On the issue of commercial insurance compensation, commercial insurance compensation provisions

First report social security, and then report commercial, can not say that business is useless, many hard terms of social security, very miscellaneous expenses can not be reported, such as: imported drugs, a chemotherapy can not be reported. There is also social security can only report up to 90%, and the remaining 10% is supplemented by commercial insurance, and social security is not insured for death, and accidents outside of work are not reimbursed, etc., to the additional insurance has a share of additional insurance that has bought social security and has not bought social security additional insurance.

It is recommended that you go to the social security network to see the terms of social security and the terms of the additional insurance you bought, and then test whether to surrender the insurance. If you are not sure, please ask your sales representative to give you a detailed analysis, and do not surrender the policy easily.

In general, it is necessary to go to social security for reimbursement first (note that the original must be used), and then go to commercial insurance for reimbursement (a copy is OK).

Upstairs is too optimistic 90% of them are now general patients who do not enter the hospital, and once they enter, they are big hospitals, and different levels of hospitals have different threshold fees (that is, absolutely.

If you don't report it, take Chongqing 3A Hospital as an example, first of all, 880 yuan will definitely not be reported, and it will also be divided into Class A and Class B drugs, unless the previous unit is better than the public institution insurance.

The insurance ratio can reach about 90%, and now the general reimbursement can reach about 50-60%. What about the remaining 50%-40%? It happens to be the validity of commercial insurance.

Supplementary space, but commercial insurance is different from person to person whether it is useful for specific situations, specific analysis. (It's worth mentioning if it's found by accident in an outpatient setting.)

The cost of medical insurance is only 50 yuan a year, while commercial insurance is much more flexible and clear in this area (100 absolute deductible, others are reported but 3 to see a protection ceiling).

The minimum reimbursement line for social insurance hospitalization expenses is generally 1,300 yuan, and the reimbursement ratio is more than 80, and self-financed drugs are not included in the reimbursement scope.

The part that can be reported by commercial hospitalization medical insurance is not reported by social insurance: the part below 1300 and the part that is not reported according to the reimbursement ratio shall be reported according to the reimbursement rules of commercial insurance.

Commercial hospitalization insurance can also add hospitalization subsidies, such as a one-day hospital stay, receiving a subsidy of 100 yuan.

Summary: Commercial hospitalization medical insurance premiums are not high, the reimbursement threshold is low, and the reimbursement amount is high, which is a good supplement to social medical insurance.

Please give me points!

It depends on whether you are buying hospitalization expenses or hospitalization subsidies.

Hospitalization expenses are 9% of the social insurance compensation first, and the other 10% of the commercial insurance will be paid again.

The hospitalization subsidy is based on the number of days of hospitalization, how much money is paid per day, and there is no conflict with social security.

The insurance is to compensate for losses, report to the insurance company with a copy, and the principle is that if the reimbursement is made, the cumulative cost with social security does not exceed the cost, and the payment is made according to the report. The excess part is not reported. It is possible to refund the additional hospitalization and change it to hospitalization allowance. Complementation!

1.Report the case: When an insured accident occurs, contact the insurance company to report the accident as soon as possible, and prepare the materials according to the specific guidelines given by the insurance company to apply for a claim.

2.Investigation: The Insurance Company will dispatch professional staff to conduct an investigation based on the information provided by the informant.

3.Negotiation: After the company investigates and confirms that there is no problem, it will negotiate with the customer to settle the claim.

4.Claim: After the insurance company approves the claim, if there is no objection between the two parties, the insurance company will release the insurance money.

Legal basis: Insurance Law of the People's Republic of China

Article 5 The parties to the insurance bridge shall follow the principle of good faith in exercising their rights and performing their obligations.

Insurance business shall be operated by insurance companies established in accordance with this law and other insurance organizations prescribed by laws and administrative regulations, and other units and individuals shall not engage in insurance business.

There are three ways to pay for commercial medical insurance: 1. Expense reimbursement type, that is, according to the medical expenses incurred by the insured, the insured claims to the insurance company with his original receipt, and is reimbursed within the maximum insurance limit. Second, the fixed amount of compensation for the type of disease, this kind of insurance has nothing to do with the actual medical expenses, and there is no need to provide invoices when settling claims, as long as the insurance company is diagnosed with a disease that belongs to the contract, the insurance company will pay the policyholder in accordance with the contract.

3. Hospitalization allowance type. This is a certain subsidy for the hospitalization** of the insured person.

Legal basis

Article 47 of the Labor Contract Law of the People's Republic of China stipulates that economic compensation shall be paid to the worker according to the standard of one month's salary for each full year of the worker's assignment in the employer. where it is more than six months but less than one year, it is calculated as one year; If it is less than six months, the worker shall be paid half a month's salary. If the monthly wage of a worker is three times higher than the average monthly wage of the employee in the previous year announced by the people of the municipality directly under the Central Government or the city divided into districts where the employer is located, the standard of severance shall be paid to him at the rate of three times the average monthly wage of the employee, and the maximum period of payment of severance shall not exceed 12 years.

The term "monthly wage" as used in this article refers to the average wage of an employee in the 12 months prior to the termination or dissolution of the contract with residual labor.

The coverage of commercial vehicle insurance depends on the type of insurance purchased. Under normal circumstances, if the damage caused by a traffic accident occurs in a motor vehicle, if it is the responsibility of the motor vehicle, the insurer underwriting the compulsory insurance of the motor vehicle shall first compensate within the limit of the liability of the compulsory insurance; For the shortfall, the insurer underwriting the commercial motor vehicle insurance shall compensate in accordance with the provisions of the insurance contract.

Legal basis

Article 1200 of the Civil Code: If a motor vehicle is involved in a traffic accident and the damage is the responsibility of the motor vehicle, the insurer that underwrites the compulsory insurance of the motor vehicle shall first compensate within the limit of the liability of the compulsory insurance; If it is not enough to make a good record, the insurer who underwrites the commercial insurance of motor vehicles shall compensate in accordance with the provisions of the insurance contract; If it is still insufficient or has not taken out commercial insurance for motor vehicles, the infringer shall compensate for it.

Vehicle Commercial Insurance Coverage:

1. The scope of compensation for compulsory traffic insurance includes compensation for death and disability, medical expenses, and property damage to a third party after a traffic accident;

2. The third-party liability insurance includes the amount of compensation that should be paid by the insured according to law if the third party suffers personal damage or property damage;

3. Vehicle loss insurance includes the loss caused by an accident of the insured vehicle.

Legal basisArticle 21 of the Regulations on Compulsory Insurance for Motor Vehicle Traffic Accident Liability.

If a road traffic accident occurs in a road traffic accident of the insured chain manual vehicle and causes personal and property losses to the victim other than the vehicle personnel and the insured, the insurance company shall compensate within the limits of the compulsory insurance liability for motor vehicle traffic accident liability in accordance with the law.

If the damage caused by the road traffic accident is intentionally caused by the victim, the insurance company will not compensate for it.

Legal analysis: If you buy commercial insurance, you generally buy commercial three liability insurance, car damage insurance, vehicle personnel liability insurance, and deductible insurance. The three liability insurance is a supplement to the compulsory traffic insurance, the car damage insurance protects the car, and the people on the car insurance protect the people in the car, and the deductible can be fully compensated when you are fully responsible.

Legal basis: Article 8 and Article 13 of the Regulations on Compulsory Insurance of Motor Vehicle Traffic Accident Liability Article 8 and Article 13 The owner or manager of a motor vehicle driving on the road within the territory of the People's Republic of China shall take out compulsory traffic insurance, and if the owner or manager of a motor vehicle fails to take out compulsory traffic insurance in accordance with the regulations, the public security organ shall have the right to detain the motor vehicle, notify the owner or manager of the motor vehicle to take out insurance in accordance with the regulations, and impose a fine of twice the insurance premium for dismemberment only.