Nhu tren;
- Luu Phong TCKT
- Luu Phong ....
BMlQT/CN/02.11
TONG CONG TY CO PHAN BAo HI EM QUAN DOl
_d---=L:?=====----
t~!:·MIC
I
,
BaoHlem Quin 091
TO TRINH BOI THUONG
(H8
SO'
sA: 13701l22/BT-CN/029-GDBT)
I. Tom t~t hA so' b6i thuong:
HQ tell ngiroi tham gia bao hi~m: Ngllyln Minh Tilting.
Thuoc don vi: CONG TYTNHHTHUONGU1,I DICHVljTAN HIep PHAT.
Dja Chi
: 219 Dai /9 Binh DUO'ng.P. VinhPhu, Thi xli Thudn An,Tinh Binh DUO'ng.
Di~n thoai : 0332959570
Tham gia loai hinh bao hiem: Bao hidm Sue Khoe Nhom va Tai Nan Nhom.
HQ'P d-(mgbao hi~m s6: 6407121IHD-CNI029-PHH.
Thai han BH: Tit 01104/2021dJn 3110312022.
Mire trach nhiern bao hi~m: chit thuang ttjt toan brJva b9 phdn vinh viln do tai nan: 293,321,009; Nizm
vien do 6m dau, benh tdt/ndm: 40.000,000; Phdu thudt do 6m dau benh tdt/nam: 40,000,000; Phdu thudt
lien quan din cdy ghep nrJi tang do 6m dau, benh tgt: 40,000,000; Di€u tri tnarc khi nhdp vien/nam:
3,000,000; ou« tri sau khi xudt vien: 3, 000,000; Y ta cham soc tai nha/nam: 2, 000,000; tro cdp nizm
vi¢nlngay: 60,000; ptch v¥ xe cU'UthuO'ngtrong It;mhth6 Vi~t Nam logi trir bizn, dwmg hang khong:
40,000,000; Tr(l cap mai tang phi: 2,000,000; DKBS 01 - Dieu tri ngo{li tru do am dau, b?nh ttjtlnam:
6,300,000; s6 tidnll[m kham: 2,000,000; S6 Jdn khdmlnam: 60; Vgt ly Iri li?ulI6n: 105,000; s6 Jdn vtjt ly
tri li¢ulnam: 60.
Ngay d6ng phi: 20/04/2021.
Ngay VaGvi~n: 0710312022.
B~nh vi~n di~u tri: PHONG KHAM Y HOC CO TRUYEN SAl GON
Nguyen nhan: HOICmiNG ONG CD TAY.
H~u
qua:). HOI, CHUNG DNG CD TAY. ).
Ro sO'gom co:
- Gifiy yeu du tni ti~n bao hi~m;
- Ch(rng tiTdi~u tri do cO'quan y t~ cAp: HDA DON, TOA THUDe, BANG KE THUDC;
II.Danh ghl hA so' eua b6i thU'(rng vien:
- Can Clr VaGnguyen nhan nh~p vi~n, chung tir y t~. K~t IlI~n: THUOC PH4M VI BH
- Gifiy ta kluim chua b~nh dAy du hQ'p I~.
- Ngay yeu cAu tra ti~n bao hi~m thea thai h?-nquy dinh.
III. Tinh toan b6i thU'()'Og:
Gi6i h~n BAi thtro-ng
Quy~n 191 dUQ'c chi tra
--
Chi phi ngo~i tru 6tr3/ nam
(2tr/lAn kluim)
TAng cQng
T5t1~
(IT,PT,T
CNV)
S6 ngay
S6 ti~n bfH
di~u trj
thu'o'ng
1,601,250
s6 ti~n
phat
sinh
D~ xu~t bAi
thuirng
1,601,250
1,601,250
1,601,250
1,601,250
-
IV. Lieh su' tAn thAt:
S6 I'F: O.
S6 lien: 0 d6ng.
Ten toi ill: Nguyln Ph.(lm Thanh Thiio vai tll' cach 1ft b6i thuang vien eua MlC cam k~t da ki~m tra tlnh
ehinh xac ;,a h<;>;p
I~ cac chun& ttTtren, d8 nghi lanh d~o duy~t 56 ti~n nhll' sau:
Bang so: 1,601,250 dong.
B~ng chii: MQt tri~u S{llI tram Ie mQt ngan hai tram nam mll'O'id6ng.
S6 ti~n tren QU'Q'cchi tra cho ngll'()'iQUQ'cbao hi~m.
N~ay 23 th~ng 03 nqm 2022.
BOI
THTfONG VIEN
PT.
PRONG
NGHI¥P
VV
LANH D~O DON VJ
Ng~ao
BM/QT/CN/02.16
t~!."MIC
I'
Bao Hlem Quan DQi
THONG BAo TRA TIEN BAo HtEM
(sa Ha SO' hal thuirng: 1370S122IBT-CNI029-GDBT)
Kinh giri Quy khach hang: Bid Viin Nguyen.
cs
T6ng Cong ty
phdn Bao hidm Qulin d(ji dil xem xet H6 sa b6i thuang cia Quy khach hang.
Can cu vaa Gi6y yeu cdu tra ti~n bao hiem, Gidy chung nhdn bao hiem, Hop d6ng bao hiem, Quy
tac bao hiem, Chung toi thong bao v~ viic giai quydt b6i thuang cua Quy khdch hang nhu sau:
Nguo'i dU'Q'c bao hi~m: Bid Van Nguyen.
Dia chi: 219 D9i l(j Binh Duong, P. Vinh Phil, Thi xCiThudn An, Tinh Binh Duong.
Tham gia bao hi~m thea HDBH sf>: 64071211HD-CNI029-PHH.
Can CLl' vao h6 so b6i thuong sf> 13705122IBT-CNI029-GDBT.
Dff diroc duyet .ngay 23 thang OJ nam 2022
Tang
s8 ti~n
b3i thucng: 844,750 d6ng.
(Bang chii: Tam tram b6n muoi b6n ngan bay tram nam muai d6ng).
Truong ho'p tra ti~n b~ng ti~n mat:
Trong th6'i h~n bay (07) ngay k~ tir khi nh~n dUQ'cthong bao nay, nguai duQ'c bao hi~m (ho~c
Nguaj thtra k~ hQ'pphap) tn,rc ti~p ho~c cir nguOi d~n IInh ti8n t~i: IT DVKH PHiA NAM
Khi d~n nh?n ti~n, d~ nghj Quy khach mang thea: Gi~y chUng minh nhan dan, truemg hQ'P nha
nguai khac nh~n h(>phai c6 Gi§y uy quy~n hQ'Pphap.
Tru'ong hO'p Chuy~n khoan:
Theo yeu c§.ucua Nguaj duQ'c bao hl~m, chung toi se chuy~n sf>ti~n tren vao:
+ Chil tai khoan: Bill VAN NGUYEN.
+ TK s8: 000050764.
+ T~i: Ngan hang VIR TPHCM.
+ NQi dung thanh toan: Tra ti~n bao hi8m cho Bui Van Nguyen, vao vi~n ngay 2510212022 t!;\i
B~nh vi~n BVDHYD TPHCM.
Chu y: s6 tidn b6i thuang tren se dU(lc thanh (oan b6ng ti~n mgt ho~c chuyJn khoan VaG Tai
khoan thea yeu cc1u cila Nguai t/u(lC bao hidm. Sau 15 ngay nhgn dU(lc thong bao nay, ndu MIC
kh6ng nh(in c-1u()'c
phon h6i lc;liHe Nguai t/u(J'cbaa hiJm !hi cai nhu Sl! ki?n baa hiJm tren dil dU(lc
giai quyir xong. khong con tht7c mAc khidu nc;ligi.
.
Tran trQng kinh chao ./.
Ngay 23 thang 03 nam 2022
NO'inhan:
- Nhu tren;
- Luu Phong TCKT.
- Luu Phong ....
BMlQT/CN/02.11
TONG CONG TV CO PHAN BAo HIEM QUAN DQI
)~i."'MIC
I
,
Bao Hiem Quan OQi
TO TRINH BOI TRUONG
(lIt) so' sA: 13705/22IBT-CN/029-GDBT)
I.T6m t~t h6 so' b6i thuong:
HQ ten nguoi tham gia bao hiem: Bui Viin Nguyen,
ThuQc dan vi: C(JNG TY TNHH THU'aNG W,l D!CH vu TAN ntt» PliAT.
Dia Chi
: 219 Dai t6 Binh Duong, P. Vtnh Phil, Thi XQ Thudn An.Tinh Binh Duong.
Di~n thoai : 0783508736
Tham gia loai hinh bao hi€m: Bao hidm Sue sss« Nhom va Tai Nqn Nh6m,
HQ'p d6ng bao hi&m s6: 6407121IHD-CNI029-PHH
Thai han BH: t» 0110412021 eMn 3110312022.
Mire tr~ch nhiern bao hiSm: Chet thuong 19t toan b6 va b(j phdn vinh viln do tai nan: 293,321,009; Nam
vi?1'l do 6m dau, benh tdt/ndm: 40,000,000; Phdu thudt do 6m dau benh tat/nam: 40,000,000,' Phdu thudt
lien quan ddn cdy ghep n(ii tang do 6m dau, benh tdt: 40,000,000; £)iJu tri trutrc khi nhdp vien/niim:
3,000,000; ou« tri sau khi xudt vien: 3,000,000; Y ta cham soc tgi nhaJnam: 2,000,000; tr(l c6p nam
vi?nlngay: 60,000,' _Dich v~ xe diu thtrcmg trong ignh th6 Vi~t Nam logi
banft duemg hang khOng:
40,000,000; Tr9' cap mai lang phi: 2,000,000; DKBS 01 - Dieu tri ngogi tril do om dati, b¢nh Igllnam:
6,300,000; S6 tiJnlldn kham: 2,000,000; S61dn kMmlnam: 60; Vgt ly tri /i?ulldn: 105,000; S6ldn vQI /y
trj /ifulnam: 60.
Ngay dong phi: 20/04/2021,
Ngay vao vi~n: 2510212022
B~nh Vi~11di~u tri: BV DHYD TPHCM
Nguyen nh3on:DA U VAl pHAI DO CANG CO
H~uqua: DA U VAl PHAI DO CANG CO
tm
J.
'
Ho sO'gom c6:
- Gifty yeu du tra ti~n bao hi8m;
_ Ch(rng ttl' di~u tri do ca quan y t~ cAp: HOA DON, TOA THUDC, BANG KE THUDC;
II. Danh gia h6 SO' eua bAi thU'(mg vien:
_ Can Clf vao nguyen 11h3o11
nh~p vi~n, eh(mg tu y t8. K8t lu~n: THUOC PlLj,M VI BH
- Gifty ta kh{un chu'a b~nh dAy du hQ'P I~,
- Ngay yeu cAu tni ti~n bao hiSm theo thai h~n quy dinh,
III.Tinb toan b6i thU'(Yng:
Gi6'i hl;lDBAi thU'(yog
Quy~n IQ'i dU'Q'C chi tra
Ty I~
(TT,PT,T
CNV)
Chi phi ngo!;litru 6tr31 nam
(2trl IAn kham)
TAng cQng
IV. Lich
S6 Vl/.' o.
-_.-
su tfin th§t:
S6 ngay
di~u trj
S6 ti~n b6i
I
o tlen p h'ta
sinh
S,(·J.
Di xudt
bBi
thtrc'Yng
thu'?mg
844,750
!--
844,750
844,750
844,750
844,750
S6 tidn: 0 d6ng,
Ten t6i lit: Nguyln Ph(lm Thanh Tluio v6i tu each Ill. b6i thuang vien eua MIC cam k~t dli ki~m tra tinh
chinh xac va hQ'P I~ cac chlmg tu tren, d6 nghi llinh dl;toduy~t s6 ti~n nhu sau:
B~ng s6: 844,750 d6ng,
B~ng chIi': Tam tram b6n muai b6n ngan bay tram nam muO'i d6ng,
S6 ti6n tren duQ'c chi tra cho ngu6'i duQ'c bac) hi~m,
Ngay 23 tMng 03 nam 2022,
BOt TlIU'ONG VIEN
PT. PHONG NGHI¥P VV
LANH J:)~O DON Vl
BM/QTICN/02.16
t~!.-MIC
I,
BaD Hiem Quan OQi
A.
,
1.
'?
:z
?
THONG BAO TRA TIEN BAO HIEM
(sa H6 SO' b6i thuimg:
J3706122IBT-CNI029-GDBT)
Kinh giri Quy khach hang: Chtiu Minh Titling.
au
Tong Cong ty cd phdn Bao hidm Qudn d()i
xem xet H6 sa b6i {huang cua Quy khach hang.
Can cu vetOGiay yeu cdu Ira (tin baa hiim, Gidy chung nhdn bao hi€m, H(1JJa6ng baa ht€m, Quy
tdc baa hidm, Chung tai thong bao vJ vitc giai quyit b6t thuong cua Quy khach hang nhu sau:
NgU'oi dU'Q'c bao hi~m:
cns« Minh
Tlzling.
Dia chi: 219 tJ(li l() Binh Duong, P. Vinn Phu, Tht xii
nca« An, Tinh Binh
Duong.
Tham gia bao hi~m thea HDBH s5: 6407121IHD-CNI029-PHH.
Can cu vao h6 sa b6i thuong s5 13706122IBT-CNI029-GDBT.
Dll diroc duyet : ngay 23 thang 03 nam 2022
Tang
s5 ti~n b~i thuong:
1,206,076 d6ng.
(Bang chic: M()I trieu hat tram
Ie sau
ngan khang tram bay muai sau a6ng).
TrU'ong ho'p tnl ti~n b~ng ti~n ma~:
Trong thai h~n bay (07) ngay k~ tir khi nh~ dUQ'cthong bao nay, nguai duQ'c bao hiSm (ho~c
Nguai thtra k~ hqp phap) tn,rc ti~p ho~c cu ngum d€n linh ti~n t~i: IT DVKH PHiA NAM
Khi d€n llh~l1 ti~n, d~ nghi Quy khach mang thea: Gi~y chung minh nhan dan, truang hQ'Pnha
nguai khac nh?l1 hQ phai c6 Gi~y uy quy~n hQ'Pphap.
TrU'o'ng ho'p Chuy~n khoan:
Theo yeu du cua Nguai duqc bao hiem, chUng toi
se chuyen s5 ti~n tren vao:
+ Chu tai kJloan: cHAu MINH TlIANG.
+ TK
s5: 613704060429211.
+ T~i: Ngan hang VIR.
+ NQi dung
thanh toan: Tni ti~n bao hi&m cho Chau Minh Thdng, vao vi~n ngay 0310312022 ~i
B~nh vi~n BV Quac TE BECAMEX.
Cltu y: 86 tidn b6i thuang tren se aU(Jc thanh todn biing ti§n m(lt ha(lc chuy€n khodn vaa Tat
khadn thea yeu cdu cLlaNguai aU(Jc baa hi€m. Sau 15 ngay nh«n aU(Jc thang bao nay, niu MIC
khang nhr;in{/tl'(),cphan h6i [(Ii h'r Ngu()'i du{)'c baa hi€m Ihi coi nhu s~· kifl1 bao hidm tren aii au9'c
gicii quydt xong, khang con thdc mac khiiu m;ligl.
Tnln trQng Idnh chao .I.
Ngay 23 thang 03 nam 2022
Nai nhan:
TONG CONG TV CO PHAN
- Nhu tren;
- Luu Phong TCKT
- Luu Phong ....
~
BMlQT/CN/02.11
BAo HIEM
QUAN D(H
)~~"MIC
I
,
Bao Hlern Quan OQI
TO' TRINH DOl THU'ONG
(liB so' sa:
13706/221BT -CN/029-GDBT)
I. Tom t~t h6 so' b6i thtrong:
HQ ten nguoi tham gia bao hiem: Chou Minl: Tltdng.
Thuoc dan vi: CONG TY TNHH THUONG MAl DICH VU TAN ntt» PHAT.
Dia Chi
: 219 Dgi 1(JBinh DU071g,P. Vlnh Phil, Th; xii Thudn An, Tinh Binh Du071g.
Di~n thoai : 0989260273
Tham ria loai hil:h bap hiBm: Bao hiem Suc Khoe Nhom va Tai Nan Nhom.
HQ'pdong bao hiern so: 6407121IHD-CNI029-PHH
Thai han BH: Ttl' 01/04/2021 din 3110312022.
Mire tr~ch nhiern bao hiBm: chi, Lhu071gI(l,tloan b(J va b(Jphdn vinh viin do tai nan: 293,321,009; Nam
vien do 6111dau, benh 1411nam:40,000,000; Phd", thudt do 6m dau benh tat/nom: 40,000,000; Phdu thudt
lien quan din cdy ghrip n(Ji tang do 6m dau, benh tdt: 40,000,000; DiJu tri truce khi nhdp vienlnam:
3,000,000; ou« tri sau khi xudt vien: 3,000,000; Y ta cham soc tai nha/nam: 2,000,000; tra cdp ndm
vien/ngay: 60,000; Dich v¥ xe cuu thuang trong lanh Ih6 Vi~t Nam loai tric biinf dUO'ng himg khong:
40,000,000; Tr9' cap mat tang phi: 2,000,000; [)KBS 01 - Dieu tri ngogi tru do om dau, bcnh IQtlnam:
6,300,000; s6 tidn/lan kham: 2,000,000; s6 Ian khtimlnam: 60; VQIiy tri lieu/Ian: 105,000; s6 Ian vQt Iy
tr; Mu/nam: 60.
Ngay dong phf: 20/04/2021.
Ngay vao vi~n: 03103/2022.
B~nh vi~n diSu tri: BV Quac TE BECAMEX.
Nguyen nhan: VLEM D4 DAy TA TRANG HP +.
H~u qua: VIEM DA DAYTATRANG HP +.
H6 so' g6m co:
- GiAy yeu c~u tra tiSn bao hi~m;
- Chlrng tll' diSu tri do co quan y t~ cdp: H6A DON, TOA THU6c, BANG
KE
CP, KQ NOl SOl - TEST
HP'
II.Danh gia h6 sO'ella bBi thU'(mg vieD:
- Gin cu vao nguyen nhan nh~p vi~n, chung tu y t€. K8t lu~n: THUOC Pll4M VI BH
- GiAy to kham cha'a b~nh d§y du hQ'p I~.
- Ngay yell d.u tra tiSn bao hiSm thea thai h~n quy dinh.
III. Tanh toan b6i thuirng:
GiOi h~n BAi thU'(rng
).
Quyen IQ·jdU'Q'cchi tnt
Ty l~
(TT,PT,T
CNV)
o~i tru 6tr3/ nam
anD_
s6
ngay
di~u trj
s6 ti~n b6i
sA ti~n
phat
sinh
D~ xu§t bAi
thllOng
thu'img
1,206,076
1,206,076
1,206,076
1,206,076
1,206,076
IV. Ljeh sil' tBn th~t:
s6 vw o.
So lien: 0 d6ng.
Ten toi 1ft: Nguyin Ph(lm Thanh Thao vai tu each la b6i thu()'J1gvien cua MIC cam k8t da kiSm tra tfnh
chfnh xac va Iwp I~cac chtrng ttl' tren, d~ nghi lanh d~o duy~t s6 ti~n nhu sau:
Bftng s6: 1,206,076 d6ng.
Bilng cha': Mot tri~u hai tram Ie sau ngan khong tram bay muoi sau d6ng.
s6 ti~n tren dU'Q'cchi tni cho nguai duQ'c bao hj~m.
NSlIy 23 lht}ng 03 nqm 2022.
BOI TWaNG VIEN
PT. PHONG NGHl¢P VV
LANHf)~O DaN Vl
Nguy~n Ph~m Thanh Thao
BM/QT/CN/02.16
,
)~!."MIC
I
Bao Hlem Quan D(jl
TO TRINH
I. Tom t~t
ha
nOI
THUONG
(116 so' sa: 13706/22/BT-CN/029-GDBT)
SO' b6i thuong:
HQ ten nguo: tharn gia bao hi~m: Ctuiu Minh Tltdng.
Thu9C dan vi: CONG TY TNHH THUONG M41 D!CH vu TAN H1ep pRAT.
Via Ch I
: 219 Dai /0 Binh Duong, P. Vinh Phu, Thi xii Thudn An, Tinh Binh Duong.
Dien thoai
: 0989260273
Tham gia loai hinh bao hi~m: Bao hiem SucKhoe Nhom va Tai Nan Nhom.
HQ"pd6ng bao hiem s6: 6407121IHD-CNI029-PHH
Thai han BH: Tit 01/04/2021 din 3110312022.
Mire tr~ch nhiern bao hiem: Chit thuong tfjt toan bo va bo phdn vinh viln do tai nan: 293,321,009; Nlim
vien do 6m dau, benh tdt/nam: 40,000,000; PMu thudt do 6m dau benh tgtlnam: 40,000,000; Phdu thudt
lien quan din cdy ghep noi tang do 6m dau, b?nh tgt: 40,000,000; Didu tritrutrc khi nhdp vien/nam:
3,000,000; Didu tri sau khi xudt vien: 3,000,000; Y td cham soc tai nha/ndm: 2,000,000; tra cdp nlim
vien/ngay: 60,000; Dicn v~ xe CUll (huang trong lanh tM Vi~t Nam loai trit blin$ duo-ng hang khong:
40,000,000; Tr(Y cap mai tang phi: 2,000,000: DKBS 01 - Dieu tri ngogi trU do om dau, b?nh tfjtlnam:
6,300,000; S6 tidnll{m kham: 2,000,000; S61dn khamlnam: 60; Vfjt If trj li?ulldn: 105,000; S6 idn VQt If
tri li?ulnam: 60,
Ngay d6ng phi: 20/04/2021.
Ngay vao vi~n: 0310312022.
B~nh vi~n di~u tri: BV Quac TE BECAMEX.
Nguyen nhfll1: VIEM D.<lDAY TA TRANG HP +.
H~u qua: VIEM D.<lDAY TA TRANG HP +.
).
). ,
Ho so' gom co:
- Gi§y yeu du tra ti~n biw hi8m;
_ Cht'rng tlr di~u tri do co quan y t€ cAp: HOA DaN, TOA THUDC, BANG
Ki
CP,
KQ NOI sal - TEST
HP;
II.Danh gin hA SO' cua b6i thU'ong vien:
_ Can cu vao nguyen nhall nh~p vi~n, cht'mg tlr y t€. K6t lu~n: THUOC Pll1.M VI BH
- Gi§y to' kham chu'a b~llh d§y du hQ"pI~.
- Ngay yeu C§U tra ti~n bao hi~m thea thai h~n quy djnh.
III.Tinh toan b3i thU'Ong:
1- Gi6'i h~n B6i thrro'ng
QlIy~n lq·j du'Q'c chi tra
Ty"l~
s6 ngay
s6 ti~n b6i
(TT,PT,T
di~u trj
thu'img
...
sA ti~n
phat
sinh
D~ xuAt b6i
thllOng
CNV)
,~-+~~~~
__~
~
Chi phi ngoC;litru 6tr31 nam
2trllinkhAm)
~~~~~~~~~~~~~_1_,2_0_6_~_7_6~~~1,_20_6_~_7_6~~~._1,_2_06_,_07_6~
1,206,076
1,206,076
IV. Lich sii' tan th~t:
S6 V1J: 0,
S6 ti€n: 0 d6ng.
Ten tai la: Nguyil'l PII(l1tl Thanh Thiio v6i tll cach lit b6i thll(Yng vien clla MIC cam k€t dil ki~m tra tinh
chinh xac va hQ'p I~ cac chung tlr tren, d~ nghi lilnh d~o duy~t 56 ti~n nhll sau:
.
B~ng s6: 1,206,076 d6ng.
B~I1gchu': M(>ttri~u hai tram Ie sau ngan khong tram bay mU'O'isau d6ng.
S6 ti~n tren d.U'Q'Cchi tra cho ngllo'i dllQ"Cbao hiSm.
N~Cty 23 lhang 03 nam 2022,
BOI
TlIUONG vrEN
PT.
PHONG
NGHI¥P
VV
LANH D~O DON Vl
Nguy~n Ph~m Thanh Thao
BM/QT/CN/02.16
t~~'_MIC
J
Bao Hii!m QuanOQi
THONG BAO TRA TIl~N nAo HIEM
(S6 HO so' hOithuirng: 13708/22/BT-CN/029-GDBT)
Kinh gui Quy khach hang: Nguyin Th] Biclt Tluio.
T6ng Cong ty C6 phdn Bao hidm Qudn tJ6i tJil xem xet H6 so b6i thuong cua Quy khacn hang.
Can cu vao Gidy yeu c6U tra tiJn bao hiem, Gidy chung nhdn bao hiem, H(lJJtJ6ng bao hiem, Quy
ttic bao hi€m, Chung toi thong bao vJ viec giai quy€t b6i thuong cua Quy khdch hang nhu sau:
NgU'O'iduo'c bdo hi~m: Nguyin Thi Bleb Thiio,
Dia chi: 219 Dai 1(JBinh Duong, P. Vinh Phu, Thi xil Thudn An.Tinh Binh Duong.
Tham gia bao hiern thea H£>BH s6: 6407121IHD-CNI029-PHH.
Can cir vao h6 sa b6i thuong
s6 J3708122IBT-CNI029-GDBT.
Va duoc duyet .ngay 23 thang 03 nam 2022
TAng 86 ti~n b6i thuirng: 1,425,752 d6ng,
(Bang chic: M(Jt trieu b6n tram hai muO'i lam ngan bay tram nam muO'i hai tJ6ng).
TrU'ong ho'p tfit ti~n b~ng ti~n mat:
Trong thai Iwn bay (07) ngay kS til kill nh~ duQ'c thong bao nay, nguai duQ'c bao hiSm (ho~c
Nguai thua k~ hQ'pphap) tr\Ic ti~p ho~c cli nguai dSn lInh ti~n tl;li: IT DVKH PHiA NAM
Khi d~n nh~n ti~n, d~ nghi Quy khach mang thea: GiAy chung minh nhan dan, truang hQ'Pnha
nguai khac nh~n h<)phai co GiAy uy quy~n hQ'Pphap.
TrU'o'ng hO'p Chuy~n khofm:
Theo yeu c~u cua Nguai duQ'c bao hiSm~chUng toi
+ Chii
tili khoan:
se chuySn s6 ti~n tren vao:
NGUYEN DUC SON.
+ TK 86: 92224392.
+ T~i:
Ngan hang VP BANK - CN TPHCM.
+ NQi dung thanh tmin: Tra ti~n bao hiSm cho Nguyln Thi Bich Thao, vao vi~n ngay 2710112022
tl;liB~nh vi~n BV CHO
RAY.
S6 tidn b6i (huang fren se aU(lc thanh toan bang aJn m(it ho(ic chuy€n khoan VaG Tat
khoan thea yeu c6u cua Nguai tJu(lCbao hdm. Sau 15 ngay nh(il'l tJu(lCthong bao nay, n€u MIC
kh6ng nhc;7nalWc phan h6i It;li fii: Ngum tJu(lc bao hi€m thi coi nhu S1,(ki?l'l bao hi€m tren tJilaU9'c
gild quydt xong, khong con thiic miic khi€u nc;zigi.
Cltti
y:
Tran trQng kinh chao .I.
Ngay 23 thang 03 nam 2022
NO'inhan:
- Nhu tren;
- Luu Phong TCKT.
- Luu Phong ....
BM!QT/CN/02.11
TONG CONG TY CO PHAN BAo IDEM QUAN DQI
J~!."'MIC
I
Bao Hiem Quan DQi
TO TRiNH BOI
(liB
SO'
THUQNG
sA: 1370S/22IBT -CN/029-GDBT)
I. Tom t~t h6 so' bAi tlnrong:
HQ ten nguoi tham gia bao hiem: Nguyin Th] Blch Tluio.
Thuoc don vi: CONG TY TNHH TWONG U1.I D1CH VT) TAN HI$P PHiT
Dia Chi
: 219 Dai 1(JSinh DU011g,P. Vinh Phu, Thi xii Thudn An, Tinh Binh DU011g.
Di~n thoai : 0903670525
Tham gia loai hinh bao hi8rn: Baa hiim Sue Khoe Nhom va Tai Nan Nhom.
Hop d6ng bao hi8rn s6: 6407121IHD-CNI029-PHH
Thai han BH: Til" 01104/2021 din 3110312022.
Muc trach nhiern bao hi€rn: Chit thuong tljl toan b(J va b9 phdn vinh viln do tai nan: 293,321,009; Nlim
vien do 6111dau, benh tdt/ndm: 40,000,000; PhJu thudt do 6m dau benh tdt/nam: 40,000,000; PhJu thudt
lien quan din cay ghep n(Ji tang do 6m dau, benh tgl: 40,000,000; Di€u tri truoc khi nhdp vien/ndm:
3,000, 000; Didu tri sou khi xudt vien: 3,000,000; Y fa cham soc tai nha/nam: 2,000,000; tro cdp nlim
vien/ngay: 60,000; _Dich v~ xe dIU thuang trong Zqnh th6 Vi~t Nom logi tru blin~ duimg hcmg khOng:
40,000,000; Tro' cap mai tang phi: 2,000,000; DKBS 01 - Dietl trj ngoqi tru do om aau, b?nh tgtlnam:
6,300,000; s6 ti€nllein kham: 2,000,000; s6 Zeinkhamlnam: 60; Vgt lj tri li¢ullein: 105,000; s6 lcin vgt Ij
tri /i?ulnam: 60,
Ngay d6ng phi: 20/04/2021.
Ngay vilO vi~n: 2710112022.
B~nh vi~n oi~u tri: BV CH(J RAY.
Nguyen nhan: DAU DAu (R6I LO~N ruAN HOAN MliU).
H~u qua: DAU DAu (R61 LO~N TuAN HOAN MliU).
HB sO'gAm co:
- GiAy yeu cAu tra ti~n bao hi€rn;
- Chung tir Oi~ll tri do co quan y t~ dp: HOA DON, TOA THU6c;
II.Danh gia h6 sO'eiia b6i thU'<rng VieD:
- Can cu vao nguyen nh8.n nh~p vi~n, chung tir y t~. K~t lu~n: THU9C PH4M VI BH
- GiAy ta kMm chu'a b~nh dAy du hQ'PI~.
~Ngay yell cAll tra ti~n bao hi€m thea thai h~n quy djnh.
III. Tinh toan b3i thu'()'Dg:
-
GiOi h~n BBi thu'<rng
Quy~n IQi dU'Q'c chi tn'i
Ty I~
(IT,PT,T
CNV)
Chi phi ngo?.i tru 6tr31 nam
(2trl l~n khal~l)
TAng cQng
s6 ngay
s6 ti~n b6i
aj~u trj
thu'img
1,425,752
sA ti~n
phat
sinh
D~xuAt b8i
thU'Ong
1,425,752
1,425,752
1,425,752
1,425,752
------
IV. Lieh sir tBn that:
s6 v1,I.: 1.
So lien: 1,183,782 d6ng.
Ten tai 1a: Nguyffn Ph(lnt Thanh Thao v6i. tu each 1ftb6i thuang vien cua MIC cam k~t da ki6rn tra tinh
chinh xac va hQ'p I~ cac chung tu tren, d~ nghj lanh dc,loduy~t s6 ti~n nhu sau:
B~ng s6: 1,425,752 dang.
B~ng chu'; M(>ttri~u b6n tram hai muoi lam ngan bay tram nam muoi hai d6ng.
S6 ti~n tren OLl'Q'C
chi tni cho nguai duQ'c bao hiSrn.
.
Ngay 23 thCtng03 nam 2022.
LA-NIl D~O DON
VI
PT. PHONG NGHl,E:P VV
BOI TmfONG
VIEN
Nguy~D Ph~m Thanh Thao
BM/QT/CN/02.16
t~!.~MIC
I
Bao Hlem Quan Diii
A
,
?",
?
:t.
THONG BAO TRA TIEN BAO HIEM
(Sblf6 so' b6i thuang: J3726/22IBT-CN/029-GDBT)
Kinh giri Quy khach hang:
vs« Bd Plti Yin.
T6ng Cong ty C6 phdn Bao hi~m Quan a9i ail xem xet H6 sa b6i thuang cua Quy khdch hang.
Can cu VaGGi6y yeu c6u trd tiJn bao hi~m, Gi6y chung nhdn bdo hiem, Hop a6ng bao hiem, Quy
tac bao hiem, Chung toi thong bao vd viec giai quyit b6i thuong cua Quy khach hang nhu sau:
Nguo'i dU'Q'c bao hi~m:
vn« es Phi yin.
Dia chi: 219 [)r,zi 19 Binh Duong,
r. Vlnh n« Thi xil Thudn
An, Tinh Binh Duong.
Tham gia bao hi~m thee HDBH sf,: 6407/21/HD-CN/029-PHH.
Can cir vao h6 sa b6i thuong sf, 13726/22/BT-CN/029-GDBT.
Di\ ducc duyet : ngay 23 thang 03 nam 2022
TAng
sA ti~n
b6i thU'ong: 176,770 d6ng.
(B{mg chic: M9t tram bay muo'; sau ngan bay tram bay muO'i a6ng).
TrU'(YDghooptra ti~n b~ng ti~n
mat:
Trong thai J1C;ln
bay (07) ngay k~ tir khi nh~ duQ'c thong bao nay, nguai duQ'c bao hi~m (ho~c
Ngum thua k~ hQ'Ppbap) tl1l'Cti€p ho~c cli nguai d~n 11nhti~n tl;1i:IT DVKH PHiA NAM
Khi d~n nh~ ti~n, d~ nghi Quy khach mang thee: Gi§.y chung min11nhan dan, truemg hQ'P nha
nguai khac nh~ h<)phai co Gi§.y uy quy~n hQ'Pphap.
Tru'ong ho'p Chuy~n khoan:
Theo yeu c~u cua Nguai duQ'c bao hi~m, chUng toi se chuy~n sf, ti~n tren vao:
+ Chii tfli khoan: VAN BA PH] YEN.
+ TK sA:
000046350.
+ T~i: Ngan himg VIB BiNII Dlf(JNG.
+ NQi dung
thanh toan: Tra ti~n bao hi€m cho Van Ba Phi Y~n, vao vi~n ngay 08/03/2022 t!;li
B~nh vi~n BV TP THO DUC.
Chu y: 86 tidn b6i thuang tren se au<)'cthanh loan bling tidn mgt hogc chuy~n khoan VaG Tai
khocm thea yeu cdu cua Nguai au<)'cbao hi~m. Sau 15 ngay nhq.n au<)'cthong bao nay, niu MIC
khong nh(in thwc phim h6i lr,zi til Ngum iJu<),cbaa hi~m Ihi coi nhu Sl:l ki?n bao h.i~m tren ail au<)'c
giai quydt XOl1g, khong con thac m6c khiiu n9i gi.
Tran trQng kinh chao .I,
Ngay 23 thang 03 nam 2022
Nai nhan:
- Nhu tren;
- Luu Phong TCKT.
- Luu Phong ....
BMlQT/CN/02.11
TONG CONG TV cO PHAN BAo HIEM QUAN B(H
"..!!,....
·....
'1
MIC
8ao Hlem Quin 091
TO TRINH DOl TIIUONG
(He} so' sa: 13726/221BT -CN/029-GDBT)
I. Tom t~t h6 so' b6i thirong:
HQ ten ngiroi tham gia bao hiem: Viin Btl Phi yin,
Thuoc dan vi: CONG TY TNHH THUONG MAl D!CH vi)TAN nit» nur.
Dia Chi
: 219 Dai l(j Binh Duong, P. Vinh Phil, Thi xii Thudn An, Tinh Binb Duong,
Bi~n thoai
: 0901303110
Tham gia IO;;J.i
hinh bao hi€m: Baa hiim Sire Khoe Nhom va Tai Nan Nhom.
HQ'p d6ng bao hiem s6: 6407121IHD-CNI029-PHH
Thai han BH: t» 01104/2021 din 3110312022,
Mire trach nhiern bao hiem: CMt thuang t~t loan b(j va b(j phdn vinh viin do tat nan: 293,321,009; Niim
viin do 6m dau, benh. tdt/nam: 40,000,000; Phdu thudt do 6m dau benh tdt/ndm: 40,000,000; Phdu thudt
lien quan din cdy ghep n(ji tang do 6m dau, benh tdt: 40,000,000; DiJu tri tnarc khi nhdp vien/nam:
3,000,000; ou« tri sau khi xudt vien: 3,000,000; Y ta cham soc tai nha/nam: 2,000,000; tra cdp niim
vien/ngay: 60,000; Dich v¥ xe cuu thuong trong 19nh th6 Vi?t Nam logi trir biin~ ducmg hang khOng:
40,000,000; TrCl cdp rna; tang phi: 2,000,000; DKBS 01 - Di~u tri ngogi tril do om dau, b?nh t(ltlnam:
6,300,000,' s6 tidnlldn kham: 2,000,000; S6 Mn khamlnam: 60; V(ll If tri Mullan: 105,000; s6 Ian v(lt If
tri li?ulnam: 60.
Ngay dong phi: 20/04/2021,
Ngay vao vi~n: 0810312022,
B~nh vi~n di~lItri: BV TP TH(; DUe.
Nguyen nhan: VIEM PHE QUAN cAp, VIEM MOl D! UNG KHAe.
H~u qua: VIEM PH£' QUAN cAp, VIEM MOl DI (fNG Kille.
). co:
,
Ho" sO'gom
- GiAy yeu cAli tra ti~n bao hi€m;
- Chlrng tll' di~u tr! do cO'quan y t~ cAp: HOA DON, TOA THUDC, KQ
II.llanh gia h6
SO'
x QUANG,'
cua b6i thU'irngvien:
- Can Clrvao nguyen nhan nMp vi~n, ch(mg tll' y t~, K~t lu~n: THUOC PH4,M VI BH
- GiAy ta kham chua b~nh dAy du hQ'p t~,
- Ngay yeu du tra ti8n bao hiSm thea thai h~n quy dinh,
III. Tinh tO~lnb6i thU'irng:
Quy~n
IQ'j
dU'Q'Cchi tn\
I
Gio'i h~n B&i thU'Ong
Ty I~
(TT,PT,T
CNV)
Chi phi ngo~i tru 6tr31 nam
(2trl tAnkham)
sA ti~n
S6 ngay
S3 ti~n b6i
di~u trj
thu'(rng
176,770
TAng cQng
pMt
sinh
D~ xu~t b&i
thllOng
176,770
176,770
176,770
176,770
IV. Lich sU' tan thit:
s6 V(.I: 12.
s6 ti~n: 2,291,286 d6ng,
Ten t6i la: NguyJn Ph(lm Thanh Tluio vai tu cach la b6i thuang vien eua MIC earn k~t da ki€m tra tinh
ehinh xac va hQ'pI~cac chlrng tll' tren, d8 nghi tanh d!,loduy~t s6 ti8n nhu sau:
B~ng s6: 176,770 d6ng,
- B~ng cha·: Mot tram bay muO'i sau ngan bay tram bay muO'i d6ng,
S6 ti~n tren duQ'Cchi tra eho nglIai dlIQCbao hiSm,
N~ay 23 thang 03 nam 2022,
LANH D~O DON Vl
PT. PHONG NGHI¥P
VV
BOI THlJ'ONG vrEN
Nguy~n Ph~m Thanh Tbao
BM/QT/CN/02.16
~~'!.'_MIC
..
Bao Hiem Quan DQi
..
THONG BAO TRA TIEN BAO HIEM
(sa H6 SO' b8i thuimg:
13728/22/BT-CN/029-GDBT)
Kinh giri Quy khach hang: Trim Th] Phuong,
T6ng Cong ty C6 phdn Baa hiim Qudn a9i aii xem xet H6 sa b6i thuang cua Quy khdch hang.
Can cu VaG Gidy yeu cdu tra tien bao hiem, Gidy chung nhdn bao hiem, H(lJJa6ng bao hiJm, Quy
tAc bao hiem, Chung toi thong bao v~ viec giai quyet b6i thuang cua Quy khach hang nhu sau:
Ngmri duge bao hi~m: Trail Th] Phuong,
Dja chi: 219 Dai 19 Binh Duong, P. Vinh Phu, Th; xii Thu(in An, Tinh Binh Duong.
Tham gia bao hiern thee HDBH s6: 6407121IHD-CNI029-PHH.
Can cir vao h6 sa b6i thuong s6 13728122IBT-CNI029-GDBT.
Da diroc duyet .ngay 23 thang 03 nam 2022
Tang
sA ti~n
bAi thuong: 515,000 d6ng.
(Bang chii: Nam tram muai lam ngan a6ng).
Tru'o'ng hQ]J tra ti~n b~ng ti~n mat:
Trong thai h~ bay (07) ngay k~ tu khi nh~n duQ'c thong bao mly, nguOi dUQ'cbao hi~m (ho~c
Nguai thtra k~ hQ'pphap) tf\l'Cti~p ho~c cu nguai d~n Hnh ti~n t~i: IT DVKH PHiA NAM
Khi d~n nh~n ti~n, d~ nghj Quy khach mang thee: Gi~y chUng minh nhan dan, tfUang hqp nha
nguai khac nh~n ho phai c6 Gi~y uy quySn hQ'pphap.
Tru'irng hop Chuy~n khoan:
Theo yeu du cua Nguai duQ'c bao hi~m, chlmg toi se chuy~n s6 ti~n tren vao:
+ Chii ali khoan: TRAN TH{ PHUONG.
+ TK sA:
613704060423180.
+ T~i: Ngan h~mg VIB.
+ NQi dung
thanh toan: Tra ti~n bao hi~m cho Trdn Thi Phuang, vao vi~n ngay 2610212022 t~i
B~nh vi~n ITYH DI TRUYEN SINH HOC PHAN TU MIEN NAM.
Chu y: s6 tidn b6i {huang tren se au(}'c thanh toan bang ti~n mi'j.thoi'j.cchuyin khoan VaG Tai
khoim thea yeu c6u cua Ngu(J'i QU'{),c bao hi€m. Sou 15 ngay nh(m au(}'c thong bao nay, niu MIC
khong nh4n C1lWC phdn h6i IC;Zi tir Nguoi au(}'cbao hiim {hi coi nhu Sl! ki¢n bcw hidm tren aa au(}'c
giai quydt xong, khong con thAc mac khiiu nc;zigi.
Trao trQng kinh chao .I.
Ngay 23 thang 03 nam 2022
Nai nhan:
- Nhu tren;
- Luu Phong TCKT
- Luu Phong ....
BMlQT/CN/02.11
TONG CONG TY CO PHAN BAO IDEM QUAN D(H
-
)~!."MIC
I
Bao Hiem Qua" Dol
TO TRINH BOI THU'<1NG
(Hi> so' sA: 1~728/22/BT-CN/029-GDBT)
I. Tom t~t h8 so b8i thuong:
H9 ten nguoi tham gia bao hi~m: Trim Th] Phuong.
ThuQc don vi: CONG TY TNHH TWaNG ~I DICH vt)TAN HIEp PI-JAT.
.
Dia Chi
: 219 Dai 19 Binh DU07Ig, P. Vinh Ph';', Thi xii Thudn An, Tinh Binh DU07Ig.
Di~n thoai : 0933982959
Tham ~ia loai hi~h ba? hiern: Bao hidm sUe Khoe Nhom va Tai Nan Nhom.
Ho-pdong baa hiem so: 6407121IHD-CNI029-PHH.
Thai han BH: n'rOl10412021 ddn 3110312022.
Mire trach nhiern baa hiem: Chit thuong t41 loan b9 va b9 phdn vinh viin do tai nan: 293,321,009; N&m
vien do 6711dau, b?nh tdt/nam: 40,000,000; Phdu thudt do 6711dau benh tdt/niim: 40,000,000; Phdu thudt
lien quan din piy ghep n9i tgnp do 6m dau, benh tgt: 40,000,000; Di€u tri truce khi nhdp vi?'}lna,!,:
3,000,000; Dieu tri sau khi xudt vien: 3,000,000; Y ta cham soc tai nha/nam: 2,000,000; tra cap nam
vien/ngay: 60,000; Dich v¥ xe cuu thuang trong lanh tl1(5 Vi~t Nam logi tru b&nfr dwYng hang khong:
40,000,000; Tr(J cap mai tang phi: 2,000,000; DKBS 01 - Dieu trj ngogi tru do om dau, b?nh t~tlniim:
6,300,000; s6 ti€nl16n khcim: 2,000,000; S6 idn khdmlnam: 60; Vgt ly tri li?ulI6n: 105,000; s6 idn vgt If
tri li?ulniim: 60.
Ngay dong phi: 20/04/2021.
Ngay vao vi~n: 2610212022.
B~nh vi~n di~u tri: TTYH DI TRUYEN SINH HOC pmN
MIEN NAM
Nguyen nhan: DUaNG TiNHCOVID 19.
H~u qua: DUONG TiNHCOVID 19.
H6 SO' gam co:
ni
- Gi~y yeu du tra ti~n baa hi~m;
_ Chung tl1 di~u tri do CO" quan y t~ cAp: HOA DON, KET QuA TEST PCR (CT 22.20);
II.Banh gia h8 sO' cua b8i thU'<rngvien:
_ Can Clr vao nguyen nhan nh~p vi~n, ch(mg tu y t~. K~t iu~n: THUOC PH1.M VI BH
- Gi~y ta khfun chua b~nh dfiy du hqp i~.
- Ngay yeu du tra ti~n bite hi~m thea thai h~n quy dinh.
III. Tinh toan b8i thU'ong:
Gi6i h:;lD B6i thU'b'ng
Quy~n )c;)'idU'Q'cchi tra
Chi phi ngo~i tru 6tr3/ nam
(2tr/ IAn kham)
TAng cQng
Ty I~
(TI,PT,T
CNV)
s6 ngay
s6 ti~n bai
l1i@utrj
thu-cYng
S.(·).
o tlen ph'ta
sinh
515,000
I
D~ xu~t bAi
thU'<mg
515,000
515,000
515,000
515,000
IV. Ljch sir tan th~t:
S6 v¥: 2.
S6 ti~n: 861,300 d6ng.
Ten toi ill: Nguyin PIl(lnl Thanh Tiziio v6i tu cach la b6i thuang vien cua MlC cam k~t da ki~m tra tinh
chinh xac va hqp I~cac chUng ttl tren, d~ nghj 1anh d~o duy~t s6 ti~n nhu sau:
"
~
.
Bang so: 515,000 dang.
B~ng chi1":Nam tram muaj lam ngim d6ng.
S6 ti~n tren olrqc chi tra cha ngu(yi duqc baa hi~m.
Ngiry 23 thang 03 niim 2022.
BOI
TWONG VIEN
PT.
PHONG
NG~P
Vl,J
LANH D~O DON VI
~
Nguy~n Ph~m Thanh Tbao
BM/QT/CN/02.16
t~!:"MIC
I
U
Bw Hiem QuanDQI
"
r
?
~
?
~1)
l/
2:
THONG BAO TRA TIEN BAO HIEM
(Sa H6 so' b6i thuong: J3596/22/BT-CN/029-GDBT)
Kinh giri Quy khach hang: Le Tit! Khoa.
cs
Tong Cong ty
phdn Baa hidm Qudn a9i ali xem xet H6 so b6i thuong cua Quy khach hang.
Can CLf VaGGidy yeu cdu Ira li~n bao hiem, Guiy chung nhdn bao hiem, H9P d6ng bao hiem, Quy
tdc baa hi€m, Chung toi thong baa v~ viec gidi quyet b6i {huang cua Quy °khach hang nhu sau:
Ngu<ri ouge bao hi~m: Le Tit! Kltoa.
Dia chi: Duong N5, khu cong nghiep Song Thdn 3, Phuong Phu Tan, Thanh ph6
Tinh Binh Duong,
n« Nam.
m« os« M9t,
Tham gia bao hi8m thea HDBH s6: 6411121IHD-CNI029-PHH.
Can cir VaGh6 sa b6i thuong s6 13596122IBT-CNI029-GDBT.
Dlt duoc duyet : ngay 23 thang 03 nam 2022
TAng
sB ti~n bBi thuong:
2,000,000 d6ng.
(Bang chit: Hai trieu tl6ng).
S6 ti8n yeu c~u: 2,1 OO,OOOd
S6 tien ill chci: 100,000d do vUQ'th~
mll'Cchi phi di~u tIi rang 2,000,0001 nam
Truong hQJJtra ti~n b~ng ti~n mat:
Trong thai lwn bay (07) ngay k~ tu khi nh~n dugc thong bao nay, nguai dugc bao hi~m (ho~c
Nguai thua k~ hgp phap) tf\.rc ti~p ho~c Cll nguai d~n linh ti~n t~i: IT DVKH PHiA NAM
Khi d~n nh~n ti~n, d~ nght Quy khach mang thea: GiAy chUng rninh nhan dan, truang hgp nha
nguai khac nh~ hQ phai co GiAy uy quy~n hgp phap.
Tru<rng ho'p Chuy~n khoan:
Theo yeu cc1ucl\a Nguai dUQ'cbao hi~m, chung toi
+ Chii titi khoan:
+ TK
sB:
LE
se chuy~n s6 ti~n tren
VaG:
TH! KHOA.
000039711.
+ T~i: Ngan himg VIR RiNH DUONG.
+ NQi dung thanh toan: Tra ti~n bao hi~m cho Le Thj Khoa, vao vi~n ngay 2110212022 t~i B~nh
vi~n NHA KHOA BiNH DUONG.
Chu y: s6 tidn b6i tlnu}'ng tJ'{m sf! a~l'9'cthanh loan bCmg tiJn m~llho(ic chuy€n khoan viw Tai
khocin thea yeu c6u cl"ta Nglt'()'i tllwc bao hi€m. Sau 15 ngity nh(in au9'c thong bao nay, niu MIC
khong nhQn aU'(J'cphan h6i i(li tit Nguo'i al,Wc bao hidm thi coi nhu SI! ki¢n bao hi€m tren aa tiu9'c
giai quyit xong, khong con thilc mile khiiu ngi gi.
Tran trQng kinh chao .I.
Ngay 23 thang 03 nam 2022
N<ri nha.n:
- Nhu fl-en;
- Luu Phong TCKT.
-Luu Phong ....
BMlQTICN/02.11
TONG CONG TV CO PHAN BAO HIEM QUAN DOl
TO TRiNH
nOI
THU'ONG
(lIt> so' sa: 13596/22/BT -CN/029-GDBT)
I.Tom t~t hB SO' bBi thuong:
HQ ten nguoi tham gia bao hi~m: Le Thi Khoa.
ThuQc dan vi: CONG TY TNHH sAN XUAT TRUONG MAl DICH
NUM BER ONE.
Dia Chi
: Duong N5, khu cong nghiep Song Thdn 3, Phuong Phu Tan, Thanh ph6 Thu Ddu
M(JI, Tinh Sinh Duong, Vi?t Nam.
Dien thoai : 0978804597
Tham gia loai hinh bao hiern: Bao hdm Sue Khoe Nhom va Tai N{In Nhom.
Hop a6ng bao hiem s6: 6411121IHD-CNI029-PHH
Thai han BH: Til' 01/04/2021 din 3110312022.
Mire trach nhiern bao hiem: Chit thuang t4t toan b(J va b(J phdn vinh vien do tai nan:
272,744,932; Nam vien do 6m dau, b?nh tat/nom: 40,000,000; Phdu thudt do 6m dau benh
tdt/ndm: 40, 000, 000; Ph6u thudt lien quan ddn cay ghep n(Ji tang do 6m dau. benh tdt:
40,000, 000; Di~u tri truce khi nhdp vien/nam: 3, 000, 000; Di~u tri sau khi xudt vien: 3, 000, 000; Y
ta cham soc tai nha/nam: 2, 000, 000; Ir9' cdp nam vien/ngay: 60, 000; Dich V~t xe cuu thuang
trong lc;mhth6 Vi¢t Narn IO{Ii{ru bang auimg hang khong: 40, 000, 000; Tr(1 cdp mai tang phi:
2,000,000; DKBS OJ - Di€u trf ngo{Ii tru do 6m aau, benh t4tlnam: 6,300,000; s6 ti~nlldn kham:
2, 000, 000; s6 ltin khamlnam: 60; V(it /-y Irf lieu/idn: 105, 000; s6 ldn v(it ly trf lieu/nam: 60.
Ngay d6ng phi: 20/04/2021.
Ngay VaGvi~n: 2110212022.
B~nh vi~n ai~u tri: NHA KHOA BiNH DUONG.
Nguyen nhan: TRAM RANG SAU R15 162636374647.
H~u qua: TRAM RANG SAU R15 162636374647.
HB so' gAm co:
- Gifry yeu d.u tra ti~n bao hi~m;
- Chung ill ai~u tri do co quan y t~ cfrp: HOA DON, PHIEU DIEU TRI RANG;·
II.Danh gia hB SO' cua b6i thu'o'ng vien:
- Can eu van nguyen 11hanllh~p vi~n, chung ttT y t~. K~t lu?n: THUOC PHAM VI BH
s6 tiJn yeu cdu: 2,100, OOOd
s6 tidn b6i thuang: 2, 000, OOOa
s6 tidn It't' ch6i: 100, OOOado vU(1th{In mt'ccchi phi didu tr; rang 2, 000, 0001 nam
- Gifry to' kham chu'a b~nh d~y au hqp l~.
- Ngay yeu du tra ti~n bao hi~m thea thai h?n quy ainh.
III. Tinh toan b6i thU'()'Og:
ro
Gio'i h~o B6i thU'o'og
Quy~n lQ'idtrQ'c chi tra
s6 ti~n
So
Ty l~
b'"
(TT,PT,'
ngay
. 01
t.htrb'ng
_ PCNV) di~u tri
Chi phi di~u tri rang
I
2,000,000
2,000,000/ l1am
i
------
TAng cQug
L-
IV. Ljch SIT tAn thit:
s6 Vl:t: O.
--=-t=L.
_
s6 ti~n
phat
sinh
1>).e xua~t b'"01
thtrbng
2,000,000
2,000,000
2,100,000
2,000,000
s6 ti€n: a tJ6ng.
Ten toi la: Nguyin P/uJn7 Thanh Tltiio v6i tu each la b6i thuang vien cua MIC cam k~t aa kiSm
tra tinh chinh xac va hqp l~ cae chung ill tren, a~ nghi Hinh a?o duy~t s6 ti~n nhu sau:
B~ng s6: 2,000,000 d6ng.
BM/QT/CN/02.16
,.._,.
MIC
t,--·.....
_
I
Bao Hlem Quan DQi
Bang chtr: Hai trieu d6ng.
S6 ti~n tren duoc chi tra cho nguoi dlIQ'C bao hiem.
LANH D~O DON vr
BM/QT/CN/02.16
PT. PHONG NGHI¢P Vl}
Ngay 23 thong 03 nam 2022.
BOI TWONG VIEN
,~
MIC
"1
'
I. ,...
;_/;y
,
MO Hiem Quan D9i
THONG BAo TRA TIl~N BAo HIEM
(sa H6
so' b6i thuirng: 14571122IBT-CNI029-GDBT)
Kinh giri Quy khach hang: Truong Th] H6ng Thl.
T6ng Cong ty C6 phdn Bdo hi~m Qudn il9i ilil xem xet H6 sa b6i thuang cua Quy khach hang.
Can cu VaGGidy yeu cau tra ti€n bao hiem, Gidy chung nhdn bao hi~m, H9P il6ng bao hi~m, Quy
tac bao hidm, Chung toi thong bdo v€ viec giai quydt b6i thuong cua Quy khach hang nhu sau:
Ngutri dUQ'c bao hi~m: Truong Th] H6ng Thl.
Dia chi: Duong N5, khu cong nghiep Song Thdn 3, Phuong Phu Tan, Thanh ph6 Thu Ddu M9t,
Tinh Sinh Duong, Vi?t Nam.
Tham gia bao hiem thea HUBH s6: 6411/21/HD-CN/029-PHH.
Can cu vao h6 sa b6i thuong s6 14571/22/BT-CN/029-GDBT.
Da duoc duyet .ngay 28 thang 03 nam 2022
TAng
sB ti~n
b6i thuO'ng: 400,000 d6ng.
(Bang chit: B6n tram ngan il6ng).
S6 tiSn yeu d.u: 400,600d
S6 tiSn tiI ch6i: 600d do vugt h"m muc chi phi kham thai dinh ki 400,0001 nam
TruOng ho'p tra ti~n b~ng ti~n mat:
Trong thai h:,m bay (07) ngay kS til khi nh~ duQ'c thong bao nay, nguai duqc bao hiSm (ho~c
Nguai thiIa k8 hqp phap) tn!c tiSp ho~c cu nguai d8n lInh ti€n t~i: IT DVKH PHiA NAM
Khi dSn nh~n ti€n, d€ nghi Quy khach mang thea: Gi~y chUng minh nhan dan, truemg hgp
nguai khac nh~ hQ phai c6 Gi~y uy quy€n hQ'pphap,
nha
TruOng hop Chuy~n khoan:
Theo yeu c~u clla Nguai duqc bao hiSm, chung toi se chuySn s6 tiSn tren vao:
+ ChiI tai khoan: TRUONG TH! HONG THI.
+ TK sB: 149991328.
+ T~i: Ngan hang VP BANK - CN BiN.H DU(JNG.
+ NQi dung thanh toan: Tra ti€n bao hiSm cho Truong Thi H6ng Thi, vao vi~n ngay 08/03/2022
t~i B~nh vi~n BV DA KHOA Quac
TE BECAMEX.
Clut y: s6 tidn b61 Ihuimg U'en se ilu9'c thanh toan bang ti€n m9t h09c chuy~n khocm VaG Tal
khoan thea yeu du czja Nguai ilu9'c bao hi~m. Sau 15 ngay nh4n au9'c thong bao nay, niu MIC
khong nhcJ.natwc phdn hdi l(li til: NguiJi aUQ'cbdo hi~m thi cai nhu Sf! ki?n baa hidm (ren ilil ilu(Jc
gidi qUY&1
xong, khong con thc1cmc7ckhi&u m;zigi.
Tran tr<;mgkinh chao .I.
Ngay 28 thang 03 nam 2022
Nai nhan:
- Nhu tren,'
- Luu Phong TCKT
- Luu Phong ....
BM/QT/CN/02.11
TONG CONG TY
CO PHAN
BAo HIEM QUA.N D(H
TO TRINH BOI THlrONG
(H6 so' s6: 14571122IBT -CN/029-GDBT)
I.Tom t~t hB so' bBi thtrirng:
HQ ten ngiroi tham gia bao hiem: Truong Th] Hang Thi.
ThuQc dan vi: CONG TY TNHH SA'N XUAT THUONG ~I D!CH Vl) NUM BER ONE.
Dia Chi
: Duong N5, khu c/ing nghiep Song Thdn 3, Phuong Phu Tan, Thanh ph6 Thu Ddu
M9t, Tinh Binh Duong,
Nam.
Di~n thoai : 0976755237
Tham gia loai hinh bao hiem: Bao hiim Sue Khoe Nhom va Tai Nan Nhom.
Hop d6ng bao hiern s6: 64I1I211HD-CN/029-PHH
Thai han BH: Tit:01/04/2021 din 3110372022.
Mire trach nhiem bao hiem: Chit thuong teJt toan b9 va b6 phdn vinh vien do tai nan:
272,744,932; Nam vien do 6m dau, b~nh tdt/nam: 40,000,000,' Phdu thudt do 6m dau benh
tdt/nam: 40,000,000; Phdu thudt lien quan din cdy ghep mJi tang do 6m dau, benh tdt:
40,000, 000; Di~u tri truce khi nhap vien/nam: 3,000, 000; Di~u tri sau khi xueit vien: 3,000,000; Y
ta cham soc tai nha/ndm: 2,000,000; tro ceip nlim vien/ngay: 60,000; Dich v~ xe cuu {huang
trong lanh th6 Vi?! Nam IO(li trit bling duang hang kh6ng: 40,000,000; Tr(J ceip mai tang phi:
2,000,000; DKBS 01 - £)i~u tri ngo(li trit do 6m dau, b?nh teJt/nam: 6,300,000; s6 ti~nlldn kham:
2,000,000; S6Zdn khamlnam: 60; VeJtIy tr; li~uIldn: 105,000; S61dn veJtIy trj li?ulnam: 60.
Ngay d6ng phi: 23/04/2021.
Ngay vao vi~n: 08/03/2022.
B~nh vi~n diSu trt: BV DA KHOA Quac TE BECAMEX.
Nguyen nhan: KHAM THAI D[NH Ki.
H~u qua: KJ-IAM THAI DINH Ki
" co:
,
Ho" SO' gom
- Gidy yeu du tra tiSn bao hi~m;
- ChUng ill diSu tri do co quan y t~ cdp: HOA DON, BANG KE CP, KQ xiT NGHrSM-SIEU AM,
PHIEU KHAM THAI;
II.Danb gia hB SO' clla bBi thuong vien:
- Can clI vao nguyen nhan nh~p vi~n, chung ill y t~. K~t lu~: THUOC PHAM VI BH
s6 ti~n yeu cdu: 400,600d
s6 ti~n b6i thuong: 400,000d
s6 ti~n tit:ch6i: 600d do vU(Jth(ln m~c chi phi kham thai djnh ki 400,000/ nam
- Gidy kM.m chua b~nh d~y du hgp l~.
- Ngay yeu du tra tiSn bao hi~m thea thai h~ quy dinh.
III. Tinh toan b8i tbu(rng:
n«
ta
Gioi h~n BBi thuo'ng
Quy~n IQ'idu'gc chi tra
Chi phi kham thai dinh ki
400,000/ nam
TAng cQng
sa
Ty l~
(TT,PT, . ngay
TCNV) di~u tri
sJ:Olen
f"
p h'at
sinh
sa
ti~n
b'"01
thU'(rng
400,000
D~ xuit bBi
thU'(rllg
400,600
400,000
400,600
400,000
i
IV. Lich sfl' tAn thit:
s6 v~: o.
s6 ti~n: 0 d6ng.
Ten tei la: Nguyin Ph{lm Thanh Tluio v6i tu each ta b6i thuang vien cua MIC cam k~t da ki~m
tra tinh chinh xac va hgp l~ cae chung ill tren, dS nghi lanh d~o duy~t s6 tiSn nhu sau:
BM/QT/CN/02.16
t~!."'MIC
,I sao Hli!m Qljan 091
B~ng s6: 400,000 d6ng.
Bang chir: 86n tram ngan d6ng.
S6 tiSn tren duoc chi tra cho nguoi duoc bao hiem.
LANH D~O DON VI
PT. PHONG NGm:E:p
vv
Ngay 28 thang 03 nam 2022.
BOI TRUONG vrEN
Nguy~n Pham Thanh Thao
BM/QT/CN/02.16
t~~'_MIC
I.
Bat Hlem l)uiin OQi
THONG BAo TRA TIEN BAo IIIEM
(Sa H6
SO'
b6i tlucang: J3603/22/BT-CN/029-GDB.T)
Kinh gui Quy khach hang: Nguyln. Hieu Hoa.
Tong Cong ty C6 phdn Bao hiim Qudn a9i aa xem xet H6 sa b6i thuong cua Quy khdch hang.
Can cu' VaGGidy yeu ceiu tra tiJn bao hiem, Gidy chung nhdn bao hi~m, H(/JJa6ng bao hiem, Quy
tlic bdo hiem, Chung toi thong bao v€ viec gidi quyet b6i thuong cua Quy khdch hang nhu sau:
Nguo'i du'Q'cbao hi~m: Nguyil1. Him Hoa.
Dia chi: Duong N5, khu cong nghiep Song Thein 3, Phuong Ph'Ll ra« Thanh ph6 ti« Ddu M9t,
Tinh Binh Duong, Viet Nam.
Tham gia bao hi~m thee HDBH s6: 64JJ/2J/HD-CN/029-PHH.
Can cir vao h6 sa b6i thirong s6 J3603/22/BT-CN/029-GDBT.
Dff duoc duyet : ngay 23 thang 03 nam 2022
Tang
s6 ti~n bai
thuong: 316,739 06ng.
(Biing chii: Ba tram muoi sau ngan bay tram ba muoi chin a6ng).
S6 ti€n yeu du: 466,7390
S6 ti€n
ch6i: 150,000d chi phi test Covid-19 khong thuQc phl;lJIlvi BH.
tu
Tru'o'ng hoop tdi ti~n b~ng ti8n mat:
Trong thai lw.n bay (07) ngay k~ ttT khi nh~n duQ'c thong bao nay, nguai duQ'c bao hi~m (ho~c
Nguai thua k~ h9'P phap) tl'l,rcti~p ho~c cu nguai d~n lInh ti~n tC;li:TT DVKH PHiA NAM
Khi d~n nh~ ti€n, d€ nghi Quy khach mang thee: Gi~y chung minh nhan dan, truang h9'P nha
nguai khac nh~n hQ phai co Gi~y uy quy~n hQ'pphap.
TrU'o'ng h9'P Chuy~n khoan:
Theo yell c~u cua Nguai duQ'c bao hi~m, chung toi
se chlly~n s6 ti~n tren vao:
+ Chu tai khoan: NGUYEN H(lU HOA.
+ TK s6: 500040688.
+ T~i: Ngan hang Vi>BANK.
+ NQi dung thanh toan: Tra ti~n bao hi~m cho NguyEn Hiru Hoa, vao vi~n ngay 22/02/2022 va
08/03/2022 tC;liB~nh vi~n BV DK rU NHAN PHUC HUNG.
C/Ill :v: s6 t;dn b6i !huong {ren se aLl'()'cthanh (oan biing ti~n m41 ho4c chuyJn khoan VaG Tai
khocm thea yell c6u clla NglCO'iaU9'Cbcw hidm. Sau 15 ngay nhqn aU(Jc thong bao nay, niu MIC
khong nhqn thule phiin h6i It;n't£I' Nguoi ctu:(Jcbao hi€m thi coi nhu Sl! ki?n bao hidm tren aa azr(Jc
g;ai quyit xong, khong con thiic m6c khiiu nQi gi.
Tran tr<;mgkinh chao .I.
Ngay 23 thang 03 nam 2022
NO'inhlin:
- Nhu tren,'
- Luu Phong TCKT
- Luu Phong ....
BM/QT/CN/02.11
TONG CONG TV
CO PHAN
BAo HIEM QUAN DQI
ct-=- S
---
TO TRINH BOI THUONG
(lIB so' s6: 13603/22/BT-CN/029-GDBT)
I. Tom tit hB so bBi thuong:
HQ ten nguoi tham gia bao hiern: Nguyln Hieu Hoa.
ThuQc dan vi: CONG TY TNHH SAN xurr THUONG M41 D[CH vu NUM BER ONE.
rsa
D~a Chi
: Duong N5, khu cong nghiep Song Thdn 3, Phuong
Tan, Thanh ph6 ti« Ddu
MrJt, Tinh Binh Duong, Vi?t Nam.
Di~n thoai : 0905672835
Tham gia loai hinh bao hiern: Baa hidm Sue Khoe Nhom va Tai Nan Nhom.
HQ'pd6ng bao hiem 56: 6411/2J/HD-CN/029-PHH
Thai han BH: Tic OJ/04/202 J din 31/03/2022.
Mire trach nhiern bao hi~m: Chit thuong t4t loan brJ va brJ phdn vinh vien do tai nan:
272,744,932; N6m vien do 6m dau, b?nh tat/nom: 40,000,000,' Phdu thudt do 6m dau benh
tat/nom: 40, 000, 000,' Phdu thudt 'lien quan din cdy ghep nrJi tang do 6m dau, benh tdt:
40,000,000; DiJu tri truce khi nhdp vien/nam: 3, 000, 000; ou« tri sau khi xud: vien: 3, 000, 000; Y
ta cham soc tai nha/nam: 2,000,000,' tro cdp nam vien/ngay: 60, 000; Dich v¥ xe cUu thuong
trong lanh th6 Vi?t Nam IO(,litnt b6ng ducmg hang khong: 40, 000, 000; Tr(l cdp mai tang phi:
2,000,000,' DKBS 01 - Didu trj ngogi tru do 6m aau, b?nh t4t/nam: 6,300,000; s6 tidnlZdn kJuim:
2,000,000; S61dn kham/nam: 60,' V4t If; trj li?ulldn: 105,000; S6ldn v4t If; trj li?u/nam: 60.
Ngay dong phi: 20/04/2021.
.
Ngay vao,vi~n: 22/02/2022 va 08/03/2022.
B~nh vi~n di€u tIi: BV DK TU NHAN PH[lC HUNG.
Nguyen nhan: VLEM PHE QUAN PHD!, DAU NG[/C KHONG DJC HIEu. TRAo NGUOC D~
DAYTHT/C QuAN.
H~u qua: VIEM PHE QUAN PHD!, DA u NGUC KHONG DAC HreU, TRAo NGU(JC D~ DAY
THTjC QuAN.
HB sO'gBm co: "
- Gi§.y yeu d,lI tra ti~n bao hi~m;
- Chung ill diSu tr~do cO'quan y t~ c§.p:HOA DON, TOA THUDe, BANG KE TIEN THUDC, KQ
X QUANG;
II.Danh gia hB sO'cua bBi thu'(mg vien:
- Can ClY vao nguyen nhan nh~p vi~n, chung tiI y t~, K~t lu~n: THUOC P H~M VI BH
s6 tiJnyeu cdu: 466,739d
s6 tiJn b6i thuang: 316, 73 9d
S6 tidn He- ch6i: 150, OOOdchi phi test Covid-19 khong thurJcphgm vi BH
- Gi§.y ta kharn chua b~nh d~y dil hQ'pl~,
- Ngay yeu c~u tra ti€n bao hi~m thea thai h~ quy d~,
III. Tinh toa" bBi thU'img:
,Quy~n lQ·j dU'Q'C chi tra
Gi6ih~n
--1'5'
1-
Tong cQng
i
__
I
(TT,PTtngay
TCNV) di~u tri
______
~
Chi pl;i ngo~i tru 6tr3/ nam
(2:1'1 lan kham)~
_
l~-
I
B6i thU'ong
s6- s6ti~~
sa ti~n phat
b6i
thU'on ~
316 7 39
1
_~ ~
_L___
sinh
466,739
316,739
466,739
316,739
IV. Lich su' tBn thftt:
S6 V1,J:
2.
BM/QT/CN/02.16
s6 tidn: 2,508,800
D~ xuit b6i
thU'Ong
d6ng
,._.fa
J,,'" ...
MIC
.
.I .Bao Hlem Quan 091
. Ten toi la: Nguy€n Pham Ttianli Tluio voi tu each la b6i thuong vien cua MIC cam k~t aa Idem
tra tinh chinh xac va hop l~ cac clnrng nr tren, d~ nghi lanh dao duyet sf>tiSn nhir sal}:
Bang s6: 316,739 d6ng.
Bang chir: Ba tram muoi sau ngan bay tram ba rmroi chin d6ng.
S6 ti~n tren duoc chi tra cho ngiroi duoc bao hiem.
Ngay 23 thdng 03 nam 2022.
BOI TmrONG VIEN
PT. PHONG NGI1I¥P VV
LANH D~O DON VJ
NgUY~DPham Thanh Thao
BM/QT /CN/02.16
t~!."'MIC
I.
Bao Hiem Quan 091
"
,
?
?).
:1:
THONG BAO TRA TIEN BAO HIEM
(s6 lfa
so' bai thuong: J3590122IBT-CNI029-GDBT)
Kinh giri Quy khach hang: Vii Van Tuyin.
Tbng C6ng ty Cb phdn Bao hi€m Qudn c1(Ji dCixem xet H6 so b6i thutmg cua Quy khacb hang.
Can cu vao Giay yeu cdu Ira tiJn baa hiem, Gidy chung nhdn baa hiem, Hop d6ng baa hiem, Quy
tAc baa hiem, Chung t6i th6ng baa v€ viec guu quyit b6i {huang cua Quy khach hang nhu sau:
Nguoi .lU'ge bao hi~m: Vii Van Tuyen.
Dia chi: 414 No Trang Lang, Phuong 13, Qudn Binh Thanh, Thanh ph6 H6 Chi Minh, Vi?! Nam.
Tham gia bao hiem thee HDBH s6: 6412/21/HD-CN/029-PHH.
Can ctr vao h6 sa b6i thuong s6 13590/22/BT-CN/029-GDBT.
Da diroc duyet : ngay 23 thang 03 nam 2022
TAng
sa ti~n bAi thuong: 544,063 d6ng.
(BJng chic: Nam tram b6n muoi b6n ngan kh6ng tram sau muui ba d6ng).
S6 ti~n yell c~u: 714,063d
S6 ti~n ttTch6i: 170,000d test Covid-19 khong thuQc ph~
vi BH
Tru'irng ho'p tra ti~n b~ng ti~n mat:
Trong thai h?n bay (07) ngay k~ ill khi nh~n duQ'c thong bao nay, nguai dUQ'cbao hiem (ho~c
Ngum thtra kS h9'J)phap) tn,rc ti~p ho~c Cll nguai dSn linh tian t?i: TT DVlfH PHiA NAM
Khi dSn nh~ ti~n, d8 nghi Quy khach mang thee: Gi~y eh(mg minh nhan dan, truang hQ'p nha
ngum khac nh~n hQ phai e6 Gi~y uy quy~n hQ'pphap.
TrU'irng ho'p Cbuy~n khoan:
Theo yell c~u eua Nguai oUQ'cbao hiem, eh(mg t6i se chuy~n
+ Cbii tai khoan:
+ TK
vir
s6 ti~n tren
vao:
VAN TUyEN.
sa: 000032050.
+ T~i: Ngan hang VIB - BiNJI DUONG.
+ NQi
dung thanh tmin: Tra ti~n bao hi€m cho
B~nh vi~n BV DK Quac TE BECAMEX.
va Van Tuy€n, vao vi~n ngay 18/02/2022
t?i
Chu -": 86 ti€n b6i (huong tren se du(),c thanh (aan bc7ng fidn m(lt ha(lc chuy€n khaim vao Tai
khaan thea yeu ceiu cua NgU:O'ictLC(),C baa hdm. 8au 15 ngay nh4n du9'c thong baa nay, n€u MIC
kh6ng I1h4n c11,l'{!c
phan h6i lr;li tIL' Nguo'i d~r()'cbela hi€m thi cai nhU'Sl! ki?rl baa hdm {ren
du(),c
giai quydt xang, kh6ng con thac mac khiiu nt;li gi.
aa
Tran trQng kinh chao .I.
Ngay 23 thang 03 nam 2022
NO'inhan:
TONG CONG TY CO PHAN BAO IDEM QUAN DOl
- Nhu tren;
- LU'UPhong TCKT.
- LU'UPhong ....
BMlQT/CN/02.11
~
~S
t~!."MIC
I
,
Bao Hiem Qui" 091
TO'TRINH
(Hi>
SO'
nOI THUO'NG
s8: 13590/22/BT-CN/029-GDBT)
I.Tom tfit h6 so bBi thuirng:
HQ ten ngiroi tham gia baa hiern: Vii Van Tuyin.
Thuoc aO'J1vi: C6NG TY CO PHAN BAT DONG SAN SONG THANH
Dia Chi
: 414 No Trang Long, Phuong 13, Qudn Binh Thanh, Thanh ph6 H6 Chi Minh, Vi?t
Nam.
Di~n thoai : 0931026579
Tham gia loai hinh baa hiern: Bao htim SU'cKhoe Nhom va Tai Nan Nhom.
HQ'pd6ng baa hiem s6: 641212JIHD-CNI029-PHH
Thai han BH: Tir 0110412021 din 3110312022.
Mire trach nhiern baa hi~m: Chit thuong {(it loan b(j va b(j phdn vinh vien do tai nan:
1,156,269,819,.54,545; Niim vien do 6m dau, b?nh tat/nom: 40,000,000; PhJu thudt do 6m dau
benh tdt/ndm: 40,000,000; PhJu thudt lien quan din cdy ghep not tang do 6m dau, benh tdt:
40,000,000; DiJu tri truce khi nhdp vien/nam: 3,000,000; Di€u tri sau khi xudt vien: 3,000,000; Y
ta cham soc tai nha/niim: 2,000,000; tro cdp n6m vien/ngay: 60,000; Dich v¥ xe cUu thuong
trong lanh th6 Vi?t Nam loai tric bang duong hang kh6ng: 40,000,000; Tr(l cdp mai tang phi:
2,000,000,' DKBS 01 - Di€u Irf ngogi tru do 6m dau, b?nh t(itlnam: 6,300,000; s6 tiJnlldn kham:
2,000,000,' s6 zeinkhamlnam: 60; V(it Ii' Irj li?ulldn: 105,000; S6ldn v(it Ii' trf li?ulnam: 60.
Ngay dong phi: 2010412021.
Ngay vaa vi~n: 18/02/2022.
B~nh vi~n di~lltd: BV DK Quac TE BECAMEX
Nguyen nhan: B! TE, TON TRUONG NONG CANG TAY
H~u qt18: TJ!TE, TON TRUONG N6NG CANG TAY
HB so' gGm c6:
- Gi~y yhl dL~tra ti~n baa hi~m;
- Ch(rng til' di~u td do co quan y t~ cftp: HOA DON, BANG KE CP, TOA THUaC;
- Bien bEmtai n?n (Truang hqp tai n?n);
1I.IHnll gia h6 sO'eua bBi thm'mg vien:
- Can CLI' vaa nguyen nhan nh~p vi~n, eh(rng tir y t~. K~t lu~: THUOC PH-1.M VI BH
s6 ti€n veu cc7u:714,063tl
s6 ti€n h6i thu'ang: 544,063d
s6 ti€n (II' chdi: 170,000d test
Covid-19 kh6ng thu9c phgm vi BH
- Gi§y 16 khc'i111chua b~nh a~y atl hqp l~.
- Ngay yell cAll tra ti~n bao hi~m thea thai h?n quy dinh.
III. Tl n h torm b6i thU'Ong:
I
U'Q'cchi tra
-
Gio'i h~n B6i thU'C)ug
sa tien
So
Ty I~ I
b'"01
(TT,PT, I ngay
thU'()'ng
TCNV) I di~u tri
tai n~ 63tr/
T6ng cQng
IV. Ljeh sil' tan th§t:
'----
-
s6 V~I:
I.
._'---.
sA ti~n
phat
sinh
544,063
D~ xu~t bBi
thu'Ong
714,063
544,063
714,063
544,063
L
s6 ti€n: 218,800
d6ng.
Ten t6i 1;'1: Ngllyln Plu,Inl Thanh TldJOvai tu cach la b6i thuang vien ella MIC earn k~t da ki~m
tra tinh chinh xac va hQ'pl~ cac chung tir tren, d~ nghi lanh d~o duy~t s6 ti~n nhu sau:
BM/QT/CN/02.16
, .1'-
Bao liiem Quan 091
Bang s6: 544,063
o6ng.
Bang chir: Naill tram b6n rmroi bon ngan khong tram sau muoi ba o6ng.
S6 ti§n tren duoc chi tra cho nguoi duoc bao hiem.
Ngay 23 thang 03 nam 2022.
BOI THlfONG VIEN
PT. PHONG NGHI¥P VT}
I,ANI I :01\0 DON VI
Nguy~nPham Thanh Thao
BM/QT/CN/02,16
pM
}~~';'MIC
I
(ObUj
Bao Hiem Quan DQi
THONG BAo TI{ATIEN nAo HIEM
(SalIa
SO'
b6i tltuong: J5112122IBT-CNI064-GDBT)
Kfnh gjri Quy khach hang: Nguyin
is Vii Hiti
yin.
Tong Cong ty cd phdn Baa hidm Qudn a(3i citi xem xet H6 so b6i thuang cua QU))khacn hang.
Can Clf vela Gi6y yeu cdu Ira lidn bao hiem, Gidy chung nhdn baa hidm, H9'P tJ6ng baa hiem, Quy
tdc baa hidm, Chung toi thong baa vd viec giai quyet b6i thuong cua Quy khacli hang nhu sau:
NgU'l:ridU'l;),cbao hi~m: Nguyil1 Le Vii Hiii Yin.
Dja chi: 03 Trein Nhdn Ton, Phuong 9, Qudn 5, TP.HCM.
Thrun gia bao hi~m theo HDBH s6: 4231121IHD-CNI064-CN.
Can cir vao h6 sa b6i thuong s6 15112122IBT-CNI064-GDBT.
- s6 tidn yeu cdu BH: 1.769.843 a6ng
- s6 ti€n b6i thuong: 619.843 a6ng
- s6 ti§n Itt ch6i: 1.150.000 a6ng (xn Thinprep,
Tang s6 ti~n b6i th u'(mg: 619.843 d6ng.
HPV tdm soat ung thu CTC)
(B6ng chit: sau 'dim muai chin ngan lam [dim b6n nnwi ba tl6ng).
TrU'cmg ho'p Chuy~n kho{m:
Theo yeu c~u ella Ngu6'i duQ'c bao hi~m, Chl1l1gtoi
se chuy6n s6 ti~n tren vao:
+ Chu tai khoan: NGUYEN LE vO HAl YEN.
+ TK s6: 3524367.
+ T~i: Ngan hang ACB.
+ NQi dung thanh toan: Tnl ti~n bao hi~m cho Nguyin Le Vii Hai Yin, vao vi~n ngay 1910212022
t9i B~nh vi~n BV TU DO.
Chit y: s6 lidn b6i thll'cmg {ren se {./u'9'Cthanh toan being tidn l77(ltho(lc chuye"n khac~n vao refi
khoCtn thea yell c6u czia Nf!,u'o'j(1U'9'C baa hi211l. Sau 15 ngay nh6/2 ciu(Jc thong hao J1(IY,ndu MIC
khong nh4n (.11WCphd71 h6i 19i til' NgIl'o'i th/'(Jc bdo hidm {hi coi nIne S(l' ki¢n bcw hidm {I'en (1a al,we
gidi quydt xong, khong con thde milc khi€u m;li gi.
Tnln trQng kfnh chao .I.
NgCIY31 thang 03
Nai nhan:
- Nhu lren,'
- Lu'U Phong TCKT
- LULl
Phong ....
BM/QT/CN/02.11
11(1171
2022
TONG CONG TV CO PHA.N BAO HIEM QUAN DQI
.t~~"MIC
I
Bao Hlem Quan DQI
TO TRINH BOI THUONG
(116 so' s6: lS112/22IBT-CN/064-GDBT)
I.Tom t~t hB so bBi thuong:
HQ ten nguoi tham gia bao hiem: Nguyil'l L€ Vii Hiii Yin.
ThuQc dan vi: CONG TY TNHH UNG DUNG BAN £JO VI$T
Dia Chi
: 03 Trdn Nhdn Ton, Phuong 9, Qudn 5, TP.HCM
Dien thoai :.
Tharn gia loai hinh bao hi€m: Baa hi6m Sue Khoe Nhom va Tai Nan Nhom.
HQ'pd6ng bao hiern s6: 4231121IHD-CNI064-CN
Thai han BH: Tii' 09103/2021 tldn 0910312022.
MLJ'Ctrach nhiern bao hiem: Chdt thuong tdt toan b6 va b6 phdn vinh viln do tai nan: 105,000,000.
Ngay dong phi: 21110/2021.
Ngay vao vien: 19102/2022 Ngay ra vien: 19102/2022.
Benh vien di~u tr]: BV TU DO.
Nguyen nhan: VIEM AM £J~O DO NAM, NANG TU CUNG.
H~u qua: V1EM AM £J~O DO NAM, NANG TU CUNG.
" c6:
Ho, so' gom
- GiAy yeu cau tra ti8n bao hiern;
_ Chung tir di8u tri do CO" quan y t~ cAp: HoA £JON, £JON THUOC, KQ SIEU AM;
II. Danh ghl hB so cua bBi thuong vien:
- Can CLr vao nguyen nhan nh~p vien, clurng nr y t~. K~t lu~n: THUOC PVBH
- S6 tiin yeu ceiu BH 1.769.843 tl6ng
- s6 liin b6i Ih~r(l11g:619.843 tl6ng
- s6 tiin Hrch6i: 1.150.000 tl6ng (xn Thinprep, HPV!dm soa! ung tlnr CTC)
- Gi§y ta kham chu'a b~nh d~y uti hQ"PI~.
- Ngay yeu du tra ti8n bao hiSm thee thc)'ih~n quy dinh.
III. TiDh toaD bBi thu'(mg:
I
Quy~u IQi dU'Q'cchi tni
Ii-Q~ kluim ngo~i tru ltr/lAn
t
Tong cQng
L_
Gi6'i h~n BAi thu()'Og
r I~
I
I (T/P+ T
___;_I
----
di~utrj
thu'()'fi
t
CNvi_ I
I
-I --
s6 ngay
So ti~n
hlH
t·).j't
D~ xu~t
, b8i
thu'o'ng
1.
p a
8 Olen
.
SInh
j-- __
1.769.843 I
_--L
I
-------
1.769.843_
--
-----r- ------
L_
619.843~
619.843
-
IV. Lieh Sl!' tBn th~t:
S6 vu: O.
S6 tiin: 0 tl6ng.
Ten toi la: Le Till TIm Hlfong v6i tu cach la b6i thucmg vien ella MIC cam k~t da ki~m tra tinh chinh x:k
va hQ"pI~ cac ch(mg tll' h'en, d6 nghi lanh d~o duy~t s6 ti8n 111m sau:
B~ng s6: 619.843d6ng.
Bing cha': Sau tram mU'ai chin ngan tam tram b6n muai ba d6ng
S6 ti8n tren duQ'c chi tra cho ngLrai dU'Q'cbao hi€m.
Ngcry 31 thcmg 03 nom 2022.
BOI THUONG VIEN
PT. PHONG NGHI~P Vl}
LANII D~O DON Vl
Le Th! Thu Hu'o'ng
BM/QT/CN/02.16
1J SG
t~~'_MIC
•
Bolo Hlem Quan DQi
"
,
..,
~
(O{~)
..,
;(
THONG BAO TRA TIEN BAO HIEM
(Sa H6 so b6i thuirng: 14952122IBT-CNI017-GDBT)
Kinh giri Quy khach hang: HOANG THU LAN.
T6ng Cong ty cd phdn Bao hiem Qudn d9i ael xem xet H6 sa b6i thuong cua Quy khach hCII1g.
C6n CLfVCIO Gidy yeu cau ira lidn bao hidm, Gidy chung nhdn bao hdm, Hop d6ng bao hiem, Quy
{(ic bao hiem, Chung toi thong bao vd viec giai quyit b6i thuong cua Quy khach hang nhu sau:
Ngrro'i duo'c bao hi~m: HOANG THU LAN.
Dja chi: 72 Cit Lao, Phuong 2, Qudn Phil Nhudn, TP.HCM.
Tham gia bao hi~m thea HDBH
s6: 4614122IHD-CNI017-KD05.
Can cir VaGh6 sa b6i thuong s614952122IBT-CNI017-GDBT.
- s6 tidnyeu cau BH: 1.542.500 d6ng
- s6 tidn b6i {huang: 881.500 d6ng
- s6 udn tu: ch6i: 661.000 d6ng (Cac Xn:
tli?n gidi tl6, dinh luang creatinin, dinh luang crp; dinh
hl'Q'!7.g
glucose; tlinh hwng ure; doa de) hO(llALT, AST; HbsAg; HCV Ab, tnfng giun, scm soi tLWi)
khong lien quan tlin b?nh
s6 ti~n b6i
Tang
thU'(mg: 881,500 d6ng.
(Bang chit: Tam tram tam muO'i m6t ngan nam tram d6ng.).
Tnl'img ho'p Chuy~n khoan:
Theo yeu
du
eLla
Nguaj oUQ'cbao hi~m, Chlll1gt6i
se chuy~n s6 tj~ll tren
vao:
+ Chu tfti khoan: HOANG THU LAN.
+ TK s6: 0371000417509.
+ T~i:
Ngan himg VCB - CN TAN DJNH.
+ NQi dung thanh toan: Tra ti€n bao hi~m cho HOANG THU LAN, VaGvi~n ngay 1710312022 tl,li
B~nh vi¢n BV DH Y DUOC HN.
y: s6 tian
b6i thucmg fren se aU'Q'cthanh loan bang tidn mr,11 ho(ic chuyill khoci/l vito T(ii
khoan theo yeu c6u Cl-iaNgU'O'ii/u'9'Cbdo hidm. Sau 15 I1gby nh(m au9'c thong bao I1CIY, ndll A11C
kh6ng nh(m all'()'cphcm h6i l(1i fir NgU/li c1u{)'cbao hdm {hi coi nhu s~t' kiqn belo hie'm fren i/o dupe
giai quydt xong, khong con {hac mac khidu l1Qigi.
ClIlI
Tran tHIng kinh chao .I.
Ngby 31 thang 03 116m2022
Nai nhan:
- Nhu lren;
- Lu'UPhong TCKT
- Luu Phong ....
BM/QT/CN/02.11
TONG CONG TY CO PHAN BAo HIEM QUAN DOl
t~~"'MIC
I
Bao Hhlm Quin D91
nOI THUO'NG
TO' TRINH
(H6
so' s6: 149S2/22/BT-CN/017-GDBT)
I.Tom t~t b8 so' b6i thu'ong:
He;>ten nguoi tham gia bao hiem: HOANG THU LAN
ThuQc dan vi: CONG TY TNHH A.B.M
Dja Chi
: 72 Cii Lao, Phuong 2, Qudn Phil Nhudn, TP.HCM
f)i~n thoai :.
Tham gia loai hinh bao hi€m: Baa hidm Sue Khoe Nhom va Tai N(1nNhom.
Hop d6ng bao hi~m 56: 4614122IHD-CNI017-KD05.
Thc)'i han BH: Tu 2810212022 tI§n 2810212023.
Mire trach nhiem bao hiern: chit thuong tdt toan b{5va b{5phdn vinh viin do tai nan: 45,000,000.
Ngay dong phi: 0910312022.
Ngay vao vien: 17103/2022 Ngay ra vien: 1710312022.
B~nh vien diSu trj: BV DH Y DUOC HN
Nguyen nhan: NHIEM KHUiN TIEU Hoi.
H~LJ qua: NHIEM KHUiN TIEU Hoi.
HA SO' gAm co:
- Gi§y yeu cAli tra ti€n bao hiem;
- Chung tir di~u tri do co' quan y tS c§p: Hoi DON, DON THU6c, KQ XN;
II. Danh ghi h8
SO'
cua b&i thuong vien:
- Gin cir van nguyen nhan nhap vien, chung tir y tS. KSt luan: THUOC PVBH
- s6 tidn yeu cdu BH: 1.542.500 tl6ng
- s6 tidn b6i thuang: 881.500 tl6ng
- s6 ti€n tt'r ch6i: 661.000 tl6ng (Cac
Xn: tli?n giai tl6, tlinh hn;mg creatinin, tljnh lU'971gcrp; tljnh hrr;mg
glucose; tljnh /u'(J11gure; tloa i1(j h0(11ALT. AST; HbsAg; HCV Ab, tn'rng giun, san soi luai) khOng lien
quan tI§n b?nh
- Gifly to' kham chu'a b~nh d§y dll hgp I~.
- Ngay yell d.u tra ti~n bao hi€m thea thai h~n quy dinh.
III. Tinh toan b8i thU'(rng:
II
1·~..
1-. -,-,
-~-i6'-i-h~-n
BAi-t-h~O-"I-lg
.>
Quy~n lQ'i dU'Q'Cchi tra
~ Ty I~
1
I (TT,PT,T
~
QL kMm
~I
T__
6n_g
__Co_.n_g
-
Ld/lfin
ngol;1itru
900.000
[-I
_i::NV)
~1
i
sl.
a
;t~l.ngt ~ I
So tlcn
n
b6i
.
-'-I
thu'o'ng
ulCU
-I
I
De xuat boi
s6 ti~n ph~1t
thucrng
sinh
-1.-5-42-.50-0
II,
881,500
----·-4--------~----1.-5-4-2.-5-0-0~1~~~~_--8-8-1,500
I
IV. Lieh sir tAn th§t:
S6 v¥:
O.
S6 tidn:
0 tl6ng.
Ten t6i la: Le Thi Tllu Hu'o'ng v6-i tu cach la b6i tlmcmg vien clla MIC cam kSt da kiSm tra tfnh chinh xac
va hgp I~cac chu'ng ttC tren, d~ nghi lanh d~o duy~t 56 tiSn nlm 5au:
B~ng 56: 881,500 d6ng.
B~ng chO': Tam tram tam Imrai 1116tngan nam tram d6ng.
S6 ti€n tren du'Q'c chi tra eho ngtrai du'Q'cbao hi~m,
Ngay 31 thang 03 nom 2022.
PT. PRONG NGlIrF;P Vl)
BOI TWONG VlEN
LA-NHD~O DON VJ
-l)n{
;::::-----Le
Thj Thu I-Iuo'ng
BM/QT /CN/02_16