How much can commercial insurance be reimbursed after medical insurance reimbursement?

After medical insurance reimbursement, commercial insurance only reimburses the rest of the medical insurance scope: including expenses below the deductible line, above the capping line and beyond the medical insurance reimbursement ratio of 50%-70%, and then reimburses according to the commercial medical insurance reimbursement ratio, but the self-funded content is still not reimbursed; The rest are reimbursed inside and outside the medical insurance: this kind of insurance is also reimbursed at its own expense.

The reimbursement standards for commercial insurance after medical insurance reimbursement are as follows:

1. After medical insurance reimbursement, commercial insurance can generally only reimburse the remaining part of the medical insurance scope, including the part below the deductible line, the part above the capping line, and related expenses beyond 50% to 70% of the medical insurance reimbursement ratio.

2. If it is a small medical insurance, the deductible line is low or even no deductible line, and the medical insurance can be reimbursed according to its proportion after reimbursement.

3. If it is a million-dollar medical insurance, the deductible of most million-dollar medical insurance is 1 000. After deducting the deductible, the general medical reimbursement will be reimbursed in proportion, and the proportion after medical insurance reimbursement is generally 1.000%.

4. Medical insurance and commercial medical insurance cannot be compensated repeatedly, because medical insurance belongs to the nature of reimbursement, and it should be spent first and then reported.

5. If it is after medical insurance reimbursement, the payment of critical illness insurance is paid immediately after diagnosis, which has nothing to do with medical insurance reimbursement. As long as it meets the definition of disease, it can be paid.

After medical insurance reimbursement, commercial insurance can supplement reimbursement, but it cannot be reimbursed repeatedly.

If you have medical insurance and buy commercial medical insurance at the same time, when you are hospitalized due to an accident or illness, you will generally be reimbursed through medical insurance first, and the rest will be reimbursed by commercial medical insurance according to the contract. The part that has been reimbursed by medical insurance cannot be reimbursed by commercial insurance. In other words, we should follow the principle of social security first and commercial insurance later. If the social security reimbursement amount is not 100%, commercial insurance can still be reimbursed, and the reimbursement standard is calculated by referring to the terms.

In addition, it should be noted that reimbursement of medical insurance belongs to the nature of reimbursement. According to the principle of cost compensation, the total amount of medical insurance reimbursement and commercial medical insurance reimbursement in social security cannot be higher than the total amount of actual medical expenses.

Also, if commercial insurance is to buy payment insurance such as critical illness insurance after medical insurance reimbursement, then the two are complementary and not in conflict, and can be reimbursed repeatedly. As long as the claim conditions are met, the claim can be settled, but the claim amount cannot be greater than the actual cost.

What is the reimbursement rate of commercial medical insurance?

Commercial medical insurance refers to profitable medical insurance operated by insurance companies. Consumers pay a certain amount of insurance money, and they can get a certain amount of medical expenses from insurance companies when they encounter major diseases. Among them, the reimbursement rate of commercial medical insurance is generally above 80%. As long as there is no "threshold" for commercial medical insurance to be hospitalized in hospitals at or above the county level, within the scope of participation, as long as the insured is hospitalized, he can be reimbursed at 80% when he is admitted to the hospital.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29 of People's Republic of China (PRC) Social Insurance Law

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.