What if there is unit insurance and commercial insurance after social security?

Case 1: According to the principle that social insurance takes precedence over commercial insurance, the insurance company pays the remaining medical expenses after social medical insurance. According to experts, the insurance company will first determine the items that can be compensated according to the insurance terms, and then deduct the paid social security amount to get the actual compensation amount.

Example: Suppose that the commercial insurance is 5000 yuan, and the total medical expenses are 10000 yuan, which can be covered. The commercial insurance in payout ratio is 90%, and the deductible is 100 yuan. Then, the compensation amount of commercial insurance is 90% = 89 10 yuan. After 80% social security reimbursement, there is still 2,000 yuan left, which is within the range of 89 10, and does not exceed the insured amount, so all 2,000 yuan is borne by the insurance company.

In the above case, you can roughly analyze some relevant information about the insurance amount. What we can find is that if the insurance amount of commercial insurance is below 2000 yuan, the insurance company's claims are limited to the insurance amount.

Experts suggest that social security agencies and insurance companies are reimbursed by invoices, especially social security requirements to show the original. Therefore, when applying for social security reimbursement, staff should be reminded to issue separate invoices for later commercial insurance reimbursement applications.

If the employer pays the medical expenses, the individual shall be regarded as social insurance when taking out insurance.

Situation 2: People who supplement the critical illness insurance and subsidy insurance.

These two kinds of commercial insurance and social medical insurance do not conflict when settling claims. According to insurance experts, commercial critical illness insurance is generally paid upon diagnosis. Even if the treatment has not started at the time of application, the insured can get the insured amount at one time with the confirmation certificate issued by the hospital, so as to ensure that there is sufficient treatment funds at the first time and the follow-up treatment can be carried out smoothly.

Similarly, subsidized insurance cannot be reimbursed by invoices. As long as you provide proof of surgery or hospitalization, you can get insurance money from the insurance company as compensation for lost time or nutrition expenses.

Experts remind that the insured person can still apply to the social security agency for reimbursement of treatment expenses with the medical expense invoice after receiving the critical illness insurance money or allowance.

It can be seen from the compensation situation that in order to fully protect the interests of the insured, commercial health insurance can be selected to supplement the social medical insurance appropriately, so as to improve the coverage, enhance the timeliness of insurance and increase the security items.