Can social insurance and commercial insurance be paid together?

Commercial insurance can make up for the shortcomings of social insurance and is an important supplement to social insurance, and social insurance cannot replace commercial insurance. If you want to know more about it, take a look at this articleIs Social Security or Commercial Insurance Better? What is the difference between social security and commercial insurance?

Of course, you can pay together and pay like this, and the guarantee will be more comprehensive. We all know that social security is our most basic protection, and the content of the five insurances covers all aspects of our lives. Take the medical insurance in the five insurances as an example, even if you are sick now, you can continue to apply for insurance in the second year, you can be reimbursed for related medical expenses, and you can enjoy lifelong medical insurance protection after paying enough for 15 years.

But this does not mean that social security is enough, its protection is still not enough, and it needs to be supplemented by commercial insurance, which can be looked at below.

There are many differences between social insurance and commercial insurance, and the following is an example of medical insurance to briefly explain why commercial insurance is not a substitute for social insurance.

1. The content of the guarantee does not completely coincide

Social medical insurance is far less comprehensive than commercial medical insurance in this regard. For example, social security does not cover the cost of service items such as "** fee", "out-of-hospital consultation fee", "medical record production cost" and the cost of prosthetic eyes, prosthetic limbs, hearing aids and other ** sexual appliances belonging to diagnosis and treatment equipment and medical materials, but most commercial insurance on the market covers these two types of medical expenses.

As shown in the figure below, the types of drugs that can be reimbursed by social security are also very limited. For example, in cancer, there are now many targeted drugs that are relatively small to the human body and have relatively high efficacy, but these special drugs are very expensive. For example, the average monthly cost of ** lung cancer is more than 50,000 yuan.

However, such imported drugs are usually not covered by social insurance, and for cancer patients who are not supplemented by commercial medical insurance, they can only choose to take traditional anti-cancer drugs.

2. The amount of reimbursement is different

Due to its welfare, the premium of social security is relatively low, and the strength of protection and the extent of reimbursement are also relatively low. If you do not accept medical insurance in the place where you buy it**, then the reimbursement ratio will be lower, which is also very different from commercial medical insurance, and the reimbursement ratio of commercial medical insurance will not be reduced because of this. Without commercial medical insurance, only social medical insurance is not enough to resist the risk.

Hope!

Yes, there is no conflict, there is no conflict.

Social security is a basic security, with the nature of welfare, but it is not comprehensive. Commercial insurance is the best supplement to social security, that is, within the scope of social security is not guaranteed, it is supplemented according to its own needs, and the two can be reasonably matched to build a personal security system.

Social security includes: endowment insurance, medical insurance, maternity insurance. Work-related injuries, unemployment benefits.

Social security is not the same as commercial insurance. The content of social insurance is endowment insurance, medical insurance, work-related injury insurance, unemployment insurance, maternity insurance and other social insurance, which are social welfare in nature; Commercial insurance is the insurance of life insurance and property insurance, and is the business activity of financial enterprises.

[Legal basis].

Article 2 of the Social Insurance Law of the People's Republic of China.

The State shall establish social insurance systems such as basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance, to ensure citizens' right to receive material assistance from the State and society in accordance with the law in the event of old age, illness, work-related injury, unemployment, childbirth, and so forth.

Article 10. Employees shall participate in the basic endowment insurance, and the employer and the employee shall jointly pay the basic endowment insurance premiums.

Individually-owned businesses without employees, part-time employees who have not participated in the basic pension insurance in the employer, and other flexibly employed persons can participate in the basic pension insurance, and the individual shall pay the basic pension insurance premium.

Article 12 of the Insurance Law of the People's Republic of China.

The policyholder of life insurance shall have an insurable interest in the insured at the time of the conclusion of the insurance contract.

The insured of property insurance shall have an insurable interest in the subject matter of insurance when an insurance malpractice occurs.

Life insurance is a rental loss insurance with a person's life and body as the subject of insurance.

Property insurance is insurance that takes property and its related interests as the subject matter of insurance.

Medical insurance and commercial insurance cannot be reimbursed at the same time, and the reimbursement of employee medical insurance and commercial insurance is based on the principle of priority. However, it should be noted that the total amount of employee medical insurance and commercial insurance reimbursement cannot be higher than the total amount of medical expenses actually spent.

Under normal circumstances, employee medical insurance and commercial insurance should follow the principle of first-come-first-served reimbursement when reimbursement, and social insurance should be followed by social insurance first. When reimbursement, it is often necessary to first reimburse through social security, and then explain to the staff that it is also necessary to reimburse through commercial insurance. Because social security has a minimum payment standard, many places cannot be reimbursed.

And these parts that cannot be reimbursed can be reimbursed through commercial insurance. Therefore, the policyholder should not reimburse the bills, the source of the source of commercial insurance insurance companies for reimbursement, if there is only one document, the original can be used for medical insurance reimbursement, and the commercial insurance can be used for reimbursement.

In addition, we need to pay attention to the reimbursement of medical insurance is a reimbursement nature, according to the principle of cost compensation, the total amount of medical insurance reimbursement and commercial medical insurance reimbursement in social security cannot be higher than the total amount of medical expenses actually spent. For a more detailed analysis of health insurance, click to read "Which is the best health insurance?" That's right!

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Legal Analysis: Yes.

Legal basis: Article 2 of the Social Insurance Law of the People's Republic of China establishes a social insurance system such as basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance, so as to protect citizens' right to obtain material assistance from the state and society in accordance with the law in the event of old age, illness, work-related injury, unemployment, childbirth, etc.

Commercial insurance is a supplement to social insurance, and after the social insurance reimbursement is completed, you can go to the commercial insurance company to apply for insurance, there is no conflict, and the two insurances are complementary.

There are the following differences between the two types of insurance: the social insurance contribution increases every year, while the commercial insurance contribution remains the same. Social medical insurance cannot be exempted from premiums, and in the event of a major illness, social medical insurance still needs to continue to pay money, while commercial insurance has an exemption function, and the insurance company pays the remaining premiums on behalf of the insurance company.

Social medical insurance liability is limited, and there are many uninsurable liabilities, such as some drugs (new drugs, imported drugs, expensive drugs, etc.) and some diagnosis and treatment items are not covered by the reimbursement scope, and other injuries caused by traffic accidents, food poisoning, medical accidents or other liabilities caused by injuries, vital organ transplantation, etc. are not within the scope of insurance; Commercial insurance can be reimbursed by 100% of the sum insured, and there is also an allowance type insurance to make up for the loss of income and part of the medical expenses caused by sick leave.

Many people encounter a problem when they suffer from illness or encounter an accident and need to make a claim:Can I still find an insurance company for reimbursement if I am reimbursed by social insurance? If you have social security, you don't need to buy commercial insurance? What is the difference between social security and commercial insurance?

Social insurance and commercial insurance can be used at the same time, but here are some small details to be aware of.

1. Critical illness insurance

Critical illness insurance, as the name suggests, means that the insured person can be paid for critical illness and other contracted illnesses, and this expense can be used freelyIt is a benefit-type insurance

There is no direct correlation between how much the insurance company pays and the cost of seeing a doctor. In fact, the insurance company will pay as much as the sum insured stipulated in the contract. That is to say,If you suffer from a contracted illness, social security reimbursement and critical illness reimbursement are both correct.

2. Medical insurance

Commercial medical insurance is:Nature of ReimbursementIs it possible to reimburse all expenses? No, commercial medical insurance usually has a deductible, and the medical expenses we incur need to be fully deductible before the insurance company will reimburse the corresponding expenses. And it is also necessary to take into account the impact of social security, generally speaking, the part that is not reimbursed by social security can be reimbursed.

In order to illustrate more vividly, I asked Ping An Insurance's medical insurance "Ping An e-Life Insurance" to explain the payment terms:

(1) If you have already sought reimbursement from social securityIf the reimbursement has been made through social security and the deductible has been deducted, Ping An Insurance will reimburse 100% of the remaining part of the expenses.

(2) Failure to find social security reimbursement: If you have purchased social security but have not been reimbursed by social security, if you confirm that the deductible has been deducted, Ping An will reimburse 60% of all expenses.

(3) If you have not purchased social securityIf you do not have social security, Ping An will reimburse 100% of all expenses if you confirm that the deductible has been deducted.

Generally speaking, the payment terms of medical insurance products are similar to those of Ping An, and the specific compensation ratio depends on the provisions in the insurance contract. But what is certain is that social security and commercial insurance can be used at the same time.

If you're still unsure, you might as well take a look at this more detailed explanation:What are the benefits of buying social security? Is Social Security or Commercial Insurance Better? What is the difference between social security and commercial insurance?

Compared with commercial insurance, the types and contents of social insurance can be said to be only the tip of the iceberg, so social insurance cannot replace commercial insurance, only buy social insurance, and the degree of protection is very limited. For more detailed explanations, please seeIs Social Security or Commercial Insurance Better? What is the difference between social security and commercial insurance?

Generally, it is reimbursed by social security first, and if there is still unreimbursed money after reimbursement, it can be reimbursed by commercial medical insurance. The subject doesn't seem to know the difference between social security and commercial insurance, you can go down to learn more about it, and you will know more about some reimbursement content.

The difference between social security and commercial insurance in medical insurance can be said to be the most typical, and below, we will take medical insurance to conduct a comparative analysis to see why commercial insurance is irreplaceable.

1. The difference between social medical insurance and commercial medical insurance in terms of protection content

The coverage of commercial medical insurance is much more than that of social medical insurance. Commercial medical insurance can cover out-of-hospital consultation fees, ambulance fees, ** fees and other medical expenses, and these social medical insurance are not responsible for insurance, that is, they are not covered by social medical insurance.

As shown in the figure below, the types of drugs that can be reimbursed by social security are also very limited. Everyone is very afraid of cancer, and there has actually been a lot of progress in cancer over the years, such as the fact that there are already special drugs for many kinds of cancer, but the cost is relatively large. For example, the average monthly cost of ** lung cancer is more than 50,000 yuan.

However, these imported special drugs often do not belong to the social security drugs, but belong to the scope of commercial medical insurance.

2. The amount of reimbursement is different

The social medical insurance with national welfare is not as reimbursed as commercial insurance because it takes into account the citizens who participate in the insurance throughout the country. Social health insurance will be different in each region, and for remote areas**, even if it can be reimbursed through medical insurance, the reimbursement ratio will be greatly discounted. For more serious diseases, the protection role played by social medical insurance is not enough to deal with the risk.

The above are just some of the differences between commercial insurance and social insurance in this aspect of medical insuranceIf you have social security, you don't need to buy commercial insurance? What is the difference between social security and commercial insurance? 》

Hello, dear, I am glad to answer this question for you, social medical insurance and commercial insurance can be reimbursed at the same time, but when reimbursing, we must follow the principle of social security first and then commercial insurance, commercial insurance is the part of the reimbursement of social security that is not reimbursed, but the reimbursement items must belong to the scope agreed in the insurance contract.

According to the first paragraph of Article 29 of the Social Insurance Law, the part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled by the social insurance agency and the medical institution and the drug business unit.

The third paragraph of Article 23 of the Insurance Law stipulates that no unit or individual shall illegally interfere with the insurer's performance of the obligation to compensate or pay insurance money, nor shall it restrict the right of the insured or beneficiary to obtain insurance money. Thanks, 2 more

Social insurance and commercial insurance can be used at the same time, and generally the part of social insurance reimbursement is reimbursed in commercial insurance.

Social insurance refers to a non-profit social security system with the function of income redistribution in order to prevent and compel the participation of the majority of members of society.

Social insurance is a social and economic system that provides income or compensation to people who are incapacitated, temporarily unemployed, or have lost their jobs due to health reasons.

The social insurance program is organized by **, forcing a certain group to form social insurance ** as a part of its income as a social insurance tax (fee), and under the condition of meeting certain conditions, the insured can receive a fixed income or loss compensation from **, it is a redistribution system, its goal is to ensure the reproduction of material and labor force and social stability.

The main items of social insurance include endowment insurance, medical insurance, unemployment insurance, work-related injury insurance, and maternity insurance.

Commercial insurance refers to a form of insurance that is operated by entering into an insurance contract for the purpose of profit, and is operated by specialized insurance companies.

The commercial insurance relationship is a contractual relationship voluntarily concluded by the parties, in which the policyholder pays insurance premiums to the insurance company according to the contract, and the insurance company bears the responsibility of compensating for the property losses caused by the occurrence of accidents that may occur as agreed in the contract, or bears the responsibility of paying insurance money when the insured dies, is disabled, sick or reaches the agreed age and period.

Social insurance refers to a social security system that collects insurance premiums to form social insurance**, and is used to provide basic living security for members who lose their ability to work or lose their job opportunities due to old age, illness, maternity, disability, death and unemployment.