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In the case that the medical insurance has not been reimbursed,Commercial insuranceYes, it can be paid. Because the protection responsibilities of these two types of insurance do not conflict, and commercial insurance is a supplementary type of medical insurance. It's just that the amount of reimbursement is calculated according to the type of insurance you insure.
However, if you go to the hospital** because you are sick, you can passMedical insuranceReimbursement, but not availableAccident insuranceindemnification. After all, accident insurance mainly provides protection against accidental injuries suffered by the insured.
For example, after you have enrolled in medical insurance, you can go to buy an accident insurance.
to get accident protection; Or you can also take out a commercial medical insurance as a supplement, as long as the economic conditions allow, and this protection will naturally be more comprehensive.
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If there is no conflict, after the medical insurance reimbursement is completed, the commercial insurance can still be reimbursed, and the remaining part is usually reimbursed according to the proportion.
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Yes, it is possible to make a claim. Accident insurance has already been compensated, and commercial insurance can also be compensated. He is in the health insurance reimbursement of all the money, can be carried out in the commercial insurance payout.
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Accidental injuries are reimbursed by Medicare. If you're reimbursed, you're spending a lot of money. What about health insurance? After reimbursement, the commercial insurance will also pay you.
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Accidental injuries are reimbursed by Medicare. Can commercial insurance still be covered? I think the accident Medicare reimbursed. The commercial insurance you take out will definitely pay you an additional payment. Because health insurance and commercial insurance are not the same thing.
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OK! Commercial insurance is a supplementary insurance to social security and medical insurance, which can reimburse part or even all of the medical insurance reimbursement balance.
If commercial insurance can't do this, no one will buy commercial insurance on the basis of social security.
The reimbursement order is also correct! Report social security first, and then report commercial insurance.
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Accidental injury medical insurance reimbursement, if your commercial insurance is also accidental, medical insurance reimbursement after the accounting sheet, can be reimbursed commercial insurance, if your commercial insurance is a disease does not include accidents, commercial insurance can not be reimbursed.
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If the accident injury medical insurance is reimbursed, can the commercial insurance still pay for it? In the case of accidental injury, if the medical insurance is reimbursed, if the commercial insurance is bought, it can still be paid, and if the accidental injury medical insurance is reimbursed, the commercial insurance should be paid.
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If the accident injury medical insurance is reimbursed, can the commercial insurance still pay for it? Accidental injury medical insurance reimburses the part that can be reimbursed by medical insurance, and there is also a part of commercial insurance that is not reimbursed by medical insurance, which can still be paid.
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Can a Shanghai medical insurance reimburse commercial insurance still pay? If you buy accident insurance, he will definitely pay, if it is commercial insurance, he comes with that kind of accident injury or accident insurance, he will definitely pay, if he does not have this accident insurance, he will not pay.
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Medical insurance refers to the duration of hospitalization. All of them can be reimbursed by medical insurance. Commercial insurance depends on the reimbursement method of the commercial insurance you buy. One type of insurance, one type of insurance. It mainly depends on which type of insurance you have bought.
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If the accidental injury is reimbursed by medical insurance, you can pay if you buy commercial insurance, but if you don't buy it, you can't be reimbursed.
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Accidental injury medical insurance reimbursement, commercial insurance can also be paid, the insurance between the two may be different, he is different from other insurance, so commercial insurance can also have an insurance.
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Yes, you can pay out. Medical insurance is a medical insurance system that is jointly paid by individuals and employers and provided for employees.
However, commercial insurance does not have any conflict with medical insurance, and it is a commercial insurance purchased by oneself, which can be used as a protection system other than medical insurance.
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Commercial insurance payouts must have hospital receipts. If so, you can pay out. However, when the medical insurance reimbursement, the documents will be collected and filed.
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Commercial insurance and medical insurance are not in conflict, and general commercial insurance is a supplementary insurance to medical insurance, which is the part after medical insurance reimbursement and supplemented by commercial insurance.
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Whether you can pay depends on whether you buy commercial insurance to cover the type of accidental injury insurance, whether there are any special regulations, this is not easy to make a direct conclusion, now there are too many insurance companies, and there are many types of insurance, you can directly call the reimbursement customer service ** to consult.
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For accidental injuries, medical insurance has been registered and sold, and whether commercial insurance can still be reimbursed depends on the contract of commercial insurance. Generally, there will be an agreement in the contract that the part that cannot be reimbursed by medical insurance will be reported and sold by commercial insurance according to the detailed rules of the commercial insurance contract.
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If the accidental injury is reimbursed by social medical care, whether the commercial insurance will pay for it. It is necessary to look at the insurance contract of commercial insurance, if the agreement of the contract can be reimbursed twice, it can be reported, if there is no agreement in the contract, it cannot be reported.
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After the accidental injury medical insurance is reimbursed, the commercial insurance can continue to pay, and there is no conflict between the two.
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Can commercial insurance be reimbursed by accident injury medical insurance? In this case, of course, yes, he does not have conflicts.
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It depends on the type of commercial insurance and the insurance liability.
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The accident insurance reimburses you, and the remaining commercial insurance can of course pay for it.
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You can pay out with both of them. No conflict.
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Yes, there are two different types of insurance, one for the national and one for the commercial.
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In fact, there is no conflict between hospitalization medical insurance and accident medical insurance, and the accidental medical insurance in the accident insurance is specifically to solve the cost reimbursement of the insured's injuries caused by accidents. The coverage of hospitalization medical insurance is relatively wide, whether it is because of illness, accident and other risks, the main insured is hospitalized**.
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Most commercial medical insurance plans are indemnified. That is, the expenses you are reimbursed elsewhere cannot be overcompensated by the insurance company. This rule applies not only between commercial medical insurance, but also between commercial medical insurance and medical insurance reimbursement.
The principle of commercial medical insurance is divided into 2 categories:
1.Only the remaining part of the medical insurance scope will be reimbursed: including the part below the minimum payment line, the part above the ceiling line and the expenses beyond the medical insurance reimbursement ratio of 50%-70%, and then reimbursed according to the reimbursement ratio of commercial medical insurance, but the part of the self-payment content will still not be reimbursed.
2.The remainder of the medical insurance is fully reimbursed both inside and outside: this insurance self-payment is also reimbursed.
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If an accidental injury results in hospitalization, the expenses incurred in hospitalization can be reimbursed by medical insurance.
1. The medical insurance can reimburse the hospitalization expenses incurred.
As long as you have medical insurance before you are injured, your health insurance will reimburse you for the cost of hospitalization at your hospital. Medical insurance payouts can only be used for reimbursement of medical expenses.
Cannot be used elsewhere.
2. Reimbursement procedures for medical insurance.
Generally, the hospitalization is directly reimbursed for medical insurance, and the remaining out-of-pocket part, if you buy commercial medical insurance, you can go to the insurance company for compensation.
3. Medical insurance and commercial medical insurance.
Medical insurance: Social security solves the basic medical security needs of individuals. It is characterized by a wide range of people, but the reimbursement ratio is low, the amount is small, and there are no additional health services.
The biggest feature of commercial medical insurance is that it is more market-oriented, with richer and more diverse services to meet the various needs of all kinds of people.
Generally, they have the following characteristics:There is no limit to the social security directory. ⅱ.No technical means. ⅲ.Not limited to social security designated hospitals. ⅳ.The amount of protection is high. ⅴ.Health services.
In fact, it can be seen from the above characteristics that commercial insurance is completely rushing to supplement the lack of medical insurance.
Commercial insurance can supplement medical insurance as follows:
1.The minimum payment line in minor illnesses, self-paid medicines, and commercial insurance can play a role in making up for most of the expenses that are not reimbursed by social insurance.
2.Critical illness can only rely on commercial insurance (critical illness insurance + mid-to-high-end medical insurance).
Commercial insurance can supplement the following gaps in social security:
1) Self-financed medicines and equipment, including ICU wards; new technologies, including Shanghai Proton and Heavy Ion Hospital; Medical expenses that cannot be reimbursed by social security, such as annual limits.
will not give up on using it because of non-reimbursement for self-financed drugs, etc.).
2) Hospitalization deposit, red envelope and family bedside expenses (necessary expenses that cannot be reimbursed).
3) Loss of income due to illness and inability to work (period of treatment and recuperation).
4) Without social security, the rate of commercial insurance is higher. Reimbursement rates are reduced.
4. Summary. Is there a limit to medical insurance reimbursement? Or do you need to pay for one at your own expense, if you can? It is possible to purchase a million medical treatment or a million medical treatment with a deductible of 0, so that if an accident results in hospitalization, all expenses can be reimbursed.
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If a traffic accident or other accident involving a third person is involved, or if it is a crime such as suicide, drug abuse, drunkenness, fighting, etc., the medical insurance will not reimburse it, but other accidents can basically be reimbursed. When reimbursement is required for falls, bleeding, fractures, burns and other reasons, the public security or transportation department shall issue a certificate of trauma to prove that the patient has no facts of violating the law or committing a crime and that there is no third-party responsible person.
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Can medical insurance reimburse me for my own fall? What to look out for?
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Legal Analysis: No. According to national regulations, medical expenses caused by accidental injuries are excluded from the reimbursement scope of resident medical insurance and urban employee medical insurance.
Legal basis: Social Insurance Law of the People's Republic of China
Article 2: 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 protect citizens' right to receive material assistance from the State and society in accordance with law in the event of old age, illness, work-related injury, unemployment, childbirth, and so forth.
Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.
Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.
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According to the scope of urban residents' medical insurance, we can clearly know that urban residents' medical insurance can reimburse medical expenses caused by accidents, but accidental injuries include accidental death and accidental disability, and this kind of reimbursement is not within the scope of urban residents' medical insurance.
In addition to the above-mentioned liability for accidental death and accidental disability, the following situations are not reimbursed by the urban resident medical insurance:
1. Self-purchased drugs;
2. It should be paid from work-related injury insurance**;
3. It should be borne by a third party;
4. It should be borne by public health;
5. Seeking medical treatment abroad;
6. Other circumstances stipulated by laws and regulations that will not be reimbursed.
In addition, work-related injuries, occupational diseases, hooligan brawls, injuries caused by alcoholism, traffic accidents, intentional injuries to others, medical accidents, cosmetology, and health examinations are not covered by the basic medical insurance**.
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Hello this friend, dad is here to introduce you to what accident insurance is.
Accident insurance generally only covers death and disability caused by accidents, and some can also reimburse accidental medical expenses.
Accident insurance is relatively simple to inform when applying for insurance, but the accident here has a clear definition in the insurance, which is different from the generalized "accident" we usually describe.
In the terms of insurance, accidental injury refers to the injury to the body directly caused by an external, sudden, unintentional and non-disease objective event.
It is important to note that only if these four conditions are met at the same time can the "accident" as defined in the terms of the insurance be satisfied.
At the same time, accident insurance will not be paid for the following situations, so you need to understand in advance when purchasing accident insurance to prevent the insurance company from not paying claims in the future.
Daddy concluded that if you meet the conditions for claims, you need to prepare the identity certificate and insurance policy of the policyholder and the insured
The insured's bank card, (if the policyholder and the insured are not the same person), also need to provide relevant relationship certificates, claim application forms, accident certificates, diagnosis certificates, outpatient medical records and original invoices for relevant outpatient expenses, etc.
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There are several situations in which medical insurance cannot be reimbursed.
The Social Security Law stipulates that the treatment of accidental injuries that cannot be included in the scope of social insurance reimbursement includes: "(1) shall be paid from work-related injury insurance**; (2) It shall be borne by a third party; (3) It shall be borne by public health; (4) Seeking medical treatment outside the country. Medical expenses shall be borne by the third party in accordance with the law, and if the third party does not pay or the third party cannot be determined, the basic medical insurance shall pay in advance.
After the basic medical insurance** is paid in advance, it has the right to recover from a third party. ”
To put it simply, medical insurance cannot be reimbursed broadly into two categories: one is overseas medical treatment, and the other is borne by other individuals or organizations.
Among them, the clause "shall be borne by a third party" is most closely related to accidents. Accidental injuries in life are divided into two types according to the different responsible persons: accidental injuries caused by others, such as being hit by a car, being injured by a high-altitude projectile, etc.; Accidental injuries caused by oneself do not involve a third person in the whole process, such as falls, burns, cuts, etc.
According to the provisions of the Social Security Law, if the medical insurance cannot be reimbursed in the first case, the "third party" can only be found for compensation. However, the lawmakers also took into account the actual situation, if "the third party does not pay or the third party cannot be determined", the medical insurance can pay first, and then recover from the third party. The Ministry of Human Resources and Social Security has refined this point in the "Interim Measures for Advance Payment of Social Insurance", if it is necessary to pay medical insurance in advance, the individual needs to apply in writing to the local social security institution, and inform the cause of the injury and illness and the third party's failure to pay medical expenses or the situation that the third party cannot be identified.
At the same time, the part of the medical expenses that exceed the liability of the third party can also be covered by the medical insurance.
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