What is covered by Accident Medical Insurance?

Accident medical insurance covers the medical expenses incurred by hospitalization** due to accidental injury, and within the scope of the insurance amount, you can reimburse the medical expenses of hospitalization** due to accidental injury, and the specific coverage is as follows:

Accidental Medical Coverage:Most accident medical insurance on the market has an accidental medical insurance amount ranging from several thousand to tens of thousands of yuan (there are also some accident medical insurance with an insurance amount of up to hundreds of thousands), covering outpatient expenses and surgical expenses for hospitalization** due to accidental injury.

Reimbursement Ratio:There are two types of reimbursement methods for accident medical insurance: limited social insurance and unrestricted social insurance.

Limit social security, that is, only expenses within the scope of the medical insurance catalogue can be reimbursed, and expenses outside the scope of the medical insurance catalogue need to be paid by the patient.

There is no restriction on social security, that is, the reimbursement is not limited to the expenses within the scope of the social security catalog, but also the expenses inside and outside the social security can be reimbursed, and the scope of social insurance reimbursement is wider and the claim threshold is lower.

On the basis of restricting social security and not limiting social insurance, the reimbursement ratio of different accident medical insurance is also different, as detailed in the insurance contract.

Deductible:Most of the accident medical insurance on the market has no or only a small deductible, if there is a deductible is generally 100 yuan, some accidental medical insurance deductible is based on whether the reimbursement is through social security, if through social security there is no deductible, if there is no deductible if not through social security, please also see the insurance contract for details.

Not very well aware of the coverage of accident medical insurance.

If the insured suffers an accidental injury, and within 180 days from the date of the accidental injury, the insured will pay the medical insurance benefits to the beneficiary in accordance with the following provisions for the reasonable medical expenses actually incurred by the insured due to the accidental injury that meet the scope of local social medical insurance payment:

1. If the medical expenses of the claim have been compensated or compensated from social medical insurance or commercial medical insurance, then: medical insurance = (medical expenses - compensation or compensation received from social medical insurance and commercial medical insurance in medical expenses) 100%;

2. If the medical expenses of the claim are not compensated or compensated from the social medical insurance or commercial medical insurance, then: medical insurance money = 80% of the medical expenses.

Accident insurance generally covers accidental death, accidental dismemberment and accidental medical treatment.

1. Accidental death: If the insured dies due to accidental injury, the insurance company will pay the accidental death insurance benefit in accordance with the contract;

2. Accidental disability: If the accident causes physical disability, the insurance company will pay the accidental disability insurance according to the agreed proportion according to the disability level;

3. Accidental medical treatment: In the event of an accident of the insured, the insurance company will reimburse the medical expenses incurred in hospitalization** in proportion, or pay the hospitalization allowance in accordance with the contract.

Extended Information: How to Buy Accident Insurance:

There are many options for purchasing accident insurance.

1. Offline channels: You can choose the right insurance purchase through the offline outlets of the insurance company and the ** person of the insurance company.

3. Third-party insurance sales platforms: such as Ant Insurance in Alipay, WeInsurance in WeChat, the online platform of insurance brokerage companies, or the brokers who contact insurance brokerage companies online, fill in the information as required to successfully purchase.

The protection content of accident insurance is mainly for death and disability caused by accidents to provide relevant protection, but also includes the reimbursement of medical expenses caused by accidents, there is usually no requirement for health, the insurance threshold is lower than that of major illness insurance and medical insurance, and the insurance age coverage is wider, and even the 70-year-old elderly can also buy accident insurance. It's just that accident insurance has occupational category requirements, and it is necessary to pay attention to the accident insurance for high-risk occupations, because most of the accident insurance covers occupational categories 1-4, and 5 and 6 occupations can be insured for accident insurance for exclusive high-risk occupations.

How does accident insurance pay:

Accident insurance can generally be paid in the following ways:

1.After the occurrence of an insured accident, the insured beneficiary also needs to notify the insurance company in time to report the case;

2.According to the requirements of the insurance company, it is necessary to prepare claims or reimbursement materials, such as accidental medical expense reimbursement, generally need to prepare the insured's ID card, bank card, outpatient medical record, outpatient invoice, disease diagnosis, total invoice for hospitalization expenses, general list of hospitalization expenses, medical insurance statement, discharge record, accident certificate, etc.; Accidental death claims generally require the preparation of a cremation certificate, a certificate of household registration closure by the public security organ, and a medical death certificate issued by the hospital (some insurance companies simplify the claim process and only need two of them); Accidental disability requires the preparation of disability appraisal forms, etc.;

3.Submit claims or reimbursement materials to the insurance company;

4.If the insurance company approves the application, the claim can be transferred to the bank account designated by the beneficiary of the insured. If the review fails, a notice of rejection will also be issued to explain the reasons for the rejection.

Scope of Liability of Accident Injury Medical Insurance: During the validity period of this contract, if the insured dies within 180 days from the date of accidental injury, the company will pay the death insurance benefit according to the amount of accident insurance, and the insurance liability will be terminated. If the insured is physically disabled within 180 days from the date of accidental injury, the company shall pay the disability insurance benefit according to the "Table of Degree of Disability and Insurance Payment Ratio of Life Insurance".

If the disability is not completed, the disability assessment shall be carried out according to the physical condition of the 180th day, and the disability insurance benefit shall be paid accordingly. If the insured suffers from more than one physical disability due to the same accidental injury, the Company shall pay the sum of the corresponding disability insurance benefits.

However, when different disability items belong to the same hand or foot, the company will only pay one of the disability insurance benefits; If the proportion of the disability is different, only the higher proportion of the disability insurance benefit will be paid.

The reimbursement scope of accident medical insurance includes accidental outpatient medical treatment and accidental inpatient medical treatment, as long as it meets the scope of responsibility, the medical expenses incurred due to accidents can be reimbursed. In general, accident medical insurance is usually in the form of riders.

Accident medical insurance covers both outpatient and inpatient medical care. If it is an injury caused by some minor accidents, you can go directly to the outpatient clinic for treatment.

If you are hospitalized due to an accident, you can directly go to a designated medical institution for hospitalization.

Whether it is a minor accident or a major accident, as long as it is within the scope of responsibility, it can be claimed.

When it comes to the reimbursement of accident medical insurance, whether it is outpatient treatment or hospitalization, it is necessary to keep the original invoice and diagnosis certificate or discharge summary and other relevant information.

Personal accident insurance can be divided into one-year comprehensive accident insurance, traffic accident insurance and driver's accident insurance according to the type.

1) One-year comprehensive accident insurance.

Accidental Death, Disability, Burns: Accidental Death, Disability, Burns, Accidental Death, Disability, Burns and Burns will be paid;

Medical treatment for accidental injuries: medical expenses incurred due to outpatient or hospitalization** due to accidental injuries shall be paid to the part of the medical expenses that exceed RMB 100 that can be reimbursed according to the regulations of the local social medical poor state insurance department within 180 days from the date of the accident;

Hospitalization Lost Work Allowance: Hospitalization due to accidental injury** shall be paid according to the daily amount of hospitalization lost work allowance stated in the insurance policy, and the cumulative number of days of payment shall be limited to the time agreed in the insurance policy.

Inpatient Care Allowance: If you are admitted to the hospital due to an accident**, you will be paid according to the daily amount of the inpatient care allowance stated in the insurance policy, and the cumulative number of days of payment will be limited to the time agreed in the insurance policy.

2) Traffic accident insurance.

Accidental Death Accidental Disability.

During the insurance period, if the insured dies or becomes disabled due to an accidental injury while taking the corresponding means of transportation as a passenger, the insurance company shall compensate the accidental death insurance or accidental disability insurance benefit.

3) Driver's accident insurance.

Accidental injury to the driver.

If the insured suffers death, disability or burns due to an accident while driving or riding in a non-commercial vehicle, the accidental death, disability and burn insurance benefits will be paid.

Accidental medical treatment for drivers: If the insured has an accident while driving or riding in a non-commercial vehicle and is in a hospital**, the accidental injury medical insurance benefit will be paid.

Accidental injury of joint passengers: If the insured suffers death, disability or burns due to an accident while riding in a non-commercial vehicle driven by the insured, the insurance benefit for accidental death, disability and burns will be paid.

Accidental medical treatment for joint passengers: If the insured has an accident during the ride in a non-commercial vehicle driven by the insured and undergoes an accident in the hospital**, the accidental injury medical insurance benefit will be paid.

The above is to talk about Qingxun for everyonePersonal Accident Insurance Coverage。We know that there are many types of personal accident insurance, such as traffic accident insurance, driver's accident insurance, etc., so due to the different types of personal accident insurance, the protection model of personal accident insurance is also different.