Is it better to reimburse hospitalization expenses with social medical insurance or commercial insur

The scope and scope of protection involved in commercial insurance are far wider than that of social insurance, so social insurance is certainly not a substitute for commercial insurance. Why is commercial insurance an important supplement to social insurance? After reading this article, you will understand it all"With social security, you really don't need 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. Differences in insurance liability

Commercial medical insurance has more insurance liability than social medical insurance. For example, the protection content of social medical insurance does not include the application of electron beam CT, ophthalmic excimer laser and other large medical equipment for examinations, but the protection content of commercial medical insurance can include the application of these large medical equipment for examinations, ** and the costs incurred.

As shown in the figure below, the types of drugs that can be reimbursed by social security are also very limited. For example, many drugs for ** cancer are better but have a relatively high cost, such as ** KEYTRUDA for lung cancer, which costs more than 50,000 yuan per month. For many cancer patients who have not purchased commercial medical insurance, they usually have to abandon this targeted drug because of the cost.

2. The amount of reimbursement is different

Social medical insurance, as a benefit given by the state to citizens, has a much lower reimbursement ratio than commercial medical insurance. If you accept it in a different place**, even if the medical insurance can reimburse you, the reimbursement ratio will usually be lower. In the event of a more serious illness and high medical costs, social insurance alone is not enough.

If you don't know why Social Security is not a substitute for commercial insurance, then take a look at this article"The difference between the protection content of commercial insurance and social insurance".Hope!

Hello! First of all, in real life, once a sudden illness occurs, even if there is medical insurance, the high medical costs are still unbearable for many families. When basic medical insurance cannot meet the higher demand, commercial medical insurance is needed.

At present, there are a wide variety of medical insurance products, each with its own coverage, which can be divided into four major types of insurance.

General medical insurance, which is generally covered by group insurance or as an additional liability of individual long-term life insurance, pays insurance benefits in the form of compensation, but stipulates a maximum limit for each time.

Accident medical insurance, which is responsible for the medical expenses incurred by the insured due to the accidental injury. The amount of insurance can be the same as the basic insurance, or it can be agreed separately, and the compensation payment method is generally adopted.

Hospitalization medical insurance is responsible for the medical expenses incurred by the insured person when the insured needs to be hospitalized due to illness or accidental injury**, but is not responsible for the outpatient medical expenses of the insured person. Insurance benefits can be paid either in the form of compensation or in the form of fixed amounts.

Finally, the choice of medical insurance company recommends that you first purchase a social insurance, if you have spare money, you can consider choosing a commercial insurance, however, it is recommended that you pay attention to choosing some cost-effective insurance when choosing commercial insurance;

As for which company is better, it is generally better to choose a well-known company, or you can choose some online insurance channels, such as China Minsheng Insurance Network, etc., The advantage of these ** is that you can compare the products of multiple insurance companies.

The hospitalization expenses are first reimbursed by the social medical insurance department, and the remaining part is reimbursed by the commercial insurance company. Commercial insurance and medical insurance are complementary.

With the continuous development of social economy, more and more people will buy insurance to help their lives be more stable, but because the types of insurance purchased are different, some people are very puzzled about commercial insurance.

Can I get reimbursement for hospitalization? However, according to relevant experts, commercial insurance is able to reimburse hospitalization expenses.

The proportion of reimbursement of hospitalization expenses by commercial insurance and basic medical insurance.

The proportion of reimbursement of hospitalization expenses is not the same, the amount of commercial hospitalization medical insurance companies is not the same, and the amount of claims is also reimbursed according to the proportion of the travel cave purchased, so the proportion of commercial hospitalization insurance is not fixed, and the proportion of reimbursement from commercial insurance, the scope is often different, but commercial hospitalization, medical insurance for the medical insurance personal self-pay part and the excess part of the medical insurance, are a lot of supplementary costs, there are still certain benefits for the policyholder.

Of course, we know that the business can be reimbursed with insurance, after the hospitalization fee, we must know what the relevant process is, first of all, we must report the case in time, once the insured has misfortune, the insured should report to the insurance company in a timely manner, generally speaking, after the relevant plan is carried out after the time specified by the insurance company, the insurance company has every reason to refuse to carry out the relevant compensation, so this point must be paid special attention, The beneficiary must submit the relevant claim materials according to the requirements of the terms and agreements, otherwise, once there is no way to pass the review, then the insurance claim obtained will not be available, in addition to many related processes that need to be understood, these are all need to be understood.

To sum up, we can clearly see that commercial insurance can completely reimburse hospitalization expenses, but the reimbursement process and related precautions must be understood, otherwise there will be a lot of unnecessary trouble in the reimbursement process, which is very bad, so we must pay attention.

Commercial insurance is fully capable of reimbursing hospitalization expenses.

1. What is commercial insurance?

Commercial insurance refers to a form of insurance that is operated by a specialized insurance company for the purpose of profit through the conclusion of an insurance contract. The insurance relationship is a contractual relationship voluntarily concluded by the parties, whereby the policyholder pays the insurance premium to the insurance company according to the contract, and the insurance company bears the liability for compensating for the property damage caused by the occurrence of the accident that may occur as agreed in the contract, or bears the responsibility of paying the insurance money when the insured dies, is disabled, sick or reaches the agreed age and period.

2. Characteristics of commercial insurance.

1. The main body of commercial insurance is a commercial insurance company.

2. The insurance relationship reflected in commercial insurance is reflected through the insurance contract.

3. The object of commercial insurance can be people and things (including tangible and intangible), and the specific subject matter is people's life and body, property, and property-related interests, responsibilities, credit, etc.

4. The operation of Wushen commercial insurance should be aimed at profit, and it is necessary to obtain the maximum profit to ensure that the insured enjoys the greatest economic security.

3. Types of commercial insurance.

Commercial insurance is divided into property insurance, life insurance, and health insurance.

1. Property insurance.

Property insurance includes motor vehicle insurance, enterprise property insurance, family property insurance, ship insurance, liability insurance, guarantee insurance, cargo transportation insurance, accident insurance, agricultural insurance, engineering insurance, credit insurance, etc.

2. Life insurance is a type of life insurance. As with all insurance businesses, the insured passes the risk to the insurer, accepts the insurer's terms and pays the premium. Unlike other insurances, life insurance passes on the risk of survival or death of the insured.

3. Health insurance.

Health insurance is a kind of insurance that takes the body of the insured as the subject matter of insurance, so that the insured can be compensated for the expenses or losses incurred by the insured in the event of injury caused by illness or accident.

Hello dear, please wait for 2 minutes, I will answer for you right away, don't worry! Commercial insurance is a supplement to "social insurance", but the overall reimbursement will not exceed the total amount of reasonable expenses you spend (the cost of local health insurance). The state stipulates that medical insurance is in the form of supplements.

It's okay for you to reimburse at that agency first, but when this agency reimburses you, you need to ask for the original invoice or insurance claim split sheet and need to go to another agency for reimbursement. This way, they will provide you with a split of the claim, and you can put up your belongings to go to the next one for reimbursement.

The general method of claim settlement is that the reasonable expenses of hospitalization incurred by you will be compensated according to the agreed proportion. That is to say, He Adou said that the total hospitalization expenses you incurred are based on this.

For example, if the hospitalization cost is 3,000 yuan, the reimbursement rate of cooperative medical treatment is 50%. 80% reimbursement for commercial establishments.

The first one: 3000 yuan * 50% = 1500 yuan. The second home:

3000 yuan * 80% = 2400 yuan. It was supposed to accompany you for 2,400 yuan, but you were reimbursed 1,500 yuan at the first one. Then the second payout is:

2400 + 1500 = 3900 yuan. 3,900 yuan is already more than your cost of 3,000 yuan, so the second one will also pay you 1,500 yuan. However, your expenses must be reasonable expenses stipulated by medical insurance, and they must also be Class A drugs and diagnosis and treatment items to be fully compensated.

Just a personal suggestion. Because I always encountered this problem at work a few days ago, I also discussed it. The specific situation also depends on the local cooperative medical regulations and the agreement of the type of insurance you are insuring.

Questions. There is no medical insurance, only commercial insurance, can you report?

Yes, you can report it.

The vast majority of commercial insurance has clear requirements for the hospital to be visited, and the accident medical insurance is generally available in public hospitals above the second level. Sickness medical insurance also refers to hospitals that are designated in the defense book, and hospitalization in public hospitals that are not designated hospitals need to apply, otherwise they will not be able to carry large claims. Private hospitals and expensive hospitals are largely not reimbursed.

Unless it is a high-end medical posture information therapy insurance.

Commercial insurance, can every hospital reimburse, yes, every hospital can be reimbursed. Reimbursement scope: commercial medical insurance mainly includes hospitalization allowance type and expense reimbursement type, the former insurance company to a fixed amount per day, to compensate the insured for the loss during hospitalization, such products are not duplicated with social security or other types of commercial medical insurance, is the best choice.

Commercial medical insurance only provides reimbursement for the medical expenses actually incurred by the insured object, while the reimbursement scope of different commercial medical insurance is different. Expense reimbursement insurance can reimburse hospitalization medical expenses, but the reimbursement scope has different regulations for different products. The insurance contract of some commercial medical insurance stipulates that the actual medical expenses in Nianzhou must be reimbursed within the scope of social security reimbursement.

If compensation has been obtained from social security or other social welfare institutions, the insurance company only pays the remaining part, and social security cannot reimburse (imported drugs, special drugs, special care wards, etc.), such commercial medical insurance is also not reimbursable, and its role is only to compensate for the part that needs to be borne proportionally after reimbursement to social security. However, some commercial medical insurance stipulates that as long as it is a reasonable expense actually incurred, it can be compensated by the insurance company on a pro-rata basis or after a certain deductible.

Questions. It's so informative.

Is that retributive or...

In general, it is possible to report.

Commercial medical insurance can be divided into two categories: pre-cost type and benefit type according to the nature of the medical insurance you insure, and you can be reimbursed according to the following forms according to the type of insurance you insure:

Expense-based commercial medical insurance reimbursement: The insurance company will first determine the items that can be paid according to the terms of the insurance (generally the same as the scope of social insurance claims), and after deducting the deductible, pay for the reasonable and necessary medical expenses actually incurred.

Reimbursement of payment-based commercial medical insurance: commercial critical illness insurance is generally paid upon diagnosis, and the insured can obtain the insurance amount at one time by virtue of the diagnosis certificate issued by the hospital, so as to ensure that the regret can have sufficient funds in the first time, so that the follow-up can be carried out smoothly; Subsidized insurance is not reimbursed on the basis of invoices. As long as you provide a certificate of surgery or a sedan hospital (specific product regulations), you can get insurance benefits from the insurance company.

Generally speaking, to apply for reimbursement of commercial medical insurance, the materials to be provided include: a copy of the front and back of the insured's ID card; A copy of a bank card or passbook; A copy of the insurance policy; Medical records; Proof of diagnosis; Discharge summary; The hospital's general list of medications and original invoices, etc.

Yes, and there are many medical insurance plans that cover this, and the cost of hospitalization can also be directly reimbursed.

Depending on the content of the insurance you buy, the loss should only be reimbursed for some serious illness medical treatment, and the part you bear after paying your social security will be reimbursed for part of the God.

Social Security and Commercial Insurance Reimbursement:

Segmented reimbursement: go to the social security reimbursement first, and then report the rest of the social security reimbursement to the commercial insurance company.

1. Social insurance is a kind of insurance that the state requires to be purchased, and the state develops social insurance, establishes a social insurance system, and establishes social insurance.

The purpose is to enable workers to receive assistance and enjoy insurance benefits in the event of old age, illness, work-related injury, unemployment, childbirth, etc. China's Labor Law.

Social Insurance Act.

It is expressly stipulated that it is the legal obligation of the employer to pay social insurance for the employee, which is obviously mandatory by the state, and the employer shall not refuse to assume the statutory obligation under any pretext or reason.

2. Commercial insurance is generally a kind of commercial insurance of insurance companies, with a certain commercial nature, and commercial insurance is a kind of virtual supplement to social security.

Generally speaking, after paying supplementary medical insurance, patients only need to bear 5%-30% of the cost after being sick and hospitalized.

It varies, and there is an upper limit to late lead.

The insurance liability for general hospitalization is: if the insured is due to a non-critical illness.

The general hospitalization insurance benefit equal to 80% of the actual medical expenses due to the need for hospitalization** is up to the insurance policy in each insurance period.

The amount of general hospitalization insurance as stated. Due to the social basic medical insurance.

The scope of responsibility is the same as that of commercial basic medical insurance, and the self-pay part must be paid by yourself.

Social medical insurance will not be reimbursed for medical expenses caused by traffic accidents, as well as expenses and nursing expenses during hospitalization. It can be seen that social security is only one of the most basic guarantees for employees, which is limited to the average level of society, and in order to further obtain medical security, it must also be supplemented by commercial insurance.

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