Is there social security reimbursement for accidental hospitalization?

Under normal circumstances, it is not reimbursed.

However, some accidental medical insurance can be reimbursed: 1, the insured has no responsibility;

2. It is determined by the relevant departments that the insured is partly responsible for the accidental injury;

3. After the judgment and ruling of the people's court, the person responsible for the criminal and public security cases in which the insured was injured due to the illegal acts of others has not fully compensated or has not solved the case for six months since the date of the injury, and it is impossible to determine the person responsible;

4. After the judgment or ruling of the people's court, the responsible person fails to make full compensation. If a traffic accident occurs during commuting hours, it can be identified as a work-related injury and needs to be reported to the local labor bureau for identification.

According to national regulations, the medical expenses caused by accidental injuries are generally not within the reimbursement scope of residents' medical insurance and urban workers' medical insurance. Simply put, those who cannot be reimbursed by medical insurance can be roughly divided into two categories: one is overseas medical treatment, and the other is borne by other individuals or organizations.

Among them, the article "should be borne by a third party" is most closely related to the accident. Accidental injuries in life can be divided into two types according to the person in charge: accidental injuries caused by others, such as being hit by a car or being hit by a high-altitude parabolic object; 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, in the first case, medical insurance cannot be reimbursed, and only a "third party" can be found for compensation. However, legislators also took into account the actual situation. If "the third person doesn't pay or can't determine the third person", medical insurance can pay first and then recover from the third person. Ministry of Human Resources and Social Security has explained this point in detail in the Interim Measures for Advance Payment of Social Insurance Funds. If medical insurance needs to be paid in advance, the individual needs to submit a written application to the local social security agency, and inform the cause of the injury and the situation that the third party does not pay the medical expenses or cannot determine the third party. At the same time, some medical expenses beyond the responsibility of third parties can also be paid by medical insurance.

Legal basis:

Article 30 of People's Republic of China (PRC) Social Insurance Law

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment. Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.

It is clear that the injuries caused by the responsible person will not be reimbursed by medical insurance, so accidental injuries are covered by insurance, but the corresponding reimbursement materials, such as hospitalization expenses certificates and invoices, should be prepared.