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보험
InsClaimService:verifyCoverage

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  3. 디지털 보험

InsClaimService:verifyCoverage

이 서비스를 사용하여 청구를 제기하는 보험 담당자의 유효한 보험 보장을 확인합니다.

클래스: InsClaimService

방법: verifyCoverage

작동 방법

  1. 사용자가 입력한 대로 DateOfLoss 및 PerilProductCode를 가져옵니다.

  2. PolicyNumber 또는 PolicyHolder 및 InsuredItemName를 사용하여 정책을 찾습니다.

  3. 정책 유효 일자 및 보장 유효 일자를 DateOfLoss와 비교하여 정책 및 관련 보장이 적용되는 동안 손실이 발생했는지 확인합니다. 손실 날짜가 증권 유효 날짜 및 보장 유효 날짜 이내인 경우 보장이 유효합니다.

  4. 다음 옵션 조합 중 하나를 사용하여 다른 데이터를 반환합니다. 위험 제품 및 정책 모두에서 서비스가 발견한 보장 범위의 목록과 "Covered":true를 반환합니다.

    • DateOfLoss + PolicyNumber/Policyholder:

      모든 루트 수준 보장 범위 및 보장 범위가 포함된 모든 보험 항목을 반환합니다.

    • DateOfLoss + PolicyNumber/Policyholder + insuredItemName (보험료):

      이 insuredItemName에 대한 모든 루트 수준 보장 범위 + 보장 범위를 반환합니다.

    • DateOfLoss + PolicyNumber/Policyholder + PerilProductCode + insuredItemName(세 번째 당사자):

      PerilProduct 및 루트 수준 정책과 연결된 겹치는 보장 범위를 반환합니다.

    • DateOfLoss + PolicyNumber/Policyholder + PerilProductCode:

      PerilProduct 및 루트 수준 정책과 연결된 겹치는 보장 범위를 반환합니다.

  5. 손실이 보장되지 않을 경우 "Covered":false을 반환합니다. policyId, coverageIds, insuredItemId 또는 InsuredPartyId도 반환합니다.

원격 옵션

옵션

설명

DateOfLoss

%LossDateTime%

또는

“YYYY-MM-DD HH:MM:SS”

(필수)

보험 담당자의 손실 날짜입니다.

PerilProductCode

%PerilCodes:ClaimProduct%

보험 소유자가 발생한 상황을 보고하는 위험과 연결된 코드입니다.

PolicyNumber

%PolicyNumber%

보험 소유자의 증권 번호입니다.

PolicyNumber에 대한 값을 입력하지 않으면 PolicyHolder에 대한 값을 입력해야 합니다.

PolicyHolder

%PolicyHolder%

asset.account.name 값입니다.

PolicyHolder에 대한 값을 입력하지 않으면 PolicyNumber에 대한 값을 입력해야 합니다.

InsuredItemName

%InsuredItemName%

이 값은 보험 항목 또는 보험 당사자의 이름일 수 있습니다. 또한 손상된 사람 또는 부동산과 같은 타사의 이름일 수 있습니다.

입력 JSON

이 서비스는 입력 JSON을 사용하지 않습니다.

출력 JSON

서비스는 "Covered":true/false 값을 반환합니다. "Covered":true 경우 서비스는 이 정책이 보장하는 보장 범위 목록도 반환합니다. insuredItem 세부 사항에는 SerialNumber (PolicyNumber)와 같은 기타 정책 정보가 포함되어 있습니다.

InsuredItemName이 증권의 보험 항목 또는 보험 당사자의 이름인 경우 이 서비스는 명명된 보험 항목 또는 보험 당사자에 적용되는 증권 보장 범위를 반환합니다. 또한 policyId, coverageIds, insuredItemId orInsuredPartyId도 반환합니다.

다음 예는 증권 소유자가 사용할 수 있는 필드를 보여줍니다.

{
  "result": {
    "covered": true,
    "Coverages": {
      "assetCoverageId": "a3n2E000005DQDVQA4",
      "AttributeSelectedValues": null,
      "PremiumAmount": null,
      "Name": "ABC Test Asset Coverage"
    },
    "policyHolderPartyId": "a0x2E00000BO3t3QAD",
    "policyHolderContactId": "0032E00002YrYj5QAF",
    "policyHolderAccountId": "0012E000022227nQAA",
    "policyId": "02i2E00000GGDGLQA5",
    "ProductCode": "SG-PPO-500-GC",
    "ProductName": "Vlocity SG - Medical Plan PPO 500",
    "AttributeSelectedValues": null,
    "SerialNumber": null,
    "Status": null
  },
  "error": "OK"
}

다음 예는 보장 범위 및 보험 항목과 각각에 대해 반환되는 모든 필드를 보여줍니다.

{
  "result": [
    {
      "covered": true,
      "Coverages": [
        {
          "assetCoverageId": "a3n2E000001zrGuQAI",
          "ProductCode": "C001096001",
          "ProductName": "DENTAL PREMIUM",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "DENTAL PREMIUM"
        },
        {
          "assetCoverageId": "a3n2E000001zrGvQAI",
          "ProductCode": "C001066001",
          "ProductName": "Foreign Assistance",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1801.77,
          "Name": "Foreign Assistance"
        },
        {
          "assetCoverageId": "a3n2E000001zrGwQAI",
          "ProductCode": "C001067001",
          "ProductName": "CATASTROPHIC DISEASES",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1827.19,
          "Name": "CATASTROPHIC DISEASES"
        },
        {
          "assetCoverageId": "a3n2E000001zrGxQAI",
          "ProductCode": "C001001155",
          "ProductName": "PLENO",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "PLENO"
        }
      ],
      "InsuredItem": {
        "insuredItemId": "a3o2E000002ItQUQA0",
        "ProductCode": "HealthPerson",
        "ProductName": "HealthPerson",
        "figure": "\"Primary\"",
        "fullname": "anik singh",
        "age": 32
        "insuredHeldProductRelationshipId": null,
        "insuredPartyId": null,
        "insuredContactId": null,
        "insuredAccountId": null
      },
      "policyId": "02i2E00000GSc9TQAT",
      "ProductCode": "001001155",
      "ProductName": "ALFA HEALTH PLAN - PLENO",
      "DedSi": false,
      "SumIns": "600000",
      "Deductible01": "15000",
      "Coinsurance01": "0 - $65,000.00",
      "CHMQ01": "0",
      "Frequency01": "Anual",
      "SerialNumber": "001001155--2020-",
      "Status": "InForce"
    },
    {
      "covered": true,
      "Coverages": [
        {
          "assetCoverageId": "a3n2E000001zpOHQAY",
          "ProductCode": "C001096001",
          "ProductName": "DENTAL PREMIUM",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "DENTAL PREMIUM"
        },
        {
          "assetCoverageId": "a3n2E000001zpOIQAY",
          "ProductCode": "C001066001",
          "ProductName": "Foreign Assistance",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1801.77,
          "Name": "Foreign Assistance"
        },
        {
          "assetCoverageId": "a3n2E000001zpOJQAY",
          "ProductCode": "C001067001",
          "ProductName": "CATASTROPHIC DISEASES",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1827.19,
          "Name": "CATASTROPHIC DISEASES"
        },
        {
          "assetCoverageId": "a3n2E000001zpOKQAY",
          "ProductCode": "C001001155",
          "ProductName": "PLENO",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "PLENO"
        },
        {
          "assetCoverageId": "a3n2E000001zqwcQAA",
          "AttributeSelectedValues": null,
          "PremiumAmount": null,
          "Name": "Catastrophic disease"
        }
      ],
      "policyId": "02i2E00000GSc84QAD",
      "ProductCode": "001001155",
      "ProductName": "ALFA HEALTH PLAN - PLENO",
      "DedSi": false,
      "SumIns": "600000",
      "Deductible01": "15000",
      "Coinsurance01": "0 - $65,000.00",
      "CHMQ01": "0",
      "Frequency01": "Anual",
      "SerialNumber": "001001155--2020-",
      "Status": "InForce"
    },
    {
      "covered": true,
      "Coverages": [
        {
          "assetCoverageId": "a3n2E000001zrH4QAI",
          "ProductCode": "C001066001",
          "ProductName": "Foreign Assistance",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1801.77,
          "Name": "Foreign Assistance"
        },
        {
          "assetCoverageId": "a3n2E000001zrH5QAI",
          "ProductCode": "C001096001",
          "ProductName": "DENTAL PREMIUM",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "DENTAL PREMIUM"
        },
        {
          "assetCoverageId": "a3n2E000001zrH6QAI",
          "ProductCode": "C001001155",
          "ProductName": "PLENO",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "PLENO"
        },
        {
          "assetCoverageId": "a3n2E000001zrH7QAI",
          "ProductCode": "C001067001",
          "ProductName": "CATASTROPHIC DISEASES",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1827.19,
          "Name": "CATASTROPHIC DISEASES"
        }
      ],
      "InsuredItem": {
        "insuredAccountId": null,
        "insuredContactId": null,
        "insuredPartyId": null,
        "insuredheldProductRelationshipId": "a3p2E000001iaP1QAI",
        "ProductCode": "HealthPerson",
        "ProductName": "HealthPerson",
        "figure": "\"Primary\"",
        "fullname": "anik singh",
        "age": 32
      },
      "policyId": "02i2E00000GSc9dQAD",
      "ProductCode": "001001155",
      "ProductName": "ALFA HEALTH PLAN - PLENO",
      "DedSi": false,
      "SumIns": "600000",
      "Deductible01": "15000",
      "Coinsurance01": "0 - $65,000.00",
      "CHMQ01": "0",
      "Frequency01": "Anual",
      "SerialNumber": "001001155--2020-",
      "Status": "InForce"
    },
    {
      "covered": true,
      "Coverages": [
        {
          "assetCoverageId": "a3n2E000001zrlfQAA",
          "ProductCode": "C001067001",
          "ProductName": "CATASTROPHIC DISEASES",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1827.19,
          "Name": "CATASTROPHIC DISEASES"
        },
        {
          "assetCoverageId": "a3n2E000001zrlgQAA",
          "ProductCode": "C001066001",
          "ProductName": "Foreign Assistance",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1801.77,
          "Name": "Foreign Assistance"
        },
        {
          "assetCoverageId": "a3n2E000001zrlhQAA",
          "ProductCode": "C001001155",
          "ProductName": "PLENO",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "PLENO"
        },
        {
          "assetCoverageId": "a3n2E000001zrliQAA",
          "ProductCode": "C001096001",
          "ProductName": "DENTAL PREMIUM",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "DENTAL PREMIUM"
        }
      ],
      "InsuredItem": {
        "insuredAccountId": null,
        "insuredContactId": null,
        "insuredPartyId": null,
        "insuredheldProductRelationshipId": "a3p2E000001iaXMQAY",
        "ProductCode": "HealthPerson",
        "ProductName": "HealthPerson",
        "figure": "\"Primary\"",
        "fullname": "anik singh",
        "age": 32
      },
      "policyId": "02i2E00000GSc9uQAD",
      "ProductCode": "001001155",
      "ProductName": "ALFA HEALTH PLAN - PLENO",
      "DedSi": false,
      "SumIns": "600000",
      "Deductible01": "15000",
      "Coinsurance01": "0 - $65,000.00",
      "CHMQ01": "0",
      "Frequency01": "Anual",
      "SerialNumber": "001001155--2020-",
      "Status": "InForce"
    },
    {
      "covered": true,
      "Coverages": [
        {
          "assetCoverageId": "a3n2E000001zrlpQAA",
          "ProductCode": "C001001155",
          "ProductName": "PLENO",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "PLENO"
        },
        {
          "assetCoverageId": "a3n2E000001zrlqQAA",
          "ProductCode": "C001067001",
          "ProductName": "CATASTROPHIC DISEASES",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1827.19,
          "Name": "CATASTROPHIC DISEASES"
        },
        {
          "assetCoverageId": "a3n2E000001zrlrQAA",
          "ProductCode": "C001096001",
          "ProductName": "DENTAL PREMIUM",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "DENTAL PREMIUM"
        },
        {
          "assetCoverageId": "a3n2E000001zrlsQAA",
          "ProductCode": "C001066001",
          "ProductName": "Foreign Assistance",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1801.77,
          "Name": "Foreign Assistance"
        }
      ],
      "InsuredItem": {
        "insuredAccountId": null,
        "insuredContactId": null,
        "insuredPartyId": null,
        "insuredheldProductRelationshipId": "a3p2E000001iaXRQAY",
        "ProductCode": "HealthPerson",
        "ProductName": "HealthPerson",
        "figure": "\"Primary\"",
        "fullname": "Neena Moore",
        "age": 34
      },
      "policyId": "02i2E00000GSc9zQAD",
      "ProductCode": "001001155",
      "ProductName": "ALFA HEALTH PLAN - PLENO",
      "DedSi": false,
      "SumIns": "600000",
      "Deductible01": "15000",
      "Coinsurance01": "0 - $65,000.00",
      "CHMQ01": "0",
      "Frequency01": "Anual",
      "SerialNumber": "001001155--2020-",
      "Status": "InForce"
    },
    {
      "covered": true,
      "Coverages": [
        {
          "assetCoverageId": "a3n2E000001ztQqQAI",
          "ProductCode": "C001096001",
          "ProductName": "DENTAL PREMIUM",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "DENTAL PREMIUM"
        },
        {
          "assetCoverageId": "a3n2E000001ztQrQAI",
          "ProductCode": "C001067001",
          "ProductName": "CATASTROPHIC DISEASES",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1827.19,
          "Name": "CATASTROPHIC DISEASES"
        },
        {
          "assetCoverageId": "a3n2E000001ztQsQAI",
          "ProductCode": "C001066001",
          "ProductName": "Foreign Assistance",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1801.77,
          "Name": "Foreign Assistance"
        },
        {
          "assetCoverageId": "a3n2E000001ztQtQAI",
          "ProductCode": "C001001155",
          "ProductName": "PLENO",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "PLENO"
        }
      ],
      "InsuredItem": {
        "insuredAccountId": null,
        "insuredContactId": null,
        "insuredPartyId": null,
        "insuredheldProductRelationshipId": "a3p2E000001ibO3QAI",
        "ProductCode": "HealthPerson",
        "ProductName": "HealthPerson",
        "figure": "\"Primary\"",
        "fullname": "anik singh",
        "age": 34
      },
      "policyId": "02i2E00000GScRDQA1",
      "ProductCode": "001001155",
      "ProductName": "ALFA HEALTH PLAN - PLENO",
      "DedSi": false,
      "SumIns": "600000",
      "Deductible01": "15000",
      "Coinsurance01": "0 - $65,000.00",
      "CHMQ01": "0",
      "Frequency01": "Anual",
      "SerialNumber": "001001155--2020-",
      "Status": "InForce"
    },
    {
      "covered": true,
      "Coverages": [
        {
          "assetCoverageId": "a3n2E000001ztQvQAI",
          "ProductCode": "C001096001",
          "ProductName": "DENTAL PREMIUM",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "DENTAL PREMIUM"
        },
        {
          "assetCoverageId": "a3n2E000001ztQwQAI",
          "ProductCode": "C001067001",
          "ProductName": "CATASTROPHIC DISEASES",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1827.19,
          "Name": "CATASTROPHIC DISEASES"
        },
        {
          "assetCoverageId": "a3n2E000001ztQxQAI",
          "ProductCode": "C001066001",
          "ProductName": "Foreign Assistance",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1801.77,
          "Name": "Foreign Assistance"
        },
        {
          "assetCoverageId": "a3n2E000001ztQyQAI",
          "ProductCode": "C001001155",
          "ProductName": "PLENO",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "PLENO"
        }
      ],
      "InsuredItem": {
        "insuredAccountId": null,
        "insuredContactId": null,
        "insuredPartyId": null,
        "insuredheldProductRelationshipId": "a3p2E000001ibO8QAI",
        "ProductCode": "HealthPerson",
        "ProductName": "HealthPerson",
        "figure": "\"Primary\"",
        "fullname": "anik singh",
        "age": 34
      },
      "policyId": "02i2E00000GScRIQA1",
      "ProductCode": "001001155",
      "ProductName": "ALFA HEALTH PLAN - PLENO",
      "DedSi": false,
      "SumIns": "600000",
      "Deductible01": "15000",
      "Coinsurance01": "0 - $65,000.00",
      "CHMQ01": "0",
      "Frequency01": "Anual",
      "SerialNumber": "001001155--2020-",
      "Status": "InForce"
    },
    {
      "covered": true,
      "Coverages": [
        {
          "assetCoverageId": "a3n2E000001ztZoQAI",
          "ProductCode": "C001096001",
          "ProductName": "DENTAL PREMIUM",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "DENTAL PREMIUM"
        },
        {
          "assetCoverageId": "a3n2E000001ztZpQAI",
          "ProductCode": "C001066001",
          "ProductName": "Foreign Assistance",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1801.77,
          "Name": "Foreign Assistance"
        },
        {
          "assetCoverageId": "a3n2E000001ztZqQAI",
          "ProductCode": "C001067001",
          "ProductName": "CATASTROPHIC DISEASES",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1827.19,
          "Name": "CATASTROPHIC DISEASES"
        },
        {
          "assetCoverageId": "a3n2E000001ztZrQAI",
          "ProductCode": "C001001155",
          "ProductName": "PLENO",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "PLENO"
        }
      ],
      "InsuredItem": {
        "insuredAccountId": "0012E00001q2cmBQAQ",
        "insuredContactId": null,
        "insuredPartyId": "a0x2E00000BrEXVQA3",
        "insuredheldProductRelationshipId": "a3p2E000001ibODQAY",
        "ProductCode": "HealthPerson",
        "ProductName": "HealthPerson",
        "age": 32,
        "figure": "\"Primary\"",
        "fullname": "Test4 Test4"
      },
      "policyId": "02i2E00000GScRXQA1",
      "ProductCode": "001001155",
      "ProductName": "ALFA HEALTH PLAN - PLENO",
      "DedSi": false,
      "SumIns": "600000",
      "Deductible01": "15000",
      "Coinsurance01": "0 - $65,000.00",
      "CHMQ01": "0",
      "Frequency01": "Anual",
      "SerialNumber": "001001155--2020-",
      "Status": "InForce"
    },
    {
      "covered": true,
      "Coverages": [
        {
          "assetCoverageId": "a3n2E000001ztZtQAI",
          "ProductCode": "C001096001",
          "ProductName": "DENTAL PREMIUM",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "DENTAL PREMIUM"
        },
        {
          "assetCoverageId": "a3n2E000001ztZuQAI",
          "ProductCode": "C001066001",
          "ProductName": "Foreign Assistance",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1801.77,
          "Name": "Foreign Assistance"
        },
        {
          "assetCoverageId": "a3n2E000001ztZvQAI",
          "ProductCode": "C001067001",
          "ProductName": "CATASTROPHIC DISEASES",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1827.19,
          "Name": "CATASTROPHIC DISEASES"
        },
        {
          "assetCoverageId": "a3n2E000001ztZwQAI",
          "ProductCode": "C001001155",
          "ProductName": "PLENO",
          "AttributeSelectedValues": null,
          "PremiumAmount": 1350.53,
          "Name": "PLENO"
        }
      ],
      "InsuredItem": {
        "insuredAccountId": "0012E00001q2cmBQAQ",
        "insuredContactId": null,
        "insuredPartyId": "a0x2E00000BrEXVQA3",
        "insuredheldProductRelationshipId": "a3p2E000001ibOIQAY",
        "ProductCode": "HealthPerson",
        "ProductName": "HealthPerson",
        "age": 32,
        "figure": "\"Primary\"",
        "fullname": "Test4 Test4"
      },
      "policyId": "02i2E00000GScRcQAL",
      "ProductCode": "001001155",
      "ProductName": "ALFA HEALTH PLAN - PLENO",
      "DedSi": false,
      "SumIns": "600000",
      "Deductible01": "15000",
      "Coinsurance01": "0 - $65,000.00",
      "CHMQ01": "0",
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  ],
  "error": "OK"
}

예

일반적으로 이 서비스는 청구 플로에서 청구가 생성되기 전에 증권 소유자에게 유효한 보장이 있는지 확인하기 위해 사용됩니다.

 
로드 중
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