Can the money paid by individuals after medical insurance be used for work related injury insurance?

Medical insurance and work-related injury insurance are two types of insurance and cannot be paid for each other.

The difference between medical insurance and work-related injuries:

1. Insurance liabilities are different.

Work-related injury insurance: insurance for accidental injuries that occur during work;

Medical Insurance: Insurance for non-work-related injuries.

2. The insurance subjects are different.

Work-related injury insurance: It is an employer's liability insurance, which individuals do not need to pay;

Medical insurance: the nature of the benefit, both parties have to pay.

During the period of work-related injury, you cannot use your medical insurance card to see a doctor, depending on the understanding and application of insurance policies in different places.

Article 10] Employers shall pay work-related injury insurance premiums on time. Individual employees do not pay work-related injury insurance premiums.

The amount of work-related injury insurance premiums paid by an employer is the product of the total wages of its employees multiplied by the employer's contribution rate.

Article 62] If an employer is required to participate in work-related injury insurance in accordance with the provisions of these Regulations but fails to do so, the social insurance administrative department shall order it to participate within a time limit, pay the work-related injury insurance premiums that should be paid, and impose a late fee of 5/10,000 per day from the date of non-payment; If the payment is still not made within the time limit, a fine of not less than 1 time but not more than 3 times the amount of the outstanding payment shall be imposed.

If an employee of an employer who is required to participate in work-related injury insurance in accordance with the provisions of these Regulations but does not participate in work-related injury insurance suffers a work-related injury, the employer shall pay the expenses in accordance with the work-related injury insurance benefits and standards stipulated in these Regulations.

After the employer participates in the work-related injury insurance and pays the work-related injury insurance premiums and late fees that should be paid, the work-related injury insurance** and the employer shall pay the newly incurred expenses in accordance with the provisions of these Regulations.

Legal analysis: If the work-related injury is gone, the medical insurance cannot be argued and then apply for compensation from the work-related injury insurance. Work-related injury insurance is the insurance in the event of an accidental injury during work, while the limb medical insurance is the insurance for non-work-related injuries.

Work-related injury insurance is employer's liability insurance, which individuals do not have to pay, while medical insurance is in the nature of benefits, and both parties have to pay.

Legal basis: Social Insurance Law of the People's Republic of China 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 national regulations.

Work-related injuries cannot be covered by medical insurance cards, and the medical expenses of work-related injuries are paid by work-related injury insurance** or the employer, which does not belong to the scope of reimbursement by medical insurance, and cannot be borne by medical insurance cards, but can be paid in advance by the employer and then reimbursed from work-related injury insurance**.

1. Can Nanjing medical insurance card be used in Suzhou?

You can use Nanjing's medical insurance card in Suzhou.

The process of handling medical reimbursement in other places:

The insured person can seek medical treatment in a designated medical institution in another place only after completing the confirmation procedures for medical treatment in a different place. The amount of his personal medical account can be withdrawn from any of the business outlets of his medical insurance card and used for the expenses of general illness in the ward outpatient clinic and the cost of purchasing and dispensing drugs at pharmacies.

Insured persons who are sick and hospitalized (including outpatient specific items**) can go to the identified local designated medical institutions for inpatient and outpatient specific items**, and the medical expenses shall be paid by the individual first, and the insured unit shall apply for reimbursement to the Municipal Medical Insurance Center within 1 month from the date of discharge.

2. What should I do if I don't bring my medical insurance card to the hospital?

Under normal circumstances, insured persons who have received a medical insurance card must present their medical insurance card for medical treatment in a designated medical institution that has opened the medical treatment settlement service with the card. If the medical insurance card is not presented, all expenses incurred must be borne by the individual in full, and the medical insurance** will not pay it. Emergency is a special case and can be "reimbursed without a card".

When seeking medical treatment, the insured person will pay the medical expenses in full first, and as long as it meets the medical insurance ** payment bar, then you can go through the manual reimbursement procedures according to the original process. In addition to emergency treatment, there are several situations that can also be "reimbursed without a cherry blossom matching card", such as family planning surgery, enterprise arrears, manual reimbursement or replacement of medical insurance card, and medical insurance card has not been issued after enrollment, etc.

Article 30 of the Social Insurance Law The following medical expenses are not included in the scope of payment of basic medical insurance**: (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.

Employee work-related injury, should be identified as work-related injury, after the identification of work-related injury, medical expenses are paid by work-related injury insurance, can not use medical insurance, medical insurance is the first employee sick or not due to work-related erection pure injury, if there is no work-related injury identification, or is not identified as a work-related injury, can only be reimbursed by medical insurance. 1. According to the provisions of the Social Insurance Law, basic medical insurance and work-related injury insurance are different types of insurance, basic medical insurance is to protect the basic medical needs of employees due to illness or non-work-related injuries (mainly used for general outpatient, emergency, hospitalization, etc.), while work-related injury insurance is to ensure that employees who are injured by accidents or suffer from occupational diseases due to work receive medical treatment and economic compensation. 2. In accordance with the provisions of the "Regulations on Work-related Injury Insurance", if an employee is injured by an accident at work, the unit shall report to the local labor administration department and the Zemen department within one month, and if it is identified as a work-related injury, the labor ability appraisal shall be carried out after the injury is stabilized, and the corresponding work-related injury treatment shall be enjoyed according to the assessed disability registration (such as hospital meal allowance, nursing expenses, wages for the period of suspension of work, one-time disability subsidy, etc.).

Employee work-related injury, should be identified as work-related injury, after the identification of work-related injury, medical expenses are paid by work-related injury insurance, can not use medical insurance, medical insurance is the first employee sick or not due to work-related erection pure injury, if there is no work-related injury identification, or is not identified as a work-related injury, can only be reimbursed by medical insurance. 1. According to the provisions of the Social Insurance Law, basic medical insurance and work-related injury insurance are different types of insurance, basic medical insurance is to protect the basic medical needs of employees due to illness or non-work-related injuries (mainly used for general outpatient, emergency, hospitalization, etc.), while work-related injury insurance is to ensure that employees who are injured by accidents or suffer from occupational diseases due to work receive medical treatment and economic compensation. 2. In accordance with the provisions of the "Regulations on Work-related Injury Insurance", if an employee is injured by an accident at work, the unit shall report to the local labor administration department and the Zemen department within one month, and if it is identified as a work-related injury, the labor ability appraisal shall be carried out after the injury is stabilized, and the corresponding work-related injury treatment shall be enjoyed according to the assessed disability registration (such as hospital meal allowance, nursing expenses, wages for the period of suspension of work, one-time disability subsidy, etc.).

It mainly includes medical expenses, hospital meal subsidies, transportation expenses, accommodation expenses, assistive device expenses, wages during the suspension of business allowance, maintenance fees during the suspension of business subsidy, one-time disability allowance, one-time disability subsidy, one-time disability employment subsidy, and in the event of work-related death, it also includes the pension of dependent relatives.

Social Insurance Act

Article 38 The following expenses incurred as a result of work-related injuries shall be paid from work-related injury insurance in accordance with the provisions of the state:

Medical expenses and expenses for work-related injuries;

2) Hospitalization meal subsidy;

3) Transportation and accommodation expenses for medical treatment outside the overall planning area;

4) The cost of installing and configuring assistive devices for the disabled;

5) Living care expenses confirmed by the Labor Ability Appraisal Committee for those who are unable to take care of themselves;

6) A one-time disability allowance and a monthly disability allowance for employees with disabilities of grades 1 to 4;

7) A one-time medical subsidy to be enjoyed when the labor contract is terminated or dissolved;

8) In the event of a work-related death, the funeral allowance, the pension for dependent relatives and the work-related death allowance received by the surviving family members;

9) Labor ability appraisal fee.

The medical treatment for work-related injuries includes: medical expenses are paid by work-related injury insurance** according to regulations; If the injured employee needs to be hospitalized**, 70% of the food subsidy standard for business trips of the unit shall be paid by the unit for hospitalization food subsidy; If it is necessary to seek medical treatment outside the city (county) where it is located, the necessary transportation, food and lodging expenses shall be reimbursed by the unit in accordance with the standards for employees traveling on business for business purposes. Among them, the medical expenses required for work-related injuries and the expenses for work-related injuries to go to the medical institutions that have signed the service agreement for recreation of amenity and relatives must meet the catalogue of work-related injury insurance medical items, the catalogue of work-related injury insurance drugs, and the hospitalization service standards of work-related injury insurance in accordance with the provisions of the state, before they can be paid by the work-related high occupancy insurance.

The medical expenses incurred by work-related injury insurance are also paid by a special work-related injury drug list, and the path is the same as that of the medical insurance hall, except that the expenses are paid from the work-related injury**.

The first step is to determine whether it is a work-related injury;

The second step is to apply for compensation.

The maximum application period for work-related injury recognition is one year. The employer shall, within 30 days from the date of occurrence of the accident injury or the date of diagnosis, apply to the overall regional human resources and social security bureau for recognition. If the employer fails to submit the request within the prescribed time limit, the trade union organization may submit a work-related injury determination to the Bureau of Human Resources and Social Security of Huchi Prefecture within one year.

Medical treatment and follow-up expenses incurred due to work-related injuries shall be paid from work-related injury insurance** in accordance with national regulations.

According to Article 38 of the Social Insurance Law, the following expenses incurred due to work-related injuries shall be paid from the work-related injury insurance** in accordance with national regulations:

1) Medical expenses and expenses for work-related injuries;

2) Hospitalization meal subsidy;

3) Transportation and accommodation expenses for medical treatment outside the overall planning area;

4) The cost of installing and configuring assistive devices for the disabled;

5) For those who are unable to take care of themselves, the living care expenses confirmed by the Labor Ability Appraisal Committee;

6) A one-time disability allowance and a monthly disability allowance for employees with disabilities of grades 1 to 4;

7) A one-time medical subsidy to be enjoyed when the labor contract is terminated or dissolved;

8) In the event of a work-related death, the funeral allowance, the pension for dependent relatives and the work-related death allowance received by the surviving family members;

9) Labor ability appraisal fee.

Medical expenses for work-related injuries will be fully reimbursed.

The Regulations on Work-related Injury Insurance have been amended and should be implemented in accordance with the new standards. If the employer pays social security, grade 10 work-related injury** will be paid:

1. One-time disability allowance: 7 months x monthly salary before injury;

2. If the labor contract is terminated or dissolved, there will be a one-time medical subsidy for work-related injuries (the standard varies from place to place, Shanghai is the average monthly wage of employees in the city for 3 months in the previous year);

3. During the period of suspension of work and salary, there is a hospital meal subsidy every day (the standard varies from place to place, but it is 20 yuan a day in Shanghai);

4. For those who seek medical treatment outside the overall planning area, there are also transportation, accommodation and accommodation fees for medical treatment in other provinces and cities (the standard varies from place to place, and Shanghai is 150 yuan a day);

5. Medical expenses and expenses for work-related injuries;

6. Labor ability appraisal fee;

7. The cost of installing and configuring assistive devices for the disabled;

8. For those who are unable to take care of themselves, the living care expenses confirmed by the Labor Ability Appraisal Committee.

If the employer does not pay social security, the above expenses shall be borne by the employer. At the same time, the employer should also bear the wages and benefits during the work-related injury and pay social security on a monthly basisWhen the labor contract is terminated or dissolved, the employer shall also bear a one-time disability employment subsidy (the standard varies from place to place, Shanghai is the average monthly wage of employees in the city for 3 months in the previous year).

Since you have been identified as a work-related injury, then you do not need to pay the medical expenses for the work-related injury by yourself, before the work-related injury is determined, you may pay the medical expenses by yourself, and when your work-related injury is determined and the work-related injury level is determined, everything will be solved for you before the work-related injury, and you will be reimbursed.

This is all based on the payout ratio and payout standard. Generally, work-related injuries are 0 deductibles, and hospitalization medical expenses and lost work expenses do not exceed 180 days a year, and a single work does not exceed 90 days. This depends on the terms of the insurance.

The medical expenses incurred by the injured employees in accordance with the governance provisions of the work-related injury insurance drug catalog, the diagnosis and treatment item catalog, and the hospitalization service standards, including the work-related injury medical expenses that have been paid by the medical insurance**, the employer or the employee before the employee's work-related injury is identified, shall be paid by the handling agency from the work-related injury insurance** according to the regulations, and the remaining part shall be borne by the unit

This depends on the cause of your injury and the extent of the injury, and if you are injured at work, the company is responsible for all your medical expenses.

It's true, as long as it's a work-related injury, you definitely need to pay part of the medical expenses yourself, and then the hospital will let the company reimburse you, and some good companies will reimburse all of them, or you will reimburse part of them.