What is the difference between commercial medical insurance and medical insurance

The difference between commercial medical insurance and medical insurance is as follows:

1, different management organizations: medical insurance is managed by government departments, commercial medical insurance is managed by insurance companies;

2, different ways to participate in the insurance: medical insurance is a mandatory social insurance, mandatory by the state within the scope of the population to participate in the insurance; commercial health care insurance is a voluntary commercial insurance, according to the individual's needs to choose and buy;

3, the scope of reimbursement is different: the scope of reimbursement of medical insurance mainly includes the medical expenses within the scope of basic medical insurance, such as hospitalization, outpatient, drugs, etc.; commercial medical insurance coverage and reimbursement standards vary according to different insurance products, which can increase the protection of some medical expenses or provide special medical services;

4, the cost is different: the cost of medical insurance is paid by the individual and the unit in accordance with a certain percentage, the medical insurance cost is paid by the individual and the unit in accordance with a certain percentage. and units in accordance with a certain percentage of the medical costs paid by the medical insurance also has a certain amount of out-of-pocket expenses; commercial medical insurance costs are calculated according to different insurance products and personal circumstances, you need to pay a certain amount of insurance costs, the scope of coverage and reimbursement standards are also different;

5, the fund source is different: medical insurance fund mainly comes from the contributions of the insured and units, as well as the government's financial allocations; The fund of commercial medical insurance comes from the insurance cost and investment income of insurance companies.

Medicare reimbursement conditions:

1. Confirmation of insurance status: Before you go to the doctor, you need to make sure that you have participated in the local health insurance, which can be confirmed by social security card, medical insurance certificate, etc.

2. Type of medical treatment: The medical insurance will only reimburse you for therapeutic medical treatment, such as outpatient treatment, hospitalization, surgery, and checkups. Some cosmetic medical practices, such as cosmetic dentistry and plastic surgery, are usually not covered by health insurance;

3. Medical expenses: Health insurance will only reimburse the medical expenses that meet the requirements, such as diagnosis and treatment costs, drug costs, examination fees, and surgical fees. The medical insurance will not reimburse you for any out-of-pocket expenses.

4. Hospital qualifications: The medical insurance will only reimburse you for medical expenses incurred by legally operated medical institutions, such as public hospitals, qualified private hospitals, etc. If you do not have a legal medical institution or clinic, you will not be reimbursed. If you are not a legitimate medical institution or clinic, you will not be reimbursed by the medical insurance.

In summary, you can consult your local health insurance organization or dental hospital to find out.

Legal basis:

Article 28 of the Social Insurance Law of the People's Republic of China

Medical expenses that are in line with the basic medical insurance drug directory, diagnostic and treatment items, standards of medical service facilities, as well as those for emergency and rescue, shall be paid from the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.

The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.