Can commercial medical insurance and employee medical insurance be reimbursed at the same time?

1.Compensation for medical expenses, the sum of the compensation of the employee medical insurance plus the compensation of the commercial medical insurance, is compensated within the amount of the medical invoice. Because medical insurance is compensatory principle.

2.Employee medical insurance is generally reimbursed in proportion, and the invoice will reflect the amount that has been paid as a whole, and the remaining cash payment can be reimbursed by the commercial medical insurance company.

OK. For example, 70% can be reimbursed by employee medical insurance and 80% by commercial medical insurance, then you can first go to employee medical insurance to reimburse 70%, and the remaining 30% can still be reimbursed by commercial insurance for 80%. This way you will spend less money yourself.

Social security reimbursement first, and the rest will be reimbursed by the insurance company.

Zhonghong Life Medical Insurance can reimburse 90%-105%.

According to the conditions of the claim, there are reimbursement and payment types in the market.

The reimbursement type is mainly based on the specific invoice amount to be reimbursed, no matter how many insurance companies are bought, the final invoice amount is limited. Common products include accident medical care, hospitalization compensation medical care, social medical care, urban medical care and rural cooperative medical care.

The payment type is mainly based on the contract, once the requirements are met, it will be paid, no matter how many (provided that it is underwritten by the insurance company). Common such as: life insurance, accidental death, disability, burns, critical illness, subsidized hospitalization, surgery, etc.

Commercial insurance and medical insurance are usually not reimbursed at the same time. Generally, it is reimbursed by medical insurance first, and then reimbursed by commercial insurance, social security can only reimburse medical expenses within the scope of the medical insurance catalog, and the amount of reimbursement is relatively limited. According to the principle of expense compensation, the total amount of medical insurance reimbursement and commercial medical insurance reimbursement in social insurance will not be higher than the actual total medical expenditure.

1. The following information is required to apply for a medical insurance card:

1. The employer's business license, registration certificate or its seal;

2. The labor contract or employee roster between the unit and the employee;

3. The original ID card and its copy of the person who handles the medical insurance card in the unit.

Second, the process of medical insurance:

1. If the party has an employer, the employer shall first apply for social security registration for it;

2. Then submit the business license of the unit, the identity information of the parties and other materials;

3. Then it will be reviewed by the social security agency;

4. Finally, according to the social security card issued to the party of the unit, the unit shall pay the medical insurance fee in accordance with the regulations;

5. If the party has no unit, he or she should bring his ID card and other materials to the social security agency to declare social security registration, get a card and pay the fee.

All in all, medical insurance and commercial insurance generally cannot be reimbursed at the same time, generally reimbursement of medical insurance and then reimbursement of commercial insurance, because not all amounts of medical insurance can be reimbursed, medical insurance can only be reimbursed after reaching the amount prescribed by law, and part of the medical insurance can not be reimbursed, and this part can not be reimbursed, generally through commercial insurance to reimburse, so when reimbursing medical insurance, you can first tell the staff that commercial insurance will be reimbursed after the medical insurance is reimbursed. Therefore, the general medical insurance is reimbursed first, and the commercial insurance is reimbursed later.

Legal basis

Article 29 of the Social Insurance Law of the People's Republic of China The part of the medical expenses of the insured persons that should be paid by the basic medical insurance shall be settled by the social insurance agency and the medical institutions and drug business units. The administrative department of social insurance and the administrative department of health shall establish a system for the settlement of medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits.

Let's start with the conclusion: commercial insurance can supplement social security and can be reimbursed at the same time. Social security includes five insurances:

Medical insurance, endowment insurance, unemployment insurance, work-related injury insurance and maternity insurance, which involves the reimbursement of expenses is medical insurance, let's take a look at the reimbursement of medical insurance, and commercial insurance does not conflict.

We all know that commercial insurance is a supplementary form of social insurance, which can solve many places that are not covered by medical insurance, which is why commercial insurance is so popular at present.

Under normal circumstances, medical insurance can solve most of the medical expense reimbursement problems, if conditions permit, you can buy another commercial insurance to supplement the part that cannot be reimbursed by social security, then the problem comes.

If reimbursement is required, can commercial medical care and social security be reimbursed at the same time?

The answer is yes, because social security has a minimum payment line and many other parts that can not be reimbursed, these parts that can not be reimbursed can be reimbursed through commercial insurance, reimbursement, to follow the principle of social security first and then commercial insurance, if the amount of social security reimbursement is not 100% reimbursement, commercial insurance can also be reimbursed, the standard of reimbursement is calculated with reference to the terms.

The maximum amount of reimbursement is the sum of the amount reimbursed by social security or other means plus the insurance company's reimbursement, which shall not exceed the actual amount of medical expenses; The amount paid by the medical insurance shall not exceed the amount of medical expenses actually incurred by the insured.

When providing the original documents of medical expenses, the signature and seal of the reimbursed institution can be provided, and the original certificate of division of the original amount and the reimbursed amount and a copy of the medical expense receipt can be clearly stated, and a detailed list of expenses can be attached, so that the insurance company is also recognized.

Note that if there is only one document, the original should be used for social security reimbursement, and the copy can be used for commercial medical insurance.

Social security is the basic welfare given to us by the state, and commercial insurance is a further guarantee for ourselves, both of which are necessary to choose.

It can be reimbursed at the same time, because commercial medical insurance will reimburse the part that cannot be reimbursed by social security.

Commercial critical illness insurance and social security can be reimbursed at the same time. This is because there was no conflict between commercial critical illness insurance and social security before. Commercial critical illness insurance protects the risk of critical illness during the insurance period of the insured, but only covers critical illness, the scope of protection is relatively narrow, and the claim method is compensation upon diagnosis.

Social security is to compensate for all medical expenses incurred by hospitalization during the insurance period of the insured. The amount of reimbursement is based on a certain proportion formulated by the relevant local departments, and the insured needs to advance the funds in advance, and then submit supporting materials to the relevant departments of medical insurance, and then pass the audit to get the first expense claim. Commercial critical illness insurance and social insurance can be regarded as two complementary types of insurance, and one of the benefits can be purchased to supplement the protection after one of them already exists.

Questions. Which is more delineated, employee medical insurance or commercial medical insurance?

This is a detailed comparison of the two, and the subject can refer to it, hoping to help. Questions.

The two are complementary, and we all know that employee medical insurance cannot be reimbursed 100%, and commercial insurance bears the role of subsidy that cannot be reimbursed by employee medical insurance.

But the conditions for commercial insurance are more demanding.

Questions. Which harsh.

1. The conditions for participating in commercial medical insurance must be informed of health and the past medical history must be explained in detail. If you are participating in commercial medical insurance with a sick person, you will either be denied insurance or your premium will be increased. 2.

The insurance coverage of commercial insurance is narrower, and the diseases that can be reimbursed generally have to be agreed in the labor insurance contract. Even commercial insurance can develop special disease insurance for some specific groups, such as leukemia insurance, cancer prevention insurance, and so on.

3. Commercial insurance claims are more complicated.

Questions. Does commercial insurance cover the inspection fee?

Can I get a reimbursement for the surgery?

It depends on what kind of commercial insurance you are insuring: commercial insurance can generally be divided into two categories: expense type and payment type according to the nature of insurance, and the expense-based commercial medical insurance reimbursement is the insurance clause to determine the items that can be compensated, and can only pay for the actual reasonable and necessary medical expenses, including hospitalization expenses, surgical expenses, examination fees, bed fees and other expenses, while the pay-type commercial medical insurance reimbursement is a fixed amount of compensation according to the situation agreed in the contract. For example, critical illness insurance generally provides a lump sum sum of coverage after diagnosis, while subsidized insurance pays based on the proof of surgery or hospitalization. Due to the large number of types of commercial insurance, the reimbursement scope of each is different, and the proportion of compensation for different types of insurance is different

If you have these two insurances, you can reimburse them through social security. There is also a lot of money to be reimbursed.

Reimbursement can be made at the same time. This is also a prerequisite, and the premise is that the commercial medical insurance can not exceed the relevant commercial insurance amount, at this time you can be reimbursed in a timely manner, and prepare the relevant procedures and certificates.

In modern society, health insurance.

It is very important to be able to ensure that a person can reduce the burden on the family when he is sick and receive good treatment. At present, there are many kinds of medical insurance, and the mainstream is divided into commercial medical insurance and social medical insurance. Both types of medical insurance can be reimbursed at the same time.

Therefore, we see that many people in the society have purchased commercial medical insurance for themselves while paying social security. The most fundamental reason for being able to reimburse at the same time is that the subjects of these two types of medical insurance issuance are different.

1. The issuer of commercial medical insurance is an insurance company.

The most fundamental purpose of commercial health insurance is to make a profit. Commercial health insurance companies rely on absorbing people's insurance premiums and then passing them through actuary.

The calculation makes it possible for the company to make a profit after the final payment of compensation. This makes commercial medical insurance an extremely personalized insurance, for example, if you have had a certain disease, then you have to increase the insurance premium. Such harsh conditions make it impossible to exclude the insurance contract.

Second, the social medical insurance issuer is **.

Social medical insurance is a welfare system issued by **, which aims to reduce the burden of medical care for everyone. As long as it is an eligible resident, everyone can purchase the same amount and receive the same level of reimbursement. Social health insurance is a broad but shallow type of insurance.

Both major and minor illnesses can be reimbursed, but the reimbursement amount is not high.

3. Commercial medical insurance and social medical insurance complement each other.

At the beginning of the emergence of medical insurance, social security and commercial insurance complemented each other, which is also the purpose of issuing commercial medical insurance licenses. Let commercial medical insurance become a supplement to social security, some people are more wealthy, want to buy personalized insurance by themselves, want to buy insurance for specific diseases, at this time you can buy commercial medical insurance. And social security only provides a back-up role.

It is because of this special design that both types of medical insurance can be purchased at the same time.

It can be reimbursed at the same time, but it needs to be reimbursed by social security before the commercial medical insurance will be reimbursed twice, and the amount of reimbursement is according to a certain percentage, because the purchase of commercial insurance is to reduce the financial burden of covering the cheating during the illness, so the bureau is in line with the relevant regulations for the second reimbursement.

Commercial medical dust insurance and social security can be reported to the grandson at the same time, generally the social security will be reimbursed first, and the remaining part will be reimbursed by commercial medical insurance, because these are two different insurances, so there is no conflict.

Those who have two years of fighting for silver can be reimbursed at the same time; Because the nature of the two is different, one is the basic guarantee, the other is the guarantee of commercial limb aging, and the two are not in conflict.

Whether medical insurance and commercial insurance can be reimbursed at the same time still need to be different. Here we have to distinguish what medical insurance is what is medical insurance: what is medical insurance? What are they?

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, with the aim of enabling workers to obtain help and enjoy insurance benefits in the case of old age, illness, work-related injury, unemployment, childbirth, etc. China's "Labor Law" and "Social Insurance Law" both clearly stipulate that it is the legal obligation of the employer to pay social insurance for the employee, which obviously has the characteristics of 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 supplement to social security.

Generally speaking, patients only need to bear 5%-30% of the cost after being hospitalized after paying supplementary medical insurance, and due to local policy reasons, medical supplementary insurance varies and has an upper limit.

The insurance liability for general hospitalization is: if the insured needs to be hospitalized due to a non-major illness** and the medical expenses are incurred, the general hospitalization insurance benefit with a value equal to 80% of the actual medical expenses shall be paid, and the cumulative compensation during each insurance period shall be up to the general hospitalization insurance amount specified in the insurance policy. Since the scope of responsibility of social basic medical insurance and commercial basic medical insurance is the same, the self-paid part must be paid by themselves.

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.